Opioid users often end up injecting heroin — adding infectious diseases like HIV to the host of other risks they face. To chip away at the intractable problem of infectious disease risk among intravenous drugs users, researchers at Stanford picked a part of the problem to tackle: What is the most cost-effective way to reduce HIV exposure?
And the answer? It appears the best value comes from opioid agonist therapy, or OAT, which replaces drugs like heroin with a safer opioid such as methadone. In a Stanford Medicine release, senior author Margaret Brandeau, PhD, a professor of engineering, explained:
We started out thinking about this as an HIV problem, but we realized that the majority of health benefit actually comes from reducing injection drug use and improving quality of life for drug users... This is why we found OAT to be the highest-value investment.
OAT also helps users stop injecting, the researchers said. Increasing access to OAT could slash the number of drug users by between 23 and 37 percent over 20 years, they found.
To reach their findings, the researchers developed a model that compares four HIV prevention methods: PrEP, the pill that provides pre-exposure protection; needle exchange programs; test-and-treat programs; and OAT. Increasing access to PrEP would reduce risk, but it is also expensive.
Using techniques in combination — such as boosting access to OAT and deploying needle exchange programs — works the best, the researchers found.
"Our study aims to help policymakers and clinicians understand how a variety of interventions can help improve health outcomes and prevent HIV," said co-author Douglas Owens, MD, a professor of medicine. "We hope our analyses help show how to use limited resources efficiently to prevent the devastating consequences of substance use."
The research appears in PLOS Medicine.