Modelling the intervention effect of opioid agonist treatment on multiple mortality outcomes in people who inject drugs: a three-setting analysis
The Lancet Psychiatry
Fecha de publicación: 1 de abril de 2021
DOI: https://doi.org/10.1016/S2215-0366(20)30538-1
Autores: Jack Stone, PhD , Prof Louisa Degenhardt, PhD, Prof Jason Grebely, PhD, Sarah Larney, PhD, Prof Frederick L Altice, MD, Pavlo Smyrnov, MPH, Prof Afarin Rahimi-Movaghar, MD, Maryam Alavi, PhD, April M Young, PhD, Jennifer R Havens, Prof William C Miller, MD, Prof Matthew Hickman, PhD †, Prof Peter Vickerman, DPhil †
Background: Opioid agonist treatment (OAT) reduces many of the harms associated with opioid dependence. We use mathematical modelling to comprehensively evaluate the overall health benefits of OAT in people who inject drugs in Perry County (KY, USA), Kyiv (Ukraine), and Tehran (Iran). Methods: We developed a dynamic model of HIV and hepatitis C virus (HCV) transmission, incarceration, and mortality through overdose, injury, suicide, disease-related and other causes. The model was calibrated to site-specific data using Bayesian methods. We evaluated preventable drug-related deaths (deaths due to HIV, HCV, overdose, suicide, or injury) averted over 2020–40 for four scenarios, added incrementally, compared with a scenario without OAT: existing OAT coverage (setting-dependent; community 4–11%; prison 0–40%); scaling up community OAT to 40% coverage; increasing average OAT duration from 4–14 months to 2 years; and scaling up prison-based OAT.
