Longitudinal analysis of HIV-risk behaviors of participants in a randomized trial of prison-initiated buprenorphine

Thomas R Blue, Michael S Gordon, Robert P Schwartz, Kathryn Couvillion, Frank J Vocci, Terrence T Fitzgerald, Kevin E O'Grady, Thomas R Blue, Michael S Gordon, Robert P Schwartz, Kathryn Couvillion, Frank J Vocci, Terrence T Fitzgerald, Kevin E O'Grady

Abstract

Background: It has been estimated that approximately 15% of people who are incarcerated in the US have histories of opioid use disorder. Relapse to opioid use after release from prison poses a serious risk of HIV infection. Prison-initiated buprenorphine may help to reduce HIV infection given the association between opioid use and HIV-risk behaviors.

Methods: The present study is a secondary analysis of longitudinal data gathered from a randomized controlled trial of buprenorphine-naloxone for people who were incarcerated (N = 211) between 2008 and 2012. It compares the impact of assignment to initiate buprenorphine in prison (N = 106 randomized, N = 104 analyzed) versus in the community (N = 107 randomized, N = 107 analyzed) and whether or not participants entered community treatment on the frequency of HIV-risk behaviors in the 12 months following release from prison. Data were analyzed hierarchically and for each outcome variable, a multilevel, over-dispersed Poisson model was fit to the data. Outcome variables were the number of times the following behaviors occurred in the last 30 days: (1) having sex without a condom (2) injecting drugs (3) using unsterilized needles, and (4) sharing injection paraphernalia.

Results: Participants assigned to begin buprenorphine in the community experienced a greater decrease in injection drug use over time compared to participants assigned to begin buprenorphine in prison. There were no significant associations between treatment assignment or community treatment entry and instances of having sex without a condom, sharing injection paraphernalia, or using unsterilized needles.

Conclusions: Overall, the present study did not find support for the initiation of buprenorphine in prison (as opposed to the community) as a means to reduce incidences of HIV-risk behaviors. Avenues for future research in the nexus of HIV-risk reduction, criminal justice, and pharmacotherapy are discussed. Trial registration This study was supported by the National Institute on Drug Abuse (NIDA), Buprenorphine for Prisoners (PI: Kinlock; R01DA021579). ClinicalTrials.gov identifier: NCT00574067.

Keywords: Buprenorphine; Correctional settings; Hiv-risk behavior; Opioid use disorder; Prison.

Conflict of interest statement

This study was supported by an unrestricted, unsolicited investigator initiated request from Reckitt Benckiser Pharmaceuticals, Inc. (provided study drug only) who had no role in study design; collection, analysis and interpretation of data; in the writing of the manuscript; or in the decision to submit the manuscript for publication. The authors alone are responsible for the content and writing of this manuscript. Dr. Blue reports no conflicts of interest. Drs. Gordon and Vocci are currently receiving free study drugs from Alkermes for an unrelated project. Dr. Schwartz provides consultation to Verily Life Sciences. Ms. Couvillion reports no competing interests. Dr. Vocci reports personal fees and other from Braeburn Pharmaceuticals; personal fees and other from Pinney Associates; personal fees and other from Indivior, personal fees and other from Demerx; personal fees from Alkermes; personal fees and other from Insys Pharmaceuticals; and stock ownership from Intratab Labs, Inc. Drs. Fitzgerald and O’Grady report no competing interests.

Figures

Fig. 1
Fig. 1
Equations for the multilevel, over-dispersed Poisson models fit to each of the four outcome measures

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