(B-044) Buprenorphine and Methadone Initiation Among People with HIV and Diagnosed Opioid Use Disorder in a Clinical Cohort in Baltimore, Maryland

Background: Buprenorphine is an effective treatment for opioid use disorder (OUD) and has fewer barriers to access than methadone. It is unclear how buprenorphine is utilized in people with human immunodeficiency virus (HIV) and OUD receiving clinical care.

Objectives: The objectives of the study are to characterize buprenorphine initiation and identify predictors for initiating buprenorphine in a clinical cohort of people with HIV (PWH) and OUD.

Methods: This retrospective cohort study uses abstracted electronic health records data and questionnaire responses from patients enrolled in the Johns Hopkins HIV Clinical Cohort (JHHCC) collected between 01 January 2012 and 31 March 2024. The cohort consists of PWH who live primarily in Maryland and receive HIV care at a Johns Hopkins clinic. In the study, we included all adult patients with a diagnosis of OUD occurring on or after 01 January 2012.

We evaluated time-to-treatment initiation for buprenorphine in a subset of patients who recently used opioids and were not on an active buprenorphine prescription. In this analysis, we classified methadone initiation, becoming one year opioid free, loss to clinic, and death as competing risks. We estimated cumulative incidence functions using the Aalen-Johansen estimator and fit a Fine-Gray model with demographic, clinical, and self-reported factors as predictors. For buprenorphine initiation, we reported 1-year, 2-year, and 5-year probabilities, the restricted mean time lost (RMTL) at five years, and subdistribution hazard ratios.

Results: Among the 769 patients included in this study, 253 were eligible for inclusion in the time-to-treatment initiation analysis. In the presence of competing risks, the 1-year, 2-year, and 5-year probabilities of initiating buprenorphine were 0.15 (95% CI: 0.11, 0.19), 0.21 (95% CI: 0.16, 0.26), and 0.23 (95% CI: 0.18, 0.29), respectively. At five years, the RMTL from buprenorphine initiation was 11.3 (95% CI: 10.2, 12.4) months. In the competing risks analysis, those with a history of receiving buprenorphine (HR: 3.52; 95% CI: 2.01, 6.16) or had used the clinic's mental health services in the past year (HR: 2.19; 95% CI: 1.19, 4.02) were significantly more likely to initiate buprenorphine following an OUD diagnosis.

Conclusions: Buprenorphine initiation remained low among our study sample. We identified usage of the clinic's mental health services as a possible predictor for buprenorphine initiation. Thus, linking PWH and OUD to mental health services may be an effective way to improve buprenorphine treatment adoption.