Rapid Implementation of Service Delivery Changes to Mitigate COVID-19 and Maintain Access to Methadone Among Persons with and at High-Risk for HIV in an Opioid Treatment Program

• Published in: AIDS and behavior 2020-09, Vol.24 (9), p.2469-2472
• Main Authors: Peavy, K. Michelle, Darnton, James, Grekin, Paul, Russo, Monica, Green, Caleb J. Banta, Merrill, Joseph O., Fotinos, Charissa, Woolworth, Steve, Soth, Sean, Tsui, Judith I.
• Format: Article
• Language: English
• Subjects: Antiretroviral agents; Antiretroviral drugs; Coronaviruses; COVID-19; Decision making; Disease control; Drug abuse; Drug addiction; Drugs; Health Psychology; HIV; HIV and COVID-19; Human immunodeficiency virus; Infectious Diseases; Medicine; Medicine & Public Health; Methadone; Narcotics; Notes From The Field; Opioids; Pandemics; Patient safety; Patients; Policies; Policy implementation; Public Health; Risk behavior; Risk taking; Safety; Sexual behavior; Sexually transmitted diseases; Social services; STD; Substance abuse treatment; Treatment programs
• ISSN: 1090-7165; 1573-3254
• DOI: 10.1007/s10461-020-02887-1

Medication treatment for opioid use disorder with methadone and buprenorphine is a key HIV prevention strategy [1–5]. Enrollment in medication treatment for opioid use disorder is associated with reductions in injection drug use [6–8], syringe/equipment sharing [6–9], and risky sexual behavior [6, 9]. Among people living with HIV, engagement in medication treatment for opioid use disorder is associated with HIV-risk behavior reductions [10, 11], and higher rates of initiating and adhering to antiretroviral treatment (ART) [12–15]. As such, this modality is associated with lower prevalence and incidence rates of HIV itself [16–19]. Many parts of the country, including Seattle, have witnessed outbreaks of HIV among persons who inject drugs related to the opioid crisis [20–23]. Given that medication treatment for opioid use disorder plays a critical role in protecting opioid users from HIV, ensuring continuous medication treatment for opioid use disorder treatment is imperative to help safeguard these individuals from acquiring HIV. Furthermore, this modality of treatment helps those living with HIV to continue to experience its benefits on ART adherence, and promotes HIV control within the surrounding community. The COVID-19 pandemic represents challenges for continuing opioid treatment services while observing social distancing directives. Here we describe the experience of one Opioid Treatment Program in rapidly creating and implementing policies that balance the safety of patients and staff with uninterrupted access to methadone. We use meeting minutes, personal communications, and written policies to describe: (1) measures adopted at the Opioid Treatment Program to mitigate the spread of COVID-19 while preserving core services to patients; (2) implementation of clinical decision-making strategies aimed at maintaining patient and community safety; and (3) changes in clinic patient flow.