Opioid agonist treatment outcomes among individuals with a history of nonfatal overdose: Findings from a pragmatic, pan-Canadian, randomized control trial.

BACKGROUND AND OBJECTIVES: History of nonfatal overdose (NFO) is common among people who use opioids, but little is known about opioid agonist treatment (OAT) outcomes for this high-risk subpopulation. The objective of this study was to investigate the relative effectiveness of buprenorphine/naloxone and methadone on retention and suppression of opioid use among individuals with opioid use disorder (OUD) and history of NFO. METHODS: Secondary analysis of a pan-Canadian pragmatic trial comparing flexible take-home buprenorphine/naloxone and supervised methadone for people with OUD and history of NFO. Logistic regression was used to examine the impact of OAT on retention in the assigned or in any OAT at 24 weeks and analysis of covariance was used to examine the mean difference in opioid use between treatment arms. RESULTS: Of the 272 randomized participants, 155 (57%) reported at least one NFO at baseline. Retention rates in the assigned treatment were 17.7% in the buprenorphine/naloxone group and 18.4% in the methadone group (adjusted odds ratio [AOR] = 0.54, 95% CI: 0.17-1.54). Rates of retention in any OAT were 28% and 20% in the buprenorphine/naloxone and methadone arms, respectively (AOR = 1.55, 95% CI: 0.65-3.78). There was an 11.9% adjusted mean difference in opioid-free urine drug tests, favoring the buprenorphine/naloxone arm (95% CI: 3.5-20.3; p = .0057). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Among adults with OUD and a history of overdose, overall retention rates were low but improved when retention in any treatment was considered. These findings highlight the importance of flexibility and patient-centered care to improve retention and other treatment outcomes in this population.

Prueba piloto de validación del método portátil PIMA para el recuento de células CD4 en comparación con la citometría de flujo / Pilot validation study of the PIMA portatil platform for the CD4 T-cell enumeration compared to flux cytometry

Objetivo: comparar la metodología PIMA con la citometría de flujo convencional para el recuento de linfocitos CD4 en pacientes con infección por HIV. Métodos: se realizaron determinaciones pareadas en sangre veno-sa de pacientes con HIV y se comparó la correlación entre ambos re-sultados. Resultados: se realizaron 223 determinaciones en forma pareadas. La concordancia fue muy buena, con una correlación lineal de Pear-son de 0,974, correlación por rangos de Spearman de 0,971 y con un coeficiente de determinación lineal (R cuadrado) de 0,949 (p < 0,01). El coeficiente de correlación intraclases para las medidas individua-les fue de 0,965 (IC 95 % 0,926-0,980) y para medidas promedio 0,982 (IC95 % 0,961-0,990). El coeficiente de variación para medidas duplicadas fue bajo siendo 11,4 %.Discusión: este estudio demuestra una buena correlación entre la de-terminación de células CD4 con el sistema PIMA frente a la citometría de flujo y apoya el uso de estas metodologías donde no hay acceso a citometría convencional

Objective: To compare PIMA methodology to the standard CD4 FACSCalibur flow cytometry for CD4 testing. Method: Paired blood samples were collectedamong HIV patients and tested using PIMA and Becton Dickinson FACSCalibur. Results: 223 samples were studied in parallel. There was a high concordance, being Pearson Linear Correlation 0.974, the Spearman Rank Correlation Coefficient 0.971. The Intraclass Correlation Coefficient for individual measures was 0.965 (95%CI 0.926-0.980) and for average measures 0.982 (95%CI 0.961-0.990). There was a low coefficient of variation from duplicate measurements (11.4%).Conclusion: This study shows a good correlation between the PIMA CD4 count and the Becton Dickinson FACSCalibur. By being a point of care methodology that produces same-day results, PIMA CD4 might be an alternative for sites without access to standard CD4 count methodology

Inclusion of trans women in pre-exposure prophylaxis trials: a review.

Trans women are at high risk of HIV infection. We conducted a review to determine the extent to which trans women were eligible for inclusion in and enrolled into pre-exposure prophylaxis (PrEP) efficacy trials. Out of seven trials analyzing PrEP efficacy, we found that trans women comprised only 1.2% of one trial and 0.2% of total trial enrollments. Although an additional PrEP trial to determine efficacy among trans women may not be warranted, further research is needed to determine the effectiveness of PrEP in this marginalized population, through observational and feasibility studies. These studies should focus on unique barriers that trans women may experience while obtaining access to PrEP, such as gender discrimination, transphobia, and violence.