Integration of methadone maintenance treatment and HIV care for injecting drug users: a cohort study in Bandung, Indonesia.

Aim: to know the effectiveness of antiretroviral treatment (ART) among methadone clients and patients who started ART outside the methadone program during the same period.

Methods: uptake of HIV testing and treatment were evaluated in a cohort of IDUs starting MMT. Effectiveness of anti-retroviral treatment (ART) was compared with matched 175 HIV-patients with a history of IDU outside MMT.

Results: overall, 223 patients were enrolled in MMT between May 2006 and January 2009, of whom 44% were tested for HIV, with an HIV prevalence of 73%. Screening of MMT clients was responsible for diagnosing HIV and starting ART in 31.9%, respectively 45.7%. Two year retention (100% vs 97.1%; p=0.23) and survival (93.9% vs 92.3%; p=0.76) during ART were not significantly different for 35 patients who combined ART with methadone, and the control group (n=175). Virological failure was found in one patient (3.7%) in MMT compared to 10.5% of the control group.

Conclusion: providing HIV testing and treatment is a feasible and effective way to increase detection and treatment of HIV among clients enrolled in MMT. HIV- treatment integrated with methadone maintenance can be very effective. These results support wider application of integrated HIV care and opioid substitution.