METHODS: A prospective, open-label trial of 310 people with HIV and opioid use disorder at Malaysia's largest prison were allocated to pre-release methadone up to 24 weeks before release or not by randomization (n = 64) or preference (n = 246); 296 were included in the final analytical sample. Directed acyclic graphing was used to theorize the relationship between pre-release methadone and post-release linkage to HIV care and identify confounding variables. An inverse probability weighted Cox proportional hazards model estimated the impact of pre-release methadone on linkage to HIV care through 360 days after release.
RESULTS: Overall, 218 (73.6 %) of 296 study participants initiated methadone before release. Receiving pre-release methadone significantly predicted linkage to HIV care at all time points through 360 days (aHR = 1.87; 95 % CI 1.15-2.85) after release. The corresponding numbers needed to treat with pre-release methadone for one increased linkage to HIV care at 30 and 360 days were 14 (95 % CI 9.2-62.4) and 5 (95 % CI 3.4-22.0), respectively.
CONCLUSIONS: While treatment with methadone should be available to everyone with opioid use disorder, it should especially be included as part of an HIV treatment-as-prevention strategy for people in prisons, especially by the time of release. It can optimize HIV treatment outcomes by jumpstarting the HIV treatment cascade.