Skip to main content
NCBI home page
American Journal of Public Health logoLink to American Journal of Public Health
. 2000 Jul;90(7):1100–1111. doi: 10.2105/ajph.90.7.1100

HIV transmission and the cost-effectiveness of methadone maintenance.

G S Zaric 1, P G Barnett 1, M L Brandeau 1
PMCID: PMC1446290  PMID: 10897189

Abstract

OBJECTIVES: This study determined the cost-effectiveness of expanding methadone maintenance treatment for heroin addiction, particularly its effect on the HIV epidemic. METHODS: We developed a dynamic epidemic model to study the effects of increased methadone maintenance capacity on health care costs and survival, measured as quality-adjusted life-years (QALYs). We considered communities with HIV prevalence among injection drug users of 5% and 40%. RESULTS: Additional methadone maintenance capacity costs $8200 per QALY gained in the high-prevalence community and $10,900 per QALY gained in the low-prevalence community. More than half of the benefits are gained by individuals who do not inject drugs. Even if the benefits realized by treated and untreated injection drug users are ignored, methadone maintenance expansion costs between $14,100 and $15,200 per QALY gained. Additional capacity remains cost-effective even if it is twice as expensive and half as effective as current methadone maintenance slots. CONCLUSIONS: Expansion of methadone maintenance is cost-effective on the basis of commonly accepted criteria for medical interventions. Barriers to methadone maintenance deny injection drug users access to a cost-effective intervention that generates significant health benefits for the general population.

Full Text

The Full Text of this article is available as a PDF (161.9 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson R. M., May R. M. Epidemiological parameters of HIV transmission. Nature. 1988 Jun 9;333(6173):514–519. doi: 10.1038/333514a0. [DOI] [PubMed] [Google Scholar]
  2. Avants S. K., Margolin A., Sindelar J. L., Rounsaville B. J., Schottenfeld R., Stine S., Cooney N. L., Rosenheck R. A., Li S. H., Kosten T. R. Day treatment versus enhanced standard methadone services for opioid-dependent patients: a comparison of clinical efficacy and cost. Am J Psychiatry. 1999 Jan;156(1):27–33. doi: 10.1176/ajp.156.1.27. [DOI] [PubMed] [Google Scholar]
  3. Ball J. C., Lange W. R., Myers C. P., Friedman S. R. Reducing the risk of AIDS through methadone maintenance treatment. J Health Soc Behav. 1988 Sep;29(3):214–226. [PubMed] [Google Scholar]
  4. Bangsberg D., Tulsky J. P., Hecht F. M., Moss A. R. Protease inhibitors in the homeless. JAMA. 1997 Jul 2;278(1):63–65. [PubMed] [Google Scholar]
  5. Barnett P. G. The cost-effectiveness of methadone maintenance as a health care intervention. Addiction. 1999 Apr;94(4):479–488. doi: 10.1046/j.1360-0443.1999.9444793.x. [DOI] [PubMed] [Google Scholar]
  6. Battjes R. J., Pickens R. W., Amsel Z. HIV infection and AIDS risk behaviors among intravenous drug users entering methadone treatment in selected U.S. cities. J Acquir Immune Defic Syndr. 1991;4(11):1148–1154. [PubMed] [Google Scholar]
  7. Battjes R. J., Pickens R. W., Brown L. S., Jr HIV infection and AIDS risk behaviors among injecting drug users entering methadone treatment: an update. J Acquir Immune Defic Syndr Hum Retrovirol. 1995 Sep 1;10(1):90–96. [PubMed] [Google Scholar]
  8. Bellis D. J. Reduction of AIDS risk among 41 heroin addicted female street prostitutes: effects of free methadone maintenance. J Addict Dis. 1993;12(1):7–23. doi: 10.1300/J069v12n01_02. [DOI] [PubMed] [Google Scholar]
  9. Berger H., Smith M. J. Letter: Economics of methadone maintenance. N Engl J Med. 1974 Mar 28;290(13):751–751. doi: 10.1056/nejm197403282901329. [DOI] [PubMed] [Google Scholar]
  10. Billy J. O., Tanfer K., Grady W. R., Klepinger D. H. The sexual behavior of men in the United States. Fam Plann Perspect. 1993 Mar-Apr;25(2):52–60. [PubMed] [Google Scholar]
  11. Binson D., Dolcini M. M., Pollack L. M., Catania J. A. Data from the National AIDS Behavioral Surveys. IV. Multiple sexual partners among young adults in high-risk cities. Fam Plann Perspect. 1993 Nov-Dec;25(6):268–272. [PubMed] [Google Scholar]
  12. Blower S. M., Hartel D., Dowlatabadi H., Anderson R. M., May R. M. Drugs, sex and HIV: a mathematical model for New York City. Philos Trans R Soc Lond B Biol Sci. 1991 Feb 28;331(1260):171–187. doi: 10.1098/rstb.1991.0006. [DOI] [PubMed] [Google Scholar]
  13. Blower S. M., McLean A. R. Mixing ecology and epidemiology. Proc Biol Sci. 1991 Sep 23;245(1314):187–192. doi: 10.1098/rspb.1991.0108. [DOI] [PubMed] [Google Scholar]
  14. Booth R. E., Crowley T. J., Zhang Y. Substance abuse treatment entry, retention and effectiveness: out-of-treatment opiate injection drug users. Drug Alcohol Depend. 1996 Sep;42(1):11–20. doi: 10.1016/0376-8716(96)01257-4. [DOI] [PubMed] [Google Scholar]
  15. Booth R. E. Gender differences in high-risk sex behaviours among heterosexual drug injectors and crack smokers. Am J Drug Alcohol Abuse. 1995 Nov;21(4):419–432. doi: 10.3109/00952999509002708. [DOI] [PubMed] [Google Scholar]
  16. Booth R. E., Watters J. K., Chitwood D. D. HIV risk-related sex behaviors among injection drug users, crack smokers, and injection drug users who smoke crack. Am J Public Health. 1993 Aug;83(8):1144–1148. doi: 10.2105/ajph.83.8.1144. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Booth R., Koester S., Brewster J. T., Weibel W. W., Fritz R. B. Intravenous drug users and AIDS: risk behaviors. Am J Drug Alcohol Abuse. 1991 Sep;17(3):337–353. doi: 10.3109/00952999109027557. [DOI] [PubMed] [Google Scholar]
  18. Brandeau M. L., Owens D. K., Sox C. H., Wachter R. M. Screening women of childbearing age for human immunodeficiency virus. A cost-benefit analysis. Arch Intern Med. 1992 Nov;152(11):2229–2237. [PubMed] [Google Scholar]
  19. Bux D. A., Lamb R. J., Iguchi M. Y. Cocaine use and HIV risk behavior in methadone maintenance patients. Drug Alcohol Depend. 1995 Jan;37(1):29–35. doi: 10.1016/0376-8716(94)01058-s. [DOI] [PubMed] [Google Scholar]
  20. Calsyn D. A., Saxon A. J., Freeman G., Jr, Whittaker S. Ineffectiveness of AIDS education and HIV antibody testing in reducing high-risk behaviors among injection drug users. Am J Public Health. 1992 Apr;82(4):573–575. doi: 10.2105/ajph.82.4.573. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Caplehorn J. R., Ross M. W. Methadone maintenance and the likelihood of risky needle-sharing. Int J Addict. 1995 May;30(6):685–698. doi: 10.3109/10826089509048753. [DOI] [PubMed] [Google Scholar]
  22. Chaisson R. E., Bacchetti P., Osmond D., Brodie B., Sande M. A., Moss A. R. Cocaine use and HIV infection in intravenous drug users in San Francisco. JAMA. 1989 Jan 27;261(4):561–565. [PubMed] [Google Scholar]
  23. Cheng F. K., Ford W. L., Cheng S. Y., Weber M. D., Kerndt P. R. Occupational risk of acquiring HIV infection through needlestick injuries. Clin Perform Qual Health Care. 1995 Jul-Sep;3(3):147–150. [PubMed] [Google Scholar]
  24. Chouinard G., Albright P. S. Economic and health state utility determinations for schizophrenic patients treated with risperidone or haloperidol. J Clin Psychopharmacol. 1997 Aug;17(4):298–307. doi: 10.1097/00004714-199708000-00010. [DOI] [PubMed] [Google Scholar]
  25. Clark L. R., Brasseux C., Richmond D., Getson P., D'Angelo L. J. Effect of HIV counseling and testing on sexually transmitted diseases and condom use in an urban adolescent population. Arch Pediatr Adolesc Med. 1998 Mar;152(3):269–273. doi: 10.1001/archpedi.152.3.269. [DOI] [PubMed] [Google Scholar]
  26. Collier A. C., Coombs R. W., Schoenfeld D. A., Bassett R. L., Timpone J., Baruch A., Jones M., Facey K., Whitacre C., McAuliffe V. J. Treatment of human immunodeficiency virus infection with saquinavir, zidovudine, and zalcitabine. AIDS Clinical Trials Group. N Engl J Med. 1996 Apr 18;334(16):1011–1017. doi: 10.1056/NEJM199604183341602. [DOI] [PubMed] [Google Scholar]
  27. Contoreggi C., Rexroad V. E., Lange W. R. Current management of infectious complications in the injecting drug user. J Subst Abuse Treat. 1998 Mar-Apr;15(2):95–106. doi: 10.1016/s0740-5472(97)00048-2. [DOI] [PubMed] [Google Scholar]
  28. Cooper J. R. Methadone treatment and acquired immunodeficiency syndrome. JAMA. 1989 Sep 22;262(12):1664–1668. [PubMed] [Google Scholar]
  29. Cushman P., Jr Abstinence following detoxification and methadone maintenance treatment. Am J Med. 1978 Jul;65(1):46–52. doi: 10.1016/0002-9343(78)90691-5. [DOI] [PubMed] [Google Scholar]
  30. Darke S., Swift W., Hall W. Prevalence, severity and correlates of psychological morbidity among methadone maintenance clients. Addiction. 1994 Feb;89(2):211–217. doi: 10.1111/j.1360-0443.1994.tb00880.x. [DOI] [PubMed] [Google Scholar]
  31. Darke S., Wodak A., Hall W., Heather N., Ward J. Prevalence and predictors of psychopathology among opioid users. Br J Addict. 1992 May;87(5):771–776. doi: 10.1111/j.1360-0443.1992.tb02723.x. [DOI] [PubMed] [Google Scholar]
  32. Des Jarlais D. C., Friedman S. R., Sotheran J. L., Wenston J., Marmor M., Yancovitz S. R., Frank B., Beatrice S., Mildvan D. Continuity and change within an HIV epidemic. Injecting drug users in New York City, 1984 through 1992. JAMA. 1994 Jan 12;271(2):121–127. [PubMed] [Google Scholar]
  33. Des Jarlais D. C., Paone D., Friedman S. R., Peyser N., Newman R. G. Regulating controversial programs for unpopular people: methadone maintenance and syringe exchange programs. Am J Public Health. 1995 Nov;85(11):1577–1584. doi: 10.2105/ajph.85.11.1577. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Dole V. P., Nyswander M. E. Methadone maintenance treatment. A ten-year perspective. JAMA. 1976 May 10;235(19):2117–2119. [PubMed] [Google Scholar]
  35. Drummond M., Torrance G., Mason J. Cost-effectiveness league tables: more harm than good? Soc Sci Med. 1993 Jul;37(1):33–40. doi: 10.1016/0277-9536(93)90315-u. [DOI] [PubMed] [Google Scholar]
  36. Eskild A., Magnus P., Samuelsen S. O., Sohlberg C., Kittelsen P. Differences in mortality rates and causes of death between HIV positive and HIV negative intravenous drug users. Int J Epidemiol. 1993 Apr;22(2):315–320. doi: 10.1093/ije/22.2.315. [DOI] [PubMed] [Google Scholar]
  37. Farley T. A., Cartter M. L., Wassell J. T., Hadler J. L. Predictors of outcome in methadone programs: effect of HIV counseling and testing. AIDS. 1992 Jan;6(1):115–121. doi: 10.1097/00002030-199201000-00016. [DOI] [PubMed] [Google Scholar]
  38. Freedberg K. A., Scharfstein J. A., Seage G. R., 3rd, Losina E., Weinstein M. C., Craven D. E., Paltiel A. D. The cost-effectiveness of preventing AIDS-related opportunistic infections. JAMA. 1998 Jan 14;279(2):130–136. doi: 10.1001/jama.279.2.130. [DOI] [PubMed] [Google Scholar]
  39. Freeman R. C., Rodriguez G. M., French J. F. A comparison of male and female intravenous drug users' risk behaviors for HIV infection. Am J Drug Alcohol Abuse. 1994;20(2):129–157. doi: 10.3109/00952999409106779. [DOI] [PubMed] [Google Scholar]
  40. French M. T., Dunlap L. J., Zarkin G. A., McGeary K. A., McLellan A. T. A structured instrument for estimating the economic cost of drug abuse treatment. The Drug Abuse Treatment Cost Analysis Program (DATCAP). J Subst Abuse Treat. 1997 Sep-Oct;14(5):445–455. doi: 10.1016/s0740-5472(97)00132-3. [DOI] [PubMed] [Google Scholar]
  41. Friedland G. H., Klein R. S. Transmission of the human immunodeficiency virus. N Engl J Med. 1987 Oct 29;317(18):1125–1135. doi: 10.1056/NEJM198710293171806. [DOI] [PubMed] [Google Scholar]
  42. Friedman S. R., Jose B., Neaigus A., Goldstein M., Curtis R., Ildefonso G., Mota P., Des Jarlais D. C. Consistent condom use in relationships between seropositive injecting drug users and sex partners who do not inject drugs. AIDS. 1994 Mar;8(3):357–361. doi: 10.1097/00002030-199403000-00010. [DOI] [PubMed] [Google Scholar]
  43. Friedman S. R., Neaigus A., Jose B., Curtis R., Goldstein M., Ildefonso G., Rothenberg R. B., Des Jarlais D. C. Sociometric risk networks and risk for HIV infection. Am J Public Health. 1997 Aug;87(8):1289–1296. doi: 10.2105/ajph.87.8.1289. [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Gable C. B., Tierce J. C., Simison D., Ward D., Motte K. Costs of HIV+/AIDS at CD4+ counts disease stages based on treatment protocols. J Acquir Immune Defic Syndr Hum Retrovirol. 1996 Aug 1;12(4):413–420. doi: 10.1097/00042560-199608010-00013. [DOI] [PubMed] [Google Scholar]
  45. Garnett G. P., Anderson R. M. Contact tracing and the estimation of sexual mixing patterns: the epidemiology of gonococcal infections. Sex Transm Dis. 1993 Jul-Aug;20(4):181–191. doi: 10.1097/00007435-199307000-00001. [DOI] [PubMed] [Google Scholar]
  46. Gershon R. M., Vlahov D. HIV infection risk to health-care workers. Am Ind Hyg Assoc J. 1990 Dec;51(12):A802–A806. [PubMed] [Google Scholar]
  47. Grönbladh L., Gunne L. Methadone-assisted rehabilitation of Swedish heroin addicts. Drug Alcohol Depend. 1989 Aug;24(1):31–37. doi: 10.1016/0376-8716(89)90005-7. [DOI] [PubMed] [Google Scholar]
  48. Grönbladh L., Ohlund L. S., Gunne L. M. Mortality in heroin addiction: impact of methadone treatment. Acta Psychiatr Scand. 1990 Sep;82(3):223–227. doi: 10.1111/j.1600-0447.1990.tb03057.x. [DOI] [PubMed] [Google Scholar]
  49. Gulick R. M., Mellors J. W., Havlir D., Eron J. J., Gonzalez C., McMahon D., Richman D. D., Valentine F. T., Jonas L., Meibohm A. Treatment with indinavir, zidovudine, and lamivudine in adults with human immunodeficiency virus infection and prior antiretroviral therapy. N Engl J Med. 1997 Sep 11;337(11):734–739. doi: 10.1056/NEJM199709113371102. [DOI] [PubMed] [Google Scholar]
  50. Hahn R. A., Onorato I. M., Jones T. S., Dougherty J. Prevalence of HIV infection among intravenous drug users in the United States. JAMA. 1989 May 12;261(18):2677–2684. [PubMed] [Google Scholar]
  51. Hammer S. M., Squires K. E., Hughes M. D., Grimes J. M., Demeter L. M., Currier J. S., Eron J. J., Jr, Feinberg J. E., Balfour H. H., Jr, Deyton L. R. A controlled trial of two nucleoside analogues plus indinavir in persons with human immunodeficiency virus infection and CD4 cell counts of 200 per cubic millimeter or less. AIDS Clinical Trials Group 320 Study Team. N Engl J Med. 1997 Sep 11;337(11):725–733. doi: 10.1056/NEJM199709113371101. [DOI] [PubMed] [Google Scholar]
  52. Hartel D. M., Schoenbaum E. E. Methadone treatment protects against HIV infection: two decades of experience in the Bronx, New York City. Public Health Rep. 1998 Jun;113 (Suppl 1):107–115. [PMC free article] [PubMed] [Google Scholar]
  53. Harwood H. J., Hubbard R. L., Collins J. J., Rachal J. V. The costs of crime and the benefits of drug abuse treatment: a cost-benefit analysis using TOPS data. NIDA Res Monogr. 1988;86:209–235. [PubMed] [Google Scholar]
  54. Henderson D. K., Fahey B. J., Willy M., Schmitt J. M., Carey K., Koziol D. E., Lane H. C., Fedio J., Saah A. J. Risk for occupational transmission of human immunodeficiency virus type 1 (HIV-1) associated with clinical exposures. A prospective evaluation. Ann Intern Med. 1990 Nov 15;113(10):740–746. doi: 10.7326/0003-4819-113-10-740. [DOI] [PubMed] [Google Scholar]
  55. Hoffmann J. P., Su S. S., Pach A. Changes in network characteristics and HIV risk behavior among injection drug users. Drug Alcohol Depend. 1997 Jun 6;46(1-2):41–51. doi: 10.1016/s0376-8716(97)00038-0. [DOI] [PubMed] [Google Scholar]
  56. Hogg R. S., Yip B., Kully C., Craib K. J., O'Shaughnessy M. V., Schechter M. T., Montaner J. S. Improved survival among HIV-infected patients after initiation of triple-drug antiretroviral regimens. CMAJ. 1999 Mar 9;160(5):659–665. [PMC free article] [PubMed] [Google Scholar]
  57. Holmberg S. D. The estimated prevalence and incidence of HIV in 96 large US metropolitan areas. Am J Public Health. 1996 May;86(5):642–654. doi: 10.2105/ajph.86.5.642. [DOI] [PMC free article] [PubMed] [Google Scholar]
  58. Holtgrave D. R., Kelly J. A. Preventing HIV/AIDS among high-risk urban women: the cost-effectiveness of a behavioral group intervention. Am J Public Health. 1996 Oct;86(10):1442–1445. doi: 10.2105/ajph.86.10.1442. [DOI] [PMC free article] [PubMed] [Google Scholar]
  59. Holtgrave D. R., Pinkerton S. D., Jones T. S., Lurie P., Vlahov D. Cost and cost-effectiveness of increasing access to sterile syringes and needles as an HIV prevention intervention in the United States. J Acquir Immune Defic Syndr Hum Retrovirol. 1998;18 (Suppl 1):S133–S138. doi: 10.1097/00042560-199802001-00022. [DOI] [PubMed] [Google Scholar]
  60. Holtgrave D. R., Pinkerton S. D. Updates of cost of illness and quality of life estimates for use in economic evaluations of HIV prevention programs. J Acquir Immune Defic Syndr Hum Retrovirol. 1997 Sep 1;16(1):54–62. doi: 10.1097/00042560-199709010-00009. [DOI] [PubMed] [Google Scholar]
  61. Hubbard R. L., Marsden M. E., Cavanaugh E., Rachal J. V., Ginzburg H. M. Role of drug-abuse treatment in limiting the spread of AIDS. Rev Infect Dis. 1988 Mar-Apr;10(2):377–384. doi: 10.1093/clinids/10.2.377. [DOI] [PubMed] [Google Scholar]
  62. Hudgins R., McCusker J., Stoddard A. Cocaine use and risky injection and sexual behaviors. Drug Alcohol Depend. 1995 Jan;37(1):7–14. doi: 10.1016/0376-8716(94)01060-x. [DOI] [PubMed] [Google Scholar]
  63. Joe G. W., Simpson D. D. HIV risks, gender, and cocaine use among opiate users. Drug Alcohol Depend. 1995 Jan;37(1):23–28. doi: 10.1016/0376-8716(94)01030-o. [DOI] [PubMed] [Google Scholar]
  64. Judson B. A., Ortiz S., Crouse L., Carney T. M., Goldstein A. A follow-up study of heroin addicts five years after first admission to a methadone treatment program. Drug Alcohol Depend. 1980 Nov;6(5):295–313. doi: 10.1016/0376-8716(80)90197-0. [DOI] [PubMed] [Google Scholar]
  65. Kaplan E. H. Economic analysis of needle exchange. AIDS. 1995 Oct;9(10):1113–1119. doi: 10.1097/00002030-199510000-00001. [DOI] [PubMed] [Google Scholar]
  66. Kaplan E. H., Heimer R. A circulation theory of needle exchange. AIDS. 1994 May;8(5):567–574. doi: 10.1097/00002030-199405000-00001. [DOI] [PubMed] [Google Scholar]
  67. Kaplan E. H., Heimer R. A model-based estimate of HIV infectivity via needle sharing. J Acquir Immune Defic Syndr. 1992;5(11):1116–1118. [PubMed] [Google Scholar]
  68. Karon J. M., Rosenberg P. S., McQuillan G., Khare M., Gwinn M., Petersen L. R. Prevalence of HIV infection in the United States, 1984 to 1992. JAMA. 1996 Jul 10;276(2):126–131. [PubMed] [Google Scholar]
  69. Klovdahl A. S., Potterat J. J., Woodhouse D. E., Muth J. B., Muth S. Q., Darrow W. W. Social networks and infectious disease: the Colorado Springs Study. Soc Sci Med. 1994 Jan;38(1):79–88. doi: 10.1016/0277-9536(94)90302-6. [DOI] [PubMed] [Google Scholar]
  70. Koblin B. A., McCusker J., Lewis B. F., Sullivan J. L. Racial/ethnic differences in HIV-1 seroprevalence and risky behaviors among intravenous drug users in a multisite study. Am J Epidemiol. 1990 Nov;132(5):837–846. doi: 10.1093/oxfordjournals.aje.a115726. [DOI] [PubMed] [Google Scholar]
  71. Kretzschmar M., Wiessing L. G. Modelling the spread of HIV in social networks of injecting drug users. AIDS. 1998 May 7;12(7):801–811. doi: 10.1097/00002030-199807000-00017. [DOI] [PubMed] [Google Scholar]
  72. Latkin C. A., Mandell W., Vlahov D. The relationship between risk networks' patterns of crack cocaine and alcohol consumption and HIV-related sexual behaviors among adult injection drug users: a prospective study. Drug Alcohol Depend. 1996 Nov;42(3):175–181. doi: 10.1016/s0376-8716(96)01279-3. [DOI] [PubMed] [Google Scholar]
  73. Latkin C. A. Outreach in natural settings: the use of peer leaders for HIV prevention among injecting drug users' networks. Public Health Rep. 1998 Jun;113 (Suppl 1):151–159. [PMC free article] [PubMed] [Google Scholar]
  74. Latkin C., Mandell W., Oziemkowska M., Celentano D., Vlahov D., Ensminger M., Knowlton A. Using social network analysis to study patterns of drug use among urban drug users at high risk for HIV/AIDS. Drug Alcohol Depend. 1995 Apr;38(1):1–9. doi: 10.1016/0376-8716(94)01082-v. [DOI] [PubMed] [Google Scholar]
  75. Leigh B. C., Temple M. T., Trocki K. F. The sexual behavior of US adults: results from a national survey. Am J Public Health. 1993 Oct;83(10):1400–1408. doi: 10.2105/ajph.83.10.1400. [DOI] [PMC free article] [PubMed] [Google Scholar]
  76. Longshore D., Annon J., Anglin M. D. Long-term trends in self-reported HIV risk behavior: injection drug users in Los Angeles, 1987 through 1995. J Acquir Immune Defic Syndr Hum Retrovirol. 1998 May 1;18(1):64–72. doi: 10.1097/00042560-199805010-00010. [DOI] [PubMed] [Google Scholar]
  77. Longshore D., Hsieh S., Danila B., Anglin M. D. Methadone maintenance and needle/syringe sharing. Int J Addict. 1993 Aug;28(10):983–996. doi: 10.3109/10826089309062178. [DOI] [PubMed] [Google Scholar]
  78. MacGowan R. J., Brackbill R. M., Rugg D. L., Swanson N. M., Weinstein B., Couchon A., Scibak J., Molde S., McLaughlin P., Barker T. Sex, drugs and HIV counseling and testing: a prospective study of behavior-change among methadone-maintenance clients in New England. AIDS. 1997 Feb;11(2):229–235. doi: 10.1097/00002030-199702000-00014. [DOI] [PubMed] [Google Scholar]
  79. Maidlow S. T., Berman H. The economics of heroin treatment. Am J Public Health. 1972 Oct;62(10):1397–1406. doi: 10.2105/ajph.62.10.1397. [DOI] [PMC free article] [PubMed] [Google Scholar]
  80. Martin G. S., Serpelloni G., Galvan U., Rizzetto A., Gomma M., Morgante S., Rezza G. Behavioural change in injecting drug users: evaluation of an HIV/AIDS education programme. AIDS Care. 1990;2(3):275–279. doi: 10.1080/09540129008257740. [DOI] [PubMed] [Google Scholar]
  81. Mason J., Drummond M., Torrance G. Some guidelines on the use of cost effectiveness league tables. BMJ. 1993 Feb 27;306(6877):570–572. doi: 10.1136/bmj.306.6877.570. [DOI] [PMC free article] [PubMed] [Google Scholar]
  82. McAuliffe W. E. Health care policy issues in the drug abuser treatment field. J Health Polit Policy Law. 1990 Summer;15(2):357–385. doi: 10.1215/03616878-15-2-357. [DOI] [PubMed] [Google Scholar]
  83. McCusker J., Bigelow C., Stoddard A. M., Zorn M. Human immunodeficiency virus type 1 antibody status and changes in risk behavior among drug users. Ann Epidemiol. 1994 Nov;4(6):466–471. doi: 10.1016/1047-2797(94)90007-8. [DOI] [PubMed] [Google Scholar]
  84. McElrath K., Chitwood D. D., Griffin D. K., Comerford M. The consistency of self-reported HIV risk behavior among injection drug users. Am J Public Health. 1994 Dec;84(12):1965–1970. doi: 10.2105/ajph.84.12.1965. [DOI] [PMC free article] [PubMed] [Google Scholar]
  85. McGlothlin W. H., Anglin M. D. Long-term follow-up of clients of high- and low-dose methadone programs. Arch Gen Psychiatry. 1981 Sep;38(9):1055–1063. doi: 10.1001/archpsyc.1981.01780340107013. [DOI] [PubMed] [Google Scholar]
  86. Meandzija B., O'Connor P. G., Fitzgerald B., Rounsaville B. J., Kosten T. R. HIV infection and cocaine use in methadone maintained and untreated intravenous drug users. Drug Alcohol Depend. 1994 Oct;36(2):109–113. doi: 10.1016/0376-8716(94)90092-2. [DOI] [PubMed] [Google Scholar]
  87. Metzger D. S., Navaline H., Woody G. E. Drug abuse treatment as AIDS prevention. Public Health Rep. 1998 Jun;113 (Suppl 1):97–106. [PMC free article] [PubMed] [Google Scholar]
  88. Metzger D. S., Woody G. E., McLellan A. T., O'Brien C. P., Druley P., Navaline H., DePhilippis D., Stolley P., Abrutyn E. Human immunodeficiency virus seroconversion among intravenous drug users in- and out-of-treatment: an 18-month prospective follow-up. J Acquir Immune Defic Syndr. 1993 Sep;6(9):1049–1056. [PubMed] [Google Scholar]
  89. Mocroft A., Youle M., Morcinek J., Sabin C. A., Gazzard B., Johnson M. A., Phillips A. N. Survival after diagnosis of AIDS: a prospective observational study of 2625 patients. Royal Free/Chelsea and Westminster Hospitals Collaborative Group. BMJ. 1997 Feb 8;314(7078):409–413. doi: 10.1136/bmj.314.7078.409. [DOI] [PMC free article] [PubMed] [Google Scholar]
  90. Moss A. R., Vranizan K., Gorter R., Bacchetti P., Watters J., Osmond D. HIV seroconversion in intravenous drug users in San Francisco, 1985-1990. AIDS. 1994 Feb;8(2):223–231. doi: 10.1097/00002030-199402000-00010. [DOI] [PubMed] [Google Scholar]
  91. Neaigus A., Friedman S. R., Curtis R., Des Jarlais D. C., Furst R. T., Jose B., Mota P., Stepherson B., Sufian M., Ward T. The relevance of drug injectors' social and risk networks for understanding and preventing HIV infection. Soc Sci Med. 1994 Jan;38(1):67–78. doi: 10.1016/0277-9536(94)90301-8. [DOI] [PubMed] [Google Scholar]
  92. Neaigus A., Friedman S. R., Jose B., Goldstein M. F., Curtis R., Ildefonso G., Des Jarlais D. C. High-risk personal networks and syringe sharing as risk factors for HIV infection among new drug injectors. J Acquir Immune Defic Syndr Hum Retrovirol. 1996 Apr 15;11(5):499–509. doi: 10.1097/00042560-199604150-00011. [DOI] [PubMed] [Google Scholar]
  93. Ortí R. M., Domingo-Salvany A., Muñoz A., Macfarlane D., Suelves J. M., Antó J. M. Mortality trends in a cohort of opiate addicts, Catalonia, Spain. Int J Epidemiol. 1996 Jun;25(3):545–553. doi: 10.1093/ije/25.3.545. [DOI] [PubMed] [Google Scholar]
  94. Owens D. K., Cardinalli A. B., Nease R. F., Jr Physicians' assessments of the utility of health states associated with human immunodeficiency virus (HIV) and hepatitis B virus (HBV) infection. Qual Life Res. 1997 Jan;6(1):77–86. doi: 10.1023/a:1026473613487. [DOI] [PubMed] [Google Scholar]
  95. Owens D. K., Harris R. A., Scott P. M., Nease R. F., Jr Screening surgeons for HIV infection. A cost-effectiveness analysis. Ann Intern Med. 1995 May 1;122(9):641–652. doi: 10.7326/0003-4819-122-9-199505010-00001. [DOI] [PubMed] [Google Scholar]
  96. Owens D. K. Interpretation of cost-effectiveness analyses. J Gen Intern Med. 1998 Oct;13(10):716–717. doi: 10.1046/j.1525-1497.1998.00211.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  97. Padian N. S., Shiboski S. C., Glass S. O., Vittinghoff E. Heterosexual transmission of human immunodeficiency virus (HIV) in northern California: results from a ten-year study. Am J Epidemiol. 1997 Aug 15;146(4):350–357. doi: 10.1093/oxfordjournals.aje.a009276. [DOI] [PubMed] [Google Scholar]
  98. Padian N. S., Shiboski S. C., Jewell N. P. Female-to-male transmission of human immunodeficiency virus. JAMA. 1991 Sep 25;266(12):1664–1667. [PubMed] [Google Scholar]
  99. Padian N., Marquis L., Francis D. P., Anderson R. E., Rutherford G. W., O'Malley P. M., Winkelstein W., Jr Male-to-female transmission of human immunodeficiency virus. JAMA. 1987 Aug 14;258(6):788–790. [PubMed] [Google Scholar]
  100. Paltiel A. D., Kaplan E. H. Modeling zidovudine therapy: a cost-effectiveness analysis. J Acquir Immune Defic Syndr. 1991;4(8):795–804. [PubMed] [Google Scholar]
  101. Paltiel A. D., Scharfstein J. A., Seage G. R., 3rd, Losina E., Goldie S. J., Weinstein M. C., Craven D. E., Freedberg K. A. A Monte Carlo simulation of advanced HIV disease: application to prevention of CMV infection. Med Decis Making. 1998 Apr-Jun;18(2 Suppl):S93–105. doi: 10.1177/0272989X98018002S11. [DOI] [PubMed] [Google Scholar]
  102. Peterson J. L., Catania J. A., Dolcini M. M., Faigeles B. Data from the National AIDS Behavioral Surveys. III. Multiple sexual partners among blacks in high-risk cities. Fam Plann Perspect. 1993 Nov-Dec;25(6):263–267. [PubMed] [Google Scholar]
  103. Pezzotti P., Napoli P. A., Acciai S., Boros S., Urciuoli R., Lazzeri V., Rezza G. Increasing survival time after AIDS in Italy: the role of new combination antiretroviral therapies. Tuscany AIDS Study Group. AIDS. 1999 Feb 4;13(2):249–255. doi: 10.1097/00002030-199902040-00013. [DOI] [PubMed] [Google Scholar]
  104. Pinkerton S. D., Abramson P. R. Effectiveness of condoms in preventing HIV transmission. Soc Sci Med. 1997 May;44(9):1303–1312. doi: 10.1016/s0277-9536(96)00258-4. [DOI] [PubMed] [Google Scholar]
  105. Pinkerton S. D., Holtgrave D. R., Bloom F. R. Cost-effectiveness of post-exposure prophylaxis following sexual exposure to HIV. AIDS. 1998 Jun 18;12(9):1067–1078. [PubMed] [Google Scholar]
  106. Pinkerton S. D., Holtgrave D. R., Pinkerton H. J. Cost-effectiveness of chemoprophylaxis after occupational exposure to HIV. Arch Intern Med. 1997 Sep 22;157(17):1972–1980. [PubMed] [Google Scholar]
  107. Pinkerton S. D., Holtgrave D. R., Valdiserri R. O. Cost-effectiveness of HIV-prevention skills training for men who have sex with men. AIDS. 1997 Mar;11(3):347–357. doi: 10.1097/00002030-199703110-00013. [DOI] [PubMed] [Google Scholar]
  108. Prins M., Hernández Aguado I. H., Brettle R. P., Robertson J. R., Broers B., Carré N., Goldberg D. J., Zangerle R., Coutinho R. A., van den Hoek A. Pre-AIDS mortality from natural causes associated with HIV disease progression: evidence from the European Seroconverter Study among injecting drug users. AIDS. 1997 Nov 15;11(14):1747–1756. doi: 10.1097/00002030-199714000-00012. [DOI] [PubMed] [Google Scholar]
  109. Rawson R. A., Hasson A. L., Huber A. M., McCann M. J., Ling W. A 3-year progress report on the implementation of LAAM in the United States. Addiction. 1998 Apr;93(4):533–540. doi: 10.1046/j.1360-0443.1998.9345338.x. [DOI] [PubMed] [Google Scholar]
  110. Rietmeijer C. A., Kane M. S., Simons P. Z., Corby N. H., Wolitski R. J., Higgins D. L., Judson F. N., Cohn D. L. Increasing the use of bleach and condoms among injecting drug users in Denver: outcomes of a targeted, community-level HIV prevention program. AIDS. 1996 Mar;10(3):291–298. [PubMed] [Google Scholar]
  111. Sabogal F., Faigeles B., Catania J. A. Data from the National AIDS Behavioral Surveys. II. Multiple sexual partners among Hispanics in high-risk cities. Fam Plann Perspect. 1993 Nov-Dec;25(6):257–262. [PubMed] [Google Scholar]
  112. Scanlon J. C. Proceedings: Cost savings/benefit analysis of drug abuse treatment. Am J Drug Alcohol Abuse. 1976;3(1):95–101. doi: 10.3109/00952997609023966. [DOI] [PubMed] [Google Scholar]
  113. Schoenbaum E. E., Hartel D., Selwyn P. A., Klein R. S., Davenny K., Rogers M., Feiner C., Friedland G. Risk factors for human immunodeficiency virus infection in intravenous drug users. N Engl J Med. 1989 Sep 28;321(13):874–879. doi: 10.1056/NEJM198909283211306. [DOI] [PubMed] [Google Scholar]
  114. Senay E. C. Methadone maintenance treatment. Int J Addict. 1985 Jun-Jul;20(6-7):803–821. doi: 10.3109/10826088509047754. [DOI] [PubMed] [Google Scholar]
  115. Serpelloni G., Carrieri M. P., Rezza G., Morganti S., Gomma M., Binkin N. Methadone treatment as a determinant of HIV risk reduction among injecting drug users: a nested case-control study. AIDS Care. 1994;6(2):215–220. doi: 10.1080/09540129408258632. [DOI] [PubMed] [Google Scholar]
  116. Shapiro M. F., Morton S. C., McCaffrey D. F., Senterfitt J. W., Fleishman J. A., Perlman J. F., Athey L. A., Keesey J. W., Goldman D. P., Berry S. H. Variations in the care of HIV-infected adults in the United States: results from the HIV Cost and Services Utilization Study. JAMA. 1999 Jun 23;281(24):2305–2315. doi: 10.1001/jama.281.24.2305. [DOI] [PubMed] [Google Scholar]
  117. Simpson D. D. Treatment for drug abuse. Follow-up outcomes and length of time spent. Arch Gen Psychiatry. 1981 Aug;38(8):875–880. doi: 10.1001/archpsyc.1981.01780330033003. [DOI] [PubMed] [Google Scholar]
  118. Sonenstein F. L., Pleck J. H., Ku L. C. Sexual activity, condom use and AIDS awareness among adolescent males. Fam Plann Perspect. 1989 Jul-Aug;21(4):152–158. [PubMed] [Google Scholar]
  119. Stein M. D., Freedberg K. A., Sullivan L. M., Savetsky J., Levenson S. M., Hingson R., Samet J. H. Sexual ethics. Disclosure of HIV-positive status to partners. Arch Intern Med. 1998 Feb 9;158(3):253–257. doi: 10.1001/archinte.158.3.253. [DOI] [PubMed] [Google Scholar]
  120. Strang J., Sheridan J., Barber N. Prescribing injectable and oral methadone to opiate addicts: results from the 1995 national postal survey of community pharmacies in England and Wales. BMJ. 1996 Aug 3;313(7052):270–272. doi: 10.1136/bmj.313.7052.270. [DOI] [PMC free article] [PubMed] [Google Scholar]
  121. Suh T., Mandell W., Latkin C., Kim J. Social network characteristics and injecting HIV-risk behaviors among street injection drug users. Drug Alcohol Depend. 1997 Aug 25;47(2):137–143. doi: 10.1016/s0376-8716(97)00082-3. [DOI] [PubMed] [Google Scholar]
  122. Tsevat J., Solzan J. G., Kuntz K. M., Ragland J., Currier J. S., Sell R. L., Weinstein M. C. Health values of patients infected with human immunodeficiency virus. Relationship to mental health and physical functioning. Med Care. 1996 Jan;34(1):44–57. doi: 10.1097/00005650-199601000-00004. [DOI] [PubMed] [Google Scholar]
  123. Turner B. J., Markson L., Hauck W., Cocroft J., Fanning T. Prenatal care of HIV-infected women: analysis of a large New York State cohort. J Acquir Immune Defic Syndr Hum Retrovirol. 1995 Aug 1;9(4):371–378. [PubMed] [Google Scholar]
  124. Vlahov D., Anthony J. C., Celentano D., Solomon L., Chowdhury N. Trends of HIV-1 risk reduction among initiates into intravenous drug use 1982-1987. Am J Drug Alcohol Abuse. 1991;17(1):39–48. doi: 10.3109/00952999108992808. [DOI] [PubMed] [Google Scholar]
  125. Vlahov D., Junge B. The role of needle exchange programs in HIV prevention. Public Health Rep. 1998 Jun;113 (Suppl 1):75–80. [PMC free article] [PubMed] [Google Scholar]
  126. Watkins K. E., Metzger D., Woody G., McLellan A. T. High-risk sexual behaviors of intravenous drug users in- and out-of-treatment: implications for the spread of HIV infection. Am J Drug Alcohol Abuse. 1992;18(4):389–398. doi: 10.3109/00952999209051037. [DOI] [PubMed] [Google Scholar]
  127. Watters J. K. Trends in risk behavior and HIV seroprevalence in heterosexual injection drug users in San Francisco, 1986-1992. J Acquir Immune Defic Syndr. 1994 Dec;7(12):1276–1281. [PubMed] [Google Scholar]
  128. Weller S. C. A meta-analysis of condom effectiveness in reducing sexually transmitted HIV. Soc Sci Med. 1993 Jun;36(12):1635–1644. doi: 10.1016/0277-9536(93)90352-5. [DOI] [PubMed] [Google Scholar]
  129. Wells E. A., Fleming C., Calsyń D. A., Jackson T. R., Saxon A. J. Users of free treatment slots at a community-based methadone maintenance clinic. J Subst Abuse Treat. 1995 Jan-Feb;12(1):13–18. [PubMed] [Google Scholar]
  130. Williams A. B., McNelly E. A., Williams A. E., D'Aquila R. T. Methadone maintenance treatment and HIV type 1 seroconversion among injecting drug users. AIDS Care. 1992;4(1):35–41. doi: 10.1080/09540129208251618. [DOI] [PubMed] [Google Scholar]
  131. Zweben J. E., Payte J. T. Methadone maintenance in the treatment of opioid dependence. A current perspective. West J Med. 1990 May;152(5):588–599. [PMC free article] [PubMed] [Google Scholar]
  132. de Vincenzi I. A longitudinal study of human immunodeficiency virus transmission by heterosexual partners. European Study Group on Heterosexual Transmission of HIV. N Engl J Med. 1994 Aug 11;331(6):341–346. doi: 10.1056/NEJM199408113310601. [DOI] [PubMed] [Google Scholar]
  133. von Limbeek J., Wouters L., Kaplan C. D., Geerlings P. J., von Alem V. Prevalence of psychopathology in drug-addicted Dutch. J Subst Abuse Treat. 1992;9(1):43–52. doi: 10.1016/0740-5472(92)90009-d. [DOI] [PubMed] [Google Scholar]

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association

RESOURCES