Integration of care for HIV and opioid use disorder

Abstract

Objective: We sought to identify optimal strategies for integrating HIV-and opioid use disorder-(OUD) screening and treatment in diverse settings. Design: Systematic review. Methods: We searched Ovid MEDLINE, PubMed, Embase, and PsycINFO and pre-identified websites. Studies were included if they were published in English on or after 2002 through May 2017, and evaluated interventions that integrated, at an organizational level, screening and/or treatment for HIV and OUD in any care setting in any country. Results: Twenty-nine articles met criteria for inclusion, including 23 unique studies: six took place in HIV care settings, 12 in opioid treatment settings, and five elsewhere. Eight involved screening strategies, 22 involved treatment strategies, and seven involved strategies that encompassed screening and treatment. Randomized controlled studies demonstrated low to moderate risk of bias and observational studies demonstrated fair to good quality. Studies in HIV care settings (n=6) identified HIV-and OUD-related clinical benefits with the use of buprenorphine/naloxone for OUD. No studies in HIV care settings focused on screening for OUD. Studies in opioid treatment settings (n=12) identified improving HIV screening uptake and clinical

A Structural Competency Curriculum for Primary Care Providers to Address the Opioid Use Disorder, HIV, and Hepatitis C Syndemic

“…Evidence shows that many people who inject drugs or are at risk for infectious diseases see their PCPs on a yearly basis but are not engaged in discussions about harm reduction; in many cases, the PCP is not even aware of the patient's risk status (72). Normalizing the management of OUD, HIV, and HCV in the primary care setting can help to reduce the stigma that exacerbates poor health outcomes in the syndemic (13,21,73). Until the barriers (including lack of awareness or clinical inertia to prescribe buprenorphine and federal regulations restricting methadone outside of opioid treatment programs) are removed, PCPs should be encouraged to complete training to prescribe buprenorphine and train patients in overdose prevention with naloxone (14,21,74).…”

“…Normalizing the management of OUD, HIV, and HCV in the primary care setting can help to reduce the stigma that exacerbates poor health outcomes in the syndemic (13,21,73). Until the barriers (including lack of awareness or clinical inertia to prescribe buprenorphine and federal regulations restricting methadone outside of opioid treatment programs) are removed, PCPs should be encouraged to complete training to prescribe buprenorphine and train patients in overdose prevention with naloxone (14,21,74). As treatment regimens have become more efficacious and simpler, PCPs should be encouraged to accept the responsibility for medical management of patients with substance use disorder, HIV, and HCV (14,75).…”

“…The previous recommendation was that all adults born between 1945 and 1965 be screened for HCV, but the new guidelines suggest screening for all adults ages 18-79. Although there have been successful models of care integration for management of HIV and OUD, these have largely been in specialty care settings and there has been inadequate uptake in primary care practices (21). Similarly, while there have been successful models of HCV integration into primary care (22)(23)(24), including increasing consideration for OUD (25), such comprehensive approaches remain underutilized.…”

“…In particular, structural competency is seen as a way to address the institutionalized factors that shape social responses and clinical interactions (1). Recent reviews highlight successful office-based models for treatment of substance use disorders, which can be modified to address structural factors fueling the syndemic (13,21,33). For example, harm reduction programs and medication for addiction treatment (MAT) promote a patient-centered Bagchi Structural Competency in Primary Care approach to treatment that shows promise for overcoming barriers associated with socioeconomic status, institutionalized racism in the criminal justice system, and stigma.…”

Effects of prescription drug diversion, misuse and abuse on the health system in eThekwini District, KwaZulu-Natal, South Africa: Key stakeholders’ perceptions

“…Subsequently leading to the increase incidence rates of blood-borne infections such as human immunodeficiency virus (HIV), hepatitis B and C which are prevalent among key populations including injecting drug users (12,13). Worldwide, HIV and opioid use disorder manifest as intersecting epidemics (14). Therefore, hindering the global priority to control the HIV epidemic especially among key populations (15).…”