Perspectives on the HIV continuum of care among adult opioid users in New York City: a qualitative study

Abstract

Background Engagement in the HIV care continuum combined with office-based opioid treatment remains a cornerstone in addressing the intertwined epidemics of opioid use disorder (OUD) and HIV/AIDS. Factors influencing patient engagement with OUD and HIV care are complex and require further study. Methods In this qualitative study, in-depth interviews were conducted among 23 adult patients who use drugs (PWUD) in an inpatient detoxification program in New York City. The semi-structured interview guide elicited participant experiences with various phases of the HIV care continuum, including factors influencing access to HIV care, interactions with HIV and primary care providers, preferences around integrated care approaches for OUD and HIV, and barriers experienced beyond clinical settings which affected access to HIV care (e.g., insurance issues, transportation, cost, retrieving prescriptions from their pharmacy). Data collection and thematic analysis took place concurrently using an iterative process-based established qualitative research method. Results Respondents elicited high acceptability for integrated or co-located care for HIV and OUD in primary care. Factors influencing engagement in HIV care included (1) access to rapid point-of-care HIV testing and counseling services, (2) insurance coverage and costs related to HIV testing and receipt of antiretroviral therapy (ART), (3) primary care providers offering HIV care and buprenorphine, (4) illicit ART sales to pharmacies, (5) disruption in supplies of ART following admissions to inpatient detoxification or residential treatment programs, (6) in-person and telephone contact with peer support networks and clinic staff, (7) stigma, and (8) access to administrative support in primary care to facilitate reengagement with care following relapse, behavioral health services, transportation vouchers, and relocation from subsidized housing exposing patients to actively using peers. Conclusion These findings suggest expanding clinical and administrative support in primary care for PWUDs with patient navigators, case managers, mobile health interventions, and peer support networks to promote linkage and retention in care.

A qualitative investigation of HIV treatment dispensing models and impacts on adherence among people living with HIV who use drugs

“…Previous epidemiological research involving PLHIV who use drugs has found DAAT models to be associated with increased viral suppression, greater adherence, and positive immunological outcomes, although the observed impact disappeared when DAAT was discontinued [7,21,22]. Past qualitative research has characterized the utility of DAAT in empowering access and adherence to ART among structurally vulnerable PLHIV who use drugs [8,23,24], and the adherence-related benefits of such highly ritualized medication routines [20]. When paired with participation in an opioid agonist therapy (e.g., methadone treatment), the benefits of DAAT have been found to be amplified [7,21,24], and the co-location of these services is thought to prompt PLHIV who use drugs to remember to take their medications, thus retaining them in care [25].…”

The Role of Technology and the Continuum of Care for Youth Suicidality: Systematic Review

“…Studies’ stages on the continuum of care were also extracted, and studies could cover more than 1 stage. The continuum of care framework used in this review was based on the literature from various health disciplines [ 25 - 27 ] and included the following stages: illness or suicide risk factor recognition, help seeking, assessment, treatment initiation, treatment module, treatment engagement, and follow-up.…”

Opioid Use Disorders in People Living with HIV/AIDS: A Review of Implications for Patient Outcomes, Drug Interactions, and Neurocognitive Disorders

“…PLWHA and OUD are more likely to encounter healthcare disparities than the general public, which remains a critical concern [ 1 , 2 ]. Geography is an important factor in determining regional barriers to public health practice, mainly due to the social and economic diversity created within specific communities across the U.S. [ 19 ].…”

“…Complications stemming from the opioid epidemic in the United States (U.S.) also led to an increased prevalence of people who inject drugs (PWID), which can further contribute to the HIV epidemic by simultaneously needing care and potentially transmitting HIV to their injecting and sex partners [ 1 , 2 ]. The true impact of OUD on PLWHA is not quantified, and additional data are needed to better assess OUD in the context of adverse effects and patient care in PLWHA.…”

“…An estimated 11.5 million Americans abuse prescription opioids [ 4 ], accounting for an estimated $78.5 billion US dollars in annual economic costs [ 5 ]. Numerous studies also described attrition along the HIV care continuum among HIV-infected drug users, including suboptimal HIV testing, delayed entry into HIV care, and initiation of antiretroviral therapy (ART) [ 1 , 2 ]. Additionally, PLWHA and OUD are also more likely to develop more severe viral progression, including neurological complications of HIV/AIDS [ 6 ], and are at risk for serious drug–drug interactions (DDI), through antiretroviral-opioid metabolic pathway-related interactions [ 7 , 8 ].…”