The Health Resources and Services Administration (HRSA) Ryan White HIV/AIDS Program’s Response to the Opioid Epidemic

Abstract

Background The United States is in the midst of an unprecedented opioid crisis with increasing injection drug use (IDU)-related human immunodeficiency virus (HIV) outbreaks, particularly in rural areas. The Health Resources and Services Administration (HRSA)’s Ryan White HIV/AIDS Program (RWHAP) is well positioned to integrate treatment for IDU-associated HIV infections with treatment for drug use disorders. These activities will be crucial for the “Ending the HIV Epidemic: A Plan for America” (EHE) initiative, in which 7 southern states were identified with rural HIV epidemics. Methods The RWHAP Services Report data were used to assess the IDU population and substance use services utilization among RWHAP clients in 2017, nationally and in the 7 EHE-identified states. THe HRSA held a 1-day Technical Expert Panel (TEP) to explore how RWHAP can best respond to the growing opioid crisis. Results During the TEP, 8 key themes emerged and 11 best practices were identified to address opioid use disorder (OUD) among people with HIV. In 2017, among RWHAP clients with reported age and transmission category, 6.7% (31 683) had HIV attributed to IDU; among IDU clients, 6.3% (1988) accessed substance use services. Conclusions The TEP results and RWHAP data were used to develop implementation science projects that focus on addressing OUD and integrating behavioral health in primary care. These activities are critical to ending the HIV epidemic.

Coordinating Systems of Care for HIV and Opioid Use Disorder: A Systematic Review of Enablers and Barriers to Integrated Service Access, and Systems and Tools Required for Implementation

“…Providers who were trained to help clients overcome barriers to entering care and who demonstrated empathy were also cited as enablers of initiating and maintaining service engagement ( Saberi et al, 2020 ). Training RWHAP providers to prescribe buprenorphine was also noted as an important opportunity to increase integrated service access ( Chavis et al, 2020 ).…”

“…Older age, patient familiarity with staff, and experience accessing services within a facility increased client access to and retention in services. Stable housing and abstinence from drug use also increased HIV and OUD service access ( Bachhuber et al, 2018 ; Chavis et al, 2020 ; Irvine et al, 2017 ; Riggins et al, 2017 ; Saag et al, 2018 ).…”

“…A lack of cultural competencies in working with individuals who are LGBTIQ+ (lesbian, gay, bisexual, transgender, intersex, and questioning) reduced likelihood of client’s accessing services. Anticipated stigma from providers and providers who were perceived as having inadequate HIV and/or OUD services training further hindered client care engagement ( Arnold et al, 2018 ; Chavis et al, 2020 ; Knudsen et al, 2017 ; Saberi et al, 2020 ).…”

“…Appraisal of the studies with quantitative method ( Table 3 ) components demonstrated that one received a strong quality rating; seven a moderate quality rating; and 10 a weak quality rating. Weak components included selection bias ( Knudsen et al, 2017 ; Shrestha et al, 2018 ), research design ( Bachhuber et al, 2018 ; Chavis et al, 2020 ; Cohn et al, 2016 ; Jessop et al, 2017 ; Knudsen et al, 2017 ; Saag et al, 2018 ; Saberi et al, 2020 ; Shrestha & Copenhaver, 2018 ; Simeone et al, 2017 ; Tofighi et al, 2019 ), confounders ( Bachhuber et al, 2018 ; Barocas et al, 2019 ; Korthius et al, 2017 ; Shrestha & Copenhaver, 2018 ; Tofighi et al, 2019 ), blinding ( Aggarwal et al, 2019 ; Barocas et al, 2019 ; Chavis et al, 2020 ; Cohn et al, 2016 ; Jessop et al, 2017 ; Knudsen et al, 2017 ; Korthius et al, 2017 ; Saberi et al, 2020 ), data collection ( Chavis et al, 2020 ; Cohn et al, 2016 ; Jessop et al, 2017 ; Knudsen et al, 2017 ; Korthius et al, 2017 ; Riggins et al, 2017 ; Saberi et al, 2020 ; Tofighi et al, 2019 ), and dropouts ( Gardner et al, 2016 ; Irvine et al, 2017 ). Appraisal of the studies with qualitative method ( Table 4 ) components demonstrated that all three qualitative studies’ results were valid ( Arnold et al, 2018 ; Oldfield et al, 2019a ; ...…”

Access to Medications for Opioid Use Disorder for Persons With Human Immunodeficiency Virus in the United States: Gaps in Coverage by State AIDS Drug Assistance Programs

“…RWHAP also provides critical support for underinsured PWH: 38% and 62% of PWH with private insurance and Medicare, respectively [ 5 ]. In 2020, RWHAP identified strategies to address OUD among PWH including the provision of MOUD and naloxone for overdose reversal within RWHAP-funded programs [ 6 ]. However, MOUD access for RWHAP clients is not guaranteed.…”