The Prevalence and Negative Impacts of Substance Use Disorders among People with HIV in the United States: A Real-Time Delphi Survey of Key Stakeholders

Abstract

Although HIV and substance use disorders (SUDs) constitute a health syndemic, no research to date has examined the perceived negative impacts of different SUDs for people with HIV (PWH). In May 2019, 643 stakeholders in the U.S., representing clients of AIDS service organizations (ASOs), ASO staff, and HIV/AIDS Planning Council members, participated in an innovative Stakeholder-Engaged Real-Time Delphi (SE-RTD) survey focused on the prevalence and individual-level negative impact of five SUDs for PWH. The SE-RTD method has advantages over conventional survey methods by efficiently sharing information, thereby reducing the likelihood that between-group differences are simply due to lack of information, knowledge, and/or understanding. The population-level negative impacts were calculated by weighting each SUD’s individual-level negative impact on indicators of the HIV Care Continuum and other important areas of life by the perceived prevalence of each SUD. Overall, we found these SUDs to have the greatest population-level negative impact scores (possible range 0–24): alcohol use disorder (population-level negative impact = 6.9; perceived prevalence = 41.9%), methamphetamine use disorder (population-level negative impact = 6.5; perceived prevalence = 3.2%), and opioid use disorder (population-level negative impact = 6.4; perceived prevalence = 34.6%). Beyond further demonstration of the need to better integrate SUD services within HIV settings, our findings may help inform how finite funding is allocated for addressing the HIV-SUD syndemic within the U.S. Based on our findings, such future efforts should prioritize the integration of evidence-based treatments that help address use disorders for alcohol, methamphetamine, and opioids.

Interventions for Integrating Behavioral Health Services Into HIV Clinical Care: A Narrative Review

“…Several gaps in the research remain. First, none of the studies directly addressed methamphetamine addiction, which is nearly as prevalent as OUD among people with HIV and has large adverse effects on HIV-related health outcomes [ 70 ]. Second, most interventions separated mental health from substance use screening and intervention.…”

From innovative applications of the effectiveness-implementation hybrid trial design to the dissemination, implementation, effectiveness, sustainment, economics, and level-of-scaling hybrid trial design

“…In response to Curran et al ( 1) "hope to stimulate further thinking and to encourage new design combinations" and the current call for proposed advancements to the effectiveness-implementation HTD, this article also codifies the DIeSEL HTD as a novel HTD with potential to further improve the speed and efficiency of translation, especially during T3 (clinical implementation), but perhaps also as part of T4 (public health) translational research. The DIeSEL HTD was codified for use as part of the NIDA-funded Substance Treatment Strategies for HIV (STS4HIV) Project, which since being funded in 2018 has completed three stakeholder-engaged real-time Delphi (SE-RTD) surveys to empirically identify the substance use disorders with the most negative population-level impact (24), the best fitting evidence-based interventions for integration into HIV service settings (25), and the best fitting strategies for the AIDS Education and Training Centers (AETC) purveyor network to use in helping improve the integration of evidence-based substance use disorder interventions within HIV service settings (26). Organized by aim, below is an overview of the this HTD, which as Figure 1 helps visualize, is essentially a dissemination trial combined with a Type 3 effectiveness-implementation hybrid trial expanded to also combine elements of sustainment research, economic research, and scaling research.…”

The implementation & sustainment facilitation (ISF) strategy: Cost and cost-effectiveness results from a 39-site cluster randomized trial integrating substance use services in community-based HIV service organizations

“…Because substance use and substance use disorders among people with HIV are both prevalent and problematic, improving the integration of substance use treatment within HIV service settings is urgently needed (Azar et al, 2010;Garner et al, 2022;Hartzler et al, 2017;Weaver et al, 2009). Motivational interviewing-based brief interventions (MIBIs) have a strong evidence base for reducing alcohol use in multiple settings and are costeffective (Jonas et al, 2012;Kaner et al, 2018).…”