Providing Buprenorphine treatment in HIV primary care settings: Lessons from the BHIVES collaborative

Issues: Office-based treatment with buprenorphine has the potential to significantly expand treatment options for opioid dependent patients. However, physicians prescribing buprenorphine must have sufficient knowledge regarding drug dependence and treatment. Their patients should also have access to services that are not normally offered in office-based settings, including drug counseling and enhanced mental health care. Description: The US Health Resources and Services Administration (HRSA) is funding implementation and evaluation of programs in 10 US cities that integrate buprenorphine treatment into HIV clinical care settings (the BHIVES Collaborative). Data from 100 in-depth interviews conducted with providers and staff at 9 of the programs suggest that models limiting buprenorphine prescribing to specialist physicians as well as those that encourage a more generalist approach may both be effective, depending on setting (e.g. clinic volume and staffing, provider commitment to buprenorphine certification and treatment) and patient characteristics (e.g. prevalence of co-morbidities). Both approaches are significantly enhanced by the inclusion of a substance abuse counselor or nurse available to patients on an as-needed basis and able to provide comprehensive psychosocial services. Lessons Learned: Integration of buprenorphine treatment into HIV clinical settings can be accomplished with a variety approaches, however all are enhanced by additional staff that can provide drug counseling and other supportive services. Recommendations: HIV clinical settings with opioid dependent patients should consider offering buprenorphine treatment. Consideration and planning is necessary regarding physician and other staff ability to provide the range of services needed by buprenorphine patients.