“They're tryin' to make me go to rehab…”: Improving care for patients with substance use disorders and HIV

Substance use is prevalent among persons living with HIV and is associated with increased HIV transmission and worse HIV outcomes. The purpose of this presentation is to review recent studies examining the overlap between the HIV and substance use epidemics and potential targets for improving the quality of substance use treatment and care in HIV treatment settings. In a cross-sectional survey of 951 HIV Research Network participants, 71% reported a history of illicit drug or hazardous alcohol use. Substance use was associated with decreased antiretroviral adherence and health-related quality of life. Only 24% of current users reported receiving substance abuse treatment and less than half reported discussing substance use issues with their HIV providers. Provider discussions of substance use issues were associated with receipt of substance use disorder treatment. In a qualitative study of 32 patients with co-existing HIV infection and opioid dependence, patients voiced a strong preference to receive buprenorphine treatment for opioid dependence at their HIV care site compared with referral to a substance use treatment center. Patients viewed HIV clinic-based buprenorphine treatment as a more patient-centered approach to care and identified strong patient-provider relationships as a key to treatment engagement and relapse prevention. The quality of HIV care will be reviewed in a national cohort of HIV-infected patients receiving office-based buprenorphine for opioid dependence. Together, these studies suggest that integrating substance use treatment services into HIV care settings offers a promising avenue for improving quality of care for patients with co-existing substance use disorders and HIV infection.