Background: Opioid use disorder (OUD) is a major risk factor in the acquisition and transmission of HIV. Clinical practice guidelines call for the integration of HIV services in OUD treatment. This mixed methods study describes the integration of HIV services in buprenorphine treatment and examines whether HIV services vary by prescribers’ medical specialty and across practice settings.
Methods: Data were obtained via qualitative interviews with buprenorphine experts (n = 21) and mailed surveys from US buprenorphine prescribers (n = 1174). Survey measures asked about screening for HIV risk behaviors at intake, offering HIV education, recommending all new patients receive HIV testing, and availability of on-site HIV testing. Prescribers’ medical specialty, practice settings, caseload demographics, and physician demographics were measured. Multivariate models of HIV services were estimated, while accounting for the nesting of physicians within states.
Results: Qualitative interviews revealed that physicians often use injection behaviors as the primary indicator for whether a patient should be tested for HIV. Interviews revealed that HIV-related services were often viewed as beyond the scope of practice among general psychiatrists. Surveys indicated that prescribers screened for an average of 3.2 of 5 HIV risk behaviors (SD = 1.6) at intake. About 62.0% of prescribers delivered HIV education to patients and 53.2% recommended HIV testing to all new patients, but only 32.3% offered on-site HIV testing. Addiction specialists and psychiatrists screened for significantly more HIV risk behaviors than physicians in other specialties. Addiction specialists and psychiatrists were significantly less likely than other physicians to offer on-site testing. Physicians in individual medical practice were significantly less likely to recommend HIV testing and to offer onsite testing than physicians in other settings.
Conclusions: Buprenorphine treatment providers have not uniformly integrated HIV-related screening, education, and testing services for patients. Differences by medical specialty and practice setting suggest an opportunity for targeting efforts to increase implementation.
Digital Object Identifier (DOI)
This study was supported by funding from the National Institute on Drug Abuse (NIDA Grant R33DA035641), an institute within the National Institutes of Health (NIH). NIDA had no further role in study design; in data collection, analysis, or interpretation; or in manuscript preparation. The study team’s use of REDCap was supported by a grant from NIH’s National Center for Advancing Translational Sciences (NIH CTSA UL1TR000117).
Due to the need to protect the identities of individuals who participated in our qualitative interviews, raw data from these interviews is not appropriate for online open access because these individuals did not consent to this form of data-sharing. De-identified survey data used in this study may be made available on request.
Knudsen, Hannah K.; Cook, Jennifer; Lofwall, Michelle R.; Walsh, Sharon L.; Studts, Jamie L.; and Havens, Jennifer R., "A Mixed Methods Study of HIV-Related Services in Buprenorphine Treatment" (2017). Behavioral Science Faculty Publications. 25.