Treating Substance Abuse and Addiction in HIV Patients

A program that integrated addiction treatment into primary care for patients with, or at risk for, HIV appears to successfully engage and treat patients with substance dependence. Developed by researchers at Boston Medical Center, the program was shown to reduce substance dependence and encourage engagement in treatment.

Published in the December 2015 issue of the Journal of Substance Abuse Treatment, the study sought to address the issue of increased risk for HIV among individuals who ingest or inhale drugs such as alcohol, cocaine, and methamphetamine.

“We know that this patient population often seeks care in emergency rooms where they see physicians who may not know their medical history,” said lead author Alexander Walley, MD, attending physician in general internal medicine at BMC. “As a result, unhealthy drug and alcohol use often goes unaddressed. Our model aims to integrate evidence-based addiction treatment into primary care.”

For the study, Walley and colleagues examined 265 participants of Boston Medical Center’s Facilitated Access to Substance Abuse Treatment with Prevention and Treatment for HIV (FAST PATH) program between February 1, 2008 and March 31, 2012. As part of the program, two specialized healthcare teams at BMC addressed addiction and substance use issues. Participants were dependent on drugs or alcohol for at least 1 year and were either infected with HIV or at high risk for contracting the infection.

Participants were deemed to be at high risk by either engaging in injection drug use within the previous 30 days or displaying high-risk sexual activity, including sex with an HIV-infected partner.

At program enrollment, 61% of participants were HIV-infected, 53% reported heroin use, 46% reported alcohol use, 37% reported cocaine use, and 28% reported marijuana use in the past 30 days, 72% reported depression, 19% were homeless, and 53% had polysubstance use. As part of the FAST PATH program, primary care physicians, nurses, and addiction counselors provided multidisciplinary assessments of each participant, including assessments of depression, poly substance use, and homelessness.

Participants had access to weekly addiction counseling sessions and HIV risk-reduction and overdose-prevention counseling. Patients who were determined to be appropriate for medication-assisted treatment were eligible for a prescription for buprenorphine to combat opioid addiction.

At 6 months follow-up, substance dependence decreased to 49%, with 60% of participants having been treated with buprenorphine and 64% engaging in care (defined as two visits in the first 14 days and two additional visits in the next 30 days). Buprenorphine treatment was associated with engagement (adjusted odds ratio [AOR], 8.32), whereas self-reported depression at baseline was associated with substance dependence at 6 months (AOR, 3.30).

“Given depression's association with adverse health outcomes in this patient population, including mental health treatment in primary care holds potential to improve addiction treatment outcomes,” said Walley. “Understanding the behaviors of these patients and determining which group is more likely to engage in addiction treatment will help us target, tailor, and improve our efforts moving forward.”