A multicomponent implementation strategy may increase access to medications for addiction treatment in HIV clinics, particularly those for the treatment of alcohol use disorder (AUD) and tobacco use disorder (TUD). These study findings were published in JAMA Network Open.
Between July 2016 and July 2020, researchers at Yale School of Medicine in Connecticut conducted a randomized clinical trial using a hybrid type-3 effectiveness-implementation design with a stepped wedge approach. The researchers assessed whether facilitation, defined as a multicomponent implementation strategy, increases the provision of medications for AUD, opioid use disorder (OUD), and TUD distributed across 4 HIV clinics. The intervention involved a team of 4 external facilitators who worked with each of the 4 HIV clinics to identify barriers to medication access. The primary outcome was the change in the use of medications for addiction treatment following implementation of the intervention.
A total of 3647 patients received care at an HIV clinic during the study period, of whom 121 had OUD, 126 had AUD, and 420 had TUD. Among all patients, the mean (SD) age was 49 (12) years, 61% were men, 50% were Black, 94% were prescribed antiretroviral therapy, and 11% had detectable HIV viral loads.
During the control, intervention, evaluation, and maintenance phases of the study, the percentage of eligible patients who were distributed medications for addiction treatment ranged between 27% and 29% for those with opioid use disorder, 8% and 17% for those with AUD, and 33% and 41% for those with TUD.
Distribution of medications for OUD did not differ significantly compared with baseline during the intervention (P =.55), evaluation (P =.59), and maintenance (P =.48) phases of the study.
No significant increase in the use of medications for AUD occurred during the intervention (P =.09) or evaluation (P =.11) periods of the study, but increases were observed during the maintenance phase of the study (odds ratio [OR], 2.43; 95% CI, 1.25-4.71; P =.009).
For patients with HIV infection, use of medications for TUD significantly increased during the intervention (OR, 1.40; 95% CI, 1.14-1.71; P =.001), evaluation (OR, 1.35; 95% CI, 1.09-1.66; P =.005), and maintenance (OR, 1.21; 95% CI, 1.00-1.46; P =.047) phases of the study when compared with baseline.
Among 85 clinicians and administrative staff who participated in the study and completed a baseline survey that evaluated readiness to distribute medications for addiction treatment, survey data were available for 70. Of these clinicians and administrative staff, the mean (SD) age was 58 (41) years, 73% were women, 65% were White, the mean (SD) number of years employed at their current HIV clinic was 7 (8) years, the median number of weekly clinic hours was 31 (range, 3-55), 32% held a waiver allowing buprenorphine prescribing, and 15% had previously prescribed naltrexone for OUD.
Compared with baseline, no significant differences in clinician or administrative staff readiness to provide medications for addiction treatment were observed at any point during the study.
Study limitations include potential social desirability bias due to the use of self-reported outcomes, and the researchers did not distinguish between patients who initiated vs continued use of medications for addiction treatment.
“Given the importance of these treatments to people with HIV and observed treatment gaps, robust implementation strategies are needed to reach individuals with HIV engaged in care,” the researchers concluded.
Disclosure: Multiple authors declared affiliations with industry. Please see the original reference for a full list of disclosures.
Edelman EJ, Gan G, Dziura J, et al. Effect of implementation facilitation to promote adoption of medications for addiction treatment in US HIV clinics: a randomized clinical trial. JAMA Netw Open. 2022;5(10):e2236904. doi:10.1001/jamanetworkopen.2022.36904