<i class="fa fa-heartbeat"> </i> Buprenorphine

Integrating Buprenorphine Treatment for Opioid Use Disorder in HIV Primary Care

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This intervention has been informed and adapted from the best practice findings of a past SPNS initiative. It is currently being implemented and evaluated across each of the 4 interventions developed, at a total of 12 funded sites. Based on the findings of this current implementation, a final evidence-informed toolkit will be designed and available at the end of 2021. Contact information provided is required in order to download these materials for review and/or implementation; however, all information is protected and any follow-up will be limited to collecting information on your impressions and experiences related to the materials and any implementation you may have done of the interventions covered therein.

Intervention Summary

HIV Continuum of Care: Retention of Care

The intersection of opioid use, particularly via injecting, and HIV is well documented.1 In the United States, contracting HIV through injection drug use, either directly or via sexual contact with a person who injects drugs, accounts for more than one-third of estimated AIDS cases since the beginning of the epidemic, and 9% of estimated new infections. Untreated opioid use disorder is problematic, particularly as injecting behavior is associated with increased risk of HIV transmission, as it interferes with antiretroviral treatment adherence2,3,4,5,6,7,8,9 and impedes HIV viral suppression.10,11,12,13 The devastating outbreak of more than 180 HIV infections diagnosed in 2015 among persons injecting oxymorphone in rural southeastern Indiana is an example of the way in which injection drug use can be the primary driver of localized epidemics.14

In recent years, dramatic increases in opioid-related fatal overdoses and acute hepatitis C infections15,16 underscore the urgent need to identify and treat opioid use disorder in both persons living with HIV (PLWH) and people at risk of HIV infection. In January 2016, the CDC reported that since 2000, there’s been a 200% increase in the rate of overdose deaths involving opioids.17

Professional Literature

There are four broad classes of opioids: endogenous opioids that are naturally produced in the body (endorphins); opium alkaloids (e.g. morphine, codeine), semi-synthetic opioids (e.g., heroin, oxycodone, buprenorphine); and fully synthetic opioids (e.g. methadone, fentanyl). Opioids are commonly prescribed for the relief of acute and chronic pain, administered as agonist pharmacotherapy for the effective treatment of moderate-to-severe opioid use disorders, and taken by persons for non-medical reasons to feel good or to feel better.

Theoretical Basis

A behavioral change theory is a combination of, "interrelated concepts, definitions, and propositions that present a systematic view of events or situations by specifying relations among variables, in order to explain or predict the events or situations."61 By grounding an intervention in theory, the component parts are intentionally sequenced to build off of one another to facilitate a change in health behavior.

Intervention Components and Activities

The Integrating Buprenorphine Treatment for Opioid Use Disorder in HIV Primary Care intervention operates at two levels by providing individual level treatment to the patient and creating systems level change within the clinic.

Staffing Requirements

The following staff positions need to be developed and filled in order to successfully implement the intervention.

Programmatic Requirements

The following are programmatic requirements that need to be addressed prior to implementation in order to facilitate a successful implementation:

Costs

During a cross-site evaluation, the median monthly cost of integrating HIV care and co-formulated buprenorphine/naloxone (bup/nx) in 2011 was $136 per patient for labor and overhead and $8 per patient for toxicology analyses.70 "This represent[ed] an incremental cost to the clinic of about $22 per month compared with treating HIV-infected patients with an opioid dependence who were not assigned to integrated care. In integrated care, however, there are fewer encounters with physicians and more encounters with non-physician providers, whose services are less expensive, but also less likely to be billable to third party payers."71

Resources

References

The following source documents were cited in the Intervention document: