Limited Integration of HIV-related Services in Buprenorphine Treatment

People with opioid use disorder (OUD) are at high risk of HIV acquisition and transmission, but HIV services are not well integrated into OUD care overall. Researchers conducted qualitative interviews of buprenorphine experts (n=21) and evaluated mailed surveys of other buprenorphine prescribers (n=1174) to explore the delivery of HIV risk assessment, education, and testing in buprenorphine treatment settings. Physicians were classified as addiction specialists (including internal medicine and psychiatry; 26%), general psychiatrists (27%), or other (e.g., internal medicine, family medicine; 51%).

• Although 62% of physicians reported that they provided HIV education, just 53% recommended HIV testing for all new patients and only 32% offered on-site testing.
• Qualitative interviews revealed that physicians may overvalue the presence or absence of injection use in determining HIV risk. This was supported by survey results showing that physicians were more likely to ask about frequency of injection (92%) than syringe sharing (83%), sharing of other injection equipment (53%), condomless sex (49%), or number of sexual partners (48%).
• Interviews revealed the perception that HIV services fall outside the scope of general psychiatry. Surveyed psychiatrists were less likely to recommend HIV testing to all new patients or to offer HIV testing on-site.
• Addiction specialists were more likely to report that they provided HIV education and to recommend testing to all new patients, but they were less likely to offer HIV testing on-site.

Comments: The integration of HIV services in buprenorphine treatment remains inadequate across care settings. This study identifies several physician characteristics associated with low HIV services implementation that can guide interventions to improve HIV care delivery. Future work should assess for differences between addiction medicine and addiction psychiatry specialists, who were grouped together in these analyses.

Jessica L. Taylor, MD

Reference: Knudsen HK, Cook J, Lofwall MR, et al. A mixed methods study of HIV-related services in buprenorphine treatment. Subst Abuse Treat Prev Policy. 2017;12:37.