title: Adaptations across clinical sites of an integrated treatment model for persons with HIV and substance abuse.
abstract: Substance use disorders are common among people living with HIV (PLWHA), and PLWHA with untreated substance use are less likely to receive antiretroviral therapy (ART) or achieve viral suppression when ART is prescribed. Integrated behavioral and medical interventions are one approach used to treat complex chronic illnesses, including HIV and substance abuse (SA). As the potential benefit for integrated HIV-substance abuse treatment is recognized, the number of providers attempting to integrate care is growing. Integrated care models can range from coordinated to colocated to fully integrated models. Providers need a better understanding of these implementation options for HIV-substance abuse treatment and how they impact providers of different disciplines. Between April and November 2006, interviews exploring the process of implementing an integrated HIV-substance abuse intervention were completed with clinic staff at three diverse HIV clinics in North Carolina. Key differences in implementation between sites were found. The degree of integrated care between sites ranged from colocated to integrated, and clinic staff perceived each integrated model to have advantages and disadvantages. Recommendations for implementing HIV-SA integrated care are made.
authors.affiliation: Center for Health Policy, Global Health Institute, Duke University, Durham, North Carolina 27708, USA. frank.lombard@duke.edu
authors.forename: Frank
authors.initials: F
authors.lastname: Lombard
authors.forename: Rae Jean
authors.initials: RJ
authors.lastname: Proescholdbell
authors.forename: Katherine
authors.initials: K
authors.lastname: Cooper
authors.forename: Laura
authors.initials: L
authors.lastname: Musselwhite
authors.forename: Evelyn Byrd
authors.initials: EB
authors.lastname: Quinlivan
mesh_terms: D000554:Ambulatory Care Facilities / Q000458:organization & administration; D019380:Anti-HIV Agents / Q000627:therapeutic use; D019033:Delivery of Health Care, Integrated / Q000379:methods / Q000458:organization & administration; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control / Q000628:therapy; D006282:Health Personnel; D006287:Health Planning Guidelines; D006801:Humans; D007407:Interviews as Topic; D009657:North Carolina; D016730:Program Development; D019966:Substance-Related Disorders / Q000188:drug therapy / Q000628:therapy; D000078329:Workforce
chemical_list: D019380:Anti-HIV Agents