title: A cross-site, comparative effectiveness study of an integrated HIV and substance use treatment program.
abstract: Co-occurrence of HIV and substance abuse is associated with poor outcomes for HIV-related health and substance use. Integration of substance use and medical care holds promise for HIV patients, yet few integrated treatment models have been reported. Most of the reported models lack data on treatment outcomes in diverse settings. This study examined the substance use outcomes of an integrated treatment model for patients with both HIV and substance use at three different clinics. Sites differed by type and degree of integration, with one integrated academic medical center, one co-located academic medical center, and one co-located community health center. Participants (n=286) received integrated substance use and HIV treatment for 12 months and were interviewed at 6-month intervals. We used linear generalized estimating equation regression analysis to examine changes in Addiction Severity Index (ASI) alcohol and drug severity scores. To test whether our treatment was differentially effective across sites, we compared a full model including site by time point interaction terms to a reduced model including only site fixed effects. Alcohol severity scores decreased significantly at 6 and 12 months. Drug severity scores decreased significantly at 12 months. Once baseline severity variation was incorporated into the model, there was no evidence of variation in alcohol or drug score changes by site. Substance use outcomes did not differ by age, gender, income, or race. This integrated treatment model offers an option for treating diverse patients with HIV and substance use in a variety of clinic settings. Studies with control groups are needed to confirm these findings.
authors.affiliation: Center for Health Policy, Global Health Institute, Duke University, Durham, North Carolina 27708, USA. Rae.Jean@duke.edu
authors.forename: Rae Jean
authors.initials: RJ
authors.lastname: Proeschold-Bell
authors.forename: Amy
authors.initials: A
authors.lastname: Heine
authors.forename: Brian Wells
authors.initials: BW
authors.lastname: Pence
authors.forename: Keith
authors.initials: K
authors.lastname: McAdam
authors.forename: Evelyn Byrd
authors.initials: EB
authors.lastname: Quinlivan
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D003151:Community Health Centers; D019033:Delivery of Health Care, Integrated / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000628:therapy; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult