title: Integration of buprenorphine/naloxone treatment into HIV clinical care: lessons from the BHIVES collaborative.
abstract: BACKGROUND
  Replication of effective practices requires detailed descriptions of implementation processes, barriers and facilitators, and lessons learned. The experiences of physicians leading the Buprenorphine HIV Evaluation and Support initiative provides valuable information for other HIV providers seeking to integrate medication-assisted treatment services into HIV clinical care.
  
  
  METHODS
  Evaluation staff conduced site visits to the 10 funded Buprenorphine HIV Evaluation and Support programs to better understand buprenorphine/naloxone (bup/nx) integration practices; services offered; staffing; provider experiences with and perceptions of bup/nx; perceived barriers, facilitators, and sustainability; and recommendations regarding replication of integrated care program components. Interviews with site principal investigators conducted during the last year of program implementation were transcribed, coded, and analyzed according to both pre-identified and emerging themes.
  
  
  RESULTS
  Integrated bup/nx and HIV treatment was successfully introduced to community and hospital-based clinics under the direction of infectious disease, psychiatry, and general internal medicine physicians. All but 1 of the principal investigators interviewed were highly satisfied with integrated HIV and bup/nx treatment, and all anticipated continued provision of the service. Multiple prescribers were necessary to ensure sufficient coverage and a bup/nx coordinator (eg, nurse, counselor) was seen as essential to the provision of quality care. Ongoing challenges included multisubstance use and mental health issues among patients; limited adoption of bup/nx treatment among colleagues; and the necessity of incorporating new procedures, including urine toxicology testing into established practice.
  
  
  CONCLUSIONS
  Findings suggest that integrated bup/nx treatment and HIV care is acceptable to providers and feasible in a variety of practice settings.
authors.affiliation: The New York Academy of Medicine, Center for Evaluation and Applied Research, New York, NY 10029, USA. lweiss@nyam.org
authors.forename: Linda
authors.initials: L
authors.lastname: Weiss
authors.forename: Julie
authors.initials: J
authors.lastname: Netherland
authors.forename: James E
authors.initials: JE
authors.lastname: Egan
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Flanigan
authors.forename: David A
authors.initials: DA
authors.lastname: Fiellin
authors.forename: Ruth
authors.initials: R
authors.lastname: Finkelstein
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Altice
mesh_terms: D000553:Ambulatory Care / Q000458:organization & administration; D019380:Anti-HIV Agents / Q000627:therapeutic use; D002047:Buprenorphine / Q000627:therapeutic use*; D000069479:Buprenorphine, Naloxone Drug Combination; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D015658:HIV Infections / Q000150:complications*; D006295:Health Resources; D006301:Health Services Needs and Demand / Q000458:organization & administration; D006801:Humans; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000150:complications* / Q000188:drug therapy*; D011320:Primary Health Care / Q000458:organization & administration; D016320:Substance Abuse Treatment Centers / Q000458:organization & administration; D014481:United States
chemical_list: D019380:Anti-HIV Agents; D000069479:Buprenorphine, Naloxone Drug Combination; D009292:Narcotic Antagonists; D009270:Naloxone; D002047:Buprenorphine