title: Improving adherence to HIV quality of care indicators in persons with opioid dependence: the role of buprenorphine.
abstract: BACKGROUND
  Opioid-dependent HIV-infected patients are less likely to receive HIV quality of care indicators (QIs) compared with nondependent patients. Buprenorphine/naloxone maintenance therapy (bup/nx) could affect the quality of HIV care for opioid-dependent patients.
  
  
  METHODS
  We abstracted 16 QIs from medical records at nine HIV clinics 12 months before and after initiation of bup/nx versus other treatment for opioid dependence. Summary quality scores (number of QIs received/number eligible × 100) were calculated. We compared change in QIs and summary quality scores in patients receiving bup/nx versus other participants.
  
  
  RESULTS
  One hundred ninety-four of 268 participants (72%) received bup/nx and 74 (28%) received other treatment. Mean summary quality scores increased over 12 months for participants receiving bup/nx (45.6% to 51.6%, P < 0.001) but not other treatment (48.6% to 47.8%, P = 0.788). Bup/nx participants experienced improvements in six of 16 HIV QIs versus three of 16 QIs in other participants. Improvements were mostly in preventive and monitoring care domains. In multivariable analysis, bup/nx was associated with improved summary quality score (β 8.55; 95% confidence interval, 2.06-15.0).
  
  
  CONCLUSIONS
  In this observational cohort study, HIV-infected patients with opioid dependence received approximately half of HIV QIs at baseline. Buprenorphine treatment was associated with improvement in HIV QIs at 12 months. Integration of bup/nx into HIV clinics may increase receipt of high-quality HIV care. Further research is required to assess the effect of improved quality of HIV care on clinical outcomes.
authors.affiliation: Department of Medicine, Oregon Health and Science University, Portland, OR 97239-3098, USA. korthuis@ohsu.edu
authors.forename: P Todd
authors.initials: PT
authors.lastname: Korthuis
authors.forename: David A
authors.initials: DA
authors.lastname: Fiellin
authors.forename: Rongwei
authors.initials: R
authors.lastname: Fu
authors.forename: Paula J
authors.initials: PJ
authors.lastname: Lum
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Altice
authors.forename: Nancy
authors.initials: N
authors.lastname: Sohler
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Tozzi
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
authors.forename: Michael
authors.initials: M
authors.lastname: Botsko
authors.forename: Margaret
authors.initials: M
authors.lastname: Fishl
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Flanigan
authors.forename: Joshua
authors.initials: J
authors.lastname: Boverman
authors.forename: Dennis
authors.initials: D
authors.lastname: McCarty
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D002047:Buprenorphine / Q000627:therapeutic use*; D000069479:Buprenorphine, Naloxone Drug Combination; D015331:Cohort Studies; D005260:Female; D019983:Guideline Adherence; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care / Q000592:standards*
chemical_list: D019380:Anti-HIV Agents; D000069479:Buprenorphine, Naloxone Drug Combination; D009292:Narcotic Antagonists; D009270:Naloxone; D002047:Buprenorphine