title: Integrating substance abuse treatment into HIV care: missed opportunities in the AIDS Drug Assistance Program.
abstract: BACKGROUND
  Untreated substance use disorders (SUD) among HIV patients contribute to worse HIV care outcomes and increased HIV transmission. Although there are clinical and policy recommendations for integrated SUD and HIV treatment, payment issues including complex funding streams are a barrier.
  
  
  OBJECTIVE
  We assessed the availability of guideline-concordant medication-assisted therapies to treat alcohol, tobacco, and opioid dependence on state-administered AIDS Drug Assistance Programs (ADAPs), an important source of drug coverage for low-income HIV patients. We examined which medication-assisted therapies are most likely to be included on formularies and variation of these therapies across states.
  
  
  METHODS
  We reviewed state-specific ADAP formularies from 1997 to 2009 for the presence of guideline-concordant medication-assisted therapies to treat alcohol, tobacco, and opioid dependence.
  
  
  RESULTS
  The most frequently included medication-assisted therapies were those to treat tobacco dependence, followed by opioid dependence. Few states covered alcohol dependence medications. In each year, <10% of states covered all recommended medications and <50% covered a partial formulary for at least 1 SUD.
  
  
  CONCLUSIONS
  ADAPs could provide access to medication-assisted therapies for SUD for a significant number of HIV patients, but these medications have not been widely covered throughout the program's history. Increased availability of medication-assisted therapies through ADAP could facilitate integrated HIV and SUD care.
authors.affiliation: *Rockefeller College of Public Affairs & Policy and †Nelson A. Rockefeller Institute of Government, University at Albany-State University of New York, Albany, NY ‡Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.
authors.forename: Erika G
authors.initials: EG
authors.lastname: Martin
authors.forename: Karen H
authors.initials: KH
authors.lastname: Wang
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D019966:Substance-Related Disorders / Q000150:complications / Q000534:rehabilitation*
chemical_list: D019380:Anti-HIV Agents