title: Engagement and Substance Dependence in a Primary Care-Based Addiction Treatment Program for People Infected with HIV and People at High-Risk for HIV Infection.
abstract: To improve outcomes for people with substance dependence and HIV infection or at risk for HIV infection, patients were enrolled in a primary care-based addiction treatment program from 2008-2012 that included a comprehensive substance use assessment, individual and group counseling, addiction pharmacotherapy and case management. We examined whether predisposing characteristics (depression, housing status, polysubstance use) and an enabling resource (buprenorphine treatment) were associated with engagement in the program and persistent substance dependence at 6 months. At program enrollment 61% were HIV-infected, 53% reported heroin use, 46% reported alcohol use, 37% reported cocaine use, and 28% reported marijuana use in the past 30 days, 72% reported depression, 19% were homeless, and 53% had polysubstance use. Within 6-months 60% had been treated with buprenorphine. Engagement (defined as 2 visits in first 14 days and 2 additional visits in next 30 days) occurred in 64%; 49% had substance dependence at 6-months. Receipt of buprenorphine treatment was associated with engagement (Adjusted Odds Ratio (AOR) 8.32 95% CI: 4.13-16.77). Self-reported depression at baseline was associated with substance dependence at 6-months (AOR 3.30 95% CI: 1.65-6.61). Neither housing status nor polysubstance use was associated with engagement or substance dependence. The FAST PATH program successfully engaged and treated patients in a primary care-based addiction treatment program. Buprenorphine, a partial opioid agonist, was a major driver of addiction treatment engagement. Given depression's association with adverse outcomes in this clinical population, including mental health treatment as part of integrated care holds potential to improve addiction treatment outcomes.
authors: Boston Medical Center, General Internal Medicine; Boston University School of Medicine, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States. Electronic address: awalley@bu.edu.
authors: Alexander Y
authors: AY
authors: Walley
authors: Boston University School of Public Health, Data Coordinating Center, 801 Massachusetts Avenue, Third Floor, Boston, MA 02118 United States.
authors: Joseph
authors: J
authors: Palmisano
authors: Boston University School of Medicine, Geriatrics Section, Boston, MA 02118 United States.
authors: Amy
authors: A
authors: Sorensen-Alawad
authors: Boston University School of Public Health, Data Coordinating Center, 801 Massachusetts Avenue, Third Floor, Boston, MA 02118 United States.
authors: Christine
authors: C
authors: Chaisson
authors: University of California, San Diego, La Jolla, CA United States.
authors: Anita
authors: A
authors: Raj
authors: Boston Medical Center, General Internal Medicine; Boston University School of Medicine, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States.
authors: Jeffrey H
authors: JH
authors: Samet
authors: Boston University School of Public Health, Department of Health Policy and Management, 715 Albany Street T3W, Boston, MA 02118 United States; Boston University School of Medicine, Infectious Diseases Section, Boston, MA 02118 United States; Center for Healthcare Organization and Implementation Research, ENRM VA Hospital, Bedford, MA 01730, United States.
authors: Mari-Lynn
authors: ML
authors: Drainoni
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000494:pharmacology*; D002047:Buprenorphine / Q000008:administration & dosage / Q000494:pharmacology*; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000453:epidemiology; D006703:Ill-Housed Persons / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D058850:Opiate Substitution Treatment / Q000379:methods*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods*; D012306:Risk; D019966:Substance-Related Disorders / Q000188:drug therapy / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D002047:Buprenorphine
keywords: Buprenorphine; Depression; HIV; Integrated treatment; Primary care