title: Integrated opioid substitution therapy and HIV care: a qualitative systematic review and synthesis of client and provider experiences.
abstract: People who use drugs in many contexts have limited access to opioid substitution therapy and HIV care. Service integration is one strategy identified to support increased access. We reviewed and synthesized literature exploring client and provider experiences of integrated opioid substitution therapy and HIV care to identify acceptable approaches to care delivery. We systematically reviewed qualitative literature. We searched nine bibliographic databases, supplemented by manual searches of reference lists of articles from the database search, relevant journals, conferences, key organizations and consultation with experts. Thematic synthesis was used to develop descriptive themes in client and provider experiences. The search yielded 11 articles for inclusion, along with 8 expert and policy reports. We identify five descriptive themes: the convenience and comprehensive nature of co-located care, contrasting care philosophies and their role in shaping integration, the limits to disclosure and communication between clients and providers, opioid substitution therapy enabling HIV care access and engagement, and health system challenges to delivering integrated services. The discussion explores how integrated opioid substitution therapy and HIV care needs to adapt to specific social conditions, rather than following universal approaches. We identify priorities for future research. Acceptable integrated opioid substitution therapy and HIV care for people who use drugs and providers is most likely through co-located care and relies upon attention to stigma, supportive relationships and client centred cultures of delivery. Further research is needed to understand experiences of integrated care, particularly delivery in low and middle income settings and models of care focused on community and non-clinic based delivery.
authors.affiliation: a Department of Global Public Health , University of California San Diego , San Diego , USA.|b Department of Public Health and Policy , London School of Hygiene and Tropical Medicine , London , UK.
authors.forename: Andy
authors.initials: A
authors.lastname: Guise
authors.affiliation: c Centre for Research on Drugs and Health Behaviour , London School of Hygiene and Tropical Medicine , London , UK.
authors.forename: Maureen
authors.initials: M
authors.lastname: Seguin
authors.affiliation: d Program Impact Unit , International HIV/AIDS Alliance , Brighton , UK.|e Department of Health Research , University of Lancaster , Lancaster , UK.
authors.forename: Gitau
authors.initials: G
authors.lastname: Mburu
authors.affiliation: d Program Impact Unit , International HIV/AIDS Alliance , Brighton , UK.
authors.forename: Susie
authors.initials: S
authors.lastname: McLean
authors.affiliation: c Centre for Research on Drugs and Health Behaviour , London School of Hygiene and Tropical Medicine , London , UK.
authors.forename: Pippa
authors.initials: P
authors.lastname: Grenfell
authors.affiliation: f Management Sciences for Health , Dhaka , Bangladesh.
authors.forename: Zahed
authors.initials: Z
authors.lastname: Islam
authors.affiliation: g Treatment, Procurement and Supply Management Department , International HIV/AIDS Alliance Ukraine , Kyiv , Ukraine.
authors.forename: Sergii
authors.initials: S
authors.lastname: Filippovych
authors.affiliation: h Tanzanian Network of People who Use Drugs , MDM Drop in centre , Dar es Salaam , Tanzania.
authors.forename: Happy
authors.initials: H
authors.lastname: Assan
authors.affiliation: i International Center for AIDS Care and Treatment Programs , Columbia University , New York , USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Low
authors.affiliation: j School of Social and Community Medicine , University of Bristol , Bristol , UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Vickerman
authors.affiliation: c Centre for Research on Drugs and Health Behaviour , London School of Hygiene and Tropical Medicine , London , UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Rhodes
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D003695:Delivery of Health Care / Q000458:organization & administration; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control / Q000523:psychology; D006801:Humans; D058850:Opiate Substitution Treatment; D011314:Preventive Health Services / Q000458:organization & administration*; D011320:Primary Health Care / Q000379:methods*; D057545:Social Stigma; D019966:Substance-Related Disorders / Q000188:drug therapy* / Q000523:psychology
chemical_list: D044966:Anti-Retroviral Agents
keywords: ART; HIV; OST; People who inject drugs; integration