Readiness to Provide Medications for Addiction Treatment in HIV Clinics: A Multisite Mixed-Methods Formative Evaluation
We sought to characterize readiness, barriers to, and facilitators of providing medications for addiction treatment (MAT) in HIV clinics. Four HIV clinics in the northeastern United States. Mixed-methods formative evaluation conducted June 2017-February 2019. Surveys assessed readiness [visual analo...
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| Veröffentlicht in: | Journal of acquired immune deficiency syndromes (1999) 2021-07, Vol.87 (3), p.959-970 |
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| container_title | Journal of acquired immune deficiency syndromes (1999) |
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| creator | Edelman, E. Jennifer Gan, Geliang Dziura, James Esserman, Denise Morford, Kenneth L. Porter, Elizabeth Chan, Philip A. Cornman, Deborah H. Oldfield, Benjamin J. Yager, Jessica E. Muvvala, Srinivas B. Fiellin, David A. |
| description | We sought to characterize readiness, barriers to, and facilitators of providing medications for addiction treatment (MAT) in HIV clinics.
Four HIV clinics in the northeastern United States.
Mixed-methods formative evaluation conducted June 2017-February 2019. Surveys assessed readiness [visual analog scale, less ready (0- 0.05). Most favored integrating MAT into HIV care but preferred models differed across substances. Barriers to MAT included identification of treatment-eligible patients, variable experiences with MAT and perceived medication complexity, perceived need for robust behavioral services, and inconsistent availability of on-site specialists. Facilitators included knowledge of adverse health consequences of opioid and tobacco use, local champions, focus on quality improvement, and multidisciplinary teamwork.
Efforts to implement MAT in HIV clinics should address both gaps in perspectives regarding the evidence for MAT and contextual factors and may require substance-specific models. |
| doi_str_mv | 10.1097/QAI.0000000000002666 |
| format | Article |
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Four HIV clinics in the northeastern United States.
Mixed-methods formative evaluation conducted June 2017-February 2019. Surveys assessed readiness [visual analog scale, less ready (0-<7) vs. more ready (≥7-10)]; evidence and context ratings for MAT provision; and preferred addiction treatment model. A subset (n = 37) participated in focus groups.
Among 71 survey respondents (48% prescribers), the proportion more ready to provide addiction treatment medications varied across substances [tobacco (76%), opioid (61%), and alcohol (49%) treatment medications (P values < 0.05)]. Evidence subscale scores were higher for those more ready to provide tobacco [median (interquartile range) = 4.0 (4.0, 5.0) vs. 4.0 (3.0, 4.0), P = 0.008] treatment medications, but not significantly different for opioid [5.0 (4.0, 5.0) vs. 4.0 (4.0, 5.0), P = 0.11] and alcohol [4.0 (3.0, 5.0) vs. 4.0 (3.0, 4.0), P = 0.42] treatment medications. Median context subscale scores ranged from 3.3 to 4.0 and generally did not vary by readiness status (P values > 0.05). Most favored integrating MAT into HIV care but preferred models differed across substances. Barriers to MAT included identification of treatment-eligible patients, variable experiences with MAT and perceived medication complexity, perceived need for robust behavioral services, and inconsistent availability of on-site specialists. Facilitators included knowledge of adverse health consequences of opioid and tobacco use, local champions, focus on quality improvement, and multidisciplinary teamwork.
Efforts to implement MAT in HIV clinics should address both gaps in perspectives regarding the evidence for MAT and contextual factors and may require substance-specific models.</description><identifier>ISSN: 1525-4135</identifier><identifier>EISSN: 1944-7884</identifier><identifier>DOI: 10.1097/QAI.0000000000002666</identifier><identifier>PMID: 33675619</identifier><language>eng</language><publisher>United States: JAIDS Journal of Acquired Immune Deficiency Syndromes</publisher><subject>Addictions ; Alcoholism ; Context ; Drug abuse ; Evaluation ; Formative evaluation ; Health Services Accessibility ; HIV ; HIV Infections - complications ; HIV Infections - therapy ; HIV-1 ; Human immunodeficiency virus ; Humans ; Mixed methods research ; Narcotics ; Opioid-Related Disorders - drug therapy ; Opioids ; Quality control ; Substance abuse treatment ; Substance-Related Disorders - drug therapy ; Surveys ; Tobacco ; Tobacco Use Cessation</subject><ispartof>Journal of acquired immune deficiency syndromes (1999), 2021-07, Vol.87 (3), p.959-970</ispartof><rights>JAIDS Journal of Acquired Immune Deficiency Syndromes</rights><rights>Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4263-88c181b2c74340c65beb3e3543d9047608cd2b4ee0e58cfd3b0d6eb5aa1b56973</citedby><cites>FETCH-LOGICAL-c4263-88c181b2c74340c65beb3e3543d9047608cd2b4ee0e58cfd3b0d6eb5aa1b56973</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttp://ovidsp.ovid.com/ovidweb.cgi?T=JS&NEWS=n&CSC=Y&PAGE=fulltext&D=ovft&AN=00126334-202107010-00013$$EHTML$$P50$$Gwolterskluwer$$H</linktohtml><link.rule.ids>314,776,780,4595,27901,27902,65206</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33675619$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Edelman, E. Jennifer</creatorcontrib><creatorcontrib>Gan, Geliang</creatorcontrib><creatorcontrib>Dziura, James</creatorcontrib><creatorcontrib>Esserman, Denise</creatorcontrib><creatorcontrib>Morford, Kenneth L.</creatorcontrib><creatorcontrib>Porter, Elizabeth</creatorcontrib><creatorcontrib>Chan, Philip A.</creatorcontrib><creatorcontrib>Cornman, Deborah H.</creatorcontrib><creatorcontrib>Oldfield, Benjamin J.</creatorcontrib><creatorcontrib>Yager, Jessica E.</creatorcontrib><creatorcontrib>Muvvala, Srinivas B.</creatorcontrib><creatorcontrib>Fiellin, David A.</creatorcontrib><title>Readiness to Provide Medications for Addiction Treatment in HIV Clinics: A Multisite Mixed-Methods Formative Evaluation</title><title>Journal of acquired immune deficiency syndromes (1999)</title><addtitle>J Acquir Immune Defic Syndr</addtitle><description>We sought to characterize readiness, barriers to, and facilitators of providing medications for addiction treatment (MAT) in HIV clinics.
Four HIV clinics in the northeastern United States.
Mixed-methods formative evaluation conducted June 2017-February 2019. Surveys assessed readiness [visual analog scale, less ready (0-<7) vs. more ready (≥7-10)]; evidence and context ratings for MAT provision; and preferred addiction treatment model. A subset (n = 37) participated in focus groups.
Among 71 survey respondents (48% prescribers), the proportion more ready to provide addiction treatment medications varied across substances [tobacco (76%), opioid (61%), and alcohol (49%) treatment medications (P values < 0.05)]. Evidence subscale scores were higher for those more ready to provide tobacco [median (interquartile range) = 4.0 (4.0, 5.0) vs. 4.0 (3.0, 4.0), P = 0.008] treatment medications, but not significantly different for opioid [5.0 (4.0, 5.0) vs. 4.0 (4.0, 5.0), P = 0.11] and alcohol [4.0 (3.0, 5.0) vs. 4.0 (3.0, 4.0), P = 0.42] treatment medications. Median context subscale scores ranged from 3.3 to 4.0 and generally did not vary by readiness status (P values > 0.05). Most favored integrating MAT into HIV care but preferred models differed across substances. Barriers to MAT included identification of treatment-eligible patients, variable experiences with MAT and perceived medication complexity, perceived need for robust behavioral services, and inconsistent availability of on-site specialists. Facilitators included knowledge of adverse health consequences of opioid and tobacco use, local champions, focus on quality improvement, and multidisciplinary teamwork.
Efforts to implement MAT in HIV clinics should address both gaps in perspectives regarding the evidence for MAT and contextual factors and may require substance-specific models.</description><subject>Addictions</subject><subject>Alcoholism</subject><subject>Context</subject><subject>Drug abuse</subject><subject>Evaluation</subject><subject>Formative evaluation</subject><subject>Health Services Accessibility</subject><subject>HIV</subject><subject>HIV Infections - complications</subject><subject>HIV Infections - therapy</subject><subject>HIV-1</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Mixed methods research</subject><subject>Narcotics</subject><subject>Opioid-Related Disorders - drug therapy</subject><subject>Opioids</subject><subject>Quality control</subject><subject>Substance abuse treatment</subject><subject>Substance-Related Disorders - drug therapy</subject><subject>Surveys</subject><subject>Tobacco</subject><subject>Tobacco Use Cessation</subject><issn>1525-4135</issn><issn>1944-7884</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkFtLAzEQhYMo3v-BSMDn1WRz2V3fSqlasHhBfV2yyZRGtxtNsq3-e1PvOC8zA-d8wxyEDig5pqQqTm4G42Pyp3Ip5RraphXnWVGWfD3NIhcZp0xsoZ0QHgmhkvNqE20xJgshabWNlregjO0gBBwdvvZuYQ3gCRirVbSuC3jqPB6YtK9WfOdBxTl0EdsOX4wf8LC1ndXhFA_wpG-jDTYmv30Fk00gzpwJ-Mz5eYItAI8Wqu0_uHtoY6raAPtffRfdn43uhhfZ5dX5eDi4zDTPJcvKUtOSNrkuOONES9FAw4AJzkxFeCFJqU3ecAACotRTwxpiJDRCKdoIWRVsFx19cp-9e-khxPrR9b5LJ-tcFpKyVZZJxT9V2rsQPEzrZ2_nyr_VlNQrRZ3Srv-nnWyHX_C-mYP5MX3H-8tdujaCD09tvwRfz0C1cZZ4NP3IeJaTnJKCUJIlMmXsHQ-qiik</recordid><startdate>20210701</startdate><enddate>20210701</enddate><creator>Edelman, E. 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Jennifer</au><au>Gan, Geliang</au><au>Dziura, James</au><au>Esserman, Denise</au><au>Morford, Kenneth L.</au><au>Porter, Elizabeth</au><au>Chan, Philip A.</au><au>Cornman, Deborah H.</au><au>Oldfield, Benjamin J.</au><au>Yager, Jessica E.</au><au>Muvvala, Srinivas B.</au><au>Fiellin, David A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Readiness to Provide Medications for Addiction Treatment in HIV Clinics: A Multisite Mixed-Methods Formative Evaluation</atitle><jtitle>Journal of acquired immune deficiency syndromes (1999)</jtitle><addtitle>J Acquir Immune Defic Syndr</addtitle><date>2021-07-01</date><risdate>2021</risdate><volume>87</volume><issue>3</issue><spage>959</spage><epage>970</epage><pages>959-970</pages><issn>1525-4135</issn><eissn>1944-7884</eissn><abstract>We sought to characterize readiness, barriers to, and facilitators of providing medications for addiction treatment (MAT) in HIV clinics.
Four HIV clinics in the northeastern United States.
Mixed-methods formative evaluation conducted June 2017-February 2019. Surveys assessed readiness [visual analog scale, less ready (0-<7) vs. more ready (≥7-10)]; evidence and context ratings for MAT provision; and preferred addiction treatment model. A subset (n = 37) participated in focus groups.
Among 71 survey respondents (48% prescribers), the proportion more ready to provide addiction treatment medications varied across substances [tobacco (76%), opioid (61%), and alcohol (49%) treatment medications (P values < 0.05)]. Evidence subscale scores were higher for those more ready to provide tobacco [median (interquartile range) = 4.0 (4.0, 5.0) vs. 4.0 (3.0, 4.0), P = 0.008] treatment medications, but not significantly different for opioid [5.0 (4.0, 5.0) vs. 4.0 (4.0, 5.0), P = 0.11] and alcohol [4.0 (3.0, 5.0) vs. 4.0 (3.0, 4.0), P = 0.42] treatment medications. Median context subscale scores ranged from 3.3 to 4.0 and generally did not vary by readiness status (P values > 0.05). Most favored integrating MAT into HIV care but preferred models differed across substances. Barriers to MAT included identification of treatment-eligible patients, variable experiences with MAT and perceived medication complexity, perceived need for robust behavioral services, and inconsistent availability of on-site specialists. Facilitators included knowledge of adverse health consequences of opioid and tobacco use, local champions, focus on quality improvement, and multidisciplinary teamwork.
Efforts to implement MAT in HIV clinics should address both gaps in perspectives regarding the evidence for MAT and contextual factors and may require substance-specific models.</abstract><cop>United States</cop><pub>JAIDS Journal of Acquired Immune Deficiency Syndromes</pub><pmid>33675619</pmid><doi>10.1097/QAI.0000000000002666</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Addictions Alcoholism Context Drug abuse Evaluation Formative evaluation Health Services Accessibility HIV HIV Infections - complications HIV Infections - therapy HIV-1 Human immunodeficiency virus Humans Mixed methods research Narcotics Opioid-Related Disorders - drug therapy Opioids Quality control Substance abuse treatment Substance-Related Disorders - drug therapy Surveys Tobacco Tobacco Use Cessation |
| title | Readiness to Provide Medications for Addiction Treatment in HIV Clinics: A Multisite Mixed-Methods Formative Evaluation |
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