Facilitation improves provision of some substance abuse medications in HIV clinics

Implementation facilitation at HIV clinics led to increased provision of medications for tobacco use and alcohol use disorders, but not of medications for opioid use disorders, researchers reported in JAMA Network Open.

Medications for addiction treatment are inconsistently offered at HIV clinics, E. Jennifer Edelman, MD, MHS, of the program in addiction medicine at Yale School of Medicine, and colleagues wrote.

Edelman and colleagues sought to evaluate the impact of implementation facilitation, a multicomponent strategy, on increasing provision of medications for addiction treatment for opioid, alcohol and tobacco use disorders.

The researchers used an unblinded, stepped wedge study design to sequentially assign each of four HIV clinics in the northeastern United States to cross over from control to facilitation to evaluation and maintenance periods every 6 months. Participants included adults who had either opioid, alcohol or tobacco use disorders.

Among 3,647 patients (mean age, 49 years; 61% male), 121 had an opioid use disorder (3%), 126 had an alcohol use disorder (3%), and 420 had a tobacco use disorder (12%).

Compared with the control period, there was no increase in provision for medications for opioid use disorders with facilitation during the evaluation period (243 patients, 27%; 95% CI, 22% to 32% vs. 135 patients, 28%; 95% CI, 22% to 35%) or in the maintenance period (198 patients, 29%; 95% CI, 22% to 36%).

The change in medications for alcohol use disorder was not statistically significant during the evaluation period (251 patients, 8%; 95% CI, 5%-12% vs. 112 patients, 13%; 95% CI, 8-21%). However, the difference increased and became significant during the maintenance period (180 patients, 17%; 95% CI, 12%-24%).

Lastly, there were significant increases in provision of medications for tobacco use disorders during the evaluation period (810 patients, 33%; 95% CI, 30%-36% vs. 471 patients, 40%; 95% CI, 36%-45%) and the maintenance period (643 patients, 38%; 95% CI, 34%-41%).

“Facilitation led to increased provision of [medications for tobacco use disorder], delayed improvements in [medications for alcohol use disorder] and no improvements in [medications for opioid use disorder] in HIV clinics,” Edelman and colleagues wrote. “Enhanced strategies, potentially including clinic and patient incentives, especially for [medications for opioid use disorder], may be needed to further increase provision of [medications for addiction treatment] in HIV clinics.”