A cross-site, comparative effectiveness study of an integrated HIV and substance use treatment program.
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Co-occurrence of HIV and substance abuse is associated with poor outcomes for HIV-related health and substance use. Integration of substance use and medical care holds promise for HIV patients, yet few integrated treatment models have been reported. Most of the reported models lack data on treatment outcomes in diverse settings. This study examined the substance use outcomes of an integrated treatment model for patients with both HIV and substance use at three different clinics. Sites differed by type and degree of integration, with one integrated academic medical center, one co-located academic medical center, and one co-located community health center. Participants (n=286) received integrated substance use and HIV treatment for 12 months and were interviewed at 6-month intervals. We used linear generalized estimating equation regression analysis to examine changes in Addiction Severity Index (ASI) alcohol and drug severity scores. To test whether our treatment was differentially effective across sites, we compared a full model including site by time point interaction terms to a reduced model including only site fixed effects. Alcohol severity scores decreased significantly at 6 and 12 months. Drug severity scores decreased significantly at 12 months. Once baseline severity variation was incorporated into the model, there was no evidence of variation in alcohol or drug score changes by site. Substance use outcomes did not differ by age, gender, income, or race. This integrated treatment model offers an option for treating diverse patients with HIV and substance use in a variety of clinic settings. Studies with control groups are needed to confirm these findings.
SubjectAcademic Medical Centers
Ambulatory Care Facilities
Community Health Centers
Delivery of Health Care, Integrated
Interviews as Topic
Severity of Illness Index
Published Version (Please cite this version)10.1089/apc.2010.0073
Publication InfoProeschold-Bell, Rae Jean; Heine, Amy; Pence, Brian Wells; McAdam, Keith; & Quinlivan, Evelyn Byrd (2010). A cross-site, comparative effectiveness study of an integrated HIV and substance use treatment program. AIDS Patient Care STDS, 24(10). pp. 651-658. 10.1089/apc.2010.0073. Retrieved from https://hdl.handle.net/10161/3342.
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Adjunct Associate Professor in the Department of Family Medicine and Community Health
Brian Wells Pence, PhD MPH, is trained as an infectious diseases epidemiologist. His research interests focus primarily on the impact of trauma, mental illness, and other psychosocial characteristics on HIV-related behaviors and clinical outcomes and on the development of effective and practical interventiosn to address mental illness in HIV patients.
Research Professor of Global Health
Rae Jean Proeschold-Bell is interested in the interplay between mental and physical well-being and has designed and tested interventions that integrate care for people with obesity and depression; HIV/AIDS and substance use; and hepatitis C and alcohol use. Most recently, Rae Jean has been studying positive mental health as a way to prevent depression and promote caring for one's physical health. Her work currently focuses on caregivers, including clergy in North Carolina and ca
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