A cross-site, comparative effectiveness study of an integrated HIV and substance use treatment program.
Abstract
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.
Type
Journal articleSubject
Academic Medical CentersAdult
Aged
Ambulatory Care Facilities
Community Health Centers
Delivery of Health Care, Integrated
Female
HIV Infections
Humans
Interviews as Topic
Male
Middle Aged
Program Evaluation
Severity of Illness Index
Substance-Related Disorders
Treatment Outcome
Young Adult
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https://hdl.handle.net/10161/3342Published Version (Please cite this version)
10.1089/apc.2010.0073Publication Info
Proeschold-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.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Brian Wells Pence
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.
Rae Jean Proeschold-Bell
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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