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Integrated Care Models: HIV and Substance Use

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Abstract

Purpose of Review

Behaviors and practices associated with substance use contribute to lack of HIV virologic suppression and onward transmission. In the USA, many recent HIV outbreaks have been connected with substance use. Evidence-based strategies for integrating care of those at risk for and living with HIV and who use substances continue to evolve. This review, based on scientific and medical literature through March 2023, provides an overview and evaluation of initiatives for integrated care aimed to serve patients at risk for and with HIV and a substance use disorder.

Recent Findings

Integrated care services can improve health outcomes for patients at risk for and with HIV and a substance use disorder; for instance, treatment for an opioid use disorder can help improve HIV viral suppression. Brick-and-mortar facilities can provide successful care integration with appropriate clinic leadership to support multidisciplinary care teams, up-to-date provider training, and sufficient pharmacy stock for substance use treatment. Delivering healthcare services to communities (e.g., mobile healthcare clinics and pharmacies, telehealth) may prove to be an effective way to provide integrated services for those with or at risk of HIV and substance use disorders. Incorporating technology (e.g., mobile phone applications) may facilitate integrated care. Other venues, including harm reduction programs and carceral settings, should be targets for integrated services.

Summary

Venues providing healthcare should invest in integrated care and support legislation that increases access to services related to HIV and substance use.

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Acknowledgements

Additionally, we would like to thank Alysse Schultheis, Cynthia Frank, PhD, and the ACTION and DP1 research teams at Yale for their input and feedback.

Funding

This work was funded by the National Institutes on Drug Abuse (NIDA) (DP1DA056106, Springer and U01DA047982, Springer). The funders were not involved in the research design, analysis, or interpretation of the data or the decision to publish the manuscript.

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Authors and Affiliations

  1. Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA

    Katherine Hill

  2. Department of Epidemiology, Milken Institute School of Public Health at The George Washington University, Washington, DC, USA

    Irene Kuo

  3. Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, 135 College Street, Suite 323, New Haven, CT, 06510, USA

    Sheela V. Shenoi & Sandra A. Springer

  4. Yale Institute of Global Health, New Haven, CT, USA

    Sheela V. Shenoi & Mahalia S. Desruisseaux

  5. Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA

    Sheela V. Shenoi & Sandra A. Springer

  6. The Veterans Administration Connecticut Healthcare System, West Haven, CT, USA

    Sheela V. Shenoi & Sandra A. Springer

  7. Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA

    Mahalia S. Desruisseaux

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  1. Katherine Hill
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Correspondence to Sandra A. Springer.

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Conflict of Interest

Author S. Springer has received paid scientific consultation honoraria from Alkermes Inc and has received in-kind study drug donations from Alkermes Inc and Indivior Pharmaceutical Company for NIH-funded research. S. Shenoi’s spouse worked for Merck Pharmaceuticals 1997–2007 and retains company stock in his retirement account. There is no conflict of interest, but it is included in the interest of full disclosure. Authors K. Hill, I. Kuo, and M. Desruisseaux have nothing to declare.

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Hill, K., Kuo, I., Shenoi, S.V. et al. Integrated Care Models: HIV and Substance Use. Curr HIV/AIDS Rep 20, 286–295 (2023). https://doi.org/10.1007/s11904-023-00667-9

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