Improving Adherence to HIV Quality of Care Indicators in Persons With Opioid Dependence: The Role of Buprenorphine.
Korthuis, P Todd MD, MPH *+; Fiellin, David A MD ++; Fu, Rongwei PhD +[S]; Lum, Paula J MD, MPH ||; Altice, Frederick L MD [P]; Sohler, Nancy PhD, MPH **; Tozzi, Mary J MS ++; Asch, Steven M MD, MPH ++++; Botsko, Michael MSW, MPhil [S][S]; Fishl, Margaret MD ||||; Flanigan, Timothy P MD [P][P]; Boverman, Joshua MD *; McCarty, Dennis PhD +; for the BHIVES Collaborative
[Article]
JAIDS Journal of Acquired Immune Deficiency Syndromes.
56 Supplement 1, Integration of Buprenorphine/Naloxone Treatment into HIV Clinical Care:S83-S90, March 1, 2011.
(Format: HTML, PDF)
Background: Opioid-dependent HIV-infected patients are less likely to receive HIV quality of care indicators (QIs) compared with nondependent patients. Buprenorphine/naloxone maintenance therapy (bup/nx) could affect the quality of HIV care for opioid-dependent patients.
Methods: We abstracted 16 QIs from medical records at nine HIV clinics 12 months before and after initiation of bup/nx versus other treatment for opioid dependence. Summary quality scores (number of QIs received/number eligible x 100) were calculated. We compared change in QIs and summary quality scores in patients receiving bup/nx versus other participants.
Results: One hundred ninety-four of 268 participants (72%) received bup/nx and 74 (28%) received other treatment. Mean summary quality scores increased over 12 months for participants receiving bup/nx (45.6% to 51.6%, P < 0.001) but not other treatment (48.6% to 47.8%, P = 0.788). Bup/nx participants experienced improvements in six of 16 HIV QIs versus three of 16 QIs in other participants. Improvements were mostly in preventive and monitoring care domains. In multivariable analysis, bup/nx was associated with improved summary quality score ([beta] 8.55; 95% confidence interval, 2.06-15.0).
Conclusions: In this observational cohort study, HIV-infected patients with opioid dependence received approximately half of HIV QIs at baseline. Buprenorphine treatment was associated with improvement in HIV QIs at 12 months. Integration of bup/nx into HIV clinics may increase receipt of high-quality HIV care. Further research is required to assess the effect of improved quality of HIV care on clinical outcomes.
(C) 2011 Lippincott Williams & Wilkins, Inc.
