Perspectives on the HIV continuum of care among adult opioid users in New York City: a qualitative study

Babak Tofighi,Victoria Vaughan Dickson,Chemi Chemi,Crystal Fuller Lewis,Joshua D Lee,Selena S Sindhu

doi:10.1186/s12954-019-0329-z

Abstract

BackgroundEngagement in the HIV care continuum combined with office-based opioid treatment remains a cornerstone in addressing the intertwined epidemics of opioid use disorder (OUD) and HIV/AIDS. Factors influencing patient engagement with OUD and HIV care are complex and require further study.MethodsIn this qualitative study, in-depth interviews were conducted among 23 adult patients who use drugs (PWUD) in an inpatient detoxification program in New York City. The semi-structured interview guide elicited participant experiences with various phases of the HIV care continuum, including factors influencing access to HIV care, interactions with HIV and primary care providers, preferences around integrated care approaches for OUD and HIV, and barriers experienced beyond clinical settings which affected access to HIV care (e.g., insurance issues, transportation, cost, retrieving prescriptions from their pharmacy). Data collection and thematic analysis took place concurrently using an iterative process-based established qualitative research method.ResultsRespondents elicited high acceptability for integrated or co-located care for HIV and OUD in primary care. Factors influencing engagement in HIV care included (1) access to rapid point-of-care HIV testing and counseling services, (2) insurance coverage and costs related to HIV testing and receipt of antiretroviral therapy (ART), (3) primary care providers offering HIV care and buprenorphine, (4) illicit ART sales to pharmacies, (5) disruption in supplies of ART following admissions to inpatient detoxification or residential treatment programs, (6) in-person and telephone contact with peer support networks and clinic staff, (7) stigma, and (8) access to administrative support in primary care to facilitate reengagement with care following relapse, behavioral health services, transportation vouchers, and relocation from subsidized housing exposing patients to actively using peers.ConclusionThese findings suggest expanding clinical and administrative support in primary care for PWUDs with patient navigators, case managers, mobile health interventions, and peer support networks to promote linkage and retention in care.

Highlights

The global strategy to eliminate AIDS relies on the 90-90-90 treatment goals ensuring that 90% of all individuals living with HIV know their HIV status, 90% of those are receiving antiretroviral therapy (ART), and 90% of those have attained viral suppression [1]
The worsening opioid use disorder (OUD) epidemic has ushered in a rise in injection drug use and new HIV and HCV outbreaks [2, 3]
The semi-structured interview guide was used to elicit participant experiences with various phases of the HIV care continuum, including factors that facilitated access to HIV care, interactions with HIV and primary care providers, preferences around integrated care approaches for OUD and HIV, and barriers experienced beyond clinical settings which affected access to HIV care

Summary

Introduction

The global strategy to eliminate AIDS relies on the 90-90-90 treatment goals ensuring that 90% of all individuals living with HIV know their HIV status, 90% of those are receiving antiretroviral therapy (ART), and 90% of those have attained viral suppression [1] Progress towards achieving these targets for 2020 relies on the five-stage HIV care continuum, including diagnosis of HIV, initiation on ART and linkage to HIV care, retention in treatment, and optimal viral suppression [1]. Barriers in linking to HIV care among people who use drugs (PWUDs) are influenced by numerous patient-, provider-, and systems-level factors, including lack of insurance coverage, access to medications for addiction treatment (MAT), substance use, criminal-justice system involvement, and stigma [7, 8]. Factors influencing patient engagement with OUD and HIV care are complex and require further study

Methods

Results

Discussion

Conclusion