Buprenorphine Treatment for Opioid Use Disorders in HIV Primary Care (BUPE-HIV) is an evidence-informed, team-based primary care intervention that allows patients to readily access comprehensive HIV and addiction services in a single setting. Opioid use disorders interfere with antiretroviral treatment (ART) adherence and impede HIV viral suppression, making buprenorphine treatment an excellent option for PLWH. Compared to methadone, buprenorphine has lower likelihood of side effects, lower overdose potential, and more predictable drug–drug interactions with antiretroviral medications.
Psychiatric Collaborative Care Management (CoCM) is more than just bringing a mental health provider to a primary care setting. In CoCM, a team of providers, including the patient’s medical provider, a behavioral health provider, and a psychiatric consultant, work together to provide evidence-informed mental health care to populations of patients. Primary care teams see their patients improve much more quickly in a successful CoCM program than in usual care.
To provide CoCM, a group of providers must function as a team and share a workflow to provide evidence-informed mental health or substance use disorder treatment. Strategies, staffing arrangements, and clinic work flows in implementing CoCM may be different among HIV service organizations, but the core principles to operationalize a successful and evidence-informed CoCM program are the same. For information about readiness requirements and other factors for successful implementation of CoCM, see the nine factors identified for effective implementation.
Unutzer J, Katon W, Callahan CM, Williams JW, Jr., Hunkeler E, Harpole L, Hoffing M, Della Penna RD, Noel PH, Lin EH, Arean PA, Hegel MT, Tang L, Belin TR, Oishi S, Langston C. Collaborative Care Management of Late-Life Depression in the Primary Care Setting: A Randomized Controlled Trial. Journal of the American Medical Association 2002;288: 2836-45.
Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-informed intervention in which a health care provider screens clients for substance use (alcohol and other drugs), provides brief motivational counseling, and refers to treatment if needed. When integrated into the standard delivery of HIV health care and social services, each part of the SBIRT process provides information and assistance tailored to individual clients and their needs. Just as checking a client’s blood pressure can reveal potential health problems and guide recommendations for a healthier lifestyle, SBIRT for substance use provides early insight into potential health problems and a chance to address problems before they worsen.