Substance Use Assistance Could Be Better for HIV-Positive Individuals, Study Says

People with HIV are more likely to abuse injectable drugs, alcohol, and opioids, resulting in suboptimal adherence to care plans and antiretroviral therapy, as well as delayed HIV diagnoses. Although the availability of substance use services has been shown to improve HIV-related care services, any changes to that effect over time have not been extensively investigated, reports a study in PLoS ONE.

“Integrating substance use services into HIV care is a promising strategy to improve both substance use and HIV-related care cascade outcomes and advance attainment of the UNAIDS 95-95-95 goals,” the authors noted.

For their study, the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium provided the data on 2 surveys, 2014-2015 and 2017, that investigated substance use education, screening, and referral practices at 286 sites in 45 countries and 237 sites in 44 countries, respectively. Final analysis included a comparison of the 147 sites that participated in both surveys.

IeDEA is a global research consortium of HIV treatment sites in Central, East, South, and West Africa; the Asia-Pacific; the Caribbean and Central and South America; and North America, which have cared for close to 2 million persons with HIV since its founding in 2006. Surveys are conducted every 2 years.

For the 2014-2015 survey, the results show that 75% (range of percentages across IeDEA regions [RAR], 42%-100%) of the sites provided on-site substance use-related education; 52%, on-site screening for substance use; and 51%, on-site referrals for treatment. All of these numbers rose through the 2017 survey, to 84%, 68%, and 59%, respectively.

The 2014-2015 survey also reported the following on service availability:

• Substance use–related education was not available on or off site at 22% (RAR, 0-51%) of the sites.
• Substance use screening was unavailable at 39% (RAR, 0%-71%).
• Treatments referrals were unavailable at 34% (RAR, 0%-76%).
• All services were unavailable at 20% of sites.

Also in the 2017 survey:

• Screening and referrals were shown to usually happen at HIV care sites that only served adult populations, at 86% and 76%, respectively. There were significant differences in the availability of these same services at sites that served only children and adolescents (37% and 47%) and adults plus children/adolescents (59% and 46%).
• Screening and referrals were more likely to happen at sites in high-income countries, at 89% and 82%, respectively, followed by upper middle income (76% and 71%), lower middle income (68% and 57%), and low-income (45% and 34%) countries.
• 49% of sites provided onsite substance use–related education, screening, and referral to treatment.
• 11% of sites were no longer providing any of the services.

Both surveys show that urban areas contained most of the HIV care sites—60% in 2014-2015 and 75% in 2017)—and that they were mostly publicly funded, at 88% and 85%, respectively. In addition, 7% of the sites discontinued substance use–related education; 7%, screenings; and 13%, referrals, between administration of the surveys.

“Although there have been increases in the proportion of sites reporting substance use education, screening, and referral services across IeDEA sites, gaps persist in the integration of substance use services into HIV care,” the authors concluded, “particularly in relation to screening and referral practices, with reduced availability for children/adolescents and those receiving care within resource-constrained settings.”

Studies need to investigate barriers to care and how to best insert substance use–related offerings at sites also providing HIV care, the authors write. This includes at the patient, provider, facility, and policy levels, they pointed out. The studies should also address the lack of culturally sensitive, validated screening tools in areas with lack of funding and help to develop integration strategies to overcome those gaps in service provision.

“Future assessments of substance use service integration should include more nuanced, culturally-specific questions capable of assessing such aspects of screening and treatment services,” the authors added.

Reference

Parcesepe AM, Lancaster K, Edelman EJ, et al. Substance use service availability in HIV treatment programs: data from the global IeDEA consortium, 2014-2015 and 2017. PLoS ONE. Published online August 27, 2020. doi:10.1371/journal.pone.0237772