Strategies for Providing Effective Integrated Care to Assist Patients with or at Risk of Both HIV and SUD

Findings from JCOIN’s Yale HIV Research Center

The intersection of substance use disorders (SUD) and human immunodeficiency virus (HIV) presents a complex public health challenge, as behaviors associated with substance use, such as sharing drug injection equipment (syringes) and engaging in risky sexual behaviors, significantly increase the risk of HIV incidents and complicate its management. While medical practitioners can prescribe antiretroviral therapy (ART) or pre-exposure prophylaxis (PrEP) to treat HIV and prevent HIV incidence, often people with SUD struggle to adhere to their HIV treatment plan, resulting in worse health outcomes, higher mortality, and further HIV transmission. Addressing this intersection requires integrated care models that combine HIV treatment with SUD services.

Previous research demonstrates addressing an individual’s opioid use disorder (OUD) through medication for OUD (MOUD) can also be critical in improving HIV viral suppression, treatment adherence, and health outcomes. Similarly, studies recommend expanding integrated care beyond brick-and-mortar clinics, to a community-based integrated care model, where people receive treatment for both HIV and SUD in the same place, and the treatments are brought into the community, by using healthcare vans, peer navigators, and community health worker to expand treatment access.

Correctional facilities are optimal settings for implementing integrated ART, PrEP, and MOUD and post-release care linkage plans as incarcerated people have higher rates of SUD and HIV than the general population. However, correctional facilities often do not offer access to testing, quality treatment, and preventative care, resulting in incarcerated people receiving inadequate care for SUD and HIV prevention or treatment.

Researchers from the JCOIN Yale HIV Research Center conducted a review of medical and scientific literature to expand on existing guidance and provide an overview of integrated care initiatives that serve people at risk for HIV and SUD. The study identified several key settings that have the ability to provide integrated HIV and SUD care, including brick-and-mortar clinics, mobile health clinics, harm reduction programs, and carceral settings. The researchers also highlighted several recommendations for integrating care of HIV and SUD at different structural levels, including at the healthcare provider level, the system level, and the policy level.

This study was published in Current HIV/AIDS Reports and was led by Katherine Hill, Dr. Sheela Shenoi, Dr. Mahalia Desruisseaux, and Dr. Sandra Springer from Yale University and Dr. Irene Kuo, George Washington University.

This summary is based on the findings from the following publication:
Hill, K., Kuo, I., Shenoi, S. V., Desruisseaux, M. S., & Springer, S. A. (2023). Integrated care models: HIV and substance use. Current HIV/AIDS Reports, 20(5), 286–295. https://doi.org/10.1007/s11904-023-00667-9