HIV provider perspectives on opioid use disorder care integration into outpatient HIV care in Baltimore, Maryland: a mixed-methods RE-AIM analysis.

Abstract

Despite the high prevalence of opioid use disorders (OUD) among people with HIV (PWH), treatment among PWH remains low. Integrating OUD care into HIV care may improve OUD outcomes; however, adoption is limited due to multilevel barriers. RESTORE is a low-threshold substance use disorder (SUD) care program integrated into an outpatient HIV-care clinic that provides training and ongoing support for SUD care adoption by HIV providers. This mixed-methods study explored providers' perspectives on barriers and facilitators to RESTORE implementation and adoption of OUD treatment in HIV care. Repeated cross-sectional surveys were administered pre-RESTORE (2019; N = 42) and post-RESTORE implementation (2021; N = 48). In-depth interviews (N = 18) were completed post-implementation. Chi-square analysis assessed differences between pre- and post-implementation responses. Interviews were analyzed using thematic analysis guided by RE-AIM. Acceptability (Acceptability of Intervention Measure [range 4-20], mean = 16.4) and appropriateness (Intervention Appropriateness Measure, mean = 17.9) were high. Adoption of buprenorphine prescribing was high (29.2% post-implementation vs. 4.8% pre-implementation). Comfort managing OUD increased twofold (21.4% to 45.8%; p = 0.02). Inexperience with buprenorphine initiation and time were barriers to adopting OUD treatment. Ongoing mentoring in OUD care was a facilitator. Future research on the integration of OUD care into HIV care should incorporate task-shifting to increase provider-level support for OUD care.