Substance use referral, treatment utilization, and patient costs associated with problematic substance use in people living with HIV in Cape Town, South Africa.
Substance use referral, treatment utilization, and patient costs associated with problematic substance use in people living with HIV in Cape Town, South Africa.
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DOI：
10.1016/j.dadr.2022.100035
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发表时间：
2022-03
期刊：
影响因子：
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通讯作者：
Magidson, Jessica F
中科院分区：
文献类型：
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作者：
Belus, Jennifer M;Regenauer, Kristen S;Hutman, Elizabeth;Rose, Alexandra L;Burnhams, Warren;Andersen, Lena S;Myers, Bronwyn;Joska, John A;Magidson, Jessica F
在艾滋病毒护理与活性物质使用（SU）的患者很少收到SU转介。SU转介，当他们发生，往往没有参与的过程中的病人。未经治疗的SU会给患者带来沉重的经济负担。同行可能能够弥合临床医生和患者之间的差距。尽管南非努力在艾滋病毒感染者（PLWH）中发现和治疗有问题的药物使用（SU），但艾滋病毒和SU服务的整合是有限的。我们试图了解PLWH和有问题的SU是否：（a）常规转诊到SU治疗，一个位于同一地点的Matrix诊所，（B）转诊时使用SU治疗服务，（c）SU的个人花费。在RE-AIM实施科学框架的指导下，我们检查了来自一项试点临床试验的患者水平定量筛查和基线数据，以了解药物依从性和有问题的SU。定性数据来自半结构化的采访艾滋病毒护理提供者（N = 8），辅以患者访谈（N = 15）。尽管有免费提供的共同定位SU治疗计划，但寻求HIV护理且有问题SU的筛选患者参与者（N = 121）均未参与SU治疗。仅1.5%的入组患者研究样本（N = 66）报告终生转诊至SU治疗。平均而言，未经治疗的SU患者每月家庭收入的33.3%（SD=34.5%）用于物质。艾滋病毒护理提供者报告说，缺乏明确的SU转诊过程，并缺乏直接沟通，患者的需求或兴趣，在接受SU转诊的患者。SU治疗转介和摄取是罕见的PLWH报告有问题的SU，尽管高比例的个人资源分配给物质和共处矩阵网站。艾滋病毒和矩阵站点之间的标准化转诊政策可以改善SU转诊的沟通和吸收。
Patients in HIV care with active substance use (SU) rarely received SU referrals. SU referrals, when they occurred, often did not engage the patient in the process. Untreated SU results in a high financial burden for patients. Peers may be able to bridge the gap between clinicians and patients. Despite efforts to detect and treat problematic substance use (SU) among people living with HIV (PLWH) in South Africa, integration of HIV and SU services is limited. We sought to understand whether PLWH and problematic SU were: (a) routinely referred to SU treatment, a co-located Matrix clinic, (b) used SU treatment services when referred, and (c) the individual amount spent on SU. Guided by the RE-AIM implementation science framework, we examined patient-level quantitative screening and baseline data from a pilot clinical trial for medication adherence and problematic SU. Qualitative data came from semi-structured interviews with HIV care providers (N = 8), supplemented by patient interviews (N = 15). None of the screened patient participants (N = 121) who were seeking HIV care and had problematic SU were engaged in SU treatment, despite the freely available co-located SU treatment program. Only 1.5% of the enrolled patient study sample (N = 66) reported lifetime referral to SU treatment. On average, patients with untreated SU spent 33.3% (SD=34.5%) of their monthly household income on substances. HIV care providers reported a lack of clarity about the SU referral process and a lack of direct communication with patients about patients’ needs or interest in receiving an SU referral. SU treatment referrals and uptake were rare among PLWH reporting problematic SU, despite the high proportion of individual resources allocated to substances and the co-located Matrix site. A standardized referral policy between the HIV and Matrix sites may improve communication and uptake of SU referrals.