PDF(Pubmed)
Abstract：
BACKGROUND: HIV, opioid use disorder (OUD), and mental health challenges share multiple syndemic risk factors. Each can be effectively treated with routine outpatient appointments, medication management, and psychosocial support, leading implementers to consider integrated screening and treatment for OUD and mental health in HIV care. Provider perspectives are crucial to understanding barriers and strategies for treatment integration.
METHODS: We conducted in-depth qualitative interviews with 21 HIV treatment providers and social services providers (12 individual interviews and 1 group interview with 9 participants) to understand the current landscape, goals, and priorities for integrated OUD, mental health, and HIV care. Providers were purposively recruited from known clinics in Mecklenburg County, North Carolina, U.S.A. Data were analyzed using applied thematic analysis in the NVivo 12 software program and evaluated for inter-coder agreement.
RESULTS: Participants viewed substance use and mental health challenges as prominent barriers to engagement in HIV care. However, few organizations have integrated structured screening for substance use and mental health into their standard of care. Even fewer screen for opioid use. Although medication assisted treatment (MAT) is effective for mitigating OUD, providers struggle to connect patients with MAT due to limited referral options, social barriers such as housing and food insecurity, overburdened staff, stigma, and lack of provider training. Providers believed there would be clear benefit to integrating OUD and mental health treatment in HIV care but lacked resources for implementation.
CONCLUSIONS: Integration of screening and treatment for substance use and mental health in HIV care could mitigate many current barriers to treatment for all three conditions. Efforts are needed to train HIV providers to provide MAT, expand resources, and implement best practices.
METHODS: We conducted in-depth qualitative interviews with 21 HIV treatment providers and social services providers (12 individual interviews and 1 group interview with 9 participants) to understand the current landscape, goals, and priorities for integrated OUD, mental health, and HIV care. Providers were purposively recruited from known clinics in Mecklenburg County, North Carolina, U.S.A. Data were analyzed using applied thematic analysis in the NVivo 12 software program and evaluated for inter-coder agreement.
RESULTS: Participants viewed substance use and mental health challenges as prominent barriers to engagement in HIV care. However, few organizations have integrated structured screening for substance use and mental health into their standard of care. Even fewer screen for opioid use. Although medication assisted treatment (MAT) is effective for mitigating OUD, providers struggle to connect patients with MAT due to limited referral options, social barriers such as housing and food insecurity, overburdened staff, stigma, and lack of provider training. Providers believed there would be clear benefit to integrating OUD and mental health treatment in HIV care but lacked resources for implementation.
CONCLUSIONS: Integration of screening and treatment for substance use and mental health in HIV care could mitigate many current barriers to treatment for all three conditions. Efforts are needed to train HIV providers to provide MAT, expand resources, and implement best practices.
摘要：
背景：艾滋病毒，阿片类药物使用障碍（OUD），和心理健康挑战共享多个共同风险因素。每个人都可以通过常规门诊预约得到有效治疗，药物管理,和社会心理支持，主要实施者考虑在艾滋病毒护理中对OUD和心理健康进行综合筛查和治疗。提供者的观点对于理解治疗整合的障碍和策略至关重要。
方法：我们对21个艾滋病毒治疗提供者和社会服务提供者进行了深入的定性访谈（12个个人访谈和9个参与者的1个小组访谈），以了解当前的情况，目标,以及综合OUD的优先事项，心理健康,和艾滋病毒护理。有目的地从梅克伦堡县的已知诊所招募了提供者，北卡罗来纳州,使用NVivo12软件程序中的应用主题分析对美国数据进行分析，并评估编码器间协议。
结果：参与者认为药物使用和心理健康挑战是参与艾滋病毒护理的主要障碍。然而,很少有组织将物质使用和心理健康的结构化筛查纳入其护理标准。甚至更少的阿片类药物使用屏幕。尽管药物辅助治疗（MAT）对减轻OUD有效，由于转诊选择有限，提供者很难将患者与MAT联系起来，住房和粮食不安全等社会障碍，工作人员负担过重，污名,缺乏提供者培训。供应商认为，将OUD和心理健康治疗纳入艾滋病毒护理将有明显的好处，但缺乏实施资源。
结论：在艾滋病毒护理中整合药物使用和心理健康的筛查和治疗可以减轻目前对这三种情况的治疗的许多障碍。需要努力培训艾滋病毒提供者提供MAT，扩大资源,并实施最佳实践。
方法：我们对21个艾滋病毒治疗提供者和社会服务提供者进行了深入的定性访谈（12个个人访谈和9个参与者的1个小组访谈），以了解当前的情况，目标,以及综合OUD的优先事项，心理健康,和艾滋病毒护理。有目的地从梅克伦堡县的已知诊所招募了提供者，北卡罗来纳州,使用NVivo12软件程序中的应用主题分析对美国数据进行分析，并评估编码器间协议。
结果：参与者认为药物使用和心理健康挑战是参与艾滋病毒护理的主要障碍。然而,很少有组织将物质使用和心理健康的结构化筛查纳入其护理标准。甚至更少的阿片类药物使用屏幕。尽管药物辅助治疗（MAT）对减轻OUD有效，由于转诊选择有限，提供者很难将患者与MAT联系起来，住房和粮食不安全等社会障碍，工作人员负担过重，污名,缺乏提供者培训。供应商认为，将OUD和心理健康治疗纳入艾滋病毒护理将有明显的好处，但缺乏实施资源。
结论：在艾滋病毒护理中整合药物使用和心理健康的筛查和治疗可以减轻目前对这三种情况的治疗的许多障碍。需要努力培训艾滋病毒提供者提供MAT，扩大资源,并实施最佳实践。
