The International journal on drug policy · 2026
Clinic-wide effects of integrating substance use disorder services into HIV care: A pragmatic evaluation of early outcomes.
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Falade-Nwulia Oluwaseun, Kostandova Natalya, Lesko Catherine, Agee Tracy, Verinumbe Tarfa, Fraker Sally, Griffith David, Lau Bryan
Аннотация
INTRODUCTION: Fragmentation of HIV and substance use disorder (SUD) care remains a barrier to effective care for people with HIV (PWH) who use drugs. Integration of SUD services into HIV care is a priority, yet evidence on real-world clinic-wide impact across the care continuum is limited. We evaluated the early effects of RESTORE (REcovery in Specialty care Through medication treatment and OutREach), an integrated HIV-SUD care model, within an urban HIV clinic.
METHODS: We conducted a pragmatic, quasi-experimental evaluation using electronic medical record data from PWH attending an urban HIV clinic that implemented RESTORE and from a comparison clinic without RESTORE. We examined clinic-level changes in documented substance use screening and electronic medical record (EMR)-documented prescribing of medications for opioid use disorder (OUD) and alcohol use disorder (AUD), during the year before implementation (January 1-December 31, 2018) and the first year after implementation (April 1, 2019-March 31, 2020). Rate ratios comparing post-implementation with pre-implementation periods were estimated. To assess robustness to unmeasured confounding, we conducted prior event rate ratio analyses.
RESULTS: Among 2397 PWH evaluated during the post-implementation period at the intervention clinic (mean age 52.2 years, 63% male, 79% Black), RESTORE implementation was associated with increased documented substance use screening (PERR-adjusted RR 1.12; 95% CI 1.02, 1.22). Although EMR-documented OUD/AUD medication prescribing increased following implementation, estimates were wide after PERR adjustment (PERR-adjusted RR 1.79; 95% CI 0.63, 5.57).
CONCLUSION: In this real-world clinic-level evaluation, RESTORE implementation was associated with improved documented substance use screening. Increases in EMR-documented OUD/AUD medication prescribing over one year were observed, but adjusted estimates demonstrated wide confidence intervals.
METHODS: We conducted a pragmatic, quasi-experimental evaluation using electronic medical record data from PWH attending an urban HIV clinic that implemented RESTORE and from a comparison clinic without RESTORE. We examined clinic-level changes in documented substance use screening and electronic medical record (EMR)-documented prescribing of medications for opioid use disorder (OUD) and alcohol use disorder (AUD), during the year before implementation (January 1-December 31, 2018) and the first year after implementation (April 1, 2019-March 31, 2020). Rate ratios comparing post-implementation with pre-implementation periods were estimated. To assess robustness to unmeasured confounding, we conducted prior event rate ratio analyses.
RESULTS: Among 2397 PWH evaluated during the post-implementation period at the intervention clinic (mean age 52.2 years, 63% male, 79% Black), RESTORE implementation was associated with increased documented substance use screening (PERR-adjusted RR 1.12; 95% CI 1.02, 1.22). Although EMR-documented OUD/AUD medication prescribing increased following implementation, estimates were wide after PERR adjustment (PERR-adjusted RR 1.79; 95% CI 0.63, 5.57).
CONCLUSION: In this real-world clinic-level evaluation, RESTORE implementation was associated with improved documented substance use screening. Increases in EMR-documented OUD/AUD medication prescribing over one year were observed, but adjusted estimates demonstrated wide confidence intervals.