Center for Health Policy, Global Health Institute, Duke University, Durham, North Carolina 27708, USA.
AIDS Patient Care STDS. 2010 Oct;24(10):651-8. doi: 10.1089/apc.2010.0073.
Co-occurrence of HIV and substance abuse is associated with poor outcomes for HIV-related health and substance use. Integration of substance use and medical care holds promise for HIV patients, yet few integrated treatment models have been reported. Most of the reported models lack data on treatment outcomes in diverse settings. This study examined the substance use outcomes of an integrated treatment model for patients with both HIV and substance use at three different clinics. Sites differed by type and degree of integration, with one integrated academic medical center, one co-located academic medical center, and one co-located community health center. Participants (n=286) received integrated substance use and HIV treatment for 12 months and were interviewed at 6-month intervals. We used linear generalized estimating equation regression analysis to examine changes in Addiction Severity Index (ASI) alcohol and drug severity scores. To test whether our treatment was differentially effective across sites, we compared a full model including site by time point interaction terms to a reduced model including only site fixed effects. Alcohol severity scores decreased significantly at 6 and 12 months. Drug severity scores decreased significantly at 12 months. Once baseline severity variation was incorporated into the model, there was no evidence of variation in alcohol or drug score changes by site. Substance use outcomes did not differ by age, gender, income, or race. This integrated treatment model offers an option for treating diverse patients with HIV and substance use in a variety of clinic settings. Studies with control groups are needed to confirm these findings.
艾滋病毒和药物滥用的同时发生与艾滋病毒相关健康和药物使用的不良结果有关。将药物使用和医疗保健相结合有望为艾滋病毒患者带来好处，但报告的综合治疗模式很少。大多数报告的模式缺乏在不同环境下治疗结果的数据。本研究在三个不同的诊所检查了同时患有艾滋病毒和药物使用的患者的综合治疗模式的药物使用结果。各站点的差异在于整合的类型和程度，其中一个是综合性学术医疗中心，一个是共置的学术医疗中心，一个是共置的社区卫生中心。参与者（n=286）接受了为期 12 个月的综合药物使用和艾滋病毒治疗，并在 6 个月的间隔接受了访谈。我们使用线性广义估计方程回归分析来检查成瘾严重程度指数（ASI）酒精和药物严重程度评分的变化。为了测试我们的治疗在不同地点是否有不同的效果，我们将包括地点与时间点交互项的完整模型与仅包括地点固定效应的简化模型进行了比较。在 6 个月和 12 个月时，酒精严重程度评分显著下降。药物严重程度评分在 12 个月时显著下降。一旦将基线严重程度变化纳入模型，就没有证据表明地点对酒精或药物评分变化有差异。药物使用结果在年龄、性别、收入或种族方面没有差异。这种综合治疗模式为治疗各种不同的艾滋病毒和药物使用患者提供了多种诊所环境的选择。需要进行对照研究来证实这些发现。
