Module 5: Key Findings From the SPNS Buprenorphine Initiative
HRSA HIV/AIDS Bureau (HAB)
This module investigates the SPNS Buprenorphine Initiative, the reasons behind its funding, and its overall findings across grantee sites.
- A computer and compatible LCD projector to play the PowerPoint presentation.
Slide #16: Background on the SPNS Initiative
- To study opioid treatment among the HIV-infected population, HRSA's HIV/AIDS Bureau funded a SPNS project.
- The project was called "An Evaluation of Innovative Methods for Integrating Buprenorphine Opioid Abuse Treatment in HIV Primary Care."
- It was a 5-year, national, multisite study involving 10 HIV primary care sites and more than 300 HIV-positive opioid-addicted patients.
- This represented the largest study of buprenorphine implementation and outcomes among opioid-addicted people living with HIV/AIDS in the United States.
Slide #17: Why Integrate Buprenorphine into HIV Primary Care Sites?
- Integrated medical care and treatment for opioid dependence dismantles a significant barrier for disenfranchised patient populations.
- Integrated treatment models foster better communication and collaboration among HIV care providers, psychiatrists, and specialists in addiction medicine and treatment.
- Data from randomized, controlled trials suggest that integrating services at a single site improves both medical and substance abuse treatment outcomes.
Slide #18: Key Findings from Initiative
Patients and providers were overwhelmingly satisfied with the treatment and its results. The Buprenorphine Initiative:
- Allowed for integration-rather than fragmentation-of services, resulting in improved retention in care.
- Facilitated initiation of antiretroviral therapy (ART) among patients not previously on treatment.
- Improved drug and HIV treatment outcomes, particularly among those not previously on ART.
- Increased CD4 counts among patients who initiated ART during this project.
- Resulted in decreased use of heroin and other opioids.
- Increased social stability.
- Decreased HIV transmission risk behaviors.
- Decreased stigma associated with substance abuse treatment.
- Was associated with improved mental and physical health related quality of life.
Slide #19: Debunking Myths: Provider and Patient Fears Were Unfounded
- HIV clinicians at the majority of SPNS Buprenorphine Initiative sites had limited or no prior experience administering Suboxone to opioid-dependent patients before project initiation.
- Physicians across sites overwhelmingly found Suboxone treatment to be a good service to provide to their patients. They reported that administering buprenorphine was easier than they expected it would be, and, in fact, no harder than anything else they were overseeing within their clinics.
- When patients started buprenorphine, some were initially worried about being in a withdrawal state but after education and administration found the results to be achievable and effective.
Slide #20: Case Example
- SPNS research supports MAT and integration of buprenorphine into HIV primary care settings.
- Results from the SPNS initiative encourage replication at other sites.
- One grantee site study compared outcomes among 93 HIV-positive, opioid-addicted patients assigned to clinic-based buprenorphine and individual counseling or to case management with referral to drug treatment.
- People in the buprenorphine group were significantly more likely to participate in treatment for opioid addiction (74 percent versus 41 percent), less likely to use opioids and cocaine, and more likely to attend their HIV primary care visits than people in the group receiving referral to drug treatment.
Slide #21: Testimonials
- Providers and patients alike have reported positive outcomes with and experiences initiating opioid-addiction treatment.