Screening, Brief Intervention, and Referral to Treatment in a rural Ryan White Part C HIV clinic.

About 24% of people living with HIV nationally are identified as needing treatment for alcohol or illicit drug use. Screening, Brief Intervention, and Referral to Treatment (SBIRT) has evolved as a strategy to assess and intervene with substance abuse behaviors in various clinical settings. However, less is known about the processes and outcomes of using the SBIRT intervention in outpatient HIV clinics. This paper presents a descriptive analysis of de-identified existing SBIRT results data from an outpatient HIV clinic located in western Colorado. From 2008 to 2013, a total of 1616 SBIRT evaluations were done, which included duplicate patients because some individual patients were screened more than once in a given year. Over this time period, 37-49% of encounters per year were notable for tobacco use, 8-21% for alcohol use, 6-16% for marijuana use, 3-9% for amphetamine use, and 0-2% for illicit opioid use. Unique, unduplicated patient data from 2013 revealed 40% of patients used tobacco, 16% used alcohol, and 11% used methamphetamine. Analyses highlighted that the majority of our patient population (58% in 2013) used and/or abused tobacco, alcohol, and/or illicit substances. An alarming finding was the increase in methamphetamine use over time with more than 50-fold prevalence of use in our population compared to national rates.

Integration of the interaction model of client health behavior and transactional model of stress and coping as a tool for understanding retention in HIV care across the lifespan.

Retaining people living with HIV (PLWH) in care over the lifespan is critical to quality and longevity of life. Individual health behavior decisions that affect care retention are complicated and multifactorial. Current health behavior theories are inadequate in isolation to guide retention in care research. Two existing models, Cox's Interaction Model of Client Health Behavior, and Lazarus and Folkman's Transactional Model of Stress and Coping have both guided research with PLWH, although not related to retention in care. Integration of these models may more comprehensively inform care retention research and practice across the lifespan as it incorporates not only intra- and inter-personal characteristics and relationships but also the stress and coping experiences inevitable when living with a chronic illness such as HIV.