Integrating a Statewide HIV Call Line: An Innovative and Tailored Approach for Rapid Linkage to HIV Care.

Only 80% of people living with HIV (PLWH) in the United States are linked to care, 40% are engaged in care, and 30% have achieved viral load suppression. We addressed linkage to care with a pilot program of a statewide referral call center to connect PLWH and their non-HIV specialty providers to HIV care. Callers received tailored referrals from nurses trained to work in an existing call center, using an electronic assessment tool and a comprehensive HIV provider list. Of 122 calls, 85% were from PLWH and 15% from providers calling about a patient. Overall, 88 of 104 (84.6%) PLWH and 16 of 18 (88.9%) providers accepted care referral, including 13% of PLWH callers without prior HIV care. Results indicated that the call center was an acceptable strategy for HIV care referral; the use of an existing call center facilitated feasibility of the program and improved linkage to HIV care.

A cross-site, comparative effectiveness study of an integrated HIV and substance use treatment program.

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.