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Abstract
We review five innovative strategies to improve access, utilization, and adherence for HIV-infected drug users and suggest areas that need further attention. In addition, we highlight two innovative programs. The first increases access and utilization through integrated HIV and opioid addiction treatment with buprenorphine in a community health center, and the second incorporates adherence counseling for antiretroviral therapy in methadone programs. Preliminary evaluations demonstrated that these strategies may improve both HIV and opioid addiction outcomes and may be appropriate for wider dissemination. Further refinement and expansion of strategies to improve outcomes of HIV-infected drug users is warranted.
THE AUTHORS
Chinazo O. Cunningham, M.D., M.S., is a general internist and Associate Professor of medicine at the Albert Einstein College of Medicine/Montefiore Medical Center. For over 10 years, Dr. Cunningham has been caring for marginalized populations such as HIV-infected individuals, substance users, and the unstably housed. She has developed unique and innovative programs to deliver health care to marginalized populations, along with research and evaluation focusing on their access to and utilization of health care. Dr. Cunningham works closely with community-based organizations and has been the principal investigator on several federally funded grants.
Nancy L. Sohler, Ph.D., M.P.H., is currently faculty at the Sophie Davis School of Biomedical Education of the City University of New York, the Doctoral Program in Public Health at the Graduate Center of the City University of New York, and the Epidemiology and Family and Social Medicine Departments at the Montefiore Medical Center/Albert Einstein College of Medicine. Her research interests include examination of barriers to accessing appropriate health care for underserved populations, evaluation of medical outreach for unstably housed people with HIV and a program which integrates opioid treatment into primary care settings, and examination of how pharmaceutical marketing practices impact health care choices and disparities in treatment for chronic disease such as depression, hypertension, and diabetes.
Nina A. Cooperman, Psy.D., is faculty in the Division of Addiction Psychiatry at the University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School. Her research focuses on HIV risk behavior, adherence to antiretroviral treatment, HIV among women in India, and smoking cessation for drug abusers. She is a member of the Motivational Interviewing Trainers Network, and she often trains health care providers to implement MI to help patients change health-related behaviors.
Karina M. Berg, M.D., M.S., is a faculty member in the Division of General Internal Medicine at the Albert Einstein College of Medicine/Montefiore Medical Center. Dr. Berg's current research interests include optimizing care for HIV-infected drug users. Specifically, she is examining improving antiretroviral adherence and treatment of chronic pain. For her research, she was awarded a Robert Wood Johnson Physician Faculty Scholars Program and a career development award from the NIH. These projects involve combining information from multiple adherence measures through structural equation modeling, examining the agreement and validity of different specific self-report measures of adherence, and exploring the underlying cognitive tasks involved in answering specific adherence questions through qualitative research methods including cognitive interviewing.
Alain H. Litwin, M.D., M.S., is Associate Professor of clinical medicine and psychiatry and behavioral sciences at the Albert Einstein College of Medicine. Since 2000, Dr. Litwin has been providing care in the South Bronx to drug users with complex social, psychiatric, and medical needs within an integrated primary care and MMTP. Dr. Litwin has worked with government and community organizations on community efforts to expand access to hepatitis C virus (HCV) treatment for citizens of NYC. He has worked on policy statements, clinical guidelines, treatment improvement protocols, and educational curricula. Dr. Litwin is currently the Site Principal Investigator of two federally funded programs focused on improving HCV-related care. Dr. Litwin's research has focused on HCV treatment outcomes of methadone-maintained drug users; drug interactions between pegylated interferon and methadone; and HCV-related attitudes, knowledge, and practices of drug users, medical providers, and nonmedical staff. Dr. Litwin currently has an NIH K23 award to study directly observed hepatitis C treatment in methadone clinics.
Julia H. Arnsten, M.D., M.P.H., is a Professor of medicine, epidemiology and population health, and psychiatry and behavioral sciences at the Albert Einstein College of Medicine/Montefiore Medical Center. Since joining the faculty of the Albert Einstein College of Medicine in 1996, Dr. Arnsten has established an NIH-funded research program focused on adherence to treatment among HIV-infected drug users and on other medical problems affecting substance abusers. In addition, Dr. Arnsten initiated a clinical addiction research and education fellowship for physicians, which has been ongoing since 2002. In 2004, Dr. Arnsten became the Founding Chief of the Unified Division of General Internal Medicine in the Department of Medicine at the Albert Einstein College of Medicine and Montefiore Medical Center. Research in this Division is conducted in a variety of fields, including substance abuse treatment, hepatitis C, tuberculosis, HIV prevention and adherence, nicotine dependence, chronic pain, women's health, medical education, diabetes, and health outcomes.