Research and engagement considerations for alcohol use telehealth services within HIV care: a qualitative exploration in federally qualified health centers

ABSTRACT

The prevalence of alcohol misuse is high among people with HIV (PWH); however, access to and utilization of evidence-based alcohol misuse interventions remain limited. Telehealth is one treatment approach with the potential for enhancing substance use disorder treatment utilization for PWH served by Federally Qualified Health Centers (FQHCs). However, questions remain regarding barriers to alcohol-focused telehealth service integration and telehealth research in FQHCs. This study employed qualitative methods, guided by the Dynamic Sustainability Framework, to evaluate barriers and cultural factors impacting FQHC telehealth integration. Eighteen qualitative interviews were completed with staff and leaders across four FQHCs. Interviews were analyzed using directed content analysis, and codes were organized into a priori and emergent themes. Key themes included the presence of common workflows for referring clients to substance use disorder treatment; existing research workflows and preferences for active project staff involvement; telehealth barriers including exacerbation of healthcare disparities and high provider turnover; and the importance of cultural humility and telehealth adaptations for sexual, gender, racial and ethnic minority clients. Findings from this study will inform the development of an alcohol-focused telehealth implementation strategy for a Hybrid Type 1 implementation effectiveness trial to enhance FQHC substance use disorder treatment.

Trial registration: ClinicalTrials.gov identifier: NCT02563574..

KEYWORDS:

• Telehealth intervention
• alcohol misuse
• alcohol use disorder
• HIV
• qualitative methods
• implementation science

Acknowledgements

This work was facilitated by the National Institute on Alcohol Abuse and Alcoholism under grant number P01AA019072 and the Providence/Boston Center for AIDS Research under grant number P30AI042853. Dr. Scott’s effort was supported by the National Institute on Drug Abuse under grant number K23050729.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The datasets generated and analyzed during this study are not publicly available due to the data containing information that could compromise research participant consent. Data are available from the first author of this manuscript on reasonable request.

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This work was supported by The National Institute of Allergy and Infectious Diseases [grant number P30AI042853]; National Institute on Alcohol Abuse and Alcoholism [grant number P01AA019072]; National Institute on Drug Abuse [grant number K23DA050729].