HRSA
awarded grants under its Special
Projects of National Significance
program to the applicants listed
below.
Brown
University, Miriam Hospital Immunology
Center (Providence, RI): Integrating
Buprenorphine Opioid Treatment
with HIV Primary Care
Target
Population: HIV infected patients
with a focus on women, substance
abusers, and persons being released
from prison
Goal:
1. To evaluate the effectiveness
of integrating buprenorphine treatment
into HIV primary care
2. To decrease HIV risk behaviors,
increase adherence to HIV medications
and/or substance abuse treatment,
and improve quality of life
Strategies:
1. Initiation of an opioid use/abuse
screening program
2. Educational session on all
forms of opioid treatment in addition
to individualized evaluation for
development of a treatment plan
3. Buprenorphine team to include
a nurse who will dispense buprenorphine
and clinic staff who will provide
comprehensive HIV and substance
abuse care
4. Near-peer outreach worker to
work with participants in the
community to improve substance
abuse treatment adherence
Evaluation: Assessment
of substance abuse, HIV risk behaviors,
adherence to HIV medications,
quality of life, patient satisfaction,
and follow-up with primary care
and substance abuse treatment
visits will take place at one,
three, six, and 12 months; HIV
viral load and CD4 data will also
be obtained through chart review
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El
Rio Santa Cruz Neighborhood Health
Center (Tucson, AZ): Buprenorphine
Opioid Abuse Treatment
Target
Population: Opioid dependent
HIV patients in a primary care
setting
Goal:
1. Improve patient adherence with
primary HIV treatment including
HAART therapy
2. Reduce substance abuse behaviors
including syringe-mediated risks
3. Maintain or enhance health
status of individuals
4. Improve quality of life for
individuals receiving the buprenorphine
intervention
Strategies:
1. Training and certification
of primary care providers in buprenorphine
administration and management
in the treatment of opioid abuse,
dependence, and addiction
2. Office-based nutritional, mental
health, and substance abuse counseling
Evaluation: Measure data
related to the goals stated above
in addition to HIV health status
markers including patients' CD4
counts and Viral Loads.
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The
Hektoen Institute, LLC/CORE Center
(Chicago, IL): Buprenorphine at
CORE: An HIV Primary Care Program
Demonstration
Target
Population: Opioid dependent
HIV positive patients
Goal: To determine the
effectiveness of a clinical/psychiatric
model including buprenorphine
treatment, as indicated by patient
acceptance, improved health outcomes,
and/or retention in care
Strategies:
1. Identification of opioid dependent
patients during assessment in
primary care clinics
2. A clinical/psychiatric model
consisting of a tightly linked
team of a psychiatrist and a chemical
dependency counselor who will
be able to administer buprenorphine
treatment to appropriate patients
Evaluation: Comparison
of subjects enrolled the current
model of care (HIV/Cognitive-Behavioral
Model including detox, residential
treatment, and/or methadone) with
those in the new clinical/psychiatric
model, with respect to health
outcomes and retention in care
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Johns
Hopkins School of Medicine (Baltimore,
MD): Randomized Trial of HIV Clinic
Based Buprenorphine versus Referred
Substance Abuse Care
Target
Population: Treatment-seeking
opioid-dependent patients who
receive primary medical care in
the Johns Hopkins HIV Clinic
Goal: The determine the
impact of clinic-based buprenorphine
treatment on HIV care utilization,
changes in health status and immunological
markers, and HIV transmission
risk behaviors
Strategies: Incorporation
of a clinic-based buprenorphine
substance abuse treatment model
Evaluation: A randomized
controlled trial of clinic-based
buprenorphine treatment versus
traditional substance abuse care,
with a focus on evaluating the
variables stated above in addition
to patient characteristics associated
with positive outcomes; costs,
administrative changes, and acceptance
of the new model will also be
evaluated
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Montefiore
Medical Center (Bronx, NY): The
Development and Evaluation of
Integration of Buprenorphine into
HIV Primary Care in Bronx Community
Health Centers
Target
Population: Patients of Bronx
HIV primary care community health
centers
Goal:
1. To integrate buprenorphine
substance abuse treatment into
the primary care setting
2. To improve access to and retention
in treatment
Strategies:
1. Develop formal linkages between
primary care providers and substance
abuse/buprenorphine treatment
experts and providers and community
pharmacies dispensing buprenorphine
2. Help facilitate certification
of providers in buprenorphine
treatment administration
3. A substance abuse treatment
team (HIV primary care physicians,
substance abuse expert physicians,
an HIV pharmacist, and a nurse
clinical coordinator) to provide
education and training, support,
and consultation for providers
Evaluation:
The evaluation will focus on clinical
and psychosocial changes among
participants treated with buprenorphine
in comparison to those receiving
usual care; the analysis will
focus on drug use, HIV-related
health status, mental and physical
health and well-being, health
service utilization, and patient
satisfaction
Menu of Grant Sites
OASIS
(Oakland, CA)
Target
Population: HIV-exposed heroin
users in the Oakland region
Goal: To improve medical,
psychosocial, and addiction outcomes
Strategies: Integration
of buprenorphine therapy into
medical services at an existing
site of HIV primary care
Evaluation: Evaluation
will compare the impact of a 2-year
enhanced group intervention for
HIV-exposed heroin users referred
for outside substance abuse treatment
to a similar enhanced intervention
combined with 2-years of medically
integrated buprenorphine
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Oregon
Health and Science University
(Portland, OR): Portland Integrates
Care for Opioid Dependent AIDS
Patients
Target
Population: Opioid addicted
patients in primary care HIV clinics
Goal: To integrate buprenorphine
treatment and substance abuse
counseling with HIV care, with
anticipated improvements in medication
adherence, attendance in substance
abuse counseling, and health outcomes
Strategies:
1. Establishing teams composed
of a physician, nurse, physician
assistant, counselor and patient
advocate to both coordinate and
make decisions about buprenorphine
integration at their clinic
2. This team will also monitor
patients and assure that individual
services provided for them are
appropriate
Evaluation: The evaluation
will compare outcomes of participants
involved in the model where buprenorphine
treatment is integrated with HIV
care, to those of participants
who receive buprenorphine treatment
according to federal guidelines
for methadone
Menu of Grant Sites
UCSF
Positive Health Program (San Francisco,
CA): Integrating Buprenorphine
into the SFGH AIDS Program
Target
Population: Patients in a
comprehensive HIV primary care
setting in San Francisco
Goal: To deliver new services
for HIV-infected patients by enabling
primary care providers to integrate
substance abuse treatment into
their existing clinical services
Strategies: A multidisciplinary
collaboration with the Division
of Substance Abuse and Addiction
Medicine and the Community Behavioral
Health Services agency to:
1. Provide physician education
and training on addiction treatment,
integrated services, and the use
of buprenorphine
2. Develop the policies and procedures
to deliver buprenorphine treatment
in HIV clinical settings
Evaluation: Process and
outcome evaluation will focus
on the efficacy of the buprenorphine
treatment intervention with a
diverse, low income, and often
homeless population of persons
living with HIV/AIDS
Menu of Grant Sites
University
of Miami AIDS Clinical Research
Unit (Miami, FL): Miami Integration
Project
Target
Population: HIV-positive opioid
users
Goal: To determine the
feasibility and effectiveness
of integrating buprenorphine substance
abuse treatment with HIV primary
care
Strategies: Subjects will
be randomized to receive the new
integrated treatment or the current
standard of care
Evaluation: Baseline and
follow-up measures will document
demographics as well as changes
in health, psychiatric needs,
support and legal status, family
health, social relationships,
drug/alcohol use, ART use, and
treatment adherence among the
two groups
Menu of Grant Sites
Yale
University AIDS Program (New Haven,
CT): Integrating Buprenorphine
into HIV Clinical Care Settings
Target
Population: HIV-infected opioid
dependent patients in an HIV treatment
setting
Goal: To determine the
best model of substance abuse
treatment for HIV-infected patients,
with a focus on the site of induction
and stabilization, the type of
counseling, adherence and health
outcomes, and cost effectiveness
Strategies: Three separate
models will be implemented, which
include:
1. On-site Addiction Treatment
Model comparing standard and enhanced
levels of counseling by a trained
addiction specialist team
2. HIV Primary Care Model with
induction and stabilization performed
on-site by the patients' primary
care providers
3. Induction/Stabilization Model
with induction and 8 week stabilization
performed in an off-site substance
abuse treatment facility
Evaluation: A control group
of HIV-infected patients enrolled
in a methadone treatment clinic
will be used as the comparison
for each of the models, and evaluation
will be conducted with respect
to retention in therapy, illicit
drug use, adherence to HAART,
and the impact on HIV transmission
behaviors
Menu of Grant Sites
The
New York Academy of Medicine (New
York, NY): Center for the Evaluation
and Support of Integrated Buprenorphine
Treatment and HIV Care
Target
Population: Buprenorphine
Initiative model demonstration
sites serving opioid dependent
HIV patients
Goal:
1. To enhance the development
of model demonstration programs
that integrate buprenorphine treatment
and HIV primary care
2. To conduct a multi-site process,
outcome, impact and cost evaluation
of these programs
3. To disseminate the findings
to providers, administrators,
and policy makers
Strategies:
1. Assemble a staff of experts
and a National Advisory Committee
to provide training and technical
support to the demonstration sites
2. Provide ongoing technical assistance
and support in program design,
clinical training and consultation,
and the development of policy
and procedures that address regulatory,
ethical, and clinical concerns
3. Translate the results of the
evaluation into peer-reviewed
publications, training materials,
briefing papers, reports, and
fact sheets
Evaluation: The Center
will conduct a multi-site evaluation
utilizing client, provider, and
program data to determine the
processes necessary to develop
integrated HIV and buprenorphine
programs, and their feasibility,
effectiveness, impact, and cost
Menu of Grant Sites
