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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
Funding
Period: 2004-2009
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
Funding
Period: 2004-2009
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
Funding
Period: 2004-2009
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
Funding
Period: 2004-2009
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
Funding
Period: 2004-2009
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
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OF GRANT SITES
OASIS
(Oakland, CA)
Funding
Period: 2004-2009
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
Funding
Period: 2004-2009
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
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UCSF
Positive Health Program (San Francisco, CA): Integrating
Buprenorphine into the SFGH AIDS Program
Funding
Period: 2004-2009
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
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University
of Miami AIDS Clinical Research Unit (Miami, FL):
Miami Integration Project
Funding
Period: 2004-2009
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
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OF GRANT SITES
Yale
University AIDS Program (New Haven, CT): Integrating
Buprenorphine into HIV Clinical Care Settings
Funding
Period: 2004-2009
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
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The
New York Academy of Medicine (New York, NY): Center
for the Evaluation and Support of Integrated Buprenorphine
Treatment and HIV Care
Funding
Period: 2004-2009
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
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