Effect of Implementation Facilitation to Promote Adoption of Medications for Addiction Treatment in US HIV Clinics: A Randomized Clinical Trial
- PMID: 36251291
- PMCID: PMC9577676
- DOI: 10.1001/jamanetworkopen.2022.36904
Effect of Implementation Facilitation to Promote Adoption of Medications for Addiction Treatment in US HIV Clinics: A Randomized Clinical Trial
Abstract
Importance: Medications for addiction treatment (MAT) are inconsistently offered in HIV clinics.
Objective: To evaluate the impact of implementation facilitation (hereafter referred to as "facilitation"), a multicomponent implementation strategy, on increasing provision of MAT for opioid use disorder (MOUD), alcohol use disorder (MAUD), and tobacco use disorder (MTUD).
Design, setting, and participants: Conducted from July 26, 2016, through July 25, 2020, the Working with HIV Clinics to adopt Addiction Treatment using Implementation Facilitation (WHAT-IF?) study used an unblinded, stepped wedge design to sequentially assign each of 4 HIV clinics in the northeastern US to cross over from control (ie, baseline practices) to facilitation (ie, intervention) and then evaluation and maintenance periods every 6 months. Participants were adult patients with opioid, alcohol, or tobacco use disorder. Data analysis was performed from August 2020 to September 2022.
Interventions: Multicomponent facilitation.
Main outcomes and measures: Outcomes, assessed using electronic health record data, were provision of MAT among patients with opioid, alcohol, or tobacco use disorder during the evaluation (primary outcome) and maintenance periods compared with the control period.
Results: Among 3647 patients, the mean (SD) age was 49 (12) years, 1814 (50%) were Black, 781 (22%) were Hispanic, and 1407 (39%) were female; 121 (3%) had opioid use disorder, 126 (3%) had alcohol use disorder, and 420 (12%) had tobacco use disorder. Compared with the control period, there was no increase in provision of MOUD with facilitation during the evaluation period (243 patients [27%; 95% CI, 22%-32%] vs 135 patients [28%; 95% CI, 22%-35%]; P = .59) or maintenance period (198 patients [29%; 95% CI, 22%-36%]; P = .48). The change in provision of MAUD from the control period to the evaluation period was not statistically significant (251 patients [8%; 95% CI, 5%-12%] vs 112 patients [13%; 95% CI, 8%-21%]; P = .11); however, the difference increased and became significant during the maintenance period (180 patients [17%; 95% CI, 12%-24%]; P = .009). There were significant increases in provision of MTUD with facilitation during both the evaluation (810 patients [33%; 95% CI, 30%-36%] vs 471 patients [40%; 95% CI, 36%-45%]; P = .005) and maintenance (643 patients [38%; 95% CI, 34%-41%]; P = .047) periods.
Conclusions and relevance: In this randomized clinical trial, facilitation led to increased provision of MTUD, delayed improvements in MAUD, and no improvements in MOUD in HIV clinics. Enhanced strategies, potentially including clinic and patient incentives, especially for MOUD, may be needed to further increase provision of MAT in HIV clinics.
Trial registration: ClinicalTrials.gov Identifier: NCT02907944.
Conflict of interest statement
Figures
![Figure 1.](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/9577676/bin/jamanetwopen-e2236904-g001.gif)
![Figure 2.](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/9577676/bin/jamanetwopen-e2236904-g002.gif)
Similar articles
-
Facilitation and Preferred Models for Delivering Substance Use Disorder Treatment in HIV Clinics: Results From a Multisite Randomized Trial.J Addict Med. 2023 Nov-Dec 01;17(6):e388-e391. doi: 10.1097/ADM.0000000000001192. Epub 2023 Jun 16. J Addict Med. 2023. PMID: 37934538 Free PMC article. Clinical Trial.
-
Accessibility to Medication for Opioid Use Disorder After Interventions to Improve Prescribing Among Nonaddiction Clinics in the US Veterans Health Care System.JAMA Netw Open. 2021 Dec 1;4(12):e2137238. doi: 10.1001/jamanetworkopen.2021.37238. JAMA Netw Open. 2021. PMID: 34870679 Free PMC article.
-
Working with HIV clinics to adopt addiction treatment using implementation facilitation (WHAT-IF?): Rationale and design for a hybrid type 3 effectiveness-implementation study.Contemp Clin Trials. 2020 Nov;98:106156. doi: 10.1016/j.cct.2020.106156. Epub 2020 Sep 23. Contemp Clin Trials. 2020. PMID: 32976995 Free PMC article.
-
Adding a Teachable Moment Approach to a Team-Based Primary Care Ask-Advise-Connect Approach for Tobacco Cessation [Internet].Washington (DC): Patient-Centered Outcomes Research Institute (PCORI); 2021 Feb. Washington (DC): Patient-Centered Outcomes Research Institute (PCORI); 2021 Feb. PMID: 37943976 Free Books & Documents. Review.
-
Strategies to improve smoking cessation rates in primary care.Cochrane Database Syst Rev. 2021 Sep 6;9(9):CD011556. doi: 10.1002/14651858.CD011556.pub2. Cochrane Database Syst Rev. 2021. PMID: 34693994 Free PMC article. Review.
Cited by
-
Implementing a pharmacist-integrated collaborative model of medication treatment for opioid use disorder in primary care: study design and methodological considerations.Addict Sci Clin Pract. 2024 Mar 18;19(1):18. doi: 10.1186/s13722-024-00452-y. Addict Sci Clin Pract. 2024. PMID: 38500166 Free PMC article. Clinical Trial.
-
Harm reduction stories: leveraging graphic medicine to engage veterans in substance use services within the VA.Harm Reduct J. 2023 Dec 6;20(1):177. doi: 10.1186/s12954-023-00886-8. Harm Reduct J. 2023. PMID: 38057789 Free PMC article.
-
Facilitation and Preferred Models for Delivering Substance Use Disorder Treatment in HIV Clinics: Results From a Multisite Randomized Trial.J Addict Med. 2023 Nov-Dec 01;17(6):e388-e391. doi: 10.1097/ADM.0000000000001192. Epub 2023 Jun 16. J Addict Med. 2023. PMID: 37934538 Free PMC article. Clinical Trial.
-
Implementing a peer-supported, integrated strategy for substance use disorder care in an outpatient infectious disease clinic is associated with improved patient outcomes.Int J Drug Policy. 2023 Nov;121:104191. doi: 10.1016/j.drugpo.2023.104191. Epub 2023 Sep 21. Int J Drug Policy. 2023. PMID: 37740989
References
-
- Department of Health and Human Services . Guidelines for the use of antiretroviral agents in adults and adolescents with HIV. February 2021. Accessed September 12, 2022. https://health.gov/healthypeople/tools-action/browse-evidence-based-reso...
Publication types
MeSH terms
Substances
Associated data
Grants and funding
LinkOut - more resources
Full Text Sources
Medical
Miscellaneous