Acceptability of a mobile health intervention to enhance HIV care coordination for patients with substance use disorders

Persons with HIV (PWH) are a population at risk for adverse sequelae of opioid use. Yet, few studies have examined correlates of chronic high risk opioid use and its impact on HIV outcomes. Trends in prescribing patterns and identification of factors that impact the use of opioid prescriptions among PWH are crucial to determine prevention and treatment interventions. This study examined electronic medical records (EMR) of patients receiving HIV care to characterize prescribing patterns and identify risk factors for chronic high risk prescription opioid use and the impact on HIV outcomes among PWH in primary care from July 1, 2016–December 31, 2017. EMR were analyzed from 8,882 patients who were predominantly male and ethnically and racially diverse with half being 50 years of age or older. The majority of the 8,744 prescriptions (98% oral and 2% transdermal preparations) given to 1,040 (12%) patients were oxycodone (71%), 8% were morphine, 7% tramadol, 4% hydrocodone, 4% codeine, 2% fentanyl, and 4% were other opioids. The number of monthly prescriptions decreased about 14% during the study period. Bivariate analyses indicated that most demographic and clinical variables were associated with receipt of any opioid prescription. After controlling for patient socio-demographic characteristics and clinical factors, the odds of receipt of any prescription were higher among patients with pain diagnoses and opioid use and mental health disorders. In addition, the odds of receipt of high average daily morphine equivalent dose (MED) prescriptions were higher for patients with pain diagnoses. Lastly, patients with substance use disorders (SUD) had an increased likelihood of detectable viral load compared to patients with no SUD, after adjusting for known covariates. Our findings show that despite opioid prescribing guidelines and monitoring systems, additional efforts are needed to prevent chronic high risk prescriptions in patients with comorbid conditions, including pain-related, mental health and substance use disorders. Evidence about the risk for chronic high risk use based on prescribing patterns could better inform pain management and opioid prescribing practices for patients receiving HIV care.

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Participation in a mobile health intervention to improve retention in early HIV care in an informal urban settlement in Nairobi, Kenya: a gender analysis

Annals of Global Health ◽

10.1016/j.aogh.2015.02.536 ◽

2015 ◽

Vol 81 (1) ◽

pp. 9

Author(s):

M. van der Kop ◽

D. Ojakaa ◽

A. Ekström ◽

J. Kimani ◽

L. Thabane ◽

...

Keyword(s):

Mobile Health ◽

Health Intervention ◽

Hiv Care ◽

Gender Analysis ◽

Urban Settlement

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A Qualitative Study of Client–Clinician Text Exchanges in a Mobile Health Intervention for Individuals With Psychotic Disorders and Substance Use

Journal of Dual Diagnosis ◽

10.1080/15504263.2016.1145312 ◽

2016 ◽

Vol 12 (1) ◽

pp. 63-71 ◽

Cited By ~ 17

Author(s):

Kelly A. Aschbrenner ◽

John A. Naslund ◽

Lydia E. Gill ◽

Stephen J. Bartels ◽

Dror Ben-Zeev

Keyword(s):

Substance Use ◽

Qualitative Study ◽

Mobile Health ◽

Psychotic Disorders ◽

Health Intervention

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Prevalence and Predictors of Substance Use Disorders Among HIV Care Enrollees in the United States

AIDS and Behavior ◽

10.1007/s10461-016-1584-6 ◽

2016 ◽

Vol 21 (4) ◽

pp. 1138-1148 ◽

Cited By ~ 42

Author(s):

Bryan Hartzler ◽

Julia C. Dombrowski ◽

Heidi M. Crane ◽

Joseph J. Eron ◽

Elvin H. Geng ◽

...

Keyword(s):

United States ◽

Substance Use ◽

Substance Use Disorders ◽

The United States ◽

Hiv Care

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Inventory and Analysis of Controlled Trials of Mobile Phone Applications Targeting Substance Use Disorders: A Systematic Review

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.622394 ◽

2021 ◽

Vol 12 ◽

Author(s):

Rubaab Bahadoor ◽

Jean-Marc Alexandre ◽

Lucie Fournet ◽

Thibaut Gellé ◽

Fuschia Serre ◽

...

Keyword(s):

Systematic Review ◽

Substance Use ◽

Substance Use Disorders ◽

Mobile Health ◽

Addiction Treatment ◽

Controlled Trials ◽

Addictive Behaviors ◽

Double Blind ◽

Adequate Treatment ◽

Addictive Disorders

Background: Less than 20% of people with addictions have access to adequate treatment. Mobile health could improve access to care. No systematic review evaluates effectiveness of mobile health applications for addiction.Objectives: First aim was to describe controlled trials evaluating the effectiveness of smartphone applications targeting substance use disorders and addictive behaviors. Secondly, we aimed to understand how the application produced changes in behavior and craving management.Method: A systematic review based on PRISMA recommendations was conducted on MEDLINE, CENTRAL, and PsycINFO. Studies had to be controlled trials concerning addictive disorders (substance/behavior), mobile application-based interventions, assessing effectiveness or impact of those applications upon use, published after 2008. Relevant information was systematically screened for synthesis. Quality and risk of bias were evaluated with JADAD score.Results: Search strategy retrieved 22 articles (2014-2019) corresponding to 22 applications targeting tobacco, alcohol, other substances and binge eating disorder. Control groups had access to usual treatments or a placebo-application or no treatment. Eight applications showed reduced use. Most of the applications informed about risks of use and suggestions for monitoring use. Twelve applications managed craving.Discussion: Heterogeneity limited study comparisons. Duration of studies was too short to predict sustainable results. A reduction of craving seemed related to a reduction in use.Conclusion: There is a lack of robust and comparable studies on mHealth applications for addiction treatment. Such applications could become significant contributors in clinical practice in the future so longer-termed double-blind studies are needed. Targeting craving to prevent relapse should be systematic.

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The Prevalence and Negative Impacts of Substance Use Disorders among People with HIV in the United States: A Real-Time Delphi Survey of Key Stakeholders

AIDS and Behavior ◽

10.1007/s10461-021-03473-9 ◽

2021 ◽

Author(s):

Bryan R. Garner ◽

Heather J. Gotham ◽

Hannah K. Knudsen ◽

Brittany A. Zulkiewicz ◽

Stephen J. Tueller ◽

...

Keyword(s):

Substance Use ◽

Real Time ◽

Substance Use Disorders ◽

Negative Impact ◽

Population Level ◽

The United States ◽

Hiv Care ◽

Individual Level ◽

Negative Impacts ◽

The U.S

AbstractAlthough HIV and substance use disorders (SUDs) constitute a health syndemic, no research to date has examined the perceived negative impacts of different SUDs for people with HIV (PWH). In May 2019, 643 stakeholders in the U.S., representing clients of AIDS service organizations (ASOs), ASO staff, and HIV/AIDS Planning Council members, participated in an innovative Stakeholder-Engaged Real-Time Delphi (SE-RTD) survey focused on the prevalence and individual-level negative impact of five SUDs for PWH. The SE-RTD method has advantages over conventional survey methods by efficiently sharing information, thereby reducing the likelihood that between-group differences are simply due to lack of information, knowledge, and/or understanding. The population-level negative impacts were calculated by weighting each SUD’s individual-level negative impact on indicators of the HIV Care Continuum and other important areas of life by the perceived prevalence of each SUD. Overall, we found these SUDs to have the greatest population-level negative impact scores (possible range 0–24): alcohol use disorder (population-level negative impact = 6.9; perceived prevalence = 41.9%), methamphetamine use disorder (population-level negative impact = 6.5; perceived prevalence = 3.2%), and opioid use disorder (population-level negative impact = 6.4; perceived prevalence = 34.6%). Beyond further demonstration of the need to better integrate SUD services within HIV settings, our findings may help inform how finite funding is allocated for addressing the HIV-SUD syndemic within the U.S. Based on our findings, such future efforts should prioritize the integration of evidence-based treatments that help address use disorders for alcohol, methamphetamine, and opioids.

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