Background

In September of 2004, the HIV/AIDS Bureau of the Health Resources and Services Administration (HRSA) funded an initiative through its Special Projects of National Significance (SPNS) branch to develop and evaluate programs that integrated HIV primary care and buprenorphine treatment for opioid dependence. Programs that integrate medical care and drug treatment have shown great promise in improving health and substance use related outcomes. The overlap in the epidemics of HIV (with its complex medical needs) and drug abuse makes HIV-infected drug users a population likely to benefit from the integration of primary care and drug treatment. Despite the demonstrated benefits of integrated care, a number of historical, systemic, regulatory, and attitudinal barriers have prevented widespread adoption of integrated care models. The Drug Addiction Treatment Act of 2000 and the approval of buprenorphine for the office-based treatment of opioid addiction eliminate a number of these barriers and provide a new opportunity to integrate addiction treatment and medical care for people with HIV. However, little is known about implementing such programs in HIV care settings; their cost; what effect they have on the health and substance use of PLWH/A; or what broader impact they have on providers, institutions, and local systems.

To answer some of these questions, SPNS funded 10 model demonstration programs around the country to develop and evaluate programs that integrate HIV primary care and treatment for opioid dependence using buprenorphine. In addition to the local evaluations that each site will conduct, all ten sites will participate in a national, multi-site evaluation that will be coordinated by the Evaluation and Support Center, housed in the Office of Special Populations at the New York Academy of Medicine.