Attitudes and Training Needs of New England HIV Care and Addiction Treatment Providers

Abstract

Objectives Unhealthy alcohol use is common among HIV-infected patients and contributes to co-morbidities, cognitive decline, unprotected sex, and poor medication adherence. Studies consistently show missed opportunities to address unhealthy alcohol use as part of care. Although treatment of other drug use has been integrated into HIV care in some settings, more information is needed regarding provider attitudes regarding the need for integration of alcohol treatment and HIV care. Methods We surveyed 119 HIV and 159 addiction providers regarding the following domains: existing knowledge, desire for new knowledge (with subdomains relative advantage, compatibility, and complexity of integrating knowledge), and individual and program development needs. Scale scores for each domain were correlated with demographics to identify factors associated with training need. Results Both HIV and addiction providers reported agreement with statements of existing knowledge and the need for additional skills. The priority attributed to training, however, was low for both groups. Knowledge and perceived prevalence of HIV and unhealthy alcohol use increased with years of experience. Perceived prevalence correlated with compatibility but not the relative advantage of training. Conclusions Though addressing alcohol use and HIV was acknowledged to be important, the priority of this was low, particularly early career providers. These providers may be important targets for training focusing on motivating coordination of care and skills related to assessment and counseling.

HIV primary care providers—Screening, knowledge, attitudes and behaviors related to alcohol interventions

“…Our results are similar to those recently reported by Montague and colleagues (Montague et al, 2015). In their study, HIV providers (N=159) also reported moderate to high levels of confidence in their abilities to assess and monitor patients with heavy/hazardous drinking patterns, and lower confidence in their ability to effectively manage alcohol treatment needs on-site in the HIV clinic.…”

The Starting Treatment for Ethanol in Primary care Trials (STEP Trials): Protocol for Three Parallel Multi-Site Stepped Care Effectiveness Studies for Unhealthy Alcohol Use in HIV-Positive Patients

“…Furthermore, alcohol pharmacotherapy is available through the VA in addition to other addiction treatment services [67–69]. These services may be more robust than those available in some non-VA HIV treatment settings [16]. Participants could be referred for additional services as deemed appropriate by their providers.…”

Differences in Receipt of Alcohol‐Related Care Across Rurality Among VA Patients Living With HIV With Unhealthy Alcohol Use

“…However, again, the availability of non-VA communitybased specialty addictions treatment for AUD in rural areas is unclear. 59 In addition, AUD medications have been shown to be as effective as specialty addictions treatment when prescribed along with ongoing medical management, [67][68][69] and thus may be a viable option for provision in primary care settings.…”

“…10 Further, while barriers indicate a need for more training about the importance of offering alcohol-related care to PLWH and the efficacy of AUD medications, HIV providers report ambivalence about receiving training in treatment of substance use disorders. 68 Primary care providers also report barriers to prescribing AUD medications, including a lack of time for training and a lack of support in managing AUD care. 54 There also may be contraindications for use of some AUD medications among HIV patients (such as naltrexone among patients with hepatic problems).…”