Addressing Substance Use Disorders to End the HIV Epidemic: The Power of Community Stakeholder Perspectives

SHEILA PATEL, PhD
RTI International

Given substance use disorders (SUDs) among people with HIV (PWH) are highly prevalent, integrating SUD services within HIV service organizations (HSOs) is warranted and may help end the HIV epidemic. The Substance-Treatment-Strategies for HIV (STS4HIV) Project funded by the National Institute on Drug Abuse (R01-DA044051) focused on bringing stakeholders together to help empirically inform integration of SUD services into HSOs.

This project harnessed perspectives from PWH, HIV service organizations, HIV planning councils/bodies, and AIDS Education and Training Centers (AETCs) to gain insights on how best to address SUDs that have the most negative impact the HIV care continuum (e.g., being linked to care, being retained in care, being virally suppressed) and other important areas of life (e.g., having stable housing, having a reliable mode of transportation, being employed).

We used an innovative Stakeholder-Engaged Real-Time Delphi (SE-RTD) method to identify (1) which SUDs have the greatest population-level negative impact, (2) which SUD interventions have the best fit for integration into HSOs, and (3) which strategies AETCs can use to support integration of SUD interventions into real world HSO settings. Each SE-RTD engaged stakeholders over a two-week period, which involved learning about (1) SUDs, (2) SUD interventions, or (3) strategies for exploring, preparing, and implementing SUD interventions, rating them across various dimensions, explaining initial responses, reviewing others’ responses and comments, and changing responses if inclined. This interactive method facilitates consensus among participating stakeholders by enabling asynchronous perspective sharing.

Our first SE-RTD engaged 643 PWH, HSO staff, and HIV planning council/body members and identified alcohol, methamphetamine, and opioid use disorders as having the greatest population-level negative impact. Representatives of 202 HSOs participated in our second SE-RTD and rated three evidence-based psychosocial interventions for SUD (i.e., motivational interviewing, cognitive behavioral therapy, and contingency management) as having the best fit for integration into HSOs. The third SE-RTD engaged 64 AETC representatives (from 8 regional offices and 56 local partners) who rated various strategies as important for supporting integration of psychosocial interventions for SUD into HSOs but with varying levels of feasibility.

The findings from our project reflect insights from key stakeholders nationally and can be used to inform HIV planning councils/bodies tasked with setting priorities, assessing capacity, and allocating resources to end the HIV epidemic. Further, we are using the information gleaned from stakeholders through these SE-RTDs to inform which SUD interventions and strategies will be the focus of a novel hybrid trial seeking to improve integration of SUD services into HSOs across the United States.