ArticleThe International journal on drug policy2026
Clinic-wide effects of integrating substance use disorder services into HIV care: A pragmatic evaluation of early outcomes.
Article in The International journal on drug policy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionFragmentation of HIV and substance use disorder (SUD) care remains a barrier to effective care for people with HIV (PWH) who use drugs. Integration of SUD services into HIV care is a priority, yet evidence on real-world clinic-wide impact across the care continuum is limited. We evaluated the early effects of RESTORE (REcovery in Specialty care Through medication treatment and OutREach), an integrated HIV-SUD care model, within an urban HIV clinic.
methodsWe conducted a pragmatic, quasi-experimental evaluation using electronic medical record data from PWH attending an urban HIV clinic that implemented RESTORE and from a comparison clinic without RESTORE. We examined clinic-level changes in documented substance use screening and electronic medical record (EMR)-documented prescribing of medications for opioid use disorder (OUD) and alcohol use disorder (AUD), during the year before implementation (January 1-December 31, 2018) and the first year after implementation (April 1, 2019-March 31, 2020). Rate ratios comparing post-implementation with pre-implementation periods were estimated. To assess robustness to unmeasured confounding, we conducted prior event rate ratio analyses.
resultsAmong 2397 PWH evaluated during the post-implementation period at the intervention clinic (mean age 52.2 years, 63% male, 79% Black), RESTORE implementation was associated with increased documented substance use screening (PERR-adjusted RR 1.12; 95% CI 1.02, 1.22). Although EMR-documented OUD/AUD medication prescribing increased following implementation, estimates were wide after PERR adjustment (PERR-adjusted RR 1.79; 95% CI 0.63, 5.57).
conclusionIn this real-world clinic-level evaluation, RESTORE implementation was associated with improved documented substance use screening. Increases in EMR-documented OUD/AUD medication prescribing over one year were observed, but adjusted estimates demonstrated wide confidence intervals.
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