Skip to main content

Table 1 Summery of included studies

From: Integrated care of severe infectious diseases to people with substance use disorders; a systematic review

Author/year of publication
Study description
Interventions with opioid agonist treatment Interventions without opioid agonist treatment
Achmad, Y.M. et al (2009) Batki, S.L. et al (2002) Bruce, D.R. et al (2012) Lucas, G.M. et al (2010) Morozova, O. et al (2013) Tetrault, J.M. et al (2012) Groessl, E.J. et al (2017) Ho, S.B. et al (2015) Sánchez, G.C. et al (2012) Simoni, J.M. et al (2007)
Aim To measure viral suppression among participants undergoing OAT and receiving ART. To evaluate drug use counseling and directly observed methadone and isoniazid treatments affect the TB treatment completion. To evaluate modified DOT compared to self-administered therapy (SOT) among HCV infected in OAT. To evalute OAT and HIV drug delivered in the HIV outpatient clinic versus specialized opioid treatment program To evaluate the effect of OAT compared to no OAT on people with substance use disorder hospitalized for TB treatment To evaluate a psychosocial intervention's effects on HIV viral suppression among OAT patients To measure the effect of a psychological intervention on SVR among participants undergoing HCV treatment To measure the effect of a psychological intervention on SVR among patients undergoing HCV treatment. To evaluate the effect of ART on HIV infected transmitted through inject drugs compared to HIV infected transmitted through intercourse. To compare the effect of an integrated intervention to standard care among HIV infected.
Method Cohort study. All participants were HIV infected. OAT is given as an intervention together with antiretrovirals in the OAT clinic. The control group receives antiretroviral without OAT. RCT. The intervention group receives directly observed methadone and isoniazid treatments and drug use disorder counseling. Additionally, psychiatric treatment and social work referrals as needed. The intervention group is compared in two different control groups. One of them the participants receive directly observed methadone and isoniazid/pyridoxine, but they received no counseling or any other services. The second control group receives routine care including a 6-month course of isoniazid preventive therapy. Pilot RCT. The intervention group receives HCV drugs and OAT in the OAT clinic. The control group self-administrated their HCV drugs. RCT. Participants with opioid dependence and HIV infection are included. The intervention group receives OAT and antiretroviral drug in the HIV clinic. Participants randomized to the control group are referred to the usual opioid treatment program. Cohort study. All participants are hospitalized and have opioid dependence are inlcuded. The intervention group receives OAT during completion of TB treatment. The control group receives TB medication without OAT. RCT. All participants have an opioid dependence and receive OAT. The intervention group receives enhanced medical management for up to 45 minutes per session delivered by a nurse. RCT. The intervention group receives psychological interventions which have a focus on motivating for treatment completion. The control group receives usual care in the treatment of HCV in the clinic. RCT. The intervention group receives psychological intervention and care management provided in a multidisciplinary team. The control group receives standard care and follow treatment guidelines within the HCV clinic. Cohort study. ART-naive and active substance users are admitted for drug dependence treatment and start antiviral medication. Those transmitted through sexual intercourse initiate antiretroviral treatment in a reference hospital. Participants receive DOT are excluded. The antiviral therapy is delivered monthly. RCT. The intervention group receives regular follow-up meetings and weekly phone calls from peers. The control group receives social and mental health referrals when requested, but no additional adherence assistance beyond the clinic's typical is offered.
Integrated care The intervention group receives OAT and antiretrovirals in the OAT clinic. The clinic offers multidisciplinary teams, counseling, HIV testing, CD4 cell count measurements and assessments for HIV. HIV assessment and treatment are integrated in the OAT clinic. The treatment is integrated team services offering counseling, social work, and psychiatric treatment. The OAT clinic offers a multidisciplinary team consists of medical and social workers. Participants are screened for mental illness, and test for severe infectious diseases such as HIV, HBV, and HCV. The assessments and treatments are integrated into the clinic. The intervention considers a collaborative model where opioid dependents are assessed and treated for OAT in the HIV clinic on regular basis. A multidisciplinary team is established and has weekly meetings to discuss the individual program for the participants. All recruited participants are hospitalized and offered integrated care of OAT and TB treatments. Onsite treatment of opioid dependence with OAT is integrated into the HIV primary care clinic. The clinic offers integrated psychiatric services, social work services, hepatitis C treatment, and dependence treatment. The intervention group receives psychological interventions delivered by a mental health provider before and during antiviral treatment. The mental health provider collaborates with different health professionals. Health professionals meet on a regular basis to discuss treatment progress. The intervention group receives integrated psychological interventions and care management provided in collaboration with clinic physicians, nurses, and other mental health providers. Additionally, training, monthly conference calls, patient discussion, frequent communications, and meetings are offered. The intervention group is followed up by a multidisciplinary team of two psychiatrists, one infectious-disease consultant, one social worker, one psychologist, and four trained nurses. The team designs, according to individual characteristics, substance use treatment, i.e., detoxification, and OAT assessment. The intervention group receives group meetings and weekly phone calls.
Study population and basic characteristics The study recruits 223 clients. Of those, 175 without OAT and 35 OAT participants. Basic characteristics between the groups are equal, except CD4 cell count. CD4 cell count for those on OAT (intervention) is 212 versus 224 for those without OAT, p = 0.05. Of the 111 individuals who are randomized, 37 are assigned to Standard Methadone Treatment, 35 to Minimal Methadone Treatment and 39 to Routine Care. All individuals injecting drugs. The basic characteristics are significant differences in the three groups on the following variables: age (p = 0,.047), The Addiction Severity Index psychiatric composite score (p = 0.03), and Beck Depression Inventory scores (p = 0.02). Twenty-one patients are recruited, 12 receive mDOT and nine self-administrated therapy. Differences in basic characteristics are not measured. In both groups, three participants are coinfected with HIV. Mean age of years are 40 and 43 in the intervention group and the control group, respectively. Fifty-eight percent in the intervention group and 33 % the control group are females. Nine mDOT participants and seven randomized to the control group have cocaine dependence. Ninety-three individuals are randomized. Forty-six assigned to the intervention and 47 to referred treatment. Basic characteristics are equal between the groups, expect injection drug use and co-infection with hepatitis C. Of the 110 participants enrolled, 57 in the intervention group and 53 in the control group. Basic charactersitics are significant differences in follow terms: site, age of years (OAT+TB: 61 %, > 36 year old, TB: 36 %, > 36 years old, p < 0.01), lifetime duration of substance use > 17 years (OAT+TB: 65 %, TB: 32 %, p < 0.01), amphetamine use 30 days prior to hospitalization (OAT+TB: 5 %, TB: 25 %, p < 0.01), < 4 TB drugs prescribed (OAT+TB: 39 %, TB: 18 %, p = 0.02), > 75 days inpatient stay at the baseline date (173 ± 170, TB: 74 ± 90, p < 0.01). Forty-seven participants are recruited. Of those, 22 are randomized to the intervention group and 25 to the control group. Basic characteristics are equal, expect duration of HIV infection (IG:9 years (SD = 6.5), CG: 15 years (SD = 4.6), p < 0.01). Benzodiazepine addicted are excluded. Of the 79 participants recruited, 39 are randomized to the control group and 40 to the intervention group. Basic characteristics are equal between the groups, expect age (p = 0.01). Of the 363 participants recruited, 182 are randomized to the intervention group and 181 participants to the control group. The basic characteristics between both groups are equal, expect single status (IG: 26.1 % versus CG: 19.4 % (p = 0.045)). Of the 119 participants, 71 active substance users and 48 participants transmitted through intercourse, are recruited. Basic characteristics are significantly different in the following variables: Origin (p = 0.01), age (p < 0.01), gender (p = 0.05), education level (p = 0.02), incarceration (p < 0.01), unemployment (p < 0.01), psychiatric disorders (p < 0.01), level of fibrosis (p < 0.01), hepatitis C coinfection (p < 0.01), and CD4 cell counts (p < 0.01). Participants with low compliance and homeless are not included. Of the 136 participants recruited, 71 are randomized to the intervention group and 65 to the control group. No significant differences in any sociodemographic or outcome variable are found, expect satisfaction with a social report (p < 0.05). Participants who have psychosis or dementia are excluded.
The poportion of participants with SUD 100% 100% 100% 100% 100% 100% In the intervention group and the control group, 48 % and 46 % report substance dependence, respectively. In the intervention group and the control group 65 % and 67 % report substance dependence, respectively. All included participants in the intervention group (60 %) Lifetime heavy substance use of crack or heroin are reported in 49 % in the intervention group and 54 % in the control group. A heavy lifetime alcohol use is reported in 48 % in both groups.
  1. Abbreviations: ART Antiretroviral therapy, CG Control group, DOT Direct observatory therapy, HBV Hepatitis B virus, HCV Hepatitis C virus, HIV Human immunodeficiency virus, IG Intervention group, mDOT Modified direct observatory therapy, OAT Opioid agonist therapy, RCT Randomized controlled trial, SD Standard deviation, SUD Substance use disorder, SVR Sustained virological response, TB Mycobactrium tuberculosis