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. 2017 May 30;20(1):21585.
doi: 10.7448/IAS.20.1.21585.

Integrating HIV and substance use services: a systematic review

Victoria Haldane  1 , Francisco Cervero-Liceras  1 , Fiona Lh Chuah  1 , Suan Ee Ong  1 , Georgina Murphy  2 , Louise Sigfrid  2 , Nicola Watt  3 , Dina Balabanova  4 , Sue Hogarth  5   6 , Will Maimaris  5   7 , Kent Buse  6   8 , Peter Piot  5 , Martin McKee  3 , Pablo Perel  5   9 , Helena Legido-Quigley  1   5
Affiliations

Integrating HIV and substance use services: a systematic review

Victoria Haldane et al. J Int AIDS Soc. .

Abstract

Introduction: Substance use is an important risk factor for HIV, with both concentrated in certain vulnerable and marginalized populations. Although their management differs, there may be opportunities to integrate services for substance use and HIV. In this paper we systematically review evidence from studies that sought to integrate care for people living with HIV and substance use problems.

Methods: Studies were included if they evaluated service integration for substance use and HIV. We searched multiple databases from inception until October 2015. Articles were screened independently by two reviewers and assessed for risk of bias.

Results and discussion: 11,057 records were identified, with 7616 after removal of duplicates. After screening titles and abstracts, 51 met the inclusion criteria. Integration models were categorized by location (HIV, substance use and other facilities), level of integration from mirco (integrated care delivered to individuals) to macro (system level integrations) and degree of integration from least (screening and counselling only) to most (care for HIV, substance use and/or other illnesses at the same facility). Most reported descriptive or cohort studies; in four randomized control trials integrated activities improved patient outcomes. There is potential for integrating services at all facility types, including mobile health services. While services offering screening only can achieve synergies, there are benefits from delivering integrated treatment for HIV and substance use, including ease of referral to other mental health and social services.

Conclusions: Our review used a wide range of databases and conference archives to increase representation of papers from low- and middle-income countries. Limitations include the overrepresentation of studies from the United States, and the descriptive nature of the majority of papers. The evidence reviewed shows that greater integration offers important benefits in both patient and service outcomes but further research and outcome reporting is needed to better understand innovative and holistic care models at the complex intersection of substance use and HIV services.

Keywords: HIV; integration; public health; substance use; systematic review.

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Conflict of interest statement

None.

Figures

Figure 1.
Figure 1.
Study flow diagram.
Figure 2.
Figure 2.
Models of integration of HIV and substance use services.
Figure 3.
Figure 3.
Map of integration by type and prevalence of HIV amongst persons who inject drugs.
See this image and copyright information in PMC

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