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. 2022 Feb:133:108553.
doi: 10.1016/j.jsat.2021.108553. Epub 2021 Jun 24.

Mobile low-threshold buprenorphine integrated with infectious disease services

Amanda Rosecrans  1 , Robert Harris  2 , Ronald E Saxton  3 , Margaret Cotterell  2 , Meredith Zoltick  2 , Catherine Willman  2 , Ingrid Blackwell  2 , Joy Bell  2 , Darryl Hayes  2 , Brian Weir  4 , Susan Sherman  4 , Gregory M Lucas  3 , Adena Greenbaum  5 , Kathleen R Page  3
Affiliations

Mobile low-threshold buprenorphine integrated with infectious disease services

Amanda Rosecrans et al. J Subst Abuse Treat. 2022 Feb.

Abstract

Introduction: In 2018, the Baltimore City Health Department launched a mobile clinic called Healthcare on The Spot, which offers low-threshold buprenorphine services integrated with health care services to meet the needs of people who use drugs. In addition to buprenorphine management, The Spot offers testing and treatment for hepatitis C, sexually transmitted infections, and HIV, as well as pre-exposure prophylaxis for HIV, wound care, vaccinations, naloxone distribution, and case management.

Methods and materials: This cohort analysis includes clinical service data from the first 15 months of The Spot mobile clinic, from September 4, 2018, to November 23, 2019. The Spot co-located with the Baltimore syringe services program in five locations across the city. Descriptive data are provided for patient demographics and services provided, as well as percent of patients retained in buprenorphine treatment at one and three months. Logistic regression identified factors associated with retention at three months.

Results: The Spot mobile clinic provided services to 569 individuals from September 4, 2018, to November 23, 2019, including prescribing buprenorphine to 73.8% and testing to more than 70% for at least one infectious disease. Patients receiving a prescription for buprenorphine were more likely to be tested for HIV, hepatitis C, and sexually transmitted infections, as well as receive treatment for hepatitis C and preventive services including vaccination and naloxone distribution. The Spot initiated HIV treatment for four patients and HIV pre-exposure prophylaxis for twelve patients. More than 32% of patients had hepatitis C; nineteen of these patients initiated treatment for hepatitis C with eight having a documented cure. Buprenorphine treatment retention was 56.0% at one month and 26.2% at three months. Patients who were Black or receiving treatment for hepatitis C were more likely to be retained in buprenorphine treatment at three months.

Conclusions: Increasing access to integrated medical services and drug treatment through low-threshold, community-based models of care can be an effective tool for addressing the effects of drug use.

Keywords: Buprenorphine; Hepatitis C; Integrated care; Low-threshold; Mobile; Opioid use disorder.

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Figures

Figure 1:
Figure 1:. Hepatitis C care continuum for patients with positive HCV antibody on The Spot mobile clinic from September 4, 2018 to November 23, 2019
a 93 patients had positive rapid HCV antibody test, 90 self-reported prior diagnosis, and 19 of these reported being previously cured or in treatment elsewhere. b 24 patients had an undetectable HCV RNA, indicating previously resolved or cured infection. c 1 patient was referred to specialty care due to decompensated cirrhosis. d 1 patient was denied treatment by their insurance company. e 11 patients were lost to follow up before labs could be drawn 12 weeks after treatment.
See this image and copyright information in PMC

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