Journal
JOURNAL OF ADDICTION MEDICINE
Volume 4, Issue 4, Pages 204-210Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/ADM.0b013e3181cc9610
Keywords
patient-centered care; physician-patient relations; buprenorphine; HIV/AIDS; opioid-related disorders
Categories
Funding
- Health Research and Services Administration [1-H97-HA03782-01]
- National Institutes of Health
- National Institute on Drug Abuse [K23DA019809, R01DA016341]
- Oregon Clinical and Translational Research Institute (OCTRI), National Center for Research Resources (NCRR) [UL1 RR024140]
- National Institutes of Health (NIH)
- National Institute of Mental Health [K23MH073008]
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Objective: To explore human immunodeficiency virus (HIV)-infected patients' attitudes about buprenorphine treatment in office-based and opioid treatment program (OTP) settings. Methods: We conducted in-depth qualitative interviews with 29 patients with coexisting HIV infection and opioid dependence seeking buprenorphine maintenance therapy in office-based and OTP settings. We used thematic analysis of transcribed audiorecorded interviews to identify themes. Results: Patients voiced a strong preference for office-based treatment. Four themes emerged to explain this preference. First, patients perceived the greater convenience of office-based treatment as improving their ability to address HIV and other healthcare issues. Second, they perceived a strong patient-focused orientation in patient- provider relationships, underpinning their preference for office- based care. This was manifested as increased trust, listening, empathy, and respect from office-based staff and providers. Third, they perceived shared power and responsibility in office-based settings. Finally, patients viewed office-based treatment as a more supportive environment for sobriety and relapse prevention. This was, in part, due to strong therapeutic alliances with office-based staff and providers who prioritized a harm reduction approach and also the perception that the office-based settings were safer for sobriety, compared with increased opportunities for purchasing and using illicit opiates in OTP settings. Conclusions: HIV-infected patients with opioid dependence preferred office-based buprenorphine, because they perceived it as offering a more patient-centered approach to care compared with OTP referral. Office-based buprenorphine may facilitate engagement in care for patients with coexisting opioid dependence and HIV infection.
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