Readiness to provide medications for opioid, alcohol and tobacco use disorder in HIV clinics: A multi-site mixed-methods formative evaluation.

Background We sought to characterize readiness, barriers to and facilitators of providing medications for addiction treatment (MAT) in HIV clinics. Setting Four HIV clinics in the US northeast. Methods Mixed-methods formative evaluation conducted June 2017-February 2019.Surveys assessed readiness (visual analog scale, less ready[0- 7-10]); evidence and context ratings for MAT provision; and preferred addiction treatment model. A subset (n=37) participated in focus groups. Results Among 71 survey respondents (48% prescribers), the proportion more ready to provide addiction treatment medications varied across substances (tobacco [76%], opioid [61%], alcohol [49%] treatment medications [p values 0.05). The majority favored integrating MAT into HIV care, but preferred models differed across substances. Barriers to MAT included identification of treatment-eligible patients; variable experiences with MAT and perceived medication complexity; perceived need for robust behavioral services, and inconsistent availability of on-site specialists. Facilitators included knowledge of adverse health consequences of opioid and tobacco use; local champions; focus on quality improvement and multidisciplinary teamwork. Conclusion Efforts to implement MAT in HIV clinics should address both gaps in perspectives regarding the evidence for MAT and contextual factors and may require substance specific models.