TY - JOUR
KW - Analgesics, Opioid/therapeutic use
KW - Antitubercular Agents/therapeutic use
KW - collaborative care
KW - Communicable Diseases/complications/diagnosis
KW - Delivery of Health Care, Integrated
KW - Epidemiology
KW - Hepatitis C
KW - HIV Infections/complications/diagnosis/mortality
KW - human immunodeficiency virus
KW - Humans
KW - integrated care
KW - Mycobacterium tuberculosis
KW - Randomized Controlled Trials as Topic
KW - Substance use disorder
KW - Substance-Related Disorders/complications/diagnosis/drug therapy
KW - Sustained Virologic Response
KW - Systematic Review
KW - Tuberculosis/complications/diagnosis/drug therapy
AU - J. H. Vold
AU - C. Aas
AU - R. A. Leiva
AU - P. Vickerman
AU - F. Chalabianloo
AU - E. M. Loberg
AU - K. A. Johansson
AU - L. T. Fadnes
A1 - 
AB - BACKGROUND: Various integrated care models have been used to improve treatment completion of medications for chronic hepatitis B virus (HBV), chronic hepatitis C virus (HCV), Mycobacterium tuberculosis (TB), and Human immunodeficiency virus (HIV) among people with substance use disorders (SUD). We have conducted a systematic review to evaluate whether integrated models have impacts of the treatment of infectious diseases among marginalized people with SUD. METHODS: We searched MEDLINE/PubMed (1946 to 2018, on July 26, 2018) and Embase (from 1974 to 2018, on July 26, 2018) for randomized controlled trials (RCTs) and cohort studies evaluating diverse integrated models' effects on sustained virological response (SVR), HIV suppression, HBV curation or suppression, completion of TB treatment regimen among people with SUD. The included studies were assessed qualitatively. RESULTS: Altogether, 1640 studies, and references to 1135 related reviews and RCTs were considered, and only seven RCTs and three cohort studies fulfilled the inclusion criteria. We identified nine integrated care models. Two studies, one RCT and one cohort study, showed a significant effect of their integrated models. The RCT evaluated psychosocial treatment, opioid agonist treatment (OAT) and directly observed TB treatment, and found a significant increase in TB treatment completions among intervention group compared to control group (60% versus 13%, p < 0.01). The cohort study including OAT and TB treatments had an effect on TB treatment completion in hospitalized patients (89% versus 73%, p = 0.03). Eight out of ten studies showed no significant effects of their integrated care models on defined outcomes. One of which having included 363 participants in a RCT showed no effect on SVR compared to the control group when the results adjusted for active substance use and alcohol dependence in a post-hoc analysis (11% versus 7%, p = 0.49). CONCLUSIONS: The findings indicate uncertainty on the effects of integrated care models' on treatment for severe infectious diseases among people with SUD. Some studies point toward that integrated models could improve care of people with SUD, yet high-quality studies and preferably, sufficiently sized clinical trials are needed to conclude on the degree of impact.
BT - BMC infectious diseases
C5 - Healthcare Disparities
CP - 1
CY - England
DO - 10.1186/s12879-019-3918-2
IS - 1
JF - BMC infectious diseases
N2 - BACKGROUND: Various integrated care models have been used to improve treatment completion of medications for chronic hepatitis B virus (HBV), chronic hepatitis C virus (HCV), Mycobacterium tuberculosis (TB), and Human immunodeficiency virus (HIV) among people with substance use disorders (SUD). We have conducted a systematic review to evaluate whether integrated models have impacts of the treatment of infectious diseases among marginalized people with SUD. METHODS: We searched MEDLINE/PubMed (1946 to 2018, on July 26, 2018) and Embase (from 1974 to 2018, on July 26, 2018) for randomized controlled trials (RCTs) and cohort studies evaluating diverse integrated models' effects on sustained virological response (SVR), HIV suppression, HBV curation or suppression, completion of TB treatment regimen among people with SUD. The included studies were assessed qualitatively. RESULTS: Altogether, 1640 studies, and references to 1135 related reviews and RCTs were considered, and only seven RCTs and three cohort studies fulfilled the inclusion criteria. We identified nine integrated care models. Two studies, one RCT and one cohort study, showed a significant effect of their integrated models. The RCT evaluated psychosocial treatment, opioid agonist treatment (OAT) and directly observed TB treatment, and found a significant increase in TB treatment completions among intervention group compared to control group (60% versus 13%, p < 0.01). The cohort study including OAT and TB treatments had an effect on TB treatment completion in hospitalized patients (89% versus 73%, p = 0.03). Eight out of ten studies showed no significant effects of their integrated care models on defined outcomes. One of which having included 363 participants in a RCT showed no effect on SVR compared to the control group when the results adjusted for active substance use and alcohol dependence in a post-hoc analysis (11% versus 7%, p = 0.49). CONCLUSIONS: The findings indicate uncertainty on the effects of integrated care models' on treatment for severe infectious diseases among people with SUD. Some studies point toward that integrated models could improve care of people with SUD, yet high-quality studies and preferably, sufficiently sized clinical trials are needed to conclude on the degree of impact.
PP - England
PY - 2019
SN - 1471-2334; 1471-2334
SP - 306
T1 - Integrated care of severe infectious diseases to people with substance use disorders; a systematic review
T2 - BMC infectious diseases
TI - Integrated care of severe infectious diseases to people with substance use disorders; a systematic review
U1 - Healthcare Disparities
U2 - 30947701
U3 - 10.1186/s12879-019-3918-2
VL - 19
VO - 1471-2334; 1471-2334
Y1 - 2019
ER -