HIV Infections Clinical Trial
Official title:
Buprenorphine Effectiveness Evaluation in HIV Enhancement (BEEHIVE): A Randomized Trial of HIV Clinic-based Buprenorphine/Naloxone vs. Case Management and Referral in Opioid-dependent Individuals
The purpose of this study is to compare the effectiveness of two approaches to treating
HIV-infected patients who are addicted to opioid drugs (e.g., heroin) in an inner-city HIV
clinic. The two approaches are:
- Case management and referral - participants are managed by a case manager and referred
to a specialized drug treatment center where they receive counseling and medications
for opioid-dependence (e.g., methadone or buprenorphine); or
- Clinic-based treatment - participants receive counseling and treatment with
buprenorphine at the HIV clinic.
We, the investigators at Johns Hopkins University, propose to enroll and randomize 120
opioid-dependent, HIV-infected participants, who receive care in the Johns Hopkins HIV
Clinic to either:
- clinic-based care with buprenorphine (clinic-based BPN/NX arm); or
- case management and referral to an opioid treatment program for opioid agonist-based
therapy (case management and referral arm).
The study interventions and follow-up will last 12 months. Participants will be enrolled
over a 3-year period. Participants who are assigned to the clinic-based BPN/NX arm will
receive BPN/NX (Suboxone®), individual counseling from a nurse interventionist, and group
therapy sessions. Participants who are assigned to the case management and referral arm will
be enrolled in an established case management and adherence program in the Johns Hopkins HIV
Clinic (Project LINK). LINK provides intensive case management, education, and support by a
team that includes a social worker, a nurse, a pharmacist educator, and peer advocates. In
addition to providing counseling and linkage to needed services, LINK will expedite intake
at licensed opioid treatment programs that provide agonist-based therapy for opioid
dependence. The clinic-based BPN intervention is a new strategy that was developed in a
pilot project over the past 6 months. The case-management and referral arm represents
standard-of-care in our clinic, which has been enhanced and codified for this trial. Study
outcome visits will be performed at baseline, 1 month, 3 months, 6 months, 9 months, and 12
months.
Comparisons:
- Retention to substance abuse treatment;
- Urine drug screens;
- Adherence to HIV primary care provider visits;
- Use of and adherence to highly active antiretroviral therapy (HAART);
- HIV RNA levels and CD4 cell counts;
- HIV transmission risk behaviors (e.g., injection, sharing of drug paraphernalia, sexual
behaviors);
- Costs and resource utilization.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
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