Table 1 Barriers to integrating HIV and SUD services for clients with multiple biopsychological and socioeconomic issues
Articles | Sample | Client-provider domain | Client-organization domain | Client-system domain |
|---|---|---|---|---|
Primary care setting | ||||
Turner et al. [40] | Clients | ♦ Concerns about drug users’ lacking adherence to ART or HAART ♦ Biases toward former drug users | ||
Lucas et al. [41] | Clients | ♦ Inability to keep scheduled clients ♦ Emergency care services overload ♦ Distrust of medical establishment | ♦ Unstable life conditions ♦ Social isolation | |
Loughlin et al. [42] | Providers | ♦ Negative attitudes toward clients’ appointment truancy and HIV denial ♦ Concerns about HIV medication and drug use interactions | ♦ Homelessness ♦ Social isolation ♦ Unstable life conditions | |
Ding et al. [43] | Clients and providers | ♦ Lack experiences in treating IDUs ♦ Bias towards HIV-infected IDUs’ ♦ Ability to adhere to treatment ♦ Provider afflicted by depression and stress | ♦ High caseload | |
Turner et al. [44] | Providers | ♦ Lack of knowledge about the efficacy of methadone in HIV prevention | ♦ Lack of familiarity with clients who misuse narcotics due to low volume ♦ Lack of social workers, counselors, psychiatrists, and psychologists ♦ Burdensome paperwork ♦ Lack of HIV specialty services | ♦ Inadequate financial reimbursement |
Ware et al. [45] | Clients | ♦ Bias towards treatment adherence ♦ Lack of awareness of the stabilizing role of HAART medication | ♦ Stigma about HIV-positive drug users ♦ Unstable life conditions | |
Vaughn [46] | Provider | ♦ Bias toward clients: - Denial of medication effectiveness - Distrust of the medical establishment - Beliefs about HIV infection as a man-made form of genocide - Difficulties controlling substance use due to pain management - Mental health conditions | ♦ Long waitlist for substance use disorder treatment ♦ Lack of interprofessional collaboration ♦ Lack of pain management therapies ♦ Negative experiences with the medical establishment | ♦ Disenfranchisement ♦ Lack of insurance for substance use disorder treatments |
Cunningham et al. [47] | Providers | ♦ Lack of confidence/knowledge to address substance misuse, drug interaction, and substance misuse treatment approaches | ♦ Lack of collaboration across service providers in different health systems | ♦ Shortage of licensed buprenorphine prescribers |
Macalino et al. [48] | Providers | ♦ Lack of knowledge and negative attitudes toward syringe sharing, exchange programs, distribution practices, and syringe prescription as HIV prevention | ♦ Lack of familiarity with IDUs | ♦ Pharmacist stigma against IDUs ♦ Police stigma against IDUs |
Westergaard et al. [49] | Providers | ♦ Discomfort treating IDUs with HIV ♦ Bias toward IDUs’ inability to adhere to HAART | ♦ Lack of HIV or SUD services ♦ Lack of experts in HIV care ♦ High caseload ♦ Lack of familiarity with HIV clients | |
Gwadz et al. [50] | Clients | ♦ Poor provider-client communication ♦ Distrust between provider and client ♦ Stigmatization of and minimization of clients’ life experiences | ♦ Racism ♦ Poverty ♦ Lack of social support ♦ Housing instability ♦ Lack of public assistance | |
Campbell et al. [51] | Providers | ♦ Provider lacking flexibility and creativity in decision-making ♦ Poor provider-client communication ♦ Provider negative attitudes towards clients’ substance use | ♦ Bureaucratic barriers (e.g., paperwork) ♦ Lack of and poor quality of outreach services ♦ Lack of coordinating staff ♦ Lack of referral tracking and evaluation system | ♦ Housing instability ♦ Illicit drug use |
Substance use disorder (SUD) treatment setting | ||||
Whetten et al. [52] | Clients | ♦ Lack of transportation and inaccessible service resources | ||
Spector et al. [10] | Providers | ♦ Lack of knowledge and bias toward: - Clients’ ability to PrEP adherence - “Risk compensation” - PrEP side effects - PrEP reimbursement ♦ Lack of training in psycho-pharmacology | ♦ Lack of structure for referral making ♦ Lack of staff to prescribe PrEP and to monitor adherence | |
Shrestha et al. [53] | Clients | ♦ Irregular access to PrEP refills or follow-up visits | ♦ High PrEP medication cost ♦ Lack of insurance coverage ♦ Stigma and social discrimination | |
Roth et al. [54] | Clients | ♦ Lack of PrEP education access | ♦ Lack of access to primary care and thus HIV risk assessment exposure and PrEP education | |
Multiple settings | ||||
Downing et al. [55] | Providers | ♦ Lack of flexible testing hours ♦ Distrust of organization’s treatment of confidential information ♦ Lack of training for providers ♦ Inadequate collaborations across agencies | ♦ Distrust of government’s treatment of confidential information | |
Wyatt et al. [56] | Clients | ♦ Poor provider-client relationship and distrust | ♦ Long wait lists and difficulty obtaining an appointment ♦ Distrust of organization’s treatment of confidential information | ♦ Financial problems |
Knowlton et al. [57] | Clients | ♦ Poor provider-client communication | ♦ Lack of outpatient services | ♦ Lack of social support ♦ Housing instability ♦ Racism |
Wright et al. [58] | Providers | ♦ Lack of capacity to provide HIV testing ♦ Additional administrative or clinical burdens coming with service integration ♦ Poor inter- and intra-agency communication | ♦ Lack of political support for HIV test (low awareness, funding, priority) ♦ Lack of regulations addressing service integration ♦ Lack of transportation ♦ Lacks state funding and infrastructure supporting service integration | |
Biello et al. [59] | Clients and providers | ♦ Poor provider-client relationship and distrust ♦ Low willingness to prescribe PrEP to drug users | ♦ Burdensome PrEP screening and retention protocols ♦ Lack of professional and interagency collaboration | ♦ HIV-related stigma ♦ Poor regional infrastructure and capacity for PrEP delivery ♦ Housing instability ♦ Poverty ♦ Disenfranchisement ♦ Transportation difficulties |
Other settings | ||||
Schoeneberger et al. [60] (NIDA Cooperative Agreement in Kentucky) | Clients | ♦ Long waitlist ♦ Some programs do not take women or women with children | ♦ Poverty ♦ Lack of regional substance use treatment resources ♦ Gender bias in treatment eligibility criteria | |
Lutnick et al. [61] (pharmacy) | Clients | ♦ Stigmatization of clients’ behaviors | ♦ Lack of private space for clients to dispose of syringes and receive services ♦ Distrust of organization’s treatment of confidential information | |