Medical providers on HIV treatment with active drug users: Challenges, benefits, and best practices

Background-This project explores medical providers' experiences with engaging active drug users in HIV treatment and identifies best practices for treating them. The NHAS identifies IDUs as highly vulnerable to acquiring HIV. Research has demonstrated that drug users are capable of successfully adhering to a HAART regimen; however, it also suggests that medical providers hold negative preconceptions about users and lack confidence in treating them. Methods-HRC conducted four focus groups and three interviews with medical providers. Providers were recruited via convenience sample at clinics or conferences. Providers answered open-ended questions about their experiences, including challenges faced in working with users, concerns about prescribing HAART and pain medication, and advice for physicians new to working with this population. HRC staff recorded and transcribed sessions, and qualitatively analyzed them using grounded theory. Results-Twenty medical providers participated in four focus groups and three interviews. Medical providers' experiences working with drug users were mixed. They identified personal and structural challenges that made treating users difficult, including rigid institutional regulations, propensity for users to miss appointments, and witnessing users' suffering and death. Providers recommended practitioners engage the support of a multidisciplinary treatment team, familiarize themselves with substance abuse resources and treatment modalities, and practice self-care. Participants encouraged measuring treatment success by quality of life or viral suppression rather than drug use cessation.Conclusions-Providers described varied experiences and strategies for engaging drug users in care that warrant further examination. Development of tools and information on best practices for engaging active users in medical care is recommended.