HIV/AIDS Treatment and Care : Clinical protocols for the European ...

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HIV/AIDS TREATMENT AND CARE CLINICAL PROTOCOLS FOR THE WHO EUROPEAN REGION
Other benefits of prescribing HAART in OST clinics include:
• the possibility of concurrent long-term treatment for drug dependence and HIV/AIDS;
• the opportunity to use directly observed treatment (DOT) in dispensing ART to patients who
already visit the clinics daily to receive methadone; 7 and
• experience in treating medical conditions related to substance use (1, 51).
There is evidence that DOT is an effective strategy in the provision of HAART with treatment for
substance dependence. Using DOT to provide HAART in conjunction with methadone maintenance
is recommended because it:
• results in significant numbers of patients achieving maximum viral suppression (11);
• achieves higher levels of viral suppression than either standard care or treatment adherence support
(48); and
• minimizes the impact of HAART on the IDU’s daily routine.
1.4. Psychosocial support
Services that can address both the biomedical needs and the psychosocial issues of IDUs concurrently
are essential. There is a wide range of psychosocial support services that should be available
in accordance with the patient needs of IDUs, including:
• support services for adherence to ART;
• psychological support, such as group therapy for IDUs and family members;
• peer support groups;
• educational programmes;
• psychiatric/psychological services for assessment and management of mental health disorders;
and
• social services to deal with problems related to housing, employment, finances, legal matters,
discrimination and other issues.
Former IDUs often have been uniquely successful in educating and motivating current IDUs to:
• access effective prevention, treatment and care services
• prepare for treatment, e.g. through advice on possible side-effects associated with ARVs
• adhere to HAART and other treatments.
2. Models of comprehensive HIV/AIDS care for IDUs
HIV/AIDS treatment and care, including HAART, should be delivered as part of a comprehensive
care model. Combining or integrating HIV/AIDS and substance dependence services provides opportunities
for HIV prevention, enhances adherence to both HIV/AIDS and substance dependence
treatment and provides better overall care. A comprehensive service develops expertise in effectively
treating substance dependence and providing HIV care. There are several models for effectively
combining HIV prevention, treatment and care with substance dependence treatment, including:
• a single site for both HIV/AIDS care and substance dependence treatment:
° on-site HIV/AIDS medical care in substance dependence treatment facilities or
° substance dependence treatment in HIV/AIDS services; 8
• separate HIV/AIDS and substance dependence treatment services in close proximity with good
coordination and liaising, including referrals to other services; and
• primary care services for both drug dependence management and HIV/AIDS care through general
practitioners or office-based practice.
7 A second “take-home” dose of ARV drugs is also likely needed.
8 A variation on the one-site model is a mobile health care service linked, for example, to a HIV/AIDS medical care centre,
a substance dependence treatment facility or a harm-reduction service. Mobile services can provide HIV and STI screening,
HIV/AIDS treatment, referrals for substance dependence treatment and mental health and other services.