Buprenorphine in the Primary HIV Care Setting  

Background:

Recent evidence suggests that increasing numbers of HIV+ persons served in Ryan White CARE Act-funded settings demonstrate opiate addictions and the need for related treatment. Barriers to receiving these addiction-related treatments and services include social stigma, lack of knowledge about available treatments and methods, and lack of providers able and willing to treat both HIV and drug addiction.

Buprenorphine is a newly available treatment of opiate addiction that could potentially serve the unique needs of these clients. By virtue of a provider’s ability to prescribe buprenorphine within an office setting, as opposed to within a specialized treatment clinic (e.g. methadone), buprenorphine presents an opportunity to overcome issues of access and stigma. Its contribution to the primary care setting in conjunction with HIV treatment has not been maximized however, and questions persist regarding its best use in this setting, as well as the financial mechanisms necessary to support its application.

Objectives:

The Forum will convene a workshop, with participation from experts in the fields of opiate addiction treatment and HIV treatment representing government, academia, clinicians, consumers, and industry to plan a workshop to:

• Identify barriers to implementation of buprenorphine into the primary HIV care setting

• Define parameters of use of buprenorphine in primary HIV care

• Analyze current approaches to integration from multiple levels (e.g., grassroots, agency, etc.) to determine opportunities for program modeling

• Recommend implementation strategies for the use of buprenorphine for HIV patients within the Ryan White CARE Act funded programs

• Discuss policy issues and examine funding mechanisms that enable provision of care

• Discuss a health services research agenda to better inform policy regarding the use of buprenorphine

• Develop criteria for assessing the impact of integration

Status:

The workshop was held on June 3-4, 2004 in Washington, DC.

Meeting Agenda

Topic	Speaker/Panelists	Moderator
Welcome and Introduction	Veronica Miller
HRSA Persepective	Laura Cheever

Session I

Topic	Speaker/Panelists	Moderator
Plenary Presentation: Buprenorphine 101: Basic Background and Framework	David Fiellin	Lynn Sullivan
Plenary Presentation: Buprenorphine Issues as They Relate to HIV	Frederick Altice
Discussion Session

Session II

Topic	Speaker/Panelists	Moderator
Poster Session	Colleen LaBelle, Dennis McCarty, Lynn Sullivan, Susan Whitley
Panel Discussion: Experiences of Buprenorphine Use: the Good, Bad, and Hopeful	Douglas Bruce, James Finch, David Haltiwanger, Colleen LaBelle	Lois Eldred

Session III
Breakout sessions

Topic	Reporters	Moderator
Systems and Programs	Alice Gleghorn	Jeff Levi
Support for Care Teams	Gregory Lucas	David Fiellin
Patient-Centered Approaches	David Haltiwanger	Fredrick Altice

Session IV

Topic	Speaker/Panelists	Moderator
Presentation of Breakout Sessions	Alice Gleghorn, David Haltiwanger, Gregory Lucas	Veronica Miller
Discussion Session

Session V

Topic	Speaker/Panelists	Moderator
Plenary Presentation: Financing Issues Across Agencies	Jeff Levi	Sharon Stancliff
Panel Discussion: Integration Issues Including: Cost-Effectiveness, Finance, Regulation, & Research Gaps	Lawrence Brown, Laura Cheever, Jerry Flanzer, Steven Kipnis, Robert Lubran, Dennis McCarty, Joseph Merrill

Session VI

Topic	Speaker/Panelists	Moderator
Final Discussion Round		Veronica Miller, Jeff Levi

Project Manager
Craig A Hunter

Project Specific Sponsor
HRSA

Project Travel Support
SAMHSA