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Substance use and the HIV care continuum

Edited by:  Dr P. Todd Korthuis and Dr Jennifer Edelman

The HIV care continuum – also referred to as the HIV treatment cascade – identifies five stages of HIV medical care: 1) HIV diagnosis, 2) linkage to HIV care, 3) engagement and retention in HIV care, 4) treatment with antiretroviral therapy (ART), and 5) achievement of HIV viral suppression – all of which are essential in order to effectively treat and prevent the spread of HIV. Recent data from the U.S. estimate that 86% of people living with HIV are diagnosed, 40% are engaged in care, 37% receive ART, and only 30% achieve HIV viral suppression. People who use drugs and alcohol are particularly likely to experience gaps in each stage of the HIV care continuum, preventing them from realizing improvements in HIV survival. Screening for and treating substance use disorders may close these gaps in care and help achieve the UNAIDS 90-90-90 goal of achieving 90% diagnosis, 90% ART treatment, and 90% HIV viral suppression by 2020.

This thematic series in Addiction Science & Clinical Practice highlights articles that address the impact of drug and/or alcohol use on the HIV care cascade and specifically the role of substance use disorder screening and treatment as a means of meeting the 90-90-90 goal.

The Editors of the series declare no competing interests.

  1. Research

    Convenience without disclosure: a formative research study of a proposed integrated methadone and antiretroviral therapy service delivery model in Dar es Salaam, Tanzania

    Though timely initiation of antiretroviral therapy (ART) is a vital component of effective HIV prevention, care and treatment, people who inject drugs are less likely to receive ART than their non-drug using c...

    Alexis Cooke, Haneefa Saleem, Dorothy Mushi, Jessie Mbwambo, Saria Hassan and Barrot H. Lambdin

    Addiction Science & Clinical Practice 2017 12:23

    Published on: 18 October 2017

  2. Research

    Barriers and facilitators of the HIV care continuum in Southern New England for people with drug or alcohol use and living with HIV/AIDS: perspectives of HIV surveillance experts and service providers

    Contemporary studies about HIV care continuum (HCC) outcomes within substance using populations primarily focus on individual risk factors rather than provider- or systems-level influences. Over 25% of people...

    Lauretta E. Grau, Abbie Griffiths-Kundishora, Robert Heimer, Marguerite Hutcheson, Amy Nunn, Caitlin Towey and Thomas J. Stopka

    Addiction Science & Clinical Practice 2017 12:24

    Published on: 2 October 2017

  3. Research

    Alcohol consumption patterns and HIV viral suppression among persons receiving HIV care in Florida: an observational study

    Alcohol consumption has been associated with poor antiretroviral therapy (ART) adherence but less is known about its relationship to HIV viral suppression, or whether certain drinking patterns have a stronger ...

    R. L. Cook, Z. Zhou, N. E. Kelso-Chichetto, J. Janelle, J. P. Morano, C. Somboonwit, W. Carter, G. E. Ibanez, N. Ennis, C. L. Cook, R. A. Cohen, B. Brumback and K. Bryant

    Addiction Science & Clinical Practice 2017 12:22

    Published on: 27 September 2017

  4. Research

    HIV treatment cascade among female entertainment and sex workers in Cambodia: impact of amphetamine use and an HIV prevention program

    HIV prevalence remains high in Cambodia among female entertainment and sex workers (FESW), and amphetamine-type stimulant (ATS) use significantly increases risk of infection. A successful continuum of care (Co...

    Sokunny Muth, Aynar Len, Jennifer L. Evans, Maly Phou, Sophal Chhit, Yuthea Neak, Song Ngak, Ellen S. Stein, Adam W. Carrico, Lisa Maher and Kimberly Page

    Addiction Science & Clinical Practice 2017 12:20

    Published on: 5 September 2017

  5. Research

    Enhancing patient navigation to improve intervention session attendance and viral load suppression of persons with HIV and substance use: a secondary post hoc analysis of the Project HOPE study

    Interventions are needed to improve viral suppression rates among persons with HIV and substance use. A 3-arm randomized multi-site study (Metsch et al. in JAMA 316:156–70, 2016) was conducted to evaluate the ef...

    Maxine Stitzer, Tim Matheson, Colin Cunningham, James L. Sorensen, Daniel J. Feaster, Lauren Gooden, Alexis S. Hammond, Heather Fitzsimons and Lisa R. Metsch

    Addiction Science & Clinical Practice 2017 12:16

    Published on: 27 June 2017

  6. Research

    Associations of criminal justice and substance use treatment involvement with HIV/HCV testing and the HIV treatment cascade among people who use drugs in Oakland, California

    People who smoke crack cocaine and people who inject drugs are at-risk for criminal justice involvement as well as HIV and HCV infection. Compared to criminal justice involvement, substance use treatment (SUT)...

    Barrot H. Lambdin, Alex H. Kral, Megan Comfort, Andrea M. Lopez and Jennifer Lorvick

    Addiction Science & Clinical Practice 2017 12:13

    Published on: 14 June 2017

  7. Research

    Seek, test, treat: substance-using women in the HIV treatment cascade in South Africa

    Women in South Africa who use alcohol and other drugs face multiple barriers to HIV care. These barriers make it difficult for women to progress through each step in the HIV treatment cascade from diagnosis to...

    Wendee M. Wechsberg, Charles van der Horst, Jacqueline Ndirangu, Irene A. Doherty, Tracy Kline, Felicia A. Browne, Jennifer M. Belus, Robin Nance and William A. Zule

    Addiction Science & Clinical Practice 2017 12:12

    Published on: 26 April 2017

  8. Research

    Acceptability of a mobile health intervention to enhance HIV care coordination for patients with substance use disorders

    Persons living with HIV and substance use disorders face barriers to sustained engagement in medical care, leading to suboptimal antiretroviral treatment outcomes. Innovative mobile technology tools such as cu...

    Ryan P. Westergaard, Andrew Genz, Kristen Panico, Pamela J. Surkan, Jeanne Keruly, Heidi E. Hutton, Larry W. Chang and Gregory D. Kirk

    Addiction Science & Clinical Practice 2017 12:11

    Published on: 26 April 2017

  9. Study protocol

    Mobile technology intervention to improve care coordination between HIV and substance use treatment providers: development, training, and evaluation protocol

    People living with HIV (PLWH) with a substance use disorder (SUD) tend to receive inadequate medical care in part because of a siloed healthcare system in which HIV and substance use services are delivered sep...

    Kasey Claborn, Sara Becker, Susan Ramsey, Josiah Rich and Peter D. Friedmann

    Addiction Science & Clinical Practice 2017 12:8

    Published on: 14 March 2017

The article processing charge for a select number of articles in this series was funded by the National Institute on Drug Abuse (NIDA), the National Drug Abuse Treatment Clinical Trials Network and the NIDA/SAMHSA Blending Initiative. This has been individually acknowledged within the articles. All articles in this series have undergone the journal’s full standard peer-review process.