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Case management for substance abusers with HIV/AIDS: a randomized clinical trial
James L Sorensen1, James Dilley, Julie London
1Department of Psychiatry, San Francisco General Hospital, University of California, San Francisco, California, USA. james@itsa.ucsf.edu
The American Journal of Drug and Alcohol Abuse
|May 7, 2003
Summary
Case management did not improve outcomes for patients with HIV/AIDS and substance abuse compared to brief contact. Initial improvements were not sustained, and mortality remained significant.
Area of Science:
- Public Health
- Clinical Medicine
- Addiction Research
Background:
- Patients with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) often experience co-occurring substance abuse.
- Effective interventions are needed to manage complex health and social needs in this population.
Purpose of the Study:
- To compare the effectiveness of 12-month case management versus brief contact for substance-abusing patients with HIV/AIDS.
- To assess the impact of interventions on substance use, HIV transmission risk, physical and psychological health, and living situation.
Main Methods:
- Random assignment study involving substance-abusing patients with HIV/AIDS in a public general hospital.
- Intervention groups: brief contact vs. 12 months of paraprofessional-delivered case management.
- Outcomes measured at intake, 6, 12, and 18 months.
Main Results:
- Both groups showed initial problem reduction from intake to 6 months, with no further significant changes at 12 or 18 months.
- No significant differences in major outcome variables were found between case management and brief contact conditions.
- Sixteen percent of participants died by the 18-month follow-up.
Conclusions:
- The study does not support the hypothesis that case management is superior to brief contact for improving outcomes in this patient population.
- Variability in case management delivery and its lack of correlation with outcomes suggest potential implementation challenges.
- Further research is needed to identify optimal support strategies for individuals with co-occurring HIV/AIDS and substance use disorders.