Improving linkage and retention in treatment among people living with HIV and comorbid substance use

HIV and substance use interact synergistically to exacerbate disease progression and contribute to poorer engagement in treatment. There is a lack of qualitative research exploring the complexity of systems that impact HIV patients' linkage to and retention in both substance use and HIV care. Data from qualitative individual interviews with 16 HIV and 13 substance use providers were analyzed using applied thematic analysis. Four themes emerged as barriers to linkage to care providers limited knowledge with appropriate referrals; limited access to treatment options within the community; difficult admission criteria to substance use facilities; and communication challenges across providers including power differential. Emergent themes as barriers to treatment retention were: unstable life of people who use drugs; providers' negative attitude and stigma towards patients; and transportation challenges. Interventions are needed to increase provider cross-training in HIV and substance use disorders, reduce barriers to accessing treatment, and improve communication across providers are needed.