Integrating substance use services into HIV care: an underused implementation science opportunity

Substance use disorders (SUDs) are common among people with HIV (PWH) and have been linked to sub-optimal HIV care outcomes. Integration of substance use services into HIV care is an implementation strategy with potential to increase uptake of substance use services and improve HIV care outcomes. This review synthesizes recent U.S.-based studies on the epidemiology of substance use and HIV and integrated care models.

We identified 18 studies published between January 2023 and June 2025. These studies reported high prevalence of substance use among PWH, with disparities by race/ethnicity and sexual orientation. Examples of integrated care models ranged from co-located low-barrier clinics to brief behavioral interventions. Overall, integration strategies were feasible and acceptable but demonstrated variable levels of reach and impact on HIV care outcomes. Few studies explicitly used implementation science frameworks.

Effective integration of SUD and HIV care has the potential to improve uptake of substance use services, address disparities, and aligns with federal initiatives to achieve HIV and substance use public health goals, such as Ending the HIV Epidemic and HEAL. Increased application of implementation science could guide the evaluation of these programs and hopefully enhance their reach and impact.