Brief Report: Availability of Substance Use Services at US HIV Care Facilities by Urbanicity

Ensuring access to substance use-related services (SUS)-including substance use disorder treatment, medication-assisted treatment, and syringe services-could improve the social determinants of health of people with HIV (PWH) with substance use disorder and reduce HIV transmission risk. We describe access to SUS at HIV care facilities by urbanicity.

We analyzed Medical Monitoring Project 2021 data from 514 HIV care facilities and linked these data to Medical Monitoring Project respondent data from 2019. We calculated weighted percentages of facility and patient characteristics by urbanicity of HIV care site: counties of ≥1,000,000 people [large metro (LM)]; 250,000-1,000,000 people (medium metro); or <250,000 people [small metro/nonmetro (SMN)]. We calculated and reported weighted percentages for service availability by urbanicity.

An estimated 72.1%, 15.2%, and 12.7% of facilities were in large, medium, and SMN counties, respectively. The percentage of PWH attending facilities with substance use disorder treatment available onsite was lower in SMN counties than LM counties (22.5% vs. 34.9%). The percentage attending facilities with no medication-assisted treatment availability either onsite or through referral was higher in SMN counties than LM counties (49.4% vs. 28.0%). A higher percentage of PWH attended facilities with no syringe services onsite or through referral in SMN areas than in LM areas (57.8% vs 48.3%).

Access to key SUS was lower among patients receiving HIV care in SMN counties. Improving access to SUS, especially for PWH attending HIV care facilities in small/nonmetro counties, may help support national goals for ending HIV and improving PWH's social determinants of health.