Study protocol for the targeting effective analgesia in clinics for HIV (TEACH) study - a cluster randomized controlled trial and parallel cohort to increase guideline concordant care for long-term opioid therapy among people living with HIV.
Marlene C LiraJudith I TsuiJane M LiebschutzJonathan A ColasantiChristin M RootDebbie M ChengAlexander Y WalleyMeg SullivanChristopher W ShanahanKristen O'ConnorCatherine AbramsLeah S FormanChristine E ChaissonCarly BriddenMelissa C PodolskyKishna OutlawCatherine E HarrisWendy S ArmstrongCarlos Del RioJeffrey H SametPublished in: HIV research & clinical practice (2020)
Background: People living with HIV (PLWH) frequently experience chronic pain and receive long-term opioid therapy (LTOT). Adherence to opioid prescribing guidelines among their providers is suboptimal. Objective: This paper describes the protocol of a cluster randomized trial, targeting effective analgesia in clinics for HIV (TEACH), which tested a collaborative care intervention to increase guideline-concordant care for LTOT among PLWH. Methods: HIV physicians and advanced practice providers (n = 41) were recruited from September 2015 to December 2016 from two HIV clinics in Boston and Atlanta. Patients receiving LTOT from participating providers were enrolled through a waiver of informed consent (n = 187). After baseline assessment, providers were randomized to the control group or the year-long TEACH intervention involving: (1) a nurse care manager and electronic registry to assist with patient management; (2) opioid education and academic detailing; and (3) facilitated access to addiction specialists. Randomization was stratified by site and LTOT patient volume. Primary outcomes (≥2 urine drug tests, early refills, provider satisfaction) were collected at 12 months. In parallel, PLWH receiving LTOT (n = 170) were recruited into a longitudinal cohort at both clinics and underwent baseline and 12-month assessments. Secondary outcomes were obtained through patient self-report among participants enrolled in both the cohort and the RCT (n = 117). Conclusions: TEACH will report the effects of an intervention on opioid prescribing for chronic pain on both provider and patient-level outcomes. The results may inform delivery of care for PLWH on LTOT for chronic pain at a time when opioid practices are being questioned in the US.
Keyphrases
- chronic pain
- pain management
- primary care
- healthcare
- antiretroviral therapy
- quality improvement
- hiv positive
- hiv infected
- randomized controlled trial
- palliative care
- human immunodeficiency virus
- hiv testing
- case report
- hiv aids
- hepatitis c virus
- men who have sex with men
- emergency department
- clinical trial
- stem cells
- adverse drug
- cancer therapy
- south africa
- mesenchymal stem cells
- weight loss
- ultrasound guided
- bone marrow
- cell therapy
- double blind