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Substance dependence (SD) is a chronic disease that requires specialty drug and alcohol treatment, primary care (PC), and management of related problems. Although patients with SD may be linked with specialty care and PC, their health care often remains episodic and fragmented, rather than longitudinal, comprehensive, integrated, and coordinated. As a result, adults with SD often enter addiction treatment later and require acute medical care, rather than entering the system earlier when interventions of lower intensity but longer duration might prevent catastrophes. Chronic disease management (CDM) is a collaborative, longitudinal approach to treatment of certain chronic medical illnesses proven to be more effective than routine care. CDM addresses individual patient and health systems barriers to receipt of needed treatment. However, the effectiveness of CDM for SD has not been tested. The objective of this Addiction Health Evaluation and Disease management (AHEAD) study, was to test the effectiveness of CDM for SD in PC.

Subject identification and recruitment occurred primarily at a local detoxification center, as well as by self and physician referral from the Boston Medical Center primary and ambulatory care clinics, emergency department, urgent care center, inpatient settings, and the community. The study enrolled 320 adults with drug dependence and 320 adults with alcohol dependence who were not in SD treatment, and randomized them to a SD CDM program (the AHEAD Clinic) integrated into a real-world PC clinic or to referral to standard PC. All subjects were assessed regarding SD diagnosis, substance use and problems, readiness to change, health-related quality of life, and medical and drug treatment utilization. Subjects were evaluated 3, 6, and 12 months later, and health services utilization data were collected for 2 years from a statewide database. Additionally, in order to better understand and explain the implementation and fidelity of the AHEAD Clinic, the primary care providers (PCPs) of AHEAD Clinic patients were surveyed. Each PCP was presented with a letter from the Principal Investigator explaining the purpose of the survey, the reason why s/he was being asked to complete the survey, compensation for completing the survey, and details about confidentiality and anonymity. The survey itself consisted of questions asking providers about their satisfaction and their attitudes towards caring for patients with alcohol and drug problems, their knowledge of services that the AHEAD Clinic provides, and their experience working with the AHEAD Clinic.

Primary outcomes were illicit drug use, alcohol use, substance-related problems, emergency department visits, and hospitalizations. The proposal's hypothesis was that compared with standard care, a health services delivery intervention (CDM for SD integrated in PC) would decrease alcohol and illicit drug use and related problems, and improve health care utilization patterns. Improved outcomes using the AHEAD approach would support the adoption of a health services delivery strategy, CDM, to better care for patients with SD.

• Dataset 1: 844 variables; 563 cases
• Dataset 2: 607 variables; 500 cases
• Dataset 3: 607 variables; 487 cases
• Dataset 4: 713 variables; 532 cases
• Dataset 5: 80 variables; 549 cases
• Dataset 6: 59 variables; 1,435 cases
• Dataset 7: 25 variables; 87 cases
• Dataset 8: 25 variables; 87 cases
• Dataset 9: 41 variables; 73 cases
• Dataset 10: 9 variables; 11,018 cases
• Dataset 11: 5 variables; 511 cases

This study is part of the Seek, Test, Treat and Retain (STTR) Collaboration Project that involved over twenty studies in the fields of HIV and drug abuse. All studies were independently developed, but were chosen for the collaboration because they focused on one or more steps of the HIV treatment cascade: Seek, Test, Treat and Retain. As part of STTR Collaboration Project, the studies were grouped into Criminal Justice-related studies and Vulnerable Population-related studies. The data collected by these studies included twelve common domains (e.g., Demographic characteristics, Mental Health) in each of which a shared questionnaire or instrument was taken up by the studies and adapted to fit the study.

Linking Infectious and Narcology Care (LINC) involved coordination between the narcology and HIV systems of care utilizing HIV strengths-based case management delivered via five one-on-one sessions by a peer case manager (i.e., HIV-infected men and women in recovery from addiction) to help motivate and reduce barriers to HIV care. The initial session was designed to be delivered in the narcology hospital and included provision of CD4 test results by the case manager (CM) in a timely fashion, to increase engagement in HIV medical care. Subsequent sessions were conducted upon discharge from the narcology hospital over a 6-month period in community (e.g., parks, coffee shops) or clinic locations, agreed upon by the case manager and participant.

The LINC intervention was developed via adaptation of the Antiretroviral Treatment Access Study (ARTAS) intervention for use in the Russian setting and specifically with people who inject drugs (PWID).