HIV Research & Clinical Practice (Apr 2019)

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. Lira,
  • Judith I. Tsui,
  • Jane M. Liebschutz,
  • Jonathan Colasanti,
  • Christin Root,
  • Debbie M. Cheng,
  • Alexander Y. Walley,
  • Meg Sullivan,
  • Christopher Shanahan,
  • Kristen O’Connor,
  • Catherine Abrams,
  • Leah S. Forman,
  • Christine Chaisson,
  • Carly Bridden,
  • Melissa C. Podolsky,
  • Kishna Outlaw,
  • Catherine E. Harris,
  • Wendy S. Armstrong,
  • Carlos del Rio,
  • Jeffrey H. Samet

DOI
https://doi.org/10.1080/15284336.2019.1627509
Journal volume & issue
Vol. 20, no. 2
pp. 48 – 63

Abstract

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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. Trial registration: ClinicalTrials.gov identifier: NCT02564341. Trial registration: ClinicalTrials.gov identifier: NCT02525731.

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