Dados os benefícios do tratamento antirretroviral, para muitos indivíduos com HIV, o transtorno por uso de substâncias – incluindo o transtorno por uso de opióides, álcool e tabaco – é uma ameaça maior à sua saúde do que o vírus. Embora...
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)
Cortesia
Dados os benefícios do tratamento antirretroviral, para muitos indivíduos com HIV, o transtorno por uso de substâncias – incluindo o transtorno por uso de opióides, álcool e tabaco – é uma ameaça maior à sua saúde do que o vírus. Embora medicamentos e tratamentos comportamentais estejam disponíveis para tratar dessas condições, muitos pacientes não os recebem e não têm a oportunidade de se beneficiar. Em colaboração com quatro clínicas de HIV parceiras no nordeste dos EUA e no contexto da New England HIV Implementation Science Network, um grupo de médicos da Escola de Medicina de Yale liderou um ensaio clínico randomizado para avaliar o impacto da Facilitação de Implementação, um pacote de estratégias de implementação (por exemplo, colaboração de aprendizagem, facilitação externa, educação e detalhamento acadêmico), para ajudar os médicos e a equipe nesses locais melhorar a oferta de tratamentos comprovados para dependência aos seus pacientes.
Os resultados deste novo estudo publicado na revista JAMA Network Open mostram que esses esforços fizeram algum progresso na promoção do recebimento de medicamentos para transtorno por uso de álcool e tabaco, mas os pesquisadores não viram muita melhora na entrega ou recebimento de medicamentos para transtorno por uso de opióides . "Foi emocionante ver que movemos a agulha em algumas áreas, mas ainda há lacunas nos tratamentos para esses pacientes que têm condições de risco de vida", disse E. Jennifer Edelman, MD, MHS , professora associada de medicina e de saúde pública e principal autor do estudo.
"Foi emocionante ver que movemos a agulha em algumas áreas, mas ainda existem lacunas nos tratamentos para esses pacientes que têm condições de risco de vida."
E. Jennifer Edelman, MD, MHS
A equipe liderada por Edelman e o autor sênior David Fiellin, MD , professor de medicina, medicina de emergência e saúde pública e diretor do Yale Program in Addiction Medicine , forneceu a médicos e funcionários de quatro clínicas de HIV no nordeste dos Estados Unidos especialistas aconselhamento de especialistas em dependência sobre medicamentos e tratamentos de aconselhamento para combater vícios e estratégias para garantir que os pacientes recebam cuidados para transtornos por uso de substâncias. Um ensaio clínico randomizado desses esforços ao longo de três anos mostrou algum progresso na implementação do tratamento da dependência para o tabagismo e o transtorno por uso de álcool, mas a disponibilidade de tratamentos para o transtorno por uso de opióides ainda estava atrasada, descobriram os pesquisadores.