Prescribe to Save Lives: Improving buprenorphine prescribing among HIV clinicians

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Background: HIV clinicians are uniquely positioned to treat their patients with opioid use disorder (OUD) using buprenorphine to prevent overdose death. The Prescribe to Save Lives (PtSL) study aimed to increase HIV clinicians' buprenorphine prescribing via an overdose prevention intervention.

Methods: The quasi-experimental stepped wedge study enrolled 22 Ryan White funded HIV clinics and delivered a peer-to-peer training to clinicians with follow-up academic detailing that included overdose prevention education and introduced buprenorphine prescribing. Site-aggregated electronic medical record (EMR) data measured with the change in X-waivered clinicians and patients prescribed buprenorphine. Clinicians completed surveys pre-intervention and at 6- and 12-months post-intervention that assessed buprenorphine training, prescribing, and attitudes. Analyses applied Generalized Estimating Equation models, adjusting for time and clustering of repeated measures among individuals and sites.

Results: Nineteen sites provided EMR prescribing data, and 122 clinicians returned surveys. Of the total patients with HIV across all sites, EMR data showed 0.38% were prescribed buprenorphine pre-intervention and 0.52% were prescribed buprenorphine post-intervention. The intervention increased completion of a buprenorphine training course (AOR 2.54, 95% CI 1.38-4.68, p=0.003) and obtaining an X-waiver (AOR 2.11, 95% CI 1.12-3.95, p=0.02). There were non-significant increases at the clinic level, as well.

Conclusion: Although the PtSL intervention resulted in increases in buprenorphine training and prescriber certification, there was no meaningful increases in buprenorphine prescribing. Engaging and teaching HIV clinicians about overdose and naloxone rescue may facilitate training in buprenorphine prescribing, but will not result in more treatment with buprenorphine without additional interventions.