This project will conduct a randomized controlled trial of a case management service intended to improve the treatment of substance abusers with HIV disease.
The specific aims are to determine the effect of case management on patient outcomes (reducing unsafe sex and substance use, maintaining physical health, improving psychological status, and improving quality of living situation), assess its cost-effectiveness, and identify predictors of treatment participation and retention. Subjects will be adult substance abusers with HIV disease, recruited at a hospital-based emergency department and medical outpatient clinics, randomly assigned to receive intensive case management versus usual care (brief contact and referral). Assessments will occur before randomization, with follow-up assessments 6, 12, and 18 months later. The hypotheses are that subjects in case management will show improvement relative to those receiving usual care on a range of measures, and will demonstrate more cost-effective use of health care programs, e.g. fewer emergency room visits and fewer hospitalizations, coupled with greater participation in social services and substance abuse treatment programs. To identify predictors of participation and retention in case management, the study will gather information about the treatment process at regular intervals. Finally, the project will complete a treatment manual that can be used in other settings. The study is a services research effort to assess innovative models of linking drug abuse treatment with health care, as a means of reducing the costs of care and improving the health care delivery system for substance abusers with HIV disease.
