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HIV Testing and Sexual Risk Reduction Counseling in Office-Based Buprenorphine/Naloxone Treatment

Edelman, E. Jennifer MD, MHS; Moore, Brent A. PhD; Caffrey, Sarah MA; Sikkema, Kathleen J. PhD; Jones, Emlyn S. MD, MPH; Schottenfeld, Richard S. MD; Fiellin, David A. MD; Fiellin, Lynn E. MD

doi: 10.1097/ADM.0b013e3182a3b603
Original Research

Objectives: We assessed the feasibility and preliminary efficacy of human immunodeficiency virus (HIV) testing with sexual risk reduction counseling for opioid-dependent patients initiating office-based buprenorphine/naloxone treatment.

Methods: We conducted a 14-week randomized, controlled trial with 30 patients (original target of 114) assigned to receive buprenorphine/naloxone induction/stabilization and HIV testing with Brief Sexual Risk Management (BSRM) or Enhanced Sexual Risk Management (ESRM). We evaluated process measures and compared outcomes at baseline and during the 3-month follow-up.

Results: Similar proportions of patients receiving BSRM and ESRM underwent HIV testing (93% vs 80%; P = 0.28) and completed counseling sessions (80% vs 67%; P = 0.40). Brief Sexual Risk Management sessions were shorter than ESRM sessions (15.4 vs 23.4 minutes), with comparable manual adherence (P = 0.80). Outcomes did not vary by BSRM versus ESRM.

Conclusions: Although the recruitment of opioid-dependent patients with sexual risk behaviors is challenging, HIV testing with sexual risk reduction counseling in office-based buprenorphine/naloxone treatment practice is feasible. Interventions to decrease sexual risk behaviors among a segment of this population are necessary.

From the Department of Internal Medicine (EJE, SC, DAF, LEF), Yale School of Medicine, New Haven, CT; Center for Interdisciplinary Research on AIDS (EJE, DAF, LEF), Yale School of Public Health, New Haven, CT; Department of Psychiatry (BAM, SC, RSS), Yale School of Medicine, New Haven, CT; Departments of Psychology, Neuroscience and Global Health, Psychiatry and Behavioral Science (KJS), Duke University, Durham, NC; and Department of Adult and Family Medicine (ESJ), The Permanente Medical Group, Oakland, CA.

Send correspondence and reprint requests to E. Jennifer Edelman, MD, MHS, Department of Internal Medicine, General Internal Medicine, Yale School of Medicine, PO Box 208093, New Haven, CT 06520. E-mail:

Supported by the Robert Wood Johnson Foundation Physician Faculty Scholars Program, which had no further role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.

Dr D. Fiellin has received honoraria from Pinney Associates and ParagonRx for serving on External Advisory Boards to review the diversion and abuse of buprenorphine. For the remaining authors, no conflicts were declared.

Received January 26, 2013

Accepted July 03, 2013

© 2013 American Society of Addiction Medicine