TEACH Study: Interventions Improve Prescriber Confidence in Chronic Opioid Therapy in PLWH

Individuals who are living with HIV and suffering from chronic pain are commonly treated with chronic opioid therapy. With such a high prevalence of chronic pain among people living with HIV (PLWH), providers sometimes stray from opioid prescribing guidelines. It is widely unknown whether system improvements to increase care that is consistent with guidelines has an impact on elements of the relationship between patients and clinicians including satisfaction, confidence, and trust.

With this in mind, a team of investigators launched the Targeting Effective Analgesia in Clinics for HIV (TEACH) study, a 2-arm cluster, randomized, controlled, clinical trial that assessed whether a collaborative care intervention could improve chronic opioid therapy prescribing practices and satisfaction with care.

Findings were presented by Carlos del Rio, MD, a member of the Contagion® Editorial Advisory Board, at the 10^th IAS Conference on HIV Science (IAS 2019).

For the study, the investigators recruited chronic opioid therapy care providers and patients from 2 HIV clinics. The providers were randomized 1 to 1 to receive the TEACH intervention or the control, which consisted of a brochure on safe opioid prescribing. Under the TEACH intervention, providers received an IT-enabled nurse care manager, opioid education and academic detailing, and access to addiction specialists.

The primary outcome of the study was provider satisfaction at 12 months. Secondary outcomes included provider confidence prescribing chronic opioid therapy; patient satisfaction with chronic opioid therapy; and patient trust in the provider.

The study enrolled a total of 41 providers—34% male, 63% white, 78% MDs, with a mean age of 46 years. A total of 187 patients were enrolled— 72% male, 28% white, with a mean age of 54 years. Further, 91% of patients had an undetectable HIV viral load and 15% had a history of injection drug use.

According to the results, at 12 months, the adjusted mean satisfaction with chronic opioid therapy was 1.11 points higher among providers who were in the intervention group (Scale 1-10; 95% confidence interval [CI]: -0.04-2.26, p = 0.06). The investigators wrote that “the adjusted mean confidence with prescribing [chronic opioid therapy] was 1.01 points higher among intervention providers (Scale 1-10; 95% CI: 0.05-1.96, p = 0.04).”

Furthermore, it is reported that no significant differences were detected in patient satisfaction with chronic opioid therapy (adjusted odds ratio (AOR) 1.17, 95% CI: 0.50-2.76, p = 0.72) or trust in provider (AOR 1.63, 95% CI: 0.65-4.09, p = 0.30).

Based on this data, it can be concluded that providers who received the intervention materials had higher satisfaction and confidence in prescribing chronic opioid therapy than their colleagues who received the controls. Further, the intervention did not have a negative impact on patient satisfaction or trust in their providers. Therefore, the investigators deduce that the TEACH intervention is a promising way to improve chronic opioid prescribing habits for PLWH.

The poster, “Targeting effective analgesia in clinics for HIV (TEACH): A randomized controlled trial (RCT) to improve satisfaction, confidence, and trust around chronic opioid therapy in HIV care,” was presented on Monday, July 22, 2019, at IAS 2019 in Mexico City, Mexico.