Achieving Equity in Patient Outcome Reporting for Timely Assessments of Life With HIV and Substance Use

Substance use disorder (SUD) and human immunodeficiency virus (HIV) are synergistic epidemics (syndemics) disproportionately affecting Black Americans. Structural racism related to inadequate access to healthcare, stigma, and criminalization, especially among those with intersectional identities related to gender and sexual minorities, further exacerbate disparities in HIV and SUD outcomes.

SUD is often unrecognized and untreated among people living with HIV (PLWH). Only about half of HIV care sites routinely screen and refer to SUD treatment. In preliminary work, the study investigators found that nearly half of patients assessed in a HIV clinic waiting room met the criteria for a SUD, but 65% had not been diagnosed with SUD. A promising strategy to address structural barriers to SUD screening for PLWH is use of electronic patient portals. Patient portals are secure websites that give patients access to health information and allow for secure messaging with providers. They are associated with improved health outcomes and patient engagement. Notably, while most SUD screening currently occurs during clinic visits, portals can be utilized for SUD screening to reach patients who miss clinic visits, which is more common among people with HIV and SUD. The study team's preliminary work has demonstrated the potential of the portal for use in a population health approach to behavioral health screening.

This study will implement and evaluate multi-level interventions to decrease barriers to SUD screening (clinic-based, in-person) and treatment (referral-focused), a program the study investigators call "Achieving Equity in Patient Outcome Reporting for Timely Assessments of Life With HIV and Substance Use (ePORTAL HIV-S)." ePORTAL HIV-S is conducting a randomized control trial to assess the effectiveness of population health vs. usual (clinic-visit) SUD screening among PLWH in a HIV clinic.

Inclusion criteria

• 18 years or older
• has been diagnosed with human immunodeficiency virus infection (HIV)
• provider has assented
• receives HIV care at the University of Chicago Ryan White Adult HIV Care Clinic, as evidenced by inclusion in the Epic HIV Registry
• speaks English
• has not completed in clinic SUD screening in the last year
• has an active MyChart account

Exclusion criteria

• Patients who have been screened for substance use disorder at the clinic in the last year using the NIDA Quick Screen
• Patient's provider has not assented to the intervention
• Patient is younger than 18 years