Title

Facilitators and barriers to the integration of substance use screening and linkage to care among people living with HIV in a tertiary care hospital in Malaysia

Presenter

Meng Li Chong

Authors

M.L. Chong^1,2, X.W. Tan², P.L. Wong^2,1, M. Stockton³, M. Wainberg⁴, Y.K. Lee⁵, R. Rajasuriar^2,1

Institutions

¹Universiti Malaya, Department of Medicine, Kuala Lumpur, Malaysia, ²Centre of Excellence for Research in AIDS, Universiti Malaya, Kuala Lumpur, Malaysia, ³University of North Carolina at Chapel Hill, Epidemiology Department, Chapel Hill, North Carolina, United States, ⁴Columbia University/New York State Psychiatric Institute, New York, United States, ⁵Universiti Malaya, Department of Primary Care Medicine, Kuala Lumpur, Malaysia

BACKGROUND: Substance use (SU) disorders are common among people living with HIV (PLWH) and contribute to suboptimal antiretroviral adherence and quality of life. Malaysia has punitive laws against individuals who possess and use substances which may pose challenges to the integration of SU screening in healthcare settings. This pre-implementation study aimed to explore facilitators and barriers to the integration of SU screening and linkage to mental health care into routine HIV care at a tertiary care hospital in Malaysia.
METHODS: PLWH receiving care at Universiti Malaya Medical Centre, Malaysia, between June 2021-Dec 2022 were invited to participate in the study. Participants with and without history of SU were recruited. SU status was ascertained using Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) questionnaire (=4=positive). A semi-structured interview guide developed using the Consolidated Framework for Implementation Research was used to explore the facilitators and barriers to the integration of SU screening and linkage to care as part of routine HIV care. Thematic analysis was used to analyse the data using Dedoose.
RESULTS: Twenty one individual interviews were conducted with PLWH (median age=38 years; males=19). Nine screened positive for SU and five were engaged in mental health care. Participants noted that the criminalization of SU in Malaysia will be a crucial barrier to SU screening and linkage to care. Societal, healthcare professional and self-stigma towards substance use was also raised as barrier to SU screening and linkage to care. Readiness and motivation to change among substance users was raised as barriers to linkage to care. Participants brought up that a clear explanation on the rationale of screening and integration of the screening for all healthcare clients by the healthcare provider (HCP) prior to screening will be helpful in facilitating the uptake of the SU screening.
CONCLUSIONS: Our findings suggest that ensuring privacy and confidentiality of SU disclosure and SU stigma reduction were important strategies to facilitate the integration of SU screening into HIV care in addition to having good HCP-PLWH rapport.

Download the e-Poster (PDF)