{"doi":"10.1093/cid/ciaa1025","title":"Improving the Delivery of Chronic Opioid Therapy Among People Living With Human Immunodeficiency Virus: A Cluster Randomized Clinical Trial","abstract":"BACKGROUND: Chronic pain is prevalent among people living with human immunodeficiency virus (PLWH); managing pain with chronic opioid therapy (COT) is common. Human immunodeficiency virus (HIV) providers often diverge from prescribing guidelines. METHODS: This 2-arm, unblinded, cluster-randomized clinical trial assessed whether the Targeting Effective Analgesia in Clinics for HIV (TEACH) intervention improves guideline-concordant care compared to usual care for PLWH on COT. The trial was implemented from 2015 to 2018 with 12-month follow-up at safety-net hospital-based HIV clinics in Boston and Atlanta. We enrolled 41 providers and their 187 patients on COT. Prescribers were randomized 1:1 to either a 12-month intervention consisting of a nurse care manager with an interactive electronic registry, opioid education, academic detailing, and access to addiction specialists or a control condition consisting of usual care. Two primary outcomes were assessed through electronic medical records: ≥2 urine drug tests and any early COT refills by 12 months. Other outcomes included possible adverse consequences. RESULTS: At 12 months, the TEACH intervention arm had higher odds of ≥2 urine drug tests than the usual care arm (71% vs 20%; adjusted odds ratio [AOR], 13.38 [95% confidence interval {CI}, 5.85-30.60]; P < .0001). We did not detect a statistically significant difference in early refills (22% vs 30%; AOR, 0.55 [95% CI, .26-1.15]; P = .11), pain severity (6.30 vs 5.76; adjusted mean difference, 0.10 [95% CI, -1.56 to 1.75]; P = .91), or HIV viral load suppression (86.9% vs 82.1%; AOR, 1.21 [95% CI, .47-3.09]; P = .69). CONCLUSIONS: TEACH is a promising intervention to improve adherence to COT guidelines without evident adverse consequences.","journal":"Clinical Infectious Diseases","year":2020,"id":103292,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":25,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9493,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":403893,"name":"Judith I. Tsui","orcid":"0000-0003-0877-5399","position":1,"is_corresponding":false},{"id":446874,"name":"Debbie M. Cheng","orcid":"0000-0002-2206-3059","position":2,"is_corresponding":false},{"id":503280,"name":"Jane M. Liebschutz","orcid":"0000-0003-3492-1521","position":3,"is_corresponding":false},{"id":463621,"name":"Marlene C. Lira","orcid":"0000-0001-7967-1963","position":4,"is_corresponding":false},{"id":320831,"name":"Alexander Y. Walley","orcid":"0000-0002-8158-4882","position":5,"is_corresponding":false},{"id":437628,"name":"Jonathan Colasanti","orcid":"0000-0002-0536-9769","position":6,"is_corresponding":false},{"id":503281,"name":"Leah S. Forman","orcid":"0000-0003-1953-2739","position":7,"is_corresponding":false},{"id":503282,"name":"Christin Root","orcid":"0000-0002-0095-9559","position":8,"is_corresponding":false},{"id":503283,"name":"Christopher W. Shanahan","orcid":"0000-0001-9067-5922","position":9,"is_corresponding":false},{"id":504045,"name":"Margaret M. Sullivan","orcid":null,"position":10,"is_corresponding":false},{"id":499507,"name":"Carly Bridden","orcid":"0000-0002-7208-7235","position":11,"is_corresponding":false},{"id":504046,"name":"Catherine Abrams","orcid":null,"position":12,"is_corresponding":false},{"id":503284,"name":"Catherine E. Harris","orcid":"0000-0001-5765-3633","position":13,"is_corresponding":false},{"id":504047,"name":"Kishna Outlaw","orcid":null,"position":14,"is_corresponding":false},{"id":350505,"name":"Wendy S. Armstrong","orcid":"0000-0002-7316-2276","position":15,"is_corresponding":false},{"id":294608,"name":"Carlos del Rı́o","orcid":"0000-0002-0153-3517","position":16,"is_corresponding":false},{"id":315654,"name":"Jeffrey H. Samet","orcid":"0000-0002-0897-3400","position":0,"is_corresponding":true}],"reference_count":43,"raw_metadata":null,"created_at":"2026-07-18T22:42:17.920911Z","pmid":"32697847","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}