The purpose of this study is to assess the feasibility, cost and effectiveness of interventions designed to integrate buprenorphine treatment for opioid dependence into HIV primary care in ten HIV care centers in the U.S.

In the site led by Dr. Altice, we compare two models of providing HIV care and buprenorphine treatment. Assignments are based on participants' city of residence. In the onsite (integrated care) model, participants receive buprenorphine, substance abuse counseling and HIV care at one location: the Waterbury Hospital Infectious Disease Clinic. In the off-site model (non-integrated care) buprenorphine induction, substance abuse counseling, and HIV care will be provided at separate locations: the Community Health Care Van (CHCV), the Yale AIDS Program, and patients' own HIV providers, respectively. Data is collected from interviews with participants, reviews of medical records, and surveys and interviews with clinicians.

Inclusion Criteria:

• HIV-infected
• Clinical diagnosis of opioid dependence
• Fluent in English or Spanish
• 18 years or older

Exclusion Criteria:

• Liver function tests (transaminase only) at five times or higher than normal level;
• Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) criteria for benzodiazepine abuse or dependence within the past 6 months;
• DSM-IV criteria for alcohol dependence within the past 6 months;
• Actively suicidal;
• Psychiatric impairment that impedes ability to consent (dementia, delusional, actively psychotic);
• Methadone dose exceeding levels allowing for safe transition to buprenorphine;
• Pregnant women and women actively trying to become pregnant;
• Clinical judgment of local site principal investigator that patient is inappropriate