***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Cocaine use is common in opioid-dependent HIV-infected patients , but its impact on treatment outcomes in these patients receiving buprenorphine/naloxone is not known . Methods : We conducted a prospect i ve study in 299 patients receiving buprenorphine/naloxone who provided baseline cocaine data and a subset of 266 patients who remained in treatment for greater than or equal to one quarter . Assessment s were conducted at baseline and quarterly for 1 year . We evaluated the association between baseline and in-treatment cocaine use on  buprenorphine/naloxone retention , illicit opioid use , antiretroviral adherence , CD4 counts , HIV RNA , and risk behaviors . Results : Sixty-six percent ( 197 of 299 ) of patients reported baseline cocaine use and 65 % ( 173 of 266 ) of patients with follow-up data reported in-treatment cocaine use . Baseline and in-treatment cocaine use did not impact  buprenorphine/naloxone retention , antiretroviral adherence , CD4 lymphocytes , or HIV risk behaviors . However , baseline cocaine use was associated with a 14.8 ( 95 % confidence interval [ CI ] , 9.0 - 24.2 ) times greater likelihood of subsequent cocaine use ( 95 % CI , 9.0 - 24.2 ) , a 1.4 ( 95 % CI , 1.02 - 2.00 ) times greater likelihood of subsequent opioid use , and higher log10 HIV RNA ( P < 0.016 ) over time . In-treatment cocaine use was associated with a 1.4 ( 95 % CI , 1.01 - 2.00 ) times greater likelihood of concurrent opioid use . Conclusions : Given cocaine use negatively impacts opioid and HIV treatment outcomes , interventions to address cocaine use in HIV-infected patients receiving buprenorphine/naloxone treatment are warranted This study was design ed to compare the neonatal abstinence syndrome ( NAS ) in neonates of methadone and buprenorphine maintained pregnant opioid-dependent women and to provide preliminary safety and efficacy data for a larger multi-center trial . This r and omized , double-blind , double-dummy , flexible dosing , parallel-group controlled trial was conducted in a comprehensive drug-treatment facility that included residential and ambulatory care . Participants were opioid-dependent pregnant women and their neonates . Treatment involved daily administration of either sublingual buprenorphine or oral methadone using flexible dosing of 4 - 24 mg or 20 - 100 mg , respectively . Primary a priori outcome measures were : ( 1 ) number of neonates treated for NAS ; ( 2 ) amount of opioid agonist medication used to treat NAS ; ( 3 ) length of neonatal hospitalization ; and ( 4 ) peak NAS score . Two of 10 ( 20 % ) buprenorphine-exposed and 5 of 11 ( 45.5 % ) methadone-exposed neonates were treated for NAS ( p=.23 ) . Total amount of opioid-agonist medication administered to treat NAS in methadone-exposed neonates was three times greater than for buprenorphine-exposed neonates ( 93.1 versus 23.6 ; p=.13 ) . Length of hospitalization was shorter for buprenorphine-exposed than for methadone-exposed neonates ( p=.021 ) . Peak NAS total scores did not significantly differ between groups ( p=.25 ) . Results suggest that buprenorphine is not inferior to methadone on outcome measures assessing NAS and maternal and neonatal safety when administered starting in the second trimester of pregnancy Background : Having opioid dependence and HIV infection are associated with poor  HIV-related treatment outcomes . Methods : HIV-infected , opioid-dependent subjects ( N = 295 ) recruited from 10 clinical sites initiated  buprenorphine/naloxone ( BUP/NX )  and were assessed at baseline and quarterly for 12 months . Primary outcomes included receiving antiretroviral therapy ( ART ) , HIV-1 RNA suppression , and mean changes in CD4 lymphocyte count . Analyses were stratified for the 119 subjects not on ART at baseline . Generalized estimating equations were deployed to examine time-dependent correlates for each outcome . Results : At baseline , subjects on ART ( N = 176 ) were more likely than those not on ART ( N = 119 ) to be older , heterosexual , have lower alcohol addiction severity scores , and lower HIV-1 RNA levels ; they were less likely to be homeless and report sexual risk behaviors . Subjects initiating BUP/NX ( N = 295 ) were significantly more likely to initiate or remain on ART and improve CD4 counts over time compared with baseline ; however , these improvements were not significantly improved by longer retention on BUP/NX . Retention on BUP/NX for three or more quarters was , however , significantly associated with increased likelihood of initiating ART ( β = 1.34 [ 1.18 , 1.53 ] ) and achieve viral suppression ( β = 1.25 [ 1.10 , 1.42 ] ) for the 64 of 119 ( 54 % ) subjects not on ART at baseline compared with the 55 subjects not retained on BUP/NX . In longitudinal analyses , being on ART was positively associated with increasing time of observation from baseline and higher mental health quality of life scores ( β = 1.25 [ 1.06 , 1.46 ] ) and negatively associated with being homo- or bisexual ( β = 0.55 [ 0.35 , 0.97 ] ) , homeless ( β = 0.58 [ 0.34 , 0.98 ] ) , and increasing levels of alcohol addiction severity ( β = 0.17 [ 0.03 , 0.88 ] ) . The strongest correlate of achieving viral suppression was being on ART ( β = 10.27 [ 5.79 , 18.23 ] ) . Female gender ( β = 1.91 [ 1.07 , 3.41 ] ) , Hispanic ethnicity ( β = 2.82 [ 1.44 , 5.49 ] ) , and increased general health quality of life ( β = 1.02 [ 1.00,1.04 ] ) were also independently correlated with viral suppression . Improvements in CD4 lymphocyte count were significantly associated with being on ART and increased over time . Conclusions : Initiating BUP/NX in HIV clinical care setting s is feasible and correlated with initiation of ART and improved CD4 lymphocyte counts . Longer retention on BPN/NX was not associated with improved prescription of ART , viral suppression , or CD4 lymphocyte counts for the overall sample in which the majority was already prescribed ART at baseline . Among those retained on BUP/NX , HIV treatment outcomes did not worsen and were sustained . Increasing time on BUP/NX , however , was especially important for improving HIV treatment outcomes for those not on ART at baseline , the group at highest risk for clinical deterioration . Retaining subjects on BUP/NX is an important goal for sustaining HIV treatment outcomes for those on ART and improving them for those who are not . Comorbid substance use disorders ( especially alcohol ) , mental health problems , and quality -of-life indicators independently contributed to HIV treatment outcomes among HIV-infected persons with opioid dependence , suggesting the need for multidisciplinary treatment strategies for this population Substance abuse is associated with poor medical and quality -of-life outcomes among HIV-infected individuals . Although drug treatment may reduce these negative consequences , for many patients , options are limited . Buprenorphine/naloxone , an opioid agonist treatment that can be prescribed in the United States in office-based setting s , can be used to exp and treatment capacity and integrate substance abuse services into HIV care . Recognizing this potential , the US Health Re sources and Services Administration funded the development and implementation of demonstration projects that integrated HIV care and buprenorphine/naloxone treatment at 10 sites across the country . An Evaluation and Technical Assistance Center provided programmatic and clinical support as well as oversight for an evaluation that examined the processes for and outcomes of integrated care . The evaluation included patient-level self-report and chart abstract ions as well as provider and site level data collected through surveys and in-depth interviews . Although multisite demonstrations pose implementation and evaluation challenges , our experience demonstrates that these can , in part , be addressed through ongoing communication and technical assistance as well as a comprehensive evaluation design that incorporates multiple research methods and data sources . Although limitations to evaluation findings persist , they may be balanced by the scope and “ real-world ” context of the initiative Background : Opioid dependence and HIV infection are associated with poor health-related quality of life ( HRQOL ) .  Buprenorphine/naloxone ( bup/nx ) provided in HIV care setting s may improve HRQOL . Methods : We surveyed 289 HIV-infected opioid-dependent persons treated with clinic-based bup/nx about HRQOL  using the Short Form Health Survey ( SF-12 ) administered at baseline , 3 , 6 , 9 , and 12 months . We used normalized SF-12 scores , which correspond to a mean HRQOL of 50 for the general US population ( SD 10 , possible range 0 - 100 ) . We compared mean normalized mental and physical composite and component scores in quarters 1 , 2 , 3 , and 4 with baseline scores using generalized estimating equation models . We assessed the effect of clinic-based bup/nx prescription on HRQOL composite scores using mixed effects regression with site as r and om effect and time as repeated effect . Results : Baseline normalized SF-12 scores were lower than the general US population for all HRQOL domains . Average composite mental HRQOL improved from 38.3 ( SE 12.5 ) to 43.4 ( SE 13.2 ) [ β 1.13 ( 95 % CI : 0.72 to 1.54 ) ] and composite physical HRQOL remained unchanged [ β 0.21 ( 95 % CI : −0.16 to 0.57 ) ] over 12 months follow-up . Continued bup/nx treatment across all 4 quarters was associated with improvements in both physical [ β 2.38 ( 95 % CI : 0.63 to 4.12 ) ] and mental [ β 2.51 ( 95 % CI : 0.42 to 4.60 ) ] HRQOL after adjusting for other contributors to HRQOL . Conclusions : Clinic-based bup/nx maintenance therapy is potentially effective in ameliorating some of the adverse effects of opioid dependence on HRQOL for HIV-infected population IMPORTANCE Buprenorphine opioid agonist treatment ( OAT ) has established efficacy for treating opioid dependency among persons seeking addiction treatment . However , effectiveness for out-of-treatment , hospitalized patients is not known . OBJECTIVE To determine whether buprenorphine administration during medical hospitalization and linkage to office-based buprenorphine OAT after discharge increase entry into office-based OAT , increase sustained engagement in OAT , and decrease illicit opioid use at 6 months after hospitalization . DESIGN , SETTING , AND PARTICIPANTS From August 1 , 2009 , through October 31 , 2012 , a total of 663 hospitalized , opioid-dependent patients in a general medical hospital were identified . Of these , 369 did not meet eligibility criteria . A total of 145 eligible patients consented to participation in the r and omized clinical trial . Of these , 139 completed the baseline interview and were assigned to the detoxification ( n = 67 ) or linkage ( n = 72 ) group . INTERVENTIONS Five-day buprenorphine detoxification protocol or buprenorphine induction , intrahospital dose stabilization , and postdischarge transition to maintenance buprenorphine OAT affiliated with the hospital 's primary care clinic ( linkage ) . MAIN OUTCOMES AND MEASURES Entry and sustained engagement with buprenorphine OAT at 1 , 3 , and 6 months ( medical record verified ) and prior 30-day use of illicit opioids ( self-report ) . RESULTS During follow-up , linkage participants were more likely to enter buprenorphine OAT than those in the detoxification group ( 52 [ 72.2 % ] vs 8 [ 11.9 % ] , P < .001 ) . At 6 months , 12 linkage participants ( 16.7 % ) and 2 detoxification participants ( 3.0 % ) were receiving buprenorphine OAT ( P = .007 ) . Compared with those in the detoxification group , participants r and omized to the linkage group reported less illicit opioid use in the 30 days before the 6-month interview ( incidence rate ratio , 0.60 ; 95 % CI , 0.46 - 0.73 ; P < .01 ) in an intent-to-treat analysis . CONCLUSIONS AND RELEVANCE Compared with an inpatient detoxification protocol , initiation of and linkage to buprenorphine treatment is an effective means for engaging medically hospitalized patients who are not seeking addiction treatment and reduces illicit opioid use 6 months after hospitalization . However , 
    Output:
    
Medication-assisted treatment more effectively reduces opioid use than behavioral treatment alone ( 5 , 6 ) .
Office-based opioid treatment may be particularly advantageous for reaching persons with OUD who are already engaged in primary care and offers an alternative for patients who can not access methadone treatment programs .
Challenges include a variable scope of psychosocial services and structure required for management of complex patients .