Patients' reasons for choosing office-based buprenorphine: Preference for patient-centered care

Objectives: To explore human immunodeficiency virus (HIV)- infected patients' attitudes about buprenorphine treatment in officebased and opioid treatment program (OTP) settings. Methods: We conducted in-depth qualitative interviews with 29 patients with coexisting HIV infection and opioid dependence seeking buprenorphine maintenance therapy in office-based and OTP settings. We used thematic analysis of transcribed audiorecorded interviews to identify themes. Results: Patients voiced a strong preference for office-based treatment. Four themes emerged to explain this preference. First, patients perceived the greater convenience of office-based treatment as improving their ability to address HIV and other healthcare issues. Second, they perceived a strong patient-focused orientation in patient-provider relationships, underpinning their preference for office-based care. This was manifested as increased trust, listening, empathy, and respect from office-based staff and providers. Third, they perceived shared power and responsibility in office-based settings. Finally, patients viewed office-based treatment as a more supportive environment for sobriety and relapse prevention. This was, in part, due to strong therapeutic alliances with office-based staff and providers who prioritized a harm reduction approach and also the perception that the office-based settings were "safer" for sobriety, compared with increased opportunities for purchasing and using illicit opiates in OTP settings. Conclusions: HIV-infected patients with opioid dependence preferred office-based buprenorphine, because they perceived it as offering a more patient-centered approach to care compared with OTP referral. Office-based buprenorphine may facilitate engagement in care for patients with coexisting opioid dependence and HIV infection.