Screening, Brief Intervention, and Referral to Treatment: E2i Toolkit

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based system-level integrated care approach to identify, reduce, and prevent patterns of substance use that put the health of people with HIV at risk. SBIRT has three basic steps: (1) screening for level of substance use (alcohol and drugs), (2) providing a brief intervention to increase awareness of substance use risk and motivation to change behaviors, and (3) referring clients for further evaluation and treatment as needed. In collaboration with HIV experts, SBIRT experts, and community members, E2i adapted SBIRT for the Ryan White HIV/AIDS Program (RWHAP) and produced a toolkit that provides the resources needed to implement SBIRT within RWHAP settings and other HIV care organizations. 


  • To identify, reduce, and prevent patterns of substance use that put the health of people with HIV at risk 

Priority Population

  • SBIRT is for all people with HIV, regardless of level of substance use

Core Elements

1.     Universal Screening 

  • All clients with HIV are screened at least annually for alcohol AND drug use

2.    Brief Intervention

  • Clients with low or no substance use receive positive reinforcement
  • Clients with moderate to severe substance use receive one or more brief interventions to increase awareness of their substance use, and to begin to engage in behavioral intervention

3.    Referral to Treatment 

  • Clients with severe substance use are referred for further evaluation and specialty treatment after the brief intervention


  • SBIRT is a systems-level intervention that may continue indefinitely
  • Clients may receive SBIRT annually 


Anywhere people with HIV receive services 

Toolkit Components

This Guide includes:

  • How to plan and implement the intervention
  • Lessons learned during implementation in RWHAP settings
  • Outcomes from the E2i initiative

SBIRT E2i Implementation Guide (PDF)

A Spanish version of the Implementation Guide is coming soon!

Watch an instructional dramatization of how to deliver SBIRT to clients.