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Eger WH, Mutchler A, Santamour T, Meaders S, Pines HA, Bazzi AR, Tookes HE, Bartholomew TS. Decentralized HIV testing: comparing peer and mail-based distribution strategies to improve the reach of HIV self-testing among people who use drugs in Florida. Harm Reduct J 2024; 21:116. [PMID: 38880929 PMCID: PMC11181602 DOI: 10.1186/s12954-024-01031-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 06/01/2024] [Indexed: 06/18/2024] Open
Abstract
INTRODUCTION People who use drugs (PWUD) are at increased risk for HIV infection. HIV self-testing (HIVST) is a promising method for identifying new infections, but optimal distribution strategies remain understudied. METHODS To characterize PWUD by HIVST distribution strategy (peers vs. mail), we examined data from July 2022 to June 2023 collected from a real-world HIVST program led by the non-profit, Florida Harm Reduction Collective. We used descriptive statistics and Poisson regressions with robust error variance to compare those who received HIVST through peers or via mail by socio-demographics, Ending the HIV Epidemic (EHE) county designation, and HIV testing experience. RESULTS Among 728 participants, 78% received HIVST from peers, 47% identified as cisgender female, 48% as heterosexual, and 45% as non-White; 66% resided in an EHE county, and 55% had no HIV testing experience. Compared to those who received an HIV self-test from peers, those who received tests via mail were less likely to be cisgender male (vs. cisgender female; prevalence ratio [PR] = 0.59, 95% confidence interval [CI]: 0.43, 0.81), non-Hispanic Black (vs. non-Hispanic White; PR = 0.57, 95% CI: 0.36, 0.89) or from EHE counties (vs. non-EHE counties; PR = 0.33, 95% CI: 0.25, 0.44). Those who received tests via mail were also more likely to identify their sexual orientation as "Other/Undisclosed" (vs. straight/heterosexual; PR = 2.00, 95% CI: 1.51, 2.66). CONCLUSION Our findings support the role of community-based HIVST distribution strategies in increasing HIV testing coverage among PWUD. Additional research could help inform the equitable reach of HIVST.
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Affiliation(s)
- William H Eger
- School of Social Work, San Diego State University, San Diego, CA, USA
- School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Alexa Mutchler
- Florida Harm Reduction Collective, St. Petersburg, FL, USA
| | - Tim Santamour
- Florida Harm Reduction Collective, St. Petersburg, FL, USA
| | - Shelby Meaders
- Florida Harm Reduction Collective, St. Petersburg, FL, USA
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Heather A Pines
- School of Public Health, San Diego State University, San Diego, CA, USA
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA, USA
| | - Angela R Bazzi
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA, USA
- Boston University School of Public Health, Boston, MA, USA
| | - Hansel E Tookes
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Tyler S Bartholomew
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA.
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Akiba CF, Smith J, Wenger LD, Morris T, Patel SV, Bluthenthal RN, Tookes HE, LaKosky P, Kral AH, Lambdin BH. Financial barriers, facilitators, and strategies among syringe services programs in the U.S., and their impact on implementation and health outcomes. SSM. QUALITATIVE RESEARCH IN HEALTH 2024; 5:100421. [PMID: 38957482 PMCID: PMC11218888 DOI: 10.1016/j.ssmqr.2024.100421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
Syringe Services Programs (SSPs) provide evidence-based services like drug use equipment to prevent infectious disease, overdose prevention education, and naloxone distribution to people who use drugs (PWUD). However, inadequate funding threatens provision of these interventions. This study aimed to document how the current funding landscape impacted determinants of SSP implementation, particularly describing financial and staffing barriers, facilitators, and proposed strategies, using qualitative methods informed by three implementation research frameworks. We interviewed 20 leaders of SSPs in the United States using a semi-structured interview guide. Participants described how structural stigma against PWUD led to insufficient and restrictive funding, and burdensome reporting for SSPs. This resulted in harming program implementation outcomes like reach, fidelity, and sustainability. Inadequate funding also led to insufficient staffing and subsequent staff stress, burnout, and turnover. Taken together, these barriers threatened the implementation of evidence-based interventions that SSPs provided, ultimately harming their ability to effectively address health outcomes like infectious disease transmission and opioid overdose mortality within their communities. Interviewees described how upstream policy strategies like political advocacy might address structural stigma at the federal level. Participants also highlighted state-level efforts like harm reduction-centered funding, technical assistance and capacity-building, and clearinghouse programs that may facilitate better implementation and health outcomes. A more robust understanding of the relationship between financial barriers, facilitators, and strategies on implementation and health outcomes represents a novel and vital area of research within harm reduction literature.
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Affiliation(s)
| | - Jessica Smith
- RTI International, Research Triangle Park, NC, United States
| | - Lynn D. Wenger
- RTI International, Research Triangle Park, NC, United States
| | - Terry Morris
- RTI International, Research Triangle Park, NC, United States
| | - Sheila V. Patel
- RTI International, Research Triangle Park, NC, United States
| | - Ricky N. Bluthenthal
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Hansel E. Tookes
- Miller School of Medicine, University of Miami, Coral Gables, FL, United States
| | - Paul LaKosky
- Dave Purchase Project, North American Syringe Exchange Network, Tacoma, WA, United States
| | - Alex H. Kral
- RTI International, Research Triangle Park, NC, United States
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Sokale I, Wilkerson J, Wermuth P, Atem F, Burnett J, Wejnert C, Khuwaja S, Troisi C. Past-Year HIV Testing, Current Antiretroviral Therapy Use, and Participation in Services for People Who Inject Drugs. AIDS Behav 2024:10.1007/s10461-024-04369-0. [PMID: 38822083 DOI: 10.1007/s10461-024-04369-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2024] [Indexed: 06/02/2024]
Abstract
Evaluating routine HIV testing and treatment and use of services for people who inject drugs (PWID) is critical to curb the ongoing HIV epidemic. We analyzed data from the 2018 National HIV Behavioral Surveillance of PWID aged 18 years or older, recruited using respondent-driven sampling and offered anonymous HIV testing after survey. We performed bivariate and multivariable analyses with log-linked Poisson regression of the generalized linear models to examine the associations between demographics and PWID service use, past-year HIV testing, and current antiretroviral therapy (ART) use. Among 10,311 HIV-negative PWID, 56% reported past-year HIV testing, and of the 553 HIV-positive PWID, 69% reported current ART use. Of the HIV-negative PWID, 64% (2874/4482) in drug treatment and 62% (3386/5440) who used syringe service programs (SSPs) reported past-year HIV testing. Among HIV-positive PWID, 75% (187/248) in drug treatment and 67% (200/298) SSP participants were on ART. In the adjusted multivariable model, past-year HIV testing was associated with drug use treatment (aPR 1.26, 95% CI 1.23-1.31) and SSP participation (aPR 1.19, 95% CI 1.13-1.26) among HIV-negative PWID. Current ART use was associated with drug use treatment (aPR 1.13, 95% CI 1.00-1.28) but the link was not significant probably due to small sample size. Findings support the expansion and improvement of PWID-targeted services, into comprehensive programs, including drug use treatment, SSP, and HIV testing and treatment.
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Affiliation(s)
- Itunu Sokale
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Room RAS E927, Houston, TX, 77030, USA
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Johnny Wilkerson
- Department of Health Promotion & Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Paige Wermuth
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Room RAS E927, Houston, TX, 77030, USA
| | - Folefac Atem
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Janet Burnett
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cyprian Wejnert
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Salma Khuwaja
- Disease Prevention and Control Division, Houston Health Department, Houston, TX, USA
| | - Catherine Troisi
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Room RAS E927, Houston, TX, 77030, USA.
- Department of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA.
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GOYAL R, HOTCHKISS J, GILMAN B, KLEIN PW, MILLS RJ, STARLING J, MARTIN NK, PATTON T, COHEN SM, CHEEVER L. The health equity implications of the Health Resources and Services Administration's Ryan White HIV/AIDS Program. AIDS 2024; 38:1025-1032. [PMID: 38691049 PMCID: PMC11063458 DOI: 10.1097/qad.0000000000003836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
OBJECTIVE Investigate the role of the Ryan White HIV/AIDS Program (RWHAP) - which funds services for vulnerable and historically disadvantaged populations with HIV - in reducing health inequities among people with HIV over a 10-year horizon. DESIGN We use an agent-based microsimulation model to incorporate the complexity of the program and long-time horizon. METHODS We use a composite measure (the Theil index) to evaluate the health equity implications of the RWHAP for each of four subgroups (based on race and ethnicity, age, gender, and HIV transmission category) and two outcomes (probability of being in care and treatment and probability of being virally suppressed). We compare results with the RWHAP fully funded versus a counterfactual scenario, in which the medical and support services funded by the RWHAP are not available. RESULTS The model indicates the RWHAP will improve health equity across all demographic subgroups and outcomes over a 10-year horizon. In Year 10, the Theil index for race and ethnicity is 99% lower for both outcomes under the RWHAP compared to the non-RWHAP scenario; 71-93% lower across HIV transmission categories; 31-44% lower for age; and 73-75% lower for gender. CONCLUSION Given the large number of people served by the RWHAP and our findings on its impact on equity, the RWHAP represents an important vehicle for achieving the health equity goals of the National HIV/AIDS Strategy (2022-2025) and the Ending the HIV Epidemic Initiative goal of reducing new infections by 90% by 2030.
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Affiliation(s)
- Ravi GOYAL
- Division of Infectious Diseases & Global Public Health, University of California San Diego, La Jolla, CA
| | | | | | - Pamela W. KLEIN
- HIV/AIDS Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services, 5600 Fishers Lane, Rockville, MD 20857
| | - Robert J. MILLS
- HIV/AIDS Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services, 5600 Fishers Lane, Rockville, MD 20857
| | | | - Natasha K. MARTIN
- Division of Infectious Diseases & Global Public Health, University of California San Diego, La Jolla, CA
| | - Thomas PATTON
- Division of Infectious Diseases & Global Public Health, University of California San Diego, La Jolla, CA
| | - Stacy M. COHEN
- HIV/AIDS Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services, 5600 Fishers Lane, Rockville, MD 20857
| | - Laura CHEEVER
- HIV/AIDS Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services, 5600 Fishers Lane, Rockville, MD 20857
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Merle JL, Zapata JP, Quieroz A, Zamantakis A, Sanuade O, Mustanski B, Smith JD. Pre-exposure prophylaxis (PrEP) among people who use drugs: a qualitative scoping review of implementation determinants and change methods. Addict Sci Clin Pract 2024; 19:46. [PMID: 38816889 PMCID: PMC11138081 DOI: 10.1186/s13722-024-00478-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 05/24/2024] [Indexed: 06/01/2024] Open
Abstract
Implementation of pre-exposure prophylaxis (PrEP) to prevent HIV transmission is suboptimal in the United States, particularly among people who use drugs (PWUD). PrEP research among PWUD is scarce, and the factors that impact implementation are largely unknown. Therefore, we conducted a scoping review of implementation determinants (i.e., barriers and facilitators), as well as the change methods (implementation strategies and adjunctive interventions) that have been evaluated to increase PrEP implementation and use among PWUD. We identified 32 peer-reviewed articles assessing determinants and five that evaluated change methods. Determinants were coded using the updated Consolidated Framework for Implementation Research (CFIR), which is an established framework to understand the multilevel barriers and facilitators associated with implementation. Findings indicate that most research was conducted among PrEP recipients (i.e., patients), focusing on awareness and willingness to use PrEP, with less focus on factors impacting clinicians and service delivery systems. Moreover, very few change methods have been evaluated to improve clinician adoption and adherence to CDC guidelines for PrEP provision and/or recipient uptake and adherence to PrEP. Future research is needed that focuses on factors impacting implementation from a clinician standpoint as well as innovative change methods to increase PrEP awareness, reach, adoption, and sustained adherence to guidelines. Implementation Science offers a wealth of knowledge to speed up the effort to end the HIV epidemic in the United States.
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Affiliation(s)
- James L Merle
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA.
| | - Juan P Zapata
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | - Artur Quieroz
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | - Alithia Zamantakis
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | - Olutobi Sanuade
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Brian Mustanski
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
- Medical Social Sciences Department, Northwestern University, Chicago, IL, USA
- Department of Infectious Diseases, Northwestern University, Chicago, IL, USA
| | - Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
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Beyrer C, Kamarulzaman A, Isbell M, Amon J, Baral S, Bassett MT, Cepeda J, Deacon H, Dean L, Fan L, Giacaman R, Gomes C, Gruskin S, Goyal R, Mon SHH, Jabbour S, Kazatchkine M, Kasoka K, Lyons C, Maleche A, Martin N, McKee M, Paiva V, Platt L, Puras D, Schooley R, Smoger G, Stackpool-Moore L, Vickerman P, Walker JG, Rubenstein L. Under threat: the International AIDS Society-Lancet Commission on Health and Human Rights. Lancet 2024; 403:1374-1418. [PMID: 38522449 DOI: 10.1016/s0140-6736(24)00302-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 09/26/2023] [Accepted: 02/12/2024] [Indexed: 03/26/2024]
Affiliation(s)
- Chris Beyrer
- Duke Global Health Institute, Duke University, Durham, NC, USA; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA.
| | | | | | - Joseph Amon
- Office of Global Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Mary T Bassett
- François-Xavier Bagnoud Center for Health and Human Rights, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Javier Cepeda
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Harriet Deacon
- Treatied Spaces Research Group and Centre of Excellence in Data Science, Artificial Intelligence and Modelling, University of Hull, Hull, UK
| | - Lorraine Dean
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | | | - Rita Giacaman
- Institute of Community and Public Health, Birzeit University, Birzeit, West Bank, Palestine
| | - Carolyn Gomes
- UNAIDS HIV & Human Rights Reference Group, Kingston, Jamaica
| | - Sofia Gruskin
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
| | - Ravi Goyal
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, CA, USA
| | | | | | | | | | - Carrie Lyons
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Allan Maleche
- Kenya Legal & Ethical Issues Network on HIV and AIDS, Nairobi, Kenya
| | - Natasha Martin
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, CA, USA
| | - Martin McKee
- London School of Hygiene & Tropical Medicine, London, UK
| | - Vera Paiva
- Institute of Psychology, University of Sao Paulo, Sao Paulo, Brazil
| | - Lucy Platt
- London School of Hygiene & Tropical Medicine, London, UK
| | - Dainius Puras
- Clinic of Psychiatry, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Robert Schooley
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, CA, USA
| | | | | | | | | | - Leonard Rubenstein
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
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7
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Facente SN, Humphrey JL, Akiba C, Patel SV, Wenger LD, Tookes H, Bluthenthal RN, LaKosky P, Prohaska S, Morris T, Kral AH, Lambdin BH. Funding and Delivery of Syringe Services Programs in the United States, 2022. Am J Public Health 2024; 114:435-443. [PMID: 38478864 PMCID: PMC10937606 DOI: 10.2105/ajph.2024.307583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2024] [Indexed: 03/17/2024]
Abstract
Objectives. To describe the current financial health of syringe services programs (SSPs) in the United States and to assess the predictors of SSP budget levels and associations with delivery of public health interventions. Methods. We surveyed all known SSPs operating in the United States from February to June 2022 (n = 456), of which 68% responded (n = 311). We used general estimating equations to assess factors influencing SSP budget size and estimated the effects of budget size on multiple measures of SSP services. Results. The median SSP annual budget was $100 000 (interquartile range = $20 159‒$290 000). SSPs operating in urban counties and counties with higher levels of opioid overdose mortality had significantly higher budget levels, while SSPs located in counties with higher levels of Republican voting in 2020 had significantly lower budget levels. SSP budget levels were significantly and positively associated with syringe and naloxone distribution coverage. Conclusions. Current SSP funding levels do not meet minimum benchmarks. Increased funding would help SSPs meet community health needs. Public Health Implications. Federal, state, and local initiatives should prioritize sustained SSP funding to optimize their potential in addressing multiple public health crises. (Am J Public Health. 2024;114(4):435-443. https://doi.org/10.2105/AJPH.2024.307583).
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Affiliation(s)
- Shelley N Facente
- Shelley N. Facente is with the School of Public Health, University of California Berkeley. Jamie L. Humphrey, Christopher Akiba, Sheila V. Patel, Lynn D. Wenger, Terry Morris, Alex H. Kral, and Barrot H. Lambdin are with RTI International, Berkeley. Hansel Tookes is with the University of Miami, Miami, FL. Ricky N. Bluthenthal is with University of Southern California, Los Angeles. Paul LaKosky and Stephanie Prohaska are with the North American Syringe Exchange Network, Tacoma, WA
| | - Jamie L Humphrey
- Shelley N. Facente is with the School of Public Health, University of California Berkeley. Jamie L. Humphrey, Christopher Akiba, Sheila V. Patel, Lynn D. Wenger, Terry Morris, Alex H. Kral, and Barrot H. Lambdin are with RTI International, Berkeley. Hansel Tookes is with the University of Miami, Miami, FL. Ricky N. Bluthenthal is with University of Southern California, Los Angeles. Paul LaKosky and Stephanie Prohaska are with the North American Syringe Exchange Network, Tacoma, WA
| | - Christopher Akiba
- Shelley N. Facente is with the School of Public Health, University of California Berkeley. Jamie L. Humphrey, Christopher Akiba, Sheila V. Patel, Lynn D. Wenger, Terry Morris, Alex H. Kral, and Barrot H. Lambdin are with RTI International, Berkeley. Hansel Tookes is with the University of Miami, Miami, FL. Ricky N. Bluthenthal is with University of Southern California, Los Angeles. Paul LaKosky and Stephanie Prohaska are with the North American Syringe Exchange Network, Tacoma, WA
| | - Sheila V Patel
- Shelley N. Facente is with the School of Public Health, University of California Berkeley. Jamie L. Humphrey, Christopher Akiba, Sheila V. Patel, Lynn D. Wenger, Terry Morris, Alex H. Kral, and Barrot H. Lambdin are with RTI International, Berkeley. Hansel Tookes is with the University of Miami, Miami, FL. Ricky N. Bluthenthal is with University of Southern California, Los Angeles. Paul LaKosky and Stephanie Prohaska are with the North American Syringe Exchange Network, Tacoma, WA
| | - Lynn D Wenger
- Shelley N. Facente is with the School of Public Health, University of California Berkeley. Jamie L. Humphrey, Christopher Akiba, Sheila V. Patel, Lynn D. Wenger, Terry Morris, Alex H. Kral, and Barrot H. Lambdin are with RTI International, Berkeley. Hansel Tookes is with the University of Miami, Miami, FL. Ricky N. Bluthenthal is with University of Southern California, Los Angeles. Paul LaKosky and Stephanie Prohaska are with the North American Syringe Exchange Network, Tacoma, WA
| | - Hansel Tookes
- Shelley N. Facente is with the School of Public Health, University of California Berkeley. Jamie L. Humphrey, Christopher Akiba, Sheila V. Patel, Lynn D. Wenger, Terry Morris, Alex H. Kral, and Barrot H. Lambdin are with RTI International, Berkeley. Hansel Tookes is with the University of Miami, Miami, FL. Ricky N. Bluthenthal is with University of Southern California, Los Angeles. Paul LaKosky and Stephanie Prohaska are with the North American Syringe Exchange Network, Tacoma, WA
| | - Ricky N Bluthenthal
- Shelley N. Facente is with the School of Public Health, University of California Berkeley. Jamie L. Humphrey, Christopher Akiba, Sheila V. Patel, Lynn D. Wenger, Terry Morris, Alex H. Kral, and Barrot H. Lambdin are with RTI International, Berkeley. Hansel Tookes is with the University of Miami, Miami, FL. Ricky N. Bluthenthal is with University of Southern California, Los Angeles. Paul LaKosky and Stephanie Prohaska are with the North American Syringe Exchange Network, Tacoma, WA
| | - Paul LaKosky
- Shelley N. Facente is with the School of Public Health, University of California Berkeley. Jamie L. Humphrey, Christopher Akiba, Sheila V. Patel, Lynn D. Wenger, Terry Morris, Alex H. Kral, and Barrot H. Lambdin are with RTI International, Berkeley. Hansel Tookes is with the University of Miami, Miami, FL. Ricky N. Bluthenthal is with University of Southern California, Los Angeles. Paul LaKosky and Stephanie Prohaska are with the North American Syringe Exchange Network, Tacoma, WA
| | - Stephanie Prohaska
- Shelley N. Facente is with the School of Public Health, University of California Berkeley. Jamie L. Humphrey, Christopher Akiba, Sheila V. Patel, Lynn D. Wenger, Terry Morris, Alex H. Kral, and Barrot H. Lambdin are with RTI International, Berkeley. Hansel Tookes is with the University of Miami, Miami, FL. Ricky N. Bluthenthal is with University of Southern California, Los Angeles. Paul LaKosky and Stephanie Prohaska are with the North American Syringe Exchange Network, Tacoma, WA
| | - Terry Morris
- Shelley N. Facente is with the School of Public Health, University of California Berkeley. Jamie L. Humphrey, Christopher Akiba, Sheila V. Patel, Lynn D. Wenger, Terry Morris, Alex H. Kral, and Barrot H. Lambdin are with RTI International, Berkeley. Hansel Tookes is with the University of Miami, Miami, FL. Ricky N. Bluthenthal is with University of Southern California, Los Angeles. Paul LaKosky and Stephanie Prohaska are with the North American Syringe Exchange Network, Tacoma, WA
| | - Alex H Kral
- Shelley N. Facente is with the School of Public Health, University of California Berkeley. Jamie L. Humphrey, Christopher Akiba, Sheila V. Patel, Lynn D. Wenger, Terry Morris, Alex H. Kral, and Barrot H. Lambdin are with RTI International, Berkeley. Hansel Tookes is with the University of Miami, Miami, FL. Ricky N. Bluthenthal is with University of Southern California, Los Angeles. Paul LaKosky and Stephanie Prohaska are with the North American Syringe Exchange Network, Tacoma, WA
| | - Barrot H Lambdin
- Shelley N. Facente is with the School of Public Health, University of California Berkeley. Jamie L. Humphrey, Christopher Akiba, Sheila V. Patel, Lynn D. Wenger, Terry Morris, Alex H. Kral, and Barrot H. Lambdin are with RTI International, Berkeley. Hansel Tookes is with the University of Miami, Miami, FL. Ricky N. Bluthenthal is with University of Southern California, Los Angeles. Paul LaKosky and Stephanie Prohaska are with the North American Syringe Exchange Network, Tacoma, WA
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8
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Blough MJ, Rocha A, Bratberg J, Silcox J, Bolivar D, Floyd AS, Gray M, Green TC. The Cost of Safe Injection: Insights on Nonprescription Syringe Price Variability From Systematic Secret Shopping. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:201-210. [PMID: 38258818 DOI: 10.1177/29767342231217831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND Although the sale of nonprescription syringes in pharmacies is legal in most states, people who inject drugs (PWID) continue to face obstacles to syringe purchase like stigma, prohibitive costs, restrictive policies, and stocking issues. We examined the consistency of syringe pricing as another possible barrier. METHODS We analyzed data on syringe prices and other relevant variables from 153 unique secret shopper visits to 2 retail chain pharmacies in Massachusetts (MA), New Hampshire (NH), Oregon (OR), and Washington (WA) as part of the fidelity component of a large pharmacy-focused intervention study. Pretax prices from purchases made between August 2019 and May 2021 were adjusted for inflation to 2022 dollars, and a linear regression of the price of a 10-pack of syringes was constructed to examine the determinants of syringe pricing. RESULTS The average real price of a 10-pack of syringes across all states was $4.53 (SD = 0.99), with wide variability between pharmacies (max = $11.44, min = $1.70) and between states (mean OR = $5.76, WA = $4.74, MA = $4.33, NH = $4.30). Forty-seven percent (n = 72) of the purchases were taxed despite syringes being tax exempt in MA and WA, and not having a sales tax in NH or OR. The results of the regression suggest that certain needle gauges were associated with lower overall prices, while 1 pharmacy chain and 2 syringe brands were associated with higher overall prices. CONCLUSIONS The high variability in syringe pricing presents another barrier to pharmacy-based syringe access since high prices may leave PWID no choice but to reuse or share needles, especially in areas with limited alternatives or without a syringe service program. Leadership from healthcare systems, pharmacy chains, and state and local policymakers is essential to reduce stigma and to implement policies that streamline syringe purchases, eliminate the taxation of exempt syringes in accordance with state laws, and reduce the variation in syringe prices.
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Affiliation(s)
- Malcolm J Blough
- Brandeis University Opioid Policy Research Collaborative, Waltham, MA, USA
| | - Amanda Rocha
- University of Rhode Island College of Pharmacy, Kingston, RI, USA
| | - Jeffrey Bratberg
- University of Rhode Island College of Pharmacy, Kingston, RI, USA
| | - Joseph Silcox
- Brandeis University Opioid Policy Research Collaborative, Waltham, MA, USA
- University of Massachusetts-Boston, Boston, MA, USA
| | - Derek Bolivar
- Brandeis University Opioid Policy Research Collaborative, Waltham, MA, USA
| | - Anthony S Floyd
- University of Washington Addictions, Drug, and Alcohol Institute, Seattle, WA, USA
| | | | - Traci C Green
- Brandeis University Opioid Policy Research Collaborative, Waltham, MA, USA
- COBRE on Opioids and Overdose at Rhode Island Hospital, Providence, RI, USA
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9
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Chapin-Bardales J, Asher A, Broz D, Teshale E, Mixson-Hayden T, Poe A, Handanagic S, Blanco C, Wejnert C. Hepatitis C virus infection and co-infection with HIV among persons who inject drugs in 10 U.S. cities-National HIV Behavioral Surveillance, 2018. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024:104387. [PMID: 38531730 DOI: 10.1016/j.drugpo.2024.104387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 02/13/2024] [Accepted: 03/06/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Characterizing acute and chronic hepatitis C virus (HCV) infection and HIV/HCV co-infection among persons who inject drugs (PWID) can inform elimination efforts. METHODS During 2018 National HIV Behavioral Surveillance in 10 U.S. metropolitan statistical areas (MSAs), PWID were recruited using respondent-driven sampling and offered a survey, HIV testing, and HCV antibody and RNA testing. We examined prevalence and associated characteristics of HCV infection and HIV/HCV co-infection. Associations were assessed using log-linked Poisson regression models with robust standard errors accounting for clustering by recruitment chain and adjusting for MSA and network size. RESULTS Overall, 44.2% had current HCV infection (RNA detected), with 3.9% classified as acute infection (HCV antibody non-reactive/RNA detected) and 40.3% as chronic (HCV antibody reactive/RNA detected). Four percent had HIV/HCV co-infection. Current HCV infection was significantly higher among PWID who were male, White, injected >1 time/day, shared syringes in past year, and shared injection equipment in past year. PWID who were transgender, injecting >5 years, and most often injected speedball (heroin and cocaine together) or stimulants alone were more likely to have HIV/HCV co-infection. Among PWID who never previously had HCV infection, 9.9% had acute HCV infection. Among PWID who started injecting ≤5 years ago, 41.5% had already acquired HCV infection. CONCLUSIONS Acute and chronic HCV infections were substantial among a sample of PWID in 10 U.S. MSAs. Accessibility to HCV RNA testing, promoting safer practices, and intervening early with harm reduction programs for recent injection initiates will be critical to disease elimination efforts for PWID.
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Affiliation(s)
| | - Alice Asher
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dita Broz
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eyasu Teshale
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tonya Mixson-Hayden
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amanda Poe
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Senad Handanagic
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, USA
| | - Cyprian Wejnert
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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10
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Bartholomew TS, Plesons M, Serota DP, Alonso E, Metsch LR, Feaster DJ, Ucha J, Suarez E, Forrest DW, Chueng TA, Ciraldo K, Brooks J, Smith JD, Barocas JA, Tookes HE. Project CHARIOT: study protocol for a hybrid type 1 effectiveness-implementation study of comprehensive tele-harm reduction for engagement of people who inject drugs in HIV prevention services. Addict Sci Clin Pract 2024; 19:21. [PMID: 38528570 PMCID: PMC10964520 DOI: 10.1186/s13722-024-00447-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/13/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND People who inject drugs (PWID) remain a high priority population under the federal Ending the HIV Epidemic initiative with 11% of new HIV infections attributable to injection drug use. There is a critical need for innovative, efficacious, scalable, and community-driven models of healthcare in non-stigmatizing settings for PWID. We seek to test a Comprehensive-TeleHarm Reduction (C-THR) intervention for HIV prevention services delivered via a syringe services program (SSP). METHODS The CHARIOT trial is a hybrid type I effectiveness-implementation study using a parallel two-arm randomized controlled trial design. Participants (i.e., PWID; n = 350) will be recruited from a syringe services program (SSP) in Miami, Florida. Participants will be randomized to receive either C-THR or non-SSP clinic referral and patient navigation. The objectives are: (1) to determine if the C-THR intervention increases engagement in HIV prevention (i.e., HIV pre-exposure prophylaxis; PrEP or medications for opioid use disorder; MOUD) compared to non-SSP clinic referral and patient navigation, (2) to examine the long-term effectiveness and cost-effectiveness of the C-THR intervention, and (3) to assess the barriers and facilitators to implementation and sustainment of the C-THR intervention. The co-primary outcomes are PrEP or MOUD engagement across follow-up at 3, 6, 9 and 12 months. For PrEP, engagement is confirmed by tenofovir on dried blood spot or cabotegravir injection within the previous 8 weeks. For MOUD, engagement is defined as screening positive for norbuprenorphine or methadone on urine drug screen; or naltrexone or buprenorphine injection within the previous 4 weeks. Secondary outcomes include PrEP adherence, engagement in HCV treatment and sustained virologic response, and treatment of sexually transmitted infections. The short and long term cost-effectiveness analyses and mixed-methods implementation evaluation will provide compelling data on the sustainability and possible impact of C-THR on comprehensive HIV prevention delivered via SSPs. DISCUSSION The CHARIOT trial will be the first to our knowledge to test the efficacy of an innovative, peer-led telehealth intervention with PWID at risk for HIV delivered via an SSP. This innovative healthcare model seeks to transform the way PWID access care by bypassing the traditional healthcare system, reducing multi-level barriers to care, and meeting PWID where they are. TRIAL REGISTRATION ClinicalTrials.gov NCT05897099. Trial registry name: Comprehensive HIV and Harm Prevention Via Telehealth (CHARIOT). Registration date: 06/12/2023.
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Affiliation(s)
- Tyler S Bartholomew
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA.
| | - Marina Plesons
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA
| | - David P Serota
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Elizabeth Alonso
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Daniel J Feaster
- Biostatistics Division, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jessica Ucha
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA
| | - Edward Suarez
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David W Forrest
- Department of Anthropology, University of Miami, Miami, FL, USA
| | - Teresa A Chueng
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Katrina Ciraldo
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jimmie Brooks
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah, USA
| | - Joshua A Barocas
- Divisions of General Internal Medicine and Infectious Diseases, Department of Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Hansel E Tookes
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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11
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Hershow RB, Love Pieczykolan L, Worthington N, Adams M, McDonald R, Wilson S, McBee S, Balleydier S, Curran KG. Were Needles Everywhere?: Differing Views on Syringe Waste and Disposal Associated With Needs-Based Syringe Services Programs Among Community Partners and Persons Who Inject Drugs. Subst Use Misuse 2024; 59:1174-1181. [PMID: 38509704 PMCID: PMC11103866 DOI: 10.1080/10826084.2024.2330895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
BACKGROUND Community concerns surrounding syringe waste are a common barrier to syringe services program (SSP) implementation. In Kanawha County, West Virginia, community opposition to SSPs resulted in the closure of needs-based SSPs prior to and during an HIV outbreak among persons who inject drugs (PWID). This qualitative analysis examines views of PWID and community partners on syringe waste and disposal associated with needs-based SSPs. METHODS Qualitative interviews with 26 PWID and 45 community partners (medical and social service providers, law enforcement personnel, policymakers, and religious leaders) were conducted. Interviews were recorded, transcribed, and coded. Code summaries described participants' views on syringe waste and disposal and needs-based SSPs. RESULTS Community partners and PWID who favored needs-based SSPs reported that needs-based SSPs had not affected or reduced syringe waste. Conversely, community partners who favored one-to-one exchange models and/or barcoded syringes described needs-based SSPs increasing syringe waste. Community partners often cited pervasive community beliefs that SSPs increased syringe waste, risk of needlesticks, drug use, and crime. Community partners were unsure how to address syringe waste concerns and emphasized that contradictory views on syringe waste posed barriers to discussing and implementing SSPs. CONCLUSIONS Participants' views on whether syringe waste was associated with needs-based SSPs often aligned with their support or opposition for needs-based SSPs. These differing views resulted in challenges finding common ground to discuss SSP operations amid an HIV outbreak among PWID. SSPs might consider addressing syringe waste concerns by expanding syringe disposal efforts and implementing community engagement and stigma reduction activities.
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Affiliation(s)
- Rebecca B. Hershow
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lauren Love Pieczykolan
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nancy Worthington
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Monica Adams
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Robert McDonald
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Suzanne Wilson
- West Virginia Bureau for Public Health, West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA
| | - Shannon McBee
- West Virginia Bureau for Public Health, West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA
| | - Shawn Balleydier
- West Virginia Bureau for Public Health, West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA
| | - Kathryn G. Curran
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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12
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Scaramutti C, Hervera B, Rivera Y, Chueng TA, Forrest DW, Suarez E, Serota DP, Alkamli H, Ciraldo K, Bartholomew TS, Tookes HE. Improving access to HIV care among people who inject drugs through tele-harm reduction: a qualitative analysis of perceived discrimination and stigma. Harm Reduct J 2024; 21:50. [PMID: 38396017 PMCID: PMC10893685 DOI: 10.1186/s12954-024-00961-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 02/11/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Tele-harm reduction (THR) is a telehealth-enhanced, peer-led, harm reduction intervention delivered within a trusted syringe services program (SSP) venue. The primary goal of THR is to facilitate linkage to care and rapid, enduring virologic suppression among people who inject drugs (PWID) with HIV. An SSP in Miami, Florida, developed THR to circumvent pervasive stigma within the traditional healthcare system. METHODS During intervention development, we conducted in-depth interviews with PWID with HIV (n = 25) to identify barriers and facilitators to care via THR. We employed a general inductive approach to transcripts guided by iterative readings of the raw data to derive the concepts, themes, and interpretations of the THR intervention. RESULTS Of the 25 PWID interviewed, 15 were in HIV care and adherent to medication; 4 were in HIV care but non-adherent; and 6 were not in care. Themes that emerged from the qualitative analysis included the trust and confidence PWID have with SSP clinicians as opposed to professionals within the traditional healthcare system. Several barriers to treatment were reported among PWID, including perceived and actual discrimination by friends and family, negative internalized behaviors, denial of HIV status, and fear of engaging in care. Facilitators to HIV care included empathy and respect by SSP staff, flexibility of telehealth location, and an overall destigmatizing approach. CONCLUSION PWID identified barriers and facilitators to receipt of HIV care through the THR intervention. Interviews helped inform THR intervention development, centered on PWID in the destigmatizing environment of an SSP.
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Affiliation(s)
- Carolina Scaramutti
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Belén Hervera
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Yanexy Rivera
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Teresa A Chueng
- 2Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David W Forrest
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Edward Suarez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David P Serota
- 2Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hatoun Alkamli
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Katrina Ciraldo
- Department of Family and Community Medicine & Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tyler S Bartholomew
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hansel E Tookes
- 2Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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13
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Tanz LJ, Gladden RM, Dinwiddie AT, Miller KD, Broz D, Spector E, O’Donnell J. Routes of Drug Use Among Drug Overdose Deaths - United States, 2020-2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2024; 73:124-130. [PMID: 38358969 PMCID: PMC10899081 DOI: 10.15585/mmwr.mm7306a2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Preliminary reports indicate that more than 109,000 drug overdose deaths occurred in the United States in 2022; nearly 70% of these involved synthetic opioids other than methadone, primarily illegally manufactured fentanyl and fentanyl analogs (IMFs). Data from the western United States suggested a transition from injecting heroin to smoking IMFs. CDC analyzed data from the State Unintentional Drug Overdose Reporting System to describe trends in routes of drug use in 27 states and the District of Columbia among overdose deaths that occurred during January 2020-December 2022, overall and by region and drugs detected. From January-June 2020 to July-December 2022, the percentage of overdose deaths with evidence of injection decreased 29.1%, from 22.7% to 16.1%, whereas the percentage with evidence of smoking increased 73.7%, from 13.3% to 23.1%. The number of deaths with evidence of smoking increased 109.1%, from 2,794 to 5,843, and by 2022, smoking was the most commonly documented route of use in overdose deaths. Trends were similar in all U.S. regions. Among deaths with only IMFs detected, the percentage with evidence of injection decreased 41.6%, from 20.9% during January-June 2020 to 12.2% during July-December 2022, whereas the percentage with evidence of smoking increased 78.9%, from 10.9% to 19.5%. Similar trends were observed among deaths with both IMFs and stimulants detected. Strengthening public health and harm reduction services to address overdose risk related to diverse routes of drug use, including smoking and other noninjection routes, might reduce drug overdose deaths.
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14
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Hershow RB, Worthington N, Adams M, McDonald R, Wilson S, McBee S, Balleydier S, Curran KG. A Qualitative Analysis of Barriers to Accessing HIV Prevention Services During an HIV Outbreak among Persons who Inject Drugs in West Virginia. AIDS Behav 2024; 28:669-681. [PMID: 38165598 PMCID: PMC10922593 DOI: 10.1007/s10461-023-04254-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 01/04/2024]
Abstract
In response to an increase in HIV diagnoses among persons who inject drugs (PWID) in Kanawha County, West Virginia, West Virginia Bureau for Public Health and CDC conducted a qualitative assessment in Kanawha County to inform HIV outbreak response activities. Interviews with 26 PWID and 45 community partners were completed. Transcribed interviews were analyzed to identify barriers to accessing HIV prevention services among PWID using the risk environment framework. Participants identified numerous political, physical, social, and economic community-level barriers that influenced access to HIV prevention services among PWID. Political factors included low community support for syringe services programs (SSPs); physical factors included low SSP coverage, low coverage of HIV testing outreach events, low HIV preexposure prophylaxis availability, and homelessness; social factors included stigma and discrimination; economic factors included community beliefs that SSPs negatively affect economic investments and limited resources for HIV screening in clinical settings. Individual-level barriers included co-occurring acute medical conditions and mental illness. Community-level interventions, such as low-barrier one-stop shop models, are needed to increase access to sterile syringes through comprehensive harm reduction services.
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Affiliation(s)
- Rebecca B Hershow
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Nancy Worthington
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Monica Adams
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Robert McDonald
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Suzanne Wilson
- West Virginia Department of Health and Human Resources, West Virginia Bureau for Public Health, Charleston, WV, USA
| | - Shannon McBee
- West Virginia Department of Health and Human Resources, West Virginia Bureau for Public Health, Charleston, WV, USA
| | - Shawn Balleydier
- West Virginia Department of Health and Human Resources, West Virginia Bureau for Public Health, Charleston, WV, USA
| | - Kathryn G Curran
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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15
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Morris E, Teplinskaya A, Olansky E, Rinderle JK, Chapin-Bardales J. Characteristics Associated with Pre-Exposure Prophylaxis Discussion and Use Among Transgender Women Without HIV Infection - National HIV Behavioral Surveillance Among Transgender Women, Seven Urban Areas, United States, 2019-2020. MMWR Suppl 2024; 73:9-20. [PMID: 38261546 PMCID: PMC10826686 DOI: 10.15585/mmwr.su7301a2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
CDC recommends pre-exposure prophylaxis (PrEP) for transgender women who have sex with men and who report sexual behaviors that place them at substantial ongoing risk for HIV exposure, including those who engage in nonsterile syringe sharing. Providing transgender women with access to PrEP is a critical strategy for reducing HIV acquisition and ending the HIV epidemic. Survey results from the National HIV Behavioral Surveillance Among Transgender Women were used to assess characteristics associated with past-year discussions of PrEP with a health care provider and PrEP use. Bivariate analyses were conducted to assess the association between covariates (sociodemographic, HIV-associated characteristics, and gender-affirming care) and each outcome, accounting for sampling design. All covariates that were statistically significant at p<0.05 in the bivariate analyses were included in multivariate models, and manual backward elimination was used to obtain final models that retained statistically significant covariates. Among 902 transgender women from seven urban areas in the United States without HIV infection in the analyses, 57% had recently discussed PrEP with a health care provider, and 32% recently had used PrEP. In the final multivariate model, the following subgroups of transgender women were more likely to report recent PrEP use: those who identified as Black or African American or Hispanic or Latina, had two or more sex partners in the past 12 months, had condomless sex in the past 12 months, reported their last sex partner was infected with HIV, had condomless sex with their last sex partner whose HIV status was positive or unknown, ever had transgender-specific health care, and currently had transgender-specific health insurance coverage. Participants who were less likely to have recently used PrEP were those who wanted to but were not currently taking hormones and those aged <40 years. Providing increased access to gender-affirming care and training health care providers who serve transgender women to incorporate PrEP into existing services might increase PrEP use among transgender women.
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Affiliation(s)
| | | | | | | | | | - National HIV Behavioral Surveillance Among Transgender Women Study Group
- Behavioral and Clinical Surveillance Branch, Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, Georgia; Social & Scientific Systems, Inc., Silver Spring, Maryland; Prevention Communication Branch, Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, Georgia
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16
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Suarez E, Bartholomew TS, Plesons M, Ciraldo K, Ostrer L, Serota DP, Chueng TA, Frederick M, Onugha J, Tookes HE. Adaptation of the Tele-Harm Reduction intervention to promote initiation and retention in buprenorphine treatment among people who inject drugs: a retrospective cohort study. Ann Med 2023; 55:733-743. [PMID: 36856571 PMCID: PMC9980015 DOI: 10.1080/07853890.2023.2182908] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/22/2022] [Accepted: 02/15/2023] [Indexed: 03/02/2023] Open
Abstract
Background: At the start of the pandemic, relaxation of buprenorphine prescribing regulations created an opportunity to create new models of medications for opioid use disorder (MOUD) delivery and care. To expand and improve access to MOUD, we adapted and implemented the Tele-Harm Reduction (THR) intervention; a multicomponent, telehealth-based and peer-driven intervention to promote HIV viral suppression among people who inject drugs (PWID) accessing a syringe services program (SSP). This study examined buprenorphine initiation and retention among PWID with opioid use disorder who received the adapted THR intervention at the IDEA Miami SSP.Methods: A retrospective chart review of participants who received the THR intervention for MOUD was performed to examine the impact of telehealth on buprenorphine retention. Our primary outcome was three-month retention, defined as three consecutive months of buprenorphine dispensed from the pharmacy.Results: A total of 109 participants received the adapted THR intervention. Three-month retention rate on buprenorphine was 58.7%. Seeing a provider via telehealth at baseline or any follow up visit (aOR = 7.53, 95% CI: [2.36, 23.98]) and participants who had received an escalating dose of buprenorphine after baseline visit (aOR = 8.09, 95% CI: [1.83, 35.87]) had a higher adjusted odds of retention at three months. Participants who self-reported or tested positive for a stimulant (methamphetamine, amphetamine, or cocaine) at baseline had a lower adjusted odds of retention on buprenorphine at three months (aOR = 0.29, 95% CI: [0.09, 0.93]).Conclusions: Harm reduction settings can adapt dynamically to the needs of PWID in provision of critical lifesaving buprenorphine in a truly destigmatising approach. Our pilot suggests that an SSP may be an acceptable and feasible venue for delivery of THR to increase uptake of buprenorphine by PWID and promote retention in care.KEY MESSAGESThe Tele-Harm Reduction intervention can be adapted for initiating and retaining people who inject drugs with opioid use disorder on buprenorphine within a syringe services program settingUsing telehealth was associated with increased three-month buprenorphine retentionBaseline stimulant use was negatively associated with three-month buprenorphine retention.
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Affiliation(s)
- Edward Suarez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tyler S. Bartholomew
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Marina Plesons
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Katrina Ciraldo
- Department of Family and Community Medicine & Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lily Ostrer
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - David P. Serota
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Teresa A. Chueng
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Morgan Frederick
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jason Onugha
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Hansel E. Tookes
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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17
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Nikitin BM, Bromberg DJ, Pykalo I, Ivasiy R, Islam Z, Altice FL. Early disruptions to syringe services programs during the Russian invasion of Ukraine. Front Public Health 2023; 11:1229057. [PMID: 38074770 PMCID: PMC10702598 DOI: 10.3389/fpubh.2023.1229057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 11/03/2023] [Indexed: 12/18/2023] Open
Abstract
Introduction The widespread HIV epidemic in Ukraine is concentrated among people who inject drugs (PWID), making access to sterile injection paraphernalia (SIP) like sterile needles and syringes a critical method of HIV/AIDS prevention; however, the Russian invasion has threatened to disrupt the operations of syringe services programs (SSPs), creating a risk of HIV outbreaks among PWID. Methods We conducted 10 semi-structured interviews with outreach workers from SSPs. Interviews were purposively sampled to cover three prototypic regions of Ukraine: temporarily Russian-controlled, frontline, and destination. Qualitative results from interviews were then compared against a standardized, nationwide harm reduction database. Results We found that the Russian invasion triggered both supply and demand challenges for SSPs. Demand increased for all regions due to client transitions from pharmacies that closed to SSPs, increases in illicit drug use, greater client openness to NGO support, and displacement of clients to destination regions. Supply decreased for all areas (except for remote destination regions) due to battle-related barriers like curfews, roadblocks, and Internet disruptions; diminished deliveries of SIP and funding; and staff displacement. Time series plots of the number of unique clients accessing harm reduction services showed that an initial decrease in service provision occurred at the start of the war but that most regions recovered within several months except for Russian-controlled regions, which continued to provide services to fewer clients relative to previous years. Conclusion To ensure continued scale-up of SIP and other HIV prevention services, the SyrEx database should be leveraged to serve as a streamlined harm reduction locator that can inform workers and clients of open site locations and other pertinent information.
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Affiliation(s)
| | | | - Iryna Pykalo
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | - Roman Ivasiy
- Yale School of Medicine, New Haven, CT, United States
| | - Zahedul Islam
- International Alliance for Public Health Ukraine, Kyiv, Ukraine
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18
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Shang M, Thiel B, Liebschutz JM, Kraemer KL, Freund A, Jawa R. Implementing harm reduction kits in an office-based addiction treatment program. Harm Reduct J 2023; 20:163. [PMID: 37919741 PMCID: PMC10621216 DOI: 10.1186/s12954-023-00897-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/24/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND The rising rates of drug use-related complications call for a paradigm shift in the care for people who use drugs. While addiction treatment and harm reduction have historically been siloed in the US, co-location of these services in office-based addiction treatment (OBAT) settings offers a more realistic and patient-centered approach. We describe a quality improvement program on integrating harm reduction kits into an urban OBAT clinic. METHODS After engaging appropriate stakeholders and delivering clinician and staff trainings on safer use best practices, we developed a clinical workflow for universal offering and distribution of pre-packaged kits coupled with patient-facing educational handouts. We assessed: (1) kit uptake with kit number and types distributed; and (2) implementation outcomes of feasibility, acceptability, appropriateness, and patient perceptions. RESULTS One-month post-implementation, 28% (40/141) of completed in-person visits had at least one kit request, and a total of 121 kits were distributed. Staff and clinicians found the program to be highly feasible, acceptable, and appropriate, and patient perceptions were positive. CONCLUSIONS Incorporating kits in OBAT settings is an important step toward increasing patient access and utilization of life-saving services. Our program uncovered a significant unmet need among our patients, suggesting that kit integration within addiction treatment can improve the standard of care for people who use drugs.
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Affiliation(s)
- Margaret Shang
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Brent Thiel
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jane M Liebschutz
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Center for Research on Healthcare, University of Pittsburgh School of Medicine, 3609 Forbes Ave, Pittsburgh, PA, 15213, USA
| | - Kevin L Kraemer
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Center for Research on Healthcare, University of Pittsburgh School of Medicine, 3609 Forbes Ave, Pittsburgh, PA, 15213, USA
| | - Ariana Freund
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Raagini Jawa
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Center for Research on Healthcare, University of Pittsburgh School of Medicine, 3609 Forbes Ave, Pittsburgh, PA, 15213, USA.
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Hill K, Thakarar K, Eslinger H, Prosperino L, Sue KL. Improving the Health of People Who Inject Drugs Through COVID-19-Related Policies. Public Health Rep 2023; 138:862-864. [PMID: 37610106 PMCID: PMC10576482 DOI: 10.1177/00333549231192468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Affiliation(s)
- Katherine Hill
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Kinna Thakarar
- Center for Interdisciplinary Population & Health Research/Maine, Portland, ME, USA
- Department of Medicine, Maine Medical Center, Portland, ME, USA
- Tufts University School of Medicine, Boston, MA, USA
- Maine Medical Partners Adult Infectious Diseases, South Portland, ME, USA
| | | | | | - Kimberly L. Sue
- Department of General Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
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20
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Salow K, Jack HE, Tinsley J, Banta-Green CJ, Kingston S, Iles-Shih M, Tsui JI, Glick S. Racial disparities in use of syringe service programs in King County, WA: a comparison of two cross-sectional surveys. Harm Reduct J 2023; 20:133. [PMID: 37704989 PMCID: PMC10500904 DOI: 10.1186/s12954-023-00868-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Syringe service programs (SSPs) provide tools to people who inject drugs (PWID) to prevent overdose, reduce the risk of HIV and HCV infection, and reduce injection frequency. While effective, previous research suggests that SSPs may not adequately reach some marginalized or particularly vulnerable subpopulations of PWID. METHODS To identify disparities in SSP use, data from two cross-sectional surveys conducted in King County, Washington were compared: a survey of SSP clients and a community survey of PWID in King County. It was hypothesized that Black PWID, women, and gender minorities would be underrepresented in the SSP survey relative to the general population of PWID. RESULTS SSP clients identified as White at a significantly higher rate than the community sample of PWID (p = 0.030). Black (p < 0.001), American Indian/Alaska Native (p < 0.001), Latinx/Hispanic (p = 0.009), and Native Hawaiian/ Pacific Islander PWID (p = 0.034) were underrepresented in the SSP client survey. The gender of SSP clients was similar to the distribution seen in the community sample of PWID (p = 0.483). CONCLUSIONS Black PWID are underrepresented in Seattle-area SSPs, consistent with studies in other large US cities. Both nationally and in Seattle, overdose deaths have been increasing among Black PWID, and harm reduction strategies are vital to reversing this trend. SSPs should explore and test ways to be more accessible to minority populations.
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Affiliation(s)
- Katheryn Salow
- School of Medicine, University of Washington, Seattle, USA.
| | - Helen E Jack
- Department of Internal Medicine, University of Washington, Seattle, USA
| | - Joe Tinsley
- HIV/STI/HCV Program, Public Health-Seattle & King County, Seattle, USA
| | - Caleb J Banta-Green
- Department of Psychiatry and Behavioral Sciences, Addictions, Drug and Alcohol Institute, School of Medicine, University of Washington, Seattle, USA
| | - Susan Kingston
- Department of Psychiatry and Behavioral Sciences, Addictions, Drug and Alcohol Institute, School of Medicine, University of Washington, Seattle, USA
| | - Matthew Iles-Shih
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Judith I Tsui
- Department of Internal Medicine, University of Washington, Seattle, USA
| | - Sara Glick
- HIV/STI/HCV Program, Public Health-Seattle & King County, Seattle, USA
- Division of Allergy and Infectious Diseases, School of Medicine, University of Washington, Seattle, USA
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21
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Bartholomew TS, Tookes HE, Chueng TA, Bluthenthal RN, Wenger LD, Kral AH, Lambdin BH. Availability of telehealth-based services at syringe services programs under the COVID-19 Public Health Emergency. Harm Reduct J 2023; 20:122. [PMID: 37660029 PMCID: PMC10475193 DOI: 10.1186/s12954-023-00861-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/27/2023] [Indexed: 09/04/2023] Open
Abstract
INTRODUCTION The expanded capacity of syringe services programs (SSPs) in the USA to integrate telehealth services was largely related to flexibility of buprenorphine prescription in response to the COVID-19 pandemic. SSPs demonstrated the potential of using telehealth to reach participants with both medical and non-medical services. The present study examines the implementation of medical and non-medical telehealth-based health services in 2020 at SSPs in the USA and organizational characteristics associated with adopting specific telehealth services. METHODS We administered a cross-sectional survey among all known SSPs operating in the USA as of 2021. The two primary study outcomes were (1) implementation of medical telehealth and (2) implementation of non-medical telehealth in 2020. Medical services included HIV counseling/care, hepatitis C virus (HCV) counseling/care, and buprenorphine. Non-medical services included wellbeing/check-ins, overdose prevention training, health navigation, harm reduction and psychological counseling. Bivariate and multivariable mixed effects logistic regression models were used to directly estimate the odds ratio associated with organizational characteristics on the implementation of telehealth-based health services. RESULTS Thirty percent of programs (n = 290) reported implementing telehealth-based health services. In multivariable logistic regression models, community-based organization SSPs had higher odds of implementing medical (aOR = 4.69, 95% CI [1.96, 11.19]) and non-medical (aOR = 2.18, 95% CI [1.10, 4.31]) health services compared to public health department SSPs. SSPs that received governmental funding had higher odds of implementing medical services via telehealth (aOR = 2.45, 95% CI [1.35, 4.47]) compared to programs without governmental funding. CONCLUSION Community-based organization SSPs and those with government funding had the highest odds of telehealth implementation in response to the COVID-19 Public Health Emergency. Federal, state, and local governments must increase funding for low-barrier venues like SSPs to support telehealth implementation to serve the needs of people who use drugs.
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Affiliation(s)
| | - Hansel E Tookes
- University of Miami, 1120 NW 14th St #860, Miami, FL, 33136, USA.
| | - Teresa A Chueng
- University of Miami, 1120 NW 14th St #860, Miami, FL, 33136, USA
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22
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Gicquelais RE, Astemborski J, Werb D, Kirk GD, Mehta SH, Genberg BL. Context and correlates of providing assistance with someone's first injection in the AIDS linked to the IntraVenous Experience cohort, Baltimore, MD. Drug Alcohol Depend 2023; 250:110909. [PMID: 37517262 PMCID: PMC10529208 DOI: 10.1016/j.drugalcdep.2023.110909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 07/14/2023] [Accepted: 07/15/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND The social processes around initiating injection may be well-suited to intervention, yet there is substantial heterogeneity in the reported experiences of people who inject drugs (PWID) who assist with another individual's first drug injection. We aimed to describe the lifetime prevalence and context of providing initiation assistance among a cohort of PWID. METHODS Participants of the AIDS Linked to the IntraVenous Experience (ALIVE) cohort of PWID in Baltimore, Maryland (n=848) were surveyed during 2019-2020 about assisting with another person's first injection. Associations between factors related to injection risk and history of providing assistance were estimated using logistic regression models adjusted for sociodemographic and behavioral characteristics. RESULTS At baseline, participants were primarily male (66.1%), black (82.9%), aged a median of 42 years, and had been injecting a median of 18 years. Overall, 19% (n=157) of participants reported ever providing assistance for a median of 2 people (Interquartile Range: 1-4). Having hepatitis C infection (adjusted Odds Ratio [95% Confidence Interval]: 2.5 [1.4-4.6]), syringe sharing (2.2 [1.2-3.9]), and injecting ≥3 times per day (2.0 [1.2-3.4]) at study enrollment were associated with a history of assistance. Participants primarily assisted friends (58.0%), acquaintances (29.9%), and partners (21.7%). Common reasons for assisting were the other person's lack of injection knowledge (73.7%) or sharing drugs (44.9%). Additional reasons included to prevent injury. CONCLUSION PWID with a history of assisting with another person's first injection exhibited heightened vulnerability to infections and more frequent substance use. Expanding implementation of interventions with an emphasis on harm reduction is needed.
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Affiliation(s)
- Rachel E Gicquelais
- University of Wisconsin-Madison School of Nursing, 701 Highland AveMadisonWI53705, United States
| | - Jacqueline Astemborski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe StBaltimoreMD21205, United States
| | - Daniel Werb
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's HospitalTorontoOntario, Canada; Department of Medicine, University of California San DiegoSan DiegoCA92161, United States
| | - Gregory D Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe StBaltimoreMD21205, United States; Johns Hopkins University School of Medicine, Division of Infectious DiseasesBaltimoreMD21205, United States
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe StBaltimoreMD21205, United States
| | - Becky L Genberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe StBaltimoreMD21205, United States.
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23
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Chatterjee A, Bannister M, Hill LG, Davis CS. Prescribing Syringes to People Who Inject Drugs: Advancing Harm Reduction in Primary Care. J Gen Intern Med 2023; 38:1980-1983. [PMID: 37020124 PMCID: PMC10271981 DOI: 10.1007/s11606-023-08183-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 03/20/2023] [Indexed: 04/07/2023]
Abstract
Access to new syringes can reduce the risk of HIV and hepatitis C transmission, skin and soft tissue infections, and infectious endocarditis for people who inject drugs (PWID). Syringe service programs (SSPs) and other harm reduction programs are a good source of syringes. However, they are sometimes not accessible due to limited hours, geographic barriers, and other factors. In this perspective, we argue that when PWID faces barriers to syringes physicians and other providers should prescribe, and pharmacists should dispense, syringes to decrease health risks associated with syringe re-use. This strategy is endorsed by professional organizations and is legally permissible in most states. Such prescribing has numerous benefits, including insurance coverage of the cost of syringes and the sense of legitimacy conveyed by a prescription. We discuss these benefits as well as the legality of prescribing and dispensing syringes and address practical considerations such as type of syringe, quantity, and relevant diagnostic codes, if required. In the face of an unprecedented overdose crisis with many associated health harms, we also make the case for advocacy to change state and federal laws to make access to prescribed syringes uniform, smooth, and universal as part of a suite of harm reduction efforts.
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Affiliation(s)
- Avik Chatterjee
- Boston Health Care for the Homeless Program, Boston, MA, USA.
- Boston Medical Center, Boston, MA, USA.
- Boston University School of Medicine, Boston, MA, USA.
| | | | - Lucas G Hill
- The University of Texas at Austin College of Pharmacy, Austin, TX, USA
| | - Corey S Davis
- Network for Public Health Law, Edina, MN, USA
- NYU Grossman School of Medicine, New York City, NY, USA
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24
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Pietrantoni D, Barroca C, Lynch S, Byrne J, Ortner M, Kotwani R, Limbrick K, Kaldas P, Moussa M, Fredrickson T, Schaefer J, Jacobs RJ. A Scoping Review on the Effects of COVID-19 on Syringe Service Programs in the United States. Cureus 2023; 15:e39023. [PMID: 37378253 PMCID: PMC10292154 DOI: 10.7759/cureus.39023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/14/2023] [Indexed: 06/29/2023] Open
Abstract
The COVID-19 pandemic has had worldwide impacts, including disrupting community services. One interrupted service was syringe service programs (SSPs), community-established initiatives that provide sterile supplies and aid in overcoming addiction in drug-using participants. In the United States (U.S.), SSPs have been key in combating the recent opioid use crisis and associated infections such as the human immunodeficiency virus (HIV) and hepatitis C. While some published reports on the pandemic's overall impacts on SSPs exist, certain aspects such as operational changes and repercussions on staff and participants may still be lacking. Information about the impact of interrupted SSP services due to the pandemic may provide insight into how to prepare to mitigate similar outcomes during possible future health outbreaks. The aim of this scoping review was thus to explore the effects of the COVID-19 pandemic on the operations, staff, and participants of SSPs in the U.S. The initial search of the databases PubMed, Embase, and Web of Science with selected keywords yielded 117 articles published in English between January 1, 2020, and August 31, 2022. After screening each article for study eligibility, 11 articles were included in the final review. Of the seven articles exploring SSP operational impacts from the pandemic, five acknowledged that mitigation strategies influenced functions, seven highlighted supply changes, and four emphasized the resulting staffing changes. Four studies inspected the pandemic's impacts on SSP participants, which included two articles highlighting participants' struggles with isolation and loneliness, one referencing the fear of exposure to the SARS-CoV-2 virus, and two examining the overall negative psychological effects experienced during this time. SSPs in various settings and regions across the U.S. experienced changes due to the COVID-19 pandemic. Many of these modifications negatively impacted operations, staffing, and participant relationships. Examining the issues that individual SSPs encountered highlights opportunities for structured solutions for the present and in the case of future infectious disease outbreaks. With the severity of the opioid use crisis in the U.S. and the dependence on SSPs for its mitigation, future work in this space should be prioritized.
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Affiliation(s)
- Dylan Pietrantoni
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Crystal Barroca
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Sarah Lynch
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Jonathan Byrne
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Miranda Ortner
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Roshni Kotwani
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Kolin Limbrick
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Paul Kaldas
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Michael Moussa
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Tatem Fredrickson
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Jeffrey Schaefer
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Robin J Jacobs
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
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25
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Bazzi AR, Bordeu M, Baumgartner K, Sproesser DM, Bositis CM, Krakower DS, Mimiaga MJ, Biello KB. Study protocol for an efficacy trial of the "PrEP for Health" intervention to increase HIV PrEP use among people who inject drugs. BMC Public Health 2023; 23:513. [PMID: 36932369 PMCID: PMC10021034 DOI: 10.1186/s12889-023-15429-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/11/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND HIV incidence has recently increased among people who inject drugs (PWID) across the United States, with outbreaks occurring in states with long-standing syringe service programs (SSPs) including Massachusetts (MA). Antiretroviral pre-exposure prophylaxis (PrEP) is an evidence-based HIV prevention strategy recommended for PWID, but uptake in this marginalized population is extraordinarily low. METHODS We describe the design and procedures for a National Institute on Drug Abuse (NIDA)-funded (R01) randomized controlled trial (RCT) testing the efficacy of "PrEP for Health," a multicomponent behavioral intervention to increase PrEP uptake, adherence, and persistence among HIV-negative PWID attending SSPs in two areas of the U.S. Northeast that are heavily affected by injection-related HIV transmission. Participants are equally randomized to receive the "PrEP for Health" intervention (involving individually tailored HIV and PrEP education, motivational interviewing, problem-solving skills and planning, and ongoing navigation support) or an enhanced standard of care (eSOC) control condition involving a brief educational video on the utility of PrEP for HIV prevention. Co-primary outcomes are PrEP uptake (using medical/pharmacy records) and adherence (using tenofovir quantification in hair samples); a secondary outcome is PrEP persistence (using medical/pharmacy records) over 12 months. Major assessments occur at baseline, 1-, 3-, 6-, and 12-month follow-up visits. Planned analyses will examine intervention efficacy, specific hypothesized conceptual mediators of the intervention effect (e.g., self-perceived HIV risk; PrEP knowledge, interest in use, motivation, and behavioral skills) and epidemiologically linked moderators (e.g., age; gender; condomless vaginal or anal sex). DISCUSSION Findings from our extensive preliminary research with the study population revealed that a multicomponent, theory-based intervention targeting PrEP knowledge, motivation, self-efficacy, behavioral skills, and structural barriers to PrEP access is urgently needed for PWID who are at risk of HIV acquisition. We also learned that SSPs represent a highly acceptable service setting for delivering such interventions. In this study, we are evaluating the efficacy of the "PrEP for Health" intervention. If efficacious, findings from our implementation evaluation could help guide its dissemination to diverse SSPs and possibly other community-based settings accessed by this population. TRIAL REGISTRATION ClinicalTrials.gov number NCT04430257, registered June 12, 2020.
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Affiliation(s)
- Angela R Bazzi
- Herbert Wertheim School of Public Health, University of California, 9500 Gilman Drive, San Diego, La Jolla, 92093, CA, USA.
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
- Herbert Wertheim School of Public Health, University of California, 9500 Gilman Drive, MTF 265E (Mail Code 0725), La Jolla, 92161, CA, USA.
| | | | | | | | - Christopher M Bositis
- Greater Lawrence Family Health Center, Lawrence, MA, USA
- Department of Family and Community Medicine, University of California, San Francisco, USA
| | - Douglas S Krakower
- Fenway Health, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Matthew J Mimiaga
- Fenway Health, Boston, MA, USA
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA
| | - Katie B Biello
- Fenway Health, Boston, MA, USA.
- Departments of Behavioral & Social Sciences and Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, 02912, RI, USA.
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA.
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26
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Bazzi AR, Shaw LC, Biello KB, Vahey S, Brody JK. Patient and Provider Perspectives on a Novel, Low-Threshold HIV PrEP Program for People Who Inject Drugs Experiencing Homelessness. J Gen Intern Med 2023; 38:913-921. [PMID: 35614171 PMCID: PMC9132566 DOI: 10.1007/s11606-022-07672-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/10/2022] [Indexed: 10/24/2022]
Abstract
BACKGROUND HIV outbreaks among people who inject drugs (PWID) and experience homelessness are increasing across the USA. Despite high levels of need, multilevel barriers to accessing antiretroviral pre-exposure prophylaxis (PrEP) for HIV prevention persist for this population. The Boston Health Care for the Homeless Program (BHCHP) initiated a low-threshold, outreach-based program to support engagement in PrEP services among PWID experiencing homelessness. METHODS To inform dissemination efforts, we explored patient and provider perspectives on key program components. From March to December 2020, we conducted semi-structured qualitative interviews with current and former BHCHP PrEP program participants and prescribers, patient navigators, and outreach workers (i.e., providers). Thematic analysis explored perspectives on key program components. RESULTS Participants (n = 21) and providers (n = 11) identified the following five key components of BHCHP's PrEP program that they perceived to be particularly helpful for supporting patient engagement in PrEP services: (1) community-driven PrEP education; (2) low-threshold, accessible programming including same-day PrEP prescribing; (3) tailored prescribing supports (e.g., on-site pharmacy, short-term prescriptions, medication storage); (4) intensive outreach and navigation; and (5) trusting, respectful patient-provider relationships. DISCUSSION Findings suggest that more patient-centered services formed the basis of BHCHP's innovative, successful PrEP program. While contextual challenges including competing public health emergencies and homeless encampment "sweeps" necessitate ongoing programmatic adaptations, lessons from BHCHP's PrEP program can inform PrEP delivery in a range of community-based settings serving this population, including syringe service programs and shelters.
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Affiliation(s)
- Angela R Bazzi
- Herbert Wertheim School of Public Health, University of California, San Diego, 9500 Gilman Drive, MTF 265E (Mail Code 0725), La Jolla, CA, 92161, USA.
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
| | - Leah C Shaw
- Boston Healthcare for the Homeless Program, Boston, MA, USA
| | - Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Seamus Vahey
- Boston Healthcare for the Homeless Program, Boston, MA, USA
| | - Jennifer K Brody
- Boston Healthcare for the Homeless Program, Boston, MA, USA
- Harvard Medical School, Boston, USA
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27
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Tookes HE, Oxner A, Serota DP, Alonso E, Metsch LR, Feaster DJ, Ucha J, Suarez E, Forrest DW, McCollister K, Rodriguez A, Kolber MA, Chueng TA, Zayas S, McCoy B, Sutherland K, Archer C, Bartholomew TS. Project T-SHARP: study protocol for a multi-site randomized controlled trial of tele-harm reduction for people with HIV who inject drugs. Trials 2023; 24:96. [PMID: 36750867 PMCID: PMC9904271 DOI: 10.1186/s13063-023-07074-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/05/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND The resurgence of HIV outbreaks and rising prevalence among people who inject drugs (PWID) remain exigent obstacles to Ending the HIV Epidemic in the USA. Adapting a low threshold, comprehensive treatment model for PWID with HIV can leverage syringe services programs (SSPs) to increase availability and accessibility of antiretrovirals (ART), medications for opioid use disorder (MOUD), and hepatitis C cure. We developed Tele-Harm Reduction, a telehealth-enhanced, harm reduction intervention delivered within an SSP venue. METHODS The T-SHARP trial is an open-label, multi-site, randomized controlled superiority trial with two parallel treatment arms. Participants (n=240) recruited from SSPs in Miami, Ft. Lauderdale, and Tampa, Florida, who are PWID with uncontrolled HIV (i.e., HIV RNA>200) will be randomized to Tele-Harm Reduction or off-site linkage to HIV care. The primary objective is to compare the efficacy of Tele-Harm Reduction for initiation of ART at SSPs vs. off-site linkage to an HIV clinic with respect to viral suppression across follow-up (suppression at 3, 6, and 12 months post randomization). Participants with HIV RNA<200 copies/ml will be considered virally suppressed. The primary trial outcome is time-averaged HIV viral suppression (HIV RNA <200 copies/ml) over 3-, 6-, and 12-month follow-up. Secondary outcomes include initiation of MOUD measured by urine drug screen and HCV cure, defined as achieving 12-week sustained virologic response (negative HCV RNA at 12 weeks post treatment completion). A cost-effectiveness analysis will be performed. DISCUSSION The T-SHARP Trial will be the first to our knowledge to test the efficacy of an innovative telehealth intervention with PWID with uncontrolled HIV delivered via an SSP to support HIV viral suppression. Tele-Harm Reduction is further facilitated by a peer to support adherence and bridge the digital divide. This innovative, flipped healthcare model sets aside the traditional healthcare system, reduces multi-level barriers to care, and meets PWID where they are. The T-SHARP trial is a pragmatic clinical trial that seeks to transform the way that PWID access HIV care and improve HIV clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT05208697. Trial registry name: Tele-Harm Reduction. Registration date: January 26, 2022.
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Affiliation(s)
- Hansel E Tookes
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Asa Oxner
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - David P Serota
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Elizabeth Alonso
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Daniel J Feaster
- Biostatistics Division, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jessica Ucha
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Edward Suarez
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - David W Forrest
- Department of Anthropology, University of Miami, Miami, FL, USA
| | - Kathryn McCollister
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Allan Rodriguez
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael A Kolber
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Teresa A Chueng
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Bernice McCoy
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Kyle Sutherland
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Chetwyn Archer
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tyler S Bartholomew
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Bradley H, Hall EW, Asher A, Furukawa NW, Jones CM, Shealey J, Buchacz K, Handanagic S, Crepaz N, Rosenberg ES. Estimated Number of People Who Inject Drugs in the United States. Clin Infect Dis 2023; 76:96-102. [PMID: 35791261 DOI: 10.1093/cid/ciac543] [Citation(s) in RCA: 47] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 06/13/2022] [Accepted: 06/29/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Public health data signal increases in the number of people who inject drugs (PWID) in the United States during the past decade. An updated PWID population size estimate is critical for informing interventions and policies aiming to reduce injection-associated infections and overdose, as well as to provide a baseline for assessments of pandemic-related changes in injection drug use. METHODS We used a modified multiplier approach to estimate the number of adults who injected drugs in the United States in 2018. We deduced the estimated number of nonfatal overdose events among PWID from 2 of our previously published estimates: the number of injection-involved overdose deaths and the meta-analyzed ratio of nonfatal to fatal overdose. The number of nonfatal overdose events was divided by prevalence of nonfatal overdose among current PWID for a population size estimate. RESULTS There were an estimated 3 694 500 (95% confidence interval [CI], 1 872 700-7 273 300) PWID in the United States in 2018, representing 1.46% (95% CI, .74-2.87) of the adult population. The estimated prevalence of injection drug use was highest among males (2.1%; 95% CI, 1.1-4.2), non-Hispanic Whites (1.8%; 95% CI, .9-3.6), and adults aged 18-39 years (1.8%; 95% CI, .9-3.6). CONCLUSIONS Using transparent, replicable methods and largely publicly available data, we provide the first update to the number of people who inject drugs in the United States in nearly 10 years. Findings suggest the population size of PWID has substantially grown in the past decade and that prevention services for PWID should be proportionally increased.
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Affiliation(s)
- Heather Bradley
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, Georgia, USA
| | - Eric W Hall
- Oregon Health Sciences University/Portland State University School of Public Health, Portland, Oregon, USA
| | - Alice Asher
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nathan W Furukawa
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christopher M Jones
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jalissa Shealey
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, Georgia, USA
| | - Kate Buchacz
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Senad Handanagic
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nicole Crepaz
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eli S Rosenberg
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, SUNY, Albany, New York, USA.,Office of Public Health, New York State Department of Public Health, Albany, New York, USA
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29
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Bonnevie E, Silesky MD, Goldbarg J, Gudmundsen C, Fields M, Smyser J. A multi-site intervention using influencers to communicate about syringe service programmes. HEALTH EDUCATION JOURNAL 2023; 82:779-791. [PMID: 38650842 PMCID: PMC11034740 DOI: 10.1177/00178969231197623] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Introduction In the USA, syringe services programmes (SSPs) provide a range of harm reduction services and have numerous benefits for communities. However, stigma, misconceptions about SSPs and changing policies/legislation remain a challenge to effective implementation. This study reviews the implementation of two digital interventions, Appalachian Influence and Shared Influence, which used social media influencers and digital volunteers to communicate positive information about harm reduction and SSPs. Methods The intervention was designed to deliver accurate and supportive messaging in locally relevant and meaningful ways. Messaging was informed by interviews with subject matter experts and community organisations, and was integrated into prompts used by local influencers (paid individuals with more than 1,000 followers) and digital volunteers (unpaid individuals with no following requirement, who joined the project independently). Results In the first 6 months of implementation, Appalachian Influence and Shared Influence engaged a total of 9,014 individuals, 236 of whom were paid influencers and 8,778 of whom were digital volunteers. Paid influencer posts achieved a total of 868,943 impressions, 42,432 engagements and 1,567 comments. Comments on paid influencer posts were overwhelmingly positive, with 87.4% positive and 0.8% negative. Interviews showed the importance of understanding local realities, leading with compassion and emphasising the 'human' aspects of dependency and addiction in messaging. Conclusion This study shows the potential to implement an influencer-led social media intervention to reach people with authentic and compassionate messaging about harm reduction and SSPs. Future research should examine intervention effectiveness and how this approach can be applied to other stigmatised topics.
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Affiliation(s)
| | | | | | | | | | - Joe Smyser
- The Public Good Projects, New York, NY, USA
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30
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Jones CM, Han B, Seth P, Baldwin G, Compton WM. Increases in methamphetamine injection among treatment admissions in the U.S. Addict Behav 2023; 136:107492. [PMID: 36156454 PMCID: PMC9809156 DOI: 10.1016/j.addbeh.2022.107492] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/18/2022] [Accepted: 09/09/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Prior research indicates rising methamphetamine use and harms in the U.S., potentially related to increases in methamphetamine injection. To date, research on trends and correlates of methamphetamine injection is limited. METHODS Analysis of trends and correlates of methamphetamine injection among treatment admissions among persons aged ≥ 12 whose primary substance of use at admission is methamphetamine. Data are from the Treatment Episode Data Set. Analyses includes descriptive statistics, trend analyses, and multilevel multivariable logistic regression. RESULTS Primary methamphetamine treatment admissions increased from 138,379 in 2010 to 201,021 in 2019. Among primary methamphetamine admissions, injection as the usual route of use increased from 24,821 (18.0 % of admissions) in 2010 to 55,951 (28.2 % of admissions) in 2019. Characteristics associated with increased adjusted odds of reporting methamphetamine injection included: males (aOR = 1.13, 95 % CI = 1.10-1.15); admission age 25-34 years (aOR = 1.23, 95 % CI = 1.19-1.28) and 35-44 years (aOR = 1.12, 95 % CI = 1.08-1.17) compared to age 18-24; dependent living (aOR = 1.33, 95 % CI = 1.29-1.37) and homelessness (aOR = 1.58, 95 % CI = 1.54-1.63) compared to independent living; part-time employment (aOR = 1.08, 95 % CI = 1.02-1.14), unemployment (aOR = 1.39, 95 % CI = 1.34-1.44) and not in labor force (aOR = 1.43, 95 % CI = 1.37-1.49) compared to full-time employment; one to ≥ four prior treatment admissions (aORs ranging from 1.19 to 1.94) compared to no prior admissions; also reporting use of cocaine (aOR = 1.10, 95 % CI = 1.05-1.16), heroin (aOR = 3.52, 95 % CI = 3.40-3.66), prescription opioids (aOR = 1.61, 95 % CI = 1.54-1.67), or benzodiazepines (aOR = 1.42, 95 % CI = 1.32-1.52) at treatment admission. CONCLUSIONS Findings lend further evidence to a resurgence of methamphetamine use that is intertwined with the ongoing opioid crisis in the U.S. Efforts to expand evidence-based prevention, treatment, and response efforts, particularly to populations at highest risk, are urgently needed.
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Affiliation(s)
- Christopher M Jones
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Beth Han
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, United States
| | - Puja Seth
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Grant Baldwin
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Wilson M Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, United States
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31
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Bartholomew TS, Andraka-Cristou B, Totaram RK, Harris S, Doblecki-Lewis S, Ostrer L, Serota DP, Forrest DW, Chueng TA, Suarez E, Tookes HE. "We want everything in a one-stop shop": acceptability and feasibility of PrEP and buprenorphine implementation with mobile syringe services for Black people who inject drugs. Harm Reduct J 2022; 19:133. [PMID: 36463183 PMCID: PMC9719627 DOI: 10.1186/s12954-022-00721-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/21/2022] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION A recent surge in HIV outbreaks, driven by the opioid and stimulant use crises, has destabilized our progress toward targets set forth by Ending the HIV Epidemic: A Plan for America for the high-priority community of people who inject drugs (PWID), particularly Black PWID. METHODS In order to ascertain the acceptability and feasibility of using a mobile syringe services program (SSP) for comprehensive HIV prevention via PrEP and medications for opioid use disorder (MOUD), our mixed methods approach included a quantitative assessment and semi-structured qualitative interviews with Black PWID (n = 30) in Miami-Dade County who were actively engaged in mobile syringe services. RESULTS Participants felt that delivery of MOUD and PrEP at a mobile SSP would be both feasible and acceptable, helping to address transportation, cost, and stigma barriers common within traditional healthcare settings. Participants preferred staff who are compassionate and nonjudgmental and have lived experience. CONCLUSIONS A mobile harm reduction setting could be an effective venue for delivering comprehensive HIV prevention services to Black PWID, a community that experiences significant barriers to care via marginalization and racism in a fragmented healthcare system.
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Affiliation(s)
- Tyler S. Bartholomew
- grid.26790.3a0000 0004 1936 8606Division of Health Services Research and Policy, Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th St., #1020, Miami, FL 33136 USA
| | - Barbara Andraka-Cristou
- grid.170430.10000 0001 2159 2859Department of Health Management and Informatics, University of Central Florida, Orlando, FL USA ,grid.170430.10000 0001 2159 2859Department of Internal Medicine, University of Central Florida, Orlando, FL USA
| | - Rachel K. Totaram
- grid.170430.10000 0001 2159 2859Department of Health Management and Informatics, University of Central Florida, Orlando, FL USA
| | - Shana Harris
- grid.170430.10000 0001 2159 2859Department of Internal Medicine, University of Central Florida, Orlando, FL USA ,grid.170430.10000 0001 2159 2859Department of Anthropology, University of Central Florida, Orlando, FL USA
| | - Susanne Doblecki-Lewis
- grid.26790.3a0000 0004 1936 8606Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL USA
| | - Lily Ostrer
- grid.26790.3a0000 0004 1936 8606Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL USA
| | - David P. Serota
- grid.26790.3a0000 0004 1936 8606Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL USA
| | - David W. Forrest
- grid.26790.3a0000 0004 1936 8606Department of Anthropology, College of Arts and Sciences, University of Miami, Miami, FL USA
| | - Teresa A. Chueng
- grid.26790.3a0000 0004 1936 8606Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL USA
| | - Edward Suarez
- grid.26790.3a0000 0004 1936 8606Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL USA
| | - Hansel E. Tookes
- grid.26790.3a0000 0004 1936 8606Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL USA
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Corneli A, Perry B, Des Marais A, Choi Y, Chen H, Lilly R, Ayers D, Bennett J, Kestner L, Meade CS, Sachdeva N, McKellar MS. Participant perceptions on the acceptability and feasibility of a telemedicine-based HIV PrEP and buprenorphine/naloxone program embedded within syringe services programs: a qualitative descriptive evaluation. Harm Reduct J 2022; 19:132. [PMID: 36463214 PMCID: PMC9719634 DOI: 10.1186/s12954-022-00718-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/19/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND People who inject drugs (PWID) are at risk for HIV and opioid overdose. We piloted PARTNER UP, a telemedicine-based program to provide PWID with access to both oral pre-exposure prophylaxis (PrEP) for HIV prevention and medication for opioid use disorder (MOUD) through two syringe services programs (SSPs) in North Carolina. We conducted a qualitative evaluation to assess the acceptability and feasibility of PARTNER UP from the participant perspective. METHODS PARTNER UP participants met with a provider for an initial in-person visit at the SSP, followed by weekly telemedicine visits in month 1 and then monthly telemedicine visits until program end at month 6. Using a qualitative descriptive study design, we conducted in-depth interviews with a subsample of PARTNER UP participants at 1 month and 4 months. Informed by the technology acceptance model, we assessed participant perceptions of the usefulness and ease of use of PARTNER UP, as well as their intent to continue to use the program's components. We audio-recorded all interviews with participants' permission and used applied thematic analysis to analyze the verbatim transcripts. RESULTS We interviewed 11 of 17 people who participated in PARTNER UP-10 in the month 1 interview and 8 in the month 4 interview. Nearly all participants were motivated to join for consistent and easy access to buprenorphine/naloxone (i.e., MOUD); only a few joined to access PrEP. Most were comfortable accessing healthcare at the SSP because of their relationship with and trust toward SSP staff, and accessing services at the SSP was preferred compared with other healthcare centers. Some participants described that telemedicine allowed them to be honest and share more information because the visits were not in-person and they chose the location, although the initial in-person meeting was helpful to build provider trust and rapport. Most participants found the visit schedule to be feasible, although half described needing to reschedule at least once. Nearly all participants who were interviewed intended to continue with MOUD after the program ended, whereas none were interested in continuing with PrEP. CONCLUSIONS Participant narratives suggest that the PARTNER UP telemedicine program was acceptable and feasible. Future studies should continue to explore the benefits of embedding both PrEP and MOUD into SSPs with larger numbers of participants. Trial registration Clinicaltrials.gov Identifier: NCT04521920.
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Affiliation(s)
- Amy Corneli
- grid.26009.3d0000 0004 1936 7961Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC 27701 USA ,grid.26009.3d0000 0004 1936 7961Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC USA ,grid.26009.3d0000 0004 1936 7961Department of Medicine, Duke University School of Medicine, Durham, NC USA
| | - Brian Perry
- grid.26009.3d0000 0004 1936 7961Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC 27701 USA
| | - Andrea Des Marais
- grid.26009.3d0000 0004 1936 7961Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC 27701 USA
| | - Yujung Choi
- grid.26009.3d0000 0004 1936 7961Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC 27701 USA
| | - Hillary Chen
- grid.26009.3d0000 0004 1936 7961Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC 27701 USA
| | - Rebecca Lilly
- North Carolina Harm Reduction Coalition, Wilmington, NC USA ,Present Address: Port City Harm Reduction, Wilmington, NC USA
| | - Denae Ayers
- Queen City Harm Reduction, Charlotte, NC USA
| | - Jesse Bennett
- North Carolina Harm Reduction Coalition, Wilmington, NC USA
| | | | - Christina S. Meade
- grid.26009.3d0000 0004 1936 7961Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC USA
| | - Nidhi Sachdeva
- grid.26009.3d0000 0004 1936 7961Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC 27701 USA ,grid.10698.360000000122483208Present Address: North Carolina Association of County Commissioners, Raleigh, NC USA
| | - Mehri S. McKellar
- grid.26009.3d0000 0004 1936 7961Department of Medicine, Duke University School of Medicine, Durham, NC USA
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Austin EJ, Corcorran MA, Briggs ES, Frost MC, Behrends CN, Juarez AM, Frank ND, Healy E, Prohaska SM, LaKosky PA, Kapadia SN, Perlman DC, Schackman BR, Jarlais DCD, Williams EC, Glick SN. Barriers to engaging people who use drugs in harm reduction services during the COVID-19 pandemic: A mixed methods study of syringe services program perspectives. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 109:103825. [PMID: 35977459 PMCID: PMC9364718 DOI: 10.1016/j.drugpo.2022.103825] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/12/2022] [Accepted: 08/06/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Syringe services programs (SSPs) provide critical evidence-based public health services that decrease harms from drug use for people who use drugs (PWUD). Many SSPs have experienced significant and evolving COVID-19-related disruptions. We aimed to characterize the impacts of COVID-19 on SSP operations in the United States approximately one year into the pandemic. METHODS Participating sites, selected from a national sample of SSPs, completed a semi-structured interview via teleconference and brief survey evaluating the impacts of COVID-19 on program operations. Data collection explored aspects of program financing, service delivery approaches, linkages to care, and perspectives on engaging PWUD in services one year into the pandemic. Interview data were analyzed qualitatively using Rapid Assessment Process. Survey data were analyzed using descriptive statistics and triangulated with qualitative findings. RESULTS 27 SSPs completed study-related interviews and surveys between February 2021 - April 2021. One year into the pandemic, SSPs reported continuing to adapt approaches to syringe distribution in response to COVID-19, and identified multiple barriers that hindered their ability to engage program participants in services, including 1) isolation and decreased connectivity with participants, 2) resource restrictions that limit responsiveness to participant needs, 3) reduced capacity to provide on-site HIV/HCV testing and treatment linkages, and 4) changing OUD treatment modalities that were a "double-edged sword" for PWUD. Quantitative survey responses aligned with qualitative findings, highlighting increases in the number of syringes distributed, increases in mobile and home delivery services, and reductions in on-site HIV and HCV testing. CONCLUSION These data illuminate persistent and cascading risks of isolation, reduced access to services, and limited engagement with program participants that resulted from COVID-19 and continue to create barriers to the delivery of critical harm reduction services. Findings emphasize the need to ensure SSPs have the resources and capacity to adapt to changing public health needs, particularly as the COVID-19 pandemic continues to evolve.
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Affiliation(s)
- Elizabeth J Austin
- Department of Health Systems and Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA, USA.
| | - Maria A Corcorran
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 1959 Pacific Street NE, Seattle, WA, USA
| | - Elsa S Briggs
- Department of Health Systems and Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA, USA
| | - Madeline C Frost
- Department of Health Systems and Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA, USA; Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, USA
| | - Czarina N Behrends
- Department of Population Health Sciences, Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA
| | - Alexa M Juarez
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 1959 Pacific Street NE, Seattle, WA, USA
| | - Noah D Frank
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 1959 Pacific Street NE, Seattle, WA, USA
| | - Elise Healy
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 1959 Pacific Street NE, Seattle, WA, USA
| | - Stephanie M Prohaska
- Dave Purchase Project, North American Syringe Exchange Network, 535 Dock Street, Tacoma, WA, USA
| | - Paul A LaKosky
- Dave Purchase Project, North American Syringe Exchange Network, 535 Dock Street, Tacoma, WA, USA
| | - Shashi N Kapadia
- Department of Population Health Sciences, Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA; Division of Infectious Diseases, Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA
| | - David C Perlman
- Center for Drug Use and HIV Research, School of Global Public Health, New York University, 708 Broadway, New York, NY, USA; Division of Infectious Diseases, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, USA
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA
| | - Don C Des Jarlais
- School of Global Public Health, New York University, 708 Broadway, New York, NY, USA
| | - Emily C Williams
- Department of Health Systems and Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA, USA; Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, USA
| | - Sara N Glick
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 1959 Pacific Street NE, Seattle, WA, USA
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Barranco MA, Rosenberg ES, Flanigan C, Shufelt S, Bruce EM, Wilberschied LA, Parker MM, Duncan E, Udo T. A cross-sectional study of hepatitis C prevalence and correlates among persons who inject drugs in rural and non-rural communities. J Viral Hepat 2022; 29:994-1003. [PMID: 35925950 DOI: 10.1111/jvh.13735] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 06/25/2022] [Accepted: 06/30/2022] [Indexed: 12/09/2022]
Abstract
Persons who inject drugs (PWID) have been experiencing a higher burden of new hepatitis C (HCV) due to the opioid epidemic. The greatest increases in injection have been in rural communities. However, less is known about the prevalence of HCV or its risk factors in rural compared to non-rural communities. This study compared HCV infection history, current infection, and associated behavioural and sociodemographic correlates among PWID recruited from rural and non-rural communities from Upstate New York (NY). This cross-sectional study recruited 309 PWID, using respondent-driven sampling. Blood samples were collected through finger stick for HCV antibody and RNA tests. A survey was also self-administered for HCV infection history, sociodemographics and behavioural correlates to compare by setting rurality. HCV seropositivity was significantly higher among PWID from rural than non-rural communities (71.0% vs. 46.8%), as was current infection (41.4% vs. 25.9%). High levels of past year syringe (44.4%) and equipment (62.2%) sharing were reported. Factors associated with infection history include syringe service program utilization, non-Hispanic white race, sharing needles and methamphetamine injection, which was higher in rural vs. non-rural communities (38.5% vs. 15.5%). HCV burden among PWID appears higher in rural than non-rural communities and may be increasing possibly due to greater levels of methamphetamine injection. On-going systematic surveillance of HCV prevalence and correlates is crucial to respond to the changing opioid epidemic landscape. Additionally, improving access to harm reduction services, especially with special focus on stimulants, may be important to reduce HCV prevalence among PWID in rural settings.
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Affiliation(s)
- Meredith A Barranco
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York, USA
| | - Eli S Rosenberg
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York, USA.,Center for Collaborative HIV Research in Practice and Policy, University at Albany, Rensselaer, New York, USA.,Office of Public Health, New York State Department of Health, Albany, New York, USA
| | - Colleen Flanigan
- AIDS Institute, New York State Department of Health, Albany, New York, USA
| | - Sarah Shufelt
- Center for Collaborative HIV Research in Practice and Policy, University at Albany, Rensselaer, New York, USA
| | - Emily M Bruce
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York, USA.,AIDS Institute, New York State Department of Health, Albany, New York, USA
| | | | - Monica M Parker
- Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Eliana Duncan
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York, USA
| | - Tomoko Udo
- Center for Collaborative HIV Research in Practice and Policy, University at Albany, Rensselaer, New York, USA.,Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, Rensselaer, New York, USA
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Eger WH, Altice FL, Lee J, Vlahov D, Khati A, Osborne S, Wickersham JA, Bohonnon T, Powell L, Shrestha R. Using nominal group technique to identify barriers and facilitators to preventing HIV using combination same-day pre-exposure prophylaxis and medications for opioid use disorder. Harm Reduct J 2022; 19:120. [PMID: 36307817 PMCID: PMC9616614 DOI: 10.1186/s12954-022-00703-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 10/20/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Preventing HIV transmission among people who inject drugs (PWID) is a key element of the US Ending the HIV Epidemic strategy and includes both pre-exposure prophylaxis (PrEP) and medications for opioid use disorder (MOUD). While both lead to decreases in HIV transmission, MOUD has other social and health benefits; meanwhile, PrEP has additional HIV prevention advantages from sexual risk and the injection of stimulants. However, these medications are often prescribed in different settings and require multiple visits before initiation. Strategies to integrate these services (i.e., co-prescription) and offer same-day prescriptions may reduce demands on patients who could benefit from them. METHODS Nominal group technique, a consensus method that rapidly generates and ranks responses, was used to ascertain barriers and solutions for same-day delivery of PrEP and MOUD as an integrated approach among PWID (n = 14) and clinical (n = 9) stakeholders. The qualitative portion of the discussion generated themes for analysis, and the ranks of the proposed barriers and solutions to the program are presented. RESULTS The top three barriers among PWID to getting a same-day prescription for both PrEP and MOUD were (1) instability of insurance (e.g., insurance lapses); (2) access to a local prescriber; and (3) client-level implementation factors, such as lack of personal motivation. Among clinical stakeholders, the three greatest challenges were (1) time constraints on providers; (2) logistics (e.g., coordination between providers and labs); and (3) availability of providers who can prescribe both medications. Potential solutions identified by both stakeholders included pharmacy delivery of the medications, coordinated care between providers and health care systems (e.g., case management), and efficiencies in clinical care (e.g., clinical checklists), among others. CONCLUSIONS Implementing and sustaining a combined PrEP and MOUD strategy will require co-training providers on both medications while creating efficiencies in systems of care and innovations that encourage and retain PWID in care. Pilot testing the co-prescribing of PrEP and MOUD with quality performance improvement is a step toward new practice models.
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Affiliation(s)
- William H Eger
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Frederick L Altice
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Jessica Lee
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
| | | | - Antoine Khati
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Sydney Osborne
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Jeffrey A Wickersham
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Terry Bohonnon
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
| | | | - Roman Shrestha
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA.
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA.
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, 358 Mansfield Rd, Unit 1101, Storrs, CT, 06269, USA.
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Davis CS, Carr DH. Repealing State Drug-Paraphernalia Laws - The Need for Federal Leadership. N Engl J Med 2022; 387:1344-1346. [PMID: 36214589 DOI: 10.1056/nejmp2207866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Corey S Davis
- From the Network for Public Health Law, Los Angeles (C.S.D.); and the Department of Population Health, New York University Grossman School of Medicine (C.S.D.), and Vital Strategies (D.H.C.) - both in New York
| | - Derek H Carr
- From the Network for Public Health Law, Los Angeles (C.S.D.); and the Department of Population Health, New York University Grossman School of Medicine (C.S.D.), and Vital Strategies (D.H.C.) - both in New York
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Khati A, Altice FL, Vlahov D, Eger WH, Lee J, Bohonnon T, Wickersham JA, Maviglia F, Copenhaver N, Shrestha R. Nurse Practitioner-Led Integrated Rapid Access to HIV Prevention for People Who Inject Drugs (iRaPID): Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e42585. [PMID: 36222826 PMCID: PMC9597427 DOI: 10.2196/42585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 09/18/2022] [Accepted: 09/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The ongoing volatile opioid epidemic remains a significant public health concern, alongside continued outbreaks of HIV and hepatitis C virus among people who inject drugs. The limited access to and scale-up of medications for opioid use disorder (MOUD) among people who inject drugs, coupled with multilevel barriers to pre-exposure prophylaxis (PrEP) uptake, makes it imperative to integrate evidence-based risk reduction and HIV prevention strategies in innovative ways. To address this need, we developed an integrated rapid access to HIV prevention program for people who inject drugs (iRaPID) that incorporates same-day PrEP and MOUD for this population. OBJECTIVE The primary objective of this pilot study is to assess the feasibility and acceptability of the program and evaluate its preliminary efficacy on PrEP and MOUD uptake for a future randomized controlled trial (RCT). We also aim to explore information on the implementation of the program in a real-world setting using a type I hybrid implementation trial design. METHODS Using a type I hybrid implementation trial design, we are pilot testing the nurse practitioner-led iRaPID program while exploring information on its implementation in a real-world setting. Specifically, we will assess the feasibility and acceptability of the iRaPID program and evaluate its preliminary efficacy on PrEP and MOUD uptake in a pilot RCT. The enrolled 50 people who inject drugs will be randomized (1:1) to either iRaPID or treatment as usual (TAU). Behavioral assessments will occur at baseline, and at 1, 3, and 6 months. Additionally, we will conduct a process evaluation of the delivery and implementation of the iRaPID program to collect information for future implementation. RESULTS Recruitment began in July 2021 and was completed in August 2022. Data collection is planned through February 2023. The Institutional Review Boards at Yale University and the University of Connecticut approved this study (2000028740). CONCLUSIONS This prospective pilot study will test a nurse practitioner-led, integrated HIV prevention program that incorporates same-day PrEP and MOUD for people who inject drugs. This low-threshold protocol delivers integrated prevention via one-stop shopping under the direction of nurse practitioners. iRaPID seeks to overcome barriers to delayed PrEP and MOUD initiation, which is crucial for people who inject drugs who have had minimal access to evidence-based prevention. TRIAL REGISTRATION ClinicalTrials.gov NCT04531670; https://clinicaltrials.gov/ct2/show/NCT04531670. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/42585.
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Affiliation(s)
- Antoine Khati
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | | | - David Vlahov
- Yale School of Nursing, West Haven, CT, United States
| | - William H Eger
- AIDS Program, Yale School of Medicine, New Haven, CT, United States
| | - Jessica Lee
- AIDS Program, Yale School of Medicine, New Haven, CT, United States
| | - Terry Bohonnon
- AIDS Program, Yale School of Medicine, New Haven, CT, United States
| | | | | | - Nicholas Copenhaver
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Roman Shrestha
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
- AIDS Program, Yale School of Medicine, New Haven, CT, United States
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Touesnard N, Brothers TD, Bonn M, Edelman EJ. Overdose deaths and HIV infections among people who use drugs: shared determinants and integrated responses. Expert Rev Anti Infect Ther 2022; 20:1061-1065. [PMID: 35615917 PMCID: PMC10693947 DOI: 10.1080/14787210.2022.2081152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/19/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Natasha Touesnard
- Canadian Association of People Who Use Drugs (CAPUD), Dartmouth, Nova Scotia, Canada
| | - Thomas D Brothers
- Department of Medicine, Division of General Internal Medicine & Clinician-Investigator Program, Dalhousie University, Halifax, Nova Scotia, Canada
- UCL Collaborative Centre for Inclusion Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Matthew Bonn
- Canadian Association of People Who Use Drugs (CAPUD), Dartmouth, Nova Scotia, Canada
| | - E Jennifer Edelman
- Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, Connecticut, USA
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Varshney K, Ghosh P, Stiles H, Iriowen R. Risk Factors for COVID-19 Mortality Among People Living with HIV: A Scoping Review. AIDS Behav 2022; 26:2256-2265. [PMID: 35024992 PMCID: PMC8756751 DOI: 10.1007/s10461-022-03578-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2021] [Indexed: 11/01/2022]
Abstract
People living with HIV (PLWH) are particularly vulnerable to worsened outcomes of COVID-19. Therefore, the purpose of this work was to provide a scoping review of the literature to assess the risk factors for COVID-19 mortality among PLWH. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR), searches were conducted in PubMed, Scopus, Global Health, and WHO Coronavirus Database. Articles were eligible for inclusion if they were in English, included PLWH who died after COVID-19 infection, and described risk factors for mortality. Results were descriptively synthesized and pooled thereafter. Study quality was assessed using the Joanna Brigg Institute's critical appraisal tools. 20 studies were eligible for inclusion, with the pooled death rate being 11.7%. Age was a major risk factor, especially after 50 (23.2%) and after 70 (41.8%), and males had a death rate nearly double that of females. As total comorbidities increased, the death rate also greatly increased; among those with comorbidities, the highest fatality rates were those with cardiovascular disease (30.2%), chronic kidney disease (23.5%), obesity (22.4%), and diabetes (18.4%). Other risk factors for mortality among PLWH included having a Black racial background, being an injection drug user, being a smoker, and having a CD4 cell count below 200. There is a need to better study confounding factors, and to understand how vaccination influences mortality risk. Overall, the findings highlight a need to ensure that focus is placed on the varying demographics of PLWH amidst COVID-19 control efforts.
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Affiliation(s)
- Karan Varshney
- College of Population Health, Thomas Jefferson University, Philadelphia, PA USA
- School of Medicine, Deakin University, 75 Pigdons Rd, Waurn Ponds, VIC 3216 Australia
| | - Prerana Ghosh
- School of Medicine, Deakin University, 75 Pigdons Rd, Waurn Ponds, VIC 3216 Australia
| | - Helena Stiles
- School of Medicine, Deakin University, 75 Pigdons Rd, Waurn Ponds, VIC 3216 Australia
| | - Rosemary Iriowen
- College of Population Health, Thomas Jefferson University, Philadelphia, PA USA
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Mackesy-Amiti ME, Falk J, Latkin C, Kaufmann M, Williams L, Boodram B. Egocentric network characteristics of people who inject drugs in the Chicago metro area and associations with hepatitis C virus and injection risk behavior. Harm Reduct J 2022; 19:58. [PMID: 35655222 PMCID: PMC9161656 DOI: 10.1186/s12954-022-00642-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hepatitis C (HCV) infection has been rising in the suburban and rural USA, mainly via injection-based transmission. Injection and sexual networks are recognized as an important element in fostering and preventing risky behavior; however, the role of social support networks has received somewhat less attention. METHODS Using baseline data from an ongoing longitudinal study, we examined the composition and structure of injection drug use (IDU), sex, and social support networks of young people who inject drugs (aged 18-30) and their injection network members. Lasso logistic regression was used to select a subset of network characteristics that were potentially important predictors of injection risk behaviors and HCV exposure. RESULTS Several measures of IDU, sexual, and support network structure and composition were found to be associated with HCV exposure, receptive syringe sharing (RSS), and ancillary equipment sharing. Gender and sexual relationships were important factors for all risk behaviors. Support network characteristics were also important, notably including a protective effect of majority Hispanic support networks for RSS and HCV exposure. Both IDU network residence heterogeneity and support network geography were associated with injection equipment sharing. CONCLUSIONS The associations of IDU and support network geography with equipment sharing highlight the need to extend harm reduction efforts beyond urban areas. Greater understanding of support network influences on risk behavior may provide important insights to strengthen the benefits of harm reduction. In considering the probability of HCV transmission, it is important to consider setting and network structures that promote propagation of risk.
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Affiliation(s)
- Mary Ellen Mackesy-Amiti
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St, Chicago, IL, 60612, USA.
| | - Joshua Falk
- Advanced Cyberinfrastructure for Education and Research (ACER), Office of the Vice Chancellor of Innovation, University of Illinois at Chicago, 728 W. Roosevelt Rd., 215A RRB, Chicago, IL, 60607, USA
| | - Carl Latkin
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | - Maggie Kaufmann
- Community Outreach Intervention Projects, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St, Chicago, IL, 60612, USA
| | - Leslie Williams
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St, Chicago, IL, 60612, USA
| | - Basmattee Boodram
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St, Chicago, IL, 60612, USA
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Acceptability of a HIV self-testing program among people who use illicit drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 103:103613. [DOI: 10.1016/j.drugpo.2022.103613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 12/19/2022]
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Randall LM, Dasgupta S, Day J, DeMaria A, Musolino J, John B, Cranston K, Buchacz K. An outbreak of HIV infection among people who inject drugs in northeastern Massachusetts: findings and lessons learned from a medical record review. BMC Public Health 2022; 22:257. [PMID: 35135527 PMCID: PMC8822794 DOI: 10.1186/s12889-022-12604-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 01/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We conducted a medical record review for healthcare utilization, risk factors, and clinical data among people who inject drugs (PWID) in Massachusetts to aid HIV outbreak response decision-making and strengthen public health practice. SETTING Two large community health centers (CHCs) that provide HIV and related services in northeastern Massachusetts. METHODS Between May and July 2018, we reviewed medical records for 88 people with HIV (PWH) connected to the outbreak. The review period included care received from May 1, 2016, through the date of review. Surveillance data were used to establish date of HIV diagnosis and assess viral suppression. RESULTS Sixty-nine (78%) people had HIV infection diagnosed during the review period, including 10 acute infections. Persons had a median of 3 primary care visits after HIV diagnosis and zero before diagnosis. During the review period, 72% reported active drug or alcohol use, 62% were prescribed medication assisted treatment, and 41% were prescribed antidepressants. The majority (68, 77%) had a documented ART prescription. HIV viral suppression at < 200 copies/mL was more frequent (73%) than the overall across the State (65%); it did not correlate with any of the sociodemographic characteristics studied in our population. Over half (57%) had been hospitalized at least once during the review period, and 36% had a bacterial infection at hospitalization. CONCLUSIONS Medical record review with a field investigation of an outbreak provided data about patterns of health care utilization and comorbidities not available from routine HIV surveillance or case interviews. Integration of HIV screening with treatment for HIV and SUD can strengthen prevention and care services for PWID in northeastern Massachusetts.
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Affiliation(s)
- Liisa M Randall
- Massachusetts Department of Public Health, Bureau of Infectious Disease and Laboratory Sciences, 305 South Street, Jamaica Plain, MA, 02130-3515, USA.
| | - Sharoda Dasgupta
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jeanne Day
- JSI Research and Training Institute, Inc., Boston, MA, USA
| | - Alfred DeMaria
- Massachusetts Department of Public Health, Bureau of Infectious Disease and Laboratory Sciences, 305 South Street, Jamaica Plain, MA, 02130-3515, USA
| | | | - Betsey John
- Massachusetts Department of Public Health, Bureau of Infectious Disease and Laboratory Sciences, 305 South Street, Jamaica Plain, MA, 02130-3515, USA
| | - Kevin Cranston
- Massachusetts Department of Public Health, Bureau of Infectious Disease and Laboratory Sciences, 305 South Street, Jamaica Plain, MA, 02130-3515, USA
| | - Kate Buchacz
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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