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Batchelder AW, Heo M, Foley JD, Sullivan MC, Lum P, Pericot Valverde I, Taylor LE, Mehta SH, Kim AY, Norton B, Tsui JI, Feinberg J, Page K, Litwin AH. Shame and stigma in association with the HCV cascade to cure among people who inject drugs. Drug Alcohol Depend 2023; 253:111013. [PMID: 37951006 DOI: 10.1016/j.drugalcdep.2023.111013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/26/2023] [Accepted: 10/22/2023] [Indexed: 11/13/2023]
Abstract
BACKGROUND Psycho-social experiences including shame and experienced and internalized stigma have been associated with substance use, HCV infection, and reluctance to disclose HCV status and pursue treatment. These psycho-social barriers have been examined independently for many chronic diseases, including HCV, but to our knowledge have not been quantitatively explored in a large multi-site US-based sample of people who inject drugs (PWID) in HCV treatment. METHODS We examine baseline relationships with HCV-stigma and engagement across the HCV treatment cascade as well as baseline and longitudinal relationships between shame and engagement across the HCV treatment cascade including treatment initiation, adherence, completion, and sustained virologic response (SVR) among a multi-site sample of PWID with HCV, where N=755 were randomized to the pragmatic trial comparing HCV treatment outcomes in modified directly observed treatment (mDOT) or patient navigation, and N=623 initiated treatment. RESULTS While cross-sectional assessments of shame and HCV-stigma were not associated with engagement across the HCV treatment cascade, those whose shame scores decreased compared to those who reported consistently high and increasing levels of shame were significantly more likely to complete HCV treatment (aOR=5.29; 95%CI: 1.56,18.00) and achieve SVR (aOR=6.32; 95%CI: 1.61, 24.87). CONCLUSION Results underscore the relationships between lower levels of shame and health-related behavior and treatment outcomes among PWID and suggest SVR achievement may contribute to reductions in shame or that reductions in shame may contribute to continued treatment and thus SVR.
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Affiliation(s)
- Abigail W Batchelder
- Behavioral Medicine Program, Psychiatry Department, Massachusetts General Hospital, One Bowdoin Square, Suite 701, Boston, MA 02114, USA; Department of Psychiatry, Harvard Medical School, One Bowdoin Square, Suite 701, Boston, MA 02114, USA; The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA.
| | - Moonseong Heo
- Department of Public Health, College of Behavioral, Social, and Health Sciences, Clemson University, 116 Edwards Hall, Clemson, SC 29634, USA
| | - Jacklyn D Foley
- Behavioral Medicine Program, Psychiatry Department, Massachusetts General Hospital, One Bowdoin Square, Suite 701, Boston, MA 02114, USA; Department of Psychiatry, Harvard Medical School, One Bowdoin Square, Suite 701, Boston, MA 02114, USA
| | - Matthew C Sullivan
- Behavioral Medicine Program, Psychiatry Department, Massachusetts General Hospital, One Bowdoin Square, Suite 701, Boston, MA 02114, USA; Department of Psychiatry, Harvard Medical School, One Bowdoin Square, Suite 701, Boston, MA 02114, USA
| | - Paula Lum
- Department of Medicine, University of California, San Francisco, CA, USA
| | | | - Lynn E Taylor
- College of Pharmacy, University of Rhode Island, Providence, RI, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Arthur Y Kim
- Department of Infectious Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Brianna Norton
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Judith I Tsui
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Judith Feinberg
- Department of Behavioral Medicine & Psychiatry and Department of Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Kim Page
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Alain H Litwin
- Department of Medicine, Clemson University, Clemson, SC, 29634 USA; Department of Medicine, University of South Carolina School of Medicine, Greenville, SC, USA; Department of Medicine, Prisma Health, Greenville, SC, USA.
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Jones AA, Schneider KE, Falade-Nwulia O, Sterner G, Tobin K, Latkin CA. Social Networks, Stigma, and Hepatitis C Care Among Women Who Inject Drugs: Findings from A Community Recruited Sample. J Psychoactive Drugs 2023; 55:464-470. [PMID: 36453686 PMCID: PMC10232671 DOI: 10.1080/02791072.2022.2129886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/19/2022] [Accepted: 08/02/2022] [Indexed: 12/05/2022]
Abstract
This study explores the role of perceived HCV stigma and social networks on HCV care among people who inject drugs (PWID) of both sexes, and solely among women who inject drugs (WWID). Data were from 269 HCV positive PWID, community-recruited through street-based outreach in Baltimore, MD. We defined HCV stigma based on participants' perceptions of treatment by others and their need to conceal their HCV status. Among WWID, HCV stigma was linked with decreased odds of undergoing liver disease staging (aOR = 0.33, 95% CI: 0.13,0.85) or to have attempted to get the HCV cure (aOR = 0.39, CI: 0.16,0.97), these associations were not evident in the overall sample with both sexes. Social network characteristics were significant correlates of HCV care in the overall sample, and these associations were stronger among WWID. WWID with more HCV positive social network members had higher odds of an HCV-related healthcare visit in the prior 12 months (aOR = 4.28, CI: 1.29,14.17) and to have undergone liver disease staging (aOR = 2.85, CI: 1.01,8.05). WWID with more social network members aware of the HCV cure were more likely to report an attempt at obtaining the HCV cure (aOR = 5.25, CI: 1.85,14.89). Our results suggest complexity in the role of social networks and stigma on HCV care.
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Affiliation(s)
- A A Jones
- Department of Human Development and Family Studies, Pennsylvania State University, PA, USA
- Consortium on Substance Use and Addiction, the Pennsylvania State University, PA, USA
| | - K E Schneider
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, John Hopkins University, Baltimore, MD, USA
| | - O Falade-Nwulia
- Division of Infectious Diseases, School of Medicine, John Hopkins University, Baltimore, MD, USA
| | - G Sterner
- Consortium on Substance Use and Addiction, the Pennsylvania State University, PA, USA
- Department of Criminal Justice, Pennsylvania State University, PA, USA
| | - K Tobin
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, John Hopkins University, Baltimore, MD, USA
| | - C A Latkin
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, John Hopkins University, Baltimore, MD, USA
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Nyamathi A, Salem BE, Lee D, Yu Z, Hudson A, Saab S, Shin SS, Jones-Patten A, Yadav K, Alikhani M, Clarke R, Chang A, White K, Gelberg L. Exploratory assessment: Nurse-led community health worker delivered HCV intervention for people experiencing homelessness. Public Health Nurs 2023; 40:641-654. [PMID: 37132164 PMCID: PMC10524682 DOI: 10.1111/phn.13204] [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: 02/03/2023] [Revised: 03/27/2023] [Accepted: 04/09/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Getting and maintaining Hepatitis C Virus (HCV) cure is challenging among people experiencing homelessness (PEH) as a result of critical social determinants of health such as unstable housing, mental health disorders, and drug and alcohol use. OBJECTIVES The purpose of this exploratory pilot study was to compare a registered nurse/community health worker (RN/CHW)-led HCV intervention tailored for PEH, "I am HCV Free," with a clinic-based standard of care (cbSOC) for treating HCV. Efficacy was measured by sustained virological response at 12 weeks after stopping antivirals (SVR12), and improvement in mental health, drug and alcohol use, and access to healthcare. METHODS An exploratory randomized controlled trial design was used to assign PEH recruited from partner sites in the Skid Row Area of Los Angeles, California, to the RN/CHW or cbSOC programs. All received direct-acting antivirals. The RN/CHW group received directly observed therapy in community-based settings, incentives for taking HCV medications, and wrap-around services, including connection to additional healthcare services, housing support, and referral to other community services. For all PEH, drug and alcohol use and mental health symptoms were measured at month 2 or 3 and 5 or 6 follow-up, depending on HCV medication type, while SVR12 was measured at month 5 or 6 follow-up. RESULTS Among PEH in the RN/CHW group, 75% (3 of 4) completed SVR12 and all three attained undetectable viral load. This was compared with 66.7% (n = 4 of 6) of the cbSOC group who completed SVR12; all four attained undetectable viral load. The RN/CHW group, as compared to the cbSOC, also showed greater improvements in mental health, and significant improvement in drug use, and access to healthcare services. DISCUSSION While this study shows significant improvements in drug use and health service access among the RN/-CHW group, the sample size of the study limits the validity and generalizability of the results. Further studies using larger sample sizes are necessitated.
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Affiliation(s)
- Adeline Nyamathi
- University of California, Irvine, Sue & Bill Gross School of Nursing, Irvine, California
| | - Benissa E Salem
- University of California, Los Angeles, School of Nursing, Los Angeles, California
| | - Darlene Lee
- University of California, Irvine, Susan Samueli Integrative Health Institute, Irvine, California
| | - Zhaoxia Yu
- University of California, Irvine, Department of Statistics, School of Information and Computer Sciences, Irvine, California
| | | | - Sammy Saab
- Adult Liver Transplant Program, University of California, Los Angeles, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Sanghyuk S Shin
- University of California, Irvine, Sue & Bill Gross School of Nursing, Irvine, California
| | | | - Kartik Yadav
- University of California, Irvine, Sue & Bill Gross School of Nursing, Irvine, California
| | - Mitra Alikhani
- University of California, Los Angeles, School of Nursing, Los Angeles, California
| | - Richard Clarke
- University of California, Irvine, Sue & Bill Gross School of Nursing, Irvine, California
| | - Alicia Chang
- Los Angeles County Department of Public Health, Community Field Services, Inglewood, California
| | - Kathryn White
- Los Angeles Christian Health Centers, Los Angeles, California
| | - Lillian Gelberg
- David Geffen School of Medicine at UCLA, UCLA Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
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Anwar I, Donadille C, Protopopescu C, Michels D, Herin J, Pladys A, Bader D, Carrieri P, Roux P. Non-disclosure of drug injection practices as a barrier to HCV testing: results from the PrebupIV community-based research study. Harm Reduct J 2023; 20:98. [PMID: 37516889 PMCID: PMC10387207 DOI: 10.1186/s12954-023-00841-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 07/22/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection prevalence is particularly high in people who inject drugs (PWID), a population that faces many barriers to HCV testing and care. A better understanding of the determinants of access to HCV testing is needed to improve their engagement in the HCV care cascade. We used data from a cross-sectional survey of people who inject drugs, mainly opioids, to identify factors associated with recent HCV testing. METHODS Self-reported data on HCV antibody testing were analyzed for 550 of the 557 PWID enrolled in PrebupIV, a French cross-sectional community-based survey which assessed PWID acceptability of injectable buprenorphine as a treatment. Factors associated with recent (i.e., in the previous six months) HCV antibody testing were identified performing multivariable logistic regression. RESULTS Among the study sample, 79% were men and 31% reported recent HCV antibody testing. Multivariable analysis found that PWID who did not disclose their injection practices to anyone (aOR [95% CI] 0.31 [0.12,0.82], p = 0.018), older PWID (aOR [95% CI] 0.97 [0.95,1.00], p = 0.030) and employed respondents (aOR [95% CI] 0.58 [0.37,0.92], p = 0.019) were all less likely to report recent HCV testing. No association was found between opioid agonist therapy and HCV testing. CONCLUSIONS Our findings suggest that non-disclosure of injection practices, employment and age were all barriers to HCV antibody testing. Preventing stigma around injection practices, developing the HCV testing offer in primary care and addiction care services, and training healthcare providers in HCV care management could improve HCV testing and therefore, the HCV care cascade in PWID.
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Affiliation(s)
- Ilhame Anwar
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, ISSPAM, Marseille, France.
| | - Cécile Donadille
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Camelia Protopopescu
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - David Michels
- AIDES, Pantin, France
- Laboratoire de Recherche Communautaire, Coalition PLUS, Pantin, France
| | | | - Adélaïde Pladys
- Coordination Nationale des Réseaux de Microstructures (CNRMS), Strasbourg, France
| | - Danièle Bader
- Coordination Nationale des Réseaux de Microstructures (CNRMS), Strasbourg, France
| | - Patrizia Carrieri
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Perrine Roux
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, ISSPAM, Marseille, France
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Balsom CR, Farrell A, Kelly DV. Barriers and enablers to testing for hepatitis C virus infection in people who inject drugs - a scoping review of the qualitative evidence. BMC Public Health 2023; 23:1038. [PMID: 37259073 DOI: 10.1186/s12889-023-16017-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/30/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Injection drug use is the primary mode of transmission of hepatitis C virus (HCV) infection in the developed world and guidelines recommend screening individuals with current or history of injection drug use for HCV; however, the majority of those living with HCV in Canada are not aware of their positive status. This low level of HCV status awareness suggests that screening is not effective with current testing strategies. The aim of this review is to determine what barriers and enablers people who inject drugs (PWID) experience surrounding testing for HCV to help inform the development of an engaging testing strategy. METHODS Comprehensive literature searches were conducted using Medline, Embase and CINAHL in February 2021. Included studies investigated the barriers and enablers to testing for HCV in PWID and the experiences of PWID in testing for HCV. Studies were included if they were qualitative or mixed-methods design, involved people with current injection drug use or those with a history of injecting drugs, and were written in the English language. Studies were compared and common themes were coded and analyzed. RESULTS The literature search resulted in 1554 citations and ultimately nine studies were included. Common barriers included self-perception of low risk for HCV, fear of diagnosis, stigma associated with IV drug use and HCV, antipathy in relation to mainstream health care services, limited knowledge about HCV, lack of rapport with provider, lack of motivation or competing priority of drug use, and limited awareness of new treatment options. Common enablers to testing included increasing awareness of HCV testing and treatment and providing positive narratives around HCV care, positive rapport with provider, accessible testing options and individualized care. CONCLUSION While there has been some qualitative research on barriers and enablers to testing for HCV in PWID more research is needed to focus on this research question as a primary objective in order to provide more understanding from the participant's perspective.
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Affiliation(s)
- Cathy R Balsom
- School of Pharmacy, Memorial University of Newfoundland, St. John's, Canada.
| | - Alison Farrell
- Health Sciences Library, Memorial University of Newfoundland, St. John's, Canada
| | - Deborah V Kelly
- School of Pharmacy, Memorial University of Newfoundland, St. John's, Canada
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6
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Rosecrans A, Harris R, Saxton RE, Cotterell M, Zoltick M, Willman C, Blackwell I, Bell J, Hayes D, Weir B, Sherman S, Lucas GM, Greenbaum A, Page KR. Mobile low-threshold buprenorphine integrated with infectious disease services. J Subst Abuse Treat 2022; 133:108553. [PMID: 34238629 PMCID: PMC8702567 DOI: 10.1016/j.jsat.2021.108553] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/24/2021] [Accepted: 06/13/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION In 2018, the Baltimore City Health Department launched a mobile clinic called Healthcare on The Spot, which offers low-threshold buprenorphine services integrated with health care services to meet the needs of people who use drugs. In addition to buprenorphine management, The Spot offers testing and treatment for hepatitis C, sexually transmitted infections, and HIV, as well as pre-exposure prophylaxis for HIV, wound care, vaccinations, naloxone distribution, and case management. METHODS AND MATERIALS This cohort analysis includes clinical service data from the first 15 months of The Spot mobile clinic, from September 4, 2018, to November 23, 2019. The Spot co-located with the Baltimore syringe services program in five locations across the city. Descriptive data are provided for patient demographics and services provided, as well as percent of patients retained in buprenorphine treatment at one and three months. Logistic regression identified factors associated with retention at three months. RESULTS The Spot mobile clinic provided services to 569 individuals from September 4, 2018, to November 23, 2019, including prescribing buprenorphine to 73.8% and testing to more than 70% for at least one infectious disease. Patients receiving a prescription for buprenorphine were more likely to be tested for HIV, hepatitis C, and sexually transmitted infections, as well as receive treatment for hepatitis C and preventive services including vaccination and naloxone distribution. The Spot initiated HIV treatment for four patients and HIV pre-exposure prophylaxis for twelve patients. More than 32% of patients had hepatitis C; nineteen of these patients initiated treatment for hepatitis C with eight having a documented cure. Buprenorphine treatment retention was 56.0% at one month and 26.2% at three months. Patients who were Black or receiving treatment for hepatitis C were more likely to be retained in buprenorphine treatment at three months. CONCLUSIONS Increasing access to integrated medical services and drug treatment through low-threshold, community-based models of care can be an effective tool for addressing the effects of drug use.
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Affiliation(s)
- Amanda Rosecrans
- Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, USA,Baltimore City Health Department, 1200 E. Fayette St., Baltimore, MD, USA
| | - Robert Harris
- Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, USA,Baltimore City Health Department, 1200 E. Fayette St., Baltimore, MD, USA
| | - Ronald E. Saxton
- Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, USA
| | - Margaret Cotterell
- Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, USA,Baltimore City Health Department, 1200 E. Fayette St., Baltimore, MD, USA
| | - Meredith Zoltick
- Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, USA,Baltimore City Health Department, 1200 E. Fayette St., Baltimore, MD, USA
| | - Catherine Willman
- Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, USA,Baltimore City Health Department, 1200 E. Fayette St., Baltimore, MD, USA
| | - Ingrid Blackwell
- Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, USA,Baltimore City Health Department, 1200 E. Fayette St., Baltimore, MD, USA
| | - Joy Bell
- Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, USA,Baltimore City Health Department, 1200 E. Fayette St., Baltimore, MD, USA
| | - Darryl Hayes
- Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, USA,Baltimore City Health Department, 1200 E. Fayette St., Baltimore, MD, USA
| | - Brian Weir
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe, Baltimore, MD USA
| | - Susan Sherman
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe, Baltimore, MD USA
| | - Gregory M. Lucas
- Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, USA
| | - Adena Greenbaum
- Baltimore City Health Department, 1200 E. Fayette St., Baltimore, MD, USA
| | - Kathleen R. Page
- Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, USA
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