Social support networks and primary care use by HIV-infected drug users

Multiple Disadvantage and Social Networks: Toward an Integrated Theory of Health Care Use During Reentry From Criminal Justice Settings

Research consistently finds the disproportionate negative health impact of the criminal justice system on racial and ethnic minorities. Yet less is known about the underlying mechanisms of health care utilization during community reintegration. We contribute to the literature theoretically by integrating two perspectives: network theory of social capital and multiple disadvantage hypothesis and providing a more nuanced explanation of health service use during reentry. We identify incarceration history as a unique disadvantaged status that precludes people from accessing social networks and social capital. We further elaborate on the phenomenon of racialized reentry and illustrate how multiple disadvantaged statuses are linked to social networks and health care.

Translation and Validation: Chinese Version of the HIV-Related Social Support Scale

Purpose

Social support is increasingly recognized to be important in care of people living with HIV/AIDS (PLWH), we firstly translate and validate the disease-targeted social support instrument in Chinese and to explore the correlation with WHOQOL-HIV.

Patients and Methods

We established content validity for HIV-related social support scale (HSSS) and administered the resultant questionnaire to 310 PLWH. Descriptive statistics were generated for each of the variables of general characteristics; student t-test was used to compare the different groups.

Results

The HSSS demonstrated a high level of internal consistency, both within each subscale and with the total score; all Cronbach’s α values exceeded a priori threshold of ≥0.70. The HSSS cores were positively correlated with WHOQOL-HIV total scores (Pearson correlation: 0.39, P < 0.001). We also found that higher educational level, personal income, CD4 cell count, and shorter duration of antiretroviral therapy are significantly associated with a higher level of social support (P < 0.05).

Conclusion

Social support may improve quality of life for PLWH, Chinese version of HIV-related social support scale can be used in future clinical practice.

Validation and psychometric properties of the community assessment inventory in Iranian persons who use drug

Objective

Social support is a key factor in the treatment and rehabilitation process of persons who use drug (PWUD). This highlights the need for a valid and reliable tool for assessing social support. The cultural and psychometric properties of community assessment inventory (CAI) in PWUDs under methadone therapy were examined in Iran in 2019.

Methods

The study was carried out as a validation and methodological study. At first, the original tool was translated into Farsi using forward-backward method. After ensuring face validity and content validity, construct reliability of the tool was supported using explorative and confirmatory factor analysis (EFA & CFA) using a sample group of 392 participants. The participants were selected through convenient-quota sampling from 24 drug clinics. Reliability of the questionnaire was supported using Pearson correlation coefficient and internal consistency based on Cronbach’s alpha.

Results

To determine content validity of the tool, CVI and CVR of it were obtained, which were on average equal to 0.79 and 0.59 respectively. The EFA supported correlation of the 37itmes of the tool (KMO = 0.975, Chi-square = 15,051.6, P_value=0.0001). The main indices of the model, based on CFA were higher than 0.9, which support goodness of fit of the model (χ2/DF = 2.98, CFI = 0.91, NFI, TLI = 0.905 GF = 0.92, REMSEA = 0.07, R2 = 0.99). Reliability of the tool based on internal consistency (Cronbach’s alpha) for the subscales were in 0.8–0.95 interval and equal to 0.85 for the whole tool.

Conclusion

As the results showed, CAI had acceptable indices for Iranian PWUDs under methadone therapy. The tool can be used for assessing social support level in the study population. It is a reliable and valid tool for studies in pertinent fields.

Achieving Smoking Cessation Among Persons with Opioid Use Disorder

While prevalence of tobacco use in the US general population is declining, prevalence among those with opioid use disorder (OUD) remains high and results in excessive tobacco-related disease and premature mortality. Among smokers with OUD, tobacco cessation rates are negligible without treatment. However, both low-intensity behavioral interventions and more intensive motivational interventions yield negligible cessation rates. While contingency management has potent short-term cessation effects, effects are not maintained at post-intervention follow-up. Evidence-based smoking cessation pharmacotherapies, such as nicotine replacement therapy, bupropion, and varenicline, result in very modest cessation rates among smokers with OUD. Intensification of pharmacotherapy, such as high-dose and combination nicotine replacement therapy or extended medication treatment, has failed to improve cessation outcomes compared with standard treatment regimens. Targeting the unique challenges faced by smokers with OUD, including nicotine-opioid interactions and poor medication adherence, has potential to improve cessation outcomes, but further research is needed to optimize intervention efficacy among smokers with OUD.

Weighted gene co-expression network analysis to explore the mechanism of heroin addiction in human nucleus accumbens

Heroin dependence is a complex behavioral disease, and a chronic encephalopathy with the important feature of relapse. The purpose of the study was to identify the regulatory mechanism of the nucleus accumbens (NAc) in heroin dependence. We used weighted gene co-expression network analysis to analyze the GSE87823 data package, which included 27 heroin users and 22 controls of human NAc tissue. Modules were correlated with basic information of samples and enrichment analyses used to identify biological function and transcription factors and online tools were used to perform the gene ontology of significant genes. We identified one gene module from the total data (blue) and the male data (turquoise), respectively. The overlap genes of top 10 hub genes in significant modules (PRR11, SLC35E1, LPP, ZNF721, ZNF611, LRRFIP1) were selected to identify as candidate genes in the regulation mechanism of NAc in heroin dependence. Then, we accorded the results to further explore that miRNA-hsa-miR-155-5p in male and total may be a potential marker. The candidate genes may serve as novel prognostic markers and treatment targets. Hsa-miR-155-5p may be a promising regulatory point for the treatment of heroin addiction.

A cohort study examining emergency department visits and hospital admissions among people who use drugs in Ottawa, Canada

Background

The health of people who use drugs (PWUD) is characterized by multimorbidity and chronicity of health conditions, necessitating an understanding of their health care utilization. The objective of this study was to evaluate emergency department (ED) visits and hospital admissions among a cohort of PWUD.

Methods

We used a retrospective observational design between 2012 and 2013. The population was a marginalized cohort of PWUD (the PROUD study) for whom survey data was linked (n = 663) to provincial health administrative data housed at the Institute for Clinical Evaluative Sciences. We constructed a 5:1 comparison group matched by age, sex, income quintile, and region. The main outcomes were defined as having two or more ED visits, or one or more hospital admissions, in the year prior to survey completion. We used multivariable logistic regression analyses to identify factors associated with these outcomes.

Results

Compared to the matched cohort, PWUD had higher rates of ED visits (rate ratio [RR] 7.0; 95% confidence interval [95% CI] 6.5–7.6) and hospitalization (RR 7.7; 95% CI 5.9–10.0). After adjustment, factors predicting more ED visits were receiving disability (adjusted odds ratio [AOR] 3.0; 95% CI 1.7–5.5) or income assistance (AOR 2.7; 95% CI 1.5–5.0), injection drug use (AOR 2.1; 95% CI 1.3–3.4), incarceration within 12 months (AOR 1.6; 95% CI 1.1–2.4), mental health comorbidity (AOR 2.1; 95% CI 1.4–3.1), and a suicide attempt within 12 months (AOR 2.1; 95% CI 1.1–3.4). Receiving methadone (AOR 0.5; 95% CI 0.3–0.9) and having a regular family physician (AOR 0.5; 95% CI 0.2–0.9) were associated with lower odds of having more ED visits. Factors associated with more hospital admissions included Aboriginal identity (AOR 2.4; 95% CI 1.4–4.1), receiving disability (AOR 2.4; 95% CI 1.1–5.4), non-injection drug use (opioids and non-opioids) (AOR 2.2; 95% CI 1.1–4.4), comorbid HIV (AOR 2.4; 95% CI 1.2–5.6), mental health comorbidity (AOR 2.4; 95% CI 1.3–4.2), and unstable housing (AOR 1.9; 95% CI 1.0–3.4); there were no protective factors for hospitalization.

Conclusions

Improved post-incarceration support, housing services, and access to integrated primary care services including opioid replacement therapy may be effective interventions to decrease acute care use among PWUD, including targeted approaches for people receiving social assistance or with mental health concerns.

Network support, technology use, depression, and ART adherence among HIV-positive MSM of color

Depression is associated with poor antiretroviral therapy (ART) adherence among people living with HIV/AIDS. This relationship may be moderated by an individual's social network characteristics. Our study sought to examine social network correlates of treatment adherence among HIV-positive men recruited from social service agencies throughout Los Angeles County (N = 150) to inform technology-driven social support interventions for this population. We administered egocentric social network and computer-assisted survey interviews focused on demographic characteristics, health history, depressive symptoms, and ART adherence, where adherence was assessed by the number of reasons participants missed taking their medication, if ever. Significant univariate correlates of adherence were included in a multivariable regression analysis, where the moderating effect of having a network member who reminds participants to take their HIV medication on the relationship between depression and adherence was tested. Over 60% of participants reported clinically significant depressive symptoms; this was significantly associated with lower adherence among those without someone in their social network to remind them about taking their HIV medication, even after adjusting for covariates in an ordinary least squares regression (adjusted mean difference b = -1.61, SE = 0.42, p = 0.0003). Having a network member who reminds participants to take their ART medication significantly ameliorated the negative association between depression and treatment adherence, especially for those reporting greater depressive symptoms (p = 0.0394). Additionally, participants demonstrated high rates of technology use to communicate with social network members. In order to achieve the aims of the National HIV/AIDS Strategy, innovative interventions addressing mental health to improve ART adherence are needed. Network strategies that leverage technology may be helpful for improving ART adherence among HIV-positive men with comorbid depressive symptoms.

"Can't you initiate me here?": Challenges to timely initiation on antiretroviral therapy among methadone clients in Dar es Salaam, Tanzania

BACKGROUND

Despite dramatic improvement in antiretroviral therapy (ART) access globally, people living with HIV who inject drugs continue to face barriers that limit their access to treatment. This paper explores barriers and facilitators to ART initiation among clients attending a methadone clinic in Dar es Salaam, Tanzania.

METHODS

We interviewed 12 providers and 20 clients living with HIV at the Muhimbili National Hospital methadone clinic between January and February 2015. We purposively sampled clients based on sex and ART status and providers based on job function. To analyze interview transcripts, we adopted a content analysis approach.

RESULTS

Participants identified several factors that hindered timely ART initiation for clients at the methadone clinic. These included delays in CD4 testing and receiving CD4 test results; off-site HIV clinics; stigma operating at the individual, social and institutional levels; insufficient knowledge of the benefits of early ART initiation among clients; treatment breakdown at the clinic level possibly due to limited staff; and initiating ART only once one feels physically ill. Participants perceived social support as a buffer against stigma and facilitator of HIV treatment. Some clients also reported that persistent monitoring and follow-up on their HIV care and treatment by methadone clinic providers led them to initiate ART.

CONCLUSION

Health system factors, stigma and limited social support pose challenges for methadone clients living with HIV to initiate ART. Our findings suggest that on-site point-of-care CD4 testing, a peer support system, and trained HIV treatment specialists who are able to counsel HIV-positive clients and initiate them on ART at the methadone clinic could help reduce barriers to timely ART initiation for methadone clients.

The Contribution of Missed Clinic Visits to Disparities in HIV Viral Load Outcomes

OBJECTIVES

We explored the contribution of missed primary HIV care visits ("no-show") to observed disparities in virological failure (VF) among Black persons and persons with injection drug use (IDU) history.

METHODS

We used patient-level data from 6 academic clinics, before the Centers for Disease Control and Prevention and Health Resources and Services Administration Retention in Care intervention. We employed staged multivariable logistic regression and multivariable models stratified by no-show visit frequency to evaluate the association of sociodemographic factors with VF. We used multiple imputations to assign missing viral load values.

RESULTS

Among 10 053 patients (mean age = 46 years; 35% female; 64% Black; 15% with IDU history), 31% experienced VF. Although Black patients and patients with IDU history were significantly more likely to experience VF in initial analyses, race and IDU parameter estimates were attenuated after sequential addition of no-show frequency. In stratified models, race and IDU were not statistically significantly associated with VF at any no-show level.

CONCLUSIONS

Because missed clinic visits contributed to observed differences in viral load outcomes among Black and IDU patients, achieving an improved understanding of differential visit attendance is imperative to reducing disparities in HIV.