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Cunningham EB, Wheeler A, Hajarizadeh B, French CE, Roche R, Marshall AD, Fontaine G, Conway A, Valencia BM, Bajis S, Presseau J, Ward JW, Degenhardt L, Dore GJ, Hickman M, Vickerman P, Grebely J. Interventions to enhance testing, linkage to care, and treatment initiation for hepatitis C virus infection: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2022; 7:426-445. [PMID: 35303490 DOI: 10.1016/s2468-1253(21)00471-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/08/2021] [Accepted: 12/08/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Despite the goal set by WHO to eliminate hepatitis C virus (HCV) as a public health threat, uptake of HCV testing and treatment remains low. To achieve this target, evidence-based interventions are needed to address the barriers to care for people with, or at risk of, HCV infection. We aimed to assess the efficacy of interventions to improve HCV antibody testing, HCV RNA testing, linkage to HCV care, and treatment initiation. METHODS In this systematic review and meta-analysis, we searched MEDLINE (PubMed), Scopus, Web of Science, the Cochrane Central Register of Controlled Trials, and PsycINFO without language restrictions for reports published between database inception and July 21, 2020, assessing the following primary outcomes: HCV antibody testing; HCV RNA testing; linkage to HCV care; and direct-acting antiviral treatment initiation. We also searched key conference abstracts. We included randomised and non-randomised studies assessing non-pharmaceutical interventions that included a comparator or control group. Studies were excluded if they enrolled only paediatric populations (aged <18 years) or if they conducted the intervention in a different health-care setting to that of the control or comparator. Authors were contacted to clarify study details and to obtain additional population-level data. Data were extracted from the records identified into a pre-piloted and standardised data extraction form and a random-effects meta-analysis was used to pool the effects of the interventions on study outcomes. This study is registered in PROSPERO, CRD42020178035. FINDINGS Of 15 342 unique records identified, 142 were included, which reported on 148 unique studies (47 randomised controlled trials and 101 non-randomised studies). Medical chart reminders, provider education, and point-of-care antibody testing significantly improved at least three study outcomes compared with a comparator or control. Interventions that simplified HCV testing, including dried blood spot testing, point-of-care antibody testing, reflex RNA testing, and opt-out screening, significantly improved testing outcomes compared with a comparator or control. Enhanced patient and provider support through patient education, provider care coordination, and provider education also significantly improved testing outcomes compared with a comparator or control. Integrated care and patient navigation or care coordination significantly improved linkage to care and the uptake of direct-acting antiviral treatment compared with a comparator or control. INTERPRETATION Several interventions to improve HCV care that address several key barriers to HCV care were identified. New models of HCV care must be designed and implemented to address the barriers faced by the population of interest. Further high-quality research, including rigorously designed randomised studies, is still needed in key populations. FUNDING None.
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Affiliation(s)
| | - Alice Wheeler
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | - Clare E French
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Rachel Roche
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, National Infection Service, Public Health England Colindale, London, UK; National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at UCL, National Institute for Health Research, London, UK
| | - Alison D Marshall
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Guillaume Fontaine
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Anna Conway
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | | | - Sahar Bajis
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - John W Ward
- Coalition for Global Hepatitis Elimination, The Task Force for Global Health, Decatur, GA, USA
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
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Burns RH, Pierre CM, Marathe JG, Ruiz-Mercado G, Taylor JL, Kimmel SD, Johnson SL, Fukuda HD, Assoumou SA. Partnering With State Health Departments to Address Injection-Related Infections During the Opioid Epidemic: Experience at a Safety Net Hospital. Open Forum Infect Dis 2021; 8:ofab208. [PMID: 34409120 PMCID: PMC8364760 DOI: 10.1093/ofid/ofab208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 04/24/2021] [Indexed: 11/13/2022] Open
Abstract
Massachusetts is one of the epicenters of the opioid epidemic and has been severely impacted by injection-related viral and bacterial infections. A recent increase in newly diagnosed human immunodeficiency virus (HIV) infections among persons who inject drugs in the state highlights the urgent need to address and bridge the overlapping epidemics of opioid use disorder (OUD) and injection-related infections. Building on an established relationship between the Massachusetts Department of Public Health and Boston Medical Center, the Infectious Diseases section has contributed to the development and implementation of a cohesive response involving ambulatory, inpatient, emergency department, and community-based services. We describe this comprehensive approach including the rapid delivery of antimicrobials for the prevention and treatment of HIV, sexually transmitted diseases, systemic infections such as endocarditis, bone and joint infections, as well as curative therapy for chronic hepatitis C virus in a manner that is accessible to patients on the addiction-recovery continuum. We also provide an overview of programs that provide access to medications for OUD, harm reduction services including overdose education, and distribution of naloxone. Finally, we outline lessons learned to inform initiatives in other settings.
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Affiliation(s)
- Rebecca H Burns
- Internal Medicine Residency Program, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Cassandra M Pierre
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Jai G Marathe
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Glorimar Ruiz-Mercado
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
| | - Jessica L Taylor
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
| | - Simeon D Kimmel
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Samantha L Johnson
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - H Dawn Fukuda
- Office of HIV/AIDS, Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Sabrina A Assoumou
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
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3
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Metsch LR, Feaster DJ, Gooden LK, Masson C, Perlman DC, Jain MK, Matheson T, Nelson CM, Jacobs P, Tross S, Haynes L, Lucas GM, Colasanti JA, Rodriguez A, Drainoni ML, Osorio G, Nijhawan AE, Jacobson JM, Sullivan M, Metzger D, Vergara-Rodriguez P, Lubelchek R, Duan R, Batycki JN, Matthews AG, Munoz F, Jelstrom E, Mandler R, Del Rio C. Care Facilitation Advances Movement Along the Hepatitis C Care Continuum for Persons With Human Immunodeficiency Virus, Hepatitis C, and Substance Use: A Randomized Clinical Trial (CTN-0064). Open Forum Infect Dis 2021; 8:ofab334. [PMID: 34377726 PMCID: PMC8339611 DOI: 10.1093/ofid/ofab334] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/24/2021] [Indexed: 12/13/2022] Open
Abstract
Background Direct-acting antivirals can cure hepatitis C virus (HCV). Persons with HCV/HIV and living with substance use are disadvantaged in benefiting from advances in HCV treatment. Methods In this randomized controlled trial, participants with HCV/HIV were randomized between February 2016 and January 2017 to either care facilitation or control. Twelve-month follow-up assessments were completed in January 2018. Care facilitation group participants received motivation and strengths-based case management addressing retrieval of HCV viral load results, engagement in HCV/HIV care, and medication adherence. Control group participants received referral to HCV evaluation and an offer of assistance in making care appointments. Primary outcome was number of steps achieved along a series of 8 clinical steps (eg, receiving HCV results, initiating treatment, sustained virologic response [SVR]) of the HCV/HIV care continuum over 12 months postrandomization. Results Three hundred eighty-one individuals were screened and 113 randomized. Median age was 51 years; 58.4% of participants were male and 72.6% were Black/African American. Median HIV-1 viral load was 27 209 copies/mL, with 69% having a detectable viral load. Mean number of steps completed was statistically significantly higher in the intervention group vs controls (2.44 vs 1.68 steps; χ 2 [1] = 7.36, P = .0067). Men in the intervention group completed a statistically significantly higher number of steps than controls. Eleven participants achieved SVR with no difference by treatment group. Conclusions The care facilitation intervention increased progress along the HCV/HIV care continuum, as observed for men and not women. Study findings also highlight continued challenges to achieve individual-patient SVR and population-level HCV elimination. Clinical Trials Registration NCT02641158.
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Affiliation(s)
- Lisa R Metsch
- Department of Sociomedical Sciences, Columbia University, New York, New York, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Lauren K Gooden
- Department of Sociomedical Sciences, Columbia University, New York, New York, USA
| | - Carmen Masson
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - David C Perlman
- Division of Infectious Diseases, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mamta K Jain
- Division of Infectious Diseases, University of Texas Southwestern Medical Center and Parkland Health & Hospital System, Dallas, Texas, USA
| | - Tim Matheson
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, California, USA
| | - C Mindy Nelson
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Petra Jacobs
- Center for Clinical Trials Network, National Institute on Drug Abuse, Rockville, Maryland, USA
| | - Susan Tross
- Department of Psychiatry, Columbia University, New York, New York, USA
| | - Louise Haynes
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Gregory M Lucas
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Allan Rodriguez
- Infectious Disease, University of Miami, Miami, Florida, USA
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Georgina Osorio
- Division of Infectious Diseases, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ank E Nijhawan
- Division of Infectious Diseases, University of Texas Southwestern Medical Center and Parkland Health & Hospital System, Dallas, Texas, USA
| | - Jeffrey M Jacobson
- Division of Infectious Diseases and HIV Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Meg Sullivan
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - David Metzger
- HIV/AIDS Prevention Research Division, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pamela Vergara-Rodriguez
- Mental Health and Substance Abuse Division, John H. Stroger, Jr Hospital of Cook County, Chicago, Illinois, USA
| | - Ronald Lubelchek
- Infectious Diseases, John H. Stroger, Jr Hospital of Cook County, Chicago, Illinois, USA
| | - Rui Duan
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Jacob N Batycki
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Abigail G Matthews
- Data Statistical Center, The Emmes Company, LLC, Rockville, Maryland, USA
| | - Felipe Munoz
- Data Statistical Center, The Emmes Company, LLC, Rockville, Maryland, USA
| | - Eve Jelstrom
- Clinical Coordinating Center, The Emmes Company, LLC, Rockville, Maryland, USA
| | - Raul Mandler
- Clinical/Medical Branch, National Institute on Drug Abuse, Rockville, Maryland, USA
| | - Carlos Del Rio
- Division of Infectious Diseases, Emory University, Atlanta, Georgia, USA
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Bartholomew TS, Tookes HE, Serota DP, Behrends CN, Forrest DW, Feaster DJ. Impact of routine opt-out HIV/HCV screening on testing uptake at a syringe services program: An interrupted time series analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 84:102875. [PMID: 32731112 PMCID: PMC8814936 DOI: 10.1016/j.drugpo.2020.102875] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 01/15/2023]
Abstract
Background: Hepatitis C (HCV) is the most common infectious disease among people who inject drugs (PWID). Engaging PWID in harm reduction services, such as syringe service programs (SSPs), is critical to reduce HCV and HIV transmission. Additionally, testing for HIV and HCV among PWID is important to improve diagnosis and linkage to care. On March 1, 2018, Florida’s only legal SSP implemented bundled opt-out HIV/HCV testing at enrollment. We aimed to examine the differences in HIV/HCV testing uptake before and after the implementation of the opt-out testing policy. Methods: Multivariable logistic regression was used to assess predictors of accepting HIV/HCV tests, controlling for opt-in and opt-out policy. Monthly estimates of the percent of participants accepting an HIV test, HCV test, or both were generated. Interrupted Time Series (ITS) analysis evaluated the immediate policy impact on level of uptake and trend in uptake over time for bundled HIV/HCV testing before and after the opt-out testing policy. Results: The total study period was 37 months between December 2016–January 2020 with 512 SSP participants 15 months prior and 547 SSP participants 22 months after implementation of bundled HIV/HCV opt-out testing. Significant predictors of accepting both HIV/HCV tests were cocaine injection (aOR = 2.36), self-reported HIV positive status (aOR = 0.39) and self-reported HCV positive status (aOR = 0.27). Based on the ITS results, there was a significant increase in uptake of HIV/HCV testing by 42.4% (95% CI: 26.2%–58.5%, p < 0.001) immediately after the policy change to opt-out testing. Conclusion: Bundled opt-out HIV/HCV testing substantially increased the percentage of SSP clients who received HIV and HCV rapid tests at enrollment into the program, and the effect remained stable across the 22 months post opt-out testing policy. Future investigation must assess PWID-level perspective of testing preferences and examine whether this testing approach improves HIV/HCV detection among PWID previously unaware of their status.
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Affiliation(s)
- Tyler S Bartholomew
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA.
| | - Hansel E Tookes
- Division of Infectious Diseases, Department of Medicine, 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
| | - Czarina N Behrends
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - David W Forrest
- Department of Anthropology, College of Arts and Sciences, University of Miami, Miami, FL, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
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Wiskel T, Merchant R, Habet M, Mackey J. Developing an Accident and Emergency HIV Testing Program in Belize City: Recommendations from Key Stakeholders. J Int Assoc Provid AIDS Care 2020; 18:2325958219856328. [PMID: 31216941 PMCID: PMC6748511 DOI: 10.1177/2325958219856328] [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] [Indexed: 11/15/2022] Open
Abstract
With the ultimate goal of developing an accident and emergency (A&E) department HIV testing program in Belize City, Belize, we sought input from key stakeholders on program components and potential facilitators and barriers to HIV testing in emergency care. We conducted semistructured interviews among 4 key stakeholder groups at Karl Heusner Memorial Hospital Authority (KHMHA) in Belize City: (1) 20 A&E patients, (2) 5 A&E physicians, (3) 5 A&E nurses, and (4) 5 KHMHA administrators. We performed a qualitative content analysis of the interview transcripts and isolated important themes. Major themes included: (1) Patient selection: patients preferred to test all A&E patients. All other stakeholder groups preferred testing specific patient groups. (2) Training: Specific training should be completed for staff. (3) Confidentiality: integral for testing. (4) Facilitators and barriers: facilitators included respectful relationships, privacy, resources, coordination, and education. Barriers included stigmatization, patient willingness, inadequate resources, privacy, and testing biases.
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Affiliation(s)
- Tess Wiskel
- 1 TeamHealth Special Operations Emergency Medicine, Northeast Division, Bala Cynwyd, PA, USA
| | - Roland Merchant
- 2 Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Marta Habet
- 3 Department of Accident and Emergency Medicine, Karl Heusner Memorial Hospital, Belize City, Belize
| | - Joy Mackey
- 4 Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
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Merchant RC, Marks SJ, Clark MA, Carey MP, Liu T. Comparison of a video to a pictorial brochure in improving HIV/AIDS and HIV testing knowledge and increasing HIV testing motivation and behavioral skills among adult emergency department patients. J Am Coll Emerg Physicians Open 2020; 1:202-213. [PMID: 33000035 PMCID: PMC7493585 DOI: 10.1002/emp2.12024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 12/27/2019] [Accepted: 01/21/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES We sought to determine if a pictorial brochure improves HIV/AIDS and HIV testing knowledge and increases HIV testing motivation and behavioral skills as well as a video among adult emergency department patients, regardless of language spoken and health literacy level. METHODS ED patients were stratified by primary language spoken (English or Spanish) and health literacy level (lower or higher) and randomly assigned to watch the study video or review the content-matched pictorial brochure. HIV/AIDS and HIV testing knowledge, motivation for HIV testing, and behavioral skills for HIV testing were assessed using study instruments before and after watching the video or reviewing the pictorial brochure. RESULTS Of the 712 English- and 655 Spanish-speaking ED patients, HIV/AIDS and HIV testing knowledge improved more among participants in the video than the pictorial brochure arm (∆ 0.43; 95% confidence interval [CI]: 0.07, 0.79). This improvement was more pronounced among those with lower (∆ 0.60; 95% CI: 0.06, 1.13) than higher health literacy (∆ 0.27; 95% CI: -0.22, 0.76). HIV testing motivation was high before the intervention and did not increase differentially between arms. Confidence in recognizing when to be tested for HIV was slightly greater in the video than pictorial brochure arm (∆ 0.15; 95% CI: 0.01, 0.28), but did not differ by language spoken or health literacy level. CONCLUSIONS A video improved HIV/AIDS and HIV testing knowledge slightly more than a pictorial brochure. Other considerations (eg, patient volume, staffing, space, and video access) should guide EDs on how best to provide information about HIV testing to ED patients.
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Affiliation(s)
- Roland C. Merchant
- Department of Emergency MedicineBrigham and Women's HospitalHarvard Medical SchoolBostonMassachusetts
| | - Sarah J. Marks
- Department of Emergency MedicineBrigham and Women's HospitalHarvard Medical SchoolBostonMassachusetts
| | - Melissa A. Clark
- Department of Health Services Policy and PracticeSchool of Public Healthand Department of Obstetrics and GynecologyAlpert Medical SchoolBrown UniversityProvidenceRhode Island
| | - Michael P. Carey
- Centers for Behavioral and Preventive MedicineThe Miriam HospitalDepartment of Behavioral and Social SciencesSchool of Public Healthand Department of Psychiatry and Human BehaviorAlpert Medical SchoolBrown UniversityProvidenceRhode Island
| | - Tao Liu
- Department of BiostatisticsCenter for Statistical SciencesSchool of Public Health, Brown UniversityProvidenceRhode Island
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Cox J, Gutner C, Kronfli N, Lawson A, Robbins M, Nientker L, Ostawal A, Barber T, Croce D, Hardy D, Jessen H, Katlama C, Mallolas J, Rizzardini G, Alcorn K, Wohlfeiler M, Le Fevre E. A need for implementation science to optimise the use of evidence-based interventions in HIV care: A systematic literature review. PLoS One 2019; 14:e0220060. [PMID: 31425524 PMCID: PMC6699703 DOI: 10.1371/journal.pone.0220060] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 07/07/2019] [Indexed: 11/24/2022] Open
Abstract
To improve health outcomes in people living with HIV, adoption of evidence-based interventions (EBIs) using effective and transferable implementation strategies to optimise the delivery of healthcare is needed. ViiV Healthcare's Positive Pathways initiative was established to support the UNAIDS 90-90-90 goals. A compendium of EBIs was developed to address gaps within the HIV care continuum, yet it was unknown whether efforts existed to adapt and implement these EBIs across diverse clinical contexts. Therefore, this review sought to report on the use of implementation science in adapting HIV continuum of care EBIs. A systematic literature review was undertaken to summarise the evaluation of implementation and effectiveness outcomes, and report on the use of implementation science in HIV care. Ten databases were reviewed to identify studies (time-period: 2013-2018; geographic scope: United States, United Kingdom, France, Germany, Italy, Spain, Canada, Australia and Europe; English only publications). Studies were included if they reported on people living with HIV or those at risk of acquiring HIV and used interventions consistent with the EBIs. A broad range of study designs and methods were searched, including hybrid designs. Overall, 118 publications covering 225 interventions consistent with the EBIs were identified. These interventions were evaluated on implementation (N = 183), effectiveness (N = 81), or both outcomes (N = 39). High variability in the methodological approaches was observed. Implementation outcomes were frequently evaluated but use of theoretical frameworks was limited (N = 13). Evaluations undertaken to assess effectiveness were inconsistent, resulting in a range of measures. This review revealed extensive reporting on implementation science as defined using evaluation outcomes. However, high variability was observed in how implementation outcomes and effectiveness were defined, quantified, and reported. A more specific and consistent approach to conducting and reporting on implementation science in HIV could facilitate achievement of UNAIDS 90-90-90 targets.
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Affiliation(s)
- Joseph Cox
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | | | - Nadine Kronfli
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Anna Lawson
- ViiV Healthcare, London, England, United Kingdom
| | | | | | | | - Tristan Barber
- Chelsea and Westminster Hospital, London, England, United Kingdom
| | | | - David Hardy
- Whitman-Walker Centre, Washington, DC, United States of America
| | | | | | | | | | - Keith Alcorn
- NAM publications, London, England, United Kingdom
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Merchant RC, Zhang Z, Zhang Z, Liu T, Baird JR. Lack of efficacy in a randomised trial of a brief intervention to reduce drug use and increase drug treatment services utilisation among adult emergency department patients over a 12-month period. Emerg Med J 2018; 35:282-288. [PMID: 29437758 DOI: 10.1136/emermed-2016-206540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 01/03/2018] [Accepted: 01/10/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Assess the 12-month efficacy of a brief intervention (BI) on reducing drug use and increasing drug treatment services utilisation among adult emergency department (ED) patients. METHODS This randomised, controlled trial enrolled 18-64-year-old ED patients needing a drug use intervention. Treatment arm participants received a tailored BI while control arm participants only completed the study questionnaires. Self-reported past 3-month drug use and engagement in drug treatment services were compared by study arm at 3-month intervals over 1 year. Multiple imputations were performed to overcome loss-to-follow-up. RESULTS Of the 1030 participants, follow-up completion ranged 55%-64% over the four follow-ups. At 12 months, the two study arms were similar in regards to mean: (1) proportion reporting any drug use (treatment: 67.1% (61.6 to 72.6), control: 74.4% (69.4 to 79.4)); (2) drug use frequency on a five-point scale (treatment: 3.7 (3.3 to 4.2), control: 4.6 (4.0 to 5.2)); (3) total days of drug use (treatment: 28.3 (23.2 to 33.4), control: 33.4 (28.5 to 38.2)); (4) most number of times drugs used/day (treatment: 4.6 (3.6 to 5.5), control: 6.1 (4.8 to 7.3)) and (5) typical number of times drugs used/day (treatment: 3.3 (2.5 to 4.1), control: 5.1 (3.9 to 6.2)). Utilisation of drug treatment services also was similar by study arm. In multivariable regression analyses, patients who were homeless or had higher drug use at baseline continued to have greater drug use in follow-up. CONCLUSIONS Among adult ED patients requiring a drug use intervention, this BI did not decrease drug use or increase drug treatment services utilisation over a 12-month period more than the control condition. TRIAL REGISTRATION NUMBER NCT01124591; Pre-trial.
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Affiliation(s)
- Roland C Merchant
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, Rhode Island, USA.,Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Zhongli Zhang
- Department of Biostatistics, Center for Statistical Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Zihao Zhang
- Department of Biostatistics, Center for Statistical Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Tao Liu
- Department of Biostatistics, Center for Statistical Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Janette R Baird
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, Rhode Island, USA
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9
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Bonar EE, Walton MA, Barry KL, Bohnert AS, Chermack ST, Cunningham RM, Massey LS, Ignacio RV, Blow FC. Sexual HIV risk behavior outcomes of brief interventions for drug use in an inner-city emergency department: Secondary outcomes from a randomized controlled trial. Drug Alcohol Depend 2018; 183:217-224. [PMID: 29291549 PMCID: PMC5803438 DOI: 10.1016/j.drugalcdep.2017.10.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 10/23/2017] [Accepted: 10/24/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Drug use is an established risk factor for HIV. Brief Interventions (BIs) targeting reductions in both drug use and HIV risk behaviors may help curtail these related epidemics. The present study evaluates the impact of BIs for drug use and HIV risk reduction on sexual HIV risk behaviors among a primarily marijuana-using sample during a 12-month post-intervention follow-up period. METHODS We conducted a randomized controlled trial of 780 adult patients in an Emergency Department (ED) with past 3-month drug use (primarily non-injecting). This study used a 3 × 2 factorial design (3 ED-based conditions: computer-delivered brief intervention [Computer BI], therapist-delivered, computer-guided BI [Therapist BI], or enhanced usual care (EUC-ED) for drug-using adults; 2 follow-up conditions at 3 months: booster or control). This analysis examines the outcomes of the BIs on sexual HIV risk behaviors at 3-, 6-, and 12-months. RESULTS Compared to the enhanced usual care control, the combined Therapist BI with booster resulted in significant reductions in scores on the sexual risk subscale of the HIV Risk Taking Behaviour Scale over 12-months, when controlling for baseline sexual risk, gender, and drug dependency status. The baseline interventions alone, booster alone, and Computer BI plus booster did not differ from the comparison group (EUC plus control). CONCLUSIONS A therapist-delivered BI for drug use and HIV risk behaviors, combined with a follow-up therapist-delivered booster, shows promise for reducing sexual HIV risk behaviors among a primarily marijuana using, non-injecting sample.
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Affiliation(s)
- Erin E. Bonar
- Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109 USA,Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10- G080, Ann Arbor, Michigan, 48109, USA
| | - Maureen A. Walton
- Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109 USA,Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10- G080, Ann Arbor, Michigan, 48109, USA
| | - Kristen L. Barry
- Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109 USA
| | - Amy S.B. Bohnert
- Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109 USA,Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10- G080, Ann Arbor, Michigan, 48109, USA,Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA
| | - Stephen T. Chermack
- Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109 USA,Mental Health Service, Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA
| | - Rebecca M. Cunningham
- Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10- G080, Ann Arbor, Michigan, 48109, USA,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA,Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights 3790A SPHI, Ann Arbor, MI 48109, USA,Department of Emergency Medicine, Hurley Medical Center, 1 Hurley Place, Flint, MI 48503, USA,Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Lynn S. Massey
- Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109 USA
| | - Rosalinda V. Ignacio
- Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109 USA,Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA
| | - Frederic C. Blow
- Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109 USA,Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10- G080, Ann Arbor, Michigan, 48109, USA,Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA
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10
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Ishizaki A, Bouscaillou J, Luhmann N, Liu S, Chua R, Walsh N, Hess S, Ivanova E, Roberts T, Easterbrook P. Survey of programmatic experiences and challenges in delivery of hepatitis B and C testing in low- and middle-income countries. BMC Infect Dis 2017; 17:696. [PMID: 29143609 PMCID: PMC5688462 DOI: 10.1186/s12879-017-2767-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background There have been few reports on programmatic experience of viral hepatitis testing and treatment in resource-limited settings. To inform the development of the 2017 World Health Organization (WHO) viral hepatitis testing guidance and in particular the feasibility of proposed recommendations, we undertook a survey across a range of organisations engaged with hepatitis testing in low- and middle-income countries (LMICs). Our objective was to describe current hepatitis B and C testing practices across a range of settings in different countries, as well as key barriers or challenges encountered and proposed solutions to promote testing scale-up. Methods Hepatitis testing programmes in predominantly LMICs were identified from the WHO Global Hepatitis Programme contacts database and through WHO regional offices, and invited to participate. The survey comprised a six-part structured questionnaire: general programme information, description of hepatitis testing, treatment and care services, budget and funding, data on programme outcomes, and perceptions on key barriers encountered and strategies to address these. Results We interviewed 22 viral hepatitis testing programmes from 19 different countries. Nine were from the African region; 6 from the Western Pacific; 4 from South-East Asia; and 3 from Eastern Europe. All but four of the programmes were based in LMICs, and 10 (45.5%) were supported by non-governmental or international organizations. All but two programmes undertook targeted testing of specific affected populations such as people living with HIV, people who inject drugs, sex workers, health care workers, and pregnant women. Only two programmes focussed on routine testing in the general population. The majority of programmes were testing in hospital-based or other health facilities, particularly HIV clinics, and community-based testing was limited. Nucleic acid testing (NAT) for confirmation of HCV and HBV viraemia was available in only 30% and 18% of programmes, respectively. Around a third of programmes required some patient co-payment for diagnosis. The most commonly identified challenges in scale-up of hepatitis testing were: limited community awareness about viral hepatitis; lack of facilities or services for hepatitis testing; no access to low cost treatment, particularly for HCV; absence of national guidance and policies; no dedicated budget for hepatitis; and lack of trained health care and laboratory workers. Conclusions At this early stage in the global scale-up of testing for viral hepatitis, there is a wide variation in testing practices and approaches across different programmes. There remains limited access to NAT to confirm viraemia, and patient self-payment for testing and treatment is common. There was consensus from implementing organizations that scale-up of testing will require increased community awareness, health care worker training, development of national strategies and guidelines, and improved access to low cost NAT virological testing. Electronic supplementary material The online version of this article (10.1186/s12879-017-2767-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Azumi Ishizaki
- Global Hepatitis Programme, World Health Organization, 20 Avenue Appia, 1211, 27, Geneva, Switzerland
| | | | - Niklas Luhmann
- Médecins du Monde, 62 rue Marcadet, 75018, Paris, France
| | - Stephanie Liu
- World Health Organization, Regional Office of the Western Pacific, United Nations Avenue, 1000, Manila, Philippines
| | - Raissa Chua
- World Health Organization, Regional Office of the Western Pacific, United Nations Avenue, 1000, Manila, Philippines
| | - Nick Walsh
- World Health Organization, Regional Office of the Western Pacific, United Nations Avenue, 1000, Manila, Philippines
| | - Sarah Hess
- Global Hepatitis Programme, World Health Organization, 20 Avenue Appia, 1211, 27, Geneva, Switzerland
| | - Elena Ivanova
- Foundation for Innovative New Diagnostics, Campus Biotech, Building B2, Level 0, 9 Chemin des Mines, 1202, Geneva, Switzerland
| | - Teri Roberts
- Foundation for Innovative New Diagnostics, Campus Biotech, Building B2, Level 0, 9 Chemin des Mines, 1202, Geneva, Switzerland
| | - Philippa Easterbrook
- Global Hepatitis Programme, World Health Organization, 20 Avenue Appia, 1211, 27, Geneva, Switzerland.
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11
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Bajis S, Dore GJ, Hajarizadeh B, Cunningham EB, Maher L, Grebely J. Interventions to enhance testing, linkage to care and treatment uptake for hepatitis C virus infection among people who inject drugs: A systematic review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 47:34-46. [DOI: 10.1016/j.drugpo.2017.07.002] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/17/2017] [Accepted: 07/10/2017] [Indexed: 12/26/2022]
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12
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Grebely J, Bruneau J, Bruggmann P, Harris M, Hickman M, Rhodes T, Treloar C. Elimination of hepatitis C virus infection among PWID: The beginning of a new era of interferon-free DAA therapy. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 47:26-33. [DOI: 10.1016/j.drugpo.2017.08.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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13
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Zhou K, Fitzpatrick T, Walsh N, Kim JY, Chou R, Lackey M, Scott J, Lo YR, Tucker JD. Interventions to optimise the care continuum for chronic viral hepatitis: a systematic review and meta-analyses. THE LANCET. INFECTIOUS DISEASES 2016; 16:1409-1422. [PMID: 27615026 DOI: 10.1016/s1473-3099(16)30208-0] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 06/21/2016] [Accepted: 06/21/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Advances in therapy for hepatitis B virus (HBV) and hepatitis C virus (HCV) have ushered in a new era in chronic hepatitis treatment. To maximise the effectiveness of these medicines, individuals must be engaged and retained in care. We analysed operational interventions to enhance chronic viral hepatitis testing, linkage to care, treatment uptake, adherence, and viral suppression or cure. METHODS We did a systematic review of operational interventions, and did meta-analyses for sufficiently comparable data. We searched PubMed, Embase, WHO library, International Clinical Trials Registry Platform, PsycINFO, and CINAHL for randomised controlled trials and controlled non-randomised studies that examined operational interventions along the chronic viral hepatitis care continuum, published in English up to Dec 31, 2014. We included non-pharmaceutical intervention studies with primary or secondary outcomes of testing, linkage to care, treatment uptake, treatment adherence, treatment completion, treatment outcome, or viral endpoints. We excluded dissertations and studies of children only. Data were extracted by two independent reviewers, with disagreements resolved by a third reviewer. Studies were assessed for bias. Data from similar interventions were pooled and quality of evidence was assessed using GRADE. This study was registered in PROSPERO (42014015094). FINDINGS We identified 7583 unduplicated studies, and included 56 studies that reported outcomes along the care continuum (41 for HCV and 18 for HBV). All studies except one were from high-income countries. Lay health worker HBV test promotion interventions increased HBV testing rates (relative risk [RR] 2·68, 95% CI 1·82-3·93). Clinician reminders to prompt HCV testing during clinical visits increased HCV testing rates (3·70, 1·81-7·57). Nurse-led educational interventions improved HCV treatment completion (1·14, 1·05-1·23) and cure (odds ratio [OR] 1·93, 95% CI 1·44-2·59). Coordinated mental health, substance misuse, and hepatitis treatment services increased HCV treatment uptake (OR 3·03, 1·24-7·37), adherence (RR 1·22, 1·05-1·41), and cure (RR 1·21, 1·07-1·38) compared with usual care. INTERPRETATION Several simple, inexpensive operational interventions can substantially improve engagement and retention along the chronic viral hepatitis care continuum. Further operational research to inform scale-up of hepatitis services is needed in low-income and middle-income countries. FUNDING World Health Organization and US Fulbright Program.
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Affiliation(s)
- Kali Zhou
- Department of Medicine, Division of Gastroenterology, University of California, San Francisco, CA, USA
| | | | - Nick Walsh
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Ji Young Kim
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Roger Chou
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Mellanye Lackey
- Spencer S Eccles Health Sciences Library, University of Utah, Salt Lake City, UT, USA
| | - Julia Scott
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Ying-Ru Lo
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Joseph D Tucker
- UNC-Project China, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; International Diagnostics Centre, London School of Hygiene & Tropical Medicine, London, UK.
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14
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Wilson CL, Johnson D, Oakley E. Knowledge translation studies in paediatric emergency medicine: A systematic review of the literature. J Paediatr Child Health 2016; 52:112-25. [PMID: 27062613 DOI: 10.1111/jpc.13074] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/19/2015] [Accepted: 09/27/2015] [Indexed: 11/29/2022]
Abstract
AIM Systematic review of knowledge translation studies focused on paediatric emergency care to describe and assess the interventions used in emergency department settings. METHODS Electronic databases were searched for knowledge translation studies conducted in the emergency department that included the care of children. Two researchers independently reviewed the studies. RESULTS From 1305 publications identified, 15 studies of varied design were included. Four were cluster-controlled trials, two patient-level randomised controlled trials, two interrupted time series, one descriptive study and six before and after intervention studies. Knowledge translation interventions were predominantly aimed at the treating clinician, with some targeting the organisation. Studies assessed effectiveness of interventions over 6-12 months in before and after studies, and 3-28 months in cluster or patient level controlled trials. Changes in clinical practice were variable, with studies on single disease and single treatments in a single site showing greater improvement. CONCLUSIONS Evidence for effective methods to translate knowledge into practice in paediatric emergency medicine is fairly limited. More optimal study designs with more explicit descriptions of interventions are needed to facilitate other groups to effectively apply these procedures in their own setting.
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Affiliation(s)
- Catherine L Wilson
- Departments of Emergency Research, Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - David Johnson
- Departments of Pediatrics and Physiology and Pharmacology, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ed Oakley
- Departments of Emergency Research, Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Emergency Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
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15
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Montoy JCC, Dow WH, Kaplan BC. Patient choice in opt-in, active choice, and opt-out HIV screening: randomized clinical trial. BMJ 2016; 532:h6895. [PMID: 26786744 PMCID: PMC4718971 DOI: 10.1136/bmj.h6895] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
STUDY QUESTION What is the effect of default test offers--opt-in, opt-out, and active choice--on the likelihood of acceptance of an HIV test among patients receiving care in an emergency department? METHODS This was a randomized clinical trial conducted in the emergency department of an urban teaching hospital and regional trauma center. Patients aged 13-64 years were randomized to opt-in, opt-out, and active choice HIV test offers. The primary outcome was HIV test acceptance percentage. The Denver Risk Score was used to categorize patients as being at low, intermediate, or high risk of HIV infection. STUDY ANSWER AND LIMITATIONS 38.0% (611/1607) of patients in the opt-in testing group accepted an HIV test, compared with 51.3% (815/1628) in the active choice arm (difference 13.3%, 95% confidence interval 9.8% to 16.7%) and 65.9% (1031/1565) in the opt-out arm (difference 27.9%, 24.4% to 31.3%). Compared with active choice testing, opt-out testing led to a 14.6 (11.1 to 18.1) percentage point increase in test acceptance. Patients identified as being at intermediate and high risk were more likely to accept testing than were those at low risk in all arms (difference 6.4% (3.4% to 9.3%) for intermediate and 8.3% (3.3% to 13.4%) for high risk). The opt-out effect was significantly smaller among those reporting high risk behaviors, but the active choice effect did not significantly vary by level of reported risk behavior. Patients consented to inclusion in the study after being offered an HIV test, and inclusion varied slightly by treatment assignment. The study took place at a single county hospital in a city that is somewhat unique with respect to HIV testing; although the test acceptance percentages themselves might vary, a different pattern for opt-in versus active choice versus opt-out test schemes would not be expected. WHAT THIS PAPER ADDS Active choice is a distinct test regimen, with test acceptance patterns that may best approximate patients' true preferences. Opt-out regimens can substantially increase HIV testing, and opt-in schemes may reduce testing, compared with active choice testing. FUNDING, COMPETING INTERESTS, DATA SHARING This study was supported by grant NIA 1RC4AG039078 from the National Institute on Aging. The full dataset is available from the corresponding author. Consent for data sharing was not obtained, but the data are anonymized and risk of identification is low.Trial registration Clinical trials NCT01377857.
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Affiliation(s)
- Juan Carlos C Montoy
- Department of Emergency Medicine, University of California, 505 Parnassus Ave, San Francisco, CA 94143, USA
| | - William H Dow
- School of Public Health, University of California, 239 University Hall #7360, University of California, Berkeley, CA 94720-7360, USA
| | - Beth C Kaplan
- Department of Emergency Medicine, University of California, 1001 Potrero Ave, San Francisco CA 94143, USA
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16
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Silva ACD, Lucchese R, Vargas LS, Benício PR, Vera I. Aplicação do instrumento Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): uma revisão integrativa. Rev Gaucha Enferm 2016; 37:e52918. [DOI: 10.1590/1983-1447.2016.01.52918] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 12/03/2015] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo Objetivou-se sistematizar o conhecimento e a aprendizagem de como é a aplicação do instrumento Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Método Revisão integrativa, realizada entre maio e julho do ano de 2014, nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Medical Literature Analysis and Retrieval System Online (Medline), PubMed e Scientific Electronic Library Online (SciELO), assim como no sistema de busca do Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES). Foram selecionados 26 artigos. Resultados: O ASSIST concentrou-se no auxílio da identificação e classificação do uso de substância psicoativa, tendo se revelado importante no rastreamento do envolvimento com o álcool e outras drogas, e efetivo no nível primário à saúde. Conclusão: Confirmou-se como instrumento a ser usado na Atenção à Saúde.
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17
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Evaluation of a brief intervention to reduce the negative consequences of drug misuse among adult emergency department patients. Drug Alcohol Depend 2015; 157:44-53. [PMID: 26482090 PMCID: PMC4663151 DOI: 10.1016/j.drugalcdep.2015.10.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/19/2015] [Accepted: 10/01/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Determine if a brief intervention (BI) reduces the negative consequences of drug use/misuse among adult emergency department (ED) patients, and identify patients more likely to benefit from the BI. METHODS This randomized, controlled trial enrolled 1026 18-64 year-old ED patients whose drug misuse indicated a needed for a BI. Differences in total Inventory of Drug Use Consequences (InDUC) scores between the treatment (BI) and control arms (no BI) were assessed every 90 days over a one-year period. Regression models were constructed to identify demographic and clinical factors associated with greater reductions in total InDUC scores. RESULTS Although total InDUC scores decreased for both the treatment and control arms, there were no differences in scores between the treatment and the control arms at baseline at each follow-up. In the regression analyses, participants who were not using drugs or received drug treatment in the past 90 days generally had lower InDUC scores at each follow-up. CONCLUSIONS Although negative consequences decreased in both study arms over time, receiving a BI did not lead to a greater reduction in the negative consequences of drug misuse than not receiving a BI. Of importance in the design of future ED drug misuse interventions, participants who were successful in stopping their drug misuse or receiving drug treatment did show fewer negative consequences of drug use/misuse.
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18
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Merchant RC, DeLong AK, Liu T, Baird JR. Factors Influencing Uptake of Rapid HIV and Hepatitis C Screening Among Drug Misusing Adult Emergency Department Patients: Implications for Future HIV/HCV Screening Interventions. AIDS Behav 2015; 19:2025-35. [PMID: 26036465 DOI: 10.1007/s10461-015-1103-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In this randomized, controlled trial among 957 English- or Spanish-speaking drug misusing adult emergency department (ED) patients, we determined if a tailored brief intervention (BI) increased uptake of rapid HIV/HCV screening, and identified factors associated with greater screening uptake. Rapid HIV/HCV screening uptake was greater in the control than the BI arm (45 vs. 38 %; p < 0.04). Screening uptake depended on elapsed study time and which research staff member offered testing. In the control arm, uptake was lowest for those spending <30 or ≥90 min in the study. In the BI arm, screening uptake generally increased over time. Tailored BI content specifically addressing participant HIV/HCV knowledge, HIV/HCV risk behaviors, or need for HIV/HCV screening was not associated with greater screening uptake. These study findings suggested factors that should be considered when designing future ED-based screening initiatives, such as elapsed study time, who offers testing, and the content of interventions.
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Affiliation(s)
- Roland C Merchant
- Department of Emergency Medicine, Rhode Island Hospital, Alpert Medical School of Brown University, 593 Eddy Street, Claverick Building, Providence, RI, 02903, USA.
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA.
| | - Allison K DeLong
- Center for Statistical Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Tao Liu
- Department of Biostatistics, Center for Statistical Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Janette R Baird
- Department of Emergency Medicine, Rhode Island Hospital, Alpert Medical School of Brown University, 593 Eddy Street, Claverick Building, Providence, RI, 02903, USA
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19
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Beaudoin FL, Baird J, Liu T, Merchant RC. Sex Differences in Substance Use Among Adult Emergency Department Patients: Prevalence, Severity, and Need for Intervention. Acad Emerg Med 2015; 22:1307-15. [PMID: 26473942 DOI: 10.1111/acem.12810] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 06/05/2015] [Accepted: 06/15/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Substance use is prevalent among emergency department (ED) patients, and sex has been implicated as an important factor in the etiology, pathophysiology, sequelae, and treatment of substance use disorders. However, additional information is needed about the epidemiology of substance use as it relates to sex among ED patients. OBJECTIVES This study examined sex differences in the prevalence and severity of self-reported tobacco, alcohol, and drug use among adult ED patients. METHODS A random sample of English- or Spanish-speaking, non-critically ill or injured, 18- to 64-year-old patients was approached at two urban EDs and asked to self-report their lifetime and past 3-month tobacco, alcohol, and drug use. Participants completed the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) using an audio computer-assisted self-interview. Participants were categorized by their substance severity (ASSIST score) and need for a brief or more intensive intervention per World Health Organization recommendations. Substance misuse prevalence, frequency, severity, and need for interventions were compared between sexes by substance category. Multivariable logistic regression models were used to examine the association between sexes and the need for intervention after adjusting for sociodemographic characteristics. RESULTS Of the 6,432 participants in the study, the median age was 37 years (interquartile range = 26 to 48 years), and 56.6% were female. Overall, lifetime, and past 3-month use was higher for men across all substances (tobacco, alcohol, and drugs). Among those reporting past 3-month use, the frequency of use was similar between sexes for tobacco and all drugs, but men reported more frequent alcohol use. Men had higher mean ASSIST scores compared to women, 30.3 (standard error [SE] ± 0.8) vs. 21.1 (SE ± 0.5); mean difference 9.2 (95% confidence interval [CI] = 7.4 to 10.9). The need for any intervention (brief or intensive) was similar between sexes for tobacco and drugs. After sociodemographic factors were adjusted for, women were less likely than men to need any intervention for alcohol (odds ratio [OR] = 0.6; 95% CI = 0.4 to 0.8), but not other substances: tobacco (OR = 0.9; 95% CI = 0.6 to 1.3), marijuana (OR = 0.8; 95% CI = 0.6 to 1.1), or other drugs (OR = 1.1; 95% CI = 0.7 to 1.7). CONCLUSIONS Although men have a higher overall prevalence of substance use, the frequency and severity of use were similar for men and women for most substances. After other characteristics were adjusted for, sex appears associated with the need for interventions for alcohol, but not tobacco, marijuana, or other drugs.
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Affiliation(s)
- Francesca L. Beaudoin
- Department of Emergency Medicine; Rhode Island Hospital; The Alpert Medical School of Brown University; Providence RI
| | - Janette Baird
- Department of Emergency Medicine; Rhode Island Hospital; The Alpert Medical School of Brown University; Providence RI
| | - Tao Liu
- Center for Statistical Sciences; The School of Public Health; Brown University; Providence RI
| | - Roland C. Merchant
- Department of Emergency Medicine; Rhode Island Hospital; The Alpert Medical School of Brown University; Providence RI
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Merchant RC, Baird JR, Liu T. Short-term Efficacy of a Brief Intervention to Reduce Drug Misuse and Increase Drug Treatment Utilization Among Adult Emergency Department Patients. Acad Emerg Med 2015; 22:1172-80. [PMID: 26375468 DOI: 10.1111/acem.12767] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 05/11/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Although brief interventions (BIs) have shown some success for smoking cessation and alcohol misuse, it is not known if they can be applied in the emergency department (ED) to drug use and misuse. The objectives of this investigation were to assess the 3-month efficacy of a BI to reduce drug use and misuse, increase drug treatment services utilization among adult ED patients, and identify subgroups more likely to benefit from the BI. METHODS This randomized, controlled trial enrolled 18- to 64-year-old English- or Spanish-speaking patients from two urban, academic EDs whose responses to the Alcohol, Smoking, and Substance Involvement Screening Test indicated a need for a brief or intensive intervention. Treatment participants received a tailored BI, while control participants only completed the study questionnaires. At the 3-month follow-up, each participant's past 3-month drug use and misuse and treatment utilization were compared to his or her baseline enrollment data. Regression modeling was used to identify subgroups of patients (per demographic and clinical factors) more likely to stop or reduce their drug use or misuse or engage in drug treatment by the 3-month follow-up assessment. RESULTS Of the 1,030 participants, the median age was 30 years (interquartile range = 24 to 42 years), and 46% were female; 57% were white/non-Hispanic, 24.9% were black/non-Hispanic, and 15% were Hispanic. The most commonly misused drugs were marijuana, prescription opioids, cocaine/crack, and benzodiazepines. Although at follow-up the proportions of participants reporting any past 3-month drug misuse had decreased in both study arms (control 84% vs. treatment 78%), the decreases were similar between the two study arms (Δ-6.3%; 95% confidence interval [CI] = -13.0% to 0.0). In addition, at follow-up there were no differences between study arms in those who were currently receiving drug treatment (Δ1.8; 95% CI = -3.5 to 6.8), who had received treatment during the past 3 months (Δ-2.0; 95% CI = -6.5 to 2.4), or who at least contacted a treatment program (Δ 1.7; 95% CI = -2.4 to 6.1). Those whose baseline screening indicated the need for a brief instead of a more intensive intervention, and those currently engaged in drug treatment at the 3-month follow-up, were generally more likely to stop or decrease their drug use/misuse. CONCLUSIONS The BI employed in this study did not reduce drug use and misuse or increase treatment utilization more than the control condition over a 3-month period. Future research should help determine what role, if any, BIs should play in affecting drug use and misuse among ED patients.
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Affiliation(s)
- Roland C. Merchant
- Department of Emergency Medicine; Alpert Medical School; School of Public Health; Brown University; Providence RI
- Department of Epidemiology; School of Public Health; Brown University; Providence RI
| | - Janette R. Baird
- Department of Emergency Medicine; Alpert Medical School; School of Public Health; Brown University; Providence RI
| | - Tao Liu
- Department of Biostatistics; Center for Statistical Sciences; School of Public Health; Brown University; Providence RI
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Baird J, Merchant RC. A randomized controlled trial of the effects of a brief intervention to increase chlamydia and gonorrhea testing uptake among young adult female emergency department patients. Acad Emerg Med 2014; 21:1512-20. [PMID: 25491714 DOI: 10.1111/acem.12539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 06/15/2014] [Accepted: 07/03/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The objective of this study was to test the effect of a brief educational and counseling intervention on increasing the uptake of free testing for Chlamydia trachomatis (chlamydia) and Neisseria gonorrhea (gonorrhea) among young female emergency department (ED) patients. Women are particularly vulnerable to more serious consequences of these infections due to asymptomatic presentation. Increased testing is important to detect, treat, and halt the spread of these infections among asymptomatic women. METHODS This was a randomized controlled trial. Research assistants (RAs) approached female patients in two EDs. Eligible patients were between 18 and 35 years of age, who reported having sex with males, but were not attending the ED for either treatment of sexually transmitted infection (STI) or testing for possible STI exposure. Participants responded to survey questions about their lifetime and past 3-month substance use, number of recent sexual partners, condom use, and perception of risks for chlamydia and gonorrhea infections. Following the survey, the RAs randomized participants into study control or treatment arms. Each treatment arm participant received a brief educational/counseling intervention from the RA. The brief intervention focused on the woman's personal risks for chlamydia and gonorrhea and condoms attitudes and usage. As the primary outcome of this study, participants were offered free urine tests for chlamydia and gonorrhea infection postintervention or post-survey completion, depending on group assignment. RESULTS A total of 171 women completed the baseline assessment and were offered chlamydia and gonorrhea testing. The mean (±SD) age was 26 (±4.76) years, 18% were Hispanic, and 12% were Spanish-speaking only. The brief intervention that was offered to increase these women's awareness of their STI risk did not result in increased acceptance of testing; 48% in the brief intervention group accepted testing (95% confidence interval [CI] = 32% to 64%) versus 36% in the control group (95% CI = 19% to 53%). In a multivariable logistic regression, only self-identifying as being Hispanic was associated with greater willingness to be tested. Of the asymptomatic women tested (n = 71), five tested positive for chlamydia. This represents a positivity rate of 7%. There were no positive test results for gonorrhea. Women who reported high-risk factors for STI, such as younger age (≤25 years), having sex in the past 90 days without using condoms, identified substance use, or previous STI, were not more likely to accept the offer of chlamydia and gonorrhea testing. CONCLUSIONS The brief intervention used in this study did not increase the uptake of testing for chlamydia and gonorrhea infections in this sample, in comparison to receiving no intervention. Although Hispanic women were more likely to accept chlamydia and gonorrhea testing, it is concerning that those women who report STI risk factors were not more likely to accept the offer of chlamydia and gonorrhea testing. Future research should focus on the refinement of an intervention protocol to focus on prior STI and lack of condom use to increase the uptake of testing among this high-risk group.
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Affiliation(s)
- Janette Baird
- Department of Emergency Medicine; Rhode Island Hospital; Alpert Medical School of Brown University; Providence RI
| | - Roland C. Merchant
- Department of Emergency Medicine; Rhode Island Hospital; Alpert Medical School of Brown University; Providence RI
- Department of Epidemiology; School of Public Health; Brown University; Providence RI
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Bernardino VL, Baird JR, Liu T, Merchant RC. Comparison of substance-use prevalence among Rhode Island and The Miriam Hospital Emergency Department patients to state and national general population prevalence estimates. RHODE ISLAND MEDICAL JOURNAL (2013) 2014; 98:30-4. [PMID: 25830171 PMCID: PMC4932856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Compare the prevalence of recent alcohol, tobacco, and drug use among patients from two Rhode Island emergency departments (EDs) to Rhode Island state and United States national general population estimates between 2010 and 2012. METHODS Secondary analysis of ED patient data and the National Survey of Drug Use and Health. RESULTS Alcohol was the most commonly reported substance, and prevalence of its use was higher among ED patients than those in the national, but not the Rhode Island, general population. Drug use was higher among ED patients than in the state and national general population. For ED patients, tobacco and opioid use was highest among 26-34 year-olds, alcohol and marijuana highest among 18-25 years-olds, and cocaine highest among 35-49 years-olds. CONCLUSION Rhode Island Hospital and The Miriam Hospital ED patients report a greater prevalence of substance use than the national population and in many cases the state general population.
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Affiliation(s)
- Vera L Bernardino
- Department of Emergency Medicine, Alpert Medical School, Brown University
| | - Janette R Baird
- Department of Emergency Medicine, Alpert Medical School, Brown University
| | - Tao Liu
- Department of Biostatistics, Center for Statistical Sciences, School of Public Health, Brown University
| | - Roland C Merchant
- Department of Emergency Medicine, Alpert Medical School, Brown University; Department of Epidemiology, School of Public Health, Brown University
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