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Appa A, Baral S, Stein B, Knight K, Gandhi M, Coffin P, Martin M. The IMPACT (Infection Management Plus Addiction Care Together) Pilot: A Case Series of Combined Contingency Management for Substance Use Disorders and Antibiotic Adherence in the Hospital Setting. J Addict Med 2024; 18:138-143. [PMID: 38109334 PMCID: PMC10939948 DOI: 10.1097/adm.0000000000001254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
OBJECTIVES Psychostimulant-related mortality is rising alongside increasing substance use-related hospitalizations, which are commonly complicated by patient-directed (or "against medical advice") discharges. Contingency management (CM) is an underused evidence-based treatment for substance use disorders with proven efficacy to support medication adherence. Our objective was to describe feasibility and preliminary effectiveness of a novel CM intervention incentivizing both drug use reduction and antibiotic adherence in the hospital setting. METHODS We conducted a pilot intervention of twice weekly CM for stimulant and/or opioid use disorder and antibiotic adherence conducted on inpatient wards and/or an embedded skilled nursing facility in an urban public hospital. Based on point-of-care urine drug test results and objective antibiotic adherence review, participants earned increasing opportunities to receive incentives. We measured feasibility via number of visits attempted and cost of gift cards dispensed. We evaluated effectiveness via antibiotic completion, discharge type, and participant perception of intervention effectiveness collected via structured survey. RESULTS Of 13 participants enrolled, most had opioid use disorder (fentanyl in 10/13) and stimulant use disorder (methamphetamine in 7/13). Almost all were receiving treatment for osteomyelitis and/or endocarditis (12/13). Feasibility challenges included competing demands of acute care with variable range of completed visits per participant (1-12 visits). Despite this, antibiotic completion was high (92%, 12/13 participants) with only two patient-directed discharges. Participants described CM as very effective in aiding infection treatment but had greater variability in beliefs regarding CM facilitation of reduced drug use. CONCLUSIONS Providing CM in the hospital setting may represent an effective approach to improving health outcomes by increasing antibiotic adherence and addressing substance use.
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Affiliation(s)
- Ayesha Appa
- Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins University, Baltimore, USA
| | - Brianna Stein
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, USA
| | - Kelly Knight
- Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Monica Gandhi
- Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Phillip Coffin
- San Francisco Department of Public Health, San Francisco, USA
| | - Marlene Martin
- Department of Medicine, University of California, San Francisco, San Francisco, USA
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Hardin B, Graboyes M, Kosty D, Cioffi C. Vaccine decision making among people who inject drugs: Improving on the WHO's 3C model of vaccine hesitancy. Prev Med Rep 2023; 35:102341. [PMID: 37593355 PMCID: PMC10428103 DOI: 10.1016/j.pmedr.2023.102341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/19/2023] Open
Abstract
The objectives of this study were to 1) identify vaccination rates among PWID in Oregon at a time when vaccines were easily accessible, 2) quantitatively identify convergence with demographic correlates of vaccination willingness and uptake to promote generalizability, and 3) explore the factors PWID were considering when deciding whether or not to receive the COVID-19 vaccine. We conducted a mixed-methods study design including 260 quantitative surveys and 41 in-depth qualitative interviews with PWID, conducted July - September 2021 at syringe services programs in Lane County, Oregon. Among the 260 survey respondents, 37.3% indicated that they had received a COVID-19 vaccine by October 1, 2021. In the same period, an estimated 70.1% of the total Lane County population had completed their COVID-19 vaccinations (not including booster rounds). We explored alignment with the WHO's 3C model of vaccine hesitancy and identified, instead, five common factors as key motivators for vaccine decisions: confidence, convenience, concern, communication, and community implications among PWID. Interviews with PWID describe systemic barriers which prevented them from accessing healthcare resources. We highlight that our proposed 5C model may more accurately depict how PWID navigate vaccine decisions by incorporating the ways that social inequities, infrastructural barriers, and community values influence an individual's vaccine deliberation.
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Affiliation(s)
- Blake Hardin
- Department of Global Studies, University of Oregon, United States
| | | | - Derek Kosty
- Prevention Science Institute, University of Oregon, United States
| | - Camille Cioffi
- Prevention Science Institute, University of Oregon, United States
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Strathdee SA, Abramovitz D, Harvey-Vera AY, Stamos-Buesig T, Vera CF, Artamonova I, Logan J, Patterson TL, Servin AE, Bazzi AR. A Brief Peer-Led Intervention to Increase COVID-19 Vaccine Uptake Among People Who Inject Drugs in San Diego County: Results From a Pilot Randomized Controlled Trial. Open Forum Infect Dis 2023; 10:ofad392. [PMID: 37547856 PMCID: PMC10404005 DOI: 10.1093/ofid/ofad392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/18/2023] [Indexed: 08/08/2023] Open
Abstract
Background We evaluated the impact of a brief peer-led intervention on COVID-19 vaccination among people who inject drugs (PWID) presenting at syringe services program (SSP) locations in San Diego County, California. Methods Between March and July 2022, PWID aged ≥18 years without recent voluntary COVID-19 testing who were not up to date on COVID-19 vaccinations received a single-session motivational interviewing intervention (LinkUP) or an attention-matched didactic control condition from trained peer counselors at SSP sites randomized by week. Following either 30-minute session, counselors offered referrals to local vaccination services. Multivariable log binomial regression via generalized estimating equations assessed LinkUP effects on (1) acceptance of COVID-19 vaccination referrals immediately postintervention and (2) COVID-19 vaccine uptake at 6-month follow-up. Results COVID-19 vaccination outcomes were obtained on 135 (90.6%) of 149 participants. In multivariable analysis, participants receiving LinkUP had greater acceptance of COVID-19 vaccination referrals than controls (adjusted relative risk, 3.50; 95% CI, 1.01-12.2) and were marginally more likely to report receiving a new COVID-19 vaccine dose (adjusted relative risk, 1.57; 95% CI, .99-2.48). After 6 months, 20% reported receiving a new vaccine dose; however, if COVID-19 vaccine had been available at SSPs, this proportion could have been as high as 34.3% (45.3% LinkUP vs 24.3% control; P = .01). Conclusions A brief peer-led SSP-based intervention significantly improved COVID-19 vaccination among PWID. Further improvements could likely be obtained by supporting SSPs to offer COVID-19 vaccination on-site instead of relying on referrals. Clinical Trials Registration ClinicalTrials.gov NCT05181657.
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Affiliation(s)
| | - Daniela Abramovitz
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Alicia Y Harvey-Vera
- School of Medicine, University of California San Diego, La Jolla, California, USA
- Facultad de Medicina, Universidad Xochicalco, Tijuana, Mexico
- United States–Mexico Border Health Commission, Tijuana, Mexico
| | - Tara Stamos-Buesig
- OnPoint, Harm Reduction Coalition of San Diego, San Diego, California, USA
| | - Carlos F Vera
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Irina Artamonova
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Jenna Logan
- OnPoint, Harm Reduction Coalition of San Diego, San Diego, California, USA
| | - Thomas L Patterson
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Argentina E Servin
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California, USA
| | - Angela R Bazzi
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California, USA
- Department of Community Health Sciences, School of Public Health, Boston University, Boston, Massachusetts, USA
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Bazzi AR, Abramovitz D, Harvey-Vera A, Stamos-Buesig T, Vera CF, Artamonova I, Logan J, Patterson TL, Strathdee SA. Preliminary Efficacy of a Theory-Informed Intervention to Increase COVID-19 Testing Uptake Among People Who Inject Drugs in San Diego County: Findings From a Pilot Randomized Controlled Trial. Ann Behav Med 2023; 57:472-482. [PMID: 37029714 PMCID: PMC10205139 DOI: 10.1093/abm/kaad012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND People who inject drugs (PWID) have low rates of COVID-19 testing yet are vulnerable to severe disease. In partnership with a mobile syringe service program (SSP) in San Diego County, CA, we developed the evidence-, community-, and Social Cognitive Theory-informed "LinkUP" intervention (tailored education, motivational interviewing, problem-solving, and planning) to increase COVID-19 testing uptake among PWID. PURPOSE To assess preliminary efficacy of LinkUP in increasing PWID COVID-19 testing in a pilot randomized controlled trial (RCT). METHODS We referred participants (PWID, ≥18 years old, San Diego County residents who had not recently undergone voluntary COVID-19 testing) to mobile SSP sites that had been randomized (by week) to offer the active LinkUP intervention or didactic attention-control conditions delivered by trained peer counselors. Following either condition, counselors offered on-site rapid COVID-19 antigen testing. Analyses estimated preliminary intervention efficacy and explored potential moderation. RESULTS Among 150 participants, median age was 40.5 years, 33.3% identified as Hispanic/Latinx, 64.7% were male, 73.3% were experiencing homelessness, and 44.7% had prior mandatory COVID-19 testing. The LinkUP intervention was significantly associated with higher COVID-19 testing uptake (p < .0001). Homelessness moderated intervention effects; LinkUP increased COVID-19 testing uptake more among participants experiencing homelessness (adjusted risk ratio [aRR]: 1.80; 95% CI: 1.56-2.09; p < .0001) than those not experiencing homelessness (aRR: 1.20; 95% CI: 1.01-1.43; p = .04). CONCLUSIONS Findings from this pilot RCT support the preliminary efficacy of the "LinkUP" intervention to increase COVID-19 testing among PWID and underscore the importance of academic-community partnerships and prevention service delivery through SSPs and other community-based organizations serving vulnerable populations.
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Affiliation(s)
- Angela R Bazzi
- Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, CA, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Daniela Abramovitz
- Department of Medicine, School of Medicine, University of California, San Diego; La Jolla, CA, USA
| | - Alicia Harvey-Vera
- Department of Medicine, School of Medicine, University of California, San Diego; La Jolla, CA, USA
- Universidad Xochicalco, Facultad de Medicina, Tijuana, BC, Mexico
- United States-Mexico Border Health Commission, Tijuana, BC, Mexico
| | | | - Carlos F Vera
- Department of Medicine, School of Medicine, University of California, San Diego; La Jolla, CA, USA
| | - Irina Artamonova
- Department of Medicine, School of Medicine, University of California, San Diego; La Jolla, CA, USA
| | - Jenna Logan
- OnPoint, Harm Reduction Coalition of San Diego, San Diego, CA, USA
| | | | - Steffanie A Strathdee
- Department of Medicine, School of Medicine, University of California, San Diego; La Jolla, CA, USA
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Webb Hooper M, Compton WM, Walsh ER, Hodes RJ, Pérez-Stable EJ. Harnessing the Power of Community-Engaged Science to Facilitate Access and Uptake of COVID-19 Testing: RADx-UP. Am J Public Health 2022; 112:S854-S857. [PMID: 36446064 PMCID: PMC9707707 DOI: 10.2105/ajph.2022.307105] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Monica Webb Hooper
- Monica Webb Hooper and Eliseo J. Pérez-Stable are with the National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD. Wilson M. Compton is with the National Institute on Drug Abuse, NIH. Elizabeth R. Walsh is with the Office of the Director, NIH. Richard J. Hodes is with the National Institute on Aging, NIH
| | - Wilson M Compton
- Monica Webb Hooper and Eliseo J. Pérez-Stable are with the National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD. Wilson M. Compton is with the National Institute on Drug Abuse, NIH. Elizabeth R. Walsh is with the Office of the Director, NIH. Richard J. Hodes is with the National Institute on Aging, NIH
| | - Elizabeth R Walsh
- Monica Webb Hooper and Eliseo J. Pérez-Stable are with the National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD. Wilson M. Compton is with the National Institute on Drug Abuse, NIH. Elizabeth R. Walsh is with the Office of the Director, NIH. Richard J. Hodes is with the National Institute on Aging, NIH
| | - Richard J Hodes
- Monica Webb Hooper and Eliseo J. Pérez-Stable are with the National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD. Wilson M. Compton is with the National Institute on Drug Abuse, NIH. Elizabeth R. Walsh is with the Office of the Director, NIH. Richard J. Hodes is with the National Institute on Aging, NIH
| | - Eliseo J Pérez-Stable
- Monica Webb Hooper and Eliseo J. Pérez-Stable are with the National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD. Wilson M. Compton is with the National Institute on Drug Abuse, NIH. Elizabeth R. Walsh is with the Office of the Director, NIH. Richard J. Hodes is with the National Institute on Aging, NIH
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Harvey-Vera A, Munoz S, Artamonova I, Abramovitz D, Mittal ML, Rosales C, Strathdee SA, Rangel MG. COVID-19 vaccine uptake among people who inject drugs in Tijuana Mexico. Front Public Health 2022; 10:931306. [PMID: 36148330 PMCID: PMC9485825 DOI: 10.3389/fpubh.2022.931306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/18/2022] [Indexed: 01/24/2023] Open
Abstract
Background SARS-CoV-2 prevalence is elevated among people who inject drugs (PWID). In Tijuana, Mexico, COVID-19 vaccines became available to the general population in June 2021, but uptake among PWID was <10%. We studied COVID-19 vaccine uptake among PWID in Tijuana following implementation of a pop-up vaccination clinic. Methods Beginning in October, 2020, PWID in Tijuana aged ≥18 years were enrolled into a longitudinal cohort study. At baseline and semi-annually, participants underwent interviewer-administered interviews on health behaviors and COVID-19 exposures through April 5, 2022. From June 21-September 20, 2021, staff referred PWID to a temporary COVID-19 vaccine pop-up clinic that was coincidentally established near the study office. Participants attending the clinic completed a short interview on barriers to vaccination and were offered facilitated access to free Janssen® COVID-19 vaccine. All participants were reimbursed $5 for this interview, regardless of whether or not they chose to be vaccinated. Poisson regression was used to evaluate the effect of the pop-up clinic on COVID-19 vaccination uptake, controlling forpotential confounders. Results Of 344 participants, 136 (39.5%) reported having received at least one COVID-19 vaccine dose during the 10 months follow-up period, of whom 113 (83.1%) received vaccine at the pop-up clinic and 23 (16.9%) elsewhere. One third of those receiving COVID-19 vaccine during the pop-up clinic were previously vaccine hesitant. Attending the pop-up clinic was independently associated with higher rates of COVID-19 vaccination Adjusted Rate Ratio (AdjRR: 9.15; 95% CI: 5.68-14.74). Conclusions We observed a significant increase in COVID-19 vaccine uptake associated with attending a temporary pop-up vaccine clinic in Tijuana suggesting that efforts to improve vaccination in this vulnerable population should include convenient locations and staff who have experience working with substance using populations. Since COVID-19 vaccination rates remain sub-optimal, sustained interventions to increase uptake are needed.
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Affiliation(s)
- Alicia Harvey-Vera
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, San Diego, CA, United States,US-Mexico Border Health Commission, Tijuana, Mexico,Escuela de Medicina, Campus Tijuana, Universidad Xochicalco, Tijuana, Mexico
| | - Sheryl Munoz
- US-Mexico Border Health Commission, Tijuana, Mexico,Escuela de Medicina, Campus Tijuana, Universidad Xochicalco, Tijuana, Mexico
| | - Irina Artamonova
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Daniela Abramovitz
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Maria Luisa Mittal
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Cecilia Rosales
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Steffanie A. Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, San Diego, CA, United States,*Correspondence: Steffanie A. Strathdee
| | - Maria Gudelia Rangel
- US-Mexico Border Health Commission, Tijuana, Mexico,Departmento de Estudios de Población, El Colegio de la Frontera Norte, Tijuana, Mexico
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