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Kennedy DP, Osilla KC, Hunter SB, Golinelli D, Maksabedian Hernandez E, Tucker JS. Restructuring personal networks with a Motivational Interviewing social network intervention to assist the transition out of homelessness: A randomized control pilot study. PLoS One 2022; 17:e0262210. [PMID: 35061795 PMCID: PMC8782388 DOI: 10.1371/journal.pone.0262210] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 10/21/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Social relationships play a key role in both substance use and homelessness. Transitioning out of homelessness often requires reduction in substance use as well as changes in social networks. A social network-based behavior change intervention that targets changes personal social networks may assist the transition out of homelessness. Most behavior change interventions that incorporate social networks assume a static network. However, people experiencing homelessness who transition into housing programs that use a harm reduction approach experience many changes in their social networks during this transition. Changes may include disconnecting from street-based network contacts, re-connecting with former network contacts, and exposure to new network members who actively engage in substance use. An intervention that helps people transitioning out of homelessness make positive alterations to their social networks may compliment traditional harm reduction housing program services. METHODS We conducted a pilot randomized controlled trial (RCT) of an innovative Social Network Intervention (MI-SNI), which combines network visualization and Motivational Interviewing to assist adults transitioning out of homelessness. The MI-SNI provides feedback to new residents about their social environments and is designed to motivate residents to make positive changes in both their individual behavior and their personal network. In a sample of 41 adult housing program residents with past year risky substance use, we examined whether participants randomized to receive a MI-SNI showed greater changes in their personal networks over 3 months compared to those receiving usual care. RESULTS There were significant differences in the networks of the MI-SNI group compared to the group receiving usual care at follow-up, controlling for baseline network characteristics. The MI-SNI group had greater reductions in the proportion of their network members who influenced alcohol or other drug use (AOD) use, such as drinking partners, and more frequently changed their relationships in the direction of lower AOD risk with network members who were retained in their networks across waves. CONCLUSIONS This study is the first pilot test of a MI-SNI customized for assisting the transition out of homelessness to test for personal network changes. Results indicate that MI-SNIs can have a positive impact on short-term network changes and thus may serve as a useful adjunct to behavioral change interventions. These findings suggest that a MI-SNI approach may help individuals experiencing homelessness and risky AOD use positively restructure their social networks while transitioning into supportive housing. These promising results suggest the need for a larger RCT test of this innovative intervention approach. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02140359.
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Affiliation(s)
- David P. Kennedy
- RAND Corporation, Santa Monica, California, United States of America
- * E-mail:
| | - Karen Chan Osilla
- RAND Corporation, Santa Monica, California, United States of America
| | - Sarah B. Hunter
- RAND Corporation, Santa Monica, California, United States of America
| | - Daniela Golinelli
- RAND Corporation, Santa Monica, California, United States of America
| | | | - Joan S. Tucker
- RAND Corporation, Santa Monica, California, United States of America
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Bajis S, Grebely J, Cooper L, Smith J, Owen G, Chudleigh A, Hajarizadeh B, Martinello M, Adey S, Read P, Gilliver R, Applegate T, Treloar C, Maher L, Dore GJ. Hepatitis C virus testing, liver disease assessment and direct-acting antiviral treatment uptake and outcomes in a service for people who are homeless in Sydney, Australia: The LiveRLife homelessness study. J Viral Hepat 2019; 26:969-979. [PMID: 30980785 DOI: 10.1111/jvh.13112] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/27/2019] [Accepted: 03/18/2019] [Indexed: 01/22/2023]
Abstract
People who are homeless have increased hepatitis C virus (HCV) infection risk, and are less likely to access primary healthcare. We aimed to evaluate HCV RNA prevalence, liver disease burden, linkage to care and treatment uptake and outcomes among people attending a homelessness service in Sydney. Participants were enrolled in an observational cohort study with recruitment at a homelessness service over eight liver health campaign days. Finger-stick whole-blood samples for Xpert® HCV Viral Load and venepuncture blood samples were collected. Participants completed a self-administered survey and received transient elastography and clinical assessment by a general practitioner or nurse. Clinical follow-up was recommended 2-12 weeks after enrolment. For participants initiating direct-acting antiviral (DAA) therapy, medical records were audited retrospectively and treatment outcome data were collected. Among 202 participants (mean age, 48 years), 82% were male (n = 165), 39% (n = 78) reported ever injecting drugs, of whom 63% (n = 49) injected in the previous month. Overall, 23% (n = 47) had detectable HCV RNA and 6% (n=12) had cirrhosis. HCV RNA prevalence among participants with either injecting or incarceration history was 35% (37/105), compared to 4% (3/73) among participants without these risk factors. Among those with detectable HCV RNA, 23 (49%) commenced therapy, of whom 65% (n = 15) achieved sustained virological response, while the remainder had no available treatment outcome. No participant had documented virological failure. HCV DAA treatment uptake among people attending a homelessness service was encouraging, but innovative models of HCV care are required to improve linkage to care and treatment uptake among this highly marginalized population.
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Affiliation(s)
- Sahar Bajis
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Lucy Cooper
- Matthew Talbot Hostel, St Vincent de Paul Society NSW Support Services, Sydney, New South Wales, Australia
| | - Julie Smith
- Matthew Talbot Hostel, St Vincent de Paul Society NSW Support Services, Sydney, New South Wales, Australia
| | - Greg Owen
- Matthew Talbot Hostel, St Vincent de Paul Society NSW Support Services, Sydney, New South Wales, Australia
| | - Alan Chudleigh
- Matthew Talbot Hostel, St Vincent de Paul Society NSW Support Services, Sydney, New South Wales, Australia
| | | | | | - Sara Adey
- NSW Users and AIDS Association, Sydney, New South Wales, Australia
| | - Phillip Read
- Kirketon Road Centre, Sydney, New South Wales, Australia
| | | | - Tanya Applegate
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Lisa Maher
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
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Santa Maria D, Flash CA, Narendorf S, Barman-Adhikari A, Petering R, Hsu HT, Shelton J, Bender K, Ferguson K. Knowledge and Attitudes About Pre-Exposure Prophylaxis Among Young Adults Experiencing Homelessness in Seven U.S. Cities. J Adolesc Health 2019; 64:574-580. [PMID: 30254009 DOI: 10.1016/j.jadohealth.2018.06.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/21/2018] [Accepted: 06/22/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Evidence suggests that young adults experiencing homelessness (YEH) are at elevated risk of HIV compared to housed youth. Given the limited research on pre-exposure prophylaxis (PrEP) awareness among YEH, this study examined their PrEP knowledge and attitudes. METHODS Data from a cross-sectional survey among YEH (ages 18-26) (n = 1,427) in seven U.S. cities were used to assess their knowledge and attitudes regarding PrEP to inform HIV prevention efforts. RESULTS Participants were primarily male youth of color. The mean age was 20.9years. While 66% felt at risk for HIV, only 14% strongly agreed that they try to protect themselves from getting infected with HIV. Most (84%) were eligible for PrEP based on risk, yet only 29% had knowledge of PrEP. Despite this, 59% reported they were likely/extremely likely to take PrEP. Access to free PrEP (55%), HIV testing (72%), healthcare (68%), and one-on-one (62%), and text messaging support (57%) were rated as very/extremely important for PrEP uptake and adherence. CONCLUSIONS The results of this study suggest missed opportunities to prevent new HIV infections among YEH. Efforts to increase PrEP uptake among this population should consider provider- and system-level interventions to increase PrEP awareness, decrease PrEP-associated healthcare costs, improve access to PrEP providers, and provide in-person and text messaging support.
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Affiliation(s)
- Diane Santa Maria
- Department of Nursing Systems, Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, Texas.
| | - Charlene A Flash
- Department of Medicine, Division of Infectious Disease, Baylor College of Medicine and Legacy Community Health, Houston, Texas.
| | - Sarah Narendorf
- Graduate College of Social Work, University of Houston, Houston, Texas.
| | | | - Robin Petering
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California.
| | - Hsun-Ta Hsu
- School of Social Work, University of Missouri, Columbia, Missouri.
| | - Jama Shelton
- Silberman School of Social Work, at Hunter College, New York, New York.
| | - Kimberly Bender
- Graduate School of Social Work, University of Denver, Denver, Colorado.
| | - Kristin Ferguson
- School of Social Work, Arizona State University, Phoenix, Arizona.
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Wenzel SL, Rhoades H, La Motte-Kerr W, Duan L, Harris T, Rice E, Henwood BF. Do HIV risk and prevention behaviors change over time among adults in permanent supportive housing? AIDS Care 2019; 31:1172-1177. [PMID: 30724581 DOI: 10.1080/09540121.2019.1576849] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Persons experiencing homelessness have a disproportionate burden of HIV infection and high rates of HIV risk behavior. Permanent supportive housing (PSH) has been identified as a primary solution to homelessness, but little is known about HIV sexual risk behavior among persons in PSH, nor about how HIV risk and prevention behavior may change as persons move from homelessness into PSH. Utilizing longitudinal data from 421 persons prior to moving in and over their first year living in PSH, this study assesses change over time in HIV risk and prevention behavior utilizing generalized linear mixed models. Results reveal changes in sexual risk behavior over time, including an overall increase in the rate of sexual activity, but a decrease in rates of some sexual risk behaviors, including condomless sex and multiple partners. While decreasing overall, the prevalence of condomless sex remains high (63%) at 12-months. Combined with a precipitous drop in HIV prevention programming exposure (from 56% at baseline to 23% at 12-months), only two-thirds of those sexually active reporting a past year HIV test at 12-months post-housing, and rare use of PrEP, these findings suggest a need for additional attention to promotion of sexual health behaviors and HIV prevention within PSH.
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Affiliation(s)
- Suzanne L Wenzel
- a Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , US
| | - Harmony Rhoades
- a Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , US
| | - Wichada La Motte-Kerr
- a Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , US
| | - Lei Duan
- a Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , US
| | - Taylor Harris
- a Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , US
| | - Eric Rice
- a Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , US
| | - Benjamin F Henwood
- a Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , US
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Opt-Out HIV Testing of Inmates in North Carolina Prisons: Factors Associated with not Wanting a Test and not Knowing They Were Tested. AIDS Behav 2016; 20:859-69. [PMID: 26386591 DOI: 10.1007/s10461-015-1203-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Opt-out HIV testing is recommended for correctional settings but may occur without inmates' knowledge or against their wishes. Through surveying inmates receiving opt-out testing in a large prison system, we estimated the proportion unaware of being tested or not wanting a test, and associations [prevalence ratios (PRs)] with inmate characteristics. Of 871 tested, 11.8 % were unknowingly tested and 10.8 % had unwanted tests. Not attending an educational HIV course [PR = 2.34, 95 % confidence interval (CI) 1.47-3.74], lower HIV knowledge (PR = 0.95, 95 % CI 0.91-0.98), and thinking testing is not mandatory (PR = 9.84, 95 % CI 4.93-19.67) were associated with unawareness of testing. No prior incarcerations (PR = 1.59, 95 % CI 1.03-2.46) and not using crack/cocaine recently (PR = 2.37, 95 % CI 1.21-4.64) were associated with unwanted testing. Residence at specific facilities was associated with both outcomes. Increased assessment of inmate understanding and enhanced implementation are needed to ensure inmates receive full benefits of opt-out testing: being informed and tested according to their wishes.
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Chadwick JJ, Andrade LF, Altice FL, Petry NM. Correlates of having never been HIV tested among entrants to substance abuse treatment clinics: empiric findings from real-world New England settings. J Psychoactive Drugs 2014; 46:208-14. [PMID: 25052879 PMCID: PMC4780256 DOI: 10.1080/02791072.2014.915363] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Routine testing is the cornerstone to identifying HIV, but not all substance abuse treatment patients have been tested. This study is a real-world evaluation of predictors of having never been HIV tested among patients initiating substance abuse treatment. Participants (N = 614) from six New England clinics were asked whether they had ever been HIV tested. Eighty-five patients (13.8%) reported having never been tested and were compared to those who had undergone testing. Clinic, male gender (adjusted odds ratio (AOR) = 1.91, 95% confidence interval (CI) = 1.07-3.41), and having fewer employment (AOR = 0.31; 95% CI = 0.11-0.88) and medical problems (AOR = 0.40, 95% CI = 0.17-0.99) were independently correlated with having never been HIV tested. Thus, there is still considerable room for improved testing strategies as a clinically significant minority of substance abuse patients have never undergone HIV testing when they initiate treatment.
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Affiliation(s)
- Jeanne J. Chadwick
- Eastern Connecticut State University, Department of Biology, Willimantic, CT, USA
| | - Leonardo F. Andrade
- University of Connecticut School Medicine, Calhoun Cardiology Center, Farmington, CT, USA
| | - Frederick L. Altice
- Yale University School of Medicine, Infectious Diseases Section, AIDS Program, New Haven, CT, USA
- Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA
| | - Nancy M. Petry
- University of Connecticut School Medicine, Calhoun Cardiology Center, Farmington, CT, USA
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Abstract
Individuals who are homeless or living in marginal conditions have an elevated burden of infection with HIV. Existing research suggests the HIV/AIDS pandemic in resource-rich settings is increasingly concentrated among members of vulnerable and marginalized populations, including homeless/marginally-housed individuals, who have yet to benefit fully from recent advances in highly-active antiretroviral therapy (HAART). We reviewed the scientific evidence investigating the relationships between inferior housing and the health status, HAART access and adherence and HIV treatment outcomes of people living with HIV/AIDS (PLWHA.) Studies indicate being homeless/marginally-housed is common among PLWHA and associated with poorer levels of HAART access and sub-optimal treatment outcomes. Among homeless/marginally-housed PLWHA, determinants of poorer HAART access/adherence or treatment outcomes include depression, illicit drug use, and medication insurance status. Future research should consider possible social- and structural-level determinants of HAART access and HV treatment outcomes that have been shown to increase vulnerability to HIV infection among homeless/marginally-housed individuals. As evidence indicates homeless/marginally-housed PLWHA with adequate levels of adherence can benefit from HAART at similar rates to housed PLWHA, and given the individual and community benefits of expanding HAART use, interventions to identify HIV-seropositive homeless/marginally-housed individuals, and engage them in HIV care including comprehensive support for HAART adherence are urgently needed.
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