The Staying Safe Intervention: Training People Who Inject Drugs in Strategies to Avoid Injection-Related HCV and HIV Infection

AIDS education and prevention: official publication of the International Society for AIDS Education (Impact Factor: 1.51). 04/2014; 26(2):144-57. DOI: 10.1521/aeap.2014.26.2.144
Source: PubMed


This pilot study explores the feasibility and preliminary efficacy of the Staying Safe Intervention, an innovative, strengths-based program to facilitate prevention of infection with the human immunodeficiency virus and with the hepatitis C virus among people who inject drugs (PWID). The authors explored changes in the intervention's two primary endpoints: (a) frequency and amount of drug intake, and (b) frequency of risky injection practices. We also explored changes in hypothesized mediators of intervention efficacy: planning skills, motivation/self-efficacy to inject safely, skills to avoid PWID-associated stigma, social support, drug-related withdrawal symptoms, and injection network size and risk norms. A 1-week, fivesession intervention (10 hours total) was evaluated using a pre- versus 3-month posttest design. Fifty-one participants completed pre- and posttest assessments. Participants reported significant reductions in drug intake and injection-related risk behavior. Participants also reported significant increases in planning skills, motivation/self-efficacy, and stigma management strategies, while reducing their exposure to drug withdrawal episodes and risky injection networks.

70 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: The advent of highly effective antiviral regimens will make the eradication of hepatitis C in high-income countries such as the United States technically feasible. But eradicating hepatitis C will require escalating our response to the epidemic in key domains, including surveillance and epidemiology, prevention, screening, care and treatment, policy, research, and advocacy. Surveillance must be nimble enough to quickly assess the magnitude of new transmission patterns as they emerge. Basic prevention strategies – community-based outreach and education, testing and counseling, and access to sterile injection equipment and opioid substitution therapies – must be scaled up and adapted to target groups in which new epidemics are emerging. All adults should be screened for hepatitis C, but special efforts must focus on groups with increased prevalence through community outreach and rapid testing. Government, industry, and payers must work together to assure full access to health services and antiviral drugs for everyone who is infected. Access to the new regimens must not be compromised by excessively high prices or arbitrary payer restrictions. Partnerships must be forged between hepatitis providers and programs that serve people who inject illicit drugs. Healthcare providers and systems, especially primary care practitioners, need education and training in treating hepatitis C and caring for substance-using populations. Services must be provided to the disadvantaged and stigmatized members of society who bear a disproportionate burden of the epidemic. Environments must be created where people who use drugs can receive prevention and treatment services without shame or stigma. Action is needed to end the policy of mass incarceration of people who use drugs, reduce the stigma associated with substance use, support the human rights of people who use drugs, expand social safety net services for the poor and the homeless, remove the legal barriers to hepatitis C prevention, and build public health infrastructure to reach, engage, and serve marginalized populations. Governments must take action to bring about these changes. Public health agencies must work with penal institutions to provide prevention and treatment services, including antiviral therapy, to those in need in jails and prisons or on probation or parole. Research is needed to guide efforts in each of these domains. Strong and sustained political advocacy will be needed to build and sustain support for these measures. Leadership must be provided by physicians, scientists, and the public health community in partnership with community advocates. Eliminating hepatitis C from the United States is possible, but will require a sustained national commitment to reach, test, treat, cure, and prevent every case. With strong political leadership, societal commitment, and community support, hepatitis C can be eradicated in the United States. If this is to happen in our lifetimes, the time for initial steps is now. This article forms part of a symposium in Antiviral Research on “Hepatitis C: next steps toward global eradication.”
    Antiviral Research 10/2014; 110. DOI:10.1016/j.antiviral.2014.07.015 · 3.94 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The combination of fee-for-service payments and the US health care system's standing commitment to treating existing illness discourages spending on the behavioral, social, and environmental (that is, the nonmedical) conditions that contribute most to long-term health. Pay-for-success, alternatively known as social impact bonds, or SIBs, offers a possible solution. The pay-for-success model relies on an investor that is willing to fund a nonmedical intervention up front while bearing the risk that the intervention may fail to prevent disease in the future. Should the intervention succeed, however, the investor is repaid in full by a predetermined payer (such as a public health agency) and receives an additional return on its investment as a reward for taking on the risk. Pay-for-success pilots are being developed to reduce asthma-related emergencies among children, poor birth outcomes, and the progression of prediabetes to diabetes, among other applications. These efforts, supported by key policy reforms such as public agency data sharing and coordinated care, promise to increase the number of evidence-based nonmedical service providers and seed a new market that values health, not just health care.
    Health Affairs 11/2014; 33(11):1897-904. DOI:10.1377/hlthaff.2014.0741 · 4.97 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Increases in prescription opioid misuse, injection drug use, and hepatitis C infections have been reported among youth and young adults in the USA, particularly in rural and suburban areas. To better understand these trends in New York City and to characterize demographics and risk factors among a population who, by virtue of their age, are more likely to be recently infected with hepatitis C, we analyzed routine hepatitis C surveillance data from 2009 to 2013 and investigated a sample of persons 30 and younger newly reported with hepatitis C in 2013. Between 2009 and 2013, 4811 persons 30 and younger were newly reported to the New York City Department of Health and Mental Hygiene with hepatitis C. There were high rates of hepatitis C among persons 30 and younger in several neighborhoods that did not have high rates of hepatitis C among older people. Among 402 hepatitis C cases 30 and younger investigated in 2013, the largest proportion (44 %) were white, non-Hispanic, and the most commonly reported risk factor for hepatitis C was injection drug use, mostly heroin. Hepatitis C prevention and harm reduction efforts in NYC focused on young people should target these populations, and surveillance for hepatitis C among young people should be a priority in urban as well as rural and suburban settings.
    Journal of Urban Health 12/2014; 92(2). DOI:10.1007/s11524-014-9920-5 · 1.90 Impact Factor
Show more