Integrating hepatitis, STD, and HIV services into a drug rehabilitation program

Division of STD Prevention, National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
American Journal of Preventive Medicine (Impact Factor: 4.53). 07/2005; 29(1):27-33. DOI: 10.1016/j.amepre.2005.03.010
Source: PubMed

ABSTRACT Considering the difficulties in providing screening and vaccination services for inmates in short-stay incarceration facilities, an evaluation was conducted of the integration of prevention services in an alternative sentencing drug rehabilitation program (alternative to incarceration) in San Diego CA.
During the period April 1999 to December 2002, clients were asked to complete a brief risk-assessment questionnaire, and were offered hepatitis B virus (HBV) vaccination, HBV and hepatitis C virus (HCV) serologic testing, STD screening, and HIV counseling and testing.
Of the estimated 1125 rehabilitation program enrollees, 930 (83%) participated in the integration program services. Most clients were male (64%), were aged >30 years (64%), and few (7%) reported previous HBV vaccination. Of the 854 clients eligible for hepatitis B vaccination, 98% received the first dose, 69% the second dose, and 42% completed the series. Eleven percent of clients had prior HBV infection, and 14.7% had HCV infection, with positivity rates being highest among those with a history of injection drug use-HBV, 19%, and HCV, 36%. HIV infection was rare (prevalence, 0.3%), and STDs were uncommon (chlamydia prevalence, 2%, and gonorrhea prevalence, 0.6%). Total annual cost of integration services (excluding HIV testing) was dollar 31,994 equating to dollar 122 per client served.
Alternative sentencing drug rehabilitation programs provide a venue to efficiently deliver integrated hepatitis and other prevention services. Considering the vast number of high-risk persons in drug rehabilitation, probation, parole, and inmate release programs, an opportunity exists to greatly expand hepatitis services.

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Available from: Marjorie A Richardson, Jul 10, 2014
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    • "Disease management, whether in primary or specialist settings, can assist patients to manage symptoms and prevent liver disease acceleration [13]. Despite these benefits, patient nonattendance rates range from 28 to 80% [14] [15] [16], and little is known about the reasons for this. Nonattendance results in wasted clinician time and health care resources, but a more critical issue is the delay in presentation and lack of monitoring and management that can predispose the patient to complications unnecessarily. "
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    ABSTRACT: This descriptive qualitative study examined the patient, provider, and institutional factors contributing to nonattendance for hepatitis C (HCV) care throughout the disease course. Eighty-four patients and health and social care providers were interviewed. Thematic analysis of the data yielded 6 interrelated nonattendance themes: self-protection, determining the benefits, competing priorities, knowledge gaps, access to services, and restrictive policies. Factors within the themes varied with the disease course, type of provider/service, and patient context. Nonattendance could span months to years and most frequently began at diagnosis where providers either advised that followup was not necessary or did not recommend any followup. The way services were organized (low barrier access) and delivered (nonjudgmental approach) and higher HCV knowledge levels of patients and providers encouraged attendance. This is the first study to explore the reasons for nonattendance for HCV care throughout the disease course and validate them from multiple perspectives. There are missed opportunities for providers to encourage attendance throughout the disease course beginning at diagnosis. Interventions required include development of integrated health and social service delivery models; mechanisms to improve knowledge dissemination of the disease, its management, and treatment; and implementation of standardized followup protocols for liver disease monitoring in primary care.
    09/2013; 2013:579529. DOI:10.1155/2013/579529
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    • "Although studies consistently recommend more HIV testing and greater access to interventions for at-risk women, outside of specifically funded projects, widespread implementation of testing and effective interventions is not yet a reality [74–78]. For example, although there is evidence for the feasibility and effectiveness of interventions such as rapid HIV testing in medical [79–81], criminal justice [82, 83], and drug treatment [82, 84] settings as well as community-based organizations such as homeless shelters and public parks [85], studies suggest that dissemination and implementation of rapid testing in these settings is lagging behind the evidence due to restrictive state policies, and administrative, organizational, and funding barriers [74, 76, 77]. Although it is clear that effective interventions exist, more emphasis must be placed diffusing these interventions in order to reach women who are at the greatest risk for HIV. "
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    ABSTRACT: We examined the effect of women's perceptions of sexual partner risks on condom use. Women from three US cities (n = 1,967) were recruited to provide data on HIV risks. In univariate models, increased odds of condom use were associated with perceiving that partners had concurrent partners and being unaware of partners': (a) HIV status, (b) bisexuality, (c) concurrency; and/or (d) injection drug use. In multivariate models, neither being unaware of the four partner risk factors nor perceiving a partner as being high risk was associated with condom use. Contextual factors associated with decreased odds of condom use were having sex with a main partner, homelessness in the past year, alcohol use during sex, and crack use in the past 30 days. Awareness of a partner's risks may not be sufficient for increasing condom use. Contextual factors, sex with a main partner in particular, decrease condom use despite awareness of partner risk factors.
    AIDS and Behavior 10/2010; 15(7):1347-58. DOI:10.1007/s10461-010-9840-7 · 3.49 Impact Factor
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    • "w becomes : What is the optimal overall strategy to vaccinate high - risk MSM ? Previous research has demonstrated successful hepatitis vaccination of injection drug users at syringe exchange sites ( Altice et al . 2005 ; Des Jarlais et al . 2001 ) . Vaccination services have also been successfully demon - strated at drug rehabilitation programs ( Gunn et al . 2005 ) , prisons ( Sutton et al . 2005 ) , university health services ( Neighbors et al . 1999 ) , STI clinics , and various other community health organizations ( Gunn et al . 2007 ; Sansom et al . 2003 ; Trubatch et al . 2000 ) . These avenues may be alternative ways of reaching high - risk MSM who do not attend Gay Pride events or openly "
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    ABSTRACT: Prevention researchers have advocated primary prevention such as vaccination in alternative venues. However, there have been major questions about both the attendance of, and the ability to, vaccinate high-risk individuals in such settings. The current study seeks to assess the feasibility of vaccinating high-risk men who have sex with men (MSM) at Gay Pride events. The research questions are: Do gay men who are sampled at Gay Pride events engage in more or less risky behavior than gay men sampled at other venues? Do the gay men who receive hepatitis vaccinations at Gay Pride engage in more or less risky behavior than gay men at Gay Pride who do not receive hepatitis vaccination? Of the 3689 MSM that completed the Field Risk Assessment (FRA), 1095/3689 = 29.68% were recruited at either the 2006 or 2007 Long Beach, California Gay Pride events. The remaining, 2594/3689 = 70.32% were recruited at Long Beach gay bars, gay community organizations and institutions, and through street recruitment in various gay enclaves in the Long Beach area. Logistic regression analysis yielded eight factors that were associated with non-attendance of Gay Pride: Age, had sex while high in the last 12 months, had unprotected anal intercourse (UAI) in the last 12 months, had sex for drugs/money in the last 12 months, been diagnosed with a sexually transmitted infection (STI) in the last 12 months, used nitrites (poppers) in the last 12 months, and used methamphetamine in the last 12 months. Identifying as White, Asian, or African American compared to Hispanic was also associated with non-attendance. Bivariate analysis indicated that, of the MSM sampled at Gay Pride, 280/1095 = 25.57% received a hepatitis vaccination there. The MSM sampled at Gay Pride who reported engaging in UAI or having used any stimulant (cocaine, crack-cocaine, or methamphetamine) in the last 12 months were more likely to receive hepatitis vaccination on-site. The results provide evidence for the viability of successfully vaccinating high-risk MSM at Gay Pride events. However, it is vital that no-cost vaccinations are also funded in other community settings such as STI clinics, drug treatment programs, prisons, universities, and other community resource centers in order to reach those additional high-risk MSM who do not attend Gay Pride.
    Prevention Science 06/2010; 11(2):219-27. DOI:10.1007/s11121-009-0164-7 · 2.63 Impact Factor
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