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ABSTRACT: Abstract Smoking among people living with HIV, particularly women living with HIV, is associated with higher morbidity and mortality rates when compared to nonsmoking individuals with HIV. Despite patients' higher risk of adverse health outcomes, in particular preventable smoking-related diseases for smokers living with HIV, few smoking cessation interventions have been examined with this population. The aim of the current study was to test the potential efficacy of a brief motivational intervention for smoking cessation with HIV-infected women smokers. Participants (N=30) were randomly assigned to receive a single session of motivational interviewing (MI) or prescribed advice (PA). The primary outcome was seven-day point prevalence abstinence at the one-month follow-up interview. Secondary outcome measures included mean cigarettes smoked per day, desire to quit smoking, perceived difficulty in quitting smoking, and expectation of success. We detected no significant differences between intervention and control groups in self-reported seven-day point prevalence abstinence at the one-month follow-up. However, participants in the MI condition reported a significant decrease in the mean cigarettes smoked per day when compared to the PA condition. There were no significant between-group differences in participants' desire to quit, perceived difficulty, and expectation of success. The results of this pilot study indicate that MI may be an effective smoking cessation intervention for HIV-positive women smokers and should be studied further in a larger clinical trial.
AIDS Care 11/2012; · 1.60 Impact Factor
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ABSTRACT: This mixed methods study examined motivations and barriers to substance abuse treatment entry and treatment continuation among Asian American and Pacific Islander (AAPI) substance users. AAPI substance users (N=61) were recruited from substance abuse treatment programs in California and Hawaii. Semi-structured interviews and interviewer-administered surveys assessed barriers and facilitators to entering substance abuse treatment. Barriers included peer pressure, family influences, and face loss concerns. Facilitators included peer support, involvement in the criminal justice system, a perceived need for treatment, and culturally competent substance abuse treatment services. Family and peer influences may act as both facilitators and impediments. AAPI substance using populations face many of the same individual-level and structural and systems barriers to entry to treatment as other substance using populations. However, similar to other racial/ethnic minority groups, it is important to address cultural differences and develop culturally competent substance abuse treatments for the AAPI population.
Journal of substance abuse treatment 09/2012; · 2.90 Impact Factor
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Lisa R Metsch,
Daniel J Feaster,
Lauren Gooden,
Tim Matheson,
Raul N Mandler,
Louise Haynes,
Susan Tross,
Tiffany Kyle,
Dianne Gallup,
Andrzej S Kosinski, [......],
Moupali Das,
Robert Lindblad,
Sarah Erickson,
P Todd Korthuis,
Steve Martino, James L Sorensen,
José Szapocznik,
Rochelle Walensky,
Bernard Branson,
Grant N Colfax
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ABSTRACT: We examined the effectiveness of risk reduction counseling and the role of on-site HIV testing in drug treatment.
Between January and May 2009, we randomized 1281 HIV-negative (or status unknown) adults who reported no past-year HIV testing to (1) referral for off-site HIV testing, (2) HIV risk-reduction counseling with on-site rapid HIV testing, or (3) verbal information about testing only with on-site rapid HIV testing.
We defined 2 primary self-reported outcomes a priori: receipt of HIV test results and unprotected anal or vaginal intercourse episodes at 6-month follow-up. The combined on-site rapid testing participants received more HIV test results than off-site testing referral participants (P<.001; Mantel-Haenszel risk ratio=4.52; 97.5% confidence interval [CI]=3.57, 5.72). At 6 months, there were no significant differences in unprotected intercourse episodes between the combined on-site testing arms and the referral arm (P=.39; incidence rate ratio [IRR]=1.04; 97.5% CI=0.95, 1.14) or the 2 on-site testing arms (P=.81; IRR=1.03; 97.5% CI=0.84, 1.26).
This study demonstrated on-site rapid HIV testing's value in drug treatment centers and found no additional benefit from HIV sexual risk-reduction counseling.
American Journal of Public Health 04/2012; 102(6):1160-7. · 3.93 Impact Factor
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P Todd Korthuis,
Daniel J Feaster,
Zoilyn L Gomez,
Moupali Das,
Susan Tross,
Katharina Wiest,
Antoine Douaihy,
Raul N Mandler, James L Sorensen,
Grant Colfax,
Dennis McCarty,
Stephanie E Cohen,
Patricia E Penn,
Diane Lape,
Lisa R Metsch
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ABSTRACT: Injection drug use (IDU) is a primary vector for blood-borne infections. Awareness of Hepatitis C virus (HCV) infection status may affect risky injection behaviors. This study determines the prevalence of risky injection practices and examines associations between awareness of positive HCV status and risky injection behaviors.
We surveyed individuals seeking treatment for substance use at 12 community treatment programs as part of a national HIV screening trial conducted within the National Drug Abuse Treatment Clinical Trials Network. Participants reported socio-demographic characteristics, substance use, risk behaviors, and HCV status. We used multivariable logistic regression to test associations between participant characteristics and syringe/needle sharing.
The 1281 participants included 244 (19.0%) individuals who reported injecting drugs in the past 6 months and 37.7% of IDUs reported being HCV positive. During the six months preceding baseline assessment, the majority of IDUs reported obtaining sterile syringes from pharmacies (51.6%) or syringe exchange programs (25.0%), but fewer than half of IDUs always used a sterile syringe (46.9%). More than one-third (38.5%) shared syringe/needles with another injector in the past 6 months. Awareness of positive HCV vs. negative/unknown status was associated with increased recent syringe/needle sharing (aOR 2.37, 95% CI 1.15, 4.88) in multivariable analysis.
Risky injection behaviors remain prevalent and awareness of HCV infection was associated with increased risky injection behaviors. New approaches are needed to broadly implement HCV prevention interventions for IDUs seeking addiction treatment.
Addictive behaviors 12/2011; 37(4):552-5. · 2.25 Impact Factor
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Susan Tross,
Aimee N C Campbell,
Donald A Calsyn,
Lisa R Metsch, James L Sorensen,
Steven Shoptaw,
Louise Haynes,
George E Woody,
Robert M Malow,
Lawrence S Brown, [......],
Robert E Booth,
Raul N Mandler,
Carmen Masson,
Beverly W Holmes,
Grant Colfax,
Audrey J Brooks,
Denise A Hien,
Bruce R Schackman,
P Todd Korthuis,
Gloria M Miele
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ABSTRACT: HIV continues to be a significant problem among substance users and their sexual partners in the United States. The National Drug Abuse Treatment Clinical Trials Network (CTN) offers a national platform for effectiveness trials of HIV interventions in community substance abuse treatment programs. This article presents the HIV activities of the CTN during its first 10 years.
While emphasizing CTN HIV protocols, this article reviews the (1) HIV context for this work; (2) the collaborative process among providers, researchers, and National Institute on Drug Abuse CTN staff, on which CTN HIV work was based; (3) results of CTN HIV protocols and HIV secondary analyses in CTN non-HIV protocols; and (4) implications for future HIV intervention effectiveness research in community substance abuse treatment programs.
While the feasibility of engaging frontline providers in this research is highlighted, the limitations of small to medium effect sizes and weak adoption and sustainability in everyday practice are also discussed.
The American Journal of Drug and Alcohol Abuse 09/2011; 37(5):283-93. · 1.55 Impact Factor
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American journal of epidemiology 07/2011; · 5.59 Impact Factor
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ABSTRACT: Some gender differences in the progression of human immunodeficiency virus (HIV) infection have been attributed to delayed treatment among women and the social context of poverty. Recent economic difficulties have led to multiple service cuts, highlighting the need to identify factors with the most influence on health in order to prioritize scarce resources. The aim of this study was to empirically rank factors that longitudinally impact the health status of HIV-infected homeless and unstably housed women. Study participants were recruited between 2002 and 2008 from community-based venues in San Francisco, California, and followed over time; marginal structural models and targeted variable importance were used to rank factors by their influence. In adjusted analysis, the factor with the strongest effect on overall mental health was unmet subsistence needs (i.e., food, hygiene, and shelter needs), followed by poor adherence to antiretroviral therapy, not having a close friend, and the use of crack cocaine. Factors with the strongest effects on physical health and gynecologic symptoms followed similar patterns. Within this population, an inability to meet basic subsistence needs has at least as much of an effect on overall health as adherence to antiretroviral therapy, suggesting that advances in HIV medicine will not fully benefit indigent women until their subsistence needs are met.
American journal of epidemiology 07/2011; 174(5):515-22. · 5.59 Impact Factor
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ABSTRACT: Little published information exists to guide health care institutions in establishing syringe exchange program (SEP) services. To address this gap, this article discusses organizational issues encountered in the implementation of a hospital-based SEP in San Francisco, California (USA). Investigators collaborated with a community organization in implementing a county hospital-based SEP. SEP services integrated into a public hospital presented unique challenges directly related to their status as a health care institution. In the course of introducing SEP services into a hospital setting as part of a clinical trial, various ethical, legal, and logistical issues were raised. Based on these experiences, this paper provides guidance on how to integrate an SEP into a traditional health care institution.
Substance Use & Misuse 05/2010; 45(6):901-15. · 1.10 Impact Factor
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ABSTRACT: This study identified predictors of condom use and developed a model of condom use in a sample of men (n = 324) enrolled in drug treatment. Utilizing a series of logistic regression analyses reported condom use was predicted by possession of condoms, future intention to use condoms, future intention to increase condom use, having a high-risk partner, low Condom Barriers Scale scores, being unmarried and ethnic minority status. A probit path analysis revealed the following model of condom use among men in drug treatment: Taking condoms from clinic stocks was the best predictor of condom possession, which in turn was the best predictor of condom use. These study findings identify condom availability in treatment programs as an important risk reduction intervention. Treatment programs can apply these predictors of condom use to better identify individuals at risk for HIV and sexually transmitted infections to better target prevention interventions.
AIDS education and prevention: official publication of the International Society for AIDS Education 10/2009; 21(5):460-73. · 1.51 Impact Factor
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ABSTRACT: This article describes therapeutic community (TC) services modified to support methadone residents and their service utilization in a study of TC patients (N = 231) receiving versus not receiving methadone.
Service utilization data are reported from providers (i.e., methadone support group counselor, acupuncturist, and consulting psychiatrist) for 12 months after admission. Descriptive statistics are used to report methadone residents use of methadone support group and acupuncture services. Pearson chi-square tests are used to compare methadone and non-methadone participants use of psychiatrist services. Additionally, such tests were used to compare both groups DSM-IV diagnoses.
Ninety-seven percent of methadone patients attended at least one methadone support group; 52% used acupuncture services. Proportionally more non-methadone residents used psychiatric services (p < .05).
Services tailored to methadone residents were accessed by this group. However, while 32% of all participants met diagnostic criteria for a current psychiatric disorder, only 22% received onsite psychiatric care, which questions whether integrated care is being provided adequately for participants with co-occurring disorders.
The American Journal of Drug and Alcohol Abuse 01/2009; 35(2):91-4. · 1.55 Impact Factor
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ABSTRACT: The potential benefits of anti-retroviral therapy for HIV is not fully realized because of difficulties in adherence with demanding treatment regimens, especially among injection drug users.
HIV-positive methadone patients who were less than 80% adherent with their primary anti-retroviral therapy were randomized to a trial of incentives for on-time adherence. Adherence was rewarded with an escalating scale of vouchers redeemable for goods. Both intervention and control group visited a medication coach twice a month. The cost of the intervention was determined by micro-costing. Other costs were obtained from administrative data and patient report of out-of-system care.
During the 12-week intervention period, the incremental direct cost of the intervention, including treatment vouchers, was $942. The voucher group incurred $2572 in anti-retroviral drug cost, significantly more than the $1973 incurred by the comparison group (p<.01). Adherence, as measured by on-time openings of an electronically monitored vial, was 78% in the intervention group and 56% in the control group.
The incremental direct cost of voucher incentives was $292 per month. If the observed increase in adherence from voucher incentives can be sustained in the long-term, the literature suggests that disease progression will be slowed. Further research is needed to evaluate if the improvement can be sustained or achieved at lower cost. Mitigation of treatment resistance and reduction in HIV transmission are additional benefits that favor adoption.
Drug and alcohol dependence 01/2009; 100(1-2):115-21. · 3.60 Impact Factor
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ABSTRACT: Residential therapeutic communities (TCs) have demonstrated effectiveness, yet for the most part they adhere to a drug-free ideology that is incompatible with the use of methadone. This study used equivalency testing to explore the consequences of admitting opioid-dependent clients currently on methadone maintenance treatment (MMT) into a TC.
The study compared 24-month outcomes between 125 MMT patients and 106 opioid-dependent drug-free clients with similar psychiatric history, criminal justice pressure and expected length of stay who were all enrolled in a TC. Statistical equivalence was expected between groups on retention in the TC and illicit opioid use. Secondary hypotheses posited statistical equivalence in the use of stimulants, benzodiazepines, and alcohol, as well as in HIV risk behaviors.
Mean number of days in treatment was statistically equivalent for the two groups (166.5 for the MMT group and 180.2 for the comparison group). At each assessment, the proportion of the MMT group testing positive for illicit opioids was indistinguishable from the proportion in the comparison group. The equivalence found for illicit opioid use was also found for stimulant and alcohol use. The groups were statistically equivalent for benzodiazepine use at all assessments except at 24 months where 7% of the MMT group and none in the comparison group tested positive. Regarding injection- and sex-risk behaviors the groups were equivalent at all observation points.
Methadone patients fared as well as other opioid users in TC treatment. These findings provide additional evidence that TCs can be successfully modified to accommodate MMT patients.
Drug and alcohol dependence 12/2008; 100(1-2):100-6. · 3.60 Impact Factor
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Amie L. Haas PhD,
James L. Sorensen PhD,
Sharon M. Hall PhD,
Christine Lin BA,
Kevin Delucchi PhD,
Karl Sporer MD,
TeChieh Chen BA,
Amie L. Haas, James L. Sorensen,
Sharon M. Hall,
Christine Lin,
Kevin Delucchi,
Karl Sporer,
TeChieh Chen
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ABSTRACT: Little is known about cigarette smoking among opioid users who are not in substance abuse treatment. The study examined cigarette smoking in out-of-treatment opioid users presenting at a hospital who participated in drug abuse research. Participants exhibited a high rate of smoking (92%) at baseline that remained unchanged at one year and were moderately nicotine-dependent. Nineteen percent preferred unfiltered cigarettes. Women were more likely to smoke menthol cigarettes; men were more likely to smoke unfiltered cigarettes. Caucasians tended to smoke more than other ethnicities and exhibited greater dependence. Out-of-treatment drug users continue to be at high risk for continued smoking.
American Journal on Addictions 01/2008; 17(1):65 - 69. · 1.74 Impact Factor
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ABSTRACT: The therapeutic community (TC) and methadone maintenance treatment (MMT) have individually demonstrated consistent positive outcomes yet rarely have been combined. This article describes how a well-established residential therapeutic community integrated methadone maintenance treatment into its activities. Practical recommendations regarding how to incorporate MMT in a residential program are provided including topics for staff (training, coordination with the methadone service provider agency), patients (education, confronting stigma about methadone maintenance), and potential therapeutic activities (methadone group therapy). The implementation of these staff, patient, and therapeutic adaptations can assist residential substance abuse treatment programs in integrating these two addiction treatment modalities.
Journal of psychoactive drugs 10/2007; 39(3):203-10. · 1.10 Impact Factor
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Drug and Alcohol Dependence 08/2007; 89(2-3):310-3. · 3.38 Impact Factor
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ABSTRACT: This study evaluated treatment outcomes for the reduction of criminal justice involvement and substance use among opioid dependent clients in a therapeutic community setting under California's Proposition 36. We compared treatment outcomes between those mandated to treatment under Proposition 36 (n = 24) and those on probation but not involved in Proposition 36 (n = 61) over 12 months. Over time, both groups showed significant improvement on drug use and employment measures, were more likely to be involved in job training and less likely to be engaged in work activity, and had similar retention in treatment. There was no evidence that treatment outcomes were different between the two groups. These findings may be helpful in guiding policy makers and clinicians in states where similar initiatives are under consideration.
Journal of drug issues 07/2007; 37(3):699-715. · 0.38 Impact Factor
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ABSTRACT: Homeless individuals experience high rates of morbidity and mortality, yet many homeless studies include small percentages of female participants. We therefore sought to determine correlates of homelessness separately for men and women in a sample of individuals visiting free food programs. Between August 2003 and April 2004, 324 individuals were recruited from San Francisco free food programs and interviewed regarding housing, sociodemographics, health, drug use, sex trade, and incarceration. Over one-half of women and almost three-fourths of men reported homelessness in the prior year. Among women, white race, younger age, not living with minor children, engaging in sex trade and recent incarceration were strongly associated with homelessness; however, only incarceration maintained the strong association in adjusted analysis (OR = 7.16, CI = 3.83-13.4). Among men, heavy alcohol use, drug use, years spent living in San Francisco and monthly income were strongly associated with homelessness; however, only years living in San Francisco (OR = 0.28, CI = 0.19-0.42) and monthly income maintained strong association in adjusted analysis (OR = 0.27, CI = 0.13-0.57). Housing patterns and the strongest correlates of homelessness among individuals visiting free food programs differ by sex. These results suggest the need to characterize homelessness and develop effective homeless interventions separately for men and women.
Journal of Urban Health 06/2007; 84(3):415-22. · 2.13 Impact Factor
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ABSTRACT: This clinical trial evaluated a contingency management intervention designed to improve medication adherence among HIV-positive methadone maintenance patients. After a 4-week baseline observation phase, eligible participants (N=66) were randomly assigned to: (a) medication coaching sessions every other week to assist with adherence strategies (comparison group) or (b) medication coaching plus voucher reinforcement for opening electronic medication caps on time (voucher group). Baseline adherence (percent doses taken/percent total possible doses) was 51% using electronic measurement, 75% using self-report and 75% using pill count. The intervention was provided for 12 weeks, with a 4-week follow-up. The primary outcome results of the clinical trial indicated effectiveness during the intervention, with significant mean adherence differences between voucher and comparison groups using electronic measurement (78% versus 56%), pill count (86% versus 75%), and self-report (87% versus 69%). Differences between groups faded after vouchers were discontinued. Contingency management shows promise as a strategy to promote antiretroviral medication adherence in this population.
Drug and Alcohol Dependence 05/2007; 88(1):54-63. · 3.38 Impact Factor
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ABSTRACT: This study examined the effect of syringe exchange program setting on the injection practices, health status, and health service utilization patterns of injection drug users (IDUs) recruited from a public urban hospital. One hundred sixty-six participants were randomized to either community- or hospital-based syringe exchange services. Poisson regression models were used to compare service utilization between groups. In both conditions, risky drug use practices decreased, and physical health functioning improved over time. Hospital-based syringe exchange program (SEP) attendees had 83% more inpatient admissions (p < .0001) and 22% more ambulatory care visits (p < .0001) than those assigned to the community-based SEP condition. Syringe exchange services that are integrated into public hospital settings may serve as a valuable strategy to engage hard to reach IDU populations in behavioral interventions designed to reduce HIV risk transmission behaviors and increase access to, or engagement in, the use of secondary and tertiary preventive medical care.
AIDS Education and Prevention 04/2007; 19(2):97-110. · 1.59 Impact Factor
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ABSTRACT: We evaluated whether implementation of Treatment on Demand (TOD) policy in San Francisco was associated with improved access to drug abuse treatment.
Data came from San Francisco's treatment program waiting list over 4 years spanning the implementation of TOD policy. Access measures were monthly applicants waiting and days waited by treatment admissions. Quantitative analyses with 69 treatment facilities contrasted those receiving vs. not receiving TOD funds. Qualitative data came from interviews with facility administrators.
There was a small statistically significant decline in monthly waiting lists in the number of people waiting for treatment during the study period. The days waited by those admitted to treatment, however, significantly increased in TOD-funded facilities. Facilities used varied criteria for completing the access measures, which limit the utility of the measures.
Access to treatment improved slightly with implementation of TOD policy.
The American Journal of Drug and Alcohol Abuse 02/2007; 33(2):227-36. · 1.55 Impact Factor
