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HIV Risk Reduction in Outpatient Drug Abuse Treatment
Abstract
In the national Drug Abuse Treatment Outcome Studies (DATOS), many clients in outpatient methadone treatment (OMT) and outpatient drug-free (ODF) modalities were admitted with multiple sex and needle-risk behaviors, but they reduced these risks significantly during treatment. Using hierarchical linear model regression analysis, we examined client and treatment program characteristics as predictors of initial risk levels and of reductions over time. Clients who used cocaine frequently before treatment or had antisocial personality disorder entered treatment with elevated risks. In both modalities, cocaine users reduced risky behaviors significantly, but antisocial clients did so only in OMT. Treatment programs located in cities with higher prevalence rates of HIV/AIDS admitted clients with lower baseline levels of risk behavior than found in other cities. OMT programs in lower prevalence cities achieved higher rates of risk reduction than programs in higher prevalence cities. Reduction of sex and needle risks in both the OMT and ODF modalities indicates the importance of outpatient drug abuse treatment to national HIV prevention policy.
... In fact, studies have documented the importance of HIV counseling/education and HIV testing components in substance abuse treatment programs (Batki & Ferrando 1996). One study concluded that HIV counseling and education services may have contributed to reductions in HIV-related risk behaviors during treatment (Broome, Joe, Simpson 1999). ...
... For example, individual and group counseling, educational provisions, and continuing care/aftercare services were required in the majority of the states. Individual and group counseling as well as education programs focusing on infectious disease transmission (e.g., HIV-related education) are central components of most treatment programs in the U.S. (NIDA 1999;Batki & Ferrando 1996;Broome et al. 1999). The limited number of states to require substance abuse and infectious disease-related testing services may be more due to potential structural barriers in the system (i.e., lack of trained staff, resource requirements, medical and safety hazards, etc.) than the fact that the states do not want treatment programs to engage in these practices. ...
... Volume 00, Number 00 '' 2017 the patients who were entered into the buprenorphine treatment group. [9][10][11] The research study by Broome et al,9 in the year 1999, showed that patients who were entered into methadone maintenance treatment (MMT) on an average had more high-risk behaviors than the buprenorphine-received group; the high-risk behaviors included unsafe sex and drug injectors, which significantly decreased after entering MMT. The results of the research study conducted by Dolan et al 12 revealed that treatment with methadone significantly reduced high-risk behaviors such as injecting drug use, sharing of injecting equipment, unsafe sexual behaviors, and sex for money or drugs. ...
... Volume 00, Number 00 '' 2017 the patients who were entered into the buprenorphine treatment group. [9][10][11] The research study by Broome et al,9 in the year 1999, showed that patients who were entered into methadone maintenance treatment (MMT) on an average had more high-risk behaviors than the buprenorphine-received group; the high-risk behaviors included unsafe sex and drug injectors, which significantly decreased after entering MMT. The results of the research study conducted by Dolan et al 12 revealed that treatment with methadone significantly reduced high-risk behaviors such as injecting drug use, sharing of injecting equipment, unsafe sexual behaviors, and sex for money or drugs. ...
Introduction: The aim of this study was to answer the question as to how demographic characteristics and the history of high-risk behavior play a role for therapists to select the method of maintenance treatment or how other factors have been important in this selection. Methods: This cross-sectional study was conducted during the period 2015 to 2016 in maintenance treatment clinics in the North Khorasan province (North East of Iran). Besides demographic data, the studied variables include the type of drugs, duration of usage, age of first use, the type of maintenance therapy, and the presence or absence of lifetime risk behaviors (eg, injection, unsafe sex, prison history, and history of suicide attempt). Results: A total of 7342 patients from 79 centers were admitted to participate in this study. In all, 82.17% of the participants were male individuals, and 17.82% were female individuals. Opium and opium sap (88.53%) and heroin or crack (11.46%) were the most commonly used drugs among the studied subjects. The type of substance, demographic characteristics, and the history of high-risk behaviors (except for injection) showed significant differences in the treatment method with methadone, buprenorphine, and opium tincture. Conclusions: It seems that the selection made by Iranian therapists to enter the patients into maintenance treatments was based on the wrong criteria, and there was a financial relationship between the patients and the therapists in the centers being effective in selecting the type of treatment. This issue can greatly affect harm reduction policies in the maintenance treatment centers.
... It is not known what affect the client-therapist relationship may have had on the subjects and how this influenced their therapeutic process. Many studies indicate that effectiveness of therapy is related to the client -therapist relationship [53,54,55,56]. ...
The purpose of this study was to evaluate the effectiveness of the Bonny Method of Guided Imagery and Music (GIM) on interpersonal problems, coping measures and immune function in 19 adults in chemical dependency treatment for an average of 43 days. Psychological measures included the Inventory of Interpersonal Problems Short Circumplex Form (IIP-SC), the Sense of Coherence Scale (SOC) and physiological measure included salivary immunoglobulin A. Pre-test measures were collected at the initial interview session and post-tests at the final BMGIM session. Experimental subjects received one GIM session a week during their treatment. Results show significant decrease on the domineering, cold, and non-assertive subscales of the IIP-SC and on the manageability subscale of the SOC scale. The physiological measure of sIgA did not show a significant increase. The BMGIM appears to be effective in addressing issues underlying substance abuse, in addition showing a positive impact on physical health.
... Heinbach found that pre-treatment demographic variables do not predict outcome, except for one: in his study, patients who were single used less illicit drugs than married respondents did (Heinbach 1997). Persons with depressive symptoms often stay in treatment for a longer time (Broome 1999b). ...
... At baseline, our sample had low overall levels of drugrelated risk, sex-related risk, and total risk (previous studies have demonstrated that IDUs' reports of both demographic and HIV risk behavior can be reliable) [30]. That finding is consistent with those of the national Drug Abuse Treatment Outcome Studies (DATOS), which found that treatment programs in cities with higher prevalence rates of HIV/AIDS such as Baltimore admitted clients with lower baseline levels of risk behavior than other cities [31]. In 2011, Chaudhry et al. [32] reported that among 303 buprenorphine-maintained individuals across nine US sites, 24% had had sex without a condom and almost 9% had shared needles in the previous 90 days. ...
We sought to develop and deploy a video-based smartphone-delivered mobile HIV Risk Reduction (mHIVRR) intervention to individuals in an addiction treatment clinic. We developed 3 video modules that consisted of a 10-minute HIVRR video, 11 acceptability questions, and 3 knowledge questions and deployed them as a secondary study within a larger study of ecological momentary and geographical momentary assessments. All 24 individuals who remained in the main study long enough completed the mHIVRR secondary study. All 3 videos met our a priori criteria for acceptability "as is" in the population: they achieved median scores of ≤2.5 on a 5-point Likert scale; ≤20% of the individuals gave them the most negative rating on the scale; a majority of the individuals stated that they would not prefer other formats over video-based smartphone-delivered one (all P < 0.05). Additionally, all of our video modules met our a priori criteria for feasibility: ≤20% of data were missing due to participant noncompliance and ≤20% were missing due to technical failure. We concluded that video-based mHIVRR education delivered via smartphone is acceptable, feasible and may increase HIV/STD risk reduction knowledge. Future studies, with pre-intervention assessments of knowledge and random assignment, are needed to confirm these findings.
... Aus der prospektiven Kohortenstudie DATOS wird berichtet, dass Drogenabhängige in ambulanten Therapieeinrichtungen nicht nur ihr Risikoverhalten bezüglich Injektionen, sondern auch in Bezug auf Sexualkontakte deutlich reduzierten [48]. Dasselbe wird aus stationären ausstiegsorientierten Behandlungen berichtet [49], und ähnliches wurde in einer prospektiven Studie an homosexuellen Drogenabhängigen beobachtet [50]. Ein besonders hohes Infektionsrisiko besteht bei wechselnder Sexualpartnerschaft. Eine Studie an i. v. Drogenkonsumenten in San Francisco fand, dass Männer mit homosexuellen Kontakten hochsignifikant häufiger eine Serokonversion für HIV-1 aufwiesen als Heterosexuelle und dass Frauen mit wechselnden Sexpartnern signifikant häufiger seropositiv wurden als Frauen mit festen Partnern [51]. ...
Der Forschungsstand zur Frage von Legitimation und Zukunft von schadensmindernden Strategien bei an sich unerwünschtem Verhalten wird diskutiert. Thematisch handelt es sich um Safer Use bei intravenösem Drogenkonsum, Strategien zur Prophylaxe bei Freizeitdrogenkonsum, Schadensminimierung durch Suchtmittelersatz, Safer Sex und weitere Maßnahmen zur Optimierung von Schadensminderung. Eine Integration wirksamer Maßnahmen in nationale Drogenpolitik ist möglich und wünschenswert, diese stehen nicht im Widerspruch zu Prävention und Behandlung. Für negative Auswirkungen von Schadensminimierung gibt es kaum Belege, Verbesserungen scheinen dennoch nötig.
Introduction:
High risk sex-such as sex with multiple partners, condomless sex, or transactional or commercial sex-is a risk factor in individuals with substance use disorders (SUDs). SUD treatment can reduce sexual risk behavior, but interventions to reduce such behavior in this context have not been consistently effective. This study sought to determine if the impact of treatment on sexual risk behavior can be increased.
Methods:
In a nested 2 × 2 factorial repeated measures design, we examined outcomes of two interventions: training for counselors in talking to patients about sexual risk; and availability to both counselors and patients of a personalized feedback report based on patient self-report of sexual behavior. Counselors received either a brief, information-based, Basic Training, or a multi-session, skills-based Enhanced Training. Their patients completed an audio-assisted computerized assessment of sexual behavior and received either No Feedback or a Personalized Feedback Report (PFR). Four hundred seventy six patients participated. Patient follow-up occurred 3- and 6-months postbaseline. Primary patient outcome measures were Number of Unsafe Sex Occasions (USO) and whether patients reported talking about sex in counseling sessions (Discussed Sex), both in the past 90 days. Secondary outcomes included Number of Sexual Partners, Sex Under the Influence of Substances, and Perceived Condom Barriers.
Results:
Patients of Enhanced-condition counselors compared to those of Basic-condition counselors were more likely to report talking about sex with their counselor at 6-month follow-up. Personalized feedback also increased the likelihood of reporting counselor discussions at 6-month follow-up. Neither the training nor the feedback condition affected USO, Number of Partners, or Sex Under the Influence.
Discussion:
We discuss why these two interventions apparently altered counselor-patient communication about sexual risk behavior without affecting the behavior itself.
Given the high prevalence of substance use reported within populations at risk for HIV infection and the number of studies demonstrating significant associations between high-risk sexual behavior and substance use-particularly use of methamphetamine, cocaine and poppers, and perhaps alcohol-substance-use treatment appears to be a logical intervention for HIV prevention. Individuals may also change their pattern of drug use over time, with non-injectors taking up injection use, and injectors discontinuing injection but maintaining drug use through other forms of administration. Therefore, associations between HIV prevalence and current or past non-injection substance use (NISU) may be confounded by changes in drug-administration behavior. NISU is far more common than injection drug use, and has been studied as a factor in increased risk for HIV infection in a number of studies, either directly or through increased risky sexual behavior. Prevention of HIV through reduction and cessation of NISU has been less straightforward than with injection drug use, because direct parenteral HIV transmission is not present with NISU as it is in the setting of high-risk injection behaviors. NISU can result in increased HIV risks, and treatment can diminish these risks, greater efforts to identify the most effective NISU treatment programs for HIV prevention must be made. HIV prevention efforts should prioritize research to identify effective treatment interventions, and make effective substance-use treatment available to those most in need.
Objective:
The aim of this study was to analyze the use of multilevel methodology in health sciences.
Design:
A literature search was performed in Medline for articles published between 1995 and 2001. Fifteen search words were used, some of which were "multilevel model", "multilevel analysis", "hierarchical linear model", "mixed model", and "random effects model". A total of 1288 abstracts were retrieved. Two hundred twenty-two of the articles on theoretical and/or applied issues related to multilevel methods were examined to determine their current use, the type of model, the number of levels, the units of analysis and the outcome variables related to health sciences.
Results:
66.7% of the articles studied was found with the keywords: "multilevel analysis", "multilevel modelling" and "multilevel model". Fifty-six percent of the articles were multilevel applications in different health sciences. However, in 10% of the articles, the main objective was to present and disseminate the methodology in a language comprehensible to non-specialists.
Conclusions:
The use of multilevel modelling in health has increased with time and is being applied in different health areas and specialties. However, it is still not considered a commonly used technique.
A National Institute on Drug Abuse demonstration project in AIDS prevention among drug users was conducted in St. Louis during the years 1990 through 1994. The main objective was to reduce the spread of HIV by counseling drug users and by improving drug-treatment programs in the area. A second objective was to examine the correlates of risk behavior. A structured interview was administered six times over an 18-month period. Of those persons assessed at baseline (n=475), 95.0% (n=451) were also reinterviewed in the last interview at 18 months. Both group and individual level changes in risk behavior were assessed using random regression models. We report on three potential risk behaviors for HIV/AIDS: (1) number of sexual partners, (2)frequency of condom use, and (3) injection drug use. For each risk behavior a separate statistical model was estimated. The results of the random regression models showed significant reductions in number of sexual partners and injection drug use. Additionally, a number of variables, such as perceived risk for AIDS and knowledge of HIV/AIDS, were statistically significant covariates of risk behavior.
This article contains a comprehensive, critical review of the acquired immunodeficiency syndrome (AIDS)-risk-reduction literature on interventions that have targeted risky sexual behavior and intravenous drug use practices. A conceptually based, highly generalizable model for promoting and evaluating AIDS-risk behavior change in any population of interest is then proposed. The model holds that AIDS-risk reduction is a function of people's information about AIDS transmission and prevention, their motivation to reduce AIDS risk, and their behavioral skills for performing the specific acts involved in risk reduction. Supportive tests of this model, using structural equation modeling techniques, are then reported for populations of university students and gay male affinity group members.
We assessed risk factors for human immunodeficiency virus (HIV) infection in 633 heterosexual intravenous drug users. The HIV seroprevalence was 26% in blacks, 10% in Hispanics, and 6% in whites. Intravenous cocaine use significantly increased the risk of HIV infection, with a seroprevalence of 35% in daily cocaine users (odds ratio, 6.4; 95% confidence interval, 3.0 to 13.3). Black subjects were more likely to use cocaine regularly. Drug use in shooting galleries and sharing of drug injection equipment were also associated with HIV infection and were more common in cocaine users. By multivariate analysis, black race, daily cocaine injection by blacks and Hispanics, all other cocaine injection, heavy use prior to entry into methadone treatment by blacks, and use of drugs in shooting galleries were independent predictors of HIV infection. Methadone therapy was associated with substantial reductions in heroin use and some reduction in cocaine use, but 24% of cocaine users receiving methadone began or increased cocaine injection after entry into treatment.
(JAMA 1989;261:561-565)
Recent advances in the statistical theory of hierarchical linear models should enable important breakthroughs in the measurement of psychological change and the study of correlates of change. A two-stage model of change is proposed here. At the first, or within-subject stage, an individual's status on some trait is modeled as a function of an individual growth trajectory plus random error. At the second, or between-subjects stage, the parameters of the individual growth trajectories vary as a function of differences between subjects in background characteristics, instructional experiences, and possible experimental treatments. This two-stage conceptualization, illustrated with data on Head Start children, allows investigators to model individual change, predict future development, assess the quality of measurement instruments for distinguishing among growth trajectories, and study systematic variation in growth trajectories as a function of background characteristics and experimental treatments. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The measurement of individual change is approached from the standpoint of individual time paths and statistical models for individual change. The authors consider both statistical and psychometric properties of measures of individual change and examine measures of change for data with more than 2 observations on each individual. It is noted that many conclusions conflict with previous behavioral science literature. (63 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Stays of 3 months or longer in drug abuse treatment generally predict better follow-up outcomes. In a national sample of community-based programs that participated in the Drug Abuse Treatment Outcome Study, median lengths of stay were 3 months for clients in long-term residential and outpatient drug-free treatments and 1 year for clients in outpatient methadone treatment. However, individual programs within each of these modalities differed widely in how long they kept their clients in treatment as well as their service delivery. Programs treating individuals with heavier cocaine and alcohol use and more psychological dysfunction usually had shorter retention rates. Nonetheless, even after statistically controlling for these client differences, some programs were more effective than others in engaging and retaining clients. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Intravenous drug abuse is strongly associated with HIV transmission and with having a diagnosis of Antisocial Personality Disorder (ASPD). While the co-occurrence of intravenous drug abuse and ASPD is related to poor drug abuse treatment outcome, little is known about the contribution of ASPD to the intravenous drug abusers (IVDAs) level of HIV risk. The present study related the diagnosis of ASPD with specific drug use behaviors associated with high risk of HIV transmission. Subjects (N = 100) were intravenous drug abusers who volunteered for an HIV risk assessment study. Subjects with ASPD reported significantly higher rates of injection-equipment sharing and shared with significantly more people than IVDAs without ASPD.
The study of correlates of change is the investigation of systematic individual differences in growth. Our representation of systematic individual differences in growth is built up in two parts: (a) a model for individual growth and, (b) a model for the dependence of parameters in the individual growth models on individual characteristics. First, explicit representations of correlates of change are constructed for various models of individual growth. Second, for the special case of initial status as a correlate of change, properties of collections of growth curves provide new results on the relation between change and initial status. Third, the shortcomings of previous approaches to the assessment of correlates of change are demonstrated. In particular, correlations of residual change measures with exogenous individual characteristics are shown to be poor indicators of systematic individual differences in growth.
In a sample of 55 consecutive methadone maintenance admissions to our clinic, 42% were diagnosed with antisocial personality disorder (ASPD) using the National Institute of Mental Health Diagnostic Interview Schedule NIMH DIS. Individuals with ASPD exhibited greater risk for HIV infection as defined by more sexual contacts, needle use and equipment sharing. Data at 1 year follow-up were obtained on this group of patients. The objective was to compare the ASPD and non-ASPD groups with regards to demographics, drug abuse history, outcome and retention in treatment. There were no significant differences between the groups on any demographic or treatment outcome variables. Survival analysis indicated that there were no group differences in treatment retention. In conclusion, although there were no differences in treatment outcome between ASPD and non-ASPD groups it is possible that ASPD patients who drop out of treatment will be at higher risk for contracting and spreading HIV within the IV drug using population. These data also suggest that in this population the diagnosis of ASPD using primarily behavioral traits as measured in the NIMH-DIS-III, has little utility in predicting treatment outcome.
An informal survey of knowledge about and behaviors relevant to the spread of AIDS was conducted on the street in New York City during October 1986. The sample (n = 204) includes IV drug users (60%) and others (40%). The informal nature of the interview suggests that respondents gave "salient" answers rather than the complete answers that would be expected in a formal interview situation. A smaller proportion of respondents reported salient knowledge about drug-related transmission of AIDS than had been found in other populations, using formal interview methods. A close association was found between any accurate knowledge about spread of AIDS and likelihood of practicing one or more risk reduction behaviors. New users (persons who had been using drugs for only 1 or 2 years) were significantly less likely than others to have salient knowledge about AIDS transmission and also less likely to practice risk reduction measures.