Large Urban Clinic Research Articles

Using Intervention Mapping to Develop an Efficacious Multicomponent Systems-Based Intervention to Increase Human Papillomavirus (HPV) Vaccination in a Large Urban Pediatric Clinic Network

Using Intervention Mapping to Develop an Efficacious Multicomponent Systems-Based Intervention to Increase Human Papillomavirus (HPV) Vaccination in a Large Urban Pediatric Clinic Network

347. Hepatic Steatosis in People Living with HIV: Effect of Sex and Race/Ethnicity

BackgroundRecent studies have shown increased weight gain and visceral adiposity in people living with HIV (PLWH) treated with integrase strand transfer inhibitors (INSTI), mostly among women, Blacks and Hispanics. A potential association of INSTI with hepatic steatosis (HS)—which has been associated with increased atherosclerotic cardiovascular disease (ASCVD) risk in the general population—has never been evaluated. We sought to evaluate the prevalence of HS among PLWH on ART, its association with race/ethnicity and INSTI exposure and its association with ASCVD risk.MethodsAll patients on stable ART in a large urban clinic were included in the analysis. We calculated Hepatic Steatosis Index (HSI = 8 × (ALT/AST ratio)+BMI (+2, if female; +2, if diabetes mellitus) in all patients and Controlled Attenuation Parameter (CAP) score in a subset that underwent transient elastography. The effects of ART class, race and ethnicity on HSI and CAP were examined using linear regression models adjusting for age. We also correlated HSI with CAP and with ASCVD risk score.ResultsAmong the 3122 patients analyzed, 84.6% were male, 45.1% Black (B), 22.5% Hispanic (H), and 30.0% non-Hispanic Whites (NHW). Mean age was 42 years. ART regimens were INSTI-based (n = 1777), PI (n = 723) or NNRTI (n = 302). A subset of 77 patients underwent transient elastography. There was no significant difference in mean BMI between INSTI (27.87), PI (27.70) and NNRTI (28.26) recipients (P = 0.49). However, HSI was lower for PI (35.99) than for INSTI (36.73) and NNRTI (37.46) groups (P = 0.02). Age is also significantly associated with his (P < 0.01). Mean HSI was higher for H (37.54) than non-Hispanics (36.56 for B and 36.19 for NHW); P = 0.001. HSI was highly correlated with ASCVD risk score (R=0.1; P < 0.001). There was also a strong correlation between HSI and CAP (R=0.45; P < 0.001), and a trend toward high CAP for H vs. B and W (P = 0.11).ConclusionHSI increased with age and was significantly associated with ASCVD risk score, suggesting that HS in PLWH might predict higher ASCVD risk. Hispanics had higher HSI and higher CAP than Blacks and Whites. We did not observe an increased BMI or HS with INSTI exposure in this cohort. PI use was associated with lower risk of HS.Disclosures All authors: No reported disclosures.

Development and Uptake of Long-Acting Reversible Contraception Services in Rwanda, 2009-2016.

Background: Long-acting reversible contraception (LARC) is highly effective at preventing pregnancy. However, in sub-Saharan Africa, LARC education for clients is relatively limited and providers are often not skilled in their insertion. Before 2009, only 1% of family planning clients in Rwanda received an LARC. Materials and Methods: We trained Rwandan government clinic nurses to promote, insert, and remove copper intrauterine devices (IUDs) and hormonal implants. Training started in two large urban clinics, and those nurses trained three successive waves of clinic nurses. Initial LARC promotions were clinic based, but in 2015 included community-based promotions in eight clinics. We compare IUD and implant insertions by year and clinic and discuss implementation successes/obstacles. Results: From 2009 to 2016, 222 nurses from 21 government clinics were LARC trained. The nurses performed 36,588 LARC insertions (19% IUD, 81% implant). LARC insertions increased over time, peaking at 8,897 in 2013. However, in 2014, the number dropped to 4,018 after closure of one large clinic, funding discontinuation, and supply stock-outs. With new funding in 2015, insertions increased reaching 8,218 in 2016. Catholic and non-Catholic and rural and urban clinics performed similarly, whereas clinics affiliated with community-based promotions performed better (p > 0.05). Between 2012 and 2014, 13% of family planning initiators chose the implant and 4% the IUD. Conclusions: LARC supply-demand services increased the proportion of family planning initiators choosing LARC to 17%. Challenges included inconsistent funding, irregular supplies, and staff turnover. Rural and Catholic clinics performed as well as urban and non-Catholic clinics. Concerted efforts to improve IUD uptake are needed.

Screening school-age children for developmental language disorder in primary care

Purpose: To evaluate the feasibility, preliminary diagnostic accuracy and reliability of a screening tool for developmental language disorder (DLD) in early school-age children seen in a paediatric primary care setting.Method: Sixty-six children aged 6–8years attending well-child visits at a large urban paediatric clinic participated. Parents completed a five-item questionnaire and children completed a 10-item sentence repetition task. A subset of participants (n = 25) completed diagnostic testing for DLD. Exploratory cut-offs were developed for the parent questionnaire, the child sentence repetition task and the combined score.Result: The screening tool could be reliably implemented in 2 min by personnel without specialty training. The best diagnostic accuracy measures were obtained by combining the parent questionnaire and child sentence repetition task. The tool showed strong internal consistency, but the parent and child scores showed only moderate agreement.Conclusion: The screening tool is promising for utilisation in primary care clinical settings but should first be validated in larger and more diverse samples. Both the parent and child components of the screening contributed to the preliminary findings of high sensitivity and specificity found in this study. Screening for DLD in school age children can increase awareness of an under-recognised disorder.

2E.3. Coaching to Increase Engagement in Online Pain Self-Management Program

Aims of Investigation Online pain self-management programs (OPMPs) provide internet-based interventions designed to help people manage their pain and related symptoms. Despite efforts to improve pain management among adults with persistent pain, engaging clients in OPMPs remains challenging. Health coaching has improved engagement in face-to-face pain management programs. This pilot investigation aims to explore what types of coaching strategies could enhance participant engagement in an OPMP. Methods A small feasibility study was conducted in a large urban pain clinic in Eastern Washington. Pain clinic personnel partnered with research staff from a local university to recruit participants from the clinic. Eligibility criteria included: age 18 years or more, enrolled at least 3 months as a patient at the partnering clinic with a current chronic pain diagnosis, email capability, and ability to speak, read, and write in English. Consenting participants met with a health coach and indicated preference for weekly communication method over the 8-weeks of the study: in-person, text, or phone. Weekly communication with health coach consisted of encouragement to engage in OPMP. Results Out of 35 referrals, 8 participants enrolled in the study (6 female, 2 male). Among participants, 5 completed at least some of the OPMP content. On average, participants responded to coaching communications for 5 of 8 weeks. The majority of participants engaged in fewer than 50% of the OPMP activities. The participants who completed the most OPMP activities were those who attended the most face-to-face sessions with their coach. Clinical Implications In this sample, structured in-person coaching sessions to review OPMP content were more beneficial for increasing engagement than weekly text, email, or phone communications. Future clinical strategies for increasing client engagement in OPMP might include requiring in-person meetings versus remote communication with a health coach.

Positive religious coping predicts self-reported HIV medication adherence at baseline and twelve-month follow-up among Black Americans living with HIV in the Southeastern United States

ABSTRACTThis paper presents the results of secondary data analyses investigating the influence of religious coping on HIV medication adherence across time among 167 Black Americans living with HIV (BALWH) in the Southeastern United States. Participants were recruited from a large urban clinic in Atlanta, GA and completed questionnaires about their religious coping at baseline assessment and about their medication adherence at baseline and 12-month follow-up assessment. Descriptive analyses and multiple linear regression were used to determine the association between religious coping and HIV medication adherence. Findings indicated that after controlling for age and depressive symptoms at baseline, positive religious coping significantly predicted medication adherence at baseline and 12-month follow-up. Negative religious coping was inversely associated with medication adherence at baseline after controlling for age and depressive symptoms but not at 12-month follow-up. The implications of these findings for future research and intervention work related to medication adherence among BALWH are discussed.

Boosted darunavir and dolutegravir dual therapy among a cohort of highly treatment-experienced individuals.

The use of dual antiretroviral therapy (ART) regimens for treatment of HIV is increasing. The contemporary combination of boosted darunavir with dolutegravir has not been widely studied. This was a retrospective cohort study that evaluated treatment-experienced individuals within three large urban clinics prescribed boosted darunavir with dolutegravir (study regimen) dual therapy. Follow-up was defined as the number of days from regimen initiation until the last HIV RNA determination on the study regimen. Virological outcomes, HIV RNA ≤50 copies/ml (undetectable), were assessed overall and by baseline HIV RNA status. Of 65 individuals included, 83% were at least 3-class antiretroviral-experienced and median time since starting ART was 19 years (IQR 13-22). Median follow-up was 419 days (IQR 286-744). An undetectable HIV RNA was achieved by 62/65 (95%) individuals at any time point on the study regimen. At the end of follow-up 61/65 (94%) individuals remained undetectable, including 48/49 (98%) with an undetectable HIV RNA at baseline (those changing for optimization) and 13/16 (81%) with viraemia at baseline (those changing therapy during virological failure). At the end of follow-up, 55 (85%) individuals were still taking the study regimen. No individuals stopped therapy due to virological failure or intolerance. In a highly treatment-experienced cohort, boosted darunavir with dolutegravir dual therapy demonstrated high rates of virological success, even in those with detectable HIV RNA prior to initiating the study regimen. Further study of this potent, simple, high-barrier dual-class regimen is warranted.

Infant Language Production and Parenting Skills: A Randomized Controlled Trial

The current study examined the indirect effect of the use of behavioral parenting skills following the Infant Behavior Program, a brief, home-based adaptation of the child-directed interaction phase of parent–child interaction therapy, on infant language production. Participants were 60 infants (55% male, mean age 13.47 ± 1.31 months) and their caregivers, who were recruited at a large urban pediatric primary care clinic and were included if their scores exceeded the 75th percentile on a brief screener of early behavior problems. Families were randomly assigned to receive the infant behavior program or standard pediatric primary care. Results demonstrated a significant indirect effect of caregivers’ use of positive parenting skills (i.e., praise, reflections, and behavior descriptions) on the relation between group and infant total utterances at the 6-month follow-up, such that infants whose caregivers increased their use of positive parenting skills following the intervention showed greater increases in language production. These findings extend previous research examining parenting skills as a mechanism of change in infant language production, and highlight the potential for an early parenting intervention to target behavior and language simultaneously during a critical period in language development.

A randomized controlled trial of a computer-based brief intervention for victimized perinatal women seeking mental health treatment.

Intimate partner victimization (IPV) during the perinatal period is associated with adverse outcomes for the woman, her developing fetus, and any children in her care. Maternal mental health concerns, including depression and anxiety, are prevalent during the perinatal period particularly among women experiencing IPV. Screening and interventions for IPV targeting women seeking mental health treatment are lacking. In the current study, we examine the feasibility, acceptability, and the preliminary efficacy of a brief, motivational computer-based intervention, SURE (Strength for U in Relationship Empowerment), for perinatal women with IPV seeking mental health treatment. The study design was a two-group, randomized controlled trial with 53 currently pregnant or within 6-months postpartum women seeking mental health treatment at a large urban hospital-based behavioral health clinic for perinatal women. Findings support the acceptability and feasibility of the SURE across a number of domains including content, delivery, and retention. All participants (100%) found the information and resources in SURE to be helpful. Our preliminary results found the degree of IPV decreased significantly from baseline to the 4-month follow-up for the SURE condition (paired t-test, p < 0.001), while the control group was essentially unchanged. Moreover, there was a significant reduction in emotional abuse for SURE participants (p = 0.023) relative to participants in the control condition. There were also reductions in physical abuse although non-significant (p = 0.060). Future work will test SURE in a larger, more diverse sample. ClinicalTrials.gov Identifier: NCT02370394.

Brief Report: Identification of Elite and Viremic Controllers From a Large Urban HIV Ambulatory Center in Kampala, Uganda

Background:Throughout the world, there are antiretroviral therapy–naive HIV+ individuals who maintain elevated peripheral CD4+ T-cell counts, historically referred to as long-term nonprogressors (LTNPs). With recent improvements in viral load (VL) detection methods to levels as low as 20 copies per milliliter, 2 subsets of LTNPs have been defined: elite controllers (ECs), with undetectable VLs for at least 6–12 months, and viremic controllers (VCs), with VLs between 200 and 2000 copies per milliliter. ECs and VCs have been extensively studied in the developed world to determine underlying mechanisms responsible for virologic control. In sub-Saharan Africa, most studies have characterized LTNPs based on immunologic criteria making it difficult to compare findings with the Western cohorts, which use virologic criteria. Here, we describe a cohort of Uganda ECs and VCs attending a large HIV ambulatory center in Kampala, Uganda, based initially on CD4 counts and confirmed by repeated VL measurements.Methods:A cross-sectional study was conducted among 14,492 HIV-infected, antiretroviral therapy–naive individuals aged 18 years and older under care for at least 5 years with serial peripheral CD4 counts ≥500 cells/μL. Among those, we determined the frequency of individuals with VLs <2000 copies per milliliter for at least 6 months.Results:We report a prevalence of 0.26% (38/14,492) of HIV controllers in the clinic. We identified 36 ECs and 2 VCs. These individuals were middle-aged with an average CD4 count of 858 ± 172 (mean ± SD, 95% confidence interval: 795 to 921). Their average duration in HIV care was 7.4 ± 2.1 years (mean ± SD, 95% confidence interval: 6.6 to 8.1). The majority of EC/VCs were women (87%, 33/38), reflecting the demographics of the urban clinic.Conclusions:For the first time, this study demonstrates the frequency of EC/VCs in a large urban clinic in Uganda. Further study of these East African subjects may provide insights into how some individuals are able to control HIV in the absence of medications.

Travel Time to Clinic but not Neighborhood Crime Rate is Associated with Retention in Care Among HIV-Positive Patients.

Using geospatial analysis, we examined the relationship of distance between a patient's residence and clinic, travel time to clinic, and neighborhood violent crime rates with retention in care or viral suppression amongpeople living with HIV (PLWH). For HIV-positive patients at a large urban clinic, we measured distance and travel time between home and clinic and violent crime rate within a two block radius of the travel route. Kruskal-Wallis rank sum was used to compare outcomes between groups. Over the observation period, 2008-2016, 219/602 (36%) patients were retained in care. Median distance from clinic was 3.6 (IQR 2.1-5.6) miles versus 3.9 (IQR 2.7-6.1) miles among those retained versus not retained in care, p = 0.06. Median travel time by car was 15.9 (IQR 9.6-22.9) versus 17.1 (IQR 12.0-24.6) minutes for those retained versus not retained, p = 0.04. Violent crime rate along travel route was not associated with retention. There was no significant association between travel time or distance and viral suppression.

The impact of rural residence and HIV infection on poor tuberculosis treatment outcomes in a large urban hospital: a retrospective cohort analysis

BackgroundSuccessful tuberculosis (TB) treatment is essential to effective TB control. TB-HIV coinfection, social determinants and access to services influenced by rural residence can affect treatment outcome. We examined the separate and joint effects of rural residence and HIV infection on poor treatment outcome among patients enrolled in a large TB treatment centre in Kano, Nigeria.MethodsWe retrospectively analysed a cohort of patients with TB enrolled in a large urban TB clinic in northern Nigeria, from January 2010 to December 2014. Poor treatment outcome was defined as death, default or treatment failure. We used Poisson regression to model rates and determine the relative risks (and 95% confidence intervals, CI) of poor treatment outcomes.ResultsAmong 1381 patients included in the analysis, 28.4% were rural residents; 39.8% were HIV-positive; and 46.1% had a poor treatment outcome. Approximately 65 and 38% of rural and urban residents, respectively, had a poor treatment outcome. Rural residents had 2.74 times (95% CI: 2.27–3.29) the risk of having a poor treatment outcome compared to urban residents. HIV-positive patients had 1.4 times (95% CI: 1.16–1.69) the risk of poor treatment outcome compared to HIV-negative patients. The proportion of poor treatment outcome attributable to rural residence (population attributable fraction, PAF) was 25.6%. The PAF for HIV infection was 11.9%. The effect of rural residence on poor treatment outcome among HIV-negative patients (aRR:4.07; 95%CI:3.15–5.25) was more than twice that among HIV-positive patients (aRR:1.99; 95%CI:1.49–2.64).ConclusionRural residents attending a large Nigerian TB clinic are at increased risk of having poor treatment outcomes, and this risk is amplified among those that are HIV-negative. Our findings indicate that rural coverage of HIV services may be better than TB services. These findings highlight the importance of expanding coverage of TB services to ensure prompt diagnosis and commencement of treatment, especially among rural-dwellers in resource-limited settings.

Low sero-prevalence of hepatitis delta antibodies in HIV/ hepatitis B co-infected patients attending an urban HIV clinic in Uganda.

Co-infection with hepatitis B (HBV) and hepatitis D (HDV) is common among human immunodeficiency virus (HIV) infected individuals in developing countries and it aggressively accelerates progression of liver disease to cirrhosis and other complications. There is scarcity of data on HDV in sub-Saharan Africa .We investigated the sero-prevalence and factors associated with HDV antibody among HIV/HBV co-infected patients attending a large urban HIV clinic in Uganda. We screened 189 HIV/HBV co-infected individuals for anti-HDV immunoglobulin G (IgG) and performed logistic regression to determine the associated factors. Socio-demographic, clinical data, immunological status, and liver fibrosis (as determined by the Aspartate transaminase to platelet ratio index and transient elastography) were included. Participants were predominately young and of sound immunologic status (median age 40 years, median CD4 440 cells/µl). 98% were on ART regimens containing anti-HBV active medications (95.2% were on TDF/3TC while 4.8% on 3TC containing regimen). Median duration on ART was 36 months (IQR 22-72). Anti-HDV was detected in 6/198, 3.2% (95% CI 1.14-6.92%), associated with male gender and a duration of more than 5 years since HIV diagnosis. The sero-prevalence of HDV antibodies among the HIV/HBV co-infected patients is low in a Ugandan urban cohort.

A Pharmacist-Led Program to Evaluate and Reduce Polypharmacy and Potentially Inappropriate Prescribing in Older HIV-Positive Patients.

The goal of this pharmacist-led study was to utilize two validated instruments, Beers Criteria and Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP), to assess potentially inappropriate prescribing (PIP) in older patients infected with the human immunodeficiency virus (HIV) and evaluate pharmacist interventions. Prospective randomized interventional trial. Large urban clinic providing interdisciplinary primary and HIV care for ~2700 HIV-positive publicly insured patients. A computerized electronic record search was conducted for all patients who met the two search criteria: 50years and older, and a primary care appointment within the last 12months. After identification of 857 patients meeting the search criteria, 324 patients were randomly selected and contacted, resulting in 248 patients assessed. Patients had a mean age of 58years, 71% male, 44% white, and a mean CD4 count of 536 cells/mm3 . Common comorbidities included hypertension (56%), depression (52%), asthma/chronic obstructive pulmonary disease (48%), dyslipidemia (39%), coronary artery disease (27%), and diabetes (22%). Patients sampled were prescribed a mean of 11.6±5.7 concomitant medications (excluding antiretrovirals) with 35% receiving at least 16 medications. PIP was identified in 54% and 63% of patients using the STOPP and Beers Criteria, respectively. Twenty-five contraindicated drug interactions were identified in 20 patients. After the pharmacist visit, at least 69% of patients had at least one medication discontinued with almost 10% having six or more medications discontinued. More than 40% of patients had at least one Beers or STOPP criteria that required immediate correction by the pharmacist. Results suggest that targeting individuals with 11 or more chronic medications would have the highest yield and greatest impact. Pharmacist-led review of medication prescribing using Beers and STOPP criteria revealed a large number of PIP, many amenable to immediate clinical pharmacist intervention.

Protocol for a randomised controlled implementation trial of point-of-care viral load testing and task shifting: the Simplifying HIV TREAtment and Monitoring (STREAM) study

IntroductionAchieving the Joint United Nations Programme on HIV and AIDS 90-90-90 targets requires models of HIV care that expand antiretroviral therapy (ART) coverage without overburdening health systems. Point-of-care (POC) viral...

Psychiatric treatment-associated stigmatization as viewed through eyes of rural health clinic patients

IntroductionHaving a mental disease is frequently a stigmatizing experience for patients. We know little about urban inhabitants who travel to rural health clinics to receive mental treatment.ObjectivesRecruit and interview urban-based psychiatric patients who, to avoid stigmatization; travel to rural community clinics with the intention of receiving treatment.MethodsStudy included participants (n = 32) who exchanged treatment in government subsidized city clinics for rural community centers. Qualitative interviews lasting thirty minutes were recorded and transcribed for content analysis. MAXQDA, version 12, was used to annotate transcripts with topic specific nodes, followed by cluster theme and trend analysis.ResultsTrend analysis yielded three areas of concern for subsidized urban psychiatry: cost/insurance, lack of staff professionalism, and family-driven ostracism. Seven respondents cited cost as the main factor, influencing the choice of rural-based care over city clinic. Patients with stable income, but without insurance (n = 14), felt unwelcome in city clinics as their ability to pay was frequently questioned by supporting staff. Lack of trained social workers caused additional distress, as participants could not receive access to additional resources. Only four patients said that their psychiatrists acknowledged poor clinic environment and encouraged remaining in treatment. For 18 respondents, family demanded that they receive treatment in rural clinic so that no one finds out about their mental disease.ConclusionIn large urban clinics, stigma in psychiatry comes in many flavors, especially projected by unprofessional clinic staff and ashamed family. Lack of support forces patients to travel to rural premises to receive unbiased, stress-free care.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Changes in elevated cholesterol in the era of tenofovir in South Africa: risk factors, clinical management and outcomes.

Antiretroviral therapy (ART) has been associated with unfavourable lipid profile changes and increased risk of cardiovascular disease (CVD). With a growing population on ART in South Africa, there has been concern about the increase in noncommunicable diseases such as CVD. We determined risk factors associated with increased total cholesterol (TC) in a large cohort on ART and describe the clinical management thereof. We conducted an observational cohort study of ART-naïve adults initiating standard first-line ART in a large urban clinic in Johannesburg, South Africa. TC was measured annually for most patients. A proportional hazards regression model was used to determine risk factors associated with incident high TC (≥ 6 mmol/L). Significant risk factors included initial regimen non-tenofovir vs. tenofovir [hazard ratio (HR) 1.54; 95% confidence interval (CI) 1.14-2.08], age ≥40 vs. <30 years (HR 3.22; 95% CI 2.07-4.99), body mass index (BMI) ≥ 30 kg/m2 (HR 1.65; 95% CI 1.18-2.31) and BMI 25-29.9 kg/m2 (HR 1.70; 95% CI 1.30-2.23) vs. 18-24.9 kg/m2 , and baseline CD4 count < 50 cells/μL (HR 1.55; 95% CI 1.10-2.20) and 50-99 cells/μL (HR 1.40; 95% CI 1.00-1.97) vs. > 200 cells/μL. Two-thirds of patients with high TC were given cholesterol-lowering drugs, after repeat TC measurements about 12 months apart, while 31.8% were likely to have received dietary counselling only. Older age, higher BMI, lower CD4 count and a non-tenofovir regimen were risk factors for incident elevated TC. Current guidelines do not indicate regular cholesterol testing at ART clinic visits, which are the main exposure to regular clinical monitoring for most HIV-positive individuals. If regular cholesterol monitoring is conducted, improvements can be made to identify and treat patients sooner.

Low sero-prevalence of hepatitis delta antibodies in HIV/ hepatitis B co-infected patients attending an urban HIV clinic in Uganda.

Co-infection with hepatitis B (HBV) and hepatitis D (HDV) is common among human immunodeficiency virus (HIV) infected individuals in developing countries and it aggressively accelerates progression of liver disease to cirrhosis and other complications. There is scarcity of data on HDV in sub-Saharan Africa .We investigated the sero-prevalence and factors associated with HDV antibody among HIV/HBV co-infected patients attending a large urban HIV clinic in Uganda. We screened 189 HIV/HBV co-infected individuals for anti-HDV immunoglobulin G (IgG) and performed logistic regression to determine the associated factors. Socio-demographic, clinical data, immunological status, and liver fibrosis (as determined by the Aspartate transaminase to platelet ratio index and transient elastography) were included. Participants were predominately young and of sound immunologic status (median age 40 years, median CD4 440 cells/µl). 98% were on ART regimens containing anti-HBV active medications (95.2% were on TDF/3TC while 4.8% on 3TC containing regimen). Median duration on ART was 36 months (IQR 22-72). Anti-HDV was detected in 6/198, 3.2% (95% CI 1.14-6.92%), associated with male gender and a duration of more than 5 years since HIV diagnosis. The sero-prevalence of HDV antibodies among the HIV/HBV co-infected patients is low in a Ugandan urban cohort.

Reducing non-injection drug use in HIV primary care: A randomized trial of brief motivational interviewing, with and without HealthCall, a technology-based enhancement

AimsIn HIV-infected individuals, non-injection drug use (NIDU) compromises many health outcomes. In HIV primary care, the efficacy of brief motivational interviewing (MI) to reduce NIDU is unknown, and drug users may need greater intervention. We designed an enhancement to MI, HealthCall (HC), for daily patient self-monitoring calls to an interactive voice response (IVR) phone system, and provided participants with periodic personalized feedback. To reduce NIDU among HIV primary care patients, we compared the efficacy of MI+HealthCall to MI-only and an educational control condition. DesignParticipants age >18 with >4days of NIDU during the prior 30days were recruited from large urban HIV primary care clinics. Of the 240 participants, 83 were randomly assigned to control, 77 to MI-only, and 80 to MI+HC. Counselors provided educational control, MI-only or MI+HC at baseline. At 30 and 60days (end-of-treatment), counselors briefly discussed drug use, moods and health behaviors, using HealthCall-generated graphs with MI+HC patients. Primary outcomes (last 30days) were number of days used primary drug (NumDU), and total quantity of primary drug used (dollar amount spent; QuantU), derived from the Time-Line Follow-Back. FindingsAcross all groups, at end-of-treatment, frequency and quantity of NIDU decreased, with significantly greater reductions in the MI-Only group. A twelve-month post-treatment follow-up indicated sustained benefits of MI+HC and MI-only relative to control. ConclusionsBrief interventions can be successfully used to reduce non-injection drug use in HIV primary care. IVR-based technology may not be sufficiently engaging to be effective. Future studies should investigate mobile technology to deliver a more engaging version of HealthCall to diverse substance abusing populations.

Hepatitis C (HCV) Treatment Experience With Direct-Acting Antivirals (DAAs) in a Large Urban Clinic

Hepatitis C (HCV) Treatment Experience With Direct-Acting Antivirals (DAAs) in a Large Urban Clinic