Persons Who Use Drugs Research Articles

Comparative 1-Year Outcomes of Invasive Staphylococcus aureus Infections Among Persons With and Without Drug Use: An Observational Cohort Study.

Persons who use drugs (PWUD) face substantial risk of Staphylococcus aureus infections. Limited data exist describing clinical and substance use characteristics of PWUD with invasive S. aureus infections or comparing treatment and mortality outcomes in PWUD vs non-PWUD. These are needed to inform optimal care for this marginalized population. We identified adults hospitalized from 2013 to 2018 at 2 medical centers in San Francisco with S. aureus bacteremia or International Classification of Diseases-coded diagnoses of endocarditis, epidural abscess, or vertebral osteomyelitis with compatible culture. In addition to demographic and clinical characteristic comparison, we constructed multivariate Cox proportional hazards models for 1-year infection-related readmission and mortality, adjusted for age, race/ethnicity, housing, comorbidities, and methicillin-resistant S. aureus (MRSA). Of 963 hospitalizations for S. aureus infections in 946 patients, 372 of 963 (39%) occurred in PWUD. Among PWUD, heroin (198/372 [53%]) and methamphetamine use (185/372 [50%]) were common. Among 214 individuals using opioids, 98 of 214 (46%) did not receive methadone or buprenorphine. PWUD had lower antibiotic completion than non-PWUD (70% vs 87%; P < .001). While drug use was not associated with increased mortality, 1-year readmission for ongoing or recurrent infection was double in PWUD vs non-PWUD (28% vs 14%; adjusted hazard ratio [aHR], 2.0 [95% confidence interval {CI}: 1.3-2.9]). MRSA was independently associated with 1-year readmission for infection (aHR, 1.5 [95% CI: 1.1-2.2]). Compared to non-PWUD, PWUD with invasive S. aureus infections had lower rates of antibiotic completion and twice the risk of infection persistence/recurrence at 1 year. Among PWUD, both opioid and stimulant use were common. Models for combined treatment of substance use disorders and infections, particularly MRSA, are needed.

"I'm Going to Stop Myself Before Someone Stops Me": Complicating Narratives of Volitional Substance Use Treatment.

Background: Often people assume that entry into drug treatment is a voluntary action for persons who use drugs (PWUD). This narrative informs the organizational and regulatory structure of most treatment programs and consequently affects patients’ ability to exert agency over their own treatment. Yet, this view ignores the complex interplay between individual and structural factors in peoples’ decision-making processes, particularly among people who use drugs who are stigmatized and criminalized. Treatment programs that assume voluntary entry may lack appropriate services for the populations of treatment seekers that they serve. Methods: This paper uses semi-structured interviews with 42 participants in Opioid Substitution Treatment (OST) (including patients, clinic doctors and staff, and advocates) informed by one of the author’s own lived experience in OST, to examine patients’ treatment decisions, and in particular, if and how, the structural context of drugs’ illegality/criminalization affected their willingness to pursue treatment. A Critical Discourse Analysis was used to identify key themes. Results: Interview data demonstrates that most people who use drugs enter treatment under constrained conditions related to drugs’ illegality. Themes that emerged included: 1. A feeling of limited choices due to drugs’ illegality; 2. Peer and family pressure; 3. Fear of losing children; and 4. Internalized stigma (i.e. feeling they are dirty or bad for using). Conclusion: Narratives that frame PWUD’s treatment decisions as volitional provide political cover to policies that criminalize PWUD by obscuring their effect on PWUD’s treatment decisions. Treatment models, particularly those that serve highly criminalized populations, should be re-conceptualized outside of normative narratives of individual choice, and be broadened to understand how larger structures constrain choices. By looking at macro-level factors, including the interplay of criminalization and drug treatment, programs can begin to understand the complexity of PWUD motivations to enter drug treatment. Recognizing the role of the War on Drugs as a force of oppression for people who use drugs, and that their treatment decisions are made within that setting, may enable people in treatment, and providers, to develop more productive ways of interacting with one another. Additionally, this may lead to better retention in treatment programs.

39. Comparative One-year Outcomes of Invasive staphylococcus Aureus infections Among Persons with and Without Drug Use in an Urban West Coast Cohort

BackgroundPersons who use drugs (PWUD) face substantial risk from invasive Staphylococcus aureus infections but have important demographic and clinical differences from persons without drug use (non-PWUD). Despite this, limited data exist comparing S. aureus infection outcomes in PWUD vs. non-PWUD; these data are needed to inform interventions to optimize care for this vulnerable population.MethodsWe identified adults hospitalized from 2013–2018 at two academic hospitals in San Francisco with S. aureus bacteremia or ICD-coded diagnoses of endocarditis, epidural abscess, or vertebral osteomyelitis with compatible S. aureus culture. Via structured chart review, we compared the following among PWUD vs. non-PWUD: clinical and substance use features, adjusted odds of antibiotic completion, and one-year infection-free survival using a multivariate Cox proportional hazards model adjusted for age/race, housing, comorbidities, and MRSA.ResultsOf 963 hospitalizations for invasive S. aureus infections in 946 patients, 372/963 (39%) occurred in PWUD. Among PWUD, heroin (198/372, 53%) and methamphetamine use (185/372, 50%) were common (Table 1). Bacteremia occurred in 82% of hospitalizations. PWUD vs. non-PWUD had higher proportions of MRSA (48% vs. 31%) and invasive infections: 20% vs. 12% with endocarditis, 25% vs. 11% with epidural abscess, and 28% vs. 13% with vertebral osteomyelitis (all p< 0.001). PWUD had more self-directed (“AMA”) discharges, and most using opioids did not receive methadone or buprenorphine (Table 2). PWUD completed antibiotic courses less often (70% vs. 87%; p< 0.001) and had 2.9-fold higher adjusted odds of incomplete treatment (95% CI:1.7–5.0). One-year mortality was lower in PWUD (18% vs. 30%), but one-year readmission for ongoing/recurrent infection was far higher (28% vs. 14%; HR 1.9 [95% CI:1.3–2.9], Figure 1).Table 1: Demographic, Clinical, and Substance Use Characteristics Table 2: Care Delivery, PWUD vs. non-PWUD Figure 1: One-year Infection-free survival in persons who use drugs (PWUD) vs. non-PWUD ConclusionPWUD had higher proportions of S. aureus vertebral osteomyelitis, epidural abscess, and endocarditis than non-PWUD, lower odds of treatment completion, and greater risk of infection persistence/recurrence at one year. Among PWUD, opioid and stimulant use were common and undertreated. New patient centered models of care that deliver synchronized S. aureus infection and substance use disorder therapy are urgently needed.Disclosures All Authors: No reported disclosures

The lived experiences of recovering Filipino persons who use drugs (PWUDs) without family support

The Philippines’s war on drugs brought about an influx or people of who use drugs (PWUDs) availing of community-based drug rehabilitation services for treatment. Programs have been created to develop skills to avoid relapse and improve family relations and support throughout the recovery process. However, not all Filipino PWUDs have the immediate presence or active participation of their families. While family support is construed as critical to sustained drug recovery in most existing studies, very few studies looked into this subset of PWUDs. In a Filipino culture wherein one’s family is integral to one’s personal identity, an interpretative phenomenological analysis was conducted to examine the experiences of Filipino PWUDs in recovery without perceived family support. Results present four main themes on the experiences of (1) loss and longing while in recovery, (2) coping, (3) self-improvement, and (4) rekindling, rejoining and restarting social connections. Insights from this study can be used in understanding the Filipino way of coping in the relative absence of one’s kin, reconstructing the role of family support and extending the meaning of family in the recovery of PWUDs, and finding ways to redesign family interventions in the Philippines.

Adherence to Direct-Acting Antiviral Therapy in People Actively Using Drugs and Alcohol: The INCLUD Study.

BackgroundHepatitis C virus treatment in persons who use drugs (PWUD) is often withheld due to adherence and reinfection concerns. In this study, we report treatment outcomes, technology-based adherence data, and adherence predictors in PWUD and/or alcohol.MethodsINCLUD was a prospective, open-label study of ledipasvir/sofosbuvir for 12 weeks in PWUD aged 18–70 years. Participants were randomized to wireless (wirelessly observed therapy) or video-based directly observed therapy (vDOT). Drug use was assessed every 2 weeks. Sustained virologic response (SVR) was examined by intention-to-treat and as-treated. Factors associated with missing ≥1 dose(s) between visits were examined using generalized linear models.ResultsSixty participants received ≥1 ledipasvir/sofosbuvir dose (47 human immunodeficiency virus [HIV]/hepatitis C virus [HCV], 13 HCV only; 78% male; 22% black; 25% cirrhotic). Substance use occurred at 94% of person-visits: 60% marijuana, 56% alcohol, 37% methamphetamine, 22% opioids, 17% cocaine, and 20% injection drug use. The SVR by intention-to-treat was 86.7% (52 of 60) and as-treated was 94.5% (52 of 55). Confirmed failures included 1 relapse, 1 reinfection, and 1 unknown (suspected reinfection). Median total adherence was 96% (interquartile range [IQR], 85%–100%; range, 30%–101%), and between-visit adherence was 100% (IQR, 86%–100%; range, 0%–107%). The odds of missing ≥1 dose between visits increased with HIV coinfection (2.94; 95% confidence interval [CI], 1.37–6.32; P = .006), black race (4.09; 95% CI, 1.42–11.74; P = .009), methamphetamine use (2.51; 95% CI, 1.44–4.37; P = .0.001), and cocaine use (2.12; 95% CI, 1.08–4.18; P = .03) and decreased with marijuana use (0.34; 95% CI, 0.17–0.70; P = .003) and vDOT (0.43; 95% CI, 0.21–0.87; P = .02).ConclusionsPersons who use drugs achieved high SVR rates with high, but variable, ledipasvir/sofosbuvir adherence using technology-based methods. These findings support efforts to expand HCV treatment in PWUD.

Validation of Texas Christian University Psychosocial Functioning and Motivation Scales in Iranian Persons Who Use Drugs.

The psychosocial functioning and motivation scales of the Texas Cristian University (TCU) were translated and validated for the Persons Who Use Drugs (PWUDs). This study was carried out as a methodological research. The scales were translated forward and backward and then, the PWUDs in Kermanshah-based (west of Iran) substance abuse treatment centers in 2019 filled out the scales. Participants included 250 individuals who were selected by convenience sampling method. A demographics form and psychosocial functioning and motivation scales were used to collect data. For data analysis, content validity, face validity, testretest, internal consistency, and construct validity were applied by using exploratory analysis methods in SPSS (v.20) and confirmatory factor analysis in LISREL software. Exploratory Factor Analysis (EFA) results were obtained by using the main component analysis and Varimax rotation of three factors (psychological function, social function, treatment motivation). Extracted factors, along with the eigenvalues, attributed variance percentage, and cumulative attributed variances by each factor, by 68.56%, showed a total variance of the questionnaire. Moreover, the fitness indexes of the Confirmatory Factor Analysis (CFA) of psychological function, social function, and treatment motivation were 0.059, 0.075 and 0.072, respectively. Therefore, the questionnaire fitness was at an acceptable level. The test-retest reliability coefficient was 0.875, and the Cronbachs alpha coefficient for all the components was higher than 0.71. The results showed that psychosocial functioning, motivation scales have good psychometric properties, and they can be used in research and treatment fields.

Validation and psychometric properties of the drug users\u2019 quality of life scale in Iranian population

IntroductionDrug dependence and the resultant problems notably decrease the quality of life (QOL). Measuring the QOL in persons who use drugs (PWUDs) and planning to improve it can be helpful for rehabilitation programs. Given the absence of a standard tool to measure the quality of life of PWUD, the present study is an attempt to validate psychometric and cultural characteristics of non-injection drug users’ QOL scale.MethodThe study was carried out as a validation and methodological work. The study population consisted of 273 PWUDs in Kermanshah-based drug clinics including outgoing and hospitalized patients. The participants were selected through convenient-quota sampling. After securing the required permission from the copyright owner of the tool, it was forward/backward translated. Face validity and content validity were determined quantitatively and qualitatively. To examine construct validity of the tool, explorative factor analysis and confirmatory factor analysis were used. Internal consistency was measured using Cronbach’s alpha and statistical analyses were performed using SPSS (v.25) and LISREL (v.8).ResultsExplorative factor analysis (EFA) and confirmatory factor analysis (CFA) results supported the tool with one factor and 22 items. The R2 index in the model was equal to 0.99, which means that 99% of the variation of dependent variable (total score of QOL) is attributed to independent variable (22 statements). In other words, 99% of the variation of dependent variable is due to the independent variables in the model. The main indices of the model based on CFA all were higher than 0.9, which indicates goodness of fit of the model (χ2/DF = 2.18, CFI, NFI, TLI = 0.93 GF = 0.84, REMSEA = 0.066, R2 = 0.99). The correlative coefficient was significant (p < 0.05). The reliability of the tool based on internal consistency (Cronbach’s alpha) for the subscales ranged from 0.84 to 0.85 and equal to 0.84 for the whole tool.ConclusionThe Farsi version of non-injection drug users’ QOL scale had acceptable indices and it was applicable to assess QOL in the target population. The tool can be used in different fields of drug addiction.

COVID-19 During the Opioid Epidemic - Exacerbation of Stigma and Vulnerabilities.

COVID-19 During the Opioid Epidemic - Exacerbation of Stigma and Vulnerabilities.

Psychological, social, and motivational factors in persons who use drugs

BackgroundPersons who use drug need family and society’s support in the process of treatment and rehabilitation. Therefore, it is imperative to determine the psychological, social, and motivational factors that can help them in the treatment process. The present study was an attempt to determine the relationship between psychological, social, and motivational factors and the demographics of persons who use drugs (PWUD).MethodsAn analytical cross-sectional study was carried out. TCU psychological functioning and motivation scales for the PWUD was first translated into Farsi and validated after securing permission from the copyright holder of the tool. Participants were 250 PWUDs under methadone therapy who were selected through convenient sampling. Before analyzing the collected data, validity and reliability of the tool were confirmed using confirmatory and exploratory factor analyses. Given the scale of demographical data, descriptive and analytic statistics were used to analyze the relationship between demographical variables and psychological, social, and motivational factors.ResultsThe results of exploratory and confirmatory factor analyses showed that out of 83 statements in the original questionnaire, 55 statements categorized into 11 aspects were usable for Iranian population. The results showed that gender, income, and marital status affect psychological functioning of the PWUD (P < 0.05). However, education level, place of residence, and type of drug and consumption did not have a significant relationship with social functioning of the participants (p > 0.05). There was a significant relationship between age, number of children, and history of using drug and psychological functioning of the participants (P < 0.01). The results showed that the demographics did not have a notable effect on the participants’ motivation for treatment; only marital status had a significant relationship with the participants’ treatment readiness (P < 0.05).ConclusionAs the results showed, the demographical variables could affect physical, psychological, and social functioning in the participants.

Knowledge, Awareness, And Practices Among Persons Who Use Drugs (Pwuds) In The Community-Based Rehabilitation Program

The purpose of this study is to assess the level of knowledge on illegal drugs and substance awareness on the negative effects of drug use, and practices of the Persons Who Use Drugs (PWUDs) who joined the community - based rehabilitation program in CY 2018-2019. The participants of the study were the 140 “tokhang responders” who voluntarily surrendered and recorded in the PNP and City Health Office of Valencia City for the screening and rehabilitation. Moreover, this covered the ­­­­­31 barangays of Valencia City, Bukidnon. The study utilized the descriptive-correlational and causal research design. Majority of the PWUDs are middle and young adults, male, with 5,000 and below income, and mostly reached high school level. The participants have high knowledge on the harmful effects of illegal drugs to the body. In contrast, they have moderate knowledge on damage to their health if used minimally. The drug increases pleasure to their lives. The participants are moderately aware on the negative effects of illegal drug use. The PWUDs who joined the community - based rehabilitation have primary care physicians since the program was monitored by the City Health Office. They have clear sense of themselves after the program. The least practiced activities are online support groups, no insurance, and active plans for lingering health problems. There is a significant relationship between the knowledge, awareness, and practices of the PWUDs. Knowledge is the single best predictor of practices of PWUDs. Keywords : illegal drugs, tokhang responders, harmful effects, online support groups, active plans

Long-Acting Lipoglycopeptides: "Lineless Antibiotics" for Serious Infections in Persons Who Use Drugs.

BackgroundInjection drug use is associated with serious infections. Due to challenges with medical management of addiction, relapses and additional infections are common. Persons who use drugs (PWUD) are more likely to leave against medical advice before completing treatment, which could result in treatment failure. Prolonged intravenous (IV) antimicrobial therapy in PWUD may be complicated by concern for IV catheter misuse, sometimes requiring prolonged hospitalization. Ideal alternatives would provide the following: (1) high success rate; (2) reduced rate of medical complications; (3) improved safety profiles; and (4) improved cost-effectiveness. Long-acting lipoglycopeptides present such opportunity for treatment of serious Gram-positive infections.MethodsWe performed a system-wide, retrospective analysis of adults admitted to University of Colorado Health from September 2015 to June 2018 and treated with dalbavancin or oritavancin based on clinical judgment of their treating physicians.ResultsFifty-six patients met inclusion criteria (17 PWUD vs 39 non-PWUD). The PWUD group were younger, healthier by Charlson comorbidity index, more likely insured by Medicaid, and admitted for conditions requiring longer treatment. Ten patients were lost to follow-up. Of the patients with follow-up, clinical failure was met in 1 PWUD patient (6%) and 6 non-PWUD patients (15%) (P = .413). The median hospital length-of-stay reduction was 20 days (interquartile range [IQR], 10–30 days) in PWUD vs 11 days (IQR, 9–14 days) in non-PWUD; P = .133. Estimated median savings were $40 455.08 (IQR, $20 900.00–$62 700.00) in PWUD vs $19 555.08 (IQR, $15 375.08–$23 735.08) in non-PWUD; P = .065.ConclusionsLong-acting lipoglycopeptides may be equally effective as standard-of-care, present a safety advantage, and secure earlier discharge and significant cost-savings.

Impact of health reform on health insurance status among persons who use opioids in eastern Kentucky: A prospective cohort analysis

BackgroundHealth insurance improves health and reduces mortality. Expanding insurance is a central feature of the Affordable Care Act (ACA). Persons who use drugs (PWUDs) have historically been at high risk of being uninsured. It is unknown if Appalachian PWUDs, who live in an extremely economically distressed region, are more likely to be insured since implementation of the ACA. MethodsData from a cohort of 503 PWUDs from eastern Appalachian Kentucky, who were interviewed at seven time-points between 2008 and 2017, were analysed using mixed effects regression models. ResultsAt baseline, only 33.8% of participants were insured, which increased to 87.3% of the cohort at the last follow-up interview. The final multivariate model, which included baseline characteristics and interactions by time, indicated there were significant baseline differences in insurance status by gender, age, education, income, and history of injection. Differences in the predictive margin probabilities of being insured across these groups had dissipated by the final follow-up interview. ConclusionsAfter Kentucky’s implementation of the ACA, this cohort of Appalachian PWUDs made substantial gains in obtaining insurance that far exceeded the increases reported in national studies.

Hepatitis E virus seroprevalence and determinants in various study populations in the Netherlands.

BackgroundThe epidemiology of hepatitis E virus (HEV) is not fully understood. In this study, we assessed putative risk factors for HEV seropositivity in various study populations in the Netherlands.MethodsData and samples from five different study populations were analysed: (A) blood donors (n = 5,239), (B) adults reporting a vegetarian life style since the age of 12 years (n = 231), (C) residents of Amsterdam, the Netherlands, with different ethnic backgrounds (n = 1,198), (D) men who have sex with men (MSM) (HIV positive and HIV negative) (n = 197), and (E) persons who use drugs (PWUD) (HIV positive and HIV negative) (n = 200). Anti-HEV immunoglobulin M (IgM) and immunoglobulin G (IgG) testing was performed using ELISA test (Wantai).ResultsHEV IgM seroprevalence was low across all study populations (<1% to 8%). The age and gender-adjusted HEV IgG seroprevalence was 24% among blood donors (reference group) and 9% among the vegetarian group (adjusted Relative Risk [aRR]:0.36, 95%CI:0.23–0.57). Among participants of different ethnic backgrounds, the adjusted HEV IgG seroprevalence was 16% among participants with a Dutch origin (aRR:0.64, 95%CI:0.40–1.02), 2% among South-Asian Surinamese (aRR:0.07, 95%CI:0.02–0.29), 3% among African Surinamese (aRR:0.11, 95%CI:0.04–0.34), 34% among Ghanaian (aRR:1.53, 95%CI:1.15–2.03), 19% among Moroccan (aRR:0.75, 95%CI:0.49–1.14), and 5% among Turkish (aRR:0.18, 95%CI:0.08–0.44) origin participants. First generation Moroccans had a higher risk for being IgG HEV seropositive compared to second generation Moroccan migrants. The statistical power to perform these analyses in the other ethnic groups was too low. In the MSM group the IgG HEV seroprevalence was 24% (aRR:0.99, 95%CI:0.76–1.29), and among PWUD it was 28% (aRR:1.19, 95%CI:0.90–1.58). The number of sexual partners in the preceding six months was not significantly associated with IgG HEV seropositivity in MSM. The association between HIV status and HEV seropositivity was significant in PWUD, yet absent in MSM. HIV viral load and CD4 cell count were not associated with HEV seropositivity in HIV positive MSM and PWUD.ConclusionsVegetarians were significantly less often HEV seropositive. Ethnic origin influenced the risk for being IgG HEV seropositive. MSM and PWUD were not at higher risk for being IgG HEV seropositive than blood donors.

1946. Heterogeneous Hospitalization Outcomes of People Who Use Drugs: The Type of Drug(s) Used Matters

BackgroundUS hospitals are experiencing an increase in admissions for persons who use drugs (PWUD). We examined predictors of two outcomes—leaving AMA and 30-day readmission—among PWUD.MethodsWe limited the 2013 National Readmissions Database to admissions of PWUD (age 18 to 65; ICD-9 codes for illicit drugs). Diagnoses and severity (Elixhauser comorbidity index (ECI)) were defined by ICD-9 codes. Uni- and multivariable logistic regression were performed.ResultsPredictors of AMA included younger age, male gender, bacterial infection, overdose, and using more than one drug. Use of opioids with stimulants was associated with the highest rate of AMA discharge (AOR 1.81, 95% CI 1.76–1.86). Leaving AMA was not found to be associated with 30-day readmission (OR 0.99, 95% CI 0.96–1.03).ConclusionPWUD represent a heterogenous patient population with hospital outcomes influenced by different patterns of drug use. Further exploration into these differences could have implications for predicting and intervening to prevent AMA discharges as well as 30-day readmissions, which are associated with worse outcomes and significant healthcare costs.Median [IQR] or N (%), N = 1,773,194AMA, N = 1,211,883*30-Day Readmission, N = 1,211,883aORAORORAORAge44 [32, 53]0.98 (0.98, 0.98)0.983 (0.98, 0.98)0.999 (0.99, 1.00)–Female777,920 (44%)0.71 (0.70, 0.72)0.64 (0.63, 0.66)0.93 (0.91, 0.95)0.93 (0.91, 0.95)Bacterial infection506,557 (29%)1.15 (1.13, 1.17)1.15 (1.12, 1.17)0.99 (0.97, 1.02)–Overdose105,291 (6%)1.18 (1.15, 1.21)1.15 (1.11, 1.19)0.91 (0.88, 0.95)0.90 (0.86, 0.95)AMA122,447 (7%)NANA0.99 (0.96, 1.03)--Death during first admission15,728 (1%)NANANANADrug usedOpioids only356,363 (47%)REFREFREFREFStimulants only269,654 (35%)0.91 (0.89, 0.93)0.94 (0.92, 0.96)1.06 (1.03, 1.10)1.05 (1.02, 1.08)Opioids/alcohol264,887 (8%)1.17 (1.14, 1.21)1.14 (1.11, 1.18)0.97 (0.92, 1.01)0.96 (0.92, 1.00)Opioids/sedatives58,875 (8%)1.41 (1.37, 1.46)1.37 (1.32, 1.41)1.02 (0.97, 1.07)1.03 (0.98, 1.08)Opioids/stimulants204,767 (27%)1.95 (1.89, 2.00)1.81 (1.76, 1.86)0.84 (0.80, 0.88)0.84 (0.80, 0.88)Elixhauser Comorbidity Index0–1466,653 (26%)REFREFREFREF2–3889,381 (50%)0.87 (0.86, 0.88)0.90 (0.88, 0.92)1.02 (0.99, 1.04)0.99 (0.96, 1.02)>3417,159 (24%)0.66 (0.64, 0.67)0.70 (0.68, 0.73)1.05 (1.02, 1.08)1.00 (0.96, 1.03) aPatients who died during index admission were removed from the logistic regression.Disclosures All authors: No reported disclosures.

Failure to get into substance abuse treatment

Among substance abusers in the US, the discrepancy in the number who access substance abuse treatment and the number who need treatment is sizable. This results in a major public health problem of access to treatment. The purpose of this study was to examine characteristics of Persons Who Use Drugs (PWUDs) that either hinder or facilitate access to treatment. 2646 participants were administered the Risk Behavior Assessment (RBA) and the Barratt Impulsiveness Scale. The RBA included the dependent variable which was responses to the question “During the last year, have you ever tried, but been unable, to get into a drug treatment or detox program?” In multivariate analysis, factors associated with being unable to access treatment included: Previously been in drug treatment (OR=4.51), number of days taken amphetamines in the last 30days (OR=1.18), traded sex for drugs (OR=1.53), homeless (OR=1.73), Nonplanning subscale of the Barratt Impulsiveness Scale (OR=1.19), age at interview (OR=0.91), and sexual orientation, with bisexual men and women significantly more likely than heterosexuals to have tried but been unable to get into treatment. The answers to the question on “why were you unable to get into treatment” included: No room, waiting list; not enough money, did not qualify, got appointment but no follow through, still using drugs, and went to jail before program start. As expected, findings suggest that limiting organizational and financial obstacles to treatment may go a long way in increasing drug abuse treatment accessibility to individuals in need. Additionally, our study points to the importance of developing approaches for increasing personal planning skills/reducing Nonplanning impulsivity among PWUDs when they are in treatment as a key strategy to ensure access to additional substance abuse treatment in the future.

Pilot Study: Combining Formal and Peer Education with FibroScan to Increase HCV Screening and Treatment in Persons who use Drugs

BackgroundTreatment uptake for hepatitis C virus (HCV) infection remains low in persons who inject drugs (PWID), due to lack of knowledge and low perceived need for treatment. Therefore, we conducted a pilot study to assess the influence on knowledge and willingness for HCV screening and treatment among persons who use drugs (PWUD) by combining formal and peer education with FibroScan measurement. MethodsClients of the Center for Alcohol and other Drug problems (CAD) in Limburg (Belgium) were randomized into a control group, which received the standard of care, and an intervention group, which received an innovative combination of formal and peer education followed by FibroScan. Knowledge of HCV infection and willingness for screening and treatment were evaluated at baseline, after intervention and 1 and 3months after intervention by means of questionnaires. ResultsBaseline knowledge was similar for the control (n=27) and the intervention group (n=25) (58 vs. 59%; p=0.67). Immediately after the information session, knowledge increased to 86% (p<0.001) in the intervention group. After 3months, knowledge decreased significantly (69%; p=0.01). No significant changes in knowledge were found in the control group. Baseline willingness for treatment was 81% in both the control and intervention groups, but after 1 month decreased in the control group (44%) and remained stable in the intervention group (75%). Differences in actual screening uptake between the control and intervention group were not significant (7% vs. 20%). Four percent of the intervention group and no one in the control group started treatment. ConclusionThe small number of subjects should be considered when interpreting the results of this study. In brief, the single information session significantly improved HCV knowledge among PWUD, but did not result in a higher uptake for screening and treatment. This could signify that there are other important reasons, besides lack of knowledge, not to undergo screening or start treatment. The fact that knowledge decreased after 3months indicates that it would be beneficial to repeat the information session regularly.

Challenges facing HIV-positive persons who use drugs and their families in Vietnam

It is hypothesized that persons who use drugs (PWUD) in Vietnam who are also HIV-positive may face additional challenges in psychosocial outcomes, and these challenges may extend to their family members. In this study, we examined depressive symptoms, stigma, social support, and caregiver burden of HIV-positive PWUD and their family members, compared to the outcomes of HIV-negative PWUD and their family members. Baseline, 3-month, and 6-month assessment data were gathered from 83 PWUD and 83 family members recruited from four communes in Phú Thọ Province, Vietnam. For PWUD, although we observed a general decline in overall stigma over time for both groups, HIV-positive PWUD consistently reported significantly higher overall stigma for all three periods. Depressive symptoms among family members in both groups declined over time; however, family members of HIV-positive PWUD reported higher depressive symptoms across all three periods. In addition, family members of HIV-positive PWUD reported lower levels of tangible support across all three periods. Caregiver burden among family members of HIV-positive PWUD increased significantly over time, whereas the reported burden among family members of HIV-negative PWUD remained relatively unchanged. The findings highlight the need for future interventions for PWUD and family members, with targeted and culturally specific strategies to focus on the importance of addressing additional stigma experienced by PWUD who are HIV-positive. Such challenges may have direct negative impact on their family members' depressive symptoms, tangible support, and caregiver burden.

A systematic review of antiretroviral adherence interventions for HIV-infected people who use drugs.

HIV-infected persons who use drugs (PWUDs) are particularly vulnerable for suboptimal combination antiretroviral therapy (cART) adherence. A systematic review of interventions to improve cART adherence and virologic outcomes among HIV-infected PWUDs was conducted. Among the 45 eligible studies, randomized controlled trials suggested directly administered antiretroviral therapy, medication-assisted therapy (MAT), contingency management, and multi-component, nurse-delivered interventions provided significant improved short-term adherence and virologic outcomes, but these effects were not sustained after intervention cessation. Cohort and prospective studies suggested short-term increased cART adherence with MAT. More conclusive data regarding the efficacy on cART adherence and HIV treatment outcomes using cognitive behavioral therapy, motivational interviewing, peer-driven interventions and the integration of MAT into HIV clinical care are warranted. Of great concern was the virtual lack of interventions with sustained post-intervention adherence and virologic benefits. Future research directions, including the development of interventions that promote long-term improvements in adherence and virologic outcomes, are discussed.