A large body of research examines the relationship between HIV and drug dependence, but considerably less information is available on viral hepatitis and drug dependence. This article summarizes research indicating what drug abuse treatment programs can do to prevent their patients from acquiring HIV or hepatitis infection and to limit the consequences for patients who are already infected. Drug treatment programs can play a pivotal role in preventing, detecting, and treating HIV and hepatitis. Some activities can be accomplished by providers simply becoming aware of the issues; others will require significant infusion of leadership, education, and fiscal support.

Although HCV is more prevalent among people with severe mental illness (SMI; e.g., schizophrenia, bipolar disorder) than in the general population (17% vs 1%), no large previous studies have examined HCV screening in this population. In this cross-sectional study, we examined administrative data for 57 170 California Medicaid enrollees with SMI to identify prevalence and predictors of HCV screening from October 2010 through September 2011. Only 4.7% (2674 of 57 170) received HCV screening, with strongest predictors being nonpsychiatric health care utilization and comorbid substance abuse.

Background

Hepatitis C virus (HCV) is highly prevalent among homeless persons, yet barriers continue to impede HCV testing and treatment in this population. We studied the experiences of homeless individuals related to accessing HCV care to inform the design of a shelter-based HCV prevention and treatment program.

Methods

Homeless shelter clients (10 women and 10 men) of a large shelter in San Francisco participated in gender segregated focus groups. Focus groups followed a semi-structured interview format, which assessed individual, program/system, and societal-level barriers and facilitators to universal HCV testing and linkage to HCV care. Focus group interviews were transcribed, coded, and analyzed using thematic analysis.

Results

We identified key barriers to HCV testing and treatment at the individual level (limited knowledge and misconceptions about HCV infection, mistrust of health care providers, co-morbid conditions of substance use, psychiatric and chronic medical conditions), system level (limited advocacy for HCV services by shelter staff), and social level (stigma of homelessness). Individual, system, and social facilitators to HCV care described by participants included internal motivation, financial incentives, prior experiences with rapid HCV testing, and availability of affordable direct acting antiviral (DAA) treatment, respectively.

Conclusions

Interrelated individual- and social-level factors were the predominant barriers affecting homeless persons' decisions to engage in HCV prevention and treatment. Integrated models of care for homeless persons at risk for or living with HCV address many of these factors, and should include interventions to improve patient knowledge of HCV and the availability of effective treatments.

Background

There is little information on how to increase the scientific writing productivity of early-stage investigators in the addictions field. A scientific writing seminar is presented in this article, aiming to encourage manuscript writing and dissemination of addiction research, and outcomes are reported for 14 years of the seminar.

Methods

In 14 years, there were 113 postdoctoral fellow enrollments in a 6-month writing seminar. Records of submission and publication rates of manuscripts were collected for 14 cohorts.

Results

Of the 113 participant enrollments, 97 (86%) submitted a manuscript for publication, and 87 participants (77%) published their manuscript.

Conclusions

A scientific writing seminar may benefit writing productivity, but more research is needed to compare this training model with other existing models.

Background

Smoking prevalence is high among people in substance use disorder (SUD) treatment, and program interventions to address smoking are often complex and lengthy. This cluster-randomized trial tested whether a brief multi-component intervention impacted tobacco outcomes among staff and clients.

Methods

Seven SUD treatment programs were randomly assigned to the multi-component intervention or to waitlist control. The 6-month intervention included a leadership motivation assessment, program incentives, 4 staff training sessions and a leadership learning community session. Survey data were collected from staff and clients at pre- and post-intervention. Outcomes were first compared across condition (intervention vs waitlist control), and then examined pre- to post-intervention with condition collapsed.

Results

Staff in the intervention (n = 48) and control conditions (n = 26) did not differ at post-intervention on smoking prevalence, self-efficacy to help clients quit, or practices used to help clients quit smoking. Intervention clients (n = 113) did not differ from controls (n = 61) in smoking prevalence or receipt of tobacco services. Pre-post comparisons collapsed across condition showed a decrease in client and staff smoking prevalence, which could not be attributed to the intervention, and a decrease in client receipt of cessation medication.

Conclusion

The brief multi-component intervention did not support changes in smoking prevalence or in tobacco-related services received by clients. Other intervention features are needed to reduce smoking among SUD clients.

Trial registration

Randomization occurred at the program level and outcomes measured are program-level measures. Accordingly, the trial is not registered.

Background

There is little information on how to increase the scientific writing productivity of early-stage investigators in the addictions field. A scientific writing seminar is presented in this article, aiming to encourage manuscript writing and dissemination of addiction research, and outcomes are reported for 14 years of the seminar.

Methods

In 14 years, there were 113 postdoctoral fellow enrollments in a 6-month writing seminar. Records of submission and publication rates of manuscripts were collected for 14 cohorts.

Results

Of the 113 participant enrollments, 97 (86%) submitted a manuscript for publication, and 87 participants (77%) published their manuscript.

Conclusions

A scientific writing seminar may benefit writing productivity, but more research is needed to compare this training model with other existing models.

Background

Limited data are available on other substance use in e-cigarettes (OSUE). The aim of this research was to determine the prevalence and predictors of OSUE among a sample of individuals in substance use disorder (SUD) treatment.

Methods

In 2019, we surveyed 553 individuals from 18 residential SUD treatment programs in California, USA. Individuals reporting any lifetime use of an e-cigarette containing nicotine (n = 279) were asked about ever use of drugs other than nicotine in their e-cigarette. Those who reported use of non-nicotine drugs in their e-cigarette also reported what psychoactive drugs were used.

Results

Among all the participants, 25 % (n = 139) . reported ever engaging in OSUE. The most common drugs used in vaping devices were marijuana/THC/hash, (70.5 %, n = 98) and amphetamines/methamphetamine (51.1 %, n = 71). Among those who had engaged in OSUE, 44.6 % (n = 62) had vaped drugs for which they sought treatment. Older persons (OR = 0.93, CI 0.91, 0.95) and African Americans (OR = 0.48, CI 0.24, 0.94) were less likely to have ever engaged in OSUE, while persons in treatment for opioid use were more likely (OR = 1.71, CI 1.08, 2.71).

Conclusion

Among a sample of clients in SUD treatment, about 25% had ever engaged in OSUE, with THC/marijuana and amphetamines most commonly reported. Further research is needed to evaluate the OSUE to understand the reasons for use and implications among persons enrolled in SUD treatment.

BACKGROUND AND AIM:: Patient reported experience (PRE) is critical for engagement in hepatitis C (HCV) therapy in hard to reach populations. However, there is no data on patient reported experience with DAA therapy among homeless patients accessing shelters. We assessed PRE with DAA treatment following implementation of HCV therapy within homeless shelters in two diverse regions in the United States. METHODS:: In a study of integrated HCV testing and treatment in four homeless shelters in San Francisco (SF) and Minnesota (MN), 66 patients received DAA therapy from 11/2018–4/2020. PREs were assessed at the end of therapy with constructs: satisfaction with communication with their HCV treatment provider, receipt of social support during therapy, perceived stigma associated with HCV infection, and their overall satisfaction with DAA therapy. Descriptive statistics and factors associated with satisfaction with HCV therapy were assessed. RESULTS:: At end of therapy, 41 patients completed the questionnaire (response rate was 62%). Median age was 56 years, 74.4% were men, 44% White (45% Black, 6% Latino), 35% had more than a high school diploma, 65% had a history of IV drug use, 56% had received SUD treatment, and 12% were co-infected with HIV. During DAA treatment, the majority of patients lived in shelters, 37% used illicit drugs, 24% consumed alcohol, and 14% received psychiatric treatment. Patient reported experience with DAA therapy were as follows: 100% agreed or strongly agreed that HCV providers seemed non-judgmental, 98% reported that their provider seemed to care about them, 98% reported that people close to them had been supportive of their care, and 98% were satisfied with their HCV treatment. There were no patient level or clinical predictors associated with PREs of stigma, perceived lack of social support or satisfaction with DAA treatment. CONCLUSIONS:: Nearly all (>95%) homeless patients receiving integrated HCV testing and therapy within homeless shelters felt supported and reported favorable views toward their providers and a high level of satisfaction with DAA treatment. As patient reported experience is key for engagement in HCV therapy, our onsite treatment intervention within shelters can serve as a model of HCV care to enhance treatment uptake in patients experiencing homelessness.

Compared with the general population, homeless individuals are at higher risk of hepatitis C infection (HCV) and may face unique barriers in receipt of HCV care. This study sought the perspectives of key stakeholders toward establishing a universal HCV screening, testing, and treatment protocol for individuals accessing homeless shelters. Four focus groups were conducted with homeless shelter staff, practice providers, and social service outreach workers (n = 27) in San Francisco, California, and Minneapolis, Minnesota. Focus groups evaluated key societal, system, and individual-level facilitators and barriers to HCV testing and management. Interviews were transcribed and analyzed thematically. The societal-level barriers identified were lack of insurance, high-out-of-pocket expenses, restriction of access to HCV treatment due to active drug and/or alcohol use, and excessive paperwork required for HCV treatment authorization from payers. System-level barriers included workforce constraints and limited health care infrastructure, HCV stigma, low knowledge of HCV treatment, and existing shelter policies. At the individual level, client barriers included competing priorities, behavioral health concerns, and health attitudes. Facilitators at the system level for HCV care service integration in the shelter setting included high acceptability and buy in, and linkage with social service providers. Conclusion: Despite societal, system, and individual-level barriers identified with respect to the scale-up of HCV services in homeless shelters, there was broad support from key stakeholders for increasing capacity for the provision of HCV services in shelter settings. Recommendations for the scale-up of HCV services in homeless shelter settings are discussed.