In developing countries, CABs can be dynamic entities that enhance the HIV research process, assist in responding to issues involving research ethics, and prepare communities for HIV research.

Few existing studies have examined health and oral health needs and treatment-seeking behavior among the homeless and injection drug users (IDUs). This paper describes the prevalence and correlates of health and oral health care needs and treatment-seeking behaviors in homeless IDUs recruited in San Francisco, California, from 2003 to 2005 (N = 340). We examined sociodemographic characteristics, drug use patterns, HIV status via oral fluid testing, physical health using the Short Form 12 Physical Component Score, self-reported needs for physical and oral health care, and the self-reported frequency of seeking medical and oral health care. The sample had a lower health status as compared to the general population and reported a frequent need for physical and oral health care. In bivariate analysis, being in methadone treatment was associated with care-seeking behavior. In addition, being enrolled in Medi-Cal, California’s state Medicaid program, was associated with greater odds of seeking physical and oral health care. Methamphetamine use was not associated with higher odds of needing oral health care as compared to people who reported using other illicit drugs. Homeless IDUs in San Francisco have a large burden of unmet health and oral health needs. Recent cuts in Medi-Cal’s adult dental coverage may result in a greater burden of oral health care which will need to be provided by emergency departments and neighborhood dental clinics.

Objectives:Patients with opioid use disorder (OUD) can initiate buprenorphine without requiring a withdrawal period through a low-dose (sometimes referred to as “micro-induction”) approach. Although there is growing interest in low-dose buprenorphine initiation, current evidence is limited to case reports and small case series.Methods:We performed a retrospective cohort study of patients with OUD seen by a hospital-based addiction medicine consult service who underwent low-dose buprenorphine initiation starting during hospital admission. We then integrated our practice-based experiences with results from the existing literature to create practice considerations.Results:Sixty-eight individuals underwent 72 low-dose buprenorphine initiations between July 2019 and July 2020. Reasons for low-dose versus standard buprenorphine initiation included co-occurring pain (91.7%), patient anxiety around the possibility of withdrawal (69.4%), history of precipitated withdrawal (9.7%), opioid withdrawal intolerance (6.9%), and other reason/not specified (18.1%). Of the 72 low-dose buprenorphine initiations, 50 (69.4%) were completed in the hospital, 9 (12.5%) transitioned to complete as an outpatient, and 13 (18.1%) were terminated early. We apply our experiences and findings from literature to recommendations for varied clinical scenarios, including acute illness, co-occurring pain, opioid withdrawal intolerance, transition from high dose methadone to buprenorphine, history of precipitated withdrawal, and rapid hospital discharge. We share a standard low-dose initiation protocol with potential modifications based on above scenarios.Conclusions:Low-dose buprenorphine initiation offers a well-tolerated and versatile approach for hospitalized patients with OUD. We share lessons from our experiences and the literature, and provide practical considerations for providers.

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Background: Opioid use disorder (OUD) is prevalent among people with HIV (PWH). Opioid agonist therapy (OAT) is the most effective treatment for OUD and is associated with improved health outcomes, but is often not initiated. To inform clinical practices and policies, we identified factors predictive of OAT initiation among patients with and without HIV. Methods: In this longitudinal, cohort study, we identified 19,698 new clinical encounters of OUD occurring between 2000 and 2012 in the Veterans Aging Cohort Study (VACS), a national observational cohort of PWH and matched uninfected controls. Mixed effects models examined factors predictive of initiation of any OAT within 30-days of a new OUD clinical encounter. We used a five-month break-in-care to ensure the identified OUD clinical encounter constituted a new opportunity for treatment. Results: 4.9% of both PWH and uninfected patients initiated any OAT within 30 days of a new OUD clinical encounter. In adjusted models, participants with a psychiatric diagnosis (adjusted odds ration [aOR] = 0.54, 95% confidence interval [CI] 0.47-0.62), PWH (aOR=0.79, 95% CI 0.68-0.92), and rural residence (aOR=0.56, 95% CI 0.39-0.78) had a lower likelihood of any OAT initiation, while African-American patients (aOR=1.60, 95% CI 1.34-1.92), those with an alcohol related diagnosis (aOR=1.76, 95% CI 1.48-2.08), diagnosis year 2005-2008 relative to 2000-2004 (aOR=1.24, 95% CI 1.05-1.45), and patients with HCV (aOR=1.50, 95% CI 1.27-1.77) had a greater likelihood of initiating any OAT within 30 days. Predictive factors were similar in the total sample and PWH only models. Conclusions: PWH were less likely to receive timely OAT initiation than demographically similar uninfected patients. Given the known health benefits of such treatment, the low rate of OAT initiation warrants focused efforts in both PWH and uninfected populations.

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Young people engaged as peer educators are increasingly important in sex and relationship education (SRE) programmes in a variety of settings and are particularly valued in the APAUSE programme (Rees et al., 1997). The increase in popularity of peer education raises a need to value the inputs of young people and to give formal recognition to peers. An assessment process focusing on aspects of performance including communication, teamwork and relationships skills has been developed to assess volunteer peer educators on the APAUSE programme that aims to reconcile the typical tension in assessment of showing public recognition of competence and the ability to motivate learners. This paper reports initial findings from a pilot of this assessment process in 28 schools, involving 484 peer educators across England. Initial data suggest this has been extremely well received by teachers and peers. Experience of the process provides teachers with a method of feedback, which, by sharing the language of assessment with peers, enables the young people to be clearer about their tasks, making them more effective as peers and better able to articulate their experiences. These data are used to describe the contributions that an assessment process, focused on assessing performance in authentic situations, can make to SRE.

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