Background Syringe Services Programs (SSPs) is one aspect of a comprehensive Harm Reduction approach necessary to reduce the transmission of blood borne infections including Hepatitis B, Hepatitis C, and HIV. Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that in 2019 that 595,000 veterans engage in opioid misuse with at least 57,000 veterans engaging in heroin. Stigmas to SSP are pervasive in the community and within the government system. Federal law prohibited the use of federal funds to purchase sterile needles or syringes for the purposes of illegal use of drugs by injection. It was officially clarified in May 24, 2021 that the prohibition to purchase syringes does not apply to Veterans Health Administration (VHA). While awaiting approximately 2 years to secure this clarification, syringes were obtained through a community donation. We aim to describe our process including difficulties encountered and data collected for SSP at two locations. Difficulties included developing an anonymous process to track quality, motivating providers to refer, educating highest risk veterans, providing face to face engagement during COVID-19 pandemic and ability to mail Harm Reduction kits containing sterile syringes. Illiana VA Program Information Sheet Orlando VA Program Information Sheet Methods Of the 140 facilities within VHA, there are currently only two SSPs established, Illiana VA and Orlando VA. A retrospective analysis of Harm Reduction benefits was performed among veterans who engaged with the two SSPs between 2018 to 2021. Orlando VA SSP Intake Process Map Process that veteran undergo when they engage with Orlando VA SSP Contents of Standard SSP Kit Distributed to Veterans at Orlando VA Results Approximately 3000 syringes were dispensed. Of the 17 veterans, 65% received syringes, 82% received naloxone, 100% engagement in mental health and 94% engagement in substance use disorder clinics. In total, 65% were screened for HIV, 82% for HCV and 29% for sexually transmitted infections. Conclusion These numbers, while modest, are notable, especially given the financial and organizational barriers that were in place. Furthermore, the COVID-19 pandemic impacted full implementation and outreach. With the recent, official clarification on syringe purchase and support for SSPs, the number of SSPs in the VA will grow, along with opportunity for more robust data collection. The experience of both facilities is a model for programs currently in development and moves us closer to ending the HIV epidemic by 2030. Disclosures All Authors: No reported disclosures
Background Substance abuse continues to be on the rise in the U.S. driven by the proliferation of fentanyl laced street drugs. Per the CDC, during May 2020 - April 2021, a 29% increase in over dose deaths was observed compared to the previous year. Harm reduction services play a major role in reducing overdose deaths, life-threatening infections and chronic diseases. Syringe service programs (SSPs) have proven to be an essential component of a broader focus on harm reduction; however, gaps remain in engaging Veterans into these programs. Figure 1.Contents of Standard SSP Kit Distributed to Veterans at the Orlando VA Methods A multimodal strategy was implemented to engage Veterans and VA staff into harm reduction services. A harm reduction short video series was developed and posted on social media channels. ICD-10 codes were utilized to identify Veterans with polysubstance use and harm reduction letters were mailed. A pre and post survey was developed to assess provider’s familiarity and level of comfort with SSPs before and after in-service education was provided by ID physicians. An ID pharmacy consult was developed for providers to request patient education or harm reduction kit dispensing. Upon completion of the quality improvement project, we expect to see an increase in the number of Veterans utilizing SSP. Figure 2.Orlando VA SSP Process MapFigure 3.Harm Reduction Letter Results Upon implementation of outreach strategies total SSP visits increased by 72%. A total of 2040 syringes and 24 Naloxone kits have been dispensed through the SSP. Survey data shows that employees' knowledge on SSPs have increased by 48%, their comfort on working with Veterans who inject drugs increased by 6%, providers confidence in the tools available to them to successfully help veterans with alcohol and substance use recovery increased by 17%, misconception that SSPs increase drug use decreased by 6%, and support of placing consults for medication assisted therapy increased by 4%. Data is notable given limitations like post survey participation. Figure 4.Pre and Post Education Survey Data Collection ComparisonFigure 5.Pre and Post Education Survey Data Collection ComparisonFigure 6.Pre and Post Education Survey Data Collection Comparison Conclusion The implementation of multimodal strategies to engage Veterans and VA staff has resulted in an increase of SSP utilization. Sustained efforts to continue to identify target patients and bring them into care will be undertaken in an effort to increase and normalize SSP utilization. The steps already taken can serve as a model for programs currently in development and moves us closer to ending the HIV epidemic by 2030. Figure 7.Outreach Strategies Summary Disclosures All Authors: No reported disclosures.
Background During the COVID-19 pandemic, there have been multiple reports concerning patients falling out of healthcare. The National VA HIV and Hepatitis and Related Conditions (HHRC) has created the Sexually TRansmitted Infection Key Evaluation (STRIKE) Dashboard to help clinicians identify Veterans who need to complete co-testing for sexually transmitted infections (STIs) or human immunodeficiency virus (HIV) and allows providers to document if the Veteran was offered pre-exposure prophylaxis (PrEP). STRIKE Interface Screen Methods A national VA Veteran dataset was generated from data within the Corporate Data Warehouse (CDW) that included all active PLWH. Positive HIV status is evaluated based on positive antibody test and positive confirmatory result or positive viral load lab result. Negative HIV status is evaluated based on a negative antibody test in the past year. Of the 140 sites, 39 participated but only 9 were active throughout the period of October 1, 2020 to March 31, 2021. Active and nonactive participating sites had metrics assessed across the study period at 3 time points: October 1, 2020, January 1, 2021 and April 1, 2021. Sites with at least 48 visits to report across the 6-month QI period were considered active. Patient level data for review Additional patient level data for review Results Multiple sites had scarcity of supplies due to the national shortage of CT/NG Test Kits during COVID-19. To improve access to CT/NG testing, the dashboard suppress the list of Veterans with + syphlis who were not co-tested for CT/NG. Co-testing improved from 60.2% to 77.2% in active sites and from 61.9% to 68.7% for nonactive across the study period. Percent of Veterans with completed HIV testing on or after STI diagnosis in active sites had an upward trend of 2.1% compared to the nonactive which increased 0.6%. Likewise, new diagnosis of STI for those on PrEP increased 2.6% in active and 0.5% increase in nonactive. On average, active sites increased percent of high risk veterans with active PrEP prescriptions by 2%, compared with nonactive that only increased 1%. STRIKE Co Testing and HIV Screen performed This graph shows average of Syphilis Co Testing and HIV screen performed by active and nonactive sites as measured at three different time point. Number of Veterans on PrEP with STIs This graph shows the average percent of veterans on PrEP with STIs between active versus nonactive sites as measured at three time points Active PrEP Prescriptions Across All Sites This graph shows average percent of active PrEP prescriptions for high risk patients between active versus nonactive sites as measured at three time points Conclusion The STRIKE Dashboard efficiently flags Veterans with STI diagnosis who need completion of STI co-testing, including HIV testing and PrEP offer. Active participating facilities who used the STRIKE Dashboard improved STI Co-testing and PrEP prescription in a short 6 month period even during COVID-19. Disclosures All Authors: No reported disclosures
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