A Co-Located Continuity Clinic Model to Address Healthcare Needs of Women Living Unhoused With Opioid Use Disorder, Who Engage in Transactional Sex in North Seattle

Stewart, Jenell; Stadeli, Kathryn M.; Green, Margaret L.; Etter-Carlson, Lisa; Dahl, Elizabeth E.; Davidson, Giana H.; Golden, Matthew R.; Dhanireddy, Shireesha

doi:10.1097/olq.0000000000001064

Cited by 14 publications

(19 citation statements)

References 7 publications

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“…26 Models of care, such as community clinics colocated with other services or peer-based clinics, may have more success engaging this population. 9,17 These results add to prior studies, suggesting that PWES are at higher risk for poor HIV and HCV outcomes. In our study, 67% of PWES reported HIV viral suppression compared with 73% in those who never exchanged sex.…”

Section: Discussionsupporting

confidence: 65%

“…In contrast, a prior study in Colorado Springs estimated that 80% of all “female prostitutes” were seen in the health department STD clinic during 1970 to 1990. One factor that likely contributed to this was health department outreach efforts, including “recruiting efforts … where and when prostitutes work.” 26 Models of care, such as community clinics colocated with other services or peer-based clinics, may have more success engaging this population 9,17 …”

Section: Discussionmentioning

confidence: 99%

“…The literature is limited regarding effective models of care for engaging PWES in the US health care system. Two published examples include a peer-based multiservice clinic in San Francisco and a continuity clinic model colocated with a community-based organization that serves people living homeless in Seattle 9,17 . These clinics address the specific health care needs of PWES and decrease emergency department utilization for outpatient services 18 .…”

mentioning

confidence: 99%

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Characterization of Patients Seeking Care at a Sexual Health Clinic Who Report Engaging in Exchange Sex

Bole

Khosropour

Glick³

et al. 2022

Sexual Trans Dis

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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Characterization of Patients Seeking Care at a Sexual Health Clinic Who Report Engaging in Exchange Sex

Bole

Khosropour

Glick³

et al. 2022

Sexual Trans Dis

Self Cite

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“…A pilot program in Seattle demonstrated feasibility, acceptability, and confirmed the high interest in SRH services among WWID [63]. Another novel community partnership clinic model in Seattle reported a high unmet need for STI and reproductive health services in homeless women who engage in transactional sex and IDU [64]. Women attending a harm reduction program in Sweden indicated that SRH services were the most valued part of the package [65].…”

Section: Strategies To Address Sexual Health Among People Who Inject ...mentioning

confidence: 99%

Challenges of sexually transmitted infections and sexual health among people who inject drugs

Dumchev

2021

Current Opinion in Infectious Diseases

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Purpose of reviewThis review provides a summary of recently published research on sexually transmitted infections (STI) and related behaviors among people who inject drugs (PWID), covering three major areas: sexual behavior and its role in STI transmission among PWID, multilevel factors associated with STI risk, and strategies addressing sexual health of PWID. This review is timely given the growing priority of combination prevention approaches and integrated care for PWID. Recent findingsModern research improves the understanding that PWID have an increased risk of STI, which varies by gender, setting, type of substance used, and presence of mental disorders. Major socioeconomic and structural factors, specific and nonspecific to PWID, facilitate inequality and sexual risk behavior. Sexual transmission continues to contribute substantially to the spread of bloodborne infections among PWID, accounting for at least 10% of new HIV cases according to epidemiological modeling. Despite the substantial evidence that behavioral interventions can improve sexual health and reduce sex-related risks among PWID, there is a research-practice gap, reflected in the scarcity of implementation studies published recently.

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“…Patients at the SHE Clinic reflect the unhoused population’s high rates of injection drug use, exchange sex, unplanned pregnancy, and sexually transmitted infections. 6 In this cohort study, we evaluated the association between use of the SHE Clinic and the frequency of nonemergent emergency department (ED) visits among women living unhoused who exchange sex and inject drugs.…”

Section: Introductionmentioning

confidence: 99%

Use of a Community Center Primary Care Clinic and Subsequent Emergency Department Visits Among Unhoused Women

et al. 2021

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In the United States, the frequent amalgamation of homelessness, drug use, and exchange of sex for money, shelter, food, or drugs increases the risk of serious health conditions, including trauma and HIV. 1 Women who are unhoused have an all-cause mortality 5 to 8 times higher than housed women. 2 Seattle, Washington, is facing a housing crisis, with a 31% increase in homelessness from 2008 to 2018 3 and a growing epidemic of opioid and methamphetamine use. In 2018, these overlapping epidemics created the context for an HIV outbreak in Seattle among unhoused heterosexual people. 4 Several US cities have created mobile health clinics in an effort to engage unhoused people in medical care. 5 In July 2018, the Safe, Healthy, Empowered (SHE) Clinic was founded to provide care for unhoused women colocated at Aurora Commons, a drop-in community center with a longstanding relationship with unhoused people in Seattle. Patients at the SHE Clinic reflect the unhoused population's high rates of injection drug use, exchange sex, unplanned pregnancy, and sexually transmitted infections. 6 In this cohort study, we evaluated the association between use of the SHE Clinic and the frequency of nonemergent emergency department (ED) visits among women living unhoused who exchange sex and inject drugs. MethodsSurvey data collected from an observational cohort of 76 women 18 years or older at Aurora Commons included self-identified demographic characteristics, fertility desires, and HIV risk factors.Participants provided oral and written consent for surveys and abstraction of electronic medical record data. REDCap (Research Electronic Data Capture software (Vanderbilt University) was used for survey collection and consenting participants. This study received ethical approval from the University of Washington Institutional Review Board. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.The SHE Clinic operates 4 hours a week and provides walk-in care. Participants with at least 1 visit to the SHE Clinic before February 2, 2019, were compared with participants with no visits. A manual review of participants' electronic medical records from February 1, 2018, through August 1, 2019, was conducted to find the dates and chief concerns for ED visits in the Seattle area (10 facilities, 91% of the area EDs). Two clinician investigators (J.S. and M.L.G.) classified each ED visit as emergent or nonemergent. Emergency department visits for sexual assault, trauma, drug overdose, mental health crisis, or illness resulting in hospitalization were classified as emergent visits. Descriptive data analyses were performed with Stata version 15.0 software (StataCorp). Emergency department visit rates were calculated per woman per month, and paired Wilcoxon signed rank tests were used to compare the frequency of ED visits in the 6 months before and after a woman's first SHE Clinic visit or a midperiod reference date for nonadopters. + Invited CommentaryAuthor affiliations and article inf...

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A Co-Located Continuity Clinic Model to Address Healthcare Needs of Women Living Unhoused With Opioid Use Disorder, Who Engage in Transactional Sex in North Seattle

Cited by 14 publications

References 7 publications

Characterization of Patients Seeking Care at a Sexual Health Clinic Who Report Engaging in Exchange Sex

Characterization of Patients Seeking Care at a Sexual Health Clinic Who Report Engaging in Exchange Sex

Challenges of sexually transmitted infections and sexual health among people who inject drugs

Use of a Community Center Primary Care Clinic and Subsequent Emergency Department Visits Among Unhoused Women

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