Pilot Study to Enhance HIV Care Using Needle Exchange-Based Health Services for Out-of-Treatment Injecting Drug Users

Altice, Frederick L.; Springer, Sandra A.; Buitrago, Marta; Hunt, David; Friedland, Gerald

doi:10.1093/jurban/jtg053

Cited by 76 publications

(62 citation statements)

References 51 publications

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“…Moreover, syringe-exchange programs have the opportunity to engage active drug users in other positive health behaviors, such as entry into drug treatment [23,24], provision of methadone maintenance therapy [25,26], direct delivery of health care services [24,[27][28][29], and provision of antiretroviral therapy [30]. Through its continuous contact with and nonjudgmental approach to drug users, health services located at sites of syringe exchange could incorporate treatment for HIV infection, particularly directly administered antiretroviral therapy (DAART).…”

mentioning

confidence: 99%

Developing a Directly Administered Antiretroviral Therapy Intervention for HIV-Infected Drug Users: Implications for Program Replication

Altice

Mezger

Hodges

et al. 2004

Clinical Infectious Diseases

106

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Directly administered antiretroviral therapy (DAART) is one approach to improving adherence to among human immunodeficiency virus (HIV)-infected drug users. We evaluated the essential features of a community-based DAART intervention in a randomized, controlled trial of DAART versus self-administered therapy. Of the initial 72 subjects, 78% were racial minorities, and 32% were women. Social and medical comorbidities among subjects included homelessness (35% of subjects), lack of interpersonal support (86%), major depression (57%), and alcoholism (36%). At baseline, the median CD4+ cell count was 403 cells/mL and the median HIV-1 RNA load was 146,333 copies/mL (log10 5.31 copies/mL). During the prior 6 months, 33% of subjects had missed a medical appointment, and 47% had visited an emergency department. Although most subjects (67%) preferred to take their own medications, 76% would accept DAART if it were made compulsory. A methadone clinic was the DAART venue acceptable to the fewest subjects (36%), and a mobile syringe-exchange program was acceptable to the most subjects (83%). Adherence was higher for supervised than for unsupervised medication administration (P<.0001), a finding that supports use of daily supervision of once-daily regimens. Moreover, DAART should incorporate enhanced elements such as convenience, flexibility, confidentiality, cues and reminders, responsive pharmacy and medical services, and specialized training for staff.

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mentioning

confidence: 99%

Developing a Directly Administered Antiretroviral Therapy Intervention for HIV-Infected Drug Users: Implications for Program Replication

Altice

Mezger

Hodges

et al. 2004

Clinical Infectious Diseases

106

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“…Strategies to increase access to and utilization of HAART have included entry into drug treatment, abstinence, community outreach and referral, and provision of medical care at nontraditional sites such as syringe exchange (Molitor et al, 2005). For example, Altice, Springer, Buitrago, Hunt, and Friedland (2003) provided HAART to out-of-treatment IDUs using a mobile van at SEP sites and found that by 6 months the proportion whose HIV-1 RNA was below the limits of detection was 85%; 77% had no detectable levels by 9 months.…”

Section: Discussionmentioning

confidence: 99%

Hospital- Versus Community–Based Syringe Exchange: A Randomized Controlled Trial

Masson¹,

Sorensen²,

Perlman³

et al. 2007

AIDS Education and Prevention

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This study examined the effect of syringe exchange program setting on the injection practices, health status, and health service utilization patterns of injection drug users (IDUs) recruited from a public urban hospital. One hundred sixty-six participants were randomized to either communityor hospital-based syringe exchange services. Poisson regression models were used to compare service utilization between groups. In both conditions, risky drug use practices decreased, and physical health functioning improved over time. Hospital-based syringe exchange program (SEP) attendees had 83% more inpatient admissions (p < .0001) and 22% more ambulatory care visits (p NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript < .0001) than those assigned to the community-based SEP condition. Syringe exchange services that are integrated into public hospital settings may serve as a valuable strategy to engage hard to reach IDU populations in behavioral interventions designed to reduce HIV risk transmission behaviors and increase access to, or engagement in, the use of secondary and tertiary preventive medical care.Syringe exchange programs (SEPs) reduce the transmission of HIV and other blood-borne pathogens through the provision of free sterile injection equipment, disposal of used syringes, and referrals to HIV testing and drug treatment. Increasing the availability of sterile syringes through SEPs, pharmacies, and other outlets reduces unsafe injection practices, such as needle sharing, and reduces the spread of HIV infection (Des Jarlais et al., 1996;Hagan & Thiede, 2000;MacDonald, Law, Kaldor, Hales, & Dore, 2003;Valente, Foreman, Junge, & Vlahov, 2001;Vlahov et al., 1997). Moreover, SEPs are a cost-effective HIV prevention strategy (Laufer, 2001).Despite the effectiveness of SEPs, questions about how to operate these programs remain unanswered. Factors such as SEP location, syringe distribution policies, number of hours of operation, days of the week and time of day of operation, ancillary services offered, harm reduction philosophy of staff, law enforcement practices and cultural appropriateness of staff may affect risk behaviors and patterns of SEP use (Bluthenthal, Kral, Lorvick, & Watters, 1997;Kral & Bluthenthal, 2003;Riley et al., 2000;Rockwell, Des Jarlais, Friedman, Perlis, & Paone, 1999). The influence of these factors on the effectiveness of SEPs requires further study.Although SEPs and health care facilities share the mission of preventing or reducing complications of injection drug use, they usually operate independently of one another. In addition, although hospital-based SEPs have been instituted in other countries, including Australia, Canada, and the United Kingdom, this approach has not gained widespread general acceptance in the United States (Commonwealth Department of Health and Ageing, 2002;Hankins, 1998;Parsons et al., 2002). In the United States SEPs are usually freestanding. Integration with the health care system may have advantages, but without fu...

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“…Pharmacologic (eg, methadone program, buprenorphine treatment program) [42] and/ or nonpharmacologic treatment (eg, Twelve Steps programs) for substance use [43] 2. Flexible outpatient and community care settings (eg, walk-in clinics, mobile health care programs) [44] 3. Low-threshold sites to engage active users (eg, syringe-exchange sites) [45] 4.…”

Section: Treatment Of Hiv Infection In Drug Usersmentioning

confidence: 99%

Clinical Care of the HIV-Infected Drug User

Bruce¹,

Altice²

2007

Infectious Disease Clinics of North America

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Pilot Study to Enhance HIV Care Using Needle Exchange-Based Health Services for Out-of-Treatment Injecting Drug Users

Abstract: ABSTRACT

Cited by 76 publications

References 51 publications

Developing a Directly Administered Antiretroviral Therapy Intervention for HIV-Infected Drug Users: Implications for Program Replication

Developing a Directly Administered Antiretroviral Therapy Intervention for HIV-Infected Drug Users: Implications for Program Replication

Hospital- Versus Community–Based Syringe Exchange: A Randomized Controlled Trial

Clinical Care of the HIV-Infected Drug User

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