PrEP in substance abuse treatment: a qualitative study of treatment provider perspectives

Spector, Anya Y.; Remien, Robert H.; Tross, Susan

doi:10.1186/1747-597x-10-1

Cited by 57 publications

(45 citation statements)

References 33 publications

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“…In Italy, 70% of HIV specialists said they would prescribe PrEP, 64% to serodiscordant couples but also 56% to other people at risk, [67] while in Argentina, 40% would consider prescribing PrEP to serodiscordant couples and 35% to sex workers [82]. Medical and counselling service providers supported PrEP in outpatient drug treatment clinics [83]. …”

Section: Resultsmentioning

confidence: 99%

Values and Preferences on the Use of Oral Pre-exposure Prophylaxis (PrEP) for HIV Prevention Among Multiple Populations: A Systematic Review of the Literature

et al. 2016

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Daily oral pre-exposure prophylaxis (PrEP) is the use of antiretroviral drugs by HIV-negative people to prevent HIV infection. WHO released new guidelines in 2015 recommending PrEP for all populations at substantial risk of HIV infection. To prepare these guidelines, we conducted a systematic review of values and preferences among populations that might benefit from PrEP, women, heterosexual men, young women and adolescent girls, female sex workers, serodiscordant couples, transgender people and people who inject drugs, and among healthcare providers who may prescribe PrEP. A comprehensive search strategy reviewed three electronic databases of articles and HIV-related conference abstracts (January 1990–April 2015). Data abstraction used standardised forms to categorise by population groups and relevant themes. Of 3068 citations screened, 76 peer-reviewed articles and 28 conference abstracts were included. Geographic coverage was global. Most studies (N = 78) evaluated hypothetical use of PrEP, while 26 studies included individuals who actually took PrEP or placebo. Awareness of PrEP was low, but once participants were presented with information about PrEP, the majority said they would consider using it. Concerns about safety, side effects, cost and effectiveness were the most frequently cited barriers to use. There was little indication of risk compensation. Healthcare providers would consider prescribing PrEP, but need more information before doing so. Findings from a rapidly expanding evidence base suggest that the majority of populations most likely to benefit from PrEP feel positively towards it. These same populations would benefit from overcoming current implementation challenges with the shortest possible delay.

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Section: Resultsmentioning

confidence: 99%

Values and Preferences on the Use of Oral Pre-exposure Prophylaxis (PrEP) for HIV Prevention Among Multiple Populations: A Systematic Review of the Literature

et al. 2016

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“…The higher level of knowledge about PrEP in MSM may stem from a number of PrEP initiatives that have primarily focused on MSM and HIV seronegative partners in sero-discordant couples (Ware et al, 2012). Recent studies have also shown that many addiction treatment providers, with whom MMP patients are in daily contact, have limited awareness of PrEP (Shrestha et al, 2016; Spector et al, 2015). In the context of clinical settings, including MMP patients in this study, treatment providers have great potential to engage their at-risk clients about PrEP through counseling, referrals, research trials, and may also effectively promote adherence to PrEP through counseling and monitoring.…”

Section: Discussionmentioning

confidence: 99%

Correlates of willingness to initiate pre-exposure prophylaxis and anticipation of practicing safer drug- and sex-related behaviors among high-risk drug users on methadone treatment

Shrestha

Karki

Altice

et al. 2017

Drug and Alcohol Dependence

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Background Although people who use drugs (PWUD) are key populations recommended to receive pre-exposure prophylaxis (PrEP) to prevent HIV, few data are available to guide PrEP delivery in this underserved group. We therefore examined the willingness to initiate PrEP and the anticipation of HIV risk reduction while on PrEP among high-risk PWUD. Methods In a cross-sectional study of 400 HIV-negative, opioid dependent persons enrolled in a methadone program and reporting recent risk behaviors, we examined independent correlates of being willing to initiate PrEP. Results While only 72 (18%) were aware of PrEP, after being given a description of it, 251 (62.7%) were willing to initiate PrEP. This outcome was associated with having neurocognitive impairment (aOR=3.184, p=0.004) and higher perceived HIV risk (aOR=8.044, p<0.001). Among those willing to initiate PrEP, only 12.5% and 28.2%, respectively, indicated that they would always use condoms and not share injection equipment while on PrEP. Consistent condom use was associated with higher income (aOR=8.315, p=0.016), always using condoms with casual partners (aOR=6.597, p=0.001), and inversely associated with ongoing drug injection (aOR=0.323, p=0.027). Consistent safe injection, however, was inversely associated with age (aOR=0.948, p=0.035), ongoing drug injection (aOR=0.342, p<0.001), and perceived HIV risk (aOR=0.191, p=0.019). Conclusions While willingness to initiate PrEP was high and correlated with being at elevated risk for HIV, anticipated higher risk behaviors in this group even while on PrEP suggests that the next generation of HIV prevention approaches may need to combine biomedical and behavioral components to sustain HIV risk reduction over time.

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“…The suicide risk is greater in first or acute psychotic episodes, during the first six months after hospitalization [11, 12] and in SUD comorbid conditions [6, 8, 11, 13–16]. Alcohol is one of the most studied substances since it has been shown to have a significant impact on suicide [17–19] and cognition [20, 21]. Furthermore, DS patients, compared to SUD patients, are less motivated to change their consumption pattern, are more difficult to involve in treatment, exhibit slower progress, tend to give up long-term programs [22] and remain at risk of relapse even years after a period of full remission [23].…”

Section: Introductionmentioning

confidence: 99%

Executive Functioning in Men with Schizophrenia and Substance Use Disorders. Influence of Lifetime Suicide Attempts

et al. 2017

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BackgroundLifetime suicide attempts in patients with comorbidity between psychotic disorders and Substance Use Disorder (SUD), known as dual diagnosis, was associated with a worse clinical and cognitive state, poor prognosis and premature death. However, to date no previous study has examined the cognitive performance of these patients considering as independent the presence or absence of lifetime suicide attempts.MethodsWe explore executive functioning differences between suicide attempters and non-attempters in dual schizophrenia (DS) patients and the possible related factors for both executive performance and current suicide risk. Fifty DS male patients in remission of SUD and clinically stables, 24 with and 26 without lifetime suicide attempts, were evaluated. We considered Z scores for all neuropsychological tests and a composite summary score for both premorbid IQ and executive functioning.ResultsDS patients showed low performance in set-shifting, planning and problem solving tasks. Those with suicide attempts presented lower composite summary scores, together with worse problem solving skills and decision-making, compared with non-attempters. However, after controlling for alcohol dependence, only differences in decision-making remained. Executive functioning was related to the premorbid intelligence quotient, and several clinical variables (duration, severity, months of abstinence and relapses of SUD, global functioning and negative symptoms). A relationship between current suicide risk, and first-degree relatives with SUD, insight and positive symptoms was also found.ConclusionsOur results suggest that problem solving and, especially, decision-making tasks might be sensitive to cognitive impairment of DS patients related to presence of lifetime suicide attempts. The assessment of these executive functions and cognitive remediation therapy when necessary could be beneficial for the effectiveness of treatment in patients with DS. However, further research is needed to expand our findings and overcome some limitations of this study.

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PrEP in substance abuse treatment: a qualitative study of treatment provider perspectives

Cited by 57 publications

References 33 publications

Values and Preferences on the Use of Oral Pre-exposure Prophylaxis (PrEP) for HIV Prevention Among Multiple Populations: A Systematic Review of the Literature

Values and Preferences on the Use of Oral Pre-exposure Prophylaxis (PrEP) for HIV Prevention Among Multiple Populations: A Systematic Review of the Literature

Correlates of willingness to initiate pre-exposure prophylaxis and anticipation of practicing safer drug- and sex-related behaviors among high-risk drug users on methadone treatment

Executive Functioning in Men with Schizophrenia and Substance Use Disorders. Influence of Lifetime Suicide Attempts

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