scholarly journals 1007. Criminal Justice Involvement Negatively Impacts Engagement in Treatments for HIV and Opioid Use Disorder in Vietnam

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S532-S532
Author(s):  
Caroline King ◽  
Ryan Cook ◽  
Giang Le Minh ◽  
Gavin Bart ◽  
P Todd Korthuis
Keyword(s):  
Criminal Justice ◽  
Statistical Significance ◽  
Opioid Use Disorder ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Opioid Use ◽  
Criminal Justice Involvement ◽  
Negatively Associated ◽  
Hiv Care Engagement ◽  
The Impact

Abstract Background People living with HIV (PLWH) and opioid use disorder (OUD) commonly experience criminal justice involvement (CJI). We sought to estimate the impact of CJI on 1) HIV care engagement, 2) antiretroviral therapy (ART) prescription rates, and 3) receipt of medications for opioid use disorder (MOUD), among PLWH and OUD in Vietnam. Methods Participants were PLWH enrolled in a 12-month MOUD treatment trial of HIV clinic-based buprenorphine vs. methadone referral in Vietnam. We compared those with CJI (arrest, incarceration, or compulsory “06” drug rehabilitation) during the first 9 months of the study to those with no CJI. To ensure participants with CJI had the opportunity to re-engage in treatment, only those who were released before their 9-month study visit were included; participants still incarcerated at 9 months were excluded. Logistic regression models estimated the association between CJI and HIV care engagement (≥ 1 visit), ART prescription, and receipt of MOUD between 9 and 12 months, controlling for demographics, substance use, past CJI, and HIV history. Results At baseline, 234 of 281 participants (83.6%) had a history of arrest/incarceration, and 172 (61.2%) reported prior 06 detention. During their first 9 months of study participation, 14 participants (5.0%) were arrested and 14 participants (5.0%) were sent to compulsory 06 rehabilitation. Being arrested (OR=0.04, 95% CI= (0.007, 0.25)), sent to compulsory 06 rehabilitation (OR=0.08, 95% CI= (0.02, 0.38)), or either (OR=0.07, 95% CI= (0.02, 0.24)), were negatively associated with receipt of MOUD. CJI involvement was also negatively associated with HIV clinic engagement after release (OR=0.20, 95% CI= (0.05, 0.84)). A similar negative association was noted for ART prescription, though it did not reach statistical significance (OR=0.17, 95% CI= (0.03, 1.22)). Conclusion Arrest, incarceration, and compulsory 06 rehabilitation negatively impact HIV and OUD care among people with HIV and OUD in Vietnam. Policies that decrease incarceration, and the impacts of incarceration, for people with OUD and HIV may improve care outcomes in Vietnam and elsewhere. Disclosures P Todd Korthuis, MD, MPH, Alkermes & Indivior (Other Financial or Material Support, Dr. Korthuis serves at principal investigator for NIH-funded studies that accept donated study medicine from Indivior (buprenorphine) and Alkermes (extended-release naltrexone).)

Incarceration and compulsory rehabilitation impede use of medication for opioid use disorder and HIV care engagement in Vietnam

2021 ◽  
pp. 108451
Author(s):  
Caroline King ◽  
Ryan Cook ◽  
Le Minh Giang ◽  
Gavin Bart ◽  
Kim Hoffman ◽  
...  
Keyword(s):  
Opioid Use Disorder ◽  
Hiv Care ◽  
Opioid Use ◽  
Hiv Care Engagement

scholarly journals Assessment of the impact of an opioid-specific education series on rates of medication-assisted treatment for opioid use disorder in veterans

2020 ◽  
Author(s):  
Taylor Kirby ◽  
Robert Connell ◽  
Travis Linneman
Keyword(s):  
Multivariate Analysis ◽  
Hospital Admission ◽  
Intervention Group ◽  
Opioid Use Disorder ◽  
Control Group ◽  
Opioid Use ◽  
Motivation To Change ◽  
Heroin Use ◽  
Ed Visits ◽  
The Impact

Abstract Purpose The impact of a focused inpatient educational intervention on rates of medication-assisted therapy (MAT) for veterans with opioid use disorder (OUD) was evaluated. Methods A retrospective cohort analysis compared rates of MAT, along with rates of OUD-related emergency department (ED) visits and/or hospital admission within 1 year, between veterans with a diagnosis of OUD who completed inpatient rehabilitation prior to implementation of a series of group sessions designed to engage intrinsic motivation to change behavior surrounding opioid abuse and provide education about MAT (the control group) and those who completed rehabilitation after implementation of the education program (the intervention group). A post hoc, multivariate analysis was performed to evaluate possible predictors of MAT use and ED and/or hospital readmission, including completion of the opioid series, gender, age (>45 years), race, and specific prior substance(s) of abuse. Results One hundred fifty-eight patients were included: 95 in the control group and 63 in the intervention group. Rates of MAT were 25% (24 of 95 veterans) and 75% (47 of 63 veterans) in control and intervention groups, respectively (P < 0.01). Gender, completion of the opioid series, prior heroin use, and marijuana use met prespecified significance criteria for inclusion in multivariate regression modeling of association with MAT utilization, with participation in the opioid series (odds ratio [OR], 9.56; 95% confidence interval [CI], 4.36-20.96) and prior heroin use (OR, 3.26; 95% CI, 1.18-9.01) found to be significant predictors of MAT utilization on multivariate analysis. Opioid series participation and MAT use were independently associated with decreased rates of OUD-related ED visits and/or hospital admission (hazard ratios of 0.16 [95% CI, 0.06-0.44] and 0.32 [95% CI, 0.14-0.77], respectively) within 1 year after rehabilitation completion. Conclusion Focused OUD-related education in a substance abuse program for veterans with OUD increased rates of MAT and was associated with a decrease in OUD-related ED visits and/or hospital admission within 1 year.

scholarly journals Free access to antiretroviral treatment and protection against the risk of catastrophic health expenditure in people living with HIV: evidence from Cameroon

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Marwân-al-Qays Bousmah ◽  
Marie Libérée Nishimwe ◽  
Christopher Kuaban ◽  
Sylvie Boyer
Keyword(s):  
Socioeconomic Status ◽  
Health Expenditure ◽  
Antiretroviral Treatment ◽  
Catastrophic Health Expenditure ◽  
Hiv Care ◽  
Free Access ◽  
People Living With Hiv ◽  
Art Policy ◽  
Living With Hiv ◽  
The Impact

Abstract Background To foster access to care and reduce the burden of health expenditures on people living with HIV (PLHIV), several sub-Saharan African countries, including Cameroon, have adopted a policy of removing HIV-related fees, especially for antiretroviral treatment (ART). We investigate the impact of Cameroon’s free antiretroviral treatment (ART) policy, enacted in May 2007, on catastrophic health expenditure (CHE) risk according to socioeconomic status, in PLHIV enrolled in the country’s treatment access program. Methods Based on primary data from two cross-sectional surveys of PLHIV outpatients in 2006–2007 and 2014 (i.e., before and after the policy’s implementation, respectively), we used inverse propensity score weighting to reduce covariate imbalances between participants in both surveys, combined with probit regressions of CHE incidence. The analysis included participants treated with ART in one of the 11 HIV services common to both surveys (n = 1275). Results The free ART policy was associated with a significantly lower risk of CHE only in the poorest PLHIV while no significant effect was found in lower-middle or upper socioeconomic status PLHIV. Unexpectedly, the risk of CHE was higher in those with middle socioeconomic status after the policy’s implementation. Conclusions Our findings suggest that Cameroon’s free ART policy is pro-poor. As it only benefitted PLHIV with the lowest socioeconomic status, increased comprehensive HIV care coverage is needed to substantially reduce the risk of CHE and the associated risk of impoverishment for all PLHIV.

scholarly journals Conceptualizing the effects of the COVID-19 pandemic on people with opioid use disorder: an application of the social ecological model

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ethan Cowan ◽  
Maria R. Khan ◽  
Siri Shastry ◽  
E. Jennifer Edelman
Keyword(s):  
Structural Changes ◽  
Ecological Model ◽  
Disease Incidence ◽  
Opioid Use Disorder ◽  
Social Ecological Model ◽  
Physical And Mental Health ◽  
Opioid Use ◽  
Social Ecological ◽  
The Social ◽  
The Impact

AbstractThe COVID-19 pandemic has resulted in unparalleled societal disruption with wide ranging effects on individual liberties, the economy, and physical and mental health. While no social strata or population has been spared, the pandemic has posed unique and poorly characterized challenges for individuals with opioid use disorder (OUD). Given the pandemic’s broad effects, it is helpful to organize the risks posed to specific populations using theoretical models. These models can guide scientific inquiry, interventions, and public policy. Models also provide a visual image of the interplay of individual-, network-, community-, structural-, and pandemic-level factors that can lead to increased risks of infection and associated morbidity and mortality for individuals and populations. Such models are not unidirectional, in that actions of individuals, networks, communities and structural changes can also affect overall disease incidence and prevalence. In this commentary, we describe how the social ecological model (SEM) may be applied to describe the theoretical effects of the COVID-19 pandemic on individuals with opioid use disorder (OUD). This model can provide a necessary framework to systematically guide time-sensitive research and implementation of individual-, community-, and policy-level interventions to mitigate the impact of the COVID-19 pandemic on individuals with OUD.

The Impact of Chronic Pain on Opioid Use Disorder Treatment Outcomes

2021 ◽  
Author(s):  
R. Ross MacLean ◽  
Suzanne Spinola ◽  
Gabriella Garcia-Vassallo ◽  
Mehmet Sofuoglu
Keyword(s):  
Chronic Pain ◽  
Treatment Outcomes ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Disorder Treatment ◽  
The Impact

Medicaid Expansion Increased Medications For Opioid Use Disorder Among Adults Referred By Criminal Justice Agencies

2021 ◽  
Vol 40 (4) ◽  
pp. 562-570
Author(s):  
Utsha G. Khatri ◽  
Benjamin A. Howell ◽  
Tyler N. A. Winkelman
Keyword(s):  
Criminal Justice ◽  
Opioid Use Disorder ◽  
Medicaid Expansion ◽  
Opioid Use

scholarly journals 213. A Comparison of Medication Assisted Therapy Treatment Strategies for Opioid Use Disorder in Persons who Inject Drugs and are Hospitalized with Serious Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S126-S126
Author(s):  
Laura Marks ◽  
Evan Schwarz ◽  
David Liss ◽  
Munigala Satish ◽  
David K Warren ◽  
...  
Keyword(s):  
Fungal Infections ◽  
Hospital Readmissions ◽  
Treatment Strategies ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Readmission Rates ◽  
Persons Who Inject Drugs ◽  
Increased Risk ◽  
Hospital Patients ◽  
The Impact

Abstract Background Persons who inject drugs (PWID) with opioid use disorder (OUD) are at increased risk of invasive bacterial and fungal infections, which warrant prolonged, inpatient parenteral antimicrobial therapy. Such admissions are complicated by opioid cravings and withdrawal. Comparisons of medications for OUD during prolonged admissions for these patients have not been previously reported. The aim of this study was to evaluate the impact of different OUD treatment strategies in this population, and their impact on ED and hospital readmissions. Methods We retrospectively analyzed consecutive admissions for invasive bacterial or fungal infections in PWID, admitted between January 2016 and January 2019 at Barnes-Jewish Hospital. Patients in our cohort were required to receive an infectious diseases consult, and an anticipated antibiotic treatment duration of >2 weeks. We collected data on demographics, comorbidities, length of stay, microbiologic data, medications prescribed for OUD, mortality, and readmission rates. We compared 90-day readmission rates by OUD treatment strategies using Kaplan–Meier curves. Results In our cohort of 237 patients, treatment of OUD was buprenorphine (17.5%), methadone (25.3%), or none (56.2%). Among patients receiving OUD treatment, 30% had methadone tapers and/or methadone discontinued upon discharge. Patient demographics were similar for each OUD treatment strategy. Infection with HIV (2.8%), and hepatitis B (3%), and hepatitis C (67%) were similar between groups. Continuation of medications for OUD was associated with increased completion of parenteral antibiotics (odds ratio 2.11; 95% confidence interval 1.70–2.63). When comparing medications for OUD strategies, methadone had the lowest readmission rates, followed by buprenorphine, and no treatment (P = 0.0013) (figure). Discontinuation of methadone during the admission or upon discharge was associated with the highest readmission rates. Conclusion Continuation of OUD treatment without tapering, was associated with improved completion of parenteral antimicrobials in PWID with invasive bacterial or fungal infections lower readmission rates. Tapering OUD treatment during admission was associated with higher readmission rates. Disclosures All authors: No reported disclosures.

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