Nurse‐led intervention to decrease drug use among LTBI positive homeless adults

Objective. We documented the prevalence, distribution, and correlates of hepatitis C virus (HCV) infection among urban homeless adults. Methods. We sampled a community-based probability sample of 534 homeless adults from 41 shelters and meal programs in the Skid Row area of downtown Los Angeles, California. Participants were interviewed and tested for HCV, hepatitis B, and HIV. Outcomes included prevalence, distribution, and correlates of HCV infection; awareness of HCV positivity; and HCV counseling and treatment history. Results. Overall, 26.7% of the sample tested HCV-positive and 4.0% tested HIV-positive. In logistic regression analysis, independent predictors of HCV infection for the total sample included older age, less education, prison history, and single- and multiple-drug injection. Among lifetime drug injectors, independent predictors of HCV infection included older age, prison history, and no history of intranasal cocaine use. Among reported non-injectors, predictors of HCV infection included older age, less education, use of non-injection drugs, and three or more tattoos. Sexual behaviors and snorting or smoking drugs had no independent relationship with HCV infection. Among HCV-infected adults, nearly half (46.1%) were unaware of their infection. Conclusions. Despite the high prevalence of HCV infection, nearly half of the cases were hidden and few had ever received any HCV-related treatment. While injection drug use was the strongest independent predictor, patterns of injection drug use, non-injection drug use, prison stays, and multiple tattoos were also independent predictors of HCV. Findings suggest that urgent interventions are needed to screen, counsel, and treat urban homeless adults for HCV infection.

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Prevention of OUD: The HOME (Housing, Opportunities, Motivation and Engagement) Feasibility Study

10.21203/rs.3.rs-805017/v1 ◽

2021 ◽

Author(s):

Kelly Kelleher ◽

Ruri Famelia ◽

Tansel Yilmazer ◽

Allen Mallory ◽

Jodi Ford ◽

...

Keyword(s):

Young Adults ◽

Drug Use ◽

Repeated Measures ◽

Cognitive Distortions ◽

Preventive Intervention ◽

Supportive Housing ◽

Housing First ◽

Homeless Adults ◽

Intervention Services

Abstract Young adults experiencing homelessness are at high risk of opioid and other substance use, poor mental health outcomes, exposure to trauma, and other risks. Providing access to stable housing has the potential to act as a powerful preventive intervention, but supportive housing programs have been studied most often among chronically homeless adults or adults with serious mental illness. The Housing First model, which does not precondition supportive housing on sobriety, has been shown to reduce drug use in homeless adults. In the present study, we piloted an adapted model of Housing First that was tailored to the needs of young adults (18–24 years) experiencing homelessness. Supportive services were added to the Housing First model and included youth-centered advocacy services, motivational interviewing, and HIV risk prevention services. This model was piloted in a single-arm study (n = 21) to assess the feasibility, acceptability, and initial efficacy of a Housing First model over a 6-month period. We use repeated measures ANOVA to test for changes in alcohol and drug use (percent days of use; alcohol or drug use consequences), housing stability, social network support, and cognitive distortions over 6 months of follow-up. A total of 17 youth completed the study (85% retention) and a high proportion of youth were stably housed at 6-month follow-up. Participation in intervention services was high with an average of 13.57 sessions for advocacy, 1.33 for MI, and 0.76 for HIV prevention. Alcohol use did not change significantly over time. However, drug use, drug use consequences, and cognitive distortions, and the size of youths’ social networks that were drug using individuals decreased significantly. The Housing First model appeared to be feasible to deliver and youth engaged in the supportive intervention services. The study demonstrates the potential for an adapted Housing First model to be delivered to youth experiencing homelessness and may improve outcomes.

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