Temporary policy changes during the coronavirus disease 2019 pandemic facilitated rapid expansion of medication for opioid use disorder via telemedicine (tele-MOUD). Evidence for tele-MOUD best ...practices and its impact on treatment engagement and retention remains limited. This quality improvement initiative compared tele-MOUD implementation among Pennsylvania medication for opioid use disorder (MOUD) programs, evaluated sociodemographic characteristics of patients using tele-MOUD, and described trends in tele-MOUD use and patient engagement and retention.
Five health systems with MOUD programs completed questionnaires regarding their tele-MOUD models and provided aggregated sociodemographic data for MOUD patients with in-person and telemedicine visits in 2020. Three programs provided aggregated monthly appointment data (scheduled, completed, no-show, tele-MOUD visits) over the period in which tele-MOUD scaled up.
Differences in tele-MOUD protocols related to provision of tele-MOUD inductions, patient eligibility for tele-MOUD, and operationalization of remote drug testing. Across programs, 88% of prescribers conducted tele-MOUD appointments, and 50% of patients used tele-MOUD in 2020. We observed sociodemographic differences, with a greater proportion of female, White, and non-Hispanic patients using tele-MOUD. Across programs with appointment data, overall patient enrollment increased, and new patient enrollment remained relatively constant. Engagement trends suggested a temporary decline in no-show appointments that aligned with the escalation of tele-MOUD in one program.
Tele-MOUD protocol differences indicate a need for research to inform evidence-based guidance. Findings suggest that patients largely remained engaged and retained in MOUD as tele-MOUD was implemented but reveal inequities in tele-MOUD use, highlighting the need for efforts to overcome technology access barriers and avoid exacerbating disparities in MOUD access.
Increased emphasis on community collaboration indicates the need for consensus regarding the definition of community within public health. This study examined whether members of diverse US ...communities described community in similar ways. To identify strategies to support community collaboration in HIV vaccine trials, qualitative interviews were conducted with 25 African Americans in Durham, NC; 26 gay men in San Francisco, Calif; 25 injection drug users in Philadelphia, Pa; and 42 HIV vaccine researchers across the United States. Verbatim responses to the question "What does the word community mean to you?" were analyzed. Cluster analysis was used to identify similarities in the way community was described. A common definition of community emerged as a group of people with diverse characteristics who are linked by social ties, share common perspectives, and engage in joint action in geographical locations or settings. The participants differed in the emphasis they placed on particular elements of the definition. Community was defined similarly but experienced differently by people with diverse backgrounds. These results parallel similar social science findings and confirm the viability of a common definition for participatory public health.
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CEKLJ, DOBA, FSPLJ, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Using qualitative interviews conducted in 1999, we examine awareness and use of drug user treatment and social service referrals, medical care, and HIV testing provided by needle exchange programs ...(NEPs) among injectors who use NEPs (N = 26) and injectors who get their syringes from other sources (N = 20). A four-category typology of NEP service knowledge and use emerges from these interviews: "Active involvement"-use of services; "Steppingstone"-no use of services but knowledge that specific services are available; "Vague awareness"-nonspecific knowledge of service availability; and "Unaware:-no awareness of the service provision function of NEPs. We describe patterns of distribution of respondents among these categories and suggest policy implications.
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DOBA, FSPLJ, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
ABSTRACT
Objective:
Injection drug use has accounted for more than one third of acquired immune deficiency syndrome cases in the United States. The purpose of this study was to compare the ...demographic characteristics, types, and frequency of human immunodeficiency virus (HIV)‐risk behaviors among injection drug users (IDUs) recruited from a needle exchange program (NEP), methadone maintenance treatment (MMT), and detoxification (detox) program. Design: A cross‐sectional, correlational design was used to determine whether the selected HIV‐risk behaviors and demographic characteristics of IDUs varied by site of recruitment. Sample and Measurements: Confidential questionnaires were completed by 445 IDUs in Philadelphia, Pennsylvania. Results: Data analysis revealed that HIV sexual and injection‐risk behavior varied by recruitment site. Subjects recruited from the NEP were more likely to engage in HIV‐risk behaviors than subjects recruited from the MMT or detox sites. Conclusions: Interventions occurring in program and treatment sites need to be sensitive to various demographic characteristics and behaviors if they are to reach those at highest risk of HIV infection. Targeting HIV prevention interventions based upon risk group membership alone (e.g. IDUs) fails to address the distinct risk behaviors and demographic characteristics of enrollees in different programs.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK, VSZLJ
Objective: Injection drug use has accounted for more than one third of acquired immune deficiency syndrome cases in the United States. The purpose of this study was to compare the demographic ...characteristics, types, and frequency of human immunodeficiency virus (HIV)-risk behaviors among injection drug users (IDUs) recruited from a needle exchange program (NEP), methadone maintenance treatment (MMT), and detoxification (detox) program. Design: A cross-sectional, correlational design was used to determine whether the selected HIV-risk behaviors and demographic characteristics of IDUs varied by site of recruitment. Sample and Measurements: Confidential questionnaires were completed by 445 IDUs in Philadelphia, Pennsylvania. Results: Data analysis revealed that HIV sexual and injection-risk behavior varied by recruitment site. Subjects recruited from the NEP were more likely to engage in HIV-risk behaviors than subjects recruited from the MMT or detox sites. Conclusions: Interventions occurring in program and treatment sites need to be sensitive to various demographic characteristics and behaviors if they are to reach those at highest risk of HIV infection. Targeting HIV prevention interventions based upon risk group membership alone (e.g. IDUs) fails to address the distinct risk behaviors and demographic characteristics of enrollees in different programs.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK, VSZLJ
Background: Home specimen collection and telephone counseling (HSCTC) may be a convenient new method for detection of HIV infection among cohorts at high-risk for HIV. Goal: To evaluate attitudes ...about HSCTC among participants, HIV counselors, and community advisory board members associated with a national multisite study of persons at high risk for HIV. Study Design: Twelve focus groups and surveys were conducted at six sites among 126 counselors, community advisory board members, and cohort participants. Results: Staff and community advisory board members raised concerns about the acceptability, feasibility, safety, and effectiveness of HSCTC. In contrast, participants (92%) reported a willingness to collect blood and oral samples on a frequent basis, and preferred telephone (73%) to office-based counseling. Conclusion: Home specimen collection and telephone counseling appear to be preferred by study participants at high risk of HIV infection. Staff and community advisory board members had stronger reservations than prospective users.
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BFBNIB, NMLJ, NUK, PNG, UL, UM, UPUK
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