Shiela M Strauss

Abstract

Drug treatment programs are uniquely situated to screen patients for antibodies for hepatitis C virus (HCV), an infectious disease that has reached epidemic proportions among drug users. This paper compares the accessibility and patients' use of opportunities for HCV antibody testing in a large sample of methadone and drug-free treatment programs (N=256) in the US, and reports programs' recent changes and future plans concerning it. Results indicate that almost all methadone and about two-thirds of drug-free programs in the sample provided HCV antibody screening to at least some patients in 2001. While about two-thirds of the methadone and close to one-third of the drug-free programs offered this service to all patients, these programs report that only about 3/5 of their patients actually provided specimens for testing for HCV antibodies. Some drug treatment programs were planning to increase the availability and accessibility of HCV antibody screening, but others were planning to cut back on these services, primarily due to limited resources. These results can inform policymakers who advocate for increased HCV antibody screening in drug treatment programs about the current level and future plans for implementing these services, illuminating where resources and motivational efforts need to be targeted.

Abstract

Although drug users are at elevated risk for hepatitis C virus (HCV) infection, many are uniformed or misinformed about the virus. Drug treatment programs are uniquely situated to provide comprehensive risk-modifying educational programs for decreasing HCV transmission, a strategy advocated in the most recent National Institutes of Health Consensus Development Conference Statement on the Management of Hepatitis C. Given the large proportion of patients that inject drugs in methadone maintenance treatment programs and the high prevalence of HCV among drug injectors, we compared a nationwide sample (N=246) of methadone maintenance treatment programs and drug-free programs regarding the content and comprehensiveness of HCV education. All of these programs provide HCV education to at least some of their patients. Results indicated that, compared to drug-free programs, methadone maintenance treatment programs cover a significantly greater number of HCV-related topics, and that a significantly greater proportion of the methadone programs cover specific topics (e.g., bow to avoid transmitting HCV, the importance of testing for HCV, treatment options if HCV positive). Of special concern is that fewer than three quarters of the drug-free programs address what to do if co-infected with human immunodeficiency virus (HIV) and HCV and bow to maintain health if HCV positive, and only about half of the drug-free and methadone maintenance treatment programs educate HCV-positive patients about the importance of obtaining vaccinations for hepatitis A and B. Drug treatment programs need to educate patients about the proactive steps these individuals can take to deal with HCV, provide critically needed HCV services, and encourage patients to make full use of these services.

Abstract

We demonstrate a model for categorical data that parallels the MIMIC model for continuous data. The model is equivalent to a latent class model with observed covariates; further, it includes simple handling of missing data. The model is used on data from a large-scale study of HIV that had both biological measures of infection and self-report (missing on some cases). The model allows the determination of sensitivity and specificity of each measure, and an assessment of how well true HIV status can be predicted from characteristics of the individuals in the study.

Abstract

This paper uses qualitative methods to examine both staff and clients' perceptions about the delivery of hepatitis C prevention education services at their respective residential drug treatment programs. Through in-depth discussion with participants, as well as program observation, we elicited clients' and staff attitudes about the role that drug treatment programs can play in providing prevention education services for hepatitis C, their evaluation of existing hepatitis C prevention education services, and recommendations for enhancing future services. Although participants identified limitations to services, most perceive that treatment programs can play an important role in hepatitis C prevention education service delivery. Participants view clients' misconceptions about hepatitis C, increased disease stigma, and diminished service utilization as potential consequences of limited hepatitis C prevention education services. Recommendations for improving services include more detailed and frequent opportunities for hepatitis C education, formalizing services, offering education in multiple formats, and providing additional staff training.

Abstract

Drug treatment facilities are important sites for providing targeted prevention and health services to injection drug users (IDUs) who are infected with the hepatitis C virus (HCV). A nationwide survey was conducted to examine whether differences exist in the HCV-related services provided by drug treatment programs that have varying proportions of IDUs among their patients. The results indicate that, overall, drug treatment programs with a greater proportion of IDUs offer significantly more HCV services as compared to programs with a smaller proportion of IDUs. However, important components of hepatitis C-related care, such as universal basic education and counseling about HCV and extensive HCV-antibody testing, are not yet being provided by all programs with a large proportion of IDUs among their patient populations.

Abstract

The hepatitis C virus (HCV) continues to penetrate populations within the United States, especially within the drug-abusing population. Therefore, drug users need access to HCV testing and medical care, and drug treatment programs are well situated to provide these services. Because directors of these programs are gatekeepers who can influence decisions about service provision, their beliefs about the value of providing particular services for drug treatment program patients are of considerable importance. Directors of 121 outpatient drug treatment programs throughout the United States responded to an in-depth telephone survey that included questions on their beliefs about providing HCV services in drug treatment programs. We constructed an eight-item scale to examine these beliefs and investigated the relationship between them and the actual HCV services offered. Overall, directors were moderately supportive of the provision of HCV medical services (on-site or through referral) during drug treatment. Our findings indicate that there is a positive significant relationship between director's beliefs and the provision of HCV antibody testing, follow-up testing, and the provision of HCV medication.

Abstract

Substance abusers are at high risk for hepatitis C (HCV) infection and also constitute a group that is medically underserved and hard to reach. We conducted a nationwide survey with 445 randomly selected drug treatment units in the United States to determine unit and patient characteristics associated with the provision of on-site medical services for HCV-infected drug users. Eighty-four percent of the 322 units that estimated having at least one HCV-infected patient reported that they provided patients with HCV-related medical care. Drug treatment units were more likely to provide at least some of this care on site if they were residential, part of a network, or affiliated with a hospital; had medical staff; and required that their patients undergo a medical examination before entering treatment. Some organizational factors appear to influence the provision of on-site medical services to HCV-positive patients in drug treatment units. Further research on the role of such factors could inform the development of effective models of care for patients with hepatitis C in drug treatment organizations.

Abstract

This article examines whether relationships between individual characteristics and HIV status can be identified when self-report data are used as a proxy for HIV serotest results. The analyses use data obtained from HIV serotests and face-to-face interviews with 7,256 out-of-treatment drug users in ten sites from 1992 to 1998. Relationships between 17 individual characteristics and HIV status (measured both by self-report and serotest results) were determined by (a) comparing and evaluating the fit of both standard and "nonstandard" loglinear models, and (b) evaluating the fit of marginal homogeneity models. The loglinear analyses showed that HIV serostatus was related to individual characteristics in 38 percent of the relationships. In most cases, the strength of the relationships between HIV status and individual characteristics did not differ when HIV status was measured with self report data.