Reducing risky relationships: a multisite randomized trial of a prison-based intervention for reducing HIV sexual risk behaviors among women with a history of drug use

Women involved in the criminal justice system, particularly those with a history of drug use, are at elevated risk of HIV infection, yet few HIV prevention interventions have been tailored for delivery to incarcerated women. Drawing on the Relational Model, the Reducing Risky Relationships for HIV (RRR-HIV) intervention was developed and evaluated in a multisite randomized clinical trial. Women with weekly drug use prior to incarceration (n = 444) who were incarcerated within correctional institutions in four states were randomized to (1) the RRR-HIV intervention consisting of an HIV educational video, five group sessions, and one postrelease booster session or (2) a control condition consisting of the HIV educational video. The RRR-HIV intervention combined didactic and interactive content regarding seven “thinking myths” about intimate relationships that may result in decisions to engage in risky sexual behaviors. Data were collected while women were still incarcerated and approximately 90 days following release from prison by trained interviewers. A negative binomial regression (NBR) model of unprotected sexual behaviors at the 90-day follow-up indicated that RRR-HIV participants reported fewer unprotected sexual behaviors than women in the control condition once the analysis was adjusted for study site. Future studies should examine the sustainability of the RRR-HIV intervention's effect on risk reduction. Implementation research is needed to determine whether delivery of this intervention by correctional staff or peers, rather than research staff, yields similar reductions in unprotected sexual behaviors.     

Preventing growth in amphetamine use: long-term effects of the Midwestern Prevention Project (MPP) from early adolescence to early adulthood

Aim   The aim of the current study was to examine the long-term effect of an early adolescent substance abuse prevention program on trajectories and initiation of amphetamine use into early adulthood.
Design   Eight middle schools were assigned randomly to a program or control condition. The randomized controlled trial followed participants through 15 waves of data, from ages 11–28 years. This longitudinal study design includes four separate periods of development from early adolescence to early adulthood.
Setting   The intervention took place in middle schools.
Participants   A total of 1002 adolescents from one large mid-western US city were the participants in the study.
Intervention   The intervention was a multi-component community-based program delivered in early adolescence with a primary emphasis on tobacco, alcohol and marijuana use.
Measures   At each wave of data collection participants completed a self-report survey that included questions about life-time amphetamine use.
Findings   Compared to a control group, participants in the Midwestern Prevention Project (MPP) intervention condition had reduced growth (slope) in amphetamine use in emerging adulthood, a lower amphetamine use intercept at the commencement of the early adulthood and delayed amphetamine use initiation.
Conclusions   The pattern of results suggests that the program worked first to prevent amphetamine use, and then to maintain the preventive effect into adulthood. Study findings suggest that early adolescent substance use prevention programs that focus initially on the 'gateway' drugs have utility for long-term prevention of amphetamine use.     

Reducing bias in telephone survey estimates of the prevalence of drug use: a randomized trial of telephone audio-CASI

AIM: To assess the impact of telephone audio computer-assisted self-interviewing (T-ACASI) on reporting of alcohol use, alcohol problems and illicit drug use in telephone surveys of the general population. Prior research suggests that illicit drug use is underreported in traditional, interviewer-administered, telephone surveys. DESIGN: Randomized experiment embedded in telephone survey of probability samples of populations of USA and Baltimore, MD. Survey respondents were randomly assigned to be interviewed either by human telephone interviewers or by T-ACASI after household screening, recruitment, and informed consent procedures were completed. SETTING: Respondents were interviewed by telephone in their homes. PARTICIPANTS: Probability samples of 1543 English-speaking adults ages 18-45 residing in telephone-accessible households in USA and 744 similarly defined adults residing in Baltimore, MD, USA. MEASUREMENTS: Nine questions on alcohol, marijuana, cocaine, and injection drug use adapted from 1994 NHSDA and four CAGE questions on alcohol problems. Crude odds ratios and odds ratios controlling for demographic factors calculated to test for differences between responses obtained by T-ACASI and human interviewers. FINDINGS: T-ACASI had mixed effects on reporting of alcohol use, but it did increase reporting of one of four CAGE alcohol problems: feeling guilty about drinking (23.0% in T-ACASI vs. 17.6% in T-IAQ, OR = 1.4, P < 0.01). T-ACASI also obtained significantly more frequent reporting of marijuana, cocaine, and injection drug use. The impact of T-ACASI was most pronounced for reporting of recent use of 'harder' drugs. Thus T-ACASI respondents were more likely to report marijuana use in the past month (10.0% vs. 5.7%, crude OR = 1.9, P < 0.001), cocaine use in the past month (2.1% vs. 0.7%, crude 3.2, P < 0.001) and injection drug use in the past five years (1.6% vs. 0.3%, crude OR = 4.8, P < 0.01). CONCLUSIONS: Telephone survey respondents were more likely to report illicit drug use and one alcohol problem when interviewed by T-ACASI rather than by human telephone interviews.     

Injecting drug use: A vector for the introduction of new hepatitis C virus genotypes

Hepatitis C virus(HCV) genotypes' monitoring allows real-time insight into the dynamic changes that occur in the global epidemiological picture of HCV infection. Intravenous drug use is currently the primary driver for HCV transmission in developed and developing countries. The distribution of HCV genotypes/subtypes differs significantly between people who inject drugs(PWID) and the general population. HCV genotypes that previously exhibited a limited geographical distribution(3a,4) are becoming more prevalent in this high-risk group. Immigration from HCV-endemic countries and the evolving networks of HCV transmission in PWID influence HCV genotypes distribution in Europe. Social vulnerabilities(e.g.,unemployment,homelessness,and limited access to social and healthcare insurances systems) are important triggers for illicit drug use,which increases the associated risks of HCV infection and the frequent emergence of less prevalent genotypes. Genotype/subtype determination bears important clinical consequences in the progression of liver disease,susceptibility to antiviral therapies and the emergence of resistance-associated variants. An estimated half of the chronically HCV-infected PWID are unaware of their infection,and only one in ten of those diagnosed enter treatment. Nevertheless,PWID exhibit high response rates to new antiviral regimens,and the level of HCV reinfection is unexpectedly low. The focus of the healthcare system must be on the early detection and treatment of infection,to avoid late presentations that are associated with high levels of viremia and liver fibrosis,which may diminish the therapeutic success rate.     

A pilot study of the accuracy of onsite immunoassay urinalysis of illicit drug use in seriously mentally ill outpatients

Objectives: This pilot study investigated the accuracy of onsite immunoassay urinalysis of illicit drug use in 42 outpatients with co-occurring substance use disorders and serious mental illness. Methods: Up to 40 urine samples were submitted by each participant as part of a larger study investigating the efficacy of contingency management in persons with co-occurring disorders. Each sample was analyzed for the presence of amphetamine, methamphetamine, cocaine, marijuana, and opiates or their metabolites using onsite qualitative immunoassays. One onsite urinalysis was randomly selected from each participant for confirmatory gas chromatography–mass spectrometry (GC–MS) analyses. Results: Agreement between immunoassay and GC–MS was calculated. Agreement was high, with 98% agreement for amphetamine, methamphetamine, opiate, and marijuana. Agreement for cocaine was 93%. Conclusions: Results of this pilot study support the use of onsite immunoassay screening cups as an assessment and outcome measure in adults with serious mental illness. Scientific significance: Data suggest that onsite urinalysis screenings may be a helpful assessment tool for measuring clinical and research outcomes.     

Estimating the size and dynamics of an injecting drug user population and implications for health service coverage: comparison of indirect prevalence estimation methods

Aims (i) To compare indirect estimation methods to obtain mean injecting drug use (IDU) prevalence for a confined geographic location; and (ii) to use these estimates to calculate IDU and injection coverage of a medically supervised injecting facility. Design Multiple indirect prevalence estimation methods. Setting Kings Cross, Sydney, Australia. Participants IDUs residing in Kings Cross area postcodes recorded in surveillance data of the Sydney Medically Supervised Injecting Centre (MSIC) between November 2001 and October 2002. Measurements Two closed and one open capture–recapture (CRC) models (Poisson regression, truncated Poisson and Jolly–Seber, respectively) were fitted to the observed data. Multiplier estimates were derived from opioid overdose mortality data and a cross‐sectional survey of needle and syringe programme attendees. MSIC client injection frequency and the number of needles and syringes distributed in the study area were used to estimate injection prevalence and injection coverage. Findings From three convergent estimates, the mean estimated size of the IDU population aged 15–54 years was 1103 (range 877–1288), yielding a population prevalence of 3.6% (2.9–4.3%). Mean IDU coverage was 70.7% (range 59.1–86.7%) and the mean adjusted injection coverage was 8.8% (range 7.3–10.8%). Approximately 11.3% of the total IDU population were estimated to be new entrants to the population per month. Conclusions Credible local area IDU prevalence estimates using MSIC surveillance data were obtained. MSIC appears to achieve high coverage of the local IDU population, although only an estimated one in 10 injections occurs at MSIC. Future prevalence estimation efforts should incorporate open models to capture the dynamic nature of IDU populations.