Harm reduction for the treatment of patients with severe injection-related infections: description of the Jackson SIRI Team

Introduction: Hospitalizations for severe injection-related infections (SIRI), such as endocarditis, osteomyelitis, and skin and soft tissue infections (SSTI) are increasingly common. People who inject drugs (PWID) experiencing SIRIs often receive inadequate substance use disorder (SUD) treatment and lack of access to harm reduction services. This translates into lengthy hospitalizations with high rates of patient-directed discharge, readmissions, and post-hospitalization mortality. The purpose of this study was to describe the development of an integrated “SIRI Team” and its initial barriers and facilitators to success. Materials and methods: The Jackson SIRI Team was developed to improve both hospital and patient-level outcomes for individuals hospitalized with SIRIs at Jackson Memorial Hospital, a 1550-bed public hospital in Miami, Florida, United States. The SIRI Team provides integrated infectious disease and SUD treatment across the healthcare system starting from the inpatient setting and continuing for 90-days post-hospital discharge. The team uses a harm reduction approach, provides care coordination, focuses on access to medications for opioid use disorder (MOUD), and utilizes a variety of infection and addiction treatment modalities to suit each individual patient. Results: Over the initial 8-months of the SIRI Team, 21 patients were treated with 20 surviving until discharge. Infections included osteomyelitis, endocarditis, bacteraemia/fungemia, SSTIs, and septic arthritis. All patients had OUD and 95% used stimulants. All patients were discharged on MOUD and 95% completed their prescribed antibiotic course. At 90-days post-discharge, 25% had been readmitted and 70% reported taking MOUD. Conclusions: A model of integrated infectious disease and SUD care for the treatment of SIRIs has the potential to improve infection and addiction outcomes. Providing attentive, patient-centered care, using a harm reduction approach can facilitate engagement of this marginalized population with the healthcare system.KEY MESSAGES Integrated infectious disease and addiction treatment is a novel approach to treating severe injection-related infections. Harm reduction should be applied to treating patients with severe injection-related infections with a goal of facilitating antibiotic completion, remission from substance use disorder, and reducing hospital readmissions

ASSOCIATIONS BETWEEN SMOKING CONSUMPTION, TOBACCO CESSATION ATTITUDES, AND AGE AMONG LATINO HEALTHCARE PROVIDERS

Hospitalization is a good opportunity to offer smoking cessation programs to smokers. Healthcare providers′ (HCP) tobacco consumption and cessation attitudes are known to affect the provision of cessation interventions. Lesser known are Latino HCP’s tobacco intervention attitudes. This study aimed to examine the associations between tobacco cessation attitudes (TCA), levels of consumption, and demographics among Latino HCP’s. A quantitative, correlational, cross-sectional design was used. 66 HCP’s working in a public hospital in Santiago, Chile self-reported demographics (age, gender, profession), tobacco consumption, and TCA. TCA’s include questions regarding Acceptability of Brief Counseling (ABC), belief whether smoking is harmful for patients, and duty to aid patients quit smoking. Majority of HCP’s (34 years old, 83% female, 58.5% technical nurses, 38.5% nurses, 3.1% Kinesiologists) did not consume tobacco (67%). Pearson’s correlation revealed that greater HCP age was significantly associated with less belief that smoking is harmful for their patients (r = -.36, p. = .004). ABC (M = 22, SD = 5.5) was positively associated with the belief that smoking is harmful for patients (r = .306, p = .016) and duty to help patients quit smoking (r = .574, p = .000). Findings provide evidence that HCP’s TCA’s are important factors to consider during implementation of a brief counseling for tobacco cessation. Further research should focus on increasing HCP’s acceptability of providing cessation care to their patients. Specifically, tailoring education and interventions by age might serve useful to address the differences in TCA’s which may subsequently influence their tobacco cessation practices

2667. Bridging the Gap: Sexually Transmitted Infections Testing, Treatment, and Prevention at a Miami Syringe Services Program for Women Who Inject Drugs

Abstract Background Women who inject drugs (WWID) remain understudied despite their compounded vulnerability to HIV. WWID experience increased mortality and multilevel barriers to care, including violence, homelessness, stigma, and competing priorities of childcare. In 2016, Florida passed the Infectious Disease Elimination Act (IDEA), legalizing IDEA Syringe Services Program (SSP) as the first in the state. Located in one of the country’s highest-incidence areas of HIV, IDEA SSP in Miami offers harm reduction and health opportunities outside of the traditional health care system. Previous IDEA SSP data show that WWID, representing 27% of participants overall, are more likely to report opioid injection, syringe sharing, injecting more than 5 times a day, sexual activity in the past 30 days, and transactional sex compared to their male counterparts. Methods IDEA SSP offered sexually transmitted infection (STI) testing and treatment July 1, 2022 through March 31, 2023. This descriptive study included women of childbearing age (18-44 years old) who injected drugs and were SSP participants (N=47). Results Among chlamydial infections, 2.1% had oropharyngeal, 4.3% had urethral, and 6.4% had rectal involvement. Three women (6.4%) experienced both gonococcal pharyngitis and urethritis. Rectal gonorrhea was detected in four of the 47 women (8.5%), with half testing positive twice within a 3-month period. 14 women (29.8%) demonstrated reactive syphilis testing. Of 37 women consenting to testing, three screened positive for pregnancy (8.1%). One had gonococcal pharyngitis, proctitis, and urethritis and two had other STI co-infections. Within this cohort of 47 women, 31 of the 32 HIV-negative participants initiated pre-exposure prophylaxis (PrEP) of HIV at IDEA SSP. Of the 12 with HIV, 83% reported adherence to antiretroviral therapy (ART). Three women had unknown HIV status. Conclusion Despite high HIV/STI co-infection and stigma precluding care in traditional health settings, WWID accessing IDEA SSP engaged with PrEP/ART and STI screening, including 100% of women receiving treatment for gonorrhea, chlamydia, and syphilis. Tailoring STI services at an SSP where WWID access nonjudgmental care caters to a historically neglected but key cohort in Ending the HIV Epidemic. Disclosures Hansel Tookes, III, MD, MPH, Gilead sciences: Grant/Research Support|Viiv: Grant/Research Suppor

Improving access to HIV care among people who inject drugs through tele-harm reduction: a qualitative analysis of perceived discrimination and stigma

Abstract Background Tele-harm reduction (THR) is a telehealth-enhanced, peer-led, harm reduction intervention delivered within a trusted syringe services program (SSP) venue. The primary goal of THR is to facilitate linkage to care and rapid, enduring virologic suppression among people who inject drugs (PWID) with HIV. An SSP in Miami, Florida, developed THR to circumvent pervasive stigma within the traditional healthcare system. Methods During intervention development, we conducted in-depth interviews with PWID with HIV (n = 25) to identify barriers and facilitators to care via THR. We employed a general inductive approach to transcripts guided by iterative readings of the raw data to derive the concepts, themes, and interpretations of the THR intervention. Results Of the 25 PWID interviewed, 15 were in HIV care and adherent to medication; 4 were in HIV care but non-adherent; and 6 were not in care. Themes that emerged from the qualitative analysis included the trust and confidence PWID have with SSP clinicians as opposed to professionals within the traditional healthcare system. Several barriers to treatment were reported among PWID, including perceived and actual discrimination by friends and family, negative internalized behaviors, denial of HIV status, and fear of engaging in care. Facilitators to HIV care included empathy and respect by SSP staff, flexibility of telehealth location, and an overall destigmatizing approach. Conclusion PWID identified barriers and facilitators to receipt of HIV care through the THR intervention. Interviews helped inform THR intervention development, centered on PWID in the destigmatizing environment of an SSP

Improving access to HIV care among people who inject drugs through tele-harm reduction: a qualitative analysis of perceived discrimination and stigma

Tele-harm reduction (THR) is a telehealth-enhanced, peer-led, harm reduction intervention delivered within a trusted syringe services program (SSP) venue. The primary goal of THR is to facilitate linkage to care and rapid, enduring virologic suppression among people who inject drugs (PWID) with HIV. An SSP in Miami, Florida, developed THR to circumvent pervasive stigma within the traditional healthcare system.During intervention development, we conducted in-depth interviews with PWID with HIV (n = 25) to identify barriers and facilitators to care via THR. We employed a general inductive approach to transcripts guided by iterative readings of the raw data to derive the concepts, themes, and interpretations of the THR intervention.Of the 25 PWID interviewed, 15 were in HIV care and adherent to medication; 4 were in HIV care but non-adherent; and 6 were not in care. Themes that emerged from the qualitative analysis included the trust and confidence PWID have with SSP clinicians as opposed to professionals within the traditional healthcare system. Several barriers to treatment were reported among PWID, including perceived and actual discrimination by friends and family, negative internalized behaviors, denial of HIV status, and fear of engaging in care. Facilitators to HIV care included empathy and respect by SSP staff, flexibility of telehealth location, and an overall destigmatizing approach.PWID identified barriers and facilitators to receipt of HIV care through the THR intervention. Interviews helped inform THR intervention development, centered on PWID in the destigmatizing environment of an SSP

Implementation of an integrated infectious disease and substance use disorder team for injection drug use-associated infections: a qualitative study

Hospitalizations for severe injection drug use-related infections (SIRIs) are characterized by high costs, frequent patient-directed discharge, and high readmission rates. Beyond the health system impacts, these admissions can be traumatizing to people who inject drugs (PWID), who often receive inadequate treatment for their substance use disorders (SUD). The Jackson SIRI team was developed as an integrated infectious disease/SUD treatment intervention for patients hospitalized at a public safety-net hospital in Miami, Florida in 2020. We conducted a qualitative study to identify patient- and clinician-level perceived implementation barriers and facilitators to the SIRI team intervention. Participants were patients with history of SIRIs (n = 7) and healthcare clinicians (n = 8) at one implementing hospital (Jackson Memorial Hospital). Semi-structured qualitative interviews were performed with a guide created using the Consolidated Framework for Implementation Research (CFIR). Interviews were transcribed, double coded, and categorized by study team members using CFIR constructs. Implementation barriers to the SIRI team intervention identified by participants included: (1) complexity of the SIRI team intervention; (2) lack of resources for PWID experiencing homelessness, financial insecurity, and uninsured status; (3) clinician-level stigma and lack of knowledge around addiction and medications for opioid use disorder (OUD); and (4) concerns about underinvestment in the intervention. Implementation facilitators of the intervention included: (1) a non-judgmental, harm reduction-oriented approach; (2) the team's advocacy for PWID as a means of institutional culture change; (3) provision of close post-hospital follow-up that is often inaccessible for PWID; (4) strong communication with patients and their hospital physicians; and (5) addressing diverse needs such as housing, insurance, and psychological wellbeing. Integration of infectious disease and SUD treatment is a promising approach to managing patients with SIRIs. Implementation success depends on institutional buy-in, holistic care beyond the medical domain, and an ethos rooted in harm reduction across multilevel (inner and outer) implementation contexts

Integrated infectious disease and substance use disorder care for the treatment of injection drug use-associated infections: a prospective cohort study with historical control.

BACKGROUND: To address the infectious disease (ID) and substance use disorder (SUD) syndemic, we developed an integrated ID/SUD clinical team rooted in harm reduction at a county hospital in Miami, Florida. The Severe Injection-Related Infection (SIRI) team treats people who inject drugs (PWID) and provides medical care, SUD treatment, and patient navigation during hospitalization and after hospital discharge. We assessed the impact of the SIRI team on ID and SUD treatment and healthcare utilization outcomes. METHODS: We prospectively collected data on patients seen by the SIRI team. A diagnostic code algorithm confirmed by chart review was used to identify a historical control group of patients with SIRI hospitalizations in the year preceding implementation of the SIRI team. The primary outcome was death or readmission within 90 days post-hospital discharge. Secondary outcomes included initiation of medications for opioid use disorder (MOUD) and antibiotic course completion. RESULTS: There were 129 patients included in the study: 59 in the SIRI team intervention and 70 in the pre-SIRI team control group. SIRI team patients had a 45% risk reduction of being readmitted in 90 days or dying compared to pre-SIRI historical controls. SIRI team patients were more likely to initiate MOUD in the hospital, complete antibiotic treatment, and less likely to have patient-directed discharge. CONCLUSIONS: An integrated ID/SUD team was associated with improvements in healthcare utilization, MOUD initiation, and antibiotic completion for PWID with infections