Coming Out to Treatment: Identifying facilitators & characterizing experiences of Sexual and Gender Minoritized Individuals in Opioid Use Disorder Treatment before and during the COVID-19 pandemic

Sexual and Gender Minority (SGM) individuals are disproportionately impacted by substance use disorders vs. their non-SGM counterparts. Additionally, SGM folks face more barriers to access for treatment than others due to minority stressors including discrimination, internalized stigma, and marginalization related to their sex and gender minority statuses. It is important for researchers and treating providers alike to understand how these different factors are impacting the treatment of substance use disorders in SGM populations. With this in mind, this two phase study employed a mixed-methods approach to (1) describe the population of SGM folks enrolled in a MOUD treatment program with a focus on engagement and retention called BRITER (“Bringing Resources Individually To Engage Recovery”) at a clinic in Baltimore, MD, (2) identify factors impacting treatment engagement and retention using subjective experiences and quantitative measures, and (3) better understand the impact of COVID-19 on treatment in a sample of SGM individuals with OUD. The majority of Phase 1 participants in the eligible participant pool (n=52) were bisexual women, screened positive for PTSD at enrollment, and were receiving Methadone treatment. Of that participant pool, N=4 completed surveys and interviews in Phase 2. From the interviews, five themes were identified as influencing treatment engagement among SGM including: how they think about themselves, their experience of support vs. discrimination during treatment by staff and fellow patients, the support they have from family and friends to engage in care, as well as policy associated with the context in which they are receiving treatment. SGM in treatment for OUD encounter unique challenges when engaging in treatment, and further research is needed to ascertain how best to support them

PREDICTORS OF EXPERIMENTAL AND CONTROL GROUP ATTENDANCE: FINDINGS FROM AN HIV/STD PREVENTION RCT WITH PREGNANT WOMEN AT RISK FOR SUBSTANCE USE

Efforts to improve inclusion in research have included mandating the recruitment of ethnic minorities and women into NIH funded studies. However, little research has been completed on who attends such interventions. This is particularly worrisome in populations for which attendance to interventions can have dire consequences. HIV is a public health concern for pregnant women in substance using communities, as pregnant women are much less likely to use condoms during intercourse to prevent HIV. Group modular HIV prevention interventions have long been the standard for HIV prevention. However, little attention in research on HIV prevention interventions RCTs has been focused on attendance to these interventions. This study examined predictors of intervention and control group attendance in a randomized controlled trial comparing a 5-session Safer Sex Skill Building (SSB) intervention to a 1-session HIV education control group in a sample of pregnant women at risk for prenatal substance use. This study identified psychosocial and mental health variables associated with both 1 session control group and 5-session SSB intervention attendance as well as endeavored to identify the number of sessions necessary to attend to achieve an adequate dose in treatment. Findings include younger age and marital status as being predictive of participation in the one session HE control group and having a trade, skill, or profession as being predictive of participation in the five session SSB intervention group. Further research is needed to understand what factors may impact five-session SSB group attendance

Predictors and moderators of outcomes of HIV/STD sex risk reduction interventions in substance abuse treatment programs: a pooled analysis of two randomized controlled trials

BACKGROUND: The objective of the current study was to examine predictors and moderators of response to two HIV sexual risk interventions of different content and duration for individuals in substance abuse treatment programs. METHODS: Participants were recruited from community drug treatment programs participating in the National Institute on Drug Abuse Clinical Trials Network (CTN). Data were pooled from two parallel randomized controlled CTN studies (one with men and one with women) each examining the impact of a multi-session motivational and skills training program, in comparison to a single-session HIV education intervention, on the degree of reduction in unprotected sex from baseline to 3- and 6- month follow-ups. The findings were analyzed using a zero-inflated negative binomial (ZINB) model. RESULTS: Severity of drug use (p < .01), gender (p < .001), and age (p < .001) were significant main effect predictors of number of unprotected sexual occasions (USOs) at follow-up in the non-zero portion of the ZINB model (men, younger participants, and those with greater severity of drug/alcohol abuse have more USOs). Monogamous relationship status (p < .001) and race/ethnicity (p < .001) were significant predictors of having at least one USO vs. none (monogamous individuals and African Americans were more likely to have at least one USO). Significant moderators of intervention effectiveness included recent sex under the influence of drugs/alcohol (p < .01 in non-zero portion of model), duration of abuse of primary drug (p < .05 in non-zero portion of model), and Hispanic ethnicity (p < .01 in the zero portion, p < .05 in the non-zero portion of model). CONCLUSION: These predictor and moderator findings point to ways in which patients may be selected for the different HIV sexual risk reduction interventions and suggest potential avenues for further development of the interventions for increasing their effectiveness within certain subgroups