Preventive healthcare services receipt and primary care provider utilization among people who inject drugs

Introduction: People who inject drugs (PWID) face barriers to accessing primary care providers (PCPs) and preventive services, but are at increased risk for preventable infections Preventive services can be accessed through PCPs, or while hospitalized or at community organizations like syringe service programs (SSPs)https://knowledgeconnection.mainehealth.org/lambrew-retreat-2021/1041/thumbnail.jp

Factors that Influence Perception of HIV Risk and Willingness to Use Pre-Exposure Prophylaxis in People Who Inject Drugs

Introduction: Sexual and injection behaviors increase the risk of HIV transmission in people who inject drugs (PWID). We aimed to determine the prevalence of sexual and drug behaviors that increase HIV risk in PWID hospitalized for infections related to injection drug use in Maine. We also examined factors that influenced their perception of HIV risk and willingness to take pre-exposure prophylaxis (PrEP). Methods: We surveyed 101 PWID with infections related to injection drug use who were hospitalized at 4 hospitals in Maine. T-tests assessed differences in means of bacterial infection risk scores and willingness to take PrEP based on different sociodemographic factors. Results: PWID engaging in unsafe sexual behavior had a higher mean score of bacterial infection risk than those engaging in safer sexual behavior (3.90 vs 3.07; P = .06). PWID with lower educational attainment had a lower mean score of willingness to take PrEP than those with a higher educational attainment (3.19 vs 3.85; P = .02). Willingness to take PrEP was positively associated with the level of educational attainment (odds ratio, 2.14; 95% CI, 1.01-4.93; P = .048). Discussion: Our findings associated willingness to take PrEP with educational attainment. To prevent HIV infection, harm reduction programs that discuss risk behaviors with PWID could be expanded, especially in rural areas where people have lower educational levels. Conclusions: We found that injection and sexual risk behaviors co-occurred in PWID, PWID had an overall perception of low HIV risk, and willingness to take PrEP was positively associated with the level of educational attainment

Under One Roof – An Integrated Clinic for Substance Use Disorder and Viral Hepatitis/HIV Treatment

Introduction: Integration of viral hepatitis/HIV care and substance use disorder (SUD) treatment has been shown to improve patient outcomes, but data are lacking in rural states like Maine. Our study objective was to assess the baseline characteristics and outcomes of patients with SUD who receive combined substance use and viral hepatitis/HIV treatment at a recently established “Bridge Program” in our rural state. Methods: We conducted a retrospective chart review of patients enrolled in the Bridge Program between January 2020 and November 2021. We then performed a descriptive analysis of demographics, health characteristics, preventive services, and treatment outcomes. Results: A total of 14 patients were enrolled in the Bridge Program, of which 13/14 (93%) had hepatitis C, and 3/14 (21%) had HIV. When indicated, 100% of participants received appropriate medication for addiction treatment (buprenorphine/naloxone or naltrexone), naloxone kits, and hepatitis A and B vaccinations. Among patients with hepatitis C, 12/13 (92%) started antiviral treatment, of which 10/12 (83%) either achieved treatment cure or are receiving ongoing treatment. Discussion: Integrated care models can successfully treat SUD and HIV/viral hepatitis as co-occurring medical conditions. These models must consider approaches to reduce the number of visits and travel time required for optimal treatment, and enhance recovery by consistently prescribing evidence-based medication for SUD. Conclusions: Our study shows how an integrated clinic model in a rural state can provide comprehensive care, including SUD treatment, naloxone prescribing, vaccinations, and, importantly, high rates of successful hepatitis C/HIV treatment

Characteristics of Inpatients with Opioid Use Disorder Seen by “IMAT” Consult Service from 7/2016 - 6/2017

Introduction: • For people with opioid use disorder (OUD), admission to the hospital can provide an opportunity to initiate substance use disorder (SUD) treatment and preventive care • In 2016, a multidisciplinary “IMAT” (integrated medication for addiction treatment) inpatient team was established to help treat patients with SU

Use of Syringe Service Programs in Rural vs Urban Maine: A Harm-Reduction Study

Introduction: Syringe service programs (SSPs) reduce HIV and viral hepatitis transmission, as well as the prevalence of improperly disposed needles and needle stick injuries among first responders. Infections associated with injection drug use are rising in rural areas, including Maine, leading to concerns that SSP services are difficult to access for rural residents. Methods: A cross-sectional survey of 101 participants hospitalized with infections associated with injection drug use at 4 hospitals in Maine was collected over a 15-month period. Descriptive analyses were performed. Statistical analyses were completed using Fisher’s exact tests, Pearson’s chi-squared tests, and Student’s t tests. Results: Of 101 participants, 66 (65%) lived in urban areas, and 35 (35%) lived rurally. Participants living in rural areas reported less SSP use in the past 3 months (76% urban vs 43% rural). Rural participants also had a higher prevalence of injecting buprenorphine than urban participants (6% urban vs 12% rural). Rural participants were also more likely to obtain needles from pharmacies than urban participants (40% urban vs 71% rural). Discussion: SSP programs are underrepresented and accessed less in rural areas of Maine. Rural populations of people who inject drugs have unique health characteristics and syringe-use practices. Conclusions: These findings highlight the need to develop rural SSP programs that address the unique needs of rural populations

Facilitators and Barriers to Accessing Harm Reduction Services in a Rural State

INTRODUCTION • The impact of social distancing policies during the COVID-19 pandemic on people who inject drugs (PWID) is not known. • We aimed to describe the impact of the pandemic on PWID access to harm reduction services in Mainehttps://knowledgeconnection.mainehealth.org/lambrew-retreat-2021/1017/thumbnail.jp

Exploration of telemedicine for the delivery of Substance Use Disorder treatment during the COVID-19 Pandemic

https://knowledgeconnection.mainehealth.org/lambrew-retreat-2021/1015/thumbnail.jp

Association Between Primary Care Provider Status and Preventive Health Care Among People Who Inject Drugs

Introduction: People who inject drugs (PWID) are at increased risk for preventable, communicable infections, such as hepatitis B. Preventive care, such as hepatitis B vaccination, is often delivered through primary care providers (PCPs). However, PWID may not have access to PCPs and, therefore, may receive preventive care through other sites. We aimed to characterize PCP and preventive care use among PWID in Maine. Methods: This is a cross-sectional study of PWID hospitalized with infections associated with injection drug use in Maine from January 2019 to May 2020. Descriptive analyses were used to identify characteristics of participants, rates of screening, and vaccination of participants with and without PCPs. Logistic regression analyses were performed to explore the relationship between PCP status and delivery of preventive services for PWID. Hepatitis B vaccination was an outcome of interest. Results: Of 101 participants, 68 (67%) had a PCP. Overall rates of hepatitis C (93%) and HIV (85%) screening were high and did not differ based on PCP status. More participants with PCPs had previously received a hepatitis B vaccination (62% of those with PCPs, 33% of those without PCPs; P = .006). Only half of those with PCPs recalled receiving a hepatitis B vaccination through a PCP office. Having a PCP was predictive of having received the hepatitis B vaccination (adjusted odds ratio, 3.59; 95% CI, 1.27-7.58; P = .014). Conclusions: Many PWID in Maine engage with PCPs and preventive care. Results from this study call for enhanced delivery of preventive services and linkages to care for PWID

A Cascade of Care of Patients with Hepatitis C Infection in a Rural State

Introduction: The substance misuse epidemic has fueled an increase in hepatitis C virus (HCV) infections. Despite the availability of sensitive screening and curative treatment, relatively few people are aware of their diagnosis and engaged in care. In this study, we aimed to identify local gaps in HCV care and inform strategies for improvement. Methods: In this retrospective study, we assessed adult patients seen at a tertiary care center from 2015 to 2019 and who were eligible for HCV screening based on recommendations from the Centers for Disease Control and Prevention. Inclusion criteria were birth from 1945 to 1965, long-term dialysis treatment, alanine aminotransferase greater than 35 U/L for 6 months or more, and/or a diagnosis of opioid use disorder (OUD), HIV/AIDS, or hepatitis B virus (HBV) infection. We summarized the HCV cascade of care with descriptive statistics and used logistic regression to identify factors associated with HCV screening. Results: We identified 4948 patients eligible for HCV screening, of whom 47% were female, 54% were male; 7% were Black, 83% were White, and 10% were Other/Unknown; and 87% were born between 1945 and 1965. Among the patients, 2791/4948 (56%) were screened and 124/2791 (4%) were identified to have chronic HCV infection, of whom 12/124 (10%) were linked to care, ever treated, and cured. Patients with HCV included 63/124 (51%) with OUD and 65/124 (52%) with HBV coinfection. All risk factors for HCV were independently associated with HCV screening, except OUD (aOR, 1.2; 95% CI, 0.9-1.6; P = .28). Discussion: We identified multiple gaps in the HCV cascade of care at our institution. Our findings, paired with data from the Veterans Health Administration and national research, indicate a need for more comprehensive strategies for HCV screening and intervention. Conclusions: Our findings will help to direct strategies for improving HCV detection and subsequent enrollment into care, particularly for patients with OUD

“I know my body better than anyone else” Perspectives of people who inject drugs on antimicrobial treatment decision making for serious infections

Introduction: • Few studies have examined the perspectives of patients with lived experience regarding outpatient treatment options for injection drug use (IDU) associated infections. • We sought to better understand the perspectives of both community partners with lived experience who work with people who inject drugs (PWID) and hospitalized patients with IDU-associated infections on shared treatment decision making.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2023/1009/thumbnail.jp