Expanded and Enhanced Treatment Services in a Los Angeles OTP

1
Expanded and Enhanced Treatment Services in a
Los Angeles OTP

• Funded by
• The Center for Substance Abuse Treatment
• Targeted Capacity Expansion for Substance Abuse
  Treatment
  
• and HIV/AIDS Services (TCE/HIV)
• 1H79 TI12619
• 6H79 TI15867
• The Matrix Institute
• Project Director Michael McCann

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Integrating HIV and HCV Groups into an OTP Setting

• Dan George
• Matrix Institute on Addictions
• Los Angeles, CA

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This Section Will Focus on

• The Implementation of Manualized, Gender-specific
  HIV Groups
  
• The Creation of a HCV Education Group
• The Nuances of Group Implementation and Their
  Resulting Impact on Program Services
  
• And.

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.. Pamela Lee Anderson?
TO BE CONTINUED.
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HIV and HCV- Affecting Our Population

• HIV IDU
• high risk needle-sharing practices
• New AIDS cases reported in 2000, 28 IDU
  associated (CDC)
  
• HIV Crack use
• high risk sexual behaviors
• stronger association in women than men (Edlin,et
  al. 1994)
  

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HIV and HCV- Affecting Our Population

• Hepatitis C
• 3.9 5 million Americans infected (CDC)
• Approx. 60 of infections due to needle-sharing
• 70-96 long-term IDUs have been exposed
  (Hepatitis Association)
  

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HIV Groups-Why Gender Specific

• Analysis of Studies Evaluating HIV education
  within SAT programs (Prendergast et al, 2001)
  
• Reviewed 18 Studies
• Ranged in length
• Ranged in type of intervention

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Important Variables

• Intensity of intervention
• Education only vs skills acquisition (role-play)
• Use of peer group discussion
• Separate sex sessions

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HIV/AIDS Prevention for Women in Drug Treatment

• NIDA Sponsored
• Principal Investigator Rita Strombeck, PhD.
• GOAL Develop and Evaluate educational program
  targeting women in drug tx.
  
• Women Talking

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Women Talking

• Adaptation of AIDS Risk Reduction Model
• 3 stages
• recognition of risk
• commitment to reducing risk
• Commitment to seeking resolution
• Video and group discussions
• 4 X 2-hour sessions

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Educational Topics

• Recognition of Risks
• Commitment to Change
• Sex Behaviors
• Drug injection Behavior

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Abbreviated Study Design

• 2 Sites- LA Chicago
• 83 Women intervention group
• 83 Women control group
• Experimental Group
• Baseline interview
• Intervention (4 sessions)
• 1-month post interview
• 3- month post interview

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Abbreviated Study Design

• Control Group
• Baseline interview
• NO INTERVENTION
• 1-month post interview
• 3- month post interview
• Each participant received 25 gift certificate
  per interview

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Study Results

• Tx Grp Participants demonstrated
• Increase in HIV Knowledge/ Risk Recognition
• Increase in Personal Susceptibility
• Increase in Commitment/ Motivation of Behavior
  Change
  

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Project Effect on OTP Program Services

• Women Talking incorporated into in-house
  Womens HIV group
  
• Women Talking used as educational component of
  group
  
• Modified Womens group includes the following
  additional teaching strategies
  
• Role-playing for negotiating safer sex behavior
• Personalized risk assessments

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Time Out! for Men

• Time Out! for Men module created in 1996
• Based off the Time Out! For Me womens
  psychoeducational workshop (Bartholomew, Chatham
  Simpson, 1991).
  
• Time Out! for Me evaluated in methadone
  maintenance programs
  
• Increased knowledge self-esteem

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Time Out! For Men

• 8 X 2-hour sessions
• Adapted into TCE program
• 90 minute sessions
• Required participation for new enrollees
• Volunteer participation for ongoing clients

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Mens Group Objectives

• Improve communication skills
• Improve relationships
• Challenge gender-role stereotypes
• Increase knowledge on Mens Health
• Increase knowledge on HIV STIs

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Mens HIV Group

• General response is positive
• Increase in knowledge (pre/post snapshot)
• Expression of openness in group
• Provide incentives
• coffee and donuts
• Certificates upon completion

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Mens HIV Group- Nuances

• Difficulty with retention
• 8- sessions may be too long
• Reduce to four sessions
• Incorporate HCV group
• Mandatory for all new TCE program admits

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Hepatitis C Education Group

• TCE funding- antibody test 94
• Created due to a general lapse in knowledge among
  patients.
  
• Many misunderstandings and myths
• Pamela Lee Anderson- Mainstream myths
• Create an education group curriculum to
  disseminate info in a quick/efficient manner

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HCV Group Topics

• Disease Overview (hx, statistics)
• Symptoms
• Modes of Transmission
• Tx Options
• Combotherapy (pegylated interferon ribavirin)
• Healthcare maintenance and MD follow-up
• Positives of Methadone Maintenance

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HCV Curriculum- Learner Domains

• Cognitive
• Learner objective increase knowledge of
  transmission, symptoms, tx options
  
• Evaluative criteria pre/ post test scores
• Affective
• Learner Objective increase perceived risk and
  perceived controllability
  
• Evaluative Criteria pre/ post test, observation
  during discussions
  

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Learner Domains

• Behavioral
• Learner Objective increase MD evaluation
  follow-up and reduce needle-sharing
  
• Evaluative criteria MD follow-up rates and
  reported needle-sharing practices (post
  6-months)
  

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Process Evaluation Effect on Program Services

• Integration of 1X HCV group within HIV specific
  series
  
• Add/ Use role-playing communication strategies
  re MD
  
• Lack staffing to conduct HCV follow-up interviews
  for evaluation

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Expanding Program Services

• Maintained/ Established strong HIV/HCV testing
  and counseling services
  
• In-house HIV testing/ counseling by County (rapid
  testing now offered)
  
• Valley Community Clinic Mobile Unit (HCV/ STD
  testing/ counseling)