No abstract

Summary This report describes an innovative HCV Peer Educator Program that facilitates education, support, and engagement in HCV treatment among patients in an opioid treatment program. Integrating peer educators in a collaborative manner with close supervision holds promise as a model to reduce barriers to HCV treatment among drug users.

The effects of androgens, testosterone and dihydrotestosterone (DHT), of an environmental anti-androgen, 2,2-bis(4-chlorophenyl)-1,1-dichloroethylene (DDE), and of glucocorticoids, hydrocortisone and dexamethasone, on growth kinetics and antibiotic susceptibility of E. faecalis, E. coli, P. aeurginosa, and S. aureus were measured. For P. aeurginosa, the presence of either DHT or DDE caused at least a fourfold shift in the minimum inhibitory concentration (MIC) of cefepime and tobramycin. DHT and DDE also affected the response of E. faecalis to meropenem and norfloxacin, resulting in a shift from sensitive to intermediate resistance (four-fold increase in MIC). Hydrocortisone (2 microM) induced an increase in the sensitivity of S. aureus to erythromycin, as compared to hormone-free control (from 0.5 to 0.06 microg/mL). The susceptibility pattern of E. coli was unaffected by the hormones tested. These changes in susceptibility to antibiotics were unrelated to alterations in growth kinetics. For all organisms tested, the alterations in MICs occurred only in the presence of hormone, indicative of changes in the phenotype of these stable quality control strains.

Chronic hepatitis C virus (HCV) infection is highly prevalent among current and former drug users. However, the minority of patients enrolled in drug treatment programs have initiated HCV treatment. New models are needed to overcome barriers to care. In this retrospective study, we describe the implementation and outcomes of 42 patients treated in a Concurrent Group Treatment (CGT) program. Patients participated in weekly provider-led group treatment sessions which included review of side effects; discussion of adherence and side effect management; administration of interferon injections; brief physical exam; and ended with brief meditation. Of the first 27 patients who initiated CGT, 42% achieved a sustained viral response. Additionally, 87% (13/15) of genotype-1 infected patients treated with direct acting antiviral agent achieved an undetectable viral load at 24 weeks. The CGT model may be effective in overcoming barriers to treatment and improving adherence and outcomes among patients enrolled in drug treatment programs.