Integrating Hepatitis, STD, and HIV Services into a Drug Rehabilitation Program

Gunn, Robert A.; Lee, Marjorie A.; Callahan, David B.; Gonzales, Paul; Murray, Paula J.; Margolis, Harold S.

doi:10.1016/j.amepre.2005.03.010

Cited by 25 publications

(24 citation statements)

References 16 publications

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“…Several studies tested for both gonorrhea and chlamydia in drug users (Bachmann et al, 2000;Friedman et al, 2003;Gunn et al, 2005;Hwang et al, 2000;Lally et al, 2002;Latka et al, 2001;Liebschutz et al, 2003;Ross et al, 2002). For gonorrhea, a prevalence rate ranging from 1% to 3% was reported in those studies.…”

Section: Stds Among Drug Usersmentioning

confidence: 99%

Behavior Change and Health-Related Interventions for Heterosexual Risk Reduction Among Drug Users

Semaan

Jarlais

Malow

2006

Substance Use & Misuse

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Prevention of heterosexual transmission of HIV between and from drug users is important for controlling the local and global HIV heterosexual epidemic. Sex risk reduction interventions and health-related interventions are important for reducing the sex risk behaviors of drug users. Sex risk reduction interventions address individual-level, peer-level, and structural-level determinants of risk reduction. Health-related interventions include HIV counseling and testing, prevention and treatment of sexually transmitted diseases, and delivery of highly active antiretroviral therapy. It is important to adapt effective interventions implemented in resource-rich countries to the realities of the resourceconstrained settings and to address relevant contextual factors.RESUMEN-Il est important de prévenir la transmission hétérosexuelle du VIH à partir des usagers de drogue pour contrôler l'épidémie hétérosexuelle locale et mondiale de VIH. Des interventions ciblant à la fois la réduction de risque sexuel et la santé des usagers de drogue sont nécessaires. Les interventions de réduction de risque sexuel prennent en compte le niveau individuel, le niveau des pairs et celui des déterminants structurels de la réduction des risques. Les interventions visant l'amélioration de la santé comprennent le conseil et le dépistage du VIH, la prévention et le traitement des infections sexuellement transmissibles et la prescription d'antirétroviraux. Il est important d'adapter les interventions efficaces mises en place dans les pays riches aux réalités des contextes de pays à ressources limitées et de tenir compte des facteurs contextuels pertinents. Keywords global research; HIV; injection drug use; research interventions; sexual risk HIV Infection and Injection Drug UsersInjection drug use continues to complicate the control of the global HIV epidemic (UNAIDS, 2004). In 2003, 136 countries reported injecting drug use and 93 countries reported HIV infection among injection drug users (IDUs) (World Health Organization, 2003). IDUs are at risk for infection with HIV through both multiperson use ("sharing") of drug injection equipment and through unsafe sex behaviors (Aceijas et al., 2004). Although the scope and effectiveness of interventions aimed at reducing HIV infection through drug injection equipment has been well documented in the literature (Des Jarlais et al., 2005;Quan et This review describes sex risk reduction interventions with drug users and their effectiveness in reducing sexual risk behaviors of IDUs and other drug users. We highlight the needs and opportunities for these interventions, discuss the generalizability of the results to resourceconstrained settings, and outline the implications for global research efforts and public health practice. Although our literature review is not comprehensive, it highlights many areas that affect sexual transmission of HIV to and from drug users in both resource-rich and resourceconstrained settings. Efforts to reduce substance abuse and HIV risk associated with injection behav...

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Section: Stds Among Drug Usersmentioning

confidence: 99%

Behavior Change and Health-Related Interventions for Heterosexual Risk Reduction Among Drug Users

Semaan

Jarlais

Malow

2006

Substance Use & Misuse

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“…In addition, a working group of diverse local stakeholders such as health departments, community-based organizations, and administrators specific to each setting was essential for ensuring the integration of vaccinations as a component of existing health services. 49,56 In the 5 model programs described in this report, appropriate training and a commitment from the project staff to introduce the new services were also crucial for the introduction and ultimate integration of the new service into existing programs at each site.…”

Section: Discussionmentioning

confidence: 99%

“…San Diego juvenile correctional facilities (2 secured facilities and 2 rural camp sites) were primary sites for this project. 48,49 Challenges to implementing this intervention included (1) differing eligibilities for federally funded vaccine of incarcerated and detained adolescents, (2) competing priorities in the correctional system, (3) a primary concern for security, (4) lack of agreement among the medical staff that vaccination was a priority, (5) inadequate record-keeping systems.…”

Section: Model Programs Designed To Vaccinate Youth At High Risk In Amentioning

confidence: 99%

“…Specifically, (1) a standardized form that identified 12-to 18-year-olds at risk for hepatitis A, B, or C was completed during medical intake, (2) all at-risk, susceptible youth were vaccinated against hepatitis A and B, and (3) serologic testing for hepatitis B and C was offered if indicated by a risk assessment. 49,50 During 2003 and 2006, Ͼ28 000 youth were assessed for hepatitis risk and vaccination status at intake. Only a small percentage of all detainees were vaccinated, because vaccine was given only to juveniles known to be unvaccinated and those who had been in the system for Ͼ14 …”

Section: Model Programs Designed To Vaccinate Youth At High Risk In Amentioning

confidence: 99%

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Vaccinating Adolescents in High-Risk Settings: Lessons Learned From Experiences With Hepatitis B Vaccine

Sneller¹,

Fishbein²,

Weinbaum³

et al. 2008

Pediatrics

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Meeting the health needs of adolescents who live in high-risk settings such as homeless shelters, migrant camps, juvenile detention centers, prisons, and other types of residential facilities presents many challenges. Although there is no doubt that adolescents in many high-risk settings are at increased risk for hepatitis B and human papillomavirus, acute medical and psychological problems may consume all of the provider's time and resources. Potential health threats such as vaccinepreventable diseases must necessarily be given lower priority. Lack of vaccination expertise, supplies, and access to records further complicate delivery of vaccines. Since the 1990s, a number of approaches have been used to deliver hepatitis B vaccine to adolescents in many high-risk settings. Close collaboration among state and federal programs, local health departments, and community-based organizations has been necessary to introduce and sustain the delivery of vaccines to these young people. Medicaid, Statute 317 of the Public Health Service Act, the Vaccines for Children program, and State Children's Health Insurance Program have been used to finance vaccinations for adolescents 18 years or younger, and the expanded Medicaid option in the Foster Care Independence Act of 1999 has been used for adolescents older than 18 years of age. A number of states allow adolescents under age 18 to consent to their own hepatitis B vaccination under laws passed to allow treatment of sexually transmitted infections without parental consent. In this article, we present the experiences of several model programs that developed successful hepatitis B vaccination programs in venues that serve adolescents at risk, the important role of state laws and state agencies in funding immunization and other preventive health services for adolescents in high-risk situations, and discuss barriers and means to resolve them. I N THEIR SENTINEL 1993 report, the National Research Council proposed that the focus for addressing high-risk behaviors by adolescents should move from the individual adolescents to the settings in which these adolescents live. 1 These settings include those that serve adolescents who are unauthorized migrants or homeless and those who are in alternative schools, detention centers, jails, and prisons (Table 1). [2][3][4][5][6] The populations served in these settings were formally defined in the McKinney-Vento Act, which was signed into law in 1987. 7 Many of these settings have long been the focus of special efforts to deliver hepatitis B vaccine and serve populations especially likely to benefit from new vaccines for adolescents, including those against human papillomavirus, pertussis, and meningococcal meningitis. This report excludes adolescents who are displaced as a result of natural or man-made disasters, refugees, and foreign students.Health care, including immunization, for the adolescents considered here is generally provided by local, state, and federal programs and their grantees. Unfortunately, missing vaccinations are b...

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“…12 Arguments have been made that integrating services can be cost-saving and decrease barriers for clients who might otherwise need to go to several locations for services. 13 Program integration is one step toward making a range of important preventive services more accessible to clients. Prior research on program integration demonstrates the need for integrated services, as well as high acceptability of such services by clients utilizing them and staff providing them.…”

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confidence: 99%

Does Integrating Viral Hepatitis Services into a Public STD Clinic Attract Injection Drug Users for Care?

2007

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SYNOPSISObjective. Injection drug users (IDUs) are at high risk for multiple health problems, including human immunodeficiency virus (HIV), viral hepatitis, and sexually transmitted diseases (STDs), and are likely to have poor access to health care. To more effectively serve high-risk clients, experts recommend that programs accessed by such client populations offer integrated services. In 2000, the New York City Department of Health and Mental Hygiene integrated viral hepatitis services (vaccine and screening) into a publicly funded STD clinic. We evaluated integrated service delivery to high-risk IDUs at this clinic.Methods. Hepatitis data were reviewed to identify clients who self-reported as IDUs. STD medical records of these clients were abstracted to ascertain primary reason for clinic visit, STD/HIV services received, and diagnoses made. Conclusions. Integrated hepatitis services appeared to attract IDUs to this STD clinic, where many also benefited from STD/HIV exams, testing, treatment, and referrals they may not have received otherwise.

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Integrating Hepatitis, STD, and HIV Services into a Drug Rehabilitation Program

Cited by 25 publications

References 16 publications

Behavior Change and Health-Related Interventions for Heterosexual Risk Reduction Among Drug Users

Behavior Change and Health-Related Interventions for Heterosexual Risk Reduction Among Drug Users

Vaccinating Adolescents in High-Risk Settings: Lessons Learned From Experiences With Hepatitis B Vaccine

Does Integrating Viral Hepatitis Services into a Public STD Clinic Attract Injection Drug Users for Care?

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