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 TI126196H79 TI15867

The Matrix InstituteProject Director: Michael McCann

Integrating HIV and HCV Groups into an OTP Setting

Dan George

Matrix Institute on Addictions

Los Angeles, CA

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………………………………………….

………….. Pamela Lee Anderson?

TO BE CONTINUED……………….

HIV and HCV- Affecting Our Population

HIV & IDUhigh risk needle-sharing practicesNew AIDS cases reported in 2000, 28%

IDU associated (CDC)

HIV & Crack usehigh risk sexual behaviorsstronger association in women than men

(Edlin,et al. 1994)

HIV and HCV- Affecting Our Population

Hepatitis C3.9 – 5 million Americans infected (CDC)Approx. 60% of infections due to needle-

sharing70-96% long-term IDUs have been

exposed (Hepatitis Association)

HIV Groups-Why Gender Specific

Analysis of Studies Evaluating HIV education within SAT programs (Prendergast et al, 2001)

Reviewed 18 StudiesRanged in lengthRanged in type of intervention

Important Variables

Intensity of interventionEducation only vs skills acquisition (role-

play)

Use of peer group discussion

Separate sex sessions

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”

Women Talking

Adaptation of AIDS Risk Reduction Model3 stages: recognition of risk commitment to reducing riskCommitment to seeking resolution

Video and group discussions4 X 2-hour sessions

Educational Topics

Recognition of Risks

Commitment to Change

Sex Behaviors

Drug injection Behavior

Abbreviated Study Design

2 Sites- LA & Chicago83 Women intervention group83 Women control group

Experimental GroupBaseline interview Intervention (4 –sessions)1-month post interview3- month post interview

Abbreviated Study Design

Control GroupBaseline interviewNO INTERVENTION1-month post interview3- month post interview

Each participant received $25 gift certificate per interview

Study Results:

Tx Grp Participants demonstrated: Increase in HIV Knowledge/ Risk

Recognition

Increase in Personal Susceptibility

Increase in Commitment/ Motivation of Behavior Change

Project Effect on OTP Program Services

“Women Talking” incorporated into “in-house” Women’s HIV group

“Women Talking” used as educational component of group

Modified Women’s group includes the following additional teaching strategies: Role-playing for negotiating safer sex behavior Personalized risk assessments

Time Out! for Men

Time Out! for Men module created in 1996

Based off the “Time Out! For Me” women’s psychoeducational workshop (Bartholomew, Chatham &

Simpson, 1991).

Time Out! for Me evaluated in methadone maintenance programs Increased knowledge & self-esteem

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

Men’s Group Objectives

Improve communication skills

Improve relationships

Challenge gender-role stereotypes

Increase knowledge on Men’s Health

Increase knowledge on HIV & STI’s

Men’s HIV Group

General response is positive

Increase in knowledge (pre/post snapshot)

Expression of “openness” in group

Provide incentives: coffee and donutsCertificates upon completion

Men’s HIV Group- Nuances

Difficulty with retention

8- sessions may be too longReduce to four sessions Incorporate HCV groupMandatory for all new TCE program admits

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

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

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

Learner Domains

BehavioralLearner Objective: increase MD

evaluation follow-up and reduce needle-sharing

Evaluative criteria: MD follow-up rates and reported needle-sharing practices (post 6-months)

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

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)