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Charles L. Hilliard, Ph.D. (CDU), Dawnesha Beaver (CDU),

Enhancing Substance Abuse Treatment for Individuals Living with HIV/AIDS in South Los Angeles: Findings from the Passport to Care Program. Charles L. Hilliard, Ph.D. (CDU), Dawnesha Beaver (CDU), Lu Shi, Ph.D. (UCLA), Kevin Heslin, Ph.D. (CDU), Eric G. Bing, M.D., Ph.D. (CDU)

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Charles L. Hilliard, Ph.D. (CDU), Dawnesha Beaver (CDU),

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  1. Enhancing Substance Abuse Treatment for Individuals Living with HIV/AIDS in South Los Angeles: Findings from thePassport to Care Program Charles L. Hilliard, Ph.D. (CDU), Dawnesha Beaver (CDU), Lu Shi, Ph.D. (UCLA), Kevin Heslin, Ph.D. (CDU), Eric G. Bing, M.D., Ph.D. (CDU) 4th Annual Drug Abuse Research Symposium September 26, 2008

  2. Nature of Problem • 2,230 people are living with AIDS in South Los Angeles (SPA 6). • South Los Angeles has one of the highest rates of annual AIDS cases (214 per 100,000 persons) and the highest HIV infection related mortality rate in the county (HIV Epidemiology Program, LA County, January 2008). • Substance abuse is common among individuals living with HIV (Bing, Burnam, Longshore, et al., 2001).

  3. Nature of Problem-2 • Substance abuse is also a major community health and social problem for residents in South Los Angeles. The area has 9 drug-related deaths per 100,000 people (1 ½ times the county average) and alcohol-related hospital discharges are on the rise. • Substance abusers with HIV not in substance abuse treatment often enter the HIV system of care later in the course of their infection (Bing, Kilbourne, Brooks, et al., 2000), are less likely to be place on antiretroviral medication (Strathdee, Palepu, Cornelisse, et al., 1998) and have worse treatment outcomes (Bing, Hays, Jacobson, et al., 2000) compared to non-substance users or substance users in treatment.

  4. Passport to Care • Funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) • 2002 - 2008 • Provided clients with a menu of services that were client-centered, flexible, and scientifically based

  5. Target Population Passport to Care provided enhanced substance abuse treatment, integrated with HIV/AIDS prevention and treatment services, for African American and Latino individuals living with HIV/AIDS, with focused outreach to: • Men and women with a history of substance use/abuse, including injection drug using men and women • Men who have sex with men • Post-incarcerated men and women

  6. Passport to Care provided integrated substance abuse and HIV/AIDS treatment services with the following goals: • increase access to HIV-specific substance abuse services in South Central Los Angeles, • increase use of substance abuse services by drug users with HIV in South Central Los Angeles, • improve retention in substance abuse care among HIV positive substance users, • increase support for family members and partners for HIV positive substance users, • decrease or eliminate drug use by individuals who enter the program • reduce high risk sexual behaviors by individuals who enter the program, and • serve as a model for others who wish to reduce drug use and improve health outcomes for indigent African American and Latino substance users with HIV.

  7. Treatment Assessment Motivational Interviewing CBT 12 Step Groups Education Relapse Prevention Crisis Intervention Medical Medication Management Psychiatric assessment & treatment Program Components Social Networking • Peer Counseling • Mentoring • Fitness • Peer Activities • Volunteer Service • (12th Step-giving back) • Education / Employment development

  8. Demographic characteristics

  9. Demographic characteristics * 16% of the participants identified as Hispanic or Latino

  10. Reported Drug Use

  11. Results: Selected Behavioral Change Rates

  12. Results: Selected Behavioral Change Rates-2

  13. Summary • A substantial number of clients who participated in PTC reduced their use of alcohol or illegal drugs at 6-month follow-up. • Substantial gains in education/employment and housing stability were experienced.

  14. Summary-2 • A comparison of six-month change among different subgroups reveal the following patterns: • Blacks experienced greater benefit in housing and employment/Latinos benefited more in abstinence • Women experienced greater gains in employment, housing and alcohol abstinence • Individuals 45 and older experienced greater gains in housing while younger individuals gained more in abstinence • Substantial gains experienced in abstinence and health consequences among the originally unemployed

  15. References • Center for Substance Abuse Treatment. (2006).Addiction counseling competencies: The knowledge, skills, and attitudes of professional practice (06-4171). Rockville, MD: Substance Abuse and Mental Health Services Administration • Ellis, B., Bernichon, T., Yu, P., Roberts, T., & Herrell, J.M. (2004). Effect of social support on substance abuse relapse in a residential treatment setting for women. Evaluation and Program Planning, 27, 213-221. • Huff., R.M. & Kline, M.V. (1999). Promoting health in multicultural populations: A handbook for practitioners. Thousand Oaks, CA: SAGE Publications. • Los Angeles County Department of Health Services (2000). Children’s Planning Council. Retrieved March 3, 2008 from http://www.lapublichealth.org/childpc/. • Los Angeles County Department of Health Services (2008). HIV/AIDS surveillance summary. Retrieved March 3, 2008 from http://www.lapublichealth.org/hiv/. • Los Angeles County Department of Public Health. (2007). Key indicators of health. Retrieved March 3, 2008 from http://www.lapublichealth.org/wwwfiles/ph/hae/ha/keyhealth.pdf. • Los Angeles County Department of Public Health (2003). “Mortality in Los Angeles County in 2003, leading causes of death and premature death.” • Shi, L. (2008). Unpublished data from SPECTRUM. • Soyez, V., De Leon, G., Broekaert, E., & Rosseel, Y. (2005). The impact of a social network intervention on retention in Belgian therapeutic communities: A quasi-experimental study. Addiction, 101, 1027-1034. • United Way of Greater Los Angeles (2007). Los Angeles County Zip Code Data Book. Retrieved March 7, 2008 from http://www.unitedwayla.org/getinformed/rr/socialreports/Pages/2007zipcode.aspx • U.S. Census Bureau (2000). Census bureau data for 2000. Retrieved March 6, 2008 fromhttp://www.census.gov.

  16. Acknowledgements • SAMHSA CSAT TCE/HIV Grant (TI-08-006) • Eric G. Bing, M.D., Ph.D., Executive Director, Drew Center for AIDS, Research, Education Services • SPECTRUM Staff and Clients

  17. Questions

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