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

2. Integrating HIV and HCV Groups into an OTP Setting Dan George Matrix Institute on Addictions Los Angeles, CA

3. 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………………………………………….

4. ………….. Pamela Lee Anderson? TO BE CONTINUED……………….

5. 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)

6. 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)

7. 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

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

9. 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”

10. 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

11. Educational Topics • Recognition of Risks • Commitment to Change • Sex Behaviors • Drug injection Behavior

12. 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

13. 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

14. Study Results: • Tx Grp Participants demonstrated: • Increase in HIV Knowledge/ Risk Recognition • Increase in Personal Susceptibility • Increase in Commitment/ Motivation of Behavior Change

15. 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

16. 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

17. 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

18. 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

19. Men’s 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

20. Men’s 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

21. 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

22. 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

23. 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

24. 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)

25. 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

26. 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)