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1.
Addict Sci Clin Pract ; 12(1): 24, 2017 10 02.
Article in English | MEDLINE | ID: mdl-28965489

ABSTRACT

BACKGROUND: Contemporary studies about HIV care continuum (HCC) outcomes within substance using populations primarily focus on individual risk factors rather than provider- or systems-level influences. Over 25% of people living with HIV (PLWH) have substance use disorders that can alter their path through the HCC. As part of a study of HCC outcomes in nine small cities in Southern New England (population 100,000-200,000 and relatively high HIV prevalence particularly among substance users), this qualitative analysis sought to understand public health staff and HIV service providers' perspectives on how substance use may influence HCC outcomes. METHODS: Interviews with 49 participants, collected between November 2015 and June 2016, were analyzed thematically using a modified social ecological model as the conceptual framework and codes for substance use, HCC barriers and facilitators, successes and failures of initiatives targeting the HCC, and criminal justice issues. RESULTS: Eight themes were identified concerning the impact of substance use on HCC outcomes. At the individual level, these included coping and satisfying basic needs and could influence all HCC steps (i.e., testing, treatment linkage, adherence, and retention, and viral load suppression). The interpersonal level themes included stigma issues and providers' cultural competence and treatment attitudes and primarily influenced treatment linkage, retention, and viral load suppression. These same HCC steps were influenced at the health care systems level by organizations' physical environment and resources as well as intra-/inter-agency communication. Testing and retention were the most likely steps to affect at the policy/society level, and the themes included opposition within an organization or community, and activities with unintended consequences. CONCLUSIONS: The most substantial HCC challenges for PLWH with substance use problems included linking and retaining in treatment those with multiple co-morbidities and meeting their basic living needs. Recommendations to improve HCC outcomes for PLWH with substance use problems include increasing easy access to effective drug and mental health treatment, expanding case management and peer navigation services, training staff about harm reduction, de-stigmatizing, and culturally competent approaches to interacting with patients, and increasing information-sharing and service coordination among service providers and the social service and criminal justice systems.


Subject(s)
HIV Infections/drug therapy , Health Services Accessibility , Medication Adherence/statistics & numerical data , Patient Acceptance of Health Care/psychology , Substance-Related Disorders/complications , Continuity of Patient Care , Female , HIV Infections/complications , Health Behavior , Humans , Male , Middle Aged , New England , Socioeconomic Factors
2.
Harm Reduct J ; 14(1): 26, 2017 05 18.
Article in English | MEDLINE | ID: mdl-28521814

ABSTRACT

BACKGROUND: Little is known about access to health insurance among people who inject drugs (PWID) who attend syringe exchange programs (SEPs). The goal of the current study was to assess perceptions of SEP staff, including health navigators and program managers, on access to health insurance and healthcare access among SEP clients following implementation of state and federal policies to enhance universal healthcare access in Massachusetts. METHODS: Between December 2014 and January 2015, we conducted in-depth interviews (n = 14) with SEP staff, including both program managers and health navigators, to assess knowledge, attitudes, and beliefs related to health insurance enrollment and access to enhanced referrals among SEP clients. We developed a preliminary coding scheme from the interview guide and used a grounded theory approach to guide inclusion of subsequent thematic codes that emanated from the data. We analyzed the coded data thematically in an iterative fashion using a consensus-based approach. RESULTS: We identified five primary themes that emerged from the qualitative interviews, including high levels of health insurance enrollment among SEP clients; barriers to enrolling in health insurance; highly needed referrals to services, including improved access to substance use disorder treatment and hepatitis C virus treatment; barriers to referring clients to these highly needed services; and recommendations for policy change. CONCLUSIONS: While barriers to enrollment and highly needed referrals remain, access to and enrollment in healthcare insurance plans among PWID at SEPs in Massachusetts are high. With the uncertain stability of the Affordable Care Act following the US presidential election of 2016, our findings summarize the opportunities and challenges that are connected to health insurance and healthcare access in Massachusetts. SEPs can play an important role in facilitating access to health insurance and enhancing access to preventive health and primary care.


Subject(s)
Health Services Accessibility/statistics & numerical data , Insurance, Health , Needle-Exchange Programs/statistics & numerical data , Health Knowledge, Attitudes, Practice , Health Personnel , Hepatitis C/therapy , Humans , Massachusetts/epidemiology , Needs Assessment , Patient Protection and Affordable Care Act , Referral and Consultation , Substance-Related Disorders/epidemiology , United States , Universal Health Insurance
3.
J Am Pharm Assoc (2003) ; 57(2S): S34-S44, 2017.
Article in English | MEDLINE | ID: mdl-28189540

ABSTRACT

OBJECTIVES: To determine the prevalence of nonprescription naloxone and sterile syringe sales, factors associated with nonprescription sales, geospatial access to nonprescription naloxone and syringe-selling pharmacies, and targets for potential interventions. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: Massachusetts has experienced steep increases in reported opioid overdoses and hepatitis C virus cases in the past decade. Pharmacists have the potential to play a substantial role in increasing access to nonprescription naloxone and sterile syringes, which can reverse opioid overdoses and decrease hepatitis C virus transmission, respectively. We completed brief telephone surveys with 809 of 1042 retail pharmacies across Massachusetts (response rate = 77.6%) during 2015 to assess experience with nonprescription sales of naloxone and sterile syringes. OUTCOME MEASURES: Our primary outcomes were the stocking and selling of naloxone in the pharmacy (yes or no) for nonprescription sales and nonprescription syringe sales (yes or no). We conducted multivariable regression analyses and created maps using a geographic information system to identify factors associated with nonprescription sales of naloxone and sterile syringes, and to improve our understanding of geospatial access to pharmacy-based naloxone and syringe sales. RESULTS: More than 97% of pharmacies reported selling sterile syringes without requiring a prescription, and 45% of pharmacies reported stocking and selling naloxone. Factors associated with nonprescription sales included hours of operation, experience with and interest in harm reduction activities, and presence in an opioid overdose hotspot. Geographic access to nonprescription sale of sterile syringes is widespread, whereas geospatial access to naloxone is limited. Training to understand the benefits, applications, and distribution needs of naloxone is of interest to surveyed pharmacists. CONCLUSION: Access to sterile syringes through nonprescription sales is strong across Massachusetts, and although more than 350 pharmacies (45%) reported stocking and selling naloxone to prevent opioid overdose deaths, there is much room for improvement in access and training among pharmacy staff members.


Subject(s)
Analgesics, Opioid/adverse effects , Community Pharmacy Services/organization & administration , Naloxone/administration & dosage , Syringes/supply & distribution , Analgesics, Opioid/administration & dosage , Community Pharmacy Services/statistics & numerical data , Cross-Sectional Studies , Drug Overdose/drug therapy , Drug Overdose/epidemiology , Health Care Surveys , Health Services Accessibility , Hepatitis C/epidemiology , Hepatitis C/prevention & control , Humans , Massachusetts , Naloxone/supply & distribution , Narcotic Antagonists/administration & dosage , Narcotic Antagonists/supply & distribution , Nonprescription Drugs/administration & dosage , Nonprescription Drugs/supply & distribution , Pharmacists/organization & administration , Professional Role
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