Design and rationale of the Botswana Smoking Abstinence Reinforcement Trial: a protocol for a stepped-wedge cluster randomized trial.

BACKGROUND: With expanded and sustained availability of HIV treatment resulting in substantial improvements in life expectancy, the need to address modifiable risk factors associated with leading causes of death among people living with HIV/AIDS (PLWH), such as tobacco smoking, has increased. Tobacco use is highly prevalent among PLWH, especially in southern Africa, where HIV is heavily concentrated, and many people who smoke would like to quit but are unable to do so without assistance. SBIRT (Screening, Brief Intervention and Referral to Treatment) is a well-established evidence-based approach successful at supporting smoking cessation in a variety of settings. Varenicline is efficacious in supporting smoking cessation. We intend to assess the effectiveness of SBIRT and varenicline on smoking cessation among PLWH in Botswana and the effectiveness of our implementation. METHODS: BSMART (Botswana Smoking Abstinence Reinforcement Trial) is a stepped-wedge, cluster randomized, hybrid Type 2 effectiveness-implementation study guided by the RE-AIM framework, to evaluate the effectiveness and implementation of an SBIRT intervention consisting of the 5As compared to an enhanced standard of care. SBIRT will be delivered by trained lay health workers (LHWs), followed by referral to treatment with varenicline prescribed and monitored by trained nurse prescribers in a network of outpatient HIV care facilities. Seven hundred and fifty people living with HIV who smoke daily and have been receiving HIV care and treatment at one of 15 health facilities will be recruited if they are up to 18 years of age and willing to provide informed consent to participate in the study. DISCUSSION: BSMART tests a scalable approach to achieve and sustain smoking abstinence implemented in a sustainable way. Integrating an evidence-based approach such as SBIRT, into an HIV care system presents an important opportunity to establish and evaluate a modifiable cancer prevention strategy in a middle-income country (MIC) setting where both LHW and non-physician clinicians are widely used. The findings, including the preliminary cost-effectiveness, will provide evidence to guide the Botswanan government and similar countries as they strive to provide affordable smoking cessation support at scale. CLINICAL TRIAL REGISTRATION: NCT05694637 Registered on 7 December 2022 on clinicaltrials.gov, https://clinicaltrials.gov/search?locStr=Botswana&country=Botswana&cond=Smoking%20Cessation&intr=SBIRT.

Optimally combining transcranial magnetic stimulation with antidepressants in major depressive disorder: A systematic review and Meta-analysis.

There is a critical knowledge gap in optimally combining transcranial magnetic stimulation (TMS) and antidepressants to treat patients with major depressive disorder (MDD). TMS is effective in treating MDD in patients who have failed at least one antidepressant trial, with accelerated protocols showing faster remission in treatment-resistant depression (TRD). Although clinicians routinely augment antidepressants with TMS, there is a knowledge gap in stopping versus continuing antidepressants or the dosing strategies when starting or tapering TMS. These considerations are important when considering maintenance TMS (delivered alone or in combination with suitable antidepressants) to maintain remission in MDD after the index course of TMS. As the first step towards filling this knowledge gap, we reviewed randomized controlled trials (RCTs) and open-label trials from 2 databases (PubMed/Medline and EMBASE) that compared active TMS combined with a pre-specified antidepressant dosed in the same manner for adults with MDD versus sham TMS combined with the same antidepressant as in the active arm. All studies were published between January 1, 2000, and December 31, 2023. We excluded case reports, case series, and clinical studies that augmented TMS with antidepressants and vice versa. We found 10 RCTs (n = 654 participants) and performed a meta-analysis. This showed active TMS combined with pre-specified antidepressants had greater efficacy for MDD treatment than sham TMS combined with the same antidepressants as in the active arm (Hedge's g = 1; 95 % CI [0.27, 1.73]). The review and meta-analysis indicate greater short-term efficacy in combining antidepressants with TMS from the get-go in MDD. Given the increasing role of accelerated TMS protocols in expediting remission in MDD and the results of our meta-analysis, we advocate for RCTs examining the short-term and long-term effects of various antidepressant classes on these TMS protocols in MDD. This can also optimize and individualize maintenance TMS protocols to prevent relapse in MDD.

Intermittent theta burst stimulation and functional connectivity in people living with HIV/AIDS who smoke tobacco cigarettes: a preliminary pilot study.

Background: People living with HIV (PLWHA) smoke at three times the rate of the general population and respond poorly to cessation strategies. Previous studies examined repetitive transcranial magnetic stimulation (rTMS) over left dorsolateral prefrontal cortex (L. dlPFC) to reduce craving, but no studies have explored rTMS among PLWHA who smoke. The current pilot study compared the effects of active and sham intermittent theta-burst stimulation (iTBS) on resting state functional connectivity (rsFC), cigarette cue attentional bias, and cigarette craving in PLWHA who smoke. Methods: Eight PLWHA were recruited (single-blind, within-subject design) to receive one session of iTBS (n=8) over the L. dlPFC using neuronavigation and, four weeks later, sham iTBS (n=5). Cigarette craving and attentional bias assessments were completed before and after both iTBS and sham iTBS. rsFC was assessed before iTBS (baseline) and after iTBS and sham iTBS. Results: Compared to sham iTBS, iTBS enhanced rsFC between the L. dlPFC and bilateral medial prefrontal cortex and pons. iTBS also enhanced rsFC between the right insula and right occipital cortex compared to sham iTBS. iTBS also decreased cigarette craving and cigarette cue attentional bias. Conclusion: iTBS could potentially offer a therapeutic option for smoking cessation in PLWHA.

Prevalence and Predictors of Medical Mistrust Among African Americans with Serious Mental Illness Receiving Care in an Urban Setting.

Patients with serious mental illness are reported to have a 10-25 year reduction in life expectancy. Medical mistrust may influence their willingness to seek care (Bynum, S. A., Davis, J. L., Green, B. L., & Katz, R. V. (2012). Unwillingness to participate in colorectal cancer screening: Examining fears, attitudes, and medical mistrust in an ethnically diverse sample of adults 50 years and older. American Journal of Health Promotion : Ajhp, 26(5), 295-300. https://doi.org/10.4278/ajhp.110113-QUAN-20 ). This cross-sectional study used baseline data from a SAMHSA funded demonstration project to describe the prevalence and of medical mistrust among a sample of African American adults with serious mental illness. Medical mistrust was identified using the Medical Mistrust Scale. One hundred and fifty-four participants completed the medical mistrust scale. Approximately, a third (34.4%) reported medical mistrust. After adjusting for financial stability, those endorsing medical mistrust reported nearly 3 times the odds of lacking support (AOR [95% CI]: 2.84 [1.01-7.97]) compared to those not endorsing medical mistrust. The study is among the first to describe elevated rates of medical mistrust among a sample of African Americans people with serious mental illness. An association between medical mistrust and lack of social support was demonstrated.

Optimizing behavioral and pharmacological smoking cessation interventions among people with HIV.

BACKGROUND: People with HIV/AIDS (PWH) smoke at nearly three times the rate of the general population. Interventions to promote sustained quitting among PWH are urgently needed. METHODS: Our study used a randomized factorial design to evaluate the effects of varenicline, compared with placebo, and behavioral cessation therapy, positively smoke free (PSF), compared with standard of care (SOC) among PWH who smoke. The study was designed with power to detect a small effect (Cohen's h of 0.28-0.36) with 240 participants. The primary outcome was the 7-day point prevalence abstinence (PPA) confirmed by exhaled carbon monoxide (ECO) less than 10 ppm for both main effects at 36 weeks. The study was conducted from June 2016 to November 2020. During the study's last year, recruitment was halted because of COVID-19. RESULTS: The study randomized 184 participants with power to detect a medium effect (Cohen's h of 0.41). Participants were mostly African American (89.7%), men (62.8%) who smoked mentholated cigarettes (96.7%). Nearly all received antiretroviral medication (96.2%). Quit rates for the entire sample were 7.5% at 36 weeks. Compared with those who received placebo, neither those who received varenicline [36 weeks; OR (95% CI), 1.31 (0.33-5.22), P  = 0.70] nor PSF [36 weeks; OR (95% CI), 0.26 (0.03-2.44), P  = 0.24) were more likely to quit smoking. CONCLUSION: Among an urban living, primarily African American sample of PWH who smoke neither varenicline nor PSF was found to be efficacious at 36 weeks. Our study was not powered to detect small effects sizes. Larger trials are needed to establish tobacco treatment standards for PWH who smoke.

Comparing cigarette-cue attentional bias between people with HIV/AIDS and people with opioid use disorder who smoke.

Background: Special populations like people living with HIV/AIDS (PLWHA) and people with opioid use disorder (OUD) smoke tobacco cigarettes at rates three to four times greater than the general population. Patients with tobacco use disorder exhibit attentional bias (AB) for cigarette cues. Eye tracking can quantify this bias by measuring fixation time (FT) on cigarette and matched neutral cues, to calculate an AB score. Although previous studies have measured this bias in people who smoke without any other comorbid conditions, no study, to our knowledge, has measured or compared this bias in special populations. Methods: We performed exploratory analyses on eye tracking data collected in two separate randomized clinical trials (RCTs) (NCT05049460, NCT05295953). We compared FT and cigarette-cue AB score (measured by subtracting FT on neutral cues from FT on cigarette cues) between PLWHA and people with OUD who smoke, using a visual probe task and Tobii Pro Fusion eye tracker. We used two cigarette cue types, one encompassing people smoking cigarettes and the other consisting of cigarette paraphernalia. We used two cue presentation times, 1000 and 2000 milliseconds (ms). Results: Cues of people smoking cigarettes elicited greater AB than cues of cigarette paraphernalia across both subject groups when cues were presented for 2000 ms, but not 1000 ms. PLWHA who smoke exhibited greater AB for cues of people smoking cigarettes than cigarette paraphernalia when presented for 2000 ms compared to people with OUD who smoke. Conclusion: We use cigarette-cue AB to quantify craving and cigarette consumption in two populations smoking at elevated rates. The addition of social cues potentiates cigarette cue AB, based on cue type and stimulus presentation time. Understanding the neurobiology of this relationship can help design novel smoking cessation treatments that target AB and prevent relapse in these populations with suboptimal response to smoking cessation treatments. Trial registration: Clinical trials that provided the data for post hoc analyses are NCT05049460 and NCT05295953.

Cross-Tailoring Integrative Alcohol and Risky Sexual Behavior Feedback for College Students: Protocol for a Hybrid Type 1 Effectiveness-Implementation Trial.

BACKGROUND: Underage drinking and related risky sexual behavior (RSB) are major public health concerns on United States college campuses. Although technology-delivered personalized feedback interventions (PFIs) are considered a best practice for individual-level campus alcohol prevention, there is room for improving the effectiveness of this approach with regard to alcohol-related RSB. OBJECTIVE: The aims of this study are to (1) evaluate the impact of a brief PFI that integrates content on alcohol use and RSB and is adapted to include a novel cross-tailored dynamic feedback (CDF) component for at-risk first-year college students and (2) identify implementation factors critical to the CDF's success to facilitate future scale-up in campus settings. METHODS: This study uses a hybrid type 1 effectiveness-implementation design and will be conducted in 3 phases. Phase 1 is a stakeholder-engaged PFI+CDF adaptation guided by focus groups and usability testing. In phase 2, 600 first-year college students who drink and are sexually active will be recruited from 2 sites (n=300 per site) to participate in a 4-group randomized controlled trial to examine the effectiveness of PFI+CDF in reducing alcohol-related RSB. Eligible participants will complete a baseline survey during the first week of the semester and follow-up surveys at 1, 2, 3, 6, and 13 months post baseline. Phase 3 is a qualitative evaluation with stakeholders to better understand relevant implementation factors. RESULTS: Recruitment and enrollment for phase 1 began in January 2022. Recruitment for phases 2 and 3 is planned for the summer of 2023 and 2024, respectively. Upon collection of data, the effectiveness of PFI+CDF will be examined, and factors critical to implementation will be evaluated. CONCLUSIONS: This hybrid type 1 trial is designed to impact the field by testing an innovative adaptation that extends evidence-based alcohol programs to reduce alcohol-related RSB and provides insights related to implementation to bridge the gap between research and practice at the university level. TRIAL REGISTRATION: ClinicalTrials.gov NCT05011903; https://clinicaltrials.gov/ct2/show/NCT05011903. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/43986.

Somatoform Symptoms in Parkinson Disease.

BACKGROUND: Co-occurring somatoform symptoms complicate the diagnosis and treatment of Parkinson disease (PD). OBJECTIVE: To learn more about the relationship between somatoform symptoms and PD by comparing demographic and clinical features across PD groups differing in somatoform symptom severity. METHOD: Using standardized Brief Symptom Inventory-18 (BSI-18) scores to measure somatoform symptom severity, we assigned 1093 individuals with PD to one of four subgroups using comparisons to normative means: low (M < -½ SD), average (M ± ½ SD), high (M +½ SD to +1 SD), very high (M > +1 SD). We used demographics and disease severity measures to assess each subgroup. RESULTS: Most of the individuals with PD (56%) had high or very high somatoform symptom levels. Increased somatoform symptom levels were associated with female gender, lower socioeconomic status, greater disease duration, increased PD severity (Total Unified Parkinson's Disease Rating Scale), greater disability (Older Americans Resource and Services Disability subscale), increased BSI-18 Depression and Anxiety subscale scores, lower cognitive function (Mini-Mental State Examination), lower self-efficacy scores (Self-Efficacy to Manage Chronic Disease Scale), lower quality of life scores (SF-12 Health Status Survey), and greater medical comorbidity (Cumulative Illness Rating Scale-Geriatrics) (all comparisons: P < 0.001). We found no significant between-group differences for age, race, or marital status. CONCLUSION: Somatoform symptom severity in individuals with PD is associated with greater PD severity and disability and is more common in females and in individuals with low socioeconomic status. Greater awareness of somatoform symptoms should help improve PD treatment.

Psychological impacts of the COVID-19 pandemic on medical students in the United States of America.

This study aimed to assess the early psychological impacts of the COVID-19 pandemic on United States medical students when compared to graduate students in fields unrelated to healthcare using the perceived stress scale (PSS-10) and the perceived COVID-19-related risk scale (PCRS). This was a cross-sectional study between May and June 2020. We created an anonymous, online questionnaire that was administered to medical students nationwide and local graduate students. We used Student's t-test, Chi-square test, and regression models. We received 425 completed responses. Contrary to similar stress levels in graduate students, medical students on average experienced significantly more stress after coursework suspension than before (20.6 vs 14.7). Female gender and a mental illness diagnosis were associated with statistically significantly elevated PSS-10 scores before and after suspension in medical students. Medical students reported a low PCRS score. Most medical students were confident in their department's infection control measures and willing to report to work. Female gender and a mental illness diagnosis remain two important risk factors for medical students' stress levels during the pandemic. This study highlights the need to foster students' public health competency and safely involve students as non-frontline workers in public health emergency responses for their mental wellbeing.

Impact of a Targeted Intervention on Hepatitis C Care Among African Americans With Serious Mental Illness.

OBJECTIVE: This study aimed to update findings on the continuum of care for hepatitis C virus (HCV) infection with follow-up data for individuals with serious mental illness and to identify predictors of decisions to decline vaccination. METHODS: The screening, testing, immunization, risk reduction, and referral (STIRR) intervention has been shown to increase testing and immunization rates. Prevalence of HCV diagnoses, HCV continuum of care, and hepatitis A (HAV) and B (HBV) vaccination were evaluated with laboratory results and chart review. RESULTS: The prevalence of HCV was 15% (N=40 of 270 African Americans receiving the STIRR intervention). Of the 40 individuals identified as having HCV, 75% (N=30) accepted referral to treatment, of whom 47% (N=14) achieved sustained virologic response. Nearly 68% (N=155) of those eligible received at least partial HAV/HBV vaccination. CONCLUSIONS: The STIRR intervention facilitated access to treatment for HCV and high acceptance of hepatitis vaccination. Avoidance proved to be a significant factor in decisions to decline vaccination.

A Within-Subject Pilot Feasibility Study of a Gambling Specific SBIRT Intervention Delivered in an Urban HIV/Primary Clinic.

BACKGROUND: Although there are few interventions available to provide screening and brief intervention targeted toward problematic gambling, Screening, Brief Intervention and Referral to Treatment (SBIRT) is an evidence-based intervention that has demonstrated effectiveness in reducing gambling behaviors. METHODS: The goal of this pilot study was to evaluate the feasibility, acceptability and preliminary outcomes of a gambling specific SBIRT intervention in a medical setting. Fifteen participants were recruited from an urban HIV/Primary Care clinic to receive the gambling specific SBIRT intervention delivered by 3 clinicians. Process and gambling specific outcome measures were evaluated at baseline, immediately after the intervention and at 1-month follow-up. RESULTS: On average, patient participants were 49 years and self-described themselves as male (60%) and Black or African American (86.7%). Three (20%) participants met 4 or more criteria of the DSM-5 gambling disorder. Compared to baseline, those who participated in the intervention decreased both the median number of days gambled (1 days vs. 0 days), as well as the median money gambled at 1-month follow-up ($7 vs. $1). Participants with 4 or more criteria of DSM-5 gambling had the greatest reduction (days gambled: (26 days vs. 21 days); money spent: (($400 vs. $65)). Participants reported that the intervention was acceptable. Clinician participants found the intervention to be easy to deliver. CONCLUSIONS: A gambling specific SBIRT intervention was feasible to deliver and acceptable to participants. Gambling specific outcome measures were reduced at 1-month follow-up. A randomized control trial to evaluate the efficacy of the intervention is a recommended next step.

Cigarette Smoking Behaviors and Beliefs in Persons Living With HIV in Nairobi, Kenya.

INTRODUCTION: Persons living with HIV (PLWH) use tobacco at higher rates than the general population in both high-income countries and low- and middle-income countries. Tobacco use rates are increasing in sub-Saharan Africa, the home to most of the world's PLWH. As the reach of antiretroviral therapy (ART) expands and HIV-related morbidity and mortality wanes, tobacco use is emerging as a leading cause of disease and death in PLWH. A better understanding of tobacco use behaviors in various settings will be crucial to designing optimal tobacco control strategies. METHODS: In late 2019, we enrolled 50 PLWH cigarette smokers from 6 clinical sites in Nairobi, Kenya (4 HIV care clinics and 2 methadone maintenance programs) for one-on-one interviews focusing on their behaviors and beliefs related to tobacco use. RESULTS: Fifty PLWH smokers completed the interviews. The mean age was 38.5 ± 9.7 years (range 20-57 years) and 68% were male. All were currently receiving ART. They smoked a mean of 14.9 ± 12.4 cigarettes per day, and 82% reported smoking every day. Only 6% reported dual use of smokeless tobacco products. Nicotine dependence was moderate or high in 74%. More than a third (36%) reported a prior history of tuberculosis. In our sample, use of other substances was common, especially alcohol, marijuana, and methadone. On the motivation to quit scale, 90% were at least in the contemplation stage, but only 2% had ever received behavioral cessation counseling, and only 8% had ever used pharmacotherapy (exclusively nicotine replacement therapy). Participants reported significant concern about developing smoking-related illness, exposing others to secondary smoke, and the financial burden associated with their tobacco use. Measures of intrinsic and extrinsic motivation to quit, smoker and abstainer self-concept, and social support yielded encouraging results regarding the possibility of successful quitting. CONCLUSIONS: Tobacco use is an important health concern in PLWH in Kenya. A more thorough understanding of their tobacco use behaviors and beliefs will provide critical information for providers, public health officials, and policy makers as they redouble their efforts to confront this urgent health challenge.

Evaluation of smoking cessation interventions for veterans in HIV clinics in the United States: a theory-informed concurrent mixed-method study.

OBJECTIVE: Although veterans living with HIV infection are burdened with smoking-related morbidities, few studies have explored theory-informed, evidence-based smoking cessation interventions in the Veterans Affairs (VA) Health System. METHOD: In this concurrent mixed-method study, we sought to better understand factors influencing the adoption of existing evidence-based smoking cessation interventions (reminders, telephone quit lines, pharmacological) for veterans in VA HIV clinics. We explored the alignment of the revised Promoting Action on Research Implementation in Health Services Framework (i-PARIHS) with study results. RESULTS: Nineteen clinicians working at eight HIV clinics in the VA System participated in the study. Seven themes were identified with relative quantitative and qualitative data convergence of clinicians' perceptions of the importance of integrating evidence-based smoking cessation interventions for veterans with HIV infection. CONCLUSION: Identified themes underscore the need for clinicians to provide smoking cessation training, supportive care, and motivate veterans living with HIV infection to quit smoking. Integrating smoking cessation programs into HIV treatment plans in the veteran patient population is critical. Dedicated time to fully implement these efforts will maximize smoking cessation intervention efforts and will yield successful utilization and subsequent patient compliance. Importantly, combination strategies will ensure cessation program impact and sustainability.Trial registration:Netherlands National Trial Register identifier: ntr050..

Outcomes for patients receiving telemedicine-delivered medication-based treatment for Opioid Use Disorder: A retrospective chart review.

This report builds on a previous study that describes the collaboration between an urban academic medical center and a rural drug treatment center, the goal of which is to provide medication-based treatment to individuals with OUD via videoconferencing. We describe results of a retrospective chart review of 472 patients treated in the program between August 2015 and April 2019. We examined several demographic and substance use variables for individuals who consented to telemedicine treatment, retention in treatment over time, and opioid use over time to understand further the impact of prescribing buprenorphine and naltrexone via telemedicine to patients in a rural OUD treatment setting. Our findings support the effectiveness of prescribing medications via telemedicine. The inclusion of more than three times as many patients as in our prior report revealed retention rates and toxicology results that are comparable to face-to-face treatment. These findings have implications for policymakers and clinicians considering implementation of similar programs.

Evaluation of a technology-enhanced intervention for older women with HIV infection: a proof of concept study.

The syndemic effects of HIV infection, side effects of highly active antiretroviral medications, and age-related changes lead to increased risk for comorbidities and functional decline for older people with HIV. This proof of concept (PoC) study evaluated perceived usefulness, satisfaction, acceptability, intervention processes, resource management, and outcome effect variances of ThE CARE Intervention guided by the Self-Determination Theory. To test the utility of ThE CARE, we conducted a one-group pre/posttest intervention design with a convenience sample of 20 women, 50 years and older. The mean age was 56 years (SD = 11) and years since HIV diagnosis was 23.7 (SD = 8.6). ThE CARE intervention was found useful and participants "felt empowered" utilizing the app. Fourteen participants (70%) reported high-intensity distress and negative impact on life from neuropathic pain, anxiety (55%), fatigue (50%), and depressive symptoms (35%). Self-awareness and self-regulation also improved. Modest results of acceptability, usability, and positive trends in the outcome measures suggest possible effects. The interactivity and cultural relevance of ThE CARE would enhance women's autonomous motivation and perceived competence to actively engage in self-care. The PoC study provides important foundational information to advance science in mHealth interventions for older women with HIV.

Personal Approach to Treatment Choices for HIV (PATCH): Randomized Controlled Trial of a Brief Motivational Enhancement Intervention to Improve Medication Adherence in Persons with HIV.

This pilot randomized controlled trial evaluated the feasibility and efficacy of a brief motivational enhancement intervention to improve adherence to antiretroviral therapy in persons with HIV called Personal Approach to Treatment Choices for HIV (PATCH). We compared PATCH to an active control condition on self-reported adherence, clinical outcomes, and psychosocial outcomes. Participants were 34 individuals (61.8% male, Mage = 47.1) receiving HIV-related services who were suboptimally engaged in care. Participants completed baseline measures, participated in either PATCH or a stress reduction skills control intervention, and completed post-treatment and 3-month follow-up assessments. Results revealed no differences between conditions on adherence or clinical outcomes. At post-treatment, PATCH participants reported greater improvements in alcohol use, psychiatric symptoms, subjective mental functioning, and emotion-focused coping; improvements in subjective mental functioning were maintained at 3-months. Results suggest that motivational enhancement interventions can improve psychosocial outcomes for people with HIV. That some improvements were not maintained at follow-up suggests that effects wane over time and longer treatment may be indicated for lasting effects.

Access to Direct-Acting Antiviral Treatment for Hepatitis C Virus Among Veterans With Serious Mental Illness.

OBJECTIVE: This study examined whether serious mental illness is associated with initiating and with completing sofosbuvir-based treatment for hepatitis C virus (HCV) among veterans who started treatment after the Veterans Health Administration (VHA) received expanded funding for HCV care. METHODS: Administrative health care data from fiscal years 2016-2017 revealed 4,288 treatment-naïve patients with HCV, of whom 1,311 had initiated sofosbuvir-based treatment. Dependent variables were initiation and completion of ≥8 weeks of sofosbuvir treatment. Associations with serious mental illness were estimated with adjusted odds ratios from multivariable logistic regression analyses. RESULTS: No statistically significant differences were found in the proportion of veterans with and veterans without serious mental illness who initiated (p=0.628) or completed ≥8 weeks (p=0.301) of sofosbuvir treatment. CONCLUSIONS: Veterans with and without serious mental illness initiated and completed sofosbuvir treatment at similar rates. The VA should continue to provide equitable access to HCV treatments and support medication adherence.