The intersection of opioid use and HIV is well documented. More than one-third of all AIDS cases in the U.S. are directly or indirectly linked to injection drug use. Additionally, dependence and abuse of pain relievers is on the rise; people living with HIV/AIDS who suffer from chronic pain may be at particular risk. Opioids are highly addictive and mortality among illicit opioid users is estimated at 13 times that of the general population. The SPNS Buprenorphine Initiative investigated the effectiveness of integrating buprenorphine opioid abuse treatment into HIV primary care settings.
This Webcast is the first in a series under the new SPNS Integrating HIV Innovative Practices project (www.careacttarget.org/ihip) to assist providers in replicating SPNS work in their sites. This Webcast will introduce providers to the SPNS Buprenorphine Initiative, its findings, its synergy with the National HIV/AIDS Strategy, and provide an overview of opioid use and HIV.
The subsequent Webcast in the series will examine the clinical aspects of buprenorphine therapy, best practices, and implementation guidance. See also Integrating Buprenorphine Therapy Into HIV Primary Care Settings, a monograph on best practices, available at: https://careacttarget.org/content/integrating-buprenorphine-therapy-hiv-primary-care-settings.
The goal of Integrating HIV Innovative Practices (IHIP) is to enable health care providers to implement proven innovations within their own practices and clinics. This Webinar is the first in a three part series featuring grantees of the Health Resources and Services Administration’s Special Projects of National Significance (SPNS) Enhancing Linkages to HIV Care & Services in Jail Settings Initiative (Jail Linkages Initiative), as they share lessons learned and advice for others hoping to create or expand similar programs.
Explore how to secure buy-in and foster partnerships within correctional settings, as well as how to navigate the “culture of corrections.” Hannah Zellman of Philadelphia FIGHT, a SPNS Jail Linkages grantee, will present alongside Dr. Linda Rose Frank and Debra D’Alessandro of the PA/MidAtlantic AIDS Education and Training Center about the work their organizations have done individually and collaboratively in the corrections setting.
The goal of Integrating HIV Innovative Practices (IHIP) is to enable health care providers to implement proven innovations in HIV care and services within their own practices. This Webinar is the second in a three-part series exploring innovative approaches to delivering oral health care and services to people living with HIV/AIDS, featuring grantees of the Health Resources and Services Administration’s Special Projects of National Significance (SPNS) Innovations in Oral Health Care Initiative (Oral Health Initiative).
This Webinar outlines dental case management programs at the AIDS Care Group (ACG) in Chester, PA and the Native American Health Center (NAHC) in San Francisco, CA. The presenters include Dr. Howell Strauss and Mr. Nelson Diaz from ACG; and Dr. Carolyn Brown and Ms. Lucy Wright, RDH, representing the NAHC. The presentation details the pros, cons, and considerations of dental case management from administrative and clinical perspectives. The presenters also provide tips for being a good dental case manager and how this can result in improved health outcomes.
The goal of Integrating HIV Innovative Practices (IHIP) is to enable health care providers to implement proven innovations in HIV care and services within their own practices. This Webinar is the third in a three-part series exploring innovative approaches to delivering oral health care and services to people living with HIV/AIDS, featuring grantees of the Health Resources and Services Administration’s Special Projects of National Significance (SPNS) Innovations in Oral Health Care Initiative (Oral Health Initiative).
This Webinar explores the clinical aspects of oral health care for people living with HIV/AIDS (PLWHA). The presenters include Dr. David Reznik of Grady Health System in Atlanta, GA and HIVdent and Ms. Helene Bednarsh, MPH of Boston Public Health Commission in Boston, MA and HIVdent. Dr. Reznik and Ms. Bednarsh detail common oral health diseases among HIV-infected people, as well as the prevention, detection, and treatment of these diseases.
This Webinar is the first in the Enhancing Linkages to HIV Primary Care and Services Webinar series, produced in association with the Health Resources and Services Administration's (HRSA's) Integrating HIV Innovative Practices (IHIP) project. The series’ three sessions each focus on a different aspect of linking people living with HIV/AIDS to HIV primary care and services in the jails setting.
This Webinar series is part of a collection of dissemination materials on the SPNS EnhanceLink Jail Linkage Initiative (http://hab.hrsa.gov/abouthab/special/carejail.html). These include:
- Training manual: https://careacttarget.org/library/creating-jail-linkage-program-training-manual
- Curriculum: https://careacttarget.org/library/creating-jail-linkage-program-curriculum, and
- Pocket guide: https://careacttarget.org/sites/default/files/JailsLinkageIHIPPocketCard.pdf
All of these resources can be found on the IHIP landing page (http://www.careacttarget.org/ihip) on the TARGET Center Web site. In addition, all Webinar sessions in this series will be recorded and also made available on the IHIP page.
This Webinar provides an overview of common oral health barriers for people living with HIV/AIDS (PLWHA) and the importance of overcoming these barriers. It will also share some of the ways HRSA has helped link PLWHA to oral health care, including the SPNS Oral Health Initiative. Featured presenters include:
- Dr. Mahyar Mofidi; Branch Chief of the Division of Community HIV/AIDS Programs and Chief Dental Officer of the HRSA HIV/AIDS Bureau
- Jane Fox, MPH; Project Director of SPNS Oral Health Initiative Evaluation Center for HIV and Oral Health (ECHO), Boston University School of Public Health.
Advancing Team-Based Care: Complex Care Management in Primary CareCHC Connecticut
This webinar investigated the ways that team members can contribute to the care of patients with complex medical and/or social needs. The focus was on developing the expanded care team and ensuring ready communication between the core and expanded care teams. Models for effective care management were presented.
This webinar was presented May 5, 2016 3:00 p.m. Eastern Time
Clinical Workforce Development NCA Informational WebinarCHC Connecticut
Learn more about training and technical assistance offered through Community Health Center Inc.'s National Cooperative Agreement (NCA) on Clinical Workforce Development. Hear more about FREE Learning Collaboratives opportunities to enhance or implement a model of Team-Based Care at your Health Center, and how to implement a Post-Graduate Residency program for Nurse Practitioners and Post-Doc Clinical Psychologists.
Advancing Team-Based Care: Enhancing the Role of the Medical AssistantCHC Connecticut
In this webinar, we explored the expanded role that medical assistants play in improving patient health outcomes. The role of the medical assistant was explored in population management, using electronic dashboards, and health coaching. We discussed how state-by-state variation and regulation may influence medical assistant practice.
The goal of Integrating HIV Innovative Practices (IHIP) is to enable health care providers to implement proven innovations within their own practices and clinics. This Webinar is the first in a three part series featuring grantees of the Health Resources and Services Administration’s Special Projects of National Significance (SPNS) Enhancing Linkages to HIV Care & Services in Jail Settings Initiative (Jail Linkages Initiative), as they share lessons learned and advice for others hoping to create or expand similar programs.
Explore how to secure buy-in and foster partnerships within correctional settings, as well as how to navigate the “culture of corrections.” Hannah Zellman of Philadelphia FIGHT, a SPNS Jail Linkages grantee, will present alongside Dr. Linda Rose Frank and Debra D’Alessandro of the PA/MidAtlantic AIDS Education and Training Center about the work their organizations have done individually and collaboratively in the corrections setting.
The goal of Integrating HIV Innovative Practices (IHIP) is to enable health care providers to implement proven innovations in HIV care and services within their own practices. This Webinar is the second in a three-part series exploring innovative approaches to delivering oral health care and services to people living with HIV/AIDS, featuring grantees of the Health Resources and Services Administration’s Special Projects of National Significance (SPNS) Innovations in Oral Health Care Initiative (Oral Health Initiative).
This Webinar outlines dental case management programs at the AIDS Care Group (ACG) in Chester, PA and the Native American Health Center (NAHC) in San Francisco, CA. The presenters include Dr. Howell Strauss and Mr. Nelson Diaz from ACG; and Dr. Carolyn Brown and Ms. Lucy Wright, RDH, representing the NAHC. The presentation details the pros, cons, and considerations of dental case management from administrative and clinical perspectives. The presenters also provide tips for being a good dental case manager and how this can result in improved health outcomes.
The goal of Integrating HIV Innovative Practices (IHIP) is to enable health care providers to implement proven innovations in HIV care and services within their own practices. This Webinar is the third in a three-part series exploring innovative approaches to delivering oral health care and services to people living with HIV/AIDS, featuring grantees of the Health Resources and Services Administration’s Special Projects of National Significance (SPNS) Innovations in Oral Health Care Initiative (Oral Health Initiative).
This Webinar explores the clinical aspects of oral health care for people living with HIV/AIDS (PLWHA). The presenters include Dr. David Reznik of Grady Health System in Atlanta, GA and HIVdent and Ms. Helene Bednarsh, MPH of Boston Public Health Commission in Boston, MA and HIVdent. Dr. Reznik and Ms. Bednarsh detail common oral health diseases among HIV-infected people, as well as the prevention, detection, and treatment of these diseases.
This Webinar is the first in the Enhancing Linkages to HIV Primary Care and Services Webinar series, produced in association with the Health Resources and Services Administration's (HRSA's) Integrating HIV Innovative Practices (IHIP) project. The series’ three sessions each focus on a different aspect of linking people living with HIV/AIDS to HIV primary care and services in the jails setting.
This Webinar series is part of a collection of dissemination materials on the SPNS EnhanceLink Jail Linkage Initiative (http://hab.hrsa.gov/abouthab/special/carejail.html). These include:
- Training manual: https://careacttarget.org/library/creating-jail-linkage-program-training-manual
- Curriculum: https://careacttarget.org/library/creating-jail-linkage-program-curriculum, and
- Pocket guide: https://careacttarget.org/sites/default/files/JailsLinkageIHIPPocketCard.pdf
All of these resources can be found on the IHIP landing page (http://www.careacttarget.org/ihip) on the TARGET Center Web site. In addition, all Webinar sessions in this series will be recorded and also made available on the IHIP page.
This Webinar provides an overview of common oral health barriers for people living with HIV/AIDS (PLWHA) and the importance of overcoming these barriers. It will also share some of the ways HRSA has helped link PLWHA to oral health care, including the SPNS Oral Health Initiative. Featured presenters include:
- Dr. Mahyar Mofidi; Branch Chief of the Division of Community HIV/AIDS Programs and Chief Dental Officer of the HRSA HIV/AIDS Bureau
- Jane Fox, MPH; Project Director of SPNS Oral Health Initiative Evaluation Center for HIV and Oral Health (ECHO), Boston University School of Public Health.
Advancing Team-Based Care: Complex Care Management in Primary CareCHC Connecticut
This webinar investigated the ways that team members can contribute to the care of patients with complex medical and/or social needs. The focus was on developing the expanded care team and ensuring ready communication between the core and expanded care teams. Models for effective care management were presented.
This webinar was presented May 5, 2016 3:00 p.m. Eastern Time
Clinical Workforce Development NCA Informational WebinarCHC Connecticut
Learn more about training and technical assistance offered through Community Health Center Inc.'s National Cooperative Agreement (NCA) on Clinical Workforce Development. Hear more about FREE Learning Collaboratives opportunities to enhance or implement a model of Team-Based Care at your Health Center, and how to implement a Post-Graduate Residency program for Nurse Practitioners and Post-Doc Clinical Psychologists.
Advancing Team-Based Care: Enhancing the Role of the Medical AssistantCHC Connecticut
In this webinar, we explored the expanded role that medical assistants play in improving patient health outcomes. The role of the medical assistant was explored in population management, using electronic dashboards, and health coaching. We discussed how state-by-state variation and regulation may influence medical assistant practice.
Members of the Coleman Supportive Oncology Collaborative including over 169 cancer care providers from 44 institutions came together in person to share lessons from their 3-year project to improve supportive cancer care across the region and to launch the next step in the Coleman Foundation initiative which is to improve patient communication and experience.
The Structure of a 12-month Residency Program and Stories from Former Residen...CHC Connecticut
The goal of the Postdoctoral Psychology Residency program is to train the next generation of psychologists in the Patient Centered Medical Home model. Through weekly seminars, group and individual supervision and clinical work with diverse, underserved populations, residents will fine-tune assessment and therapy skills.
This FREE learning collaborative opportunity will provide health centers with the support, resources and structure to implement a Postdoctoral Clinical Psychology Residency program at their organization.
2021-2022 NTTAP Webinar: Fundamentals of Comprehensive CareCHC Connecticut
Join us as we discuss the core concepts of team-based care and introduce elements of team-based care that builds upon these basics to support your teams in advancing their capability to provide satisfying and effective care to complex patient populations. .
We will be joined by Margaret Flinter, Senior Vice President/Clinical Director for Community Health Center, Inc., and both Thomas Bodenheimer, MD, Physician and Founding Director, and Rachel Willard Grace, Director, from the Center for Excellence in Primary Care.
At the end of this 90 minute session patient/ family/ advisors/ champions as well as health providers/ leaders/ authorities will leave with at least one practical idea to apply to patient advisor training as a result of their increased understanding of:
Current training programs and models in use across Canada
Training needs of patient advisors at different system levels
Gaps in training needs and ideas on how to fill them
Available supporting resources and leading practices
Advancing Team-Based Care: The Emerging Role of Nurses in Primary CareCHC Connecticut
In this webinar, we explored the emerging role of nurses in primary care. We explored the role of nurses in the team, in complex care management, and in independent nurse visits.
This webinar was presented March 31, 2016 2:00 PM ET
Advancing Team-Based Care:Data Driven Dashboards to Support Team Based Care CHC Connecticut
This webinar highlighted the ways that practices utilize technology to improve individual patient care and track and meet the needs of their whole patient population. By using electronic health record data and clinical dashboards, members of the team can organize visits to resolve care gaps, optimize prevention, and improve clinical outcomes.
This webinar was presented April 7, 2016 3:00 PM Eastern Time
Advancing Team-Based Care: Achieving Full Integration of Behavioral Health an...CHC Connecticut
This webinar highlighted ways to fully integrate behavioral health care into primary care. The role of nurses, medical assistants, behaviorists, lay health workers, and primary care providers was discussed along with the use of clinical dashboards and warm hand-offs.
This webinar was presented May 19, 2016 3:00 p.m. Eastern Time
Understanding the value and contribution of nurses and midwives to public health in the UK - presentation at the Faculty of Public Health annual conference 2016
Postgraduate residency presentation #2 from recruitment to graduationCHC Connecticut
What does the 12-month Nurse Practitioner Residency program look like? This webinar will delve into the details of the structure, design, and content of a 12-month, Federally Qualified Health Center (FQHC) based, postgraduate nurse practitioner residency program. Topics such as recruitment, screening and selection of candidates, core programmatic and curricula elements, and the essential contributions of other staff will be discussed. This webinar will feature speakers from the Community Health Center, Inc.’s first-in-the-nation nurse practitioner residency program and guests from other exemplary programs around the country.
Improvement Story session at the 2013 Saskatchewan Health Care Quality Summit. For more information about the summit, visit www.qualitysummit.ca. Follow @QualitySummit on Twitter.
Better Care
Germain Bukassa Kazadi
Implementing Post-Graduate Nurse Practitioner and Clinical Psychology Residen...CHC Connecticut
This webinar discussed the importance of research and evaluation in measuring successes and failures in the implementing of postgraduate residency programs within health centers. Different evaluative methods were explored in this webinar including self-assessment, standardized tools and journaling.
This webinar took place April 13, 2016 3:00 PM Eastern Time as part of the CHC Clinical Workforce Development National Cooperative Agreement.
Implementing Post-Graduate Nurse Practitioner and Clinical Psychology Residen...CHC Connecticut
In this final webinar of the Training the Next Generation series, we featured successful postgraduate nurse practitioner and psychology residency programs from around the country. Each presenter shared their unique experiences, successes, and failures of implementing these programs at their health centers.
Permaculture Design Introduction with Background, State of the World, and Principles of Ecological, Energy Efficient Design of human settlements and organic agriculture
Members of the Coleman Supportive Oncology Collaborative including over 169 cancer care providers from 44 institutions came together in person to share lessons from their 3-year project to improve supportive cancer care across the region and to launch the next step in the Coleman Foundation initiative which is to improve patient communication and experience.
The Structure of a 12-month Residency Program and Stories from Former Residen...CHC Connecticut
The goal of the Postdoctoral Psychology Residency program is to train the next generation of psychologists in the Patient Centered Medical Home model. Through weekly seminars, group and individual supervision and clinical work with diverse, underserved populations, residents will fine-tune assessment and therapy skills.
This FREE learning collaborative opportunity will provide health centers with the support, resources and structure to implement a Postdoctoral Clinical Psychology Residency program at their organization.
2021-2022 NTTAP Webinar: Fundamentals of Comprehensive CareCHC Connecticut
Join us as we discuss the core concepts of team-based care and introduce elements of team-based care that builds upon these basics to support your teams in advancing their capability to provide satisfying and effective care to complex patient populations. .
We will be joined by Margaret Flinter, Senior Vice President/Clinical Director for Community Health Center, Inc., and both Thomas Bodenheimer, MD, Physician and Founding Director, and Rachel Willard Grace, Director, from the Center for Excellence in Primary Care.
At the end of this 90 minute session patient/ family/ advisors/ champions as well as health providers/ leaders/ authorities will leave with at least one practical idea to apply to patient advisor training as a result of their increased understanding of:
Current training programs and models in use across Canada
Training needs of patient advisors at different system levels
Gaps in training needs and ideas on how to fill them
Available supporting resources and leading practices
Advancing Team-Based Care: The Emerging Role of Nurses in Primary CareCHC Connecticut
In this webinar, we explored the emerging role of nurses in primary care. We explored the role of nurses in the team, in complex care management, and in independent nurse visits.
This webinar was presented March 31, 2016 2:00 PM ET
Advancing Team-Based Care:Data Driven Dashboards to Support Team Based Care CHC Connecticut
This webinar highlighted the ways that practices utilize technology to improve individual patient care and track and meet the needs of their whole patient population. By using electronic health record data and clinical dashboards, members of the team can organize visits to resolve care gaps, optimize prevention, and improve clinical outcomes.
This webinar was presented April 7, 2016 3:00 PM Eastern Time
Advancing Team-Based Care: Achieving Full Integration of Behavioral Health an...CHC Connecticut
This webinar highlighted ways to fully integrate behavioral health care into primary care. The role of nurses, medical assistants, behaviorists, lay health workers, and primary care providers was discussed along with the use of clinical dashboards and warm hand-offs.
This webinar was presented May 19, 2016 3:00 p.m. Eastern Time
Understanding the value and contribution of nurses and midwives to public health in the UK - presentation at the Faculty of Public Health annual conference 2016
Postgraduate residency presentation #2 from recruitment to graduationCHC Connecticut
What does the 12-month Nurse Practitioner Residency program look like? This webinar will delve into the details of the structure, design, and content of a 12-month, Federally Qualified Health Center (FQHC) based, postgraduate nurse practitioner residency program. Topics such as recruitment, screening and selection of candidates, core programmatic and curricula elements, and the essential contributions of other staff will be discussed. This webinar will feature speakers from the Community Health Center, Inc.’s first-in-the-nation nurse practitioner residency program and guests from other exemplary programs around the country.
Improvement Story session at the 2013 Saskatchewan Health Care Quality Summit. For more information about the summit, visit www.qualitysummit.ca. Follow @QualitySummit on Twitter.
Better Care
Germain Bukassa Kazadi
Implementing Post-Graduate Nurse Practitioner and Clinical Psychology Residen...CHC Connecticut
This webinar discussed the importance of research and evaluation in measuring successes and failures in the implementing of postgraduate residency programs within health centers. Different evaluative methods were explored in this webinar including self-assessment, standardized tools and journaling.
This webinar took place April 13, 2016 3:00 PM Eastern Time as part of the CHC Clinical Workforce Development National Cooperative Agreement.
Implementing Post-Graduate Nurse Practitioner and Clinical Psychology Residen...CHC Connecticut
In this final webinar of the Training the Next Generation series, we featured successful postgraduate nurse practitioner and psychology residency programs from around the country. Each presenter shared their unique experiences, successes, and failures of implementing these programs at their health centers.
Permaculture Design Introduction with Background, State of the World, and Principles of Ecological, Energy Efficient Design of human settlements and organic agriculture
In this webinar, clinicians from two Ryan White clinics with successful buprenorphine programs describe what buprenorphine is, how it works, what opioids do to the brain, how buprenorphine differs from methadone, important drug-drug interactions, the concept of precipitated withdrawal and how to recognize it, how to determine patient eligibility, and clinical aspects of working with opiod-addicted people living with HIV.
Presenters Pamela Vergara-Rodriguez, MD, (CORE Center in Chicago), and Jacqueline Tulsky, MD (University of California at San Francisco and San Francisco General Hospital), also describe the challenges and successes of the SPNS buprenorphine projects at their institutions.
Visit the Integrating HIV Innovative Practices webpage to learn more about integrating buprenorphine into HIV primary care settings and to access additional training materials.
WHO - Community management-of-opioid-overdoseEmergency Live
These guidelines were produced by the Management of Substance Abuse unit of the WHO Department of Mental Health and Substance Abuse in collaboration with the WHO HIV Department. Vladimir Poznyak and Nicolas Clark coordinated the development of these guidelines under the direction of Shekhar Saxena and in collaboration with Rachel Baggaley and Annette Verster. Members of the project’s WHO Steering Group included: Annabel Badderley, Rachel Baggaley, Nicolas Clark, Selma Khamassi, Elizabeth Mathai, Maggie Peden, Vladimir Poznyak, and Annette Verster (see Annex 7 for affiliations). The members of the project’s Guideline Development Group (GDG) were: Robert Balster (Chair), Barbara Broers, Jane Buxton, Paul Dietze, Kirsten Horsburgh, Raka Jain, Nadeem Ullah Khan, Walter Kloeck, Emran M Razaghi, Hendry Robert Sawe, John Strang, and Oanh Thi Hai Khuat (see Annex 7 for affiliations).
Daniel Blaney-Koen, American Medical Association, presented on The Nation's Opioid Epidemic: Are we Asking the Right Questions? at the State Legislative Conference on November 6, 2015.
Dr. Tom Frieden, Director of the Centers for Disease Control and Prevention, keynote presentation at the National Rx Drug Abuse & Heroin Summit on March 30, 2016.
Presentation was originally done at Group Health Cooperative’s National Summit on Opioid Safety: http://www.ghinnovates.org/?p=3502.
Presentation by Andrew Kolodny, M.D., chair, department of Psychiatry Maimonides Medical Center Brooklyn, New York
Overview of the 2018 Update to the Integrated Plan and PrEP Workgroup Draft R...Office of HIV Planning
Mari Ross-Russell (Office of HIV Planning) and Matthew McClain (Public Health Policy & Planning Consultant) presented these slides to the PrEP Workgroup of the Philadelphia EMA HIV Integrated Planning Council on January 16, 2019.
RESEARCH ARTICLELong term effect of primary health care.docxrgladys1
RESEARCH ARTICLE
Long term effect of primary health care
training on HIV testing: A quasi-experimental
evaluation of the Sexual Health in Practice
(SHIP) intervention
Kamla Pillay
1
, Melissa Gardner
2,3
, Allon Gould
4
, Susan Otiti
5
, Judith Mullineux
6
,
Till Bärnighausen
7,8,9,10
, Philippa Margaret Matthews
11,12*
1 Homerton Hospital, London, United Kingdom, 2 Sexual Health in Practice Community Interest Company,
London, United Kingdom, 3 Killick Street Health Centre, London, United Kingdom, 4 Whipps Cross Hospital,
London, United Kingdom, 5 Public Health, London Borough of Haringey, London, United Kingdom, 6 Sexual
Health Promotion, Birmingham, United Kingdom, 7 Africa Health Research Institute, Somkhele, South Africa,
8 Institute of Public Health, Heidelberg University, Heidelberg, Germany, 9 Infection and Population Health,
University College London, London, United Kingdom, 10 Department of Global Health and Population,
Harvard T.H. Chan School of Public Health, Boston, United States of America, 11 Division of Infection and
Immunity, University College London, London, United Kingdom, 12 Africa Health Research Institute,
Somkhele, South Africa
* [email protected]
Abstract
Background
To examine the effect of Sexual Health in Practice (SHIP) training for general practitioners
(GPs) on HIV testing rates in Haringey, a deprived area of London, UK, with a population of
over 250,000 and HIV prevalence of 0.7% (in 2014). SHIP is an educational intervention
delivering peer-developed and peer-led face-to-face training to improve quality of sexual
and reproductive health (SRH) care.
Methods
We carried out a quasi-experimental study of intervention effects across 52 GP practices
(2008–2016). We used time variation in SHIP intervention exposure for effect estimation,
controlling for practice and calendar month fixed effects in panel analysis. From 2008–2010,
baseline data were collected, and in the subsequent six-year period, 78 GPs in Haringey
(approximately 40% of all GPs) were SHIP trained. 46 Haringey practices (of 52) had at
least one trained doctor. Outcome measures were monthly HIV tests and results by practice
(obtained from the hospital laboratories).
Results
SHIP significantly increased HIV testing; for every GP trained, practice HIV testing rates
increased by 16% (testing rate ratio (TRR) 1.16, 95% confidence interval (CI) 1.05–1.28,
p value 0.004). This significant effect was demonstrated using an 8-year observation period,
PLOS ONE | https://doi.org/10.1371/journal.pone.0199891 August 1, 2018 1 / 13
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OPEN ACCESS
Citation: Pillay K, Gardner M, Gould A, Otiti S,
Mullineux J, Bärnighausen T, et al. (2018) Long
term effect of primary health care training on HIV
testing: A quasi-experimental evaluation of the
Sexual Health in Practice (SHIP) intervention. PLoS
ONE 13(8): e0199891. https://doi.org/10.1371/
journal.pone.0199891
.
OHP's Antonio Boone gave this presentation on different prevention continuum examples at the July meeting of the Prevention Committee of the Philadelphia EMA HIV Integrated Planning Council.
Philadelphia Department of Public Health HIV Prevention ActivitiesOffice of HIV Planning
Coleman Terrell of the Philadelphia Department of Public Health presented on the PDPH's HIV Prevention Activities at the Philadelphia HIV Prevention Planning Group's December 2014 meeting.
Geoff Honnor (ACON) redefines wellness in an evolving HIV epidemic, as well as discussing the context of the UN Goals for reducing HIV transmission 2010-2015 and the ACON response.
This presentation was given at the AFAO Positive Services Forum 2012.
Jennifer Mason, Senior Advisor for FP/HIV Integration for USAID's Office of Population and Reproductive Health describes the agency's approach to integrating family planning services with HIV health services and provides country examples of integration practices.
SYNCing Government Agencies with NHAS and VHAP healthhiv
Warren W. Hewitt, Jr. DrPH, M.S.
Center for Substance Abuse Treatment
Substance Abuse Mental Health Services Administration
U.S. Department of Health & Human Services
Representatives from the Philadelphia Department of Public Health (PDPH) presented an update on their strategic plan for sexual health at the February 2015 meeting of the Philadelphia Ryan White Part A Planning Council.
The mission of the Sexually Transmitted Diseases (STD) Control Program is to reduce the occurrence of STDs through disease surveillance, case and outbreak investigation, screening, preventive therapy, outreach, diagnosis, case management, and education.
PIHCI programmatic grants webinar (en) for circulationAlexandra Enns
These are the slides from CIHR’s webinar providing information for the upcoming PIHCI Network Programmatic Grant funding opportunity.
The complete instructions are on ResearchNet: https://www.researchnet-recherchenet.ca/rnr16/vwOpprtntyDtls.do?prog=2734&view=currentOpps&org=CIHR&type=EXACT&resultCount=25&sort=program&next=1&all=1&masterList=true
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
2. Agenda
Brief introduction to the new SPNS IHIP project (Sarah Cook-Raymond, Impact
Marketing + Communications)
Overview of the “Innovative Methods for Integrating Buprenorphine Abuse Treatment
in HIV Primary Care Settings Initiative” including:
Its synergy with the National HIV/AIDS Strategy (Adan Cajina, Chief –
Demonstration Branch SPNS Program)
Findings from the Initiative (Linda Weiss, PhD, New York Academy of Medicine)
Addressing misconceptions (Cindy MacLeod, ACRN, The Miriam Hospital
Immunology Center)
Patient testimony (Arthur, Miriam Hospital Immunology Center)
Q &A
3. Introducing IHIP…
SPNS has launched the “Integrating HIV Innovative Practices”
(IHIP) project.
IHIP takes innovative findings from SPNS Initiatives and assists
health providers in replicating proven models of care.
The result? Improved care delivery and healthier patients.
4. Findings from the Buprenorphine Initiative have been translated
into:
A training manual
A curriculum
A Web site and online wiki (forthcoming) to share lessons learned and
provide a virtual community of providers.
A Webinar series
This is the first of three focusing on buprenorphine
Subsequent Webinars will review the clinical aspects of delivering
buprenorphine and how to build capacity within your clinic.
All IHIP products and a buprenorphine monograph can be accessed at
www.careacttarget.org.
The Buprenorphine Initiative is the first initiative in the IHIP series.
Outreach and retention are next, with more to come.
5. Questions about the IHIP project can be directed to
Sarah Cook-Raymond, Managing Director
Impact Marketing + Communications (www.impactmc.net)
scook@impactmc.net
6. August 28, 2012
Adan Cajina
Chief – Demonstration Branch SPNS Program
U.S. Department of Health and Human Services, Health
Resources and Services Administration, HIV/AIDS Bureau
6
7.
Mission: Respond to emerging HIV primary
care needs of individuals receiving assistance
under the Ryan White HIV/AIDS Program
Development of innovative models of HIV care
Evaluation of program effectiveness
Build capacity by promoting dissemination and lessons
learned
Replication of successful models
8.
White House releases the
NHAS & Implementation
Plan – July, 2010
Nation’s first
comprehensive
coordinated HIV/AIDS
roadmap with clear,
measurable goals for
2015
Refocuses existing efforts
to maximize available
resources and make the
case for new investments
8
9. •
•
•
Reduce new infections (25%), lower
transmission rate (30%), and increase to 90%
awareness of HIV+ serostatus
Improve access to and outcomes of care by
linking 80% of PLH to care w/in 3 mo of
diagnosis, increase to 80% RW clients in
continuous care, and increase to 86% RW
clients with permanent housing
Reduce HIV-related health disparities by
increasing by 20% the number of men who
have sex with men (MSM), Blacks, and Latinos
with undetectable viral load
9
10.
NHAS tasked HAB: “To collaborate with States
and localities on pilot initiatives for
expanding the most promising models for
integrating HIV testing, outreach, linkage and
retention in high risk communities”.
SPNS initiatives have and continue to promote
the strategy through innovative models
related to access, health care integration and
optimization, and re-engagement and
retention.
11.
Enhancing Linkages to Primary Care & Services in
Jail Settings
Enhancing Access to and Retention in Quality
HIV/AIDS Care for Women of Color
Hepatitis C Treatment Expansion
HIT Capacity Building Initiative for Ryan White
HIV/AIDS Program AIDS Drug Assistance Program
(ADAP)
Systems Linkage and Access to Care for
Populations at High Risk of HIV Infection
Retention and Re-engagement Project
12.
Enhancing Access to and Retention in HIV
Primary Care for Transgender Women of
Color
Integrated HIV Care, Mental Health and
Substance Abuse Treatment for Homeless
populations
HIT Capacity Building Initiative for Ryan White
Program Providers
Replication of a Public Health Information
Exchange to Support Engagement in HIV Care
13.
Oral Health
Prevention with Positives
Outreach
Electronic Networks of Care
YMSM
Others found at:
http://hab.hrsa.gov/abouthab/special/previousinitiat
ives.html
And the Buprenorphine Initiative funded from
2004-2009.
14. Innovative Methods for integrating Buprenorphine
Opioid Abuse Treatment in HIV Primary Care Initiative
Catalyst to fund this initiative:
◦ Approximately one-third of all AIDS cases are
directly or indirectly linked to injection drug use.
◦ Opioids are among the most frequently abused
drugs.
◦ Nonmedical opioid pain medication abuse is on
the rise.
◦ Mortality among illicit opioid users is estimated at
approximately 13 times that of the general
population.
14
15.
Catalyst to fund this initiative:
◦ HRSA-SAMHSA Collaboration
◦ Licensing of Buprenorphine (DATA 2000)
◦ Need to bridge the two cultures of substance
abuse treatment and HIV primary care by building
capacity for both medication-assisted treatment
(MAT) and the supportive services that are critical
to its success.
◦ Ryan White HIV/AIDS Program providers were
seeing opioid dependent patients already;
integration of buprenorphine offered one more
way to create a comprehensive medical home.
16.
First of its class demonstration project piloted in
real-world clinical settings
5-year initiative comprised of 10 demonstration sites
across the Nation and coordinated by an Evaluation
and Technical Assistance Center – The New York
Academy of Medicine – in collaboration with Yale
University School of Medicine.
Lessons learned adding to the knowledge base and
expansion of substance abuse treatment into not just
HIV primary care, but primary care more generally.
18. Integration of Buprenorphine into HIV Care:
Findings from the BHIVES Collaborative
Linda Weiss, PhD
Center for Evaluation and Applied Research
August 2012
19. Presentation Objectives
1. Describe the HIV, drug use, and quality of life outcomes for integrated HIV
and buprenorphine treatment at BHIVES sites.
2. Describe promising practices for integration of buprenorphine treatment into
an HIV primary care clinic
3. Describe common challenges faced by providers offering buprenorphine
treatment to their HIV patients, as well as effective responses to those
challenges
20. Buprenorphine Overview
• An opioid replacement therapy that has been shown to be as effective as
methadone in reducing opioid use.
• Approved by the FDA in 2002 for office based treatment of addiction.
• Can be prescribed by physicians that complete buprenorphine training and
register with the DEA.
• Offers a unique opportunity to integrate drug treatment for opioid use into
HIV care settings.
• Provides an alternative to patients who are uninterested in or unsuccessful
with methadone programs.
21. BHIVES Initiative
BHIVES INITIATIVE
•
Starting in 2005, HRSA/SPNS funded 10 sites to design and implement programs
that integrate primary HIV care and the office-based treatment of opioid addiction
using buprenorphine.
•
Sites designed their own integrated models consistent with clinic characteristics,
including staffing and patient population.
•
The initiative included an Evaluation and Support Center based at The New York
Academy of Medicine to coordinate a multi-site evaluation, provide clinical and
evaluation technical assistance, and promote dissemination of findings.
•
Clinical support provided by Yale University School of Medicine.
Multisite Evaluation
Objectives
•
Assess the feasibility and effectiveness of integrating buprenorphine treatment and
HIV primary care.
•
Identify best practices for integrated care.
•
Promote the replication of these practices.
22. Model Demonstration Sites
• EL Rio Santa Cruz Neighborhood Health
Center (Tucson, AZ)
• OASIS (Oakland, CA)
• Oregon Health & Sciences University
(Portland, OR)
• Montefiore Medical Center, (Bronx, NY)
• University of Miami Medical School (Miami,
FL)
• The Miriam Hospital (Providence, RI)
• UCSF Positive Health Program (San
Francisco, CA)
• Johns Hopkins University (Baltimore, MD)
• CORE Center (Chicago, IL)
• Yale University School of Medicine (New
Haven, CT)
Evaluation & Support Center (BHIVES)
• The New York Academy of Medicine
(evaluation)
• Yale University Medical School (clinical
expertise)
• Weill Cornell Medical College (cost
analysis)
BHIVES Sites
23. Multisite Evaluation Methods: Patient Data
•
Study participants were assessed at baseline, 30 days and quarterly for one year
•
Assessments included interview and chart abstraction data focused on:
• Sociodemographics
• Substance use
• Health status
• HIV clinical indicators
• Quality of life
• Service utilization
•
Validated measures incorporated into the assessments included:
• Addiction Severity Index (ASI)
• SF-12
• CES-D
• Brief Symptom Inventory
• NAIDS Symptom Distress Module
•
Qualitative interviews were conducted with a convenience sample of 33 patients from 7
BHIVES sites. Interviews focused on:
• Drug use cessation and buprenorphine treatment
• Experience with other treatment modalities, including methadone
• Advantages and disadvantages of integrating substance abuse treatment into HIV care.
24. Multisite Evaluation Methods: Provider Data
•
Provider surveys were administered three times during the study
period and focused on:
•
•
•
•
•
A survey of providers examining the quality of opioid prescribing was
administered at the midpoint of the study. Topics included:
•
•
•
•
HIV and substance use treatment experience
Patient characteristics
Knowledge regarding buprenorphine treatment
Factors affecting willingness to prescribe buprenorphine
Adherence to recommended guidelines for opioid prescribing
Concern around substance abuse and the misuse of prescriptions opioids
Confidence in ability to recognize opioid analgesic abuse
Individual and group interviews with providers and staff were
conducted during the first and fifth year of the study covering:
•
•
•
Program implementation
Best practice recommendations
Lessons learned
25. BHIVES Sample (N=303)
Participant Characteristics
Age (mean)
%
45.2
Years HIV+ (mean)
•
•
Most participants were over 40 years
of age (71%); had been HIV+ for >10
years (61%) and had been using
opioids for an average of 17 years.
Just over half of the sample were
African-American/Black (52%)
12
Years using heroin (mean)
17
Unemployed
74.3
Homeless
25.1
Sex
Male
67.7
Female
32.3
Race/ethnicity
•
At baseline, most of the participants
reported being unemployed (74%) and
a quarter (25%) were homeless
African-American/Black
51.5
Latino/a
22.4
White
22.7
Other
3.3
Education
< HS
42.2
HS/GED
34.4
College
23.2
27. Findings: Heroin and Other Opioid Use Outcomes
There were significant decreases in heroin and other opioid use over time
•
•
“Any opioid use” decreased from 84% at baseline to 42% at year 4.
On average participants were 52% less likely to use any opiates for each quarter of
participation in the intervention (OR = .659, p ≤ .001).
•
•
Heroin use decreased from 70% at baseline to 27% at year 4.
On average participants were 59% less likely to use heroin for each quarter of
participation in the intervention (OR = .629 p ≤ .001)
Opioid Use Outcomes
100
90
80
%
70
60
50
40
30
20
10
0
Heroin
Opioids
Baseline
70.5
84.4
Quarter 1
35.6
43.8
Quarter 2
28.7
38.8
Quarter 3
26.5
41.6
Quarter 4
27.7
42.4
28. Findings: HIV Outcomes
•
Patients initiating buprenorphine were significantly more likely to start or
remain on ART and improve CD4 levels
•
For patients not on ART at baseline, retention in buprenorphine treatment
for 3 or more quarters was associated with starting ART and reduced viral
load
29. Findings: Health Related Quality of Life
•
Baseline normalized SF-12 scores were lower than the general US
population (mean of 50) for all HRQOL domains
•
Average composite mental HRQOL improved from 38.3 to 43.4 over 12
months
•
Average composite physical HRQOL remained unchanged over 12
months (varied between 42.1 and 43.9)
•
In multivariate analysis, continued buprenorphine treatment across all 4
quarters was associated with improvements in both physical and mental
HRQOL
30. Findings: Qualitative Patient Interviews
Patient perspectives regarding buprenorphine and integrated care were positive
•
Satisfaction & Perspectives on Effectiveness
•
•
•
Impact on Health & HIV care
•
•
•
Nuanced ability to manage treatment
Less fear of withdrawal
Integrated Care: Benefits & Concerns
•
•
•
Improved health
Increased engagement with health and HIV care
Self Management & Withdrawal
•
•
•
Effective in controlling opioid use and blocking cravings; buprenorphine treatment
resulted in decreased substance use
Greatly improved quality of life: feel “normal”
Benefits include convenience, improved quality of care, improved treatment
environment
Concerns include confidentiality issues and time saving (too much saved)
Counseling
•
Substance abuse treatment is complicated – needs more than just buprenorphine
31. Findings: Qualitative Patient Interviews
“I love it. Absolutely. This stuff’s like a frigging gift from God, Suboxone, it is, I love
it. The shit works so good.”
“It was like a big yoke being lifted off my shoulders. It means freedom to me.”
“With buprenorphine you just feel like you’re just normal…it’s kind of like, it takes
me back to before I had ever done opiates.”
“Actually I don’t feel like I’m on any drug when I take the Suboxone [compared to
methadone]. I don’t nod. I’m not speedy. I’m not sleeping. I feel good when I’m on
the Suboxone.”
“Now they know I got [HIV], and it’s like nothing to them, you know what I mean.
They treat me nice, you know. I mean they’re all, you know, here to help you.”
“For me having it in the same place worked out well. I can get everything right here
in this one facility, without having to run over here and over there.”
32. Findings: Provider and Staff Interviews
•
Integrated buprenorphine and HIV treatment successfully introduced into
community and hospital based-clinics under the direction of ID,
psychiatry, and general internal medicine physicians
•
At virtually all sites, providers and staff were highly satisfied with
integrated care
•
Anticipated continued provision of the service after the end of the grant period
•
Multiple prescribers necessary to ensure sufficient coverage
•
A “buprenorphine coordinator” (e.g. nurse, counselor) was seen as
essential to the provision of quality care
•
Ongoing challenges included:
•
•
•
Multi-substance use and mental health issues among patients
Limited adoption of buprenorphine treatment among colleagues
Necessity of incorporating new procedures (e.g. urine toxicology) testing into
established practice
33. Findings: Provider and Staff Interviews
Positive perceptions of buprenorphine and integrated care
•
“Is it worth it? Absolutely…. it expanded our capacity to take care of folks who were
previously on the margins of engaging in health care. So, it ended up bringing in
folks who haven't been previously engaged in HIV care, and it gave us tools to
better take care of the ones who were engaged in some fashion, in our practices
already, but not doing well from an addiction standpoint… it also had this spill-over
effect of raising our awareness of addiction issues in general .”
•
“One of the beauties of office based buprenorphine is really embracing a harm
reduction model. I’m not going to stop their buprenorphine if they have a positive
drug screen.”
Buprenorphine coordinator
•
“I think they really benefit from closer follow-up than I could give them, like phone
contacts and those sorts of things, and in person with their counselor, and
addressing some of the mental health issues that I just can't get to in a 25 minute
visit.”
•
“It's more like somebody to … stay on top of what's going on with the patients and
then to actually work with them—that has the experience and training to know how
to work with substance abusers and counsel them individually and run a group, for
example. I think those are, by far, the more important components of the job.”
34. Findings: Provider and Staff Interviews
Challenges to integrated care
•
“These patients are really complex. On one hand, treating the substance abuse is
basically just opening the [door] to all the other sorts of problems that are going on
with these folks.”
•
“[For induction] we have to assess the patient, give them the prescription, they go
down [to the pharmacy], get the medication and bring it on up. So on the first days,
you're often dealing with one or two visits and then that first week, you're dealing
with three to five visits and then two visits after that. So it's just so many visits that
it's just hard.”
•
“We had this precipitated withdrawal, we brought the patient back to this area we
call the treatment room where we have a few stretchers … and this nurse, and I
never would have expected it, but before we brought the patient back she said, “ I
just hate dealing with these kinds of patients.” And I mean she works in the
treatment room of the HIV clinic, I mean she sees a lot of-- but as soon as she
heard it was somebody in withdrawal. And that sort of struck me that, if we were
asking existing staff, if we came to them and said, ‘Hey, we got this new exciting
thing, but you need to put in some effort on it’ I don't know exactly how well it would
go over.”
35. Other Findings
•
Costs: Implementing buprenorphine treatment is associated with some
increased costs.
•
•
Integrated HIV and buprenorphine treatment require different resources;
buprenorphine treatment has costs that are not third-party reimbursed.
HIV quality of care: Buprenorphine treatment was associated with
improvement in HIV quality of care indicators (QI) at 12 months (46% of
QIs at baseline, compared to 52% at 6 months) .
–
Improvements primarily in preventive and monitoring care domains
•
Safety: Buprenorphine did not produce measurable hepatic toxicity or
pharmacodynamic interaction with atazanavir in HIV-infected opioiddependent patients.
•
Policy considerations: Financing issues, workforce and training issues
are barriers to the full integration of buprenorphine treatment into HIV
care.
–
Recommendations include changes to financing and reimbursement policies,
as well cross training between the fields of addiction medicine, drug
treatment, and HIV medicine
36. Limitations
• Diversity in programs
• Staffing, intervention and patient population differed across sites.
Impossible to determine (statistically) the impact of program
characteristics
• Primary mandate was service delivery
• Essentially no one was excluded
• Although most sites had control arms, they permitted patient choice
and cross-over
• Use of clinical judgment regarding frequency of VL, CD4, urine
toxicology. Data available for the evaluation were in some cases
sparse
• Sample size smaller than anticipated
• A portion of the sample was lost to follow-up
37. Conclusions/Discussion
•
Integrated buprenorphine and HIV care proved feasible and
acceptable in almost all BHIVES sites
•
Buprenorphine treatment provided in HIV care settings resulted in
• reduced heroin/opioid and other substance use
• improved self-reported mental and physical health over time
• some improvement in HIV treatment
•
The longer participants were in the intervention the better their selfreported outcomes
•
The opioid use findings are consistent with those observed with
buprenorphine treatment among HIV-negative patients in specialty
and office-based treatment settings
38. For More Information
•
Integrating Buprenorphine/Naloxone Treatment into HIV Clinical
Care, JAIDS Volume 56, Supplement 1, March 1 2011.
(http://journals.lww.com/jaids/toc/2011/03011)
•
Lucas GM, Chaudhry A, Hsu J, et al. Clinic-Based Treatment of
Opioid-Dependent HIV-Infected Patients Versus Referral to an
Opioid Treatment Program. Annals of Internal Medicine. 2010,
152(11): 704-711.
•
Netherland J, Botsko M, Egan JE, Weiss L, Cunningham C,
Finkelstein R, Kunins H, Saxon A, Sohler N, Sullivan L, and Fiellin
D. Factors affecting willingness to provide buprenorphine treatment.
Journal of Substance Abuse Treatment. 2009, 36(3): 244-251.
•
Linda Weiss: lweiss@nyam.org, 212-822-7298
39. Acknowledgements
• Patients who agreed to participate in these intervention programs and evaluation
• The Evaluation and Support Center Staff: D Fiellin (Yale University Medical School), R
Finkelstein, L Weiss, J Netherland, J Gass, and M Botsko, J Egan (NYAM)
• The BHIVES Principal Investigators: K Carmichael (EL Rio Santa Cruz Neighborhood
Health Center, Tucson, AZ), D Sylvestre (OASIS, Oakland, CA), P T Korthuis (Oregon
Health & Sciences University, Portland, OR), C Cunningham (Montefiore Medical
Center, New York, NY), M Fischl (University of Miami Medical School, Miami, FL),
FLANNIGAN (The Miriam Hospital, Providence, RI), P Lum (UCSF Positive Health
Program, San Francisco, CA), G Lucas (Johns Hopkins University, Baltimore, MD), J
Watts (CORE Center, Chicago, IL), R Altice (Yale University School of Medicine, New
Haven, CT), and L Sullivan (Yale University School of Medicine, New Haven, CT),
• HRSA/SPNS Project Officers: Adan Cajina, Pamela Belton, and Katherine McElroy
• This initiative was funded by the U.S. Health and Human Services/Health Resources
and Services Administration Grant Number H97HA03793
40. “RUBBER”, PLEASE MEET THE
“ROAD…”
Integrating buprenorphine treatment in a Rhode
Island HIV primary care clinic
41. WHY OUR CLINIC FELT THAT
BUPRENORPHINE INTEGRATION WOULD
MESH WITH OUR MISSION:
Our years of adherence research among active drug users
showing link between addiction treatment and improved
HIV/health outcomes
Existing primary care model
Medical and substance abuse treatment ‘silos’ in
community
Serve many active users of opiates and other substances
Strong bonds between patients and physicians, staff
Many patients had hx of long term use and social
instability
Patients actively seeking alternatives to methadone
maintenance
5 MDs became certified to prescribe buprenorphine
Willingness to dedicate nurse to co-manage buprenorphine
clinic
42. MISCONCEPTIONS (AKA, REALITY
BITES…)
What we thought:
1.
2.
Successful
management of opiate
craving attenuates use
of other substances
Patients pleading for
‘bup’ would also do
“whatever it takes” to
promote long term
recovery (self-help
meetings, counseling).
What we learned:
1.
Addictive focus may
change to another drug
or behavior
2.
Once the
pharmacological
treatment began, many
patients avoided
developing recovery
network, preferring to
rely on “the pill.”
43. What we thought…
What we learned…
3. Imposing highly
structured and
restrictive protocol for
referral and induction
was necessary
3. With experience, we were
able to merge clinical
competency with expediency
We learned the value of
flexibility within a
structured model.
4. Buprenorphine would
not be adequate to treat
any patients with
mixed pain and
addiction disorders
4. Some patients responded
well and stabilized,
something they were not
able to do with full agonist
opiates. Others were
referred for methadone or
pain management.
44. What we thought…
5. Patients would taper
from buprenorphine and
successfully utilize their
recovery support
networks.
What we learned…
5. Some did. Many
relapsed and often
returned for multiple reinductions. The same
relapse-recovery cycles
prevailed as for all
treatments. A good
number have remained
on treatment for up to 7
years, since our program
began.
45. What we thought…
6. Could we safely
transition patients from
methadone to
buprenorphine?
What we learned…
6. Our physician mentors
(PCSS) were invaluable
in talking us through
challenges such as
methadone transfers,
precipitated
withdrawals,
emergency/trauma care
and pre/postoperative
care.
46. What we thought…
7. This addition to our
already busy practice
would be too burdensome
for, and unsupported by,
clinic staff .
What we learned…
7. In fact, the MDs and
‘bup nurse’ have a good
reputation for immediate
intervention with active
substance users. The
nurse case manages her
clients and has the
capacity to do
community outreach and
linkage to Miriam
Hospital, social services
and other resources as
well as linkage to clinical
HIV and primary care.
47. What we thought…
What we learned…
8. Be tough!
8. Our HIV patients are,
until the cure, our
patients for life. We
choose to take a long view
and a harm reduction
approach. We build on
the patient-physician
bonds and leverage these
to promote the patient’s
optimal treatment plan.
Our door is always open.
48. What we thought…
What we learned…
9. We are not substance
abuse treatment
specialists!
9. We can reduce harm and
promote recovery with a
relatively safe opiate
replacement. We can
collaborate with our
community treatment
specialists. We can bridge
addiction treatment and
HIV care. We can do
this!