Harm Reduction Contingency Management for Stimulant Use Reduction and Antiretroviral Therapy Adherence in HIV Primary Care: Protocol for an Implementation Effectiveness Study.

Background: Stimulant use disorder has been linked with medication nonadherence and mortality among people living with HIV. Contingency management (CM) is a strategy incentivizing measurable behavior change that is recommended as the first-line treatment for stimulant use disorder and can support antiretroviral therapy (ART) adherence. However, CM is not widely implemented, in part due to feasibility concerns.

A Review of Implementation Strategies to Enhance PrEP Delivery for People Experiencing Housing Insecurity: Advancing a Multifaceted High-Touch, Low-Barrier Approach.

Purpose Of Review: This review summarizes key implementation strategies to advance oral and long-acting PrEP delivery for unstably housed people in the United States.

Recent Findings: People experiencing homelessness and housing instability face barriers to PrEP uptake and adherence including lack of safe medication storage, competing basic needs, insurances issues, and/or mental health or substance use disorders. Recent advancements in HIV treatment and prevention provide evidence on high-touch, low-barrier implementation approaches to address these challenges.

High Retention and Adherence With Rapid Long-acting Injectable Preexposure Prophylaxis Implementation in an Urban Safety Net Clinic Population.

In a low-barrier, long-acting preexposure prophylaxis (PrEP) program in a safety net setting, permitting same-day or next-day initiation, 85% of injections were on time, and 6-month retention was 83%, surpassing outcomes from most previously reported oral PrEP studies. With drop-in, wraparound services, similar retention among housing-insecure populations was seen. Long-acting PrEP expansion is urgently needed.

National HIV and HCV Screening Rates for Hospitalized People who Use Drugs Are Suboptimal and Heterogeneous Across 11 US Hospitals.

Background: To end the HIV and hepatitis C virus (HCV) epidemics, people who use drugs (PWUD) need more opportunities for testing. While inpatient hospitalizations are an essential opportunity to test people who use drugs (PWUD) for HIV and HCV, there is limited research on rates of inpatient testing for HIV and HCV among PWUD.

Methods: Eleven hospital sites were included in the study.

Participant perspectives on incentives for TB preventative therapy adherence and reduced alcohol use: A qualitative study.

Economic incentives to promote health behavior change are highly efficacious for substance use disorders as well as increased medication adherence. Knowledge about participants' experiences with and perceptions of incentives is needed to understand their mechanisms of action and optimize future incentive-based interventions. The Drinkers' Intervention to Prevent Tuberculosis (DIPT) trial enrolled people with HIV (PWH) in Uganda with latent tuberculosis and unhealthy alcohol use in a 2x2 factorial trial that incentivized recent alcohol abstinence and isoniazid (INH) adherence on monthly urine testing while on INH preventive therapy.

Identifying Implementation Determinants and Strategies for Long-Acting Injectable Cabotegravir-Rilpivirine in People With HIV Who Are Virally Unsuppressed.

Background: Early evidence suggests long-acting injectable cabotegravir and rilpivirine (LA-CAB/RPV) may be beneficial for people with HIV (PWH) who are unable to attain viral suppression (VS) on oral therapy. Limited guidance exists on implementation strategies for this population.

Setting: Ward 86, a clinic serving publicly insured PWH in San Francisco.

Stimulant use and opioid-related harm in patients on long-term opioids for chronic pain.

Background: There is lack of clarity regarding the impact of and optimal clinical response to stimulant use among people prescribed long-term opioid therapy (LTOT) for pain.

Objective: To determine if a positive urine drug test (UDT) for stimulants was associated with subsequent opioid-related harm or discontinuation of LTOT.

Design: Retrospective cohort study.

A Qualitative Exploration of Intimate Partner Violence Among HIV/TB Coinfected Persons With Problematic Alcohol Use Participating in an Incentive-Based Alcohol/Medication Adherence Intervention in Uganda During COVID-19.

In Uganda, four in ten women report experiencing intimate partner violence (IPV) in the past year. Salient drivers of IPV in sub-Saharan Africa include stress related to household finances, alcohol use, and partner infidelity. We conducted 42 interviews with participants ( = 32) in the Drinkers' Intervention to Prevent Tuberculosis (DIPT) study which included economic incentives, and their partners ( = 10) to understand how participating in DIPT during COVID-19 lockdown restrictions impacted relationship dynamics in intimate partnerships.

The IMPACT (Infection Management Plus Addiction Care Together) Pilot: A Case Series of Combined Contingency Management for Substance Use Disorders and Antibiotic Adherence in the Hospital Setting.

Objectives: Psychostimulant-related mortality is rising alongside increasing substance use-related hospitalizations, which are commonly complicated by patient-directed (or "against medical advice") discharges. Contingency management (CM) is an underused evidence-based treatment for substance use disorders with proven efficacy to support medication adherence. Our objective was to describe feasibility and preliminary effectiveness of a novel CM intervention incentivizing both drug use reduction and antibiotic adherence in the hospital setting.

Contemporary Management of Staphylococcus aureus Bacteremia-Controversies in Clinical Practice.

Staphylococcus aureus bacteremia (SAB) carries a high risk for excess morbidity and mortality. Despite its prevalence, significant practice variation continues to permeate clinical management of this syndrome. Since the publication of the 2011 Infectious Diseases Society of America (IDSA) guidelines on management of methicillin-resistant Staphylococcus aureus infections, the field of SAB has evolved with the emergence of newer diagnostic strategies and therapeutic options.

HIV Treatment Outcomes in POP-UP: Drop-in HIV Primary Care Model for People Experiencing Homelessness.

Background: People with HIV experiencing homelessness have low rates of viral suppression, driven by sociostructural barriers and traditional care system limitations. Informed by the capability-opportunity-motivation-behavior (COM-B) model and patient preference research, we developed POP-UP, an integrated drop-in (nonappointment-based) HIV clinic with wrap-around services for persons with housing instability and viral nonsuppression in San Francisco.

Methods: We report HIV viral suppression (VS; <200 copies/mL), care engagement, and mortality at 12 months postenrollment.

Engagement in HIV care and viral suppression following changes in long-term opioid therapy for treatment for chronic pain.

Chronic pain is common among persons living with HIV and changes in opioid prescribing practices may complicate HIV care management. Using medical record data from a retrospective cohort study conducted January 1, 2012 to June 30, 2019 for 300 publicly insured HIV-positive primary care patients prescribed opioids for chronic non-cancer pain in San Francisco, we examined associations between opioid dose changes and both time to disengagement from HIV care and experiencing virologic failure using logistic regression. Discontinuation of prescribed opioids was associated with increased odds of disengagement in care at 3, 6, and 9 months after discontinuation.

Meeting people where they are: implementing hospital-based substance use harm reduction.

Background: Hospital-based addiction care focuses on assessing and diagnosing substance use disorders, managing withdrawal, and initiating medications for addiction treatment. Hospital harm reduction is generally limited to prescribing naloxone. Hospitals can better serve individuals with substance use disorders by incorporating harm reduction education and equipment provision as essential addiction care.

Can I Safely Discharge a Patient with a Substance Use Disorder Home with a Peripherally Inserted Central Catheter?

Discharging Patients Who Use Drugs Home with PICCAmid the U.S. overdose crisis, serious injection-related infections are rising.

Patient-Directed Discharges Among Persons Who Use Drugs Hospitalized with Invasive Staphylococcus aureus Infections: Opportunities for Improvement.

Background: Despite the high burden of Staphylococcus aureus infections among persons who use drugs, limited data exist comparing outcomes of patient-directed discharge (known as discharge against medical advice) compared with standard discharge among persons who use drugs hospitalized with S. aureus infection.

Methods: We conducted a retrospective study of hospitalizations among adults with S.

SARS-CoV-2 PCR and antibody testing for an entire rural community: methods and feasibility of high-throughput testing procedures.

Background: Early in the pandemic, inadequate SARS-CoV-2 testing limited understanding of transmission. Chief among barriers to large-scale testing was unknown feasibility, particularly in non-urban areas. Our objective was to report methods of high-volume, comprehensive SARS-CoV-2 testing, offering one model to augment disease surveillance in a rural community.

Universal Polymerase Chain Reaction and Antibody Testing Demonstrate Little to No Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 in a Rural Community.

Background: Limited systematic surveillance for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the early months of the US epidemic curtailed accurate appraisal of transmission intensity. Our objective was to perform case detection of an entire rural community to quantify SARS-CoV-2 transmission using polymerase chain reaction (PCR) and antibody testing.

Methods: We conducted a cross-sectional survey of SARS-CoV-2 infection in the rural town of Bolinas, California (population 1620), 4 weeks after shelter-in-place orders.

Drug Overdose Deaths Before and After Shelter-in-Place Orders During the COVID-19 Pandemic in San Francisco.

This cross-sectional study evaluates the association of the shelter-in-place order with fatal drug overdoses in San Francisco, California.

Comparative 1-Year Outcomes of Invasive Staphylococcus aureus Infections Among Persons With and Without Drug Use: An Observational Cohort Study.

Background: Persons who use drugs (PWUD) face substantial risk of Staphylococcus aureus infections. Limited data exist describing clinical and substance use characteristics of PWUD with invasive S. aureus infections or comparing treatment and mortality outcomes in PWUD vs non-PWUD.