CEACEA CENTROCENTRO DE ESTUDIOS EN ADICCION Testing an Intervention Model to Reduce HIV/AIDS Among Hispanic Drug Users Residing in Puerto Rico Robles RR,

CEACEACEACEACENTRO CENTRO CENTRO CENTRO

DE ESTUDIOSDE ESTUDIOSDE ESTUDIOSDE ESTUDIOS

EN ADICCIONEN ADICCIONEN ADICCIONEN ADICCION

Testing an Testing an Intervention Intervention

Model to Model to Reduce Reduce

HIV/AIDS HIV/AIDS Among Among

Hispanic Drug Hispanic Drug Users Users

Residing in Residing in Puerto RicoPuerto Rico

Robles RR, Reyes JC, Matos TD, Colón HM, Marrero CA,

Sahai H

The Intervention Model: Motivational The Intervention Model: Motivational InterviewingInterviewing

Strategy:Strategy: Delivered By:Delivered By:Role inducement in the community to Role inducement in the community to enter and continue in the enter and continue in the intervention;intervention;

Community Community CounselorsCounselors

Role inducement in the project’s Role inducement in the project’s center to enter health care services;center to enter health care services;

Clinical Clinical CounselorsCounselors

Visits to primary care physicians Visits to primary care physicians and other activities related to health and other activities related to health status (e.g., immunology clinics, status (e.g., immunology clinics, laboratories);laboratories);


Counseling to continue inducement Counseling to continue inducement to enter and complete drug to enter and complete drug treatment;treatment;

Community & Community & Clinical CounselorsClinical Counselors

Counseling for HIV risk behaviors, Counseling for HIV risk behaviors, including demonstration and including demonstration and practice;practice;


Continuous outreach contacts Continuous outreach contacts in the community or in treatment in the community or in treatment and booster sessions.and booster sessions.

Community & Community & Clinical Clinical

CounselorsCounselors

CEACEACENTRO CENTRO CENTRO CENTRO


EN ADICCIONEN ADICCIONEN ADICCIONEN ADICCION IntroductionIntroduction

Puerto Rico continues to be a major AIDS Puerto Rico continues to be a major AIDS epicenterepicenter

Presently, Puerto Rico’s AIDS incidence rate Presently, Puerto Rico’s AIDS incidence rate is 2is 2ndnd (37.0/100,000) among US states and (37.0/100,000) among US states and territoriesterritories

The main HIV risk category in Puerto Rico is The main HIV risk category in Puerto Rico is drug injectiondrug injection

High rates of HIV risk behaviors continue to High rates of HIV risk behaviors continue to take place, mainly:take place, mainly:– Frequency of daily drug injectionFrequency of daily drug injection– Use of shooting galleriesUse of shooting galleries

Intervention GroupControl Group

Recruitment (Targeted Sampling in Communities of the North Health Care Region)

Initial Assessment Randomization

Follow-Up Assessment

Afte

r 6

mon

ths

Inte

rventi

on

Pro

cess

:

Motivational Interviewing by Outreach Workers•Inducement to Enter Change Process

Motivational Interviewing by Clinical Counselors •Skill Building to Change Risk Behaviors •Inducement to Enter Treatment and Health Care

Outco

mes

Experimental Design



EN ADICCIONEN ADICCIONEN ADICCIONEN ADICCION MethodsMethods

N = 556 Injection drug users not in treatment and residing in the North Metro Health Region of PR

Eligibility– Injected in the 30

days prior to the interview

– At least 18 yrs old– Not enrolled in

drug treatment during the last 30 days



EN ADICCIONEN ADICCIONEN ADICCIONEN ADICCION AnalysisAnalysis

Frequency distributions to describe study sample

Bivariate analyses– Compare participants in both groups

• Follow-up measures of injection risk behaviors and engagement in drug treatment

4 logistic regression models– Fitted to estimate effects of intervention

model in reducing HIV behaviors, including engagement in drug treatment

Description of the study sample by Description of the study sample by experimental groupexperimental group

VariablesVariables ControlControl

(n=272)(n=272)InterventionIntervention

(n=285)(n=285)

nn %% nn %% p

GenderGender

MalesMales 239239 87.987.9 259259 90.990.9

FemalesFemales 3333 12.112.1 2626 9.19.1 0.249

AgeAge

Less than 25 yrs.Less than 25 yrs. 9090 34.634.6 9696 34.234.2

25 – 34 yrs. old25 – 34 yrs. old 101101 38.838.8 9797 34.534.5

35 yrs. old35 yrs. old 6969 26.526.5 8888 31.331.3 0.415

EducationEducation

< High school< High school 156156 57.457.4 161161 56.556.5

High schoolHigh school 9090 33.133.1 8686 30.230.2

> High School> High School 2626 9.69.6 3838 13.313.3 0.347

TABLE TABLE 11

Continue from previousContinue from previous



(n=285)(n=285)

nn %% nn %% p

HIV SeroprevalenceHIV Seroprevalence

NegativeNegative 222222 89.589.5 214214 85.385.3

PositivePositive 2626 10.510.5 3737 14.714.7 0.152

Frequency of Daily Frequency of Daily InjectionInjection

0 – 2 times0 – 2 times 9797 35.935.9 106106 37.237.2

3 or more times3 or more times 173173 64.164.1 179179 62.862.8 0.757

Years of Drug InjectionYears of Drug Injection

0 – 5 years0 – 5 years 159159 58.558.5 155155 54.454.4

6 – 10 years6 – 10 years 4444 16.216.2 4141 14.414.4

11 – 15 years11 – 15 years 2929 10.710.7 3131 10.910.9

16 years or more16 years or more 4040 14.714.7 5858 20.420.4 0.358

Continue from previousContinue from previous



(n=285)(n=285)

nn %% nn %% p

Social IntegrationSocial Integration

AloneAlone 101101 37.537.5 116116 40.840.8

Time w/ friendsTime w/ friends 7373 27.227.2 6464 22.622.6

Time w/ familyTime w/ family 9595 35.335.3 104104 36.636.6 0.443

Drug TreatmentDrug Treatment

NoNo 5151 18.818.8 7676 26.726.7

YesYes 220220 81.281.2 209209 73.373.3 0.034

Depression SymptomsDepression Symptoms

MinimalMinimal 2323 8.58.5 2828 9.89.8

ModerateModerate 103103 38.138.1 113113 39.639.6

SevereSevere 144144 53.353.3 144144 50.550.5 0.760

Discontinue Drug InjectionDiscontinue Drug Injection

O.RO.R 95% C.I.95% C.I. pp

Regression Model #1Regression Model #1

Intervention Model 0.55 (0.33,0.92) 0.022



Social Integration

Time with family 0.56 (0.31,1.03) 0.061

Time with friends 0.69 (0.32,1.48) 0.340

Depression Symptoms

Moderate 2.75 (1.53,4.95) 0.001

Severe 5.26 (2.55,10.83) ≤0.001

TABLE TABLE 22

Discontinue Drug Injection Discontinue Drug Injection cont.cont.

O.RO.R 95% C.I.95% C.I. pp



Social Integration

Time with family 0.49 (0.18,1.30) 0.153


Depression Symptoms

Moderate 2.57 (1.41,4.68) 0.002

Severe 5.24 (2.53,10.86) ≤0.001

Interaction #1

(model by time with family)

0.52 (0.15,1.76) 0.291

Interaction #2

(model by time with friends)

0.57 (0.12,2.78) 0.489

Interaction #3

(drug treatment by time with family)

3.44 (1.15,10.25) 0.027

TABLE TABLE 22

Frequency of Daily Frequency of Daily InjectionInjection

O.RO.R 95% C.I.95% C.I. pp





Social Integration

Time with family 0.54 (0.31,0.94) 0.028


Depression Symptoms

Moderate 1.82 (0.93,3.58) 0.081

Severe 3.39 (1.68,6.84) 0.001

TABLE TABLE 33

Drug Abuse Treatment Drug Abuse Treatment InitiationInitiation

O.RO.R 95% C.I.95% C.I. pp





Social Integration

Time with family 1.32 (0.81,2.15) 0.272


Depression Symptoms

Moderate 0.67 (0.39,1.14) 0.137

Severe 0.53 (0.30,0.93) 0.028

TABLE TABLE 44

Drug Abuse Treatment Initiation Drug Abuse Treatment Initiation cont.cont.

O.RO.R 95% C.I.95% C.I. pp



Social Integration

Time with family 0.77 (0.38,1.55) 0.461


Depression Symptoms

Moderate 0.69 (0.40,1.18) 0.177

Severe 0.54 (0.31,0.96) 0.035

Interaction #1

(model by time with family)

2.82 (1.06,7.48) 0.037

Interaction #2

(model by time with friends)

1.84 (0.54,6.22) 0.328

TABLE TABLE 44

Share NeedlesShare Needles

O.RO.R 95% C.I.95% C.I. pp





Social Integration

Time with family 0.80 (0.28,2.31) 0.685


Depression Symptoms

Moderate 0.48 (0.09,2.52) 0.382

Severe 3.68 (0.96,14.1) 0.057

TABLE TABLE 55

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CEACEA CENTROCENTRO DE ESTUDIOS EN ADICCION Testing an Intervention Model to Reduce HIV/AIDS Among Hispanic Drug Users Residing in Puerto Rico Robles RR,