Transcript Time with family

CEA
CENTRO
DE ESTUDIOS
EN ADICCION
Robles RR, Reyes JC,
Matos TD, Colón HM,
Marrero CA, Sahai H
Testing an Intervention
Model to Reduce
HIV/AIDS Among
Hispanic Drug Users
Residing in Puerto Rico
The Intervention Model: Motivational Interviewing
Strategy:
Delivered By:
Role inducement in the community to enter Community Counselors
and continue in the intervention;
Role inducement in the project’s center to
enter health care services;
Clinical
Counselors
Visits to primary care physicians
and other activities related to health status
(e.g., immunology clinics, laboratories);
Clinical
Counselors
Counseling to continue inducement to
enter and complete drug treatment;
Community & Clinical
Counselors
Counseling for HIV risk behaviors,
including demonstration and practice;
Clinical
Counselors
Continuous outreach contacts
in the community or in treatment
and booster sessions.
Community & Clinical
Counselors
CEA
CENTRO
DE ESTUDIOS
EN ADICCION
Introduction
 Puerto Rico continues to be a major AIDS
epicenter
 Presently, Puerto Rico’s AIDS incidence rate is
2nd (37.0/100,000) among US states and
territories
 The main HIV risk category in Puerto Rico is
drug injection
 High rates of HIV risk behaviors continue to take
place, mainly:
– Frequency of daily drug injection
– Use of shooting galleries
Experimental Design
Recruitment
(Targeted Sampling in Communities of the North Health Care Region)
Initial Assessment Randomization
Control Group
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
Follow-Up Assessment
Outcomes
After 6
months
Intervention Process:
Intervention Group
CEA
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Methods
 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
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CENTRO
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Analysis
 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
experimental group
TABLE
1
Variables
Control
(n=272)
n
Gender
Males
Females
Age
Less than 25 yrs.
25 – 34 yrs. old
35 yrs. old
Education
< High school
High school
> High School
Intervention
(n=285)
%
n
%
p
239
87.9
259
90.9
33
12.1
26
9.1
0.249
90
101
69
34.6
38.8
26.5
96
97
88
34.2
34.5
31.3
0.415
156
90
26
57.4
33.1
9.6
161
86
38
56.5
30.2
13.3
0.347
Continue from previous
Variables
Control
(n=272)
n
Intervention
(n=285)
%
n
%
p
HIV Seroprevalence
Negative
Positive
Frequency of Daily
Injection
0 – 2 times
3 or more times
222
26
89.5
10.5
214
37
85.3
14.7
0.152
97
173
35.9
64.1
106
179
37.2
62.8
0.757
0 – 5 years
159
58.5
155
54.4
6 – 10 years
44
16.2
41
14.4
11 – 15 years
29
10.7
31
10.9
16 years or more
40
14.7
58
20.4
Years of Drug Injection
0.358
Continue from previous
Variables
Control
(n=272)
n
Intervention
(n=285)
%
n
%
p
Social Integration
Alone
101
37.5
116
40.8
Time w/ friends
73
27.2
64
22.6
Time w/ family
95
35.3
104
36.6
No
51
18.8
76
26.7
Yes
220
81.2
209
73.3
23
8.5
28
9.8
Moderate
103
38.1
113
39.6
Severe
144
53.3
144
50.5
0.443
Drug Treatment
0.034
Depression Symptoms
Minimal
0.760
Discontinue Drug Injection
TABLE
2
O.R
95% C.I.
p
Regression Model #1
Intervention Model
0.55
(0.33,0.92)
0.022
0.56
(0.33,0.96)
0.036
Time with family
0.56
(0.31,1.03)
0.061
Time with friends
0.69
(0.32,1.48)
0.340
Moderate
2.75
(1.53,4.95)
0.001
Severe
5.26
(2.55,10.83)
≤0.001
Regression Model #2
Intervention Model
Social Integration
Depression Symptoms
Discontinue Drug Injection cont.
TABLE
2
O.R
95% C.I.
p
Regression Model #3
Intervention Model
0.84
(0.32,2.21)
0.725
Time with family
0.49
(0.18,1.30)
0.153
Time with friends
1.07
(0.32,3.58)
0.911
Moderate
2.57
(1.41,4.68)
0.002
Severe
5.24
(2.53,10.86)
≤0.001
0.52
(0.15,1.76)
0.291
0.57
(0.12,2.78)
0.489
3.44
(1.15,10.25)
0.027
Social Integration
Depression Symptoms
Interaction #1
(model by time with family)
Interaction #2
(model by time with friends)
Interaction #3
(drug treatment by time with
family)
Frequency of Daily Injection
TABLE
3
Regression Model #1
Intervention Model
O.R
95% C.I.
p
1.34
(0.81,2.20)
0.256
1.42
(0.84,2.40)
0.190
Time with family
0.54
(0.31,0.94)
0.028
Time with friends
1.64
(0.75,3.60)
0.212
Moderate
1.82
(0.93,3.58)
0.081
Severe
3.39
(1.68,6.84)
0.001
Regression Model #2
Intervention Model
Social Integration
Depression Symptoms
Drug Abuse Treatment Initiation
TABLE
4
O.R
95% C.I.
p
Regression Model #1
Intervention Model
1.91
(1.24,2.96)
0.004
1.89
(1.21,2.94)
0.005
Time with family
1.32
(0.81,2.15)
0.272
Time with friends
2.11
(1.15,3.90)
0.017
Moderate
0.67
(0.39,1.14)
0.137
Severe
0.53
(0.30,0.93)
0.028
Regression Model #2
Intervention Model
Social Integration
Depression Symptoms
Drug Abuse Treatment Initiation cont.
TABLE
4
O.R
95% C.I.
p
Regression Model #3
Intervention Model
1.08
(0.53,2.20)
0.526
Time with family
0.77
(0.38,1.55)
0.461
Time with friends
1.84
(0.54,6.22)
0.328
Moderate
0.69
(0.40,1.18)
0.177
Severe
0.54
(0.31,0.96)
0.035
2.82
(1.06,7.48)
0.037
1.84
(0.54,6.22)
0.328
Social Integration
Depression Symptoms
Interaction #1
(model by time with family)
Interaction #2
(model by time with friends)
Share Needles
TABLE
5
O.R
95% C.I.
p
Regression Model #1
Intervention Model
0.34
(0.13,0.93)
0.036
0.33
(0.12,0.90)
0.031
Time with family
0.80
(0.28,2.31)
0.685
Time with friends
1.43
(0.39,5.24)
0.590
Moderate
0.48
(0.09,2.52)
0.382
Severe
3.68
(0.96,14.1)
0.057
Regression Model #2
Intervention Model
Social Integration
Depression Symptoms