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Expanded and Enhanced
Treatment Services in a Los Angeles OTP
Funded by
The Center for Substance Abuse Treatment
Targeted Capacity Expansion for Substance Abuse Treatment
and HIV/AIDS Services (TCE/HIV)
1H79 TI12619
6H79 TI15867
The Matrix Institute
Project Director: Michael McCann
Integrating HIV and
HCV Groups into an
OTP Setting
Dan George
Matrix Institute on Addictions
Los Angeles, CA
This Section Will Focus
on:
The Implementation of Manualized, Genderspecific HIV Groups
The Creation of a HCV Education Group
The Nuances of Group Implementation and
Their Resulting Impact on Program Services
And………………………………………….
………….. Pamela Lee Anderson?
TO BE CONTINUED……………….
HIV and HCV- Affecting
Our Population
HIV & IDU
high risk needle-sharing practices
 New AIDS cases reported in 2000, 28%
IDU associated (CDC)

HIV & Crack use
high risk sexual behaviors
 stronger association in women than men

(Edlin,et al. 1994)
HIV and HCV- Affecting
Our Population
Hepatitis C
3.9 – 5 million Americans infected (CDC)
 Approx. 60% of infections due to needlesharing
 70-96% long-term IDUs have been
exposed (Hepatitis Association)

HIV GroupsWhy Gender Specific
Analysis of Studies Evaluating HIV
education within SAT programs (Prendergast
et al, 2001)
Reviewed 18 Studies
Ranged in length
 Ranged in type of intervention

Important Variables
Intensity of intervention

Education only vs skills acquisition (roleplay)
Use of peer group discussion
Separate sex sessions
HIV/AIDS Prevention for
Women in Drug
Treatment
NIDA Sponsored
Principal Investigator: Rita Strombeck,
PhD.
GOAL: Develop and Evaluate
educational program targeting women in
drug tx.
“Women Talking”
Women Talking
Adaptation of AIDS Risk Reduction
Model
3 stages:
recognition of risk
 commitment to reducing risk
 Commitment to seeking resolution

Video and group discussions
4 X 2-hour sessions
Educational Topics
Recognition of Risks
Commitment to Change
Sex Behaviors
Drug injection Behavior
Abbreviated Study
Design
2 Sites- LA & Chicago
83 Women intervention group
 83 Women control group

Experimental Group
Baseline interview
 Intervention (4 –sessions)
 1-month post interview
 3- month post interview

Abbreviated Study
Design
Control Group
Baseline interview
 NO INTERVENTION
 1-month post interview
 3- month post interview

Each participant received $25 gift
certificate per interview
Study Results:
Tx Grp Participants demonstrated:

Increase in HIV Knowledge/ Risk
Recognition

Increase in Personal Susceptibility

Increase in Commitment/ Motivation of
Behavior Change
Project Effect on OTP
Program Services
“Women Talking” incorporated into “in-house”
Women’s HIV group
“Women Talking” used as educational
component of group
Modified Women’s group includes the
following additional teaching strategies:


Role-playing for negotiating safer sex behavior
Personalized risk assessments
Time Out! for Men
Time Out! for Men module created in 1996
Based off the “Time Out! For Me” women’s
psychoeducational workshop (Bartholomew, Chatham &
Simpson, 1991).
Time Out! for Me evaluated in methadone
maintenance programs

Increased knowledge & self-esteem
Time Out! For Men
8 X 2-hour sessions
Adapted into TCE program

90 minute sessions
Required participation for new enrollees
Volunteer participation for ongoing clients
Men’s Group Objectives
Improve communication skills
Improve relationships
Challenge gender-role stereotypes
Increase knowledge on Men’s Health
Increase knowledge on HIV & STI’s
Men’s HIV Group
General response is positive
Increase in knowledge (pre/post
snapshot)
Expression of “openness” in group
Provide incentives:
coffee and donuts
 Certificates upon completion

Men’s HIV GroupNuances
Difficulty with retention
8- sessions may be too long
Reduce to four sessions
 Incorporate HCV group
 Mandatory for all new TCE program admits

Hepatitis C Education
Group
TCE funding- antibody test 94% +
Created due to a general lapse in knowledge
among patients.
Many misunderstandings and myths
“Pamela Lee Anderson”- Mainstream myths
Create an education group curriculum to
disseminate info in a quick/efficient manner
HCV Group Topics
Disease Overview (hx, statistics)
Symptoms
Modes of Transmission
Tx Options

Combotherapy (pegylated interferon & ribavirin)
Healthcare maintenance and MD follow-up
Positives of Methadone Maintenance
HCV CurriculumLearner Domains
Cognitive


Learner objective: increase knowledge of
transmission, symptoms, tx options
Evaluative criteria: pre/ post test scores
Affective


Learner Objective: increase perceived risk and
perceived “controllability”
Evaluative Criteria: pre/ post test, observation
during discussions
Learner Domains
Behavioral
Learner Objective: increase MD
evaluation follow-up and reduce needlesharing
 Evaluative criteria: MD follow-up rates
and reported needle-sharing practices
(post 6-months)

Process Evaluation &
Effect on Program
Services
Integration of 1X HCV group within HIV
specific series
Add/ Use role-playing communication
strategies re: MD
Lack staffing to conduct HCV follow-up
interviews for evaluation
Expanding Program
Services
Maintained/ Established strong
HIV/HCV testing and counseling
services
In-house HIV testing/ counseling by County
(rapid testing now offered)
 Valley Community Clinic Mobile Unit (HCV/
STD testing/ counseling)
