Transcript Passport to CARE: HIV/AIDS and Substance Abuse Outreach

Enhancing Substance Abuse Treatment
for Individuals Living with HIV/AIDS in
South Los Angeles: Findings from the
Passport to Care Program
Charles L. Hilliard, Ph.D. (CDU), Dawnesha Beaver (CDU),
Lu Shi, Ph.D. (UCLA), Kevin Heslin, Ph.D. (CDU),
Eric G. Bing, M.D., Ph.D. (CDU)
4th Annual Drug Abuse Research Symposium
September 26, 2008
Nature of Problem
 2,230 people are living with AIDS in South Los
Angeles (SPA 6).
 South Los Angeles has one of the highest rates of
annual AIDS cases (214 per 100,000 persons) and
the highest HIV infection related mortality rate in the
county (HIV Epidemiology Program, LA County,
January 2008).
 Substance abuse is common among individuals living
with HIV (Bing, Burnam, Longshore, et al., 2001).
Nature of Problem-2
 Substance abuse is also a major community health
and social problem for residents in South Los
Angeles. The area has 9 drug-related deaths per
100,000 people (1 ½ times the county average) and
alcohol-related hospital discharges are on the rise.
 Substance abusers with HIV not in substance abuse
treatment often enter the HIV system of care later in
the course of their infection (Bing, Kilbourne, Brooks,
et al., 2000), are less likely to be place on
antiretroviral medication (Strathdee, Palepu,
Cornelisse, et al., 1998) and have worse treatment
outcomes (Bing, Hays, Jacobson, et al., 2000)
compared to non-substance users or substance users
in treatment.
Passport to Care
 Funded by the Substance Abuse and Mental
Health Services Administration (SAMHSA)
 2002 - 2008
 Provided clients with a menu of services that were
client-centered, flexible, and scientifically based
Target Population
Passport to Care provided enhanced substance abuse
treatment, integrated with HIV/AIDS prevention and
treatment services, for African American and Latino
individuals living with HIV/AIDS, with focused
outreach to:
 Men and women with a history of substance
use/abuse, including injection drug using men and
women
 Men who have sex with men
 Post-incarcerated men and women
Passport to Care provided integrated substance abuse and
HIV/AIDS treatment services with the following goals:
1)
2)
3)
4)
5)
6)
7)
increase access to HIV-specific substance abuse services in
South Central Los Angeles,
increase use of substance abuse services by drug users with HIV
in South Central Los Angeles,
improve retention in substance abuse care among HIV positive
substance users,
increase support for family members and partners for HIV
positive substance users,
decrease or eliminate drug use by individuals who enter the
program
reduce high risk sexual behaviors by individuals who enter the
program, and
serve as a model for others who wish to reduce drug use and
improve health outcomes for indigent African American and
Latino substance users with HIV.
Program Components
Medical
Treatment
Social Networking
 Assessment
 Medication
Peer Counseling
 Motivational
Management
Mentoring
Interviewing
 Psychiatric
Fitness
 CBT
assessment &
 12 Step Groups
Peer Activities
treatment
 Education
Volunteer Service
 Relapse
 (12th Step-giving
Prevention
back)
 Crisis Intervention
Education /
Employment
development
Demographic characteristics
Gender
Male
Frequency
Percentage
275
79%
Female
62
17.8%
Transgender
10
2.9%
1
0.3%
349
100%
Other
Total
Demographic characteristics
Race
Black/African American
Frequency
Percentage
282
81.7%
12
3.5%
4
1.2%
Other
22
6.4%
None of the above
21
6.1%
4
1.2%
349
100%
White
American Indian
Multi-Racial
Total*
* 16% of the participants identified as Hispanic or Latino
Reported Drug Use
Drug
Any Alcohol
Frequency
Percentage Used
149
42.7%
Marijuana/Hashish
90
25.8%
Cocaine/Crack
75
21.5%
Results: Selected Behavioral
Change Rates
# of Valid
Cases
% at Intake
% at 6-month
follow up
Rate of
Change
Abstinence: did not
use alcohol or illegal
drugs
249
47.0%
55.8%
18.8%
Employment/
Education:
249
16.1%
23.3%
45.0%
Health/Behavior/
Social Consequences:
243
80.2%
88.5%
10.3%
Housing: stability or
permanent housing
249
48.2%
57.8%
20.0%
Results: Selected Behavioral
Change Rates-2
# of Valid
Cases
% at Intake
% at 6-month
follow up
Rate of
Change
Had unprotected
sexual contact
87
47.1%
34.5%
-26.8%
Had unprotected
sexual contact with
an individual who is
or was HIV positive
or has AIDS
22
90.9%
54.5%
-40.0%
Had unprotected sex
with injected drug
user
22
22.7%
4.5%
-80.0%
Summary
 A substantial number of clients who
participated in PTC reduced their use of
alcohol or illegal drugs at 6-month follow-up.
 Substantial gains in education/employment
and housing stability were experienced.
Summary-2
 A comparison of six-month change among different
subgroups reveal the following patterns:
 Blacks experienced greater benefit in housing and
employment/Latinos benefited more in abstinence
 Women experienced greater gains in employment,
housing and alcohol abstinence
 Individuals 45 and older experienced greater gains in
housing while younger individuals gained more in
abstinence
 Substantial gains experienced in abstinence and
health consequences among the originally
unemployed
References
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Shi, L. (2008). Unpublished data from SPECTRUM.
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Acknowledgements
 SAMHSA CSAT TCE/HIV Grant (TI-08-006)
 Eric G. Bing, M.D., Ph.D., Executive Director,
Drew Center for AIDS, Research, Education
Services
 SPECTRUM Staff and Clients
Questions