Transcript Open slide - CTN Dissemination Library

Modifying Practices in a MAT program to
the needs of the local patient population
Katharina Wiest,
1CODA,
1
PhD ,
Dennis McCarty,
2
PhD ,
Timothy Hartnett, MSW,
1
MHA
Inc, Portland OR; 2Dept Public Health & Preventive Medicine, OHSU, Portland OR
Problem Statement
 Hepatitis C (HCV) is a major public health
issue affecting 68% to 80% of injection drug
users (IDU)
 IDU are the largest group infected with HCV
in the US
 IDU is the best predictor of HCV risk
 HCV testing not mandatory in Oregon
substance abuse treatment facilities (although
recommended by CDC for all current or former
IDU)
 In Oregon 13 per 1000 residents are HCV
positive; ten times Oregon’s estimate for HIV
prevalence
 30 day retention in treatment is lower in IDU
Research Question
Are practices, behaviors and/or lifestyle
choices associated with increased risk of
HCV in patients receiving substance abuse
treatment at CODA?
Materials and Methods
Medication-Assisted Treatment (MAT) for
opioid dependence
 methadone and Suboxone®
 Not-for-profit
 Portland, Oregon
 Active caseload 652 patients
Patients receiving methadone and
beginning care after 6/1/09 were included
 Data abstracted from electronic medical
record and analyzed using SPSS 18
New Patient Characteristics
CODA Intake Data 6/2009 – 8/31/2010
IDU
non-IDU
(N=107)
(N=80)
Mean Age (yrs)
41
33
Male
56%
28%
Female
Ethnicity
 white
Primary Substance
30 Day Retention
44%
72%
79%
97% Heroin
91%
80%
73% Opioids
99%
Results
Conclusions
High Risk Behaviors
New CODA Patients 6/2009 – 8/31/2010
IDU Non-IDU
RR
N=107
N=80
60%
85%
57%
25%
51%
19%
2.4 (1.6, 3.5)
1.6 (1.4, 2.1)
3.0 (1.9, 4.7)
51%
16%
3.2 (2.0, 5.2)
14%
19%
22%
3%
13%
16%
4.7 (1.4, 5.7)
1.5 (0.8, 2.8)
1.4 (0.8, 2.5)
Ever homeless
Ever incarcerated
Ever shared needles
Sex with drug
injector
Sex with HIV/AIDS
infected person
Sex unprotected
Sex for drugs or $
95% CI
Self-Reported HCV Risk
New CODA Patients 6/2009 – 8/31/2010
IDU Non-IDU
I am infected
I am high risk
I am low risk
I have no risk
Don’t know risk
N=107
N=80
52%
6%
16%
20%
6%
9%
1%
22%
60%
8%
Rationale for modifying CODA
intake procedures to include rapid
HCV testing
 Adjusted increased risk of HCV is
5.0 (1.9, 13.3) in IDU patients
CODA self-reported HCV
prevalence is 61%
 High prevalence of risky behaviors
in IDU patients
Lower 30 day retention in IDU
patients
Lack of perceived risk of HCV in
IDU patients
Rapid oral fluid and fingerstick
HCV testi will be available early 2011
Contact Information
[email protected]
[email protected]
[email protected]
Acknowledgements
• Research was conducted under an IRB waiver
from Portland State University, Portland, OR
• Study supported through cooperative
agreement NIDA U10DA013036
• Special thanks to Whitney Nash, BA for her
assistance with data entry and analyses