Facilitating entry into drug treatment among injection drug users referred from a needle exchange program: Results from a community-based behavioral intervention trial
We evaluated a case management intervention to increase treatment entry among injecting drug users referred from a needle exchange program (NEP). A randomized trial of a strengths based case management (intervention) versus passive referral (control) was conducted among NEP attenders requesting and...
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| Published in | Drug and alcohol dependence Vol. 83; no. 3; pp. 225 - 232 |
|---|---|
| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Shannon
Elsevier Ireland Ltd
27.07.2006
Elsevier Science |
| Subjects | |
| Online Access | Get full text |
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| Abstract | We evaluated a case management intervention to increase treatment entry among injecting drug users referred from a needle exchange program (NEP). A randomized trial of a strengths based case management (intervention) versus passive referral (control) was conducted among NEP attenders requesting and receiving referrals to subsidized, publicly funded opiate agonist treatment programs in Baltimore, MD. Logistic regression identified predictors of treatment entry within 7 days, confirmed through treatment program records. Of 247 potential subjects, 245 (99%) participated. HIV prevalence was 19%. Overall, 34% entered treatment within 7 days (intervention: 40% versus control: 26%,
p
=
0.03). In a multivariate “intention to treat’ model (i.e., ignoring the amount of case management actually received), those randomized to case management were more likely to enter treatment within 7 days. Additional ‘as treated’ analyses revealed that participants who received 30
min or more of case management within 7 days were 33% more likely to enter treatment and the active ingredient of case management activities was provision of transportation. These findings demonstrate the combined value of offering dedicated treatment referrals from NEP, case management and transportation in facilitating entry into drug abuse treatment. Such initiatives could be implemented at more than 140 needle exchange programs currently operating in the United States. These data also support the need for more accessible programs such as mobile or office-based drug abuse treatment. |
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| AbstractList | We evaluated a case management intervention to increase treatment entry among injecting drug users referred from a needle exchange program (NEP). A randomized trial of a strengths based case management (intervention) versus passive referral (control) was conducted among NEP attenders requesting and receiving referrals to subsidized, publicly funded opiate agonist treatment programs in Baltimore, MD. Logistic regression identified predictors of treatment entry within 7 days, confirmed through treatment program records. Of 247 potential subjects, 245 (99%) participated. HIV prevalence was 19%. Overall, 34% entered treatment within 7 days (intervention: 40% versus control: 26%, p=0.03). In a multivariate "intention to treat" model (i.e., ignoring the amount of case management actually received), those randomized to case management were more likely to enter treatment within 7 days. Additional "as treated" analyses revealed that participants who received 30 min or more of case management within 7 days were 33% more likely to enter treatment and the active ingredient of case management activities was provision of transportation. These findings demonstrate the combined value of offering dedicated treatment referrals from NEP, case management and transportation in facilitating entry into drug abuse treatment. Such initiatives could be implemented at more than 140 needle exchange programs currently operating in the United States. These data also support the need for more accessible programs such as mobile or office-based drug abuse treatment. We evaluated a case management intervention to increase treatment entry among injecting drug users referred from a needle exchange program (NEP). A randomized trial of a strengths based case management (intervention) versus passive referral (control) was conducted among NEP attenders requesting and receiving referrals to subsidized, publicly funded opiate agonist treatment programs in Baltimore, MD. Logistic regression identified predictors of treatment entry within 7 days, confirmed through treatment program records. Of 247 potential subjects, 245 (99%) participated. HIV prevalence was 19%. Overall, 34% entered treatment within 7 days (intervention: 40% versus control: 26%, p=0.03). In a multivariate "intention to treat" model (i.e., ignoring the amount of case management actually received), those randomized to case management were more likely to enter treatment within 7 days. Additional "as treated" analyses revealed that participants who received 30 min or more of case management within 7 days were 33% more likely to enter treatment and the active ingredient of case management activities was provision of transportation. These findings demonstrate the combined value of offering dedicated treatment referrals from NEP, case management and transportation in facilitating entry into drug abuse treatment. Such initiatives could be implemented at more than 140 needle exchange programs currently operating in the United States. These data also support the need for more accessible programs such as mobile or office-based drug abuse treatment.We evaluated a case management intervention to increase treatment entry among injecting drug users referred from a needle exchange program (NEP). A randomized trial of a strengths based case management (intervention) versus passive referral (control) was conducted among NEP attenders requesting and receiving referrals to subsidized, publicly funded opiate agonist treatment programs in Baltimore, MD. Logistic regression identified predictors of treatment entry within 7 days, confirmed through treatment program records. Of 247 potential subjects, 245 (99%) participated. HIV prevalence was 19%. Overall, 34% entered treatment within 7 days (intervention: 40% versus control: 26%, p=0.03). In a multivariate "intention to treat" model (i.e., ignoring the amount of case management actually received), those randomized to case management were more likely to enter treatment within 7 days. Additional "as treated" analyses revealed that participants who received 30 min or more of case management within 7 days were 33% more likely to enter treatment and the active ingredient of case management activities was provision of transportation. These findings demonstrate the combined value of offering dedicated treatment referrals from NEP, case management and transportation in facilitating entry into drug abuse treatment. Such initiatives could be implemented at more than 140 needle exchange programs currently operating in the United States. These data also support the need for more accessible programs such as mobile or office-based drug abuse treatment. We evaluated a case management intervention to increase treatment entry among injecting drug users referred from a needle exchange program (NEP). A randomized trial of a strengths based case management (intervention) versus passive referral (control) was conducted among NEP attenders requesting & receiving referrals to subsidized, publicly funded opiate agonist treatment programs in Baltimore, MD. Logistic regression identified predictors of treatment entry within 7 days, confirmed through treatment program records. Of 247 potential subjects, 245 (99%) participated. HIV prevalence was 19%. Overall, 34% entered treatment within 7 days (intervention: 40% versus control: 26%, p = 0.03). In a multivariate "intention to treat' model (i.e., ignoring the amount of case management actually received), those randomized to case management were more likely to enter treatment within 7 days. Additional 'as treated' analyses revealed that participants who received 30 min or more of case management within 7 days were 33% more likely to enter treatment & the active ingredient of case management activities was provision of transportation. These findings demonstrate the combined value of offering dedicated treatment referrals from NEP, case management & transportation in facilitating entry into drug abuse treatment. Such initiatives could be implemented at more than 140 needle exchange programs currently operating in the United States. These data also support the need for more accessible programs such as mobile or office-based drug abuse treatment. 3 Tables, 32 References. [Copyright 2005 Elsevier Ireland Ltd.] We evaluated a case management intervention to increase treatment entry among injecting drug users referred from a needle exchange program (NEP). A randomized trial of a strengths based case management (intervention) versus passive referral (control) was conducted among NEP attenders requesting and receiving referrals to subsidized, publicly funded opiate agonist treatment programs in Baltimore, MD. Logistic regression identified predictors of treatment entry within 7 days, confirmed through treatment program records. Of 247 potential subjects, 245 (99%) participated. HIV prevalence was 19%. Overall, 34% entered treatment within 7 days (intervention: 40% versus control: 26%, p = 0.03). In a multivariate “intention to treat’ model (i.e., ignoring the amount of case management actually received), those randomized to case management were more likely to enter treatment within 7 days. Additional ‘as treated’ analyses revealed that participants who received 30 min or more of case management within 7 days were 33% more likely to enter treatment and the active ingredient of case management activities was provision of transportation. These findings demonstrate the combined value of offering dedicated treatment referrals from NEP, case management and transportation in facilitating entry into drug abuse treatment. Such initiatives could be implemented at more than 140 needle exchange programs currently operating in the United States. These data also support the need for more accessible programs such as mobile or office-based drug abuse treatment. We evaluated a case management intervention to increase treatment entry among injecting drug users referred from a needle exchange program (NEP). A randomized trial of a strengths based case management (intervention) versus passive referral (control) was conducted among NEP attenders requesting and receiving referrals to subsidized, publicly funded opiate agonist treatment programs in Baltimore, MD. Logistic regression identified predictors of treatment entry within 7 days, confirmed through treatment program records. Of 247 potential subjects, 245 (99%) participated. HIV prevalence was 19%. Overall, 34% entered treatment within 7 days (intervention: 40% versus control: 26%, p = 0.03). In a multivariate “intention to treat’ model (i.e., ignoring the amount of case management actually received), those randomized to case management were more likely to enter treatment within 7 days. Additional ‘as treated’ analyses revealed that participants who received 30 min or more of case management within 7 days were 33% more likely to enter treatment and the active ingredient of case management activities was provision of transportation. These findings demonstrate the combined value of offering dedicated treatment referrals from NEP, case management and transportation in facilitating entry into drug abuse treatment. Such initiatives could be implemented at more than 140 needle exchange programs currently operating in the United States. These data also support the need for more accessible programs such as mobile or office-based drug abuse treatment. |
| Author | Beilenson, Peter Latkin, Carl A. Huettner, Steven Cornelius, Lee Rapp, Charles Bishai, David Strathdee, Steffanie A. Ricketts, Erin P. Lloyd, Jacqueline J. Havens, Jennifer R. |
| AuthorAffiliation | a Division of International Health and Cross-Cultural Medicine, Department of Family and Preventive Medicine, University of California, San Diego, 9500 Gilman Drive, Ash Building, Room 118, Mailstop 0622, San Diego, CA 92093, USA b Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA e Baltimore City Health Department, Baltimore, MD, USA f University of Kansas School of Social Welfare, Laurence, KS, USA g Temple University, School of Social Administration, Philadelphia, PA 19122, USA d University of Kentucky Center on Drug and Alcohol Research, Lexington, KY, USA c University of Maryland School of Social Work, Baltimore, MD, USA |
| AuthorAffiliation_xml | – name: b Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA – name: f University of Kansas School of Social Welfare, Laurence, KS, USA – name: g Temple University, School of Social Administration, Philadelphia, PA 19122, USA – name: e Baltimore City Health Department, Baltimore, MD, USA – name: a Division of International Health and Cross-Cultural Medicine, Department of Family and Preventive Medicine, University of California, San Diego, 9500 Gilman Drive, Ash Building, Room 118, Mailstop 0622, San Diego, CA 92093, USA – name: c University of Maryland School of Social Work, Baltimore, MD, USA – name: d University of Kentucky Center on Drug and Alcohol Research, Lexington, KY, USA |
| Author_xml | – sequence: 1 givenname: Steffanie A. surname: Strathdee fullname: Strathdee, Steffanie A. email: sstrathdee@ucsd.edu organization: Division of International Health and Cross-Cultural Medicine, Department of Family and Preventive Medicine, University of California, San Diego, 9500 Gilman Drive, Ash Building, Room 118, Mailstop 0622, San Diego, CA 92093, USA – sequence: 2 givenname: Erin P. surname: Ricketts fullname: Ricketts, Erin P. organization: Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA – sequence: 3 givenname: Steven surname: Huettner fullname: Huettner, Steven organization: Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA – sequence: 4 givenname: Lee surname: Cornelius fullname: Cornelius, Lee organization: University of Maryland School of Social Work, Baltimore, MD, USA – sequence: 5 givenname: David surname: Bishai fullname: Bishai, David organization: Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA – sequence: 6 givenname: Jennifer R. surname: Havens fullname: Havens, Jennifer R. organization: University of Kentucky Center on Drug and Alcohol Research, Lexington, KY, USA – sequence: 7 givenname: Peter surname: Beilenson fullname: Beilenson, Peter organization: Baltimore City Health Department, Baltimore, MD, USA – sequence: 8 givenname: Charles surname: Rapp fullname: Rapp, Charles organization: University of Kansas School of Social Welfare, Laurence, KS, USA – sequence: 9 givenname: Jacqueline J. surname: Lloyd fullname: Lloyd, Jacqueline J. organization: Temple University, School of Social Administration, Philadelphia, PA 19122, USA – sequence: 10 givenname: Carl A. surname: Latkin fullname: Latkin, Carl A. organization: Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA |
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| SubjectTerms | Addictive behaviors Adult Adult and adolescent clinical studies Baltimore Behavior Therapy Biological and medical sciences Case Management Community based programmes Community Mental Health Services Drug abuse treatment Drug addiction Drug replacement therapy Female Health Services Accessibility HIV Seroprevalence HIV/AIDS Human viral diseases Humans Infectious diseases Injection drug use Intravenous drug addicts Male Medical sciences Methadone - therapeutic use Methadone maintenance Methadyl Acetate - therapeutic use Middle Aged Motivation Narcotics - therapeutic use Needle exchange programs Needle exchange schemes Opioid-Related Disorders - epidemiology Opioid-Related Disorders - rehabilitation Patient Acceptance of Health Care Psychology. Psychoanalysis. Psychiatry Psychopathology. Psychiatry Referral and Consultation Referrals Substance Abuse, Intravenous - epidemiology Substance Abuse, Intravenous - rehabilitation Toxicology Transportation Urban Population Viral diseases Viral diseases of the lymphoid tissue and the blood. Aids |
| Title | Facilitating entry into drug treatment among injection drug users referred from a needle exchange program: Results from a community-based behavioral intervention trial |
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