Sexually transmitted infections (STIs) and HIV infection are increasing at an alarming rate in Mexico (United Nations Program on AIDS [UNAIDS], 2006). Female sex workers (FSWs) are one of the groups affected by the increase in HIV prevalence in Mexico. Early surveillance of FSWs found seroprevalence rates of 4.8% in Tijuana and 4.9% in Ciudad Juarez, Mexico (Patterson et al., 2006b), while the most recent study of FSWs from these two cities found a seroprevalence rate of 6% (Strathdee et al, in press). Prevention efforts that are culturally sensitive and appropriately tailored are needed to stem the rise of HIV in this high-risk population. The current study examined the applicability of the Social Ecological model for HIV prevention in a sample of female sex workers (FSWs) (N=472) participating in a safe sex counseling intervention in Tijuana, Mexico. Within the framework of the Social Ecological Model we explored differential predictors of condom use by comparing women who work in bar settings to those who work on the street hypothesizing that there would be differences across venue (bar vs street) with higher condom use in bar workers. Baseline models were established using path analysis in bar (N=233); (CFI= .890, RMSEA =.062) and street workers (N=203); (CFI =.928, RMSEA = .040). For bar workers individual level factors, (self-efficacy, condom use beliefs, alcohol use before sex) and institutional level factors (condom access) were directly and indirectly related to condom use, while in street workers interpersonal level factors (social support, previous abuse, client power) and drug use were the most important factors associated with condom use. Multiple group partial structural invariance was then performed comparing street workers (N=79) to bar workers (N=103) on the 5 paths that their baseline models shared, showing that these paths were invariant across groups ([delta][chi]²(5) =6.30). Multiple group comparisons found similarities between the bar and street workers, including the relationship between self-efficacy and condom use. Baseline model comparisons found differences including the type of substance used before sex, and the relationship between monetary incentives for unprotected sex and condom use self- efficacy, supporting the need for the tailoring of interventions for women based on location of their sex work

This clinical case presentation and discussion illustrates a culturally adapted alcohol and drug use intervention using the Screening, Brief Intervention, and Referral to Treatment (SBIRT) approach, incorporating motivational interviewing skills. This case conference serves to complement the accompanying review article on SBIRT with diverse cultural groups, placing information from the review in the context of a typical clinical setting. In this example, SBIRT is provided in a primary care clinic to a Latino patient who reports hazardous drinking, depression, chronic pain and use of prescription opioids.

Participation in clinical research trials has been hypothesized to facilitate the adoption of evidence-based practices by community-based substance abuse treatment providers. However, little empirical information is available regarding the methodological and collaborative characteristics of research trials that may affect the chances of adoption. The current paper describes the development of the Survey of Practiced Research Efforts to Aid Dissemination (SPREAD), a standardized instrument designed to measure characteristics of clinical trials that may facilitate adoption. The survey was administered to a sample of 33 community-based research trials from the top four impact factor journals of 2007. Overall, methodological quality was high and levels of collaboration were low, with little involvement of community-based clinic staff in most study related activities. Future research to determine the predictive validity of the SPREAD instrument on post-trial adoption of studies interventions in clinical research is encouraged. © 2014 Springer Science+Business Media New York.

Substance abuse disproportionately impacts American Indian/Alaska Native (AI/AN) communities in the United States. For the increasing numbers of AI/AN individuals who enter and receive treatment for their alcohol or other drug problem it is imperative that the service they receive be effective. This study used qualitative methodology to examine attitudes toward evidence-based practices, also known as evidence-based treatments (EBTs) in minority-serving substance abuse treatment programs in the San Francisco Bay area. Twenty-two interviews were conducted in the study, of which seven were with program directors and substance abuse counselors at two urban AI/AN focused sites. These clinics were more likely than other minority-focused programs to have experience with research and knowledge about adapting EBTs. Only in the AI/AN specific sites did an issue arise concerning visibility, that is, undercounting AI/AN people in national and state databases. Similar to other minority-focused programs, these clinics described mistrust, fear of exploitation from the research community, and negative attitudes towards EBTs. The underutilization of EBTs in substance abuse programs is prevalent and detrimental to the health of patients who would benefit from their use. Future research should explore how to use this research involvement and experience with adaptation to increase the adoption of EBTs in AI/AN serving clinics.

Abstract Practitioners in federally-assisted substance use disorder (SUD) treatment programs are faced with increasingly complex decisions when addressing patient confidentiality issues. Recent policy changes, intended to make treatment more available and accessible, are having an impact on delivery of SUD treatment in the United States. The addition of electronic health records provides opportunity for more rapid and comprehensive communication between patients’ primary and SUD care providers while promoting a collaborative care environment. This shift toward collaborative care is complicated by the special protections that SUD documentation receives in SUD treatment programs, which vary depending on what care is provided and the setting where the patient is treated. This article explores the special protections for substance abuse documentation, discrepancies in treatment documentation, ways to deal with these issues in clinical practice, and the need for more knowledge about how to harmonize treatment in the SUD and primary care systems.

Devising interventions to provide integrated treatment for addiction and medical problems is an urgent issue. This study piloted a structural intervention, Directly Administered Antiretroviral Therapy (DAART), to assist methadone-maintenance patients in HIV medication adherence. Twenty-four participants received: (1) antiretroviral medications at the methadone clinic daily before receiving their methadone; (2) take-home antiretroviral medication for days they were not scheduled to attend the methadone clinic, and (3) brief adherence counseling to address adherence barriers. DAART lasted 24 weeks, with a planned step-down to twice-weekly administration in weeks 25-36, followed by self-administration in weeks 37-48. Retention rates at weeks 24, 36, and 48 were 83, 92, and 75% respectively. DAART was associated with improvement in the proportion of participants achieving viral suppression as well as with high medication adherence rates (clinic-verified; 85% and self-reported 97%) during the active intervention phase. DAART was effective as an intervention but did not promote transition to self-administration. This study demonstrates that DAART is adaptable and simple enough to be implemented into methadone treatment programs interested in providing HIV adherence services.

The aim of this study was to evaluate the effectiveness of an educational method of providing viral hepatitis education for methadone maintenance patients. Four hundred forty participants were randomly assigned to either a control or a motivationally-enhanced viral hepatitis education and counseling intervention. Viral hepatitis A (HAV), B (HBV), and C (HCV) knowledge tests were administered at baseline, following each of two education sessions (post-education), and at a 3-month follow-up assessment. Results indicated a significant increase in knowledge of HAV, HBV, and HCV over time. No differences were found in knowledge between the intervention groups in knowledge acquisition regarding any of the hepatitis viruses suggesting that a motivational interviewing style may not augment hepatitis knowledge beyond standard counseling. A two-session viral hepatitis education intervention effectively promotes hepatitis knowledge and can be integrated in methadone treatment settings.

The aim of this study was to evaluate the effectiveness of an educational method of providing viral hepatitis education for methadone maintenance patients. Four hundred forty participants were randomly assigned to either a control or a motivationally-enhanced viral hepatitis education and counseling intervention. Viral hepatitis A (HAV), B (HBV), and C (HCV) knowledge tests were administered at baseline, following each of two education sessions (post-education), and at a 3-month follow-up assessment. Results indicated a significant increase in knowledge of HAV, HBV, and HCV over time. No differences were found in knowledge between the intervention groups in knowledge acquisition regarding any of the hepatitis viruses suggesting that a motivational interviewing style may not augment hepatitis knowledge beyond standard counseling. A two-session viral hepatitis education intervention effectively promotes hepatitis knowledge and can be integrated in methadone treatment settings.