The feasibility of an intensive case management program for injection drug users on antiretroviral therapy in St. Petersburg, Russia
The majority of HIV-infected individuals requiring antiretroviral therapy (ART) in Russia are Injection Drug Users (IDU). Substitution therapy used as part of a comprehensive harm reduction program is unavailable in Russia. Past data shows that only 16% of IDU receiving substance abuse treatment com...
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| Veröffentlicht in: | Harm reduction journal 2013-09, Vol.10 (1), p.15-15 |
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| creator | Shaboltas, Alla V Skochilov, Roman V Brown, Lillian B Elharrar, Vanessa N Kozlov, Andrei P Hoffman, Irving F |
| description | The majority of HIV-infected individuals requiring antiretroviral therapy (ART) in Russia are Injection Drug Users (IDU). Substitution therapy used as part of a comprehensive harm reduction program is unavailable in Russia. Past data shows that only 16% of IDU receiving substance abuse treatment completed the course without relapse, and only 40% of IDU on ART remained on treatment at 6 months. Our goal was to determine if it was feasible to improve these historic outcomes by adding intensive case management (ICM) to the substance abuse and ART treatment programs for IDU.
IDU starting ART and able to involve a "supporter" who would assist in their treatment plan were enrolled. ICM included opiate detoxification, bi-monthly contact and counseling with the case, weekly group sessions, monthly contact with the "supporter" and home visits as needed. Full follow- up (FFU) was 8 months. Stata v10 (College Station, TX) was used for all analysis. Descriptive statistics were calculated for all baseline demographic variables, baseline and follow-up CD4 count, and viral load. Median baseline and follow-up CD4 counts and RNA levels were compared using the Kruskal-Wallis test. The proportion of participants with RNA |
| doi_str_mv | 10.1186/1477-7517-10-15 |
| format | Article |
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IDU starting ART and able to involve a "supporter" who would assist in their treatment plan were enrolled. ICM included opiate detoxification, bi-monthly contact and counseling with the case, weekly group sessions, monthly contact with the "supporter" and home visits as needed. Full follow- up (FFU) was 8 months. Stata v10 (College Station, TX) was used for all analysis. Descriptive statistics were calculated for all baseline demographic variables, baseline and follow-up CD4 count, and viral load. Median baseline and follow-up CD4 counts and RNA levels were compared using the Kruskal-Wallis test. The proportion of participants with RNA < 1000 copies mL at baseline and follow-up was compared using Fisher's Exact test. McNemar's test for paired proportions was used to compare the change in proportion of participants with RNA < 1000 copies mL from baseline to follow-up.
Between November 2007 and December 2008, 60 IDU were enrolled. 34 (56.7%) were male. 54/60 (90.0%) remained in FFU. Overall, 31/60 (52%) were active IDU at enrollment and 27 (45%) were active at their last follow-up visit. 40/60 (66.7%) attended all of their ART clinic visits, 13/60 (21.7%) missed one or more visit but remained on ART, and 7/60 (11.7%) stopped ART before the end of FFU. Overall, 39/53 (74%) had a final 6-8 month HIV RNA viral load (VL) < 1000 copies/mL.
Despite no substitution therapy to assist IDU in substance abuse and ART treatment programs, ICM was feasible, and the retention and adherence of IDU on ART in St. Petersburg could be greatly enhanced by adding ICM to the existing treatment programs.</description><identifier>ISSN: 1477-7517</identifier><identifier>EISSN: 1477-7517</identifier><identifier>DOI: 10.1186/1477-7517-10-15</identifier><identifier>PMID: 24006958</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Adolescent ; Adult ; Anti-HIV Agents - therapeutic use ; Antiretroviral agents ; Case Management - organization & administration ; CD4 antigen ; CD4 Lymphocyte Count ; Counseling ; Critical Care - methods ; Detoxification ; Detoxification (Substance abuse treatment) ; Drug abuse ; Feasibility Studies ; Female ; Fertility clinics ; Harm reduction ; Highly active antiretroviral therapy ; HIV Infections - drug therapy ; Human immunodeficiency virus ; Humans ; Injection ; Intensive care units ; Male ; Medication Adherence ; Patient compliance ; Prospective Studies ; RNA ; RNA, Viral - blood ; Russia ; Substance abuse ; Substance Abuse, Intravenous - rehabilitation ; Treatment Outcome ; Viral Load ; Young Adult</subject><ispartof>Harm reduction journal, 2013-09, Vol.10 (1), p.15-15</ispartof><rights>COPYRIGHT 2013 BioMed Central Ltd.</rights><rights>2013 Shaboltas et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</rights><rights>Copyright © 2013 Shaboltas et al.; licensee BioMed Central Ltd. 2013 Shaboltas et al.; licensee BioMed Central Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b580t-86a18d1de75f8cf13b5ebed079d60585c5c669eb9ca03f74c7ce582f36be4fd03</citedby><cites>FETCH-LOGICAL-b580t-86a18d1de75f8cf13b5ebed079d60585c5c669eb9ca03f74c7ce582f36be4fd03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3844607/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3844607/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24006958$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shaboltas, Alla V</creatorcontrib><creatorcontrib>Skochilov, Roman V</creatorcontrib><creatorcontrib>Brown, Lillian B</creatorcontrib><creatorcontrib>Elharrar, Vanessa N</creatorcontrib><creatorcontrib>Kozlov, Andrei P</creatorcontrib><creatorcontrib>Hoffman, Irving F</creatorcontrib><title>The feasibility of an intensive case management program for injection drug users on antiretroviral therapy in St. Petersburg, Russia</title><title>Harm reduction journal</title><addtitle>Harm Reduct J</addtitle><description>The majority of HIV-infected individuals requiring antiretroviral therapy (ART) in Russia are Injection Drug Users (IDU). Substitution therapy used as part of a comprehensive harm reduction program is unavailable in Russia. Past data shows that only 16% of IDU receiving substance abuse treatment completed the course without relapse, and only 40% of IDU on ART remained on treatment at 6 months. Our goal was to determine if it was feasible to improve these historic outcomes by adding intensive case management (ICM) to the substance abuse and ART treatment programs for IDU.
IDU starting ART and able to involve a "supporter" who would assist in their treatment plan were enrolled. ICM included opiate detoxification, bi-monthly contact and counseling with the case, weekly group sessions, monthly contact with the "supporter" and home visits as needed. Full follow- up (FFU) was 8 months. Stata v10 (College Station, TX) was used for all analysis. Descriptive statistics were calculated for all baseline demographic variables, baseline and follow-up CD4 count, and viral load. Median baseline and follow-up CD4 counts and RNA levels were compared using the Kruskal-Wallis test. The proportion of participants with RNA < 1000 copies mL at baseline and follow-up was compared using Fisher's Exact test. McNemar's test for paired proportions was used to compare the change in proportion of participants with RNA < 1000 copies mL from baseline to follow-up.
Between November 2007 and December 2008, 60 IDU were enrolled. 34 (56.7%) were male. 54/60 (90.0%) remained in FFU. Overall, 31/60 (52%) were active IDU at enrollment and 27 (45%) were active at their last follow-up visit. 40/60 (66.7%) attended all of their ART clinic visits, 13/60 (21.7%) missed one or more visit but remained on ART, and 7/60 (11.7%) stopped ART before the end of FFU. Overall, 39/53 (74%) had a final 6-8 month HIV RNA viral load (VL) < 1000 copies/mL.
Despite no substitution therapy to assist IDU in substance abuse and ART treatment programs, ICM was feasible, and the retention and adherence of IDU on ART in St. Petersburg could be greatly enhanced by adding ICM to the existing treatment programs.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Anti-HIV Agents - therapeutic use</subject><subject>Antiretroviral agents</subject><subject>Case Management - organization & administration</subject><subject>CD4 antigen</subject><subject>CD4 Lymphocyte Count</subject><subject>Counseling</subject><subject>Critical Care - methods</subject><subject>Detoxification</subject><subject>Detoxification (Substance abuse treatment)</subject><subject>Drug abuse</subject><subject>Feasibility Studies</subject><subject>Female</subject><subject>Fertility clinics</subject><subject>Harm reduction</subject><subject>Highly active antiretroviral therapy</subject><subject>HIV Infections - drug therapy</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Injection</subject><subject>Intensive care units</subject><subject>Male</subject><subject>Medication Adherence</subject><subject>Patient compliance</subject><subject>Prospective Studies</subject><subject>RNA</subject><subject>RNA, Viral - blood</subject><subject>Russia</subject><subject>Substance abuse</subject><subject>Substance Abuse, Intravenous - rehabilitation</subject><subject>Treatment Outcome</subject><subject>Viral Load</subject><subject>Young Adult</subject><issn>1477-7517</issn><issn>1477-7517</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp1kk2PFCEQhjtG437o2Zsh8eJhexaahqYvJrsbv5JNNLqeCU0XPUy6YQR6krn7w2Uy67hj1nAAqp56qaKqKF4RvCBE8EtSN03ZMNKUBJeEPSlOD5anD84nxVmMK4yrllHxvDipaox5y8Rp8etuCciAirazo01b5A1SDlmXwEW7AaRVBDQppwaYwCW0Dn4IakLGh0ytQCfrHerDPKA5Qogo35RLNkAKfmODGlFaQlDrbcbR97RAXyFlrpvDcIG-zTFa9aJ4ZtQY4eX9fl78-PD-7uZTefvl4-ebq9uyYwKnUnBFRE96aJgR2hDaMeigx03bc8wE00xz3kLXaoWpaWrdaGCiMpR3UJse0_Pi3V53PXcT9DrXk_OT62AnFbbSKyuPPc4u5eA3koq65rjJAtd7gc76_wgce7Sf5K4LctcFSbAkLIu8vc8i-J8zxCQnGzWMo3Lg55h52la0zg3K6Jt_0JWfg8t_tKMqTKqasr_UoEaQ1hmf39Y7UXnFaM25wIxnavEIlVcPk9XegbHZfhRwuQ_QwccYwBzq3NWRp--Ryl4__N8D_2fc6G-KHNdy</recordid><startdate>20130905</startdate><enddate>20130905</enddate><creator>Shaboltas, Alla V</creator><creator>Skochilov, Roman V</creator><creator>Brown, Lillian B</creator><creator>Elharrar, Vanessa N</creator><creator>Kozlov, Andrei P</creator><creator>Hoffman, Irving F</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PATMY</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PYCSY</scope><scope>7U9</scope><scope>H94</scope><scope>5PM</scope></search><sort><creationdate>20130905</creationdate><title>The feasibility of an intensive case management program for injection drug users on antiretroviral therapy in St. Petersburg, Russia</title><author>Shaboltas, Alla V ; Skochilov, Roman V ; Brown, Lillian B ; Elharrar, Vanessa N ; Kozlov, Andrei P ; Hoffman, Irving F</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b580t-86a18d1de75f8cf13b5ebed079d60585c5c669eb9ca03f74c7ce582f36be4fd03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Anti-HIV Agents - therapeutic use</topic><topic>Antiretroviral agents</topic><topic>Case Management - organization & administration</topic><topic>CD4 antigen</topic><topic>CD4 Lymphocyte Count</topic><topic>Counseling</topic><topic>Critical Care - methods</topic><topic>Detoxification</topic><topic>Detoxification (Substance abuse treatment)</topic><topic>Drug abuse</topic><topic>Feasibility Studies</topic><topic>Female</topic><topic>Fertility clinics</topic><topic>Harm reduction</topic><topic>Highly active antiretroviral therapy</topic><topic>HIV Infections - drug therapy</topic><topic>Human immunodeficiency virus</topic><topic>Humans</topic><topic>Injection</topic><topic>Intensive care units</topic><topic>Male</topic><topic>Medication Adherence</topic><topic>Patient compliance</topic><topic>Prospective Studies</topic><topic>RNA</topic><topic>RNA, Viral - blood</topic><topic>Russia</topic><topic>Substance abuse</topic><topic>Substance Abuse, Intravenous - rehabilitation</topic><topic>Treatment Outcome</topic><topic>Viral Load</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shaboltas, Alla V</creatorcontrib><creatorcontrib>Skochilov, Roman V</creatorcontrib><creatorcontrib>Brown, Lillian B</creatorcontrib><creatorcontrib>Elharrar, Vanessa N</creatorcontrib><creatorcontrib>Kozlov, Andrei P</creatorcontrib><creatorcontrib>Hoffman, Irving F</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Environmental Science Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>Environmental Science Collection</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Harm reduction journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shaboltas, Alla V</au><au>Skochilov, Roman V</au><au>Brown, Lillian B</au><au>Elharrar, Vanessa N</au><au>Kozlov, Andrei P</au><au>Hoffman, Irving F</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The feasibility of an intensive case management program for injection drug users on antiretroviral therapy in St. Petersburg, Russia</atitle><jtitle>Harm reduction journal</jtitle><addtitle>Harm Reduct J</addtitle><date>2013-09-05</date><risdate>2013</risdate><volume>10</volume><issue>1</issue><spage>15</spage><epage>15</epage><pages>15-15</pages><issn>1477-7517</issn><eissn>1477-7517</eissn><abstract>The majority of HIV-infected individuals requiring antiretroviral therapy (ART) in Russia are Injection Drug Users (IDU). Substitution therapy used as part of a comprehensive harm reduction program is unavailable in Russia. Past data shows that only 16% of IDU receiving substance abuse treatment completed the course without relapse, and only 40% of IDU on ART remained on treatment at 6 months. Our goal was to determine if it was feasible to improve these historic outcomes by adding intensive case management (ICM) to the substance abuse and ART treatment programs for IDU.
IDU starting ART and able to involve a "supporter" who would assist in their treatment plan were enrolled. ICM included opiate detoxification, bi-monthly contact and counseling with the case, weekly group sessions, monthly contact with the "supporter" and home visits as needed. Full follow- up (FFU) was 8 months. Stata v10 (College Station, TX) was used for all analysis. Descriptive statistics were calculated for all baseline demographic variables, baseline and follow-up CD4 count, and viral load. Median baseline and follow-up CD4 counts and RNA levels were compared using the Kruskal-Wallis test. The proportion of participants with RNA < 1000 copies mL at baseline and follow-up was compared using Fisher's Exact test. McNemar's test for paired proportions was used to compare the change in proportion of participants with RNA < 1000 copies mL from baseline to follow-up.
Between November 2007 and December 2008, 60 IDU were enrolled. 34 (56.7%) were male. 54/60 (90.0%) remained in FFU. Overall, 31/60 (52%) were active IDU at enrollment and 27 (45%) were active at their last follow-up visit. 40/60 (66.7%) attended all of their ART clinic visits, 13/60 (21.7%) missed one or more visit but remained on ART, and 7/60 (11.7%) stopped ART before the end of FFU. Overall, 39/53 (74%) had a final 6-8 month HIV RNA viral load (VL) < 1000 copies/mL.
Despite no substitution therapy to assist IDU in substance abuse and ART treatment programs, ICM was feasible, and the retention and adherence of IDU on ART in St. Petersburg could be greatly enhanced by adding ICM to the existing treatment programs.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>24006958</pmid><doi>10.1186/1477-7517-10-15</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Harm reduction journal, 2013-09, Vol.10 (1), p.15-15 |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; SpringerNature Complete Journals; PubMed Central Open Access; Springer Nature OA Free Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Adolescent Adult Anti-HIV Agents - therapeutic use Antiretroviral agents Case Management - organization & administration CD4 antigen CD4 Lymphocyte Count Counseling Critical Care - methods Detoxification Detoxification (Substance abuse treatment) Drug abuse Feasibility Studies Female Fertility clinics Harm reduction Highly active antiretroviral therapy HIV Infections - drug therapy Human immunodeficiency virus Humans Injection Intensive care units Male Medication Adherence Patient compliance Prospective Studies RNA RNA, Viral - blood Russia Substance abuse Substance Abuse, Intravenous - rehabilitation Treatment Outcome Viral Load Young Adult |
| title | The feasibility of an intensive case management program for injection drug users on antiretroviral therapy in St. Petersburg, Russia |
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