Providing reproductive health services for women who inject drugs: a pilot program

Harm Reduction Journal - Tập 17 Số 1 - 2020
Lauren Owens1, Kelly Gilmore2, Mishka Terplan3, Sarah Prager2, Elizabeth Micks2
1Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, USA
2Department of Obstetrics and Gynecology, University of Washington, Seattle, USA
3Department of Obstetrics and Gynecology, Department of Psychiatry, Virginia Commonwealth University, Richmond, USA

Tóm tắt

Abstract Background Needle syringe programs (NSPs), a proven harm reduction strategy for people who inject drugs, frequently offer limited healthcare services for their clients. Women who inject drugs face multiple barriers to accessing reproductive health care in traditional settings: personal histories of trauma, judgmental treatment from providers, and competing demands on their time. Our aim was to implement patient-centered reproductive healthcare services at a Seattle NSP. Methods We interviewed clients and staff of an NSP in Seattle and staff of other community-based organizations serving women who inject drugs, then used the Consolidated Framework for Implementation Research to code transcripts deductively. Based on our qualitative work, we implemented reproductive health care at the NSP program 1 day per week. We evaluated the implementation by surveying staff and clients and auditing charts over a 9-month period. Results Clients and staff (N = 15 for clients, N = 13 for staff) noted a high unmet need for trauma-informed, accessible reproductive health care. We successfully implemented reproductive health care services including short- and long-acting contraception, sexually transmitted disease testing, and cervical cancer screening. Survey data was limited but demonstrated client satisfaction with services. Conclusions Integrating reproductive health care into an NSP’s clinical services is feasible and can be a source of low-barrier preventive care for women unable to seek gynecologic care elsewhere.

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Tài liệu tham khảo

Lansky A, Finlayson T, Johnson C, et al. Estimating the number of persons who inject drugs in the United States by meta-analysis to calculate national rates of HIV and hepatitis C virus infections. PLoS One. 2014;9(5):e97596.

King County Needle Exchange. Public Health Seattle & King County. https://www.kingcounty.gov/depts/health/communicable-diseases/hiv-std/patients/drug-use-harm-reduction/needle-exchange.aspx Accessed 12/6/19.

Statistical profile of King County. King County. https://www.kingcounty.gov/~/media/depts/executive/performance-strategy-budget/regional-planning/Demographics/Dec-2018-Update/KC-Profile2018.ashx?la=en Accessed 12/6/19.

Wodak A, Cooney A. Do needle syringe programs reduce HIV infection among injecting drug users: a comprehensive review of the international evidence. Subst Use Misuse. 2006;41(6-7):777–813.

CDC. Syringe exchange programs --- United States, 2008. MMWR Morb Mortal Wkly Rep. 2010;59(45):1488–91.

Black K, Stephens C, Haber P, Lintzeris N. Unplanned pregnancy and contraceptive use in women attending drug treatment services. Aust N Z J Obs Gynaecol. 2012;52(2):146–50.

Terplan M, Hand DJ, Hutchinson M, Salisbury-Afshar E, Heil SH. Contraceptive use and method choice among women with opioid and other substance use disorders: A systematic review. Prev Med. 2015;80:23–31.

Moore E, Han J, Serio-Chapman C, Mobley C, Watson C, Terplan M. Contraception and clean needles: feasibility of combining mobile reproductive health and needle exchange services for female exotic dancers. Am J Public Health. 2012;102(10):1833–6.

Young M, Stuber J, Ahern J, Galea S. Interpersonal discrimination and the health of illicit drug users. Am J Drug Alcohol Abuse. 2005;31(3):371–91. https://doi.org/10.1081/ADA-200056772.

Paquette CE, Syvertsen JL, Pollini RA. Stigma at every turn: Health services experiences among people who inject drugs. Int J Drug Policy. 2018;57(April):104–10. https://doi.org/10.1016/j.drugpo.2018.04.004.

Chitwood DD, Sanchez J, Comerford M, McCoy CB. Primary preventive health care among injection drug users, other sustained drug users, and non-users. Subst Use Misuse. 2001;36(6-7):807–24. https://doi.org/10.1081/JA-100104092.

Chitwood DD, McBride DC, French MT, Comerford M. Health care need and utilization: a preliminary comparison of injection drug users, other illicit drug users, and nonusers. Subst Use Misuse. 1999;34(4-5):727–46.

Sterk CE, Theall KP, Elifson KW. Health care utilization among drug-using and non-drug-using women. J Urban Health. 2002;79(4):586–99. https://doi.org/10.1093/jurban/79.4.586.

McNeil R, Small W. “Safer environment interventions”: A qualitative synthesis of the experiences and perceptions of people who inject drugs. Soc Sci Med. 2014;106:151–8. https://doi.org/10.1016/j.socscimed.2014.01.051.

Treloar C, Rance J, Yates K, Mao L. Trust and people who inject drugs: The perspectives of clients and staff of Needle Syringe Programs. Int J Drug Policy. 2016;27:138–45. https://doi.org/10.1016/j.drugpo.2015.08.018.

Starrs AM, Ezeh AC, Barker G, et al. Accelerate progress—sexual and reproductive health and rights for all: report of the Guttmacher–Lancet Commission. Lancet. 2018;391:2642–92.

Gilbert L, El-Bassel N, Schilling RF, et al. Partner violence and sexual HIV risk behaviors among women in methadone treatment. AIDS Behav. 2000;4:261–9.

El-Bassel N, Gilbert L, Wu E, Go H, Hill J. HIV and intimate partner violence among methadone-maintained women in New York City. Soc Sci Med. 2005;61(1):171–83.

Hoffman A, Montgomery R, Aubry W, Tunis SR. How best to engage patients, doctors, and other stakeholders in designing comparative effectiveness studies. Health Aff. 2010;29(10):1834–41. https://doi.org/10.1377/hlthaff.2010.0675.

Bechtel C, Ness DL. If you build it, will they come? Designing truly patient-centered health care. Health Aff. 2010;29(5):914–20. https://doi.org/10.1377/hlthaff.2010.0305.

Haines KJ, Kelly P, Fitzgerald P, Skinner EH, Iwashyna TJ. The untapped potential of patient and family engagement in the organization of critical care. Crit Care Med. 2017;45(5):899–906. https://doi.org/10.1097/CCM.0000000000002282.

The Consolidated Framework for Implementation Research- Constructs. CFIR Research Team. https://cfirguide.org/constructs/ Accessed 12/6/19.

Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50. https://doi.org/10.1186/1748-5908-4-50.

Damschroder LJ, Hagedorn HJ. A guiding framework and approach for implementation research in substance use disorders treatment. Psychol Addict Behav. 2011;25(2):194–205.

CAHPS Surveys and Guidance. Agency for Healthcare Research and Quality. https://www.ahrq.gov/cahps/surveys-guidance/index.html. Accessed 12/6/19.

Romero LM, Olaiya O, Hallum-Montes R, et al. Efforts to increase implementation of evidence-based clinical practices to improve adolescent-friendly reproductive health services. J Adolesc Health. 2017. 60(3 Suppl): S30:S37.

Kirk MA, Kelley C, Yankey N, Birken SA, Abadie B, Damschroder L. A systematic review of the use of the Consolidated Framework for Implementation Research. Implement Sci. 2016;11:72. https://doi.org/10.1186/s13012-016-0437-z.

Robins LS, Jackson JE, Green BB, Korngiebel D, Force RW, Baldwin L-M. Barriers and facilitators to evidence-based blood pressure control in community practice. J Am Board Fam Med. 2013;26(5):539–57. https://doi.org/10.3122/jabfm.2013.05.130060.

Curtis KM, Jatlaoui TC, Tepper NK, et al. U.S. Selected Practice Recommendations for Contraceptive Use, 2016. MMWR Recomm Rep. 2016. 65(No. RR-4):1–66. DOI: https://doi.org/10.15585/mmwr.rr6504a1.

Dosing & Administration. Merck. 2018. https://www.merckconnect.com/nexplanon/dosing-administration/ Accessed 12/6/19.