Using nominal group technique to identify barriers and facilitators to preventing HIV using combination same-day pre-exposure prophylaxis and medications for opioid use disorder

Harm Reduction Journal - Tập 19 Số 1
William Eger1, Frederick L. Altice1, Jessica Lee1, David Vlahov2, Antoine Khati3, Sydney Osborne3, Jeffrey A. Wickersham1, Terry Bohonnon1, Lindsay Powell2, Roman Shrestha4
1Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
2Yale School of Nursing, New Haven, CT, USA
3Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
4Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, 358 Mansfield Rd, Unit 1101, Storrs, CT, 06269, USA

Tóm tắt

Abstract Background Preventing HIV transmission among people who inject drugs (PWID) is a key element of the US Ending the HIV Epidemic strategy and includes both pre-exposure prophylaxis (PrEP) and medications for opioid use disorder (MOUD). While both lead to decreases in HIV transmission, MOUD has other social and health benefits; meanwhile, PrEP has additional HIV prevention advantages from sexual risk and the injection of stimulants. However, these medications are often prescribed in different settings and require multiple visits before initiation. Strategies to integrate these services (i.e., co-prescription) and offer same-day prescriptions may reduce demands on patients who could benefit from them. Methods Nominal group technique, a consensus method that rapidly generates and ranks responses, was used to ascertain barriers and solutions for same-day delivery of PrEP and MOUD as an integrated approach among PWID (n = 14) and clinical (n = 9) stakeholders. The qualitative portion of the discussion generated themes for analysis, and the ranks of the proposed barriers and solutions to the program are presented. Results The top three barriers among PWID to getting a same-day prescription for both PrEP and MOUD were (1) instability of insurance (e.g., insurance lapses); (2) access to a local prescriber; and (3) client-level implementation factors, such as lack of personal motivation. Among clinical stakeholders, the three greatest challenges were (1) time constraints on providers; (2) logistics (e.g., coordination between providers and labs); and (3) availability of providers who can prescribe both medications. Potential solutions identified by both stakeholders included pharmacy delivery of the medications, coordinated care between providers and health care systems (e.g., case management), and efficiencies in clinical care (e.g., clinical checklists), among others. Conclusions Implementing and sustaining a combined PrEP and MOUD strategy will require co-training providers on both medications while creating efficiencies in systems of care and innovations that encourage and retain PWID in care. Pilot testing the co-prescribing of PrEP and MOUD with quality performance improvement is a step toward new practice models.

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Tài liệu tham khảo

U.S. Department of Health and Human Services (DHHS). HIV National Strategic Plan for the United States: a Roadmap to End the Epidemic 2021–2025. Washington, DC. Washington, D.C. 2021. https://hivgov-prod-v3.s3.amazonaws.com/s3fs-public/HIV-National-Strategic-Plan--5.pdf. Accessed 12 May 2021

Hodder SL, Feinberg J, Strathdee SA, Shoptaw S, Altice FL, Ortenzio L, et al. The opioid crisis and HIV in the USA: deadly synergies. Lancet. 2021;397(10279):1139–50.

Centers for Disease Control and Prevention. HIV and People Who Inject Drugs. 2021.

Maxwell S, Shahmanesh M, Gafos M. Chemsex behaviours among men who have sex with men: a systematic review of the literature. Int J Drug Policy. 2019;63:74–89.

Degenhardt L, Grebely J, Stone J, Hickman M, Vickerman P, Marshall BDL, et al. Global patterns of opioid use and dependence: harms to populations, interventions, and future action. Lancet. 2019;394(10208):1560–79.

Spector AY, Remien RH, Tross S. PrEP in substance abuse treatment: a qualitative study of treatment provider perspectives. Subst Abuse Treat Prev Policy. 2015;10(1):1.

Paquette CE, Syvertsen JL, Pollini RA. Stigma at every turn: Health services experiences among people who inject drugs. Int J Drug Policy. 2018;57:104–10.

Kamis KF, Marx GE, Scott KA, Gardner EM, Wendel KA, Scott ML, et al. Same-day HIV pre-exposure prophylaxis (PrEP) initiation during drop-in sexually transmitted diseases clinic appointments is a highly acceptable, feasible, and safe model that engages individuals at risk for HIV into PrEP Care. Open Forum Infect Dis. 2019. https://doi.org/10.1093/ofid/ofz310.

Centers for Disease Control and Prevention. Preexposure Prophylaxis for the Prevention of HIV Infection in the United States – 2021 Update. 2021; p. 35–7.

National Academies of Sciences E, and Medicine. Barriers to broader use of medications to treat opioid use disorder. In: Mancher MLA, editor. Medications for opioid use disorder save lives. Washington (DC): National Academies Press; 2019.

Jaffe JH, O’Keeffe C. From morphine clinics to buprenorphine: regulating opioid agonist treatment of addiction in the United States. Drug Alcohol Depend. 2003;70(2 Suppl):S3-11.

Halperin J, Butler I, Conner K, Myers L, Holm P, Bartram L, et al. Linkage and antiretroviral therapy within 72 hours at a federally qualified health center in New Orleans. AIDS Patient Care STDS. 2018;32(2):39–41.

Koenig SP, Dorvil N, Dévieux JG, Hedt-Gauthier BL, Riviere C, Faustin M, et al. Same-day HIV testing with initiation of antiretroviral therapy versus standard care for persons living with HIV: a randomized unblinded trial. PLoS Med. 2017;14(7): e1002357.

Rosen S, Maskew M, Fox MP, Nyoni C, Mongwenyana C, Malete G, et al. Initiating antiretroviral therapy for HIV at a patient’s first clinic visit: the RapIT randomized controlled trial. PLoS Med. 2016;13(5): e1002015.

Centers for Disease Control and Prevention. Pre-Exposure Prophylaxis (PrEP) 2021.

Substance Abuse and Mental Health Services Administration. Buprenorphine. 2021.

Sivakumar A, Madden L, DiDomizio E, Eller A, Villanueva M, Altice FL. Treatment of hepatitis C virus among people who inject drugs at a syringe service program during the COVID-19 response: the potential role of telehealth, medications for opioid use disorder and minimal demands on patients. Int J Drug Policy. 2022;101: 103570.

Delbecq AL, Van de Ven AH, Gustafson DH. Group techniques for program planning: a guide to nominal group and Delphi processes. Scott: Foresman; 1975.

Sav A, McMillan SS, Kelly F, King MA, Whitty JA, Kendall E, et al. The ideal healthcare: priorities of people with chronic conditions and their carers. BMC Health Serv Res. 2015;15(1):1–10.

McMillan SS, Kelly F, Sav A, Kendall E, King MA, Whitty JA, et al. Using the nominal group technique: how to analyse across multiple groups. Health Serv Outcomes Res Method. 2014;14(3):92–108.

Grimsrud A, Bygrave H, Doherty M, Ehrenkranz P, Ellman T, Ferris R, et al. Reimagining HIV service delivery: the role of differentiated care from prevention to suppression. J Int AIDS Soc. 2016. https://doi.org/10.7448/IAS.19.1.21484.

Walters SM, Kral AH, Simpson KA, Wenger L, Bluthenthal RN. HIV pre-exposure prophylaxis prevention awareness, willingness, and perceived barriers among people who inject drugs in Los Angeles and San Francisco, CA, 2016–2018. Subst Use Misuse. 2020;55(14):2409–19.

Allen ST, O’Rourke A, White RH, Smith KC, Weir B, Lucas GM, et al. Barriers and facilitators to PrEP Use among people who inject drugs in Rural Appalachia: a qualitative study. AIDS Behav. 2020;24(6):1942–50.

Matsuzaki M, Vu QM, Gwadz M, Delaney JAC, Kuo I, Trejo MEP, et al. Perceived access and barriers to care among illicit drug users and hazardous drinkers: findings from the Seek, Test, Treat, and Retain data harmonization initiative (STTR). BMC Public Health. 2018;18(1):366.

Mark TL, Treiman K, Padwa H, Henretty K, Tzeng J, Gilbert M. Addiction treatment and telehealth: review of efficacy and provider insights during the COVID-19 pandemic. Psychiatr Serv. 2021. https://doi.org/10.1176/appi.ps.202100088.

Vanhamel J, Rotsaert A, Reyniers T, Nöstlinger C, Laga M, Van Landeghem E, et al. The current landscape of pre-exposure prophylaxis service delivery models for HIV prevention: a scoping review. BMC Health Serv Res. 2020;20(1):704.

Degenhardt L, Mathers B, Vickerman P, Rhodes T, Latkin C, Hickman M. Prevention of HIV infection for people who inject drugs: why individual, structural, and combination approaches are needed. Lancet. 2010;376(9737):285–301.

Broz D, Carnes N, Chapin-Bardales J, Des Jarlais DC, Handanagic S, Jones CM, et al. Syringe services programs’ role in ending the HIV epidemic in the U.S.: why we cannot do it without them. Am J Prev Med. 2021;61(5 Suppl 1):S118–29.

O’Byrne P, Vandyk A, Orser L, Haines M. Nurse-led PrEP-RN clinic: a prospective cohort study exploring task-Shifting HIV prevention to public health nurses. BMJ Open. 2021;11(1):e040817.

Clifford-Rashotte M, Fawcett N, Fowler B, Reinhart J, Tan DHS. Assessing the potential for nurse-led HIV pre- and postexposure prophylaxis in Ontario. Can J Nursing Res. 2020;53(2):145–54.

O’Byrne P, Orser L, Jacob JD. The costs of HIV pre-exposure prophylaxis (PrEP) care delivery: comparing specialists, primary Care, and PrEP-RN. Sex Res Soc Policy. 2020;17(2):326–33.

Newhouse RP, Stanik-Hutt J, White KM, Johantgen M, Bass EB, Zangaro G, et al. Advanced practice nurse outcomes 1990–2008: a systematic review. Nurs Econ. 2011;29(5):230–50.

Peterson ME. Barriers to practice and the impact on health care: a nurse practitioner focus. J Adv Pract Oncol. 2017;8(1):74–81.

Hinton E, Stolyar L. Medicaid Authorities and Options to Address Social Determinants of Health (SDOH): Kaiser Family Foundation. 2021.

Andreae MH, Maman SR, Behnam AJ. An electronic medical record-derived individualized performance metric to measure risk-adjusted adherence with perioperative prophylactic bundles for health care disparity research and implementation science. Appl Clin Inform. 2020;11(3):497–514.

Duan L, Lee MS, Adams JL, Sharp AL, Doctor JN. Opioid and Naloxone prescribing following insertion of prompts in the electronic health record to encourage compliance with California State Opioid law. JAMA Netw Open. 2022;5(5): e229723.

Granger BB, Kaltenbach LA, Fonarow GC, Allen LA, Lanfear DE, Albert NM, et al. Health system-level performance in prescribing guideline-directed medical therapy for patients with HFrEF: results from the CONNECT-HF trial. J Card Fail. 2022. https://doi.org/10.1016/j.cardfail.2022.03.356.

Walters SM, Perlman DC, Guarino H, Mateu-Gelabert P, Frank D. Lessons from the first wave of COVID-19 for improved Medications for Opioid Use Disorder (MOUD) treatment: benefits of easier access, extended take homes, and new delivery modalities. Subst Use Misuse. 2022;57(7):1144–53.

Rycroft-Malone J. It’s more complicated than that comment on “Translating evidence into healthcare policy and practice: Single versus multi-faceted implementation strategies–is there a simple answer to a complex question?” Int J Health Policy Manag. 2015;4(7):481–2.

Broder-Fingert S, Kuhn J, Sheldrick RC, Chu A, Fortuna L, Jordan M, et al. Using the Multiphase Optimization Strategy (MOST) framework to test intervention delivery strategies: a study protocol. Trials. 2019;20(1):728.

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Harm Reduction Journal

Tập 19 Số 1

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