Faculty Bibliography

INTRODUCTION/UNASSIGNED:Methadone maintenance treatment (MMT) is among the best strategies for reducing harms associated with illegal opioid use, yet it is hindered by low rates of treatment initiation and retention that limit its impact. There has been a lack of studies that describe how people who use illegal opioids use methadone-both from opioid treatment programs, and bought illegally-over time, or what factors correlate with long-term participation in MMT. METHODS/UNASSIGNED: = 412 people who use illicit opioids in New York City from April 2019-2022. We used bivariate analyses to estimate the distribution of baseline sociodemographic and background characteristics. Multinomial logistic regression was then used to estimate the association between those characteristics and methadone use over time. RESULTS/UNASSIGNED:Findings show that people who are older, who used heroin for longer amounts of time, and who had multiple episodes of substance use disorder treatment other than medication for opioid use disorder are more likely to use MMT consistently over time. DISCUSSION/UNASSIGNED:Our findings may be related to the many barriers to long-term participation in MMT, such as travel distance, the need for regular attendance, and patients' dissatisfaction with opioid treatment programs. Consistent participation in MMT may become acceptable only when the difficulties and burdens of criminalized drug use begin to outweigh those of MMT participation, and after non-medication-using treatments have already been tried. Efforts to make MMT less burdensome could reduce the tendency to avoid MMT until later in life and improve people's consistency of participation over time.

BACKGROUND:Permanent supportive housing (PSH) is an evidence-based intervention for people experiencing homelessness which integrates permanent housing with voluntary support services. PSH tenants are at high risk for overdose death, yet little research to date has examined overdose in PSH. We sought to examine overdose risk and existing responses in PSH, which can shed light on opportunities for future overdose prevention efforts. METHODS:We conducted focus groups with PSH tenants, staff, and leaders in New York City and New York's Capital Region. Focus groups were recorded and professionally transcribed. Two investigators independently completed rapid turnaround qualitative analysis, completing templated summaries of each focus group and compiling key content in an analysis matrix, which a third investigator reviewed; discrepancies were resolved by consensus. RESULTS:From October to December 2022, we held 8 focus group sessions with PSH tenants (3 focus groups, n = 10 total participants), staff (3 focus groups, n = 13), and leaders (2 focus groups, n = 11) grouped by role and region. Participants were diverse in age (26-67 years), gender (18 women, 16 men), race (3 Asian, 12 Black, 11 White, 5 multiracial, 3 other), and ethnicity (5 Latinx, 29 not Latinx). Analysis revealed four main themes: (1) Overdose was a large concern in PSH and created significant trauma for tenants and staff; (2) Environmental factors in PSH contributed to overdose risk; (3) There was heterogeneity in PSH buildings' current overdose prevention efforts and adoption of harm reduction principles; and (4) Multifactorial barriers resulted in limited tenant use of opioid agonist treatment. CONCLUSIONS:Overdose is a major concern for PSH tenants, staff, and leaders. Our findings shed new light on overdose in PSH settings, providing insight into risk factors, existing responses, and barriers and facilitators to future overdose prevention efforts. These findings can inform future overdose prevention interventions within PSH. TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov, NCT05786222, registered 27 March 2023.

BACKGROUND:Racial/ethnic and age-related disparities in HIV care continuum engagement are serious in the US. American/Black and Latine (AABL) young/emerging adults living with HIV have the lowest rates of engagement, but aspects of their experiences and some subpopulations are understudied. The present study is grounded in social action theory and uses a sequential explanatory mixed methods design to explore social interaction processes (e.g., social networks, trust), and their relationships to HIV management, in a diverse cohort including those with non-suppressed HIV viral load. METHODS: = 62) was purposively sampled for maximum variability for qualitative interviews. Quantitative data were analyzed with descriptive statistics and logistic regression. The primary outcomes were engagement in HIV care and viral suppression. Quantitative results were used to develop qualitative research questions, and qualitative data were analyzed with directed content analysis. Joint display methods were used to integrate results. RESULTS: = 0.045) increased the odds of viral suppression. In qualitative results we found social networks were vital to well-being, but, like participants, located in strained socioeconomic circumstances. In this context, we organized results into five themes: (1) social losses were disruptive to HIV management; (2) service settings and care providers were important network members; (3) family disapproval of sexual/gender minority status had negative effects; (4) immigrant participants were highly reliant on service settings; and (5) networks influenced participants’ drug use and their drug use also reduced the size and changed the composition of networks. CONCLUSIONS:The present study advances knowledge on social interaction processes among diverse AABL young/emerging adults living with HIV, and highlights points of intervention. SUPPLEMENTARY INFORMATION:The online version contains supplementary material available at 10.1186/s12939-025-02662-5.

Black and Latine transgender/gender-expansive youth/emerging adults ages 13-24 years, experience disproportionate HIV risk, yet have the lowest PrEP uptake rates in the U.S. (< 8%). This study examines the effects of gender-minority stressors, gender affirmation, and heavy substance use on their PrEP outcomes using data from the CDC's 2018 START study (N = 423). We used structural equation modeling (Mplus v. 8.10) to examine factors related to their PrEP intentions using our newly developed conceptual model. The majority of participants were 18-24 (77.3%), transfemale (69.7%), Latine (63.1%), and reported heavy substance use behaviors (50.6%). Family rejection increased perceived stigma (b = 0.209, SE = 0.050, p < 0.001) and heavy substance use behaviors (b = 0.356, SE = 0.072, p < 0.001). Perceived stigma also increased heavy substance use behaviors (b = 0.084, SE = 0.041, p 0.041). Additionaly, heavy substance use decreased PrEP intentions (b = -0.160, SE = 0.049, p < 0.001), while gender affirmation increased PrEP intentions (b = 0.087, SE = 0.030, p < 0.004). When family rejection was present, for each 1-point increase in gender affirmation, the risk of heavy substance use was reduced by -0.197 (SE = 0.038; p < 0.001). This study identifies heavy substance use as a potential barrier to PrEP uptake among Black and Latine transgender and gender-expansive youth, given its significant negative association with PrEP intentions. Findings highlight the need for strategies to improve PrEP outcomes, underscoring the importance of operationalizing gender affirmation across settings, particularly amid family rejection and heavy substance use.

BACKGROUND AND AIMS/OBJECTIVE:'Tusi', also known as 'tusibí' or 'pink cocaine', is a drug concoction which previously emerged in Latin America and Europe and has recently acquired popularity in the United States (US). Consumers are often unaware that Tusi contains a mixture of ketamine and other drugs, and the concoction can be confused with 2C/2C-B (ring-substituted phenethylamines/4-bromo-2,5-dimethoxyphenethylamine) or cocaine. This study aimed to estimate the prevalence and correlates of past-year Tusi use in the electronic dance music (EDM) nightclub-attending population in New York City (NYC), US. DESIGN AND SETTING/METHODS:This cross-sectional study included surveys and optional saliva testing of adults entering randomly selected EDM events in NYC in 2024. PARTICIPANTS/METHODS:Adults aged ≥18 years entering EDM events at nightclubs (n = 1465). MEASUREMENTS/METHODS:Exposures were demographic characteristics and past-year use of other drugs. The primary outcome was self-reported past-year use of Tusi, and in a subsample, biologically confirmed exposure to various drugs determined by saliva testing. FINDINGS/RESULTS:Based on self-report, an estimated 2.7% [95% confidence interval (CI) = 1.9-3.9] of adults in the NYC EDM nightclub-attending population have used Tusi in the past year. Compared with white individuals, Hispanic individuals were at higher odds for use [adjusted odds ratio (aOR) = 5.10, 95% CI = 1.96-13.25]. Compared with those who did not use, those who used ecstasy/3,4-Methylenedioxymethamphetamine (MDMA) (aOR = 6.59, 95% CI = 1.60-27.16), ketamine (aOR = 3.44, 95% CI = 1.18-10.08) and/or 2C series (aOR = 14.82, 95% CI = 4.77-46.04) in the past year were at higher odds for use. Compared with those not reporting Tusi use, those reporting past-year use were more likely to have saliva test positive for cocaine, ketamine, MDMA, methamphetamine and/or synthetic cathinones (Ps < 0.001). They were also more likely to test positive for cocaine, ketamine or methamphetamine after not reporting past-year use (Ps < 0.01). CONCLUSIONS:An estimated 2.7% of electronic dance music-nightclub attending adults in New York City appear to have used Tusi in the past year, with higher use among Hispanic individuals and people exposed (sometimes unintentionally) to other drugs.

Racial/ethnic disparities in COVID-19 morbidity and mortality are serious in the United States, particularly among African American/Black and Latine (AABL) populations. Staying up-to-date on COVID-19 vaccination is essential for mitigating risk, but AABL vaccination rates are low. The present qualitative study explores perspectives on COVID-19 among AABL persons at high-risk for exposure to the SARS-CoV- 2 virus: frontline essential workers engaged in public-facing professions (e.g., retail). From a larger study of AABL frontline essential workers not up-to-date on COVID-19 vaccination, N = 50 participants were purposively sampled for maximum variability. Participants engaged in semi-structured qualitative interviews in English or Spanish that were audio-recorded, professionally transcribed, and translated into English as needed. Data were analyzed using a directed content analysis approach that was both inductive and theory-driven. Participants were 37 years old, on average, and most (65%) were men. Approximately half (56%) were Latine/Hispanic and 44% were African American/Black. Occupations included food preparation (40%), retail (28%), construction (12%), in-home health care (8%), and building maintenance and personal services (12%). Approximately a third (38%) had received ≥ 1 COVID-19 vaccine dose. We found COVID-19 vaccination perspectives were grounded in a larger context of medical and institutional distrust and past/ongoing systemic racism. In this context, results were organized into the following themes: general perspectives on COVID-19; barriers/facilitators related to race/ethnicity, social class, and community; specific aspects of the COVID-19 vaccine as barriers; mandates, incentives, and pressures to be vaccinated; and mixed effects of public health initiatives. Overall, participants were knowledgeable about COVID-19. Social norms reduced vaccine intentions but altruism and community/family concern could motivate it. Aspects of the public health response (e.g., advertisement campaigns targeting AABL populations) increased distrust and reduced vaccination willingness. However, at least some ambivalence about vaccination was common (participants would consider it). Yet there was a large gap between considering and receiving vaccination. Thus, barriers to COVID-19 vaccination for AABL frontline essential workers operate at multiple levels of influence, but are addressable. The present study yields recommendations to improve vaccination, including increasing the trustworthiness of systems and institutions, reducing systemic/structural barriers, harnessing social forces, and engaging AABL communities in program planning.

Racial/ethnic disparities in COVID-19, including incidence, hospitalization, and death rates, are serious and persistent. Among those at highest risk for COVID-19 and its adverse effects are African American/Black and Latine (AABL) frontline essential workers in public-facing occupations (e.g., food services, retail). Testing for COVID-19 in various scenarios (when exposed or symptomatic, regular screening testing) is an essential component of the COVID-19 control strategy in the United States. However, AABL frontline workers have serious barriers to COVID-19 testing at the individual (insufficient knowledge, distrust, cognitive biases), social (norms), and structural levels of influence (access). Thus, testing rates are insufficient and interventions are needed. The present study is grounded in the multiphase optimization strategy (MOST) framework. It tests the main and interaction effects of a set of candidate behavioral intervention components to increase COVID-19 testing rates in this population. The study enrolled adult AABL frontline essential workers who were not up-to-date on COVID-19 vaccination nor recently tested for COVID-19. It used a factorial design to examine the effects of candidate behavioral intervention components, where each component was designed to address a specific barrier to COVID-19 testing. All participants received a core intervention comprised of health education. The candidate components were motivational interviewing counseling (MIC), a behavioral economics intervention (BEI), peer education (PE), and access to testing (either self-test kits [SK] or a navigation meeting [NM]). The primary outcome was COVID-19 testing in the follow-up period. Participants were assessed at baseline, randomly assigned to one of 16 experimental conditions, and assessed six- and 12-weeks later. The study was carried out in English and Spanish. We used a logistic regression model and multiple imputation to examine the main and interaction effects of the four factors (representing components): MIC, BEI, PE, and Access. We also conducted a sensitivity analysis using the complete case analysis. Participants (N = 438) were 35 years old on average (SD = 10). Half identified as men/male (52%), and 48% as women/female/other. Almost half (49%) were African American/Black, and 51% were Latine/Hispanic (12% participated in Spanish). A total of 32% worked in food services. Attendance in components was very high (~ 99%). BEI had positive effect on the outcome (OR = 1.543; 95% CI: [0.977, 2.438]; p-value = 0.063) as did Access, in favor of SK (OR = 1.351; 95% CI: [0.859, 2.125]; p-value = 0.193). We found a three-way interaction among MIC*PE*Access (OR: 0.576; 95% CI: [0.367, 0.903]; p-value = 0.016): when MIC was present, SK tended to increase COVID testing when PE was not present. The study advances intervention science and takes the first step toward creating an efficient and effective multi-component intervention to increase COVID-19 testing rates in AABL frontline workers.

OBJECTIVE:This paper examines depression, post-traumatic stress disorder (PTSD), and comorbid depression/PTSD among Black and Latinx young and emerging adults (YEA) living with HIV. We incorporated a social-ecological framework to examine risk factors associated with mental health conditions, comparing foreign and US-born groups. METHODS:We used a hybrid recruitment strategy and surveyed 271 Black and Latinx YEA (ages 19-28 years) living with HIV in the Eastern USA. We used multivariable logistic regressions and hypothesized certain individual, interpersonal, community/societal risk factors would be positively associated with depression, PTSD, and comorbid depression/PTSD. RESULTS:Participants experienced elevated rates of depression (33.9%), PTSD (34.0%), and comorbid depression/PTSD (19.1%). Contrary to our hypothesis, US-born participants had significantly higher rates of mental health conditions compared to foreign-born participants. At the individual-level, foreign-born was associated with lower comorbid depression/PTSD [RRR 0.38 (95% CI 0.15, 0.97)], cisgender with lower comorbid depression/PTSD [RRR 0.42 (95% CI 0.18, 0.99)], greater number of Adverse Childhood Experiences with PTSD [OR 1.18 (95% CI 1.08, 1.29)], and comorbid depression/PTSD [RRR 1.28 (95% CI 1.12, 1.47)], while moderate/high substance use with depression [OR 2.30 (95% CI 1.01, 5.25)] and comorbid depression/PTSD [RRR 3.74 (95% CI 1.07, 13.03)]. At the interpersonal-level, lower social support was associated with higher depression [OR 0.99 (95% CI 0.97, 1.00)], PTSD [OR 0.98 (95% CI 0.97, 0.99)], and comorbid depression/PTSD [RRR 0.97 (95% CI 0.96, 0.99)]. At the community/societal-level, discrimination was associated with higher depression [OR 1.05 (95% CI 1.02, 1.08)] and comorbid depression/PTSD [RRR 1.07 (95% CI 1.02, 1.11)]. IMPLICATIONS/CONCLUSIONS:Understanding social-ecological risk factors associated with mental health conditions of Black and Latinx YEA living with HIV is important in determining potential avenues for targeted prevention and intervention to improve mental health.

INTRODUCTION/BACKGROUND:Little data exists on the effectiveness of HIV prevention interventions among people who inject drugs (PWID) in Africa. We used empirical data from Kenya to fill this evidence gap. METHODS:Six rounds of bio-behavioural surveys using respondent-driven-sampling were conducted among PWID in Nairobi and Coastal Kenya over 2012-2015. Dried blood spot samples were tested for HIV and HIV viral load, and HIV incidence was estimated through linking participants between rounds. Regression analyses evaluated whether self-reported usage of opioid agonist therapy (OAT) or needle and syringe programmes (NSP) in last year were associated with reduced injecting risk behaviours, increased ART uptake and viral suppression, and reduced risk of HIV acquisition. RESULTS:Overall, 4897 PWID participated in the study, with 3903 participating in >1 round. Over the rounds, coverage increased from zero to 80-86 % for NSP and zero to 10-20 % for OAT. The proportion of people living with HIV (PLHIV) that were virally suppressed increased from 7-14 % to 39-55 %. Accessing NSP and OAT was associated with reduced syringe sharing at last injection (NSP adjusted odds ratio (aOR)=0.31; 95 %CI:0.24-0.40; OAT aOR=0.046; 95 %CI:0.034-0.061) and OAT was associated with reduced injecting frequency (adjusted rate ratio=0.21; 95 %CI:0.12-0.36). Using OAT was associated with increased ART coverage (aOR=2.76; 95 %CI:1.50-5.06) and viral suppression (aOR=2.99; 95 %CI:1.78-5.03) among PLHIV, while NSP was not. HIV incidence decreased from 6.10 (95 %CI:3.56-9.77) to 1.49 (95 %CI:0.79-2.54) per 100 person-years between the first and second half of the study. Accessing NSP was associated with lower HIV incidence (adjusted hazard ratio=0.25; 95 %CI:0.087-0.58). CONCLUSIONS:This study provides strong evidence for the benefits of NSP and OAT on varied HIV outcomes among PWID in Africa.