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.

INTRODUCTION/BACKGROUND:The United States is facing an opioid use disorder (OUD) epidemic, marked by unprecedented overdose death rates. In New York State, synthetic opioids significantly contribute to the increasing overdose deaths, disproportionately impacting Black and Latinx communities. There is an urgent need to address issues related to equitable access to and the quality of care provided by substance use disorder (SUD) treatment programs. In light of this, the Quality Measurement and Management Research Center (QM2-RC) brought together an academic-government partnership to develop a person-centered quality measurement system and to assess its impact on a statewide treatment system that serves approximately 180,000 individuals per year. METHODS AND ANALYSIS/METHODS:The QM2-RC encompasses three interconnected projects (Project 1, 2, and 3) aimed at developing a quality management strategy and evaluating its impact on system performance across New York State. This report specifically focuses on Project 3, which involves a stepped-wedge trial with 35 clinics receiving a quality management intervention that includes performance coaching. This intervention will be compared to a treatment-as-usual (TAU) condition for clinics not participating in the trial. Administrative data will be utilized to monitor outcomes over four years. The coaching intervention, guided by the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) model, emphasizes interpreting quality measures and applying insights to enhance care. Coaches will provide support on data utilization, patient-centered care, harm reduction strategies, and the use of patient monitoring tools. The trial aims to evaluate clinic staff and leadership attitudes, experiences, and behaviors through surveys, semi-structured interviews, and external facilitator notes. Primary clinic outcomes will be assessed through adverse events, decreased clinic rates of substance use related emergency department visits and hospitalizations as well as mortality among patients within the first 12 months after admission to treatment after adjusting for individual and community level characteristics. This study is being developed over a multi-year period and will be informed by a mixed-methods approach incorporating multiple data sources, qualitative interviews, patient and clinic surveys. The study is being conducted in partnership with New York State Office of Addiction Services and Supports (OASAS) and will be informed by input from patient, providers, health insurers, family members and local governing units. DISCUSSION/CONCLUSIONS:Project 3 of the QM2 study specifically targets key barriers in measuring the quality of SUD treatment, including technological limitations, unvalidated measures, workforce data literacy, and concerns about fairness in assessing clinical complexity. Through the implementation of a stepped-wedge trial involving 35 clinics, the project aims to develop new quality measures, offer performance feedback, and engage clinic leadership and staff in efforts to improve practices. The ultimate goal of Project 3 is to overcome these barriers, promote person-centered care, and improve SUD treatment practices across New York State.

BACKGROUND:HIV care continuum engagement is inadequate among African American/Black and Latine (AABL) young/emerging adults living with HIV in the United States. Within this population, some subgroups face barriers to research and are under-studied. Grounded in social action theory, the present study focuses on a diverse community-recruited cohort including those with non-suppressed HIV viral load. Using a sequential explanatory mixed methods design, we describe contextual self-regulatory resources (e.g., substance use, mental health), and their relationships to HIV management. METHODS:Participants (N = 271) engaged in structured baseline assessments and biomarker testing (HIV viral load, drug screening). Being well-engaged in HIV care and HIV viral suppression were the primary outcomes. We purposively sampled a subset for maximum variability for in-depth interviews (N = 41). Quantitative data were analyzed via descriptive statistics and logistic regression, and results were used to develop qualitative research questions. Then, qualitative data were analyzed via directed content analysis. The joint display method was used to integrate results. RESULTS:Participants' mean age was 25 years (SD = 2). The majority (59%) were Latine/Hispanic and 41% were African American/Black. Nearly all were assigned male sex at birth (96%) and identified as gay/bisexual/queer (93%). The average HIV diagnosis was 4 years prior (SD = 3). The majority were well-engaged in HIV care (72%) and evidenced viral suppression (81%). Substance use (tobacco, marijuana, alcohol) was prevalent, mainly at low- and moderate-risk levels. Drug screening indicated marijuana, methamphetamine, and MDMA were the most common recent substances. Symptoms of depression and PTSD were associated with decreased odds of engagement in care. High-risk cannabis use was associated with decreased odds of HIV viral suppression. Qualitative results highlighted the prevalence of substance use in social networks and venues, and the importance of substances as a coping strategy, including for mental health distress. Tobacco and methamphetamine (but not marijuana) were described as problematic, and marijuana was used as harm reduction. Substance use was more common among those with non-suppressed versus suppressed HIV viral load. However, overall, substance use did not commonly interfere substantially with HIV management. CONCLUSIONS:The present study advances knowledge on AABL young/emerging adults living with HIV and highlights ways to improve screening and services.

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.

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.

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.

BACKGROUND:Permanent supportive housing (PSH) is the gold standard intervention for chronic homelessness, but PSH tenants face high risk for overdose due to a combination of individual and environmental risk factors. Little research has examined overdose prevention in PSH. METHODS:We conducted baseline surveys with staff from 20 New York PSH buildings participating in an overdose prevention technical assistance intervention study. PSH staff from participating buildings were invited via email to complete a brief online survey about their knowledge of overdose and perspectives on implementing overdose prevention practices in PSH. RESULTS:Surveys were completed by 178 staff of 286 invitations sent (response rate 62.2%). Average score on the Brief Opioid Overdose Knowledge (BOOK) questionnaire was 8.62 (SD 2.64) out of 12 points. Staff felt very positively (91.6-97.2% agreed or completely agreed) regarding the appropriateness and acceptability of implementing overdose prevention practices in PSH, but less certain about the feasibility of implementing these practices (62.4-65.5% agreed or completely agreed). Most (77.3%) felt it was mostly or definitely true that overdose prevention was a top priority in their building. Most PSH staff (median = 85.0%) but fewer tenants (median = 22.5%) had received a naloxone kit and training in overdose response. CONCLUSION/CONCLUSIONS:Staff feel positively about the acceptability and appropriateness of implementing overdose response practices in PSH, but somewhat more uncertain about the feasibility of implementing these practices. This study's results help hone targets for interventions to help PSH buildings take steps to reduce tenant overdose risk.