Faculty Bibliography

INTRODUCTION/BACKGROUND:Skin and soft tissue infections (SSTI) and severe injection-related infections (SIRI) cause serious morbidity among people who inject drugs (PWID). Data suggest that specific injection practices associate with a higher risk of developing SSTI/SIRI, and that a brief screening tool may help identify at-risk individuals. This study examines injection drug use behaviors and SSTI/SIRI experiences among a sample of PWID in New York City (NYC). In particular, the analysis explores the potential utility of the bacterial infections risk scale for injection drug use (BIRSI) in identifying people at risk for developing SSTI/SIRI in a non-hospitalized population of PWID. METHODS:This study examines associations between sociodemographic factors, healthcare system usage, injection practices, and the seven-item BIRSI instrument in relation to reported past 90-day SSTI/SIRI among a subset of respondents who reported past 90-day injection drug use (146 total respondents). Each respondent received a composite score for the BIRSI instrument by adding a point for each reported behavior. Analyses examine the association between select factors and reporting ≥1 SSTI/SIRI in the past 90 days. RESULTS:Among participants, 55.5 % identified as Hispanic and 30.1 % as female. The mean age was 44.6 years and 32.2 % had stable housing. The prevalence of reported past 90-day SSTI/SIRI was 24.7 %. Unadjusted univariate models showed age (prevalence ratio, PR: 0.97, 95 % CI: 0.94, 0.99), receptive syringe sharing (RSS) (PR: 2.91, 95 % CI: 1.69, 4.88) or using other people's previously used (non-syringe) injection equipment (PR: 2.61, 95 % CI: 1.53, 4.45), and a higher BIRSI composite score (PR: 1.33, 95 % CI, 1.34, 1.56) to associate with reporting of past 90-day SSTI/SIRI. Further modeling showed that a higher BIRSI score, exclusive of other injection related behaviors, was associated with self-reported SSTI/SIRI (adjusted PR: 1.35, 95 % CI: 1.13, 1.62) when controlling for age, sex, race, and housing status. CONCLUSION/CONCLUSIONS:Findings suggest the BIRSI instrument may be a useful, brief tool to identify individuals at higher risk of developing SSTI/SIRI among non-hospitalized PWID. Using the BIRSI instrument can help programs and staff serving PWID to implement strategies to reduce SSTI/SIRI risk among their participants, such as wound prevention and care interventions.

BACKGROUND:Spatial accessibility of substance use disorder (SUD) treatment is a crucial component of access and a comprehensive analysis can help to identify if and where a lack of spatial accessibility is a barrier to treatment. METHODS:We conducted a cross-sectional analysis of spatial accessibility of SUD treatment (outpatient, opioid treatment program, and residential) in New York State (NYS). We estimated two measures of spatial accessibility: one-way travel time (i.e., drive time for NYS outside of New York City [NYC] and public transit time for NYC) and robustness (i.e., the difference in travel time between the closest and fifth closest facility). Comparison facilities included Federally Qualified Health Centers, dialysis facilities, and hospitals. We compared travel time and robustness by urbanicity (NYC, urban non-NYC, rural) and NYS economic development region using population-weighted paired t-tests. RESULTS:The percentage of NYS residents within 30 min travel time was 97.2% for outpatient SUD treatment programs and 82.3% for opioid treatment programs. Mean statewide travel time to outpatient SUD treatment programs was comparable to travel time to Federally Qualified Health Centers (difference: 1.0 min [95%CI 0.9 to 1.1; P < 0.001]) and dialysis facilities (difference: 0.1 min [95%CI 0.03 to 0.2; P = 0.01]), and significantly shorter than to hospitals (difference: 5.6 min [95%CI 5.4 to 5.7; P < 0.001]). Travel time to opioid treatment programs was significantly longer than to Federally Qualified Health Centers (difference: -7.4 min [95%CI - 7.6 to - 7.2; P < 0.001]), dialysis facilities (difference: -8.2 min [95%CI - 8.4 to - 8.1; P < 0.001]), and hospitals (difference: - 2.8 min [95%CI - 3.0 to - 2.6; P < 0.001]). Compared with NYC, mean travel time to each type of SUD treatment program was significantly shorter in urban non-NYC areas and longer in rural areas. For robustness, compared with NYC, there was no significant difference in urban non-NYC areas for outpatient and residential SUD treatment programs, but more limited robustness for opioid treatment programs in urban non-NYC areas and all types of SUD treatment programs in rural areas. CONCLUSION/CONCLUSIONS:We identified widespread spatial accessibility of SUD treatment facilities across NYS. Recent opportunities such as revised federal regulations on opioid treatment program mobile medication units, increased flexibility in using telehealth in opioid treatment programs and other settings, and opioid settlement funding can be leveraged to increase access in rural areas.

BACKGROUND:During the COVID-19 pandemic, data collection activities largely became tele-remote, excluding those who did not have the required technology or digital literacy. METHODS:Between June and September 2020, we collected data in-person from people who use opioids in New York City. Participants were recruited via street intercept and outside four syringe service programs in the city. Surveys were conducted outdoors, with researchers and participants wearing masks and maintaining physical distance. RESULTS:A total of 329 people participated in the survey. Participants reported an average age of 45.8 years, 69.6% identified as male, 32.6% identified as Hispanic/Latino/a and 22.3% identified as Black. Many experienced unstable housing/street homelessness (65.9%) and half did not have regular smartphone access (51.1%). CONCLUSION/CONCLUSIONS:Many participants were struggling to meet their basic needs and did not have the resources to participate in tele-remote research or surveillance. In-person engagement may help researchers build trust, explain data security measures, and decrease technology and comprehension barriers. As data inform policies and programs, researchers must center equity by including under-engaged groups in data collection activities.

BACKGROUND:Opioid agonist treatments (OAT; methadone and buprenorphine) for opioid use disorder (OUD) reduce overdose death by more than 50%. Low population-level rates of OAT are missed opportunities to reduce OUD-related mortality. OBJECTIVE:We examined county-level OAT utilization patterns to guide state-level and county-level initiatives to improve equitable access and utilization in New York State (NYS). RESEARCH DESIGN/METHODS:We calculated NYS county-level methadone and buprenorphine population utilization rates per 100,000 residents by county of patient residence using NYS Office of Addiction Services and Supports and public access datasets. MEASURES/METHODS:We mapped rates onto counties and conducted analyses to assess if utilization varied by county, and to identify areas of high utilization (hot spots) and low utilization (cold spots). We used t tests and Fisher exact tests to compare county-level factors. RESULTS:County-level buprenorphine and methadone utilization rates were 673.76 and 132.19 per 100,000 residents, respectively. Buprenorphine hot spot counties had significantly lower proportions of unemployed (-1.4, P- value<0.01), and higher proportions of non-Hispanic white residents (+50.1, P value<0.01) than counties identified as buprenorphine cold spots. Methadone hot spot counties had significantly higher proportions of unemployed (+1.0, P- value<0.01) and lower proportions of non-Hispanic white residents (-48.1, P- value<0.01) than counties identified as methadonecold spots. All buprenorphine cold spot counties were methadone hot spot counties. CONCLUSIONS:We found that OAT utilization rates differed by race/ethnicity and socioeconomic factors at the county level consistent with national and other state-level findings. Ensuring equitable OAT access must be part of a coordinated response to address the overdose crisis.

BACKGROUND:Methadone is an effective treatment for opioid use disorder; however, its provision in the US is limited to federally-regulated opioid treatment programs (OTP). Expansion of methadone treatment into non-OTP substance use disorder (SUD) treatment programs ('expanded methadone treatment access') is a promising intervention to increase access. METHODS:We performed a cross-sectional geospatial analysis of public transit times to OTPs, expanded methadone treatment access, and other healthcare facilities as of March, 2024 in New York City (NYC). We estimated one-way public transit travel time and compared travel times using population weighted paired t-tests. RESULTS:For OTPs, 38.2% (95% CI: 38.0, 38.4) of the NYC population was within 15 minutes and 79.7% (95% CI: 79.5, 79.9) was within 30 minutes. For expanded methadone treatment access, 72.1% (95% CI: 71.9, 72.2) of the NYC population was within 15 minutes and 97.5% (95% CI: 97.5, 97.6) was within 30 minutes. The mean travel time was 20.4 minutes (SD: 10.9) for OTPs and 12.1 minutes (SD: 7.1) for expanded methadone treatment access (difference: -8.3 minutes [95% CI: -8.5, -8.1]; P < 0.001). The mean travel time for expanded methadone treatment access was slightly longer than the mean travel time for dialysis facilities (difference: 0.22 minutes [95% CI: 0.06, 0.39]; P = 0.009]), not significantly different than Federally Qualified Health Centers (difference: -0.06 minutes [95% CI: -0.22, 0.11]; P = 0.51), and significantly shorter than the mean travel time to ambulatory surgical centers (difference: -6.3 [95% CI: -6.5, -6.0]; P < 0.001) and hospitals (difference: -8.1 [95% CI: -8.3, -7.9]; P < 0.001). CONCLUSION/CONCLUSIONS:Efforts to increase access to methadone treatment in the US should promote expansion to additional non-OTP outpatient SUD treatment programs. Such integration is anticipated to increase spatial accessibility of methadone treatment substantially, greatly enhancing the potential for patient access.

OBJECTIVES/OBJECTIVE:To assess the acceptability of an infection-control prevention strategy during the COVID-19 pandemic for skilled nursing facilities (SNFs) staff and residents, to describe implementation challenges and potential solutions, and to explore intervention impact perceptions. DESIGN/METHODS:Qualitative investigation of a multimethod pragmatic clinical trial designed to develop and test a novel cohorting intervention to mitigate infection transmission in SNFs during the COVID-19 pandemic. SETTING AND PARTICIPANTS/METHODS:We used a purposive sample of staff and residents in 2 New York City nonprofit SNFs participating in the intervention trial. METHODS:We developed a novel cohorting strategy to minimize infection transmission by using infection risk (vaccination or prior infection history) to assign staff to specific residents. We employed a qualitative descriptive approach using content thematic analysis of semistructured interviews with staff and residents to identify themes of acceptability, challenges, and potential impact. RESULTS:Seventy-one staff and 16 residents completed semistructured interviews. Staff and residents supported the intervention. However, both identified challenges, including concerns that switching assignments could lead to staffing issues and care discontinuity. Staff identified communication about the intervention as both a challenge and potential solution, citing a desire for clear and consistent communication across all employees. Staff felt the intervention had potential impact in reducing infection risk fear, promoting effective protective equipment usage, and encouraging more interaction and less isolation than standard prevention practices. CONCLUSIONS AND IMPLICATIONS/CONCLUSIONS:We developed a novel and acceptable preventive strategy that may increase residents' flexibility and reduce their isolation as well as staff stress. Clear, consistent, and proactive communication may improve intervention acceptability and perceptions about impact. Similar infection-control protocols might be adapted for different long-term care infection risks. Communication at all staffing levels and with residents is essential to ensure the intervention is acceptable to both. Future trials could include social isolation and staff burnout as potential outcomes.