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This is the primary outcomes article for CTN-0080-A-2. Introduction: Racial and ethnic inequities persist in medication treatment initiation and adherence for pregnant and postpartum people with opioid use disorder (OUD). Our objective was to understand the experiences of “positive outliers,” specifically pregnant and postpartum people of color with OUD who utilized medication treatment and engaged in a randomized clinical trial for buprenorphine despite historical, cultural, and structural barriers.

Methods: We conducted two sets of semi-structured qualitative interviews. First, trained peers with lived expertise as mothers in recovery interviewed individuals who identified with a non-white race and/or ethnicity and enrolled in the Medication Treatment for OUD in Expectant Mothers (MOMs) trial (NCT03918850). Second, we interviewed principal investigators, clinicians, and research coordinators from the 13 MOMs trial sites. We used an inductive thematic approach informed by the Social Ecological Model of Racism and Anti-Racism. Transcripts were double-coded and reviewed until consensus was reached. Preliminary findings from participant and staff interviews were merged and triangulated with peers to inform theme development.

Results: We completed 17 interviews with MOMs trial participants from 7 sites. Participants identified as Hispanic (29%), Black non-Hispanic (24%), multi-racial Hispanic (18%), multi-racial non-Hispanic (18%), and American Indian, Native Hawaiian, or Pacific Islander (12%). Thirty-two interviews with trial staff were also completed. Three themes emerged: (1) Although some participants expected racist treatment and research exploitation, all participants interviewed reported non-discriminatory, non-judgmental care within the MOMs trial; (2) Compassionate care, frequent, personalized, and integrated encounters, and emotional support helped counteract prior stigmatizing and discriminatory health care interactions, enabling participants of color to feel particularly supported, trusted, and empowered during the MOMs trial; and (3) Despite pervasive cultural stigma around addiction and concerns about taking an investigational drug while pregnant, participants expressed that pregnancy status, care team trust, and transparent communication with MOMs trial staff encouraged medication utilization and adherence.

Conclusion: Facilitators of successful engagement in the MOMs trial and retention in medication treatment among pregnant and postpartum people of color with OUD included non-judgmental care, sustained trust, and frequent contact. Key perinatal OUD clinical interventions and trial improvements include personalized communication and scheduling flexibility to promote engagement of marginalized populations.

Related protocols: CTN-0080-A-2

This is the Results Article for CTN-0095-A-2.

Many primary care clinicians (PCCs) hold stigma toward people with opioid use disorder (OUD), which may be a barrier to care. Few interventions exist to address PCC stigma toward people with OUD. This study examined whether an online training incorporating patient narratives reduced PCCs’ stigma toward people with OUD (primary) and increased intentions to treat people with OUD compared to an attention-control training (secondary).

PCCs from 15 primary care clinics were invited to complete a 30 minute online training for an electronic health record-embedded clinical decision support (CDS) tool that alerts PCCs to screen, diagnose, and treat people with OUD. PCCs were randomized to receive a stigma-reduction version of the training with patient narrative videos or a control training without patient narratives and were blinded to group assignment. Immediately after the training, PCCs completed surveys of stigma towards people with OUD and intentions and willingness to treat OUD. CDS tool use was monitored for 6 months. Analyses included independent samples t-tests, Pearson correlations, and logistic regression.

A total of 162 PCCs were randomized; 88 PCCs (58% female; 68% white) completed the training (Stigma=48; Control=40) and were included in analyses. There was no significant difference between intervention and control groups for stigma (t=-0.48, p=.64, Cohen’s d=-0.11), intention to get waivered (t=1.11, p=.27, d=0.26), or intention to prescribe buprenorphine if a waiver were no longer required (t=0.90, p=0.37, d=0.21). PCCs who reported greater stigma reported lower intentions both to get waivered (r=-0.25, p=0.03) and to prescribe buprenorphine with no waiver (r=- 0.25, p=0.03). Intervention group and self-reported stigma were not significantly related to CDS tool use.

Conclusions: Stigma toward people with OUD may require more robust intervention than this brief training was able to accomplish. However, stigma was related to lower intentions to treat people with OUD, suggesting stigma acts as a barrier to care. Future work should identify effective interventions to reduce stigma among PCCs.

Related protocols: CTN-0095-A-2

This is the outcomes article for CTN-0084-A-1.

Buprenorphine is an effective medication for opioid use disorder that reduces mortality; however, many patients are not retained in buprenorphine treatment, and an optimal length of treatment after which patients can safely discontinue treatment has not been identified. This study measured the association between buprenorphine treatment duration and all-cause mortality among patients who discontinued treatment. Secondary objectives were to measure the association between treatment duration and drug overdose and opioid-related overdoses.

This study use data from 8 US health systems participating in CTN-0084-A-1, focusing on patients who initiated and discontinued buprenorphine treatment between January 2012 and 31 December 2018 (n=6550). Outcomes occurring after patients discontinued buprenorphine treatment were compared between patients who initiated and discontinued treatment after 8–30, 31–90, 91–180, 181–365 and >365 days.

Covariate data were obtained from electronic health records (EHRs). Mortality outcomes were derived from EHRs and state vital statistics. Non-fatal opioid and drug overdoses were obtained from diagnostic codes. Four sites provided cause-of-death data to identify fatal drug and opioid-related overdoses. Adjusted frailty regression was conducted on a propensity-weighted cohort to assess associations between duration of the final treatment episode and outcomes.

The mortality rate after buprenorphine treatment was 1.82 per 100 person-years (n=191 deaths). In regression analyses with >365 days as the reference group, treatment duration was not associated with all-cause mortality and drug overdose (P>0.05 for both). However, compared with >365 days of treatment, 91–180 days of treatment was associated with increased opioid overdose risk (hazard ratio =2.94, 95% confidence interval=1.11–7.79).

Conclusions: Among patients who discontinue buprenorphine treatment, there appears to be no treatment duration period associated with a reduced risk for all-cause mortality. Patients who discontinue buprenorphine treatment after 91–180 days appear to be at heightened risk for opioid overdose compared with patients who discontinue after >365 days of treatment.

Related protocols: CTN-0084-A-1

This is the outcomes paper for CTN-0069-A-1.

Emergency departments (EDs) sporadically use a high-dose buprenorphine induction strategy for the treatment of opioid use disorder (OUD) in response to the increasing potency of the illicit opioid drug supply and commonly encountered delays in access to follow-up care. This study, NIDA Clinical Trials Network protocol CTN-0069-A-1, aimed to examine the safety and tolerability of high-dose (>12mg) buprenorphine induction for patients with OUD presenting to an ED.

Using a case series of ED encounters, data were manually abstracted from electronic health records for all ED patients with OUD treated with buprenorphine at a single, urban, safety-net hospital in Oakland, California, for the calendar year 2018. Data analysis was performed from April 2020 to March 2021. ED physicians and advanced practice practitioners were trained on a high-dose sublingual buprenorphine induction protocol, which was then clinically implemented.

Vital signs; use of supplemental oxygen; the presence of precipitated withdrawal, sedation, and respiratory depression; adverse events; length of stay; and hospitalization during and 24 hours after the ED visit were reported according to total sublingual buprenorphine dose (range, 2 to >28 mg).

Among a total of 391 unique patients (median [interquartile range] age, 36 [29-48] years), representing 579 encounters, 267 (68.3%) were male and 170 were (43.5%) Black. Homelessness (88 patients [22.5%]) and psychiatric disorders (161 patients [41.2%]) were common. A high dose of sublingual buprenorphine (>12 mg) was administered by 54 unique clinicians during 366 (63.2%) encounters, including 138 doses (23.8%) greater than or equal to 28 mg. No cases of respiratory depression or sedation were reported. All 5 (0.8%) cases of precipitated withdrawal had no association with dose; 4 cases occurred after doses of 8 mg of buprenorphine. Three serious adverse events unrelated to buprenorphine were identified. Nausea or vomiting was rare (2%-6% of cases). The median (interquartile range) length of stay was 2.4 (1.6-3.75) hours.

Conclusions: These findings suggest that high-dose buprenorphine induction, adopted by multiple clinicians in a single-site urban ED, was safe and well tolerated in patients with untreated OUD. Further prospective investigations conducted in multiple sites would enhance these findings.

Related protocols: CTN-0069-A-1

This is the Results Article for CTN-0057-Ot.

The majority of the U.S. health care resources are utilized by a small population characterized as high-risk, high-need persons with complex care needs (e.g., adults with multiple chronic conditions). Substance use disorders (SUDs) and mental health disorders (MHDs) are a driver of poor health and additional healthcare costs, but they are understudied among high-need patients. This study examined the prevalence and correlates of SUDs and MHDs among adults with high-risk diabetes, who are patients at the top 10% risk score for developing poor outcomes (hospital admission or death). A risk algorithm developed from Duke University Health System electronic health record (EHR) data was used to identify patients with high-risk diabetes for targeting home-based primary care. The EHR data of the 263 patients with high-risk diabetes were analyzed to understand patterns of SUDs and MHDs to inform care-coordinating efforts

Results found that both SUDs and MHDs were prevalent:

• Any SUD: 48.3%; Alcohol: 12.5%; Tobacco: 38.8%; Drug: 23.2%
• Any MHD: 74.9%; Mood: 53.2%; Sleep: 37.3%; Anxiety: 32.7%; Schizophrenia/Psychotics/Delusional: 14.8%; Dementia/Delirium/Amnestic/Cognitive: 14.4%; Adjustment: 9.1%

Overall, 81% of the same had SUD or MHD. Elevated odds of SUD were noted among men (tobacco, alcohol) and those who were never married (alcohol, cannabis). African American race (vs. other race/ethnicity) was associated with lower odds of anxiety disorders.

Conclusions: This study is the first to document a comprehensive pattern of SUD and MHD prevalence among adults with high-risk diabetes. While data are limited to one large academic health system, they provide clinical evidence revealing that 82% of patients with high-risk diabetes had SUD and/or MHD record in their EHRs, highlighting a need for developing service models to optimize high-risk care.

Related protocols: CTN-0057-Ot

This is the Results Article for CTN-0056-Ot.

Multistage, stepwise HIV testing and treatment procedures can result in lost opportunities to provide timely antiretroviral therapy (ART). Incomplete engagement of patients along the care cascade translates into high preventable mortality. This study aimed to identify whether a structural intervention to streamline testing and linkage to HIV health care, the “One4All” intervention, would improve testing completeness, ART initiation, and viral suppression and reduce mortality.

This cluster-randomised, controlled trial in Guangxi, China was conducted in 12 hospitals, similar in structural characteristics, past patient caseloads, and testing procedures. Hospitals were randomly assigned (1:1) to either the One4All intervention or standard of care. Hospitals were randomised in a block design and stratified by the historical rate of testing completeness of the individual hospital during the first 6 months of 2013.

A total of 478 patients were enrolled (232 in One4All, 246 in standard of care). They were aged 18 years or older who were identified as HIV-reactive during screening in study hospitals, who sought inpatient or outpatient care in a study hospital, and who resided in the study catchment area. The One4All strategy incorporated rapid, point-of-care HIV screening and CD4 counts, and in-parallel viral load testing, to promote fast and complete diagnosis and staging and provide immediate ART to eligible patients. Participants in control hospitals received standard care services. All enrolled patients were assessed for the primary outcome, which was testing completeness within 30 days, defined as completion of three required tests and their post-test counselling. Safety assessments were hospital admissions for the first 90 days and deaths up to 12 months after enrolment.

Although no difference was observed between study groups in the number of hospital admissions at 90 days, by 12 months there were 65 deaths (28%) in the in the One4All group compared with 115 (47%) in the standard-of-care group (Cox proportional hazard ratio 0·44, 0·19–1·01, p=0·0531). The One4All package of interventions also substantially increased the odds of achieving testing completeness within 30 days and ART initiation within 90 days.

Conclusions: The study provides strong evidence for the benefits of a patient-centered approach to streamlined HIV testing and treatment that could help China change the trajectory of its HIV epidemic, and help to achieve the goal of an end to AIDS. Taken together with new, strong evidence of the benefits of treating all people with HIV regardless of CD4 level, a patient-centered approach to streamline HIV testing and ART initiation regardless of CD4 count is clearly beneficial.

Related protocols: CTN-0056-Ot

This is the Results Article for CTN-0066-Ot.

Elevated mortality has been observed among individuals with opioid use disorder (OUD) treated in addiction specialty clinics or programs. Information about OUD patients in general healthcare settings is needed in light of the current effort to integrate addiction services into primary healthcare systems. This study examined mortality rates, causes of death, and associated risk factors among patients with OUD in a large general healthcare system. Mortality data were linked with the electronic health records of 1,683 OUD patients cared for in a large university health system from 2006-2014 (UCLA of the former CTN Pacific Region Node).

There were 465 deaths confirmed (27.6% of the study participants), corresponding to a crude mortality rate of 68.7 per 1000 person-years and SMR of 15.9 (95% CI, 14.5-17.4). Drug overdose and disorder (19.4%), cardiovascular diseases (16.9%), cancer (16.3%), and infectious diseases (14.5%, including 12% hepatitis C virus [HCV]) were the leading causes of death. HCV (HR: 2.08, 95% CI, 1.68-2.59) and cannabis use disorder (HR: 1.63, 95% CI, 1.28-2.07) were two clinically important indicators of overall mortality risk. Chronic pain (AHR: 1.92, 95% CI, 1.16-3.19) and tobacco use disorder (AHR: 2.88; 95% CI, 1.80-4.63) were associated with increased risk of cardiovascular death, HCV infection with cancer mortality risk (AHR: 2.51, 95% CI, 1.47-4.28), and alcohol use disorder with liver-related mortality risk (AHR: 5.06, 95% CI, 2.72-9.42).

Conclusions: Patients with OUD in a general healthcare system demonstrated alarmingly high morbidity and mortality, which challenges health care systems to find innovative ways to identify and treat patients with substance use disorder. Given the chronic, relapsing nature of OUD, and high medical and psychiatric comorbidity, continued care encompassing screening, early intervention, support, and monitoring is essential.

Related protocols: CTN-0066-Ot

This is the Results Article for CTN-0030-A-3.

Despite the growing prevalence of prescription opioid dependence, longitudinal studies have not examined long-term treatment response. The current study examined outcomes over 42 months in the National Drug Abuse Treatment Clinical Trials Network Prescription Opioid Addiction Treatment Study (POATS, CTN-0030). POATS was a multi-site clinical trial lasting up to 9 months, examining different durations of buprenorphine-naloxone plus standard medical management for prescription opioid dependence, with participants randomized to receive or not receive additional opioid drug counseling. A subset of participants (N=375 of 653) enrolled in a follow-up study. Telephone interviews were administered approximately 18, 30, and 42 months after main-trial enrollment. Comparison of baseline characteristics by follow-up participation suggested few differences.

Results found that at Month 42, much improvement was seen: 31.7% were abstinent from opioids and not on agonist therapy; 29.4% were receiving opioid agonist therapy, but met no symptom criteria for current opioid dependence; 7.5% were using illicit opioids while on agonist therapy; and the remaining 31.4% were using opioids without agonist therapy. Participants reporting a lifetime history of heroin use at baseline were more likely to meet DSM-IV criteria for opioid dependence at Month 42. Engagement in agonist therapy was associated with a greater likelihood of illicit-opioid abstinence. Eight percent (n = 27/338) used heroin for the first time during follow-up; 10.1% reported first-time injection heroin use.

Conclusions: This was the first study to examine long-term treatment outcomes of patients with prescription opioid dependence, and results were more encouraging than short-term outcomes from POATS suggested they might be. Long-term outcomes for those dependent on prescription opioids demonstrated clear improvement from baseline. These results are consistent with research on heroin dependence in supporting the value of opioid agonist therapy for prescription opioid dependence; however, half of the follow-up participants reported good outcomes without agonist therapy as well. Additionally, a subset exhibited a worsening course, by initiating heroin use and/or injection opioid use. These data underscore the importance of longer-term follow-up in understanding the course of this increasingly prevalent substance use disorder.

Related protocols: CTN-0030, CTN-0030-A-3

This is the Results Article for CTN-0036-Ot.

Clinical and cultural characteristics of Hispanic adolescent heroin users are not well described. This study, National Drug Abuse Treatment Clinical Trials Network protocol CTN-0036-Ot, was conducted to describe a sample of in-treatment Hispanic adolescents with opioid dependence, specifically cheese heroin (black tar heroin typically mixed with crushed over-the-counter sleep aids that has a granular texture similar to that of grated cheese). Mexican and Mexican American adolescents with heroin dependence (N=72) in three treatment programs were interviewed and completed self-report measures. Participants reported, on average, first using cheese heroin at age 13.5 years and daily use at age 14.2 years. The majority (74%) reported a previous overdose. They were also engaging in other risky behaviors, such as abuse of other drugs and unprotected sex. Adolescents being raised by caregivers other than both biological parents, who used drugs with relatives, and whose immediate family members have documentation to be in the United States fared worse on several indicators of drug use severity and other risky behaviors.

Conclusions: The self-reported brief time period from first use to daily use strongly suggests the need for early prevention and rapid intervention efforts after first use of heroin in this population. Additional research is needed to add to these preliminary results and inform prevention efforts.

Related protocols: CTN-0036-Ot

This is the Results Article for CTN-0045-Ot.

Increasing rates of HIV testing within substance use disorder (SUD) treatment clients is an important public health strategy for reducing HIV transmission rates. This study from the National Drug Abuse Treatment Clinical Trials Network (“Rates of HIV Testing and Barriers to Testing in African Americans Receiving Substance Abuse Treatment,” CTN-0045-Ot) examined uptake of HIV testing among 1,224 clients in five SUD treatment units that offered on-site testing in Florida, New York, and California. Nearly one-third (30%) of the participants, who had not previously tested positive, reported not having been tested for HIV within the past 12 months. Women, African Americans, and injection drug users had a higher likelihood of having been tested within the past 12 months. The SUD treatment program was the most frequently identified location of participants’ last HIV test. Of those who were tested in the previous 12 months, 5% tested positive, suggesting that testing of SUD treatment clients has the potential to identify new cases of HIV and, thereby, potentially reduce further transmission.

Conclusions: Despite the availability of free, on-site testing, a substantial proportion of clients were not tested, suggesting that strategies to increase uptake of testing should include addressing barriers not limited to location and cost. Though the majority of HIV tests will have negative results, the benefits of finding even a small number of cases far outweigh the costs.

Related protocols: CTN-0045-Ot

This is the Results Article for CTN-0027-A-1.

Two commonly prescribed treatments for opioid addiction are methadone and buprenorphine. Although these drugs show some efficacy in treating opioid dependence, treatment response varies among individuals. It is likely that genetic factors have a role in determine treatment outcome. This study analyses the pharmacogenetic association of six polymorphisms in OPRD1, the gene encoding the delta-opioid receptor, on treatment outcome in 582 opioid addicted European Americans randomized to either methadone or buprenorphine/naloxone (Suboxone) over the course of a 24-week open-label clinical trial. Treatment outcome was assessed as the number of missed or opioid-positive urine drug screens over the 24 weeks. In the total sample, no single-nucleotide polymorphisms (SNPs) in OPRD1 were significantly associated with treatment outcome in either treatment arm. However, sex-specific analyses revealed two intronic SNPs (rs581111 and rs529520) that predicted treatment outcomes in females treated with buprenorphine. Females with the AA or AG genotypes at rs581111 had significantly worse outcomes than those with the GG genotype when treated with buprenorphine. For rs529520, females with the AA genotype had a significantly worse outcome than those with the CC genotype. No significant associations were detected in males.

Conclusions: These findings suggest that rs581111 and rs52920 may be useful when considering treatment options for female opioid addicts; however, confirmation in an independent sample is warranted.

Related protocols: CTN-0027, CTN-0027-A-1

This is the Results Article for CTN-0014-A-1.

Isomorphism, or parallel process, occurs in family therapy when patterns of therapist-client interaction replicate problematic interaction patterns within the family. This study investigated parallel demand-withdraw process in Brief Strategic Family Therapy (BSFT) for adolescent drug abuse, hypothesizing that therapist-demand/adolescent-withdraw interaction (TD/AW) cycles observed early in treatment would predict poor adolescent outcomes at follow-up for families who exhibited entrenched parent-demand/adolescent-withdraw interaction (PD/AW) before treatment began.

Participants were 91 families who received at least four sessions of BSFT in the National Drug Abuse Treatment Clinical Trials Network (CTN) study CTN-0014 (“Brief Strategic Family Therapy (BSFT) for Adolescent Drug Abusers”), a multisite clinical trial on adolescent drug abuse. Prior to receiving therapy, families completed videotaped family interaction tasks from which trained observers coded PD/AW. Another team of raters coded TD/AW during two early BSFT sessions. The main dependent variable was the number of drug-use days that adolescents reported in timeline follow-back interviews 7 to 12 months after family therapy began. Zero-inflated Poisson regression analyses supported the main hypothesis, showing that PD/AW and TD/AW interacted to predict adolescent drug use at follow-up. For adolescents in high PD/AW families, higher levels of TD/AW predicted significant increases in drug use at follow-up, whereas for low PD/AW families, TD/AW and follow-up drug use were unrelated.

Conclusions: Results suggest that attending to parallel demand–withdraw processes in parent–adolescent and therapist–adolescent dyads may be useful in family therapy for substance-using adolescents, as it appears that parallel demand-withdraw processes in family therapy for adolescent drug abuse can compromise treatment outcome. Findings highlight two key BSFT principles — remaining decentralized and placing more demand for change on parents than on adolescents — and suggest these principles are particularly important to observe with therapists work with families that exhibit PD/AW.

Related protocols: CTN-0014-A-1

This is the Results Article for Project AWARE.

To increase human immunodeficiency virus (HIV) testing rates, many institutions and jurisdictions have revised policies to make the testing process rapid, simple, and routine. A major issue for testing scale-up efforts is the effectiveness of HIV risk-reduction counseling, which has historically been an integral part of the HIV testing process. The objective of Project AWARE, an adaptation of CTN-0032, was to assess the effect of brief patient-centered risk-reduction counseling at the time of a rapid HIV test on the subsequent acquisition of sexually transmitted infections (STIs). From April to December 2010, Project AWARE randomized 5012 patients from 9 sexually transmitted disease (STD) clinics in the United States to receive either brief patient-centered HIV risk-reduction counseling with a rapid HIV test or the rapid HIV test with information only. Participants were assessed for multiple STIs at both baseline and 6-month follow-up. Participants randomized to counseling received individual patient-centered risk-reduction counseling based on an evidence-based model. The core elements included a focus on the patient’s specific HIV/STI risk behavior and negotiation of realistic and achievable risk-reduction steps. All participants received a rapid HIV test.

The prespecified outcome was a composite end point of cumulative incidence of any of the measure STIs over 6 months. All participants were tested for Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum (syphilis), herpes simplex virus 2, and HIV. Women were also tested for Trichomonas vaginalis. Results found no significant difference in 6-month composite STI incidence by study group (adjusted risk ratio, 1.12; 95% CI, 0.94-1.33). There were 250 of 2039 incident cases (12.3%) in the counseling group and 226 of 2032 (11.1%) in the information-only group.

Conclusions: Risk-reduction counseling in conjunction with a rapid HIV test did not significantly affect STI acquisition among STD clinic patients, suggesting no added benefit from brief patient-centered risk-reduction counseling. These study findings lend support for reconsidering the role of counseling as an essential adjunct to HIV testing. This inference is further buttressed by the additional costs associated with counseling at the time of testing; without evidence of effectiveness, counseling cannot be considered an effective use of resources. Posttest counseling for patients testing HIV-positive remains essential, however, both for addressing psychological needs and for providing and ensuring follow-through with medical care and support.

Comment: Haukoos JS, Thrun MW. Eliminating prevention counseling to improve HIV screening. JAMA 2013;310(16):1679-1680.

Related protocols: CTN-0032, Project AWARE

This is the Results Article for CTN-0035-Ot.

Illicit drug users have a high prevalence of HCV and represent the majority of newly infected persons in the U.S. Despite the availability of effective HCV treatment, few drug users have been evaluated or treated for HCV. Racial and ethnic minorities have a higher incidence and prevalence of HCV and higher HCV-related mortality. Factors contributing to poor engagement in care are incompletely understood. In this study, National Drug Abuse Treatment Clinical Trials Network protocol CTN-0035-Ot (“Access to HIV and Hepatitis Screening and Care Among Ethnic Minority Drug Users In and Out of Drug Treatment”), fourteen mixed-gender focus groups of either African American or Latino/a drug users (N=95) discussed barriers to HCV testing and treatment. Themes were identified through content analysis of focus group discussions. Many drug users were tested for HCV in settings where they were receiving care. Outside of these settings, most were unaware of voluntary test sites. After testing HCV positive, drug users reported not receiving clear messages regarding the meaning of a positive HCV test, the impact of HCV infection, or appropriate next steps including HCV clinical evaluations. Many drug users perceived treatment as unimportant because they lacked symptoms, healthcare providers minimized the severity of the diagnosis, or providers did not recommend treatment. Mistrust of the motivations of healthcare providers was cited as a barrier to pursuing treatment. Social networks or social interactions were a source of HCV-related information and were influential in shaping drug users perceptions of treatment and its utility.

Conclusions: Drug users perceived a paucity of settings for self-initiated HCV testing and poor provider-patient communication at test sites and during medical encounters. Notably, drug users reported having an unclear understanding about the meaning of a positive HCV test, the health implications of HCV infection, the importance of clinical evaluations and monitoring, and of treatment options for HCV. Efforts to improve the delivery of clinical messages about HCV infection for drug users at test settings and clinical encounters are needed.

Related protocols: CTN-0035-Ot

This is the Results Article for CTN-0038-Ot.

This study examined motivations and barriers to substance abuse treatment entry and treatment continuation among Asian Americans and Pacific Islander (AAPI) substance users. APPI substance users (N=61) were recruited from substance abuse treatment programs in California and Hawaii. Semi-structured interviews and interviewer-administered surveys assessed barriers and facilitators to entering substance abuse treatment.

Barriers included peer pressure, family influences, and fear of “losing face.” Facilitators included peer support, involvement in the criminal justice system, a perceived need for treatment, and culturally competent substance abuse treatment services. Family and peer influences may act as both facilitators and impediments. AAPI substance using populations face many of the same individual-level and structural and systems barriers to entry to treatment as other substance using populations. However, similar to other racial/ethnic minority groups, it is important to address cultural differences. It may be important to keep in mind the ideas of family harmony, solidarity, and subordination of individual goals for the sake of family goals while designing substance abuse treatments for this population. In addition, integrating culturally sensitive screening tools, brief interventions, and referral to substance abuse treatment in medical care settings and non-traditional settings (e.g., health fairs, community cultural celebrations) may increase the numbers of AAPIs who seek substance abuse treatment.

Related protocols: CTN-0038-Ot