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IntroductionAddiction treatment clients are more likely to die of tobacco-related diseases than of alcohol or illicit drug-related causes. We aimed to assess smoking behavior, and smoking-related attitudes and services, in New York addiction treatment programs before a statewide smoking ban in treatment facilities was implemented (2008), 1 year (2009) and 5 years after implementation (2013).MethodsWe conducted surveys at each time point with clients (N = 329, 341, and 353, respectively) and staff (N = 202, 203, and 166, respectively) from five residential and two methadone maintenance programs in New York State. At each data collection wave, questionnaires measured smoking behavior as well as smoking-related knowledge, attitudes, and experiences with tobacco cessation services as part of addiction treatment.ResultsStaff smoking prevalence decreased from 35.2% in 2008 to 21.8% in 2013 (P = .005) while client smoking prevalence over the same period was unchanged (68.1% vs. 66.0%, P = .564). Among clients who smoked, mean cigarettes per day decreased from 13.7 (SD = 8.38) to 10.2 (SD = 4.44; P < .001). There were significant time-by-treatment-type interactions for client tobacco-related attitudes and cessation services received; and for staff self-efficacy and cessation services provided. In residential programs, scores for most items decreased (became less positive) in 2009 followed by a partial rebound in 2013. Methadone program scores tended to rise (become more positive) throughout the study period.ConclusionsStaff and clients may respond differentially to tobacco-free policies depending on type of treatment program, and this finding may help to inform the implementation of tobacco-free policies in other statewide addiction treatment systems.

Background/objectivesHIV continues to be a significant problem among substance users and their sexual partners in the United States. The National Drug Abuse Treatment Clinical Trials Network (CTN) offers a national platform for effectiveness trials of HIV interventions in community substance abuse treatment programs. This article presents the HIV activities of the CTN during its first 10 years.ResultsWhile emphasizing CTN HIV protocols, this article reviews the (1) HIV context for this work; (2) the collaborative process among providers, researchers, and National Institute on Drug Abuse CTN staff, on which CTN HIV work was based; (3) results of CTN HIV protocols and HIV secondary analyses in CTN non-HIV protocols; and (4) implications for future HIV intervention effectiveness research in community substance abuse treatment programs.Conclusion/significanceWhile the feasibility of engaging frontline providers in this research is highlighted, the limitations of small to medium effect sizes and weak adoption and sustainability in everyday practice are also discussed.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jsat.2006.03.006 Byline: Lawrence S. Brown (a)(b), Steven Kritz (a), Melissa Chu (a), Charles Madray (a) Keywords: HIV; Hepatitis C; Nelfinavir; Methadone maintenance Abstract: The safety, efficacy, and tolerability of nelfinavir (NFV)-containing antiretroviral therapy were evaluated in patients coinfected with HIV and hepatitis C undergoing methadone maintenance at an urban outpatient opioid treatment program serving a minority adult population. Eligibility covered methadone-maintained patients coinfected with HIV and hepatitis C who had received or were currently receiving NFV. The yield was 51 case patients. Parameters examined looked into safety, efficacy, and tolerability. Nelfinavir was discontinued in 2 patients for liver function abnormalities but resumed in 1 patient. One patient developed laboratory abnormalities during NFV therapy that were not present before NFV therapy; in 12 case patients, pre-NFV therapy liver function abnormalities resolved completely during NFV therapy. There was a statistically significant increase in CD4 count during NFV therapy. Viral load decreased or was unchanged in 10 case patients and increased in 8, of whom 5 had a CD4 count increase during NFV therapy. Three patients had diarrhea and 4 patients had constipation. Nelfinavir was not discontinued -- neither was dose adjusted -- in any of these patients. Patients who had received NFV [greater than or equal to]36 months had a smaller increase in mean methadone dose as compared with patients who had received NFV Author Affiliation: (a) Division of Medical Services, Evaluation and Research, Addiction Research and Treatment Corporation, Brooklyn, NY 11201, USA (b) Department of Public Health, Weill Medical College, Cornell University, New York, NY 10021, USA Article History: Received 17 January 2006; Accepted 13 March 2006

Illicit drug users sustain the epidemics of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), hepatitis C (HCV), and sexually transmitted infections (STIs). Substance abuse treatment programs present a major intervention point in stemming these epidemics. As a part of the 'Infections and Substance Abuse' study, established by the National Drug Abuse Treatment Clinical Trials Network, sponsored by National Institute on Drug Abuse, three surveys were developed; for treatment program administrators, for clinicians, and for state and District of Columbia health and substance abuse department administrators, capturing service availability, government mandates, funding, and other key elements related to the three infection groups. Treatment programs varied in corporate structure, source of revenue, patient census, and medical and non-medical staffing; medical services, counseling services, and staff education targeted HIV/AIDS more often than HCV or STIs. The results from this study have the potential to generate hypotheses for further health services research to inform public policy. Keywords: HIV/AIDS; Hepatitis C virus infection; Sexually transmitted infections; National Drug Abuse Treatment Clinical Trials Network; Community treatment program

The effect of an HIV educational program on efficacy and adherence with a simple, compact, twice-daily triple nucleoside regimen containing a lamivudine/zidovudine combination tablet plus abacivir is evaluated. The intervention is limited to patient empowerment and improving knowledge about HIV and its treatment.

Preventive tuberculosis treatment with isoniazid does not appear to be necessary in HIV-infected patients even if they have risk factors for tuberculosis. Researchers randomly assigned 517 HIV-infected patients with abnormal skin tests results to take isoniazid or placebo for six months. Over 90% had one or more risk factors for tuberculosis. After an average follow-up of two to three years, 3 of the 260 patients taking isoniazid had developed active tuberculosis. However, the risk of active tuberculosis was also low in the placebo group, occurring in 6 of 257 patients.

There has been little attention to the problem of violent stressors leading to post-traumatic stress disorder (PTSD) among opioid-dependent patients. In a sample of methadone maintenance patients, the prevalence of lifetime PTSD was determined to be 20% for women and 11% for men. The most common stressors reported were rape for women and seeing someone hurt or killed for men. Further research with methadone patients focused on PTSD should also ascertain current rates of PTSD and determine whether special treatments for PTSD and related problems of depression and suicidal ideation are necessary. Keywords: posttraumatic stress disorder; methadone maintenance; depression; violence, rape.

HIV-infected women may have a greater risk of death than HIV-infected men, although the overall risk of disease progression may not differ significantly according to gender. Researchers studied the medical, demographic, and HIV risk factor data of 768 HIV-infected women and 3,779 HIV-infected men to determine gender-based differences in disease progression and death. After a median follow-up period of 14.5 to 15.5 months, the women were 1.33 times more likely to die than the men, independent of the patients' CD4 counts and other variables associated with the disease. The risk of disease progression measured in terms of AIDS-related infections was similar among patients of both genders. Women were more likely to develop bacterial pneumonia or other mycobacterial infections as men. But they were less likely to develop nonvisceral Kaposi's sarcoma or oral hairy leukoplakia ., Objective.--To compare disease progression and mortality between women and men infected with human immunodeficiency virus (HIV). Design.--Multicenter cohort. Setting.--Seventeen community-based centers participating in the Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA). Patients.--A total of 768 women and 3779 men enrolled in one or more of 11 protocols between September 7, 1990, and September 30, 1993. Main Outcome Measures.--Survival and opportunistic events. Results.--The median CD[4.sup.+] cell count at enrollment into the cohort was 0.240 x[10.sup.9]/L (240/[micro]L) for women and 0.137 x [10.sup.9]/L for men (P Conclusions.--Compared with men, HIV-injected women in the CPCRA were at increased risk of death but not disease progression. Risks of most incident opportunistic diseases were similar for women and men; however, women were at an increased risk of bacterial pneumonia. These findings may reflect differential access to health care and standard treatments or different socioeconomic status and social support for women compared with men. (JAMA. 1994;272:1915-1921)

This paper reviews the activities of the Addiction Research and Treatment Corporation (ARTC), a substance abuse treatment agency, located in Brooklyn, New York, which services approximat 2,300 patients annually. ARTC's history, treatment, and research activities are first described. We then proceed to detail the ARTC's employee health maintenance and community relations programs. A multicomponent treatment model is then outlined, which emphasizes the interact role of the above functions within an optimal treatment network. Keywords--substance abuse; employee assistance program (EAP); health program (HP); public relations; HIV., The Addiction Research and Treatment Corp (ARTC) was established to provide treatment for socially disadvantaged, opiate abusers. Their multi-faceted approach is composed of pharmacologic, psychological and educational programs, using a holistic approach to develop responsibility and independence among their patients. Research is an integral policy of the ARTC and the company is giving emphasis to AIDS prevention, especially for high risk individuals. They strongly believe in fostering good health and motivation among their employees and advocate better community relations.

Background Despite high hepatitis C virus (HCV) prevalence, opioid use disorder (OUD) patients on methadone rarely engage in HCV treatment. We investigated the effectiveness of HCV management via telemedicine in an opioid substitution therapy (OST) program. Methods OUD patients on methadone underwent biweekly telemedicine sessions between a hepatologist and physician assistant during the entire HCV treatment course. All pretreatment labs (HCV RNA, genotype, and noninvasive fibrosis assessments) were obtained onsite and direct-acting antivirals were coadministered with methadone using modified directly observed therapy. We used multiple correspondence analysis, least absolute shrinkage and selection operator, and logistic regression to identify variables associated with pursuit of HCV care. Results Sixty-two HCV RNA–positive patients (24% human immunodeficiency virus [HIV] infected, 61% male, 61% African American, 25.8% Hispanic) were evaluated. All patients were stabilized on methadone and all except 4 were HCV genotype 1 infected. Advanced fibrosis/cirrhosis was present in 34.5% of patients. Of the 45 treated patients, 42 (93.3%) achieved viral eradication. Of 17 evaluated patients who were not treated, 5 were discontinued from the drug treatment program or did not follow up after the evaluation, 2 had HIV adherence issues, and 10 had insurance authorization issues. Marriage and a mental health diagnosis other than depression were the strongest positive predictors of treatment pursuit, whereas being divorced, separated, or widowed was the strongest negative predictor. Conclusions HCV management via telemedicine integrated into an OST program is a feasible model with excellent virologic effectiveness. Psychosocial and demographic variables can assist in identification of subgroups with a propensity or aversion to pursue HCV treatment. [ABSTRACT FROM AUTHOR]