SCHOOL OF NURSINGUNIVERSITY OF CALIFORNIA, SAN FRANCISCO

Not Ready for Prime Time?A Web-Based SBIRT Intervention in an Urban Safety-Net HIV Clinic

Carol Dawson Rose, PhD, RN, FAAN

Roland Zepf, RN, MS, ACRN Yvette Cuca, PhD

Paula J. Lum, MD, MPH

November 6, 2014

SCHOOL OF NURSINGUNIVERSITY OF CALIFORNIA, SAN FRANCISCO

Background Substance use is

common among people living with HIV/AIDS associated with lower medication adherence,

lower viral suppression, and increased mortality Screening, Brief Intervention, and Referral to

Treatment (SBIRT) evidence based approach for substance use

screening in primary care Computer based screening

may increase access to clinic based screening

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SCHOOL OF NURSINGUNIVERSITY OF CALIFORNIA, SAN FRANCISCO

Study Aim

Examines the acceptability of the web-based Screening, Brief Intervention (SBI) delivery

Compares participants who completed SBI with those who did not

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SCHOOL OF NURSINGUNIVERSITY OF CALIFORNIA, SAN FRANCISCO

Methods Sample recruited at an HIV primary care

clinic Parent study comparing Mode of delivery of

SBI: Web-based arm: N = 96 Clinician-based arm: N = 112

SBI to be completed within one week

Intervention given in English and Spanish

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SCHOOL OF NURSINGUNIVERSITY OF CALIFORNIA, SAN FRANCISCO

Measures Primary outcome

Completed SBI – yes/no

Substance Use The Alcohol, Smoking and Substance

Involvement Screening Test (ASSIST) by WHO Specific Substance Involvement Score

(SSIS)

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SCHOOL OF NURSINGUNIVERSITY OF CALIFORNIA, SAN FRANCISCO

Age and Gender

Completed SBI Mean 43.9 (SD 7.1)

Did not complete SBI Mean 46.3 (SD 8.9)

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GenderAge

SCHOOL OF NURSINGUNIVERSITY OF CALIFORNIA, SAN FRANCISCO

Race7

SCHOOL OF NURSINGUNIVERSITY OF CALIFORNIA, SAN FRANCISCO

Education and Employment8

Education Employment

SCHOOL OF NURSINGUNIVERSITY OF CALIFORNIA, SAN FRANCISCO

HIV: Year and Viral Load

Did not complete SBI Mean 1999 (SD 6.9)

Completed SBI Mean

1998 (SD 7.4)

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HIV Viral LoadYear of HIV Diagnosis

SCHOOL OF NURSINGUNIVERSITY OF CALIFORNIA, SAN FRANCISCO

Specific Substance Involvement Score (mean, SD)

Substance Completed SBIDid not

complete SBI p-value

Tobacco 16.3 (±11.6) 14.8 (±11.0) 0.54

Alcohol 11.4 (±10.8) 12.0 (±10.8) 0.78

Cocaine 10.1 (±11.2) 8.6 (±10.6) 0.54

Amphetamine 11.9 (±12.4) 6.9 (±9.9) 0.04

Opioids 5.6 (±10.1) 3.9 (±7.9) 0.36

Sedatives 5.7 (±8.3) 4.3 (±7.5) 0.42

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SCHOOL OF NURSINGUNIVERSITY OF CALIFORNIA, SAN FRANCISCO

Limitations Convenience sample

Analysis was bivariate

Self-reported data

Computer skills and knowledge not assessed

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SCHOOL OF NURSINGUNIVERSITY OF CALIFORNIA, SAN FRANCISCO

Implications/Considerations

Is a web-based SBI better for amphetamine-using persons?

Further assessments of substance-using mode of interacting is needed

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SCHOOL OF NURSINGUNIVERSITY OF CALIFORNIA, SAN FRANCISCO

Conclusions Web-based SBI was not a successful

delivery modality for all substance users

Significantly more amphetamine users completed the SBI compared to amphetamine users who did not complete the SBI

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SCHOOL OF NURSINGUNIVERSITY OF CALIFORNIA, SAN FRANCISCO

References

Madras BK, Compton WM, Avula D, Stegbauer T, Stein JB, Clark HW. Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: comparison at intake and 6 months later. Drug Alcohol Depend. 2009

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SCHOOL OF NURSINGUNIVERSITY OF CALIFORNIA, SAN FRANCISCO

Acknowledgement

Patients and providers at Positive Health Program

Funding: National Institute on Drug Abuse 1RC1DA028224-01 (PI: Dr. C. Dawson-Rose)

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