SCHOOL OF NURSING UNIVERSITY 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 NURSING UNIVERSITY 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 2

SCHOOL OF NURSING UNIVERSITY 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 3

SCHOOL OF NURSING UNIVERSITY 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 4

SCHOOL OF NURSING UNIVERSITY 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) 5

SCHOOL OF NURSING UNIVERSITY 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) 6 Gender Age

SCHOOL OF NURSING UNIVERSITY OF CALIFORNIA, SAN FRANCISCO Race 7

SCHOOL OF NURSING UNIVERSITY OF CALIFORNIA, SAN FRANCISCO Education and Employment 8 Education Employment

SCHOOL OF NURSING UNIVERSITY 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 ) 9 HIV Viral Load Year of HIV Diagnosis

SCHOOL OF NURSING UNIVERSITY OF CALIFORNIA, SAN FRANCISCO Specific Substance Involvement Score (mean, SD) SubstanceCompleted SBI Did not complete SBIp-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)

SCHOOL OF NURSING UNIVERSITY OF CALIFORNIA, SAN FRANCISCO Limitations  Convenience sample  Analysis was bivariate  Self-reported data  Computer skills and knowledge not assessed 11

SCHOOL OF NURSING UNIVERSITY 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 12

SCHOOL OF NURSING UNIVERSITY 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 13

SCHOOL OF NURSING UNIVERSITY 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

SCHOOL OF NURSING UNIVERSITY OF CALIFORNIA, SAN FRANCISCO Acknowledgement  Patients and providers at Positive Health Program  Funding: National Institute on Drug Abuse 1RC1DA (PI: Dr. C. Dawson-Rose) 15