A Brief Peer-Led Intervention to Increase COVID-19 Vaccine Uptake Among People Who Inject Drugs in San Diego County: Results From a Pilot Randomized Controlled Trial.

Background: We evaluated the impact of a brief peer-led intervention on COVID-19 vaccination among people who inject drugs (PWID) presenting at syringe services program (SSP) locations in San Diego County, California. Methods: Between March and July 2022, PWID aged ≥18 years without recent voluntary COVID-19 testing who were not up to date on COVID-19 vaccinations received a single-session motivational interviewing intervention (LinkUP) or an attention-matched didactic control condition from trained peer counselors at SSP sites randomized by week. Following either 30-minute session, counselors offered referrals to local vaccination services. Multivariable log binomial regression via generalized estimating equations assessed LinkUP effects on (1) acceptance of COVID-19 vaccination referrals immediately postintervention and (2) COVID-19 vaccine uptake at 6-month follow-up. Results: COVID-19 vaccination outcomes were obtained on 135 (90.6%) of 149 participants. In multivariable analysis, participants receiving LinkUP had greater acceptance of COVID-19 vaccination referrals than controls (adjusted relative risk, 3.50; 95% CI, 1.01-12.2) and were marginally more likely to report receiving a new COVID-19 vaccine dose (adjusted relative risk, 1.57; 95% CI, .99-2.48). After 6 months, 20% reported receiving a new vaccine dose; however, if COVID-19 vaccine had been available at SSPs, this proportion could have been as high as 34.3% (45.3% LinkUP vs 24.3% control; P = .01). Conclusions: A brief peer-led SSP-based intervention significantly improved COVID-19 vaccination among PWID. Further improvements could likely be obtained by supporting SSPs to offer COVID-19 vaccination on-site instead of relying on referrals. Clinical Trials Registration: ClinicalTrials.gov NCT05181657.

Correlates of recent overdose among people who inject drugs in the San Diego/Tijuana border region.

BACKGROUND: Along the Mexico-US border, illicitly manufactured fentanyls (fentanyl) have been detected in other illicit drugs, including street opioid formulations known as 'china white.' We studied correlates of recent overdose among people who inject drugs (PWID), focusing on the risk of knowlingly or unknowingly using fentanyl in china white. METHODS: From October 2020 - September, 2021 we surveyed participants in San Diego, California and Tijuana, Mexico and employed Poisson regression to identify correlates of recent overdose. RESULTS: Of 612 PWID, most were male (74.0 %), Latinx (71.9 %), US residents (67.0 %). Mean age was 43 years. In the last six months, 15.8 % experienced overdose, 31.0 % knowingly used fentanyl and 11.1 % used china white, of whom 77.9 % did not think it contained fentanyl. After controlling for sex and race, factors independently associated with risk of overdose included knowingly using fentanyl, using china white and not believing it contained fentanyl, recent drug rehabilitation, being stopped/arrested by police, and homelessness. Further, PWID who believed china white contained fentanyl were less likely to use it. CONCLUSIONS: Both intentional fentanyl use and unintentional exposure to fentanyl via china white were associated with overdose risk; however, PWID who believed china white contained fentanyl were less likely to use it. These data suggest that advanced drug checking systems should be implemented to empower PWID to avoid dangerous street formulations or to plan their drug use knowing its contents. Other overdose risk factors such as decreased tolerance following drug treatment, police interactions, and homelessness also require urgent intervention.

Correlates of seeking injection assistance among injection drug users in Tijuana, Mexico.

Assisted injection among injection drug users (IDUs) remains understudied. We recruited 1,056 IDUs using respondent-driven sampling in Tijuana, Mexico. Participants underwent HIV and syphilis testing and structured interviews. One-quarter (25%) sought injection assistance in the past 6 months. Seeking injection assistance was independently associated with being female (adjusted odds ratio [AOR]= 2.59; 95% confidence interval [CI]= 1.73-3.90), being born outside Baja California (AOR = 1.75; CI = 1.26-2.42), having recent abscesses (AOR = 2.59; CI = 1.93-3.47), using syringes previously used by others in the past 6 months (AOR = 1.99; CI = 1.45-2.71), and ever being arrested for carrying sterile syringes (AOR = 1.55; CI = 1.15-2.09).

Self-report INH adherence measures were reliable and valid in Latino adolescents with latent tuberculosis infection.

BACKGROUND AND OBJECTIVE: To test the reliability and validity of 8-day and 30-day self-report measures of adherence to daily isoniazid (INH) for treatment of latent tuberculosis infection (LTBI). METHODS: Participants were 286 Latino adolescents (ages 13-18, 55.6% male) with LTBI recruited from 10 public middle and high schools in San Diego County. INH adherence was measured monthly for up to 9 months by interview and urine specimens at unannounced visits. Reliability and validity analyses were performed within 5 consecutive months. Reliability was assessed by correlating: (1) 8- and 30-day INH adherence measures within each month; and (2) each of the two adherence measures across months. Validity was assessed by correlating reported measures with biological assays within each month. RESULTS: Reliability tests yielded significant correlation coefficients (p < .05 to .001), both across measures (r = 0.71-0.93) and across time (r = 0.29-0.64 for 8-day recall; r = 0.32-0.69 for 30-day recall). Validity tests of both adherence measures were also significant (p < .05 to .001): 8-day recall (r(pb) = 0.52-0.72) and 30-day recall (r(pb) = 0.37-0.71). CONCLUSION: Results suggest that impromptu recall measures of INH adherence, combined with urine collection, are reliable and valid in Latino adolescents.

Increasing Latino adolescents' adherence to treatment for latent tuberculosis infection: a controlled trial.

OBJECTIVES: We sought to determine the efficacy of coaching Latino adolescents with latent tuberculosis infection to adhere to isoniazid treatment. METHODS: Participants (n = 286) were randomly assigned to adherence coaching, attention control, or usual care groups. Adherence was measured via interviews and validated with urine assays. RESULTS: Coaching resulted in significant increases in adherence compared with attention and usual care groups. Bicultural adolescents were more likely to be adherent than those most or least acculturated. Age and risk behavior were negatively related to adherence. CONCLUSIONS: Coaching can increase Latino adolescents' adherence to treatment for latent tuberculosis infection and should contribute to tuberculosis control for adolescents at high risk of contracting the disease.