Lauren Gooden - Academia.edu (original) (raw)

Papers by Lauren Gooden

Drug and Alcohol Dependence, 2021

Background: People living with HIV who report substance use (PLWH-SU) face many barriers to care,... more Background: People living with HIV who report substance use (PLWH-SU) face many barriers to care, resulting in an increased risk for poor health outcomes and the potential for ongoing disease transmission. This study evaluates the mechanisms by which Patient Navigation (PN) and Contingency Management (CM) interventions may work to address barriers to care and improve HIV outcomes in this population. Methods: Mediation analysis was conducted using data from a randomized, multi-site trial testing PN interventions to improve HIV care outcomes among 801 hospitalized PLHW-SU.

Open Forum Infectious Diseases, 2021

Background Direct-acting antivirals can cure hepatitis C virus (HCV). Persons with HCV/HIV and li... more Background Direct-acting antivirals can cure hepatitis C virus (HCV). Persons with HCV/HIV and living with substance use are disadvantaged in benefiting from advances in HCV treatment. Methods In this randomized controlled trial, participants with HCV/HIV were randomized between February 2016 and January 2017 to either care facilitation or control. Twelve-month follow-up assessments were completed in January 2018. Care facilitation group participants received motivation and strengths-based case management addressing retrieval of HCV viral load results, engagement in HCV/HIV care, and medication adherence. Control group participants received referral to HCV evaluation and an offer of assistance in making care appointments. Primary outcome was number of steps achieved along a series of 8 clinical steps (eg, receiving HCV results, initiating treatment, sustained virologic response [SVR]) of the HCV/HIV care continuum over 12 months postrandomization. Results Three hundred eighty-one in...

Clinical Infectious Diseases, 2020

Background Studies have demonstrated benefits of antiretroviral therapy (ART) initiation on the d... more Background Studies have demonstrated benefits of antiretroviral therapy (ART) initiation on the day of human immunodeficiency virus (HIV) testing or at first clinical visit. The hospital setting is understudied for immediate ART initiation. Methods CTN0049, a linkage-to-care randomized clinical trial, enrolled 801 persons living with HIV (PLWH) and substance use disorder (SUD) from 11 hospitals across the United States. This secondary analysis examined factors related to initiating (including reinitiating) ART in the hospital and its association with linkage to HIV care, frequency of outpatient care visits, retention, and viral suppression. Results Of 801 participants, 124 (15%) initiated ART in the hospital, with more than two-thirds of these participants (80/124) initiating ART for the first time. Time to first HIV care visit among those who initiated ART in the hospital and those who did not was 29 and 54 days, respectively (P = .0145). Hospital initiation of ART was associated w...

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2018

Background: Under the Affordable Care Act, hospitals receive reduced reimbursements for excessive... more Background: Under the Affordable Care Act, hospitals receive reduced reimbursements for excessive 30-day readmissions. However, the Centers for Medicare and Medicaid Services does not consider social and behavioral variables in expected readmission rate calculations, which may unfairly penalize systems caring for socially disadvantaged patients, including patients with HIV. Setting: Randomized controlled trial of patient navigation with or without financial incentives in HIV-positive substance users recruited from the inpatient setting at 11 US hospitals. Methods: External validation of an existing 30-day readmission prediction model, using variables available in the electronic health record (EHR-only model), in a new multicenter cohort of HIV-positive substance users was assessed by C-statistic and Hosmer-Lemeshow testing. A second model evaluated sociobehavioral factors in improving the prediction model (EHR-plus model) using multivariable regression and C-statistic with cross-validation. Results: The mean age of the cohort was 44.1 years, and participants were predominantly males (67.4%), non-white (88.0%), and poor (62.8%, ,$20,000/year). Overall, 17.5% individuals had a hospital readmission within 30 days of initial hospital discharge. The EHRonly model resulted in a C-statistic of 0.65 (95% confidence interval: 0.60 to 0.70). Inclusion of additional sociobehavioral variables, food insecurity and readiness for substance use treatment, in the EHR-plus model resulted in a C-statistic of 0.74 (0.71 after cross-validation, 95% confidence interval: 0.64 to 0.77). Conclusions: Incorporation of detailed social and behavioral variables substantially improved the performance of a 30-day readmission prediction model for hospitalized HIV-positive substance users. Our findings highlight the importance of social determinants in readmission risk and the need to ask about, adjust for, and address them.

AIDS patient care and STDs, 2018

This secondary analysis compares health behavior outcomes for two groups of HIV+ substance users ... more This secondary analysis compares health behavior outcomes for two groups of HIV+ substance users randomized in a 3-arm trial [1] to receive Patient Navigation with (PN+CM) or without (PN) contingent financial incentives (CM). Mean age of participants was 45 years; the majority was male (67%), African American (78%), unemployed (35%), or disabled (50%). Behaviors incentivized for PN+CM were (1) attendance at HIV care visits and (2) verification of an active HIV medication prescription. Incentives were associated with shorter time to treatment initiation and higher rates of behaviors during the 6-month intervention with exception of month 6 HIV care visits. Median HIV care visits were 3 (IQR 2-4) for PN+CM versus 1.5 (IQR 0-3) for PN (Wilcoxon p < 0.001); median validated medication checks were 4 (IQR 2-6) for PN+CM versus 1 (IQR 0-3) for PN (Wilcoxon p < 0.001). Viral suppression rates at end of treatment were not significantly different for the two groups but were directly rel...

Drug and Alcohol Dependence, 2017

Aims: Gender differences in cannabis use and CUD have been established, yet differences in treatm... more Aims: Gender differences in cannabis use and CUD have been established, yet differences in treatment response are not well understood. Though some evidence suggests women fare worse than men, the mechanisms are unclear. The current study aims to identify factors associated with gender differences in cannabis use outcomes. (1) Examine how motivation to change and self-efficacy impact treatment outcomes, and whether gender moderates these relationships. (2) Explore additional clinical correlates that may account for gender differences in cannabis outcomes. Methods: A secondary data analysis of a 12-week double-blind placebo controlled trial of buspirone treatment for cannabis dependent adults (N = 175) was conducted. Self-report assessments of motivation, self-efficacy, and other clinical correlates were completed at baseline, and cannabis use was measured weekly using self-report and urine toxicology. Primary outcomes included point prevalence abstinence and creatinine adjusted cannabinoid levels. Results: There was a significant interaction between gender and SOCRATES-Taking Steps on abstinence (p = .018). Higher taking steps reduced likelihood of achieving abstinence among women (p = .001); there was no association among men. Subsequently, taking steps was positively associated with self-efficacy (p = .006) and quantity of use (p = .000) among men, and cannabis related problems (p = .04) among women. There was a significant interaction between gender and MJ Ladder-Readiness to Change on creatinine adjusted cannabinoid levels (p = .004). Change readiness was positively associated with cannabinoid levels among women (p = .000), but not men. Conclusions: Readiness to change and initiation of change behavior predicts worse cannabis outcomes in women. Men and women differ in what motivates change behavior. Social desirability, neurobiology, and treatment type may impact these effects. Gender differences in cannabis treatment response must be considered in future studies. Financial support: NIDA: T32DA007288 (PI McGinty) R01DA026782, K24DA038240 (PI McRae-Clark).

Addiction Science & Clinical Practice, 2017

Background: Interventions are needed to improve viral suppression rates among persons with HIV an... more Background: Interventions are needed to improve viral suppression rates among persons with HIV and substance use. A 3-arm randomized multi-site study (Metsch et al. in JAMA 316:156-70, 2016) was conducted to evaluate the effect on HIV outcomes of usual care referral to HIV and substance use services (N = 253) versus patient navigation delivered alone (PN: N = 266) or together with contingency management (PN + CM; N = 271) that provided financial incentives targeting potential behavioral mediators of viral load suppression. Aims: This secondary analysis evaluates the effects of financial incentives on attendance at PN sessions and the relationship between session attendance and viral load suppression at end of the intervention. Methods: Frequency of sessions attended was analyzed over time and by distribution of individual session attendance frequency (PN vs PN + CM). Percent virally suppressed (≤200 copies/mL) at 6 months was compared for low, medium and high rate attenders. In PN

Drug and Alcohol Dependence, 2016

Objectives-Sexually transmitted infections (STIs) are significant public health and financial bur... more Objectives-Sexually transmitted infections (STIs) are significant public health and financial burdens in the United States. This manuscript examines the relationship between substance use and prevalent and incident STIs in HIV-negative adult patients at STI clinics. Methods-A secondary analysis of Project AWARE was performed based on 5,012 patients from 9 STI clinics. STIs were assessed by laboratory assay and substance use by self-report. Patterns of substance use were assessed using latent class analysis. The relationship of latent class to STI rates was investigated using Poisson regression by population groups at high risk for STIs defined by participant's and partner's gender Results-Drug use patterns differed by risk group and substance use was related to STI rates with the relationships varying by risk behavior group. Substance use treatment participation was associated with increased STI rates Conclusions-Substance use focused interventions may be useful in STI clinics to reduce morbidity associated with substance use. Conversely, gender-specific sexual health interventions may be useful in substance use treatment.

Journal of substance abuse treatment, Jan 28, 2016

Contingency management (CM) interventions generally target a single behavior such as attendance o... more Contingency management (CM) interventions generally target a single behavior such as attendance or drug use. However, disease outcomes are mediated by complex chains of both healthy and interfering behaviors enacted over extended periods of time. This paper describes a novel multi-target contingency management (CM) program developed for use with HIV positive substance users enrolled in a CTN multi-site study (0049 Project HOPE). Participants were randomly assigned to usual care (referral to health care and SUD treatment) or 6-months strength-based patient navigation interventions with (PN+CM) or without (PN only) the CM program. Primary outcome of the trial was viral load suppression at 12-months post-randomization. Up to $1160 could be earned over 6 months under escalating schedules of reinforcement. Earnings were divided among eight CM targets; two PN-related (PN visits; paperwork completion; 26% of possible earnings), four health-related (HIV care visits, lab blood draw visits, m...

JAMA, 2016

IMPORTANCE Substance use is a major driver of the HIV epidemic and is associated with poor HIV ca... more IMPORTANCE Substance use is a major driver of the HIV epidemic and is associated with poor HIV care outcomes. Patient navigation (care coordination with case management) and the use of financial incentives for achieving predetermined outcomes are interventions increasingly promoted to engage patients in substance use disorders treatment and HIV care, but there is little evidence for their efficacy in improving HIV-1 viral suppression rates. OBJECTIVE To assess the effect of a structured patient navigation intervention with or without financial incentives to improve HIV-1 viral suppression rates among patients with elevated HIV-1 viral loads and substance use recruited as hospital inpatients.

Archives of Sexual Behavior, 2016

This study examined differences in sexual risk behaviors by gender and over time among 1281 patie... more This study examined differences in sexual risk behaviors by gender and over time among 1281 patients (777 males and 504 females) from 12 community-based substance use disorder treatment programs throughout the United States participating in CTN-0032, a randomized control trial conducted within the National Drug Abuse Treatment Clinical Trials Network. Zero-inflated negative binomial (ZINB) and negative binomial (NB) models were used in the statistical analysis. Results indicated significant reductions in most types of sexual risk behaviors among substance users regardless of the intervention arms. There were also significant gender differences in sexual risk behaviors. Men (compared with women) reported more condomless sex acts with their nonprimary partners (IRR=1.80, 95% CI=1.21-2.69) and condomless anal sex acts (IRR=1.74, 95% CI=1.11-2.72), but fewer condomless sex partners (IRR=0.87, 95% CI=0.77-0.99), condomless vaginal sex acts (IRR=0.83, 95% CI=0.69-1.00), and condomless sex acts within two hours of using drugs or alcohol (IRR=0.70, 95% CI=0.53-0.90). Gender specific intervention approaches are called for in substance use disorder treatment.

Drug and Alcohol Dependence, 2015

Purpose: Micro-costing is often conducted to determine incremental costs of an intervention for c... more Purpose: Micro-costing is often conducted to determine incremental costs of an intervention for cost-effectiveness analysis, but may not be consistent with budgetary costs used for implementation. We describe these differences using a case study of implementation of rapid HIV testing and counseling in a substance abuse treatment program following a clinical trial. Method: During the clinical trial, we used micro-costing methods to determine the cost of HIV testing in substance abuse treatment programs to conduct a cost-effectiveness analysis. Time and materials were from study records (including start and stop times for time conducting on-site testing and counseling) and site interviews; labor costs assume full capacity and were valued at local labor rates; and overhead was calculated from site financial records and applied as a percentage of labor costs. Costs include counselor and other labor, rapid HIV test and materials, supervision, quality control, and overhead. After the tria...

AIDS and behavior, Jan 8, 2015

Substance users are at increased risk for HIV and HCV infection. Still, many substance use treatm... more Substance users are at increased risk for HIV and HCV infection. Still, many substance use treatment programs (SUTP) fail to offer HIV/HCV testing. The present secondary analysis of screening data from a multi-site randomized trial of rapid HIV testing examines self-reported HIV/HCV testing patterns and serostatus of 2473 SUTP patients in 12 community-based sites that had not previously offered on-site testing. Results indicate that most respondents screened for the randomized trial tested more than a year prior to intake for HIV (52 %) and HCV (38 %). Prevalence rates were 3.6 and 30 % for HIV and HCV, respectively. The majority of participants that were HIV (52.2 %) and HCV-positive (40.5 %) reported having been diagnosed within the last 1-5 years. Multivariable logistic regression showed that members of high-risk groups were more likely to have tested. Bundled HIV/HCV testing and linkage to care issues are recommended for expanding testing in community-based SUTP settings.

Purpose: Many US sexually transmitted disease (STD) clinics conduct routine enzyme immunoassay (E... more Purpose: Many US sexually transmitted disease (STD) clinics conduct routine enzyme immunoassay (EIA) laboratory HIV testing that requires follow up to receive results. On-site rapid HIV testing delivers results in 20 minutes at a higher initial cost, but reduces follow up costs and risks of loss to follow up for newly identified HIV cases. Methods: Using micro-costing techniques, we determined the average cost per person offered a rapid HIV test for two strategies: 1) rapid test with information only and 2) rapid test with risk-reduction counseling. Data were from seven public health STD clinics participating in a randomized trial comparing the effectiveness and cost-effectiveness of the two strategies. Data included staff activity logs, clinic overhead including additional space for on-site rapid testing, and supplies. We applied national labor rates and supply costs. Analysis was from the STD clinic perspective; start-up costs and patient costs were excluded. We calculated the thr...

Sexually Transmitted Diseases, 2014

Introduction-Rapid HIV testing in high-risk populations can increase the number of persons who le... more Introduction-Rapid HIV testing in high-risk populations can increase the number of persons who learn their HIV status and avoid spending clinic resources to locate persons identified as HIV-infected. Methods-We determined the cost to sexually transmitted disease clinics of point-of-care rapid HIV testing using data from 7 public clinics that participated in a randomized trial of rapid testing with and without brief patient-centered risk-reduction counseling in 2010. Costs included counselor and trainer time, supplies, and clinic overhead. We applied national labor rates and test costs. We calculated median clinic start-up costs and mean cost per patient tested, and projected §

Aims: HIV-infected crack cocaine users have poor engagement in HIV primary care services and low ... more Aims: HIV-infected crack cocaine users have poor engagement in HIV primary care services and low use of antiretroviral therapy. We examined correlates of HAART use in this population. Methods: 413 HIV-infected crack cocaine users hospitalized at Grady Memorial Hospital, Atlanta, GA, and Jackson Memorial Hospital, Miami, FL, were enrolled in Project HOPE, a randomized trial of a behavioral intervention that seeks to improve linkage to HIV primary care. We conducted a cross-sectional analysis of the baseline data for those participants who had any lifetime use of HAART or CD4 ≤ 350. Multivariate logistic regression was performed to evaluate correlates of current HAART use. Results: Among 358 eligible participants, mean age was 45 years, 51% were women, and 90% were African-American. Median CD4 count was 149 cells/uL. Despite being eligible for HAART according to DHHS guidelines, only 33% were currently on HAART. Correlates of HAART use in the multivariate analysis were at least 2 visi...

JAMA, 2013

IMPORTANCE To increase human immunodeficiency virus (HIV) testing rates, many institutions and ju... more IMPORTANCE 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. OBJECTIVE 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). DESIGN, SETTING, AND PARTICIPANTS 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. INTERVENTIONS 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. MAIN OUTCOMES AND MEASURES The prespecified outcome was a composite end point of cumulative incidence of any of the measured 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 There was 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. CONCLUSION AND RELEVANCE 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.