Brendan Quinn

People who inject drugs are over-represented among incarcerated populations. However, there are few studies elucidating patterns of incarceration among peo

Background: Preventing and treating methamphetamine-related harm in Aboriginal and Torres Strait Islander populations is a significant challenge for health care services. Digital health care may offer opportunities to support individuals and families in ways that complement existing methamphetamine treatment options. This study responds to a community-identified priority as Aboriginal Community Controlled Health Services identified methamphetamine use as a key concern and sought support to respond to the needs of people who use methamphetamine and their families. Objective: This paper reports on a process evaluation of the web application’s acceptability and feasibility when used by clients and clinicians in residential rehabilitation services and primary care. This study is part of a larger project entitled “Novel Interventions to address Methamphetamine use in Aboriginal and Torres Strait Islander Communities” (NIMAC), which seeks to develop culturally appropriate and strengths-based prevention and treatment interventions to reduce methamphetamine related harm. “We Can Do This” was a web application developed for Aboriginal and Torres Strait Islander people who are seeking to reduce or stop methamphetamine use. Methods: Clinicians and clients who had used the web application were recruited through Aboriginal Community Controlled Health Services and Aboriginal residential rehabilitation services in urban and regional Victoria and South Australia. Unidentified usage data was collected from all participants. After using the web application, those who indicated a willingness to be interviewed were contacted and interviewed by phone or in person and asked about the feasibility and acceptability of the web application. The framework method of analysis was used to structure and summarise the resulting qualitative data. Results: Interviews with 24 clients and 11 clinicians explored the acceptability and feasibility of the web application. Acceptability incorporated the following domains: affective attitude, burden, ethicality, cultural appropriateness, coherence, opportunity cost, perceived effectiveness, and self-efficacy. The evaluation of feasibility assessed barriers and facilitators to the implementation of the program, with a focus on demand, practicality, fidelity, and integration. Results indicated that both clients and clinicians found the web application content coherent, relatable, empowering, and culturally safe. Barriers to using the web application for clients included a lack of internet connectivity and personal issues such as scheduling. Conclusions: Process evaluation is often under-valued. However, as “We Can Do This” was new, innovative and targeted a hard-to-reach population, understanding its feasibility and acceptability as a clinical tool was essential to understanding its potential. “We Can Do This” is unique as the only evidence-based, culturally appropriate internet-based therapeutic program specifically designed for Aboriginal and Torres Strait Islander people who use methamphetamine. Findings suggest it was both acceptable and feasible as a low-cost adjunct to usual care in residential rehabilitation and primary care settings.

Background: Digital interventions can help to overcome barriers to care, including stigma, geographical distance, and a lack of culturally appropriate treatment options. “We Can Do This” is a web-based app that was designed with input from cultural advisors and end users to support Aboriginal and Torres Strait Islander people seeking to stop or reduce their use of methamphetamine and increase psychosocial well-being. Objective: This study aimed to evaluate the effectiveness of the “We Can Do This” web-based app as a psychosocial treatment for Aboriginal and Torres Strait Islander people who use methamphetamine. Methods: The web app was evaluated using a randomized waitlist controlled parallel group trial. Participants were Aboriginal and Torres Strait Islander people aged 16 years or older who self-identified as having used methamphetamine at least weekly for the past 3 months. Participants were randomized on a 1:1 ratio to receive either access to the web-based app for 6 weeks or a waitlist control group. Both groups received access to a website with harm minimization information. The primary outcome was days of methamphetamine use in the past 4 weeks assessed at 1, 2, and 3 months post randomization. Secondary outcomes included severity of methamphetamine dependence (Severity of Dependence Scale [SDS]), psychological distress (Kessler 10 [K10]), help-seeking behavior, and days spent out of role due to methamphetamine use. Results: Participants (N=210) were randomized to receive either access to the web-based app (n=115) or the waitlist control condition (n=95). Follow-up was 63% at 1 month, 57% at 2 months, and 54% at 3 months. There were no significant group differences in days of methamphetamine use in the past 4 weeks at 1 the month (mean difference 0.2 days, 95% CI –1.5 to –2), 2 months (mean difference 0.6 days, 95% CI –1 to 2.4 days) or 3 months (mean difference 1.4 days, 95% CI –0.3 to 3.3 days) follow-up. There were no significant group differences in K10 scores, SDS scores, days out of role, or help-seeking at any of the 3 follow-up timepoints. There was poor adherence to the web-based app, only 20% of participants in the intervention group returned to the web-based app after their initial log-in. Participants cited personal issues and forgetting about the web-based app as the most common reasons for nonadherence. Conclusions: We found poor engagement with this web-based app. The web-based app had no significant effects on methamphetamine use or psychosocial well-being. Poor adherence and low follow-up hindered our ability to accurately evaluate the effectiveness of the web-based app. Future web-based apps for this population need to consider methods to increase participant engagement. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619000134123p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376088 International Registered Report Identifier (IRRID): RR2-10.2196/14084

Background: Active follow-up of chronic hepatitis C notifications to promote linkage to care is a promising strategy to support elimination. Aim: This pilot study in Victoria, Australia, explored if the Department of Health could follow-up on hepatitis C cases through their diagnosing clinicians, to assess and support linkage to care and complete data missing from the notification. Methods: For notifications received between 1 September 2021 and 31 March 2022 of unspecified hepatitis C cases (i.e. acquired > 24 months ago or of unknown duration), contact with diagnosing clinicians was attempted. Data were collected on risk exposures, clinical and demographic characteristics and follow-up care (i.e. HCV RNA test; referral or ascertainment of previous negative testing or treatment history). Reasons for unsuccessful doctor contact and gaps in care provision were investigated. Advice to clinicians on care and resources for clinical support were given on demand. Results: Of 513 cases where information was sought, this was able to be obtained for 356 (69.4%). Reasons for unsuccessful contact included incomplete contact details or difficulties getting in touch across three attempts, particularly for hospital diagnoses. Among the 356 cases, 307 (86.2%) had received follow-up care. Patient-management resources were requested by 100 of 286 contacted diagnosing clinicians. Conclusions: Most doctors successfully contacted had provided follow-up care. Missing contact information and the time taken to reach clinicians significantly impeded the feasibility of the intervention. Enhancing system automation, such as integration of laboratory results, could improve completeness of notifications and support further linkage to care where needed.

BACKGROUND We Can Do This was a web-based application (web-app) developed for Aboriginal and Torres Strait Islander people who are seeking to reduce or stop methamphetamine use. OBJECTIVE This paper reports on a process evaluation of the web-app’s acceptability and feasibility when used by clients and clinicians in residential rehabilitation services and primary care. METHODS Clinicians and clients who had used the web-app were recruited via Aboriginal Community Controlled Health Services and Aboriginal residential rehabilitation services in urban and regional Victoria and South Australia. Non-identified usage data was collected from all participants. After using the web-app, those who indicated a willingness to be interviewed were contacted and interviewed by phone or in person and asked about the feasibility and acceptability of the web-app. RESULTS Interviews with ten clients and eleven clinicians highlighted that both clients and clinicians found the content coherent, relatable, empowering and culturally safe. Barriers to using the web-app for clients included a lack of internet connectivity and personal issues such as scheduling. CONCLUSIONS Process evaluation is often under-valued. However, as We Can Do This was new, innovative and targeted a hard-to-reach population, understanding its feasibility and acceptability as a clinical tool was essential to understanding its potential. We Can Do This is unique as the only evidence-based, culturally appropriate online therapeutic program specifically designed for Aboriginal and Torres Strait Islander people who use methamphetamine. Findings suggest it was both acceptable and feasible as a low-cost adjunct to usual care in residential rehabilitation and primary care settings.

BACKGROUND Digital interventions can help to overcome barriers to care, including stigma, geographical distance, and a lack of culturally appropriate treatment options. “We Can Do This” is a web-based app that was designed with input from cultural advisors and end users to support Aboriginal and Torres Strait Islander people seeking to stop or reduce their use of methamphetamine and increase psychosocial well-being. OBJECTIVE This study aimed to evaluate the effectiveness of the “We Can Do This” web-based app as a psychosocial treatment for Aboriginal and Torres Strait Islander people who use methamphetamine. METHODS The web app was evaluated using a randomized waitlist controlled parallel group trial. Participants were Aboriginal and Torres Strait Islander people aged 16 years or older who self-identified as having used methamphetamine at least weekly for the past 3 months. Participants were randomized on a 1:1 ratio to receive either access to the web-based app for 6 weeks or a waitlist control group. Both groups received access to a website with harm minimization information. The primary outcome was days of methamphetamine use in the past 4 weeks assessed at 1, 2, and 3 months post randomization. Secondary outcomes included severity of methamphetamine dependence (Severity of Dependence Scale [SDS]), psychological distress (Kessler 10 [K10]), help-seeking behavior, and days spent out of role due to methamphetamine use. RESULTS Participants (N=210) were randomized to receive either access to the web-based app (n=115) or the waitlist control condition (n=95). Follow-up was 63% at 1 month, 57% at 2 months, and 54% at 3 months. There were no significant group differences in days of methamphetamine use in the past 4 weeks at 1 the month (mean difference 0.2 days, 95% CI –1.5 to –2), 2 months (mean difference 0.6 days, 95% CI –1 to 2.4 days) or 3 months (mean difference 1.4 days, 95% CI –0.3 to 3.3 days) follow-up. There were no significant group differences in K10 scores, SDS scores, days out of role, or help-seeking at any of the 3 follow-up timepoints. There was poor adherence to the web-based app, only 20% of participants in the intervention group returned to the web-based app after their initial log-in. Participants cited personal issues and forgetting about the web-based app as the most common reasons for nonadherence. CONCLUSIONS We found poor engagement with this web-based app. The web-based app had no significant effects on methamphetamine use or psychosocial well-being. Poor adherence and low follow-up hindered our ability to accurately evaluate the effectiveness of the web-based app. Future web-based apps for this population need to consider methods to increase participant engagement. CLINICALTRIAL Australian New Zealand Clinical Trials Registry ACTRN12619000134123p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376088 INTERNATIONAL REGISTERED REPORT RR2-10.2196/14084

Background and Aims: Few studies of the impacts of the coronavirus disease 2019 (COVID‐19) public health measures on drug markets and drug use patterns have used longitudinal data. We aimed to examine whether COVID‐19 measures were associated with increases in methamphetamine price, decreases in methamphetamine use frequency and subsequent changes in secondary outcomes of other drug use frequency in metropolitan Melbourne and regional Victoria.Design: Longitudinal analysis framework was used from a longitudinal cohort of people who use methamphetamine.Setting: Victoria state, Australia.Participants: One hundred eighty‐five VMAX study participants who reported a methamphetamine purchase after the onset of the pandemic were used for the price paid analysis. Methamphetamine or other drug use frequency analysis was performed using 277 participants who used methamphetamine during the pandemic or in the year before the pandemic.Measurements: Price paid per gram of methamphetamine derived from the most recent purchase price and most recent purchase quantity. Frequency of methamphetamine and other drug use measured as the average number of days per week used in the last month.Findings: Compared with pre‐COVID‐19 period, methamphetamine prices increased by AUD351.63 (P value P value P value P value P value = 0.006) that was not offset by any changes in the frequency of use of other drugs such as alcohol, tobacco or other illicit drugs.Conclusion: COVID‐19 public health measures in Victoria state, Australia, appear to have been associated with major price changes in the methamphetamine market and decreased frequency of use of the drug.

Introduction: Around half of Australian students aged 16–17 are estimated to have drunk alcohol in the past month, with 11% drinking at ‘risky’ levels. This study investigated: (i) how many Australian adolescents aged 16–17 had parental permission to drink at home in 2016/17 and whether prevalence differed by adolescent sex; (ii) whether adolescents allowed to drink at home had drunk more recently and were drinking greater quantities; (iii) if adolescents allowed to drink at home experienced more alcohol‐related harms; and (iv) if parental drinking patterns were associated with permitting adolescents to drink at home.Methods: Data from Wave 7 of the Longitudinal Study of Australian Children were used. Descriptive and bivariate analyses addressed Aims i–iii. Nested multivariable logistic regression models addressed aim iv.Results: In 2016/17, 28% of Australian adolescents aged 16–17 were allowed to drink alcohol at home. More adolescents with permission had drunk alcohol in the past month (77% vs. 63% of those without permission). There was no difference in quantity of alcohol consumed in the past week between groups. More adolescents allowed to drink at home had experienced alcohol‐related harm compared to those without permission (23% vs. 17%). In multivariable analyses, alcohol consumption by primary parents was associated with an increased likelihood of allowing adolescents to drink at home.Discussions and Conclusions: In order to reduce adolescent alcohol use and associated harms, parents should avoid permitting alcohol use among adolescents at home. Frequent (twice or more/week) primary parental alcohol consumption was especially associated with greater odds of allowing adolescents to drink at home.

Background: Mental health disorders are ranked globally as the single largest contributor to non-fatal ill-health. Social support can be a means of reducing and managing depression. However, depression can also impact on a person’s level of social support. Objective: As men typically have fewer sources of social support than females, this study investigated the bi-directional associations between depressive symptoms and perceived levels of social support among Australian males, aged 18–63. Methods: Three waves of panel data from Ten to Men: The Australian Longitudinal Study on Male Health collected over 7 years (2013–2020) were used. A random intercept cross-lagged panel analysis with 5112 participants was undertaken. Mediating effects and indirect and total effects for lagged and cross-lagged pathways were also examined. Results: Over time, greater social support was found to be associated with lower depression levels, and simultaneously greater levels of depression was found to be associated with lower levels of social support. Standardised cross-lagged effects between waves were mostly similar (β = 0.10). However, mediation analyses identified that only the total effect size of the association for depression at wave 1 predicting social support at wave 3 (β = −0.29) was significant. Mediated effects of social support at wave 1 predicting depression at wave 3 were not significant. Limitations: These include the number of years between each wave, and data were collected during the COVID pandemic. Conclusion: The study provides robust longitudinal evidence supporting the notion that social support and depression are both a cause and consequence of the other. However, the long-term effects of depression reducing social support were longer lasting than the effects of social support reducing depression.