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Chemsex Screening and Intervention Training for Urban Primary Care Providers

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Chemsex Screening and Intervention Training for Urban Primary Care Providers Yale University EliScholar – A Digital Platform for Scholarly Publishing at Yale Yale School of Medicine Physician Associate Program Theses School of Medicine 7-31-2020 Chemsex Screening and Intervention Training for Urban Primary Care Providers Jona Tanguay Yale Physician Associate Program, [email protected] Follow this and additional works at: https://elischolar.library.yale.edu/ysmpa_theses Recommended Citation Tanguay, Jona, "Chemsex Screening and Intervention Training for Urban Primary Care Providers" (2020). Yale School of Medicine Physician Associate Program Theses. 33. https://elischolar.library.yale.edu/ysmpa_theses/33 This Open Access Thesis is brought to you for free and open access by the School of Medicine at EliScholar – A Digital Platform for Scholarly Publishing at Yale. It has been accepted for inclusion in Yale School of Medicine Physician Associate Program Theses by an authorized administrator of EliScholar – A Digital Platform for Scholarly Publishing at Yale. For more information, please contact [email protected]. CHEMSEX SCREENING AND INTERVENTION TRAINING FOR URBAN PRIMARY CARE PROVIDERS A Thesis Presented to The Faculty of the School of Medicine Yale University In Candidacy for the degree of Master of Medical Science 2020 Jona Tanguay, PA-SII John Encandela, PhD Class of 2020 Associate Professor Yale Physician Associate Program Department of Psychiatry Yale School of Medicine i TABLE OF CONTENTS TABLE OF CONTENTS .................................................................................................... ii LIST OF TABLES ............................................................................................................. iv LIST OF FIGURES ........................................................................................................... iv ABSTRACT .........................................................................................................................v CHAPTER 1 – INTRODUCTION .....................................................................................1 1.1 Background ................................................................................................................1 1.1.1 Chemsex Proliferation and Associated Risks .....................................................1 1.1.2 Epidemiology of Chemsex ..................................................................................2 1.1.3 Barriers and Opportunities in Treatment ............................................................4 1.2 Statement of the Problem ...........................................................................................6 1.3 Goals and Objectives .................................................................................................6 1.4 Hypothesis..................................................................................................................7 1.5 Definitions..................................................................................................................7 1.6 References ..................................................................................................................8 CHAPTER 2 – REVIEW OF THE LITERATURE ..........................................................10 2.1 Introduction ..............................................................................................................10 2.2 Review of Relevant Literature .................................................................................11 2.2.1 Primary Care and Sexual and Gender Minority Health ....................................11 2.2.2 Screening in Men Who Have Sex With Men....................................................13 2.2.3 Continuing Medical Education Activities to Improve Screening Rates ...........15 2.3 Review of Literature to Identify Possible Confounding Variables ..........................20 2.4 Review of Relevant Methodology ...........................................................................21 2.4.1 Overview of Stepped Wedge Cluster Randomized Trial Design .....................21 2.4.2 Sample Size in Stepped Wedge Cluster Randomized Trials ............................22 2.4.3 Intervention and Outcome Variables ................................................................23 2.5 Conclusion ...............................................................................................................24 2.6 References ................................................................................................................25 CHAPTER 3 – STUDY METHODS ................................................................................29 3.1 Study Design ............................................................................................................29 3.2 Study Population and Sampling ...............................................................................29 3.3 Subject Protection and Confidentiality ....................................................................31 3.4 Recruitment ..............................................................................................................32 3.5 Study Variables and Measures .................................................................................33 3.6 Assignment of Intervention and Blinding ................................................................34 ii 3.7 Adherence ................................................................................................................35 3.8 Data Collection ........................................................................................................35 3.9 Sample Size Calculation ..........................................................................................36 3.10 Analysis..................................................................................................................39 3.11 Timeline and Resources .........................................................................................40 3.12 References ..............................................................................................................41 CHAPTER 4 – CONCLUSION .......................................................................................42 4.1 Advantages and Disadvantages................................................................................42 4.2 Public Health Significance .......................................................................................44 4.3 References ................................................................................................................45 APPENDICES ...................................................................................................................46 Appendix A: Gay Affirmative Practice Scale ................................................................46 Appendix B: Informed Consent Form ...........................................................................48 Appendix C: Provider Eligibility Form .........................................................................52 Appendix D: Chemsex Printed Materials ......................................................................53 Appendix E: Chemsex Online Resource Guide .............................................................56 Appendix F: Didactic Session Content Blue Print .........................................................56 BIBLIOGRAPHY ..............................................................................................................57 iii List of Tables Table 1. Chemsex Prevalence ..........................................................................................3 List of Figures Figure 1. Study Design .................................................................................................29 Figure 2. P1 Sensitivity Analysis ..................................................................................38 iv ABSTRACT Chemsex, defined as the use of drugs before or during sex to enhance and facilitate the experience, is increasingly prevalent in urban populations of men who have sex with men. Chemsex is associated with higher risks of sexually transmitted infections including HIV, and it has negative effects on mental health and productivity. However, chemsex is under- or un-addressed in most primary care practices, and chemsex users rarely present to specialists in addiction medicine. We hypothesize that an integrative, multimodal training program for urban primary care providers in chemsex identification and harm reduction will increase the proportion of male patients screened for chemsex. We propose a stepped-wedge cluster randomized trial to measure baseline prevalence of screening and determine the effect of training on the relative risk of screening. Screening and appropriate safety counseling can stem the progression of the epidemic and reduce the burden of consequences associated with chemsex. v CHAPTER ONE - INTRODUCTION 1.1 Background 1.1.1 Chemsex Proliferation and Associated Risks Chemsex can be defined as the use of drugs before or during sexual experiences in order to facilitate or enhance the experience1. Typical substances identified in the literature associated with chemsex include crystal methamphetamine, gamma hydroxybutyric acid (GHB), gamma butyrolactone (GBL), and less frequently inhaled nitrates (“poppers”), phosphodiesterase-5 inhibitors (Viagra), and 3,4-Methylenedioxy methamphetamine (“ecstasy”) 2. Chemsex is a distinct form of recreational drug use, with its own culture and language allowing users to communicate, source drugs,
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