Directly observed antidepressant medication treatment and HIV outcomes among homeless and marginally housed HIV-positive adults: a randomized controlled trial.

Objectives: We assessed whether directly observed fluoxetine treatment reduced depression symptom severity and improved HIV outcomes among homeless and marginally housed HIV-positive adults in San Francisco, California, from 2002 to 2008.

Methods: We conducted a nonblinded, randomized controlled trial of once-weekly fluoxetine, directly observed for 24 weeks, then self-administered for 12 weeks (n = 137 persons with major or minor depressive disorder or dysthymia). Hamilton Depression Rating Scale score was the primary outcome.

Tripling of methamphetamine/amphetamine use among homeless and marginally housed persons, 1996-2003.

Methamphetamine/amphetamine (MA)-related morbidity and mortality has been increasing in the United States. MA use is associated with high-risk sexual behavior and syringe-sharing practices. Homeless and marginalized housed persons (H/M) have high rates of substance use and mental health disorders.

Testing strategy to identify cases of acute hepatitis C virus (HCV) infection and to project HCV incidence rates.

Surveillance for hepatitis C virus (HCV) is limited by the challenge of differentiating between acute and chronic infections. In this study, we evaluate a cross-sectional testing strategy that identifies individuals with acute HCV infection and we estimate HCV incidence. Anti-HCV-negative persons from four populations with various risks, i.

BRIEF REPORT: the aging of the homeless population: fourteen-year trends in San Francisco.

Background: Homelessness is associated with high rates of health and substance use problems.

Objective: To examine trends in the age, housing, health status, health service utilization, and drug use of the homeless population over a 14-year period.

Design: Serial cross-sectional.

Revolving doors: imprisonment among the homeless and marginally housed population.

Objectives: We studied a sample of homeless and marginally housed adults to examine whether a history of imprisonment was associated with differences in health status, drug use, and sexual behaviors among the homeless.

Methods: We interviewed 1426 community-based homeless and marginally housed adults. We used multivariate models to analyze factors associated with a history of imprisonment.

Heroin overdose among young injection drug users in San Francisco.

Objectives: We sought to identify prevalence and predictors of heroin-related overdose among young injection drug users (IDU).

Methods: A total of 795 IDU under age of 30 years were interviewed in four neighbourhoods in San Francisco, California, USA. Participants were recruited as part of a broader study of HIV, hepatitis B and C among injecting drug users in San Francisco using street outreach and snowball techniques.

Cash benefits are associated with lower risk behavior among the homeless and marginally housed in San Francisco.

To address the widespread debate about the role of public assistance to the urban poor, the authors determined characteristics of individuals receiving cash assistance and explored the link between cash subsidies and risk behavior. From 1999 to 2000, a representative sample of homeless and marginally housed (HMH) adults living in San Francisco was recruited and interviewed about subsidies, shelter, jail, and drug use. Among 1,156 adults, 87% were ever homeless, 22% currently injected drugs, and 14% were HIV positive.

Antiretroviral therapy, hepatitis C virus, and AIDS mortality among San Francisco's homeless and marginally housed.

Mortality has declined in most HIV-infected populations yet remains high among those with barriers to accessing antiretroviral (ARV) therapy. We sought to determine predictors of death in a group of HIV-infected homeless persons in San Francisco. Between 1996 and 2002, quarterly interviews and blood draws were conducted.

Adherence to highly active antiretroviral therapy in the homeless population in San Francisco: a prospective study.

Background: We examined adherence to highly active antiretroviral therapy (HAART) in the homeless population, a population thought to be at high risk for poor adherence to therapy and for development of drug-resistant strains of human immunodeficiency virus (HIV).

Methods: We performed a 12-month prospective study of 148 persons receiving HAART who were identified in a stratified screening of the homeless and marginally housed. We sampled in lunch lines, shelters, and hotels in 3 neighborhoods of San Francisco, California.

HIV seroprevalence among homeless and marginally housed adults in San Francisco.

Objectives: We report HIV seroprevalence and risk factors for urban indigent adults.

Methods: A total of 2508 adults from shelters, meal programs, and low-cost hotels received interviews, blood tests, and tuberculosis screening.

Results: Seroprevalence was 10.

Are untimed antiretroviral drug levels useful predictors of adherence behavior?

We examined cross-sectionally the relationship between untimed drug levels and adherence in 83 individuals. Abnormally low untimed antiretroviral drug levels were sensitive in identifying individuals adherent to 60% or less of medication doses over 3 - 5-week period. An abnormally low drug level was associated with a higher viral load.

Hepatitis C virus infection in San Francisco's HIV-infected urban poor.

Objective: To measure Hepatitis C Virus (HCV) prevalence, incidence, and initiation of HCV therapy in a representative HIV-infected cohort of the urban poor.

Design: Cohort analysis.

Setting: The Research and Access to Care for the Homeless (REACH) Cohort is a systematic sample of HIV-infected marginally housed individuals identified from single-room occupancy hotels, homeless shelters, and free lunch programs in San Francisco.

Paradoxes of adherence and drug resistance to HIV antiretroviral therapy.

Public health debates about providing HIV antiretroviral therapy to impoverished populations have centred on the relationship between adherence and risk of drug resistance. Recent data indicate that each antiretroviral therapeutic class has a unique adherence-resistance relationship. Resistance to single protease inhibitor therapy occurs most frequently at moderate to high levels of adherence, resistance to non-nucleoside reverse transcriptase inhibitor therapy occurs at low to moderate levels of adherence, and resistance to ritonavir-boosted protease inhibitor therapy is most likely to occur at middle ranges of adherence.

No door to lock: victimization among homeless and marginally housed persons.

Background: Homeless persons experience high rates of sexual and physical assault; homeless women are thought to be at highest risk. To determine the prevalence, distribution, and factors associated with sexual and physical assault, we surveyed homeless and marginally housed adults in San Francisco, Calif.

Methods: We interviewed 2577 respondents about their history of recent sexual and physical assault, housing history, sexual practices, substance use, health status, and criminal justice history.

Depression and drug use impact health status among marginally housed HIV-infected individuals.

A representative sample of HIV-positive homeless and marginally housed individuals completed SF-36 health surveys and responses were analyzed for associations with sociodemographic, health, health care, and drug use variables. Among 330 respondents, 83% were male, 43% were African American, and the median age was 39 years. Negative associations were found between female gender and vitality as well as physical functioning; older age and physical functioning; drug use or drug treatment and role-emotional, social functioning, body pain, as well as vitality; health care utilization and depression with all scales.

Fatal heroin-related overdose in San Francisco, 1997-2000: a case for targeted intervention.

Heroin-related overdose is the single largest cause of accidental death in San Francisco. We examined demographic, location, nontoxicological, and toxicological characteristics of opiate overdose deaths in San Francisco, California. Medical examiner's case files for every opioid-positive death from July 1, 1997, to June 30, 2000, were reviewed and classified as overdose deaths or other.

Gender differences in sexual and injection risk behavior among active young injection drug users in San Francisco (the UFO Study).

Female injection drug users (IDUs) represent a large proportion of persons infected with HIV in the United States, and women who inject drugs have a high incidence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. Therefore, it is important to understand the role of gender in injection risk behavior and the transmission of blood-borne virus. In 2000-2002, 844 young (<30 years old) IDUs were surveyed in San Francisco.

Witnessing heroin-related overdoses: the experiences of young injectors in San Francisco.

Aims: Assessment of young injectors' exposure and response to others' heroin-related overdose.

Design: Cross-sectional survey.

Setting: San Francisco, CA, United States.

Hepatitis C virus seroconversion among young injection drug users: relationships and risks.

The present study examined reasons for the high incidence of hepatitis C virus (HCV) infection among young injection drug users (IDUs). IDUs <30 years old who tested negative for HCV antibody were enrolled in a prospective cohort. Risk factors for seroconversion were examined using time-dependent regression analyses: 48 of 195 IDUs seroconverted to HCV, for an incidence rate of 25.

Emergency department use among the homeless and marginally housed: results from a community-based study.

Objectives: This study examined factors associated with emergency department use among homeless and marginally housed persons.

Methods: Interviews were conducted with 2578 homeless and marginally housed persons, and factors associated with different patterns of emergency department use were assessed in multivariate models.

Results: Findings showed that 40.

Population-based community prevalence of methicillin-resistant Staphylococcus aureus in the urban poor of San Francisco.

The study objective was to determine the prevalence and risk factors for nasal colonization with Staphylococcus aureus and methicillin resistance among the urban poor and to compare antibiotic resistance and genetic similarity to concurrently collected clinical isolates of methicillin-resistant S. aureus (MRSA). A population-based community sample of 833 homeless and marginally housed adults were cultured and compared with 363 clinical isolates of MRSA; 22.