ABSTRACT Background and Aims People with mental health disorders experience disproportionately poor oral health and face persistent barriers to maintaining oral hygiene. This study aimed to assess the feasibility of supporting oral hygiene routines in community‐dwelling adults using a self‐regulation‐based education approach informed by Self‐Determination Theory, to identify practical strategies for integrated mental and oral health care. Methods Thirty‐nine participants from two community mental health centers received single‐session oral health education at baseline (T1). Oral health status was assessed using the Oral Health Assessment Tool and the Silness and Loe Plaque Index. Oral health knowledge and motivation were measured at T1, 4 weeks (T2) and 8 weeks (T3) using a knowledge questionnaire, the Treatment Self‐Regulation Questionnaire, the Perceived Competence Scale and the Relative Autonomy Index (RAI). At T2 and T3, participants received plaque feedback, reinforcement of the key message and motivational support. Results Most participants were aged 50 years or older. At baseline, over half of the participants demonstrated poor oral cleanliness, and fewer than one‐third had healthy natural teeth. Plaque scores improved significantly from T1 to T2 (mean reduction 21%, p < 0.001), but plateaued by T3. Oral health knowledge improved across all domains, particularly in understanding oral‐systemic links and recognizing oral disease risk factors. Autonomous motivation was modest at T1 (RAI = + 0.15), declined at T2 (RAI = −0.93), and partially recovered at T3 (RAI = −0.57), indicating variability in motivational regulation over time. Conclusion Single‐session oral health education was associated with short‐term improvements in knowledge and plaque control; however, sustaining behavior change and motivation likely requires ongoing reinforcement, support and repeated engagement. Visual feedback, structured routines and collaboration between mental health and oral health services may facilitate the integration of oral care into routine community mental health practice.

INTRODUCTION:Methadone-to-buprenorphine transfers (MBT) are increasingly common as buprenorphine use expands. Evidence describing patient experience of withdrawal during MBT in real-world populations is limited. This study aimed to characterise withdrawal trajectories during MBT and examine whether psychosocial and clinical factors influence the severity or timing of withdrawal. METHODS:This analysis used data from a prospective, non-randomised clinical trial comparing low-dose and stop-and-start MBT techniques (n = 117). Covariates included methadone dose, duration on methadone, transfer setting, study arm, withdrawal expectancy, psychological distress, substance use and unstable housing. Withdrawal was assessed daily using the Clinical Opioid Withdrawal Scale (COWS) and Short Opiate Withdrawal Scale. RESULTS:Ninety-four participants (80.3%) completed transfer. Withdrawal followed a consistent trajectory across the cohort, peaking around Day 5. Psychosocial and clinical characteristics-including unstable housing, substance use, psychological distress and methadone dose-were not associated with withdrawal severity or timing. Compared with stop-and-start transfer, low-dose transfer was associated with a delayed and larger increase in objective withdrawal: peak COWS occurred 2.3 days later (95% CI 0.3-4.3) and the largest one-day increase was 3.8 points higher (95% CI 0.5-7.0). DISCUSSION AND CONCLUSIONS:Patient factors often considered barriers to MBT were not associated with withdrawal severity or timing. Low-dose transfer was associated with a delayed and slightly higher withdrawal peak but did not reduce overall transfer success. These findings suggest that withdrawal during MBT follows a broadly similar trajectory across patients with differing psychosocial complexity. Planning for expected withdrawal, rather than selecting patients based on perceived complexity, may be more clinically relevant.

INTRODUCTION:Opioid agonist therapies (OAT) reduce adverse outcomes of illicit opioid use, with individual preferences potentially improving treatment outcomes. We explored preferences for OAT and associated factors in a national sample of people with opioid dependence. METHODS:This cross-sectional study recruited 400 participants (October 2020-April 2021) across Australia (excluding Tasmania) through snowball sampling. Participants completed an interviewer-administered questionnaire on sociodemographic and drug use characteristics. Multivariable logistic regression assessed factors associated with methadone preference (vs. buprenorphine). RESULTS:Among all participants (median age 45, 41% female, 87% ever received OAT), 92% (n = 366) indicated a preference for receiving OAT (vs. not receiving OAT) and 96% of those (n = 352) preferred a particular type of OAT. Among 366 with a stated preference, 61% (n = 216) preferred methadone and 39% (n = 136) preferred buprenorphine. Among those preferring buprenorphine (n = 136), 50% (n = 68) preferred buprenorphine ± naloxone and 50% (n = 68) preferred long-acting injectable buprenorphine. Independent correlates of preferring methadone included past month heroin use (aOR 1.78, 95% CI 1.06-3.00) and non-prescribed pharmaceutical opioid use (aOR 2.23, 95% CI 1.07, 4.95), and any prior receipt of methadone treatment (aOR 6.54, 95% CI 2.66, 17.91). Among those receiving OAT, a higher proportion of people currently receiving buprenorphine preferred their medication (61/66, 92%) compared to methadone recipients (180/235, 77%). DISCUSSION AND CONCLUSIONS:Nearly all participants preferred OAT, mostly reflecting prior experiences, underscoring the need for expanded access to OAT in Australia. Given the multiple stated preferences, OAT options should include a variety of treatment options aligned with patient preferences, including expanded take-home options.

INTRODUCTION:Alcohol and other drug use is common in Australia, yet laypeople struggle to detect intoxication in others via observation. We examined cues laypeople use to detect alcohol and cannabis intoxication to explore whether knowledge (in)accuracy may account for intoxication detection difficulties. METHODS:Participants (N = 467; 77.7% female) completed a survey assessing familiarity with/use of alcohol and cannabis. Participants reported the cues they use to detect whether a person is intoxicated with alcohol and cannabis and rated the difficulty of such detection. Researchers assessed reported cues for accuracy and organised them into descriptive categories. Participant characteristics were examined as predictors of cue accuracy. RESULTS:Alcohol intoxication detection was viewed as easy, while difficulty ratings for cannabis intoxication detection varied. Most reported cues to alcohol and cannabis intoxication were accurate. However, non-responses were common across both substances. Participants provided more cues-including accurate cues-to alcohol intoxication compared to cannabis intoxication. Cannabis consumption on a 'monthly'/'less than monthly' basis was associated with greater cue accuracy, and participants who viewed cannabis intoxication detection as difficult reported less accurate cannabis cues. DISCUSSION AND CONCLUSIONS:Accurate assessment of intoxication is essential in many high-risk contexts (e.g., healthcare, criminal justice, road and workplace safety). Our findings suggest that while laypeople can provide some accurate cues to alcohol and cannabis intoxication, substantial knowledge gaps exist-especially for cannabis. Education about an extensive range of cues to intoxication may improve intoxication detection in these contexts.

BACKGROUND:Understanding patient preferences for hepatitis C virus (HCV) testing is essential to improve uptake and support elimination efforts. Despite innovative testing modalities, limited research examines how preferences influence testing choices. This study compared the uptake of HCV testing modalities when participants were given a choice. METHODS:People at risk of HCV were recruited from community sites in the Australian Hepatitis C Point-of-Care Testing Program. Participants used a visual aid outlining test features, including time to result and collection methods. Those reporting prior HCV infection were offered staff-assisted HCV RNA tests [point-of-care XpertⓇ HCV Viral Load Fingerstick (result in 60 min) or dried blood spot (DBS) (1-2 weeks)]. Participants without prior HCV infection were offered self-administered INSTIⓇ HCV antibody (1 min), staff-assisted INSTIⓇ HCV antibody (1 min), staff-assisted BiolineⓇ HCV antibody (5-20 min), and HCV RNA tests. Participants completed their preferred test, a survey, and received AUD$20 reimbursement. Logistic regression evaluated factors associated with preference for point-of-care RNA testing in those with and without prior HCV infection. RESULTS:404 people were enrolled (27% female, 75% ever injected drugs). Among those with a history of HCV (n=129), 91% (n=117) selected point-of-care RNA testing and cited the short time to result (52%) and wanting to find out the RNA result today (21%) as key reasons. Among those without a history of HCV (n=275), 72% (n=199) selected staff-assisted INSTIⓇ antibody testing, 19% (n=51) selected point-of-care RNA testing, and 4% (n=10) chose self-administered INSTIⓇ antibody testing. Key reasons for selecting staff-assisted INSTIⓇ included short time to result (75%) and reduced clinic time (8%). Factors associated with selecting point-of-care RNA testing among those without prior infection included recent injecting drug use, homelessness and recent opioid agonist therapy. CONCLUSION:Findings highlight the importance of offering rapid, staff-assisted HCV testing to improve uptake among at-risk populations.

Police officers must frequently decide whether an individual has consumed alcohol or cannabis. This survey of 128 Australian Federal Police officers investigated the indicators officers use to determine whether someone is intoxicated by alcohol or cannabis, the validity of these indicators, and the factors (experience, gender, training, and confidence) that predict indicator validity. For both alcohol and cannabis, officers listed up to three visual and three verbal cues they would use to determine whether someone was intoxicated by the substance. They also provided information about their work history, demographics, training, and confidence in intoxication detection. Overall, 538 alcohol and 338 cannabis indicators were reported. Greater work experience was associated with decreased validity of cannabis indicators. Officers reported more indicators for alcohol than cannabis, but these were no more valid. The findings provide insight into what officers use to make judgments about intoxication, creating opportunities to inform police training and practices.

Introduction Methamphetamine dependence is associated with psychological distress (stress, anxiety, and depression). Insomnia is common in this population, yet its association with distress remains underexplored. This study examined the relationship between insomnia severity and psychological distress in treatment-seeking individuals with methamphetamine dependence. Methods This is a secondary cross-sectional analysis of baseline data from 152 participants enrolled in a randomised controlled trial of lisdexamfetamine versus placebo for methamphetamine dependence. Insomnia severity was assessed using the Insomnia Severity Index (ISI), and distress was measured via the Depression Anxiety and Stress Scale (DASS-21). Associations were analysed using Spearman’s correlations and regression models adjusted for demographics, methamphetamine use, concomitant medication, and co-occurring distress. Results Insomnia severity showed moderate correlations with depression, anxiety, stress, and total distress (ρ = 0.46–0.59, p < .001). In adjusted models, insomnia remained associated with distress: each 1-point ISI increase related to a 2.1–2.5% rise in DASS-21 depression and stress scores (β = 0.021–0.025, p = .003–.007), and a 6.5% increase in total scores (β = 0.063, p < .001); the association with anxiety was attenuated. Conclusions Our study identified insomnia as an independent correlate of psychological distress in treatment-seeking individuals with methamphetamine dependence. Findings underscore sleep problems’ relevance and support further research into sleep-focused interventions.

Background: Harmful alcohol use among some groups of women is increasing globally. Despite being susceptible to negative health impacts, women are less likely than men to seek treatment and can face barriers of access, acceptability, and affordability to treatment. Objectives: This study aims to identify key factors affecting treatment access for women with alcohol use disorders (AUDs), and to identify individual, social, and organizational factors that facilitate treatment uptake. Design: Systematic review with narrative synthesis, guided by a social-ecological framework to identify organizational, individual, and societal enablers of treatment uptake among women with AUDs. Methods: Six electronic databases were systematically searched for studies published between 2000 and 2024 in high-income countries. Data on study design, sample characteristics, interventions, and outcomes were extracted and synthesized. Results: Twenty-five studies, conducted in various countries, identified factors affecting women’s treatment uptake. Key themes included individual motivators linked to problem perception, alcohol use severity, age, relationships, and family cohesion; societal motivators influenced by social norms and relationships; and organizational themes of accessibility, acceptability, and affordability were positively affected by healthcare provider knowledge of treatment options. Conclusion: Facilitating factors of treatment uptake for women with AUDs include relational and personal goals, societal environments, normative expectations, and the knowledge of alcohol treatment from individual and organizational perspectives. Sober curiosity movements, alcohol-free months, and digital strategies can positively impact women’s alcohol treatment uptake.

Ketamine is a restricted and regulated medication in Australia and New Zealand, which has implications when considering treatment for patients with treatment-resistant depression and a history of illicit drug use, abuse or dependence. Regulations governing prescription of ketamine for treatment-resistant depression vary between jurisdictions in Australia and New Zealand, though most restrict use in those with drug dependence. There is substantial variation in definitions of drug dependence used in each jurisdiction, and between the legal and clinical definitions, with the latter specified in the current International Classification of Diseases, Eleventh Revision and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. This paper reviews the literature assessing the risk of ketamine misuse and dependence in patients with a history of illicit drug use, abuse or dependence and presents recommendations for psychiatrists who prescribe ketamine in such patients with treatment-resistant depression.

OBJECTIVES:Although factors associated with alcohol use have been researched at a population level, descriptions of the alcohol and other drug (AOD) treatment-seeking population in New South Wales (NSW), Australia, are limited. This study addresses this gap by analyzing sociodemographic and health characteristics in the NSW AOD treatment-seeking population. METHODS:Self-reported Australian Treatment Outcomes Profile data on substance use, health ratings, and sociodemographic factors were acquired from public AOD services (offering services from counseling to ambulatory/inpatient withdrawal management) in 6 administrative health districts from 2016 to 2019 (n = 14,287). Gaussian and multiple logistic regressions were conducted to examine associations between these factors and alcohol consumption quantity. RESULTS:Data were analyzed for patients seeking treatment for alcohol consumption specifically (n = 5929; median age, 44 years; 65% male). Valid alcohol consumption data were available for 5460 patients, among whom the mean volume of alcohol consumed was 311 standard drinks (3110 grams of ethanol) over the past 28 days and 15 standard drinks (150 grams of ethanol) per occasion. Higher volumes were consumed by males and those with recent experiences of violence and/or injecting drug use. Caring for children younger than 5 years and having above-median health ratings were associated with lower alcohol consumption. CONCLUSIONS:This study contributes to the characterization of the NSW public AOD treatment population and identifies associations between alcohol consumption, sociodemographic factors, and health ratings among people seeking treatment for alcohol consumption. Findings point towards multilevel assessment and comprehensive interventions for people engaging in treatment for alcohol use. Future research should address barriers to treatment.

INTRODUCTION:Developmental outcomes for children and young people with fetal alcohol spectrum disorder (FASD) are optimised if their needs are identified early. Yet, health workers miss vital opportunities to identify and respond to FASD due to a lack of support, knowledge and skills. METHODS:Through surveys and interviews, our study investigated what child and family health workers in an Australian metropolitan local health district understand, already do and want to learn about FASD. RESULTS:The study provided evidence of low FASD knowledge and confidence and a lack of referral options with some workers 'patching together' care planning in a 'referral black hole'. Qualitative data provided insight into how skilled clinicians engage families in FASD assessment and negotiate gaps in clinical knowledge. DISCUSSION AND CONCLUSIONS:Health workers in this study requested high-quality training and the development of FASD practice guidelines to improve role clarity and clinical impact when working with FASD populations.

OBJECTIVE:There have been no well-controlled and well-powered comparative trials of topiramate with other pharmacotherapies for alcohol use disorder (AUD), such as naltrexone. Moreover, the literature is mixed on the effects of two polymorphisms-rs2832407 (in GRIK1) and rs1799971 (in OPRM1)-on response to topiramate and naltrexone, respectively. The authors sought to examine the comparative effectiveness of topiramate and naltrexone in improving outcomes in AUD and to examine the role of the rs2832407 and rs1799971 polymorphisms, respectively, on response to these medications.METHODS:In a 12-week, double-blind, placebo-controlled, randomized, multisite, genotype-stratified (rs2832407 and rs1799971) clinical trial comparing topiramate and naltrexone in treating AUD, 147 patients with AUD were randomly assigned to treatment with topiramate or naltrexone, stratified by genotype (rs2832407*CC and *AC/AA genotypes and rs1799971*AA and *AG/GG genotypes). The predefined primary outcome was number of heavy drinking days per week. Predefined secondary outcomes included standard drinks per drinking day per week, body mass index (BMI), craving, markers of liver injury, mood, and adverse events.RESULTS:For the number of heavy drinking days per week, there was a near-significant time-by-treatment interaction. For the number of standard drinks per drinking day per week, there was a significant time-by-treatment interaction, which favored topiramate. There were significant time-by-treatment effects, with greater reductions observed with topiramate than naltrexone for BMI, craving, and gamma-glutamyltransferase level. Withdrawal due to side effects occurred in 8% and 5% of the topiramate and naltrexone groups, respectively. Neither polymorphism showed an effect on treatment response.CONCLUSIONS:Topiramate is at least as effective and safe as the first-line medication, naltrexone, in reducing heavy alcohol consumption, and superior in reducing some clinical outcomes. Neither rs2832407 nor rs1799971 had effects on topiramate and naltrexone treatments, respectively.

BACKGROUND:The most recent formulation of buprenorphine treatment is extended-release depot injections (BUP-XR) that are administered subcutaneously by health care professionals. This study aimed to observe treatment outcomes of BUP-XR delivered in standard practice during a 96-week follow-up period in a community setting. METHODS:This study is an extension of the CoLAB study, a prospective single-arm, multicentre, open label trial (N=100, 7 sites in Australia) among people with opioid dependence who received monthly injections of BUP-XR to evaluate the retention in treatment. Participants were followed for 96 weeks, comprising 48 weeks of the CoLAB study followed by a 48-week extension. RESULTS:Of 100 participants at baseline, 47 were retained on BUP-XR at 96 weeks. The median time retained on monthly depot was 90 weeks. Heroin use (adjusted OR=0.19, P=0.012) in the month prior to baseline was associated with lower odds of retention on BUP-XR. Older age at first opioid use (adjusted OR= 1.08, P=0.009) and longer duration in OAT at baseline (adjusted OR= 1.12, P=0.001) were associated with increased retention. Prevalence of past four-weeks opioid use was estimated at 4% at 96 weeks of treatment (prevalence 0.04, 95%CI: 0.00-0.11) compared to 15% at baseline. Quality of life and medication treatment satisfaction improved over time for those retained in treatment. CONCLUSION:This is one of the few studies to describe long term (96 week) retention in treatment with BUP-XR in a community setting. It displayed retention rates with 47% of participants completing 96 weeks of treatment with BUP-XR. Patient reported outcomes suggest improvements in client wellbeing. FUNDING:Indivior.

Background Cannabis use disorder (CUD) is increasingly common and contributes to a range of health and social problems. Cannabidiol (CBD) is a non-intoxicating cannabinoid recognised for its anticonvulsant, anxiolytic and antipsychotic effects with no habit-forming qualities. Results from a Phase IIa randomised clinical trial suggest that treatment with CBD for four weeks reduced non-prescribed cannabis use in people with CUD. This study examines the efficacy, safety and quality of life of longer-term CBD treatment for patients with moderate-to-severe CUD. Methods/Design A phase III multi-site, randomised, double-blinded, placebo controlled parallel design of a 12-week course of CBD to placebo, with follow-up at 24 weeks after enrolment. Two hundred and fifty adults with moderate-to-severe CUD (target 20% Aboriginal), with no significant medical, psychiatric or other substance use disorders from seven drug and alcohol clinics across NSW and VIC, Australia will be enrolled. Participants will be administered a daily dose of either 4 mL (100 mg/mL) of CBD or a placebo dispensed every 3-weeks. All participants will receive four-sessions of Cognitive Behavioural Therapy (CBT) based counselling. Primary endpoints are self-reported cannabis use days and analysis of cannabis metabolites in urine. Secondary endpoints include severity of CUD, withdrawal severity, cravings, quantity of use, motivation to stop and abstinence, medication safety, quality of life, physical/mental health, cognitive functioning, and patient treatment satisfaction. Qualitative research interviews will be conducted with Aboriginal participants to explore their perspectives on treatment. Discussion Current psychosocial and behavioural treatments for CUD indicate that over 80% of patients relapse within 1–6 months of treatment. Pharmacological treatments are highly effective with other substance use disorders but there are no approved pharmacological treatments for CUD. CBD is a promising candidate for CUD treatment due to its potential efficacy for this indication and excellent safety profile. The anxiolytic, antipsychotic and neuroprotective effects of CBD may have added benefits by reducing many of the mental health and cognitive impairments reported in people with regular cannabis use. Trial registration Australian and New Zealand Clinical Trial Registry: ACTRN12623000526673 (Registered 19 May 2023).

INTRODUCTION:Stigma has negative consequences for the health of people who inject drugs and people living with hepatitis C virus (HCV). This study evaluated factors associated with stigma related to injecting drug use (IDU) or HCV and those associated with being treated negatively by health workers. METHODS:ETHOS Engage is an observational cohort study of people who inject drugs attending drug treatment clinics and needle and syringe programs in Australia. Participants completed a questionnaire including IDU- and HCV-related stigma, and negative treatment by health workers. Logistic regression was used to identify factors associated with experiencing stigma and negative treatment in a cross-sectional sample. RESULTS:Of 1,211 participants, 31% were women, 64% had injected drugs in the previous month, and 65% had been diagnosed with HCV. IDU-related stigma was reported by 57% of participants and was associated with being a woman, higher than Year 10 education, homelessness, opioid agonist treatment, recent injecting, overdose history, hospitalisation for drug use, and unknown HCV status. HCV-related stigma was reported by 34% of participants diagnosed with HCV and was associated with being a woman, homelessness, receptive needle/syringe sharing, arrest for drug use/possession, and recent HCV testing. Negative treatment from health workers was reported by 45% of participants and was associated with being a woman, receptive needle/syringe sharing, hospitalisation for drug use, and arrest for drug use/possession. DISCUSSION AND CONCLUSIONS:Results highlight important intersections and disparities in stigmatising experiences among people who inject drugs. Considering these intersections can assist health services provide more inclusive care.

Objective To assess Australian psychiatrists’ and psychiatry trainees’ knowledge of and attitudes towards psychedelics as treatment for psychiatric disorders. Method Australian members of the Royal Australian and New Zealand College of Psychiatrists were invited to participate in an anonymous survey that ran from October 1 to November 30 2021. Participants were asked about their knowledge of the risks and benefits of, and attitudes towards, psychedelics, including the factors that influence those attitudes. Results Fifty-one doctors responded to the survey, and 38 completed all items. The majority were male, consultants and based primarily in New South Wales. Respondents reported awareness of the evidence demonstrating the benefits of psychedelics for most disorders; however most respondents, particularly females, perceived psychedelics as risky. Most considered themselves open-minded and believed psychedelics deserved further research. Conclusions The poor response rate was a major limitation of this study. Our sample of Australian psychiatrists and trainees were enthusiastic about psychedelics as psychiatric treatment and were aware of some of the evidence demonstrating their efficacy. Safety continues to be a concern, despite growing evidence of their safety in therapeutic settings. Education about the evidence of their efficacy and the risks associated with their use is needed.

OBJECTIVE:To investigate the demographic characteristics, substance use, and self-rated health of people entering treatment in New South Wales public health services for alcohol, amphetamine-type stimulants, cannabis, cocaine, or opioids use, by principal drug of concern.DESIGN:Baseline findings of a cohort study; analysis of data in patient electronic medical records and NSW minimum data set for drug and alcohol treatment services.SETTING, PARTICIPANTS:People completing initial Australian Treatment Outcomes Profile (ATOP) assessments on entry to publicly funded alcohol and other drug treatment services in six NSW local health districts/networks, 1 July 2016 - 30 June 2019.MAIN OUTCOME MEASURES:Socio-demographic characteristics, and substance use and self-rated health (psychological, physical, quality of life) during preceding 28 days, by principal drug of concern.RESULTS:Of 14 087 people included in our analysis, the principal drug of concern was alcohol for 6051 people (43%), opioids for 3158 (22%), amphetamine-type stimulants for 2534 (18%), cannabis for 2098 (15%), and cocaine for 246 (2%). Most people commencing treatment were male (9373, 66.5%), aged 20-39 years (7846, 50.4%), and were born in Australia (10 934, 86.7%). Polysubstance use was frequently reported, particularly by people for whom opioids or amphetamine-type stimulants were the principal drugs of concern. Large proportions used tobacco daily (53-82%, by principal drug of concern group) and reported poor psychological health (47-59%), poor physical health (32-44%), or poor quality of life (43-52%).CONCLUSIONS:The prevalence of social disadvantage and poor health is high among people seeking assistance with alcohol, amphetamine-type stimulants, cannabis, cocaine, or opioids use problems. Given the differences in these characteristics by principal drug of concern, health services should collect comprehensive patient information during assessment to facilitate more holistic, tailored, and person-centred care.

Drug and Alcohol ReviewEarly View LETTER TO THE EDITOR A call for concern: Frailty in middle-aged adults with alcohol use disorder Ripley J. Corbett, Corresponding Author Ripley J. Corbett [email protected] orcid.org/0000-0001-8435-265X Drug and Alcohol Services, Northern Sydney Local Health District, Sydney, New South Wales, Australia Correspondence Ripley J. Corbett, Level 5 Douglas Building, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia. Email: [email protected]Search for more papers by this authorSarah K. Blakemore, Sarah K. Blakemore orcid.org/0000-0003-0045-3272 Drug and Alcohol Services, Northern Sydney Local Health District, Sydney, New South Wales, AustraliaSearch for more papers by this authorErica G. Martin, Erica G. Martin orcid.org/0000-0003-2156-529X Drug and Alcohol Services, Northern Sydney Local Health District, Sydney, New South Wales, AustraliaSearch for more papers by this authorLauren A. Monds, Lauren A. Monds orcid.org/0000-0002-2592-7238 Drug and Alcohol Services, Northern Sydney Local Health District, Sydney, New South Wales, AustraliaSearch for more papers by this authorMark E. Montebello, Mark E. Montebello orcid.org/0000-0002-1776-3974 Drug and Alcohol Services, Northern Sydney Local Health District, Sydney, New South Wales, AustraliaSearch for more papers by this author Ripley J. Corbett, Corresponding Author Ripley J. Corbett [email protected] orcid.org/0000-0001-8435-265X Drug and Alcohol Services, Northern Sydney Local Health District, Sydney, New South Wales, Australia Correspondence Ripley J. Corbett, Level 5 Douglas Building, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia. Email: [email protected]Search for more papers by this authorSarah K. Blakemore, Sarah K. Blakemore orcid.org/0000-0003-0045-3272 Drug and Alcohol Services, Northern Sydney Local Health District, Sydney, New South Wales, AustraliaSearch for more papers by this authorErica G. Martin, Erica G. Martin orcid.org/0000-0003-2156-529X Drug and Alcohol Services, Northern Sydney Local Health District, Sydney, New South Wales, AustraliaSearch for more papers by this authorLauren A. Monds, Lauren A. Monds orcid.org/0000-0002-2592-7238 Drug and Alcohol Services, Northern Sydney Local Health District, Sydney, New South Wales, AustraliaSearch for more papers by this authorMark E. Montebello, Mark E. Montebello orcid.org/0000-0002-1776-3974 Drug and Alcohol Services, Northern Sydney Local Health District, Sydney, New South Wales, AustraliaSearch for more papers by this author First published: 16 August 2023 https://doi.org/10.1111/dar.13734 Ripley J. Corbett and Sarah K. Blakemore are first authors. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. REFERENCES 1Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging. 2012; 16: 601–608. 2Monds LA, Ridley NJ, Rivas C, Withall A, Draper B, Lintzeris N. Cognition and adaptive functioning in older people attending drug and alcohol services. Int Psychogeriatr. 2017; 29: 815–823. 3Ridley N, Batchelor J, Draper B, Demirkol A, Lintzeris N, Withall A. Cognitive screening in substance users: diagnostic accuracies of the mini-mental state examination, Addenbrooke's cognitive examination-revised, and montreal cognitive assessment. J Clin Exp Neuropsychol. 2018; 40: 107–122. 4 Ministry of Health. Older person's drug and alcohol project [Internet]. Sydney: Ministry of Health; 2015 [cited 24 May 2023]. Available from: https://www.health.nsw.gov.au/aod/professionals/Publications/opdap-fullreport.pdf 5 Australian Institute of Health and Welfare. Alcohol and other drug treatment services in Australia annual report [Internet]. Canberra: Australian Institute of Health and Welfare; 2022 [cited 24 May 2023]. Available from: https://www.aihw.gov.au/reports/alcohol-other-drug-treatment-services/alcohol-other-drug-treatment-services-australia 6Dent E, Morley JE, Cruz-Jentoft AJ, Woodhouse L, Rodríguez-Mañas L, Fried LP, et al. Physical frailty: ICFSR international clinical practice guidelines for identification and management. J Nutr Health Aging. 2019; 23: 771–787. Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

This study evaluated HCV treatment initiation among people who inject drugs (PWID) following an intervention of campaign days involving peer connection, point-of-care HCV RNA testing, and linkage to nursing support. ETHOS Engage is an observational cohort study of PWID attending 25 drug treatment clinics and needle and syringe programs in Australia (May 2018–September 2019). Point-of-care results were provided to the nurse, facilitating confirmatory testing and treatment. The study aimed to evaluate treatment uptake and factors associated with treatment at 24 months post-enrolment. There were 317 people with current HCV infection and eligible for treatment (median age 43, 65% male, 15% homeless, 69% receiving opioid agonist treatment, 70% injected in last month). Overall, 15% (47/317), 27% (85/317), 38% (120/317), and 49% (155/317) of people with current HCV infection had initiated treatment at 3-, 6-, 12-, and 24-months following testing, respectively. Homelessness (adjusted hazard ratio (aHR): 0.40; 95% confidence interval: 0.23, 0.71) and incarceration in the past 12 months (vs. never, aHR:0.46; 0.28, 0.76) were associated with decreased treatment initiation in the 24 months post-enrolment. This testing campaign intervention facilitated HCV treatment uptake among PWID. Further interventions are needed to achieve HCV elimination among people experiencing homelessness or incarceration.