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Winetsky D, Fox A, Nijhawan A, Rich JD. Treating Opioid Use Disorder and Related Infectious Diseases in the Criminal Justice System. Infect Dis Clin North Am 2021; 34:585-603. [PMID: 32782103 DOI: 10.1016/j.idc.2020.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article provides an overview of the diagnosis and management of opioid use disorder and its infectious complications among populations with criminal justice involvement. Opioid use disorder and chronic infections such as human immunodeficiency virus and hepatitis C virus are highly prevalent among incarcerated individuals and some of the unique features of correctional facilities present challenges for their appropriate medical management. We outline evidence-based strategies for integrated, patient-centered treatment during incarceration and the potentially hazardous transition back to the community upon release.
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Affiliation(s)
- Daniel Winetsky
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, 622 West 168th Street, PH 8 W-876, New York, NY 10032, USA; HIV Center for Clinical and Behavioral Studies at Columbia University and New York State Psychiatric Institute, New York, NY, USA.
| | - Aaron Fox
- Department of Internal Medicine, Montefiore Medical Center, 305 East 161th Street, Room 4, Bronx, NY, USA
| | - Ank Nijhawan
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Josiah D Rich
- Department of Medicine, Brown University, 164 Summit Avenue, Providence, RI 02906, USA; Department of Epidemiology, Brown University, 164 Summit Avenue, Providence, RI 02906, USA
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202
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The Impact of Medications for Opioid Use Disorder on Hepatitis C Incidence Among Incarcerated Persons: A Systematic Review. Infect Dis Clin North Am 2021; 34:559-584. [PMID: 32782102 DOI: 10.1016/j.idc.2020.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Hepatitis C virus (HCV) is highly prevalent in the criminal justice system and in persons who inject drugs, particularly opioids. Data on the impact of medications for opioid use disorder (MOUD) are abundant for infectious and noninfectious outcomes but are limited for justice-involved settings. This systematic review and meta-analysis focuses on the impact of MOUD on HCV incidence for persons in prisons and jails. Six studies were included in the qualitative synthesis, of which four were included for meta-analysis. A varied MOUD effect on HCV incidence was observed in part due to wide variability in prison and jail risk environments.
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203
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Knittel AK, Shook-Sa BE, Rudolph JE, Edmonds A, Ramirez C, Cohen MH, Adedimeji A, Taylor TN, Michel KG, Milam J, Cohen J, Donohue JD, Foster A, Fischl M, Konkle-Parker D, Adimora AA. Incidence and Prevalence of Incarceration in a Longitudinal Cohort of Women at Risk for Human Immunodeficiency Virus in the United States, 2007-2017. J Womens Health (Larchmt) 2021; 30:694-704. [PMID: 33544023 PMCID: PMC8112715 DOI: 10.1089/jwh.2020.8417] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: To estimate the incidence, prevalence, frequency, and duration of incarceration and to identify risk factors for incarceration among women at risk for human immunodeficiency virus (HIV) in the United States. Methods: During semiannual study visits in a multicenter cohort study, 970 HIV sero-negative participants at risk for HIV were asked about their own incarceration (10/2007-09/2017) and incarceration of sexual partners (10/2013-09/2017). We used descriptive statistics and multivariable log-binomial regression to identify baseline predictors of incident incarceration. Results: Median follow-up time across the 970 participants was 5.5 years (IQR 3.5-9.5). Nearly half (n = 453, 46.7%) of participants were incarcerated during or before the study, and the incarceration rate was 5.5 per 100 person-years. In multivariable models, incident incarceration was associated with prior incarceration (RR 5.20, 95% CI: 3.23-8.41) and noninjection drug use (RR 1.57, 95% CI: 1.10-2.25). Conclusions: Incarceration is common for women at risk for HIV. Prevention interventions that address the complex interplay of drug use, sex exchange, and housing instability for women who have experienced incarceration have the potential to reach an important group of U.S. women at risk of HIV infection.
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Affiliation(s)
- Andrea K. Knittel
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Bonnie E. Shook-Sa
- Department of Biostatistics and University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Jacqueline E. Rudolph
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Andrew Edmonds
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Catalina Ramirez
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | | | - Adebola Adedimeji
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Brooklyn, New York, USA
| | - Tonya N. Taylor
- Division of Infectious Disease, SUNY Downstate Medical Center, College of Medicine, Brooklyn, New York, USA
| | - Katherine G. Michel
- Department of Infectious Diseases, Georgetown University, Washington, District of Columbia, USA
| | - Joel Milam
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Jennifer Cohen
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jessica D. Donohue
- WIHS Data Management and Analysis Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Antonina Foster
- Division of Infectious Disease, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Margaret Fischl
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Deborah Konkle-Parker
- Division of Infectious Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Adaora A. Adimora
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
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204
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Randomized Clinical Trial of Inreach With or Without Mailed Outreach to Promote Hepatitis C Screening in a Difficult-to-Reach Patient Population. Am J Gastroenterol 2021; 116:976-983. [PMID: 33337657 DOI: 10.14309/ajg.0000000000001085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/06/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Hepatitis C virus (HCV) treatment can significantly reduce the risk of liver-related mortality; however, many patients remain unaware of their infection in clinical practice. The aim of this study is to compare the effectiveness of inreach, with and without mailed outreach, to increase HCV screening and follow-up in a large, difficult-to-reach patient population. METHODS We conducted a pragmatic randomized clinical trial from August 2018 to May 2019 in a large safety-net health system. Patients born between 1945 and 1965 were randomly assigned (1:1) to inreach with an electronic health record reminder to providers (n = 6,195) or inreach plus mailed HCV screening outreach (n = 6,191) to complete HCV antibody screening. Outreach also included processes to promote HCV RNA testing among those with a positive HCV antibody and linkage to care among those with positive HCV RNA. The primary outcome was completion of HCV antibody testing within 3 months of randomization (ClinicalTrials.gov NCT03706742). RESULTS We included 12,386 eligible patients (median age 60 years; 46.5% Hispanic, 33.0% Black, and 16.0% White). In intent-to-treat analyses, HCV screening completion was significantly higher among inreach-plus-outreach patients than inreach-alone patients at 3 months (14.6% vs 7.4%, P < 0.001) and 6 months (17.4% vs 9.8%, P < 0.001) after randomization. Among those who completed HCV screening within 6 months, a higher proportion of inreach-plus-outreach patients with positive antibody results completed RNA testing within 3 months than inreach-alone patients (81.1% vs 57.1%, respectively, P = 0.02); however, linkage to care within 3 months of HCV infection confirmation did not significantly differ between the 2 groups (48.1% vs 75.0%, respectively, P = 0.24). DISCUSSION Among difficult-to-reach patients, a combination of inreach and mailed outreach significantly increased HCV screening compared with inreach alone. However, HCV screening completion in both arms remained low, highlighting a need for more intensive interventions.
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205
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Zhang AY, Shrum S, Williams S, Petnic S, Nadle J, Johnston H, Barter D, Vonbank B, Bonner L, Hollick R, Marceaux K, Harrison L, Schaffner W, Tesini BL, Farley MM, Pierce RA, Phipps E, Mody RK, Chiller TM, Jackson BR, Vallabhaneni S. The Changing Epidemiology of Candidemia in the United States: Injection Drug Use as an Increasingly Common Risk Factor-Active Surveillance in Selected Sites, United States, 2014-2017. Clin Infect Dis 2021; 71:1732-1737. [PMID: 31676903 DOI: 10.1093/cid/ciz1061] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/29/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Injection drug use (IDU) is a known, but infrequent risk factor on candidemia; however, the opioid epidemic and increases in IDU may be changing the epidemiology of candidemia. METHODS Active population-based surveillance for candidemia was conducted in selected US counties. Cases of candidemia were categorized as IDU cases if IDU was indicated in the medical records in the 12 months prior to the date of initial culture. RESULTS During 2017, 1191 candidemia cases were identified in patients aged >12 years (incidence: 6.9 per 100 000 population); 128 (10.7%) had IDU history, and this proportion was especially high (34.6%) in patients with candidemia aged 19-44. Patients with candidemia and IDU history were younger than those without (median age, 35 vs 63 years; P < .001). Candidemia cases involving recent IDU were less likely to have typical risk factors including malignancy (7.0% vs 29.4%; relative risk [RR], 0.2 [95% confidence interval {CI}, .1-.5]), abdominal surgery (3.9% vs 17.5%; RR, 0.2 [95% CI, .09-.5]), and total parenteral nutrition (3.9% vs 22.5%; RR, 0.2 [95% CI, .07-.4]). Candidemia cases with IDU occurred more commonly in smokers (68.8% vs 18.5%; RR, 3.7 [95% CI, 3.1-4.4]), those with hepatitis C (54.7% vs 6.4%; RR, 8.5 [95% CI, 6.5-11.3]), and in people who were homeless (13.3% vs 0.8%; RR, 15.7 [95% CI, 7.1-34.5]). CONCLUSIONS Clinicians should consider injection drug use as a risk factor in patients with candidemia who lack typical candidemia risk factors, especially in those with who are 19-44 years of age and have community-associated candidemia.
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Affiliation(s)
- Alexia Y Zhang
- Oregon Public Health Division, Oregon Health Authority, Portland, Oregon, USA
| | - Sarah Shrum
- New Mexico Department of Health, Santa Fe, New Mexico, USA
| | - Sabrina Williams
- Mycotic Disease Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah Petnic
- California Emerging Infections Program, Oakland, California, USA
| | - Joelle Nadle
- California Emerging Infections Program, Oakland, California, USA
| | - Helen Johnston
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Devra Barter
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | | | - Lindsay Bonner
- Maryland Emerging Infections Program, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Rosemary Hollick
- Maryland Emerging Infections Program, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Kaytlynn Marceaux
- Maryland Emerging Infections Program, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Lee Harrison
- Maryland Emerging Infections Program, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | | | - Brenda L Tesini
- University of Rochester School of Medicine, Rochester, New York, USA
| | - Monica M Farley
- Emory University School of Medicine and Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | - Rebecca A Pierce
- Oregon Public Health Division, Oregon Health Authority, Portland, Oregon, USA
| | - Erin Phipps
- New Mexico Emerging Infections Program, University of New Mexico, Albuquerque, New Mexico, USA
| | - Rajal K Mody
- Minnesota Department of Health, St Paul, Minnesota, USA.,Division of State and Local Readiness, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tom M Chiller
- Mycotic Disease Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brendan R Jackson
- Mycotic Disease Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Snigdha Vallabhaneni
- Mycotic Disease Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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206
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Springer SA, Del Rio C. Co-located Opioid Use Disorder and Hepatitis C Virus Treatment Is Not Only Right, But It Is Also the Smart Thing To Do as It Improves Outcomes! Clin Infect Dis 2021; 71:1723-1725. [PMID: 32011653 DOI: 10.1093/cid/ciaa111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 01/31/2020] [Indexed: 01/26/2023] Open
Affiliation(s)
- Sandra A Springer
- Department of Internal Medicine, Division of Infectious Disease, Yale AIDS Program, Yale School of Medicine, New Haven, Connecticut, USA
| | - Carlos Del Rio
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
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207
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Lanzillotta-Rangeley J, Zeller TA, Beachler T, Litwin AH, Clark A, Stem J. The Impact of the Disease Model of Substance Use Disorder on Evidence Based Practice Adoption and Stigmatizing Attitudes: A Comparative Analysis. Pain Manag Nurs 2021; 22:616-622. [PMID: 33906806 DOI: 10.1016/j.pmn.2021.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 01/17/2021] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Evidence-based practices are shown to improve health outcomes in persons with substance use disorder (SUD), but practice adoption is often limited by stigma. Stigma towards these patients leads to poor communication, missed diagnoses, and treatment avoidance. AIMS The purpose of this study was to survey a rural community to conceptualize knowledge and attitudes towards SUD and opioid use disorder. DESIGN The study design was cross-sectional survey using a convenience sample in a rural community in southwestern Ohio. METHODS A 25-item electronic survey was created to assess knowledge and attitudes of the community towards SUD, evidenced-based practices, and stigma. Questions were grouped into five subcategories to meaningfully address high-priority areas. Descriptive statistics included frequencies and percentages. A comparative analysis was performed using Chi-square and phi to evaluate response rates from the first question, A substance use disorder is a real illness like diabetes and heart disease, to the other survey questions. RESULTS A total of 173 people responded to the survey. The response to "A substance use disorder is a real illness like diabetes and heart disease" resulted in two groups of similar size, with 83 (48.5%) of the respondents agreeing with the statement. There was a significant difference (p < .001) in 15 questions between the two groups. CONCLUSIONS People who believe SUD is a real illness were more likely to support evidence-based treatment practices, show less stigma towards those suffering from SUD, and support harm reduction services.
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Affiliation(s)
| | - Timothy A Zeller
- Seneca Family Medicine Residency Program, Prisma Health, Seneca, South Carolina; University of South Carolina School of Medicine - Greenville, Greenville, South Carolina
| | - Taylor Beachler
- Prisma Health Addiction Research Center, Greenville, South Carolina
| | - Alain H Litwin
- University of South Carolina School of Medicine - Greenville, Greenville, South Carolina; Prisma Health Addiction Research Center, Greenville, South Carolina; Clemson University School of Health Research, Clemson, South Carolina
| | - Angela Clark
- University of Cincinnati, College of Nursing, Cincinnati, Ohio
| | - Jack Stem
- University of Cincinnati, College of Nursing, Cincinnati, Ohio
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208
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Viera A, Gotham H, Cheng AL, Carlson K, Witt J. Barriers and Challenges to Making Referrals for Treatment and Services for Opioid Misuse in Family Planning Settings. J Womens Health (Larchmt) 2021; 31:38-46. [PMID: 33844948 DOI: 10.1089/jwh.2020.8761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: In this opioid overdose epidemic, women are an overlooked group seeing increasing rates of overdose death. Implementation challenges have prevented evidence-based interventions from effectively reaching women who misuse opioids, with gaps in access to effective treatment and services. Family planning clinics could serve as important points of contact for referral to needed treatments and services. The study explores how family planning staff knowledge and attitudes related to opioid misuse serve as potential barriers and challenges in making referrals for evidence-based services and treatments. Methods: In 2018, we conducted a national online survey of family planning staff, assessing knowledge and attitudes of treatments and services for opioid misuse. Results: A total of 691 family planning staff completed the survey. Most respondents agreed that opioid misuse was a major problem in their community (86.0%) and identified challenges in responding to it, including a lack of treatment access (70.3%), the absence of in-house behavioral health staff (67.2%), and unfamiliarity with local treatment providers (54.1%). Respondents reported low levels of acceptability for syringe services programs (46.0%), medications such as methadone and buprenorphine (55.4%), and naloxone to reverse opioid overdose (60.1%). Controlling for other factors, race/ethnicity, urbanicity, workplace role, and substance use training were associated with differences in acceptability. Conclusions: Family planning settings could play a critical role in connecting women who misuse opioids to treatment and services. Strategies are needed to increase the acceptability of evidence-based interventions and the feasibility of having family planning staff play a linkage role.
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Affiliation(s)
- Adam Viera
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, Connecticut, USA.,Yale University Center for Interdisciplinary Research on AIDS, New Haven, Connecticut, USA
| | - Heather Gotham
- Department of Psychiatry and Behavioral Sciences, Center for Behavioral Health Services and Implementation Research, Stanford University School of Medicine, Palo Alto, California, USA
| | - An-Lin Cheng
- Department of Biomedical and Health Informatics, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA
| | | | - Jacki Witt
- School of Nursing and Health Studies, University of Missouri Kansas City, Kansas City, Missouri, USA
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209
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Seval N, Frank CA, Litwin AH, Roth P, Schade MA, Pavlicova M, Levin FR, Brady KT, Nunes EV, Springer SA. Design and methods of a multi-site randomized controlled trial of an integrated care model of long-acting injectable buprenorphine with infectious disease treatment among persons hospitalized with infections and opioid use disorder. Contemp Clin Trials 2021; 105:106394. [PMID: 33838307 DOI: 10.1016/j.cct.2021.106394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hospitalization with co-occurring opioid use disorder (OUD) and infections presents a critical time to intervene to improve outcomes for these intertwined epidemics that are typically managed separately. A surge in life-threatening infectious diseases associated with injection drug use, including bacterial and fungal infections, HIV, and HCV accounts for substantial healthcare utilization, morbidity, and mortality. Infectious Disease (ID) specialists manage severe infections that require hospitalization and are a logical resource to engage patients in medication treatment for OUD (MOUD). An injectable long-acting monthly formulation of buprenorphine (LAB) has a potential advantage for initiating MOUD within hospital settings and bridging to treatment after discharge. METHODS A randomized multi-site trial tests a new model of care (ID/LAB) in which OUD and infections are managed by ID specialists and hospitalists using LAB coupled with referrals to community resources for long-term MOUD. A sample of 200 adults admitted to three U.S. hospitals for OUD and infections are randomly assigned 1:1 to ID/LAB or treatment as usual (TAU). The primary outcome measure is the proportion of patients enrolled in effective MOUD at 12 weeks after randomization. Secondary outcomes include relapse to opioid use, adherence to infectious disease treatment, infection morbidity and mortality, and drug overdose. RESULTS We describe the design, procedures, statistical analysis, and early implementation issues of this randomized trial. CONCLUSIONS Study findings will provide insight into the feasibility and effectiveness of integrated treatment of OUD and serious infections and have the potential to reduce morbidity and mortality in this vulnerable population.
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Affiliation(s)
- Nikhil Seval
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Disease, Yale AIDS Program, New Haven, CT, USA
| | - Cynthia A Frank
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Disease, Yale AIDS Program, New Haven, CT, USA
| | - Alain H Litwin
- University of South Carolina School of Medicine Greenville, Prisma Health: Upstate Affiliate, Department of Infectious Disease, Greenville, SC, USA; Department of Medicine, University of South Carolina School of Medicine- Greenville, Greenville, SC, USA
| | - Prerana Roth
- University of South Carolina School of Medicine Greenville, Prisma Health: Upstate Affiliate, Department of Infectious Disease, Greenville, SC, USA
| | - Meredith A Schade
- Penn State Milton S. Hershey Medical Center, Department of Medicine, Division of Infectious Diseases, Hershey, PA, USA
| | - Martina Pavlicova
- Columbia University Mailman School of Public Health, Department of Biostatistics, New York, NY, USA
| | - Frances R Levin
- College of Physicians and Surgeons of Columbia University, New York State Psychiatric Institute/Division on Substance Use Disorders, New York, NY, USA
| | - Kathleen T Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Edward V Nunes
- College of Physicians and Surgeons of Columbia University, New York State Psychiatric Institute/Division on Substance Use Disorders, New York, NY, USA
| | - Sandra A Springer
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Disease, Yale AIDS Program, New Haven, CT, USA.
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210
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Self-Reported Prevalence of HIV Testing Among Those Reporting Having Been Diagnosed With Selected STIs or HCV, United States, 2005-2016. Sex Transm Dis 2021; 47:S53-S60. [PMID: 32332427 DOI: 10.1097/olq.0000000000001146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Persons with STIs or HCV infection often have indicators of HIV risk. We used weighted data from 6 cycles of the National Health and Nutrition Examination Survey (NHANES) to assess the proportion of persons who reported ever being diagnosed as having a selected STI or HCV infection and who reported that they were ever tested for HIV. METHODS Persons aged 20 to 59 years with prior knowledge of HCV infection before receiving NHANES HCV RNA-positive results (2005-2012) or reporting ever being told by a doctor that they had HCV infection (2013-2016), or ever had genital herpes, or had chlamydia or gonorrhea in the past 12 months were categorized as having had a selected STI or HCV infection. Weighted proportions and 95% confidence intervals were estimated for reporting ever being tested for HIV for those who did and did not report a selected STI or HCV infection. RESULTS A total of 19,102 respondents had nonmissing data for STI and HCV diagnoses and HIV testing history; 44.4% reported ever having been tested for HIV, and 5.2% reported being diagnosed as having a selected STI or HCV infection. The proportion reporting an HIV test was higher for the group that reported an STI or HCV infection than for the group that did not. CONCLUSION Self-reported HIV testing remains low in the United States, even among those who reported a previous selected STI or HCV infection. Ensuring HIV tests are conducted routinely for those with overlapping risk factors can help facilitate the diagnosis of HIV infections.
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211
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Mirzazadeh A, Chen YH, Lin J, Burk K, Wilson EC, Miller D, Veloso D, McFarland W, Morris MD. Progress toward closing gaps in the hepatitis C virus cascade of care for people who inject drugs in San Francisco. PLoS One 2021; 16:e0249585. [PMID: 33798243 PMCID: PMC8018615 DOI: 10.1371/journal.pone.0249585] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/19/2021] [Indexed: 12/24/2022] Open
Abstract
Background People who inject drugs (PWID) are disproportionately affected by hepatitis C virus (HCV). Data tracking the engagement of PWID in the continuum of HCV care are needed to assess the reach, target the response, and gauge impact of HCV elimination efforts. Methods We analyzed data from the National HIV Behavioral Surveillance (NHBS) surveys of PWID recruited via respondent driven sampling (RDS) in San Francisco in 2018. We calculated the number and proportion who self-reported ever: (1) tested for HCV, (2) tested positive for HCV antibody, (3) diagnosed with HCV, (4) received HCV treatment, (5) and attained sustained viral response (SVR). To assess temporal changes, we compared 2018 estimates to those from the 2015 NHBS sample. Results Of 456 PWID interviewed in 2018, 88% had previously been tested for HCV, 63% tested antibody positive, and 50% were diagnosed with HCV infection. Of those diagnosed, 42% received treatment. Eighty-one percent of those who received treatment attained SVR. In 2015 a similar proportion of PWID were tested and received an HCV diagnosis, compared to 2018. However, HCV treatment was more prevalent in the 2018 sample (19% vs. 42%, P-value 0.01). Adjusted analysis of 2018 survey data showed having no health insurance (APR 1.6, P-value 0.01) and having no usual source of health care (APR 1.5, P-value 0.01) were significantly associated with untreated HCV prevalence. Conclusion While findings indicate an improvement in HCV treatment uptake among PWID in San Francisco, more than half of PWID diagnosed with HCV infection had not received HCV treatment in 2018. Policies and interventions to increase coverage are necessary, particularly among PWID who are uninsured and outside of regular care.
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Affiliation(s)
- Ali Mirzazadeh
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
- * E-mail:
| | - Yea-Hung Chen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
| | - Jess Lin
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Katie Burk
- Community Health Equity and Promotion Branch, San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Erin C. Wilson
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Desmond Miller
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Danielle Veloso
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Willi McFarland
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Meghan D. Morris
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
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Fong C, Mateu-Gelabert P, Ciervo C, Eckhardt B, Aponte-Melendez Y, Kapadia S, Marks K. Medical provider stigma experienced by people who use drugs (MPS-PWUD): Development and validation of a scale among people who currently inject drugs in New York City. Drug Alcohol Depend 2021; 221:108589. [PMID: 33621804 PMCID: PMC8029599 DOI: 10.1016/j.drugalcdep.2021.108589] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Stigmatizing attitudes towards people who use drugs (PWUD) impact their access and retention in health care. Current measures of PWUD stigma in medical settings are limited. Therefore, we developed and validated theMedical Provider Stigma Experienced by PWUD (MPS-PWUD) scale. METHODS As part of an ongoing clinical trial, we recruited HCV RNA positive people who inject drugs in New York City. Based on 164 participants, principal component analysis (PCA) was conducted on fifteen stigma items answered on a 5-point Likert scale. We evaluated internal consistency using Cronbach's alpha coefficient and assessed construct validity by comparing stigma levels with willingness to communicate health concerns with medical providers and likelihood to seek HCV treatment. RESULTS PCA identified a 9-item scale with two components of stigmatization that explained 60.8 % of the total variance and overall high internal consistency (alpha = 0.90). Theenacted stigma (alpha = 0.90) consisted of 6 scale items related to the medical providers' stigmatizing actions or perceptions. The internalized stigma component (alpha = 0.84) included 3 scale items related to PWUD's shame or drug use disclosure. As hypothesized, higher levels of either stigma were associated with less likelihood to openly communicate with medical providers (p < 0.005). Participants with a higher level of enacted stigma were less likely to seek HCV treatment (p = 0.011). CONCLUSIONS The validated MPS-PWUD scale could help healthcare providers, harm reduction services and researchers measure stigma experienced by PWUD in medical settings in efforts to minimize the impact of stigma on limiting access to and retention of care for PWUD.
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Affiliation(s)
- Chunki Fong
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH) 55 West 125th Street, New York, NY 10027, USA.
| | - Pedro Mateu-Gelabert
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH) 55 West 125th Street, New York, NY 10027, USA
| | - Courtney Ciervo
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH) 55 West 125th Street, New York, NY 10027, USA
| | | | - Yesenia Aponte-Melendez
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH) 55 West 125th Street, New York, NY 10027, USA
| | - Shashi Kapadia
- Weill Cornell Medicine, 1305 York Ave 4th Floor, New York, NY, 10021, USA
| | - Kristen Marks
- Weill Cornell Medicine, 1305 York Ave 4th Floor, New York, NY, 10021, USA
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213
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Tsui JI, Akosile MA, Lapham GT, Boudreau DM, Johnson EA, Bobb JF, Binswanger IA, Yarborough BJH, Glass JE, Rossom RC, Murphy MT, Cunningham CO, Arnsten JH, Thakral M, Saxon AJ, Merrill JO, Samet JH, Bart GB, Campbell CI, Loree AM, Silva A, Stotts AL, Ahmedani B, Braciszewski JM, Hechter RC, Northrup TF, Horigian VE, Bradley KA. Prevalence and Medication Treatment of Opioid Use Disorder Among Primary Care Patients with Hepatitis C and HIV. J Gen Intern Med 2021; 36:930-937. [PMID: 33569735 PMCID: PMC8041979 DOI: 10.1007/s11606-020-06389-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 12/03/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Hepatitis C and HIV are associated with opioid use disorders (OUD) and injection drug use. Medications for OUD can prevent the spread of HCV and HIV. OBJECTIVE To describe the prevalence of documented OUD, as well as receipt of office-based medication treatment, among primary care patients with HCV or HIV. DESIGN Retrospective observational cohort study using electronic health record and insurance data. PARTICIPANTS Adults ≥ 18 years with ≥ 2 visits to primary care during the study (2014-2016) at 6 healthcare systems across five states (CO, CA, OR, WA, and MN). MAIN MEASURES The primary outcome was the diagnosis of OUD; the secondary outcome was OUD treatment with buprenorphine or oral/injectable naltrexone. Prevalence of OUD and OUD treatment was calculated across four groups: HCV only; HIV only; HCV and HIV; and neither HCV nor HIV. In addition, adjusted odds ratios (AOR) of OUD treatment associated with HCV and HIV (separately) were estimated, adjusting for age, gender, race/ethnicity, and site. KEY RESULTS The sample included 1,368,604 persons, of whom 10,042 had HCV, 5821 HIV, and 422 both. The prevalence of diagnosed OUD varied across groups: 11.9% (95% CI: 11.3%, 12.5%) for those with HCV; 1.6% (1.3%, 2.0%) for those with HIV; 8.8% (6.2%, 11.9%) for those with both; and 0.92% (0.91%, 0.94%) among those with neither. Among those with diagnosed OUD, the prevalence of OUD medication treatment was 20.9%, 16.0%, 10.8%, and 22.3%, for those with HCV, HIV, both, and neither, respectively. HCV was not associated with OUD treatment (AOR = 1.03; 0.88, 1.21), whereas patients with HIV had a lower probability of OUD treatment (AOR = 0.43; 0.26, 0.72). CONCLUSIONS Among patients receiving primary care, those diagnosed with HCV and HIV were more likely to have documented OUD than those without. Patients with HIV were less likely to have documented medication treatment for OUD.
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Affiliation(s)
- Judith I Tsui
- University of Washington/Harborview Medical Center, Seattle, USA
| | - Mary A Akosile
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, STE 1600, Seattle, WA, 98101 (206) 948-1933, USA
| | - Gwen T Lapham
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, STE 1600, Seattle, WA, 98101 (206) 948-1933, USA
| | - Denise M Boudreau
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, STE 1600, Seattle, WA, 98101 (206) 948-1933, USA
| | - Eric A Johnson
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, STE 1600, Seattle, WA, 98101 (206) 948-1933, USA
| | - Jennifer F Bobb
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, STE 1600, Seattle, WA, 98101 (206) 948-1933, USA
| | - Ingrid A Binswanger
- Kaiser Permanente Colorado, Colorado Permanente Medical Group, and the University of Colorado School of Medicine, Aurora, USA
| | | | - Joseph E Glass
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, STE 1600, Seattle, WA, 98101 (206) 948-1933, USA
| | - Rebecca C Rossom
- HealthPartners Institute, University of Minnesota, Bloomington, USA
| | - Mark T Murphy
- MultiCare Institute for Research and Innovation, MultiCare Health System WA, Seattle, USA
| | - Chinazo O Cunningham
- Albert Einstein College of Medicine, Montefiore Medical Center, New York City, USA
| | - Julia H Arnsten
- Albert Einstein College of Medicine, Montefiore Medical Center, New York City, USA
| | - Manu Thakral
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, USA
| | - Andrew J Saxon
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System/University of Washington School of Medicine, Seattle, USA
| | - Joseph O Merrill
- University of Washington/Harborview Medical Center, Seattle, USA
| | | | - Gavin B Bart
- Hennepin Healthcare, University of Minnesota, Minneapolis, USA
| | - Cynthia I Campbell
- Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Amy M Loree
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, USA
| | - Angela Silva
- MultiCare Institute for Research and Innovation, MultiCare Health System WA, Seattle, USA
| | - Angela L Stotts
- Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, USA
| | - Brian Ahmedani
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, USA
| | - Jordan M Braciszewski
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, USA
- Department of Psychiatry, Henry Ford Health System, Detroit, USA
| | - Rulin C Hechter
- Department of Research and Evaluation, Kaiser Permanente Southern California, Oakland, USA
| | - Thomas F Northrup
- Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, USA
| | - Viviana E Horigian
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Florida, USA
| | - Katharine A Bradley
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, STE 1600, Seattle, WA, 98101 (206) 948-1933, USA.
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214
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Malik F, Bailey H, Chan P, Collins IJ, Mozalevskis A, Thorne C, Easterbrook P. Where are the children in national hepatitis C policies? A global review of national strategic plans and guidelines. JHEP Rep 2021; 3:100227. [PMID: 33665586 PMCID: PMC7898178 DOI: 10.1016/j.jhepr.2021.100227] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND & AIMS It is estimated that 3.26 million children and adolescents worldwide have chronic HCV infection. To date, the global response has focused on the adult population, but direct-acting antiviral (DAA) regimens are now approved for children aged ≥3 years. This global review describes the current status of policies on HCV testing and treatment in children, adolescents, and pregnant women in WHO Member States. METHODS We identified national strategic plans and/or clinical practice guidelines (CPGs) for HCV infection from a World Health Organization (WHO) database of national policies from Member States as of August 2019. A standardised proforma was used to abstract data on polices or recommendations on testing and treatment in children, adolescents and pregnant women. Analysis was stratified according to the country-income status and results were validated through WHO regional focal points through August 2020. RESULTS National HCV policies were available for 122 of the 194 WHO Member States. Of these, the majority (n = 71/122, 58%) contained no policy recommendations for either testing or treatment in children or adolescents. Of the 51 countries with policies, 24 had specific policies for both testing and treatment, and were mainly from the European region; 18 countries for HCV testing only (12 from high- or upper-middle income); and 9 countries for treatment only (7 high- or upper-middle income). Twenty-one countries provided specific treatment recommendations: 13 recommended DAA-based regimens for adolescents ≥12 years and 6 still recommended interferon/ribavirin-based regimens. CONCLUSIONS There are significant gaps in policies for HCV-infected children and adolescents. Updated guidance on testing and treatment with newly approved DAA regimens for younger age groups is needed, especially in most affected countries. LAY SUMMARY To date, the predominant focus of the global response towards elimination of hepatitis C has been on the testing and treatment of adults. Much less attention has been paid to testing and treatment among children and adolescents, although in 2018 an estimated 3.26 million were infected with HCV. Our review shows that many countries have no national guidance on HCV testing and treatment in children and adolescents. It highlights the urgent need for advocacy and updated policies and guidelines specific for children and adolescents.
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Key Words
- AASLD, American Association for the Study of Liver Diseases
- APASL, Asian Pacific Association for the Study of the Liver
- Adolescents
- CPGs, clinical practice guidelines
- Children
- Clinical practice guidelines
- DAAs, direct-acting antivirals
- EASL, European Association for the Study of the Liver
- ESPGHAN, European Society for Paediatric Gastroenterology Hepatology and Nutrition
- GHSS, Global Health Sector Strategy
- GLE, glecaprevir
- GT, genotype
- Hepatitis C
- IDU, injecting drug use
- IFN, interferon
- LED, ledipasvir
- LMICs, low- and middle-income countries
- MoH, ministries of health
- NASPGHAN, North American Society for Pediatric Gastroenterology Hepatology and Nutrition
- NSPs, national strategic plans
- National strategic plans
- PIB, pibrentasvir
- Policies
- Policy review
- Pregnancy
- RBV, ribavirin
- SOF, sofosbuvir
- VEL, velpatasvir
- WHO, World Health Organization
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Affiliation(s)
- Farihah Malik
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Heather Bailey
- UCL Institute for Global Health, University College London, London, UK
| | - Polin Chan
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Intira Jeannie Collins
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | | | - Claire Thorne
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Philippa Easterbrook
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
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215
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Dhanani LY, Franz B. Attitudes toward and experiences working with patients who misuse opioids among board certified physicians in Ohio. Subst Abus 2021; 42:466-470. [PMID: 33759723 DOI: 10.1080/08897077.2021.1901172] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background: The United States has experienced substantial consequences associated with the opioid epidemic. One such consequence has been an increased need for patients who misuse opioids to interface with health care professionals. As such, it is important to understand physician attitudes toward and experiences with this patient population. The goal of this paper is to assess the extent to which physicians hold negative attitudes toward patients who misuse opioids and whether this patient population receives differential treatment. Methods: Using a mixed methods design, we surveyed board-certified physicians in Ohio regarding their attitudes toward patients who misuse opioids as well as their observations of bias toward these patients in health care settings. Results: Our findings suggest that negative attitudes toward patients who misuse opioids are common among physicians as were personal experiences of bias toward this patient population. We also found that physicians rationalized treating these patients differently and perceived barriers to achieving more equitable treatment. Finally, some physicians expressed a desire for additional training and resources to reduce bias. Conclusions: Negative attitudes toward patients who misuse opioids may serve as a critical barrier to patients accessing care in areas heavily affected by the U.S. opioid epidemic.
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Affiliation(s)
| | - Berkeley Franz
- Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio, USA
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216
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Wesner CA, Zhang W, Melstad S, Ruen E, Deffenbaugh C, Gu W, Clayton JL. Assessing County-Level Vulnerability for Opioid Overdose and Rapid Spread of Human Immunodeficiency Virus and Hepatitis C Infection in South Dakota. J Infect Dis 2021; 222:S312-S321. [PMID: 32877549 DOI: 10.1093/infdis/jiaa231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Key indicators of vulnerability for the syndemic of opioid overdose, human immunodeficiency virus (HIV), and hepatitis C virus (HCV) due to injection drug use (IDU) in rural reservation and frontier counties are unknown. We examined county-level vulnerability for this syndemic in South Dakota. METHODS Informed by prior methodology from the Centers for Disease Control and Prevention, we used acute and chronic HCV infections among persons aged ≤40 years as a proxy measure of IDU. Twenty-nine county-level indicators potentially associated with HCV infection rates were identified. Using these indicators, we examined relationships through bivariate and multivariate analysis and calculated a composite index score to identify the most vulnerable counties (top 20%) to this syndemic. RESULTS Of the most vulnerable counties, 69% are reservation counties and 62% are rural. The county-level HCV infection rate is 4 times higher in minority counties than nonminority counties, and almost all significant indicators of opioid-related vulnerability in our analysis are structural and potentially modifiable through public health interventions and policies. CONCLUSIONS Our assessment gives context to the magnitude of this syndemic in rural reservation and frontier counties and should inform the strategic allocation of prevention and intervention services.
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Affiliation(s)
- Chelsea A Wesner
- Master of Public Health Program, University of South Dakota, Vermillion, South Dakota, USA
| | - Weiwei Zhang
- Department of Sociology & Rural Studies, South Dakota State University, Brookings, South Dakota, USA
| | | | - Elizabeth Ruen
- Master of Public Health Program, University of South Dakota, Vermillion, South Dakota, USA
| | | | - Wei Gu
- Department of Sociology & Rural Studies, South Dakota State University, Brookings, South Dakota, USA
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217
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Holtzman D, Asher AK, Schillie S. The Changing Epidemiology of Hepatitis C Virus Infection in the United States During the Years 2010 to 2018. Am J Public Health 2021; 111:949-955. [PMID: 33734844 PMCID: PMC8034015 DOI: 10.2105/ajph.2020.306149] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Hepatitis C virus (HCV) infection remains an important cause of morbidity and mortality throughout the world, leading to serious health problems among those who are chronically infected. Since 1992, the Centers for Disease Control and Prevention has been collecting data on the incidence of HCV infection in the United States. In 2018, more than 50 000 individuals were estimated to have acute HCV infection.The most recently reported data on the prevalence of infection indicate that approximately 2.4 million people are living with hepatitis C in the United States. Transmission of HCV occurs predominantly through sharing contaminated equipment for injecting drugs.Two major events have had a significant impact on the incidence and prevalence of hepatitis C in the past few decades: the US opioid crisis and the discovery of curative treatments for HCV infection. To better understand the impact of these events, we examine reported trends in the incidence and prevalence of infection.
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Affiliation(s)
- Deborah Holtzman
- Deborah Holtzman was previously with the Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA. She was retired at the time the study was undertaken and the article was prepared. Alice K. Asher is with the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. At the time of the study, Sarah Schillie was with the Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. Note. The contents of this report on behalf of authors A. K. Asher and S. Schillie do not necessarily represent the official views of the CDC
| | - Alice K Asher
- Deborah Holtzman was previously with the Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA. She was retired at the time the study was undertaken and the article was prepared. Alice K. Asher is with the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. At the time of the study, Sarah Schillie was with the Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. Note. The contents of this report on behalf of authors A. K. Asher and S. Schillie do not necessarily represent the official views of the CDC
| | - Sarah Schillie
- Deborah Holtzman was previously with the Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA. She was retired at the time the study was undertaken and the article was prepared. Alice K. Asher is with the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. At the time of the study, Sarah Schillie was with the Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. Note. The contents of this report on behalf of authors A. K. Asher and S. Schillie do not necessarily represent the official views of the CDC
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218
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Coyle JR, Freeland M, Eckel ST, Hart AL. Trends in Morbidity, Mortality, and Cost of Hospitalizations Associated With Infectious Disease Sequelae of the Opioid Epidemic. J Infect Dis 2021; 222:S451-S457. [PMID: 32877550 DOI: 10.1093/infdis/jiaa012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Increases in fatal drug poisonings and hepatitis C infections associated with the opioid epidemic are relatively well defined, because passive surveillance systems for these conditions exist. Less described is the association between the opioid epidemic and skin, soft-tissue, and venous infections (SSTVIs), endocarditis, sepsis, and osteomyelitis. METHODS Michigan hospitalizations between 2016 and 2018 that included an International Classification of Diseases, Tenth Revision, Clinical Modification, code indicating substance use were examined for codes indicative of infectious conditions associated with injecting drugs. Trends in these hospitalizations were examined, as were demographic characteristics, discharge disposition, payer, and cost data. RESULTS Among hospitalized patients with a substance use diagnosis code, endocarditis, osteomyelitis, sepsis, and SSTVI hospitalizations increased by 33%, 35%, 24%, and 12%, respectively between 2016 and 2018. During this time frame, 1257 patients died or were discharged to hospice. All SSTVI hospitalizations resulted in >$1.3 billion in healthcare costs. Public insurance accounted for more than two-thirds of all hospitalization costs. CONCLUSIONS This study describes a method for performing surveillance for infection-related sequelae of injection drug use. Endocarditis, osteomyelitis, sepsis, and SSTVI hospitalizations have increased year over year between 2016 and 2018. These hospitalizations result in significant morbidity, mortality, and healthcare costs and should be a focus of future surveillance and prevention efforts.
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Affiliation(s)
- Joseph R Coyle
- Michigan Department of Health and Human Services, Bureau of Epidemiology and Population Health, Communicable Disease Division, Lansing, Michigan, USA
| | - Melissa Freeland
- Michigan Department of Health and Human Services, Bureau of Epidemiology and Population Health, Communicable Disease Division, Lansing, Michigan, USA
| | - Seth T Eckel
- Michigan Department of Health and Human Services, Bureau of Epidemiology and Population Health, Communicable Disease Division, Lansing, Michigan, USA
| | - Adam L Hart
- Michigan Department of Health and Human Services, Bureau of Epidemiology and Population Health, Communicable Disease Division, Lansing, Michigan, USA
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219
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Jordan AE, Cleland CM, Schackman BR, Wyka K, Perlman DC, Nash D. Hepatitis C Virus (HCV) Care Continuum Outcomes and HCV Community Viral Loads Among Patients in an Opioid Treatment Program. J Infect Dis 2021; 222:S335-S345. [PMID: 32877560 DOI: 10.1093/infdis/jiz686] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) remains endemic among people who use drugs (PWUD). Measures of HCV community viral load (CVL) and HCV care continuum outcomes may be valuable for ascertaining unmet treatment need and for HCV surveillance and control. METHODS Data from patients in an opioid treatment program during 2013-2016 were used to (1) identify proportions of antibody and viral load (VL) tested, linked-to-care, and treated, in 2013-2014 and 2015-2016, and pre- and postimplementation of qualitative reflex VL testing; (2) calculate engaged-in-care HCV CVL and "documented" and "estimated" unmet treatment need; and (3) examine factors associated with linkage-to-HCV-care. RESULTS Among 11 267 patients, proportions of HCV antibody tested (52.5% in 2013-2014 vs 73.3% in 2015-2016), linked-to-HCV-care (15.7% vs 51.8%), and treated (12.0% vs 44.7%) all increased significantly. Hispanic ethnicity was associated with less linkage-to-care, and Manhattan residence was associated with improved linkage-to-care. The overall engaged-in-care HCV CVL was 4 351 079 copies/mL (standard deviation = 7 149 888); local HCV CVLs varied by subgroup and geography. Documented and estimated unmet treatment need decreased but remained high. CONCLUSIONS After qualitative reflex VL testing was implemented, care continuum outcomes improved, but gaps remained. High rates of unmet treatment need suggest that control of the HCV epidemic among PWUD will require expansion of HCV treatment coverage.
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Affiliation(s)
- Ashly E Jordan
- Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA.,Center for Drug Use and HIV Research (multi-institutional), New York, New York, USA.,Behavioral Science Training Program in Drug Abuse Research, New York University, New York, New York, USA
| | - Charles M Cleland
- Center for Drug Use and HIV Research (multi-institutional), New York, New York, USA.,Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Bruce R Schackman
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York, USA
| | - Katarzyna Wyka
- Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
| | - David C Perlman
- Center for Drug Use and HIV Research (multi-institutional), New York, New York, USA.,Division of Infectious Diseases, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Denis Nash
- Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
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220
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Winetsky D, Burack D, Antoniou P, Garcia B, Gordon P, Scherer M. Psychosocial Factors and the Care Cascade for Hepatitis C Treatment Colocated at a Syringe Service Program. J Infect Dis 2021; 222:S392-S400. [PMID: 32877544 DOI: 10.1093/infdis/jiaa142] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) is highly effective. However, people who inject drugs face significant barriers to DAA access. METHODS We describe a program that colocates HCV management within a syringe service program in New York City. We performed a retrospective chart review of all patients with confirmed HCV viremia. RESULTS From 2015 to 2018, 102 patients with viremia completed intake. Fifty-eight patients started DAAs. Nine patients discontinued treatment or were lost to follow-up before completion; 1 is continuing DAA treatment. Of 48 patients who completed therapy, sustained virologic response (SVR) was achieved in 43 (89.6%). Age and established mental health treatment at intake were associated with SVR. Regular cocaine use was negatively associated with SVR in univariate analysis, but this association was not significant after adjustment for age. Of 30 patients completing DAA therapy with active illicit opioid use at intake, 14 (46.4%) engaged in opioid use disorder (OUD) treatment during therapy, and 9 remained in OUD treatment after completion of DAA treatment. CONCLUSIONS Loss to follow-up is a challenge for people who inject drugs, but among those who completed treatment, SVR was achieved at a high rate. Mental health treatment may facilitate HCV cure. Conversely, HCV therapy may facilitate engagement in OUD treatment and other services.
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Affiliation(s)
- Daniel Winetsky
- Comprehensive Health Program, New York Presbyterian Hospital, New York, USA.,Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, USA.,HIV Center for Clinical and Behavioral Studies at Columbia University and New York State Psychiatric Institute, New York, USA
| | - Daniel Burack
- Department of Medicine, Columbia University Irving Medical Center, New York, USA
| | - Pantelis Antoniou
- Comprehensive Health Program, New York Presbyterian Hospital, New York, USA
| | - Bill Garcia
- Washington Heights Corner Project, New York, USA
| | - Peter Gordon
- Comprehensive Health Program, New York Presbyterian Hospital, New York, USA.,Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, USA
| | - Matthew Scherer
- Comprehensive Health Program, New York Presbyterian Hospital, New York, USA.,Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, USA
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221
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See I, Gokhale RH, Geller A, Lovegrove M, Schranz A, Fleischauer A, McCarthy N, Baggs J, Fiore A. National Public Health Burden Estimates of Endocarditis and Skin and Soft-Tissue Infections Related to Injection Drug Use: A Review. J Infect Dis 2021; 222:S429-S436. [PMID: 32877563 DOI: 10.1093/infdis/jiaa149] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Despite concerns about the burden of the bacterial and fungal infection syndromes related to injection drug use (IDU), robust estimates of the public health burden of these conditions are lacking. The current article reviews and compares data sources and national burden estimates for infective endocarditis (IE) and skin and soft-tissue infections related to IDU in the United States. METHODS A literature review was conducted for estimates of skin and soft-tissue infection and endocarditis disease burden with related IDU or substance use disorder terms since 2011. A range of the burden is presented, based on different methods of obtaining national projections from available data sources or published data. RESULTS Estimates using available data suggest the number of hospital admissions for IE related to IDU ranged from 2900 admissions in 2013 to more than 20 000 in 2017. The only source of data available to estimate the annual number of hospitalizations and emergency department visits for skin and soft-tissue infections related to IDU yielded a crude estimate of 98 000 such visits. Including people who are not hospitalized, a crude calculation suggests that 155 000-540 000 skin infections related to IDU occur annually. DISCUSSION These estimates carry significant limitations. However, regardless of the source or method, the burden of disease appears substantial, with estimates of thousands of episodes of IE among persons with IDU and at least 100 000 persons who inject drugs (PWID) with skin and soft-tissue infections annually in the United States. Given the importance of these types of infections, more robust and reliable estimates are needed to better quantitate the occurrence and understand the impact of interventions.
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Affiliation(s)
- Isaac See
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Runa H Gokhale
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Andrew Geller
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maribeth Lovegrove
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Asher Schranz
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Aaron Fleischauer
- North Carolina Department of Health, Raleigh, North Carolina, USA
- Career Epidemiology Field Officer, Centers for Disease Control and Prevention, Atlanta, Georgia, UA
| | - Natalie McCarthy
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - James Baggs
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Anthony Fiore
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Lee AB, Karumberia S, Gilmore A, Williams E, Bruner N, Overton ET, Saag MS, Franco RA. Hepatitis C Among High-Risk Alabamians: Disease Burden and Screening Effectiveness. J Infect Dis 2021; 222:S365-S375. [PMID: 32877566 DOI: 10.1093/infdis/jiaa207] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The effectiveness of hepatitis C testing and linkage-to-care (LTC) is poorly characterized in low-resource jurisdictions facing gaps in harm reduction, including illegality of syringe exchange services. Effectiveness of a community-based test/LTC program was evaluated in Alabama. METHODS In 2016-2018, shelters, drug treatment centers (DTCs), AIDS organizations, and Federally Qualified Health Centers (FQHCs) engaged in screening/LTC. A coordinator navigated individuals to confirm viremia and link to substance use treatment or primary care with hepatitis C prescribers. RESULTS Point-of-care (POC) tested 4293 individuals (10% [427] antibody-positive, 71% [299/419] RNA performed, 80% [241/299] viremia confirmed) and 93% linked to care (225/241). Electronic medical record (EMR)-based reflex strategy screened 4654 (15% [679] antibody positive, 99% [670/679] RNA performed, 64% [433/679] viremia confirmed) and 85% linked to care (368/433). We observed higher odds of RNA confirmation in EMR-based reflex versus POC (OR, 2.07; P < .0001) and higher odds of LTC in EMR-based reflex versus POC (OR, 1.51; P < .0001). Overall, 53% individuals tested were nonbaby boomers. CONCLUSIONS In Alabama, screening at high-risk settings identified significant hepatitis C burden and reflex testing outperformed point-of-care linkage indicators. Colocating testing in DTCs and treatment in FQHCs provided key LTC venues to at-risk younger groups.
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Affiliation(s)
- Anthony B Lee
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sandra Karumberia
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ashley Gilmore
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ebony Williams
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Nichole Bruner
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Edgar Turner Overton
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michael S Saag
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ricardo A Franco
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
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223
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Chavis NS, Klein PW, Cohen SM, Dempsey A, Hauck H, Cheever LW. The Health Resources and Services Administration (HRSA) Ryan White HIV/AIDS Program's Response to the Opioid Epidemic. J Infect Dis 2021; 222:S477-S485. [PMID: 32877537 DOI: 10.1093/infdis/jiaa230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The United States is in the midst of an unprecedented opioid crisis with increasing injection drug use (IDU)-related human immunodeficiency virus (HIV) outbreaks, particularly in rural areas. The Health Resources and Services Administration (HRSA)'s Ryan White HIV/AIDS Program (RWHAP) is well positioned to integrate treatment for IDU-associated HIV infections with treatment for drug use disorders. These activities will be crucial for the "Ending the HIV Epidemic: A Plan for America" (EHE) initiative, in which 7 southern states were identified with rural HIV epidemics. METHODS The RWHAP Services Report data were used to assess the IDU population and substance use services utilization among RWHAP clients in 2017, nationally and in the 7 EHE-identified states. THe HRSA held a 1-day Technical Expert Panel (TEP) to explore how RWHAP can best respond to the growing opioid crisis. RESULTS During the TEP, 8 key themes emerged and 11 best practices were identified to address opioid use disorder (OUD) among people with HIV. In 2017, among RWHAP clients with reported age and transmission category, 6.7% (31 683) had HIV attributed to IDU; among IDU clients, 6.3% (1988) accessed substance use services. CONCLUSIONS The TEP results and RWHAP data were used to develop implementation science projects that focus on addressing OUD and integrating behavioral health in primary care. These activities are critical to ending the HIV epidemic.
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Affiliation(s)
- Nicole S Chavis
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Division of Policy and Data, Rockville, Maryland, USA
| | - Pamela W Klein
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Division of Policy and Data, Rockville, Maryland, USA
| | - Stacy M Cohen
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Division of Policy and Data, Rockville, Maryland, USA
| | - Antigone Dempsey
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Division of Policy and Data, Rockville, Maryland, USA
| | - Heather Hauck
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Office of the Associate Administrator, Rockville, Maryland, USA
| | - Laura W Cheever
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Office of the Associate Administrator, Rockville, Maryland, USA
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Social vulnerability in persons with chronic hepatitis C virus infection is associated with a higher risk of prescription opioid use. Sci Rep 2021; 11:5883. [PMID: 33723313 PMCID: PMC7961056 DOI: 10.1038/s41598-021-85283-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/15/2021] [Indexed: 01/20/2023] Open
Abstract
Prescription opioid use (POU) is often a precursor to opioid use disorder (OUD) and subsequent consequences. Persons with chronic hepatitis C virus infection (CHC) may be at a higher risk of POU due to a higher comorbidity burden and social vulnerability factors. We sought to determine the burden of POU and associated risk factors among persons with CHC in the context of social vulnerability. We identified CHC persons and propensity-score matched HCV− controls in the electronically retrieved Cohort of HCV-Infected Veterans and determined the frequency of acute, episodic long-term and chronic long-term POU and the prevalence of social vulnerability factors among persons with POU. We used logistic regression analysis to determine factors associated with POU. Among 160,856 CHC and 160,856 propensity-score matched HCV-controls, acute POU was recorded in 38.4% and 38.0% (P = 0.01) respectively. Episodic long-term POU was recorded in 3.9% in each group (P = 0.5), while chronic long-term POU was recorded in 28.4% and 19.2% (P < 0.0001). CHC was associated with a higher risk of chronic long-term POU (OR 1.66, 95%CI 1.63, 1.69), but not with acute or episodic long-term POU. Black race, female sex and homelessness were associated with a higher risk of chronic long-term POU. Presence of ≥ 1 factor was associated with a higher risk of all POU patterns. Persons with CHC have more social vulnerability factors and a higher risk of chronic long-term POU. Presence of ≥ 1 social vulnerability factor is associated with a higher risk of POU. Downstream consequences of POU need further study.
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225
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Wagner K, Zhong Y, Teshale E, White K, Winstanley EL, Hettema J, Thornton K, Bisztray B, Fiuty P, Page K. Hepatitis C virus infection and polysubstance use among young adult people who inject drugs in a rural county of New Mexico. Drug Alcohol Depend 2021; 220:108527. [PMID: 33465605 PMCID: PMC7889731 DOI: 10.1016/j.drugalcdep.2021.108527] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/06/2020] [Accepted: 12/27/2020] [Indexed: 01/07/2023]
Abstract
AIMS We assessed prevalence and correlates for hepatitis C virus (HCV) infection in young adult people who inject drugs (PWID) in rural New Mexico, where opioid use has been historically problematic. METHODS Participants were 18-29 years old with self-reported injection drug use in the past 90 days. We conducted testing for HCV antibodies (anti-HCV) and HCV ribonucleic acid (RNA) and assessed sociodemographic and risk exposures. We provided counseling and referrals to prevention services and drug treatment. We estimated prevalence ratios (PR) to assess bivariate associations with HCV infection; and adjusted PRs using modified Poisson regression methods. RESULTS Among 256 participants tested for anti-HCV, 156 (60.9 %) had been exposed (anti-HCV positive), and of 230 tested for both anti-HCV and HCV RNA, 103 (44.8 %) had current infection (RNA-positive). The majority (87.6 %) of participants were Hispanic. Almost all (96.1 %) had ever injected heroin; 52.4 % and 52.0 % had ever injected methamphetamine or cocaine, respectively. Polysubstance injecting (heroin and any other drug) was associated with significantly higher prevalence of HCV infection (76.0 %) compared to injecting only heroin (24.0 %) (PR: 3.17 (95 % CI:1.93, 5.23)). Years of injecting, history of non-fatal opioid-involved overdose, polysubstance injecting, and stable housing were independently associated with HCV infection. CONCLUSIONS HCV is highly prevalent among young adult PWID in rural NM. The high reported prevalence of polysubstance injecting and its association with HCV infection should be considered in prevention planning.
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Affiliation(s)
- Katherine Wagner
- Department of Internal Medicine, MSC10 5550, 1 University of New Mexico, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, 84131 USA
| | - Yuna Zhong
- Division of Viral Hepatitis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eyasu Teshale
- Division of Viral Hepatitis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kirsten White
- Department of Internal Medicine, MSC10 5550, 1 University of New Mexico, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, 84131 USA
| | - Erin L Winstanley
- Department of Behavioral Medicine and Psychiatry, School of Medicine and Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Jennifer Hettema
- Department of Family and Community Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Karla Thornton
- Department of Internal Medicine, MSC10 5550, 1 University of New Mexico, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, 84131 USA,ECHO Institute University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Birgitta Bisztray
- Department of Internal Medicine, MSC10 5550, 1 University of New Mexico, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, 84131 USA
| | | | - Kimberly Page
- Department of Internal Medicine, MSC10 5550, 1 University of New Mexico, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, 84131, USA.
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Ballard AM, Haardöerfer R, Prood N, Mbagwu C, Cooper HLF, Young AM. Willingness to Participate in At-Home HIV Testing Among Young Adults Who Use Opioids in Rural Appalachia. AIDS Behav 2021; 25:699-708. [PMID: 32910353 PMCID: PMC7481760 DOI: 10.1007/s10461-020-03034-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
New HIV infections associated with injection drug use are of major concern in rural US communities. This study explores acceptability of, consent for, and uptake of free at-home HIV testing among people who use drugs (PWUD) in one of the nation’s epicenters for drug-related harms and HIV vulnerability: Rural Central Appalachia. Eligible participants were 18–35 years old, lived in Appalachian Kentucky, and reported using opioids to get high in the previous 30 days. A majority reported being likely (63.6%, 96/151) to take a free at-home HIV tests and 66.9% (101/151) consented to receive one. Among those who were randomly selected to receive a Home Access HIV-1 test kit (n = 37), 37.8% mailed in blood spots and 21.6% called to receive results. This study provides evidence that PWUD may be willing to take an at-home test, but other barriers may inhibit actual completion.
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Affiliation(s)
- April M Ballard
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, USA.
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30329, USA.
| | - Regine Haardöerfer
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Nadya Prood
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Chukwudi Mbagwu
- Department of Preventive Medicine and Environmental Health, University of Kentucky College of Public Health, Lexington, KY, USA
| | - Hannah L F Cooper
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - April M Young
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, USA
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
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227
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Age and gender-specific hepatitis C continuum of care and predictors of direct acting antiviral treatment among persons who inject drugs in Seattle, Washington. Drug Alcohol Depend 2021; 220:108525. [PMID: 33461152 PMCID: PMC7938869 DOI: 10.1016/j.drugalcdep.2021.108525] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/11/2020] [Accepted: 12/23/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Direct acting antivirals (DAAs) have revolutionized management of hepatitis C virus (HCV), but treatment uptake remains low among persons who inject drugs (PWID). We report the continuum of care for HCV and describe predictors of treatment with DAAs among PWID in Seattle. METHODS We analyzed data from the 2018 Seattle area National HIV Behavioral Surveillance (NHBS) survey of PWID. Persons ≥18 years of age who injected drugs in the past year and completed the core NHBS survey, a local survey supplement, and rapid HCV antibody testing were included. Among those who screened HCV antibody positive, we calculated proportions and 95 % confidence intervals for self-reported steps along the HCV care continuum. Multivariable logistic regression was used to calculate the adjusted odds (AOR) of having received DAA therapy. RESULTS The sample included 533 PWID, 376 (71 %) of whom tested positive for antibodies to HCV. Among those who were HCV antibody positive, 94 % reported any prior HCV test, 81 % reported a prior confirmatory test, and 68 % reported a prior HCV diagnosis. Of those diagnosed, 26 % had undergone treatment and 18 % had been cured. In a multivariate model, being one year older (AOR 1.05 per year, 1.01-1.08) was predictive of DAA treatment, while homelessness (AOR 0.39, 0.19-0.80) and female gender (AOR 0.36, 0.16-0.78) were associated with a lower odds of DAA therapy. CONCLUSIONS Despite widespread HCV testing among PWID in Seattle, treatment uptake remains low in the DAA era. In particular, treatment of women, younger adults and persons living homeless is lagging behind.
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228
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Scott J, Fagalde M, Baer A, Glick S, Barash E, Armstrong H, Kowdley KV, Golden MR, Millman AJ, Nelson NP, Canary L, Messerschmidt M, Patel P, Ninburg M, Duchin J. A Population-Based Intervention to Improve Care Cascades of Patients With Hepatitis C Virus Infection. Hepatol Commun 2021; 5:387-399. [PMID: 33681674 PMCID: PMC7917269 DOI: 10.1002/hep4.1627] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/14/2020] [Accepted: 09/23/2020] [Indexed: 12/24/2022] Open
Abstract
Hepatitis C virus (HCV) infection is common in the United States and leads to significant morbidity, mortality, and economic costs. Simplified screening recommendations and highly effective direct-acting antivirals for HCV present an opportunity to eliminate HCV. The objective of this study was to increase testing, linkage to care, treatment, and cure of HCV. This was an observational, prospective, population-based intervention program carried out between September 2014 and September 2018 and performed in three community health centers, three large multiclinic health care systems, and an HCV patient education and advocacy group in King County, WA. There were 232,214 patients included based on criteria of documented HCV-related diagnosis code, positive HCV laboratory test or prescription of HCV medication, and seen at least once at a participating clinical site in the prior year. Electronic health record (EHR) prompts and reports were created. Case management linked patients to care. Primary care providers received training through classroom didactics, an online curriculum, specialty clinic shadowing, and a telemedicine program. The proportion of baby boomer patients with documentation of HCV testing increased from 18% to 54% during the project period. Of 77,577 baby boomer patients screened at 87 partner clinics, 2,401 (3%) were newly identified HCV antibody positive. The number of patients staged for treatment increased by 391%, and those treated increased by 1,263%. Among the 79% of patients tested after treatment, 95% achieved sustained virologic response. Conclusion: A combination of EHR-based health care system interventions, active linkage to care, and clinician training contributed to a tripling in the number of patients screened and a more than 10-fold increase of those treated. The interventions are scalable and foundational to the goal of HCV elimination.
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Affiliation(s)
- John Scott
- Division of Allergy and Infectious DiseasesUniversity of WashingtonSeattleWAUSA
| | | | - Atar Baer
- Public Health – Seattle King CountySeattleWAUSA
| | - Sara Glick
- Division of Allergy and Infectious DiseasesUniversity of WashingtonSeattleWAUSA
- Public Health – Seattle King CountySeattleWAUSA
| | | | | | | | - Matthew R. Golden
- Division of Allergy and Infectious DiseasesUniversity of WashingtonSeattleWAUSA
- Public Health – Seattle King CountySeattleWAUSA
| | - Alexander J. Millman
- Division of Viral HepatitisNational Center for HIV/AIDS, Viral Hepatitis, STD, and TB PreventionCenters for Disease Control and PreventionAtlantaGAUSA
| | - Noele P. Nelson
- Division of Viral HepatitisNational Center for HIV/AIDS, Viral Hepatitis, STD, and TB PreventionCenters for Disease Control and PreventionAtlantaGAUSA
| | - Lauren Canary
- Division of Viral HepatitisNational Center for HIV/AIDS, Viral Hepatitis, STD, and TB PreventionCenters for Disease Control and PreventionAtlantaGAUSA
| | | | | | | | - Jeff Duchin
- Division of Allergy and Infectious DiseasesUniversity of WashingtonSeattleWAUSA
- Public Health – Seattle King CountySeattleWAUSA
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Outbreak of hepatitis B and hepatitis C virus infections associated with a cardiology clinic, West Virginia, 2012-2014. Infect Control Hosp Epidemiol 2021; 42:1458-1463. [PMID: 33641684 DOI: 10.1017/ice.2021.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
OBJECTIVE To stop transmission of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in association with myocardial perfusion imaging (MPI) at a cardiology clinic. DESIGN Outbreak investigation and quasispecies analysis of HCV hypervariable region 1 genome. SETTING Outpatient cardiology clinic. PATIENTS Patients undergoing MPI. METHODS Case patients met definitions for HBV or HCV infection. Cases were identified through surveillance registry cross-matching against clinic records and serological screening. Observations of clinic practices were performed. RESULTS During 2012-2014, 7 cases of HCV and 4 cases of HBV occurred in 4 distinct clusters among patients at a cardiology clinic. Among 3 case patients with HCV infection who had MPI on June 25, 2014, 2 had 98.48% genetic identity of HCV RNA. Among 4 case patients with HCV infection who had MPI on March 13, 2014, 3 had 96.96%-99.24% molecular identity of HCV RNA. Also, 2 clusters of 2 patients each with HBV infection had MPI on March 7, 2012, and December 4, 2014. Clinic staff reused saline vials for >1 patient. No infection control breaches were identified at the compounding pharmacy that supplied the clinic. Patients seen in clinic through March 27, 2015, were encouraged to seek testing for HBV, HCV, and human immunodeficiency virus. The clinic switched to all single-dose medications and single-use intravenous flushes on March 27, 2015, and no further cases were identified. CONCLUSIONS This prolonged healthcare-associated outbreak of HBV and HCV was most likely related to breaches in injection safety. Providers should follow injection safety guidelines in all practice settings.
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Evaluation of a strategy for identification of hepatitis C virus carriers in outpatient and emergency units: contribution to the microelimination of hepatitis C in Brazil. Braz J Infect Dis 2021; 25:101546. [PMID: 33636108 PMCID: PMC9392148 DOI: 10.1016/j.bjid.2021.101546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/06/2021] [Accepted: 01/19/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction Hepatitis C virus (HCV) infection continues to be an important public health problem worldwide. Despite the availability of drugs that promote the cure of infection in more than 95% of cases, the identification of HCV carriers remains a major challenge. Objective To evaluate a strategy for identifying HCV carriers based on combined criteria: screening in emergency units and specialty outpatient clinics of a tertiary hospital and among older adults (≥45 years), both suggested as efficient in epidemiological studies. Methods A cross-sectional, analytical and descriptive study was conducted on individuals of both sexes, aged 45 years and older, attending the emergency department and specialty outpatient clinics of a University Hospital in São Paulo, Brazil, from January 2016 to June 2018. After giving formal consent, the patients were submitted to a standardized interview and rapid testing for the identification of HCV antibodies (SD BIOLINE® anti-HCV). Results A total of 606 adult patients (62% women and 37% men) were evaluated. The mean age was 62 ± 10 years. Four positive tests were identified, with confirmation by conventional serology and HCV-RNA determination. Thus, the prevalence of HCV identified in the sample was 0.66%. All patients had a history of risk factors for infection. Conclusion The strategies of birth-cohort testing and screening in emergency medical services for the identification of HCV carries, both suggested in the literature as efficient for the diagnosis of hepatitis C, resulted in a low rate of HCV infection. These findings highlight the magnitude of the challenge of identifying asymptomatic HCV carriers in Brazil.
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231
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Hochstatter KR, Gustafson DH, Landucci G, Pe-Romashko K, Cody O, Maus A, Shah DV, Westergaard RP. Effect of an mHealth Intervention on Hepatitis C Testing Uptake Among People With Opioid Use Disorder: Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e23080. [PMID: 33616545 PMCID: PMC7939944 DOI: 10.2196/23080] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 12/12/2020] [Accepted: 01/08/2021] [Indexed: 12/11/2022] Open
Abstract
Background The growing epidemic of opioid use disorder (OUD) and associated injection drug use has resulted in a surge of new hepatitis C virus (HCV) infections. Approximately half of the people with HCV infection are unaware of their HCV status. Improving HCV awareness and increasing screening among people with OUD are critical. Addiction-Comprehensive Health Enhancement Support System (A-CHESS) is an evidence-based, smartphone-delivered relapse prevention system that has been implemented among people with OUD who are receiving medications for addiction treatment (MAT) to improve long-term recovery. Objective We incorporated HCV-related content and functionality into A-CHESS to characterize the HCV care continuum among people in early remission and receiving MAT for OUD and to determine whether incorporating such content and functionality into A-CHESS increases HCV testing. Methods HCV intervention content, including dissemination of educational information, private messages tailored to individuals’ stage of HCV care, and a public discussion forum, was implemented into the A-CHESS platform. Between April 2016 and April 2020, 416 participants with OUD were enrolled in this study. Participants were randomly assigned to receive MAT alone (control arm) or MAT+A-CHESS (experimental arm). Quarterly telephone interviews were conducted from baseline to month 24 to assess risk behaviors and HCV testing history. Cox proportional hazards regression was used to assess whether participants who used A-CHESS were tested for HCV (either antibody [Ab] or RNA testing) at a higher rate than those in the control arm. To assess the effect of A-CHESS on subsets of participants at the highest risk for HCV, additional analyses were performed to examine the effect of the intervention among participants who injected drugs and shared injection equipment. Results Overall, 44.2% (184/416) of the study participants were HCV Ab positive, 30.3% (126/416) were HCV Ab negative, and 25.5% (106/416) were considered untested at baseline. At month 24, there was no overall difference in HCV testing uptake between the intervention and control participants. However, among the subset of 109 participants who engaged in injection drug use, there was a slight trend toward increased HCV testing uptake among those who used A-CHESS (89% vs 85%; hazard ratio: 1.34; 95% CI 0.87-2.05; P=.18), and a stronger trend was observed when focusing on the subset of 32 participants who reported sharing injection equipment (87% vs 56%; hazard ratio: 2.92; 95% CI 0.959-8.86; P=.06). Conclusions Incorporating HCV prevention and care information into A-CHESS may increase the uptake of HCV testing while preventing opioid relapse when implemented among populations who engage in high-risk behaviors such as sharing contaminated injection equipment. However, more studies that are powered to detect differences in HCV testing among high-risk groups are needed. Trial Registration ClinicalTrials.gov NCT02712034; https://clinicaltrials.gov/ct2/show/NCT02712034 International Registered Report Identifier (IRRID) RR2-10.2196/12620
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Affiliation(s)
- Karli R Hochstatter
- School of Social Work, Columbia University, New York, NY, United States.,Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States.,Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - David H Gustafson
- Department of Industrial and Systems Engineering, Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Gina Landucci
- Department of Industrial and Systems Engineering, Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Klaren Pe-Romashko
- Department of Industrial and Systems Engineering, Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Olivia Cody
- Department of Industrial and Systems Engineering, Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Adam Maus
- Department of Industrial and Systems Engineering, Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Dhavan V Shah
- Department of Industrial and Systems Engineering, Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Ryan P Westergaard
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States.,Bureau of Communicable Diseases, Wisconsin Department of Health Services, Madison, WI, United States
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232
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233
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Gatta LA, Hughes BL. Premature Rupture of Membranes with Concurrent Viral Infection. Obstet Gynecol Clin North Am 2021; 47:605-623. [PMID: 33121648 DOI: 10.1016/j.ogc.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Treatment of viral infections is geared toward ameliorating maternal symptoms and minimizing perinatal transmission. Multidisciplinary teams often are required to manage sequelae due to viral diseases in patients with preterm premature rupture of membranes (PPROM). although data are scarce regarding the antepartum management of common viruses in PPROM, essential principles may be extrapolated from national guidelines and studies in gravid patients. The well-established risks of prematurity are weighed against the often unclear risks of vertical transmission.
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Affiliation(s)
- Luke A Gatta
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Duke University Hospital, 2608 Erwin Road, Durham, NC 27705-4597, USA.
| | - Brenna L Hughes
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Duke University Hospital, 2608 Erwin Road, Durham, NC 27705-4597, USA
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234
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Walters SM, Kral AH, Lamb S, Goldshear JL, Wenger L, Bluthenthal RN. Correlates of Transactional Sex and Violent Victimization among Men Who Inject Drugs in Los Angeles and San Francisco, California. J Urban Health 2021; 98:70-82. [PMID: 33409836 PMCID: PMC7873178 DOI: 10.1007/s11524-020-00494-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Men who inject drugs (MWID) and engage in transactional sex (i.e., receive money or drugs in exchange for sex) are vulnerable to HIV and violence. However, MWID who engage in transactional sex have been less studied than women. We examine factors associated with transactional sex among MWID in Los Angeles and San Francisco and whether transactional sex is associated with violent victimization. MWID were recruited using targeted sampling methods in 2011-2013 and completed surveys that covered demographics, drug use, HIV risk, violence, transactional sex, and other items. Multivariable logistic regression was used to (1) determine factors independently associated with transactional sex and (2) determine if transactional sex was independently associated with violence victimization in the last 6 months among MWID. An interaction term between income source and sexual identity was included in the transactional sex model. Of the 572 male PWID in the sample, 47 (8%) reported transactional sex in the past 6 months. Self-reported HIV infection was 7% for MWID who did not report transactional sex, 17% for MWID who reported transactional sex, and 24% for MWID who reported transactional sex and reported gay or bisexual identity. In multivariable analysis, transactional sex was positively associated with gay or bisexual identity (GB without illegal income adjusted odds ratio [AOR] = 5.16; 95% confidence interval [CI] = 1.86-14.27; GB with illegal income AOR = 13.55, CI = 4.57-40.13), coerced sex in the last 12 months (AOR = 11.66, CI = 1.94-70.12), and violent victimization in the last 12 months (AOR = 2.31, CI = 1.13-4.75). Transactional sex was negatively associated with heroin injection (last 30 days) (AOR = 0.37; 95% CI = 0.18-0.78). Transactional sex was independently associated with violent victimization in the last 12 months (AOR = 2.04; 95% CI = 1.00-4.14) while controlling for confounders. MWID who engaged in transactional sex are at elevated risk for HIV and multiple forms of violent victimization. Interventions focused on this at-risk subpopulation are urgently needed and should include access to substance use disorder treatment, victimization services, and harm reduction services across the HIV care continuum.
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Affiliation(s)
- Suzan M Walters
- Rory Meyers College of Nursing, New York University, New York, NY, USA.
| | | | - Shona Lamb
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jesse L Goldshear
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Ricky N Bluthenthal
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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235
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Zhu X, Bratanow NC. Physician Perspective and Challenges Ordering/Interpreting Laboratory Tests Related to the Opioid Crisis in America. Ther Drug Monit 2021; 43:6-13. [PMID: 33230042 DOI: 10.1097/ftd.0000000000000840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/28/2020] [Indexed: 11/25/2022]
Abstract
ABSTRACT The opioid crisis is a profound public health crisis in the United States. It has significantly increased morbidity and mortality in our nation. There are many contributing factors to the opioid crisis, including a strong national and international interest to treat pain as effectively as possible. To combat this crisis, numerous strategies have been implemented over the past few years at the legislative, health system, and patient levels. As a result of these efforts, for the first time since 1999, drug overdose deaths in the United States decreased from 2017 to 2018, when deaths involving all opioids, prescription opioids, and heroin decreased by 2%, 13.5%, and 4.1%, respectively. To continue to curb the opioid crisis, it is imperative to optimize pain control through multidisciplinary and multimodal approaches and to adhere to opioid prescribing guidelines from regulatory and professional organizations to minimize risks for opioid misuse and abuse. Urine drug testing is an important means to assist with opioid monitoring and safe opioid prescribing. There are challenges when ordering urine drug tests, collecting specimens, and interpreting test results. Inaccurate interpretations of laboratory results can have significantly negative impacts on patients care and life. There is a critical need for prescriber education by laboratory experts in the use of drug testing and interpretation of results. To interpret test results correctly and make safe prescribing decisions, it is very important for prescribers/providers to consult clinical toxicologists, laboratory directors, and reporting staff. This interaction is vital and provides excellence of care for patients. This review aims to provide information concerning the opioid crisis in the United States and summarizes the challenges ordering and interpreting opioid-related laboratory testing as well as pertinent guidelines and recommendations.
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Affiliation(s)
- Xiaoying Zhu
- Department of Anesthesiology, Pain Management Center, University of Virginia Health System, Charlottesville, Virginia; and
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236
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Kapadia SN, Katzman C, Fong C, Eckhardt BJ, Guarino H, Mateu-Gelabert P. Hepatitis C testing and treatment uptake among young people who use opioids in New York City: A cross-sectional study. J Viral Hepat 2021; 28:326-333. [PMID: 33141503 PMCID: PMC8207521 DOI: 10.1111/jvh.13437] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 09/22/2020] [Accepted: 10/23/2020] [Indexed: 12/16/2022]
Abstract
Young people who use drugs have a rising hepatitis C (HCV) incidence in the United States, but they may face barriers to testing and treatment adoption due to stigma. We conducted a cross-sectional study of New York City residents aged 18-29 years who reported non-medical prescription opioid and/or heroin use in the past 30 days. Participants were recruited from the community between 2014-2016 via respondent-driven sampling. Participants completed an in-person structured survey that included questions about HCV testing and treatment and received HCV antibody testing. There were 539 respondents: 353 people who inject drugs (PWID) and 186 non-PWID. For PWID, median age was 25 years, 65% were male and 73% non-Hispanic White. For non-PWID, median age was 23 years, 73% were male and 39% non-Hispanic White. 20% of PWID and 54% of non-PWID had never been tested for HCV (P < .001). Years since first injection (aOR 1.16, CI: 1.02-1.32, P = .02) and history of substance use treatment (aOR 3.17, CI: 1.53-6.61, P = .02) were associated with prior testing among PWID. The seroprevalence of HCV among PWID was 25%, adjusted for sampling weights. Of the 75 who were aware of their HCV-positive status, 53% had received HCV-related medical care, and 28% had initiated treatment. HCV prevalence among young PWID is high, and many have never been tested. Injection experience and treatment engagement is associated with testing. Interventions to increase testing earlier in injection careers, and to improve linkage to HCV treatment, will be critical for young PWID.
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Affiliation(s)
- Shashi N Kapadia
- Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
| | - Caroline Katzman
- Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Chunki Fong
- Institute for Implementation Science in Population Health, City University of New York Graduate School of Public Health & Health Policy, New York, NY, USA
| | - Benjamin J Eckhardt
- Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Honoria Guarino
- Institute for Implementation Science in Population Health, City University of New York Graduate School of Public Health & Health Policy, New York, NY, USA
| | - Pedro Mateu-Gelabert
- Department of Community Health and Social Sciences, City University of New York Graduate School of Public Health & Health Policy, New York, NY, USA
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237
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Delays and Gaps in Progressing Through the Hepatitis C Virus Cascade of Care: An Underserved Safety-net Hospital Experience. J Transl Int Med 2021; 8:261-267. [PMID: 33511053 PMCID: PMC7805291 DOI: 10.2478/jtim-2020-0039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background and Objective While highly effective hepatitis C virus (HCV) therapies exist, gaps in the cascade of care remain. Disparities in the HCV cascade are prominent among underserved safety-net populations. We aim to evaluate the HCV cascade among an urban safety-net cohort of HCV patients. Methods We retrospectively evaluated adults with chronic HCV to determine rates of linkage to care (LTC), retention to care, and receiving HCV treatment from 2002 to 2018. Comparisons between groups utilized Chi-square testing; comparisons of median time to LTC and HCV treatment were evaluated with Student’s t-test and analysis of variance. Results Among 600 chronic HCV patients (60.7% male, 20.7% non-Hispanic white, 49.2% African American, 92.5% treatment naïve, 26.8% cirrhosis), successful LTC within one year of HCV diagnosis was 57.7%, among which, 91.6% were successfully retained into care. In those with successful LTC, 72.6% received HCV treatment, 91.8% completed treatment, and 89% achieved SVR12. Women with HCV experienced longer delays from LTC to HCV treatment (331 vs. 206 days in men, P < 0.05), as did African Americans (280 vs. 165 days in non-Hispanic whites, P < 0.05). Compared to the non-Hispanic whites, HCV treatment was lower in African Americans (70.4% vs. 74.4%, P < 0.05). Conclusion Women with HCV experienced significant delays along the HCV cascade, with median time of over 2 years from diagnosis to treatment. African Americans also experienced significant delays along the HCV cascade of care. However, sex and race/ethnicity were not found to be significant predictors of overall LTC or treatment.
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238
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Jandovitz N, Nair V, Grodstein E, Molmenti E, Fahmy A, Abate M, Bhaskaran M, Teperman L. Hepatitis C-positive donor to negative recipient kidney transplantation: A real-world experience. Transpl Infect Dis 2021; 23:e13540. [PMID: 33259125 DOI: 10.1111/tid.13540] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 11/03/2020] [Accepted: 11/22/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Several studies have shown that transplanting a hepatitis C virus (HCV)-negative recipients with a HCV-positive donor is feasible in a research setting. In February 2018, we began transplanting HCV-negative recipients with HCV-positive donors as standard of care. METHODS All patients, except those with previously cured HCV and those with cirrhosis, were consented for HCV NAT-positive donor kidneys. After transplantation, patients were tested for HCV RNA until viremic. A direct-acting antiviral (DAA) agent was prescribed based on genotype and insurance approval. Sustained virologic response (SVR) at weeks 4 and 12 was recorded. Renal function and death censored graft survival at 1 year were evaluated and compared to recipients of HCV NAT-negative kidneys. RESULTS A total of 25 HCV NAT-positive donor kidney transplants from February to October 2018 were performed. All patients received basiliximab and maintained with tacrolimus, mycophenolate mofetil, and prednisone. Median time from viremia to start of DAA was 13 (8-22) days. The most common genotype was 1a (60%), followed by 3a (28%). The most commonly prescribed DAA was ledipasvir/sofosbuvir (56%), followed by velpatasvir/sofosbuvir (32%), and then glecaprevir/pibrentasvir (12%). All patients achieved initial SVR12, except one. One patient had a mixed-genotype infection requiring retreatment to achieve SVR12. Death censored graft survival was 96%. Recipients of HCV NAT-positive organs compared to HCV NAT-negative organs received younger donors (mean 35 ± 8.9 vs 45.1 ± 15.7 years; P < .01) and spent less time on the waitlist (median 479 (93-582) vs 1808 (567-2263) days; P = .02). CONCLUSION HCV NAT-negative recipients can be safely and successfully transplanted with HCV NAT-positive donor kidneys outside of a research protocol. Access to DAA and timely administration of therapy is important and an insurance approval process within the transplant center can be beneficial to patients. A case of mixed-genotype infection was presented, and although not as common, can be successfully treated. HCV organs can expand the organ pool and should no longer be considered experimental. The use of these organs in HCV-negative recipient's decreases waiting time, have excellent outcomes, and should be considered standard of care.
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Affiliation(s)
- Nicholas Jandovitz
- Department of Pharmacy, North Shore University Hospital -Northwell Health, Manhasset, NY, USA.,Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Vinay Nair
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Elliot Grodstein
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Ernesto Molmenti
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Ahmed Fahmy
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Mersema Abate
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Madhu Bhaskaran
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Lewis Teperman
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
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Sharma R. Descriptive epidemiology of incidence and mortality of primary liver cancer in 185 countries: evidence from GLOBOCAN 2018. Jpn J Clin Oncol 2021; 50:1370-1379. [PMID: 32719873 DOI: 10.1093/jjco/hyaa130] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/03/2020] [Indexed: 12/24/2022] Open
Abstract
PURPOSE This study aims to examine the burden of primary liver cancer in 185 countries in 2018. METHODS The estimates of incidence, mortality and prevalence of primary liver cancer were procured from GLOBOCAN 2018. The development status of a country was measured using the human development index-a composite indicator of income per capita, education and life expectancy. RESULTS Globally, primary liver cancer resulted in an estimated 781 631 deaths at age-standardized mortality rate of 8.5/100 000, and 841 080 cases were estimated to be diagnosed in 2018. Males accounted for 596 574 cases and 548 375 deaths, which is more than twice the burden of primary liver cancer in females (cases: 244 506; deaths: 233 456). The global age-standardized incidence rate was 9.3/100 000 in 2018, varying from Morocco (1.1/100 000) to Mongolia (93.7/100 000). There were remarkable variations in terms of age-standardized mortality rate, too, which ranged from 1/100 000 in Nepal to 75.4/100 000 in Mongolia. East Asia was the top region contributing 55.6% of global cases and 54.7% of global deaths. CONCLUSIONS Since majority of the primary liver cancer burden pertains to hepatocellular carcinoma and screening approaches are yet to be fully proven, the policy focus must be on prevention approaches through the hepatitis-B vaccine, early detection of hepatitis-C infection, reduced alcohol consumption, obesity control, reduced aflatoxin exposure and containment of other modifiable risk factors.
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Affiliation(s)
- Rajesh Sharma
- University School of Management and Entrepreneurship, Delhi Technological University, Delhi, India
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240
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Choi S, Healy S, Shapoval L, Forthal S, Neighbors CJ. Hepatitis C Virus Screening among Medicaid-Insured Individuals with Opioid Use Disorder across Substance Use Disorder Treatment Settings. Subst Use Misuse 2021; 56:258-263. [PMID: 33345680 PMCID: PMC8262086 DOI: 10.1080/10826084.2020.1858106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective: Although the rapid increase in opioid use disorders (OUD) and concurrent increase in Hepatitis C virus (HCV) in the United States is well-documented, little is known about HCV testing among high-risk populations. We examine patterns of HCV testing across OUD treatment settings for individuals with OUD in New York. Methods: Using 2014 New York Medicaid claims data, we identified OUD diagnosis, OUD treatment (methadone, buprenorphine, naltrexone, other treatment (inpatient or outpatient non-medication-based psychosocial treatment, such as psychotherapy) and no treatment) utilization and HCV-testing status among beneficiaries. We performed multivariable logistic regression to identify factors associated with HCV screening across OUD treatment settings. Results: 79,764 individuals with OUD diagnoses were identified in 2014. The prevalence of HCV screening was 32.4%, 16.2%, 20.6%, 16.8%, and 18.1% for those receiving methadone, buprenorphine, naltrexone, other treatment, and no treatment, respectively. In the adjusted logistic regression, those receiving any OUD treatment had greater odds of being screened, with the highest odds among methadone clients. Conclusions: Engagement in medication for OUD is associated with increased HCV testing. Findings indicate the importance of access to medication-based treatment for OUD and a need to further improve HCV screening rates.
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Affiliation(s)
- Sugy Choi
- Department of Health Services Research, Center on Addiction, New York, NY, USA.,Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Shannon Healy
- Department of Health Services Research, Center on Addiction, New York, NY, USA
| | - Liudmila Shapoval
- Department of Health Services Research, Center on Addiction, New York, NY, USA
| | - Sarah Forthal
- Department of Health Services Research, Center on Addiction, New York, NY, USA
| | - Charles J Neighbors
- Department of Health Services Research, Center on Addiction, New York, NY, USA.,Health Evaluation and Analytics Lab, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
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241
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Hack B, Timalsina U, Tefera E, Wilkerson B, Paku E, Fernandez S, Fishbein D. Oral Prescription Opioids as a High-Risk Indicator for Hepatitis C Infection: Another Step Toward HCV Elimination. J Prim Care Community Health 2021; 12:21501327211034379. [PMID: 34467805 PMCID: PMC8414604 DOI: 10.1177/21501327211034379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The opioid epidemic across the U.S. poses an array of public health concerns, especially HCV transmission. HCV is now widely curable, yet incident rates are increasing due to the opioid epidemic. Despite the established trajectory from oral prescription opioids (OPOs) to opioid use disorder (OUD), OUD to injection drug use (IDU), and IDU to hepatitis C virus (HCV), OPOs are not a defined risk factor (RF) for HCV infection. The objective of this study was to observe rates of HCV testing and Ab reactivity (HCVAb+) in patients receiving OPOs to substantiate them as a RF, ultimately contributing to HCV elimination. METHODS Data from MedStar Health patients receiving OPOs from 1/2017 to 12/2018 were collected and analyzed using chi-squared or student t-tests and logistic regression for uni- or multi-variable analyses, respectively. Statistical significance was defined as P < .05; Epi Info and SAS v 9·4 were used for statistical analyses; IRB approval was received. RESULTS There were 115 415 individuals prescribed OPOs over the study period. In this population, 8.6% (932) were HCVAb+ when tested and not previously diagnosed (10 900); 3.4% (3893) had an OUD diagnosis, 20.6% (803) of whom were HCV tested; 25.4% (361) of all HCVAb+ (1421) had an OUD diagnosis. OUD (ORadj 8.53 [7.22-10.07]) was an independent predictor of HCVAb+ in this population. CONCLUSIONS (1) In a large population prescribed oral opioids, HCVAb+ was 8.6%, higher than our previously published data (2.5%) and the US rate (1.7%); (2) only 20% of patients diagnosed with OUD were tested; and (3) only 25% of HCVAb+ patients were classified with OUD; this suggests underreporting of OUD in this population. Primary Care and Community Health Recommendations: (1) Re-testing for HCV in patients taking OPOs; (2) increased HCV testing among OUD patients; and (3) improved surveillance and reporting of OUD.
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Affiliation(s)
- Benjamin Hack
- Georgetown University Medical School,
Washington, DC, USA
| | | | - Eshetu Tefera
- MedStar Health Research Institute,
Hyattsville, MD, USA
| | | | - Emily Paku
- MedStar Health Research Institute,
Hyattsville, MD, USA
| | | | - Dawn Fishbein
- MedStar Health Research Institute,
Hyattsville, MD, USA
- MedStar Washington Hospital Center,
Washington, DC, USA
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242
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Norton BL, Litwin AH. A Call to Action: HCV Treatment of People Who Inject Drugs in the United States. Clin Infect Dis 2021; 70:2366-2368. [PMID: 31513706 DOI: 10.1093/cid/ciz701] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 07/23/2019] [Indexed: 12/13/2022] Open
Affiliation(s)
- B L Norton
- Department of Medicine, Division of General Internal Medicine, Montefiore Medical Center, Bronx, New York
- Department of Medicine, Division of Infectious Diseases, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - A H Litwin
- Department of Medicine, University of South Carolina School of Medicine - Greenville, Greenville
- Department of Medicine, Prisma Health-Upstate, Greenville
- Clemson University School of Health Research, South Carolina
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243
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Compton WM, Valentino RJ, DuPont RL. Polysubstance use in the U.S. opioid crisis. Mol Psychiatry 2021; 26:41-50. [PMID: 33188253 PMCID: PMC7815508 DOI: 10.1038/s41380-020-00949-3] [Citation(s) in RCA: 116] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 10/04/2020] [Accepted: 10/29/2020] [Indexed: 02/07/2023]
Abstract
Interventions to address the U.S. opioid crisis primarily target opioid use, misuse, and addiction, but because the opioid crisis includes multiple substances, the opioid specificity of interventions may limit their ability to address the broader problem of polysubstance use. Overlap of opioids with other substances ranges from shifts among the substances used across the lifespan to simultaneous co-use of substances that span similar and disparate pharmacological categories. Evidence suggests that nonmedical opioid users quite commonly use other drugs, and this polysubstance use contributes to increasing morbidity and mortality. Reasons for adding other substances to opioids include enhancement of the high (additive or synergistic reward), compensation for undesired effects of one drug by taking another, compensation for negative internal states, or a common predisposition that is related to all substance consumption. But consumption of multiple substances may itself have unique effects. To achieve the maximum benefit, addressing the overlap of opioids with multiple other substances is needed across the spectrum of prevention and treatment interventions, overdose reversal, public health surveillance, and research. By addressing the multiple patterns of consumption and the reasons that people mix opioids with other substances, interventions and research may be enhanced.
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Affiliation(s)
- Wilson M. Compton
- grid.420090.f0000 0004 0533 7147U.S. Department of Health and Human Service, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD USA
| | - Rita J. Valentino
- grid.420090.f0000 0004 0533 7147U.S. Department of Health and Human Service, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD USA
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244
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Witte TH, Jaiswal J, Mumba MN, Mugoya GCT. Stigma Surrounding the Use of Medically Assisted Treatment for Opioid Use Disorder. Subst Use Misuse 2021; 56:1467-1475. [PMID: 34116605 DOI: 10.1080/10826084.2021.1936051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This study sought to determine whether certain factors influenced public stigma toward the use of medication to treat opioid use disorders (MOUD). Method: In a series of 3 studies using between-subjects designs, hypothetical MOUD patients matched in age and educational status with the participants were varied in systematic ways to determine whether certain factors influenced stigmatizing views of the patients. Results: Study 1 (n = 142) determined that stigma levels were elevated for hypothetical patients receiving agonist medication for OUD compared to other medications or no medication at all. Study 2 (n = 144) found that hypothetical patients receiving opioid agonist medication for either heroin or pain pills were equally stigmatized and stigmatized more than hypothetical patients on nicotine agonist medication. Study 3 (n = 151) showed that stigmatizing attitudes did not change as a result of enhanced treatment services for hypothetical MOUD patients (i.e. therapy as a supplement to medication). Conclusions/Importance: Results indicate that patients receiving agonist medication for an OUD may be the target of public stigma. Public education on the efficacy of agonist medications for OUD is urgently needed to help reduce such stigma, which may facilitate treatment delivery, treatment adherence, and treatment success.
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245
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Goldshear JL, Simpson KA, Kral AH, Wenger LD, Bluthenthal RN. Novel Routes of Potential Hepatitis C Virus Transmission among People Who Inject Drugs: Secondary Blood Exposures Related to Injection Drug Use. Subst Use Misuse 2021; 56:751-757. [PMID: 33769203 PMCID: PMC9563097 DOI: 10.1080/10826084.2021.1879149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND The US is in the midst of a national Hepatitis C Virus (HCV) epidemic that appears to be driven by new cases among people who inject drugs (PWID). While HCV transmission among PWID is believed to occur mostly through direct sharing of syringes, some infections may be spread via secondary processes and materials involved in injecting. OBJECTIVES Here, we present the prevalence of secondary blood exposures on clothing and nearby surfaces after injection episodes and examine the correlations of these exposures to lifetime HCV infection among a targeted sample of 553 PWID in Los Angeles and San Francisco, California in 2016-18. RESULTS In multivariate logistic regression models, higher odds of blood on clothing in the last 30 days was significantly (p < 0.05) associated with lifetime positive HCV status, opioids as primary drug, injecting with others, sharing cookers, and receptive syringe sharing. Higher adjusted odds of blood on nearby surfaces in the last 30 days was significantly associated with lifetime positive HCV status, sharing cookers, and receptive syringe sharing. Native American race was associated with significantly lower adjusted odds of both outcome variables. Conclusions/Importance: Results indicate the relevance of physical and social micro-environments to the potential for blood exposures secondary to injection episodes. Individuals with chronic HCV seropositivity are potentially more likely to expose others to blood due to decreases in the blood's ability to clot. This highlights the need for increased HCV testing at harm reduction sites and increased supply of first aid and wound-care materials to help stop potential blood exposures after injection episodes.
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Affiliation(s)
- Jesse L Goldshear
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kelsey A Simpson
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Alex H Kral
- Behavioral Health Research Division, RTI International, Berkeley, California, USA
| | - Lynn D Wenger
- Behavioral Health Research Division, RTI International, Berkeley, California, USA
| | - Ricky N Bluthenthal
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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246
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Sulkowski M, Cheng WH, Marx S, Sanchez Gonzalez Y, Strezewski J, Reau N. Estimating the Year Each State in the United States Will Achieve the World Health Organization's Elimination Targets for Hepatitis C. Adv Ther 2021; 38:423-440. [PMID: 33145648 PMCID: PMC7609357 DOI: 10.1007/s12325-020-01535-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/14/2020] [Indexed: 12/12/2022]
Abstract
Introduction Although hepatitis C virus (HCV) infection remains a major clinical, economic, and societal burden, the development of curative antiviral therapy may accelerate the path toward elimination. This analysis assessed the progress of United States (US) states towards achieving the World Health Organization’s (WHO) 2030 HCV elimination targets for incidence, mortality, diagnosis, and treatment. Methods A previously published Markov model was used to simulate HCV progression over time to estimate the path to HCV elimination in each state based on prevalence, annual treatment, and diagnosis inputs from two large US laboratory datasets from January 2013 to December 2017. State-specific fibrosis stage restrictions on treatment in 2017 were included. The model estimated the year individual states would meet the WHO targets for diagnosing 90% of the HCV-infected population, treating 80% of the eligible population, reducing new HCV infections by 80%, and reducing HCV-related deaths by 65%. The minimum number of annual treatments needed between 2020 and 2030 to achieve the WHO treatment target was also calculated. Results Overall, the USA is projected to achieve HCV elimination by 2037, with individual targets related to mortality, diagnosis, treatment, and incidence being achieved by 2020, 2027, 2033, and 2037, respectively. Three states (Connecticut, South Carolina, and Washington) are on track to meet all four elimination targets by 2030, and 18 states are not expected to meet these targets before 2040. The estimated annual number of treatments required during 2020–2030 nationally to reach the WHO treatment target is 173,514. Conclusion With the exception of three states, the USA is not on target to meet the WHO 2030 elimination targets and 35% are off track by 10 years or more. Strategies must be implemented to reduce overall prevalence by preventing new infections, increasing rates of screening, improving linkage to care, and implementing unfettered access to curative therapy. Electronic supplementary material The online version of this article (10.1007/s12325-020-01535-3) contains supplementary material, which is available to authorized users.
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247
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Belz TF, Olson ME, Giang E, Law M, Janda KD. Evaluation of a Series of Lipidated Tucaresol Adjuvants in a Hepatitis C Virus Vaccine Model. ACS Med Chem Lett 2020; 11:2428-2432. [PMID: 33335664 DOI: 10.1021/acsmedchemlett.0c00413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/23/2020] [Indexed: 01/02/2023] Open
Abstract
Hepatitis C virus (HCV) infections represent a global health challenge; however, developing a vaccine for treatment of HCV infection has remained difficult as heterogeneous HCV contains distinct genotypes, and each genotype contains various subtypes and different envelope glycoproteins. Currently, there is no effective preventive vaccine for achieving global control over HCV. In our efforts to improve upon current HCV vaccines we designed a synthetically accessible adjuvant platform, wherein we synthesized 11 novel lipidated tucaresol analogues to assess their immunological potential. Using a tucaresol-based adjuvant approach, truncated lipid-variants together with an engineered E1E2 antigen construct, namely E2ΔTM3, elicited antibody (Ab) responses that were significantly higher than tucaresol. In sum, antibody end-point titer values largely corroborated HCV neutralization data with a simplified lipidated tucaresol variant affording the highest end point titer and % neutralization. This study lays the groundwork for additional permutations in tucaresol adjuvant design, including the examination of other proteins in vaccine development.
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Affiliation(s)
- Tyson F. Belz
- Department of Chemistry, Department of Immunology and Microbial Science, The Skaggs Institute for Chemical Biology, The Worm Institute of Research and Medicine (WIRM), The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, California 92037, United States
| | - Margaret E. Olson
- Department of Chemistry, Department of Immunology and Microbial Science, The Skaggs Institute for Chemical Biology, The Worm Institute of Research and Medicine (WIRM), The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, California 92037, United States
- College of Pharmacy, Roosevelt University, 1400 North Roosevelt Boulevard, Schaumburg, Illinois 60173, United States
| | - Erick Giang
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, California 92037, United States
| | - Mansun Law
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, California 92037, United States
| | - Kim D. Janda
- Department of Chemistry, Department of Immunology and Microbial Science, The Skaggs Institute for Chemical Biology, The Worm Institute of Research and Medicine (WIRM), The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, California 92037, United States
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248
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Dimova RB, Rude E, Talal AH. Age- and risk factor-based serologic screening for Hepatitis C virus among an Urban, high-risk population. J Viral Hepat 2020; 27:1369-1387. [PMID: 32615009 DOI: 10.1111/jvh.13359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 06/10/2020] [Accepted: 06/15/2020] [Indexed: 12/09/2022]
Abstract
Hepatitis C virus (HCV) screening among individuals born between 1945 and 1965 (ie birth cohort) may augment risk factor-based screening. We assessed HCV seropositivity among injection drug users (IDUs) and birth cohort members from New York City. We assessed HCV risk factors and seropositivity in 7722 participants from community health, HIV prevention, syringe exchange and drug treatment programmes. A total of 26.6% were HCV seropositive, 55.8% were born between 1945 and 1965, and 82.2% had ever injected drugs. Among all participants, HCV seropositivity was higher among IDUs compared to non-IDUs (60.5% versus 7.7%, odds ratio (OR) = 18.5, 95% confidence interval (CI) [16.2, 21.1], P < .0001) and among birth cohort members compared to non-birth cohort members (31.3% versus 22.3%, OR = 1.6, 95%CI [1.4, 1.8], P < .0001). Within the birth cohort, HCV seroprevalence among IDUs was 68.5% versus 11.8%, OR = 16.2, 95%CI [13.7, 19.3]. After adjustment, HCV seroprevalence was higher in IDUs, previously incarcerated, whites (<42 years) and 'other races' (versus blacks), HIV-infected, those who snorted heroin, those with liver disease history, and those who had sex with an HCV-seropositive partner. HCV seroprevalence among IDU, birth cohort members, was considerably higher than among the general population. In this high-risk, urban population, the association between IDU and HCV seropositivity was approximately ten times that between birth cohort membership and HCV seropositivity.
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Affiliation(s)
- Rositsa B Dimova
- Department of Biostatistics, University at Buffalo, Buffalo, NY, USA
| | - Eric Rude
- New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Andrew H Talal
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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249
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Compton WM, Wiley T, Blanco C. The Importance of Learning Health Systems in Addressing the Opioid Crisis. J Gen Intern Med 2020; 35:891-894. [PMID: 33145682 PMCID: PMC7728900 DOI: 10.1007/s11606-020-06267-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
Interventions and research to address the US opioid crisis have, for the most part, targeted opioid use, misuse, and addiction specifically. While such a focus can lead to useful innovations in the care of opioid use disorder, the fact that many persons with opioid use disorder use multiple substances (both over their life course and simultaneously in drug-using episodes) makes it imperative to address broader issues of addiction in persons who have opioid use disorder as their presenting concern. Because of integrated care and the ability to target multiple clinical concerns in parallel, the Veterans Administration (VA) may be uniquely situated to address the key issue of multi-morbidity that persons with opioid use disorder so frequently exhibit. Research at the VA can build on new interventions developed by the National Institutes of Health (and others) and can help to determine the best ways to implement these interventions. Research at the VA does not need to duplicate efforts supported by other funders but can complement such work by providing an integrated platform for determining the best approaches to implementing innovations. The real-world learning health system that has been developed in the VA is poised to contribute in just such important ways.
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Affiliation(s)
- Wilson M Compton
- National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Service, Bethesda, MD, USA.
| | - Tisha Wiley
- National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Service, Bethesda, MD, USA
| | - Carlos Blanco
- National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Service, Bethesda, MD, USA
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250
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Richmond A, Pfieffer ML, Henry-Okafor Q. Update on Guidelines for Sexually Transmitted Infection Treatment and Management in the Adult and Adolescent Population. Nurs Clin North Am 2020; 55:307-323. [PMID: 32762852 DOI: 10.1016/j.cnur.2020.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Sexually transmitted infections (STIs) are a prevalent global health care problem. Incidence rates are rising yearly. STI incidence is highest for adolescents and young adults ages 15 to 24, who are diagnosed with half of all new STIs. Chlamydia trachomatis and Neisseria gonorrhea are common STIs caused by bacteria. Treatment guidelines change frequently as a result of antimicrobial resistance and public health trends. It is important for primary care providers to remain up to date with new guidelines. This article provides updates on pharmacologic treatment as well as patient education and follow-up specific to the primary care setting.
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Affiliation(s)
- Anna Richmond
- Vanderbilt University School of Nursing, 356 Frist Hall, 461 21st Avenue South, Nashville, TN 37240, USA.
| | - Mary Lauren Pfieffer
- Vanderbilt University School of Nursing, 354 Frist Hall, 461 21st Avenue South, Nashville, TN 37240, USA
| | - Queen Henry-Okafor
- Vanderbilt University School of Nursing, 354 Frist Hall, 461 21st Avenue South, Nashville, TN 37240, USA
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