1
|
Baia KLN, Cordeiro ACC, Frade PCR, Gouveia AGN, Resque RL, Pinheiro LML, Fonseca RRS, Machado LFA, Martins LC, Kupek E, Fischer B, Oliveira-Filho AB. Syphilis and Co-Infections with HIV-1, HBV, and HCV among People Who Use Crack-Cocaine in Northern Brazil. Pathogens 2022; 11:pathogens11091055. [PMID: 36145487 PMCID: PMC9502650 DOI: 10.3390/pathogens11091055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/23/2022] Open
Abstract
The rates of syphilis and viral co-infections among people who use crack-cocaine (PWUCC) were assessed in this study. This cross-sectional study relied on biological and self-reported socio-behavioral data from a convenience sample of 990 PWUCC from twenty-six municipalities in the states of Amapá and Pará, northern Brazil. Blood samples were collected to assess the presence of Treponema pallidum using the Rapid Qualitative Test (RQT) and the Venereal Disease Research Laboratory (VDRL). Reactive samples by RQT were used to assess the presence of HBV, HCV, and HIV-1 using Enzyme Immunoassay (EIA) and Polymerase Chain Reaction (PCR). Logistic regression models were used to determine the association of variables assessed with syphilis. In total, 287 (29.0%) of the PWUCC sample had reactive results for syphilis. HBV (15.7%), HCV (5.9%), and HIV-1 (9.8%) were detected among PWUCC with syphilis. Young age, low monthly income and education level, long duration of crack-cocaine use, condomless sex, multiple sex partners, and exchange of sex for money/drugs were associated with syphilis. The present study provides unique insights on the epidemiological status of syphilis among PWUCC in northern Brazil, with multiple implications for improving urgent interventions for diagnosis, prevention, and treatment.
Collapse
Affiliation(s)
- Karen Lorena N. Baia
- Programa de Pós-Graduação em Doenças Tropicais, Universidade Federal do Pará, Belém 66075-110, Brazil
| | - Ana Caroline C. Cordeiro
- Residência Multiprofissional em Saúde da Mulher e da Criança, Hospital Santo Antônio Maria Zaccaria, Bragança 68600-000, Brazil
| | - Paula Cristina R. Frade
- Programa de Pós-Graduação em Doenças Tropicais, Universidade Federal do Pará, Belém 66075-110, Brazil
- Residência Multiprofissional em Saúde da Mulher e da Criança, Hospital Santo Antônio Maria Zaccaria, Bragança 68600-000, Brazil
- Grupo de Estudo e Pesquisa em Populações Vulneráveis, Instituto de Estudos Costeiros, Universidade Federal do Pará, Bragança 68600-000, Brazil
| | - Alanna Gabrielly N. Gouveia
- Grupo de Estudo e Pesquisa em Populações Vulneráveis, Instituto de Estudos Costeiros, Universidade Federal do Pará, Bragança 68600-000, Brazil
| | - Rafael Lima Resque
- Departamento de Ciências Biológicas e da Saúde, Universidade Federal do Amapá, Macapá 68903-419, Brazil
| | - Luiz Marcelo L. Pinheiro
- Residência Multiprofissional em Saúde da Mulher e da Criança, Hospital Santo Antônio Maria Zaccaria, Bragança 68600-000, Brazil
- Faculdade de Ciências Biológicas, Campus do Marajó, Universidade Federal do Pará, Soure 68870-000, Brazil
| | - Ricardo Roberto S. Fonseca
- Laboratório de Virologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66077-830, Brazil
| | - Luiz Fernando A. Machado
- Laboratório de Virologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66077-830, Brazil
| | - Luisa C. Martins
- Programa de Pós-Graduação em Doenças Tropicais, Universidade Federal do Pará, Belém 66075-110, Brazil
- Residência Multiprofissional em Saúde da Mulher e da Criança, Hospital Santo Antônio Maria Zaccaria, Bragança 68600-000, Brazil
- Laboratório de Patologia Clínica de Doenças Tropicais, Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém 66055-240, Brazil
| | - Emil Kupek
- Departamento de Saúde Pública, Universidade Federal de Santa Catarina, Florianópolis 88040-900, Brazil
| | - Benedikt Fischer
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, BC V6B 5K3, Canada
- Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo 04038-000, Brazil
| | - Aldemir B. Oliveira-Filho
- Programa de Pós-Graduação em Doenças Tropicais, Universidade Federal do Pará, Belém 66075-110, Brazil
- Residência Multiprofissional em Saúde da Mulher e da Criança, Hospital Santo Antônio Maria Zaccaria, Bragança 68600-000, Brazil
- Grupo de Estudo e Pesquisa em Populações Vulneráveis, Instituto de Estudos Costeiros, Universidade Federal do Pará, Bragança 68600-000, Brazil
- Correspondence:
| |
Collapse
|
2
|
Effectiveness of incorporating contingency management into a public treatment program for people who use crack cocaine in Brazil. A single-blind randomized controlled trial. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 99:103464. [PMID: 34619447 DOI: 10.1016/j.drugpo.2021.103464] [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] [Received: 04/23/2021] [Revised: 09/08/2021] [Accepted: 09/12/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Smoked cocaine (i.e., crack use) is a severe health problem in Brazil, with the country being reported as having the largest crack market in the world. The objective of this study was to evaluate the effectiveness of incorporating Contingency Management targeting cocaine abstinence into a public treatment program in Brazil. METHODS Single-blind randomized controlled trial conducted at Unidade Recomeço Helvétia (URH), a public ambulatory treatment program for persons who use crack and live in the "Crackland" region in downtown São Paulo, Brazil. In total, 98 treatment-seeking individuals who use crack were randomized to one of two treatment conditions. Participants allocated to the control condition (n = 48) received 12 weeks of the standard treatment provided at URH. Participants allocated to the experimental condition (n = 50) received the same treatment in combination with Contingency Management (URH+CM). In URH+CM, participants were provided with vouchers with monetary value for submission of negative cocaine urinalysis twice weekly. RESULTS Compared to the URH group, the URH+CM group was significantly more likely to submit a negative cocaine urinalysis during treatment, with odds ratios ranging from 4.17 to 6.78, depending on how missing data was accounted for (p<0.01). Participants receiving Contingency Management also had higher odds of achieving three or more weeks of continuous abstinence (OR= 8.07; 95% CI [2.48, 26.24]), achieved longer durations of abstinence (B = 2.14; 95% CI [0.67, 3.61]), submitted a higher percentage of negative urinalysis (B = 19.85; 95% CI [6.89, 32.82]), and were retained in treatment for a longer period (B = 3.00; 95% CI [1.04, 4.97]), compared to those receiving URH alone (p<0.01 for all). CONCLUSIONS The incorporation of Contingency Management was effective in promoting cocaine abstinence and treatment retention. The large-scale dissemination of Contingency Management may be an effective strategy to treat Brazilians with cocaine use disorders.
Collapse
|
3
|
Oliveira-Filho AB, Silva FQ, Santos FJA, Cardoso YMN, Di Miceli JFF, Resque RL, Silva-Oliveira GC, Martins LC, Pinheiro LML, Machado LFA, Pinto AR, Lemos JAR, Fischer B, Kupek E. Prevalence and risk factors for HIV-1 infection in people who use illicit drugs in northern Brazil. Trans R Soc Trop Med Hyg 2021; 114:213-221. [PMID: 31746322 DOI: 10.1093/trstmh/trz106] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 09/09/2019] [Accepted: 10/01/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND People who use illicit drugs (PWUDs) have a high risk of viral infections. To date, there is a paucity of information on HIV infection among PWUDs in remote Brazilian regions. This study determined the prevalence and factors associated with HIV-1 infection among PWUDs in northern Brazil. METHODS Sociodemographic, economic, drug use and health-related information were collected through interviews from a community-recruited, multi-site sample of 1753 PWUDs. The blood samples collected were tested for the presence of HIV-1 using chemiluminescence immunoassay and PCR or western blotting. Logistic regressions identified factors independently associated with HIV-1 infection. RESULTS In total, 266 (15.2%) PWUDs were HIV-1 positive. Hepatitis B virus and/or hepatitis C virus nucleic acid was detected in 65 (3.7%) PWUDs infected by HIV-1. The factors associated with HIV-1 infection were male gender, older age, a lower educational level and a lower income, crack cocaine use, a longer drug use history and a history of drug injection and engagement in unsafe sex, sex work and a higher number of sexual partners. CONCLUSIONS The current study provides unique, initial insights into HIV and co-infection status and pertinent risk factors among PWUDs in northern Brazil, with clear and diverse implications for urgently improved prevention and treatment intervention needs.
Collapse
Affiliation(s)
- Aldemir B Oliveira-Filho
- Laboratório de Células e Patógenos, Grupo de Estudo e Pesquisa em Populações Vulneráveis, Instituto de Estudos Costeiros, Universidade Federal do Pará, Bragança PA, Brazil.,Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal de Santa Catarina, Florianopólis SC, Brazil
| | - Fabricio Quaresma Silva
- Laboratório de Células e Patógenos, Grupo de Estudo e Pesquisa em Populações Vulneráveis, Instituto de Estudos Costeiros, Universidade Federal do Pará, Bragança PA, Brazil
| | - Francisco Junior A Santos
- Laboratório de Células e Patógenos, Grupo de Estudo e Pesquisa em Populações Vulneráveis, Instituto de Estudos Costeiros, Universidade Federal do Pará, Bragança PA, Brazil
| | - Yasmin Maria N Cardoso
- Laboratório de Toxicologia e Química Farmacêutica, Centro de Ciências Biológicas e da Saúde, Universidade Federal do Amapá, Macapá AP, Brazil
| | - Jeruza Ferraz F Di Miceli
- Laboratório de Toxicologia e Química Farmacêutica, Centro de Ciências Biológicas e da Saúde, Universidade Federal do Amapá, Macapá AP, Brazil
| | - Rafael Lima Resque
- Laboratório de Toxicologia e Química Farmacêutica, Centro de Ciências Biológicas e da Saúde, Universidade Federal do Amapá, Macapá AP, Brazil
| | - Gláucia C Silva-Oliveira
- Laboratório de Células e Patógenos, Grupo de Estudo e Pesquisa em Populações Vulneráveis, Instituto de Estudos Costeiros, Universidade Federal do Pará, Bragança PA, Brazil
| | - Luisa Caricio Martins
- Laboratório de Patologia Clínica de Doenças Tropicais, Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém PA, Brazil
| | - Luiz Marcelo L Pinheiro
- Faculdade de Ciências Biológicas, Campus do Marajó - Soure, Universidade Federal do Pará, Soure PA, Brazil
| | - Luiz Fernando A Machado
- Laboratório de Virologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém PA, Brazil
| | - Aguinaldo Roberto Pinto
- Departamento de Microbiologia, Imunologia e Parasitologia, Universidade Federal de Santa Catarina, Florianópolis SC, Brazil
| | - José Alexandre R Lemos
- Programa de Pós-Graduação em Análises Clínicas, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém PA, Brazil
| | - Benedikt Fischer
- Faculty of Medical and Health Sciences, University of Auckland, New Zealand.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Emil Kupek
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal de Santa Catarina, Florianopólis SC, Brazil.,Departamento de Saúde Pública, Universidade Federal de Santa Catarina, Florianópolis SC, Brazil
| |
Collapse
|
4
|
High prevalence of Hepatitis C Virus infection among people who use crack cocaine in an important international drug trafficking route in Central-West Region Brazil. INFECTION GENETICS AND EVOLUTION 2020; 85:104488. [PMID: 32745809 DOI: 10.1016/j.meegid.2020.104488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/13/2020] [Accepted: 07/28/2020] [Indexed: 12/23/2022]
Abstract
In this study, the prevalence rate, associated risk factors and genetic diversity of hepatitis C virus (HCV) infection were determined among people who use crack from an international drug trafficking route in Central-West, Brazil. Blood samples were collected from 700 users of crack from Campo Grande and two border cities of Mato Grosso do Sul State and tested for HCV infection using serological and molecular testing methodologies. Anti-HCV was detected in 31/700 (4.5%, 95% CI: 2.9-6.0%) and HCV RNA in 26/31 (83.9%) of anti-HCV positive samples. Phylogenetic analysis of three HCV sub-genomic regions (5'UTR, NS5B and HVR-1) revealed the circulation of 1a (73.9%), 1b (8.7%) and 3a (17.4%) genotypes. Next-generation sequencing and phylogenetic analysis of intra-host viral populations of HCV HVR-1 showed a significant variation in intra-host genetic diversity among infected individuals, with 58.8% composed of more than one sub-population. Bayesian analysis estimated that the most recent common HCV ancestor for strains identified here was introduced to this region after 1975 following expansion of intravenous drug use in Brazil. Multivariate analyses showed that only 'ever having injected drugs' was independently associated with HCV infection. These results indicate an increasing spread of multiple HCV strains requiring public health intervention, such as harm reduction, testing services and treatment among crack users in this important border region of Central Brazil.
Collapse
|
5
|
de Queiroz Constantino Miguel A, Sandi Madruga C, Simões V, Yamauchi R, da Silva CJ, McDonell M, McPherson S, Roll J, Laranjeira RR, de Jesus Mari J. Contingency management is effective in promoting abstinence and retention in treatment among crack cocaine users with a previous history of poor treatment response: a crossover trial. PSICOLOGIA-REFLEXAO E CRITICA 2019; 32:14. [PMID: 32026092 PMCID: PMC6967308 DOI: 10.1186/s41155-019-0127-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 06/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Crack use has become a severe health problem in Brazil. Contingency management has shown robust evidence of efficacy in the treatment of cocaine use disorder (CUD) in high-income countries; however, it is still unclear how this intervention can impact treatment in low-income countries. OBJECTIVE To evaluate the efficacy of contingency management in the treatment of CUD among individuals with a previous history of poor treatment response in Brazil. METHODS Six months after the end of treatment, 32 participants previously allocated to the usual care condition (UCC) were invited to receive an additional 12 weeks of treatment in a contingency management condition (CMC), and 16 accepted the invitation. We compared data obtained from only the 16 participants (14 male) exposed to both treatment conditions. RESULTS Participants attended more treatment sessions and were retained in treatment for a longer period during the CMC than during the UCC (p < .01 for both). The proportion of negative cocaine samples submitted, the mean longest duration of cocaine abstinence, and the odds of being abstinent from cocaine during the 12 weeks of treatment were significantly higher during treatment in the CMC when compared to the UCC (p < .05). CONCLUSIONS This study provides further evidence that contingency management is effective in promoting abstinence and retention in treatment among individuals with CUD with a history of poor treatment response. Our findings argue for the incorporation of CM among public treatment services for CUD in Brazil. TRIAL REGISTRATION This study was registered at ClinicalTrials.gov as NCT01815645 on March 21, 2013.
Collapse
Affiliation(s)
- André de Queiroz Constantino Miguel
- National Institute of Policies on Alcohol and Drugs (INPAD) of the Department of Psychiatry and Medical Psychology, Federal University of São Paulo (UNIFESP), Rua: Dr. Diogo de Faria, 1036, 3º Andar–Vila Clementino, São Paulo, SP Brazil
- Department of Psychiatry and Medical Psychology, Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 570 – 1o andar – Vila Clementino, São Paulo, SP 04038-030 Brazil
- Spokane Valley, USA
| | - Clarice Sandi Madruga
- National Institute of Policies on Alcohol and Drugs (INPAD) of the Department of Psychiatry and Medical Psychology, Federal University of São Paulo (UNIFESP), Rua: Dr. Diogo de Faria, 1036, 3º Andar–Vila Clementino, São Paulo, SP Brazil
- Department of Psychiatry and Medical Psychology, Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 570 – 1o andar – Vila Clementino, São Paulo, SP 04038-030 Brazil
| | - Viviane Simões
- National Institute of Policies on Alcohol and Drugs (INPAD) of the Department of Psychiatry and Medical Psychology, Federal University of São Paulo (UNIFESP), Rua: Dr. Diogo de Faria, 1036, 3º Andar–Vila Clementino, São Paulo, SP Brazil
| | - Rodolfo Yamauchi
- National Institute of Policies on Alcohol and Drugs (INPAD) of the Department of Psychiatry and Medical Psychology, Federal University of São Paulo (UNIFESP), Rua: Dr. Diogo de Faria, 1036, 3º Andar–Vila Clementino, São Paulo, SP Brazil
| | - Claudio Jerônimo da Silva
- National Institute of Policies on Alcohol and Drugs (INPAD) of the Department of Psychiatry and Medical Psychology, Federal University of São Paulo (UNIFESP), Rua: Dr. Diogo de Faria, 1036, 3º Andar–Vila Clementino, São Paulo, SP Brazil
| | - Michael McDonell
- Program of Excellence in Addictions Research, Washington State University, P.O Box 1469, Spokane, WA USA
| | - Sterling McPherson
- Program of Excellence in Addictions Research, Washington State University, P.O Box 1469, Spokane, WA USA
| | - John Roll
- Program of Excellence in Addictions Research, Washington State University, P.O Box 1469, Spokane, WA USA
| | - Ronaldo Ramos Laranjeira
- National Institute of Policies on Alcohol and Drugs (INPAD) of the Department of Psychiatry and Medical Psychology, Federal University of São Paulo (UNIFESP), Rua: Dr. Diogo de Faria, 1036, 3º Andar–Vila Clementino, São Paulo, SP Brazil
- Department of Psychiatry and Medical Psychology, Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 570 – 1o andar – Vila Clementino, São Paulo, SP 04038-030 Brazil
| | - Jair de Jesus Mari
- Department of Psychiatry and Medical Psychology, Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 570 – 1o andar – Vila Clementino, São Paulo, SP 04038-030 Brazil
| |
Collapse
|
6
|
Schuch-Goi SB, Scherer JN, Kessler FHP, Sordi AO, Pechansky F, von Diemen L. Hepatitis C: clinical and biological features related to different forms of cocaine use. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2018; 39:285-292. [PMID: 29267513 DOI: 10.1590/2237-6089-2016-0076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 07/03/2017] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Hepatitis C virus (HCV) infection is related with several liver diseases such as cirrhosis and hepatocellular carcinomas, leading to more than 0.5 million deaths every year and to a great global burden. It is known that injection drug users show a high prevalence of HCV infection, being considered a risk group for this disease. Cocaine users seem to be in greater risk than other drug users, and several hypotheses for this association are being studied. AIM To review data on HCV infection in cocaine users, taking into consideration the relevance of the different routes of drug administration and other risk behaviors. METHODS This was a narrative review performed in the main scientific databases. RESULTS AND CONCLUSION Data suggest that cocaine use could be associated with HCV infection due to the specificities of cocaine consumption pattern, even in those subjects who do not inject drugs, in addition to other risky behaviors, such as tattooing and unprotected sex. Injectable cocaine users seem to be more susceptible to contamination than users who do not inject drugs. However, evidence is pointing to the possibility of infection by sharing drug paraphernalia other than syringes. Moreover, specific immune system impairments caused by cocaine use are also being linked with HCV infection susceptibility, persistence and increased pathological effects.
Collapse
Affiliation(s)
- Silvia Bassani Schuch-Goi
- Centro de Pesquisas em Álcool e Drogas, Centro Colaborador em Álcool e Drogas HCPA/SENAD, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Juliana Nichterwitz Scherer
- Centro de Pesquisas em Álcool e Drogas, Centro Colaborador em Álcool e Drogas HCPA/SENAD, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Felix Henrique Paim Kessler
- Centro de Pesquisas em Álcool e Drogas, Centro Colaborador em Álcool e Drogas HCPA/SENAD, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Anne Orgler Sordi
- Centro de Pesquisas em Álcool e Drogas, Centro Colaborador em Álcool e Drogas HCPA/SENAD, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Flavio Pechansky
- Centro de Pesquisas em Álcool e Drogas, Centro Colaborador em Álcool e Drogas HCPA/SENAD, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Lisia von Diemen
- Centro de Pesquisas em Álcool e Drogas, Centro Colaborador em Álcool e Drogas HCPA/SENAD, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| |
Collapse
|
7
|
França DDDS, Del-Rios NHA, Carneiro MADS, Guimarães RA, Caetano KAA, Reis MNDG, Martins RMB, Motta-Castro ARC, Stefani MMDA, Teles SA. HIV-1 infection among crack cocaine users in a region far from the epicenter of the HIV epidemic in Brazil: Prevalence and molecular characteristics. PLoS One 2018; 13:e0199606. [PMID: 30016324 PMCID: PMC6049907 DOI: 10.1371/journal.pone.0199606] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 06/09/2018] [Indexed: 12/11/2022] Open
Abstract
Brazil has the largest cocaine market in South America, and crack cocaine use is closely associated with HIV-1 infection. This study investigated the prevalence, risk factors, and HIV-1 subtypes, including recombinant forms and mutations associated with drug resistance, among crack cocaine users in Central-West Brazil. We recruited 600 crack cocaine users admitted to a referral hospital in Goiânia for psychiatric disorders. The participants were interviewed; blood samples were collected for anti-HIV-1/2 serological screening. HIV-1 pol gene sequences (entire protease [PR] and partial reverse transcriptase [RT]) were obtained from plasma RNA. HIV-1 subtypes, recombinant viruses, transmitted drug resistance (TDR), and secondary drug resistance mutations were investigated. The median participant age was 30 years (range, 18-68 years); most were male, single, unemployed, and of mixed races. Among them, 2.8% (17/600) were HIV-1 positive: 2.2% of men (11/507) and 6.5% of women (6/93). The main predictors of HIV-1 seropositivity were a sexual partner with HIV infection, irregular condom use, and previous homelessness. HIV-1 pol sequences (12/17) indicated the predominance of subtype B (n = 7), followed by recombinant forms FPR/BRT (n = 1) and BPR/FRT (n = 2) and subtypes F1 (n = 1) and C (n = 1). TDR prevalence was 58.3% (7/12). Isolates from two participants showed mutations associated with resistance to nucleoside reverse transcriptase inhibitors (NRTI) only (M41L, T125C, T125F, M184V), while an isolate from one patient who had received antiretroviral therapy (ART) since 2008 had a mutation associated with resistance to non-NRTI (G190S). Five isolates had secondary mutations to protease inhibitors (K20M, L10V, L33I, A71T, A71V). In conclusion, the findings of HIV-1 circulation, TDR to NRTI, and secondary mutations to protease inhibitors in ART-naïve crack cocaine users support the importance of monitoring this population in regions far from the epicenter of the HIV epidemic.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Ana Rita Coimbra Motta-Castro
- Center of Biological and Health Sciences, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | | | - Sheila Araujo Teles
- Faculty of Nursing, Federal University of Goiás, Goiânia, Goiás, Brazil
- * E-mail: ,
| |
Collapse
|
8
|
Tirado-Muñoz J, Gilchrist G, Fischer G, Taylor A, Moskalewicz J, Giammarchi C, Köchl B, Munro A, Dąbrowska K, Shaw A, Di Furia L, Leeb I, Hopf C, Torrens M. Psychiatric comorbidity and intimate partner violence among women who inject drugs in Europe: a cross-sectional study. Arch Womens Ment Health 2018; 21:259-269. [PMID: 29230558 DOI: 10.1007/s00737-017-0800-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 11/30/2017] [Indexed: 11/30/2022]
Abstract
Women who inject drugs (WWID) are an especially vulnerable group of drug users. This study determined the prevalence of psychiatric comorbidity and intimate partrner violence (IPV), and factors associated with psychiatric comorbidity among WWID recruited from drug treatment services (67%) and harm reduction services in five European regions in Austria, Catalonia, Italy, Poland, and Scotland. Psychiatric comorbidity was assessed among 226 WWID using the Dual Diagnosis Screening Instrument. IPV was assessed using the Composite Abuse Scale and injecting and sexual risk behaviors were assessed using a battery of questionnaires adapted and developed for the study. Eighty-seven percent met criteria for at least one lifetime psychiatric disorder. The most common disorders were depression (76%), panic (54%), and post-traumatic stress (52%). WWID recruited in drug treatment services were almost three times as likely (OR 2.90 95% CI 1.30-6.43; p = 0.007) to meet criteria for a lifetime psychiatric disorder than those recruited from harm reduction services, specifically dysthymia (OR 5.32 95% CI 2.27-12.48; p = 0.000) and post-traumatic stress disorder (OR 1.83 95% CI 1.02-3.27; p = 0.040). WWID who reported sharing needles and syringes were almost three times as likely to meet criteria for lifetime psychiatric comorbidity than those who did not (OR 2.65 95% CI 1.07-6.56). Compared to WWID who had not experienced IPV, victims (70%) were almost two times more likely to meet criteria for post-traumatic stress disorder (OR 1.95 95% CI 1.10-3.48). Psychiatric comorbidity and IPV among WWID are common. Drug treatment and harm reduction services should address psychiatric comorbidity and IPV to improve treatment outcomes.
Collapse
Affiliation(s)
- Judit Tirado-Muñoz
- Addiction Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Gail Gilchrist
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Avril Taylor
- School of Social Sciences, University of the West of Scotland, Paisley, Scotland
| | - Jacek Moskalewicz
- Department of Studies on Alcoholism and Drug Dependence, Institute of Psychiatry and Neurology, Warsaw, Poland
| | | | - Birgit Köchl
- Addiction Clinic, Medical University of Vienna, Vienna, Austria
| | - Alison Munro
- School of Social Sciences, University of the West of Scotland, Paisley, Scotland
| | - Katarzyna Dąbrowska
- Department of Studies on Alcoholism and Drug Dependence, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - April Shaw
- School of Social Sciences, University of the West of Scotland, Paisley, Scotland
| | | | - Isabella Leeb
- Addiction Clinic, Medical University of Vienna, Vienna, Austria
| | - Caroline Hopf
- Addiction Clinic, Medical University of Vienna, Vienna, Austria
| | - Marta Torrens
- Institute of Neuropsychiatry and Addictions, Parc de Salut Mar, Barcelona, Spain. .,Universitat Autònoma de Barcelona, Barcelona, Spain.
| |
Collapse
|
9
|
Hepatitis C virus infection among illicit drug users in an archipelago of the Amazon. Arch Virol 2017; 163:617-622. [PMID: 29164400 DOI: 10.1007/s00705-017-3656-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 10/12/2017] [Indexed: 10/18/2022]
Abstract
Hepatitis C virus (HCV) infection causes acute and chronic liver disease and may lead to cirrhosis, liver failure or hepatocellular carcinoma. The behavior of illicit drug users (DUs) typically exposes them to risks of viral infection. In the Brazilian Amazon region, a number of studies have identified high rates of drug use among adolescents, and a high prevalence of HBV infection in DUs, disseminated by sexual and parenteral activities. However, the epidemiological scenario of HCV infection in the region is still poorly understood. This study determined the prevalence, genotypes, and risk factors for HCV infection among DUs of the Marajó Archipelago. This cross-sectional study collected samples and epidemiological information from DUs in 11 municipalities. The diagnosis was established by EIA and real-time PCR, and the samples were genotyped by multiplex real time PCR. The data were analyzed by simple and multiple logistical regression. In 466 DUs, 28.3% had anti-HCV antibodies, and 25.5% had HCV-RNA. In 92 injecting drug users, 88.0% had anti-HCV antibodies, and 80.4% had HCV-RNA. Genotypes 1 and 3 were detected, with three cases of mixed infections. The multivariate analysis indicated associations of HCV infection with age (≥ 35 years), tattoos, intravenous drug use, shared use of injection equipment, and the daily and long-term (> 3 years) use of illicit drugs. These findings will contribute to the development of effective measures for the prevention of HCV infection among Brazilian DUs, as well as its general population.
Collapse
|
10
|
Health outcomes associated with crack-cocaine use: Systematic review and meta-analyses. Drug Alcohol Depend 2017; 180:401-416. [PMID: 28982092 DOI: 10.1016/j.drugalcdep.2017.08.036] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Crack-cocaine use is prevalent largely in socio-economically marginalized populations in the Americas. Its use has been associated with diverse health outcomes, yet no recent or systematic reviews of these exist. METHODS A systematic review of health outcomes associated with crack-cocaine use was performed, using MEDLINE, Scopus, Web of Science, CINAHL, PsycINFO, and LILACS up to October 2016. Search terms included crack-cocaine and health outcome-related keywords, targeting peer-reviewed studies on quantified health outcomes associated with crack-cocaine use. Random effects meta-analyses produced pooled odds ratios. Levels of evidence for major results were assessed using the GRADE approach. A review protocol was registered with PROSPERO (CRD42016035486). RESULTS Of 4700 articles returned, 302 met eligibility criteria, reporting on health outcomes for 14 of 22 ICD-10 chapters. Conclusive evidence and meta-analyses showed positive associations between crack-cocaine use and blood/sexually transmitted diseases (HIV and hepatitis C virus, others); moderate evidence and meta-analyses supported associations with neonatal health, and violence. There were mixed associations for mental and other health outcomes, yet insufficient evidence to perform meta-analyses for many categories (e.g., mortality). Most underlying research was of limited or poor quality, with crack-cocaine commonly assessed as a secondary covariate. CONCLUSIONS Crack-cocaine use was associated with a range of health outcomes, although it was unclear if there was direct causal impact, interactions between risk factors, or external drivers of both crack-cocaine use and outcomes. Rigorous epidemiological studies are needed to systematically assess health outcomes of crack-cocaine use and underlying pathways, also to inform evidence-based interventions.
Collapse
|
11
|
Jarlais DCD, Arasteh K, McKnight C, Feelemyer J, Campbell ANC, Tross S, Cooper HLF, Hagan H, Perlman DC. What happened to the HIV epidemic among non-injecting drug users in New York City? Addiction 2017; 112:290-298. [PMID: 27613968 PMCID: PMC5233554 DOI: 10.1111/add.13601] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 08/23/2016] [Accepted: 09/08/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS HIV has reached high prevalence in many non-injecting drug user (NIDU) populations. The aims of this study were to (1) examine the trend in HIV prevalence among non-injecting cocaine and heroin NIDUs in New York City, (2) identify factors potentially associated with the trend and (3) estimate HIV incidence among NIDUs. DESIGN Serial-cross sectional surveys of people entering drug treatment programs. People were permitted to participate only once per year, but could participate in multiple years. SETTING Mount Sinai Beth Israel drug treatment programs in New York City, USA. PARTICIPANTS We recruited 3298 non-injecting cocaine and heroin users from 2005 to 2014. Participants were 78.7% male, 6.1% white, 25.7% Hispanic and 65.8% African American. Smoking crack cocaine was the most common non-injecting drug practice. MEASURES Trend tests were used to examine HIV prevalence, demographics, drug use, sexual behavior and use of antiretroviral treatment (ART) by calendar year; χ2 and multivariable logistic regression were used to compare 2005-10 versus 2011-14. FINDINGS HIV prevalence declined approximately 1% per year (P < 0.001), with a decline from 16% in 2005-10 to 8% in 2011-14 (P < 0.001). The percentages of participants smoking crack and having multiple sexual partners declined and the percentage of HIV-positive people on ART increased. HIV incidence among repeat participants was 1.2 per 1000 person-years (95% confidence interval = 0.03/1000-7/1000). CONCLUSIONS HIV prevalence has declined and a high percentage of HIV-positive non-injecting drug users (NIDUs) are receiving antiretroviral treatment, suggesting an end to the HIV epidemic among NIDUs in New York City. These results can be considered a proof of concept that it is possible to control non-injecting drug use related sexual transmission HIV epidemics.
Collapse
Affiliation(s)
| | | | | | | | - Aimee N. C. Campbell
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Medical Center, New York, NY
| | - Susan Tross
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Medical Center, New York, NY
| | - Hannah LF Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta Georgia
| | - Holly Hagan
- College of Nursing, New York University, New York NY
| | | |
Collapse
|
12
|
Miguel AQC, Madruga CS, Cogo-Moreira H, Yamauchi R, Simões V, da Silva CJ, McPherson S, Roll JM, Laranjeira RR. Contingency management is effective in promoting abstinence and retention in treatment among crack cocaine users in Brazil: A randomized controlled trial. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2016; 30:536-543. [PMID: 27442691 DOI: 10.1037/adb0000192] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Crack cocaine dependence has become a severe public health problem in Brazil, and current psychosocial approaches to this problem have shown little or no effectiveness. Although contingency management is among the most effective behavioral treatments for substance use disorders, it has never been applied in the treatment of crack cocaine-dependent individuals in Brazil. The aim of this study was to evaluate the efficacy of incorporating contingency management into standard outpatient treatment for crack cocaine dependence, as well as the impact that doing so has on treatment attendance, retention in treatment, maintenance of abstinence, and the frequency of substance use. We evaluated 65 treatment-seeking, crack cocaine-dependent individuals, randomized to receive 12 weeks of standard treatment plus contingency management (STCM; n = 33) or 12 weeks of standard treatment alone (STA; n = 32). Those in the STCM group received monetary incentives for being abstinent, earning up to US$235.50 if they remained abstinent throughout the entire treatment period. The STCM group participants attended a mean of 19.5 (SD = 14.9) treatment sessions, compared with 3.7 (SD = 5.9) for the STA group participants (p < .01). Those in the STCM group were 3.8, 4.6, and 68.9 times more likely to be retained in treatment at weeks 4, 8, and 12 than were those in the STA group. The likelihood of detecting 4, 8, and 12 weeks of continuous abstinence was 17.7, 9.9, and 18.6 times higher in the STCM group than in the STA group (p < .05). Compared to the STA group, the STCM group submitted a significantly higher proportion of negative samples for crack cocaine, delta-9-tetrahydrocannabinol, and alcohol (p < .001) when all expected samples were included in the denominator but not when only submitted samples were considered. The average monthly cost/participant for incentives was $29.00. Contingency management showed efficacy in a sample of Brazilian crack cocaine users. The intervention holds promise for broader application in international settings. (PsycINFO Database Record
Collapse
Affiliation(s)
- André Q C Miguel
- National Institute of Policies on Alcohol and Drugs (INPAD), Department of Psychiatry and Medical Psychology, Federal University of São Paulo (UNIFESP)
| | - Clarice S Madruga
- National Institute of Policies on Alcohol and Drugs (INPAD), Department of Psychiatry and Medical Psychology, Federal University of São Paulo (UNIFESP)
| | - Hugo Cogo-Moreira
- Department of Psychiatry and Medical Psychology, Federal University of São Paulo (UNIFESP)
| | - Rodolfo Yamauchi
- National Institute of Policies on Alcohol and Drugs (INPAD), Department of Psychiatry and Medical Psychology, Federal University of São Paulo (UNIFESP)
| | - Viviane Simões
- National Institute of Policies on Alcohol and Drugs (INPAD), Department of Psychiatry and Medical Psychology, Federal University of São Paulo (UNIFESP)
| | - Claudio J da Silva
- National Institute of Policies on Alcohol and Drugs (INPAD), Department of Psychiatry and Medical Psychology, Federal University of São Paulo (UNIFESP)
| | - Sterling McPherson
- Program of Excellence in Addictions Research, Washington State University
| | - John M Roll
- Program of Excellence in Addictions Research, Washington State University
| | - Ronaldo R Laranjeira
- National Institute of Policies on Alcohol and Drugs (INPAD), Department of Psychiatry and Medical Psychology, Federal University of São Paulo (UNIFESP)
| |
Collapse
|
13
|
Valdez A, Nowotny KM, Negi N, Mora EZ, Cepeda A. Un Jalón, Un Volteón, y Otra Vez: High-Risk Crack Smoking Paraphernalia in México City. J Psychoactive Drugs 2016; 48:295-302. [PMID: 27356211 DOI: 10.1080/02791072.2016.1198510] [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: 10/21/2022]
Abstract
During the past decade, crack smoking has increased in Mexico among poor urban populations. Despite this increasing prevalence, little is known about the types of paraphernalia used and related sharing practices and physical harms. Data come from in-depth semi-structured interviews and observations with 156 current crack smokers in Mexico City. Findings reveal a complex, crack-smoking process in Mexico City that represents an interconnected structure of paraphernalia items and pipes that could contribute to detrimental health consequences. Specifically, we identify essential paraphernalia items that make the smoking of crack possible; describe the homemade construction of two categories of pipes; and detail the sharing practices and physical harms associated with these paraphernalia. Results point towards a smoking process that is embedded in impoverished urban neighborhoods sustained by an accessible street-level crack market. Discussed are the policy and intervention implications associated with reducing crack-related health consequences in Mexico and other Latin American countries.
Collapse
Affiliation(s)
- Avelardo Valdez
- a Professor, School of Social Work , University of Southern California , Los Angeles , CA , USA
| | - Kathryn M Nowotny
- b Assistant Professor, Department of Sociology , University of Miami , Miami , FL , USA
| | - Nalini Negi
- c Associate Professor, School of Social Work , University of Maryland , Baltimore , MD , USA
| | | | - Alice Cepeda
- e Associate Professor, School of Social Work , University of Southern California , Los Angeles , CA , USA
| |
Collapse
|
14
|
Sá LCD, Araújo TMED, Griep RH, Campelo V, Monteiro CFDS. Seroprevalence of hepatitis C and factors associated with this in crack users. Rev Lat Am Enfermagem 2015; 21:1195-202. [PMID: 24402335 DOI: 10.1590/0104-1169.3126.2354] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 08/21/2013] [Indexed: 09/24/2023] Open
Abstract
OBJECTIVE to investigate the seroprevalence of hepatitis C in crack users in Piauí. METHOD seroepidemiological survey, undertaken in the Psycho-Social Care Centers for Drugs and Alcohol (CAPS AD) in Piauí in the period December 2011 to May 2012. A questionnaire was administered and blood samples were collected for serological research. Fisher's exact test and the Mann-Whitney test were used, with a level of significance of (p<0.05). RESULTS the prevalence of Anti-HCV was 05 (1.4%) and 04 (1.1%) for the RNA-HCV. There was a statistically significant association between hepatitis C (serological marker RNA-HCV) and age, being resident at home, length of use of crack, interruption of the use of crack, and the habit of sharing the crack pipes. CONCLUSION the findings support the need to implement health policies aimed at crack users, due to the accelerated process of physical and psychological deterioration to which these are subject.
Collapse
|
15
|
Oxidative stress and BDNF as possible markers for the severity of crack cocaine use in early withdrawal. Psychopharmacology (Berl) 2014; 231:4031-9. [PMID: 24676990 DOI: 10.1007/s00213-014-3542-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 03/10/2014] [Indexed: 12/12/2022]
Abstract
RATIONALE An important goal of addiction research is to discover neurobiological markers that could predict the severity of addiction and help to determine appropriate treatment. Brain-derived neurotrophic factor (BDNF) and thiobarbituric acid reactive substances (TBARS) are being related to cerebral plasticity and impairment caused by substance abuse. OBJECTIVES This study aims to evaluate alteration of TBARS and BDNF levels among crack cocaine users during early drug withdrawal and its relationship to severity of drug use. METHODS Forty-nine adults crack cocaine users were recruited at a public psychiatric hospital with a specialized addiction treatment unit. Blood sample was collected at intake and discharge for the analysis of TBARS and BDNF measures. Information about drug use was assessed by the Addiction Severity Index 6th Version (ASI-6). Detailed information about crack cocaine use was obtained through the "Profile of the crack cocaine user." Severity of crack use was estimated using information from age of first crack use, years of crack use, and crack rocks used in the previous 30 days. RESULTS There is a positive correlation between TBARS levels and severity of crack cocaine use (R = 0.304, p = 0.04) and a negative correlation between BDNF and severity of crack cocaine use (R = -0.359, p = 0.01) at discharge. Also, we found an inverse correlation between TBARS and BDNF levels (R = -0.294, p = 0.004) at discharge. CONCLUSIONS Our findings suggest that BDNF and TBARS could be possible markers for the severity of drug use. Further studies may show how those markers could be related to staging, prognosis, and treatment in crack cocaine dependence.
Collapse
|
16
|
Narvaez JCM, Jansen K, Pinheiro RT, Kapczinski F, Silva RA, Pechansky F, Magalhães PVS. Violent and sexual behaviors and lifetime use of crack cocaine: a population-based study in Brazil. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1249-55. [PMID: 24519271 DOI: 10.1007/s00127-014-0830-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 01/19/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate the prevalence of lifetime use of crack cocaine and to assess associations with violent and sexual behaviors in young adults selected from the general population of Pelotas, Southern Brazil. METHODS This cross-sectional population-based study included 1,560 participants aged 18-24 years. The use of alcohol and other substances, including crack cocaine, was assessed using the alcohol, smoking and substance involvement screening test. Other variables included violent behaviors, firearm possession, and sexual risk behaviors. The frequency of antisocial personality disorder was also investigated. Associations were analyzed using a crude model and models adjusted for sex, social class, and the use of snorted cocaine. RESULTS Lifetime prevalence of crack cocaine use was 2.51 %, and it was higher among males and individuals coming from more vulnerable social classes (D or E). In the final multivariate models, lifetime use of crack cocaine was associated with episodes of aggression and firearm possession, as well as with a higher chance of not having used condom in the last sexual intercourse. In less conservative models, crack cocaine use was associated with other violent and sexual risk behaviors. DISCUSSION The strong association observed between lifetime use of crack cocaine and different violent and sexual risk behaviors underscores relevant characteristics of people who use crack cocaine. Improving our understanding of possible causal chains leading to such associations should be a priority in future studies.
Collapse
Affiliation(s)
- Joana C M Narvaez
- Laboratório de Psiquiatria Molecular, National Institute for Translational Medicine, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2350, Porto Alegre, RS, CEP 90035-003, Brazil,
| | | | | | | | | | | | | |
Collapse
|
17
|
Scalioni LDP, Cruz HM, de Paula VS, Miguel JC, Marques VA, Villela-Nogueira CA, Milagres FAP, Cruz MS, Bastos FI, Andrade TM, Motta-Castro ARC, Lewis-Ximenez LL, Lampe E, Villar LM. Performance of rapid hepatitis C virus antibody assays among high- and low-risk populations. J Clin Virol 2014; 60:200-5. [PMID: 24794796 DOI: 10.1016/j.jcv.2014.04.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 03/18/2014] [Accepted: 04/02/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Rapid tests for the detection of antibodies to hepatitis C virus (anti-HCV) can facilitate access to diagnosis. OBJECTIVES This study aimed to evaluate the performance of rapid tests for anti-HCV detection in the sera, whole blood, and oral fluid samples from individuals with different endemicity profiles and risk behaviors. STUDY DESIGN Three groups donated biological samples that were tested using three anti-HCV rapid tests (WAMA, Bioeasy and OraSure): (I) suspected cases of hepatitis C, (II) individuals who were living in remote areas in Brazil and (III) crack users and beauty professionals. Reproducibility, repeatability and cross-reactivity to other infectious agents (dengue, HIV, malaria, and syphilis) were also evaluated. RESULTS In group I, specificities varied from 93.75% to 100% and sensitivities varied from 76.03% to 93.84% according to the EIA results. When anti-HCV/HCV RNA-reactive sera samples were considered true-positive HCV cases, the sensitivities and specificities varied from 86.3% to 99.09% and 93.75% to 100%, respectively. In group II, the OraSure rapid test presented the best performance. In group III, the Bioeasy assay performed best using saliva and whole blood and the OraSure assay performed best using oral fluid samples. The reproducibility and repeatability of the WAMA and Bioeasy tests were excellent. The level of concordance between the HCV EIAs and the rapid tests using samples that were reactive for other infectious agents varied from 82.35% to 100% for the WAMA assay and 94.11% to 100% for the Bioeasy assay. CONCLUSION All of the rapid tests could be used to identify active HCV infection among individuals with different endemicity profiles and risk behaviors.
Collapse
Affiliation(s)
| | - Helena Medina Cruz
- Laboratory of Viral Hepatitis, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
| | - Vanessa Salete de Paula
- Laboratory of Tecnhological Development of Virology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
| | | | - Vanessa Alves Marques
- Laboratory of Viral Hepatitis, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
| | | | | | - Marcelo Santos Cruz
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Francisco Inácio Bastos
- Institute of Communication and Scientific Information & Technology for Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | | | | | - Elisabeth Lampe
- Laboratory of Viral Hepatitis, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
| | - Livia Melo Villar
- Laboratory of Viral Hepatitis, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil.
| |
Collapse
|
18
|
Des Jarlais DC, Arasteh K, McKnight C, Perlman DC, Feelemyer J, Hagan H, Cooper HLF. HSV-2 co-infection as a driver of HIV transmission among heterosexual non-injecting drug users in New York City. PLoS One 2014; 9:e87993. [PMID: 24498235 PMCID: PMC3909306 DOI: 10.1371/journal.pone.0087993] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 01/02/2014] [Indexed: 11/18/2022] Open
Abstract
Objective To examine herpes simplex virus 2 (HSV-2)/HIV co-infection as a contributing factor in the increase in HIV infection among non-injecting heroin and cocaine users in New York City. Methods Subjects were recruited from the Beth Israel Medical Center drug detoxification and methadone maintenance programs in New York City in 1995–1999 and 2005–2011. All reported current heroin and/or cocaine use and no injection drug use. A structured questionnaire was administered and serum samples collected for HIV and HSV-2 testing. Population-attributable risk percentages (PAR%s) were estimated for associations between HSV-2 and increased susceptibility to and increased transmissibility of HIV among female NIDUs. Results 785 subjects were recruited from 1995–1999, and 1764 subjects from 2005–2011. HIV prevalence increased from 7% to 13%, with nearly uniform increases among all demographic subgroups. HSV-2/HIV co-infection was common in both time periods, with an average (over the two time periods) of 80% of HIV negative females infected with HSV-2, an average of 43% of HIV negative males infected with HSV-2; an average of 97% of HIV positive females also infected with HSV-2 and an average of 67% of HIV positive males also infected with HSV-2. The increase in HIV prevalence was predominantly an increase in HSV-2/HIV co-infection, with relatively little HIV mono-infection in either time period. The estimated PAR%s indicate that approximately half of HIV acquisition among females was caused by HSV-2 infection and approximately 60% of HIV transmission from females was due to HSV-2 co-infection. Conclusions The increase in HIV infection among these non-injecting drug users is better considered as an increase in HSV-2/HIV co-infection rather than simply an increase in HIV prevalence. Additional interventions (such as treatment as prevention and suppressing the effects of HSV-2 on HIV transmission) are needed to reduce further HIV transmission from HSV-2/HIV co-infected non-injecting drug users.
Collapse
Affiliation(s)
- Don C. Des Jarlais
- The Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, New York, United States of America
- * E-mail:
| | - Kamyar Arasteh
- The Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, New York, United States of America
| | - Courtney McKnight
- The Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, New York, United States of America
| | - David C. Perlman
- The Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, New York, United States of America
| | - Jonathan Feelemyer
- The Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, New York, United States of America
| | - Holly Hagan
- School of Nursing, New York University, New York, New York, United States of America
| | - Hannah L. F. Cooper
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| |
Collapse
|
19
|
Santos Cruz M, Andrade T, Bastos FI, Leal E, Bertoni N, Lipman L, Burnett C, Fischer B. Patterns, determinants and barriers of health and social service utilization among young urban crack users in Brazil. BMC Health Serv Res 2013; 13:536. [PMID: 24373346 PMCID: PMC3893546 DOI: 10.1186/1472-6963-13-536] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Accepted: 12/17/2013] [Indexed: 11/11/2022] Open
Abstract
Background Crack use is prevalent across the Americas, and specifically among marginalized urban street drug users in Brazil. Crack users commonly feature multiple physical and mental health problems, while low rates of and distinct barriers to help service use have been observed in these populations. This study examined profiles and determinants of social and health service utilization, and unmet service needs, in a two-city sample of young (18–24 years), marginalized crack users in Brazil. Methods N = 160 study participants were recruited by community-based methods from impoverished neighborhoods in the cities of Rio de Janeiro (n = 81) and Salvador (n = 79). A mixed methods protocol was used. Participants’ drug use, health, and social and health service utilization characteristics were assessed by an anonymous interviewer-administered questionnaire completed in a community setting; descriptive statistics on variables of interest were computed. Service needs and barriers were further assessed by way of several focus groups with the study population; narrative data were qualitatively analyzed. The study protocol was approved by institutional ethics review boards; data were collected between November 2010 and June 2011. Results The majority of the sample was male, without stable housing, and used other drugs (e.g., alcohol, marijuana). About half the sample reported physical and mental health problems, yet most had not received medical attention for these problems. Only small minorities had utilized locally available social or health services; utilization appeared to be influenced by sex, race and housing characteristics in both sites. Participants cited limited service resources, lack of needs-specific professional skills, bureaucratic barriers and stigma as obstacles to better service access. However, most respondents stated strong interest and need for general social, health and treatment services designed for the study population, for which various key features were emphasized as important. Conclusions The study contributes substantive evidence to current discussions about the development and utilization of health and treatment interventions for crack use in Brazil. Based on our data, crack users’ social, service needs are largely unmet; these gaps appear to partly root in systemic barriers of access to existing services, while improved targeted service offers for the target population seem to be needed also.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Benedikt Fischer
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, 2400 - 515 W Hasting St, Vancouver, BC V6B 5K3, Canada.
| |
Collapse
|
20
|
de Almeida-Neto C, Goncalez TT, Birch RJ, de Carvalho SMF, Capuani L, Leão SC, Miranda C, Rocha PC, Carneiro-Proietti AB, Johnson BR, Wright DJ, Murphy EL, Custer B. Risk factors for human immunodeficiency virus infection among Brazilian blood donors: a multicentre case-control study using audio computer-assisted structured interviews. Vox Sang 2013; 105:91-9. [PMID: 23517235 PMCID: PMC3733490 DOI: 10.1111/vox.12028] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 01/09/2013] [Accepted: 01/13/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although risk factors for HIV infection are known, it is important for blood centres to understand local epidemiology and disease transmission patterns. Current risk factors for HIV infection in blood donors in Brazil were assessed. METHODS A case-control study was conducted at large public blood centres located in four major cities between April 2009 and March 2011. Cases were persons whose donations were confirmed positive by enzyme immunoassays followed by Western blot confirmation. Audio computer-assisted structured interviews (ACASI) were completed by all cases and controls. Multivariable logistic regression was used to estimate adjusted odds ratios (AORs) and associated 95% confidence intervals (CIs). RESULTS There were 341 cases, including 47 with recently acquired infection, and 791 controls. Disclosed risk factors for both females and males were sex with an HIV-positive person AOR 11.3, 95% CI (4.1, 31.7) and being an IVDU or sexual partner of an IVDU [AOR 4.65 (1.8, 11.7)]. For female blood donors, additional risk factors were having male sex partners who also are MSM [AOR 13.5 (3.1, 59.8)] and having unprotected sex with multiple sexual partners [AOR 5.19 (2.1, 12.9)]. The primary risk factor for male blood donors was MSM activity [AOR 21.6 (8.8, 52.9)]. Behaviours associated with recently acquired HIV were being a MSM or sex partner of MSM [13.82, (4.7, 40.3)] and IVDU [11.47, (3.0, 43.2)]. CONCLUSION Risk factors in blood donors parallel those in the general population in Brazil. Identified risk factors suggest that donor compliance with selection procedures at the participating blood centres is inadequate.
Collapse
Affiliation(s)
| | | | | | | | - Ligia Capuani
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, SP, Brazil
| | | | | | | | | | | | | | | | - Brian Custer
- Blood Systems Research Institute, San Francisco, CA, USA
| |
Collapse
|
21
|
Kuehlkamp VM, Schuelter-Trevisol F. Prevalence of human immunodeficiency virus/hepatitis C virus co-infection in Brazil and associated factors: a review. Braz J Infect Dis 2013; 17:455-63. [PMID: 23680064 PMCID: PMC9428044 DOI: 10.1016/j.bjid.2012.10.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 10/29/2012] [Accepted: 10/29/2012] [Indexed: 11/18/2022] Open
Abstract
The hepatitis C virus and human immunodeficiency virus share the same transmission routes, which makes co-infection an unfavorable condition for the natural history of both viral diseases. In this context, it should be highlighted that the knowledge of the extent of co-infection and associated risk factors is a vital tool for prevention and control over infectious diseases. The aim of this study was to review the literature, seeking to examine the prevalence of human immunodeficiency virus/hepatitis C virus co-infection reported in studies conducted in Brazil, and identify the main risk factors associated with co-infection. The electronic search was conducted in the Medline, Lilacs and SciELO databases. The following keywords were used: human immunodeficiency virus and Hepatitis C or hepatitis C virus and Brazil. The search led to 376 articles, of which 69 were selected for data extraction. We excluded animal studies, reports or case series, review articles, letters to the editor, other types of hepatitis and those studies in which co-infected patients were intentionally selected for comparison to single infected individuals. As a result, 40 articles were reviewed. The majority of the population in these studies was male (71%) and young adults, with a mean age of 26.7 years. The prevalence of hepatitis C virus co-infection among individuals living with human immunodeficiency virus in the studies conducted in Brazil ranged from 3.3% (serum samples) to 82.4% (drug users), with an average of 20.3%. The findings reveal that the prevalence of human immunodeficiency virus/hepatitis C virus co-infection is highly variable, depending on the characteristics of the study population. Risk factors associated with human immunodeficiency virus/hepatitis C virus co-infection were injection drug use and blood transfusion.
Collapse
|
22
|
Reed E, Emanuel AN, Myers B, Johnson K, Wechsberg WM. The relevance of social contexts and social action in reducing substance use and victimization among women participating in an HIV prevention intervention in Cape Town, South Africa. Subst Abuse Rehabil 2013; 4:55-64. [PMID: 24648788 PMCID: PMC3931639 DOI: 10.2147/sar.s45961] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives To examine qualitatively how women’s social context and community mobilization (eg, mobilizing women to take social action and engaging their community in social change) influence substance use abstinence and victimization among women participating in a human immunodeficiency virus (HIV) intervention in Cape Town, South Africa. Methods Thirty women who had participated in a randomized controlled trial of a group-delivered intervention to address substance use, gender-based violence, and associated risk for HIV (The Women’s Health CoOp) were selected to participate in semi-structured interviews about their perceived impact of the intervention on their substance use and exposure to victimization. The Women’s CoOp intervention involved creating a new positive social environment for women within a group setting that also fostered women’s social action (eg, educating peers or family members) in the community. Interviews were analyzed using content analysis and coded to examine women’s descriptions of social contexts and social action, and the influence of these on women’s substance use abstinence and exposure to victimization. Results Social support (eg, via program staff and other participants) and social action (eg, engaging others in the community on issues relevant to substance use prevention or other health topics) promoted within the program, as well as outside social influences within women’s life contexts (eg, support from non-substance using family or male partners, leaving male partners or other peer relationships characterized by drug use, or finding employment) were key factors reported by women in terms of facilitating their substance use abstinence and in reducing women’s exposures to victimization. Conclusion Findings highlight the potential for group-delivered interventions that include mobilizing women to take social action in the larger community to be effective approaches for facilitating substance use abstinence, reductions in victimization, and ultimately, to address the intersection between substance use, violence, and HIV risk among women in this high HIV prevalence setting.
Collapse
Affiliation(s)
- Elizabeth Reed
- George Washington University School of Public Health, Department of Prevention and Community Health, Washington, DC, USA
| | | | - Bronwyn Myers
- Alcohol and Drug Abuse Research Unit, Medical Research Council, Cape Town, South Africa ; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Kim Johnson
- Alcohol and Drug Abuse Research Unit, Medical Research Council, Cape Town, South Africa
| | - Wendee M Wechsberg
- RTI International, Research Triangle Park, NC, USA ; Gillings Global School of Public Health, University of North Carolina, Chapel Hill, NC, USA ; Psychology in the Public Interest, North Carolina State University, NC, USA ; Psychiatry and Behavioral Sciences, Duke University School of Medicine, NC, USA
| |
Collapse
|
23
|
Santos Cruz M, Andrade T, Bastos FI, Leal E, Bertoni N, Villar LM, Tiesmaki M, Fischer B. Key drug use, health and socio-economic characteristics of young crack users in two Brazilian cities. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 24:432-8. [PMID: 23632130 DOI: 10.1016/j.drugpo.2013.03.012] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 03/13/2013] [Accepted: 03/20/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Crack use constitutes a major problem in cities across Brazil. While existing data suggest that crack use is generally concentrated among disenfranchised young people with extensive health problems and crime involvement, extensive data gaps exist. To address this issue, this study aimed to assess key characteristics of young crack users in two Brazilian cities. METHODS N=160 regular and young adult (ages 18-24) crack users were recruited by community-based methods in the cities of Rio de Janeiro (Southeast) and Salvador (Northeast). Assessments included an interviewer-administered questionnaire on key social, drug use, health and service use characteristics, as well as serological testing of HBV, HCV and HIV status, and were conducted anonymously between November 2010 and June 2011. Participants provided informed consent and received transportation vouchers following assessment completion. The study was approved by institutional ethics review boards. RESULTS The majority of participants were: male, with less than high school education, unstably housed (Rio only); gained income from legal or illegal work; arrested by police in past year (Salvador only); had numerous daily crack use episodes and shared paraphernalia (Salvador only); co-used alcohol, tobacco, cannabis and cocaine; had no injection history; rated physical and mental health as 'fair' or lower (Salvador only); had unprotected sex; were never HIV tested; were not HIV, HBV or HCV positive; and did not use existing social or health services, but desired access to crack user specific services. CONCLUSION Crack users in the two Brazilian sites featured extensive socio-economic marginalization, crack and poly-drug use as well as sexual risk behaviours, and compromised health status. Social and health service utilization are low, yet needs are high. There is an urgent need for further research and for targeted interventions for crack use in Brazil.
Collapse
Affiliation(s)
- Marcelo Santos Cruz
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Pedroso RS, Kessler F, Pechansky F. Treatment of female and male inpatient crack users: a qualitative study. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2013; 35:36-45. [DOI: 10.1590/s2237-60892013000100005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: To map treatment trajectories in a sample of male and female crack users through their narratives about the course of treatment seeking and their attempts to access health care services in Brazil. METHODS: Qualitative study of a purposive sample (five female and nine male hospitalized crack users) using semi-structured interviews. The interviews were transcribed and data explored using content analysis. RESULTS: Respondents reported difficulties getting access to hospitalization, relapse after discharge, and abandonment of treatment. There seems to be a peculiar model of behavior for women and men while dealing with craving for crack: while women got involved with prostitution and consequently became infected with HIV, every men of the sample reported criminal involvement. CONCLUSIONS: The relationship between relapse and a social environment conducive to consumption, associated with belief or disbelief in spiritual support, prostitution, and the legal complications arising from the use of crack, are relevant issues and should be taken into consideration in the development of preventive actions aimed at this specific population.
Collapse
|
25
|
Dual HIV risk and vulnerabilities among women who use or inject drugs: no single prevention strategy is the answer. Curr Opin HIV AIDS 2012; 7:326-31. [PMID: 22498480 DOI: 10.1097/coh.0b013e3283536ab2] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW This article examines the dual HIV and sexually transmitted infection (STI) risk behaviors engaged in by women who use or inject drugs; the individual, social, and structural drivers of HIV and STI risk; prevention strategies; and the implications for multilevel, combined, sex-specific HIV prevention strategies. RECENT FINDINGS Women who use or inject drugs, especially female sex workers, are at dual risk for HIV, the hepatitic C virus (HCV), and other STIs. In countries with HIV prevalence higher than 20% among injecting drug users (IDUs), female IDUs have slightly higher HIV prevalence than male IDUs. Women who use or inject drugs face multilevel drivers that increase their vulnerabilities to HIV, HCV, and STIs. Despite advances in behavioral HIV prevention strategies for this population, most prevention studies have not sufficiently targeted dyadic, social, and structural levels. Few recent advances in biomedical HIV prevention have focused on women who use drugs and their unique needs. SUMMARY HIV prevention strategies and services need to address the unique and multilevel drivers that increase the vulnerabilities to HIV, HCV, and STIs among women who use drugs including those who engage in sex work. Scaling-up and improving access to multilevel and combined HIV prevention strategies for these women is central to combating the HIV epidemic.
Collapse
|
26
|
Shen YZ, Wang ZY, Qi TK, Jiang XY, Song W, Tang Y, Wang JR, Liu L, Zhang RF, Zheng YF, Dai ZS, Lu HZ. Serological survey of viral hepatitis markers among newly diagnosed patients with HIV/AIDS in China. HIV Med 2012; 14:167-75. [DOI: 10.1111/j.1468-1293.2012.01048.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2012] [Indexed: 01/29/2023]
Affiliation(s)
- YZ Shen
- Department of Infectious Diseases; Shanghai Public Health Clinical Center; Fudan University; Shanghai; China
| | - ZY Wang
- Department of Infectious Diseases; Shanghai Public Health Clinical Center; Fudan University; Shanghai; China
| | - TK Qi
- Department of Infectious Diseases; Shanghai Public Health Clinical Center; Fudan University; Shanghai; China
| | - XY Jiang
- Department of Infectious Diseases; Shanghai Public Health Clinical Center; Fudan University; Shanghai; China
| | - W Song
- Department of Infectious Diseases; Shanghai Public Health Clinical Center; Fudan University; Shanghai; China
| | - Y Tang
- Department of Infectious Diseases; Shanghai Public Health Clinical Center; Fudan University; Shanghai; China
| | - JR Wang
- Department of Infectious Diseases; Shanghai Public Health Clinical Center; Fudan University; Shanghai; China
| | - L Liu
- Department of Infectious Diseases; Shanghai Public Health Clinical Center; Fudan University; Shanghai; China
| | - RF Zhang
- Department of Infectious Diseases; Shanghai Public Health Clinical Center; Fudan University; Shanghai; China
| | - YF Zheng
- Department of Infectious Diseases; Shanghai Public Health Clinical Center; Fudan University; Shanghai; China
| | - ZS Dai
- Department of Infectious Diseases; Shanghai Public Health Clinical Center; Fudan University; Shanghai; China
| | - HZ Lu
- Department of Infectious Diseases; Shanghai Public Health Clinical Center; Fudan University; Shanghai; China
| |
Collapse
|
27
|
Costa GDM, Soibelman M, Zanchet DL, Costa PDM, Salgado CAI. Pregnant crack addicts in a psychiatric unit. JORNAL BRASILEIRO DE PSIQUIATRIA 2012. [DOI: 10.1590/s0047-20852012000100003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: In this study we aim to characterize a sample of 85 pregnant crack addicts admitted for detoxification in a psychiatric inpatient unit. METHOD: Cross-sectional study. Sociodemographic, clinical, obstetric and lifestyle information were evaluated. RESULTS: Age of onset for crack use varied from 11 to 35 years (median = 21). Approximately 25% of the patients smoked more than 20 crack rocks in a typical day of use (median = 10; min-max = 1-100). Tobacco (89.4%), alcohol (63.5%) and marijuana (51.8%) were the drugs other than crack most currently used. Robbery was reported by 32 patients (41.2%), imprisonment experience by 21 (24.7%), trade of sex for money/drugs by 38 (44.7%), home desertion by 33 (38.8%); 15.3% were positive for HIV, 5.9% for HCV, 1.2% for HBV and 8.2% for syphilis. After discharge from the psychiatric unit, only 25% of the sample followed the proposed treatment in the chemical dependency outpatient service. CONCLUSION: Greater risky behaviors for STD, as well as high rates of maternal HIV and Syphilis were found. Moreover, the high rates of concurrent use of other drugs and involvement in illegal activities contribute to show their chaotic lifestyles. Prevention and intervention programs need to be developed to address the multifactorial nature of this problem.
Collapse
|
28
|
Bassols AMS, Boni RD, Pechansky F. Alcohol, drugs, and risky sexual behavior are related to HIV infection in female adolescents. BRAZILIAN JOURNAL OF PSYCHIATRY 2011; 32:361-8. [PMID: 21308256 DOI: 10.1590/s1516-44462010000400008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Accepted: 07/07/2010] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine associations between risk factors for HIV infection in a sample of young women who sought HIV testing in a city of southern Brazil. METHOD Cross-sectional study with a consecutive convenience sample of 258 female adolescents aged 13 to 20 years evaluated in an anonymous testing site for HIV and sexually transmitted diseases in Brazil. Risk behavior for HIV was assessed with the Brazilian version of the Risk Assessment Battery and HIV status was assessed through ELISA (Enzyme Linked Immunosorbent Assay). RESULTS Overall seropositivity rate was 7.4%. HIV-seropositive patients had significantly more sexual intercourse in exchange for money, higher rates of pregnancy and abortion, as well as earlier sexual debut. In multiple analyses with the inclusion of two composite variables (sex risk and drug risk), only drug risk was associated with positive HIV status (OR=4.178; IC 95%=1.476-11.827). CONCLUSION Our findings suggest that high HIV seropositivity among female adolescents seeking HIV testing in Brazil directly reflects the need for effective interventions specifically designed to prevent risk behaviors in order to halt the spread of HIV infection.
Collapse
Affiliation(s)
- Ana Margareth Siqueira Bassols
- Serviço de Psiquiatria da Infância e Adolescência, Hospital de Clínicas de Porto Alegre, Center for Drug and Alcohol Research, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | | | | |
Collapse
|