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Stone J, Fraser H, Walker JG, Mafirakureva N, Mundia B, Cleland C, Bartilol K, Musyoki H, Waruiru W, Ragi A, Bhattacharjee P, Chhun N, Lizcano J, Akiyama MJ, Cherutich P, Wisse E, Kurth A, Luhmann N, Vickerman P. Modelling the impact of HIV and hepatitis C virus prevention and treatment interventions among people who inject drugs in Kenya. AIDS 2022; 36:2191-2201. [PMID: 36111533 PMCID: PMC9671825 DOI: 10.1097/qad.0000000000003382] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 04/11/2022] [Accepted: 04/19/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES People who inject drugs (PWID) in Kenya have high HIV (range across settings: 14-26%) and hepatitis C virus (HCV; 11-36%) prevalence. We evaluated the impact of existing and scaled-up interventions on HIV and HCV incidence among PWID in Kenya. DESIGN HIV and HCV transmission model among PWID, calibrated to Nairobi and Kenya's Coastal region. METHODS For each setting, we projected the impact (percent of HIV/HCV infections averted in 2020) of existing coverages of antiretroviral therapy (ART; 63-79%), opioid agonist therapy (OAT; 8-13%) and needle and syringe programmes (NSP; 45-61%). We then projected the impact (reduction in HIV/HCV incidence over 2021-2030), of scaling-up harm reduction [Full harm reduction ('Full HR'): 50% OAT, 75% NSP] and/or HIV (UNAIDS 90-90-90) and HCV treatment (1000 PWID over 2021-2025) and reducing sexual risk (by 25/50/75%). We estimated HCV treatment levels needed to reduce HCV incidence by 90% by 2030. RESULTS In 2020, OAT and NSP averted 46.0-50.8% (range of medians) of HIV infections and 50.0-66.1% of HCV infections, mostly because of NSP. ART only averted 12.9-39.8% of HIV infections because of suboptimal viral suppression (28-48%). Full HR and ART could reduce HIV incidence by 51.5-64% and HCV incidence by 84.6-86.6% by 2030. Also halving sexual risk could reduce HIV incidence by 68.0-74.1%. Alongside full HR, treating 2244 PWID over 2021-2025 could reduce HCV incidence by 90% by 2030. CONCLUSION Existing interventions are having substantial impact on HIV and HCV transmission in Kenya. However, to eliminate HIV and HCV, further scale-up is needed with reductions in sexual risk and HCV treatment.
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Affiliation(s)
- Jack Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol
| | - Hannah Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol
| | - Josephine G. Walker
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol
| | | | | | | | | | | | - Wanjiru Waruiru
- Global Programs for Research and Training, Surveillance Department, University of California San Francisco, San Francisco, California, USA
| | | | | | - Nok Chhun
- Yale University School of Nursing, New Haven, Connecticut
| | - John Lizcano
- Yale University School of Nursing, New Haven, Connecticut
| | - Matthew J. Akiyama
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | | | - Ann Kurth
- Yale University School of Nursing, New Haven, Connecticut
| | - Niklas Luhmann
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, Bristol, UK
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Befekadu B, Shuremu M, Zewdie A. Seroprevalence of syphilis and its predictors among pregnant women in Buno Bedele zone, southwest Ethiopia: a community-based cross-sectional study. BMJ Open 2022; 12:e063745. [PMID: 35940833 PMCID: PMC9364416 DOI: 10.1136/bmjopen-2022-063745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The study was aimed at assessing the prevalence of syphilis and associated factors among pregnant women with antenatal care follow-up. DESIGN A health facility-based, cross-sectional study. SETTING The study was conducted in 12 health facilities in Buno Bedele zone, southwest Ethiopia. PARTICIPANTS Randomly selected 920 pregnant women who came to health facilities in the Buno Bedele zone for antenatal care services from May to August 2021 were included in the study. Women with previously diagnosed syphilis and those on treatment were excluded from the study. OUTCOME MEASURES Blood samples and data on sociodemographic and other risk factors for syphilis were collected. Sera were screened for syphilis using the one-step rapid syphilis diagnostic test kit, and positive tests were retested using the rapid plasma reagin test. Data were analysed using SPSS V.22. Bivariate and multivariate logistic regression analyses were used to identify risk factors for maternal syphilis at a p value less than 0.05. RESULTS The prevalence of syphilis among pregnant women was found to be 1.4% (95% CI: 0.8% to 2.3%, p=0.002). Women with no formal education (adjusted OR (AOR)=3.6; 95% CI: 1.02 to 13.2, p=0.047), husbands with a history of substance use (AOR=3.3, 95% CI: 1.04 to 10.7, p=0.042), more than one antenatal care visit (AOR=3.5, 95% CI: 1.07 to 10.5, p=0.038), age at marriage under 18 years (AOR=4.3, 95% CI: 2.2 to 7.9, p=0.045) and a woman's poor knowledge of syphilis (AOR=3.3, 95% CI: 1.04 to 10.4, p=0.042) were significantly associated with syphilis. CONCLUSION The prevalence of maternal syphilis in this study area was found to be comparable with the national prevalence. Women's educational status, husbands' history of substance use, antenatal care, age at marriage and knowledge about syphilis were the independent predictors of syphilis. Emphasis shall be given to screening all pregnant women, education of women, lifestyle factors and avoiding early marriage.
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Affiliation(s)
- Biruk Befekadu
- Shobe Health Center, Buno Bedele Zone Health Department, Bedele, Oromia, Ethiopia
| | - Muluneh Shuremu
- Department of Public Health, College of Health Science, Mettu University, Mettu, Oromia, Ethiopia
| | - Asrat Zewdie
- Department of Public Health, College of Health Science, Mettu University, Mettu, Oromia, Ethiopia
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Jaguga F, Kiburi SK, Temet E, Barasa J, Karanja S, Kinyua L, Kwobah EK. A systematic review of substance use and substance use disorder research in Kenya. PLoS One 2022; 17:e0269340. [PMID: 35679248 PMCID: PMC9186181 DOI: 10.1371/journal.pone.0269340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 05/18/2022] [Indexed: 12/27/2022] Open
Abstract
Objectives The burden of substance use in Kenya is significant. The objective of this
study was to systematically summarize existing literature on substance use
in Kenya, identify research gaps, and provide directions for future
research. Methods This systematic review was conducted in line with the PRISMA guidelines. We
conducted a search of 5 bibliographic databases (PubMed, PsychINFO, Web of
Science, Cumulative Index of Nursing and Allied Professionals (CINAHL) and
Cochrane Library) from inception until 20 August 2020. In addition, we
searched all the volumes of the official journal of the National Authority
for the Campaign Against Alcohol & Drug Abuse (the African Journal of
Alcohol and Drug Abuse). The results of eligible studies have been
summarized descriptively and organized by three broad categories including:
studies evaluating the epidemiology of substance use, studies evaluating
interventions and programs, and qualitative studies exploring various themes
on substance use other than interventions. The quality of the included
studies was assessed with the Quality Assessment Tool for Studies with
Diverse Designs. Results Of the 185 studies that were eligible for inclusion, 144 investigated the
epidemiology of substance use, 23 qualitatively explored various substance
use related themes, and 18 evaluated substance use interventions and
programs. Key evidence gaps emerged. Few studies had explored the
epidemiology of hallucinogen, prescription medication, ecstasy, injecting
drug use, and emerging substance use. Vulnerable populations such as
pregnant women, and persons with physical disability had been
under-represented within the epidemiological and qualitative work. No
intervention study had been conducted among children and adolescents. Most
interventions had focused on alcohol to the exclusion of other prevalent
substances such as tobacco and cannabis. Little had been done to evaluate
digital and population-level interventions. Conclusion The results of this systematic review provide important directions for future
substance use research in Kenya. Systematic review registration PROSPERO: CRD42020203717.
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Affiliation(s)
- Florence Jaguga
- Department of Mental Health, Moi Teaching & Referral Hospital,
Eldoret, Kenya
- * E-mail:
| | | | - Eunice Temet
- Department of Mental Health & Behavioral Sciences, Moi University
School of Medicine, Eldoret, Kenya
| | - Julius Barasa
- Population Health, Academic Model Providing Access to Healthcare,
Eldoret, Kenya
| | - Serah Karanja
- Department of Mental Health, Gilgil Sub-County Hospital, Gilgil,
Kenya
| | - Lizz Kinyua
- Intensive Care Unit, Aga Khan University Hospital, Nairobi,
Kenya
| | - Edith Kamaru Kwobah
- Department of Mental Health, Moi Teaching & Referral Hospital,
Eldoret, Kenya
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Boothe MAS, Semá Baltazar C, Sathane I, Raymond HF, Fazito E, Temmerman M, Luchters S. Young key populations left behind: The necessity for a targeted response in Mozambique. PLoS One 2021; 16:e0261943. [PMID: 34972172 PMCID: PMC8719759 DOI: 10.1371/journal.pone.0261943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The first exposure to high-risk sexual and drug use behaviors often occurs during the period of youth (15-24 years old). These behaviors increase the risk of HIV infection, especially among young key populations (KP)-men how have sex with men (MSM), female sex workers (FSW), and people who inject drugs (PWID). We describe the characteristics of young KP participants in the first Biobehavioral Surveillance (BBS) surveys conducted in Mozambique and examine their risk behaviors compared to adult KP. METHODS Respondent-driven sampling (RDS) methodology was used to recruit KP in three major urban areas in Mozambique. RDS-weighted pooled estimates were calculated to estimate the proportion of young KP residing in each survey city. Unweighted pooled estimates of risk behaviors were calculated for each key population group and chi-square analysis assessed differences in proportions between youth (aged less than 24 years old) and older adult KP for each population group. RESULTS The majority of MSM and FSW participants were young 80.7% (95% CI: 71.5-89.9%) and 71.9% (95% CI: 71.9-79.5%), respectively, although not among PWID (18.2%, 95% CI: 13.2-23.2%). Young KP were single or never married, had a secondary education level or higher, and low employment rates. They reported lower perception of HIV risk (MSM: 72.3% vs 56.7%, p<0.001, FSW: 45.3% vs 24.4%, p<0.001), lower HIV testing uptake (MSM: 67.5% vs 72.3%, p<0.001; FSW: 63.2% vs 80.6%; p<0.001, PWID: 53.3% vs 31.2%; p = 0.001), greater underage sexual debut (MSM: 9.6% vs 4.8%, p<0.001; FSW: 35.2% vs 22.9%, p<0.001), and greater underage initiation of injection drug use (PWID: 31.9% vs 7.0%, p<0.001). Young KP also had lower HIV prevalence compared to older KP: MSM: 3.3% vs 27.0%, p<0.001; FSW: 17.2% vs 53.7%, p<0.001; and PWID: 6.0% vs 55.0%, p<0.001. There was no significant difference in condom use across the populations. CONCLUSION There is an immediate need for a targeted HIV response for young KP in Mozambique so that they are not left behind. Youth must be engaged in the design and implementation of interventions to ensure that low risk behaviors are sustained as they get older to prevent HIV infection.
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Affiliation(s)
- Makini A. S. Boothe
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Cynthia Semá Baltazar
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- National Institute of Health, Maputo, Mozambique
| | - Isabel Sathane
- National STI-HIV/AIDS Control Program, National Directorate of Public Health, Mozambique
| | - Henry F. Raymond
- School of Public Health, Rutgers University, Piscataway, New Jersey, United States of America
| | - Erika Fazito
- ICAP, Columbia University, Pretoria, South Africa
| | - Marleen Temmerman
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Obstetrics and Gynecology, Aga Khan University, Nairobi, Kenya
| | - Stanley Luchters
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Population Health, Aga Khan University, Nairobi, Kenya
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Ludwig-Barron NT, Guthrie BL, Mbogo L, Bukusi D, Sinkele W, Gitau E, Farquhar C, Monroe-Wise A. Barriers and facilitators of HIV and hepatitis C care among people who inject drugs in Nairobi, Kenya: a qualitative study with peer educators. Harm Reduct J 2021; 18:133. [PMID: 34922548 PMCID: PMC8684158 DOI: 10.1186/s12954-021-00580-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 12/01/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In Kenya, people who inject drugs (PWID) are disproportionately affected by HIV and hepatitis C (HCV) epidemics, including HIV-HCV coinfections; however, few have assessed factors affecting their access to and engagement in care through the lens of community-embedded, peer educators. This qualitative study leverages the personal and professional experiences of peer educators to help identify HIV and HCV barriers and facilitators to care among PWID in Nairobi, including resource recommendations to improve service uptake. METHODS We recruited peer educators from two harm reduction facilities in Nairobi, Kenya, using random and purposive sampling techniques. Semi-structured interviews explored circumstances surrounding HIV and HCV service access, prevention education and resource recommendations. A thematic analysis was conducted using the Modified Social Ecological Model (MSEM) as an underlying framework, with illustrative quotes highlighting emergent themes. RESULTS Twenty peer educators participated, including six women, with 2-months to 6-years of harm reduction service. Barriers to HIV and HCV care were organized by (a) individual-level themes including the competing needs of addiction and misinterpreted symptoms; (b) social network-level themes including social isolation and drug dealer interactions; (c) community-level themes including transportation, mental and rural healthcare services, and limited HCV resources; and (d) policy-level themes including nonintegrated health services, clinical administration, and law enforcement. Stigma, an overarching barrier, was highlighted throughout the MSEM. Facilitators to HIV and HCV care were comprised of (a) individual-level themes including concurrent care, personal reflections, and religious beliefs; (b) social network-level themes including community recommendations, navigation services, family commitment, and employer support; (c) community-level themes including quality services, peer support, and outreach; and (d) policy-level themes including integrated health services and medicalized approaches within law enforcement. Participant resource recommendations include (i) additional medical, social and ancillary support services, (ii) national strategies to address stigma and violence and (iii) HCV prevention education. CONCLUSIONS Peer educators provided intimate knowledge of PWID barriers and facilitators to HIV and HCV care, described at each level of the MSEM, and should be given careful consideration when developing future initiatives. Recommendations emphasized policy and community-level interventions including educational campaigns and program suggestions to supplement existing HIV and HCV services.
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Affiliation(s)
- Natasha T Ludwig-Barron
- Department of Epidemiology, School of Public Health, University of Washington, 3980 15th Ave NE, Box # 351619, Seattle, WA, 98195, USA.
- Department of Global Health, School of Public Health and School of Medicine, University of Washington, 3980 15th Ave NE, Box #351620, Seattle, WA, 98195, USA.
| | - Brandon L Guthrie
- Department of Epidemiology, School of Public Health, University of Washington, 3980 15th Ave NE, Box # 351619, Seattle, WA, 98195, USA
- Department of Global Health, School of Public Health and School of Medicine, University of Washington, 3980 15th Ave NE, Box #351620, Seattle, WA, 98195, USA
| | - Loice Mbogo
- University of Washington Global Assistance Program-Kenya, Nairobi, Kenya
| | - David Bukusi
- VCT and HIV Prevention, Kenyatta National Hospital, Nairobi, Kenya
| | - William Sinkele
- Support for Addictions Prevention and Treatment in Africa (SAPTA), Nairobi, Kenya
| | - Esther Gitau
- Support for Addictions Prevention and Treatment in Africa (SAPTA), Nairobi, Kenya
| | - Carey Farquhar
- Department of Epidemiology, School of Public Health, University of Washington, 3980 15th Ave NE, Box # 351619, Seattle, WA, 98195, USA
- Department of Global Health, School of Public Health and School of Medicine, University of Washington, 3980 15th Ave NE, Box #351620, Seattle, WA, 98195, USA
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Box 356423, Seattle, WA, 98195, USA
| | - Aliza Monroe-Wise
- Department of Global Health, School of Public Health and School of Medicine, University of Washington, 3980 15th Ave NE, Box #351620, Seattle, WA, 98195, USA
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Box 356423, Seattle, WA, 98195, USA
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Twahirwa Rwema JO, Nizeyimana V, Prata NM, Okonkwo NE, Mazzei AA, Muhirwa S, Rukundo A, Lucas L, Niyigena A, Makuza JD, Beyrer C, Baral SD, Kagaba A. Injection drug use practices and HIV infection among people who inject drugs in Kigali, Rwanda: a cross-sectional study. Harm Reduct J 2021; 18:130. [PMID: 34911554 PMCID: PMC8672501 DOI: 10.1186/s12954-021-00579-0] [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: 09/28/2021] [Accepted: 11/30/2021] [Indexed: 11/11/2022] Open
Abstract
Background In Rwanda, epidemiological data characterizing people who inject drugs (PWID) and their burden of HIV are limited. We examined injection drug use (IDU) history and practices, and HIV infection in a sample of PWID in Kigali. Methods From October 2019 to February 2020, 307 PWID aged ≥ 18 were enrolled in a cross-sectional study using convenience sampling in Kigali. Participants completed interviewer-administered questionnaires on IDU history and practices and HIV testing. We used Poisson regression with robust variance estimation to assess IDU practices associated with HIV infection and assessed factors associated with needle sharing in the six months preceding the study. Results The median age was 28 years (IQR 24–31); 81% (251) were males. Female PWID were more likely to report recent IDU initiation, selling sex for drugs, and to have been injected by a sex partner (p < 0.05). In the prior six months, heroin was the primary drug of choice for 99% (303) of participants, with cocaine and methamphetamine also reported by 10% (31/307) and 4% (12/307), respectively. In total, 91% (280/307) of participants reported ever sharing needles in their lifetime and 43% (133) knew someone who died from a drug-related overdose. HIV prevalence was 9.5% (95% CI 8.7–9.3). Sharing needles at least half of the time in the previous six months was positively associated with HIV infection (adjusted prevalence ratio (aPR) 2.67; 95% CI 1.23–5.78). Overall, 31% (94/307) shared needles and 33% (103/307) reused needles in the prior six months. Female PWID were more likely to share needles compared to males (aPR 1.68; 95% CI 1.09–2.59). Additionally, bisexual PWID (aPR 1.68; 95% CI 1.09–2.59), those who shared needles at the first injection (aPR 2.18; 95% CI 1.59–2.99), reused needles recently (aPR 2.27; 95% CI 1.51–3.43) and shared other drug paraphernalia (aPR 3.56; 95% CI 2.19–5.81) were more likely to report recent needle sharing. Conclusion HIV infection was common in this study. The high prevalence of needle reuse and sharing practices highlights significant risks for onward transmission and acquisition of HIV and viral hepatitis. These data highlight the urgent need for PWID-focused harm reduction services in Rwanda, including syringe services programs, safe injection education, naloxone distribution, and substance use disorder treatment programs and optimizing these services to the varied needs of people who use drugs in Rwanda.
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Affiliation(s)
- Jean Olivier Twahirwa Rwema
- Department of Epidemiology, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street E 7133, Baltimore, MD, 21205, USA.
| | | | - Neia M Prata
- Department of Epidemiology, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street E 7133, Baltimore, MD, 21205, USA
| | - Nneoma E Okonkwo
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Amelia A Mazzei
- Emory University School of Medicine, Atlanta, GA, USA.,Projet San Francisco, Kigali, Rwanda
| | | | | | - Lisa Lucas
- Department of Epidemiology, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street E 7133, Baltimore, MD, 21205, USA
| | - Audace Niyigena
- Département de Psychiatrie, Service d'addictologie, Hôpitaux Universitaire de Genève, Geneva, Switzerland
| | - Jean Damascene Makuza
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,BC Center for Disease Control, Vancouver, BC, Canada.,Rwanda Biomedical Center, Kigali, Rwanda
| | - Chris Beyrer
- Department of Epidemiology, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street E 7133, Baltimore, MD, 21205, USA
| | - Stefan D Baral
- Department of Epidemiology, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street E 7133, Baltimore, MD, 21205, USA
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Fraser H, Stone J, Wisse E, Sambu V, Mfisi P, Duran IJ, Soriano MA, Walker JG, Makere N, Luhmann N, Kafura W, Nouvellet M, Ragi A, Mundia B, Vickerman P. Modelling the impact of HIV and HCV prevention and treatment interventions for people who inject drugs in Dar es Salaam, Tanzania. J Int AIDS Soc 2021; 24:e25817. [PMID: 34661964 PMCID: PMC8522890 DOI: 10.1002/jia2.25817] [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] [Received: 02/08/2021] [Accepted: 08/19/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction People who inject drugs (PWID) in Dar es Salaam, Tanzania, have a high prevalence of HIV and hepatitis C virus (HCV). While needle and syringe programmes (NSP), opioid agonist therapy (OAT) and anti‐retroviral therapy (ART) are available in Tanzania, their coverage is sub‐optimal. We assess the impact of existing and scaled up harm reduction (HR) interventions on HIV and HCV transmission among PWID in Dar es Salaam. Methods An HIV and HCV transmission model among PWID in Tanzania was calibrated to data over 2006–2018 on HIV (∼30% and ∼67% prevalence in males and females in 2011) and HCV prevalence (∼16% in 2017), numbers on HR interventions (5254 ever on OAT in 2018, 766–1479 accessing NSP in 2017) and ART coverage (63.1% in 2015). We evaluated the impact of existing interventions in 2019 and impact by 2030 of scaling‐up the coverage of OAT (to 50% of PWID), NSP (75%, both combined termed “full HR”) and ART (81% with 90% virally suppressed) from 2019, reducing sexual HIV transmission by 50%, and/or HCV‐treating 10% of PWID infected with HCV annually. Results The model projects HIV and HCV prevalence of 19.0% (95% credibility interval: 16.4–21.2%) and 41.0% (24.4–49.0%) in 2019, respectively. For HIV, 24.6% (13.6–32.6%) and 70.3% (59.3–77.1%) of incident infections among male and female PWID are sexually transmitted, respectively. Due to their low coverage (22.8% for OAT, 16.3% for NSP in 2019), OAT and NSP averted 20.4% (12.9–24.7%) of HIV infections and 21.7% (17.0–25.2%) of HCV infections in 2019. Existing ART (68.5% coverage by 2019) averted 48.1% (29.7–64.3%) of HIV infections in 2019. Scaling up to full HR will reduce HIV and HCV incidence by 62.6% (52.5–74.0%) and 81.4% (56.7–81.4%), respectively, over 2019–2030; scaled up ART alongside full HR will decrease HIV incidence by 66.8% (55.6–77.5%), increasing to 81.5% (73.7–87.5%) when sexual risk is also reduced. HCV‐treatment alongside full HR will decrease HCV incidence by 92.4% (80.7–95.8%) by 2030. Conclusions Combination interventions, including sexual risk reduction and HCV treatment, are needed to eliminate HCV and HIV among PWID in Tanzania.
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Affiliation(s)
- Hannah Fraser
- Population HealthSciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jack Stone
- Population HealthSciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Veryeh Sambu
- National AIDS Control Programmes, Dar es Salaam, Tanzania
| | - Peter Mfisi
- The Drug Control and Enforcement Authority, Prime Ministers Office, Dar es Salaam, Tanzania
| | | | | | - Josephine G Walker
- Population HealthSciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nobelrich Makere
- Tanzania Council for Social Development (TACOSODE), Dar es Salaam, Tanzania
| | | | - William Kafura
- Tanzania Commission for AIDS (TACAIDS), Dar es Salaam, Tanzania
| | | | - Allan Ragi
- Kenya AIDS NGO Consortium, Nairobi, Kenya
| | | | - Peter Vickerman
- Population HealthSciences, Bristol Medical School, University of Bristol, Bristol, UK
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Gornalusse GG, Vojtech LN, Levy CN, Hughes SM, Kim Y, Valdez R, Pandey U, Ochsenbauer C, Astronomo R, McElrath J, Hladik F. Buprenorphine Increases HIV-1 Infection In Vitro but Does Not Reactivate HIV-1 from Latency. Viruses 2021; 13:1472. [PMID: 34452338 PMCID: PMC8402857 DOI: 10.3390/v13081472] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/28/2021] [Accepted: 07/24/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND medication-assisted treatment (MAT) with buprenorphine is now widely prescribed to treat addiction to heroin and other illicit opioids. There is some evidence that illicit opioids enhance HIV-1 replication and accelerate AIDS pathogenesis, but the effect of buprenorphine is unknown. METHODS we obtained peripheral blood mononuclear cells (PBMCs) from healthy volunteers and cultured them in the presence of morphine, buprenorphine, or methadone. We infected the cells with a replication-competent CCR5-tropic HIV-1 reporter virus encoding a secreted nanoluciferase gene, and measured infection by luciferase activity in the supernatants over time. We also surveyed opioid receptor expression in PBMC, genital epithelial cells and other leukocytes by qPCR and western blotting. Reactivation from latency was assessed in J-Lat 11.1 and U1 cell lines. RESULTS we did not detect expression of classical opioid receptors in leukocytes, but did find nociception/orphanin FQ receptor (NOP) expression in blood and vaginal lymphocytes as well as genital epithelial cells. In PBMCs, we found that at physiological doses, morphine, and methadone had a variable or no effect on HIV infection, but buprenorphine treatment significantly increased HIV-1 infectivity (median: 8.797-fold increase with 20 nM buprenorphine, eight experiments, range: 3.570-691.9, p = 0.0078). Using latently infected cell lines, we did not detect reactivation of latent HIV following treatment with any of the opioid drugs. CONCLUSIONS our results suggest that buprenorphine, in contrast to morphine or methadone, increases the in vitro susceptibility of leukocytes to HIV-1 infection but has no effect on in vitro HIV reactivation. These findings contribute to our understanding how opioids, including those used for MAT, affect HIV infection and reactivation, and can help to inform the choice of MAT for people living with HIV or who are at risk of HIV infection.
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Affiliation(s)
- Germán Gustavo Gornalusse
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; (G.G.G.); (L.N.V.); (C.N.L.); (S.M.H.); (Y.K.); (R.V.); (U.P.); (R.A.); (J.M.)
- Departments of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195, USA
| | - Lucia N. Vojtech
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; (G.G.G.); (L.N.V.); (C.N.L.); (S.M.H.); (Y.K.); (R.V.); (U.P.); (R.A.); (J.M.)
- Departments of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195, USA
| | - Claire N. Levy
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; (G.G.G.); (L.N.V.); (C.N.L.); (S.M.H.); (Y.K.); (R.V.); (U.P.); (R.A.); (J.M.)
- Departments of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195, USA
| | - Sean M. Hughes
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; (G.G.G.); (L.N.V.); (C.N.L.); (S.M.H.); (Y.K.); (R.V.); (U.P.); (R.A.); (J.M.)
- Departments of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195, USA
| | - Yeseul Kim
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; (G.G.G.); (L.N.V.); (C.N.L.); (S.M.H.); (Y.K.); (R.V.); (U.P.); (R.A.); (J.M.)
- Departments of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195, USA
| | - Rogelio Valdez
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; (G.G.G.); (L.N.V.); (C.N.L.); (S.M.H.); (Y.K.); (R.V.); (U.P.); (R.A.); (J.M.)
| | - Urvashi Pandey
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; (G.G.G.); (L.N.V.); (C.N.L.); (S.M.H.); (Y.K.); (R.V.); (U.P.); (R.A.); (J.M.)
- Departments of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195, USA
| | - Christina Ochsenbauer
- School of Medicine, Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL 35233, USA;
| | - Rena Astronomo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; (G.G.G.); (L.N.V.); (C.N.L.); (S.M.H.); (Y.K.); (R.V.); (U.P.); (R.A.); (J.M.)
| | - Julie McElrath
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; (G.G.G.); (L.N.V.); (C.N.L.); (S.M.H.); (Y.K.); (R.V.); (U.P.); (R.A.); (J.M.)
- Department of Medicine, University of Washington, Seattle, WA 98195, USA
- Department of Pathobiology, Global Health and Laboratory Medicine, University of Washington, Seattle, WA 98195, USA
| | - Florian Hladik
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; (G.G.G.); (L.N.V.); (C.N.L.); (S.M.H.); (Y.K.); (R.V.); (U.P.); (R.A.); (J.M.)
- Departments of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195, USA
- Department of Medicine, University of Washington, Seattle, WA 98195, USA
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Monroe-Wise A, Mbogo L, Guthrie B, Bukusi D, Sambai B, Chohan B, Scott J, Cherutich P, Musyoki H, Bosire R, Dunbar M, Macharia P, Masyuko S, Wilkinson E, De Oliveira T, Ludwig-Barron N, Sinkele B, Herbeck J, Farquhar C. Peer-mediated HIV assisted partner services to identify and link to care HIV-positive and HCV-positive people who inject drugs: a cohort study protocol. BMJ Open 2021; 11:e041083. [PMID: 33895711 PMCID: PMC8074565 DOI: 10.1136/bmjopen-2020-041083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Targeted, tailored interventions to test high-risk individuals for HIV and hepatitis C virus (HCV) are vital to achieving HIV control and HCV microelimination in Africa. Compared with the general population, people who inject drugs (PWID) are at increased risk of HIV and HCV and are less likely to be tested or successfully treated. Assisted partner services (APS) increases HIV testing among partners of people living with HIV and improves case finding and linkage to care. We describe a study in Kenya examining whether APS can be adapted to find, test and link to HIV care the partners of HIV-positive PWID using a network of community-embedded peer educators (PEs). Our study also identifies HCV-positive partners and uses phylogenetic analysis to determine risk factors for onward transmission of both viruses. METHODS This prospective cohort study leverages a network of PEs to identify 1000 HIV-positive PWID for enrolment as index participants. Each index completes a questionnaire and provides names and contact information of all sexual and injecting partners during the previous 3 years. PEs then use a stepwise locator protocol to engage partners in the community and bring them to study sites for enrolment, questionnaire completion and rapid HIV and HCV testing. Outcomes include number and type of partners per index who are mentioned, enrolled, tested, diagnosed with HIV and HCV and linked to care. ETHICS AND DISSEMINATION Potential index participants are screened for intimate partner violence (IPV) and those at high risk are not eligible to enrol. Those at medium risk are monitored for IPV following enrolment. A community advisory board engages in feedback and discussion between the community and the research team. A safety monitoring board discusses study progress and reviews data, including IPV monitoring data. Dissemination plans include presentations at quarterly Ministry of Health meetings, local and international conferences and publications. TRIAL REGISTRATION NUMBER NCT03447210, Pre-results stage.
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Affiliation(s)
- Aliza Monroe-Wise
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Loice Mbogo
- HIV Testing and Counseling and HIV Prevention, Kenyatta National Hospital, Nairobi, Kenya
| | - Brandon Guthrie
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - David Bukusi
- HIV Testing and Counseling and HIV Prevention, Kenyatta National Hospital, Nairobi, Kenya
| | - Betsy Sambai
- HIV Testing and Counseling and HIV Prevention, Kenyatta National Hospital, Nairobi, Kenya
| | - Bhavna Chohan
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Kenya Medical Research Institute, Nairobi, Kenya
| | - John Scott
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | | | | | - Rose Bosire
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Matthew Dunbar
- Center for Studies in Demography and Ecology, University of Washinigton, Seattle, Washington, USA
| | | | - Sarah Masyuko
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Kenya's Ministry of Health, Nairobi, Kenya
| | - Eduan Wilkinson
- KwaZulu-Natal Research and Innovation Sequencing Platform, University of KwaZulu-Natal, Durban, South Africa
| | - Tulio De Oliveira
- KwaZulu-Natal Research and Innovation Sequencing Platform, University of KwaZulu-Natal, Durban, South Africa
| | | | - Bill Sinkele
- Support for Addiction Prevention and Treatment in Africa, Nairobi, Kenya
| | - Joshua Herbeck
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Carey Farquhar
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
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10
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Semá Baltazar C, Kellogg TA, Boothe M, Loarec A, de Abreu E, Condula M, Fazito E, Raymond HF, Temmerman M, Luchters S. Prevalence of HIV, viral hepatitis B/C and tuberculosis and treatment outcomes among people who use drugs: Results from the implementation of the first drop-in-center in Mozambique. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 90:103095. [PMID: 33429163 DOI: 10.1016/j.drugpo.2020.103095] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/09/2020] [Accepted: 12/19/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND People who use drugs (PWUD) which includes both people who inject drugs (PWID) and non-injection drug users (NIDU) are marginalized, experience high levels of stigma and discrimination, and are likely to have challenges with accessing health services. Mozambique implemented the first drop-in center (DIC) for PWUD in Maputo City in 2018. This analysis aims to assess the prevalence of HIV, viral hepatitis B (HBV) and C (HCV) and tuberculosis (TB) among PWUD, and assess their linkage to care and associated correlates. METHODS We conducted a cross-sectional retrospective analysis of routine screening data collected from the first visit at the drop-in center (DIC) during the period of May 2018 to November 2019 (18 months). Descriptive and multivariable logistic regression analysis were conducted to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) of HIV, HBV, HCV and TB infections among PWID and NIDU. Cox proportional hazards models of determinants were used to estimate time from HIV diagnosis to linkage to care for PWUD. RESULTS A total of 1,818 PWUD were screened at the DIC, of whom 92.6% were male. The median age was 27 years (range:14-63). Heroin was the most consumed drug (93.8%), and among people who used it, 15.5% injected it. Prevalence of HIV (43.9%), HCV (22.6%) and HBV (5.9%) was higher among PWID (p<0.001). Linkage to HIV care was observed in 40.5% of newly diagnosed PWID. Factors associated with shorter time to linkage to care included drug injection (aHR=1.6) and confirmed TB infection (aHR=2.9). CONCLUSION This was the first analysis conducted on the implementation of the DIC in Mozambique and highlights the importance of targeted services for this high-risk population. Our analysis confirmed a high prevalence of HIV, HBV and HCV, and highlight the challenges with linkage to care among PWID. The expansion of DIC locations to other high-risk localities to enhance HIV testing, treatment services and linkage to care to reduce ongoing transmission of HIV, HBV, HCV and TB and improve health outcomes.
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Affiliation(s)
- Cynthia Semá Baltazar
- Instituto Nacional de Saúde (INS), Maputo, Mozambique; Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | | | - Makini Boothe
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Anne Loarec
- Médecins Sans Frontières, Maputo, Mozambique
| | | | | | - Erika Fazito
- International Center Aids Program (ICAP), Maputo, Mozambique
| | - Henry F Raymond
- University of California, San Francisco (UCSF), USA; School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Marleen Temmerman
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of OBGYN, Aga Khan University, Nairobi, Kenya
| | - Stanley Luchters
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Population Health, Aga Khan University, Nairobi, Kenya; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Burnet Institute, Melbourne, Australia
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11
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Semá Baltazar C, Boothe M, Kellogg T, Ricardo P, Sathane I, Fazito E, Raymond HF, Temmerman M, Luchters S. Prevalence and risk factors associated with HIV/hepatitis B and HIV/hepatitis C co-infections among people who inject drugs in Mozambique. BMC Public Health 2020; 20:851. [PMID: 32493347 PMCID: PMC7271460 DOI: 10.1186/s12889-020-09012-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 05/29/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND There is scare information about HIV co-infections with hepatitis B virus (HBV) and/or hepatitis C virus (HCV) among People Who Inject Drugs (PWID) in Mozambique. This information is critical to ensure the treatment necessary to decrease the progression of liver disease and the transmission of both HIV and hepatitis. We assess the prevalence of HIV, HBV and HCV co-infections as well as associated risk factors among PWID. METHODS The first Bio-Behavioral Surveillance Survey was conducted in 2013-2014 among persons who self-reported to have ever injected drugs. Using respondent-driven sampling, PWID aged 18 years and older were recruited in two cross-sectional samples in Maputo and Nampula/Nacala, two large urban centers of Mozambique. Rapid screening of HIV, HBV (HBsAg) and HCV was performed on site. Data from participants in both cities were pooled to conduct RDS-weighted bivariate analyses with HIV/HBV and HIV/HCV co-infections as separate outcomes. Unweighted bivariate and multivariate logistic regression analyses were conducted to assess correlates of co-infection. RESULTS Among 492 eligible PWID, 93.3% were male and median age was 32 years [IQR: 27-36]. HIV, HBV and HCV prevalence were respectively 44.9% (95% CI:37.6-52.3), 32.8% (95% CI:26.3-39.5) and 38.3 (95% CI:30.6-45.9). Co-infections of HIV/HBV, HIV/HCV and HIV/HBV/HCV were identified in 13.1% (95% CI:7.2-18.9), 29.5% (95% CI:22.2-36.8) and 9.2% (95% CI:3.7-14.7) of PWID, respectively. Older age, history of needle/syringe sharing and history of injection with used needle/syringe was associated with HIV/HBV co-infection. Living in Maputo city, have older age, history of needle/syringe sharing and history of injection with used needle/syringe was associated with HIV/HCV co-infection. CONCLUSION There is a high burden of HBV and HCV among HIV-infected PWID in Mozambique. Our results highlight the need for targeted harm reduction interventions that include needle exchange programs and integrated services for the diagnosis and treatment of HIV, HBV and HCV to address these epidemics among PWID. Efforts should be made to strengthen ART coverage in the population as an important treatment strategy for both viruses.
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Affiliation(s)
- Cynthia Semá Baltazar
- Instituto Nacional de Saúde (INS), Maputo, Mozambique.
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Makini Boothe
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- University of California, San Francisco, USA
| | | | | | - Isabel Sathane
- National Program to Control STIs and HIV/AIDS, Ministry of Health, Maputo, Mozambique
| | - Erika Fazito
- International Center Aids Program (ICAP), Maputo, Mozambique
| | - Henry F Raymond
- University of California, San Francisco, USA
- School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Marleen Temmerman
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of OBGYN, Aga Khan University, Nairobi, Kenya
| | - Stanley Luchters
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Population Health, Aga Khan University, Nairobi, Kenya
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Burnet Institute, Melbourne, Australia
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12
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Rashti R, Sharafi H, Alavian SM, Moradi Y, Mohamadi Bolbanabad A, Moradi G. Systematic Review and Meta-Analysis of Global Prevalence of HBsAg and HIV and HCV Antibodies among People Who Inject Drugs and Female Sex Workers. Pathogens 2020; 9:pathogens9060432. [PMID: 32486342 PMCID: PMC7350380 DOI: 10.3390/pathogens9060432] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 05/01/2020] [Accepted: 05/29/2020] [Indexed: 02/06/2023] Open
Abstract
The main objective of this study was to evaluate the prevalence of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), hepatitis C virus (HCV) and hepatitis B virus (HBV) and their co-infections among people who inject drugs (PWID) and female sex workers (FSWs). Data sources were searched from January 2008 to October 2018 in different databases. Data were analyzed in Stata 16 software using the Metaprop command. The results showed that the prevalence of HIV, HCV and HBV among PWID was 15%, 60% and 6%, respectively. The prevalence of HIV, HCV and HBV among FSWs was 5%, 1% and 3%, respectively. The prevalence of HIV/HCV, HIV/HBV, HCV/HBV and HIV/HCV/HBV co-infections among PWID was 13%, 2%, 3% and 2%, respectively. The prevalence of HIV/HCV and HIV/HBV co-infections among FSWs was 3% and 1%, respectively. The results show that the prevalence of HCV and HIV infections in PWID and the prevalence of HIV in FSWs is higher than their prevalence in the general population. Interventions for the prevention of HIV and HCV in PWID appear to be poor, and may not be sufficient to effectively prevent HIV and HCV transmission.
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Affiliation(s)
- Roya Rashti
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj 6617713446, Iran; (R.R.); (A.M.B.)
| | - Heidar Sharafi
- Middle East Liver Diseases Center, Tehran 1598976513, Iran;
| | - Seyed Moayed Alavian
- Professor of Gastroenterology and Hepatology, Middle East Liver Disease Center, Tehran 1598976513, Iran;
| | - Yousef Moradi
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran 1449614535, Iran;
| | - Amjad Mohamadi Bolbanabad
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj 6617713446, Iran; (R.R.); (A.M.B.)
| | - Ghobad Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj 6617713446, Iran; (R.R.); (A.M.B.)
- Correspondence:
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13
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Semá Baltazar C, Horth R, Boothe M, Sathane I, Young P, Chitsondzo Langa D, Condula M, Ricardo H, Dengo Baloi L, Cummings B, Schaad N, Gouveia L, Teodoro E, Raymond HF. High prevalence of HIV, HBsAg and anti-HCV positivity among people who injected drugs: results of the first bio-behavioral survey using respondent-driven sampling in two urban areas in Mozambique. BMC Infect Dis 2019; 19:1022. [PMID: 31791273 PMCID: PMC6889180 DOI: 10.1186/s12879-019-4655-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/22/2019] [Indexed: 12/14/2022] Open
Abstract
Background Few countries in sub-Saharan Africa know the magnitude of their HIV epidemic among people who inject drugs (PWID). This was the first study in Mozambique to measure prevalence of HIV, HBV, and HCV, and to assess demographic characteristics and risk behaviors in this key population. Methods We used respondent-driven sampling (RDS) to conduct a cross-sectional behavioral surveillance survey of PWID in two cities of Mozambique lasting six months. Participants were persons who had ever injected drugs without a prescription. Participants completed a behavioral questionnaire and provided blood specimens for HIV, hepatitis B surface antigen (HBsAg) and hepatitis C virus antibody (anti-HCV) testing. We performed RDS-adjusted analysis in R 3.2 using RDSAT 7.1 weights. Results We enrolled 353 PWID in Maputo and 139 in Nampula/Nacala; approximately 95% of participants were men. Disease prevalence in Maputo and Nampula/Nacala, respectively, was 50.1 and 19.9% for HIV, 32.1 and 36.4% for HBsAg positivity, and 44.6 and 7.0% for anti-HCV positivity. Additionally, 8% (Maputo) and 28.6% (Nampula/Nacala) of PWID reported having a genital sore or ulcer in the 12 months preceding the survey. Among PWID who injected drugs in the last month, 50.3% (Maputo) and 49.6% (Nampula/Nacala) shared a needle at least once that month. Condomless sex in the last 12 months was reported by 52.4% of PWID in Maputo and 29.1% in Nampula/Nacala. Among PWID, 31.6% (Maputo) and 41.0% (Nampula/Nacala) had never tested for HIV. In multivariable analysis, PWID who used heroin had 4.3 (Maputo; 95% confidence interval [CI]: 1.2, 18.2) and 2.3 (Nampula/Nacala; 95% CI: 1.2, 4.9) greater odds of having HIV. Conclusion Unsafe sexual behaviors and injection practices are frequent among PWID in Mozambique, and likely contribute to the disproportionate burden of disease we found. Intensified efforts in prevention, care, and treatment specific for PWID have the potential to limit disease transmission.
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Affiliation(s)
- Cynthia Semá Baltazar
- National Institute of Health, P.O. Box 264, Maputo, Mozambique. .,Ghent University, Faculty of Medicine and Health Sciences, Ghent, Belgium.
| | - Roberta Horth
- University of California, San Francisco, California, USA
| | - Makini Boothe
- Ghent University, Faculty of Medicine and Health Sciences, Ghent, Belgium.,University of California, San Francisco, California, USA
| | - Isabel Sathane
- University of California, Global Programs for Research and Training, Maputo, Mozambique
| | - Peter Young
- Centers for Disease Control and Prevention, Nairobi, Kenya
| | | | - Manuel Condula
- Rede Nacional Contra a Droga (UNIDOS), Maputo, Mozambique
| | - Helena Ricardo
- National Institute of Health, P.O. Box 264, Maputo, Mozambique
| | | | - Beverley Cummings
- Substance Abuse and Mental Health Services Administration, Pretoria, South Africa
| | - Nicolas Schaad
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lídia Gouveia
- Department of Mental Health, National Public Health Directorate, Ministry of Health, Maputo, Mozambique
| | - Eugénia Teodoro
- Department of Mental Health, National Public Health Directorate, Ministry of Health, Maputo, Mozambique
| | - Henry F Raymond
- University of California, San Francisco, California, USA.,School of Public Health, Rutgers University, Piscataway, NJ, USA
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Baluku M, Wamala T, Muhangi D. HIV- and hepatitis C-related risk behaviors among people who inject drugs in Uganda: implications for policy and programming. Harm Reduct J 2019; 16:56. [PMID: 31481086 PMCID: PMC6724292 DOI: 10.1186/s12954-019-0324-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/21/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND There is a dearth of evidence on injecting drug use and associated HIV and hepatitis C virus (HCV) infections in Uganda. As such, policy and programming for people who inject drugs (PWID) is limited due to scarcity of epidemiological data. We therefore conducted this study to assess the injecting drug and sexual practices among PWID in Kampala Capital City and Mbale Municipality. METHODS Using a rapid situation assessment framework, we conducted semi-structured interviews among 125 PWID (102 males and 23 females)-recruited through outreach and snowball sampling. We assessed their injecting drug and sexual practices. We also conducted 12 focus group discussions among PWID and 30 in-depth interviews among key informants. RESULTS A total of 125 PWID (81.6% males and 18.4% females) were recruited into the study. Approximately three quarters of PWID started injecting before the age of 25. More females (21.7%) compared to males (13.7%) started injecting by the age of 17. Fifty-seven percent of the PWID in Kampala and 50% in Mbale shared injecting equipment in the last 3 months prior to the study. There was an emerging practice of mixing drugs with blood and sharing it among different PWID as a sign of oneness. Heroin was being injected by 72% of the participants. Less than one half of the PWID had used a condom during the last casual sex, and 42.7% did not use a condom the last time they engaged in sex work. Seventy-six percent of the PWID had undertaken an HIV test in the last 12 months, and 9.2% self-reported to be HIV positive. CONCLUSIONS This study highlights the need for introducing harm reduction policies and services including increased access to sterile injecting equipment and education around safer injecting and sexual practices. Programs for PWID should also address the specific needs of female sex workers who inject drugs.
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Affiliation(s)
- Matayo Baluku
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Denis Muhangi
- School of Social Sciences, Makerere University, Kampala, Uganda
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15
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Role of boyfriends and intimate sexual partners in the initiation and maintenance of injecting drug use among women in coastal Kenya. Addict Behav 2019; 93:20-28. [PMID: 30682678 DOI: 10.1016/j.addbeh.2019.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 01/07/2019] [Accepted: 01/14/2019] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Gender dynamics and interpersonal relations within intimate partnerships are known to determine health behaviors, including substance use, within couples. In addition, influence from intimate partners may occur in the context of wider social ecological determinants of health behavior. The aim of this study was to document the role of intimate partners in influencing injecting drug use among women in Kenya, where injecting drug use is on the rise. METHODS We performed secondary data analysis of an existing dataset from a 2015 qualitative study involving 45 women who inject drugs and 5 key stakeholders in coastal Kenya. Primary data had been collected via a combination of in-depth interviews and focus group discussions exploring sexual, reproductive, drug use, and other social contexts of women who inject drugs. The process by which intimate partners influenced women's initiation of drug use, transition to injecting practices, and maintenance of injecting drug use were identified using thematic analysis. RESULTS Boyfriends and intimate either facilitated or restrained women's drug-injecting. On the one hand, young women's entry into drug use was prompted by relationship problems, or a need to acquiesce with their drug-using boyfriends. Once women started injecting, intimate partners facilitated ongoing drug-injecting by financing the acquisition of drugs, peddling drugs to their women, or sharing their drugs with their women. The social capital that peddlers held insulated women from police arrests, and encouraged women to seek and sustain intimate relations with well-connected peddlers. Men's influences over women were driven by an underlying patriarchal drug acquisition and economic power. On the other hand, boyfriends and intimate partners who were non-injectors or non-drug users sought to moderate women's injecting drug use by encouraging them to inject less, to smoke or snort instead of injecting, or to enroll into rehabilitation. These moderating influences were most prominent when couples were pregnant. Despite men being a source of practical and emotional support, women were frequently unable limit or alter their injecting drug use, due to its addictive nature. Men's disagreement with women's ongoing injecting strained relationships, and occasionally led to separation. CONCLUSIONS Some boyfriends facilitated women's injecting drug use, while others moderated it, supporting assertions that intimate relationships can both be a site of injecting risks or protection. At the micro-level, these findings highlight an opportunity for couple-based interventions, leveraging on non-drug injecting males as a resource to support women adopt safer injecting practices. At a macro level, incorporating livelihood interventions into harm reduction programs is required in order to mitigate economic-based influence of male intimate partners on women's injecting drug use. At both levels, gender transformative approaches are essential. To gain a comprehensive understanding of women's injecting drug use, future studies drug use should explore women's contexts beyond micro influences and consider their wider macro-structural determinants.
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Mwangi C, Karanja S, Gachohi J, Wanjihia V, Ngang'a Z. Depression, injecting drug use, and risky sexual behavior syndemic among women who inject drugs in Kenya: a cross-sectional survey. Harm Reduct J 2019; 16:35. [PMID: 31146748 PMCID: PMC6543607 DOI: 10.1186/s12954-019-0307-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 05/16/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Injecting drug use (IDU) is a key driver of the HIV epidemic particularly when individuals experience psychosocial conditions and risky sexual behavior in a syndemic manner. This study sets out to assess evidence of a syndemic pattern of psychosocial conditions (IDU, depression, intimate partner violence (IPV)) on one the hand and risky sexual behavior on the other while accounting for the socio-economic disadvantage among women who inject drugs (WWID) in low-income urban settings in Kenya. METHODS Using a cross-sectional study design, this study recruited 306 WWIDs from two sites in Nairobi between January 2017 and July 2017. Multiple methodologies including descriptive analyses of co-occurrences of psychosocial conditions at the individual level, standard logistic regression analyses to examine relationships and interactions within and between psychosocial conditions and risky sexual behavior, and classification trees algorithm for predictive modeling via machine learning were employed. RESULTS The prevalence of the psychosocial conditions was as follows: IDU, 88%; depression, 77.1%; and IPV, 84%. The prevalence of risky sexual behavior was 69.3%. IDU and depression were related to each other (P < 0.05) and each of them with risky sexual behavior (P < 0.05). The highest 2-way and 3-way co-occurrence of conditions were reported in IDU and depression (72%) and in IDU, depression, and risky sexual behavior (62%), respectively, indicating clustering of the conditions at the individual level. Further, each additional psychosocial condition (IDU and depression) was associated with sixfold odds (P = 0.000) of having risky sexual behavior suggesting a dose-response relationship. Logistic regression analyses incorporating multiplicative interactive effects returned three significant variables (P < 0.05): IDU*depression interaction effect, "Age when delivered the first child," and "Income." Classification tree modeling represented a 5-level interaction analysis with IDU and depression predicted to have the highest influence on risky sexual behavior. CONCLUSION Findings provide possible evidence of a syndemic pattern involving IDU, depression, and risky sexual behavior suggesting the need for an integrated approach to the implementation of harm reduction interventions among WWID in low-income urban settings in Kenya. This work highlights the need for further studies to authenticate the findings and to characterize pathways in the syndemic development in WWID.
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Affiliation(s)
- Catherine Mwangi
- School of Public Health, Jomo Kenyatta University of Agriculture & Technology, Juja, Kenya.,Partners for Health and Development in Africa, Nairobi, Kenya
| | - Simon Karanja
- School of Public Health, Jomo Kenyatta University of Agriculture & Technology, Juja, Kenya
| | - John Gachohi
- School of Public Health, Jomo Kenyatta University of Agriculture & Technology, Juja, Kenya. .,Washington State University - Global Health, Nairobi, Kenya.
| | - Violet Wanjihia
- Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
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Ayon S, Jeneby F, Hamid F, Badhrus A, Abdulrahman T, Mburu G. Developing integrated community-based HIV prevention, harm reduction, and sexual and reproductive health services for women who inject drugs. Reprod Health 2019; 16:59. [PMID: 31138238 PMCID: PMC6538559 DOI: 10.1186/s12978-019-0711-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite being a priority population for HIV prevention and harm reduction programs, the sexual and reproductive health (SRH) needs of women who inject drugs are being overlooked. Furthermore, models for providing integrated SRH, HIV, and harm reduction services for women who inject drugs are rare. This article reports the development of community-based outreach services that integrated family planning and other SRH interventions with HIV and harm reduction services for this population in coastal Kenya. METHODS Using mixed-methods implementation research, a qualitative baseline needs assessment was conducted with women who inject drugs and harm reduction stakeholders using a combination of in-depth interviews and focus group discussions. The qualitative data from participants was subjected to thematic analysis using Nvivo. Based on the baseline needs assessment, integration of SRH into existing HIV and harm reduction services was implemented. After two years of implementation, an evaluation of the program was conducted using a combination of qualitative interviews and review of quantitative service delivery records and other program documents. The process, impacts, and challenges of integrating SRH into a community-based HIV prevention and harm reduction program were identified. RESULTS This article highlights: 1) low baseline utilization of family planning services among women who inject drugs, 2) improved utilization and high acceptability of outreach-based provision of SRH services including contraception among this population, 3) importance of training, capacity strengthening, technical support and financial resourcing of community-based organizations to integrate SRH into HIV prevention and harm reduction services, and 4) the value of beneficiary involvement, advocacy, and collaboration with other partners in the planning, designing and implementing of SRH interventions for women who inject drugs. CONCLUSIONS Women who inject drugs in this study had low utilization of family planning and other SRH services, which can be improved through the integration of contraceptive and other SRH interventions into existing outreach-based HIV prevention and harm reduction programs. This integration is acceptable to women who inject drugs, and is programmatically feasible. For successful integration, a rights-based beneficiary involvement, coupled with sustainable technical and financial capacity strengthening at the community level is essential.
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Affiliation(s)
| | - Fatma Jeneby
- Muslim Education and Welfare Association, Mombasa, Kenya
| | | | | | | | - Gitau Mburu
- Division of Health Research, University of Lancaster, Lancaster, LA1 4YW, UK. .,Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
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Guise A, Ndimbii J, Igonya EK, Owiti F, Strathdee SA, Rhodes T. Integrated and differentiated methadone and HIV care for people who use drugs: a qualitative study in Kenya with implications for implementation science. Health Policy Plan 2019; 34:110-119. [PMID: 30789208 PMCID: PMC6481284 DOI: 10.1093/heapol/czz002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2019] [Indexed: 11/13/2022] Open
Abstract
Integrating methadone and HIV care is a priority in many low- and middle-income settings experiencing a growing challenge of HIV epidemics linked to injecting drug use. There is as yet little understanding of how to integrate methadone and HIV care in these settings and how such services can be implemented; such a gap reflects, in part, limitations in theorizing an implementation science of integrated care. In response, we qualitatively explored the delivery of methadone after its introduction in Kenya to understand integration with HIV care. Semi-structured interviews with people using methadone (n = 30) were supplemented by stakeholder interviews (n = 2) and participant observation in one city. Thematic analysis was used, that also drew on Mol's logic of care as an analytical framework. Respondents described methadone clinic-based care embedded in community support systems. Daily observed clinic care was challenging for methadone and stigmatizing for HIV treatment. In response to these challenges, integration evolved and HIV care differentiated to other sites. The resulting care system was acceptable to respondents and allowed for choice over locations and approaches to HIV care. Using Mol's logic of care as an analytical framework, we explore what led to this differentiation in integrated care. We explore co-production and experimentation around HIV care that compares with more limited experimentation for methadone. This experimentation is bounded by available discourses and materials. The study supports continued integration of services whilst allowing for differentiation of these models to adapt to client preferences. Co-location of integrated services must prioritize clinic organization that prevents HIV status disclosure. Our analysis fosters a material perspective for theory of implementation science and integration of services that focuses attention on local experimentation shaped by context.
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Affiliation(s)
- Andy Guise
- Department of Medicine, University of California San Diego, San Diego, 9500 Gilman Drive, La Jolla, CA, USA
- School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - James Ndimbii
- Kenya AIDS NGOs Consortium, Regent Management Suites, Argwings Kodhek Road, Nairobi, Kenya
| | - Emmy Kageha Igonya
- School of Medicine, University of Nairobi, Kenyatta National Hospital, Nairobi, Kenya
| | - Frederick Owiti
- School of Medicine, University of Nairobi, Kenyatta National Hospital, Nairobi, Kenya
| | - Steffanie A Strathdee
- Department of Medicine, University of California San Diego, San Diego, 9500 Gilman Drive, La Jolla, CA, USA
| | - Tim Rhodes
- Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, UK
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Mburu G, Limmer M, Holland P. HIV risk behaviours among women who inject drugs in coastal Kenya: findings from secondary analysis of qualitative data. Harm Reduct J 2019; 16:10. [PMID: 30728012 PMCID: PMC6364406 DOI: 10.1186/s12954-019-0281-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 01/18/2019] [Indexed: 01/21/2023] Open
Abstract
Background Injecting drug users are at high risk of HIV infection globally. Research related to female drug users is rare in Kenya, yet it is required to inform the development of gender-sensitive HIV prevention and harm reduction services in East Africa, where injecting drug use is on the rise. Methods This study aimed to document the nature of HIV risks encountered by women who inject drugs in the Mombasa and Kilifi, Kenya. Secondary data analysis was conducted on an existing dataset from a 2015 primary qualitative study involving 24 interviews and 3 focus group discussions with 45 women who inject drugs. These were complemented with five interviews with key stakeholders involved in the provision of services to women who inject drugs. Guided by the social ecology theory, a thematic analysis was conducted to identify the nature of HIV risks and their underlying determinants. Results HIV risk behaviours fell into two broad categories: unsafe injecting and unprotected sex. These risks occurred in the form of sharing of needles, unprotected oral, anal, and vaginal sex, sexual assaults, injecting drug use during sex, sex work, and other types of transactional sex. The primary determinants underlying these risks were a low-risk perception, inequitable gender power, economic pressures, and poor availability of needles and condoms. These social-ecological determinants did not exist in isolation, but intersected with each other to create powerful influences which exposed women to HIV. Social-ecological determinants exerted constant influence and created a persistent ‘HIV risk environment’ that was involuntarily experienced by women. Conclusion Individual, interpersonal, and societal-structural factors intersect to produce HIV risk behaviours. As a minimum, these risks will require a combination of multifaceted micro-level interventions including self-efficacy training, risk assessment skills, couple counselling, and universal access to the recommended harm reduction package. In addition, the current focus on micro-level interventions in Kenya needs to shift to incorporate macro-level interventions, including livelihood, employability, and gender norms-transforming interventions, to mitigate economic and gender-related drivers of HIV risks. In the Kenyan context, injecting drug use during sex work is emerging as an increasingly important HIV risk behaviour needing to be addressed.
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Affiliation(s)
- Gitau Mburu
- Division of Health Research, University of Lancaster, Lancaster, LA1 4YW, UK.
| | - Mark Limmer
- Division of Health Research, University of Lancaster, Lancaster, LA1 4YW, UK
| | - Paula Holland
- Division of Health Research, University of Lancaster, Lancaster, LA1 4YW, UK
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Sharma V, Tun W, Sarna A, Saraswati LR, Pham MD, Thior I, Luchters S. Prevalence and determinants of unprotected sex in intimate partnerships of men who inject drugs: findings from a prospective intervention study. Int J STD AIDS 2018; 30:386-395. [PMID: 30541403 PMCID: PMC6446434 DOI: 10.1177/0956462418802142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Unprotected sex, common among people who inject drugs, puts them and their partners at risk of sexually transmitted infections including human immunodeficiency virus (HIV). This analysis assesses the changes in sexual risk behavior with regular female partners (RFPs), among married men who inject drugs, before and after implementation of a HIV prevention intervention, and identifies correlates of unprotected sex. People who inject drugs (PWID) were assessed at three points: baseline, preintervention follow-up visit (FV)1, and postintervention FV2. Descriptive analysis was used for reporting changes in sexual behavior over time. Generalized estimating equation assessed the population-averaged change in self-reported unprotected sex with an RFP, attributable to intervention uptake. Multivariable logistic regression determined correlates of self-reported unprotected sex with an RFP at FV2. Findings suggest that the proportion of men reporting any unprotected sex remained high (baseline = 46.0%, FV1 = 43.5%, FV2 = 37.0%). A reduction was observed in unprotected sex after the intervention phase, but this could not be attributed to uptake of the intervention. Higher odds of self-reported unprotected sex with an RFP in the past three months at FV2 were associated with self-reported unprotected sex at baseline, living with family, and being HIV-negative. Married male PWID should receive counseling for safe sex with RFPs, especially those who are HIV-negative and live with their families.
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Affiliation(s)
- Vartika Sharma
- 1 Department of Obstetrics and Gynaecology, International Centre for Reproductive Health, Ghent University, Ghent, Belgium.,2 Ex-Population Council, Delhi, India
| | - Waimar Tun
- 3 Population Council, Washington, DC, USA
| | | | | | | | | | - Stanley Luchters
- 1 Department of Obstetrics and Gynaecology, International Centre for Reproductive Health, Ghent University, Ghent, Belgium.,5 Burnet Institute, Melbourne, Australia.,7 School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Cheng W, Xu H, Zhong F, Pan S, Tucker JD, Weir S, Zhao J, Tang W. Can HIV service data be used for surveillance purposes?: a case study in Guangzhou, China. BMC Public Health 2018; 18:1268. [PMID: 30453934 PMCID: PMC6245699 DOI: 10.1186/s12889-018-6128-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 10/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Timely monitoring HIV epidemic among key populations is a formidable challenge. This study aimed to evaluate the agreement between data collected from an enhanced HIV sentinel surveillance (HSS+) and an HIV service, and to discuss whether testing service data can be used for surveillance purposes. METHODS The HSS+ data were collected from HIV sentinel surveillance conducted annually among men who have sex with men (MSM) between 2009 and 2013 in Guangzhou, China. The HIV service data were obtained from the China-Bill & Melinda Gates Foundation Cooperation Program on HIV Prevention and Care (China-Gates HIV Program) in Guangzhou during the same period. The China-Gates HIV Program aimed to increase HIV counseling and testing among MSM. We compared demographic characteristics, condom use, HIV testing history, and the HIV status among individuals in these two datasets. The Armitage-trend test was used to evaluate the HIV epidemic and behaviors of the participants in the two datasets over the study period. RESULTS Overall, a total of 2224 and 5311 MSM were included in the surveillance and service datasets, respectively. The majority of participants in the two datasets were between 20 and 29 years old, at least attended college, and had never been married. However, socio-demographic characteristics varied slightly between the two datasets. Similar trends were observed for the HIV epidemic in these two datasets. The surveillance dataset indicated that HIV prevalence increased from 3.9% in 2009 to 11.4% in 2013 (P-value for trend < 0.001), while data from the HIV service dataset indicated that MSM HIV prevalence during this same period increased from 6.2 to 8.9% (P-value for trend = 0.025). The rates of condom use were similar between the two datasets and remained consistent throughout the study period. CONCLUSION HIV service data can complement existing HIV surveillance systems for MSM in China, though it may underestimate the HIV prevalence (HSS+ data contains people whose status is already know, while service data contains people who were initially negative or people of unknown status). HIV service data can be used for surveillance purposes, when prerequisite variables are collected from a large number people, if the quality assessment is conducted.
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Affiliation(s)
- Weibin Cheng
- Dermatology Hospital of Southern Medical University, Guangzhou, China.,Department of AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Huifang Xu
- Department of AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Fei Zhong
- Department of AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Stephen Pan
- University of North Carolina Project-China, No. 2 Lujing Road, Guangzhou, China
| | - Joseph D Tucker
- University of North Carolina Project-China, No. 2 Lujing Road, Guangzhou, China
| | - Sharon Weir
- School of Medicine of University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jinkou Zhao
- Technical Advice and Partnership Department, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Chemin de Blandonnet 8, CH 1214, Geneva, Switzerland.
| | - Weiming Tang
- Dermatology Hospital of Southern Medical University, Guangzhou, China. .,University of North Carolina Project-China, No. 2 Lujing Road, Guangzhou, China.
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Abstract
Purpose of review Opioid use disorder (OUD) is a global phenomenon and is on the rise in Africa, denoting a shift from historical patterns of drug transport to internal consumption. In contrast, opioids for clinical pain management in Africa remain among the least available globally. This region also has the highest HIV and HCV disease burden, and the greatest shortages of health workers and addiction treatment. We undertook a systematic review of the literature to describe opioid use in Africa and how it is being addressed. Recent findings A total of 84 articles from 2000 to 2018 were identified. Descriptions of country-specific populations and patterns of opioid misuse were common. A smaller number of articles described interventions to address OUD. Summary OUD occurs in sub-Saharan Africa, with attendant clinical and social costs. Evidence-based policies and health system resources are needed to promote OUD prevention and management, and infectious disease transmission reduction.
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Demissie M, Johnston LG, Muleta M, Desyebelew D, Belete W, G/Egxiabehre A, Gezahegn N, Kassa D, Aseffa Y. Prevalence of HIV and other infections and injection behaviours among people who inject drugs in Addis Ababa, Ethiopia. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2018; 17:259-264. [PMID: 30319040 DOI: 10.2989/16085906.2018.1511604] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Ethiopia is one of the sub-Saharan African countries most affected by HIV/AIDS. However, the country lacks data describing the extent of the epidemic among people who inject drugs (PWID). Thus, a bio-behavioural study was conducted in 2015 to generate strategic information on the magnitude of HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis and related risk behaviours among PWID in Addis Ababa. METHODS A cross-sectional study using respondent-driven sampling was conducted among people reported to have injected illicit drugs within 6 months before the study. Males and females aged 15 years or above and who were resident in Addis Ababa were included in the study between 26 March and 22 May 2015. Data was analysed using respondent-driven (RDS) Analyst software. RESULTS A total of 237 participants, including 6 seeds, enrolled in the study; most of the PWID were males (96%) with a mean age of 26 years. Most (79%) of the PWID reported injecting heroin but also reported using non-injecting drugs, including marijuana or ganja (47%) and/or khat (31%). Forty per cent of PWID reported ever sharing needles and 56% reported sharing other injecting equipment. However, only 14% reported injecting daily, and 49% reported injecting only 1 to 3 times a month. HIV prevalence was 6%, HBV was 5.1%, HCV was 2.9% and syphilis 5.1% among PWID. Among HIV-positive PWID, 60% reported sharing a needle the last time they injected. CONCLUSION Even though the prevalence of HIV among drug users is not much higher than in the general population in Addis Ababa, the needle sharing prevalence was high. Thus, this baseline study shows the need to establish harm reduction programmes and prevention strategies for the PWID in Addis Ababa.
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Affiliation(s)
| | - Lisa G Johnston
- b United Nations Office on Drug and Crime , Washington , DC , USA
| | - Mekonnen Muleta
- b United Nations Office on Drug and Crime , Washington , DC , USA
| | - Dires Desyebelew
- b United Nations Office on Drug and Crime , Washington , DC , USA
| | - Wudinesh Belete
- a Ethiopian Public Health Institute , Addis Ababa , Ethiopia
| | | | | | - Desta Kassa
- a Ethiopian Public Health Institute , Addis Ababa , Ethiopia
| | - Yibeltal Aseffa
- a Ethiopian Public Health Institute , Addis Ababa , Ethiopia
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Kavanagh MM, Baral SD, Milanga M, Sugarman J. Biometrics and public health surveillance in criminalised and key populations: policy, ethics, and human rights considerations. Lancet HIV 2018; 6:S2352-3018(18)30243-1. [PMID: 30305236 DOI: 10.1016/s2352-3018(18)30243-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/22/2018] [Accepted: 08/28/2018] [Indexed: 01/04/2023]
Abstract
Widespread public health surveillance efforts focused on key populations (men who have sex with men, sex workers, people who inject drugs, and others) gather data on population sizes, HIV prevalence, and other information for planning and resource allocation. Biometric identification might improve this data gathering. However, in the context of extensive criminalisation of these populations, the use of biometrics such as fingerprints raises concerns that are insufficiently addressed in current policies. These concerns include infringing privacy, exposing participants to risks of legal action or violence, biasing surveillance results, and undermining trust in the health system. We set out key ethics and human rights considerations regarding the use of biometrics in HIV surveillance among these populations, and outline a typology of jurisdictions wherein such methods might be considered, based on data about legal, political, and social environments. In this Review, we suggest that the biometrics approach is not currently likely to be appropriate in many jurisdictions.
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Affiliation(s)
- Matthew M Kavanagh
- O'Neill Institute of National & Global Health Law, Georgetown University, Washington, DC, USA.
| | - Stefan D Baral
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | | | - Jeremy Sugarman
- Berman Institute of Bioethics and Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Mburu G, Ayon S, Tsai AC, Ndimbii J, Wang B, Strathdee S, Seeley J. "Who has ever loved a drug addict? It's a lie. They think a 'teja' is as bad person": multiple stigmas faced by women who inject drugs in coastal Kenya. Harm Reduct J 2018; 15:29. [PMID: 29801494 PMCID: PMC5970466 DOI: 10.1186/s12954-018-0235-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 05/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A tenth of all people who inject drugs in Kenya are women, yet their social contexts and experiences remain poorly understood. This paper reports how multiple forms of stigma are experienced by women who inject drugs in coastal Kenya and the impact that they have on their ability to access essential health services. METHODS In 2015, in-depth interviews and focus group discussions were held with 45 women who inject drugs in two coastal towns. These data were supplemented with in-depth interviews with five individual stakeholders involved in service provision to this population. Data were analyzed thematically using NVivo. RESULTS Women who inject drugs experience multiple stigmas, often simultaneously. These included the external stigma and self-stigma of injection drug use, external gender-related stigma of being a female injecting drug user, and the external stigma of being HIV positive (i.e., among those living with HIV). Stigma led to rejection, social exclusion, low self-esteem, and delay or denial of services at health facilities. CONCLUSION HIV and harm reduction programs should incorporate interventions that address different forms of stigma among women who inject drugs in coastal Kenya. Addressing stigma will require a combination of individual, social, and structural interventions, such as collective empowerment of injecting drug users, training of healthcare providers on issues and needs of women who inject drugs, peer accompaniment to health facilities, addressing wider social determinants of stigma and discrimination, and expansion of harm reduction interventions to change perceptions of communities towards women who inject drugs.
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Affiliation(s)
- Gitau Mburu
- Division of Health Research, Lancaster University, Lancaster, UK.
| | | | - Alexander C Tsai
- Chester M. Pierce, MD Division of Global Psychiatry, The Massachusetts General Hospital, Boston, USA
| | | | | | - Steffanie Strathdee
- Division of Global Public Health, University of California San Diego School of Medicine, San Diego, USA
| | - Janet Seeley
- Department of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Oyaro M, Wylie J, Chen CY, Ondondo RO, Kramvis A. Human immunodeficiency virus infection predictors and genetic diversity of hepatitis B virus and hepatitis C virus co-infections among drug users in three major Kenyan cities. South Afr J HIV Med 2018; 19:737. [PMID: 29707384 PMCID: PMC5913779 DOI: 10.4102/sajhivmed.v19i1.737] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 10/02/2017] [Indexed: 12/28/2022] Open
Abstract
Background Drug users act as reservoirs and transmission channels for hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections to the general population worldwide. Periodic epidemiological studies to monitor the prevalence and genetic diversity of these infections to inform on interventions are limited. Objective of the study The objective of this study was to determine the predictors of HIV infection and genetic diversity of HBV and HCV among drug users in Kenya. Materials and methods A cross-sectional study on previous drug use history among drug users was conducted in three Kenyan cities using a respondent-driven sampling method between January 2011 and September 2012. Blood samples were collected and analysed for the presence of HBV, HCV and HIV serological markers and to determine the genotypes of HBV and HCV. Results The overall prevalence of HBV, HCV and HIV among drug users was 4.3%, 6.5% and 11.1%, respectively, with evidence of HBV/HIV, HCV/HIV and HBV/HCV/HIV co-infections. The HBV circulating genotypes were A1 (69%) and D6 (19%), whereas HCV genotypes were 1a (72%) and 4a (22%). Injection drug use was a significant predictor of HIV/HCV infections. Younger age (30 years; aOR (adjusted odds ratio) = 0.50, 95% CI (confidence interval): 0.33–0.76; p < 0.001) and early sexual debut (aOR = 0.54, 95% CI: 0.40–0.82; p < 0.05) were negatively associated with detection of any of the three infections. Injecting drug use was positively associated with HCV infection (aOR = 5.37, 95% CI: 2.61–11.06; p < 0.001). Conclusion This high level of genetic diversity exhibited by HBV and HCV isolates requires urgent implementation of harm reduction strategies and continuous monitoring for effective management of the patients.
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Affiliation(s)
- Micah Oyaro
- Immunology Unit, Department of Human Pathology, University of Nairobi, Kenya
| | - John Wylie
- Department of Medical Microbiology, University of Manitoba, Canada
| | - Chien-Yu Chen
- Hepatitis Virus Diversity Research Unit (HVDRU), Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Raphael O Ondondo
- Department of Medical Laboratory Sciences, Masinde Muliro University of Science and Technology, Kenya.,Kenya Medical Research Institute, Centre for Microbiology Research, Nairobi, Kenya
| | - Anna Kramvis
- Hepatitis Virus Diversity Research Unit (HVDRU), Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
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Budambula V, Matoka C, Ouma J, Ahmed AA, Otieno MF, Were T. Socio-demographic and sexual practices associated with HIV infection in Kenyan injection and non-injection drug users. BMC Public Health 2018; 18:193. [PMID: 29378631 PMCID: PMC5789578 DOI: 10.1186/s12889-018-5100-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 01/18/2018] [Indexed: 11/19/2022] Open
Abstract
Background Substance use is increasingly becoming prevalent on the African continent, fueling the spread of HIV infection. Although socio-demographic factors influence substance consumption and risk of HIV infection, the association of these factors with HIV infection is poorly understood among substance users on the African continent. The objective of the study was to assess socio-demographic and sexual practices that are associated with HIV infection among injection drug users (IDUs), non-IDUs, and non-drug users (DUs) at an urban setting of coastal Kenya. Methods A cross-sectional descriptive study was conducted among 451 adults comprising HIV-infected and -uninfected IDUs (n = 157 and 39); non-IDUs (n = 17 and 48); and non-DUs (n = 55 and 135); respectively at coastal, Kenya. Respondent driven sampling, snowball and makeshift methods were used to enroll IDUs and non-IDUs. Convenience and purposive sampling were used to enroll non-DUs from the hospital’s voluntary HIV testing unit. Participant assisted questionnaire was used in collecting socio-demographic data and sexual practices. Results Binary logistic regression analysis indicated that higher likelihood of HIV infection was associated with sex for police protection (OR, 9.526; 95% CI, 1.156-78.528; P = 0.036) and history of sexually transmitted infection (OR, 5.117; 95% CI, 1.924-13.485; P = 0.001) in IDUs; divorced, separated or widowed marital status (OR, 6.315; 95% CI, 1.334-29.898; P = 0.020) in non-IDUs; and unemployment (OR, 2.724; 95% CI, 1.049-7.070; P = 0.040) in non-drug users. However, never married (single) marital status (OR, 0.140; 95% CI, 0.030-0.649; P = 0.012) was associated with lower odds for HIV infection in non-drug users. Conclusion Altogether, these results suggest that socio-demographic and sexual risk factors for HIV transmission differ with drug use status, suggesting targeted preventive measures for drug users.
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Affiliation(s)
- Valentine Budambula
- Department of Environment and Health Sciences, Technical University of Mombasa, P. O. Box 90420-80100, Mombasa, Kenya.
| | - Charles Matoka
- Department of Applied Sciences, Technical University of Mombasa, P. O. Box 90420-80100, Mombasa, Kenya
| | - James Ouma
- Department of Environmental Health, University of Kabianga, P. O. Box 2030-20200, Kericho, Kenya
| | | | - Michael F Otieno
- Department of Medical Laboratory Sciences, Kenyatta University, P. O. Box 43844-00100, Nairobi, Kenya
| | - Tom Were
- Department of Medical Laboratory Sciences, Masinde Muliro University of Science and Technology, P.O. Box 190-50100, Kakamega, Kenya.
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Ayon S, Ndimbii J, Jeneby F, Abdulrahman T, Mlewa O, Wang B, Ragi A, Mburu G. Barriers and facilitators of access to HIV, harm reduction and sexual and reproductive health services by women who inject drugs: role of community-based outreach and drop-in centers. AIDS Care 2017; 30:480-487. [PMID: 29067855 DOI: 10.1080/09540121.2017.1394965] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
There is limited data regarding women who inject drugs, and how harm-reduction services can be made more women-centered. This study explored experiences of Kenyan women who inject drugs, with regard to access to HIV, harm reduction and sexual and reproductive health (SRH) services. A total of 45 women who inject drugs and 5 key stakeholders participated in-depth interviews and focus group discussions. Thematic analysis of the data revealed that stigma, long distances, lack of confidentiality, user fees, multiple appointments, drug users' unfamiliarity with health facilities, disconnect in communication with healthcare providers, and healthcare providers' lack of understanding of women's needs were factors that impede women's access to health services. Community-based services, comprising of outreach and drop-in centers mitigate these barriers by building trust, educating women on their health and rights, linking women to health facilities, sensitizing health providers on the needs of women who inject drugs, and integrating women's SRH services into community-based harm-reduction outreach. Inclusion of SRH services into community-based harm-reduction activities increased women's interest and access to harm-reduction interventions. These findings underscore the need to strengthen community-based programming for women who inject drugs, and to integrate SRH services into needle and syringe exchange programs.
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Affiliation(s)
- Sylvia Ayon
- a Kenya AIDS NGO Consortium , Nairobi , Kenya
| | | | - Fatma Jeneby
- b Muslim Education and Welfare Association , Mombasa , Kenya
| | | | | | | | - Allan Ragi
- a Kenya AIDS NGO Consortium , Nairobi , Kenya
| | - Gitau Mburu
- e Division of Health Research , University of Lancaster , UK
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Coleman RL, McLean S. Commentary: the value of PrEP for people who inject drugs. J Int AIDS Soc 2016; 19:21112. [PMID: 27760686 PMCID: PMC5071747 DOI: 10.7448/ias.19.7.21112] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 07/05/2016] [Accepted: 07/12/2016] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION The offer of pre-exposure prophylaxis (PrEP) is recommended as an additional option for HIV prevention for people at substantial risk of HIV infection as part of combination HIV prevention approaches. Implementing this depends on integrating PrEP in public health programmes that address risky practices with evidence-based interventions, and that operate in an enabling legal and policy environment for the delivery of health services to those at higher risk of HIV infection. What does this recommendation mean in terms of the diverse range of HIV prevention needs of key populations, some of whom are so discriminated against that they exist essentially outside formal systems such as national public health services, and for whom a substantial risk of HIV is part of a larger adverse and hostile situation? We discuss this question with reference to people who inject drugs, informed by concerns and comments that emerged from a series of consultations. DISCUSSION HIV prevention is part of a spectrum of injecting drug users' priorities, and their access and uptake of HIV prevention services is contingent on their wider "risk environment." The need to address structural barriers to services and human rights violations, and to improve access to comprehensive harm reduction programmes are of prime importance and would have higher value than a mono-focus on HIV prevention. Where existing harm reduction activities are inadequate, fragile or dependent on external donors, shifts in funding priorities, including, for example, towards PrEP, could threaten investment in the broader programmes. For these reasons, it cannot be assumed that PrEP promotion will always be supported by people who inject drugs.The sexual partners of people who inject drugs, non-opioid users who also inject and for whom there is no established substitution treatment, as well as drug users who are unable to negotiate safe sex may value PrEP. As for all key populations, the involvement of people who inject drugs in shaping services for their consumption is vital and too often ignored. CONCLUSIONS For people who inject drugs and who experience discrimination, violence or harassment, implementation of PrEP should be guided by understanding and engaging with their interconnected range of needs, risk practices, priorities and options. The differentiated needs of sub-populations that inject a range of drugs, and their sexual partners, require further exploration.
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Global implementation of PrEP as part of combination HIV prevention - Unsolved challenges. J Int AIDS Soc 2016. [DOI: 10.7448/ias.19.7.21479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Guise A, Rhodes T, Ndimbii J, Ayon S, Nnaji O. Access to HIV treatment and care for people who inject drugs in Kenya: a short report. AIDS Care 2016; 28:1595-1599. [PMID: 27267309 DOI: 10.1080/09540121.2016.1191606] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
People who inject drugs (PWID) experience a range of barriers to HIV treatment and care access. The Kenyan government and community-based organisations have sought to develop HIV care for PWID. A principal approach to delivery in Kenya is to provide care from clinics serving the general population and for this to be linked to support from community-based organisations providing harm reduction outreach. This study explores accounts of PWID accessing care in Kenya to identify care barriers and facilitators. PWID accounts were collected within a qualitative longitudinal study. In-depth interviews with PWID living with HIV (n = 44) are combined with interviews with other PWID, care providers and community observation. Results show that some PWID are able to access care successfully, whilst other PWID report challenges. The results focus on three principal themes to give insights into these experiences: the hardship of addiction and the costs of care, the silencing of HIV in the community and then discrimination and support in the clinic. Some PWID are able to overcome, often with social and outreach support, barriers to clinic access; for others, the challenges of addiction, hardship, stigma and discrimination are too constraining. We discuss how clinics serving the general population could be further adapted to increase access. Clinic-based care, even with community links, may, however, be fundamentally challenging for some PWID to access. Additional strategies to develop stand-alone care for PWID and also decentralise HIV treatment and care to community settings and involve peers in delivery should be considered.
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Affiliation(s)
- Andy Guise
- a Dept of Global Public Health , University of California San Diego , San Diego , CA , USA.,b Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine , London , UK
| | - Tim Rhodes
- b Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine , London , UK
| | - James Ndimbii
- c Community Action on Harm Reduction Project, Kenya AIDS NGOs Consortium , Nairobi , Kenya
| | - Sylvia Ayon
- c Community Action on Harm Reduction Project, Kenya AIDS NGOs Consortium , Nairobi , Kenya
| | - Obiora Nnaji
- d Mount Sinai Hospital Services, Elmhurst Hospital Centre , Elmhurst , NY , USA
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Okal J, Raymond HF, Tun W, Musyoki H, Dadabhai S, Broz D, Nyamu J, Kuria D, Muraguri N, Geibel S. Lessons learned from respondent-driven sampling recruitment in Nairobi: experiences from the field. BMC Res Notes 2016; 9:158. [PMID: 26969505 PMCID: PMC4788831 DOI: 10.1186/s13104-016-1965-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 02/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Respondent-driven sampling (RDS) is used in a variety of settings to study hard-to-reach populations at risk for HIV and sexually transmitted infections. However, practices leading to successful recruitment among diverse populations in low-resource settings are seldom reported. We implemented the first, integrated, bio-behavioural surveillance survey among men who have sex with men, female sex workers and people who injected drugs in Nairobi, Kenya. METHODS The survey period was June 2010 to March 2011, with a target sample size of 600 participants per key populations. Formative research was initially conducted to assess feasibility of the survey. Weekly monitoring reports of respondent characteristics and recruitment chain graphs from NetDraw illustrated patterns and helped to fill recruitment gaps. RESULTS RDS worked well with men who have sex with men and female sex workers with recruitment initiating at a desirable pace that was maintained throughout the survey. Networks of people who injected drugs were well-integrated, but recruitment was slower than the men who have sex with men and female sex workers surveys. CONCLUSION By closely monitoring RDS implementation and conducting formative research, RDS studies can effectively develop and adapt strategies to improve recruitment and improve adherence to the underlying RDS theory and assumptions.
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Affiliation(s)
| | - Henry F Raymond
- San Francisco Department of Public Health, San Francisco, CA, USA
| | | | | | | | - Dita Broz
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Syvertsen JL, Ohaga S, Agot K, Dimova M, Guise A, Rhodes T, Wagner KD. An ethnographic exploration of drug markets in Kisumu, Kenya. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 30:82-90. [PMID: 26838470 DOI: 10.1016/j.drugpo.2016.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 12/15/2015] [Accepted: 01/03/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Illegal drug markets are shaped by multiple forces, including local actors and broader economic, political, social, and criminal justice systems that intertwine to impact health and social wellbeing. Ethnographic analyses that interrogate multiple dimensions of drug markets may offer both applied and theoretical insights into drug use, particularly in developing nations where new markets and local patterns of use traditionally have not been well understood. This paper explores the emergent drug market in Kisumu, western Kenya, where our research team recently documented evidence of injection drug use. METHODS Our exploratory study of injection drug use was conducted in Kisumu from 2013 to 2014. We draw on 151 surveys, 29 in-depth interviews, and 8 months of ethnographic fieldwork to describe the drug market from the perspective of injectors, focusing on their perceptions of the market and reports of drug use therein. RESULTS Injectors described a dynamic market in which the availability of drugs and proliferation of injection drug use have taken on growing importance in Kisumu. In addition to reports of white and brown forms of heroin and concerns about drug adulteration in the market, we unexpectedly documented widespread perceptions of cocaine availability and injection in Kisumu. Examining price data and socio-pharmacological experiences of cocaine injection left us with unconfirmed evidence of its existence, but opened further possibilities about how the chaos of new drug markets and diffusion of injection-related beliefs and practices may lend insight into the sociopolitical context of western Kenya. CONCLUSIONS We suggest a need for expanded drug surveillance, education and programming responsive to local conditions, and further ethnographic inquiry into the social meanings of emergent drug markets in Kenya and across sub-Saharan Africa.
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Affiliation(s)
- Jennifer L Syvertsen
- Department of Anthropology, The Ohio State University, 4046 Smith Laboratory, 174 W. 18th Ave., Columbus, OH 43210-1106, USA.
| | - Spala Ohaga
- Impact Research and Development Organization, P.O. Box 9171-40141, Kisumu, Kenya
| | - Kawango Agot
- Impact Research and Development Organization, P.O. Box 9171-40141, Kisumu, Kenya
| | - Margarita Dimova
- Department of Politics and International Studies, SOAS, Thornhaugh Street, Russell Square, London, England WC1H 0XG, United Kingdom
| | - Andy Guise
- Division of Global Public Health, University of California, San Diego, Central Research Services Facility (CRSF), La Jolla, CA 92093-0507, USA; London School of Hygiene & Tropical Medicine, Keppel Street, London, England WC1E 7HT, United Kingdom
| | - Tim Rhodes
- London School of Hygiene & Tropical Medicine, Keppel Street, London, England WC1E 7HT, United Kingdom
| | - Karla D Wagner
- School of Community Health Sciences, University of Nevada, Reno, 1664 N. Virginia St. MS 0274, Reno, NV 89557, USA
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Mattocks KM, Sullivan JC, Bertrand C, Kinney RL, Sherman MD, Gustason C. Perceived Stigma, Discrimination, and Disclosure of Sexual Orientation Among a Sample of Lesbian Veterans Receiving Care in the Department of Veterans Affairs. LGBT Health 2015; 2:147-53. [PMID: 26790121 DOI: 10.1089/lgbt.2014.0131] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Many lesbian women experience stigma and discrimination from their healthcare providers as a result of their sexual orientation. Additionally, others avoid disclosure of their sexual orientation to their providers for fear of mistreatment. With the increasing number of lesbian, gay, bisexual, and transgender (LGBT) veterans seeking care from the Veterans Health Administration (VHA), it is important to understand lesbian veterans' experiences with stigma, discrimination, and disclosure of sexual orientation. This article examines lesbian veterans' experiences with perceived stigma and discrimination in VHA healthcare, their perspectives on disclosure of sexual orientation to VHA providers, and their recommendations for improvements in VHA healthcare to create a welcoming environment for lesbian veterans. METHODS This is a mixed methods study of twenty lesbian veterans at four VHA facilities. The women veterans participated in a one-hour interview and then completed an anonymous survey. RESULTS Ten percent of lesbian veterans had experienced mistreatment from VHA staff or providers, but nearly 50% feared that their Veterans Affairs (VA) providers would mistreat them if they knew about their sexual orientation. A majority of lesbian veterans (70%) believed that VHA providers should never ask about sexual orientation or should only ask if the veteran wanted to discuss it. A majority (80%) believed the VHA had taken steps to create a welcoming environment for LBGT veterans. CONCLUSION Though many lesbian veterans have fears of stigma and discrimination in the context of VHA care, few have experienced this. Most lesbian veterans believed the VHA was trying to create a welcoming environment for its LGBT veterans. Future research should focus on expanding this study to include a larger and more diverse sample of lesbian, gay, bisexual, and transgender veterans receiving care at VA facilities across the country.
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Affiliation(s)
- Kristin M Mattocks
- 1 Department of Research and Education, VA Central Western Massachusetts Healthcare System , Leeds, Massachusetts
- 2 Department of Quantitative Health Sciences, University of Massachusetts Medical School , Worcester, Massachusetts
| | - J Cherry Sullivan
- 1 Department of Research and Education, VA Central Western Massachusetts Healthcare System , Leeds, Massachusetts
| | - Christina Bertrand
- 1 Department of Research and Education, VA Central Western Massachusetts Healthcare System , Leeds, Massachusetts
| | - Rebecca L Kinney
- 1 Department of Research and Education, VA Central Western Massachusetts Healthcare System , Leeds, Massachusetts
| | - Michelle D Sherman
- 3 Department of Psychology, University of Minnesota , St. Paul, Minnesota
| | - Carolyn Gustason
- 1 Department of Research and Education, VA Central Western Massachusetts Healthcare System , Leeds, Massachusetts
- 4 Department of Nursing, University of Massachusetts , Amherst, Massachusetts
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