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Moulis L, Le SM, Hai VV, Huong DT, Minh KP, Oanh KTH, Rapoud D, Quillet C, Thi TTN, Vallo R, Hoang GT, Moles JP, Laureillard D, Feelemyer J, Des Jarlais DC, Michel L, Nagot N. Gender, homelessness, hospitalization and methamphetamine use fuel depression among people who inject drugs: implications for innovative prevention and care strategies. Front Psychiatry 2023; 14:1233844. [PMID: 38025448 PMCID: PMC10661402 DOI: 10.3389/fpsyt.2023.1233844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Background The co-occurrence of substance use disorder and mental disorder, known as dual diagnosis, has a distressingly high prevalence among individuals grappling with either of these conditions. Mood disorders, especially depression, constitute a substantial burden for People Who Inject Drugs (PWID) and a significant public health concern in Vietnam. Identifying risk factors for depression in PWID is imperative for the development of targeted interventions. Methods We enrolled PWID into a cohort using the respondent-driven sampling method. Over a 36-month period, we systematically tracked the emergence of depression and employed multiple imputation in conjunction with a mixed nonlinear model to pinpoint risk factors for depression in this demographic. At inclusion, depression was screened using the PHQ-2 questionnaire, and subsequent episodes of depression were assessed semi-annually using the CES-D8. Results Three hundred and ninety-one PWID (26.6%) were depressed. Major risk factors for depression included being female, not having a permanent residency, having been hospitalized and using methamphetamine more than weekly. Other risk factors included age, being single, not having a health insurance card and not being on methadone. Limitations The exclusion of missing visits and social desirability could have led to selection and information biases. In this observational study, confusion biases are possible despite our best efforts. Conclusion Depression is alarmingly frequent in PWID. In this study taking in account the chronological relationship between sociodemographic and clinical factors and depression, risk factors were identified in this specific setting of low-to-middle income country. The findings highlight the need to develop innovative targeted psychiatric interventions with the help of supporting peers.
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Affiliation(s)
- Lionel Moulis
- PCCEI, University of Montpellier, INSERM, EFS, University of Antilles, Montpellier, France
| | - Sao Mai Le
- Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam
| | - Vinh Vu Hai
- Department of Infectious and Tropical Diseases, Viet Tiep Hospital, Haiphong, Vietnam
| | - Duong Thi Huong
- Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam
| | - Khuê Pham Minh
- Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam
| | | | - Delphine Rapoud
- PCCEI, University of Montpellier, INSERM, EFS, University of Antilles, Montpellier, France
| | - Catherine Quillet
- PCCEI, University of Montpellier, INSERM, EFS, University of Antilles, Montpellier, France
| | | | - Roselyne Vallo
- PCCEI, University of Montpellier, INSERM, EFS, University of Antilles, Montpellier, France
| | - Giang Thi Hoang
- Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam
| | - Jean-Pierre Moles
- PCCEI, University of Montpellier, INSERM, EFS, University of Antilles, Montpellier, France
| | - Didier Laureillard
- PCCEI, University of Montpellier, INSERM, EFS, University of Antilles, Montpellier, France
- Infectious Diseases Department, Caremeau University Hospital, Nîmes, France
| | | | | | - Laurent Michel
- CESP Inserm UMRS, Pierre Nicole Center, Paris Saclay University, Fench Red Cross, Paris, France
| | - Nicolas Nagot
- PCCEI, University of Montpellier, INSERM, EFS, University of Antilles, Montpellier, France
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The role of depression in secondary HIV transmission among people who inject drugs in Vietnam: A mathematical modeling analysis. PLoS One 2022; 17:e0275995. [PMID: 36240142 PMCID: PMC9565425 DOI: 10.1371/journal.pone.0275995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022] Open
Abstract
Background Among people who inject drugs (PWID), depression burden is high and may interfere with HIV prevention efforts. Although depression is known to affect injecting behaviors and HIV treatment, its overall impact on HIV transmission has not been quantified. Using mathematical modeling, we sought to estimate secondary HIV transmissions and identify differences by depression among PWID. Methods We analyzed longitudinal data from 455 PWID living with HIV in Vietnam during 2009–2013. Using a Bernoulli process model with individual-level viral load and behavioral data from baseline and 6-month follow-up visits, we estimated secondary HIV transmission events from participants to their potentially susceptible injecting partners. To evaluate differences by depression, we compared modeled transmissions per 1,000 PWID across depressive symptom categories (severe, mild, or no symptoms) in the three months before each visit. Results We estimated a median of 41.2 (2.5th, 97.5th percentiles: 33.2–49.2) secondary transmissions from all reported acts of sharing injection equipment with 833 injecting partners in the three months before baseline. Nearly half (41%) of modeled transmissions arose from fewer than 5% of participants in that period. Modeled transmissions per 1,000 PWID in that period were highest for severe depressive symptoms (100.4, 80.6–120.2) vs. mild (87.0, 68.2–109.4) or no symptoms (78.9, 63.4–94.1). Transmission estimates fell to near-zero at the 6-month visit. Conclusions Secondary transmissions were predicted to increase with depression severity, although most arose from a small number of participants. Our findings suggest that effective depression interventions could have the important added benefit of reducing HIV transmission among PWID.
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Dumchev K. Challenges of sexually transmitted infections and sexual health among people who inject drugs. Curr Opin Infect Dis 2022; 35:55-60. [PMID: 34799511 DOI: 10.1097/qco.0000000000000801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review provides a summary of recently published research on sexually transmitted infections (STI) and related behaviors among people who inject drugs (PWID), covering three major areas: sexual behavior and its role in STI transmission among PWID, multilevel factors associated with STI risk, and strategies addressing sexual health of PWID. This review is timely given the growing priority of combination prevention approaches and integrated care for PWID. RECENT FINDINGS Modern research improves the understanding that PWID have an increased risk of STI, which varies by gender, setting, type of substance used, and presence of mental disorders. Major socioeconomic and structural factors, specific and nonspecific to PWID, facilitate inequality and sexual risk behavior. Sexual transmission continues to contribute substantially to the spread of bloodborne infections among PWID, accounting for at least 10% of new HIV cases according to epidemiological modeling. Despite the substantial evidence that behavioral interventions can improve sexual health and reduce sex-related risks among PWID, there is a research-practice gap, reflected in the scarcity of implementation studies published recently. SUMMARY Integration of sexual health into prevention programs for PWID is essential to curb transmission of STI, including HIV, among PWID and their sexual partners.
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Assessment of a psychiatric intervention at community level for people who inject drugs in a low-middle income country: the DRIVE-Mind cohort study in Hai Phong, Viet Nam. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 18:100337. [PMID: 35024661 PMCID: PMC8669310 DOI: 10.1016/j.lanwpc.2021.100337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Access to psychiatric care for people who inject drugs (PWID) is limited/absent and stigmatized in most low-middle-income countries (LMICs). Innovative interventions are needed. We aimed to describe and assess the impact of a community-based psychiatric intervention among PWID in Hai Phong, Vietnam Methods In a cohort study with one year psychiatric follow-up, PWID diagnosed with a psychotic disorder, a major depressive episode, or suicide risk, were recruited from the wider Drug-Related Infections in ViEtnam (DRIVE) project in the city of Hai Phong. The community-based psychiatric intervention included specialized follow-up (free consultations with psychiatrists, free medication, referral to mental health department for hospitalization when necessary) and support from community-based organisations (case management, harm reduction, administrative support, linkage to HIV care, methadone maintenance treatment and mental health support). The main outcome was reduction/remission of symptoms. Access to and retention in psychiatric care, quality-of-life and stigmatization were also measured pre and post-intervention. Findings Among the 1212 participants screened from March to May 2019, 271 met the inclusion criteria, 233 (86.3%) accepted the intervention and 170 completed the follow-up (72.9%). At inclusion, 80.6% were diagnosed with current depression, 44.7% with psychotic disorder and 42.4% with suicide risk. After a one-year follow-up, these proportions dropped to 15.9%, 21.8%, and 22.9% respectively. Quality-of-life and perceived stigma related to mental health were also significantly improved, while drug use decreased only marginally. Interpretation Community-based psychiatric interventions are both feasible and efficient in the Vietnamese context. Similar interventions should be implemented and evaluated in other, different LMICs. Funding : This work was supported by grants from NIDA (US) (#DA041978) and ANRS (France) (#13353). The funding agencies had no role in designing the research, data analyses, or preparation of the report.
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Key Words
- ANRS, French Agency for Research on AIDS and Viral Hepatitis
- CBO, community-based organization
- CGI, clinical global impression scale
- DRIVE, Drug-Related Infections in ViEtnam
- EQ5D5L, 5 levels/5 dimensions EuroQol instrument
- HIV, human immunodeficiency virus
- LMICs, low-middle income countries
- MINI, MINI international neuropsychiatric interview
- MMT, methadone maintenance treatment
- NIDA, National Institute on Drug Abuse
- PHQ, patient health questionnaire
- PWID, people who inject drugs
- RDS, respondent driven sampling
- SCDI, Supporting Community Development Initiatives
- VND, Vietnamese dong
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LEVINTOW SN, PENCE BW, POWERS KA, BRESKIN A, SRIPAIPAN T, HA TV, CHU VA, QUAN VM, LATKIN CA, GO VF. Depression, antiretroviral therapy initiation, and HIV viral suppression among people who inject drugs in Vietnam. J Affect Disord 2021; 281:208-215. [PMID: 33333474 PMCID: PMC7855445 DOI: 10.1016/j.jad.2020.12.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 11/23/2020] [Accepted: 12/05/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The burden of depression is high among people who inject drugs (PWID) and may contribute to the spread of HIV through poor treatment engagement and persistent viremia. We estimated the effects of depression on antiretroviral therapy (ART) initiation and viral suppression among PWID living with HIV. METHODS Longitudinal data were collected from 455 PWID living with HIV in Vietnam during 2009-2013. We estimated the 6- and 12-month cumulative incidence of ART initiation and viral suppression, accounting for time-varying confounding, competing events, and missing data. The cumulative incidence difference (CID) contrasted the incidence of each outcome had participants always vs. never experienced severe depressive symptoms across study visits to date. RESULTS Severe depressive symptoms decreased the cumulative incidence of ART initiation, with CID values comparing always vs. never having severe depressive symptoms of -7.5 percentage points (95% CI: -17.2, 2.2) at 6 months and -7.1 (95% CI: -17.9, 3.7) at 12 months. There was no appreciable difference in the cumulative incidence of viral suppression at 6 months (CID = 0.3, 95% CI: -11.3, 11.9) or 12 months (CID = 2.0, 95% CI: -21.8, 25.8). LIMITATIONS Discrepancies between the ART initiation and viral suppression outcomes could be due to under-reporting of ART use and missing data on viral load. CONCLUSIONS Future work probing the seemingly antagonistic effect of depression on treatment uptake - but not viral suppression - will inform the design of interventions promoting HIV clinical outcomes and reducing onward transmission among PWID.
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Affiliation(s)
- Sara N. LEVINTOW
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill NC, USA
| | - Brian W. PENCE
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill NC, USA
| | - Kimberly A. POWERS
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill NC, USA
| | | | - Teerada SRIPAIPAN
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill NC, USA
| | - Tran Viet HA
- UNC Project Vietnam, University of North Carolina, Hanoi, Vietnam
| | - Viet Anh CHU
- UNC Project Vietnam, University of North Carolina, Hanoi, Vietnam
| | - Vu Minh QUAN
- Centers for Disease Control and Prevention, Atlanta GA, USA
| | - Carl A. LATKIN
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | - Vivian F. GO
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill NC, USA
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