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Yeung A, Wilkinson M, Bishop J, Taylor B, Palmateer N, Barnsdale L, Lang J, Cameron C, McCormick D, Clusker T, McAuley A, Hutchinson S. SARS-CoV-2 vaccine uptake and risks of severe COVID-19 disease among people prescribed opioid agonist therapy in Scotland. J Epidemiol Community Health 2024; 78:380-387. [PMID: 38594065 DOI: 10.1136/jech-2023-221602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/29/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND There is limited evidence quantifying the risk of severe COVID-19 disease among people with opioid dependence. We examined vaccine uptake and severe disease (admission to critical care or death with COVID-19) among individuals prescribed opioid agonist therapy (OAT). METHOD A case-control design was used to examine vaccine uptake in those prescribed OAT compared with the general population, and the association between severe disease and OAT. In both analyses, 10 controls from the general population were matched (to each OAT recipient and COVID-19 case, respectively) according to socio-demographic factors. Conditional logistic regression was used to estimate rate ratios (RR) for severe disease. RESULTS Vaccine uptake was markedly lower in the OAT cohort (dose 1: 67%, dose 2: 53% and dose 3: 31%) compared with matched controls (76%, 72% and 57%, respectively). Those prescribed OAT within the last 5 years, compared with those not prescribed, had increased risk of severe COVID-19 (RR 3.38, 95% CI 2.75 to 4.15), particularly in the fourth wave (RR 6.58, 95% CI 4.20 to 10.32); adjustment for comorbidity and vaccine status attenuated this risk (adjusted RR (aRR) 2.43, 95% CI 1.95 to 3.02; wave 4 aRR 3.78, 95% CI 2.30 to 6.20). Increased risk was also observed for those prescribed OAT previously (>3 months ago) compared with recently (aRR 1.74, 95% CI 1.11 to 2.71). CONCLUSIONS The widening gap in vaccine coverage for those prescribed OAT, compared with the general population, is likely to have exacerbated the risk of severe COVID-19 in this population over the pandemic. However, continued OAT use may have provided protection from severe COVID-19 among those with opioid dependence.
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Affiliation(s)
- Alan Yeung
- Glasgow Caledonian University, Glasgow, UK
- Public Health Scotland, Edinburgh, UK
| | - Max Wilkinson
- Glasgow Caledonian University, Glasgow, UK
- Public Health Scotland, Edinburgh, UK
| | | | | | - Norah Palmateer
- Glasgow Caledonian University, Glasgow, UK
- Public Health Scotland, Edinburgh, UK
| | | | | | | | | | | | - Andrew McAuley
- Glasgow Caledonian University, Glasgow, UK
- Public Health Scotland, Edinburgh, UK
| | - Sharon Hutchinson
- Glasgow Caledonian University, Glasgow, UK
- Public Health Scotland, Edinburgh, UK
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2
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Walker S, Curtis M, Kirwan A, Thatcher R, Dietze P. "No-one just does drugs during business hours!": evaluation of a 24/7 primary needle and syringe program in St Kilda, Australia. Harm Reduct J 2024; 21:51. [PMID: 38402389 PMCID: PMC10894474 DOI: 10.1186/s12954-024-00960-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/09/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Primary needle and syringe programs (NSPs) have been integral for the prevention of blood-borne virus (BBV) transmission among people who inject drugs. Despite this, many people who inject drugs face barriers accessing these services, particularly after-hours when most services are closed. To our knowledge, the St Kilda NSP, in Melbourne, Victoria, is the only primary NSP providing 24/7 dedicated stand-alone face-to-face services for people who inject drugs in Australia. We conducted an evaluation of the St Kilda NSP to assess its role and effectiveness in meeting client needs. METHODS Mixed research methods were used to conduct the evaluation. We analysed four quantitative data sets including the Victorian Needle and Syringe Program Information System data; NSP 'snapshot' survey data; and St Kilda NSP records of after-hours contacts and naloxone training events. Qualitative interviews were conducted with 20 purposively selected NSP clients, which were focused on individual needs, expectations and experiences accessing the service. Interviews were audio recorded and transcribed, and data were analysed thematically. A convergent research design was used to merge the five data sets. RESULTS St Kilda NSP had 39,898 service contacts in 2018; 72% of contacts occurred outside business hours. Similarly, of 1,185,000 sterile needles and syringes dispatched, 71% were distributed outside business hours. Participants described valuing the after-hours service because drug use patterns did not always align with standard NSP opening hours and after-hours access afforded anonymity when collecting injecting equipment. Narratives highlighted several additional benefits of the 24/7 service, including: access to safer sex equipment; material support; naloxone training; referrals to specialist services; face-to-face emotional and social support from a non-judging worker; and for women involved in sex work in particular, being able to seek refuge when feeling unsafe on the streets. CONCLUSIONS Our study provides evidence of the social and health benefits (beyond that of preventing BBV transmission) that can be gained through the provision of 24/7 primary NSP services. Findings support the need for the establishment of after-hours primary NSPs in other areas of Australia where active street-based drug markets operate outside business hours and concentrated numbers of people who inject drugs live and spend time.
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Affiliation(s)
- Shelley Walker
- National Drug Research Institute, Curtin University, Perth, Western Australia, Australia.
- Burnet Institute, Melbourne, Victoria, Australia.
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Michael Curtis
- National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
- Burnet Institute, Melbourne, Victoria, Australia
| | - Amy Kirwan
- Burnet Institute, Melbourne, Victoria, Australia
| | - Rebecca Thatcher
- Access Health & 24/7 Needle and Syringe Program, Alcohol, Drugs and Other Addictions Stream, Victoria Social Mission Department, The Salvation Army Australian Territory, Melbourne, Victoria, Australia
| | - Paul Dietze
- National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
- Burnet Institute, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Monash University, Melbourne, Victoria, Australia
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Kristensen K, Williams LD, Kaplan C, Pineros J, Lee E, Kaufmann M, Mackesy-Amiti ME, Boodram B. A Novel Index Measure of Housing-related Risk as a Predictor of Overdose among Young People Who Inject Drugs and Injection Networks. RESEARCH SQUARE 2023:rs.3.rs-3083889. [PMID: 37461549 PMCID: PMC10350242 DOI: 10.21203/rs.3.rs-3083889/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Background For people who inject drugs (PWID), housing instability due to decreasing housing affordability and other factors (e.g., loss of housing due to severed relational ties, evictions due to drug use) results in added pressure on an already vulnerable population. Research has shown that housing instability is associated with overdose risk among PWID. However, the construct of housing instability has often been operationalized as a single dimension (e.g., housing type, homelessness, transience). We propose a multi-dimensional measure of housing instability risk and examine its association with drug overdose to promote a more holistic examination of housing status as a predictor of overdose. Methods The baseline data from a network-based, longitudinal study of young PWID and their networks living in metropolitan Chicago, Illinois was analyzed to examine the relationship between a housing instability risk index-consisting of five dichotomous variables assessing housing instability-and lifetime overdose count using negative binomial regression. Results We found a significant positive association between the housing instability risk score and lifetime overdose count after adjusting for 12 variables. Conclusions Our results support the practical utility of a multi-dimensional measure of housing instability risk in predicting overdose and highlight the importance of taking a holistic approach to addressing housing instability when designing interventions.
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Affiliation(s)
| | | | | | | | - Eunhye Lee
- University of Illinois Chicago School of Public Health
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4
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Abstract
Context In recent years, cities across the world have seen widespread growth in unsheltered homelessness, in which a person sleeps in a place not meant for human habitation such as cars, parks, sidewalks, and abandoned buildings. It is widely understood that people experiencing homelessness have poorer health outcomes than the general population. Less is known about the health of people who are unsheltered, yet they may be exposed to greater health risks than their sheltered counterparts. The purpose of this literature review is to evaluate and summarize the evidence on unsheltered homelessness and health. Evidence Acquisition A literature search was conducted using PubMed to identify publications on unsheltered homelessness and health. A total of 42 studies were included for review. Evidence Synthesis Unsheltered populations experience higher rates of chronic disease, serious mental illness, and substance abuse than sheltered populations. Unsheltered homelessness is strongly associated with chronic homelessness that exacerbates serious mental illness and substance use, which is often co-occurring. Despite having large unmet health needs, unsheltered populations have lower healthcare utilization and often lack health insurance. Conclusions Evaluating the impact of shelter status on health outcomes has important implications for the allocation of housing and health services. Longitudinal studies are needed to examine the relationship between the duration of sheltered and unsheltered homelessness and health outcomes and explore the mediating mechanisms that lead to poor health among unsheltered populations. Despite these limitations, our results also suggest an urgent need to address the unique and severe challenges facing unsheltered populations and the need for intervention approaches that are sensitive to these unique disease burdens.
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Affiliation(s)
- Jessica Richards
- Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Randall Kuhn
- Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
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5
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Silkoff D, Chenhall R, Guillemin M, McDougall R. The ethical dimensions of everyday alcohol and other drug work: An empirical ethics investigation. Drug Alcohol Rev 2023; 42:614-624. [PMID: 36691114 DOI: 10.1111/dar.13604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/14/2022] [Accepted: 12/17/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The complex and contentious nature of alcohol and other drug (AOD) clinical work affords the likelihood of significant ethical dimensions. However, little attention has been paid to clinicians' perspectives of ethics in their practice within AOD settings. This potentially neglects an important aspect of AOD clinical work. METHODS We used an insider empirical ethics methodology, where the first author (DS) concurrently worked as an AOD clinician in the research setting. Participants were 30 experienced AOD clinicians, working within a large specialist AOD service in Victoria, Australia. We used three qualitative data collection methods: moral conversation, involving semi-structured interviews; moral participation, involving the first author reflecting on his own ethical practices; and participant-observation, involving observation of clinical meetings. We used Applied Thematic Analysis to analyse the data. RESULTS Although participants rarely used explicitly ethical language to describe their work, they described four ethical goals: helping clients to access AOD care and treatment; facilitating change in clients' lives; challenging stigma; and keeping people safe. We argue that these clinical goals should also be conceptualised as ethical goals. DISCUSSION AND CONCLUSIONS Ethics is an integral component of everyday AOD work. Our findings had some overlap with established ethical principles. Participants demonstrated expertise in engaging with ethical dimensions, without using ethical language. Given the limited attention paid to ethics in AOD clinical settings, increasing the focus on ethics in everyday clinical practice is an important contribution to future AOD clinical work. Its absence negates important aspects of care for clients.
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Affiliation(s)
- David Silkoff
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Richard Chenhall
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Marilys Guillemin
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Rosalind McDougall
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia
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6
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Stewart AC, Cossar RD, Quinn B, Dietze P, Romero L, Wilkinson AL, Stoové M. Criminal Justice Involvement after Release from Prison following Exposure to Community Mental Health Services among People Who Use Illicit Drugs and Have Mental Illness: a Systematic Review. J Urban Health 2022; 99:635-654. [PMID: 35501591 PMCID: PMC9360359 DOI: 10.1007/s11524-022-00635-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 01/31/2023]
Abstract
Illicit drug use and mental illness are common among people in prison and are associated with higher rates of reoffending and reimprisonment. We conducted a systematic review, searching MEDLINE, Embase, and PsycINFO to January 10, 2022, for studies reporting criminal justice involvement following exposure to community mental health services among people released from jail or prison who use illicit drugs and have mental illness. Our search identified 6954 studies; 13 were eligible for inclusion in this review. Studies were separated into three broad categories based on community mental health service type. Eleven of 13 studies reported a reduction in criminal justice involvement among participants exposed to community mental health services compared to a comparison group. Findings indicate a need to expand and improve integration and referral mechanisms linking people to community mental health services after jail or prison release, alongside a need for tailored programs for individuals with complex illicit drug use and mental health morbidities.
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Affiliation(s)
- Ashleigh C Stewart
- Behaviours and Health Risks, Burnet Institute, 85 Commercial Rd, Melbourne, 3004, Australia. .,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Reece D Cossar
- Behaviours and Health Risks, Burnet Institute, 85 Commercial Rd, Melbourne, 3004, Australia.,Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Australia
| | - Brendan Quinn
- Behaviours and Health Risks, Burnet Institute, 85 Commercial Rd, Melbourne, 3004, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Paul Dietze
- Behaviours and Health Risks, Burnet Institute, 85 Commercial Rd, Melbourne, 3004, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,National Drug Research Institute, Curtin University, Melbourne, Victoria, Australia
| | - Lorena Romero
- Ian Potter Library, Alfred Health, Melbourne, Australia
| | - Anna L Wilkinson
- Behaviours and Health Risks, Burnet Institute, 85 Commercial Rd, Melbourne, 3004, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mark Stoové
- Behaviours and Health Risks, Burnet Institute, 85 Commercial Rd, Melbourne, 3004, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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7
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Pérez-Figueroa RE, Obonyo DJ, Santoscoy S, Surratt HL, Lekas HM, Lewis CF, Lyons JS, Amesty SC. Housing Instability, Structural Vulnerability, and Non-Fatal Opioid Overdoses Among People Who Use Heroin in Washington Heights, New York City. Behav Med 2022; 48:320-330. [PMID: 34086534 DOI: 10.1080/08964289.2021.1922347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Nationally, opioid overdose remains strikingly persistent among people experiencing homelessness and housing instability. Limited information is available about the characteristics of this phenomenon in economically disadvantaged communities of color. This study sought to evaluate the association between key contextual factors and experiencing a non-fatal opioid overdose among people who use heroin in Washington Heights, New York City. We conducted a cross-sectional survey (N = 101) among participants seeking harm reduction services who reported heroin use in the last three months. Binary logistic regression models examined the association between key social and structural factors and the likelihood of ever experiencing a non-fatal opioid overdose and recently experiencing a non-fatal opioid overdose. The majority of the sample reported housing instability and lived in poverty; almost 42% were homeless. After adjustment, participants who injected heroin were more likely to have ever experienced a non-fatal opioid overdose. Also, younger participants who reported hunger in the last six months were more likely to have experienced a non-fatal opioid overdose in the last three months. Findings suggest the role of structural vulnerability in shaping overdose risk among the participants. Overdose prevention strategies should consider factors of the social and economic environment to mitigate barriers to accessing health and social services within the context of the current opioid crisis.
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Affiliation(s)
- R E Pérez-Figueroa
- Department of Health, Behavior, and Society, University of Kentucky College of Public Health.,Center for Innovation in Population Health, University of Kentucky College of Public Health
| | - D J Obonyo
- Department of Health Management and Policy, University of Kentucky College of Public Health
| | - S Santoscoy
- Research and Drug Education, Washington Heights Corner Project
| | - H L Surratt
- Department of Behavioral Science, University of Kentucky College of Medicine
| | - H M Lekas
- Department of Psychiatry, New York University School of Medicine.,Department of Social Solutions and Services Research, Nathan S. Kline Institute for Psychiatric Research
| | - C F Lewis
- Department of Psychiatry, New York University School of Medicine.,Department of Social Solutions and Services Research, Nathan S. Kline Institute for Psychiatric Research
| | - J S Lyons
- Center for Innovation in Population Health, University of Kentucky College of Public Health.,Department of Health Management and Policy, University of Kentucky College of Public Health
| | - S C Amesty
- Center for Family and Community Medicine, Columbia University Irving Medical Center Vagelos College of Physicians and Surgeons.,Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health
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8
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Holeksa J. Dealing with low access to harm reduction: a qualitative study of the strategies and risk environments of people who use drugs in a small Swedish city. Harm Reduct J 2022; 19:23. [PMID: 35246162 PMCID: PMC8894830 DOI: 10.1186/s12954-022-00602-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 02/17/2022] [Indexed: 12/02/2022] Open
Abstract
Background The development of harm reduction has been limited in many areas of Sweden. This study aims to understand the implications that this has for the life circumstances and risk management of people who use drugs in areas of low access. Methods Eleven qualitative, semi-structured interviews were undertaken with people who use drugs in a small urban centre with no needle and syringe exchange program (NSP) or Housing First policy. Results Participants reported many solutions to lack of NSP, including travel to an external NSP, creating bridging distribution networks, stealing, borrowing, reusing, ordering online, and smuggling injection equipment. They were at risk of having their equipment confiscated by police. Participants were mostly homeless, and to address exclusion from housing services, were forced to frequently find new temporary solutions, sheltering themselves in public places, with friends, in cars, among others. Participants felt the lack of services reflected stigmatized notions of drug use and heightened their exclusion from general society. For example, they avoided accessing other health care services for fear of discrimination. These issues caused high levels of stress and anxiety, in addition to serious risk for many somatic and psychological health conditions, including HIV and HCV transmission. Conclusion Lack of harm reduction services placed a great burden on study participants to develop strategies due to gaps in official programming. It also contributes to a vicious cycle of exclusion from services. The implementation of such evidence-based programs will reduce this burden, as well as provide the indirect, symbolic effect of inclusion.
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Affiliation(s)
- Julie Holeksa
- Department of Social Work, Faculty of Health and Society, Malmö University, Citadellsvägen 7, 211 18, Malmö, Sweden.
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9
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Khezri M, Shokoohi M, Mirzazadeh A, Tavakoli F, Ghalekhani N, Mousavian G, Mehmandoost S, Kazerooni PA, Haghdoost AA, Karamouzian M, Sharifi H. HIV Prevalence and Related Behaviors Among People Who Inject Drugs in Iran from 2010 to 2020. AIDS Behav 2022; 26:2831-2843. [PMID: 35195820 DOI: 10.1007/s10461-022-03627-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 11/26/2022]
Abstract
Injection drug use has been the leading route of HIV transmission in Iran. We assessed HIV prevalence, risk behaviors, and uptake of prevention services among people who inject drugs (PWID) in Iran between 2010 and 2020. We also examined the individual and environmental determinants of HIV among PWID. PWID were recruited in major cities across the country in three national bio--behavioral surveillance surveys in 2010, 2014, and 2020. Participants were tested for HIV and interviewed using a behavioral questionnaire. Between 2010 and 2020, the prevalence of HIV (15.1% to 3.5%), receptive needle sharing (25.2% to 3.9%) and unprotected sex (79.4% to 65.2%) decreased. Moreover, uptake of free needle/syringe increased (57.4% to 87.9%), while uptake of free condoms remained relatively stable across the surveys (34.3% to 32.6%). Multivariable analysis for the 2020 survey showed that a history of homelessness, incarceration, and a longer injection career significantly increased the odds of HIV seropositivity. During the past decade, HIV prevalence and drug- and sexual-related risk behaviors decreased among Iranian PWID. However, individual and structural determinants continue to drive HIV among this population. HIV prevention, diagnosis, and treatment among marginalized PWID with a history of homelessness or incarceration and those who inject drugs for a longer period, should be further prioritized in HIV care planning and resource allocation in Iran.
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Affiliation(s)
- Mehrdad Khezri
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mostafa Shokoohi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ali Mirzazadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Fatemeh Tavakoli
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Nima Ghalekhani
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ghazal Mousavian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Soheil Mehmandoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Ali Akbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Karamouzian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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10
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Stone J, Artenie A, Hickman M, Martin NK, Degenhardt L, Fraser H, Vickerman P. The contribution of unstable housing to HIV and hepatitis C virus transmission among people who inject drugs globally, regionally, and at country level: a modelling study. Lancet Public Health 2022; 7:e136-e145. [PMID: 35012711 PMCID: PMC8848679 DOI: 10.1016/s2468-2667(21)00258-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/27/2021] [Accepted: 11/10/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND A considerable proportion of people who inject drugs are unstably housed. Although unstable housing is associated with HIV and HCV infection among people who inject drugs, its contribution to transmission is unknown. We estimated the global and national proportions of incident HIV and HCV infections among people who inject drugs attributed to housing instability from 2020 to 2029. METHODS In this modelling study, we developed country-level models of unstable housing and HIV and HCV transmission among people who inject drugs in 58 countries globally, calibrated to country-specific data on the prevalences of HIV and HCV and unstable housing. Based on a recently published systematic review, unstably housed people who inject drugs were assumed to have a 39% (95% CI 6-84) increased risk of HIV transmission and a 64% (95% CI 43-89%) increased risk of HCV transmission. We used pooled country-level estimates from systematic reviews on HCV and HIV prevalence in people who inject drugs. Our models estimated the transmission population attributable fraction (tPAF) of unstable housing to HIV and HCV transmission among people who inject drugs, defined as the percentage of infections prevented from 2020 to 2029 if the additional risk due to unstable housing was removed. FINDINGS Our models were produced for 58 countries with sufficient data (accounting for >66% of the global people who inject drugs population). Globally, we project unstable housing contributes 7·9% (95% credibility interval [CrI] 2·3-15·7) of new HIV infections and 11·2% (7·7-15·5) of new HCV infections among people who inject drugs from 2020 to 2029. Country-level tPAFs were strongly associated with the prevalence of unstable housing. tPAFs were greater in high-income countries (HIV 17·2% [95% CrI 5·1-30·0]; HCV 19·4% [95% CrI 13·8-26·0]) than in low-income or middle-income countries (HIV 6·6% [95% CrI 1·8-13·1]; HCV 8·3% [95% CrI 5·5-11·7]). tPAFs for HIV and HCV were highest in Afghanistan, Czech Republic, India, USA, England, and Wales where unstable housing contributed more than 20% of new HIV and HCV infections. INTERPRETATION Unstable housing is an important modifiable risk factor for HIV and HCV transmission among people who inject drugs in many countries. The study emphasises the importance of implementing initiatives to mitigate these risks and reduce housing instability. FUNDING National Institute for Health Research and National Institute of Allergy and Infectious Diseases and National Institute for Drug Abuse.
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Affiliation(s)
- Jack Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Adelina Artenie
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Natasha K Martin
- Division of Global Public Health, University of California San Diego, San Diego, CA, USA
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Hannah Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
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11
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Cossar RD, Stewart AC, Wilkinson AL, Dietze P, Ogloff JRP, Aitken C, Butler T, Kinner SA, Curtis M, Walker S, Kirwan A, Stoové M. Emergency department presentations in the first weeks following release from prison among men with a history of injecting drug use in Victoria, Australia: A prospective cohort study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 101:103532. [PMID: 34871944 DOI: 10.1016/j.drugpo.2021.103532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 10/26/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Rates of emergency department (ED) use are higher among people released from prison than in the general population. However, little is known about ED presentations specifically among people with a history of injecting drug use (IDU) leaving prison. We measured the incidence of ED presentation in the three months following release from prison, among a cohort of men with histories of IDU, and determined pre-release characteristics associated with presenting to an ED during this period. METHODS We analysed linked survey and administrative data from the Prison and Transition Health (PATH) study (N = 400) using multiple-failure survival analysis. RESULTS Twenty-one percent (n = 81/393) of the cohort presented to an ED at least once within the three months after release from prison. The incidence of ED presentation was highest in the first six days after release. Cox proportional hazards modelling showed that a history of in-patient psychiatric admission and housing instability were associated with increased hazard of an ED presentation, and identifying as Aboriginal and Torres Strait Islander was associated with decreased hazard. CONCLUSIONS In our study, ED presentations following release from prison among people with a history of IDU was linked to acute health risks related to known mental health and social vulnerabilities in this population. Greater collaboration and systems integration between prison and community health and support services is needed to reduce presentations to ED and associated morbidities among people with a history of IDU after release from prison.
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Affiliation(s)
- Reece David Cossar
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia; Centre for Forensic Behavioural Science, Swinburne University of Technology and Forensicare, Melbourne, VIC, Australia.
| | - Ashleigh Cara Stewart
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Anna Lee Wilkinson
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia; Centre for Forensic Behavioural Science, Swinburne University of Technology and Forensicare, Melbourne, VIC, Australia
| | - Paul Dietze
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; National Drug Research Institute, Curtin University, Perth, Australia
| | - James R P Ogloff
- Centre for Forensic Behavioural Science, Swinburne University of Technology and Forensicare, Melbourne, VIC, Australia
| | - Campbell Aitken
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia
| | - Tony Butler
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Stuart A Kinner
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Griffith Criminology Institute, Griffith University, Brisbane, QLD, Australia; Mater Research Institute-UQ, University of Queensland, Brisbane, QLD, Australia
| | - Michael Curtis
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Monash Addiction Research Centre, Monash University, Melbourne, VIC, Australia
| | - Shelley Walker
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia
| | - Amy Kirwan
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia
| | - Mark Stoové
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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12
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Stewart AC, Cossar RD, Wilkinson AL, Quinn B, Dietze P, Walker S, Butler T, Curtis M, Aitken C, Kirwan A, Winter R, Ogloff J, Kinner S, Stoové M. The Prison and Transition Health (PATH) cohort study: Prevalence of health, social, and crime characteristics after release from prison for men reporting a history of injecting drug use in Victoria, Australia. Drug Alcohol Depend 2021; 227:108970. [PMID: 34488074 DOI: 10.1016/j.drugalcdep.2021.108970] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/22/2021] [Accepted: 07/24/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND People who inject drugs are overrepresented in prison and have diverse and complex health needs. However, outcomes after release from prison are poorly understood, limiting effective interventions supporting community reintegration. We describe the prevalence of socio-demographics, physical and mental health, alcohol and other drug use, and crime characteristics of men with histories of injecting drug use after their release from prison in Victoria, Australia. METHODS Data come from the Prison and Transition Health (PATH) prospective cohort study. Interviews were undertaken approximately three, 12, and 24 months after release from their index prison episode and were completed in the community, or in prison for those reimprisoned during the study. We present cross-sectional descriptive statistics for each follow-up wave of the PATH study. RESULTS Among 400 men recruited into PATH, 85 % (n = 336) completed at least one follow-up interview; 162 (42 %) completed all three interviews. Participants reported social disadvantage and health inequity, including high rates of unemployment, homelessness, and physical and mental health morbidities at each follow-up time point. Rapid return to illicit substance use was common, as was overdose (ranging 9 %-13 %), receptive syringe sharing (ranging 20 %-29 %), involvement in crime-related activities (ranging 49 %-58 %), and reimprisonment (ranging 22 %-50 %) over the duration of follow-up. CONCLUSION Men in this study experienced substantial health and social challenges across a 24-month prospective follow-up period. Improved understanding of characteristics and experiences of this group after release from prison can inform more coordinated and continued care between prison and the community.
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Affiliation(s)
- Ashleigh C Stewart
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Reece D Cossar
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia; Centre for Forensic Behavioural Science, Swinburne University of Technology and Forensicare, Australia.
| | - Anna L Wilkinson
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Brendan Quinn
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Paul Dietze
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; National Drug Research Institute, Curtin University, Perth, Australia
| | - Shelley Walker
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia
| | - Tony Butler
- School of Public Health and Community Medicine, University of Sydney, Sydney, Australia
| | - Michael Curtis
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Campbell Aitken
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Amy Kirwan
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia
| | - Rebecca Winter
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia; Department of Gastroenterology, St Vincent's Hospital, Melbourne, Australia
| | - James Ogloff
- Centre for Forensic Behavioural Science, Swinburne University of Technology and Forensicare, Australia
| | - Stuart Kinner
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Justice Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Australia; Griffith Criminology Institute, Griffith University, Brisbane, Australia; Mater Research Institute-UQ, University of Queensland, Brisbane, Australia
| | - Mark Stoové
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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13
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Sanchez DP, Tookes H, Pastar I, Lev-Tov H. Wounds and Skin and Soft Tissue Infections in People Who Inject Drugs and the Utility of Syringe Service Programs in Their Management. Adv Wound Care (New Rochelle) 2021; 10:571-582. [PMID: 33913781 PMCID: PMC8312019 DOI: 10.1089/wound.2020.1243] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Significance: Opioid use disorder and transition to injection drug use (IDU) are an urgent, nationwide public health crisis. Wounds and skin and soft tissue infections (SSTIs) are common complications of IDU that disproportionately affect people who inject drugs (PWID) and are a major source of morbidity and mortality for this population. Critical Issues: Injections in a nonsterile environment and reusing or sharing needles facilitates bacterial inoculation, with subsequent risk of serious complications such as sepsis, gangrene, amputation, and death. PWID are susceptible to infections with a wide spectrum of organisms beyond common culprits of SSTI, including Clostridium and Bacillus spp., as well as Candida. Recent Advances: Syringe services programs (SSPs) are cost-effective and successful in reducing harms associated with IDU. SSPs provide new equipment to PWID and aid in discarding used equipment. SSPs aim to reduce the risks of unhygienic injecting practices, which are associated with transmission of infections and blood-borne pathogens. Future Directions: Concurrently run SSPs and wound care clinics are uniquely positioned to facilitate care to PWID. Providing new, sterile equipment as well as early wound care intervention can reduce morbidity and mortality as well as health care expenditures by reducing the number of SSTI and injection-related wounds that require hospital admission. Establishment of wound care clinics as part of an SSP represents an untapped potential to reduce harm.
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Affiliation(s)
- Daniela P. Sanchez
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Hansel Tookes
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Irena Pastar
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Hadar Lev-Tov
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
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14
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Busschots D, Bielen R, Koc ÖM, Heyens L, Dercon E, Verrando R, Janssens F, Van den Bergh L, Van Lint P, Bruckers L, Nevens F, Robaeys G. On-site testing and case management to improve hepatitis C care in drug users: a prospective, longitudinal, multicenter study in the DAA era. BMC Public Health 2021; 21:1574. [PMID: 34416867 PMCID: PMC8379886 DOI: 10.1186/s12889-021-11608-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 08/08/2021] [Indexed: 01/15/2023] Open
Abstract
Background Screening and treatment of hepatitis C virus (HCV) infection in people who use drugs (PWUD) remains insufficient. Reducing the burden of HCV infection in PWUD requires interventions focusing on the different steps of the HCV care cascade. Methods We performed a prospective, multicenter study, evaluating the impact of an HCV care model on the HCV care cascade among PWUD attending an addiction care center in Belgium between 2015 and 2018. Interventions within the care model consisted of pre-test counseling, on-site HCV screening and case management services. A multiple logistic regression model was performed to identify the independent factors influencing the outcomes. Results During the study period, 441 PWUD were registered at the addiction care center, 90% (395/441) were contacted, 88% (349/395) were screened for HCV infection. PWUD were more likely to be screened if they had ever injected drugs (p < .001; AOR 6.411 95% CI 3.464–11.864). In 45% (157/349), the HCV antibody (Ab) test was positive, and in 27% (94/349) HCV RNA was positive. Within the Belgian reimbursement criteria (fibrosis stage ≥ F2), 44% (41/94) were treated. Specialist evaluation at the hospital was lower for PWUD receiving decentralized opioid agonist therapy (p = .005; AOR 0.430 95% CI 0.005–0.380), PWUD with unstable housing in the past 6 months before inclusion (p = .015; AOR 0.035 95% CI 0.002–0.517) or if they were recently incarcerated (p = .001; AOR 0.010 95% CI 0.001–0.164). Conclusions This HCV care model demonstrated high screening, linkage to care, and treatment initiation among PWUD in Belgium. Using the cascade of care to guide interventions is easy and necessary to monitor results. This population needs guidance, not only for screening and treatment initiation but also for the long-term follow-up since one in six had cirrhosis and could develop hepatocellular carcinoma. Further interventions are necessary to increase linkage to care and treatment initiation. Universal access to direct-acting antiviral therapy from 2019 will contribute to achieving HCV elimination in the PWUD population. Trial registration Clinical trial registration details: www.clinicaltrials.gov (NCT03106194). Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11608-9.
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Affiliation(s)
- Dana Busschots
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Diepenbeek, Belgium. .,Department of Gastroenterology and Hepatology, Ziekenhuis-Oost Limburg, Genk, Belgium.
| | - Rob Bielen
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Diepenbeek, Belgium.,Department of Gastroenterology and Hepatology, Ziekenhuis-Oost Limburg, Genk, Belgium
| | - Özgür M Koc
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Diepenbeek, Belgium.,Department of Gastroenterology and Hepatology, Ziekenhuis-Oost Limburg, Genk, Belgium.,Medical Microbiology, School of NUTRIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Leen Heyens
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Diepenbeek, Belgium.,Department of Gastroenterology and Hepatology, Ziekenhuis-Oost Limburg, Genk, Belgium.,Medical Microbiology, School of NUTRIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | | | - Filip Janssens
- Department of Gastroenterology, Jessa Hospital, Hasselt, Belgium
| | - Luc Van den Bergh
- Department of Gastroenterology, Sint-Trudo Hospital, Sint-Truiden, Belgium
| | - Peter Van Lint
- Department of Gastroenterology, AZ Vesalius, Tongeren, Belgium
| | - Liesbeth Bruckers
- Faculty of Science, Center for statistics, Interuniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, Diepenbeek, Belgium
| | - Frederik Nevens
- Department of Gastroenterology and Hepatology, University Hospitals KU Leuven, Leuven, Belgium
| | - Geert Robaeys
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Diepenbeek, Belgium.,Department of Gastroenterology and Hepatology, Ziekenhuis-Oost Limburg, Genk, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals KU Leuven, Leuven, Belgium
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15
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Negotiating Multiple Stigmas: Substance Use in the Lives of Women Experiencing Homelessness. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-021-00560-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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16
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Schneider KE, Wilson D, Dayton L, Goodell EMA, Latkin CA. Political partisanship and stigma against people who use drugs in opinions about allocating COVID-19 prevention resources to vulnerable populations. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 95:103301. [PMID: 34049234 PMCID: PMC8530849 DOI: 10.1016/j.drugpo.2021.103301] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 05/02/2021] [Accepted: 05/07/2021] [Indexed: 12/03/2022]
Abstract
Background The distribution of resources during the COVID-19 pandemic has been politicized and contentious in the United States. Vulnerable populations, such as those living in poverty, experiencing homelessness, or who use drugs, are particularly susceptible to becoming infected with COVID-19 and often have limited access to protective supplies, such as masks and hand sanitizer. Our aim was to understand public opinion on increasing the allocation of COVID-19 prevention resources to vulnerable populations. Methods Data were from an online survey of 680 United States adults. Participants’ opinions on the allocation of COVID-19 prevention resources to people with low income, experiencing homelessness, or who use drugs were assessed using a five-item Likert scale. We examined the prevalence of these opinions and their relationship to sociodemographic characteristics, COVID-19 beliefs, and drug-related experiences. Results Most participants supported increasing resources for individuals with low incomes (79.6%) and experiencing homelessness (74.6%), while a minority supported increasing resources for people who use drugs (33.5%). Politically conservative participants were less likely to support increasing resources for all three populations than those who were politically liberal. Skepticism about the severity of COVID-19 was also associated with less support for increasing resources across groups. Discussion Our results demonstrate that people who use drugs continue to be stigmatized in the context of the COVID-19 pandemic, resulting in popular opinion not supporting people who use drugs with potentially lifesaving resources. Overcoming this stigma is essential to prevent COVID-19 among people who use drugs, a population which experiences elevated risk of COVID-19 infection.
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Affiliation(s)
- Kristin E Schneider
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA.
| | - Deborah Wilson
- School of Nursing, Johns Hopkins University, 525 N Wolfe St, Baltimore, MD 21205, USA
| | - Lauren Dayton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Erin M Anderson Goodell
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Carl A Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
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17
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Arum C, Fraser H, Artenie AA, Bivegete S, Trickey A, Alary M, Astemborski J, Iversen J, Lim AG, MacGregor L, Morris M, Ong JJ, Platt L, Sack-Davis R, van Santen DK, Solomon SS, Sypsa V, Valencia J, Van Den Boom W, Walker JG, Ward Z, Stone J, Vickerman P. Homelessness, unstable housing, and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis. Lancet Public Health 2021; 6:e309-e323. [PMID: 33780656 PMCID: PMC8097637 DOI: 10.1016/s2468-2667(21)00013-x] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND People who inject drugs (PWID) are at increased risk for HIV and hepatitis C virus (HCV) infection and also have high levels of homelessness and unstable housing. We assessed whether homelessness or unstable housing is associated with an increased risk of HIV or HCV acquisition among PWID compared with PWID who are not homeless or are stably housed. METHODS In this systematic review and meta-analysis, we updated an existing database of HIV and HCV incidence studies published between Jan 1, 2000, and June 13, 2017. Using the same strategy as for this existing database, we searched MEDLINE, Embase, and PsycINFO for studies, including conference abstracts, published between June 13, 2017, and Sept 14, 2020, that estimated HIV or HCV incidence, or both, among community-recruited PWID. We only included studies reporting original results without restrictions to study design or language. We contacted authors of studies that reported HIV or HCV incidence, or both, but did not report on an association with homelessness or unstable housing, to request crude data and, where possible, adjusted effect estimates. We extracted effect estimates and pooled data using random-effects meta-analyses to quantify the associations between recent (current or within the past year) homelessness or unstable housing compared with not recent homelessness or unstable housing, and risk of HIV or HCV acquisition. We assessed risk of bias using the Newcastle-Ottawa Scale and between-study heterogeneity using the I2 statistic and p value for heterogeneity. FINDINGS We identified 14 351 references in our database search, of which 392 were subjected to full-text review alongside 277 studies from our existing database. Of these studies, 55 studies met inclusion criteria. We contacted the authors of 227 studies that reported HIV or HCV incidence in PWID but did not report association with the exposure of interest and obtained 48 unpublished estimates from 21 studies. After removal of duplicate data, we included 37 studies with 70 estimates (26 for HIV; 44 for HCV). Studies originated from 16 countries including in North America, Europe, Australia, east Africa, and Asia. Pooling unadjusted estimates, recent homelessness or unstable housing was associated with an increased risk of acquiring HIV (crude relative risk [cRR] 1·55 [95% CI 1·23-1·95; p=0·0002]; I2= 62·7%; n=17) and HCV (1·65 [1·44-1·90; p<0·0001]; I2= 44·8%; n=28]) among PWID compared with those who were not homeless or were stably housed. Associations for both HIV and HCV persisted when pooling adjusted estimates (adjusted relative risk for HIV: 1·39 [95% CI 1·06-1·84; p=0·019]; I2= 65·5%; n=9; and for HCV: 1·64 [1·43-1·89; p<0·0001]; I2= 9·6%; n=14). For risk of HIV acquisition, the association for unstable housing (cRR 1·82 [1·13-2·95; p=0·014]; n=5) was higher than for homelessness (1·44 [1·13-1·83; p=0·0036]; n=12), whereas no difference was seen between these outcomes for risk of HCV acquisition (1·72 [1·48-1·99; p<0·0001] for unstable housing, 1·66 [1·37-2·00; p<0·0001] for homelessness). INTERPRETATION Homelessness and unstable housing are associated with increased risk of HIV and HCV acquisition among PWID. Our findings support the development of interventions that simultaneously address homelessness and unstable housing and HIV and HCV transmission in this population. FUNDING National Institute for Health Research, National Institute on Drug Abuse, National Institute of Allergy and Infectious Diseases, and Commonwealth Scholarship Commission.
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Affiliation(s)
- Chiedozie Arum
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Hannah Fraser
- Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Sandra Bivegete
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Adam Trickey
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Michel Alary
- Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada; Département de médecine sociale et préventive, Université Laval, Quebec City, QC, Canada; Institut national de santé publique du Québec, Québec, QC, Canada
| | - Jacquie Astemborski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer Iversen
- Kirby Institute for Infection and Immunity, UNSW Sydney, NSW, Australia
| | - Aaron G Lim
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Louis MacGregor
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Meghan Morris
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Jason J Ong
- Population Health Sciences, University of Bristol, Bristol, UK; Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Rachel Sack-Davis
- Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Daniela K van Santen
- Burnet Institute, Melbourne, VIC, Australia; Department of Infectious Disease Research and Prevention, Public Health Service of Amsterdam, Amsterdam, Netherlands
| | - Sunil S Solomon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Jorge Valencia
- Harm Reduction Unit "SMASD", Department of Addictions and Mental Health, Madrid, Spain
| | | | | | - Zoe Ward
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Jack Stone
- Population Health Sciences, University of Bristol, Bristol, UK.
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
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18
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Nyamathi AM, Salem BE. The impact of unstable housing on health. LANCET PUBLIC HEALTH 2021; 6:e265-e266. [PMID: 33780657 DOI: 10.1016/s2468-2667(21)00035-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/12/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Adeline M Nyamathi
- Sue & Bill Gross School of Nursing, University of California, Irvine, CA 92697, USA.
| | - Benissa E Salem
- School of Nursing, University of California, Los Angeles, CA, USA
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19
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Høj SB, Jacka B, Minoyan N, Bussière P, Bruneau J. Deconstructing the 'cheque effect': short-term changes in injection drug use after receiving income assistance and associated factors. Addiction 2021; 116:571-582. [PMID: 32649010 DOI: 10.1111/add.15192] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/17/2019] [Accepted: 07/08/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Disbursement of income assistance has been temporally associated with intensified drug use and related harms (coined the 'cheque effect'). However, relationships to injection drug use (IDU) remain understudied. We examined short-term 'cheque effects' and associated factors among people who inject drugs (PWID). DESIGN Cross-sectional analysis nested within a cohort study. SETTING Montreal, Quebec, Canada. PARTICIPANTS PWID receiving income assistance, with no employment income. A total of 613 PWID (median age 41, 83% male) contributed 3269 observations from 2011 to 2017. MEASUREMENTS AND METHODS At each cohort visit, an interviewer-administered questionnaire captured retrospective reports of injection-related behaviour during the 2-day periods (i) before and (ii) including/after receiving last month's income assistance payment (number of injections; drugs injected; any receptive syringe-sharing). The relative likelihood (odds) and magnitude (rate) of an increase in injection frequency ('cheque effect') were estimated in relation to social and behavioural factors using logistic and negative binomial regression in a covariate-adjusted two-part model. FINDINGS Prevalence of IDU and syringe-sharing were, respectively, 1.80 and 2.50 times higher in the days following versus preceding cheque receipt (P < 0.001). Among people with past-month IDU, most observations showed increased injection frequency (52%) or no change in injection frequency (44%). The likelihood of a 'cheque effect' was positively associated with cocaine injection [versus injection of other substances, odds ratio (OR) = 2.639, 95% confidence interval (CI) = 2.04-3.41], unstable housing (OR = 1.272, 95% CI = 1.03-1.57) and receiving opioid agonist therapy (OR =1.597, 95% CI = 1.27-2.00) during the same month. Magnitude of the 'cheque effect' was positively associated with cocaine injection [rate ratio (RR) = 1.795, 95% CI = 1.43-2.16], unstable housing (RR = 1.198, 95% CI = 1.02-1.38) and frequent injection (RR = 2.938, 95% CI = 2.43-3.44), but inversely associated with opioid agonist therapy (RR = 0.817, 95% CI = 0.68-0.95) and prescription opioid injection (RR = 0.794, 95% CI = 0.66-0.93). CONCLUSION Among people who inject drugs in Montreal, Canada, injection drug use and receptive syringe-sharing appear to be more prevalent in the 2 days after versus before receiving income assistance. The odds and rate of individual-level increases in injection frequency appear to be positively associated with cocaine injection (versus injection of other substances) and unstable housing.
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Affiliation(s)
- Stine Bordier Høj
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Brendan Jacka
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Nanor Minoyan
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, Canada.,Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, Canada
| | - Phélix Bussière
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Julie Bruneau
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, Canada.,Department of Family and Emergency Medicine, Université de Montréal, Montréal, Canada
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20
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Mezaache S, Briand-Madrid L, Rahni L, Poireau J, Branchu F, Moudachirou K, Wendzinski Y, Carrieri P, Roux P. A two-component intervention to improve hand hygiene practices and promote alcohol-based hand rub use among people who inject drugs: a mixed-methods evaluation. BMC Infect Dis 2021; 21:211. [PMID: 33632143 PMCID: PMC7905764 DOI: 10.1186/s12879-021-05895-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 02/12/2021] [Indexed: 11/29/2022] Open
Abstract
Background Inconsistent hand hygiene puts people who inject drugs (PWID) at high risk of infectious diseases, in particular skin and soft tissue infections. In healthcare settings, handwashing with alcohol-based hand rubs (ABRH) is recommended before aseptic procedures including intravenous injections. We aimed to evaluate the acceptability, safety and preliminary efficacy of an intervention combining ABHR provision and educational training for PWID. Methods A mixed-methods design was used including a pre-post quantitative study and a qualitative study. Participants were active PWID recruited in 4 harm reduction programmes of France and followed up for 6 weeks. After baseline assessment, participants received a face-to-face educational intervention. ABHR was then provided throughout the study period. Quantitative data were collected through questionnaires at baseline, and weeks 2 (W2) and 6 (W6) post-intervention. Qualitative data were collected through focus groups with participants who completed the 6-week study. Results Among the 59 participants included, 48 (81%) and 43 (73%) attended W2 and W6 visits, respectively. ABHR acceptability was high and adoption rates were 50% (W2) and 61% (W6). Only a minority of participants reported adverse skin reactions (ranging from 2 to 6%). Preliminary efficacy of the intervention was shown through increased hand hygiene frequency (multivariable linear mixed model: coef. W2 = 0.58, p = 0.002; coef. W6 = 0.61, p = 0.002) and fewer self-reported injecting-related infections (multivariable logistic mixed model: AOR W6 = 0.23, p = 0.021). Two focus groups were conducted with 10 participants and showed that young PWID and those living in unstable housing benefited most from the intervention. Conclusions ABHR for hand hygiene prior to injection are acceptable to and safe for PWID, particularly those living in unstable housing. The intervention’s educational component was crucial to ensure adoption of safe practices. We also provide preliminary evidence of the intervention’s efficacy through increased hand hygiene frequency and a reduced risk of infection. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-05895-1.
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Affiliation(s)
- Salim Mezaache
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France. .,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.
| | - Laélia Briand-Madrid
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Linda Rahni
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | | | | | - Khafil Moudachirou
- Aides, Béziers & Pantin, France.,Laboratoire de Recherche Communautaire, Coalition Plus, Pantin, France
| | | | - Patrizia Carrieri
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Perrine Roux
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
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21
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Iversen J, Maher L. Commentary on Hamilton White et al. : Receptive syringe-sharing among people who inject drugs in rural settings. Addiction 2021; 116:337-338. [PMID: 33179307 DOI: 10.1111/add.15301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/19/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Jenny Iversen
- Faculty of Medicine, University of New South Wales, Kirby Institute for Infection and Immunity, Sydney, Australia
| | - Lisa Maher
- Faculty of Medicine, University of New South Wales, Kirby Institute for Infection and Immunity, Sydney, Australia
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22
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Roux P, Donadille C, Magen C, Schatz E, Stranz R, Curado A, Tsiakou T, Verdes L, Aleksova A, Carrieri P, Mezaache S, Charif Ali B. Implementation and evaluation of an educational intervention for safer injection in people who inject drugs in Europe: a multi-country mixed-methods study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 87:102992. [PMID: 33096364 DOI: 10.1016/j.drugpo.2020.102992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Harm reduction (HR) interventions are essential to reduce human immunodeficiency virus (HIV) and hepatitis C virus (HCV) transmission in people who inject drugs (PWID). Preliminary testing of the Individually Tailored Support and Education for Safer Injection (ITSESI) evidence-based educational intervention for PWID was performed in France in 2011. We created the Eurosider project to implement and evaluate ITSESI at a wider European level, with a view to its future pan-European diffusion. METHODS We performed a mixed-methods study involving quantitative (a 6-month before-after study with PWID) and qualitative (focus groups with field workers) components. The study was conducted in 2018-2019 with 307 eligible PWID participating in four existing HR programmes in Bulgaria, Greece, Portugal, and Romania. ITSESI consists in trained field workers observing PWID injection practices and providing an educational exchange. For the present study, PWID participants were allocated to either the control group (i.e., they continued receiving only the current HR services) or the intervention group (i.e., current HR services plus ITSESI). We used the RE-AIM QuEST framework to assess the effectiveness of ITSESI and its acceptability by field workers. Effectiveness was defined as a reduction in both syringe sharing - the highest HIV/HCV transmission risk practice - and in cutaneous abscesses. We used a multivariable mixed logit model to analyse both effectiveness outcomes and to provide adjusted odds ratios (aOR) and 95% confidence intervals (CI). Field workers' acceptability of the intervention was described using a thematic analysis of the qualitative data. RESULTS Of the 307 PWID, 55% received ITSESI. Syringe sharing and cutaneous abscesses decreased during follow-up in the intervention group (from 25 to 16% and from 27 to 14%, respectively). Reductions were smaller in the control group (from 29 to 24% and from 23 to 18%, respectively). The multivariable analyses confirmed the effect of the intervention on both of these outcomes (aOR [95% CI]: 0.38 [0.17, 0.85]) and (aOR [95% CI]: 0.38 [0.16, 0.90], respectively). Our qualitative data on acceptability showed the feasibility of involving field workers as proactive research partners in making ITSESI more accessible and acceptable across Europe. CONCLUSIONS We demonstrated both the effectiveness of ITSESI in reducing syringe sharing and cutaneous abscesses in four European countries, and a high level of intervention acceptability by field workers. Our findings provide important insights into how ITSESI can be adapted for pan-European implementation.
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Affiliation(s)
- Perrine Roux
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France.
| | - Cécile Donadille
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France
| | - Carine Magen
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France
| | | | | | | | | | | | | | - Patrizia Carrieri
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France
| | - Salim Mezaache
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France
| | - Ben Charif Ali
- VITAM - Centre de recherche en santé durable, Université Laval, QC, Canada; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, QC, Canada
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23
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Rezaei O, Ghiasvand H, Higgs P, Noroozi A, Noroozi M, Rezaei F, Armoon B, Bayani A. Factors associated with injecting-related risk behaviors among people who inject drugs: a systematic review and meta-analysis study. J Addict Dis 2020; 38:420-437. [DOI: 10.1080/10550887.2020.1781346] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Omid Rezaei
- Fellowship of Psychosomatic, Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hesam Ghiasvand
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
- Health Economics Group, Medical School, Saint Luke’s Campus, University of Exeter, Exeter, UK
| | - Peter Higgs
- Department of Public Health, La Trobe University, Melbourne, Australia
| | - Alireza Noroozi
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Noroozi
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Fatemeh Rezaei
- Department of Epidemiology and Biostatics, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Azadeh Bayani
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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24
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Damon W, McNeil R, Milloy MJ, Nosova E, Kerr T, Hayashi K. Residential eviction predicts initiation of or relapse into crystal methamphetamine use among people who inject drugs: a prospective cohort study. J Public Health (Oxf) 2020; 41:36-45. [PMID: 29425315 DOI: 10.1093/pubmed/fdx187] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 11/30/2017] [Accepted: 12/20/2017] [Indexed: 02/03/2023] Open
Abstract
Reports of increasing methamphetamine use among vulnerable populations may be attributed in part to the adaptive use of stimulants in response to the loss of stable housing through residential eviction. We employed multivariable recurrent event extended Cox regression to examine the independent association between recent evictions and initiation of or relapse into crystal methamphetamine use among people who inject drugs in Vancouver, Canada enrolled in two prospective cohort studies. In a multivariable analysis, eviction remained independently associated with methamphetamine initiation or relapse (adjusted hazard ratio = 1.90; 95% confidence interval: 1.31-2.75). Findings demonstrate the need to secure tenancies for drug-using populations to reduce harms.
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Affiliation(s)
- William Damon
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, Canada
| | - Ryan McNeil
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, Canada
| | - M-J Milloy
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, Canada
| | - Ekaterina Nosova
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, Canada
| | - Kanna Hayashi
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, Canada.,Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, Canada
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25
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Bajis S, Grebely J, Hajarizadeh B, Applegate T, Marshall AD, Ellen Harrod M, Byrne J, Bath N, Read P, Edwards M, Gorton C, Hayllar J, Cock V, Peterson S, Thomson C, Weltman M, Jefferies M, Wood W, Haber P, Ezard N, Martinello M, Maher L, Dore GJ. Hepatitis C virus testing, liver disease assessment and treatment uptake among people who inject drugs pre- and post-universal access to direct-acting antiviral treatment in Australia: The LiveRLife study. J Viral Hepat 2020; 27:281-293. [PMID: 31698545 DOI: 10.1111/jvh.13233] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 09/04/2019] [Accepted: 10/07/2019] [Indexed: 02/06/2023]
Abstract
Gaps in hepatitis C virus (HCV) testing, diagnosis, liver disease assessment and treatment uptake among people who inject drugs (PWID) persist. We aimed to describe the cascade of HCV care among PWID in Australia, prior to and following unrestricted access to direct-acting antiviral (DAA) treatment. Participants enrolled in an observational cohort study between 2014 and 2018 provided fingerstick whole-blood samples for dried blood spot, Xpert HCV Viral Load and venepuncture samples. Participants underwent transient elastography and clinical assessment by a nurse or general practitioner. Among 839 participants (mean age 43 years), 66% were male (n = 550), 64% (n = 537) injected drugs in the previous month, and 67% (n = 560) reported currently receiving opioid substitution therapy. Overall, 45% (n = 380) had detectable HCV RNA, of whom 23% (n = 86) received HCV treatment within 12 months of enrolment. HCV treatment uptake increased from 2% in the pre-DAA era to 38% in the DAA era. Significant liver fibrosis (F2-F4) was more common in participants with HCV infection (38%) than those without (19%). Age 50 years or older (aOR, 2.88; 95% CI, 1.18-7.04) and attending a clinical follow-up with nurse (aOR, 3.19; 95% CI, 1.61-6.32) or physician (aOR, 11.83; 95% CI, 4.89-28.59) were associated with HCV treatment uptake. Recent injection drug use and unstable housing were not associated with HCV treatment uptake. HCV treatment uptake among PWID has increased markedly in the DAA era. Evaluation of innovative and simplified models of care is required to further enhance treatment uptake.
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Affiliation(s)
- Sahar Bajis
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | | | - Alison D Marshall
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.,Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | | | - Jude Byrne
- Australian Injecting and Illicit Drug Users League, Canberra, ACT, Australia
| | - Nicky Bath
- NSW Users and AIDS Association, Sydney, NSW, Australia
| | | | - Michael Edwards
- South Western Sydney Local Health District Drug Health Services, Sydney, NSW, Australia
| | - Carla Gorton
- Cairns Sexual Health Service, Cairns, QLD, Australia
| | - Jeremy Hayllar
- Alcohol and Drug Service, Metro North Mental Health, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Victoria Cock
- Drug and Alcohol Services of South Australia, Adelaide, SA, Australia
| | | | - Claire Thomson
- Bayside Alcohol and Drug Services, Cleveland, QLD, Australia
| | | | | | - William Wood
- Sydney Medically Supervised Injecting Centre, Sydney, NSW, Australia
| | - Paul Haber
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Nadine Ezard
- Alcohol and Drug Service, St Vincent's Hospital, Sydney, NSW, Australia.,Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | | | - Lisa Maher
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.,Burnet Institute, Melbourne, Vic, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
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26
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O'Connor A, Harris E, Hamilton D, Fisher C, Sachmann M. The experiences of pregnant women attending a specialist service and using methamphetamine. Women Birth 2020; 34:170-179. [PMID: 32061546 DOI: 10.1016/j.wombi.2020.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pregnant women attending the Specialist Drug and Alcohol Service in Perth use methamphetamine as their primary drug of choice. This is the only tertiary service for pregnant and postnatal women with complex Alcohol and Other Drug Use in Western Australia. It is a midwifery-led multidisciplinary team. Many of the women struggle with addiction, polysubstance use, co-occurring mental health, family and domestic violence, complex trauma and fear of Child Protection and infant removal. Therefore, the aim of this study was to understand the impact of methamphetamine use of pregnant women attending the service and explore and highlight the potential barriers to engagement and follow-up. METHODS A qualitative study informed by phenomenological methods was undertaken using semi-structured interviews with 20 women with methamphetamine use attending the service in order to explore and understand the experience of using methamphetamine in pregnancy and the postpartum period. A thematic analysis was undertaken with data from the women in the study (n=20) to identify key themes. RESULTS Key themes that emerged from the women's experiences detail their resilience and experience with methamphetamine and the impact that methamphetamine has on their life. A key concern for women regarding methamphetamine use and engagement with specialist services was the welfare of their child(ren). Agencies charged with child protection was a barrier to treatment because women feared disclosure of methamphetamine use would result in loss of child custody. Themes highlighted the multiple layers of adversities, and trauma from childhood to adulthood including, co-occurring drug use, mental health and life histories of trauma (abuse, violence, and neglect; intergenerational trauma; intergenerational drug and alcohol use, and child removal), the omnipresence of methamphetamine, and the impact on pregnancy and mothering. CONCLUSION We conclude that understanding the experiences of women and the impact methamphetamine use has on their life is paramount to providing effective and appropriate care to support pregnant women in a trauma-informed and woman-centred approach. Poor engagement in pregnancy care for women with methamphetamine use has significant impacts on mother and infant.
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Affiliation(s)
- Angela O'Connor
- King Edward Memorial Hospital, Australian College of Nursing (ACN), (ACM) Australian College of Midwives, Australia. Angela.O'
| | | | - Dale Hamilton
- King Edward Obstetrics and Gynaecology, FRANZCOG, Australia.
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27
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Fortier E, Sylvestre MP, Artenie AA, Minoyan N, Jutras-Aswad D, Roy É, Grebely J, Bruneau J. Associations between housing stability and injecting frequency fluctuations: findings from a cohort of people who inject drugs in Montréal, Canada. Drug Alcohol Depend 2020; 206:107744. [PMID: 31785537 DOI: 10.1016/j.drugalcdep.2019.107744] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 11/09/2019] [Accepted: 11/14/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The relationship between housing stability and drug injecting is complex, as both outcomes fluctuate over time. The objectives were to identify short-term trajectories of housing stability and injecting frequency among people who inject drugs (PWID) and examine how patterns of injecting frequency relate to those of housing stability. METHODS At three-month intervals, PWID enrolled between 2011 and 2016 in the Hepatitis Cohort completed an interviewer-administered questionnaire and were tested for hepatitis C and HIV infections. At each visit, participants reported, for each of the past three months, the accommodation they lived in the longest (stable/unstable) and the number of injecting days (0-30). Group-based dual trajectory modeling was conducted to identify housing stability and injecting frequency trajectories evolving concomitantly over 12 months and estimate the probabilities of following injecting trajectories conditional upon housing trajectories. RESULTS 386 participants were included (mean age 40.0, 82 % male). Three housing stability trajectories were identified: sustained (53 %), declining (20 %), and improving (27 %). Five injecting frequency trajectories were identified: sporadic (26 %), infrequent (34 %), increasing (15 %), decreasing (11 %), and frequent (13 %). PWID with improving housing were less likely to increase injecting (8 %) compared to those with sustained (17 %) or declining housing (17 %). CONCLUSIONS Improving housing was associated with a lower probability of increasing injecting compared to declining housing, while sustained housing stability was associated with a higher probability of increasing injecting compared to improving housing. Therefore, policies to improve PWID's access to stable housing are warranted and may reduce, to some extent, drug injecting and related harms.
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Affiliation(s)
- Emmanuel Fortier
- CHUM Research Centre, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Marie-Pierre Sylvestre
- CHUM Research Centre, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, QC, Canada
| | - Andreea Adelina Artenie
- CHUM Research Centre, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, QC, Canada
| | - Nanor Minoyan
- CHUM Research Centre, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, QC, Canada
| | - Didier Jutras-Aswad
- CHUM Research Centre, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Élise Roy
- Addiction Research and Study Program, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada; Institut national de santé publique du Québec, Montréal, QC, Canada
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Julie Bruneau
- CHUM Research Centre, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.
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28
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Clustering of hepatitis C virus antibody positivity within households and communities in Punjab, India. Epidemiol Infect 2019; 147:e283. [PMID: 31587676 PMCID: PMC6805795 DOI: 10.1017/s0950268819001705] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
To better understand hepatitis C virus (HCV) epidemiology in Punjab state, India, we estimated the distribution of HCV antibody positivity (anti-HCV+) using a 2013-2014 HCV household seroprevalence survey. Household anti-HCV+ clustering was investigated (a) by individual-level multivariable logistic regression, and (b) comparing the observed frequency of households with multiple anti-HCV+ persons against the expected, simulated frequency assuming anti-HCV+ persons are randomly distributed. Village/ward-level clustering was investigated similarly. We estimated household-level associations between exposures and the number of anti-HCV+ members in a household (N = 1593 households) using multivariable ordered logistic regression. Anti-HCV+ prevalence was 3.6% (95% confidence interval 3.0-4.2%). Individual-level regression (N = 5543 participants) found an odds ratio of 3.19 (2.25-4.50) for someone being anti-HCV+ if another household member was anti-HCV+. Thirty households surveyed had ⩾2 anti-HCV+ members, whereas 0/1000 (P < 0.001) simulations had ⩾30 such households. Excess village-level clustering was evident: 10 villages had ⩾6 anti-HCV+ members, occurring in 31/1000 simulations (P = 0.031). The household-level model indicated the number of household members, living in southern Punjab, lower socio-economic score, and a higher proportion having ever used opium/bhuki were associated with a household's number of anti-HCV+ members. Anti-HCV+ clusters within households and villages in Punjab, India. These data should be used to inform screening efforts.
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29
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Ickowicz S, Salleh NAM, Fairbairn N, Richardson L, Small W, Milloy MJ. Criminal Justice System Involvement as a Risk Factor for Detectable Plasma HIV Viral Load in People Who Use Illicit Drugs: A Longitudinal Cohort Study. AIDS Behav 2019; 23:2634-2639. [PMID: 31236749 PMCID: PMC6773261 DOI: 10.1007/s10461-019-02547-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Among HIV-positive people who use illicit drugs (PWUD) in our setting, repeated periods of incarceration adversely affect ART adherence in a dose-dependent manner. However, the impact of non-custodial criminal justice involvement on HIV-related outcomes has not been previously investigated. Data were obtained from a longitudinal cohort of HIV-positive PWUD in a setting of universal no-cost ART and complete dispensation records. Multivariate generalized estimating equations were used to calculate the longitudinal odds of having a detectable HIV VL (VL) associated with custodial and non-custodial CJS exposure. Between 2005 and 2014, 716 HIV-positive ART-exposed PWUD were recruited. In multivariate analysis, both custodial [Adjusted odds ratio (AOR) 0.61, 95% CI 0.45-0.82] and noncustodial (AOR 0.78, 95% CI 0.62-0.99) involvement in the criminal justice system was associated with detectable HIV VL. Among HIV-positive PWUD, both custodial and non-custodial criminal justice involvement is associated with worse HIV treatment outcomes. Our findings highlight the need for increased ART adherence support across the full spectrum of the criminal justice system.
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Affiliation(s)
- Sarah Ickowicz
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - N A Mohd Salleh
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Lindsey Richardson
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Sociology, University of British Columbia, Vancouver, BC, Canada
| | - Will Small
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, Vancouver, BC, Canada.
- Department of Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
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30
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Bajis S, Grebely J, Cooper L, Smith J, Owen G, Chudleigh A, Hajarizadeh B, Martinello M, Adey S, Read P, Gilliver R, Applegate T, Treloar C, Maher L, Dore GJ. Hepatitis C virus testing, liver disease assessment and direct-acting antiviral treatment uptake and outcomes in a service for people who are homeless in Sydney, Australia: The LiveRLife homelessness study. J Viral Hepat 2019; 26:969-979. [PMID: 30980785 DOI: 10.1111/jvh.13112] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/27/2019] [Accepted: 03/18/2019] [Indexed: 01/22/2023]
Abstract
People who are homeless have increased hepatitis C virus (HCV) infection risk, and are less likely to access primary healthcare. We aimed to evaluate HCV RNA prevalence, liver disease burden, linkage to care and treatment uptake and outcomes among people attending a homelessness service in Sydney. Participants were enrolled in an observational cohort study with recruitment at a homelessness service over eight liver health campaign days. Finger-stick whole-blood samples for Xpert® HCV Viral Load and venepuncture blood samples were collected. Participants completed a self-administered survey and received transient elastography and clinical assessment by a general practitioner or nurse. Clinical follow-up was recommended 2-12 weeks after enrolment. For participants initiating direct-acting antiviral (DAA) therapy, medical records were audited retrospectively and treatment outcome data were collected. Among 202 participants (mean age, 48 years), 82% were male (n = 165), 39% (n = 78) reported ever injecting drugs, of whom 63% (n = 49) injected in the previous month. Overall, 23% (n = 47) had detectable HCV RNA and 6% (n=12) had cirrhosis. HCV RNA prevalence among participants with either injecting or incarceration history was 35% (37/105), compared to 4% (3/73) among participants without these risk factors. Among those with detectable HCV RNA, 23 (49%) commenced therapy, of whom 65% (n = 15) achieved sustained virological response, while the remainder had no available treatment outcome. No participant had documented virological failure. HCV DAA treatment uptake among people attending a homelessness service was encouraging, but innovative models of HCV care are required to improve linkage to care and treatment uptake among this highly marginalized population.
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Affiliation(s)
- Sahar Bajis
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Lucy Cooper
- Matthew Talbot Hostel, St Vincent de Paul Society NSW Support Services, Sydney, New South Wales, Australia
| | - Julie Smith
- Matthew Talbot Hostel, St Vincent de Paul Society NSW Support Services, Sydney, New South Wales, Australia
| | - Greg Owen
- Matthew Talbot Hostel, St Vincent de Paul Society NSW Support Services, Sydney, New South Wales, Australia
| | - Alan Chudleigh
- Matthew Talbot Hostel, St Vincent de Paul Society NSW Support Services, Sydney, New South Wales, Australia
| | | | | | - Sara Adey
- NSW Users and AIDS Association, Sydney, New South Wales, Australia
| | - Phillip Read
- Kirketon Road Centre, Sydney, New South Wales, Australia
| | | | - Tanya Applegate
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Lisa Maher
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
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Ireland G, Simmons R, Hickman M, Eastwood B, Ramsay M, Mandal S. Mapping the hepatitis C cascade of care in people attending drug treatment services in England: A data linkage study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 72:55-60. [PMID: 31257040 DOI: 10.1016/j.drugpo.2019.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 06/07/2019] [Accepted: 06/07/2019] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Hepatitis C (HCV) infection in England primarily affects people who inject drugs (PWID). We describe persons HCV tested, estimate incidence and establish the cascade of care (CoC) for people engaging with drug services. METHODS Persons testing for HCV in drug services in Sentinel Surveillance of Blood Borne Virus Testing (SSBBV) between 2008 and 2016 were linked with people attending drug services in the National Drug and Treatment Monitoring System (NDTMS). We describe risk characteristics, establish the CoC, and estimate HCV incidence in PWID diagnosed in drug services. RESULTS Of 46,721 persons tested for anti-HCV in SSBBV in drug services, 29,773 (63.7%) linked to NDTMS. Of these, 9100 (30.6%) were antiV positive and anti-HCV positivity was 45.0% in persons reporting urgent housing problems and 43.8% in persons reporting ever injecting. Among persons anti-HCV positive, half had ≥1 positive anti-HCV test. For persons' first anti-HCV positive between 2008 and 2013 (n = 3123), 74.9% were HCV RNA tested, of whom 71.2% were RNA positive, and of these, 14.0% had evidence of interferon-based treatment, with 52.8% achieving cure. Among PWID, HCV incidence was 8.7 per 100 person-years (95% CI: 8.1-9.2). CONCLUSION Through record linkage of surveillance datasets, we estimated the HCV CoC for people attending drug services, providing a benchmark from which to monitor the impact of strategies to scale-up prevention, testing, and curative treatment with direct acting antivirals. Our study highlights wasteful repeated testing and poor linkage to care for this high risk population which need to be addressed.
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Affiliation(s)
- G Ireland
- National Infection Service, Public Health England, UK; The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London, UK.
| | - R Simmons
- National Infection Service, Public Health England, UK; The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London, UK
| | - M Hickman
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Evaluation of Interventions at University of Bristol, UK; Population Health Sciences, Bristol Medical School, UK
| | - B Eastwood
- Alcohol, Drugs, Tobacco and Justice Division, Health Improvement Directorate, Public Health England, UK
| | - M Ramsay
- National Infection Service, Public Health England, UK
| | - S Mandal
- National Infection Service, Public Health England, UK; The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London, UK
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32
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Harney BL, Whitton B, Lim C, Paige E, McDonald B, Nolan S, Pemberton D, Hellard ME, Doyle JS. Quantitative evaluation of an integrated nurse model of care providing hepatitis C treatment to people attending homeless services in Melbourne, Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 72:195-198. [PMID: 30981613 DOI: 10.1016/j.drugpo.2019.02.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/27/2019] [Accepted: 02/28/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND The prevalence of hepatitis C virus (HCV) has been reported to be high among people experiencing homelessness. People who are homeless often have multiple needs that may take precedence over HCV testing and treatment. We quantitatively evaluated the outcomes of a service providing HCV treatment to people attending homeless services. METHODS Clients attending homeless services were referred to a nurse specialising in HCV-related care. The nurse provided HCV testing, education and case-management while prescriptions were provided by an affiliated doctor. Logistic regression was used to explore factors associated with treatment commencement. RESULTS Fifty-two clients referred (78%) underwent testing, thirty-nine were HCV-RNA positive among whom 18 (46%) reported sleeping rough and 29 (74%) reported injecting drug use; 66% had injected less than three months ago. Twenty-four (62%) clients commenced treatment, of whom thirteen (54%) had a sustained virological response test; all were cured. Treatment commencement was lower among people who reported sleeping rough (aOR 0.15, 95%CI 0.029-0.73). There was no difference in treatment commencement based on injecting drugs (aOR 1.06, 95%CI 0.21-5.2). CONCLUSION Most clients' commenced treatment and the majority were successfully cured using a dedicated nursing service. Clients who reported sleeping rough may still face personal and/or system level barriers to HCV treatment.
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Affiliation(s)
- Brendan L Harney
- Department of Infectious Diseases, Alfred Health & Monash University, 85 Commercial Road, Melbourne, Victoria, 3004, Australia; Disease Elimination Program, Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Melbourne, Australia.
| | - Bradley Whitton
- Department of Infectious Diseases, Alfred Health & Monash University, 85 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Cheryl Lim
- Department of Infectious Diseases, Alfred Health & Monash University, 85 Commercial Road, Melbourne, Victoria, 3004, Australia; Star Health, 341 Coventry St, South Melbourne, Victoria, 3205, Australia
| | - Emma Paige
- Department of Infectious Diseases, Alfred Health & Monash University, 85 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Belinda McDonald
- Star Health, 341 Coventry St, South Melbourne, Victoria, 3205, Australia
| | - Sarah Nolan
- Star Health, 341 Coventry St, South Melbourne, Victoria, 3205, Australia; Launch Housing, 52 Haig St, Southbank, Victoria, 3205, Australia
| | - David Pemberton
- Star Health, 341 Coventry St, South Melbourne, Victoria, 3205, Australia; Launch Housing, 52 Haig St, Southbank, Victoria, 3205, Australia
| | - Margaret E Hellard
- Department of Infectious Diseases, Alfred Health & Monash University, 85 Commercial Road, Melbourne, Victoria, 3004, Australia; Disease Elimination Program, Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Melbourne, Australia
| | - Joseph S Doyle
- Department of Infectious Diseases, Alfred Health & Monash University, 85 Commercial Road, Melbourne, Victoria, 3004, Australia; Disease Elimination Program, Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Melbourne, Australia
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Sweeney S, Ward Z, Platt L, Guinness L, Hickman M, Hope V, Maher L, Iversen J, Hutchinson SJ, Smith J, Ayres R, Hainey I, Vickerman P. Evaluating the cost-effectiveness of existing needle and syringe programmes in preventing hepatitis C transmission in people who inject drugs. Addiction 2019; 114:560-570. [PMID: 30674091 DOI: 10.1111/add.14519] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 07/06/2018] [Accepted: 11/26/2018] [Indexed: 12/12/2022]
Abstract
AIM To evaluate the cost-effectiveness of needle and syringe programmes (NSPs) compared with no NSPs on hepatitis C virus (HCV) transmission in the United Kingdom. DESIGN Cost-effectiveness analysis from a National Health Service (NHS)/health-provider perspective, utilizing a dynamic transmission model of HCV infection and disease progression, calibrated using city-specific surveillance and survey data, and primary data collection on NSP costs. The effectiveness of NSPs preventing HCV acquisition was based on empirical evidence. SETTING AND PARTICIPANTS UK settings with different chronic HCV prevalence among people who inject drugs (PWID): Dundee (26%), Walsall (18%) and Bristol (45%) INTERVENTIONS: Current NSP provision is compared with a counterfactual scenario where NSPs are removed for 10 years and then returned to existing levels with effects collected for 40 years. MEASUREMENTS HCV infections and cost per quality-adjusted life year (QALY) gained through NSPs over 50 years. FINDINGS Compared with a willingness-to-pay threshold of £20 000 per QALY gained, NSPs were highly cost-effective over a time-horizon of 50 years and decreased the number of HCV incident infections. The mean incremental cost-effectiveness ratio was cost-saving in Dundee and Bristol, and £596 per QALY gained in Walsall, with 78, 46 and 40% of simulations being cost-saving in each city, respectively, with differences driven by coverage of NSP and HCV prevalence (lowest in Walsall). More than 90% of simulations were cost-effective at the willingness-to-pay threshold. Results were robust to sensitivity analyses, including varying the time-horizon, HCV treatment cost and numbers of HCV treatments per year. CONCLUSIONS Needle and syringe programmes are a highly effective low-cost intervention to reduce hepatitis C virus transmission, and in some settings they are cost-saving. Needle and syringe programmes are likely to remain cost-effective irrespective of changes in hepatitis C virus treatment cost and scale-up.
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Affiliation(s)
- Sedona Sweeney
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Zoe Ward
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Lorna Guinness
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Matthew Hickman
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Vivian Hope
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Lisa Maher
- Kirby Institute for Infection and Immunity, UNSW, Sydney, Australia
| | - Jenny Iversen
- Kirby Institute for Infection and Immunity, UNSW, Sydney, Australia
| | | | - Josie Smith
- Public Health Wales, Cardiff, Wales, UK, CF10 4BZ
| | | | | | - Peter Vickerman
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
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Chronister KJ, Lothian R, Gilliver R, Kearley J, Read P. Feasibility and acceptability of adherence support for direct acting antiviral therapy for hepatitis C in a low-threshold primary health-care opioid agonist treatment program. Drug Alcohol Rev 2019; 38:185-189. [DOI: 10.1111/dar.12903] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 12/13/2018] [Accepted: 12/16/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Karen J. Chronister
- Kirketon Road Centre, South Eastern Sydney Local Health District; Sydney Australia
- Kirby Institute; UNSW Sydney; Sydney Australia
| | - Rebecca Lothian
- Kirketon Road Centre, South Eastern Sydney Local Health District; Sydney Australia
| | - Rosie Gilliver
- Kirketon Road Centre, South Eastern Sydney Local Health District; Sydney Australia
| | - John Kearley
- Kirketon Road Centre, South Eastern Sydney Local Health District; Sydney Australia
| | - Phillip Read
- Kirketon Road Centre, South Eastern Sydney Local Health District; Sydney Australia
- Kirby Institute; UNSW Sydney; Sydney Australia
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35
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Stone J, Fraser H, Lim AG, Walker JG, Ward Z, MacGregor L, Trickey A, Abbott S, Strathdee SA, Abramovitz D, Maher L, Iversen J, Bruneau J, Zang G, Garfein RS, Yen YF, Azim T, Mehta SH, Milloy MJ, Hellard ME, Sacks-Davis R, Dietze PM, Aitken C, Aladashvili M, Tsertsvadze T, Mravčík V, Alary M, Roy E, Smyrnov P, Sazonova Y, Young AM, Havens JR, Hope VD, Desai M, Heinsbroek E, Hutchinson SJ, Palmateer NE, McAuley A, Platt L, Martin NK, Altice FL, Hickman M, Vickerman P. Incarceration history and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2018; 18:1397-1409. [PMID: 30385157 PMCID: PMC6280039 DOI: 10.1016/s1473-3099(18)30469-9] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/30/2018] [Accepted: 07/12/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND People who inject drugs (PWID) experience a high prevalence of incarceration and might be at high risk of HIV and hepatitis C virus (HCV) infection during or after incarceration. We aimed to assess whether incarceration history elevates HIV or HCV acquisition risk among PWID. METHODS In this systematic review and meta-analysis, we searched MEDLINE, Embase, and PsycINFO databases for studies in any language published from Jan 1, 2000 until June 13, 2017 assessing HIV or HCV incidence among PWID. We included studies that measured HIV or HCV incidence among community-recruited PWID. We included only studies reporting original results and excluded studies that evaluated incident infections by self-report. We contacted authors of cohort studies that met the inclusion or exclusion criteria, but that did not report on the outcomes of interest, to request data. We extracted and pooled data from the included studies using random-effects meta-analyses to quantify the associations between recent (past 3, 6, or 12 months or since last follow-up) or past incarceration and HIV or HCV acquisition (primary infection or reinfection) risk among PWID. We assessed the risk of bias of included studies using the Newcastle-Ottawa Scale. Between-study heterogeneity was evaluated using the I2 statistic and the P-value for heterogeneity. FINDINGS We included published results from 20 studies and unpublished results from 21 studies. These studies originated from Australasia, western and eastern Europe, North and Latin America, and east and southeast Asia. Recent incarceration was associated with an 81% (relative risk [RR] 1·81, 95% CI 1·40-2·34) increase in HIV acquisition risk, with moderate heterogeneity between studies (I2=63·5%; p=0·001), and a 62% (RR 1·62, 95% CI 1·28-2·05) increase in HCV acquisition risk, also with moderate heterogeneity between studies (I2=57·3%; p=0·002). Past incarceration was associated with a 25% increase in HIV (RR 1·25, 95% CI 0·94-1·65) and a 21% increase in HCV (1·21, 1·02-1·43) acquisition risk. INTERPRETATION Incarceration is associated with substantial short-term increases in HIV and HCV acquisition risk among PWID and could be a significant driver of HCV and HIV transmission among PWID. These findings support the need for developing novel interventions to minimise the risk of HCV and HIV acquisition, including addressing structural risks associated with drug laws and excessive incarceration of PWID. FUNDING Engineering and Physical Sciences Research Council, National Institute for Health Research, National Institutes of Health.
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Affiliation(s)
- Jack Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Hannah Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Aaron G Lim
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Josephine G Walker
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Zoe Ward
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Louis MacGregor
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Adam Trickey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sam Abbott
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Daniela Abramovitz
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Lisa Maher
- Kirby Institute for Infection and Immunity, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Jenny Iversen
- Kirby Institute for Infection and Immunity, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Julie Bruneau
- Department of Family Medicine, Université de Montréal, Montréal, QC, Canada; Centre hospitalier de l'Université de Montreal, Montréal, QC, Canada
| | - Geng Zang
- Centre hospitalier de l'Université de Montreal, Montréal, QC, Canada
| | - Richard S Garfein
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Yung-Fen Yen
- Section of Infectious Diseases, Taipei City Hospital, Taipei City Government, Taipei, Taiwan
| | - Tasnim Azim
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael-John Milloy
- BC Centre for Excellence in HIV/AIDS and Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Margaret E Hellard
- Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Rachel Sacks-Davis
- Burnet Institute, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | | | | | - Malvina Aladashvili
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Tengiz Tsertsvadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; Faculty of Medicine, Tbilisi State University, Tbilisi, Georgia
| | - Viktor Mravčík
- National Monitoring Centre for Drugs and Addiction, Prague, Czech Republic; Department of Addictology, The First Medical Faculty, Charles University and General University Hospital in Prague, Prague, Czech Republic; National Institute of Mental Health, Klecany, Czech Republic
| | - Michel Alary
- University Hospital Centre of Québec Research Centre-Laval University, QC, Canada; National Institute of Public Health of Québec, QC, Canada
| | - Elise Roy
- National Institute of Public Health of Québec, QC, Canada; Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, QC, Canada
| | - Pavlo Smyrnov
- International Charitable Foundation Alliance for Public Health, Kiev, Ukraine
| | - Yana Sazonova
- International Charitable Foundation Alliance for Public Health, Kiev, Ukraine
| | - April M Young
- Department of Epidemiology, University of Kentucky College of Public Health, KY, USA; Center on Drug and Alcohol Research, University of Kentucky, KY, USA
| | - Jennifer R Havens
- Center on Drug and Alcohol Research, University of Kentucky, KY, USA
| | - Vivian D Hope
- Public Health Institute, Liverpool John Moores University, Liverpool, UK; National Infection Service, Public Health England, London, UK
| | - Monica Desai
- National Infection Service, Public Health England, London, UK
| | | | - Sharon J Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, National Health Service National Services Scotland, Glasgow, UK
| | - Norah E Palmateer
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, National Health Service National Services Scotland, Glasgow, UK
| | - Andrew McAuley
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Natasha K Martin
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Frederick L Altice
- Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Abstract
Purpose
The Uniting Medically Supervised Injecting Centre (MSIC) opened in Sydney, Australia, in May 2001. Homelessness among people who inject drugs (PWID) in Australia has been increasing, and establishing how supervised injecting facilities (SIFs) might best support clients into housing is an important goal. The purpose of this paper is to update knowledge regarding the accommodation status of MSIC clients, thereby supporting a better understanding of the complex needs of these clients.
Design/methodology/approach
Client accommodation status at MSIC registration (first visit) and in a brief survey (conducted in May 2016) were compared; unstable accommodation was defined as rough sleeping, couch surfing, hostel, boarding house or crisis accommodation. The bivariate logistic regression analysis was used to explore the association between socio-demographics and accommodation status at both time points; a paired t-test was used to compare the visit records for those who reported stable and unstable accommodation in May 2016.
Findings
Of 232 clients who were present at MSIC during the week the Brief Survey was conducted, 107 participated. Most were male (79 per cent) with a mean age of 41.4 years. A total of 64 (60 per cent) identified as living in unstable accommodation; having increased from 40 per cent at the time of registration (first visit). There were significant positive associations between unstable accommodation status and unemployment, imprisonment and history of overdose, all measured at registration. In May 2016, unstable accommodation status was significantly associated with age of first injection and with unemployment status (as measured at registration); those living in unstable accommodation in May 2016 had a lower number of visits, a lower number of referrals to health and social services and a lower number of overdoses at MSIC than those living in a stable accommodation.
Originality/value
The rates of unstable accommodation among MSIC clients have been increasing. These findings highlight the importance of SIFs and drug consumption rooms as venue to address the essential needs of PWID, such as housing. The window of opportunity to support PWID who experience housing instability seems to be narrower than for those who live in stable accommodation.
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Syringe Sharing Among a Prospective Cohort of Street-Involved Youth: Implications for Needle Distribution Programs. AIDS Behav 2017; 21:2717-2725. [PMID: 28409267 DOI: 10.1007/s10461-017-1762-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The sharing of previously used syringes is associated with the transmission of Hepatitis C and HIV. This longitudinal study examines syringe borrowing and syringe lending within a prospective cohort of street-involved youth in Vancouver, Canada. From September 2005 to May 2014, data were collected from the At-Risk Youth Study, a cohort of street-involved youth age 14-26 at enrollment, and analyzed using generalized estimating equations. Among 505 participants, 142 (28.1%) reported syringe borrowing and 132 (26.1%) reported syringe lending during the study period. In separate multivariable analyses, having difficulty finding clean needles and homelessness were significantly associated with syringe borrowing (Adjusted Odds Ratio (AOR) = 2.28, 95% CI 1.66-3.12 and AOR = 1.52, CI 1.05-2.21, respectively) and syringe lending (AOR = 1.89, 95% CI 1.32-2.71 and AOR = 1.65, 95% CI 1.11-2.44, respectively) (all p values < 0.05). Findings highlight gaps in syringe access for vulnerable young injectors and suggest that service delivery for youth may be suboptimal. Further examination of how needle distribution efforts might be improved to better meet the needs of young people is warranted.
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38
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Read P, Lothian R, Chronister K, Gilliver R, Kearley J, Dore GJ, van Beek I. Delivering direct acting antiviral therapy for hepatitis C to highly marginalised and current drug injecting populations in a targeted primary health care setting. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 47:209-215. [DOI: 10.1016/j.drugpo.2017.05.032] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 04/28/2017] [Accepted: 05/08/2017] [Indexed: 12/18/2022]
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Stone J, Martin NK, Hickman M, Hutchinson SJ, Aspinall E, Taylor A, Munro A, Dunleavy K, Peters E, Bramley P, Hayes PC, Goldberg DJ, Vickerman P. Modelling the impact of incarceration and prison-based hepatitis C virus (HCV) treatment on HCV transmission among people who inject drugs in Scotland. Addiction 2017; 112:1302-1314. [PMID: 28257600 PMCID: PMC5461206 DOI: 10.1111/add.13783] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 10/05/2016] [Accepted: 02/01/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND AIMS People who inject drugs (PWID) experience high incarceration rates, and previous incarceration is associated with elevated hepatitis C virus (HCV) transmission risk. In Scotland, national survey data indicate lower HCV incidence in prison than the community (4.3 versus 7.3 per 100 person-years), but a 2.3-fold elevated transmission risk among recently released (< 6 months) PWID. We evaluated the contribution of incarceration to HCV transmission among PWID and the impact of prison-related prevention interventions, including scaling-up direct-acting antivirals (DAAs) in prison. DESIGN Dynamic mathematical modelling of incarceration and HCV transmission, using approximate Bayesian computation for model calibration. SETTING Scotland, UK. PARTICIPANTS A simulated population of PWID. MEASUREMENTS Population-attributable fraction (PAF) of incarceration to HCV transmission among PWID. Decrease in HCV incidence and chronic prevalence due to current levels of prison opiate substitution therapy (OST; 57% coverage) and HCV treatment, as well as scaling-up DAAs in prison and/or preventing the elevated risk associated with prison release. FINDINGS Incarceration contributes 27.7% [PAF; 95% credible interval (CrI) -3.1 to 51.1%] of HCV transmission among PWID in Scotland. During the next 15 years, current HCV treatment rates (10.4/6.8 per 1000 incarcerated/community PWID annually), with existing prison OST, could reduce incidence and chronic prevalence among all PWID by a relative 10.7% (95% CrI = 8.4-13.3%) and 9.7% (95% CrI = 7.7-12.1%), respectively. Conversely, without prison OST, HCV incidence and chronic prevalence would decrease by 3.1% (95% CrI = -28.5 to 18.0%) and 4.7% (95% CrI = -11.3 to 14.5%). Additionally, preventing the heightened risk among recently released PWID could reduce incidence and chronic prevalence by 45.0% (95% CrI = 19.7-57.5%) and 33.3% (95% CrI = 15.6-43.6%) or scaling-up prison HCV treatments to 80% of chronic PWID prison entrants with sufficient sentences (>16 weeks) could reduce incidence and prevalence by 45.6% (95% CrI = 38.0-51.3%) and 45.5% (95% CrI = 39.3-51.0%), respectively. CONCLUSIONS Incarceration and the elevated transmission risk following prison release can contribute significantly to hepatitis C virus transmission among people who inject drugs. Scaling-up hepatitis C virus treatment in prison can provide important prevention benefits.
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Affiliation(s)
- Jack Stone
- School of Social and Community MedicineUniversity of Bristol, BristolUK
| | - Natasha K. Martin
- School of Social and Community MedicineUniversity of Bristol, BristolUK,Division of Global Public HealthUniversity of California San DiegoSan DiegoCAUSA
| | - Matthew Hickman
- School of Social and Community MedicineUniversity of Bristol, BristolUK
| | - Sharon J. Hutchinson
- School of Health and Life SciencesGlasgow Caledonian University, GlasgowUK,Health Protection ScotlandGlasgowUK
| | - Esther Aspinall
- School of Health and Life SciencesGlasgow Caledonian University, GlasgowUK,Health Protection ScotlandGlasgowUK
| | - Avril Taylor
- School of Media, Culture and SocietyUniversity of the West of Scotland, PaisleyUK
| | - Alison Munro
- School of Media, Culture and SocietyUniversity of the West of Scotland, PaisleyUK
| | - Karen Dunleavy
- School of Media, Culture and SocietyUniversity of the West of Scotland, PaisleyUK
| | | | - Peter Bramley
- NHS Forth Valley Viral Hepatitis Service, StirlingUK
| | - Peter C. Hayes
- Division of Health SciencesRoyal Infirmary Edinburgh, EdinburghUK
| | - David J. Goldberg
- School of Health and Life SciencesGlasgow Caledonian University, GlasgowUK,Health Protection ScotlandGlasgowUK
| | - Peter Vickerman
- School of Social and Community MedicineUniversity of Bristol, BristolUK
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Goodhew M, Salmon AM, Marel C, Mills KL, Jauncey M. Mental health among clients of the Sydney Medically Supervised Injecting Centre (MSIC). Harm Reduct J 2016; 13:29. [PMID: 27733167 PMCID: PMC5062820 DOI: 10.1186/s12954-016-0117-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 09/24/2016] [Indexed: 11/10/2022] Open
Abstract
The Sydney Medically Supervised Injecting Centre (MSIC) is a supervised injecting facility (SIF) where people who inject drugs (PWID) can do so legally, under health professional supervision. The majority of clients have low levels of education and employment, high rates of incarceration and unstable housing and poor social networks, and 70 % do not access local health services. These factors increase the risk of poor mental health, and it has been documented that PWID have elevated rates of mood, anxiety, personality and psychotic disorders; post-traumatic stress disorder (PTSD); and higher rates of trauma exposure, suicidality and self-harm. The current study is the first to investigate the mental health among clients of a SIF. Validated instruments to examine clients' mental health, social networks and trauma histories were administered to 50 frequently attending clients by a mental health nurse. The majority of respondents were unemployed, homeless and had a history of incarceration, and 82 % report they had been diagnosed with a mental health problem, but only 24 % report they were receiving treatment. Respondents had poor social networks, had poorer mental health symptoms compared to US inpatients and had experienced multiple traumatic events, and a high number of respondents had scores indicative of PTSD. These results highlight the need for mental health clinicians to be employed in SIFs and other drug consumption rooms (DCRs) to assist clients to address their mental health and psychosocial needs, particularly in light of the fact that these services are often the only places these PWID engage with in an ongoing way.
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Affiliation(s)
- Mark Goodhew
- Sydney Medically Supervised Injecting Centre, PO Box 293, Kings Cross, Sydney, NSW, 1340, Australia.
| | - Allison M Salmon
- Sydney Medically Supervised Injecting Centre, PO Box 293, Kings Cross, Sydney, NSW, 1340, Australia
| | - Christina Marel
- Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, Australia
| | - Katherine L Mills
- Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, Australia
| | - Marianne Jauncey
- Sydney Medically Supervised Injecting Centre, PO Box 293, Kings Cross, Sydney, NSW, 1340, Australia
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Folch C, Casabona J, Espelt A, Majó X, Meroño M, Gonzalez V, Wiessing L, Colom J, Brugal MT. High Prevalence and Incidence of HIV and HCV Among New Injecting Drug Users With a Large Proportion of Migrants--Is Prevention Failing? Subst Use Misuse 2016; 51:250-60. [PMID: 26820260 DOI: 10.3109/10826084.2015.1092991] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The aim of this study was to assess differences in the prevalence of HIV and HCV infection and associated risk factors between new (injecting for ≤5 years) and long-term injectors and to estimate HIV/HCV incidence among new injectors. METHODS Cross-sectional study among people who inject drugs (PWID) who attended harm reduction centers in Catalonia in 2010-11. Anonymous questionnaires and oral fluid samples were collected. Poisson regression models were applied to determine the association between HIV/HCV infection and risk factors. RESULTS Of the 761 participants, 21.4% were new injectors. New injectors were younger than long-term injectors (mean age = 31.6 vs. 37.8) and were more likely to be immigrants (59.0% vs. 33.4%). HIV and HCV prevalence was 20.6% and 59.4% among new injectors, and estimated HIV and HCV incidence 8.7 and 25.1 /100 person-years, respectively. Among new injectors, HIV infection was associated with homelessness (PR = 3.10) and reporting a previous sexually transmitted infection (PR = 1.79). Reporting front/backloading (PR = 1.33) and daily injection (PR = 1.35) were risk-factors for HCV infection. For long-term injectors, HIV risk factors were: having shared syringes (PR = 1.85), having injected cocaine (PR = 1.38), reporting front/backloading (PR = 1.30) and ever having been in prison (PR = 2.03). CONCLUSION A large proportion of PWID in Catalonia are new injectors, a subgroup with a high level of both sexual and parenteral exposure and a high incidence rate of HIV/ HCV infections. It is important to improve early diagnosis of these infections among this group, in particular among migrants. To identify and address risk factors for homelessness PWID should be a priority.
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Affiliation(s)
- Cinta Folch
- a Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agéncia de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya , Badalona , Spain.,b CIBER Epidemiología y Salud Pública (CIBERESP) , Spain.,c Fundació Institut d'Investigació Germans Trias i Pujol (IGTP) , Badalona , Spain
| | - Jordi Casabona
- a Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agéncia de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya , Badalona , Spain.,b CIBER Epidemiología y Salud Pública (CIBERESP) , Spain.,c Fundació Institut d'Investigació Germans Trias i Pujol (IGTP) , Badalona , Spain.,d Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Pública, Facultat de Medicina, Universitat Autònoma de Barcelona , Bellaterra (Cerdanyola del Vallés) , Spain
| | - Albert Espelt
- b CIBER Epidemiología y Salud Pública (CIBERESP) , Spain.,e Agéncia de Salut Pública de Barcelona , Spain.,f Departament de Psicologia i Metodologia de les Ciéncies de la Salut, Universitat Autònoma de Barcelona , Bellaterra (Cerdanyola del Vallés) , Spain
| | - Xavier Majó
- g Subdirecció General de Drogodependéncies, Agéncia Salut Pública de Catalunya (ASPC), Departament de Salut de la Generalitat de Catalunya
| | | | - Victoria Gonzalez
- a Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agéncia de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya , Badalona , Spain.,b CIBER Epidemiología y Salud Pública (CIBERESP) , Spain.,i Microbiology Service, Hospital Universitari Germans Trias i Pujol , Badalona , Spain
| | - Lucas Wiessing
- j European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) , Lisbon , Portugal
| | - Joan Colom
- g Subdirecció General de Drogodependéncies, Agéncia Salut Pública de Catalunya (ASPC), Departament de Salut de la Generalitat de Catalunya
| | - M Teresa Brugal
- b CIBER Epidemiología y Salud Pública (CIBERESP) , Spain.,e Agéncia de Salut Pública de Barcelona , Spain
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42
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Fortier E, Alavi M, Micallef M, Dunlop AJ, Balcomb AC, Day CA, Treloar C, Bath N, Haber PS, Dore GJ, Bruneau J, Grebely J. The effect of social functioning and living arrangement on treatment intent, specialist assessment and treatment uptake for hepatitis C virus infection among people with a history of injecting drug use: The ETHOS study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:1094-102. [DOI: 10.1016/j.drugpo.2015.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 05/11/2015] [Accepted: 06/02/2015] [Indexed: 12/11/2022]
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43
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Whittaker E, Swift W, Roxburgh A, Dietze P, Cogger S, Bruno R, Sindicich N, Burns L. Multiply disadvantaged: Health and service utilisation factors faced by homeless injecting drug consumers in Australia. Drug Alcohol Rev 2015; 34:379-87. [DOI: 10.1111/dar.12257] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 01/20/2015] [Indexed: 11/29/2022]
Affiliation(s)
| | - Wendy Swift
- NHMRC Centre of Research Excellence in Mental Health and Substance Use; National Drug and Alcohol Research Centre; UNSW; Sydney Australia
| | - Amanda Roxburgh
- National Drug and Alcohol Research Centre; UNSW; Sydney Australia
| | - Paul Dietze
- Centre for Population Health; Burnet Institute; Melbourne Australia
| | - Shelley Cogger
- Centre for Population Health; Burnet Institute; Melbourne Australia
| | - Raimondo Bruno
- National Drug and Alcohol Research Centre; UNSW; Sydney Australia
- School of Medicine; University of Tasmania; Hobart Australia
| | | | - Lucy Burns
- National Drug and Alcohol Research Centre; UNSW; Sydney Australia
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44
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Zivanovic R, Milloy MJ, Hayashi K, Dong H, Sutherland C, Kerr T, Wood E. Impact of unstable housing on all-cause mortality among persons who inject drugs. BMC Public Health 2015; 15:106. [PMID: 25884182 PMCID: PMC4389703 DOI: 10.1186/s12889-015-1479-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 01/27/2015] [Indexed: 11/10/2022] Open
Abstract
Background Illicit drug injecting is a well-established risk factor for morbidity and mortality. However, a limited number of prospective studies have examined the independent effect of unstable housing on mortality among persons who inject drugs (PWIDs). In this study we sought to identify if a relationship exists between unstable housing and all-cause mortality among PWIDs living in Vancouver, Canada. Methods PWIDs participating in two prospective cohort studies in Vancouver, Canada were followed between May 1996 and December 2012. Cohort data were linked to the provincial vital statistics database to ascertain mortality rates and causes of death. We used multivariate Cox proportional hazards regression to determine factors associated with all-cause mortality and to investigate the independent relationship between unstable housing and time to all-cause mortality. Results During the study period, 2453 individuals were followed for a median of 69 months (Inter-quartile range [IQR]: 34 – 113). In total, there were 515 (21.0%) deaths for an incidence density of 3.1 (95% Confidence Interval [CI]: 2.8 – 3.4) deaths per 100 person years. In multivariate analyses, after adjusting for potential confounders including HIV infection and drug use patterns, unstable housing remained independently associated with all-cause mortality (adjusted hazard ratio [AHR] = 1.30, 95% CI: 1.08 – 1.56). Conclusions These findings demonstrate that unstable housing is an important risk factor for mortality independent of known risk factors including HIV infection and patterns of drug use. This study highlights the urgent need to provide supportive housing interventions to address elevated levels of preventable mortality among this population.
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Affiliation(s)
- Rebecca Zivanovic
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, 608-1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada. .,Department of Medicine, University of British Columbia, Vancouver, Canada.
| | - M J Milloy
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, 608-1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada. .,Department of Medicine, University of British Columbia, Vancouver, Canada.
| | - Kanna Hayashi
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, 608-1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada. .,Department of Medicine, University of British Columbia, Vancouver, Canada.
| | - Huiru Dong
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, 608-1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.
| | - Christy Sutherland
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, 608-1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, 608-1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada. .,Department of Medicine, University of British Columbia, Vancouver, Canada.
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, 608-1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada. .,Department of Medicine, University of British Columbia, Vancouver, Canada.
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45
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Eskandarieh S, Jafari F, Yazdani S, Hazrati N, Saberi-Zafarghandi MB. Compulsory maintenance treatment program amongst Iranian injection drug users and its side effects. INTERNATIONAL JOURNAL OF HIGH RISK BEHAVIORS & ADDICTION 2014; 3:e21765. [PMID: 25741482 PMCID: PMC4331656 DOI: 10.5812/ijhrba.21765] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 07/27/2014] [Accepted: 08/20/2014] [Indexed: 11/21/2022]
Abstract
Background: Psychoactive substance use can cause a broad variety of mental health disorders and social health problems for the drug users, their family and society. Objectives: The Ministry of Health, Treatment, and Medical Education of Iran has recently proclaimed an estimated number of 2 million drug abusers and 200,000 injecting drug users (IDUs). Patients and Methods: For data collection, the directory of mental, social health, and Addiction designed a questionnaire in cooperation with Drug Control Headquarters of Iran. Results: Among 402 IDUs patients, a large amount of them were male, single, and younger than 39 years. Regarding psychotic and somatic symptoms caused by methadone therapy, most of the participants had no problem with methadone maintenance treatment (MMT). Conclusions: There is a need to train health staff, and the community, concerning preventive measures, treatment, and reducing harm for substance drug users.
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Affiliation(s)
- Sharareh Eskandarieh
- Bureau of Mental, Social Health and Addiction, Ministry of Health, Treatment and Medical Education, Tehran, IR Iran
| | - Firoozeh Jafari
- Substance Abuse and Dependency Research Centre, Social Welfare and Rehabilitation Sciences University, Tehran, IR Iran
| | - Somayeh Yazdani
- Bureau of Mental, Social Health and Addiction, Ministry of Health, Treatment and Medical Education, Tehran, IR Iran
| | - Nazanin Hazrati
- Bureau of Mental, Social Health and Addiction, Ministry of Health, Treatment and Medical Education, Tehran, IR Iran
| | - Mohammad Bagher Saberi-Zafarghandi
- Tehran Institute of Psychiatry, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Mohammad Bagher Saberi-Zafarghandi, 3Tehran Institute of Psychiatry, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, IR Iran. Tel: +98-9121055106, Fax: +98-2188364380, E-mail:
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Havinga P, van der Velden C, de Gee A, van der Poel A. Differences in sociodemographic, drug use and health characteristics between never, former and current injecting, problematic hard-drug users in the Netherlands. Harm Reduct J 2014; 11:6. [PMID: 24524263 PMCID: PMC3926265 DOI: 10.1186/1477-7517-11-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 01/30/2014] [Indexed: 01/15/2023] Open
Abstract
Background Injecting drug users are at increased risk for harmful effects compared to non-injecting drug users. Some studies have focused on differences in characteristics between these two groups (e.g., housing, overall health). However, no study has investigated the specific Dutch situation which in the last years has seen a decrease in homelessness among problematic hard-drug users and an increasing focus on physical health in low-threshold addiction care. The purpose of this study was to determine differences in sociodemographic, drug use and health characteristics between never-injecting (NIDUs), former-injecting (FIDUs) and current-injecting drug users (IDUs) and describe injecting practices. Methods A total of 202 problematic hard-drug users (NIDU = 64; FIDU = 76; IDU = 62) were recruited from 22 low-threshold care facilities, including drug consumption rooms, methadone maintenance treatment, heroin-assisted therapy, day shelter and/or night shelter, supported housing and day activity centres. Data were collected on-site through structured face-to-face interviews. Results Results indicate that IDUs represented a separate group of problematic hard-drug users, with distinct sociodemographic and drug use characteristics. Overall, IDUs appeared to be the group with least favourable characteristics (unstable housing/homelessness, illegal activities, polydrug use) and NIDUs appeared to have the most favourable characteristics (stable housing, help with debts, less polydrug use). The FIDU group lies somewhere in between. The three groups did not differ significantly in terms of health. Regarding injecting practices, results showed that majority of IDUs had injected drugs for over 10 years and IDUs injected heroin, cocaine, amphetamine and/or methadone in the past 6 months. Sharing syringes was not common. A quarter reported public injecting. Conclusions Unstable housing and homelessness are related to (former) injecting drug use, and stable housing is related to never-injecting drug use. Our study suggests that the number of ‘new’ IDUs is low. However, public injecting among IDUs is not uncommon and is associated with unstable housing. This emphasizes the potential of housing projects as a component of harm reduction measures. Therefore, prevention of (risks associated with) injecting drug use and supported housing programmes for problematic hard-drug users deserve the continuous attention of policymakers and professionals in low-threshold addiction care.
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Affiliation(s)
| | | | | | - Agnes van der Poel
- Network of Infectious Diseases and Harm Reduction, Trimbos Institute, P,O, Box 725, Utrecht 3500, AS, The Netherlands.
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