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Qi CC, Xu LR, Zhao CJ, Zhang HY, Li QY, Liu MJ, Zhang YX, Tang Z, Ma XX. Prevalence and risk factors of tuberculosis among people living with HIV/AIDS in China: a systematic review and meta-analysis. BMC Infect Dis 2023; 23:584. [PMID: 37674103 PMCID: PMC10481577 DOI: 10.1186/s12879-023-08575-4] [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: 01/27/2023] [Accepted: 08/29/2023] [Indexed: 09/08/2023] Open
Abstract
OBJECTIVE To estimate the prevalence and risk factors associated with tuberculosis (TB) among people living with human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS) in China. METHODS A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. After the literature was screened based on the inclusion and exclusion criteria, STATA® version 17.0 software was used for the meta-analysis. The heterogeneity among study data was assessed using I2 statistics. Subgroup analysis and meta-regressions were performed to further explore the source of heterogeneity. RESULTS A total of 5241 studies were retrieved. Of these, 44 studies were found to be eligible. The pooled prevalence of HIV/TB co-infection was 6.0%. The risk factors for HIV/TB co-infection included a low CD4+ T cell count, smoking, intravenous drug use and several other sociodemographic and clinical factors. Bacillus Calmette-Guérin (BCG) vaccination history was a protective factor. CONCLUSION A high prevalence of TB was observed among people living with HIV/AIDS in China. Low CD4+ T cell count, smoking, and intravenous drug use were the primary risk factors for HIV/TB co-infection, whereas BCG vaccination history was a protective factor. Checking for TB should be prioritized in HIV screening and healthcare access. SYSTEMATIC REVIEW REGISTRATION Registered on PROSPERO, Identifier: CRD42022297754.
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Affiliation(s)
- Cong-Cong Qi
- Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
| | - Li-Ran Xu
- Henan University of Chinese Medicine, Zhengzhou, Henan Province, China.
- Key Laboratory in Chinese Medicine for the Prevention and Treatment of Viral Diseases in Henan Province, Zhengzhou, Henan Province, China.
- The First Affiliated Hospital of Henan University of Chinese Medicine, Renmin Road 19, Jinshui District, Zhengzhou City, Henan Province, 450000, China.
| | - Chang-Jia Zhao
- Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
| | - Hai-Yan Zhang
- Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
| | - Qing-Ya Li
- Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
| | - Mei-Jun Liu
- Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
| | - Ye-Xuan Zhang
- Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
| | - Zhou Tang
- Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
| | - Xiu-Xia Ma
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
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Rafiemanesh H, Shadloo B, Amin-Esmaeili M, Rahimi Y, Gholami J, Rahimi-Movaghar A. Prevalence of Tuberculosis among People Who Use Drugs in Iran: A Systematic Review and Meta-analysis. ADDICTION & HEALTH 2023; 15:219-227. [PMID: 38026719 PMCID: PMC10658100 DOI: 10.34172/ahj.2023.1399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/28/2023] [Indexed: 12/01/2023]
Abstract
Background Drug use, especially injecting drug use, is associated with a higher risk of tuberculosis (TB). This study aimed to systematically review the prevalence of TB among people who use drugs (PWUD) in Iran. Methods A systematic search was conducted in international and national databases. All studies that provided data on the prevalence of TB among PWUD based on screening tests and diagnosis from 1990 up to August 2019 were assessed. Meta-analysis was performed on the prevalence of active TB among people who inject drugs (PWID). Findings Overall, nine studies were included. The studies were carried out from 1994 to 2012 in seven out of the 31 provinces of Iran. Seven studies provided data on the prevalence of TB diagnosis among 1087 PWID. The pooled prevalence of TB diagnosis was 10.1% (95% CI: 4.5, 15.8) in studies carried out in hospitals and 0.54% (95% CI: 0.04, 1.04) in other settings. Conclusion The present review suggests an approximately 40 times higher prevalence of TB among PWID compared to the general population. However, most of the included studies were conducted on a subpopulation of drug users, and caution should be exercised when generalizing the findings.
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Affiliation(s)
- Hosein Rafiemanesh
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Alborz University of Medical Sciences, Karaj, Iran
| | - Behrang Shadloo
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Amin-Esmaeili
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Yekta Rahimi
- Student Research Committee, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jaleh Gholami
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
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Computed Tomography Angiography Quantification of Intracranial and Extracranial Vascular Narrowing in Ischemic Stroke: Differences Between Patients With and Without Illicit Drug Use. J Comput Assist Tomogr 2022; 46:929-937. [PMID: 36055121 DOI: 10.1097/rct.0000000000001367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Previous studies have linked illicit drug consumption and stroke. The purpose of this study is to identify specific imaging findings depicted on computed tomography angiography on patients with illicit drug-associated stroke. METHODS This is a retrospective case-control study that included ischemic stroke patients. Subjects who tested positive for cocaine or marijuana were considered as cases, while patients who tested negative were included as controls. Matching of the controls was carried out based on the presence of stroke risk factors. A previously validated scale was used to calculate narrowing scores through computed tomography angiography. Comparison between cases and matched controls was evaluated by paired t test for age and body mass index, and by Wilcoxon signed rank test for intracranial, extracranial, and total scores. RESULTS One hundred seventy-four patients were included in the study, 87 subjects for each group. Because of matching, baseline status differed only on body mass index, with a greater proportion of obese subjects among controls (P < 0.016). Subgroup analysis demonstrated that it is more likely to find any intracranial abnormality among cocaine consumers when compared with controls (P = 0.041). CONCLUSIONS By using computed tomography angiography, we found that stroke patients with history of cocaine consumption had a higher incidence of intracranial circulation narrowing compared with matched controls.
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Salomon A, Law S, Johnson C, Baddeley A, Rangaraj A, Singh S, Daftary A. Interventions to improve linkage along the HIV-tuberculosis care cascades in low- and middle-income countries: A systematic review and meta-analysis. PLoS One 2022; 17:e0267511. [PMID: 35552547 PMCID: PMC9098064 DOI: 10.1371/journal.pone.0267511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/09/2022] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION In support of global targets to end HIV/AIDS and tuberculosis (TB) by 2030, we reviewed interventions aiming to improve TB case-detection and anti-TB treatment among people living with HIV (PLHIV) and HIV testing and antiretroviral treatment initiation among people with TB disease in low- and middle-income countries (LMICs). METHODS We conducted a systematic review of comparative (quasi-)experimental interventional studies published in Medline or EMBASE between January 2003-July 2021. We performed random-effects effect meta-analyses (DerSimonian and Laird method) for interventions that were homogenous (based on intervention descriptions); for others we narratively synthesized the intervention effect. Studies were assessed using ROBINS-I, Cochrane Risk-of-Bias, and GRADE. (PROSPERO #CRD42018109629). RESULTS Of 21,516 retrieved studies, 23 were included, contributing 53 arms and 84,884 participants from 4 continents. Five interventions were analyzed: co-location of test and/or treatment services; patient education and counselling; dedicated personnel; peer support; and financial support. A majority were implemented in primary health facilities (n = 22) and reported on HIV outcomes in people with TB (n = 18). Service co-location had the most consistent positive effect on HIV testing and treatment initiation among people with TB, and TB case-detection among PLHIV. Other interventions were heterogenous, implemented concurrent with standard-of-care strategies and/or diverse facility-level improvements, and produced mixed effects. Operational system, human resource, and/or laboratory strengthening were common within successful interventions. Most studies had a moderate to serious risk of bias. CONCLUSIONS This review provides operational clarity on intervention models that can support early linkages between the TB and HIV care cascades. The findings have supported the World Health Organization 2020 HIV Service Delivery Guidelines update. Further research is needed to evaluate the distinct effect of education and counselling, financial support, and dedicated personnel interventions, and to explore the role of community-based, virtual, and differentiated service delivery models in addressing TB-HIV co-morbidity.
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Affiliation(s)
- Angela Salomon
- School of Medicine, Queen’s University, Kingston, Canada
- McGill International TB Centre, Research Institute of the McGill University Health Centre, Montréal, Canada
| | - Stephanie Law
- McGill International TB Centre, Research Institute of the McGill University Health Centre, Montréal, Canada
| | - Cheryl Johnson
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Annabel Baddeley
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Ajay Rangaraj
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Satvinder Singh
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Amrita Daftary
- School of Global Health and Dahdaleh Institute of Global Health Research, York University, Toronto, Canada
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
- * E-mail:
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Hook K, Sereda Y, Makarenko O, Bendiks S, Rybak NR, Dutta A, Idrisov B, Drainoni ML, Kiriazova T, Lunze K. TB stigma and its correlates among HIV-positive people who inject drugs in Ukraine. Int J Tuberc Lung Dis 2021; 25:747-753. [PMID: 34802497 PMCID: PMC8716997 DOI: 10.5588/ijtld.21.0048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: TB is commonly stigmatized. Correlates of perceived TB stigma have not been assessed specifically among HIV-positive people who inject drugs (PWIDs). It is also unclear how perceived TB stigma intersects with other forms of stigma affecting this population. We aimed to evaluate perceived TB stigma, its correlates and its intersection with HIV and substance use stigma among HIV-positive PWIDs in Ukraine.METHODS: Among 191 participants at three sites across Ukraine, we assessed stigma scores, socio-demographic, behavioral and health-related variables by TB status (history of active TB infection, history of treatment for latent TB infection LTBI, no history of TB infection). We used self-reported history of LTBI treatment as a proxy for LTBI status. We used ordinary least squares to estimate factors associated with perceived TB stigma.RESULTS: Lower perceived TB stigma scores were associated with LTBI status (adjusted beta (aβ) -0.2, 95% CI -0.3 to 0.0; P = 0.032). Higher perceived TB stigma scores were associated with higher substance use stigma scores (aβ 0.1, 95% CI 0.0 to 0.2; P = 0.004). Depressive symptoms were common in this sample, although not significantly associated with TB status.CONCLUSION: History of LTBI treatment appears to impact beliefs about perceived TB stigma. Individuals who endorse higher substance use stigma are more likely to hold stigmatizing perceptions about people with TB. HIV-positive PWIDs with history of active TB infection or LTBI treatment commonly experience mental health distress. This stigma intersection needs further exploration in this population, including of its relation with mental health, to provide further insights for targeted interventions.
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Affiliation(s)
- K Hook
- Department of Psychiatry, Boston Medical Center, Boston, MA, Department of Psychiatry, Boston University School of Medicine, Boston, MA, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Y Sereda
- Ukrainian Institute on Public Health Policy Consultant, Kyiv, Ukraine
| | - O Makarenko
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | - S Bendiks
- Department of Medicine, Boston Medical Center, Boston, MA
| | - N R Rybak
- Warren Alpert Medical School of Brown University, Providence, RI
| | - A Dutta
- Internal Medicine, McLaren Flint/Michigan State University, Flint, MI, USA
| | - B Idrisov
- Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation, Moscow, Russia, Bashkir State Medical University, Ufa, Russia, Moscow Institute of Physics and Technology, Moscow, Russia
| | - M-L Drainoni
- Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, Boston University Center for Implementation & Improvement Sciences, Boston, MA, USA
| | - T Kiriazova
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | - K Lunze
- Department of Medicine, Boston Medical Center, Boston, MA
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Correlates of Self-Reported HIV Testing Among Patients in Specialized Substance Abuse Treatment Centers in South Africa. AIDS Behav 2021; 25:2755-2766. [PMID: 33950340 DOI: 10.1007/s10461-021-03178-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2021] [Indexed: 10/21/2022]
Abstract
Substance use is a recognized risk factor for HIV acquisition, transmission and progression in South Africa. Persons who use drugs (PWUD) and access specialist substance abuse treatment centers (SSATCs) are a potentially critical target group for HIV services because of the severity of their substance use and associated health risks. SSATCs represent an opportunity for integrated programming, particularly HIV testing services (HTS), to reach PWUD who are at an increased risk of or living with HIV. This analysis of national SSATC admission data explores self-reported HIV testing and associated factors to identify coverage gaps and integration opportunities. The South African Community Epidemiology Network on Drug Use (SACENDU) collects routine surveillance data to monitor national treatment admission trends in alcohol and other drug use. SACENDU data from 2012 to 2017 was analyzed using chi-square test of independence and logistic regression to examine associations between HTS, demographic characteristics and substances of use. Of 87,339 treatment admissions, 47.5% (n = 41,481) of patients had not accessed HTS in the prior 12 months. HTS was reported less frequently by patients whose primary substance of use was cannabis or those with polysubstance use (36.9% and 41.1%, respectively). None of the substance use sub-groups reported a testing rate above 70%. Compared to specific reference groups, logistic regression showed those with lower odds of HTS were: 15-19 years (OR = 0.59); had primary-level education (OR = 0.51); were scholars/learners (OR = 0.27); and primarily cannabis users (OR = 0.64). Patients whose primary drug was heroin had higher odds of testing (OR = 2.45) as did those who injected drugs (OR = 2.86). Given the low coverage and decreased odds of self-reported HTS among sub-groups of patients in SSATCs, the integration of HIV services for PWUD should be a priority in South Africa and a focus of the national HIV strategy.
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Semá Baltazar C, Kellogg TA, Boothe M, Loarec A, de Abreu E, Condula M, Fazito E, Raymond HF, Temmerman M, Luchters S. Prevalence of HIV, viral hepatitis B/C and tuberculosis and treatment outcomes among people who use drugs: Results from the implementation of the first drop-in-center in Mozambique. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 90:103095. [PMID: 33429163 DOI: 10.1016/j.drugpo.2020.103095] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/09/2020] [Accepted: 12/19/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND People who use drugs (PWUD) which includes both people who inject drugs (PWID) and non-injection drug users (NIDU) are marginalized, experience high levels of stigma and discrimination, and are likely to have challenges with accessing health services. Mozambique implemented the first drop-in center (DIC) for PWUD in Maputo City in 2018. This analysis aims to assess the prevalence of HIV, viral hepatitis B (HBV) and C (HCV) and tuberculosis (TB) among PWUD, and assess their linkage to care and associated correlates. METHODS We conducted a cross-sectional retrospective analysis of routine screening data collected from the first visit at the drop-in center (DIC) during the period of May 2018 to November 2019 (18 months). Descriptive and multivariable logistic regression analysis were conducted to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) of HIV, HBV, HCV and TB infections among PWID and NIDU. Cox proportional hazards models of determinants were used to estimate time from HIV diagnosis to linkage to care for PWUD. RESULTS A total of 1,818 PWUD were screened at the DIC, of whom 92.6% were male. The median age was 27 years (range:14-63). Heroin was the most consumed drug (93.8%), and among people who used it, 15.5% injected it. Prevalence of HIV (43.9%), HCV (22.6%) and HBV (5.9%) was higher among PWID (p<0.001). Linkage to HIV care was observed in 40.5% of newly diagnosed PWID. Factors associated with shorter time to linkage to care included drug injection (aHR=1.6) and confirmed TB infection (aHR=2.9). CONCLUSION This was the first analysis conducted on the implementation of the DIC in Mozambique and highlights the importance of targeted services for this high-risk population. Our analysis confirmed a high prevalence of HIV, HBV and HCV, and highlight the challenges with linkage to care among PWID. The expansion of DIC locations to other high-risk localities to enhance HIV testing, treatment services and linkage to care to reduce ongoing transmission of HIV, HBV, HCV and TB and improve health outcomes.
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Affiliation(s)
- Cynthia Semá Baltazar
- Instituto Nacional de Saúde (INS), Maputo, Mozambique; Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | | | - Makini Boothe
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Anne Loarec
- Médecins Sans Frontières, Maputo, Mozambique
| | | | | | - Erika Fazito
- International Center Aids Program (ICAP), Maputo, Mozambique
| | - Henry F Raymond
- University of California, San Francisco (UCSF), USA; School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Marleen Temmerman
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of OBGYN, Aga Khan University, Nairobi, Kenya
| | - Stanley Luchters
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Population Health, Aga Khan University, Nairobi, Kenya; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Burnet Institute, Melbourne, Australia
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Huang C, Yuan Q, Zhang L, Wang L, Cui S, Zhang K, Zhou X. Associations Between Childhood Trauma and the Age of First-Time Drug Use in Methamphetamine-Dependent Patients. Front Psychiatry 2021; 12:658205. [PMID: 33868060 PMCID: PMC8044866 DOI: 10.3389/fpsyt.2021.658205] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/03/2021] [Indexed: 01/03/2023] Open
Abstract
Childhood trauma is related to substance use disorder; however, few studies have examined the relationship between childhood trauma and the age at which the drug was first used. The aim of this study was to investigate the relationship between childhood trauma and the age of first-time drug use among methamphetamine-dependent patients. Moreover, we analyzed the characteristics of adverse family environment associated with severe childhood trauma and the risk factors for starting drugs in minors. A baseline interview was conducted with 110 participants who were in detoxification, including demographic information, past substance use, and age of first-time drug use. The participants' childhood trauma experience before 18 years of age was evaluated using the simplified version of the Childhood Trauma Questionnaire (CTQ-SF). The Chinese version of the Family Environment Scale (FES-CV) was used to assess the family environment of methamphetamine-dependent patients. Among 110 non-injecting methamphetamine-dependent patients, nearly half (n = 48, 43.6%) had moderate and severe childhood trauma. Correlation analysis showed that the age of first-time drug use negatively correlated with emotional abuse (r = -0.32, p < 0.01) and physical abuse (r = -0.27, p < 0.01). The age of first-time drug use negatively correlated with conflict (r = -0.20, p < 0.05) and independence (r = -0.22, p < 0.05) of family environment, but positively correlated with intellectual-cultural orientation (r = 0.28, p < 0.01). Additionally, childhood trauma factors significantly correlated with many indexes of family environment, especially cohesion (r = -0.45, p < 0.01), conflict (r = 0.49, p < 0.01), and independence (r = 0.33, p < 0.01). Additionally, the regression model showed that when emotional abuse increased by one point, the age of first-time drug use was 0.69 years earlier. These findings suggest that a detrimental family environment can aggravate childhood trauma, and the experience of childhood emotional or physical abuse may be an effective predictor of early drug use among methamphetamine-dependent patients.
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Affiliation(s)
- Cui Huang
- Chaohu Hospital, Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Qiuyu Yuan
- Chaohu Hospital, Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Ling Zhang
- Chaohu Hospital, Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Lei Wang
- Chaohu Hospital, Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Shu Cui
- Chaohu Hospital, Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Kai Zhang
- Chaohu Hospital, Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Xiaoqin Zhou
- Chaohu Hospital, Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
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Radfar SR, Nematollahi P, Tayeri K, Dehghan H, Janani M, Higgs P, Mohsenifar S, Noroozi A. Prevalence of latent tuberculosis infection and HIV among people who inject drugs in Iran. Drug Alcohol Rev 2020; 40:572-579. [PMID: 33345378 DOI: 10.1111/dar.13233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 11/05/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Iran has an human immunodeficiency viruses (HIV) epidemic that is concentrated among people who inject drugs (PWID), who have higher risks of progression from latent tuberculosis infection (LTBI) to active disease. The aim of this study is to measure prevalence of LTBI, HIV infection and any risk behaviors among PWID in Iran. METHODS The cross-sectional study was conducted from August to December 2013 in six cities across Iran. A total of 420 PWID were recruited from drop-in centres using convenience sampling. Trained interviewers collected data on socio-demographic characteristics, drug use history and drug-related risk behaviors across the study sites. A tuberculin skin test (TST) was performed, and HIV infection was assessed by a rapid test. Multivariable modified Poisson regression and logistic regression were used for data analysis. RESULTS Prevalence of positive TST and HIV positivity was 35.7% and 8.6%, respectively. The prevalence of LTBI and HIV was significantly different across the cities of this study. Positive TST was independently associated with older age (APR 1.03, 95% CI 1.01, 1.05) and being HIV positive (APR 1.89, 95% CI 1.45, 2.47). HIV infection was associated with lifetime history of sharing syringes (AOR 3.28, 95% CI 1.44, 10.71) and lifetime number of imprisonment (AOR 1.09, 95% CI 1.03-1.14). DISCUSSION AND CONCLUSIONS Prevalence of LTBI infections among PWID is high and independently associated with HIV infection. Given that there are currently no TB services available within drop-in centres, programs which integrate TB case finding, TB preventive therapy, referral and care services for PWID are urgently needed.
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Affiliation(s)
- Seyed Ramin Radfar
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.,UCLA Integrated Substance Abuse Programs, Los Angeles, USA
| | - Pardis Nematollahi
- Department of Pathology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Katayoun Tayeri
- Iranian Research Center of HIV and AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Dehghan
- Consultation Center for Secondary Researches, Data Mining, and Knowledge Transfer in Health and Medical Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Majid Janani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Peter Higgs
- Department of Public Health, La Trobe University, Melbourne, Australia.,Burnet Institute, Behaviours and Health Risks, 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
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MONTECUCCO ALFREDO, DINI GUGLIELMO, RAHMANI ALBORZ, STICCHI LAURA, DURANDO PAOLO. The seedbeds of Tuberculosis: is it time to target congregate settings and workplaces? JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2020; 61:E324-E330. [PMID: 33150222 PMCID: PMC7595065 DOI: 10.15167/2421-4248/jpmh2020.61.3.1759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 09/24/2020] [Indexed: 11/17/2022]
Abstract
Countries where the incidence of Tuberculosis (TB) is low display a low transmission rate in the general population, and this rate has progressively declined in recent decades; however, TB epidemiology has shown a shift of the disease burden from the general population to specific populations at higher risk, such as vulnerable individuals and hard-to-reach groups. In low-incidence countries, preventive and therapeutic strategies must therefore be geared towards targeted interventions in these populations, with the priority being to promptly identify and treat latent tuberculosis infection (LTBI) rather than manage infectious cases. One of the most complex challenges in this area is to identify population subgroups with increased incidence/prevalence of LTBI/TB. The aim of this study was to provide a concise overview of the main studies and available evidence concerning the epidemiology of TB and LTBI in non-healthcare congregate settings, with specific emphasis on studies conducted in occupational settings and workplaces. Recognizing settings at increased risk might contribute to eliminating TB in low-incidence countries, a challenge which requires tailored responses. Occupational and preventive medicine has a major role to play in directing ad hoc policies and programs of LTBI surveillance. If TB is to be eradicated, it is essential to contain the seedbeds of infection: indeed, as long as a large reservoir of infected subjects exists, new active TB cases may arise at any time.
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Affiliation(s)
- ALFREDO MONTECUCCO
- Department of Health Sciences (DISSAL), University of Genoa, Italy
- IRCCS Polyclinic San Martino Hospital, Genoa, Italy
| | - GUGLIELMO DINI
- Department of Health Sciences (DISSAL), University of Genoa, Italy
- IRCCS Polyclinic San Martino Hospital, Genoa, Italy
| | - ALBORZ RAHMANI
- Department of Health Sciences (DISSAL), University of Genoa, Italy
- IRCCS Polyclinic San Martino Hospital, Genoa, Italy
| | - LAURA STICCHI
- Department of Health Sciences (DISSAL), University of Genoa, Italy
- IRCCS Polyclinic San Martino Hospital, Genoa, Italy
| | - PAOLO DURANDO
- Department of Health Sciences (DISSAL), University of Genoa, Italy
- IRCCS Polyclinic San Martino Hospital, Genoa, Italy
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Sereda Y, Kiriazova T, Makarenko O, Carroll JJ, Rybak N, Chybisov A, Bendiks S, Idrisov B, Dutta A, Gillani FS, Samet JH, Flanigan T, Lunze K. Stigma and quality of co-located care for HIV-positive people in addiction treatment in Ukraine: a cross-sectional study. J Int AIDS Soc 2020; 23:e25492. [PMID: 32372534 PMCID: PMC7201176 DOI: 10.1002/jia2.25492] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 03/25/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Co-located treatment for HIV and opioid use disorder has been shown to improve care outcomes for HIV-positive people who inject drugs (PWID) in Ukraine. However, patients continue to be stigmatized for both HIV and substance use. This study aimed to assess whether co-located care for HIV-positive PWID receiving opioid agonist treatment (OAT) services in Ukraine is associated with less stigma and better perceived quality of HIV services. METHODS This cross-sectional study enrolled 191 HIV-positive PWID who received OAT services at three healthcare facilities providing substance use treatment (OAT only) and at four facilities that provided co-located care (both OAT and HIV treatment) in six regions in Ukraine during July-September, 2017. Primary outcomes were HIV stigma (Berger scale), substance use stigma (Substance Abuse Stigma Scale) and intersectional stigma (both stigma forms above 75th percentile). Secondary outcome was quality of HIV care, a composite score based on a package of received services. Linear and ordinal regressions were used to assess the predictors of selected outcomes. RESULTS Study participants were 75% male, mean age 40 ± 7 years; 47% received co-located care, and 10.5% had both high HIV and substance use stigma. Co-located care was neither associated with HIV nor substance use stigma but it was linked to better quality of HIV care (adjusted odds ratio: 4.13; 95% CI: 2.31, 7.54). HIV stigma was associated with suicide attempts (adjusted beta (aβ): 5.90; 95% CI: 2.05, 9.75), and substance use stigma was linked to poor mental health (aβ: -0.26; 95% CI: -0.44, -0.08) and lower likelihood of receipt of services from non-governmental organization (NGO; aβ: -6.40; 95% CI: -10.23, -2.57). CONCLUSION One in ten people with HIV in this cohort who received OAT services experienced high levels of both HIV and substance use stigma, which was associated with poorer mental health and less NGO support. Co-located HIV and OAT services were linked to better perceived quality of HIV care, but did not seem to reduce stigma for this key population. Stigma interventions for PWID, possibly delivered involving NGOs, may be an approach to mitigate this challenge.
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Affiliation(s)
- Yuliia Sereda
- Ukrainian Institute on Public Health Policy ConsultantKyivUkraine
| | | | | | - Jennifer J Carroll
- Elon UniversityElonNCUSA
- Warren Alpert Medical School of Brown UniversityProvidenceRIUSA
| | - Natasha Rybak
- Warren Alpert Medical School of Brown UniversityProvidenceRIUSA
| | | | | | - Bulat Idrisov
- Bashkir State Medical UniversityUfaRussia
- Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian FederationMoscowRussia
- Moscow Institute of Physics and TechnologyMoscowRussia
| | | | - Fizza S Gillani
- Warren Alpert Medical School of Brown UniversityProvidenceRIUSA
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12
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Towe VL, Bogart L, McBain R, Wagner L, Stevens C, Fischer S, MacCarthy S. Mixed-methods study of integration of housing and medical data systems for enhanced service coordination of people with HIV. INTERNATIONAL JOURNAL OF CARE COORDINATION 2020. [DOI: 10.1177/2053434520913206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Housing is a determinant of HIV-related medical outcomes. Care coordination has been successfully used to treat patients with HIV and can be improved through electronic exchange of patient data, including housing data. Methods Primary data were collected from four sites across the U.S., each comprising partnerships between local HIV medical and housing providers. Between March 2017 and May 2018, we conducted a mixed-methods evaluation, focusing on preparatory activities, implementation of tasks related to data integration, and service coordination. Nineteen focus group discussions were conducted with providers, organizational leaders, and clients. Ten interviews were conducted with data system vendors and administrators. Site visits, logs, and progress reports provided information about data integration progress and other activities. Results Key activities included changes to client consent, setting up data use agreements, and planning with data system vendors. Sites selected one of three models: one-way data transmission between two systems, bidirectional transmission between two systems, and integration into one data system. Focus group discussion themes included: challenges of using existing data systems; concerns about the burden of learning a new data system; and potential benefits to providers and client, such as having more time to spend delivering client services. Discussion Using health information technologies to share data has widespread support, but uptake is still met with resistance from end users. The additional level of complexity differentiating this study from others is the exchange of data between service providers and care providers, but sites were able to accomplish this goal by navigating extensive barriers.
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13
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Gómez LM, Paniagua-Saldarriaga LA, Richert Q, Keynan Y, Montes F, López L, Rueda ZV. Homelessness and HIV: A Combination Predictive of Poor Tuberculosis Treatment Outcomes and in Need of Innovative Strategies to Improve Treatment Completion. Am J Trop Med Hyg 2020; 100:932-939. [PMID: 30860023 DOI: 10.4269/ajtmh.18-0305] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Antioquia Department is the state with the highest burden of tuberculosis (TB) in Colombia. Our aim was to determine the risk factors associated with unsuccessful TB treatment in HIV-seropositive and homeless persons, compared with non-HIV-infected and non-homeless persons with TB. We conducted a retrospective cohort study using observational, routinely collected health data from all drug-susceptible TB cases in homeless and/or HIV-seropositive individuals in Antioquia from 2014 to 2016. Unsuccessful TB treatment was defined as individuals having been lost to follow-up, having died, or treatment failure occurrence during the study period. Successful treatment was defined as cure of TB or treatment completion according to the WHO definitions. We identified 544 homeless persons with TB (432 HIV- and 112 HIV+), 835 HIV+ persons with TB and non-homeless, and 5,086 HIV-/non-homeless people with TB. Unsuccessful treatment rates were 19.3% in HIV-/non-homeless persons, 37.4% in non-homeless HIV+ patients, 61.5% in homeless HIV- patients, and 70.3% in homeless HIV+ patients; all rates fall below End TB strategy targets. More than 50% of homeless patients were lost to follow-up. Risk factors associated with unsuccessful treatment were HIV seropositivity, homelessness, male gender, age ≥ 25 years, noncontributory-type health insurance, TB diagnosis made during hospitalization, and previous treatment for TB. These results highlight the challenge of treating TB in the homeless population. These findings should put an onus on TB programs, governments, clinicians, and others involved in the collaborative care of TB patients to pursue innovative strategies to improve treatment success in this population.
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Affiliation(s)
| | | | - Quinlan Richert
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Yoav Keynan
- Department of Community Health Science, University of Manitoba, Winnipeg, Canada.,Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.,Department of Medical Microbiology and Infectious Disease, University of Manitoba, Winnipeg, Canada
| | | | - Lucelly López
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Zulma Vanessa Rueda
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
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14
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Collin SM, Wurie F, Muzyamba MC, de Vries G, Lönnroth K, Migliori GB, Abubakar I, Anderson SR, Zenner D. Effectiveness of interventions for reducing TB incidence in countries with low TB incidence: a systematic review of reviews. Eur Respir Rev 2019; 28:28/152/180107. [PMID: 31142548 DOI: 10.1183/16000617.0107-2018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 03/22/2019] [Indexed: 12/18/2022] Open
Abstract
AIMS What is the evidence base for the effectiveness of interventions to reduce tuberculosis (TB) incidence in countries which have low TB incidence? METHODS We conducted a systematic review of interventions for TB control and prevention relevant to low TB incidence settings (<10 cases per 100 000 population). Our analysis was stratified according to "direct" or "indirect" effects on TB incidence. Review quality was assessed using AMSTAR2 criteria. We summarised the strength of review level evidence for interventions as "sufficient", "tentative", "insufficient" or "no" using a framework based on the consistency of evidence within and between reviews. RESULTS We found sufficient review level evidence for direct effects on TB incidence/case prevention of vaccination and treatment of latent TB infection. We also found sufficient evidence of beneficial indirect effects attributable to drug susceptibility testing and adverse indirect effects (measured as sub-optimal treatment outcomes) in relation to use of standardised first-line drug regimens for isoniazid-resistant TB and intermittent dosing regimens. We found insufficient review level evidence for direct or indirect effects of interventions in other areas, including screening, adherence, multidrug-resistant TB, and healthcare-associated infection. DISCUSSION Our review has shown a need for stronger evidence to support expert opinion and country experience when formulating TB control policy.
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Affiliation(s)
- Simon M Collin
- TB Unit, National Infection Service, Public Health England, London, UK
| | - Fatima Wurie
- TB Unit, National Infection Service, Public Health England, London, UK
| | - Morris C Muzyamba
- TB Unit, National Infection Service, Public Health England, London, UK
| | | | | | | | | | - Sarah R Anderson
- TB Unit, National Infection Service, Public Health England, London, UK
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Vold JH, Aas C, Leiva RA, Vickerman P, Chalabianloo F, Løberg EM, Johansson KA, Fadnes LT. Integrated care of severe infectious diseases to people with substance use disorders; a systematic review. BMC Infect Dis 2019; 19:306. [PMID: 30947701 PMCID: PMC6449980 DOI: 10.1186/s12879-019-3918-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 03/19/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Various integrated care models have been used to improve treatment completion of medications for chronic hepatitis B virus (HBV), chronic hepatitis C virus (HCV), Mycobacterium tuberculosis (TB), and Human immunodeficiency virus (HIV) among people with substance use disorders (SUD). We have conducted a systematic review to evaluate whether integrated models have impacts of the treatment of infectious diseases among marginalized people with SUD. METHODS We searched MEDLINE/PubMed (1946 to 2018, on July 26, 2018) and Embase (from 1974 to 2018, on July 26, 2018) for randomized controlled trials (RCTs) and cohort studies evaluating diverse integrated models' effects on sustained virological response (SVR), HIV suppression, HBV curation or suppression, completion of TB treatment regimen among people with SUD. The included studies were assessed qualitatively. RESULTS Altogether, 1640 studies, and references to 1135 related reviews and RCTs were considered, and only seven RCTs and three cohort studies fulfilled the inclusion criteria. We identified nine integrated care models. Two studies, one RCT and one cohort study, showed a significant effect of their integrated models. The RCT evaluated psychosocial treatment, opioid agonist treatment (OAT) and directly observed TB treatment, and found a significant increase in TB treatment completions among intervention group compared to control group (60% versus 13%, p < 0.01). The cohort study including OAT and TB treatments had an effect on TB treatment completion in hospitalized patients (89% versus 73%, p = 0.03). Eight out of ten studies showed no significant effects of their integrated care models on defined outcomes. One of which having included 363 participants in a RCT showed no effect on SVR compared to the control group when the results adjusted for active substance use and alcohol dependence in a post-hoc analysis (11% versus 7%, p = 0.49). CONCLUSIONS The findings indicate uncertainty on the effects of integrated care models' on treatment for severe infectious diseases among people with SUD. Some studies point toward that integrated models could improve care of people with SUD, yet high-quality studies and preferably, sufficiently sized clinical trials are needed to conclude on the degree of impact.
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Affiliation(s)
- Jørn Henrik Vold
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Christer Aas
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | | | - Fatemeh Chalabianloo
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Else-Marie Løberg
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Kjell Arne Johansson
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Lars Thore Fadnes
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Guise A, Ndimbii J, Igonya EK, Owiti F, Strathdee SA, Rhodes T. Integrated and differentiated methadone and HIV care for people who use drugs: a qualitative study in Kenya with implications for implementation science. Health Policy Plan 2019; 34:110-119. [PMID: 30789208 PMCID: PMC6481284 DOI: 10.1093/heapol/czz002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2019] [Indexed: 11/13/2022] Open
Abstract
Integrating methadone and HIV care is a priority in many low- and middle-income settings experiencing a growing challenge of HIV epidemics linked to injecting drug use. There is as yet little understanding of how to integrate methadone and HIV care in these settings and how such services can be implemented; such a gap reflects, in part, limitations in theorizing an implementation science of integrated care. In response, we qualitatively explored the delivery of methadone after its introduction in Kenya to understand integration with HIV care. Semi-structured interviews with people using methadone (n = 30) were supplemented by stakeholder interviews (n = 2) and participant observation in one city. Thematic analysis was used, that also drew on Mol's logic of care as an analytical framework. Respondents described methadone clinic-based care embedded in community support systems. Daily observed clinic care was challenging for methadone and stigmatizing for HIV treatment. In response to these challenges, integration evolved and HIV care differentiated to other sites. The resulting care system was acceptable to respondents and allowed for choice over locations and approaches to HIV care. Using Mol's logic of care as an analytical framework, we explore what led to this differentiation in integrated care. We explore co-production and experimentation around HIV care that compares with more limited experimentation for methadone. This experimentation is bounded by available discourses and materials. The study supports continued integration of services whilst allowing for differentiation of these models to adapt to client preferences. Co-location of integrated services must prioritize clinic organization that prevents HIV status disclosure. Our analysis fosters a material perspective for theory of implementation science and integration of services that focuses attention on local experimentation shaped by context.
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Affiliation(s)
- Andy Guise
- Department of Medicine, University of California San Diego, San Diego, 9500 Gilman Drive, La Jolla, CA, USA
- School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - James Ndimbii
- Kenya AIDS NGOs Consortium, Regent Management Suites, Argwings Kodhek Road, Nairobi, Kenya
| | - Emmy Kageha Igonya
- School of Medicine, University of Nairobi, Kenyatta National Hospital, Nairobi, Kenya
| | - Frederick Owiti
- School of Medicine, University of Nairobi, Kenyatta National Hospital, Nairobi, Kenya
| | - Steffanie A Strathdee
- Department of Medicine, University of California San Diego, San Diego, 9500 Gilman Drive, La Jolla, CA, USA
| | - Tim Rhodes
- Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, UK
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17
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Grau LE, Griffiths-Kundishora A, Heimer R, Hutcheson M, Nunn A, Towey C, Stopka TJ. Barriers and facilitators of the HIV care continuum in Southern New England for people with drug or alcohol use and living with HIV/AIDS: perspectives of HIV surveillance experts and service providers. Addict Sci Clin Pract 2017; 12:24. [PMID: 28965489 PMCID: PMC5623965 DOI: 10.1186/s13722-017-0088-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 08/11/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Contemporary studies about HIV care continuum (HCC) outcomes within substance using populations primarily focus on individual risk factors rather than provider- or systems-level influences. Over 25% of people living with HIV (PLWH) have substance use disorders that can alter their path through the HCC. As part of a study of HCC outcomes in nine small cities in Southern New England (population 100,000-200,000 and relatively high HIV prevalence particularly among substance users), this qualitative analysis sought to understand public health staff and HIV service providers' perspectives on how substance use may influence HCC outcomes. METHODS Interviews with 49 participants, collected between November 2015 and June 2016, were analyzed thematically using a modified social ecological model as the conceptual framework and codes for substance use, HCC barriers and facilitators, successes and failures of initiatives targeting the HCC, and criminal justice issues. RESULTS Eight themes were identified concerning the impact of substance use on HCC outcomes. At the individual level, these included coping and satisfying basic needs and could influence all HCC steps (i.e., testing, treatment linkage, adherence, and retention, and viral load suppression). The interpersonal level themes included stigma issues and providers' cultural competence and treatment attitudes and primarily influenced treatment linkage, retention, and viral load suppression. These same HCC steps were influenced at the health care systems level by organizations' physical environment and resources as well as intra-/inter-agency communication. Testing and retention were the most likely steps to affect at the policy/society level, and the themes included opposition within an organization or community, and activities with unintended consequences. CONCLUSIONS The most substantial HCC challenges for PLWH with substance use problems included linking and retaining in treatment those with multiple co-morbidities and meeting their basic living needs. Recommendations to improve HCC outcomes for PLWH with substance use problems include increasing easy access to effective drug and mental health treatment, expanding case management and peer navigation services, training staff about harm reduction, de-stigmatizing, and culturally competent approaches to interacting with patients, and increasing information-sharing and service coordination among service providers and the social service and criminal justice systems.
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Affiliation(s)
- Lauretta E. Grau
- Yale School of Public Health, PO Box 208034, New Haven, CT 06520-8034 USA
| | | | - Robert Heimer
- Yale School of Public Health, PO Box 208034, New Haven, CT 06520-8034 USA
| | | | - Amy Nunn
- Brown University School of Public Health, Providence, RI 02912 USA
| | - Caitlin Towey
- Brown University School of Public Health, Providence, RI 02912 USA
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18
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de Vries SG, Cremers AL, Heuvelings CC, Greve PF, Visser BJ, Bélard S, Janssen S, Spijker R, Shaw B, Hill RA, Zumla A, van der Werf MJ, Sandgren A, Grobusch MP. Barriers and facilitators to the uptake of tuberculosis diagnostic and treatment services by hard-to-reach populations in countries of low and medium tuberculosis incidence: a systematic review of qualitative literature. THE LANCET. INFECTIOUS DISEASES 2017; 17:e128-e143. [PMID: 28291721 DOI: 10.1016/s1473-3099(16)30531-x] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 10/11/2016] [Accepted: 11/03/2016] [Indexed: 01/25/2023]
Abstract
Tuberculosis disproportionately affects hard-to-reach populations, such as homeless people, migrants, refugees, prisoners, or drug users. These people often face challenges in accessing quality health care. We did a systematic review of the qualitative literature to identify barriers and facilitators to the uptake of tuberculosis diagnostic and treatment services by people from hard-to-reach populations in all European Union (EU), European Economic Area, EU candidate, and Organisation for Economic Co-operation and Development countries. The 12 studies included in this review mainly focused on migrants. Views on perceived susceptibility to and severity of tuberculosis varied widely and included many misconceptions. Stigma and challenges regarding access to health care were identified as barriers to tuberculosis diagnosis and treatment uptake, whereas support from nurses, family, and friends was a facilitator for treatment adherence. Further studies are required to identify barriers and facilitators to the improved identification and management of tuberculosis in hard-to-reach populations to inform recommendations for more effective tuberculosis control programmes.
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Affiliation(s)
- Sophia G de Vries
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Anne L Cremers
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Charlotte C Heuvelings
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Patrick F Greve
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Benjamin J Visser
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Sabine Bélard
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Saskia Janssen
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - René Spijker
- Medical Library, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands; Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Beth Shaw
- National Institute for Health and Care Excellence, Piccadilly Plaza, Manchester, UK
| | - Ruaraidh A Hill
- National Institute for Health and Care Excellence, Piccadilly Plaza, Manchester, UK; Health Services Research, University of Liverpool, Liverpool, UK
| | - Alimuddin Zumla
- Division of Infection and Immunity, University College London, London, UK; National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, UK
| | | | - Andreas Sandgren
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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Guise A, Seguin M, Mburu G, McLean S, Grenfell P, Islam Z, Filippovych S, Assan H, Low A, Vickerman P, Rhodes T. Integrated opioid substitution therapy and HIV care: a qualitative systematic review and synthesis of client and provider experiences. AIDS Care 2017; 29:1119-1128. [PMID: 28281354 DOI: 10.1080/09540121.2017.1300634] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
People who use drugs in many contexts have limited access to opioid substitution therapy and HIV care. Service integration is one strategy identified to support increased access. We reviewed and synthesized literature exploring client and provider experiences of integrated opioid substitution therapy and HIV care to identify acceptable approaches to care delivery. We systematically reviewed qualitative literature. We searched nine bibliographic databases, supplemented by manual searches of reference lists of articles from the database search, relevant journals, conferences, key organizations and consultation with experts. Thematic synthesis was used to develop descriptive themes in client and provider experiences. The search yielded 11 articles for inclusion, along with 8 expert and policy reports. We identify five descriptive themes: the convenience and comprehensive nature of co-located care, contrasting care philosophies and their role in shaping integration, the limits to disclosure and communication between clients and providers, opioid substitution therapy enabling HIV care access and engagement, and health system challenges to delivering integrated services. The discussion explores how integrated opioid substitution therapy and HIV care needs to adapt to specific social conditions, rather than following universal approaches. We identify priorities for future research. Acceptable integrated opioid substitution therapy and HIV care for people who use drugs and providers is most likely through co-located care and relies upon attention to stigma, supportive relationships and client centred cultures of delivery. Further research is needed to understand experiences of integrated care, particularly delivery in low and middle income settings and models of care focused on community and non-clinic based delivery.
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Affiliation(s)
- Andy Guise
- a Department of Global Public Health , University of California San Diego , San Diego , USA.,b Department of Public Health and Policy , London School of Hygiene and Tropical Medicine , London , UK
| | - Maureen Seguin
- c Centre for Research on Drugs and Health Behaviour , London School of Hygiene and Tropical Medicine , London , UK
| | - Gitau Mburu
- d Program Impact Unit , International HIV/AIDS Alliance , Brighton , UK.,e Department of Health Research , University of Lancaster , Lancaster , UK
| | - Susie McLean
- d Program Impact Unit , International HIV/AIDS Alliance , Brighton , UK
| | - Pippa Grenfell
- c Centre for Research on Drugs and Health Behaviour , London School of Hygiene and Tropical Medicine , London , UK
| | - Zahed Islam
- f Management Sciences for Health , Dhaka , Bangladesh
| | - Sergii Filippovych
- g Treatment, Procurement and Supply Management Department , International HIV/AIDS Alliance Ukraine , Kyiv , Ukraine
| | - Happy Assan
- h Tanzanian Network of People who Use Drugs , MDM Drop in centre , Dar es Salaam , Tanzania
| | - Andrea Low
- i International Center for AIDS Care and Treatment Programs , Columbia University , New York , USA
| | - Peter Vickerman
- j School of Social and Community Medicine , University of Bristol , Bristol , UK
| | - Tim Rhodes
- c Centre for Research on Drugs and Health Behaviour , London School of Hygiene and Tropical Medicine , London , UK
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Hermosilla S, You P, Aifah A, Abildayev T, Akilzhanova A, Kozhamkulov U, Muminov T, Darisheva M, Zhussupov B, Terlikbayeva A, El-Bassel N, Schluger N. Identifying risk factors associated with smear positivity of pulmonary tuberculosis in Kazakhstan. PLoS One 2017; 12:e0172942. [PMID: 28249005 PMCID: PMC5332099 DOI: 10.1371/journal.pone.0172942] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 02/13/2017] [Indexed: 01/27/2023] Open
Abstract
Background Sputum smear-positive tuberculosis (TB) patients have a high risk of transmission and are of great epidemiological and infection control significance. Little is known about the smear-positive populations in high TB burden regions, such as Kazakhstan. The objective of this study is to characterize the smear-positive population in Kazakhstan and identify associated modifiable risk factors. Methods Data on incident TB cases’ (identified between April 2012 and March 2014) socio-demographic, risk behavior, and comorbidity characteristics were collected in four regions of Kazakhstan through structured survey and medical record review. We used multivariable logistic regression to determine factors associated with smear positivity. Results Of the total sample, 193 (34.3%) of the 562 study participants tested smear-positive. In the final adjusted multivariable logistic regression model, sex (adjusted odds ratio (aOR) = 2.0, 95% CI:1.3–3.1, p < 0.01), incarceration (aOR = 3.6, 95% CI:1.2–11.1, p = 0.03), alcohol dependence (aOR = 2.6, 95% CI:1.2–5.7, p = 0.02), diabetes (aOR = 5.0, 95% CI:2.4–10.7, p < 0.01), and physician access (aOR = 2.7, 95% CI:1.3–5.5p < 0.01) were associated with smear-positivity. Conclusions Incarceration, alcohol dependence, diabetes, and physician access are associated with smear positivity among incident TB cases in Kazakhstan. To stem the TB epidemic, screening, treatment and prevention policies should address these factors.
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Affiliation(s)
- Sabrina Hermosilla
- Columbia University Mailman School of Public Health, Department of Epidemiology, New York, NY, United States of America
- * E-mail:
| | - Paul You
- Columbia University Mailman School of Public Health, Department of Epidemiology, New York, NY, United States of America
| | - Angela Aifah
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, United States of America
| | | | - Ainur Akilzhanova
- Center for Life Sciences, Nazarbayev University, 53 Kabanbay Batyr Ave., Astana, Republic of Kazakhstan
| | - Ulan Kozhamkulov
- Center for Life Sciences, Nazarbayev University, 53 Kabanbay Batyr Ave., Astana, Republic of Kazakhstan
| | - Talgat Muminov
- National Association for TB Specialists, Almaty, Kazakhstan
| | - Meruert Darisheva
- Columbia University Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Baurzhan Zhussupov
- Columbia University Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Assel Terlikbayeva
- Columbia University Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Nabila El-Bassel
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, United States of America
| | - Neil Schluger
- Columbia University Mailman School of Public Health, Department of Epidemiology, New York, NY, United States of America
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Abstract
Introduction: Meeting the complex health needs of people often
requires interaction among numerous different sectors. No one service can
adequately respond to the diverse care needs of consumers. Providers working
more effectively together is frequently touted as the solution. Cross-sector
service provision is defined as independent, yet interconnected sectors working
together to better meet the needs of consumers and improve the quality and
effectiveness of service provision. Cross-sector service provision is expected,
yet much remains unknown about how it is conceptualised or its impact on health
status. This umbrella review aims to clarify the critical attributes that shape
cross-sector service provision by presenting the current state of the literature
and building on the findings of the 2004 review by Sloper. Methods: Literature related to cross-sector service provision is
immense, which poses a challenge for decision makers wishing to make
evidence-informed decisions. An umbrella review was conducted to articulate the
overall state of cross-sector service provision literature and examine the
evidence to allow for the discovery of consistencies and discrepancies across
the published knowledge base. Findings: Sixteen reviews met the inclusion criteria. Seven themes
emerged: Focusing on the consumer, developing a shared vision of care,
leadership involvement, service provision across the boundaries, adequately
resourcing the arrangement, developing novel arrangements or aligning with
existing relationships, and strengthening connections between sectors. Future
research from a cross-organisational, rather than individual provider,
perspective is needed to better understand what shapes cross-sector service
provision at the boundaries. Conclusion: Findings aligned closely with the work done by Sloper
and raise red flags related to reinventing what is already known. Future
researchers should look to explore novel areas rather than looking into areas
that have been explored at length. Evaluations of out-comes related to
cross-sector service provision are still needed before any claims about
effectiveness can be made.
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Apidechkul T. A 20-year retrospective cohort study of TB infection among the Hill-tribe HIV/AIDS populations, Thailand. BMC Infect Dis 2016; 16:72. [PMID: 26861536 PMCID: PMC4746815 DOI: 10.1186/s12879-016-1407-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 02/02/2016] [Indexed: 11/27/2022] Open
Abstract
Background A retrospective cohort study was conducted to determine the situation, trend, and factors associated with TB infection, and factors related to the life status among the HIV/AIDS Hill-tribe in Northern Thailand. Hill-tribe people have been migrating to and formed settlements along the Thai border areas for many decades. There are now having 1.6 million people of 6 different groups–Akha, Lahu, Lisu, Hmong, Yao and Keren–each with a specific culture, language and lifestyle. The Hill-tribe becomes a new vulnerable of HIV and TB infections in Thailand. Methods A systematic data-reviewing approach was used to identify the information from the rosters of ARV clinics, OPD cards, and laboratory reports from 16 hospitals in Chiang Rai Province, Thailand. The data were collected from the first reported HIV/AIDS case of the Hill-tribe to the end of 2010. A chi-square test and logistic regression models were used to identify associations at the significance level of alpha = 0.05. Results A total of 3,130 cases were included in the study. The majority of patients were Akha (46.0 %) followed by Lahu (19.7 %), 54.6 % were males, 44.6 % were 26–35 years old. The major risk factor of HIV infection was sexual intercourse (93.1 %); 23.9 % were still alive at the date of data collection, 30.7 % were diagnosed with pulmonary TB. The Akha Hill-tribe HIV/AIDS individuals had a greater chance of TB infection than did Yao individuals with ORadj = 1.50 (95 % CI = 1.01-1.92). Females had a greater chance of TB infection than males with ORadj = 1.33 (95 % CI = 1.11-1.59); being classified as HIV and AIDS groups had a greater chance of TB infection than those asymptomatic group with ORadj = 11.59 (95 % CI = 7.19-18.71), and ORadj = 1.71 (95 % CI = 1.03-2.87); and not having received the ARV group had a greater chance of TB infection than those who having received the ARV group with ORadj = 2.59 (95 % CI = 2.09-3.22). The patients who had been diagnosed with HIV infection during 1990–1995 and 1996–2000 had less chance of TB infection than those who were diagnosed from 2006–2010, with ORadj = 0.04 (95 % CI = 0.01-0.14) and 0.11 (95 % CI = 0.07-0.17), respectively. Regarding life status; females had a better chance of being still alive at the date of data collection than being males with ORadj = 1.41 (95 % CI = 1.19-1.66). Those who had a defined route of transmission in the category of “mother-to-child” and “IDU” had a better chance of being still alive compared to those who contracted HIV from “sexual intercourse,” with ORadj = 2.05 (95 % CI = 1.56-2.18), and ORadj = 8.45 (95 % CI = 1.55-46.13), respectively. Conclusions Thailand needs to create a TB and HIV/AIDS surveillance system for Hill-tribe populations to determine the situation and trend and to develop an appropriate model for providing care at the earlier stage of HIV/AIDS infection to prevent later TB infection.
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Affiliation(s)
- Tawatchai Apidechkul
- School of Health Science, Mae Fah Luang University, Chiang Rai, 57100, Thailand.
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23
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Craig GM, Zumla A. The social context of tuberculosis treatment in urban risk groups in the United Kingdom: a qualitative interview study. Int J Infect Dis 2016; 32:105-10. [PMID: 25809765 DOI: 10.1016/j.ijid.2015.01.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 01/06/2015] [Accepted: 01/07/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES There is scant qualitative research into the experiences of tuberculosis (TB) treatment in urban risk groups with complex health and social needs in the UK. This study aimed to describe the social context of adherence to treatment in marginalized groups attending a major TB centre in London. METHODS A qualitative cross-sectional study was performed using semi-structured interviews with patients receiving treatment for TB. Analytical frameworks aimed to reflect the role of broader social structures in shaping individual health actions. RESULTS There were 17 participants; the majority were homeless and had complex medical and social needs, including drug and alcohol use or immigration problems affecting entitlement to social welfare. Participants rarely actively chose not to take their medication, but described a number of social and institutional barriers to adherence and their need for practical support. Many struggled with the physical aspects of taking medication and the side effects. Participants receiving directly observed therapy (DOT) reported both positive and negative experiences, reflecting the type of DOT provider and culture of the organization. CONCLUSIONS There is a need for integrated care across drug, alcohol, HIV, and homeless services in order to address the complex clinical co-morbidities and social needs that impact on the patient's ability to sustain a course of treatment.
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Affiliation(s)
- Gillian M Craig
- School of Health Sciences, City University London, Northampton Square, London, EC1 V 0HB, UK.
| | - Alimuddin Zumla
- Department of Infection, Division of Infection and Immunity, Centre for Clinical Microbiology, University College London, and NIHR Biomedical Research Centre, University College London Hospitals, London, UK
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Abstract
PURPOSE OF REVIEW HIV management in people who use drugs (PWUD) is typically complex and challenging due to the presence of multiple medical and psychiatric comorbidities as well as social, physical, economic and legal factors that often disrupt the HIV continuum of care. In this review, we describe the individual, health systems and societal barriers to HIV treatment access and care retention for PWUD. In addition, the clinical management of HIV-infected PWUD is often complicated by the presence of multiple infectious and noninfectious comorbidities. RECENT FINDINGS Improved HIV treatment outcomes can be enhanced through improved testing and linkage strategies along with better treatment retention and antiretroviral (ART) adherence. Improved ART adherence can be achieved through the provision of opioid substitution therapy (OST), directly administered ART (DAART) and integration of ART with OST services. Recent advances with direct-acting antivirals (DAAs) for hepatitis C virus (HCV) have shown superior outcomes than interferon-based regimes in HIV-HCV coinfected patients. Newer diagnostic technologies for tuberculosis (TB) hold promise for earlier diagnosis for PWUD coinfected with TB, and TB treatment outcomes are improved through combination with OST. SUMMARY HIV-infected PWUDs are a key population who frequently experience suboptimal outcomes along the HIV continuum of care. A comprehensive strategy that encompasses evidence-based prevention and treatment interventions that target the individual, family, healthcare system, legal and societal structure is required to ensure greater participation and success in HIV treatment and care.
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Affiliation(s)
- Adeeba Kamarulzaman
- aCentre of Excellence for Research in AIDS (CERiA), University of Malaya, Faculty of Medicine, Kuala Lumpur, Malaysia bYale University, School of Medicine, Section of Infectious Diseases cYale University, School of Public Health, Section of Epidemiology of Microbial Diseases, New Haven, Connecticut, USA
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25
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Mansfeld M, Skrahina A, Shepherd L, Schultze A, Panteleev AM, Miller RF, Miro JM, Zeltina I, Tetradov S, Furrer H, Kirk O, Grzeszczuk A, Bolokadze N, Matteelli A, Post FA, Lundgren JD, Mocroft A, Efsen A, Podlekareva DN. Major differences in organization and availability of health care and medicines for HIV/TB coinfected patients across Europe. HIV Med 2015; 16:544-52. [PMID: 25959854 DOI: 10.1111/hiv.12256] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The aim of the study was to investigate the organization and delivery of HIV and tuberculosis (TB) health care and to analyse potential differences between treatment centres in Eastern (EE) and Western Europe (WE). METHODS Thirty-eight European HIV and TB treatment centres participating in the TB:HIV study within EuroCoord completed a survey on health care management for coinfected patients in 2013 (EE: 17 respondents; WE:21; 76% of all TB:HIV centres). Descriptive statistics were obtained for regional comparisons. The reported data on health care strategies were compared with actual clinical practice at patient level via data derived from the TB:HIV study. RESULTS Respondent centres in EE comprised: Belarus (n = 3), Estonia (1), Georgia (1), Latvia (1), Lithuania (1), Poland (4), Romania (1), the Russian Federation (4) and Ukraine (1); those in WE comprised: Belgium (1), Denmark (1), France (1), Italy (7), Spain (2), Switzerland (1) and UK (8). Compared with WE, treatment of HIV and TB in EE are less often located at the same site (47% in EE versus 100% in WE; P < 0.001) and less often provided by the same doctors (41% versus 90%, respectively; P = 0.002), whereas regular screening of HIV-infected patients for TB (80% versus 40%, respectively; P = 0.037) and directly observed treatment (88% versus 20%, respectively; P < 0.001) were more common in EE. The reported availability of rifabutin and second- and third-line anti-TB drugs was lower, and opioid substitution therapy (OST) was available at fewer centres in EE compared with WE (53% versus 100%, respectively; P < 0.001). CONCLUSIONS Major differences exist between EE and WE in relation to the organization and delivery of health care for HIV/TB-coinfected patients and the availability of anti-TB drugs and OST. Significant discrepancies between reported and actual clinical practices were found in EE.
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Affiliation(s)
- M Mansfeld
- CHIP (Centre for Health and Infectious Disease Research), Department of Infectious Diseases, Section 2100, Rigshospitalet - University of Copenhagen, Copenhagen, Denmark
| | - A Skrahina
- Research Institute of Pulmonology and Pulmonary Tuberculosis, Minsk, Belarus
| | - L Shepherd
- Department of Infection and Population Health, University College London Medical School, London, UK
| | - A Schultze
- Department of Infection and Population Health, University College London Medical School, London, UK
| | - A M Panteleev
- TB Hospital #2, St Petersburg, Russia.,St Petersburg AIDS Centre, St Petersburg, Russia
| | - R F Miller
- Centre for Sexual Health & HIV Research, Mortimer Market Centre, University College London, London, UK
| | - J M Miro
- Infectious Diseases Service, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - I Zeltina
- Infectology Centre of Latvia, Riga, Latvia
| | - S Tetradov
- 'Dr Victor Babes' Hospital of Tropical and Infectious Diseases, Bucharest, Romania.,'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
| | - H Furrer
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland
| | - O Kirk
- CHIP (Centre for Health and Infectious Disease Research), Department of Infectious Diseases, Section 2100, Rigshospitalet - University of Copenhagen, Copenhagen, Denmark
| | - A Grzeszczuk
- Department of Infectious Diseases and Hepatology, Medical University of Bialystok, Bialystok, Poland
| | - N Bolokadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - A Matteelli
- Institute of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | - F A Post
- King's College Hospital NHS Foundation Trust, London, UK
| | - J D Lundgren
- CHIP (Centre for Health and Infectious Disease Research), Department of Infectious Diseases, Section 2100, Rigshospitalet - University of Copenhagen, Copenhagen, Denmark
| | - A Mocroft
- Department of Infection and Population Health, University College London Medical School, London, UK
| | - Amw Efsen
- CHIP (Centre for Health and Infectious Disease Research), Department of Infectious Diseases, Section 2100, Rigshospitalet - University of Copenhagen, Copenhagen, Denmark
| | - D N Podlekareva
- CHIP (Centre for Health and Infectious Disease Research), Department of Infectious Diseases, Section 2100, Rigshospitalet - University of Copenhagen, Copenhagen, Denmark
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Gobis K, Foks H, Suchan K, Augustynowicz-Kopeć E, Napiórkowska A, Bojanowski K. Novel 2-(2-phenalkyl)-1H-benzo[d]imidazoles as antitubercular agents. Synthesis, biological evaluation and structure–activity relationship. Bioorg Med Chem 2015; 23:2112-20. [DOI: 10.1016/j.bmc.2015.03.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 02/26/2015] [Accepted: 03/02/2015] [Indexed: 10/23/2022]
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Hermosilla S, El-Bassel N, Aifah A, Terlikbayeva A, Zhumadilov Z, Berikkhanova K, Darisheva M, Gilbert L, Schluger N, Galea S. Tuberculosis report among injection drug users and their partners in Kazakhstan. Public Health 2015; 129:569-75. [PMID: 25795015 DOI: 10.1016/j.puhe.2015.01.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 01/05/2015] [Accepted: 01/21/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Tuberculosis (TB) is a major threat to global public health. Kazakhstan has the second highest percentage of multidrug-resistant tuberculosis (MDR-TB) cases among incident tuberculosis cases in the world (WHO 2013). A high burden of MDR-TB suggests TB prevention, control, and treatment programs are failing. This study provides an epidemiologic profile of TB among injection drug users (IDUs), a high-risk and chronically underserved population, in Kazakhstan. STUDY DESIGN Cross-sectional study. METHODS The authors studied the characteristics and risk environment of IDUs with self-reported previous active TB and their primary sexual partners in Almaty, Kazakhstan. 728 individuals (364 couples) participated in a couple-based study in 2009. RESULTS 16.75% of participants reported at least one positive TB test (x-ray) in their lifetime. In a multivariable logistic regression adjusting for couple-based sampling, persons with positive TB test were significantly more likely to be older (odds ratio (OR) 7.26, 95% confidence interval (CI): 1.73, 30.43), male (OR 5.53, 95% CI: 2.74, 11.16), have a shorter duration of injection drug use (OR 0.17, 95% CI: 0.04, 0.65), have received high social support from their significant other (OR 2.13, 95% CI: 1.03, 4.40) and more likely (non-significantly) to have been incarcerated (OR 7.03, 95% CI: 0.64, 77.30). CONCLUSIONS Older men with a history of incarceration and recent injection drug use were more likely to have positive TB test in Kazakhstan. Social network support, while potentially positive for many aspects of population health, may increase risk of TB among IDUs in this context. Public health policies that target high-risk populations and their at-risk networks may be necessary to stem the rise of MDR-TB in Central Asia.
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Affiliation(s)
| | - N El-Bassel
- Columbia University School of Social Work, USA
| | - A Aifah
- Columbia University School of Social Work, USA
| | | | | | | | - M Darisheva
- Global Health Research Center of Central Asia, USA
| | - L Gilbert
- Columbia University School of Social Work, USA
| | | | - S Galea
- Columbia University Medical Center, USA
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Schluger NW, El-Bassel N, Hermosilla S, Terlikbayeva A, Darisheva M, Aifah A, Galea S. Tuberculosis, drug use and HIV infection in Central Asia: an urgent need for attention. Drug Alcohol Depend 2013; 132 Suppl 1:S32-6. [PMID: 23928052 DOI: 10.1016/j.drugalcdep.2013.07.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 07/11/2013] [Accepted: 07/12/2013] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Rates of tuberculosis in Central Asia are extremely high, and even more alarming are the very high rates of multidrug-resistant tuberculosis (MDR-TB) in Kazakhstan, Uzbekistan, Tajikistan and Kyrgyzstan. In addition, rates of HIV infection related to injection drug use seems to be rising as well, thus creating conditions for a potentially devastating co-epidemic of TB/HIV and MDR-TB/HIV which would have terrible consequences for public health in these countries. CURRENT STATUS In many countries of Central Asia, diagnosis of tuberculosis still rests on clinical grounds or simple technologies such as chest radiograph and sputum smear examination. Modern molecular techniques such as GenExpert are being introduced in Kazakhstan and Uzbekistan, and perhaps soon in Kyrgyzstan. Treatment of TB is still often centered around prolonged inpatient stay at TB hospitals. Only a minority of patients with HIV infection are receiving ART, and TB and HIV services are not well integrated. Needle exchange programs are becoming increasingly available, but opioid substitution therapy is rarely used in Central Asia. TB, drug treatment and HIV services are generally not well-integrated. CONCLUSIONS To combat this developing storm, integration of TB services, HIV care, and substance abuse treatment programs is needed urgently to allow efficient and effective diagnosis and treatment of these conditions in a coordinated manner.
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Tuberculosis screening and treatment compliance in human immunodeficiency virus patients. REVISTA PORTUGUESA DE PNEUMOLOGIA 2013; 19:134-8. [PMID: 23688819 DOI: 10.1016/j.rppneu.2013.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Revised: 03/04/2013] [Accepted: 03/06/2013] [Indexed: 11/23/2022] Open
Abstract
This study aims to evaluate compliance of HIV patients to TB screening and treatment, identifying determinants for non-compliance. We reviewed clinical records of all HIV infected patients first attended in a Portuguese-Infectious-Unit from 2007-2010 (152 patients). Screening included: symptom inquiry, chest x-ray, TST/IGRA. In 2008 a protocol was established with a TB outpatient clinic allowing patients to choose where to perform screening (decentralization). All patients were offered screening, 69 (45.4%) accepted. Before decentralization, out of 78 patients, 20 (25%) accepted screening. After decentralization, out of 64 patients, 49 (76.6%) accepted screening. Decentralization was associated with higher levels of acceptance (p<0.001), having an AIDS-defining-disease (p=0.002) and being older (p=0.04) was associated with lower screening acceptance. LTBI was diagnosed in 14 and active-TB in 18 cases; 14 cases of active-TB were later diagnosed during hospital appointments. For active-TB, being on HAART was related with treatment adherence (p=0.03). In this population, improving health care access was important for screening compliance.
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Radke JB, Owen KP, Sutter ME, Ford JB, Albertson TE. The Effects of Opioids on the Lung. Clin Rev Allergy Immunol 2013; 46:54-64. [DOI: 10.1007/s12016-013-8373-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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