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Piatkowski T, Benn S, Ayurzana L, King M, McMillan S, Hattingh L. Exploring the role of community pharmacies as a harm reduction environment for anabolic-androgenic steroid consumers: triangulating the perspectives of consumers and pharmacists. Harm Reduct J 2024; 21:59. [PMID: 38481218 PMCID: PMC10935940 DOI: 10.1186/s12954-024-00972-5] [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: 07/31/2023] [Accepted: 02/22/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND While community pharmacies have been successful in providing harm reduction support for illicit substance consumers, little research has explored their role in addressing the needs of anabolic-androgenic steroid (AAS) consumers. OBJECTIVE This study aimed to triangulate the attitudes and experiences of AAS consumers and community pharmacist's regarding AAS harm reduction. METHODS Semi-structured interviews were conducted with AAS consumers (n = 8) and community pharmacists (n = 15) between December 2022 and August 2023 in Australia. Interview data were analysed using reflexive thematic analysis. RESULTS While consumers emphasised easy access to pharmacies, particularly in urban areas, challenges were noted in rural regions. AAS consumers expressed a preference for community pharmacies, perceiving them as less confronting and a feasible avenue for accessing professional advice, highlighting the potential role of pharmacists in nurturing therapeutic alliances with AAS consumers. Similarly, pharmacists expressed receptivity to providing harm reduction information but acknowledged knowledge gaps, suggesting a need for tailored education programs to support AAS consumers effectively. CONCLUSIONS Community pharmacies can be an important environment for AAS harm reduction. Strategies include utilising private spaces for open discussions with AAS consumers and enhancing pharmacists' understanding of AAS to foster trust and support. Further research is needed to address knowledge gaps and training needs for pharmacy staff, with the aim of creating a safer environment for AAS consumers.
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Affiliation(s)
- Timothy Piatkowski
- School of Applied Psychology, Griffith University, Gold Coast, QLD, Australia.
- Griffith Centre for Mental Health, Griffith University, Brisbane, QLD, Australia.
| | - Sarah Benn
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD, Australia
| | - Lkhagvadulam Ayurzana
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD, Australia
| | - Michelle King
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD, Australia
| | - Sara McMillan
- Griffith Centre for Mental Health, Griffith University, Brisbane, QLD, Australia
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD, Australia
| | - Laetitia Hattingh
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD, Australia
- Pharmacy Department, Gold Coast Health, Southport, QLD, 4215, Australia
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2
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Young AM, Havens JR, Cooper HLF, Fallin-Bennett A, Fanucchi L, Freeman PR, Knudsen H, Livingston MD, McCollister KE, Stone J, Vickerman P, Freeman E, Jahangir T, Larimore E, White CR, Cheatom C, Community Staff K, Design Team K. Kentucky Outreach Service Kiosk (KyOSK) Study protocol: a community-level, controlled quasi-experimental, type 1 hybrid effectiveness study to assess implementation, effectiveness and cost-effectiveness of a community-tailored harm reduction kiosk on HIV, HCV and overdose risk in rural Appalachia. BMJ Open 2024; 14:e083983. [PMID: 38431295 PMCID: PMC10910671 DOI: 10.1136/bmjopen-2024-083983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION Many rural communities bear a disproportionate share of drug-related harms. Innovative harm reduction service models, such as vending machines or kiosks, can expand access to services that reduce drug-related harms. However, few kiosks operate in the USA, and their implementation, impact and cost-effectiveness have not been adequately evaluated in rural settings. This paper describes the Kentucky Outreach Service Kiosk (KyOSK) Study protocol to test the effectiveness, implementation outcomes and cost-effectiveness of a community-tailored, harm reduction kiosk in reducing HIV, hepatitis C and overdose risk in rural Appalachia. METHODS AND ANALYSIS KyOSK is a community-level, controlled quasi-experimental, non-randomised trial. KyOSK involves two cohorts of people who use drugs, one in an intervention county (n=425) and one in a control county (n=325). People who are 18 years or older, are community-dwelling residents in the target counties and have used drugs to get high in the past 6 months are eligible. The trial compares the effectiveness of a fixed-site, staffed syringe service programme (standard of care) with the standard of care supplemented with a kiosk. The kiosk will contain various harm reduction supplies accessible to participants upon valid code entry, allowing dispensing data to be linked to participant survey data. The kiosk will include a call-back feature that allows participants to select needed services and receive linkage-to-care services from a peer recovery coach. The cohorts complete follow-up surveys every 6 months for 36 months (three preceding kiosk implementation and four post-implementation). The study will test the effectiveness of the kiosk on reducing risk behaviours associated with overdose, HIV and hepatitis C, as well as implementation outcomes and cost-effectiveness. ETHICS AND DISSEMINATION The University of Kentucky Institutional Review Board approved the protocol. Results will be disseminated in academic conferences and peer-reviewed journals, online and print media, and community meetings. TRIAL REGISTRATION NUMBER NCT05657106.
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Affiliation(s)
- April M Young
- Department of Epidemiology and Environmental Health, University of Kentucky, Lexington, Kentucky, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
| | - Jennifer R Havens
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Hannah L F Cooper
- Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | | | - Laura Fanucchi
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Patricia R Freeman
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
- Department of Pharmacy Practice and Science, University of Kentucky, Lexington, Kentucky, USA
| | - Hannah Knudsen
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Melvin D Livingston
- Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Kathryn E McCollister
- Division of Health Services Research and Policy, University of Miami, Coral Gables, Florida, USA
| | - Jack Stone
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Edward Freeman
- Department of Epidemiology and Environmental Health, University of Kentucky, Lexington, Kentucky, USA
| | - Tasfia Jahangir
- Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Elizabeth Larimore
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
| | - Carol R White
- Department of Epidemiology and Environmental Health, University of Kentucky, Lexington, Kentucky, USA
| | | | - KyOSK Community Staff
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
- College of Public Health, University of Kentucky, Lexington, Kentucky, USA
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3
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Tonin FS, Alves da Costa F, Fernandez-Llimos F. Impact of harm minimization interventions on reducing blood-borne infection transmission and some injecting behaviors among people who inject drugs: an overview and evidence gap mapping. Addict Sci Clin Pract 2024; 19:9. [PMID: 38310293 PMCID: PMC10838443 DOI: 10.1186/s13722-024-00439-9] [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: 05/29/2023] [Accepted: 01/18/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND This study aimed to synthetize the evidence on the effectiveness of harm minimization interventions on reducing blood-borne infection transmission and injecting behaviors among people who inject drugs (PWID) through a comprehensive overview of systematic reviews and evidence gap mapping. METHODS A systematic review was conducted with searches in PubMed and Scopus to identify systematic reviews assessing the impact of interventions aimed at reducing the harms associated with injectable drug use. The overall characteristics of the studies were extracted and their methodological quality was assessed using AMSTAR-2. An evidence gap map was constructed, highlighting the most frequently reported outcomes by intervention (CRD42023387713). RESULTS Thirty-three systematic reviews were included. Of these, 14 (42.2%) assessed the impact of needle/syringe exchange programs (NSEP) and 11 (33.3%) examined opioid agonist therapy (OAT). These interventions are likely to be associated with reductions of HIV/HCV incidence (10-40% risk reduction for NSEP; 50-60% for OAT) and sharing injecting paraphernalia (50% for NSEP, 25-85% for OAT), particularly when combined (moderate evidence). Behavioral/educational interventions were assessed in 12 reviews (36.4%) with most authors in favor/partially in favor of the use of these approaches (moderate evidence). Take-home naloxone programs and supervised-injection facilities were each assessed in two studies (6.1%), which reported inconclusive results (limited/inconsistent evidence). Most authors reported high levels of heterogeneity and risk of bias. Other interventions and outcomes were inadequately reported. Most systematic reviews presented low or critically low quality. CONCLUSION The evidence is sufficient to support the effectiveness of OAT, NSEP and their combination in reducing blood-borne infection transmission and certain injecting behaviors among PWID. However, evidence of other harm minimizations interventions in different settings and for some outcomes remain insufficient.
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Affiliation(s)
- Fernanda S Tonin
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Filipa Alves da Costa
- Research Institute for Medicines (iMED.ULisboa), Faculty of Pharmacy, University of Lisbon, Av. Prof. Gama Pinto, Lisbon, Portugal.
| | - Fernando Fernandez-Llimos
- Applied Molecular Biosciences Unit, (UCIBIO-i4HB) Laboratory of Pharmacology, Faculty of Pharmacy, University of Porto, Porto, Portugal
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Walker JG, Kirtadze I, Tabatadze M, Vickerman P, Otiashvili D. Costs of syringe vending machines in Tbilisi, Georgia. Harm Reduct J 2023; 20:103. [PMID: 37533020 PMCID: PMC10394772 DOI: 10.1186/s12954-023-00829-3] [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: 04/25/2023] [Accepted: 07/16/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Syringe vending machines (SVM) can improve access to sterile injecting equipment, but they have not been widely implemented or evaluated. We evaluate the cost of SVM installed between July 2019-December 2020 in Tbilisi, Georgia. METHODS The SVM were stocked with several kit types, including injecting equipment for opioid or stimulant users, naloxone, male and female condoms, and pregnancy tests. We gathered financial data from the project to estimate fixed (staff time, start-up costs, equipment, running costs, and consumables) and variable (harm reduction kits) costs. We calculated the full cost of the SVM intervention, cost per user, cost per additional syringe accessed by SVM users, and cost per kit distributed (2020 Euros). RESULTS SVM access cards were issued to 1132 users, and 29,238 kits were distributed through SVM, total cost €204,358. Staff costs were 51% of total, consumable costs 28%, equipment 10%, and start up, recurrent costs, and overheads 5% or less each. Opioid and stimulant kits were most accessed (35% and 32% of total). Cost per user was €66/year, and cost per transaction €7, of which €5 fixed costs and €2 variable. If monthly transactions increased from the average of 1622/month to highest monthly usage (4714), fixed costs per transaction would decrease to < €1. It cost €0.55 per additional syringe accessed/user/month. CONCLUSIONS This study provides evidence for governments about the cost of SVM, a novel harm reduction intervention. This is particularly relevant where Global Fund is withdrawing and harm reduction services need to be incorporated into national budgets.
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Affiliation(s)
| | - Irma Kirtadze
- Alternative Georgia, Tbilisi, Georgia
- Ilia State University, Tbilisi, Georgia
| | | | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
| | - David Otiashvili
- Alternative Georgia, Tbilisi, Georgia
- Ilia State University, Tbilisi, Georgia
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Batty EJ, Ibragimov U, Fadanelli M, Gross S, Cooper K, Klein E, Ballard AM, Young AM, Lockard AS, Oser CB, Cooper HLF. A qualitative analysis of rural syringe service program fidelity in Appalachian Kentucky: Staff and participant perspectives. J Rural Health 2023; 39:328-337. [PMID: 36117151 PMCID: PMC10484119 DOI: 10.1111/jrh.12715] [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] [Indexed: 11/29/2022]
Abstract
PURPOSE As drug-related epidemics have expanded from cities to rural areas, syringe service programs (SSPs) and other harm reduction programs have been slow to follow. The recent implementation of SSPs in rural areas demands attention to program fidelity based on core components of SSP success. METHODS Semistructured interviews conducted with clients and staff at 5 SSPs in 5 counties within 2 Central Appalachian health districts. Interviews covered fidelity of SSP implementation to 6 core components: (1) meet needs for harm reduction supplies; (2) education and counseling for sexual, injection, and overdose risks; (3) cooperation between SSPs and local law enforcement; (4) provide other health and social services; (5) ensure low threshold access to services; and (6) promote dignity, the impact of poor fidelity on vulnerability to drug-related harms, and the risk environment's influence on program fidelity. We applied thematic methods to analyze the data. FINDINGS Rural SSPs were mostly faithful to the 6 core components. Deviations from core components can be attributed to certain characteristics of the local rural risk environment outlined in the risk environment model, including geographic remoteness, lack of resources and underdeveloped infrastructure, and stigma against people who inject drugs (PWID) CONCLUSIONS: As drug-related epidemics continue to expand outside cities, scaling up SSPs to serve rural PWID is essential. Future research should explore whether the risk environment features identified also influence SSP fidelity in other rural areas and develop and test strategies to strengthen core components in these vulnerable areas.
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Affiliation(s)
- E J Batty
- Department of Sociology, University of Kentucky, Lexington, Kentucky, USA
| | - U Ibragimov
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, Georgia, USA
| | - M Fadanelli
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, Georgia, USA
| | - S Gross
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| | - K Cooper
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, Georgia, USA
| | - E Klein
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| | - A M Ballard
- Department of Environmental Health, Emory University, Atlanta, Georgia, USA
| | - A M Young
- Department of Epidemiology, University of Kentucky, Lexington, Kentucky, USA
| | - A S Lockard
- Kentucky River District Health Department, Hazard, Kentucky, USA
| | - C B Oser
- Department of Sociology, University of Kentucky, Lexington, Kentucky, USA
| | - H L F Cooper
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, Georgia, USA
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6
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Kerr P, Cossar RD, Livingston M, Jacka D, Dietze P, O’Keefe D. Analysis of four syringe dispensing machine point-of-access data 2017-2020 in Melbourne, Australia: machine utilisation and client demographics. Harm Reduct J 2022; 19:144. [PMID: 36544124 PMCID: PMC9768389 DOI: 10.1186/s12954-022-00726-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Australian needle and syringe distribution occurs via a mix of modalities, including syringe dispensing machines (SDMs). SDMs are electronic vending machines providing (often) 24-h access to needles/syringes and may attract greater numbers of people who are younger, female, and/or have limited connection to health care services compared to individuals accessing fixed-site needle and syringe programs (NSPs). However, validating the demographic characteristics of SDM clients has proven difficult in previous research. METHODS In this paper, we analyse SDM order and client demographic data from four SDMs located in South-East Melbourne, Australia, and compare this against the managing fixed-site NSP between May 2017 and December 2020. SDM data were collected via a novel 0-9 numeric keypad input tool. Via the tool, SDM clients were requested to input their categorised age, gender and postcode. Given the novelty of the tool, we evaluate the feasibility of the data collection method. We analysed data according to: (1) total SDM orders made, (2) estimated 'unique SDM presentations' and (3) describing the demographics of unique SDM clients. Importantly, we noted substantial invalid demographic data, and consequently, severely restricted data for analysis. RESULTS There were 180,989 SDM orders made across the four SDMs to an estimated 90,488 unique SDM presentations. There was little variation in unique presentations across days of the week, but 69% occurred out of NSP operating hours. Across the study period, the SDMs distributed 66% of the number of syringes distributed by the fixed-site NSP. Due to invalid demographic data, our restriction method provided only 10,914 (6% of all data) unique presentations for analysis. There were some demographic differences between SDM and NSP client, but these should be treated with caution. CONCLUSIONS The data collection tool provides a novel means of comparing SDM and fixed-site presentations, demonstrating the substantial expansion of service via the SDMs. However, the validity of the demographic data was highly questionable and requires significant data coding, meaning it is not feasible for community NSPs. While we recommend the inclusion of automatically collected SDM order data, the use of a 0-9 numeric keypad to collect demographic data-while an innovation-requires alteration to support NSP data.
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Affiliation(s)
- Phoebe Kerr
- grid.1056.20000 0001 2224 8486Behaviours and Health Risks, Burnet Institute, 85 Commercial Road, Melbourne, VIC 3004 Australia
| | - Reece D. Cossar
- grid.1056.20000 0001 2224 8486Behaviours and Health Risks, Burnet Institute, 85 Commercial Road, Melbourne, VIC 3004 Australia
| | - Michael Livingston
- grid.1056.20000 0001 2224 8486Behaviours and Health Risks, Burnet Institute, 85 Commercial Road, Melbourne, VIC 3004 Australia ,grid.1032.00000 0004 0375 4078Faculty of Health Sciences, National Drug Research Institute and enAble Institute, Curtin University, Perth, WA Australia ,grid.1018.80000 0001 2342 0938Centre for Alcohol Policy Research, La Trobe University, Melbourne, VIC Australia
| | - David Jacka
- grid.419789.a0000 0000 9295 3933Drug and Alcohol Service, Monash Health, Dandenong, VIC Australia
| | - Paul Dietze
- grid.1056.20000 0001 2224 8486Behaviours and Health Risks, Burnet Institute, 85 Commercial Road, Melbourne, VIC 3004 Australia ,grid.1032.00000 0004 0375 4078Faculty of Health Sciences, National Drug Research Institute and enAble Institute, Curtin University, Perth, WA Australia ,grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC Australia
| | - Daniel O’Keefe
- grid.1056.20000 0001 2224 8486Behaviours and Health Risks, Burnet Institute, 85 Commercial Road, Melbourne, VIC 3004 Australia ,grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC Australia
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Puzhko S, Eisenberg MJ, Filion KB, Windle SB, Hébert-Losier A, Gore G, Paraskevopoulos E, Martel MO, Kudrina I. Effectiveness of Interventions for Prevention of Common Infections Among Opioid Users: A Systematic Review of Systematic Reviews. Front Public Health 2022; 10:749033. [PMID: 35273933 PMCID: PMC8901608 DOI: 10.3389/fpubh.2022.749033] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background The North American opioid crisis is marked by high opioid-related mortality and morbidity, including opioid use-associated infections (OUAIs). Users of pharmaceutical and non-pharmaceutical opioids are at an increased risk of acquiring hepatitis C (HCV), human immunodeficiency virus (HIV), and other infections. No high-level evidence, however, has been synthesized regarding effectiveness of interventions to prevent OUAIs in legal, and illegal/mixed opioid users. The aim of the study is to synthesize available systematic review (SR)-level evidence on the scope and effectiveness of interventions to prevent OUAIs among opioid users. Methods A SR of SRs approach was applied. We searched PubMed, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Epistemonikos and Google Scholar from inception to September 2020. Data selection and extraction were performed independently by three researchers. Risk of bias and quality of evidence were assessed using the AMSTAR2 tool. Results were narratively synthesized. Strength of evidence for each category was reported. Results Eleven of twelve identified SRs included interventions to prevent HCV/HIV transmission in persons who inject drugs (PWID), including opioids. One SR evaluated interventions to prevent recurrent infectious endocarditis. There was sufficient and tentative SR of SRs-level evidence for the effectiveness of opioid substitution therapy (OST) in preventing HIV and HCV, respectively. We found tentative evidence to support effectiveness of needle/syringe exchange programs (NSP) in HIV prevention, and sufficient evidence to support effectiveness of the combined OST and NSP in HCV prevention. There was insufficient SR-level evidence to support or discount effectiveness of other interventions to prevent OUAIs. No SR focused on non-PWID populations. Conclusion SR-level evidence supports the use of OST, NSP, and combined interventions for the reduction of HCV and HIV transmission in PWID. More research on prevention of other OUAIs and on prevention of OUAIs in non-PWID populations is urgently needed. Systematic Review Registration Registered in PROSPERO on July 30, 2020. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=195929, identifier: #195929.
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Affiliation(s)
- Svetlana Puzhko
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Mark J Eisenberg
- Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Kristian B Filion
- Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Department of Medicine, Faculty of Medicine and Health Sciences, McGill University Health Center, McGill University, Montreal, QC, Canada
| | - Sarah B Windle
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Andréa Hébert-Losier
- Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, QC, Canada
| | - Genevieve Gore
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, QC, Canada
| | | | - Marc O Martel
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Faculty of Dentistry, McGill University, Montréal, QC, Canada
| | - Irina Kudrina
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
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Otiashvili D, Kirtadze I, Mgebrishvili T, Beselia A, Tabatadze M, Vardanashvili I, Ober AJ. Implementation and evaluation of a syringe vending machine trial in Tbilisi, Georgia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 103:103649. [PMID: 35299004 DOI: 10.1016/j.drugpo.2022.103649] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/26/2022] [Accepted: 02/28/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Syringe vending machines (SVM) have proven to be an effective vehicle for providing an uninterrupted supply of sterile equipment to PWID, but they have not been implemented or disseminated broadly. The aim of this study was to implement and evaluate outcomes of introducing SVM in Tbilisi, Georgia. METHODS We installed SVM at five HIV prevention sites in 10 locations in Tbilisi, Georgia and studied implementation over 20 months. We used the RE-AIM framework to assess outcomes across four RE-AIM domains: reach, effectiveness at providing syringe access, adoption and implementation. RESULTS Reach. SVM reached 8% of the target population. Effectiveness at Providing Syringe Access. SVM dispensed 14% of all syringes distributed by HIV prevention services. Using SVM was associated with PWID receiving more sterile syringes from HIV prevention outlets. Adoption. All HIV prevention sites (N=5) invited to implement SVM agreed to participate. Sixty one percent of PWID who received SVM access cards used SVM at least once. Women and young PWID were more likely to use SVM compared to other PWID. IMPLEMENTATION At some sites adherence of the outreach staff to the operational protocol was suboptimal. CONCLUSIONS SVM are an acceptable, feasible and effective intervention for improving access to sterile injection equipment for PWID. Future research will need to elaborate approaches to build the sense of ownership and improve motivation of the field staff to engage with the new intervention, and to examine strategies for attracting groups of PWID who are not in contact with prevention and treatment services.
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Affiliation(s)
- David Otiashvili
- Addiction Research Center Alternative Georgia, 14A Nutsubidze Street, office 2, Tbilisi 0177, Georgia; School of Natural Sciences and Medicine, Ilia State University, 3/5 Kakutsa Cholokashvili Ave., Tbilisi 0162, Georgia.
| | - Irma Kirtadze
- Addiction Research Center Alternative Georgia, 14A Nutsubidze Street, office 2, Tbilisi 0177, Georgia; School of Arts and Sciences, Ilia State University, 3/5 Kakutsa Cholokashvili Ave., Tbilisi 0162, Georgia
| | - Tamar Mgebrishvili
- Addiction Research Center Alternative Georgia, 14A Nutsubidze Street, office 2, Tbilisi 0177, Georgia
| | - Ada Beselia
- Addiction Research Center Alternative Georgia, 14A Nutsubidze Street, office 2, Tbilisi 0177, Georgia
| | - Mzia Tabatadze
- Addiction Research Center Alternative Georgia, 14A Nutsubidze Street, office 2, Tbilisi 0177, Georgia
| | - Irina Vardanashvili
- School of Business, Ilia State University, 3/5 Kakutsa Cholokashvili Ave., Tbilisi 0162, Georgia
| | - Allison J Ober
- RAND Corporation, 1776 Main Street PO Box 2138 Santa Monica, CA 90407-2138, United States
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Searby A, Burr D, McGrath I. The demographic profile of alcohol and other drug (AOD) nurses in Australia: Experienced, highly qualified… and endangered? Collegian 2022. [DOI: 10.1016/j.colegn.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Kudrina I, Puzhko S, Filion KB, Gore G, Paraskevopoulos E, Windle S, Martel MO, Eisenberg MJ. Effectiveness of interventions for prevention of common infections in people who use opioids: a protocol for a systematic review of systematic reviews. Syst Rev 2021; 10:298. [PMID: 34782008 PMCID: PMC8591821 DOI: 10.1186/s13643-021-01852-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 11/01/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The North American opioid crisis is driven by opioid-related mortality and morbidity, including opioid use-associated infections (OUAIs), resulting in a substantial burden for society. Users of legal and illegal opioids are at an increased risk of OUAIs compared to individuals not using opioids. As reported for hepatitis C virus (HCV), human immunodeficiency virus (HIV), bacterial, fungal, and other infections, OUAIs transmission and acquisition risks may be modifiable. Several systematic reviews (SRs) synthetized data regarding interventions to prevent infections in persons using drugs (e.g., opioid substitution therapy, needle and syringes exchange programs, psycho-social interventions); however, their conclusions varied. Therefore, SR of published SRs is needed to synthesize the highest level of evidence on the scope and effectiveness of interventions to prevent OUAIs in people using opioids legally or illegally. METHODS We will comprehensively search for SRs in the PubMed, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Epistemonikos, and Google Scholar databases from inception to November 2020. Data selection and extraction for each SR will be performed independently by two researchers, with disagreements resolved by consensus. All SRs regarding interventions with evaluated effectiveness to prevent OUAI in legal and/or illegal opioid users will be eligible. Risk of bias assessment will be performed using the AMSTAR2 tool. The results will be qualitatively synthesized, and a typology of interventions' effectiveness with a statement on the strength of evidence for each category will be created. DISCUSSION Our pilot search of PubMed resulted in 379 SRs analyzing the effectiveness of interventions to prevent HCV and HIV in persons who inject different types of drugs, including opioids. Of these 379 SRs, 8 evaluated primary studies where participants used opioids and would therefore be eligible for inclusion. The search results thus justify the application of SR of SRs approach. Comprehensive data on the scope and effectiveness of existing interventions to prevent OUAIs will help policy-makers to plan and implement preventive interventions and will assist clinicians in the guidance for their patients using opioids. SYSTEMATIC REVIEW REGISTRATION Registered in PROSPERO on 30 July 2020 ( #195929 ).
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Affiliation(s)
- Irina Kudrina
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, 5858 Chemin de la Côte-des-Neiges, Suite 300, Montreal, QC H3S 1Z1 Canada
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, 1650 Cedar Ave., Montreal, QC H3G 1A4 Canada
| | - Svetlana Puzhko
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, 5858 Chemin de la Côte-des-Neiges, Suite 300, Montreal, QC H3S 1Z1 Canada
| | - Kristian B. Filion
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Purvis Hall, 1020 Pine Avenue West, Montreal, QC H3A 1A2 Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC H3T 1E2 Canada
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University Health Center, McGill University, 1001 Decarie Boulevard, Suite D05-2212, Montreal, QC H4A3JI Canada
| | - Genevieve Gore
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, 3459 rue McTavish, Montreal, QC H3A OC9 Canada
| | - Elena Paraskevopoulos
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, 5858 Chemin de la Côte-des-Neiges, Suite 300, Montreal, QC H3S 1Z1 Canada
- Queensway Carleton Hospital, 3045 Baseline Rd, Ottawa, ON K2H 8P4 Canada
| | - Sarah Windle
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Purvis Hall, 1020 Pine Avenue West, Montreal, QC H3A 1A2 Canada
| | - Marc O. Martel
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, 1650 Cedar Ave., Montreal, QC H3G 1A4 Canada
- Faculty of Dentistry, McGill University, 2001 Avenue McGill College, Suite 500, Montreal, QC H3A 1G1 Canada
| | - Mark J. Eisenberg
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Purvis Hall, 1020 Pine Avenue West, Montreal, QC H3A 1A2 Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC H3T 1E2 Canada
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, 3605 de la Montagne, Montreal, Qc H3G 2M1 Canada
- Division of Cardiology, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC H3T 1E2 Canada
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Broz D, Carnes N, Chapin-Bardales J, Des Jarlais DC, Handanagic S, Jones CM, McClung RP, Asher AK. Syringe Services Programs' Role in Ending the HIV Epidemic in the U.S.: Why We Cannot Do It Without Them. Am J Prev Med 2021; 61:S118-S129. [PMID: 34686281 DOI: 10.1016/j.amepre.2021.05.044] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/18/2021] [Accepted: 05/23/2021] [Indexed: 11/17/2022]
Abstract
Diagnoses of HIV among people who inject drugs have increased in the U.S. during 2014-2018 for the first time in 2 decades, and multiple HIV outbreaks have been detected among people who inject drugs since 2015. These epidemiologic trends pose a significant concern for achieving goals of the federal initiative for Ending the HIV Epidemic in the U.S. Syringe services programs are cost effective, safe, and highly effective in reducing HIV transmission and are an essential component of a comprehensive, integrated approach to addressing these concerns. Yet, geographic coverage of these programs remains limited in the U.S., and many jurisdictions continue to have laws and policies that limit or disallow syringe services programs. An in-depth literature review was conducted on the role of syringe services programs in the Ending the HIV Epidemic initiative. Empirical and model-based evidence consistently shows that syringe services programs have the highest impact in HIV prevention when combined with access to medications for substance use disorder and antiretroviral therapy. Their effectiveness is further maximized when they provide services without restrictions and include proven and innovative strategies to expand access to harm-reduction and clinical services (e.g., peer outreach, telehealth). Increasing geographic and service coverage of syringe services programs requires strong and sustainable policy, funding, and community support and will need to address new challenges related to the COVID-19 pandemic. Syringe services programs have a key role in all 4 Ending the HIV Epidemic initiative strategies-Prevent, Diagnose, Treat, and Respond-and thus are instrumental to its success in preventing disease and saving lives.
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Affiliation(s)
- Dita Broz
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Neal Carnes
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Johanna Chapin-Bardales
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Don C Des Jarlais
- Department of Epidemiology, School of Global Health, New York University, New York, New York
| | - Senad Handanagic
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christopher M Jones
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia; U.S. Public Health Service Commissioned Corps, Rockville, Maryland
| | - R Paul McClung
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia; U.S. Public Health Service Commissioned Corps, Rockville, Maryland
| | - Alice K Asher
- Office of Policy, Planning and Partnerships, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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12
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Kimmel SD, Gaeta JM, Hadland SE, Hallett E, Marshall BDL. Principles of Harm Reduction for Young People Who Use Drugs. Pediatrics 2021; 147:S240-S248. [PMID: 33386326 PMCID: PMC7907587 DOI: 10.1542/peds.2020-023523g] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2020] [Indexed: 11/24/2022] Open
Abstract
In summarizing the proceedings of a longitudinal meeting of experts on substance use disorders among adolescents and young adults, we review 2 principles of care related to harm reduction for young adults with substance use disorders. The first is that harm reduction services are critical to keeping young adults alive and healthy and can offer opportunities for future engagement in treatment. Such services therefore should be offered at every opportunity, regardless of an individual's interest or ability to minimize use of substances. The second is that all evidence-based harm reduction strategies available to older adults should be available to young adults and that whenever possible, harm reduction programs should be tailored to young adults and be developmentally appropriate.
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Affiliation(s)
- Simeon D Kimmel
- Clinical Addition Research and Education Unit,
- Sections of General Internal Medicine and
- Infectious Diseases, Department of Medicine, Boston University School of Medicine and
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts
| | - Jessie M Gaeta
- Sections of General Internal Medicine and
- Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts
| | - Scott E Hadland
- Division of General Pediatrics, Department of Pediatrics, School of Medicine, Boston University and Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts; and
| | - Eliza Hallett
- Division of General Pediatrics, Department of Pediatrics, School of Medicine, Boston University and Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts; and
| | - Brandon D L Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
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13
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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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14
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Nassau T, Al-Tayyib A, Robinson WT, Shinefeld J, Brady KA. The Impact of Syringe Services Program Policy on Risk Behaviors Among Persons Who Inject Drugs in 3 US Cities, 2005-2015. Public Health Rep 2020; 135:138S-148S. [PMID: 32735193 PMCID: PMC7407040 DOI: 10.1177/0033354920930137] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The impact of a syringe services program (SSP) policy on risk behaviors and its durability are not as well studied as the impact of the SSPs themselves. We examined whether trends in syringe sharing among persons who inject drugs (PWID) were associated with changes to syringe access policies in 3 US cities: Denver, New Orleans, and Philadelphia. METHODS PWID were surveyed through National HIV Behavioral Surveillance System surveys in each city in 2005, 2009, 2012, and 2015. We assessed changes in syringe sharing from 2005 to 2015 by city. We used multivariable stepwise logistic regression analysis to measure the associations among syringe sharing and injection works sharing, time, and SSP access. RESULTS From 2005 to 2015, syringe sharing decreased significantly from 49.1% to 33.1% in Denver (P < .001), increased significantly from 32.0% to 50.5% in New Orleans (P < .001), and remained unchanged in Philadelphia (30.4% to 31.5%; P = .87). Compared with persons who obtained syringes from any nonsterile source, the adjusted odds of syringe sharing among PWID were significantly lower in each city if syringes were obtained from sterile sources only: Denver adjusted odds ratio (aOR) = 0.23 (95% confidence interval [CI], 0.18-0.30; New Orleans aOR = 0.26 (95% CI, 0.19-0.35), and Philadelphia aOR = 0.43 (95% CI, 0.33-0.57). CONCLUSIONS The lowest proportion of PWID reporting syringe sharing was in Philadelphia, which has a long-standing legal SSP. Implementation of a legal SSP in Denver in 2012 corresponded to a decrease in sharing, whereas the lack of a legal SSP in New Orleans corresponded to an increase in sharing. Universal long-term access to legal SSPs could further the progress made in HIV prevention among PWID.
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Affiliation(s)
- Tanner Nassau
- 6542 AIDS Activities Coordinating Office, Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Alia Al-Tayyib
- 47804 Denver Health and Hospital Authority, Denver Public Health, Denver, CO, USA
| | - William T Robinson
- 51530 School of Public Health, Louisiana State University Health Sciences Center at New Orleans, New Orleans, LA, USA
- STD/HIV Program, Office of Public Health, Louisiana Department of Health, New Orleans, LA, USA
| | - Jennifer Shinefeld
- 6542 AIDS Activities Coordinating Office, Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Kathleen A Brady
- 6542 AIDS Activities Coordinating Office, Philadelphia Department of Public Health, Philadelphia, PA, USA
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15
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Whitfield M, Reed H, Webster J, Hope V. The impact of COVID-19 restrictions on needle and syringe programme provision and coverage in England. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 83:102851. [PMID: 32736959 PMCID: PMC7362866 DOI: 10.1016/j.drugpo.2020.102851] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/07/2020] [Indexed: 11/27/2022]
Abstract
Background The restrictions introduced in response to COVID-19 present many challenges, particularly for vulnerable and marginalised populations. These include maintaining access to Needle and Syringe Programmes (NSPs) to reduce the harms associated with injecting drugs. NSPs effectiveness is coverage dependent, but lockdowns and social distancing limit NSP access and availability. The impact on NSP provision in England is explored using enhanced monitoring data. Method Data collected through an established comprehensive regional monitoring system from five four-week periods, centred on the implementation of restrictions in the UK in mid-March 2020, are examined. Weekly averages are compared to allow for public holidays and weekly variation in activity. Results The restrictions resulted in the number of NSP clients decreasing by 36%, visits by 36%, and needles distributed by 29%. NSP coverage for those injecting psychoactive drugs halved, declining from 14 needles per-week during the 4-weeks to 15th March 2020 to 7 needles per-week by mid-April, and coverage has remained at this level since then. Conclusions Though it is currently unclear if there has been a decline in injecting, the decline in NSP coverage is so marked that it almost certainly reflects decreased utilisation among those in need, indicating increased equipment reuse and risk.
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Affiliation(s)
- Mark Whitfield
- Public Health Institute, Liverpool John Moores University, 3rd Floor Exchange Station, Tithebarn Street, Liverpool L2 2QP
| | - Howard Reed
- Public Health Institute, Liverpool John Moores University, 3rd Floor Exchange Station, Tithebarn Street, Liverpool L2 2QP
| | - Jane Webster
- Public Health Institute, Liverpool John Moores University, 3rd Floor Exchange Station, Tithebarn Street, Liverpool L2 2QP
| | - Vivian Hope
- Public Health Institute, Liverpool John Moores University, 3rd Floor Exchange Station, Tithebarn Street, Liverpool L2 2QP.
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16
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Rosalim JP. A Senior Management Perspective on the Policy Debate of Needle and Syringe Exchange Program Provision in Irish Prisons. JOURNAL OF CORRECTIONAL HEALTH CARE 2020; 26:27-35. [PMID: 31983260 DOI: 10.1177/1078345819897399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examined from an Irish perspective the contentious policy debate about providing clean needles to injecting drug users within prison systems; specifically, it examined the views of six senior managers who were prison health staff and security management. Research participants were generally opposed to the introduction of prison-based needle and syringe exchange programs (PNSP) in Ireland. They argued that (1) PNSP were unnecessary since injecting drug use within Irish prisons has declined significantly, (2) PNSP, by making needles freely available to prisoners, would make prisons riskier since these needles might be used as weapons against prison staff or other prisoners, and (3) PNSP might be seen as condoning illicit drug use and sending the "wrong message." It is concluded that, for the moment at least, there is little likelihood of PNSP becoming a reality in the Irish Prison Service.
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Affiliation(s)
- Jay P Rosalim
- Department of Justice and Equality, Dublin, Republic of Ireland
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17
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Kender-Jeziorska I. Needle exchange programmes in Visegrad countries: a comparative case study of structural factors in effective service delivery. Harm Reduct J 2019; 16:54. [PMID: 31481068 PMCID: PMC6724252 DOI: 10.1186/s12954-019-0323-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 08/21/2019] [Indexed: 11/30/2022] Open
Abstract
Background Harm reduction services, despite their proved effectiveness in the prevention of infectious diseases, are still underdeveloped in several European states. The situation in the Visegrad Group countries is especially interesting. Notwithstanding the shared history, culture and political situation in the last decades, there are significant differences in the state of harm reduction between the countries. Methods The research applies the ecological systems model to identify the structural barriers and facilitators affecting organisations providing needle exchange services. It uses a comparative multiple case study design with embedded units of analysis complemented by within-case analysis to establish the relationship between the number and scope of identified factors and the performance of needle exchange services. The qualitative data were collected through semi-structured interviews with professionals working in needle exchange services in the Czech Republic, Poland, Slovakia and Hungary. Additionally, relevant documents, reports and online sources were analysed. Results A total of 24 themes (structural factors) were identified across 11 categories on 3 levels (mesosystem, exosystem, macrosystem). The list includes themes related to the broader society, politics and policy on state and local level, frameworks and amounts of funding, the situation on the education labour market, and attitudes of local communities, among others. The data shows that in the Czech Republic, many facilitators can be identified. In the three remaining countries, on the contrary, one can observe mostly barriers in NSP services delivery. Conclusions The study addresses a highly unexplored topic of the functioning of harm reduction organisations in East-Central Europe. It sheds light on the environment of analysed services, identifying a number of structural factors in effective service delivery in the Czech Republic, Poland, Slovakia and Hungary. The research confirms the significant role of the barriers and facilitators in the services’ performance. It highlights the relationships between various elements of the needle exchange programmes’ environment, suggesting holistic strategies for addressing them. It also provides a potential starting point for further research. Electronic supplementary material The online version of this article (10.1186/s12954-019-0323-5) contains supplementary material, which is available to authorized users.
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Otiashvili D, Kirtadze I, Vardanashvili I, Tabatadze M, Ober AJ. Perceived acceptability of and willingness to use syringe vending machines: results of a cross-sectional survey of out-of-service people who inject drugs in Tbilisi, Georgia. Harm Reduct J 2019; 16:21. [PMID: 30898120 PMCID: PMC6429706 DOI: 10.1186/s12954-019-0292-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 03/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The growing HIV epidemic in Eastern Europe and Central Asia has been driven by high rates of injection drug use. The Republic of Georgia has among the highest injection drug use rates globally, with a prevalence of 2.24%. The reach of evidence-based HIV prevention interventions like needle and syringe programs (NSP) among people who inject drugs (PWID) has remained below rates that could significantly impact the epidemic. Syringe vending machines (SVM) are an effective and cost-effective supplement to standard NSP; if acceptable to PWID, SVM could reach hard-to-reach PWID and cover geographic areas where fixed or mobile NSPs do not operate. The aim of this study was to assess the perceived acceptability of SVM among out-of-service (harm reduction or substance use treatment) PWID in Tbilisi, Georgia. METHODOLOGY Participants were recruited using respondent-driven sampling (RDS) to participate in cross-sectional, face-to-face interviews. We conducted individual interviews using a structured questionnaire that covered participants' socio-demographics, drug use practices, and perceived acceptability of SVM. Uni-variate analyses were employed for data analysis. RESULTS The final sample (n = 149) was almost exclusively male with a mean age of 42.2 years and mean years of injection drug use of 14.4 years. Heroin, buprenorphine, and stimulants were the main drugs injected. Eighty-five percent of the sample had never received any harm reduction services, and 30% had never been tested for HIV. Fifteen percent of the sample reported sharing injection equipment with others during last month. All but one participant agreed that PWID would benefit from SVM and 145 (97%) said they would personally use SVM. Ninety percent of those sampled stated that they would use HIV self-tests if available from vending machines. The most highly endorsed features of SVM were provision of free injection equipment, no need to deal with pharmacies, uninterrupted 24/7 access, and availability of HIV self-testing kits. DISCUSSION Perceived acceptability of syringe vending machines was extremely high among PWID not currently receiving any harm reduction or treatment services, with strong support indicated for uninterrupted free access to sterile injection equipment, privacy, and anonymity. Introducing SVM in Georgia holds the potential to deliver significant public health benefits by attracting hard-to-reach PWID, reducing unsafe injection behavior, and contributing to HIV testing uptake and linkage to care.
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Affiliation(s)
- David Otiashvili
- Addiction Research Centre Alternative Georgia, 14A Nutsubidze Street, Office 2, 0177 Tbilisi, Georgia
| | - Irma Kirtadze
- Addiction Research Centre Alternative Georgia, 14A Nutsubidze Street, Office 2, 0177 Tbilisi, Georgia
- School of Arts and Sciences, Ilia State University, 3/5 Kakutsa Cholokashvili Ave., 0162 Tbilisi, Georgia
| | - Irina Vardanashvili
- School of Arts and Sciences, Ilia State University, 3/5 Kakutsa Cholokashvili Ave., 0162 Tbilisi, Georgia
| | - Mzia Tabatadze
- Addiction Research Centre Alternative Georgia, 14A Nutsubidze Street, Office 2, 0177 Tbilisi, Georgia
- School of Business, Ilia State University, 3/5 Kakutsa Cholokashvili Ave., 0162 Tbilisi, Georgia
| | - Allison J. Ober
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138 USA
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Lang J, Jin L, Yao Y. Comparative efficacy of interventions for reducing injection and sexual risk behaviours to prevent HIV in injection drug users: protocol for Bayesian network meta-analysis. BMJ Open 2019; 9:e022811. [PMID: 30696672 PMCID: PMC6352824 DOI: 10.1136/bmjopen-2018-022811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Drug users are more vulnerable to AIDS than the general population. While several interventions are effective for addressing HIV in injection drug users, no meta-analysis has yet been performed to compare interventions and determine the relative benefits of each. We intend to conduct a Bayesian network meta-analysis to compare all available interventions evaluated by a randomised controlled trial for reducing injection and risky sexual behaviours for the prevention of HIV in injection drug users. METHODS AND ANALYSIS Studies will be retrieved by searching the following databases: MEDLINE, Embase, PsycINFO and Cochrane Central Register of Controlled Trials. The search will be performed between May and July 2018 for the literature published between 1980 and May 2018. Two authors will extract data independently. Primary outcome measures will be injection risk behaviour and HIV risk behaviour. HIV seroconversion, confirmed using an antibody test, will be the secondary outcome. Bayesian network meta-analyses will be conducted using the Markov Chains Monte Carlo method. The Cochrane revised tool, Risk of Bias, will be used to assess the risk of bias. Grading of Recommendations Assessment, Development and Evaluation will be used to assess evidence quality. ETHICS AND DISSEMINATION The results of this study will be disseminated at professional conferences and via publications in peer-reviewed journals. This study will not include any confidential personal data or data on human trials; therefore, ethical approval is not required. PROSPERO REGISTRATION NUMBER CRD42018086999.
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Affiliation(s)
- Junjie Lang
- School of Public Health, Wannan Medical College, Wuhu, China
| | - Lairun Jin
- School of Public Health, Wannan Medical College, Wuhu, China
| | - Yingshui Yao
- School of Public Health, Wannan Medical College, Wuhu, China
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Bagot KS, Kaminer Y. Harm Reduction for Youth in Treatment for Substance Use Disorders: One Size Does Not Fit All. CURRENT ADDICTION REPORTS 2018. [DOI: 10.1007/s40429-018-0217-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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21
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Strategies for the elimination of hepatitis C virus infection as a public health threat in the United States. ACTA ACUST UNITED AC 2018; 17:111-120. [PMID: 30294518 DOI: 10.1007/s11901-018-0394-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Purpose of Review Direct-acting antiviral regimens for chronic hepatitis C virus (HCV) became available in 2014, and these highly curative therapies have the potential to reduce HCV-associated morbidity and mortality, decrease transmission, and eliminate HCV infection as a public health problem. This review summarizes the recommendations by the National Academies of Sciences, Engineering, and Medicine for a US strategy for HCV elimination. Recent Findings To achieve proposed targets of reducing HCV incidence by 90% and decreasing HCV-related mortality by 60% by 2030, there is a critical need to improve HCV diagnosis and linkage to care; reduce HCV-related disease by antiviral treatment scale-up; reduce HCV incidence; and strengthen HCV surveillance to determine achievement of HCV elimination targets over time. Summary While HCV elimination is feasible, success of this national effort will require ongoing collaboration and critical resource investment by key stakeholders, including medical and public health communities, legislators, community organizers, and patient advocates.
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Strike C, Miskovic M. Scoping out the literature on mobile needle and syringe programs-review of service delivery and client characteristics, operation, utilization, referrals, and impact. Harm Reduct J 2018; 15:6. [PMID: 29422042 PMCID: PMC5806231 DOI: 10.1186/s12954-018-0212-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 01/31/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Needle and syringe program (NSP) service delivery models encompass fixed sites, mobile services, vending machines, pharmacies, peer NSPs, street outreach, and inter-organizational agreements to add NSP services to other programs. For programs seeking to implement or improve mobile services, access to a synthesis of the evidence related to mobile services is beneficial, but lacking. METHODS We used a scoping study method to search MEDLINE, PSYCHInfo, Embase, Scopus, and Sociological for relevant literature. We identified 39 relevant manuscripts published between 1975 and November 2017 after removing duplicates and non-relevant manuscripts from the 1313 identified by the search. RESULTS Charting of the data showed that these publications reported findings related to the service delivery model characteristics, client characteristics, service utilization, specialized interventions offered on mobile NSPs, linking clients to other services, and impact on injection risk behaviors. Mobile NSPs are implemented in high-, medium-, and low-income countries; provide equipment distribution and many other harm reduction services; face limitations to service complement, confidentiality, and duration of interactions imposed by physical space; adapt to changes in locations and types of drug use; attract people who engage in high-risk/intensity injection behavior and who are often not reached by other service models; and may lead to reduced injection-related risks. DISCUSSION It is not clear from the literature reviewed, what are, or if there are, a "core and essential" complement of services that mobile NSPs should offer. Decisions about service complement for mobile NSPs need to be made in relation to the context and also other available services. Reports of client visits to mobile NSP provide a picture of the volume and frequency of utilization but are difficult to compare given varied measures and reference periods. CONCLUSION Mobile NSPs have an important role to play in improving HIV and HCV prevention efforts across the world. However, more work is needed to create clearer assessment metrics and to improve access to NSP services across the world.
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Affiliation(s)
- Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T3M7 Canada
| | - Miroslav Miskovic
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T3M7 Canada
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Luchenski S, Maguire N, Aldridge RW, Hayward A, Story A, Perri P, Withers J, Clint S, Fitzpatrick S, Hewett N. What works in inclusion health: overview of effective interventions for marginalised and excluded populations. Lancet 2018; 391:266-280. [PMID: 29137868 DOI: 10.1016/s0140-6736(17)31959-1] [Citation(s) in RCA: 202] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 06/16/2017] [Accepted: 07/05/2017] [Indexed: 12/28/2022]
Abstract
Inclusion health is a service, research, and policy agenda that aims to prevent and redress health and social inequities among the most vulnerable and excluded populations. We did an evidence synthesis of health and social interventions for inclusion health target populations, including people with experiences of homelessness, drug use, imprisonment, and sex work. These populations often have multiple overlapping risk factors and extreme levels of morbidity and mortality. We identified numerous interventions to improve physical and mental health, and substance use; however, evidence is scarce for structural interventions, including housing, employment, and legal support that can prevent exclusion and promote recovery. Dedicated resources and better collaboration with the affected populations are needed to realise the benefits of existing interventions. Research must inform the benefits of early intervention and implementation of policies to address the upstream causes of exclusion, such as adverse childhood experiences and poverty.
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Affiliation(s)
- Serena Luchenski
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK; The Farr Institute of Health Informatics Research, University College London, London, UK.
| | - Nick Maguire
- Department of Psychology, University of Southampton, Southampton, UK
| | - Robert W Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK; The Farr Institute of Health Informatics Research, University College London, London, UK
| | - Andrew Hayward
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK; The Farr Institute of Health Informatics Research, University College London, London, UK; Institute of Epidemiology and Health Care, University College London, London, UK
| | - Alistair Story
- Find and Treat Service, University College London Hospitals, London, UK
| | - Patrick Perri
- Center for Inclusion Health, Allegheny Health Network, Pittsburgh, PA, USA; Street Medicine Institute, Ingomar, PA, USA
| | | | | | - Suzanne Fitzpatrick
- Institute for Social Policy, Housing and Equalities Research, Heriot-Watt University, Edinburgh, UK
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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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25
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Community pharmacist experiences of providing needle and syringe programmes in Ireland. Res Social Adm Pharm 2017; 13:767-777. [DOI: 10.1016/j.sapharm.2016.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 06/13/2016] [Accepted: 07/06/2016] [Indexed: 11/21/2022]
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Chandrasekaran S, Kyaw NTT, Harries AD, Yee IA, Ellan P, Kurusamy T, Yusoff N, Mburu G, Mohammad WMZW, Suleiman A. Enrolment and retention of people who inject drugs in the Needle & Syringe Exchange Programme in Malaysia. Public Health Action 2017; 7:155-160. [PMID: 28695090 DOI: 10.5588/pha.17.0003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 03/21/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: Needle and Syringe Exchange Programme (NSEP) implemented by non-governmental organisations in Malaysia. Objectives: To determine enrolment, characteristics and retention in the NSEP of people who inject drugs (PWID) between 2013 and 2015. Design: Retrospective cohort study. Results: There were 20 946 PWID, with a mean age of 38 years. The majority were male (98%) and of Malay ethnicity (92%). Follow-up data were available for 20 761 PWID. Annual retention of newly enrolled PWID for each year was respectively 85%, 87% and 78% for 2013, 2014 and 2015, although annual enrolment over these years declined from 10 724 to 6288 to 3749. Total person-years (py) of follow-up were 27 806, with loss to follow-up of 40 per 100 py. Cumulative probability of retention in NSEP was 66% at 12 months, 45% at 24 months and 26% at 36 months. Significantly higher loss to follow-up rates were observed in those aged 15-24 years or ⩾50 years, females, transgender people and non-Malay ethnic groups. Conclusion: Annual retention of new PWID on NSEP was impressive, although enrolment declined over the 3 years of the study and cumulative loss to follow-up was high. A better understanding of these programmatic outcomes is required.
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Affiliation(s)
| | - N T T Kyaw
- International Union Against Tuberculosis and Lung Disease, Myanmar Country Office, Mandalay, Myanmar
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France.,London School of Hygiene & Tropical Medicine, London, UK
| | - I A Yee
- Malaysian AIDS Council, Kuala Lumpur, Malaysia
| | - P Ellan
- Malaysian AIDS Council, Kuala Lumpur, Malaysia
| | - T Kurusamy
- Malaysian AIDS Council, Kuala Lumpur, Malaysia
| | - N Yusoff
- Malaysian AIDS Council, Kuala Lumpur, Malaysia
| | - G Mburu
- Department of Health Research, Lancaster University, Lancaster, UK
| | - W M Z W Mohammad
- School of Medical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - A Suleiman
- Ministry of Health Malaysia, Putrajaya, Malaysia
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Fernandes RM, Cary M, Duarte G, Jesus G, Alarcão J, Torre C, Costa S, Costa J, Carneiro AV. Effectiveness of needle and syringe Programmes in people who inject drugs - An overview of systematic reviews. BMC Public Health 2017; 17:309. [PMID: 28399843 PMCID: PMC5387338 DOI: 10.1186/s12889-017-4210-2] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 03/31/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Needle and syringe programmes (NSP) are a critical component of harm reduction interventions among people who inject drugs (PWID). Our primary objective was to summarize the evidence on the effectiveness of NSP for PWID in reducing blood-borne infection transmission and injecting risk behaviours (IRB). METHODS We conducted an overview of systematic reviews that included PWID (excluding prisons and consumption rooms), addressed community-based NSP, and provided estimates of the effect regarding incidence/prevalence of Human Immunodeficiency Virus (HIV), Hepatitis C virus (HCV), Hepatitis B virus (HBV) and bacteremia/sepsis, and/or measures of IRB. Systematic literature searches were undertaken on relevant databases, including EMBASE, MEDLINE, and PsychINFO (up to May 2015). For each review we identified relevant studies and extracted data on methods, and findings, including risk of bias and quality of evidence assessed by review authors. We evaluated the risk of bias of each systematic review using the ROBIS tool. We categorized reviews by reported outcomes and use of meta-analysis; no additional statistical analysis was performed. RESULTS We included thirteen systematic reviews with 133 relevant unique studies published between 1989 and 2012. Reported outcomes related to HIV (n = 9), HCV (n = 8) and IRB (n = 6). Methods used varied at all levels of design and conduct, with four reviews performing meta-analysis. Only two reviews were considered to have low risk of bias using the ROBIS tool, and most included studies were evaluated as having low methodological quality by review authors. We found that NSP was effective in reducing HIV transmission and IRB among PWID, while there were mixed results regarding a reduction of HCV infection. Full harm reduction interventions provided at structural level and in multi-component programmes, as well as high level of coverage, were more beneficial. CONCLUSIONS The heterogeneity and the overall low quality of evidence highlights the need for future community-level studies of adequate design to support these results. TRIAL REGISTRATION The protocol of this systematic review was registered in Prospective Register of Systematic Reviews (PROSPERO 2015: CRD42015026145 ).
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Affiliation(s)
- Ricardo M Fernandes
- Center for Evidence-Based Medicine, Faculty of Medicine, University of Lisbonl, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal
- Portuguese Collaborating Centre of the IberoAmerican Cochrane Network-Cochrane Portugal Faculty of Medicine, University of Lisbon, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal
| | - Maria Cary
- Centre for Health Evaluation & Research (CEFAR), National Association of Pharmacies, Rua Marechal Saldanha, n°1, 1249-069 Lisbon, Portugal
| | - Gonçalo Duarte
- Center for Evidence-Based Medicine, Faculty of Medicine, University of Lisbonl, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal
| | - Gonçalo Jesus
- Center for Evidence-Based Medicine, Faculty of Medicine, University of Lisbonl, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal
| | - Joana Alarcão
- Center for Evidence-Based Medicine, Faculty of Medicine, University of Lisbonl, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal
| | - Carla Torre
- Centre for Health Evaluation & Research (CEFAR), National Association of Pharmacies, Rua Marechal Saldanha, n°1, 1249-069 Lisbon, Portugal
| | - Suzete Costa
- Centre for Health Evaluation & Research (CEFAR), National Association of Pharmacies, Rua Marechal Saldanha, n°1, 1249-069 Lisbon, Portugal
| | - João Costa
- Center for Evidence-Based Medicine, Faculty of Medicine, University of Lisbonl, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal
- Portuguese Collaborating Centre of the IberoAmerican Cochrane Network-Cochrane Portugal Faculty of Medicine, University of Lisbon, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal
| | - António Vaz Carneiro
- Center for Evidence-Based Medicine, Faculty of Medicine, University of Lisbonl, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal
- Portuguese Collaborating Centre of the IberoAmerican Cochrane Network-Cochrane Portugal Faculty of Medicine, University of Lisbon, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal
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28
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Fisher K, Smith T, Nairn K, Anderson D. Rural people who inject drugs: A cross-sectional survey addressing the dimensions of access to secondary needle and syringe program outlets. Aust J Rural Health 2016; 25:94-101. [DOI: 10.1111/ajr.12304] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2016] [Indexed: 11/26/2022] Open
Affiliation(s)
- Karin Fisher
- University of Newcastle Department of Rural Health (UONDRH); Tamworth New South Wales Australia
| | - Tony Smith
- University of Newcastle Department of Rural Health Taree; Tamworth New South Wales Australia
| | - Karen Nairn
- Hunter New England Local Health District (HNELHD); Health Reform Transitional Organisation Northern; Newcastle New South Wales Australia
| | - Donna Anderson
- University of Newcastle Department of Rural Health (UONDRH); Tamworth New South Wales Australia
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Newland J, Newman C, Treloar C. "We get by with a little help from our friends": Small-scale informal and large-scale formal peer distribution networks of sterile injecting equipment in Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 34:65-71. [PMID: 27449331 DOI: 10.1016/j.drugpo.2016.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 04/05/2016] [Accepted: 04/06/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND In Australia, sterile needles and syringes are distributed to people who inject drugs (PWID) through formal services for the purposes of preventing blood borne viruses (BBV). Peer distribution involves people acquiring needles from formal services and redistributing them to others. This paper investigates the dynamics of the distribution of sterile injecting equipment among networks of people who inject drugs in four sites in New South Wales (NSW), Australia. METHODS Qualitative data exploring the practice of peer distribution were collected through in-depth, semi-structured interviews and participatory social network mapping. These interviews explored injecting equipment demand, access to services, relationship pathways through which peer distribution occurred, an estimate of the size of the different peer distribution roles and participants' understanding of the illegality of peer distribution in NSW. RESULTS Data were collected from 32 participants, and 31 (98%) reported participating in peer distribution in the months prior to interview. Of those 31 participants, five reported large-scale formal distribution, with an estimated volume of 34,970 needles and syringes annually. Twenty-two participated in reciprocal exchange, where equipment was distributed and received on an informal basis that appeared dependent on context and circumstance and four participants reported recipient peer distribution as their only access to sterile injecting equipment. Most (n=27) were unaware that it was illegal to distribute injecting equipment to their peers. CONCLUSION Peer distribution was almost ubiquitous amongst the PWID participating in the study, and although five participants reported taking part in the highly organised, large-scale distribution of injecting equipment for altruistic reasons, peer distribution was more commonly reported to take place in small networks of friends and/or partners for reasons of convenience. The law regarding the illegality of peer distribution needs to change so that NSPs can capitalise on peer distribution to increase the options available to PWID and to acknowledge PWID as essential harm reduction agents in the prevention of BBVs.
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Affiliation(s)
- Jamee Newland
- Centre of Social Research in Health, UNSW Australia, John Goodsell Building, UNSW 2052, Australia.
| | - Christy Newman
- Centre of Social Research in Health, UNSW Australia, John Goodsell Building, UNSW 2052, Australia
| | - Carla Treloar
- Centre of Social Research in Health, UNSW Australia, John Goodsell Building, UNSW 2052, Australia
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Handanagic S, Bozicevic I, Civljak M, Dominkovic Z, Sevic S, Barbaric J, Nemeth Blazic T, Dakovic Rode O, Begovac J. HIV and hepatitis C prevalence, and related risk behaviours among people who inject drugs in three cities in Croatia: Findings from respondent-driven sampling surveys. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 32:57-63. [PMID: 27160504 DOI: 10.1016/j.drugpo.2016.04.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 03/30/2016] [Accepted: 04/07/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND There are limited data on HIV and hepatitis C virus (HCV) epidemiology among people who inject drugs (PWID) in Croatia. This study aims to provide data on HIV and HCV prevalence and sexual and injecting risk behaviours among PWID in Zagreb, Split, and Rijeka. METHODS Using respondent-driven sampling (RDS) we recruited from November 2014 to February 2015 a total of 176 PWID in Zagreb, 255 in Rijeka and 399 in Split. Participants provided biological specimens for HIV and HCV testing and completed a behavioural questionnaire. RESULTS The proportion of female PWID ranged from 19.5% in Zagreb to 26.0% in Split. In the month before the survey, 2.5% of PWID in Split, 5.6% in Rijeka and 8.0% in Zagreb reported sharing non-sterile needles and syringes. Many PWID injected opioid substitution therapy (OST) in the month before the survey (57.0% in Zagreb and 57.5% in Split and Rijeka, respectively). Among PWID who had a casual sexual partner in the past 12 months (ranging from 39.2% in Split to 44.4% in Rijeka) condom use was low. Although HIV prevalence was low (0.2% in Rijeka and Zagreb, 0.3% in Split), HCV antibody prevalence was considerable (29.1% in Zagreb, 31.5% in Rijeka, 38.3% in Split). HIV and HCV testing coverage in the past 12 months was insufficient (6.8% and 7.0% in Split; 13.2% and 13.5% in Zagreb; 20.2% and 21.5% in Rijeka, respectively). CONCLUSION We found a low-level HIV epidemic and a sizable HCV epidemic among PWID in Zagreb, Split and Rijeka. Presence of high-risk injecting and sexual behaviours together with inadequate HIV and HCV testing coverage call for development of a comprehensive approach to harm reduction and introduction of needle and syringe exchange programmes in prisons, as well as strengthening sexual health interventions.
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Affiliation(s)
- Senad Handanagic
- WHO Collaborating Centre for HIV Surveillance, Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Rockefellerova 4, 10000, Zagreb, Croatia.
| | - Ivana Bozicevic
- WHO Collaborating Centre for HIV Surveillance, Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Rockefellerova 4, 10000, Zagreb, Croatia
| | - Marta Civljak
- Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Rockefellerova 4, 10000, Zagreb, Croatia
| | - Zoran Dominkovic
- WHO Collaborating Centre for HIV Surveillance, Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Rockefellerova 4, 10000, Zagreb, Croatia
| | - Sandra Sevic
- Department of Sociology, Faculty of Humanities and Social Sciences, University of Zagreb, Ivana Lucica 3, 10000, Zagreb, Croatia
| | - Jelena Barbaric
- WHO Collaborating Centre for HIV Surveillance, Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Rockefellerova 4, 10000, Zagreb, Croatia
| | | | - Oktavija Dakovic Rode
- University Hospital for Infectious Diseases "Dr Fran Mihaljevic", School of Medicine, University of Zagreb, Mirogojska 8, 10000, Zagreb, Croatia
| | - Josip Begovac
- University Hospital for Infectious Diseases "Dr Fran Mihaljevic", School of Medicine, University of Zagreb, Mirogojska 8, 10000, Zagreb, Croatia
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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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Nazari SSH, Noroozi M, Soori H, Noroozi A, Mehrabi Y, Hajebi A, Sharifi H, Higgs P, Mirzazadeh A. The effect of on-site and outreach-based needle and syringe programs in people who inject drugs in Kermanshah, Iran. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 27:127-31. [PMID: 26764125 DOI: 10.1016/j.drugpo.2015.10.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 10/16/2015] [Accepted: 10/29/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Needle and syringe programs (NSPs) are widely used to reduce harms associated with drug injecting. This study assessed the effect of facility-based (on-site services at drop-in centre) and outreach models of NSP on injection risk behaviours. METHODS Self-reported data from 455 people who injected drugs (PWID) during 2014 in Kermanshah, Iran, were examined to measure demographic characteristics and risk behaviors. Self-reported and program data were also assessed to identify their main source of injection equipment. Participants were divided into three sub-groups: facility-based NSP users, outreach NSP users and non-users (comparison group). Coarsened exact matching was used to make the three groups statistically equivalent based on age, place of residence, education and income, and groups were compared regarding the proportion of borrowing or lending of syringes/cookers, reusing syringes and recent HIV testing. RESULTS Overall, 76% of participants reported any NSP service use during the two months prior to interview. Only 23% (95%CI: 17-27) reported outreach NSP as their main source of syringes. Using facility-based NSP significantly decreased recent syringe borrowing (OR: 0.27, 95%CI: 0.10-0.70), recent syringe reuse (OR: 0.38, 95%CI: 0.23-0.68) and increased recent HIV testing (OR: 2.60, 95%CI: 1.48-4.56). Similar effects were observed among outreach NSP users; in addition, the outreach NSP model significantly reduced the chance of lending syringes (OR: 0.31, 95%CI: 0.15-0.60), compared to facility-based NSP (OR: 1.25, 95%CI: 0.74-2.17). CONCLUSION These findings suggest that the outreach NSP model is as effective as facility-based NSP in reducing injection risk behaviours and increasing the rate of HIV testing. Outreach NSP was even more effective than facility-based in reducing the lending of syringes to others. Scaling up outreach NSP is an effective intervention to further reduce transmission of HIV via needle sharing.
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Affiliation(s)
- Seyed Saeed Hashemi Nazari
- Safety Promotion and Injury Prevention Research Center, Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Noroozi
- Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hamid Soori
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Noroozi
- School of Advanced Technologies in Medicine (SATM), Tehran University of Medical Sciences (TUMS), Tehran, Iran; Iranian National Center for Addiction Studies (INCAS), Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Yadollah Mehrabi
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Hajebi
- Mental Health Research Center, Tehran Institute of Psychiatry, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Sharifi
- Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Peter Higgs
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Australia
| | - Ali Mirzazadeh
- Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; Global Health Sciences, University of California, San Francisco, CA, USA.
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El-Ghitany EM, Abdel Wahab MM, Abd El-Wahab EW, Hassouna S, Farghaly AG. A comprehensive hepatitis C virus risk factors meta-analysis (1989-2013): do they differ in Egypt? Liver Int 2015; 35:489-501. [PMID: 24923487 DOI: 10.1111/liv.12617] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/05/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS The prevention and control of HCV infection is complex and challenging in terms of describing risk factors and modes of transmission. This meta-analysis was conducted to summarize the best available data on HCV risk factors worldwide and in Egypt. METHODS Through exhaustive literature searches (1989-2013) of HCV risk factors, 357 original eligible articles were included in this study. RESULTS The highest detected risk was intravenous drug users (IDUs) (OR = 9.6) followed by HIV infection (OR = 4.9), having an IDU partner (OR = 4.1), HBV infection (OR = 3.5), Caesarean section (CS) (OR = 3.35), blood transfusion (OR = 3.2) and having an HCV+ partner (OR = 3). Organ transplantation, hospital admission, haemodialysis and having a sexually transmitted infection carry 2.96, 2.4, 2.18 and 2 risks of having HCV respectively. Other significant risk factors included poor education, older age, sharing sharp or blunt objects, MSM, tattooing, hijama, body piercing, minor operations and medical procedures. Some risks showed a decrease over the previous decade, including blood transfusion, organ transplantation, IDUs, IDU partner and CS. Others showed rising risks, including having an HCV+ partner, MSM and suffering from STI. In Egypt, male gender, rural residence, acupuncture and receiving parenteral antischistosomal treatment were significant risks, while neither HIV nor HBV were found to carry a risk of HCV infection. CONCLUSION Blood transfusion, organ transplantation, CS, IDUs, haemodialysis, minor operations and medical procedures are established risk factors. Attention and urgent intervention should be given to the sexual route of transmission, as well as that through minor operations and medical procedures.
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Affiliation(s)
- Engy Mohamed El-Ghitany
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
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Dwyer R, Power R, Denham G, Dietze P. Public injecting and public amenity in an inner-city suburb of Melbourne, Australia. JOURNAL OF SUBSTANCE USE 2014. [DOI: 10.3109/14659891.2014.987834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Rácz J, Csák R. [Emergence of novel psychoactive substances among clients of a needle exchange program in Budapest, Hungary]. Orv Hetil 2014; 155:1383-94. [PMID: 25161053 DOI: 10.1556/oh.2014.29955] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In this paper the authors summarize experience of a drug service provider with the injecting use of novel psychoactive substances. Among clients of the needle exchange programme of Blue Point Drug Counselling and Outpatient Centre, the authors observed the spread of the novel substances since 2009. The extensive spread of the novel substances caused substantial change in injecting use patterns, thus in the usage of the needle exchange programme. The novel psychoactive substances appeared consecutively, so that this setting gave a unique opportunity to observe and track the emergence of these substances. The authors summarize the characteristics which are important for medical practice (risks, frequent use, severe psychopathological conditions) as well as special risks associated with these substances (substances with unknown composition and effect). They highlight the importance and role of the early warning system, monitoring the online sources of information and testing of samples containing novel psychoactive substances.
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Affiliation(s)
- József Rácz
- Semmelweis Egyetem, Egészségtudományi Kar Addiktológiai Tanszék Budapest Eötvös Loránd Tudományegyetem, Pedagógiai és Pszichológiai Kar Pszichológiai Intézet Budapest
| | - Róbert Csák
- Semmelweis Egyetem, Egészségtudományi Kar Addiktológiai Tanszék Budapest
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Syringe disposal among people who inject drugs in Los Angeles: The role of sterile syringe source. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 25:905-10. [DOI: 10.1016/j.drugpo.2014.05.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 04/23/2014] [Accepted: 05/06/2014] [Indexed: 11/20/2022]
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Cama E, Brener L, Bryant J. Characteristics and attendance patterns of a fixed-site NSP and nearby SVM: The benefits of 24-hour access to sterile injecting equipment. DRUGS-EDUCATION PREVENTION AND POLICY 2014. [DOI: 10.3109/09687637.2014.956051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kimergård A, McVeigh J. Variability and dilemmas in harm reduction for anabolic steroid users in the UK: a multi-area interview study. Harm Reduct J 2014; 11:19. [PMID: 24986546 PMCID: PMC4098923 DOI: 10.1186/1477-7517-11-19] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 06/19/2014] [Indexed: 11/22/2022] Open
Abstract
Background The UK continues to experience a rise in the number of anabolic steroid-using clients attending harm reduction services such as needle and syringe programmes. Methods The present study uses interviews conducted with harm reduction service providers as well as illicit users of anabolic steroids from different areas of England and Wales to explore harm reduction for this group of drug users, focussing on needle distribution policies and harm reduction interventions developed specifically for this population of drug users. Results The article addresses the complexity of harm reduction service delivery, highlighting different models of needle distribution, such as peer-led distribution networks, as well as interventions available in steroid clinics, including liver function testing of anabolic steroid users. Aside from providing insights into the function of interventions available to steroid users, along with principles adopted by service providers, the study found significant tensions and dilemmas in policy implementation due to differing perspectives between service providers and service users relating to practices, risks and effective interventions. Conclusion The overarching finding of the study was the tremendous variability across harm reduction delivery sites in terms of available measures and mode of operation. Further research into the effectiveness of different policies directed towards people who use anabolic steroids is critical to the development of harm reduction.
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Affiliation(s)
- Andreas Kimergård
- Addictions Department, National Addiction Centre, Institute of Psychiatry, King's College London, 4 Windsor Walk, London SE5 8BB, UK.
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Treloar C, McLeod R, Yates K, Mao L. What's the Cost of Finding the Right Fit? The Cost of Conducting NSP Business in a Range of Modalities. ACTA ACUST UNITED AC 2014. [DOI: 10.1177/009145091404100103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to calculate the cost of a range of needle and syringe program (NSP) models to contribute to planning for effective NSP delivery. Existing health service data was used to estimate the cost per needle distributed across four modes of service delivery (Primary NSP, including one model of Primary NSP providing primary health care; Secondary NSP; Vending Machine and Outreach) over three years. Costs were primarily affected by the ratio of the volume of equipment distributed to staff costs. The average cost per unit for Primary, Secondary and Outreach modes was approximately $1.00. The cost for Vending Machine provision (accounting for income from service users) was the cheapest option at $0.30–0.40 per unit. When income from services users are not included in calculations, other considerations may be more important than cost when making decisions about providing access to NSP services to a marginalized client group with diverse needs.
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Aspinall EJ, Nambiar D, Goldberg DJ, Hickman M, Weir A, Van Velzen E, Palmateer N, Doyle JS, Hellard ME, Hutchinson SJ. Are needle and syringe programmes associated with a reduction in HIV transmission among people who inject drugs: a systematic review and meta-analysis. Int J Epidemiol 2013; 43:235-48. [PMID: 24374889 DOI: 10.1093/ije/dyt243] [Citation(s) in RCA: 255] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Needle and syringe programmes (NSP) aim to reduce the risk of HIV by providing people who inject drugs (PWID) with sterile injecting equipment. A recent review of reviews (ROR) concluded that there was only tentative evidence to support the effectiveness of NSP in reducing HIV. We carried out a systematic review and meta-analysis to assess the association between NSP and HIV transmission. METHODS Relevant primary articles presenting data on the risk of HIV transmission associated with NSP were identified in two stages: (i) from reviews identified in two published RORs (covering the period 1980-2008); and (ii) a literature search of CINAHL, Cochrane Library, EMBASE, MEDLINE and PsychINFO for primary articles published since the most recent high quality review (covering the period 2008-12). Study results were synthesized using random-effects meta-analysis. RESULTS There were 12 studies comprising at least 12 000 person-years of follow-up. Exposure to NSP was associated with a reduction in HIV transmission: pooled effect size 0·66 [95% confidence interval (CI) 0·43, 1·01] across all studies, and 0·42 (95% CI 0·22, 0·81) across six higher quality studies (according to the Newcastle-Ottawa tool). CONCLUSIONS There is evidence to support the effectiveness of NSP in reducing the transmission of HIV among PWID, although it is likely that other harm reduction interventions have also contributed to the observed reduction in HIV risk. NSP should be considered as just one component of a programme of interventions to reduce both injecting risk and other types of HIV risk behaviour.
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Affiliation(s)
- Esther J Aspinall
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK, Health Protection Scotland, Glasgow, UK, Centre for Population Health, Burnet Institute, Melbourne, Australia, School of Social and Community Medicine, University of Bristol, Bristol, UK, Infectious Diseases Unit, Alfred Hospital, Melbourne, Australia and Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Abdul-Quader AS, Feelemyer J, Modi S, Stein ES, Briceno A, Semaan S, Horvath T, Kennedy GE, Des Jarlais DC. Effectiveness of structural-level needle/syringe programs to reduce HCV and HIV infection among people who inject drugs: a systematic review. AIDS Behav 2013; 17:2878-92. [PMID: 23975473 PMCID: PMC6509353 DOI: 10.1007/s10461-013-0593-y] [Citation(s) in RCA: 153] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Needle-syringe programs (NSP) have been effective in reducing HIV and hepatitis C (HCV) infection among people who inject drugs (PWID). Achieving sustainable reductions in these blood-borne infections requires addressing structural factors so PWID can legally access NSP services. Systematic literature searches collected information on NSP coverage and changes in HIV or HCV infection prevalence or incidence at the population level. Included studies had to document biomarkers (HIV or HCV) coupled with structural-level NSP, defined by a minimum 50 % coverage of PWID and distribution of 10 or more needles/syringe per PWID per year. Fifteen studies reported structural-level NSP and changes in HIV or HCV infection prevalence/incidence. Nine reported decreases in HIV prevalence, six in HCV infection prevalence, and three reported decreases in HIV incidence. The results support NSP as a structural-level intervention to reduce population-level infection and implementation of NSP for prevention and treatment of HIV and HCV infection.
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Affiliation(s)
- Abu S Abdul-Quader
- Center for Global Health, Division of Global HIV/AIDS, Epidemiology and Strategic Information Branch, Centers for Disease Control and Prevention, CORP Bldg 1 Rm 2308.02, MS E30, Atlanta, GA, 30329-1902, USA,
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MacArthur GJ, van Velzen E, Palmateer N, Kimber J, Pharris A, Hope V, Taylor A, Roy K, Aspinall E, Goldberg D, Rhodes T, Hedrich D, Salminen M, Hickman M, Hutchinson SJ. Interventions to prevent HIV and Hepatitis C in people who inject drugs: a review of reviews to assess evidence of effectiveness. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 25:34-52. [PMID: 23973009 DOI: 10.1016/j.drugpo.2013.07.001] [Citation(s) in RCA: 208] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 06/25/2013] [Accepted: 07/03/2013] [Indexed: 01/23/2023]
Abstract
BACKGROUND Injecting drug use is a major risk factor for the acquisition and transmission of HIV and Hepatitis C virus (HCV). Prevention of these infections among people who inject drugs (PWID) is critical to reduce ongoing transmission, morbidity and mortality. METHODS A review of reviews was undertaken involving systematic literature searches of Medline, Embase, CINAHL, PsychINFO, IBSS and the Cochrane Library (2000-2011) to identify English language reviews regarding the effectiveness of harm reduction interventions in relation to HIV transmission, HCV transmission and injecting risk behaviour (IRB). Interventions included needle and syringe programmes (NSP); the provision of injection paraphernalia; opiate substitution treatment (OST); information, education and counselling (IEC); and supervised injecting facilities (SIFs). Reviews were classified into 'core' or 'supplementary' using critical appraisal criteria, and the strength of review-level evidence was assessed. RESULTS Twelve core and thirteen supplementary reviews were included. From these reviews we identified: (i) for NSP: tentative review-level evidence to support effectiveness in reducing HIV transmission, insufficient review-level evidence relating to HCV transmission, but sufficient review-level evidence in relation to IRB; (ii) for OST: sufficient review-level evidence of effectiveness in relation to HIV transmission and IRB, but tentative review-level evidence in relation to HCV transmission; (iii) for IEC, the provision of injection paraphernalia and SIFs: tentative review-level evidence of effectiveness in reducing IRB; and either insufficient or no review-level evidence for these interventions in relation to HIV or HCV transmission. CONCLUSION Review-level evidence indicates that harm reduction interventions can reduce IRB, with evidence strongest for OST and NSP. However, there is comparatively little review-level evidence regarding the effectiveness of these interventions in preventing HCV transmission among PWID. Further studies are needed to assess the effectiveness and impact of scaling up comprehensive packages of harm reduction interventions to minimise HIV and HCV transmission among PWID.
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Affiliation(s)
- Georgina J MacArthur
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK.
| | - Eva van Velzen
- NHS Sutton and Merton/London KSS Specialty School of Public Health, UK
| | | | - Jo Kimber
- University of New South Wales, Sydney, Australia
| | | | - Vivian Hope
- Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London, UK; Health Protection Services, Health Protection Agency, London, UK
| | - Avril Taylor
- University of the West of Scotland, Paisley, Scotland, UK
| | | | - Esther Aspinall
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | | | - Tim Rhodes
- Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London, UK
| | - Dagmar Hedrich
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Mika Salminen
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Matthew Hickman
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Sharon J Hutchinson
- Health Protection Scotland, Glasgow, UK; University of the West of Scotland, Paisley, Scotland, UK
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Grenfell P, Baptista Leite R, Garfein R, de Lussigny S, Platt L, Rhodes T. Tuberculosis, injecting drug use and integrated HIV-TB care: a review of the literature. Drug Alcohol Depend 2013; 129:180-209. [PMID: 23306095 DOI: 10.1016/j.drugalcdep.2012.11.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 11/13/2012] [Accepted: 11/17/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND People who inject drugs (PWID) are at increased risk of tuberculosis (TB) and reduced retention in treatment. There is a need to document strategies for integrated delivery of HIV, TB and drug dependency care. METHODS This article reviews the literature on rates of TB mono- and co-infection, and published and grey literature descriptions of TB and HIV-TB care, among PWID. RESULTS Latent TB infection prevalence was high and active disease more common among HIV-positive PWID. Data on multidrug-resistant TB and co-infections among PWID were scarce. Models of TB care fell into six categories: screening and prevention within HIV-risk studies; prevention at TB clinics; screening and prevention within needle-and-syringe-exchange (NSP) and drug treatment programmes; pharmacy-based TB treatment; TB service-led care with harm reduction/drug treatment programmes; and TB treatment within drug treatment programmes. Co-location with NSP and opioid substitution therapy (OST), combined with incentives, consistently improved screening and prevention uptake. Small-scale combined TB treatment and OST achieved good adherence in diverse settings. Successful interventions involved collaboration across services; a client-centred approach; and provision of social care. No peer-reviewed studies described models of integrated HIV-TB care for PWID but grey literature highlighted key components: co-located services, provision of drug treatment, multidisciplinary staff training; and remaining barriers: staffing inefficiencies, inadequate funding, police interference, and limited OST availability. CONCLUSIONS Integration with drug treatment improves PWID engagement in TB services but there is a need to document approaches to HIV-TB care, improve surveillance of TB and co-infections among PWID, and advocate for improved OST availability.
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Affiliation(s)
- Pippa Grenfell
- Centre for Research on Drugs and Health Behaviour, London School of Hygiene & Tropical Medicine, London, UK.
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Abstract
The current anti-doping policy (‘war on doping’) resembles the ‘war on drugs’ in several aspects, including a zero-tolerance approach, ideology encroaching on human rights and public health principles, high cost using public money for repression and control, and attempts to shape internationally harmonized legal frameworks to attain its aim. Furthermore, even if for different reasons, both wars seem not to be able to attain their objectives, and possibly lead to more harm to society than they can prevent. The Olympic buzz is mounting and we can expect multiple headlines in the media on doping and anti-doping stories related to this event. In this article we describe current anti-doping policy, reflect on its multiple unplanned consequences, and end with a discussion, if lessons learned from harm reduction experiences in the illicit drugs field could be applied to anti-doping.
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Affiliation(s)
- Bengt Kayser
- Institute of movement sciences and sports medicine, University of Geneva, 10, rue du Conseil Général, 1205, Geneva, Switzerland.
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Abstract
The HIV epidemic in higher-income nations is driven by receptive anal intercourse, injection drug use through needle/syringe sharing, and, less efficiently, vaginal intercourse. Alcohol and noninjecting drug use increase sexual HIV vulnerability. Appropriate diagnostic screening has nearly eliminated blood/blood product-related transmissions and, with antiretroviral therapy, has reduced mother-to-child transmission radically. Affected subgroups have changed over time (e.g., increasing numbers of Black and minority ethnic men who have sex with men). Molecular phylogenetic approaches have established historical links between HIV strains from central Africa to those in the United States and thence to Europe. However, Europe did not just receive virus from the United States, as it was also imported from Africa directly. Initial introductions led to epidemics in different risk groups in Western Europe distinguished by viral clades/sequences, and likewise, more recent explosive epidemics linked to injection drug use in Eastern Europe are associated with specific strains. Recent developments in phylodynamic approaches have made it possible to obtain estimates of sequence evolution rates and network parameters for epidemics.
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Affiliation(s)
- Sten H Vermund
- Institute for Global Health and Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
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Parker J, Jackson L, Dykeman M, Gahagan J, Karabanow J. Access to harm reduction services in Atlantic Canada: Implications for non-urban residents who inject drugs. Health Place 2012; 18:152-62. [DOI: 10.1016/j.healthplace.2011.08.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 07/22/2011] [Accepted: 08/25/2011] [Indexed: 11/28/2022]
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Hagan H, Pouget ER, Des Jarlais DC. A systematic review and meta-analysis of interventions to prevent hepatitis C virus infection in people who inject drugs. J Infect Dis 2011; 204:74-83. [PMID: 21628661 DOI: 10.1093/infdis/jir196] [Citation(s) in RCA: 241] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION High rates of hepatitis C virus (HCV) transmission are found in samples of people who inject drugs (PWID) throughout the world. The objective of this paper was to meta-analyze the effects of risk-reduction interventions on HCV seroconversion and identify the most effective intervention types. METHODS We performed a systematic review and meta-analysis of published and unpublished studies. Eligible studies reported on the association between participation in interventions intended to reduce unsafe drug injection and HCV seroconversion in samples of PWID. RESULTS The meta-analysis included 26 eligible studies of behavioral interventions, substance-use treatment, syringe access, syringe disinfection, and multicomponent interventions. Interventions using multiple combined strategies reduced risk of seroconversion by 75% (pooled relative risk, .25; 95% confidence interval, .07-.83). Effects of single-method interventions ranged from .6 to 1.6. CONCLUSIONS Interventions using strategies that combined substance-use treatment and support for safe injection were most effective at reducing HCV seroconversion. Determining the effective dose and combination of interventions for specific subgroups of PWID is a research priority. However, our meta-analysis shows that HCV infection can be prevented in PWID.
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Affiliation(s)
- Holly Hagan
- New York University College of Nursing, NY, USA.
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Jackson LA, Dykeman M, Gahagan J, Karabanow J, Parker J. Challenges and opportunities to integrating family members of injection drug users into harm reduction efforts within the Atlantic Canadian context. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2011; 22:385-92. [PMID: 21742479 DOI: 10.1016/j.drugpo.2011.05.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 05/06/2011] [Accepted: 05/17/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND This paper explores injection drug users' (IDUs) relationships with non-drug using family members in order to understand the potential opportunities for, and challenges to, having these family members provide harm reduction services (e.g., clean syringes). METHODS The qualitative data for this paper were drawn from a larger study of IDUs' relationships with key individuals in their lives (e.g., friends, family members). Interviews were conducted with 115 IDUs from across Atlantic Canada living in both urban and rural areas. RESULTS IDUs report that their relationships with family members are variable and dynamic, often changing over time. IDUs and family members engage in a variety of strategies to protect themselves from the multiple harms associated with drug use. Several strategies of self-protection (e.g., discontinuing all contact) are antithetical to the provision of harm reduction supports by family members. However, other strategies are based on continued contact, providing a potential opportunity for the integration of harm reduction approaches. Some family members not only have contact but provide supports (e.g., emotional support, housing) thus potentially facilitating the integration of harm reduction. In a few instances, family members already provide harm reduction supports (e.g., safe space to use). CONCLUSIONS Conceptualizing addictions as a health and social justice issue, and providing appropriate interventions, may reduce some of the harms experienced by users and family members thus encouraging sustained relationships and greater integration of harm reduction approaches into the relationship. Targeted education to family members about harm reduction may also further encourage their involvement in such efforts. Likewise, supporting family members who are already providing harm reduction supports will likely assist in the scaling-up of harm reduction efforts.
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Affiliation(s)
- Lois A Jackson
- School of Health and Human Performance, Faculty of Health Professions, Dalhousie University, 1459 Oxford Street, Halifax, Nova Scotia, Canada B3H 4R2.
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