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Webb P, Ireland J, Colledge-Frisby S, Peacock A, Leung J, Vickerman P, Farrell M, Hickman M, Grebely J, Degenhardt L. Patterns of drug use among people who inject drugs: A global systematic review and meta-analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 128:104455. [PMID: 38796926 DOI: 10.1016/j.drugpo.2024.104455] [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: 12/11/2023] [Revised: 03/28/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND A better understanding of global patterns of drug use among people who inject drugs can inform interventions to reduce harms related to different use profiles. This review aimed to comprehensively present the geographical variation in drug consumption patterns among this population. METHODS Systematic searches of peer reviewed (PsycINFO, Medline, Embase) and grey literature published from 2008-2022 were conducted. Data on recent (past year) and lifetime drug use among people who inject drugs were included. Data were extracted on use of heroin, amphetamines, cocaine, benzodiazepines, cannabis, alcohol, and tobacco; where possible, estimates were disaggregated by route of administration (injecting, non-injecting, smoking). National estimates were generated and, where possible, regional, and global estimates were derived through meta-analysis. RESULTS Of 40,427 studies screened, 394 were included from 81 countries. Globally, an estimated 78.1 % (95 %CI:70.2-84.2) and 71.8 % (65.7-77.2) of people who inject drugs had recently used (via any route) and injected heroin, while an estimated 52.8 % (47.0-59.0) and 19.8 % (13.8-26.5) had recently used and injected amphetamines, respectively. Over 90 % reported recent tobacco use (93.5 % [90.8-95.3]) and recent alcohol use was 59.1 % (52.6-65.6). In Australasia recent heroin use was lowest (49.4 % [46.8-52.1]) while recent amphetamine injecting (64.0 % [60.8-67.1]) and recent use of cannabis (72.3 % [69.9-74.6]) were higher than in all other regions. Recent heroin use (86.1 % [78.3-91.4]) and non-injecting amphetamine use (43.3 % [38.4-48.3]) were highest in East and Southeast Asia. Recent amphetamine use (75.8 % [72.7-78.8]) and injecting heroin use (84.8 % (81.4-87.8) were highest in North America while non-injecting heroin use was highest in Western Europe (45.0 % [41.3-48.7]). CONCLUSION There is considerable variation in types of drugs and routes of administration used among people who inject drugs. This variation needs to be considered in national and global treatment and harm reduction interventions to target the specific behaviours and harms associated with these regional profiles of use.
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Affiliation(s)
- Paige Webb
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.
| | - Jeremy Ireland
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Samantha Colledge-Frisby
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia; National Drug Research Institute (NDRI) Melbourne, Curtin University, Melbourne, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia; School of Psychological Sciences, University of Tasmania, Hobart, Australia
| | - Janni Leung
- National Centre for Youth Substance Use Research, University of Queensland, Brisbane, Australia
| | - Peter Vickerman
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, England
| | - Michael Farrell
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Matthew Hickman
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, England
| | | | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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Fellows IE, Corcoran C, McIntyre AF. Triangulating Truth and Reaching Consensus on Population Size, Prevalence, and More: Modeling Study. JMIR Public Health Surveill 2024; 10:e48738. [PMID: 38502183 PMCID: PMC10988376 DOI: 10.2196/48738] [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: 05/04/2023] [Revised: 10/06/2023] [Accepted: 12/15/2023] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Population size, prevalence, and incidence are essential metrics that influence public health programming and policy. However, stakeholders are frequently tasked with setting performance targets, reporting global indicators, and designing policies based on multiple (often incongruous) estimates of these variables, and they often do so in the absence of a formal, transparent framework for reaching a consensus estimate. OBJECTIVE This study aims to describe a model to synthesize multiple study estimates while incorporating stakeholder knowledge, introduce an R Shiny app to implement the model, and demonstrate the model and app using real data. METHODS In this study, we developed a Bayesian hierarchical model to synthesize multiple study estimates that allow the user to incorporate the quality of each estimate as a confidence score. The model was implemented as a user-friendly R Shiny app aimed at practitioners of population size estimation. The underlying Bayesian model was programmed in Stan for efficient sampling and computation. RESULTS The app was demonstrated using biobehavioral survey-based population size estimates (and accompanying confidence scores) of female sex workers and men who have sex with men from 3 survey locations in a country in sub-Saharan Africa. The consensus results incorporating confidence scores are compared with the case where they are absent, and the results with confidence scores are shown to perform better according to an app-supplied metric for unaccounted-for variation. CONCLUSIONS The utility of the triangulator model, including the incorporation of confidence scores, as a user-friendly app is demonstrated using a use case example. Our results offer empirical evidence of the model's effectiveness in producing an accurate consensus estimate and emphasize the significant impact that the accessible model and app offer for public health. It offers a solution to the long-standing problem of synthesizing multiple estimates, potentially leading to more informed and evidence-based decision-making processes. The Triangulator has broad utility and flexibility to be adapted and used in various other contexts and regions to address similar challenges.
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Affiliation(s)
- Ian E Fellows
- Division of Global HIV & TB, Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Carl Corcoran
- Division of Global HIV & TB, Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Anne F McIntyre
- Division of Global HIV & TB, Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Dumchev K, Kovtun O, Salnikov S, Titar I, Saliuk T. Integrated biobehavioral surveillance among people who inject drugs in Ukraine, 2007-2020. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024:104319. [PMID: 38216437 DOI: 10.1016/j.drugpo.2024.104319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 12/16/2023] [Accepted: 01/02/2024] [Indexed: 01/14/2024]
Abstract
BACKGROUND Repeated integrated biobehavioral surveys (IBBS) have been implemented among people who inject drugs (PWID) in Ukraine to monitor the trends in key epidemiologic and programmatic indicators. METHODS The study analyzed seven PWID IBBS rounds from 2007 to 2020 in seven Ukrainian cities. Participants were recruited using respondent-driven sampling, tested for HIV and anti-HCV antibodies, and completed a structured questionnaire. Composite weights (based on individual sampling probability and population size) were applied to generate point estimates and confidence intervals for HIV and HCV prevalence, injection risk behaviors, prevention service coverage, and HIV treatment cascade. Multi-level regression assessed temporal trends in these indicators in 2007-2020. RESULTS The samples consisted of 1587 participants in 2007, 1905 in 2008/9, 3066 in 2011, 2846 in 2013, 2699 in 2015, 2798 in 2017, and 3651 in the 2020 rounds. HIV prevalence decreased from 27% to 19% overall, and among PWID younger than 25 from 10.5% to 5.5%. Anti-HCV prevalence increased from 50% to 73% overall but decreased from 58% to 27% in the younger subgroup. Past-30-days injection risk behaviors consistently decreased, reaching a minimum of 38% for any risk in 2020. HIV treatment cascade indicators and coverage with opioid agonist treatment substantially improved in the last three rounds. Harm reduction services coverage fluctuated, declining from 52% to 33% in the last three rounds. CONCLUSIONS This analysis demonstrates the potential of repeated IBBS for monitoring the HIV epidemic and program coverage. We confirmed a sustained decline in overall HIV and HCV transmission, likely driven by reduced risky injection practices among PWID. The impact of harm reduction services requires further study. HIV status awareness and treatment coverage among PWID markedly increased, reaching the national average, possibly indicating the success of case-finding and linkage-to-care interventions. The upcoming IBBS round in Ukraine will also assess the impact of the war on service provision, risk behavior, and HIV transmission among PWID.
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Affiliation(s)
| | | | - Serhii Salnikov
- Public Health Center of the Ministry of Health of Ukraine, Kyiv, Ukraine
| | - Ivan Titar
- Public Health Center of the Ministry of Health of Ukraine, Kyiv, Ukraine
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German D, Glick JL, Yenokyan K, Genberg B, Sawyer A, Gribbin M, Flynn C. Injection Behaviors and Use of Syringe Service Programs over Time among People Who Inject Drugs in Baltimore, Maryland. Subst Use Misuse 2023; 59:651-664. [PMID: 38115628 DOI: 10.1080/10826084.2023.2294966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Introduction: People who inject drugs (PWID) are at increased risk for infectious disease transmission, including hepatitis C and HIV. Understanding trends in injection risk behaviors and syringe service program (SSP) use over time can help improve infectious disease prevention and other harm reduction services. Methods: Using National HIV Behavioral Surveillance System data from Baltimore, Maryland, we examined changes in receptive sharing of (1) syringes, (2) injection equipment, (3) syringes to divide drugs; and (4) receipt of syringes from SSPs among PWID from 2009 to 2018 (n = 518 in 2009, n = 638 in 2012, n = 586 in 2015, and n = 575 in 2018) using unadjusted and adjusted logistic models calculated across time for the total sample. Results: The conditional probability of receptive sharing of syringes and receipt of syringes from SSPs remained relatively stable, while receptive sharing of injection equipment and receptive sharing of syringes to divide drugs dropped substantially after 2009. White race and daily injection frequency were positively associated with sharing syringes and injection equipment and negatively associated with SSP use over time. In 2015, there was a notable shift such that women were twice as likely as men to receive syringes from SSPs and less likely than men to report the use of shared syringes or equipment. Conclusion: Findings indicate overall steady or decreasing trends in injection risk and steady trends in SSP usage over time, with some notable improvements among women and indications of shifting drug market patterns. Injection-related risk behaviors remain high among White PWID and may require targeted outreach and interventions.
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Affiliation(s)
- Danielle German
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer L Glick
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Karine Yenokyan
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Becky Genberg
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Anne Sawyer
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Molly Gribbin
- Maryland Department of Health, Baltimore, Maryland, USA
| | - Colin Flynn
- Maryland Department of Health, Baltimore, Maryland, USA
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Uusküla A, Rannap J, Weijler L, Abagiu A, Arendt V, Barrio G, Barros H, Brummer-Korvenkontio H, Casabona J, Croes E, Jarlais DD, Seguin-Devaux C, Dudás M, Eritsyan K, Folch C, Hatzakis A, Heimer R, Heinsbroek E, Hope V, Jipa R, Ķīvīte-Urtāne A, Levina O, Lyubimova A, Malczewski A, Matser A, McAuley A, Meireles P, Mravčík V, Op de Coul E, Ojavee SE, Parés-Badell O, Prins M, Pulido J, Romanyak E, Rosinska M, Seyler T, Stone J, Sypsa V, Talu A, Tarján A, Taylor A, Vickerman P, Vorobjov S, Dolan K, Wiessing L. Incarceration history is associated with HIV infection among community-recruited people who inject drugs in Europe: A propensity-score matched analysis of cross-sectional studies. Addiction 2023; 118:2177-2192. [PMID: 37991429 DOI: 10.1111/add.16283] [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: 06/03/2022] [Accepted: 05/22/2023] [Indexed: 11/23/2023]
Abstract
AIMS We measured the association between a history of incarceration and HIV positivity among people who inject drugs (PWID) across Europe. DESIGN, SETTING AND PARTICIPANTS This was a cross-sectional, multi-site, multi-year propensity-score matched analysis conducted in Europe. Participants comprised community-recruited PWID who reported a recent injection (within the last 12 months). MEASUREMENTS Data on incarceration history, demographics, substance use, sexual behavior and harm reduction service use originated from cross-sectional studies among PWID in Europe. Our primary outcome was HIV status. Generalized linear mixed models and propensity-score matching were used to compare HIV status between ever- and never-incarcerated PWID. FINDINGS Among 43 807 PWID from 82 studies surveyed (in 22 sites and 13 countries), 58.7% reported having ever been in prison and 7.16% (n = 3099) tested HIV-positive. Incarceration was associated with 30% higher odds of HIV infection [adjusted odds ratio (aOR) = 1.32, 95% confidence interval (CI) = 1.09-1.59]; the association between a history of incarceration and HIV infection was strongest among PWID, with the lowest estimated propensity-score for having a history of incarceration (aOR = 1.78, 95% CI = 1.47-2.16). Additionally, mainly injecting cocaine and/or opioids (aOR = 2.16, 95% CI = 1.33-3.53), increased duration of injecting drugs (per 8 years aOR = 1.31, 95% CI = 1.16-1.48), ever sharing needles/syringes (aOR = 1.91, 95% CI = 1.59-2.28) and increased income inequality among the general population (measured by the Gini index, aOR = 1.34, 95% CI = 1.18-1.51) were associated with a higher odds of HIV infection. Older age (per 8 years aOR = 0.84, 95% CI = 0.76-0.94), male sex (aOR = 0.77, 95% CI = 0.65-0.91) and reporting pharmacies as the main source of clean syringes (aOR = 0.72, 95% CI = 0.59-0.88) were associated with lower odds of HIV positivity. CONCLUSIONS A history of incarceration appears to be independently associated with HIV infection among people who inject drugs (PWID) in Europe, with a stronger effect among PWID with lower probability of incarceration.
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Affiliation(s)
- Anneli Uusküla
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Jürgen Rannap
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Lisa Weijler
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - Adrian Abagiu
- National Institute for Infectious diseases 'Professor Dr Matei Bals', Bucharest, Romania
| | - Vic Arendt
- Service National des Maladies Infectieuses, Centre Hospitalier de Luxembourg, Luxembourg
| | - Gregorio Barrio
- National School of Public Health, Carlos III Health Institute, Madrid, Spain
| | - Henrique Barros
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | | | - Jordi Casabona
- Centre for Epidemiological Studies on Sexually Transmitted Infections and HIV/AIDS of Catalonia (CEEISCAT), Catalonia Public Health Agency (ASPCAT), Badalona, Spain
- Biomedical Research Networking Centre in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Don Des Jarlais
- School of Global Public Health, New York University, New York, NY, 10012, USA
| | - Carole Seguin-Devaux
- Department of Infection and Immunity, Luxembourg Institute of Health, Luxembourg
| | - Mária Dudás
- National Public Health Center, Budapest, Hungary
| | - Ksenia Eritsyan
- National Research University Higher School of Economics, St Petersburg, Russia
| | - Cinta Folch
- Centre for Epidemiological Studies on Sexually Transmitted Infections and HIV/AIDS of Catalonia (CEEISCAT), Catalonia Public Health Agency (ASPCAT), Badalona, Spain
- Biomedical Research Networking Centre in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Robert Heimer
- Department of the Epidemiology of Microbial Diseases, Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | - Ellen Heinsbroek
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
| | - Vivian Hope
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Raluca Jipa
- National Institute for Infectious diseases 'Professor Dr Matei Bals', Bucharest, Romania
| | | | - Olga Levina
- National Research University Higher School of Economics, St Petersburg, Russia
- Acuity Systems, Herndon, VA, USA
| | - Alexandra Lyubimova
- National Research University Higher School of Economics, St Petersburg, Russia
| | - Artur Malczewski
- EMCDDA Polish National Focal Point, National Bureau for Drug Prevention, Warsaw, Poland
| | - Amy Matser
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Infectious Diseases, Amsterdam Infection andd Immunity Institute, Amsterdam, the Netherlands
| | - Andrew McAuley
- Public Health Scotland, Meridian Court, Glasgow, Scotland, UK
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Paula Meireles
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Viktor Mravčík
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
- Společnost Podané ruce, Brno, Czech Republic
- Klinika Podané ruce, Brno, Czech Republic
| | - Eline Op de Coul
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Sven E Ojavee
- Department of Computational Biology, University of Lausanne, Lausanne, Switzerland
| | | | - Maria Prins
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Infectious Diseases, Amsterdam Infection andd Immunity Institute, Amsterdam, the Netherlands
| | - José Pulido
- National School of Public Health, Carlos III Health Institute, Madrid, Spain
- Biomedical Research Networking Centre in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Department of Public Health and Maternal and Child Health, Complutense University of Madrid, Madrid, Spain
| | | | - Magdalena Rosinska
- Department of Infectious Diseases Epidemiology and Surveillance, National Institute of Public Health NIH, National Research Institute, Warsaw, Poland
| | - Thomas Seyler
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - Jack Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Ave Talu
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Anna Tarján
- Hungarian Reitox National Focal Point, Budapest, Hungary
| | - Avril Taylor
- Emeritus Professor of Public Health, School of Education and Social Sciences, University of West Scotland, Paisley, Scotland, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sigrid Vorobjov
- Department of Drug and Infectious Diseases Epidemiology, National Institute for Health Development, Tallinn, Estonia
| | - Kate Dolan
- National Drug and Alcohol Research Centre, the University of New South Wales, Sydney, NSW, Australia
| | - Lucas Wiessing
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
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Sypsa V, Roussos S, Tsirogianni E, Tsiara C, Paraskeva D, Chrysanthidis T, Chatzidimitriou D, Papadimitriou E, Paraskevis D, Goulis I, Kalamitsis G, Hatzakis A. A new outbreak of HIV infection among people who inject drugs during the COVID-19 pandemic in Greece. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 117:104073. [PMID: 37263112 DOI: 10.1016/j.drugpo.2023.104073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/08/2023] [Accepted: 05/12/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Multiple HIV outbreaks have been recorded among people who inject drugs (PWID) since 2010. During an intervention for PWID in 2019-2021 in Thessaloniki, Greece, an increasing number of HIV cases was documented. Here, we provide an analysis of this new outbreak. METHODS ALEXANDROS was a community-based program and participation included interviewing, rapid HIV/HCV tests, counselling and linkage to care. PWID were recruited through Respondent-Driven Sampling (RDS) in five sampling rounds. Crude and RDS-weighted HIV prevalence estimates were obtained. HIV incidence was estimated from data on 380 initially seronegative PWID with at least two tests. Multivariable Cox proportional hazards model was used to assess risk factors for HIV seroconversion. RESULTS In total, 1,101 PWID were recruited. At first participation, 53.7% were current PWID, 20.1% homeless, 20.3% on opioid substitution treatment and 4.8% had received syringes in the past 12 months. HIV prevalence (95% CI) was 7.0% (5.6-8.7%) and an increasing trend was observed over 2019-2021 (p = 0.002). Two-thirds of the cases (67.5%) were new diagnoses. HIV incidence was 7.0 new infections/100 person-years (95% CI:4.8-10.2). Homelessness in the past 12 months (HR:2.68; 95% CI:1.24-5.81) and receptive syringe sharing (HR:3.86; 95% CI:1.75-8.51) were independently associated with increased risk of seroconversion. By the end of the program, 67.3% of the newly diagnosed cases initiated antiretroviral treatment. CONCLUSIONS A new HIV outbreak among PWID was documented in Greece during the COVID-19 pandemic with homelessness and syringe sharing being associated with increased risk of HIV acquisition. Peer-driven programs targeting the population of high-risk underserved PWID can be used to early identify emerging outbreaks and to improve linkage to HIV care.
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Affiliation(s)
- Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Sotirios Roussos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Efrossini Tsirogianni
- Fourth Department of Internal Medicine, Hippokratio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; Greek Organisation Against Drugs (OKANA), Athens, Greece
| | - Chrissa Tsiara
- Hellenic National Public Health Organization, Marousi, Greece
| | | | - Theofilos Chrysanthidis
- Infectious Diseases Unit, 1st Internal Medicine Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Dimitrios Chatzidimitriou
- National AIDS Reference Centre of Northern Greece, Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evaggelia Papadimitriou
- National AIDS Reference Centre of Northern Greece, Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Goulis
- Fourth Department of Internal Medicine, Hippokratio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Hellenic Scientific Society for the Study of AIDS, Sexually Transmitted Diseases and Emerging Diseases, Athens, Greece
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Glick JL, Zhang L, Rosen JG, Yaroshevich K, Atiba B, Pelaez D, Park JN. A Novel Capacity-Strengthening Intervention for Frontline Harm Reduction Workers to Support Pre-exposure Prophylaxis Awareness-Building and Promotion Among People Who Use Drugs: Formative Research and Intervention Development. JMIR Form Res 2023; 7:e42418. [PMID: 37052977 PMCID: PMC10141312 DOI: 10.2196/42418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 02/08/2023] [Accepted: 02/08/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND HIV prevalence among people who use drugs (PWUD) in Baltimore, Maryland, is higher than among the general population. Pre-exposure prophylaxis (PrEP) is a widely available medication that prevents HIV transmission, yet its usefulness is low among PWUD in Baltimore City and the United States. Community-level interventions to promote PrEP uptake and adherence among PWUD are limited. OBJECTIVE We describe the development of a capacity-strengthening intervention designed for frontline harm reduction workers (FHRWs) to support PrEP awareness-building and promotion among PWUD. METHODS Our study was implemented in 2 phases in Baltimore City, Maryland. The formative phase focused on a qualitative exploration of the PrEP implementation environment, as well as facilitators and barriers to PrEP willingness and uptake, among cisgender women who use drugs. This work, as well as the existing literature, theory, and feedback from our community partners, informed the intervention development phase, which used an academic-community partnership model. The intervention involved a 1-time, 2-hour training with FHRWs aimed at increasing general PrEP knowledge and developing self-efficacy promoting PrEP in practice (eg, facilitating PrEP dialogues with clients, supporting client advancement along a model of PrEP readiness, and referring clients to PrEP services). In a separate paper, we describe the conduct and results of a mixed methods evaluation to assess changes in PrEP-related knowledge, attitudes, self-efficacy, and promotion practices among FHRWs participating in the training. RESULTS The pilot was developed from October to December 2021 and implemented from December 2021 through April 2022. We leveraged existing relationships with community-based harm reduction organizations to recruit FHRWs into the intervention. A total of 39 FHRWs from 4 community-based organizations participated in the training across 4 sessions (1 in-person, 2 online synchronous, and 1 online asynchronous). FHRW training attendees represented a diverse range of work cadres, including peer workers, case managers, and organizational administrators. CONCLUSIONS This intervention could prevent the HIV burden among PWUD by leveraging the relationships that FHRWs have with PWUD and by supporting advancement along the PrEP continuum. Given suboptimal PrEP uptake among PWUD and the limited number of interventions designed to address this gap, our intervention offers an innovative approach to a burgeoning public health problem. If effective, our intervention has the potential to be further developed and scaled up to increase PrEP awareness and uptake among PWUD worldwide.
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Affiliation(s)
- Jennifer L Glick
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Leanne Zhang
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Joseph G Rosen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | | | - Bakari Atiba
- Charm City Care Connection, Baltimore, MD, United States
| | - Danielle Pelaez
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Ju Nyeong Park
- Division of General Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI, United States
- Center of Biomedical Research Excellence on Opioids and Overdose, Rhode Island Hospital, Providence, RI, United States
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8
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Champion JD, Recto P. An Assessment of HIV Risk, Perceptions of Risk, and Potential Adherence to Preexposure Prophylaxis Among HIV-Negative People With Injection Drug Use Who Access Mobile Outreach Services. J Addict Nurs 2023; 34:101-110. [PMID: 37276199 DOI: 10.1097/jan.0000000000000522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The purpose of this study was to assess HIV risk, perceptions of risk, and potential adherence to preexposure prophylaxis (PrEP) for the prevention of HIV infection among people who inject drugs (PWID), who self-report HIV negative status and access mobile outreach intravenous drug use (IVDU) services. METHODS/SAMPLE Participants (N = 93) were non-Hispanic White (59.1%) and Hispanic (36.6%), between the ages of 18 and 63 years, primarily male (58.1%), who reported a length of IVDU between 1 and >20 years and accessed mobile outreach IVDU services in a metropolitan area of the Southwestern United States; all self-reported HIV-negative status. Self-report questionnaires completed via iPad included HIV risk behavior, perceived risk of HIV, and beliefs about medicines. RESULTS PWID perceived themselves at a low risk for HIV with minimal concerns about contracting HIV. High levels of comorbidities (schizophrenia, anxiety, depression, hepatitis, diabetes, and hypertension), substance use, and limited HIV protective behavior and social support existed; women reported significantly more risk behaviors and comorbidities. Positive attitudes toward and interest in use of medication for HIV prevention were present, however, with concurrent concerns regarding long-term medication use and the potential to forget medications. CONCLUSIONS PrEP adherence for PWID presents challenges for clinicians. Addressing perceptions of PrEP, perceived and actual risk for contracting HIV, potential barriers to PrEP adherence, social support, and treatment of comorbidities in primary care and IVDU outreach services potentially enhances PrEP maintenance among PWID, notably women.
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Syangbo A, Hickman M, Colledge‐Frisby S, Leung J, Grebely J, Larney S, Degenhardt L, Trickey A. Associations between the prevalence of chronic hepatitis B among people who inject drugs and country-level characteristics: An ecological analysis. Drug Alcohol Rev 2023; 42:569-581. [PMID: 36600489 PMCID: PMC10728688 DOI: 10.1111/dar.13595] [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: 06/09/2022] [Revised: 11/17/2022] [Accepted: 12/07/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Globally, hepatitis B virus (HBV) is a leading cause of liver disease. People who inject drugs (PWID) are at greater risk than the general population of contracting HBV. This risk could depend on societal factors in different countries. We investigated the associations between country-level chronic HBV prevalence in PWID with national indicators of development and prevalence of HIV and hepatitis C virus (HCV). METHODS We used global systematic review data on chronic HBV prevalence (hepatitis B surface antigen-positive) among PWID and country-level sociodemographic characteristics from online databases. National random-effects meta-analysis estimates of HBV prevalence were the outcome in linear regression models testing for associations with country-level characteristics. RESULTS The study included 131,710 PWID from 304 estimates in 55 countries: the pooled HBV prevalence among PWID in the countries analysed was 4.5% (95% CI 3.9-5.1), the highest regional pooled prevalence was in East and Southeast Asia (17.6% [13.3-22.3]), and the lowest was in Western Europe (1.7% [1.4-2.1]). In multivariable models, no indicators of development were associated with HBV prevalence, but there was evidence of positive associations between HBV prevalence in the general population and among PWID, and evidence of HIV and HCV prevalence in PWID being associated with HBV prevalence in PWID: multivariable coefficients 0.03 (95% CI 0.01-0.04); p < 0.001, and 0.01 (95% CI 0.00-0.03); p = 0.01, respectively. DISCUSSION AND CONCLUSIONS HBV prevalence among PWID was associated with HIV and HCV prevalence among PWID and background HBV prevalence in the general population, highlighting the need for improving harm reduction in PWID and implementation of HBV vaccination, especially where HBV is endemic.
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Affiliation(s)
| | | | - Samantha Colledge‐Frisby
- National Drug and Alcohol Research Centre, UNSW SydneySydneyAustralia
- National Drug Research InstituteMelbourneAustralia
| | - Janni Leung
- National Drug and Alcohol Research Centre, UNSW SydneySydneyAustralia
- National Centre for Youth Substance Use ResearchThe University of QueenslandBrisbaneAustralia
| | | | - Sarah Larney
- National Drug and Alcohol Research Centre, UNSW SydneySydneyAustralia
- Department of Family Medicine and Emergency MedicineUniversity of MontrealMontrealCanada
- Research Centre of the Hospital Centre of the University of MontrealMontrealCanada
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW SydneySydneyAustralia
| | - Adam Trickey
- Population Health SciencesUniversity of BristolBristolUK
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Roussos S, Paraskevis D, Malliori M, Hatzakis A, Sypsa V. Estimating the number of people who inject drugs using repeated respondent-driven sampling (RDS) in a community-based program: implications for the burden of hepatitis C and HIV infections and harm reduction coverage. AIDS Behav 2023; 27:424-430. [PMID: 35947234 DOI: 10.1007/s10461-022-03777-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2022] [Indexed: 11/30/2022]
Abstract
Estimates of the population size of people who inject drugs (PWID) are essential for efficient program planning and for monitoring key targets. Existing estimates in Greece are based on the capture-recapture method applied to drug treatment sources. We aimed to obtain estimates based on data collected from a community-based program addressing PWID in Athens, Greece. The program was implemented in 2012-2013 to increase diagnosis and treatment for HIV among PWID during an HIV outbreak. Five Responden-Driven Sampling (RDS) rounds were used to recruit participants. A unique code was used to identify participants among rounds. Capture-recapture was applied to estimate the population size in 2013 (PWID with injection in the past 12 months; active PWID with injection in the past 30 days). Log-linear models were applied. In 2013, the estimated number of active PWID in Athens was 4,117 [95% confidence interval (CI): 3,728-4,507] (vs. 1,956 [95% CI: 1,525-2,565] the existing population size estimate). Based on this estimate, the coverage of needle and syringe programs in 2013 was 103 syringes/PWID/year (vs. 216 based on the existing estimate). The population prevalence of injecting drug use in Athens (past 12 months) was 0.222% (95% CI: 0.200-0.245). The inclusion of data from community-based programs in the estimation of the PWID population size resulted in 2.1-fold higher estimates, compared to the official estimates obtained from drug treatment data, and indicates the need for re-evaluation of necessary resources for harm reduction and elimination of HIV and hepatitis C in PWID.
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Affiliation(s)
- Sotirios Roussos
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias street, 11527, Athens, Greece
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias street, 11527, Athens, Greece
| | - Meni Malliori
- First Department of Psychiatry, School of Medicine, National and Kapodistrian University of Athens, 72 Vasilissis Sofias Avenue, (Aiginiteio University Hospital), 11528, Athens, Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias street, 11527, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias street, 11527, Athens, Greece.
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11
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Allen ST, Grieb SM, Glick JL, White RH, Puryear T, Smith KC, Weir BW, Sherman SG. Applications of research evidence during processes to acquire approvals for syringe services program implementation in rural counties in Kentucky. Ann Med 2022; 54:404-412. [PMID: 35098828 PMCID: PMC8812801 DOI: 10.1080/07853890.2022.2028001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Despite decades of empirical research in the US and internationally documenting the benefits of implementing syringe services programs (SSPs), their implementation may be controversial in many jurisdictions. Better understanding how research evidence is applied during SSP implementation processes may enable the public health workforce to advocate for program scale up. This study explores applications of research evidence during processes to acquire approvals for SSP implementation in rural counties in Kentucky. METHODS In-depth interviews were conducted among eighteen stakeholders (e.g. health department directors, SSP operators) involved in SSP implementation in rural Kentucky counties. Stakeholders were asked to describe the contexts surrounding SSP implementation processes. Interviews were transcribed and analysed for applications of research evidence. Research evidence-related quotes were subsequently categorised based on the typologies for applications of research evidence developed by Weiss et al. (instrumental, conceptual, and symbolic) and a fourth category for instances when research evidence was not used. RESULTS Instrumental applications of research evidence occurred at the intrapersonal and interpersonal levels to dispel concerns about SSPs and formed the basis for implementation support. SSP proponents used research evidence in a conceptual manner to address underlying attitudes and beliefs that were not evidence-based. Participants reported symbolic research evidence applications to justify pre-existing attitudes and beliefs about meeting the public health needs of people who inject drugs. Lastly, in some instances, research evidence was met with scepticism and an unwillingness to consider its merits. CONCLUSION Applications of research evidence during SSP implementation approval processes in rural Kentucky counties were heterogeneous in nature. Better understanding the diversity of ways in which research evidence may be employed during SSP implementation processes may support efforts to improve the public health of people who inject drugs.Key messagesApplications of research evidence during SSP implementation approval processes in rural Kentucky counties were heterogeneous in nature.Instrumental applications of research evidence occurred at the intrapersonal and interpersonal levels to dispel concerns about SSPs and formed the basis for implementation support.SSP proponents used research evidence in a conceptual manner to address underlying attitudes and beliefs that were not evidence-based.
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Affiliation(s)
- Sean T Allen
- Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Suzanne M Grieb
- Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jennifer L Glick
- Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rebecca Hamilton White
- Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tyler Puryear
- Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Katherine C Smith
- Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Brian W Weir
- Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Susan G Sherman
- Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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12
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Nafeh F, Fusigboye S, Sornpaisarn B. Understanding injecting drug use in Afghanistan: A scoping review. Subst Abuse Treat Prev Policy 2022; 17:65. [PMID: 36123586 PMCID: PMC9484158 DOI: 10.1186/s13011-022-00491-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2022] [Indexed: 12/02/2022] Open
Abstract
Background Several reports have described a growing prevalence of illicit drug use in Afghanistan, with recognition of a recent shift from traditional modes of consumption involving inhalation and oral ingestion to injecting drug use. Objective Conduct a comprehensive review of existing literature to map the injecting drug use situation in Afghanistan. The review intends to describe risk factors and impacts of injecting drug use, drug use characteristics and risk behaviours among people who inject drugs (PWID), and access to harm reduction and treatment. Methods We searched Embase, Global Health, Medline, PsycINFO, Web of Science, and grey literature to identify English language publications up to March 26th, 2022. Studies were eligible for inclusion if they explicitly targeted PWID or injecting drug use in Afghanistan and provided information relevant to the review questions. Two reviewers independently screened titles and abstracts for inclusion and extracted information based on the review objectives. Results A total of 25 articles were identified representing 15 studies (11 quantitative, 2 qualitative, 2 mixed methods). All but one studies were cross-sectional. In majority of the studies, over 95% of the participants were male and most were conducted over a decade ago, in urban settings, mainly Kabul. Only one study examined risk factors of injecting drug use. Eleven studies described drug use characteristics and 9 reported risk behaviours among PWID. Health and social burden of injecting drug use were reported by 8 and 5 studies, respectively. Nine studies described access to harm reduction and treatment. Afghan PWID had high levels of injecting and sexual risk behaviours compared to global estimates. They reported high prevalence of incarceration and displacement. Access to harm reduction and treatment was very limited. This scoping review revealed important knowledge gaps including a gender gap in research with serious implications for drug policy and substance use care. Conclusions Development of a national public health-oriented drug policy and substance use care programme is warranted along with efforts to develop health research capacity to address the need for epidemiological data. The current humanitarian crisis necessitates continued access to evidence-based harm reduction and treatment in Afghanistan. Supplementary Information The online version contains supplementary material available at 10.1186/s13011-022-00491-1.
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13
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Grimshaw C, Trayner KMA. Editorial on 'Epidemiology of HIV infection and associated behaviours among people who inject drugs in England, Wales, and Northern Ireland: nearly 40 years on'. HIV Med 2022; 23:933-935. [PMID: 35508802 DOI: 10.1111/hiv.13300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 03/01/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Ceilidh Grimshaw
- Sandyford Initiative/Brownlee Centre, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Kirsten M A Trayner
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Public Health Scotland, Glasgow, UK
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14
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Aaraj E, Haddad P, Khalife S, Fawaz M, Van Hout MC. Understanding and Responding to Substance Use and Abuse in the Palestinian Refugee Camps in Lebanon Prior to and During COVID-19 Times. Int J Ment Health Addict 2021; 21:1-17. [PMID: 34867120 PMCID: PMC8628828 DOI: 10.1007/s11469-021-00714-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2021] [Indexed: 11/24/2022] Open
Abstract
Due to its geographical proximity to the Syrian conflict and the occupied territories, Lebanon has experienced an influx of refugees in recent times. Palestinian refugees are an identified key vulnerable population, with displaced communities increasingly experiencing camp insecurity, vulnerability to drug use and related health harms. A qualitative study consisting of in-depth interviews and focus group discussions (FGDs) was undertaken as part of a regional exercise investigating Palestinian community experiences of substance and drug use in refugee camps. Thematic analysis triangulated the perspectives of 11 professional stakeholders representing United Nations, human rights and non-governmental organizations (NGOs), and eight Palestinian community members. Emerging themes centered on the interplay between socio-economic instability, lack of law enforcement and camp governance contributing to concerning levels of familial, drug and camp violence, trafficking and availability of drugs. Transactional sex and the exploitation of women and children in drug dealing, diversification toward drug manufacture and dealing of drugs with the outside community were described. There is a lack of harm reduction and rehabilitation supports for those in need. This study highlights the complexities in tackling drug dealing and related criminal activity within refugee camps and humanitarian settings, and the vulnerabilities of those living within to harmful drug use.
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Affiliation(s)
- Elie Aaraj
- Middle East and North African Harm Reduction Association (MENAHRA), Beirut, Lebanon
| | - Patricia Haddad
- Middle East and North African Harm Reduction Association (MENAHRA), Beirut, Lebanon
| | - Sara Khalife
- Middle East and North African Harm Reduction Association (MENAHRA), Beirut, Lebanon
| | - Mirna Fawaz
- Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
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15
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Grebely J, Collins AB, Artenie AA, Sutherland R, Meyer JP, Barocas JA, Falade-Nwulia O, Cepeda JA, Cunningham EB, Hajarizadeh B, Lafferty L, Lazarus JV, Bonn M, Marshall AD, Treloar C. Progress and remaining challenges to address hepatitis C, other infectious diseases, and drug-related harms to improve the health of people who use drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103469. [PMID: 34610884 DOI: 10.1016/j.drugpo.2021.103469] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 12/31/2022]
Affiliation(s)
- Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, Australia.
| | | | | | - Rachel Sutherland
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Jaimie P Meyer
- AIDS Program, Yale School of Medicine, New Haven, United States; Chronic Disease Epidemiology, Yale School of Public Health, New Haven, United States
| | - Joshua A Barocas
- Divisions of General Internal Medicine and Infectious Diseases, University of Colorado School of Medicine, Aurora, United States
| | - Oluwaseun Falade-Nwulia
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Javier A Cepeda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health,Baltimore, United States
| | | | | | - Lise Lafferty
- The Kirby Institute, UNSW Sydney, Sydney, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Matthew Bonn
- Canadian Association of People Who Use Drugs, Dartmouth, Canada
| | - Alison D Marshall
- The Kirby Institute, UNSW Sydney, Sydney, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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16
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Corcorran MA, Ludwig-Baron N, Cheng DM, Lioznov D, Gnatienko N, Patts G, So-Armah K, Blokhina E, Bendiks S, Krupitsky E, Samet JH, Tsui JI. The Hepatitis C Continuum of Care Among HIV-Positive Persons with Heavy Alcohol Use in St. Petersburg, Russia. AIDS Behav 2021; 25:2533-2541. [PMID: 33730255 DOI: 10.1007/s10461-021-03214-y] [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] [Accepted: 02/26/2021] [Indexed: 11/28/2022]
Abstract
This study describes the self-reported prevalence of hepatitis C virus (HCV) coinfection and the HCV care continuum among persons enrolled in the St PETER HIV Study, a randomized controlled trial of medications for smoking and alcohol cessation in HIV-positive heavy drinkers and smokers in St. Petersburg, Russia. Baseline health questionnaire data were used to calculate proportions and 95% confidence intervals for self-reported steps along the HCV continuum of care. The cohort included 399 HIV-positive persons, of whom 387 [97.0% (95% CI 95.3-98.7%)] reported a prior HCV test and 315 [78.9% (95% CI 74.9-82.9%)] reported a prior diagnosis of HCV. Among those reporting a diagnosis of HCV, 43 [13.7% (95% CI 9.9-17.4%)] had received treatment for HCV, and 31 [9.8% (95% CI 6.6-13.1%)] had been cured. Despite frequent HCV testing in this HIV-positive Russian cohort, the proportion reporting prior effective HCV treatment was strikingly low. Increased efforts are needed to scale-up HCV treatment among HIV-positive Russians in St. Petersburg.
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Affiliation(s)
- Maria A Corcorran
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA.
- Division of Allergy and Infectious Diseases, Department of Medicine, Harborview Medical Center, University of Washington School of Medicine, 325 9th Ave, Box 359782, Seattle, WA, 98104, USA.
| | | | - Debbie M Cheng
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Dmitry Lioznov
- First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russian Federation
- Smorodintsev Research Institute of Influenza, St. Petersburg, Russian Federation
| | - Natalia Gnatienko
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, Boston, MA, USA
| | - Gregory Patts
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Kaku So-Armah
- Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine/Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, Boston, MA, USA
| | - Elena Blokhina
- First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russian Federation
| | - Sally Bendiks
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, Boston, MA, USA
| | - Evgeny Krupitsky
- First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russian Federation
- Department of Addictions, V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology, St. Petersburg, Russian Federation
| | - Jeffrey H Samet
- Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine/Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, Boston, MA, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Judith I Tsui
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
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Neal JJ, Prybylski D, Sanchez T, Hladik W. Population Size Estimation Methods: Searching for the Holy Grail. JMIR Public Health Surveill 2020; 6:e25076. [PMID: 33270035 PMCID: PMC7746490 DOI: 10.2196/25076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/30/2020] [Indexed: 11/24/2022] Open
Abstract
Accurate size estimates of key populations (eg, sex workers, people who inject drugs, transgender people, and men who have sex with men) can help to ensure adequate availability of services to prevent or treat HIV infection; inform HIV response planning, target setting, and resource allocation; and provide data for monitoring and evaluating program outcomes and impact. A gold standard method for population size estimation does not exist, but quality of estimates could be improved by using empirical methods, multiple data sources, and sound statistical concepts. To highlight such methods, a special collection of papers in JMIR Public Health and Surveillance has been released under the title “Key Population Size Estimations.” We provide a summary of these papers to highlight advances in the use of empirical methods and call attention to persistent gaps in information.
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Affiliation(s)
- Joyce J Neal
- Epidemiology and Surveillance Branch, Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Dimitri Prybylski
- Epidemiology and Surveillance Branch, Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Travis Sanchez
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Wolfgang Hladik
- Epidemiology and Surveillance Branch, Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Rashti R, Sharafi H, Alavian SM, Moradi Y, Mohamadi Bolbanabad A, Moradi G. Systematic Review and Meta-Analysis of Global Prevalence of HBsAg and HIV and HCV Antibodies among People Who Inject Drugs and Female Sex Workers. Pathogens 2020; 9:pathogens9060432. [PMID: 32486342 PMCID: PMC7350380 DOI: 10.3390/pathogens9060432] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 05/01/2020] [Accepted: 05/29/2020] [Indexed: 02/06/2023] Open
Abstract
The main objective of this study was to evaluate the prevalence of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), hepatitis C virus (HCV) and hepatitis B virus (HBV) and their co-infections among people who inject drugs (PWID) and female sex workers (FSWs). Data sources were searched from January 2008 to October 2018 in different databases. Data were analyzed in Stata 16 software using the Metaprop command. The results showed that the prevalence of HIV, HCV and HBV among PWID was 15%, 60% and 6%, respectively. The prevalence of HIV, HCV and HBV among FSWs was 5%, 1% and 3%, respectively. The prevalence of HIV/HCV, HIV/HBV, HCV/HBV and HIV/HCV/HBV co-infections among PWID was 13%, 2%, 3% and 2%, respectively. The prevalence of HIV/HCV and HIV/HBV co-infections among FSWs was 3% and 1%, respectively. The results show that the prevalence of HCV and HIV infections in PWID and the prevalence of HIV in FSWs is higher than their prevalence in the general population. Interventions for the prevention of HIV and HCV in PWID appear to be poor, and may not be sufficient to effectively prevent HIV and HCV transmission.
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Affiliation(s)
- Roya Rashti
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj 6617713446, Iran; (R.R.); (A.M.B.)
| | - Heidar Sharafi
- Middle East Liver Diseases Center, Tehran 1598976513, Iran;
| | - Seyed Moayed Alavian
- Professor of Gastroenterology and Hepatology, Middle East Liver Disease Center, Tehran 1598976513, Iran;
| | - Yousef Moradi
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran 1449614535, Iran;
| | - Amjad Mohamadi Bolbanabad
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj 6617713446, Iran; (R.R.); (A.M.B.)
| | - Ghobad Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj 6617713446, Iran; (R.R.); (A.M.B.)
- Correspondence:
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19
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Saxton PJW, McAllister SM, Noller GE, Newcombe DAL, Leafe KA. Injecting drug use among gay and bisexual men in New Zealand: Findings from national human immunodeficiency virus epidemiological and behavioural surveillance. Drug Alcohol Rev 2020; 39:365-374. [PMID: 32101629 DOI: 10.1111/dar.13046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/08/2020] [Accepted: 02/06/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND AIMS Gay and bisexual men (GBM) who inject drugs are disproportionately affected by human immunodeficiency virus (HIV) because of dual transmission risks. New Zealand has a progressive history of harm reduction and was the first country to publicly fund needle exchange programs in 1988 for people who inject drugs (PWID). We combine national HIV epidemiological and bio-behavioural surveillance data to understand HIV risk among this subpopulation. DESIGN AND METHODS We examine trends in new HIV diagnoses 1996-2018 by mode of transmission, and compare HIV cases attributed to sex between men (MSM-only), MSM/injecting drug use (IDU) and IDU-only. IDU among GBM in a national HIV behavioural surveillance survey was also examined. We compare GBM by IDU status (never, 'recent', previous) and identified predictors of recent IDU. RESULTS Of 1653 locally-acquired HIV diagnoses 1996-2018, 77.4% were MSM-only, 1.5% MSM/IDU, 1.4% IDU-only and 14.2% heterosexual mode of transmission. On average, just one HIV diagnosis attributed to MSM/IDU and IDU, respectively, occurred per annum. MSM/IDU cases were more likely than MSM-only cases to be indigenous Māori ethnicity. Of 3163 GBM survey participants, 5.4% reported lifetime IDU and 1.2% were recent IDU. Among GBM, HIV positivity was 20% among recent IDU and 5.3% among never injectors. Predictors of recent IDU were: age under 30; more than 20 male partners; female partner; condomless intercourse; HIV positivity. DISCUSSION AND CONCLUSION New Zealand has averted high endemic HIV rates seen among GBM and PWID in other countries and results have been sustained over 30 years.
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Affiliation(s)
- Peter J W Saxton
- Gay Men's Sexual Health Research Group, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Susan M McAllister
- AIDS Epidemiology Group, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Geoffrey E Noller
- Needle Exchange Services Trust, New Zealand Needle Exchange Programme, Christchurch, New Zealand
| | - David A L Newcombe
- Centre for Addiction Research, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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