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Yela E, Solé N, Puig L, López Gallegos D, Clua-García R. Barriers to access to hepatitis C treatment with direct-acting antivirals in people who inject drugs in the community setting. Harm Reduct J 2024; 21:88. [PMID: 38678266 PMCID: PMC11055286 DOI: 10.1186/s12954-024-01009-7] [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: 02/07/2023] [Accepted: 04/22/2024] [Indexed: 04/29/2024] Open
Abstract
Barriers to access to hepatitis C treatment with direct-acting antivirals in people who inject drugs in the community setting. Qualitative study with prison population. Hepatitis C (HCV) treatments with direct-acting antiviral therapy (DAA) are an easy and effective option among people who inject drugs (PWID). However, difficulties in accessing and monitoring treatment in community services and dropouts on release from prison are detected among PWID. For this reason, the aim of the study is to know the access barriers in the diagnosis and treatment of HCV in community health services. An exploratory qualitative study was carried out through semi-structured interviews with 33 PWID recruited in a pre-trial detention prison in Barcelona. The information obtained was analysed using grounded theory. Among PWID sub-population entering prison, personal barriers are related to intense drug use, lack of interest and ignorance of HCV infection and treatment, as well as being in a situation of social exclusion. In relation to health providers, they reported receiving little information, the existence of language barriers in migrants, not receiving screening and treatment proposals, and having poor interactions with some professionals. Systemic barriers were expressed related to the health system circuit being complicated, perceiving little comprehensive care and lack of community support. It is recommended to intensify prevention and treatment campaigns, promoting drug substitution programmes than current ones, improve health education, make the diagnosis and treatment process more flexible, and promote social policies and holistic care for greater coverage of the needs of PWID.
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Affiliation(s)
- Elena Yela
- Sant Esteve Sesrovires Prison Health Care Team (Brians 1 Prison Centre), South Metropolitan Health Care Department, Catalan Health Institute, Sant Esteve Sesrovires, Barcelona, Spain.
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.
| | - Neus Solé
- Sant Esteve Sesrovires Prison Health Care Team (Brians 1 Prison Centre), South Metropolitan Health Care Department, Catalan Health Institute, Sant Esteve Sesrovires, Barcelona, Spain
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Lidia Puig
- Sant Esteve Sesrovires Prison Health Care Team (Brians 1 Prison Centre), South Metropolitan Health Care Department, Catalan Health Institute, Sant Esteve Sesrovires, Barcelona, Spain
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Darío López Gallegos
- South Metropolitan Health Care Department, Catalan Health Institute, Barcelona, Spain
| | - Rafael Clua-García
- Manresa Faculty of Health Sciences, University of Vic - Central University of Catalonia, Manresa, Spain
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[Managing pleasures and harms: An ethnographic study of drug consumption in public spaces, homes and drug consumption rooms]. Salud Colect 2020; 16:e2481. [PMID: 33147386 DOI: 10.18294/sc.2020.2481] [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: 08/20/2019] [Accepted: 06/16/2020] [Indexed: 11/24/2022] Open
Abstract
Drug consumption rooms (DCR) aim to facilitate consumption in hygienic and safe conditions. However, users also consume drugs in public spaces and homes generating incremental risk for health. To strengthen our understanding of consumption practices, we conducted an ethnographic study in different consumption locations in Barcelona, including DCRs, public spaces, and homes. Focusing on consumption practices and narratives, we conducted participant observation and interviewed 16 DCR users. Our findings show that different consumption spaces allow users to experiment different types of pleasures. In addition, consumption in each type of location is associated with various types of harms, which are managed by users by self-regulating their practices. These aspects, therefore, must be taken into account to design harm reduction action aligned with users' practices.
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Saini R, Rao R, Parmar A, Mishra AK, Ambekar A, Agrawal A, Dhingra N. Rates, knowledge and risk factors of non-fatal opioid overdose among people who inject drugs in India: A community-based study. Drug Alcohol Rev 2019; 39:93-97. [PMID: 31769134 DOI: 10.1111/dar.13016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/01/2019] [Accepted: 11/01/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS Non-fatal opioid overdose (NFOO) predicts future fatal opioid overdose and is associated with significant morbidity. There is limited literature on the rates and risk factors for NFOO in people who inject drugs (PWID) from India. We aimed to study the rates of NFOO and documented risk factors for NFOO, as well as knowledge-level of NFOO among PWID from India. DESIGN AND METHODS Community-based, cross-sectional and observational study. We interviewed 104 adult male participants receiving HIV prevention services. Drug use patterns, rates of NFOO and opioid overdose risk factors, knowledge about opioid overdose and its management were assessed. RESULTS The mean age of the participants was 27.9 years. The most common opioid used for injecting was heroin followed by buprenorphine. About 45% (n = 47) participants had experienced an opioid overdose at least once in their lifetime. Around 25% (n = 26) participants had overdosed in the past year, while 21% (n = 22) participants had overdosed within the past 3 months. The majority had risk factors that could predispose them to NFOO. No participant was aware of the use of naloxone for opioid overdose. DISCUSSION AND CONCLUSION The rates of NFOO as well as risk factors for overdose among PWID from India are high, with poor knowledge on overdose management. There is urgent need for a program to prevent and manage opioid overdose among PWID in India.
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Affiliation(s)
- Romil Saini
- National Drug Dependence Treatment Centre, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Ravindra Rao
- National Drug Dependence Treatment Centre, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Arpit Parmar
- National Drug Dependence Treatment Centre, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Ashwani K Mishra
- National Drug Dependence Treatment Centre, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Ambekar
- National Drug Dependence Treatment Centre, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Agrawal
- National Drug Dependence Treatment Centre, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
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The prevalence of non-fatal overdose among people who inject drugs: A multi-stage systematic review and meta-analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 73:172-184. [DOI: 10.1016/j.drugpo.2019.07.030] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 07/15/2019] [Accepted: 07/15/2019] [Indexed: 12/13/2022]
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Deering DEA, Adamson SJ, Sellman JD, Henderson C, Sheridan J, Pooley S, Robertson RM, Noller G, Frampton CMA. Potential risk for fatal drug overdose perceived by people using opioid drugs. Drug Alcohol Rev 2017. [DOI: 10.1111/dar.12635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Daryle E. A. Deering
- National Addiction Centre, Department of Psychological Medicine; University of Otago; Christchurch New Zealand
| | - Simon J. Adamson
- National Addiction Centre, Department of Psychological Medicine; University of Otago; Christchurch New Zealand
| | - John D. Sellman
- National Addiction Centre, Department of Psychological Medicine; University of Otago; Christchurch New Zealand
| | - Charles Henderson
- New Zealand Needle Exchange Programme (trading as Needle Exchange Services Trust); Christchurch New Zealand
| | - Janie Sheridan
- School of Pharmacy; University of Auckland; Āotearoa New Zealand
| | - Sheridan Pooley
- Community Alcohol and Drug Service; Waitemata District Health Board; Auckland New Zealand
| | - Rhonda Marie Robertson
- Salvation Army Addiction; Supportive Accommodation and Reintegration Services; Auckland New Zealand
| | - Geoff Noller
- Substance Use and Policy Analysis; Dunedin New Zealand
| | - Christopher M. A. Frampton
- National Addiction Centre, Department of Psychological Medicine; University of Otago; Christchurch New Zealand
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Espelt A, Bosque-Prous M, Folch C, Sarasa-Renedo A, Majó X, Casabona J, Brugal MT. Is systematic training in opioid overdose prevention effective? PLoS One 2017; 12:e0186833. [PMID: 29088247 PMCID: PMC5663400 DOI: 10.1371/journal.pone.0186833] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 10/09/2017] [Indexed: 12/03/2022] Open
Abstract
The objectives were to analyze the knowledge about overdose prevention, the use of naloxone, and the number of fatal overdoses after the implementation of Systematic Training in Overdose Prevention (STOOP) program. We conducted a quasi-experimental study, and held face-to-face interviews before (n = 725) and after (n = 722) implementation of systematic training in two different samples of people who injected opioids attending harm reduction centers. We asked participants to list the main causes of overdose and the main actions that should be taken when witnessing an overdose. We created two dependent variables, the number of (a) correct and (b) incorrect answers. The main independent variable was Study Group: Intervention Group (IG), Comparison Group (CG), Pre-Intervention Group With Sporadic Training in Overdose Prevention (PREIGS), or Pre-Intervention Group Without Training in Overdose Prevention (PREIGW). The relationship between the dependent and independent variables was assessed using a multivariate Poisson regression analysis. Finally, we conducted an interrupted time series analysis of monthly fatal overdoses before and after the implementation of systematic program during the period 2006–2015. Knowledge of overdose prevention increased after implementing systematic training program. Compared to the PREIGW, the IG gave more correct answers (IRR = 1.40;95%CI:1.33–1.47), and fewer incorrect answers (IRR = 0.33;95%CI:0.25–0.44). Forty percent of people who injected opioids who received a naloxone kit had used the kit in response to an overdose they witnessed. These courses increase knowledge of overdose prevention in people who use opioids, give them the necessary skills to use naloxone, and slightly diminish the number of fatal opioid overdoses in the city of Barcelona.
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Affiliation(s)
- Albert Espelt
- Agència de Salut Pública de Barcelona, Plaça Lesseps, Barcelona, Spain
- Centros de Investigación Biomédica en Red. Epidemiología y Salud Pública (CIBERESP), Calle Melchor Fernández Almagro, Madrid, Spain
- Facultat de Ciències de la Salut de Manresa, Universitat de Vic Universitat Central de Catalunya (UVicUCC), Av. Universitària, Manresa, Spain
- Departament de Psicobiologia i Metodologia en Ciències de la Salut, Universitat Autònoma de Barcelona, Campus UAB, Bellaterra, Spain
- * E-mail:
| | | | - Cinta Folch
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Carretera Canyet s/n, Badalona, Spain
| | - Ana Sarasa-Renedo
- Agència de Salut Pública de Barcelona, Plaça Lesseps, Barcelona, Spain
- Programa de Epidemiología Aplicada y de Campo (PEAC), Instituto de Salud Carlos III, Calle Sinesio Delgado, Madrid, Spain
| | - Xavier Majó
- Subdirecció General de Drogodependències, Departament de Salut de la Generalitat de Catalunya, Carrer de Roc Boronat, Barcelona, Spain
| | - Jordi Casabona
- Subdirecció General de Drogodependències, Departament de Salut de la Generalitat de Catalunya, Carrer de Roc Boronat, Barcelona, Spain
| | - M. Teresa Brugal
- Agència de Salut Pública de Barcelona, Plaça Lesseps, Barcelona, Spain
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Espelt A, Barrio G, Álamo-Junquera D, Bravo MJ, Sarasa-Renedo A, Vallejo F, Molist G, Brugal MT. Lethality of Opioid Overdose in a Community Cohort of Young Heroin Users. Eur Addict Res 2015; 21:300-6. [PMID: 26022713 DOI: 10.1159/000377626] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 02/01/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of the study was to estimate the lethality of opioid overdose among young heroin users. METHODS A prospective community cohort study was conducted in Barcelona and Madrid, Spain. Participants included 791 heroin users aged 18-30 years who were followed up between 2001 and 2006. Fatal overdoses were identified by record linkage of the cohort with the general mortality register, while non-fatal overdoses were self-reported at baseline and follow-up interviews. The person-years (py) at risk were computed for each participant. Fatal and non-fatal overdose rates were estimated by city. Transition towards injection shortly before the overdose could not be measured. Overdose lethality (rate of fatal overdose in proportion to total overdose) and its 95% CI was estimated using Bayesian models. RESULTS The adjusted rates of fatal and non-fatal opioid overdose were 0.7/100 py (95% CI: 0.4-1.1) and 15.8/100 py (95% CI: 14.3-17.6), respectively. The adjusted lethality was 4.2% (95% CI: 2.5-6.5). CONCLUSIONS Four out of 100 opioid overdoses are fatal. These are preventable deaths that could be avoided before or after the overdose takes place. Resources are urgently needed to prevent fatal opioid overdose.
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Affiliation(s)
- Albert Espelt
- Agx00E8;ncia de Salut Px00FA;blica de Barcelona, Barcelona, Spain
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