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Corona-Mata D, Rivero-Juárez A, Camacho Á, Ruiz-Torres L, Ruiz-Cáceres I, Pérez AB, de la Fuente Darder B, Cáceres-Anillo D, Castro-Granados MDG, Lizaur-Barbudo M, Cabrera-Gisbert MV, Redondo-Écija J, Aparicio-Aparicio A, Manchado-López L, Cobos L, Pérez-Valero I, Rivero A. Comparison of hepatitis B and SARS-CoV2 vaccination rates in people who attended Drugs and Addiction Centres. Front Public Health 2024; 11:1258095. [PMID: 38292385 PMCID: PMC10824845 DOI: 10.3389/fpubh.2023.1258095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 12/26/2023] [Indexed: 02/01/2024] Open
Abstract
Background and aims Persons with substance use disorder are at increased risk for hepatitis B virus (HBV) infection. Although most of them are attached to social health centers, the vaccination rate in this group is low. In this context, we designed a study to evaluate the prevalence of users of drug addiction centers (DAC) not immunized against hepatitis B and to compare the rate of vaccination against hepatitis B with the rate of immunization against SARS-Cov-2 in 2 years of follow-up. Design Retrospective study that included individuals attended at DAC. Patients were screened at baseline (June 2020-January 2021) for HBV immunization. Individuals with HBsAb < 10 IU/mL were recommended to receive hepatitis B vaccine, during follow-up (January 2021-October 2022). At the end of follow-up, the HBV vaccination rate among candidates was determined and compared with the vaccination rate against SARS-Cov-2 in this population in the same period. Findings A total of 325 subjects were surveyed and tested. At baseline, the 65% (211/325) of were candidates to initiate vaccination and were advisor to HBV vaccination. During the follow-up 15 individuals received at least one dose of HBV vaccine, supposing a vaccination rate of 7.2%. In the same period, 186 individuals received at least one dose against SARS-Cov-2, representing a vaccination rate of 83%. The comparison between vaccination rates reached statistically significant (p < 0.001). Conclusion Our study manifests a low rate of immunization against HBV in DAC users, despite a high level of immunization for SARS-Cov-2 during the same period in the same population. Consequently, the lack of immunization against HVB in this population might be related with health policy issue more than to individuals linked to care and awareness. A similar approach for vaccination intended for SARS-CoV2 should be applied in high-risk population to warrant the success of immunization program against other preventable diseases such as HBV.
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Affiliation(s)
- Diana Corona-Mata
- Infectious Diseases Department, Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), Reina Sofía University Hospital of Córdoba, University of Córdoba, Córdoba, Spain
- CIBERINFEC, ISCIII – CIBER of Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio Rivero-Juárez
- Infectious Diseases Department, Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), Reina Sofía University Hospital of Córdoba, University of Córdoba, Córdoba, Spain
- CIBERINFEC, ISCIII – CIBER of Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | - Ángela Camacho
- Infectious Diseases Department, Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), Reina Sofía University Hospital of Córdoba, University of Córdoba, Córdoba, Spain
- CIBERINFEC, ISCIII – CIBER of Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | - Laura Ruiz-Torres
- Infectious Diseases Department, Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), Reina Sofía University Hospital of Córdoba, University of Córdoba, Córdoba, Spain
| | - Inmaculada Ruiz-Cáceres
- Infectious Diseases Department, Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), Reina Sofía University Hospital of Córdoba, University of Córdoba, Córdoba, Spain
| | - Ana Belén Pérez
- CIBERINFEC, ISCIII – CIBER of Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
- Microbiology Unit, Reina Sofía University Hospital of Córdoba, Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), Córdoba, Spain
| | - Bartolomé de la Fuente Darder
- Unidad de Drogas y Adicciones-CPD (UDA-CPD), Instituto Provincial Bienestar Social, Diputación Córdoba, Córdoba, Spain
| | | | - María de Guía Castro-Granados
- Unidad de Drogas y Adicciones-CPD (UDA-CPD), Instituto Provincial Bienestar Social, Diputación Córdoba, Córdoba, Spain
| | - María Lizaur-Barbudo
- Unidad de Drogas y Adicciones-CPD (UDA-CPD), Instituto Provincial Bienestar Social, Diputación Córdoba, Córdoba, Spain
| | | | - Justa Redondo-Écija
- Unidad de Drogas y Adicciones-CPD (UDA-CPD), Instituto Provincial Bienestar Social, Diputación Córdoba, Córdoba, Spain
| | - Ana Aparicio-Aparicio
- Unidad de Drogas y Adicciones-CPD (UDA-CPD), Instituto Provincial Bienestar Social, Diputación Córdoba, Córdoba, Spain
| | - Leticia Manchado-López
- Unidad de Drogas y Adicciones-CPD (UDA-CPD), Instituto Provincial Bienestar Social, Diputación Córdoba, Córdoba, Spain
| | - Luciano Cobos
- Unidad de Drogas y Adicciones-CPD (UDA-CPD), Instituto Provincial Bienestar Social, Diputación Córdoba, Córdoba, Spain
| | - Ignacio Pérez-Valero
- Infectious Diseases Department, Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), Reina Sofía University Hospital of Córdoba, University of Córdoba, Córdoba, Spain
- CIBERINFEC, ISCIII – CIBER of Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio Rivero
- Infectious Diseases Department, Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), Reina Sofía University Hospital of Córdoba, University of Córdoba, Córdoba, Spain
- CIBERINFEC, ISCIII – CIBER of Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
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Streifel AC, Rivera Sarti JE, Sikka MK, Conte M, Winders B, Varley CD. Fixing a Hole: a retrospective cohort study evaluating HAV, HBV, tetanus screening, and vaccination during hospitalization in persons who use substances. Ther Adv Infect Dis 2024; 11:20499361241245822. [PMID: 38681966 PMCID: PMC11055482 DOI: 10.1177/20499361241245822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 03/20/2024] [Indexed: 05/01/2024] Open
Abstract
Background Rates of serious injection-related infections in persons who use drugs have increased. Resulting admissions are an opportunity for screening and vaccination of preventable infections such as hepatitis A virus (HAV), hepatitis B virus (HBV), and tetanus. Design and methods We conducted a retrospective review of adults with documented substance use admitted for bacterial infection between July 2015 and March 2020. We evaluated HAV, HBV, and tetanus vaccination status at admission, along with screening for HAV and HBV infection and immunity. We identified the proportion of patients at risk for infection who received HAV, HBV, and tetanus vaccines during admission and patient-level factors associated with vaccination. Results We identified 280 patients who met our inclusion criteria. Of the 198 (70.7%) patients at risk for HAV, infectious disease providers recommended vaccination for 21 (10.6%) and 15 (7.6%) received HAV vaccine. Of the 174 (62.1%) patients at risk for HBV, infectious disease providers recommended vaccination for 32 (18.3%) and 25 (14.4%) received HBV vaccine. A large proportion of patients (31.4%, 88) had no documentation of prior tetanus vaccination, and infectious disease providers recommended tetanus vaccination for three (1.1%) and five patients (1.8%) received a tetanus booster. Infectious disease consult vaccine recommendations were statistically significantly associated with HAV or HBV vaccination prior to discharge. Conclusion Over 70% of our population is at risk for one or more of these preventable infections. Efforts are needed to maximize inpatient screening and vaccination for HAV, HBV, and tetanus in patients with barriers to care.
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Affiliation(s)
- Amber C. Streifel
- Department of Pharmacy, Oregon Health & Science University, Portland, OR, USA
| | - Jose Eduardo Rivera Sarti
- School of Medicine, Division of Infectious Diseases, Oregon Health & Science University, Portland, OR, USA
| | - Monica K. Sikka
- School of Medicine, Division of Infectious Diseases, Oregon Health & Science University, Portland, OR, USA
| | - Michael Conte
- School of Medicine, Division of Infectious Diseases, Oregon Health & Science University, Portland, OR, USA
| | - Bradie Winders
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
| | - Cara D. Varley
- School of Medicine, Division of Infectious Diseases, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Mailcode L457, Portland, OR 97239-3098, USA
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
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Malik AA, Ahmed N, Shafiq M, Elharake JA, James E, Nyhan K, Paintsil E, Melchinger HC, Team YBI, Malik FA, Omer SB. Behavioral interventions for vaccination uptake: A systematic review and meta-analysis. Health Policy 2023; 137:104894. [PMID: 37714082 PMCID: PMC10885629 DOI: 10.1016/j.healthpol.2023.104894] [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: 02/08/2023] [Revised: 06/22/2023] [Accepted: 08/15/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Human behavior and more specifically behavioral insight-based approaches to vaccine uptake have often been overlooked. While there have been a few narrative reviews indexed in Medline on behavioral interventions to increase vaccine uptake, to our knowledge, none have been systematic reviews and meta-analyses covering not just high but also low-and-middle income countries. METHODS We included 613 studies from the Medline database in our systematic review and meta-analysis categorizing different behavioral interventions in 9 domains: education campaigns, on-site vaccination, incentives, free vaccination, institutional recommendation, provider recommendation, reminder and recall, message framing, and vaccine champion. Additionally, considering that there is variability in the acceptance of vaccines among different populations, we assessed studies from both high-income countries (HICs) and low- to middle-income countries (LMICs), separately. FINDINGS Our results showed that behavioral interventions can considerably improve vaccine uptake in most settings. All domains that we examined improved vaccine uptake with the highest effect size associated with provider recommendation (OR: 3.4 (95%CI: 2.5-4.6); Domain: motivation) and on-site vaccination (OR: 2.9 (95%CI: 2.3-3.7); Domain: practical issues). While the number of studies conducted in LMICs was smaller, the quality of studies was similar with those conducted in HICs. Nevertheless, there were variations in the observed effect sizes. INTERPRETATION Our findings indicate that "provider recommendation" and "on-site vaccination" along with other behavioral interventions can be employed to increase vaccination rates globally.
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Affiliation(s)
- Amyn A Malik
- Yale Institute for Global Health, New Haven, CT 06510, USA; Analysis Group, Inc, Boston, MA 02199, USA
| | - Noureen Ahmed
- UT Southwestern Peter O'Donnell Jr. School of Public Health, Dallas, TX 75390, USA
| | - Mehr Shafiq
- Yale Institute for Global Health, New Haven, CT 06510, USA; Columbia University School of Public Health, New York, NY 10032, USA
| | - Jad A Elharake
- Yale Institute for Global Health, New Haven, CT 06510, USA; UT Southwestern Peter O'Donnell Jr. School of Public Health, Dallas, TX 75390, USA; The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Erin James
- Yale Institute for Global Health, New Haven, CT 06510, USA
| | - Kate Nyhan
- Yale University, New Haven, CT 06510, USA
| | - Elliott Paintsil
- Yale Institute for Global Health, New Haven, CT 06510, USA; Columbia University Institute of Human Nutrition, New York, NY 10032, USA
| | | | | | - Fauzia A Malik
- UT Southwestern Peter O'Donnell Jr. School of Public Health, Dallas, TX 75390, USA
| | - Saad B Omer
- UT Southwestern Peter O'Donnell Jr. School of Public Health, Dallas, TX 75390, USA.
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Cama E, Beadman K, Beadman M, Walker M, Treloar C. Insights from the scale-up and implementation of the Deadly Liver Mob program across nine sites in New South Wales, Australia, according to the RE-AIM framework. Harm Reduct J 2023; 20:154. [PMID: 37864220 PMCID: PMC10588043 DOI: 10.1186/s12954-023-00889-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/11/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND The Deadly Liver Mob (DLM) program is a peer-led health promotion program that aims to improve access to screening and treatment for blood borne viruses and sexually transmissible infections for Aboriginal and Torres Strait Islander Australians. In this paper, we used client and staff insights to explore the successes and challenges of implementing the DLM program according to the RE-AIM framework, which explores real-world implementation of interventions according to reach, effectiveness, adoption, implementation, and maintenance. METHODS Clients and staff were recruited through the DLM program. Semi-structured interviews were conducted with four Aboriginal and Torres Strait Islander and 11 non-Aboriginal or Torres Strait Islander health workers, as well as 33 Aboriginal and Torres Strait Islander clients of the program. RESULTS Findings show the positive effects of the DLM program, in creating a culturally safe and sensitive environment for Aboriginal and Torres Strait Islander clients to access care. In particular, the employment of frontline Aboriginal and Torres Strait Islander workers to deliver the education was touted as one of the primary successes of the program, in enabling workers to build trust between clients and mainstream health systems, which has the flow on effect of encouraging clients to go through to screening. The use of the RE-AIM framework illustrates the challenges of implementing real-world interventions across various locations, such as the difficulties in delivering DLM in regional and remote areas due to covering large geographic areas with minimal public transport available. CONCLUSIONS The data emphasise the need for interventions to be adaptable and flexible, altering elements of the program to suit local and community needs, such as by offering mobile and outreach services to enable access across regional and rural areas. The findings of this evaluation have been used to develop tools so that the learnings from DLM can be shared with others who may be hoping to implement DLM or other similar programs.
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Affiliation(s)
- Elena Cama
- Centre for Social Research in Health, John Goodsell Building, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | - Kim Beadman
- Centre for Social Research in Health, John Goodsell Building, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Mitch Beadman
- Centre for Social Research in Health, John Goodsell Building, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Melinda Walker
- Centre for Social Research in Health, John Goodsell Building, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Carla Treloar
- Centre for Social Research in Health, John Goodsell Building, UNSW Sydney, Sydney, NSW, 2052, Australia
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Treloar C, Beadman K, Beadman M, Smith KA, Christian J, Jackson AC, Tyson B, Anderson C, Smyth L, Walker M, Heslop J, Gahan G, Tawil V, Sheaves F, Maher L, Page J, Tilley D, Ryan A, Grant K, Donovan B, Stevens A, Slattery T, Pearce K, John-Leader F, Walden A, Lenton J, Crowley M, Cama E. Evaluating a complex health promotion program to reduce hepatitis C among Aboriginal and Torres Strait Islander peoples in New South Wales, Australia: the Deadly Liver Mob. Harm Reduct J 2023; 20:153. [PMID: 37864234 PMCID: PMC10588051 DOI: 10.1186/s12954-023-00885-9] [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: 03/24/2023] [Accepted: 10/06/2023] [Indexed: 10/22/2023] Open
Abstract
The Deadly Liver Mob (DLM) is a peer-delivered incentivised health promotion program by and for Aboriginal and Torres Strait Islander Australians, and was introduced in response to the disproportionate number of Aboriginal and Torres Strait Islander Australians who are impacted by blood borne viruses (BBVs) and sexually transmitted infections (STIs). The goal of the program is to increase access to BBV and STI education, screening, treatment, and vaccination in recognition and response to the systemic barriers that Aboriginal and Torres Strait Islander peoples face in accessing health care. This commentary introduces a series of papers that report on various aspects of the evaluation of the Deadly Liver Mob (DLM) program. In this paper, we explain what DLM is and how we constructed an evaluation framework for this complex health promotion intervention.
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Affiliation(s)
- Carla Treloar
- Centre for Social Research in Health, John Goodsell Building, UNSW Sydney, Kensington, NSW, 2052, Australia.
| | - Kim Beadman
- Centre for Social Research in Health, John Goodsell Building, UNSW Sydney, Kensington, NSW, 2052, Australia
| | - Mitch Beadman
- Centre for Social Research in Health, John Goodsell Building, UNSW Sydney, Kensington, NSW, 2052, Australia
| | - Kerri-Anne Smith
- Needle and Syringe Program, Mount Druitt Community Health Centre, Western Sydney Local Health District, Sydney, NSW, 2770, Australia
| | - Jade Christian
- Needle and Syringe Program, Nepean Blue Mountains Local Health District, Penrith, NSW, 2747, Australia
| | - Aunty Clair Jackson
- Centre for Social Research in Health, John Goodsell Building, UNSW Sydney, Kensington, NSW, 2052, Australia
| | - Beverley Tyson
- Dubbo Sexual Health, Western NSW Local Health District, Dubbo, NSW, 2830, Australia
| | - Clayton Anderson
- Dubbo Sexual Health, Western NSW Local Health District, Dubbo, NSW, 2830, Australia
| | - Larissa Smyth
- Byron Central Hospital, Mid North Coast and Northern NSW Local Health District, Byron Bay, NSW, 2481, Australia
| | - Melinda Walker
- Centre for Social Research in Health, John Goodsell Building, UNSW Sydney, Kensington, NSW, 2052, Australia
| | - Jennifer Heslop
- HIV & Related Programs, Mid North Coast and Northern NSW Local Health District, Coffs Harbour, NSW, 2450, Australia
| | - Gary Gahan
- Kirketon Road Centre, South Eastern Sydney Local Health District, Sydney, NSW, 1340, Australia
| | - Victor Tawil
- Centre for Population Health, Ministry of Health, St Leonards, NSW, 2065, Australia
| | - Felicity Sheaves
- Needle and Syringe Program, Nepean Blue Mountains Local Health District, Penrith, NSW, 2747, Australia
| | - Louise Maher
- Needle and Syringe Program, Nepean Blue Mountains Local Health District, Penrith, NSW, 2747, Australia
| | - Julie Page
- Needle and Syringe Program, Nepean Blue Mountains Local Health District, Penrith, NSW, 2747, Australia
| | - Donna Tilley
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, NSW, 2150, Australia
| | - Ann Ryan
- HIV & Related Programs (HARP) Unit, Western and Far West NSW Local Health District, Dubbo, NSW, 2830, Australia
| | - Kim Grant
- HIV & Related Programs (HARP) Unit, Western and Far West NSW Local Health District, Dubbo, NSW, 2830, Australia
| | - Basil Donovan
- Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Annabelle Stevens
- Centre for Population Health, Ministry of Health, St Leonards, NSW, 2065, Australia
| | - Trevor Slattery
- HIV & Related Programs (HARP) Unit, Western and Far West NSW Local Health District, Dubbo, NSW, 2830, Australia
| | - Kate Pearce
- Needle and Syringe Program, Mount Druitt Community Health Centre, Western Sydney Local Health District, Sydney, NSW, 2770, Australia
| | - Franklin John-Leader
- HIV & Related Programs, Mid North Coast and Northern NSW Local Health District, Coffs Harbour, NSW, 2450, Australia
| | - Andrew Walden
- Needle and Syringe Program, Western NSW Local Health District, Dubbo, NSW, 2830, Australia
| | - Jo Lenton
- Broken Hill Community Centre, Far West Local Health District, Broken Hill, NSW, 2880, Australia
| | - Margaret Crowley
- Dubbo Sexual Health, Western NSW Local Health District, Dubbo, NSW, 2830, Australia
| | - Elena Cama
- Centre for Social Research in Health, John Goodsell Building, UNSW Sydney, Kensington, NSW, 2052, Australia
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Rezaei SJ, de Walque D, Mateen FJ. Conditional cash transfers to improve health-focused outcomes: a global scoping review. Glob Public Health 2022; 17:3368-3385. [PMID: 35727705 DOI: 10.1080/17441692.2022.2092186] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This scoping review assesses the use of conditional cash transfer (CCT) interventions - direct distribution of money to individuals conditional on their compliance to certain requirements - in randomised controlled trials, quasi-experimental studies and large community-based randomised trials with health-focused outcomes. Five databases were searched to identify 68 records published 2004-2021 from 25 countries (8 low- (32%), 5 lower middle- (20%), 6 upper middle- (24%) and 6 high-income (24%), according to the World Bank Categorisation (2017). Forty-six studies were unique (after excluding multiple publications on a single study). The most common outcomes assessed were infectious diseases (30%); maternal health (24%); vaccination rates (17%); and childhood developmental measures (17%). The number of participants receiving CCT in each study ranged from 47 to 5,788, with a median of 487 individuals. The number of total participants ranged from 72 to 14,000, with a median of 1,289 individuals. Fifteen percent of studies involved mobile CCT disbursement. More than a quarter of payments were greater than 50 USD (29%), and most payments were 20 USD or less (58%). Seventy-eight percent of unique full-length studies reported statistically significant CCT effects. Although CCTs remain controversial, a growing evidence base is emerging for their potential impact in specific health conditions.
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Affiliation(s)
- Shawheen J Rezaei
- Massachusetts General Hospital, Department of Neurology, Boston, MA, USA
| | | | - Farrah J Mateen
- Massachusetts General Hospital, Department of Neurology, Boston, MA, USA
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Knaub RJ, Evans J, Yang C, Roura R, McGinn T, Verschoore B, Ricketts EP, Rothman RE, Latkin CA, Hsieh YH. A pilot study of a mixed-method approach to design an ED-based peer mHealth referral tool for HIV/HCV and opioid overdose prevention services. Drug Alcohol Depend 2022; 238:109585. [PMID: 35926299 PMCID: PMC9620482 DOI: 10.1016/j.drugalcdep.2022.109585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 07/20/2022] [Accepted: 07/20/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The intersecting epidemics of opioid misuse, injection drug use, and HIV/HCV have resulted in record overdose deaths and sustained high levels of HIV/HCV transmissions. Literature on social networks suggests opportunities to connect people who use drugs (PWUD) and their peers to HIV/HCV and opioid overdose prevention services. However, little evidence exists on how to design such peer referral interventions in emergency department (ED) settings. METHODS A mixed-method study was conducted to assess the feasibility of an mHealth-facilitated 'patient to peer social network referral program' for PWUD. In-depth interviews (IDIs) and quantitative surveys were conducted with urban ED patients (n = 15), along with 3 focus group discussions (FGDs) (n = 19). RESULTS Overall, 34 participants were enrolled (71 % males, 53 % Black). 13/15 IDI participants reported a history of opioid overdose; all had witnessed overdose events; all received HIV/HCV testing. From survey responses, most would invite their peers for HIV/HCV testing and naloxone training; and anticipated peers to accept referrals (HIV: 60 %, HCV: 73 %, naloxone: 93 %). Qualitative data showed PWUD shared health-related information with each other but preferred word of mouth rather than text messages. Participants used smartphones regularly and suggested using Internet advertising for prevention services. Participants expressed enthusiasm for ED-based peer mHealth referral platform to prevention services, as well as referring their peers to proposed services, with monetary incentives. CONCLUSION ED-based peer referral intervention to HIV/HCV testing and naloxone training was viewed favorably by PWUD. Frequent smartphone use among PWUD suggests that the medium could be a promising mode for peer referral.
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Affiliation(s)
- Ross J. Knaub
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Julie Evans
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Cui Yang
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, U.S.A
| | - Raúl Roura
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Tanner McGinn
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Benjamin Verschoore
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Erin P. Ricketts
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Richard E. Rothman
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Carl A. Latkin
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, U.S.A
| | - Yu-Hsiang Hsieh
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Loyalty Program Rewards Increases Willingness to Use Responsible Gambling Tools and Attitudinal Loyalty. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00905-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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Montgomery MP, Zhong Y, Roberts E, Asher A, Bixler D, Doshani M, Christensen A, Eckert M, Weng MK, Carry M, Samuel CR, Teshale EH. Vaccination barriers and opportunities at syringe services programs in the United States, June-August 2021-A cross-sectional survey. Drug Alcohol Depend 2022; 237:109540. [PMID: 35753280 DOI: 10.1016/j.drugalcdep.2022.109540] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/23/2022] [Accepted: 06/11/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Syringe services programs (SSPs) are an important venue for reaching people who inject drugs (PWID) to offer preventive services; however, not all SSPs offer vaccinations. We aimed to describe barriers and opportunities for SSPs to offer vaccinations. METHODS During June-August 2021, we conducted a descriptive, cross-sectional survey of SSP providers in the United States. SSPs were recruited from national listservs using purposive sampling to ensure geographic diversity. The survey included questions about SSP characteristics, client demographics, existing vaccination resources, resource needs, and staff perspectives on client vaccination barriers. Statistical comparisons were made using Pearson's chi-square test. RESULTS In total, 105 SSPs from 34 states responded to the survey; 46 SSPs (43.8%) offered on-site vaccinations. SSPs without on-site vaccinations were more likely operated by community-based organizations (81.4% vs 30.4%, p < 0.001) in urban areas (71.4% vs 40.0%, p = 0.002) than SSPs offering on-site vaccinations. The most common staffing need was for personnel licensed to administer vaccines (74/98, 75.5%). Over half of SSPs reported vaccine supply, administration supplies, storage equipment, and systems to follow-up clients for multidose series as important resource needs. The most common resource need was for reminder/recall systems for vaccines with multidose series (75/92, 81.5%). Vaccine safety concerns (92/95, 96.8%) and competing priorities (92/96, 95.8%) were the most common staff-reported client barriers to vaccinations. CONCLUSIONS Addressing missed opportunities for offering vaccinations to PWID who use SSPs will require increased numbers of on-site personnel licensed to administer vaccines and additional training, vaccination supplies, and storage and handling equipment.
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Affiliation(s)
- Martha P Montgomery
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA.
| | - Yuna Zhong
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Emma Roberts
- National Harm Reduction Coalition, 22 West 27th Street, 5th Floor, New York, NY 10001, USA
| | - Alice Asher
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Danae Bixler
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Mona Doshani
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Aleta Christensen
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Maribeth Eckert
- Immunization Services Division, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Mark K Weng
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Monique Carry
- Division of Global HIV & TB, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Christina R Samuel
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Eyasu H Teshale
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
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10
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Iversen J, Wand H, Kemp R, Bevan J, Briggs M, Patten K, Heard S, Maher L. Uptake of COVID-19 vaccination among people who inject drugs. Harm Reduct J 2022; 19:59. [PMID: 35655217 PMCID: PMC9162792 DOI: 10.1186/s12954-022-00643-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/21/2022] [Indexed: 12/14/2022] Open
Abstract
Background People who inject drugs (PWID) may be at elevated risk of adverse outcomes from SARS-CoV-2 infection; however, data on COVID-19 vaccine uptake among PWID are scarce. This study aimed to determine COVID-19 vaccine uptake among PWID, identify factors associated with sub-optimal uptake, and compare uptake to the general population.
Methods The Australian Needle Syringe Program Survey is an annual sentinel surveillance project, comprising a self-completed questionnaire and provision of a dried blood sample for HIV and HCV testing. In 2021, respondents provided information on their COVID-19 vaccination status. Multivariate logistic regression models identified correlates of vaccine uptake.
Results Among 1166 respondents, 49% had been vaccinated and in most states and territories, vaccine uptake was significantly lower than among the general population. Independent predictors of vaccine uptake were longer duration of vaccine eligibility (AOR 3.42, 95% CI 2.65, 4.41); prior SARS-CoV-2 diagnostic testing (AOR 2.90, 95% CI 2.22, 3.79); injection of opioids (AOR 1.91, 95% CI 1.20, 3.05); and current opioid agonist therapy (AOR 1.70, 95% CI 1.23, 2.33). Women (AOR 0.70, 95% CI 0.54, 0.92) and those who reported daily or more frequent injection (AOR 0.75, 95% CI 0.57, 1.00) were significantly less likely to be vaccinated. Conclusions In most Australian states and territories, uptake of COVID-19 vaccine among PWID lagged uptake among the general population. Increased efforts are required to ensure PWID have equitable access to vaccination. Vaccination programmes within harm reduction services and via outreach, coupled with increased support for peers to act as vaccine champions, are likely to reduce barriers and improve COVID-19 vaccine uptake in this population.
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Affiliation(s)
- Jenny Iversen
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | - Handan Wand
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Robert Kemp
- Queensland Health Department, Brisbane, Australia
| | - Jude Bevan
- Western Australian Department of Health, Perth, Australia
| | - Myf Briggs
- Tasmanian Department of Health, Hobart, Australia
| | - Kate Patten
- New South Wales Ministry of Health, Sydney, Australia
| | - Sue Heard
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Lisa Maher
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia
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11
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Willingness of people who inject drugs to participate in a randomised controlled trial involving financial incentives to initiate hepatitis C treatment. Drug Alcohol Depend 2022; 235:109438. [PMID: 35430521 DOI: 10.1016/j.drugalcdep.2022.109438] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/24/2022] [Accepted: 03/31/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Evidence regarding the acceptability of contingency management is limited. We investigated the willingness of people who inject drugs to participate in a randomised controlled trial (RCT) involving financial incentives to initiate HCV treatment. METHODS ETHOS Engage is an observational cohort study of people with a history of injecting drug use who either injected in the past six months or receive opioid agonist therapy (OAT) in Australia. We assessed willingness to participate in a RCT with financial incentives and factors associated with preference for entire incentive ($60) at first clinic visit versus delayed incentive with logistic regression. RESULTS 93% (593/635) of eligible participants agreed to participate in an RCT with financial incentives of which 24% were Aboriginal or Torres Strait Islander, 84% had completed secondary school, and 59% injected drugs in the prior month. Willingness to participate in an RCT increased by amount offered: unspecified (72%), $20 (75%), $60 (80%), and $100 (85%). The preferred incentive distribution method over three clinical visits was entire incentive at first clinical visit (32%). Among those with a preferred distribution method (n = 369), factors associated with entire incentive at first clinic visit were being Aboriginal or Torres Strait Islander (aOR 1.75; 95% CI 1.05-2.94), completion of secondary school (aOR 0.46; 95% CI 0.26-0.83) and mainly injected heroin in month prior (aOR 1.82; 95% CI 1.03-3.20). CONCLUSION Most participants were willing to participate in an RCT involving financial incentives to initiate treatment but differed regarding distribution. Study findings inform implementation of incentives in clinical practice.
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12
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Cioffi CC, Kosty D, Capron CG, Tavalire HF, Barnes RC, Mauricio AM. Contingency Management and SARS-CoV-2 Testing Among People Who Inject Drugs. Public Health Rep 2022; 137:573-579. [PMID: 35238240 PMCID: PMC9109524 DOI: 10.1177/00333549221074385] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES People who inject drugs (PWID) are especially vulnerable to morbidity and mortality as a result of SARS-CoV-2 infection because of social and physical health vulnerabilities. Routine testing for SARS-CoV-2 is critical to reduce transmission. Contingency management-the provision of tangible rewards to reinforce positive behavior-can promote the use of health services among PWID. Evidence is scarce on the utility of contingency management to promote SARS-CoV-2 testing. The objective of this study was to evaluate the effectiveness of contingency management to increase testing among PWID. METHODS SARS-CoV-2 testing was implemented at 9 syringe exchange program sites in partnership with an Oregon-based nonprofit organization for 5 weeks without contingency management and for 6 weeks with contingency management (a $10 financial incentive for testing) from February 1 through mid-April 2021. We measured rates of testing among syringe exchange program clients before and after implementation of contingency management. RESULTS Before contingency management, SARS-CoV-2 testing occurred during approximately 131 of 1410 (9.3%) client encounters, and 123 of 997 (12.3%) unique clients were tested. During contingency management, testing occurred during approximately 571 of 1756 (32.5%) client encounters, and 407 of 1151 (35.4%) unique clients were tested. Rates of testing increased from 0.04 (SD, 0.04) before contingency management implementation to 0.25 (SD, 0.15) after implementation (t8 = -3.88; P = .005; Cohen d = 1.46). CONCLUSIONS Contingency management facilitated uptake of SARS-CoV-2 testing among PWID. Contingency management may be an effective strategy for improving communicable disease testing beyond testing for SARS-CoV-2 and for improving vaccine uptake among PWID and warrants additional research.
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Affiliation(s)
- Camille C. Cioffi
- Prevention Science Institute,
University of Oregon, Eugene, OR, USA,Camille C. Cioffi, PhD, University of
Oregon, Prevention Science Institute, 1600 Millrace Dr, Eugene, OR 97401, USA.
| | - Derek Kosty
- Prevention Science Institute,
University of Oregon, Eugene, OR, USA
| | | | | | | | - Anne Marie Mauricio
- Prevention Science Institute,
University of Oregon, Eugene, OR, USA,College of Education, University of
Oregon, Eugene, OR, USA
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13
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Palmer AY, Chan K, Gold J, Layton C, Elsum I, Hellard M, Stoove M, Doyle JS, Pedrana A, Scott N. A modelling analysis of financial incentives for hepatitis C testing and treatment uptake delivered through a community-based testing campaign. J Viral Hepat 2021; 28:1624-1634. [PMID: 34415639 DOI: 10.1111/jvh.13596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/20/2021] [Accepted: 08/11/2021] [Indexed: 01/20/2023]
Abstract
Financial incentives may reduce opportunity costs associated with people who become lost to follow-up in hepatitis C treatment programs. We estimated the impact that different financial incentive amounts would need to have on retention in care to maintain the same unit cost per (1) RNA-positive person completing testing (defined as awareness of RNA status) and (2) RNA diagnosed person initiating treatment. Costing data were obtained from a 2019 community-based testing campaign focused on engaging people who inject drugs. For different financial incentive amounts, we modelled the corresponding improvements in retention in care that would be needed to maintain the same overall (1) unit cost per testing completion and (2) unit cost per treatment initiation. In the testing campaign, the unit cost per RNA-positive person completing testing was A$3215 and the unit cost per RNA diagnosed person initiating treatment was A$1055. Modelling found that an incentive of A$500 per RNA-positive person completing testing would result in more people completing testing for the same unit cost if the percentage of attendees receiving their test results increased from 63% to 74%. An incentive of A$200 per RNA diagnosed person initiating treatment would result in more people initiating treatment for the same unit cost if the percentage initiating treatment increased from 67% to 83%. Monetary incentives for completing testing and initiating treatment may be an effective way to increase retention in care without increasing the overall unit cost of completing testing/initiating treatment.
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Affiliation(s)
- Anna Y Palmer
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Kico Chan
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Judy Gold
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Chloe Layton
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Imogen Elsum
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, Australia.,The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Mark Stoove
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Joseph S Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, Australia
| | - Alisa Pedrana
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Nick Scott
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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14
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Epstein D, Enticott J, Larson H, Barton C. Pragmatic cluster randomised control trial using Vaxcards as an age-appropriate tool to incentivise and educate school students about vaccination. BMJ Open 2021; 11:e049562. [PMID: 34475171 PMCID: PMC8413930 DOI: 10.1136/bmjopen-2021-049562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This trial aimed to determine if return rates of consent forms for vaccination could be improved when Vaxcards were offered as an incentive to school children. SETTING Nineteen schools in South East Melbourne participated. INTERVENTIONS Students in the experimental arm received a pack of Vaxcards when they returned their government consent form. OUTCOME MEASURES Return of 'yes' consent forms for vaccination as part of a local government council vaccine programme was the primary outcome of this trial. Return rates were compared between the intervention and control schools and with historical return rates. RESULTS Secondary school students (N=3087) from 19 schools participated. Compared with historical returns, a small global reduction in 'yes' responses to consent forms of -4.21% in human papilloma virus consent 'yes' responses and -4.69% for diphtheria, tetanus and pertussis was observed across all schools. No difference between the experimental and control groups was observed. CONCLUSIONS Low 'yes' consent rates and reduction in consent rates between 2018 and 2019 for all groups are concerning. This finding highlights the need for behaviour change interventions across all groups to increase vaccine confidence. Lack of effect of incentivisation with Vaxcards in this study may have been due to the timing of receiving the cards (after the decision to vaccinate had been made, not before) and the limited intensity of the intervention. Optimising the timing and the intensity of exposure to Vaxcards could improve the outcome. TRIAL REGISTRATION NUMBER ACTRN12618001753246.
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Affiliation(s)
- Daniel Epstein
- Department of General Practice, Monash University, Clayton, Victoria, Australia
| | - Joanne Enticott
- Department of General Practice, Monash University, Notting Hill, Victoria, Australia
- Southern Synergy, Victoria, Australia
| | - Heidi Larson
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Christopher Barton
- Department of General Practice, Monash University, Clayton, Victoria, Australia
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15
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Price O, Dietze P, Sullivan SG, Salom C, Peacock A. Uptake, barriers and correlates of influenza vaccination among people who inject drugs in Australia. Drug Alcohol Depend 2021; 226:108882. [PMID: 34216866 DOI: 10.1016/j.drugalcdep.2021.108882] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Comorbid chronic health conditions place people who inject drugs (PWID) at risk of severe health outcomes after influenza infection. However, little is known about the uptake, barriers and correlates of influenza vaccination among PWID. METHODS During structured surveys, 872 PWID reported whether they had received an influenza vaccination during the last year (disaggregated as pre- or post-March 2020 to ascertain current season vaccine uptake), and if not, the barriers to vaccination. Logistic regression was used to examine demographic, drug use, health and service engagement correlates of vaccine uptake. RESULTS Thirty-nine percent of participants reported past-year influenza vaccination, with one-quarter (24 %) vaccinated in the current season. The main barriers to vaccination were motivation-based, with few citing issues relating to affordability, supply or perceived stigma. Opioid agonist therapy in the past six months was significantly associated with vaccination. CONCLUSIONS Influenza vaccine uptake was lower among PWID than the Australian general population. Provision of the vaccine at services commonly accessed by PWID may increase uptake.
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Affiliation(s)
- Olivia Price
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
| | - Paul Dietze
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia; Behaviours and Health Risks, Burnet Institute, Melbourne, Australia; National Drug Research Institute, Curtin University, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Australia
| | - Sheena G Sullivan
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, and Department of Infectious Diseases, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; Department of Epidemiology, University of California, Los Angeles, USA
| | - Caroline Salom
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia; Institute for Social Science Research, University of Queensland, Brisbane, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia; School of Psychological Sciences, University of Tasmania, Hobart, Australia
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16
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Iversen J, Peacock A, Price O, Byrne J, Dunlop A, Maher L. COVID-19 vaccination among people who inject drugs: Leaving no one behind. Drug Alcohol Rev 2021; 40:517-520. [PMID: 33650174 PMCID: PMC8013693 DOI: 10.1111/dar.13273] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/11/2021] [Indexed: 12/19/2022]
Affiliation(s)
- Jenny Iversen
- Kirby Institute for Infection and Immunity, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Olivia Price
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Jude Byrne
- Australian Injecting and Illicit Drug Users League, Canberra, Australia
| | - Adrian Dunlop
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia.,Faculty of Health, University of Newcastle, Newcastle, Australia
| | - Lisa Maher
- Kirby Institute for Infection and Immunity, Faculty of Medicine, UNSW Sydney, Sydney, Australia.,Burnet Institute, Melbourne, Australia
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17
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Calin R, Massari V, Pialoux G, Reydellet N, Plenel E, Chauvin C, Jauffret-Roustide M, Day N, Kreplak G, Maresca AF, Derche N, Louis S, Pol S, Doré V, Rouzioux C, Chauvin P. Acceptability of on-site rapid HIV/HBV/HCV testing and HBV vaccination among three at-risk populations in distinct community-healthcare outreach centres: the ANRS-SHS 154 CUBE study. BMC Infect Dis 2020; 20:851. [PMID: 33198672 PMCID: PMC7670674 DOI: 10.1186/s12879-020-05601-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 11/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV, HBV and HCV infections continue to represent major health concerns, especially among key at-risk populations such as men who have sex with men (MSM), people who inject drugs (PWIDs), transgender women (TGW) and sex workers (SW). The objective of the ANRS-CUBE study was to evaluate the acceptability of a healthcare, community-based strategy offering a triple rapid HIV-HBV-HCV testing, and HBV vaccination, targeted at three priority groups (MSM, PWIDs and TGW/SWs), in three community centers, in the Paris area. METHODS This longitudinal multicentric non-randomized study included all adult volunteers attending one of the three specialized community centers in Paris, between July 2014 and December 2015. HIV, HBV and HCV status and acceptability of HBV vaccination were evaluated. RESULTS A total of 3662, MSM, 80 PWIDs and 72 TGW/SW were recruited in the three centers respectively. Acceptability of rapid tests was 98.5% in MSM and 14.9% in TGW/SWs, but could not be estimated in PWIDs since the number of users attending and the number of proposals were not recorded. User acceptability of HBV vaccination was weak, only 17.9% of the eligible MSM (neither vaccinated, nor infected) agreed to receive the first dose, 12.2% two doses, 5.9% had a complete vaccination. User acceptability of HBV vaccination was greater in PWIDs and TGW/SWs, but decreased for the last doses (66.7 and 53.3% respectively received a first dose, 24.4 and 26.7% a second dose and 6.7 and 0% a third dose). Fifty-three participants (49 MSM and 4 PWIDs) were discovered HIV positive, more than half with a recent infection. All but two HIV positive participants were linked to appropriate care in less than one month. CONCLUSIONS Rapid HIV-HCV-HBV screening showed a very high level of acceptability among MSM. Efforts need to be made to improve immediate acceptability for HBV vaccination, especially among MSM, and follow-up doses compliance. Our results show the important role of community centers in reaching targets, often fragile, populations, while also suggesting the need to reinforce on-site human support in terms of testing and vaccination, especially when addressing PWIDs.
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Affiliation(s)
- Ruxandra Calin
- Service de Maladies Infectieuses, Hôpital Tenon, Groupe Hospitalier Est, AP-HP, 4 rue de la Chine, 75970, Paris, Cedex 20, France.
- Inserm, IPLESP, ERES, Institut Pierre-Louis d'épidémiologie et de santé publique, Sorbonne Université, 75012, Paris, France.
| | - Véronique Massari
- Inserm, IPLESP, ERES, Institut Pierre-Louis d'épidémiologie et de santé publique, Sorbonne Université, 75012, Paris, France
| | - Gilles Pialoux
- Service de Maladies Infectieuses, Hôpital Tenon, Groupe Hospitalier Est, AP-HP, 4 rue de la Chine, 75970, Paris, Cedex 20, France
- Sorbonne Université, UPMC Université, Paris 06, France
| | | | - Eve Plenel
- Le Kiosque, Checkpoint-Paris, Groupe SOS, Paris, France
| | - Carole Chauvin
- Le Kiosque, Checkpoint-Paris, Groupe SOS, Paris, France
- Cermes3, Inserm U988, CNRS UMR8211, EHESS, Université de Paris, Paris, France
| | | | - Nesrine Day
- Laboratoires Centre Biologique Chemin Vert (CBCV), Paris, France
| | - Georges Kreplak
- Laboratoires Centre Biologique Chemin Vert (CBCV), Paris, France
| | - Anaenza Freire Maresca
- ARCAT, Pasaje Latino, Groupe SOS, Paris, France
- AP-HP, Hôpital Ambroise Pare, Service de Médecine Interne, Boulogne-Billancourt, France
| | | | - Sandra Louis
- CSAPA 110 Les Halles, ARCAT, Groupe SOS, Paris, France
| | - Stanislas Pol
- AP-HP, Hôpital Cochin, Service d'hépatologie, Paris, France
| | - Véronique Doré
- ANRS: Agence Nationale de Recherche sur le sida et les hépatites virales, Paris, France
| | - Christine Rouzioux
- Le Kiosque, Checkpoint-Paris, Groupe SOS, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Pierre Chauvin
- Inserm, IPLESP, ERES, Institut Pierre-Louis d'épidémiologie et de santé publique, Sorbonne Université, 75012, Paris, France
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18
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Koyama Y, Fujiwara T, Isumi A, Doi S. Is Japan's child allowance effective for the well-being of children? A statistical evaluation using data from K-CHILD study. BMC Public Health 2020; 20:1503. [PMID: 33023534 PMCID: PMC7542372 DOI: 10.1186/s12889-020-09367-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 08/09/2020] [Indexed: 12/01/2022] Open
Abstract
Background Child allowance payment is one form of social security policy that aims to mitigate the child poverty gap by providing financial support to families. This study aimed to explore the impact of the child allowance on children’s physical and mental health (BMI, problem behavior, depression, and self-rated health), and parental investment in child health (children’s material goods, family events, extracurricular activities, interaction with children, and involvement in child maltreatment). Methods We used cross-sectional data from the 2016 Kochi Child Health Impact of Living Difficulty (K-CHILD) study. Participants were 1st, 5th and 8th grade children living in Kochi prefecture in Japan (N = 8207). Caregivers reported children’s child allowance status, BMI and behavior problems, while children filled out a self-assessment on depression and health condition. Propensity score matching analysis regarding potential confounders was used. Results We found that children in families that received child allowance showed a smaller total difficulties score by 1.29 points (95% CI: − 2.32 to − 0.25) and a lower risk of overweight (OR: 0.51, 95% CI: 0.29 to 0.91) although there is no association with underweight, prosocial behavior, depressive symptoms and self-rated health. Parental investment did not differ by child allowance status (p > 0.05). Conclusions Child allowance was found to be potentially beneficial in decreasing behavior problems and reducing child overweight. Further longitudinal studies are needed to elucidate how child allowance is used by family members and associated with children’s well-being. (230/350 words)
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Affiliation(s)
- Yuna Koyama
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Aya Isumi
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Satomi Doi
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
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19
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Mirzazadeh A, Hosseini-Hooshyar S, Shahesmaeili A, Bahramnejad A, Barshan A, Mousavian G, Najafi E, Sharifi H, Haghdoost AA, Briceno A, McFarland W, Page K. Barriers and motivators to participation and retention in HIV/HCV cohort studies among people who inject drugs: a community consultation in Iran. Subst Abuse Treat Prev Policy 2020; 15:56. [PMID: 32758246 PMCID: PMC7405425 DOI: 10.1186/s13011-020-00298-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 07/22/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The lack of robust estimates of HIV/HCV incidence among people who inject drugs (PWID) in Iran calls for well-designed prospective cohort studies. Successful recruitment and follow-up of PWID in cohort studies may require formative assessment of barriers PWID are faced with in participation and retention in cohort studies and factors they think may facilitate their engagement in such studies. Using a focus group discussion (FGD) format, we conducted a consultation with PWID in southeast Iran to recognize those barriers and motivators. METHODS Using targeted sampling and through snowball referrals, we recruited PWID (aged≥18, injected in last 6 months) from community-based drop-in centers (DICs), homeless shelters, and through outreach efforts to participate in four FGDs (one women-only). Socio-demographic characteristics, injection behaviors and self-reported HCV/HIV testing and diagnosis history were obtained. Then, a semi-structured FGD guide was applied to explore barriers and motivators to participation and retention in cohort studies among study participants. All FGD sessions were recorded and transcribed verbatim, removing any identifying information. The content of FGDs were analyzed by thematic analysis using an inductive approach. RESULTS In total, 30 individuals (10 women) participated in the study. The median age of participants was 35 (IQR 31-40), with majority (73.3%) reporting injecting drug use within the last month. Only 40.0% reported ever being tested for HCV whereas a larger proportion (63.4%) reported ever being tested for HIV. While the majority were willing to participate in cohort studies, breach of confidentiality, fear of positive test results, perceived required commitment, and marginalization were reported as barriers to participation and retention in such studies. Monetary incentive, the thought of a better life, protection from police interventions and trust between health workers and PWID were addressed as motivators of engagement in cohort studies among PWID. CONCLUSIONS Strategies to enhance data security and reduce stigma associated with injecting drug use along with involving peer workers in research, providing pre and post-test counselling and education and addressing the needs of more marginalized groups potentially through integrated healthcare programs and housing support are among few approaches that may help address barriers and strengthen the motivators for successful cohort studies among this population.
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Affiliation(s)
- Ali Mirzazadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
- Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.
| | - Samira Hosseini-Hooshyar
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Armita Shahesmaeili
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | | | | | - Ghazal Mousavian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Esmail Najafi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali-Akbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Alya Briceno
- University of California San Francisco, San Francisco, CA, USA
| | - Willi McFarland
- Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
- University of California San Francisco, San Francisco, CA, USA
| | - Kimberly Page
- Epidemiology, Biostatistics and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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20
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Fleming T, Valleriani J, Ng C, Maher L, Small W, McNeil R. Acceptability of a hypothetical preventative HIV vaccine among people who use drugs in Vancouver, Canada. BMC Public Health 2020; 20:1081. [PMID: 32646390 PMCID: PMC7350753 DOI: 10.1186/s12889-020-09202-6] [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] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 07/02/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND As research on HIV vaccines continues to advance, studies exploring the feasibility of this intervention are necessary to inform uptake and dissemination strategies with key populations, including people who use drugs (PWUD). METHODS We conducted 25 in-depth qualitative interviews examining HIV vaccine acceptability among PWUD in Vancouver, Canada. Participants were recruited from an ongoing prospective cohort of HIV-negative PWUD. Data were coded using NVivo, and analyzed thematically. RESULTS Acceptability was framed by practical considerations such as cost and side effects, and was influenced by broader trust of government bodies and health care professionals. While an HIV vaccine was perceived as an important prevention tool, willingness to be vaccinated was low. Results suggest that future vaccine implementation must consider how to minimize the burden an HIV vaccine may place on PWUD. Centering the role of health care providers in information dissemination and delivery may assist with uptake. CONCLUSIONS Our findings suggest improvements in care and improved patient-provider relationships would increase the acceptability of a potential HIV vaccine among this population.
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Affiliation(s)
- Taylor Fleming
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Interdisciplinary Graduate Studies Program, University of British Columbia, Vancouver, BC, Canada
| | - Jenna Valleriani
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- National Institute for Cannabis Health and Education, Toronto, ON, Canada
| | - Cara Ng
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Lisa Maher
- The Kirby Institute for Infection and Immunity, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- The Burnet Institute, Melbourne, VIC, Australia
| | - Will Small
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, Vancouver, BC, Canada.
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA.
- Program in Addiction Medicine, Yale School of Medicine, Yale University, 367 Cedar Street, New Haven, CT, USA.
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21
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Telephone delivered incentives for encouraging adherence to supervised methadone consumption (TIES): Study protocol for a feasibility study for an RCT of clinical and cost effectiveness. Contemp Clin Trials Commun 2020; 17:100506. [PMID: 31909291 PMCID: PMC6938936 DOI: 10.1016/j.conctc.2019.100506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 11/18/2019] [Accepted: 12/07/2019] [Indexed: 02/02/2023] Open
Abstract
The majority of people receiving treatment for their heroin addiction, are prescribed methadone; for which there is an extensive evidence base. When treatment starts, people take their daily dose of methadone under supervision at a community pharmacy. Supervision guarantees methadone is taken as directed by the individual for whom it has been prescribed, helps to ensure individuals take their correct dose every day, and safeguards against diversion and overdose. However, individuals often fail to attend the pharmacy to take their methadone. Each missed dose is of concern. If a patient misses their daily dose of methadone, they will start to experience opiate withdrawal and cravings and are more likely to use heroin. If they miss three days dose, there are concerns that they may lose tolerance to the drug and may be at risk of overdose when the next dose is taken. Hence there is an urgent need to develop effective interventions for medication adherence. Research suggests that incentive-based medication adherence interventions may be very effective, but there are few controlled trials and the provision of incentives requires time and organisational systems which can be challenging in pharmacies. The investigators have developed the technology to deliver incentives by mobile telephone. This cluster randomised trial will test the feasibility of conducting a future trial evaluating the clinical and cost effectiveness of using telephone delivered incentives (praise and modest financial rewards via text messaging) to encourage adherence with supervised consumption of methadone in community pharmacies. Three drug services (each with two or three community pharmacies supervising methadone consumption that will enrol 20 individuals, a total of 60 participants) will be recruited and randomly allocated to deliver either i) telephone delivered incentives, ii) telephone delivered reminders or iii) no telephone system. Acceptability, recruitment, follow-up, and suitable measures of clinical and cost effectiveness will be assessed. Findings from this feasibility study will be assessed against stated progression criteria and used to inform a future confirmatory trial of the clinical and cost effectiveness of telephone delivered incentives to encourage medication adherence. Trial registration ISRCTN58958179 (retrospectively registered).
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22
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Tressler S, Bhandari R. Interventions to Increase Completion of Hepatitis B Vaccination in People who Inject Drugs: A Systematic Review and Meta-analysis. Open Forum Infect Dis 2019; 6:ofz521. [PMID: 31890724 PMCID: PMC6929254 DOI: 10.1093/ofid/ofz521] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/04/2019] [Indexed: 12/05/2022] Open
Abstract
Increases in opioid misuse and injection drug use have resulted in a rise in acute cases of hepatitis B. We conducted a systematic review and meta-analysis of randomized studies to determine the effect (pooled odds ratio) of interventions to increase hepatitis B vaccination completion in people who inject drugs (PWID). Odds ratios from the included studies were combined to create a pooled odds ratio (OR) using the Inverse Heterogeneity Model. Eleven studies met the eligibility criterion of having a randomized intervention to increase hepatitis B virus vaccination completion among PWID. The odds of vaccine completion in the intervention group were greater than in the control/comparison group (pooled OR, 2.53; 95% confidence interval [CI], 1.07–5.99). Subgroup analysis indicated that financial incentives were most effective (OR, 7.01; 95% CI, 2.88–17.06), followed by accelerated vaccine schedules (OR, 1.90; 95% CI, 1.14–3.14). Interventions using financial incentives and accelerated vaccine schedules are moderately effective at increasing hepatitis B vaccination completion in PWID.
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Affiliation(s)
- Stacy Tressler
- Department of Epidemiology, West Virginia University, Morgantown, West Virginia, USA
- Correspondence: Stacy Tressler, MPH, Department of Epidemiology, West Virginia University, P.O. Box 9190, Morgantown, WV 26506 ()
| | - Ruchi Bhandari
- Department of Epidemiology, West Virginia University, Morgantown, West Virginia, USA
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23
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Gopalan A, Shaw PA, Lim R, Paramanund J, Patel D, Zhu J, Volpp KG, Buttenheim AM. Use of financial incentives and text message feedback to increase healthy food purchases in a grocery store cash back program: a randomized controlled trial. BMC Public Health 2019; 19:674. [PMID: 31151390 PMCID: PMC6544953 DOI: 10.1186/s12889-019-6936-5] [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: 10/01/2018] [Accepted: 05/02/2019] [Indexed: 12/01/2022] Open
Abstract
Background The HealthyFood (HF) program offers members up to 25% cash back monthly on healthy food purchases. In this randomized controlled trial, we tested the efficacy of financial incentives combined with text messages in increasing healthy food purchases among HF members. Methods Members receiving the lowest (10%) cash back level were randomized to one of six arms: Arm 1 (Usual Care): 10% cash back, no weekly text, standard monthly text; Arm 2: 10% cash back, generic weekly text, standard monthly text; Arm 3: 10% cash back, personalized weekly text, standard monthly text; Arm 4: 25% cash back, personalized weekly text, standard monthly text; Arm 5: 10 + 15%NET cash back, personalized weekly text, standard monthly text; and, Arm 6: 10 + 15%NET cash back, personalized weekly text, unbundled monthly text. In the 10 + 15%NET cash back, the cash back amount was the baseline 10% plus 15% of the net difference between healthy and unhealthy spending. The generic text included information on HF and healthy eating, while the personalized text had individualized feedback on purchases. The standard monthly text contained the cash back amount. The unbundled monthly text included the amount lost due to unhealthy purchases. The primary outcome was the average monthly percent healthy food spending. Secondary outcomes were the percent unhealthy food spending, and the percent healthy and unhealthy food items. Results Of the members contacted, 20 opted out, and 2841 met all inclusion criteria. There were no between-arm differences in the examined outcomes. The largest mean (standard deviation) difference in percent healthy spending was between Arm 1 (24.8% [11%]) and Arm 2 (26.8% [13%]), and the largest mean difference in percent unhealthy spending was also between Arm 1 (24.4% [20%]) and Arm 2 (21.7% [17%]), but no differences were statistically significant after correction for multiple comparisons. Conclusions None of the tested financial incentive structures or text strategies differentially affected food purchasing. Notably, more than doubling the cash back amount and introducing a financial disincentive for unhealthy purchases did not affect purchasing. These findings speak to the difficulty of changing shopping habits and to the need for innovative strategies to shift complex health behaviors. Trial registration NCT02486588 Increasing Engagement with a Healthy Food Benefit. The trial was prospectively registered on July 1, 2015. Electronic supplementary material The online version of this article (10.1186/s12889-019-6936-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anjali Gopalan
- Division of Research, Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA94612, USA.
| | - Pamela A Shaw
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Raymond Lim
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA.,Departments of Medicine and Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Jingsan Zhu
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA.,Departments of Medicine and Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kevin G Volpp
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA.,Departments of Medicine and Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Alison M Buttenheim
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA.,Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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24
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Johnson KD, Lu X, Zhang D. Adherence to hepatitis A and hepatitis B multi-dose vaccination schedules among adults in the United Kingdom: a retrospective cohort study. BMC Public Health 2019; 19:404. [PMID: 30987613 PMCID: PMC6466685 DOI: 10.1186/s12889-019-6693-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 03/21/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Timely and complete vaccination with multi-dose schedules is of public health importance, because an incomplete vaccination series may yield suboptimal disease protection. However, data on adherence of adults to multi-dose vaccines are limited. We sought to estimate adherence to multi-dose hepatitis vaccination schedules among adults in the United Kingdom (UK). METHODS This retrospective cohort study was conducted using anonymized electronic health record (EHR) data from the Clinical Practice Research Datalink (CPRD). Individuals aged 19 years and older at their first identified dose of hepatitis vaccine (2009-2016) were included if they had continuous EHR data for 12 months before the first identified hepatitis A dose or for 6 months before the first identified hepatitis B or combination hepatitis A/B dose. We estimated dose and series completion for each vaccine and adherence to recommended vaccination schedules, as well as adherence within additional prespecified time periods after the first vaccine dose, with sensitivity analyses restricted to adults who had available data for up to 24 months after the first dose. Median time to series completion was estimated using Kaplan-Meier methods. RESULTS Mean (SD) age at initiation was 42 (16) years for hepatitis A (n = 374,881), 40 (16) years for hepatitis B (n = 71,634), and 38 (15) years for hepatitis A/B (n = 10,335). Women comprised 52 to 55% of each vaccine cohort. Overall, 42,294 adults (11%) completed the two-dose hepatitis A vaccine series within the recommended 12 months; and 15,564 (22%) and 1076 (10%) completed the three-dose hepatitis B and hepatitis A/B series, respectively, within the recommended 6 months. These percentages rose to only 23, 35, and 33%, respectively, when the follow-up periods were extended to 36 months for hepatitis A and to 30 months for hepatitis B and A/B vaccines. Median times to series completion within recommended schedules were not reached in any cohort. Sensitivity analyses supported the primary findings for the full cohorts. CONCLUSIONS Adherence and series completion rates for hepatitis A and B vaccines in the UK are low. Identifying, understanding, and addressing barriers to series completion for multi-dose vaccines for adults in real-world settings are needed.
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Affiliation(s)
- Kelly D Johnson
- Center for Observational and Real World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ, USA. .,Center for Observational and Real World Evidence (CORE), Merck & Co., Inc., UG2AB-30, 351 N. Sumneytown Pike, North Wales, PA, 19454, USA.
| | - Xiaoyan Lu
- MSD Vaccines, Center for Observational and Real World Evidence (CORE), Lyon, France
| | - Dongmu Zhang
- Center for Observational and Real World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ, USA
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25
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Roncero C, Ryan P, Littlewood R, Macías J, Ruiz J, Seijo P, Palma-Álvarez RF, Vega P. Practical steps to improve chronic hepatitis C treatment in people with opioid use disorder. Hepat Med 2018; 11:1-11. [PMID: 30613166 PMCID: PMC6307489 DOI: 10.2147/hmer.s187133] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES People with a history of injecting drugs have high prevalence of hepatitis C virus (HCV) infection, and many have opioid use disorder (OUD). Modern HCV therapies with improved efficacy and tolerability are available, but access is often limited for this group, who may be underserved for health care and face social inequity. This work develops practical steps to improve HCV care in this population. METHODS Practical steps to improve HCV care in OUD populations were developed based on clinical experience from Spain, structured assessment of published evidence. RESULTS Options for improving care at engagement/screening stages include patient education programs, strong provider-patient relationship, peer support, and adoption of rapid effective screening tools. To facilitate work up/treatment, start options include simplified work up process, integration of HCV and OUD care, and continuous psychosocial support prior, during, and after HCV treatment. CONCLUSION It is important to plan on local basis to set up a joint integrated approach between specific drug treatment services and local points of HCV care. The elements for a specific integrated program should be chosen from options identified, including education services, peer input, organization to make HCV screening and treatment easier by co-location of services, and wider access to prescribing direct-acting antiviral (DAA) therapy.
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Affiliation(s)
- Carlos Roncero
- Psychiatric Service, University of Salamanca Health Care Complex, Institute of Biomedicine of Salamanca, University of Salamanca, Salamanca, Spain,
| | - Pablo Ryan
- Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain
- School of Medicine, Complutense University of Madrid, Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
| | | | - Juan Macías
- Department of Infectious Diseases and Microbiology, Valme University Hospital, Seville, Spain
| | - Juan Ruiz
- Provincial Center of Drug Addiction, Malaga, Spain
| | - Pedro Seijo
- Addiction Treatment Center of Villamartín, Cádiz, Spain
| | - Raúl Felipe Palma-Álvarez
- Addiction and Dual Diagnosis Unit, Vall Hebron University Hospital, Barcelona, Spain
- Psychiatry Service, Biomedical Research Networking Center for Mental Health Network, Vall Hebron University Hospital, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Pablo Vega
- Spanish Society of Dual Diagnosis, Bilbao, Spain
- Institute of Addictions, Madrid, Spain
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26
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Abadie R, Brown B, Fisher CB. "Money Helps": People who inject drugs and their perceptions of financial compensation and its ethical implications. ETHICS & BEHAVIOR 2018; 29:607-620. [PMID: 31579222 PMCID: PMC6774386 DOI: 10.1080/10508422.2018.1535976] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This study documents how people who inject drugs (PWID) in rural Puerto Rico perceive payments for participating in HIV epidemiological studies. In-depth interviews were conducted among a subset (n = 40) of active PWID older than 18 years of age who had been previously enrolled in a much larger study (N = 360). Findings suggest that financial compensation was the main motivation for initially enrolling in the parent study. Then, as trust in the researchers developed, participants came to perceive compensation as part of a reciprocal exchange in which they assisted researchers by providing a trustful account of their experiences and researchers reciprocated with financial support.
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Affiliation(s)
- Roberto Abadie
- Department of Sociology, University of Nebraska-Lincoln Brandon Brown
| | - Brandon Brown
- Center for Healthy Communities, University of California Riverside
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27
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Brewer NT, Chapman GB, Rothman AJ, Leask J, Kempe A. Increasing Vaccination: Putting Psychological Science Into Action. Psychol Sci Public Interest 2018; 18:149-207. [DOI: 10.1177/1529100618760521] [Citation(s) in RCA: 483] [Impact Index Per Article: 80.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Vaccination is one of the great achievements of the 20th century, yet persistent public-health problems include inadequate, delayed, and unstable vaccination uptake. Psychology offers three general propositions for understanding and intervening to increase uptake where vaccines are available and affordable. The first proposition is that thoughts and feelings can motivate getting vaccinated. Hundreds of studies have shown that risk beliefs and anticipated regret about infectious disease correlate reliably with getting vaccinated; low confidence in vaccine effectiveness and concern about safety correlate reliably with not getting vaccinated. We were surprised to find that few randomized trials have successfully changed what people think and feel about vaccines, and those few that succeeded were minimally effective in increasing uptake. The second proposition is that social processes can motivate getting vaccinated. Substantial research has shown that social norms are associated with vaccination, but few interventions examined whether normative messages increase vaccination uptake. Many experimental studies have relied on hypothetical scenarios to demonstrate that altruism and free riding (i.e., taking advantage of the protection provided by others) can affect intended behavior, but few randomized trials have tested strategies to change social processes to increase vaccination uptake. The third proposition is that interventions can facilitate vaccination directly by leveraging, but not trying to change, what people think and feel. These interventions are by far the most plentiful and effective in the literature. To increase vaccine uptake, these interventions build on existing favorable intentions by facilitating action (through reminders, prompts, and primes) and reducing barriers (through logistics and healthy defaults); these interventions also shape behavior (through incentives, sanctions, and requirements). Although identification of principles for changing thoughts and feelings to motivate vaccination is a work in progress, psychological principles can now inform the design of systems and policies to directly facilitate action.
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Affiliation(s)
- Noel T. Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina
| | | | | | - Julie Leask
- Faculty of Nursing and Midwifery, University of Sydney
- Faculty of Medicine, University of Sydney
| | - Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine
- Department of Pediatrics, University of Colorado Anschutz Medical Campus
- Department of Pediatrics, Children’s Hospital Colorado, Aurora, Colorado
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28
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Treloar C, Hopwood M, Cama E, Saunders V, Jackson LC, Walker M, Ooi C, Ubrihien A, Ward J. Evaluation of the Deadly Liver Mob program: insights for roll-out and scale-up of a pilot program to engage Aboriginal Australians in hepatitis C and sexual health education, screening, and care. Harm Reduct J 2018; 15:5. [PMID: 29391019 PMCID: PMC5796347 DOI: 10.1186/s12954-018-0209-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 01/15/2018] [Indexed: 11/16/2022] Open
Abstract
Background Deadly Liver Mob (DLM) is a peer-driven, incentivised health promotion program aimed at increasing understanding of hepatitis C, promoting harm reduction in relation to injecting drug use, and linking participants to screening for hepatitis C, other blood borne viruses and sexually transmissible infections among Aboriginal people in Western Sydney, NSW. This paper presents the evaluation of a pilot study examining the acceptability of the program as a first step of a scalability assessment. Methods Deadly Liver Mob operated in co-located needle and syringe programs and sexual health clinics in two sites: (Site 1: two and a half years for 2 days/week; Site 2: 1 year for 1 day per week). Comparisons were made of the proportion of Aboriginal clients (Site 1) and occasions of service provided to Aboriginal clients (Site 2) in the 12 months prior and post-introduction of DLM. Interviews were conducted with 13 staff involved in delivery of DLM and with 19 clients. Results A total of 655 and 55 Aboriginal clients, respectively, attended Site 1 and Site 2 for health education. The proportion of Aboriginal clients attending both sites was significantly higher during the DLM compared with prior to its implementation. Of those attending for health education, 79 and 73%, respectively, attended screening following education. DLM clients strongly endorsed the program. Some staff were concerned about workforce capacity to effectively engage Aboriginal clients with multiple and complex needs, managing the differing aims of the participating services involved, and about offering of incentives for attendance at health services. Conclusion While acceptability was high among staff and clients and preliminary results show high engagement with Aboriginal communities, this evaluation of a pilot program raises some issues to consider in scale up of DLM to other sites. The initiation of additional DLM sites should address issues of alignment with governing strategies and workforce capacity.
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Affiliation(s)
- Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia.
| | - Max Hopwood
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Elena Cama
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Veronica Saunders
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - L Clair Jackson
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Melinda Walker
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Catriona Ooi
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Sydney, Australia
| | - Ashley Ubrihien
- Western Sydney HIV and Related Programs Unit, Western Sydney Local Health District, Sydney, Australia
| | - James Ward
- South Australian Health and Medical Research Institute, Adelaide, Australia
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29
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de Dassel JL, Ralph AP, Cass A. A systematic review of adherence in Indigenous Australians: an opportunity to improve chronic condition management. BMC Health Serv Res 2017; 17:845. [PMID: 29282117 PMCID: PMC5745645 DOI: 10.1186/s12913-017-2794-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 12/13/2017] [Indexed: 12/21/2022] Open
Abstract
Background Indigenous Australians experience high rates of chronic conditions. It is often asserted Indigenous Australians have low adherence to medication; however there has not been a comprehensive examination of the evidence. This systematic literature review presents data from studies of Indigenous Australians on adherence rates and identifies supporting factors and impediments from the perspective of health professionals and patients. Methods Search strategies were used to identify literature in electronic databases and websites. The following databases were searched: Scopus, Medline, CINAHL Plus, PsycINFO, Academic Search Premier, Cochrane Library, Trove, Indigenous Health infonet and Grey Lit.org. Articles in English, reporting original data on adherence to long-term, self-administered medicines in Australia’s Indigenous populations were included. Data were extracted into a standard template and a quality assessment was undertaken. Results Forty-seven articles met inclusion criteria. Varied study methodologies prevented the use of meta-analysis. Key findings: health professionals believe adherence is a significant problem for Indigenous Australians; however, adherence rates are rarely measured. Health professionals and patients often reported the same barriers and facilitators, providing a framework for improvement. Conclusions There is no evidence that medication adherence amongst Indigenous Australians is lower than for the general population. Nevertheless, the heavy burden of morbidity and mortality faced by Indigenous Australians with chronic conditions could be alleviated by enhancing medication adherence. Some evidence supports strategies to improve adherence, including the use of dose administration aids. This evidence should be used by clinicians when prescribing, and to implement and evaluate programs using standard measures to quantify adherence, to drive improvement in health outcomes. Electronic supplementary material The online version of this article (10.1186/s12913-017-2794-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Anna P Ralph
- Menzies School of Health Research, Bld 58, Royal Darwin Hospital Campus, Rocklands Drive, Tiwi, Darwin, NT, 0811, Australia
| | - Alan Cass
- Menzies School of Health Research, Bld 58, Royal Darwin Hospital Campus, Rocklands Drive, Tiwi, Darwin, NT, 0811, Australia
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Boyd A, Bottero J, Carrat F, Gozlan J, Rougier H, Girard PM, Lacombe K. Testing for hepatitis B virus alone does not increase vaccine coverage in non-immunized persons. World J Gastroenterol 2017; 23:7037-7046. [PMID: 29097876 PMCID: PMC5658321 DOI: 10.3748/wjg.v23.i38.7037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/11/2017] [Accepted: 09/19/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To determine whether hepatitis B virus (HBV)-testing could serve as a gateway to vaccinate non-immunized individuals in a low-prevalent country.
METHODS Non-immunized subjects participating in a multi-center, HBV-testing campaign in Paris, France were identified and contacted via telephone 3-9 mo after testing in order to determine vaccination status. Vaccination coverage was evaluated in per-protocol (for all respondents) and intent-to-treat analysis (assuming all non-responders did not vaccinate).
RESULTS In total, 1215/4924 (24.7%) enrolled subjects with complete HBV serology were identified as non-immunized and eligible for analysis. There were 99/902 successfully contacted subjects who had initiated HBV vaccination after screening: per-protocol, 11.0% (95%CI: 9.0-13.2); intent-to-treat, 8.2% (95%CI: 6.7-9.8). In multivariable analysis, vaccination was more likely to be initiated in individuals originating from moderate or high HBV-endemic countries (P < 0.001), patients with limited healthcare coverage (P = 0.01) and men who have sex with men (P = 0.02). When asked about the reasons for not initiating HBV vaccination, the most frequent response was “will be vaccinated later” (33.4%), followed by “did not want to vaccinate” (29.8%), and “vaccination was not proposed by the physician” (21.5%). Sub-group analysis indicated a stark contrast in vaccination coverage across centers, ranging from 0%-56%.
CONCLUSION HBV-vaccination after HBV screening was very low in this study, which appeared largely attributed to physician-patient motivation towards vaccination. Increased vaccination coverage might be achieved by emphasizing its need at the organizational level.
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Affiliation(s)
- Anders Boyd
- Institute Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136), INSERM, Sorbonne Universités, F-75012 Paris, France
| | - Julie Bottero
- Institute Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136), INSERM, Sorbonne Universités, F-75012 Paris, France
- Service de maladies infectieuses, Hôpital Saint-Antoine, AP-HP, F-75012 Paris, France
| | - Fabrice Carrat
- Institute Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136), INSERM, Sorbonne Universités, F-75012 Paris, France
- Département de santé publique, Hôpital Saint-Antoine, AP-HP, F-75012 Paris, France
| | - Joël Gozlan
- Laboratoire de Virologie, Hôpital Saint-Antoine, AP-HP, F-75012 Paris, France
- INSERM, UMR_S1135 CIMI, Paris F-75013, France
| | - Hayette Rougier
- Service de maladies infectieuses, Hôpital Saint-Antoine, AP-HP, F-75012 Paris, France
| | - Pierre-Marie Girard
- Institute Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136), INSERM, Sorbonne Universités, F-75012 Paris, France
- Service de maladies infectieuses, Hôpital Saint-Antoine, AP-HP, F-75012 Paris, France
| | - Karine Lacombe
- Institute Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136), INSERM, Sorbonne Universités, F-75012 Paris, France
- Service de maladies infectieuses, Hôpital Saint-Antoine, AP-HP, F-75012 Paris, France
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Feng Y, Shi J, Gao L, Yao T, Feng D, Luo D, Li Z, Zhang Y, Wang F, Cui F, Li L, Liang X, Wang S. Immunogenicity and safety of high-dose hepatitis B vaccine among drug users: A randomized, open-labeled, blank-controlled trial. Hum Vaccin Immunother 2017; 13:1-7. [PMID: 28301282 PMCID: PMC5489281 DOI: 10.1080/21645515.2017.1283082] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 12/29/2016] [Accepted: 01/12/2017] [Indexed: 01/05/2023] Open
Abstract
Due to the low uptake, adherence, and completion of vaccination among drug users, and their compromised immune responses to hepatitis B vaccination, the current practice of hepatitis B vaccination may not provide optimal protection. The aim of this study was to evaluate the immunogenicity and safety of 60 µg and 20 µg hepatitis B vaccines among drug users. A randomized, open-labeled, blank-controlled trial was conducted among drug users at 2 drug rehabilitation centers in China. The eligible participants were drug users who were serologically negative for the hepatitis B surface antigen (HBsAg) and the hepatitis B surface antibody (anti-HBs). Participants were randomized in a ratio of 1:1:1 to receive 20 µg (IM20 group) or 60 µg (IM60 group) of hepatitis B vaccine or blank control at months 0, 1, and 6, and followed at months 6, 7, and 12. Seroconversion rates of 94.7% and 92.6% were observed in IM20 and IM60 groups at month 7, and correspondingly decreased to 89.5% and 91.7% respectively at month 12. The IM60 group showed significantly higher geometric mean concentrations (GMCs) of anti-HBs (2022.5 and 676.7 mIU mL-1) than the IM20 group did (909.6 and 470.5 mIU mL-1) at months 7 and 12 (P < 0.05). No safety concerns associated with vaccination were noted. Three-dose intramuscular immunization with hepatitis B vaccines showed good immunogenicity among the drug users.
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Affiliation(s)
- Yongliang Feng
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jing Shi
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Linying Gao
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Tian Yao
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Dan Feng
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Dan Luo
- Yongji Center for Disease Control and Prevention, Yongji, Shanxi, China
| | - Zhansheng Li
- Yongji Center for Disease Control and Prevention, Yongji, Shanxi, China
| | | | - Fuzhen Wang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fuqiang Cui
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Li Li
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaofeng Liang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Suping Wang
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
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BROUARD C, PILLONEL J, SOGNI P, CHOLLET A, LAZARUS JV, PASCAL X, BARIN F, JAUFFRET-ROUSTIDE M. Hepatitis B virus in drug users in France: prevalence and vaccination history, ANRS-Coquelicot Survey 2011-2013. Epidemiol Infect 2017; 145:1-11. [PMID: 28100289 PMCID: PMC9507829 DOI: 10.1017/s0950268816003137] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/24/2016] [Accepted: 11/30/2016] [Indexed: 01/10/2023] Open
Abstract
People who use drugs (PWUD) are a key population for hepatitis B virus (HBV) vaccination and screening. We aimed to estimate the seroprevalence of HBs antigen (HBsAg) and self-reported HBV vaccination history in French PWUD attending harm reduction centres using data from the ANRS-Coquelicot multicentre survey conducted in 2011-2013 in 1718 PWUD. Self-fingerprick blood samples were collected on dried blood spots to detect the presence of HBsAg. HBsAg seroprevalence was estimated at 1·4% [95% confidence interval (CI) 0·8-2·5]. It varied between PWUD born in high (7·6%, 95% CI 2·7-19·1), moderate (2·2%, 95% CI 0·8-5·7) and low (0·7%, 95% CI 0·3-1·5) endemic zones. Factors independently associated with HBsAg carriage were being born in a moderate or high endemic zone or reporting precarious housing. Self-reported HBV vaccination history varied from 47·4% in high endemic zones, to 59·3% and 62·6% for moderate and low endemic zones, respectively. Our results suggest that drug use plays a small and substantial role, respectively, in HBsAg carriage in PWUD born in high/moderate and low endemic zones.
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Affiliation(s)
- C. BROUARD
- Santé publique France, Direction des Maladies Infectieuses, Saint-Maurice, France
| | - J. PILLONEL
- Santé publique France, Direction des Maladies Infectieuses, Saint-Maurice, France
| | - P. SOGNI
- Université Paris Descartes, Paris, France
- Inserm U1223, Institut Pasteur, France
- Assistance Publique des Hôpitaux de Paris, Hôpital Cochin, Service d'Hépatologie, Paris, France
| | - A. CHOLLET
- Cermes3, Inserm U988, UMR CNRS 8211, Université Paris Descartes, EHESS, Paris, France
| | - J. V. LAZARUS
- Centre for Health and Infectious Disease Research and WHO Collaborating Centre on HIV and Viral Hepatitis, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- ISGlobal, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - X. PASCAL
- Cermes3, Inserm U988, UMR CNRS 8211, Université Paris Descartes, EHESS, Paris, France
| | - F. BARIN
- Inserm U966, Centre National de Référence du VIH, CHU Bretonneau, Université François-Rabelais, Tours, France
| | - M. JAUFFRET-ROUSTIDE
- Santé publique France, Direction des Maladies Infectieuses, Saint-Maurice, France
- Cermes3, Inserm U988, UMR CNRS 8211, Université Paris Descartes, EHESS, Paris, France
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Stitzer M, Calsyn D, Matheson T, Sorensen J, Gooden L, Metsch L. Development of a Multi-Target Contingency Management Intervention for HIV Positive Substance Users. J Subst Abuse Treat 2017; 72:66-71. [PMID: 27624618 PMCID: PMC5154853 DOI: 10.1016/j.jsat.2016.08.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 08/24/2016] [Indexed: 12/23/2022]
Abstract
Contingency management (CM) interventions generally target a single behavior such as attendance or drug use. However, disease outcomes are mediated by complex chains of both healthy and interfering behaviors enacted over extended periods of time. This paper describes a novel multi-target contingency management (CM) program developed for use with HIV positive substance users enrolled in a CTN multi-site study (0049 Project HOPE). Participants were randomly assigned to usual care (referral to health care and SUD treatment) or 6-months strength-based patient navigation interventions with (PN+CM) or without (PN only) the CM program. Primary outcome of the trial was viral load suppression at 12-months post-randomization. Up to $1160 could be earned over 6 months under escalating schedules of reinforcement. Earnings were divided among eight CM targets; two PN-related (PN visits; paperwork completion; 26% of possible earnings), four health-related (HIV care visits, lab blood draw visits, medication check, viral load suppression; 47% of possible earnings) and two drug-use abatement (treatment entry; submission of drug negative UAs; 27% of earnings). The paper describes rationale for selection of targets, pay amounts and pay schedules. The CM program was compatible with and fully integrated into the PN intervention. The study design will allow comparison of behavioral and health outcomes for participants receiving PN with and without CM; results will inform future multi-target CM development.
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Affiliation(s)
- Maxine Stitzer
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Hopkins Bayview Medical Center, 5510 Nathan Shock Drive, Baltimore, MD, 21224.
| | - Donald Calsyn
- Department of Psychiatry and Behavioral Science, University of Washington
| | - Timothy Matheson
- San Francisco Department of Public Health, 25 Van Ness Avenue Suite 500, San Francisco, CA, 94102.
| | - James Sorensen
- UCSF Department of Psychiatry, Zuckerberg San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue SFGH Building 20, Rm. 2117, San Francisco, CA, 94110.
| | - Lauren Gooden
- Department of Sociomedical Sciences Mailman School of Public Health, Columbia University Columbia University, 722 West 168th Street, Room 918, New York, NY, 10032.
| | - Lisa Metsch
- Department of Sociomedical Sciences Mailman School of Public Health, Columbia University Columbia University, 722 West 168th Street, Room 918, New York, NY, 10032.
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Herrmann ES, Matusiewicz AK, Stitzer ML, Higgins ST, Sigmon SC, Heil SH. Contingency Management Interventions for HIV, Tuberculosis, and Hepatitis Control Among Individuals With Substance Use Disorders: A Systematized Review. J Subst Abuse Treat 2017; 72:117-125. [PMID: 27394070 PMCID: PMC5386179 DOI: 10.1016/j.jsat.2016.06.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/14/2016] [Accepted: 06/17/2016] [Indexed: 12/12/2022]
Abstract
Hepatitis, HIV and tuberculosis are significant and costly public health problems that disproportionately affect individuals with substance use disorders (SUDs). Incentive-based treatment approaches (i.e., contingency management; CM) are highly effective at reducing drug use. The primary aim of this report is to review the extant literature that examines the efficacy of CM interventions for the prevention, diagnosis and treatment of hepatitis, HIV and tuberculosis among individuals with SUDs. A literature search identified 23 controlled studies on this topic. In approximately 85% of the studies, CM produced significantly better adherence to prevention, diagnosis and treatment-related medical services, with adherence rates averaging almost 35% higher among patients receiving incentives vs. control condition participants. Findings from these studies parallel the results of a meta-analysis of CM interventions for the treatment of SUDs. The results also suggest that the principles that underlie the efficacy of CM generalize across infectious disease and substance abuse treatment behaviors. The application of additional principles from the literature on CM for treatment of SUDs to interventions targeting infectious disease control would be beneficial. Further development and dissemination of these interventions has the potential to greatly impact public health.
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Affiliation(s)
- Evan S Herrmann
- Department of Psychology, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401.
| | - Alexis K Matusiewicz
- Department of Psychiatry, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401; Vermont Center on Behavior and Health, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401
| | - Maxine L Stitzer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224
| | - Stephen T Higgins
- Department of Psychology, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401; Department of Psychiatry, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401; Vermont Center on Behavior and Health, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401
| | - Stacey C Sigmon
- Department of Psychology, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401; Department of Psychiatry, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401; Vermont Center on Behavior and Health, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401
| | - Sarah H Heil
- Department of Psychology, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401; Department of Psychiatry, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401; Vermont Center on Behavior and Health, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401
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Giunta H. Treatment Incentives and the Nature of the Doctor-Patient Relationship. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2016; 16:77-78. [PMID: 27653413 DOI: 10.1080/15265161.2016.1214327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Rafia R, Dodd PJ, Brennan A, Meier PS, Hope VD, Ncube F, Byford S, Tie H, Metrebian N, Hellier J, Weaver T, Strang J. An economic evaluation of contingency management for completion of hepatitis B vaccination in those on treatment for opiate dependence. Addiction 2016; 111:1616-27. [PMID: 26990598 PMCID: PMC5347913 DOI: 10.1111/add.13385] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 01/18/2016] [Accepted: 03/10/2016] [Indexed: 12/21/2022]
Abstract
AIMS To determine whether the provision of contingency management using financial incentives to improve hepatitis B vaccine completion in people who inject drugs entering community treatment represents a cost-effective use of health-care resources. DESIGN A probabilistic cost-effectiveness analysis was conducted, using a decision-tree to estimate the short-term clinical and health-care cost impact of the vaccination strategies, followed by a Markov process to evaluate the long-term clinical consequences and costs associated with hepatitis B infection. SETTINGS AND PARTICIPANTS Data on attendance to vaccination from a UK cluster randomized trial. INTERVENTION Two contingency management options were examined in the trial: fixed versus escalating schedule financial incentives. MEASUREMENT Life-time health-care costs and quality-adjusted life years discounted at 3.5% annually; incremental cost-effectiveness ratios. FINDINGS The resulting estimate for the incremental life-time health-care cost of the contingency management strategy versus usual care was £21.86 [95% confidence interval (CI) = -£12.20 to 39.86] per person offered the incentive. For 1000 people offered the incentive, the incremental reduction in numbers of hepatitis B infections avoided over their lifetime was estimated at 19 (95% CI = 8-30). The probabilistic incremental cost per quality adjusted life-year gained of the contingency management programme was estimated to be £6738 (95% CI = £6297-7172), with an 89% probability of being considered cost-effective at a threshold of £20 000 per quality-adjusted life years gained (97.60% at £30 000). CONCLUSIONS Using financial incentives to increase hepatitis B vaccination completion in people who inject drugs could be a cost-effective use of health-care resources in the UK as long as the incidence remains above 1.2%.
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Affiliation(s)
- Rachid Rafia
- Health Economics and Decision Science (HEDS), School of Health and Related Research, (ScHARR)University of SheffieldSheffieldUK
| | - Peter J. Dodd
- Health Economics and Decision Science (HEDS), School of Health and Related Research, (ScHARR)University of SheffieldSheffieldUK
| | - Alan Brennan
- Health Economics and Decision Science (HEDS), School of Health and Related Research, (ScHARR)University of SheffieldSheffieldUK
| | - Petra S. Meier
- Section of Public Health, School of Health and Related Research (ScHARR)University of SheffieldSheffieldUK
| | - Vivian D. Hope
- Injecting Drug Use Team, HIV and STI Department, Centre for Infectious Disease, Surveillance and ControlPublic Health UK (PHE)LondonUK
| | - Fortune Ncube
- Injecting Drug Use Team, HIV and STI Department, Centre for Infectious Disease, Surveillance and ControlPublic Health UK (PHE)LondonUK
| | - Sarah Byford
- Centre for the Economics of Mental and Physical HealthKing's College LondonLondonUK
| | - Hiong Tie
- Centre for the Economics of Mental and Physical HealthKing's College LondonLondonUK
| | - Nicola Metrebian
- National Addiction Centre, Addictions Department, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | | | - Tim Weaver
- Department of Mental Health, Social Work and Integrative MedicineMiddlesex UniversityHendonUK
| | - John Strang
- National Addiction Centre, Addictions Department, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
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Field engagement further facilitates hepatitis B vaccination completion: Letter in response to: Day et al. (in press). J Clin Virol 2016; 82:64-65. [PMID: 27448171 DOI: 10.1016/j.jcv.2016.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 07/11/2016] [Indexed: 11/22/2022]
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Stone J, Martin NK, Hickman M, Hellard M, Scott N, McBryde E, Drummer H, Vickerman P. The Potential Impact of a Hepatitis C Vaccine for People Who Inject Drugs: Is a Vaccine Needed in the Age of Direct-Acting Antivirals? PLoS One 2016; 11:e0156213. [PMID: 27224423 PMCID: PMC4880220 DOI: 10.1371/journal.pone.0156213] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 05/10/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND AND AIMS The advent of highly effective hepatitis C (HCV) treatments has questioned the need for a vaccine to control HCV amongst people who inject drugs (PWID). However, high treatment costs and ongoing reinfection risk suggest it could still play a role. We compared the impact of HCV vaccination amongst PWID against providing HCV treatment. METHODS Dynamic HCV vaccination and treatment models among PWID were used to determine the vaccination and treatment rates required to reduce chronic HCV prevalence or incidence in the UK over 20 or 40 years. Projections considered a low (50% protection for 5 years), moderate (70% protection for 10 years) or high (90% protection for 20 years) efficacy vaccine. Sensitivities to various parameters were examined. RESULTS To halve chronic HCV prevalence over 40 years, the low, moderate and high efficacy vaccines required annual vaccination rates (coverage after 20 years) of 162 (72%), 77 (56%) and 44 (38%) per 1000 PWID, respectively. These vaccination rates were 16, 7.6 and 4.4 times greater than corresponding treatment rates. To halve prevalence over 20 years nearly doubled these vaccination rates (moderate and high efficacy vaccines only) and the vaccination-to-treatment ratio increased by 20%. For all scenarios considered, required annual vaccination rates and vaccination-to-treatment ratios were at least a third lower to reduce incidence than prevalence. Baseline HCV prevalence had little effect on the vaccine's impact on prevalence or incidence, but substantially affected the vaccination-to-treatment ratios. Behavioural risk heterogeneity only had an effect if we assumed no transitions between high and low risk states and vaccinations were targeted or if PWID were high risk for their first year. CONCLUSIONS Achievable coverage levels of a low efficacy prophylactic HCV vaccine could greatly reduce HCV transmission amongst PWID. Current high treatment costs ensure vaccination could still be an important intervention option.
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Affiliation(s)
- Jack Stone
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- * E-mail:
| | - Natasha K. Martin
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- Division of Global Public Health, University of California San Diego, La Jolla, United States of America
| | - Matthew Hickman
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Margaret Hellard
- Centre for Population Health, Burnet Institute, Melbourne, Australia
| | - Nick Scott
- Centre for Population Health, Burnet Institute, Melbourne, Australia
| | - Emma McBryde
- Centre for Population Health, Burnet Institute, Melbourne, Australia
| | - Heidi Drummer
- Centre for Biomedical Research, Burnet Institute, Melbourne, Australia
| | - Peter Vickerman
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
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Neale J, Tompkins CNE, Strang J. Qualitative evaluation of a novel contingency management-related intervention for patients receiving supervised injectable opioid treatment. Addiction 2016; 111:665-74. [PMID: 26498274 DOI: 10.1111/add.13212] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 08/28/2015] [Accepted: 10/18/2015] [Indexed: 11/28/2022]
Abstract
AIM To evaluate a novel contingency management (CM)-related intervention for people experiencing complex drug problems, thereby increasing understanding of CM implementation in real-world settings. Objectives are to provide new insights into (i) how context influences intervention delivery; (ii) aspects of intervention delivery that influence outcomes; and (iii) intervention outcomes. DESIGN Qualitative realist evaluation of a novel CM-related intervention: conditional budgets (CB). SETTING Supervised injectable opioid treatment (IOT) clinic in England (May 2014-March 2015). PARTICIPANTS Twenty IOT clinic patients (14 men; six women); 10 IOT clinic staff (seven men; three women). MEASUREMENTS Semi-structured interviews systematically coded relating to knowledge and views of the intervention, experiences of delivering/receiving the intervention, and effectiveness of the intervention. INTERVENTION Personal budgets provided to patients who reduced their supervised IOT while demonstrating ongoing stability. FINDINGS (i) Contextual factors influencing intervention delivery included patient motivation; clarity of intervention information; prior trust in the treatment system; patient and staff involvement in intervention design; stability of the treatment setting. (ii) Aspects of delivery influencing outcomes included transparency of the eligibility criteria, rules and operating processes; rule enforcement; continued verbal information about the intervention; speed of incentive processing and receipt. (iii) Reduced drug use was difficult to attribute to CBs, as patients who did well were those most motivated to change before the intervention started. Unintended outcomes were positive (improved patient psychological wellbeing, staff job satisfaction, staff/patient relationships) and negative (patient relapse, increased staff work-load, tensions in clinic relationships). CONCLUSIONS A 'qualitative realist' evaluation of a contingency management intervention to help address complex substance use disorder problems suggests that the programmes need to have stakeholder input, implement consistent eligibility criteria, rules and processes and be introduced into stable treatment settings where relationships are trusting and patients and staff feel secure.
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Affiliation(s)
- Joanne Neale
- National Addiction Centre, King's College London, London, UK
| | | | - John Strang
- National Addiction Centre, King's College London, London, UK
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Crewe Dixon T, Stein E, Ngak S, Srean C, Maly P, Sokunny M, Carrico A, Page K, Maher L. Qualitative research and implementation science: Informing the acceptability and implementation of a trial of a conditional cash transfer intervention designed to reduce drug use and HIV risk. METHODOLOGICAL INNOVATIONS 2016; 9:10.1177/2059799115622751. [PMID: 30956811 PMCID: PMC6448801 DOI: 10.1177/2059799115622751] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
HIV risk remains high among Cambodian female entertainment and sex workers, driven by amphetamine-type substance use and sexual risk. Conditional cash transfer is an evidence-based approach to reduce stimulant use and optimize HIV/AIDS prevention, but questions remain regarding implementation in resource-limited settings. We conducted formative qualitative research to enhance acceptability of a conditional cash transfer intervention aimed at reducing amphetamine-type substance use and HIV risk among female entertainment/sex workers and inform implementation as part of a large cluster randomized trial. We conducted in-depth interviews with 30 female entertainment/sex workers. Interviews were digitally recorded and conducted and transcribed in Khmer. English transcripts were read for emerging themes and an initial coding scheme was developed. Data were coded using open and axial coding to clarify and consolidate initial themes. While most participants expressed enthusiasm for the intervention, financial and transportation issues emerged as key barriers to participation. The proposed incentive of USD$1 per screen was regarded as unacceptable and participants identified a need for transportation assistance. Participants also expressed concerns about directly observed urine specimen collection. Finally, while most participants found the 4-week aftercare program acceptable, the need for enjoyable as well as educational content was emphasized. Revisions to the protocol taking these data into account were made to optimize the acceptability of the intervention and the implementation of the trial. Findings identified key concerns and preferences that were taken into account in the final trial protocol. In particular, financial and transportation issues were identified as critical barriers to participation, with the potential to impact both intervention uptake and trial feasibility. Results demonstrate the value of formative qualitative research for clinical trial planning and implementation, particularly in settings where little is known about acceptability of interventions or willingness to participate.
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Affiliation(s)
| | - Ellen Stein
- Global Health Sciences, University of California—San Francisco, San Francisco, CA, USA
| | | | | | | | | | - Adam Carrico
- School of Nursing, University of California—San Francisco, San Francisco, CA, USA
| | - Kimberly Page
- Health Sciences Center, University of New Mexico, Albuquerque, NM, USA
| | - Lisa Maher
- The Kirby Institute for Infection and Immunity in Society, Faculty of Medicine, UNSW Australia, Sydney, NSW, Australia
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Development of immunity following financial incentives for hepatitis B vaccination among people who inject drugs: A randomized controlled trial. J Clin Virol 2015; 74:66-72. [PMID: 26679830 DOI: 10.1016/j.jcv.2015.11.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 10/21/2015] [Accepted: 11/25/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND People who inject drugs (PWID) are at risk of hepatitis B virus (HBV) but have low rates of vaccination completion. The provision of modest financial incentives increases vaccination schedule completion, but their association with serological protection has yet to be determined. OBJECTIVE To investigate factors associated with vaccine-induced immunity among a sample of PWID randomly allocated to receive AUD$30 cash following receipt of doses two and three ('incentive condition') or standard care ('control condition') using an accelerated 3-dose (0,7,21 days) HBV vaccination schedule. STUDY DESIGN A randomised controlled trial among PWID attending two inner-city health services and a field site in Sydney, Australia, assessing vaccine-induced immunity measured by hepatitis B surface antibodies (HBsAb ≥ 10 mIU/ml) at 12 weeks. The cost of the financial incentives and the provision of the vaccine program are also reported. RESULTS Just over three-quarters of participants - 107/139 (77%)--completed the vaccination schedule and 79/139 (57%) were HBsAb ≥ 10 mIU/ml at 12 weeks. Vaccine series completion was the only variable significantly associated with vaccine-induced immunity in univariate analysis (62% vs 41%, p<0.035) but was not significant in multivariate analysis. There was no statistically discernible association between group allocation and series completion (62% vs 53%). The mean costs were AUD$150.5, (95% confidence interval [CI]: 142.7-158.3) and AUD$76.9 (95% CI: 72.6-81.3) for the intervention and control groups respectively. CONCLUSION Despite increasing HBV vaccination completion, provision of financial incentives was not associated with enhanced serological protection. Further research into factors which affect response rates and the optimal vaccination regimen and incentive schemes for this population are needed.
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Ghomraoui FA, Alfaqeeh FA, Algadheeb AS, Al-Alsheikh AS, Al-Hamoudi WK, Alswat KA. Medical students' awareness of and compliance with the hepatitis B vaccine in a tertiary care academic hospital: An epidemiological study. J Infect Public Health 2015; 9:60-5. [PMID: 26185014 DOI: 10.1016/j.jiph.2015.06.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 06/11/2015] [Accepted: 06/12/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND The hepatitis B virus (HBV) poses a health risk to healthcare workers who are in close proximity to infected individuals. Medical students are a particularly high-risk group due to the lack of an obligatory vaccination program and a post-vaccination screening program to determine immunity status, which results in a lack of awareness of and compliance with the HBV vaccine. METHODS This cross-sectional survey was conducted in King Khalid University Hospital (KKUH), a tertiary care academic hospital in Riyadh, Saudi Arabia, from November 2013 to March 2014. Medical students in their second to fifth years (n=444; 213 men and 231 women) completed a self-administered questionnaire regarding awareness of HBV and compliance with the HBV vaccination program in KKUH. RESULTS Medium to low knowledge levels were present in 53.5% of the participants, and 44.3% reported that they were not compliant with the vaccination program provided by KKUH. While 93.9% received the HBV vaccine upon entry to medical school, only 59.5% received all 3 doses, citing forgetfulness and a busy schedule as common reasons for the low compliance. There was no association between the knowledge and awareness of the participants and their compliance (p=0.988). CONCLUSION Medical students had a low level of compliance with the HBV vaccination program, regardless of their knowledge and awareness of the disease and vaccination. We recommend that programs and campaigns be developed to increase the overall awareness of this disease. We also suggest that a mandatory HBV vaccination program should be implemented to improve the compliance rate among medical students.
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Affiliation(s)
- Firas A Ghomraoui
- Department of Medicine, College of Medicine, King Saud University, Saudi Arabia
| | - Faisal A Alfaqeeh
- Department of Medicine, College of Medicine, King Saud University, Saudi Arabia
| | | | | | - Waleed K Al-Hamoudi
- Department of Medicine, College of Medicine, Liver Disease Research Center, King Saud University, Saudi Arabia
| | - Khalid A Alswat
- Department of Medicine, College of Medicine, Liver Disease Research Center, King Saud University, Saudi Arabia.
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Weaver T, Metrebian N, Strang J. Hepatitis B vaccination for people who inject drugs--authors' reply. Lancet 2015; 385:116. [PMID: 25706468 DOI: 10.1016/s0140-6736(15)60021-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Tim Weaver
- Centre for Mental Health, Imperial College London, London, UK
| | - Nicola Metrebian
- Institute of Psychiatry, National Addiction Centre, Kings College London, Strand, London WC2R 2LS, UK
| | - John Strang
- Institute of Psychiatry, National Addiction Centre, Kings College London, Strand, London WC2R 2LS, UK.
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Affiliation(s)
- Paul S Haber
- Drug Health Services, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia; Addiction Medicine, Central Clinical School, Sydney Medical School, University of Sydney, NSW, Australia.
| | - Carolyn A Day
- Addiction Medicine, Central Clinical School, Sydney Medical School, University of Sydney, NSW, Australia
| | - Libby Topp
- Cancer Council NSW, Woolloomooloo, NSW, Australia
| | - Marian Shanahan
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia
| | - Handan Wand
- Kirketon Road Centre, Kings Cross, NSW, Australia
| | | | - Lisa Maher
- The Kirby Institute, University of New South Wales, NSW, Australia
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Wadhera P, Evans JL, Stein E, Gandhi M, Couture MC, Sansothy N, Sichan K, Maher L, Kaldor J, Page K, Kien. Human papillomavirus knowledge, vaccine acceptance, and vaccine series completion among female entertainment and sex workers in Phnom Penh, Cambodia: the Young Women's Health Study. Int J STD AIDS 2014; 26:893-902. [PMID: 25505042 DOI: 10.1177/0956462414563626] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 11/04/2014] [Indexed: 11/17/2022]
Abstract
Human papillomavirus is a common sexually transmitted infection and the causative agent for cervical cancer, a frequently occurring malignant disease among women in developing countries. We assessed human papillomavirus awareness prior to the delivery of a brief information and education intervention, and human papillomavirus vaccine provision to female entertainment and sex workers (N = 220). At baseline, only 23.6% of women had heard of human papillomavirus. Following the educational intervention, 90% answered all the human papillomavirus knowledge questions correctly. Of 192 participants attending the first quarterly cohort visit where vaccine was offered, 149 (78%) were eligible for vaccination; HIV-positive (n = 32) and pregnant (n = 11) women were excluded. Acceptance of vaccine among eligible women was universal, and 79.2% completed the three-dose vaccination series. Women who reported use of amphetamine-type stimulants had significantly and independently lower odds of vaccine completion (adjusted odds ratio [AOR] 0.24; 95% confidence interval [CI] 0.08, 0.69). New pregnancies also had an impact on vaccine completion: 5.4% (8/149 5.4%) who started the series had to stop due to new pregnancy. Results demonstrate the effectiveness of a simple education intervention designed to increase human papillomavirus knowledge and the feasibility of successful human papillomavirus vaccine in a population that is often difficult to engage in preventive health care.
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Affiliation(s)
- Priya Wadhera
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, and Global Health Sciences, San Francisco, CA, USA
| | - Jennifer L Evans
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, and Global Health Sciences, San Francisco, CA, USA
| | - Ellen Stein
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, and Global Health Sciences, San Francisco, CA, USA
| | - Monica Gandhi
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Marie-Claude Couture
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
| | - Neth Sansothy
- National Center for HIV/AIDS, Dermatology and STDs (NCHADS), Phnom Penh, Cambodia
| | - Keo Sichan
- Cambodian Women's Development Association (CWDA), Phnom Penh, Cambodia
| | - Lisa Maher
- The Kirby Institute for Infection and Immunity (formerly the National Centre in HIV Epidemiology and Clinical Research); University of New South Wales, Sydney, NSW, Australia
| | - John Kaldor
- The Kirby Institute for Infection and Immunity (formerly the National Centre in HIV Epidemiology and Clinical Research); University of New South Wales, Sydney, NSW, Australia
| | - Kimberly Page
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, and Global Health Sciences, San Francisco, CA, USA Division of Epidemiology, Biostatistics and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | | | - Kien
- Cambodian Women's Development Association (CWDA), Phnom Penh, Cambodia
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Factors associated with hepatitis B vaccine series completion in a randomized trial for injection drug users reached through syringe exchange programs in three US cities. BMC Public Health 2014; 14:820. [PMID: 25107530 PMCID: PMC4138371 DOI: 10.1186/1471-2458-14-820] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 07/29/2014] [Indexed: 11/10/2022] Open
Abstract
Background Hepatitis B virus (HBV) is a vaccine preventable infection yet vaccination rates are low among injection drug users (IDUs) despite the high risk of infection and longstanding recommendations to promote vaccination. We sought to improve vaccination rates by reaching IDUs through syringe exchange programs (SEPs) in three U.S. cities. Methods IDUs were randomized in a trial comparing the standard HBV vaccination schedule (0, 1, and 6 months) to an accelerated schedule (0, 1, and 2 months) and participation data were analyzed to identify determinants of completion of the three-dose vaccine series. Independent variables explored included sociodemographics, injection and syringe access behaviors, assessment of health beliefs, HBV-associated knowledge, and personal health status. Results Covariates associated with completion of the three-dose vaccine series were accelerated vaccine schedule (aOR 1.92, 95% CI 1.34, 2.58, p = <0.001), older age (aOR 1.05, 95% CI 1.03, 1.07, p = <0.001), and poorer self-rated health score (aOR 1.26, 95% CI 1.05, 1.5, p = 0.02). Completion was less likely for those getting syringes from SEP customers than for SEP customers (OR 0.33, 95% CI 0.19, 0.58, p = <0.001). Conclusions SEPs should offer hepatitis vaccination in a manner that minimizes time between first and last visits by accelerating the dosing schedule. Public health interventions should target younger, less healthy, and non-SEP customer participants. Other health interventions at SEPs may benefit from similar approaches that reach out beyond regular SEP customers.
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Olsen A, Wallace J, Maher L. Responding to Australia's National Hepatitis B Strategy 2010-13: gaps in knowledge and practice in relation to Indigenous Australians. Aust J Prim Health 2014; 20:134-42. [PMID: 24216010 DOI: 10.1071/py12162] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 08/27/2013] [Indexed: 11/23/2022]
Abstract
The Australian National Hepatitis B Strategy 2010-13 outlines five priority areas for developing a comprehensive response to the hepatitis B virus (HBV): building partnerships and strengthening community action; preventing HBV transmission; optimising diagnosis and screening; clinical management of people with chronic hepatitis B (CHB); and developing health maintenance, care and support for people with HBV. A scoping study was used to map the main sources and types of evidence available on the epidemiology and natural history of HBV among Indigenous Australians as well as public health responses published since 2001 (January 2001-May 2013). Gaps in current knowledge were identified. While the literature documents the success of universal infant immunisation and indicates the potential for screening initiatives to identify infected and susceptible individuals, prevalence of CHB and hepatocellular cancer remain high in Indigenous Australians. Significant gaps in knowledge and practice were identified in relation to each of the five National Hepatitis B Strategy priority action areas. Successful implementation of the strategy in Indigenous communities and reducing the burden of HBV and hepatocellular cancer in Indigenous Australians will require increased investment in research and knowledge transfer across all priority areas.
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Affiliation(s)
- Anna Olsen
- The Kirby Institute, The University of New South Wales, Sydney, NSW 2052, Australia
| | - Jack Wallace
- Australian Research Centre in Sex, Health and Society, Latrobe University, 215 Franklin Street, Melbourne, Vic. 3000, Australia
| | - Lisa Maher
- The Kirby Institute, The University of New South Wales, Sydney, NSW 2052, Australia
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Weaver T, Metrebian N, Hellier J, Pilling S, Charles V, Little N, Poovendran D, Mitcheson L, Ryan F, Bowden-Jones O, Dunn J, Glasper A, Finch E, Strang J. Use of contingency management incentives to improve completion of hepatitis B vaccination in people undergoing treatment for heroin dependence: a cluster randomised trial. Lancet 2014; 384:153-63. [PMID: 24725468 DOI: 10.1016/s0140-6736(14)60196-3] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Poor adherence to treatment diminishes its individual and public health benefit. Financial incentives, provided on the condition of treatment attendance, could address this problem. Injecting drug users are a high-risk group for hepatitis B virus (HBV) infection and transmission, but adherence to vaccination programmes is poor. We aimed to assess whether contingency management delivered in routine clinical practice increased the completion of HBV vaccination in individuals receiving opioid substitution therapy. METHODS In our cluster randomised controlled trial, we enrolled participants at 12 National Health Service drug treatment services in the UK that provided opioid substitution therapy and nurse-led HBV vaccination with a super-accelerated schedule (vaccination days 0, 7, and 21). Clusters were randomly allocated 1:1:1 to provide vaccination without incentive (treatment as usual), with fixed value contingency management (three £10 vouchers), or escalating value contingency management (£5, £10, and £15 vouchers). Both contingency management schedules rewarded on-time attendance at appointments. The primary outcome was completion of clinically appropriate HBV vaccination within 28 days. We also did sensitivity analyses that examined vaccination completion with full adherence to appointment times and within a 3 month window. The trial is registered with Current Controlled Trials, number ISRCTN72794493. FINDINGS Between March 16, 2011, and April 26, 2012, we enrolled 210 eligible participants. Compared with six (9%) of 67 participants treated as usual, 35 (45%) of 78 participants in the fixed value contingency management group met the primary outcome measure (odds ratio 12·1, 95% CI 3·7-39·9; p<0·0001), as did 32 (49%) of 65 participants in the escalating value contingency management group (14·0, 4·2-46·2; p<0·0001). These differences remained significant with sensitivity analyses. INTERPRETATION Modest financial incentives delivered in routine clinical practice significantly improve adherence to, and completion of, HBV vaccination programmes in patients receiving opioid substitution therapy. Achievement of this improvement in routine clinical practice should now prompt actual implementation. Drug treatment providers should employ contingency management to promote adherence to vaccination programmes. The effectiveness of routine use of contingency management to achieve long-term behaviour change remains unknown. FUNDING National Institute for Health Research (RP-PG-0707-10149).
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Affiliation(s)
- Tim Weaver
- Centre for Mental Health, Imperial College London, London, UK
| | - Nicola Metrebian
- King's College London National Addiction Centre, King's College London Institute of Psychiatry, King's College London, London, UK
| | - Jennifer Hellier
- King's Clinical Trials Unit, Department of Biostatistics, King's College London Institute of Psychiatry, King's College London, London, UK
| | - Stephen Pilling
- Research Department of Clinical Educational and Health Psychology, University College London, London, UK
| | - Vikki Charles
- King's College London National Addiction Centre, King's College London Institute of Psychiatry, King's College London, London, UK
| | - Nicholas Little
- Research Department of Clinical Educational and Health Psychology, University College London, London, UK
| | | | - Luke Mitcheson
- South London & Maudsley NHS Foundation Trust, London, UK
| | - Frank Ryan
- Camden and Islington NHS Foundation Trust, London, UK
| | | | - John Dunn
- Camden and Islington NHS Foundation Trust, London, UK
| | | | - Emily Finch
- South London & Maudsley NHS Foundation Trust, London, UK
| | - John Strang
- King's College London National Addiction Centre, King's College London Institute of Psychiatry, King's College London, London, UK; South London & Maudsley NHS Foundation Trust, London, UK.
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Walsh N, Verster A, Rodolph M, Akl EA. WHO guidance on the prevention of viral hepatitis B and C among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 25:363-71. [PMID: 24561223 DOI: 10.1016/j.drugpo.2014.01.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 12/21/2013] [Accepted: 01/13/2014] [Indexed: 01/17/2023]
Abstract
Viral hepatitis B and C (HBV, HCV) disproportionately affect people who inject drugs (PWID) across the world. To date there has been little global action focusing on prevention, care and treatment of HBV and HCV among PWID. Here we report on the development process and discuss the implications of evidence informed WHO Guidelines for the Prevention of HBV and HCV in PWID. The World Health Organization (WHO) convened a Guideline Development Panel to develop recommendations on the prevention of HBV and HCV among PWID. The process followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. It included the development of PICO (Population, Interventions, Comparator, Outcomes) questions and conducting systematic reviews. Quality of evidence was classified into 4 levels: high, moderate, low, and very low. In the process of moving from evidence to recommendations, the following were considered: quality of evidence, balance of benefits and harms, community values and preferences and resource use. The WHO recommendations include the following for working with PWID: offer the rapid HBV vaccination regimen; offer incentives to increase uptake and completion of the HBV vaccine schedule; needle and syringe programs should also provide low dead-space syringes for distribution; and offer peer interventions to reduce the incidence of viral hepatitis. This guideline complements other WHO documents regarding PWID, including HIV prevention initiatives such as needle and syringe programs and opioid substitution therapy. This guidance offers a first step in the prevention of HBV and HCV among PWID. However, the lack of high quality evidence in this area necessitates further research and resources for implementation.
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Affiliation(s)
- Nick Walsh
- Department of Epidemiology and Preventive Medicine, Monash University, 89 Commercial Road, Melbourne, Victoria 3004, Australia.
| | - Annette Verster
- HIV/AIDS Program, World Health Organization, Geneva, Switzerland
| | - Michelle Rodolph
- HIV/AIDS Program, World Health Organization, Geneva, Switzerland
| | - Elie A Akl
- Clinical Epidemiology Unit, Clinical Research Institute, American University of Beirut, Lebanon; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
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Dolan P, Rudisill C. The effect of financial incentives on chlamydia testing rates: evidence from a randomized experiment. Soc Sci Med 2013; 105:140-8. [PMID: 24373390 PMCID: PMC3969100 DOI: 10.1016/j.socscimed.2013.11.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 10/31/2013] [Accepted: 11/11/2013] [Indexed: 11/28/2022]
Abstract
Financial incentives have been used in a variety of settings to motivate behaviors that might not otherwise be undertaken. They have been highlighted as particularly useful in settings that require a single behavior, such as appointment attendance or vaccination. They also have differential effects based on socioeconomic status in some applications (e.g. smoking). To further investigate these claims, we tested the effect of providing different types of non-cash financial incentives on the return rates of chlamydia specimen samples amongst 16–24 year-olds in England. In 2011 and 2012, we ran a two-stage randomized experiment involving 2988 young people (1489 in Round 1 and 1499 in Round 2) who requested a chlamydia screening kit from Freetest.me, an online and text screening service run by Preventx Limited. Participants were randomized to control, or one of five types of financial incentives in Round 1 or one of four financial incentives in Round 2. We tested the effect of five types of incentives on specimen sample return; reward vouchers of differing values, charity donation, participation in a lottery, choices between a lottery and a voucher and including vouchers of differing values in the test kit prior to specimen return. Financial incentives of any type, did not make a significant difference in the likelihood of specimen return. The more deprived individuals were, as calculated using Index of Multiple Deprivation (IMD), the less likely they were to return a sample. The extent to which incentive structures influenced sample return was not moderated by IMD score. Non-cash financial incentives for chlamydia testing do not seem to affect the specimen return rate in a chlamydia screening program where test kits are requested online, mailed to requestors and returned by mail. They also do not appear more or less effective in influencing test return depending on deprivation level. This chlamydia testing study is one of the largest, most thorough incentives trials. Non-cash financial incentives had no impact on chlamydia testing for young adults. Incentives were no more or less effective depending on socioeconomic status. The results are surprising given the theoretical underpinnings of the incentives' designs. Context is important in the success of any policies designed to change behavior.
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Affiliation(s)
- Paul Dolan
- Department of Social Policy, London School of Economics & Political Science, Houghton St., London WC2A 2AE, UK
| | - Caroline Rudisill
- Department of Social Policy, London School of Economics & Political Science, Houghton St., London WC2A 2AE, UK.
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