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Belisle LA, Solano-Patricio EDC. Harm reduction: a public health approach to prison drug use. Int J Prison Health 2021; 18:458-472. [PMID: 34962726 DOI: 10.1108/ijph-06-2021-0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE As prison drug use continues to be a concern worldwide, harm reduction practices serve as an alternative approach to traditional abstinence-only or punishment-oriented methods to address substance use behind bars. The purpose of this study is to present a summary of research surrounding prison-based harm reduction programs. DESIGN/METHODOLOGY/APPROACH This narrative review of the international literature summarizes the harms associated with prison drug use followed by an overview of the literature surrounding three prison-based harm reduction practices: opioid agonist therapy, syringe exchange programs and naloxone distribution. FINDINGS A collection of international research has found that these three harm reduction programs are safe and feasible to implement in carceral settings. Additionally, these services can effectively reduce some of the harms associated with prison drug use (e.g. risky injection practices, needle sharing, fatal overdoses, etc.). However, these practices are underused in correctional settings in comparison to their use in the community. ORIGINALITY/VALUE Various policy recommendations are made based on the available literature, including addressing ethical concerns surrounding prison populations' rights to the same standard of health care and services available in the community. By taking a public health approach to prison drug use, harm reduction practices can provide a marginalized, high-risk population of incarcerated individuals with life-saving services rather than punitive, punishment-oriented measures.
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Affiliation(s)
- Linsey Ann Belisle
- Department of Criminal Justice and Social Work, University of Houston - Downtown, Houston, Texas, USA
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Rosenthal ES, Silk R, Mathur P, Gross C, Eyasu R, Nussdorf L, Hill K, Brokus C, D'Amore A, Sidique N, Bijole P, Jones M, Kier R, McCullough D, Sternberg D, Stafford K, Sun J, Masur H, Kottilil S, Kattakuzhy S. Concurrent Initiation of Hepatitis C and Opioid Use Disorder Treatment in People Who Inject Drugs. Clin Infect Dis 2021; 71:1715-1722. [PMID: 32009165 DOI: 10.1093/cid/ciaa105] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/31/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND People who inject drugs have a high prevalence of hepatitis C virus (HCV) and significant disease associated with drug use; however, HCV treatment often occurs in absence of interventions to address opioid use disorder and drug use-related harms. The impact of concurrent initiation of opioid agonist therapy (OAT) on HCV treatment and drug use outcomes is unknown. METHODS In this prospective, open-label, observational trial at a harm reduction organization's drop-in center in Washington, DC, 100 patients with chronic HCV infection, opioid use disorder, and ongoing injection drug use were treated with sofosbuvir-velpatasvir for 12-weeks and offered buprenorphine initiation. The primary end point was sustained virologic response (SVR), and secondary end points included uptake of and retention in OAT, change in risk behavior, and determinants of SVR. RESULTS Eighty-two patients (82%) achieved SVR, which was not associated with baseline OAT status (P = .33), on-treatment drug use (P >.99), or imperfect daily adherence (P = .35) but was significantly associated with completing 2 or more 28-pill bottles of sofosbuvir-velpatasvir (P < .001) and receiving OAT at week 24 (P = .01). Of 67 patients not already receiving OAT at baseline, 53 (79%) started OAT. At week 24, 68 (68%) patients were receiving OAT. Receipt of OAT was associated with fewer opiate-positive urine drug screens (P = .003), lower human immunodeficiency virus risk-taking behavior scores (P < .001), and lower rates of opioid overdose (P = .04). CONCLUSIONS The Novel Model of Hepatitis C Treatment as an Anchor to Prevent HIV, Initiate Opioid Agonist Therapy, and Reduce Risky Behavior study demonstrates high uptake of buprenorphine collocated with HCV treatment, and it shows that concurrent initiation of OAT with HCV treatment can result in high rates of SVR while reducing risks associated with drug use. CLINICAL TRIALS REGISTRATION NCT03221309.
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Affiliation(s)
- Elana S Rosenthal
- Institute of Human Virology at the University of Maryland School of Medicine, Baltimore, Maryland, USA.,DC Partnership for HIV/AIDS Progress, Hepatitis Clinical Research Program, Washington, DC, USA
| | - Rachel Silk
- Institute of Human Virology at the University of Maryland School of Medicine, Baltimore, Maryland, USA.,DC Partnership for HIV/AIDS Progress, Hepatitis Clinical Research Program, Washington, DC, USA
| | - Poonam Mathur
- Institute of Human Virology at the University of Maryland School of Medicine, Baltimore, Maryland, USA.,DC Partnership for HIV/AIDS Progress, Hepatitis Clinical Research Program, Washington, DC, USA
| | - Chloe Gross
- Institute of Human Virology at the University of Maryland School of Medicine, Baltimore, Maryland, USA.,DC Partnership for HIV/AIDS Progress, Hepatitis Clinical Research Program, Washington, DC, USA
| | - Rahwa Eyasu
- Institute of Human Virology at the University of Maryland School of Medicine, Baltimore, Maryland, USA.,DC Partnership for HIV/AIDS Progress, Hepatitis Clinical Research Program, Washington, DC, USA
| | - Laura Nussdorf
- DC Partnership for HIV/AIDS Progress, Hepatitis Clinical Research Program, Washington, DC, USA.,Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland, USA
| | - Kristi Hill
- DC Partnership for HIV/AIDS Progress, Hepatitis Clinical Research Program, Washington, DC, USA.,Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland, USA
| | - Christopher Brokus
- DC Partnership for HIV/AIDS Progress, Hepatitis Clinical Research Program, Washington, DC, USA.,Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland, USA
| | - Aaron D'Amore
- DC Partnership for HIV/AIDS Progress, Hepatitis Clinical Research Program, Washington, DC, USA.,Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland, USA
| | - Nadeera Sidique
- DC Partnership for HIV/AIDS Progress, Hepatitis Clinical Research Program, Washington, DC, USA.,Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland, USA
| | - Phyllis Bijole
- Helping Individual Prostitutes Survive, Washington, DC, USA
| | - Miriam Jones
- Helping Individual Prostitutes Survive, Washington, DC, USA
| | - Randy Kier
- Helping Individual Prostitutes Survive, Washington, DC, USA
| | | | | | - Kristen Stafford
- Institute of Human Virology at the University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Junfeng Sun
- Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland, USA
| | - Henry Masur
- DC Partnership for HIV/AIDS Progress, Hepatitis Clinical Research Program, Washington, DC, USA.,Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland, USA
| | - Shyamasundaran Kottilil
- Institute of Human Virology at the University of Maryland School of Medicine, Baltimore, Maryland, USA.,DC Partnership for HIV/AIDS Progress, Hepatitis Clinical Research Program, Washington, DC, USA
| | - Sarah Kattakuzhy
- Institute of Human Virology at the University of Maryland School of Medicine, Baltimore, Maryland, USA.,DC Partnership for HIV/AIDS Progress, Hepatitis Clinical Research Program, Washington, DC, USA
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Lovrecic B, Lovrecic M, Gabrovec B, Carli M, Pacini M, Maremmani AGI, Maremmani I. Non-Medical Use of Novel Synthetic Opioids: A New Challenge to Public Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16020177. [PMID: 30634521 PMCID: PMC6352208 DOI: 10.3390/ijerph16020177] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/03/2019] [Accepted: 01/05/2019] [Indexed: 01/28/2023]
Abstract
Background: In the last decade there has been a progressive increase in the use of new psychoactive substances (NPSs) that are not yet under international control. In particular, novel synthetic opioids (NSOs) have reappeared on the recreational drug market in the last few years. As a result, the use of NSOs has increased rapidly. This poses an emerging and demanding challenge to public health. Aim: To raise awareness among clinicians and other professionals about NPSs, especially NSOs, to summarize current knowledge about pharmacological properties, forms of NSO on the market, pattern of use, effects and consequences of use. Methods: An electronic search was carried out on the Medline/PubMed and Google Scholar databases to find selected search terms. Results: Some NPSs are already controlled, while others can be legally sold directly on the drug market (mainly via internet, less so by drug dealers) or be used as precursors for the synthesis of other designer drugs that mimic the psychoactive effects of controlled substances. Potential side-effects of NSOs include miosis, sedation, respiratory depression, hypothermia, inhibition of gastrointestinal propulsion, death (from opioid overdose). Conclusions: The severity of the opioid crisis has intensified with the introduction of highly potent NSOs on the drug market. As long as addicts are dying from overdose or similar causes, there is something more constructive to do than waiting for addicts to overdose on heroin at a place located near a remedy, as if to say, within reach of naloxone.
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Affiliation(s)
| | - Mercedes Lovrecic
- National Institute of Public Health, 1000 Ljubljana, Slovenia.
- Centre for Psychiatry and Addiction Medicine, Izola Health Centre, 6310 Izola, Slovenia.
| | - Branko Gabrovec
- National Institute of Public Health, 1000 Ljubljana, Slovenia.
| | - Marco Carli
- Department of Translational Research and New Technologies, University of Pisa, 56100 Pisa, Italy.
| | - Matteo Pacini
- G. De Lisio Institute of Behavioral Sciences, 56100 Pisa, Italy.
| | - Angelo G I Maremmani
- Department of Psychiatry, North-Western Tuscany Region NHS Local Health Unit, Versilia Zone, 55049 Viareggio, Italy.
- Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), Pietrasanta, 55045 Lucca, Italy.
| | - Icro Maremmani
- G. De Lisio Institute of Behavioral Sciences, 56100 Pisa, Italy.
- Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), Pietrasanta, 55045 Lucca, Italy.
- Vincent P. Dole Dual Disorder Unit, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy.
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Social and structural factors associated with greater time with a plasma HIV-1 RNA viral load above log10(1500) copies/ml among illicit drug users. AIDS 2018; 32:1059-1067. [PMID: 29424782 DOI: 10.1097/qad.0000000000001777] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Although previous cross-sectional studies have identified correlates of detectable plasma HIV-1 RNA viral load (VL) among HIV-positive people who use drugs (PWUD), longitudinal factors associated with heightened HIV transmission potential have not been well described. Therefore, we longitudinally examined factors associated with amount of person-time spent above log10(1500) copies/ml plasma among HIV-positive PWUD in Vancouver, Canada. DESIGN Data were derived from a long-running prospective cohort of HIV-positive PWUD linked to comprehensive clinical records including systematic VL monitoring. METHODS We used generalized estimating equations modeling to longitudinally examine factors associated with person-time (in days) with a VL more than log10(1500) copies/ml plasma in the previous 180 days. RESULTS Between December 2005 and May 2014, 845 PWUD were eligible and included in the study. Participants spent an average of 26.8% of observation time with a VL more than log10(1500) copies/ml. In multivariable analyses, homelessness (Adjusted Rate Ratio [ARR] = 1.45) and lack of social support (ARR = 1.27) were positively associated with person-time with a VL more than log10(1500) copies/ml. Older age (ARR = 0.97) and enrolment in addiction treatment (ARR = 0.75) were negatively associated with the outcome in multivariable analyses (all P < 0.05). CONCLUSION Social and structural factors, including periods of homelessness or lacking in social support, were independently associated with greater amount of time with heightened HIV transmission potential. These findings suggest the need for targeted efforts to address modifiable contextual factors that contribute to increased risk of onward HIV transmission among PWUD.
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Bojko MJ, Mazhnaya A, Marcus R, Makarenko I, Islam Z, Filippovych S, Dvoriak S, Altice FL. The Future of Opioid Agonist Therapies in Ukraine: A Qualitative Assessment of Multilevel Barriers and Ways Forward to Promote Retention in Treatment. J Subst Abuse Treat 2016; 66:37-47. [PMID: 27211995 PMCID: PMC4919997 DOI: 10.1016/j.jsat.2016.03.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 02/03/2016] [Accepted: 03/13/2016] [Indexed: 12/22/2022]
Abstract
Opioid agonist therapies (OAT) to treat opioid addiction in people who inject drugs (PWID) began in Ukraine in 2004. Scale-up of OAT, however, has been hampered by both low enrollment and high attrition. To better understand the factors influencing OAT retention among PWID in Ukraine, qualitative data from 199 PWIDs were collected during 25 focus groups conducted in five Ukrainian cities from February to April 2013. The experiences of PWID who were currently or previously on OAT or currently trying to access OAT were analyzed to identify entry and retention barriers encountered. Transcribed data were analyzed using a grounded theory approach. Individual beliefs about OAT, particularly misaligned treatment goals between clients and providers, influenced PWID's treatment seeking behaviors. Multiple programmatic and structural issues, including inconvenient hours and treatment site locations, complicated dosing regimens, inflexible medication dispensing guidelines, and mistreatment by clinic and medical staff also strongly influenced OAT retention. Findings suggest the need for both programmatic and policy-level structural changes such as revising legal regulations covering OAT dispensing, formalizing prescription dosing policies and making OAT more available through other sites, including primary care settings as a way to improve treatment retention. Quality improvement interventions that target treatment settings could also be deployed to overcome healthcare delivery barriers. Additional patient education and medical professional development around establishing realistic treatment goals as well as community awareness campaigns that address the myths and fears associated with OAT can be leveraged to overcome individual, family and community-level barriers.
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Affiliation(s)
- Martha J Bojko
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA.
| | | | - Ruthanne Marcus
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | | | | | | | - Sergii Dvoriak
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | - Frederick L Altice
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA; Centre of Excellence on Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
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Mlunde LB, Sunguya BF, Mbwambo JKK, Ubuguyu OS, Yasuoka J, Jimba M. Association of opioid agonist therapy with the initiation of antiretroviral therapy - a systematic review. Int J Infect Dis 2016; 46:27-33. [PMID: 27044520 DOI: 10.1016/j.ijid.2016.03.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 03/18/2016] [Accepted: 03/24/2016] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES People who inject drugs are at high risk of HIV infection but often face barriers in accessing medical care including access to antiretroviral therapy (ART). Evidence is available about the effectiveness of opioid agonist therapy on drug dependency and risk behaviors. However, it remains scattered regarding access to ART among HIV-positive people who inject drugs. We conducted a systematic review to examine the association of opioid agonist therapy with ART initiation among HIV-positive people who inject drugs. METHODS We searched the literature for evidence from seven databases. We conducted a narrative synthesis and meta-analysis to examine the association of opioid agonist therapy with ART initiation. RESULTS Five out of 2,901 identified studies met the inclusion criteria. Three out of five studies reported that, HIV-positive people receiving opioid agonist therapy initiated ART more than those not receiving opioid agonist therapy. In meta-analysis, opioid agonist therapy was associated with ART initiation among HIV positive people who inject drugs (pooled odds ratio: 1.68; 95% confidence interval: 1.03-2.73). CONCLUSIONS Opioid agonist therapy is positively associated with ART initiation among HIV-positive people who inject drugs. It is important to scale up opioid agonist therapy among people who inject drugs to improve their ART initiation.
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Affiliation(s)
- Linda Beatrice Mlunde
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Bruno Fokas Sunguya
- Department of Community Health, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar es Salaam, Tanzania.
| | | | - Omary Said Ubuguyu
- Department of Psychiatry and Mental Health, Muhimbili National Hospital, P.O. Box 65000, Dar es Salaam, Tanzania.
| | - Junko Yasuoka
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
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Nosyk B, Krebs E, Min JE, Ahamad K, Buxton J, Goldsmith C, Hull M, Joe R, Krajden M, Lima VD, Olding M, Wood E, Montaner JSG. The 'Expanded HIV care in opioid substitution treatment' (EHOST) cluster-randomized, stepped-wedge trial: A study protocol. Contemp Clin Trials 2015; 45:201-209. [PMID: 26342295 DOI: 10.1016/j.cct.2015.08.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/28/2015] [Accepted: 08/30/2015] [Indexed: 11/18/2022]
Abstract
The public health response to HIV/AIDS has turned its focus onto optimizing health care system delivery to maximize case identification, access and sustained engagement in antiretroviral treatment (ART). Opioid Agonist Treatment (OAT) provides a critical opportunity for HIV testing and linkage to ART. The EHOST study is a cluster-randomized, stepped-wedge trial to evaluate a prescriber-focused intervention to increase HIV testing rates, and optimize ART engagement and retention outcomes among individuals engaged in OAT. The study will encompass all drug treatment clinics currently admitting patients for the treatment of opioid use disorder across the province of British Columbia, encompassing an estimated 90% of the OAT caseload. The trial will be executed over a 24-month period, with groups of clinics receiving the intervention in 6-month intervals. Evaluation of the proposed intervention's effectiveness will focus on three primary outcomes: (i) the HIV testing rate among those not known to be HIV positive; (ii) the rate of ART initiation among those not on ART; and (iii) the rate of ART continuation among those on ART. A difference-in-differences analytical framework will be applied to estimate the intervention's effect. This approach will assess site-specific changes in primary outcomes across clusters while adjusting for potential residual heterogeneity in patient case mix, volume, and quality of care across clinics. Statistical analysis of outcomes will be conducted entirely with linked population-level administrative health datasets. Facilitated by established collaborations between key stakeholders across the province, the EHOST intervention promises to optimize HIV testing and care within a marginalized and hard-to-reach population.
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Affiliation(s)
- B Nosyk
- BC Centre for Excellence in HIV/AIDS, Canada; Faculty of Health Sciences, Simon Fraser University, Canada.
| | - E Krebs
- BC Centre for Excellence in HIV/AIDS, Canada
| | - J E Min
- BC Centre for Excellence in HIV/AIDS, Canada
| | - K Ahamad
- BC Centre for Excellence in HIV/AIDS, Canada
| | - J Buxton
- BC Centre for Disease Control and Prevention, Canada; School of Population and Public Health, University of British Columbia, Canada
| | - C Goldsmith
- Faculty of Health Sciences, Simon Fraser University, Canada
| | - M Hull
- BC Centre for Excellence in HIV/AIDS, Canada; Vancouver Coastal Health Authority, Canada
| | - R Joe
- Vancouver Coastal Health Authority, Canada
| | - M Krajden
- BC Centre for Disease Control and Prevention, Canada
| | - V D Lima
- BC Centre for Excellence in HIV/AIDS, Canada; Division of AIDS, Faculty of Medicine, University of British Columbia, Canada
| | - M Olding
- BC Centre for Excellence in HIV/AIDS, Canada
| | - E Wood
- BC Centre for Excellence in HIV/AIDS, Canada; Division of AIDS, Faculty of Medicine, University of British Columbia, Canada
| | - J S G Montaner
- BC Centre for Excellence in HIV/AIDS, Canada; Division of AIDS, Faculty of Medicine, University of British Columbia, Canada
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Azbel L, Wickersham JA, Wegman MP, Polonsky M, Suleymanov M, Ismayilov R, Dvoryak S, Rotberga S, Altice FL. Burden of substance use disorders, mental illness, and correlates of infectious diseases among soon-to-be released prisoners in Azerbaijan. Drug Alcohol Depend 2015; 151:68-75. [PMID: 25861943 PMCID: PMC4447560 DOI: 10.1016/j.drugalcdep.2015.02.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 02/27/2015] [Accepted: 02/28/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND Despite low HIV prevalence in the South Caucasus region, transmission is volatile. Little data are available from this region about addiction and infectious diseases among prisoners who transition back to communities. METHODS A nation-wide randomly sampled biobehavioral health survey was conducted in 13 non-specialty Azerbaijani prisons among soon-to-be-released prisoners. After informed consent, participants underwent standardized health assessment surveys and testing for HIV, hepatitis B and C, and syphilis. RESULTS Of the 510 participants (mean age = 38.2 years), 11.4% were female, and 31.9% reported pre-incarceration drug injection, primarily of heroin. Prevalence of HCV (38.2%), HIV (3.7%), syphilis (3.7%), and HBV (2.7%) was high. Among the 19 HIV-infected inmates, 14 (73.7%) were aware of their HIV status, 12 (63.2%) were receiving antiretroviral therapy (ART), and 5 (26.3%) had CD4 < 350 cells/mL (4 of these were on ART). While drug injection was the most significant independent correlate of HCV (AOR = 12.9; p = 0.001) and a significant correlate of HIV (AOR = 8.2; p = 0.001), both unprotected sex (AOR = 3.31; p = 0.049) and working in Russia/Ukraine (AOR = 4.58; p = 0.008) were also correlated with HIV. CONCLUSION HIV and HCV epidemics are concentrated among people who inject drugs (PWIDs) in Azerbaijan, and magnified among prisoners. A transitioning HIV epidemic is emerging from migration from high endemic countries and heterosexual risk. The high diagnostic rate and ART coverage among Azerbaijani prisoners provides new evidence that HIV treatment as prevention in former Soviet Union (FSU) countries is attainable, and provides new insights for HCV diagnosis and treatment as new medications become available. Within prison evidence-based addiction treatments with linkage to community care are urgently needed.
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Affiliation(s)
- Lyuba Azbel
- Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | - Jeffrey A. Wickersham
- Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | - Martin P. Wegman
- Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | - Maxim Polonsky
- Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | - Murad Suleymanov
- Main Medical Department of the Ministry of Justice of the Azerbaijan Republic, Baku, Azerbaijan
| | - Rafik Ismayilov
- Independent Assistance and Consultancy Center “For the Sake of Civil Society”, Baku, Azerbaijan
| | - Sergey Dvoryak
- Ukrainian Institute on Public Health Policy, Kiev, Ukraine
| | - Signe Rotberga
- Head of UNODC Program Office in Kazakhstan, Astana, Kazakhstan
| | - Frederick L. Altice
- Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA,Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA,Corresponding author at: 135 College Street, Suite 323, New Haven, CT 06511, USA. Tel.: +1 203 737 2883; fax: +1 203 737 4051. (F.L. Altice)
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Bojko MJ, Mazhnaya A, Makarenko I, Marcus R, Dvoriak S, Islam Z, Altice FL. "Bureaucracy & Beliefs": Assessing the Barriers to Accessing Opioid Substitution Therapy by People Who Inject Drugs in Ukraine. DRUGS-EDUCATION PREVENTION AND POLICY 2015; 22:255-262. [PMID: 27087758 DOI: 10.3109/09687637.2015.1016397] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIMS Opioid substitution therapy (OST) is an evidence-based HIV prevention strategy for people who inject drugs (PWIDs). Yet, only 2.7% of Ukraine's estimated 310,000 PWIDs receive it despite free treatment since 2004. The multi-level barriers to entering OST among opioid dependent PWIDs have not been examined in Ukraine. METHODS A multi-year mixed methods implementation science project included focus group discussions with 199 PWIDs in 5 major Ukrainian cities in 2013 covering drug treatment attitudes and beliefs and knowledge of and experiences with OST. Data were transcribed, translated into English and coded. Coded segments related to OST access, entry, knowledge, beliefs and attitudes were analyzed among 41 PWIDs who were eligible for but had never received OST. FINDINGS A number of programmatic and structural barriers were mentioned by participants as barriers to entry to OST, including compulsory drug user registration, waiting lists, and limited number of treatment slots. Participants also voiced strong negative attitudes and beliefs about OST, especially methadone. Their perceptions about methadone's side effects as well as the stigma of being a methadone client were expressed as obstacles to treatment. CONCLUSIONS Despite expressed interest in treatment, Ukrainian OST-naïve PWIDs evade OST for reasons that can be addressed through changes in program-level and governmental policies and social-marketing campaigns. Voiced OST barriers can effectively inform public health and policy directives related to HIV prevention and treatment in Ukraine to improve evidence-based treatment access and availability.
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Affiliation(s)
- Martha J Bojko
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, Connecticut, USA
| | - Alyona Mazhnaya
- ICF International HIV/AIDS Alliance in Ukraine, Kyiv, Ukraine
| | | | - Ruthanne Marcus
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, Connecticut, USA
| | - Sergii Dvoriak
- Ukrainian Institute for Public Health Policy, Kyiv, Ukraine
| | - Zahedul Islam
- ICF International HIV/AIDS Alliance in Ukraine, Kyiv, Ukraine
| | - Frederick L Altice
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, Connecticut, USA; Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, Connecticut, USA
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Liebrenz M, Stohler R, Nordt C. Ethnic- and gender-specific differences in the prevalence of HIV among patients in opioid maintenance treatment-a case register analysis. Harm Reduct J 2014; 11:23. [PMID: 25130184 PMCID: PMC4178317 DOI: 10.1186/1477-7517-11-23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 08/02/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We have sought to identify ethnic- and gender-specific differences in HIV prevalence among heroin users receiving opioid maintenance treatment in the canton of Zurich, Switzerland. METHODS We used a generalized linear model (GEE) to analyze data from the anonymized case register for all opioid maintenance treatments in the canton of Zurich. Patients who received either methadone or buprenorphine between 1991 and 2012 (n=11,422) were evaluated for gender (male vs. female), ethnic background (Swiss vs. non-Swiss), and lifetime method of drug use (ever injector vs. non-injector). We addressed missing data by multiple imputation. RESULTS The overall prevalence of HIV among patients declined substantially from 33.7% in 1991 to 10.6% in 2012 in the complete dataset. In the imputed datasets, the respective prevalence dropped from 32.8% in 1991 to 9.7% in 2012. Non-injectors had a four to five times lower risk ratio (RR) compared to the reference group, 'Swiss males who ever injected'. In addition, we found a significantly higher risk ratio of HIV prevalence among females who had ever injected; this was true both for the complete dataset and the imputed dataset (Swiss RR 1.18 CI 95% 1.04-1.34, non-Swiss RR 1.58 CI 95% 1.18-2.12). CONCLUSION In this population, gender, ethnic background, and lifetime method of drug use influenced the risk of being HIV positive. Different access to treatment and different characteristics of risk exposure among certain subgroups might explain these findings. In particular, the higher risk for women who inject drugs-especially for those with an immigrant background-warrants additional research. Further exploration should identify what factors deter women from using available HIV-prevention measures and whether and how these measures can be better adapted to high-risk groups.
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Affiliation(s)
- Michael Liebrenz
- Research Group on Substance Use Disorders, Psychiatric University Hospital, Selnaustrasse 9, 8001 Zurich, Switzerland.
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Bachireddy C, Soule MC, Izenberg JM, Dvoryak S, Dumchev K, Altice FL. Integration of health services improves multiple healthcare outcomes among HIV-infected people who inject drugs in Ukraine. Drug Alcohol Depend 2014; 134:106-114. [PMID: 24128379 PMCID: PMC3865106 DOI: 10.1016/j.drugalcdep.2013.09.020] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 09/16/2013] [Accepted: 09/17/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND People who inject drugs (PWID) experience poor outcomes and fuel HIV epidemics in middle-income countries in Eastern Europe and Central Asia. We assess integrated/co-located (ICL) healthcare for HIV-infected PWID, which despite international recommendations, is neither widely available nor empirically examined. METHODS A 2010 cross-sectional study randomly sampled 296 HIV-infected opioid-dependent PWID from two representative HIV-endemic regions in Ukraine where ICL, non-co-located (NCL) and harm reduction/outreach (HRO) settings are available. ICL settings provide onsite HIV, addiction, and tuberculosis services, NCLs only treat addiction, and HROs provide counseling, needles/syringes, and referrals, but no opioid substitution therapy (OST). The primary outcome was receipt of quality healthcare, measured using a quality healthcare indicator (QHI) composite score representing percentage of eight guidelines-based recommended indicators met for HIV, addiction and tuberculosis treatment. The secondary outcomes were individual QHIs and health-related quality-of-life (HRQoL). RESULTS On average, ICL-participants had significantly higher QHI composite scores compared to NCL- and HRO-participants (71.9% versus 54.8% versus 37.0%, p<0.001) even after controlling for potential confounders. Compared to NCL-participants, ICL-participants were significantly more likely to receive antiretroviral therapy (49.5% versus 19.2%, p<0.001), especially if CD4 ≤ 200 (93.8% versus 62.5% p<0.05); guideline-recommended OST dosage (57.3% versus 41.4%, p<0.05); and isoniazid preventive therapy (42.3% versus 11.2%, p<0.001). Subjects receiving OST had significantly higher HRQoL than those not receiving it (p<0.001); however, HRQoL did not differ significantly between ICL- and NCL-participants. CONCLUSIONS These findings suggest that OST alone improves quality-of-life, while receiving care in integrated settings collectively and individually improves healthcare quality indicators for PWID.
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Affiliation(s)
- Chethan Bachireddy
- Yale University School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, USA
| | - Michael C. Soule
- Massachussetts General Hospital, Department of Psychiatry, Boston, USA
| | - Jacob M. Izenberg
- Yale University School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, USA
| | - Sergey Dvoryak
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | | | - Frederick L. Altice
- Yale University School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, USA,Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, USA
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Investigation of the interactions between methadone and elvitegravir-cobicistat in subjects receiving chronic methadone maintenance. Antimicrob Agents Chemother 2013; 57:6154-7. [PMID: 24080665 DOI: 10.1128/aac.01229-13] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Interactions between HIV and opioid dependence therapies are known to occur. We sought to determine if such interactions occurred between methadone and elvitegravir boosted with cobicistat (EVG/COBI). We performed a within-subject open-label pharmacokinetic and pharmacodynamic study of 11 HIV-seronegative subjects stabilized on at least 2 weeks of methadone. Subjects underwent baseline and steady-state evaluation of the effect of elvitegravir 150 mg once a day (QD) boosted with 150 mg QD of cobicistat (EVG/COBI) on methadone pharmacokinetic parameters. Safety and pharmacodynamics were monitored throughout the study. Compared to baseline values, the R-methadone mean area under the concentration-time curve to the end of the dosing period (AUCtau) (5,550 versus 6,210 h · ng/ml) and mean maximum concentration of drug in serum (Cmax) (316 versus 337 ng/ml) did not significantly increase in the presence of EVG/COBI. Compared to baseline values, the S-methadone mean AUCtau (7,040 versus 7,540 h · ng/ml) and mean Cmax (446 versus 452 ng/ml) did not significantly increase in the presence of EVG/COBI. The AUCtau, Cmax, and Ctau of elvitegravir and cobicistat did not significantly differ from those of historical controls. Opioid withdrawal or overdose was not observed among subjects in this study. The addition of EVG/COBI to stabilized patients receiving methadone did not affect methadone pharmacokinetics and pharmacodynamics. These two agents can be safely coadministered.
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The Pharmacokinetic and Pharmacodynamic Interactions Between Buprenorphine/Naloxone and Elvitegravir/Cobicistat in Subjects Receiving Chronic Buprenorphine/Naloxone Treatment. J Acquir Immune Defic Syndr 2013; 63:480-4. [DOI: 10.1097/qai.0b013e3182961d31] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Douglas Bruce R, Moody DE, Chodkowski D, Andrews L, Fang WB, Morrison J, Parsons TL, Friedland GH. Pharmacokinetic Interactions between Buprenorphine/Naloxone and Raltegravir in Subjects Receiving Chronic Buprenorphine/Naloxone Treatment. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2013; 39:80-5. [DOI: 10.3109/00952990.2013.764885] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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The effect of methadone maintenance on illicit opioid use, human immunodeficiency virus and hepatitis C virus infection, health status, employment, and criminal activity among heroin abusers during 6 months of treatment in china. J Addict Med 2012; 1:186-90. [PMID: 21768956 DOI: 10.1097/adm.0b013e318156cc19] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE : This study was designed to evaluate the effects of methadone maintenance treatment (MMT) on severity of dependence, depression, human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection, health status, employment, and criminal activity among heroin abusers after 3 and 6 months of treatment, compared with baseline, in China. METHODS : A total of 102 methadone maintenance treatment (MMT) patients (87 men and 15 women; mean age, 36.1 years; standard deviation = 6.9) without major medical or psychiatric comorbidity participated in the experimental procedure. They were given oral methadone (maximum daily dose 80 mg, minimum daily dose 30 mg). Opioid use was assessed by twice-weekly urinalysis; HIV and HCV status were assessed by standard blood tests. Questionnaires were administered to assess blood-borne-virus risk behavior, severity of dependence, depression, health status, employment, and criminal activity. Changes over time were evaluated by 1-way analysis of variance (ANOVA) followed by post hoc t tests. RESULTS : Opioid use was reduced from 26.7 days per month at baseline to 0.7 and 0.0 days at 3 and 6 months, respectively. No participant seroconverted to HIV and HCV positivity during the 6 months of MMT. Health status significantly improved, as did severity of dependence, depression, and criminal activity, after 3 and 6 months MMT. CONCLUSIONS : The results support the broad beneficial effects of MMT in China.
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Stanekzai MR, Todd CS, Orr MG, Bayan S, Rasuli MZ, Wardak SR, Strathdee SA. Baseline assessment of community knowledge and attitudes toward drug use and harm reduction in Kabul, Afghanistan. Drug Alcohol Rev 2011; 31:451-60. [PMID: 21919980 DOI: 10.1111/j.1465-3362.2011.00352.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS Problem drug use has been identified as a significant public health problem in Afghanistan. The study aim was to assess community knowledge and attitude toward drug use and harm reduction in Kabul, Afghanistan. DESIGN AND METHODS A cross-sectional convenience sample of community representatives of 10 possible professions were recruited, distributed between the 17 Kabul city districts in 2007. A questionnaire measured sociodemographic characteristics and awareness, knowledge, and attitudes toward drug use and harm reduction. Logistic regression and cluster analysis were performed to test for associations with participant attitude. RESULTS Of 210 participants, mean age was 36.7 years. Most (98.6%) were Afghan and employed (87.6%). Most (88.6%) were aware of problem drug use in Afghanistan, primarily attributed to unemployment. The majority of participants agreed that addiction is a disease (88.6%) and believed more and better treatment and vocational training facilities were needed (90.5%). Use of only punitive measures in response to drug use was favoured by few (7.1%) participants. Only 33.3% of participants could correctly identify legal consequences of drug use. DISCUSSION AND CONCLUSIONS Community acknowledgement of problem drug use and support for addiction treatment are present in Kabul, Afghanistan. However, knowledge gaps concerning drug laws and harm reduction should be addressed in efforts to introduce culturally appropriate harm reduction programming.
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Lin C, Wu Z, Detels R. Family support, quality of life and concurrent substance use among methadone maintenance therapy clients in China. Public Health 2011; 125:269-74. [PMID: 21414646 DOI: 10.1016/j.puhe.2011.01.009] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The methadone maintenance therapy (MMT) programme has been scaled up rapidly in China. This study explored the family support perceived by MMT clients and its association with their quality of life and concurrent illicit drug use. STUDY DESIGN Cross-sectional study. METHODS Five hundred and sixty MMT clients were selected at random from 28 MMT clinics and services in Zhejiang and Jiangxi Provinces, China for participation in a face-to-face interview study. The participants' perceived family support and quality of life were measured through face-to-face structured interviews conducted by trained interviewers. Self-reported information about illicit drug use was obtained from clients. Urine specimens were collected from the participants to test for heroin use. RESULTS Among the 560 participants, 471 (84.1%) were male and 168 (30.0%) were unemployed at the time of the study. In total, 398 (71.1%) were injecting drug users and 309 (55.2%) had a history of drug use of more than 10 years. Around one-third (n = 211, 37.7%) of the participants reported concurrent illicit drug use or had a positive urine test. Perceived family support was associated with increased physical health, psychological health, environmental health and social health. In addition, perceived family support was negatively correlated with concurrent substance use. CONCLUSIONS Drug use and MMT is a family issue in China. Based on the findings of this study, it is suggested that involving family members in recruitment and interventions of the MMT programme will achieve higher rates of participation and compliance.
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Affiliation(s)
- C Lin
- Centre for Health Behaviours Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, China.
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Lin C, Wu Z, Detels R. Opiate users' perceived barriers against attending methadone maintenance therapy: a qualitative study in China. Subst Use Misuse 2011; 46:1190-8. [PMID: 21417558 PMCID: PMC3392119 DOI: 10.3109/10826084.2011.561905] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Methadone maintenance therapy (MMT) in China is facing challenges such as high relapse rates and low coverage. The study assessed factors influencing MMT utilization among opiate users. In-depth interviews were conducted among 30 opiate users in 2008 to ascertain the barriers against seeking MMT. Data were analyzed using ATLAS.ti. Barriers to the treatment included requirement of registration with police, perceived discrimination, logistic difficulties, side effects, fear of being addicted to another drug, lack of additional services, and economic burden. The result suggests the need for structural changes such as improving comprehensive services, simplifying application procedure, and enhancing referral system. The study's limitations are noted.
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Affiliation(s)
- Chunqing Lin
- Semel Institute Center for Community Health, University of California, Los Angeles, California, USA.
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Alistar SS, Brandeau ML. Decision making for HIV prevention and treatment scale up: bridging the gap between theory and practice. Med Decis Making 2010; 32:105-17. [PMID: 21191118 DOI: 10.1177/0272989x10391808] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Effectively controlling the HIV epidemic will require efficient use of limited resources. Despite ambitious global goals for HIV prevention and treatment scale up, few comprehensive practical tools exist to inform such decisions. METHODS We briefly summarize modeling approaches for resource allocation for epidemic control, and discuss the practical limitations of these models. We describe typical challenges of HIV resource allocation in practice and some of the tools used by decision makers. We identify the characteristics needed in a model that can effectively support planners in decision making about HIV prevention and treatment scale up. RESULTS An effective model to support HIV scale-up decisions will be flexible, with capability for parameter customization and incorporation of uncertainty. Such a model needs certain key technical features: it must capture epidemic effects; account for how intervention effectiveness depends on the target population and the level of scale up; capture benefit and cost differentials for packages of interventions versus single interventions, including both treatment and prevention interventions; incorporate key constraints on potential funding allocations; identify optimal or near-optimal solutions; and estimate the impact of HIV interventions on the health care system and the resulting resource needs. Additionally, an effective model needs a user-friendly design and structure, ease of calibration and validation, and accessibility to decision makers in all settings. CONCLUSIONS Resource allocation theory can make a significant contribution to decision making about HIV prevention and treatment scale up. What remains now is to develop models that can bridge the gap between theory and practice.
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Affiliation(s)
- Sabina S Alistar
- Department of Management Science and Engineering, Stanford University, Stanford, California 94305, USA.
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20
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Degenhardt L, Mathers B, Vickerman P, Rhodes T, Latkin C, Hickman M. Prevention of HIV infection for people who inject drugs: why individual, structural, and combination approaches are needed. Lancet 2010; 376:285-301. [PMID: 20650522 DOI: 10.1016/s0140-6736(10)60742-8] [Citation(s) in RCA: 330] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
HIV can spread rapidly between people who inject drugs (through injections and sexual transmission), and potentially the virus can pass to the wider community (by sexual transmission). Here, we summarise evidence on the effectiveness of individual-level approaches to prevention of HIV infection; review global and regional coverage of opioid substitution treatment, needle and syringe programmes, and antiretroviral treatment; model the effect of increased coverage and a combination of these three approaches on HIV transmission and prevalence in injecting drug users; and discuss evidence for structural-level interventions. Each intervention alone will achieve modest reductions in HIV transmission, and prevention of HIV transmission necessitates high-coverage and combined approaches. Social and structural changes are potentially beneficial components in a combined-intervention strategy, especially when scale-up is difficult or reductions in HIV transmission and injection risk are difficult to achieve. Although further evidence is needed on how to optimise combinations of interventions in different settings and epidemics, we know enough now about which actions are effective: the challenge is to deliver these well and to scale.
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Affiliation(s)
- Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
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21
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Bruce RD. Methadone as HIV prevention: high volume methadone sites to decrease HIV incidence rates in resource limited settings. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2010; 21:122-4. [PMID: 19931444 DOI: 10.1016/j.drugpo.2009.10.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 10/12/2009] [Accepted: 10/14/2009] [Indexed: 10/20/2022]
Abstract
The link between injection drug use and HIV has been extensively described. Despite worldwide prevention efforts, injection drug use continues to be a risk factor for HIV transmission and both HIV and injection drug use continues to spread across the globe. Although methadone has demonstrated multiple health benefits including the reduction in injection drug use and HIV acquisition, the utilisation of methadone in many areas of the world remains one of secondary, rather than primary, HIV prevention. As a result, many who finally begin methadone enter treatment having accumulated medical and mental health problems as a result of delayed treatment. Rapid access to treatment and a more aggressive policy that realizes that methadone can help reduce opioid drug use is necessary if methadone is effectively going to act as primary HIV prevention. To delay access to methadone only increases the probability that the individual will acquire an infectious disease that is more costly to the individual in terms of morbidity and mortality and more costly to society as a whole.
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Affiliation(s)
- R Douglas Bruce
- Yale University, School of Medicine, AIDS Programme, 135 College Street, Suite 323, New Haven, CT 06510, United States.
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22
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Vlahov D, Robertson AM, Strathdee SA. Prevention of HIV infection among injection drug users in resource-limited settings. Clin Infect Dis 2010; 50 Suppl 3:S114-21. [PMID: 20397939 PMCID: PMC3114556 DOI: 10.1086/651482] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Injection drug use contributes to considerable global morbidity and mortality associated with human immunodeficiency virus (HIV) infection and AIDS and other infections due to blood-borne pathogens through the direct sharing of needles, syringes, and other injection equipment. Of approximately 16 million injection drug users (IDUs) worldwide, an estimated 3 million are HIV infected. The prevalence of HIV infection among IDUs is high in many countries in Asia and eastern Europe and could exacerbate the HIV epidemic in sub-Saharan Africa. This review summarizes important components of a comprehensive program for prevention of HIV infection in IDUs, including unrestricted legal access to sterile syringes through needle exchange programs and enhanced pharmacy services, treatment for opioid dependence (ie, methadone and buprenorphine treatment), behavioral interventions, and identification and treatment of noninjection drug and alcohol use, which accounts for increased sexual transmission of HIV. Evidence supports the effectiveness of harm-reduction programs over punitive drug-control policies.
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Affiliation(s)
- David Vlahov
- Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, New York 10029, USA.
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Uhlmann S, Milloy MJ, Kerr T, Zhang R, Guillemi S, Marsh D, Hogg RS, Montaner JSG, Wood E. Methadone maintenance therapy promotes initiation of antiretroviral therapy among injection drug users. Addiction 2010; 105:907-13. [PMID: 20331553 PMCID: PMC2857602 DOI: 10.1111/j.1360-0443.2010.02905.x] [Citation(s) in RCA: 119] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS Despite proven benefits of antiretroviral therapy (ART), many human immunodeficiency virus (HIV)-infected injection drug users (IDU) do not access treatment even in settings with free health care. We examined whether methadone maintenance therapy (MMT) increased initiation and adherence to ART among an IDU population with free health care. DESIGN We examined prospectively a cohort of opioid-using antiretroviral-naive HIV-infected IDU and investigated factors associated with initiation of antiretroviral therapy as well as subsequent adherence. Factors associated independently with time to first initiation of antiretroviral therapy were modelled using Cox proportional hazards regression. FINDINGS Between May 1996 and April 2008, 231 antiretroviral-naive HIV-infected opioid-using IDU were enrolled, among whom 152 (65.8%) initiated ART, for an incidence density of 30.5 [95% confidence interval (CI): 25.9-35.6] per 100 person-years. After adjustment for time-updated clinical characteristics and other potential confounders, use of MMT was associated independently with more rapid uptake of antiretroviral therapy [relative hazard = 1.62 (95% CI: 1.15-2.28); P = 0.006]. Those prescribed methadone also had higher rates of ART adherence after first antiretroviral initiation [odds ratio = 1.49 (95% CI: 1.07-2.08); P = 0.019]. CONCLUSION These results demonstrate that MMT contributes to more rapid initiation and subsequent adherence to ART among opioid-using HIV-infected IDU. Addressing international barriers to the use and availability of methadone may increase dramatically uptake of HIV treatment among this population.
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Affiliation(s)
- Sasha Uhlmann
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - M-J Milloy
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Ruth Zhang
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, Canada
| | - Silvia Guillemi
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, Canada
| | | | - Robert S. Hogg
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Julio S. G. Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
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Lakhman SS, Ma Q, Morse GD. Pharmacogenomics of CYP3A: considerations for HIV treatment. Pharmacogenomics 2010; 10:1323-39. [PMID: 19663676 DOI: 10.2217/pgs.09.53] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The understanding of the cytochrome P450 3A SNP in antiretroviral therapy is important, because it is highly inducible, extremely polymorphic and metabolizes many of the drugs that are key components of highly active antiretroviral therapy regimens. This enzyme is prolific and promiscuous towards drug and xenobiotic substrate selection and it is also unpredictable among individuals, having a 5- to 20-fold variability in its ability to contribute to drug clearance. The importance of human CYP3A pharmacogenetics is also gaining attention in other established areas of pharmacotherapy as it may contribute to the goal of predicting efficacy and/or toxicity, specifically with the discovery of null allele CYP3A4*20. This review summarizes the current understanding, implications of genetic variation in the CYP3A enzymes, the central role of CYP3A in linking human genetics, the pharmacokinetics and resulting pharmacodynamic responses to certain antiretroviral drugs, and their eventual place in applied clinical pharmacotherapy.
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Affiliation(s)
- Sukhwinder S Lakhman
- Department of Pharmaceutical Sciences, DYC School of Pharmacy, Buffalo, NY 14201 USA
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Wood E, Kerr T. Could a United Nations organisation lead to a worsening of drug-related harms? Drug Alcohol Rev 2010; 29:99-100. [PMID: 20078689 DOI: 10.1111/j.1465-3362.2009.00119.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
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26
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Bruce RD, Altice FL, Moody DE, Lin SN, Fang WB, Sabo JP, Wruck JM, Piliero PJ, Conner C, Andrews L, Friedland GH. Pharmacokinetic interactions between buprenorphine/naloxone and tipranavir/ritonavir in HIV-negative subjects chronically receiving buprenorphine/naloxone. Drug Alcohol Depend 2009; 105:234-9. [PMID: 19726139 PMCID: PMC2779257 DOI: 10.1016/j.drugalcdep.2009.07.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 07/12/2009] [Accepted: 07/14/2009] [Indexed: 11/22/2022]
Abstract
HIV-infected patients with opioid dependence often require opioid replacement therapy. Pharmacokinetic interactions between HIV therapy and opioid dependence treatment medications can occur. HIV-seronegative subjects stabilized on at least 3 weeks of buprenorphine/naloxone (BUP/NLX) therapy sequentially underwent baseline and steady-state pharmacokinetic evaluation of open-label, twice daily tipranavir 500 mg co-administered with ritonavir 200 mg (TPV/r). Twelve subjects were enrolled and 10 completed the study. Prior to starting TPV/r, the geometric mean BUP AUC(0-24h) and C(max) were 43.9 ng h/mL and 5.61 ng/mL, respectively. After achieving steady-state with TPV/r (> or = 7 days), these values were similar at 43.7 ng h/mL and 4.84 ng/mL, respectively. Similar analyses for norBUP, the primary metabolite of BUP, demonstrated a reduction in geometric mean for AUC(0-24h) [68.7-14.7 ng h/mL; ratio=0.21 (90% CI 0.19-0.25)] and C(max) [4.75-0.94 ng/mL; ratio=0.20 (90% CI 0.17-0.23)]. The last measurable NLX concentration (C(last)) in the concentration-time profile, never measured in previous BUP/NLX interaction studies with antiretroviral medications, was decreased by 20%. Despite these pharmacokinetic effects on BUP metabolites and NLX, no clinical opioid withdrawal symptoms were noted. TPV steady-state AUC(0-12h) and C(max) decreased 19% and 25%, respectively, and C(min) was relatively unchanged when compared to historical control subjects receiving TPV/r alone. No dosage modification of BUP/NLX is required when co-administered with TPV/r. Though mechanistically unclear, it is likely that decreased plasma RTV levels while on BUP/NLX contributed substantially to the decrease in TPV levels. BUP/NLX and TPV/r should therefore be used cautiously to avoid decreased efficacy of TPV in patients taking these agents concomitantly.
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Affiliation(s)
- R Douglas Bruce
- Yale University AIDS Program, 135 College Street, Suite 323, New Haven, CT, United States.
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Todd CS, Abed AMS, Scott PT, Safi N, Earhart KC, Strathdee SA. A cross-sectional assessment of utilization of addiction treatment among injection drug users in Kabul, Afghanistan. Subst Use Misuse 2009; 44:416-30. [PMID: 18979391 PMCID: PMC7153687 DOI: 10.1080/10826080802347669] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The purpose of this study was to describe prior use of detoxification and addiction-treatment programs among injection drug users (IDUs) in Kabul, Afghanistan. From 2005-2006, IDUs (n = 464) recruited into this cross-sectional study completed an interviewer-administered questionnaire and whole blood rapid testing with fingerstick samples for HIV, syphilis, and hepatitis C antibody and B surface antigen testing. Participants were predominantly male (99.8%), Afghan (98.9%), and had little formal education. Correlates of detoxification and addiction treatment were identified with logistic regression. The majority (94.0%, n = 435) felt great/urgent need for treatment, of whom 56.3% (n = 245) reported inability to access treatment. Prior detoxification was associated with new needle use with each injection (AOR = 1.91, 95% CI: 1.12-3.26) and prior incarceration (AOR = 1.81, 95% CI: 1.04-3.13). The study's limitations are noted. Rapid scale-up and subsidy of needle and syringe programs and opioid agonist treatment is urgently needed in Kabul.
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Affiliation(s)
- Catherine S Todd
- Department of Family & Preventive Medicine, University of California, San Diego, California, USA.
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Abstract
Injecting drug users (IDU) now account for one in 10 new HIV infections world wide. Yet it has been known since the early 1990s that HIV among IDU can be effectively, safely and cost-effectively controlled by the early and vigorous implementation of a comprehensive package of strategies known as 'harm reduction'. This concept means that decreasing drug-related harms is accorded an even higher priority than reduction of drug consumption. Strategies required involve: explicit and peer-based education about the risk of HIV from sharing injecting equipment; needle syringe programmes; drug treatment (including especially opiate substitution treatment) and community development. Many countries experiencing or threatened by an HIV epidemic among IDU have now adopted harm reduction but often implementation has been too little and too late. Although coverage is slowly improving in many countries, HIV is still spreading faster among IDU than harm reduction programmes while coverage in correctional centres lags far behind community settings. The scientific debate about harm reduction is now over. National and international support for harm reduction is growing while almost all the major UN organizations responsible for drug policy now support harm reduction. Only a small number of countries, led by the USA, are still vehemently opposed to harm reduction. Excessive reliance on drug law enforcement remains the major barrier to increased adoption of harm reduction. Sometimes zealous drug law enforcement undermines harm reduction. A more balanced approach to drug law enforcement is required with illicit drug use recognized primarily as a health and social problem.
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Abstract
Globally, injection drug use continues to account for a substantial proportion of HIV infections. There have not, however, been any evidence-based reviews of the barriers and facilitators of HIV treatment among injection drug users. For this review, published studies were extracted from nine academic databases, with no language or date specified in the search criteria. Existing evidence demonstrates that, although injection drug users often have worse outcomes from HIV treatment than non-injection drug users, major antiretroviral-associated survival gains still have been observed among this population. Inferior outcomes are explained by a range of barriers to antiretroviral access and adherence, which often stem from the negative influences of illicit drug policies, as well as issues within medical systems, including lack of physician education about substance abuse. Evidence demonstrates that several under-utilized interventions and novel antiretroviral delivery modalities have helped to greatly address these barriers in several settings, and there is sufficient evidence to support immediate scale-up of these programmes. These interventions include coupling antiretroviral therapy with opioid substitution therapies as well as directly administered antiretroviral therapy programmes. Of particular interest for future evaluation is the coupling of HIV treatment programmes within comprehensive services, which also provide low-threshold (harm reduction) HIV prevention programmes. Scale-up of evidence-based HIV treatment and prevention to injection drug users, however, will require increasing political will among both national policy-makers and international public health agencies.
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Kerr T, Wood E. Closing the gap between evidence and action: The need for knowledge translation in the field of drug policy research. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2008. [DOI: 10.1016/j.drugpo.2008.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Todd CS, Nassiramanesh B, Stanekzai MR, Kamarulzaman A. Emerging HIV epidemics in muslim countries: Assessment of different cultural responses to harm reduction and implications for HIV control. Curr HIV/AIDS Rep 2007; 4:151-7. [DOI: 10.1007/s11904-007-0022-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Affiliation(s)
- Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Providence Health Care, Vancouver, BC, Canada V6Z 1Y6
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Abstract
HIV/AIDS and chemical dependency, the latter often intertwined with mental illness, are complex, overlapping spheres that adversely influence each other and the overall clinical outcomes of the affected individual. Each disorder individually impact tens of millions of people adversely, with explosive epidemics described worldwide. This article addresses the adverse consequences of HIV/AIDS, drug injection, the secondary comorbidities of both, and the impact of immunosuppression on presentation of disease as well as approaches to managing the HIV-infected drug user.
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Affiliation(s)
- R. Douglas Bruce
- Yale University AIDS Program, Yale University School of Medicine, 135 College Street, Suite 323, New Haven, CT 06510, USA
| | - Frederick L. Altice
- Yale University AIDS Program, Yale University School of Medicine, 135 College Street, Suite 323, New Haven, CT 06510, USA
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Implementation of harm reduction in Central and Eastern Europe and Central Asia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2006; 18:129-35. [PMID: 17689355 DOI: 10.1016/j.drugpo.2006.11.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2006] [Revised: 11/12/2006] [Accepted: 11/15/2006] [Indexed: 11/15/2022]
Abstract
Harm reduction (HR) interventions began in Central-Eastern Europe and Central Asia in the mid-1980s with the establishment of substitution treatment (ST) in Yugoslavia. In the mid-1990s, the first needle and syringe programmes (NSPs) opened in selected countries following the outbreaks of HIV among injecting drug users (IDUs). The number of NSPs continues to increase via a combination of international and state funding with large expansions made possible via the Global Fund to Fight AIDS, Tuberculosis and Malaria. While ST is still unaccepted in several countries, others have made some progress which is especially visible in South Eastern and Central Europe and the Baltic States. Development of regional networking including Central and Eastern European HR Network and a number of national networks helped to coordinate joint advocacy effort and in some cases sustain HR services. Activism of drug users and people living with HIV (PLWH) increased in the region in the last several years and helped to better link HR with the affected communities. Still a number of challenges remain important for the movement today such as repressive drug policies; stigma and discrimination of IDUs, PLWH, sex workers and inmates, including poor access to prevention and treatment; lack of important components of HR work such as naloxone distribution and hepatitis B vaccination, prevention in prisons; issues of quality control; sustaining services after finishing of major international projects; reaching of adequate coverage and others.
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Maas B, Kerr T, Fairbairn N, Montaner J, Wood E. Pharmacokinetic interactions between HIV antiretroviral therapy and drugs used to treat opioid dependence. Expert Opin Drug Metab Toxicol 2006; 2:533-43. [PMID: 16859402 DOI: 10.1517/17425255.2.4.533] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Injection drug use is a common risk factor for HIV infection, and opioid use and dependence is the underlying condition that often fuels HIV risk behaviour and subsequent HIV seroconversion among injection drug users (IDUs). Treatment of opioid dependence often requires continued opioid administration in the form of substitution therapy, which means that opioid-using IDUs often continue receiving opioids even after cessation of illicit drug use. The concurrent use of both antiretrovirals and opioids in HIV-positive individuals is thus common. This review was undertaken to summarise current knowledge on the interactions between the opioids and antiretrovirals and to make recommendations on the treatment of HIV-positive opioid-dependent patients.
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Affiliation(s)
- Benjamin Maas
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
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Abstract
BACKGROUND Historically, China has had extraordinarily high rates of opiate dependence. These rates declined drastically following the 1949 revolution; however, opiate abuse has re-emerged in the late 1980's and has spread quickly since then. AIMS To describe the current situation of opiate addiction and treatments in China and make some suggestions. DESIGN A descriptive study based on literature searched from Medline and the China National Knowledge Infrastructure database (1996 to 2004) and hand-picked references. FINDINGS The number of registered addicts in 2004 was 1.14 million (more than 75% of them heroin addicts), but the actual number is probably far higher. Opiate abuse contributes substantially to the spread of HIV/AIDS in China, with intravenous drug use the most prevalent route of transmission (51.2%). Currently, the main treatments for opiate dependence in China include short-term detoxification with opiate agonists or non-opiate agents, such as clonidine or lofexidine; Chinese herbal medicine and traditional non-medication treatments are also used. Methadone maintenance treatment (MMT) has not been officially approved by the Chinese government for widespread implementation, but some pilot studies are currently underway. CONCLUSION China faces substantial drug abuse problems that appear to be worsening with time. Opiate dependence is a major threat to the public health and social security of China because of its devastating medical effects, its impact on risk for HIV/AIDS and criminal behaviors, low rates of recovery and high rates of relapse. There is an urgent need to implement MMT and other modern treatments for opiate dependence more widely in China.
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Affiliation(s)
- Yi-Lang Tang
- Beijing Anding Hospital, Capital University of Medical Sciences, Beijing, China.
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Safer injecting education for HIV prevention within a medically supervised safer injecting facility. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2005. [DOI: 10.1016/j.drugpo.2005.07.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Wood E, Hogg RS, Harrigan PR, Montaner JSG. When to initiate antiretroviral therapy in HIV-1-infected adults: a review for clinicians and patients. THE LANCET. INFECTIOUS DISEASES 2005; 5:407-14. [PMID: 15978527 DOI: 10.1016/s1473-3099(05)70162-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
One of the most controversial topics in the medical management of HIV disease is the optimal time to initiate highly active antiretroviral therapy (HAART) in HIV-1-infected adults. Premature exposure to antiretrovirals may precipitate early evolution of resistance and unnecessary side-effects, whereas remaining off HAART until late in the course of HIV disease may lead to reduced therapeutic benefits and elevated mortality. The lack of a randomised clinical trial to consider this issue has resulted in ongoing revision of expert recommendations and substantial variability between international consensus guidelines regarding the optimal time to initiate therapy. Since this uncertainty is a source of unease for both patients and clinicians, we summarise the latest evidence regarding the optimal time to initiate HAART with consideration of the potential benefits and drawbacks of starting HIV treatment at the different levels presently recommended in leading consensus guidelines.
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Affiliation(s)
- Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, BC V6Z 1Y6, Canada
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Wood E, Hogg RS, Yip B, Dong WWY, Wynhoven B, Mo T, Brumme CJ, Montaner JSG, Harrigan PR. Rates of antiretroviral resistance among HIV-infected patients with and without a history of injection drug use. AIDS 2005; 19:1189-95. [PMID: 15990572 DOI: 10.1097/01.aids.0000176219.48484.f1] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There exist concerns regarding the potential for elevated rates of antiretroviral resistance among HIV-infected injection drug users (IDUs) prescribed highly active antiretroviral therapy (HAART), however, no population-based study has examined if IDUs have elevated rates of antiretroviral resistance in comparison to non-IDUs. OBJECTIVE To evaluate the time to the development of antiretroviral resistance among antiretroviral-naive patients with and without a history of injection drug use. METHODS In British Columbia there is a province-wide HIV/AIDS treatment program that provides antiretrovirals free of charge. We examined all antiretroviral-naive patients initiating HAART between 1 August 1996 and 30 September 2000 and who were followed to 31 March 2002. The main outcome measure was the time to class-specific antiretroviral resistance. Cumulative antiretroviral resistance rates among IDUs and non-IDUs were evaluated using Kaplan-Meier methods and relative hazards were estimated using Cox regression. RESULTS Overall, 1191 antiretroviral-naive patients initiated HAART during the study period. Resistance mutations were observed in 298 (25%) subjects during the first 30 months of HAART. In comparison with non-IDUs, the risk of protease inhibitor resistance [relative hazard (RH), 0.9; 95% confidence interval (CI), 0.5-1.6] and non-nucleoside reverse transcriptase inhibitor resistance (RH, 1.5; 95% CI, 1.0-2.2) were similar among IDUs, and there were no differences in the rates of resistance to the sub-classes of nucleoside reverse transcriptase inhibitors. CONCLUSIONS Resistance to all major classes of antiretrovirals were similar among IDUs and non-IDUs after 30 months of follow-up. These findings should help to allay fears that prescribing HAART to IDUs may result in elevated rates of resistance.
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Affiliation(s)
- Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
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Wood E, Hogg RS, Kerr T, Palepu A, Zhang R, Montaner JSG. Impact of accessing methadone on the time to initiating HIV treatment among antiretroviral-naive HIV-infected injection drug users. AIDS 2005; 19:837-9. [PMID: 15867502 DOI: 10.1097/01.aids.0000168982.20456.eb] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We examined the impact of methadone maintenance therapy (MMT) on subsequent antiretroviral therapy (ART) use in a prospective cohort of injection drug users. At 24 months after enrollment, the rate of ART use was 69.7% among those who were on MMT at baseline and 44.4% among those not on MMT (log-rank P = 0.001). In a Cox model, the use of MMT was independently associated with an elevated rate of ART use.
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Affiliation(s)
- Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, BC, Canada
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