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Malaguti A, Byrne CJ, Sani F, Power K, Eriksen A, Dillon JF. Drug network identification predicts injecting risk behavior among people who inject drugs on hepatitis C virus treatment in Tayside, Scotland. Behav Med 2024; 50:130-140. [PMID: 36411523 DOI: 10.1080/08964289.2022.2142501] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/10/2022] [Accepted: 10/28/2022] [Indexed: 11/23/2022]
Abstract
The risk of Hepatitis C Virus (HCV) acquisition among People Who Inject Drugs (PWID) remains high when injecting risk behavior within networks endures. Several psychosocial factors influence such behavior. Following a drive within Tayside, a geographic region in Scotland, to achieve World Health Organization HCV elimination targets, addressing HCV re-infection risk as a barrier to elimination is critically important. This cross-sectional study seeks to address this barrier to elimination by investigating associations between group identification (one's subjective sense of belonging and connectedness to a social group coupled with a sense of shared goals, beliefs and values with the other members of the group) and injecting risk behavior among PWID on HCV treatment at needle and syringe provision sites in Tayside. Participants completed psychosocial questionnaires between treatment weeks zero and three of treatment. Correlation analyses were undertaken, and significant factors included in multiple linear regression models for injecting risk behavior. Injecting frequency, drug network identification, and family identification, were correlated with injecting risk behavior, and drug network identification had a positive predictive on injecting risk behavior. Identification with a social group, conventionally associated with improved health, may pose health risks in specific contexts. Healthcare providers should consider stratifying individuals with higher group identification with PWID networks for enhanced harm reduction engagement to mitigate transmissible infection risk among PWID. Additionally, psychological interventions to strengthen group identification with networks which impact positively on health behavior should be explored.
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Affiliation(s)
- Amy Malaguti
- Tayside Drug and Alcohol Recovery Psychology Service, Constitution House, NHS Tayside, Dundee, UK
- Department of Psychology, Scrymgeour Building, School of Social Sciences, University of Dundee, Dundee, UK
| | - Christopher J Byrne
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
- Directorate of Public Health, Kings Cross Hospital, NHS Tayside, Dundee, UK
| | - Fabio Sani
- Department of Psychology, Scrymgeour Building, School of Social Sciences, University of Dundee, Dundee, UK
| | - Kevin Power
- Tayside Adult Psychological Therapy Services, Dudhope Terrace, NHS Tayside, Dundee, UK
- School of Natural Sciences, University of Stirling, Stirling, UK
| | - Ann Eriksen
- Directorate of Public Health, Kings Cross Hospital, NHS Tayside, Dundee, UK
| | - John F Dillon
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
- Department of Gastroenterology, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK
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Chen S, Owolabi Y, Dulin M, Robinson P, Witt B, Samoff E. Applying a machine learning modelling framework to predict delayed linkage to care in patients newly diagnosed with HIV in Mecklenburg County, North Carolina, USA. AIDS 2021; 35:S29-S38. [PMID: 33867487 DOI: 10.1097/qad.0000000000002830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Machine learning has the potential to help researchers better understand and close the gap in HIV care delivery in large metropolitan regions such as Mecklenburg County, North Carolina, USA. OBJECTIVES We aim to identify important risk factors associated with delayed linkage to care for HIV patients with novel machine learning models and identify high-risk regions of the delay. METHODS Deidentified 2013-2017 Mecklenburg County surveillance data in eHARS format were requested. Both univariate analyses and machine learning random forest model (developed in R 3.5.0) were applied to quantify associations between delayed linkage to care (>30 days after diagnosis) and various risk factors for individual HIV patients. We also aggregated linkage to care by zip codes to identify high-risk communities within the county. RESULTS Types of HIV-diagnosing facility significantly influenced time to linkage; first diagnosis in hospital was associated with the shortest time to linkage. HIV patients with lower CD4+ cell counts (<200/ml) were twice as likely to link to care within 30 days than those with higher CD4+ cell count. Random forest model achieved high accuracy (>80% without CD4+ cell count data and >95% with CD4+ cell count data) to predict risk of delay in linkage to care. In addition, we also identified top high-risk zip codes of delayed linkage. CONCLUSION The findings helped public health teams identify high-risk communities of delayed HIV care continuum across Mecklenburg County. The methodology framework can be applied to other regions with HIV epidemic and challenge of delayed linkage to care.
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Affiliation(s)
- Shi Chen
- Department of Public Health Sciences, College of Health and Human Services
- School of Data Science, UNC Charlotte, Charlotte, North Carolina
| | - Yakubu Owolabi
- Department of Public Health Sciences, College of Health and Human Services
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael Dulin
- Department of Public Health Sciences, College of Health and Human Services
- Academy for Population Health Innovation, UNC Charlotte
| | - Patrick Robinson
- Academy for Population Health Innovation, UNC Charlotte
- Mecklenburg County Health Department, Charlotte
| | - Brian Witt
- Academy for Population Health Innovation, UNC Charlotte
- Mecklenburg County Health Department, Charlotte
| | - Erika Samoff
- HIV/STD Prevention and Care Branch, North Carolina Department of Health and Human Services, Raleigh, North Carolina, USA
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Mohammadi M, Kazeminia M, Abdoli N, Khaledipaveh B, Shohaimi S, Salari N, Hosseinian-Far M. The effect of methadone on depression among addicts: a systematic review and meta-analysis. Health Qual Life Outcomes 2020; 18:373. [PMID: 33225933 PMCID: PMC7681984 DOI: 10.1186/s12955-020-01599-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/12/2020] [Indexed: 11/20/2022] Open
Abstract
Background Opioids addiction and misuse are among the major problems in the world today. There have been several preliminary studies examining the effect of methadone on depression among addicts, however, these studies have reported inconsistent and even contradictory results. Therefore, the aim of the present study was to determine the effect of methadone on depression in addicts in Iran and around the world, using a meta-analysis approach.
Methods This study was a systematic review and meta-analysis including articles published in the SID, MagIran, IranMedex, IranDoc, Cochrane, Embase, ScienceDirect, Scopus, PubMed and Web of Science databases were searched systematically to find articles published from 2006 to March 2019. Heterogeneity index was determined using the Cochran's test (Qc) and I2. Considering heterogeneity of studies, the random effects model was used to estimate the standardized difference of mean score for depression. Subsequently, the level of depression reduction in Iran and worldwide in the intervention group before and after the testwas measured. Results A total of 19 articles met the inclusion criteria, and were therefore selected for this systematic review and meta-analysis. The sample size of the intervention group in the selected studies was 1948. According to the meta-analysis results, the mean depression score in the intervention group was 26.4 ± 5.6 and 18.4 ± 2.6 before and after intervention respectively, indicating the reducing effect of methadone on depression, and this difference was statistically significant (P < 0.01). Conclusion The results of the present study show that methadone significantly reduces depression in addicts. Therefore, regular methadone use can be part of a drug treatment plan.
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Affiliation(s)
- Masoud Mohammadi
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohsen Kazeminia
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nasrin Abdoli
- Department of Psychiatry, Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Behnam Khaledipaveh
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shamarina Shohaimi
- Department of Biology, Faculty of Science, University Putra Malaysia, Serdang, Selangor, Malaysia
| | - Nader Salari
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran. .,Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Melika Hosseinian-Far
- Department of Food Science and Technology, Ferdowsi University of Mashhad (FUM), Mashhad, Iran
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Blondino CT, Gormley MA, Taylor DDH, Lowery E, Clifford JS, Burkart B, Graves WC, Lu J, Prom-Wormley EC. The Influence of Co-Occurring Substance Use on the Effectiveness of Opiate Treatment Programs According to Intervention Type. Epidemiol Rev 2020; 42:57-78. [PMID: 32944731 DOI: 10.1093/epirev/mxaa005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/23/2020] [Accepted: 09/15/2020] [Indexed: 12/31/2022] Open
Abstract
This systematic review describes the influence of co-occurring substance use on the effectiveness of opiate treatment programs. MEDLINE/PubMed, Embase, PsychINFO, and the Cumulative Index to Nursing and Allied Health Literature were searched from database inception to November 28, 2018, to identify eligible opioid treatment studies in the United States that assessed the relationship between co-occurring substance use and treatment outcome (i.e., opioid abstinence and treatment retention). A total of 34 eligible studies were included. Overall, co-occurring substance use was associated with negative treatment outcomes regardless of intervention type. However, patterns varied by substance and intervention type. In particular, co-occurring use of cocaine or marijuana with opioids was associated with reduced treatment retention and opioid abstinence regardless of intervention type. Co-occurring use of amphetamines, compared with no use or reduced use of amphetamines, decreased treatment retention. Co-occurring use of alcohol was both positively and negatively associated with treatment outcomes. One study reported a significant positive association between sedative use and opioid abstinence. Generally, findings suggest that combined interventions reported better health outcomes compared with pharmacological or behavioral intervention studies alone. The findings of this review emphasize the need to comprehensively study and address co-occurring substance use to improve opiate treatment programs.
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Appel PW, Warren BE, Yu J, Rogers M, Harris B, Highsmith S, Davis C. Implementing Substance Abuse Intervention Services in New York City Sexually Transmitted Disease Clinics: Factors Promoting Interagency Collaboration. J Behav Health Serv Res 2018; 44:168-176. [PMID: 26276420 DOI: 10.1007/s11414-015-9473-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This report presents results of Project LINK, a Substance Abuse and Mental Health Services Administration (SAMHSA)-funded, 5-year collaboration (2007-2012) between New York City (NYC) health and NY State substance abuse disorder (SUD) agencies, an LGBT organization contractor, and multiple SUD, social service, and mental health referral agencies. LINK allowed the first ever SUD screening, brief intervention, and referrals to treatment (SBIRT) intervention services onsite in NYC Bureau of Sexually Transmitted Disease Control (BSTDC) clinics. Factors favoring collaboration were (a) joint recognition of substance abuse as an STD risk factor; (b) prior collaborations; (c) agreement on priority of BSTDC's mission and policies; (d) extensive SBIRT training, cross training on STDs; (e) a memorandum of agreement; and (f) mutual transparency of collaborative efforts, among others. LINK screened over 151,000 STD clinic patients and delivered brief interventions to 60% of positively screened patients and met a mandated follow-up target. Factors found to facilitate collaboration here may help screen prospective new health collaborations.
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Affiliation(s)
- Philip W Appel
- NYS Office of Alcoholism and Substance Abuse Services, 501 7th Avenue, New York, NY, 10018, USA.
| | - Barbara E Warren
- Office of Diversity and Inclusion, Mount Sinai Health System, New York, NY, USA
| | - Jiang Yu
- NYS Office of Alcoholism and Substance Abuse Services, 1450 Western Avenue, Albany, NY, 12203, USA
- Center for Addictions Research, School of Social Welfare, University at Albany, Albany, NY, USA
| | - Meighan Rogers
- Bureau of STD Control and Prevention, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Brett Harris
- Research Foundation for Mental Hygiene, 1450 Western Avenue, Albany, NY, 12203, USA
| | | | - Carrie Davis
- LGBT Center, 208 West 13th Street, New York, NY, 10011, USA
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Wiessing L, Ferri M, Darke S, Simon R, Griffiths P. Large variation in measures used to assess outcomes of opioid dependence treatment: A systematic review of longitudinal observational studies. Drug Alcohol Rev 2017; 37 Suppl 1:S323-S338. [PMID: 28971544 DOI: 10.1111/dar.12608] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 07/24/2017] [Accepted: 08/01/2017] [Indexed: 12/19/2022]
Abstract
ISSUES Treatment outcomes for drug users are critical for informing policy and therapeutic practice. The coherence of outcomes, changes and drug use measures from observational studies on opioid use treatment were reviewed. APPROACH Systematic review of the literature for longitudinal observational studies, from 1980 through November 2015, in all languages, with data on treated opioid users, using Pubmed, the Cochrane Library and additional strategies (e.g. Pubmed function 'related citations' and checking reference lists of eligible studies). KEY FINDINGS Twenty-seven studies were included (11 countries, 85 publications, recruitment 1962-2009). Baseline n was >65 686 and median follow-up 34.5 months (21 studies) or 51.4 person-months (10 studies). Eight outcome domains were identified: 'drug use' (21/27 studies), 'crime' (13), 'health' (13), 'treatment-related' outcomes (16), 'social functioning' (13), 'harms' (8), 'mortality' (13) and 'economic estimates' (2 studies). All studies using drug use outcomes included a binary (abstinence) category in at least one measure. Studies typically reported outcomes on less than half (on average 3.7 or 46%) of the eight outcome domains, while the average was 5.1 (64%) in seven studies initiated since 2000. IMPLICATIONS AND CONCLUSION Wide variation exists in outcome measures found in longitudinal observational studies of treatment of opioid users. This reduces replicability of studies and suggests a lack of common expectations on treatment success. Future studies should consider using all or most of eight outcome domains identified (excluding economic analyses if unfeasible), non-binary measures and amount/value of drugs used and consensus meetings with joint ownership of scientific, treatment and patient communities.
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Affiliation(s)
- Lucas Wiessing
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Marica Ferri
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Shane Darke
- National Drug & Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Roland Simon
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Paul Griffiths
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
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Wimberly AS, Ivey M, Rennert L, McKay JR. Effect of Continuing Care for Cocaine Dependence on HIV Sex-Risk Behaviors. AIDS Behav 2017; 21:1082-1090. [PMID: 27224980 PMCID: PMC5123976 DOI: 10.1007/s10461-016-1434-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Evaluate the effect of continuing care interventions for cocaine use with HIV risk-reduction components on HIV sex-risk. Explore whether cocaine use at treatment initiation interacts with the type of continuing care intervention to affect HIV sex-risk. Cocaine dependent participants (N = 321) were randomized to: (1) Treatment as usual (TAU): intensive outpatient treatment, (2) TAU and telephone monitoring and counseling (TMC), and (3) TAU and TMC plus incentives for participation in telephone contacts (TMC+). Participants in TMC and TMC+ received a brief HIV intervention, with booster sessions as needed. Generalized estimating equations analysis compared TAU, TMC and TMC+ at 6, 12, 18, 24 months post-baseline on the following outcomes: overall HIV sex-risk, number of sexual partners, condom usage, exchange of drugs for sex, exchange of sex for drugs, exchange of money for sex, exchange of sex for money, and crack house visits. Overall sex-risk decreased for all treatment conditions at follow-up, with no treatment main effects. For people with no cocaine use at baseline, TAU experienced greater sex-risk reductions than TMC (p < .01) and TMC+ (p < .001). The three treatment conditions are effective in reducing HIV sex-risk. TMC with HIV risk-reduction components is unnecessary for cocaine-dependent clients who stop using cocaine early in treatment.
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Affiliation(s)
- Alexandra S Wimberly
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA.
| | - Megan Ivey
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lior Rennert
- Biomedical Graduate Studies, University of Pennsylvania, Philadelphia, PA, USA
| | - James R McKay
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Behavioral Health, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
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Lee CS, Liebschutz JM, Anderson BJ, Stein MD. Hospitalized opioid-dependent patients: Exploring predictors of buprenorphine treatment entry and retention after discharge. Am J Addict 2017; 26:667-672. [PMID: 28324627 DOI: 10.1111/ajad.12533] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 03/02/2017] [Accepted: 03/04/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Few studies have explored predictors of entry into and retention in buprenorphine treatment following linkage from an acute medical hospitalization. METHODS This secondary analysis of a completed clinical trial focuses on medically hospitalized, opioid-dependent patients (n = 72) who were randomized to an intervention including buprenorphine induction and dose stabilization during hospitalization followed by post-discharge transition to office-based buprenorphine treatment (OBOT). Predictors included demographics, days hospitalized, prior buprenorphine/methadone treatment, PTSD symptoms, social support, and readiness for drug use cessation. Outcome variables were treatment entry and retention (number of days in OBOT). RESULTS Previous buprenorphine treatment, more days hospitalized, and higher PTSD symptoms predicted OBOT entry. Prior treatment, older age, and non-minority status were associated with a higher mean number of days in OBOT. CONCLUSIONS OBOT may appeal to patients who have tried buprenorphine in other settings. Linking hospitalized patients to OBOT may improve utilization of addiction treatment. SCIENTIFIC SIGNIFICANCE Prior substance treatment, longer hospital stay, and mental health should be examined in future linkage studies. (Am J Addict 2017;26:667-672).
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Affiliation(s)
- Christina S Lee
- Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Jane M Liebschutz
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts.,Boston University School of Medicine, Boston, Massachusetts
| | - Bradley J Anderson
- Department of Behavioral Medicine, Butler Hospital, Providence, Rhode Island
| | - Michael D Stein
- Department of Behavioral Medicine, Butler Hospital, Providence, Rhode Island.,Boston University School of Public Health, Boston, Massachusetts
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Corsi KF, Kwiatkowski CF, Booth RE. Long-Term Predictors of HIV Risk Behaviors among IDUs. JOURNAL OF DRUG ISSUES 2016. [DOI: 10.1177/002204260603600307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Drug users are at high risk for disease due to injection and sex behaviors. Longitudinal research with drug users can help researchers understand reasons for continued high-risk behaviors among this vulnerable population. Data are from a follow-up study conducted from 1999 to 2003, which attempted to relocate clients who were initially recruited through street outreach in Denver, Colorado from 1990 to 1995. A total of 773 subjects were located (82% relocation rate), 578 of whom were interviewed at follow-up. Statistical analysis revealed significant improvement in most high-risk injection and sex behaviors. However, over half the sample reported having sex without a condom at follow-up. Further analysis revealed that having sex without a condom at baseline, not having previously participated in drug treatment, being of an ethnicity other than African American, smoking crack, and having sex with a drug injector were all significantly related to having sex without a condom at follow-up. These findings are discussed with regards to developing interventions in order to increase condom use in this high risk population.
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Roux P, Le Gall JM, Debrus M, Protopopescu C, Ndiaye K, Demoulin B, Lions C, Haas A, Mora M, Spire B, Suzan-Monti M, Carrieri MP. Innovative community-based educational face-to-face intervention to reduce HIV, hepatitis C virus and other blood-borne infectious risks in difficult-to-reach people who inject drugs: results from the ANRS-AERLI intervention study. Addiction 2016; 111:94-106. [PMID: 26234629 DOI: 10.1111/add.13089] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/28/2015] [Accepted: 07/30/2015] [Indexed: 11/30/2022]
Abstract
AIMS To study the effectiveness of an educational intervention on risks associated with drug injection, comparing primary [unsafe HIV-hepatitis C virus (HCV) practices] and secondary (local complications at injecting site) end-points in harm reduction (HR) programmes offering this intervention versus HR programmes not offering it. DESIGN This non-random clustered intervention study was conducted in nine intervention groups (programmes offering the intervention) and eight control groups (programmes not offering it). Each participant was followed-up through a telephone interview at enrolment and at 6 and 12 months. SETTING The study took place in 17 cities throughout France. PARTICIPANTS Of the 271 participants, 144 were enrolled into the intervention group and 127 in the control group. Of the latter, 113 received at least one educational session. INTERVENTION A series of participant-centred face-to-face educational sessions. Each session included direct observation by trained non-governmental organization (NGO) staff or volunteers of participants' self-injecting the psychoactive product they used habitually; analysis by the trained NGO staff or volunteers of the participant's injecting practices, identification of injection-related risks and explanation of safer injecting practices; and an educational exchange on the individual participant's injection practices and the questions he or she asked. MEASUREMENTS Primary and secondary outcomes were 'at least one unsafe HIV-HCV practice' and at least one injection-related complication (derived from a checklist). FINDINGS The proportion of participants with at least one unsafe HIV-HCV practice in the intervention group decreased significantly, from 44% at M0 to 25% at M6, as well as complications at the injection site (from 66 to 39% at M12), while in the control group it remained mainly stable. Multivariate probit analyses showed that the intervention group experienced a significant reduction in unsafe HIV-HCV practices at M6 [coefficient, 95% confidence interval (CI) = -0.73 (-1.47 to 0.01)] and in injection-related complications at M12 [coefficient, 95% CI = -1.01 (-1.77 to -0.24)], compared with the control group. CONCLUSIONS An inexpensive and easily implemented educational intervention on risks associated with drug injection reduces significantly unsafe HIV-HCV transmission practices and injection-related complications.
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Affiliation(s)
- Perrine Roux
- INSERM U912 (SESSTIM), Marseille, France.,Aix Marseille Université, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
| | | | | | - Camélia Protopopescu
- INSERM U912 (SESSTIM), Marseille, France.,Aix Marseille Université, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
| | - Khadim Ndiaye
- INSERM U912 (SESSTIM), Marseille, France.,Aix Marseille Université, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
| | - Baptiste Demoulin
- INSERM U912 (SESSTIM), Marseille, France.,Aix Marseille Université, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
| | - Caroline Lions
- INSERM U912 (SESSTIM), Marseille, France.,Aix Marseille Université, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
| | | | - Marion Mora
- INSERM U912 (SESSTIM), Marseille, France.,Aix Marseille Université, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
| | - Bruno Spire
- INSERM U912 (SESSTIM), Marseille, France.,Aix Marseille Université, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France.,AIDES, Marseille, France
| | - Marie Suzan-Monti
- INSERM U912 (SESSTIM), Marseille, France.,Aix Marseille Université, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France.,AIDES, Marseille, France
| | - Maria Patrizia Carrieri
- INSERM U912 (SESSTIM), Marseille, France.,Aix Marseille Université, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
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11
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Booth BM, Wright PB, Ounpraseuth ST, Stewart KE. Trajectory of substance use after an HIV risk reduction intervention. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2015; 41:345-52. [PMID: 26035094 DOI: 10.3109/00952990.2015.1043437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Research assessments can confound the results of treatment outcome studies and can be themselves an intervention or form of aftercare. OBJECTIVE To determine the trajectory of substance use and substance severity in a sample of African American cocaine users participating in a community-based sexual risk reduction trial. METHODS Out-of-treatment participants were recruited using Respondent-Driven Sampling in two African American majority counties in rural Arkansas. They participated in either the sexual risk reduction condition or an active control focused on access to social services. They were interviewed at baseline, post-intervention, and 6 and 12 months post-intervention. Substance use outcome measures were use of crack cocaine, powder cocaine, marijuana, alcohol, and the Addiction Severity Index Alcohol and Drug Severity composites. A random sample of participants completed qualitative interviews post-12-month interview. RESULTS 251 were enrolled. Substance use outcomes did not differ among the two conditions at any point in the study. Use of measured substances and the ASI composites significantly decreased between baseline and post-intervention (p < 0.01), decreases that persisted at the 12-month assessment period compared to baseline. Qualitative findings suggested that many participants identified increased awareness of their drug use and need to control it through the programs. Participants also noted strong bonding with interviewers. CONCLUSION Clinical trials may have positive unexpected outcomes in terms of reduced substance use even though the trial is not substance use focused. Behavioral interventions for drug users that are not focused specifically on reducing drug use may nonetheless have unanticipated positive associations with reductions in drug use.
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12
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Ward CL, Mertens JR, Bresick GF, Little F, Weisner CM. Screening and brief intervention for substance misuse: Does it reduce aggression and HIV-related risk behaviours? Alcohol Alcohol 2015; 50:302-9. [PMID: 25731180 DOI: 10.1093/alcalc/agv007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 01/27/2015] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To explore whether reducing substance misuse through a brief motivational intervention also reduces aggression and HIV risk behaviours. METHODS Participants were enrolled in a randomized controlled trial in primary care if they screened positive for substance misuse. Substance misuse was assessed using the Alcohol, Smoking and Substance Involvement Screening Test; aggression, using a modified version of the Explicit Aggression Scale; and HIV risk, through a count of common risk behaviours. The intervention was received on the day of the baseline interview, with a 3-month follow-up. RESULTS Participants who received the intervention were significantly more likely to reduce their alcohol use than those who did not; no effect was identified for other substances. In addition, participants who reduced substance misuse (whether as an effect of the intervention or not) also reduced aggression but not HIV risk behaviours. CONCLUSIONS Reducing substance misuse through any means reduces aggression; other interventions are needed for HIV risk reduction.
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Affiliation(s)
- Catherine L Ward
- Department of Psychology and Safety and Violence Initiative, University of Cape Town, Rondebosch, South Africa
| | | | - Graham F Bresick
- School of Public Health and Family Medicine, University of Cape Town, Rondebosch, South Africa
| | - Francesca Little
- Department of Statistical Sciences, University of Cape Town, Rondebosch, South Africa
| | - Constance M Weisner
- Langley Porter Psychiatric Institute, University of California, San Francisco, CA, USA Division of Research, Kaiser Permanente, Oakland, CA, USA
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HIV risk reduction with buprenorphine-naloxone or methadone: findings from a randomized trial. J Acquir Immune Defic Syndr 2014; 66:288-93. [PMID: 24751432 DOI: 10.1097/qai.0000000000000165] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Compare HIV injecting and sex risk in patients being treated with methadone (MET) or buprenorphine-naloxone (BUP). METHODS Secondary analysis from a study of liver enzyme changes in patients randomized to MET or BUP who completed 24 weeks of treatment and had 4 or more blood draws. The initial 1:1 randomization was changed to 2:1 (BUP:MET) after 18 months due to higher dropout in BUP. The Risk Behavior Survey measured HIV risk before 30 days at baseline and weeks 12 and 24. RESULTS Among 529 patients randomized to MET, 391 (74%) were completers; among 740 randomized to BUP, 340 (46%) were completers; 700 completed the Risk Behavior Survey. There were significant reductions in injecting risk (P < 0.0008) with no differences between groups in mean number of times reported injecting heroin, speedball, other opiates, and number of injections; or percent who shared needles; did not clean shared needles with bleach; shared cookers; or engaged in front/back loading of syringes. The percent having multiple sex partners decreased equally in both groups (P < 0.03). For males on BUP, the sex risk composite increased; for males on MET, the sex risk decreased resulting in significant group differences over time (P < 0.03). For females, there was a significant reduction in sex risk (P < 0.02) with no group differences. CONCLUSIONS Among MET and BUP patients who remained in treatment, HIV injecting risk was equally and markedly reduced; however, MET retained more patients. Sex risk was equally and significantly reduced among females in both treatment conditions, but it increased for males on BUP and decreased for males on MET.
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Abstract
Few studies of pre-exposure prophylaxis (PrEP) to prevent HIV infection have focused on drug users. Between February to September 2013, we asked 351 opiate injectors entering detoxification treatment about HIV risk, knowledge about PrEP, and willingness to use a once daily PrEP pill under one of two randomly assigned effectiveness scenarios-40 % (low) or 90 % (high) effective in reducing HIV risk. Participants were 70 % male and 87 % non-Hispanic White. Only 7 % had heard of a drug to reduce HIV risk, yet once informed, 47 % would be willing to take such a pill [35 % of those in the low effectiveness scenario and 58 % in the high group (p < 0.001)]. Higher perceived HIV risk was associated with greater willingness to take medication. Increasing knowledge of PrEP and the rate of HIV reduction-effectiveness promised will influence its use among targeted high-risk drug users.
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Affiliation(s)
- Michael Stein
- General Medicine Research Unit, Butler Hospital, Alpert School of Medicine at Brown University, 345 Blackstone Blvd, Providence, RI, 02906, USA,
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Wang L, Wei X, Wang X, Li J, Li H, Jia W. Long-term effects of methadone maintenance treatment with different psychosocial intervention models. PLoS One 2014; 9:e87931. [PMID: 24498406 PMCID: PMC3912169 DOI: 10.1371/journal.pone.0087931] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 12/31/2013] [Indexed: 11/18/2022] Open
Abstract
This study evaluated the long-term effects of different psychosocial intervention models in methadone maintenance treatment (MMT) in Xi'an China. Patients from five MMT clinics were divided into three groups receiving MMT only, MMT with counseling psychology (CP) or MMT with contingency management (CM). A five-year follow-up was carried out with daily records of medication, monthly random urine morphine tests, and tests for anti-HIV and anti-HCV every six months. Drug use behavior was recorded six months after initial recruitment using a survey. Adjusted RRs and their 95% confidence intervals (CIs) were estimated using an unconditional logistic regression model or a Cox proportional hazard model. A total of 2662 patients were recruited with 797 in MMT, 985 in MMT with CP, and 880 in MMT with CM. Following six months of treatment, the injection rates of MMT with CP and MMT with CM groups were significantly lower than that of MMT (5.1% and 6.9% vs. 16.3%, x² = 47.093 and 29.908, respectively; P<0.05). HIV incidences for MMT, MMT with CP and MMT with CM at the five year follow-up were 20.09, 0.00 and 10.02 per ten thousand person-years, respectively. HCV incidences were 18.35, 4.42 and 6.61 per hundred person-years, respectively, demonstrating that CP and CM were protective factors for HCV incidence (RR = 0.209 and 0.414, with range of 0.146-0.300 and 0.298-0.574, respectively). MMT supplemented with CP or CM can reduce heroin use and related risk behaviors, thereby reducing the incidence of HIV and HCV.
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Affiliation(s)
- Lirong Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Xiaoli Wei
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Xueliang Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
- * E-mail:
| | - Jinsong Li
- Xi'an Center for Disease Control and Prevention, Xi'an, Shaanxi, China
| | - Hengxin Li
- Xi'an Center for Disease Control and Prevention, Xi'an, Shaanxi, China
| | - Wei Jia
- Methadone Maintenance Therapy Clinic, Xi’an Mental Health Center, Xi'an, Shaanxi, China
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16
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Keshtkaran A, Mirahmadizadeh A, Heidari A, Javanbakht M. Cost-effectiveness of Methadone Maintenance Treatment in Prevention of HIV Among Drug Users in Shiraz, South of Iran. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e7801. [PMID: 24719714 PMCID: PMC3964432 DOI: 10.5812/ircmj.7801] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 02/20/2013] [Accepted: 11/12/2013] [Indexed: 01/25/2023]
Abstract
Background: The increase in high-risk injections and unsafe sexual behaviors has led to increased HIV infection prevalence among Intravenous Drug Users (IDUs). The high costs of HIV/AIDS care and low financial resources necessitate an economic evaluation to make the best decision for the control of HIV/AIDS. Objectives: This study was conducted to determine the cost-effectiveness of Methadone Maintenance Treatment (MMT) centers in HIV infection prevention among drug users. Materials and Methods: In this interventional study, we included all the seven MMT centers and the drug users registered there (n = 694). We calculated all the costs imposed on the government, i.e. Provider of case. Mathematical models were used to estimate the number of HIV cases averted from high-risk behaviors. Sensitivity analyses were performed to show the effects of uncertainty in parameters on the number of HIV cases averted and also Incremental Cost-Effectiveness Ratio (ICER). Results: Based on the averted models, the selected MMT centers could prevent 128 HIV cases during 1 year. The total cost was $ 547423 and that of HIV/AIDS care in the no intervention scenario was estimated $ 14171816. ICER was $ 106382 per HIV case averted. The results of the sensitivity analysis indicated that MMT intervention was cost-effective even in the worst scenario and ICER varied from $ 39149 to $ 290004 per HIV case averted. Conclusions: With regard to the high prevalence of drug injection among drug users and considering the high effectiveness and cost-effectiveness of MMT centers in preventing HIV infection, establishment of MMT centers in regional and national levels seems reasonable.
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Affiliation(s)
- Ali Keshtkaran
- School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Alireza Mirahmadizadeh
- Shiraz AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Corresponding Author: Alireza Mirahmadizadeh, Shiraz AIDS Research Center Central Building of Shiraz University of Medical Sciences, 8th floor, Zand Blvd., Shiraz, IR Iran. Tel: +98-7112122320, E-mail:
| | - Alireza Heidari
- Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran
| | - Mehdi Javanbakht
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Lin TY, Chen VCH, Lee CH, Chen CY, Shao WC, Chang SH, Chou JY, Lai TJ, Ferri CP, Gossop M, Lee CTC. Prevalence, correlates, and risk perception of HIV infection among heroin users in Central Taiwan. Kaohsiung J Med Sci 2013; 29:673-9. [PMID: 24296056 DOI: 10.1016/j.kjms.2013.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 04/25/2013] [Indexed: 11/29/2022] Open
Abstract
We investigated the prevalence and correlated factors of human immunodeficiency virus (HIV) among heroin users attending methadone maintenance treatment (MMT) programs in Central Taiwan, and explored the degree of risk perception of HIV infection among the participants. Our study participants were 781 heroin users seeking treatment at the MMT program at Tsaotun Psychiatric Center in Taiwan. The presence of HIV antibodies was identified by microparticle enzyme immunoassay and confirmed by western blot. Multivariate logistic regression was used to identify the independent correlates of HIV infection. The mean age of the sample was 36.1 years [standard deviation (SD) = 7.6]; of the patients, 710 (90.9%) were men. The prevalence of HIV infection among our study population was 20.7%. Multivariate logistic regression analysis revealed that HIV infection was independently associated with the age of the patients of initial heroin use, heroin injection use, nondrug-related criminal convictions, needle-sharing behaviors, and sharing injection paraphernalia. A strong agreement existed between self-reported HIV serostatus and the results of laboratory analyses, with 88.8% of patients reporting their condition correctly. We found a high rate of HIV infection among patients in the MMT program. Factors associated with HIV infection were mostly related to drug-use behaviors. These findings stress the importance of education regarding drug-risk behaviors.
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Affiliation(s)
- Tsang-Yaw Lin
- Tsaotun Psychiatric Center, Department of Health, Nan-Tou, Taiwan
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Cummins E, Leri F. Animal studies trigger new insights on the use of methadone maintenance. Expert Opin Drug Discov 2013; 4:577-86. [PMID: 23485087 DOI: 10.1517/17460440902915533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Although steady-state methadone (SSM) treatment is mainly used for opioid addiction, some clinical studies indicate that it also reduces cocaine abuse in opioid-dependent individuals. OBJECTIVE/METHODS To present evidence suggesting that SSM may be useful in the treatment of cocaine addiction without pre-existing opioid dependence. We review studies in animals investigating the effects of SSM on behaviors motivated by cocaine and on cocaine-induced alterations of genes expression in the rat brain. CONCLUSION SSM reduces cocaine intake, blocks cocaine seeking and normalizes expression of genes known to regulate cocaine seeking. These findings suggest that SSM could be an effective pharmacological agent to assist cocaine detoxification and prevention of relapse to cocaine abuse in individuals not co-dependent on opioid.
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Affiliation(s)
- Erin Cummins
- PhD Student University of Guelph, Department of Psychology, Guelph (ON), N1G 2W1, Canada
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Zaric GS, Brennan AW, Varenbut M, Daiter JM. The cost of providing methadone maintenance treatment in Ontario, Canada. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2012; 38:559-66. [PMID: 22783917 DOI: 10.3109/00952990.2012.694518] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To estimate the cost of providing methadone maintenance treatment in Ontario, Canada, from the perspective of the public payer. METHODS We analyzed a database of all patient clinic visits, laboratory tests for urine toxicology screening, and methadone scripts from a group of methadone clinics in Ontario. The database consisted of patient visits and visit information from 1 January 2003 to 31 December 2009. We estimated the cost of providing methadone maintenance treatment as the sum of physician costs, laboratory costs for urine samples (toxicology screens), methadone costs, and pharmacy costs. Pharmacy costs include dispensing fees and markups. All costs are expressed in 2010 Canadian dollars. RESULTS The database consisted of 9479 unique patients. The average age on the date of the first recorded visit was 34.3, and among the patients 62.3% were male. There were 6,425,937 patient days of treatment and the total cost of all treatment-related services was approximately $99,491,000. The total cost was comprised of physician billing (9.8%), pharmacy costs (39.8%), methadone (3.8%), and performing urine toxicology screens (46.7%). The average cost per day for treatment was $15.48, corresponding to $5651per year if patients were to remain in treatment continuously. CONCLUSIONS The cost of providing methadone maintenance treatment in Ontario is comparable to estimates from the United States and Australia. SCIENTIFIC SIGNIFICANCE This information is important to policy makers for planning and budgeting purposes and as part of a full cost-benefit or cost-effectiveness analysis of methadone treatment.
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Affiliation(s)
- Gregory S Zaric
- Ivey School of Business, University of Western Ontario, 1151 Richmond St. North, London, ON, Canada.
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20
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Roux P, Carrieri PM, Cohen J, Ravaux I, Spire B, Gossop M, Comer SD. Non-medical use of opioids among HIV-infected opioid dependent individuals on opioid maintenance treatment: the need for a more comprehensive approach. Harm Reduct J 2011; 8:31. [PMID: 22123176 PMCID: PMC3286372 DOI: 10.1186/1477-7517-8-31] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 11/28/2011] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Opioid maintenance treatment (OMT) has a positive impact on substance use and health outcomes among HIV-infected opioid dependent patients. The present study investigates non-medical use of opioids by HIV-infected opioid-dependent individuals treated with buprenorphine or methadone. METHODS The MANIF 2000 study is a longitudinal study that enrolled a cohort of 476 HIV-infected opioid-dependent individuals. Data were collected in outpatient hospital services delivering HIV care in France. The sample comprised all patients receiving OMT (either methadone or buprenorphine) who attended at least one follow-up visit with data on adherence to OMT (N = 235 patients, 1056 visits). Non-medical use of opioids during OMT was defined as having reported use of opioids in a non-medical context, and/or the misuse of the prescribed oral OMT by an inappropriate route of administration (injection or sniffing). After adjusting for the non-random assignment of OMT type, a model based on GEE was then used to identify predictors of non-medical use of opioids. RESULTS Among the 235 patients, 144 (61.3%) and 91 (38.9%) patients were receiving buprenorphine and methadone, respectively, at baseline. Non-medical use of opioids was found in 41.6% of visits for 83% of individual patients. In the multivariate analysis, predictors of non-medical use of opioids were: cocaine, daily cannabis, and benzodiazepine use, experience of opioid withdrawal symptoms, and less time since OMT initiation. CONCLUSIONS Non-medical use of opioids was found to be comparable in OMT patients receiving methadone or buprenorphine. The presence of opioid withdrawal symptoms was a determinant of non-medical use of opioids and may serve as a clinical indicator of inadequate dosage, medication, or type of follow-up. Sustainability and continuity of care with adequate monitoring of withdrawal symptoms and polydrug use may contribute to reduced harms from ongoing non-medical use of opioids.
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Affiliation(s)
- Perrine Roux
- INSERM, U912 (SE4S), 23 rue Stanislas Torrents, 13006 Marseille, France
- Université Aix Marseille, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
| | - Patrizia M Carrieri
- INSERM, U912 (SE4S), 23 rue Stanislas Torrents, 13006 Marseille, France
- Université Aix Marseille, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
| | - Julien Cohen
- INSERM, U912 (SE4S), 23 rue Stanislas Torrents, 13006 Marseille, France
- Université Aix Marseille, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
| | - Isabelle Ravaux
- Hôpital La Conception, Service des Maladies Infectieuses, 147 boulevard Baille, 13005 Marseille, France
| | - Bruno Spire
- INSERM, U912 (SE4S), 23 rue Stanislas Torrents, 13006 Marseille, France
- Université Aix Marseille, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
| | - Michael Gossop
- King's College London, 4 Windsor Walk, London, SE5 8BB, UK
| | - Sandra D Comer
- Division on Substance Abuse, New York State Psychiatric Institute and Columbia University, NY, USA
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Gender differences in the perceived self-efficacy of safer HIV practices among polydrug abusers in Taiwan. Compr Psychiatry 2011; 52:763-8. [PMID: 21195395 DOI: 10.1016/j.comppsych.2010.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 10/11/2010] [Accepted: 10/27/2010] [Indexed: 11/22/2022] Open
Abstract
Studies have documented that the perceived self-efficacy of attempts to engage in safer behavior is critical for the prevention of blood-borne diseases, including hepatitis C and HIV. The aim of this study was to examine gender differences in the perceived self-efficacy of safer HIV-related behavior among heroin and amphetamine abusers. Of the eligible participants from Taiwan prisons, 1622 polydrug users voluntarily agreed to complete a questionnaire regarding HIV risks. Participants had to be polydrug abusers (amphetamines and heroin), 18 years or older, sexually experienced, and literate. The questionnaire addressed background information, drug abuse, sexual behavior, and perceived self-efficacy in drug- and sex-related HIV risk situations. Twenty-four percent of respondents were HIV positive. Compared to men, women started illicit drug use at a younger age and were less likely to share syringes. Women also tended to have their first sexual coitus at an older age and were less likely to use a condom in their last sexual encounter. Men were more likely to have multiple sexual partners in the past 6 months. Results from a multinomial logistic regression indicate that gender, age, their interaction, age of first sexual encounter, HIV knowledge, condom use at last sexual encounter, and multiple sexual partners were associated with perceived self-efficacy of condom use. Results also show that gender, HIV serostatus, HIV knowledge, condom use at last sexual encounter, and sharing needles at last injection were associated with perceived self-efficacy in not sharing needles. The findings provide evidence for gender differences among polydrug abusers in Taiwan regarding perceived self-efficacy in adopting HIV prevention practices. Findings also provide evidence that knowledge about HIV transmission is related to perceived self-efficacy in promoting safe behavior. To raise polydrug abusers' perceived self-efficacy, gender and HIV/AIDS education must be taken into consideration in counseling and/or public health education related to HIV prevention for drug abusers.
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Psychosocial and behavioral correlates of anxiety symptoms in a sample of HIV-positive, methamphetamine-using men who have sex with men. AIDS Care 2011; 23:628-37. [PMID: 21293993 DOI: 10.1080/09540121.2010.525608] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Studies show high rates of psychiatric symptoms among methamphetamine users; however, little information exists regarding methamphetamine use and anxiety. This study investigated psychosocial and behavioral correlates of anxiety symptoms in a sample of 245 HIV-positive men having sex with men (MSM) who were enrolled in a sexual risk-reduction intervention. In a multiple regression analysis, anxiety symptoms were associated with homelessness, recent experience of HIV symptoms, injection drug use, lifetime sexual abuse, engaging in risky sexual behaviors, and seeking out partners at risky sexual venues when "high" on methamphetamine. These findings can be used to inform and refine sexual risk-reduction interventions and substance-use treatment programs for HIV-positive methamphetamine-using MSM.
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Gowing L, Farrell MF, Bornemann R, Sullivan LE, Ali R. Oral substitution treatment of injecting opioid users for prevention of HIV infection. Cochrane Database Syst Rev 2011:CD004145. [PMID: 21833948 DOI: 10.1002/14651858.cd004145.pub4] [Citation(s) in RCA: 165] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Injecting drug users are vulnerable to infection with Human Immunodeficiency Virus (HIV) and other blood borne viruses as a result of collective use of injecting equipment as well as sexual behaviour OBJECTIVES To assess the effect of oral substitution treatment for opioid dependent injecting drug users on risk behaviours and rates of HIV infections SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and PsycINFO to May 2011. We also searched reference lists of articles, reviews and conference abstracts SELECTION CRITERIA Studies were required to consider the incidence of risk behaviours, or the incidence of HIV infection related to substitution treatment of opioid dependence. All types of original studies were considered. Two authors independently assessed each study for inclusion DATA COLLECTION AND ANALYSIS Two authors independently extracted key information from each of the included studies. Any differences were resolved by discussion or by referral to a third author. MAIN RESULTS Thirty-eight studies, involving some 12,400 participants, were included. The majority were descriptive studies, or randomisation processes did not relate to the data extracted, and most studies were judged to be at high risk of bias. Studies consistently show that oral substitution treatment for opioid-dependent injecting drug users with methadone or buprenorphine is associated with statistically significant reductions in illicit opioid use, injecting use and sharing of injecting equipment. It is also associated with reductions in the proportion of injecting drug users reporting multiple sex partners or exchanges of sex for drugs or money, but has little effect on condom use. It appears that the reductions in risk behaviours related to drug use do translate into reductions in cases of HIV infection. However, because of the high risk of bias and variability in several aspects of the studies, combined totals were not calculated. AUTHORS' CONCLUSIONS Oral substitution treatment for injecting opioid users reduces drug-related behaviours with a high risk of HIV transmission, but has less effect on sex-related risk behaviours. The lack of data from randomised controlled studies limits the strength of the evidence presented in this review.
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Affiliation(s)
- Linda Gowing
- Discipline of Pharmacology, University of Adelaide, Frome Road, Adelaide, South Australia, Australia, 5005
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Jones HE, Wechsberg WM, O'Grady KE, Tuten M. HIV Sexual and Drug-Use Risk in Drug-Dependent Pregnant Patients in Comprehensive Drug Treatment. INTERNATIONAL JOURNAL OF FAMILY MEDICINE 2011; 2011:872638. [PMID: 23050147 PMCID: PMC3461282 DOI: 10.1155/2011/872638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 01/17/2011] [Accepted: 01/21/2011] [Indexed: 06/01/2023]
Abstract
This secondary analysis study investigated HIV sexual and drug-use risk in drug-dependent pregnant patients over the first month postrandomization to reinforcement-based treatment (RBT) (n = 47) or usual care (UC) (n = 42). Analysis of primary outcomes had indicated that RBT participants spent significantly longer time in treatment and recovery housing than UC participants. The present study examined the ability of 9 risk markers-age, race, estimated gestational age at treatment entry, lifetime substance abuse treatment episodes, history of prostitution charges, history of serious depression, current heroin injection status, current housing status, and current partner substance use-to predict changes in HIV risks. Sexual risk declined for participant subgroups with prostitution-charge histories and unstable housing. Drug-use risk declined for heroin injectors and nondepressed participants. A relationship was found between number of lifetime drug treatment episodes and sexual and drug-use risk. The role of risk markers in the response of drug-dependent pregnant women to drug treatment require attention.
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Affiliation(s)
- Hendrée E. Jones
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
- Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Wendee M. Wechsberg
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - Kevin E. O'Grady
- Department of Psychology, University of Maryland, College Park, MD 20742, USA
| | - Michelle Tuten
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
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Chan YF, Passetti LL, Garner BR, Lloyd JJ, Dennis ML. HIV risk behaviors: risky sexual activities and needle use among adolescents in substance abuse treatment. AIDS Behav 2011; 15:114-24. [PMID: 20411413 DOI: 10.1007/s10461-010-9702-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study estimated prevalence of HIV risk behaviors and its association with substance use and mental health problems among adolescents in treatment. A pooled dataset of 9,519 adolescents admitted to substance abuse treatment programs between 2002 and 2006 was analyzed. HIV risk behaviors, substance use, and mental health problems were assessed at treatment intake. Sixty percent of adolescents were engaged in at least one sexual or needle use risk behavior in the year prior to entering treatment. Sex with multiple partners, sex under the influence of alcohol or drugs, and unprotected sex were the most prevalent HIV risk behaviors. Several gender differences were found for specific types of sexual and needle use behaviors. Adolescents with substance dependence or other comorbid mental health problems were at increased odds for HIV risk. Findings suggest treatment programs may benefit adolescents better by screening them consistently for HIV risk behaviors and incorporating tailored interventions.
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Affiliation(s)
- Ya-Fen Chan
- Lighthouse Institute, Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61761, USA.
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Abstract
Drug use continues to be a major factor fueling the global epidemic of HIV infection. This article reviews the current literature on the ability of drug treatment programs to reduce HIV transmission among injection and noninjection drug users. Most data come from research on the treatment of opiate dependence and provide strong evidence on the effectiveness of medication-assisted treatment for reducing the frequency of drug use, risk behaviors, and HIV infections. This has been a consistent finding since the epidemic began among diverse populations and cultural settings. Use of medications other than methadone (such as buprenorphine/naloxone and naltrexone) has increased in recent years with promising data on their effectiveness as HIV prevention and as new treatment options for communities heavily affected by opiate use and HIV infection. However, few treatment interventions for stimulant abuse and dependence have shown efficacy in reducing HIV risk. The cumulative literature provides strong support of drug treatment programs for improving access and adherence to antiretroviral treatment. Drug users in substance abuse treatment are significantly more likely to achieve sustained viral suppression, making viral transmission less likely. Although there are challenges to implementing drug treatment programs for maximum impact, the scientific literature leaves no doubt about the effectiveness of drug treatment as an HIV prevention strategy.
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Chaudhury R, Jones HE, Wechsberg W, O'Grady KE, Tuten M, Chisolm MS. Addiction severity index composite scores as predictors for sexual-risk behaviors and drug-use behaviors in drug-using pregnant patients. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2010; 36:25-30. [PMID: 20141393 DOI: 10.3109/00952990903544810] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND HIV sexual-risk and drug-use behavior predictors have been studied in non-pregnant but not pregnant drug-dependent populations. OBJECTIVE Examine the ability of the ASI composite scores to predict HIV sexual- and drug-risk scores as well as the individual items of a modified version of the Risk Assessment Battery in drug-using pregnant women. METHODS Pregnant women (N = 76) completing pretreatment ASI and HIV-risk questionnaires. RESULTS The Legal composite score was the sole significant predictor of the sexual-risk score, with a 1 SD increase in the Legal composite score resulting in a 24% increase in sexual-risk, p < .001. The Medical, Drug, and Legal composite scores were each significant predictors of the drug-risk score, with a 1 SD increase resulting in a 31% decrease, and 121% and 73% increases, respectively, in drug-risk, all ps < .05. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Drug-using pregnant women and their fetuses are vulnerable to the consequences of both sexual-risk behaviors and drug-use. The ASI may help screen such patients for HIV sexual-risk and drug-use behaviors as a first step in tailoring treatment to address these issues.
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Affiliation(s)
- R Chaudhury
- Johns Hopkins University, Baltimore, Maryland, USA
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Comer SD, Sullivan MA, Vosburg SK, Manubay J, Amass L, Cooper ZD, Saccone P, Kleber HD. Abuse liability of intravenous buprenorphine/naloxone and buprenorphine alone in buprenorphine-maintained intravenous heroin abusers. Addiction 2010; 105:709-18. [PMID: 20403021 PMCID: PMC3489277 DOI: 10.1111/j.1360-0443.2009.02843.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sublingual buprenorphine is an effective maintenance treatment for opioid dependence, yet intravenous buprenorphine misuse occurs. A buprenorphine/naloxone formulation was developed to mitigate this misuse risk. This randomized, double-blind, cross-over study was conducted to assess the intravenous abuse potential of buprenorphine/naloxone compared with buprenorphine in buprenorphine-maintained injection drug users (IDUs). METHODS Intravenous heroin users (n = 12) lived in the hospital for 8-9 weeks and were maintained on each of three different sublingual buprenorphine doses (2 mg, 8 mg, 24 mg). Under each maintenance dose, participants completed laboratory sessions during which the reinforcing and subjective effects of intravenous placebo, naloxone, heroin and low and high doses of buprenorphine and buprenorphine/naloxone were examined. Every participant received each test dose under the three buprenorphine maintenance dose conditions. RESULTS Intravenous buprenorphine/naloxone was self-administered less frequently than buprenorphine or heroin (P < 0.0005). Participants were most likely to self-administer drug intravenously when maintained on the lowest sublingual buprenorphine dose. Subjective ratings of 'drug liking' and 'desire to take the drug again' were lower for buprenorphine/naloxone than for buprenorphine or heroin (P = 0.0001). Participants reported that they would pay significantly less money for buprenorphine/naloxone than for buprenorphine or heroin (P < 0.05). Seven adverse events were reported; most were mild and transient. CONCLUSIONS These data suggest that although the buprenorphine/naloxone combination has intravenous abuse potential, that potential is lower than it is for buprenorphine alone, particularly when participants received higher maintenance doses and lower buprenorphine/naloxone challenge doses. Buprenorphine/naloxone may be a reasonable option for managing the risk for buprenorphine misuse during opioid dependence treatment.
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Affiliation(s)
- Sandra D. Comer
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York, New York, USA
| | - Maria A. Sullivan
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York, New York, USA
| | - Suzanne K. Vosburg
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York, New York, USA
| | - Jeanne Manubay
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York, New York, USA
| | - Leslie Amass
- Schering-Plough Corporation, Kenilworth, New Jersey, USA
| | - Ziva D. Cooper
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York, New York, USA
| | - Phillip Saccone
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York, New York, USA
| | - Herbert D. Kleber
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York, New York, USA
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Kivelä PS, Krol A, Partanen ALA, Ristola MA. High prevalence of unprotected sex among Finnish HIV-positive and HIV-negative injecting drug users. Scand J Public Health 2009; 37:357-63. [PMID: 19372233 DOI: 10.1177/1403494809105290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS To study the prevalence of sexual risk behaviour and to identify factors associated with inconsistent condom use of Finnish injecting drug users (IDUs), and thus to examine the potential of sexual transmission of HIV within and from this population. METHODS HIV-positive (n = 89) and HIV-negative (n = 207) IDUs from the Helsinki metropolitan area were interviewed using a standardized questionnaire. Determinants of inconsistent condom use in the past 6 months were analyzed with logistic regression. RESULTS Inconsistent condom use was reported by 63% (39) of HIV-positive and 80% (144) of HIV-negative sexually active IDUs. Unprotected sex was more common in steady relationships (OR 5.6, CI 2.4-13.4). Inconsistent condom use was also associated with recent inpatient addiction treatment especially in the HIV-positive group (OR 15.7, 95% CI 1.7-143.0). Inpatient or outpatient addiction treatment was reported by 72% of the participants. Inconsistent condom use was not associated with age, gender, drug use frequency or markers of marginalization (unstable living, unemployment). CONCLUSIONS Inconsistent condom use allows for the spread of HIV and other sexually transmitted infections among Finnish IDUs. Addiction treatment programmes should include interventions focused on sexual behaviour to all of their clients. Partners of IDUs should be actively offered HIV counselling and testing.
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Affiliation(s)
- Pia S Kivelä
- Division of Infectious Diseases, Helsinki University Central Hospital, Helsinki, Finland.
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30
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Predictors of opiate agonist treatment retention among injection drug users referred from a needle exchange program. J Subst Abuse Treat 2009; 36:306-12. [DOI: 10.1016/j.jsat.2008.07.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Revised: 06/24/2008] [Accepted: 07/17/2008] [Indexed: 10/21/2022]
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31
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Testa M, Livingston JA. Alcohol consumption and women's vulnerability to sexual victimization: can reducing women's drinking prevent rape? Subst Use Misuse 2009; 44:1349-76. [PMID: 19938922 PMCID: PMC2784921 DOI: 10.1080/10826080902961468] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Before effective prevention interventions can be developed, it is necessary to identify the mechanisms that contribute to the targeted negative outcomes. A review of the literature on women's substance use and sexual victimization points to women's heavy episodic drinking as a proximal risk factor, particularly among college samples. At least half of sexual victimization incidents involve alcohol use and the majority of rapes of college women occur when the victim is too intoxicated to resist ("incapacitated rape"). Despite the importance of women's heavy episodic drinking as being a risk factor, existing rape prevention programs have rarely addressed women's alcohol use and have shown little success in reducing rates of sexual victimization. We argue that given the strength of the association between heavy episodic drinking and sexual victimization among young women, prevention programs targeting drinking may prove more efficacious than programs targeting sexual vulnerability. Applications of existing drinking prevention strategies to reducing women's sexual victimization are discussed.
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Affiliation(s)
- Maria Testa
- Research Institute on Addictions, University at Buffalo, Buffalo, New York 14203, USA.
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32
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Deren S, Strauss S, Kang SY, Colón HM, Robles RR. Sex risk behaviors of drug users: a dual site study of predictors over time. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2008; 20:325-337. [PMID: 18673065 DOI: 10.1521/aeap.2008.20.4.325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Reducing sex risk behaviors among high-risk injection drug users (IDUs) and crack smokers is a continuing challenge for HIV prevention. Based on a longitudinal study of sexually active Puerto Rican IDUs and crack smokers in New York (n = 573) and Puerto Rico (n = 264), baseline predictors of changes in sex risk (number of unprotected sex acts) at 6- and 36-month follow-up interviews were examined. In New York, predictors of higher sex risk were being younger, having primary partners, having more other sex partners, never exchanging sex, having lower self-efficacy for reducing sex risk behaviors and being HIV-negative, and these predictors were significant at both postbaseline periods. In Puerto Rico, short-term predictors included being male, having primary partners, never exchanging sex, lower sex risk norms and lower self-efficacy. However, only having primary partners was significant in longer-term behaviors. Results indicated the need for enhancing self-efficacy and for developing risk reduction strategies related to community differences.
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Affiliation(s)
- Sherry Deren
- National Development & Research Insdtitutes, Inc., Center for Drug Use & HIV Research, New York, NY 10010, USA.
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Hanson T, Alessi SM, Petry NM. Contingency management reduces drug-related human immunodeficiency virus risk behaviors in cocaine-abusing methadone patients. Addiction 2008; 103:1187-97. [PMID: 18494842 DOI: 10.1111/j.1360-0443.2008.02216.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Contingency management (CM) is efficacious in reducing drug use. This study examined whether CM also reduces human immunodeficiency virus (HIV) risk behaviors and if these effects are mediated by longest duration of abstinence achieved during treatment. DESIGN Data were analyzed from a subset of participants in a combined data set of three published randomized controlled trials of CM treatments. SETTING A community-based methadone maintenance clinic. PARTICIPANTS One-hundred and sixty-five cocaine-abusing methadone maintenance patients. INTERVENTION Participants received either standard methadone treatment or standard methadone treatment with CM for 3 months. MEASUREMENTS The HIV Risk Behavior Scale (HRBS) was administered prior to randomization to a study condition and 3 months after the study treatments ended. The primary objective indicator of drug use was longest duration of cocaine and opioid abstinence achieved during treatment. FINDINGS Relative to those assigned to standard care, participants receiving CM significantly decreased overall HIV risk behaviors and injection drug use risk behaviors. CM participants also achieved longer durations of consecutive cocaine and opioid abstinence during treatment. Duration of abstinence achieved mediated the relationship between treatment condition and HRBS difference scores. CONCLUSIONS These results suggest that CM treatment reduces HIV drug use risk behaviors in cocaine-abusing methadone maintenance patients.
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Affiliation(s)
- Tressa Hanson
- University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-3944, USA
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Gowing L, Farrell M, Bornemann R, Sullivan L, Ali R. Substitution treatment of injecting opioid users for prevention of HIV infection. Cochrane Database Syst Rev 2008:CD004145. [PMID: 18425898 DOI: 10.1002/14651858.cd004145.pub3] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Injecting drug users are vulnerable to infection with HIV and other blood borne viruses as a result of collective use of injecting equipment as well as sexual behaviour. OBJECTIVES To assess the effect of oral substitution treatment for opioid dependent injecting drug users on rates of HIV infections, and high risk behaviours. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and PsycINFO to March 2007. We also searched reference lists of articles, reviews and conference abstracts SELECTION CRITERIA Studies were required to consider the incidence of risk behaviours, or the incidence of HIV infection related to substitution treatment of opioid dependence. All types of original studies were considered. Two reviewers independently assessed studies for inclusion. DATA COLLECTION AND ANALYSIS One reviewer extracted data from included studies, assessed quality and confirmed decisions by consulting with all other reviewers. MAIN RESULTS Thirty-three studies, involving 10,400 participants, were included. The majority were not randomised controlled studies and there were problems of confounding and bias. The studies varied in several aspects limiting the extent of quantitative analysis. Studies consistently show that oral substitution treatment for opioid-dependent injecting drug users is associated with statistically significant reductions in illicit opioid use, injecting use and sharing of injecting equipment. It is also associated with reductions in the proportion of injecting drug users reporting multiple sex partners or exchanges of sex for drugs or money, but has little effect on condom use. It appears that the reductions in risk behaviours related to drug use do translate into reductions in cases of HIV infection. AUTHORS' CONCLUSIONS Oral substitution treatment for injecting opioid users reduces drug-related behaviours with a high risk of HIV transmission, but has less effect on sex-related risk behaviours. The lack of data from randomised controlled studies limits the strength of the evidence presented in this review.
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Affiliation(s)
- L Gowing
- University of Adelaide, Department of Clinical and Experimental Pharmacology, DASC Evidence-Bsed Practice Unit, Adelaide, Australia, 5005.
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35
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Conner KR, Pinquart M, Duberstein PR. Meta-analysis of depression and substance use and impairment among intravenous drug users (IDUs). Addiction 2008; 103:524-34. [PMID: 18261192 PMCID: PMC4864591 DOI: 10.1111/j.1360-0443.2007.02118.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS To evaluate, among intravenous drug users (IDUs), the hypothesized positive association of depression with substance-related behaviors including concurrent drug use and impairment, future drug use and impairment, alcohol use and impairment, needle sharing and substance use treatment participation, and to identify moderators of these associations. DESIGN Meta-analysis of reports on IDUs published in English in peer-reviewed journals since 1986 that contained data on depression and substance use outcome(s) with no restrictions on range of depression scores to select the sample. SETTING Fifty-five reports containing 55 samples met criteria, including 42 (76%) samples from clinical venues and 13 (24%) that were community-based. PARTICIPANTS Mean age was 34.3 (standard deviation = 4.5) years, comprising approximately 68% men and 43% white, non-Hispanic subjects. MEASUREMENTS Depression was assessed with the Beck Depression Inventory, Center for Epidemiological Studies Depression Scale (CES-D) and other validated scales or diagnostic interviews. The Addiction Severity Index was the most frequently used measure of substance-related outcomes. FINDINGS A priori hypotheses pertaining to depression and the substance-related variables were supported, with the exception of the predicted association of depression and future drug use and impairment. Effect sizes were small. Moderating effects of gender were identified, including greater associations of depression with substance use treatment participation and needle sharing among women and a greater association of depression with future drug use and impairment among men. Effect sizes of moderators were large. CONCLUSIONS Depression is associated with several substance-related behaviors, and select associations are stronger according to gender. Prospective associations of depression with future drug use and impairment are not immediately evident, but could be examined in subsequent research.
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Yin WY, Wu ZY. Challenges and opportunities: the expanded government-led HIV/AIDS programs in China. Virol Sin 2008. [DOI: 10.1007/s12250-007-0051-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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37
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Todd CS, Earhart KC, Botros BA, Khakimov MM, Giyasova GM, Bautista CT, Carr JK, Sanchez JL. Prevalence and correlates of risky sexual behaviors among injection drug users in Tashkent, Uzbekistan. AIDS Care 2007; 19:122-9. [PMID: 17129867 DOI: 10.1080/09540120600852150] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The objective of this paper is to describe prevalence and correlates of sexual risk behaviors among injection drug users (IDUs) in Tashkent, Uzbekistan. Participants in this cross-sectional study completed a questionnaire detailing sociodemographic, medical and drug and sexual risk behaviors and HIV antibody testing. Of 701 IDUs surveyed, only 20.5% reported consistent condom use, which was more likely for women. Prior sexually-transmitted infection (STI) diagnosis was reported by 36.2% of participants and was associated with early (</=18 years) drug initiation, group drug use, being older, higher educational level, marriage, needle sharing, multiple sex partners in the preceding month and daily injection use. Having multiple partners in the preceding month was common (29.71%) and related to employment, consistent condom use with regular partners and STI self-treatment in multivariate logistic regression. Participants with a history of sharing needles were less likely to have had multiple partners in the previous month. Risky sexual behaviors are common and interrelated with risky injection habits among IDUs in Tashkent, Uzbekistan, representing a continued threat of infection with HIV and other blood-borne agents.
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Affiliation(s)
- C S Todd
- Department of Family & Preventive Medicine, University of California, San Diego, La Jolla, California, USA.
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38
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[Treatment retention and evolution of clientele in a low threshold methadone substitution treatment program in Montreal]. Canadian Journal of Public Health 2007. [PMID: 17278675 DOI: 10.1007/bf03405382] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To evaluate client treatment retention and evolution in terms of living conditions, at-risk behaviours, and the use of psychoactive substances (PAS) over a one-year period, following admission into a low-threshold methadone program in Montreal. METHOD Individual interviews were administered to 114 clients from Relais-Méthadone (RM) at admission and one year after treatment initiation. Participants reported on PAS consumption and unsafe practices of drug use and sexual behaviours at high risk for transmission of HIV, sexually transmitted infections (STI) and other blood-borne viruses (BBV). Services utilized by clients were documented from Relais-Méthadone files. Bivariate analyses were used to compare data recorded at admission and one-year follow-up. RESULTS The treatment retention rate after one year at RM was 64%. However, by taking into account those clients who were transferred to a regular program during the study period, as well as those who voluntarily tapered their methadone treatment (16.7%), the status of 80.7% of clients demonstrated improvement one year after admission into treatment. Furthermore, the clients who remained in treatment for a year for whom information was available (n = 60) showed a tendency towards more stable living conditions. They also demonstrated a significant decrease in both the number of PAS injections and in risky behaviours related to drug consumption. A statistically significant decrease in the frequency of heroine and cocaine use was also observed. By contrast, however, two thirds of the individuals in treatment after a year (n = 42) maintained or increased their daily consumption of other PAS. DISCUSSION The treatment retention rate is comparable to other low or regular threshold substitution programs. The results support previous studies showing that the methadone substitution treatment reduces heroine and cocaine consumption, and decreases the number of unsafe behaviours that could potentially transmit HIV, STI and BBV for the majority of clients who remained in treatment. Future research could focus attention on people who abandon treatment and those who present at-risk behaviours during treatment.
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39
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Meade CS, Weiss RD. Substance abuse as a risk factor for HIV sexual risk behavior among persons with severe mental illness: Review of evidence and exploration of mechanisms. ACTA ACUST UNITED AC 2007. [DOI: 10.1111/j.1468-2850.2007.00059.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Four factors have driven China's response to the HIV/AIDS pandemic: (1) existing government structures and networks of relationships; (2) increasing scientific information; (3) external influences that underscored the potential consequences of an HIV/AIDS pandemic and thus accelerated strategic planning; and (4) increasing political commitment at the highest levels. China's response culminated in legislation to control HIV/AIDS-the AIDS Prevention and Control Regulations. Three major initiatives are being scaled up concurrently. First, the government has prioritised interventions to control the epidemic in injection drug users, sex workers, men who have sex with men, and plasma donors. Second, routine HIV testing is being implemented in populations at high risk of infection. Third, the government is providing treatment for infected individuals. These bold programmes have emerged from a process of gradual and prolonged dialogue and collaboration between officials at every level of government, researchers, service providers, policymakers, and politicians, and have led to decisive action.
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Affiliation(s)
- Zunyou Wu
- National Centre for AIDS/STD Control and Prevention, Beijing, China
| | - Sheena G Sullivan
- National Centre for AIDS/STD Control and Prevention, Beijing, China
- Edith Cowan University, Perth, Western Australia, Australia
| | - Yu Wang
- Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Mary Jane Rotheram-Borus
- UCLA Center for HIV Identification, Prevention and Treatment Services (CHIPTS), Los Angeles, CA, USA
| | - Roger Detels
- UCLA School of Public Health, Los Angeles, CA, USA
- Correspondence to: Prof Roger Detels, School of Public Health, University of California, Los Angeles, CA 90095-1772, USA
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Peles E, Rados V, Adelson M. Characterization of former heroin addict patients with Hepatitis C virus antibodies in a methadone maintenance treatment (MMT) clinic in israel. Subst Use Misuse 2007; 42:1477-84. [PMID: 17886143 DOI: 10.1080/10826080701212550] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIMS To compare characteristics, retention in treatment and cessation of drug abuse of 249 positive hepatitis C (HCV+) with 188 negative hepatitis C (HCV-) antibody patients. METHODS Data on Hepatitis C, Hepatitis B and HIV results, urine-proven drug use, and modified ASI of all patients admitted to the Adelson MMT clinic between June/1993-Dec/2002 were prospectively collected. RESULTS HCV+ patients manifested more ever injecting drug use, immigrants, positive HIV antibody, hepatitis B antigen, years of opiate addiction pre-MMT and benzodiazepines misuse after one year in MMT than HCV- patients, with similar 1-year retention and proportion of opiate use cessation. CONCLUSIONS Although characteristics of HCV+ and HCV- differed, they manifested similar outcomes: treatment retention and proportion of opiate use cessation.
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Affiliation(s)
- Einat Peles
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment & Research, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.
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42
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Appel PW, Piculell R, Jansky HK, Griffy K. Assessing alcohol and other drug problems (AOD) among sexually transmitted disease (STD) clinic patients with a modified CAGE-A: implications for AOD intervention services and STD prevention. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2006; 32:225-36. [PMID: 16595325 DOI: 10.1080/00952990500479555] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The close link between alcohol and other drug abuse and STD morbidity and the positive impact of AOD intervention services in reducing STD morbidity, led the New York State Office of Alcoholism and Substance Abuse Services (OASAS) and the New York City Bureau of STD Control (BSTDC) to assess the prevalence of AOD problems among STD clinic patients. Assessing problematic AOD involvement among STD patients was of interest to BSTDC for STD prevention and to OASAS, for new AOD case-finding and early intervention. During fall, 2000, 100 STD patients in each of the 7 full-time BSTDC clinics in New York City were solicited in clinic waiting rooms; eligible patients were screened individually and anonymously with a modified CAGE-A (mCA). The mCA asks 4 questions about problematic AOD use "ever" (i.e., "lifetime") and currently (i.e., "in the past 30 days) rather than "in the past 12 months" of the CAGE and uses two or more "Yes" answers as a "positive" screen. The mCA also asks for age, sex, ethnicity, prior AOD treatment, and interest in an AOD referral. Only 2 of 704 eligible patients refused mCA screening, n = 702. Sixty percent were male, 87.7% Black and/or Hispanic, and 69%, <or=35 years old. Of the sample screened, 30.5% were "positive" on the "ever" and 16.5%, on "the past 30 days," mCA questions. 13.2% reported prior AOD treatment, 1.4% were in AOD treatment or about to start, and <1% wanted an AOD referral. Eight of 10 STD patients currently in AOD treatment screened positive on the "ever" mCA questions. The AOD prevalence rates observed here were deemed high since: 1) CAGE (and CAGE-A) data on general hospital and emergency room admissions showed positive screening rates of only 5-14 % and 2) only an estimated 6-7% of adults in New York have received any formal intervention with an AOD problem, less than half the rate found for treatment alone with the STD patients in this study. The results support implementing AOD screening and intervention services in STD clinics since an estimated 11,000 patients annually would screen positive but now are undetected and untreated. As AOD intervention services also can reduce risky sexual behavior, providing them could expand STD prevention services significantly. Policy, funding, and evaluation issues related to implementing AOD intervention services in STD and other public health clinics also are discussed.
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Affiliation(s)
- Philip W Appel
- New York State Office of Alcoholism and Substance Abuse Services, New York, New York 10018-5903, USA.
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43
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Meade CS. Sexual risk behavior among persons dually diagnosed with severe mental illness and substance use disorder. J Subst Abuse Treat 2006; 30:147-57. [PMID: 16490678 DOI: 10.1016/j.jsat.2005.11.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2005] [Revised: 10/31/2005] [Accepted: 11/23/2005] [Indexed: 11/30/2022]
Abstract
Persons dually diagnosed with severe mental illness (SMI) and substance use disorder (SUD) have disproportionately high rates of HIV and other sexually transmitted infections (STIs). This study examined the relationship between multiple sexual risk behaviors among persons with active, remitted, and no SUD. Participants were 152 adults with SMI recruited from multiple treatment sites. A structured interview assessed the participants' psychiatric, psychosocial, and behavioral factors. Rates of sexual risk behavior in the past 3 months were high and differed across the SUD groups. Multivariate logistic regression models found that lifetime SUD predicted sexual activity and partner-related risk whereas active substance abuse predicted condom-related risk. The results also support indirect effects of interpersonal and psychiatric factors (e.g., romantic partnership and psychotic disorder). Findings underscore the need for integrated HIV/STI prevention interventions targeting dually diagnosed patients.
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Margolin A, Beitel M, Schuman-Olivier Z, Avants SK. A controlled study of a spirituality-focused intervention for increasing motivation for HIV prevention among drug users. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2006; 18:311-22. [PMID: 16961448 DOI: 10.1521/aeap.2006.18.4.311] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Spiritual Self-Schema (3-S) therapy is a manual-guided intervention for increasing motivation for HIV prevention that integrates a cognitive model of self within a Buddhist framework suitable for people of all faiths. In this controlled study, 72 methadone-maintained clients received either standard care and 8 weeks of 3-S therapy, or standard care alone. At treatment completion, 3-S clients reported significantly greater increases in spiritual practices, expression of spiritual qualities, and motivation for HIV prevention. They were also less likely to have engaged in HIV risk behavior. Correlational analyses showed that attendance at 3-S therapy sessions was significantly positively related to spiritual practice at treatment completion and to motivation for HIV prevention, and that both attendance at 3-S sessions and motivation for HIV preventive behavior were significantly negatively related to HIV risk behavior. Completion of 3-S therapy predicted posttreatment HIV preventive behavior, controlling for pretreatment behavior, demographics, and addiction severity measures (odds ratio = 8.89; 95% confidence interval = 1.62-48.93).
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Affiliation(s)
- Arthur Margolin
- Yale University School of Medicine, New Haven, CT 06519, USA.
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O'Leary A, Broadwell SD, Yao P, Hasin D. Major Depression, Alcohol and Drug Use Disorders Do Not Appear to Account for the Sexually Transmitted Disease and HIV Epidemics in the Southern United States. Sex Transm Dis 2006; 33:S70-7. [PMID: 16543865 DOI: 10.1097/01.olq.0000204840.90020.88] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Sexually transmitted disease (STD) and HIV infection are occurring at epidemic rates in the southern region of the United States. Depression and substance use disorders are associated with sexual risk behavior, so we investigated whether regionwide societal rates of major depression or substance use disorders could explain the higher southern rates. METHODS Data came from two surveys, the National Longitudinal Alcohol Epidemiologic Survey (NLAES; 1991-1992, N = 42,862) and the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC; 2001-2002, N = 43,093). Outcome variables included Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) major depressive disorder and substance use disorders (abuse/dependence), binge drinking, and lifetime drinker versus abstainer. Southern region was contrasted to all others. Because the STD/HIV epidemics affect blacks, especially young black women (18-44 years) disproportionately, we examined the relationships among region, depression, and substances in these subpopulations separately. RESULTS DSM-IV alcohol and cannabis abuse or dependence and being a lifetime drinker were significantly lower in the south than elsewhere in both the NLAES and NESARC with similar trends for DSM-IV cocaine abuse/dependence. CONCLUSIONS Counter to hypotheses, higher societal rates of depression or substance use disorders cannot account for the epidemic of STDs and HIV infection in the southern United States. Further studies are needed to determine if alcohol and drug disorders, being more deviant when they occur in the south, are more strongly associated with sexual risk behavior there than elsewhere.
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Affiliation(s)
- Ann O'Leary
- Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Latka MH, Wilson TE, Cook JA, Bacon MC, Richardson JL, Sohler N, Cohen MH, Greenblatt RM, Andreopoulis E, Vlahov D. Impact of drug treatment on subsequent sexual risk behavior in a multisite cohort of drug-using women: a report from the Women's Interagency HIV Study. J Subst Abuse Treat 2006; 29:329-37. [PMID: 16311186 DOI: 10.1016/j.jsat.2005.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2004] [Revised: 07/10/2005] [Accepted: 08/23/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND The evidence that drug treatment programs are associated with changes in sexual behavior and, thus, have prevention benefits beyond addiction is inconclusive. We examined whether entry into drug treatment was associated with subsequent alterations in sexual behavior among a group of drug-using women. METHODS Data were collected semiannually via structured interviews over 8 years. Generalized estimating equations evaluated the relationship between self-reported drug treatment at each visit and sexual abstinence and consistent condom use in the subsequent 6-month period. RESULTS In this sample (N = 1,658; mean age, 37.3 years; 57.5% African American; 80.3% HIV positive; 49.6% crack/cocaine users), 40% reported being in a variety of drug treatment programs. Those undergoing drug treatment (vs. those not) were less likely to become sexually active (adjusted odds ratio [AOR], 0.83; 95% confidence interval [CI], 0.76-0.91); this association was unchanged when the frequency of attendance and number of different drug treatment programs were evaluated. Drug treatment was not associated with subsequent consistent condom, regardless of frequency of attendance, but involvement in at least three treatment programs was (AOR, 1.40; 95% CI, 1.00-1.97). CONCLUSIONS Additional efforts are needed to integrate effective sexual risk reduction programs into drug treatment settings; expanding access to different types of drug treatment modalities may be indicated.
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Affiliation(s)
- Mary H Latka
- Center for Urban Epidemiological Studies, New York Academy of Medicine, New York, NY 10029, USA.
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Palepu A, Raj A, Horton NJ, Tibbetts N, Meli S, Samet JH. Substance abuse treatment and risk behaviors among HIV-infected persons with alcohol problems. J Subst Abuse Treat 2005; 28:3-9. [PMID: 15723726 DOI: 10.1016/j.jsat.2004.09.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2004] [Revised: 07/19/2004] [Accepted: 09/24/2004] [Indexed: 10/25/2022]
Abstract
We examined the association of substance abuse treatment with sexual and drug use risk behaviors among 349 HIV-infected persons with a history of alcohol problems using a standardized questionnaire regarding sexual and drug use risk behaviors, demographics, substance use, and use of substance abuse treatment. We defined substance abuse treatment services as any of the following in the past 6 months: 12 weeks in a half-way house or residential facility; 12 visits to a substance abuse counselor or mental health professional; day treatment for at least 30 days; or participation in any methadone maintenance program. Our three outcome variables of high-risk behavior were the Risk Assessment Battery sex-risk and drug-risk scores and high-risk sex behavior which included any of the following: inconsistent condom use; having more than one sexual partner; and exchanging sex for money or drugs. Although sexual risk was high (51%) in our HIV-infected cohort, engagement in substance abuse treatment was not independently associated with lower frequency of any of our measures of high- risk behaviors. Although the opportunity exists to address HIV risk behaviors in the setting of substance abuse treatment, effective institutionalization of this challenging behavior change effort has not yet been realized.
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Affiliation(s)
- Anita Palepu
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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McCoy CB, Metsch LR, Comerford M, Zhao W, Coltes AJ, Messiah SE. Trends of HIV risk behaviors in a cohort of injecting drug users and their sex partners in Miami, Florida, 1988-1998. AIDS Behav 2005; 9:187-99. [PMID: 15933838 DOI: 10.1007/s10461-005-3900-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2003] [Revised: 09/17/2004] [Accepted: 01/25/2005] [Indexed: 11/29/2022]
Abstract
A cohort of 111 injection drug users (IDUs) and their sex partners was assessed in 1988 concerning risk behaviors for HIV and knowledge of HIV/AIDS. Ten years later, in 1998, the cohort was reassessed using the same instrument. All who were HIV negative in 1988 were retested by blood draw for antibodies to HIV. A paired analysis was utilized to determine individual changes in risk behaviors for three serostatus groups--those who remained HIV negative (long-term HIV negatives), seroconverters, and those positive in 1988 (long-term HIV positives). Incidence was twice as high for sex partners (37.5%) as for IDUs (18.0%). Drug and needle use risk behaviors, except crack use, showed decreases; sexual risk behaviors were less amenable to change. Knowledge significantly increased among the long-term HIV negatives and seroconverters but not among those HIV positive in 1988. This analysis demonstrates the need for continued intervention among IDUs and their sex partners.
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Affiliation(s)
- Clyde B McCoy
- Comprehensive Drug Research Center, Department of Epidemiology and Public Health, University of Miami School of Medicine, Florida 33136, USA.
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Sullivan LE, Metzger DS, Fudala PJ, Fiellin DA. Decreasing international HIV transmission: the role of expanding access to opioid agonist therapies for injection drug users. Addiction 2005; 100:150-8. [PMID: 15679744 DOI: 10.1111/j.1360-0443.2004.00963.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To examine the role of expanded access to opioid agonist treatment as a means to decrease international HIV transmission. DESIGN Review of the English language literature via Medline. MEASUREMENTS Estimates of prevalence rates for injection drug use, HIV infection and treatment effect sizes for changes in opioid use, opioid injection, needle-sharing, injection-related HIV risk behavior and cost. FINDINGS An estimated 12.6 million injection drug users internationally accounted for 10% of the 4.2 million new HIV infections in 2003. Ninety-three of the 136 countries (68%) that report injection drug use identify HIV infection related to this behavior. Observational studies of methadone treatment demonstrate decreases in opioid use, opioid injection, needle-sharing and lower rates of HIV prevalence and incidence. The effectiveness of buprenorphine in demonstrating similar findings is expected, although implementations and research are still emerging. The cost-effectiveness of opioid agonist treatment has been established. The barriers to international adoption of opioid agonist treatment, despite the research evidence and international guidelines, are discussed. CONCLUSIONS Untreated opioid dependence leads to HIV transmission, on an international level. Opioid agonist treatments are associated with reductions in the frequency of opioid use, fewer injections and injection-related HIV risk behaviors and lower rates of HIV prevalence and incidence. Despite international recommendations, treatment for opioid-dependent injection drug users with methadone and buprenorphine is limited. Research, implementation efforts and political strategies to expand access to opioid agonist treatment are needed in order to combat the spread of HIV, especially in the developing world.
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Affiliation(s)
- Lynn E Sullivan
- Yale University School of Medicine, New Haven, CT 06520-8025, USA.
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Gowing L, Farrell M, Bornemann R, Ali R. Substitution treatment of injecting opioid users for prevention of HIV infection. Cochrane Database Syst Rev 2004:CD004145. [PMID: 15495080 DOI: 10.1002/14651858.cd004145.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Injecting drug users are vulnerable to infection with HIV and other blood borne viruses as a result of collective use of injecting equipment as well as sexual behaviour. OBJECTIVES To assess the effect of oral substitution treatment for opioid dependent injecting drug users on rates of HIV infections, and high risk behaviours. SEARCH STRATEGY Multiple electronic databases were searched. Reference lists of retrieved studies, reviews and conference abstracts were handsearched. SELECTION CRITERIA Studies were required to consider the incidence of risk behaviours, or the incidence of HIV infection related to substitution treatment of opioid dependence. All types of original studies were considered. DATA COLLECTION AND ANALYSIS Each potentially relevant study was independently assessed by two reviewers. For studies that met the inclusion criteria, key information was extracted by one reviewer and confirmed by consultation between all four reviewers. MAIN RESULTS Twenty-eight studies, involving 7900 participants, were included. The majority were not randomised controlled studies. Issues of confounding and bias are discussed. The studies varied in several aspects limiting the extent of quantitative analysis. REVIEWERS' CONCLUSIONS Oral substitution treatment for opioid-dependent injecting drug users is associated with statistically significant reductions in illicit opioid use, injecting use and sharing of injecting equipment. It is also associated with reductions in the proportion of injecting drug users reporting multiple sex partners or exchanges of sex for drugs or money, but has little effect on condom use. It appears that the reductions in risk behaviours related to drug use do translate into reductions in cases of HIV infection. The lack of data from randomised controlled studies limits the strength of the evidence presented in this review. However, these findings add to the stronger evidence of effectiveness of substitution treatment on drug use, and treatment retention outcomes shown by other systematic reviews. On this basis, the provision of substitution treatment for opioid dependence in countries with emerging HIV and injecting drug use problems as well as in countries with established populations of injecting drug users should be supported.
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Affiliation(s)
- L Gowing
- Evidence-Based Practice Unit, Drug and Alcohol Services Council, 161 Greenhill Road, Parkside, SA, Australia, 5063.
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