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Abara WE, Trujillo L, Broz D, Finlayson T, Teshale E, Paz-Bailey G, Glick S, Al-Tayyib AA, Robinson WT, Masiello-Schuette S, Sey EK, Anderson BJ, Poe J, Braunstein S. Age-Related Differences in Past or Present Hepatitis C Virus Infection Among People Who Inject Drugs: National Human Immunodeficiency Virus Behavioral Surveillance, 8 US Cities, 2015. J Infect Dis 2019; 220:377-385. [PMID: 30915477 PMCID: PMC11111175 DOI: 10.1093/infdis/jiz142] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 03/26/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Historically, older people who inject drugs (PWID) have had the highest hepatitis C virus (HCV) burden; however, young PWID now account for recent increases. We assessed factors associated with past or present HCV infection (HCV antibody [anti-HCV] positive) among young (≤35 years) and older (>35 years) PWID. METHODS We calculated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) to examine sociodemographic and past 12-month injection behaviors associated with HCV infection. RESULTS Of 4094 PWID, 55.2% were anti-HCV positive. Among young PWID, anti-HCV prevalence was 42.1% and associated with ≤high school diploma/General Education Development diploma (GED) (aPR, 1.17 [95% CI, 1.03-1.33]), receptive syringe sharing (aPR, 1.37 [95% CI, 1.21-1.56]), sharing injection equipment (aPR, 1.16 [95% CI, 1.01-1.35]), arrest history (aPR, 1.14 [95% CI, 1.02-1.29]), and injecting speedball (aPR, 1.37 [95% CI, 1.16-1.61]). Among older PWID, anti-HCV prevalence was 62.2% and associated with ≤high school diploma/GED (aPR, 1.08 [95% CI, 1.02-1.15]), sharing injection equipment (aPR, 1.08 [95% CI, 1.02-1.15]), high injection frequency (aPR, 1.16 [95% CI, 1.01-1.34]), and injecting speedball (aPR, 1.09 [95% CI, 1.01-1.16]). CONCLUSIONS Anti-HCV prevalence is high among PWID and varies with age. Scaling up direct-acting antiviral treatment, syringe service programs, and medication-assisted therapy is critical to mitigating transmission risk and infection burden.
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Affiliation(s)
- Winston E Abara
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lindsay Trujillo
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dita Broz
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Teresa Finlayson
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eyasu Teshale
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gabriela Paz-Bailey
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sara Glick
- Division of Allergy and Infectious Diseases, School of Medicine, University of Washington, Seattle, Washington
| | - Alia A Al-Tayyib
- Denver Public Health, Denver Health and Hospital Authority, Denver, Colorado
| | - William T Robinson
- STD/HIV Program, Louisiana Department of Health and LSU Health Sciences Center, School of Public Health, New Orleans, Louisiana
| | | | - Ekow K Sey
- Los Angeles County Department of Public Health, Los Angeles, California
| | - Bridget J Anderson
- Bureau of HIV/AIDS Epidemiology, New York State Department of Health, Albany, New York
| | - Jonathon Poe
- TB/HIV/STD Branch, Texas Department of State Health Services, Austin, Texas
| | - Sarah Braunstein
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York
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Jacka B, Kemp R, Degenhardt L, Peacock A, Clare P, Bruno R, Dev A, Sotade O, Larance B. Trends in methamphetamine and opioid use among clients of needle-syringe programs in Queensland, Australia: 2007-2015. Drug Alcohol Rev 2019; 38:159-168. [PMID: 30761653 DOI: 10.1111/dar.12908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 01/08/2019] [Accepted: 01/09/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS Needle-syringe programs (NSP) are an underutilized source of data on drug injection trends; these data are essential for informing public health interventions. We examine trends in NSP service occasions from 2007-2015. DESIGN AND METHODS Using standardised data from 26 NSP outlets through the Queensland NSP Minimum Data Set (QNSPMDS), trends in service occasions among clients intending to inject methamphetamine, heroin, opioid substitution therapy (OST) medications and other pharmaceutical opioids were assessed using multilevel mixed-effects negative binomial regression, adjusting for month, year, age and clustering by site. RESULTS Over 1.5 million service occasions were recorded in 2007-2015. Methamphetamine was the main 'drug intended to inject' (33.7%), however cf. 2007, the incidence rate ratio decreased to 0.64 (95% CI: 0.62, 0.66) in 2009, remaining low until 2015. Among clients reporting methamphetamine injection, there was a shift in the form from base to the higher-potency crystal methamphetamine since 2012. Heroin injection (22.5% service occasions) initially increased (cf. 2007), followed by a decline to 0.77 (95% CI: 0.75, 0.79) in 2015. Significant and sustained increases in OST and other pharmaceutical opioids injection were observed throughout the study period, accounting for 7.2% and 19.8% of total visits, respectively. DISCUSSION AND CONCLUSIONS The QNSPMDS provides unique, routinely collected, jurisdiction-wide and standardised data on the demographics of people who inject drugs, types of drugs injected and regional variations; these data are essential in informing policy, planning and program implementation. There remains significant opportunity to enhance engagement and linkage to care alongside needle-syringe provision.
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Affiliation(s)
- Brendan Jacka
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.,Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Robert Kemp
- Communicable Diseases Branch, Queensland Health, Brisbane, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.,School of Medicine (Psychology), University of Tasmania, Hobart, Australia
| | - Philip Clare
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Raimondo Bruno
- School of Medicine (Psychology), University of Tasmania, Hobart, Australia
| | - Abhilash Dev
- Chief Medical Officer and Healthcare Regulation Branch, Queensland Health, Brisbane, Australia
| | | | - Briony Larance
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.,School of Psychology, University of Wollongong, Wollongong, Australia
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Banwell C, Bammer G, Main N, Gifford SM, O'Brien M. Disturbingly low levels of contraception among women living with hepatitis C. Aust N Z J Public Health 2007; 27:620-6. [PMID: 14723410 DOI: 10.1111/j.1467-842x.2003.tb00609.x] [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: 01/04/2023] Open
Abstract
OBJECTIVE To describe the prevalence of contraception among a sample of women with hepatitis C (HCV), compare it with contraceptive use among Australian women generally, and look for associations between contraception and sample characteristics. METHOD Women who self-identified as living with HCV were recruited through a wide range of non-clinical and clinical sites in the Australian Capital Territory (ACT) and Victoria to complete a self-administered questionnaire. RESULTS Seventy-five per cent of distributed questionnaires were completed and returned. Of the 462 women surveyed, 34% of those aged 18-49 reported using contraceptives; a much lower prevalence than the 67% in the Australian population. Surprisingly, women who reported concerns about transmission to children were no more likely to use contraceptives. Not surprisingly, women who were lesbian or who did not have a current partner were even less likely to use contraceptives. Both employed women and those not on benefits reported significantly higher levels of contraception. Otherwise, contraception did not vary with a range of variables including age, education, injecting drug use status, self-rated health status, experience of HCV symptoms, time since diagnosis, ever having received HCV treatment, or venue at which the participants were recruited. CONCLUSIONS The low prevalence of contraception among women with HCV is both disturbing and puzzling. IMPLICATIONS These findings raise several important and hitherto unconsidered issues for the sexual and reproductive health and well-being of women with HCV. These require both further research and urgent attention by service providers.
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Affiliation(s)
- Cathy Banwell
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory.
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Abelson J, Treloar C, Crawford J, Kippax S, van Beek I, Howard J. Some characteristics of early-onset injection drug users prior to and at the time of their first injection. Addiction 2006; 101:548-55. [PMID: 16548934 DOI: 10.1111/j.1360-0443.2006.01379.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS This paper examines differences between early- and late-onset injection drug users (12-16 years versus 17-24 years) in terms of the antecedents and circumstances of first injection. DESIGN Cross-sectional retrospective design, using logistic regression. Setting Australia: Sydney, Brisbane, rural New South Wales. PARTICIPANTS A total of 336 injection drug users aged 16-25 years at the time of interview. MEASUREMENTS Independent variables included family injection drug use, homelessness and other demographic variables, drugs used prior to the first injection, length of pre-injection drug career, behaviours at time of first injection (e.g. drug injected, reasons/motives for the first injection, risk behaviours). FINDINGS Early-onset injection was associated independently with: having a family who injected drugs, having left school early, an unreliable source of income, a short pre-injection drug career, planning of the first injection, reliance on others for administration of the first injection and denial that experimentation was the motive for the first injection. In bivariate analysis, early-onset injection was associated further with: homelessness, being an Indigenous Australian, omission of use of certain pre-injection drugs, group presence at first injection, reliance on others for acquisition of the first needle and syringe and having injected the first time because an injection was offered. CONCLUSIONS The research shows that early-onset, compared with late-onset injectors, are more likely to have an immediate family who inject drugs and other problematic beginnings in early life. They have an accelerated transition to injection, and differences in autonomy and motivation at first injection. These characteristics may make them more vulnerable to risk taking.
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Affiliation(s)
- Jeanne Abelson
- National Centre in HIV Social Research, University of New South Wales, NSW 2052, Australia.
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Neuman MG, Monteiro M, Rehm J. Drug interactions between psychoactive substances and antiretroviral therapy in individuals infected with human immunodeficiency and hepatitis viruses. Subst Use Misuse 2006; 41:1395-463. [PMID: 17002989 DOI: 10.1080/10826080600846235] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The liver disease characteristic of alcohol dependence encompasses three main related entities: steatosis, alcoholic hepatitis, and cirrhosis. Alcoholic cirrhosis is a leading cause of global morbidity and mortality. Alcohol intake among injecting drug users is a major contributor to transmission of viral infections, such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C viruses (HCV). HIV and HCV coinfected patients develop liver diseases earlier and more severely than the monoinfected individuals, including hepatocellular carcinoma. Interactions exist between the therapeutic drugs used to minimize and control the drug and alcohol dependence. Furthermore, drug-drug interactions occur between the highly active antiretroviral therapy (HAART) and alcohol, different HAART components and methadone, or each one of the therapies with the other, thus contributing to a higher toxicity level. With the evolution of effective antiretroviral therapy, survival of persons with HIV, and the syndrome it causes, acquired immunodeficiency syndrome (AIDS) has increased dramatically. Drug-drug interactions may appear between alcohol and anti-HBV or anti-HCV, therapy in the presence or absence of anti-HIV therapy. Several other medical-, social-, and drug-related factors of this population have to be considered when providing HAART. Because many coinfected patients also have problems with substance use, dealing with their drug dependence is an important first step in an attempt to improve adherence to and tolerance of antiviral therapy. It is necessary to minimize the risk of liver disease acceleration and/or reinfection with hepatitis viruses. Knowledge of potential drug interactions between methadone, antiretroviral therapy, psychoactive drugs, and antipsychotics and the role of coinfection with HBV or HCV and the drugs used in eradicating viral hepatitis permits suitable antiretroviral combinations.
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Judd A, Parry J, Hickman M, McDonald T, Jordan L, Lewis K, Contreras M, Dusheiko G, Foster G, Gill N, Kemp K, Main J, Murray-Lyon I, Nelson M. Evaluation of a modified commercial assay in detecting antibody to hepatitis C virus in oral fluids and dried blood spots. J Med Virol 2003; 71:49-55. [PMID: 12858408 DOI: 10.1002/jmv.10463] [Citation(s) in RCA: 141] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Oral fluid testing is an effective alternative to serum antibody testing for surveillance of human immunodeficiency virus (HIV) and hepatitis B infections, and is being extended to hepatitis C infections. The objective of this study was to determine and compare the sensitivity and specificity of a modified commercial assay for the detection of antibody to hepatitis C virus (anti-HCV) in oral fluids collected by two different oral fluid collection devices (the Epitope OraSure trade mark and Sarstedt Salivette ) and in dried fingerprick blood spots. In this study, 253 anti-HCV seropositive patients and 394 blood donors (all anti-HCV negative) were recruited between August 2000 and January 2001. Each participant provided oral fluid specimens by OraSure and Salivette, and at least one dried blood spot. Serum specimens were collected from the patients whenever possible. For those injecting drug users who did not provide a serum specimen, HCV status was established on the basis of previous testing. All the nonserum samples were tested for the presence of anti-HCV, using a modified Ortho HCV 3.0 SAVe enzyme-linked immunosorbent assay (ELISA) protocol. The recommended preliminary cutoffs for the modified ELISA were suboptimal. Further, the sensitivity, specificity, and positive and negative predictive values could be improved by varying the cutoff and taking into account the likely prevalence of HCV in the population under investigation. For instance, given a population with a 50% prevalence of anti-HCV, the optimal sensitivities of the modified assay on OraSure, Salivette, and dried blood spots were 92%, 83%, and virtually 100%, respectively, in contrast to 83%, 59%, and 99% using the preliminary cutoffs. The respective optimal specificities were 99%, 93%, and 100%. In conclusion, oral fluids collected by the OraSure device provide an extremely useful method to conduct public health surveillance of not only HIV, but also hepatitis C, among injecting drug users. In addition, dried blood spot specimens may be useful for surveillance and could be employed as a first line diagnostic specimen.
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Affiliation(s)
- Ali Judd
- Centre for Research on Drugs and Health Behaviour, Department of Social Science and Medicine, Faculty of Medicine, Imperial College London, United Kingdom.
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Beckerman NL, Grube-Farrell B. Hepatitis C: what every case manager should know. CARE MANAGEMENT JOURNALS : JOURNAL OF CASE MANAGEMENT ; THE JOURNAL OF LONG TERM HOME HEALTH CARE 2003; 3:160-5. [PMID: 12847931 DOI: 10.1891/cmaj.3.4.160.57453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Over the next decade, case managers can anticipate encountering increasing numbers of clients with hepatitis C. This article provides a sociopolitical and medical overview of hepatitis C, diagnosis, risk and transmission factors, co-infection of HIV and hepatitis C treatment issues. The article identifies and analyzes policy and practice implications for case managers in health care.
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Affiliation(s)
- Nancy L Beckerman
- Yeshiva University, Wurzweiler School of Social Work, 2495 Amsterdam Ave., New York, NY 10033, USA.
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Abstract
BACKGROUND Knowing the facts and displaying the proper attitudes and behaviors are critical in preventing the spread of infectious diseases. Hepatitis C is a common infection, but the public's understanding of it has not been studied. METHODS A convenience sample of 431 French adults, ages 18 to 81 years, completed a questionnaire designed to assess knowledge of hepatitis C and acquired immune deficiency syndrome. A group of nine medical experts also answered the hepatitis C questions. RESULTS The lay participants had many uncertainties about hepatitis C, and their beliefs frequently differed from medical understanding about hepatitis C. Their responses were correlated more closely with their own responses to the AIDS questions than with the experts' understanding of hepatitis C. CONCLUSIONS Information regarding hepatitis C should emphasize the distinctions between hepatitis C and AIDS as well as between hepatitis C and hepatitis B and between seropositivity and infection. People should also be informed that blood donation is safe, that using injected drugs is the main risk factor for hepatitis C, that alcohol aggravates hepatitis C, that hepatitis C can cause cancer, that an effective treatment for hepatitis C exists, and that they are not put at risk by mere causal contact with people ill with hepatitis C.
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Magura S, Nwakeze PC, Rosenblum A, Joseph H. Substance misuse and related infectious diseases in a soup kitchen population. Subst Use Misuse 2000; 35:551-83. [PMID: 10741541 DOI: 10.3109/10826080009147472] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Representative samples of female (N = 119) and male (N = 100) guests were selected at two inner city soup kitchens. In the preceding month, 75% used cocaine/crack and 25% used heroin/opiates as determined by hair analysis. Relatively few guests (25%) were in substance dependency treatment. Infectious disease rates were: HIV (16%), hepatitis B exposure (21%), hepatitis B carrier (6%), syphilis exposure (15%). Years of injecting drug use and homelessness/marginal housing were associated with HIV infection and hepatitis B exposure. Soup kitchens should be prime locations for outreach to cocaine/crack and heroin users in need of treatment, medical care, and interventions to prevent infectious disease transmission.
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Affiliation(s)
- S Magura
- Institute for Treatment and Services Resarch, National Development and Research Institutes, Inc., New York, New York 10048, USA.
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