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Toro-Tobón D, Berbesi-Fernández D. Prevalence of HIV/Hepatitis C Virus Co-Infection and Injection Risk Correlations in People Who Inject Drugs in Colombia: A Cross-Sectional Study Using Respondent Driven Sampling. Subst Use Misuse 2020; 55:414-423. [PMID: 31691646 DOI: 10.1080/10826084.2019.1683198] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: In Colombia, an exponential growth of people who inject drugs (PWID) has been reported over the past decades. The main burden of disease in PWID is attributed to human immunodeficiency virus (HIV) and hepatitis C virus (HCV) and their co-infection is associated with poor prognosis, high morbidity and treatment related implications. Nevertheless, the prevalence of HIV/HCV co-infection in Colombian PWIDs is unknown. Objective: To determine the prevalence, demographic characteristics, and injecting behaviors of HIV/HCV co-infected PWID in Colombia. Methods: This was a cross-sectional study of 1,123 PWID recruited by respondent driven sampling in five Colombian cities between January and June of 2014. Each participant completed a quantitative survey, and blood samples for HIV and HCV antibody testing were obtained. A multinomial logistic regression was used for statistical analysis. Results: Average participant age was 26.3 ± 6.5 years, and the majority was male (86%). HIV or HCV mono-infection prevalence was 27.6%, while co-infection was 3.3%. Compared with PWID with mono-infection, co-infected PWID exhibited higher odds of: injecting ≥4 times daily (OR: 3.5; CI: 1.7-7.2; p < .001), cleaning needles and syringes with water (OR 3.2; CI: 1.6-6.3; p < .001), passing drug mix between syringes (OR: 2.7; CI: 1.3-5.3; p = .04), injecting on illegal indoor shooting galleries (OR: 2.4; CI: 1.0-5.3, p = .02), and getting injected by someone who charges for injecting (OR 2.3; CI: 1.0-5.2; p = .04). Conclusion: Prevalence of HIV/HCV co-infection among PWID in Colombia is lower than that reported in other countries. However, addressing the identified demographic characteristics and injection risk behaviors of co-infected PWID is essential for the implementation of broadly available harm reduction interventions as well as routine HIV/HCV testing and treatment strategies aiming to control the spread of both viruses and their associated morbidity and mortality.
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Affiliation(s)
- David Toro-Tobón
- Department of Medicine, Georgetown University Hospital, Washington, DC, USA.,Epidemiology and Biostatistics Research Group, CES University, Medellin, Colombia
| | - Dedsy Berbesi-Fernández
- Epidemiology and Biostatistics Research Group, CES University, Medellin, Colombia.,School of Nursing, CES University, Medellin, Colombia
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Zhang L, Zou X, Xu Y, Medland N, Deng L, Liu Y, Su S, Ling L. The Decade-Long Chinese Methadone Maintenance Therapy Yields Large Population and Economic Benefits for Drug Users in Reducing Harm, HIV and HCV Disease Burden. Front Public Health 2019; 7:327. [PMID: 31781529 PMCID: PMC6861367 DOI: 10.3389/fpubh.2019.00327] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 10/23/2019] [Indexed: 12/21/2022] Open
Abstract
Objectives: We aimed to conduct a comprehensive evaluation of the population impact of methadone maintenance treatment (MMT) for its future program planning. Methods: We conducted a literature review of the effects of MMT in China on HIV and HCV disease burden, injecting, and sexual behaviors and drug-related harm during 2004–2015. Data synthesis and analysis were conducted to obtain the pooled estimates of parameters for a mathematical model which was constructed to evaluate the effectiveness and cost-effectiveness of the program. Results: Based on a review of 134 articles, this study demonstrated that MMT is highly effective in reducing crime-related, high risk sexual, and injecting behaviors. The model estimated US$1,037 m which was invested in MMT from 2004 to 2015 has prevented 29,463 (15,325–43,600) new HIV infections, 130,563 (91,580–169,546) new HCV infections, 10,783 (10,380–11,187) deaths related to HIV, HCV and drug-related harm, and 338,920.0 (334,596.2–343,243.7) disability-adjusted life years (DALYs). The costs for each prevented HIV infection, HCV infection, death, and DALY were $35,206.8 (33,594.8–36,981.4), $7,944.7 ($7,714.4–8,189.2), $96,193.4 (92,726.0–99,930.2), and $3,060.6 ($3,022.0–3,100.1) respectively. Conclusion: The Chinese MMT program has been effective and cost-effective in reducing injecting, injecting-related risk behaviors and adversities due to HIV/HCV infection and drug-related harm among drug users.
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Affiliation(s)
- Lei Zhang
- Sun Yat-sen Center for Migrant Health Policy, Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China.,China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia.,Faculty of Medicine, Nursing and Health Sciences, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xia Zou
- Sun Yat-sen Center for Migrant Health Policy, Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yong Xu
- Sun Yat-sen Center for Migrant Health Policy, Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Nick Medland
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Liwei Deng
- Sun Yat-sen Center for Migrant Health Policy, Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yin Liu
- Sun Yat-sen Center for Migrant Health Policy, Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Shu Su
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Li Ling
- Sun Yat-sen Center for Migrant Health Policy, Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
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Toro-Tobón D, Berbesi-Fernandez D, Mateu-Gelabert P, Segura-Cardona ÁM, Montoya-Vélez LP. Prevalence of hepatitis C virus in young people who inject drugs in four Colombian cities: A cross-sectional study using Respondent Driven Sampling. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 60:56-64. [PMID: 30107313 DOI: 10.1016/j.drugpo.2018.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 06/16/2018] [Accepted: 07/15/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Colombia has a growing population of young people who inject drugs (PWID). Despite the previously reported association of injection drug use with hepatitis c virus (HCV) in other countries, studies on HCV prevalence in PWID in Colombia are lacking. The objective of this study is to determine the prevalence, demographics, and correlations of risky injection behaviours in HCV seropositive PWID in four Colombian cities (Armenia, Bogotá, Cúcuta and Pereira). METHODS This was a cross-sectional study carried out between January and June of 2014 that included 918 PWID from four Colombian cities, recruited by Respondent Driven Sampling. A survey was administered to each participant, and blood samples were collected. Binary logistic regression and multivariate analyses for each city were conducted. RESULTS Average participant age was 26 years (SD 6.5). Of all participants, 27.3% of PWID were HCV seropositive, of which 52% were 25 years old or younger. In Pereira, increased risk of HCV infection was found for PWID that: had a history of injection drug use of 5 years or more (AOR: 3.0, CI: 1.7-7.8); were between 25 and 28 years of age (AOR: 5.2, CI: 1.0-26.3); had higher injection frequency (AOR: 2.5, CI: 1.4-4.2), and daily use of gifted, sold, or rented needles or syringes (AOR: 4.5, CI: 1.0-7.1). Additionally, in Cucuta, being HIV seropositive appeared to be greatly associated with risk of HCV seropositivity (AOR: 16.9, CI: 3.5-81.5). CONCLUSION Although prevalence of HCV in PWID in Colombia is lower than that reported for other countries, the described demographic characteristics and diverse risky injection behaviors on each city, in the context of a young PWID population with a short injection drug use history, should be taken into account in order to guide efforts towards preventing and reducing risk of HCV infection in PWID in Colombia.
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Affiliation(s)
- David Toro-Tobón
- School of Medicine, CES University, Medellin, Colombia; Epidemiology and Bioestatistics Research Group, CES University, Medellin, Colombia.
| | - Dedsy Berbesi-Fernandez
- Epidemiology and Bioestatistics Research Group, CES University, Medellin, Colombia; School of Nursing, CES University, Medellin, Colombia.
| | | | - Ángela M Segura-Cardona
- School of Medicine, CES University, Medellin, Colombia; Epidemiology and Bioestatistics Research Group, CES University, Medellin, Colombia.
| | - Liliana P Montoya-Vélez
- School of Medicine, CES University, Medellin, Colombia; Division of Public Health, CES University, Medellin, Colombia.
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Substance Abuse Treatment, HIV/AIDS, and the Continuum of Response for People Who Inject Drugs. Adv Prev Med 2012; 2012:541489. [PMID: 23243517 PMCID: PMC3517826 DOI: 10.1155/2012/541489] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 10/03/2012] [Accepted: 10/04/2012] [Indexed: 11/17/2022] Open
Abstract
The continuum of response (CoR) to HIV/AIDS is a framework for implementation of HIV prevention, care, and treatment programs based on a national strategic plan for HIV/AIDS services. The CoR for people who inject drugs (PWID) is an important extension of the developed CoR to HIV/AIDS. The CoR-PWID employs stakeholders who together plan, develop, pilot, and provide a full range of services that address the various prevention, care/support, and treatment needs of people, families, and communities infected or affected by HIV/AIDS and injection drug use. The CoR-PWID comprises a broad range of services that include but are not limited to the World Health Organization priority interventions for HIV/AIDS prevention, treatment, and care in the health sector and the package of essential interventions for the prevention, treatment, and care of HIV for people who inject drugs. Implementation of these well-defined, essential prevention, care/support, and treatment services, in addition to locally defined needed services, in a coordinated fashion is important to clients, their families, and communities. The CoR-PWID is, therefore, a necessary framework essential for service development for countries that address HIV/AIDS in populations of PWID.
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