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Jaafar S, Torres-Leguizamon M, Duplessy C, Stambolis-Ruhstorfer M. Hormonothérapie injectable et réduction des risques : pratiques, difficultés, santé des personnes trans en France. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2023; 34:109-122. [PMID: 37336724 DOI: 10.3917/spub.hs2.0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
INTRODUCTION Hormone therapy (HT) adherence practices among trans people are poorly studied. For a large proportion of these people, HT is administered parenterally. The unavailability of certain treatments in France, combined with poor institutional care, keeps injectors away from the health care system and encourages potentially risky injection practices. Following a significant increase in the number of trans people in its active list, the association Safe, coordinator of the remote harm reduction system in France, conducted a cross-sectional descriptive study from December 2020 to February 2021 using an anonymous self-administered online questionnaire. PURPOSE OF RESEARCH The objective is to better understand the profile of trans people who inject their HT and their injection practices. RESULTS We observed that a significant proportion of trans injectors do not benefit from professional support, either to obtain treatment or to carry out the injection. This situation can lead to certain misuses of medical supplies, such as needle sharing or reuse, which present significant health risks. This is especially true for injectors whose treatment is not legally available and who obtain it through parallel markets. This study also underlines the importance of self-support associations to accompany transition. CONCLUSIONS We therefore propose that a harm reduction policy adapted to the practices of trans people be implemented in order to better support this population and avoid the emergence of major health problems such as HIV infection.
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Rousselet M, Guerlais M, Caillet P, Le Geay B, Mauillon D, Serre P, Chameau PY, Bleher Y, Mounsande S, Jolliet P, Victorri-Vigneau C. Consumption of psychoactive substances in prison: Between initiation and improvement, what trajectories occur after incarceration? COSMOS study data. PLoS One 2019; 14:e0225189. [PMID: 31800580 PMCID: PMC6892542 DOI: 10.1371/journal.pone.0225189] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 10/30/2019] [Indexed: 11/27/2022] Open
Abstract
Background Few studies have examined the consumption trajectories of inmates after entry to prison. The aim of this study was to assess the changes in the consumption of psychoactive substance between the period before detention and during incarceration and to characterize the profiles of prisoners with similar consumption trajectories during incarceration. Methods and findings A multicenter, cross-sectional study was performed in all of the prisons from one region of France. All prisoners incarcerated during their 3rd months, over 18 years old, and with a sufficient level of French fluency to participate in the study were recruited over a period of 12 months. A total of 800 prisoners were recruited. All prisoners were interviewed face-to-face by a trained interviewer. A majority of prisoners had used at least one psychoactive substance in the weeks prior to incarceration. During incarceration, a substantial reduction in alcohol and illicit drug consumption was observed. The initiation of consumption and an increase in consumption were primarily related to medications. Five different profiles of consumption before incarceration were identified. These profiles all had a high probability of migrating to a similar profile during detention, characterized by less severe consumption of psychoactive substances. Conclusions Based on their consumption profile prior to incarceration, most prisoners would benefit from a specific medical evaluation as soon as possible following entry into detention. Prison could be an opportunity for reduced consumption and/or the initiation of treatment for the majority of prisoners, despite the pejorative development observed for a minority of prisoners during incarceration.
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Affiliation(s)
- Morgane Rousselet
- Centre for Evaluation and Information on Pharmacodependence, Clinical Pharmacology Department, Nantes University Hospital, France
- INSERM U1246 SPHERE “methodS in Patient-centered outcomes and HEalth ResEarch”, Nantes and Tours University, Nantes, France
- Addictology and Psychiatry Department, University Hospital, Nantes, France
| | - Marylène Guerlais
- Centre for Evaluation and Information on Pharmacodependence, Clinical Pharmacology Department, Nantes University Hospital, France
| | - Pascal Caillet
- Centre for Evaluation and Information on Pharmacodependence, Clinical Pharmacology Department, Nantes University Hospital, France
- INSERM U1246 SPHERE “methodS in Patient-centered outcomes and HEalth ResEarch”, Nantes and Tours University, Nantes, France
| | - Bertrand Le Geay
- Department of Prison Psychiatry, Nantes University Hospital, France
| | - Damien Mauillon
- Medical department of prison, Angers University Hospital, France
| | - Patrick Serre
- Medical department of prison, Le Mans HospitalFrance
| | | | - Yves Bleher
- Medical department of prison, La Roche sur Yon Departemental Hospital, Boulevard Stéphane Moreau, France
| | - Serge Mounsande
- Medical department of prison, Fontenay-Le-Comte Hospital, France
| | - Pascale Jolliet
- Centre for Evaluation and Information on Pharmacodependence, Clinical Pharmacology Department, Nantes University Hospital, France
- INSERM U1246 SPHERE “methodS in Patient-centered outcomes and HEalth ResEarch”, Nantes and Tours University, Nantes, France
| | - Caroline Victorri-Vigneau
- Centre for Evaluation and Information on Pharmacodependence, Clinical Pharmacology Department, Nantes University Hospital, France
- INSERM U1246 SPHERE “methodS in Patient-centered outcomes and HEalth ResEarch”, Nantes and Tours University, Nantes, France
- * E-mail:
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Auriacombe M, Roux P, Briand Madrid L, Kirchherr S, Kervran C, Chauvin C, Gutowski M, Denis C, Carrieri MP, Lalanne L, Jauffret-Roustide M. Impact of drug consumption rooms on risk practices and access to care in people who inject drugs in France: the COSINUS prospective cohort study protocol. BMJ Open 2019; 9:e023683. [PMID: 30796121 PMCID: PMC6398695 DOI: 10.1136/bmjopen-2018-023683] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 12/27/2018] [Accepted: 01/04/2019] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION The high prevalence of hepatitis C and the persistence of HIV and hepatitis C virus (HCV) risk practices in people who inject drugs (PWID) in France underlines the need for innovative prevention interventions. The main objective of this article is to describe the design of the COSINUS cohort study and outline the issues it will explore to evaluate the impact of drug consumption rooms (DCR) on PWID outcomes. Secondary objectives are to assess how DCR (a) influence other drug-related practices, such as the transition from intravenous to less risky modes of use, (b) reduce drug use frequency/quantity, (c) increase access to treatment for addiction and comorbidities (infectious, psychiatric and other), (d) improve social conditions and (e) reduce levels of violence experienced and drug-related offences. COSINUS will also give us the opportunity to investigate the impact of other harm reduction tools in France and their combined effect with DCR on reducing HIV-HCV risk practices. Furthermore, we will be better able to identify PWID needs. METHODS AND ANALYSIS Enrollment in this prospective multi-site cohort study started in June 2016. Overall, 680 PWID in four different cities (Bordeaux, Marseilles, Paris and Strasbourg) will be enrolled and followed up for 12 months through face-to-face structured interviews administered by trained staff to all eligible participants at baseline (M0), 3 month (M3), 6 month (M6) and 12 month (M12) follow-up visits. These interviews gather data on socio-demographic characteristics, past and current drug and alcohol consumption, drug-use related practices, access to care and social services, experience of violence (as victims), offences, other psychosocial issues and perception and needs about harm reduction interventions and services. Longitudinal data analysis will use a mixed logistic model to assess the impact of individual and structural factors, including DCR attendance and exposure to other harm reduction services, on the main outcome (HIV-HCV risk practices). ETHICS AND DISSEMINATION This study was reviewed and approved by the institutional review board of the French Institute of Medical Research and Health (opinion number: 14-166). The findings of this cohort study will help to assess the impact of DCR on HIV-HCV risk practices and other psycho-social outcomes and trajectories. Moreover, they will enable health authorities to shape health and harm reduction policies according to PWID needs. Finally, they will also help to improve current harm reduction and therapeutic interventions and to create novel ones.
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Affiliation(s)
- Marc Auriacombe
- University of Bordeaux, Bordeaux, Aquitaine, France
- Addiction Team, SANPSY, CNRS USR 3413, Bordeaux, France
- Department of Psychiatry, University of Pennsylvania Center for Studies of Addiction, Philadelphia, Pennsylvania, USA
- Pôle Addictologie, CH Charles Perrens and CHU de Bordeaux, Bordeaux, France
| | - Perrine Roux
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Laélia Briand Madrid
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Sébastien Kirchherr
- Department of Psychiatry and Addictology, INSERM 1114, University Hospital of Strasbourg, Strasbourg, France
| | - Charlotte Kervran
- University of Bordeaux, Bordeaux, Aquitaine, France
- Addiction Team, SANPSY, CNRS USR 3413, Bordeaux, France
| | - Carole Chauvin
- CERMES3 (INSERM U988/UMR CNRS 8211/EHESS/Paris Descartes University), Paris, France
| | - Marie Gutowski
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Cécile Denis
- Addiction Team, SANPSY, CNRS USR 3413, Bordeaux, France
- Department of Psychiatry, University of Pennsylvania Center for Studies of Addiction, Philadelphia, Pennsylvania, USA
| | - Maria Patrizia Carrieri
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Laurence Lalanne
- INSERM U1114, Strasbourg, Alsace, France
- Department of Psychiatry and Addictology, Hopitaux universitaires de Strasbourg, Strasbourg, France
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Coutin L, Decreusefond L, Dhersin JS. A Markov Model for the Spread of Viruses in an Open Population. J Appl Probab 2016. [DOI: 10.1239/jap/1294170513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Inspired by methods of queueing theory, we propose a Markov model for the spread of viruses in an open population with an exogenous flow of infectives. We apply it to the diffusion of AIDS and hepatitis C diseases among drug users. From a mathematical point of view, the difference between the two viruses is shown in two parameters: the probability of curing the disease (which is 0 for AIDS but positive for hepatitis C) and the infection probability, which seems to be much higher for hepatitis. This model bears some resemblance to the M/M/∞ queueing system and is thus rather different from the models based on branching processes commonly used in the epidemiological literature. We carry out an asymptotic analysis (large initial population) and show that the Markov process is close to the solution of a nonlinear autonomous differential system. We prove both a law of large numbers and a functional central limit theorem to determine the speed of convergence towards the limiting system. The deterministic system itself converges, as time tends to ∞, to an equilibrium point. We then show that the sequence of stationary probabilities of the stochastic models shrinks to a Dirac measure at this point. This means that in a large population and for long-term analysis, we may replace the individual-based microscopic stochastic model with the macroscopic deterministic system without loss of precision. Moreover, we show how to compute the sensitivity of any functional of the Markov process with respect to a slight variation of any parameter of the model. This approach is applied to the spread of diseases among drug users, but could be applied to many other case studies in epidemiology.
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A Markov Model for the Spread of Viruses in an Open Population. J Appl Probab 2016. [DOI: 10.1017/s0021900200007300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Inspired by methods of queueing theory, we propose a Markov model for the spread of viruses in an open population with an exogenous flow of infectives. We apply it to the diffusion of AIDS and hepatitis C diseases among drug users. From a mathematical point of view, the difference between the two viruses is shown in two parameters: the probability of curing the disease (which is 0 for AIDS but positive for hepatitis C) and the infection probability, which seems to be much higher for hepatitis. This model bears some resemblance to the M/M/∞ queueing system and is thus rather different from the models based on branching processes commonly used in the epidemiological literature. We carry out an asymptotic analysis (large initial population) and show that the Markov process is close to the solution of a nonlinear autonomous differential system. We prove both a law of large numbers and a functional central limit theorem to determine the speed of convergence towards the limiting system. The deterministic system itself converges, as time tends to ∞, to an equilibrium point. We then show that the sequence of stationary probabilities of the stochastic models shrinks to a Dirac measure at this point. This means that in a large population and for long-term analysis, we may replace the individual-based microscopic stochastic model with the macroscopic deterministic system without loss of precision. Moreover, we show how to compute the sensitivity of any functional of the Markov process with respect to a slight variation of any parameter of the model. This approach is applied to the spread of diseases among drug users, but could be applied to many other case studies in epidemiology.
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Roux P, Sagaon-Teyssier L, Lions C, Fugon L, Verger P, Carrieri MP. HCV seropositivity in inmates and in the general population: an averaging approach to establish priority prevention interventions. BMJ Open 2014; 4:e005694. [PMID: 25331969 PMCID: PMC4202016 DOI: 10.1136/bmjopen-2014-005694] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Despite the fact that a considerable portion of hepatitis C virus (HCV) positive individuals are viraemic, the risk of transmitting HCV to others is context dependent. Prison is a particularly risky environment as HCV prevention tools are often unavailable. Using data from a cross-sectional study conducted in centres for HCV testing in southeastern France, we aimed to compare the patterns of risk factors in HCV-positive inmates with those in the general population. SETTING 26 centres for HIV/HCV testing in southeastern France (23 in the general population and 3 in prison). PRIMARY OUTCOME MEASURE HCV seropositivity measured with ELISA test. METHODS A propensity score method to ensure that the general and inmate populations could be compared and a multimodel averaging to estimate the degree (strong, weak, none) of the association of a number of specific factors with HCV seropositivity in each group. RESULTS Among the 52,082 participants, HCV infection prevalence was 1.5% and 5.2% in the general (n=46,125) and inmate (n=5957) populations, respectively. In both populations, 'drug injection without snorting' and 'drug injection with snorting' were very strongly associated with HCV seropositivity. Among inmates, 'drug snorting alone' (OR (95% CI) 2.21 (1.39 to 3.52) was also a strong correlate while tattoos, piercings (OR (95% CI) 1.22 (0.92 to 1.61)) and the sharing of toiletry items (OR (95% CI) 1.44 (0.84 to 2.47)) were weak correlates. CONCLUSIONS The pattern of risk factors associated with HCV seropositivity is different between the general and prison populations, injection and snorting practices being more prevalent in the latter. Access to prevention measures in prisons is not only a public health issue but also a human right for inmates who deserve equity of care and prevention.
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Affiliation(s)
- P Roux
- INSERM UMR912 (SESSTIM), Marseille, France
- Université Aix Marseille, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
| | - L Sagaon-Teyssier
- INSERM UMR912 (SESSTIM), Marseille, France
- Université Aix Marseille, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
| | - C Lions
- INSERM UMR912 (SESSTIM), Marseille, France
- Université Aix Marseille, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
| | - L Fugon
- INSERM UMR912 (SESSTIM), Marseille, France
- Université Aix Marseille, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
- AIDES, Tour Essor, Pantin, France
| | - P Verger
- INSERM UMR912 (SESSTIM), Marseille, France
- Université Aix Marseille, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
| | - M P Carrieri
- INSERM UMR912 (SESSTIM), Marseille, France
- Université Aix Marseille, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
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Wiessing L, Ferri M, Grady B, Kantzanou M, Sperle I, Cullen KJ, Hatzakis A, Prins M, Vickerman P, Lazarus JV, Hope VD, Matheï C. Hepatitis C virus infection epidemiology among people who inject drugs in Europe: a systematic review of data for scaling up treatment and prevention. PLoS One 2014; 9:e103345. [PMID: 25068274 PMCID: PMC4113410 DOI: 10.1371/journal.pone.0103345] [Citation(s) in RCA: 178] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 06/29/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND People who inject drugs (PWID) are a key population affected by hepatitis C virus (HCV). Treatment options are improving and may enhance prevention; however access for PWID may be poor. The availability in the literature of information on seven main topic areas (incidence, chronicity, genotypes, HIV co-infection, diagnosis and treatment uptake, and burden of disease) to guide HCV treatment and prevention scale-up for PWID in the 27 countries of the European Union is systematically reviewed. METHODS AND FINDINGS We searched MEDLINE, EMBASE and Cochrane Library for publications between 1 January 2000 and 31 December 2012, with a search strategy of general keywords regarding viral hepatitis, substance abuse and geographic scope, as well as topic-specific keywords. Additional articles were found through structured email consultations with a large European expert network. Data availability was highly variable and important limitations existed in comparability and representativeness. Nine of 27 countries had data on HCV incidence among PWID, which was often high (2.7-66/100 person-years, median 13, Interquartile range (IQR) 8.7-28). Most common HCV genotypes were G1 and G3; however, G4 may be increasing, while the proportion of traditionally 'difficult to treat' genotypes (G1+G4) showed large variation (median 53, IQR 43-62). Twelve countries reported on HCV chronicity (median 72, IQR 64-81) and 22 on HIV prevalence in HCV-infected PWID (median 3.9%, IQR 0.2-28). Undiagnosed infection, assessed in five countries, was high (median 49%, IQR 38-64), while of those diagnosed, the proportion entering treatment was low (median 9.5%, IQR 3.5-15). Burden of disease, where assessed, was high and will rise in the next decade. CONCLUSION Key data on HCV epidemiology, care and disease burden among PWID in Europe are sparse but suggest many undiagnosed infections and poor treatment uptake. Stronger efforts are needed to improve data availability to guide an increase in HCV treatment among PWID.
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Affiliation(s)
- Lucas Wiessing
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - Marica Ferri
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - Bart Grady
- Cluster Infectious Diseases, Department of Research, Public Health Service, Amsterdam, The Netherlands
- Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, Amsterdam, The Netherlands
| | - Maria Kantzanou
- National Reference Centre for Retroviruses, Laboratory of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Ida Sperle
- Copenhagen HIV Programme (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Katelyn J. Cullen
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
| | | | - Angelos Hatzakis
- National Reference Centre for Retroviruses, Laboratory of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Maria Prins
- Cluster Infectious Diseases, Department of Research, Public Health Service, Amsterdam, The Netherlands
- Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, Amsterdam, The Netherlands
| | - Peter Vickerman
- London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Jeffrey V. Lazarus
- Copenhagen HIV Programme (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Vivian D. Hope
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
- London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Catharina Matheï
- Department of Public Health and Primary Care, KULeuven, Leuven, Belgium
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Hall HI, Halverson J, Wilson DP, Suligoi B, Diez M, Le Vu S, Tang T, McDonald A, Camoni L, Semaille C, Archibald C. Late diagnosis and entry to care after diagnosis of human immunodeficiency virus infection: a country comparison. PLoS One 2013; 8:e77763. [PMID: 24223724 PMCID: PMC3818378 DOI: 10.1371/journal.pone.0077763] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 09/04/2013] [Indexed: 12/12/2022] Open
Abstract
Background Testing for HIV infection and entry to care are the first steps in the continuum of care that benefit individual health and may reduce onward transmission of HIV. We determined the percentage of people with HIV who were diagnosed late and the percentage linked into care overall and by demographic and risk characteristics by country. Methods Data were analyzed from national HIV surveillance systems. Six countries, where available, provided data on two late diagnosis indicators (AIDS diagnosis within 3 months of HIV diagnosis, and AIDS diagnosis within 12 months before HIV diagnosis) and linkage to care (≥1 CD4 or viral load test result within 3 months of HIV diagnosis) for people diagnosed with HIV in 2009 or 2010 (most recent year data were available). Principal Findings The percentage of people presenting with late stage disease at HIV diagnosis varied by country, overall with a range from 28.7% (United States) to 8.8% (Canada), and by transmission categories. The percentage of people diagnosed with AIDS who had their initial HIV diagnosis within 12 months before AIDS diagnosis varied little among countries, except the percentages were somewhat lower in Spain and the United States. Overall, the majority of people diagnosed with HIV were linked to HIV care within 3 months of diagnosis (more than 70%), but varied by age and transmission category. Conclusions Differences in patterns of late presentation at HIV diagnosis among countries may reflect differences in screening practices by providers, public health agencies, and people with HIV. The percentage of people who received assessments of immune status and viral load within 3 months of diagnosis was generally high.
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Affiliation(s)
- H. Irene Hall
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Jessica Halverson
- Public Health Agency of Canada/Agence de la santé publique du Canada, Ontario, Canada
| | - David P. Wilson
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Mercedes Diez
- Secretaría del Plan Nacional sobre el Sida/Centro Nacional de Epidemiología, Madrid, Spain
| | | | - Tian Tang
- ICF Marcro International, Atlanta, Georgia, United States of America
| | - Ann McDonald
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | | | | | - Chris Archibald
- Public Health Agency of Canada/Agence de la santé publique du Canada, Ontario, Canada
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Fatseas M, Denis C, Serre F, Dubernet J, Daulouède JP, Auriacombe M. Change in HIV-HCV risk-taking behavior and seroprevalence among opiate users seeking treatment over an 11-year period and harm reduction policy. AIDS Behav 2012; 16:2082-90. [PMID: 21983799 DOI: 10.1007/s10461-011-0054-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Our purpose was to assess change in HIV and HCV prevalence and risk-taking behaviors among IDUs over a period of time that included changes in French Public Health policy. Risk behavior and biological testing for serostatus were collected from cross-sectional samples of yearly new requests for opiate dependence treatment in Aquitaine, France between 1994 and 2004 (n = 648). Coincident declines in injection equipment sharing and HIV prevalence among injectors were observed, while sexual behavior remained stable. There was a decline in HCV prevalence that was not significant among injectors. After controlling for potential confounding variables, participants enrolled after 1995 were less likely to share injection material and those enrolled after 1999 were less likely to share spoons. Our findings give evidence for behavioral and seroprevalence changes among IDUs over a period of time that included changes in needle access policy.
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Affiliation(s)
- Melina Fatseas
- Laboratoire de Psychiatrie/CNRS USR 3413, Université Bordeaux Segalen, 121 rue de la Béchade, Bordeaux, France, Europe
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10
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Prevalence and characteristics of individuals with undiagnosed HIV infection in France: evidence from a survey on hepatitis B and C seroprevalence. J Acquir Immune Defic Syndr 2012; 60:e114-7. [PMID: 22772350 DOI: 10.1097/qai.0b013e318256b3fd] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Thibault V, Bara JL, Nefau T, Duplessy-Garson C. Hepatitis C transmission in injection drug users: could swabs be the main culprit? J Infect Dis 2011; 204:1839-42. [PMID: 22013222 DOI: 10.1093/infdis/jir650] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Prevention programs for intravenous drug users have proven their efficacy in decreasing human immunodeficiency virus transmission but have limited effect on hepatitis C virus (HCV) contamination. A study was conducted to document the presence of HCV genome (HCV RNA) in 620 items of used injecting paraphernalia collected from representative sites. Using sensitive molecular techniques, HCV RNA was not detected on used filters or water vials and was seldom detected on cups (9%). However, HCV RNA was frequently found on syringe pools (38%) and on swabs (82%) at high titers. Our investigation, which was conducted in real injecting settings, highlights swabs as a potential source for HCV transmission.
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Affiliation(s)
- Vincent Thibault
- Virology Laboratory, Hôpital Pitié-Salpêtrière, Assistance Publique, and Pierre et Marie Curie University, France.
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12
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Jauffret-Roustide M, Cohen J, Poisot-Martin I, Spire B, Gossop M, Carrieri MP, the MANIF 2000 Study Group. Distributive sharing among HIV–HCV co-infected injecting drug users: the preventive role of trust in one's physician. AIDS Care 2011; 24:232-8. [DOI: 10.1080/09540121.2011.596515] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Marie Jauffret-Roustide
- a Institut de Veille Sanitaire , Saint-Maurice , France
- b CERMES3: Centre de Recherche Médecine, Sciences, Santé, Santé Mentale et Société , (INSERM U988 Université Paris Descartes, Ecole des Hautes Etudes en Sciences Sociales) , Paris , France
| | - Julien Cohen
- c INSERM, U912 (SE4S) , Marseille , France
- d Université Aix Marseille, IRD , Marseille , France
- e ORS PACA , Observatoire Régional de la Santé Provence Alpes Côte d'Azur , Marseille , France
| | | | - Bruno Spire
- c INSERM, U912 (SE4S) , Marseille , France
- d Université Aix Marseille, IRD , Marseille , France
- e ORS PACA , Observatoire Régional de la Santé Provence Alpes Côte d'Azur , Marseille , France
| | | | - M. Patrizia Carrieri
- c INSERM, U912 (SE4S) , Marseille , France
- d Université Aix Marseille, IRD , Marseille , France
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Abstract
SUMMARYOver the last 40 years, the dynamics of hepatitis C virus (HCV) infection in drug users has been affected by the illicit drug market, the health environment including the devastating impact of the HIV/AIDS epidemic which erupted in the 1980s, and the diffusion of substitution treatment beginning in 1995. The purpose of this literature review is to present the dynamics of HCV infection in drug users in France over the last 40 years. Two prevalence studies of HCV infection in the general population were conducted by the French Institute for Public Health Surveillance in 1994 and 2004 and were the touchstone data sources for this analysis. Hypotheses constructed from the findings of these two studies were examined in light of results reported by multicentre prevalence and incidence studies in drug-user populations. The incidence of HCV infection in drug users in France reached a peak in the late 1980s or early 1990s after a lengthy period of epidemic expansion. Implementation of a risk reduction policy enabled a very significant reduction in the incidence of HCV infection in drug users over the last 20 years, leading to incidence figures which are now 10–15% of the 1990 estimate.
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Jauffret-Roustide M, Le Strat Y, Couturier E, Thierry D, Rondy M, Quaglia M, Razafandratsima N, Emmanuelli J, Guibert G, Barin F, Desenclos JC. A national cross-sectional study among drug-users in France: epidemiology of HCV and highlight on practical and statistical aspects of the design. BMC Infect Dis 2009; 9:113. [PMID: 19607712 PMCID: PMC2733898 DOI: 10.1186/1471-2334-9-113] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Accepted: 07/16/2009] [Indexed: 12/01/2022] Open
Abstract
Background Epidemiology of HCV infection among drug users (DUs) has been widely studied. Prevalence and sociobehavioural data among DUs are therefore available in most countries but no study has taken into account in the sampling weights one important aspect of the way of life of DUs, namely that they can use one or more specialized services during the study period. In 2004–2005, we conducted a national seroepidemiologic survey of DUs, based on a random sampling design using the Generalised Weight Share Method (GWSM) and on blood testing. Methods A cross-sectional multicenter survey was done among DUs having injected or snorted drugs at least once in their life. We conducted a two stage random survey of DUs selected to represent the diversity of drug use. The fact that DUs can use more than one structure during the study period has an impact on their inclusion probabilities. To calculate a correct sampling weight, we used the GWSM. A sociobehavioral questionnaire was administered by interviewers. Selected DUs were asked to self-collect a fingerprick blood sample on blotting paper. Results Of all DUs selected, 1462 (75%) accepted to participate. HCV seroprevalence was 59.8% [95% CI: 50.7–68.3]. Of DUs under 30 years, 28% were HCV seropositive. Of HCV-infected DUs, 27% were unaware of their status. In the month prior to interview, 13% of DUs shared a syringe, 38% other injection parapharnelia and 81% shared a crack pipe. In multivariate analysis, factors independently associated with HCV seropositivity were age over 30, HIV seropositivity, having ever injected drugs, opiate substitution treatment (OST), crack use, and precarious housing. Conclusion This is the first time that blood testing combined to GWSM is applied to a DUs population, which improve the estimate of HCV prevalence. HCV seroprevalence is high, indeed by the youngest DUs. And a large proportion of DUs are not aware of their status. Our multivariate analysis identifies risk factors such as crack consumption and unstable housing.
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Affiliation(s)
- Marie Jauffret-Roustide
- Infectious Diseases Departement, National Institute for Public Health Surveillance, Saint-Maurice, France.
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Diversité et modes de transmission du virus de l’hépatite C Signes cliniques et évolution de l’infection. ACTUALITES PHARMACEUTIQUES 2008. [DOI: 10.1016/s0515-3700(08)70085-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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de la Tribonnière X, Pugliese P, Cabié A, Cuzin L, Billaud E, Poizot-Martin I, Duvivier C, Yazdanpanah Y. Caractéristiques démographiques, cliniques, immunovirologiques et thérapeutiques de 8714 patients infectés par le VIH de la cohorte Nadis en 2006. Med Mal Infect 2008; 38:299-308. [DOI: 10.1016/j.medmal.2008.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Revised: 12/18/2007] [Accepted: 02/12/2008] [Indexed: 10/22/2022]
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Michel L, Carrieri MP, Wodak A. Harm reduction and equity of access to care for French prisoners: a review. Harm Reduct J 2008; 5:17. [PMID: 18495018 PMCID: PMC2430551 DOI: 10.1186/1477-7517-5-17] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2007] [Accepted: 05/21/2008] [Indexed: 11/23/2022] Open
Abstract
Background Despite France being regarded as a model of efficient harm reduction policy and equity of access to care in the general community, the health of French inmates is a critical issue, as harm reduction measures are either inaccessible or only partially implemented in French prisons. Method Using specific inclusion and exclusion criteria, information was collected and analyzed about HIV, HBV and HCV prevalence, risk practices, mortality, access to harm reduction measures and care for French prison inmates. Results Data about the occurrence of bloodborne diseases, drug use and access to care in prisons remain limited and need urgent updating. Needle exchange programs are not yet available in French prisons and harm reduction interventions and access to OST remain limited or are heterogeneous across prisons. The continuity of care at prison entry and after release remains problematic and should be among the primary public health priorities for French prisoners. Conclusion Preventive and harm reduction measures should be urgently introduced at least as pilot programs. The implementation of such measures, not yet available in French prisons, is not only a human right for prison inmates but can also provide important public health benefits for the general population.
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Affiliation(s)
- Laurent Michel
- Health and Medical Research National Institute, Research Unit 669, Paris, France.
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Esteban JI, Sauleda S, Quer J. The changing epidemiology of hepatitis C virus infection in Europe. J Hepatol 2008; 48:148-62. [PMID: 18022726 DOI: 10.1016/j.jhep.2007.07.033] [Citation(s) in RCA: 334] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2007] [Accepted: 07/30/2007] [Indexed: 02/07/2023]
Abstract
The epidemic of hepatitis C virus (HCV) infection in Europe is continuously evolving and epidemiological parameters (prevalence, incidence, disease transmission patterns and genotype distribution) have changed substantially during the last 15 years. Four main factors contribute to such changes: increased blood transfusion safety, improvement of healthcare conditions, continuous expansion of intravenous drug use and immigration to Europe from endemic areas. As a result, intravenous drug use has become the main risk factor for HCV transmission, prevalent infections have increased and genotype distribution has changed and diversified. Hence, prevalence data from studies conducted a decade ago may not be useful to estimate the current and future burden of HCV infection and additional epidemiological studies should be conducted, as well as new preventive strategies implemented to control the silent epidemic. This review summarizes recently published data on the epidemiology of HCV infection in Europe focusing on the factors currently shaping the epidemic.
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Affiliation(s)
- Juan I Esteban
- Liver Unit, Department of Medicine, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.
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Jauffret-Roustide M, Emanuelli J, Dsenclos J. L’impact limité de la réduction des risques sur la transmission du VHC chez les usagers de drogues. L’exemple de l’étude ANRS-Coquelicot. Rev Epidemiol Sante Publique 2006. [DOI: 10.1016/s0398-7620(06)76763-3] [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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Adrian M. Addiction and sexually transmitted disease (STD), human immunodeficiency virus, (HIV), and acquired immune deficiency syndrome (AIDS): their mutual interactions. Subst Use Misuse 2006; 41:1337-48. [PMID: 17002986 DOI: 10.1080/10826080600837978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We explore the links between substance use, misuse, addiction, and dependency1 and sexuality, sexually transmitted diseases (STD), human immunodeficiency virus (HIV), and acquired immune deficiency syndrome (AIDS) to increase our awareness of their interdependence and to identify new ways to perceive, judge, and intervene (or not to) with associated problems. We consider the sociocultural and economic context in which these behaviors occur; the impact these behaviors have on one another; the personal opinions and attitudes; the religious, moral, or political beliefs and agendas; the physiological and fiscal constraints; and theories of rational decision-making and psychological motivation that act to increase or reduce the incidence of these behaviors and their sequellae, while hindering or facilitating prevention, harm reduction, and treatment interventions. Mechanisms of epidemic spread of STDS/HIV/AIDS are presented in the Appendix. Each of these terms are loaded "container concepts" that are culture-bound and stakeholder-driven and whose dimensions are less than consensus-based. They represent a range of meanings, uses, and misuses in an ongoing politicalized area of human and systemic functioning and adaptations.
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Affiliation(s)
- Manuella Adrian
- Master of Public Health Program, College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
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