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Fitzpatrick T, McMahan VM, Frank ND, Glick SN, Violette LR, Davis S, Jama S. Heroin pipe distribution to reduce high-risk drug consumption behaviors among people who use heroin: a pilot quasi-experimental study. Harm Reduct J 2022; 19:103. [PMID: 36138407 PMCID: PMC9493152 DOI: 10.1186/s12954-022-00685-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Heroin pipe distribution may encourage people who use heroin (PWUH) to transition from injecting to smoking heroin, reducing harms associated with injection drug use. A syringe services program (SSP) in Seattle, Washington, led by people who use drugs developed a heroin pipe distribution program. METHODS We conducted a pretest-posttest quasi-experimental study to evaluate the impact of heroin pipe distribution on drug consumption behaviors among PWUH between March and December 2019. SSP clients were surveyed during three weeklong timepoints before and four weeklong timepoints after heroin pipe distribution. Primary outcomes were change in proportion of SSP clients who exclusively injected heroin, exclusively smoked heroin, and both injected and smoked heroin in the past seven days comparing the pre- and post-intervention periods. RESULTS Across the seven observation timepoints, 694 unique respondents completed 957 surveys. Multiple responses from a single respondent in a given period were collapsed, resulting in 360 pre-intervention and 430 post-intervention records. Heroin use was reported in over half of pre-intervention (56%, 201/360) and post-intervention records (58%, 251/430). Compared to pre-intervention behaviors, the proportion of respondents who exclusively injected heroin was lower after the start of heroin pipe distribution (32%, 80/251 vs 43%, 86/201, p = 0.02), while the proportion of respondents who both injected and smoked heroin was higher (45%, 113/251 vs 36%, 72/201, p = 0.048). Just under half (44%, 110/251) of respondents who used heroin during the post-intervention period used a heroin pipe obtained from the SSP, of which 34% (37/110) reported heroin pipe distribution had reduced their heroin injection frequency. Self-reported hospitalization for a pulmonary cause was not associated with using a heroin pipe. CONCLUSIONS The proportion of SSP clients who exclusively injected heroin was lower after implementation of heroin pipe distribution. Randomized studies with longer follow-up are needed to investigate whether heroin pipe distribution reduces heroin injection and improves health outcomes associated with drug use. Limited intervention exposure, loss to follow-up, and pipe availability from other sources pose methodological challenges to evaluations of route transition interventions in community settings. This pilot highlights the potential for organizations led by people who use drugs to develop, implement, and evaluate novel public health programming.
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Affiliation(s)
- Thomas Fitzpatrick
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA.
- The People's Harm Reduction Alliance, 1959 NE Pacific St., Box 356423, Seattle, WA, 98195, USA.
| | - Vanessa M McMahan
- The People's Harm Reduction Alliance, 1959 NE Pacific St., Box 356423, Seattle, WA, 98195, USA
- Center on Substance use and Health, Department of Public Health, San Francisco, CA, USA
| | - Noah D Frank
- The People's Harm Reduction Alliance, 1959 NE Pacific St., Box 356423, Seattle, WA, 98195, USA
- Office of Infectious Disease, Washington State Department of Health, Olympia, WA, USA
| | - Sara N Glick
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Lauren R Violette
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Shantel Davis
- Safer Alternatives Thru Networking and Education, Sacramento, CA, USA
| | - Shilo Jama
- Safer Alternatives Thru Networking and Education, Sacramento, CA, USA
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O'Brien S, Kyaw KWY, Jaramillo MM, Roberts B, Bijl M, Platt L. Determinants of health among people who use illicit drugs in the conflict-affected countries of Afghanistan, Colombia and Myanmar: a systematic review of epidemiological evidence. Confl Health 2022; 16:39. [PMID: 35799203 PMCID: PMC9264525 DOI: 10.1186/s13031-022-00467-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 06/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Afghanistan, Colombia and Myanmar are the world's leading heroin and cocaine producers and have also experienced prolonged periods of armed conflict. The link between armed conflict and drug markets is well established but how conflict impacts on the health and social determinants of people who use drugs is less clear. The aim was to investigate health outcomes and associated factors among people who use illicit drugs in Afghanistan, Colombia and Myanmar. METHODS We conducted a systematic review searching Medline, EMBASE, PsychINFO and Global Health databases using terms relating to Afghanistan, Colombia and Myanmar; illicit drug use (all modes of drug administration); health and influencing factors. Quality assessment was assessed with the Newcastle-Ottawa-Scale and papers were analysed narratively. RESULTS 35 studies were included in Afghanistan (n = 15), Colombia (n = 9) and Myanmar (n = 11). Health outcomes focused predominantly on HIV, Hepatitis C (HCV), Hepatitis B and sexually transmitted infections (STIs), with one study looking at human rights violations (defined as maltreatment, abuse and gender inequality). Drug use was predominantly injection of heroin, often alongside use of amphetamines (Myanmar), cocaine and cocaine-based derivatives (Colombia). Only one study measured the effect of a period of conflict suggesting this was linked to increased reporting of symptoms of STIs and sharing of needles/syringes among people who inject drugs. Findings show high levels of external and internal migration, alongside low-income and unemployment across the samples. External displacement was linked to injecting drugs and reduced access to needle/syringe programmes in Afghanistan, while initiation into injecting abroad was associated with increased risk of HCV infection. Few studies focused on gender-based differences or recruited women. Living in more impoverished rural areas was associated with increased risk of HIV infection. CONCLUSIONS More research is needed to understand the impact of armed-conflict and drug production on the health of people who use drugs. The immediate scale-up of harm reduction services in these countries is imperative to minimize transmission of HIV/HCV and address harms associated with amphetamine use and other linked health and social care needs that people who use drugs may face.
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Affiliation(s)
- Sally O'Brien
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Khine Wut Yee Kyaw
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Margarita Marin Jaramillo
- Observatorio de Restitución Y Regulación de los Derechos de Propiedad Agraria, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Bayard Roberts
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Murdo Bijl
- Asian Harm Reduction Network (AHRN), Yangon, Myanmar
| | - Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
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Imbeth-Acosta P, Leal-Martínez V, Ramos-Clason E, Pájaro-Galvis N, Martínez-Ávila MC, Almanza-Hurtado A, Rodríguez-Yanez T, Bermudez-Montero J, Vergara-Serpa O, Abuabara-Franco E, Raad-Sarabia M, Villar-González EP, Tatis-Geney SI, Collazos-Torres LA, Rico-Fontalvo J, Daza-Arnedo R, Pérez-Calvo C, Alvarado-Castell H, López Acuña GH. Prevalence of Chronic Infection by Hepatitis C Virus in Asymptomatic Population With Risk Factors in Cartagena, Colombia. Front Med (Lausanne) 2022; 9:814622. [PMID: 35860730 PMCID: PMC9289182 DOI: 10.3389/fmed.2022.814622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Infection by the hepatitis C virus (HCV) is an important cause of chronic liver disease, considered a public health problem worldwide with high morbidity and mortality due to limited access to diagnostic tests in developing countries. Only a small percentage know their infection status and receive timely treatment. It is critical to make diagnostic tests for HCV infection accessible and to provide timely treatment, which not only reduces the spread of infection but also stops the progression of HCV disease without symptoms. Objective To determine the prevalence of chronic infection by HCV in patients with risk factors by using rapid tests in Cartagena, Colombia, and describe their epidemiological characteristics. Methodology A cross-sectional descriptive observational study was carried out on asymptomatic adults with risk factors for HCV infection in the city of Cartagena between December 2017 and November 2019. A rapid immunochromatographic test was performed to detect antibodies, characterizing the population. Results In total, 1,023 patients were identified who met the inclusion criteria, 58.5% women and 41.4% men, obtaining nine positive results, confirming chronic infection with viral load for HCV, finding seven cases of genotype 1b and two genotype 1a. Conclusion In our study, a prevalence of hepatitis C infection of 0.9% was found in asymptomatic individuals with risk factors, which allows us to deduce that the active search for cases in risk groups constitutes a pillar for the identification of the disease, the initiation of antiviral therapy, and decreased morbidity and mortality.
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Affiliation(s)
- Pedro Imbeth-Acosta
- Department of Gastroenterology and Hepatology, Diagnostico y Terapeutica en Gastroenterologia y Hepatologia (DITEG), Cartagena, Colombia
- Department of Internal Medicine, University of Sinu, Cartagena, Colombia
| | | | - Enrique Ramos-Clason
- Department of Public Health and Medical Research, University of Sinu, Cartagena, Colombia
| | | | - María Cristina Martínez-Ávila
- Epidemiologist, Grupo Biotoxam, Universidad de Cartagena, Cartagena, Colombia
- *Correspondence: María Cristina Martínez-Ávila
| | - Amilkar Almanza-Hurtado
- Department of Critical Care Médicine, Gestion Salud Instituto Prestador de Salud (IPS), University of Cartagena, Cartagena, Colombia
| | - Tomás Rodríguez-Yanez
- Department of Critical Care Médicine, Gestion Salud Instituto Prestador de Salud (IPS), University of Cartagena, Cartagena, Colombia
| | | | | | | | - María Raad-Sarabia
- Department of Internal Medicine, University of Sinu, Cartagena, Colombia
| | | | | | | | - Jorge Rico-Fontalvo
- Department of Nephrology, Colombian Association of Nephrology, Medellín, Colombia
| | - Rodrigo Daza-Arnedo
- Department of Nephrology, Colombian Association of Nephrology, Medellín, Colombia
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HIV and Substance Use in Latin America: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127198. [PMID: 35742448 PMCID: PMC9222977 DOI: 10.3390/ijerph19127198] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 12/13/2022]
Abstract
This scoping review aims to explore the interplay between substance use (SU) and HIV in Latin America (LA). Database searches yielded 3481 references; 196 were included. HIV prevalence among people who used substances (PWUS) ranged from 2.8–15.2%. SU definitions were variable throughout studies, and thus data were not easily comparable. In 2019, only 2% of new HIV infections were attributed to injection drug use (IDU) in LA. Factors associated with HIV among PWUS included being female, IDU and homelessness, and PWUS were likely to engage in risky sexual behaviors, start antiretroviral treatment late, have poor adherence, have treatment failure, be lost to follow-up, have comorbidities, and experience higher mortality rates and lower quality of life, as has been reported in PLWH with SU in other regions. Five intervention studies were identified, and only one was effective at reducing HIV incidence in PWUS. Interventions in other regions have varying success depending on context-specific characteristics, highlighting the need to conduct more research in the LA region. Though progress has been made in establishing SU as a major concern in people living with HIV (PLWH), much more is yet to be done to reduce the burden of HIV and SU in LA.
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Selfridge M, Cunningham EB, Barnett T, Drost A, Gray-Schleihauf C, Guarasci K, Lundgren K, Milne R, Grebely J, Fraser C. Reinfection following successful direct-acting antiviral therapy for HCV infection among people attending an inner-city community health centre in Victoria, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103418. [PMID: 34538704 DOI: 10.1016/j.drugpo.2021.103418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/08/2021] [Accepted: 08/06/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Studies of HCV reinfection following direct-acting antiviral (DAA) therapy among PWID have been limited by short follow-up and small case numbers. This study evaluated the incidence of HCV reinfection following successful DAA therapy among people attending an inner-city community health centre in Victoria, Canada. METHODS In this observational study, participants treated with DAA therapy between November 2014 and December 31, 2019 were included. Retrospective chart review was performed to assess demographics, recent injecting drug use at treatment initiation (previous six months), opioid agonist treatment (OAT), and HIV. Endpoints included sustained virologic response (SVR), HCV reinfection, and mortality. RESULTS Of 482 participants initiating DAA treatment, 30% were female, 46% were receiving OAT, 49% had recent injection drug use, 15% had HIV/HCV coinfection, and 22% had cirrhosis. Treatment completion was 97% (468/482; 12 discontinued therapy, and 2 died during treatment). SVR was 87% (418/482). Outcomes among those who completed treatment but did not achieve SVR (n=53), included loss to follow-up (n=11), HCV RNA for SVR testing not completed (n=18), viral relapse (n=6), reinfection (n=5) and viral recurrence (n=5, unable to distinguish viral relapse from reinfection), and death (n=7). The rate of HCV reinfection was 3.6/100 person-years (95% confidence interval [CI] 2.4-5.5; 22 cases; 602 person-years follow-up). Factors associated with an increased risk of HCV reinfection included recent injection drug use (adjusted relative risk [aRR] 8.55, 95% CI 1.98-36.96) and HIV co-infection (aRR 2.35, 95% CI 1.01-5.44). Fifty-five people died (overdose, n=19) during (n=2) or following (n=53) therapy (7.4/100 person-years; 95% CI 5.6-9.6). CONCLUSION This study demonstrates ongoing reinfection among a marginalized population at an inner-city community health centre, with higher rates among those with HIV and recent injecting drug use. The rates of reinfection and mortality highlight the importance of integrating HCV care with strategies to address drug-related harms.
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Affiliation(s)
| | | | | | - Anne Drost
- Cool Aid Community Health Centre, Victoria, Canada
| | | | | | | | - Roz Milne
- Cool Aid Community Health Centre, Victoria, Canada
| | | | - Chris Fraser
- Cool Aid Community Health Centre, Victoria, Canada
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López-Osorio MC, Beltrán M, Navas MC. [Epidemiology of hepatitis C virus infection in ColombiaEpidemiologia da infecção pelo vírus da hepatite C na Colômbia]. Rev Panam Salud Publica 2021; 45:e96. [PMID: 34539763 PMCID: PMC8442709 DOI: 10.26633/rpsp.2021.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/25/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To describe the epidemiology of hepatitis C virus (HCV) infection in Colombia. METHODS Critical review of epidemiological studies of HCV infection in Colombia. The PubMed, SciELO, and ScienceDirect databases were searched for original articles and reviews on the subject published from 1989 to 2020. Reports from the National Institute of Health and the High Cost Account of the Ministry of Health and Social Protection were also reviewed. RESULTS Data on seroprevalence of HCV antibodies in blood donors range from 1.5% to 0.32%, corresponding to reports at the beginning and end of the study period, respectively. In the population with risk factors, a high prevalence of HCV infection is observed, although with variations over time. With respect to HCV genotypes in Colombia, genotypes 1, 2, 3, and 4 (subtypes 1a, 1b, 2a, and 3a) have been identified. CONCLUSIONS In the observation period, a decrease was seen in seroprevalence of HCV infection in blood donors and hemodialysis patients in Colombia, demonstrating the impact of safe blood policies and biosafety measures. Studies in people who inject illicit drugs indicate a high prevalence of infection, with regional differences within the country. HCV genotype 1, subtype 1b, is the most frequent in the different studies carried out in Colombia, and the most recent report of the High Cost Account of the Ministry of Health and Social Protection indicates that genotype 4 is the second most frequent genotype in the country.
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Affiliation(s)
- María C. López-Osorio
- Facultad de Medicina, Universidad de AntioquiaMedellínColombiaFacultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
| | - Mauricio Beltrán
- Organización Panamericana de la SaludWashington D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud, Washington D.C., Estados Unidos de América.
| | - María-Cristina Navas
- Facultad de Medicina, Universidad de AntioquiaMedellínColombiaFacultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
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Saing CH, Prem K, Uk P, Chhoun P, Chann N, Tuot S, Mun P, Yi S. Risk factors associated with HIV and hepatitis C virus co-infection among people who inject drugs in Cambodia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 86:102974. [PMID: 33068831 DOI: 10.1016/j.drugpo.2020.102974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Globally, research on the co-infection of the human immunodeficiency virus (HIV) and hepatitis C virus (HCV) among people who inject drugs is growing. However, studies in resource-poor countries remain limited. Therefore, we conducted this study to explore factors associated with HIV/HCV co-infection among people who inject drugs in Cambodia. METHODS This national survey was conducted in 2017 in the capital city and 11 provinces. We used a 'peer-based social network recruitment' method to recruit 286 participants for face-to-face interviews and HIV and HCV testing. A modified Cox proportional hazard model was used to identify risk factors associated with HIV/HCV co-infection. RESULTS The prevalence of HIV and HCV was 15.4% and 30.4%, respectively. Of the total, 9.4% of the participants were HIV/HCV co-infected, and 61.4% of the HIV-infected participants were co-infected with HCV. About half (56.8%) of the participants tested HIV positive were aware of their HIV status; of whom, 83.3% were on antiretroviral therapy. Only 11.5% of the participants with HCV antibody positivity were aware of their HCV infection status; of whom, 50.0% were on HCV treatment. The adjusted prevalence ratio (APR) of HIV/HCV co-infection was significantly higher among women than among men and among participants who lived on the streets than among those living with their family or relatives. The APR of HIV/HCV co-infection was also significantly higher among participants who had received methadone maintenance therapy than those who had not received it. CONCLUSIONS The prevalence of HIV/HCV co-infection among people who inject drugs in Cambodia was considerably high. Intervention programs are required to increase access to harm-reduction interventions among most marginalized people who inject drugs to prevent HIV and HCV infection. HCV screening services should be expanded in this key population, given its small population size and the availability of directly-acting antiviral agents in the country.
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Affiliation(s)
- Chan Hang Saing
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Kiesha Prem
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | - Ponha Uk
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia.
| | - Navy Chann
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia; Faculty of Social Science and Humanity, Royal University of Phnom Penh, Phnom Penh, Cambodia.
| | - Phalkun Mun
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia.
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore; KHANA Center for Population Health Research, Phnom Penh, Cambodia; School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia; Center for Global Health Research, Touro University California, Vallejo, CA, United States.
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