1
|
Lazarus L, McClarty LM, Herpai N, Pavlova D, Tarasova T, Gnatenko A, Bondar T, Lorway R, Becker ML. "…because the social work never ends": a qualitative study exploring how NGOs responded to emerging needs while upholding responsibility to HIV prevention and treatment during the war in Ukraine. J Int AIDS Soc 2024; 27 Suppl 3:e26309. [PMID: 39030857 PMCID: PMC11258434 DOI: 10.1002/jia2.26309] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/30/2024] [Indexed: 07/22/2024] Open
Abstract
INTRODUCTION Since the onset of the Russian invasion on 24 February 2022, the health system in Ukraine has been placed under tremendous pressure, with damage to critical infrastructure, large losses of human resources, restricted mobility and significant supply chain interruptions. Based on a longstanding partnership between the Ukrainian Institute for Social Research after Oleksandr Yaremenko (UISR after O. Yaremenko) and the Institute for Global Public Health at the University of Manitoba, we explore the impact of the full-scale war on non-governmental organizations (NGOs, including charitable organizations) providing services for key population groups in Ukraine. METHODS We conducted in-depth qualitative interviews with key representatives from NGOs working with key population groups (i.e., people living with HIV, sex workers, men who have sex with men, people who inject drugs and transgender people) throughout Ukraine. Members of the UISR after O. Yaremenko research team recruited participants from organizations working at national, regional and local levels. The research team members conducted 26 interviews (22 with women and four with men) between 15 May and 7 June 2023. Interviews were conducted virtually in Ukrainian and interpretively analysed to draw out key themes. RESULTS Applying Roels et al.'s notion of "first responders", our findings explore how the full-scale war personally and organizationally impacted workers at Ukrainian NGOs. Despite the impacts to participants' physical and mental health, frontline workers continued to support HIV prevention and treatment while also responding to the need for humanitarian aid among their clients and the wider community. Furthermore, despite inadequate pay and compensation for their work, frontline workers assumed additional responsibilities, thereby exceeding their normal workload during the extraordinary conditions of war. CONCLUSIONS NGOs play a vital role as responders, adapting their services to meet the emergent needs of communities during structural shocks, such as war. There is an urgent need to support NGOs with adequate resources for key population service delivery and to increase support for their important role in humanitarian aid.
Collapse
Affiliation(s)
- Lisa Lazarus
- Institute for Global Public HealthRady Faculty of Health SciencesUniversity of ManitobaWinnipegCanada
- Department of Community Health SciencesMax Rady College of MedicineRady Faculty of Health SciencesUniversity of ManitobaWinnipegCanada
| | - Leigh M McClarty
- Institute for Global Public HealthRady Faculty of Health SciencesUniversity of ManitobaWinnipegCanada
- Department of Community Health SciencesMax Rady College of MedicineRady Faculty of Health SciencesUniversity of ManitobaWinnipegCanada
| | - Nicole Herpai
- Institute for Global Public HealthRady Faculty of Health SciencesUniversity of ManitobaWinnipegCanada
- Department of Community Health SciencesMax Rady College of MedicineRady Faculty of Health SciencesUniversity of ManitobaWinnipegCanada
| | - Daria Pavlova
- Institute for Global Public HealthRady Faculty of Health SciencesUniversity of ManitobaWinnipegCanada
- Ukrainian Institute for Social Research after Oleksandr YaremenkoKyivUkraine
| | - Tatiana Tarasova
- Ukrainian Institute for Social Research after Oleksandr YaremenkoKyivUkraine
| | - Anna Gnatenko
- Institute for Global Public HealthRady Faculty of Health SciencesUniversity of ManitobaWinnipegCanada
| | - Tetiana Bondar
- Ukrainian Institute for Social Research after Oleksandr YaremenkoKyivUkraine
| | - Robert Lorway
- Institute for Global Public HealthRady Faculty of Health SciencesUniversity of ManitobaWinnipegCanada
- Department of Community Health SciencesMax Rady College of MedicineRady Faculty of Health SciencesUniversity of ManitobaWinnipegCanada
| | - Marissa L Becker
- Institute for Global Public HealthRady Faculty of Health SciencesUniversity of ManitobaWinnipegCanada
- Department of Community Health SciencesMax Rady College of MedicineRady Faculty of Health SciencesUniversity of ManitobaWinnipegCanada
| | | |
Collapse
|
2
|
Mathias H, Foster LA, Rushton A. Programs and practices that support pregnant people who use drugs' access to sexual and reproductive health care in Canada: a scoping review. BMC Pregnancy Childbirth 2024; 24:72. [PMID: 38254076 PMCID: PMC10804510 DOI: 10.1186/s12884-023-06225-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 12/25/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Pregnant people who use unregulated drugs (PPWUD) are at high risk of health complications yet experience a range of barriers to sexual and reproductive health care. Given that improving maternal health and access to reproductive health care are key targets underpinning the Sustainable Development Goals (SDG), there is an urgent need to improve access to appropriate supports and services for this population. Little is known about what programs and practices exist to support PPWUD's access to sexual and reproductive health care. This scoping review aimed to identify the available literature on these programs and practices in Canada. METHODS A scoping review was conducted using JBI methodology and reported using PRISMA guidelines. Scholarly databases and grey literature sources were searched to identify literature published between 2016-2023 in English or French that discussed, defined, conceptualised, or evaluated programs and practices that support PPWUD's access to sexual and reproductive health care in Canada. Identified literature was screened using Covidence. Data were extracted from included texts, then analysed descriptively. Frequencies and key concepts were reported. RESULTS A total of 71 articles were included, most of which were grey literature. Of the total, 46 unique programs were identified, as well as several useful practices. Most programs were in urban centres in Western Canada, and most programs offered holistic 'wrap-around services.' Several programs delivered these services on-site or as 'drop-in' programs with the support of staff with lived/living experience of substance use. Most frequent program outcomes included keeping parents and children together, improving connection to other services, and reducing substance use harms. Noted helpful practices included non-judgmental care and the use of harm-reduction strategies. CONCLUSIONS Several programs and practices that support PPWUD exist in Canada, though few focus exclusively on sexual and reproductive health. There remain opportunities to improve access to programs, including expanding geographic availability and range of services. The review has clinical application by providing an overview of available programs that may support clinicians in identifying services for PPWUD. Future research should consider client perspectives and experiences of these programs. REVIEW REGISTRATION NUMBER Open Science Framework https://osf.io/5y64j .
Collapse
Affiliation(s)
- Holly Mathias
- School of Public Health, University of Alberta, 11405 87 Ave NW, Edmonton, AB, T6G 1C9, Canada.
| | - Lesley Ann Foster
- Department of Cultural Studies, Queen's University, 99 University Ave, Kingston, ON, K7L 3N6, Canada
| | - Ashleigh Rushton
- Faculty of Health Sciences, The University of the Fraser Valley, 45190 Caen Ave, Chilliwack, B.C, V2R 0N3, Canada
| |
Collapse
|
3
|
Parra-Soto S, Duran-Aguero S, Vargas-Silva F, Vázquez-Morales K, Pizarro-Mena R. Social Outbreak in Chile, and Its Association with the Effects Biological, Psychological, Social, and Quality of Life. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7096. [PMID: 38063526 PMCID: PMC10706229 DOI: 10.3390/ijerph20237096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023]
Abstract
The World Health Organization has defined collective violence as the instrumental use of violence by people who identify themselves as members of a group against other individuals and have political, economic, or social objectives. In Chile, the "Social Outbreak" was used to describe an episode of collective violence, which began on October 18, 2019, triggered by a multitude of socioeconomic and political factors, with protests and mobilizations in the country's large and small cities; in central, commercial, and residential areas, that lasted for several months, affecting a large part of the population. The objective of the present study was to associate the social outbreak in Chile with its biological, psychological, and social effects on people's health and quality of life, as well as its characteristics in terms of exposure, proximity, type, and frequency. This was a cross-sectional study with non-probabilistic national-level sampling, conducted from 28 November 2019, to 3 March 2020. The instrument had four sections. A total of 2651 participants answered the survey; 70.8% were female, and the mean age was 35.2. The main disturbances perceived were protests (70.9%), alarm sounds (68.1%), shooting sounds (59.0%), and tear gas bombs (56.9%). When quantifying the magnitude of these associations, people who had a medium exposure have a higher probability (OR: 1.99, CI: 1.58; 2.50) of suffering three or more biological effects than people that have a low exposure, while people with higher exposition have a 4.09 times higher probability (CI: 3.11; 5.38). A similar pattern was observed regarding psychological effects, although social effects were primarily experienced by those with high exposure. Social networks, TV, and radio were the most used media among people who perceived a greater effect. People who lived, worked, or shopped near the disturbance's areas show a higher proportion negative effect.
Collapse
Affiliation(s)
- Solange Parra-Soto
- Departamento de Nutrición y Salud Pública, Universidad del Bío-Bío, Chillan 3780000, Chile;
- School Cardiovascular and Metabolic Health, University of Glasgow, Glasgow G12 8QQ, UK
| | - Samuel Duran-Aguero
- Facultad de Ciencias para el Cuidado de la Salud, Universidad San Sebastián, Sede Los Leones, Santiago 7500000, Chile;
| | - Francisco Vargas-Silva
- Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Sede Los Leones, Santiago 7500000, Chile; (F.V.-S.); (K.V.-M.)
| | - Katherine Vázquez-Morales
- Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Sede Los Leones, Santiago 7500000, Chile; (F.V.-S.); (K.V.-M.)
| | - Rafael Pizarro-Mena
- Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Sede Los Leones, Santiago 7500000, Chile; (F.V.-S.); (K.V.-M.)
| |
Collapse
|
4
|
Feder KA, Patel EU, Buresh M, Kirk GD, Mehta SH, Genberg BL. Trends in self-reported non-fatal overdose and patterns of substance use before and during the COVID-19 pandemic in a prospective cohort of adults who have injected drugs - Baltimore, Maryland, 2014-2022. Drug Alcohol Depend 2023; 251:110954. [PMID: 37716287 PMCID: PMC10538370 DOI: 10.1016/j.drugalcdep.2023.110954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/25/2023] [Accepted: 08/26/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Overdose deaths increased during the COVID-19 pandemic in the United States. Less is known about drug use behavior changes during the same time period. We examined differences in non-fatal overdose and drug use behaviors before and after the start of the COVID-19 pandemic in a community-recruited cohort of adults who have injected drugs. METHODS 721 participants attended 7401 visits between Jan 2014 and Mar 2022. Outcomes (non-fatal overdose, drug route of administration, type of drugs used) were assessed via self-report in the last six months. We compared pre-pandemic (Jan 2014-Mar 2020) to inter-pandemic (Dec 2020-Mar 2022) prevalence of each outcome using Cohcrane-Maentel-Haeszel odds ratios (CMH-OR). We then estimated probabilities for transitioning between specific behaviors from participants' last pre-pandemic visit to their first inter-pandemic visit. RESULTS Comparing pre-pandemic visits to inter-pandemic visits, the prevalence of non-fatal overdose did not change (CMH-OR 1.06, 95% CI 0.75-1.50); the prevalence of injection (CMH-OR 0.13, 95% CI 0.1-0.17) and non-injection (CMH-OR 0.51, 95% CI 0.42-0.61) drug use declined. More than a third (35.7%) of persons using both injection and non-injection drugs pre-pandemic transitioned to exclusive non-injection use during the pandemic. By contrast, few (4.0%) persons using non-injection drugs exclusively pre-pandemic transitioned to injecting during the pandemic. CONCLUSION Among adults who have injected drugs, the start of the COVID-19 pandemic was associated with a reduced drug use prevalence and transitions from injection to non-injection use. Average overdose prevalence was unchanged, but these behavior changes may have helped mitigate overdose harm.
Collapse
Affiliation(s)
- Kenneth A Feder
- Department of Mental Health, Bloomberg School of Public Health, USA.
| | - Eshan U Patel
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, USA
| | - Megan Buresh
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, USA; Department of Medicine, Johns Hopkins University School of Medicine, USA
| | - Gregory D Kirk
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, USA; Department of Medicine, Johns Hopkins University School of Medicine, USA
| | - Shruti H Mehta
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, USA
| | - Becky L Genberg
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, USA
| |
Collapse
|
5
|
Friedman SR, Smyrnov P, Vasylyeva TI. Will the Russian war in Ukraine unleash larger epidemics of HIV, TB and associated conditions and diseases in Ukraine? Harm Reduct J 2023; 20:119. [PMID: 37658448 PMCID: PMC10472698 DOI: 10.1186/s12954-023-00855-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/22/2023] [Indexed: 09/03/2023] Open
Abstract
The Russian war in Ukraine poses many risks for the spread of HIV, TB and associated conditions, including possible increases in the numbers of people who inject drugs or engage in sex work in the years ahead. Ukrainian civil society and volunteer efforts have been able to maintain and at times expand services for HIV Key Populations. The extent of mutual-aid and volunteer efforts as well as the continued strength and vitality of harm reduction organizations such as the Alliance for Public Health and the rest of civil society will be crucial resources for postwar efforts to assist Key Populations and prevent the spread of HIV, TB and other diseases. The postwar period will pose great economic and political difficulties for Ukrainians, including large populations of people physically and/or psychically damaged and in pain who might become people who inject drugs. Local and international support for public health and for harm reduction will be needed to prevent potentially large-scale increases in infectious disease and related mortality.
Collapse
Affiliation(s)
| | | | - Tetyana I Vasylyeva
- Division of Infectious Diseases and Global Public Health, UC San Diego, San Diego, CA, USA.
| |
Collapse
|
6
|
Friedman SR, Perlman DC, Paraskevis D, Feldman J. Sociopolitical Diagnostic Tools to Understand National and Local Response Capabilities and Vulnerabilities to Epidemics and Guide Research into How to Improve the Global Response to Pathogens. Pathogens 2023; 12:1023. [PMID: 37623983 PMCID: PMC10457759 DOI: 10.3390/pathogens12081023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/04/2023] [Accepted: 08/05/2023] [Indexed: 08/26/2023] Open
Abstract
The AIDS and COVID-19 pandemics demonstrated that nations at similar economic development levels varied widely in their capacity to protect the health of their residents. For AIDS, Britain and Australia brought gay representatives into official counsels and adopted harm reduction far more rapidly than the United States or Spain, and East African countries responded more effectively than South Africa or the Democratic Republic of the Congo. National responses to COVID-19 varied widely, with New Zealand, China, and Vietnam more effective than Italy, Brazil, or the United States. Further, as phylogenetic research has demonstrated, these pandemics spread from one country to another, with those that responded poorly acting as sources for mutations and potentially sources of transmission to countries with more effective responses. Many observers expressed surprise at the poor responses of the United States to COVID-19, but in retrospect the cutbacks in public health funding at state and national levels made it clear that this was a predictable weakness even in addition to the political vacillations that crippled the US and Brazilian responses. In a time of global sociopolitical and climate instability, it is important to measure and conduct research into spatial and time variations in 1. public health and medical funding, 2. social influence networks, social cohesion and trust, and stigmatization, 3. income inequality, 4. social conflict, and 5. other factors that affect responsiveness to pandemics.
Collapse
Affiliation(s)
| | - David C. Perlman
- Infectious Diseases, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Justin Feldman
- Visiting Scientist, Harvard FXB Center for Health and Human Rights, Cambridge, MA 02138, USA;
| |
Collapse
|
7
|
Gray A, Liu T, Giorgi S, Fisher CB, Curtis B. Differences in mental health and alcohol use across profiles of COVID-19 disruptions. Alcohol Alcohol 2023; 58:393-403. [PMID: 37097736 PMCID: PMC10331928 DOI: 10.1093/alcalc/agad028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/28/2023] [Accepted: 04/02/2023] [Indexed: 04/26/2023] Open
Abstract
This study aimed to examine differences in mental health and alcohol use outcomes across distinct patterns of work, home, and social life disruptions associated with the COVID-19 pandemic. Data from 2093 adult participants were collected from September 2020 to April 2021 as a part of a larger study examining the impacts of the COVID-19 pandemic on substance use. Participants provided data on COVID-19 pandemic experiences, mental health outcomes, media consumption, and alcohol use at baseline. Alcohol use difficulties, including problems related to the use, desire to use alcohol, failure to cut down on alcohol use, and family/friend concern with alcohol use, were measured at 60-day follow-up. Factor mixture modeling followed by group comparisons, multiple linear regressions, and multiple logistic regressions was conducted. A four-profile model was selected. Results indicated that profile membership predicted differences in mental health and alcohol use outcomes above and beyond demographics. Individuals experiencing the most disruption reported the strongest daily impact of COVID-19 and significantly high levels of depression, anxiety, loneliness, overwhelm, alcohol use at baseline, and alcohol use difficulties measured at 60-day follow-up. The findings highlight the need for integrated mental health and/or alcohol services and social services targeting work, home, and social life during public health emergencies in order to respond effectively and comprehensively to the needs of those requiring different types of support.
Collapse
Affiliation(s)
- Aaliyah Gray
- Department of Psychology, Fordham University, Bronx, NY 10458, United States
| | - Tingting Liu
- Technology and Translational Research Unit, Translational Addiction Medicine Branch, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD 21224, United States
- Positive Psychology Center, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Salvatore Giorgi
- Technology and Translational Research Unit, Translational Addiction Medicine Branch, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD 21224, United States
- Department of Computer and Information Science, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Celia B Fisher
- Department of Psychology, Fordham University, Bronx, NY 10458, United States
- Center for Ethics Education, Fordham University, Bronx, NY 10458, United States
| | - Brenda Curtis
- Technology and Translational Research Unit, Translational Addiction Medicine Branch, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD 21224, United States
| |
Collapse
|
8
|
Rhodes T, Lancaster K. Early warnings and slow deaths: A sociology of outbreak and overdose. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 117:104065. [PMID: 37229960 DOI: 10.1016/j.drugpo.2023.104065] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/04/2023] [Accepted: 05/06/2023] [Indexed: 05/27/2023]
Abstract
In this paper, we offer a sociological analysis of early warning and outbreak in the field of drug policy, focusing on opioid overdose. We trace how 'outbreak' is enacted as a rupturing event which enables rapid reflex responses of precautionary control, based largely on short-term and proximal early warning indicators. We make the case for an alternative view of early warning and outbreak. We argue that practices of detection and projection that help to materialise drug-related outbreaks are too focused on the proximal and short-term. Engaging with epidemiological and sociological work investigating epidemics of opioid overdose, we show how the short-termism and rapid reflex response of outbreak fails to appreciate the slow violent pasts of epidemics indicative of an ongoing need and care for structural and societal change. Accordingly, we gather together ideas of 'slow emergency' (Ben Anderson), 'slow death' (Lauren Berlant) and 'slow violence' (Rob Nixon), to re-assemble outbreaks in 'long view'. This locates opioid overdose in long-term attritional processes of deindustrialisation, pharmaceuticalisation, and other forms of structural violence, including the criminalisation and problematisation of people who use drugs. Outbreaks evolve in relation to their slow violent pasts. To ignore this can perpetuate harm. Attending to the social conditions that create the possibilities for outbreak invites early warning that goes 'beyond outbreak' and 'beyond epidemic' as generally configured.
Collapse
Affiliation(s)
- Tim Rhodes
- London School of Hygiene and Tropical Medicine, London, UK; University of New South Wales, Sydney, Australia.
| | | |
Collapse
|
9
|
Patel EU, Astemborski J, Feder KA, Rudolph JE, Winiker A, Sosnowski DW, Kirk GD, Mehta SH, Genberg BL. Temporal association of pre-pandemic perceived social support with psychological resilience and mental well-being during the COVID-19 pandemic among people with a history of injection drug use. Drug Alcohol Depend 2023; 244:109802. [PMID: 36774804 PMCID: PMC9908589 DOI: 10.1016/j.drugalcdep.2023.109802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND There are limited data on whether modifiable social factors foster psychological resilience and mental well-being among people who use drugs following Big Events. We examined the temporal association of pre-pandemic perceived social support with psychological resilience and negative mental health symptoms during the COVID-19 pandemic among people with a history of injection drug use. METHODS Between June and September 2020, we conducted a telephone survey among 545 participants in the AIDS Linked to the IntraVenous Experience (ALIVE) study: a community-based cohort of adults with a history of injection drug use. Leveraging data from study visits in 2018-early 2020, associations of pre-pandemic perceived social support with psychological resilience scores (range=1-5) and the probability of negative mental health symptoms during the pandemic were assessed using multivariable linear and modified Poisson regression models, respectively. RESULTS Participants' median age was 58 years, 38.2% were female, 83.3% identified as Black, and 30.3% were living with HIV. During the pandemic, 14.5% had low (<3) resilience scores, 36.1% experienced anxiety, and 35.8% reported increased loneliness. Compared to participants in the lowest tertile of pre-pandemic social support, participants in the highest tertile had higher mean resilience scores (β = 0.27 [95% CI = 0.12, 0.43]), a lower probability of anxiety (prevalence ratio [PR] = 0.71 [95% CI = 0.52, 0.96]), and a lower probability of increased loneliness (PR = 0.62 [95% CI = 0.45, 0.84]). CONCLUSIONS Pre-pandemic perceived social support was associated with greater psychological resilience and generally better mental well-being during the pandemic. Interventions that improve social support may foster psychological resilience and protect the mental well-being of people who use drugs, especially during periods of social disruption.
Collapse
Affiliation(s)
- Eshan U Patel
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jacquie Astemborski
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kenneth A Feder
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jacqueline E Rudolph
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Abigail Winiker
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - David W Sosnowski
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Gregory D Kirk
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Shruti H Mehta
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Becky L Genberg
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| |
Collapse
|
10
|
Frank D, Krawczyk N, Arshonsky J, Bragg MA, Friedman SR, Bunting AM. COVID-19-Related Changes to Drug-Selling Networks and Their Effects on People Who Use Illicit Opioids. J Stud Alcohol Drugs 2023; 84:222-229. [PMID: 36971722 PMCID: PMC10171252 DOI: 10.15288/jsad.21-00438] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 08/20/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The COVID-19 pandemic has significantly affected people's ability to buy, sell, and obtain items that they use in their daily lives. It may have had a particularly negative effect on the ability of people who use illicit opioids to obtain them because the networks they relied on are illicit and not part of the formal economy. Our objective in this research was to examine if, and how, disruptions related to COVID-19 of illicit opioid markets have affected people who use illicit opioids. METHOD We collected 300 posts--including replies to posts--related to the intersection of COVID-19 and opioid use from Reddit.com, a forum that has several discussion threads (i.e., subreddits) dedicated to opioids. We then coded posts from the two most popular opioid subreddits during the early pandemic period (March 5, 2020-May 13, 2020) using an inductive/deductive approach. RESULTS We found two themes related to active opioid use during the early pandemic: (a) changes in drug supply and difficulty obtaining opioids, and (b) buying less-trustworthy drugs from lesser-known sources. CONCLUSIONS Our findings suggest that COVID-19 has created market conditions that place people who use opioids at risk of adverse outcomes, such as fatal overdose.
Collapse
Affiliation(s)
- David Frank
- NYU School of Global Public Health, New York, New York
| | - Noa Krawczyk
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Joshua Arshonsky
- Section on Health Choice, Policy, and Evaluation, Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Marie A. Bragg
- Section on Health Choice, Policy, and Evaluation, Department of Population Health, NYU Grossman School of Medicine, New York, New York
- Department of Public Health Nutrition, NYU School of Global Public Health, New York, New York
| | - Sam R. Friedman
- Section on Health Choice, Policy, and Evaluation, Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Amanda M. Bunting
- Section on Tobacco, Alcohol, & Drug Use, Department of Population Health, NYU Grossman School of Medicine, New York, New York
| |
Collapse
|
11
|
Jordan AE, Izar R, Nicolas R, Beharie N, Harocopos A. Understanding Vaccine Perceptions and Willingness to Receive COVID-19 Vaccination: Opportunities to Strengthen Public Health Responses and COVID-19 Services for People Who Use Drugs. Vaccines (Basel) 2022; 10:vaccines10122044. [PMID: 36560454 PMCID: PMC9784169 DOI: 10.3390/vaccines10122044] [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: 10/29/2022] [Revised: 11/23/2022] [Accepted: 11/26/2022] [Indexed: 12/02/2022] Open
Abstract
Background: People who use drugs (PWUD) are at high risk for COVID-19 infection, morbidity, and mortality. COVID-19 vaccines are safe and effective at reducing serious illness and death from COVID-19. There are sparse data on the perceptions and willingness of PWUD to receive COVID-19 vaccination. Materials and Methods: In order to assess the perceptions of, and willingness to receive, COVID-19 vaccination among PWUD, we conducted a rapid survey-based assessment of 100 PWUD in NYC (Spring 2021) who reported not having received COVID-19 vaccination and who reported past 30-day illicit drug use. Results: More than 80% of respondents agreed that personally receiving a COVID-19 vaccine was important for the health of others in the community, and endorsing this belief was significantly associated with COVID-19 vaccine willingness reflecting a high prevalence of altruistic beliefs (p-value: 0.01). Other reported perceptions that were significantly associated with COVID-19 vaccine willingness were believing that COVID-19 vaccines are safe for PWUD and trusting COVID-19 information from their healthcare providers (p-values < 0.05). That said, 62% reported being unwilling to receive a COVID-19 vaccine, and 70−83% had concerns about general vaccine safety/efficacy. Examining pairs of questions to explore potential ambivalence between vaccine endorsement and vaccine concerns identified that 56−65% simultaneously reported vaccine safety/efficacy concerns and beliefs that vaccination was an important intervention. Of the 75 respondents who reported past 30-day use of harm reduction and/or substance use disorder (SUD) programs, nearly 90% reported these programs as trusted sources of COVID-19 information. Conclusion: Most participants reported altruistic beliefs about the role of vaccines for community health, including COVID-19 vaccines, and this altruism was associated with willingness to be vaccinated against COVID-19. These findings suggest a complex relationship between beliefs about the role of vaccination in community health and the safety/efficacy of vaccines; this ambivalence suggests that COVID-19 vaccine willingness may not be firmly fixed, indicating potential opportunities to address questions and build vaccine confidence. Harm reduction and SUD programs could be leveraged to further engage PWUD in receipt of COVID-19 information and/or vaccination. Recognizing vaccine ambivalence, emphasizing collective and individual benefits of vaccination, and messaging from trusted sources may be promising approaches to increase vaccination in this population.
Collapse
|
12
|
Friedman SR, Perlman DC, DiClemente RJ. Editorial: The outbreak and sequelae of the increase in opioid use in the United States, Canada, and beyond. FRONTIERS IN SOCIOLOGY 2022; 7:1023531. [PMID: 36134361 PMCID: PMC9483207 DOI: 10.3389/fsoc.2022.1023531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 06/16/2023]
Affiliation(s)
| | - David C. Perlman
- Infectious Diseases, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Ralph J. DiClemente
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
| |
Collapse
|
13
|
Conway A, Treloar C, Crawford S, Grebely J, Marshall AD. People engaged in opioid agonist treatment as a counterpublic during the COVID-19 pandemic in Australia: A qualitative study. Drug Alcohol Rev 2022; 42:203-212. [PMID: 36054577 PMCID: PMC9538012 DOI: 10.1111/dar.13531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 06/08/2022] [Accepted: 07/31/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION People receiving opioid agonist treatment (OAT) are at higher risk of comorbidities, poverty and discrimination, which Big Events like the COVID-19 pandemic may exacerbate. The behaviours of people receiving OAT do not always align with normative behaviours as conceived by ruling institutions and laws, and so the group becomes a counterpublic, not imagined in mainstream public discourse. The aim of this study was to understand how people receiving OAT, as a counterpublic, implemented practises of care to mitigate negative health outcomes during COVID-19. METHODS Participants were recruited via eight peer-led organisations across Australia. In-depth, semi-structured interviews were completed between August and December 2020 with 40 people receiving OAT. The analysis centres practises of care, allowing interactions that influence the health of participants, to be understood in their unique contexts. RESULTS Aspects of the COVID-19 state response were designed for an idealised public, demonstrated by the increased policing that accompanied enforcement of restrictions which was detrimental to the wellbeing of people receiving OAT. Counterpublic health strategies employed by people receiving OAT were disrupted, but participants were often able to adapt to the changing context. DISCUSSION AND CONCLUSION This study elucidates how practises of care among people receiving OAT are enacted and disrupted during a Big Event, with implications beyond the COVID-19 pandemic for future Big Events. The study findings evidence the need for policies that mitigate the impact of Big Events such as supporting re-groupment within the counterpublic, legitimising counterpublic health strategies and stopping the criminalisation of people who use drugs.
Collapse
Affiliation(s)
- Anna Conway
- The Kirby InstituteUNSW SydneySydneyAustralia,Centre for Social Research in HealthUNSW SydneySydneyAustralia
| | - Carla Treloar
- Centre for Social Research in HealthUNSW SydneySydneyAustralia
| | | | | | - Alison D. Marshall
- The Kirby InstituteUNSW SydneySydneyAustralia,Centre for Social Research in HealthUNSW SydneySydneyAustralia
| |
Collapse
|
14
|
Walters SM, Bolinski RS, Almirol E, Grundy S, Fletcher S, Schneider J, Friedman SR, Ouellet LJ, Ompad DC, Jenkins W, Pho MT. Structural and community changes during COVID-19 and their effects on overdose precursors among rural people who use drugs: a mixed-methods analysis. Addict Sci Clin Pract 2022; 17:24. [PMID: 35468860 PMCID: PMC9037978 DOI: 10.1186/s13722-022-00303-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 03/21/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Drug overdose rates in the United States have been steadily increasing, particularly in rural areas. The COVID-19 pandemic and associated mitigation strategies may have increased overdose risk for people who use drugs by impacting social, community, and structural factors. METHODS The study included a quantitative survey focused on COVID-19 administered to 50 people who use drugs and semi-structured qualitative interviews with 17 people who use drugs, 12 of whom also participated in the quantitative survey. Descriptive statistics were run for the quantitative data. Qualitative coding was line-by-line then grouped thematically. Quantitative and qualitative data were integrated during analysis. RESULTS Findings demonstrate how COVID-19 disruptions at the structural and community level affected outcomes related to mental health and drug use at the individual level. Themes that emerged from the qualitative interviews were (1) lack of employment opportunities, (2) food and housing insecurity, (3) community stigma impacting health service use, (4) mental health strains, and (5) drug market disruptions. Structural and community changes increased anxiety, depression, and loneliness on the individual level, as well as changes in drug use patterns, all of which are likely to increase overdose risk. CONCLUSION The COVID-19 pandemic, and mitigation strategies aimed at curbing infection, disrupted communities and lives of people who use drugs. These disruptions altered individual drug use and mental health outcomes, which could increase risk for overdose. We recommend addressing structural and community factors, including developing multi-level interventions, to combat overdose. Trial registration Clinicaltrails.gov: NCT04427202. Registered June 11, 2020: https://clinicaltrials.gov/ct2/show/NCT04427202?term=pho+mai&draw=2&rank=3.
Collapse
Affiliation(s)
- Suzan M Walters
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, USA.
- Center for Drug Use and HIV/HCV Research, New York, NY, USA.
| | - Rebecca S Bolinski
- Department of Sociology, Southern Illinois University, Carbondale, IL, USA
| | - Ellen Almirol
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Stacy Grundy
- Department of Population Science and Policy, SIU School of Medicine, Springfield, IL, USA
| | | | - John Schneider
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Samuel R Friedman
- Center for Drug Use and HIV/HCV Research, New York, NY, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, USA
| | - Lawrence J Ouellet
- Division of Epidemiology & Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL, USA
| | - Danielle C Ompad
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, USA
- Center for Drug Use and HIV/HCV Research, New York, NY, USA
| | - Wiley Jenkins
- Department of Population Science and Policy, SIU School of Medicine, Springfield, IL, USA
| | - Mai T Pho
- Department of Medicine, University of Chicago, Chicago, IL, USA
| |
Collapse
|
15
|
Abstract
This introduction to the Special Issue (SI) on COVID-19 and adverse social determinants of health (SDoH) provides theoretical and empirical context for featured articles. Existing disparities and inequities are highlighted and emerging research on disparities resulting from these and the COVID-19 pandemic are briefly reviewed. General disparities and inequities resulting from the COVID-19 pandemic are briefly conceptualized through the SDoH. Critical factors outlined by the SDoH framework parallel those discussed by the Centers for Disease Control and Prevention as well as those in a conceptual framework article also feature in this SI. Some of these consist of racism, exclusion, blocked opportunity, and socioeconomic status (SES), among others. Furthermore, we discuss broader social inequities, namely growing income and wealth inequality that undermine the health and wellbeing of the general population and ethnic minority groups in particular. Big Event theory is offered as an additional conceptual framework that can illuminate potential downstream negative impacts of the pandemic. Having provided summaries of featured articles in this SI, we make a call for researchers to engage in further theoretical and empirical work to identify the most critical SDOH to further the field of public health as well as related fields and inform policy.
Collapse
Affiliation(s)
- Saul G Alamilla
- Department of Psychological Science, Kennesaw State University
| | | |
Collapse
|
16
|
Moody RL, Chen YT, Schneider JA, Knox J, Timmins L, Hanson H, Koli K, Durrell M, Dehlin J, Eavou R, Martins SS, Duncan DT. Polysubstance use in a community sample of Black cisgender sexual minority men and transgender women in Chicago during initial COVID-19 pandemic peak. Subst Abuse Treat Prev Policy 2022; 17:4. [PMID: 35090507 PMCID: PMC8796750 DOI: 10.1186/s13011-022-00433-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In response to COVID-19, the city of Chicago issued stay-at-home orders, which began on March 20, 2020, and restrictions meant to "flatten the curve" remained in effect until June 2, 2020. On June 3, 2020, Chicago entered the reopening phase. This study compares rates of polysubstance use by COVID-19 lockdown phase and across sociodemographic characteristics in a Chicago-based sample of Black cisgender sexual minority men (SMM) and transgender women. METHOD Data come from the Neighborhood and Networks (N2) cohort, an ongoing study of Black cisgender SMM and transgender women living in Chicago. Participants (N = 226) completed a survey between April 20, 2020, and July 30, 2020, during the initial peak of the COVID-19 pandemic in Chicago. We conducted chi-square tests of independence and modified Poisson regression models with robust error variance and estimated adjusted prevalence ratios. RESULTS Alcohol and marijuana were the most used substances, with 73.5% reporting at least one drinking day and 71.2% of the sample reporting marijuana use in the past 14 days. Tobacco was used by 41.6% of the sample, and illegal drug use, which does not include marijuana, was reported by 17.7% of the sample. Substance use was consistently associated with the use of other substances. As such, polysubstance use (i.e., using two or more substances) was common in this sample (63.7%). Few sociodemographic differences emerged, and substance use was not associated with lockdown phase. CONCLUSION Substance use, including polysubstance use, was high in our sample of Black SMM and transgender women during the initial peak of the COVID-19 pandemic. Continued monitoring is needed given the duration of the COVID-19 pandemic and the negative health consequences associated with substance use in this population.
Collapse
Affiliation(s)
- Raymond L Moody
- Department of Epidemiology, Columbia University Mailman School of Public Health, 772 West 168th Street, New York, NY, 10032, USA.
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA.
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA.
| | - Yen-Tyng Chen
- Department of Public Health, William Paterson University of New Jersey, 300 Pompton Road, Wayne, New Jersey, 07470, USA
- Chicago Center for HIV Elimination, University of Chicago, 5837 South Maryland Avenue, Chicago, IL, 60637, USA
| | - John A Schneider
- Chicago Center for HIV Elimination, University of Chicago, 5837 South Maryland Avenue, Chicago, IL, 60637, USA
- Department of Public Health Sciences, University of Chicago, 5841 South Maryland Avenue, MC2000, Chicago, IL, 60637, USA
- Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC6092, Chicago, IL, 60637, USA
| | - Justin Knox
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, 772 West 168th Street, New York, NY, 10032, USA
| | - Liadh Timmins
- Department of Epidemiology, Columbia University Mailman School of Public Health, 772 West 168th Street, New York, NY, 10032, USA
| | - Hillary Hanson
- Survey Lab, University of Chicago, 5841 South Maryland Avenue, Chicago, IL, 60637, USA
| | - Kangkana Koli
- Survey Lab, University of Chicago, 5841 South Maryland Avenue, Chicago, IL, 60637, USA
| | - Mainza Durrell
- Department of Public Health Sciences, University of Chicago, 5841 South Maryland Avenue, MC2000, Chicago, IL, 60637, USA
- Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC6092, Chicago, IL, 60637, USA
| | - Jessica Dehlin
- Department of Public Health Sciences, University of Chicago, 5841 South Maryland Avenue, MC2000, Chicago, IL, 60637, USA
| | - Rebecca Eavou
- Department of Public Health Sciences, University of Chicago, 5841 South Maryland Avenue, MC2000, Chicago, IL, 60637, USA
| | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, 772 West 168th Street, New York, NY, 10032, USA
| | - Dustin T Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, 772 West 168th Street, New York, NY, 10032, USA
| |
Collapse
|
17
|
Friedman SR, Jordan AE, Perlman DC, Nikolopoulos GK, Mateu-Gelabert P. Emerging Zoonotic Infections, Social Processes and Their Measurement and Enhanced Surveillance to Improve Zoonotic Epidemic Responses: A "Big Events" Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020995. [PMID: 35055817 PMCID: PMC8776232 DOI: 10.3390/ijerph19020995] [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] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/23/2021] [Accepted: 01/10/2022] [Indexed: 02/04/2023]
Abstract
Zoonotic epidemics and pandemics have become frequent. From HIV/AIDS through COVID-19, they demonstrate that pandemics are social processes as well as health occurrences. The roots of these pandemics lie in changes in the socioeconomic interface between humanity and non-human host species that facilitate interspecies transmission. The degree to which zoonoses spread has been increased by the greater speed and extent of modern transportation and trade. Pre-existing sociopolitical and economic structures and conflicts in societies also affect pathogen propagation. As an epidemic develops, it can itself become a social and political factor, and change and interact with pre-existing sociobehavioral norms and institutional structures. This paper uses a "Big Events" approach to frame these processes. Based on this framework, we discuss how social readiness surveys implemented both before and during an outbreak might help public health predict how overall systems might react to an epidemic and/or to disease control measures, and thus might inform interventions to mitigate potential adverse outcomes or possibly preventing outbreaks from developing into epidemics. We conclude by considering what "pathways measures", in addition to those we and others have already developed, might usefully be developed and validated to assist outbreak and epidemic disease responses.
Collapse
Affiliation(s)
- Samuel R. Friedman
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA
- Center for Drug Use and HIV/HCV Research, New York, NY 10003, USA; (A.E.J.); (D.C.P.); (P.M.-G.)
- Correspondence:
| | - Ashly E. Jordan
- Center for Drug Use and HIV/HCV Research, New York, NY 10003, USA; (A.E.J.); (D.C.P.); (P.M.-G.)
| | - David C. Perlman
- Center for Drug Use and HIV/HCV Research, New York, NY 10003, USA; (A.E.J.); (D.C.P.); (P.M.-G.)
- Department of Infectious Diseases, Icahn School of Medicine, Mount Sinai Beth Israel, New York, NY 10003, USA
| | | | - Pedro Mateu-Gelabert
- Center for Drug Use and HIV/HCV Research, New York, NY 10003, USA; (A.E.J.); (D.C.P.); (P.M.-G.)
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY 10027, USA
| |
Collapse
|
18
|
Salamanca-Buentello F, Cheng DK, Sabioni P, Majid U, Upshur R, Sud A. Mal/adaptations: A qualitative evidence synthesis of opioid agonist therapy during major disruptions. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 101:103556. [PMID: 34902805 DOI: 10.1016/j.drugpo.2021.103556] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/12/2021] [Accepted: 11/25/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Opioid agonist therapy (OAT) has been severely disrupted by the COVID-19 pandemic. The risks of opioid withdrawal, overdose, and diversion have increased, so there is an urgent need to adapt OAT to best support people who use drugs (PWUD). This review examines the views and experiences of PWUD, health care providers, and health system administrators on OAT during major disruptions to medical care to inform appropriate health system responses during the current pandemic and beyond. METHODS We conducted a systematic review and qualitative evidence synthesis. We searched three comprehensive datasets for qualitative and mixed-methods studies that examined OAT in the context of major disruptions such as natural disasters, and analyzed included studies using thematic analysis and the constant comparative method. We used conceptual frameworks of health systems resilience and adaptive systems to interpret our findings. RESULTS We included 10 studies published between 2002 and 2020 that examined OAT in the context of hurricanes, earthquakes, and terrorist attacks. We organized our results into three themes: uncertainty, inconsistency, and vulnerability; regulatory inflexibility; and lack of coordination. The highly regulated but poorly coordinated systems of OAT provision lacked flexibility to adapt to major disruptions, thereby manufacturing vulnerability for both PWUD and health workers. CONCLUSIONS OAT programs must be resilient and adaptable to face major disruptions while maintaining quality care. Our findings provide guidance to develop and implement innovative strategies that increase the adaptive potential of OAT programs while focusing on the needs of PWUD.
Collapse
Affiliation(s)
- Fabio Salamanca-Buentello
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Drive, Toronto, Ontario M4M 2B5, Canada
| | - Darren K Cheng
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Drive, Toronto, Ontario M4M 2B5, Canada
| | - Pamela Sabioni
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Drive, Toronto, Ontario M4M 2B5, Canada
| | - Umair Majid
- Institute for Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario M5T 3M6, Canada
| | - Ross Upshur
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Drive, Toronto, Ontario M4M 2B5, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario M5T 3M6, Canada; Division of Clinical Public Health, Dalla Lana Faculty of Public Health, 155 College Street, Toronto, Ontario M5G 1L4, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario M5G 1V7, Canada
| | - Abhimanyu Sud
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Drive, Toronto, Ontario M4M 2B5, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario M5T 3M6, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario M5G 1V7, Canada.
| |
Collapse
|
19
|
Gountas I, Nikolopoulos G, Touloumi G, Fotiou A, Souliotis K. Could the 2010 HIV outbreak in Athens, Greece have been prevented? A mathematical modeling study. PLoS One 2021; 16:e0258267. [PMID: 34618836 PMCID: PMC8496824 DOI: 10.1371/journal.pone.0258267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/22/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION In 2009 and 2010, Athens, Greece experienced a hepatitis C virus (HCV) and a Human Immunodeficiency Virus (HIV) outbreak among People Who Inject Drugs (PWID), respectively. The HCV outbreak was not detected, while that of HIV was identified in 2011. The integrated HIV-interventions, launched in early 2012, managed to reduce directly the HIV incidence and indirectly the HCV incidence. This study aims to assess what would have been the course of the HIV outbreak and its associated economic consequences if the 2009 HCV outbreak had been detected and integrated interventions had been initiated 1- or 2-years earlier. METHODS The model was calibrated to reproduce the observed HIV epidemiological and clinical parameters among PWID of Athens, Greece. We examined the effect of the 1- or 2-years earlier detection scenarios, the 1-year later detection, the non-detection scenario, and compared them to the status quo scenario. RESULTS Cumulative HIV cases, under the status-quo scenario during 2009-2019, were 1360 (90% Credible intervals: 290, 2470). If the HCV outbreak had been detected 1- or 2- years earlier, with immediate initiation of integrated interventions, 740 and 1110 HIV cases could be averted by 2019, respectively. Regarding the costs, if there was an efficient notification system to detect the HCV outbreak 1 or 2 years earlier, 35.2-53.2 million euros could be saved compared to the status quo by 2019. CONCLUSIONS If the HCV outbreak had been detected and promptly addressed, the HIV outbreak would have been prevented and 35.2-53.2 million euros could have been saved.
Collapse
Affiliation(s)
- Ilias Gountas
- Faculty of Social and Political Sciences, University of Peloponnese, Korinthos, Greece
- * E-mail:
| | | | - Giota Touloumi
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasios Fotiou
- Greek Reitox Focal Point at the Athens University Mental Health, Neurosciences, & Precision Medicine Research Institute (MHRI), Athens, Greece
| | - Kyriakos Souliotis
- Faculty of Social and Political Sciences, University of Peloponnese, Korinthos, Greece
| |
Collapse
|
20
|
Abstract
This Special Issue of Global Public Health on Politics & Pandemics brings together 26 articles and commentaries that address diverse aspects of the politics of COVID-19 and related issues. These papers are grouped together in six topical areas: theories and politics of global health, health systems and policies, country responses, social inequalities, social responses, and the politics of science and technology. The goal of the Special Issue is to give readers a sense of the range of topics that have been a focus for research in relation to the COVID-19 pandemic and to provide diverse examples of how research and analysis on the political dimensions of the pandemic can contribute to confronting the COVID-19 crisis.
Collapse
Affiliation(s)
- Richard Parker
- Instituto de Estudos de Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,ABIA - Associação Brasileira Interdisciplinar de AIDS, Rio de Janeiro, Brazil.,Sociomedical Sciences and Anthropology, Columbia University, New York City, NY, USA
| | - Dulce Ferraz
- Escola FIOCRUZ de Governo, Diretoria Regional de Brasília, Fundação Oswaldo Cruz, Brasília, Brazil.,Groupe de Recherche en Psychologie Sociale, Université Lumière Lyon 2, Bron, France
| |
Collapse
|