1
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Ostrach B, Hixon V, Bryce A. "When people who use drugs can't differentiate between medical care and cops, it's a problem." Compounding risks of law Enforcement Harassment & Punitive Healthcare Policies. HEALTH & JUSTICE 2024; 12:3. [PMID: 38319474 PMCID: PMC10848405 DOI: 10.1186/s40352-023-00256-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 12/13/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Community-based harm reduction programming is widely recognized as an effective strategy for reducing the increased risks for and spread of HIV, HCV, and for reducing the growing rate of overdose deaths among people who use drugs (PWUD). PWUD in the United States (US) are a highly justice-involved population, also at increased risk for law enforcement interaction, arrest, and incarceration. These risks compound and interact in the context of criminalization and law enforcement surveillance. Justice involvement increases risks for overdose and for riskier injecting behavior among PWUD, in turn increasing HCV and HIV risks. In Central and Southern Appalachia specifically, PWUD have identified fear of law enforcement harassment and arrest as a barrier to engaging in harm reduction behavior, and a deterrent to seeking help at the scene of an overdose. Moreover, stigmatizing and punitive treatment in healthcare settings can deter PWUD from seeking care, with life or death consequences. This evaluation research study assessing the successes and impacts of a grant-funded project to increase access to safer drug consumption supplies and overdose prevention education for PWUD, including justice-involved participants of a syringe access program (SAP), in public housing and beyond in a South-Central Appalachian setting used key informant and opportunistic sampling. Mixed-methods data were compiled and collected including secondary program data; primary interview and participant-observation data. RESULTS The evaluation research identified that grant deliverables were largely achieved, despite challenges presented by the COVID-19 pandemic. In addition, SAP participants and staff reported larger themes surrounding grant-funded activities, in which they perceived that widespread local law enforcement harassment of PWUD increased participants' risks for overdose death and infectious disease risks and that punitive local healthcare settings and policies acted as deterrents to care-seeking for many PWUD. CONCLUSIONS Overall, the evaluation research found that participants' experiences with and perceptions of local law enforcement harassment combined with their understandings and experiences of local punitive healthcare settings and policies; together compounding and increasing overdose risks and negative health consequences for local justice-involved PWUD.
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Affiliation(s)
- Bayla Ostrach
- Boston University School of Medicine; Fruit of Labor Action Research & Technical Assistance, LLC, Fairview, NC, USA.
| | - Vanessa Hixon
- Appalachian Medical Solidarity, Asheville, North Carolina, USA
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2
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McCormick KA, Stanton MC, Ali SB. A Mixed Methods Analysis of Southern HIV Service Organizations' Implementation of Harm Reduction to Address the HIV and Opioid Syndemic. J Behav Health Serv Res 2024; 51:44-56. [PMID: 37697180 DOI: 10.1007/s11414-023-09859-y] [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] [Accepted: 08/08/2023] [Indexed: 09/13/2023]
Abstract
Southern HIV Service Organizations (SHSOs) are promising sites for the adoption and implementation of harm reduction as a means for addressing the HIV and opioid syndemic. However, little research to date has examined exactly how harm reduction is operationalized within and among SHSOs. Using program evaluation data (i.e., organizational assessment data and semi-structured qualitative group interview data with SHSO staff), this study aimed to characterize organizational implementation of harm reduction among SHSOs that sought harm reduction capacity-building assistance (i.e., training, coaching, funding) from the SUSTAIN Center. Authors utilized a convergent mixed methods design in which quantitative and qualitative approaches were employed in parallel to gain simultaneous insights into how harm reduction was operationalized in SHSOs and how the local context influenced implementation. Means and proportions of each organizational assessment domain were compared. Thematic analysis of group interview transcripts examined SHSO staff perceptions of harm reduction implementation in their respective communities. Quantitative results revealed that SHSOs most commonly operationalize harm reduction in the Outreach, Advocacy, and Principles domains but struggle to do so in terms of Services and Organizational Infrastructure. Qualitative results revealed that various factors in SHSOs' local context, such as the community's lack of knowledge and understanding of harm reduction, limited harm reduction services, and a challenging socio-political context, influence SHSOs implementation of harm reduction. Taken together, analyses reveal that (1) SHSOs expend significant effort conducting outreach activities because Southern communities are generally unaware of harm reduction, (2) SHSOs continually advocate for harm reduction in the midst of a challenging socio-political context, and (3) SHSOs offer fewer harm reduction services and integrate harm reduction into their organizational infrastructure to a lesser extent due to external, contextual factors. The combination of organizational-level data and SHSO staff insights provided by this mixed methods study have implications for policy advocacy, funding initiatives, and capacity-building efforts.
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Affiliation(s)
- Katie A McCormick
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX, 78712, USA.
| | - Megan C Stanton
- Department of Sociology, Anthropology, Criminology and Social Work, Eastern Connecticut State University, 83 Windham St, Willimantic, CT, 06226, USA
| | - Samira B Ali
- Graduate College of Social Work, University of Houston, 3511 Cullen Blvd, Houston, TX, 77204, USA
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3
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Giglio RE, Mantha S, Harocopos A, Saha N, Reilly J, Cipriano C, Kennelly M, Landau L, McRae M, Chokshi DA. The Nation's First Publicly Recognized Overdose Prevention Centers: Lessons Learned in New York City. J Urban Health 2023; 100:245-254. [PMID: 37016269 PMCID: PMC10072795 DOI: 10.1007/s11524-023-00717-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 04/06/2023]
Abstract
In November of 2021, multiple factors converged to create a window of opportunity to open overdose prevention centers (OPCs) at two existing syringe service programs (SSPs) in New York City (NYC). Political will exists in NYC, particularly toward the end of the de Blasio administration's term, and the NYC Health Department worked to garner additional support from local and state elected officials given the dire need to address the overdose crisis. This coincided with readiness on the part of one of the NYC SSP providers, OnPoint NYC, to open and operate OPC services. Legal risks were assessed by both the city and the provider. This case study outlines the sequence of events that resulted in NYC supporting OnPoint to open the first two publicly recognized OPCs in the nation, including lessons learned to inform other jurisdictions considering offering such services.
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Affiliation(s)
- Rebecca E Giglio
- New York City Department of Health and Mental Hygiene, Queens 42-09 28Th St, New York, NY, 11101, USA.
| | - Shivani Mantha
- New York City Department of Health and Mental Hygiene, Queens 42-09 28Th St, New York, NY, 11101, USA
| | - Alex Harocopos
- New York City Department of Health and Mental Hygiene, Queens 42-09 28Th St, New York, NY, 11101, USA
| | - Nilova Saha
- New York City Department of Health and Mental Hygiene, Queens 42-09 28Th St, New York, NY, 11101, USA
| | - Jacqueline Reilly
- New York City Department of Health and Mental Hygiene, Queens 42-09 28Th St, New York, NY, 11101, USA
| | - Chelsea Cipriano
- New York City Department of Health and Mental Hygiene, Queens 42-09 28Th St, New York, NY, 11101, USA
| | - Maura Kennelly
- New York City Department of Health and Mental Hygiene, Queens 42-09 28Th St, New York, NY, 11101, USA
| | - Lisa Landau
- New York City Department of Health and Mental Hygiene, Queens 42-09 28Th St, New York, NY, 11101, USA
| | - Michael McRae
- New York City Department of Health and Mental Hygiene, Queens 42-09 28Th St, New York, NY, 11101, USA
| | - Dave A Chokshi
- New York Health Foundation, New York, NY, USA
- New York University Grossman School of Medicine, New York, NY, USA
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4
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Rijnink A, Blake D, Groot S, Brough C. Accessing needle exchange services in disasters for remote areas of Aotearoa New Zealand. Harm Reduct J 2022; 19:145. [PMID: 36544156 PMCID: PMC9771773 DOI: 10.1186/s12954-022-00709-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/21/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Needle Exchange Programme (NEP) mobile outreach services in Aotearoa New Zealand distribute injecting equipment to people who inject drugs (PWID) living in remote regions. In disasters, continued access to such services is imperative for the health and wellbeing of PWID. Disasters can compound existing inequities, particularly in regions characterised by poor or limited infrastructure, smaller populations, and challenging socioeconomic conditions. To gain insight into the barriers that prevent access to NEP harm-reduction services and understand the needs of PWID prior to and during disasters, this study foregrounds the voices of PWID based on the West Coast of the South Island, Aotearoa New Zealand. METHODS This qualitative study applied an interpretive phenomenological analysis approach, where 14 PWID and one key NEP staff member took part in semi-structured interviews. The interviews provided the opportunity for participants to share their experiences and perspectives about accessing sterile drug-injecting equipment during disasters, including the four-week COVID-19 Level 4 lockdown in March 2020. In total five superordinate and 14 subordinate themes were identified from the interveiws. RESULTS This study focuses on four of the key themes that impacted accessibility to NEP services: infrastructural hazards and equipment costs; social capital and practical support from peers and key contact networks; social stigma in public locations, including NEP-based pharmacies and emergency centres; and potential solutions to NEP equipment accessibility as frequently suggested by participants. CONCLUSIONS Access to NEP services is essential during natural hazard and human-generated disasters, as such NEP mobile outreach services and disaster resilience efforts should focus on maintaining service continuity for PWID during adverse times. This study champions a needs-based, stigma free approach to inclusive harm-reduction and emergency management practices for groups with specific needs in a disaster context.
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Affiliation(s)
- Anne Rijnink
- grid.148374.d0000 0001 0696 9806School of Psychology, Massey University, Wellington, Aotearoa New Zealand
| | - Denise Blake
- grid.267827.e0000 0001 2292 3111School of Health, Te Herenga Waka-Victoria University of Wellington, Wellington, Aotearoa New Zealand
| | - Shiloh Groot
- grid.9654.e0000 0004 0372 3343School of Psychology, University of Auckland, Auckland, Aotearoa New Zealand
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5
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Barranco MA, Rosenberg ES, Flanigan C, Shufelt S, Bruce EM, Wilberschied LA, Parker MM, Duncan E, Udo T. A cross-sectional study of hepatitis C prevalence and correlates among persons who inject drugs in rural and non-rural communities. J Viral Hepat 2022; 29:994-1003. [PMID: 35925950 DOI: 10.1111/jvh.13735] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 06/25/2022] [Accepted: 06/30/2022] [Indexed: 12/09/2022]
Abstract
Persons who inject drugs (PWID) have been experiencing a higher burden of new hepatitis C (HCV) due to the opioid epidemic. The greatest increases in injection have been in rural communities. However, less is known about the prevalence of HCV or its risk factors in rural compared to non-rural communities. This study compared HCV infection history, current infection, and associated behavioural and sociodemographic correlates among PWID recruited from rural and non-rural communities from Upstate New York (NY). This cross-sectional study recruited 309 PWID, using respondent-driven sampling. Blood samples were collected through finger stick for HCV antibody and RNA tests. A survey was also self-administered for HCV infection history, sociodemographics and behavioural correlates to compare by setting rurality. HCV seropositivity was significantly higher among PWID from rural than non-rural communities (71.0% vs. 46.8%), as was current infection (41.4% vs. 25.9%). High levels of past year syringe (44.4%) and equipment (62.2%) sharing were reported. Factors associated with infection history include syringe service program utilization, non-Hispanic white race, sharing needles and methamphetamine injection, which was higher in rural vs. non-rural communities (38.5% vs. 15.5%). HCV burden among PWID appears higher in rural than non-rural communities and may be increasing possibly due to greater levels of methamphetamine injection. On-going systematic surveillance of HCV prevalence and correlates is crucial to respond to the changing opioid epidemic landscape. Additionally, improving access to harm reduction services, especially with special focus on stimulants, may be important to reduce HCV prevalence among PWID in rural settings.
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Affiliation(s)
- Meredith A Barranco
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York, USA
| | - Eli S Rosenberg
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York, USA.,Center for Collaborative HIV Research in Practice and Policy, University at Albany, Rensselaer, New York, USA.,Office of Public Health, New York State Department of Health, Albany, New York, USA
| | - Colleen Flanigan
- AIDS Institute, New York State Department of Health, Albany, New York, USA
| | - Sarah Shufelt
- Center for Collaborative HIV Research in Practice and Policy, University at Albany, Rensselaer, New York, USA
| | - Emily M Bruce
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York, USA.,AIDS Institute, New York State Department of Health, Albany, New York, USA
| | | | - Monica M Parker
- Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Eliana Duncan
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York, USA
| | - Tomoko Udo
- Center for Collaborative HIV Research in Practice and Policy, University at Albany, Rensselaer, New York, USA.,Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, Rensselaer, New York, USA
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6
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Stanton MC, Ali SB, McCormick K. Harm reduction implementation among HIV service organizations (HSOs) in the U.S. south: a policy context analysis and results from a survey of HSOs. BMC Health Serv Res 2022; 22:913. [PMID: 35831861 PMCID: PMC9281157 DOI: 10.1186/s12913-022-08277-8] [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: 04/19/2022] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV service organizations are integral to serving communities disproportionately impacted by the HIV and opioid epidemics in the U.S. South. Addressing these intersecting epidemics requires implementation of evidence-based approaches, such as harm reduction. However, little is known about the extent to which Southern HIV service organizations implement harm reduction. This manuscript examines: 1) the implementation context of harm reduction in the South, 2) Southern HIV service organization implementation of harm reduction, and 3) the impact of different contexts within the South on HIV service organization implementation of harm reduction. METHODS To examine implementation context, authors analyzed nation-wide harm reduction policy and drug-related mortality data. To examine HIV service organization implementation of harm reduction, authors performed frequency distributions on survey data (n = 207 organizations). Authors then constructed logistic regressions, using state mortality data and policy context as predictors, to determine what contextual factors predicted HIV service organization implementation of harm reduction. RESULTS Drug-related mortality data revealed an increased need for harm reduction, and harm reduction policy data revealed an increased political openness to harm reduction. Frequency distributions revealed that approximately half of the HIV service organizations surveyed reported that their organizations reflect a harm reduction orientation, and only 26% reported providing harm reduction services. Despite low utilization rates, HIV service organizations indicated a strong interest in harm reduction. Logistic regressions revealed that while increased mortality rates do not predict HIV service organization implementation of harm reduction, a harm reduction-friendly policy context does. DISCUSSION This study highlights how regions within a high-income country can face unique barriers to healthcare and therefore require a unique understanding of implementation context. Study findings indicate a rapidly changing implementation context where increased need meets increased political opportunity to implement harm reduction, however there is a lag in HIV service organization adoption of harm reduction. Financial resources, capacity building, and continued policy advocacy are required for increased HIV service organization adoption of harm reduction.
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Affiliation(s)
- Megan C Stanton
- Department of Sociology, Anthropology, Criminology and Social Work, Eastern Connecticut State University, 83 Windham St, Willimantic, CT, 06226, USA.
| | - Samira B Ali
- Graduate College of Social Work, University of Houston, Houston, USA
| | - Katie McCormick
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, USA
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7
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Fraser H, Stone J, Wisse E, Sambu V, Mfisi P, Duran IJ, Soriano MA, Walker JG, Makere N, Luhmann N, Kafura W, Nouvellet M, Ragi A, Mundia B, Vickerman P. Modelling the impact of HIV and HCV prevention and treatment interventions for people who inject drugs in Dar es Salaam, Tanzania. J Int AIDS Soc 2021; 24:e25817. [PMID: 34661964 PMCID: PMC8522890 DOI: 10.1002/jia2.25817] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/19/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction People who inject drugs (PWID) in Dar es Salaam, Tanzania, have a high prevalence of HIV and hepatitis C virus (HCV). While needle and syringe programmes (NSP), opioid agonist therapy (OAT) and anti‐retroviral therapy (ART) are available in Tanzania, their coverage is sub‐optimal. We assess the impact of existing and scaled up harm reduction (HR) interventions on HIV and HCV transmission among PWID in Dar es Salaam. Methods An HIV and HCV transmission model among PWID in Tanzania was calibrated to data over 2006–2018 on HIV (∼30% and ∼67% prevalence in males and females in 2011) and HCV prevalence (∼16% in 2017), numbers on HR interventions (5254 ever on OAT in 2018, 766–1479 accessing NSP in 2017) and ART coverage (63.1% in 2015). We evaluated the impact of existing interventions in 2019 and impact by 2030 of scaling‐up the coverage of OAT (to 50% of PWID), NSP (75%, both combined termed “full HR”) and ART (81% with 90% virally suppressed) from 2019, reducing sexual HIV transmission by 50%, and/or HCV‐treating 10% of PWID infected with HCV annually. Results The model projects HIV and HCV prevalence of 19.0% (95% credibility interval: 16.4–21.2%) and 41.0% (24.4–49.0%) in 2019, respectively. For HIV, 24.6% (13.6–32.6%) and 70.3% (59.3–77.1%) of incident infections among male and female PWID are sexually transmitted, respectively. Due to their low coverage (22.8% for OAT, 16.3% for NSP in 2019), OAT and NSP averted 20.4% (12.9–24.7%) of HIV infections and 21.7% (17.0–25.2%) of HCV infections in 2019. Existing ART (68.5% coverage by 2019) averted 48.1% (29.7–64.3%) of HIV infections in 2019. Scaling up to full HR will reduce HIV and HCV incidence by 62.6% (52.5–74.0%) and 81.4% (56.7–81.4%), respectively, over 2019–2030; scaled up ART alongside full HR will decrease HIV incidence by 66.8% (55.6–77.5%), increasing to 81.5% (73.7–87.5%) when sexual risk is also reduced. HCV‐treatment alongside full HR will decrease HCV incidence by 92.4% (80.7–95.8%) by 2030. Conclusions Combination interventions, including sexual risk reduction and HCV treatment, are needed to eliminate HCV and HIV among PWID in Tanzania.
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Affiliation(s)
- Hannah Fraser
- Population HealthSciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jack Stone
- Population HealthSciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Veryeh Sambu
- National AIDS Control Programmes, Dar es Salaam, Tanzania
| | - Peter Mfisi
- The Drug Control and Enforcement Authority, Prime Ministers Office, Dar es Salaam, Tanzania
| | | | | | - Josephine G Walker
- Population HealthSciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nobelrich Makere
- Tanzania Council for Social Development (TACOSODE), Dar es Salaam, Tanzania
| | | | - William Kafura
- Tanzania Commission for AIDS (TACAIDS), Dar es Salaam, Tanzania
| | | | - Allan Ragi
- Kenya AIDS NGO Consortium, Nairobi, Kenya
| | | | - Peter Vickerman
- Population HealthSciences, Bristol Medical School, University of Bristol, Bristol, UK
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8
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Ostrander N, Carlberg-Racich S. "I feel safe here": Participants identify key components of syringe access programs. J Prev Interv Community 2021; 50:89-103. [PMID: 34547981 DOI: 10.1080/10852352.2021.1915733] [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] [Indexed: 10/20/2022]
Abstract
Syringe access programs (SAPs) provide an array of supplies and services to people who inject drugs (PWID). Governmental reports within the United States have often neglected to include the voices of people who utilize SAPs. This project, which was part of a master's of public health practicum, surveyed 28 injection drug users about their experiences with an SAP in a major Midwestern city. Through this work, participants prioritized the supplies they most frequently need and the services they most often utilize. The results of this study may provide guidance to emerging SAPs that are working to prioritize supplies and services.
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Affiliation(s)
- Noam Ostrander
- Department of Social Work, DePaul University, Chicago, USA
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9
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Trooskin SB, Dore G, Kostman J. We Must Do Better: Addressing HCV Treatment Barriers in Persons Who Inject Drugs in the United States. J Infect Dis 2021; 222:S773-S781. [PMID: 33245349 DOI: 10.1093/infdis/jiaa574] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The opioid epidemic in the United States, along with a lack of adequate harm reduction services, has contributed to a sharp rise in hepatitis C virus (HCV) infections. Despite considerable evidence of the effectiveness of HCV treatment in people who inject drugs (PWID), and recommendations from clinical guidelines to prioritize treatment in PWID, there are multiple barriers to broad uptake of HCV treatment. These barriers exist at the systems level, as well as at the level of medical providers and patients. Interventions to remove treatment barriers in the United States include harm reduction services, simplifying HCV testing algorithms, improved linkage to HCV care services, and application of new treatment models including colocating services at substance use disorder treatment programs. By following the lead of other countries who have addressed the barriers to HCV treatment, the United States has opportunities to do better in addressing the consequences of the opioid epidemic, including chronic HCV infection.
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Affiliation(s)
- Stacey B Trooskin
- Philadelphia FIGHT Community Health Centers, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gregory Dore
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Jay Kostman
- Philadelphia FIGHT Community Health Centers, Philadelphia, Pennsylvania, USA
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10
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Jordan AE, Cleland CM, Schackman BR, Wyka K, Perlman DC, Nash D. Hepatitis C Virus (HCV) Care Continuum Outcomes and HCV Community Viral Loads Among Patients in an Opioid Treatment Program. J Infect Dis 2021; 222:S335-S345. [PMID: 32877560 DOI: 10.1093/infdis/jiz686] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) remains endemic among people who use drugs (PWUD). Measures of HCV community viral load (CVL) and HCV care continuum outcomes may be valuable for ascertaining unmet treatment need and for HCV surveillance and control. METHODS Data from patients in an opioid treatment program during 2013-2016 were used to (1) identify proportions of antibody and viral load (VL) tested, linked-to-care, and treated, in 2013-2014 and 2015-2016, and pre- and postimplementation of qualitative reflex VL testing; (2) calculate engaged-in-care HCV CVL and "documented" and "estimated" unmet treatment need; and (3) examine factors associated with linkage-to-HCV-care. RESULTS Among 11 267 patients, proportions of HCV antibody tested (52.5% in 2013-2014 vs 73.3% in 2015-2016), linked-to-HCV-care (15.7% vs 51.8%), and treated (12.0% vs 44.7%) all increased significantly. Hispanic ethnicity was associated with less linkage-to-care, and Manhattan residence was associated with improved linkage-to-care. The overall engaged-in-care HCV CVL was 4 351 079 copies/mL (standard deviation = 7 149 888); local HCV CVLs varied by subgroup and geography. Documented and estimated unmet treatment need decreased but remained high. CONCLUSIONS After qualitative reflex VL testing was implemented, care continuum outcomes improved, but gaps remained. High rates of unmet treatment need suggest that control of the HCV epidemic among PWUD will require expansion of HCV treatment coverage.
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Affiliation(s)
- Ashly E Jordan
- Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA.,Center for Drug Use and HIV Research (multi-institutional), New York, New York, USA.,Behavioral Science Training Program in Drug Abuse Research, New York University, New York, New York, USA
| | - Charles M Cleland
- Center for Drug Use and HIV Research (multi-institutional), New York, New York, USA.,Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Bruce R Schackman
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York, USA
| | - Katarzyna Wyka
- Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
| | - David C Perlman
- Center for Drug Use and HIV Research (multi-institutional), New York, New York, USA.,Division of Infectious Diseases, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Denis Nash
- Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
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11
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Jordan AE, Cleland CM, Wyka K, Schackman BR, Perlman DC, Nash D. Hepatitis C Virus Incidence in a Cohort in Medication-Assisted Treatment for Opioid Use Disorder in New York City. J Infect Dis 2021; 222:S322-S334. [PMID: 32877567 DOI: 10.1093/infdis/jiz659] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) incidence has increased in the worsening opioid epidemic. We examined the HCV preventive efficacy of medication-assisted treatment (MAT), and geographic variation in HCV community viral load (CVL) and its association with HCV incidence. METHODS HCV incidence was directly measured in an open cohort of patients in a MAT program in New York City between 1 January 2013 and 31 December 2016. Area-level HCV CVL was calculated. Associations of individual-level factors, and of HCV CVL, with HCV incidence were examined in separate analyses. RESULTS Among 8352 patients, HCV prevalence was 48.7%. Among 2535 patients seronegative at first antibody test, HCV incidence was 2.25/100 person-years of observation (PYO). Incidence was 6.70/100 PYO among those reporting main drug use by injection. Female gender, drug injection, and lower MAT retention were significantly associated with higher incidence rate ratios. Female gender, drug injection, and methadone doses <60 mg were independently associated with shorter time to HCV seroconversion. HCV CVLs varied significantly by geographic area. CONCLUSIONS HCV incidence was higher among those with lower MAT retention and was lower among those receiving higher methadone doses, suggesting the need to ensure high MAT retention, adequate doses, and increased HCV prevention and treatment engagement. HCV CVLs vary geographically and merit further study as predictors of HCV incidence.
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Affiliation(s)
- Ashly E Jordan
- Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA.,Center for Drug Use and HIV Research, New York, New York, USA.,Behavioral Science Training Program in Drug Abuse Research, New York University, New York, New York, USA
| | - Charles M Cleland
- Center for Drug Use and HIV Research, New York, New York, USA.,Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Katarzyna Wyka
- Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
| | - Bruce R Schackman
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, USA
| | - David C Perlman
- Center for Drug Use and HIV Research, New York, New York, USA.,Division of Infectious Diseases, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Denis Nash
- Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
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Sulkowski M, Cheng WH, Marx S, Sanchez Gonzalez Y, Strezewski J, Reau N. Estimating the Year Each State in the United States Will Achieve the World Health Organization's Elimination Targets for Hepatitis C. Adv Ther 2021; 38:423-440. [PMID: 33145648 PMCID: PMC7609357 DOI: 10.1007/s12325-020-01535-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/14/2020] [Indexed: 12/12/2022]
Abstract
Introduction Although hepatitis C virus (HCV) infection remains a major clinical, economic, and societal burden, the development of curative antiviral therapy may accelerate the path toward elimination. This analysis assessed the progress of United States (US) states towards achieving the World Health Organization’s (WHO) 2030 HCV elimination targets for incidence, mortality, diagnosis, and treatment. Methods A previously published Markov model was used to simulate HCV progression over time to estimate the path to HCV elimination in each state based on prevalence, annual treatment, and diagnosis inputs from two large US laboratory datasets from January 2013 to December 2017. State-specific fibrosis stage restrictions on treatment in 2017 were included. The model estimated the year individual states would meet the WHO targets for diagnosing 90% of the HCV-infected population, treating 80% of the eligible population, reducing new HCV infections by 80%, and reducing HCV-related deaths by 65%. The minimum number of annual treatments needed between 2020 and 2030 to achieve the WHO treatment target was also calculated. Results Overall, the USA is projected to achieve HCV elimination by 2037, with individual targets related to mortality, diagnosis, treatment, and incidence being achieved by 2020, 2027, 2033, and 2037, respectively. Three states (Connecticut, South Carolina, and Washington) are on track to meet all four elimination targets by 2030, and 18 states are not expected to meet these targets before 2040. The estimated annual number of treatments required during 2020–2030 nationally to reach the WHO treatment target is 173,514. Conclusion With the exception of three states, the USA is not on target to meet the WHO 2030 elimination targets and 35% are off track by 10 years or more. Strategies must be implemented to reduce overall prevalence by preventing new infections, increasing rates of screening, improving linkage to care, and implementing unfettered access to curative therapy. Electronic supplementary material The online version of this article (10.1007/s12325-020-01535-3) contains supplementary material, which is available to authorized users.
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Jones JF, Legaspi J, Chen E, Lee K, Le J. Emerging Viral and Bacterial Infections: Within an Era of Opioid Epidemic. Infect Dis Ther 2020; 9:737-755. [PMID: 32918275 PMCID: PMC7680496 DOI: 10.1007/s40121-020-00335-0] [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: 06/29/2020] [Indexed: 11/09/2022] Open
Abstract
The opioid epidemic is a public health crisis that continues to impact healthcare in the United States of America (USA). While changes in opioid prescribing have curbed the medical use of opioids, the increase in nonmedical use, largely driven by injection drug use (IDU), has contributed to the escalating incidence of opioid use disorder (OUD). Furthermore, IDU is associated with high-risk injection practices that can increase the risk of acquiring viral and bacterial infections. Here in this comprehensive review, we aimed to summarize the epidemiology and management of OUD, along with the screening and antimicrobial treatment of associated infections, specifically focused on human immunodeficiency virus, hepatitis C virus, skin and soft tissue infections, endocarditis, and osteomyelitis. Medication-assisted therapy (MAT) and infection guidelines from the USA will be presented.
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Affiliation(s)
- Jessica F Jones
- University of California San Diego Health, San Diego, CA, USA.
| | - Jamie Legaspi
- University of California San Diego Health, San Diego, CA, USA
| | - Eric Chen
- University of California San Diego Health, San Diego, CA, USA
| | - Kelly Lee
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Jennifer Le
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, San Diego, CA, USA
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Dwivedi N, Breslin MA, McDermott A, Lin S, Vallier HA, Tornetta P. What Is the Financial Impact of Orthopaedic Sequelae of Intravenous Drug Use on Urban Tertiary-care Centers? Clin Orthop Relat Res 2020; 478:2202-2212. [PMID: 32667752 PMCID: PMC7491896 DOI: 10.1097/corr.0000000000001330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 05/08/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Orthopaedic sequelae such as skin and soft-tissue abscesses are frequent complications of intravenous drug use (IVDU) and comprise many of the most common indications for emergency room visits and hospitalizations within this population. Urban tertiary-care and safety-net hospitals frequently operate in challenging economic healthcare environments and are disproportionately tasked with providing care to this largely underinsured patient demographic. Although many public health initiatives have been instituted in recent years to understand the health impacts of IVDU and the spreading opioid epidemic, few efforts have been made to investigate its economic impact on healthcare systems. The inpatient treatment of orthopaedic sequelae of IVDU is a high-cost healthcare element that is critically important to understand within the current national context of inflationary healthcare costs. QUESTIONS/PURPOSES (1) What were the total healthcare costs incurred and total hospital reimbursements received in the treatment of extraspinal orthopaedic sequelae of IVDU? (2) What were the total healthcare costs incurred and total hospital reimbursements received in the treatment of spinal orthopaedic sequelae of IVDU? (3) How did patient insurance status effect the economic burden of orthopaedic sequelae of IVDU? METHODS An internal departmental record of all successive patients requiring inpatient treatment of orthopaedic sequelae of IVDU was initiated at Boston Medical Center (Boston, MA, USA) in 2012 and MetroHealth Medical Center (Cleveland, OH, USA) in 2015. A total of 412 patient admissions between 2012 to 2017 to these two safety-net hospitals (n = 236 and n = 176, respectively) for orthopaedic complications of IVDU were included in the study. These sequelae included cellulitis, cutaneous abscess, bursitis, myositis, tenosynovitis, septic arthritis, osteomyelitis, and epidural abscess. Patients were included if they were older than 18 years of age, presented to the emergency department for management of a musculoskeletal infection secondary to IVDU, and required inpatient orthopaedic treatment during their admission. Exclusion criteria included all patients presenting with a musculoskeletal infection not directly secondary to active IVDU. Patients presenting with an epidural abscess (Boston Medical Center, n = 36) were evaluated separately to explore potential differences in costs within this subgroup. A robust retrospective financial analysis was performed using internal financial databases at each institution which directly enumerated all true hospital costs associated with each patient admission, independent of billed hospital charges. All direct, indirect, variable, and fixed hospital costs were individually summed for each hospitalization, constituting a true "bottom-up" micro-costing approach. Labor-based costs were calculated through use of time-based costing; for instance, the cost of nursing labor care associated with a patient admission was determined through ascription of the median hospital cost of a registered nurse within that department (that is, compensation for salary plus benefits) to the total length of nursing time needed by that patient during their hospitalization. Primary reimbursements reflected the true monetary value received by the study institutions from insurers and were determined through the total adjusted payment for each inpatient admission. All professional fees were excluded. A secondary analysis was performed to assess the effect of patient insurance status on hospital costs and reimbursements for each patient admission. RESULTS The mean healthcare cost incurred for the treatment of extraspinal orthopaedic sequelae of IVDU was USD 9524 ± USD 1430 per patient admission. The mean hospital reimbursement provided for the treatment of these extraspinal sequelae was USD 7678 ± USD 1248 per patient admission. This resulted in a mean financial loss of USD 1846 ± USD 1342 per patient admission. The mean healthcare cost incurred at Boston Medical Center for the treatment of epidural abscesses secondary to IVDU was USD 44,357 ± USD 7384 per patient. Hospital reimbursements within this subgroup were highly dependent upon insurance status. The median (range) reimbursement provided for patients possessing a unique hospital-based nonprofit health plan (n = 4) was USD 103,016 (USD 9022 to USD 320,123), corresponding to a median financial gain of USD 24,904 (USD 2289 to USD 83,079). However, the mean reimbursement for all other patients presenting with epidural abscesses (n = 32) was USD 30,429 ± USD 5278, corresponding to a mean financial loss of USD 5768 ± USD 4861. A secondary analysis demonstrated that treatment of extraspinal orthopaedic sequelae of IVDU for patients possessing Medicaid insurance (n = 309) resulted in a financial loss of USD 2813 ± USD 1593 per patient admission. Conversely, treatment of extraspinal orthopaedic sequelae for patients possessing non-Medicaid insurance (n = 67) generated a mean financial gain of USD 2615 ± USD 1341 per patient admission. CONCLUSIONS Even when excluding all professional fees, the inpatient treatment of orthopaedic sequelae of IVDU resulted in substantial financial losses driven primarily by high proportions of under- and uninsured people within this patient population. These financial losses may be unsustainable for medical centers operating in challenging economic healthcare landscapes. The development of novel initiatives and support of existing programs aimed at mitigating the health-related and economic impact of IVDU must remain a principal priority of healthcare providers and policymakers in coming years. Advocacy for the expansion of Medicaid accountable care organizations and national syringe service programs (SSPs), and the development of specialized outpatient wound and abscess clinics at healthcare centers may help to substantially alleviate the economic burden of the orthopaedic sequelae of IVDU. LEVEL OF EVIDENCE Level, IV, economic and decision analyses.
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Affiliation(s)
- Nishant Dwivedi
- N. Dwivedi, Department of Orthopaedic Surgery, Washington University in St. Louis/Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Mary A Breslin
- M. A. Breslin, A. McDermott, S. Lin, H. A. Vallier, Department of Orthopaedics, the MetroHealth System, affiliated with Case Western Reserve University, Cleveland, OH, USA
| | - Amber McDermott
- M. A. Breslin, A. McDermott, S. Lin, H. A. Vallier, Department of Orthopaedics, the MetroHealth System, affiliated with Case Western Reserve University, Cleveland, OH, USA
| | - Steve Lin
- M. A. Breslin, A. McDermott, S. Lin, H. A. Vallier, Department of Orthopaedics, the MetroHealth System, affiliated with Case Western Reserve University, Cleveland, OH, USA
| | - Heather A Vallier
- M. A. Breslin, A. McDermott, S. Lin, H. A. Vallier, Department of Orthopaedics, the MetroHealth System, affiliated with Case Western Reserve University, Cleveland, OH, USA
| | - Paul Tornetta
- P. Tornetta, Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA, USA
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Hochstatter KR, Hull SJ, Sethi AK, Burns ME, Mundt MP, Westergaard RP. Promoting Safe Injection Practices, Substance Use Reduction, Hepatitis C Testing, and Overdose Prevention Among Syringe Service Program Clients Using a Computer-Tailored Intervention: Pilot Randomized Controlled Trial. J Med Internet Res 2020; 22:e19703. [PMID: 32990630 PMCID: PMC7556373 DOI: 10.2196/19703] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/05/2020] [Accepted: 07/07/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Syringe service programs (SSPs) are safe, highly effective programs for promoting health among people who inject drugs. However, resource limitations prevent the delivery of a full package of prevention services to many clients in need. Computer-tailored interventions may represent a promising approach for providing prevention information to people who inject drugs in resource-constrained settings. OBJECTIVE The aim of this paper is to assess the effect of a computer-tailored behavioral intervention, called Hep-Net, on safe injection practices, substance use reduction, overdose prevention, and hepatitis C virus (HCV) testing among SSP clients. METHODS Using a social network-based recruitment strategy, we recruited clients of an established SSP in Wisconsin and peers from their social networks. Participants completed a computerized baseline survey and were then randomly assigned to receive the Hep-Net intervention. Components of the intervention included an overall risk synthesis, participants' selection of a behavioral goal, and an individualized risk reduction exercise. Individuals were followed up 3 months later to assess their behavior change. The effect of Hep-Net on receiving an HCV screening test, undergoing Narcan training, reducing the frequency of drug use, and sharing drug equipment was assessed. The individual's readiness to change each behavior was also examined. RESULTS From 2014 to 2015, a total of 235 people who injected drugs enrolled into the Hep-Net study. Of these, 64.3% (151/235) completed the follow-up survey 3-6 months postenrollment. Compared with the control group, individuals who received the Hep-Net intervention were more likely to undergo HCV testing (odds ratio [OR] 2.23, 95% CI 1.05-4.74; P=.04) and receive Narcan training (OR 2.25, 95% CI 0.83-6.06; P=.11), and they shared drug equipment less frequently (OR 0.06, 95% CI 0.55-0.65; P<.001). Similarly, individuals who received the intervention were more likely to advance in their stage of readiness to change these 3 behaviors. However, intervention participants did not appear to reduce the frequency of drug use or increase their readiness to reduce drug use more than control participants, despite the fact that the majority of the intervention participants selected this as the primary goal to focus on after participation in the baseline survey. CONCLUSIONS Implementing computer-based risk reduction interventions in SSPs may reduce harms associated with the sharing of injection equipment and prevent overdose deaths; however, brief computerized interventions may not be robust enough to overcome the challenges associated with reducing and ceasing drug use when implemented in settings centered on the delivery of prevention services. TRIAL REGISTRATION ClinicalTrials.gov NCT02474043; https://clinicaltrials.gov/ct2/show/NCT02474043. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/resprot.4830.
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Affiliation(s)
| | - Shawnika J Hull
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington DC, DC, United States
| | - Ajay K Sethi
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Marguerite E Burns
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Marlon P Mundt
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Ryan P Westergaard
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
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Minoyan N, Artenie AA, Zang G, Jutras-Aswad D, Turcotte MÈ, Bruneau J. Harm Reduction Coverage and Hepatitis C Incidence: Findings From a Cohort of People Who Inject Drugs. Am J Prev Med 2020; 58:845-853. [PMID: 32444003 DOI: 10.1016/j.amepre.2020.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 01/12/2020] [Accepted: 01/13/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Needle and syringe programs and opioid agonist therapy are essential for harm reduction among people who inject drugs. Few studies assess their combined potential in preventing hepatitis C virus infection. No studies have assessed whether they perform similarly among individuals at risk of primary and recurrent infection. This study aimed to estimate the rates of hepatitis C virus acquisition according to harm reduction coverage among hepatitis C virus-naive and previously infected people who inject drugs in Montreal, Canada. METHODS This prospective cohort study involved regular interviews and hepatitis C antibody and RNA testing (data collection: 2010-2017, analysis: 2018). Opioid agonist therapy coverage was defined by current dose: high (≥60 mg/day methadone, ≥16 mg buprenorphine), low, or none. Complete needle and syringe program coverage was defined as exclusively reporting safe needle and syringe sources (past 6 or 3 months). Combined coverage was defined as full (high-dose agonist/complete needle/syringe coverage), minimal (low-dose agonist/incomplete needle/syringe coverage), and partial (remaining combinations). Cox regression models were fit. RESULTS A total of 106 events were observed over 1,183.1 person-years for primary and recurrent incidence rates of 10.6 (95% CI=8.0, 13.8) and 7.6 (95% CI=5.6, 9.9) per 100 years, respectively. High-dose opioid agonist therapy was associated with a 77% reduction in hepatitis C virus acquisition (hazard ratio=0.23, 95% CI=0.10, 0.50) compared with not receiving opioid agonist therapy. Needle and syringe coverage was not associated with infection rates. Estimates considering their combination reflected opioid agonist therapy coverage. Associations were similar among hepatitis C virus-naive and previously infected people who inject drugs. CONCLUSIONS High-dose opioid agonist therapy seems particularly important to reduce drug-related harms among hepatitis C virus-naive and previously infected people who inject drugs in Montreal.
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Affiliation(s)
- Nanor Minoyan
- Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Quebec, Canada
| | - Andreea A Artenie
- Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Quebec, Canada
| | - Geng Zang
- Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Didier Jutras-Aswad
- Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Marie-Ève Turcotte
- Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Julie Bruneau
- Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.
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Feuerstein-Simon R, Lowenstein M, Sharma M, Dupuis R, Luna Marti X, Cannuscio CC. Local health departments and the implementation of evidence-based policies to address opioid overdose mortality. Subst Abus 2020; 41:468-474. [PMID: 32213045 DOI: 10.1080/08897077.2019.1709250] [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] [Indexed: 10/24/2022]
Abstract
BACKGROUND In the context of the opioid overdose crisis, local health departments are on the front lines, coordinating programs and services and translating state and federal policies into community action. While media reports describe growth of Overdose Education and Naloxone Distribution (OEND) programs among local health departments, little is known about program features, scope, and target populations. Methods: We surveyed health departments in 180 United States counties with high overdose mortality rates. Results: Among health officials from 54 counties (30% response), many counties reported implementation of evidence-based practices, with a high degree of programmatic variation. The majority of responding health departments (94%) conducted overdose education and naloxone distribution (OEND) programs. Programs were heterogeneous in scale, with a reported median of 250 naloxone kits (range 1-25,000 kits) acquired for community distribution. In addition, four in five respondents were aware of their state's standing order policy for increasing naloxone access. While the majority of respondents reported county-level availability of at least one form of evidence-based medications to treat opioid use disorder (MOUD), many reported no availability of buprenorphine (33%) or methadone (43%). Conclusions: Local health departments are vital to reducing opioid overdose mortality, and many are implementing relevant evidence-based practices. To support further adoption of potentially life-saving strategies, health departments need adequate funding and staffing as well as policies and guidelines to support implementation.
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Affiliation(s)
- Rachel Feuerstein-Simon
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Margaret Lowenstein
- National Clinician Scholars Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Meghana Sharma
- Master of Public Health Program, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Roxanne Dupuis
- Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Xochitl Luna Marti
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Carolyn C Cannuscio
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Enkelmann J, Gassowski M, Nielsen S, Wenz B, Roß S, Marcus U, Bremer V, Zimmermann R. High prevalence of hepatitis C virus infection and low level of awareness among people who recently started injecting drugs in a cross-sectional study in Germany, 2011-2014: missed opportunities for hepatitis C testing. Harm Reduct J 2020; 17:7. [PMID: 31924208 PMCID: PMC6954578 DOI: 10.1186/s12954-019-0338-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 11/06/2019] [Indexed: 12/17/2022] Open
Abstract
Background In Germany, risk of hepatitis C virus (HCV) infection is highest among people who inject drugs (PWID). New injectors (NI) are particularly vulnerable for HCV-acquisition, but little is known about health seeking behaviour and opportunities for intervention in this group. We describe characteristics, HCV prevalence, estimated HCV incidence and awareness of HCV-status among NIs and missed opportunities for hepatitis C testing. Methods People who had injected drugs in the last 12 months were recruited into a cross-sectional serobehavioural study using respondent-driven sampling in 8 German cities, 2011–2014. Data on sociodemographic characteristics, previous HCV testing and access to care were collected through questionnaire-based interviews. Capillary blood was tested for HCV. People injecting drugs < 5 years were considered NI. Results Of 2059 participants with available information on duration of injection drug use, 232 (11% were NI. Estimated HCV incidence among NI was 19.6 infections/100 person years at risk (95% CI 16–24). Thirty-six percent of NI were HCV-positive (thereof 76% with detectable RNA) and 41% of those HCV-positive were unaware of their HCV-status. Overall, 27% of NI reported never having been HCV-tested. Of NI with available information, more than 80% had attended low-threshold drug services in the last 30 days, 24% were released from prison in the last 12 months and medical care was most commonly accessed in hospitals, opioid substitution therapy (OST)-practices, practices without OST and prison hospitals. Conclusion We found high HCV-positivity and low HCV-status awareness among NI, often with missed opportunities for HCV-testing. To increase early diagnosis and facilitate treatment, HCV-testing should be offered in all facilities, where NI can be reached, especially low-threshold drug services and addiction therapy, but also prisons, hospitals and practices without OST.
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Affiliation(s)
- Julia Enkelmann
- Postgraduate Training for Applied Epidemiology, Robert Koch Institute, Berlin, Germany. .,European Programme for Intervention Epidemiology Training, ECDC, Stockholm, Sweden. .,Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
| | - Martyna Gassowski
- Department of Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Stine Nielsen
- Department of Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany.,Charité University Medicine, Berlin, Germany
| | - Benjamin Wenz
- Department of Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Stefan Roß
- Institute of Virology, National Reference Centre for Hepatitis C, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ulrich Marcus
- Department of Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Viviane Bremer
- Department of Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Ruth Zimmermann
- Department of Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
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Distributive Syringe Sharing and Use of Syringe Services Programs (SSPs) Among Persons Who Inject Drugs. AIDS Behav 2019; 23:3306-3314. [PMID: 31512066 DOI: 10.1007/s10461-019-02615-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Monitoring distributive syringe sharing (DSS) and syringe services program (SSP) use among persons who inject drugs (PWID) is important for HIV prevention. PWID aged ≥ 18 in 20 US cities were recruited for National HIV Behavioral Surveillance in 2015 using respondent-driven sampling, interviewed and offered HIV testing. Bivariate and multivariable analyses via log-linked Poisson regression with generalized estimating equations were conducted to examine associations between demographic and behavioral variables and DSS. Effect of SSP use on DSS by HIV sero-status was assessed by including an interaction between SSP and sero-status. Analyses were adjusted for sampling design. Among 10,402 PWID, 42% reported DSS. DSS was less likely to be reported among HIV-positive compared to HIV-negative PWID (aPR = 0.51, CI 0.45-0.60), and among those who primarily obtained syringes from SSPs versus those who did not (aPR = 0.82, 95% CI 0.77-0.88). After adjustment, those who primarily used SSPs were less likely to report DSS than those who did not among both HIV-negative PWID (aPR = 0.84, 95% CI 0.78-0.90) and HIV-positive PWID (aPR = 0.54, 95% CI 0.39-0.75). Findings support expansion of SSPs, and referrals to SSPs by providers working with PWID.
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Davis CS, Carr DH, Samuels EA. Paraphernalia Laws, Criminalizing Possession and Distribution of Items Used to Consume Illicit Drugs, and Injection-Related Harm. Am J Public Health 2019; 109:1564-1567. [PMID: 31536408 DOI: 10.2105/ajph.2019.305268] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The United States remains in the grip of an unprecedented epidemic of drug-related harm. Infections of HIV, hepatitis C, and endocarditis related to lack of access to new syringes and subsequent syringe sharing among people who inject drugs have increased alongside a surge in opioid overdose deaths.Overwhelming evidence shows that using a new syringe with every injection prevents injection-related blood-borne disease transmission. Additionally, there is promising research suggesting that the distribution of fentanyl test strips to people who inject drugs changes individuals' injection decisions, which enables safer drug use and reduces the risk of fatal overdose. However, laws prohibiting the possession of syringes and fentanyl test strips persist in nearly every state.The full and immediate repeal of state paraphernalia laws is both warranted and needed to reduce opioid overdose death and related harms. Such repeal would improve the health of people who inject drugs and those with whom they interact, reducing the spread of blood-borne disease and fatal overdose associated with infiltration of illicitly manufactured fentanyl into the illicit drug supply. It would also free up scarce public resources that could be redirected toward evidence-based approaches to reducing drug-related harm.
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Affiliation(s)
- Corey S Davis
- Corey S. Davis and Derek H. Carr are with the Network for Public Health Law, Los Angeles, CA. Corey S. Davis is also with the Brody School of Medicine, East Carolina University, Greenville, NC. Elizabeth A. Samuels is with the Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI
| | - Derek H Carr
- Corey S. Davis and Derek H. Carr are with the Network for Public Health Law, Los Angeles, CA. Corey S. Davis is also with the Brody School of Medicine, East Carolina University, Greenville, NC. Elizabeth A. Samuels is with the Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI
| | - Elizabeth A Samuels
- Corey S. Davis and Derek H. Carr are with the Network for Public Health Law, Los Angeles, CA. Corey S. Davis is also with the Brody School of Medicine, East Carolina University, Greenville, NC. Elizabeth A. Samuels is with the Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI
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Des Jarlais DC, McKnight C, Arasteh K, Feelemyer J, Ross Z, Cooper HLF. Geographic distribution of risk ("Hotspots") for HIV, HCV, and drug overdose among persons who use drugs in New York City: the importance of local history. Harm Reduct J 2019; 16:53. [PMID: 31477150 PMCID: PMC6721211 DOI: 10.1186/s12954-019-0326-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/21/2019] [Indexed: 11/10/2022] Open
Abstract
AIMS To identify geographic "hotspots" for potential transmission of HIV and HCV and for drug overdose among persons who use heroin and cocaine in New York City and to examine historical continuities in problem drug use hotspots in the city. METHODS A total of 2714 study participants were recruited among persons entering Beth Israel substance use treatment programs. A structured questionnaire was administered and blood samples for HIV and HCV testing were collected. Hotspots for potential virus transmission were defined as ZIP codes with 10+ participants, 2+ persons infected with the virus and engaging in transmission behavior, and 2+ persons not infected and engaging in acquisition behavior. ZIP codes with 3+ persons with previous overdoses were considered potential hotspots for future overdoses. RESULTS Participants resided in 166/178 (93%) of the ZIP codes in New York City. Injecting drug use was reported in 150/178 (84%) of the ZIP codes. No zip codes were identified for injecting-related HIV transmission, 5 zip codes were identified for sexual HIV transmission, 3 for HCV transmission, and 8 for drug overdose. Many of the ZIP code potential hotspots were in neighborhoods long associated with drug use: Lower Eastside and Harlem in Manhattan, the South Bronx, and Central Brooklyn. DISCUSSION Heroin and cocaine use requiring treatment were reported from almost all ZIP codes in New York City, indicating needs for widely dispersed harm reduction services. Identified hotspots should be targeted for reducing sexual transmission of HIV, transmission of HCV, and drug overdoses. Some of the hotspots have persisted as problem drug use areas for 40 to over 100 years. Monitoring of drug use patterns in historical hotspot neighborhoods may permit early identification of and response to emerging drug use-related health problems. Persistent historical hotspots for problem drug use present a complex problem for implementing harm reduction services that deserve additional research.
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Affiliation(s)
- D C Des Jarlais
- College of Global Public Health, New York University, 665 Broadway, 8th Floor, New York, NY, 10003, USA.
| | - C McKnight
- College of Global Public Health, New York University, 665 Broadway, 8th Floor, New York, NY, 10003, USA
| | - K Arasteh
- College of Global Public Health, New York University, 665 Broadway, 8th Floor, New York, NY, 10003, USA
| | - J Feelemyer
- College of Global Public Health, New York University, 665 Broadway, 8th Floor, New York, NY, 10003, USA
| | - Zev Ross
- ZevRoss Spatial Analysis, Ithaca, NY, 14850, USA
| | - H L F Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Surratt HL, Otachi JK, Williams T, Gulley J, Lockard AS, Rains R. Motivation to Change and Treatment Participation Among Syringe Service Program Utilizers in Rural Kentucky. J Rural Health 2019; 36:224-233. [PMID: 31415716 DOI: 10.1111/jrh.12388] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/21/2019] [Accepted: 07/16/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE Kentucky experiences a disproportionate burden of substance use disorder (SUD), particularly in rural areas of the state. Multiple factors increase vulnerability to SUD and limit access to services in rural communities. However, the recent implementation and expansion of syringe service programs (SSPs) in rural Kentucky may provide a leverage point to reach at-risk people who inject drugs (PWID). METHODS Data were collected as part of an ongoing NIDA-funded study designed to examine uptake of SSPs among PWID in Appalachian Kentucky. Using Respondent Driven Sampling (RDS), the study enrolled a sample of 186 PWID SSP attenders across 3 rural Appalachian Kentucky counties and conducted face-to-face interviews regarding health behaviors, injecting practices, SSP utilization, and treatment services. Using logistic regression analyses, we examined consistent SSP use, as well as importance and confidence to reduce substance use as predictors of current treatment participation. FINDINGS For the prior 6 months, 44.6% of the sample reported consistent SSP use. Consistent use of SSPs was associated with treatment participation in the unadjusted logistic regression models. Significant predictors of treatment participation in the adjusted model included high confidence to reduce substance use, and not reporting primary methamphetamine injection. CONCLUSIONS Rurally located SSPs may play an important role in supporting confidence and motivation to change substance use behaviors among PWID impacted by SUD. SSPs may be critical venues for integration and expansion of prevention, health promotion, and treatment linkage services for this underserved population.
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Affiliation(s)
- Hilary L Surratt
- Center for Health Services Research, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Janet K Otachi
- Center for Health Services Research, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Timothy Williams
- Center for Health Services Research, College of Medicine, University of Kentucky, Lexington, Kentucky
| | | | | | - Rebecca Rains
- Knox County Health Department, Barbourville, Kentucky
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Sutter A, Curtis M, Frost T. Public drug use in eight U.S. cities: Health risks and other factors associated with place of drug use. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 64:62-69. [DOI: 10.1016/j.drugpo.2018.11.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/06/2018] [Accepted: 11/19/2018] [Indexed: 10/27/2022]
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O’Riordan K, Khan M, Mazulis A. CON: Needle Exchange Programs Should Not Be Instituted to Reduce Hepatitis C Virus Transmission. Clin Liver Dis (Hoboken) 2019; 12:173-175. [PMID: 30988938 PMCID: PMC6446454 DOI: 10.1002/cld.738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 06/12/2018] [Accepted: 06/20/2018] [Indexed: 02/04/2023] Open
Affiliation(s)
| | - Mohsen Khan
- Advocate Lutheran General HospitalPark RidgeIL
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Cotter TG, Stier MW, Aronsohn A. PRO: Needle Exchange Programs Should Be Instituted to Reduce Hepatitis C Virus Transmission. Clin Liver Dis (Hoboken) 2019; 12:170-172. [PMID: 30988937 PMCID: PMC6446444 DOI: 10.1002/cld.739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/10/2018] [Accepted: 06/20/2018] [Indexed: 02/04/2023] Open
Affiliation(s)
- Thomas G. Cotter
- Center for Liver Diseasesthe University of Chicago MedicineChicagoIL
| | - Matthew W. Stier
- Center for Liver Diseasesthe University of Chicago MedicineChicagoIL
| | - Andrew Aronsohn
- Center for Liver Diseasesthe University of Chicago MedicineChicagoIL
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26
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Des Jarlais DC, Arasteh K, Feelemyer J, McKnight C, Barnes DM, Perlman DC, Uuskula A, Cooper HLF, Tross S. Hepatitis C virus prevalence and estimated incidence among new injectors during the opioid epidemic in New York City, 2000-2017: Protective effects of non-injecting drug use. Drug Alcohol Depend 2018; 192:74-79. [PMID: 30243142 PMCID: PMC6206865 DOI: 10.1016/j.drugalcdep.2018.07.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/18/2018] [Accepted: 07/23/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Assess hepatitis C virus (HCV) prevalence and incidence among person who began injecting drugs during the opioid epidemic in New York City (NYC) and identify possible new directions for reducing HCV infection among persons who inject drugs. METHODS 846 persons who began injecting drugs between 2000 and 2017 were recruited from persons entering Mount Sinai Beth Israel substance use treatment programs. A structured interview was administered and HCV antibody testing conducted. Protective effects of non-injecting drug use were examined among persons who "reversed transitioned" to non-injecting drug use and persons who used non-injected heroin in addition to injecting. RESULTS Participants were 79% male, 41% White, 15% African-American, 40% Latinx, with a mean age of 35. Of those who began injecting in 2000 or later, 97 persons (11%) "reverse transitioned" back to non-injecting drug use. Reverse transitioning was strongly associated with lower HCV seroprevalence (30% versus 47% among those who continued injecting, p < 0.005). Among those who continued injecting, HCV seropositivity was inversely associated with current non-injecting heroin use (AOR = 0.72, 95%CI 0.52-0.99). HCV incidence among persons continuing to inject was estimated as 13/100 person-years. HCV seropositive persons currently injecting cocaine were particularly likely to report behavior likely to transmit HCV. CONCLUSIONS Similar to other locations in the US, NYC is experiencing high rates of HCV infection among persons who have begun injecting since 2000. New interventions that facilitate substitution of non-injecting for injecting drug use and that reduce transmission behavior among HCV seropositives may provide additional methods for reducing HCV transmission.
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Affiliation(s)
- Don C Des Jarlais
- Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - K Arasteh
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - J Feelemyer
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - C McKnight
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - David M Barnes
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - David C Perlman
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - H L F Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Susan Tross
- Department of Psychiatry, Columbia University, New York, NY, United States
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Johnson K, Jones C, Compton W, Baldwin G, Fan J, Mermin J, Bennett J. Federal Response to the Opioid Crisis. Curr HIV/AIDS Rep 2018; 15:293-301. [PMID: 29968173 PMCID: PMC11034841 DOI: 10.1007/s11904-018-0398-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW In light of the current crisis in opioid involved overdose deaths, the federal Department of Health and Human Services operating divisions are working together to implement a data-driven, research-based strategy to reduce opioid misuse and its consequences. RECENT FINDINGS The strategy has five elements: (1) strengthening public health data collection and reporting; (2) advancing the practice of pain management; (3) improving access to addiction prevention, treatment, and recovery support services; (4) increasing availability of overdose-reversing drugs; and (5) supporting cutting-edge research in treatment of pain, opioid use disorder, and associated conditions. The Department of Health and Human Services has developed a concerted, coordinated evidence-based effort across department divisions to reduce opioid misuse, prevalence of opioid use disorder, and reduce deaths due to opioid use.
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Affiliation(s)
- Kimberly Johnson
- Substance Abuse Mental Health Services Administration (SAMHSA), Rockville, MD, USA.
- University of South Florida, Tampa, Florida, USA.
| | - Chris Jones
- Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services, Washington, DC, USA
| | | | - Grant Baldwin
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer Fan
- Substance Abuse Mental Health Services Administration (SAMHSA), Rockville, MD, USA
| | - Jonathan Mermin
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jean Bennett
- Substance Abuse Mental Health Services Administration (SAMHSA), Rockville, MD, USA
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Aldridge RW, Story A, Hwang SW, Nordentoft M, Luchenski SA, Hartwell G, Tweed EJ, Lewer D, Vittal Katikireddi S, Hayward AC. Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis. Lancet 2018; 391:241-250. [PMID: 29137869 PMCID: PMC5803132 DOI: 10.1016/s0140-6736(17)31869-x] [Citation(s) in RCA: 440] [Impact Index Per Article: 73.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 06/23/2017] [Accepted: 07/05/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Inclusion health focuses on people in extremely poor health due to poverty, marginalisation, and multimorbidity. We aimed to review morbidity and mortality data on four overlapping populations who experience considerable social exclusion: homeless populations, individuals with substance use disorders, sex workers, and imprisoned individuals. METHODS For this systematic review and meta-analysis, we searched MEDLINE, Embase, and the Cochrane Library for studies published between Jan 1, 2005, and Oct 1, 2015. We included only systematic reviews, meta-analyses, interventional studies, and observational studies that had morbidity and mortality outcomes, were published in English, from high-income countries, and were done in populations with a history of homelessness, imprisonment, sex work, or substance use disorder (excluding cannabis and alcohol use). Studies with only perinatal outcomes and studies of individuals with a specific health condition or those recruited from intensive care or high dependency hospital units were excluded. We screened studies using systematic review software and extracted data from published reports. Primary outcomes were measures of morbidity (prevalence or incidence) and mortality (standardised mortality ratios [SMRs] and mortality rates). Summary estimates were calculated using a random effects model. FINDINGS Our search identified 7946 articles, of which 337 studies were included for analysis. All-cause standardised mortality ratios were significantly increased in 91 (99%) of 92 extracted datapoints and were 11·86 (95% CI 10·42-13·30; I2=94·1%) in female individuals and 7·88 (7·03-8·74; I2=99·1%) in men. Summary SMR estimates for the International Classification of Diseases disease categories with two or more included datapoints were highest for deaths due to injury, poisoning, and other external causes, in both men (7·89; 95% CI 6·40-9·37; I2=98·1%) and women (18·72; 13·73-23·71; I2=91·5%). Disease prevalence was consistently raised across the following categories: infections (eg, highest reported was 90% for hepatitis C, 67 [65%] of 103 individuals for hepatitis B, and 133 [51%] of 263 individuals for latent tuberculosis infection), mental health (eg, highest reported was 9 [4%] of 227 individuals for schizophrenia), cardiovascular conditions (eg, highest reported was 32 [13%] of 247 individuals for coronary heart disease), and respiratory conditions (eg, highest reported was 9 [26%] of 35 individuals for asthma). INTERPRETATION Our study shows that homeless populations, individuals with substance use disorders, sex workers, and imprisoned individuals experience extreme health inequities across a wide range of health conditions, with the relative effect of exclusion being greater in female individuals than male individuals. The high heterogeneity between studies should be explored further using improved data collection in population subgroups. The extreme health inequity identified demands intensive cross-sectoral policy and service action to prevent exclusion and improve health outcomes in individuals who are already marginalised. FUNDING Wellcome Trust, National Institute for Health Research, NHS England, NHS Research Scotland Scottish Senior Clinical Fellowship, Medical Research Council, Chief Scientist Office, and the Central and North West London NHS Trust.
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Affiliation(s)
- Robert W Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK; The Farr Institute of Health Informatics Research, University College London, London, UK.
| | - Alistair Story
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK; The Farr Institute of Health Informatics Research, University College London, London, UK; University College London NHS Foundation Trust, London, UK
| | - Stephen W Hwang
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Merete Nordentoft
- Mental Health Centre Copenhagen and Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Serena A Luchenski
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK; The Farr Institute of Health Informatics Research, University College London, London, UK
| | - Greg Hartwell
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Emily J Tweed
- Medical Research Council/Scottish Government Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Dan Lewer
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK; The Farr Institute of Health Informatics Research, University College London, London, UK
| | - Srinivasa Vittal Katikireddi
- Medical Research Council/Scottish Government Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Andrew C Hayward
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK; The Farr Institute of Health Informatics Research, University College London, London, UK; Institute of Epidemiology and Health Care, University College London, London, UK
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Fraser H, Zibbell J, Hoerger T, Hariri S, Vellozzi C, Martin NK, Kral AH, Hickman M, Ward JW, Vickerman P. Scaling-up HCV prevention and treatment interventions in rural United States-model projections for tackling an increasing epidemic. Addiction 2018; 113:173-182. [PMID: 28734093 PMCID: PMC6211174 DOI: 10.1111/add.13948] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/06/2017] [Accepted: 07/18/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Effective strategies are needed to address dramatic increases in hepatitis C virus (HCV) infection among people who inject drugs (PWID) in rural settings of the United States. We determined the required scale-up of HCV treatment with or without scale-up of HCV prevention interventions to achieve a 90% reduction in HCV chronic prevalence or incidence by 2025 and 2030 in a rural US setting. DESIGN An ordinary differential equation model of HCV transmission calibrated to HCV epidemiological data obtained primarily from an HIV outbreak investigation in Indiana. SETTING Scott County, Indiana (population 24 181), USA, a rural setting with negligible baseline interventions, increasing HCV epidemic since 2010, and 55.3% chronic HCV prevalence among PWID in 2015. PARTICIPANTS PWID. MEASUREMENTS Required annual HCV treatments per 1000 PWID (and initial annual percentage of infections treated) to achieve a 90% reduction in HCV chronic prevalence or incidence by 2025/30, either with or without scaling-up syringe service programmes (SSPs) and medication-assisted treatment (MAT) to 50% coverage. Sensitivity analyses considered whether this impact could be achieved without re-treatment of re-infections, and whether greater intervention scale-up was required due to the increasing epidemic in this setting. FINDINGS To achieve a 90% reduction in incidence and prevalence by 2030, without MAT and SSP scale-up, 159 per 1000 PWID (initially 24.9% of infected PWID) need to be HCV-treated annually. However, with MAT and SSP scaled-up, treatment rates are halved (89 per 1000 annually or 14.5%). To reach the same target by 2025 with MAT and SSP scaled-up, 121 per 1000 PWID (19.9%) need treatment annually. These treatment requirements are threefold higher than if the epidemic was stable, and the impact targets are unattainable without retreatment. CONCLUSIONS Combined scale-up of hepatitis C virus treatment and prevention interventions is needed to decrease the increasing burden of hepatitis C virus incidence and prevalence in rural Indiana, USA, by 90% by 2025/30.
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Affiliation(s)
- Hannah Fraser
- Social and Community Medicine, University of Bristol, UK
| | - Jon Zibbell
- RTI International, Research Triangle Park, USA
| | | | - Susan Hariri
- U.S. Centers for Disease Control and Prevention, Atlanta, USA
| | | | - Natasha K Martin
- Social and Community Medicine, University of Bristol, UK,Division of Global Public Health, University of California San Diego, California, USA
| | | | | | - John W. Ward
- U.S. Centers for Disease Control and Prevention, Atlanta, USA
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Platt L, Minozzi S, Reed J, Vickerman P, Hagan H, French C, Jordan A, Degenhardt L, Hope V, Hutchinson S, Maher L, Palmateer N, Taylor A, Bruneau J, Hickman M. Needle syringe programmes and opioid substitution therapy for preventing hepatitis C transmission in people who inject drugs. Cochrane Database Syst Rev 2017; 9:CD012021. [PMID: 28922449 PMCID: PMC5621373 DOI: 10.1002/14651858.cd012021.pub2] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Needle syringe programmes and opioid substitution therapy for preventing hepatitis C transmission in people who inject drugsNeedle syringe programmes (NSP) and opioid substitution therapy (OST) are the primary interventions to reduce hepatitis C (HCV) transmission in people who inject drugs. There is good evidence for the effectiveness of NSP and OST in reducing injecting risk behaviour and increasing evidence for the effectiveness of OST and NSP in reducing HIV acquisition risk, but the evidence on the effectiveness of NSP and OST for preventing HCV acquisition is weak. OBJECTIVES To assess the effects of needle syringe programmes and opioid substitution therapy, alone or in combination, for preventing acquisition of HCV in people who inject drugs. SEARCH METHODS We searched the Cochrane Drug and Alcohol Register, CENTRAL, the Cochrane Database of Systematic Reviews (CDSR), the Database of Abstracts of Reviews of Effects (DARE), the Health Technology Assessment Database (HTA), the NHS Economic Evaluation Database (NHSEED), MEDLINE, Embase, PsycINFO, Global Health, CINAHL, and the Web of Science up to 16 November 2015. We updated this search in March 2017, but we have not incorporated these results into the review yet. Where observational studies did not report any outcome measure, we asked authors to provide unpublished data. We searched publications of key international agencies and conference abstracts. We reviewed reference lists of all included articles and topic-related systematic reviews for eligible papers. SELECTION CRITERIA We included prospective and retrospective cohort studies, cross-sectional surveys, case-control studies and randomised controlled trials that measured exposure to NSP and/or OST against no intervention or a reduced exposure and reported HCV incidence as an outcome in people who inject drugs. We defined interventions as current OST (within previous 6 months), lifetime use of OST and high NSP coverage (regular attendance at an NSP or all injections covered by a new needle/syringe) or low NSP coverage (irregular attendance at an NSP or less than 100% of injections covered by a new needle/syringe) compared with no intervention or reduced exposure. DATA COLLECTION AND ANALYSIS We followed the standard Cochrane methodological procedures incorporating new methods for classifying risk of bias for observational studies. We described study methods against the following 'Risk of bias' domains: confounding, selection bias, measurement of interventions, departures from intervention, missing data, measurement of outcomes, selection of reported results; and we assigned a judgment (low, moderate, serious, critical, unclear) for each criterion. MAIN RESULTS We identified 28 studies (21 published, 7 unpublished): 13 from North America, 5 from the UK, 4 from continental Europe, 5 from Australia and 1 from China, comprising 1817 incident HCV infections and 8806.95 person-years of follow-up. HCV incidence ranged from 0.09 cases to 42 cases per 100 person-years across the studies. We judged only two studies to be at moderate overall risk of bias, while 17 were at serious risk and 7 were at critical risk; for two unpublished datasets there was insufficient information to assess bias. As none of the intervention effects were generated from RCT evidence, we typically categorised quality as low. We found evidence that current OST reduces the risk of HCV acquisition by 50% (risk ratio (RR) 0.50, 95% confidence interval (CI) 0.40 to 0.63, I2 = 0%, 12 studies across all regions, N = 6361), but the quality of the evidence was low. The intervention effect remained significant in sensitivity analyses that excluded unpublished datasets and papers judged to be at critical risk of bias. We found evidence of differential impact by proportion of female participants in the sample, but not geographical region of study, the main drug used, or history of homelessness or imprisonment among study samples.Overall, we found very low-quality evidence that high NSP coverage did not reduce risk of HCV acquisition (RR 0.79, 95% CI 0.39 to 1.61) with high heterogeneity (I2 = 77%) based on five studies from North America and Europe involving 3530 participants. After stratification by region, high NSP coverage in Europe was associated with a 76% reduction in HCV acquisition risk (RR 0.24, 95% CI 0.09 to 0.62) with less heterogeneity (I2 =0%). We found low-quality evidence of the impact of combined high coverage of NSP and OST, from three studies involving 3241 participants, resulting in a 74% reduction in the risk of HCV acquisition (RR 0.26 95% CI 0.07 to 0.89). AUTHORS' CONCLUSIONS OST is associated with a reduction in the risk of HCV acquisition, which is strengthened in studies that assess the combination of OST and NSP. There was greater heterogeneity between studies and weaker evidence for the impact of NSP on HCV acquisition. High NSP coverage was associated with a reduction in the risk of HCV acquisition in studies in Europe.
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Affiliation(s)
- Lucy Platt
- London School of Hygiene and Tropical MedicineDepartment of Social and Environmental Health Research15 ‐ 17 Tavistock PlaceLondonUKWC1H 9SH
| | - Silvia Minozzi
- Lazio Regional Health ServiceDepartment of EpidemiologyVia Cristoforo Colombo, 112RomeItaly00154
| | | | - Peter Vickerman
- University of BristolSchool of Social and Community MedicineBristolUK
| | - Holly Hagan
- New York University College of NursingNew YorkNYUSA
| | - Clare French
- University of BristolSchool of Social and Community MedicineBristolUK
| | - Ashly Jordan
- New York University College of NursingNew YorkNYUSA
| | - Louisa Degenhardt
- UNSWNational Drug and Alcohol Research CentreBuilding R322‐32 King StreetRandwickNSWAustralia2031
| | - Vivian Hope
- Liverpool John Moores UniversityPublic Health InstituteLiverpoolUKL3 2ET
| | | | - Lisa Maher
- Kirby Institute, University of New South WalesSydneyAustralia
| | | | | | - Julie Bruneau
- University of MontrealDepartment of Family and Emergency MedicineMontrealCanada
| | - Matthew Hickman
- University of BristolSchool of Social and Community MedicineBristolUK
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Gonzalez SA, Fierer DS, Talal AH. Medical and Behavioral Approaches to Engage People Who Inject Drugs Into Care for Hepatitis C Virus Infection. ADDICTIVE DISORDERS & THEIR TREATMENT 2017; 16:S1-S23. [PMID: 28701904 PMCID: PMC5491232 DOI: 10.1097/adt.0000000000000104] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Direct-acting antivirals for hepatitis C virus infection may revolutionize treatment among persons with substance use disorders. Despite persons with substance use disorders having the highest hepatitis C virus prevalence and incidence, the vast majority have not engaged into care for the infection. Previously, interferon-based treatments, with substantial side effects and the propensity to exacerbate mental health conditions, were major disincentives to pursuit of care for the infection. Direct-acting antivirals with viral eradication rates of >90%, significantly improved side effect profiles, and shorter treatment duration are dramatic improvements over prior treatment regimens that should promote widespread hepatitis C virus care among persons with substance use disorders. The major unmet need is strategies to promote persons with substance use disorders engagement into care for hepatitis C virus. Although physical integration of treatment for substance use and co-occurring conditions has been widely advocated, it has been difficult to achieve. Telemedicine offers an opportunity for virtual integration of behavioral and medical treatments that could be supplemented by conventional interventions such as hepatitis C virus education, case management, and peer navigation. Furthermore, harm reduction and strategies to reduce viral transmission are important to cease reinfection among persons with substance use disorders. Widespread prescription of therapy for hepatitis C virus infection to substance users will be required to achieve the ultimate goal of global virus elimination. Combinations of medical and behavioral interventions should be used to promote persons with substance use disorders engagement into and adherence with direct-acting antiviral-based treatment approaches. Ultimately, either physical or virtual colocation of hepatitis C virus and substance use treatment has the potential to improve adherence and consequently treatment efficacy.
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Affiliation(s)
- Stevan A. Gonzalez
- Division of Hepatology, Baylor Simmons Transplant Institute, Fort Worth, TX
| | | | - Andrew H. Talal
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine, State University of New York at Buffalo, Buffalo, NY
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Dombrowski K, Khan B, Habecker P, Hagan H, Friedman SR, Saad M. The Interaction of Risk Network Structures and Virus Natural History in the Non-spreading of HIV Among People Who Inject Drugs in the Early Stages of the Epidemic. AIDS Behav 2017; 21:1004-1015. [PMID: 27699596 PMCID: PMC5344741 DOI: 10.1007/s10461-016-1568-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This article explores how social network dynamics may have reduced the spread of HIV-1 infection among people who inject drugs during the early years of the epidemic. Stochastic, discrete event, agent-based simulations are used to test whether a "firewall effect" can arise out of self-organizing processes at the actor level, and whether such an effect can account for stable HIV prevalence rates below population saturation. Repeated simulation experiments show that, in the presence of recurring, acute, and highly infectious outbreaks, micro-network structures combine with the HIV virus's natural history to reduce the spread of the disease. These results indicate that network factors likely played a significant role in the prevention of HIV infection within injection risk networks during periods of peak prevalence. They also suggest that social forces that disturb network connections may diminish the natural firewall effect and result in higher rates of HIV.
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Affiliation(s)
- Kirk Dombrowski
- Department of Sociology, University of Nebraska-Lincoln, 711 Oldfather Hall, Lincoln, NE, 68588, USA.
| | - Bilal Khan
- Department of Sociology, University of Nebraska-Lincoln, 711 Oldfather Hall, Lincoln, NE, 68588, USA
| | - Patrick Habecker
- Department of Sociology, University of Nebraska-Lincoln, 711 Oldfather Hall, Lincoln, NE, 68588, USA
| | - Holly Hagan
- College of Nursing, New York University, New York, NY, USA
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Meyerson BE, Lawrence CA, Miller L, Gillespie A, Raymond D, Kelley K, Shannon DJ. Against the Odds: Syringe Exchange Policy Implementation in Indiana. AIDS Behav 2017; 21:973-981. [PMID: 28108875 DOI: 10.1007/s10461-017-1688-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Indiana recently passed legislation allowing local governments to establish syringe exchanges. While the effectiveness of syringe exchange programming is established, there is a dearth of studies about associated policy adoption and implementation. This study documents the experiences of 24 Indiana counties engaged in the process of establishing syringe exchange programming under new state law. A mixed method, qualitative, exploratory case study was conducted from May 2015 to April 2016. We observed rapid and widespread policy adoption interest, and yet counties reported significant policy ambiguity, epidemiologic and resource capacity issues. The emergence of health commons involving information and tangible resource sharing networks allowed institutional rearrangement in the midst of resource scarcity; however, such rearrangement appeared to be a central threat to policy adoption and implementation given state structural barriers. The emerging commons could be a critical policy success factor, as it would achieve efficiencies not possible in the current resource environment, and can help achieve institutional rearrangement for the improvement of population health. Several recommendations for improvement are offered.
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Affiliation(s)
- Beth E Meyerson
- Rural Center for AIDS/STD Prevention, Indiana University School of Public Health-Bloomington, 1025 E. 7th Street, Bloomington, IN, USA.
| | - Carrie A Lawrence
- Rural Center for AIDS/STD Prevention, Indiana University School of Public Health-Bloomington, 1025 E. 7th Street, Bloomington, IN, USA
| | - Laura Miller
- Rural Center for AIDS/STD Prevention, Indiana University School of Public Health-Bloomington, 1025 E. 7th Street, Bloomington, IN, USA
| | - Anthony Gillespie
- Indiana Minority Health Coalition, 3737 North Meridian Street, Indianapolis, IN, 46208, USA
| | - Daniel Raymond
- Harm Reduction Coalition, 22 West 27th Street, 5th Floor, New York, NY, 10001, USA
| | - Kristen Kelley
- Prescription Drug Abuse Prevention Task Force, Office of the Indiana Attorney General, 302 West Washington Street, 5th Floor, Indianapolis, IN, 46204, USA
| | - D J Shannon
- Rural Center for AIDS/STD Prevention, Indiana University School of Public Health-Bloomington, 1025 E. 7th Street, Bloomington, IN, USA
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Jordan AE, Perlman DC, Neurer J, Smith DJ, Des Jarlais DC, Hagan H. Prevalence of hepatitis C virus infection among HIV+ men who have sex with men: a systematic review and meta-analysis. Int J STD AIDS 2017; 28:145-159. [PMID: 26826159 PMCID: PMC4965334 DOI: 10.1177/0956462416630910] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Since 2000, an increase in hepatitis C virus infection among HIV-infected (HIV+) men who have sex with men has been observed. Evidence points to blood exposure during sex as the medium of hepatitis C virus transmission. Hepatitis C virus prevalence among HIV + MSM overall and in relation to injection drug use is poorly characterized. In this study, a systematic review and meta-analysis examining global hepatitis C virus antibody prevalence and estimating active hepatitis C virus prevalence among HIV + MSM were conducted; 42 reports provided anti-hepatitis C virus prevalence data among HIV + MSM. Pooled prevalence produced an overall anti-hepatitis C virus prevalence among HIV + MSM of 8.1%; active HCV prevalence estimate was 5.3%-7.3%. Anti-hepatitis C virus prevalence among injection drug use and non-injection drug use HIV + MSM was 40.0% and 6.7%, respectively. Among HIV + MSM, hepatitis C virus prevalence increased significantly over time among the overall and non-injection drug use groups, and decreased significantly among injection drug use HIV + MSM. We identified a moderate prevalence of hepatitis C virus among all HIV + MSM and among non-injection drug use HIV + MSM; for both, prevalence was observed to be increasing slightly. Pooled prevalence of hepatitis C virus among HIV + MSM was higher than that observed in the 1945-1965 US birth cohort. The modest but rising hepatitis C virus prevalence among HIV + MSM suggests an opportunity to control HCV among HIV + MSM; this combined with data demonstrating a rising hepatitis C virus incidence highlights the temporal urgency to do so.
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Affiliation(s)
- Ashly E Jordan
- 1 New York University, New York, NY, USA
- 2 Center for Drug Use and HIV Research, New York, NY, USA
| | - David C Perlman
- 2 Center for Drug Use and HIV Research, New York, NY, USA
- 3 Icahn School of Medicine, Mount Sinai Beth Israel, New York, NY, USA
| | | | | | - Don C Des Jarlais
- 2 Center for Drug Use and HIV Research, New York, NY, USA
- 3 Icahn School of Medicine, Mount Sinai Beth Israel, New York, NY, USA
| | - Holly Hagan
- 1 New York University, New York, NY, USA
- 2 Center for Drug Use and HIV Research, New York, NY, USA
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Trend Analyses of Users of a Syringe Exchange Program in Philadelphia, Pennsylvania: 1999-2014. AIDS Behav 2016; 20:2922-2932. [PMID: 27066985 DOI: 10.1007/s10461-016-1393-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study examines trends of injection drug users' (IDUs) use of a Philadelphia, Pennsylvania, syringe exchange program (SEP) from 1999 to 2014, including changes in demographics, drug use, substance abuse treatment, geographic indicators, and SEP use. Prevention Point Philadelphia's SEP registration data were analyzed using linear regression, Pearson's Chi square, and t-tests. Over time new SEP registrants have become younger, more racially diverse, and geographically more concentrated in specific areas of the city, corresponding to urban demographic shifts. The number of new registrants per year has decreased, however syringes exchanged have increased. Gentrification, cultural norms, and changes in risk perception are believed to have contributed to the changes in SEP registration. Demographic changes indicate outreach strategies for IDUs may need adjusting to address unique barriers for younger, more racially diverse users. Implications for SEPs are discussed, including policy and continued ability to address current public health threats.
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Brothers S. Merchants, samaritans, and public health workers: Secondary syringe exchanger discursive practices. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 37:1-8. [PMID: 27449813 DOI: 10.1016/j.drugpo.2016.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 02/07/2016] [Accepted: 06/01/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Secondary syringe exchangers (SSEs) are a vital component of harm reduction efforts among persons who inject drugs (PWIDs). However, little research has explored how secondary exchange occurs, nor why SSEs do their work. This study looks at secondary exchange as an act of resilience within the PWID risk environment. It asks how secondary syringe exchangers utilize syringes to improve their mental and material well-being. METHODS This article draws on findings from semi-structured in-depth interviews of 30 SSEs. It is also informed by 4 years of participant observation as a volunteer and site supervisor at the San Francisco Aids Foundation syringe exchange sites, and 1 year of participant observation with SSEs and their clients. RESULTS This study finds that SSEs use syringes as a resource to support three discursive practices - those of merchants, public health workers, and samaritans. These discursive practices correlate to their work and educational backgrounds, and to their accounts of charging for syringes, disseminating public health information, and helping their clients in various ways. CONCLUSION SSEs hold heterogeneous motivations and operate in multiple contexts. Many SSEs see themselves as, and behave as, informal health care workers or helpers in their community. They could be utilized, with minimal training and encouragement, to disseminate additional harm reduction information and materials.
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Affiliation(s)
- Sarah Brothers
- Department of Sociology, Yale University, 493 College Street, New Haven, CT 06511, United States.
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Abstract
Drug use is a public health problem associated with high mortality and morbidity, and is often accompanied by suboptimal engagement in health care. Harm reduction is a pragmatic public health approach encompassing all goals of public health: improving health, social well-being, and quality of life. Harm reduction prioritizes improving the lives of people who use drugs in partnership with those served without a narrow focus on abstinence from drugs. Evidence has shown that harm reduction oriented practice can reduce transmission of blood-borne illnesses, and other injection related infections, as well as preventing fatal overdose.
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Carlberg-Racich S. Harm reduction interventions in HIV care: a qualitative exploration of patient and provider perspectives. PeerJ 2016; 4:e1932. [PMID: 27114879 PMCID: PMC4841234 DOI: 10.7717/peerj.1932] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 03/22/2016] [Indexed: 11/28/2022] Open
Abstract
Background. A culture of stringent drug policy, one-size-fits-all treatment approaches, and drug-related stigma has clouded clinical HIV practice in the United States. The result is a series of missed opportunities in the HIV care environment. An approach which may address the broken relationship between patient and provider is harm reduction—which removes judgment and operates at the patient’s stage of readiness. Harm reduction is not a routine part of care; rather, it exists outside clinic walls, exacerbating the divide between compassionate, stigma-free services and the medical system. Methods. Qualitative, phenomenological, semi-structured, individual interviews with patients and providers were conducted in three publicly-funded clinics in Chicago, located in areas of high HIV prevalence and drug use and serving African-American patients (N = 38). A deductive thematic analysis guided the process, including: the creation of an index code list, transcription and verification of interviews, manual coding, notation of emerging themes and refinement of code definitions, two more rounds of coding within AtlasTi, calculation of Cohen’s Kappa for interrater reliability, queries of major codes and analysis of additional common themes. Results. Thematic analysis of findings indicated that the majority of patients felt receptive to harm reduction interventions (safer injection counseling, safer stimulant use counseling, overdose prevention information, supply provision) from their provider, and expressed anticipated gratitude for harm reduction information and/or supplies within the HIV care visit, although some were reluctant to talk openly about their drug use. Provider results were mixed, with more receptivity reported by advanced practice nurses, and more barriers cited by physicians. Notable barriers included: role-perceptions, limited time, inadequate training, and the patients themselves. Discussion. Patients are willing to receive harm reduction interventions from their HIV care providers, while provider receptiveness is mixed. The findings reveal critical implications for diffusion of harm reduction into HIV care, including the need to address cited barriers for both patients and providers to ensure feasibility of implementation. Strategies to address these barriers are discussed, and recommendations for further research are also shared.
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Joy JB, McCloskey RM, Nguyen T, Liang RH, Khudyakov Y, Olmstead A, Krajden M, Ward JW, Harrigan PR, Montaner JSG, Poon AFY. The spread of hepatitis C virus genotype 1a in North America: a retrospective phylogenetic study. THE LANCET. INFECTIOUS DISEASES 2016; 16:698-702. [PMID: 27039040 DOI: 10.1016/s1473-3099(16)00124-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 02/16/2016] [Accepted: 02/19/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND The timing of the initial spread of hepatitis C virus genotype 1a in North America is controversial. In particular, how and when hepatitis C virus reached extraordinary prevalence in specific demographic groups remains unclear. We quantified, using all available hepatitis C virus sequence data and phylodynamic methods, the timing of the spread of hepatitis C virus genotype 1a in North America. METHODS We screened 45 316 publicly available sequences of hepatitis C virus genotype 1a for location and genotype, and then did phylogenetic analyses of available North American sequences from five hepatitis C virus genes (E1, E2, NS2, NS4B, NS5B), with an emphasis on including as many sequences with early collection dates as possible. We inferred the historical population dynamics of this epidemic for all five gene regions using Bayesian skyline plots. FINDINGS Most of the spread of genotype 1a in North America occurred before 1965, and the hepatitis C virus epidemic has undergone relatively little expansion since then. The effective population size of the North American epidemic stabilised around 1960. These results were robust across all five gene regions analysed, although analyses of each gene separately show substantial variation in estimates of the timing of the early exponential growth, ranging roughly from 1940 for NS2, to 1965 for NS4B. INTERPRETATION The expansion of genotype 1a before 1965 suggests that nosocomial or iatrogenic factors rather than past sporadic behavioural risk (ie, experimentation with injection drug use, unsafe tattooing, high risk sex, travel to high endemic areas) were key contributors to the hepatitis C virus epidemic in North America. Our results might reduce stigmatisation around screening and diagnosis, potentially increasing rates of screening and treatment for hepatitis C virus. FUNDING The Canadian Institutes of Health Research, Michael Smith Foundation for Health Research, and BC Centre for Excellence in HIV/AIDS.
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Affiliation(s)
- Jeffrey B Joy
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | | | - Thuy Nguyen
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | | | - Yury Khudyakov
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Mel Krajden
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada; BC Centre for Disease Control, Vancouver, BC, Canada
| | - John W Ward
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - P Richard Harrigan
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Julio S G Montaner
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Art F Y Poon
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Abstract
OBJECTIVE Although the global burden of HIV infection among sex workers (SW) has been well recognized, HIV-related risks among sex workers who inject drugs (SW-IDU) have received less attention. We investigated the relationship between sex work and HIV incidence among people who inject drugs (IDU) in a Canadian setting. DESIGN Prospective cohort study. METHODS Using Kaplan-Meier methods and the extended Cox regression, we compared HIV incidence among SW-IDU and non-SW-IDU in Vancouver, Canada, after adjusting for potential confounders. RESULTS Between 1996 and 2012, 1647 participants were included in the study, including 512 (31.1%) IDU engaged in sex work. At 5 years the HIV cumulative incidence was higher among SW-IDU in comparison to other IDU (12 vs. 7%, P = 0.001). In unadjusted Cox regression analyses, HIV incidence among SW-IDU was also elevated [relative hazard: 1.69; 95% confidence interval (CI): 1.13-2.53]. However, in a multivariable analysis, sex work did not remain associated with HIV infection (adjusted relative hazard: 0.74; 95% CI: 0.45-1.20), with cocaine injection appearing to account for the elevated risk for HIV infection among SW-IDU. CONCLUSION These data suggest that local SW-IDU have elevated rates of HIV infection. However, our exploration of risk factors among SW-IDU demonstrated that drug use patterns and environmental factors, rather than sexual risks, may explain the elevated HIV incidence among SW-IDU locally. Our findings highlight the need for social and structural interventions, including increased access to harm reduction programs and addiction treatment.
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41
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Jordan AE, Des Jarlais DC, Arasteh K, McKnight C, Nash D, Perlman DC. Incidence and prevalence of hepatitis c virus infection among persons who inject drugs in New York City: 2006-2013. Drug Alcohol Depend 2015; 152:194-200. [PMID: 25891230 PMCID: PMC4458155 DOI: 10.1016/j.drugalcdep.2015.03.039] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 03/31/2015] [Accepted: 03/31/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Hepatitis C virus infection is a source of significant preventable morbidity and mortality among persons who inject drugs (PWID). We sought to assess trends in hepatitis C virus (HCV) infection among PWID from 2006 to 2013 in New York City (NYC). METHODS Annual cross-sectional surveys of PWID entering a large drug abuse treatment program were performed. Risk behavior questionnaires were administered, and HIV and HCV testing were conducted. Comparisons were made with prior prevalence and incidence estimates in 1990-1991 and 2000-2001 reflecting different periods of combined prevention and treatment efforts. RESULTS HCV prevalence among PWID (N: 1535) was 67% (95% CI: 66-70%) during the study period, and was not significantly different from that observed in 2000-2001. The estimated HCV incidence among new injectors (persons injecting for ≤6 years) during 2006-2013 was 19.5/100 PYO (95% CI: 17-23) and did not differ from that observed in 2000-2001 (18/100 PYO, 95% CI: 14-23/100). CONCLUSIONS Despite the expansion of combined prevention programming between 2000-2001 and 2006-2013, HCV prevalence remained high. Estimated HCV incidence among new injectors also remained high, and not significantly lower than in 2000-2001, indicating that expanded combined prevention efforts are needed to control the HCV epidemic among PWID in NYC.
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Affiliation(s)
- Ashly E. Jordan
- The Graduate Center at the City University of New York, 365 Fifth
Avenue, New York, New York 10016 USA,Center for Drug Use and HIV Research, New York, New York USA
| | - Don C. Des Jarlais
- Center for Drug Use and HIV Research, New York, New York USA,Mount Sinai Beth Israel, Baron Edmond de Rothschild Chemical
Dependency Institute, 120 Water St, Floor 24, New York, New York 10038 USA
| | - Kamyar Arasteh
- Center for Drug Use and HIV Research, New York, New York USA,Mount Sinai Beth Israel, Baron Edmond de Rothschild Chemical
Dependency Institute, 120 Water St, Floor 24, New York, New York 10038 USA
| | - Courtney McKnight
- Center for Drug Use and HIV Research, New York, New York USA,Mount Sinai Beth Israel, Baron Edmond de Rothschild Chemical
Dependency Institute, 120 Water St, Floor 24, New York, New York 10038 USA
| | - Denis Nash
- City University of New York, Hunter College, 2180 Third Avenue, New
York, New York 10035 USA
| | - David C. Perlman
- Center for Drug Use and HIV Research, New York, New York USA,Mount Sinai Beth Israel, 120 East 16 Street, New York,
NY 10003 USA
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42
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Perlman DC, Des Jarlais DC, Feelemyer J. Can HIV and Hepatitis C Virus Infection be Eliminated Among Persons Who Inject Drugs? J Addict Dis 2015; 34:198-205. [PMID: 26075647 PMCID: PMC4550554 DOI: 10.1080/10550887.2015.1059111] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
HIV and hepatitis C virus (HCV) infection are readily transmitted among persons who inject drugs. The HIV and HCV epidemics have expanded rapidly, becoming global health issues. Combined prevention has been implemented to reduce injection and sexual transmission of HIV and HCV among persons who inject drugs. Reductions in risky injection and sexual behavior have led to dramatic reductions in HIV in many countries. Whether comparable reductions in HCV transmission can be achieved has yet to be determined. Eliminating HIV and HCV among persons who inject drugs will require considerable resources and commitment, particularly in low and middle income countries.
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Affiliation(s)
- David C. Perlman
- Department of Medicine, Mount Sinai Beth Israel, New York, NY
- Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Beth Israel, New York, NY
| | - Don C. Des Jarlais
- Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Beth Israel, New York, NY
| | - Jonathan Feelemyer
- Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Beth Israel, New York, NY
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Alanko Blomé M, Björkman P, Molnegren V, Höglund P, Widell A. Hepatitis C viremia patterns in incident hepatitis C infection and one year later in 150 prospectively tested persons who inject drugs. PLoS One 2014; 9:e97022. [PMID: 24830647 PMCID: PMC4022632 DOI: 10.1371/journal.pone.0097022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 04/15/2014] [Indexed: 12/15/2022] Open
Abstract
Objectives To assess HCV viremia levels just before, during and one year after anti-HCV seroconversion in people who inject drugs (PWID). Methods PWID enrolling into a needle exchange program in Malmö, Sweden, 1997–2005 constituted the source population. Sera were obtained at enrolment and at approximately 3–4 monthly intervals afterwards, and were initially tested for anti-HIV, HBsAg/anti-HBc and anti-HCV and thereafter for markers previously negative. Seroconversion to anti-HCV had occurred during the study period in 186 out of 332 seronegative subjects. In these anti-HCV seroconverters, quantitative HCV RNA PCR was retrospectively performed on frozen sera to determine viremia levels in the last anti-HCV negative, the first anti-HCV positive and in one year follow-up samples. Results Among 150 subjects seroconverting to anti-HCV with samples available from all three defined time-points, eight different patterns of viremia were observed. Spontaneous clearance at one year was noted in 48 cases (32%) and was associated with female gender (p = 0.03, CI 0.17–1.00). In 13 cases HCV-RNA was not detected in any study sample. Among 61 subjects with pre-seroconversion viremia, viral load was significantly higher in the pre-seroconversion samples compared to subsequent samples. For the whole group, viral load declined to undetectable levels at seroconversion in 28% of cases (but with recurrent viremia in 15%). Conclusions Different patterns of HCV RNA kinetics were observed among PWID with documented seroconversion to anti-HCV. The frequently observed absence of detectable HCV RNA in the first anti-HCV positive sample (irrespective of subsequent viremia) demonstrates the importance of repeated sampling and RNA testing for determination of the outcome of acute infection.
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Affiliation(s)
- Marianne Alanko Blomé
- Infectious Disease Unit, Division of Clinical Sciences, Lund University, Malmö, Sweden
| | - Per Björkman
- Infectious Disease Unit, Division of Clinical Sciences, Lund University, Malmö, Sweden
| | - Vilma Molnegren
- Department of Clinical Microbiology, Division of Laboratory Sciences, Lund University, Malmö, Sweden
| | - Peter Höglund
- Medical Statistics and Epidemiology Unit, Research and Development Centre Skåne, Lund, Sweden
| | - Anders Widell
- Department of Clinical Microbiology, Division of Laboratory Sciences, Lund University, Malmö, Sweden
- * E-mail:
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Broz D, Pham H, Spiller M, Wejnert C, Le B, Neaigus A, Paz-Bailey G. Prevalence of HIV infection and risk behaviors among younger and older injecting drug users in the United States, 2009. AIDS Behav 2014; 18 Suppl 3:284-96. [PMID: 24242754 DOI: 10.1007/s10461-013-0660-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study compared HIV sero-prevalence and risk behaviors between younger and older injecting drug users (IDUs). IDUs aged ≥18 years were interviewed for the 2009 National HIV Behavioral Surveillance System. Using GEE regression, we assessed characteristics of younger (18-29 years) and older (≥30 years) IDUs, and factors associated with past 12-month receptive syringe sharing and unprotected sex (vaginal/anal). Of 10,090 participants, 10 % were younger. HIV sero-prevalence was lower among younger than older IDUs (4 vs. 10 %, p = 0.001). Younger IDUs were more likely (p ≤ 0.002) to be non-black race/ethnicity, report higher household income, homelessness, being arrested and to engage in receptive syringe sharing and unprotected sex. In multivariable models, age remained associated (p < 0.001) with receptive syringe sharing (aPR = 1.14, 95 % CI1.07-1.22) and unprotected sex (aPR = 1.10, 95 % CI1.06-1.14). Although younger IDUs had lower HIV prevalence, their behaviors place them at increased risk of HIV infection and could lead to a rapid spread in this susceptible population.
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Affiliation(s)
- Dita Broz
- Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS-E46, Atlanta, GA, 30333, USA,
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Burr CK, Storm DS, Hoyt MJ, Dutton L, Berezny L, Allread V, Paul S. Integrating health and prevention services in syringe access programs: a strategy to address unmet needs in a high-risk population. Public Health Rep 2014; 129 Suppl 1:26-32. [PMID: 24385646 DOI: 10.1177/00333549141291s105] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Injection drug users are at a high risk for a number of preventable diseases and complications of drug use. This article describes the implementation of a nurse-led health promotion and disease prevention program in New Jersey's syringe access programs. Initially designed to target women as part of a strategy to decrease missed opportunities for perinatal HIV prevention, the program expanded by integrating existing programs and funding streams available through the state health department. The program now offers health and prevention services to both men and women, with 3,488 client visits in 2011. These services extend the reach of state health department programs, such as adult vaccination and hepatitis and tuberculosis screening, which clients would have had to seek out at multiple venues. The integration of prevention, treatment, and health promotion services in syringe access programs reaches a vulnerable and underserved population who otherwise may receive only urgent and episodic care.
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Affiliation(s)
- Carolyn K Burr
- Rutgers, The State University of New Jersey, School of Nursing, François-Xavier Bagnoud Center, Newark, NJ
| | - Deborah S Storm
- Rutgers, The State University of New Jersey, School of Nursing, François-Xavier Bagnoud Center, Newark, NJ
| | - Mary Jo Hoyt
- Rutgers, The State University of New Jersey, School of Nursing, François-Xavier Bagnoud Center, Newark, NJ
| | - Loretta Dutton
- New Jersey Department of Health, Division of HIV, STD and TB Services, Trenton, NJ
| | - Linda Berezny
- New Jersey Department of Health, Division of HIV, STD and TB Services, Trenton, NJ
| | - Virginia Allread
- Rutgers, The State University of New Jersey, School of Nursing, François-Xavier Bagnoud Center, Newark, NJ
| | - Sindy Paul
- New Jersey Department of Health, Division of HIV, STD and TB Services, Trenton, NJ
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46
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Des Jarlais DC, Arasteh K, McKnight C, Feelemyer J, Hagan H, Cooper HLF, Perlman DC. Combined HIV prevention, the New York City condom distribution program, and the evolution of safer sex behavior among persons who inject drugs in New York City. AIDS Behav 2014; 18:443-51. [PMID: 24271348 DOI: 10.1007/s10461-013-0664-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Examine long term sexual risk behaviors among persons who inject drugs (PWID) in New York City following implementation of "combined" prevention programming, including condom social marketing. Quantitative interviews and human immunodeficiency virus (HIV) testing were conducted among PWID entering Beth Israel Medical Center drug treatment programs 1990-2012. Data were analyzed by four time periods corresponding to the cumulative implementation of HIV prevention interventions. 7,132 subjects were recruited from 1990 to 2012; little change in sexual behavior occurred among HIV seronegative subjects, while HIV seropositive subjects reported significant decreases in being sexually active and significant increases in consistent condom use. HIV transmission risk (being HIV positive and engaging in unprotected sex) declined from 14 % in 1990-1995 to 2 % in 2007-2012 for primary sexual partners and from 6 to 1 % for casual partners. Cumulative implementation of combined prevention programming for PWID was associated with substantial decreases in sexual risk behavior among HIV seropositives.
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Affiliation(s)
- D C Des Jarlais
- Beth Israel Medical Center, The Baron Edmond de Rothschild Chemical Dependency Institute, 160 Water Street, New York, NY, 10038, USA,
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Paintsil E, Binka M, Patel A, Lindenbach BD, Heimer R. Hepatitis C virus maintains infectivity for weeks after drying on inanimate surfaces at room temperature: implications for risks of transmission. J Infect Dis 2013; 209:1205-11. [PMID: 24273176 DOI: 10.1093/infdis/jit648] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Healthcare workers may come into contact with fomites that contain infectious hepatitis C virus (HCV) during preparation of plasma or following placement or removal of venous lines. Similarly, injection drugs users may come into contact with fomites. Hypothesizing that prolonged viability of HCV in fomites may contribute significantly to incidence, we determined the longevity of virus infectivity and the effectiveness of antiseptics. METHODS We determined the volume of drops misplaced during transfer of serum or plasma. Aliquots equivalent to the maximum drop volume of plasma spiked with the 2a HCV reporter virus were loaded into 24-well plates. Plates were stored uncovered at 3 temperatures: 4°C, 22°C, and 37°C for up to 6 weeks before viral infectivity was determined in a microculture assay. RESULTS The mean volume of an accidental drop was 29 µL (min-max of 20-33 µL). At storage temperatures 4°C and 22°C, we recovered viable HCV from the low-titer spots for up to 6 weeks of storage. The rank order of HCV virucidal activity of commonly used antiseptics was bleach (1:10) > cavicide (1:10) > ethanol (70%). CONCLUSIONS The hypothesis of potential transmission from fomites was supported by the experimental results. The anti-HCV activity of commercial antiseptics varied.
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Affiliation(s)
- Elijah Paintsil
- Departments of Pediatrics and Pharmacology, Yale School of Medicine
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Abdul-Quader AS, Feelemyer J, Modi S, Stein ES, Briceno A, Semaan S, Horvath T, Kennedy GE, Des Jarlais DC. Effectiveness of structural-level needle/syringe programs to reduce HCV and HIV infection among people who inject drugs: a systematic review. AIDS Behav 2013; 17:2878-92. [PMID: 23975473 PMCID: PMC6509353 DOI: 10.1007/s10461-013-0593-y] [Citation(s) in RCA: 153] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Needle-syringe programs (NSP) have been effective in reducing HIV and hepatitis C (HCV) infection among people who inject drugs (PWID). Achieving sustainable reductions in these blood-borne infections requires addressing structural factors so PWID can legally access NSP services. Systematic literature searches collected information on NSP coverage and changes in HIV or HCV infection prevalence or incidence at the population level. Included studies had to document biomarkers (HIV or HCV) coupled with structural-level NSP, defined by a minimum 50 % coverage of PWID and distribution of 10 or more needles/syringe per PWID per year. Fifteen studies reported structural-level NSP and changes in HIV or HCV infection prevalence/incidence. Nine reported decreases in HIV prevalence, six in HCV infection prevalence, and three reported decreases in HIV incidence. The results support NSP as a structural-level intervention to reduce population-level infection and implementation of NSP for prevention and treatment of HIV and HCV infection.
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Affiliation(s)
- Abu S Abdul-Quader
- Center for Global Health, Division of Global HIV/AIDS, Epidemiology and Strategic Information Branch, Centers for Disease Control and Prevention, CORP Bldg 1 Rm 2308.02, MS E30, Atlanta, GA, 30329-1902, USA,
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Porter JC, Lusk HM, Katz AR. Prevalence of HCV infection among clients in community-based health settings in Hawaii, 2002-2010: assessing risk factors. Am J Public Health 2013; 104:1534-9. [PMID: 24028267 DOI: 10.2105/ajph.2013.301282] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES We sought to determine the prevalence of HCV infection and identify risk factors associated with HCV infection among at-risk clients presenting to community-based health settings in Hawaii. METHODS Clients from 23 community-based sites were administered risk factor questionnaires and screened for HCV antibodies from December 2002 through May 2010. We performed univariate and multivariate logistic regression analyses. RESULTS Of 3306 participants included in the analysis, 390 (11.8%) tested antibody positive for HCV. Highest HCV antibody prevalence (17.0%) was in persons 45 to 64 years old compared with all other age groups. Significant independent risk factors were current or prior injection drug use (P < .001), blood transfusion prior to July 1992 (P = .002), and having an HCV-infected sex partner (P = .03). Stratification by gender revealed sexual exposure to be significant for males (P = .001). CONCLUSIONS Despite Hawaii's ethnic diversity, high hepatocellular carcinoma incidence, and a statewide syringe exchange program in place since the early 1990s, our HCV prevalence and risk factor findings are remarkably consistent with those reported from the mainland United States. Hence, effective interventions identified from US mainland population studies should be generalizable to Hawaii.
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Affiliation(s)
- Jeremy C Porter
- Jeremy C. Porter and Alan R. Katz are with the Department of Public Health Sciences, John A. Burns School of Medicine, University of Hawaii, Honolulu. Heather M. Lusk is with the Adult Viral Hepatitis Prevention Program, Communicable Disease Division, Hawaii State Department of Health, Honolulu
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MacArthur GJ, van Velzen E, Palmateer N, Kimber J, Pharris A, Hope V, Taylor A, Roy K, Aspinall E, Goldberg D, Rhodes T, Hedrich D, Salminen M, Hickman M, Hutchinson SJ. Interventions to prevent HIV and Hepatitis C in people who inject drugs: a review of reviews to assess evidence of effectiveness. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 25:34-52. [PMID: 23973009 DOI: 10.1016/j.drugpo.2013.07.001] [Citation(s) in RCA: 208] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 06/25/2013] [Accepted: 07/03/2013] [Indexed: 01/23/2023]
Abstract
BACKGROUND Injecting drug use is a major risk factor for the acquisition and transmission of HIV and Hepatitis C virus (HCV). Prevention of these infections among people who inject drugs (PWID) is critical to reduce ongoing transmission, morbidity and mortality. METHODS A review of reviews was undertaken involving systematic literature searches of Medline, Embase, CINAHL, PsychINFO, IBSS and the Cochrane Library (2000-2011) to identify English language reviews regarding the effectiveness of harm reduction interventions in relation to HIV transmission, HCV transmission and injecting risk behaviour (IRB). Interventions included needle and syringe programmes (NSP); the provision of injection paraphernalia; opiate substitution treatment (OST); information, education and counselling (IEC); and supervised injecting facilities (SIFs). Reviews were classified into 'core' or 'supplementary' using critical appraisal criteria, and the strength of review-level evidence was assessed. RESULTS Twelve core and thirteen supplementary reviews were included. From these reviews we identified: (i) for NSP: tentative review-level evidence to support effectiveness in reducing HIV transmission, insufficient review-level evidence relating to HCV transmission, but sufficient review-level evidence in relation to IRB; (ii) for OST: sufficient review-level evidence of effectiveness in relation to HIV transmission and IRB, but tentative review-level evidence in relation to HCV transmission; (iii) for IEC, the provision of injection paraphernalia and SIFs: tentative review-level evidence of effectiveness in reducing IRB; and either insufficient or no review-level evidence for these interventions in relation to HIV or HCV transmission. CONCLUSION Review-level evidence indicates that harm reduction interventions can reduce IRB, with evidence strongest for OST and NSP. However, there is comparatively little review-level evidence regarding the effectiveness of these interventions in preventing HCV transmission among PWID. Further studies are needed to assess the effectiveness and impact of scaling up comprehensive packages of harm reduction interventions to minimise HIV and HCV transmission among PWID.
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Affiliation(s)
- Georgina J MacArthur
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK.
| | - Eva van Velzen
- NHS Sutton and Merton/London KSS Specialty School of Public Health, UK
| | | | - Jo Kimber
- University of New South Wales, Sydney, Australia
| | | | - Vivian Hope
- Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London, UK; Health Protection Services, Health Protection Agency, London, UK
| | - Avril Taylor
- University of the West of Scotland, Paisley, Scotland, UK
| | | | - Esther Aspinall
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | | | - Tim Rhodes
- Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London, UK
| | - Dagmar Hedrich
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Mika Salminen
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Matthew Hickman
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Sharon J Hutchinson
- Health Protection Scotland, Glasgow, UK; University of the West of Scotland, Paisley, Scotland, UK
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