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Luvuno ZPB, Wiafe E, Mpofana N, Urusla MM, Nxumalo CT. Fast-track interventions for HIV and AIDS epidemic control among key populations: A rapid review. Afr J Prim Health Care Fam Med 2024; 16:e1-e12. [PMID: 38708735 PMCID: PMC11079388 DOI: 10.4102/phcfm.v16i1.4088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Targeted interventions for key populations remain critical for realisation of epidemic control for human immunodeficiency virus (HIV) infection because of the causal relationship between HIV infection in the general population and among key population groups. AIM To consolidate evidence on the fast-track interventions towards achieving HIV epidemic control among key populations. METHODS A rapid scoping review was conducted using the methodological framework by Arksey and O' Malley. The Population, Intervention, Context and Outcome (PICO) framework was used to identify relevant studies using key words with Boolean operators in electronic data bases, namely CINHAL, Web of Science, Psych Info and Sabinet. Studies were extracted using a modified data extraction tool, and results were presented narratively. RESULTS A total of 19 articles were included in this review. Most articles were primary studies (n = 17), while another involved the review of existing literature and policies (n = 2) and routinely collected data (n = 1). Most studies were conducted in the United States of America (n = 6), while another were conducted in China, Kenya, Botswana, South Africa and Mozambique. All studies revealed findings on tested interventions to achieve HIV epidemic control among key populations. CONCLUSION Effective interventions for HIV epidemic control were stand-alone behavioural preventive interventions, stand-alone biomedical preventive strategies and combination prevention approaches. Furthermore, the findings suggest that effective activities to achieve HIV epidemic control among key populations should be centred around prevention.Contribution: The findings of this study have policy and practice implications for high HIV burden settings such as South Africa in terms of interventions to facilitate realisation of the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets, thereby contributing to HIV epidemic control.
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Affiliation(s)
- Zamasomi P B Luvuno
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Howard Campus, Durban.
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Bernard CL, Rao IJ, Robison KK, Brandeau ML. Health outcomes and cost-effectiveness of diversion programs for low-level drug offenders: A model-based analysis. PLoS Med 2020; 17:e1003239. [PMID: 33048929 PMCID: PMC7553283 DOI: 10.1371/journal.pmed.1003239] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/14/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cycles of incarceration, drug abuse, and poverty undermine ongoing public health efforts to reduce overdose deaths and the spread of infectious disease in vulnerable populations. Jail diversion programs aim to divert low-level drug offenders toward community care resources, avoiding criminal justice costs and disruptions in treatment for HIV, hepatitis C virus (HCV), and drug abuse. We sought to assess the health benefits and cost-effectiveness of a jail diversion program for low-level drug offenders. METHODS AND FINDINGS We developed a microsimulation model, calibrated to King County, Washington, that captured the spread of HIV and HCV infections and incarceration and treatment systems as well as preexisting interventions such as needle and syringe programs and opiate agonist therapy. We considered an adult population of people who inject drugs (PWID), people who use drugs but do not inject (PWUD), men who have sex with men, and lower-risk heterosexuals. We projected discounted lifetime costs and quality-adjusted life years (QALYs) over a 10-year time horizon with and without a jail diversion program and calculated resulting incremental cost-effectiveness ratios (ICERs) from the health system and societal perspectives. We also tracked HIV and HCV infections, overdose deaths, and jail population size. Over 10 years, the program was estimated to reduce HIV and HCV incidence by 3.4% (95% CI 2.7%-4.0%) and 3.3% (95% CI 3.1%-3.4%), respectively, overdose deaths among PWID by 10.0% (95% CI 9.8%-10.8%), and jail population size by 6.3% (95% CI 5.9%-6.7%). When considering healthcare costs only, the program cost $25,500/QALY gained (95% CI $12,600-$48,600). Including savings from reduced incarceration (societal perspective) improved the ICER to $6,200/QALY gained (95% CI, cost-saving $24,300). Sensitivity analysis indicated that cost-effectiveness depends on diversion program participants accessing community programs such as needle and syringe programs, treatment for substance use disorder, and HIV and HCV treatment, as well as diversion program cost. A limitation of the analysis is data availability, as fewer data are available for diversion programs than for more established interventions aimed at people with substance use disorder. Additionally, like any model of a complex system, our model relies on simplifying assumptions: For example, we simplified pathways in the healthcare and criminal justice systems, modeled an average efficacy for substance use disorder treatment, and did not include costs associated with homelessness, unemployment, and breakdown in family structure. CONCLUSIONS We found that diversion programs for low-level drug offenders are likely to be cost-effective, generating savings in the criminal justice system while only moderately increasing healthcare costs. Such programs can reduce incarceration and its associated costs, and also avert overdose deaths and improve quality of life for PWID, PWUD, and the broader population (through reduced HIV and HCV transmission).
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Affiliation(s)
- Cora L. Bernard
- Department of Management Science and Engineering, Stanford University, Stanford, California, United States of America
| | - Isabelle J. Rao
- Department of Management Science and Engineering, Stanford University, Stanford, California, United States of America
| | - Konner K. Robison
- Department of Management Science and Engineering, Stanford University, Stanford, California, United States of America
| | - Margaret L. Brandeau
- Department of Management Science and Engineering, Stanford University, Stanford, California, United States of America
- * E-mail:
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Estem KS, Catania J, Klausner JD. HIV Self-Testing: a Review of Current Implementation and Fidelity. Curr HIV/AIDS Rep 2016; 13:107-15. [PMID: 26879653 DOI: 10.1007/s11904-016-0307-y] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Oral HIV self-testing is an innovative and potentially high-impact means to increase HIV-case identification globally. As a screening test, oral HIV self-testing offers the potential for increased adoption through greater convenience and privacy, and the potential to increase the proportion of the population who test regularly. Research on how best to translate the innovation of oral self-testing to high-risk populations is underway. Currently only one oral HIV self-test kit is FDA-approved (OraQuick In-Home HIV Test) and available for retail sale. In the present report we review recent studies on the dissemination, adoption, and implementation of oral HIV testing. Prior work has focused primarily on adoption, but recent studies have begun to identify methods for improving dissemination and problems associated with self-implementation. At present a major barrier to wider adoption is the relatively high retail cost of the oral HIV test kit. Significant but minor barriers are represented by overly complex instructional materials for some population segments, and dissemination programs of unknown efficacy. Theoretical and practical suggestions for conducting research on dissemination, adoption, and implementation of oral HIV testing are discussed.
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Affiliation(s)
- Kristecia S Estem
- New York City Department of Health and Mental Hygiene, Bureau of HIV/AIDS Prevention and Control, 42-09 28th Street, WS 21-64, Queens, NY, 11101, USA
| | - Joseph Catania
- Social and Behavioral Health Sciences, Oregon State University College of Public Health and Human Sciences, 401 Waldo Hall, Corvallis, OR, 97331, USA
| | - Jeffrey D Klausner
- Department of Medicine, Division of Infectious Diseases, UCLA David Geffen School of Medicine and Department of Epidemiology, Fielding School of Public Health, 10920 Wilshire Blvd, Suite #350, Los Angeles, CA, 90024, USA.
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4
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Gooden L, Metsch LR, Pereyra MR, Malotte CK, Haynes LF, Douaihy A, Chally J, Mandler RN, Feaster DJ. Examining the Efficacy of HIV Risk-Reduction Counseling on the Sexual Risk Behaviors of a National Sample of Drug Abuse Treatment Clients: Analysis of Subgroups. AIDS Behav 2016; 20:1893-906. [PMID: 26837631 PMCID: PMC4970956 DOI: 10.1007/s10461-016-1300-6] [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] [Indexed: 10/22/2022]
Abstract
HIV counseling with testing has been part of HIV prevention in the U.S. since the 1980s. Despite the long-standing history of HIV testing with prevention counseling, the CDC released HIV testing recommendations for health care settings contesting benefits of prevention counseling with testing in reducing sexual risk behaviors among HIV-negatives in 2006. Efficacy of brief HIV risk-reduction counseling (RRC) in decreasing sexual risk among subgroups of substance use treatment clients was examined using multi-site RCT data. Interaction tests between RRC and subgroups were performed; multivariable regression evaluated the relationship between RRC (with rapid testing) and sex risk. Subgroups were defined by demographics, risk type and level, attitudes/perceptions, and behavioral history. There was an effect (p < .0028) of counseling on number of sex partners among some subgroups. Certain subgroups may benefit from HIV RRC; this should be examined in studies with larger sample sizes, designed to assess the specific subgroup(s).
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Affiliation(s)
- Lauren Gooden
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA.
- Department of Sociomedical Sciences, Mailman School of Public Health, Miami Research Center, Columbia University, 1120 NW 14th Street, Room 1030, Miami, FL, 33136, USA.
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Margaret R Pereyra
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
- Department of Sociomedical Sciences, Mailman School of Public Health, Miami Research Center, Columbia University, 1120 NW 14th Street, Room 1030, Miami, FL, 33136, USA
| | - C Kevin Malotte
- Department of Health Science, California State University, Long Beach, CA, USA
| | - Louise F Haynes
- Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, SC, USA
| | - Antoine Douaihy
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jack Chally
- Johns Hopkins University, Baltimore, MD, USA
- EMMES Corporation, Inc., Rockville, MD, USA
| | - Raul N Mandler
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
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Lin T, Chen CH, Chou P. Effects of combination approach on harm reduction programs: the Taiwan experience. Harm Reduct J 2016; 13:23. [PMID: 27377896 PMCID: PMC4932706 DOI: 10.1186/s12954-016-0112-3] [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: 04/19/2016] [Accepted: 06/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2003, a major epidemic of human immunodeficiency virus emerged among injection drug users in Taiwan. In response to the twin epidemics of HIV and intravenous drug addiction, the government implemented comprehensive harm reduction programs beginning in 2005. Collected data from relevant agencies were used to explore the impact of the harm reduction programs on HIV and illicit drug use. METHODS This study divided 2002-2015 into three intervention phases and used the surveillance data and statistics on the HIV epidemic, drug abuse, and the intervention from relevant agencies to explore the correlations between different variables in different intervention periods and the combination effects of interventions on the HIV epidemic. RESULTS In the pre-intervention phase, the growth of the HIV epidemic followed the rapidly increasing number of heroin users, reaching a peak in 2005. After the initiation of harm reduction programs, the HIV epidemic ceased growing, even rapidly declining with the expansion of needle and syringe exchange programs and opioid substitution therapy; however, the number of heroin users remained high. When the implementation of the needle and syringe exchange programs and the opioid substitution therapy program reached the plateau level in the consolidation phase, the number of heroin users also decreased rapidly. The combination effects of the harm reduction programs in this period also pushed levels of HIV infection below those before this outbreak. CONCLUSIONS The HIV epidemic among injection drug users incorporates the dual problems of drug addiction and needle-sharing behaviors, so the use of a single intervention will not resolve all of the problems. Facing a severe HIV epidemic among injection drug users, quickly scaling up and promoting comprehensive harm reduction programs is a good strategy that can be used to simultaneously reverse the HIV epidemic and to resolve the illicit drug use problems. More research is needed to find out the reasons behind why there were cases that declined opioid substitution therapy, so that efforts can be undertaken to avoid the epidemic rebounding.
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Affiliation(s)
- Ting Lin
- Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, No.155, Section 2, Ni-Long Street, Taipei, 11221, Taiwan.,Taiwan AIDS Foundation, No. 410, 8F, Nanjing W. Rd., Tatung Dist., Taipei, 10343, Taiwan
| | - Chang-Hsun Chen
- Taiwan Centers for Disease Control, Ministry of Health and Welfare, No.6, Linsen S. Rd., Zhongzheng Dist., Taipei, 10050, Taiwan
| | - Pesus Chou
- Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, No.155, Section 2, Ni-Long Street, Taipei, 11221, Taiwan.
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Coffin PO, Jin H, Huriaux E, Mirzazadeh A, Raymond HF. Trends in use of health care and HIV prevention services for persons who inject drugs in San Francisco: results from National HIV Behavioral Surveillance 2005-2012. Drug Alcohol Depend 2015; 146:45-51. [PMID: 25468816 DOI: 10.1016/j.drugalcdep.2014.10.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 10/28/2014] [Accepted: 10/29/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Multiple developments addressing health of people who inject drugs (PWIDs) in San Francisco were initiated from 2003 to 2012, including expanded health care coverage, syringe access, HIV testing and universal HIV treatment. METHODS We evaluated 3 PWID cycles of the National HIV Behavioral Surveillance for several healthcare measures related to the expanded services. Using RDSAT estimators, we applied the Cochran-Armitage test for trend to evaluate signals of improvement during the time in which health system changes were made. RESULTS Participant demographics were similar (n=565, 535, and 570 in 2005, 2009, and 2012, respectively). There was a substantial increase in healthcare coverage (37.6 to 82.5%, P<0.0001). Obtaining syringes from pharmacies (17.8 to 32.1%, P<0.0001) increased substantially. Past year hepatitis C testing increased (16.5 to 33.1%, P<0.0001) with stable self-reported prevalence (45.7-54.2%, P=0.8). Among those with known HIV, antiretroviral treatment was reported among 46.6% in 2005 and 66.3% in 2012. Past year HIV testing declined from 74.2 to 42.1%, (P<0.0001) and the prevalence of unrecognized HIV among PWIDs was 42.2-42.7% in 2009 and 2012. CONCLUSIONS There is evidence of improvement in some health measures for PWIDs in San Francisco from 2005 to 2012. However, there are also some concerning findings, such as declining prevalence of HIV testing and high prevalence of undiagnosed HIV. There is a need for renewed attention and innovative ideas to track and address HIV and other medical sequelae among PWIDs.
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Affiliation(s)
- Phillip O Coffin
- San Francisco Department of Public Health, San Francisco, CA, United States
| | - Harry Jin
- San Francisco Department of Public Health, San Francisco, CA, United States
| | - Emalie Huriaux
- San Francisco Department of Public Health, San Francisco, CA, United States
| | - Ali Mirzazadeh
- University of California, San Francisco, CA, United States
| | - Henry F Raymond
- San Francisco Department of Public Health, San Francisco, CA, United States.
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Edelman EJ, Chantarat T, Caffrey S, Chaudhry A, O’Connor P, Weiss L, Fiellin DA, Fiellin LE. The impact of buprenorphine/naloxone treatment on HIV risk behaviors among HIV-infected, opioid-dependent patients. Drug Alcohol Depend 2014; 139:79-85. [PMID: 24726429 PMCID: PMC4029496 DOI: 10.1016/j.drugalcdep.2014.03.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Revised: 03/05/2014] [Accepted: 03/05/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Opioid dependence is a major risk factor for HIV infection, however, the impact of buprenorphine/naloxone treatment on HIV risk behaviors among HIV-infected opioid-dependent patients is unknown. METHODS We conducted a longitudinal analysis of 303 HIV-infected opioid-dependent patients initiating buprenorphine/naloxone treatment. Outcomes included self-reported past 90-day needle-sharing and non-condom use. We assessed trends over the 12 months using the Cochran-Armitage trend test. Using generalized estimating equations, after multiple imputation, we determined factors independently associated with needle-sharing and non-condom use, including time-updated variables. We then conducted a mediation analysis to determine whether substance use explained the relationship between time since treatment initiation and needle-sharing. RESULTS Needle-sharing decreased from baseline to the fourth quarter following initiation of buprenorphine/naloxone (9% vs. 3%, p<0.001), while non-condom use did not (23% vs. 21%, p=0.10). HIV risk behaviors did not vary based on the presence of a detectable HIV-1 RNA viral load. Patients who were homeless and used heroin, cocaine/amphetamines or marijuana were more likely to report needle-sharing. Heroin use fully mediated the relationship between time since treatment initiation and needle-sharing. Women, patients who identified as being gay/lesbian/bisexual, those married or living with a partner and who reported heroin or alcohol use were more likely to report non-condom use. Older patients were less likely to report non-condom use. CONCLUSIONS While buprenorphine/naloxone is associated with decreased needle-sharing among HIV-infected opioid-dependent patients, sexual risk behaviors persist regardless of viral load. Targeted interventions to address HIV risk behaviors among HIV-infected opioid-dependent populations receiving buprenorphine/naloxone are needed.
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Affiliation(s)
- E. Jennifer Edelman
- Yale University School of Medicine, PO Box 208025, New Haven, CT 06510,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT
| | | | - Sarah Caffrey
- Yale University School of Medicine, PO Box 208025, New Haven, CT 06510
| | - Amina Chaudhry
- Chase Brexton Health Care, 1111 North Charles Street, Baltimore, MD 21201
| | - Patrick O’Connor
- Yale University School of Medicine, PO Box 208025, New Haven, CT 06510
| | - Linda Weiss
- New York Academy of Medicine, 1216 5 Avenue, New York, NY 10029
| | - David A. Fiellin
- Yale University School of Medicine, PO Box 208025, New Haven, CT 06510,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT
| | - Lynn E. Fiellin
- Yale University School of Medicine, PO Box 208025, New Haven, CT 06510,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT
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Mackesy-Amiti ME, Finnegan L, Ouellet LJ, Golub ET, Hagan H, Hudson SM, Latka MH, Garfein RS. Peer-education intervention to reduce injection risk behaviors benefits high-risk young injection drug users: a latent transition analysis of the CIDUS 3/DUIT study. AIDS Behav 2013; 17:2075-83. [PMID: 23142857 PMCID: PMC3672505 DOI: 10.1007/s10461-012-0373-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We analyzed data from a large randomized HIV/HCV prevention intervention trial with young injection drug users (IDUs) conducted in five U.S. cities. The trial compared a peer education intervention (PEI) with a time-matched, attention control group. Applying categorical latent variable analysis (mixture modeling) to baseline injection risk behavior data, we identified four distinct classes of injection-related HIV/HCV risk: low risk, non-syringe equipment-sharing, moderate-risk syringe-sharing, and high-risk syringe-sharing. The trial participation rate did not vary across classes. We conducted a latent transition analysis using trial baseline and 6-month follow-up data, to test the effect of the intervention on transitions to the low-risk class at follow-up. Adjusting for gender, age, and race/ethnicity, a significant intervention effect was found only for the high-risk class. Young IDU who exhibited high-risk behavior at baseline were 90 % more likely to be in the low-risk class at follow-up after the PEI intervention, compared to the control group.
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Affiliation(s)
- Mary E Mackesy-Amiti
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA.
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Pace JE, Siberry GK, Hazra R, Kapogiannis BG. Preexposure prophylaxis for adolescents and young adults at risk for HIV infection: is an ounce of prevention worth a pound of cure? Clin Infect Dis 2013; 56:1149-55. [PMID: 23223604 PMCID: PMC3657491 DOI: 10.1093/cid/cis1020] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 10/26/2012] [Indexed: 12/27/2022] Open
Abstract
An alarming proportion of incident human immunodeficiency virus (HIV) infections worldwide occur in youth. In the United States, 69% of all new infections among youth occurred in young men who have sex with men (YMSM). Recent studies show the promise of preexposure prophylaxis (PrEP) for preventing HIV infection, but research efforts suffer from disproportionately low representation of the youth who are most at risk. Youth-focused research is critical and should include behavioral, community, and biomedical interventions to create a comprehensive HIV prevention package. The many ethical, legal, and regulatory considerations in conducting HIV research among, and in providing care services to, youth must be addressed so that those at high risk and most likely to benefit can have unfettered access to safe and effective health-promoting interventions. YMSM and minority youth are at substantial HIV risk and urgently need effective HIV prevention tools for which the short and long-term benefits and risks have been carefully considered.
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Affiliation(s)
- Jill E Pace
- Pediatric, Adolescent and Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892-7510, USA
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10
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Edelman EJ, Fiellin DA. Moving HIV pre-exposure prophylaxis into clinical settings: lessons from buprenorphine. Am J Prev Med 2013; 44:S86-90. [PMID: 23253768 PMCID: PMC3645931 DOI: 10.1016/j.amepre.2012.09.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 09/04/2012] [Accepted: 09/19/2012] [Indexed: 11/28/2022]
Affiliation(s)
- E Jennifer Edelman
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06520-8093, USA
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11
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Potential role of safer injection facilities in reducing HIV and hepatitis C infections and overdose mortality in the United States. Drug Alcohol Depend 2011; 118:100-10. [PMID: 21515001 DOI: 10.1016/j.drugalcdep.2011.03.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 03/08/2011] [Accepted: 03/09/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Safer injection facilities (SIFs) reduce risks associated with injecting drugs, particularly public injection and overdose mortality. They exist in many countries, but do not exist in the United States. We assessed several ethical, operational, and public health considerations for establishing SIFs in the United States. METHOD We used the six-factor Kass framework (goals, effectiveness, concerns, minimization of concerns, fair implementation, and balancing of benefits and concerns), summarized needs of persons who inject drugs in the United States, and reviewed global evidence for SIFs. RESULTS SIFs offer a hygienic environment to inject drugs, provide sterile injection equipment at time of injection, and allow for safe disposal of used equipment. Injection of pre-obtained drugs, purchased by persons who inject drugs, happens in a facility where trained personnel provide on-site counseling and referral to addiction treatment and health care and intervene in overdose emergency situations. SIFs provide positive health benefits (reducing transmission of HIV and viral hepatitis, bacterial infections, and overdose mortality) without evidence for negative health or social consequences. SIFs serve most-at-risk persons, including those who inject in public or inject frequently, and those who do not use other public health programs. It is critical to address legal, ethical, and local concerns, develop and implement relevant policies and procedures, and assess individual- and community-level needs and benefits of SIFs given local epidemiologic data. CONCLUSIONS SIFs have the potential to reduce viral and bacterial infections and overdose mortality among those who engage in high-risk injection behaviors by offering unique public health services that are complementary to other interventions.
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Lambert EY, Normand JL, Volkow ND. Prevention and treatment of HIV/AIDS among drug-using populations: a global perspective. J Acquir Immune Defic Syndr 2010; 55 Suppl 1:S1-4. [PMID: 21045592 PMCID: PMC3074297 DOI: 10.1097/qai.0b013e3181f9c120] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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