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Blouin K, Blanchette C, Leclerc P, Morissette C, Vallée M, Diabaté S. HIV and HCV seroincidence, associated factors and drug use in people who inject drugs, SurvUDI network, eastern central Canada, 1995-2020. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024:104483. [PMID: 38880701 DOI: 10.1016/j.drugpo.2024.104483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 05/30/2024] [Accepted: 06/02/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND The SurvUDI network is a biobehavioural survey among people who inject drugs (PWID) in Eastern Central Canada. OBJECTIVES The objectives were to describe HIV and HCV seroincidence trends, associated factors and changes in drug use behaviours. METHODS The network was initiated in 1995 and targets hard-to-reach, mostly out-of- treatment PWID. Participants were recruited mostly in harm reduction programs, completed an interviewer-administered questionnaire, provided a sample of gingival exudate for HIV and HCV antibody testing and were identified using an encrypted code allowing identification of multiple participations. Time trends were examined for HIV and HCV seroincidence, selected characteristics and behaviours. Cox proportional hazard regression was used to examine factors associated to HIV and HCV seroincidence. RESULTS Between January 1995 and March 2020, 15,907 individuals have completed 31,051 questionnaires. HIV seroincidence decreased significantly from 5.0 per 100 person-years (p-y) in 1995 to 0.4 per 100 p-y in 2018. HCV seroincidence also decreased significantly between 1998 and 2011. The use of syringes already used by someone else decreased significantly, from 43.4 % in 1995 to 12.4 % in 2019, as well as the use of equipment other than syringe already used by someone else. Cocaine/crack injection decreased significantly while "opioids other than heroin" injection increased, concomitant to daily injection. Injection with syringes already used by someone else and cocaine as the most often injected drug were significantly associated with HIV seroincidence (1995-2020). Injected opioid other than heroin, injected cocaine/crack, injected 100 or more times in the past month, injected for less than 3 years, injected with syringes or equipment already used by someone else, injected with someone else and reported client sex partners were significantly associated with HCV seroincidence (2004-2020). CONCLUSION HIV seroincidence and syringe/equipment sharing behaviour trends are encouraging, but HCV seroincidence remains high.
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Affiliation(s)
- Karine Blouin
- Unité sur les infections transmissibles sexuellement et par le sang, Institut national de santé publique du Québec, Québec, Canada; École de santé publique de l'Université de Montréal, Montréal, Canada; Département de médecine sociale et préventive, Université Laval, Québec, Canada.
| | - Caty Blanchette
- Centre de recherche du CHU de Québec - Université Laval, Québec, Canada
| | - Pascale Leclerc
- Direction régionale de Santé Publique - CIUSSS du Centre-Sud-de-l'Île-de Montréal, Montréal, Canada
| | - Carole Morissette
- Direction régionale de Santé Publique - CIUSSS du Centre-Sud-de-l'Île-de Montréal, Montréal, Canada
| | - Maud Vallée
- Laboratoire de santé publique du Québec, Institut national de santé publique du Québec, Sainte-Anne de Bellevue, Canada
| | - Souleymane Diabaté
- Département de médecine sociale et préventive, Université Laval, Québec, Canada; Centre de recherche du CHU de Québec - Université Laval, Québec, Canada
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Høj SB, Minoyan N, Zang G, Larney S, Bruneau J. Gender, sexual orientation identity, and initiation of amphetamine injecting among people who inject drugs: Examination of an expanding drug era in Montreal, Canada, 2011-19. Drug Alcohol Depend 2023; 251:110956. [PMID: 37716286 DOI: 10.1016/j.drugalcdep.2023.110956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/26/2023] [Accepted: 08/29/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Amphetamine injection is expanding in North America and has been associated with male homosexuality among people who inject drugs (PWID). Applying subcultural evolution theory, we examined overall and gender-stratified trends in amphetamine injection and assessed sexual orientation as a gender-specific predictor of initiation among PWID in Montreal, Canada. METHODS Data were from HEPCO, an open prospective cohort of PWID. Gender and sexual orientation were self-identified at enrolment. Interviewer-administered questionnaires at three-monthly (HCV RNA-negative participants) or yearly (RNA-positive) intervals captured past three-month amphetamine injection and covariates. Annual prevalence and linear trends in amphetamine injection were estimated using GEE. Incidence was computed among naïve individuals and hazard ratios for initiation estimated using gender-stratified, time-varying Cox regression models. RESULTS 803 participants contributed 8096 observations between March 2011 and December 2019. Annual prevalence of amphetamine injecting increased from 3.25% [95%CI: 2.06-4.43%] to 12.7% [9.50-16.0] (trend p<0.001). Bivariate Cox regression models suggested similar and divergent predictors of initiation by gender. Incidence was 3.27 per 100 person-years [95%CI: 2.51-4.18] among heterosexual men, 7.18 [3.50-13.2] among gay/bisexual men, 1.93 [0.78-4.02] among heterosexual women and 5.30 [1.69-12.8] among gay/bisexual women. Among men, gay/bisexual identity doubled risk of initiation after adjusting for age, ethnicity, calendar year (aHR 2.16 [1.07-4.36]) and additional covariates (2.56 [1.24-5.30]). Among women, evidence for an association with gay/bisexual identity was inconclusive (aHR 2.63 [0.62-11.2]) and sample size precluded further adjustment CONCLUSIONS: Prevalence of amphetamine injection among PWID increased four-fold from 2011 to 2019, with elevated risk of initiation in gay and bisexual men.
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Affiliation(s)
- Stine Bordier Høj
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 Rue Saint Denis, Montreal H2X 0A9, Canada.
| | - Nanor Minoyan
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 Rue Saint Denis, Montreal H2X 0A9, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, 7101 Avenue du Parc, Montreal H3N 1X9, Canada
| | - Geng Zang
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 Rue Saint Denis, Montreal H2X 0A9, Canada
| | - Sarah Larney
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 Rue Saint Denis, Montreal H2X 0A9, Canada; Department of Family Medicine and Emergency Medicine, Université de Montréal, 2900 Boulevard Édouard-Montpetit, Montreal H3T 1J4, Canada
| | - Julie Bruneau
- Research Centre, Centre Hospitalier de l'Université de Montréal, 900 Rue Saint Denis, Montreal H2X 0A9, Canada; Department of Family Medicine and Emergency Medicine, Université de Montréal, 2900 Boulevard Édouard-Montpetit, Montreal H3T 1J4, Canada.
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Lanièce Delaunay C, Godin A, Kronfli N, Panagiotoglou D, Cox J, Alary M, Klein MB, Maheu-Giroux M. Can hepatitis C elimination targets be sustained among people who inject drugs post-2030? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103343. [PMID: 34215459 DOI: 10.1016/j.drugpo.2021.103343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/24/2021] [Accepted: 06/02/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND In high-income countries, people who inject drugs (PWID) are a priority population for eliminating hepatitis C virus (HCV) by 2030. Despite evidence informing micro-elimination strategies, little is known regarding efforts needed to maintain elimination targets in populations with ongoing acquisition risks. This model-based study investigates post-elimination transmission dynamics of HCV and HIV among PWID under different scenarios where harm reduction interventions and HCV testing and treatment are scaled-down. METHODS We calibrated a dynamic compartmental model of concurrent HCV and HIV transmission among PWID in Montréal (Canada) to epidemiological data (2003-2018). We then simulated achieving the World Health Organization elimination targets by 2030. Finally, we assessed the impact of four post-elimination scenarios (2030-2050): 1) scaling-down testing, treatment, opioid agonist therapy (OAT), and needle and syringe programs (NSP) to pre-2020 levels; 2) only scaling-down testing and treatment; 3) suspending testing and treatment, while scaling down OAT and NSP to pre-2020 levels; 4) suspending testing and treatment and maintaining OAT and NSP coverage required for elimination. RESULTS Scaling down interventions to pre-2020 levels (scenario 1) leads to a modest rebound in chronic HCV incidence from 2.4 to 3.6 per 100 person-years by 2050 (95% credible interval - CrI: 0.8-7.2). When only scaling down testing and treatment (scenario 2), chronic HCV incidence continues to decrease. In scenario 3 (suspending treatment and scaling down OAT and NSP), HCV incidence and mortality rapidly increase to 11.4 per 100 person-years (95%CrI: 7.4-15.5) and 3.2 per 1000 person-years (95%CrI: 2.4-4.0), respectively. HCV resurgence was mitigated in scenario 4 (maintaining OAT and NSP) as compared to scenario 3. All scenarios lead to decreases in the proportion of reinfections among incident cases and have little impact on HIV incidence and HIV-HCV coinfection prevalence. CONCLUSION Despite ongoing transmission risks, HCV incidence rebounds slowly after 2030 under pre-2020 testing and treatment levels. This is heightened by maintaining high-coverage harm reduction interventions. Overall, sustaining elimination would require considerably less effort than achieving it.
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Affiliation(s)
- Charlotte Lanièce Delaunay
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, Faculty of Medicine, McGill University, 1020 Avenue des Pins Ouest, H3A 1A2, Montréal (QC), Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 Boulevard de Maisonneuve Ouest, H4A 3S5, Montréal (QC), Canada
| | - Arnaud Godin
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, Faculty of Medicine, McGill University, 1020 Avenue des Pins Ouest, H3A 1A2, Montréal (QC), Canada
| | - Nadine Kronfli
- Department of Medicine, Division of Infectious Disease and Chronic Viral Illness Service, McGill University Health Centre, 1001 Boulevard Décarie, H4A 3J1, Montréal (QC), Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 Boulevard de Maisonneuve Ouest, H4A 3S5, Montréal (QC), Canada
| | - Dimitra Panagiotoglou
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, Faculty of Medicine, McGill University, 1020 Avenue des Pins Ouest, H3A 1A2, Montréal (QC), Canada
| | - Joseph Cox
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, Faculty of Medicine, McGill University, 1020 Avenue des Pins Ouest, H3A 1A2, Montréal (QC), Canada; Department of Medicine, Division of Infectious Disease and Chronic Viral Illness Service, McGill University Health Centre, 1001 Boulevard Décarie, H4A 3J1, Montréal (QC), Canada
| | - Michel Alary
- Département de Médecine Sociale et Préventive, Université Laval, 1050 Avenue de la Médecine, G1V 016, Québec (QC), Canada; Axe Santé des Populations et Pratiques Optimales en Santé, Centre de recherche du CHU de Québec-Université Laval, 1050 Chemin Sainte-Foy, G1S 4L8, Québec (QC), Canada; Institut National de Santé Publique du Québec, 945 Avenue Wolfe, G1V 5B3, Québec (QC), Canada
| | - Marina B Klein
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, Faculty of Medicine, McGill University, 1020 Avenue des Pins Ouest, H3A 1A2, Montréal (QC), Canada; Department of Medicine, Division of Infectious Disease and Chronic Viral Illness Service, McGill University Health Centre, 1001 Boulevard Décarie, H4A 3J1, Montréal (QC), Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 Boulevard de Maisonneuve Ouest, H4A 3S5, Montréal (QC), Canada
| | - Mathieu Maheu-Giroux
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, Faculty of Medicine, McGill University, 1020 Avenue des Pins Ouest, H3A 1A2, Montréal (QC), Canada.
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Social vulnerability in persons with chronic hepatitis C virus infection is associated with a higher risk of prescription opioid use. Sci Rep 2021; 11:5883. [PMID: 33723313 PMCID: PMC7961056 DOI: 10.1038/s41598-021-85283-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/15/2021] [Indexed: 01/20/2023] Open
Abstract
Prescription opioid use (POU) is often a precursor to opioid use disorder (OUD) and subsequent consequences. Persons with chronic hepatitis C virus infection (CHC) may be at a higher risk of POU due to a higher comorbidity burden and social vulnerability factors. We sought to determine the burden of POU and associated risk factors among persons with CHC in the context of social vulnerability. We identified CHC persons and propensity-score matched HCV− controls in the electronically retrieved Cohort of HCV-Infected Veterans and determined the frequency of acute, episodic long-term and chronic long-term POU and the prevalence of social vulnerability factors among persons with POU. We used logistic regression analysis to determine factors associated with POU. Among 160,856 CHC and 160,856 propensity-score matched HCV-controls, acute POU was recorded in 38.4% and 38.0% (P = 0.01) respectively. Episodic long-term POU was recorded in 3.9% in each group (P = 0.5), while chronic long-term POU was recorded in 28.4% and 19.2% (P < 0.0001). CHC was associated with a higher risk of chronic long-term POU (OR 1.66, 95%CI 1.63, 1.69), but not with acute or episodic long-term POU. Black race, female sex and homelessness were associated with a higher risk of chronic long-term POU. Presence of ≥ 1 factor was associated with a higher risk of all POU patterns. Persons with CHC have more social vulnerability factors and a higher risk of chronic long-term POU. Presence of ≥ 1 social vulnerability factor is associated with a higher risk of POU. Downstream consequences of POU need further study.
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Høj SB, Jacka B, Minoyan N, Bussière P, Bruneau J. Deconstructing the 'cheque effect': short-term changes in injection drug use after receiving income assistance and associated factors. Addiction 2021; 116:571-582. [PMID: 32649010 DOI: 10.1111/add.15192] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/17/2019] [Accepted: 07/08/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Disbursement of income assistance has been temporally associated with intensified drug use and related harms (coined the 'cheque effect'). However, relationships to injection drug use (IDU) remain understudied. We examined short-term 'cheque effects' and associated factors among people who inject drugs (PWID). DESIGN Cross-sectional analysis nested within a cohort study. SETTING Montreal, Quebec, Canada. PARTICIPANTS PWID receiving income assistance, with no employment income. A total of 613 PWID (median age 41, 83% male) contributed 3269 observations from 2011 to 2017. MEASUREMENTS AND METHODS At each cohort visit, an interviewer-administered questionnaire captured retrospective reports of injection-related behaviour during the 2-day periods (i) before and (ii) including/after receiving last month's income assistance payment (number of injections; drugs injected; any receptive syringe-sharing). The relative likelihood (odds) and magnitude (rate) of an increase in injection frequency ('cheque effect') were estimated in relation to social and behavioural factors using logistic and negative binomial regression in a covariate-adjusted two-part model. FINDINGS Prevalence of IDU and syringe-sharing were, respectively, 1.80 and 2.50 times higher in the days following versus preceding cheque receipt (P < 0.001). Among people with past-month IDU, most observations showed increased injection frequency (52%) or no change in injection frequency (44%). The likelihood of a 'cheque effect' was positively associated with cocaine injection [versus injection of other substances, odds ratio (OR) = 2.639, 95% confidence interval (CI) = 2.04-3.41], unstable housing (OR = 1.272, 95% CI = 1.03-1.57) and receiving opioid agonist therapy (OR =1.597, 95% CI = 1.27-2.00) during the same month. Magnitude of the 'cheque effect' was positively associated with cocaine injection [rate ratio (RR) = 1.795, 95% CI = 1.43-2.16], unstable housing (RR = 1.198, 95% CI = 1.02-1.38) and frequent injection (RR = 2.938, 95% CI = 2.43-3.44), but inversely associated with opioid agonist therapy (RR = 0.817, 95% CI = 0.68-0.95) and prescription opioid injection (RR = 0.794, 95% CI = 0.66-0.93). CONCLUSION Among people who inject drugs in Montreal, Canada, injection drug use and receptive syringe-sharing appear to be more prevalent in the 2 days after versus before receiving income assistance. The odds and rate of individual-level increases in injection frequency appear to be positively associated with cocaine injection (versus injection of other substances) and unstable housing.
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Affiliation(s)
- Stine Bordier Høj
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Brendan Jacka
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Nanor Minoyan
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, Canada.,Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, Canada
| | - Phélix Bussière
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Julie Bruneau
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, Canada.,Department of Family and Emergency Medicine, Université de Montréal, Montréal, Canada
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Artenie AA, Cunningham EB, Dore GJ, Conway B, Dalgard O, Powis J, Bruggmann P, Hellard M, Cooper C, Read P, Feld JJ, Hajarizadeh B, Amin J, Lacombe K, Stedman C, Litwin AH, Marks P, Matthews GV, Quiene S, Erratt A, Bruneau J, Grebely J. Patterns of Drug and Alcohol Use and Injection Equipment Sharing Among People With Recent Injecting Drug Use or Receiving Opioid Agonist Treatment During and Following Hepatitis C Virus Treatment With Direct-acting Antiviral Therapies: An International Study. Clin Infect Dis 2020; 70:2369-2376. [PMID: 31300820 PMCID: PMC7245153 DOI: 10.1093/cid/ciz633] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/10/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND In many settings, recent or prior injection drug use remains a barrier to accessing direct-acting antiviral treatment (DAA) for hepatitis C virus (HCV) infection. We examined patterns of drug and alcohol use and injection equipment sharing among people with recent injecting drug use or receiving opioid agonist treatment (OAT) during and following DAA-based treatment. METHODS SIMPLIFY and D3FEAT are phase 4 trials evaluating the efficacy of DAA among people with past 6-month injecting drug use or receiving OAT through a network of 25 international sites. Enrolled in 2016-2017, participants received sofosbuvir/velpatasvir (SIMPLIFY) or paritaprevir/ritonavir/dasabuvir/ombitasvir ± ribavirin (D3FEAT) for 12 weeks and completed behavioral questionnaires before, during, and up to 2 years posttreatment. The impact of time in HCV treatment and follow-up on longitudinally measured longitudinally measured behaviors was estimated using generalized estimating equations. RESULTS At screening, of 190 participants (mean age, 47 years; 74% male), 62% reported any past-month injecting 16% past-month injection equipment sharing, and 61% current OAT. Median alcohol use was 2 (Alcohol Use Disorders Identification Test-Consumption; range, 1-12). During follow-up, opioid injecting (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.92-0.99) and sharing (OR, 0.87; 95% CI, 0.80-0.94) decreased, whereas no significant changes were observed for stimulant injecting (OR, 0.98; 95% CI, 0.94-1.02) or alcohol use (OR, 0.99; 95% CI, 0.95-1.04). CONCLUSIONS Injecting drug use and risk behaviors remained stable or decreased following DAA-based HCV treatment. Findings further support expanding HCV treatment to all, irrespective of injection drug use. CLINICAL TRIALS REGISTRATION SIMPLIFY, NCT02336139; D3FEAT, NCT02498015.
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Affiliation(s)
- Andreea A Artenie
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Canada
- Research Centre, Centre Hospitalier de l’Université de Montréal, Canada
| | | | - Gregory J Dore
- Kirby Institute, University of New South Wales, Australia
- Department of Infectious Diseases, St Vincent’s Hospital, Sydney, Australia
| | | | - Olav Dalgard
- Department of Infectious Disease, Akershus University Hospital, Oslo, Norway
| | - Jeff Powis
- South Riverdale Community Health Centre, Toronto, Canada
| | | | - Margaret Hellard
- Centre for Population Health, Burnet Institute, Australia
- Department of Infectious Diseases, Alfred Hospital, Melbourne, Victoria, Australia
| | | | - Philip Read
- Kirby Institute, University of New South Wales, Australia
- Kirketon Road Centre, Sydney, Australia
| | | | | | - Janaki Amin
- Kirby Institute, University of New South Wales, Australia
- Department of Health Systems and Populations, Macquarie University, Sydney, Australia
| | - Karine Lacombe
- Department of Infectious and Tropical Diseases, Saint-Antoine Hospital, Paris, France
- Institut Pierre Louis d’Épidémiologie et de Santé Publique, INSERM, Sorbonne Université, Paris, France
| | | | - Alain H Litwin
- Department of Medicine, School of Medicine Greenville, University of South Carolina
- Department of Medicine, School of Health Research, Clemson University, Greenville, South Carolina
- Prisma Health—Upstate, Greenville, South Carolina
| | - Pip Marks
- Kirby Institute, University of New South Wales, Australia
| | - Gail V Matthews
- Kirby Institute, University of New South Wales, Australia
- Department of Infectious Diseases, St Vincent’s Hospital, Sydney, Australia
| | - Sophie Quiene
- Kirby Institute, University of New South Wales, Australia
| | - Amanda Erratt
- Kirby Institute, University of New South Wales, Australia
| | - Julie Bruneau
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Canada
- Research Centre, Centre Hospitalier de l’Université de Montréal, Canada
| | - Jason Grebely
- Kirby Institute, University of New South Wales, Australia
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Binka M, Janjua NZ, Grebely J, Estes C, Schanzer D, Kwon JA, Shoukry NH, Kwong JC, Razavi H, Feld JJ, Krajden M. Assessment of Treatment Strategies to Achieve Hepatitis C Elimination in Canada Using a Validated Model. JAMA Netw Open 2020; 3:e204192. [PMID: 32374397 PMCID: PMC7203608 DOI: 10.1001/jamanetworkopen.2020.4192] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/04/2020] [Indexed: 12/19/2022] Open
Abstract
Importance Achievement of the World Health Organization (WHO) target of eliminating hepatitis C virus (HCV) by 2030 will require an increase in key services, including harm reduction, HCV screening, and HCV treatment initiatives in member countries. These data are not available for Canada but are important for informing a national HCV elimination strategy. Objective To use a decision analytical model to explore the association of different treatment strategies with HCV epidemiology and HCV-associated mortality in Canada and to assess the levels of service increase needed to meet the WHO elimination targets by 2030. Design, Setting, and Participants Study participants in this decision analytical model included individuals with hepatitis C virus infection in Canada. Five HCV treatment scenarios (optimistic, very aggressive, aggressive, gradual decrease, and rapid decrease) were applied using a previously validated Markov-type mathematical model. The optimistic and very aggressive treatment scenarios modeled a sustained annual treatment of 10 200 persons and 14 000 persons, respectively, from 2018 to 2030. The aggressive, gradual decrease, and rapid decrease scenarios assessed decreases in treatment uptake from 14 000 persons to 10 000 persons per year, 12 000 persons to 8500 persons per year, and 12 000 persons to 4500 persons per year, respectively, between 2018 and 2030. Main Outcomes and Measures Hepatitis C virus prevalence and HCV-associated health outcomes were assessed for each of the 5 treatment scenarios with the goal of identifying strategies to achieve HCV elimination by 2030. Results An estimated mean 180 142 persons (95% CI, 122 786-196 862 persons) in Canada had chronic HCV infection at the end of 2017. The optimistic and gradual decrease scenarios estimated a decrease in HCV prevalence from 180 142 persons to 37 246 persons and 37 721 persons, respectively, by 2030. Relative to 2015, this decrease in HCV prevalence was associated with 74%, 69%, and 69% reductions in the prevalence of decompensated cirrhosis, hepatocellular carcinoma, and liver-associated mortality, respectively, leading to HCV elimination by 2030. More aggressive treatment uptake (very aggressive scenario) could result in goal achievement up to 3 years earlier than 2030, although a rapid decrease in the initiation of treatment (rapid decrease scenario) would preclude Canada from reaching the HCV elimination goal by 2030. Conclusions and Relevance The study findings suggest that Canada could meet the WHO goals for HCV elimination by 2030 by sustaining the current national HCV treatment rate during the next decade. This target will not be achieved if treatment uptake is allowed to decrease rapidly.
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Affiliation(s)
- Mawuena Binka
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Naveed Z. Janjua
- British Columbia Centre for Disease Control, Vancouver, Canada
- Canadian Network on Hepatitis C, Montreal, Quebec, Canada
- University of British Columbia, Vancouver, Canada
| | - Jason Grebely
- Canadian Network on Hepatitis C, Montreal, Quebec, Canada
- Kirby Institute, University of New South Wales Sydney, Sydney, Australia
| | - Chris Estes
- Center for Disease Analysis, Lafayette, Colorado
| | - Dena Schanzer
- Canadian Network on Hepatitis C, Montreal, Quebec, Canada
| | - Jisoo A. Kwon
- Kirby Institute, University of New South Wales Sydney, Sydney, Australia
| | - Naglaa H. Shoukry
- Canadian Network on Hepatitis C, Montreal, Quebec, Canada
- Centre de Recherche du Centre Hospitalier de l’Universite de Montreal, Montreal, Quebec, Canada
| | - Jeffrey C. Kwong
- Canadian Network on Hepatitis C, Montreal, Quebec, Canada
- ICES, Toronto, Ontario, Canada
| | - Homie Razavi
- Center for Disease Analysis, Lafayette, Colorado
| | - Jordan J. Feld
- Canadian Network on Hepatitis C, Montreal, Quebec, Canada
- Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, Canada
- Canadian Network on Hepatitis C, Montreal, Quebec, Canada
- University of British Columbia, Vancouver, Canada
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Artenie AA, Minoyan N, Jacka B, Høj S, Jutras-Aswad D, Roy É, Gauvin L, Zang G, Bruneau J. Opioid agonist treatment dosage and patient-perceived dosage adequacy, and risk of hepatitis C infection among people who inject drugs. CMAJ 2020; 191:E462-E468. [PMID: 31036608 DOI: 10.1503/cmaj.181506] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Opioid agonist treatment is considered important in preventing acquisition of hepatitis C virus (HCV) among people who inject drugs; however, the role of dosage in opioid agonist treatment is unclear. We investigated the joint association of prescribed dosage of opioid agonist treatment and patient-perceived dosage adequacy with risk of HCV infection among people who inject drugs. METHODS We followed prospectively people who inject drugs at risk of acquiring HCV infection (who were RNA negative and HCV-antibody negative or positive) in Montréal, Canada (2004-2017). At 6-month, then 3-month intervals, participants were tested for HCV antibodies or RNA, and completed an interviewer-administered behavioural questionnaire, reporting the following: current exposure to opioid agonist treatment (yes/no), prescribed dosage either high (methadone ≥ 60 mg/d or buprenorphine ≥ 16 mg/d) or low, and perceived dosage adequacy (adequate/inadequate). We then assigned participants to 1 of 5 exposure categories: no opioid agonist treatment, high dosage of opioid agonist treatment perceived to be adequate, high dosage perceived to be inadequate, low dosage perceived to be adequate or low dosage perceived to be inadequate. To estimate associations between categories of opioid agonist treatment dosage and incident HCV infection, we conducted Cox regression analyses, adjusting for multiple confounding factors. RESULTS Of 513 participants (median age 35.0 yr, 77.6% male), 168 acquired HCV over 1422.6 person-years of follow-up (incidence 11.8/100 person-years, 95% confidence interval [CI] 10.1-13.7). We observed a gradient in the relative risks of HCV infection across categories of opioid agonist treatment dosage. Compared with people who inject drugs not receiving opioid agonist treatment, adjusted hazard ratios were 0.43 (95% CI 0.23-0.84) for those receiving high dosages perceived to be adequate, 0.61 (95% CI 0.25-1.50) for those receiving high dosages perceived to be inadequate, 1.22 (95% CI 0.74-2.00) for those receiving low dosages perceived to be adequate and 1.94 (95% CI 1.11-3.39) for those receiving low dosages perceived to be inadequate. INTERPRETATION Risk of HCV infection varies considerably according to dosage of opioid agonist treatment and patient-perceived adequacy, with associations indicating both protective and harmful effects relative to no exposure to opioid agonist treatment.
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Affiliation(s)
- Andreea A Artenie
- Department of Social and Preventive Medicine (Artenie, Minoyan, Gauvin), School of Public Health, Université de Montréal; Research Centre (Artenie, Minoyan, Jacka, Høj, Jutras-Aswad, Gauvin, Zang, Bruneau), Centre Hospitalier de l'Université de Montréal; Department of Psychiatry (Jutras-Aswad), Université de Montréal, Montréal, Que.; Addiction Studies and Research Program (Roy), Université de Sherbrooke, Longueuil, Que.; Institut national de santé publique du Québec (Roy); Department of Family and Emergency Medicine (Bruneau), Université de Montréal, Montréal, Que
| | - Nanor Minoyan
- Department of Social and Preventive Medicine (Artenie, Minoyan, Gauvin), School of Public Health, Université de Montréal; Research Centre (Artenie, Minoyan, Jacka, Høj, Jutras-Aswad, Gauvin, Zang, Bruneau), Centre Hospitalier de l'Université de Montréal; Department of Psychiatry (Jutras-Aswad), Université de Montréal, Montréal, Que.; Addiction Studies and Research Program (Roy), Université de Sherbrooke, Longueuil, Que.; Institut national de santé publique du Québec (Roy); Department of Family and Emergency Medicine (Bruneau), Université de Montréal, Montréal, Que
| | - Brendan Jacka
- Department of Social and Preventive Medicine (Artenie, Minoyan, Gauvin), School of Public Health, Université de Montréal; Research Centre (Artenie, Minoyan, Jacka, Høj, Jutras-Aswad, Gauvin, Zang, Bruneau), Centre Hospitalier de l'Université de Montréal; Department of Psychiatry (Jutras-Aswad), Université de Montréal, Montréal, Que.; Addiction Studies and Research Program (Roy), Université de Sherbrooke, Longueuil, Que.; Institut national de santé publique du Québec (Roy); Department of Family and Emergency Medicine (Bruneau), Université de Montréal, Montréal, Que
| | - Stine Høj
- Department of Social and Preventive Medicine (Artenie, Minoyan, Gauvin), School of Public Health, Université de Montréal; Research Centre (Artenie, Minoyan, Jacka, Høj, Jutras-Aswad, Gauvin, Zang, Bruneau), Centre Hospitalier de l'Université de Montréal; Department of Psychiatry (Jutras-Aswad), Université de Montréal, Montréal, Que.; Addiction Studies and Research Program (Roy), Université de Sherbrooke, Longueuil, Que.; Institut national de santé publique du Québec (Roy); Department of Family and Emergency Medicine (Bruneau), Université de Montréal, Montréal, Que
| | - Didier Jutras-Aswad
- Department of Social and Preventive Medicine (Artenie, Minoyan, Gauvin), School of Public Health, Université de Montréal; Research Centre (Artenie, Minoyan, Jacka, Høj, Jutras-Aswad, Gauvin, Zang, Bruneau), Centre Hospitalier de l'Université de Montréal; Department of Psychiatry (Jutras-Aswad), Université de Montréal, Montréal, Que.; Addiction Studies and Research Program (Roy), Université de Sherbrooke, Longueuil, Que.; Institut national de santé publique du Québec (Roy); Department of Family and Emergency Medicine (Bruneau), Université de Montréal, Montréal, Que
| | - Élise Roy
- Department of Social and Preventive Medicine (Artenie, Minoyan, Gauvin), School of Public Health, Université de Montréal; Research Centre (Artenie, Minoyan, Jacka, Høj, Jutras-Aswad, Gauvin, Zang, Bruneau), Centre Hospitalier de l'Université de Montréal; Department of Psychiatry (Jutras-Aswad), Université de Montréal, Montréal, Que.; Addiction Studies and Research Program (Roy), Université de Sherbrooke, Longueuil, Que.; Institut national de santé publique du Québec (Roy); Department of Family and Emergency Medicine (Bruneau), Université de Montréal, Montréal, Que
| | - Lise Gauvin
- Department of Social and Preventive Medicine (Artenie, Minoyan, Gauvin), School of Public Health, Université de Montréal; Research Centre (Artenie, Minoyan, Jacka, Høj, Jutras-Aswad, Gauvin, Zang, Bruneau), Centre Hospitalier de l'Université de Montréal; Department of Psychiatry (Jutras-Aswad), Université de Montréal, Montréal, Que.; Addiction Studies and Research Program (Roy), Université de Sherbrooke, Longueuil, Que.; Institut national de santé publique du Québec (Roy); Department of Family and Emergency Medicine (Bruneau), Université de Montréal, Montréal, Que
| | - Geng Zang
- Department of Social and Preventive Medicine (Artenie, Minoyan, Gauvin), School of Public Health, Université de Montréal; Research Centre (Artenie, Minoyan, Jacka, Høj, Jutras-Aswad, Gauvin, Zang, Bruneau), Centre Hospitalier de l'Université de Montréal; Department of Psychiatry (Jutras-Aswad), Université de Montréal, Montréal, Que.; Addiction Studies and Research Program (Roy), Université de Sherbrooke, Longueuil, Que.; Institut national de santé publique du Québec (Roy); Department of Family and Emergency Medicine (Bruneau), Université de Montréal, Montréal, Que
| | - Julie Bruneau
- Department of Social and Preventive Medicine (Artenie, Minoyan, Gauvin), School of Public Health, Université de Montréal; Research Centre (Artenie, Minoyan, Jacka, Høj, Jutras-Aswad, Gauvin, Zang, Bruneau), Centre Hospitalier de l'Université de Montréal; Department of Psychiatry (Jutras-Aswad), Université de Montréal, Montréal, Que.; Addiction Studies and Research Program (Roy), Université de Sherbrooke, Longueuil, Que.; Institut national de santé publique du Québec (Roy); Department of Family and Emergency Medicine (Bruneau), Université de Montréal, Montréal, Que.
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Jacka B, Roy É, Høj S, Minoyan N, Artenie AA, Zang G, Jutras-Aswad D, Bruneau J. Sexual behaviour as a risk factor for hepatitis C virus infection among people who inject drugs in Montreal, Canada. J Viral Hepat 2019; 26:1413-1422. [PMID: 31433888 DOI: 10.1111/jvh.13194] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/24/2019] [Accepted: 07/26/2019] [Indexed: 01/24/2023]
Abstract
Hepatitis C virus (HCV) acquisition remains high in key risk environments including injection drug use and sex between men. However, few studies examine the independent contribution of sexual behaviour to HCV acquisition among people who inject drugs (PWID). We estimated HCV incidence and examined sexual behaviour as a time-varying predictor of HCV acquisition in a prospective cohort study of PWID in Montreal (2004-2017). Initially, HCV-negative participants completed behavioural questionnaires and HCV antibody testing (6 months until 2011, 3 months thereafter). A time-updating exposure variable (no sex, opposite-sex partner only, ≥1 same-sex partner) was generated for the previous 6/3 months. Time to HCV seroconversion was examined using Cox regression analysis, adjusted for age, unstable housing and incarceration (both past 3 months), and daily, heroin, cocaine and prescription opioid injecting (all past month). Among 440 PWID (baseline: median age 33 years, 18.9% female, 1.4% HIV-positive), 156 participants seroconverted during follow-up (overall incidence rate: 11.9/100 person-years [PY]). Incidence was lowest in the no sex group (8.70 and 2.91 cases/100 PY in males and females, respectively) and highest in the ≥1 same-sex partner group (24.14 and 21.97 cases/100 PY in males and females, respectively). Among males, HCV risk was 47% lower in those reporting no sex compared to ≥1 same-sex partner (adjusted hazard ratio: 0.53, 95% confidence interval: 0.28, 0.99). In this cohort of PWID, reporting recent same-sex partners was associated with greater risk of HCV acquisition among males, necessitating targeted harm reduction strategies that consider the complex interplay of sexual and injecting risk behaviours.
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Affiliation(s)
- Brendan Jacka
- Research Centre, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Élise Roy
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada.,Direction des Risques Biologiques et de la Santé au Travail, Institut National de Santé Publique du Québec, Montréal, QC, Canada
| | - Stine Høj
- Research Centre, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Nanor Minoyan
- Research Centre, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada.,Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, QC, Canada
| | - Andreea Adelina Artenie
- Research Centre, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada.,Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, QC, Canada
| | - Geng Zang
- Research Centre, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Didier Jutras-Aswad
- Research Centre, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada.,Department of Psychiatry and Addiction, Université de Montréal, Montréal, QC, Canada
| | - Julie Bruneau
- Research Centre, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada.,Department of Family and Emergency Medicine, Université de Montréal, Montréal, QC, Canada
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