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Bose DL, Hundal A, Singh S, Singh S, Seth K, Hadi SU, Saran A, Joseph J, Goyal K, Salve S. Evidence and gap map report: Social and Behavior Change Communication (SBCC) interventions for strengthening HIV prevention and research among adolescent girls and young women (AGYW) in low- and middle-income countries (LMICs). CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1297. [PMID: 36911864 PMCID: PMC9831290 DOI: 10.1002/cl2.1297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Adolescent girls and young women (AGYW), aged 15-24 years, are disproportionately affected by HIV and other sexual and reproductive health (SRH) risks due to varying social, cultural, and economic factors that affect their choices and shape their knowledge, understanding, and practices with regard to their health. Socio-Behavioral Change Communication (SBCC) interventions targeted at strengthening the capabilities of individuals and their networks have supported the demand and uptake of prevention services and participation in biomedical research. However, despite growing global recognition of the domain, high-quality evidence on the effectiveness of SBCC remains scattered. This evidence and gap map (EGM) report characterizes the evidence base on SBCC interventions for strengthening HIV Prevention and Research among AGYW in low- and middle-income countries (LMICs), identifying evidence gaps and outlining the scope of future research and program design. OBJECTIVES The objectives of the proposed EGM are to: (a) identify and map existing EGMs in the use of diverse SBCC strategies to strengthen the adoption of HIV prevention measures and participation in research among AGYW in LMICs and (b) identify areas where more interventions and evidence are needed to inform the design of future SBCC strategies and programs for AGYW engagement in HIV prevention and research. METHODS This EGM is based on a comprehensive search of systematic reviews and impact evaluations corresponding to a range of interventions and outcomes-aimed at engaging AGYW in HIV prevention and research - that were published in LMICs from January 2000 to April 2021. Based on guidance for producing a Campbell Collaboration EGM, the intervention and outcome framework was designed in consultation with a group of experts. These interventions were categorized across four broad intervention themes: mass-media, community-based, interpersonal, and Information Communication and Technology (ICT)/Digital Media-based interventions. They were further sub-categorized into 15 intervention categories. Included studies looked at 23 unique behavioral and health outcomes such as knowledge attitude and skills, relationship dynamics, household dynamics, health care services, and health outcomes and research engagement. The EGM is presented as a matrix in which the rows are intervention categories/sub-categories, and the columns are outcome domains/subdomains. Each cell is mapped to an intervention targeted at outcomes. Additional filters like region, country, study design, age group, funding agency, influencers, population group, publication status, study confidence, setting, and year of publication have been added. SELECTION CRITERIA To be eligible, studies must have tested the effectiveness of SBCC interventions at engaging AGYW in LMICs in HIV prevention and research. The study sample must have consisted of AGYW between the ages of 15-24, as defined by UNAIDS. Both experimental (random assignment) and quasi-experimental studies that included a comparison group were eligible. Relevant outcomes included those at the individual, influencer, and institutional levels, along with those targeting research engagement and prevention-related outcomes. RESULTS This EGM comprises 415 impact evaluations and 43 systematic reviews. Interventions like peer-led interactions, counseling, and community dialogues were the most dominant intervention sub-types. Despite increased digital penetration use of media and technology-driven interventions are relatively less studied. Most of the interventions were delivered by peers, health care providers, and educators, largely in school-based settings, and in many cases are part of sex-education curricula. Evidence across geographies was mostly concentrated in Sub-Saharan Africa (70%). Most measured outcomes focused on disease-related knowledge dissemination and enhancing awareness of available prevention options/strategies. These included messaging around consistent condom use, limiting sexual partners, routine testing, and awareness. Very few studies were able to include psychographic, social, and contextual factors influencing AGYW health behaviors and decisions, especially those measuring the impact of social and gender norms, relationship dynamics, and household dynamics-related outcomes. Outcomes related to engagement in the research were least studied. CONCLUSION This EGM highlights that evidence is heavily concentrated within the awareness-intent spectrum of behavior change and gets lean for outcomes situated within the intent-action and the action-habit formation spectrum of the behavior change continuum. Most of the evidence was concentrated on increasing awareness, knowledge, and building risk perception around SRH domains, however, fewer studies focused on strengthening the agency and self-efficacy of individuals. Similarly, evidence on extrinsic factors-such as strengthening social and community norms, relationships, and household dynamics-that determine individual thought and action such as negotiation and life skills were also found to be less populated. Few studies explore the effectiveness of these interventions across diverse AGYW identities, like pregnant women and new mothers, sex workers, and people living with HIV, leading to limited understanding of the use of these interventions across multiple user segments including key influencers such as young men, partners, families, religious leaders, and community elders was relatively low. There is a need for better quality evidence that accounts for the diversity of experiences within these populations to understand what interventions work, for whom, and toward what outcome. Further, the evidence for use of digital and mass-media tools remains poorly populated. Given the increasing penetration of these tools and growing media literacy on one end, with widening gender-based gaps on the other, it is imperative to gather more high-quality evidence on their effectiveness. Timely evidence generation can help leverage these platforms appropriately and enable intervention designs that are responsive to changing communication ecologies of AGYW. SBCC can play a critical role in helping researchers meaningfully engage and collaborate with communities as equal stakeholders, however, this remains poorly evidenced and calls for investigation and investment. A full list of abbreviations and acronyms are available in Supporting Information: Appendix F.
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Lawlor C, Gogia M, Kirtadze I, Stvilia K, Jikia G, Zurashvili T. Hidden populations: risk behaviours in drug-using populations in the Republic of Georgia through subsequent peer-driven interventions. Harm Reduct J 2021; 18:78. [PMID: 34321004 PMCID: PMC8320034 DOI: 10.1186/s12954-021-00527-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/21/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Georgia has a significant risk of ongoing HIV and HCV outbreak. Within this context, harm reduction aims to reduce risk associated with drug use through community activities, such as peer recruitment and involvement. The aim of this study was to identify significant differences between known and hidden populations, and attest to the ongoing utility of peer-driven intervention across multiple years in recruiting high-risk, vulnerable populations through peer networks. It was hypothesised that significant differences would remain between known, and previously unknown, members of the drug-using community, and that peer-driven intervention would recruit individuals with high-risk, vulnerable individuals with significant differences to the known population. METHODS Sampling occurred across 9 months in 11 cities in Georgia, recruiting a total of 2807 drug-using individuals. Standardised questionnaires were completed for all consenting and eligible participants, noting degree of involvement in harm reduction activities. These data underwent analysis to identify statistically significant different between those known and unknown to harm reduction activities, including in demographics, knowledge and risk behaviours. RESULTS Peer recruitment was able to attract a significantly different cohort compared to those already known to harm reduction services. Peer-driven intervention was able to recruit a younger population by design, with 25.1% of PDI participants being under 25, compared to 3.2% of NSP participants. PDI successfully recruited women by design, with 6.9% of PDI participants being women compared to 2.0% in the NSP sample. Important differences in drug use, behaviour and risk were seen between the two groups, with the peer-recruited cohort undertaking higher-risk injecting behaviours. A mixture of risk differences was seen across different subgroups and between the known and unknown population. Overall risk, driven by sex risk, was consistently higher in younger people (0.59 vs 0.57, p = 0.00). Recent overdose was associated with higher risk in all risk categories. Regression showed age and location as important variables in overall risk. Peer-recruited individuals reported much lower rates of previous HIV testing (34.2% vs 99.5%, p = 0.00). HIV knowledge and status were not significantly different. CONCLUSIONS Significant differences were seen between the known and unknown drug-using populations, and between previous and current research, speaking to the dynamic change of the drug-using culture. The recruitment strategy was successful in recruiting females and younger people. This is especially important, given that this sampling followed subsequent rounds of peer-driven intervention, implying the ability of peer-assisted recruitment to consistently reach hidden, unknown populations of the drug-using community, who have different risks and behaviours. Risk differences were seen compared to previous samples, lending strength to the peer-recruitment model, but also informing how harm reduction programmes should cater services, such as education, to different cohorts.
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Affiliation(s)
- Cale Lawlor
- The Georgian Harm Reduction Network, Tbilisi, Georgia
| | - Marine Gogia
- The Georgian Harm Reduction Network, Tbilisi, Georgia.
| | | | - Keti Stvilia
- National Centre for Disease Control and Prevention, Tbilisi, Georgia
| | - Guranda Jikia
- The Georgian Harm Reduction Network, Tbilisi, Georgia
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Satinsky EN, Kleinman MB, Tralka HM, Jack HE, Myers B, Magidson JF. Peer-delivered services for substance use in low- and middle-income countries: A systematic review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 95:103252. [PMID: 33892281 DOI: 10.1016/j.drugpo.2021.103252] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 03/02/2021] [Accepted: 03/29/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND AIMS Addressing the burden of disease associated with substance use is a global priority, yet access to treatment is limited, particularly in low- and middle-income countries (LMICs). Peers, individuals with lived experience of substance use, may play an important role in expanding access to treatment, supporting outcomes, and reducing stigma. While peer-delivered services for substance use have been scaling up in high-income countries (HICs), less is known about their application in LMICs. This systematic review synthesizes the evidence of peer-delivered services for substance use in LMICs. METHODS PsycINFO, Embase, Global Health, PubMed, and six region-specific databases were searched, and articles that described peer-delivered services for substance use and related outcomes in LMICs were included. Risk of bias was evaluated using tools appropriate for each study design. To provide a more stringent evaluation of structured interventions, a subset of articles was analyzed using the Cochrane Effective Practice and Organization of Care (EPOC) framework. RESULTS The search yielded 6540 articles. These were narrowed down to 34 included articles. Articles spanned four continents, included quantitative and qualitative methodologies, and primarily targeted infectious disease risk behaviors. Ten articles were included in the EPOC sub-analysis. In the context of high risk of bias, some of these articles demonstrated positive impacts of the peer-delivered services, including reductions in risk behaviors and increases in infectious disease knowledge scores, while many others showed no significant difference in outcomes between peer intervention and control groups. CONCLUSIONS Peer-delivered services may be feasible for addressing substance use and reducing infectious disease risk behaviors in LMICs, where there are severe human resource shortages. Globally, peers' lived experience is valuable for engaging patients in substance use treatment and harm reduction services. Further research is needed to better characterize and quantify outcomes for peer-delivered services for substance use in LMICs.
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Affiliation(s)
- Emily N Satinsky
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA; Department of Psychology, University of Maryland, College Park, MD, USA.
| | - Mary B Kleinman
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Hannah M Tralka
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Helen E Jack
- Department of Medicine, University of Washington, Seattle, WA, USA; Centre for Global Mental Health, King's College London, London, UK
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South Africa Medical Research Council, Cape Town, South Africa; Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
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Chang J, Shelly S, Busz M, Stoicescu C, Iryawan AR, Madybaeva D, de Boer Y, Guise A. Peer driven or driven peers? A rapid review of peer involvement of people who use drugs in HIV and harm reduction services in low- and middle-income countries. Harm Reduct J 2021; 18:15. [PMID: 33536033 PMCID: PMC7857348 DOI: 10.1186/s12954-021-00461-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/05/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction Peer involvement of people who use drugs within HIV and harm reduction services is widely promoted yet under-utilised. Alongside political and financial barriers is a limited understanding of the roles, impacts, contexts and mechanisms for peer involvement, particularly in low- and middle-income settings. We conducted a rapid review of available literature on this topic. Methods Within a community-academic partnership, we used a rapid review approach, framed by realist theory. We used a network search strategy, focused on core journals and reference lists of related reviews. Twenty-nine studies were included. We developed thematic summaries framed by a realist approach of exploring interventions, their mechanisms, outcomes and how they are shaped by contexts. Results Reported outcomes of peer involvement included reduced HIV incidence and prevalence; increased service access, acceptability and quality; changed risk behaviours; and reduced stigma and discrimination. Mechanisms via which these roles work were trust, personal commitment and empathy, using community knowledge and experience, as well as ‘bridge’ and ‘role model’ processes. Contexts of criminalisation, under-resourced health systems, and stigma and discrimination were found to shape these roles, their mechanisms and outcomes. Though contexts and mechanisms are little explored within the literature, we identified a common theme across contexts, mechanisms and outcomes. Peer outreach interventions work through trust, community knowledge and expertise, and ‘bridge’ mechanisms (M) to counter criminalisation and constraining clinic and service delivery environments (C), contributing towards changed drug-using behaviours, increased access, acceptability and quality of harm reduction services and decreased stigma and discrimination (O). Conclusion Peer involvement in HIV and harm reduction services in low- and middle-income settings is linked to positive health outcomes, shaped by contexts of criminalisation, stigma, and resource scarcity. However, peer involvement is under-theorised, particularly on how contexts shape mechanisms and ultimately outcomes. Efforts to study peer involvement need to develop theory and methods to evaluate the complex mechanisms and contexts that have influence. Finally, there is a need to expand the range of peer roles, to embrace the capacities and expertise of people who use drugs.
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Affiliation(s)
- Judy Chang
- International Network of People Who Use Drugs, INPUD Secretariat, Unit 2C09, South Bank Technopark, 90 London Road, London, SE1 6LN, UK.
| | - Shaun Shelly
- South African Network of People Who Use Drugs; University of Pretoria, Cape Town, South Africa
| | | | - Claudia Stoicescu
- School of Social Work, Columbia University, New York, USA.,HIV/AIDS Research Centre, Atma Jaya University, Jakarta, Indonesia
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Gogia M, Lawlor C, Shengelia N, Stvilia K, Raymond HF. Hidden populations: discovering the differences between the known and the unknown drug using populations in the Republic of Georgia. Harm Reduct J 2019; 16:15. [PMID: 30755222 PMCID: PMC6373035 DOI: 10.1186/s12954-019-0287-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/01/2019] [Indexed: 11/10/2022] Open
Abstract
Background The HIV epidemic in Georgia is increasing. Data shows that compared to previous years, Georgia has increasingly more HIV-infected individuals than previous assessments. Select client groups remain hard to reach by harm reduction programs. The need for innovative strategies to involve these individuals is imperative. Methods The following study examines demographics and risk factors of participants, previously known and not known to harm reduction services, for HIV and other infectious disease in towns across Georgia in 2015 and compares risk among different groups, while also assessing the rationale for implementing Peer-Driven Interventions in Georgian Harm Reduction activities. Important differences in demographics and risk profile are thought to exist between those exposed, and those unexposed, to harm reduction activity. Results Important and striking differences between previously known and unknown participants, including demographic background and risk profile and behaviours exist in the drug using community. These differences can potentially explain some of the rise of HIV prevalence in Georgia. Conclusion Significant differences exist between known and unknown drug users in Georgia, the differences between which are crucial for planning future and holistic harm reduction activities in Georgia, regionally and globally. The research advocates for smarter harm reduction activity, adds to the global evidence for the utility of Peer-Driven Intervention, and encourages sustained global effort for reduction of blood-borne disease burden globally.
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Affiliation(s)
- M Gogia
- The Georgian Harm Reduction Network, Tbilisi, Georgia.
| | - C Lawlor
- The Georgian Harm Reduction Network, Tbilisi, Georgia
| | - N Shengelia
- Curatio International Foundation, Tbilisi, Georgia
| | - K Stvilia
- The National Centre for Disease Control and Public Health, Tbilisi, Georgia
| | - H F Raymond
- School of Public Health, Rutgers University, New Brunswick, NJ, USA
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Noroozi M, Marshall BDL, Noroozi A, Armoon B, Sharifi H, Farhoudian A, Ghiasvand H, Vameghi M, Rezaei O, Sayadnasiri M, Pouya RH. Do needle and syringe programs reduce risky behaviours among people who inject drugs in Kermanshah City, Iran? A coarsened exact matching approach. Drug Alcohol Rev 2017; 37 Suppl 1:S303-S308. [DOI: 10.1111/dar.12646] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 11/21/2017] [Accepted: 11/23/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Mehdi Noroozi
- Social Determinants of Health Research Center; University of Social Welfare and Rehabilitation Sciences; Tehran Iran
| | | | - Alireza Noroozi
- Iranian National Center for Addiction Studies; Tehran University of Medical Sciences; Tehran Iran
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine; Tehran University of Medical Sciences; Tehran Iran
| | - Bahram Armoon
- Student Research Committee, School of Health; Shahid Beheshti University of Medical Sciences; Tehran Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center and WHO Collaborating Center for HIV Surveillance; Institute for Futures Studies in Health, Kerman University of Medical Sciences; Kerman Iran
| | - Ali Farhoudian
- Substance Abuse and Dependence Research Center; University of Social Welfare and Rehabilitation Sciences; Tehran Iran
| | - Hesam Ghiasvand
- Social Determinants of Health Research Center; University of Social Welfare and Rehabilitation Sciences; Tehran Iran
| | - Meroe Vameghi
- Social Welfare Management Research Center; University of Social Welfare and Rehabilitation Sciences; Tehran Iran
| | - Omid Rezaei
- Psychosis Research Center, Department of Psychiatry; University of Social Welfare and Rehabilitation Sciences; Tehran Iran
| | - Mohammad Sayadnasiri
- Psychosis Research Center, Department of Psychiatry; University of Social Welfare and Rehabilitation Sciences; Tehran Iran
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Alexander J, Edwards RA, Savoldelli A, Manca L, Grugni R, Emir B, Whalen E, Watt S, Brodsky M, Parsons B. Integrating data from randomized controlled trials and observational studies to predict the response to pregabalin in patients with painful diabetic peripheral neuropathy. BMC Med Res Methodol 2017; 17:113. [PMID: 28728577 PMCID: PMC5520324 DOI: 10.1186/s12874-017-0389-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 07/10/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND More patient-specific medical care is expected as more is learned about variations in patient responses to medical treatments. Analytical tools enable insights by linking treatment responses from different types of studies, such as randomized controlled trials (RCTs) and observational studies. Given the importance of evidence from both types of studies, our goal was to integrate these types of data into a single predictive platform to help predict response to pregabalin in individual patients with painful diabetic peripheral neuropathy (pDPN). METHODS We utilized three pivotal RCTs of pregabalin (398 North American patients) and the largest observational study of pregabalin (3159 German patients). We implemented a hierarchical cluster analysis to identify patient clusters in the Observational Study to which RCT patients could be matched using the coarsened exact matching (CEM) technique, thereby creating a matched dataset. We then developed autoregressive moving average models (ARMAXs) to estimate weekly pain scores for pregabalin-treated patients in each cluster in the matched dataset using the maximum likelihood method. Finally, we validated ARMAX models using Observational Study patients who had not matched with RCT patients, using t tests between observed and predicted pain scores. RESULTS Cluster analysis yielded six clusters (287-777 patients each) with the following clustering variables: gender, age, pDPN duration, body mass index, depression history, pregabalin monotherapy, prior gabapentin use, baseline pain score, and baseline sleep interference. CEM yielded 1528 unique patients in the matched dataset. The reduction in global imbalance scores for the clusters after adding the RCT patients (ranging from 6 to 63% depending on the cluster) demonstrated that the process reduced the bias of covariates in five of the six clusters. ARMAX models of pain score performed well (R 2 : 0.85-0.91; root mean square errors: 0.53-0.57). t tests did not show differences between observed and predicted pain scores in the 1955 patients who had not matched with RCT patients. CONCLUSION The combination of cluster analyses, CEM, and ARMAX modeling enabled strong predictive capabilities with respect to pain scores. Integrating RCT and Observational Study data using CEM enabled effective use of Observational Study data to predict patient responses.
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Affiliation(s)
- Joe Alexander
- Pfizer Inc, 235 E 42nd St, New York, NY, 10017, USA.
| | - Roger A Edwards
- Health Services Consulting Corporation, 169 Summer Road, Boxborough, MA, 01719, USA
| | | | - Luigi Manca
- Fair Dynamics Consulting, srl, Via Carlo Farini, 5, 20154, Milan, Italy
| | - Roberto Grugni
- Fair Dynamics Consulting, srl, Via Carlo Farini, 5, 20154, Milan, Italy
| | - Birol Emir
- Pfizer Inc, 235 E 42nd St, New York, NY, 10017, USA
| | - Ed Whalen
- Pfizer Inc, Eastern Point Rd, Groton, CT, 06340, USA
| | - Stephen Watt
- Pfizer Inc, 235 E 42nd St, New York, NY, 10017, USA
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Rezaie F, Farhadi MH, Farhoudian A, Najafi M, Bazrafshan A, Higgs P, Mohammadi Shahboulagh F, Ranjbar M, Vameghi M, Abbasi M, Noroozi A, Noroozi M. Access to needle and syringe programs and the relationship to equipment sharing among people who inject drugs in Kermanshah, Iran. JOURNAL OF SUBSTANCE USE 2016. [DOI: 10.1080/14659891.2016.1227384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Fatemeh Rezaie
- Department of Social Medicine, Jahrom University of Medical Science, Jahrom, Iran
| | - Mohammad Hassan Farhadi
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ali Farhoudian
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Najafi
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ali Bazrafshan
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Peter Higgs
- Department of Public Health, La Trobe University, Melbourne, Australia
| | - Farahnaz Mohammadi Shahboulagh
- Social Determinants of Health Research Center, Nursing Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Maryam Ranjbar
- Social Determinants of Health Research Center, Nursing Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Meroe Vameghi
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Abbasi
- Department of Nursing and Midwifery, Qom University of Medical Science, Qom, Iran
| | - Alireza Noroozi
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehdi Noroozi
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Noroozi A, Mirzazadeh A, Farhoudian A, Hajebi A, Khankeh HR, Higgs P, Sharifi H, Armoon B, Noroozi M. Impact of HIV Status Notification on Risk Behaviors among Men Who Inject Drugs in Kermanshah, West of Iran. J Res Health Sci 2016; 16:116-121. [PMID: 27840338 PMCID: PMC7191024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 08/13/2016] [Accepted: 08/22/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND It is unclear whether knowing of current HIV status is associated with change in injecting behaviors among people who inject drugs (PWID) in Iran. The objective of the present study was to determine whether awareness of HIV positive status is associated with a reduction in injecting risk behaviors, after matching for socio-demographic characteristics. METHODS Five hundred male PWID were recruited in 2014 from two drop-in centers (DICs) in Kermanshah west of Iran. Trained interviewers collected data on socio-demographic characteristics, HIV testing and drug-related risk behaviors over the last month prior to interview using a structured questionnaire. Our primary exposure of interest was awareness of HIV status, used to group participants into three categories: positive, negative, unaware. We used coarsened exact matching to make the three groups statistically equivalent based on age, place of residence, education and income, and then compared them regarding the proportion of borrowing, lending and reuse of syringes. RESULTS Matched sample (n=320) had a mean age ± standard deviation (SD) of 33.5 ±7.6 yr. Overall, 25% (95% CI: 14%, 32%) of participants reported "borrowing a syringe" in the past month and 15% (95% CI: 7%, 22%) of them reported "lending a used syringe" to others in the past month. In comparison to PWID who were unaware of their HIV status, those knew they were HIV positive (OR 1.68, CI95%1.32-2.81) or negative (OR 1.54; 95% CI: 1.28, 2.71) were both more likely to report borrowing syringes in past month. CONCLUSIONS PWID WHO know they are positive for HIV are more likely to borrow another person's syringe, to report reuse of their own used syringes and less likely to report lending their syringes to others. Strategies to scale up HIV testing and counseling for PWID, which also increase awareness of HIV status, may decrease injecting related the risk behaviors.
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Affiliation(s)
- Alireza Noroozi
- a Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Mirzazadeh
- b Department of Epidemiology and Biostatics, University of California, San Francisco, CA, USA
,c HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Farhoudian
- d Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ahmad Hajebi
- e Addiction and High Risk Behavior Research Center, Tehran Institute of Psychiatry, Faculty of Behavioral Sciences and Mental Health, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Hamid Reza Khankeh
- f Research Center in Emergency and Disaster Health, University of Social Welfare and Rehabilitation, Tehran, Iran
,g Department of Clinical Sciences and Education, Karolinska Institute, Stockholm, Sweden
| | - Peter Higgs
- h Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Hamid Sharifi
- c HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Bahram Armoon
- i Student’s Research Committee, School of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Noroozi
- d Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
,Correspondence Mehdi Noroozi (PhD) Tel: +98 21 44856494
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Gutwinski S, Schoofs N, Stuke H, Riemer TG, Wiers CE, Bermpohl F. Opioid tolerance in methadone maintenance treatment: comparison of methadone and levomethadone in long-term treatment. Harm Reduct J 2016; 13:7. [PMID: 26879120 PMCID: PMC4754801 DOI: 10.1186/s12954-016-0095-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 02/04/2016] [Indexed: 12/05/2022] Open
Abstract
Background This study aimed to investigate the development of opioid tolerance in patients receiving long-term methadone maintenance treatment (MMT). Methods A region-wide cross-sectional study was performed focusing on dosage and duration of treatment. Differences between racemic methadone and levomethadone were examined. All 20 psychiatric hospitals and all 110 outpatient clinics in Berlin licensed to offer MMT were approached in order to reach patients under MMT fulfilling the DSM IV criteria of opiate dependence. In the study, 720 patients treated with racemic methadone or levomethadone gave information on the dosage of treatment. Out of these, 679 patients indicated the duration of MMT. Results Treatment with racemic methadone was reported for 370 patients (54.5 %), with levomethadone for 309 patients (45.5 %). Mean duration of MMT was 7.5 years. We found a significant correlation between dosage and duration of treatment, both in a conjoint analysis for the two substances racemic methadone and levomethadone and for each substance separately. These effects remained significant when only patients receiving MMT for 1 year or longer were considered, indicating proceeding tolerance development in long-term treatment. When correlations were compared between racemic methadone and levomethadone, no significant difference was found. Conclusions Our data show a tolerance development under long-term treatment with both racemic methadone and levomethadone. Tolerance development did not differ significantly between the two substances.
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Affiliation(s)
- Stefan Gutwinski
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Nikola Schoofs
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Heiner Stuke
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Thomas G Riemer
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Corinde E Wiers
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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11
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Abstract
Persons who inject drugs (PWID) are at high risk for infection with and poor outcomes from HIV and hepatitis C virus (HCV). Well-established interventions for HIV/HCV prevention among PWID include syringe access, opioid agonist maintenance treatment, and supervised injection facilities, yet these interventions remain unavailable or inadequately resourced in much of the world. We review recent literature on biomedical and behavioral interventions to reduce the burden of HIV/HCV among PWID, with an emphasis on randomized controlled trials and quasi-experimental studies. Since 2013, there have been significant advancements in utilizing antiviral therapy and behavioral interventions for prevention among PWID, including approaches that address the unique needs of couples and sex workers. In addition, there have been significant developments in pharmacotherapies for substance use and the implementation of naloxone for opioid overdose prevention. Notwithstanding multiple ongoing structural challenges in delivering HIV/HCV prevention interventions to PWID, these emerging and rigorously evaluated interventions expand possibilities for prevention among PWID.
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12
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Zhang XD, Kelly-Hanku A, Chai JJ, Luo J, Temmerman M, Luchters S. Sexual and reproductive health risks amongst female adolescents who use amphetamine-type stimulants and sell sex: a qualitative inquiry in Yunnan, China. Harm Reduct J 2015; 12:34. [PMID: 26472221 PMCID: PMC4608054 DOI: 10.1186/s12954-015-0065-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 09/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND China, as other Southeast Asian countries, has witnessed an increased use in amphetamine-type stimulants (ATS) amongst urban youth. Amongst female adolescents who both sell sex and use ATS, risk behaviours are compounded resulting in even poorer health outcomes. However, limited knowledge exists on ATS use patterns and ATS-related risk behaviours, particularly in this context. This research aimed to improve the understanding of these issues amongst female adolescents who use ATS and sell sex, and to inform future programming. METHOD This study utilised monthly focus group discussions (four in total) with the same study participants in Yunnan, China. From within a drug-treatment programme, female adolescents who reported both a history of drug use and selling sex were purposively enrolled in the study. RESULTS Participating adolescent females were aged 17-19 years and were all internal-migrants with low literacy. All reported polydrug use (mainly methamphetamine and heroin, whereas ecstasy and ketamine have been infrequently employed). Being less informed about risks of drug use and lack of sexual and reproductive health knowledge seemed to contribute to problematic drug use, rough and prolonged sexual intercourse, inconsistent condom use and ineffective contraceptive practice. For their income, participants largely relied on selling sex, which was frequently coupled with drug sharing services to clients. However, despite the practices, women did not self-identify as sex workers, and therefore did not think that existing intervention services targeting female sex workers were relevant to them. Moreover, criminalization and stigmatisation of drug use and selling sex impeded their access to care services. CONCLUSION Current harm reduction and HIV/sexually transmitted infection (STI) prevention services are unlikely to address the demand of female adolescents engaged in drug use and commercial sex. Our findings highlight that a comprehensive and coordinated harm reduction and sexual and reproductive health response should be conducted involving these most vulnerable adolescents.
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Affiliation(s)
- Xu-Dong Zhang
- International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Ghent University, De Pintelaan 185, UZP114, 9000, Ghent, Belgium.
- Centre for International Health, Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Australia.
| | - Angela Kelly-Hanku
- International HIV Research Group, School of Public Health and Community Medicine, UNSW, Sydney, 2052, Australia.
- Sexual & Reproductive Health Unit, Institute of Medical Research, PO Box 60, Goroka, EHP, Papua New Guinea.
| | - Jia-Jia Chai
- City College, Kunming University of Science and Technology, East Ring Road 50, 650051, Kunming, China.
| | - Jian Luo
- Department of Prevention and Education, Yunnan Institute for Drug Abuse, Xi Hu Lu 300, 650228, Kunming, China.
| | - Marleen Temmerman
- International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Ghent University, De Pintelaan 185, UZP114, 9000, Ghent, Belgium.
| | - Stanley Luchters
- International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Ghent University, De Pintelaan 185, UZP114, 9000, Ghent, Belgium.
- Centre for International Health, Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Australia.
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Commercial Rd, Melbourne, Victoria, 3004, Australia.
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13
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Minghui R, Scano F, Sozi C, Schwartländer B. The Global Fund in China: success beyond the numbers. LANCET GLOBAL HEALTH 2015; 3:e75-7. [PMID: 25617197 PMCID: PMC7128703 DOI: 10.1016/s2214-109x(14)70366-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Ren Minghui
- Department of International Cooperation, National Health and Family Planning Commission, Beijing, China
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14
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Hatzakis A, Sypsa V, Paraskevis D, Nikolopoulos G, Tsiara C, Micha K, Panopoulos A, Malliori M, Psichogiou M, Pharris A, Wiessing L, van de Laar M, Donoghoe M, Heckathorn DD, Friedman SR, Des Jarlais DC. Design and baseline findings of a large-scale rapid response to an HIV outbreak in people who inject drugs in Athens, Greece: the ARISTOTLE programme. Addiction 2015; 110:1453-67. [PMID: 26032121 PMCID: PMC4854521 DOI: 10.1111/add.12999] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 01/30/2015] [Accepted: 05/26/2015] [Indexed: 11/28/2022]
Abstract
AIMS To (i) describe an intervention implemented in response to the HIV-1 outbreak among people who inject drugs (PWIDs) in Greece (ARISTOTLE programme), (ii) assess its success in identifying and testing this population and (iii) describe socio-demographic characteristics, risk behaviours and access to treatment/prevention, estimate HIV prevalence and identify risk factors, as assessed at the first participation of PWIDs. DESIGN A 'seek, test, treat, retain' intervention employing five rounds of respondent-driven sampling. SETTING Athens, Greece (2012-13). PARTICIPANTS A total of 3320 individuals who had injected drugs in the past 12 months. INTERVENTION ARISTOTLE is an intervention that involves reaching out to high-risk, hard-to-reach PWIDs ('seek'), engaging them in HIV testing and providing information and materials to prevent HIV ('test') and initiating and maintaining anti-retroviral and opioid substitution treatment for those testing positive ('treat' and 'retain'). MEASUREMENTS Blood samples were collected for HIV testing and personal interviews were conducted. FINDINGS ARISTOTLE recruited 3320 PWIDs during the course of 13.5 months. More than half (54%) participated in multiple rounds, resulting in 7113 visits. HIV prevalence was 15.1%. At their first contact with the programme, 12.5% were on opioid substitution treatment programmes and the median number of free syringes they had received in the preceding month was 0. In the multivariable analysis, apart from injection-related variables, homelessness was a risk factor for HIV infection in male PWIDs [odds ratio (OR) yes versus no = 1.89, 95% confidence interval (CI) = 1.41, 2.52] while, in female PWIDS, the number of sexual partners (OR for > 5 versus one partner in the past year = 4.12, 95% CI = 1.93, 8.77) and history of imprisonment (OR yes versus no = 2.76, 95% CI = 1.43, 5.31) were associated with HIV. CONCLUSIONS In Athens, Greece, the ARISTOTLE intervention for identifying HIV-positive people among people who inject drugs (PWID) facilitated rapid identification of a hidden population experiencing an outbreak and provided HIV testing, counselling and linkage to care. According to ARISTOTLE data, the 2011 HIV outbreak in Athens resulted in 15% HIV infection among PWID. Risk factors for HIV among PWID included homelessness in men and history of imprisonment and number of sexual partners in women.
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Affiliation(s)
- Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece
| | - Georgios Nikolopoulos
- IAS/NIDA Fellow, Hellenic Center for Diseases Prevention and Control, Athens, Greece
| | - Chrissa Tsiara
- Hellenic Centre for Diseases Control and Prevention, Athens, Greece
| | | | | | - Meni Malliori
- Medical School, University of Athens, Athens, Greece
| | - Mina Psichogiou
- Department of Propedeutic Medicine, Medical School, University of Athens, Athens, Greece
| | - Anastasia Pharris
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Lucas Wiessing
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | | | - Martin Donoghoe
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
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15
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Wheeler J, Anfinson K, Valvert D, Lungo S. Is violence associated with increased risk behavior among MSM? Evidence from a population-based survey conducted across nine cities in Central America. Glob Health Action 2014; 7:24814. [PMID: 25361722 PMCID: PMC4212078 DOI: 10.3402/gha.v7.24814] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 09/04/2014] [Accepted: 09/07/2014] [Indexed: 01/11/2023] Open
Abstract
Background/Objective There is a dearth of research examining the linkages between violence and HIV risk behavior among men who have sex with men (MSM), including those who identify as transgender women (TW), particularly in Central America where violence is widespread. In this paper, we use population-based survey results to independently examine the correlations between physical, emotional and sexual violence and HIV risk behavior among MSM populations in five countries in Central America. Design As part of USAID's Combination Prevention for HIV program in Central America, PASMO conducted population based surveys using respondent-driven sampling (RDS) in nine cities in Guatemala, El Salvador, Nicaragua, Costa Rica, and Panama. Initial seeds were recruited using the following criteria: individuals who represented subgroups of MSM by self-identification (homosexual vs. heterosexual or bisexual vs. transgender), social economic strata, and by sex work practices. This study examines the association between violence and 1) HIV risk behaviors relevant to the study populations; 2) protective behaviors; and 3) reported STIs. Individualized RDS estimator weights for each outcome variable were calculated using RDSAT software, and logistic regression analysis was used to determine associations between different forms of violence and the outcome variables. Results MSM who experienced physical violence were more likely to be engaged in transactional sex (OR: 1.76 [1.42–2.18]), have multiple partners in the past 30 days (OR: 1.37 [1.09–1.71]), and have engaged in sex under the influence of alcohol or drugs (OR: 1.51 [1.24–1.83]). Both physical violence and psychological/verbal violence were also associated with reporting STI symptoms or diagnosis within the past 12 months (OR: 1.72 [1.34–2.21] and 1.80 [1.45–2.23]). The effects of violence on the outcomes were observed after controlling for other risk factors. Transgender women were 3.9 times more likely to report engaging in transactional sex. Respondents who were heterosexual, bisexual, or transgender were also more likely to both report multiple partnerships (OR: 1.44 [1.07–1.96], 1.99 [1.67–2.38], 1.79 [1.37–2.33], respectively) and more likely to report engaging in sex under the influence of alcohol or drugs (OR: 1.52 [1.15–2.01], 1.38 [1.17–1.63], 1.47 [1.16–1.87], respectively), as compared to those identifying as homosexual. Conclusion Violence experienced by MSM and TW is widespread in Central America. The experience of violence is shown in this study to be independently associated with risk behaviors for HIV infections. Further research and studies are needed to identify the effects violence has on HIV risk behavior among this under-researched population to improve targeted HIV prevention interventions.
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Affiliation(s)
| | | | | | - Susana Lungo
- Association PASMO, Guatemala City, Central America
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