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Aronowitz SV, Carroll JJ, Hansen H, Jauffret-Roustide M, Parker CM, Suhail-Sindhu S, Albizu-Garcia C, Alegria M, Arrendondo J, Baldacchino A, Bluthenthal R, Bourgois P, Burraway J, Chen JS, Ekhtiari H, Elkhoy H, Farhoudian A, Friedman J, Jordan A, Kato L, Knight K, Martinez C, McNeil R, Murray H, Namirembe S, Radfar R, Roe L, Sarang A, Scherz C, Tay Wee Teck J, Textor L, Thi Hai Oanh K. Substance use policy and practice in the COVID-19 pandemic: Learning from early pandemic responses through internationally comparative field data. Glob Public Health 2022; 17:3654-3669. [PMID: 36692903 DOI: 10.1080/17441692.2022.2129720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The COVID-19 pandemic has created an unprecedented natural experiment in drug policy, treatment delivery, and harm reduction strategies by exposing wide variation in public health infrastructures and social safety nets around the world. Using qualitative data including ethnographic methods, questionnaires, and semi-structured interviews with people who use drugs (PWUD) and Delphi-method with experts from field sites spanning 13 different countries, this paper compares national responses to substance use during the first wave of the COVID-19 pandemic. Field data was collected by the Substance Use x COVID-19 (SU x COVID) Data Collaborative, an international network of social scientists, public health scientists, and community health practitioners convened to identify and contextualise health service delivery models and social protections that influence the health and wellbeing of PWUD during COVID-19. Findings suggest that countries with stronger social welfare systems pre-COVID introduced durable interventions targeting structural drivers of health. Countries with fragmented social service infrastructures implemented temporary initiatives for PWUD led by non-governmental organisations. The paper summarises the most successful early pandemic responses seen across countries and ends by calling for greater systemic investments in social protections for PWUD, diversion away from criminal-legal systems toward health interventions, and integrated harm reduction, treatment and recovery supports for PWUD.
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Affiliation(s)
- Shoshana V Aronowitz
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, United States
| | - Jennifer J Carroll
- Department of Anthropology, North Carolina State University, Raleigh, United States
| | - Helena Hansen
- UCLA Center for Social Medicine and Humanities, University of California Los Angeles, Los Angeles, United States
| | - Marie Jauffret-Roustide
- Centre d'étude des mouvements sociaux (Inserm U12/76/CNRS UMR 8044/EHESS), Paris, France.,Baldy Center for Law and Social Policy, Buffalo University of Social Science, NY, USA
| | - Caroline Mary Parker
- The University of Manchester, Manchester University, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Selena Suhail-Sindhu
- University of California Los Angeles, UCLA Center for Social Medicine and Humanities, Los Angeles, United States
| | - Carmen Albizu-Garcia
- Universidad de Puerto Rico, Graduate School of Public Health, San Juan, Puerto Rico
| | - Margarita Alegria
- Massachusetts General Hospital, Disparities Research Unit, Boston, United States
| | - Jaimie Arrendondo
- Center for Research and Economic Teaching, Drug Policy Program, Aguascalientes, MX, Mexico
| | - Alexander Baldacchino
- Medicine, University of St Andrews, St Andrews, United Kingdom of Great Britain and Northern Ireland
| | - Ricky Bluthenthal
- Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, United States
| | - Philippe Bourgois
- Center for Social Medicine and Humanities, University of California Los Angeles, Los Angeles, United States
| | - Joshua Burraway
- Institute for Advanced Studies, University of Virginia, Charlottesville, United States
| | - Jia-Shin Chen
- Institute of Science, Technology and Society, National Yang-Ming University, Hsinchu, Taiwan
| | - Hamed Ekhtiari
- Laureate Institute for Brain Research, The University of Oklahoma, Norman, United States
| | - Hussien Elkhoy
- Neurology and Psychiatry, Ain Shams University, Cairo, Egypt
| | - Ali Farhoudian
- University of Social Welfare and Rehabilitation Sciences, Substance Abuse and Dependence Research Center, Tehran, Iran (the Islamic Republic of)
| | - Joseph Friedman
- David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, United States
| | - Ayana Jordan
- Psychiary, Yale University, New Haven, United States
| | - Lindsey Kato
- Centers for Disease Control and Prevention, Overdose Response Strategy, Atlanta, United States
| | - Kelly Knight
- Humanities and Social Sciences, University of California San Francisco, San Francisco, United States
| | - Carlos Martinez
- Medical Anthropology, University of California at Berkeley, Berkeley, USA
| | - Ryan McNeil
- Addiction Medicine, Yale University, New Haven, United States
| | - Hayley Murray
- Anthropology, Universiteit van Amsterdam, Amsterdam, Netherlands
| | | | - Ramin Radfar
- Isfahan University of Medical Sciences, Thought, Culture and Health Institute, Isfahan, Iran (the Islamic Republic of)
| | - Laura Roe
- Social Anthropology, University of St Andrews, St Andrews, United Kingdom of Great Britain and Northern Ireland
| | - Anya Sarang
- Andrey Rylkov Foundation for Health and Social Justice, President, RU, Moscow, Russian Federation
| | - China Scherz
- Anthropology, University of Virginia, Charlottesville, United States
| | - Joe Tay Wee Teck
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom of Great Britain and Northern Ireland
| | - Lauren Textor
- David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, United States
| | - Khuat Thi Hai Oanh
- Center for Supporting Community Development Initiatives, Executive Director, Hanoi, VN, Vietnam
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Wei LC, Chan HY. Relationship between choice of opioid agonist therapy and distance from patients' residences in Taiwan, 2012-2014. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2021; 47:590-598. [PMID: 34402338 DOI: 10.1080/00952990.2021.1955896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Choice of opioid agonist therapy (OAT) for opioid use disorder (OUD) can be impacted by variables such as age, sex, and socioeconomic status. However, it remains unknown whether accessibility of treatment affects patient choice of OAT. OBJECTIVES To investigate the association between distance to the treatment site and choice of OAT. METHODS Electronic records were collected for the last outpatient visits of individuals with OUD between January 1, 2012 and December 31, 2014. The address of each patient was processed using the Geographic Information System to obtain the distance between place of residence and the hospital. Multivariate logistic regression was used to assess the correlation between individual drug selection and distance of residence. Among the study population of 2804 patients (81.5% male), 74.1% were receiving methadone while 25.8% were receiving buprenorphine. The vast majority (95%) of all patients lived within 50 km of the hospital, so regression analysis was limited to this distance. Sensitivity analysis was estimated using robust Poisson regression. RESULTS Logistic regression revealed that every 1-km increase in distance from home to hospital increased the odds ratio of choosing sublingual buprenorphine tablets over methadone by 1.05 (p = .02, 95% confidence interval (CI) = 1.02-1.08). CONCLUSIONS Patients living closer to the treatment center were more likely to choose methadone as treatment, while patients living farther away were more likely to choose sublingual buprenorphine tablets. To mitigate the influence of travel distance on therapy choice, we recommend that more medical institutions participate in OAT services.
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Affiliation(s)
- Lien-Chung Wei
- Department of Addiction Psychiatry, Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan, Taiwan.,Department of Counseling and Industrial/Organizational Psychology, Ming-Chuan University, Taoyuan, Taiwan.,Division of Epidemiology, School of Public Health, UC Berkeley, Berkeley, CA, USA
| | - Hung-Yu Chan
- Department of General Psychiatry, Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan, Taiwan.,Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
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Lai HH, Kuo YC, Kuo CJ, Lai YJ, Chen M, Chen YT, Chen CC, Yen MY, Hu BS, Wang TH, Wang CC, Kuo LL, Yen TF, Chuang PH, Yen YF. Methamphetamine Use Associated with Non-adherence to Antiretroviral Treatment in Men Who Have Sex with Men. Sci Rep 2020; 10:7131. [PMID: 32346081 PMCID: PMC7188802 DOI: 10.1038/s41598-020-64069-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 04/09/2020] [Indexed: 01/19/2023] Open
Abstract
Methamphetamine is a prevalent recreational drug among men who have sex with men (MSM) living with HIV and could cause the cognitive impairment and memory loss. However, studies on the association between methamphetamine use and adherence to antiretroviral treatment (ART) are limited and had inconsistent findings. This study aimed to determine the impact of methamphetamine use on adherence to ART among MSM living with HIV. From December 2018 to October 2019, MSM living with HIV were recruited (N = 351) and non-adherence to ART was defined as a Medication Adherence Report Scale score of <23. Overall, 16.0% of the participants reported methamphetamine use in the prior three months and 13.4% of the participants had non-adherence to ART. The proportion of non-adherence to ART among HIV-positive MSM were 28.6% and 10.5% with and without methamphetamine use, respectively. After controlling for demographics, illicit drug use, and co-morbidities, methamphetamine use during the prior three months was associated with a higher risk of non-adherence to ART (adjusted odds ratio = 3.08; 95% confidence intervals: 1.24-7.69). Compared with HIV-positive MSM with non-adherence to ART, HIV-positive MSM with good adherence to ART had a higher CD4 counts and were more likely to achieve an undetectable viral load. Since poor adherence to ART is associated with an increased HIV viral load and the risk of HIV transmission to others, our study suggests that it is imperative to screen HIV-positive patients for methamphetamine use and to provide effective therapy to reduce methamphetamine use and the associated non-adherence to ART.
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Affiliation(s)
- Hsin-Hao Lai
- Section of Infectious Diseases, Taipei City Hospital, Yangming Branch, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yen-Chun Kuo
- Department of Psychiatry, Taipei City Hospital, Linsen, Chinese Medicine, and Kunming Branch, Taipei, Taiwan
| | - Chian-Jue Kuo
- Taipei City Psychiatric Centre, Taipei City Hospital, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yun-Ju Lai
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, Nantou, Taiwan.,Department of Exercise Health Science, National Taiwan University of Sport, Taichung, Taiwan
| | - Marcelo Chen
- Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Cosmetic Applications and Management, Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Yi-Tui Chen
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chu-Chieh Chen
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Muh-Yong Yen
- Section of Infectious Diseases, Taipei City Hospital, Yangming Branch, Taipei, Taiwan.,Section of Infectious Diseases, Taipei City Hospital, Taipei, Taiwan
| | - Bor-Shen Hu
- Section of Infectious Diseases, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan
| | - Teng-Ho Wang
- Section of Infectious Diseases, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan
| | - Chien Chun Wang
- Section of Infectious Diseases, Taipei City Hospital, Linsen, Chinese Medicine, and Kunming Branch, Taipei, Taiwan
| | - Li-Lan Kuo
- Department of Nursing, Taipei City Hospital, Linsen, Chinese Medicine, and Kunming Branch, Taipei, Taiwan
| | - Tsen-Fang Yen
- Department of Nursing, Taipei City Hospital, Linsen, Chinese Medicine, and Kunming Branch, Taipei, Taiwan
| | - Pei-Hung Chuang
- Taipei Association of Health and Welfare Data Science, Taipei, Taiwan
| | - Yung-Feng Yen
- Section of Infectious Diseases, Taipei City Hospital, Yangming Branch, Taipei, Taiwan. .,Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan. .,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
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Chen J. Therapy without a prescription: buprenorphine/naloxone diversion and the therapeutic assemblage in Taiwan. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:596-609. [PMID: 31837048 PMCID: PMC7079079 DOI: 10.1111/1467-9566.13045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Buprenorphine/naloxone (B/N) therapy is a prescription pharmacotherapy for opioid dependence. For certain health service providers, when B/N escapes supervision and diverts into the hands of people for whom it is unintended, it can pose serious risks even if it may still have therapeutic benefits. The line between therapy and diversion is thus a problematic one. By qualitatively analysing archival review and in-depth interviews, this study uses the concept of a therapeutic assemblage to understand the relationships among government, knowledge, and professionals that surround the regulation of B/N in Taiwan. The therapeutic assemblage is characterised by the partitioning of administration, the loose regulation of prescription, the exclusion of addiction treatment from National Health Insurance (NHI), and the materiality and technicality of therapies. These elements contribute to the therapeutic assemblage's different territorial modes as reflected in the substance schedules that allow for diversion. This is the first grounded work in Asia that empirically examines and theoretically explains the diversion of B/N from an assemblage perspective. It suggests establishing new associations by incorporating addiction treatment into NHI. Lastly, it addresses the analytic purchase of the assemblage approach in unveiling and problematising unintended outcomes of an intervention.
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Affiliation(s)
- Jia‐shin Chen
- Institute of Science, Technology and SocietyNational Yang‐Ming UniversityTaipeiTaiwan
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Lee YL, Lin KY, Cheng CY, Li CW, Yang CJ, Tsai MS, Tang HJ, Lin TY, Wang NC, Lee YC, Lin SP, Huang YS, Sun HY, Zhang JY, Ko WC, Cheng SH, Lee YT, Liu CE, Hung CC. Evolution of hepatitis A virus seroprevalence among HIV-positive adults in Taiwan. PLoS One 2017; 12:e0186338. [PMID: 29036227 PMCID: PMC5643057 DOI: 10.1371/journal.pone.0186338] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 10/01/2017] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The study aimed to describe the seroprevalence of hepatitis A virus (HAV) in HIV-positive adult patients in Taiwan between 2012 and 2016 and to examine the evolution of HAV seroprevalence between 2004-2007 and 2012-2016. METHODS Clinical information and data of anti-HAV antibody results were collected from 2,860 antiretroviral-naïve HIV-positive Taiwanese aged 18 years or older who initiated combination antiretroviral therapy at 11 hospitals around Taiwan between 2012 and 2016 (2012-2016 cohort). A multivariate logistic regression model was applied to identify independent variables associated with HAV seropositivity. Comparisons of HAV seroprevalences and associated clinical characteristics were made between this 2012-2016 cohort and a previous cohort of 1580 HIV-positive patients in 2004-2007 (2004-2007 cohort). RESULTS Of the 2,860 HIV-positive patients between 2012 and 2016, the overall HAV seropositivity rate was 21.2% (605/2860), which was independently associated with an older age (adjusted odds ratio [AOR], per 1-year increase, 1.13; 95% confidence interval [95% CI], 1.11-1.15) and co-infection with hepatitis B virus (AOR 1.44; 95% CI, 1.08-1.93). Residence in southern Taiwan (AOR 0.49; 95% CI, 0.34-0.72) was inversely associated with HAV seropositivity. The overall HAV seroprevalence in the 2012-2016 cohort was significantly lower than that in the 2004-2007 cohort (21.2% vs 60.9%, p<0.01). The decreases of HAV seropositivity rate were observed in nearly every age-matched group, which suggested the cohort effect on HAV seroepidemiology. However, among individuals aged 25 years or younger, the HAV seropositivity rate increased from 3.8% (2/52) in the 2004-2007 cohort to 8.5% (50/587) in the 2012-2016 cohort, with 95.4% (560/587) being MSM in this age group of the latter cohort. CONCLUSIONS HAV seroprevalence has decreased with time among HIV-positive adults in Taiwan. The cohort effect has increased the number of young HIV-positive patients that are susceptible to HAV infection in a country without nationwide childhood vaccination program against HAV.
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Affiliation(s)
- Yu-Lin Lee
- Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Kuan-Yin Lin
- Department of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City, Taiwan
| | - Chien-Yu Cheng
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
- School of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Wen Li
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
- Department of Medicine, National Cheng Kung University Medical College, Tainan, Taiwan
| | - Chia-Jui Yang
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Mao-Song Tsai
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hung-Jen Tang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Department of Health and Nutrition, Chia Nan University of Pharmacy and Sciences, Tainan, Taiwan
| | - Te-Yu Lin
- Department of Internal Medicine, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Ning-Chi Wang
- Department of Internal Medicine, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Yi-Chien Lee
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Shih-Ping Lin
- Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Shan Huang
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Hsin-Yun Sun
- Department of Internal Medicine, National Taiwan University Hospital, and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jun-Yu Zhang
- Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
- Department of Medicine, National Cheng Kung University Medical College, Tainan, Taiwan
| | - Shu-Hsing Cheng
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
- School of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Yuan-Ti Lee
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- * E-mail: (CEL); (YTL)
| | - Chun-Eng Liu
- Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
- * E-mail: (CEL); (YTL)
| | - Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital, and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan
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