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Glancy M, Yeung A, McAuley A, Palmateer N, Bishop J, Taylor B, Lang J, Barnsdale L, Priyadarshi S, Hutchinson S. Factors associated with SARS-CoV-2 testing, diagnosis and COVID-19 disease among individuals prescribed opioid-agonist treatment: a nationwide retrospective cohort study. Clin Microbiol Infect 2024; 30:1312-1318. [PMID: 38936544 DOI: 10.1016/j.cmi.2024.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 06/03/2024] [Accepted: 06/19/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVES Among people receiving opioid-agonist treatment (OAT), the risk of COVID-19 infection and disease may be higher owing to underlying health problems and vulnerable social circumstances. We aimed to determine whether recent OAT, when compared with past exposure, affected the risk of (i) testing for SARS-CoV-2, (ii) testing positive for SARS-CoV-2, and (iii) being hospitalized or dying with COVID-19 disease. METHODS We included individuals prescribed OAT in Scotland from 2015 to 2020. We performed record linkage to SARS-CoV-2 PCR testing, vaccination, hospitalization, and mortality data, and followed up from March 2020 to December 2021. We used proportional hazards analysis and multivariate logistic regression to estimate associations between recent OAT prescription (in the previous 2 months), compared with past exposure (off treatment for over a year), and COVID-19 outcomes. Models were adjusted for confounders. RESULTS Among 36 093 individuals prescribed OAT, 19 071 (52.9%) were tested for SARS-CoV-2; 2896 (8.3%) tested positive; and 552 (1.5%) were hospitalized or died with COVID-19. Recent OAT, compared with past exposure, was associated with lower odds of testing positive among those tested (aOR, 0.63; 95% CI, 0.57-0.69). However, among those testing positive, recent OAT was associated with two-fold higher odds of hospitalization or death (aOR, 2.04; 95% CI, 1.60-2.59). DISCUSSION We found that recent OAT was associated with lower odds of SARS-CoV-2 infection, but with higher odds of disease once diagnosed. Clinical studies are needed to unravel the role of OAT in these associations. An enhanced effort is warranted to increase vaccine coverage among OAT patients to mitigate the severe consequences of COVID-19.
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Affiliation(s)
- Megan Glancy
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Glasgow, UK.
| | - Alan Yeung
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Glasgow, UK
| | - Andrew McAuley
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Glasgow, UK
| | - Norah Palmateer
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Glasgow, UK
| | | | | | | | | | - Saket Priyadarshi
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Glasgow Alcohol and Drug Recovery Services, Glasgow, UK
| | - Sharon Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Glasgow, UK
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Wüsthoff LEC, Lund-Johansen F, Henriksen K, Wildendahl G, Jacobsen JA, Gomes L, Anjum HS, Barlinn R, Kran AMB, Munthe LA, Vaage JT. Seroprevalence of SARS-CoV-2 and humoral immune responses to COVID-19 mRNA vaccines among people who use drugs - in the light of tailored mitigating strategies. Harm Reduct J 2024; 21:120. [PMID: 38890611 PMCID: PMC11186241 DOI: 10.1186/s12954-024-01023-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/14/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND During the initial wave of the COVID-19 pandemic, there was a surprisingly low incidence of SARS-CoV-2 among People Who Use Drugs (PWUD) in Oslo, Norway, despite their heightened vulnerability regarding risk of infection and severe courses of the disease.This study aims to investigate the seroprevalence of SARS-CoV-2 antibodies among PWUD, their antibody responses to relevant virus infections and COVID-19 mRNA vaccines, and their vaccination coverage compared to the general population. METHODS Conducted as a prospective cohort study, data was collected from residents in six institutions for homeless PWUD and users of a low-threshold clinic for opioid agonist treatment. Ninety-seven participants were recruited for SARS-CoV-2 seroprevalence analysis. Additional two participants with known positive SARS-CoV-2 test results were recruited for further analyses. Twenty-five participants completed follow-up. Data included questionnaires, nasal swabs and blood samples. Data on vaccination coverage was obtained from the National Vaccine Register. Serologic methods included detection of antibodies to relevant virus proteins, neutralizing antibodies to SARS-CoV-2, antibodies to the full-length spike protein, and receptor-binding domain from SARS-CoV-2. RESULTS Among PWUD, antibodies to SARS-CoV-2 were detected in 2 out of 97 samples before vaccines against SARS-CoV-2 were available, comparable to a 2.8% frequency in population-based screening. Levels of serum antibodies to seasonal coronaviruses and Epstein-Barr-Virus (EBV) in PWUD were similar to population-based levels. After the second vaccine dose, binding and neutralizing antibody levels to SARS-CoV-2 in PWUD were comparable to controls. Eighty-four of PWUD received at least one dose of COVID-19 mRNA vaccine, compared to 89% in the general population. CONCLUSION Results indicate that PWUD did not exhibit increased SARS-CoV-2 seroprevalence or elevated serum antibodies to seasonal coronaviruses and EBV. Moreover, vaccine responses in PWUD were comparable to controls, suggesting that vaccination is effective in conferring protection against SARS-CoV-2 also in this population.
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Affiliation(s)
- Linda Elise Couëssurel Wüsthoff
- Unit for Clinical Research on Addictions, Oslo University Hospital, PO Box 4959 Nydalen, Oslo, 0424, Norway.
- Norwegian Centre for Addiction Reasearch, Institute of Clinical Medicine, University of Oslo, PO Box 1039 Blindern, Oslo, 0315, Norway.
| | - Fridtjof Lund-Johansen
- Department of Immunology, Oslo University Hospital, PO Box 4950 Nydalen, Oslo, 0424, Norway
- ImmunoLingo Convergence Center, Institute of Clinical Medicine, University of Oslo, Gaustadalleen 21, Oslo, 0349, Norway
- Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, Oslo, 0318, Norway
- Precision Immunotherapy Alliance, Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, 0318, Oslo, Norway
| | - Kathleen Henriksen
- Agency for Social and Welfare Services, Oslo Municipality, PO Box 30 Sentrum, Oslo, 0101, Norway
- Student Health Services, Student Welfare Services in Oslo, Problemveien 9, Oslo, 0313, Norway
| | - Gull Wildendahl
- Agency for Social and Welfare Services, Oslo Municipality, PO Box 30 Sentrum, Oslo, 0101, Norway
| | - Jon-Aksel Jacobsen
- Agency for Social and Welfare Services, Oslo Municipality, PO Box 30 Sentrum, Oslo, 0101, Norway
| | - Leni Gomes
- Agency for Social and Welfare Services, Oslo Municipality, PO Box 30 Sentrum, Oslo, 0101, Norway
| | - Hina Sarwar Anjum
- Agency for Social and Welfare Services, Oslo Municipality, PO Box 30 Sentrum, Oslo, 0101, Norway
| | - Regine Barlinn
- Department of Microbiology, Oslo University Hospital, PO Box 4950 Nydalen, Oslo, 0424, Norway
| | - Anne-Marte Bakken Kran
- Division of Infection Control, Norwegian Institute of Public Health, PO Box 222 Skøyen, Oslo, 0213, Norway
| | - Ludvig Andre Munthe
- Department of Immunology, Oslo University Hospital, PO Box 4950 Nydalen, Oslo, 0424, Norway
- KG Jebsen Centre for B cell Malignancies, and Precision Immunotherapy Alliance, Institute of Clinical Medicine, University of Oslo, PO Box 4950 Nydalen, Oslo, 0424, Norway
| | - John T Vaage
- Department of Immunology, Oslo University Hospital, PO Box 4950 Nydalen, Oslo, 0424, Norway
- Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, Oslo, 0318, Norway
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3
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Rivera Saldana CD, Abramovitz D, Beletsky L, Borquez A, Kiene S, Marquez LK, Patton T, Strathdee S, Zúñiga ML, Martin NK, Cepeda J. Estimating the impact of a police education program on hepatitis C virus transmission and disease burden among people who inject drugs in Tijuana, Mexico: A dynamic modeling analysis. Addiction 2023; 118:1763-1774. [PMID: 37039246 PMCID: PMC10524658 DOI: 10.1111/add.16203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 03/23/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND AND AIMS Criminalization of drug use and punitive policing are key structural drivers of hepatitis C virus (HCV) risk among people who inject drugs (PWID). A police education program (Proyecto Escudo) delivering training on occupational safety together with drug law content was implemented between 2015 and 2016 in Tijuana, Mexico, to underpin drug law reform implementation. We used data from a longitudinal cohort of PWID in Tijuana to inform epidemic modeling and assess the long-term impact of Escudo on HCV transmission and burden among PWID in Tijuana. METHODS We developed a dynamic, compartmental model of HCV transmission and incarceration among PWID and tracked liver disease progression among current and former PWID. The model was calibrated to data from Tijuana, Mexico, with 90% HCV seroprevalence. We used segmented regression analysis to estimate impact of Escudo on recent incarceration among an observational cohort of PWID. By simulating the observed incarceration trends, we estimated the potential impact of the implemented (2-year reduction in incarceration) and an extended (10-year reduction in incarceration) police education program over a 50-year follow-up (2016-2066) on HCV outcomes (incidence, cirrhosis, HCV-related deaths and disability adjusted life-years averted) compared with no intervention. RESULTS Over the 2-year follow-up, Proyecto Escudo reduced HCV incidence among PWID from 21.5 per 100 person years (/100py) (95% uncertainty interval [UI] = 15.3-29.7/100py) in 2016 to 21.1/100py (UI = 15.0-29.1/100py) in 2018. If continued for 10 years, Escudo could reduce HCV incidence to 20.0/100py (14.0-27.8/100py) by 2026 and avert 186 (32-389) new infections, 76 (UI = 12-160) cases of cirrhosis and 32 (5-73) deaths per 10 000 PWID compared with no intervention over a 50-year time horizon. CONCLUSIONS In Tijuana, Mexico, implementation of a police education program delivering training on occupational safety and drug law content appears to have reduced hepatitis C virus incidence among people who inject drugs.
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Affiliation(s)
- Carlos D Rivera Saldana
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, USA
- School of Public Health, San Diego State University, San Diego, California, USA
| | - Daniela Abramovitz
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Leo Beletsky
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, USA
- School of Law and Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Annick Borquez
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Susan Kiene
- School of Public Health, San Diego State University, San Diego, California, USA
| | - Lara K Marquez
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Thomas Patton
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Steffanie Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - María Luisa Zúñiga
- School of Social Work, San Diego State University, San Diego, California, USA
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, USA
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Javier Cepeda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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4
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Patel EU, Mehta SH, Genberg BL, Baker OR, Schluth CG, Astemborski J, Fernandez RE, Quinn TC, Kirk GD, Laeyendecker O. Prevalence and correlates of SARS-CoV-2 seropositivity among people who inject drugs in Baltimore, Maryland. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 8:100184. [PMID: 37637232 PMCID: PMC10450408 DOI: 10.1016/j.dadr.2023.100184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/29/2023]
Abstract
Background SARS-CoV-2 serosurveys can help characterize disparities in SARS-CoV-2 infection and identify gaps in population immunity. Data on SARS-CoV-2 seroprevalence among people who inject drugs (PWID) are limited. Methods We conducted a cross-sectional study between December 2020 and July 2022 among 561 participants in the AIDS Linked to the IntraVenous Experience (ALIVE) study-a community-based cohort of current and former PWID in Baltimore, Maryland. Serum samples were assayed for infection-induced anti-nucleocapsid (anti-N) and infection and/or vaccination-induced anti-spike-1 (anti-S) SARS-CoV-2 IgG. We estimated adjusted prevalence ratios (aPR) via modified Poisson regression models. Results The median age was 59 years, 35% were female, 84% were non-Hispanic Black, and 16% reported recent injection drug use. Anti-N antibody prevalence was 26% and anti-S antibody prevalence was 63%. Anti-N and anti-S antibody prevalence increased over time. Being employed (aPR=1.53 [95%CI=1.11-2.11]) was associated with higher anti-N prevalence, while a cancer history (aPR=0.40 [95%CI=0.17-0.90]) was associated with lower anti-N prevalence. HIV infection was associated with higher anti-S prevalence (aPR=1.13 [95%CI=1.02-1.27]), while younger age and experiencing homelessness (aPR=0.78 [95%CI=0.60-0.99]) were factors associated with lower anti-S prevalence. Substance use-related behaviors were not significantly associated with anti-N or anti-S prevalence. Conclusions SARS-CoV-2 seroprevalence increased over time among current and former PWID, suggesting cumulative increases in the incidence of SARS-CoV-2 infection and vaccination; however, there were disparities in infection-induced seroprevalence and infection and/or vaccine-induced seroprevalence within this study sample. Dedicated prevention and vaccination programs are needed to prevent disparities in infection and gaps in population immunity among PWID during emerging epidemics.
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Affiliation(s)
- Eshan U. Patel
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Shruti H. Mehta
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Becky L. Genberg
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Owen R. Baker
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Catherine G. Schluth
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Jacquie Astemborski
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Reinaldo E. Fernandez
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thomas C. Quinn
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Baltimore, MD, USA
| | - Gregory D. Kirk
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Oliver Laeyendecker
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Baltimore, MD, USA
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5
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Gunn J, O'Keefe D, Draper BL, Djordjevic F, Ryan K, Kerr P, Elsum I, Gold J, Layton C, Chan K, Dietze P, Higgs P, Doyle J, Stoové MA, Hellard M, Pedrana A. The eliminate hepatitis C (EC) experience study: baseline characteristics of a cohort of people who inject drugs in Melbourne, Australia. BMJ Open 2023; 13:e071665. [PMID: 37400235 PMCID: PMC10335404 DOI: 10.1136/bmjopen-2023-071665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 06/15/2023] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVES Direct-acting antivirals provide an opportunity to eliminate hepatitis C virus (HCV) as a public health threat in Australia, yet barriers to care remain. In this study, we use baseline data from a longitudinal cohort of people who inject drugs to understand differences in participant characteristics and explore experiences of stigma, health service utilisation and health literacy between three care cascade groups. DESIGN Cross-sectional. SETTING Community and private primary healthcare services in Melbourne, Australia. PARTICIPANTS Participants completed baseline surveys between 19 September 2018 and 15 December 2020. We recruited 288 participants; the median age was 42 years (IQR: 37-49 years) and 198 (69%) were male. At baseline, 103 (36%) self-reported being 'not engaged in testing', 127 (44%) had HCV RNA positivity but were 'not engaged in treatment' and 58 (20%) were 'engaged in HCV treatment'. OUTCOME MEASURES Descriptive statistics were used to present the baseline demographics, health service utilisation and experiences of stigma data. We explored differences in these scales between participant demographics using χ2 test or fisher's exact tests, and differences between health literacy scores using one-way analysis of variance tests. RESULTS A majority were in regular contact with multiple health services, and most had previously been identified as at-risk of HCV. In the 12 months preceding baseline, 70% reported any experiences of stigma related to injecting drug use. Assessment of health literacy data identified gaps for those 'not engaged in testing' and 'not engaged in treatment' across two relevant domains: 'ability to appraise health information' and 'ability to actively engage with healthcare providers'. CONCLUSION In eliminate hepatitis C experience, lower HCV testing and treatment may be explained by experiences of stigmatisation or gaps in health literacy. Enhanced interventions targeting people who inject drugs to promote HCV care are needed.
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Affiliation(s)
- Jack Gunn
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Daniel O'Keefe
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Bridget Louise Draper
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Filip Djordjevic
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Kathleen Ryan
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Phoebe Kerr
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Imogen Elsum
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Judy Gold
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Chloe Layton
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Kico Chan
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Paul Dietze
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Peter Higgs
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Victoria, Australia
- Department of Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Joseph Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Mark A Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, Australia
- Doherty Institute and Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Alisa Pedrana
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
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6
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Turner R, Barrett D, Petersson F, Kåberg M. Legal Minors Who Inject: Differences in Socio-Demographics and Treatment Needs Compared to Adults in a Swedish National Sample of People with Injecting Drug Use. Subst Use Misuse 2023; 58:1473-1482. [PMID: 37358188 DOI: 10.1080/10826084.2023.2223267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
BACKGROUND Injection drug use among legal minors is under-researched. Although the population may be small in absolute terms, treatment needs may be greater than for those who began injecting as adults. Such knowledge may help tailor services more effectively. Previous research tends to use selective samples or focuses solely on medical indicators. The present study uses a larger sample drawn from national register data in Sweden over a 9-year period (2013-2021) to analyze differences in medical and social treatment needs between people who began injecting as legal minors and their older counterparts. METHOD Data on first-time visitors to needle and syringe programmes (n = 8225, mean age 37.6, 26% women) were used. Historical socio-demographics and presenting treatment needs were compared between those with a debut injecting age under 18, and those who began injecting as adults. RESULTS The prevalence of injecting before 18 years was 29%. This group had more negative social circumstances, such as leaving school early, worse health, and greater service consumption, compared to those who began injecting as adults. In particular, they had been subjected to a greater level of control measures, such as arrest and compulsory care. CONCLUSIONS The present study shows that there are important health and social differences between those who inject prior to 18 and those who begin injecting as adults. This raises important questions for both child protection services and harm reduction approaches for legal minors who inject, who still qualify as 'children' in a legal and policy sense.
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Affiliation(s)
- R Turner
- Department of Social Work, University of Gothenburg, Gothenburg, Sweden
| | - D Barrett
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - F Petersson
- Department of Social Work, University of Gothenburg, Gothenburg, Sweden
| | - M Kåberg
- Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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7
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Kågström E, Lannergård A, El Khosht J, Lörelius P, Månflod J, Strömdahl S. Prevalence, risk factors, treatment uptake and treatment outcome of hepatitis C virus in people who inject drugs at the needle and syringe program in Uppsala, Sweden. Harm Reduct J 2023; 20:77. [PMID: 37328868 PMCID: PMC10273738 DOI: 10.1186/s12954-023-00806-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/06/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND The World Health Organization has set a goal to reach world elimination of hepatitis C virus (HCV) by 2030. Needle and syringe programs (NSP) for people who inject drugs (PWID) are crucial to achieve this goal. The NSP in Uppsala, Sweden, was opened in 2016 and has since 2018 provided HCV treatment for PWID. The aim of this study was to investigate HCV prevalence, risk factors and treatment uptake and outcome in NSP participants. METHODS Data from 450 PWID registered at the Uppsala NSP between 2016-11-01 and 2021-12-31 were collected from the national quality registry InfCare NSP. Data from the 101 PWID treated for HCV at the Uppsala NSP were collected through patient journal review. Descriptive and inferential analysis was performed. Ethical approval was obtained from the Ethical Review Board in Uppsala (dnr 2019/00215). RESULTS The mean age was 35 years. 75% were males (336/450), and 25% were females (114/450). The overall HCV prevalence was 48% (215/450) with a declining trend over time. Factors associated with a higher risk of HCV were older age at registration (OR 1.025, 95% CI 1.004-1.046), lower age at injection drug debut (OR 0.963, 95% CI 0.932-0.996), lower education level (OR 1.829, 95% CI 1.185-2.821) and higher number of total visits at the NSP (OR 1.005, 95% CI 1.001-1.009). The overall HCV treatment uptake was 47% (101/215), of which 77% (78/101) completed HCV treatment. The HCV treatment compliance was 88% (78/89). 99% (77/78) were cured with a sustained virologic response 12 weeks after completed treatment. The reinfection rate over the study period was 9/77 (11.7%); all were male with mean age of 36. CONCLUSIONS HCV prevalence, treatment uptake and treatment outcome have improved since the opening of the Uppsala NSP. However, further measures are needed to reach the HCV elimination goal. Outreach HCV treatment programs for PWID should be explored and evaluated in combination with further implementation of low-threshold programs.
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Affiliation(s)
- E Kågström
- Department of Medical Sciences, Infectious Diseases, Uppsala University, Uppsala, Sweden.
| | - A Lannergård
- Department of Medical Sciences, Infectious Diseases, Uppsala University, Uppsala, Sweden
| | - J El Khosht
- Needle and Syringe Program Uppsala, Nära Vård och Hälsa, Region Uppsala, Uppsala, Sweden
| | - P Lörelius
- Needle and Syringe Program Uppsala, Nära Vård och Hälsa, Region Uppsala, Uppsala, Sweden
| | - J Månflod
- Needle and Syringe Program Uppsala, Nära Vård och Hälsa, Region Uppsala, Uppsala, Sweden
| | - S Strömdahl
- Department of Medical Sciences, Infectious Diseases, Uppsala University, Uppsala, Sweden
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8
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Lindqvist K, Thorin Z, Kåberg M. Real-world hepatitis C treatment outcomes and reinfections among people who inject drugs at a needle and syringe program in Stockholm, Sweden. Harm Reduct J 2023; 20:72. [PMID: 37308951 DOI: 10.1186/s12954-023-00801-1] [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: 12/21/2022] [Accepted: 06/03/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND People who inject drugs (PWID) represent a population with an increased prevalence of hepatitis C (HCV) infections. HCV treatment among PWID is essential to reach the WHO goal of eliminating HCV as a major public health threat by 2030. Despite better understanding of PWID subgroups and changes in risk behaviors over time, more knowledge about HCV treatment outcomes in different HCV prevalence populations and settings is warranted to enhance the continuum of care. METHODS All Stockholm Needle and Syringe Program (NSP) participants who initiated HCV treatment between October 2017 and June 2020 were HCV RNA tested at end of treatment and twelve weeks thereafter to confirm cure with a sustained virological response (SVR). All cured participants were prospectively followed from SVR to the last negative HCV RNA test or a subsequent reinfection, until October 31, 2021. RESULTS Overall, 409 NSP participants initiated HCV treatment, 162 at the NSP and 247 in another treatment setting. There were a total of 6.4% treatment dropouts (n = 26), 11.7% among participants treated at the NSP and 2.8% among those treated elsewhere (p < 0.001). Stimulant use (p < 0.05) and not being in an opioid agonist treatment program (p < 0.05) was associated with dropout. More participants treated outside the NSP were lost to follow-up between end of treatment and SVR (p < 0.05). During follow-up post-SVR, 43 reinfections occurred, corresponding to a reinfection rate of 9.3/100 PY (95% CI 7.0, 12.3). Factors associated with reinfection were younger age (p < 0.001), treatment while in prison (p < 0.01) and homelessness (p < 0.05). DISCUSSION In this high HCV prevalence NSP setting, with a majority of stimulant users, treatment success was high and the level of reinfections manageable. To reach HCV elimination, there is a need to target specific PWID subgroups for HCV treatment, in both harm reduction and adjacent healthcare settings frequented by PWID.
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Affiliation(s)
- K Lindqvist
- Stockholm Centre for Dependency Disorders, Stockholm Needle Syringe Program, Stockholm, Sweden
| | - Z Thorin
- Stockholm Centre for Dependency Disorders, Stockholm Needle Syringe Program, Stockholm, Sweden
| | - M Kåberg
- Stockholm Centre for Dependency Disorders, Stockholm Needle Syringe Program, Stockholm, Sweden.
- Department of Global Public Health, Karolinska Institutet, Sprututbytet, S:t Görans Sjukhus, Akutvägen 29, 112 81, Stockholm, Sweden.
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Holmén E, Warnqvist A, Kåberg M. Sweden's first Take-Home Naloxone program: participant characteristics, dose endpoints and predictors for overdose reversals. Subst Abuse Treat Prev Policy 2023; 18:24. [PMID: 37087485 PMCID: PMC10121425 DOI: 10.1186/s13011-023-00533-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 04/04/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Opioid overdoses are a growing concern, particularly among people who inject drugs. Sweden, with a comparatively high proportion of drug-related mortality, introduced its first Take-Home Naloxone (THN) program in 2018, at the Stockholm needle and syringe program (NSP). In this study we compare THN participant characteristics regarding refills and overdose reversals as well as investigate predictors associated with number of reversals. We also investigate interventions performed in overdose situations and endpoints for naloxone doses. METHODS This was a prospective open inclusion cohort study conducted between January 24th 2018 and March 31st 2022 at the Stockholm NSP. Participants received THN, free of charge, after a training session and provided data regarding drug use and overdose experiences. During refill visits, participants reported if the naloxone was used for overdose reversal and, if so, responded to a ten-item questionnaire which included stating whether the naloxone recipient was the participant themselves or somebody else. Questionnaire data was combined with NSP database demographic data. Zero-inflated Poisson regression was applied to analyse predictors for number of reported overdose reversals. RESULTS Among study participants (n = 1,295), 66.5% stated opioids as their primary drug, and 61.4% and 81.0% had previous experience of a personal or witnessed overdose, respectively. Overall, 44.0% of participants reported a total of 1,625 overdose reversals and the victim was known to have survived in 95.6% of cases. Stimulant use (aIRR 1.26; 95% CI 1.01, 1.58), benzodiazepine use (aIRR 1.75; 95% CI 1.1, 2.78) and homelessness (aIRR 1.35; 95% CI 1.06, 1.73) were predictors associated with an increased number of reported overdose reversals. Mortality was higher among those who reported at least one overdose reversal (HR 3.4; 95% CI 2.2, 5.2). CONCLUSIONS An NSP's existent framework can be utilised to effectively implement a THN program, provide basic training and reach numerous high-risk individuals. During the four-year study, THN participants reversed a sizeable number of potentially fatal overdoses, of which many were reported by participants whose primary drug was not opioids. Naloxone refill rate was high, indicating that participants were motivated to maintain a supply of naloxone in case of future overdose events.
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Affiliation(s)
- Elin Holmén
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- Stockholm Needle and Syringe Program, Stockholm Centre for Dependency Disorders, Stockholm, Sweden.
| | - Anna Warnqvist
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Martin Kåberg
- Stockholm Needle and Syringe Program, Stockholm Centre for Dependency Disorders, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Holmén E, Hammarberg A, Kåberg M, Storbjörk J. Take-Home Naloxone and risk management from the perspective of people who survived an opioid overdose in Stockholm - An analysis informed by drug, set and setting. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 115:104021. [PMID: 37011507 DOI: 10.1016/j.drugpo.2023.104021] [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: 10/25/2022] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Take-Home Naloxone (THN) programs were introduced in Sweden in 2018 - a country with one of the highest rates of overdose mortality in the EU and a severe stigmatisation of people who inject drugs. This qualitative study builds on the international research that has expanded a previously narrow and medical focus on overdose deaths. It uses Zinberg's framework to look beyond the role of the "drug" to include the attitudes and personality of the person ("set") and contextual factors ("setting"). This study explores the impacts of THN from the perspective of overdose survivors. METHODS Between November 2021 and May 2022 semi-structured interviews were conducted with 22 opioid overdose survivors, recruited among clients of the Stockholm needle and syringe program. All the participants had been treated with naloxone in an overdose situation. The interviews were processed through thematic analysis using deductive and inductive coding in accordance with the theoretical framework. RESULTS Interviewees included men and women who used different types of drugs. THN has impacted on "drug" in terms of naloxone-induced withdrawal symptoms and peers having to deal with survivors' emotions. Exploring "set" revealed feelings of shame following naloxone revival for the person who overdosed. Despite such reactions, participants retained an overwhelmingly positive attitude towards THN. Participants integrated THN into their risk management practices ("setting") and some acknowledged that THN provided a new way to treat overdoses without necessarily needing to interact with authorities, especially the police. CONCLUSION The THN program has influenced "drug, set and setting" for participants, providing increased safety at drug-intake and transferring overdose management and the burden of care to the community. The lived experience of participants also exposes the limitations of THN indicating that there are additional unmet needs beyond THN programs, particularly in terms of "setting".
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Affiliation(s)
- E Holmén
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Needle and Syringe program, Stockholm Centre for Dependency Disorders, Stockholm, Sweden.
| | - A Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Centre for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - M Kåberg
- Stockholm Needle and Syringe program, Stockholm Centre for Dependency Disorders, Stockholm, Sweden; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - J Storbjörk
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
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11
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Doshi S, Kingston H, Tseng AS, Chohan BH, Sambai B, Guthrie BL, Monroe-Wise A, Mbogo LW, Masyuko S, Tram KH, Sinkele W, Macharia P, Bukusi D, Herbeck JT, Farquhar C. SARS-CoV-2 antibody prevalence, correlates, and access to harm reduction services among people who inject drugs living with and without HIV and their partners in Kenya. Harm Reduct J 2023; 20:21. [PMID: 36823596 PMCID: PMC9947430 DOI: 10.1186/s12954-023-00754-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/09/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND In sub-Saharan Africa many people who inject drugs (PWID) are living with undiagnosed or untreated HIV and experience high levels of poverty and conditions that can contribute to worse outcomes from SARS-CoV-2 infection. Identifying the burden of SARS-CoV-2 infection in marginalized populations like PWID may contribute to controlling the pandemic. METHODS This is a nested cross-sectional study within an ongoing cohort study that recruits PWID living with HIV and their injecting and/or sexual partners at needle and syringe program sites and methadone clinics in Kenya. Blood samples were collected from consenting participants at enrollment to determine SARS-CoV-2 antibodies using a Platellia BioRad SARS-CoV-2 total antibody enzyme-linked immunosorbent assay. Baseline data were collected on HIV status, antiretroviral therapy and methadone adherence. We used logistic regression to identify factors associated with antibody positivity and descriptive statistics to report SARS-CoV-2 antibody prevalence. RESULTS One thousand participants were enrolled between April and July 2021, of whom 323 (32.3%) were women and 677 (67.7%) were men. Median age of participants was 36 years (interquartile range: 30, 42). SARS-CoV-2 antibody positivity was found in 309 (30.9%) participants. Disruption in obtaining methadone service was reported by 106 (24.3%) of the participants. Men were significantly less likely than women to have SARS-CoV-2 antibodies (adjusted odds ratio [aOR] = 0.68, 95% confidence interval [CI] 0.51, 0.95; p < 0.01) Participants who reported a sexual or injecting partner diagnosed with SARS-CoV-2 were twofold more likely to have SARS-CoV-2 antibodies detected (aOR = 2.21, 95% CI 1.06, 4.58; p < 0.032). Living with HIV was not associated with presence of SARS-CoV-2 antibodies. CONCLUSION The seroprevalence of SARS-CoV-2 of 30.9% in this cohort suggests high transmission rates within this population. SARS-CoV-2 seroprevalence was similar for people living with and without HIV. A large portion of this population was noted to have had disruption in access to harm reduction services.
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Affiliation(s)
- Shradha Doshi
- Aga Khan University Hospital, Nairobi, Kenya.
- Department of Global Health, University of Washington, Seattle, WA, USA.
| | - Hanley Kingston
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Ashley S Tseng
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Bhavna H Chohan
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Betsy Sambai
- University of Washington-Global Assistance Programme, Nairobi, Kenya
| | - Brandon L Guthrie
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Aliza Monroe-Wise
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Loice W Mbogo
- University of Washington-Global Assistance Programme, Nairobi, Kenya
| | - Sarah Masyuko
- Department of Global Health, University of Washington, Seattle, WA, USA
- Ministry of Health, Nairobi, Kenya
| | - Khai Hoan Tram
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - William Sinkele
- Support for Addiction Prevention and Treatment in Africa, Nairobi, Kenya
| | - Paul Macharia
- University of Washington-Global Assistance Programme, Nairobi, Kenya
| | | | - Joshua T Herbeck
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Carey Farquhar
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- University of Washington-Global Assistance Programme, Nairobi, Kenya
- Department of Medicine, University of Washington, Seattle, WA, USA
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12
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Torres-Leguizamon M, Favaro J, Coello D, Reynaud EG, Néfau T, Duplessy C. Remote harm reduction services are key solutions to reduce the impact of COVID-19-like crises on people who use drugs: evidence from two independent structures in France and in the USA. Harm Reduct J 2023; 20:1. [PMID: 36611167 PMCID: PMC9823260 DOI: 10.1186/s12954-023-00732-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 01/03/2023] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Harm Reduction (HR) policies for People Who Use Drugs (PWUD) have a significant positive impact on their health. Such approaches limit the spread of infections and reduce opioid overdose mortality. These policies have led to the opening of specialized structures located mainly in big cities and urbanized zones. The COVID-19 pandemic reduced access to HR structures in locations undergoing lockdown. Before the pandemic, HR services in France and in the USA were complemented by the development of remote HR programs: HaRePo (Harm Reduction by Post) for France, implemented in 2011, and NEXT Distro for the USA founded in 2017. These programs are free and specifically designed for people who have difficulties accessing HR tools and counseling in-person. PWUD can access HaRePo program by phone and/or email. NEXT Distro users can access the program through its dedicated website. The aim of the study is to test if and possibly how COVID-19 pandemic and the associated lockdowns have impacted the HR services in both countries. METHODS By using t-test comparing the year 2019 with the year 2020, we analyzed how lockdowns impacted the number of new users entering the programs, as well as the numbers of parcels sent and naloxone distributed, by using records of both structures. RESULTS We showed that the activity of both programs was significantly impacted by the pandemic. Both show an increase in the number of new users joining the programs (+ 77.6% for HaRePo and + 247.7% for NEXT Distro) as well as for the number of parcels sent per month (+ 42.7% for HaRePo and + 211.3% for NEXT Distro). It shows that remote HR was able to partially compensate for the reduced HR activities due to COVID-19. We also observed that the distribution of naloxone per parcel tends to increase for both structures. CONCLUSION With the ability to reach PWUD remotely, HaRePo and NEXT Distro were particularly effective at maintaining service continuity and scaling up services to meet the needs of PWUD during the COVID-19 pandemic. By studying two independent structures in France and in the USA sharing similar objectives (remote HR), we showed that this approach can be a key solution to crises that impact classical HR structures despite various differences in operating procedures between countries.
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Affiliation(s)
| | | | | | - Emmanuel G. Reynaud
- grid.7886.10000 0001 0768 2743School of Biomolecular and Biomedical Science, University College Dublin, Dublin, Ireland
| | - Thomas Néfau
- SAFE, 11 Avenue de la Porte de la Plaine, 75015 Paris, France
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Lessons from the COVID-19 pandemic for substance misuse services: findings from a peer-led study. Harm Reduct J 2022; 19:140. [PMID: 36503439 PMCID: PMC9742020 DOI: 10.1186/s12954-022-00713-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 11/08/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The measures implemented to contain the spread of the COVID-19 virus disrupted the provision of substance misuse treatment and support. However, little is known about the impact of this disruption on individuals seeking treatment for drug- and/or alcohol-related problems (henceforth service users). This study aimed to help substance misuse services learn lessons and identify ways of optimising delivery and minimising harm in the event of any future lockdowns or global crises. METHODS The study was co-produced by a team of peer researchers, practitioners, policymakers and academics. Telephone interviews were conducted with 202 substance misuse service users over a 6-month period commencing June 2020. The interviews were conducted by a small group of seven peer researchers each with lived experience of substance use problems. The interview data were recorded by the peers in an anonymous online questionnaire survey and analysed using standard quantitative and qualitative methods. RESULTS Service users responded to the COVID-19 pandemic in a variety of ways. Diverse responses were noted in relation to their substance use patterns, their personal lives and their substance misuse treatment experiences. For some, the pandemic acted as a new risk environment factor that increased their vulnerability to substance-related harm. For others, it facilitated aspects of the enabling environment, thereby reducing the risk of harm. CONCLUSIONS Service users are not a homogenous group, and an individualised approach to treatment that recognises the potential for varied responses to the same stimuli is needed. The findings suggest that service users would benefit from having a choice in how they access treatment and from greater access to outreach programmes that take treatments and harm reduction tools such as naloxone into the community. The research also supports the involvement of people with lived experience in substance use research, policy and practice.
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Giang HT, Duc NQ, Molès JP, Vinh VH, Nagot N, Thanh NTT, Huong DT, Oanh KTH, Khue PM, Mai LS, Trang NT, Ngoc PT, Quillet C, Feelemyer J, Vallo R, Michel L, Jarlais DD, Laureillard D, Rapoud D. "Maintaining HIV and HCV prevention and care for people who inject drugs despite COVID-19 in Hai Phong, Vietnam". THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 110:103870. [PMID: 36244242 PMCID: PMC9489978 DOI: 10.1016/j.drugpo.2022.103870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/31/2022] [Accepted: 09/15/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND After the emergence of COVID-19, a one-month strict lockdown was imposed in April 2020 in Vietnam, followed by lighter social distancing restrictions over the year. We investigated whether those measures affected people who inject drugs (PWID) in terms of risk behaviors for HIV and HCV and access to prevention and care in the city of Haiphong, a historic hotspot for HIV and drug use. METHODOLOGY We carried out a 'before-after' study from 2019 to 2020 using respondent-driven sampling method to enroll PWID. They were interviewed on their socioeconomic situation, drug use and sexual behaviors, relations to care services and tested for drugs and methadone in the urine, for HIV, HCV, and HIV plasma viral load when HIV-positive. Changes following the restrictions were assessed by comparing 'before' to 'after' data. RESULTS 780 PWID were enrolled. Mean age was 44 years; 94% were male. All were actively injecting heroin 'before', versus 56% 'after'. Among those, frequency of consumption decreased from 24 to 17 days per month. No changes were observed in the frequency and practices of methamphetamine smoking. The proportion of PWID on MMT increased from 68.7% to 75.3%, and that of PWID engaging in risky behaviors related to drug injection decreased from 6.0% to 1.5%. No HIV seroconversions were observed; HCV incidence was 2.6/100 person-years (95% CI [0.7-6.7]). 9% of PWID reported a monthly income of less than 130USD 'before' versus 53% 'after'. CONCLUSION The case of Hai Phong shows that it is possible, during times of COVID-19 pandemic, to maintain access to harm reduction and care and to prevent HIV and HCV transmission among PWID in a resource-limited setting where severe social distancing restrictions are implemented. Further research is needed to assess the consequences of long-term economic difficulties and the impact of actual spread of SARS-Cov2 that has since emerged in Haiphong.
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Affiliation(s)
- Hoang Thi Giang
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam,Corresponding author
| | - Nguyen Quang Duc
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Jean-Pierre Molès
- Pathogenesis and Control of Chronic & Emerging Infections, University of Montpellier, INSERM, Établissement Français du Sang, University of Antilles-Guyane, Montpellier, France
| | - Vu Hai Vinh
- Infectious and Tropical Diseases Department, Viet Tiep Hospital, Hai Phong, Vietnam
| | - Nicolas Nagot
- Pathogenesis and Control of Chronic & Emerging Infections, University of Montpellier, INSERM, Établissement Français du Sang, University of Antilles-Guyane, Montpellier, France
| | | | - Duong Thi Huong
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | | | - Pham Minh Khue
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Le Sao Mai
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | | | - Pham Thi Ngoc
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Catherine Quillet
- Pathogenesis and Control of Chronic & Emerging Infections, University of Montpellier, INSERM, Établissement Français du Sang, University of Antilles-Guyane, Montpellier, France
| | | | - Roselyne Vallo
- Pathogenesis and Control of Chronic & Emerging Infections, University of Montpellier, INSERM, Établissement Français du Sang, University of Antilles-Guyane, Montpellier, France
| | - Laurent Michel
- CESP Inserm UMRS 1018, Paris Saclay University, Pierre Nicole Center, French Red Cross, Paris, France
| | - Don Des Jarlais
- New York University School of Global Public Health, New York, USA
| | - Didier Laureillard
- Infectious Diseases Department, Caremeau University Hospital, Nimes, France
| | - Delphine Rapoud
- Pathogenesis and Control of Chronic & Emerging Infections, University of Montpellier, INSERM, Établissement Français du Sang, University of Antilles-Guyane, Montpellier, France
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15
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Miller RL, McLaughlin A, Montoya V, Toy J, Stone S, Harding J, Liang RH, Wong J, Barrios R, Montaner JS, Joy JB. Impact of SARS-CoV-2 lockdown on expansion of HIV transmission clusters among key populations: A retrospective phylogenetic analysis. LANCET REGIONAL HEALTH. AMERICAS 2022; 16:100369. [PMID: 36168656 PMCID: PMC9500205 DOI: 10.1016/j.lana.2022.100369] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background Public health measures designed to reduce SARS-CoV-2 transmission led to reduced access to care and prevention services for people living with or at risk of acquiring HIV, particularly during the initial introduction of extensive restrictions. This reduction in access may have contributed to increases in HIV transmission not outweighed by decreases in transmission occurring as a result of reduced contact rates promoted by the same public health measures. Methods We synthesize available province-wide HIV data in British Columbia, Canada, together with public mobility data to phylogenetically investigate the early impacts of SARS-CoV-2 on HIV transmission. Cluster growth, coalescent branching events and lineage-level diversification rates were assessed in "pre-lockdown" (January 22-March 21, 2020), "lockdown" (March 22-May 20, 2020) and "post-lockdown" (May 21-July 19, 2020) to facilitate comparison of transmission trends across key populations. Findings Results reveal increased HIV transmission in a limited number of clusters in association with reduced access to health services during the initial introduction of SARS-CoV-2-related restrictions. In particular, clusters associated with people who inject drugs (PWID) show rapid growth, extensive branching events in phylogenetic trees during and following the lockdown period, and elevated median change in individuals' viral diversification rates during lockdown compared to clusters associated with men who have sex with men (MSM), consistent with increased transmission rates between PWID. Interpretation Increased vigilance and innovative targeted solutions are critical to offset potential negative impacts of SARS-CoV-2 or future pandemic-related restrictions on HIV epidemic dynamics. Funding Funding sources include Genome Canada and Genome BC, the Public Health Agency of Canada, the BC Centre for Excellence in HIV/AIDS, and the Canadian Institutes of Health Research Coronavirus Rapid Response Programme. Student funding includes a NSERC CREATE scholarship and a Canadian Institutes of Health Research graduate fellowship.
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Affiliation(s)
- Rachel L. Miller
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Bioinformatics Program, University of British Columbia, Vancouver, BC, Canada
| | - Angela McLaughlin
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Bioinformatics Program, University of British Columbia, Vancouver, BC, Canada
| | - Vincent Montoya
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Junine Toy
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Sarah Stone
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Vancouver Coastal Health, Vancouver, BC, Canada
| | | | - Richard H. Liang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Jason Wong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Julio S.G. Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jeffrey B. Joy
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Bioinformatics Program, University of British Columbia, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Saldana CDR, Beletsky L, Borquez A, Kiene SM, Marquez LK, Strathdee SA, Zúñiga ML, Cepeda J, Martin NK. Modelling the contribution of incarceration and public health oriented drug law reform to HCV transmission and elimination among PWID in Tijuana, Mexico. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 110:103878. [PMID: 36242829 PMCID: PMC9841890 DOI: 10.1016/j.drugpo.2022.103878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/27/2022] [Accepted: 10/03/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Incarceration is associated with increased risk of hepatitis C virus (HCV) among people who inject drugs (PWID). Mexico's previous attempt in implementing a public health-oriented drug law reform resulted in minimal impact on incarceration among PWID. However, implementation of reforms alongside Mexico's HCV elimination program has the potential to reshape the HCV epidemic among PWID in the next decade. We use data from a cohort of PWID in Tijuana, Mexico, to inform epidemic modeling to assess the contribution of incarceration and fully implemented drug reform on HCV transmission and elimination among PWID. METHODS We developed a dynamic, deterministic model of incarceration, HCV transmission and disease progression among PWID. The model was calibrated to data from Tijuana, Mexico, with 90% HCV seroprevalence among 10,000 PWID. We estimated the 10-year population attributable fraction (PAF) of incarceration to HCV incidence among PWID and simulated, from 2022, the potential impact of the following scenarios: 1) decriminalization (80% reduction in incarceration rates); 2) fully implemented drug law reform (decriminalization and diversion to opiate agonist therapy [OAT]); 3) fully implemented drug law reform with HCV treatment (direct-acting antivirals [DAA]). We also assessed the number DAA needed to reach the 80% incidence reduction target by 2030 under these scenarios. RESULTS Projections suggest a PAF of incarceration to HCV incidence of 5.4% (95% uncertainty interval [UI]:0.6-11.9%) among PWID in Tijuana between 2022-2032. Fully implemented drug reforms could reduce HCV incidence rate by 10.6% (95%UI:3.1-19.2%) across 10 years and reduce the number of DAA required to achieve Mexico's HCV incidence reduction goal by 14.3% (95%UI:5.3-17.1%). CONCLUSIONS Among PWID in Tijuana, Mexico, incarceration remains an important contributor to HCV transmission. Full implementation of public health-oriented drug law reform could play an important role in reducing HCV incidence and improve the feasibility of reaching the HCV incidence elimination target by 2030.
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Affiliation(s)
- Carlos D Rivera Saldana
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States; School of Public Health, San Diego State University, San Diego, CA, 92182, United States.
| | - Leo Beletsky
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States; School of Law and Bouve College of Health Sciences, Northeastern University, Boston, MA, 02115, United States
| | - Annick Borquez
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States
| | - Susan M Kiene
- School of Public Health, San Diego State University, San Diego, CA, 92182, United States
| | - Lara K Marquez
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States
| | - María Luisa Zúñiga
- School of Social Work, San Diego State University, San Diego, CA, 92182, United States
| | - Javier Cepeda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, United States
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States; Population Health Sciences, University of Bristol, Bristol BS8 1QU, United Kingdom
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17
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Brener L, Horwitz R, Rance J, Caruana T, Bryant J. Health worker perceptions of the impact of COVID-19 on harm reduction services for people who inject drugs. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:2320-2329. [PMID: 35293054 PMCID: PMC9111390 DOI: 10.1111/hsc.13782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/19/2021] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
The COVID-19 pandemic has affected entire systems of health service provision globally, including health service closure, redeployment of staff and resources and implementation of infection prevention protocols. Harm reduction facilities face particular challenges responding to COVID-19, attempting to continue service provision to people who inject drugs with minimal service disruption whilst protecting their staff. This research assessed the impact of COVID-19 on staff working at harm reduction and alcohol and other drug (AOD) services in Australia in the first 9 months of the pandemic. The research employed mixed methods, using survey data to inform in-depth interviews. Surveys were completed by 207 participants working in the AOD sector and the harm reduction sector nationally. Interviews were conducted with 16 staff at three harm reduction sites in metropolitan Sydney and one regional NSW service. Staff felt able to respond to the trying circumstances of this pandemic, especially as practical messages around the COVID-19 response were similar to those already in place for clients in relation to blood-borne virus prevention. Staff felt that they were still able to provide core services to clients with some modifications in delivery. They were willing to take on additional responsibilities to ensure their own safety and that of clients, including conducting temperature checks and screening questions, whilst also adopting novel service provision strategies to reach clients during lockdowns such as postal services, outreach work and telehealth. NSP and AOD services were able to implement COVID-19 infection control strategies, whilst maintaining and expanding service access through remote and innovative strategies in a manner which supported both clients and service providers, during the first wave of the pandemic in 2020.
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Affiliation(s)
- Loren Brener
- Centre for Social Research in HealthUniversity of New South WalesSydneyAustralia
| | - Robyn Horwitz
- Centre for Social Research in HealthUniversity of New South WalesSydneyAustralia
| | - Jake Rance
- Centre for Social Research in HealthUniversity of New South WalesSydneyAustralia
| | - Theresa Caruana
- Centre for Social Research in HealthUniversity of New South WalesSydneyAustralia
| | - Joanne Bryant
- Centre for Social Research in HealthUniversity of New South WalesSydneyAustralia
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18
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Rezaeiahari M, Fairman BJ. Impact of COVID-19 on the characteristics of opioid overdose deaths in Arkansas. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 109:103836. [PMID: 36027767 PMCID: PMC9376304 DOI: 10.1016/j.drugpo.2022.103836] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/18/2022] [Accepted: 08/10/2022] [Indexed: 11/20/2022]
Abstract
Background In the US, spikes in drug overdose deaths overlapping with the COVID-19 pandemic create concern that persons who use drugs are especially vulnerable. This study aimed to compare the trends in opioid overdose deaths and characterize opioid overdose deaths by drug subtype and person characteristics pre-COVID (2017-2019) and one-year post-COVID-19 emergence (2020). Methods We obtained death certificates on drug overdose deaths in Arkansas from January 1, 2017, through December 31, 2020. Our analyses consisted of an interrupted time-series and segmented regression analysis to assess the impact of COVID-19 on the number of opioid overdose deaths. Results The proportion of opioid overdose deaths increased by 36% post-COVID emergence (95% CI: 14%, 59%). The trend in overdose deaths involving synthetic narcotics other than methadone, such as fentanyl and tramadol, has increased since 2018 (74 in 2018 vs 79 in 2019; p =0.02 and 79 in 2019 versus 158 in 2020; p = 0.03). Opioid overdose deaths involving methamphetamine have more than doubled (36 in 2019 vs 82 in 2020; p = 0.06) despite remaining steady from 2018 to 2019. Synthetic narcotics have surpassed methamphetamine (71% vs. 37%) as the leading cause of opioid overdose deaths in Arkansas during the pandemic. This study found that synthetic narcotics are the significant drivers of the increase in opioid overdose deaths in Arkansas during the pandemic. Conclusions The co-occurrence of the COVID-19 pandemic and the drug abuse epidemic further highlights the increased need for expanding awareness and availability of resources for treating substance use disorders.
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Affiliation(s)
- Mandana Rezaeiahari
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| | - Brian J Fairman
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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19
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McDonald R, Eide D, Abel-Ollo K, Barnsdale L, Carter B, Clausen T, Day E, Fonseca F, Holmén E, Horsburgh K, Kelleher M, Kåberg M, Ladenhauf M, McAuley A, Metrebian N, Neale J, Parkin S, Ratcliffe K, Rintoul C, Smith J, Stifanoviciute V, Torrens M, Thiesen H, Strang J. A rapid assessment of take-home naloxone provision during COVID-19 in Europe. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 107:103787. [PMID: 35849935 PMCID: PMC9247228 DOI: 10.1016/j.drugpo.2022.103787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Rebecca McDonald
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Norway.
| | - Desiree Eide
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Norway
| | - Katri Abel-Ollo
- Drug Abuse and Infectious Diseases Prevention Centre, National Institute for Health Development, Tallinn, Estonia
| | | | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Thomas Clausen
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Norway
| | - Ed Day
- Institute for Mental Health, School of Psychology, University of Birmingham, UK
| | - Francina Fonseca
- Addiction Research Group, Neuroscience Research Program, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Elin Holmén
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden
| | | | - Mike Kelleher
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Martin Kåberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Department of Medicine, Division of Infectious Diseases, Karolinska Institute, Stockholm, Sweden
| | - Martin Ladenhauf
- Caritas Kontaktladen und Streetwork im Drogenbereich, Graz, Austria
| | - Andrew McAuley
- Public Health Scotland, UK; School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Nicola Metrebian
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Joanne Neale
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stephen Parkin
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | | | - Josie Smith
- Substance Misuse Programme, Public Health Wales, Cardiff, UK
| | | | - Marta Torrens
- Addiction Research Group, Neuroscience Research Program, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Henrik Thiesen
- Health Team for the Homeless, Center for Marginalized Adults and Families, Copenhagen City Social Services, Denmark
| | - John Strang
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
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20
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Lugoboni F, Stella L, Zamboni L, Campagnari S, Fusina F, De Bernardis E. COVID-19 vaccination and drug users: Past, present, and future. J Public Health Res 2022; 11:22799036221105314. [PMID: 35966046 PMCID: PMC9373134 DOI: 10.1177/22799036221105314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 04/19/2022] [Indexed: 11/26/2022] Open
Abstract
Vaccination against COVID-19 is crucial in the attempt of containing the virus' spread, but facing a viral pathogen with such a high prevalence means that vaccination strategies are facing an unprecedented situation. People that use illicit drugs may have elevated risk of adverse outcomes from COVID-19 given their high prevalence of underlying medical conditions, including respiratory and pulmonary disease, chronic liver disease, cardiovascular and cerebrovascular conditions, diabetes, and compromised immune systems. Despite a widespread distribution on the Italian territory, a large presence of health personnel and a long-standing experience in vaccinations, addiction clinics have yet to be involved in the vaccination campaign against COVID-19. The aim of this study was to investigate the beliefs of drug users attending some Italian addiction clinics, in order to envisage any vaccine administration strategies involving the services themselves. A questionnaire used for the Italian general population to investigate the relative importance of some factors in influencing the propensity to vaccinate against COVID-19, was administrated to drug users in a multicenter survey. The majority of respondents expressed general confidence in vaccines and a good willingness to undergo vaccination. Given strong peer networks, high coverage of treatment and harm reduction interventions, Italian public addiction clinics could play a strategic role in administering the vaccine in this hard-to-reach population, usefully aiding the global campaign against the virus.
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Affiliation(s)
- Fabio Lugoboni
- Department of Medicine, Addiction
Medicine Unit, Verona University Hospital, Verona, Italy
| | | | - Lorenzo Zamboni
- Department of Medicine, Addiction
Medicine Unit, Verona University Hospital, Verona, Italy
- Department of Neurosciences,
Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Simone Campagnari
- Department of Medicine, Addiction
Medicine Unit, Verona University Hospital, Verona, Italy
| | - Francesca Fusina
- Department of General Psychology,
University of Padova, Padova, Italy
- Padova Neuroscience Center, University
of Padova, Padova, Italy
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21
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Williams LD, Lee E, Latkin C, Mackesy-Amiti ME, Kaufmann M, Copulsky E, Kaplan C, Boodram B. Economic Challenges and Behavioral and Mental Health Risks for Overdose during the COVID-19 Pandemic among People Who Inject Drugs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5351. [PMID: 35564746 PMCID: PMC9101403 DOI: 10.3390/ijerph19095351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/21/2022] [Accepted: 04/26/2022] [Indexed: 02/03/2023]
Abstract
People who inject drugs (PWID) are a population that disproportionately struggles with economic and mental health challenges. However, despite numerous reports of people globally experiencing new or exacerbated economic and/or mental health challenges during the COVID-19 pandemic, the literature on the effect of the pandemic on PWID and their risk for harm (e.g., overdose) remains sparse. The present study will describe reported changes during the pandemic in risk factors for drug overdose (including changes in mental health symptoms and care access) among PWID in Chicago, and it will examine associations between such risk factor changes and the experience of economic challenges during the pandemic. Participants from an ongoing longitudinal study of young PWID from the Chicago suburbs and their injection risk network members (N = 138; mean age = 28.7 years) were interviewed about changes in their experiences, substance use behavior, and mental health since the start of the COVID-19 pandemic. Bivariate cross tabulations were computed of each "overdose risk factor" with experiences of economic challenges during the pandemic. Fisher's Exact Tests were used to assess statistical significance. Adjusted logistic regression models were also conducted that controlled for sociodemographic characteristics, for time elapsed since the start of the pandemic, and for pre-pandemic income, homelessness, and injection frequency. Over half of our sample reported using alone more than usual during the pandemic, and over 40% reported using more than usual and/or buying drugs that were of a decreased purity or quality. Additionally, a large proportion of our sample (52.5% of those asked) reported more difficulty than usual accessing mental health care. Experiencing loss of a source of income during the pandemic was associated with using more drugs, using alone more, using a larger amount of drugs while using alone, wanting to stop using but being unable, and difficulty accessing mental health care. The preliminary associations found by the present study suggest that economic challenges or disruptions experienced during the pandemic are likely to increase risk for overdose among PWID experiencing such challenges, via changes in the above behaviors and/or conditions that are associated with risk for overdose. Intervention efforts should therefore be focused not only directly on overdose prevention, but also on assisting PWID with their economic challenges and helping them regain economic stability and access to services that may have been impeded by financial difficulty.
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Affiliation(s)
- Leslie D. Williams
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL 60612, USA; (E.L.); (M.E.M.-A.); (E.C.); (B.B.)
| | - Eunhye Lee
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL 60612, USA; (E.L.); (M.E.M.-A.); (E.C.); (B.B.)
| | - Carl Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Mary Ellen Mackesy-Amiti
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL 60612, USA; (E.L.); (M.E.M.-A.); (E.C.); (B.B.)
| | - Maggie Kaufmann
- Community Outreach Intervention Projects, University of Illinois at Chicago School of Public Health, Chicago, IL 60612, USA; (M.K.); (C.K.)
| | - Elizabeth Copulsky
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL 60612, USA; (E.L.); (M.E.M.-A.); (E.C.); (B.B.)
| | - Charlie Kaplan
- Community Outreach Intervention Projects, University of Illinois at Chicago School of Public Health, Chicago, IL 60612, USA; (M.K.); (C.K.)
| | - Basmattee Boodram
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL 60612, USA; (E.L.); (M.E.M.-A.); (E.C.); (B.B.)
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22
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Strathdee SA, Abramovitz D, Harvey-Vera A, Vera CF, Rangel G, Artamonova I, Chaillon A, Ignacio C, Calderon A, Martin NK, Patterson TL. Prevalence and correlates of SARS-CoV-2 seropositivity among people who inject drugs in the San Diego-Tijuana border region. PLoS One 2021; 16:e0260286. [PMID: 34807963 PMCID: PMC8608290 DOI: 10.1371/journal.pone.0260286] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/05/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND People who inject drugs may be at elevated SARS-CoV-2 risk due to their living conditions and/or exposures when seeking or using drugs. No study to date has reported upon risk factors for SARS-CoV-2 infection among people who inject drugs. METHODS AND FINDINGS Between October, 2020 and June, 2021, participants aged ≥18 years from San Diego, California, USA and Tijuana, Baja California, Mexico who injected drugs within the last month underwent interviews and testing for SARS-CoV-2 RNA and antibodies. Binomial regressions identified correlates of SARS-CoV-2 seropositivity. RESULTS Of 386 participants, SARS-CoV-2 seroprevalence was 36.3% (95% CI: 31.5%-41.1%); 92.1% had detectable IgM antibodies. Only 37.5% had previously been tested. Seroprevalence did not differ by country of residence. None tested RNA-positive. Most (89.5%) reported engaging in ≥1 protective behavior [e.g., facemasks (73.5%), social distancing (46.5%), or increasing handwashing/sanitizers (22.8%)]. In a multivariate model controlling for sex, older age, and Hispanic/Latinx/Mexican ethnicity were independently associated with SARS-CoV-2 seropositivity, as was engaging in sex work (AdjRR: 1.63; 95% CI: 1.18-2.27) and having been incarcerated in the past six months (AdjRR: 1.49; 95% CI: 0.97-2.27). Comorbidities and substance using behaviors were not associated with SARS-CoV-2 seropositivity. CONCLUSIONS In this community-based study of people who inject drugs in the San Diego-Tijuana border region, over one third were SARS-CoV-2 seropositive, exceeding estimates from the general population in either city. We found no evidence that substance use behaviors were associated with an elevated risk of SARS-CoV-2 infection, but observed that circumstances in the risk environment, notably sex work and incarceration, were independently associated with higher SARS-CoV-2 seroprevalence. Our findings suggest that a binational policy response to COVID-19 mitigation is warranted beyond the closure of the U.S.-Mexico border. Furthermore, decriminalizing sex work and drug use could reduce the burden of COVID-19 among people who inject drugs.
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Affiliation(s)
- Steffanie A. Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, United States of America
| | - Daniela Abramovitz
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, United States of America
| | - Alicia Harvey-Vera
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, United States of America
- Facultad de Medicina, Campus Tijuana, Universidad Xochicalco, Baja California, Mexico
- United States-Mexico Border Health Commission, Tijuana, Baja California, Mexico
| | - Carlos F. Vera
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, United States of America
| | - Gudelia Rangel
- United States-Mexico Border Health Commission, Tijuana, Baja California, Mexico
- Departmento de Estudios de Población, El Colegio de la Frontera Norte, Tijuana, Baja California, Mexico
| | - Irina Artamonova
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, United States of America
| | - Antoine Chaillon
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, United States of America
| | - Caroline Ignacio
- Department of Medicine, San Diego Center for AIDS Research Translational Virology Core, University of California San Diego, La Jolla, CA, United States of America
| | - Alheli Calderon
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, United States of America
- School of Public Health, San Diego State University, San Diego, California, United States of America
| | - Natasha K. Martin
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, United States of America
| | - Thomas L. Patterson
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States of America
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23
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Understanding the Impacts of Novel Coronavirus Outbreaks on People Who Use Drugs: A Systematic Review to Inform Practice and Drug Policy Responses to COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168470. [PMID: 34444219 PMCID: PMC8394531 DOI: 10.3390/ijerph18168470] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/27/2021] [Accepted: 07/31/2021] [Indexed: 12/28/2022]
Abstract
People who use drugs (PWUD) experience many social and health harms and are considered at greater risk of acquiring COVID-19. Little research has examined the impact of coronaviruses either on PWUD, or on services targeted to PWUD. We report the findings of a systematic review of empirical evidence from studies which have examined the impact of coronaviruses (Severe Acute Respiratory Syndrome (SARS-CoV-1) and Middle Eastern Respiratory Syndrome (MERS-CoV) and COVID-19) on PWUD or on service responses to them. Five databases were searched (MEDLINE, PsycINFO, CINAHL, ASSIA and EMBASE) as well as COVID-19 specific databases. Inclusion criteria were studies reporting any impact of SARS, MERS or COVID-19 or any service responses to those, published between January 2000 and October 2020. Weight of Evidence judgements and quality assessment were undertaken. In total, 27 primary studies were included and grouped by seven main themes: treatment/recovery services; emergency medical settings; low-threshold services; prison setting, PWUD/substance use disorder (SUD) diagnosis; people with SUD and HIV; ‘Sexual minority’ men. Overall, research in the area was scant, and of average/poor quality. More robust research is required to inform on-going and future responses to coronavirus epidemics for PWUD.
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