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Zhang B, Yan X, Li Y, Zhu H, Liu Z, Lu Z, Jia Z. Epidemic of HIV infection among persons who inject drugs in mainland China: a series, cross-sectional study. Harm Reduct J 2021; 18:63. [PMID: 34118933 PMCID: PMC8199561 DOI: 10.1186/s12954-021-00511-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background Studies have suggested that the injection drug use (IDU) was no longer the main transmission route of HIV/AIDS in China. However, there has never been a study to assess the national HIV epidemic among persons who inject drugs (PWIDs) based on a nationwide database.
Methods PWIDs among new entrants in detoxification centers with HIV test results were extracted from the 2008–2016 National Dynamic Management and Control Database for Persons Who Use Drugs (NDMCD). Logistic regressions were used to analyze factors associated with HIV infection, and joinpoint regression were used to examine trends in the HIV prevalence. Results A total of 103,619 PWIDs among new entrants tested for HIV in detoxification centers between 2008 and 2016 were included in the analysis. The HIV prevalence was 5.0% (n = 5167) among PWIDs. A U-shaped curve of the HIV prevalence decreased from 4.9% in 2008 to 3.3% in 2010 (Annual Percent Change [APC] − 20.6, 95% CI − 32.5 to − 6.7, p < 0.05) and subsequently increased from 3.3% in 2010 to 8.6% in 2016 (APC 17.9, 95% CI 14.5–21.4, p < 0.05) was observed. The HIV prevalence in west regions in China all presented decreased trends, while central and eastern regions presented increased trends. Conclusions Although the HIV prevalence has been declining in general population, the HIV prevalence among PWIDs has shown an increasing trend since 2010. Current policies on HIV control in PWIDs should be reassessed. Supplementary Information The online version contains supplementary material available at 10.1186/s12954-021-00511-6.
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Affiliation(s)
- Bo Zhang
- School of Basic Medical Sciences, Peking University, Beijing, 100191, China
| | - Xiangyu Yan
- School of Public Health, Peking University, Beijing, 100191, China
| | - Yongjie Li
- School of Public Health, Peking University, Beijing, 100191, China
| | - He Zhu
- China Center for Health Development Studies, Peking University, Beijing, 100191, China
| | - Zhimin Liu
- National Institute on Drug Dependence, Peking University, Beijing, 100191, China
| | - Zuhong Lu
- State Key Laboratory for Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing, 211189, China
| | - Zhongwei Jia
- School of Public Health, Peking University, Beijing, 100191, China. .,Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing, 100191, China. .,Center for Drug Abuse Control and Prevention, National Institute of Health Data Science, Peking University, Beijing, 100191, China.
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Soria J, Johnson T, Collins J, Corby-Lee G, Thacker J, White C, Hoven A, Thornton A. Risk factors for loss to follow-up of persons who inject drugs enrolled at syringe services programs in Kentucky. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 95:103255. [PMID: 33853033 DOI: 10.1016/j.drugpo.2021.103255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/23/2021] [Accepted: 04/01/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Syringe services programs (SSP) are an effective strategy to reduce blood-borne infections of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) in persons who inject drugs (PWID). The objectives of this study were to determine the frequency and risk factors for loss to follow-up (LTFU) in PWID enrolled at SSPs in Kentucky. METHODS A retrospective cohort study was conducted which included data of PWID enrolled at 32 SSP. Demographics, use of drugs, HIV testing, HCV testing, and medical services were analyzed. A generalized linear model (GLM), family binomial was used to determine risk factors for LTFU. RESULTS The analysis included 5742 PWID. LTFU by year of enrollment was 287/770 (37.3%) in 2017, 796/1874 (42.5%) in 2018, and 1479/3,098 (47.7%) in 2019. LTFU was significantly associated with distance to SSP from home of more than five miles (RR 1.25; 95%CI 1.09-1.43; p = 0.002) and SSPs housed in rural counties (RR 1.22; 95%CI 1.06-1.40; p = 0.004), adjusted by age, sex, and race. The use of buprenorphine was associated with less risk of LTFU (RR 0.79, p = 0.034). CONCLUSION The distance to an SSP from home and SSPs in rural counties were identified as risk factors for LTFU. Initiatives that bring health services closer to PWID homes and offer opioid use disorder treatment may improve repeated participation in SSPs.
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Affiliation(s)
- Jaime Soria
- KADAP Income Reinvestment Program (KIRP), Division of Infectious Diseases, University of Kentucky, United States.
| | - Tisha Johnson
- Kentucky Department for Public Health, KY, United States
| | - Jana Collins
- KADAP Income Reinvestment Program (KIRP), Division of Infectious Diseases, University of Kentucky, United States
| | - Greg Corby-Lee
- KADAP Income Reinvestment Program (KIRP), Division of Infectious Diseases, University of Kentucky, United States
| | - James Thacker
- KADAP Income Reinvestment Program (KIRP), Division of Infectious Diseases, University of Kentucky, United States
| | - Connie White
- Kentucky Department for Public Health, KY, United States
| | - Ardis Hoven
- KADAP Income Reinvestment Program (KIRP), Division of Infectious Diseases, University of Kentucky, United States
| | - Alice Thornton
- KADAP Income Reinvestment Program (KIRP), Division of Infectious Diseases, University of Kentucky, United States
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Karlsson N, Kåberg M, Berglund T, Hammarberg A, Widman L, Ekström AM. A prospective cohort study of risk behaviours, retention and loss to follow-up over 5 years among women and men in a needle exchange program in Stockholm, Sweden. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 90:103059. [PMID: 33360734 DOI: 10.1016/j.drugpo.2020.103059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 11/09/2020] [Accepted: 11/18/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Needle exchange programs (NEP) are important in reducing risk behaviours among people who inject drugs (PWID), also exposed to HIV and hepatitis C (HCV) through injecting drug use (IDU). Women (WWID) compared to men who inject drugs (MWID), are particularly vulnerable with complex needs, however less is known about their risk determinants and NEP outcomes. METHODS In an open prospective NEP cohort, 697 WWID and 2122 MWID were followed, 2013-2018. Self-reported socio/drug-related determinants for receptive injection (needle/syringe and paraphernalia) and sexual risk behaviours at enrolment, lost to follow-up (LTFU) and probability of retention, were assessed for both groups. Multivariable logistic regression (adjusted odds ratios, aOR) for enrolment and Poisson regression (adjusted incidence rate ratios, aIRR) for LTFU, were used. Cumulative NEP-retention probability was analysed using a six- and 12-month scenario. RESULTS At NEP enrolment, injection risk behaviours among WWID were associated with: younger age; homelessness; amphetamine-IDU; non-participation in opioid substitution therapy (OST); history of custody and among MWID: lower education level; cohabitation; homelessness, being a tenant; amphetamine-IDU; non-participation in OST; history of being sectioned, HIV-negative and HCV-positive. Condomless sex among WWID was associated with: younger age; lower education-level; cohabitation; having a partner; amphetamine-IDU; non-participation in OST; being HIV-negative and HCV-positive and among MWID: younger age; married; cohabitation; having a partner; amphetamine-IDU; non-participation in OST; history of custody, prison and being HIV-negative. WWID had higher NEP-retention levels compared to MWID over time. Being LTFU among WWID was associated with being HIV-negative and reporting injection risk behaviours and among MWID, younger age, non-participation in OST, being HIV-negative and having protected sex. CONCLUSIONS Despite better NEP compliance among WWID, high injection and sexual risk behaviours in both gender-subgroups, especially in intimate relationships, suggests ongoing HCV and HIV-infection risks. Subgroup-variation in the NEP continuum of care warrants more gender-disaggregated research and tailoring gender-sensitive services may improve prevention, health and retention outcomes.
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Affiliation(s)
- Niklas Karlsson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Department of Public Health Analysis and Development, Public Health Agency of Sweden (Folkhälsomyndigheten), Solna, Sweden.
| | - Martin Kåberg
- Department of Medicine Huddinge, Division of Infection and Dermatology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden; Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden
| | - Torsten Berglund
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Department of Public Health Analysis and Development, Public Health Agency of Sweden (Folkhälsomyndigheten), Solna, Sweden
| | - Anders Hammarberg
- Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Centre for Dependency Disorders, Stockholm Health Care Services, Stockholm County Council, Sweden
| | - Linnea Widman
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Mukhtar F, Butt ZA. Establishing a cohort in a developing country: Experiences of the diabetes-tuberculosis treatment outcome cohort study. J Epidemiol Glob Health 2017; 7:249-254. [PMID: 29110865 PMCID: PMC7384568 DOI: 10.1016/j.jegh.2017.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 08/08/2017] [Accepted: 08/12/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Prospective cohort studies are instrumental in generating valid scientific evidence based on identifying temporal associations between cause and effect. Researchers in a developing country like Pakistan seldom undertake cohort studies hence little is known about the challenges encountered while conducting them. We describe the retention rates among tuberculosis patients with and without diabetes, look at factors associated with loss to follow up among the cohort and assess operational factors that contributed to retention of cohort. METHODS A prospective cohort study was initiated in October 2013 at the Gulab Devi Chest Hospital, Lahore, Pakistan. We recruited 614 new adult cases of pulmonary tuberculosis, whose diabetic status was ascertained by conducting random and fasting blood glucose tests. The cohort was followed up at the 2nd, 5th and 6th month while on anti-tuberculosis therapy (ATT) and 6months after ATT completion to determine treatment outcomes among the two groups i.e. patients with diabetes and patients without diabetes. RESULTS The overall retention rate was 81.9% (n=503), with 82.3% (93/113) among patients with diabetes and 81.8% (410/501) among patients without diabetes (p=0.91). Age (p=0.001), area of residence (p=0.029), marital status (p=0.001), educational qualification (p=<0.001) and smoking (p=0.026) were significantly associated with loss to follow up. Respondents were lost to follow up due to inability of research team to contact them as either contact numbers provided were incorrect or switched off (44/111, 39.6%). CONCLUSION We were able to retain 81.9% of PTB patients in the diabetes tuberculosis treatment outcome (DITTO) study for 12months. Retention rates among people with and without diabetes were similar. Older age, rural residence, illiteracy and smoking were associated with loss to follow up. The study employed gender matched data collectors, had a 24-h helpline for patients and sent follow up reminders through telephone calls rather than short messaging service, which might have contributed to retention of cohort.
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Affiliation(s)
- Fatima Mukhtar
- Health Services Academy, Islamabad, Pakistan; Department of Community Medicine, Lahore Medical & Dental College, Lahore, Pakistan.
| | - Zahid A Butt
- Department of Epidemiology & Biostatistics, Health Services Academy, Islamabad, Pakistan; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Chandrasekaran S, Kyaw NTT, Harries AD, Yee IA, Ellan P, Kurusamy T, Yusoff N, Mburu G, Mohammad WMZW, Suleiman A. Enrolment and retention of people who inject drugs in the Needle & Syringe Exchange Programme in Malaysia. Public Health Action 2017; 7:155-160. [PMID: 28695090 DOI: 10.5588/pha.17.0003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 03/21/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: Needle and Syringe Exchange Programme (NSEP) implemented by non-governmental organisations in Malaysia. Objectives: To determine enrolment, characteristics and retention in the NSEP of people who inject drugs (PWID) between 2013 and 2015. Design: Retrospective cohort study. Results: There were 20 946 PWID, with a mean age of 38 years. The majority were male (98%) and of Malay ethnicity (92%). Follow-up data were available for 20 761 PWID. Annual retention of newly enrolled PWID for each year was respectively 85%, 87% and 78% for 2013, 2014 and 2015, although annual enrolment over these years declined from 10 724 to 6288 to 3749. Total person-years (py) of follow-up were 27 806, with loss to follow-up of 40 per 100 py. Cumulative probability of retention in NSEP was 66% at 12 months, 45% at 24 months and 26% at 36 months. Significantly higher loss to follow-up rates were observed in those aged 15-24 years or ⩾50 years, females, transgender people and non-Malay ethnic groups. Conclusion: Annual retention of new PWID on NSEP was impressive, although enrolment declined over the 3 years of the study and cumulative loss to follow-up was high. A better understanding of these programmatic outcomes is required.
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Affiliation(s)
| | - N T T Kyaw
- International Union Against Tuberculosis and Lung Disease, Myanmar Country Office, Mandalay, Myanmar
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France.,London School of Hygiene & Tropical Medicine, London, UK
| | - I A Yee
- Malaysian AIDS Council, Kuala Lumpur, Malaysia
| | - P Ellan
- Malaysian AIDS Council, Kuala Lumpur, Malaysia
| | - T Kurusamy
- Malaysian AIDS Council, Kuala Lumpur, Malaysia
| | - N Yusoff
- Malaysian AIDS Council, Kuala Lumpur, Malaysia
| | - G Mburu
- Department of Health Research, Lancaster University, Lancaster, UK
| | - W M Z W Mohammad
- School of Medical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - A Suleiman
- Ministry of Health Malaysia, Putrajaya, Malaysia
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