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Springgate B, Matta I, True G, Doran H, Torres WV, Stevens E, Holland E, Mott K, Ardoin TR, Nixdorff N, Haywood C, Meyers D, Johnson A, Tatum T, Palinkas LA. Implementation of medication for opioid use disorder treatment during a natural disaster: The PROUD-LA study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 165:209469. [PMID: 39094901 DOI: 10.1016/j.josat.2024.209469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 05/17/2024] [Accepted: 07/23/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND The impacts of climate change-related extreme weather events (EWEs) on Medication for Opioid Use Disorders (MOUD) implementation for Medicaid beneficiaries are relatively unknown. Such information is critical to disaster planning and other implementation strategies. In this study we examined implementation determinants and strategies for MOUD during EWEs. METHODS The Louisiana-based Community Resilience Learning Collaborative and Research Network (C-LEARN) utilized Rapid Assessment Procedures-Informed Community Ethnography (RAPICE), involving community leaders in study design, execution, and data analysis. We conducted qualitative semi-structured interviews with 42 individuals, including MOUD Medicaid member patients and their caregivers, healthcare providers and administrators, and public health officials with experience with climate-related disasters. We mapped key themes onto updated Consolidated Framework for Implementation Research domains. RESULTS MOUD use is limited during EWEs by pharmacy closures, challenges to medication prescription and access across state lines, hospital and clinic service limits, overcrowded emergency departments, and disrupted communications with providers. MOUD demand simultaneously increases due to the stress associated with displacement, resource loss, the COVID-19 pandemic, and social determinants of health. Effective implementation strategies include healthcare system disaster plans with protocols for clear and regular patient-provider communication, community outreach, additional staffing, and virtual delivery of services. Providers can also increase MOUD access by having remote access to EHRs, laptops and contact information, resource lists, collaborative networks, and contact with patients via call centers and social media. Patients can retain access to MOUD via online patient portals, health apps, call centers, and provider calls and texts. The impact of EWEs on MOUD access and use is also influenced by individual characteristics of both patients and providers. CONCLUSIONS The increasing frequency and severity of climate-related EWEs poses a serious threat to MOUD for Medicaid beneficiaries. MOUD-specific disaster planning and use of telehealth for maintaining contact and providing care are effective strategies for MOUD implementation during EWEs. Potential considerations for policies and practices of Medicaid, providers, and others to benefit members during hurricanes or major community stressors, include changes in Medicaid policies to enable access to MOUD by interstate evacuees, improvement of medication refill flexibilities, and incentivization of telehealth services for more systematic use.
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Affiliation(s)
- Benjamin Springgate
- LSU Health Sciences Center - New Orleans, School of Medicine and School of Public Health, New Orleans, LA, USA.
| | - Isha Matta
- LSU Health Sciences Center - New Orleans, School of Medicine and School of Public Health, New Orleans, LA, USA.
| | - Gala True
- LSU Health Sciences Center - New Orleans, School of Medicine and School of Public Health, New Orleans, LA, USA.
| | - Hanna Doran
- LSU Health Sciences Center - New Orleans, School of Medicine and School of Public Health, New Orleans, LA, USA.
| | | | - Elyse Stevens
- LSU Health Sciences Center - New Orleans, School of Medicine and School of Public Health, New Orleans, LA, USA.
| | - Elizabeth Holland
- LSU Health Sciences Center - New Orleans, School of Medicine and School of Public Health, New Orleans, LA, USA.
| | - Karlee Mott
- LSU Health Sciences Center - New Orleans, School of Medicine and School of Public Health, New Orleans, LA, USA.
| | - Tiffany R Ardoin
- LSU Health Sciences Center - New Orleans, School of Medicine and School of Public Health, New Orleans, LA, USA.
| | - Neil Nixdorff
- Department of Internal Medicine, Division of Geriatric & Palliative Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Diana Meyers
- St. Anna's Episcopal Church, New Orleans, LA, USA.
| | - Arthur Johnson
- Lower Ninth Ward Center for Sustainable Engagement and Development, New Orleans, LA, USA.
| | - Thad Tatum
- Formerly Incarcerated Peers Support Group, New Orleans, LA, USA
| | - Lawrence A Palinkas
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA.
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Padilla M, Luna-Gierke RE, Carree T, Gutierrez M, Yuan X, Dasgupta S. Racial Differences in Social Determinants of Health and Outcomes Among Hispanic/Latino Persons with HIV-United States, 2015-2020. J Racial Ethn Health Disparities 2024; 11:574-588. [PMID: 36826779 PMCID: PMC10447624 DOI: 10.1007/s40615-023-01542-4] [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: 10/20/2022] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Hispanic/Latino people with HIV (PWH) experience disparities in health outcomes compared with other racial and ethnic groups. Disaggregated data based on race for Hispanic/Latino PWH in the United States are rarely reported, potentially masking inequities. METHODS The Medical Monitoring Project (MMP) is a complex sample survey of adults with diagnosed HIV. We used weighted interview and medical record data collected from June 2015-May 2021 to examine differences in social determinants of health (SDH) and health outcomes by self-reported race among Hispanic/Latino adults with diagnosed HIV. RESULTS Compared with White Hispanic/Latino PWH, Black Hispanic/Latino PWH were more likely to be unemployed (PR, 1.4; CI, 1.2-1.8), have a disability (PR, 1.3; CI, 1.2-1.5), have experienced homelessness (PR, 1.8; CI, 1.2-2.6), and have been incarcerated (PR, 2.6; CI, 1.5-4.5). American Indian/Alaska Native (AI/AN) (PR, 1.8; CI, 1.1-2.7) and multiracial (PR, 2.0; CI, 1.4-2.9) Hispanic/Latino PWH were more likely to have experienced homelessness than White Hispanic/Latino PWH. Black (PR, 1.3; CI, 1.2-1.5) and multiracial (PR, 1.2; CI, 1.1-1.5) Hispanic/Latino PWH were more likely to be virally unsuppressed than White Hispanic/Latino PWH. CONCLUSION Black, multiracial, and AI/AN Hispanic/Latino PWH experience disparities in SDH and HIV outcomes. Lumping Hispanic/Latino people into one racial and ethnic category obscures health disparities, which might limit our progress towards reaching national HIV goals. Future studies should consider disaggregating by other factors such as Hispanic origin, place of birth, immigration status, and primary language. Doing so recognizes the diversity of the Hispanic/Latino population.
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Affiliation(s)
- Mabel Padilla
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
- DHAP/NCHHSTP/CDC, 1600 Clifton Road NE MS E-46, Atlanta, GA, 30333, USA.
| | - Ruth E Luna-Gierke
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Mariana Gutierrez
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Xin Yuan
- DLH Corporation, Atlanta, GA, USA
| | - Sharoda Dasgupta
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Aponte-Meléndez Y, Mateu-Gelabert P, Eckhardt B, Fong C, Padilla A, Trinidad-Martínez W, Maldonado-Rodríguez E, Agront N. Hepatitis C virus care cascade among people who inject drugs in puerto rico: Minimal HCV treatment and substantial barriers to HCV care. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 8:100178. [PMID: 37555192 PMCID: PMC10404601 DOI: 10.1016/j.dadr.2023.100178] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 08/10/2023]
Abstract
Background People who inject drugs (PWID) in Puerto Rico are disproportionately affected by the hepatitis C virus (HCV) epidemic. However, there is a scarcity of data on the HCV care cascade among PWID in Puerto Rico. This study aims to describe the HCV cascade of care among PWID in Puerto Rico, identify gaps, and explore barriers to HCV care. Methods Participants were recruited using respondent-driven sampling and tested for both HCV antibodies (Ab) and RNA (ribonucleic acid) using rapid testing and dried blood spot samples (DBS). The cascade of care was estimated based on the DBS HCV Ab and RNA results, as well as self-reported data on HCV screening, linkage to care, treatment uptake and sustained virologic response collected through a questionnaire. The cascade was constructed sequentially, with each step using the number of people from the preceding step as the base denominator. The survey also assessed participants' perceived barriers to HCV care. Results Out of 150 participants, 126 (84%) had previously been HCV screened, 87% (109/126) were HCV Ab positive, 72% (79/109) were RNA positive,48% (38/79) were linked to care, 32% (12/38) initiated treatment, 58% (7/12) finished treatment, and 71% (5/7) achieved SVR. Barriers to HCV care included concerns about drug abstinence requirements, access to transportation, stigma in healthcare settings, and lack of knowledge about HCV treatment sites. Conclusion This study provides insights into the HCV cascade of care among PWID in Puerto Rico for the first time and highlights limited diagnosis, treatment uptake, and barriers to care.
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Affiliation(s)
- Yesenia Aponte-Meléndez
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health(ISPH) 55 West 125th street, New York, NY 10027,USA
- NYU Rory Meyers College of Nursing 433 1st Ave., New York, NY 10010
| | - Pedro Mateu-Gelabert
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health(ISPH) 55 West 125th street, New York, NY 10027,USA
| | - Benjamin Eckhardt
- New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Chunki Fong
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health(ISPH) 55 West 125th street, New York, NY 10027,USA
| | - Adriana Padilla
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health(ISPH) 55 West 125th street, New York, NY 10027,USA
| | - Wanda Trinidad-Martínez
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health(ISPH) 55 West 125th street, New York, NY 10027,USA
| | - Eric Maldonado-Rodríguez
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health(ISPH) 55 West 125th street, New York, NY 10027,USA
| | - Nancy Agront
- AbbVie Corp., Paseo Caribe Building Suite 22415 Ave Munoz Rivera San Juan, 00901, Puerto Rico
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Bennett SJ, Davila CA, Reyes Z, Valentín-Acevedo A, Carrasco KG, Abadie R, Marlin MC, Beel M, Chapple AG, Fernando S, Guthridge JM, Chiou KS, Dombrowski K, West JT, Wood C. Immune profiling in Puerto Rican injection drug users with and without HIV-1 infection. J Leukoc Biol 2023; 114:142-153. [PMID: 37042743 PMCID: PMC10776106 DOI: 10.1093/jleuko/qiad045] [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: 12/14/2022] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 04/13/2023] Open
Abstract
Antiretroviral therapy has been effective in suppressing HIV viral load and enabling people living with HIV to experience longer, more conventional lives. However, as people living with HIV are living longer, they are developing aging-related diseases prematurely and are more susceptible to comorbidities that have been linked to chronic inflammation. Coincident with HIV infection and aging, drug abuse has also been independently associated with gut dysbiosis, microbial translocation, and inflammation. Here, we hypothesized that injection drug use would exacerbate HIV-induced immune activation and inflammation, thereby intensifying immune dysfunction. We recruited 50 individuals not using injection drugs (36/50 HIV+) and 47 people who inject drugs (PWID, 12/47 HIV+). All but 3 of the HIV+ subjects were on antiretroviral therapy. Plasma immune profiles were characterized by immunoproteomics, and cellular immunophenotypes were assessed using mass cytometry. The immune profiles of HIV+/PWID-, HIV-/PWID+, and HIV+/PWID+ were each significantly different from controls; however, few differences between these groups were detected, and only 3 inflammatory mediators and 2 immune cell populations demonstrated a combinatorial effect of injection drug use and HIV infection. In conclusion, a comprehensive analysis of inflammatory mediators and cell immunophenotypes revealed remarkably similar patterns of immune dysfunction in HIV-infected individuals and in people who inject drugs with and without HIV-1 infection.
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Affiliation(s)
- Sydney J. Bennett
- School of Biological Sciences, University of Nebraska–Lincoln, 1104 T St, Lincoln, NE 68588, United States
- Department of Interdisciplinary Oncology, Louisiana State University Health Sciences Center, Louisiana Cancer Research Center, 1700 Tulane Ave, New Orleans, LA 70112, United States
| | - Carmen Ana Davila
- Department of Sociology, University of Nebraska–Lincoln, 660 N 12th St, Lincoln, NE 68588, United States
| | - Zahiraliz Reyes
- Department of Microbiology and Immunology, Universidad Central del Caribe, PO Box 60327, Bayamón, Puerto Rico 00960, United States
| | - Aníbal Valentín-Acevedo
- Department of Microbiology and Immunology, Universidad Central del Caribe, PO Box 60327, Bayamón, Puerto Rico 00960, United States
| | - Kim Gocchi Carrasco
- Department of Sociology, University of Nebraska–Lincoln, 660 N 12th St, Lincoln, NE 68588, United States
| | - Roberto Abadie
- Department of Sociology, University of Nebraska–Lincoln, 660 N 12th St, Lincoln, NE 68588, United States
| | - M. Caleb Marlin
- Arthritis & Clinical Immunology, Oklahoma Medical Research Foundation, 825 NE 13th St, Oklahoma City, OK 73104, United States
| | - Marci Beel
- Arthritis & Clinical Immunology, Oklahoma Medical Research Foundation, 825 NE 13th St, Oklahoma City, OK 73104, United States
| | - Andrew G. Chapple
- Department of Interdisciplinary Oncology, Louisiana State University Health Sciences Center, Louisiana Cancer Research Center, 1700 Tulane Ave, New Orleans, LA 70112, United States
| | - Samodha Fernando
- Department of Animal Science, University of Nebraska–Lincoln, 3940 Fair St, Lincoln, NE 68503, United States
| | - Joel M. Guthridge
- Arthritis & Clinical Immunology, Oklahoma Medical Research Foundation, 825 NE 13th St, Oklahoma City, OK 73104, United States
- Department of Pathology, University of Oklahoma Health Sciences Center, 940 Stanton L. Young Blvd, Oklahoma City, OK 73104, United States
| | - Kathy S. Chiou
- Department of Psychology, University of Nebraska–Lincoln, 1220 T St, Lincoln, NE 68588, United States
| | - Kirk Dombrowski
- University of Vermont, 5 South Prospect St, Burlington, VT 05405, United States
| | - John T. West
- Department of Interdisciplinary Oncology, Louisiana State University Health Sciences Center, Louisiana Cancer Research Center, 1700 Tulane Ave, New Orleans, LA 70112, United States
| | - Charles Wood
- Department of Interdisciplinary Oncology, Louisiana State University Health Sciences Center, Louisiana Cancer Research Center, 1700 Tulane Ave, New Orleans, LA 70112, United States
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Abadie R, Cano M, Habecker P, Gelpí-Acosta C. Substance use, injection risk behaviors, and fentanyl-related overdose risk among a sample of PWID post-Hurricane Maria. Harm Reduct J 2022; 19:129. [PMID: 36424666 PMCID: PMC9694860 DOI: 10.1186/s12954-022-00715-4] [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: 08/25/2022] [Accepted: 11/15/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND While natural disasters like hurricanes are increasingly common, their long-term effects on people who inject drugs are not well understood. Although brief in duration, natural disasters can radically transform risk environments, increasing substance use and drug-related harms. METHODS Based on a study of people who inject drugs (PWID) and injection risk behaviors in rural Puerto Rico, the present study uses data from two different phases of the parent study. Data for 110 participants were collected from December 2015 to January 2017, soon before Hurricane Maria landed in September 2017; the 2019 phase, in the aftermath of the hurricane, included a total of 103 participants. The present study's main analyses used data from 66 PWID who participated in both the pre-Maria and post-Maria interviews (66 individuals measured at two time points, for a total of 132 observations), using mixed-effects binomial logistic regression to examine recent overdose experiences pre- and post-Maria. A separate descriptive analysis included all 103 participants from the 2019 interview. RESULTS After Hurricane Maria, some declines in injection frequency were observed (the percentage of people reporting injecting monthly or less increased from 3.0% before Hurricane Maria to 22.7% after Hurricane Maria). However, fewer PWID reported using a new needle for most or all injections. In the pre-Maria interview, 10.6% of participants indicated they had experienced an overdose during the year of the interview and/or the calendar year prior, and this figure increased to 24.2% in the post-Maria interview. In the regression analysis, the odds of reporting an overdose during the interview year and/or calendar year prior were three times as high post-Maria, relative to pre-Maria (odds ratio 3.25, 95% confidence interval 1.06-9.97). CONCLUSION Substance use patterns, injection risk behaviors, and overdose episodes and deaths differed after Hurricane Maria, relative to before the hurricane, yet it is unclear to what extent these changes also reflect the simultaneous arrival of fentanyl. In preparation for future natural disasters, it is imperative to strengthen the health infrastructure by enhancing access and curbing barriers to syringe services programs and medications for opioid use disorder, particularly in rural or underserved locations.
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Affiliation(s)
- Roberto Abadie
- grid.24434.350000 0004 1937 0060University of Nebraska-Lincoln, Lincoln, NE 68588 USA
| | - Manuel Cano
- grid.215654.10000 0001 2151 2636Arizona State University, Central Avenue 800, Phoenix, AZ 85004 USA
| | - Patrick Habecker
- grid.24434.350000 0004 1937 0060University of Nebraska-Lincoln, Lincoln, NE 68588 USA
| | - Camila Gelpí-Acosta
- grid.212340.60000000122985718LaGuardia Community College, City University of New York, 31-10 Thomson Avenue, Long Island City, NY 11101 USA
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Joudrey PJ, Kolak M, Lin Q, Paykin S, Anguiano V, Wang EA. Assessment of Community-Level Vulnerability and Access to Medications for Opioid Use Disorder. JAMA Netw Open 2022; 5:e227028. [PMID: 35438757 PMCID: PMC9020217 DOI: 10.1001/jamanetworkopen.2022.7028] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Given that COVID-19 and recent natural disasters exacerbated the shortage of medication for opioid use disorder (MOUD) services and were associated with increased opioid overdose mortality, it is important to examine how a community's ability to respond to natural disasters and infectious disease outbreaks is associated with MOUD access. OBJECTIVE To examine the association of community vulnerability to disasters and pandemics with geographic access to each of the 3 MOUDs and whether this association differs by urban, suburban, or rural classification. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study of zip code tabulation areas (ZCTAs) in the continental United States excluding Washington, DC, conducted a geospatial analysis of 2020 treatment location data. EXPOSURES Social vulnerability index (US Centers for Disease Control and Prevention measure of vulnerability to disasters or pandemics). MAIN OUTCOMES AND MEASURES Drive time in minutes from the population-weighted center of the ZCTA to the ZCTA of the nearest treatment location for each treatment type (buprenorphine, methadone, and extended-release naltrexone). RESULTS Among 32 604 ZCTAs within the continental US, 170 within Washington, DC, and 20 without an urban-rural classification were excluded, resulting in a final sample of 32 434 ZCTAs. Greater social vulnerability was correlated with longer drive times for methadone (correlation, 0.10; 95% CI, 0.09 to 0.11), but it was not correlated with access to other MOUDs. Among rural ZCTAs, increasing social vulnerability was correlated with shorter drive times to buprenorphine (correlation, -0.10; 95% CI, -0.12 to -0.08) but vulnerability was not correlated with other measures of access. Among suburban ZCTAs, greater vulnerability was correlated with both longer drive times to methadone (correlation, 0.22; 95% CI, 0.20 to 0.24) and extended-release naltrexone (correlation, 0.15; 95% CI, 0.13 to 0.17). CONCLUSIONS AND RELEVANCE In this study, communities with greater vulnerability did not have greater geographic access to MOUD, and the mismatch between vulnerability and medication access was greatest in suburban communities. Rural communities had poor geographic access regardless of vulnerability status. Future disaster preparedness planning should match the location of services to communities with greater vulnerability to prevent inequities in overdose deaths.
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Affiliation(s)
- Paul J. Joudrey
- Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Marynia Kolak
- Healthy Regions & Policies Lab, Center for Spatial Data Science, University of Chicago, Chicago, Illinois
| | - Qinyun Lin
- Healthy Regions & Policies Lab, Center for Spatial Data Science, University of Chicago, Chicago, Illinois
| | - Susan Paykin
- Healthy Regions & Policies Lab, Center for Spatial Data Science, University of Chicago, Chicago, Illinois
| | - Vidal Anguiano
- Healthy Regions & Policies Lab, Center for Spatial Data Science, University of Chicago, Chicago, Illinois
| | - Emily A. Wang
- Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- SEICHE Center for Health and Justice, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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Mezaache S, Briand-Madrid L, Laporte V, Rojas Castro D, Carrieri P, Roux P. A syndemic examination of injecting drug use, incarceration and multiple drug-related harms in French opioid users. Int J Prison Health 2021; 18:417-428. [PMID: 34928106 DOI: 10.1108/ijph-06-2021-0056] [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] [Indexed: 11/17/2022]
Abstract
PURPOSE People who inject drugs (PWID) face multiple health problems, including infectious diseases and drug overdoses. Applying syndemic and risk environment frameworks, this paper aims to examine the co-occurrence and clustering of drug-related harms and their association with incarceration experience with or without in-prison drug injection. DESIGN/METHODOLOGY/APPROACH The authors used data from a cross-sectional survey conducted in 2015 among 557 active opioid injectors. Self-reported data were collected through face-to-face or online questionnaires. They distinguished three harm categories, namely, viral infections, bacterial infections and overdoses, and built an index variable by summing the number of harm categories experienced, yielding a score from 0 to 3. Association between incarceration experience and co-occurrence of harms was modelled using a multinomial logistic regression. FINDINGS Of the 557 participants, 30% reported lifetime experience of drug-related viral infection, 46% bacterial infection and 22% drug overdose. Multinomial logistic models showed that those who injected drugs during incarceration were more likely to report two (aOR = 2.35, 95% CI: 1.03-5.36) and three (aOR = 9.72, 95% CI: 3.23-29.22) harm categories than those who had never been incarcerated. They were also more likely to report three harm categories than formerly incarcerated respondents who did not inject drugs in prison (aOR = 5.14, 95% CI: 1.71-15.48). ORIGINALITY/VALUE This study provides insights of the syndemic nature of drug-related harms and highlights that drug injection during incarceration is associated with co-occurring harms. Public health interventions and policy changes are needed to limit the deleterious impact of prison on PWID.
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Affiliation(s)
- Salim Mezaache
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France and ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Laélia Briand-Madrid
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France and ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | | | - Daniela Rojas Castro
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France; ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France and Coalition PLUS, Pantin, France
| | - Patrizia Carrieri
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France, and ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Perrine Roux
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France, and ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
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Vega Ocasio D, Pérez Ramos JG, Dye TDV. "Y no quedó nada, nada de la casa, todo salió volando" (And there was nothing left, nothing of the house, everything flew away): a critical medical ecological perspective on the lived experience of hurricane María in Puerto Rico. BMC Public Health 2021; 21:1833. [PMID: 34627180 PMCID: PMC8502391 DOI: 10.1186/s12889-021-11847-w] [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: 03/04/2021] [Accepted: 09/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background Ecological disasters create dramatic changes as man-made and natural ecosystems adapt to their effects. In 2017, Hurricanes Irma and María devastated Puerto Rico. Public focus after such traumatic ecological events often neglects pre-existing community dynamics, heterogeneity of lived experience, and complexity of decision-making in the disaster context. We intended to better understand the lived experience of this ecological trauma in communities across ecosystems in Puerto Rico and among those displaced to Florida. Method We used the Critical Medical Ecological (CME) framework to assess the relative contribution of ecological dimensions on lived experience across community levels and time. We used qualitative methods with emic coding and etic mapping of salient constructs to the ecological model. In total, 96 people participated in 23 discussion encounters. Two people coded interviews in Spanish using Dedoose. We identified common themes in sequential order mapped to elements of the CME to approximate the participants’ temporal experience. Results Codes applied to the period of the hurricane’s landfall, traverse, and exit were markedly distinct from the other two periods (before and after) examined in this study: the experience of the hurricane’s strike was highly personal and, at this level, reflected a mix of sociocultural, biological, and abiotic factors. After the hurricanes, social and community factors re-emerged while new risks and conditions arose that were biological (e.g., leptospirosis, no food or water) or abiotic (e.g., unusable roads/bridges, structures destroyed), but created ongoing stressors and social needs for communities. As we found, the dynamics of the social and household landscape sometimes involved the decision to leave Puerto Rico altogether, or forced people to continually face and adapt to the ongoing collapse in basic services that were only slowly and differentially restored. Conclusion Lived experience across each stage of the hurricanes differed substantially from one another. Communities disrupted by ecological disaster are also frequently entangled within global economic and political histories and dependencies that could preclude recovery. Island nations are especially vulnerable to both climate-induced ecological change and political-economic exploitation. The ongoing health effect of the hurricane remains palpable in many communities of Puerto Rico and among the diaspora in Florida. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11847-w.
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Affiliation(s)
- D Vega Ocasio
- Department of Obstetrics and Gynecology, University of Rochester, School of Medicine and Dentistry, 601 Elmwood Avenue, Box 668, Rochester, NY, 14642, USA
| | - J G Pérez Ramos
- Department of Obstetrics and Gynecology, University of Rochester, School of Medicine and Dentistry, 601 Elmwood Avenue, Box 668, Rochester, NY, 14642, USA
| | - T D V Dye
- Department of Obstetrics and Gynecology, University of Rochester, School of Medicine and Dentistry, 601 Elmwood Avenue, Box 668, Rochester, NY, 14642, USA.
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Melin K, Zhang C, Zapata JP, Rivera YM, Fernandez K, Shacham E, Malavé-Rivera SM, Rodriguez-Diaz CE. Factors Associated with Intention to Receive Vaccination against COVID-19 in Puerto Rico: An Online Survey of Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7743. [PMID: 34360042 PMCID: PMC8345654 DOI: 10.3390/ijerph18157743] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/02/2021] [Accepted: 07/12/2021] [Indexed: 01/22/2023]
Abstract
We conducted an online survey among adults in Puerto Rico to identify factors associated with the intention to receive vaccination against COVID-19. Sociodemographic variables were analyzed independently for association with intent to receive vaccination. Significant associations were included in the multivariate logistic regression analysis. A total of 1016 responses were available for analysis. In the bivariate analysis, younger age, higher education, pre-COVID-19 employment, male sex, gay/bisexual identity, and single marital status were associated with increased intent to receive the vaccination. In the multivariate logistic regression, younger, male respondents, and those with higher educational attainment reported higher intent to receive the vaccination. Lower-income and living outside the San Juan metro region were associated with lower intent to receive the vaccination. National and international health organizations were identified as the most reliable sources of information, followed by healthcare professionals. These findings highlight the importance of considering sociodemographic characteristics and using trusted sources of information when designing COVID-19 vaccination public messaging.
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Affiliation(s)
- Kyle Melin
- Department of Pharmacy Practice, School of Pharmacy, University of Puerto Rico Medical Sciences Campus, San Juan, PR 00931, USA
| | - Cheyu Zhang
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA; (C.Z.); (K.F.); (C.E.R.-D.)
| | - Juan P. Zapata
- Department of Psychology, Marquette University, Milwaukee, WI 53233, USA;
| | - Yonaira M. Rivera
- Department of Communication, School of Communication and Information, Rutgers University, New Brunswick, NJ 08901, USA;
| | - Katie Fernandez
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA; (C.Z.); (K.F.); (C.E.R.-D.)
| | - Enbal Shacham
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO 63104, USA;
| | - Souhail M. Malavé-Rivera
- Center for Evaluation and Sociomedical Research, Graduate School of Public Health, Medical Sciences Campus, San Juan, PR P.O. Box 35607, USA;
| | - Carlos E. Rodriguez-Diaz
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA; (C.Z.); (K.F.); (C.E.R.-D.)
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10
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Quiñones DS, Melin K, Roman L, Rodriguez F, Alvarado J, Rodríguez-Díaz CE. Treating Opioid Use Disorder in Puerto Rico During the COVID-19 Pandemic: Providers' Leadership Efforts in Unprecedented Times. J Addict Med 2021; 15:276-279. [PMID: 33229933 PMCID: PMC8327765 DOI: 10.1097/adm.0000000000000764] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/26/2020] [Indexed: 11/25/2022]
Abstract
Opioid use disorder (OUD) is an unprecedented medical and public health issue both in Puerto Rico (PR) and the greater US with an increase incidence of opioid use every year. Unprecedented and compounded emergencies in PR such as those caused by hurricanes, earthquakes, and the COVID-19 pandemic coupled with limited national and local governmental support, has forced most clinics in PR to take action to be able to continue providing care. This commentary summarizes the leadership and clinical initiatives of 3 community organizations in PR to maintain services for people with OUD during the COVID-19 pandemic. Local legislation that supported the continuity of OUD care is summarized, along with unique experiences specific to each organization. In addition, the vulnerability of economically disadvantaged people or experiencing homelessness as well as those affected by these compounded events in PR is discussed, with an emphasis on how some challenges were addressed and future directions for continuity of care as our country adjusts to new demands caused by the COVID-19 pandemic.
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Affiliation(s)
- Darlene Santiago Quiñones
- School of Pharmacy, Medical Sciences Campus, University of Puerto Rico, San Juan, PR (DSQ); School of Pharmacy, Medical Sciences Campus, University of Puerto Rico, San Juan, PR (KM); SANOS Corporation, Buprenorphine Treatment Clinic, Caguas, PR (LR); Coalición de Coaliciones, Ponce, PR (FR); Pitirre Iniciativa Comunitaria, San Juan, PR (JA); Community-Oriented Primary Care Program, Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC (CER); Social Sciences Department, School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, PR (CER)
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11
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Cano M, Gelpí-Acosta C. Risk of Drug Overdose Mortality for Island-Born and US-Born Puerto Ricans, 2013-2019. J Racial Ethn Health Disparities 2021; 9:1403-1414. [PMID: 34081305 DOI: 10.1007/s40615-021-01077-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 01/06/2023]
Abstract
In the United States (US), individuals of Puerto Rican heritage die of drug overdoses at higher rates than other Hispanic groups or non-Hispanic Whites; yet, little is known about the extent to which drug overdose mortality affects island-born, versus US-born, Puerto Ricans. The distinction between Puerto Rican-born and US-born provides a starting point for culturally tailored services and interventions, as place of birth often informs language preferences and cultural identifications. Therefore, this study analyzed 2013-2019 death certificate data from the National Center for Health Statistics for 415,111 US deaths attributed to drug overdose. Drug overdose deaths were compared for island-born Puerto Ricans (N=3516), US-born Puerto Ricans (N=4949), and individuals not of Puerto Rican heritage (N=406,646). Drug overdose mortality rates, including age-specific and directly age-standardized rates, were calculated for each subgroup using population estimates from the US Census Bureau's American Community Survey. Results indicated that age-adjusted drug overdose mortality rates over the period of 2013-2019 were significantly higher for island-born than US-born Puerto Rican men (46.8 versus 34.6, per 100,000), with rates in both groups significantly higher than for men not of Puerto Rican heritage (24.0 per 100,000). For women, in contrast, drug overdose mortality rates were lower for island-born than US-born Puerto Ricans (8.6 versus 11.1, per 100,000). Within stateside Puerto Rican communities, island-born men experience a disproportionate burden of drug overdose mortality, necessitating targeted, culturally appropriate interventions built around the specific norms, circumstances, and lived experiences shared by Puerto Rican migrants who use drugs.
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Affiliation(s)
- Manuel Cano
- University of Texas at San Antonio, 501 W. César E. Chávez Blvd, San Antonio, TX, 78207, USA.
| | - Camila Gelpí-Acosta
- LaGuardia Community College, City University of New York, 31-10 Thomson Avenue, Long Island City, NY, 11101, USA
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12
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Muncan B, Jordan AE, Perlman DC, Frank D, Ompad DC, Walters SM. Acceptability and Effectiveness of Hepatitis C Care at Syringe Service Programs for People Who Inject Drugs in New York City. Subst Use Misuse 2021; 56:728-737. [PMID: 33682610 PMCID: PMC8514132 DOI: 10.1080/10826084.2021.1892142] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction/Objectives: The incidence of hepatitis C (HCV) infection is rising among people who inject drugs (PWID). Even in the context of known HCV prevention and treatment strategies, some PWID remain unengaged in HCV care. This study aimed to identify and characterize experiences and perceptions of PWID regarding the acceptability and effectiveness of HCV testing and treatment at a local syringe service program (SSP). Methods: A total of 36 PWID participated in semi-structured interviews at an SSP in New York City. Interviews were audio-recorded, transcribed, and coded by three coders, following a constructivist grounded theory approach. Relevant themes were identified as they emerged from the data. Results: Interviews with PWID revealed three themes related to the impact of SSPs on HCV care: (1) non-stigmatizing SSP environments, (2) the role of SSPs in improving HCV knowledge, and (3) acceptability of SSPs as sites for HCV care among PWID. Discussion: This paper contributes to the ongoing understanding that SSPs provide a well-accepted source of HCV services for PWID. Participants believed that SSPs are accessible and effective sites for HCV care, and suggested that stigma among PWID continues to affect receipt of HCV care in traditional settings. Conclusions: Understanding attitudes and beliefs of PWID regarding the effectiveness of SSPs as sites for HCV care is crucial for the development of focused strategies to reduce HCV transmission, and to ultimately achieve HCV elimination. Given this, further research is warranted investigating how best to improve HCV care at harm reduction sites such as SSPs.
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Affiliation(s)
- Brandon Muncan
- Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA
| | - Ashly E. Jordan
- Behavioral Science Training Program in Drug Abuse Research, Rory Meyers College of Nursing, New York University, New York, NY, USA
- Center for Drug Use and HIV/HCV Research, New York, NY, USA
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - David C. Perlman
- Center for Drug Use and HIV/HCV Research, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Frank
- Behavioral Science Training Program in Drug Abuse Research, Rory Meyers College of Nursing, New York University, New York, NY, USA
- Center for Drug Use and HIV/HCV Research, New York, NY, USA
| | - Danielle C. Ompad
- Center for Drug Use and HIV/HCV Research, New York, NY, USA
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, USA
| | - Suzan M. Walters
- Behavioral Science Training Program in Drug Abuse Research, Rory Meyers College of Nursing, New York University, New York, NY, USA
- Center for Drug Use and HIV/HCV Research, New York, NY, USA
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13
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Abadie R, McLean K, Habecker P, Dombrowski K. Treatment trajectories and barriers in opioid agonist therapy for people who inject drugs in rural Puerto Rico. J Subst Abuse Treat 2021; 127:108347. [PMID: 34134865 DOI: 10.1016/j.jsat.2021.108347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 01/18/2021] [Accepted: 02/15/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Research has shown medication for opioid use disorder (MOUD) to have positive effects, including reducing HIV and HCV transmission, but important barriers to access remain among people who inject drugs (PWID). Barriers include lack of social and familial support, bureaucracy, distance to treatment, poverty, and homelessness. However, we know little about how these barriers interact with each other to shape PWID's drug treatment access and retention. METHODS We used qualitative methods with a dataset from a study conducted during 2019 with 31 active PWID residing in rural Puerto Rico. The study gathered ethnographic data and narratives about treatment trajectories to document the lived experiences of PWID as they moved in and out of treatment. RESULTS Participants were at least 18 years old; 87.7% were male, the mean age was 44.1 years, and the mean age at first injection was 22 years. Participants identified homelessness, lack of proper ID or other identifying documents, and previous negative experiences with MOUD as the main barriers to treatment entry and retention. In addition, PWID's belief that MOUD simply substitutes an illegal drug for a legal one, while furthering drug dependence by chronically subjecting patients to treatment, constitutes an additional barrier to entry. Findings from this study demonstrate that MOUD barriers to access and retention compound and are severely affected by poverty and other forms of vulnerability among PWID in rural Puerto Rico. CONCLUSION Policies to increase access and retention should consider barriers not in isolation but as an assemblage of many factors.
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Affiliation(s)
- Roberto Abadie
- Department of Anthropology, University of Nebraska-Lincoln, 839 Old Father Hall, Lincoln, NE 68588, United States of America.
| | - Katherine McLean
- Department of Administration of Justice, Penn State Greater Allegheny, 400 University Drive, McKeesport, PA 15216, United States of America
| | - Patrick Habecker
- Department of Sociology, University of Nebraska-Lincoln, 430 Old Father Hall, Lincoln, NE 68588, United States of America
| | - Kirk Dombrowski
- Department of Anthropology, University of Vermont, 72 University Place, VT 05405, United States of America
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14
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Drug overdose mortality among stateside Puerto Ricans: Evidence of a health disparity. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 90:103079. [PMID: 33341699 DOI: 10.1016/j.drugpo.2020.103079] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/23/2020] [Accepted: 11/29/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND This study compared drug overdose mortality rates in Puerto Rican-heritage and Non-Hispanic (NH) White individuals in the United States (US), examining time trends and recent variation by age, sex, state of residence, and drugs involved in overdose. METHODS Death certificate data from the National Center for Health Statistics, as well as American Community Survey population estimates, were used to calculate age-specific and age-adjusted drug overdose mortality rates for Puerto Rican-heritage and NH White residents of the 50 United States or District of Columbia (DC). Rates for 2018 were compared between Puerto Rican-heritage and NH White individuals, overall and by sex, age, state, and specific drug involved in overdose. Joinpoint Regression was used to examine trends in drug overdose mortality rates from 2009 to 2018. RESULTS From 2009 to 2018, the age-adjusted drug overdose mortality rate in stateside Puerto Ricans doubled among women (from 6.0 to 12.5 per 100,000) and nearly tripled among men (from 15.3 to 45.2 per 100,000). In 2018, the age-adjusted drug overdose mortality rate was significantly higher in Puerto Rican-heritage than NH White individuals (28.7 vs. 26.2 per 100,000, respectively). The 2018 drug overdose mortality rate was highest among Puerto Rican-heritage men ages 45-54 (104.1 per 100,000). CONCLUSION Findings emphasize the necessity of policies, programs, and interventions to mitigate risk of fatal overdose in stateside Puerto Rican communities.
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Abadie R, Dombrowski K. "Caballo": risk environments, drug sharing and the emergence of a hepatitis C virus epidemic among people who inject drugs in Puerto Rico. Harm Reduct J 2020; 17:85. [PMID: 33097062 PMCID: PMC7582446 DOI: 10.1186/s12954-020-00421-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sharing drug injection equipment has been associated with the transmission of HCV among PWID through blood contained in the cooker and cotton used to prepare and divide up the drug solution. While epidemiologists often subsume this practice under the sharing of "ancillary equipment," more attention should be paid to the fact that indirect sharing takes place within the process of joint drug acquisition and preparation. METHODS We employed an ethnographic approach observing active PWID (N = 33) in four rural towns in Puerto Rico in order to document drug sharing arrangements involved in "caballo", as this practice is locally known. We explored partners' motivation to engage in drug sharing, as well as its social organization, social roles and existing norms. FINDINGS Findings suggest that drug sharing, is one of the main drivers of the HCV epidemic in this population. Lack of financial resources, drug packaging, drug of choice and the desire to avoid the painful effects of heroin withdrawal motivates participants' decision to partner with somebody else, sharing injection equipment-and risk-in the process. Roles are not fixed, changing not only according to caballo partners, but also, power dynamics. CONCLUSION In order to curb the HCV epidemic, harm reduction policies should recognize the particular sociocultural contexts in which people inject drugs and make decisions about risk. Avoiding sharing of injection equipment within an arrangement between PWID to acquire and use drugs is more complex than assumed by harm reduction interventions. Moving beyond individual risk behaviors, a risk environment approach suggest that poverty, and a strict drug policy that encourage users to carry small amounts of illicit substances, and a lack of HCV treatment among other factors, contribute to HCV transmission.
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Affiliation(s)
- R Abadie
- Department of Anthropology, University of Nebraska-Lincoln, 839 Oldfather Hall, Lincoln, NE, 68588, USA.
| | - K Dombrowski
- Department of Anthropology, University of Vermont, 72 University Place, Burlington, VE, 05405, USA
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Abadie R, Gelpi-Acosta C, Aquino-Ruiz F, Aponte-Melendez Y. COVID-19 risks among people who inject drugs in Puerto Rico. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 93:102903. [PMID: 33069554 PMCID: PMC7428716 DOI: 10.1016/j.drugpo.2020.102903] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/02/2020] [Accepted: 08/04/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Roberto Abadie
- Department of Anthropology, University of Nebraska-Lincoln. 839 Oldfather Hall. Lincoln, NE, United States.
| | - Camila Gelpi-Acosta
- Social Science Department, LaGuardia Community College, 29-10 Thompson Avenue, New York, NY 11101, United States
| | - Frank Aquino-Ruiz
- Sociology and Anthropology Department, University of Puerto Rico, Rio Piedras, San Juan, PR 00931, United States
| | - Yesenia Aponte-Melendez
- The CUNY Graduate School of Public Health and Health Policy, 55W 125th St., New York, NY 10027, United States
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