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Wiessing L, Sypsa V, Abagiu AO, Arble A, Berndt N, Bosch A, Buskin S, Chemtob D, Combs B, Conyngham C, Feelemyer J, Fitzgerald M, Goldberg D, Hatzakis A, Patrascu RE, Keenan E, Khan I, Konrad S, Leahy J, McAuley A, Menza T, Merrick S, Metcalfe R, Rademaker T, Revivo S, Rosca P, Seguin-Devaux C, Skinner S, Smith C, Tinsley J, Wilberg M, Des Jarlais D. Impact of COVID-19 & Response Measures on HIV-HCV Prevention Services and Social Determinants in People Who Inject Drugs in 13 Sites with Recent HIV Outbreaks in Europe, North America and Israel. AIDS Behav 2023; 27:1140-1153. [PMID: 36367613 PMCID: PMC9651099 DOI: 10.1007/s10461-022-03851-x] [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] [Accepted: 08/30/2022] [Indexed: 11/13/2022]
Abstract
HIV/HCV prevention among people who inject drugs (PWID) is of key public health importance. We aimed to assess the impact of COVID-19 and associated response measures on HIV/HCV prevention services and socio-economic status of PWID in high-HIV-risk sites. Sites with recent (2011-2019) HIV outbreaks among PWID in Europe North America and Israel, that had been previously identified, were contacted early May 2020. Out of 17 sites invited to participate, 13 accepted. Semi-structured qualitative site reports were prepared covering data from March to May 2020, analyzed/coded and confirmed with a structured questionnaire, in which all sites explicitly responded to all 103 issues reported in the qualitative reports. Opioid maintenance treatment, needle/syringe programs and antiretroviral treatment /hepatitis C treatment continued, but with important reductions and operational changes. Increases in overdoses, widespread difficulties with food and hygiene needs, disruptions in drug supply, and increased homelessness were reported. Service programs rapidly reformed long established, and politically entrenched, restrictive service delivery policies. Future epidemic control measures should include mitigation of negative side-effects on service provision and socio-economic determinants in PWID.
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Affiliation(s)
- Lucas Wiessing
- Public Health Unit, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Praça Europa 1, Cais do Sodré, 1249-289, Lisbon, Portugal.
| | - V Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - A O Abagiu
- National Institute for Infectious Diseases, Bucharest, Romania
| | - A Arble
- Hamilton County Public Health, Cincinnati, OH, USA
| | - N Berndt
- Luxembourg National Focal Point of the European Monitoring Centre for Drugs and Drug Addiction, Department of Epidemiology and Statistics, Directorate of Health, Luxembourg-Hamm, Luxembourg
| | - A Bosch
- STD, HIV, and TB Section - Infectious Disease Epidemiology, Prevention and Control, Minnesota Department of Health, St. Paul, MN, USA
| | - S Buskin
- University of Washington, Seattle, WA, USA
- Public Health - Seattle & King County, Seattle, WA, USA
| | - D Chemtob
- Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel
- Braun School of Public Health and Community Medicine, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - B Combs
- Scott County Health Department, Scottsburg, IN, USA
| | - C Conyngham
- Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - J Feelemyer
- School of Global Public Health, New York University, New York, NY, USA
| | - M Fitzgerald
- National Social Inclusion Office, Health Services Executive, Dublin, Ireland
| | - D Goldberg
- Public Health Scotland, Glasgow, Scotland, United Kingdom
| | - A Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - R E Patrascu
- National Institute for Infectious Diseases, Bucharest, Romania
| | - E Keenan
- National Social Inclusion Office, Health Services Executive, Dublin, Ireland
| | - I Khan
- First Nations and Inuit Health Branch, Indigenous Services Canada, Regina, Canada
| | - S Konrad
- First Nations and Inuit Health Branch, Indigenous Services Canada, Regina, Canada
| | - J Leahy
- Oregon Health Authority, Portland, OR, USA
| | - A McAuley
- Public Health Scotland, Glasgow, Scotland, United Kingdom
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom
| | - T Menza
- Oregon Health Authority, Portland, OR, USA
- Oregon Health and Science University, Portland, OR, USA
| | - S Merrick
- Hamilton County Public Health, Cincinnati, OH, USA
| | - R Metcalfe
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom
- Sandyford Sexual Health Service, Glasgow, Scotland, United Kingdom
| | - T Rademaker
- Hamilton County Public Health, Cincinnati, OH, USA
| | - S Revivo
- Izhar Needle and Syringe Programme, Public Health Association, Jerusalem, Israel
| | - P Rosca
- Department for the Treatment of Substance Abuse, Ministry of Health, Jerusalem, Israel
| | - C Seguin-Devaux
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - S Skinner
- University of Saskatchewan, Saskatoon, Canada
| | - C Smith
- Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - J Tinsley
- Public Health - Seattle & King County, Seattle, WA, USA
| | - M Wilberg
- Minnesota Department of Human Services, St. Paul, Minnesota, USA
| | - D Des Jarlais
- School of Global Public Health, New York University, New York, NY, USA
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Bratberg JP, Simmons A, Arya V, Bhatia A, Vakharia SP. Support, don't punish: Drug decriminalization is harm reduction. J Am Pharm Assoc (2003) 2023; 63:224-229. [PMID: 36682855 DOI: 10.1016/j.japh.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 12/05/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
Despite large investments in and policy support for harm reduction including naloxone, syringes, and medications for opioid use disorder, people who use drugs continue to experience unprecedented rates of mortality from overdose and morbidity from infectious diseases. The criminalization of drug use has disproportionately exacerbated these drug-related harms and imposed short- and long-term burdens on already marginalized and vulnerable populations. Pharmacy professionals and students are not immune to the effects of drug criminalization, where one conviction can lead to the loss of their license, employment, or educational progress. Communities become less healthy and stagnate in punitive criminalization systems, further reducing opportunities for growth. Decriminalization of drug use and possession is an urgently needed and effective approach to drug use that shifts resources from punishment to public health, thereby reducing the negative impacts of drug use and keeping communities safe and healthy. Pharmacists play essential roles in the prevention and management of drug misuse and use disorders. As policy makers consider and implement drug decriminalization, pharmacists must actively advocate for these policies and educate community and organizational partners on the individual, professional, and community benefits of this harm reduction strategy.
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Generaal E, Logtenberg van der Grient H, Schatz E, van Santen DK, Boyd A, Woods SK, Baak BLC, Prins M. A Feasibility Study to Increase Chronic Hepatitis C Virus RNA Testing and Linkage to Care among Clients Attending Homeless Services in Amsterdam, The Netherlands. Diagnostics (Basel) 2021; 11:diagnostics11071197. [PMID: 34209440 PMCID: PMC8306529 DOI: 10.3390/diagnostics11071197] [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: 05/07/2021] [Revised: 06/25/2021] [Accepted: 06/25/2021] [Indexed: 11/16/2022] Open
Abstract
People who inject drugs (PWID) are disproportionately affected by hepatitis C virus (HCV) infections and are frequently homeless. To improve HCV case finding in these individuals, we examined the feasibility of rapid HCV RNA testing in homeless services in Amsterdam. In 2020, we provided a comprehensive service to homeless facilities, which included workshops on HCV for personnel, a “hepatitis ambassador” at each facility, a rapid, onsite HCV RNA fingerstick test service, and assistance with linkage to care. Risk factors for HCV RNA-positive status were examined using Bayesian logistic regression. Of the 152 participants enrolled, 150 (87% men; median age: 47 years) accepted rapid HCV testing. Seven tested HCV RNA positive (4.7%, 95%CrI = 1.31–8.09; 7/150). Of these, five (71%) were linked to care, of whom four (57%, 4/7) initiated treatment and one (14%, 1/7) delayed treatment due to a drug–drug interaction. Of these four people, two completed treatment (50%), of whom one (25%) achieved sustained virologic response after 12 weeks. HCV RNA-positive individuals were more likely to originate from Eastern Europe (posterior-odds ratio (OR) = 3.59 (95% credible interval (CrI) = 1.27–10.04)) and to inject drugs (ever: posterior-OR = 3.89 (95% CrI = 1.37–11.09); recent: posterior-OR = 3.94 (95% CrI = 1.29–11.71)). We identified HCV RNA-positive individuals and linkage to care was relatively high. Screening in homeless services with rapid testing is feasible and could improve HCV case finding for PWID who do not regularly attend primary care or other harm reduction services for people who use drugs.
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Affiliation(s)
- Ellen Generaal
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, 1018 WT Amsterdam, The Netherlands; (D.K.v.S.); (A.B.); (M.P.)
- Correspondence: ; Tel.: +31-(0)20-555-5043
| | | | - Eberhard Schatz
- De Regenboog Groep, 1013 GE Amsterdam, The Netherlands; (H.L.v.d.G.); (E.S.)
| | - Daniela K. van Santen
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, 1018 WT Amsterdam, The Netherlands; (D.K.v.S.); (A.B.); (M.P.)
- Disease Elimination Programs, Burnet Institute, Melbourne, VIC 3004, Australia
| | - Anders Boyd
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, 1018 WT Amsterdam, The Netherlands; (D.K.v.S.); (A.B.); (M.P.)
- Stichting HIV Monitoring, 1105 BD Amsterdam, The Netherlands
| | | | - Bert L. C. Baak
- Department of Gastroenterology and Hepatology, OLVG Hospital, 1091 AC Amsterdam, The Netherlands;
| | - Maria Prins
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, 1018 WT Amsterdam, The Netherlands; (D.K.v.S.); (A.B.); (M.P.)
- Department of Infectious Diseases, Amsterdam UMC, Location AMC, Amsterdam Infection and Immunity (AII), University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
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Derks L, Gassowski M, Nielsen S, An der Heiden M, Bannert N, Bock CT, Bremer V, Kücherer C, Ross S, Wenz B, Marcus U, Zimmermann R. Risk behaviours and viral infections among drug injecting migrants from the former Soviet Union in Germany: Results from the DRUCK-study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 59:54-62. [PMID: 30005420 DOI: 10.1016/j.drugpo.2018.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 04/25/2018] [Accepted: 06/11/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND High prevalence of drug use and injection-related risk behaviours have been reported among former Soviet Union (FSU)-migrants. To investigate hepatitis C (HCV) and HIV seroprevalence and related risk behaviours in this subgroup in Germany, we compared first generation FSU-migrants and native Germans using data from a sero-behavioural survey of people who inject drugs (PWID). METHODS Current injectors were recruited using respondent-driven sampling in eight German cities in 2011-2014. Questionnaire-based interviews were conducted and dried blood spots collected and tested for anti-HCV, HCV-RNA, and anti-HIV1/2. Descriptive and multivariable analyses (MVA) were performed. RESULTS A total of 208 FSU-born and 1318 native German PWID were included in the analysis. FSU-migrants were younger than Germans (median age: 33 vs. 39 years), and more often male (83.1% vs. 75.9%, p = 0.022). HCV seroprevalence was 74.5% in FSU-migrants vs. 64.6% in Germans (p = 0.006), HIV seroprevalence was 5.8% and 4.6%, respectively (p = 0.443). The proportion of FSU-migrants reporting injecting-related risk behaviours was higher than among Germans: injecting daily (39.4% vs. 30.2%, p = 0.015), with friends (39.2% vs. 31.2%, p = 0.038), cocaine (32.7% vs. 23.8%, p = 0.044), more than one drug (18.2% vs. 9.6%, p = 0.006), and sharing filters/cookers (35.5% vs. 28.0%, p = 0.045). No statistically significant differences were observed in HIV/HCV testing rates (range: 50.7%-65.6%), opioid substitution treatment (43.9% vs. 50.5%), and access to clean needles/syringes (89.8% vs. 90.3%). In MVA, risk for HCV-infection was increased in male FSU-migrants compared to German males (OR 3.32, p = 0.006), no difference was identified between female FSU-migrants and German females (OR: 0.83, p = 0.633). CONCLUSION Male FSU-migrants were at highest risk of being HCV infected. Therefore, targeted actions are needed to ensure access and acceptance of harm reduction measures, including HCV-testing and -treatment for this subpopulation of PWID.
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Affiliation(s)
- Lineke Derks
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Martyna Gassowski
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Stine Nielsen
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany; Charité University Medicine, Berlin, Germany
| | - Matthias An der Heiden
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Norbert Bannert
- Department of Infectious Diseases, Division for HIV and other Retroviruses, Robert Koch Institute, Berlin, Germany
| | - Claus-Thomas Bock
- Department of Infectious Diseases, Division for Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Robert Koch Institute, Berlin, Germany
| | - Viviane Bremer
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Claudia Kücherer
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Stefan Ross
- Institute of Virology, National Reference Centre for Hepatitis C, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Benjamin Wenz
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Ulrich Marcus
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Ruth Zimmermann
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany.
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Ellwanger JH, Kaminski VDL, Valverde-Villegas JM, Simon D, Lunge VR, Chies JAB. Immunogenetic studies of the hepatitis C virus infection in an era of pan-genotype antiviral therapies - Effective treatment is coming. INFECTION GENETICS AND EVOLUTION 2017; 66:376-391. [PMID: 28811194 DOI: 10.1016/j.meegid.2017.08.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/10/2017] [Accepted: 08/11/2017] [Indexed: 02/08/2023]
Abstract
What are the factors that influence human hepatitis C virus (HCV) infection, hepatitis status establishment, and disease progression? Firstly, one has to consider the genetic background of the host and HCV genotypes. The immunogenetic host profile will reflect how each infected individual deals with infection. Secondly, there are environmental factors that drive susceptibility or resistance to certain viral strains. These will dictate (I) the susceptibility to infection; (II) whether or not an infected person will promote viral clearance; (III) the immune response and the response profile to therapy; and (IV) whether and how long it would take to the development of HCV-associated diseases, as well as their severity. Looking at this scenario, this review addresses clinical aspects of HCV infection, following by an update of molecular and cellular features of the immune response against the virus. The evasion mechanisms used by HCV are presented, considering the potential role of exosomes in infection. Genetic factors influencing HCV infection and pathogenesis are the main topics of the article. Shortly, HLAs, MBLs, TLRs, ILs, and IFNLs genes have relevant roles in the susceptibility to HCV infection. In addition, ILs, IFNLs, as well as TLRs genes are important modulators of HCV-associated diseases. The viral aspects that influence HCV infection are presented, followed by a discussion about evolutionary aspects of host and HCV interaction. HCV and HIV infections are close related. Thus, we also present a discussion about HIV/HCV co-infection, focusing on cellular and molecular aspects of this interaction. Pharmacogenetics and treatment of HCV infection are the last topics of this review. The understanding of how the host genetics interacts with viral and environmental factors is crucial for the development of new strategies to prevent HCV infection, even in an era of potential development of pan-genotypic antivirals.
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Affiliation(s)
- Joel Henrique Ellwanger
- Laboratório de Imunobiologia e Imunogenética, Departamento de Genética, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Valéria de Lima Kaminski
- Laboratório de Imunobiologia e Imunogenética, Departamento de Genética, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Jacqueline María Valverde-Villegas
- Laboratório de Imunobiologia e Imunogenética, Departamento de Genética, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Daniel Simon
- Laboratório de Genética Molecular Humana, Universidade Luterana do Brasil (ULBRA), Canoas, Brazil
| | - Vagner Ricardo Lunge
- Laboratório de Diagnóstico Molecular, Universidade Luterana do Brasil (ULBRA), Canoas, Brazil
| | - José Artur Bogo Chies
- Laboratório de Imunobiologia e Imunogenética, Departamento de Genética, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
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Crowley D, Cullen W, Laird E, Lambert JS, Mc Hugh T, Murphy C, Van Hout MC. Exploring Patient Characteristics and Barriers to Hepatitis C Treatment in Patients on Opioid Substitution Treatment Attending a Community Based Fibro-scanning Clinic. J Transl Int Med 2017; 5:112-119. [PMID: 28721344 PMCID: PMC5506411 DOI: 10.1515/jtim-2017-0017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Hepatitis C virus (HCV) infection is a major public health issue. There is substandard uptake in HCV assessment and treatment among people who inject drugs (PWID). Community fibroscanning is used to assess disease severity and target treatment. METHODS A survey was administered to a cohort of chronically HCV infected patients attending a community fibroscanning clinic. Questions targeted diagnosis of HCV, suitability, willingness and barriers to engagement in treatment. Descriptive and regression analysis, with thematic analysis of open-ended data was conducted. RESULTS There was high acceptance of community fibroscanning among this cohort with over 90% (68) attending. High levels of unemployment (90%) and homelessness (40%) were identified. Most patients were on methadone treatment and had been HCV infected for greater than 10 years with length of time since HCV diagnosis being significantly longer in patients with fibroscan scores > 8.5 kPa (P = 0.016). With each unit increase in methadone dose, the odds of the >8.5 fibroscan group increased by 5.2%. Patient identified barriers to engagement were alcohol and drug use, fear of HCV treatment and liver biopsy, imprisonment, distance to hospital and early morning appointments. CONCLUSION The study highlights the usefulness of community fibroscanning. Identifying barriers to treatment in this cohort affords an opportunity to increase the treatment uptake. The availability of afternoon clinics and enhanced prison linkage are warranted.
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Affiliation(s)
| | | | - Eamon Laird
- Trinity College Dublin, University College Dublin, Dublin2, Ireland
| | - John S Lambert
- Infectious Disease Department, Mater Hospital, Dublin7, Ireland
| | | | - Carol Murphy
- Infectious Disease Department, Mater Hospital, Dublin7, Ireland
| | - Marie Claire Van Hout
- Public Health Institute, Liverpool John Moore’s University, Liverpool, United Kingdom
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Rey D, Muret P, Piroth L. Optimum combination therapy regimens for HIV/HCV infection. Expert Rev Anti Infect Ther 2016; 14:299-309. [PMID: 26822803 DOI: 10.1586/14787210.2016.1147952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
HIV-HCV co-infection mostly affects intravenous drug users, in whom prevalence has tended to decrease in recent years, while it has increased in men who have sex with men, with occurrence of acute hepatitis C. Hepatitis C has a poorer prognosis in patients co-infected with HIV, as clinical progression is faster and degree of hepatic fibrosis is greater. However, optimized ARV treatment is clearly associated with slower progression to hepatic complications. Interactions between HCV and HIV drugs are numerous, which underlines the importance of pharmacological advice for HIV-treated patients before they start HCV treatment. In HIV-HCV co-infection, treatment of hepatitis C has to be offered as in mono-infected patients (US and European countries) or to all patients (French guidelines). In most patients, HCV eradication is achieved with different DAA associations, the choice and duration being driven by HCV genotype, hepatic fibrosis stage, and whether patients have been previously treated or not.
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Affiliation(s)
- David Rey
- a Le Trait d'Union, Center for HIV Care, NHC , Hôpitaux Universitaires , Strasbourg , France
| | - Patrice Muret
- b Laboratoire de Pharmacologie Clinique , INSERM U1098 , CHRU Besançon , France
| | - Lionel Piroth
- c Infectious Diseases Department, Centre Hospitalier Universitaire and UMR 1347 , Université de Bourgogne , Dijon , France
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Wenz B, Nielsen S, Gassowski M, Santos-Hövener C, Cai W, Ross RS, Bock CT, Ratsch BA, Kücherer C, Bannert N, Bremer V, Hamouda O, Marcus U, Zimmermann R. High variability of HIV and HCV seroprevalence and risk behaviours among people who inject drugs: results from a cross-sectional study using respondent-driven sampling in eight German cities (2011-14). BMC Public Health 2016; 16:927. [PMID: 27595567 PMCID: PMC5011883 DOI: 10.1186/s12889-016-3545-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 08/18/2016] [Indexed: 12/15/2022] Open
Abstract
Background People who inject drugs (PWID) are at increased risk of acquiring and transmitting HIV and Hepatitis C (HCV) due to sharing injection paraphernalia and unprotected sex. To generate seroprevalence data on HIV and HCV among PWID and related data on risk behaviour, a multicentre sero- and behavioural survey using respondent driven sampling (RDS) was conducted in eight German cities between 2011 and 2014. We also evaluated the feasibility and effectiveness of RDS for recruiting PWID in the study cities. Methods Eligible for participation were people who had injected drugs within the last 12 months, were 16 years or older, and who consumed in one of the study cities. Participants were recruited, using low-threshold drop-in facilities as study sites. Initial seeds were selected to represent various sub-groups of people who inject drugs (PWID). Participants completed a face-to-face interview with a structured questionnaire about socio-demographics, sexual and injecting risk behaviours, as well as the utilisation of health services. Capillary blood samples were collected as dried blood spots and were anonymously tested for serological and molecular markers of HIV and HCV. The results are shown as range of proportions (min. and max. values (%)) in the respective study cities. For evaluation of the sampling method we applied criteria from the STROBE guidelines. Results Overall, 2,077 PWID were recruited. The range of age medians was 29–41 years, 18.5–35.3 % of participants were female, and 9.2–30.6 % were foreign born. Median time span since first injection were 10–18 years. Injecting during the last 30 days was reported by 76.0–88.4 % of participants. Sharing needle/syringes (last 30 days) ranged between 4.7 and 22.3 %, while sharing unsterile paraphernalia (spoon, filter, water, last 30 days) was reported by 33.0–43.8 %. A majority of participants (72.8–85.8 %) reported incarceration at least once, and 17.8–39.8 % had injected while incarcerated. Between 30.8 and 66.2 % were currently in opioid substitution therapy. Unweighted HIV seroprevalence ranged from 0–9.1 %, HCV from 42.3–75.0 %, and HCV-RNA from 23.1–54.0 %. The implementation of RDS as a recruiting method in cooperation with low-threshold drop in facilities was well accepted by both staff and PWID. We reached our targeted sample size in seven of eight cities. Conclusions In the recruited sample of mostly current injectors with a long duration of injecting drug use, seroprevalence for HIV and HCV varied greatly between the city samples. HCV was endemic among participants in all city samples. Our results demonstrate the necessity of intensified prevention strategies for blood-borne infections among PWID in Germany. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3545-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Benjamin Wenz
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Stine Nielsen
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany.,Charité University Medicine, Berlin, Germany
| | - Martyna Gassowski
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Claudia Santos-Hövener
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Wei Cai
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - R Stefan Ross
- Institute of Virology, National Reference Centre for Hepatitis C, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Claus-Thomas Bock
- Department of Infectious Diseases, Division for Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Robert Koch Institute, Berlin, Germany
| | - Boris-Alexander Ratsch
- Department of Infectious Diseases, Division for Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Robert Koch Institute, Berlin, Germany
| | - Claudia Kücherer
- Department of Infectious Diseases, Division for HIV and other Retroviruses, Robert Koch Institute, Berlin, Germany
| | - Norbert Bannert
- Department of Infectious Diseases, Division for HIV and other Retroviruses, Robert Koch Institute, Berlin, Germany
| | - Viviane Bremer
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Osamah Hamouda
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Ulrich Marcus
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Ruth Zimmermann
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany.
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Gilchrist G, Tirado-Munoz J, Taylor A, Fischer G, Moskalewicz J, Köchl B, Giammarchi C, Dabrowska K, Shaw A, Munro A, Di Furia L, Torrens M. An uncontrolled, feasibility study of a group intervention to reduce hepatitis C transmission risk behaviours and increase transmission knowledge among women who inject drugs. DRUGS-EDUCATION PREVENTION AND POLICY 2016. [DOI: 10.1080/09687637.2016.1197885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- G. Gilchrist
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK,
| | - J. Tirado-Munoz
- IMIM-Institut Hospital del Mar d'Investigacions Mèdiques and Institute of Neuropsychiatry and Addictions, Barcelona, Barcelona, Spain,
| | - A. Taylor
- School of Media, Culture and Society, University of the West of Scotland, Paisley, UK,
| | - G. Fischer
- Addiction Clinic, Medical University of Vienna, Vienna, Austria,
| | - J. Moskalewicz
- Department of Studies on Alcoholism and Drug Dependence, Institute of Psychiatry and Neurology, Warsaw, Poland,
| | - B. Köchl
- Addiction Clinic, Medical University of Vienna, Vienna, Austria,
| | | | - K. Dabrowska
- Department of Studies on Alcoholism and Drug Dependence, Institute of Psychiatry and Neurology, Warsaw, Poland,
| | - A. Shaw
- School of Media, Culture and Society, University of the West of Scotland, Paisley, UK,
| | - A. Munro
- School of Media, Culture and Society, University of the West of Scotland, Paisley, UK,
| | - L. Di Furia
- Servizio Salute Regione Marche, Ancona, Italy, and
| | - M. Torrens
- IMIM-Institut Hospital del Mar d'Investigacions Mèdiques and Institute of Neuropsychiatry and Addictions, Barcelona, Barcelona, Spain,
- Psychiatry Department, Universitat Autònoma de Barcelona, Barcelona, Spain
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Direct Observed Therapy of Chronic Hepatitis C With Interferon-Free All-Oral Regimens at a Low-Threshold Drug Treatment Facility-a New Concept for Treatment of Patients With Borderline Compliance Receiving Opioid Substitution Therapy. Am J Gastroenterol 2016; 111:903-5. [PMID: 27249993 DOI: 10.1038/ajg.2016.119] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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11
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Hepatitis B and C prevalence in Portugal: disparity between the general population and high-risk groups. Eur J Gastroenterol Hepatol 2016; 28:640-4. [PMID: 26866523 DOI: 10.1097/meg.0000000000000608] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS The prevalence of anti-HCV and HBsAg in Portugal has been shown to be elevated in high-risk groups, such as intravenous drug-users and incarcerated individuals. However, in the general population, prevalence remains largely unknown. The aims of this study were to estimate the prevalence of anti-HCV and HBsAg in the general Portuguese population and identify associated risk factors. MATERIALS AND METHODS We carried out a nationwide, population-based cross-sectional study of adults resident in mainland Portugal. Serology for HBsAg, anti-HBc, anti-HBs, and anti-HCV was performed. Anti-HCV-positive individuals were tested for HCV RNA by PCR. RESULTS Of 1685 participants, 50.6% were men, mean age 50.2±18.3 years. In terms of hepatitis C, the prevalence of anti-HCV was 0.54% [95% confidence interval (CI): 0.2-0.9] and 0.12% (95% CI: 0.0-0.3) were viremic, with peak prevalence among individuals 35-64 years of age (0.8%), men (0.8%), and individuals from Lisbon and Tagus Valley region (1.9%).In terms of hepatitis B, the estimated prevalence of HBsAg was 1.45% (95% CI: 0.9-2.0). A higher prevalence was found in individuals who were 35-64 years old (2.2%), in men (2.5%), and in the Northern region (2.6%).The presence of positive serological markers of hepatitis C virus and hepatitis B virus infection did not correlate with elevated aminotransferases, race, place of birth, and alcohol consumption. CONCLUSION These results suggest a low endemicity for both hepatitis B and hepatitis C in the general population, in contrast to a very high prevalence in risk groups, thus suggesting that targeted screening to high-risk groups may be more cost-effective than general population screening.
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Wang C, Shi CX, Rou K, Zhao Y, Cao X, Luo W, Liu E, Wu Z. Baseline HCV Antibody Prevalence and Risk Factors among Drug Users in China's National Methadone Maintenance Treatment Program. PLoS One 2016; 11:e0147922. [PMID: 26906025 PMCID: PMC4764346 DOI: 10.1371/journal.pone.0147922] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 01/11/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) is the most common viral infection among injecting drug users worldwide. We aimed to assess HCV antibody prevalence and associated risk factors among clients in the Chinese national methadone maintenance treatment (MMT) program. METHODS Data from 296,209 clients who enrolled in the national MMT program between March 2004 and December 2012 were analyzed to assess HCV antibody prevalence, associated risk factors, and geographical distribution. RESULTS Anti-HCV screening was positive for 54.6% of clients upon MMT entry between 2004 and 2012. HCV antibody prevalence at entry declined from 66.8% in 2005 to 45.9% in 2012. The most significant predictors of HCV seropositivity were injecting drug use (adjusted odds ratio [AOR]: 8.34, 95% confidence interval [CI]: 8.17-8.52, p<0.0001) and a history of drug use ≥9 years (AOR: 2.01, 95% CI: 1.96-2.06, p<0.0001). Being female, of Uyghur or Zhuang ethnicity, and unmarried were identified as demographic risk factors (all p-values<0.0001). Of the 28 provincial-level divisions included in the study, we found that 5 divisions had HCV antibody prevalence above 70% and 20 divisions above 50%. The HCV screening rate within 6 months after MMT entry greatly increased from 30.4% in 2004 to 93.1% in 2012. CONCLUSIONS The current HCV antibody prevalence remains alarmingly high among MMT clients throughout most provincial-level divisions in China, particularly among injecting drug users and females. A comprehensive prevention strategy is needed to control the HCV epidemic among MMT clients in China.
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Affiliation(s)
- Changhe Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Cynthia X. Shi
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Keming Rou
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yan Zhao
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaobin Cao
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wei Luo
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Enwu Liu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail: ;
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Reyes-Urueña J, Brugal MT, Majo X, Domingo-Salvany A, Caylà JA. Cross sectional study of factors associated to self-reported blood-borne infections among drug users. BMC Public Health 2015; 15:1122. [PMID: 26566634 PMCID: PMC4644320 DOI: 10.1186/s12889-015-2442-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 10/22/2015] [Indexed: 11/16/2022] Open
Abstract
Background The study’s aim was to estimate the self-reported prevalence of Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV), and to describe their associated risk factors in a population of users of illicit drugs recruited in Catalonia- Spain, during 2012. Methods Cross-sectional study. People with illicit drugs use were selected in three different types of healthcare centres. The questionnaire was a piloted, structured ad hoc instrument. An analysis was made to identify factors associated to self-reported HCV, HIV and co-infection. Correlates of reported infections were determined using univariate and multivariate Poisson regression (with robust variance). Results Among 512 participants, 39.65 % self-reported positive serostatus for HCV and 14.84 % for HIV, co-infection was reported by 13.48 %. Among the 224 injecting drug users (IDUs), 187 (83.48 %), 68 (30.36 %) and 66 (29.46 %) reported being positive for HCV, HIV and co-infection, respectively. A higher proportion of HIV-infected cases was observed among women, (18.33 % vs. 13.78 % in men). Prevalence of HCV, HIV and co-infection were higher among participants with early onset of drug consumption, long periods of drug injection or who were unemployed. A positive serostatus was self-reported by 21(7.34 %) participants who did not report any injection; among them 16 and eight, reported being positive for HCV and HIV, respectively; three reported co-infection. Only two people declared exchanging sex for money. For those that reported a negative test, the median time since the last HIV test was 11.41 months (inter-quartile range (IQR) 4–12) and for the HCV test was 4.5 months (IQR 2–7). Conclusions Among drug users in Catalonia, HIV, HCV and co-infection prevalence are still a big issue especially among IDUs. Women and drug users who have never injected drugs are groups with a significant risk of infection; this might be related to their high-risk behaviours and to being unaware of their serological status.
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Affiliation(s)
- Juliana Reyes-Urueña
- Department of Paediatrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain. .,Drug Use Epidemiology Research Group, IMIM-Hospital del Mar Medical Research Institute, Dr Aiguader 88, 08003, Barcelona, Spain. .,Teaching Unit of Preventive Medicine and Public Health, PSMAR-UPF-ASPB, Barcelona, Spain. .,Public Health Agency of Barcelona, Barcelona, Spain.
| | - M Teresa Brugal
- Public Health Agency of Barcelona, Barcelona, Spain. .,Institute of Biomedical Research Sant Pau (IIB Sant Pau), Barcelona, Spain.
| | - Xavier Majo
- Department of Health Government of Catalonia, Barcelona, Spain.
| | - Antonia Domingo-Salvany
- Drug Use Epidemiology Research Group, IMIM-Hospital del Mar Medical Research Institute, Dr Aiguader 88, 08003, Barcelona, Spain.
| | - Joan A Caylà
- Department of Paediatrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain. .,Public Health Agency of Barcelona, Barcelona, Spain. .,Institute of Biomedical Research Sant Pau (IIB Sant Pau), Barcelona, Spain. .,CIBER in Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
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García Comas L, Ordobás Gavín M, Sanz Moreno JC, Ramos Blázquez B, Gutiérrez Rodríguez A, Astray Mochales J, Moreno Guillén S. Prevalence of hepatitis C antibodies in the population aged 16-80 years in the Community of Madrid 2008-2009. J Med Virol 2015; 87:1697-701. [PMID: 25989026 DOI: 10.1002/jmv.24219] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2015] [Indexed: 12/18/2022]
Abstract
Together with AIDS, the burden of hepatitis C virus (HCV) in Spain heads the list of communicable diseases in terms of impact on public health. The aim of this study was to estimate the prevalence of HCV antibodies in the Community of Madrid, assess changes in recent years and analyse associated risk factors. Descriptive cross-sectional study of a target population consisting of Community of Madrid residents aged 16-80 years old. Two-stage cluster sampling was performed, with stratification by socioeconomic status and percentage immigrant population. The sampling frame consisted of public blood extraction centers attached to the Madrid Health Service. Seroprevalence of HCV antibodies, prevalence ratios by age groups in comparison with 1999 survey data and prevalence association with risk factors were assessed using a logistic regression model. Prevalence of HCV antibodies for the age group 16-80 years was 1.8% (95% CI: 1.3-2.5). The age group with the highest prevalence was 41-60 years. In comparison with the 1999 survey, prevalence fell for the age groups 21-30 and 31-40 years and increased for the age group 41-60. Statistically significant associations were found for age, education, history of hepatitis C and consultation regarding liver problems. Seroprevalence of HCV antibodies in the Community of Madrid is similar to that shown in other regions of Spain. It is increasing in older age groups as the population at risk ages. Incidence of hepatitis C may be decreasing considering the decrease in the seroprevalence in the population younger than 40 related to the previous serosurvey.
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Affiliation(s)
- Luis García Comas
- Subdirectorate of Health Promotion and Prevention, Health Department of the Community of Madrid (institution at which the work was performed), Madrid, Spain
| | - María Ordobás Gavín
- Subdirectorate of Health Promotion and Prevention, Health Department of the Community of Madrid (institution at which the work was performed), Madrid, Spain
| | - Juan Carlos Sanz Moreno
- Health Department of the Community of Madrid, Regional Public Health Laboratory, Madrid, Spain
| | - Belén Ramos Blázquez
- Health Department of the Community of Madrid, Regional Public Health Laboratory, Madrid, Spain
| | - Angeles Gutiérrez Rodríguez
- Subdirectorate of Health Promotion and Prevention, Health Department of the Community of Madrid (institution at which the work was performed), Madrid, Spain
| | - Jenaro Astray Mochales
- Subdirectorate of Health Promotion and Prevention, Health Department of the Community of Madrid (institution at which the work was performed), Madrid, Spain
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Cruciani M, Wiessing L, Serpelloni G, Genetti B, Andreotti A, Iulia C, Zermiani M, Suligoi B. Increasing prevalence of HIV infection among first time clients in Italian drug treatment services - is it sexual transmission? BMC Infect Dis 2015; 15:201. [PMID: 25925747 PMCID: PMC4431036 DOI: 10.1186/s12879-015-0940-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 04/23/2015] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Over the last two decades, the proportion of people who inject drugs among newly reported HIV cases in Italy has been continuously declining. This trend is reflected in the prevalence of HIV infection among problem drug users followed in drug treatment services. We report nationwide trends in the prevalence of HIV and HCV among tested clients in charge to drug addiction services from 2005 to 2011. METHODS Data on the prevalence of HIV and HCV among drug users from public drug treatment services across Italy were collected and analyzed for the period from 2005 to 2011. Prevalence of HIV and HCV were compared between clients returning to treatment and those entering treatment for the first time, and by gender. Due to the high percentage of missing data, the "inverse probability weight" method was used. Trends in testing uptake were also analysed. RESULTS A significant decrease of HIV and HCV prevalence is observed among all PDUs entering treatment (from 14.7% to 11.1% and from 61.6% to 50%, respectively, in 2005-2011). By contrast, among those entering the services for the first time, after an initial decline the prevalence of HIV infection steadily increased in both sexes, from 2.2% in 2009 to 5.3% in 2011. Self-reported injecting rates in this group decreased over time, and in 2011 the proportion reporting drug injecting was lower among new clients than in people returning to services (14.5 vs. 34.4%). We also observed a progressive and significant reduction in HIV and HCV testing in drug treatment services. CONCLUSIONS Changes in injection practice and type of drugs used, coupled with a concurrent reduction in HCV prevalence, do not support drug injection as the main explanation for an increased HIV transmission in people entering drug treatment services for the first time. While reductions in testing rates raise concerns over data quality, the possibility of increased sexual transmission needs to be considered.
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Affiliation(s)
- Mario Cruciani
- Center of Community Medicine and HIV Outpatient Clinic, Via Germania, 20, Verona, Italy.
| | - Lucas Wiessing
- European Monitoring Centre for Drugs and Drug Addiction (EMCCDA), Cais do Sodré, 1249-289, Lisboa, Portugal.
| | - Giovanni Serpelloni
- Dipartimento Politiche Antidroga, Presidenza del Consiglio dei Ministri, Via dei Laterani, 34, 00184, Roma, Italy.
| | - Bruno Genetti
- Dipartimento Politiche Antidroga, Presidenza del Consiglio dei Ministri, Via dei Laterani, 34, 00184, Roma, Italy.
| | - Alessandra Andreotti
- Dipartimento Politiche Antidroga, Presidenza del Consiglio dei Ministri, Via dei Laterani, 34, 00184, Roma, Italy.
| | - Carpignano Iulia
- Dipartimento Politiche Antidroga, Presidenza del Consiglio dei Ministri, Via dei Laterani, 34, 00184, Roma, Italy.
| | - Monica Zermiani
- Center of Community Medicine and HIV Outpatient Clinic, Via Germania, 20, Verona, Italy.
| | - Barbara Suligoi
- Istituto Superiore di Sanità (ISS), Viale Regina Elena, 299, 00161, Roma, Italy.
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Nikolopoulos GK, Fotiou A, Kanavou E, Richardson C, Detsis M, Pharris A, Suk JE, Semenza JC, Costa-Storti C, Paraskevis D, Sypsa V, Malliori MM, Friedman SR, Hatzakis A. National income inequality and declining GDP growth rates are associated with increases in HIV diagnoses among people who inject drugs in Europe: a panel data analysis. PLoS One 2015; 10:e0122367. [PMID: 25875598 PMCID: PMC4398461 DOI: 10.1371/journal.pone.0122367] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 02/16/2015] [Indexed: 11/18/2022] Open
Abstract
Background There is sparse evidence that demonstrates the association between macro-environmental processes and drug-related HIV epidemics. The present study explores the relationship between economic, socio-economic, policy and structural indicators, and increases in reported HIV infections among people who inject drugs (PWID) in the European Economic Area (EEA). Methods We used panel data (2003–2012) for 30 EEA countries. Statistical analyses included logistic regression models. The dependent variable was taking value 1 if there was an outbreak (significant increase in the national rate of HIV diagnoses in PWID) and 0 otherwise. Explanatory variables included the growth rate of Gross Domestic Product (GDP), the share of the population that is at risk for poverty, the unemployment rate, the Eurostat S80/S20 ratio, the Gini coefficient, the per capita government expenditure on health and social protection, and variables on drug control policy and drug-using population sizes. Lags of one to three years were investigated. Findings In multivariable analyses, using two-year lagged values, we found that a 1% increase of GDP was associated with approximately 30% reduction in the odds of an HIV outbreak. In GDP-adjusted analyses with three-year lagged values, the effect of the national income inequality on the likelihood of an HIV outbreak was significant [S80/S20 Odds Ratio (OR) = 3.89; 95% Confidence Interval (CI): 1.15 to 13.13]. Generally, the multivariable analyses produced similar results across three time lags tested. Interpretation Given the limitations of ecological research, we found that declining economic growth and increasing national income inequality were associated with an elevated probability of a large increase in the number of HIV diagnoses among PWID in EEA countries during the last decade. HIV prevention may be more effective if developed within national and European-level policy contexts that promote income equality, especially among vulnerable groups.
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Affiliation(s)
- Georgios K. Nikolopoulos
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece
- Hellenic Centre for Disease Control and Prevention, Amarousio, Greece
- * E-mail:
| | - Anastasios Fotiou
- Greek Reitox Focal Point of the EMCDDA, University Mental Health Research Institute, Athens, Greece
- Department of Psychiatry, Athens University Medical School, Athens, Greece
| | - Eleftheria Kanavou
- Greek Reitox Focal Point of the EMCDDA, University Mental Health Research Institute, Athens, Greece
| | - Clive Richardson
- Greek Reitox Focal Point of the EMCDDA, University Mental Health Research Institute, Athens, Greece
- Panteion University of Social and Political Sciences, Athens, Greece
| | - Marios Detsis
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece
| | - Anastasia Pharris
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Jonathan E. Suk
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Jan C. Semenza
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Claudia Costa-Storti
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece
| | | | - Samuel R. Friedman
- National Development and Research Institutes, New York, New York, United States of America
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece
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Sypsa V, Paraskevis D, Malliori M, Nikolopoulos GK, Panopoulos A, Kantzanou M, Katsoulidou A, Psichogiou M, Fotiou A, Pharris A, Van De Laar M, Wiessing L, Jarlais DD, Friedman SR, Hatzakis A. Homelessness and Other Risk Factors for HIV Infection in the Current Outbreak Among Injection Drug Users in Athens, Greece. Am J Public Health 2015; 105:196-204. [PMID: 24524508 DOI: 10.2105/ajph.2013.301656] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Objectives. We examined HIV prevalence and risk factors among injection drug users (IDUs) in Athens, Greece, during an HIV outbreak. Methods. We used respondent-driven sampling (RDS) to recruit 1404 IDUs to the Aristotle intervention in August to October 2012. We interviewed participants and tested for HIV. We performed bivariate and multivariate analyses. Results. Estimated HIV prevalence was 19.8% (RDS-weighted prevalence = 14.8%). Odds of infection were 2.3 times as high in homeless as in housed IDUs and 2.1 times as high among IDUs who injected at least once per day as among less frequent injectors (both, P < .001). Six percent of men and 23.5% of women reported transactional sex in the past 12 months, and condom use was low. Intercourse with non-IDUs was common (53.2% of men, 25.6% of women). Among IDUs who had been injecting for 2 years or less the estimated incidence rate was 23.4 new HIV cases per 100 person-years at risk. Conclusions. Efforts to reduce HIV transmission should address homelessness as well as scaling up prevention services, such as needle and syringe distribution and other risk reduction interventions.
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Affiliation(s)
- Vana Sypsa
- At the time of the study, Vana Sypsa, Dimitrios Paraskevis, Maria Kantzanou, Antigoni Katsoulidou, Mina Psichogiou, and Angelos Hatzakis were with the National Retrovirus Reference Center, Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, University of Athens, Greece. Meni Malliori and Anastasios Panopoulos were with the Organisation Against Drugs (OKANA), Athens. Georgios K. Nikolopoulos was with the Hellenic Center for Disease Control and Prevention, Athens. Anastasios Fotiou was with the Greek Reitox Focal Point of the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), University Mental Health Research Institute, Athens. Anastasia Pharris and Marita Van De Laar were with the European Centre for Disease Prevention and Control, Stockholm, Sweden. Lucas Wiessing was with the EMCDDA, Lisbon, Portugal. Don Des Jarlais was with the Beth Israel Medical Center, New York, NY. Samuel R. Friedman was with the National Development and Research Institutes, New York, NY
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Pottie K, Medu O, Welch V, Dahal GP, Tyndall M, Rader T, Wells G. Effect of rapid HIV testing on HIV incidence and services in populations at high risk for HIV exposure: an equity-focused systematic review. BMJ Open 2014; 4:e006859. [PMID: 25510889 PMCID: PMC4267075 DOI: 10.1136/bmjopen-2014-006859] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE To assess the effects of rapid voluntary counselling and testing (VCT) for HIV on HIV incidence and uptake of HIV/AIDS services in people at high risk for HIV exposure. DESIGN Cochrane systematic review and meta-analysis. DATA SOURCES We searched PubMed, EMBASE, AIDSearch, LILACS, Global Health, Medline Africa, PsychInfo, CINAHL, Cochrane CENTRAL, Cochrane HIV/AIDS Group Specialized Register and grey literature from 1 January 2001 to 5 June 2014 without language restriction. DATA SELECTION We included controlled studies that compared rapid VCT with conventional testing among people at risk for HIV exposure. DATA EXTRACTION Two reviewers extracted data. We used Cochrane risk of bias tool and GRADE criteria: risk of bias, inconsistency, indirectness, imprecision and publication bias. For observational studies we used the Newcastle-Ottawa Scale. We used the PRISMA-Equity reporting guideline. RESULTS From 2441 articles, we included 8 randomised controlled trials and 5 observational studies. Rapid VCT was associated with a threefold increase in HIV-testing uptake (relative risk (RR)=2.95 95% CI 1.69 to 5.16) and a twofold increase in the receipt of test results (RR=2.14, 95% CI 1.08 to 4.24). Women accepted testing more often than men in rapid VCT arm, but no differences in effect for age or socioeconomic status. Observational studies also showed rapid VCT led to higher rates of uptake of testing. Heterogeneity was high. A cluster-randomised trial reported an 11% reduction in HIV incidence in intervention communities (RR=0.89, 95% CI=0.63 to 1.24) over 3 years trial. CONCLUSIONS Rapid VCT in health facilities and communities was associated with a large increase in HIV-testing uptake and receipt of results. This has implications for WHO guidelines. The routine use of rapid VCT may also help avoid human rights violations among marginalised populations where testing may occur without informed consent and where existing stigma may create barriers to testing.
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Affiliation(s)
- Kevin Pottie
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Centre for Global Health, Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Bruyere Research Institute, Bruyere Continuing Care
- Ottawa Hospital Research Institute, The Ottawa Hospital
| | - Olanrewaju Medu
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Vivian Welch
- Centre for Global Health, Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada
- Bruyere Research Institute, Bruyere Continuing Care
- Division of Infectious Disease, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Govinda P Dahal
- Centre for Global Health, Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada
- Canada Foundation for Nepal, Ottawa, Ontario, Canada
| | - Mark Tyndall
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Bruyere Research Institute, Bruyere Continuing Care
| | - Tamara Rader
- Centre for Global Health, Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada
| | - George Wells
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, The Ottawa Hospital
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Lazarus JV, Lundgren J, Casabona J, Wiessing L, Matheï C, Vickerman P, Prins M, Kretzschmar M, Kantzanou M, Giraudon I, Ferri M, Griffiths P, Harris M, Walker M, Chavdarova L, Schatz E, Schiffer K, Kools J, Farell J, Mendão L. Roundtable discussion: how lessons learned from HIV can inform the global response to viral hepatitis. BMC Infect Dis 2014; 14 Suppl 6:S18. [PMID: 25252919 PMCID: PMC4178551 DOI: 10.1186/1471-2334-14-s6-s18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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20
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Zimmermann R, Marcus U, Schäffer D, Leicht A, Wenz B, Nielsen S, Santos-Hövener C, Ross RS, Stambouli O, Ratsch BA, Bannert N, Bock CT, Kücherer C, Hamouda O. A multicentre sero-behavioural survey for hepatitis B and C, HIV and HTLV among people who inject drugs in Germany using respondent driven sampling. BMC Public Health 2014; 14:845. [PMID: 25124485 PMCID: PMC4247126 DOI: 10.1186/1471-2458-14-845] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 07/25/2014] [Indexed: 01/03/2023] Open
Abstract
Background People who inject drugs are at high risk for hepatitis B, hepatitis C and HIV. HTLV was reported by neighboring countries to be prevalent in this population, but the situation for Germany is unclear. To generate seroprevalence and related behavioural data and to enhance prevention efforts against these infections for drug users in Germany, a multicentre sero- and behavioural survey was initiated. People who inject drugs are not well reached by services for testing and counselling for blood-borne infections in Germany. An interventional part of the study is intended to prove feasibility and acceptance of testing and counselling in low-threshold drop-in settings. Methods/Design Between May 2011 and March 2015, eligible participants (persons having injected drugs within the last 12 months, aged 16 years+, and living in the study city) are recruited by respondent driven sampling, using low-threshold drop-in facilities as study-sites in eight German cities with large drug scenes. Calculated sample size is 2,033 participants. Capillary blood samples collected as dried blood spots are anonymously tested for serological and molecular markers of hepatitis B and C, HIV, and HTLV I and II. A detailed face-to-face-interview about hepatitis- and HIV-related knowledge, former testing, imprisonment, sexual and injecting risk behaviour is conducted with participants. Staff is trained to offer pre- and post-test-counselling of blood-borne infections and HIV rapid testing to participants. Discussion We chose respondent driven sampling for recruitment of participants to improve representativeness of results. Persons, who are not reached by the facility where the study is conducted, are aimed to be included by recruitment through their personal social network of injecting drug users. To reduce differential biases in the questions on knowledge of transmission and prevention of infections, we present true statements on hepatitis B, C and HIV, their possible routes of transmission and measures of prevention to participants. Participants are told that the statements are true and are asked to answer if they knew this fact already or if it is new to them. In case of knowledge gaps they are offered free targeted counselling as well as free HIV rapid testing and post-test counselling of HIV and hepatitis test results.
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Affiliation(s)
- Ruth Zimmermann
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany.
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Marco A, Gallego C, Caylà JA. Incidence of hepatitis C infection among prisoners by routine laboratory values during a 20-year period. PLoS One 2014; 9:e90560. [PMID: 24587394 PMCID: PMC3938777 DOI: 10.1371/journal.pone.0090560] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 02/03/2014] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND To estimate the incidence of Hepatitis C virus (HCV) and the predictive factors through repeated routine laboratory analyses. METHODS An observational cohort study was carried out in Quatre Camins Prison, Barcelona. The study included subjects with an initial negative HCV result and routine laboratory analyses containing HCV serology from 1992 to 2011. The incidence of infection was calculated for the study population and for sub-groups by 100 person-years of follow-up (100 py). The predictive factors were determined through Kaplan-Meier curves and a Cox regression. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated. RESULTS A total of 2,377 prisoners were included with a median follow-up time of 1,540.9 days per patient. Among the total population, 117 HCV seroconversions were detected (incidence of 1.17/100 py). The incidence was higher between 1992 and 1995 (2.57/100 py), among cases with HIV co-infection (8.34/100 py) and among intravenous drug users (IDU) without methadone treatment (MT) during follow-up (6.66/100 py). The incidence rate of HCV seroconversion among cases with a history of IDU and current MT was 1.35/100 py, which is close to that of the total study population. The following variables had a positive predictive value for HCV infection: IDU (p<0.001; HR = 7,30; CI: 4.83-11.04), Spanish ethnicity (p = 0.009; HR = 2,03; CI: 1.93-3.44) and HIV infection (p = 0.015; HR = 1.97; CI: 1.14-3.39). CONCLUSION The incidence of HCV infection among prisoners was higher during the first part of the study and among IDU during the entire study period. Preventative programs should be directed toward this sub-group of the prison population.
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Affiliation(s)
- Andrés Marco
- Health Services of Barcelona Men’s Penitentiary Centre, Barcelona, Department of Justice, Government of Catalonia, Barcelona, Spain
| | - Carlos Gallego
- Health Services of Quatre Camins Penitentiary Centre, La Roca del Vallés, Barcelona, Department of Justice, Government of Catalonia, Barcelona, Spain
| | - Joan A. Caylà
- Epidemiology Service of the Public Health Agency of Barcelona, CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
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Oprea C, Ceausu E, Ruta S. Ongoing outbreak of multiple blood-borne infections in injecting drug users in Romania. Public Health 2013; 127:1048-50. [PMID: 24239282 DOI: 10.1016/j.puhe.2013.08.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 08/15/2013] [Accepted: 08/27/2013] [Indexed: 12/23/2022]
Affiliation(s)
- C Oprea
- Victor Babes Infectious and Tropical Diseases Hospital, 281 Mihai Bravu Bvd, Bucharest, Romania; Carol Davila University of Medicine and Pharmacy, 8 Eroilor Sanitari Bvd, Bucharest, Romania
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Paraskevis D, Nikolopoulos G, Fotiou A, Tsiara C, Paraskeva D, Sypsa V, Lazanas M, Gargalianos P, Psichogiou M, Skoutelis A, Wiessing L, Friedman SR, Jarlais DCDES, Terzidou M, Kremastinou J, Malliori M, Hatzakis A. Economic recession and emergence of an HIV-1 outbreak among drug injectors in Athens metropolitan area: a longitudinal study. PLoS One 2013; 8:e78941. [PMID: 24265730 PMCID: PMC3827120 DOI: 10.1371/journal.pone.0078941] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 09/16/2013] [Indexed: 12/22/2022] Open
Abstract
Background During 2011, a dramatic increase (1600%) of reported HIV-1 infections among injecting drug users (IDUs) was noted in Athens, Greece. We herein assess the potential causal pathways associated with this outbreak. Methods Our study employed high resolution HIV-1 phylogenetic and phylogeographic analyses. We examined also longitudinal data of ecological variables such as the annual growth of gross domestic product (GDP) of Greece in association with HIV-1 and HCV sentinel prevalence in IDUs, unemployment and homelessness rates and HIV transmission networks in Athens IDUs before and during economic recession (2008–2012). Results IDU isolates sampled in 2011 and 2012 suggested transmission networks in 94.6% and 92.7% of the cases in striking contrast with the sporadic networking (5%) during 1998–2009. The geographic origin of most HIV-1 isolates was consistent with the recently documented migratory waves in Greece. The decline in GDP was inversely correlated with annual prevalence rates of HIV and HCV and with unemployment and homelessness rates in IDUs (all p<0.001). The slope of anti-HCV prevalence in the sentinel populations of IDUs and in “new” drug injectors was found 120 and 1.9-fold (p = 0.007, p = 0.08 respectively) higher in 2008–2012 (economic recession) compared with 2002–2006. The median (25th, 75th) size of transmission networks were 34 (12, 58) and 2 (2, 2) (p = 0.057) in 2008–2012 and 1998–2007, respectively. The coverage of harm reduction services was low throughout the study period. Conclusions Scaling-up harm reduction services and addressing social and structural factors related to the current economic crisis should be urgently considered in environments where HIV-1 outbreaks may occur.
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Affiliation(s)
- Dimitrios Paraskevis
- National Retrovirus Reference Center, Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece
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MacArthur GJ, van Velzen E, Palmateer N, Kimber J, Pharris A, Hope V, Taylor A, Roy K, Aspinall E, Goldberg D, Rhodes T, Hedrich D, Salminen M, Hickman M, Hutchinson SJ. Interventions to prevent HIV and Hepatitis C in people who inject drugs: a review of reviews to assess evidence of effectiveness. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 25:34-52. [PMID: 23973009 DOI: 10.1016/j.drugpo.2013.07.001] [Citation(s) in RCA: 208] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 06/25/2013] [Accepted: 07/03/2013] [Indexed: 01/23/2023]
Abstract
BACKGROUND Injecting drug use is a major risk factor for the acquisition and transmission of HIV and Hepatitis C virus (HCV). Prevention of these infections among people who inject drugs (PWID) is critical to reduce ongoing transmission, morbidity and mortality. METHODS A review of reviews was undertaken involving systematic literature searches of Medline, Embase, CINAHL, PsychINFO, IBSS and the Cochrane Library (2000-2011) to identify English language reviews regarding the effectiveness of harm reduction interventions in relation to HIV transmission, HCV transmission and injecting risk behaviour (IRB). Interventions included needle and syringe programmes (NSP); the provision of injection paraphernalia; opiate substitution treatment (OST); information, education and counselling (IEC); and supervised injecting facilities (SIFs). Reviews were classified into 'core' or 'supplementary' using critical appraisal criteria, and the strength of review-level evidence was assessed. RESULTS Twelve core and thirteen supplementary reviews were included. From these reviews we identified: (i) for NSP: tentative review-level evidence to support effectiveness in reducing HIV transmission, insufficient review-level evidence relating to HCV transmission, but sufficient review-level evidence in relation to IRB; (ii) for OST: sufficient review-level evidence of effectiveness in relation to HIV transmission and IRB, but tentative review-level evidence in relation to HCV transmission; (iii) for IEC, the provision of injection paraphernalia and SIFs: tentative review-level evidence of effectiveness in reducing IRB; and either insufficient or no review-level evidence for these interventions in relation to HIV or HCV transmission. CONCLUSION Review-level evidence indicates that harm reduction interventions can reduce IRB, with evidence strongest for OST and NSP. However, there is comparatively little review-level evidence regarding the effectiveness of these interventions in preventing HCV transmission among PWID. Further studies are needed to assess the effectiveness and impact of scaling up comprehensive packages of harm reduction interventions to minimise HIV and HCV transmission among PWID.
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Affiliation(s)
- Georgina J MacArthur
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK.
| | - Eva van Velzen
- NHS Sutton and Merton/London KSS Specialty School of Public Health, UK
| | | | - Jo Kimber
- University of New South Wales, Sydney, Australia
| | | | - Vivian Hope
- Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London, UK; Health Protection Services, Health Protection Agency, London, UK
| | - Avril Taylor
- University of the West of Scotland, Paisley, Scotland, UK
| | | | - Esther Aspinall
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | | | - Tim Rhodes
- Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London, UK
| | - Dagmar Hedrich
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Mika Salminen
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Matthew Hickman
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Sharon J Hutchinson
- Health Protection Scotland, Glasgow, UK; University of the West of Scotland, Paisley, Scotland, UK
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Zohrabyan L, Johnston L, Scutelniciuc O, Iovita A, Todirascu L, Costin T, Plesca V, Cotelnic-Harea T, Ionascu G. HIV, hepatitis and syphilis prevalence and correlates of condom use during anal sex among men who have sex with men in the Republic of Moldova. Int J STD AIDS 2013; 24:357-64. [PMID: 23970702 DOI: 10.1177/0956462412472808] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Limited data on HIV prevalence and related risks among men who have sex with men (MSM) exist in the Republic of Moldova. In Chisinau and Balti, 188 and 209, respectively, men who reported having anal or oral sex in the last six months with another man, aged ≥16 years were recruited into a study in 2010 using respondent-driven sampling methods. MSM reported having multiple male and female partners and inconsistent condom use. In Chisinau, 2% of MSM were HIV seropositive, 3.7% had antibodies to hepatitis C (HCV), 5.7% had antibodies to hepatitis B (HBV) and 12.1% had syphilis. In Balti, less than 1% of MSM were HIV seropositive, 1.2% had antibodies to HCV, 3.2% had antibodies to HBV and only 0.5% had syphilis. MSM who used a condom at last anal sex with a man were less likely to reside in Chisinau, to have casual sex partners and to have had an HIV test in the last year and were more likely to know where to get an HIV test. Although HIV prevalence was low, MSM practice a number of risky sexual behaviours that may heighten the risk of further HIV transmission in this population and to the wider population.
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Affiliation(s)
- L Zohrabyan
- UNAIDS Regional Support Team, Moscow, Russia
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Racial and ethnic disparities and implications for the prevention of HIV among persons who inject drugs. Curr Opin HIV AIDS 2012; 7:354-61. [PMID: 22498481 DOI: 10.1097/coh.0b013e328353d990] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW There are now an estimated 16 million people who inject drugs (PWID) throughout the world, 3 million of whom are estimated to be infected with HIV. In many countries, substantial proportions of PWID belong to racial/ethnic/nationality minority groups, and are at increased likelihood of being infected with HIV. This article reviews current evidence on ethnic disparities in HIV infection among PWID and assesses the issues that would need to be addressed to reduce these disparities. RECENT FINDINGS An ongoing systematic review of ethnic disparities has found that, in a pooled weighted odds ratio, ethnic minority PWID are twice as likely to be HIV seropositive than ethnic majority, PWID from the same geographic area. If implemented with sufficient quality and coverage, current HIV prevention programs probably have the capability of ending HIV transmission among both ethnic majority and minority PWID. Large-scale, evidence-based prevention programs need to be implemented in the contexts of patterns of injecting drug use that continue to evolve-with injecting practices spreading to new areas, changes in drugs injected, and some transitions from injecting to noninjecting drug use. Lack of financial resources and policies against evidence-based programming are increasingly important problems that are likely to have particularly adverse effects on ethnic minority PWID. SUMMARY Racial/ethnic/nationality disparities in HIV infection are quite common among PWID. Addressing these disparities will be a fundamental challenge within a human rights approach to public health.
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