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Lee T, Buchanan AL, Katenka NV, Forastiere L, Halloran ME, Friedman SR, Nikolopoulos G. Estimating Causal Effects of HIV Prevention Interventions with Interference in Network-based Studies among People Who Inject Drugs. Ann Appl Stat 2023; 17:2165-2191. [PMID: 38250709 PMCID: PMC10798667 DOI: 10.1214/22-aoas1713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Evaluating causal effects in the presence of interference is challenging in network-based studies of hard-to-reach populations. Like many such populations, people who inject drugs (PWID) are embedded in social networks and often exert influence on others in their network. In our setting, the study design is observational with a non-randomized network-based HIV prevention intervention. Information is available on each participant and their connections that confer possible HIV risk through injection and sexual behaviors. We considered two inverse probability weighted (IPW) estimators to quantify the population-level spillover effects of non-randomized interventions on subsequent health outcomes. We demonstrated that these two IPW estimators are consistent, asymptotically normal, and derived a closed-form estimator for the asymptotic variance, while allowing for overlapping interference sets (groups of individuals in which the interference is assumed possible). A simulation study was conducted to evaluate the finite-sample performance of the estimators. We analyzed data from the Transmission Reduction Intervention Project, which ascertained a network of PWID and their contacts in Athens, Greece, from 2013 to 2015. We evaluated the effects of community alerts on subsequent HIV risk behavior in this observed network, where the connections or links between participants were defined by using substances or having unprotected sex together. In the study, community alerts were distributed to inform people of recent HIV infections among individuals in close proximity in the observed network. The estimates of the risk differences for spillover using either IPW estimator demonstrated a protective effect. The results suggest that HIV risk behavior could be mitigated by exposure to a community alert when an increased risk of HIV is detected in the network.
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Affiliation(s)
- TingFang Lee
- Department of Pharmacy Practice, University of Rhode Island
| | | | - Natallia V Katenka
- Department of Computer Science and Statistics, University of Rhode Island
| | | | - M Elizabeth Halloran
- Biostatistics, Bioinformatics, and Epidemiology Program, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, and Department of Biostatistics, University of Washington
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Abadie R. "The Drug Sellers Were Better Organized than the Government": A Qualitative Study of Participants' Views of Drug Markets during COVID-19 and Other Big Events. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1295. [PMID: 36674050 PMCID: PMC9859057 DOI: 10.3390/ijerph20021295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/06/2023] [Accepted: 01/08/2023] [Indexed: 06/17/2023]
Abstract
"Big events", such as wars, economic crises, pandemics, or natural disasters, affect the risk environment in which people use drugs. While the impact of big events on injection risk behaviors and access to drug-treatment services is well documented, less is known about the effects of big events on drug markets. Based on self-reporting data on drug availability among people who use drugs (PWUD) in the aftermath of Hurricane Maria in Puerto Rico and during the COVID-19 lockdown in a Midwestern US state, this study aims to document the effects of big events on drug markets. Qualitative data on the effects of Hurricane Maria on drug markets are based on participants' self-reporting (N = 31). Data collection started after the hurricane and ended in 2020. Data on changes to the drug supply during the COVID-19 lockdown were collected based on semi-structured interviews with PWUD (N = 40) in a Midwestern US state. Findings show that while the drug markets might have initially been affected by big events, most effects were temporary. Drug availability, pricing, and quality might have suffered some initial fluctuations but stabilized as the drug markets absorbed the initial shocks caused by the hurricane and the lockdown measures. In preparation for increasingly more frequent and virulent pandemics and natural disasters, health infrastructures should be strengthened to prevent not only overdose episodes and deaths but also drug-related harms.
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Affiliation(s)
- Roberto Abadie
- School of Global Integrative Studies, University of Nebraska-Lincoln, Lincoln, NE 68588-0368, USA
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Nikolopoulos GK, Tsantes AG. Recent HIV Infection: Diagnosis and Public Health Implications. Diagnostics (Basel) 2022; 12:2657. [PMID: 36359500 PMCID: PMC9689622 DOI: 10.3390/diagnostics12112657] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 08/15/2024] Open
Abstract
The early period of infection with human immunodeficiency virus (HIV) has been associated with higher infectiousness and, consequently, with more transmission events. Over the last 30 years, assays have been developed that can detect viral and immune biomarkers during the first months of HIV infection. Some of them depend on the functional properties of antibodies including their changing titers or the increasing strength of binding with antigens over time. There have been efforts to estimate HIV incidence using antibody-based assays that detect recent HIV infection along with other laboratory and clinical information. Moreover, some interventions are based on the identification of people who were recently infected by HIV. This review summarizes the evolution of efforts to develop assays for the detection of recent HIV infection and to use these assays for the cross-sectional estimation of HIV incidence or for prevention purposes.
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Affiliation(s)
| | - Andreas G. Tsantes
- Microbiology Department, “Saint Savvas” Oncology Hospital, 11522 Athens, Greece
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Waetjen M, Papadopoulou M, Flores R, Sypsa V, Roussos S, Chanos S, Dedes N, Liao C, Paraskevis D, Hatzakis A, Schneider J, Psichogiou M. Pre-exposure Prophylaxis Persistence Among Greek Sexual Minority Men: Results from PrEP for Greece (P4G) Study. AIDS Behav 2022; 26:1039-1046. [PMID: 34494178 DOI: 10.1007/s10461-021-03459-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 01/24/2023]
Abstract
Nearly half the new HIV infections in Greece occur in sexual minority men, yet pre-exposure prophylaxis is not currently supported in the national HIV program. We examined factors associated with PrEP persistence among Greek SMM in PrEP for Greece, the first PrEP study in Greece. Participants (n = 100) were recruited from 2016 to 2018 through respondent-driven sampling among SMM in Athens, receiving supplies for daily PrEP at interval visits over 12-months. PrEP persistence, operationalized as Total PrEP Time, was high, 74% of participants achieving perfect persistence. Higher alcohol risk scores (OR 1.27, 95% CI 1.08-1.49) and adherence to HIV testing guidelines (OR 1.23, 95% CI 1.00-1.51) were associated with persistence. Housing impermanence (OR 0.14, 95% CI 0.04-0.48) and serostatus disclosure concerns (OR 0.77, 95% CI 0.60-0.97) were associated with limited PrEP persistence. While PrEP persistence among Greek SMM is high, socioeconomic factors and societal attitudes may challenge prevention efforts.
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Friedman SR, Jordan AE, Perlman DC, Nikolopoulos GK, Mateu-Gelabert P. Emerging Zoonotic Infections, Social Processes and Their Measurement and Enhanced Surveillance to Improve Zoonotic Epidemic Responses: A "Big Events" Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020995. [PMID: 35055817 PMCID: PMC8776232 DOI: 10.3390/ijerph19020995] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/23/2021] [Accepted: 01/10/2022] [Indexed: 02/04/2023]
Abstract
Zoonotic epidemics and pandemics have become frequent. From HIV/AIDS through COVID-19, they demonstrate that pandemics are social processes as well as health occurrences. The roots of these pandemics lie in changes in the socioeconomic interface between humanity and non-human host species that facilitate interspecies transmission. The degree to which zoonoses spread has been increased by the greater speed and extent of modern transportation and trade. Pre-existing sociopolitical and economic structures and conflicts in societies also affect pathogen propagation. As an epidemic develops, it can itself become a social and political factor, and change and interact with pre-existing sociobehavioral norms and institutional structures. This paper uses a "Big Events" approach to frame these processes. Based on this framework, we discuss how social readiness surveys implemented both before and during an outbreak might help public health predict how overall systems might react to an epidemic and/or to disease control measures, and thus might inform interventions to mitigate potential adverse outcomes or possibly preventing outbreaks from developing into epidemics. We conclude by considering what "pathways measures", in addition to those we and others have already developed, might usefully be developed and validated to assist outbreak and epidemic disease responses.
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Affiliation(s)
- Samuel R. Friedman
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA
- Center for Drug Use and HIV/HCV Research, New York, NY 10003, USA; (A.E.J.); (D.C.P.); (P.M.-G.)
- Correspondence:
| | - Ashly E. Jordan
- Center for Drug Use and HIV/HCV Research, New York, NY 10003, USA; (A.E.J.); (D.C.P.); (P.M.-G.)
| | - David C. Perlman
- Center for Drug Use and HIV/HCV Research, New York, NY 10003, USA; (A.E.J.); (D.C.P.); (P.M.-G.)
- Department of Infectious Diseases, Icahn School of Medicine, Mount Sinai Beth Israel, New York, NY 10003, USA
| | | | - Pedro Mateu-Gelabert
- Center for Drug Use and HIV/HCV Research, New York, NY 10003, USA; (A.E.J.); (D.C.P.); (P.M.-G.)
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY 10027, USA
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Gountas I, Nikolopoulos G, Touloumi G, Fotiou A, Souliotis K. Could the 2010 HIV outbreak in Athens, Greece have been prevented? A mathematical modeling study. PLoS One 2021; 16:e0258267. [PMID: 34618836 PMCID: PMC8496824 DOI: 10.1371/journal.pone.0258267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/22/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION In 2009 and 2010, Athens, Greece experienced a hepatitis C virus (HCV) and a Human Immunodeficiency Virus (HIV) outbreak among People Who Inject Drugs (PWID), respectively. The HCV outbreak was not detected, while that of HIV was identified in 2011. The integrated HIV-interventions, launched in early 2012, managed to reduce directly the HIV incidence and indirectly the HCV incidence. This study aims to assess what would have been the course of the HIV outbreak and its associated economic consequences if the 2009 HCV outbreak had been detected and integrated interventions had been initiated 1- or 2-years earlier. METHODS The model was calibrated to reproduce the observed HIV epidemiological and clinical parameters among PWID of Athens, Greece. We examined the effect of the 1- or 2-years earlier detection scenarios, the 1-year later detection, the non-detection scenario, and compared them to the status quo scenario. RESULTS Cumulative HIV cases, under the status-quo scenario during 2009-2019, were 1360 (90% Credible intervals: 290, 2470). If the HCV outbreak had been detected 1- or 2- years earlier, with immediate initiation of integrated interventions, 740 and 1110 HIV cases could be averted by 2019, respectively. Regarding the costs, if there was an efficient notification system to detect the HCV outbreak 1 or 2 years earlier, 35.2-53.2 million euros could be saved compared to the status quo by 2019. CONCLUSIONS If the HCV outbreak had been detected and promptly addressed, the HIV outbreak would have been prevented and 35.2-53.2 million euros could have been saved.
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Affiliation(s)
- Ilias Gountas
- Faculty of Social and Political Sciences, University of Peloponnese, Korinthos, Greece
- * E-mail:
| | | | - Giota Touloumi
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasios Fotiou
- Greek Reitox Focal Point at the Athens University Mental Health, Neurosciences, & Precision Medicine Research Institute (MHRI), Athens, Greece
| | - Kyriakos Souliotis
- Faculty of Social and Political Sciences, University of Peloponnese, Korinthos, Greece
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Friedman SR, Mateu-Gelabert P, Nikolopoulos GK, Cerdá M, Rossi D, Jordan AE, Townsend T, Khan MR, Perlman DC. Big Events theory and measures may help explain emerging long-term effects of current crises. Glob Public Health 2021; 16:1167-1186. [PMID: 33843462 PMCID: PMC8338763 DOI: 10.1080/17441692.2021.1903528] [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] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/25/2021] [Indexed: 12/17/2022]
Abstract
Big Events are periods during which abnormal large-scale events like war, economic collapse, revolts, or pandemics disrupt daily life and expectations about the future. They can lead to rapid change in health-related norms, beliefs, social networks and behavioural practices. The world is undergoing such Big Events through the interaction of COVID-19, a large economic downturn, massive social unrest in many countries, and ever-worsening effects of global climate change. Previous research, mainly on HIV/AIDS, suggests that the health effects of Big Events can be profound, but are contingent: Sometimes Big Events led to enormous outbreaks of HIV and associated diseases and conditions such as injection drug use, sex trading, and tuberculosis, but in other circumstances, Big Events did not do so. This paper discusses and presents hypotheses about pathways through which the current Big Events might lead to better or worse short and long term outcomes for various health conditions and diseases; considers how pre-existing societal conditions and changing 'pathway' variables can influence the impact of Big Events; discusses how to measure these pathways; and suggests ways in which research and surveillance might be conducted to improve human capacity to prevent or mitigate the effects of Big Events on human health.
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Affiliation(s)
| | - Pedro Mateu-Gelabert
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | | | | | - Diana Rossi
- Intercambios Civil Association and University of Buenos Aires, Buenos Aires, Argentina
| | - Ashly E Jordan
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | | | - Maria R Khan
- NYU Grossman School of Medicine, New York, NY, USA
| | - David C Perlman
- Mount Sinai Beth Israel and Center for Drug Use and HIV Research, New York, NY, USA
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Urwitz V, Vuylsteke B, Apers H, Hales D, Wentzlaff-Eggebert M, Nöstlinger C. A multicountry European study on Succeed: a general quality improvement tool in HIV prevention. Health Promot Int 2021; 35:935-946. [PMID: 33099280 DOI: 10.1093/heapro/daz081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The context-sensitive nature of the European HIV epidemic (e.g. differences in key populations, prevention settings, resource commitments) makes it challenging to monitor and evaluate HIV prevention and sexual health promotion programs. Systematic quality improvement (QI) tools and quality indicators adapted to HIV prevention are not widely known or implemented. The European 'Quality Action' introduced five such tools in 26 countries involving 45 nongovernmental and governmental organizations during 2014-2016. Approximately, half of the organizations used the tool 'Succeed'. This study aims to describe challenges and supportive factors in its use, and answers the research question if Succeed can be applied as a general QI tool despite the high contextuality of the European HIV prevention field. Mixed method research was conducted: data from quantitative pre- and post-training and implementation surveys were triangulated with qualitative data from multiple data sources analysed inductively. In a second analytical step, Chaudoir's evidence-based framework on implementation of innovations (2013) guided the data analysis on five levels: policy, organization, functionality of the tool, results and perceived innovations. Succeed contributed to goal and result orientation, facilitated stakeholders' participation and contributed to organizational development. Succeed was used in similar ways and with similar results across different policy contexts, types of organizations, target groups and interventions. Contributing factors for sustainable implementation were supporting environments, sufficient resources and a strategy for training tool users. Findings strongly support the use of Succeed as a general QI tool to monitor, document, adapt and improve HIV prevention and sexual health promotion work across Europe.
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Affiliation(s)
- Viveca Urwitz
- The Public Health Agency of Sweden, Stockholm, Sweden
| | - Bea Vuylsteke
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Hanne Apers
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Augusto GF, Hodges-Mameletzis I, Karanikolos M, Abrantes A, Martins MRO. HIV prevention and treatment in Southern Europe in the aftermath of bailout programmes. Eur J Public Health 2021; 30:967-973. [PMID: 32363377 DOI: 10.1093/eurpub/ckaa062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The global financial crisis impacted public health in Europe, and had a particularly critical detriment to health systems in Southern Europe. We aim to describe HIV response and progress towards the current global HIV targets in specific Southern European countries, which received financial adjustment programmes. METHODS We examined and compared a set of HIV indicators in Cyprus, Greece, Portugal and Spain. The indicators included: (i) HIV epidemiology; (ii) adoption of WHO's 'Treat All' recommendation; (iii) progress towards the UNAIDS global targets of 90-90-90; (iv) adoption/implementation of pre-exposure prophylaxis (PrEP); and (v) adoption/implementation of WHO's HIV self-testing (HIVST) recommendation. RESULTS HIV incidence varied across countries since 2010, with sustained declines in Portugal and Spain, and marked increases in Greece and Cyprus. By 2016, all four countries have adopted WHO's 'Treat All' recommendation, leading to a marked increase in people receiving ART. Improvements were seen in all 90-90-90 targets, with Portugal achieving those in 2017, but Greece lagging somewhat behind, as of 2016. Portugal and Spain have also started implementing PrEP, and Greece has completed a pilot with no additional access to PrEP for pilot participants and no national programme in place. Cyprus has been the slowest in terms of adopting PrEP and HIVST. CONCLUSIONS Countries need to focus on prioritizing effective and comprehensive prevention measures, including HIVST and PrEP, and scale-up access to quality treatment and care for those diagnosed, in order to accelerate the reduction of new HIVs infections and successfully meet the global targets for HIV treatment.
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Affiliation(s)
- Gonçalo F Augusto
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical - Universidade NOVA de Lisboa (IHMT-UNL), Lisbon, Portugal
| | | | - Marina Karanikolos
- European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, London, UK
| | - Alexandre Abrantes
- Department of Health Policy and Administration, Escola Nacional de Saúde Pública - Universidade NOVA de Lisboa (ENSP-UNL), Lisbon, Portugal
| | - Maria R O Martins
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical - Universidade NOVA de Lisboa (IHMT-UNL), Lisbon, Portugal
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Bowman B, Psichogyiou M, Papadopoulou M, Sypsa V, Khanna A, Paraskevis D, Chanos S, Friedman SR, Hatzakis A, Schneider J. Sexual Mixing and HIV Transmission Potential Among Greek Men Who have Sex with Men: Results from SOPHOCLES. AIDS Behav 2021; 25:1935-1945. [PMID: 33555414 PMCID: PMC8081711 DOI: 10.1007/s10461-020-03123-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 11/29/2022]
Abstract
HIV incidence among men who have sex with men (MSM) in Greece remains unchanged despite effective response to a recent outbreak among people who inject drugs (PWID). Network factors are increasingly understood to drive transmission in epidemics. The primary objective of the study was to characterize MSM in Greece, their sexual behaviors, and sexual network mixing patterns. We investigated the relationship between serostatus, sexual behaviors, and self-reported sex networks in a sample of MSM in Athens, Greece, generated using respondent driven sampling. We estimated mixing coefficients (r) based on survey-generated egonets. Additionally, multiple logistic regression was used to estimate adjusted odds ratios (AOR) and to assess relationships between serostatus, sexual behaviors, and sociodemographic indicators. A sample of 1,520 MSM participants included study respondents (n = 308) and their network members (n = 1,212). Mixing based on serostatus (r = 0.12, σr = 0.09–0.15) and condomless sex (r = 0.11, σr = 0.07–0.14) was random. However, mixing based on sex-drug use was highly assortative (r = 0.37, σr = 0.32–0.42). This study represents the first analysis of Greek MSM sexual networks. Our findings highlight protective behavior in two distinct network typologies. The first typology mixed assortatively based on serostatus and sex-drug use and was less likely to engage in condomless sex. The second typology mixed randomly based on condomless sex but was less likely to engage in sex-drug use. These findings support the potential benefit of HIV prevention program scale-up for this population including but not limited to PrEP.
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Affiliation(s)
- Benjamin Bowman
- Pritzker School of Medicine, University of Chicago, Chicago, IL USA
| | - Mina Psichogyiou
- First Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Martha Papadopoulou
- Department of Hygiene, Epidemiology & Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece
| | - Vana Sypsa
- First Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Aditya Khanna
- Department of Medicine, Infectious Diseases, University of Chicago, Chicago, IL USA
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology & Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Samuel R. Friedman
- Institute for Infectious Disease Research, National Development & Research Institutes, New York, NY USA
- Department of Population Health, New York University Langone Medical School, New York, NY USA
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology & Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece
| | - John Schneider
- Pritzker School of Medicine, University of Chicago, Chicago, IL USA
- Department of Medicine, Infectious Diseases, University of Chicago, Chicago, IL USA
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Socially-supportive norms and mutual aid of people who use opioids: An analysis of Reddit during the initial COVID-19 pandemic. Drug Alcohol Depend 2021; 222:108672. [PMID: 33757708 PMCID: PMC8057693 DOI: 10.1016/j.drugalcdep.2021.108672] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/28/2020] [Accepted: 01/03/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Big events (i.e., unique historical disruptions) like the COVID-19 epidemic and its associated period of social distancing can transform social structures, social interactions, and social norms. Social distancing rules and the fear of infection have greatly reduced face-to-face interactions, increased loneliness, reduced ties to helping institutions, and may also have disrupted the opioid use behaviors of people who use drugs. This research used Reddit to examine the impact of COVID-19 on the social networks and social processes of people who use opioids. METHODS Data were collected from the social media forum, Reddit.com. At the beginning of the COVID-19 pandemic in the U.S. (March 5, 2020, to May 13, 2020), 2,000 Reddit posts were collected from the two most popular opioid subreddits (r/OpiatesRecovery, r/Opiates). Posts were reviewed for relevance to COVID-19 and opioid use resulting in a final sample of 300. Thematic analysis was guided by the Big Events framework. RESULTS The COVID-19 pandemic was found to create changes in the social networks and daily lives among persons who use opioids. Adaptions to these changes shifted social networks leading to robust social support and mutual aid on Reddit, including sharing and seeking advice on facing withdrawal, dealing with isolation, managing cravings, and accessing recovery resources. CONCLUSIONS Reddit provided an important source of social support and mutual aid for persons who use opioids. Findings indicate online social support networks are beneficial to persons who use opioids, particularly during big events where isolation from other social support resources may occur.
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12
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Kalapos MP. Negative trends in outpatient care of addicted patients in Hungary. Cent Eur J Public Health 2021; 29:62-67. [PMID: 33831288 DOI: 10.21101/cejph.a5419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 12/07/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This article investigates how the numbers of registered addict patients have changed in the last three decades in Hungary and whether the predicted HIV epidemic among intravenous drug users has occurred. METHODS Data were collected from the Annual Reports of the National Bureau of Statistics and National Epidemiological Centre as well as from the medical records of the author. RESULTS The total number of registered alcoholics decreased by about 75% during the investigated period. This decrease was more pronounced among males than females. After initial increase, the number of registered drug addicts showed stagnation with an about 50% drop-out rate. Fortunately, the anticipated HIV epidemic did not manifest. The negative effect of a poor political action upon the number of client visits could, however, be documented. CONCLUSION In conclusion, negative trends are seen in the Hungarian addiction care. Numerous variables may be taken into consideration as affecting factors, but it is not yet clear to what extent these negative factors are responsible for trends. These data, however, warrant further investigations.
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Key Findings from the European Men-Who-Have-Sex-With-Men Internet Survey in Greece. EPIDEMIOLGIA (BASEL, SWITZERLAND) 2021; 2:114-123. [PMID: 36417194 PMCID: PMC9620921 DOI: 10.3390/epidemiologia2010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/25/2021] [Accepted: 03/11/2021] [Indexed: 12/14/2022]
Abstract
The European Men-Who-Have-Sex-With-Men Internet Survey (EMIS-2017) is an international survey for men who have sex with men (MSM) designed to measure the level and distribution of four dimensions: (a) sexual health outcomes, (b) risk and precaution behaviors, (c) health promotion needs, and (d) coverage/uptake of interventions. The aim of the current work is to provide an overview of key demographics and findings for MSM in Greece covering the abovementioned dimensions of EMIS-2017, especially regarding HIV. Overall, 2909 men met the inclusion criteria for the analysis. The participants' age ranged between 15 and 74 years old (median 35 years). According to the descriptive analysis, 14.4% of the participants reported moderate and 8.9% severe anxiety and depression. The self-reported HIV prevalence was 11%. A high number of participants had non-steady male partners (74%, n = 2153). The number of non-steady intercourse partners in the last 12 months was over two for about 61.5% (n = 1321) of the participants. A very small number of participants had ever tried to get pre-exposure prophylaxis (PrEP) (2.2%, n = 63), and 41.2% of the participants (n = 1199) were unaware of PrEP. About half of the participants (51.6%, n = 1501) did not know that vaccination against both hepatitis A and B viruses is recommended for MSM. The results of EMIS-2017 identify important needs and can help policy making and prevention planning.
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Pampaka D, Pantavou K, Giallouros G, Pavlitina E, Williams LD, Piovani D, Bonovas S, Nikolopoulos GK. Mental Health and Perceived Access to Care among People Who Inject Drugs in Athens, Greece. J Clin Med 2021; 10:jcm10061181. [PMID: 33808991 PMCID: PMC8002050 DOI: 10.3390/jcm10061181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/06/2021] [Accepted: 03/08/2021] [Indexed: 11/16/2022] Open
Abstract
Poor mental health among human immunodeficiency virus (HIV)-positive people who inject drugs (PWID) may contribute to stigma, and together they act as barriers to medical care. This analysis aims to examine factors associated with the mental health of PWID and their network contacts, and the association of poor mental health with the experience of HIV-related stigmatizing events, with HIV-related social support, and with perceived access to care. Data were collected during the Transmission Reduction Intervention Project (TRIP) conducted in Athens, Greece (2013-2015). PWID (n = 292; n = 122 HIV-positive) were interviewed both at baseline and follow-up. Items of depression, anxiety, and general positive affect subscales of the Mental Health Inventory were used to explore the psychological distress and well-being of participants at follow-up. Items of the Access to Care Scale were used to evaluate perceived access to medical care at baseline and follow-up. Linear regression showed that unemployment was positively related to depression (β = 1.49, p = 0.019), while injecting drug use was a risk factor for a low general positive affect score (β = -3.21, p = 0.015). Poor mental health was not linked to HIV-related stigma or social support. Positive perception of access to care was associated in multivariable analyses with low depression (β = -0.22, p = 0.049). The perceived access to care score improved from baseline to follow-up (p = 0.019) and HIV-positive participants had a higher score than HIV-negative participants. Future interventions should include targets to improve the mental well-being of participants, reduce psychosocial distress, and minimize perceived barriers to accessing medical care.
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Affiliation(s)
- Despina Pampaka
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol 3041, Cyprus;
| | - Katerina Pantavou
- Medical School, University of Cyprus, Nicosia 2029, Cyprus; (K.P.); (G.G.)
| | - George Giallouros
- Medical School, University of Cyprus, Nicosia 2029, Cyprus; (K.P.); (G.G.)
- Department of Business and Public Administration, University of Cyprus, Nicosia 1678, Cyprus
| | - Eirini Pavlitina
- Transmission Reduction Intervention Project, Athens Site, 11527 Athens, Greece;
| | - Leslie D. Williams
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL 60612, USA;
- National Development and Research Institutes, New York, NY 10010, USA
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy; (D.P.); (S.B.)
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy; (D.P.); (S.B.)
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Georgios K. Nikolopoulos
- Medical School, University of Cyprus, Nicosia 2029, Cyprus; (K.P.); (G.G.)
- Correspondence: ; Tel.: +357-228-952-23
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15
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Drug Injection-Related and Sexual Behavior Changes in Drug Injecting Networks after the Transmission Reduction Intervention Project (TRIP): A Social Network-Based Study in Athens, Greece. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052388. [PMID: 33804500 PMCID: PMC7967732 DOI: 10.3390/ijerph18052388] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 12/30/2022]
Abstract
The Transmission Reduction Intervention Project (TRIP) was a network-based, enhanced contact tracing approach, targeting recently HIV-infected people who inject drugs (PWID) in Athens, Greece (2013–2015). This analysis examines behavioral changes of participants in TRIP and their determinants between baseline and follow-up visits to the program. All participants of TRIP were tested for HIV and interviewed using a questionnaire with items on drug injection-related and sexual behaviors. Multivariable logistic regression models were used to examine potential relationships between participants’ behaviors and sociodemographic or other characteristics. The analysis included 292 participants. At follow-up, the percentage of participants who injected drugs decreased [92.5%, n = 270 versus 72.3%, n = 211 (p < 0.001)], and more participants adopted safer behaviors. Employment, age, and gender were significantly associated with some behavioral changes. For instance, unemployed participants were half as likely as the employed to stop drug injection [adjusted odds ratio (aOR): 0.475, 95% confidence interval (CI): 0.228, 0.988]. Increasing age was associated with lower probability of sharing syringes at follow-up (aOR: 0.936, 95%CI: 0.887, 0.988). Finally, females were less likely than males to improve their behavior related to sharing cookers, filters, or rinse water (aOR: 0.273, 95% CI: 0.100, 0.745). In conclusion, adoption of safer behaviors was observed following TRIP implementation. Future prevention programs should focus on younger PWID and especially females. Social efforts to support employment of PWID are also important.
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Hadjikou A, Pavlopoulou ID, Pantavou K, Georgiou A, Williams LD, Christaki E, Voskarides K, Lavranos G, Lamnisos D, Pouget ER, Friedman SR, Nikolopoulos GK. Drug Injection-Related Norms and High-Risk Behaviors of People Who Inject Drugs in Athens, Greece. AIDS Res Hum Retroviruses 2021; 37:130-138. [PMID: 33126818 DOI: 10.1089/aid.2020.0050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Drug use involves social interactions. Therefore, norms in the proximal environment of people who inject drugs (PWID) can favor behaviors that may result in HIV transmission. This work aimed at studying drug injection-related norms and their potential association with risky behaviors among PWID in Athens, Greece, in the context of economic recession and political activism that followed the fiscal crisis and soon after a recent HIV outbreak had leveled off. The Transmission Reduction Intervention Project (TRIP) was a social network-based approach (June 2013 to July 2015) that involved two groups of PWID seeds-with recent HIV infection and with long-term HIV infection and one control group of HIV-negative PWID. Network contacts of seeds were also enrolled. TRIP participants answered a questionnaire that included items on injection-related norms and behaviors. TRIP recruited 320 PWID (HIV positive, 44.4%). TRIP participants, especially those without HIV, often recalled or perceived as normative among their partners and in their networks some behaviors that can lead to HIV transmission. TRIP participants who recalled that they were encouraged by their regular drug partners to use an unclean syringe were almost twice as likely to report that they share syringes [odds ratio (OR) = 2.03; 95% confidence interval (CI) = 1.86-2.21], or give syringes to someone else (OR = 1.70; 95% CI = 1.42-2.04) as those who did not recall such an encouragement. Associations were modified by HIV status. HIV negatives, who were reportedly encouraged to share nonsyringe injecting equipment, were almost 4.5 times as likely to share that material as HIV-negative participants who were not encouraged (OR = 4.59, 95% CI = 4.12-5.11). Further research is needed on the multiple determinants (social, economic, and political) of norms in the social environments of PWID. Since peer norms are associated with risky behaviors, interventions should be developed to encourage norms and peer pressure against the sharing of injection equipment.
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Affiliation(s)
- Andria Hadjikou
- Department of Health Sciences European University of Cyprus, Nicosia, Cyprus
- Medical School, University of Cyprus, Nicosia, Cyprus
| | - Ioanna D. Pavlopoulou
- Pediatric Research Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Leslie D. Williams
- National Development and Research Institutes, New York, New York, USA
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, Illinois, USA
| | | | | | - Giagkos Lavranos
- Department of Health Sciences European University of Cyprus, Nicosia, Cyprus
| | - Demetris Lamnisos
- Department of Health Sciences European University of Cyprus, Nicosia, Cyprus
| | | | - Samuel R. Friedman
- National Development and Research Institutes, New York, New York, USA
- Department of Population Health, NYU Medical School, New York, New York, USA
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17
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Hadjikou A, Pantavou K, Pavlitina E, Pavlopoulou ID, Economou M, Christaki E, Lamnisos D, Kostaki EG, Paraskevis D, Schneider J, Talias M, Friedman SR, Nikolopoulos GK. Sociometric Risk Network Structure, HIV Prevalence, and Drug Injection-Related Norms among People Who Inject Drugs (PWID) in Athens, Greece. Subst Use Misuse 2021; 56:1190-1201. [PMID: 33975493 DOI: 10.1080/10826084.2021.1914103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Structural properties of sociometric networks have been associated with behaviors related to HIV transmission. Very few studies, however, have explored the correlation between sociometric network factors and drug injection-related norms. Methods: This exploratory work: (i) describes basic structural qualities of a sociometric risk network of participants in the Transmission Reduction Intervention Project (TRIP) in Athens, Greece, in the context of a large HIV outbreak among people who inject drugs (PWID); (ii) measures HIV prevalence within specific structures within the sociometric risk network of PWID in TRIP; and (iii) explores the association of structural properties of the sociometric risk network in TRIP with drug injection-related norms. Results: The sociometric risk network in TRIP consisted of a large component (n = 241, 67.8%), a few small components (n = 36, 10.1%) with 2-10 individuals each, and some isolates (n = 79, 22.2%). HIV prevalence was significantly higher in the large component (55.6%), the 2-core (59.1%) and 3-core (66.3%) of the large component, and the 3-cliques of the cores. Drug injection-related norms were significantly associated with structural characteristics of the sociometric risk network. A safe behavioral pattern (use of unclean cooker/filter/rinse water was never encouraged) was significantly (p = 0.03) less normative among people who TRIP participants of the 2-core injected with (40.5%) than among network contacts of TRIP participants outside the 2-core (55.6%). On the contrary, at drug-using venues, 2-core members reported that safer behaviors were normative compared to what was reported by those without 2-core membership. Conclusions: Sociometric network data can give useful insights into HIV transmission dynamics and inform prevention strategies.Supplemental data for this article is available online at https://doi.org/10.1080/10826084.2021.1914103 .
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Affiliation(s)
- Andria Hadjikou
- Medical School, University of Cyprus, Nicosia, Cyprus.,Department of Health Sciences, School of Sciences, European University of Cyprus, Nicosia, Cyprus
| | | | | | - Ioanna D Pavlopoulou
- Pediatric Research Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | - Mary Economou
- Medical School, University of Cyprus, Nicosia, Cyprus
| | | | - Demetris Lamnisos
- Department of Health Sciences, School of Sciences, European University of Cyprus, Nicosia, Cyprus
| | - Evangelia-Georgia Kostaki
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - John Schneider
- Departments of Medicine and Public Health Sciences, University of Chicago Medical Center, Center for AIDS Elimination, Chicago, Illinois, USA
| | - Michael Talias
- Healthcare Management Postgraduate Program, Open University of Cyprus, Nicosia, Cyprus
| | - Samuel R Friedman
- Department of Population Health, NYU Medical School, New York City, New York, USA.,National Development and Research Institutes, New York City, New York, USA
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18
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Friedman SR, Krawczyk N, Perlman DC, Mateu-Gelabert P, Ompad DC, Hamilton L, Nikolopoulos G, Guarino H, Cerdá M. The Opioid/Overdose Crisis as a Dialectics of Pain, Despair, and One-Sided Struggle. Front Public Health 2020; 8:540423. [PMID: 33251171 PMCID: PMC7676222 DOI: 10.3389/fpubh.2020.540423] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 10/09/2020] [Indexed: 12/20/2022] Open
Abstract
The opioid/overdose crisis in the United States and Canada has claimed hundreds of thousands of lives and has become a major field for research and interventions. It has embroiled pharmaceutical companies in lawsuits and possible bankruptcy filings. Effective interventions and policies toward this and future drug-related outbreaks may be improved by understanding the sociostructural roots of this outbreak. Much of the literature on roots of the opioid/overdose outbreak focuses on (1) the actions of pharmaceutical companies in inappropriately promoting the use of prescription opioids; (2) "deaths of despair" based on the deindustrialization of much of rural and urban Canada and the United States, and on the related marginalization and demoralization of those facing lifetimes of joblessness or precarious employment in poorly paid, often dangerous work; and (3) increase in occupationally-induced pain and injuries in the population. All three of these roots of the crisis-pharmaceutical misconduct and unethical marketing practices, despair based on deindustrialization and increased occupational pain-can be traced back, in part, to what has been called the "one-sided class war" that became prominent in the 1970s, became institutionalized as neo-liberalism in and since the 1980s, and may now be beginning to be challenged. We describe this one-sided class war, and how processes it sparked enabled pharmaceutical corporations in their misconduct, nurtured individualistic ideologies that fed into despair and drug use, weakened institutions that created social support in communities, and reduced barriers against injuries and other occupational pain at workplaces by reducing unionization, weakening surviving unions, and weakening the enforcement of rules about workplace safety and health. We then briefly discuss the implications of this analysis for programs and policies to mitigate or reverse the opioid/overdose outbreak.
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Affiliation(s)
- Samuel R. Friedman
- Division of Epidemiology, Department of Population Health, Center for Opioid Epidemiology and Policy, School of Medicine, New York University, New York, NY, United States
| | - Noa Krawczyk
- Department of Population Health, School of Medicine, New York University, New York, NY, United States
| | - David C. Perlman
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Mount Sinai Medical Center, Miami Beach, FL, United States
| | - Pedro Mateu-Gelabert
- Graduate School of Public Health & Health Policy, City University of New York, New York, NY, United States
| | - Danielle C. Ompad
- Department of Epidemiology, College of Global Public Health, New York University, New York, NY, United States
- Center for Drug Use and HIV Research (CDUHR), New York, NY, United States
| | - Leah Hamilton
- Division of Epidemiology, Department of Population Health, Center for Opioid Epidemiology and Policy, School of Medicine, New York University, New York, NY, United States
| | | | - Honoria Guarino
- Graduate School of Public Health & Health Policy, City University of New York, New York, NY, United States
| | - Magdalena Cerdá
- Division of Epidemiology, Department of Population Health, Center for Opioid Epidemiology and Policy, School of Medicine, New York University, New York, NY, United States
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19
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Williams LD, Korobchuk A, Smyrnov P, Sazonova Y, Nikolopoulos GK, Skaathun B, Morgan E, Schneider J, Vasylyeva TI, Duong YT, Chernyavska S, Goncharov V, Kotlik L, Friedman SR. Social network approaches to locating people recently infected with HIV in Odessa, Ukraine. J Int AIDS Soc 2020; 22:e25330. [PMID: 31245917 PMCID: PMC6595706 DOI: 10.1002/jia2.25330] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 05/28/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction This paper examines the extent to which an intervention succeeded in locating people who had recently become infected with HIV in the context of the large‐scale Ukrainian epidemic. Locating and intervening with people who recently became infected with HIV (people with recent infection, or PwRI) can reduce forward HIV transmission and help PwRI remain healthy. Methods The Transmission Reduction Intervention Project (TRIP) recruited recently‐infected and longer‐term infected seeds in Odessa, Ukraine, in 2013 to 2016, and asked them to help recruit their extended risk network members. The proportions of network members who were PwRI were compared between TRIP arms (i.e. networks of recently‐infected seeds vs. networks of longer‐term infected seeds) and to the proportion of participants who were PwRI in an RDS‐based Integrated Biobehavioral Surveillance of people who inject drugs in 2013. Results The networks of PwRI seeds and those of longer‐term infected seeds had similar (2%) proportions who were themselves PwRI. This was higher than the 0.25% proportion in IBBS (OR = 7.80; p = 0.016). The odds ratio among the subset of participants who injected drugs was 11.17 (p = 0.003). Cost comparison analyses using simplified ingredients‐based methods found that TRIP spent no more than US $4513 per PwRI located whereas IBBS spent $11,924. Conclusions Further research is needed to confirm these results and improve TRIP further, but our findings suggest that interventions that trace the networks of people who test HIV‐positive are a cost‐effective way to locate PwRI and reduce HIV transmission and should therefore be implemented.
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Affiliation(s)
| | | | | | | | | | - Britt Skaathun
- Division of Global Public Health, University of California San Diego, San Diego, CA, USA.,University of Chicago, Chicago, IL, USA
| | - Ethan Morgan
- Department of Medicine and Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | - John Schneider
- Department of Medicine and Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | | | - Yen T Duong
- ICAP-NY, Columbia University, New York, NY, USA
| | - Svitlana Chernyavska
- Odessa Regional Laboratory Center of the Ministry of Health of Ukraine, Odessa, Ukraine
| | - Vitaliy Goncharov
- Odessa Regional Laboratory Center of the Ministry of Health of Ukraine, Odessa, Ukraine
| | - Ludmila Kotlik
- Odessa Regional Laboratory Center of the Ministry of Health of Ukraine, Odessa, Ukraine
| | - Samuel R Friedman
- National Development and Research Institutes, New York, NY, USA.,Center for Drug Use and HIV Research, New York, NY, USA.,Department of Population Health, New York University Medical School, New York, NY, USA
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20
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Theodoropoulou L. Connections built and broken: The ontologies of relapse. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 86:102739. [PMID: 32273178 DOI: 10.1016/j.drugpo.2020.102739] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/27/2020] [Accepted: 03/17/2020] [Indexed: 02/02/2023]
Abstract
'Relapse prevention' has become a familiar concept and practice for those engaged with drug treatment services. The ways that 'relapse prevention' is currently practised and talked about departs primarily from research produced within the discipline of psychology, and especially by researchers and practitioners adopting cognitive behavioural (Marlatt & Donovan, 2005; Witkiewitz & Marlatt, 2009) and neurocognitive approaches (Tapert et al., 2004). The outcome has been the production of 'tools' and 'mechanisms', put in place to 'prevent' people from relapsing. This way of thinking about relapse has generated the assumption that once access to these 'tools' has been granted, relapse becomes a problem of the individual, a personal 'success' or 'failure', depending on how these tools are used, a measurement of how much one 'really' wants to recover. This system of thought reproduces longstanding discourses of blame against AOD users and fuels the discussion on the 'revolving doors' of recovery (White & Kelly, 2010), holding treatment services accountable for 'failing' to produce and maintain 'recovered' bodies. In this paper my aim is to challenge the production of relapse as a 'threat' and to rethink it as a desire to connect, a desire that can be either enhanced, or broken. Drawing on empirical data produced in two recovery services, one in Liverpool (UK) and one in Athens (Greece), analysed through a Deleuzo-Guattarian system of thought, I discuss relapse in two different ways: (a) as part of the temporality of recovery, a way to start building connections with services; as the expression of an emerging desire under exploration, and(b) as the consequence of broken and interrupted connections when policy fails to support the encounters emerging in the recovery space, disrupting thus the recovery process.
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Affiliation(s)
- Lena Theodoropoulou
- Department of Sociology, Social Policy and Criminology, School of Law and Social Justice building, University of Liverpool, Chatham street, PGR suite 5, L69 7ZR, UK.
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21
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Williams LD, Ibragimov U, Tempalski B, Stall R, Satcher Johnson A, Wang G, Cooper HLF, Friedman SR. Trends over time in HIV prevalence among people who inject drugs in 89 large US metropolitan statistical areas, 1992-2013. Ann Epidemiol 2020; 45:12-23. [PMID: 32439148 DOI: 10.1016/j.annepidem.2020.03.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/26/2020] [Accepted: 03/27/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE After years of stable or declining HIV prevalence and declining incidence among people who inject drugs (PWID) in the United States, some rapidly emerging outbreaks have recently occurred in new areas (e.g., Scott County, Indiana). However, to our knowledge, trends over time in HIV prevalence among PWID in US metropolitan statistical areas (MSAs) across all major regions of the country have not been systematically estimated beyond 2002, and the extent to which HIV prevalence may be increasing in other areas is largely unknown. This article estimates HIV prevalence among PWID in 89 of the most populated US MSAs, both overall and by geographic region, using more recent surveillance and HIV testing data. METHODS We computed MSA-specific annual estimates of HIV prevalence (both diagnosed and undiagnosed infections) among PWID for these 89 MSAs, for 1992-2013, using several data series from the Centers for Disease Control and Prevention's (CDC) National HIV Surveillance System and National HIV Prevention Monitoring and Evaluation data; Holmberg's (1997) estimates of 1992 PWID population size and of HIV prevalence and incidence among PWID; and research estimates from published literature using 1992-2013 data. A mixed effects model, with time nested within MSAs, was used to regress the literature review estimates on all of the other data series. Multiple imputation was used to address missing data. Resulting estimates were validated using previous 1992-2002 estimates of HIV prevalence and data on antiretroviral (ARV) prescription volumes and examined for patterns based on geographic region, numbers of people tested for HIV, and baseline HIV prevalence. RESULTS Mean (across all MSAs) trends over time suggested decreases through 2002 (from approximately 11.4% in 1992 to 9.2% in 2002), followed by a period of stability, and steep increases after 2010 (to 10.6% in 2013). Validation analyses found a moderate positive correlation between our estimates and ARV prescription volumes (r = 0.45), and a very strong positive correlation (r = 0.94) between our estimates and previous estimates by Tempalski et al. (2009) for 1992-2002 (which used different methods). Analysis by region and baseline prevalence suggested that mean increases in later years were largely driven by MSAs in the Western United States and by MSAs in the Midwest that had low baseline prevalence. Our estimates suggest that prevalence decreased across all years in the Eastern United States. These trends were particularly clear when MSAs with very low numbers of people tested for HIV were removed from analyses to reduce unexplained variability in mean trajectories. CONCLUSIONS Our estimates suggest a fairly large degree of variation in 1992-2013 trajectories of PWID HIV prevalence among 89 US MSAs, particularly by geographic region. They suggest that public health responses in many MSAs (particularly those with larger HIV prevalence among PWID in the early 1990s) were sufficient to decrease or maintain HIV prevalence over time. However, future research should investigate potential factors driving the estimated increase in prevalence after 2002 MSAs in the West and Midwest. These findings have potentially important implications for program and/or policy decisions, but estimates for MSAs with low HIV testing denominators should be interpreted with caution and verified locally before planning action.
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Affiliation(s)
- Leslie D Williams
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago.
| | | | - Barbara Tempalski
- Institute for Infectious Disease Research, National Development and Research Institutes, New York, NY; North Jersey Community Research Initiative (NJCRI) at North Jersey AIDS Alliance, Inc Newark, NJ
| | | | | | - Guoshen Wang
- Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Samuel R Friedman
- Institute for Infectious Disease Research, National Development and Research Institutes, New York, NY; Department of Population Health, New York University School of Medicine, New York
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22
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Jordan AE, Perlman DC, Cleland CM, Wyka K, Schackman BR, Nash D. Community viral load and hepatitis C virus infection: Community viral load measures to aid public health treatment efforts and program evaluation. J Clin Virol 2020; 124:104285. [PMID: 32007842 PMCID: PMC7195813 DOI: 10.1016/j.jcv.2020.104285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is the most prevalent blood-borne infection and causes more deaths than any other infectious disease in the US. Incident HCV infection in the US increased nearly 300 % between 2010 and 2015, Community viral load (CVL) measures have been developed for HIV to measure both transmission risk and treatment engagement in programs or areas. OBJECTIVE This paper presents a systematic review exploring the published literature on CVL constructs applied to HCV epidemiology and proposes novel CVL measures for HCV. STUDY DESIGN AND SETTING A systematic review was conducted of electronic databases; the search sought to identify published literature on HCV which discussed or applied CVL measures to HCV epidemiology. Novel CVL measures were constructed to apply to HCV. RESULTS No reports examining quantitative measures of HCV CVL were identified. Using the HIV CVL literature and the specific characteristics of HCV epidemiology, five HCV CVL measures are proposed. Narrower measures focusing on those engaged-in-care may be useful for program evaluation and broader measures including undiagnosed people may be useful for surveillance of HCV transmission potential. CONCLUSION Despite their potential value, CVL constructs have not yet formally been developed and applied to HCV epidemiology. The CVL measures proposed here could serve as valuable HCV program and surveillance measures. There is a need for informative surveillance measures to enhance policy and public health responses to achieve HCV control. Further study of these proposed HCV CVL measures to HCV epidemiology is warranted.
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Affiliation(s)
- Ashly E Jordan
- Graduate School of Public Health and Health Policy, City University of New York, 55 West 125th St, Floor 6, New York, NY 10027, United States; Center for Drug Use and HIV Research, New York, NY, United States; Behavioral Science Training Program in Substance Abuse Research, 380 Second Avenue, Suite 306, New York, NY 10010, United States.
| | - David C Perlman
- Center for Drug Use and HIV Research, New York, NY, United States; Division of Infectious Diseases, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, 350 East 17th St, Floor 19, New York, NY 10003, United States
| | - Charles M Cleland
- Center for Drug Use and HIV Research, New York, NY, United States; Division of Biostatistics, Department of Population Health, New York University School of Medicine, 180 Madison Avenue, 17-51, New York, NY 10016, United States
| | - Katarzyna Wyka
- Graduate School of Public Health and Health Policy, City University of New York, 55 West 125th St, Floor 6, New York, NY 10027, United States
| | - Bruce R Schackman
- Department of Healthcare Policy & Research, Weill Cornell Medicine, 425 East 61st Street, Suite 301, New York, NY 10065, United States
| | - Denis Nash
- Graduate School of Public Health and Health Policy, City University of New York, 55 West 125th St, Floor 6, New York, NY 10027, United States
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Determinants and Outcomes of Late Presentation of HIV Infection in Migrants in Catalonia, Spain: PISCIS Cohort 2004-2016. J Immigr Minor Health 2020; 21:920-930. [PMID: 30377891 DOI: 10.1007/s10903-018-0834-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This study using the Catalan PISCIS cohort explores risk factors of migrants' late presentation and the impact of late presentation on their health outcomes. We analyse 9590 new HIV diagnoses enrolled in the cohort between 2004 and 2016. Univariate and multivariate logistic regression models are used to identify risk factors associated with late presentation among migrants, giving crude and adjusted odds ratios and their 95% confidence intervals. Cox regression models are estimated to identify risk factors associated with AIDS/death, and crude and adjusted hazard ratios and 95% confidence intervals are reported. Late presentation is higher in migrants than non-migrants. Among migrants, region of origin is associated with late presentation and AIDS/death during follow-up. The results highlight persisting inequalities in HIV diagnosis and care among migrants in Catalonia. Targeted interventions addressed to specific subgroups in the migrant population are needed.
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Pavlopoulou ID, Dikalioti SK, Gountas I, Sypsa V, Malliori M, Pantavou K, Jarlais DD, Nikolopoulos GK, Hatzakis A. High-risk behaviors and their association with awareness of HIV status among participants of a large-scale prevention intervention in Athens, Greece. BMC Public Health 2020; 20:105. [PMID: 31992240 PMCID: PMC6986033 DOI: 10.1186/s12889-020-8178-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 01/08/2020] [Indexed: 11/25/2022] Open
Abstract
Background Aristotle was a seek-test-treat intervention during an outbreak of human immunodeficiency virus (HIV) infection among people who inject drugs (PWID) in Athens, Greece that started in 2011. The aims of this analysis were: (1) to study changes of drug injection-related and sexual behaviors over the course of Aristotle; and (2) to compare the likelihood of risky behaviors among PWID who were aware and unaware of their HIV status. Methods Aristotle (2012–2013) involved five successive respondent-driven sampling rounds of approximately 1400 PWID each; eligible PWID could participate in multiple rounds. Participants were interviewed using a questionnaire, were tested for HIV, and were classified as HIV-positive aware of their status (AHS), HIV-positive unaware of their status (UHS), and HIV-negative. Piecewise linear generalized estimating equation models were used to regress repeatedly measured binary outcomes (high-risk behaviors) against covariates. Results Aristotle recruited 3320 PWID (84.5% males, median age 34.2 years). Overall, 7110 interviews and blood samples were collected. The proportion of HIV-positive first-time participants who were aware of their HIV infection increased from 21.8% in round A to 36.4% in the last round. The odds of dividing drugs at least half of the time in the past 12 months with a syringe someone else had already used fell from round A to B by 90% [Odds Ratio (OR) (95% Confidence Interval-CI): 0.10 (0.04, 0.23)] among AHS and by 63% among UHS [OR (95% CI): 0.37 (0.19, 0.72)]. This drop was significantly larger (p = 0.02) among AHS. There were also decreases in frequency of injection and in receptive syringe sharing in the past 12 months but they were not significantly different between AHS (66 and 47%, respectively) and UHS (63 and 33%, respectively). Condom use increased only among male AHS from round B to the last round [OR (95% CI): 1.24 (1.01, 1.52)]. Conclusions The prevalence of risky behaviors related to drug injection decreased in the context of Aristotle. Knowledge of HIV infection was associated with safer drug injection-related behaviors among PWID. This highlights the need for comprehensive interventions that scale-up HIV testing and help PWID become aware of their HIV status.
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Affiliation(s)
- Ioanna D Pavlopoulou
- Pediatric Research Laboratory, National and Kapodistrian University of Athens, Faculty of Nursing, Athens, Greece
| | - Stavroula K Dikalioti
- Pediatric Research Laboratory, National and Kapodistrian University of Athens, Faculty of Nursing, Athens, Greece
| | - Ilias Gountas
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens, Greece.,Hellenic Scientific Society for the Study of AIDS and Sexually Transmitted Diseases, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Meni Malliori
- Psychiatric Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Katerina Pantavou
- Medical School, University of Cyprus, P.O.Box 20537, Nicosia, Cyprus
| | | | | | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens, Greece.,Hellenic Scientific Society for the Study of AIDS and Sexually Transmitted Diseases, Athens, Greece
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25
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Friedman SR, Pouget ER, Sandoval M, Nikolopoulos GK, Mateu-Gelabert P, Rossi D, Auerbach JD. New Measures for Research on Men Who Have Sex with Men and for At-Risk Heterosexuals: Tools to Study Links Between Structural Interventions or Large-Scale Social Change and HIV Risk Behaviors, Service Use, and Infection. AIDS Behav 2020; 24:257-273. [PMID: 31313092 DOI: 10.1007/s10461-019-02582-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Large-scale structural interventions and "Big Events" like revolutions, wars and major disasters can affect HIV transmission by changing the sizes of at-risk populations, making high-risk behaviors more or less likely, or changing contexts in which risk occurs. This paper describes new measures to investigate hypothesized pathways that could connect macro-social changes to subsequent HIV transmission. We developed a "menu" of novel scales and indexes on topics including norms about sex and drug injecting under different conditions, experiencing denial of dignity, agreement with cultural themes about what actions are needed for survival or resistance, solidarity and other issues. We interviewed 298 at-risk heterosexuals and 256 men who have sex with men in New York City about these measures and possible validators for them. Most measures showed evidence of criterion validity (absolute magnitude of Pearson's r ≥ 0.20) and reliability (Cronbach's alpha ≥ 0.70). These measures can be (cautiously) used to understand how macro-changes affect HIV and other risk. Many can also be used to understand risk contexts and dynamics in more normal situations. Additional efforts to improve and to replicate the validation of these measures should be conducted.
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Affiliation(s)
- S R Friedman
- Institute for Infectious Disease Research, National Development and Research Institutes, Inc., 71 West 23rd Street, Fourth Floor, New York, NY, 10010, USA.
- Center for Drug Use and HIV Research, New York, NY, USA.
| | - E R Pouget
- Health and Nutrition Sciences, Brooklyn College, Brooklyn, NY, USA
| | - M Sandoval
- Brooklyn Legal Service's Corp A (Group Representation Unit), Brooklyn, NY, USA
| | | | - P Mateu-Gelabert
- Institute for Infectious Disease Research, National Development and Research Institutes, Inc., 71 West 23rd Street, Fourth Floor, New York, NY, 10010, USA
- Center for Drug Use and HIV Research, New York, NY, USA
| | - D Rossi
- University of Buenos Aires and Intercambios Civil Association, Buenos Aires, Argentina
| | - J D Auerbach
- Medicine, University of California San Francisco, San Francisco, CA, USA
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26
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Gountas I, Sypsa V, Papatheodoridis G, Paraskevis D, Kalamitsis G, Anagnostou O, Antaraki A, Fotiou A, Hatzakis A. A hepatitis C outbreak preceded the HIV outbreak among persons who inject drugs in Athens, Greece: Insights from a mathematical modelling study. J Viral Hepat 2019; 26:1311-1317. [PMID: 31322302 DOI: 10.1111/jvh.13178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 06/20/2019] [Indexed: 01/08/2023]
Abstract
People who inject drugs (PWID) comprise one of the major transmission risk groups for human immunodeficiency virus (HIV) and hepatitis C virus (HCV). In 2011, Athens experienced a large HIV outbreak among PWID. Significant public health interventions were implemented in response to the HIV outbreak. The aims of this study were to estimate the indirect effects of the HIV interventions on HCV infection and to evaluate the concept of the association between HCV and HIV infections in the case of Athens. A dynamic, stochastic, individual-based model was developed to simulate HCV transmission among PWID. We calibrated the model to reproduce the observed HCV prevalence among PWID in Greece. Two years prior to the HIV outbreak, an undetected HCV outbreak has occurred. In 2009, the incidence of HCV infection increased from 640 (495, 842) cases in 2008 to 1260 (1060, 1500). The mean time from initiation of injecting drug use to HCV acquisition decreased from 29 months in 2008 to 13 months in 2009. After HIV interventions, HCV incidence declined by 64.8% in 2012, compared to 2009. The averted HCV incidence cases attributed to the HIV-implemented interventions were 2200 (1950, 2480), during 2012-2015. The cumulative number incident HCV cases in Athens during 2002-2015 was about 9900 (7800, 12 100). Our results highlight that before the 2011 HIV outbreak in Athens, an HCV outbreak occurred in 2009. Prevention measures for HIV that took place in the Athens metropolitan area in 2012 reduced significantly the incidence of HCV.
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Affiliation(s)
- Ilias Gountas
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Hellenic Scientific Society for the Study of AIDS and Sexually Transmitted Diseases, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George Papatheodoridis
- Department of Gastroenterology, Medical School, National and Kapodistrian University of Athens, General Hospital of Athens 'Laiko', Athens, Greece
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Argiro Antaraki
- Greek Reitox focal point at the Athens University Mental Health, Neurosciences, & Precision Medicine Research Institute (MHRI), Athens, Greece
| | - Anastasios Fotiou
- Greek Reitox focal point at the Athens University Mental Health, Neurosciences, & Precision Medicine Research Institute (MHRI), Athens, Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Hellenic Scientific Society for the Study of AIDS and Sexually Transmitted Diseases, Athens, Greece
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27
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Nikolopoulos GK, Chanos S, Tsioptsias E, Hodges-Mameletzis I, Paraskeva D, Dedes N. HIV incidence among men who have sex with men at a community-based facility in Greece. Cent Eur J Public Health 2019; 27:54-57. [PMID: 30927398 DOI: 10.21101/cejph.a4856] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Men who have sex with men (MSM) are disproportionately affected by HIV in Greece. However, research on HIV incidence in this group is lacking. This study aimed at estimating HIV incidence among MSM in Athens, Greece. METHODS The analysis included routinely collected data between January 2013-June 2015 from adult MSM who visited a community-based facility (Ath Checkpoint) at least twice and were non-reactive to the rapid INSTITM HIV-1/HIV-2 assay at baseline. HIV conversion rates were calculated by dividing the number of clients who became reactive by the person-years of observation. All statistical analyses including Poisson regression models were conducted in STATA 14. RESULTS A total of 1,243 MSM contributed 1,102.50 person-years (py). The overall (per 100 py) conversion rate was 3.99 (95% CI: 2.97-5.36). In multivariable analyses, age less than 30 years was associated with an increased risk of HIV conversion (rate ratio: 2.01; 95% CI: 1.08-3.76). CONCLUSIONS This analysis shows high rates of HIV conversion among MSM who repeatedly visit a community-based testing site. Ath Checkpoint could contribute to HIV surveillance and identify a high-risk group that could benefit from essential health interventions.
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Affiliation(s)
| | | | | | | | - Dimitra Paraskeva
- Hellenic Centre for Disease Control and Prevention, Amarousio, Greece
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28
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Giannou F, Nikolopoulos GK, Pantavou K, Benetou V, Kantzanou M, Sypsa V, Williams LD, Friedman SR, Hatzakis A. Knowledge, Normative Beliefs and Attitudes Related to Recent HIV Infection among People who Inject Drugs in Athens, Greece. Curr HIV Res 2019; 15:386-395. [PMID: 29173178 DOI: 10.2174/1570162x15666171122165636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 09/26/2017] [Accepted: 10/23/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Despite great improvements in prevention over the last years, much has to be done to reduce new human immunodeficiency virus (HIV) infections. Substantial evidence shows that the six-month period of recent HIV infection contributes disproportionately to HIV transmission. OBJECTIVE This study aims to investigate knowledge, normative beliefs, and attitudes of people who inject drugs (PWID) regarding recent HIV infection. METHODS People who inject drugs in Athens, Greece were recruited in the fifth round of a respondent- driven sampling program (ARISTOTLE). The participants were tested for HIV and answered a structured questionnaire, which also included items on knowledge, normative beliefs, and attitudes regarding recent infection to address needs of the social network-based Transmission Reduction Intervention Project. The multivariable analyses included logistic regression models, which produced odds ratios (OR) and 95% confidence intervals (CI). RESULTS In total, 1,407 people (mean age: 36.3 ± 7.9 years old; males: 81.9%) took part in the fifth round of ARISTOTLE. Of these, 61.5% knew that HIV-infected people who are not on treatment are more likely to transmit HIV during the first six months of their infection and 58.4% reported that people in their network would react positively towards a recently HIV-infected person. People who inject drugs who were knowledgeable of recent HIV infection were more likely to disagree with statements such as that one should avoid all contact with a person recently infected by HIV (adjusted OR: 1.510, 95% CI: 1.090, 2.091) or more likely to agree with statements such as that an HIV+ person is much less likely to transmit HIV when h/she is on combination antiretroviral treatment (adjusted OR: 2.083, 95% CI: 1.231, 3.523). CONCLUSION A considerable proportion of PWID in Athens, Greece, were aware of the high HIV transmission risk of recent HIV infection, although improvement is needed for some population segments. People who inject drugs who were knowledgeable of the role of recent HIV infection were more likely to have normative beliefs and attitudes that favor behaviors that could help rather than harm or stigmatize people who have recently been infected with HIV. Interventions that are based on the role of recent HIV infection in HIV transmission could be important to HIV prevention.
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Affiliation(s)
- Foteini Giannou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Vassiliki Benetou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Kantzanou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Leslie D Williams
- Institute for Infectious Diseases Research, National Development and Research Institutes, New York, United States
| | - Samuel R Friedman
- Institute for Infectious Diseases Research, National Development and Research Institutes, New York, United States
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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29
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Psichogiou M, Giallouros G, Pantavou K, Pavlitina E, Papadopoulou M, Williams LD, Hadjikou A, Kakalou E, Skoutelis A, Protopapas K, Antoniadou A, Boulmetis G, Paraskevis D, Hatzakis A, Friedman SR, Nikolopoulos GK. Identifying, linking, and treating people who inject drugs and were recently infected with HIV in the context of a network-based intervention. AIDS Care 2019; 31:1376-1383. [PMID: 30939897 DOI: 10.1080/09540121.2019.1601671] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Identifying and linking people to care soon after HIV infection could limit viral transmission and protect their health. This work aims at describing the continuum of care among recently HIV-infected people who inject drugs (PWID) and participated in an intervention in the context of an HIV outbreak in Athens, Greece. The Transmission Reduction Intervention Project (TRIP) conducted risk network-based contact tracing and screened people for recent HIV infection. A comprehensive approach with a case management component that aimed to remove barriers to accessing care was adopted. Follow-up data on antiretroviral treatment (ART) and HIV-RNA levels were obtained from HIV clinics. TRIP enrolled 45 recently HIV-infected PWID (80% male) with a median viral load at recruitment of 5.43 log10 copies/mL. Of the recently infected persons in TRIP, 87% were linked to care; of these, 77% started ART; and of those on ART, 89% achieved viral load <200 copies/mL. TRIP and its public health allies managed to get most of the recently HIV-infected PWID who were identified by the program into care and many of them onto ART. This resulted in very low HIV-RNA levels. Treatment as prevention can work if individuals are aided in overcoming difficulties in entry to, or attrition from care.
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Affiliation(s)
- Mina Psichogiou
- First Department of Internal Medicine, Medical School, "Laiko" General Hospital, National and Kapodistrian University of Athens , Athens , Greece
| | | | | | - Eirini Pavlitina
- Transmission Reduction Intervention Project, Athens site , Athens , Greece
| | - Martha Papadopoulou
- First Department of Internal Medicine, Medical School, "Laiko" General Hospital, National and Kapodistrian University of Athens , Athens , Greece
| | - Leslie D Williams
- National Development and Research Institutes , New York City , NY , USA
| | - Andria Hadjikou
- Medical School, University of Cyprus , Nicosia , Cyprus.,European University Cyprus , Nicosia , Cyprus
| | - Eleni Kakalou
- General Hospital of Athens "Evangelismos" , Athens , Greece
| | | | - Konstantinos Protopapas
- Department of Internal Medicine, Medical School, University General Hospital "Attikon", National and Kapodistrian University of Athens , Athens , Greece
| | - Anastasia Antoniadou
- Department of Internal Medicine, Medical School, University General Hospital "Attikon", National and Kapodistrian University of Athens , Athens , Greece
| | | | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - Samuel R Friedman
- National Development and Research Institutes , New York City , NY , USA
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30
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Magiorkinis G, Karamitros T, Vasylyeva TI, Williams LD, Mbisa JL, Hatzakis A, Paraskevis D, Friedman SR. An Innovative Study Design to Assess the Community Effect of Interventions to Mitigate HIV Epidemics Using Transmission-Chain Phylodynamics. Am J Epidemiol 2018; 187:2615-2622. [PMID: 30101288 DOI: 10.1093/aje/kwy160] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 07/24/2018] [Indexed: 11/13/2022] Open
Abstract
Given globalization and other social phenomena, controlling the spread of infectious diseases has become an imperative public health priority. A plethora of interventions that in theory can mitigate the spread of pathogens have been proposed and applied. Evaluating the effectiveness of such interventions is costly and in many circumstances unrealistic. Most important, the community effect (i.e., the ability of the intervention to minimize the spread of the pathogen from people who received the intervention to other community members) can rarely be evaluated. Here we propose a study design that can build and evaluate evidence in support of the community effect of an intervention. The approach exploits molecular evolutionary dynamics of pathogens in order to track new infections as having arisen from either a control or an intervention group. It enables us to evaluate whether an intervention reduces the number and length of new transmission chains in comparison with a control condition, and thus lets us estimate the relative decrease in new infections in the community due to the intervention. We provide as an example one working scenario of a way the approach can be applied with a simulation study and associated power calculations.
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Affiliation(s)
- Gkikas Magiorkinis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | - Jean L Mbisa
- Virus Reference Department, Public Health England, London, United Kingdom
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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31
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Williams LD, Kostaki EG, Pavlitina E, Paraskevis D, Hatzakis A, Schneider J, Smyrnov P, Hadjikou A, Nikolopoulos GK, Psichogiou M, Friedman SR. Pockets of HIV Non-infection Within Highly-Infected Risk Networks in Athens, Greece. Front Microbiol 2018; 9:1825. [PMID: 30197629 PMCID: PMC6117409 DOI: 10.3389/fmicb.2018.01825] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 07/23/2018] [Indexed: 01/11/2023] Open
Abstract
As part of a network study of HIV infection among people who inject drugs (PWID) and their contacts, we discovered a connected subcomponent of 29 uninfected PWID. In the context of a just-declining large epidemic outbreak, this raised a question: What explains the existence of large pockets of uninfected people? Possible explanations include “firewall effects” (Friedman et al., 2000; Dombrowski et al., 2017) wherein the only HIV+ people that the uninfected take risks with have low viral loads; “bottleneck effects” wherein few network paths into the pocket of non-infection exist; low levels of risk behavior; and an impending outbreak. We considered each of these. Participants provided information on their enhanced sexual and injection networks and assisted us in recruiting network members. The largest connected component had 241 members. Data on risk behaviors in the last 6 months were collected at the individual level. Recent infection was determined by LAg (SediaTM Biosciences Corporation), data on recent seronegative tests, and viral load. HIV RNA was quantified using Artus HI Virus-1 RG RT-PCR (Qiagen). The 29 members of the connected subcomponent of uninfected participants were connected (network distance = 1) to 17 recently-infected and 24 long-term infected participants. Fourteen (48%) of these 29 uninfected were classified as “extremely high risk” because they self-reported syringe sharing and had at least one injection partner with viral load >100,000 copies/mL who also reported syringe sharing. Seventeen of the 29 uninfected were re-interviewed after 6 months, but none had seroconverted. These findings show the power of network research in discovering infection patterns that standard individual-level studies cannot. Theoretical development and exploratory network research studies may be needed to understand these findings and deepen our understanding of how HIV does and does not spread through communities. Finally, the methods developed here provide practical tools to study “bottleneck” and “firewall” network hypotheses in practice.
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Affiliation(s)
- Leslie D Williams
- Institute for Infectious Disease Research, National Development and Research Institutes, New York, NY, United States
| | - Evangelia-Georgia Kostaki
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - John Schneider
- Departments of Medicine and Public Health Sciences, University of Chicago Medical Center, Center for AIDS Elimination, Chicago, IL, United States
| | | | - Andria Hadjikou
- Medical School, University of Cyprus, Nicosia, Cyprus and European University Cyprus, Nicosia, Cyprus
| | | | - Mina Psichogiou
- First Department of Internal Medicine, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Samuel R Friedman
- Institute for Infectious Disease Research, National Development and Research Institutes, New York, NY, United States
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32
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Paraskevis D, Kostaki E, Nikolopoulos GK, Sypsa V, Psichogiou M, Del Amo J, Hodges-Mameletzis I, Paraskeva D, Skoutelis A, Malliori M, Williams L, Friedman SR, Daikos GL, Hatzakis A. Molecular Tracing of the Geographical Origin of Human Immunodeficiency Virus Type 1 Infection and Patterns of Epidemic Spread Among Migrants Who Inject Drugs in Athens. Clin Infect Dis 2018; 65:2078-2084. [PMID: 29020180 DOI: 10.1093/cid/cix717] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/12/2017] [Indexed: 12/13/2022] Open
Abstract
Background High numbers of human immunodeficiency virus type 1 (HIV-1) infections among people who inject drugs (PWID) have been diagnosed in Athens, Greece, since 2011. We aimed to trace the geographic origin of HIV-1 infection for migrants who inject drugs and to investigate whether transmissions occur more frequently among migrants than among Greek nationals. Methods Multiple cross-sectional studies were pooled to assemble all persons diagnosed with HIV-1 in Greece between 1 January 2011 and 31 October 2014. Phylogenetic analyses used maximum likelihood estimation. The hypothesis of ethnic compartmentalization was tested by reconstructing ancestral states of characters at the tips using the criterion of parsimony over a set of bootstrap trees. Results Of 2274 persons, 38.4% were PWID. Phylogenetic analyses showed the existence of 4 major PWID-specific local transmission networks (LTNs): CRF14_BG (437 [58.6%]), CRF35_AD (139 [18.6%]), subtype B (116 [15.6%]), and subtype A (54 [7.2%]). Of 184 non-Greek PWID, 78.3% had been infected within the PWID-LTNs. For 173 (94.3%), the origin of their infection was assumed to be in Greece (postmigration). For PWID infected within LTNs, transmissions for subtype A and CRF14_BG occurred more frequently among migrants than would be expected by chance (phyloethnic study). Conclusions Our analysis showed that the majority of infections among migrants occurred postmigration. The existence of significant transmission networking among migrants highlights that this population is a priority for HIV prevention. As molecular analysis can estimate the probable country of HIV infection, it can help to inform the design of public health strategies.
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Affiliation(s)
- Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece
| | - Evangelia Kostaki
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece
| | | | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece
| | - Mina Psichogiou
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Greece
| | - Julia Del Amo
- National Center for Epidemiology, Institute of Health Carlos III, Madrid, Spain
| | | | | | - Athanasios Skoutelis
- Fifth Department of Internal Medicine and Infectious Diseases Evangelismos Hospital Athens
| | - Meni Malliori
- Medical School, National and Kapodistrian University of Athens, Greece
| | - Leslie Williams
- National Development and Research Institutes, New York, New York
| | | | - Georgios L Daikos
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece
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33
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Melo JS, Mittal ML, Horyniak D, Strathdee SA, Werb D. Injection Drug Use Trajectories among Migrant Populations: A Narrative Review. Subst Use Misuse 2018; 53:1558-1570. [PMID: 29364762 PMCID: PMC6033671 DOI: 10.1080/10826084.2017.1416404] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Dual epidemics of injection drug use and blood-borne disease, characterized as "syndemics," are present in a range of settings. Behaviors that drive such syndemics are particularly prevalent among mobile drug-using populations, for whom cross-border migration may pose additional risks. OBJECTIVES This narrative review aims to characterize the risk factors for injection drug use initiation associated with migration, employing a risk environment framework and focusing on the San Diego-Tijuana border region as the most dynamic example of these phenomena. METHODS Based on previous literature, we divide migration streams into three classes: intra-urban, internal, and international. We synthesized existing literature on migration and drug use to characterize how mobility and migration drive the initiation of injection drug use, as well as the transmission of hepatitis and HIV, and to delineate how these might be addressed through public health intervention. RESULTS Population mixing between migrants and receiving communities and the consequent transmission of social norms about injection drug use create risk environments for injection drug use initiation. These risk environments have been characterized as a result of local policy environments, injection drug use norms in receiving communities, migration-related stressors, social dislocation, and infringement on the rights of undocumented migrants. CONCLUSION Policies that exacerbate risk environments for migrants may inadvertently contribute to the expansion of epidemics of injection-driven blood-borne disease. Successful interventions that address emerging syndemics in border regions may therefore need to be tailored to migrant populations and distinguish between the vulnerabilities experienced by different migration classes and border settings.
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Affiliation(s)
- Jason S Melo
- a Division of Global Public Health, Department of Medicine , University of California San Diego , La Jolla , California , USA
| | - Maria Luisa Mittal
- a Division of Global Public Health, Department of Medicine , University of California San Diego , La Jolla , California , USA.,b School of Medicine, Universidad Xochicalco , Tijuana , Baja California , Mexico
| | - Danielle Horyniak
- a Division of Global Public Health, Department of Medicine , University of California San Diego , La Jolla , California , USA.,c Centre for Population Health, Burnet Institute , Melbourne , Victoria , Australia.,d School of Public Health and Preventive Medicine, Monash University , Melbourne , Victoria , Australia
| | - Steffanie A Strathdee
- a Division of Global Public Health, Department of Medicine , University of California San Diego , La Jolla , California , USA
| | - Dan Werb
- a Division of Global Public Health, Department of Medicine , University of California San Diego , La Jolla , California , USA.,e Centre for Urban Health Solutions, St. Michael's Hospital , Toronto , Ontario , Canada
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Paraskevis D, Nikolopoulos GK, Sypsa V, Psichogiou M, Pantavou K, Kostaki E, Karamitros T, Paraskeva D, Schneider J, Malliori M, Friedman SR, Des Jarlais DC, Daikos GL, Hatzakis A. Molecular investigation of HIV-1 cross-group transmissions during an outbreak among people who inject drugs (2011-2014) in Athens, Greece. INFECTION GENETICS AND EVOLUTION 2018; 62:11-16. [PMID: 29653216 DOI: 10.1016/j.meegid.2018.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 03/31/2018] [Accepted: 04/07/2018] [Indexed: 01/12/2023]
Abstract
New diagnoses of HIV-1 infection among people who inject drugs (PWID) rocketed in Athens, Greece between 2011 and 2014 (HIV-1 outbreak). Our aim was to identify, during that period, potential cross-group transmissions between the within-Greece PWID and other risk or national groups using molecular methods. Sequences from 33 PWID were outside the PWID-outbreak networks in Greece (PWID-imported transmissions). Phylogenetic analyses on 28 of these sequences (subtypes A and B) showed that 11 subtype B infections originated from Greece, whereas 8 and 7 subtype A strains were from former Soviet Union countries (AFSU) and Greece, respectively. The putative source in half of the PWID-imported transmissions with Greek origin was an individual who acquired HIV via sexual contact. During four years of an HIV-1 outbreak among PWID in Athens, Greece, 33 individuals in this group (4.6% of all diagnoses with phylogenetic analyses) are likely to represent infections, sexually or injection-acquired, outside the within-Greece-PWID-outbreak networks. Combined molecular and traditional HIV surveillance to monitor introductions of new strains, and interventions that aim at reducing the rate of both injection and sexual risky practices are needed during drug injection-related HIV outbreaks.
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Affiliation(s)
- Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Mina Psichogiou
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Evangelia Kostaki
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Timokratis Karamitros
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitra Paraskeva
- Hellenic Center for Disease Control and Prevention, Amarousio, Greece
| | - John Schneider
- Departments of Medicine and Public Health Sciences, and The Chicago Center for HIV Elimination, University of Chicago, Chicago, USA
| | - Melpomeni Malliori
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Don C Des Jarlais
- The Baron Edmond de Rothschild Chemical Dependency Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Georgios L Daikos
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Perlman DC, Jordan AE. The Syndemic of Opioid Misuse, Overdose, HCV, and HIV: Structural-Level Causes and Interventions. Curr HIV/AIDS Rep 2018; 15:96-112. [PMID: 29460225 PMCID: PMC5884743 DOI: 10.1007/s11904-018-0390-3] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW This article reviews the case for recognizing (1) the epidemics of opioid misuse, overdose, hepatitis C virus, and HIV as a syndemic and (2) the importance of examining and addressing structural factors in responses to this syndemic. We focus on the current syndemic in the US, but also consider data from other locations to highlight the issues existing and arising in various contexts. RECENT FINDINGS Advances in multi-level theory and statistical methods allow sound ecologic and multi-level analyses of the impact of structural factors on the syndemic. Studies of opioid misuse, overdoses, hepatitis C virus, and HIV demonstrate that area-level access to healthcare, medication-assisted treatment of opioid use disorders, sterile injection equipment, and overdose prevention with naloxone, as well as factors such as opioid marketing, income inequality, intensity of policing activities, and health care policies, are related to the prevalence of substance misuse, overdoses, infection risk, and morbidity. Structural variables can predict area-level vulnerability to the syndemic. The implementation of combined prevention and treatment interventions can control and reverse components of the syndemic. Recognizing and monitoring potent structural factors can facilitate the identification of areas at risk of vulnerability to the syndemic. Further, many structural factors are modifiable through intervention and policy to reduce structural vulnerability and create health-enabling environments. Evidence supports the immediate implementation of broader HCV and HIV testing and substance use screening, medication-assisted treatment, needle/syringe exchange programs, naloxone programs, increased population-level implementation of HCV treatment, and further attention to structural-level factors predicting, and contributing to, area-level vulnerability, such as degrees of opioid marketing, distribution, and prescribing.
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Affiliation(s)
- David C Perlman
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, 350 East 17th St, 19th Floor, New York, NY, 10003, USA.
- Center for Drug Use and HIV Research, New York, NY, 10003, USA.
| | - Ashly E Jordan
- Center for Drug Use and HIV Research, New York, NY, 10003, USA
- City University New York, Graduate School of Public Health and Health Policy, New York, NY, 10016, USA
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Interpersonal Attacks on the Dignity of Members of HIV Key Populations: A Descriptive and Exploratory Study. AIDS Behav 2017; 21:2561-2578. [PMID: 27752870 DOI: 10.1007/s10461-016-1578-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Attacks on peoples' dignity help to produce and maintain stigmatization and interpersonal hostility. As part of an effort to develop innovative measures of possible pathways between structural interventions or socially-disruptive Big Events and HIV outbreaks, we developed items to measure dignity denial. These measures were administered to 300 people who inject drugs (PWID), 260 high-risk heterosexuals who do not inject drugs, and 191 men who have sex with men who do not inject drugs (MSM). All of the PWID and many of the high risk heterosexuals and MSM were referred to our study in 2012-2015 by a large New York city study that used respondent-driven sampling; the others were recruited by chain-referral. Members of all three key populations experienced attacks on their dignity fairly often and also reported frequently seeing others' dignity being attacked. Relatives are major sources of dignity attacks. MSM were significantly more likely to report having their dignity attacked by police officers than were the other groups. 40 % or more of each key population reported that dignity attacks are followed "sometimes" or more often both by using more drugs and also by using more alcohol. Dignity attacks and their health effects require more research and creative interventions, some of which might take untraditional forms like social movements.
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A network intervention that locates and intervenes with recently HIV-infected persons: The Transmission Reduction Intervention Project (TRIP). Sci Rep 2016; 6:38100. [PMID: 27917890 PMCID: PMC5137009 DOI: 10.1038/srep38100] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 11/04/2016] [Indexed: 01/01/2023] Open
Abstract
Early treatment, soon after infection, reduces HIV transmissions and benefits patients. The Transmission Reduction Intervention Project (TRIP) evaluated a network intervention to detect individuals recently infected (in the past 6 months). TRIP was conducted in Greece (2013-2015) and focused on drug injector networks. Based on HIV status, testing history, and the results of an assay to detect recent infections, TRIP classified drug injector "Seeds" into groups: Recent Seeds (RS), and Control Seeds with Long-term HIV infection (LCS). The network members of RS and LCS were traced for two steps. The analysis included 23 RS, 171 network members of the RS, 19 LCS, and 65 network members of the LCS. The per-seed number of recents detected in the network of RS was 5 times the number in the network of LCS (Ratio RS vs. LCS: 5.23; 95% Confidence Interval (CI): 1.54-27.61). The proportion of recents among HIV positives in the network of RS (27%) was approximately 3 times (Ratio RS vs. LCS: 3.30; 95% CI: 1.04-10.43) that in the network of LCS (8%). Strategic network tracing that starts with recently infected persons could support public health efforts to find and treat people early in their HIV infection.
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Evaluation of the limiting antigen avidity EIA (LAg) in people who inject drugs in Greece. Epidemiol Infect 2016; 145:401-412. [PMID: 27780490 DOI: 10.1017/s0950268816002417] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
This analysis assessed the utility of the limiting antigen avidity assay (LAg). Samples of people who inject drugs (PWID) in Greece with documented duration of HIV-1 infection were tested by LAg. A LAg-normalized optical density (ODn) ⩽1·5 corresponds to a recency window period of 130 days. The proportion true recent (PTR) and proportion false recent (PFR) were estimated in 28 seroconverters and in 366 samples collected >6 months after HIV diagnosis, respectively. The association between LAg ODn and HIV RNA level was evaluated in 232 persons. The PTR was 85·7%. The PFR was 20·8% but fell to 5·9% in samples from treatment-naive individuals with long-standing infection (>1 year), and to 0 in samples with the circulating recombinant form CRF35 AD. A LAg-based algorithm with a PFR of 3·3% estimated a similar incidence trend to that calculated by analyses based on HIV-1 seroconversions. In recently infected persons indicated by LAg, the median log10 HIV RNA level was high (5·30, interquartile range 4·56-5·90). LAg can help identify highly infectious HIV(+) individuals as it accurately identifies recent infections and is correlated with the HIV RNA level. It can also produce reliable estimates of HIV-1 incidence.
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Fotiou A, Kanavou E, Antaraki A, Richardson C, Terzidou M, Kokkevi A. HCV/HIV coinfection among people who inject drugs and enter opioid substitution treatment in Greece: prevalence and correlates. HEPATOLOGY, MEDICINE AND POLICY 2016; 1:9. [PMID: 30288313 PMCID: PMC5918725 DOI: 10.1186/s41124-016-0017-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 08/15/2016] [Indexed: 12/12/2022]
Abstract
Background HCV/HIV coinfection in people who inject drugs is a public health issue, which presents a variety of challenges to healthcare providers. The determinants of HCV/HIV coinfection in this population are nonetheless not well known. The aim of the present study is to identify the factors associated with HCV/HIV coinfection in people who inject drugs and enter drug-related treatment. Methods Linked serological and behavioral data were collected from people who entered 38 opioid substitution treatment clinics in central and southern Greece between January and December 2013. Three mutually exclusive groups were defined based on the presence of HCV and HIV antibodies. Group 1 clients had neither infection, Group 2 had HCV but not HIV, and Group 3 had HCV/HIV coinfection. Multinomial logistic regression analyses identified differences between groups according to socio-demographic, drug use and higher-risk behavioral characteristics. Results Our study population consisted of 580 people who injected drugs in the past 12 months (79.8 % males, with median age 36 years).79.4 % were HCV and 15.7 % HIV infected. Of those with complete serological data in both HCV and HIV indicators, 20.4 % were uninfected, 64.0 % HCV monoinfected, and 14.9 % HCV/HIV coinfected. HCV infection with or without HIV coinfection was positively associated with living alone or with a spouse/partner without children, prior incarceration, drug injecting histories of ≥10 years, and syringe sharing in the past 12 months, and negatively associated with never having previously been tested for HCV. HCV/HIV coinfection, but not HCV infection alone, was positively associated with residence in urban areas (relative risk ratio [RRR] = 4.8, 95 % confidence interval [CI]: 1.7–13.7, p = 0.004) and averaging >3 injections a day in the past 30 days (RRR = 4.5, 95 % CI: 1.6–12.8, p = 0.005), and negatively associated with using a condom in the last sexual intercourse. Conclusions People who inject drugs and live in urban areas and inject frequently have higher risk of coinfection. Findings highlight the need for scaling-up needle and syringe programs in inner city areas and promoting access of this population to screening and treatment, especially in prisons. The protective role of living with parents and children could inform the implementation of indicated interventions.
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Affiliation(s)
- Anastasios Fotiou
- 1Epidemiology Unit, Greek Reitox Focal Point of the EMCDDA, University Mental Health Research Institute, 2 Soranou tou Efesiou St., Athens, 11527 Greece
| | - Eleftheria Kanavou
- 1Epidemiology Unit, Greek Reitox Focal Point of the EMCDDA, University Mental Health Research Institute, 2 Soranou tou Efesiou St., Athens, 11527 Greece
| | - Argyro Antaraki
- 1Epidemiology Unit, Greek Reitox Focal Point of the EMCDDA, University Mental Health Research Institute, 2 Soranou tou Efesiou St., Athens, 11527 Greece
| | - Clive Richardson
- 2Panteion University of Social and Political Sciences, 136, Leoforos A. Siggrou, Kallithea, Athens 17671 Greece
| | - Manina Terzidou
- 1Epidemiology Unit, Greek Reitox Focal Point of the EMCDDA, University Mental Health Research Institute, 2 Soranou tou Efesiou St., Athens, 11527 Greece
| | - Anna Kokkevi
- 3University Mental Health Research Institute, 2 Soranou tou Efesiou St., Athens, 11527 Greece
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Pouget ER, Sandoval M, Nikolopoulos GK, Mateu-Gelabert P, Rossi D, Smyrnov P, Jones Y, Friedman SR. Developing Measures of Pathways that May Link Macro Social/Structural Changes with HIV Epidemiology. AIDS Behav 2016; 20:1808-20. [PMID: 26796384 DOI: 10.1007/s10461-016-1291-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Macro-social/structural events ("big events") such as wars, disasters, and large-scale changes in policies can affect HIV transmission by making risk behaviors more or less likely or by changing risk contexts. The purpose of this study was to develop new measures to investigate hypothesized pathways between macro-social changes and HIV transmission. We developed novel scales and indexes focused on topics including norms about sex and drug injecting under different conditions, involvement with social groups, helping others, and experiencing denial of dignity. We collected data from 300 people who inject drugs in New York City during 2012-2013. Most investigational measures showed evidence of validity (Pearson correlations with criterion variables range = 0.12-0.71) and reliability (Cronbach's alpha range = 0.62-0.91). Research is needed in different contexts to evaluate whether these measures can be used to better understand HIV outbreaks and help improve social/structural HIV prevention intervention programs.
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Affiliation(s)
- Enrique R Pouget
- Institute for Infectious Disease Research, National Development and Research Institutes, Inc., 71 West 23rd St., 4th floor, New York, NY, 10010, USA.
| | - Milagros Sandoval
- Institute for Infectious Disease Research, National Development and Research Institutes, Inc., 71 West 23rd St., 4th floor, New York, NY, 10010, USA
| | - Georgios K Nikolopoulos
- Institute for Infectious Disease Research, National Development and Research Institutes, Inc., 71 West 23rd St., 4th floor, New York, NY, 10010, USA
| | - Pedro Mateu-Gelabert
- Institute for Infectious Disease Research, National Development and Research Institutes, Inc., 71 West 23rd St., 4th floor, New York, NY, 10010, USA
| | - Diana Rossi
- Intercambios Civil Association, Corrientes 2548, Piso 2 Oficina D, Buenos Aires, 1046, Argentina
| | - Pavlo Smyrnov
- Alliance for Public Health, 5 Dymytrova Street, Building 10-A, Kiev, 03680, Ukraine
| | - Yolanda Jones
- Institute for Infectious Disease Research, National Development and Research Institutes, Inc., 71 West 23rd St., 4th floor, New York, NY, 10010, USA
| | - Samuel R Friedman
- Institute for Infectious Disease Research, National Development and Research Institutes, Inc., 71 West 23rd St., 4th floor, New York, NY, 10010, USA
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Nikolopoulos GK, Kostaki EG, Paraskevis D. Overview of HIV molecular epidemiology among people who inject drugs in Europe and Asia. INFECTION GENETICS AND EVOLUTION 2016; 46:256-268. [PMID: 27287560 DOI: 10.1016/j.meegid.2016.06.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/01/2016] [Accepted: 06/05/2016] [Indexed: 01/14/2023]
Abstract
HIV strains continuously evolve, tend to recombine, and new circulating variants are being discovered. Novel strains complicate efforts to develop a vaccine against HIV and may exhibit higher transmission efficiency and virulence, and elevated resistance to antiretroviral agents. The United Nations Joint Programme on HIV/AIDS (UNAIDS) set an ambitious goal to end HIV as a public health threat by 2030 through comprehensive strategies that include epidemiological input as the first step of the process. In this context, molecular epidemiology becomes invaluable as it captures trends in HIV evolution rates that shape epidemiological pictures across several geographical areas. This review briefly summarizes the molecular epidemiology of HIV among people who inject drugs (PWID) in Europe and Asia. Following high transmission rates of subtype G and CRF14_BG among PWID in Portugal and Spain, two European countries, Greece and Romania, experienced recent HIV outbreaks in PWID that consisted of multiple transmission clusters including subtypes B, A, F1, and recombinants CRF14_BG and CRF35_AD. The latter was first identified in Afghanistan. Russia, Ukraine, and other Former Soviet Union (FSU) states are still facing the devastating effects of epidemics in PWID produced by AFSU (also known as IDU-A), BFSU (known as IDU-B), and CRF03_AB. In Asia, CRF01_AE and subtype B (Western B and Thai B) travelled from PWID in Thailand to neighboring countries. Recombination hotspots in South China, Northern Myanmar, and Malaysia have been generating several intersubtype and inter-CRF recombinants (e.g. CRF07_BC, CRF08_BC, CRF33_01B etc.), increasing the complexity of HIV molecular patterns.
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Affiliation(s)
- Georgios K Nikolopoulos
- Hellenic Centre for Diseases Control and Prevention, Amarousio, Greece; Hellenic Scientific Society for the Study of AIDS and Sexually Transmitted Diseases, Transmission Reduction Intervention Project-Athens site, Athens, Greece.
| | - Evangelia-Georgia Kostaki
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Friedman SR, Pouget ER, Sandoval M, Jones Y, Nikolopoulos GK, Mateu-Gelabert P. Measuring Altruistic and Solidaristic Orientations Toward Others Among People Who Inject Drugs. J Addict Dis 2016; 34:248-54. [PMID: 26076380 DOI: 10.1080/10550887.2015.1059654] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The altruism and/or solidarity of people who inject drugs helps protect sex and drug partners from HIV. Research has been hindered by lack of measures. We developed and administered scales to assess them to 300 people who inject drugs. Altruism and Solidarity Scales were both internally consistent. Each correlated significantly with measures of helping others. These measures appear reliable and valid. They can be used to study how big events or structural interventions affect altruism and solidarity, and how altruism and solidarity are associated with changes in HIV or other risks, among people who inject drugs.
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Affiliation(s)
- Samuel R Friedman
- a Institute for Infectious Disease Research, National Development and Research Institutes, Inc., New York , New York , USA
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Friedman SR, Tempalski B, Brady JE, West BS, Pouget ER, Williams LD, Des Jarlais DC, Cooper HLF. Income inequality, drug-related arrests, and the health of people who inject drugs: Reflections on seventeen years of research. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 32:11-6. [PMID: 27198555 DOI: 10.1016/j.drugpo.2016.03.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/24/2016] [Accepted: 03/03/2016] [Indexed: 11/24/2022]
Abstract
This paper reviews and then discusses selected findings from a seventeen year study about the population prevalence of people who inject drugs (PWID) and of HIV prevalence and mortality among PWID in 96 large US metropolitan areas. Unlike most research, this study was conducted with the metropolitan area as the level of analysis. It found that metropolitan area measures of income inequality and of structural racism predicted all of these outcomes, and that rates of arrest for heroin and/or cocaine predicted HIV prevalence and mortality but did not predict changes in PWID population prevalence. Income inequality and measures of structural racism were associated with hard drug arrests or other properties of policing. These findings, whose limitations and implications for further research are discussed, suggest that efforts to respond to HIV and to drug injection should include supra-individual efforts to reduce both income inequality and racism. At a time when major social movements in many countries are trying to reduce inequality, racism and oppression (including reforming drug laws), these macro-social issues in public health should be both addressable and a priority in both research and action.
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Affiliation(s)
- Samuel R Friedman
- National Development and Research Institute, Inc., 71 West 23rd Street, 4th Floor, New York, NY 10010, USA.
| | - Barbara Tempalski
- National Development and Research Institute, Inc., 71 West 23rd Street, 4th Floor, New York, NY 10010, USA
| | - Joanne E Brady
- NORC at the University of Chicago, 4350 East-West Hwy, Bethesda, MD 20814 USA
| | - Brooke S West
- Division of Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Drive 0507, La Jolla, CA 92093-0507, USA
| | - Enrique R Pouget
- National Development and Research Institute, Inc., 71 West 23rd Street, 4th Floor, New York, NY 10010, USA
| | - Leslie D Williams
- National Development and Research Institute, Inc., 71 West 23rd Street, 4th Floor, New York, NY 10010, USA
| | - Don C Des Jarlais
- Psychiatry and Preventive Medicine, Icahn School of Medicine at Mount Sinai., 39 Broadway, Suite 530, New York, NY 10006, USA
| | - Hannah L F Cooper
- Rollins School of Public Health at Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322, USA
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Nikolopoulos GK, Fotiou A. "Integrated interventions are dead. Long live sustainable integrated interventions!"--Austerity Challenges the Continuation of Effective Interventions in the Field of Drug Use-Related Harm Reduction. Subst Use Misuse 2015; 50:1220-2. [PMID: 26361930 PMCID: PMC4832113 DOI: 10.3109/10826084.2015.1042326] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Georgios K Nikolopoulos
- a 1 Transmission Reduction Intervention Project (TRIP) , Athens , Greece.,b 2 Hellenic Center for Disease Control and Prevention , Athens , Greece
| | - Anastasios Fotiou
- c 3 Greek Reitox focal point of the EMCDDA at the University Mental Health Research Institute , Athens , Greece
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