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Essar MY, Siddiqui A, Head MG. Infectious diseases in Afghanistan: Strategies for health system improvement. Health Sci Rep 2023; 6:e1775. [PMID: 38116172 PMCID: PMC10728369 DOI: 10.1002/hsr2.1775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/02/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023] Open
Abstract
Background and Aim Afghanistan is grappling with a severe health crisis marked by a high prevalence of infectious diseases, particularly tuberculosis, malaria, HIV, and the added strain of the COVID-19 pandemic. The nation's healthcare system, already fragile, faces formidable challenges. Socioeconomic constraints, including limited resources and financial barriers, hinder healthcare accessibility, leading to delayed or inadequate care. Environmental factors, such as poor sanitation and crowded living conditions, exacerbate the transmission of diseases, especially waterborne illnesses. Governance issues, encompassing transparency, corruption, and political instability, disrupt healthcare efficiency and resource allocation. Addressing these multifaceted issues is vital to enhance Afghanistan's healthcare system and overall well-being. The withdrawal of international support has exacerbated these challenges. The primary research goal is to deeply understand Afghanistan's health system, focusing on the major disease burdens: Tuberculosis, Malaria, AIDS, COVID-19, Measles, Hepatitis, and Cholera. The study aims to assess the feasibility and effectiveness of current approaches, presenting a comprehensive view of challenges and opportunities within the Afghan healthcare system. The research concludes by highlighting policy implications, practical implementation, and offering recommendations for future endeavors. Methodology This paper provides a thorough analysis of the literature concerning infectious diseases in Afghanistan and the enhancement of the healthcare system in the nation. A systematic exploration of the literature was conducted through PubMed and Google Scholar databases. The search terms used encompassed "Tuberculosis" OR "TB," "Malaria," "acquired immunodeficiency syndrome" OR "AIDS," "Human immunodeficiency virus" OR "HIV," "COVID-19," "Measles," "Hepatitis virus," "Cholera," "Health system improvement," and "Afghanistan." Additionally, external sources like UNICEF, CDC, and WHO were referenced. Results In conclusion, while improving access to vital medicines and vaccines is crucial for enhancing health outcomes in Afghanistan, significant challenges must be addressed to ensure the effectiveness and sustainability of such strategies. The Afghan health system's fragile governance, corruption, logistical complexities, and failure to address broader social and economic factors pose significant risks and obstacles to the implementation of proposed health strategies. Therefore, the strategies discussed in this analysis align with key Sustainable Development Goals, particularly SDG 3, and their successful implementation will have implications not only for the health and well-being of Afghanistan but also for global health. Conclusion Hence, by adopting a comprehensive approach with complementary interventions as discussed, we can address issues in the Afghan health system and reduce transmissible diseases' burden, thereby building a better world for all.
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Affiliation(s)
- Mohammad Yasir Essar
- Department of DentistryKabul University of Medical SciencesKabulAfghanistan
- Department of Global HealthMcMaster UniversityHamiltonOntarioCanada
| | - Amna Siddiqui
- Department of MedicineKarachi Medical and Dental CollegeKarachiPakistan
| | - Michael G. Head
- Clinical Informatics Research Unit, Faculty of MedicineUniversity of SouthamptonSouthamptonUK
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Tsegay B, Gebrecherkos T, Kahsay AG, Abdulkader M. Seroprevalence and Associated Factors of Hepatitis B and Hepatitis C Viral Infections Among Prisoners in Tigrai, Northern Ethiopia. Infect Drug Resist 2023; 16:3743-3750. [PMID: 37333685 PMCID: PMC10276587 DOI: 10.2147/idr.s410017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 06/07/2023] [Indexed: 06/20/2023] Open
Abstract
Background Hepatitis B and C viruses are important health and socioeconomic problem across the globe, with a remarkable number of diseases and deaths in sub-Saharan African countries. The burden of hepatitis is unknown in the prison settings of Tigrai. Therefore, we aimed to describe the seroprevalence and associated factors of hepatitis B and C viruses among prisoners in Tigrai, Ethiopia. Methods A cross-sectional study was carried out from February 2020 to May 2020 at the prison facilities of Tigrai. Demographics and associated factors were collected from 315 prisoners prospectively. Five milliliters of blood was collected and tested using rapid tests kits of HBsAg (Zhejiang orient Gene Biotech Co., Ltd., China) and HCV antibodies (Volkan Kozmetik Sanayi Ve Ticaret Ltd. STI, Turkey). Positive samples were confirmed using enzyme-linked immunosorbent assay (ELISA) (Beijing Wantai Biological Pharmacy Enterprise Co. Ltd). Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 20 and p<0.05 was considered statistically significant. Results The overall seroprevalence of HBV and HCV were 25 (7.9%) and 1 (0.3%), respectively. The majority of hepatitis B viral infections were identified from the age groups of 18-25 years (10.7%) and unmarried prisoners (11.8%). Prisoners greater than 100 per cell (AOR=3.95, 95% CI=1.15-13.6, p=0.029) and with a history of alcohol consumption (AOR=3.01, 95% CI=1.17-7.74, p=0.022) were significantly associated with HBV infections. Conclusion The seroprevalence of HBV among prisoners was nearly high or borderline (7.9%) with a very low HCV prevalence (0.3%). HBV was most prevalent among young adults, those housed with a large number of prisoners per cell, and those who had a history of alcohol consumption. This study recommends that there should be prison-focused intervention, including regular health education, with the emphasis on the mode of transmission and introducing HBV screening policy for prisoners, especially when they enter the prison.
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Affiliation(s)
- Belaynesh Tsegay
- Ayder Comprehensive Specialized Hospital Laboratory Department, Mekelle University, Mekelle, Tigrai, Northern Ethiopia
| | - Teklay Gebrecherkos
- Department of Medical Microbiology and Immunology, College of Health Sciences, Mekelle University, Mekelle, Tigrai, Northern Ethiopia
| | - Atsebaha Gebrekidan Kahsay
- Department of Medical Microbiology and Immunology, College of Health Sciences, Mekelle University, Mekelle, Tigrai, Northern Ethiopia
| | - Mahmud Abdulkader
- Department of Medical Microbiology and Immunology, College of Health Sciences, Mekelle University, Mekelle, Tigrai, Northern Ethiopia
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Nafeh F, Fusigboye S, Sornpaisarn B. Understanding injecting drug use in Afghanistan: A scoping review. Subst Abuse Treat Prev Policy 2022; 17:65. [PMID: 36123586 PMCID: PMC9484158 DOI: 10.1186/s13011-022-00491-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2022] [Indexed: 12/02/2022] Open
Abstract
Background Several reports have described a growing prevalence of illicit drug use in Afghanistan, with recognition of a recent shift from traditional modes of consumption involving inhalation and oral ingestion to injecting drug use. Objective Conduct a comprehensive review of existing literature to map the injecting drug use situation in Afghanistan. The review intends to describe risk factors and impacts of injecting drug use, drug use characteristics and risk behaviours among people who inject drugs (PWID), and access to harm reduction and treatment. Methods We searched Embase, Global Health, Medline, PsycINFO, Web of Science, and grey literature to identify English language publications up to March 26th, 2022. Studies were eligible for inclusion if they explicitly targeted PWID or injecting drug use in Afghanistan and provided information relevant to the review questions. Two reviewers independently screened titles and abstracts for inclusion and extracted information based on the review objectives. Results A total of 25 articles were identified representing 15 studies (11 quantitative, 2 qualitative, 2 mixed methods). All but one studies were cross-sectional. In majority of the studies, over 95% of the participants were male and most were conducted over a decade ago, in urban settings, mainly Kabul. Only one study examined risk factors of injecting drug use. Eleven studies described drug use characteristics and 9 reported risk behaviours among PWID. Health and social burden of injecting drug use were reported by 8 and 5 studies, respectively. Nine studies described access to harm reduction and treatment. Afghan PWID had high levels of injecting and sexual risk behaviours compared to global estimates. They reported high prevalence of incarceration and displacement. Access to harm reduction and treatment was very limited. This scoping review revealed important knowledge gaps including a gender gap in research with serious implications for drug policy and substance use care. Conclusions Development of a national public health-oriented drug policy and substance use care programme is warranted along with efforts to develop health research capacity to address the need for epidemiological data. The current humanitarian crisis necessitates continued access to evidence-based harm reduction and treatment in Afghanistan. Supplementary Information The online version contains supplementary material available at 10.1186/s13011-022-00491-1.
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Matsangos M, Ziaka L, Exadaktylos AK, Klukowska-Rötzler J, Ziaka M. Health Status of Afghan Refugees in Europe: Policy and Practice Implications for an Optimised Healthcare. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159157. [PMID: 35954518 PMCID: PMC9368211 DOI: 10.3390/ijerph19159157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/21/2022] [Accepted: 07/23/2022] [Indexed: 02/05/2023]
Abstract
Four decades of civil war, violence, and destabilisation have forced millions of Afghans to flee their homes and to move to other countries worldwide. This increasing phenomenon may challenge physicians unfamiliar with the health status of this population, which may be markedly different from that of the host country. Moreover, several factors during their migration, such as transport in closed containers, accidental injuries, malnutrition, and accommodation in detention centres and refugee camps have a major influence on the health of refugees. By taking into account the variety of the specific diseases among migrant groups, the diversity of the origins of refugees and asylum seekers, and the increasing numbers of Afghan refugees, in this review we focus on the population of Afghans and describe their health status with the aim of optimising our medical approach and management. Our literature review shows that the most prevalent reported infections are tuberculosis and other respiratory tract infections and parasitic diseases, for example leishmaniasis, malaria, and intestinal parasitic infections. Anaemia, hyperlipidaemia, arterial hypertension, diabetes, smoking, overweight, malnutrition, low socioeconomic status, and poor access to healthcare facilities are additional risk factors for non-communicable diseases among Afghan refugees. With regards mental health issues, depression and post-traumatic stress disorder (PTSD) are the most common diagnoses and culture shock and the feeling of being uprooted modulate their persistence. Further research is needed in order to provide us with extensive, high-quality data about the health status of Afghan refugees. The main objective of this review is to identify protective factors which could ensure key health concepts and good clinical practice.
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Affiliation(s)
- Michael Matsangos
- Department of General Surgery, Insel Gruppe AG, Kreditorenbuchhaltung, Freiburgstrasse 18, 3010 Bern , Switzerland;
| | - Laoura Ziaka
- Department of Special Needs Education, University of Oslo, 0315 Oslo, Norway;
| | - Artistomenis K. Exadaktylos
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3010 Bern, Switzerland; (A.K.E.); (J.K.-R.)
| | - Jolanta Klukowska-Rötzler
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3010 Bern, Switzerland; (A.K.E.); (J.K.-R.)
| | - Mairi Ziaka
- Department of Internal Medicine, General Hospital of Thun, 3600 Thun, Switzerland
- Correspondence:
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Kaposi Sarcoma in Afghanistan: A Case Series from a Tertiary Referral Center. Dermatopathology (Basel) 2022; 9:258-270. [PMID: 35892483 PMCID: PMC9326635 DOI: 10.3390/dermatopathology9030030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/08/2022] [Accepted: 07/09/2022] [Indexed: 11/17/2022] Open
Abstract
Kaposi sarcoma is a vascular endothelial neoplasm caused by human herpesvirus 8. Although it is a well-studied disease, little is known about the specific characteristics or epidemiology of Kaposi sarcoma in Afghanistan. The data consist primarily of anecdotal reports and epidemiological studies extrapolated from neighboring countries. In this case series, we summarize existing data about Kaposi sarcoma in Afghanistan and present seven histologically confirmed cases with associated clinical features to shed light on the characteristics of Kaposi sarcoma in this unique geographic setting.
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O'Brien S, Kyaw KWY, Jaramillo MM, Roberts B, Bijl M, Platt L. Determinants of health among people who use illicit drugs in the conflict-affected countries of Afghanistan, Colombia and Myanmar: a systematic review of epidemiological evidence. Confl Health 2022; 16:39. [PMID: 35799203 PMCID: PMC9264525 DOI: 10.1186/s13031-022-00467-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 06/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Afghanistan, Colombia and Myanmar are the world's leading heroin and cocaine producers and have also experienced prolonged periods of armed conflict. The link between armed conflict and drug markets is well established but how conflict impacts on the health and social determinants of people who use drugs is less clear. The aim was to investigate health outcomes and associated factors among people who use illicit drugs in Afghanistan, Colombia and Myanmar. METHODS We conducted a systematic review searching Medline, EMBASE, PsychINFO and Global Health databases using terms relating to Afghanistan, Colombia and Myanmar; illicit drug use (all modes of drug administration); health and influencing factors. Quality assessment was assessed with the Newcastle-Ottawa-Scale and papers were analysed narratively. RESULTS 35 studies were included in Afghanistan (n = 15), Colombia (n = 9) and Myanmar (n = 11). Health outcomes focused predominantly on HIV, Hepatitis C (HCV), Hepatitis B and sexually transmitted infections (STIs), with one study looking at human rights violations (defined as maltreatment, abuse and gender inequality). Drug use was predominantly injection of heroin, often alongside use of amphetamines (Myanmar), cocaine and cocaine-based derivatives (Colombia). Only one study measured the effect of a period of conflict suggesting this was linked to increased reporting of symptoms of STIs and sharing of needles/syringes among people who inject drugs. Findings show high levels of external and internal migration, alongside low-income and unemployment across the samples. External displacement was linked to injecting drugs and reduced access to needle/syringe programmes in Afghanistan, while initiation into injecting abroad was associated with increased risk of HCV infection. Few studies focused on gender-based differences or recruited women. Living in more impoverished rural areas was associated with increased risk of HIV infection. CONCLUSIONS More research is needed to understand the impact of armed-conflict and drug production on the health of people who use drugs. The immediate scale-up of harm reduction services in these countries is imperative to minimize transmission of HIV/HCV and address harms associated with amphetamine use and other linked health and social care needs that people who use drugs may face.
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Affiliation(s)
- Sally O'Brien
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Khine Wut Yee Kyaw
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Margarita Marin Jaramillo
- Observatorio de Restitución Y Regulación de los Derechos de Propiedad Agraria, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Bayard Roberts
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Murdo Bijl
- Asian Harm Reduction Network (AHRN), Yangon, Myanmar
| | - Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
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Rasikh AS. Factors Associated with HIV Risk and Vulnerability Among Injecting Drug Users in Afghanistan: A Narrative Review. HIV AIDS (Auckl) 2022; 14:331-339. [PMID: 35911789 PMCID: PMC9329675 DOI: 10.2147/hiv.s366970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
The number of human immunodeficiency virus (HIV) cases in Afghanistan is increasing mainly associated with injecting drug use (IDU). This study aimed to explore the risk and vulnerability factors associated with HIV infection among injecting drug users (IDUs) in Afghanistan in order to contribute to improving the response and reversing the concentrated HIV epidemic among this group. A narrative review of the literature was conducted to reach the objective. The modified social ecological model was used as conceptual framework for analysis of the HIV risk and vulnerability factors among IDUs at five levels. At the “individual level”, the injecting risk behaviors among IDUs such as sharing the injecting equipment and their sexual risk behaviors like unprotected sexual contact with multiple partners identified as immediate factors that put them at risk of HIV infection. At the “network level”, lack of HIV knowledge and low uptake of the harm reduction services were identified as the factors that increase their vulnerability. At the “community level”, massive drug production and easy access to illicit drugs, armed conflicts, massive internal and external migration, unemployment and poverty, high stigma and discrimination against IDUs, unsafe injecting locations such as under the bridges; and at the “public policy level”, punitive drug laws, and weak national political response to HIV and IDU were identified as determinants that add to the IDUs vulnerability to HIV. At the “stage of epidemic level”, the concentrated HIV epidemic among IDUs in the country poses a potential risk to uninfected IDUs and beyond. In conclusion, the IDUs in Afghanistan are highly at risk and vulnerable to HIV. An informed and multisectoral response is required to control the epidemic. A rapid expansion of the harm reduction interventions is urgently needed.
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Affiliation(s)
- Ahmad Shekaib Rasikh
- Department of Infectious Diseases, Kabul University of Medical Sciences, Kabul, Afghanistan
- KIT Health (Royal Tropical Institute), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Correspondence: Ahmad Shekaib Rasikh, Tel +93791906514, Email
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Hashemi E, Waheed U, Saba N, Wazeer A. First Report from Afghanistan on the Prevalence of Blood-Borne Infections: A Retrospective Cross-Sectional Multicentre Study for an Epidemiological Assessment. J Blood Med 2022; 13:45-50. [PMID: 35027857 PMCID: PMC8752068 DOI: 10.2147/jbm.s344180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/24/2021] [Indexed: 11/24/2022] Open
Abstract
Background The transfusion of blood and blood components has a significant role in healthcare services. However, it remains a possible risk factor for blood-borne infections. The present study was conducted to assess the prevalence of serological markers of common blood-borne infections among the blood donor population of Afghanistan. Methodology This was a cross-sectional study based on retrospectively collected data over a period of six years from 284 blood centres across 34 provinces of Afghanistan. Every blood donor’s sample was tested by rapid immunoassays for the serological markers of blood-borne infections namely hepatitis B surface antigen (HBsAg), anti-hepatitis C virus (anti-HCV), anti-human immunodeficiency virus 1/2 (anti-HIV1/2), and anti-Treponema pallidum (anti-TP). Results All blood donors during the study period were males. The majority of blood donations were from the family replacement category 56.93% (n = 544,568). The overall pooled prevalence of blood-borne infections was 4.36% with a comparatively higher percentage in family replacement donors 4.88%. The seropositivity for HBsAg, anti-HCV, anti-HIV1/2, and anti-TP was 2.95%, 0.81%, 0.04%, and 0.54%, respectively. Conclusion Complete reliance on voluntary blood donors and screening with quality assured highly sensitive assay is recommended to ensure blood safety in the country.
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Affiliation(s)
- Enayatullah Hashemi
- Afghan National Blood Safety and Transfusion Service, General Directorate of Curative Medicine, Ministry of Public Health, Kabul, Afghanistan
| | - Usman Waheed
- Afghan National Blood Safety and Transfusion Service, General Directorate of Curative Medicine, Ministry of Public Health, Kabul, Afghanistan
| | - Noore Saba
- Peshawar Regional Blood Centre, Provincial Ministry of Health, Khyber Pakhtunkhwa, Pakistan
| | - Akhlaaq Wazeer
- Mirpur Regional Blood Centre, State Ministry of Health, Azad Jammu and Kashmir, Pakistan
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Karimi SE, Vameghi M, Roshanfekr P, Ahmadi S, Ali D, Higgs P. Drug injection in Iranian prisons: evidence from the National Rapid Assessment and Response (RAR) survey, 2017. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.1941340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Salah Eddin Karimi
- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Meroe Vameghi
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Payam Roshanfekr
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Sina Ahmadi
- Department of Social Welfare Management, Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Delaram Ali
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Peter Higgs
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Australia
- Department of Public Health, La Trobe University, Bundoora, Australia
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Shayan SJ, Nazari R, Kiwanuka F. Prevalence of HIV and HCV among injecting drug users in three selected WHO-EMRO countries: a meta-analysis. Harm Reduct J 2021; 18:59. [PMID: 34044849 PMCID: PMC8161998 DOI: 10.1186/s12954-021-00505-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/17/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND HIV and Hepatitis C Virus (HCV) infections are responsible for a significant burden of mortality and morbidity, particularly in developing countries. This study sought to determine the prevalence of HIV and Hepatitis C among injecting drug users in Afghanistan, Iran, and Pakistan. METHODS This review conforms to the Preferred Reporting Guidelines for Systematic Reviews and Meta-Analysis (PRISMA) statement. Databases including PubMed, Scopus, Web of Science/Knowledge, SID.ir, and MAGIRAN were searched. Studies that were published from 2003 up to 2018 were considered for analysis. Studies were screened for inclusion in duplicate, and also, that data were narratively synthesized. RESULTS We report on data from 79 articles. The total number of participants in studies that assessed the prevalence of HIV among injecting drug users included 68,926 participants, while those from studies that assessed HCV prevalence were 23,016 participants. Overall HIV and HCV prevalence among injecting drug users in the three selected countries were 9.1% (95% CI 6.9-12.0%) and 48.3% (95% CI 43.9-52.7%), respectively. Iran had the highest HIV prevalence of 11.0% among injectable drug users (95% CI 8.4-14.2%), while Afghanistan had the lowest HIV prevalence of 3.1% (95% CI 1.5-6.3%) among three selected countries. In Pakistan, the prevalence of HIV was 8.6% (95% CI 4.8-15.0%). Regarding HCV prevalence, Pakistan had the highest while Afghanistan had the lowest, 54.4% (95% CI 33.5-73.9%) and 37.3% (95% CI 35.2-39.4%), respectively. HCV prevalence in Iran was 47.7% (95% CI 43.4-52.0%). CONCLUSION Injecting drug users form a special cohort of persons at risk of HIV and Hepatitis C infections. The prevalence of HIV and Hepatitis noted from our findings is significantly high. Awareness of the grave risk of spreading HIV and Hepatitis C associated with sharing needles is recommended among this sub-group of drug users.
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Affiliation(s)
- Shah Jahan Shayan
- Department of Fundamental of Nursing, School of Nursing, Kabul University of Medical Sciences, Jamal Mina, 3rd District, Kabul, Afghanistan.
| | - Rajab Nazari
- Department of Fundamental of Nursing, School of Nursing, Kabul University of Medical Sciences, Jamal Mina, 3rd District, Kabul, Afghanistan
| | - Frank Kiwanuka
- Department of Nursing Sciences, University of Eastern Finland, Kuopio, Finland
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Paniccia JE, Weckstein TN, Lebonville CL, Lysle DT. Female rats express heroin-induced and -conditioned suppression of peripheral nitric oxide production in response to endotoxin challenge. Brain Behav Immun 2021; 91:315-323. [PMID: 33039661 PMCID: PMC7749831 DOI: 10.1016/j.bbi.2020.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 01/28/2023] Open
Abstract
Opioids and opioid-conditioned stimuli (CS) negatively alter host immunity, impairing the response to pathogens during opioid use and following drug cessation. Using male rats, our laboratory has determined that heroin or heroin-CS exposure preceding a lipopolysaccharide (LPS) challenge markedly suppresses normal induction of peripheral pro-inflammatory biomarkers. Presently, it is unknown if these heroin-induced and -conditioned effects extend to the female immune response. To begin this venture, the current study tested the direct effects of heroin and heroin-CS on LPS-induced peripheral nitric oxide (NO) production in female rats. We focused investigations on peripheral NO as it is a critical pro-inflammatory molecule necessary for pathogen resistance. In Experiment 1, male and female Lewis rats were administered 0 (Saline), 1, or 3 mg/kg heroin subcutaneously (s.c). Sixty minutes later, animals were injected with LPS (1 mg/kg, s.c.). Spleen and plasma samples were collected 6 h later to examine NO production through inducible NO synthase (iNOS) expression and nitrate/nitrite concentration, respectively. In Experiment 2, female Lewis rats underwent five, 60-minute context conditioning sessions with heroin (1 mg/kg, s.c.) or saline. On test day, CS-exposed and control (home cage) animals were injected with LPS (1 mg/kg, s.c.). Tissue was collected 6 h later to examine splenic iNOS expression and plasma nitrate/nitrite concentration. Both heroin administration alone and exposure to heroin-CS suppressed LPS-induced indices of NO production in spleen and plasma. Our results are the first to indicate that, similar to males, female rats express heroin-induced and -conditioned immunomodulation to a LPS challenge.
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Affiliation(s)
- Jacqueline E Paniccia
- University of North Carolina at Chapel Hill, Department of Psychology and Neuroscience, Chapel Hill, NC, USA
| | - Taylor N Weckstein
- University of North Carolina at Chapel Hill, Department of Psychology and Neuroscience, Chapel Hill, NC, USA
| | - Christina L Lebonville
- University of North Carolina at Chapel Hill, Department of Psychology and Neuroscience, Chapel Hill, NC, USA
| | - Donald T Lysle
- University of North Carolina at Chapel Hill, Department of Psychology and Neuroscience, Chapel Hill, NC, USA.
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Mahmud S, Mumtaz GR, Chemaitelly H, Al Kanaani Z, Kouyoumjian SP, Hermez JG, Abu‐Raddad LJ. The status of hepatitis C virus infection among people who inject drugs in the Middle East and North Africa. Addiction 2020; 115:1244-1262. [PMID: 32009283 PMCID: PMC7318323 DOI: 10.1111/add.14944] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 08/14/2019] [Accepted: 12/16/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS People who inject drugs (PWID) are a key population at high risk of hepatitis C virus (HCV) infection. The aim of this study was to delineate the epidemiology of HCV in PWID in the Middle East and North Africa (MENA). METHODS Syntheses of data were conducted on the standardized and systematically assembled databases of the MENA HCV Epidemiology Synthesis Project, 1989-2018. Random-effects meta-analyses and meta-regressions were performed. Meta-regression variables included country, study site, year of data collection and year of publication [to assess trends in HCV antibody prevalence over time], sample size and sampling methodology. Numbers of chronically infected PWID across MENA were estimated. The Shannon Diversity Index was calculated to assess genotype diversity. RESULTS Based on 118 HCV antibody prevalence measures, the pooled mean prevalence in PWID for all MENA was 49.3% [95% confidence interval (CI) = 44.4-54.1%]. The country-specific pooled mean ranged from 21.7% (95% CI = 4.9-38.6%) in Tunisia to 94.2% (95% CI = 90.8-96.7%) in Libya. An estimated 221 704 PWID were chronically infected, with the largest numbers found in Iran at 68 526 and in Pakistan at 46 554. There was no statistically significant evidence for a decline in HCV antibody prevalence over time. Genotype diversity was moderate (Shannon Diversity Index of 1.01 out of 1.95; 52.1%). The pooled mean percentage for each HCV genotype was highest in genotype 3 (42.7%) and in genotype 1 (35.9%). CONCLUSION Half of people who inject drugs in the Middle East and North Africa appear to have ever been infected with hepatitis C virus, but there are large variations in antibody prevalence among countries. In addition to > 200 000 chronically infected current people who inject drugs, there is an unknown number of people who no longer inject drugs who may have acquired hepatitis C virus during past injecting drug use. Harm reduction services must be expanded, and innovative strategies need to be employed to ensure accessibility to hepatitis C virus testing and treatment.
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Affiliation(s)
- Sarwat Mahmud
- Infectious Disease Epidemiology Group, Weill Cornell Medicine‐QatarCornell University, Qatar Foundation, Education CityDohaQatar
| | - Ghina R. Mumtaz
- Infectious Disease Epidemiology Group, Weill Cornell Medicine‐QatarCornell University, Qatar Foundation, Education CityDohaQatar,Department of Epidemiology and Population Health, Faculty of Health SciencesAmerican University of BeirutBeirutLebanon
| | - Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine‐QatarCornell University, Qatar Foundation, Education CityDohaQatar
| | - Zaina Al Kanaani
- Infectious Disease Epidemiology Group, Weill Cornell Medicine‐QatarCornell University, Qatar Foundation, Education CityDohaQatar
| | - Silva P. Kouyoumjian
- Infectious Disease Epidemiology Group, Weill Cornell Medicine‐QatarCornell University, Qatar Foundation, Education CityDohaQatar
| | - Joumana G. Hermez
- Department of Communicable Diseases, HIV/Hepatitis/STIs Unit, World Health Organization,Regional Office for the Eastern MediterraneanCairoEgypt
| | - Laith J. Abu‐Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine‐QatarCornell University, Qatar Foundation, Education CityDohaQatar,Department of Healthcare Policy and Research, Weill Cornell MedicineCornell UniversityNew YorkNY, USA,College of Health and Life SciencesHamad bin Khalifa UniversityDohaQatar
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13
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Kumar GS, Pezzi C, Wien S, Mamo B, Scott K, Payton C, Urban K, Hughes S, Kennedy L, Cabanting N, Montour J, Titus M, Aguirre J, Kawasaki B, Ford R, Jentes ES. Health of Special Immigrant Visa holders from Iraq and Afghanistan after arrival into the United States using Domestic Medical Examination data, 2014-2016: A cross-sectional analysis. PLoS Med 2020; 17:e1003083. [PMID: 32231361 PMCID: PMC7108690 DOI: 10.1371/journal.pmed.1003083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 02/24/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Since 2008, the United States has issued between 2,000 and 19,000 Special Immigrant Visas (SIV) annually, with the majority issued to applicants from Iraq and Afghanistan. SIV holders (SIVH) are applicants who were employed by, or on behalf of, the US government or the US military. There is limited information about health conditions in SIV populations to help guide US clinicians caring for SIVH. Thus, we sought to describe health characteristics of recently arrived SIVH from Iraq and Afghanistan who were seen for domestic medical examinations. METHODS AND FINDINGS This cross-sectional analysis included data from Iraqi and Afghan SIVH who received a domestic medical examination from January 2014 to December 2016. Data were gathered from state refugee health programs in seven states (California, Colorado, Illinois, Kentucky, Minnesota, New York, and Texas), one county, and one academic medical center and included 6,124 adults and 4,814 children. Data were collected for communicable diseases commonly screened for during the exam, including tuberculosis (TB), hepatitis B, hepatitis C, malaria, strongyloidiasis, schistosomiasis, other intestinal parasites, syphilis, gonorrhea, chlamydia, and human immunodeficiency virus, as well as elevated blood lead levels (EBLL). We investigated the frequency and proportion of diseases and whether there were any differences in selected disease prevalence in SIVH from Iraq compared to SIVH from Afghanistan. A majority of SIV adults were male (Iraqi 54.0%, Afghan 58.6%) and aged 18-44 (Iraqi 86.0%, Afghan 97.7%). More SIV children were male (Iraqi 56.2%, Afghan 52.2%) and aged 6-17 (Iraqi 50.2%, Afghan 40.7%). The average age of adults was 29.7 years, and the average age for children was 5.6 years. Among SIV adults, 14.4% were diagnosed with latent tuberculosis infection (LTBI), 63.5% were susceptible to hepatitis B virus (HBV) infection, and 31.0% had at least one intestinal parasite. Afghan adults were more likely to have LTBI (prevalence ratio [PR]: 2.0; 95% confidence interval [CI] 1.5-2.7) and to be infected with HBV (PR: 4.6; 95% CI 3.6-6.0) than Iraqi adults. Among SIV children, 26.7% were susceptible to HBV infection, 22.1% had at least one intestinal parasite, and 50.1% had EBLL (≥5 mcg/dL). Afghan children were more likely to have a pathogenic intestinal parasite (PR: 2.7; 95% CI 2.4-3.2) and EBLL (PR: 2.0; 95% CI 1.5-2.5) than Iraqi children. Limitations of the analysis included lack of uniform health screening data collection across all nine sites and possible misclassification by clinicians of Iraqi and Afghan SIVH as Iraqi and Afghan refugees, respectively. CONCLUSION In this analysis, we observed that 14% of SIV adults had LTBI, 27% of SIVH had at least one intestinal parasite, and about half of SIV children had EBLL. Most adults were susceptible to HBV. In general, prevalence of infection was higher for most conditions among Afghan SIVH compared to Iraqi SIVH. The Centers for Disease Control and Prevention (CDC) Guidelines for the US Domestic Medical Examination for Newly Arriving Refugees can assist state public health departments and clinicians in the care of SIVH during the domestic medical examination. Future analyses can explore other aspects of health among resettled SIV populations, including noncommunicable diseases and vaccination coverage.
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Affiliation(s)
- Gayathri S. Kumar
- Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, Immigrant, Refugee, and Migrant Health Branch, Atlanta, Georgia, United States of America
- * E-mail:
| | - Clelia Pezzi
- Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, Immigrant, Refugee, and Migrant Health Branch, Atlanta, Georgia, United States of America
| | - Simone Wien
- Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, Immigrant, Refugee, and Migrant Health Branch, Atlanta, Georgia, United States of America
| | - Blain Mamo
- Minnesota Department of Health, Saint Paul, Minnesota, United States of America
| | - Kevin Scott
- Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Colleen Payton
- Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Kailey Urban
- Minnesota Department of Health, Saint Paul, Minnesota, United States of America
| | - Stephen Hughes
- Bureau of Tuberculosis Control, New York State Department of Health, Albany, New York, United States of America
| | - Lori Kennedy
- Colorado Department of Public Health and Environment, Disease Control and Environmental Epidemiology Division, Refugee Health Program, Denver, Colorado, United States of America
| | - Nuny Cabanting
- Office of Refugee Health, Center for Infectious Diseases, California Department of Public Health, Sacramento, California, United States of America
| | - Jessica Montour
- Texas Department of State Health Services, Austin, Texas, United States of America
| | - Melissa Titus
- Marion County Public Health Department, Indianapolis, Indiana, United States of America
| | - Jenny Aguirre
- Illinois Department of Public Health, Refugee Health Program, Chicago, Illinois, United States of America
| | - Breanna Kawasaki
- Colorado Department of Public Health and Environment, Disease Control and Environmental Epidemiology Division, Refugee Health Program, Denver, Colorado, United States of America
| | - Rebecca Ford
- University of Louisville Division of Infectious Diseases, Louisville, Kentucky, United States of America
| | - Emily S. Jentes
- Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, Immigrant, Refugee, and Migrant Health Branch, Atlanta, Georgia, United States of America
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14
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Pouri AA, Ghojazadeh M, Pourasghari B, Baiaz B, Soghra Hamzavi F, Somi MH. Seroepidemiology and risk factors of hepatitis C virus infection in East Azerbaijan, Iran: a population-based Azar Cohort study. CASPIAN JOURNAL OF INTERNAL MEDICINE 2019; 10:326-331. [PMID: 31558996 PMCID: PMC6729152 DOI: 10.22088/cjim.10.3.326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: Hepatitis C virus (HCV) is a blood-borne virus. It is a major global public health problem and can cause both acute and chronic hepatitis. The aim of this study was to report the epidemiological features of HCV infection and risk factors based on the data from Azar Cohort, East Azerbaijan province, Iran. Methods: The population of this study comprised the people in the age range of 35-70 years from Azar Cohort, East Azerbaijan province, Iran. The study was conducted between 2015 and 2016. Based on cluster sampling, 4, 949 people were selected and invited to complete the questionnaire and perform the tests. Blood samples collected in this study were analyzed to detect the presence of antibodies against HCV using enzyme immunoassay (ELISA) Kit. The positive samples were re-tested by qualitative HCV-RNA polymerase chain reaction. All data were analyzed using SPSS version 19.0 software. Results: The mean age of the participants was 49.15±9.02 years. Of these participants, 54.3% (n=2686) were females. Seven people (0.14%) were detected as HCV positive and the highest frequency was seen in the age range of 40-50 (0.16%). There was a statistical significant relationship between history of hospitalization (P=0.02) and history of abnormal urine (P=0.01) with the frequency of HCV infection. Conclusion: The findings of this study indicated that the frequency of hepatitis C virus infection is 0.14% in the general population of Azar Cohort.
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Affiliation(s)
- Ali Asghar Pouri
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Ghojazadeh
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Behrouz Pourasghari
- Laboratory Department Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Babak Baiaz
- Laboratory Department Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Soghra Hamzavi
- Laboratory Department Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Hossein Somi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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15
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Prevalence and Risk Factors of Hepatitis B, Hepatitis C and HIV Viruses Among People Who Use Drugs (PWUD) in Kabul, Health Care Facilities. HEPATITIS MONTHLY 2019. [DOI: 10.5812/hepatmon.84298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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16
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Mousavi SH, Khairkhah N, Bahri TD, Anvar A, Saraji AA, Behnava B, Alavian SM, Namvar A. First Report of Prevalence of Blood-Borne Viruses (HBV, HCV, HIV, HTLV-1 and Parvovirus B19) Among Hemophilia Patients in Afghanistan. Sci Rep 2019; 9:7259. [PMID: 31086199 PMCID: PMC6513844 DOI: 10.1038/s41598-019-43541-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 04/26/2019] [Indexed: 12/13/2022] Open
Abstract
Blood-borne viruses including Hepatitis B and C, HIV, HTLV-1 and parvovirus B19 are still a factor of concern, especially for hemophilia patients. Although the safety of the blood supply continues to improve worldwide, the blood supply system in Afghanistan was damaged by many years of conflict and political instability. To date, there are few studies focused on the prevalence of blood-borne viruses in hemophilia patients. This study is first to investigate the prevalence of five blood-borne viruses in Afghanistan hemophilia patients in four cities including Kabul, Herat, Mazar-i-Sharif and Jalal Abad. A total of 80 hemophilia male patients were screening for the presence of five transfusion-transmitted viruses using ELISA and PCR. Data obtained showed 2.5% seropositivity for HBV, 8.75% seropositivity for HCV, and 91.25% seropositivity for parvovirus B19. None of the patients were positive for HIV and HTLV-1 and the prevalence of HCV was higher in older patients rather than younger patients. This finding, the first to report in Afghanistan, shows a high prevalence of parvovirus B19 in Afghanistan hemophilia patients and implementation of highly sensitive screening is necessary.
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Affiliation(s)
- Sayed Hamid Mousavi
- Department of the Biochemistry, Faculty of medicine, Kateb University, Kabul, Afghanistan.,Afghanistan National Charity organization for Special Diseases (ANCOSD), Kabul, Afghanistan
| | - Niloofar Khairkhah
- Molecular Diagnostic Divisions, Iranian Comprehensive Hemophilia Care Center, Tehran, Iran.,Department of Molecular Medicine, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Tina Delsouz Bahri
- Molecular Diagnostic Divisions, Iranian Comprehensive Hemophilia Care Center, Tehran, Iran.,Department of Microbiology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Anvar
- Molecular Diagnostic Divisions, Iranian Comprehensive Hemophilia Care Center, Tehran, Iran
| | - Alireza Azizi Saraji
- Molecular Diagnostic Divisions, Iranian Comprehensive Hemophilia Care Center, Tehran, Iran
| | - Bita Behnava
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Seyed Moayed Alavian
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ali Namvar
- Molecular Diagnostic Divisions, Iranian Comprehensive Hemophilia Care Center, Tehran, Iran.
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17
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Zhao Q, Kim BKE, Li W, Hsiao HY, Rice E. Incarceration history, social network composition, and substance use among homeless youth in Los Angeles. J Addict Dis 2018; 37:64-76. [PMID: 30592248 DOI: 10.1080/10550887.2018.1545555] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Homeless youth in the United States have high rates of substance use. Existing research has identified social network composition and street-associated stressors as contributing factors. Incarceration is a highly prevalent stressor for homeless youth. Its effect on youth's social network composition and substance use, however, has been neglected. Aims: This study investigated the direct and indirect associations between incarceration history and substance use (through social networks) among homeless youth in Los Angeles, California. Methods: A sample of 1047 homeless youths were recruited between 2011 and 2013. Computerized self-administrated surveys and social network interviews were conducted to collect youth's sociodemographic characteristics, incarceration history, social network composition, and substance use. Bootstrapping was used to identify the direct and indirect associations between youth's incarceration history and substance use. Results: Incarceration history was positively associated with youth's cannabis, methamphetamine, and injection drug use. The percentage of cannabis-using peers partially mediated the associations between incarceration history and youth's cannabis, cocaine, and heroin use. The percentage of methamphetamine-using peers partially mediated the associations between incarceration history and youth's methamphetamine, cocaine, and injection drug use. The percentage of heroin-using peers partially mediated the association between incarceration history and youth's heroin use. Moreover, the percentage of peers who inject drugs partially mediated the associations between incarceration history and youth's methamphetamine, heroin, and injection drug use. Discussion: Incarceration history should be taken to a more central place in future research and practice with homeless youth in the United States.
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Affiliation(s)
- Qianwei Zhao
- a USC Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , CA , USA
| | - B K Elizabeth Kim
- a USC Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , CA , USA
| | - Wen Li
- b School of Social Work , Rutgers University , New Brunswick , NJ , USA
| | - Hsin-Yi Hsiao
- a USC Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , CA , USA
| | - Eric Rice
- a USC Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , CA , USA
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18
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Aisyah DN, Shallcross L, Hayward A, Aldridge RW, Hemming S, Yates S, Ferenando G, Possas L, Garber E, Watson JM, Geretti AM, McHugh TD, Lipman M, Story A. Hepatitis C among vulnerable populations: A seroprevalence study of homeless, people who inject drugs and prisoners in London. J Viral Hepat 2018; 25:1260-1269. [PMID: 29851232 DOI: 10.1111/jvh.12936] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 05/17/2018] [Indexed: 01/17/2023]
Abstract
Injecting drugs substantially increases the risk of hepatitis C virus (HCV) infection and is common in the homeless and prisoners. Capturing accurate data on disease prevalence within these groups is challenging but is essential to inform strategies to reduce HCV transmission. The aim of this study was to estimate the prevalence of HCV in these populations. We conducted a cross-sectional study between May 2011 and June 2013 in London and, using convenience sampling, recruited participants from hostels for the homeless, drug treatment services and a prison. A questionnaire was administered and blood samples were tested for hepatitis C. We recruited 491 individuals who were homeless (40.7%), 205 drug users (17%) and 511 prisoners (42.3%). Eight per cent of patients (98/1207, 95% CI: 6.7%-9.8%) had active HCV infection and 3% (38/1207, 95% CI: 2.3%-4.3%) past HCV infection. Overall, one quarter (51/205) of people recruited in drug treatment services, 13% (65/491) of people from homeless residential sites and 4% (20/511) prisoners in this study were anti-HCV positive. Seventy-seven of the 136 (56.6%, 95% CI: 47.9%-65%) of HCV infected participants identified had a history of all three risk factors (homelessness, imprisonment and drug use), 27.3% (95% CI: 20.1%-35.6%) had 2 overlapping risk factors, and 15.4% (95% CI: 10.6%-23.7%) one risk factor. Drug treatment services, prisons and homelessness services provide good opportunities for identifying hepatitis C-infected individuals. Effective models need to be developed to ensure case identification in these settings that can lead to an effective treatment and an efficient HCV prevention.
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Affiliation(s)
- D N Aisyah
- UCL Infectious Disease Informatics, Farr Institute of Health Informatics, London, UK.,Faculty of Public Health Universitas Indonesia, Depok, Indonesia
| | - L Shallcross
- UCL Infectious Disease Informatics, Farr Institute of Health Informatics, London, UK
| | - A Hayward
- UCL Infectious Disease Informatics, Farr Institute of Health Informatics, London, UK.,Institute of Epidemiology and Health Care, University College London, London, UK
| | - R W Aldridge
- UCL Infectious Disease Informatics, Farr Institute of Health Informatics, London, UK.,Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - S Hemming
- UCL Infectious Disease Informatics, Farr Institute of Health Informatics, London, UK.,Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - S Yates
- UCL Infectious Disease Informatics, Farr Institute of Health Informatics, London, UK.,Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - G Ferenando
- UCL Infectious Disease Informatics, Farr Institute of Health Informatics, London, UK.,Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - L Possas
- UCL Infectious Disease Informatics, Farr Institute of Health Informatics, London, UK.,Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - E Garber
- UCL Infectious Disease Informatics, Farr Institute of Health Informatics, London, UK.,Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - J M Watson
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - A M Geretti
- Institute of Infection & Global Health, University of Liverpool, Liverpool, UK
| | - T D McHugh
- Centre for Clinical Microbiology, Division of Infection and Immunity, University College London, London, UK
| | - M Lipman
- Royal Free London NHS Foundation Trust, London, UK.,UCL Respiratory, Division of Medicine, University College London, London, UK
| | - A Story
- University College London Hospitals, London, UK
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19
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Prevalence of Hepatitis B Surface Antigen Among People Attending Medical Diagnostic Laboratories in Neyshabur, Northeast of Iran, During Years 2011 to 2015. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2017. [DOI: 10.5812/pedinfect.61633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Ghaddar A, Nassar K, Elsoury G. Barriers to Access to Sterile Syringes as Perceived by Pharmacists and Injecting Drug Users: Implications for Harm Reduction in Lebanon. Subst Use Misuse 2017; 52:1420-1428. [PMID: 28430013 DOI: 10.1080/10826084.2017.1284235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Access to sterile syringes to injecting drug users (IDU) reduces sharing behavior and prevents the transmission of HIV. OBJECTIVES To describe the barriers to access to sterile syringes for IDUs in Lebanon from the perspectives of pharmacists and IDUs. METHODS in this qualitative study conducted in Lebanon, data were collected from 72 syringe purchase tests at pharmacies, 64 interviewees with pharmacists and 2 focus groups with injecting drug users. Two independent researchers analyzed the verbatim transcripts. RESULTS Results revealed that pharmacists often deny access to sterile syringes to IDUs who are frequently stigmatized and intimidated at pharmacies. While no large gender differences in pharmacists' attitudes and practices were observed, inequalities in syringe access were noticed with men IDUs more often denied purchase. Pharmacists had several barriers to sell syringes to IDUs including fear of disease spread, increased drug use, inappropriately discarded syringes, staff and customer safety, and business concerns. IDUs had several challenges to purchase syringes including stigmatization, intimidation, physical harassment, concern to reveal identity, fear of arrest and syringe price abuse. CONCLUSIONS Identifying the barriers to and facilitators of access to sterile syringes to IDUs is important to guide the development of efficient policies. Findings implicate the importance of empowering IDUs to purchase syringes at pharmacies through reducing the negative attitude towards IDUs and strengthening pharmacists' role in the promotion of health of IDUs. Findings also suggest that the habit of syringe sharing would decrease if the legal and cultural barriers to access are reduced.
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Affiliation(s)
- Ali Ghaddar
- a Observatory of Public Policies and Health , Beirut , Lebanon.,b Department of Biomedical Sciences , Lebanese International University , Beirut , Lebanon
| | - Karine Nassar
- c Soins Infirmiers et Developement Communitaire , Beirut , Lebanon
| | - Ghadier Elsoury
- a Observatory of Public Policies and Health , Beirut , Lebanon.,b Department of Biomedical Sciences , Lebanese International University , Beirut , Lebanon
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21
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Alaei A, Alaei K, Waye K, Tracy M, Nalbandyan M, Mutlu E, Cetin MK. Hepatitis C infection and other drug-related harms among inpatients who injected drugs in Turkey. J Viral Hepat 2017; 24:496-505. [PMID: 27925346 DOI: 10.1111/jvh.12662] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 11/22/2016] [Indexed: 01/07/2023]
Abstract
Hepatitis C virus (HCV) is easily spread among those who share drug injection equipment. Due to the ease of contraction and growing prevalence of HCV in Eastern Europe, the aims of this study focused on describing risky injection practices as well as the prevalence of HCV, HIV and hepatitis B virus (HBV) among people who inject drugs (PWID) who were admitted to public and private drug treatment centres in Turkey from 2012 to 2013. Other aims included identifying correlates of needle sharing and HCV infection. Of the 4694 inpatients who ever injected drugs and the 3914 who injected in the past 30 days, nearly all (98%) reported heroin as their drug of choice, the vast majority reported ever sharing a needle (73.4% and 79.3%), and the mean age at first injection was 23 years. Of current PWID, 51.9% were HCV-positive, 5.9% were HBV-positive and only 0.34% of lifetime PWID were HIV-positive. Predictors of increased needle sharing include younger age, being unemployed, having lesser education and reporting heroin as a drug of choice. Significant predictors of HCV infection included being 40 years or older, receiving treatment in the Mediterranean region of Turkey, reporting heroin as a primary substance, a longer duration of drug use and sharing needles. With this information, it is essential to improve access to clean injection equipment in Turkey, to focus on improving education on clean injection practices and to enhance efforts in testing and treating HCV-positive PWID.
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Affiliation(s)
- A Alaei
- Global Institute for Health and Human Rights, State University of New York at Albany, Albany, NY, USA.,Department of Health Policy, Management, and Behavior, School of Public Health, State University of New York at Albany, Rensselaer, NY, USA
| | - K Alaei
- Global Institute for Health and Human Rights, State University of New York at Albany, Albany, NY, USA.,Department of Health Policy, Management, and Behavior, School of Public Health, State University of New York at Albany, Rensselaer, NY, USA.,Department of Public Administration and Policy, State University of New York at Albany, Albany, NY, USA
| | - K Waye
- Global Institute for Health and Human Rights, State University of New York at Albany, Albany, NY, USA
| | - M Tracy
- Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, Rensselaer, NY, USA
| | - M Nalbandyan
- Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, Rensselaer, NY, USA
| | - E Mutlu
- Department of Psychology, Gelisim University, Avcılar, Turkey
| | - M K Cetin
- Turkish Ministry of Health, Ankara, Turkey
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22
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Mansha S, Imran M, Shah AMUH, Jamal M, Ahmed F, Atif M, Saleem M, Safi SZ, Fatima Z, Bilal Waqar A. Hepatitis B and C Virus Infections Among Human Immunodeficiency Virus-Infected People Who Inject Drugs in Lahore, Pakistan. Viral Immunol 2017; 30:366-370. [PMID: 28346804 DOI: 10.1089/vim.2016.0144] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Hepatitis B virus (HBV) and hepatitis C virus (HCV) are the major cause of the global burden of hepatitis. One of the main routes of transmission for both viruses is through exposure to infected blood, which includes sharing blood-contaminated syringes and needles. Human immunodeficiency virus (HIV) attacks the immune system and results in acquired immune deficiency syndrome and opportunistic infections. The objective of this study was to assess the epidemiology of HBV and HCV infections among HIV-infected people who inject drugs (PWID). The study enrolled 100 PWID from different addiction centers of the city of Lahore in Pakistan. All subjects were HIV-infected males and were above 16 years of age. Screening of HBV and HCV infections was performed through immunochromatography tests and enzyme-linked immunosorbent assays. The prevalence of HCV and HBV infections among the 100 HIV-infected PWID was 55% and 6%, respectively. HIV monoinfection was found in 37% of the subjects, while triple infection was detected in 2% of the subjects. Majority of the HIV-infected PWID were using heroin and Avil injections (65%). Half of the subjects had used injection drugs for 1-5 years, while 32% had used injection drugs for 6-10 years. HCV infection was more common than HBV infection among the enrolled subjects. Most of the PWID were practicing heroin and Avil injections.
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Affiliation(s)
- Sana Mansha
- 1 Department of Pathology, Allama Iqbal Medical College , Lahore, Pakistan
| | - Muhammad Imran
- 2 Department of Medical Laboratory Sciences (DMLS), Faculty of Health and Allied Sciences (FHAS), Imperial College of Business Studies (ICBS) , Lahore, Pakistan
| | - Amir Miraj Ul Hussain Shah
- 2 Department of Medical Laboratory Sciences (DMLS), Faculty of Health and Allied Sciences (FHAS), Imperial College of Business Studies (ICBS) , Lahore, Pakistan
| | - Muhsin Jamal
- 3 Department of Microbiology, Abdul Wali Khan University , Mardan, Pakistan
| | - Fayyaz Ahmed
- 2 Department of Medical Laboratory Sciences (DMLS), Faculty of Health and Allied Sciences (FHAS), Imperial College of Business Studies (ICBS) , Lahore, Pakistan
| | - Muhammad Atif
- 2 Department of Medical Laboratory Sciences (DMLS), Faculty of Health and Allied Sciences (FHAS), Imperial College of Business Studies (ICBS) , Lahore, Pakistan
| | - Muhammmad Saleem
- 2 Department of Medical Laboratory Sciences (DMLS), Faculty of Health and Allied Sciences (FHAS), Imperial College of Business Studies (ICBS) , Lahore, Pakistan
| | - Sher Zaman Safi
- 4 Interdisciplinary Research Center in Biomedical Materials (IRCBM), COMSATS Institute of Information Technology , Lahore, Pakistan
| | - Zareen Fatima
- 5 Department of Radiological Sciences and Medical Imaging (DRSMI), Faculty of Health and Allied Sciences (FHAS), Imperial College of Business Studies (ICBS) , Lahore, Pakistan
| | - Ahmed Bilal Waqar
- 2 Department of Medical Laboratory Sciences (DMLS), Faculty of Health and Allied Sciences (FHAS), Imperial College of Business Studies (ICBS) , Lahore, Pakistan
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23
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Rezaei F, Noroozi A, Armoon B, Farhoudian A, Massah O, Sharifi H, Ahounbar E, Khodadost M, Mohammadi F, Barkhordar N, Mansourian M, Noroozi M. Social determinants and hepatitis C among people who inject drugs in Kermanshah, Iran: Socioeconomic status, homelessness, and sufficient syringe coverage. JOURNAL OF SUBSTANCE USE 2016. [DOI: 10.1080/14659891.2016.1245793] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Fatemeh Rezaei
- Department of Epidemiology and Biostatics, Jahrom University of Medical Sciences, Fars, Iran
| | - Alireza Noroozi
- School of Advanced Technologies in Medicine (SATiM), Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Substance Abuse Prevention and Treatment Office (SAPTO), Ministry of Health and Medical Education (MoHME), Tehran, Iran
| | - Bahram Armoon
- Department of Epidemiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Farhoudian
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Omid Massah
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Elaheh Ahounbar
- Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mahmoud Khodadost
- Gastroenterology and Liver Diseases Research Center, Baqiyatallah University of Medical Science, Tehran, Iran
- Department of Epidemiology, Faculty of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Farahnaz Mohammadi
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Nasrin Barkhordar
- Mental Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Morteza Mansourian
- Department of Health Education and Promotion, School of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Noroozi
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Akbarzadeh V, Mumtaz GR, Awad SF, Weiss HA, Abu-Raddad LJ. HCV prevalence can predict HIV epidemic potential among people who inject drugs: mathematical modeling analysis. BMC Public Health 2016; 16:1216. [PMID: 27912737 PMCID: PMC5135754 DOI: 10.1186/s12889-016-3887-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 11/28/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) and HIV are both transmitted through percutaneous exposures among people who inject drugs (PWID). Ecological analyses on global epidemiological data have identified a positive association between HCV and HIV prevalence among PWID. Our objective was to demonstrate how HCV prevalence can be used to predict HIV epidemic potential among PWID. METHODS Two population-level models were constructed to simulate the evolution of HCV and HIV epidemics among PWID. The models described HCV and HIV parenteral transmission, and were solved both deterministically and stochastically. RESULTS The modeling results provided a good fit to the epidemiological data describing the ecological HCV and HIV association among PWID. HCV was estimated to be eight times more transmissible per shared injection than HIV. A threshold HCV prevalence of 29.0% (95% uncertainty interval (UI): 20.7-39.8) and 46.5% (95% UI: 37.6-56.6) were identified for a sustainable HIV epidemic (HIV prevalence >1%) and concentrated HIV epidemic (HIV prevalence >5%), respectively. The association between HCV and HIV was further described with six dynamical regimes depicting the overlapping epidemiology of the two infections, and was quantified using defined and estimated measures of association. Modeling predictions across a wide range of HCV prevalence indicated overall acceptable precision in predicting HIV prevalence at endemic equilibrium. Modeling predictions were found to be robust with respect to stochasticity and behavioral and biological parameter uncertainty. In an illustrative application of the methodology, the modeling predictions of endemic HIV prevalence in Iran agreed with the scale and time course of the HIV epidemic in this country. CONCLUSIONS Our results show that HCV prevalence can be used as a proxy biomarker of HIV epidemic potential among PWID, and that the scale and evolution of HIV epidemic expansion can be predicted with sufficient precision to inform HIV policy, programming, and resource allocation.
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Affiliation(s)
- Vajiheh Akbarzadeh
- Infectious Disease Epidemiology Group, Weill Cornell Medical College - Qatar, Cornell University, Doha, Qatar.,Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, New York, USA
| | - Ghina R Mumtaz
- Infectious Disease Epidemiology Group, Weill Cornell Medical College - Qatar, Cornell University, Doha, Qatar. .,Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Susanne F Awad
- Infectious Disease Epidemiology Group, Weill Cornell Medical College - Qatar, Cornell University, Doha, Qatar
| | - Helen A Weiss
- Department of Infectious Disease Epidemiology, MRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medical College - Qatar, Cornell University, Doha, Qatar. .,Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, New York, USA. .,College of Public Health, Hamad bin Khalifa University, Doha, Qatar.
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25
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Heijnen M, Mumtaz GR, Abu-Raddad LJ. Status of HIV and hepatitis C virus infections among prisoners in the Middle East and North Africa: review and synthesis. J Int AIDS Soc 2016; 19:20873. [PMID: 27237131 PMCID: PMC4884676 DOI: 10.7448/ias.19.1.20873] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 04/05/2016] [Accepted: 04/26/2016] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION The status of HIV and hepatitis C virus (HCV) infections among incarcerated populations in the Middle East and North Africa (MENA) and the links between prisons and the HIV epidemic are poorly understood. This review synthesized available HIV and HCV data in prisons in MENA and highlighted opportunities for action. METHODS The review was based on data generated through the systematic searches of the MENA HIV/AIDS Epidemiology Synthesis Project (2003 to December 15, 2015) and the MENA HCV Epidemiology Synthesis Project (2011 to December 15, 2015). Sources of data included peer-reviewed publications and country-level reports and databases. RESULTS AND DISCUSSION We estimated a population of 496,000 prisoners in MENA, with drug-related offences being a major cause for incarceration. Twenty countries had data on HIV among incarcerated populations with a median prevalence of 0.6% in Afghanistan, 6.1% in Djibouti, 0.01% in Egypt, 2.5% in Iran, 0% in Iraq, 0.1% in Jordan, 0.05% in Kuwait, 0.7% in Lebanon, 18.0% in Libya, 0.7% in Morocco, 0.3% in Oman, 1.1% in Pakistan, 0% in Palestine, 1.2% in Saudi Arabia, 0% in Somalia, 5.3% in Sudan and South Sudan, 0.04% in Syria, 0.05% in Tunisia, and 3.5% in Yemen. Seven countries had data on HCV, with a median prevalence of 1.7% in Afghanistan, 23.6% in Egypt, 28.1% in Lebanon, 15.6% in Pakistan, and 37.8% in Iran. Syria and Libya had only one HCV prevalence measure each at 1.5% and 23.7%, respectively. There was strong evidence for injecting drug use and the use of non-sterile injecting-equipment in prisons. Incarceration and injecting drugs, use of non-sterile injecting-equipment, and tattooing in prisons were found to be independent risk factors for HIV or HCV infections. High levels of sexual risk behaviour, tattooing and use of non-sterile razors among prisoners were documented. CONCLUSIONS Prisons play an important role in HIV and HCV dynamics in MENA and have facilitated the emergence of large HIV epidemics in at least two countries, Iran and Pakistan. There is evidence for substantial but variable HIV and HCV prevalence, as well as risk behaviour including injecting drug use and unprotected sex among prisoners across countries. These findings highlight the need for comprehensive harm-reduction strategies in prisons.
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Affiliation(s)
- Marieke Heijnen
- Infectious Disease Epidemiology Group, Weill Cornell Medicine - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, NY, USA; ;
| | - Ghina R Mumtaz
- Infectious Disease Epidemiology Group, Weill Cornell Medicine - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, NY, USA
- College of Public Health, Hamad bin Khalifa University, Doha, Qatar
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Socio-demographic correlates of injection drug use among male drug users: a cross sectional study in Nepal. J Community Health 2016; 39:1124-32. [PMID: 24705679 DOI: 10.1007/s10900-014-9867-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Drug abuse is one of the major public health problems in Nepal. The objective of this study is to explore the factors responsible for the injecting drug use in Nepal. A cross sectional study was conducted among drug users in Pokhara sub metropolitan city in Nepal. Taking prevalence of 20% at 95% confidence interval and 20% non-response rate, 448 samples were calculated for face to face interviews. Most of the study participants were >24 year's age. Sixty-one percentage of the participants were unemployed. The largest percentage belonged to Gurung/Rai/Pun (37%) ethnic groups, and had completed secondary level of education (47.5%). In the logistic regression analysis occupation, motivating factors for drug use, ever been to custody, age at first drug use, age at first sex, money spent on drugs, ever been rehabilitated and age of the respondents showed a statistically significant association with injecting drug use status. The respondents having business [Adjusted Odds ratio (aOR) 4.506, 95% CI (1.677-12.104)], service [aOR 2.698, 95% CI (a1.146-6.355], having tragedy/turmoil [aOR 3.867, 95% CI (1.596-9.367)], family problem [aOR 2.010, 95% CI (2.010-53.496)], had sex at >19 years [aOR 1.683, 95% CI (1.017-2.785)], rehabilitated >2 times [aOR 4.699, 95% CI (1.401-15.763)], >24 years age group [aOR 1.741, 95% CI (1.025-2.957)] had higher odds of having injecting habits. Having money spent on drugs >3,000 NRs (300 USD) [aOR 0.489, 95%CI (0.274-0.870), not been to custody (aOR 0.330, 95%CI (0.203-0.537)] and having curiosity for drug use [aOR 0.147, 95% CI (0.029-0.737)] were found to be protective for injecting drug use. This study recommends the harm reduction program specifically focused on drug users of occupational groups like business, service and the youths through public health actions to stop transiting them to injecting drug use.
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Cottler LB, Ajinkya S, Goldberger BA, Ghani MA, Martin DM, Hu H, Gold MS. Prevalence of drug and alcohol use in urban Afghanistan: epidemiological data from the Afghanistan National Urban Drug Use Study (ANUDUS). LANCET GLOBAL HEALTH 2015; 2:e592-600. [PMID: 25304635 DOI: 10.1016/s2214-109x(14)70290-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Previous attempts to assess the prevalence of drug use in Afghanistan have focused on subgroups that are not generalisable. In the Afghanistan National Urban Drug Use Study, we assessed risk factors and drug use in Afghanistan through self-report questionnaires that we validated with laboratory test confirmation using analysis of hair, urine, and saliva. METHODS The study took place between July 13, 2010, to April 25, 2012, in 11 Afghan provinces. 2187 randomly selected households completed a survey, representing 19 025 household members. We completed surveys with the female head of the household about past and current drug use among members of their household. We also obtained hair, urine, and saliva samples from 5236 people in these households and tested them for metabolites of 13 drugs. FINDINGS Of 2170 households with biological samples tested, 247 (11·4%) tested positive for any drug. Overall, opioids were the most prevalent drug in the biological samples (5·6%), although prescription drugs (prescription pain pills, sedatives, and tranquilliser) were the most commonly reported in the past 30 days in the questionnaires (7·6%). Of individuals testing positive for at least one substance, opioids accounted for more than 50% of substance use in women and children, but only a third of substances in men, who predominantly tested positive for cannabinoids. After controlling for age with direct standardisation, individual prevalence of substance use (from laboratory tests) was 7·2% (95% CI 6·1-8·3) in men and 3·1% (2·5-3·7) in women-with a national prevalence of 5·1% (4·4-5·8) and a prevalence of 5·0% (4·1-5·8) in Kabul. Concordance between laboratory test results and self-reports was high. INTERPRETATION These data suggest the female head of household to be a knowledgeable informant for household substance use. They also might provide insight into new avenues for targeted behavioural interventions and prevention messages.
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Affiliation(s)
- Linda B Cottler
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA; Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA.
| | - Shaun Ajinkya
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Bruce A Goldberger
- Departments of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL, USA
| | | | | | - Hui Hu
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Mark S Gold
- Department of Psychiatry, McKnight Brain Institute, College of Medicine, University of Florida, Gainesville, FL, USA
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Todd CS, Nasir A, Stanekzai MR, Fiekert K, Sipsma HL, Vlahov D, Strathdee SA. Hepatitis C and HIV incidence and harm reduction program use in a conflict setting: an observational cohort of injecting drug users in Kabul, Afghanistan. Harm Reduct J 2015; 12:22. [PMID: 26472126 PMCID: PMC4608295 DOI: 10.1186/s12954-015-0056-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 07/06/2015] [Indexed: 11/14/2022] Open
Abstract
Background Armed conflict may increase the risk of HIV and other pathogens among injecting drug users (IDUs); however, there are few prospective studies. This study aimed to measure incidence and potential predictors, including environmental events and needle and syringe distribution and collection program (NSP) use, of hepatitis C virus (HCV) and HIV among IDUs in Kabul, Afghanistan. Methods Consenting adult IDUs completed interviews quarterly in year 1 and semi-annually in year 2 and HCV and HIV antibody testing semi-annually through the cohort period (November 2007–December 2009). Interviews detailed injecting and sexual risk behaviors, NSP service use, and conflict-associated displacement. Quarters with peak conflict or local displacement were identified based on literature review, and key events, including insurgent attacks and deaths, were reported with simple counts. Incidence and predictors of HCV and HIV were measured with Cox proportional hazards models. Results Of 483 IDUs enrolled, 385 completed one or more follow-up visits (483.8 person-years (p-y)). All participants were male with a median age of 28 years and a median duration of injecting of 2 years. Reported NSP use among the participants ranged from 59.9 to 70.5 % in the first year and was 48.4 and 55.4 % at 18 and 24 months, respectively. There were 41 confirmed deaths, with a crude death rate of 93.4/1000 p-y (95 % confidence interval (CI) 67.9–125) and overdose as the most common cause. HCV and HIV incidence were 35.6/100 p-y (95 % CI 28.3–44.6) and 1.5/100 p-y (95 % CI 0.6–3.3), respectively. Changing from injecting to smoking was protective for HCV acquisition (adjusted hazard ratio (AHR) = 0.53, 95 % CI 0.31–0.92), while duration of injecting (AHR = 1.09, 95 % CI 1.01–1.18/year) and sharing syringes (AHR = 10.09, 95 % CI 1.01–100.3) independently predicted HIV infection. Conclusion There is high HCV incidence and high numbers of reported deaths among male Kabul IDUs despite relatively consistent levels of harm reduction program use; peak violence periods did not independently predict HCV and HIV risk. Programming should increase awareness of HCV transmission and overdose risks, prepare clients for harm reduction needs during conflict or other causes of displacement, and continue efforts to engage community and police force support.
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Affiliation(s)
- Catherine S Todd
- Department of Obstetrics & Gynecology, College of Physicians and Surgeons, and Heilbrunn Department of Population & Family Health, Columbia University, Mailman School of Public Health, PH 16-69, 622 West 168th Street, New York, NY, 10032, USA. .,Asia Pacific Business Unit and Clinical Sciences Division, FHI 360, Sindhorn Building, 130-132 Wittayu Road, Bangkok, 10330, Thailand.
| | - Abdul Nasir
- Health Protection and Research Organisation, Street 4, Taimani, Kabul, Afghanistan.
| | | | - Katja Fiekert
- Health Protection and Research Organisation, Street 4, Taimani, Kabul, Afghanistan.
| | - Heather L Sipsma
- Department of Epidemiology, Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, CT, 06520-8034, USA.
| | - David Vlahov
- Department of Community Health Systems, University of California, San Francisco School of Nursing, 2 Koret Way, #N-319X UCSF Box 0602, San Francisco, CA, 94143-0602, USA.
| | - Steffanie A Strathdee
- Division of Global Public Health, University of California San Diego School of Medicine, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA.
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The epidemiology of hepatitis C virus in Afghanistan: systematic review and meta-analysis. Int J Infect Dis 2015; 40:54-63. [PMID: 26417880 DOI: 10.1016/j.ijid.2015.09.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 09/15/2015] [Accepted: 09/18/2015] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To characterize hepatitis C virus (HCV) epidemiology and inform public health research, policy, and programming priorities in Afghanistan. METHODS Records of HCV incidence and prevalence were reviewed systematically and synthesized following PRISMA guidelines. Meta-analyses were implemented using a DerSimonian-Laird random effects model with inverse variance weighting to estimate HCV prevalence among various at risk populations. A risk of bias assessment was incorporated. RESULTS The search identified one HCV incidence and 76 HCV prevalence measures. HCV incidence was only assessed among people who inject drugs (PWID), and was reported at 66.7 per 100 person-years. Meta-analyses estimated HCV prevalence at 0.7% among the general population (range 0-9.1%, 95% confidence interval (CI) 0.5-0.9%), 32.6% among PWID (range 9.5-70.0%, 95% CI 24.5-41.3%), and 2.3% among populations at intermediate risk (range 0.0-8.3%, 95% CI 1.3-3.7%). No data were available for other high risk populations such as hemodialysis, thalassemia, and hemophilia patients. CONCLUSIONS HCV prevalence among the general population in Afghanistan is comparable to global levels. Data are needed for the level of infection among key clinical populations at high risk of infection. There is also an immediate need for expansion of harm reduction programs among PWID and prisoners.
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Ruiseñor-Escudero H, Vu A, Wirtz AL, Familiar-Lopez I, Berry M, Mfochive I, Engineer C, Farhad A, Tschakarjan S, Wisse E, Paikan FM, Burnham G. Cross-sectional assessments of participants' characteristics and loss to follow-up in the first Opioid Substitution Therapy Pilot Program in Kabul, Afghanistan. Harm Reduct J 2015; 12:28. [PMID: 26337832 PMCID: PMC4559065 DOI: 10.1186/s12954-015-0062-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 08/23/2015] [Indexed: 11/25/2022] Open
Abstract
Background Kabul has over 12,000 people who inject drugs (PWID), most of them heroin users, and opioid substitution therapy has recently been introduced as an effective method to reduce opioid use. We aimed to evaluate a pilot Opioid Substitution Therapy Pilot Program (OSTPP) in Kabul, Afghanistan, particularly to (1) describe characteristics of the participants enrolled in the program and (2) identify factors associated with client retention in the OSTPP. Findings Two cross-sectional surveys evaluated participants attending the OSTPP at baseline (n = 83) and 18 months after (n = 57). Questionnaires assessed socio-demographic, drug use behavior, and general and mental health factors. After 18 months, 57 participants remained in the OSTPP. Participants lost to follow-up were younger (p < 0.01) and married (p < 0.01) and had no family contact (p < 0.01). Participants at 18 months reported no criminal activity in the last month and only two (3.5 %) reported heroin use in the last month, constituting significant decreases from baseline. Conclusions While preliminary results are promising, further evaluation is needed to determine the feasibility of implementing OSTPP in this setting and effectiveness in reducing injection risk behaviors in Afghanistan.
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Affiliation(s)
- Horacio Ruiseñor-Escudero
- Department of Psychiatry, Michigan State University, College of Ostheopathic Medicine, 965 E Fee Hall Suite A227, Lansing, MI, 48824, USA. .,Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA.
| | - Alexander Vu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA.,Department of Emergency Medicine, Johns Hopkins University, School of Medicine, 5801 Smith Avenue, Suite 3220, Baltimore, MD, 21205, USA
| | - Andrea L Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, 615 N Wolfe Street, Baltimore, MD, 21205, USA
| | - Itziar Familiar-Lopez
- Department of Psychiatry, Michigan State University, College of Ostheopathic Medicine, 965 E Fee Hall Suite A227, Lansing, MI, 48824, USA
| | - Mark Berry
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA
| | - Iliassou Mfochive
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA
| | - Cyrus Engineer
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA.,Department of Interprofessional Health Studies, Towson University, Baltimore, MD, 21252, USA
| | | | | | - Ernst Wisse
- Medecins du Monde, Kabul, Afghanistan.,Medecins du Monde, 63 rue de Marcadet, Paris, 75018, France
| | | | - Gilbert Burnham
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA
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Mumtaz GR, Weiss HA, Vickerman P, Larke N, Abu-Raddad LJ. Using hepatitis C prevalence to estimate HIV epidemic potential among people who inject drugs in the Middle East and North Africa. AIDS 2015; 29:1701-10. [PMID: 26372281 PMCID: PMC4541475 DOI: 10.1097/qad.0000000000000761] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 05/26/2015] [Accepted: 05/28/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The objective of this study is to understand the association between HIV and hepatitis C virus (HCV) among people who inject drugs (PWIDs) in the Middle East and North Africa (MENA), and to estimate HIV epidemic potential among PWIDs using HCV prevalence. DESIGN/METHODS Using data from a systematic review of HIV and HCV among PWID in MENA, we conducted two analyses, stratified by HIV epidemic state: a meta-analysis of the risk ratio of HCV to HIV prevalence (RRHCV/HIV) using DerSimonian-Laird random-effects models, and multivariable linear regression predicting log HIV prevalence. The HCV-HIV association from both analyses was used to estimate HIV prevalence at endemic equilibrium. We compared predicted with current HIV prevalence to classify HIV epidemic potential at country-level as low, medium or high, using predefined criteria. RESULTS The review identified 88 HCV prevalence measures among PWID in MENA, of which 54 had a paired HIV prevalence measure. The pooled RRHCV/HIV were 16, 4 and 3 in low-level, emerging and established HIV epidemics, respectively. There was a significant linear relationship between HCV and HIV at endemic equilibrium (P = 0.002). The predicted endemic HIV prevalence ranged between 8% (Tunisia) and 22% (Pakistan). Of the nine countries with data, five have high and three medium HIV epidemic potential. Only one country, Pakistan, appears to have reached saturation. CONCLUSION HCV prevalence could be a predictor of future endemic HIV prevalence. In MENA, we predict that there will be further HIV epidemic growth among PWID. The proposed methodology can identify PWID populations that should be prioritized for HIV prevention interventions.
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Affiliation(s)
- Ghina R. Mumtaz
- Infectious Disease Epidemiology Group, Weill Cornell Medical College - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London
| | - Helen A. Weiss
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London
| | - Peter Vickerman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Natasha Larke
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London
| | - Laith J. Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medical College - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, Ithaca, New York
- Vaccine and Infectious Disease Institute, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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Todd CS, Nasir A, Stanekzai MR, Fiekert K, Sipsma HL, Strathdee SA, Vlahov D. Impact of conflict and displacement on risk behaviours amongst people who inject drugs in Kabul, Afghanistan. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 27:173-7. [PMID: 26303577 DOI: 10.1016/j.drugpo.2015.07.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 06/11/2015] [Accepted: 07/22/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Catherine S Todd
- Department of Obstetrics & Gynecology, Columbia University & Heilbrunn Department of Population & Family Health, Mailman School of Public Health, PH 16-69, 622 West 168th Street, New York, NY 10032, USA.
| | - Abdul Nasir
- Health Protection and Research Organisation, Street 4, Taimani, Kabul, Afghanistan
| | | | - Katja Fiekert
- Health Protection and Research Organisation, Street 4, Taimani, Kabul, Afghanistan
| | - Heather L Sipsma
- Department of Epidemiology, Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, CT 06520-8034, USA
| | - Steffanie A Strathdee
- Division of Global Public Health, University of California San Diego School of Medicine, 9500 Gilman Drive, MC 0507, La Jolla, CA 92093-0507, USA
| | - David Vlahov
- Department of Community Health Systems, University of California, San Francisco School of Nursing, 2 Koret Way, #N-319X UCSF Box 0602, San Francisco, CA 94143-0602, USA
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33
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Kargar Kheirabad A, Elmira Jokari E, Sajjadi MJ, Gouklani H. Prevalence of Hepatitis B virus between Qeshm Island people in 2013-2014, Iran. J Med Life 2015; 8:173-177. [PMID: 28316686 PMCID: PMC5348928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 06/18/2015] [Indexed: 11/24/2022] Open
Abstract
Introduction: About 1/ 3 of the world crowd (2 billion) suffers from HBV infection. 15 to 40% of Hepatitis B cases develop into chronic hepatitis, cirrhosis, and hepatocellular carcinoma (HCC). Considering the dangerous complication of the illness and the evidence that the prevalence is different in various areas of the country, this research was directed with the purpose of determining the currency of the Hepatitis B between Qeshm Island crowds. Method: This cross-partial research was directed on 1500 cases. The sampling procedure was the stratify-cluster organization. Later creating the checklist, including the demographic information and risk factors, blood cases were formed. ELISA system evaluated the currency of HBsAg. At the end, the mathematical studies were conducted by applying the mathematical Plans for software of Social Sciences (SPSS) system issue 16.0. The information were investigated by Chi-square and detailed mathematical exams. Result: The overall currency of HBsAg positivity was 1%, 0.8%, and 1.1% between male and female, individually. The middle age of members was 30.07 years old. Virus was more currency in married persons, students, lower than in 15-years-old educated people and persons who had a past of vaccination and transfusion. The currency of Hepatitis B in people who had a past of sex and substance infusion was zero. Finally, the finding of the research showed that none of the investigated factors was associated with the prevalence of HBsAg. Conclusion: It appears that the currency of HBV virus in Qeshm is slightly lower than that of the public.
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Affiliation(s)
- A Kargar Kheirabad
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - E Elmira Jokari
- Student Research Committee, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - M J Sajjadi
- Student Research Committee, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - H Gouklani
- Molecular Medicine Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Talpur A, George TP. A review of drug policy in the Golden Crescent: towards the development of more effective solutions. Asian J Psychiatr 2014; 12:31-5. [PMID: 25440559 DOI: 10.1016/j.ajp.2014.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 07/03/2014] [Accepted: 07/04/2014] [Indexed: 01/20/2023]
Abstract
There is a high prevalence of drug trafficking and misuse in Asia. Drugs grown in Afghanistan are trafficked through Iran and Pakistan to the rest of the world. This has led to an increase in the prevalence of drug use disorders in these regions, especially heroin. This has in turn led to an increase in the use of syringes and syringe sharing which has resulted in the exponential spread of blood borne diseases such as HIV/AIDS. A lack of awareness of the detrimental use of heroin, syringe sharing and the concept of HIV has been revealed. The literature reviewed provides evidence for a change in policy with an increase in epidemiological and clinical research in these regions as well as an increase in public awareness.
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Affiliation(s)
- Anushka Talpur
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Department of Psychiatry, University of Toronto, Toronto, ON, Canada M5T 1R8
| | - Tony P George
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Department of Psychiatry, University of Toronto, Toronto, ON, Canada M5T 1R8.
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Ruiseñor-Escudero H, Wirtz AL, Berry M, Mfochive-Njindan I, Paikan F, Yousufi HA, Yadav RS, Burnham G, Vu A. Risky behavior and correlates of HIV and Hepatitis C Virus infection among people who inject drugs in three cities in Afghanistan. Drug Alcohol Depend 2014; 143:127-33. [PMID: 25131717 DOI: 10.1016/j.drugalcdep.2014.07.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 07/12/2014] [Accepted: 07/13/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND Injecting drug use is the primary mode of HIV transmission and acquisition in Afghanistan. People who inject drugs (PWID) in the country have been characterized by high risk injecting behavior and a high burden of HCV infection. We aimed to estimate the burden of HIV, HCV, and other infectious diseases and to identify the correlates of HIV and HCV infection among PWID living in three major Afghan cities in 2009. METHODS Epidemiologic data was collected among PWID for the integrated biological and behavioral surveillance (IBBS) survey between May and August, 2009 in three Afghan cities. Data were collected using a structured questionnaire and biologic specimens to screen for HIV, HBV, HCV, syphilis, and HSV-2 using rapid testing kits. Multiple logistic regression models were constructed to identify correlates of infection. RESULTS Among 548 participants, pooled HIV prevalence was 7.1% (Mazar-i-Sharif: 1.0%, Kabul: 3.1%, Herat: 18.4%) and HCV prevalence was 40.3%. Almost all participants with HIV infection were co-infected with HCV (94.9%). Pooled prevalence estimates for other diseases included 7.1% for HBV, 5.5% for syphilis; and 9.3% for HSV-2. Living in Herat, ever in prison and time injecting were independently associated with HIV infection. Living in Kabul, Herat and time injecting were independently associated with HCV infection. CONCLUSIONS There is a high and heterogeneous burden of HIV and HCV among PWID in Afghan cities. Provision of comprehensive harm reduction services to PWID in Afghanistan is warranted to reduce exposures associated with HIV and HCV infection, especially in the city of Herat.
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Affiliation(s)
- Horacio Ruiseñor-Escudero
- Department of Psychiatry, Michigan State University, 965 E Fee Hall Suite A227, East Lansing, MI, 48824, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - Andrea L Wirtz
- Department of Emergency Medicine, Johns Hopkins Medical Institution, Baltimore, MD, 21205, USA; Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Mark Berry
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Iliassou Mfochive-Njindan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Feda Paikan
- National AIDS Control Program, Ministry of Public Health, Kabul, Afghanistan
| | - Hussain A Yousufi
- National AIDS Control Program, Ministry of Public Health, Kabul, Afghanistan
| | | | - Gilbert Burnham
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Alexander Vu
- Department of Emergency Medicine, Johns Hopkins Medical Institution, Baltimore, MD, 21205, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
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Mohamoud YA, Miller FD, Abu-Raddad LJ. Potential for human immunodeficiency virus parenteral transmission in the Middle East and North Africa: An analysis using hepatitis C virus as a proxy biomarker. World J Gastroenterol 2014; 20:12734-12752. [PMID: 25278675 PMCID: PMC4177460 DOI: 10.3748/wjg.v20.i36.12734] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 02/20/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
The Middle East and North Africa (MENA) region has endured several major events of infection parenteral transmission. Recent work has established the utility of using hepatitis C virus (HCV) as a proxy biomarker for assessing the epidemic potential for human immunodeficiency virus (HIV) parenteral transmission. In this review, we use data on the prevalence of HCV infection antibody (seroprevalence) among general population and high risk population groups to assess the potential for HIV parenteral transmission in MENA. Relatively low prevalence of HCV infection in the general population groups was reported in most MENA countries indicating that parenteral HIV transmission at endemic levels does not appear to be a cause for concern. Nonetheless, there could be opportunities for localized HIV outbreaks and transmission of other blood-borne infections in some settings such as healthcare facilities. Though there have been steady improvements in safety measures related to parenteral modes of transmission in the region, these improvements have not been uniform across all countries. More precautions, including infection control training programs, surveillance systems for nosocomial infections and wider coverage and evaluation of hepatitis B virus immunization programs need to be implemented to avoid the unnecessary spread of HIV, HCV, and other blood-borne pathogens along the parenteral modes of transmission.
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Mumtaz GR, Weiss HA, Thomas SL, Riome S, Setayesh H, Riedner G, Semini I, Tawil O, Akala FA, Wilson D, Abu-Raddad LJ. HIV among people who inject drugs in the Middle East and North Africa: systematic review and data synthesis. PLoS Med 2014; 11:e1001663. [PMID: 24937136 PMCID: PMC4061009 DOI: 10.1371/journal.pmed.1001663] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 05/08/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND It is perceived that little is known about the epidemiology of HIV infection among people who inject drugs (PWID) in the Middle East and North Africa (MENA). The primary objective of this study was to assess the status of the HIV epidemic among PWID in MENA by describing HIV prevalence and incidence. Secondary objectives were to describe the risk behavior environment and the HIV epidemic potential among PWID, and to estimate the prevalence of injecting drug use in MENA. METHODS AND FINDINGS This was a systematic review following the PRISMA guidelines and covering 23 MENA countries. PubMed, Embase, regional and international databases, as well as country-level reports were searched up to December 16, 2013. Primary studies reporting (1) the prevalence/incidence of HIV, other sexually transmitted infections, or hepatitis C virus (HCV) among PWIDs; or (2) the prevalence of injecting or sexual risk behaviors, or HIV knowledge among PWID; or (3) the number/proportion of PWID in MENA countries, were eligible for inclusion. The quality, quantity, and geographic coverage of the data were assessed at country level. Risk of bias in predefined quality domains was described to assess the quality of available HIV prevalence measures. After multiple level screening, 192 eligible reports were included in the review. There were 197 HIV prevalence measures on a total of 58,241 PWID extracted from reports, and an additional 226 HIV prevalence measures extracted from the databases. We estimated that there are 626,000 PWID in MENA (range: 335,000-1,635,000, prevalence of 0.24 per 100 adults). We found evidence of HIV epidemics among PWID in at least one-third of MENA countries, most of which are emerging concentrated epidemics and with HIV prevalence overall in the range of 10%-15%. Some of the epidemics have however already reached considerable levels including some of the highest HIV prevalence among PWID globally (87.1% in Tripoli, Libya). The relatively high prevalence of sharing needles/syringes (18%-28% in the last injection), the low levels of condom use (20%-54% ever condom use), the high levels of having sex with sex workers and of men having sex with men (15%-30% and 2%-10% in the last year, respectively), and of selling sex (5%-29% in the last year), indicate a high injecting and sexual risk environment. The prevalence of HCV (31%-64%) and of sexually transmitted infections suggest high levels of risk behavior indicative of the potential for more and larger HIV epidemics. CONCLUSIONS Our study identified a large volume of HIV-related biological and behavioral data among PWID in the MENA region. The coverage and quality of the data varied between countries. There is robust evidence for HIV epidemics among PWID in multiple countries, most of which have emerged within the last decade and continue to grow. The lack of sufficient evidence in some MENA countries does not preclude the possibility of hidden epidemics among PWID in these settings. With the HIV epidemic among PWID in overall a relatively early phase, there is a window of opportunity for prevention that should not be missed through the provision of comprehensive programs, including scale-up of harm reduction services and expansion of surveillance systems.
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Affiliation(s)
- Ghina R. Mumtaz
- Infectious Disease Epidemiology Group, Weill Cornell Medical College - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Helen A. Weiss
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sara L. Thomas
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Suzanne Riome
- Infectious Disease Epidemiology Group, Weill Cornell Medical College - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
| | - Hamidreza Setayesh
- Joint United Nations Programme on HIV/AIDS Regional Support Team, Middle East and North Africa, Cairo, Egypt
| | - Gabriele Riedner
- Regional Office of the Eastern Mediterranean, World Health Organization, Cairo, Egypt
| | - Iris Semini
- Joint United Nations Programme on HIV/AIDS Regional Support Team, Middle East and North Africa, Cairo, Egypt
| | - Oussama Tawil
- Joint United Nations Programme on HIV/AIDS Regional Support Team, Middle East and North Africa, Cairo, Egypt
| | - Francisca Ayodeji Akala
- Human Development Sector, Middle East and North Africa Region, World Bank, Washington (D.C.), United States of America
| | - David Wilson
- Global HIV/AIDS Program, World Bank, Washington (D.C.), United States of America
| | - Laith J. Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medical College - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, New York, New York, United States of America
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
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Behzadi MA, Ziyaeyan M, Asaei S. Hepatitis B virus DNA level Among the Seropositive Afghan Immigrants, Southern Iran. Jundishapur J Microbiol 2014; 7:e10127. [PMID: 25147713 PMCID: PMC4138643 DOI: 10.5812/jjm.10127] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 03/18/2013] [Accepted: 04/24/2013] [Indexed: 12/20/2022] Open
Abstract
Background: Diagnosis and control programs for infectious diseases among immigrants are the most important aspects of epidemiological studies for both origin and destination countries. Data about hepatitis B virus (HBV) infection among the Afghan immigrants in Iran is limited. Objectives: To the best of HBV treatment and prevention in Afghan immigrants in Iran, the present study was conducted to determine the virus DNA level, and the frequency of respective hepatitis B risk factors among the respective seropositive patients in Fars province, southern Iran. Patients and Methods: A total of 64 HBsAg positive Afghan immigrants including 47 (73.4%) men and 17 (26.6%) women, with ages ranging between 15 and 74 years (mean ± standard deviation: 37.69 ± 15.02 years) participated in this study. From those, whole blood sample were collected and DNAs were extracted from the sera and analyzed by TaqMan real-time PCR assay with a set of primers and probe amplified core protein region of HBV genome. Results: HBV DNA was detected in a total of 51/64 (79.7 %) serum samples; 37 (72.5%) male and 14 (27.5%) female. The copy number of HBV DNA ranged from 5 × 102 to 8.49 × 108 copies/mL in the serum samples; median 3.8 × 104 copies/mL. Demographic data and risk factors were also evaluated. The comparison of viral loads between the age groups and sex indicated no significant correlation (P > 0.05). However, the serum HBV DNA level significantly decreased in the treated patient group (P = 0.03). There was no significant difference in medicine usage between the two sexes in the study population (P > 0.05). Conclusions: Considering the results, determining the HBV DNA load and evaluation of treatment response can help to reduce the costs of diagnosis and treatment procedures in such patients, as well as, decreasing the risk of HBV transmission in immigrant Afghan population. Moreover, HBV screening strategies in country border entrances among immigrant should be performed. Moreover, free vaccination and treatment programs, and improving the level of HBV knowledge among Afghan immigrants in Iran is highly recommended.
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Affiliation(s)
- Mohammad Amin Behzadi
- Professor Alborzi Clinical Microbiology Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Mazyar Ziyaeyan
- Professor Alborzi Clinical Microbiology Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Corresponding author: Mazyar Ziyaeyan, Professor Alborzi Clinical Microbiology Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98-7116474304, Fax: +98-7116474303, E-mail:
| | - Sadaf Asaei
- Professor Alborzi Clinical Microbiology Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, IR Iran
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Tanju IA, Levent F, Sezer RG, Cekmez F. Hepatitis B, hepatitis C and human immunodeficiency virus seropositivity among children in kabul, afghanistan: a cross-sectional study. HEPATITIS MONTHLY 2014; 14:e16154. [PMID: 24693318 PMCID: PMC3955263 DOI: 10.5812/hepatmon.16154] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 01/11/2014] [Accepted: 02/09/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hepatitis B virus (HBV), hepatitis C Virus (HCV), and human immunodeficiency virus (HIV) infections are significant causes of morbidity and mortality all over the world, especially in underdeveloped countries like Afghanistan. Limited data are available concerning the seroprevalence of HBV, HCV and HIV in the pediatric age group in Afghanistan . OBJECTIVES The aim of the study was to assess HBV, HCV and HIV serology among children at an outpatient clinic in Kabul. PATIENTS AND METHODS A total number of 330 children were included to the study from outpatient clinics of Ataturk Kabul ISAF Role II Military Hospital from May to November 2012. Hepatitis B surface antigen (HBsAg), hepatitis C antibody (anti-HCV), and human immunodeficiency virus antibody (anti-HIV) were measured. RESULTS The mean age of children was 6.5 ± 4.2 years. The frequency of positive results for HBsAg, anti-HBs and anti-HCV in all age groups were 12 (3.6%), 47 (14.2%) and 2 (0.6%), respectively. Anti-HIV was not detected in any of the children's serum samples. The frequency of positive results for HBsAg was significantly higher in children older than six years than in other age groups. CONCLUSIONS Vaccination program including HBV has begun during the last five years in Afghanistan. The continuation of the vaccination program is of great importance. Vaccination program and implementation steps should be revised and the deficiencies, if any, should be overcome without delay.
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Affiliation(s)
- Ilhan Asya Tanju
- Department of Pediatrics, Gulhane Military Medical Academy, GATA Haydarpasa Training Hospital, Istanbul, Turkey
- Corresponding Author: Ilhan Asya Tanju, Department of Pediatrics, Gulhane Military Medical Academy, GATA Haydarpasa Training Hospital, Istanbul, Turkey. Tel: +90-2163028836, Fax: +90-2165423651, E-mail:
| | - Fatma Levent
- Department of Pediatrics, Texas Tech Health Sciences Center, Lubbock, USA
| | - Rabia Gonul Sezer
- Department of Pediatrics, Zeynep Kamil Maternity and Children’s Diseases Training and Research Hospital, Istanbul, Turkey
| | - Ferhat Cekmez
- Department of Pediatrics, Gulhane Military Medical Academy, School of Medicine, Etlik, Turkey
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Barnawal SP, Niraula SR, Agrahari AK, Bista N, Jha N, Pokharel PK. Human immunodeficiency virus and hepatitis C virus coinfection in Nepal. Indian J Gastroenterol 2014; 33:141-5. [PMID: 24078191 DOI: 10.1007/s12664-013-0407-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Accepted: 08/27/2013] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The study aimed at finding prevalence, mode of transmission, and pattern of CD4 cell count among hepatitis C virus (HCV) coinfected human immunodeficiency virus (HIV)-positive individuals in Nepal. METHODS This was a descriptive cross-sectional study carried out in three Volunteer Counseling and Testing clinics, one from Dharan and two from Kathmandu, Nepal. Three hundred and thirteen individuals were recruited. RESULTS Forty-two percent of HIV-infected persons had HCV coinfection. Significant associations with HIV and HCV coinfection were male gender (p <0.001) and injection drug use (IDU) (p <0.001). The mean CD4 cell count was significantly lower in HCV coinfected individuals, compared to those without coinfection, after 1.5 years (p =0.017), 2 years (p =0.0457), 3 years (p =0.011), and 3.5 years (p <0.001) of antiretroviral therapy. CONCLUSION HCV coinfection was common in HIV-infected individuals in Nepal and was associated with male gender, IDU, and lower CD4 counts.
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Affiliation(s)
- Satish Prasad Barnawal
- School of Public Health and Community Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal.
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Sanders-Buell E, Rutvisuttinunt W, Todd CS, Nasir A, Bradfield A, Lei E, Poltavee K, Savadsuk H, Kim JH, Scott PT, de Souza M, Tovanabutra S. Hepatitis C genotype distribution and homology among geographically disparate injecting drug users in Afghanistan. J Med Virol 2014; 85:1170-9. [PMID: 23918535 DOI: 10.1002/jmv.23575] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2013] [Indexed: 01/25/2023]
Abstract
Hepatitis C virus (HCV) prevalence is high among injecting drug users in Afghanistan, but transmission dynamics are poorly understood. Samples from HCV-infected injecting drug users were sequenced to determine circulating genotypes and potential transmission linkages. Serum samples were obtained from injecting drug user participants in Hirat, Jalalabad, and Mazar-i-Sharif between 2006 and 2008 with reactive anti-HCV rapid tests. Specimens with detected HCV viremia were amplified and underwent sequence analysis. Of 113 samples evaluated, 25 samples (35.2%) were only typeable in NS5B, nine samples (12.7%) were only typeable in CE1, and 37 samples (52.1%) were genotyped in both regions. Of those with typeable HCV, all were Afghan males with a mean age of 31.1 (standard deviation [SD] ± 8.0) years and mean duration of injecting of 3.9 (SD ± 4.3) years. Most reported residence outside Afghanistan in the last decade (90.1%) and prior incarceration (76.8%). HCV genotypes detected were: 1a, (35.2%, n = 25), 3a (62.0%, n = 44), and 1b (2.8%, n = 2). Cluster formation was detected in NS5B and CE1 and were generally from within the same city. All participants within clusters reported being a refugee in Iran compared to 93.5% of those outside clusters. Only 22.2% (4/11) of those within clusters had been refugees in Pakistan and these four individuals had also been refugees in Iran. Predominance of genotype 3a and the association between HCV viremia and having been a refugee in Iran potentially reflects migration between Afghanistan and Iran among IDUs from Mazar-i-Sharif and Hirat and carry implications for harm reduction programs for this migratory population.
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Affiliation(s)
- Eric Sanders-Buell
- Department of Molecular Virology and Pathogenesis, United States Military HIV Research Program (MHRP), Walter Reed Army Institute of Research, Silver Spring, MD, USA
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Wirtz AL, Kirey A, Peryskina A, Houdart F, Beyrer C. Uncovering the epidemic of HIV among men who have sex with men in Central Asia. Drug Alcohol Depend 2013; 132 Suppl 1:S17-24. [PMID: 23906993 DOI: 10.1016/j.drugalcdep.2013.06.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 06/26/2013] [Accepted: 06/28/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Research among people who inject drugs (PWID) in Central Asia has described same sex behavior among male PWID and may be associated with HIV and other infections. Little is known about the population of men who have sex with men (MSM) and the burden of HIV among MSM in Central Asian countries. METHODS We conducted a comprehensive search of peer-reviewed publications and gray literature on MSM and HIV in the region. Search strategies included terms for MSM combined with five Central Asian countries and neighbors, including Mongolia, Afghanistan, and Xinjiang Province, China. RESULTS 230 sources were identified with 43 eligible for inclusion: 12 provided HIV prevalence and population size estimates for MSM, none provided incidence estimates, and no publications for Turkmenistan were identified. National reports estimate HIV prevalence among MSM to range from 1 to 2% in Kazakhstan, Kyrgyzstan, Tajikistan, Uzbekistan, Xinjiang, to 10% in Mongolia. Biobehavioral studies estimated HIV prevalence at 0.4% in Afghanistan and 20.2% in Kazakhstan. Sexual identities and behaviors vary across countries. Injection drug use was relatively low among MSM (<5% for most). Non-injection drugs, alcohol use prior to sex, and binge drinking were more common and potentially associated with violence. Criminalization of homosexuality (Afghanistan, Uzbekistan, and Turkmenistan) and stigma has limited research and HIV prevention. CONCLUSION Improved understanding of risks, including potential linkages between sexual exposures and substance use, among MSM are important for response. The little known about HIV among MSM in Central Asia speaks to the urgency of improvements in HIV research, prevention, and care.
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Affiliation(s)
- Andrea L Wirtz
- Johns Hopkins Bloomberg School of Public Health, USA; Johns Hopkins Medical Institute, USA.
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Des Jarlais DC, Boltaev A, Feelemyer J, Bramson H, Arasteh K, Phillips BW, Hagan H. Gender disparities in HIV infection among persons who inject drugs in Central Asia: a systematic review and meta-analysis. Drug Alcohol Depend 2013; 132 Suppl 1:S7-12. [PMID: 23891035 PMCID: PMC3825744 DOI: 10.1016/j.drugalcdep.2013.06.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 06/24/2013] [Accepted: 06/25/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Disparities in HIV infection, with females having higher rates of HIV infection than males, have been noted among persons who inject drugs (PWID) in many countries. We examined male/female HIV disparities among PWID in Central Asia and compared these disparities with patterns worldwide. METHODS A systematic review and meta-analyses were conducted for studies reporting HIV prevalence by gender among PWID. To be included in the analyses, reports had to contain (1) samples of PWID from Central Asia, (2) HIV data based on laboratory testing, (3) HIV prevalence reported for males and females, and (4) samples that were not recruited on the basis of HIV status. RESULTS Data were abstracted from 11 studies in 5 countries in Central Asia: China, Kazakhstan, Russia, Tajikistan, and Uzbekistan; the total sample size was 12,225. The mean weighted OR for HIV prevalence among females to males was 0.913 (95% CI 0.07, 1.26), with high heterogeneity among studies (I(2)=70.0%) and a possible publication bias among studies with small sample sizes (Eggers test=-1.81, 95% CI -5.18, 0.54). CONCLUSIONS The non-significant higher HIV prevalence among male PWID in Central Asia contrasts with the worldwide findings which show slightly higher HIV prevalence among female PWID. This may reflect the relative recency of the HIV epidemics in Central Asia. The findings also suggest there may be factors that protect female PWID from HIV in some settings. Further examination of transmission dynamics in Central Asia is necessary to better understand the HIV epidemic among PWID.
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Affiliation(s)
- Don C Des Jarlais
- The Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York City, USA.
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Petersen Z, Myers B, van Hout MC, Plüddemann A, Parry C. Availability of HIV prevention and treatment services for people who inject drugs: findings from 21 countries. Harm Reduct J 2013; 10:13. [PMID: 23957896 PMCID: PMC3765101 DOI: 10.1186/1477-7517-10-13] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 08/13/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND About a third of the global HIV infections outside sub-Saharan Africa are related to injecting drug use (IDU), and this accounts for a growing proportion of persons living with HIV. This paper is a response to the need to monitor the state of the HIV epidemic as it relates to IDU and the availability of HIV treatment and harm reduction services in 21 high epidemic countries. METHODS A data collection form was designed to cover questions on rates of IDU, prevalence and incidence of HIV and information on HIV treatment and harm reduction services available to people who inject drugs (PWID). National and regional data on HIV infection, IDU in the form of reports and journal articles were sought from key informants in conjunction with a systematic search of the literature. RESULTS Completed data collection forms were received for 11 countries. Additional country-specific information was sourced via the literature search. The overall proportion of HIV positive PWID in the selected countries ranged from 3% in Kazakhstan to 58% in Vietnam. While IDU is relatively rare in sub-Saharan Africa, it is the main driver of HIV in Mauritius and Kenya, with roughly 47% and 36% of PWID respectively being HIV positive. All countries had antiretroviral treatment (ART) available to PWID, but data on service coverage were mainly missing. By the end of 2010, uptake of needle and syringe programmes (NSP) in Bangladesh, India and Slovakia reached the internationally recommended target of 200 syringes per person, while uptake in Kazakhstan, Vietnam and Tajikistan reached between 100-200 syringes per person. The proportion of PWID receiving opioid substitution therapy (OST) ranged from 0.1% in Kazakhstan to 32.8% in Mauritius, with coverage of less than 3% for most countries. CONCLUSIONS In order to be able to monitor the impact of HIV treatment and harm reduction services for PWID on the epidemic, epidemiological data on IDU and harm reduction service provision to PWID needs to be regularly collected using standardised indicators.
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Affiliation(s)
- Zaino Petersen
- Medical Research Council, Alcohol and Drug Abuse Research Unit, PO Box 19070, Tygerberg 7505, Cape Town, South Africa.
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45
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Reduction in Prevalence of Hepatitis B Surface Antigen Among Intravenous Drug Users in Tehran Drop-in-Centers. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2013. [DOI: 10.5812/archcid.15531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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46
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Mazières S, Temory SA, Vasseur H, Gallian P, Di Cristofaro J, Chiaroni J. Blood group typing in five Afghan populations in the North Hindu-Kush region: implications for blood transfusion practice. Transfus Med 2013; 23:167-74. [DOI: 10.1111/tme.12038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 03/12/2013] [Accepted: 03/13/2013] [Indexed: 11/29/2022]
Affiliation(s)
- S. Mazières
- Aix Marseille Université; CNRS, EFS, ADÉS; UMR 7268; Marseille; France
| | - S. A. Temory
- Centre National de Transfusion Sanguine de Kabul; Kabul; Afghanistan
| | - H. Vasseur
- Etablissement Français du Sang Auvergne-Loire; Saint-Etienne; France
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Sharif M, Sherif A, Sayyah M. Frequency of HBV, HCV and HIV infections among hospitalized injecting drug users in Kashan. Indian J Sex Transm Dis AIDS 2012; 30:28-30. [PMID: 21938111 DOI: 10.4103/0253-7184.55477] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
CONTEXT Infectious diseases including HIV and viral hepatitis constitute a major health issue, with high prevalence among injecting drug users (IDUs). AIMS The present study assessed the frequency of HIV, and hepatitis B and C viruses (HBV and HCV) among 200 IDUs, hospitalized between 2001 and 2006, in Shahid Beheshti Hospital of Kashan, Iran. SETTING AND DESIGN A population-based cross-sectional study in Iran. MATERIALS AND METHODS A total of 200 subjects participated in this study. Serological markers including HBsAg, anti-HCV antibodies and HIV were assessed by ELISA method using Monobid kits made in US. Demographic data was collected by using a questionnaire, which was designed by a researcher. STATISTICAL ANALYSIS USED Frequencies were determined by employing SPSS:PC version 15.0, and Chi-square and Fisher's exact tests were used to compare proportions. RESULTS The mean age of subjects was 36.5 ± 10.2 years. Approximately 88.5% (177 cases) were male and 11.5%. (23 cases) were female. The frequency of positive infection test results for males with respect to HBV, HCV, and HIV was 4% (8 cases), 10.5% (21 cases), and 1.5% (3 cases); and for females it was 0.5% (1 case), 1.5% (3 cases), and 0% (0 case), respectively. CONCLUSION This study demonstrates that the frequency of HBV, HCV, and HIV infection in the IVD user in Kashan, Iran, is relatively high and this condition is more serious in male than female drug addicts. It is very important, especially for health providers and policy makers, to recognize the risk factors of HBV, HCV and particularly HIV infection in this area and design effective preventive programs.
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Affiliation(s)
- M Sharif
- Department of Infectious Diseases, Ghotb Ravand blvd, Kashan University of Medical Science, Kashan, Iran
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Todd CS, Macdonald D, Khoshnood K, Mansoor GF, Eggerman M, Panter-Brick C. Opiate use, treatment, and harm reduction in Afghanistan: recent changes and future directions. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2012; 23:341-5. [PMID: 22717389 PMCID: PMC7153691 DOI: 10.1016/j.drugpo.2012.05.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 05/09/2012] [Accepted: 05/14/2012] [Indexed: 11/16/2022]
Abstract
Afghanistan leads global opium and cannabis production, amidst concerted efforts to improve the country's infrastructure. In this commentary, the evidence base for drivers of increased drug use in the context of deteriorating security is presented, government, donor, and civil society responses to date are described, and key areas for health policy response are summarized. Opiate use in Afghanistan shows disturbing trends: multiple substances are accessible at low cost and frequently used in combination, and injecting use has become more common. Pressures from both donor and governmental sectors have compromised innovations in programming. Further, civil unrest and resultant displacement have created challenges for programme implementation. Afghanistan urgently needs a well-funded, sustainable, comprehensive, and inclusive programme of drug dependency treatment, aftercare, and harm reduction services, as well as realistic, effective, and culturally salient primary prevention programmes. To date, drug dependence is not a prioritised issue, current programmes are under-resourced, and the continuum of care has a narrow scope generally limited to treatment. Unless this issue is addressed, the next generation of Afghans is poised to become a casualty of the opiate industry.
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Affiliation(s)
- Catherine S Todd
- Department of Obstetrics & Gynaecology, Columbia University, 622 West 168th Street, PH 16-69, New York, NY 10032, USA.
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Nokhodian Z, Meshkati M, Adibi P, Ataei B, Kassaian N, Yaran M, Shoaei P, Hassannejad R. Hepatitis C among Intravenous Drug Users in Isfahan, Iran: a Study of Seroprevalence and Risk Factors. Int J Prev Med 2012; 3:S131-8. [PMID: 22826755 PMCID: PMC3399288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 10/12/2011] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES Hepatitis C virus (HCV) is one of the major public health problems worldwide which is transmitted through contact with infected blood or blood products. One of the most prevalent modes of HCV transmission is injecting drug with unclean needles or syringes. Therefore intravenous drug users (IVDUs) are the most important group who should be considered. The aim of this study was to evaluate seroprevalence and risk factors of hepatitis C virus in IVDUs population. METHODS The cross-sectional study was carried out on intravenous drug users who attended health and social care Drop-in centers during November 2008 to February 2009 in Isfahan province, Iran. Data was gathered using interviewer-administered questionnaire including demographic characteristics and main risk factors for HCV infection. 5ml venous blood sample was obtained from each subject. The HCV-Ab test was performed on all blood samples by ELISA. The data was analyzed using descriptive statistical methods and multiple logistic regressions by SPSS software, version 15. RESULTS The mean age of participants was 31.77 ± 8.51. 503 (94.7%) were men and 28 (5.3%) were women. HCV seroprevalence was 47.1% (95% CI: 42.9, 51.3). The multiple logistic regressions demonstrated that history of tattooing (OR 1.72, 95% CI 1.02-2.90), history of imprisonment (OR 2.49, 95% CI 1.40-4.42) and sharing needles/syringes (OR 2.76, 95% CI 1.54-4.95) are significant predictors of risk of HCV in IVDU population. CONCLUSIONS In conclusion, according to the high prevalence of HCV infection among IVDUs and high adds of HCV infection from tattooing, sharing of needles/syringes and imprisonment, effective harm reduction programs should be expanded among IVDUs to prevent new HCV infections.
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Affiliation(s)
- Zary Nokhodian
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marjan Meshkati
- Isfahan Province Health Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Peyman Adibi
- Department of Gastroenterology, Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behrooz Ataei
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nazila Kassaian
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Yaran
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parisa Shoaei
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Razieh Hassannejad
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Correspondence to:Razieh Hassannejad, Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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50
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Hassannejad R, Kassaian N, Ataei B, Adibi P. High risky behaviors among intravenous drug users in Isfahan, Iran: A study for hepatitis C harm reduction programs. Int J Prev Med 2012; 3:S73-8. [PMID: 22826773 PMCID: PMC3399296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Accepted: 08/01/2011] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES Intravenous drug users (IVDUs) who share needles/syringes and practice sexual behaviors, are the most important group in the transmission of blood-borne infection diseases such as hepatitis C virus (HCV). Therefore identification of prevalent high-risky behaviors among IVDUs to detect the most route of transmission among them is essential to develop harm reduction programs among IVDUs and decrease HCV transmission from them to community. METHODS The cross-sectional study was carried out on 1510 intravenous drug users from November 2008 to February 2009 in Isfahan province, Iran. After obtaining consent form from participants, information was collected by interviewer-administered validated questionnaire. The data was analyzed with descriptive statistical methods by SPSS software, version 15. RESULTS 1510 IVDUs participated in the study with the mean age 32.16 ± 8.26. 66.4% of participants had a history of illegal sexual activity. Among male IVDUs who had illegal sexual contact, 40.6% reported having homosexual contact and 36.2% of them have used condom in their contact. Also 57.7% had sexual contact with female sex workers. 83.5% of IVDUs reported having multiple sexual partners, and 30.9% had IVDUs sexual partners. The mean number of injection and duration of injection among IVDUs were 75.12 ± 95.51 times per month and 12.34 ± 7.53 years respectively. 36.9% of subjects have reported sharing needles/syringes. CONCLUSIONS According to the high prevalence of unprotected sexual contacts and unsafe injection among IVDUs, effectiveness interventions and harm reduction programs are necessary to prevent spread of blood-borne infection diseases particularly HCV. With reduction of risky behaviors and consequently decrease of spread of HCV, these programs benefit both drug users and society.
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Affiliation(s)
- Razieh Hassannejad
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nazila Kassaian
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Correspondence to: Nazila Kassaian, Infectious Diseases and Tropical Medicine Research center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Behrooz Ataei
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Peyman Adibi
- Department of Gastroenterology, Integrative Functional Gastroenterology Research center, Isfahan University of Medical Sciences, Isfahan, Iran
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