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Hatch MA, Laschober TC, Paschen-Wolff M, Ertl MM, Nelson CM, Wright L, Lancaster C, Feaster DJ, Forrest D, Hankey C, Monger M, Fegley JP, Irving R, Young C, Rose J, Spector A, Dresser L, Moran L, Jelstrom E, Tross S. PrEP for people who use opioids: A NIDA clinical trials network survey study in Southern U.S. cities where HIV incidence is high. Drug Alcohol Depend 2024; 257:111133. [PMID: 38447393 DOI: 10.1016/j.drugalcdep.2024.111133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND People who use opioids (PWUO) are at increased risk for HIV. Pre-exposure prophylaxis (PrEP) is effective but underutilized as HIV prevention among PWUO. This study examined predictors of willingness to take daily oral PrEP and long-acting injectable (LAI) PrEP among PWUO across eight Southern urban cities with high HIV incidence. METHODS HIV-negative PWUO (N = 308) seeking services in community-based programs participated in this cross-sectional survey study. Measures included demographics, sexual risk behavior, substance use frequency, and awareness of and willingness to take oral and injectable PrEP. Data were analyzed using mixed-effects models. RESULTS Willingness to take daily oral and LAI PrEP was moderately high (69.16% and 62.02%, respectively). Half had heard of PrEP, but only 4% had ever taken it. Only education and condomless vaginal sex predicted willingness to take oral PrEP. Only education predicted willingness to take LAI PrEP. Polysubstance use was prevalent, with substantial proportions of PWUO reporting frequent use of injection drugs (opioids or stimulants, 79.5%), non-injection opioids (73.3%), non-injection stimulants (71.1%), cannabis (62.6%), and hazardous drinking (29.6%). About 20% reported past-year condomless anal sex, and one-third reported past-year condomless vaginal sex. CONCLUSIONS PWUO in this study were amenable to PrEP, particularly in light of education and condomless vaginal sex. Careful consideration for matching PrEP messaging to the PWUO audience is needed. PrEP promotion should expand beyond men who have sex with men to include groups such as these predominantly heterosexual, polysubstance-using PWUO with HIV risk who were open to both formulations of PrEP.
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Affiliation(s)
- Mary A Hatch
- University of Washington Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences, Seattle, WA 98185, USA.
| | - Tanja C Laschober
- University of Washington Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences, Seattle, WA 98185, USA
| | - Margaret Paschen-Wolff
- Division on Substance Use Disorders, Department of Psychiatry, Columbia University Irving Medical Center at New York State Psychiatric Institute, New York, NY 10032, USA
| | - Melissa M Ertl
- University of Minnesota-Twin Cities, Department of Psychology, Minneapolis, MN 55455, USA
| | - C Mindy Nelson
- University of Miami Miller School of Medicine, Department of Public Health Sciences, Miami, FL 33136, USA
| | - Lynette Wright
- University of Washington Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences, Seattle, WA 98185, USA
| | - Chloe Lancaster
- University of South Florida, Department of Leadership, Policy, and Lifelong Learning, Tampa, FL 33620, USA
| | - Daniel J Feaster
- University of Miami Miller School of Medicine, Department of Public Health Sciences, Miami, FL 33136, USA
| | - David Forrest
- University of Miami, Department of Anthropology, Coral Gables, FL, USA
| | - Colby Hankey
- Aspire Health Partners, HIV Services, Orlando, FL 32804, USA
| | - Mauda Monger
- My Brother's Keeper, 710 Avignon Dr, Ridgeland, MS 39157, USA
| | - Joshua P Fegley
- CrescentCare, 330 Tulane Ave, 1st Floor, New Orleans, LA 70119, USA
| | - Rhonda Irving
- Capitol Area Reentry Program, Baton Rouge, LA 70807, USA
| | - Cynthia Young
- Capitol Area Reentry Program, Baton Rouge, LA 70807, USA
| | - Juliana Rose
- Gateway Community Services, Research Department, Jacksonville, FL, USA
| | - Anya Spector
- Stella and Charles Guttman Community College, City University of New York, New York, NY, USA
| | | | - Landhing Moran
- Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, USA
| | | | - Susan Tross
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, NY 10032, USA
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2
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Greiner MG, Shulman M, Opara O, Potter K, Voronca DC, Tafessu HM, Hefner K, Hamilton A, Scheele C, Ho R, Dresser L, Jelstrom E, Fishman M, Ghitza UE, Rotrosen J, Nunes EV, Bisaga A. Surmounting Withdrawal to Initiate Fast Treatment with Naltrexone (SWIFT): A stepped wedge hybrid type 1 effectiveness-implementation study. Contemp Clin Trials 2023; 128:107148. [PMID: 36931426 PMCID: PMC10895892 DOI: 10.1016/j.cct.2023.107148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Extended-release injectable naltrexone (XR-NTX) is an effective treatment for opioid use disorder (OUD), but initiation remains a barrier to implementation. Standard practice requires a 10- to 15-day inpatient admission prior to XR-NTX initiation and involves a methadone or buprenorphine taper followed by a 7- to 10-day washout, as recommended in the Prescribing Information for XR-NTX. A 5- to 7-day rapid induction approach was developed that utilizes low-dose oral naltrexone and non-opioid medications. METHODS The CTN-0097 Surmounting Withdrawal to Initiate Fast Treatment with Naltrexone (SWIFT) study was a hybrid type I effectiveness-implementation trial that compared the effectiveness of the standard procedure (SP) to the rapid procedure (RP) for XR-NTX initiation across six community inpatient addiction treatment units, and evaluated the implementation process. Sites were randomized to RP every 14 weeks in an optimized stepped wedge design. Participants (target recruitment = 450) received the procedure (SP or RP) that the site was implementing at time of admission. The hypothesis was RP will be non-inferior to SP on proportion of inpatients who receive XR-NTX, with a shorter admission time for RP. Superiority testing of RP was planned if the null hypothesis of inferiority of RP to SP was rejected. DISCUSSION If RP for XR-NTX initiation is shown to be effective, the shorter inpatient stay could make XR-NTX more feasible and have an important public health impact expanding access to OUD pharmacotherapy. Further, a better understanding of facilitators and barriers to RP implementation can help with future translatability and uptake to other community programs. TRIAL REGISTRATION NCT04762537 Registered February 21, 2021.
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Affiliation(s)
- Miranda G Greiner
- New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, NY, United States of America
| | - Matisyahu Shulman
- New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, NY, United States of America
| | - Onumara Opara
- New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, NY, United States of America
| | - Kenzie Potter
- New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, NY, United States of America
| | | | - Hiwot M Tafessu
- The Emmes Company, LLC, Rockville, MD, United States of America
| | - Kathryn Hefner
- The Emmes Company, LLC, Rockville, MD, United States of America
| | - Amy Hamilton
- The Emmes Company, LLC, Rockville, MD, United States of America
| | | | - Rachel Ho
- The Emmes Company, LLC, Rockville, MD, United States of America
| | - Lauren Dresser
- The Emmes Company, LLC, Rockville, MD, United States of America
| | - Eve Jelstrom
- The Emmes Company, LLC, Rockville, MD, United States of America
| | - Marc Fishman
- Johns Hopkins University School of Medicine and Maryland Treatment Centers, Baltimore, MD, United States of America
| | - Udi E Ghitza
- National Institute on Drug Abuse (NIDA), Bethesda, MD, United States of America
| | - John Rotrosen
- New York University Grossman School of Medicine, New York, NY, United States of America
| | - Edward V Nunes
- New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, NY, United States of America
| | - Adam Bisaga
- New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, NY, United States of America.
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3
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Morris AM, Rennert-May E, Dalton B, Daneman N, Dresser L, Fanella S, Grant J, Keynan Y, Le Saux N, McDonald J, Shevchuk Y, Thirion D, Conly JM. Rationale and development of a business case for antimicrobial stewardship programs in acute care hospital settings. Antimicrob Resist Infect Control 2018; 7:104. [PMID: 30181869 PMCID: PMC6114185 DOI: 10.1186/s13756-018-0396-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 08/21/2018] [Indexed: 11/27/2022] Open
Abstract
Background Antimicrobial stewardship programs (ASPs) have been shown to reduce inappropriate antimicrobial use and its consequences. However, these programs lack legislative requirements in many places and it can be difficult to determine what human resources are required for these programs and how to create a business case to present to hospital administrators for program funding. The objectives of the current paper were to review legislative requirements and outline human resource requirements for ASPs, and to create a base business case for ASPs. Methods A working group of antimicrobial stewardship experts from across Canada met to discuss the necessary components for creation of a business case for antimicrobial stewardship. A narrative review of the literature of the regulatory requirements and human resource recommendations for ASPs was conducted. Informed by the review and using a consensus decision-making process, the expert working group developed human resource recommendations based on a 1000 bed acute care health care facility in Canada. A spreadsheet based business case model for ASPs was also created. Results Legislative and /or regulatory requirements for ASPs were found in 2 countries and one state jurisdiction. The literature review and consensus development process recommended the following minimum human resources complement: 1 physician, 3 pharmacists, 0.5 program administrative and coordination support, and 0.4 data analyst support as full time equivalents (FTEs) per 1000 acute care beds. Necessary components for the business case model, including the human resource requirements, were determined to create a spreadsheet based model. Conclusions There is evidence to support the negative outcomes of inappropriate antimicrobial use as well as the benefits of ASPs. Legislative and /or regulatory requirements for ASPs are not common. The available evidence for human resource recommendations for ASPs using a narrative review process was examined and a base business case modelling scenario was created. As regulatory requirements for ASPs increase, it will be necessary to create accurate business cases for ASPs in order to obtain the necessary funding to render these programs successful. Electronic supplementary material The online version of this article (10.1186/s13756-018-0396-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A M Morris
- 1Department of Medicine, University of Toronto, Sinai Health System, and University Health Network, Toronto, ON Canada
| | - E Rennert-May
- 2Department of Medicine, University of Calgary and Foothills Medical Centre, Alberta Health Services, Calgary, AB Canada
| | - B Dalton
- Pharmacy Services, Foothills Medical Centre, Alberta Health Services, Calgary, AB Canada
| | - N Daneman
- 4Department of Medicine, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON Canada
| | - L Dresser
- 5Antimicrobial Stewardship, University Health Network, Toronto, ON Canada
| | - S Fanella
- 6Department of Pediatrics and Child Health and Medical Microbiology, University of Manitoba, Winnipeg, MB Canada
| | - J Grant
- 7Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, BC Canada
| | - Y Keynan
- 8Departments of Internal Medicine, Medical Microbiology and National Collaborating Center for Infectious Diseases, University of Manitoba, Winnipeg, MB Canada
| | - N Le Saux
- 9Department of Pediatrics, University of Ottawa and Children's Hospital of Eastern Ontario, Ottawa, ON Canada
| | - J McDonald
- 10Pharmacy Services, Children's Hospital of Eastern Ontario, Ottawa, ON Canada
| | - Y Shevchuk
- 11College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK Canada
| | - D Thirion
- 12Faculté de pharmacie, Université de Montréal, Department of Pharmacy, McGill University Health Centre, Montréal, QC Canada
| | - J M Conly
- 13Departments of Medicine and Immunology, Microbiology & Infectious Diseases, University of Calgary and Alberta Health Services, AGW5 Ground Floor SSB, Foothills Medical Centre, 1403 29 St NW, Calgary, AB T2N 2T9 Canada
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Bast DJ, Dresser L, Duncan CL, Walker SE, Mandell LA, Low DE, de Azavedo JCS. Short-Course Therapy of Gemifloxacin Effective Against Pneumococcal Pneumonia in Mice. J Chemother 2013; 18:634-40. [PMID: 17267342 DOI: 10.1179/joc.2006.18.6.634] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Standard 7-14 day (d) courses of antimicrobial therapy for community-acquired pneumonia (CAP) are thought to have contributed to the emergence of resistant pneumoccoci. Consequently, short-course fluoroquinolone regimens have been proposed to minimize resistance. To test this, we examined 2-day versus 5-day regimens of gemifloxacin and levofloxacin for treatment of pneumonia in a murine model. In doing so, we also investigated whether the enhanced potency of gemifloxacin would influence outcomes. CD1 Swiss mice were infected intratracheally with 10(5)-CFU of a virulent Streptococcus pneumoniae strain. Drugs were administered every 8 h for 2 d and 5 d, starting at 24 h postinfection. Temperature was used to assess disease progression. Gemifloxacin remained effective for 2 d and 5 d, with survival rates of 100%-83% compared with 40%-58% for levofloxacin. Eighty-nine to 100% of gemifloxacin-treated mice were clear of pulmonary bacteria compared with only 0%-20% for levofloxacin. For levofloxacin-treated mice, 2 of 7 (29%) isolates with a levofloxacin minimum inhibitory concentration (MIC) 4 times that of the infecting parent strain had ParC mutations. By contrast, no isolates recovered from gemifloxacin-treated mice were reduced in susceptibility. Gemifloxacin could be effective in shortening duration of therapy for CAP treatment as well as minimize resistance development.
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Affiliation(s)
- D J Bast
- Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
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De Azavedo JCS, Dresser L, Duncan CL, Walker SE, Low DE, Bast DJ. Antipneumococcal activity of ertapenem compared with gatifloxacin in a temperature-sensitive murine model of acute pneumonia. J Chemother 2007; 19:392-7. [PMID: 17855183 DOI: 10.1179/joc.2007.19.4.392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Fluoroquinolone-resistance among pneumococci is low; however the number of isolates with a single ParC mutation has increased. Consequently, more potent agents are needed to minimize resistance selection. We investigated the efficacy of ertapenem versus gatifloxacin in a temperature-sensitive mouse model of pneumonia caused by a wildtype Streptococcus pneumoniae strain (A66) and an isogenic mutant with a ParC mutation (R222). Treatment started at 24 h and lasted for 5 days. Temperature was used to assess disease progression before and during treatment. Of mice infected with either strain and treated at an early stage of infection, 79-94% of those given ertapenem survived compared with 56-61% given gatifloxacin. If treated at a later stage, the results were similar for ertapenem (71-84%) but were considerably lower for gatifloxacin (17-33%). Ertapenem was as bactericidal as gatifloxacin against A66 (94-100% vs 92-100%) but was superior to gatifloxacin against R222 (95-100% vs 50-77%). Ertapenem is a promising new treatment for patients with pneumococcal pneumonia, including those at risk of infection with a fluoroquinolone-resistant strain.
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Affiliation(s)
- J C S De Azavedo
- Toronto Centre for Antimicrobial Research and Evaluation (ToCare), Mount Sinai Hospital, Canada.
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Muller MP, Richardson SE, McGeer A, Dresser L, Raboud J, Mazzulli T, Loeb M, Louie M. Early diagnosis of SARS: lessons from the Toronto SARS outbreak. Eur J Clin Microbiol Infect Dis 2006; 25:230-7. [PMID: 16586072 PMCID: PMC7087683 DOI: 10.1007/s10096-006-0127-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The clinical presentation of SARS is nonspecific and diagnostic tests do not provide accurate results early in the disease course. Initial diagnosis remains reliant on clinical assessment. To identify features of the clinical assessment that are useful in SARS diagnosis, the exposure status and the prevalence and timing of symptoms, signs, laboratory and radiographic findings were determined for all adult patients admitted with suspected SARS during the Toronto SARS outbreak. Findings were compared between patients with laboratory-confirmed SARS and those in whom SARS was excluded by laboratory or public health investigation. Of 364 cases, 273 (75%) had confirmed SARS, 30 (8%) were excluded, and 61 (17%) remained indeterminate. Among confirmed cases, exposure occurred in the healthcare environment (80%) or in the households of affected patients (17%); community or travel-related cases were rare (<3%). Fever occurred in 97% of patients by the time of admission. Respiratory findings including cough, dyspnea and pulmonary infiltrates evolved later and were present in only 59, 37 and 68% of patients, respectively, at admission. Direct exposure, fever on the first day of illness, and elevated temperature, pulmonary infiltrates, lymphopenia and thrombocytopenia at admission were associated with confirmed cases. Rhinorrhea, sore throat, and an elevated neutrophil count at admission were associated with excluded cases. In the absence of fever or significant exposure, SARS is unlikely. Other clinical, laboratory and radiographic findings further raise or lower the likelihood of SARS and provide a rational basis for estimating the likelihood of SARS and directing initial management.
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Affiliation(s)
- M P Muller
- Department of Microbiology, Mount Sinai Hospital, 600 University Avenue, M5G 1X5 Toronto, Canada.
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7
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Bast DJ, Yue M, Chen X, Bell D, Dresser L, Saskin R, Mandell LA, Low DE, de Azavedo JCS. Novel murine model of pneumococcal pneumonia: use of temperature as a measure of disease severity to compare the efficacies of moxifloxacin and levofloxacin. Antimicrob Agents Chemother 2004; 48:3343-8. [PMID: 15328095 PMCID: PMC514736 DOI: 10.1128/aac.48.9.3343-3348.2004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2004] [Revised: 03/04/2004] [Accepted: 04/22/2004] [Indexed: 11/20/2022] Open
Abstract
Surface temperature measured by an infrared temperature-scanning thermometer was used to evaluate disease severity and predict imminent death in a murine model of pneumococcal pneumonia. We showed that a decrease in temperature was associated with increasing severity of disease and concomitant histological changes and also that a temperature of 30 degrees C or less was a predictor of death. Furthermore, viable bacterial counts in the lungs of mice euthanized at a temperature of < or = 30 degrees C were not significantly different from those seen in the lungs of mice allowed to die without intervention. These data support temperature change as a more subtle indicator of outcome than death and demonstrate that this could be used as a reliable end point for euthanasia. To test the utility of our model in a drug trial, we examined the efficacies of moxifloxacin and levofloxacin by using temperature as a measure of disease severity prior to and during treatment. Regardless of the antibiotic used, mice assessed as moderately ill (temperature > or = 32 degrees C) at the start of treatment had better clinical and bacteriological outcomes than mice assessed as severely ill (temperature < 32 degrees C). However, moxifloxacin offered better protection and greater bacterial clearance than did levofloxacin in all infected mice independent of disease severity. This model not only allows a more subtle evaluation of drug efficacy but also ensures a better degree of standardization and a more humane approach to drug efficacy studies involving animals.
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Affiliation(s)
- Darrin J Bast
- Toronto Centre for Antimicrobial Research and Evaluation, Room 1483, Mount Sinai Hospital, 600 University Ave., Toronto, Ontario M5G 1X5, Canada.
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