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Jiang H, Zhang X, Zhang C, Lu R, Zhou C, Ouyang L, Xing H, Vermund SH, Shao Y, Ruan Y, Wu G, Qian HZ. Trends of HIV, hepatitis C virus and syphilis seroprevalence among injection and non-injection drug users in southwestern China, 2010-2017. AIDS Care 2024; 36:612-617. [PMID: 33345591 PMCID: PMC10767711 DOI: 10.1080/09540121.2020.1856320] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 07/18/2020] [Accepted: 11/17/2020] [Indexed: 01/26/2023]
Abstract
Background: The primary risk of HIV transmission in China has shifted from injecting drug use (IDU) to sexual contact since 2006. We evaluated the prevalence trends of HIV, hepatitis C virus (HCV), syphilis, and sexual and drug use behaviors among drug users. Methods: People who use drugs participated in any of four rounds of cross-sectional surveys during 2010-2017 in Chongqing. Participants were tested for HIV, HCV, and syphilis. Questionnaire interviewing was conducted to collect behavioral information. Chi-square and trend tests were employed to assess the changes in diseases and behaviors over time. Results: A total of 8,171 people who inject drugs (PWID) and 5,495 non-injection drug users (NIDU) were included in the analyses. HIV prevalence among PWID in four rounds of the survey in 2010-11, 2012-13, 2014-15, and 2016-17 was 11.5%, 9.7%, 6.5%, and 6.9%, and among NIDU, 2.4%, 1.4%, 2.1% and 2.6%, respectively. HCV prevalence among PWID was 83.5%, 85.2%, 67.1% and 79.7% (P < 0.001), and among NIDU, 22.2%, 10.8%, 13.4% and 14.8%, (P < 0.001). Conclusions: The declining HIV and HCV prevalence among PWID is coincident with declining risky drug use behaviors. Tailored disease prevention and interventions targeting PWID and NIDU are needed.
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Affiliation(s)
- Hehong Jiang
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, People’s Republic of China
| | - Xiangjun Zhang
- College of Education, Health, and Human Sciences, University of Tennessee, Knoxville, TN, USA
| | - Chen Zhang
- School of Nursing, University of Rochester, Rochester, NY, USA
| | - Rongrong Lu
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, People’s Republic of China
| | - Chao Zhou
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, People’s Republic of China
| | - Lin Ouyang
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, People’s Republic of China
| | - Hui Xing
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Chinese Center for Disease Control and Prevention (China CDC), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, People’s Republic of China
| | - Sten H. Vermund
- School of Public Health, Yale University, New Haven, CT, USA
| | - Yiming Shao
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Chinese Center for Disease Control and Prevention (China CDC), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, People’s Republic of China
| | - Yuhua Ruan
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Chinese Center for Disease Control and Prevention (China CDC), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, People’s Republic of China
| | - Guohui Wu
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, People’s Republic of China
| | - Han-Zhu Qian
- School of Public Health, Yale University, New Haven, CT, USA
- Xiangya Nursing School, Central South University, Changsha, People’s Republic of China
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Lee JS, Batchelder AW, Stanton AM, Westphal L, Klevens RM, Mayer KH, O'Cleirigh C. Structural vulnerabilities and PrEP awareness among Boston heterosexuals and people who inject drugs at risk for HIV: findings from 2018 to 2019 cycles from the Boston, MA site of the NHBS. AIDS Care 2024; 36:641-651. [PMID: 38091449 PMCID: PMC10994762 DOI: 10.1080/09540121.2023.2288646] [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: 05/29/2023] [Accepted: 11/21/2023] [Indexed: 04/05/2024]
Abstract
Little is known about biopsychosocial factors relating to pre-exposure prophylaxis (PrEP) awareness among people with either heterosexual or injection drug use HIV risk behaviors. Participants engaged in vaginal/anal sex with a person of the opposite sex (N = 515) or were people who injected drugs (PWID; N = 451) in the past 12 months from 2018-2019 in Boston, MA. We examined associations between PrEP awareness and: homelessness; perceived HIV-related stigma; country of birth; bacterial STDs, chlamydia, and/or gonorrhea in the past 12 months, lifetime hepatitis C virus (HCV) infection, sexual orientation, and poverty. More PWID (36.8%) were aware of PrEP than people with heterosexual HIV risk (28%; p = .001). Among people with heterosexual risk, homelessness (aOR = 1.99, p = .003), and among PWID: homelessness (aOR = 2.11, p = .032); bacterial STD (aOR = 2.96, p = .012); chlamydia (aOR = 6.14, p = .008); and HCV (aOR = 2.40, p < .001) were associated with increased likelihood of PrEP awareness. In the combined sample: homelessness (aOR = 2.25, p < .001); HCV (aOR = 2.18, p < .001); identifying as homosexual (aOR = 3.71, p = .036); and bisexual (aOR = 1.55, p = .016) were each associated with PrEP awareness. Although having an STD, HCV, identifying as homosexual or bisexual, and experiencing homelessness were associated with increased PrEP awareness, most participants were unaware of PrEP. Efforts to increase PrEP awareness could engage PWID and heterosexual HIV risk behavior.
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Affiliation(s)
- J S Lee
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - A W Batchelder
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - A M Stanton
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - L Westphal
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - R M Klevens
- Massachusetts Department of Public Health, Bureau of Infectious Disease and Laboratory Sciences, Boston, MA, USA
| | - K H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - C O'Cleirigh
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Sutherland R, King C, Karlsson A, Treloar C, Broady T, Chandrasena U, Salom C, Dietze P, Peacock A. Stigma, and factors associated with experiencing stigma, while visiting health-care services among samples of people who use illegal drugs in Australia. Drug Alcohol Rev 2024. [PMID: 38644679 DOI: 10.1111/dar.13846] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 03/13/2024] [Accepted: 03/16/2024] [Indexed: 04/23/2024]
Abstract
INTRODUCTION People who inject drugs experience stigma across multiple settings, including when accessing health-care services, however, comparatively little is known about experiences of stigma towards other groups of people who use illegal drugs. This paper examines experience of, and factors associated with, stigma among two samples of people who use illegal drugs when visiting both specialist alcohol and other drug (AOD) and general health-care services. METHODS Australians who regularly (i.e., ≥monthly) inject drugs (n = 879; illicit drug reporting system [IDRS]) or use ecstasy and/or other illegal stimulants (n = 700; ecstasy and related drugs reporting system [EDRS]) were surveyed between April and July 2022 about past 6-month experience of stigma in the above services. Multi-variable regression analyses were performed to determine the socio-demographic, drug use and health factors associated with stigma. RESULTS Experiences of stigma in general health-care services were more common among IDRS (40%) than EDRS (24%; p < 0.001) participants, however, experiences were comparable in specialist AOD health-care settings (22% and 20%, respectively; p = 0.687). Gender identity and experiencing high psychological distress were associated with experiencing stigma across both samples. Past-year overdose was associated with experiencing stigma among the IDRS sample, while unstable housing and incomplete high school education were associated with experiencing stigma in the EDRS sample. DISCUSSION AND CONCLUSIONS Experiences of stigma when accessing health-care services are relatively common across different populations of people who use illegal drugs. Our findings highlight the multiple and intersecting dimensions of stigma and provide further support for recent calls for a universal precautions approach to stigma in health care.
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Affiliation(s)
- Rachel Sutherland
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Cate King
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Antonia Karlsson
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Timothy Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Udesha Chandrasena
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Caroline Salom
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- Institute for Social Science Research, The University of Queensland, Brisbane, Australia
| | - Paul Dietze
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Australia
- National Drug Research Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- School of Psychology, University of Tasmania, Hobart, Australia
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Spinelli MA, Christopoulos KA, Moreira CV, Jain JP, Lisha N, Glidden DV, Burkholder GA, Crane HM, Shapiro AE, Jacobson JM, Cachay ER, Mayer KH, Napravnik S, Moore RD, Gandhi M, Johnson MO. Viral Suppression Trajectories Destabilized After Coronavirus Disease 2019 Among US People With Human Immunodeficiency Virus: An Interrupted Time Series Analysis. Clin Infect Dis 2024; 78:991-994. [PMID: 37963086 PMCID: PMC11006098 DOI: 10.1093/cid/ciad657] [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: 07/26/2023] [Accepted: 10/24/2023] [Indexed: 11/16/2023] Open
Abstract
We examined changes in the proportion of people with human immunodeficiency virus (PWH) with virologic suppression (VS) in a multisite US cohort before and since the coronavirus disease 2019 (COVID-19) pandemic. Overall, prior gains in VS slowed during COVID-19, with disproportionate impacts on Black PWH and PWH who inject drugs.
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Affiliation(s)
- Matthew A Spinelli
- Division of HIV, ID, and Global Medicine, University of California, SanFrancisco, California, USA
| | - Katerina A Christopoulos
- Division of HIV, ID, and Global Medicine, University of California, SanFrancisco, California, USA
| | - Carlos V Moreira
- Division of HIV, ID, and Global Medicine, University of California, SanFrancisco, California, USA
| | - Jennifer P Jain
- Division of Prevention Science, University of California, SanFrancisco, California, USA
| | - Nadra Lisha
- Department of Epidemiology and Biostatistics, University of California, SanFrancisco, California, USA
| | - David V Glidden
- Department of Epidemiology and Biostatistics, University of California, SanFrancisco, California, USA
| | - Greer A Burkholder
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham,Alabama, USA
| | - Heidi M Crane
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Adrienne E Shapiro
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Jeffrey M Jacobson
- Divsion of Infectious Diseases, Case Western Reserve University, Cleveland, Ohio, USA
| | - Edward R Cachay
- Division of Infectious Diseases, University of California, San Diego, California, USA
| | - Kenneth H Mayer
- Department of Medicine, Harvard University and the Fenway Institute/Fenway Health, Boston, Massachusetts, USA
| | - Sonia Napravnik
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Richard D Moore
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
| | - Monica Gandhi
- Division of HIV, ID, and Global Medicine, University of California, SanFrancisco, California, USA
| | - Mallory O Johnson
- Division of Prevention Science, University of California, SanFrancisco, California, USA
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5
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Yang J, Lo NC, Dankwa EA, Donnelly CA, Gupta R, Montgomery MP, Weng MK, Martin NK. Determining Herd Immunity Thresholds for Hepatitis A Virus Transmission to Inform Vaccination Strategies Among People Who Inject Drugs in 16 US States. Clin Infect Dis 2024; 78:976-982. [PMID: 37738564 PMCID: PMC11006109 DOI: 10.1093/cid/ciad552] [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: 05/01/2023] [Revised: 08/31/2023] [Accepted: 09/13/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Widespread outbreaks of person-to-person transmitted hepatitis A virus (HAV), particularly among people who inject drugs (PWID), continue across the United States and globally. However, the herd immunity threshold and vaccination coverage required to prevent outbreaks are unknown. We used surveillance data and dynamic modeling to estimate herd immunity thresholds among PWID in 16 US states. METHODS We used a previously published dynamic model of HAV transmission calibrated to surveillance data from outbreaks involving PWID in 16 states. Using state-level calibrated models, we estimated the basic reproduction number (R0) and herd immunity threshold for PWID in each state. We performed a meta-analysis of herd immunity thresholds to determine the critical vaccination coverage required to prevent most HAV outbreaks among PWID. RESULTS Estimates of R0 for HAV infection ranged from 2.2 (95% confidence interval [CI], 1.9-2.5) for North Carolina to 5.0 (95% CI, 4.5-5.6) for West Virginia. Corresponding herd immunity thresholds ranged from 55% (95% CI, 47%-61%) for North Carolina to 80% (95% CI, 78%-82%) for West Virginia. Based on the meta-analysis, we estimated a pooled herd immunity threshold of 64% (95% CI, 61%-68%; 90% prediction interval, 52%-76%) among PWID. Using the prediction interval upper bound (76%) and assuming 95% vaccine efficacy, we estimated that vaccination coverage of 80% could prevent most HAV outbreaks. CONCLUSIONS Hepatitis A vaccination programs in the United States may need to achieve vaccination coverage of at least 80% among PWID in order to prevent most HAV outbreaks among this population.
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Affiliation(s)
- Judy Yang
- Division of Infectious Diseases and Global Public Health, University of California–San Diego, La Jolla, California, USA
| | - Nathan C Lo
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | - Emmanuelle A Dankwa
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Christl A Donnelly
- Department of Statistics, University of Oxford, Oxford, United Kingdom
- Medical Research Council Centre for Global Infectious Disease Analysis, Imperial College London, London, United Kingdom
| | - Ribhav Gupta
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California, USA
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Martha P Montgomery
- Division of Viral Hepatitis, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark K Weng
- Division of Viral Hepatitis, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California–San Diego, La Jolla, California, USA
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
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Malaguti A, Byrne CJ, Sani F, Power K, Eriksen A, Dillon JF. Drug network identification predicts injecting risk behavior among people who inject drugs on hepatitis C virus treatment in Tayside, Scotland. Behav Med 2024; 50:130-140. [PMID: 36411523 DOI: 10.1080/08964289.2022.2142501] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/10/2022] [Accepted: 10/28/2022] [Indexed: 11/23/2022]
Abstract
The risk of Hepatitis C Virus (HCV) acquisition among People Who Inject Drugs (PWID) remains high when injecting risk behavior within networks endures. Several psychosocial factors influence such behavior. Following a drive within Tayside, a geographic region in Scotland, to achieve World Health Organization HCV elimination targets, addressing HCV re-infection risk as a barrier to elimination is critically important. This cross-sectional study seeks to address this barrier to elimination by investigating associations between group identification (one's subjective sense of belonging and connectedness to a social group coupled with a sense of shared goals, beliefs and values with the other members of the group) and injecting risk behavior among PWID on HCV treatment at needle and syringe provision sites in Tayside. Participants completed psychosocial questionnaires between treatment weeks zero and three of treatment. Correlation analyses were undertaken, and significant factors included in multiple linear regression models for injecting risk behavior. Injecting frequency, drug network identification, and family identification, were correlated with injecting risk behavior, and drug network identification had a positive predictive on injecting risk behavior. Identification with a social group, conventionally associated with improved health, may pose health risks in specific contexts. Healthcare providers should consider stratifying individuals with higher group identification with PWID networks for enhanced harm reduction engagement to mitigate transmissible infection risk among PWID. Additionally, psychological interventions to strengthen group identification with networks which impact positively on health behavior should be explored.
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Affiliation(s)
- Amy Malaguti
- Tayside Drug and Alcohol Recovery Psychology Service, Constitution House, NHS Tayside, Dundee, UK
- Department of Psychology, Scrymgeour Building, School of Social Sciences, University of Dundee, Dundee, UK
| | - Christopher J Byrne
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
- Directorate of Public Health, Kings Cross Hospital, NHS Tayside, Dundee, UK
| | - Fabio Sani
- Department of Psychology, Scrymgeour Building, School of Social Sciences, University of Dundee, Dundee, UK
| | - Kevin Power
- Tayside Adult Psychological Therapy Services, Dudhope Terrace, NHS Tayside, Dundee, UK
- School of Natural Sciences, University of Stirling, Stirling, UK
| | - Ann Eriksen
- Directorate of Public Health, Kings Cross Hospital, NHS Tayside, Dundee, UK
| | - John F Dillon
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
- Department of Gastroenterology, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK
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Page KR, Weir BW, Zook K, Rosecrans A, Harris R, Grieb SM, Falade-Nwulia O, Landry M, Escobar W, Ramirez MP, Saxton RE, Clarke WA, Sherman SG, Lucas GM. Integrated care van delivery of evidence-based services for people who inject drugs: A cluster-randomized trial. Addiction 2024. [PMID: 38561602 DOI: 10.1111/add.16486] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 02/15/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND AND AIMS People who inject drugs (PWID) are at risk for adverse outcomes across multiple dimensions. While evidence-based interventions are available, services are often fragmented and difficult to access. We measured the effectiveness of an integrated care van (ICV) that offered services for PWID. DESIGN, SETTING AND PARTICIPANTS This was a cluster-randomized trial, which took place in Baltimore, MD, USA. Prior to randomization, we used a research van to recruit PWID cohorts from 12 Baltimore neighborhoods (sites), currently served by the city's mobile needle exchange program. INTERVENTION AND COMPARATOR We randomized sites to receive weekly visits from the ICV (n = 6) or to usual services (n = 6) for 14 months. The ICV offered case management; buprenorphine/naloxone; screening for HIV, hepatitis C virus and sexually transmitted infections; HIV pre-exposure prophylaxis; and wound care. MEASUREMENTS The primary outcome was a composite harm mitigation score that captured access to evidence-based services, risk behaviors and adverse health events (range = 0-15, with higher numbers indicating worse status). We evaluated effectiveness by comparing changes in the composite score at 7 months versus baseline in the two study arms. FINDINGS We enrolled 720 cohort participants across the study sites (60 per site) between June 2018 and August 2019: 38.3% women, 72.6% black and 85.1% urine drug test positive for fentanyl. Over a median of 10.4 months, the ICV provided services to 734 unique clients (who may or may not have been cohort participants) across the six intervention sites, including HIV/hepatitis C virus testing in 577 (78.6%) and buprenorphine/naloxone initiation in 540 (74%). However, only 52 (7.2%) of cohort participants received services on the ICV. The average composite score decreased at 7 months relative to baseline, with no significant difference in the change between ICV and usual services (difference in differences: -0.31; 95% confidence interval: -0.70, 0.08; P = 0.13). CONCLUSIONS This cluster-randomized trial in Baltimore, MD, USA, found no evidence that weekly neighborhood visits from a mobile health van providing injection-drug-focused services improved access to services and outcomes among people who injected drugs in the neighborhood, relative to usual services. The van successfully served large numbers of clients but unexpectedly low use of the van by cohort participants limited the ability to detect meaningful differences.
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Affiliation(s)
- Kathleen R Page
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brian W Weir
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Katie Zook
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amanda Rosecrans
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Baltimore City Health Department, Baltimore, MD, USA
| | - Robert Harris
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Baltimore City Health Department, Baltimore, MD, USA
| | - Suzanne M Grieb
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Miles Landry
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wendy Escobar
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Ronald E Saxton
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Susan G Sherman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gregory M Lucas
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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8
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Eschliman EL, Patel EU, Murray SM, German D, Kirk GD, Mehta SH, Kaufman MR, Genberg BL. Drug Use-Related Discrimination in Healthcare Settings and Subsequent Emergency Department Utilization in a Prospective Cohort Study of People With a History of Injection Drug Use. Subst Use Misuse 2024; 59:1210-1220. [PMID: 38519443 DOI: 10.1080/10826084.2024.2330906] [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] [Indexed: 03/25/2024]
Abstract
BACKGROUND People with a history of injection drug use face discrimination in healthcare settings that may impede their use of routine care, leading to greater reliance on the emergency department (ED) for addressing health concerns. The relationship between discrimination in healthcare settings and subsequent ED utilization has not been established in this population. METHODS This analysis used longitudinal data collected between January 2014 and March 2020 from participants of the ALIVE (AIDS Linked to the IntraVenous Experience) study, a community-based observational cohort study of people with a history of injection drug use in Baltimore, Maryland. Logistic regressions with generalized estimating equations were used to estimate associations between drug use-related discrimination in healthcare settings and subsequent ED utilization for the sample overall and six subgroups based on race, sex, and HIV status. RESULTS 1,342 participants contributed data from 7,289 semiannual study visits. Participants were predominately Black (82%), mostly male (66%), and 33% were living with HIV. Drug use-related discrimination in healthcare settings (reported at 6% of study visits) was positively associated with any subsequent ED use (OR = 1.40, 95% CI: 1.15-1.72). Positive associations persisted after adjusting for covariates, including past sixth-month ED use and drug use, among the overall sample (aOR = 1.28, 95% CI: 1.04-1.59) and among some subgroups. CONCLUSIONS Drug use-related discrimination in healthcare settings was associated with greater subsequent ED utilization in this sample. Further exploration of mechanisms driving this relationship may help improve care and optimize healthcare engagement for people with a history of injection drug use.
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Affiliation(s)
- Evan L Eschliman
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Eshan U Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sarah M Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Danielle German
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Gregory D Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michelle R Kaufman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Becky L Genberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Midgard H, Malme KB, Pihl CM, Berg-Pedersen RM, Tanum L, Klundby I, Haug A, Tveter I, Bjørnestad R, Olsen IC, Finbråten AK, Dalgard O. Opportunistic Treatment of Hepatitis C Infection Among Hospitalized People Who Inject Drugs (OPPORTUNI-C): A Stepped Wedge Cluster Randomized Trial. Clin Infect Dis 2024; 78:582-590. [PMID: 37992203 PMCID: PMC10954343 DOI: 10.1093/cid/ciad711] [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: 07/24/2023] [Revised: 09/28/2023] [Accepted: 11/17/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND We aimed to evaluate the efficacy of opportunistic treatment of hepatitis C virus (HCV) infection among hospitalized people who inject drugs (PWID). METHODS We performed a pragmatic, stepped wedge cluster randomized trial recruiting HCV RNA positive individuals admitted for inpatient care in departments of internal medicine, addiction medicine, and psychiatry at three hospitals in Oslo, Norway. Seven departments were sequentially randomized to change from control conditions (standard of care referral to outpatient care) to intervention conditions (immediate treatment initiation). The primary outcome was treatment completion, defined as dispensing the final package of the prescribed treatment within six months after enrolment. RESULTS A total of 200 HCV RNA positive individuals were enrolled between 1 October 2019 and 31 December 2021 (mean age 47.4 years, 72.5% male, 60.5% injected past 3 months, 20.4% cirrhosis). Treatment completion was accomplished by 67 of 98 (68.4% [95% confidence interval {CI}: 58.2-77.4]) during intervention conditions and by 36 of 102 (35.3% [95% CI: 26.1-45.4]) during control conditions (risk difference 33.1% [95% CI: 20.0-46.2]; risk ratio 1.9 [95% CI: 1.4-2.6]). The intervention was superior in terms of treatment completion (adjusted odds ratio [aOR] 4.8 [95% CI: 1.8-12.8]; P = .002) and time to treatment initiation (adjusted hazard ratio [aHR] 4.0 [95% CI: 2.5-6.3]; P < .001). Sustained virologic response was documented in 60 of 98 (61.2% [95% CI: 50.8-70.9]) during intervention and in 66 of 102 (64.7% [95% CI: 54.6-73.9]) during control conditions. CONCLUSIONS An opportunistic test-and-treat approach to HCV infection was superior to standard of care among hospitalized PWID. The model of care should be considered for broader implementation. Clinical Trials Registration. NCT04220645.
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Affiliation(s)
- Håvard Midgard
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway
| | - Kristian Braathen Malme
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Charlotte Meinich Pihl
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway
- Unger-Vetlesen Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
| | | | - Lars Tanum
- Department for Research and Development in Mental Health, Akershus University Hospital, Lørenskog, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Ingvild Klundby
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
| | - Anne Haug
- Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
| | - Ida Tveter
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | | | - Inge Christoffer Olsen
- Department of Research Support for Clinical Trials, Oslo University Hospital, Oslo, Norway
| | - Ane-Kristine Finbråten
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway
- Unger-Vetlesen Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Olav Dalgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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10
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Sheehan Y, Grebely J, Lloyd AR. Reply to: " 'One-stop-shop' point-of-care hepatitis C RNA testing intervention in the prison - some issues". J Hepatol 2024; 80:e107-e108. [PMID: 37890725 DOI: 10.1016/j.jhep.2023.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023]
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11
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O'Keefe D, Jacka D, Douglass C, Gunn J, Stoove M, Crawford S, Bryant M, Higgs P, Dietze P, Hellard M. Distribution of rapid HCV antibody self-test kits via needle/syringe dispensing machines: Implementation and evaluation of the Vend-C pilot study in Melbourne, Australia. J Viral Hepat 2024; 31:151-155. [PMID: 38158743 DOI: 10.1111/jvh.13909] [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: 08/11/2023] [Revised: 10/14/2023] [Accepted: 12/13/2023] [Indexed: 01/03/2024]
Abstract
Recent guidance from the World Health Organization strongly recommended hepatitis C virus (HCV) self-testing. We implemented the Vend-C pilot study to explore the effectiveness and feasibility of distributing rapid HCV antibody self-test kits to people who inject drugs via needle/syringe dispensing machines (SDMs). Over a 51-day study period between August and September 2022, we distributed HCV antibody self-test kits via two SDMs. During the study period, 63 self-test kits were dispensed, averaging 1.2 self-test kits per day. Our access methods for evaluation questionnaires failed to attract participants (n = 4). We implemented the Vend-C pilot study in direct response to recent WHO recommendations. While self-test kits were effectively distributed from the two SDMs, our evaluation methodology failed. Consequently, we cannot determine the success of linkage to care. Even so, with HCV treatment numbers dropping in Australia, innovative engagement solutions are needed, and considering the number of self-test kits provided in our pilot, the model could have an important future place in HCV elimination efforts.
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Affiliation(s)
| | - David Jacka
- Monash Health, Dandenong, Victoria, Australia
| | | | - Jack Gunn
- Burnet Institute, Melbourne, Victoria, Australia
| | - Mark Stoove
- Burnet Institute, Melbourne, Victoria, Australia
| | | | | | - Peter Higgs
- Burnet Institute, Melbourne, Victoria, Australia
| | - Paul Dietze
- Burnet Institute, Melbourne, Victoria, Australia
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Fursman H, Finch E, Xiao L, Lefrançois E, Gupta A, Bartlett M, Latimer J, Chadwick S, Roux C, Morelato M. A snapshot of injecting drug consumption from the analysis of used syringes within the Medically Supervised Injecting Centre in Sydney, Australia. Drug Alcohol Rev 2024; 43:787-798. [PMID: 38145366 DOI: 10.1111/dar.13803] [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: 09/03/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION The administration of illicit drugs by injection is associated with considerable harm, including an increased risk of overdose. The chemical analysis of used syringes can enhance knowledge on injecting drug consumption beyond traditional data sources (self-report surveys). This additional information may be useful during significant global events like the COVID-19 pandemic. This study aimed to examine a snapshot of the drugs injected at the Medically Supervised Injecting Centre (MSIC) in Sydney, Australia, in 2019-2020. METHODS Used syringes were collected from MSIC across three periods throughout 2019 and 2020 (February 2019, March-April 2020 and June-September 2020). Drug residues were extracted from used syringes using methanol before detection by gas chromatography-mass spectrometry and ultra-performance liquid chromatography-tandem mass spectrometry. The chemical analysis results were compared to self-report data obtained from MSIC clients. RESULTS Heroin (46-53%), methamphetamine (24-34%) and pharmaceutical opioids (15-27%) were the most common drug residues detected. The chemically detected drugs had declining coherence with the drugs self-reported by MSIC clients across the time periods examined. DISCUSSION AND CONCLUSIONS There was no significant change in the drugs injected (heroin, methamphetamine and pharmaceutical opioids) across the three periods collected throughout varying COVID-19 lockdown restrictions. Changes in the frequency of other drugs injected and discrepancies between chemical analysis and self-report were potentially related to regulatory changes, degradation or misinformed sales. Routine chemical analysis of used syringes has provided an alternative information source to promote awareness of current drug trends and aid harm reduction.
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Affiliation(s)
- Harrison Fursman
- Centre for Forensic Science, University of Technology Sydney, Sydney, Australia
| | - Eleanor Finch
- Centre for Forensic Science, University of Technology Sydney, Sydney, Australia
| | - Linda Xiao
- Centre for Forensic Science, University of Technology Sydney, Sydney, Australia
| | - Elodie Lefrançois
- School of Criminal Justice, Faculty of Law, Criminal Justice and Public Administration, University of Lausanne, Lausanne, Switzerland
| | - Anjali Gupta
- Centre for Forensic Science, University of Technology Sydney, Sydney, Australia
| | - Mark Bartlett
- Uniting Medically Supervised Injecting Centre, Sydney, Australia
| | - Julie Latimer
- Uniting Medically Supervised Injecting Centre, Sydney, Australia
| | - Scott Chadwick
- Centre for Forensic Science, University of Technology Sydney, Sydney, Australia
| | - Claude Roux
- Centre for Forensic Science, University of Technology Sydney, Sydney, Australia
| | - Marie Morelato
- Centre for Forensic Science, University of Technology Sydney, Sydney, Australia
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Cooper H, Beane S, Yarbrough C, Haardörfer R, Ibragimov U, Haley D, Linton S, Beletsky L, Landes S, Lewis R, Peddireddy S, Sionean C, Cummings J. Association of Medicaid expansion with health insurance, unmet need for medical care and substance use disorder treatment among people who inject drugs in 13 US states. Addiction 2024; 119:582-592. [PMID: 38053235 PMCID: PMC11025622 DOI: 10.1111/add.16383] [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: 01/30/2023] [Accepted: 10/09/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND AND AIMS Impoverished people who inject drugs (PWID) are at the epicenter of US drug-related epidemics. Medicaid expansion is designed to reduce cost-related barriers to care by expanding Medicaid coverage to all US adults living at or below 138% of the federal poverty line. This study aimed to measure whether Medicaid expansion is (1) positively associated with the probability that participants are currently insured; (2) inversely related to the probability of reporting unmet need for medical care due to cost in the past year; and (3) positively associated with the probability that they report receiving substance use disorder (SUD) treatment in the past year, among PWID subsisting at ≤ 138% of the federal poverty line. DESIGN A two-way fixed-effects model was used to analyze serial cross-sectional observational data. SETTING Seventeen metro areas in 13 US states took part in the study. PARTICIPANTS Participants were PWID who took part in any of the three waves (2012, 2015, 2018) of data gathered in the Center for Disease Control and Prevention's National HIV Behavioral Surveillance (NHBS), were aged ≤ 64 years and had incomes ≤ 138% of the federal poverty line. For SUD treatment analyses, the sample was further limited to PWID who used drugs daily, a proxy for SUD. MEASUREMENTS State-level Medicaid expansion was measured using Kaiser Family Foundation data. Individual-level self-report measures were drawn from the NHBS surveys (e.g. health insurance coverage, unmet need for medical care because of its cost, SUD treatment program participation). FINDINGS The sample for the insurance and unmet need analyses consisted of 19 946 impoverished PWID across 13 US states and 3 years. Approximately two-thirds were unhoused in the past year; 41.6% reported annual household incomes < $5000. In multivariable models, expansion was associated with a 19.0 [95% confidence interval (CI) = 9.0, 30.0] percentage-point increase in the probability of insurance coverage, and a 9.0 (95% CI = -15.0, -0.2) percentage-point reduction in the probability of unmet need. Expansion was unrelated to SUD treatment among PWID who used daily (n = 17 584). CONCLUSIONS US Medicaid expansion may curb drug-related epidemics among impoverished people who inject drugs by increasing health insurance coverage and reducing unmet need for care. Persisting non-financial barriers may undermine expansion's impact upon substance use disorder treatment in this sample.
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Affiliation(s)
- Hannah Cooper
- Department of Behavioral, Social, and Health Education Sciences, Rollins Chair of Substance Use Disorder Research, Rollins School of Public Health at Emory University, Atlanta, GA, USA
| | - Stephanie Beane
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health at Emory University, Atlanta, GA, USA
| | - Courtney Yarbrough
- Department of Health Policy and Management, Rollins School of Public Health at Emory University, Atlanta, GA, USA
| | - Regine Haardörfer
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health at Emory University, Atlanta, GA, USA
| | - Umed Ibragimov
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health at Emory University, Atlanta, GA, USA
| | - Danielle Haley
- Department of Community Health Sciences, Boston University School of Public Helth, Boston, MA, USA
| | - Sabriya Linton
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA
| | | | - Sarah Landes
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health at Emory University, Atlanta, GA, USA
| | - Rashunda Lewis
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention at the Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Snigdha Peddireddy
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health at Emory University, Atlanta, GA, USA
| | - Catlainn Sionean
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention at the Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Janet Cummings
- Department of Health Policy and Management, Rollins School of Public Health at Emory University, Atlanta, GA, USA
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14
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Hearps AC, Vootukuru N, Ebrahimnezhaddarzi S, Harney BL, Boo I, Nguyen L, Pavlyshyn D, Dietze PM, Drummer HE, Thompson AJ, Jaworowski A, Hellard ME, Sacks-Davis R, Doyle JS. Injecting drug use and hepatitis C virus infection independently increase biomarkers of inflammatory disease risk which are incompletely restored by curative direct-acting antiviral therapy. Front Immunol 2024; 15:1352440. [PMID: 38420130 PMCID: PMC10899672 DOI: 10.3389/fimmu.2024.1352440] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024] Open
Abstract
Background Hepatitis C virus (HCV) infections are more prevalent in people who inject drugs (PWID) who often experience additional health risks. HCV induces inflammation and immune alterations that contribute to hepatic and non-hepatic morbidities. It remains unclear whether curative direct acting antiviral (DAA) therapy completely reverses immune alterations in PWID. Methods Plasma biomarkers of immune activation associated with chronic disease risk were measured in HCV-seronegative (n=24) and HCV RNA+ (n=32) PWID at baseline and longitudinally after DAA therapy. Adjusted generalised estimating equations were used to assess longitudinal changes in biomarker levels. Comparisons between community controls (n=29) and HCV-seronegative PWID were made using adjusted multiple regression modelling. Results HCV-seronegative PWID exhibited significantly increased levels of inflammatory biomarkers including soluble (s) TNF-RII, IL-6, sCD14 and sCD163 and the diabetes index HbA1c as compared to community controls. CXCL10, sTNF-RII, vascular cell adhesion molecule-1 and lipopolysaccharide binding protein (LBP) were additionally elevated in PWID with viremic HCV infection as compared to HCV- PWID. Whilst curative DAA therapy reversed some biomarkers, others including LBP and sTNF-RII remained elevated 48 weeks after HCV cure. Conclusion Elevated levels of inflammatory and chronic disease biomarkers in PWID suggest an increased risk of chronic morbidities such as diabetes and cardiovascular disease. HCV infection in PWID poses an additional disease burden, amplified by the incomplete reversal of immune dysfunction following DAA therapy. These findings highlight the need for heightened clinical surveillance of PWID for chronic inflammatory diseases, particularly those with a history of HCV infection.
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Affiliation(s)
- Anna C. Hearps
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia
| | - Nikil Vootukuru
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Gastroenterology, Eastern Health and Monash University, Melbourne, VIC, Australia
| | | | - Brendan L. Harney
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Irene Boo
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
| | - Long Nguyen
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
| | - Damian Pavlyshyn
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
| | - Paul M. Dietze
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- National Drug Research Institute, Curtin University, Melbourne, VIC, Australia
| | - Heidi E. Drummer
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
- Department of Microbiology, Monash University, Melbourne, VIC, Australia
| | - Alexander J. Thompson
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne, Melbourne, VIC, Australia
| | - Anthony Jaworowski
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia
| | - Margaret E. Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Joseph S. Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia
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15
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McDonald SA, Hickman M, Dillon JF, Yeung A, McAuley A, Fraser A, Hayes PC, Hutchinson SJ. A transient positive association between direct-acting antiviral therapy for hepatitis C infection and drug-related hospitalization among people who inject drugs: Self-controlled case-series analysis of national data. Addiction 2024; 119:369-378. [PMID: 37726951 DOI: 10.1111/add.16344] [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: 01/30/2023] [Accepted: 08/03/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND AND AIMS Direct-acting antiviral (DAA) treatment has an established positive effect on liver outcomes in people with hepatitis C infection; however, there is insufficient evidence regarding its effects on the 'extra-hepatic' outcomes of drug-related hospitalization and mortality (DRM) among people who inject drugs (PWID). We investigated associations between these outcomes and DAA treatment by comparing post-treatment to baseline periods using a within-subjects design to minimize selection bias concerns with cohort or case-control designs. DESIGN This was a self-controlled case-series study. SETTING Scotland, 1 January 2015-30 November 2020. PARTICIPANTS The study population of non-cirrhotic, DAA-treated PWID was identified using a data set linking Scotland's hepatitis C diagnosis, HCV clinical databases, national inpatient/day-case hospital records and the national deaths register. Three principal outcomes (drug overdose admission, non-viral injecting related admission and drug-related mortality) were defined using ICD codes. MEASUREMENTS Self-controlled case-series methodology was used to estimate the relative incidence (RI) of each outcome associated with time on treatment and up to six 90-day exposure risk periods thereafter. FINDINGS A total of 6050 PWID were treated with DAAs in the sampling time-frame. Compared with the baseline period, there was a significantly lowered risk of a drug overdose hospital admission in the second to fifth exposure risk periods only [relative incidence (RI) = 0.86, 95% confidence interval (CI) = 0.80-0.99; 0.89, 95% CI = 0.80-0.99; 0.86, 95% CI = 0.77-0.96; 0.88, 95% CI = 0.78-0.99, respectively]. For non-viral injecting-related admission, there was a reduced risk in the first, third and fourth exposure risk periods (RI = 0.76, 95% CI = 0.64-0.90; 0.75, 95% CI = 0.62-0.90; 0.79, 95% CI = 0.66-0.96, respectively). There was no evidence for reduced DRM risk in any period following treatment end. CONCLUSIONS Among people who inject drugs in Scotland, direct-acting antiviral treatment appears to be associated with a small, non-durable reduction in the risk of drug-related hospital admission, but not drug-related mortality. Direct-acting antiviral therapy, despite high effectiveness against liver disease, does not appear to offer a panacea for reducing other drug-related health harms.
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Affiliation(s)
- Scott A McDonald
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Public Health Scotland, Glasgow, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - John F Dillon
- School of Medicine, University of Dundee, Dundee, UK
| | - Alan Yeung
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Public Health Scotland, Glasgow, UK
| | - Andrew McAuley
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Public Health Scotland, Glasgow, UK
| | | | | | - Sharon J Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Public Health Scotland, Glasgow, UK
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Bromberg DJ, Machavariani E, Madden LM, Dumchev K, LaMonaca K, Earnshaw VA, Pykalo I, Filippovych M, Haddad MS, Dvoriak S, Altice FL. Integrating methadone into primary care settings in Ukraine: effects on provider stigma and knowledge. J Int AIDS Soc 2024; 27:e26202. [PMID: 38379179 PMCID: PMC10879646 DOI: 10.1002/jia2.26202] [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: 03/20/2023] [Accepted: 12/08/2023] [Indexed: 02/22/2024] Open
Abstract
INTRODUCTION Stigma has undermined the scale-up of evidence-based HIV prevention and treatment. Negative beliefs influence clinicians' discriminatory behaviour and ultimately have wide-ranging effects across the HIV prevention and treatment continuum. Stigma among clinicians can be mitigated in several ways, including through interpersonal contact. In this study, we test whether interactions with people who inject drugs (PWID) influence attitudes of both direct and indirect providers of opioid agonist therapies (OATs) within the same primary care clinics (PCCs) where OAT is newly introduced. METHODS In a cluster randomized controlled trial integrating OAT and HIV care into PCCs in Ukraine, clinicians at 24 integrated care sites (two sites in 12 regions) from January 2018 to August 2022 completed a structured survey at baseline, 12 and 24 months. The survey included feeling thermometers and standardized scales related to clinician attitudes towards patients and evidence-based care. Nested linear mixed-effects models were used to examine changes in mean scores over three timepoints for both direct and indirect clinicians. RESULTS There were fewer significant changes in any of the scales for direct providers (n = 87) than for indirect providers (n = 155). Direct providers became less tough-minded about substance use disorders (p = 0.002), had less negative opinions about PWID (p = 0.006) and improved their beliefs regarding OAT maintenance (p<0.001) and medical information (p = 0.004). Indirect providers reported improvements in most stigma constructs, including a significant decrease in prejudice (p<0.001), discrimination (p = 0.001), shame (p = 0.007) and fear (p = 0.001) towards PWID. CONCLUSIONS Integrating OAT services within primary settings was associated with significantly reduced stigma constructs and improved attitudes towards PWID, possibly through increased intergroup contact between PWID and general clinical staff. Unlike most stigma reduction interventions, re-engineering clinical processes so that PWID receive their care in PCCs emerges as a multilevel stigma reduction intervention through the integration of specialized services in PCCs. Integration influences different types of stigma, and has positive effects not only on health outcomes, but also improves clinician attitudes and efficiently reduces clinician stigma.
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Affiliation(s)
- Daniel J. Bromberg
- Yale School of Public Health, Yale UniversityNew HavenConnecticutUSA
- Center for Interdisciplinary Research on AIDS, Yale UniversityNew HavenConnecticutUSA
- Yale School of Medicine, Yale UniversityNew HavenConnecticutUSA
| | | | - Lynn M. Madden
- Yale School of Medicine, Yale UniversityNew HavenConnecticutUSA
- APT FoundationNew HavenConnecticutUSA
| | | | | | | | - Iryna Pykalo
- Ukrainian Institute on Public Health PolicyKyivUkraine
| | | | - Marwan S. Haddad
- Center for Key Populations, Community Health Center, Inc.MiddletownConnecticutUSA
| | | | - Frederick L. Altice
- Yale School of Public Health, Yale UniversityNew HavenConnecticutUSA
- Center for Interdisciplinary Research on AIDS, Yale UniversityNew HavenConnecticutUSA
- Yale School of Medicine, Yale UniversityNew HavenConnecticutUSA
- University of DelawareNewarkDelawareUSA
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17
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O'Sullivan M, Jones AM, Mourad A, Haddadin Y, Verma S. Excellent hepatitis C virus cure rates despite increasing complexity of people who use drugs: Integrated-Test-stage Treat study final outcomes. J Viral Hepat 2024; 31:66-77. [PMID: 38018328 DOI: 10.1111/jvh.13897] [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: 06/15/2023] [Revised: 08/27/2023] [Accepted: 10/31/2023] [Indexed: 11/30/2023]
Abstract
Achieving hepatitic C virus (HCV) elimination requires linking people who use drugs (PWUD) into care. We report final direct-acting antivirals (DAAs)-based outcomes from the Integrated-Test-stage -Treat (ITTREAT) study. Project ITTREAT (2013-2021), based at an addiction centre, was a 'one-stop' service with innovative linkage to care strategies. Primary outcome was sustained virological response (SVR12) (intention to treat ITT) including whether individuals were recruited in first (period 1) versus last four (period 2 included the COVID-19 pandemic) years of the study. Number recruited were n = 765, mean age 40.9 ± 10.1 years, 78% males, history of current/past injecting drug use (IDU) and alcohol use being 77% and 90%, respectively. Prevalence of a positive HCV PCR was 84% with 19% having cirrhosis. Comparing those recruited in period 2 versus period 1, there was increasing prevalence of IDU, 90% versus 72% (p < .001); homelessness, 67% versus 50% (p < .001); psychiatric diagnosis, 84% versus 50% (p < .001); overdose history 71% versus 31% (p < .001), receiving opioid agonist treatment (OAT) 75% versus 52% (p < .001) and comorbidity 44% versus 25% (p < .001). Of those treated with DAAs (n = 272), ITT SVR rates were 86% (95% CI: 81%-90%), being similar in period 2 versus period 1. Predictors of non-SVR were receiving OAT (OR 0.33, 95% CI: 0.12-0.87, p = .025) and ≥80% adherence (OR 0.01, 95% CI: 0.003-0.041, p < .001). Reinfection rates period 2 versus period 1 (per 100 person-years) were 1.84 versus 1.70, respectively. In the treated cohort, mortality was 15%, being mostly drug-related. Despite increasing complexity of PWUD, high SVR12 rates are achievable with use of OAT and good adherence.
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Affiliation(s)
- Margaret O'Sullivan
- University Hospitals Sussex NHS Foundation Trust Brighton and Sussex University, Brighton, UK
| | | | - Adele Mourad
- University Hospitals Sussex NHS Foundation Trust Brighton and Sussex University, Brighton, UK
- Brighton & Sussex Medical School, Brighton, UK
| | - Yazan Haddadin
- University Hospitals Sussex NHS Foundation Trust Brighton and Sussex University, Brighton, UK
- Brighton & Sussex Medical School, Brighton, UK
| | - Sumita Verma
- University Hospitals Sussex NHS Foundation Trust Brighton and Sussex University, Brighton, UK
- Brighton & Sussex Medical School, Brighton, UK
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18
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Haddad SF, Lahr BD, El Sabbagh A, Wilson WR, Chesdachai S, DeSimone DC, Baddour LM. Percutaneous mechanical aspiration in patients with right-sided infective endocarditis: An analysis of the national inpatient sample database-2016-2020. Catheter Cardiovasc Interv 2024; 103:464-471. [PMID: 38287781 DOI: 10.1002/ccd.30958] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/10/2024] [Accepted: 01/16/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND Given the challenges of conventional therapies in managing right-sided infective endocarditis (RSIE), percutaneous mechanical aspiration (PMA) of vegetations has emerged as a novel treatment option. Data on trends, characteristics, and outcomes of PMA, however, have largely been limited to case reports and case series. AIMS The aim of the current investigation was to provide a descriptive analysis of PMA in the United States and to profile the frequency of PMA with a temporal analysis and the patient cohort. METHODS The International Classification of Diseases, 10th Revision codes were used to identify patients with RSIE in the national (nationwide) inpatient sample (NIS) database between 2016 and 2020. The clinical characteristics and temporal trends of RSIE hospitalizations in patients who underwent PMA was profiled. RESULTS An estimated 117,955 RSIE-related hospital admissions in the United States over the 5-year study period were estimated and 1675 of them included PMA. Remarkably, the rate of PMA for RSIE increased 4.7-fold from 2016 (0.56%) to 2020 (2.62%). Patients identified with RSIE who had undergone PMA were young (medial age 36.5 years) and had few comorbid conditions (median Charlson Comorbidity Index, 0.6). Of note, 36.1% of patients had a history of hepatitis C infection, while only 9.9% of patients had a cardiovascular implantable electronic device. Staphylococcus aureus was the predominant (61.8%) pathogen. Concomitant transvenous lead extraction and cardiac valve surgery during the PMA hospitalization were performed in 18.2% and 8.4% of admissions, respectively. The median hospital stay was 19.0 days, with 6.0% in-hospital mortality. CONCLUSIONS The marked increase in the number of PMA procedures in the United States suggests that this novel treatment option has been embraced as a useful tool in select cases of RSIE. More work is needed to better define indications for the procedure and its efficacy and safety.
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Affiliation(s)
- Sara F Haddad
- Department of Medicine, Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian D Lahr
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Abdallah El Sabbagh
- Department of Cardiovascular Disease, Mayo Clinic College of Medicine and Science, Mayo Clinic, Jacksonville, Florida, USA
| | - Walter R Wilson
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, USA
| | - Supavit Chesdachai
- Department of Medicine, Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel C DeSimone
- Department of Medicine, Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, USA
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, USA
| | - Larry M Baddour
- Department of Medicine, Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, USA
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, USA
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19
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Amundsen EJ, Melsom AKM, Eriksen BO, Løchen ML. No decline in drug overdose deaths in Norway: An ecological approach to understanding at-risk groups and the impact of interventions. Nordisk Alkohol Nark 2024; 41:111-130. [PMID: 38356787 PMCID: PMC10863554 DOI: 10.1177/14550725231195413] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Aim: This Norwegian case study examines groups at risk of drug overdose deaths, evidence-based harm reduction interventions, low-threshold services and treatment implemented, as well as trends in drug overdose deaths between 2010 and 2021. We aimed to explore the relevance of interventions for at-risk groups and discuss their potential impact on drug overdose trends. Method/data: Using an ecological approach, we analysed the following: (1) groups identified through latent profile analysis (LPA) among a sample of 413 high-risk drug users collected in 2010-2012, supplemented with other relevant studies up to 2021; (2) published information on harm-reduction interventions, low-threshold services and treatment in Norway; and (3) nationwide drug overdose mortality figures supplemented with published articles on the topic. Results: High-risk drug users in 2010-2012 commonly engaged in frequent illegal drug use, injecting and poly-drug use (including pharmaceutical opioids), which continued into following decade. The interventions implemented between 2010 and 2021 were relevant for at-risk groups identified in the surveys. However, there was no decrease in the trend of drug overdose deaths up to 2021. While relevant interventions may have mitigated a theoretical increase in mortality, new at-risk groups may have contributed to fatal outcomes associated with pharmaceutical opioids. Conclusion: The interventions were relevant to the risk groups identified among high-risk drug users and potentially effective in preventing an increase in drug overdose trends. However, tailored interventions are needed for individuals at risk of death from prescribed opioids. Comprehensive studies encompassing all at-risk populations, including both legal and non-medical users of prescription opioids, are needed.
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Affiliation(s)
- Ellen J Amundsen
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
| | - Anne-Karine M Melsom
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Centre for Clinical Research and Education, University Hospital of North Norway, Tromsø, Norway
| | - Bjørn O Eriksen
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway; Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Maja-Lisa Løchen
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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20
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Tai CM, Yu ML. Hepatitis C virus micro-elimination in people who inject drugs: Challenges and chance in Taiwan and worldwide. Kaohsiung J Med Sci 2024; 40:112-118. [PMID: 38010851 DOI: 10.1002/kjm2.12788] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023] Open
Abstract
With the introduction of direct-acting antivirals, elimination of hepatitis C virus (HCV) infection is becoming possible. People who inject drugs (PWID) represent a population with a high risk for HCV infection, which has been reported as high as 90% in Taiwanese PWID. To reach the goal of HCV elimination, PWID is a key population deserving special attention. Barriers in HCV care cascade still exist in PWID, and interventions to promote access to HCV diagnosis, link-to-care, treatment, and prevention for PWID are warranted. Although HCV micro-elimination can be achieved in some prisons and opioid substitution therapy (OST) centers by a multidisciplinary team and integrated care in Taiwan, there are still several unmet needs for HCV elimination in PWID. Continuous efforts, such as the participation of OST specialists and the continuum of care for HCV among PWID, are needed to achieve HCV elimination in Taiwan. In addition, the combination of harm reduction services, treatment as prevention and regular posttreatment HCV surveillance is critical to substantially reduce HCV transmission and prevalence in PWID.
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Affiliation(s)
- Chi-Ming Tai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Ming-Lung Yu
- School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-Sen University, Kaohsiung, Taiwan
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Medicine and Hepatitis Research Center, College of Medicine, and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
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21
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Cheng Q, Valerio H, Cunningham EB, Shih STF, Silk D, Conway A, Treloar C, Murray C, Henderson C, Amin J, Read P, Dore GJ, Grebely J. Health-Related Quality of Life of People Who Inject Drugs: The Enhancing Treatment of Hepatitis C in Opioid Substitution Settings Engage Study. Value Health 2024; 27:216-225. [PMID: 37951538 DOI: 10.1016/j.jval.2023.10.013] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/11/2023] [Accepted: 10/29/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES There is limited research on health-related quality of life (HRQoL) among people who inject drugs (PWID). We evaluated the HRQoL and associated factors among a cohort of PWID in Australia. METHODS Participants were enrolled in an observational cohort study (the Enhancing Treatment of Hepatitis C in Opioid Substitution Settings Engage Study) from May 2018 to September 2019 (wave 1) and November 2019 to June 2021 (wave 2). Participants completed the EQ-5D-5L survey at enrolment. Two-part models were used to assess the association of clinical and socioeconomic characteristics with EQ-5D-5L scores. RESULTS Among 2395 participants (median age, 43 years; 66% male), 65% reported injecting drug use in the past month, 20% had current hepatitis C virus (HCV) infection, and 68% had no/mild liver fibrosis (F0/F1). Overall, the mean EQ-5D-5L and EQ-visual analog scale scores were 0.78 and 57, respectively. In adjusted analysis, factors associated with significantly lower EQ-5D-5L scores include older ages, female (marginal effect = -0.03, P = .014), being homeless (marginal effect = -0.04, P = .040), and polysubstance use (marginal effect = -0.05, P < .001). Factors associated with significantly higher EQ-5D-5L scores were being Aboriginal/Torres Strait Islander (marginal effect = 0.03, P = .021) and recent injecting drug use in the past 12 months. Current HCV infection and liver fibrosis stage were not associated with reduced HRQoL among the study participants. CONCLUSIONS PWID experienced a lower HRQoL compared with the general population. Further research is needed to understand HRQoL in this population to facilitate the development of multifaceted care models for PWID beyond HCV cure and inform health economic analyses for identifying optimal health strategies for PWID.
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Affiliation(s)
- Qinglu Cheng
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
| | - Heather Valerio
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Evan B Cunningham
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Sophy T F Shih
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - David Silk
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Anna Conway
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Carla Treloar
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Carolyn Murray
- Population Health Strategy and Performance, NSW Health, St Leonards, NSW, Australia
| | | | - Janaki Amin
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Department of Health Sciences, Macquarie University, Sydney, NSW, Australia
| | | | - Gregory J Dore
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Jason Grebely
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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Silhol R, Anderson RL, Stevens O, Stannah J, Booton RD, Baral S, Dimitrov D, Mitchell KM, Donnell D, Bershteyn A, Brown T, Kelly SL, Kim HY, Johnson LF, Maheu-Giroux M, Martin-Hughes R, Mishra S, Peerapatanapokin W, Stone J, Stover J, Teng Y, Vickerman P, Garcia SA, Korenromp E, Imai-Eaton JW, Boily MC. Measuring HIV Acquisitions Among Partners of Key Populations: Estimates From HIV Transmission Dynamic Models. J Acquir Immune Defic Syndr 2024; 95:e59-e69. [PMID: 38180739 PMCID: PMC10769162 DOI: 10.1097/qai.0000000000003334] [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] [Indexed: 01/06/2024]
Abstract
BACKGROUND Key populations (KPs), including female sex workers (FSWs), gay men and other men who have sex with men (MSM), people who inject drugs (PWID), and transgender women (TGW) experience disproportionate risks of HIV acquisition. The UNAIDS Global AIDS 2022 Update reported that one-quarter of all new HIV infections occurred among their non-KP sexual partners. However, this fraction relied on heuristics regarding the ratio of new infections that KPs transmitted to their non-KP partners to the new infections acquired among KPs (herein referred to as "infection ratios"). We recalculated these ratios using dynamic transmission models. SETTING One hundred seventy-eight settings (106 countries). METHODS Infection ratios for FSW, MSM, PWID, TGW, and clients of FSW were estimated from 12 models for 2020. RESULTS Median model estimates of infection ratios were 0.7 (interquartile range: 0.5-1.0; n = 172 estimates) and 1.2 (0.8-1.8; n = 127) for acquisitions from FSW clients and transmissions from FSW to all their non-KP partners, respectively, which were comparable with the previous UNAIDS assumptions (0.2-1.5 across regions). Model estimates for female partners of MSM were 0.5 (0.2-0.8; n = 20) and 0.3 (0.2-0.4; n = 10) for partners of PWID across settings in Eastern and Southern Africa, lower than the corresponding UNAIDS assumptions (0.9 and 0.8, respectively). The few available model estimates for TGW were higher [5.1 (1.2-7.0; n = 8)] than the UNAIDS assumptions (0.1-0.3). Model estimates for non-FSW partners of FSW clients in Western and Central Africa were high (1.7; 1.0-2.3; n = 29). CONCLUSIONS Ratios of new infections among non-KP partners relative to KP were high, confirming the importance of better addressing prevention and treatment needs among KP as central to reducing overall HIV incidence.
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Affiliation(s)
- Romain Silhol
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- HIV Prevention Trials Network Modelling Centre, Imperial College London, London, United Kingdom
| | - Rebecca L. Anderson
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Oliver Stevens
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - James Stannah
- Department of Epidemiology and Biostatistics, School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
| | - Ross D. Booton
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Dobromir Dimitrov
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Kate M. Mitchell
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- HIV Prevention Trials Network Modelling Centre, Imperial College London, London, United Kingdom
- Department of Nursing and Community Health, Glasgow Caledonian University London, London, United Kindom
| | - Deborah Donnell
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Anna Bershteyn
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - Tim Brown
- Research Program, East-West Center, Honolulu, HI
| | | | - Hae-Young Kim
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - Leigh F. Johnson
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Mathieu Maheu-Giroux
- Department of Epidemiology and Biostatistics, School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
| | | | - Sharmistha Mishra
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Jack Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | | | - Yu Teng
- Avenir Health, Glastonbury, CT
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | | | | | - Jeffrey W. Imai-Eaton
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Marie-Claude Boily
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- HIV Prevention Trials Network Modelling Centre, Imperial College London, London, United Kingdom
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23
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Solheim K, Hegg Reime M, Eide LSP. How Do Persons Who Inject Drugs Experience Care From Nurses in Hospital Settings? A Qualitative Study. Glob Qual Nurs Res 2024; 11:23333936241240795. [PMID: 38577493 PMCID: PMC10993672 DOI: 10.1177/23333936241240795] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 04/06/2024] Open
Abstract
People who inject drugs (PWID) are at increased risk of acute and chronic health outcomes and in need of in-hospital healthcare services. This study aims to give insight into how PWID experience care from nurses in hospital settings. We used a qualitative descriptive design and applied reflexive thematic analysis to 11 individual semi-structured interviews with PWID. Our analysis generated the following main themes: (1) diminishment and distance-always just a drug addict, (2) gratitude-equal care not taken for granted, and (3) vulnerability-already carrying a heavy burden. Our findings reveal a complex, nuanced narrative regarding participants' experiences of nursing care and highlight the importance of enhancing knowledge, understanding, empathy, and communication skills when nurses encounter PWID. Our research suggests that patients' vulnerability resulting from previous experiences defined their perception of quality of care. Insight from this study provides valuable knowledge about how to enhance nursing care for PWID.
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Affiliation(s)
| | - Marit Hegg Reime
- Western Norway University of Applied Sciences, Bergen, Hordaland, Norway
- Lovisenberg Diaconal University College, Oslo, Norway
| | - Leslie S. P. Eide
- Western Norway University of Applied Sciences, Bergen, Hordaland, Norway
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24
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Stevens O, Anderson R, Stover J, Teng Y, Stannah J, Silhol R, Jones H, Booton RD, Martin-Hughes R, Johnson L, Maheu-Giroux M, Mishra S, Stone J, Bershteyn A, Kim HY, Sabin K, Mitchell KM, Dimitrov D, Baral S, Donnell D, Korenromp E, Rice B, Hargreaves JR, Vickerman P, Boily MC, Imai-Eaton JW. Comparison of Empirically Derived and Model-Based Estimates of Key Population HIV Incidence and the Distribution of New Infections by Population Group in Sub-Saharan Africa. J Acquir Immune Defic Syndr 2024; 95:e46-e58. [PMID: 38180738 PMCID: PMC10769165 DOI: 10.1097/qai.0000000000003321] [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] [Indexed: 01/06/2024]
Abstract
BACKGROUND The distribution of new HIV infections among key populations, including female sex workers (FSWs), gay men and other men who have sex with men (MSM), and people who inject drugs (PWID) are essential information to guide an HIV response, but data are limited in sub-Saharan Africa (SSA). We analyzed empirically derived and mathematical model-based estimates of HIV incidence among key populations and compared with the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates. METHODS We estimated HIV incidence among FSW and MSM in SSA by combining meta-analyses of empirical key population HIV incidence relative to the total population incidence with key population size estimates (KPSE) and HIV prevalence. Dynamic HIV transmission model estimates of HIV incidence and percentage of new infections among key populations were extracted from 94 country applications of 9 mathematical models. We compared these with UNAIDS-reported distribution of new infections, implied key population HIV incidence and incidence-to-prevalence ratios. RESULTS Across SSA, empirical FSW HIV incidence was 8.6-fold (95% confidence interval: 5.7 to 12.9) higher than total population female 15-39 year incidence, and MSM HIV incidence was 41.8-fold (95% confidence interval: 21.9 to 79.6) male 15-29 year incidence. Combined with KPSE, these implied 12% of new HIV infections in 2021 were among FSW and MSM (5% and 7% respectively). In sensitivity analysis varying KPSE proportions within 95% uncertainty range, the proportion of new infections among FSW and MSM was between 9% and 19%. Insufficient data were available to estimate PWID incidence rate ratios. Across 94 models, median proportion of new infections among FSW, MSM, and PWID was 6.4% (interquartile range 3.2%-11.7%), both much lower than the 25% reported by UNAIDS. CONCLUSION Empirically derived and model-based estimates of HIV incidence confirm dramatically higher HIV risk among key populations in SSA. Estimated proportions of new infections among key populations in 2021 were sensitive to population size assumptions and were substantially lower than estimates reported by UNAIDS.
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Affiliation(s)
- Oliver Stevens
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Rebecca Anderson
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - John Stover
- Center for Modeling, Planning and Policy Analysis, Avenir Health, Glastonbury, CT
| | - Yu Teng
- Center for Modeling, Planning and Policy Analysis, Avenir Health, Glastonbury, CT
| | - James Stannah
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, Canada
| | - Romain Silhol
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- HIV Prevention Trials Network Modelling Centre, Imperial College London, London, United Kingdom
| | - Harriet Jones
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ross D. Booton
- United Kingdom Heath Security Agency, London, United Kingdom
| | - Rowan Martin-Hughes
- Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Australia
| | - Leigh Johnson
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Mathieu Maheu-Giroux
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, Canada
| | - Sharmistha Mishra
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
| | - Jack Stone
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Anna Bershteyn
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Hae-Young Kim
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Keith Sabin
- Data for Impact, The Joint United Nations Program on HIV/AIDS (UNAIDS), Geneva, Switzerland
| | - Kate M. Mitchell
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- Department of Nursing and Community Health, Glasgow Caledonian University London, London, United Kingdom
| | - Dobromir Dimitrov
- HIV Prevention Trials Network Modelling Centre, Imperial College London, London, United Kingdom
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Deborah Donnell
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Eline Korenromp
- Data for Impact, The Joint United Nations Program on HIV/AIDS (UNAIDS), Geneva, Switzerland
| | - Brian Rice
- School of Health and Related Research (SchARR), University of Sheffield, Sheffield, United Kingdom; and
| | - James R. Hargreaves
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Marie-Claude Boily
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- HIV Prevention Trials Network Modelling Centre, Imperial College London, London, United Kingdom
| | - Jeffrey W. Imai-Eaton
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
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25
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Brown A, Jefferson HL, Daley P, Kent WDT, Webster D, Adams C. Partial oral versus full intravenous antibiotic treatment of endocarditis in people who inject drugs: A systematic review. J Assoc Med Microbiol Infect Dis Can 2024; 8:253-261. [PMID: 38250624 PMCID: PMC10797769 DOI: 10.3138/jammi-2023-0013] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/13/2023] [Accepted: 07/27/2023] [Indexed: 01/23/2024]
Abstract
Background Prolonged intravenous (IV) antibiotic therapy may not be optimal for people who inject drugs (PWID) with infective endocarditis (IE) due to unique social and medical needs. The role of partial IV antibiotic therapy with continued oral (PO) antibiotic therapy is unclear. Methods A systematic review was performed using EMBASE and MEDLINE databases. Included studies compared PO to IV antibiotic treatment for IE in PWID. Results Four studies met eligibility. Observational studies included full IV treatment groups and partial IV, partial PO treatment groups for severe injection-related infections. PWID with IE comprised 41.0%-64.7% of the study populations but outcomes specific to IE were not separately reported. All-cause 90-day readmission rates were comparable between the IV treatment group (27.9%-31.5%) and partial IV, partial PO treatment group (24.8%-32.5%). Ninety-day mortality was non-significantly different between IV treatment (4.9%-10.7%) and partial IV, partial PO treatment groups (2.4%-13.0%). One small randomized clinical trial compared IV oxacillin or vancomycin with gentamicin to PO ciprofloxacin plus rifampin. The cure rates were 91% and 90%, respectively. Conclusion There is limited evidence comparing IV treatment to partial IV, partial PO antibiotic treatment in PWID with IE. Observational studies suggest that PO antibiotic therapy after initial IV treatment may be equivalent to full IV treatment alone within specific parameters, but randomized trials are needed to inform recommendations. Substantial clinical and social benefits for PWID and advantages for the health care system will result if PO treatment strategies with equal efficacy can be implemented.
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Affiliation(s)
- Amy Brown
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Hallie L Jefferson
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Peter Daley
- Division of Infectious Diseases, Department of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - William DT Kent
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Duncan Webster
- Division of Infectious Diseases, Department of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
| | - Corey Adams
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
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Barbati S, Strasser J, Allemann SS, Arnet I. Initiation of oral hepatitis C virus treatment: Which barriers are pertinent for ambulatory individuals with a history of illicit substance use? A qualitative interview study. Health Sci Rep 2024; 7:e1814. [PMID: 38260184 PMCID: PMC10802086 DOI: 10.1002/hsr2.1814] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/01/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
Background and Aims The World Health Organization has set a goal to eradicate hepatitis C virus (HCV) by the year 2030. Nonadherence to HCV treatment has substantial economic implications due to high treatment costs, among others. Barriers to start HCV treatment may be critical. The aim of this study was to assess pertinent barriers to HCV treatment in ambulatory patients with a history of illicit substance use and to compare them to the literature. Methods Barriers to HCV treatment mentioned by the key risk group (i.e., people who inject drugs) were retrieved from literature through a pragmatic literature search. From 34 published articles, we identified 80 modifiable barriers that were bundled in 23 items within the four topics "Personal difficulties and barriers to treatment," "Personal motivation to be treated," "Knowledge about the disease," and "Received information about the medicine." In-depth semistructured interviews were performed face-to-face with ambulatory patients from the University Psychiatric Clinics in Basel, Switzerland. Transcripts were coded inductively. Results Interviews were performed with seven individuals (mean age: 48.3 years; range: 38-63 years; one woman) treated with oral direct-acting antivirals between 2014 and 2022. Thirteen barriers to start HCV treatment were mentioned that corresponded to the five categories: information, attitudes, swallowing difficulties, social environment, and unfavorable lifestyle. The barrier "swallowing difficulties" emerged exclusively from the statements provided by the interviewees. Conclusion Barriers to the initiation of HCV treatment indicated by our interviewees clearly differed from the literature. Notably, the challenge of swallowing medicines may be particularly relevant for physicians prescribing and pharmacists dispensing HCV medication.
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Affiliation(s)
- Selina Barbati
- Pharmaceutical Care Research Group, Department of Pharmaceutical SciencesUniversity of BaselBaselSwitzerland
| | | | - Samuel S. Allemann
- Pharmaceutical Care Research Group, Department of Pharmaceutical SciencesUniversity of BaselBaselSwitzerland
| | - Isabelle Arnet
- Pharmaceutical Care Research Group, Department of Pharmaceutical SciencesUniversity of BaselBaselSwitzerland
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Fox AD, Riback L, Perez-Correa A, Ohlendorf E, Ghiroli M, Behrends CN, López-Castro T. High Interest in Injectable Opioid Agonist Treatment With Hydromorphone Among Urban Syringe Service Program Participants. Subst Use Addctn J 2024; 45:44-53. [PMID: 38258851 DOI: 10.1177/29767342231210552] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND Injectable opioid agonist treatment with hydromorphone (iOAT-H) is effective for persons who inject drugs (PWID) with opioid use disorder (OUD) but remains unavailable in the United States. Our objective was to determine interest in iOAT-H among syringe services program (SSP) participants. METHODS We recruited PWID with OUD from SSPs in New York City. Interest in iOAT-H was assessed on a 4-point scale. We compared participants who were and were not interested in iOAT-H regarding sociodemographic characteristics and self-reported variables (past 30 days): heroin use, public injection practices, and participation in illegal activity other than drug possession. Participants reported their preferred OUD treatment and reasons for these preferences. RESULTS Of 108 participants, most were male (69%), Hispanic (68%), and median age was 42 years. The median number of prior OUD treatment episodes was 6 (interquartile range: 2-12). Most (65%) were interested in iOAT-H. Interested participants (vs not interested) reported, over the prior 30 days, greater heroin use days (mean, 26.4 vs 22.3), injecting in public more times (median, 15 vs 6), and a higher percentage having participated in illegal activity (40% vs 16%). Preferences for OUD treatment were: iOAT-H (43%), methadone (39%), and buprenorphine (9%). Participants who preferred iOAT-H to conventional OUD treatments reported preferring injection as a route of administration and that available OUD treatments helped them insufficiently. CONCLUSIONS SSP participants with OUD reported high interest in iOAT-H. Participants had attempted conventional treatments but still used heroin almost daily. We identified PWID at risk for opioid-related harms who potentially could benefit from iOAT-H.
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Affiliation(s)
- Aaron D Fox
- Albert Einstein College of Medicine, Bronx, NY, USA
- Montefiore Medical Center, Bronx, NY, USA
| | - Lindsey Riback
- Albert Einstein College of Medicine, Bronx, NY, USA
- Montefiore Medical Center, Bronx, NY, USA
| | - Andres Perez-Correa
- Albert Einstein College of Medicine, Bronx, NY, USA
- Montefiore Medical Center, Bronx, NY, USA
| | | | - Megan Ghiroli
- Albert Einstein College of Medicine, Bronx, NY, USA
- Montefiore Medical Center, Bronx, NY, USA
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Christensen KT, Pierard F, Bonsall D, Bowden R, Barnes E, Florence E, Ansari MA, Nguyen D, de Cesare M, Nevens F, Robaeys G, Schrooten Y, Busschots D, Simmonds P, Vandamme AM, Van Wijngaerden E, Dierckx T, Cuypers L, Van Laethem K. Phylogenetic Analysis of Hepatitis C Virus Infections in a Large Belgian Cohort Using Next-Generation Sequencing of Full-Length Genomes. Viruses 2023; 15:2391. [PMID: 38140632 PMCID: PMC10747466 DOI: 10.3390/v15122391] [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: 09/04/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 12/24/2023] Open
Abstract
The hepatitis C virus (HCV) epidemic in Western countries is primarily perpetuated by the sub-populations of men who have sex with men (MSM) and people who inject drugs (PWID). Understanding the dynamics of transmission in these communities is crucial for removing the remaining hurdles towards HCV elimination. We sequenced 269 annotated HCV plasma samples using probe enrichment and next-generation sequencing, obtaining 224 open reading frames of HCV (OR497849-OR498072). Maximum likelihood phylogenies were generated on the four most prevalent subtypes in this study (HCV1a, 1b, 3a, 4d) with a subsequent transmission cluster analysis. The highest rate of clustering was observed for HCV4d samples (13/17 (76.47%)). The second highest rate of clustering was observed in HCV1a samples (42/78 (53.85%)) with significant association with HIV-positive MSM. HCV1b and HCV3a had very low rates of clustering (2/83 (2.41%) and (0/29)). The spread of the prevalent subtype HCV1b appears to have been largely curtailed, and we demonstrate the onwards transmission of HCV1a and HCV4d in the HIV-positive MSM population across municipal borders. More systematic data collection and sequencing is needed to allow a better understanding of the HCV transmission among the community of PWID and overcome the remaining barriers for HCV elimination in Belgium.
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Affiliation(s)
- Kasper T. Christensen
- Laboratory of Clinical and Epidemiological Virology, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, 3000 Leuven, Belgium; (F.P.); (Y.S.); (A.-M.V.); (T.D.); (L.C.); (K.V.L.)
| | - Florian Pierard
- Laboratory of Clinical and Epidemiological Virology, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, 3000 Leuven, Belgium; (F.P.); (Y.S.); (A.-M.V.); (T.D.); (L.C.); (K.V.L.)
| | - David Bonsall
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LF, UK;
- The Wellcome Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK; (R.B.); (D.N.); (M.d.C.)
| | - Rory Bowden
- The Wellcome Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK; (R.B.); (D.N.); (M.d.C.)
| | - Eleanor Barnes
- Peter Medawar Building for Pathogen Research, University of Oxford, Oxford OX1 3SY, UK;
- Translational Gastroenterology Unit, University of Oxford, Oxford OX3 9DU, UK
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford OX3 9DU, UK
| | - Eric Florence
- Department of General Internal Medicine, Infectious Diseases and Tropical Medicine, Antwerp University Hospital, 2650 Edegem, Belgium;
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium
| | - M. Azim Ansari
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7BN, UK;
| | - Dung Nguyen
- The Wellcome Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK; (R.B.); (D.N.); (M.d.C.)
| | - Mariateresa de Cesare
- The Wellcome Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK; (R.B.); (D.N.); (M.d.C.)
| | - Frederik Nevens
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, 3000 Leuven, Belgium; (F.N.); (G.R.)
| | - Geert Robaeys
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, 3000 Leuven, Belgium; (F.N.); (G.R.)
- Faculty of Medicine and Life Sciences—LCRC, UHasselt, Agoralaan, 3590 Diepenbeek, Belgium;
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, 3600 Genk, Belgium
| | - Yoeri Schrooten
- Laboratory of Clinical and Epidemiological Virology, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, 3000 Leuven, Belgium; (F.P.); (Y.S.); (A.-M.V.); (T.D.); (L.C.); (K.V.L.)
- Department of Laboratory Medicine, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Dana Busschots
- Faculty of Medicine and Life Sciences—LCRC, UHasselt, Agoralaan, 3590 Diepenbeek, Belgium;
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, 3600 Genk, Belgium
| | - Peter Simmonds
- Henry Wellcome Building for Molecular Physiology, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Headington, Oxford OX3 7BN, UK;
| | - Anne-Mieke Vandamme
- Laboratory of Clinical and Epidemiological Virology, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, 3000 Leuven, Belgium; (F.P.); (Y.S.); (A.-M.V.); (T.D.); (L.C.); (K.V.L.)
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, Universidade Nova de Lisboa, Rua da Junqueira 100, 1349-008 Lisbon, Portugal
| | - Eric Van Wijngaerden
- Department of General Internal Medicine, University Hospitals Leuven, 3000 Leuven, Belgium;
| | - Tim Dierckx
- Laboratory of Clinical and Epidemiological Virology, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, 3000 Leuven, Belgium; (F.P.); (Y.S.); (A.-M.V.); (T.D.); (L.C.); (K.V.L.)
| | - Lize Cuypers
- Laboratory of Clinical and Epidemiological Virology, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, 3000 Leuven, Belgium; (F.P.); (Y.S.); (A.-M.V.); (T.D.); (L.C.); (K.V.L.)
- Department of Laboratory Medicine, University Hospitals Leuven, 3000 Leuven, Belgium
- Laboratory of Clinical Microbiology, Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium
| | - Kristel Van Laethem
- Laboratory of Clinical and Epidemiological Virology, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, 3000 Leuven, Belgium; (F.P.); (Y.S.); (A.-M.V.); (T.D.); (L.C.); (K.V.L.)
- Department of Laboratory Medicine, University Hospitals Leuven, 3000 Leuven, Belgium
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Kagaya A, Nagaoki Y, Shimura S, Kawana K, Chayama K. A single site study to investigate the current prevalence of anti-hepatitis C virus antibody among substance use disorder patients in Hiroshima-Insufficient testing and diagnosis. Neuropsychopharmacol Rep 2023; 43:521-531. [PMID: 37193604 PMCID: PMC10739169 DOI: 10.1002/npr2.12346] [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: 02/03/2023] [Revised: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 05/18/2023] Open
Abstract
AIMS Hepatitis C virus (HCV) infection among drug users presents an important public health problem; however, little recognition and few approaches to address this issue in Japan. This study was conducted to investigate the current disease status by assessing anti-HCV antibody (Ab) seroprevalence among people who inject drugs (PWIDs) and people who use drugs (PWUDs) in Hiroshima, Japan. METHODS This study was a psychiatric single-site chart review in patients with drug abuse problems in the Hiroshima region. The primary outcome was anti-HCV Ab prevalence among PWIDs who underwent anti-HCV Ab testing. The secondary outcomes included the prevalence of anti-HCV Ab among PWUDs who underwent anti-HCV Ab testing and the proportion of patients who underwent anti-HCV Ab examination. RESULTS A total of 222 PWUD patients were enrolled. Among these, 16 patients (7.2%) had records of injection drug use (PWIDs). Eleven (68.8%) of the 16 PWIDs received anti-HCV Ab tests, and 4 (36.4%, 4/11) were anti-HCV Ab-positive. Among 222 PWUDs, 126 (56.8%) patients received anti-HCV Ab tests, and 57 of these patients (45.2%, 57/126) were anti-HCV Ab-positive. CONCLUSION The prevalence of anti-HCV Ab among PWIDs and PWUDs who visited the study site was higher than the general population, which was 2.2% among hospitalized patients between May 2018 and November 2019. Considering the World Health Organization's (WHO) elimination goal and recent advances in HCV treatment, patients with drug abuse experience should be encouraged to take HCV tests and consult hepatologists for further investigations and treatment if they are positive for anti-HCV Ab.
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Affiliation(s)
- Ariyuki Kagaya
- KONUMA Memorial Institute of Addiction and Mental HealthHiroshimaJapan
| | - Yuko Nagaoki
- Department of GastroenterologyMazda Hospital, Mazda Motor CorporationHiroshimaJapan
| | | | | | - Kazuaki Chayama
- Department of Collaborative Research Laboratory of Medical Innovation, Graduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
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Killion JA, Magana C, Cepeda JA, Vo A, Hernandez M, Cyr CL, Heskett KM, Wilson DP, Graff Zivin J, Zúñiga ML, Pines HA, Garfein RS, Vickerman P, Terris-Prestholt F, Wynn A, Martin NK. Unit costs of needle and syringe program provision: a global systematic review and cost extrapolation. AIDS 2023; 37:2389-2397. [PMID: 37773035 PMCID: PMC10653296 DOI: 10.1097/qad.0000000000003718] [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: 03/03/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Needle and syringe programs (NSPs) are effective at preventing HIV and hepatitis C virus (HCV) among people who inject drugs (PWID), yet global coverage is low, partly because governments lack data on the cost and cost-effectiveness of NSP in their countries to plan and fund their responses. We conducted a global systematic review of unit costs of NSP provision to inform estimation of cost drivers and extrapolated costs to other countries. METHODS We conducted a systematic review to extract data on the cost per syringe distributed and its cost drivers. We estimated the impact of country-level and program-level variables on the cost per syringe distributed using linear mixed-effects models. These models were used to predict unit costs of NSP provision, with the best performing model used to extrapolate the cost per syringe distributed for 137 countries. The total cost for a comprehensive NSP (200 syringes per PWID/year) was also estimated for 68 countries with PWID population size estimates. RESULTS We identified 55 estimates of the unit cost per syringe distributed from 14 countries. Unit costs were extrapolated for 137 countries, ranging from $0.08 to $20.77 (2020 USD) per syringe distributed. The total estimated spend for a high-coverage, comprehensive NSP across 68 countries with PWID size estimates is $5 035 902 000 for 10 887 500 PWID, 2.1-times higher than current spend. CONCLUSION Our review identified cost estimates from high-income, upper-middle-income, and lower-middle-income countries. Regression models may be useful for estimating NSP costs in countries without data to inform HIV/HCV prevention programming and policy.
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Affiliation(s)
- Jordan A. Killion
- University of California San Diego, La Jolla
- San Diego State University, San Diego, California
| | | | | | - Anh Vo
- Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Natasha K. Martin
- University of California San Diego, La Jolla
- University of Bristol, Bristol, UK
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Caroline A, Kate M, Roberts M, Ryan J, Murphy S, Richardson C, Coyte A, Taha Y, Stuart M. What is the impact of a Hepatitis C 'test, trace and treat' pilot using peer workers? J Viral Hepat 2023; 30:922-925. [PMID: 37723934 DOI: 10.1111/jvh.13888] [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: 08/02/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 09/20/2023]
Abstract
Chronic Hepatitis C virus (HCV) infection is a major cause of morbidity and deaths worldwide. HCV treating teams are working toward the goal of eliminating HCV by 2030. People who inject drugs (PWIDs) are at high risk of HCV but contact tracing is not routine practice. Here, we present the outcomes of a HCV 'test, trace and treat' pilot using peer workers to test contacts of individuals with HCV. PWIDs with HCV were invited to participate when they presented for treatment. For those agreeing to participate, a peer approached them to invite potential contacts for HCV testing. Data were collected on uptake, HCV test results, treatment rates and reasons for declining. Overall, 295 individuals (162 recent HCV [<1 year], 69 reinfections, 64 known chronic HCV) were invited to participate, of whom 147 (50%) agreed and 30 (20% of those agreeing) brought forward 120 contacts for testing. Of these, 44 (37%) were HCV RNA positive, including 23 who were not known to services. 34 (77%) started antiviral treatment. HCV RNA positivity was highest in contacts of reinfections (45%) compared with recent HCV (33%) and known chronic HCV (25%). The most common reason for index individuals declining participation was that they reported no longer being in contact with individuals from their injecting network (65%). In conclusion, half of PWIDs with HCV agreed to participate in the pilot, but only 20% of these brought contacts forward. The frequency of active HCV was high in the contacts and the majority started antiviral treatment.
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Affiliation(s)
- Allsop Caroline
- Viral Hepatitis Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mcque Kate
- Viral Hepatitis Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Jelley Ryan
- Viral Hepatitis Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | | | - Aishah Coyte
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Yusri Taha
- Viral Hepatitis Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - McPherson Stuart
- Viral Hepatitis Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Newcastle NIHR Biomedical Research Centre, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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Rosen JG, Cepeda J, Park JN. Demographic patterns and disparities in new HIV diagnoses attributed to injection drug use in the United States. AIDS 2023; 37:2262-2265. [PMID: 37877284 PMCID: PMC10605962 DOI: 10.1097/qad.0000000000003688] [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] [Indexed: 10/26/2023]
Abstract
People who inject drugs (PWID) exhibit disproportionate HIV burdens in the United States. We characterized longitudinal patterns and demographic disparities in new HIV diagnoses attributed to injection drug use (IDU) in 2008-2020. Although new IDU-attributed HIV diagnoses fell by 53.9%, new HIV diagnoses remained disproportionately elevated in female (100.9/100 000), Black (258.8/100 000), and Hispanic (131.0/100 000) PWID. Despite considerable declines in new HIV diagnoses, disparities by race/ethnicity and sex persist among US PWID.
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Affiliation(s)
- Joseph G. Rosen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Javier Cepeda
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Ju Nyeong Park
- Harm Reduction Innovation Lab, Rhode Island Hospital, Providence, RI
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI
- Department of General Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI
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Sutherland R, Peacock A, Crawford S, Holly C, Gava P, Dicka J, Manu G, Byrne J. Information acquisition and dissemination among a sample of people who inject drugs in Australia. Drug Alcohol Rev 2023. [PMID: 37952935 DOI: 10.1111/dar.13765] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 09/13/2023] [Accepted: 10/02/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION This paper examines the acquisition and dissemination of harm reduction information among people who inject drugs, as well as preferred sources of information. METHODS Data were obtained from 862 people who inject drugs, recruited from Australian capital cities for the 2021 Illicit Drug Reporting System. Multivariable regression analyses were performed to assess potential factors associated with knowledge sharing. RESULTS Almost two-fifths (37%) reported that they had received information about how to keep themselves safe when using drugs within the past 6 months. Reporting on their last occasion of receiving information, participants stated that it was commonly about injecting practices (56%), overdose prevention (26%) and injection-related injuries (22%), and was mostly received from an alcohol and other drug worker (54%), followed by other health professional (24%) and social network (18%). Among those who reported receiving information, 50% shared this information with other people, predominantly with their social network: no factors were found to be significantly associated with sharing information. The majority reported that peer workers and/or people with lived experience would be the first person they would talk to for information about a range of topics (e.g., injecting/harm reduction practices, overdose prevention). DISCUSSION AND CONCLUSIONS Two in five participants had recently obtained information about how to keep themselves safe while using drugs, with half sharing this information with their social network. Peer workers were the preferred source of information, suggesting that the peer educator workforce should be expanded to embrace the capacities and expertise of people who inject drugs.
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Affiliation(s)
- Rachel Sutherland
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- School of Psychological Sciences, University of Tasmania, Hobart, Australia
| | | | | | - Peta Gava
- Peer Based Harm Reduction WA, Perth, Australia
| | - Jane Dicka
- Harm Reduction Victoria, Melbourne, Australia
| | - Geoff Manu
- Australian Injecting and Illicit Drug Users League, Canberra, Australia
| | - Jude Byrne
- Australian Injecting and Illicit Drug Users League, Canberra, Australia
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Shukla L, Shivaprakash P, Kumar MS. HIV, hepatitis B & C in people who inject drugs in India: A systematic review of regional heterogeneity & overview of opioid substitution treatment. Indian J Med Res 2023; 158:522-534. [PMID: 38265946 PMCID: PMC10878493 DOI: 10.4103/ijmr.ijmr_1930_23] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND OBJECTIVES This systematic review evaluates the human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV) burden among people who inject drugs (PWIDs) in India. In addition, we selectively examined research on opioid substitution treatment (OST)-related services due to their role in antiviral treatment uptake and adherence. METHODS Data were sourced from peer-reviewed and government publications between 1991 and September 20, 2023, searched in MEDLINE, Scopus and EBSCOhost. English language studies reporting weighted prevalence or raw numbers and recruitment sites were included for review. Quality was assessed using the Joanna Briggs Institute tool. Data synthesis was done in graphs and tables. RESULTS We included 50 reports, yielding 150 HIV, 68 HCV and 24 HBV prevalence estimates across India, revealing significant regional heterogeneity. Notably, 16 States had a single community-based HIV estimate, and 19 States had limited or no HCV data. The highest HIV and HCV prevalence was in Manipur (74.7% and 97.5%, respectively) in 1996. Recent spikes included 50.2 per cent HIV prevalence in Punjab (2010) and 73 per cent HCV in Uttar Pradesh (2021). Nationally, OST coverage in 2020 was under five per cent, with some northeast, north and central States exceeding this, but most others were falling below two per cent. No studies on the cost-effectiveness of directly observed treatment models for OST were identified. INTERPRETATION CONCLUSIONS There is a lack of sufficiently granular and generalizable estimates for HIV prevalence and any estimates for HCV and HBV among PWIDs in large parts of the country. Community-based representative studies are required to quantify the prevalence and severity of these diseases and allocate resources.
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Affiliation(s)
- Lekhansh Shukla
- Department of Psychiatry, Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Prakrithi Shivaprakash
- Department of Psychiatry, Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - M. Suresh Kumar
- Schizophrenia Research Foundation (SCARF), Chennai, Tamil Nadu, India
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Evans KN, Vettese T, Wortley PM, Gandhi AP, Bradley H. HIV and HCV testing at clinical encounters among people who inject drugs, 2013-2018-Opportunities for increased testing and prevention. J Viral Hepat 2023; 30:848-858. [PMID: 37726974 DOI: 10.1111/jvh.13877] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/05/2023] [Accepted: 07/17/2023] [Indexed: 09/21/2023]
Abstract
People who inject drugs (PWID) with unsafe injection practices have substantial risk for HIV and hepatitis C virus (HCV) infections. We describe frequency of, and factors associated with, HIV and HCV testing during clinical encounters with PWID. Inpatient and Emergency Department clinical encounters at an Atlanta hospital were abstracted from medical records spanning January 2013-December 2018. We estimated frequency of HIV and HCV testing during injection drug use (IDU)-related encounters among PWID without previous diagnoses. We assessed associations between patient factors and testing using generalized estimating equations models. HIV testing occurred in 39.3% and HCV testing occurred in 17.1% of eligible IDU-related encounters. Testing was more likely in IDU-related encounters during 2017-2018 than in encounters during 2013-2014; (HIV, AOR = 2.14, 95% CI, 1.32-3.49, p < .01). Testing was less likely among Black/African American patients compared to White patients (adjusted odds ratio [AOR]: HIV, AOR = 0.48, 95% confidence interval [CI], 0.33-0.72, p < .01); HCV, AOR = 0.41, 95% CI, 0.24-0.70, p < .01). This difference may be attributable to recent testing among Black patients in non-IDU related encounters. HIV and HCV testing improved over time; however, missed opportunities for testing still existed. Strategies should aim to improve equitable HIV and HCV testing among PWID.
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Affiliation(s)
- Kimberly N Evans
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, Georgia, USA
| | - Theresa Vettese
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Ami P Gandhi
- Georgia Department of Public Health, Atlanta, Georgia, USA
| | - Heather Bradley
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, Georgia, USA
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Hobday S, Valerio H, Combo T, Monaghan R, Scott C, Silk D, Murray C, Read P, Henderson C, Degenhardt L, Treloar C, Dore GJ, Grebely J, Martinello M. Evaluating the prevalence of current hepatitis C infection and treatment among Aboriginal and Torres Strait Islander peoples who inject drugs in Australia: The ETHOS engage study. Drug Alcohol Rev 2023; 42:1617-1632. [PMID: 37556376 PMCID: PMC10946462 DOI: 10.1111/dar.13723] [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: 12/19/2022] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 08/11/2023]
Abstract
INTRODUCTION Evaluating progress towards hepatitis C virus (HCV) elimination among Aboriginal and Torres Strait Islander peoples is critical given the disproportionate burden of infection. We examined factors associated with current HCV infection and self-reported treatment among Aboriginal and Torres Strait Islander (hereafter referred to as Aboriginal peoples) and non-Aboriginal peoples who inject drugs (PWID) in Australia. METHODS ETHOS Engage is an observational cohort study of PWID attending drug treatment and needle and syringe programs in Australia. Participants underwent point-of-care HCV RNA testing (Xpert HCV RNA Viral Load Fingerstick) and completed a questionnaire including self-reported history of HCV treatment. RESULTS Between May 2018 and June 2021, 2395 participants were enrolled and 555 (23%) identified as Aboriginal (median age 42 years, 58% were men, 63% injected drugs in last month, 76% ever incarcerated). HCV RNA prevalence was 23% among Aboriginal PWID (24% in 2018-2019 and 21% in 2019-2021; p = 0.44), and 21% among non-Aboriginal PWID (24% in 2018-2019 and 16% in 2019-2021; p < 0.001). Self-reported HCV treatment was 65% among Aboriginal PWID (63% in 2018-2019 and 69% in 2019-2021; p = 0.30), and 70% among non-Aboriginal PWID (67% in 2018-2019 and 75% in 2019-2021; p < 0.001). Among Aboriginal PWID, current HCV infection was associated with recently injecting drugs and receiving opioid agonist treatment, and self-reported HCV treatment was negatively associated with younger age, homelessness and recently injecting drugs. DISCUSSION AND CONCLUSIONS Equitable access to HCV care and prevention is needed to ensure Australia meets its elimination targets among Aboriginal PWID.
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Affiliation(s)
- Steven Hobday
- The Kirby InstituteUniversity of New South WalesSydneyAustralia
| | - Heather Valerio
- The Kirby InstituteUniversity of New South WalesSydneyAustralia
| | - Troy Combo
- Infectious Disease Implementation Science GroupBurnet InstituteMelbourneAustralia
- Poche Centre for Indigenous Health, University of QueenslandBrisbaneAustralia
| | - Robert Monaghan
- The Kirby InstituteUniversity of New South WalesSydneyAustralia
| | - Clarke Scott
- Nepean Blue Mountains Local Health District, NSW HealthPenrithAustralia
| | - David Silk
- The Kirby InstituteUniversity of New South WalesSydneyAustralia
| | | | - Phillip Read
- The Kirby InstituteUniversity of New South WalesSydneyAustralia
- Kirketon Road CentreSydneyAustralia
| | | | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW SydneySydneyAustralia
| | - Carla Treloar
- Centre for Social Research in HealthUniversity of New South WalesSydneyAustralia
| | - Gregory J. Dore
- The Kirby InstituteUniversity of New South WalesSydneyAustralia
| | - Jason Grebely
- The Kirby InstituteUniversity of New South WalesSydneyAustralia
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Roshanfekr P, Karimi SE, Narouee S, Moftakhar L, Vameghi M, Ali D, Higgs P, Soleimanvandiazar N. Life-time HIV testing among people who inject drugs in Iran: results from the National Rapid Assessment and Response survey. Front Public Health 2023; 11:1253407. [PMID: 37915820 PMCID: PMC10616789 DOI: 10.3389/fpubh.2023.1253407] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/04/2023] [Indexed: 11/03/2023] Open
Abstract
Background HIV testing is recommended for people who inject drugs (PWID). The aim of this study was to determine the prevalence of lifetime HIV testing among PWID and to better understand the predictors for HIV testing in a convenience sample across Iran. Materials and methods This study is a secondary analysis of Iran's National Rapid Assessment and Response survey conducted between October 2016 and March 2017. Analysis includes the 999 people who reported injecting drugs across the capital cities of 21 provinces. Data were collected by using the venue-based application of the Time Location Sampling (TLS) frame. Chi-square tests were used to examine the difference between HIV testing across different quantitative variables. Logistic regression was used to determine the predictors of life-time HIV testing. Analysis was performed using STATA V.12 software with a significance level of 95%. Results Most participants were male (n = 902, 93.50%), and over half (n = 555, 59.17%) were older than 35 years old. About one-third, (n = 326, 38%) of people interviewed were single and another one-third (n = 251, 29%) reported being divorced. Over two-thirds of participants (n = 678, 69.78%) in this study reported lifetime HIV testing. The results from a multiple variable logistic regression showed people with a university education were more likely to have been previously tested for HIV than illiterate people (OR = 18.87, 95%CI 2.85-124.6, value of p = 0.002). Those individuals who reported ever receiving methadone treatment were 2.8 times more likely to have been tested for HIV than individuals without methadone treatment experience (OR = 2.89, 95%CI 1.53-5.42, value of p < 0.001). Needle syringe sharing in last month, was negatively associated with life-time HIV testing (OR = 0.29, 95%CI 0.17-0.48, value of p < 0.001). Conclusion Despite Iran's wide availability and access to counseling services for HIV testing in key populations, the proportion of PWID being tested for HIV could be improved. Developing effective strategies to increase people's understanding and awareness of the importance of and need for HIV prevention and familiarity with HIV testing sites is an essential step in increasing HIV testing for this population. Studies on more recent HIV testing are required to better assess and understand the frequency of HIV testing among PWID in Iran.
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Affiliation(s)
- Payam Roshanfekr
- Social Welfare Management Research Center, Social Health Research Institute, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Salah Eddin Karimi
- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sakineh Narouee
- Department of Statistics and Epidemiology, Faculty of Health, Kerman University Medical of Sciences, Kerman, Iran
| | - Leila Moftakhar
- Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Meroe Vameghi
- Social Welfare Management Research Center, Social Health Research Institute, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Delaram Ali
- Social Welfare Management Research Center, Social Health Research Institute, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Peter Higgs
- Department of Public Health, La Trobe University, Melbourne, VIC, Australia
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, VIC, Australia
| | - Neda Soleimanvandiazar
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
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Yang H, Li Y, Xu M, Hu Y, Yuan F, Liu L, Li L, Yuan D, Ye L, Zhou C, Zhang Y, Su L, Liang S. The Update of HIV-1 Prevalence and Incidence and Spatio-Temporal Analyses of HIV Recent Infection Among Four Sub-Groups in Sichuan, China During Surveillance Period Between 2016 and 2022. Infect Drug Resist 2023; 16:6535-6548. [PMID: 37814665 PMCID: PMC10560476 DOI: 10.2147/idr.s428744] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/27/2023] [Indexed: 10/11/2023] Open
Abstract
Background Sichuan Province has gradually become a hot-spot for HIV/AIDS. Little is known about the HIV-1 incidence and prevalence among four sub-groups since 2015. Meanwhile, the distributions of hot-spot areas related to recent infection cases that indicate current transmission among the four subgroups are also rare. Objective The main purpose of this study was to assess the HIV-1 prevalence and incidence and to visualize the distributions of hot-spot areas of current transmission among four subgroups (people who inject drugs, male STD clinic attendees, female sex workers and men who had sex with men) during the surveillance period in Sichuan province between 2016 and 2022. Results Of the 267,617 individuals, 2158 HIV-positive samples were tested with Lag-Avidity EIA, among which 493 samples were identified as recent infections. Among people who inject drugs (PWID), both HIV-1 prevalence (from 1.41% to 0.34%) and incidence (from 0.03% to 0.140%) showed a significant decreasing trend. Among men who had sex with men (MSM), female sex workers (FSWs), and male STD clinic attendees, HIV-1 prevalence indicated significant decreasing trends, whereas HIV-1 incidence showed no significant changes. Spatial analysis demonstrated the formation of hot-spots and clusters of current transmissions sharing regional differences, mainly concentrated in the southeast, and most of these were consecutive hot-spots. Conclusion The prevention and control were efficacious and persistent. However, among the other three subgroups, there is a need for a regional cooperative in prevention and control approaches and collaborative research in many aspects.
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Affiliation(s)
- Hong Yang
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Yiping Li
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Mengjiao Xu
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Ying Hu
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Fengshun Yuan
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Lunhao Liu
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Ling Li
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Dan Yuan
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Li Ye
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Chang Zhou
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Yan Zhang
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Ling Su
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Shu Liang
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
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Dubov A, Krakower DS, Rockwood N, Montgomery S, Shoptaw S. Provider Implicit Bias in Prescribing HIV Pre-exposure Prophylaxis (PrEP) to People Who Inject Drugs. J Gen Intern Med 2023; 38:2928-2935. [PMID: 36964426 PMCID: PMC10593689 DOI: 10.1007/s11606-023-08040-7] [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: 11/23/2022] [Accepted: 01/10/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Multiple HIV outbreaks among people who inject drugs (PWIDs) have occurred in the USA since 2015, highlighting the need for additional HIV prevention tools. Despite high levels of need, pre-exposure prophylaxis (PrEP) is drastically underutilized among PWIDs. Implicit bias toward PWID held by clinicians may impede PrEP scale-up among these underserved patients. This study examined how primary care providers' (PCPs) clinical decisions related to PrEP can be impacted by biases when the patient has a history of substance use. METHODS We conducted an online survey of PCPs (n = 208). The survey included the implicit association test (IAT) to assess unconscious attitudes toward PWIDs, direct questions regarding clinicians' explicit PWID attitudes, and an embedded experiment in which we systematically varied the risk behavior of a hypothetical patient and asked PCPs to make clinical judgments. RESULTS A minority (32%) of PCPs reported explicit PWID bias. The IAT indicated strong implicit PWID bias (meant IAT score = 0.59, p < .0001) among 88% of the sample. Only 9% of PCPs had no implicit or explicit PWID bias. PWID patients were judged as less likely to adhere to a PrEP regimen, less responsible, and less HIV safety conscious than heterosexual or gay male patients. Anticipated lack of adherence mediated PCPs' intent to prescribe PrEP to PWID. CONCLUSIONS PCPs' bias may contribute to PrEP being under-prescribed to PWID. Implicit and explicit PWID biases were common in our sample. This study illustrates the need to develop and test tailored interventions to decrease biases against PWID in primary care settings.
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Affiliation(s)
- Alex Dubov
- School of Behavioral Health, Loma Linda University, Loma Linda, CA USA
| | - Douglas S. Krakower
- Division of Infectious Diseases, Department of Population Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA
| | - Nicholas Rockwood
- School of Behavioral Health, Loma Linda University, Loma Linda, CA USA
| | | | - Steven Shoptaw
- Department of Family Medicine, University of California Los Angeles, Los Angeles, CA USA
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40
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Coyle CR, Desjardins MR, Curriero FC, Rudolph J, Astemborski J, Falade-Nwulia O, Kirk GD, Thomas DL, Mehta SH, Genberg BL. Geographic variation in HCV treatment penetration among people who inject drugs in Baltimore, MD. J Viral Hepat 2023; 30:810-818. [PMID: 37382024 PMCID: PMC10527489 DOI: 10.1111/jvh.13864] [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: 05/10/2023] [Revised: 06/06/2023] [Accepted: 06/09/2023] [Indexed: 06/30/2023]
Abstract
We evaluated geographic heterogeneity in hepatitis C virus (HCV) treatment penetration among people who inject drug (PWID) across Baltimore, MD since the advent of direct-acting antivirals (DAAs) using space-time clusters of HCV viraemia. Using data from a community-based cohort of PWID, the AIDS Linked to the IntraVenous Experience (ALIVE) study, we identified space-time clusters with higher-than-expected rates of HCV viraemia between 2015 and 2019 using scan statistics. We used Poisson regression to identify covariates associated with HCV viraemia and used the regression-fitted values to detect adjusted space-time clusters of HCV viraemia in Baltimore city. Overall, in the cohort, HCV viraemia fell from 77% in 2015 to 64%, 49%, 39% and 36% from 2016 to 2019. In Baltimore city, the percentage of census tracts where prevalence of HCV viraemia was ≥85% dropped from 57% to 34%, 25%, 22% and 10% from 2015 to 2019. We identified two clusters of higher-than-expected HCV viraemia in the unadjusted analysis that lasted from 2015 to 2017 in East and West Baltimore and one adjusted cluster of HCV viraemia in West Baltimore from 2015 to 2016. Neither differences in age, sex, race, HIV status, nor neighbourhood deprivation were able to explain the significant space-time clusters. However, residing in a cluster with higher-than-expected viraemia was associated with age, sex, educational attainment and higher levels of neighbourhood deprivation. Nearly 4 years after DAAs became available, HCV treatment has penetrated all PWID communities across Baltimore city. While nearly all census tracts experienced improvements, change was more gradual in areas with higher levels of poverty.
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Affiliation(s)
- Catelyn R. Coyle
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Merck & Co. Inc., Rahway, NJ
| | - Michael R. Desjardins
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Spatial Science for Public Health Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Frank C. Curriero
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Spatial Science for Public Health Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Jacqueline Rudolph
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Jacquie Astemborski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Oluwaseun Falade-Nwulia
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Gregory D. Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - David L. Thomas
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Shruti H. Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Becky L. Genberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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Small W, O'Callaghan S. Commentary on Brothers et al.: The role of safer environment interventions in addressing injecting-related bacterial and fungal infections. Addiction 2023; 118:1878-1880. [PMID: 37544882 DOI: 10.1111/add.16313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023]
Affiliation(s)
- Will Small
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Sean O'Callaghan
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
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Martinello M, Carson JM, Van Der Valk M, Rockstroh JK, Ingiliz P, Hellard M, Nelson M, Lutz T, Bhagani S, Kim AY, Hull M, Cordes C, Moon J, Feld JJ, Gane E, Rauch A, Bruneau J, Tu E, Applegate T, Grebely J, Dore GJ, Matthews GV. Reinfection incidence and risk among people treated for recent hepatitis C virus infection. AIDS 2023; 37:1883-1890. [PMID: 37467042 PMCID: PMC10529102 DOI: 10.1097/qad.0000000000003651] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 07/21/2023]
Abstract
OBJECTIVE Reinfection poses a challenge to hepatitis C virus (HCV) elimination. This analysis assessed incidence of, and factors associated with reinfection among people treated for recent HCV (duration of infection <12 months). METHODS Participants treated for recent HCV (primary infection or reinfection) in an international randomized trial were followed at 3-monthly intervals for up to 2 years to assess for reinfection. Reinfection incidence was calculated using person-time of observation. Factors associated with HCV reinfection were assessed using Cox proportional hazards regression analysis. RESULTS Of 222 participants treated for recent HCV, 196 (62% primary infection, 38% reinfection) were included in the cohort at risk for reinfection, of whom 87% identified as gay or bisexual men, 71% had HIV and 20% injected drugs in the month prior to enrolment. During 198 person-years of follow-up, 28 cases of HCV reinfection were identified among 27 participants, for an incidence of 14.2 per 100 person-years [95% confidence interval (CI) 9.8-20.5]. Reinfection was associated with prior HCV reinfection [adjusted hazards ratio (aHR) 2.42; 95% CI 1.08-5.38], injection drug use posttreatment (aHR 2.53; 95% CI 1.14-5.59), condomless anal intercourse with casual male partners (aHR 3.32; 95% CI 1.14-9.65) and geographic region (United Kingdom, aHR 0.21; 95% CI 0.06-0.75). Among gay and bisexual men (GBM), reinfection was also associated with sexualized drug use involving injecting posttreatment (aHR 2.97; 95% CI 1.10-8.02). CONCLUSION High reinfection incidence following treatment for recent HCV among people with ongoing sexual and drug use risk behaviour highlights the need for posttreatment surveillance, rapid retreatment of reinfection and targeted harm reduction strategies.
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Affiliation(s)
| | | | - Marc Van Der Valk
- Division of Infectious Diseases, Amsterdam Infection and Immunity Institute, Amsterdam University Medical Centers, University of Amsterdam
- Stichting HIV Monitoring, Amsterdam, the Netherlands
| | | | - Patrick Ingiliz
- Zentrum für Infektiologie Berlin-Prenzlauer Berg, Berlin, Germany
| | | | - Mark Nelson
- Chelsea and Westminster Hospital, London, UK
| | - Thomas Lutz
- Infektiologikum Frankfurt, Frankfurt am Main, Germany
| | | | - Arthur Y Kim
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mark Hull
- St Paul's Hospital, Vancouver, Canada
| | | | - Juhi Moon
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Jordan J Feld
- Toronto Centre for Liver Diseases, Toronto General Hospital, Toronto, Canada
| | - Ed Gane
- Auckland City Hospital, Auckland, New Zealand
| | - Andri Rauch
- Department of Infectious Diseases, Bern Inselspital, Bern, Switzerland
| | - Julie Bruneau
- Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Elise Tu
- Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | | | - Gregory J Dore
- Kirby Institute, UNSW Sydney, Sydney, Australia
- St Vincent's Hospital, Sydney, Australia
| | - Gail V Matthews
- Kirby Institute, UNSW Sydney, Sydney, Australia
- St Vincent's Hospital, Sydney, Australia
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Dzinamarira T, Moyo E. The use of oral HIV pre-exposure prophylaxis among people who inject drugs: barriers, and recommendations. Front Public Health 2023; 11:1265063. [PMID: 37732092 PMCID: PMC10507712 DOI: 10.3389/fpubh.2023.1265063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/24/2023] [Indexed: 09/22/2023] Open
Affiliation(s)
- Tafadzwa Dzinamarira
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
- ICAP at Columbia University, Lusaka, Zambia
| | - Enos Moyo
- School of Nursing and Public Health, College of Health Sciences, University of Kwa-Zulu Natal, Durban, South Africa
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Heidari O, O’Conor KJ, Meyer D, Cargill V, Lowensen K, Farley JE. High Primary COVID-19 Vaccine Series Completion by People Who Inject Drugs When Colocating Services at a Syringe Services Van. J Addict Med 2023; 17:e287-e289. [PMID: 37788618 PMCID: PMC10492892 DOI: 10.1097/adm.0000000000001164] [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] [Indexed: 03/11/2023]
Abstract
OBJECTIVE The aim of the study is to describe the impact of colocating COVID-19 vaccinations with local syringe service programs on vaccine completion among people who inject drugs. METHODS Data were derived from 6 community-based clinics. People who inject drugs who received at least one COVID-19 vaccine from a colocated clinic partnering with a local syringe service program were included in the study. Vaccine completion was abstracted from electronic medical records; additional vaccinations were abstracted using health information exchanges embedded within the electronic medical records. RESULTS Overall, 142 individuals with a mean age of 51 years, predominantly male (72%) and Black, non-Hispanic (79%) received COVID-19 vaccines. More than half elected to receive a 2-dose mRNA vaccine (51.4%). Eighty-five percent completed a primary series, and 71% of those who received a mRNA vaccine completed the 2-dose series. Booster uptake was 34% in those completing a primary series. CONCLUSIONS Colocated clinics are an effective means of reaching vulnerable populations. As the COVID-19 pandemic continues and need for annual booster vaccines arises, it is important to bolster public support and funding to continue low-barrier preventive clinics colocated with harm reduction services for this population.
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Affiliation(s)
- Omeid Heidari
- Department of Child, Family, and Population Health Nursing, University of Washington, School of Nursing
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, School of Nursing
| | - Katie J. O’Conor
- Departments of Anesthesiology, Critical Care Medicine and Emergency Medicine, Johns Hopkins University School of Medicine
| | - Diane Meyer
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, School of Nursing
- Center for Health Security, Johns Hopkins University, Bloomberg School of Public Health
| | | | - Kelly Lowensen
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, School of Nursing
| | - Jason E. Farley
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, School of Nursing
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45
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Martinello M, Naggie S, Rockstroh JK, Matthews GV. Direct-Acting Antiviral Therapy for Treatment of Acute and Recent Hepatitis C Virus Infection: A Narrative Review. Clin Infect Dis 2023; 77:S238-S244. [PMID: 37579203 DOI: 10.1093/cid/ciad344] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Abstract
Following the discovery of hepatitis C virus (HCV) in 1989, 3 decades of basic, translational, and clinical research culminated in the development of direct-acting antiviral (DAA) therapy-curative oral treatment for HCV infection. The availability of DAA therapy revolutionized HCV clinical management, including acute (duration of infection <6 mo) and recent (duration of infection <12 mo) infection. Several DAA regimens, including the contemporary pan-genotypic combinations of sofosbuvir-velpatasvir and glecaprevir-pibrentasvir, have been shown to be safe and effective among people with acute and recent HCV infection, highlighting their potential in an HCV controlled human infection model. This article describes the natural history and management of acute and recent HCV infection in the era of DAA therapy and outlines a strategy for use of DAA therapies in the setting of an HCV controlled human infection model.
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Affiliation(s)
- Marianne Martinello
- Kirby Institute, University of New South Wales (UNSW Sydney), Sydney, Australia
- Prince of Wales Hospital, Sydney, Australia
| | - Susanna Naggie
- Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | - Gail V Matthews
- Kirby Institute, University of New South Wales (UNSW Sydney), Sydney, Australia
- St Vincent's Hospital, Sydney, Australia
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46
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Macdonald V, Mathers B, Sabin K, Me A, Carpentier C, Niaz K, Mozalevskis A, Luhmann N, Ciupagea M, Soltani F, Verster A. New data confirm lack of progress in harm reduction after three decades of proven evidence of effectiveness. Addiction 2023; 118:1411-1413. [PMID: 37051682 DOI: 10.1111/add.16193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Affiliation(s)
- Virginia Macdonald
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Bradley Mathers
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | | | - Angela Me
- United Nations Office on Drugs and Crime, Vienna, Austria
| | | | - Kamran Niaz
- United Nations Office on Drugs and Crime, Vienna, Austria
| | - Antons Mozalevskis
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Niklas Luhmann
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | | | - Fariba Soltani
- United Nations Office on Drugs and Crime, Vienna, Austria
| | - Annette Verster
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
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47
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Hibbert M, Simmons R, Harris H, Desai M, Sabin CA, Mandal S. Investigating rates and risk factors for hepatitis C virus reinfection in people receiving antiviral treatment in England. J Viral Hepat 2023; 30:646-655. [PMID: 36929670 DOI: 10.1111/jvh.13835] [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: 09/23/2022] [Revised: 02/06/2023] [Accepted: 03/11/2023] [Indexed: 03/18/2023]
Abstract
England has committed to the World Health Organization target to eliminate hepatitis C virus (HCV) as a public threat by the year 2030. Given successful treatments for HCV in recent years, it is unclear whether HCV reinfection will impact England's ability to achieve HCV elimination. We aimed to estimate the HCV reinfection rate among a cohort of patients receiving antiviral treatment using available surveillance data. Linkage between a treatment dataset from 2015 to 2019 and an HCV RNA testing dataset were used to identify people who experienced reinfection using three criteria. A Cox proportional hazards model was used to determine risk factors associated with HCV reinfection among a cohort who received treatment and had follow-up HCV RNA testing. The reinfection rate among those receiving HCV treatment was 7.91 per 100 person-years (PYs, 95% confidence interval (CI) 7.37-8.49) and highest among current injecting drug users (22.55 per 100 PYs, 95% CI 19.98-25.46) and people who had been in prison (20.42 per 100 PYs, 95% CI 17.21-24.24). In the adjusted model, women had a significantly reduced risk of reinfection. Being of younger age, current injecting drug users, and receipt of first treatment in prison were each significantly associated with increased risk of reinfection. Two-fifths of those with reinfection (43%, n = 329/767) were linked to treatment after reinfection, and of those starting treatment, three quarters (75%, n = 222/296) achieved a sustained virologic response. Guidance for testing groups at risk of reinfection and harm reduction strategies to minimize transmission should be implemented if England is to achieve HCV elimination targets.
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Affiliation(s)
- Matthew Hibbert
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, UK Health Security Agency (UKHSA), London, UK
- National Institute for Health and Care Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London in partnership with UKHSA, London, UK
| | - Ruth Simmons
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, UK Health Security Agency (UKHSA), London, UK
- National Institute for Health and Care Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London in partnership with UKHSA, London, UK
| | - Helen Harris
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, UK Health Security Agency (UKHSA), London, UK
| | - Monica Desai
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, UK Health Security Agency (UKHSA), London, UK
- National Institute for Health and Care Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London in partnership with UKHSA, London, UK
| | - Caroline A Sabin
- National Institute for Health and Care Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London in partnership with UKHSA, London, UK
- Institute for Global Health, University College London, London, UK
| | - Sema Mandal
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, UK Health Security Agency (UKHSA), London, UK
- National Institute for Health and Care Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London in partnership with UKHSA, London, UK
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48
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Carpenter JE, Catalanotti J, Notis M, Brokus C, Moran TP, Akselrod H, Burkholder G, Eaton EF, Kuo I, Mai W, McGonigle K, Steck A, del Rio C, Saag M, Kottilil S, Masur H, Kattakuzhy S, Rosenthal ES. Use of nonstigmatizing language is associated with improved outcomes in hospitalized people who inject drugs. J Hosp Med 2023; 18:670-676. [PMID: 37286190 PMCID: PMC10524912 DOI: 10.1002/jhm.13146] [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: 02/03/2023] [Revised: 05/11/2023] [Accepted: 05/24/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Stigma surrounding opioid use disorder (OUD) is a barrier to treatment. The use of stigmatizing language may be evidence of negative views toward patients. OBJECTIVE We aimed to identify associations between language and clinical outcomes in patients admitted for infectious complications of OUD. DESIGNS We performed a retrospective medical record review. SETTINGS AND PARTICIPANTS Four U.S. academic health systems. Participants were patients with OUD admitted for infectious complications of injection opioid use from January 1, 2018, to December 31, 2018, identified through international classification of diseases, 10th revision codes consistent with OUD and acute bacterial/fungal infection. MAIN OUTCOME AND MEASURES Discharge summaries were reviewed for language, specifically: abuse, addiction, dependence, misuse, use disorder, intravenous drug use, and others. Binary outcomes including medication for OUD, planned discharge, naloxone provision, and an OUD treatment plan were evaluated using logistic regressions and admission duration was evaluated using Gamma regression. RESULTS A total of 1285 records were reviewed and 328 met inclusion criteria. Of those, 191 (58%) were male, with a median age of 38 years. The most common term was "abuse" (219, 67%), whereas "use disorder" was recorded in 75 (23%) records. Having "use disorder" in the discharge summary was associated with increased odds of having a documented plan for ongoing OUD treatment (adjusted odds ratio [AOR]: 4.11, 95% confidence interval [CI]: 1.89-8.93) and having a documented plan for addiction-specific follow-up care (AOR: 2.31, 95% CI: 1.30-4.09). CONCLUSIONS Stigmatizing language was common in this study of patients hospitalized for infectious complications of OUD. Best-practice language was uncommon, but when used was associated with increased odds of addiction treatment and specialty care referrals.
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Affiliation(s)
- Joseph E. Carpenter
- Department of Emergency Medicine, Emory University School
of Medicine
- Grady Health System, Atlanta GA
| | - Jillian Catalanotti
- Department of Medicine, The George Washington School of
Medicine and Health Sciences
| | - Melissa Notis
- Department of Medicine, The George Washington School of
Medicine and Health Sciences
| | - Christopher Brokus
- Division of Clinical Care and Research, Institute of Human
Virology, University of Maryland School of Medicine, Baltimore
| | - Timothy P. Moran
- Department of Emergency Medicine, Emory University School
of Medicine
| | - Hana Akselrod
- Department of Medicine, The George Washington School of
Medicine and Health Sciences
| | - Greer Burkholder
- Division of Infectious Diseases, University of Alabama at
Birmingham
| | - Ellen F. Eaton
- Division of Infectious Diseases, University of Alabama at
Birmingham
| | - Irene Kuo
- Department of Epidemiology, Milken Institute of Public
Health, The George Washington University
| | - William Mai
- Department of Medicine, The George Washington School of
Medicine and Health Sciences
| | - Keanan McGonigle
- Department of Medicine, The George Washington School of
Medicine and Health Sciences
| | - Alaina Steck
- Department of Emergency Medicine, Emory University School
of Medicine
- Grady Health System, Atlanta GA
| | - Carlos del Rio
- Division of Infectious Diseases, Emory University School
of Medicine
- Grady Health System, Atlanta GA
| | - Michael Saag
- Division of Infectious Diseases, University of Alabama at
Birmingham
| | - Shyamasundaran Kottilil
- Division of Clinical Care and Research, Institute of Human
Virology, University of Maryland School of Medicine, Baltimore
| | - Henry Masur
- Critical Care Medicine Department, National Institutes of
Health
| | - Sarah Kattakuzhy
- Division of Clinical Care and Research, Institute of Human
Virology, University of Maryland School of Medicine, Baltimore
| | - Elana S Rosenthal
- Division of Clinical Care and Research, Institute of Human
Virology, University of Maryland School of Medicine, Baltimore
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49
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Lee P, Docrat A. Prevalence and shared risk factors of HIV in three key populations in Vietnam: A systematic review and meta-analysis. Epidemiol Infect 2023; 151:e138. [PMID: 37525376 PMCID: PMC10540180 DOI: 10.1017/s0950268823001243] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 07/18/2023] [Accepted: 07/23/2023] [Indexed: 08/02/2023] Open
Abstract
This study aims to estimate the prevalence of HIV among each of the three key populations in Vietnam: people who inject drugs (PWID), female sex workers (FSW), and men who have sex with men (MSM) and quantify their shared risk factors for HIV infection through a systematic review and meta-analysis of recent literature (published in 2001-2017) in the relevant topics. A total of 17 studies consisting of 16,304 participants were selected in this review. The meta-analysis results revealed that the pooled prevalence estimates with 95% confidence intervals (CIs) among PWID, FSW, and MSM were: 0.293 (0.164, 0.421), 0.075 (0.060, 0.089), and 0.085 (0.044, 0.126), respectively. The findings also indicated that injecting drug use (OR: 9.88, 95%CI: 4.47-15.28), multiperson use of injecting equipment (OR: 2.91, 95%CI: 1.69, 4.17), and inconsistent condom use (OR: 2.11, 95%CI: 1.33, 2.90) were the shared risk factors for HIV infection among these population groups. The findings highlighted the importance of HIV prevention approaches to addressing the shared sexual and drug-related practices among the key populations in consideration of their overlapping social networks.
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Affiliation(s)
- Patricia Lee
- School of Medicine & Dentistry, Griffith University, Gold Coast, QLD, Australia
- Department of Medical Research, China Medical University Hospital, Taichung City, Taiwan
| | - Ashraf Docrat
- School of Medicine & Dentistry, Griffith University, Gold Coast, QLD, Australia
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50
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Palma-Álvarez RF, Daigre C, Ballabriga- Córdoba T, Monterde-Ochoa E, Sierra-Fortuny M, Cantillo M, Pelaez M, Castrillo E, Camañes L, Roncero C, Ramos-Quiroga JA, Grau-López L. CLINICAL VIEW ON SUBSTANCE-INDUCED PSYCHOTIC SYMPTOMS IN A MEDICALLY SUPERVISED INJECTING ROOM: A DECADE OF EXPERIENCE. Actas Esp Psiquiatr 2023; 51:188-191. [PMID: 37817739 PMCID: PMC10803840] [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] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 07/01/2023] [Indexed: 10/12/2023]
Abstract
Medically supervised injecting rooms (MSIRs) are extremely important facilities for people who inject drugs (PWID) as MSIRs provide a safe place for the consumption of street-sourced drugs, impacting overdose rates and viral transmitted infections.
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Affiliation(s)
- Raul F. Palma-Álvarez
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
| | - Constanza Daigre
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
| | | | | | | | - Miguel Cantillo
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Manuel Pelaez
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Eduardo Castrillo
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Laura Camañes
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Carlos Roncero
- Psychiatry Service, University of Salamanca Health Care Complex, Insitute of Biomedicine, Salamanca, Spain
- Psychiatry Unit, School of Medicine, University of Salamanca, Salamanca, Spain
| | - Josep A. Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
| | - Lara Grau-López
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
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