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Frost MC, Sweek EW, Austin EJ, Corcorran MA, Juarez AM, Frank ND, Prohaska SM, LaKosky PA, Asher AK, Broz D, Jarlais DCD, Williams EC, Glick SN. Program Adaptations to Provide Harm Reduction Services During the COVID-19 Pandemic: A Qualitative Study of Syringe Services Programs in the U.S. AIDS Behav 2022; 26:57-68. [PMID: 34110506 PMCID: PMC8190167 DOI: 10.1007/s10461-021-03332-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 01/19/2023]
Abstract
Syringe services programs (SSPs) are essential to preventing injection drug use-related infections and overdose death among people who use drugs (PWUD). The novel coronavirus (COVID-19) pandemic initially impeded SSPs' operations. To effectively support these programs, information is needed regarding SSPs' experiences adapting their services and the challenges posed by COVID-19. We conducted qualitative interviews with leadership and staff from a sample of 31 U.S. SSPs. Respondents discussed urgent concerns including reduced reach of services, suspended HIV/hepatitis C testing, high COVID-19 risk among PWUD, and negative impacts of isolation on overdose and mental health. They also noted opportunities to improve future services for PWUD, including shifting to evidence-based distribution practices and maintaining regulatory changes that increased access to opioid use disorder medications post-pandemic. Findings can inform efforts to support SSPs in restoring and expanding services, and provide insight into SSPs' role in engaging PWUD during the COVID-19 response and future emergencies.
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Affiliation(s)
- Madeline C Frost
- Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Elsa W Sweek
- Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA
| | - Elizabeth J Austin
- Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA
| | - Maria A Corcorran
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, WA, USA
| | - Alexa M Juarez
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, WA, USA
| | - Noah D Frank
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Paul A LaKosky
- Dave Purchase Project, North American Syringe Exchange Network, Tacoma, WA, USA
| | - Alice K Asher
- Office of Policy, Planning and Partnerships, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention , Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dita Broz
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention , Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Don C Des Jarlais
- School of Global Public Health, New York University, New York, NY, USA
| | - Emily C Williams
- Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Sara N Glick
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, WA, USA.
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Broz D, Carnes N, Chapin-Bardales J, Des Jarlais DC, Handanagic S, Jones CM, McClung RP, Asher AK. Syringe Services Programs' Role in Ending the HIV Epidemic in the U.S.: Why We Cannot Do It Without Them. Am J Prev Med 2021; 61:S118-S129. [PMID: 34686281 DOI: 10.1016/j.amepre.2021.05.044] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/18/2021] [Accepted: 05/23/2021] [Indexed: 11/17/2022]
Abstract
Diagnoses of HIV among people who inject drugs have increased in the U.S. during 2014-2018 for the first time in 2 decades, and multiple HIV outbreaks have been detected among people who inject drugs since 2015. These epidemiologic trends pose a significant concern for achieving goals of the federal initiative for Ending the HIV Epidemic in the U.S. Syringe services programs are cost effective, safe, and highly effective in reducing HIV transmission and are an essential component of a comprehensive, integrated approach to addressing these concerns. Yet, geographic coverage of these programs remains limited in the U.S., and many jurisdictions continue to have laws and policies that limit or disallow syringe services programs. An in-depth literature review was conducted on the role of syringe services programs in the Ending the HIV Epidemic initiative. Empirical and model-based evidence consistently shows that syringe services programs have the highest impact in HIV prevention when combined with access to medications for substance use disorder and antiretroviral therapy. Their effectiveness is further maximized when they provide services without restrictions and include proven and innovative strategies to expand access to harm-reduction and clinical services (e.g., peer outreach, telehealth). Increasing geographic and service coverage of syringe services programs requires strong and sustainable policy, funding, and community support and will need to address new challenges related to the COVID-19 pandemic. Syringe services programs have a key role in all 4 Ending the HIV Epidemic initiative strategies-Prevent, Diagnose, Treat, and Respond-and thus are instrumental to its success in preventing disease and saving lives.
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Affiliation(s)
- Dita Broz
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Neal Carnes
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Johanna Chapin-Bardales
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Don C Des Jarlais
- Department of Epidemiology, School of Global Health, New York University, New York, New York
| | - Senad Handanagic
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christopher M Jones
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia; U.S. Public Health Service Commissioned Corps, Rockville, Maryland
| | - R Paul McClung
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia; U.S. Public Health Service Commissioned Corps, Rockville, Maryland
| | - Alice K Asher
- Office of Policy, Planning and Partnerships, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Carnes NA, Asher AK, Bohm MK, Bessler PA. Access to HIV, Viral Hepatitis, and Substance Use Disorder Treatment/Overdose Prevention Services: A Qualitative Analysis of Syringe Service Programs (SSPs) Serving Rural PWID. Subst Use Misuse 2021; 56:1933-1940. [PMID: 34353216 PMCID: PMC10506068 DOI: 10.1080/10826084.2021.1958863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/20/2022]
Abstract
BACKGROUND Syringe service programs (SSP) increasingly serve rural areas of the United States, yet little is known about access and perceived need for their services. Objectives: This paper presents the HIV and viral hepatitis prevention, testing, and treatment, and, substance use disorder treatment and overdose prevention services offered at three SSPs and which services their clients accessed. Across the three SSPs, 45 clients (people who inject drugs [PWID]), 11 staff, and five stakeholders were interviewed. Results: Most clients (n = 34) reported accessing SSP services weekly and primarily for sterile syringes and injection-related supplies. All clients reported testing for HIV at least once, though concern for acquiring or transmitting HIV was divided between some or no concern. Most clients (n = 43) reported testing for hepatitis C virus (HCV). Concern for acquiring or transmitting HCV was also mixed. Vaccination for hepatitis A and/or B teetered around half (HAV: n = 23) to a third (HBV: n = 15). Most clients (n = 43) knew where to access the overdose countering medication, Narcan. Feelings about substance use treatment options varied, yet most felt not enough were available. Of note, not all assessed services were offered by the sampled SSPs. Conclusions/Importance: The findings help us understand PWIDs' rationale regarding services accessed and preference for particular services. The need for some services was not perceived by those at risk for the illness the services addressed. Discussing risk and providing tailored education is important when providing SSP services to rural residing PWIDs.
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Affiliation(s)
- Neal A. Carnes
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alice K. Asher
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michele K. Bohm
- Division of Unintentional Injury, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Patricia A. Bessler
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Holtzman D, Asher AK, Schillie S. The Changing Epidemiology of Hepatitis C Virus Infection in the United States During the Years 2010 to 2018. Am J Public Health 2021; 111:949-955. [PMID: 33734844 PMCID: PMC8034015 DOI: 10.2105/ajph.2020.306149] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Hepatitis C virus (HCV) infection remains an important cause of morbidity and mortality throughout the world, leading to serious health problems among those who are chronically infected. Since 1992, the Centers for Disease Control and Prevention has been collecting data on the incidence of HCV infection in the United States. In 2018, more than 50 000 individuals were estimated to have acute HCV infection.The most recently reported data on the prevalence of infection indicate that approximately 2.4 million people are living with hepatitis C in the United States. Transmission of HCV occurs predominantly through sharing contaminated equipment for injecting drugs.Two major events have had a significant impact on the incidence and prevalence of hepatitis C in the past few decades: the US opioid crisis and the discovery of curative treatments for HCV infection. To better understand the impact of these events, we examine reported trends in the incidence and prevalence of infection.
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Affiliation(s)
- Deborah Holtzman
- Deborah Holtzman was previously with the Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA. She was retired at the time the study was undertaken and the article was prepared. Alice K. Asher is with the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. At the time of the study, Sarah Schillie was with the Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. Note. The contents of this report on behalf of authors A. K. Asher and S. Schillie do not necessarily represent the official views of the CDC
| | - Alice K Asher
- Deborah Holtzman was previously with the Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA. She was retired at the time the study was undertaken and the article was prepared. Alice K. Asher is with the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. At the time of the study, Sarah Schillie was with the Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. Note. The contents of this report on behalf of authors A. K. Asher and S. Schillie do not necessarily represent the official views of the CDC
| | - Sarah Schillie
- Deborah Holtzman was previously with the Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA. She was retired at the time the study was undertaken and the article was prepared. Alice K. Asher is with the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. At the time of the study, Sarah Schillie was with the Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. Note. The contents of this report on behalf of authors A. K. Asher and S. Schillie do not necessarily represent the official views of the CDC
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5
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Cox AL, Page K, Melia M, Veenhuis R, Massaccesi G, Osburn W, Wagner K, Giudice L, Stein E, Asher AK, Vassilev V, Lin L, Nicosia A, Capone S, Scarselli E, Folgori A, Gorman R, Chang S, Wolff P, Liang TJ, Ghany M, Wierzbicki M, Lum P. LB10. A Randomized, Double-Blind, Placebo-Controlled Efficacy Trial of a Vaccine to Prevent Chronic Hepatitis C Virus Infection in an at-Risk Population. Open Forum Infect Dis 2019. [PMCID: PMC6809985 DOI: 10.1093/ofid/ofz415.2493] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
The development of a safe and effective vaccine to prevent chronic hepatitis C virus (HCV) infection is a critical component of elimination efforts, providing the rationale for the first HCV vaccine efficacy trial.
Methods
In a randomized, multicenter, double-blind, placebo-controlled efficacy trial (NCT01436357), we evaluated a recombinant chimpanzee adenovirus 3 vector vaccine prime followed by a recombinant modified vaccinia Ankara boost, both encoding nonstructural proteins of HCV. HCV-uninfected adults 18–45 years old at-risk for HCV infection due to injection drug use were randomized to receive the prime-boost regimen or placebo at Days 0 and 56. Trial participants were monitored for vaccine reactogenicity, adverse events, and HCV viremia. Vaccine safety, immunogenicity, and efficacy against progression to chronic HCV infection were assessed.
Results
A total of 455 subjects received the prime-boost regimen or two doses of placebo, with 202 and 199 in the respective groups included in the according-to-protocol efficacy cohort. Overall incidence of infection was 14.1 infections per 100 person-years. There were no differences in development of chronic infection between vaccine and placebo arms, with 14 chronically infected subjects in each group. Specifically, the vaccine efficacy in preventing chronic infection was −0.53 (95% confidence interval [CI], −2.5 to 0.34). Of vaccinated subjects, 78% generated T-cell responses to ≥1 vaccine-encoded HCV antigens. The vaccine was generally safe and well tolerated with no serious vaccine-related adverse events. There were more solicited reports of adverse events after either injection in the vaccine group (81%) than in the placebo group (59%), with the difference mainly due to injection-site reactions. Serious adverse events and deaths occurred with similar frequencies in the two groups.
Conclusion
A randomized, placebo controlled, Phase I/II trial of a prime-boost vaccine to prevent chronic HCV infection was completed in an at-risk population, demonstrating the feasibility of conducting rigorous vaccine research in people who inject drugs. The regimen elicited robust immune responses without evident safety concerns, but did not provide protection against chronic HCV infection.
Disclosures
Ventzislav Vassilev, PhD, GlaxoSmithKlein Vaccines (Employee), Lan Lin, MD, GlaxoSmithKlein Vaccines (Employee), Alfredo Nicosia, PhD, ReiThera (Employee, Shareholder), Antonella Folgori, PhD, ReiThera (Employee), ReiThera (Employee, Shareholder. Other Authors: No reported disclosures.
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Affiliation(s)
| | | | | | | | | | | | | | - Linda Giudice
- The University of California, San Francisco, San Francicso, California
| | - Ellen Stein
- The University of California, San Francisco, San Francicso, California
| | - Alice K Asher
- The University of California, San Francisco, San Francicso, California
| | | | - Lan Lin
- GlaxoSmithKline Vaccines, Wavre, Brussels Hoofdstedelijk Gewest, Belgium
| | | | | | | | | | - Richard Gorman
- The National Institute of Allergy and Infectious Diseases, Rockville, Maryland
| | - Soju Chang
- The National Institute of Allergy and Infectious Diseases, Rockville, Maryland
| | - Peter Wolff
- The National Institute of Allergy and Infectious Diseases, Rockville, Maryland
| | - T Jake Liang
- The National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - Marc Ghany
- The National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | | | - Paula Lum
- The University of California, San Francisco, San Francicso, California
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Bardossy AC, Gokhale RH, Hartnett K, Hatfield KM, Jackson KA, Felsen CB, McDonald R, Kracalik I, Lucas T, McGovern OL, Van Beneden C, Vallabhaneni S, Williams SR, Mendoza M, Bohm MK, Brooks J, Asher AK, Magill SS, Fiore A, Blog D, Dufort E, See I, Dumyati G. 1890. Missed Clinical Opportunities to Prevent Infections and Treat Substance Use Disorder (SUD) in People Who Inject Drugs (PWID). Open Forum Infect Dis 2019. [PMCID: PMC6808892 DOI: 10.1093/ofid/ofz359.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The age-adjusted rate of drug overdose deaths in the United States tripled from 1999 to 2016. Public health surveillance data indicate that an increasing proportion of infections due to bacterial and fungal pathogens is associated with injection drug use (IDU). We describe healthcare encounters (HCEs) of PWID as potential opportunities to prevent infections related to IDU by identifying risks and treating SUD, including with medication-assisted treatment (MAT) for opioid use disorder. Methods At six hospitals in western New York, we abstracted medical records from hospital admissions and emergency department (ED) visits for PWID (i.e., IDU in the preceding year) who had positive cultures for Staphylococcus aureus (any clinical specimen, April–July 2017), group A Streptococcus (invasive specimens, all of 2017) or Candida spp. (blood specimens, all of 2017). We reviewed hospital admission and ED records for 1 year preceding the positive culture to identify visits during which opportunities to prevent infection and treat SUD by addressing SUD and IDU were missed. Results We identified 99 PWID with positive cultures. The median age was 33 years (range 19–68) and 61 were female. Sixty-nine had a skin and soft-tissue infection, 44 had a bloodstream infection, and 20 had both. Thirty-one PWID left against medical advice during a hospital admission or an ED visit. Seventy-nine PWID were hospitalized, of whom 4 died. Ninety-five used opioids and 71 used cocaine in the preceding year. Seventy-five PWID had an HCE in the 12 months prior to the index visit, with a median of two HCE per person (interquartile range 1–4); 53 of PWID had a previous HCE for infection and 28 for opioid overdose. SUD was documented during a prior HCE at the same hospital for 61 PWID, but only 10 (16%) were offered MAT during any prior HCE and for 24 (39%) there was no documentation that any form of treatment for SUD was offered. Conclusion In this cohort, PWID frequently had one or more healthcare encounters documented at the same hospital in the year prior to a serious bacterial or fungal infection. These prior HCEs were often for infections or overdose that signaled the need for MAT, demonstrating that there are critical missed opportunities to identify risks, prevent infection, and treat SUD. Disclosures All Authors: No reported Disclosures.
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Affiliation(s)
- Ana C Bardossy
- Centers for Disease Control and Prevention, Decatur, Georgia
| | - Runa H Gokhale
- Centers for Disease Control and Prevention, Decatur, Georgia
| | | | - Kelly M Hatfield
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Kelly A Jackson
- Centers for Disease Control and Prevention, Decatur, Georgia
| | | | - Robert McDonald
- Centers for Disease Control and Prevention, Decatur, Georgia
| | - Ian Kracalik
- Centers for Disease Control and Prevention, Decatur, Georgia
| | - Todd Lucas
- Centers for Disease Control and Prevention, Decatur, Georgia
| | | | | | | | | | | | - Michele K Bohm
- Centers for Disease Control and Prevention, Decatur, Georgia
| | - John Brooks
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alice K Asher
- Centers for Disease Control and Prevention, Decatur, Georgia
| | | | - Anthony Fiore
- DIv of Healthcare Quality Promotion, Atlanta, Georgia
| | - Debra Blog
- New York State Department of Health, Albany, New York
| | | | - Isaac See
- Centers for Disease Control and Prevention, Decatur, Georgia
| | - Ghinwa Dumyati
- New York Rochester Emerging Infections Program at the University of Rochester Medical Center, Rochester, New York
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7
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Hartnett KP, Jackson KA, Felsen C, McDonald R, Bardossy AC, Gokhale RH, Kracalik I, Lucas T, McGovern O, Van Beneden CA, Mendoza M, Bohm M, Brooks JT, Asher AK, Magill SS, Fiore A, Blog D, Dufort EM, See I, Dumyati G. Bacterial and Fungal Infections in Persons Who Inject Drugs - Western New York, 2017. MMWR Morb Mortal Wkly Rep 2019; 68:583-586. [PMID: 31269011 PMCID: PMC6613572 DOI: 10.15585/mmwr.mm6826a2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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8
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Holmes JR, Clayton HB, Pham T, Asher AK, Starr RR. Prevalence of Risk and Protective Factors Associated with HIV and HCV Infections Among Male High School Students Who Have Sex with Males-Hawai'i, 2013, 2015, and 2017. Hawaii J Med Public Health 2019; 78:191-194. [PMID: 31205813 PMCID: PMC6554547] [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] [Indexed: 06/09/2023]
Abstract
Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections are increasing among young adults, and males who have sex with males (MSM) are at high risk for both infections. Limited Hawai'i data exists on the extent to which populations, such as MSM, are engaging in behaviors that place them at increased risk for either infection. This analysis quantified the proportion of Hawai'i public high school students who are MSM and are at risk for HCV and HIV infections. Data from the 2013, 2015, and 2017 Hawai'i Youth Risk Behavior Surveys (YRBS) were combined (n=16,751) to investigate the prevalence of risk factors associated with HIV and HCV infections (eg, sexual risk behaviors, substance use) and protective factors among MSM public high school students. Among sexually experienced male students (n=3,391), 13.1% were classified as MSM and among these, 40.3% identified as heterosexual despite reporting same-sex sexual contact. Multivariate modeling demonstrated that MSM students are significantly more likely than non-MSM students to engage in behaviors that increase their risk for HIV and HCV infections (composite risk variable; adjusted Prevalence Ratio: 1.40, 95% CI 1.15 - 1.70) and are significantly less likely to have protective factors. Evidence-based prevention strategies for reducing HIV and HCV risk behaviors while improving protective factors among sexual minority youth in Hawai'i are necessary and must address sexual behavior along with other dimensions of sexual orientation.
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Affiliation(s)
- Joshua R Holmes
- Surveillance, Evaluation, and Epidemiology Office, Chronic Disease Prevention and Health Promotion Division, Hawai'i State Department of Health, Honolulu, HI (JRH, RRS)
| | - Heather B Clayton
- School-based Surveillance Branch, Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, The Centers for Disease Control and Prevention, Atlanta, GA (HBC)
| | - Thaddeus Pham
- Harm Reduction Services Branch, Communicable Disease and Public Health Nursing Division, Hawai'i State Department of Health, Honolulu, HI (TP)
| | - Alice K Asher
- Epidemiology and Surveillance Branch, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, The Centers for Disease Control and Prevention, Atlanta, GA (AKA)
| | - Ranjani R Starr
- Surveillance, Evaluation, and Epidemiology Office, Chronic Disease Prevention and Health Promotion Division, Hawai'i State Department of Health, Honolulu, HI (JRH, RRS)
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9
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Zibbell JE, Asher AK, Patel RC, Kupronis B, Iqbal K, Ward JW, Holtzman D. Increases in Acute Hepatitis C Virus Infection Related to a Growing Opioid Epidemic and Associated Injection Drug Use, United States, 2004 to 2014. Am J Public Health 2018; 108:175-181. [PMID: 29267061 PMCID: PMC5846578 DOI: 10.2105/ajph.2017.304132] [Citation(s) in RCA: 476] [Impact Index Per Article: 79.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To compare US trends in rates of injection drug use (IDU), specifically opioid injection, with national trends in the incidence of acute HCV infection to assess whether these events correlated over time. METHODS We calculated the annual incidence rate and demographic and risk characteristics of reported cases of acute HCV infection using surveillance data from 2004 to 2014 and the annual percentage of admissions to substance use disorder treatment facilities reporting IDU for the same time period by type of drug injected and demographic characteristics. We then tested for trends. RESULTS The annual incidence rate of acute HCV infection increased more than 2-fold (from 0.3 to 0.7 cases/100 000) from 2004 to 2014, with significant increases among select demographic subgroups. Admissions for substance use disorder attributed to injection of heroin and prescription opioid analgesics increased significantly, with an almost 4-fold increase in prescription opioid analgesic injection. Significant increases in opioid injection mirrored those for reported cases of acute HCV infection among demographic subgroups. CONCLUSIONS These findings strongly suggest that the national increase in acute HCV infection is related to the country's opioid epidemic and associated increases in IDU.
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Affiliation(s)
- Jon E Zibbell
- Jon E. Zibbell is with the Behavioral and Urban Health Program, RTI International, Atlanta, GA. Alice K. Asher is with the Epidemiology, Surveillance and Prevention among Substance users Unit, Epidemiology and Surveillance Branch, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA. Rajiv C. Patel is a second year Medical Student with Virginia Commonwealth University, Richmond, VA. Ben Kupronis is with the Epidemiology and Surveillance Branch, Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention. Kashif Iqbal is with the Epidemiology Branch, Division of HIV/AIDS Prevention, NCHHSTP, Centers for Disease Control and Prevention. John W. Ward and Deborah Holtzman are with the Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention
| | - Alice K Asher
- Jon E. Zibbell is with the Behavioral and Urban Health Program, RTI International, Atlanta, GA. Alice K. Asher is with the Epidemiology, Surveillance and Prevention among Substance users Unit, Epidemiology and Surveillance Branch, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA. Rajiv C. Patel is a second year Medical Student with Virginia Commonwealth University, Richmond, VA. Ben Kupronis is with the Epidemiology and Surveillance Branch, Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention. Kashif Iqbal is with the Epidemiology Branch, Division of HIV/AIDS Prevention, NCHHSTP, Centers for Disease Control and Prevention. John W. Ward and Deborah Holtzman are with the Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention
| | - Rajiv C Patel
- Jon E. Zibbell is with the Behavioral and Urban Health Program, RTI International, Atlanta, GA. Alice K. Asher is with the Epidemiology, Surveillance and Prevention among Substance users Unit, Epidemiology and Surveillance Branch, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA. Rajiv C. Patel is a second year Medical Student with Virginia Commonwealth University, Richmond, VA. Ben Kupronis is with the Epidemiology and Surveillance Branch, Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention. Kashif Iqbal is with the Epidemiology Branch, Division of HIV/AIDS Prevention, NCHHSTP, Centers for Disease Control and Prevention. John W. Ward and Deborah Holtzman are with the Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention
| | - Ben Kupronis
- Jon E. Zibbell is with the Behavioral and Urban Health Program, RTI International, Atlanta, GA. Alice K. Asher is with the Epidemiology, Surveillance and Prevention among Substance users Unit, Epidemiology and Surveillance Branch, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA. Rajiv C. Patel is a second year Medical Student with Virginia Commonwealth University, Richmond, VA. Ben Kupronis is with the Epidemiology and Surveillance Branch, Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention. Kashif Iqbal is with the Epidemiology Branch, Division of HIV/AIDS Prevention, NCHHSTP, Centers for Disease Control and Prevention. John W. Ward and Deborah Holtzman are with the Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention
| | - Kashif Iqbal
- Jon E. Zibbell is with the Behavioral and Urban Health Program, RTI International, Atlanta, GA. Alice K. Asher is with the Epidemiology, Surveillance and Prevention among Substance users Unit, Epidemiology and Surveillance Branch, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA. Rajiv C. Patel is a second year Medical Student with Virginia Commonwealth University, Richmond, VA. Ben Kupronis is with the Epidemiology and Surveillance Branch, Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention. Kashif Iqbal is with the Epidemiology Branch, Division of HIV/AIDS Prevention, NCHHSTP, Centers for Disease Control and Prevention. John W. Ward and Deborah Holtzman are with the Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention
| | - John W Ward
- Jon E. Zibbell is with the Behavioral and Urban Health Program, RTI International, Atlanta, GA. Alice K. Asher is with the Epidemiology, Surveillance and Prevention among Substance users Unit, Epidemiology and Surveillance Branch, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA. Rajiv C. Patel is a second year Medical Student with Virginia Commonwealth University, Richmond, VA. Ben Kupronis is with the Epidemiology and Surveillance Branch, Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention. Kashif Iqbal is with the Epidemiology Branch, Division of HIV/AIDS Prevention, NCHHSTP, Centers for Disease Control and Prevention. John W. Ward and Deborah Holtzman are with the Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention
| | - Deborah Holtzman
- Jon E. Zibbell is with the Behavioral and Urban Health Program, RTI International, Atlanta, GA. Alice K. Asher is with the Epidemiology, Surveillance and Prevention among Substance users Unit, Epidemiology and Surveillance Branch, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA. Rajiv C. Patel is a second year Medical Student with Virginia Commonwealth University, Richmond, VA. Ben Kupronis is with the Epidemiology and Surveillance Branch, Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention. Kashif Iqbal is with the Epidemiology Branch, Division of HIV/AIDS Prevention, NCHHSTP, Centers for Disease Control and Prevention. John W. Ward and Deborah Holtzman are with the Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention
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Asher AK, Portillo CJ, Cooper BA, Dawson-Rose C, Vlahov D, Page KA. Clinicians' Views of Hepatitis C Virus Treatment Candidacy With Direct-Acting Antiviral Regimens for People Who Inject Drugs. Subst Use Misuse 2016; 51:1218-23. [PMID: 27219274 PMCID: PMC6907073 DOI: 10.3109/10826084.2016.1161054] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Direct-acting antivirals (DAAs) are curative in most persons with chronic hepatitis C virus (HCV) infection. However, high cost and concerns about adherence and reinfection may present continued barriers to treatment, particularly for people who inject drugs (PWID). OBJECTIVE To understand changes in assessments of treatment candidacy, given advances in treatment. METHODS Clinicians attending the Liver Meeting® in 2014 who reported prescribing HCV treatment in the past three years were invited to complete a survey regarding HCV treatment decisions. Participants assessed their likelihood to treat HCV in PWID in association with time of abstinence from injection drug use and what impacts their decision to provide treatment using interferon and DAAs. RESULTS 108 clinicians completed the survey; 10% were willing to treat an active PWID (last injection within 30 days) using interferon-containing regimens, and 15% with all-oral regimens. For each increasing time interval of injection abstinence, there was an increase in the odds of a clinician reporting willingness to treat with DAAs (Odds Ratio (OR) 2.57, 95% CI 2.18, 3.03) and with interferon-based treatment (OR 2.22 (95% CI 1.90, 2.61), Reinfection and medication cost were cited as most important concerns when determining candidacy. CONCLUSIONS A cure is now the norm in HCV treatment, and there is an increasing need to address the barriers to treating PWID, the population with the highest burden of infection. Understanding treatment candidacy assessments is essential to improving uptake. This study provides insight into how clinicians view treatment candidacy in this era of DAAs and can help identify supportive treatment environments and concurrent programs.
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Affiliation(s)
- Alice K Asher
- a School of Nursing , University of California, San Francisco , San Francisco , California , USA.,b Institute for Global Health , University of California, San Francisco , San Francisco , California , USA
| | - Carmen J Portillo
- a School of Nursing , University of California, San Francisco , San Francisco , California , USA
| | - Bruce A Cooper
- a School of Nursing , University of California, San Francisco , San Francisco , California , USA
| | - Carol Dawson-Rose
- a School of Nursing , University of California, San Francisco , San Francisco , California , USA
| | - David Vlahov
- a School of Nursing , University of California, San Francisco , San Francisco , California , USA
| | - Kimberly A Page
- c Biostatistics & Preventive Medicine , University of New Mexico Health Sciences Center , Albuquerque , New Mexico , USA
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Webel AR, Cuca Y, Okonsky JG, Asher AK, Kaihura A, Salata RA. The impact of social context on self-management in women living with HIV. Soc Sci Med 2013; 87:147-54. [PMID: 23631790 PMCID: PMC3656470 DOI: 10.1016/j.socscimed.2013.03.037] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [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: 08/07/2012] [Revised: 02/18/2013] [Accepted: 03/25/2013] [Indexed: 02/06/2023]
Abstract
HIV self-management is central to the health of people living with HIV and is comprised of the daily tasks individuals employ to manage their illness. Women living with HIV are confronted with social context vulnerabilities that impede their ability to conduct HIV self-management behaviors, including demanding social roles, poverty, homelessness, decreased social capital, and limited access to health care. We examined the relationship between these vulnerabilities and HIV self-management in a cross-sectional secondary analysis of 260 women living with HIV from two U.S. sites. All social context variables were assessed using validated self-report scales. HIV Self-Management was assessed using the HIV Self-Management Scale that measures daily health practices, HIV social support, and the chronic nature of HIV. Data were analyzed using appropriate descriptive statistics and multivariable regression. Mean age was 46 years and 65% of participants were African-American. Results indicated that social context variables, particularly social capital, significantly predicted all domains of HIV self-management including daily health practices (F = 5.40, adjusted R(2) = 0.27, p < 0.01), HIV social support (F = 4.50, adjusted R(2) = 0.22, p < 0.01), and accepting the chronic nature of HIV (F = 5.57, adjusted R(2) = 0.27, p < 0.01). We found evidence to support the influence of the traditional social roles of mother and employee on the daily health practices and the chronic nature of HIV domains of HIV self-management. Our data support the idea that women's social context influences their HIV self-management behavior. While social context has been previously identified as important, our data provide new evidence on which aspects of social context might be important targets of self-management interventions for women living with HIV. Working to improve social capital and to incorporate social roles into the daily health practices of women living with HIV may improve the health of this population.
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Affiliation(s)
- Allison R. Webel
- Frances Payne Bolton School of Nursing Case Western Reserve University, 10900 Euclid Avenue Cleveland, OH 44106-4904, USA, Fax: 216-368-3542, Phone: 216-368-3939
| | - Yvette Cuca
- Department of Social and Behavioral Sciences, University of California, San Francisco 3333 California St., Suite 455, San Francisco, CA 94118, USA
| | - Jennifer G. Okonsky
- Department of Community Health Systems University of California, San Francisco School of Nursing 2 Koret Way Suite #N-505 San Francisco, CA 94143-0608, USA
| | - Alice K. Asher
- Department of Community Health Systems University of California, San Francisco School of Nursing 2 Koret Way Suite #N-505 San Francisco, CA 94143-0608, USA
- Institute for Global Health University of California, San Francisco 50 Beale Street, Suite 1200 San Francisco, CA 94105, USA
| | - Alphoncina Kaihura
- Department of Community Health Systems University of California, San Francisco School of Nursing 2 Koret Way Suite #N-505 San Francisco, CA 94143-0608, USA
| | - Robert A. Salata
- Division of Infectious Diseases and HIV Medicine, Case Western Reserve University, 10900 Euclid Avenue Cleveland, OH 44106, USA
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Asher AK, Hahn JA, Couture MC, Maher K, Page K. people who inject drugs, HIV risk, and HIV testing uptake in sub-Saharan Africa. J Assoc Nurses AIDS Care 2012; 24:e35-44. [PMID: 23164598 DOI: 10.1016/j.jana.2012.09.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 09/14/2012] [Indexed: 10/27/2022]
Abstract
Dramatic rises in injection drug use (IDU) in sub-Saharan Africa account for increasingly more infections in a region already overwhelmed by the HIV epidemic. There is no known estimate of the number of people who inject drugs (PWID) in the region, or the associated HIV prevalence in PWID. We reviewed literature with the goal of describing high-risk practices and exposures in PWID in sub-Saharan Africa, as well as current HIV prevention activities aimed at drug use. The literature search looked for articles related to HIV risk, injection drug users, stigma, and HIV testing in sub-Saharan Africa. This review found evidence demonstrating high rates of HIV in IDU populations in sub-Saharan Africa, high-risk behaviors of the populations, lack of knowledge regarding HIV, and low HIV testing uptake. There is an urgent need for action to address IDU in order to maintain recent decreases in the spread of HIV in sub-Saharan Africa.
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