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Lira JAS, Goodman-Meza D. Overdose and COVID-19 in Baja California, Mexico: The Need for New Methodologies for Understanding Local Trends. Am J Public Health 2024; 114:590-592. [PMID: 38718336 PMCID: PMC11079839 DOI: 10.2105/ajph.2024.307672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Affiliation(s)
- Jaime Arredondo Sanchez Lira
- Jaime Arredondo Sanchez Lira is an assistant professor at the School of Public Health and Social Policy, University of Victoria, British Columbia, Canada, and a Canada research chair on substance use and health systems at the Canadian Institute of Substance Use Research. David Goodman-Meza is with the Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - David Goodman-Meza
- Jaime Arredondo Sanchez Lira is an assistant professor at the School of Public Health and Social Policy, University of Victoria, British Columbia, Canada, and a Canada research chair on substance use and health systems at the Canadian Institute of Substance Use Research. David Goodman-Meza is with the Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
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Sundaram G, Sato T, Goodman-Meza D, Haddad M, Thakarar K, Feinberg J, Springer SA, Barton K, Butler N, Eaton EF, Wurcel AG. Perspectives on benefits and risks of creation of an "injection drug use" billing code. J Subst Use Addict Treat 2024:209392. [PMID: 38735482 DOI: 10.1016/j.josat.2024.209392] [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] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 05/09/2024] [Indexed: 05/14/2024]
Abstract
People with substance use disorder (SUD) face barriers to prevention and treatment services, increasing risk for hospitalization and death. Injection drug use (IDU) can lead to an increased risk of overdose and infections. However, identifying people who inject drugs (PWID) within healthcare systems is challenging. International Classification of Disease (ICD-10) codes are used for billing and tracking healthcare utilization. In this commentary, experts in the field weigh the benefits and risks of creating an IDU-specific ICD-10 code. Potential benefits include earlier identification, better access to health services, and improved systems of resource allocation. Potential risks include further stigmatization of PWID and, if not tied to financial reimbursement, low rates of code utilization. As the current systems of identifying PWID are lacking, we feel that a guided operationalization of an ICD code to identify PWID could improve quantitative and epidemiological research accuracy and, therefore, support the health and well-being of PWID.
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Affiliation(s)
- Gayathri Sundaram
- Tufts University School of Medicine, Boston, MA, United States of America
| | - Taisuke Sato
- Tufts Medical Center, Boston, MA, United States of America
| | - David Goodman-Meza
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Marwan Haddad
- Center for Key Populations, Community Health Center, Inc., Middletown, CT, United States of America
| | - Kinna Thakarar
- Tufts University School of Medicine, Boston, MA, United States of America; Maine Health Institute of Research, Portland, ME, United States of America; Maine Medical Center, Portland, ME, United States of America; Maine Medical Partners Adult Infectious Diseases, South Portland, ME, United States of America; West Virginia University School of Medicine, Morgantown, WV, United States of America
| | - Judith Feinberg
- West Virginia University School of Medicine, Morgantown, WV, United States of America
| | - Sandra A Springer
- Yale University School of Medicine, New Haven, CT, United States of America; Yale University School of Public Health, New Haven, CT, United States of America
| | - Kerri Barton
- Harm Reduction Program Coordinator, Portland Public Health, Portland, ME, United States of America
| | - Nikki Butler
- Maine Access Points, Portland, ME, United States of America
| | - Ellen F Eaton
- University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Alysse G Wurcel
- Tufts University School of Medicine, Boston, MA, United States of America; Tufts Medical Center, Boston, MA, United States of America.
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Shover CL, Friedman JR, Romero R, Jimenez S, Beltran J, Garcia C, Goodman-Meza D. Leveraging pooled medical examiner records to surveil complex and emerging patterns of polysubstance use in the United States. Int J Drug Policy 2024:104397. [PMID: 38729890 DOI: 10.1016/j.drugpo.2024.104397] [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: 01/21/2023] [Revised: 03/06/2024] [Accepted: 03/18/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND The United States (US) is an extreme global outlier for drug-related death rates. However, data describing drug-related deaths are generally available only on an 8-13-month lag. Furthermore, granular details about substance-involvement are often not available, which particularly stymies efforts to track fatal polysubstance and novel psychoactive substance use. Detailed medical examiner records provide a powerful source of information for drug-related death surveillance, but have been underutilized. METHODS We pooled medical examiner data from five US states and 14 counties that together comprise 18% of the US population to examine demographic, geographic, and drug-specific trends in polysubstance drug-related deaths. We employed mixed effects logistic regression to identify demographic factors associated with polysubstance rather than single substance drug-related deaths. We assessed the correlations between drug classes and described geographic variation in the prevalence of specific drugs and the presence of novel and emerging psychoactive substances. RESULTS Our sample included 73,077 drug-related deaths from 2012 through early 2022. Nearly two-thirds of drug-related deaths were polysubstance-involved, with the number and percentage growing annually. High percentages of polysubstance drug-related deaths were observed in both urban and rural jurisdictions. After adjusting for year and jurisdiction, female, American Indian and Alaska Native, and White individuals had the most elevated odds of polysubstance drug-related deaths. Drug-related deaths involving benzodiazepines or opioids, whether pharmaceutical or illicit, and other pharmaceutical drugs were most likely to have polysubstance involvement, while methamphetamine-involved deaths were least likely to involve multiple substances. Strong correlations were observed between prescription opioids and prescription benzodiazepines, fentanyl and xylazine, and designer benzodiazepines and novel synthetic opioids. CONCLUSIONS Analysis of detailed medical examiner records reveals the breadth and complexity of polysubstance drug-related deaths in the US. Future efforts to use this unique resource can improve population-based surveillance of drug-related deaths to better tailor interventions and solutions to this critical health crisis.
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Affiliation(s)
- Chelsea L Shover
- David Geffen School of Medicine at University of California Los Angeles, Division of General Internal Medicine and Health Services Research, United States.
| | - Joseph R Friedman
- David Geffen School of Medicine at University of California Los Angeles, Center for Social Medicine, United States
| | - Ruby Romero
- David Geffen School of Medicine at University of California Los Angeles, Division of General Internal Medicine and Health Services Research, United States
| | - Sergio Jimenez
- Fielding School of Public Health at University of California Los Angeles, Department of Epidemiology, United States
| | - Jacqueline Beltran
- Fielding School of Public Health at University of California Los Angeles, Department of Community Health Sciences, United States
| | - Candelaria Garcia
- Fielding School of Public Health at University of California Los Angeles, Department of Epidemiology, United States
| | - David Goodman-Meza
- David Geffen School of Medicine at University of California Los Angeles, Division of Infectious Diseases
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Avra T, Cowan A, Friedman J, Fukushima J, Nelson A, Truman K, Stevens A, Bourgois P, Hansen H, Shover C, Goodman-Meza D. Decreasing Stigma Toward People Who Inject Drugs: Harm Reduction Training for First-Year Medical Students. Acad Med 2024:00001888-990000000-00776. [PMID: 38412474 DOI: 10.1097/acm.0000000000005675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
PROBLEM Stigma in health care toward people who inject drugs (PWID) is a well described, significant barrier to quality care, resulting in poor health outcomes. Harm reduction offers a person-centered counter-framework for minimizing harm for people who use drugs. Despite the evidence in support of harm reduction, medical students typically receive minimal training on harm reduction and the care of PWID. APPROACH To fill this gap, medical students at University of California, Los Angeles organized around the principles of harm reduction to improve the medical school curriculum related to PWID. Students screened lectures for stigmatizing language and collaborated with faculty to improve lecture materials. They partnered with a community organizer and hosted a mandatory 1-hour lecture and 30-minute discussion introducing the principles of harm reduction within an overdose prevention, recognition, and response training for first-year medical students during medical school orientation in August 2022. An anonymous online pre- and posttest survey, assessing student attitudes toward PWID, was used to evaluate the effects of the training. OUTCOMES A total of 156 students completed the pretest survey, and 107 students completed the pre- and posttest survey (68.5% response rate). The overall posttest mean stigma score was 1.8 (standard deviation [SD] = 0.5) and was significantly lower than the pretest mean of 2.1 (SD = 0.7; P < .0001), indicating a reduction in stigma among medical student attitudes after the course. There was statistically significant improvement in attitudes for 7 of 13 component measures. NEXT STEPS This analysis demonstrated that the mandatory class has the capacity to improve medical student attitudes toward PWID. The authors plan to further evaluate the program's effectiveness through measuring and reporting outcomes for future student cohorts. The authors are working with curriculum directors to further incorporate harm reduction principles into other lectures and problem-based learning exercises.
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Affiliation(s)
- Tucker Avra
- T. Avra is a medical student, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Amanda Cowan
- A. Cowan is executive director, Los Angeles Community Health Project, Los Angeles, California
| | - Joseph Friedman
- J. Friedman is an MD/PhD student, Center for Social Medicine and Humanities, University of California, Los Angeles, Los Angeles, California
| | - Jack Fukushima
- J. Fukushima is a medical student, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Andrew Nelson
- A. Nelson is a medical student, School of Osteopathic Medicine, A.T. Still University, Mesa, Arizona
| | - Kyla Truman
- K. Truman is a medical student, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Autumn Stevens
- A. Stevens is a graduate student, Antioch University Los Angeles, Los Angeles, California
| | - Philippe Bourgois
- P. Bourgois is professor of anthropology and director, Center for Social Medicine and Humanities, Department of Psychiatry, University of California, Los Angeles, Los Angeles, California
| | - Helena Hansen
- H. Hansen is interim chair, Department of Psychiatry and Biobehavioral Sciences, and interim director, UCLA Semel Institute for Neuroscience and Human Behavior, professor of psychiatry and biobehavioral sciences and co-chair of research theme in translational social science and health equity, David Geffen School of Medicine, University of California, Los Angeles, and interim physician-in-chief, Resnick Neuropsychiatric Hospital, Los Angeles, California
| | - Chelsea Shover
- C. Shover is assistant professor-in-residence, Department of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - David Goodman-Meza
- D. Goodman-Meza is assistant professor, UCLA Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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Goodman-Meza D, Shoptaw S, Hanscom B, Smith LR, Andrew P, Kuo I, Lake JE, Metzger D, Morrison EAB, Cummings M, Fogel JM, Richardson P, Harris J, Heitner J, Stansfield S, El-Bassel N. Delivering integrated strategies from a mobile unit to address the intertwining epidemics of HIV and addiction in people who inject drugs: the HPTN 094 randomized controlled trial protocol (the INTEGRA Study). Trials 2024; 25:124. [PMID: 38360750 PMCID: PMC10870682 DOI: 10.1186/s13063-023-07899-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 12/22/2023] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Persons with opioid use disorders who inject drugs (PWID) in the United States (US) face multiple and intertwining health risks. These include interference with consistent access, linkage, and retention to health care including medication for opioid use disorder (MOUD), HIV prevention using pre-exposure prophylaxis (PrEP), and testing and treatment for sexually transmitted infections (STIs). Most services, when available, including those that address substance misuse, HIV prevention, and STIs, are often provided in multiple locations that may be difficult to access, which further challenges sustained health for PWID. HPTN 094 (INTEGRA) is a study designed to test the efficacy of an integrated, "whole-person" strategy that provides integrated HIV prevention including antiretroviral therapy (ART), PrEP, MOUD, and STI testing and treatment from a mobile health delivery unit ("mobile unit") with peer navigation compared to peer navigation alone to access these services at brick and mortar locations. METHODS HPTN 094 (INTEGRA) is a two-arm, randomized controlled trial in 5 US cities where approximately 400 PWID without HIV are assigned either to an experimental condition that delivers 26 weeks of "one-stop" integrated health services combined with peer navigation and delivered in a mobile unit or to an active control condition using peer navigation only for 26 weeks to the same set of services delivered in community settings. The primary outcomes include being alive and retained in MOUD and PrEP at 26 weeks post-randomization. Secondary outcomes measure the durability of intervention effects at 52 weeks following randomization. DISCUSSION This trial responds to a need for evidence on using a "whole-person" strategy for delivering integrated HIV prevention and substance use treatment, while testing the use of a mobile unit that meets out-of-treatment PWID wherever they might be and links them to care systems and/or harm reduction services. Findings will be important in guiding policy for engaging PWID in HIV prevention or care, substance use treatment, and STI testing and treatment by addressing the intertwined epidemics of addiction and HIV among those who have many physical and geographic barriers to access care. TRIAL REGISTRATION ClinicalTrials.gov NCT04804072 . Registered on 18 March 2021.
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Affiliation(s)
- David Goodman-Meza
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave., CHS 52-215, Los Angeles, CA 90095-1688 USA
| | - Steven Shoptaw
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA USA
| | - Brett Hanscom
- Statistical Center for HIV/AIDS Research and Prevention (SCHARP), Seattle, WA USA
| | - Laramie R. Smith
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, CA USA
| | - Philip Andrew
- Family Health International (FHI 360), Durham, NC USA
| | - Irene Kuo
- Milken Institute School of Public Health Department of Epidemiology, George Washington University, Washington, DC, USA
| | | | - David Metzger
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | | | - Melissa Cummings
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Center, Seattle, WA USA
| | - Jessica M. Fogel
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Paul Richardson
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Jayla Harris
- Family Health International (FHI 360), Durham, NC USA
| | - Jesse Heitner
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA USA
| | - Sarah Stansfield
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA USA
| | | | - for the HPTN 094 Study Team
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave., CHS 52-215, Los Angeles, CA 90095-1688 USA
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA USA
- Statistical Center for HIV/AIDS Research and Prevention (SCHARP), Seattle, WA USA
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, CA USA
- Family Health International (FHI 360), Durham, NC USA
- Milken Institute School of Public Health Department of Epidemiology, George Washington University, Washington, DC, USA
- UTHealth-Houston, Houston, TX USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- ICAP, Mailman School of Public Health, Columbia University, New York, NY USA
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Center, Seattle, WA USA
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA USA
- School of Social Work, Columbia University, New York, NY USA
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Goodman-Meza D, Goto M, Salimian A, Shoptaw S, Bui AAT, Gordon AJ, Goetz MB. Impact of Potential Case Misclassification by Administrative Diagnostic Codes on Outcome Assessment of Observational Study for People Who Inject Drugs. Open Forum Infect Dis 2024; 11:ofae030. [PMID: 38379573 PMCID: PMC10878055 DOI: 10.1093/ofid/ofae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/12/2024] [Indexed: 02/22/2024] Open
Abstract
Introduction Initiation of medications for opioid use disorder (MOUD) within the hospital setting may improve outcomes for people who inject drugs (PWID) hospitalized because of an infection. Many studies used International Classification of Diseases (ICD) codes to identify PWID, although these may be misclassified and thus, inaccurate. We hypothesized that bias from misclassification of PWID using ICD codes may impact analyses of MOUD outcomes. Methods We analyzed a cohort of 36 868 cases of patients diagnosed with Staphylococcus aureus bacteremia at 124 US Veterans Health Administration hospitals between 2003 and 2014. To identify PWID, we implemented an ICD code-based algorithm and a natural language processing (NLP) algorithm for classification of admission notes. We analyzed outcomes of prescribing MOUD as an inpatient using both approaches. Our primary outcome was 365-day all-cause mortality. We fit mixed-effects Cox regression models with receipt or not of MOUD during the index hospitalization as the primary predictor and 365-day mortality as the outcome. Results NLP identified 2389 cases as PWID, whereas ICD codes identified 6804 cases as PWID. In the cohort identified by NLP, receipt of inpatient MOUD was associated with a protective effect on 365-day survival (adjusted hazard ratio, 0.48; 95% confidence interval, .29-.81; P < .01) compared with those not receiving MOUD. There was no significant effect of MOUD receipt in the cohort identified by ICD codes (adjusted hazard ratio, 1.00; 95% confidence interval, .77-1.30; P = .99). Conclusions MOUD was protective of all-cause mortality when NLP was used to identify PWID, but not significant when ICD codes were used to identify the analytic subjects.
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Affiliation(s)
- David Goodman-Meza
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Greater Los Angeles Veterans Health Administration, Los Angeles, California, USA
| | - Michihiko Goto
- University of Iowa, Iowa City, Iowa, USA
- Iowa City VA Medical Center, Iowa City, Iowa, USA
| | - Anabel Salimian
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Steven Shoptaw
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Alex A T Bui
- Medical & Imaging Informatics (MII) Group, Department of Radiological Sciences, UCLA, Los Angeles, California, USA
| | - Adam J Gordon
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Matthew B Goetz
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Greater Los Angeles Veterans Health Administration, Los Angeles, California, USA
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Scialli A, Saab S, Salimian A, Bhattacharya D, Goodman-Meza D. Hepatitis C Treatment Among Primary Care and Specialty Providers: A Single Center Study, 2015 to 2022. J Prim Care Community Health 2024; 15:21501319241253521. [PMID: 38727179 PMCID: PMC11088289 DOI: 10.1177/21501319241253521] [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: 03/25/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/13/2024] Open
Abstract
INTRODUCTION Despite national goals to eliminate Hepatitis C (HCV) and the advancement of curative, well-tolerated direct-acting antiviral (DAAs) regimens, rates of HCV treatment have declined nationally since 2015. Current HCV guidelines encourage treatment of HCV by primary care providers (PCPs). Payors have reduced restrictions to access DAAs nationally and in California however it remains unclear if the removal of these restrictions has impacted the proportion of PCPs prescribing DAAs at a health system level. Our objective was to examine the proportion of DAAs prescribed by PCPs and specialists and to describe the population receiving treatment in a single health system from 2015 to 2022. METHODS We examined the proportion of DAAs prescribed by PCPs and specialists and the population receiving treatment through a retrospective analysis of claims data in the University of California, Los Angeles (UCLA) Health System from 2015 to 2022. We described number of prescriptions for HCV medication prescribed by PCPs and specialists by year, medication type, and physician specialty. We also described numbers of prescriptions by patient demographics and comorbidities. RESULTS A total of 1515 adult patients received a prescription for HCV medication through the UCLA Health System between 2015 and 2022. The proportion of patients receiving prescriptions for PCPs peaked at 19% in 2016, yet decreased to 5.7% in 2022, an average of 13% across all years. Median age of patients receiving treatment was 60 years old, and 56% of patients receiving HCV treatment had commercial insurance as their primary payer. CONCLUSIONS HCV treatment declined from 2015 to 2022 among specialists and PCPs in our health system. Older patients comprised the majority of patients receiving treatment, suggesting a need for novel approaches to reach patients under 40, an age group with significant increases in HCV transmission.
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Affiliation(s)
| | - Sammy Saab
- University of California, Los Angeles, CA, USA
- Pfleger Liver Institute, Los Angeles, CA, USA
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Friedman J, Godvin M, Molina C, Romero R, Borquez A, Avra T, Goodman-Meza D, Strathdee S, Bourgois P, Shover CL. Fentanyl, heroin, and methamphetamine-based counterfeit pills sold at tourist-oriented pharmacies in Mexico: An ethnographic and drug checking study. Drug Alcohol Depend 2023; 249:110819. [PMID: 37348270 PMCID: PMC10368172 DOI: 10.1016/j.drugalcdep.2023.110819] [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: 02/08/2023] [Revised: 05/30/2023] [Accepted: 06/03/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Fentanyl- and methamphetamine-based counterfeit prescription drugs have driven escalating overdose death rates in the US, however their presence in Mexico has not been assessed. Our ethnographic team has conducted longitudinal research focused on illicit drug markets in Northern Mexico since 2018. In 2021-2022, study participants described the arrival of new, unusually potent tablets sold as ostensibly controlled substances, without a prescription, directly from pharmacies that cater to US tourists. AIMS To characterize the availability of counterfeit and authentic controlled substances at pharmacies in Northern Mexico available to English-speaking tourists without a prescription. METHODS We employed an iterative, exploratory, mixed methods design. Longitudinal ethnographic data was used to characterize tourist-oriented micro-neighborhoods and guide the selection of n=40 pharmacies in n=4 cities in Northern Mexico. In each pharmacy, samples of "oxycodone", "Xanax", and "Adderall" were sought as single pills, during English-language encounters, after which detailed ethnographic accounts were recorded. We employed immunoassay-based testing strips to check each pill for the presence of fentanyls, benzodiazepines, amphetamines, and methamphetamines. We used Fourier-Transform Infrared Spectroscopy to further characterize drug contents. RESULTS Of n=40 pharmacies, one or more of the requested controlled substances could be obtained with no prescription (as single pills or in bottles) at 28 (70.0%) and as single pills at 19 (47.5%). Counterfeit pills were obtained at 11 pharmacies (27.5%). Of n=45 samples sold as one-off controlled substances, 18 were counterfeit. 7 of 11 (63.6%) samples sold as "Adderall" contained methamphetamine, 8 of 27 (29.6%) samples sold as "Oxycodone" contained fentanyl, and 3 "Oxycodone" samples contained heroin. Pharmacies providing counterfeit drugs were uniformly located in tourist-serving micro-neighborhoods, and generally featured English-language advertisements for erectile dysfunction medications and "painkillers". Pharmacy employees occasionally expressed concern about overdose risk and provided harm reduction guidance. DISCUSSION The availability of fentanyl-, heroin-, and methamphetamine-based counterfeit medications in tourist-oriented independent pharmacies in Northern Mexico represents a public health risk, and occurs in the context of 1) the normalization of medical tourism as a response to rising unaffordability of healthcare in the US, 2) plummeting rates of opioid prescription in the US, affecting both chronic pain patients and the availability of legitimate pharmaceuticals on the unregulated market, 3) the rise of fentanyl-based counterfeit opioids as a key driver of the fourth, and deadliest-to-date, wave of the opioid crisis. It was not possible to distinguish counterfeit medications based on appearance of pills or geography of pharmacies, because identically-appearing authentic and counterfeit versions were often sold in close geographic proximity. Nevertheless, people who consume drugs may be more trusting of controlled substances purchased directly from pharmacies. Due to Mexico's limited opioid overdose surveillance infrastructure, the current death rate from these substances remains unknown.
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Affiliation(s)
- Joseph Friedman
- Center for Social Medicine and Humanities, University of California, Los Angeles, United States.
| | - Morgan Godvin
- The Action Lab, Center for Health Policy and Law, Northeastern University, United States
| | - Caitlin Molina
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, United States
| | - Ruby Romero
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, United States
| | - Annick Borquez
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, United States
| | - Tucker Avra
- David Geffen School of Medicine, University of California, Los Angeles, United States
| | - David Goodman-Meza
- Division of Infectious Diseases, University of California, Los Angeles, United States
| | - Steffanie Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, United States
| | - Philippe Bourgois
- Center for Social Medicine and Humanities, University of California, Los Angeles, United States
| | - Chelsea L Shover
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, United States
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Shover CL, Friedman JR, Romero R, Buhr R, Chu B, Tang A, Medina JA, Wisk L, Lucas J, Goodman-Meza D. Longitudinal changes in co-involved drugs, comorbidities, and demographics of methamphetamine-related deaths in Los Angeles County. J Subst Use Addict Treat 2023; 151:209101. [PMID: 37315796 PMCID: PMC10623547 DOI: 10.1016/j.josat.2023.209101] [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] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 06/01/2023] [Accepted: 06/04/2023] [Indexed: 06/16/2023]
Abstract
INTRODUCTION We conducted a population-based observational study of all medical examiner cases in Los Angeles County from January 2012 through June 2021 in which methamphetamine was listed as a cause of or contributing factor to death (n = 6125). We aimed to characterize demographics, comorbidities, and co-involved substances in methamphetamine-related deaths longitudinally in Los Angeles County, California. METHODS We used detailed death record data to manually classify fatalities by involvement of each organ system, opioids, alcohol, cocaine, other drugs or medications, and external/traumatic causes. Primary outcomes included: the number of methamphetamine-involved deaths, demographics of decedents, percentage of methamphetamine deaths also involving other drugs, and percentage of methamphetamine deaths involving different organ systems. We performed Mann Kendall tests of trends to identify statistically significant longitudinal changes. RESULTS During the study period, the percentage of methamphetamine-related deaths involving opioids significantly increased from 16 % in 2012 to 54 % in 2021 (p < 0.001). Concurrently, the percentage involving cardiovascular causes significantly decreased from 47 % to 26 % (p < 0.05). Methamphetamine-related deaths in LAC increasingly affected people experiencing homelessness, for whom the percentage tripled from 13 % in 2012 to 35 % in 2021. The share of decedents under 40 years old increased from 33 % to 41 %. The percentage of Black or African American decedents increased over five-fold from 3 % to 17 %. CONCLUSIONS Methamphetamine-related deaths involving opioids more than tripled in Los Angeles County from 2012 to 2021, reflecting the drug supply's shift to illicit fentanyl. More than a quarter involved cardiovascular causes. These findings have implications for treatment and prevention, including scaling up contingency management, distributing naloxone to people who primarily use stimulants, and including cardiovascular care alongside these interventions directly targeted to reduce harms of methamphetamine use.
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Affiliation(s)
- Chelsea L Shover
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA.
| | | | - Ruby Romero
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
| | - Russell Buhr
- Division of Pulmonary and Critical Care, University of California, Los Angeles, CA, USA
| | - Brian Chu
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Amber Tang
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Jesus A Medina
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Lauren Wisk
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
| | - Jonathan Lucas
- Department of Medical Examiner-Coroner, Los Angeles County, Los Angeles, CA, USA
| | - David Goodman-Meza
- Division of Infectious Diseases, University of California, Los Angeles, CA, USA
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Strathdee SA, Goodman-Meza D, Rafful CM. Addressing opioid use disorder: Mexico's step backwards. Lancet Reg Health Am 2023; 23:100520. [PMID: 37497392 PMCID: PMC10366457 DOI: 10.1016/j.lana.2023.100520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/11/2023] [Indexed: 07/28/2023]
Affiliation(s)
| | - David Goodman-Meza
- Department of Medicine, Daniel Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Claudia M. Rafful
- Faculty of Psychology, Universidad Nacional Autónoma de México, Ciudad de México, CDMX, Mexico
- Center for Global Mental Health Research, National Institute of Psychiatry, Rockville, MD, USA
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Bejarano Romero R, Arredondo Sánchez-Lira J, Slim Pasaran S, Chávez Rivera A, Angulo Corral L, Salimian A, Romero Vadilllo JJ, Goodman-Meza D. Implementing a decentralized opioid overdose prevention strategy in Mexico, a pending public policy issue. Lancet Reg Health Am 2023; 23:100535. [PMID: 37351156 PMCID: PMC10282171 DOI: 10.1016/j.lana.2023.100535] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/13/2023] [Accepted: 06/01/2023] [Indexed: 06/24/2023]
Abstract
The public health crisis due to opioid overdose is worsening in Mexico's northern region due to the introduction of illicitly manufactured fentanyl into the local drug supply. Though there is an increase in overdose deaths, there is no accurate report of overdoses by Mexican government agencies and no comprehensive opioid overdose prevention strategy. There is currently only an anti-drug marketing strategy which is likely insufficient to mitigate the growing epidemic. In order to address the growing opioid overdose crisis in the country, it is necessary to create and implement a decentralized prevention strategy, that includes naloxone distribution, expanded treatment services in regions most in need, and create active dialogue with community organisations already implementing harm reduction actions. Decisive action must be taken by the Mexican government to ensure the health and wellbeing of the Mexican citizens, especially those at high risk for opioid overdose.
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Affiliation(s)
- Raúl Bejarano Romero
- SDSU-UCSD Joint Doctoral Program in Interdisciplinary Research on Substance Use, 5500 Campanile Drive, San Diego, CA 92123-4119, USA
| | - Jaime Arredondo Sánchez-Lira
- School of Public Health and Social Policy, University of Victoria, British Columbia, HSD University of Victoria, Victoria, BC, Canada
| | - Said Slim Pasaran
- Integración Social Verter A.C., C. José Azueta 230, Primera, Mexicali, BC 21100, Mexico
| | | | - Lourdes Angulo Corral
- Integración Social Verter A.C., C. José Azueta 230, Primera, Mexicali, BC 21100, Mexico
| | - Anabel Salimian
- Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095, USA
| | - Jorge J. Romero Vadilllo
- Universidad Autónoma Metropolitana – Campus Xochimilco, Calz. del Hueso 1100, Coapa, Villa Quietud, Coyoacán, Ciudad de México, CDMX 04960, Mexico
| | - David Goodman-Meza
- Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095, USA
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Gonzalez-Nieto P, Salimian A, Arredondo J, Angulo L, García de Loera A, Slim S, Shoptaw S, Cambou MC, Pitpitan EV, Goodman-Meza D. Intersections between syndemic conditions and stages along the continuum of overdose risk among women who inject drugs in Mexicali, Mexico. Harm Reduct J 2023; 20:79. [PMID: 37355611 PMCID: PMC10290314 DOI: 10.1186/s12954-023-00815-9] [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: 03/13/2023] [Accepted: 06/16/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Research on women who inject drugs is scarce in low- and middle-income countries. Women experience unique harms such as sexism and sexual violence which translate into negative health outcomes. The present work aims to provide insight into the experiences of women who inject drugs at the US-Mexico border to identify social and health-related risk factors for overdose to guide harm reduction interventions across the Global South. METHODS We recruited 25 women ≥ 18 years of age accessing harm reduction and sexual health services at a non-governmental harm reduction organization, "Verter", in Mexicali, Mexico. We employed purposeful sampling to recruit women who inject drugs who met eligibility criteria. We collected quantitative survey data and in-depth interview data. Analyses of both data sources involved the examination of descriptive statistics and thematic analysis, respectively, and were guided by the syndemic and continuum of overdose risk frameworks. RESULTS Survey data demonstrated reports of initiating injection drug use at a young age, experiencing homelessness, engaging in sex work, being rejected by family members, experiencing physical violence, injecting in public spaces, and experiencing repeated overdose events. Interview data provided evidence of stigma and discrimination toward women, a lack of safe spaces and support systems, risk of overdose-related harms, sexual violence, and the overall need for harm reduction services. CONCLUSION Women who inject drugs in Mexicali describe experiences of violence, overdose, and public injecting. Women are particularly vulnerable in the Mexicali context, as this area faces a noticeable lack of health and social services. Evidenced-based harm reduction strategies such as safe consumption sites and overdose prevention strategies (e.g., naloxone distribution and training) may benefit this population. Evidence from local organizations could help close the gap in service provision in low-resource settings like Mexico, where government action is almost nonexistent.
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Affiliation(s)
- Pablo Gonzalez-Nieto
- Integración Social Verter, A.C., Calle José Azueta 230, Primera, 21100, Mexicali, BC, Mexico
- Canadian Institute for Substance Use Research (CISUR), 2300, McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Anabel Salimian
- Department of Medicine, David Geffen School of Medicine at UCLA, 10833, Le Conte Ave, CHS 52-215, Los Angeles, CA, 90095, USA
| | - Jaime Arredondo
- Integración Social Verter, A.C., Calle José Azueta 230, Primera, 21100, Mexicali, BC, Mexico
- Canadian Institute for Substance Use Research (CISUR), 2300, McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Lourdes Angulo
- Integración Social Verter, A.C., Calle José Azueta 230, Primera, 21100, Mexicali, BC, Mexico
| | - Alejandra García de Loera
- Universidad Autónoma de Aguascalientes (UAA), Avenida Universidad #940, 20100, Aguascalientes, AGS, Mexico
| | - Said Slim
- Integración Social Verter, A.C., Calle José Azueta 230, Primera, 21100, Mexicali, BC, Mexico
| | - Steve Shoptaw
- Department of Family Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Mary C Cambou
- Department of Medicine, David Geffen School of Medicine at UCLA, 10833, Le Conte Ave, CHS 52-215, Los Angeles, CA, 90095, USA
| | - Eileen V Pitpitan
- School of Social Work, San Diego State University, Hepner Hall Room 119, 5500 Campanile Drive, San Diego, CA, 92182-4119, USA
| | - David Goodman-Meza
- Department of Medicine, David Geffen School of Medicine at UCLA, 10833, Le Conte Ave, CHS 52-215, Los Angeles, CA, 90095, USA.
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Romero R, Friedman JR, Goodman-Meza D, Shover CL. US drug overdose mortality rose faster among hispanics than non-hispanics from 2010 to 2021. Drug Alcohol Depend 2023; 246:109859. [PMID: 37031488 DOI: 10.1016/j.drugalcdep.2023.109859] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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] [Received: 09/20/2022] [Revised: 03/20/2023] [Accepted: 03/26/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Historically, overdose mortality rates among Hispanics have been lower than non-Hispanics. The purpose of this analysis was to characterize the U.S. overdose crisis among Hispanics compared to non-Hispanics. METHODS We used the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research (WONDER) platform to obtain drug overdose mortality rates per 100,000 population between 2010 and 2021 for Hispanics and non-Hispanics. We examined the relative percent change and specific drug involvement (2010-2021) and state-level disparities (2010-2020) among Hispanics versus non-Hispanics. We calculated rate ratios by state and annual percent change in total and for each specific drug. Statistical analyses were performed using R software version 4.0.3 (R Project for Statistical Computing). RESULTS Nationally, from 2010 to 2021, Hispanic overdose rates rose from 5.6 to 21.7 per 100,000, an increase of 287.5 % compared to 13.5-35.1 per 100,000, an increase of 160 % among non-Hispanics. The average annual percent change was 12 % for Hispanics and 9 % for non-Hispanics. The three most common drug classes involved in overdose deaths among both groups included: Fentanyls and synthetic opioids; cocaine; and prescription opioids. Hispanic overdose rates were higher than non-Hispanic rates in New Mexico, Colorado, Massachusetts, and Pennsylvania in 2020, versus only Michigan in 2010. CONCLUSIONS We observed disparities in overdose mortality growth among Hispanics compared to non-Hispanics from 2010 to 2021. These disparities highlight the urgency to develop community-centered solutions that take into consideration the social and structural inequalities that exacerbate the effects of the opioid overdose crisis on Hispanic communities.
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Affiliation(s)
- Ruby Romero
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
| | | | - David Goodman-Meza
- Division of Infectious Diseases, University of California, Los Angeles, CA, USA
| | - Chelsea L Shover
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA.
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Friedman J, Godvin M, Molina C, Romero R, Borquez A, Avra T, Goodman-Meza D, Strathdee S, Bourgois P, Shover CL. Fentanyl, Heroin, and Methamphetamine-Based Counterfeit Pills Sold at Tourist-Oriented Pharmacies in Mexico: An Ethnographic and Drug Checking Study. medRxiv 2023:2023.01.27.23285123. [PMID: 36747647 PMCID: PMC9901047 DOI: 10.1101/2023.01.27.23285123] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background Our ethnographic team has conducted longitudinal research focused on illicit drug markets in Northern Mexico since 2018. In 2021-2022, study participants described the arrival of new, unusually potent tablets sold as ostensibly controlled substances, without a prescription, directly from pharmacies that cater to US tourists. Concurrently, fentanyl- and methamphetamine-based counterfeit prescription drugs have driven escalating overdose death rates in the US, however their presence in Mexico has not been assessed. Aims To characterize the availability of counterfeit and authentic controlled substances at pharmacies in Northern Mexico available to English-speaking tourists without a prescription. Methods We employed an iterative, exploratory, mixed methods design. Longitudinal ethnographic data was used to characterize tourist-oriented micro-neighborhoods and guide the selection of n=40 pharmacies in n=4 cities in Northern Mexico. In each pharmacy, samples of "oxycodone", "Xanax", and "Adderall" were sought as single pills, during English-language encounters, after which detailed ethnographic accounts were recorded. We employed immunoassay-based testing strips to check each pill for the presence of fentanyls, benzodiazepines, amphetamines, and methamphetamines. We used Fourier-Transform Infrared Spectroscopy to further characterize drug contents. Results Of 40 pharmacies, these controlled substances could be obtained in any form with no prescription at 68.3% and as single pills at 46.3%. Counterfeit pills were obtained at n=11 (26.8%) of pharmacies. Of n=45 samples sold as one-off controlled substances, n=20 were counterfeit including 9 of 11 (81.8%) of samples sold as "Adderall" that contained methamphetamine, and 8 of 27 (29.6%) of samples sold as "Oxycodone" that contained fentanyl, and n=3 'Oxycodone' samples containing heroin. Pharmacies providing counterfeit drugs were uniformly located in tourist-serving micro-neighborhoods, and generally featured English-language advertisements for erectile dysfunction medications and 'painkillers'. Pharmacy employees occasionally expressed concern about overdose risk and provided harm reduction guidance. Discussion The availability of fentanyl-, heroin-, and methamphetamine-based counterfeit medications in Northern Mexico represents a public health risk, and occurs in the context of 1) the normalization of medical tourism as a response to rising unaffordability of healthcare in the US, 2) plummeting rates of opioid prescription in the US, affecting both chronic pain patients and the availability of legitimate pharmaceuticals on the unregulated market, 3) the rise of fentanyl-based counterfeit opioids as a key driver of the fourth, and deadliest-to-date, wave of the opioid crisis. It is not possible to distinguish counterfeit medications based on appearance, because identically-appearing authentic and counterfeit versions are often sold in close geographic proximity. Nevertheless, US tourist drug consumers may be more trusting of controlled substances purchased directly from pharmacies. Due to Mexico's limited opioid overdose surveillance infrastructure, the current death rate from these substances remains unknown.
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Affiliation(s)
- Joseph Friedman
- Center for Social Medicine and Humanities, University of California, Los Angeles
| | - Morgan Godvin
- The Action Lab, Center for Health Policy and Law, Northeastern University
| | - Caitlin Molina
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles
| | - Ruby Romero
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles
| | - Annick Borquez
- Division of Infectious Diseases and Global Public Health. Department of Medicine, University of California, San Diego
| | - Tucker Avra
- David Geffen School of Medicine, University of California, Los Angeles
| | | | - Steffanie Strathdee
- Division of Infectious Diseases and Global Public Health. Department of Medicine, University of California, San Diego
| | - Philippe Bourgois
- Center for Social Medicine and Humanities, University of California, Los Angeles
| | - Chelsea L. Shover
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles
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Edwards GG, Miyashita-Ochoa A, Castillo EG, Goodman-Meza D, Kalofonos I, Landovitz RJ, Leibowitz AA, Pulsipher C, El Sayed E, Shoptaw S, Shover CL, Tabajonda M, Yang YS, Harawa NT. Long-Acting Injectable Therapy for People with HIV: Looking Ahead with Lessons from Psychiatry and Addiction Medicine. AIDS Behav 2023; 27:10-24. [PMID: 36063243 PMCID: PMC9443641 DOI: 10.1007/s10461-022-03817-z] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 01/24/2023]
Abstract
Long-acting injectable antiretroviral medications are new to HIV treatment. People with HIV may benefit from a treatment option that better aligns with their preferences, but could also face new challenges and barriers. Authors from the fields of HIV, substance use treatment, and mental health collaborated on this commentary on the issues surrounding equitable implementation and uptake of LAI ART by drawing lessons from all three fields. We employ a socio-ecological framework beginning at the policy level and moving through the community, organizational, interpersonal, and patient levels. We look at extant literature on the topic as well as draw from the direct experience of our clinician-authors.
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Affiliation(s)
- Gabriel G Edwards
- Division of General Internal Medicine & Health Services Research, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA.
- Division of General Internal Medicine & Health Services Research, David Geffen School of Medicine at UCLA, 1100 Glendon Ave., Suite 850, Los Angeles, CA, 90024, USA.
| | - Ayako Miyashita-Ochoa
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
| | - Enrico G Castillo
- Center for Social Medicine and Humanities in the Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - David Goodman-Meza
- Division of Infectious Diseases, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Ippolytos Kalofonos
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
- Greater Los Angeles Veterans Healthcare Administration, Los Angeles, CA, USA
| | - Raphael J Landovitz
- UCLA Center for Clinical AIDS Research & Education, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Arleen A Leibowitz
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
| | - Craig Pulsipher
- Department of Government Affairs, APLA Health, Los Angeles, CA, USA
| | - Ed El Sayed
- Department of Pharmacology, Touro College of Medicine, New York, NY, USA
| | - Steven Shoptaw
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
- Department of Family Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Chelsea L Shover
- Division of General Internal Medicine & Health Services Research, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Michelle Tabajonda
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Yvonne S Yang
- Greater Los Angeles Veterans Healthcare Administration, Los Angeles, CA, USA
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Nina T Harawa
- Division of General Internal Medicine & Health Services Research, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
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Goodman-Meza D, Tang A, Aryanfar B, Vazquez S, Gordon AJ, Goto M, Goetz MB, Shoptaw S, Bui AAT. Natural Language Processing and Machine Learning to Identify People Who Inject Drugs in Electronic Health Records. Open Forum Infect Dis 2022; 9:ofac471. [PMID: 36168546 PMCID: PMC9511274 DOI: 10.1093/ofid/ofac471] [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: 08/04/2022] [Accepted: 09/08/2022] [Indexed: 11/15/2022] Open
Abstract
Background Improving the identification of people who inject drugs (PWID) in electronic medical records can improve clinical decision making, risk assessment and mitigation, and health service research. Identification of PWID currently consists of heterogeneous, nonspecific International Classification of Diseases (ICD) codes as proxies. Natural language processing (NLP) and machine learning (ML) methods may have better diagnostic metrics than nonspecific ICD codes for identifying PWID. Methods We manually reviewed 1000 records of patients diagnosed with Staphylococcus aureus bacteremia admitted to Veterans Health Administration hospitals from 2003 through 2014. The manual review was the reference standard. We developed and trained NLP/ML algorithms with and without regular expression filters for negation (NegEx) and compared these with 11 proxy combinations of ICD codes to identify PWID. Data were split 70% for training and 30% for testing. We calculated diagnostic metrics and estimated 95% confidence intervals (CIs) by bootstrapping the hold-out test set. Best models were determined by best F-score, a summary of sensitivity and positive predictive value. Results Random forest with and without NegEx were the best-performing NLP/ML algorithms in the training set. Random forest with NegEx outperformed all ICD-based algorithms. F-score for the best NLP/ML algorithm was 0.905 (95% CI, .786-.967) and 0.592 (95% CI, .550-.632) for the best ICD-based algorithm. The NLP/ML algorithm had a sensitivity of 92.6% and specificity of 95.4%. Conclusions NLP/ML outperformed ICD-based coding algorithms at identifying PWID in electronic health records. NLP/ML models should be considered in identifying cohorts of PWID to improve clinical decision making, health services research, and administrative surveillance.
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Affiliation(s)
- David Goodman-Meza
- Correspondence: David Goodman-Meza, MD, MAS, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, CHS 52-215, Los Angeles, CA, 90095-1688 ()
| | - Amber Tang
- Department of Internal Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Babak Aryanfar
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Sergio Vazquez
- Undergraduate Studies, Dartmouth College, Hanover, New Hampshire, USA
| | - Adam J Gordon
- Informatics, Decision-Enhancement, and Analytic Sciences Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Michihiko Goto
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa, USA
| | - Matthew Bidwell Goetz
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Internal Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Steven Shoptaw
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
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Goodman-Meza D, Arredondo J, Slim S, Angulo L, Gonzalez-Nieto P, Loera A, Shoptaw S, Cambou MC, Pitpitan EV. Behavior change after fentanyl testing at a safe consumption space for women in Northern Mexico: A pilot study. Int J Drug Policy 2022; 106:103745. [PMID: 35636071 PMCID: PMC9924820 DOI: 10.1016/j.drugpo.2022.103745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/29/2022] [Accepted: 05/14/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Fentanyl has led to an increased number of overdose deaths in North America. Testing substances for fentanyl may be a harm reduction strategy to prevent overdose. Little is known about behavior change after fentanyl testing and the attitudes around fentanyl knowledge and testing along the US-Mexico border in the context of a safe consumption site. METHODS This was a pilot quantitative and qualitative study with 30 women who use drugs at an unsanctioned safe consumption site in Mexicali, Mexico. Women participated in a quantitative survey, a semi-structured interview, and fentanyl testing of substances. Injection behavior was observed after fentanyl testing results were provided. Qualitative data were collected to explore the meanings participants attributed to fentanyl and fentanyl testing. RESULTS Half of the substances tested positive for fentanyl (n=15, 50%), and all of them were in samples of black tar heroin. Among those participants who tested positive for fentanyl, 7 (47%) subsequently used less of the intended substance, 1 did not use the intended substance, and 7 (47%) did not change their behavior (i.e., used as originally intended). In qualitative interviews, a predominant theme was a description of fentanyl as dangerous and deadly and fentanyl testing as being helpful for modifying drug use behaviors. However, participants recognized that there could be no change in behavior following a positive fentanyl test in the context of not being able to find substances free of fentanyl. CONCLUSION We observed mixed results related to behavior change after women's intended substance for use tested positive for fentanyl. Fentanyl testing was acceptable to women, but behavior change was hampered by the inability to find substances free of fentanyl. Further research is needed to maximize the potential of fentanyl testing as a harm reduction tool especially in the context of a changing drug supply.
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Affiliation(s)
- David Goodman-Meza
- Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
| | - Jaime Arredondo
- Integración Social Verter, A.C., Calle José Azueta 230, Primera, 21100 Mexicali, B.C., México; School of Public Health and Social Policy, University of Victoria, Victoria, BC V8P 5C2, Canada
| | - Said Slim
- Integración Social Verter, A.C., Calle José Azueta 230, Primera, 21100 Mexicali, B.C., México
| | - Lourdes Angulo
- Integración Social Verter, A.C., Calle José Azueta 230, Primera, 21100 Mexicali, B.C., México
| | - Pablo Gonzalez-Nieto
- Integración Social Verter, A.C., Calle José Azueta 230, Primera, 21100 Mexicali, B.C., México
| | - Alejandra Loera
- Centro de Investigación y Docencia Económicas (CIDE), Circuito Tecnopolo Norte #117, Col. Tecnopolo Pocitos II, 20313 Aguascalientes, Ags., México
| | - Steve Shoptaw
- Centro de Investigación y Docencia Económicas (CIDE), Circuito Tecnopolo Norte #117, Col. Tecnopolo Pocitos II, 20313 Aguascalientes, Ags., México; Department of Family Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Mary C Cambou
- Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Eileen V Pitpitan
- School of Social Work, San Diego State University, Hepner Hall room 119 5500 Campanile Drive, San Diego, CA, 92182, USA
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Goodman-Meza D, Shover CL, Medina JA, Tang AB, Shoptaw S, Bui AAT. Development and Validation of Machine Models Using Natural Language Processing to Classify Substances Involved in Overdose Deaths. JAMA Netw Open 2022; 5:e2225593. [PMID: 35939303 PMCID: PMC9361079 DOI: 10.1001/jamanetworkopen.2022.25593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Overdose is one of the leading causes of death in the US; however, surveillance data lag considerably from medical examiner determination of the death to reporting in national surveillance reports. OBJECTIVE To automate the classification of deaths related to substances in medical examiner data using natural language processing (NLP) and machine learning (ML). DESIGN, SETTING, AND PARTICIPANTS Diagnostic study comparing different natural language processing and machine learning algorithms to identify substances related to overdose in 10 health jurisdictions in the US from January 1, 2020, to December 31, 2020. Unstructured text from 35 433 medical examiner and coroners' death records was examined. EXPOSURES Text from each case was manually classified to a substance that was related to the death. Three feature representation methods were used and compared: text frequency-inverse document frequency (TF-IDF), global vectors for word representations (GloVe), and concept unique identifier (CUI) embeddings. Several ML algorithms were trained and best models were selected based on F-scores. The best models were tested on a hold-out test set and results were reported with 95% CIs. MAIN OUTCOMES AND MEASURES Text data from death certificates were classified as any opioid, fentanyl, alcohol, cocaine, methamphetamine, heroin, prescription opioid, and an aggregate of other substances. Diagnostic metrics and 95% CIs were calculated for each combination of feature extraction method and machine learning classifier. RESULTS Of 35 433 death records analyzed (decedent median age, 58 years [IQR, 41-72 years]; 24 449 [69%] were male), the most common substances related to deaths included any opioid (5739 [16%]), fentanyl (4758 [13%]), alcohol (2866 [8%]), cocaine (2247 [6%]), methamphetamine (1876 [5%]), heroin (1613 [5%]), prescription opioids (1197 [3%]), and any benzodiazepine (1076 [3%]). The CUI embeddings had similar or better diagnostic metrics compared with word embeddings and TF-IDF for all substances except alcohol. ML classifiers had perfect or near perfect performance in classifying deaths related to any opioids, heroin, fentanyl, prescription opioids, methamphetamine, cocaine, and alcohol. Classification of benzodiazepines was suboptimal using all 3 feature extraction methods. CONCLUSIONS AND RELEVANCE In this diagnostic study, NLP/ML algorithms demonstrated excellent diagnostic performance at classifying substances related to overdoses. These algorithms should be integrated into workflows to decrease the lag time in reporting overdose surveillance data.
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Affiliation(s)
- David Goodman-Meza
- Division of Infectious Diseases, David Geffen School of Medicine at University of California, Los Angeles
| | - Chelsea L. Shover
- Division of General Internal Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Jesus A. Medina
- David Geffen School of Medicine at University of California, Los Angeles
| | - Amber B. Tang
- David Geffen School of Medicine at University of California, Los Angeles
| | - Steven Shoptaw
- Department of Family Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Alex A. T. Bui
- Medical & Imaging Informatics (MII) Group, Department of Radiological Sciences, University of California, Los Angeles
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Filosa JN, Botello-Mares A, Goodman-Meza D. COVID-19 needs no passport: the interrelationship of the COVID-19 pandemic along the U.S.-Mexico border. BMC Public Health 2022; 22:1081. [PMID: 35641957 PMCID: PMC9153860 DOI: 10.1186/s12889-022-13513-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/25/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To investigate the impact of the COVID-19 pandemic along the U.S.-Mexico border region and evaluate the relationship of COVID-19 related mortality, socioeconomic status, and vaccination. METHODS We used indirect standardization to age-adjust mortality rates and calculate standardized mortality ratios [SMR] in both countries. To examine the impact of socioeconomic factors, we calculated the Human Development Index (HDI) by county/municipality. We performed linear regression to understand the relationship between mortality, vaccination, and HDI. We used choropleth maps to visualize the trends seen in the region. RESULTS Between January 22nd, 2020 and December 1st, 2021, surges of cases and deaths were similar in dyad cities along the U.S.-Mexico border visualizing the interconnectedness of the region. Mortality was higher in U.S. counties along the border compared to the national average (SMR 1.17, 95% CI 1.15-1.19). In Mexico, border counties had a slightly lower mortality to the national average (SMR 0.94, 95% CI 0.93-0.95). In U.S. border states, SMR was shown to negatively correlate with human development index (HDI), a socioeconomic proxy, resulting in a higher SMR in the border region compared to the rest of the counties. Conversely in Mexican border states, there was no association between SMR and HDI. Related to vaccination, U.S. counties along the border were vaccinated at a greater percentage than non-border counties and vaccination was negatively correlated with HDI. In Mexico, states along the border had a higher ratio of vaccinations per person than non-border states. CONCLUSIONS The U.S.-Mexico border is a divide of incredible importance not only to immigration but as a region with unique social, economic, environmental, and epidemiological factors that impact disease transmission. We investigated how the COVID-19 pandemic followed trends of previously studied diseases in the corridor such as tuberculosis, HIV, and influenza H1N1. These data state how targeted intervention along the U.S.-Mexico border region is a necessity when confronting COVID-19 and have implications for future control of infectious diseases in the region.
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Affiliation(s)
- John N Filosa
- David Geffen School of Medicine, University of California, Los Angeles (UCLA), 10833 Le Conte Ave, Los Angeles, CA, 90095-1688, USA
| | - Adrian Botello-Mares
- Department of Population Studies, Colegio de la Frontera Norte, Sonora, Nogales, Mexico
| | - David Goodman-Meza
- David Geffen School of Medicine, University of California, Los Angeles (UCLA), 10833 Le Conte Ave, Los Angeles, CA, 90095-1688, USA. .,Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles (UCLA), CA, Los Angeles, USA.
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20
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Friedman J, Montero F, Bourgois P, Wahbi R, Dye D, Goodman-Meza D, Shover C. Xylazine spreads across the US: A growing component of the increasingly synthetic and polysubstance overdose crisis. Drug Alcohol Depend 2022; 233:109380. [PMID: 35247724 PMCID: PMC9128597 DOI: 10.1016/j.drugalcdep.2022.109380] [Citation(s) in RCA: 104] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Sharp exacerbations of the US overdose crisis are linked to polysubstance use of synthetic compounds. Xylazine is a veterinary tranquilizer, long noted in the street opioid supply of Puerto Rico, and more recently Philadelphia. Yet its national trends, geographic distribution, and health risks are poorly characterized. METHODS In this sequential mixed-methods study, xylazine was increasingly observed by ethnographers in Philadelphia among drug-sellers and people who inject drugs (PWID). Subsequently, we systematically searched for records describing xylazine-present overdose mortality across the US and assessed time trends and overlap with other drugs. RESULTS In 10 jurisdictions - representing all four US Census Regions - xylazine was increasingly present in overdose deaths, rising from 0.36% of deaths in 015m 6.7% in 2020. The highest xylazine prevalence data was observed in Philadelphia, (25.8% of deaths), followed by Maryland (19.3%) and Connecticut (10.2%). Illicitly-manufactured-fentanyls were present in 98.4% of xylazine-present-overdose-deaths - suggesting a strong ecological link - as well as cocaine (45.4%), benzodiazepines (28.4%), heroin (23.3%), and alcohol (19.7%). PWID in Philadelphia described xylazine as a sought-after adulterant that lengthens the short duration of fentanyl injections. They also linked it to increased risk of soft tissue infection and naloxone-resistant overdose. CONCLUSIONS Xylazine is increasingly present in overdose deaths, linked to the proliferation of illicitly-manufactured-fentanyls. Ethnographic accounts associate it with profound risks for PWID. Nevertheless, many jurisdictions do not routinely test for xylazine, and it is not comprehensively tracked nationally. Further efforts are needed to provide PWID with services that can help minimize additional risks associated with a shifting drug supply.
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Affiliation(s)
- Joseph Friedman
- Center for Social Medicine and Humanities, University of California, Los Angeles, CA, USA; Medical Informatics Home Area, University of California, Los Angeles, CA, USA.
| | - Fernando Montero
- Department of Anthropology, Columbia University, New York, NY, USA
| | - Phillippe Bourgois
- Center for Social Medicine and Humanities, University of California, Los Angeles, CA, USA.
| | - Rafik Wahbi
- Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Daniel Dye
- Department of Pathology, University of Alabama, Birmingham, AL, USA
| | - David Goodman-Meza
- Division of Infectious Diseases, University of California, Los Angeles, CA, USA
| | - Chelsea Shover
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA.
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Shoptaw S, Li MJ, Javanbakht M, Ragsdale A, Goodman-Meza D, Gorbach PM. Frequency of reported methamphetamine use linked to prevalence of clinical conditions, sexual risk behaviors, and social adversity in diverse men who have sex with men in Los Angeles. Drug Alcohol Depend 2022; 232:109320. [PMID: 35093681 PMCID: PMC8885921 DOI: 10.1016/j.drugalcdep.2022.109320] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This study tested the hypothesis that reported frequency of methamphetamine use is significantly associated with measures of social adversity, sexual risk behaviors, chronic health conditions, bacterial STIs and HIV-related factors among diverse men who have sex with men (MSM). METHODS Data were 2428 visits from 515 mSTUDY participants (261 people living with HIV; 254 HIV-negative). mSTUDY is an ongoing longitudinal study of racially/ethnically diverse MSM in Los Angeles County. Logistic regression with random intercepts modeled associations between self-reported past 6-month methamphetamine use (none, monthly or less, weekly or more) with reported adverse social outcomes (unemployment, housing instability, intimate partner violence), sexual risk behaviors, chronic health conditions, and biomarkers of bacterial STIs (chlamydia, gonorrhea, or syphilis) and detectable HIV viral load (among HIV-positive). Models controlled for confirmed HIV-serostatus. RESULTS Prevalence of reported monthly or less methamphetamine use was 19%; weekly or more use was 18%. Multivariable models showed escalating odds of adverse social outcomes and sexual risk behaviors (p's < 0.001) with increased methamphetamine use frequency. Frequency of methamphetamine use associated with increased odds of a positive bacterial STI test (p < .001), detectable viral load (in HIV-positive participants) (p < .001), renal condition (p = .047), neurological condition (p = .008), and psychological condition (p = .001). CONCLUSIONS Findings show cross-sectional links between reported methamphetamine use frequency and adverse social and health outcomes among MSM in Los Angeles and suggest there may be fewer social and physical health harms corresponding to less frequent use of methamphetamine in this group.
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Affiliation(s)
- Steve Shoptaw
- David Geffen School of Medicine, Department of Family Medicine, University of California, Los Angeles, United States; David Geffen School of Medicine, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, United States.
| | - Michael J. Li
- David Geffen School of Medicine, Department of Family Medicine, University of California, Los Angeles
| | - Marjan Javanbakht
- Fielding School of Public Health, Department of Epidemiology, University of California, Los Angeles
| | - Amy Ragsdale
- Fielding School of Public Health, Department of Epidemiology, University of California, Los Angeles
| | - David Goodman-Meza
- David Geffen School of Medicine, Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles
| | - Pamina M. Gorbach
- Fielding School of Public Health, Department of Epidemiology, University of California, Los Angeles
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22
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Jolayemi O, Bogart LM, Storholm ED, Goodman-Meza D, Rosenberg-Carlson E, Cohen R, Kao U, Shoptaw S, Landovitz RJ. Perspectives on preparing for long-acting injectable treatment for HIV among consumer, clinical and nonclinical stakeholders: A qualitative study exploring the anticipated challenges and opportunities for implementation in Los Angeles County. PLoS One 2022; 17:e0262926. [PMID: 35113892 PMCID: PMC8812879 DOI: 10.1371/journal.pone.0262926] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 01/09/2022] [Indexed: 01/01/2023] Open
Abstract
Long-acting injectable (LAI) antiretroviral therapy (ART) is a novel HIV treatment option for people with HIV. The first LAI ART regimen for HIV treatment received regulatory approval in the United States in January 2021. In February 2020, we collected qualitative data from 18 consumers and 23 clinical and non-clinical stakeholders to catalog anticipated individual-consumer, healthcare system, and structural levels barriers and facilitators to LAI ART implementation in Los Angeles County, California. Thematic analysis was guided by the CFIR implementation science model. CFIR constructs of intervention characteristics, individual characteristics, outer and inner setting, intervention characteristics, and implementation process emerged in analysis. Under intervention characteristics, anticipated facilitators included the relative advantage of LAI ART over pills for adherence and reduced treatment management burden and related anxiety; anticipated barriers included non-adherence to injection appointments, concerns of developing HIV resistance, discomfort with injection and cost. Anticipated facilitators based on individual characteristics included overall acceptability based on knowledge and positive beliefs about LAI ART. Participant noted several characteristics of the outer setting that could negatively impact implementation, such as medical mistrust, external policies, and LAI ART eligibility (i.e., to be virally suppressed prior to initiation). Participants were optimistic about the potential to decrease stigma but expressed that provider willingness for adoption could be hindered by challenges in organizational inner setting related to payment authorizations, increased staffing needs, medication procurement and storage, and provider and healthcare system readiness. Results from this pre-implementation study may inform rollout and scale-up of LAI ART in Los Angeles County.
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Affiliation(s)
- Oluwadamilola Jolayemi
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Laura M. Bogart
- RAND Corporation, Santa Monica, CA, United States of America
| | - Erik D. Storholm
- RAND Corporation, Santa Monica, CA, United States of America
- School of Public Health, San Diego State University, San Diego, CA, United States of America
| | - David Goodman-Meza
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Elena Rosenberg-Carlson
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Rebecca Cohen
- Division of HIV and STD Programs, County of Los Angeles Department of Public Health, Los Angeles, CA, United States of America
| | - Uyen Kao
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Steve Shoptaw
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Raphael J. Landovitz
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
- UCLA Center for Clinical AIDS Research and Education, University of California, Los Angeles, CA, United States of America
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23
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Goodman-Meza D, Slim S, Angulo L, Gonzalez-Nieto P, Cambou MC, Loera A, Shoptaw S, Arredondo J. Impact of an overdose reversal program in the context of a safe consumption site in Northern Mexico. Drug Alcohol Depend Rep 2021; 2:100021. [PMID: 36845896 PMCID: PMC9948854 DOI: 10.1016/j.dadr.2021.100021] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/14/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
Background Drug overdoses are prevalent in low- and middle-income countries but are scarcely reported in the literature. We report on an opioid overdose reversal and naloxone distribution program that was instituted at the first safe consumption site in Latin America. Methods A cross-sectional analysis of witnessed drug overdoses and naloxone distribution between 1 June 2019 and 31 May 2021 in Mexicali, Mexico. Case report forms were entered in an electronic database. Trends in overdose and naloxone distribution were described. Comparisons were made before and after the COVID-19 pandemic was declared in the city. Maps were created to represent the geographic distribution of overdose in the city. Results During the study period 1,534 doses of naloxone were distributed throughout the community. In addition, there were 464 overdoses reported during this period, of which 4 were fatal. There was a 30% increase in reported overdoses from the period before the COVID-19 pandemic to the period after the pandemic was declared (p = 0.03). Most common substance reported included heroin (93%), sedatives (21%), methamphetamine (16%) and fentanyl (14%). Naloxone was given in 96% of cases (median 1 dose, IQR 1-2 doses) and emergency services were called in 20% of cases. Conclusions An opioid overdose reversal program in Mexicali, Mexico was able to distribute naloxone and register drug overdoses between 2019 and 2021 as a harm reduction strategy. This adds to the growing body of literature on the impact of community-based programs on preventing fatal overdoses and the potential for implementation in low-resource settings.
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Affiliation(s)
- David Goodman-Meza
- Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095,Corresponding author at: David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, CHS 52-215, Los Angeles, CA 90095
| | - Said Slim
- Integración Social Verter, A.C., Calle José Azueta 230, Primera, 21100 Mexicali, B.C., México
| | - Lourdes Angulo
- Integración Social Verter, A.C., Calle José Azueta 230, Primera, 21100 Mexicali, B.C., México
| | - Pablo Gonzalez-Nieto
- Integración Social Verter, A.C., Calle José Azueta 230, Primera, 21100 Mexicali, B.C., México
| | - Mary C. Cambou
- Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095
| | - Alejandra Loera
- Centro de Investigación y Docencia Económicas (CIDE), Circuito Tecnopolo Norte #117, Col. Tecnopolo Pocitos II, 20313 Aguascalientes, Ags., México
| | - Steve Shoptaw
- Department of Family Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095
| | - Jaime Arredondo
- Integración Social Verter, A.C., Calle José Azueta 230, Primera, 21100 Mexicali, B.C., México,Centro de Investigación y Docencia Económicas (CIDE), Circuito Tecnopolo Norte #117, Col. Tecnopolo Pocitos II, 20313 Aguascalientes, Ags., México
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24
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Fraser H, Borquez A, Stone J, Abramovitz D, Brouwer KC, Goodman-Meza D, Hickman M, Patterson TL, Silverman J, Smith L, Strathdee SA, Martin NK, Vickerman P. Overlapping Key Populations and HIV Transmission in Tijuana, Mexico: A Modelling Analysis of Epidemic Drivers. AIDS Behav 2021; 25:3814-3827. [PMID: 34216285 PMCID: PMC8560668 DOI: 10.1007/s10461-021-03361-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 06/20/2021] [Indexed: 12/18/2022]
Abstract
Tijuana, Mexico, has a concentrated HIV epidemic among overlapping key populations (KPs) including people who inject drugs (PWID), female sex workers (FSW), their male clients, and men who have sex with men (MSM). We developed a dynamic HIV transmission model among these KPs to determine the extent to which their unmet prevention and treatment needs is driving HIV transmission. Over 2020-2029 we estimated the proportion of new infections acquired in each KP, and the proportion due to their unprotected risk behaviours. We estimate that 43.7% and 55.3% of new infections are among MSM and PWID, respectively, with FSW and their clients making-up < 10% of new infections. Projections suggest 93.8% of new infections over 2020-2029 will be due to unprotected sex between MSM or unsafe injecting drug use. Prioritizing interventions addressing sexual and injecting risks among MSM and PWID are critical to controlling HIV in Tijuana.
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Affiliation(s)
- Hannah Fraser
- Oakfield House, Population Health Sciences - Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK.
| | - Annick Borquez
- School of Medicine, University of California San Diego, San Diego, USA
| | - Jack Stone
- Oakfield House, Population Health Sciences - Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | | | | | - David Goodman-Meza
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Matthew Hickman
- Oakfield House, Population Health Sciences - Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | | | - Jay Silverman
- School of Medicine, University of California San Diego, San Diego, USA
| | - Laramie Smith
- School of Medicine, University of California San Diego, San Diego, USA
| | | | - Natasha K Martin
- Oakfield House, Population Health Sciences - Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
- School of Medicine, University of California San Diego, San Diego, USA
| | - Peter Vickerman
- Oakfield House, Population Health Sciences - Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK.
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25
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Snyder H, Kalmin MM, Moulin A, Campbell A, Goodman-Meza D, Padwa H, Clayton S, Speener M, Shoptaw S, Herring AA. Rapid Adoption of Low-Threshold Buprenorphine Treatment at California Emergency Departments Participating in the CA Bridge Program. Ann Emerg Med 2021; 78:759-772. [PMID: 34353655 DOI: 10.1016/j.annemergmed.2021.05.024] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/14/2021] [Accepted: 05/24/2021] [Indexed: 02/04/2023]
Abstract
STUDY OBJECTIVE We retrospectively evaluated the implementation of low-threshold emergency department (ED) buprenorphine treatment at 52 hospitals participating in the CA Bridge Program using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework. METHODS The CA Bridge model included low-threshold buprenorphine, connection to outpatient care, and harm reduction. Implementation began in March 2019. Participating hospitals reported aggregated clinical data monthly after program initiation. Outcomes included identification of opioid use disorder, buprenorphine administration, and linkage to outpatient addiction treatment. Multivariable models assessed associations between hospital location (rural versus urban) and teaching status (clinical teaching hospital versus community hospital) and outcomes in adopting the CA Bridge Program. RESULTS Reach: A diverse and geographically distributed group of 52 California hospitals were enrolled in 2 phases (March and August 2019); 12 (23%) were rural and 13 (25%) were teaching hospitals. Effectiveness: Over a 14-month implementation period, 12,009 opioid use disorder patient encounters were identified, including 7,179 (59.7%) where buprenorphine was administered and 4,818 (40.1%) where follow-up visits were attended. Adoption: In multivariable analysis, adoption did not differ significantly between rural and urban or teaching and nonteaching hospitals. IMPLEMENTATION By program completion, all 52 (100%) hospitals treated opioid use disorder with buprenorphine; 45 (86.5%) administered buprenorphine after naloxone reversal; 41 (84.6%) offered buprenorphine for inpatients; 48 (92.3%) initiated buprenorphine in pregnant women; and 29 (55.8%) offered take-home naloxone. Maintenance: At 8-month follow-up, all 52 sites reported continued buprenorphine treatment. CONCLUSION Low-threshold ED buprenorphine treatment implemented with a harm reduction approach and active navigation to outpatient addiction treatment was successful in achieving buprenorphine treatment for opioid use disorder in diverse California communities.
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Affiliation(s)
- Hannah Snyder
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA; CA Bridge Program, Public Health Institute, Oakland, CA
| | - Mariah M Kalmin
- Department of Family Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Aimee Moulin
- CA Bridge Program, Public Health Institute, Oakland, CA; Department of Emergency Medicine and Psychiatry, UC Davis Medical Center, Sacramento, CA
| | - Arianna Campbell
- CA Bridge Program, Public Health Institute, Oakland, CA; Department of Emergency Medicine, US Acute Care Solutions at Marshall Medical Center, Placerville, CA
| | - David Goodman-Meza
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Howard Padwa
- Integrated Substance Abuse Programs, University of California, Los Angeles, Los Angeles, CA
| | | | | | - Steve Shoptaw
- Department of Family Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Andrew A Herring
- CA Bridge Program, Public Health Institute, Oakland, CA; Department of Emergency Medicine and Internal Medicine, Highland Hospital-Alameda Health System, Oakland, CA; University of California San Francisco, San Francisco, CA.
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26
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Ibarrondo FJ, Hofmann C, Fulcher JA, Goodman-Meza D, Mu W, Hausner MA, Ali A, Balamurugan A, Taus E, Elliott J, Krogstad P, Tobin NH, Ferbas KG, Kitchen SG, Aldrovandi GM, Rimoin AW, Yang OO. Primary, Recall, and Decay Kinetics of SARS-CoV-2 Vaccine Antibody Responses. ACS Nano 2021; 15:11180-11191. [PMID: 34159781 DOI: 10.1021/acsnano.1c03972] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Studies of two SARS-CoV-2 mRNA vaccines suggested that they yield ∼95% protection from symptomatic infection at least short-term, but important clinical questions remain. It is unclear how vaccine-induced antibody levels quantitatively compare to the wide spectrum induced by natural SARS-CoV-2 infection. Vaccine response kinetics and magnitudes in persons with prior COVID-19 compared to virus-naı̈ve persons are not well-defined. The relative stability of vaccine-induced versus infection-induced antibody levels is unclear. We addressed these issues with longitudinal assessments of vaccinees with and without prior SARS-CoV-2 infection using quantitative enzyme-linked immunosorbent assay (ELISA) of anti-RBD antibodies. SARS-CoV-2-naı̈ve individuals achieved levels similar to mild natural infection after the first vaccination; a second dose generated levels approaching severe natural infection. In persons with prior COVID-19, one dose boosted levels to the high end of severe natural infection even in those who never had robust responses from infection, increasing no further after the second dose. Antiviral neutralizing assessments using a spike-pseudovirus assay revealed that virus-naı̈ve vaccinees did not develop physiologic neutralizing potency until the second dose, while previously infected persons exhibited maximal neutralization after one dose. Finally, antibodies from vaccination waned similarly to natural infection, resulting in an average of ∼90% loss within 90 days. In summary, our findings suggest that two doses are important for quantity and quality of humoral immunity in SARS-CoV-2-naı̈ve persons, while a single dose has maximal effects in those with past infection. Antibodies from vaccination wane with kinetics very similar to that seen after mild natural infection; booster vaccinations will likely be required.
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Affiliation(s)
- F Javier Ibarrondo
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California 90095, United States
| | - Christian Hofmann
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California 90095, United States
| | - Jennifer A Fulcher
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California 90095, United States
| | - David Goodman-Meza
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California 90095, United States
| | - William Mu
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California 90095, United States
| | - Mary Ann Hausner
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California 90095, United States
| | - Ayub Ali
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California 90095, United States
| | - Arumugam Balamurugan
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California 90095, United States
| | - Ellie Taus
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California 90095, United States
| | - Julie Elliott
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California 90095, United States
| | - Paul Krogstad
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California 90095, United States
| | - Nicole H Tobin
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California 90095, United States
| | - Kathie G Ferbas
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California 90095, United States
| | - Scott G Kitchen
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California 90095, United States
| | - Grace M Aldrovandi
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California 90095, United States
| | - Anne W Rimoin
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California 90095, United States
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, California 90095, United States
| | - Otto O Yang
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California 90095, United States
- Department of Microbiology, Immunology, and Molecular Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California 90095, United States
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Affiliation(s)
| | - Steven Shoptaw
- Department of Family Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - David Goodman-Meza
- Department of Medicine and Department of Family Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Hiromi Ono
- Independent Scholar, Washington D.C., USA
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Saab FG, Chiang JN, Brook R, Adamson PC, Fulcher JA, Halperin E, Manuel V, Goodman-Meza D. Discharge Clinical Characteristics and Post-Discharge Events in Patients with Severe COVID-19: A Descriptive Case Series. J Gen Intern Med 2021; 36:1017-1022. [PMID: 33532963 PMCID: PMC7853705 DOI: 10.1007/s11606-020-06494-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/17/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND As the SARS-CoV-2 pandemic continues, little guidance is available on clinical indicators for safely discharging patients with severe COVID-19. OBJECTIVE To describe the clinical courses of adult patients admitted for COVID-19 and identify associations between inpatient clinical features and post-discharge need for acute care. DESIGN Retrospective chart reviews were performed to record laboratory values, temperature, and oxygen requirements of 99 adult inpatients with COVID-19. Those variables were used to predict emergency department (ED) visit or readmission within 30 days post-discharge. PATIENTS (OR PARTICIPANTS) Age ≥ 18 years, first hospitalization for COVID-19, admitted between March 1 and May 2, 2020, at University of California, Los Angeles (UCLA) Medical Center, managed by an inpatient medicine service. MAIN MEASURES Ferritin, C-reactive protein, lactate dehydrogenase, D-dimer, procalcitonin, white blood cell count, absolute lymphocyte count, temperature, and oxygen requirement were noted. KEY RESULTS Of 99 patients, five required ED admission within 30 days, and another five required readmission. Fever within 24 h of discharge, oxygen requirement, and laboratory abnormalities were not associated with need for ED visit or readmission within 30 days of discharge after admission for COVID-19. CONCLUSION Our data suggest that neither persistent fever, oxygen requirement, nor laboratory marker derangement was associated with need for acute care in the 30-day period after discharge for severe COVID-19. These findings suggest that physicians need not await the normalization of laboratory markers, resolution of fever, or discontinuation of oxygen prior to discharging a stable or improving patient with COVID-19.
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Affiliation(s)
- Faysal G Saab
- David Geffen School of Medicine, Ronald Reagan UCLA Medical Center, 757 Westwood Blvd., Suite 7501, Los Angeles, CA, 90095, USA.
| | - Jeffrey N Chiang
- Department of Computational Medicine, UCLA, California, Los Angeles, USA
| | - Rachel Brook
- David Geffen School of Medicine, Ronald Reagan UCLA Medical Center, 757 Westwood Blvd., Suite 7501, Los Angeles, CA, 90095, USA
| | - Paul C Adamson
- Division of Infectious Diseases, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Jennifer A Fulcher
- Division of Infectious Diseases, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Eran Halperin
- Department of Computational Medicine, UCLA, California, Los Angeles, USA.,UCLA Clinical and Translational Science Institute, Los Angeles, CA, USA.,Department of Computer Science, UCLA, Los Angeles, CA, USA.,Department of Anesthesiology and Perioperative Medicine, UCLA, Los Angeles, CA, USA.,Department of Human Genetics, UCLA, Los Angeles, CA, USA.,Institute of Precision Health, UCLA, Los Angeles, CA, USA
| | - Vladimir Manuel
- UCLA Clinical and Translational Science Institute, Los Angeles, CA, USA.,Faculty Practice Group, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - David Goodman-Meza
- Division of Infectious Diseases, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
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29
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Kalmin M, Goodman-Meza D, Anderson E, Ariana A, Speener M, Snyder H, Sampson A, Moulin A, Shoptaw S, Herring AA. Voting with their feet: Social factors linked with treatment for opioid use disorder using same-day buprenorphine delivered in California hospitals. Drug Alcohol Depend 2021; 222:108673. [PMID: 33773868 PMCID: PMC8058318 DOI: 10.1016/j.drugalcdep.2021.108673] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/31/2020] [Accepted: 01/05/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Medication for opioid use disorder (MOUD) using buprenorphine in primary or specialty care settings is accessed primarily by persons with private health insurance, stable housing, and no polysubstance use. This paper applies Social Cognitive Theory to frame links between social factors and treatment outcomes among patients with social and economic disadvantages who are seeking MOUD at California Bridge Program (CA Bridge) hospitals. METHODS Electronic medical records for patients identified with OUD between January-April, 2020 receiving care at CA Bridge hospitals defined outcomes: hospital-administered buprenorphine; provision of buprenorphine prescription at discharge. Multi-level models assessed whether social factors-housing status, insurance type, and co-methamphetamine use-predicted outcomes while accounting for group-level effects of treating hospital and controlling for age, race/ethnicity, and gender. RESULTS 15 CA Bridge hospitals yielded 845 patient records. Most patients received hospital-administered buprenorphine (58 %) and/or a buprenorphine prescription (55 %); 26 % received neither treatment. Patients with unstable housing had greater odds of hospital-administered buprenorphine compared to patients with stable housing. Patients with Medicaid had greater odds of receiving a buprenorphine prescription compared to patients with other insurance. Co-methamphetamine use was not associated with outcomes. CONCLUSIONS Patients with OUD are successful in accessing same-day MOUD in CA Bridge hospital settings over a significant period. Importantly, access to MOUD in these settings was facilitated for patients traditionally not treated using buprenorphine, i.e., those with housing instability, Medicaid insurance, and co-methamphetamine use. Findings suggest barriers to MOUD for patients with social and economic disadvantages can be lowered by changing treatment delivery.
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Affiliation(s)
- Mariah Kalmin
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA
| | - David Goodman-Meza
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA,Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA
| | - Erik Anderson
- Department of Emergency Medicine and Internal Medicine, Highland Hospital—Alameda Health System, Oakland, CA and University of California, San Francisco, San Francisco, CA
| | - Abid Ariana
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA
| | | | - Hannah Snyder
- California Bridge Program, Public Health Institute,Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA
| | - Arianna Sampson
- California Bridge Program, Public Health Institute,Department of Emergency Medicine, Marshall Medical Center, Placerville, CA
| | - Aimee Moulin
- California Bridge Program, Public Health Institute,Department of Emergency Medicine and Psychiatry UC Davis Medical Center Sacramento CA
| | - Steve Shoptaw
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Andrew A Herring
- Department of Emergency Medicine and Internal Medicine, Highland Hospital—Alameda Health System, Oakland, CA and University of California, San Francisco, San Francisco, CA,California Bridge Program, Public Health Institute
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30
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Nobles AL, Johnson DC, Leas EC, Goodman-Meza D, Zúñiga ML, Ziedonis D, Strathdee SA, Ayers JW. Characterizing Self-Reports of Self-Identified Patient Experiences with Methadone Maintenance Treatment on an Online Community during COVID-19. Subst Use Misuse 2021; 56:2134-2140. [PMID: 34486471 PMCID: PMC8820092 DOI: 10.1080/10826084.2021.1972317] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: The coronavirus disease (COVID-19) pandemic has impacted patients receiving methadone maintenance treatment (MMT) through opioid treatment programs (OTPs), especially because of the unique challenges of the care delivery model. Previously, documentation of patient experiences during emergencies often comes years after the fact, in part because there is a substantial data void in real-time. Methods: We extracted 308 posts that mention COVID-19 keywords on r/methadone, an online community for patients receiving MMT to share information, on Reddit occurring between January 31, 2020 and September 30, 2020. 215 of these posts self-report an impact to their MMT. Using qualitative content analysis, we characterized the impacts described in these posts and identified four emergent themes describing patients' experience of impacts to MMT during COVID-19. Results: The themes included (1) 54.4% of posts reporting impediments to accessing their methadone, (2) 28.4% reporting impediments to accessing physicial OTPs, (3) 19.5% reporting having to self-manage their care, and (4) 4.7% reporting impediments to accessing OTP providers and staff. Conclusions: Patients described unanticipated consequences to one-size-fits-all policies that are unevenly applied resulting in suboptimal dosing, increased perceived risk of acquiring COVID-19 at OTPs, and reduced interaction with OTP providers and staff. While preliminary, these results are formative for follow-up surveillance metrics for patients of OTPs as well as digitally-mediated resource needs for this online community. This study serves as a model of how social media can be employed during and after emergencies to hear the lived experiences of patients for informed emergency preparedness and response.
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Affiliation(s)
- Alicia L Nobles
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Derek C Johnson
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Eric C Leas
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - David Goodman-Meza
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - María Luisa Zúñiga
- School of Social Work, San Diego State University, San Diego, California, USA
| | - Douglas Ziedonis
- University of New Mexico Health Sciences, Albuquerque, New Mexico, USA
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - John W Ayers
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, USA
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31
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Dieringer TD, Pham C, Goodman-Meza D. 1705. Treatment of Disseminated Adenovirus with Cidofovir in a Patient with HIV and ESRD. Open Forum Infect Dis 2020. [PMCID: PMC7778031 DOI: 10.1093/ofid/ofaa439.1883] [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: 11/19/2022] Open
Abstract
Background Adenovirus is a common cause of upper respiratory infections and gastroenteritis. Severe adenovirus infections and disseminated disease are known to occur in immunocompromised hosts. Cidofovir has been associated with clinical improvement in patients with severe or disseminated disease in which immunosuppression cannot be readily reversed or those unresponsive to supportive care. However, a narrow therapeutic index has limited its clinical use particularly in patients with end-stage renal disease (ESRD). Methods We present a case of disseminated adenovirus in a well-controlled person living with HIV (PLWHIV) treated successfully with dose-reduced cidofovir in the setting of ESRD on hemodialysis (HD) at the University of California Los Angeles. A literature review was conducted to investigate the treatment of severe adenovirus disease and use of cidofovir in patients with ESRD. Results Our patient is a 59 year-old woman who presented with fever, non-productive cough, and diarrhea. She is living with HIV/AIDS with virologic control and CD4 count of 470 treated with dose adjusted lamivudine, tenofovir alafenamide, and dolutegravir in the setting of ESRD on HD, chronic hepatitis B, and group I pulmonary hypertension. Her course was complicated by development of multifocal pneumonia with hypoxemic respiratory failure requiring high-flow nasal cannula. Adenovirus PCR was detected in stool, respiratory, and serum samples. Given high risk intubation, dose-reduced cidofovir 0.5 mg/kg weekly was given twice over three weeks with symptomatic improvement, elimination of serum adenovirus DNA, and without development of adverse medication-related effects. Sixteen primary and review articles were identified discussing adenovirus pathology and treatment. A single pharmacokinetic study outlined a dosing regimen for cidofovir of 0.5 mg/kg weekly which provided comparable serum drug levels in asymptomatic patients with ESRD on HD compared to controls with adequate renal function. Conclusion This case report illustrates although there is limited data to establish the efficacy and safety of cidofovir for treatment of disseminated adenovirus infections in ESRD patients, dose-reduced cidofovir 0.5 mg/kg weekly while on HD appears to have been effective and well tolerated. Disclosures All Authors: No reported disclosures
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Affiliation(s)
| | - Christine Pham
- University of California, Los Angeles; David School of Medicine/University of California, Los Angeles, Los Angeles, California
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32
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Monteiro AC, Suri R, Emeruwa IO, Stretch RJ, Cortes-Lopez RY, Sherman A, Lindsay CC, Fulcher JA, Goodman-Meza D, Sapru A, Buhr RG, Chang SY, Wang T, Qadir N. Obesity and smoking as risk factors for invasive mechanical ventilation in COVID-19: A retrospective, observational cohort study. PLoS One 2020; 15:e0238552. [PMID: 33351817 PMCID: PMC7755188 DOI: 10.1371/journal.pone.0238552] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/07/2020] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To describe the trajectory of respiratory failure in COVID-19 and explore factors associated with risk of invasive mechanical ventilation (IMV). MATERIALS AND METHODS A retrospective, observational cohort study of 112 inpatient adults diagnosed with COVID-19 between March 12 and April 16, 2020. Data were manually extracted from electronic medical records. Multivariable and Univariable regression were used to evaluate association between baseline characteristics, initial serum markers and the outcome of IMV. RESULTS Our cohort had median age of 61 (IQR 45-74) and was 66% male. In-hospital mortality was 6% (7/112). ICU mortality was 12.8% (6/47), and 18% (5/28) for those requiring IMV. Obesity (OR 5.82, CI 1.74-19.48), former (OR 8.06, CI 1.51-43.06) and current smoking status (OR 10.33, CI 1.43-74.67) were associated with IMV after adjusting for age, sex, and high prevalence comorbidities by multivariable analysis. Initial absolute lymphocyte count (OR 0.33, CI 0.11-0.96), procalcitonin (OR 1.27, CI 1.02-1.57), IL-6 (OR 1.17, CI 1.03-1.33), ferritin (OR 1.05, CI 1.005-1.11), LDH (OR 1.57, 95% CI 1.13-2.17) and CRP (OR 1.13, CI 1.06-1.21), were associated with IMV by univariate analysis. CONCLUSIONS Obesity, smoking history, and elevated inflammatory markers were associated with increased need for IMV in patients with COVID-19.
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Affiliation(s)
- Ana C. Monteiro
- Division of Pulmonary and Critical Care, Department of Medicine, UCLA Medical Center, Los Angeles, CA, United States of America
| | - Rajat Suri
- Division of Pulmonary and Critical Care, Department of Medicine, UCLA Medical Center, Los Angeles, CA, United States of America
| | - Iheanacho O. Emeruwa
- Division of Pulmonary and Critical Care, Department of Medicine, UCLA Medical Center, Los Angeles, CA, United States of America
| | - Robert J. Stretch
- Division of Pulmonary and Critical Care, Department of Medicine, UCLA Medical Center, Los Angeles, CA, United States of America
| | - Roxana Y. Cortes-Lopez
- Division of Pulmonary and Critical Care, Department of Medicine, UCLA Medical Center, Los Angeles, CA, United States of America
| | - Alexander Sherman
- Division of Pulmonary and Critical Care, Department of Medicine, UCLA Medical Center, Los Angeles, CA, United States of America
| | - Catherine C. Lindsay
- Department of Medicine, UCLA Medical Center, Los Angeles, CA, United States of America
| | - Jennifer A. Fulcher
- Division of Infectious Disease, Department of Medicine, UCLA Medical Center, Los Angeles, CA, United States of America
| | - David Goodman-Meza
- Division of Infectious Disease, Department of Medicine, UCLA Medical Center, Los Angeles, CA, United States of America
| | - Anil Sapru
- Division of Critical Care, Department of Pediatrics, UCLA Medical Center, Los Angeles, CA, United States of America
| | - Russell G. Buhr
- Division of Pulmonary and Critical Care, Department of Medicine, UCLA Medical Center, Los Angeles, CA, United States of America
| | - Steven Y. Chang
- Division of Pulmonary and Critical Care, Department of Medicine, UCLA Medical Center, Los Angeles, CA, United States of America
| | - Tisha Wang
- Division of Pulmonary and Critical Care, Department of Medicine, UCLA Medical Center, Los Angeles, CA, United States of America
| | - Nida Qadir
- Division of Pulmonary and Critical Care, Department of Medicine, UCLA Medical Center, Los Angeles, CA, United States of America
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33
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Vijayan T, Shin M, Adamson PC, Harris C, Seeman T, Norris KC, Goodman-Meza D. Beyond the 405 and the 5: Geographic variations and factors associated with SARS-CoV-2 positivity rates in Los Angeles County. Clin Infect Dis 2020; 73:e2970-e2975. [PMID: 33141164 PMCID: PMC7665433 DOI: 10.1093/cid/ciaa1692] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Indexed: 01/03/2023] Open
Abstract
Objectives To highlight geographic differences and the socio-structural determinants of SARS-CoV-2 test positivity within Los Angeles County (LAC). Methods A geographic information system was used to integrate, map, and analyze SARS-CoV-2 testing data reported by LAC DPH, and data from the American Community Survey. Structural determinants included race/ethnicity, poverty, insurance status, education, population and household density. We examined which factors were associated with positivity rates, using a 5% test positivity threshold, with spatial analysis and spatial regression. Results Between 1 March and 30 June 2020 there were 843,440 SARS-CoV-2 tests and 86,383 diagnoses reported, for an overall positivity rate of 10.2% within the study area. Communities with high proportions of Latino/a residents, those living below the federal poverty line and with high household densities had higher crude positivity rates. Age- adjusted diagnosis rates were significantly associated with the proportion of Latino/as, individuals living below the poverty line, population, and household density. Conclusions There are significant local variations in test positivity within LAC and several socio-structural determinants contribute to ongoing disparities. Public health interventions, beyond shelter in place, are needed to address and target such disparities.
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Affiliation(s)
- Tara Vijayan
- Division of Infectious Diseases, David GeffenSchool of Medicine, UCLA
| | | | - Paul C Adamson
- Division of Infectious Diseases, David GeffenSchool of Medicine, UCLA
| | - Christina Harris
- VA Greater Los Angeles Healthcare System, David Geffen School of Medicine, UCLA
| | - Teresa Seeman
- Division of Geriatrics, David Geffen School of Medicine, UCLA
| | - Keith C Norris
- Division of General Internal Medicine-Health Services Research, David Geffen School of Medicine, UCLA
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Adamson PC, Goodman-Meza D, Vijayan T, Yang S, Garner OB. Diagnostic yield of repeat testing for SARS-CoV-2: Experience from a large health system in Los Angeles. Int J Infect Dis 2020; 100:298-301. [PMID: 32835787 PMCID: PMC7441934 DOI: 10.1016/j.ijid.2020.08.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Received: 07/17/2020] [Revised: 08/12/2020] [Accepted: 08/16/2020] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To determine the diagnostic yield of repeat testing for SARS-CoV-2. METHODS A retrospective analysis was performed of all SARS-CoV-2 test results within the UCLA Health System between March 9th and April 29th, 2020. All patients with repeat test results were identified and those with discordant results were reviewed. RESULTS Between March 9th and April 29th there were 10,165 SARS-CoV-2 test results, of which 630 (6.2%) were positive. Among the 904 patients with repeat test results, 808 (89.4%) were initially negative and 96 (10.6%) were initially positive. Among the 808 patients with an initial negative test, 15 (1.9%) subsequently tested positive. Eleven cases with an initial negative SARS-CoV-2 test and without a known prior positive SARS-CoV-2 test were reviewed; 6 were employed as healthcare workers and 10 were positive on the second test. CONCLUSIONS We found a low diagnostic yield of repeat testing for SARS-CoV-2 in our health system. Repeat testing might prove useful in certain clinical scenarios, such as in healthcare workers, when symptoms develop after a negative test, and in hospitalized patients with a high clinical suspicion for COVID-19.
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Affiliation(s)
- Paul C Adamson
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - David Goodman-Meza
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Tara Vijayan
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Shangxin Yang
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Omai B Garner
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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35
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Yang B, Fulcher JA, Ahn J, Berro M, Goodman-Meza D, Dhody K, Sacha JB, Naeim A, Yang OO. Clinical Characteristics and Outcomes of COVID-19 Patients Receiving Compassionate Use Leronlimab. Clin Infect Dis 2020; 73:e4082-e4089. [PMID: 33079180 PMCID: PMC7665416 DOI: 10.1093/cid/ciaa1583] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Indexed: 12/31/2022] Open
Abstract
Background Leronlimab, a monoclonal antibody blocker of C-C chemokine receptor type 5 originally developed to treat human immunodeficiency virus infection, was administered as an open-label compassionate-use therapeutic for coronavirus disease 2019 (COVID-19). Methods Twenty-three hospitalized severe/critical COVID-19 patients received 700 mg leronlimab subcutaneously, repeated after 7 days in 17 of 23 patients still hospitalized. Eighteen of 23 received other experimental treatments, including convalescent plasma, hydroxychloroquine, steroids, and/or tocilizumab. Five of 23 received leronlimab after blinded, placebo-controlled trials of remdesivir, sarilumab, selinexor, or tocilizumab. Outcomes and results were extracted from medical records. Results Mean age was 69.5 ± 14.9 years; 20 had significant comorbidities. At baseline, 22 were receiving supplemental oxygen (3 high flow, 7 mechanical ventilation). Blood showed markedly elevated inflammatory markers (ferritin, D-dimer, C-reactive protein) and an elevated neutrophil-to-lymphocyte ratio. By day 30 after initial dosing, 17 were recovered, 2 were still hospitalized, and 4 had died. Of the 7 intubated at baseline, 4 were fully recovered off oxygen, 2 were still hospitalized, and 1 had died. Conclusions Leronlimab appeared safe and well tolerated. The high recovery rate suggested benefit, and those with lower inflammatory markers had better outcomes. Some, but not all, patients appeared to have dramatic clinical responses, indicating that unknown factors may determine responsiveness to leronlimab. Routine inflammatory and cell prognostic markers did not markedly change immediately after treatment, although interleukin-6 tended to fall. In some persons, C-reactive protein clearly dropped only after the second leronlimab dose, suggesting that a higher loading dose might be more effective. Future controlled trials will be informative.
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Affiliation(s)
- Bryant Yang
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
| | - Jennifer A Fulcher
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA.,VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Jenny Ahn
- Clinical and Translational Science Institute Office of Clinical Research, Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
| | - Marlene Berro
- Clinical and Translational Science Institute Office of Clinical Research, Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
| | - David Goodman-Meza
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
| | - Kush Dhody
- Amarex Clinical Research, LLC, Germantown, MD
| | - Jonah B Sacha
- Vaccine and Gene Therapy Institute and Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR
| | - Arash Naeim
- Clinical and Translational Science Institute Office of Clinical Research, Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
| | - Otto O Yang
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA.,Department of Microbiology, Immunology, and Molecular Genetics, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
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36
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Goodman-Meza D, Rudas A, Chiang JN, Adamson PC, Ebinger J, Sun N, Botting P, Fulcher JA, Saab FG, Brook R, Eskin E, An U, Kordi M, Jew B, Balliu B, Chen Z, Hill BL, Rahmani E, Halperin E, Manuel V. A machine learning algorithm to increase COVID-19 inpatient diagnostic capacity. PLoS One 2020; 15:e0239474. [PMID: 32960917 PMCID: PMC7508387 DOI: 10.1371/journal.pone.0239474] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/01/2020] [Indexed: 01/09/2023] Open
Abstract
Worldwide, testing capacity for SARS-CoV-2 is limited and bottlenecks in the scale up of polymerase chain reaction (PCR-based testing exist. Our aim was to develop and evaluate a machine learning algorithm to diagnose COVID-19 in the inpatient setting. The algorithm was based on basic demographic and laboratory features to serve as a screening tool at hospitals where testing is scarce or unavailable. We used retrospectively collected data from the UCLA Health System in Los Angeles, California. We included all emergency room or inpatient cases receiving SARS-CoV-2 PCR testing who also had a set of ancillary laboratory features (n = 1,455) between 1 March 2020 and 24 May 2020. We tested seven machine learning models and used a combination of those models for the final diagnostic classification. In the test set (n = 392), our combined model had an area under the receiver operator curve of 0.91 (95% confidence interval 0.87-0.96). The model achieved a sensitivity of 0.93 (95% CI 0.85-0.98), specificity of 0.64 (95% CI 0.58-0.69). We found that our machine learning algorithm had excellent diagnostic metrics compared to SARS-CoV-2 PCR. This ensemble machine learning algorithm to diagnose COVID-19 has the potential to be used as a screening tool in hospital settings where PCR testing is scarce or unavailable.
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Affiliation(s)
- David Goodman-Meza
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Akos Rudas
- Department of Computational Medicine, UCLA, Los Angeles, California, United States of America
- Faculty of Informatics, Eötvös Loránd University (ELTE), Budapest, Hungary
| | - Jeffrey N. Chiang
- Department of Computational Medicine, UCLA, Los Angeles, California, United States of America
| | - Paul C. Adamson
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Joseph Ebinger
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Nancy Sun
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Patrick Botting
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Jennifer A. Fulcher
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Faysal G. Saab
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Rachel Brook
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Eleazar Eskin
- Department of Computational Medicine, UCLA, Los Angeles, California, United States of America
- Department of Computer Science, UCLA, Los Angeles, California, United States of America
- Department of Human Genetics, UCLA, Los Angeles, California, United States of America
| | - Ulzee An
- Department of Computer Science, UCLA, Los Angeles, California, United States of America
| | - Misagh Kordi
- Department of Computational Medicine, UCLA, Los Angeles, California, United States of America
| | - Brandon Jew
- Department of Computational Medicine, UCLA, Los Angeles, California, United States of America
| | - Brunilda Balliu
- Department of Computational Medicine, UCLA, Los Angeles, California, United States of America
| | - Zeyuan Chen
- Department of Computer Science, UCLA, Los Angeles, California, United States of America
| | - Brian L. Hill
- Department of Computer Science, UCLA, Los Angeles, California, United States of America
| | - Elior Rahmani
- Department of Computer Science, UCLA, Los Angeles, California, United States of America
| | - Eran Halperin
- Department of Computational Medicine, UCLA, Los Angeles, California, United States of America
- Department of Computer Science, UCLA, Los Angeles, California, United States of America
- Department of Human Genetics, UCLA, Los Angeles, California, United States of America
- Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Vladimir Manuel
- Faculty Practice Group, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
- UCLA Clinical and Translational Science Institute, Los Angeles, California, United States of America
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Ibarrondo FJ, Fulcher JA, Goodman-Meza D, Elliott J, Hofmann C, Hausner MA, Ferbas KG, Tobin NH, Aldrovandi GM, Yang OO. Rapid Decay of Anti-SARS-CoV-2 Antibodies in Persons with Mild Covid-19. N Engl J Med 2020; 383:1085-1087. [PMID: 32706954 PMCID: PMC7397184 DOI: 10.1056/nejmc2025179] [Citation(s) in RCA: 779] [Impact Index Per Article: 194.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- F Javier Ibarrondo
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Jennifer A Fulcher
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - David Goodman-Meza
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Julie Elliott
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Christian Hofmann
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Mary A Hausner
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Kathie G Ferbas
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Nicole H Tobin
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Grace M Aldrovandi
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Otto O Yang
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
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Monteiro AC, Suri R, Emeruwa IO, Stretch RJ, Cortes-Lopez RY, Sherman A, Lindsay CC, Fulcher JA, Goodman-Meza D, Sapru A, Buhr RG, Chang S, Wang T, Qadir N. Obesity and Smoking as Risk Factors for Invasive Mechanical Ventilation in COVID-19: a Retrospective, Observational Cohort Study. medRxiv 2020. [PMID: 32817959 PMCID: PMC7430603 DOI: 10.1101/2020.08.12.20173849] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Purpose: To describe the trajectory of respiratory failure in COVID-19 and explore factors associated with risk of invasive mechanical ventilation (IMV). Materials and Methods: A retrospective, observational cohort study of 112 inpatient adults diagnosed with COVID-19 between March 12 and April 16, 2020. Data were manually extracted from electronic medical records. Multivariable and Univariable regression were used to evaluate association between baseline characteristics, initial serum markers and the outcome of IMV. Results: Our cohort had median age of 61 (IQR 45–74) and was 66% male. In-hospital mortality was 6% (7/112). ICU mortality was 12.8% (6/47), and 18% (5/28) for those requiring IMV. Obesity (OR 5.82, CI 1.74–19.48), former (OR 8.06, CI 1.51–43.06) and current smoking status (OR 10.33, CI 1.43–74.67) were associated with IMV after adjusting for age, sex, and high prevalence comorbidities by multivariable analysis. Initial absolute lymphocyte count (OR 0.33, CI 0.11–0.96), procalcitonin (OR 1.27, CI 1.02–1.57), IL-6 (OR 1.17, CI 1.03–1.33), ferritin (OR 1.05, CI 1.005–1.11), LDH (OR 1.57, 95% CI 1.13–2.17) and CRP (OR 1.13, CI 1.06–1.21), were associated with IMV by univariate analysis. Conclusions: Obesity, smoking history, and elevated inflammatory markers were associated with increased need for IMV in patients with COVID-19.
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Affiliation(s)
- Ana C Monteiro
- Division of Pulmonary and Critical Care, UCLA Medical Center
| | - Rajat Suri
- Division of Pulmonary and Critical Care, UCLA Medical Center
| | | | | | | | | | | | | | | | - Anil Sapru
- Division of Pediatric Critical Care, UCLA Medical Center
| | - Russell G Buhr
- Division of Pulmonary and Critical Care, UCLA Medical Center
| | - Steven Chang
- Division of Pulmonary and Critical Care, UCLA Medical Center
| | - Tisha Wang
- Division of Pulmonary and Critical Care, UCLA Medical Center
| | - Nida Qadir
- Division of Pulmonary and Critical Care, UCLA Medical Center
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Ling W, Shoptaw S, Goodman-Meza D. Depot Buprenorphine Injection In The Management Of Opioid Use Disorder: From Development To Implementation. Subst Abuse Rehabil 2019; 10:69-78. [PMID: 31819701 PMCID: PMC6889966 DOI: 10.2147/sar.s155843] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/08/2019] [Indexed: 12/12/2022] Open
Abstract
Buprenorphine has pharmacologic advantages over methadone, especially buprenorphine's better safety profile. The true significance of buprenorphine's introduction lies in returning the care of those suffering from opioid use disorder (OUD) to the hands of the physician. The clinical success of buprenorphine has been meager, in part because most physicians have not been exposed to treating these patients. For physicians inclined to treat OUD, the barriers to buprenorphine's implementation have been onerous and largely counter to the norms of medical practice. Some notable concerns pertain to buprenorphine's clinical pharmacology like street diversion, unintended use and accidental poisoning. Recently, injectable buprenorphine preparations have been introduced to mitigate these latter shortcomings. Yet, the injectable preparations' clinical and commercial success has fallen far short of expectation. Here, we review the clinical pharmacology of these products and their expected clinical advantages for the manufacturers, clinicians, policy makers and patients, and offer our perspective, as clinicians and researchers, on how things can improve. Questions remain whether clinicians are willing to overcome barriers to treat OUD using these medications.
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Affiliation(s)
- Walter Ling
- UCLA Department of Family Medicine, Center for Behavioral and Addiction Medicine, Los Angeles, CA, USA
| | - Steve Shoptaw
- UCLA Department of Family Medicine, Center for Behavioral and Addiction Medicine, Los Angeles, CA, USA
| | - David Goodman-Meza
- UCLA Department of Medicine, Division of Infectious Diseases, Los Angeles, CA, USA
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Goodman-Meza D, Weiss RE, Gamboa S, Gallegos A, Bui AAT, Goetz MB, Shoptaw S, Landovitz RJ. Long term surgical outcomes for infective endocarditis in people who inject drugs: a systematic review and meta-analysis. BMC Infect Dis 2019; 19:918. [PMID: 31699053 PMCID: PMC6839097 DOI: 10.1186/s12879-019-4558-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/11/2019] [Indexed: 02/18/2023] Open
Abstract
Background In recent years, the number of infective endocarditis (IE) cases associated with injection drug use has increased. Clinical guidelines suggest deferring surgery for IE in people who inject drugs (PWID) due to a concern for worse outcomes in comparison to non-injectors (non-PWID). We performed a systematic review and meta-analysis of long-term outcomes in PWID who underwent cardiac surgery and compared these outcomes to non-PWID. Methods We systematically searched for studies reported between 1965 and 2018. We used an algorithm to estimate individual patient data (eIPD) from Kaplan-Meier (KM) curves and combined it with published individual patient data (IPD) to analyze long-term outcomes after cardiac surgery for IE in PWID. Our primary outcome was survival. Secondary outcomes were reoperation and mortality at 30-days, one-, five-, and 10-years. Random effects Cox regression was used for estimating survival. Results We included 27 studies in the systematic review and 19 provided data (KM or IPD) for the meta-analysis. PWID were younger and more likely to have S. aureus than non-PWID. Survival at 30-days, one-, five-, and 10-years was 94.3, 81.0, 62.1, and 56.6% in PWID, respectively; and 96.4, 85.0, 70.3, and 63.4% in non-PWID. PWID had 47% greater hazard of death (HR 1.47, 95% CI, 1.05–2.05) and more than twice the hazard of reoperation (HR 2.37, 95% CI, 1.25–4.50) than non-PWID. Conclusion PWID had shorter survival that non-PWID. Implementing evidence-based interventions and testing new modalities are urgently needed to improve outcomes in PWID after cardiac surgery.
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Affiliation(s)
- David Goodman-Meza
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave (Room 37-121CHS), Los Angeles, CA, 90095-1688, USA. .,Infectious Diseases, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
| | - Robert E Weiss
- Department of Biostatistics, Fielding School of Public Health, UCLA, Los Angeles, CA, USA
| | | | - Abel Gallegos
- Universidad Autónoma de Baja California, Tijuana, USA
| | - Alex A T Bui
- Medical Imaging Informatics (MII) Group, Department of Radiological Sciences, UCLA, Los Angeles, CA, USA
| | - Matthew B Goetz
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave (Room 37-121CHS), Los Angeles, CA, 90095-1688, USA.,Infectious Diseases, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Steven Shoptaw
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Raphael J Landovitz
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave (Room 37-121CHS), Los Angeles, CA, 90095-1688, USA.,UCLA Center for Clinical AIDS Research & Education, David Geffen School of Medicine, Los Angeles, CA, USA
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Goodman-Meza D, Beymer MR, Kofron RM, Amico KR, Psaros C, Bushman LR, Anderson PL, Bolan R, Jordan WC, Rooney JF, Wohl AR, Landovitz RJ. Effective use of pre-exposure prophylaxis (PrEP) Among stimulant users with multiple condomless sex partners: a longitudinal study of men who have sex with men in Los Angeles. AIDS Care 2019; 31:1228-1233. [PMID: 30894013 DOI: 10.1080/09540121.2019.1595523] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PrEP's potential benefit for men who have sex with men (MSM) who use stimulants may be limited by adherence or prescriber willingness to recommend PrEP due to concerns of non-compliance. Using data from PATH-PrEP, a 48-week study evaluating PrEP for MSM in Los Angeles, we modeled an interaction between stimulant use and condomless sex with multiple partners (CAS-MP) on prevention-effective dried blood spot tenofovir-diphosphate concentrations. At week 4, participants reporting stimulant use and CAS-MP had a decreased odds of prevention-effective adherence compared to non-stimulant use and non-CAS-MP (AOR 0.15, 95% CI 0.04-0.57). From week 4-48, participants reporting stimulant use and CAS-MP had increased odds of prevention-effective adherence (AOR 1.06 per week, 95%CI 1.01-1.12). Participants reporting CAS-MP without stimulant use had no significant change in prevention-effective adherence (AOR 0.99 per week, 95%CI 0.96-1.02). Stimulant use moderated the association of CAS-MP on prevention-effective PrEP adherence over time.
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Affiliation(s)
- David Goodman-Meza
- a Division of Infectious Diseases, David Geffen School of Medicine at UCLA , Los Angeles , CA , USA
| | - Matthew R Beymer
- a Division of Infectious Diseases, David Geffen School of Medicine at UCLA , Los Angeles , CA , USA.,b Health and Mental Health Services, Los Angeles LGBT Center , Los Angeles , CA , USA
| | - Ryan M Kofron
- c UCLA Center for Clinical AIDS Research & Education (CARE) , Los Angeles , CA , USA
| | - K Rivet Amico
- d Department of Health Behavior and Health Education, University of Michigan School of Public Health , Ann Arbor , MI , USA
| | - Christina Psaros
- e Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital , Boston , MA , USA
| | - Lane R Bushman
- f Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado , Aurora , CO , USA
| | - Peter L Anderson
- f Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado , Aurora , CO , USA
| | - Robert Bolan
- b Health and Mental Health Services, Los Angeles LGBT Center , Los Angeles , CA , USA
| | - Wilbert C Jordan
- g OASIS Clinic, Charles R. Drew University of Medicine and Science , Los Angeles , CA , USA
| | | | - Amy R Wohl
- i Division of HIV and STD Programs, Los Angeles County Department of Public Health , Los Angeles , CA , USA
| | - Raphael J Landovitz
- a Division of Infectious Diseases, David Geffen School of Medicine at UCLA , Los Angeles , CA , USA.,c UCLA Center for Clinical AIDS Research & Education (CARE) , Los Angeles , CA , USA
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Goodman-Meza D, Medina-Mora ME, Magis-Rodríguez C, Landovitz RJ, Shoptaw S, Werb D. Where Is the Opioid Use Epidemic in Mexico? A Cautionary Tale for Policymakers South of the US-Mexico Border. Am J Public Health 2018; 109:73-82. [PMID: 30495992 DOI: 10.2105/ajph.2018.304767] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In North America, opioid use and its harms have increased in the United States and Canada over the past 2 decades. However, Mexico has yet to document patterns suggesting a higher level of opioid use or attendant harms.Historically, Mexico has been a country with low-level use of opioids, although heroin use has been documented. Low-level opioid use is likely attributable to structural, cultural, and individual factors. However, a range of dynamic factors may be converging to increase the use of opioids: legislative changes to opioid prescribing, national health insurance coverage of opioids, pressure from the pharmaceutical industry, changing demographics and disease burden, forced migration and its trauma, and an increase in the production and trafficking of heroin. In addition, harm-reduction services are scarce.Mexico may transition from a country of low opioid use to high opioid use but has the opportunity to respond effectively through a combination of targeted public health surveillance of high-risk groups, preparation of appropriate infrastructure to support evidence-based treatment, and interventions and policies to avoid a widespread opioid use epidemic.
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Affiliation(s)
- David Goodman-Meza
- David Goodman-Meza and Raphael J. Landovitz are with Division of Infectious Diseases, David Geffen School of Medicine at University of California Los Angeles (UCLA). Raphael J. Landovitz is also with Center for Clinical AIDS Research and Education, Los Angeles. Maria Elena Medina-Mora is with Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico. Carlos Magis-Rodríguez is with National Center for the Prevention and Control of HIV and AIDS, Mexico City. Steve Shoptaw is with Department of Family Medicine, David Geffen School of Medicine at UCLA. Dan Werb is with Department of Medicine, University of California San Diego, La Jolla
| | - Maria Elena Medina-Mora
- David Goodman-Meza and Raphael J. Landovitz are with Division of Infectious Diseases, David Geffen School of Medicine at University of California Los Angeles (UCLA). Raphael J. Landovitz is also with Center for Clinical AIDS Research and Education, Los Angeles. Maria Elena Medina-Mora is with Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico. Carlos Magis-Rodríguez is with National Center for the Prevention and Control of HIV and AIDS, Mexico City. Steve Shoptaw is with Department of Family Medicine, David Geffen School of Medicine at UCLA. Dan Werb is with Department of Medicine, University of California San Diego, La Jolla
| | - Carlos Magis-Rodríguez
- David Goodman-Meza and Raphael J. Landovitz are with Division of Infectious Diseases, David Geffen School of Medicine at University of California Los Angeles (UCLA). Raphael J. Landovitz is also with Center for Clinical AIDS Research and Education, Los Angeles. Maria Elena Medina-Mora is with Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico. Carlos Magis-Rodríguez is with National Center for the Prevention and Control of HIV and AIDS, Mexico City. Steve Shoptaw is with Department of Family Medicine, David Geffen School of Medicine at UCLA. Dan Werb is with Department of Medicine, University of California San Diego, La Jolla
| | - Raphael J Landovitz
- David Goodman-Meza and Raphael J. Landovitz are with Division of Infectious Diseases, David Geffen School of Medicine at University of California Los Angeles (UCLA). Raphael J. Landovitz is also with Center for Clinical AIDS Research and Education, Los Angeles. Maria Elena Medina-Mora is with Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico. Carlos Magis-Rodríguez is with National Center for the Prevention and Control of HIV and AIDS, Mexico City. Steve Shoptaw is with Department of Family Medicine, David Geffen School of Medicine at UCLA. Dan Werb is with Department of Medicine, University of California San Diego, La Jolla
| | - Steve Shoptaw
- David Goodman-Meza and Raphael J. Landovitz are with Division of Infectious Diseases, David Geffen School of Medicine at University of California Los Angeles (UCLA). Raphael J. Landovitz is also with Center for Clinical AIDS Research and Education, Los Angeles. Maria Elena Medina-Mora is with Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico. Carlos Magis-Rodríguez is with National Center for the Prevention and Control of HIV and AIDS, Mexico City. Steve Shoptaw is with Department of Family Medicine, David Geffen School of Medicine at UCLA. Dan Werb is with Department of Medicine, University of California San Diego, La Jolla
| | - Dan Werb
- David Goodman-Meza and Raphael J. Landovitz are with Division of Infectious Diseases, David Geffen School of Medicine at University of California Los Angeles (UCLA). Raphael J. Landovitz is also with Center for Clinical AIDS Research and Education, Los Angeles. Maria Elena Medina-Mora is with Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico. Carlos Magis-Rodríguez is with National Center for the Prevention and Control of HIV and AIDS, Mexico City. Steve Shoptaw is with Department of Family Medicine, David Geffen School of Medicine at UCLA. Dan Werb is with Department of Medicine, University of California San Diego, La Jolla
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Goodman-Meza D, Weiss RE, Gamboa S, Gallegos A, Landovitz RJ, Bui AAT, Goetz MB, Shoptaw S. 1082. Meta-Analysis of Survival Outcomes in People Who Inject Drugs After Cardiac Surgery for Infective Endocarditis. Open Forum Infect Dis 2018. [PMCID: PMC6255531 DOI: 10.1093/ofid/ofy210.917] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background The United States’ opioid epidemic has led to an increase in people who inject drugs (PWID) and opioid-associated infections, including infectious endocarditis (IE). Cardiac surgery is often indicated in IE to improve outcomes but is controversial in PWID due to the concerns about continued injection drug use leading to risk for reinfection and decreased survival. In response, we assessed the long-term survival after cardiac valve surgery in PWID compared with people who do not inject drugs (non-PWID) in the published literature. Methods We performed a systematic review and meta-analysis (MA) of studies that reported survival data after surgery for IE in PWID. We searched PUBMED up to April 2018. We extracted Kaplan–Meier (KM) curves from included studies. From the KM curves, we used an algorithm to estimate individual participant data (eIPD). In a one-step approach, we ran a Cox proportional hazards (CPH) model analysis of the eIPD with study random effects. In a two-step approach, we fitted CPH models by individual study; then, we ran a mixed-effects MA model of the log hazard ratios (HR) and standard errors. Results We identified 11 retrospective studies. Of these, six reported comparisons of PWID vs. non-PWID, and five reported results for PWID only. Based on eIPD, we included 407 PWID and 1,877 non-PWID. Mean age for PWID was 36.7 years (95% CI 34.4–39.1) and for non-PWID was 52.0 years (95% CI 45.3–59.4). There were 144 deaths (35.3%) in PWID and 559 (29.8%) deaths in non-PWID. We present by study and by group KM curves of eIPD (Figures 1 and 2). In one-step MA (included all 11 studies), the HR for PWID was 1.13 (95% CI 0.92–1.39). In two-step MA (included six comparison studies), heterogeneity was high (I2 = 72%); and there was no significant between-group difference (HR 1.29, 95% CI 0.80–2.07) (Figure 3). Conclusion Survival time post-surgery of PWID was similar to that of non-PWID. These estimates are concerning, as PWID on average are much younger than non-PWID with IE. Future studies should explore interventions to improve outcomes in PWID after surgery, including treatment of addiction during and after the index hospitalization and provision of naloxone at the time of discharge. ![]()
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Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | - Robert E Weiss
- Department of Biostatistics, Fielding School of Public Health, UCLA, Los Angeles, California
| | | | - Abel Gallegos
- Universidad Autonoma de Baja California, Tijuana, Mexico
| | - Raphael J Landovitz
- UCLA Center for Clinical AIDS Research & Education, University of California Los Angeles, Los Angeles, California
| | - Alex A T Bui
- Medical Imaging Informatics (MII) Group, Department of Radiological Sciences, UCLA, Los Angeles, California
| | - Matthew B Goetz
- Infectious Diseases, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Steven Shoptaw
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
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Beletsky L, Baker P, Arredondo J, Emuka A, Goodman-Meza D, Medina-Mora ME, Werb D, Davidson P, Amon JJ, Strathdee S, Magis-Rodriguez C. The global health and equity imperative for safe consumption facilities. Lancet 2018; 392:553-554. [PMID: 30152386 DOI: 10.1016/s0140-6736(18)31469-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 06/22/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Leo Beletsky
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA 92093, USA; School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA.
| | - Pieter Baker
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA 92093, USA; Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Jaime Arredondo
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA 92093, USA
| | - Ashley Emuka
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA 92093, USA
| | - David Goodman-Meza
- Division of Infectious Diseases, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Dan Werb
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada; Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA 92093, USA
| | - Peter Davidson
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA 92093, USA
| | - Joseph J Amon
- Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, NJ, USA
| | - Steffanie Strathdee
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA 92093, USA
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Quintero-Quiñónez JF, Goodman-Meza D, Burgos-Regil JL, Muñoz-Carvajal FA, Zúñiga-de Nuncio ML, Ornelas-Aguirre JM. [Quality of life in persons with Human Immunodeficiency Virus infection in Mexico]. Rev Med Inst Mex Seguro Soc 2018; 56:126-131. [PMID: 29901901] [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: 06/08/2023]
Abstract
BACKGROUND The evaluation of quality of life related to health (HRQOL) has become an important prognostic indicator in HIV/AIDS. The aim of this study was to determine the impact of socio-demographic, clinical and psychological factors in HRQOL in a group of subjects with HIV/AIDS in northwestern Mexico and determine which variables best predict HRQOL. METHODS In a cross-sectional study with a sample of 87% of patients receiving care at a clinic for HIV/AIDS in northwestern Mexico between November 2010 to June 2011, we measure the HRQOL using the Tool Medical Outcomes Study HIV Health Survey (MOS-HIV). A model of multiple linear regression was performed to identify variables that allow us to predict HRQOL in this population. RESULTS In a sample of 54 subjects with HIV/AIDS. Patients had an average age of 43 ± 9 years, 83% were men with a mean time of 6.5 ± 4.5 years from diagnosis. HRQOL scores of physical and mental health of the participants were 57 ± 6 and 57 ± 13 respectively. In multivariate analysis, the variables that influenced the physical health punctuation were gender, marital status, sexual orientation, time since diagnosis and viral load (log). CONCLUSIONS Prospective studies are needed to better explain the influence of the factors that predict changes or trends in HRQOL in patients with HIV/AIDS.
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Affiliation(s)
- Jhonis Francisco Quintero-Quiñónez
- Instituto Mexicano del Seguro Social, Hospital de Especialidades No. 2, Centro Médico Nacional del Noroeste, Servicio de Medicina Interna. Ciudad Obregón, Sonora, México
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Semple SJ, Pitpitan EV, Goodman-Meza D, Strathdee SA, Chavarin CV, Rangel G, Torres K, Patterson TL. Correlates of condomless anal sex among men who have sex with men (MSM) in Tijuana, Mexico: The role of public sex venues. PLoS One 2017; 12:e0186814. [PMID: 29065132 PMCID: PMC5655432 DOI: 10.1371/journal.pone.0186814] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/09/2017] [Indexed: 11/17/2022] Open
Abstract
Condomless anal sex between male partners is the primary risk factor for HIV transmission among men who have sex with men (MSM). Correlates of condomless anal sex have been well-studied in developed countries, but they have received less attention in lower-to-middle income countries (LMIC), where MSM are often subject to stigma, discrimination, intolerance, and even the criminalization of same sex behavior. In Mexico, a LMIC where traditional views on homosexuality are common, HIV prevalence among MSM is high (16.9%), yet little research has been conducted on the correlates of condomless anal sex in this high-risk population. The present study examined correlates of condomless anal sex among 201 MSM recruited in Tijuana, Mexico, with a focus on the role of public sex venues in relation to sexual risk behavior. Eligibility requirements were: biologically male, 18 years of age or older, resident of Tijuana, and self-reported anal or oral sex with a male partner in the past year. Participants completed an interviewer-administered, demographic and psychosocial survey, and were tested for HIV and syphilis. A hierarchical multiple linear regression model was tested to identify correlates of condomless anal sex. Thirty-eight percent of participants (N = 76) reported condomless anal sex with a male partner in the past 2 months. Higher levels of condomless anal sex were associated with higher levels of depressive symptoms, greater sexual compulsivity, and more frequent seeking out of sex partners in a public venue in the past 2 months. In view of these findings, we recommend the development of multi-level, “combination” interventions, which in the Mexican context should include enhanced condom promotion and distribution, improved availability and access to mental health treatment and counseling services, and expanded HIV/STI testing in public venues.
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Affiliation(s)
- Shirley J Semple
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
| | - Eileen V Pitpitan
- Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, United States of America
| | - David Goodman-Meza
- Division of Infectious Diseases, University of California Los Angeles, Los Angeles, California, United States of America
| | - Steffanie A Strathdee
- Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, United States of America
| | - Claudia V Chavarin
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
| | | | - Karla Torres
- Agencia Familiar Binacional, A.C., Tijuana, Mexico
| | - Thomas L Patterson
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
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Semple SJ, Stockman JK, Goodman-Meza D, Pitpitan EV, Strathdee SA, Chavarin CV, Rangel G, Torres K, Patterson TL. Correlates of Sexual Violence Among Men Who Have Sex With Men in Tijuana, Mexico. Arch Sex Behav 2017; 46:1011-1023. [PMID: 27178173 PMCID: PMC5107348 DOI: 10.1007/s10508-016-0747-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/12/2016] [Accepted: 03/21/2016] [Indexed: 05/14/2023]
Abstract
Sexual violence among men who have sex with men (MSM) is prevalent in developing countries and is associated with increased HIV/STI risk. Despite high HIV prevalence (20 %) among MSM in Tijuana, Mexico, little attention has been paid to the occurrence of sexual violence in this high-risk group. The present study used a syndemic conditions framework to examine correlates of sexual violence victimization in a sample of 201 MSM surveyed in Tijuana, Mexico during 2012 and 2013. Participants were recruited through respondent-driven sampling and underwent a 2-h baseline interview and testing for HIV and syphilis. Sexual violence was defined as any incident during the past year in which the participant had been raped, sexually molested, or sexually harassed. The majority of participants self-identified as gay or bisexual, had never married, were employed, and had a high school education or greater. The average age was 29.7 years. Thirty-nine percent reported sexual violence in the past year. A hierarchical multiple linear regression model predicting more experiences of sexual violence was tested. In a final model, a higher number of experiences of sexual violence was associated with a history of childhood sexual abuse, more adult experiences of homophobia, more depression and hostility symptoms, and not living with a spouse or steady partner. The findings from this study support a model of co-occurring psychosocial factors that increase the likelihood of sexual violence experiences among MSM. Multi-level approaches to the prevention of childhood and adult experiences of sexual violence and homophobia are needed to avert the development of adverse mental and physical health outcomes associated with sexual violence victimization.
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Affiliation(s)
- Shirley J Semple
- Department of Psychiatry, University of California San Diego, Mail Code 0680, 9500 Gilman Drive, La Jolla, CA, 92093-0680, USA
| | - Jamila K Stockman
- Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - David Goodman-Meza
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Eileen V Pitpitan
- Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Steffanie A Strathdee
- Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Claudia V Chavarin
- Department of Psychiatry, University of California San Diego, Mail Code 0680, 9500 Gilman Drive, La Jolla, CA, 92093-0680, USA
| | | | - Karla Torres
- Agencia Familiar Binacional, A.C., Tijuana, Mexico
| | - Thomas L Patterson
- Department of Psychiatry, University of California San Diego, Mail Code 0680, 9500 Gilman Drive, La Jolla, CA, 92093-0680, USA.
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Abstract
OBJECTIVES HIV testing is critical to the delivery of comprehensive HIV prevention and care services, yet coverage of sexual minorities by HIV testing programmes remains insufficient in many low- and middle-income countries, including Mexico. The objective of this study was to identify the prevalence and correlates of HIV testing among men who have sex with men (MSM) in Tijuana, Mexico. METHODS We conducted a cross-sectional study (2012-2013) among 189 MSM recruited via respondent-driven sampling (RDS). RDS-weighted logistic regression was used to identify correlates of prior HIV testing. RESULTS RDS-adjusted prevalence of prior and recent (≤ 12 months) HIV testing was 63.5% (95% CI 51.9% to 73.5%) and 36.8% (95% CI 25.4% to 46.4%), respectively. Prior HIV testing was positively associated with older age (adjusted OR (AOR)=1.09, 95% CI 1.04 to 1.15), being born in Tijuana (AOR=2.68, 95% CI 1.05 to 6.86), higher levels of education (AOR=2.65, 95% CI 1.08 to 6.53), identifying as homosexual or gay (AOR=3.73, 95% CI 1.48 to 9.42), being more 'out' about having sex with men (AOR=1.28, 95% CI:1.02 to 1.62), and a history of sexual abuse (AOR=3.24, 95% CI 1.06 to 9.86). Prior HIV testing was negatively associated with reporting more condomless anal intercourse acts (past 2 months) (AOR=0.95, 95% CI 0.92 to 0.98) and greater internalised homophobia (AOR=0.92, 95% CI 0.86 to 0.99). CONCLUSIONS Our findings indicate an urgent need for expanded HIV testing services for MSM in Tijuana. Innovative, non-stigmatising, confidential HIV testing interventions targeted at young, less educated, migrant and non-gay identifying MSM may facilitate HIV testing and timely linkage to HIV care and treatment within this population.
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Affiliation(s)
- Heather A Pines
- Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California, USA
| | - David Goodman-Meza
- Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Eileen V Pitpitan
- Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Karla Torres
- Agencia Familiar Binacional, AC, Tijuana, Mexico
| | - Shirley J Semple
- Department of Psychiatry, University of California, San Diego, La Jolla, USA
| | - Thomas L Patterson
- Department of Psychiatry, University of California, San Diego, La Jolla, USA
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Mojadidi MK, Galeas JN, Goodman-Meza D, Eshtehardi P, Msaouel P, Kelesidis I, Zaman MO, Winoker JS, Roberts SC, Christia P, Zolty R. Thrombocytopaenia as a Prognostic Indicator in Heart Failure with Reduced Ejection Fraction. Heart Lung Circ 2016; 25:568-75. [PMID: 26868831 DOI: 10.1016/j.hlc.2015.11.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 07/21/2015] [Revised: 10/14/2015] [Accepted: 11/08/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Studies suggest that thrombocytopaenia is associated with a higher mortality in several diseases. Little is known about the effect of low platelet count on mortality in patients with heart failure with reduced ejection fraction (HFrEF). The aim of this study was to determine the prognostic value of thrombocytopaenia in these patients by assessing all-cause mortality. METHODS A total of 1,907 patients with HFrEF, defined by left ventricular ejection fraction <40% on echocardiography, were analysed in this multi-centre retrospective study. All patients were on medical therapy with a beta-blocker and an angiotensin-converting enzyme inhibitor. Patients were categorised into two groups based on platelet count measured within one month of the diagnosis of HFrEF: normal to mild thrombocytopaenia (platelet count 100,000-450,000 per uL); and moderate to severe thrombocytopaenia (platelet count <100,000 per uL). One-year all-cause mortality was compared between the two groups. RESULTS Mean age was 65±15 years and 62% of patients were male. Overall one-year mortality was 17.2% with higher mortality among patients with HFrEF and moderate/severe thrombocytopaenia compared to those with normal/mild thrombocytopaenia (33.0% vs. 15.4%, p <0.001). After adjusting for baseline characteristics, patients with HFrEF and moderate/severe thrombocytopaenia had a higher mortality compared to patients with normal/mild thrombocytopaenia (HR 1.84, 95% CI 1.33-2.56, p <0.001). CONCLUSION In patients with HFrEF, higher degree of thrombocytopaenia is associated with higher all-cause mortality. These findings may support the use of platelet counts as a prognostic marker in the assessment of the patient with HFrEF.
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Affiliation(s)
- Mohammad Khalid Mojadidi
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center and Jacobi Medical Center, Bronx, New York, USA.
| | - Jose Nahun Galeas
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center and Jacobi Medical Center, Bronx, New York, USA
| | - David Goodman-Meza
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center and Jacobi Medical Center, Bronx, New York, USA
| | - Parham Eshtehardi
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center and Jacobi Medical Center, Bronx, New York, USA
| | - Pavlos Msaouel
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center and Jacobi Medical Center, Bronx, New York, USA
| | - Iosif Kelesidis
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center and Jacobi Medical Center, Bronx, New York, USA
| | - Muhammad Omer Zaman
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center and Jacobi Medical Center, Bronx, New York, USA
| | - Jared S Winoker
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center and Jacobi Medical Center, Bronx, New York, USA
| | - Scott C Roberts
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center and Jacobi Medical Center, Bronx, New York, USA
| | - Panagiota Christia
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center and Jacobi Medical Center, Bronx, New York, USA
| | - Ronald Zolty
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center and Jacobi Medical Center, Bronx, New York, USA
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Romero J, Lupercio F, Díaz JC, Goodman-Meza D, Haramati LB, Levsky JM, Shaban N, Piña I, Garcia MJ. Microvascular obstruction detected by cardiac MRI after AMI for the prediction of LV remodeling and MACE: A meta-analysis of prospective trials. Int J Cardiol 2016; 202:344-8. [DOI: 10.1016/j.ijcard.2015.08.197] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 08/26/2015] [Indexed: 11/25/2022]
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