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Dumchev K, Guo X, Ha TV, Djoerban Z, Zeziulin O, Go VF, Sarasvita R, Metzger DS, Latkin CA, Rose SM, Piwowar-Manning E, Richardson P, Hanscom B, Lancaster KE, Miller WC, Hoffman IF. Causes and risk factors of death among people who inject drugs in Indonesia, Ukraine and Vietnam: findings from HPTN 074 randomized trial. BMC Infect Dis 2023; 23:319. [PMID: 37170118 PMCID: PMC10173611 DOI: 10.1186/s12879-023-08201-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 03/27/2023] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION The HIV Prevention Trials Network (HPTN) 074 study demonstrated a positive effect of an integrated systems navigation and psychosocial counseling intervention on HIV treatment initiation, viral suppression, medication assisted treatment (MAT) enrollment, and risk of death among people who inject drugs (PWID). In this sub-study, we analyzed the incidence, causes, and predictors of death among HIV-infected and uninfected participants. METHODS The HPTN 074 randomized clinical trial was conducted in Indonesia, Ukraine, and Vietnam. HIV-infected PWID with unsuppressed viral load (indexes) were recruited together with at least one of their HIV-negative injection partners. Indexes were randomized in a 1:3 ratio to the intervention or standard of care. RESULTS The trial enrolled 502 index and 806 partner participants. Overall, 13% (66/502) of indexes and 3% (19/806) of partners died during follow-up (crude mortality rates 10.4 [95% CI 8.1-13.3] and 2.1 [1.3-3.3], respectively). These mortality rates were for indexes nearly 30 times and for partners 6 times higher than expected in a population of the same country, age, and gender (standardized mortality ratios 30.7 [23.7-39.0] and 5.8 [3.5-9.1], respectively). HIV-related causes, including a recent CD4 < 200 cells/μL, accounted for 50% of deaths among indexes. Among partners, medical conditions were the most common cause of death (47%). In the multivariable Cox model, the mortality among indexes was associated with sex (male versus female aHR = 4.2 [1.5-17.9]), CD4 count (≥ 200 versus < 200 cells/μL aHR = 0.3 [0.2-0.5]), depression (moderate-to-severe versus no/mild aHR = 2.6 [1.2-5.0]) and study arm (intervention versus control aHR = 0.4 [0.2-0.9]). Among partners, the study arm of the index remained the only significant predictor (intervention versus control aHR = 0.2 [0.0-0.9]) while controlling for the effect of MAT (never versus ever receiving MAT aHR = 2.4 [0.9-7.4]). CONCLUSIONS The results confirm that both HIV-infected and uninfected PWID remain at a starkly elevated risk of death compared to general population. Mortality related to HIV and other causes can be significantly reduced by scaling-up ART and MAT. Access to these life-saving treatments can be effectively improved by flexible integrated interventions, such as the one developed and tested in HPTN 074.
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Affiliation(s)
- Kostyantyn Dumchev
- Ukrainian Institute On Public Health Policy, 5 Biloruska Str., Office 20, Kyiv, 04050, Ukraine.
| | - Xu Guo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Tran Viet Ha
- Dept. of Health Behavior, Gilings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Zubairi Djoerban
- Depts. of Hematology, Medical Oncology, and Medicine, Univ. of Indonesia/ Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Oleksandr Zeziulin
- Ukrainian Institute On Public Health Policy, 5 Biloruska Str., Office 20, Kyiv, 04050, Ukraine
| | - Vivian F Go
- Dept. of Health Behavior, Gilings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - David S Metzger
- HIV Prevention Research Division, Department of Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Carl A Latkin
- Dept. of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Scott M Rose
- Science Facilitation Department, Durham, North Carolina, FHI 360, USA
| | | | - Paul Richardson
- Dept. of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Brett Hanscom
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Kathryn E Lancaster
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - William C Miller
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Irving F Hoffman
- Dept. of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Greenberg AE, Celentano DD, Metzger DS, Magnus M, Blank MB, Davis W, Brooks D, Dominque T, Page KR, Limaye RJ, Collman RG, Chaisson RE, Zea MC, Beyrer C. The Mid-Atlantic Centers for AIDS Research Consortium: Promoting HIV Science Through Regional Collaboration. AIDS Res Hum Retroviruses 2022; 38:181-187. [PMID: 34465217 PMCID: PMC8968835 DOI: 10.1089/aid.2021.0017] [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] [Indexed: 11/13/2022] Open
Abstract
The Centers for AIDS Research (CFAR) program was established by the National Institutes of Health in 1988 to catalyze and support high-impact HIV research and to develop the next generation of HIV investigators at academic institutions throughout the United States. In 2014, the Penn CFAR, the Johns Hopkins University CFAR and the District of Columbia CFAR developed a partnership-the Mid-Atlantic CFAR Consortium (MACC)-to promote cross-CFAR scientific collaboration, mentoring, and communication and to address the regional HIV epidemic. Over the past 6 years, the creation of the MACC has resulted in a rich web of interconnectivity, which has fostered scientific collaboration through working groups on the black men who have sex with men (MSM) and Latinx regional HIV epidemics, joint peer-reviewed publications, and successful collaborative grant applications on topics ranging from HIV prevention in young MSM, transgender women, implementation science, and clinical epidemiology; supported developmental activities through the MACC Scholars program, cross-CFAR mentoring, joint symposia, cross-CFAR seminar participation, and keynote speakers; and promoted strategic communication through advisory committees, best practices consultations, and the social and behavioral science research network. The MACC has been highly impactful by promoting HIV science through regional collaboration, supporting a diverse network of scholars across three cities and focusing on the epidemic in underrepresented and marginalized communities. Lessons learned from this consortium may have implications for scientific research centers beyond the field of HIV.
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Affiliation(s)
- Alan E. Greenberg
- District of Columbia Center for AIDS Research and George Washington University, Washington, District of Columbia, USA.,Address correspondence to: Alan E. Greenberg, Department of Epidemiology, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, 5th floor, Washington, DC 20052, USA
| | - David D. Celentano
- Johns Hopkins University Center for AIDS Research and Johns Hopkins University, Baltimore, Maryland, USA
| | - David S. Metzger
- Penn Center for AIDS Research and University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Manya Magnus
- District of Columbia Center for AIDS Research and George Washington University, Washington, District of Columbia, USA
| | - Michael B. Blank
- Penn Center for AIDS Research and University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Wendy Davis
- Johns Hopkins University Center for AIDS Research and Johns Hopkins University, Baltimore, Maryland, USA
| | - Durryle Brooks
- Johns Hopkins University Center for AIDS Research and Johns Hopkins University, Baltimore, Maryland, USA
| | - Tiffany Dominque
- Penn Center for AIDS Research and University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kathleen R. Page
- Johns Hopkins University Center for AIDS Research and Johns Hopkins University, Baltimore, Maryland, USA
| | - Rupali J. Limaye
- Johns Hopkins University Center for AIDS Research and Johns Hopkins University, Baltimore, Maryland, USA
| | - Ronald G. Collman
- Penn Center for AIDS Research and University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Richard E. Chaisson
- Johns Hopkins University Center for AIDS Research and Johns Hopkins University, Baltimore, Maryland, USA
| | - Maria Cecilia Zea
- District of Columbia Center for AIDS Research and George Washington University, Washington, District of Columbia, USA
| | - Chris Beyrer
- Johns Hopkins University Center for AIDS Research and Johns Hopkins University, Baltimore, Maryland, USA
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Chhatre S, Woody G, Metzger DS, Jayadevappa R. Burden of chronic conditions among persons with HIV/AIDS and psychiatric comorbidity. Curr HIV Res 2021; 19:504-513. [PMID: 34353265 DOI: 10.2174/1570162x19666210805092258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/23/2021] [Accepted: 06/28/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Improved survivorship among persons living with HIV translates into higher risk of medical comorbidities. OBJECTIVE We assessed the association between intersection of physical (HIV) and mental health (psychiatric) conditions and intermediate outcomes. METHODS Cross-sectional study of Medical Expenditure Panel Survey (MEPS)-Household Component between 1996 and 2016. We created four groups for persons aged ≥18: (1) HIV + psychiatric comorbidity, (2) HIV, (3) psychiatric comorbidity, and (4) no-HIV/no-psychiatric comorbidity. We compared the burden of medical comorbidities (metabolic disorders, cardiovascular disease, cancers, infectious diseases, pain, and substance use) across groups using chi square tests. We used logistic regression to determine the association between group status and medical comorbidity. RESULTS Of 218,133,630 (weighted) persons aged ≥18, 0.18% were HIV-positive. Forty-three percent of HIV group and 19% of no-HIV group had psychiatric comorbidities. Half of the HIV+ psychiatric disorder group had at least one medical comorbidity. Compared to the no-HIV/no-psychiatric comorbidity group, the HIV + psychiatric comorbidity group had highest odds of medical comorbidity (OR= 3.69, 95% CI = 2.99, 4.52). CONCLUSION Persons presenting with HIV + psychiatric comorbidity had higher odds of medical comorbidities of pain, cancer, cardiovascular disease, substance use, metabolic disorders and infectious diseases, beyond that experienced by persons with HIV infection or psychiatric disorders, independently. Future research will focus on the mediating effects of social determinants and biological factors on outcomes as quality of life, cost and mortality. This will facilitate a shift away from the single-disease framework and compress morbidity of the aging cohort of HIV-infected persons.
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Affiliation(s)
- Sumedha Chhatre
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. United States
| | - George Woody
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. United States
| | - David S Metzger
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. United States
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Lancaster KE, Mollan KR, Hanscom BS, Shook-Sa BE, Ha TV, Dumchev K, Djoerban Z, Rose SM, Latkin CA, Metzger DS, Go VF, Dvoriak S, Reifeis SA, Piwowar-Manning EM, Richardson P, Hudgens MG, Hamilton EL, Eshleman SH, Susami H, Chu VA, Djauzi S, Kiriazova T, Nhan DT, Burns DN, Miller WC, Hoffman IF. Engaging People Who Inject Drugs Living With HIV in Antiretroviral Treatment and Medication for Opioid Use Disorder: Extended Follow-up of HIV Prevention Trials Network (HPTN) 074. Open Forum Infect Dis 2021; 8:ofab281. [PMID: 34458390 PMCID: PMC8391093 DOI: 10.1093/ofid/ofab281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/28/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND People who inject drugs (PWID) living with HIV experience inadequate access to antiretroviral treatment (ART) and medication for opioid use disorders (MOUD). HPTN 074 showed that an integrated intervention increased ART use and viral suppression over 52 weeks. To examine durability of ART, MOUD, and HIV viral suppression, participants could re-enroll for an extended follow-up period, during which standard-of-care (SOC) participants in need of support were offered the intervention. METHODS Participants were recruited from Ukraine, Indonesia and Vietnam and randomly allocated 3:1 to SOC or intervention. Eligibility criteria included: HIV-positive; active injection drug use; 18-60 years of age; ≥1 HIV-uninfected injection partner; and viral load ≥1,000 copies/mL. Re-enrollment was offered to all available intervention and SOC arm participants, and SOC participants in need of support (off-ART or off-MOUD) were offered the intervention. RESULTS The intervention continuation group re-enrolled 89 participants, and from week 52 to 104, viral suppression (<40 copies/mL) declined from 41% to 29% (estimated 9.4% decrease per year, 95% CI -17.0%; -1.8%). The in need of support group re-enrolled 94 participants and had increased ART (re-enrollment: 55%, week 26: 69%) and MOUD (re-enrollment: 16%, week 26: 25%) use, and viral suppression (re-enrollment: 40%, week 26: 49%). CONCLUSIONS Viral suppression declined in year 2 for those who initially received the HPTN 074 intervention and improved maintenance support is warranted. Viral suppression and MOUD increased among in need participants who received intervention during the study extension. Continued efforts are needed for widespread implementation of this scalable, integrated intervention.
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Affiliation(s)
- Kathryn E Lancaster
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Katie R Mollan
- Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brett S Hanscom
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Bonnie E Shook-Sa
- Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tran V Ha
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- UNC Vietnam, Hanoi, Vietnam
| | | | - Zubairi Djoerban
- Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Scott M Rose
- Science Facilitation Department, FHI 360, Durham, North Carolina, USA
| | - Carl A Latkin
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - David S Metzger
- HIV Prevention Research Division, Department of Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Vivian F Go
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sergii Dvoriak
- Academy of Labor, Social Relations and Tourism, Kyiv, Ukraine
| | - Sarah A Reifeis
- Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Paul Richardson
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael G Hudgens
- Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Erica L Hamilton
- Science Facilitation Department, FHI 360, Durham, North Carolina, USA
| | - Susan H Eshleman
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hepa Susami
- Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | | | - Samsuridjal Djauzi
- Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | | | - Do Thi Nhan
- Vietnam Administration of HIV/AIDS Control, Hanoi, Vietnam
| | - David N Burns
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - William C Miller
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Irving F Hoffman
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Brown LA, Denis CM, Leon A, Blank MB, Douglas SD, Morales KH, Crits-Christoph PF, Metzger DS, Evans DL. Number of opioid overdoses and depression as a predictor of suicidal thoughts. Drug Alcohol Depend 2021; 224:108728. [PMID: 33971515 PMCID: PMC8491541 DOI: 10.1016/j.drugalcdep.2021.108728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/20/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Opioid use disorders are associated with increased risk of suicide thoughts, attempts, and death. We explored key variables from two theories of the development of suicidal thoughts and attempts (the interpersonal and three-step theories of suicide) to understand possible mechanisms underlying the association between opioid use and suicide risk. We hypothesized that interpersonal connections, variables reflecting psychological and physical pain, and variables that reduce fear of death (prior overdoses and risk-taking behaviors) would be associated with increased risk of thoughts of suicide. METHODS Participants (N = 141) were opioid users recruited from an epicenter of the opioid crisis in Philadelphia using a mobile research center and completed an interview to assess substance use, depression, medical comorbidities, and suicidal thoughts among other variables. RESULTS Univariate analyses showed that prior history of overdose, diagnosis of depression, older age, homelessness, and interpersonal connection were each associated with increased likelihood of endorsing thoughts of death/suicide. Multivariable analyses revealed prior history of overdose and depression were the variables most strongly associated with risk for thoughts of suicide. CONCLUSIONS Consistent with two theories of the development of suicidal thoughts and attempts, exposure to variables that reduce fear of death (e.g., overdoses) were associated with suicidal thoughts. In contrast, other risk-taking behaviors, medical comorbidities, and substance use were not key predictors of suicidal thoughts in this sample. Implications for targeted risk assessment among clinicians are discussed.
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Affiliation(s)
- Lily A Brown
- University of Pennsylvania, Department of Psychiatry, 3535 Market Street, Philadelphia, PA, 19104, USA.
| | - Cecile M Denis
- University of Pennsylvania, Department of Psychiatry, 3535 Market Street, Philadelphia, PA, 19104, USA.
| | - Anthony Leon
- University of Pennsylvania, Department of Psychiatry, 3535 Market Street, Philadelphia, PA, 19104, USA.
| | - Michael B Blank
- University of Pennsylvania, Department of Psychiatry, 3535 Market Street, Philadelphia, PA, 19104, USA.
| | - Steven D Douglas
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA; University of Pennsylvania, Department of Pediatrics, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
| | - Knashawn H Morales
- University of Pennsylvania, Department of Biostatistics, Epidemiology and Informatics, 423 Guardian Dr, Philadelphia, PA, 19104, USA.
| | - Paul F Crits-Christoph
- University of Pennsylvania, Department of Psychiatry, 3535 Market Street, Philadelphia, PA, 19104, USA.
| | - David S Metzger
- University of Pennsylvania, Department of Psychiatry, 3535 Market Street, Philadelphia, PA, 19104, USA.
| | - Dwight L Evans
- University of Pennsylvania, Department of Psychiatry, 3535 Market Street, Philadelphia, PA, 19104, USA
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Chao E, Hung CC, Lin CP, Ku YCJ, Ain QU, Metzger DS, Lee TSH. Correction to: Adherence among HIV-positive injection drug users undergoing methadone treatment in Taiwan. BMC Psychiatry 2021; 21:163. [PMID: 33757465 PMCID: PMC7989203 DOI: 10.1186/s12888-021-03161-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
An amendment to this paper has been published and can be accessed via the original article.
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Affiliation(s)
- En Chao
- grid.412090.e0000 0001 2158 7670Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan ,grid.416121.10000 0004 0573 0539Tri-Service General Hospital Songshan Branch, Taipei, Taiwan
| | - Chia-Chun Hung
- grid.260770.40000 0001 0425 5914Institute of Brain Science, National Yang Ming University, Taipei, Taiwan ,grid.25879.310000 0004 1936 8972Department of Psychiatry, University of Pennsylvania, Philadelphia, USA
| | - Ching-Po Lin
- grid.260770.40000 0001 0425 5914Institute of Brain Science, National Yang Ming University, Taipei, Taiwan
| | - Yi-Chien Jacob Ku
- grid.412090.e0000 0001 2158 7670Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan ,grid.25879.310000 0004 1936 8972Department of Psychiatry, University of Pennsylvania, Philadelphia, USA
| | - Qurat Ul Ain
- grid.412090.e0000 0001 2158 7670Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan ,grid.440552.20000 0000 9296 8318Pir Mehr Ali Shah Arid Agriculture University, Rawalpindi, Pakistan
| | - David S. Metzger
- grid.25879.310000 0004 1936 8972Department of Psychiatry, University of Pennsylvania, Philadelphia, USA
| | - Tony Szu-Hsien Lee
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan. .,CTBC Center for Addiction Prevention and Policy Research, National Taiwan Normal University, No 162 Sec. 1 He-Ping East Road, Taipei, 10610, Taiwan.
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Zeziulin O, Mollan KR, Shook-Sa BE, Hanscom B, Lancaster KE, Dumchev K, Go VF, Chu VA, Kiriazova T, Syarif Z, Dvoryak S, Reifeis SA, Hamilton E, Sarasvita R, Rose S, Richardson P, Clarke W, Latkin CA, Metzger DS, Hoffman IF, Miller WC. Depressive symptoms and use of HIV care and medication-assisted treatment among people with HIV who inject drugs. AIDS 2021; 35:495-501. [PMID: 33252489 PMCID: PMC7855840 DOI: 10.1097/qad.0000000000002774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Vietnam, Indonesia, and Ukraine have major burdens of IDU and HIV. We estimated the prevalence of depressive symptoms at baseline among people living with HIV who inject drugs, evaluated associations between depression at baseline and 12-month HIV care outcomes and medication-assisted treatment (MAT), and evaluated the study intervention effect by baseline depression subgroups. DESIGN HPTN 074 was a randomized study. The study intervention included psychosocial counseling, systems navigation, and antiretroviral treatment (ART) at any CD4+ cell count. METHODS Moderate-to-severe depression was defined as a Patient Health Questionnaire-9 score of 10 or above. ART and MAT were self-reported. Eligibility criteria were: 18-60 years of age, active IDU, and viral load of at least 1000 copies/ml. Adjusted probability differences (aPD) were estimated using inverse-probability weighting. RESULTS A total of 502 participants enrolled from April 2015 to June 2016. Median age was 35 years; 85% identified as men. Prevalence of baseline moderate-to-severe depression was 14% in Vietnam, 14% in Indonesia, and 56% in Ukraine. No evident associations were detected between baseline depression and ART, viral suppression, or MAT at 12-month follow-up. The study intervention improved the proportions of people who inject drugs achieving 12-month viral suppression in both the depressed [intervention 44%; standard of care 24%; estimated aPD = 25% (95% confidence interval: 4.0%, 45%)] and nondepressed subgroups [intervention 38%; standard of care 24%; aPD = 13% (95% confidence interval: 2.0%, 25%)]. CONCLUSION High levels of depressive symptoms were common among people living with HIV who inject drugs in Ukraine but were less common in Vietnam and Indonesia. The study intervention was effective among participants with or without baseline depression symptoms.
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Affiliation(s)
| | - Katie R Mollan
- School of Medicine
- Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Bonnie E Shook-Sa
- Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brett Hanscom
- Statistical Center for HIV/AIDS Research and Prevention (SCHARP), Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | - Vivian F Go
- Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | | | - Zulvia Syarif
- Abhipraya Foundation & Department Psychiatry Faculty of Medicine, University of Indonesia, Depok, Indonesia
| | - Sergii Dvoryak
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | - Sarah A Reifeis
- Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Erica Hamilton
- Family Health International (FHI 360), Durham, North Carolina, USA
| | - Riza Sarasvita
- Indonesia National Narcotics Board & Abhipraya Foundation, East Jakarta, Indonesia
| | - Scott Rose
- Family Health International (FHI 360), Durham, North Carolina, USA
| | | | | | - Carl A Latkin
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | - William C Miller
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
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Tomescu C, Colon K, Smith P, Taylor M, Azzoni L, Metzger DS, Montaner LJ. Persons who inject drugs (PWID) retain functional NK cells, dendritic cell stimulation, and adaptive immune recall responses despite prolonged opioid use. J Leukoc Biol 2020; 110:10.1002/JLB.5A0920-604R. [PMID: 33289158 PMCID: PMC8244827 DOI: 10.1002/jlb.5a0920-604r] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/22/2020] [Accepted: 06/11/2020] [Indexed: 01/28/2023] Open
Abstract
Previous literature suggests that acute opioid use results in the functional impairment of the immune response, thereby decreasing resistance to viral infection. Here, we assessed if innate and adaptive immune responses are compromised ex vivo in persons who inject drugs (PWID) and whether long-term injection drug use may impact host susceptibility to in vitro HIV infection. We measured the frequency, activation state, and functional profile of NK cells, dendritic cells, and CD4+ and CD8+ T cells in low-risk PWID who do not share needles, high-risk needle-sharing PWID, and control donors who did not inject drugs. We also assessed plasma levels of inflammatory markers and CD4+ T cell susceptibility to HIV infection. We observed a significant increase in the amount of sCD14 (P = 0.0023, n = 16) and sCD163 (P = 0.0001, n = 16) in the plasma of PWID compared to controls. Evidence of constitutive activation was noted in PWID as compared to controls with increased CD69 expression in CD56dim NK cells (P = 0.0103, n = 26) and increased CD38 and HLA-DR expression in CD4+ T cells (P = 0.0355, n = 23). However, no innate or adaptive functional differences were detected between PWID and controls, including: NK cell direct or antibody-dependent cellular cytotoxicity poly-functional response, TLR-stimulated dendritic cell/NK crosstalk, CD8+ T cell response to Staphylococcal enterotoxin B or CMV/EBV/FLU peptides, or constitutive or anti-CD3/CD28-stimulated CD4+ T cell infectivity with CCR5-tropic or CXCR4-tropic HIV-1 isolates. Our data indicate that PWID who utilize opioids over as prolonged time frame can retain a functional ex vivo immune response without a measurable increase in CD4+ T cell infectivity suggesting that leukocytes from PWID are not intrinsically more susceptibility to infection with HIV than non-PWID controls.
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Affiliation(s)
- Costin Tomescu
- The Wistar Institute, HIV Immunopathogenesis Laboratory, Philadelphia, PA 19104
| | - Krystal Colon
- The Wistar Institute, HIV Immunopathogenesis Laboratory, Philadelphia, PA 19104
| | - Peter Smith
- The University of Pennsylvania, Department of Psychiatry, HIV Prevention Division, Philadelphia, PA, 19104
| | - Mack Taylor
- The University of Pennsylvania, Department of Psychiatry, HIV Prevention Division, Philadelphia, PA, 19104
| | - Livio Azzoni
- The Wistar Institute, HIV Immunopathogenesis Laboratory, Philadelphia, PA 19104
| | - David S. Metzger
- The University of Pennsylvania, Department of Psychiatry, HIV Prevention Division, Philadelphia, PA, 19104
| | - Luis J. Montaner
- The Wistar Institute, HIV Immunopathogenesis Laboratory, Philadelphia, PA 19104
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Chao E, Hung CC, Lin CP, Ku YCJ, Ain QU, Metzger DS, Lee TSH. Adherence among HIV-positive injection drug users undergoing methadone treatment in Taiwan. BMC Psychiatry 2020; 20:346. [PMID: 32616019 PMCID: PMC7331024 DOI: 10.1186/s12888-020-02764-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/25/2020] [Indexed: 01/29/2023] Open
Abstract
AIMS The study aims were to investigate adherence to methadone maintenance treatment (MMT) and to identify associated clinical factors in patients who inject drugs diagnosed with human immunodeficiency virus (HIV) infection in Taiwan. METHODS Data were from the National Health Surveillance System on HIV and the National Drug Treatment System on MMT. HIV-positive people who inject drugs (HIVPWID) were defined as the study population. Information obtained included age, sex, education, marital status, employment, methadone dose, and date of diagnosis of HIV infection. Adherence was defined as taking methadone for the past 90, 180 and 365 days, then categorized as high (> 90%), moderate (51 to 90%), or low (<=50%) adherent respectively. RESULTS Of 1641 HIVPWID registered in the datasets from 2007 to 2012, 961 (58.56%) had received MMT. For HIVPWID evaluated at 90 days (n = 951), 271 (28.5%), 382 (40.2%), and 298 (31.3%) were classified as high, moderate, and low adherent respectively. For HIVPWID evaluated at 180 days (n = 936), 190 (20.3%), 349 (37.3%), and 397 (42.4%) were classified as high, moderate, and low adherent respectively. For HIVPWID evaluated at 365 days (n = 919), 133 (14.5%), 271 (29.5%), and 515 (56.0%) were classified as high, moderate, and low adherent respectively. After controlling for sociodemographics, results showed that methadone dose, location of MMT clinic, and date of HIV diagnosis were significantly associated with MMT adherence. CONCLUSIONS Study findings underscore the importance to MMT adherence of methadone dosage, early diagnosis of patient's HIV infection, and area of patient residence.
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Affiliation(s)
- En Chao
- grid.412090.e0000 0001 2158 7670Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan ,grid.416121.10000 0004 0573 0539Tri-Service General Hospital Songshan Branch, Taipei, Taiwan
| | - Chia-Chun Hung
- grid.260770.40000 0001 0425 5914Institute of Brain Science, National Yang Ming University, Taipei, Taiwan ,grid.454740.6Bali Psychiatric Center, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Ching-Po Lin
- grid.260770.40000 0001 0425 5914Institute of Brain Science, National Yang Ming University, Taipei, Taiwan
| | - Yi-Chien Jacob Ku
- grid.412090.e0000 0001 2158 7670Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan ,grid.25879.310000 0004 1936 8972Department of Psychiatry, University of Pennsylvania, Philadelphia, USA
| | - Qurat Ul Ain
- grid.412090.e0000 0001 2158 7670Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan ,grid.440552.20000 0000 9296 8318Pir Mehr Ali Shah Arid Agriculture University, Rawalpindi, Pakistan
| | - David S. Metzger
- grid.454740.6Bali Psychiatric Center, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Tony Szu-Hsien Lee
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan. .,CTBC Center for Addiction Prevention and Policy Research, National Taiwan Normal University, No 162 Sec. 1 He-Ping East Road, Taipei, 10610, Taiwan.
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Chhatre S, Schapira M, Metzger DS, Jayadevappa R. Association between HIV infection and outcomes of care among medicare enrollees with breast cancer. EClinicalMedicine 2019; 17:100205. [PMID: 31891138 PMCID: PMC6933147 DOI: 10.1016/j.eclinm.2019.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND To assess the interaction of breast cancer, HIV infection, Medicare disability status, cancer stage and its implications for outcomes, after accounting for competing risks among female, fee-for-service Medicare enrollees. METHODS We used data from Surveillance, Epidemiology and End Results (SEER) -Medicare (2000-2013). From primary female breast cancer cases diagnosed between 2001 and 2011, we identified those with HIV infection. We used Generalized Linear Model for phase-specific incremental cost of HIV, Cox regression for association between HIV and all-cause mortality, and Fine and Gray competing risk models to assess hazard of breast cancer-specific mortality by HIV status. We also studied this association for subgroups of cancer stage and disability status. FINDINGS Of 164,080 eligible cases of breast cancer, 176 had HIV infection. Compared to HIV-uninfected patients, HIV infected patients had 16% higher cost in initial phase, and 80% higher cost in interim stage of care, and at least two times higher mortality (all-cause and breast cancer-specific), after accounting for competing risk. Among disabled enrollees, HIV-infected patients had higher risk of all-cause and breast cancer-specific mortality, compared to HIV-uninfected patients. INTERPRETATION Female fee-for-service Medicare enrollees with breast cancer experience higher initial and interim phase cost and worse survival in the presence of HIV. This association was also significant among disabled Medicare enrollees. Medicare is the single largest source of federal financing for HIV care. Burden on Medicare will grow exponentially due to higher proportion of disabled among HIV-infected enrollees, longer survival among HIV- infected persons, increased HIV incidence in older adults, and increased age related risk of breast cancer. Future research can identify the pathways via which HIV infection affects cost and mortality, and develop integrated strategies for effective management of concomitant breast cancer and HIV and inform survivorship guidelines. FUNDING National Institute on Aging, National Institutes of Health, Grant # R21AG34870-1A1.
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Affiliation(s)
- Sumedha Chhatre
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Corresponding author.
| | - Marilyn Schapira
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA, United States
| | - David S. Metzger
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Ravishankar Jayadevappa
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA, United States
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania United States
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Miller WC, Hoffman IF, Hanscom BS, Ha TV, Dumchev K, Djoerban Z, Rose SM, Latkin CA, Metzger DS, Lancaster KE, Go VF, Dvoriak S, Mollan KR, Reifeis SA, Piwowar-Manning EM, Richardson P, Hudgens MG, Hamilton EL, Sugarman J, Eshleman SH, Susami H, Chu VA, Djauzi S, Kiriazova T, Bui DD, Strathdee SA, Burns DN. A scalable, integrated intervention to engage people who inject drugs in HIV care and medication-assisted treatment (HPTN 074): a randomised, controlled phase 3 feasibility and efficacy study. Lancet 2018; 392:747-759. [PMID: 30191830 PMCID: PMC6299325 DOI: 10.1016/s0140-6736(18)31487-9] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/10/2018] [Accepted: 06/22/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND People who inject drugs (PWID) have a high incidence of HIV, little access to antiretroviral therapy (ART) and medication-assisted treatment (MAT), and high mortality. We aimed to assess the feasibility of a future controlled trial based on the incidence of HIV, enrolment, retention, and uptake of the intervention, and the efficacy of an integrated and flexible intervention on ART use, viral suppression, and MAT use. METHODS This randomised, controlled vanguard study was run in Kyiv, Ukraine (one community site), Thai Nguyen, Vietnam (two district health centre sites), and Jakarta, Indonesia (one hospital site). PWID who were HIV infected (index participants) and non-infected injection partners were recruited as PWID network units and were eligible for screening if they were aged 18-45 years (updated to 18-60 years 8 months into study), and active injection drug users. Further eligibility criteria for index participants included a viral load of 1000 copies per mL or higher, willingness and ability to recruit at least one injection partner who would be willing to participate. Index participants were randomly assigned via a computer generated sequence accessed through a secure web portal (3:1) to standard of care or intervention, stratified by site. Masking of assignment was not possible due to the nature of intervention. The intervention comprised systems navigation, psychosocial counselling, and ART at any CD4 count. Local ART and MAT services were used. Participants were followed up for 12-24 months. The primary objective was to assess the feasibility of a future randomised controlled trial. To achieve this aim we looked at the following endpoints: HIV incidence among injection partners in the standard of care group, and enrolment and retention of HIV-infected PWID and their injection partners and the uptake of the integrated intervention. The study was also designed to assess the feasibility, barriers, and uptake of the integrated intervention. Endpoints were assessed in a modified intention-to-treat popualtion after exclusion of ineligible participants. This trial is registered on ClinicalTrials.gov, NCT02935296, and is active but not recruiting new participants. FINDINGS Between Feb 5, 2015, and June 3, 2016, 3343 potential index participants were screened, of whom 502 (15%) were eligible and enrolled. 1171 injection partners were referred, and 806 (69%) were eligible and enrolled. Index participants were randomly assigned to intervention (126 [25%]) and standard of care (376 [75%]) groups. At week 52, most living index participants (389 [86%] of 451) and partners (567 [80%] of 710) were retained, and self-reported ART use was higher among index participants in the intervention group than those in the standard of care group (probability ratio [PR] 1·7, 95% CI 1·4-1·9). Viral suppression was also higher in the intervention group than in the standard of care group (PR 1·7, 95% CI 1·3-2·2). Index participants in the intervention group reported more MAT use at 52 weeks than those in the standard of care group (PR 1·7, 95% CI 1·3-2·2). Seven incident HIV infections occurred, and all in injection partners in the standard of care group (intervention incidence 0·0 per 100 person-years, 95% CI 0·0-1·7; standard of care incidence 1·0 per 100 person-years, 95% CI 0·4-2·1; incidence rate difference -1·0 per 100 person-years, 95% CI -2·1 to 1·1). No severe adverse events due to the intervention were recorded. INTERPRETATION This vanguard study provides evidence that a flexible, scalable intervention increases ART and MAT use and reduces mortality among PWID. The low incidence of HIV in both groups impedes a future randomised, controlled trial, but given the strength of the effect of the intervention, its implementation among HIV-infected PWID should be considered. FUNDING US National Institutes of Health.
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Affiliation(s)
- William C Miller
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA.
| | - Irving F Hoffman
- Division of Infectious Diseases, School of Medicine, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Brett S Hanscom
- Statistical Center for HIV/AIDS Research and Prevention (SCHARP), Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Tran V Ha
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; UNC Vietnam, Yen Hoa, Cau Giay District, Hanoi, Vietnam
| | | | - Zubairi Djoerban
- Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Scott M Rose
- Science Facilitation Department, FHI 360, Durham, NC, USA
| | - Carl A Latkin
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, MA, USA
| | - David S Metzger
- HIV Prevention Research Division, Department of Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kathryn E Lancaster
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Vivian F Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sergii Dvoriak
- Academy of Labor, Social Relations and Tourism, Kyiv, Ukraine
| | - Katie R Mollan
- Center for AIDS Research, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sarah A Reifeis
- Center for AIDS Research, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Estelle M Piwowar-Manning
- Bloomberg School of Public Health and Department of Pathology, Johns Hopkins University, Baltimore, MA, USA
| | - Paul Richardson
- Bloomberg School of Public Health and Department of Pathology, Johns Hopkins University, Baltimore, MA, USA
| | - Michael G Hudgens
- Center for AIDS Research, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Jeremy Sugarman
- Berman Institute of Bioethics and Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MA, USA
| | - Susan H Eshleman
- Bloomberg School of Public Health and Department of Pathology, Johns Hopkins University, Baltimore, MA, USA
| | - Hepa Susami
- Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Viet Anh Chu
- UNC Vietnam, Yen Hoa, Cau Giay District, Hanoi, Vietnam
| | - Samsuridjal Djauzi
- Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | | | - Duong D Bui
- Vietnam Administration of HIV/AIDS Control, Hanoi, Vietnam
| | - Steffanie A Strathdee
- Department of Medicine, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - David N Burns
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MA, USA
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Buckingham L, Becher J, Voytek CD, Fiore D, Dunbar D, Davis-Vogel A, Metzger DS, Frank I. Going social: Success in online recruitment of men who have sex with men for prevention HIV vaccine research. Vaccine 2017; 35:3498-3505. [PMID: 28526330 DOI: 10.1016/j.vaccine.2017.05.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [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: 11/21/2016] [Revised: 04/29/2017] [Accepted: 05/02/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the use of four different social media sites to recruit men who have sex with men (MSM) and transgender women to a phase 2b HIV prevention vaccine trial, HVTN 505. DESIGN Retrospective, observational study. METHODS The University of Pennsylvania HIV Vaccine Trials Unit (Penn HVTU) employed street outreach and online recruitment methods to recruit participants for HVTN 505 using a combination of national recruitment images/messages with Philadelphia-specific language and imagery. We compared the efficiency (number of enrolled participants per number of completed phone screens) and effectiveness (number of enrolled participants per time interval employed) of each strategy, as well as the demographics and risk behaviors of the populations. RESULTS Online recruitment strategies populated 37% (71/191) of trial participants at our site. Among the four social media strategies employed, 45.1% (32/71) were enrolled through Facebook, 16.9% (12/71) through Craigslist, 15.5% (11/71) through a web-based marketing company (WBMC), and 22.5% (16/71) via GRINDR. The number of participants enrolled per month of strategy and the months the strategy was employed were Facebook - 32(33months), Craigslist - 12(33months), WBMC - 11(6months), and GRINDR - 16(0.56months). In-person and online recruitment strategies yielded participants of similar demographics and levels of risk behavior. CONCLUSION Use of several social media recruitment modalities produced large numbers of MSM engaging in high risk behavior and willing to participate in an HIV prevention vaccine trial. In comparison to other social media and online strategies, recruitment via GRINDR was the most effective.
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Affiliation(s)
- Lindsey Buckingham
- HIV Prevention Research Division, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Julie Becher
- HIV Prevention Research Division, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Chelsea D Voytek
- HIV Prevention Research Division, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Danielle Fiore
- HIV Prevention Research Division, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Debora Dunbar
- HIV Prevention Research Division, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Annet Davis-Vogel
- HIV Prevention Research Division, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David S Metzger
- HIV Prevention Research Division, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ian Frank
- HIV Prevention Research Division, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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13
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Metsch LR, Feaster DJ, Gooden L, Matheson T, Stitzer M, Das M, Jain MK, Rodriguez AE, Armstrong WS, Lucas GM, Nijhawan AE, Drainoni ML, Herrera P, Vergara-Rodriguez P, Jacobson JM, Mugavero MJ, Sullivan M, Daar ES, McMahon DK, Ferris DC, Lindblad R, VanVeldhuisen P, Oden N, Castellón PC, Tross S, Haynes LF, Douaihy A, Sorensen JL, Metzger DS, Mandler RN, Colfax GN, del Rio C. Effect of Patient Navigation With or Without Financial Incentives on Viral Suppression Among Hospitalized Patients With HIV Infection and Substance Use: A Randomized Clinical Trial. JAMA 2016; 316:156-70. [PMID: 27404184 PMCID: PMC5339876 DOI: 10.1001/jama.2016.8914] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Substance use is a major driver of the HIV epidemic and is associated with poor HIV care outcomes. Patient navigation (care coordination with case management) and the use of financial incentives for achieving predetermined outcomes are interventions increasingly promoted to engage patients in substance use disorders treatment and HIV care, but there is little evidence for their efficacy in improving HIV-1 viral suppression rates. OBJECTIVE To assess the effect of a structured patient navigation intervention with or without financial incentives to improve HIV-1 viral suppression rates among patients with elevated HIV-1 viral loads and substance use recruited as hospital inpatients. DESIGN, SETTING, AND PARTICIPANTS From July 2012 through January 2014, 801 patients with HIV infection and substance use from 11 hospitals across the United States were randomly assigned to receive patient navigation alone (n = 266), patient navigation plus financial incentives (n = 271), or treatment as usual (n = 264). HIV-1 plasma viral load was measured at baseline and at 6 and 12 months. INTERVENTIONS Patient navigation included up to 11 sessions of care coordination with case management and motivational interviewing techniques over 6 months. Financial incentives (up to $1160) were provided for achieving targeted behaviors aimed at reducing substance use, increasing engagement in HIV care, and improving HIV outcomes. Treatment as usual was the standard practice at each hospital for linking hospitalized patients to outpatient HIV care and substance use disorders treatment. MAIN OUTCOMES AND MEASURES The primary outcome was HIV viral suppression (≤200 copies/mL) relative to viral nonsuppression or death at the 12-month follow-up. RESULTS Of 801 patients randomized, 261 (32.6%) were women (mean [SD] age, 44.6 years [10.0 years]). There were no differences in rates of HIV viral suppression versus nonsuppression or death among the 3 groups at 12 months. Eighty-five of 249 patients (34.1%) in the usual-treatment group experienced treatment success compared with 89 of 249 patients (35.7%) in the navigation-only group for a treatment difference of 1.6% (95% CI, -6.8% to 10.0%; P = .80) and compared with 98 of 254 patients (38.6%) in the navigation-plus-incentives group for a treatment difference of 4.5% (95% CI -4.0% to 12.8%; P = .68). The treatment difference between the navigation-only and the navigation-plus-incentives group was -2.8% (95% CI, -11.3% to 5.6%; P = .68). CONCLUSIONS AND RELEVANCE Among hospitalized patients with HIV infection and substance use, patient navigation with or without financial incentives did not have a beneficial effect on HIV viral suppression relative to nonsuppression or death at 12 months vs treatment as usual. These findings do not support these interventions in this setting. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01612169.
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Affiliation(s)
- Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Daniel J Feaster
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - Lauren Gooden
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Tim Matheson
- San Francisco Department of Public Health, San Francisco, California
| | - Maxine Stitzer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Moupali Das
- San Francisco Department of Public Health, San Francisco, California5San Francisco General Hospital, San Francisco, California6University of California, San Francisco
| | - Mamta K Jain
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas8Parkland Health and Hospital System, Dallas, Texas
| | - Allan E Rodriguez
- Division of Infectious Diseases, Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida
| | - Wendy S Armstrong
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Gregory M Lucas
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ank E Nijhawan
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Mari-Lynn Drainoni
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts13Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Patricia Herrera
- Ruth M. Rothstein CORE Center, John H. Stroger, Jr, Hospital of Cook County, Chicago, Illinois
| | | | - Jeffrey M Jacobson
- Division of Infectious Diseases, Drexel University College of Medicine, Philadelphia, Pennsylvania16Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania17Department of Neuroscience, Lewis Katz School of Medi
| | - Michael J Mugavero
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham
| | - Meg Sullivan
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Eric S Daar
- Los Angeles Biomedical Research Institute at Harbor-University of California Los Angeles Medical Center, Torrance
| | | | - David C Ferris
- Mount Sinai St Luke's and Mount Sinai West Hospitals, New York, New York23Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Neal Oden
- The Emmes Corporation, Rockville, Maryland
| | - Pedro C Castellón
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Susan Tross
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, Department of Psychiatry, Columbia University Medical Center, New York, New York26Greater New York Node, National Drug Abuse Treatment Clinical Trials Network, Subst
| | - Louise F Haynes
- Division of Addiction Sciences, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Antoine Douaihy
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - James L Sorensen
- Western States Node, National Drug Abuse Treatment Clinical Trials Network, Department of Psychiatry, University of California, San Francisco
| | - David S Metzger
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia31Treatment Research Institute, Philadelphia, Pennsylvania
| | - Raul N Mandler
- Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Grant N Colfax
- San Francisco Department of Public Health, San Francisco, California
| | - Carlos del Rio
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia33Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Wang AL, Lowen SB, Shi Z, Bissey B, Metzger DS, Langleben DD. Targeting modulates audiences' brain and behavioral responses to safe sex video ads. Soc Cogn Affect Neurosci 2016; 11:1650-7. [PMID: 27217112 DOI: 10.1093/scan/nsw070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 05/13/2016] [Indexed: 12/30/2022] Open
Abstract
Video ads promoting condom use are a key component of media campaigns to stem the HIV epidemic. Recent neuroimaging studies in the context of smoking cessation, point to personal relevance as one of the key variables that determine the effectiveness of public health messages. While minority men who have sex with men (MSM) are at the highest risk of HIV infection, most safe-sex ads feature predominantly Caucasian actors in heterosexual scenarios. We compared brain respons of 45 African American MSM to safe sex ads that were matched (i.e. 'Targeted') to participants' sexual orientation and race, and 'Untargeted' ads that were un matched for these characteristics. Ad recall, perceived 'convincingness' and attitudes towards condom use were also assessed. We found that Targeted ads were better remembered than the Untargeted ads but perceived as equally convincing. Targeted ads engaged brain regions involved in self-referential processing and memory, including the amygdala, hippocampus, temporal and medial prefrontal cortices (MPFC) and the precuneus. Connectivity between MPFC and precuneus and middle temporal gyrus was stronger when viewing Targeted ads. Our results suggest that targeting may increase cognitive processing of safe sex ads and justify further prospective studies linking brain response to media public health interventions and clinical outcomes.
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Affiliation(s)
- An-Li Wang
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Steven B Lowen
- Department of Psychiatry, Harvard Medical School, Cambridge, MA, USA
| | - Zhenhao Shi
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Bryn Bissey
- Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, PA, USA
| | - David S Metzger
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel D Langleben
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, PA, USA Behavioral Health Service, Veterans Administration Medical Center, Philadelphia, PA, USA
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15
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Festinger DS, Dugosh KL, Kurth AE, Metzger DS. Examining the efficacy of a computer facilitated HIV prevention tool in drug court. Drug Alcohol Depend 2016; 162:44-50. [PMID: 26971228 PMCID: PMC5824990 DOI: 10.1016/j.drugalcdep.2016.02.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 12/01/2015] [Revised: 02/05/2016] [Accepted: 02/06/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Although they have demonstrated efficacy in reducing substance use and criminal recidivism, competing priorities and limited resources may preclude drug court programs from formally addressing HIV risk. This study examined the efficacy of a brief, three-session, computer-facilitated HIV prevention intervention in reducing HIV risk among adult felony drug court participants. METHODS Two hundred participants were randomly assigned to an HIV intervention (n=101) or attention control (n=99) group. All clients attended judicial status hearings approximately every six weeks. At the first three status hearings following study entry, clients in the intervention group completed the computerized, interactive HIV risk reduction sessions while those in the control group viewed a series of educational life-skill videos of matched length. Outcomes included the rate of independently obtained HIV testing, engagement in high risk HIV-related behaviors, and rate of condom procurement from the research site at each session. RESULTS Results indicated that participants who received the HIV intervention were significantly more likely to report having obtained HIV testing at some point during the study period than those in the control condition, although the effect was marginally significant when examined in a longitudinal model. In addition, they had higher rates of condom procurement. No group differences were found on rates of high-risk sexual behavior, and the low rate of injection drug reported precluded examination of high-risk drug-related behavior. CONCLUSIONS The study provides support for the feasibility and utility of delivering HIV prevention services to drug court clients using an efficient computer-facilitated program.
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Affiliation(s)
- David S Festinger
- Treatment Research Institute, 600 Public Ledger Building, 150 S. Independence Mall West, Philadelphia, PA 19106, United States.
| | - Karen L Dugosh
- Treatment Research Institute, 600 Public Ledger Building, 150 S. Independence Mall West, Philadelphia, PA 19106, United States
| | - Ann E Kurth
- New York University School of Nursing & College of Global Public Health, 41 East 11th Street, New York, NY 10003, United States
| | - David S Metzger
- Treatment Research Institute, 600 Public Ledger Building, 150 S. Independence Mall West, Philadelphia, PA 19106, United States; University of Pennsylvania, Department of Psychiatry, Philadelphia, PA 19104, United States
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Chambers JE, Brooks AC, Medvin R, Metzger DS, Lauby J, Carpenedo CM, Favor KE, Kirby KC. Examining multi-session brief intervention for substance use in primary care: research methods of a randomized controlled trial. Addict Sci Clin Pract 2016; 11:8. [PMID: 27090097 PMCID: PMC4835884 DOI: 10.1186/s13722-016-0057-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 05/29/2015] [Accepted: 04/10/2016] [Indexed: 11/30/2022] Open
Abstract
Background Brief interventions such as Screening, a single session of Brief Intervention, and Referral to Treatment (SBIRT) have shown mixed effectiveness in primary care. However, there are indications that multi-session brief interventions may demonstrate more consistently positive outcomes, and perhaps a more intensive approach would be of benefit in addressing substance use in primary care. This study compared the effectiveness of SBIRT with a single BI session (BI/RT) to a multi-session brief-treatment intervention (BI/RT+) in primary care. We also developed easy-to-use, evidence-based materials to assist clinicians in delivering these interventions. Methods/design This study was conducted in three Federally Qualified Healthcare Centers (FQHCs). A total of 10,935 patients were screened, and 600 individuals were recruited. The sample was primarily Black/African American (82 %) with a mean age of 40. Patients who attended a healthcare appointment were screened for substance use via the AUDIT and DAST. Patients were eligible for the study if they scored 8 or higher on the AUDIT, were using only marijuana and scored 2 or higher on the DAST, or were using other illicit drugs and scored 1 or higher on the DAST. Participants were randomly assigned to receive one-session BI/RT, or two to six sessions of brief intervention that incorporated elements of motivational enhancement therapy and cognitive-behavioral therapy (BI/RT+). Both interventions were delivered by behavioral health consultants at the FQHCs. Participants completed follow-up assessments every 3 months for 1 year. Primary outcome variables included substance use treatment sessions attended and days of substance use. Secondary outcomes included measures of health, employment, legal, and psychiatric functioning and HIV risk behaviors. Additionally, we will conduct an economic evaluation examining cost-effectiveness and will analyze outcomes from a process evaluation examining patient and provider experiences. Discussion The ability of brief interventions to impact substance use has great potential, but research findings have been mixed. By conducting a large-scale randomized controlled trial in real-world health centers, this study will answer important questions about the effectiveness of expanded BIs for patients who screen positive for risky substance use in primary care. Trial registration NCT01751672
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Affiliation(s)
- Jaclyn E Chambers
- Treatment Research Institute, 600 Public Ledger Building, 150 S. Independence Mall West, Philadelphia, PA, 19106, USA.
| | - Adam C Brooks
- Treatment Research Institute, 600 Public Ledger Building, 150 S. Independence Mall West, Philadelphia, PA, 19106, USA
| | - Rachel Medvin
- Treatment Research Institute, 600 Public Ledger Building, 150 S. Independence Mall West, Philadelphia, PA, 19106, USA.,The Institute for Graduate Clinical Psychology, Widener University, One University Place, Chester, PA, 19013, USA
| | - David S Metzger
- Treatment Research Institute, 600 Public Ledger Building, 150 S. Independence Mall West, Philadelphia, PA, 19106, USA.,Department of Psychiatry, University of Pennsylvania School of Medicine, 3900 Chestnut Street, Philadelphia, PA, 19104, USA
| | - Jennifer Lauby
- Public Health Management Corporation, Centre Square East, 1500 Market St. 15th Floor, Philadelphia, PA, 19102, USA
| | - Carolyn M Carpenedo
- Treatment Research Institute, 600 Public Ledger Building, 150 S. Independence Mall West, Philadelphia, PA, 19106, USA
| | - Kevin E Favor
- Lincoln University, 1570 Baltimore Pike, Lincoln University, PA, 19352, USA
| | - Kimberly C Kirby
- Treatment Research Institute, 600 Public Ledger Building, 150 S. Independence Mall West, Philadelphia, PA, 19106, USA.,Rowan University, 201 Mullica Hill Road, Glassboro, NJ, 08028, USA
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Brooks AC, Chambers JE, Lauby J, Byrne E, Carpenedo CM, Benishek LA, Medvin R, Metzger DS, Kirby KC. Implementation of a Brief Treatment Counseling Toolkit in Federally Qualified Healthcare Centers: Patient and Clinician Utilization and Satisfaction. J Subst Abuse Treat 2016; 60:70-80. [PMID: 26508714 DOI: 10.1016/j.jsat.2015.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 03/09/2015] [Revised: 08/14/2015] [Accepted: 08/28/2015] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The need to integrate behavioral health care within medical settings is widely recognized, and integrative care approaches are associated with improved outcomes for a range of disorders. As substance use treatment integration efforts expand within primary care settings, training behavioral health providers in evidence-based brief treatment models that are cost-effective and easily fit within the medical flow is essential. METHODS Guided by principles drawn from Diffusion of Innovations theory (Rogers, 2003) and the Consolidated Framework of Implementation Research (Damschroder et al., 2009), we adapted elements of Motivational Enhancement Therapy, cognitive-behavioral therapy, and 12-step facilitation into a brief counseling toolkit. The toolkit is a menu driven assortment of 35 separate structured clinical interventions that each include client takeaway resources to reinforce brief clinical contacts. We then implemented this toolkit in the context of a randomized clinical trial in three Federally Qualified Healthcare Centers. Behavioral Health Consultants (BHCs) used a pre-screening model wherein 10,935 patients received a brief initial screener, and 2011 received more in-depth substance use screening. Six hundred patients were assigned to either a single session brief intervention or an expanded brief treatment encompassing up to five additional sessions. We conducted structured interviews with patients, medical providers, and BHCs to obtain feedback on toolkit implementation. RESULTS On average, patients assigned to brief treatment attended 3.29 sessions. Fifty eight percent of patients reported using most or all of the educational materials provided to them. Patients assigned to brief treatment reported that the BHC sessions were somewhat more helpful than did patients assigned to a single session brief intervention (p=.072). BHCs generally reported that the addition of the toolkit was helpful to their work in delivering screening and brief treatment. DISCUSSION This work is significant because it provides support to clinicians in delivering evidence-based brief interventions and has been formatted into presentation styles that can be presented flexibly depending on patient need.
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Affiliation(s)
- Adam C Brooks
- Treatment Research Institute, 600 Public Ledger Building, 150S. Independence Mall West, Philadelphia, PA 19106, USA.
| | - Jaclyn E Chambers
- Treatment Research Institute, 600 Public Ledger Building, 150S. Independence Mall West, Philadelphia, PA 19106, USA.
| | - Jennifer Lauby
- Public Health Management Corporation, Centre Square East, 1500 Market St. 15th Floor, Philadelphia, PA 19102, USA.
| | - Elizabeth Byrne
- Treatment Research Institute, 600 Public Ledger Building, 150S. Independence Mall West, Philadelphia, PA 19106, USA
| | - Carolyn M Carpenedo
- Treatment Research Institute, 600 Public Ledger Building, 150S. Independence Mall West, Philadelphia, PA 19106, USA.
| | - Lois A Benishek
- Treatment Research Institute, 600 Public Ledger Building, 150S. Independence Mall West, Philadelphia, PA 19106, USA; University of Pennsylvania School of Medicine, Department of Psychiatry, 3900 Chestnut Street, Philadelphia, PA 19104, USA.
| | - Rachel Medvin
- Treatment Research Institute, 600 Public Ledger Building, 150S. Independence Mall West, Philadelphia, PA 19106, USA; Widener University, The Institute for Graduate Clinical Psychology, One University Place, Chester, PA, 19013.
| | - David S Metzger
- Treatment Research Institute, 600 Public Ledger Building, 150S. Independence Mall West, Philadelphia, PA 19106, USA; University of Pennsylvania School of Medicine, Department of Psychiatry, 3900 Chestnut Street, Philadelphia, PA 19104, USA.
| | - Kimberly C Kirby
- Treatment Research Institute, 600 Public Ledger Building, 150S. Independence Mall West, Philadelphia, PA 19106, USA; University of Pennsylvania School of Medicine, Department of Psychiatry, 3900 Chestnut Street, Philadelphia, PA 19104, USA.
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Chhatre S, Metzger DS, Malkowicz SB, Woody G, Jayadevappa R. Substance use disorder and its effects on outcomes in men with advanced-stage prostate cancer. Cancer 2014; 120:3338-45. [PMID: 25042396 DOI: 10.1002/cncr.28861] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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: 01/24/2014] [Revised: 04/20/2014] [Accepted: 05/21/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND Substance use disorder in patients with cancer has implications for outcomes. The objective of this study was to analyze the effects of the type and timing of substance use on outcomes in elderly Medicare recipients with advanced prostate cancer. METHODS This was an observational cohort study using Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data from 2000 to 2009. Among men who were diagnosed with advanced prostate cancer between 2001 and 2004, we identified those who had a claim for substance use disorder in the year before cancer diagnosis, 1 year after cancer diagnosis, and an additional 4 years after diagnosis. The outcomes investigated were use of health services, costs, and mortality. RESULTS The prevalence of substance use disorder was 10.6%. The category drug psychoses and related had greater odds of inpatient hospitalizations (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.9-2.8), outpatient hospital visits (OR, 2.6; 95% CI, 1.9-3.6), and emergency room visits (OR, 1.7; 95% CI, 1.2-2.4). Substance use disorder in the follow-up phase was associated with greater odds of inpatient hospitalizations (OR, 2.0; 95% CI, 1.8-2.2), outpatient hospital visits (OR, 2.0; 95% CI, 1.7-2.4), and emergency room visits (OR, 1.7; 95% CI, 1.5-2.1). Compared with men who did not have substance use disorder, those in the category drug psychoses and related had 70% higher costs, and those who had substance use disorder during the follow-up phase had 60% higher costs. The hazard of all-cause mortality was highest for patients in the drug psychoses and related category (hazard ratio, 1.3; 95% CI, 1.1-1.7) and the substance use disorder in treatment phase category (hazard ratio, 1.5; 95% CI, 1.3-1.7). CONCLUSIONS The intersection of advanced prostate cancer and substance use disorder may adversely affect outcomes. Incorporating substance use screening and treatments into prostate cancer care guidelines and coordination of care is desirable.
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Affiliation(s)
- Sumedha Chhatre
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Blank MB, Himelhoch SS, Balaji AB, Metzger DS, Dixon LB, Rose CE, Oraka E, Davis-Vogel A, Thompson WW, Heffelfinger JD. A multisite study of the prevalence of HIV with rapid testing in mental health settings. Am J Public Health 2014; 104:2377-84. [PMID: 24524493 DOI: 10.2105/ajph.2013.301633] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We estimated HIV prevalence and risk factors among persons receiving mental health treatment in Philadelphia, Pennsylvania, and Baltimore, Maryland, January 2009 to August 2011. METHODS We used a multisite, cross-sectional design stratified by clinical setting. We tested 1061 individuals for HIV in university-based inpatient psychiatric units (n = 287), intensive case-management programs (n = 273), and community mental health centers (n = 501). RESULTS Fifty-one individuals (4.8%) were HIV-infected. Confirmed positive HIV tests were 5.9% (95% confidence interval [CI] = 3.7%, 9.4%) for inpatient units, 5.1% (95% CI = 3.1%, 8.5%) for intensive case-management programs, and 4.0% (95% CI = 2.6%, 6.1%) for community mental health centers. Characteristics associated with HIV included Black race, homosexual or bisexual identity, and HCV infection. CONCLUSIONS HIV prevalence for individuals receiving mental health services was about 4 times as high as in the general population. We found a positive association between psychiatric symptom severity and HIV infection, indicating that engaging persons with mental illness in appropriate mental health treatment may be important to HIV prevention. These findings reinforce recommendations for routine HIV testing in all clinical settings to ensure that HIV-infected persons receiving mental health services are identified and referred to timely infectious disease care.
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Affiliation(s)
- Michael B Blank
- Michael B. Blank and David S. Metzger are with the Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia. Seth S. Himelhoch is with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Alexandra B. Balaji, Charles E. Rose, and James D. Heffelfinger are with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Lisa B. Dixon is with the Department of Psychiatry, Columbia University, New York, NY. Emeka Oraka is with ICF International, Atlanta. Annet Davis-Vogel is with the HIV/AIDS Prevention Research Division, University of Pennsylvania, Philadelphia. William W. Thompson is with the Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta
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Benton TD, Lynch KG, Dubé B, Gettes DR, Tustin NB, Metzger DS, Blume J, Douglas SD, Evans DL. The glucocorticoid antagonist RU-486 suppresses HIV infectivity and replication. J Neuropsychiatry Clin Neurosci 2013; 25:51-7. [PMID: 23487193 DOI: 10.1176/appi.neuropsych.12060147] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The effects of RU-486, a glucocorticoid antagonist, on HIV infection and replication in depressed and nondepressed women were studied using ex vivo models of HIV infection. RU-486 treatment of cells decreased HIV reverse transcriptase activity of monocyte-derived macrophages in a model of acute infectivity. RU-486 also decreased HIV viral replication in the chronically-infected T-cell line ACH-2, but not in the promonocyte cell line U1. No differences were associated with depression status. Thus, glucocorticoid antagonism may suppress HIV infectivity and replication ex vivo. Studies to determine the role of glucocorticoid antagonists in the host defense against HIV should be performed.
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Affiliation(s)
- Tami D Benton
- Children’s Hospital of Philadelphia Research Institute, Division of Allergy and Immunology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA.
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Chhatre S, Metzger DS, Frank I, Boyer J, Thompson E, Nidich S, Montaner LJ, Jayadevappa R. Effects of behavioral stress reduction Transcendental Meditation intervention in persons with HIV. AIDS Care 2013; 25:1291-7. [PMID: 23394825 DOI: 10.1080/09540121.2013.764396] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Stress is implicated in the pathogenesis and progression of HIV. The Transcendental Meditation (TM) is a behavioral stress reduction program that incorporates mind-body approach, and has demonstrated effectiveness in improving outcomes via stress reduction. We evaluated the feasibility of implementing TM and its effects on outcomes in persons with HIV. In this community-based single blinded Phase-I, randomized controlled trial, outcomes (psychological and physiological stress, immune activation, generic and HIV-specific health-related quality of life, depression and quality of well-being) were assessed at baseline and at six months, and were compared using parametric and nonparametric tests. Twenty-two persons with HIV were equally randomized to TM intervention or healthy eating (HE) education control group. Retention was 100% in TM group and 91% in HE control group. The TM group exhibited significant improvement in vitality. Significant between group differences were observed for generic and HIV-specific health-related quality of life. Small sample size may possibly limit the ability to observe significant differences in some outcomes. TM stress reduction intervention in community dwelling adults with HIV is viable and can enhance health-related quality of life. Further research with large sample and longer follow-up is needed to validate our results.
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Affiliation(s)
- Sumedha Chhatre
- a Department of Psychiatry, HIV/AIDS Prevention Research Division , University of Pennsylvania , Philadelphia , PA , USA
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Gollub EL, Morrow KM, Mayer KH, Koblin BA, Peterside PB, Husnik MJ, Metzger DS. Three city feasibility study of a body empowerment and HIV prevention intervention among women with drug use histories: Women FIT. J Womens Health (Larchmt) 2012; 19:1705-13. [PMID: 20662629 DOI: 10.1089/jwh.2009.1778] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND New intervention models are needed for HIV prevention among drug-using women. METHODS The Women Fighting Infection Together (Women FIT) feasibility study enrolled 189 women in three U.S. cities (Providence, New York, Philadelphia) with drug-using histories, who also reported risky sexual behavior. Eligible women had participated previously in a yearlong study of HIV Counseling and Testing (HIV-CT) and limited case management. Two thirds of the sample were black, most were unemployed, and about two thirds reported prior or current crack use. Women were randomized into two groups. In one group, women participated in a manualized, four-session, peer-led, interactive group intervention that stressed body knowledge, woman-initiated HIV/sexually transmitted infection (HIV/STI) prevention, including a focus on women's health (reproductive health screening, sexual violence, self-breast examination, STI signs, symptoms), which aimed to increase comfort with and pride in their bodies. Control group women received HIV-CT enriched by female condom counseling. Outcomes included study retention, session attendance and ratings, changes in knowledge, and use of protection methods. RESULTS The study successfully retained 95% of the participants for a 2-month follow-up. Positive assessments from participants and peer leaders exceeded preset thresholds for success. Pre-post changes in body knowledge (p < 0.0001) and protection methods knowledge (p < 0.01) was greater among the intervention women than the control women. CONCLUSIONS The body empowerment model deserves further elaboration in interventions focusing on women at high risk of HIV/STI acquisition.
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Affiliation(s)
- Erica L Gollub
- Department of Epidemiology and Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida 33199, USA.
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Voytek CD, Jones KT, Curtis BL, Fiore DT, Dunbar D, Frank I, Metzger DS. Using an internet consumer marketing strategy to reach men who have sex with men for participation in a preventive HIV vaccine clinical trial. Retrovirology 2012. [PMCID: PMC3441554 DOI: 10.1186/1742-4690-9-s2-p119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Festinger DS, Dugosh KL, Metzger DS, Marlowe DB. The Prevalence of HIV Risk Behaviors among Felony Drug Court Participants. Drug Court Rev 2012; 8:131-146. [PMID: 25309974 PMCID: PMC4191852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
15 HIV RISK BEHAVIORS IN DRUG COURT A small percentage of participants in a large metropolitan felony Drug Court engaged in high-risk injection drug use, but a large percentage engaged in high-risk sexual behaviors. 16 HIV RISK FACTORS IN DRUG COURT HIV risk behaviors were associated with being male, African-American, and younger. 17 GEOGRAPHIC RISK FOR HIV A large proportion of Drug Court participants resided in areas of the city with a high prevalence of persons living with HIV/AIDS, thus heightening the probability of exposure to the virus.
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Abstract
Research conducted during the first 20 years of the AIDS epidemic provided a solid foundation of data supporting methadone treatment as HIV prevention. Drug users in methadone treatment were consistently found to reduce the frequency of drug use, risk behaviors, and infections. These data have been consistent over time and across cultural settings and have been used to promote the expansion of drug treatment as a prevention intervention. More recently, data have emerged suggesting the prevention potential of medication-assisted treatments other than methadone (buprenorphine/naloxone and naltrexone). Still, with a few notable exceptions, global drug treatment coverage for opiate injectors remains remarkably low and only a few treatment interventions for stimulant use have shown efficacy in reducing HIV risk. Importantly, more recent data provide support for the role of drug treatment programs in improving access and adherence to antiretroviral treatment and that injection drug users in substance abuse treatment are more likely to achieve sustained viral suppression. While important challenges remain in maximizing its impact, the scientific literature provides strong evidence of the efficacy of drug treatment as an HIV prevention strategy.
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Affiliation(s)
- David S Metzger
- HIV/AIDS Prevention Research Division, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA.
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Tomescu C, Duh FM, Lanier MA, Kapalko A, Mounzer KC, Martin MP, Carrington M, Metzger DS, Montaner LJ. Increased plasmacytoid dendritic cell maturation and natural killer cell activation in HIV-1 exposed, uninfected intravenous drug users. AIDS 2010; 24:2151-60. [PMID: 20647906 DOI: 10.1097/qad.0b013e32833dfc20] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Increased natural killer (NK) activation has been associated with resistance to HIV-1 infection in several cohorts of HIV-1 exposed, uninfected individuals. Inheritance of protective NK receptor alleles (KIR3DS1 and KIR3DL1) has also been observed in a subset of HIV-1 exposed, uninfected individuals. However, the exact mechanism contributing to NK activation in HIV-1 exposed, uninfected intravenous drug users (EU-IDU) remains to be elucidated. OBJECTIVE We investigated the role of both host genotype and pathogen-induced dendritic cell modulation of NK activation during high-risk activity in a cohort of 15 EU-IDU individuals and 15 control, uninfected donors from Philadelphia. DESIGN We assessed the activation status of NK cells and dendritic cells by flow cytometry and utilized functional assays of NK-DC cross-talk to characterize the innate immune compartment in EU-IDU individuals. RESULTS As previously reported, NK cell activation (CD69) and/or degranulation (CD107a) was significantly increased in EU-IDU individuals compared with control uninfected donors (P = 0.0056, n = 13). Genotypic analysis indicated that the frequency of protective KIR (KIR3DS1) and HLA-Bw4*80I ligands was not enriched in our cohort of EU-IDU individuals. Rather, plasmacytoid dendritic cells (PDC) from EU-IDU exhibited heightened maturation (CD83) compared with control uninfected donors (P = 0.0011, n = 12). When stimulated in vitro, both PDCs and NK cells from EU-IDU individuals maintained strong effector cell function and did not exhibit signs of exhaustion. CONCLUSION Increased maturation of PDCs is associated with heightened NK activation in EU-IDU individuals suggesting that both members of the innate compartment may contribute to resistance from HIV-1 infection in EU-IDU.
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Williams CT, Metzger DS. Race and distance effects on regular syringe exchange program use and injection risks: a geobehavioral analysis. Am J Public Health 2010; 100:1068-74. [PMID: 20395589 DOI: 10.2105/ajph.2008.158337] [Citation(s) in RCA: 38] [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: 11/04/2022]
Abstract
OBJECTIVES We conducted "geobehavioral" analyses by race to understand how distances among injection drug users' (IDUs') residences, drug purchase and use locations, and syringe exchange programs (SEPs) are associated with injection behaviors. METHODS Data were from the HIV Prevention Trial Network 037 (2002-2006) site in Philadelphia, Pennsylvania, a randomized study evaluating the efficacy of a network-oriented HIV prevention intervention for IDUs. At prescreening, participants were asked the nearest intersections to their residence, where they buy and use drugs, and about their injection behaviors. RESULTS Geographic distances had independent and interactive effects on injection risk behaviors and SEP use. Blacks, regardless of distance, were less likely than Whites to inject in public places (odds ratio [OR] = 0.62; 95% confidence interval [CI] = 0.43, 0.90), to use syringes after someone else (OR = 0.27; 95% CI = 0.19, 0.38), and to access syringes from SEPs (OR = 2.08; 95% CI = 1.48, 2.92). Latinos' injection behaviors were more distance-dependent than Blacks' or Whites'. CONCLUSIONS Distances among IDUs' homes, drug purchase and injecting sites, and prevention resources affected safe injection practices differentially by race. Understanding individuals' geographic relation to the risks and resources that surround them is an important aspect of understanding effects of the environment on health and behavior and the development of targeted interventions.
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Affiliation(s)
- Chyvette T Williams
- University of Illinois School of Public Health, 1603 West Taylor St, M/C 923, Chicago, IL 60612, USA.
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Ye L, Wang X, Metzger DS, Riedel E, Montaner LJ, Ho W. Upregulation of SOCS-3 and PIAS-3 impairs IL-12-mediated interferon-gamma response in CD56 T cells in HCV-infected heroin users. PLoS One 2010; 5:e9602. [PMID: 20231901 PMCID: PMC2834757 DOI: 10.1371/journal.pone.0009602] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [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: 12/10/2009] [Accepted: 02/16/2010] [Indexed: 12/23/2022] Open
Abstract
Background CD56+ T cells are abundant in liver and play an important role in host innate immunity against viral infections, including hepatitis C virus (HCV) infection, a common infection among heroin abusers. We thus investigated the in vivo impact of heroin use or heroin use plus HCV infection on the CD56+ T cell frequency and function. Methodology/Principal Findings A total of 37 heroin users with (17) or without (20) HCV infection and 17 healthy subjects were included in the study. Although there was no significant difference in CD56+ T cell frequency in PBMCs among three study groups, CD56+ T cells isolated from the heroin users had significantly lower levels of constitutive interferon-gamma (IFN-γ) expression than those from the normal subjects. In addition, when stimulated by interleukin (IL)-12, CD56+ natural T cells from HCV-infected heroin users produced significantly lower levels of IFN-γ than those from the normal subjects. This diminished ability to produce IFN-γ by CD56+ T cells was associated with the increased plasma HCV viral loads in the HCV-infected heroin users. Investigation of the mechanisms showed that although heroin use or heroin use plus HCV infection had little impact on the expression of the key positive regulators (IL-12 receptors, STAT-1, 3, 4, 5, JAK-2, and TYK-2) in IL-12 pathway, heroin use or heroin use plus HCV infection induced the expression of suppressor of cytokine signaling protein-3 (SOCS-3) and protein inhibitors of activated STAT-3 (PIAS-3), two key inhibitors of IL-12 pathway. Conclusion/Significance These findings provide compelling in vivo evidence that heroin use or heroin use plus HCV infection impairs CD56+ T cell-mediated innate immune function, which may account for HCV infection and persistence in liver.
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Affiliation(s)
- Li Ye
- Department of Pathology and Laboratory Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Xu Wang
- Department of Pathology and Laboratory Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - David S. Metzger
- Department of Psychiatry, The Center for Studies of Addiction, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Eric Riedel
- Department of Pediatrics, Joseph Stokes, Jr. Research Institute, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Luis J. Montaner
- The Wistar Institute, Philadelphia, Pennsylvania, United States of America
| | - Wenzhe Ho
- Department of Pathology and Laboratory Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, United States of America
- * E-mail:
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Tomescu C, Abdulhaqq SA, Metzger DS, Kapalko A, Mounzer KC, Maino VC, Montaner LJ. Heightened activation of plasmacytoid dendritic cells and increased NK activity in HIV-1 exposed, uninfected intra-venous drug users. Cytokine 2009. [DOI: 10.1016/j.cyto.2009.07.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Plotzker RE, Metzger DS, Holmes WC. Childhood sexual and physical abuse histories, PTSD, depression, and HIV risk outcomes in women injection drug users: a potential mediating pathway. Am J Addict 2008; 16:431-8. [PMID: 18058406 DOI: 10.1080/10550490701643161] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
We explored links between childhood sexual abuse (CSA), childhood physical abuse (CPA), posttraumatic stress disorder (PTSD)/depression, and women injection drug users' (IDUs') risk in 113 women recruited from two syringe exchange sites. More than half (56%) reported CSA, 68% CPA, 23% likely were depressed-only, and 53% likely had PTSD/depression. CSA was associated with sexual (p = 0.003) and drug risk (p = 0.05); CPA was not. CSA was associated with PTSD/depression (p = 0.03); PTSD/depression was associated with sexual (p < 0.01) and drug (p < 0.03) risk. After PTSD/depression adjustment, CSA was no longer associated with sexual or drug risk. These results suggest that women IDUs' CSA-to-risk path is mediated by PTSD/depression.
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Affiliation(s)
- Rosalyn E Plotzker
- Center for the Studies of Addiction, HIV Prevention Division, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, USA
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Kegeles SM, Johnson MO, Strauss RP, Ralston B, Hays RB, Metzger DS, McLellan-Lemal E, MacQueen KM. How should HIV vaccine efficacy trials be conducted? Diverse U.S. communities speak out. AIDS Educ Prev 2006; 18:560-72. [PMID: 17166081 DOI: 10.1521/aeap.2006.18.6.560] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Developing an effective vaccine remains a critical long-term approach to HIV prevention. Every efficacy trial should be responsive to the concerns of participating communities because the successful development of an HIV preventive vaccine will require long-term involvement of people who have been marginalized and who distrust the government and biomedical research. Using qualitative interviews and purposive sampling, we elicited recommendations regarding how vaccine efficacy trials should be conducted from 90 members of communities that have been disproportionately affected by HIV/AIDS: injection drug users, gay men, and African Americans. The most common recommendation was for complete disclosure of all aspects of the trial. Other themes included participant and community education, who to include in trials, preventing harm, trust, community involvement, researcher attributes, and respect for participants. Developing positive, respectful and collaborative experiences with community members will facilitate vaccine research because negative experiences and unfavorable community reactions can greatly impede success in future trials.
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Affiliation(s)
- Susan M Kegeles
- Center for AIDS Prevention Studies, University of California, San Francisco, USA
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Simoes AA, Bastos FI, Moreira RI, Lynch KG, Metzger DS. A randomized trial of audio computer and in-person interview to assess HIV risk among drug and alcohol users in Rio De Janeiro, Brazil. J Subst Abuse Treat 2006; 30:237-43. [PMID: 16616168 DOI: 10.1016/j.jsat.2005.12.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [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: 05/12/2005] [Revised: 12/10/2005] [Accepted: 12/18/2005] [Indexed: 11/28/2022]
Abstract
This study compares drug patterns and prevalence of risk behaviors in a randomized trial using two methods of administration, Audio Computer-Assisted Self-Interview (ACASI) and Interviewer-Administered Questionnaire (IAQ), among drug users seeking treatment in a drug treatment center. We randomized 735 participants: 367 to ACASI and 368 to IAQ. No significant difference in sociodemographic variables were found between subjects in the two arms of the study. Those interviewed by ACASI were more likely to report use on 7 of 10 substances assessed. Rates of reporting of sexual risk behaviors (male-to-male and commercial sex) were higher among participants in the ACASI arm. ACASI seems to be a key resource in improving the reporting of sensitive data in Brazil, as it has been in prior international studies.
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Affiliation(s)
- Anna Azevedo Simoes
- Health Department of the State Government of Rio de Janeiro, Rio de Janeiro, Brazil.
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Simões AA, Bastos FI, Moreira RI, Lynch KG, Metzger DS. Acceptability of audio computer-assisted self-interview (ACASI) among substance abusers seeking treatment in Rio de Janeiro, Brazil. Drug Alcohol Depend 2006; 82 Suppl 1:S103-7. [PMID: 16769438 DOI: 10.1016/s0376-8716(06)80016-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2005] [Revised: 08/10/2005] [Accepted: 10/13/2005] [Indexed: 11/17/2022]
Abstract
This study aimed to determine the acceptability of the ACASI approach to risk assessment and the impact of personal preference regarding mode of interview on reporting risk behaviors among drug users entering treatment in Rio de Janeiro, Brazil. We assessed 268 substance users who completed the ACASI arm in a randomized trial comparing the ACASI with the Interviewer-Administered Questionnaire (IAQ). The vast majority of interviewees (90.7%) reported no problem using the computer, and 37.3% felt that their privacy was best protected by the ACASI (vs. 16.4% who preferred the IAQ). Nearly half (45.5%) reported that the computer interview would produce more "honest" answers, whereas 30.6% selected the IAQ. In the adjusted regression analysis, problems using the computer were associated only with lower educational level (p<0.05). We found no evidence that preference had an impact on reporting risk behaviors or drug use. Our study showed both good feasibility and acceptability of the ACASI for interviewing drug users in Brazil. The findings extend our understanding of the role of the ACASI method by suggesting the utility of this approach in assessing HIV risk among low-to middle-income drug users in a cultural setting quite different from previous studies.
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Wang X, Douglas SD, Peng JS, Metzger DS, O'Brien CP, Zhang T, Ho WZ. Naltrexone inhibits alcohol-mediated enhancement of HIV infection of T lymphocytes. J Leukoc Biol 2006; 79:1166-72. [PMID: 16574767 DOI: 10.1189/jlb.1105642] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [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] [Indexed: 11/24/2022] Open
Abstract
Acute and chronic alcohol abuse impairs various functions of the immune system and thus, has been implicated as a cofactor in the immunopathogenesis of human immunodeficiency virus (HIV) disease progression. We determined whether naltrexone, an opioid receptor antagonist widely used in the treatment of alcoholism, inhibits alcohol-mediated enhancement of HIV infection of T cells. Alcohol enhanced HIV infection of peripheral blood lymphocytes (PBL) and a human lymphoid cell line (CEMX174). Alcohol increased HIV X4 envelope (Env), not murine leukemia virus Env-pseudotyped infection of CEMX174 cells. Naltrexone antagonized the enhancing effect of alcohol on HIV infection of PBL and CEMX174 cells. The specific mu-opioid receptor antagonist, Cys2, Tyr3, Arg5, Pen7 (CTAP) amide, also blocked the enhancing effect of alcohol on HIV infection. Investigation of the underlying mechanism for the alcohol action showed that alcohol significantly increased endogenous beta-endorphin production and induced mu-opioid receptor mRNA expression in PBL and CEMX174 cells. The role of beta-endorphin in alcohol-mediated enhancement of HIV infection was indicated by the observations that naltrexone and CTAP antagonized ether alcohol- or exogenous beta-endorphin-mediated enhancement of HIV infection. These findings suggest a biological mechanism for the potential therapeutic benefit of naltrexone in treating HIV-infected alcoholics.
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MESH Headings
- Adult
- Alcohol Deterrents/pharmacology
- Alcohol Deterrents/therapeutic use
- Alcoholism/complications
- Alcoholism/immunology
- Cells, Cultured/drug effects
- Cells, Cultured/virology
- Disease Susceptibility
- Drug Evaluation, Preclinical
- Ethanol/pharmacology
- Female
- HIV Infections/etiology
- HIV Reverse Transcriptase/analysis
- HIV-1/physiology
- Humans
- Hybrid Cells/drug effects
- Hybrid Cells/virology
- Leukemia Virus, Murine/physiology
- Lymphocytes/drug effects
- Lymphocytes/virology
- Male
- Middle Aged
- Naltrexone/pharmacology
- Naltrexone/therapeutic use
- Peptide Fragments
- Peptides/pharmacology
- RNA, Messenger/biosynthesis
- RNA, Messenger/genetics
- Receptors, Opioid, mu/antagonists & inhibitors
- Receptors, Opioid, mu/biosynthesis
- Receptors, Opioid, mu/genetics
- Receptors, Opioid, mu/physiology
- Somatostatin
- T-Lymphocytes/drug effects
- T-Lymphocytes/virology
- Up-Regulation/drug effects
- Virion/physiology
- Virus Replication/drug effects
- beta-Endorphin/biosynthesis
- beta-Endorphin/genetics
- beta-Endorphin/physiology
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Affiliation(s)
- Xu Wang
- Division of Allergy and Immunology, Joseph Stokes Jr. Research Institute at the Children's Hospital of Philadelphia, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, USA
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36
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Abstract
We previously demonstrated that morphine enhances hepatitis C virus (HCV) replication in human hepatic cells. Here we describe the impact of morphine withdrawal (MW), a recurrent event during the course of opioid abuse, on HCV replicon expression in human hepatic cells. MW enhanced both viral RNA and protein expression in HCV replicon cells. Blocking opioid receptors by treatment with naloxone after morphine cessation (precipitated withdrawal, PW) induced greater HCV replicon expression than MW. Investigation of the mechanism responsible for MW- or PW-mediated HCV enhancement showed that both MW and PW inhibited the expression of endogenous interferon-alpha (IFN-alpha) in the hepatic cells. This down-regulation of intracellular IFN-alpha expression was due to the negative impact of MW or PW on IFN-alpha promoter activation and on the expression of IFN regulatory factor 7 (IRF-7), a strong transactivator of the IFN-alpha promoter. In addition, both MW and PW inhibited the anti-HCV ability of recombinant IFN-alpha in the hepatic cells. These in vitro observations support the concept that opioid abuse favors HCV persistence in hepatic cells by suppressing IFN-alpha-mediated intracellular innate immunity and contributes to the development of chronic HCV infection.
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Affiliation(s)
- Chuan-Qing Wang
- Department of Pediatrics, Division of Allergy and Immunology, The Children's Hospital of Philadelphia, and the Department of Psychiatry, University of Pennsylvania School of Medicine, 34th St. and Civic Center Blvd., Philadelphia, PA 19104, USA
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37
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Zhang T, Guo CJ, Douglas SD, Metzger DS, O'Brien CP, Li Y, Wang YJ, Wang X, Ho WZ. Alcohol suppresses IL-2-induced CC chemokine production by natural killer cells. Alcohol Clin Exp Res 2005; 29:1559-67. [PMID: 16205356 PMCID: PMC4015110 DOI: 10.1097/01.alc.0000179364.32003.9f] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Natural killer (NK) cells are a critical component of the host innate immune system. We investigated whether alcohol impairs NK cell function, particularly production of CC chemokines induced by interleukin (IL)-2, the natural ligands for CCR5 receptor. METHODS Primary NK cells and NK cell line (YTS) were cultured with or without alcohol (10 to 80 mM) for three hours. The culture supernatants were then harvested and used to treat human peripheral blood monocyte-derived macrophages and a HeLa cell line, which expresses CD4, CCR5, and CXCR4 receptors (MAGI cells). CC chemokine expression by YTS and primary NK cells treated with or without alcohol was analyzed with the real-time RT-PCR and ELISA. [Ca(2)(+)]i and Western blot assays were used to determine calcium-mediated intracellular signaling pathway and NF-kappaB p65 expression. HIV strains (Bal and UG024) were used to infect macrophages and MAGI cells. In addition, ADA (macrophage-tropic strain) and murine leukemia virus (MLV) envelope-pseudotyped HIV infection was carried out in macrophages. HIV infectivity was determined by HIV reverse transcriptase (RT) and beta-galactosidase activity assays. RESULTS Alcohol inhibited IL-2-induced CC chemokine (CCL3 and CCL4) expression by NK cells. Functional tests demonstrated that this reduced expression of CC chemokines was associated with diminished anti-HIV ability of NK cells. Alcohol also reduced the ability of NK cells to response to CCL3-mediated chemotaxis. Alcohol inhibited IL-2-induced NF-kappaB p65 protein expression and calcium mobilization by NK cells. CONCLUSIONS Alcohol, through the inhibition of IL-2-induced NF-kappaB p65 protein expression and intracellular calcium mobilization, suppressed NK cell production of CC chemokines. This suppression of CC chemokine production was associated with diminished anti-HIV activity of NK cells. Thus, by inhibiting NK cell-mediated innate immunity against HIV, alcohol consumption may have a cofactor role in the immunopathogenesis of HIV disease.
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Affiliation(s)
- Ting Zhang
- Department of Pediatrics, Division of Allergy and Immunology, Joseph Stokes Jr. Research Institute at The Children's Hospital of Philadelphia, PA 19104, USA
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38
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Li Y, Wang X, Douglas SD, Metzger DS, Woody G, Zhang T, Song L, Ho WZ. CD8+ T cell depletion amplifies hepatitis C virus replication in peripheral blood mononuclear cells. J Infect Dis 2005; 192:1093-101. [PMID: 16107965 DOI: 10.1086/432957] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [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: 03/31/2005] [Accepted: 04/28/2005] [Indexed: 11/03/2022] Open
Abstract
We investigated the ability of CD8+ T cells to inhibit hepatitis C virus (HCV) replication in peripheral blood mononuclear cells (PBMCs). PBMCs isolated from 11 of 20 HCV-infected subjects had no detectable HCV RNA. Removal of CD8+ T cells from these PBMCs resulted in detection of HCV RNA, and depletion of CD8+ T cells from PBMCs that had detectable HCV RNA amplified HCV replication. Reconstitution of CD8- PBMCs with autologous CD8+ T cells led to inhibition of HCV replication. Interferon-gamma produced by CD8+ T cells was partially responsible for CD8+ T cell-mediated noncytotoxic anti-HCV activity in PBMCs. This noncytotoxic anti-HCV activity was confirmed in HCV replicon cells. Supernatants from CD8+ T cell cultures inhibited HCV RNA expression in the replicon cells. These findings may have important implications for the immunopathogenesis of HCV in both immune and hepatic cells and are relevant to the development of host innate immunity-based anti-HCV interventions.
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Affiliation(s)
- Yuan Li
- Division of Allergy and Immunology, Department of Pediatrics, Joseph Stokes Jr. Research Institute, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
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39
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Abstract
AIMS To examine the role of expanded access to opioid agonist treatment as a means to decrease international HIV transmission. DESIGN Review of the English language literature via Medline. MEASUREMENTS Estimates of prevalence rates for injection drug use, HIV infection and treatment effect sizes for changes in opioid use, opioid injection, needle-sharing, injection-related HIV risk behavior and cost. FINDINGS An estimated 12.6 million injection drug users internationally accounted for 10% of the 4.2 million new HIV infections in 2003. Ninety-three of the 136 countries (68%) that report injection drug use identify HIV infection related to this behavior. Observational studies of methadone treatment demonstrate decreases in opioid use, opioid injection, needle-sharing and lower rates of HIV prevalence and incidence. The effectiveness of buprenorphine in demonstrating similar findings is expected, although implementations and research are still emerging. The cost-effectiveness of opioid agonist treatment has been established. The barriers to international adoption of opioid agonist treatment, despite the research evidence and international guidelines, are discussed. CONCLUSIONS Untreated opioid dependence leads to HIV transmission, on an international level. Opioid agonist treatments are associated with reductions in the frequency of opioid use, fewer injections and injection-related HIV risk behaviors and lower rates of HIV prevalence and incidence. Despite international recommendations, treatment for opioid-dependent injection drug users with methadone and buprenorphine is limited. Research, implementation efforts and political strategies to expand access to opioid agonist treatment are needed in order to combat the spread of HIV, especially in the developing world.
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Affiliation(s)
- Lynn E Sullivan
- Yale University School of Medicine, New Haven, CT 06520-8025, USA.
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40
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Abstract
This article uses data from an 8-year study of injection drug users to examine whether homelessness independently influenced the likelihood of engaging in human immunodeficiency virus (HIV) risk behaviors. Fixed effects regression analyses are used to estimate the associations between four different housing contexts and four different behaviors related to transmitting HIV infections. Results showed that 16% of the study group experienced homelessness at some point during the study, and that homelessness was significantly associated with a higher likelihood of frequenting shooting galleries (odds ratio = 2.05), but did not have a significant effect on sharing syringes, sharing other injection drug paraphernalia, or participating in paid sex. These results provide limited support for positing homelessness as independently associated with increased levels of HIV-related risk behavior among injection drug users and highlights the need for more research that examines the housing dynamics among this population.
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Affiliation(s)
- Stephen Metraux
- Graduate Program in Health Policy, University of the Sciences in Philadelphia, 600 South 43rd Street, Philadelphia, PA 19104-4495, USA.
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41
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Abstract
Since first recognition of the scope of the acquired immunodeficiency syndrome epidemic among the drug-using community, substance abuse treatment has been viewed as playing an important role in preventing new infections. In the past 20 years, many studies have documented significantly lower rates of drug use, drug-related risk behaviors, and human immunodeficiency virus (HIV) infections among drug users who remain in treatment programs. There is also growing evidence that drug detoxification alone is insufficient to provide protection from HIV infection. These findings have important implications for users of cocaine and noninjection drugs, as well as heroin injectors. Despite strong evidence of effectiveness and widespread support for the important public health role of drug treatment, its impact has been compromised by limited availability and acceptability. The available data clearly establish drug abuse treatment as HIV prevention, yet without expansion of existing treatment programs and the continued development of treatments for addiction to cocaine and other widely used stimulants, its public health potential cannot be realized.
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Affiliation(s)
- David S Metzger
- University of Pennsylvania/Veteran's Affairs Medical Center, Center for Studies of Addiction, Philadelphia, Pennsylvania 19104, USA.
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42
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Abstract
Opportunistic infections (OIs) were first recognized among injection drug users (IDUs) in New York City in 1981. By the mid-1980s, OIs had become associated with HIV infection, and attention began to focus on efforts to prevent HIV transmission among IDUs. Since then, a range of prevention strategies has been implemented and evaluated in an attempt to reduce the spread of HIV infection among drug users. These prevention strategies include (1) HIV testing and counseling and educational and behavioral interventions delivered through community outreach; (2) condom, bleach, and needle distribution and syringe access and exchange programs; (3) substance abuse treatment; and, more recently, (4) prevention interventions targeting HIV-positive IDUs. Data from evaluations of these strategies over the past 20 years have provided substantial evidence of effectiveness and have helped to inform network-based and structural interventions. Despite the cumulative empirical evidence, however, research findings have yet to be widely disseminated, adopted, and implemented in a sustained and integrated fashion. The reasons for this are unclear, but point to a need for improved communications with program developers and community planners to facilitate the implementation and evaluation of integrated intervention strategies, and for collaborative research to help understand policy, legal, economic, and local barriers to implementation.
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Affiliation(s)
- David S Metzger
- University of Pennsylvania/VA Medical Center, Center for Studies of Addiction, Philadelphia, PA 19104, USA.
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43
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Abstract
Perinatal transmission of HIV accounts for almost all new HIV infections in children. There is an increased risk of perinatal transmission of HIV with maternal illicit substance abuse. Little is known about neonatal immune system alteration and subsequent susceptibility to HIV infection after morphine exposure. We investigated the effects of morphine on HIV infection of neonatal monocyte-derived macrophages (MDM). Morphine significantly enhanced HIV infection of neonatal MDM. Morphine-induced HIV replication in neonatal MDM was completely suppressed by naltrexone, the opioid receptor antagonist. Morphine significantly up-regulated CCR5 receptor expression and inhibited the endogenous production of macrophage inflammatory protein-1beta in neonatal MDM. Thus, morphine, most likely through alteration of beta-chemokines and CCR5 receptor expression, enhances the susceptibility of neonatal MDM to HIV infection, and may have a cofactor role in perinatal HIV transmission and infection.
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Affiliation(s)
- Yuan Li
- Division of Immunologic and Infectious Diseases, The Children's Hospital of Philadelphia, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, U.S.A
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44
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Abstract
Alcohol consumption accelerates liver damage and diminishes the anti-hepatitis C virus (HCV) effect of interferon alfa (IFN-alpha) in patients with HCV infection. It is unknown, however, whether alcohol enhances HCV replication and promotes HCV disease progression. The availability of the HCV replicon containing hepatic cells has provided a unique opportunity to investigate the interaction between alcohol and HCV replicon expression. We determined whether alcohol enhances HCV RNA expression in the replicon containing hepatic cells. Alcohol, in a concentration-dependent fashion, significantly increased HCV replicon expression. Alcohol also compromised the anti-HCV effect of IFN-alpha. Investigation of the mechanism(s) responsible for the alcohol action on HCV replicon indicated that alcohol activated nuclear factor kappaB (NF-kappaB) promoter. Caffeic acid phenethyl ester (CAPE), a specific inhibitor of the activation of NF-kappaB, abolished alcohol-induced HCV RNA expression. In addition, naltrexone, an opiate receptor antagonist, abrogated the enhancing effect of alcohol on HCV replicon expression. In conclusion, alcohol, probably through the activation of NF-kappaB and the endogenous opioid system, enhances HCV replicon expression and compromises the anti-HCV effect of IFN-alpha. Thus, alcohol may play an important role in vivo as a cofactor in HCV disease progression and compromise IFN-alpha-based therapy against HCV infection.
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Affiliation(s)
- Ting Zhang
- Division of Allergy and Immunology, Joseph Stokes Jr. Research Institute at The Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
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45
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Coletti AS, Heagerty P, Sheon AR, Gross M, Koblin BA, Metzger DS, Seage GR. Randomized, controlled evaluation of a prototype informed consent process for HIV vaccine efficacy trials. J Acquir Immune Defic Syndr 2003; 32:161-9. [PMID: 12571526 DOI: 10.1097/00126334-200302010-00008] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [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] [Indexed: 11/25/2022]
Abstract
Procedures must be developed to ensure that valid informed consent is obtained from participants in HIV vaccine efficacy trials. A prototype informed consent process was evaluated among 4,892 persons at high risk for HIV infection in the HIV Network for Prevention Trials Vaccine Preparedness Study (VPS), a prospective cohort study of HIV seroincidence in eight U.S. metropolitan areas. Twenty percent of VPS participants were selected at random to undergo the prototype informed consent process at VPS month 3. Participants' knowledge of 10 key HIV vaccine trial concepts and willingness to participate in HIV vaccine efficacy trials were assessed and compared at baseline and semiannually thereafter for 18 months. Knowledge of HIV vaccine trial concepts was low at baseline. Participation in the prototype process was associated with substantial and sustained increases in knowledge (relative risks for the 10 items, 1.04-2.26), which were of similar magnitude across HIV risk groups, race/ethnicity, and educational levels. It is recommended that the prototype informed consent process be adopted for future HIV vaccine efficacy trials as well as for clinical trials in other research areas.
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Affiliation(s)
- Anne S Coletti
- Family Health International, Research Triangle Park, North Carolina, USA
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46
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Wang X, Douglas SD, Metzger DS, Guo CJ, Li Y, O'Brien CP, Song L, Davis-Vogal A, Ho WZ. Alcohol Potentiates HIV-1 Infection of Human Blood Mononuclear Phagocytes. Alcohol Clin Exp Res 2002. [DOI: 10.1111/j.1530-0277.2002.tb02496.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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47
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Wang X, Douglas SD, Metzger DS, Guo CJ, Li Y, O'Brien CP, Song L, Davis-Vogal A, Ho WZ. Alcohol potentiates HIV-1 infection of human blood mononuclear phagocytes. Alcohol Clin Exp Res 2002; 26:1880-6. [PMID: 12500113 PMCID: PMC4015111 DOI: 10.1097/01.alc.0000042148.50808.04] [Citation(s) in RCA: 21] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Acute and chronic alcohol abuse impairs various functions of the immune system and thus has been implicated as a cofactor in HIV infection. The mechanisms by which alcohol affects the function of human immune cells that are the targets for HIV are unknown. METHODS Human blood monocyte-derived macrophages (MDM) were incubated with or without alcohol (10-40 mM) for 24 hr and then infected with HIV for 24 hr. Culture supernatants were harvested for HIV reverse transcription assay. HIV entry receptor (CCR5, CD4, and CXCR4) expression was determined by reverse transcription-polymerase chain reaction and flow cytometry assays. Beta-chemokines were analyzed using enzyme-linked immunosorbent assay. Different HIV strains (Bal, SF-162, 89.6, and UG024) were used for infection experiments. In addition, ADA (macrophage-tropic strain) and murine leukemia virus envelope-pseudotyped HIV infection was carried out. RESULTS Although alcohol had little effect on HIV T-lymphocyte-tropic strain infection, it significantly enhanced HIV R5 strain infection in MDM. The enhancing effect of alcohol on the HIV R5 strain was further evidenced by the observation that the R5 (ADA) strain envelope-pseudotyped HIV infection is markedly increased by alcohol, whereas murine leukemia virus envelope-pseudotyped HIV infection was not affected. Alcohol significantly up-regulated CCR5 receptor expression and inhibited the endogenous production of beta-chemokines by MDM. CONCLUSION Alcohol, through the down-regulation of beta-chemokine production and the up-regulation of CCR5 receptor expression, enhances HIV R5 strain infection of MDM and may have an important role as a cofactor in the progression of HIV disease.
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Affiliation(s)
- Xu Wang
- Division of Immunologic and Infectious Disease, Joseph Stokes Jr Research Institute at the Children's Hospital of Philadelphia, Department of Pediatrics, Pennsylvania 19104, USA
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48
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MacQueen KM, McLellan E, Metzger DS, Kegeles S, Strauss RP, Scotti R, Blanchard L, Trotter RT. What is community? An evidence-based definition for participatory public health. Am J Public Health 2001; 91:1929-38. [PMID: 11726368 PMCID: PMC1446907 DOI: 10.2105/ajph.91.12.1929] [Citation(s) in RCA: 228] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Increased emphasis on community collaboration indicates the need for consensus regarding the definition of community within public health. This study examined whether members of diverse US communities described community in similar ways. To identify strategies to support community collaboration in HIV vaccine trials, qualitative interviews were conducted with 25 African Americans in Durham, NC; 26 gay men in San Francisco, Calif; 25 injection drug users in Philadelphia, Pa; and 42 HIV vaccine researchers across the United States. Verbatim responses to the question "What does the word community mean to you?" were analyzed. Cluster analysis was used to identify similarities in the way community was described. A common definition of community emerged as a group of people with diverse characteristics who are linked by social ties, share common perspectives, and engage in joint action in geographical locations or settings. The participants differed in the emphasis they placed on particular elements of the definition. Community was defined similarly but experienced differently by people with diverse backgrounds. These results parallel similar social science findings and confirm the viability of a common definition for participatory public health.
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Affiliation(s)
- K M MacQueen
- National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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49
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Abstract
BACKGROUND The problems of underenrollment and selective enrollment may undermine AIDS vaccine trials. If prospective study subjects' stated willingness to participate (WTP) in hypothetical vaccine trials predicts future enrollment, then measuring WTP before recruitment may enhance the enrollment in, and ethics of, such trials. METHODS We prospectively studied changes over an 18-month period in the stated WTP in, and knowledge of, a hypothetical AIDS vaccine trial among 610 Philadelphia residents at high risk for HIV infection. Of these people, 499 were subsequently recruited to participate in an actual, phase II AIDS vaccine trial. We used multivariable logistic regression and the area under the receiver-operating characteristic (ROC) curve to model predictors of actual enrollment. RESULTS Actual enrollment rates were 8.3%, 6.8%, 15.8%, and 29.0% among those who had initially said they were "definitely not," "probably not," "probably," and "definitely" willing to participate, respectively (p =.006). The area under the ROC curve was 0.65, indicating a modest ability of stated WTP to differentiate those who enroll from those who do not. Knowledge of basic vaccine trial concepts, though unrelated to enrollment, increased over an 18-month period with repeated education sessions (p <.0001), whereas stated WTP declined over this same period (p <.0001). CONCLUSION Although other factors not captured by stated WTP may also influence future enrollment, prospectively assessing stated WTP may augment the validity of the informed consent process, help prevent underenrollment, and clarify the population from which the study sample is drawn.
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Affiliation(s)
- S D Halpern
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pensylvania 19104-6021, USA.
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Rosenberg SD, Trumbetta SL, Mueser KT, Goodman LA, Osher FC, Vidaver RM, Metzger DS. Determinants of risk behavior for human immunodeficiency virus/acquired immunodeficiency syndrome in people with severe mental illness. Compr Psychiatry 2001; 42:263-71. [PMID: 11458300 DOI: 10.1053/comp.2001.24576] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
We examined the prevalence and correlates of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) risk behaviors in a large sample of severely mentally ill (SMI) patients. Risk levels were correlated with demographic factors, diagnosis, symptom severity, trauma history, post-traumatic stress disorder (PTSD), substance use disorder (SUD), and sexual orientation. SMI clients from urban and rural settings (N = 275) were assessed regarding HIV/AIDS risk behaviors, and hypothesized risk factors. Patients exhibited substantial levels of risky behavior, particularly sexual risk. Correlates of increased risk included SUD, trauma, male homosexual orientation, younger age, and symptom severity. Structural equation modeling identified SUD and sexual orientation as the primary determinants of both drug and sexual risk behavior. We conclude that specific illness related variables appear to have less impact on risk behavior among people with SMI than previously hypothesized. Substance abuse prevention and treatment may be the most effective means of reducing HIV risk in this population.
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Affiliation(s)
- S D Rosenberg
- New Hampshire-Dartmouth Psychiatric Research Center, Lebanon, NH 03766, USA
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