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Tozer K, Tzemis D, Amlani A, Coser L, Taylor D, Van Borek N, Saewyc E, Buxton JA. Reorienting risk to resilience: street-involved youth perspectives on preventing the transition to injection drug use. BMC Public Health 2015; 15:800. [PMID: 26286577 PMCID: PMC4545775 DOI: 10.1186/s12889-015-2153-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 08/14/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Youth Injection Prevention (YIP) project aimed to identify factors associated with the prevention of transitioning to injection drug use (IDU) among street-involved youth (youth who had spent at least 3 consecutive nights without a fixed address or without their parents/caregivers in the previous six months) aged 16-24 years in Metro Vancouver, British Columbia. METHODS Ten focus groups were conducted by youth collaborators (peer-researchers) with street-involved youth (n = 47) from November 2009-April 2010. Audio recordings and focus group observational notes were transcribed verbatim and emergent themes identified by open coding and categorizing. RESULTS Through ongoing data analysis we identified that youth produced risk and deficiency rather than resiliency-based answers. This enabled the questioning guide to be reframed into a strengths-based guide in a timely manner. Factors youth identified that prevented them from IDU initiation were grouped into three domains loosely derived from the risk environment framework: Individual (fear and self-worth), Social Environment (stigma and group norms - including street-entrenched adults who actively discouraged youth from IDU, support/inclusion, family/friend drug use and responsibilities), and Physical/Economic Environment (safe/engaging spaces). Engaging youth collaborators in the research ensured relevance and validity of the study. CONCLUSION Participants emphasized having personal goals and ties to social networks, supportive family and role models, and the need for safe and stable housing as key to resiliency. Gaining the perspectives of street-involved youth on factors that prevent IDU provides a complementary perspective to risk-based studies and encourages strength-based approaches for coaching and care of at-risk youth and upon which prevention programs should be built.
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Affiliation(s)
- Kira Tozer
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z4R4, Canada.
| | - Despina Tzemis
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z4R4, Canada.
| | - Ashraf Amlani
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z4R4, Canada.
| | - Larissa Coser
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A1S6, Canada.
| | - Darlene Taylor
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z4R4, Canada. .,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T1Z3, Canada.
| | - Natasha Van Borek
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z4R4, Canada.
| | - Elizabeth Saewyc
- University of British Columbia School of Nursing, T201-2211 Westbrook Mall, Vancouver, BC, V6T2B5, Canada.
| | - Jane A Buxton
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z4R4, Canada. .,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T1Z3, Canada.
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Buxton JA, Omura J, Kuo M, Ross C, Tzemis D, Purssell R, Gardy J, Carleton B. Genetic determinants of cocaine-associated agranulocytosis. BMC Res Notes 2015; 8:240. [PMID: 26070312 PMCID: PMC4467676 DOI: 10.1186/s13104-015-1219-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 06/01/2015] [Indexed: 11/25/2022] Open
Abstract
Background Drug-induced agranulocytosis is a recognized adverse drug event associated with serious infectious complications. Levamisole is an antihelminthic and immunomodulator withdrawn from North American markets in 2005 after reports of agranulocytosis. Previous studies of levamisole, suggest that the human leukocyte antigen (HLA)-B27 confers a genetic predisposition to this adverse drug event. Since 2009, emergency room visits due to agranulocytosis in individuals consuming levamisole-adulterated crack-cocaine have increased. Methods We performed a case–control study using a genotyping assay and novel gene chip to test the association between cocaine-associated agranulocytosis (CAA) and HLA-B27 and to identify pharmacokinetic and pharmacodynamic gene variants associated with the phenotype. Results Fifty-one CAA cases were identified through a provincial physician reporting system between 2008 and 2011. We examined eight of these cases and 26 matched controls. Genotyping revealed a significant association between HLA-B27 and CAA (odds ratio [OR] 9.2, 95% confidence interval [CI], 1.54–54.6). We also observed a similar association with the HLA-B27 tag single nucleotide polymorphism rs4349859 (OR 9.2, 95% CI 1.5–54.6) and rs13202464 (OR 6.7, 95% CI 1.1–41). Further associations were identified with variants in the ARBCC12 (OR 10.0, 95% CI 2.7–36.8) and CYP11A1 (OR 7.4, 95% CI 2.1–26.6) genes, while a novel protective association was observed with variants in the ARDB1 gene (OR 0.06, 95% CI 0.007–0.46). Conclusions We confirmed the association of HLA-B27 with CAA and identified additional susceptibility variants. Health care providers should inform people who are identified as having CAA that it is genetically determined and can recur with continued cocaine use. The severity of infections and subsequent hospitalization, and the risk of recurrence may prompt health-promoting behaviour changes of the affected individuals. These genetic associations warrant the attention of public health and knowledge translation efforts to highlight the implications for susceptibility to this severe adverse drug event.
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Affiliation(s)
- Jane A Buxton
- BC Center for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada. .,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - John Omura
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Margot Kuo
- BC Center for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.
| | - Colin Ross
- Child and Family Research Institute, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada.
| | - Despina Tzemis
- BC Center for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.
| | - Roy Purssell
- Drug and Poison Information Centre, BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.
| | - Jennifer Gardy
- BC Center for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada. .,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Bruce Carleton
- Child and Family Research Institute, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada.
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Nicol JJE, Yarema MC, Jones GR, Martz W, Purssell RA, MacDonald JC, Wishart I, Durigon M, Tzemis D, Buxton JA. Deaths from exposure to paramethoxymethamphetamine in Alberta and British Columbia, Canada: a case series. CMAJ Open 2015; 3:E83-90. [PMID: 25844375 PMCID: PMC4382046 DOI: 10.9778/cmajo.20140070] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Paramethoxymethamphetamine (PMMA) is a ring-substituted amphetamine similar in structure to 3,4-methylenedioxymethamphetamine (MDMA or "ecstasy"), but substantially more toxic. We describe the clinical features of fatal exposures in the provinces of Alberta and British Columbia, Canada. METHODS We conducted a retrospective case series on deaths in Alberta and BC between June 2011 and April 2012 for which forensic toxicologic analysis was positive for PMMA and the drug was implicated as the primary toxic agent. Data collected included patient demographics, exposure history, clinical features, investigations, therapy provided and postmortem toxicologic findings. RESULTS A total of 27 PMMA-associated deaths (20 in Alberta, 7 in BC) were reported in the 11-month period. The median age was 24 (range 14-52) years, and 22 (81%) were male. Ten patients were pronounced dead at the scene, and 17 died in hospital. The median time from exposure to death was 17 (range 5-264) hours. The median first-recorded vital signs (and ranges) were: heart rate 160 (86-201) beats/min, blood pressure 89/43 (69/30-162/83) mm Hg, respiratory rate 40 (26-48) breaths/min, oxygen saturation 81% (68%-100%) and temperature 39.4°C (34-43.8°C). Sixteen of the 17 people who died in hospital presented with clinical features consistent with serotonin syndrome. End-organ dysfunction included hepatic (30%) and acute kidney injury (85%), rhabdomyolysis (54%), coagulopathy (61%) and cardiac ischemia (15%). Other drugs identified on toxicologic analysis were MDMA (n = 27), cocaine or its metabolite benzoylecgonine (n = 14) and methamphetamine (n = 12). INTERPRETATION Exposure to PMMA was characterized by multiorgan dysfunction and serotonin syndrome, followed by cardiovascular collapse. In addition to PMMA, multiple synthetic amphetamines were present on toxicologic analysis. When evaluating patients suspected of exposure to sympathomimetic drugs of abuse, clinicians must anticipate multiple clinical effects from the increased release of dopamine, serotonin, norepinephrine and other neurotransmitters.
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Affiliation(s)
| | - Mark C Yarema
- Department of Emergency Medicine, University of Calgary, Calgary, Alta. ; Poison and Drug Information Service, Alberta Health Services, Calgary, Alta
| | | | | | - Roy A Purssell
- British Columbia Drug and Poison Information Centre, Vancouver, BC ; Department of Emergency Medicine, University of British Columbia, Vancouver, BC
| | - Judy C MacDonald
- Population, Public and Aboriginal Health, Alberta Health Services - Calgary Zone, Calgary, Alta. ; Department of Community Health Sciences, University of Calgary, Calgary, Alta
| | - Ian Wishart
- Department of Emergency Medicine, University of Calgary, Calgary, Alta
| | - Monica Durigon
- Environmental Health Services, British Columbia Centre for Disease Control, Vancouver, BC ; Canadian Field Epidemiology Program, Public Health Agency of Canada, Ottawa, Ont
| | - Despina Tzemis
- British Columbia Centre for Disease Control, Vancouver, BC
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, BC ; British Columbia Centre for Disease Control, Vancouver, BC
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Banjo O, Tzemis D, Al-Qutub D, Amlani A, Kesselring S, Buxton JA. A quantitative and qualitative evaluation of the British Columbia Take Home Naloxone program. CMAJ Open 2014; 2:E153-61. [PMID: 25295235 PMCID: PMC4183165 DOI: 10.9778/cmajo.20140008] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [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: 11/22/2022] Open
Abstract
BACKGROUND In August 2012, the British Columbia Take Home Naloxone (BCTHN) program was introduced to help to reduce opioid overdose and its consequences. This study evaluates the BCTHN program, identifying the successes and challenges of implementing a provincial program in Canada. METHODS In this cross-sectional study, we reviewed the records of the BCTHN administrative program to report on program outcomes (participation and overdose reversals). Focus groups and individual interviews were conducted with 40 clients in Vancouver; 12 individual interviews were completed with service providers, police officers and parents of people who use opioids from both the Vancouver and Interior regions of British Columbia. Qualitative data were analyzed using content analysis and a qualitative descriptive approach. RESULTS As of March 13, 2014, the BCTHN program had been implemented at 40 sites, trained 1318 participants in overdose prevention, recognition and response, distributed 836 kits to clients and received reports of 85 overdose reversals. Stakeholders were supportive of the program, and clients reported greater confidence in response to overdose. Service providers found the program training materials easy to use and that training increased client engagement. Some of the challenges included difficulty in identifying physician willing to prescribe, recruitment of some at-risk populations (e.g., long-term opioid users and patients with chronic pain), and clients' reluctance to call 911. We also found that the police had some misconceptions about BCTHN. INTERPRETATION The BCTHN program was easy to implement, empowering for clients and was responsible for reversing 85 overdoses in its first 20 months. We suggest communities across Canada should consider implementing take-home naloxone programs and evaluate their findings.
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Affiliation(s)
- Oluwajenyo Banjo
- British Columbia Centre for Disease Control, Vancouver, BC
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC
| | - Despina Tzemis
- British Columbia Centre for Disease Control, Vancouver, BC
| | - Diana Al-Qutub
- British Columbia Centre for Disease Control, Vancouver, BC
- School of Population and Public Health, University of British Columbia, Vancouver, BC
| | - Ashraf Amlani
- British Columbia Centre for Disease Control, Vancouver, BC
| | - Sarah Kesselring
- British Columbia Centre for Disease Control, Vancouver, BC
- School of Population and Public Health, University of British Columbia, Vancouver, BC
| | - Jane A Buxton
- British Columbia Centre for Disease Control, Vancouver, BC
- School of Population and Public Health, University of British Columbia, Vancouver, BC
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Kuo M, Shamsian A, Tzemis D, Buxton JA. A drug use survey among clients of harm reduction sites across British Columbia, Canada, 2012. Harm Reduct J 2014; 11:13. [PMID: 24766846 PMCID: PMC4016659 DOI: 10.1186/1477-7517-11-13] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 04/10/2014] [Indexed: 02/06/2023] Open
Abstract
Background In British Columbia (BC), understanding of high-risk drug use trends is largely based on survey and cohort study data from two major cities, which may not be representative of persons who use drugs in other regions. Harm reduction stakeholders, representing each of the five geographic health regions in BC, identified a need for data on drug use to inform local and regional harm reduction activities across the province. The aims of this project were to (1) develop a drug use survey that could be feasibly administered at harm reduction (HR) sites across all health regions and (2) assess the data for differences in reported drug use frequencies by region. Methods A pilot survey focusing on current drug use was developed with stakeholders and administered among clients at 28 HR supply distribution sites across the province by existing staff and peers. Data were collated and analysed using univariate and bivariate descriptive statistics to assess differences in reported drug use frequencies by geography. A post-survey evaluation was conducted to assess acceptability and feasibility of the survey process for participating sites. Results Crack cocaine, heroin, and morphine were the most frequently reported drugs with notable regional differences. Polysubstance use was common among respondents (70%) with one region having 81% polysubstance use. Respondents surveyed in or near their region's major centre were more likely to report having used crack cocaine (p < 0.0001) and heroin (p < 0.0001) in the past week as compared to those residing >50 km from the major centre. Participants accessing services >50 km from the regional centre were more likely to have used morphine (p < 0.0001). There was no difference in powder cocaine use by client/site proximity to the regional centre. Participating sites found the survey process acceptable, feasible to administer annually, and useful for responding to client needs. Conclusions The survey was a feasible way for harm reduction sites across BC to obtain drug use data from clients who actively use drugs. Drug use frequencies differed substantially by region and community proximity to the regional centre, underlining the need for locally collected data to inform service planning.
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Affiliation(s)
- Margot Kuo
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada.
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Abstract
This article uses a Positive Youth Development framework to explore the experiences of six experiential youth coresearchers (YCs) in the Youth Injection Prevention (YIP) participatory research project, and the parallel track process of empowerment and capacity building that developed. The YIP project was conducted in Metro Vancouver at the BC Centre for Disease Control and community organizations serving street-involved youth. A process evaluation was conducted to explore themes in the YCs experience in the project, as well as process strengths and challenges. Semistructured interviews with the YCs, researcher field notes, and team meeting and debrief session minutes were analyzed. The YIP project appears to have exerted a positive influence on the YCs. Positive self-identities, sense of purpose, reconceptualization of intellectual ability, new knowledge and skills, supportive relationships, finding a voice, and social and self-awareness were among the positive impacts. Process strengths included team-building activities, team check-in and checkout sessions, and professional networking opportunities. Process challenges included the time required to help YCs overcome personal barriers to participation. The YIP project demonstrates that participatory research with street-involved youth is a viable research option that contributes to positive youth development and empowerment.
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Affiliation(s)
| | - Kira Tozer
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Natasha Van Borek
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Despina Tzemis
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Darlene Taylor
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Elizabeth Saewyc
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Jane A. Buxton
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
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Tzemis D, Campbell J, Kuo M, Buxton JA. A cross-sectional study of public attitudes towards safer drug use practices in British Columbia, Canada. Subst Abuse Treat Prev Policy 2013; 8:40. [PMID: 24289280 PMCID: PMC4221987 DOI: 10.1186/1747-597x-8-40] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 11/26/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Harm reduction programs are often vulnerable to political and vocal opposition despite documented evidence of their effectiveness and economic benefit. It is not well understood if opponents to harm reduction represent the general public's attitudes. OBJECTIVE To understand the attitudes of the people of British Columbia (BC) towards various harm reduction strategies and services, and factors associated with support for harm reduction. METHODS A random-digit dialing telephone survey assessing attitudes towards various harm reduction strategies was administered to British Columbians in August 2011 (n = 2000). We compared the level of support for general harm reduction by sex, age, education level, and area of residence (Health Authority region) (χ2). Multivariate logistic regression was used to assess odds of support for harm reduction. RESULTS Overall support for general harm reduction among participants was 76%; needle distribution 72%; needle distribution in one's local community 65%; and safer inhalation equipment distribution 52%. In the multivariate analysis, those with significantly lower odds of supporting harm reduction were male, older, had equal or less than high school education or completed a certificate/diploma program, and resided in the Fraser Health Authority region. The Health Authority region with a municipality that has introduced a bylaw prohibiting the implementation of harm reduction services was found to have 69% support for harm reduction. Another Health Authority region with a municipality that closed a long-standing needle distribution site was found to have over 78% support. CONCLUSION In contrast to some local policies, our results show the British Columbians surveyed in our study support harm reduction. It is unclear whether policy makers are swayed by a vocal minority or block harm reduction activities for other reasons. Tailoring messages towards segments of the public less likely to support harm reduction, as well civic policy-makers and the media, may help to reduce stigma and gain support for harm reduction services designed to protect and improve the health of the individual and the public.
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Affiliation(s)
- Despina Tzemis
- Communicable Disease Prevention and Control Services, British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada.
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Ti L, Tzemis D, Buxton JA. Engaging people who use drugs in policy and program development: a review of the literature. Subst Abuse Treat Prev Policy 2012; 7:47. [PMID: 23176382 PMCID: PMC3551750 DOI: 10.1186/1747-597x-7-47] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 11/08/2012] [Indexed: 11/14/2022]
Abstract
Health policies and programs are increasingly being driven by people from the community to more effectively address their needs. While a large body of evidence supports peer engagement in the context of policy and program development for various populations, little is known about this form of engagement among people who use drugs (PWUD). Therefore, a narrative literature review was undertaken to provide an overview of this topic. Searches of PubMed and Academic Search Premier databases covering 1995–2010 were conducted to identify articles assessing peer engagement in policy and program development. In total, 19 articles were included for review. Our findings indicate that PWUD face many challenges that restrict their ability to engage with public health professionals and policy makers, including the high levels of stigma and discrimination that persist among this population. Although the literature shows that many international organizations are recommending the involvement of PWUD in policy and program development, our findings revealed a lack of published data on the implementation of these efforts. Gaps in the current evidence highlight the need for additional research to explore and document the engagement of PWUD in the areas of policy and program development. Further, efforts to minimize stigmatizing barriers associated with illicit drug use are urgently needed to improve the engagement of PWUD in decision making processes.
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Affiliation(s)
- Lianping Ti
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada
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Tzemis D, Forrest JI, Puskas CM, Zhang W, Orchard TR, Palmer AK, McInnes CW, Fernades KA, Montaner JSG, Hogg RS. Identifying self-perceived HIV-related stigma in a population accessing antiretroviral therapy. AIDS Care 2012; 25:95-102. [PMID: 22672228 DOI: 10.1080/09540121.2012.687809] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study identifies factors associated with self-perceived HIV-related stigma (stigma) among a cohort of individuals accessing antiretroviral therapy in British Columbia, Canada. Data were drawn from the Longitudinal Investigations into Supportive and Ancillary Health Services study, which collects social, clinical, and quality of life (QoL) information through an interviewer-administered survey. Clinical variables (i.e., CD4 count) were obtained through linkages with the British Columbia HIV/AIDS Drug Treatment Program. Multivariable linear regression was performed to determine the independent predictors of stigma. Our results indicate that among participants with high school education or greater the outcome stigma was associated with a 3.05 stigma unit decrease (95% CI: -5.16, -0.93). Having higher relative standard of living and perceiving greater neighborhood cohesion were also associated with a decrease in stigma (-5.30 95% CI: -8.16, -2.44; -0.80 95% CI: -1.39, -0.21, respectively). Lower levels of stigma were found to be associated with better QoL measures, including perceiving better overall function (-0.90 95% CI: -1.47, -0.34), having fewer health worries (-2.11 95% CI: -2.65, -1.57), having fewer financial worries (-0.67 95% CI: -1.12, -0.23), and having less HIV disclosure concerns (-4.12 95% CI: -4.63, -3.62). The results of this study show that participants with higher education level, better QoL measures, and higher self-reported standards of living are less likely to perceive HIV-related stigma.
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Affiliation(s)
- Despina Tzemis
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
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Funk A, Van Borek N, Taylor D, Grewal P, Tzemis D, Buxton J. Climbing the "ladder of participation": engaging experiential youth in a participatory research project. Can J Public Health 2012. [PMID: 23618643 DOI: 10.1007/bf03404237] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Street-involved youth are at high risk for acquiring HIV and hepatitis C infection due to potential engagement in high-risk behaviours, including injection drug use. The Youth Injection Prevention (YIP) Project sought to identify factors that prevented street-involved youth from moving into injection drug use in Vancouver, BC. Our project used a participatory research orientation to study these factors. This paper describes the level of participation observed among the street-involved youth taking part in our project. METHODS The YIP project employed street-involved youth as co-researchers. To assess the level of participation among the co-researchers, we applied Roger Hart's "Ladder of Youth Participation". Each advancing rung in the ladder represents a higher level of participation. We compared the youth's involvement in the project to the rungs in Roger Hart's tool. RESULTS Throughout the duration of the project, the youth's participation increased. Initially the youth had low levels of participation as they were hired based on their life experiences and initially consulted and informed. Over the course of the project, team- and skill-building activities took place. This helped the project environment evolve into a safe space where youth felt comfortable to engage at the highest levels of participation. CONCLUSION The YIP Project was successful in being a highly participatory research project. In a safe and open environment, the youth felt comfortable to question and take on initiatives that went beyond the academic researcher's initial expectations. This project highlights the success of engaging street-involved youth in participatory research.
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Affiliation(s)
- Anna Funk
- British Columbia Centre for Disease Control, Vancouver, BC.
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Palmer AK, Duncan KC, Ayalew B, Zhang W, Tzemis D, Lima V, Montaner JS, Hogg RS. “The way I see it”: the effect of stigma and depression on self-perceived body image among HIV-positive individuals on treatment in British Columbia, Canada. AIDS Care 2011; 23:1456-66. [DOI: 10.1080/09540121.2011.565021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Alexis K. Palmer
- a British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
| | - Katrina C. Duncan
- a British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
- b University of British Columbia , Vancouver , BC , Canada
| | - Beza Ayalew
- c Faculty of Health Sciences , Simon Fraser University , Burnaby , BC , Canada
| | - Wendy Zhang
- a British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
| | - Despina Tzemis
- a British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
| | - V. Lima
- a British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
- b University of British Columbia , Vancouver , BC , Canada
| | - Julio S.G. Montaner
- a British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
- d Faculty of Medicine , University of British Columbia , Vancouver , BC , Canada
| | - Robert S. Hogg
- a British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
- c Faculty of Health Sciences , Simon Fraser University , Burnaby , BC , Canada
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Racey CS, Zhang W, Brandson EK, Fernandes KA, Tzemis D, Harrigan PR, Montaner JSG, Barrios R, Toy J, Hogg RS. HIV antiviral drug resistance: patient comprehension. AIDS Care 2011; 22:816-26. [PMID: 20635245 DOI: 10.1080/09540120903431355] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A patient's understanding and use of healthcare information can affect their decisions regarding treatment. Better patient understanding about HIV resistance may improve adherence to therapy, decrease population viral load and extend the use of first-line HIV therapies. We examined knowledge of developing HIV resistance and explored treatment outcomes in a cohort of HIV+ persons on highly active antiretroviral therapy (HAART). The longitudinal investigations into supportive and ancillary health services (LISA) cohort is a prospective study of HIV+ persons on HAART. A comprehensive interviewer-administrated survey collected socio-demographic variables. Drug resistance knowledge was determined using a three-part definition. Clinical markers were collected through linkage with the Drug Treatment Program (DTP) at the British Columbia Centre for Excellence in HIV/AIDS. Categorical variables were compared using Fisher's Exact Test and continuous variables using the Wilcoxon rank-sum test. Proportional odds logistic regression was performed for the adjusted multivariable analysis. Of 457 LISA participants, less than 4% completely defined HIV resistance and 20% reported that they had not discussed resistance with their physician. Overall, 61% of the cohort is >or=95% adherent based on prescription refills. Owing to small numbers pooling was preformed for analyses. The model showed that being younger (OR=0.97, 95% CI: 0.95-0.99), having greater than high school education (OR=1.64, 95% CI: 1.07-2.51), discussing medication with physicians (OR=3.67, 95% CI: 1.76-7.64), having high provider trust (OR=1.02, 95% CI: 1.01-1.03), and receiving one-to-one counseling by a pharmacist (OR=2.14, 95% CI: 1.41-3.24) are predictive of a complete or partial definition of HIV resistance. The probability of completely defining HIV resistance increased from 15.8 to 63.9% if respondents had discussed HIV medication with both a physician and a pharmacist. Although the understanding of HIV resistance showed no differences in treatment outcomes in this cohort, overall adherence and complete understanding of HIV resistance were low. If patient understanding could be improved through discussions with physicians and pharmacists, potential exists to enhance overall adherence and treatment outcomes.
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Affiliation(s)
- C Sarai Racey
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
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