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Alsdurf H, Hill PC, Matteelli A, Getahun H, Menzies D. The cascade of care in diagnosis and treatment of latent tuberculosis infection: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2016; 16:1269-1278. [PMID: 27522233 DOI: 10.1016/s1473-3099(16)30216-x] [Citation(s) in RCA: 292] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 06/22/2016] [Accepted: 06/28/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND WHO estimates that a third of the world's population has latent tuberculosis infection and that less than 5% of those infected are diagnosed and treated to prevent tuberculosis. We aimed to systematically review studies that report the steps from initial tuberculosis screening through to treatment for latent tuberculosis infection, which we call the latent tuberculosis cascade of care. We specifically aimed to assess the number of people lost at each stage of the cascade. METHODS We did a systematic review and meta-analysis of study-level observational data. We searched MEDLINE (via OVID), Embase, and Health Star for observational studies, published between 1946 and April 12, 2015, that reported primary data for diagnosis and treatment of latent tuberculosis infection. We did meta-analyses using random and fixed effects analyses to identify percentages of patients with latent tuberculosis infection completing each step in the cascade. We also estimated pooled proportions in subgroups stratified by different characteristics of interest to assess risk factors for losses. RESULTS We identified 58 studies, describing 70 distinct cohorts and 748 572 people. Steps in the cascade associated with greater losses included completion of testing (71·9% [95% CI 71·8-72·0] of people intended for screening), completion of medical evaluation (43·7% [42·5-44·9]), recommendation for treatment (35·0% [33·8-36·4]), and completion of treatment if started (18·8% [16·3-19·7]). Steps with fewer losses included receiving test results, referral for evaluation if test positive, and accepting to start therapy if recommended. Factors associated with fewer losses were immune-compromising medical indications, being part of contact investigations, and use of rifamycin-based regimens. INTERPRETATION We identify major losses at several steps in the cascade of care for latent tuberculosis infection. Improvements in management of latent tuberculosis will need programmatic approaches to address the losses at each step in the cascade. FUNDERS Canadian Institutes of Health Research.
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Affiliation(s)
- Hannah Alsdurf
- Montreal Chest Institute, McGill University, Montreal, QC, Canada
| | - Philip C Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Alberto Matteelli
- Global TB Programme, WHO, Geneva, Switzerland; Clinic of Infectious and Tropical Diseases, WHO Collaborating Center for TB/HIV and TB Elimination, University of Brescia, Brescia, Italy
| | | | - Dick Menzies
- Montreal Chest Institute, McGill University, Montreal, QC, Canada; Global TB Programme, WHO, Geneva, Switzerland.
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Sandgren A, Vonk Noordegraaf-Schouten M, van Kessel F, Stuurman A, Oordt-Speets A, van der Werf MJ. Initiation and completion rates for latent tuberculosis infection treatment: a systematic review. BMC Infect Dis 2016; 16:204. [PMID: 27184748 PMCID: PMC4869320 DOI: 10.1186/s12879-016-1550-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 05/07/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Control of latent tuberculosis infection (LTBI) is an important step towards tuberculosis elimination. Preventive treatment will prevent the development of disease in most cases diagnosed with LTBI. However, low initiation and completion rates affect the effectiveness of preventive treatment. The objective was to systematically review data on initiation rates and completion rates for LTBI treatment regimens in the general population and specific populations with LTBI. METHODS A systematic review of the literature (PubMed, Embase) published up to February 2014 was performed. RESULTS Forty-five studies on initiation rates and 83 studies on completion rates of LTBI treatment were found. These studies provided initiation rates (IR) and completion rates (CR) in people with LTBI among the general population (IR 26-99 %, CR 39-96 %), case contacts (IR 40-95 %, CR 48-82 %), healthcare workers (IR 47-98 %, CR 17-79 %), the homeless (IR 34-90 %, CR 23-71 %), people who inject drugs (IR 52-91 %, CR 38-89 %), HIV-infected individuals (IR 67-92 %, CR 55-95 %), inmates (IR 7-90 %, CR 4-100 %), immigrants (IR 23-97 %, CR 7-86 %), and patients with comorbidities (IR 82-93 %, CR 75-92 %). Generally, completion rates were higher for short than for long LTBI treatment regimens. CONCLUSION Initiation and completion rates for LTBI treatment regimens were frequently suboptimal and varied greatly within and across different populations.
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Affiliation(s)
- Andreas Sandgren
- Former Surveillance and Response Section, European Centre for Disease Prevention and Control (ECDC), Stockholm, 171 65, Sweden
| | | | - Femke van Kessel
- Pallas, Health Research and Consultancy B.V., Rotterdam, 3001, The Netherlands
| | - Anke Stuurman
- Pallas, Health Research and Consultancy B.V., Rotterdam, 3001, The Netherlands
| | - Anouk Oordt-Speets
- Pallas, Health Research and Consultancy B.V., Rotterdam, 3001, The Netherlands
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Moroz E, Albrecht RA, Aden B, Beeder AB, Yuan J, García-Sastre A, Edlin BR, Salvatore M. Active opioid use does not attenuate the humoral responses to inactivated influenza vaccine. Vaccine 2016; 34:1363-9. [PMID: 26859239 DOI: 10.1016/j.vaccine.2016.01.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 01/18/2016] [Accepted: 01/25/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Influenza vaccination is recommended for vulnerable individuals, including active drug users, to prevent influenza complications and decrease influenza spread. Recent studies suggest that opioids negatively regulate immune responses in experimental models, but the extent to which opioid use will affect the humoral responses to influenza vaccine in humans is unknown. This information is critical in maximizing vaccination efforts. OBJECTIVE To determine whether there is a difference in antibody response after influenza vaccination in heroin or methadone users compared to control subjects. METHODS We studied active heroin users, subjects on methadone maintenance treatment (MMT) and subjects that did not use any drugs before and 1 and 4 weeks after vaccination with trivalent influenza vaccine (TIV). We measured hemagglutination inhibition and microneutralization titers, and we compared geometric mean titers (GMT), and rates of seroprotection and seroconversion for each of the vaccine strains among the 3 groups of subjects. RESULTS Heroin users, subjects on MMT and non-user controls mount a similarly robust serologic response to TIV. GMT and rates of seroprotection and seroconversion were not significantly different among groups. CONCLUSION Our results suggest that opioid use do not significantly alter antibody responses to influenza vaccine supporting the vaccination effort in these populations.
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Affiliation(s)
| | - Randy A Albrecht
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, US; Global Health and Emerging Pathogens Institute, Icahn School of Medicine Mount Sinai, US
| | - Brandon Aden
- Department of Medicine, Weill Cornell Medical College, US
| | | | - Jianda Yuan
- Immune Monitoring Facility, Ludwig Center for Center Immunotherapy, Memorial Sloan Kettering Cancer Center, New York, NY, US
| | - Adolfo García-Sastre
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, US; Global Health and Emerging Pathogens Institute, Icahn School of Medicine Mount Sinai, US; Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, US
| | - Brian R Edlin
- Department of Medicine, Weill Cornell Medical College, US; Institute for Infectious Disease Research, National Development and Research Institutes, New York, NY, US
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Grenfell P, Baptista Leite R, Garfein R, de Lussigny S, Platt L, Rhodes T. Tuberculosis, injecting drug use and integrated HIV-TB care: a review of the literature. Drug Alcohol Depend 2013; 129:180-209. [PMID: 23306095 DOI: 10.1016/j.drugalcdep.2012.11.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 11/13/2012] [Accepted: 11/17/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND People who inject drugs (PWID) are at increased risk of tuberculosis (TB) and reduced retention in treatment. There is a need to document strategies for integrated delivery of HIV, TB and drug dependency care. METHODS This article reviews the literature on rates of TB mono- and co-infection, and published and grey literature descriptions of TB and HIV-TB care, among PWID. RESULTS Latent TB infection prevalence was high and active disease more common among HIV-positive PWID. Data on multidrug-resistant TB and co-infections among PWID were scarce. Models of TB care fell into six categories: screening and prevention within HIV-risk studies; prevention at TB clinics; screening and prevention within needle-and-syringe-exchange (NSP) and drug treatment programmes; pharmacy-based TB treatment; TB service-led care with harm reduction/drug treatment programmes; and TB treatment within drug treatment programmes. Co-location with NSP and opioid substitution therapy (OST), combined with incentives, consistently improved screening and prevention uptake. Small-scale combined TB treatment and OST achieved good adherence in diverse settings. Successful interventions involved collaboration across services; a client-centred approach; and provision of social care. No peer-reviewed studies described models of integrated HIV-TB care for PWID but grey literature highlighted key components: co-located services, provision of drug treatment, multidisciplinary staff training; and remaining barriers: staffing inefficiencies, inadequate funding, police interference, and limited OST availability. CONCLUSIONS Integration with drug treatment improves PWID engagement in TB services but there is a need to document approaches to HIV-TB care, improve surveillance of TB and co-infections among PWID, and advocate for improved OST availability.
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Affiliation(s)
- Pippa Grenfell
- Centre for Research on Drugs and Health Behaviour, London School of Hygiene & Tropical Medicine, London, UK.
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Olson NA, Davidow AL, Winston CA, Chen MP, Gazmararian JA, Katz DJ. A national study of socioeconomic status and tuberculosis rates by country of birth, United States, 1996-2005. BMC Public Health 2012; 12:365. [PMID: 22607324 PMCID: PMC3506526 DOI: 10.1186/1471-2458-12-365] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 05/18/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) in developed countries has historically been associated with poverty and low socioeconomic status (SES). In the past quarter century, TB in the United States has changed from primarily a disease of native-born to primarily a disease of foreign-born persons, who accounted for more than 60% of newly-diagnosed TB cases in 2010. The purpose of this study was to assess the association of SES with rates of TB in U.S.-born and foreign-born persons in the United States, overall and for the five most common foreign countries of origin. METHODS National TB surveillance data for 1996-2005 was linked with ZIP Code-level measures of SES (crowding, unemployment, education, and income) from U.S. Census 2000. ZIP Codes were grouped into quartiles from low SES to high SES and TB rates were calculated for foreign-born and U.S.-born populations in each quartile. RESULTS TB rates were highest in the quartiles with low SES for both U.S.-born and foreign-born populations. However, while TB rates increased five-fold or more from the two highest to the two lowest SES quartiles among the U.S.-born, they increased only by a factor of 1.3 among the foreign-born. CONCLUSIONS Low SES is only weakly associated with TB among foreign-born persons in the United States. The traditional associations of TB with poverty are not sufficient to explain the epidemiology of TB among foreign-born persons in this country and perhaps in other developed countries. TB outreach and research efforts that focus only on low SES will miss an important segment of the foreign-born population.
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Affiliation(s)
- Nicole A Olson
- California Department of Public Health, STD Control Branch, Richmond, CA, USA
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Currie MJ, Schmidt M, Davis BK, Baynes AM, O'Keefe EJ, Bavinton TP, McNiven M, Martin SJ, Bowden FJ. 'Show me the money': financial incentives increase chlamydia screening rates among tertiary students: a pilot study. Sex Health 2010; 7:60-5. [DOI: 10.1071/sh08091] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Accepted: 12/03/2009] [Indexed: 11/23/2022]
Abstract
Background: We hypothesise that text-messaging and financial incentives would increase tertiary student participation in chlamydia screening. Methods: A cross-sectional study was conducted over two phases on eight tertiary campuses during 2007. During Phase 1 (6 months) study activities were advertised through student organisations and media. Education and screening were offered during a range of student activities. During Phase 2 (4 days) education and screening were offered via text messages. Non-financial incentives were offered during Phase 1 and a $10 cash incentive was offered during Phase 2. Rates of specimens provided by students and the direct costs incurred during each phase were compared. Results: 2786 students attended the 31 activities conducted in Phase 1. Of these, 627 students (22.5%) provided urine specimens for chlamydia testing. During Phase 2, the dissemination of 866 text messages resulted in urine specimens from 392 students (45.3%). Costs per test were AUD $175.11 in Phase 1 and AUD $27.13 in Phase 2. Conclusions: Compared with more labour intensive (and therefore more expensive) screening activities conducted over a 6-month period, offering a small financial incentive to tertiary students through text messaging over a 4-day period significantly increased participation in on-campus chlamydia screening. This model could readily be applied to other populations to increase participation in chlamydia screening.
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Deiss RG, Rodwell TC, Garfein RS. Tuberculosis and illicit drug use: review and update. Clin Infect Dis 2009; 48:72-82. [PMID: 19046064 DOI: 10.1086/594126] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Illicit drug users continue to be a group at high risk for tuberculosis (TB). Here, we present an updated review of the relationship between TB and illicit drug use, and we summarize more than a decade of new research. Drug users, and injection drug users in particular, have driven TB epidemics in a number of countries. The successful identification and treatment of TB among illicit drug users remain important components of a comprehensive TB strategy, but illicit drug users present a unique set of challenges for TB diagnosis and control. New diagnostic modalities, including interferon-gamma-release assays, offer potential for improved diagnosis and surveillance among this group, along with proven treatment strategies that incorporate the use of directly observed therapy with treatment for drug abuse. Special considerations, including coinfection with viral hepatitis and the rifampin-methadone drug interaction, warrant clinical attention and are also updated here.
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Affiliation(s)
- Robert G Deiss
- University of California, San Diego, La Jolla, California, USA
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Bluthenthal RN, Do DP, Finch B, Martinez A, Edlin BR, Kral AH. Community characteristics associated with HIV risk among injection drug users in the San Francisco Bay Area: a multilevel analysis. J Urban Health 2007; 84:653-66. [PMID: 17657607 PMCID: PMC1988782 DOI: 10.1007/s11524-007-9213-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2007] [Accepted: 06/22/2007] [Indexed: 10/23/2022]
Abstract
Community characteristics have been associated with racial and ethnic health disparities for a wide range of ailments and conditions. Previous research has found that rates of AIDS cases among injection drug users (IDUs) vary by community characteristics. However, few studies have examined whether community characteristics are associated with HIV risk behaviors among IDUs. To address this gap in the literature, we examined the associations between census-tract-level community characteristics and injection-related and sex-related HIV risk behaviors among IDUs in the San Francisco Bay Area. Individual HIV risk behaviors were collected from 4,956 IDUs between 1998 and 2002. Using 2000 US census data, we constructed four census-level community measures: percent African American, percent male unemployment, percent of households that receive public assistance, and median household income. All community variables were measured continuously. Multilevel modeling was used to determine if community characteristics were associated with recent (in the last 6 months) receptive and distributive syringe sharing, multiple sex partners, and unprotected sex risk while controlling for potential individual-level confounders. In bivariate analysis, most of the census-tract-level community characteristics were significantly associated with injection-related HIV risk, while no community characteristics were associated with sex-related risk. However, results from multivariate multilevel models indicate that only percent African American in a census tract was associated with receptive [adjusted odds ratio (AOR) = 0.93; 95% confidence interval (CI) = 0.89, 0.99] and distributive syringe sharing (AOR = 0.94; 95% CI = 0.92, 0.99), net of individual-level characteristics. Accounting for individual-level factors in the multivariate model in the sex-related risk models revealed a significant inverse relationship between percent African American and propensity to engage in unprotected sex (AOR = 0.95; 95% CI = 0.92, 0.99); community-level characteristics remained unassociated with multiple sex partners. In this exploratory analysis, percent African American in a census tract was inversely associated with injection-related risk. The census-tract-level community characteristics we examined seem to exert little influence on individual risk among long-term chronic IDUs. More research is needed examining the influence of other community characteristics that were unmeasured in this paper but might be related to sex and drug risk among IDUs such as shooting galleries, crack houses, drug markets, and availability of preventive HIV services.
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Affiliation(s)
- Ricky N Bluthenthal
- Health Program and Drug Policy Research Center, RAND Corporation, Santa Monica, CA 90407, USA.
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Kim S, Crittenden K. Treatment Completion Among TB Patients Returned To The Community From A Large Urban Jail. J Community Health 2007; 32:135-47. [PMID: 17571526 DOI: 10.1007/s10900-006-9036-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Despite the current decline of TB in the general population, the prevalence of TB remains conspicuously higher among inmates. While treatment completion is a key to controlling and preventing drug-resistant TB, it is difficult to be achieved among incarcerated populations due to their social, economic, and behavioral characteristics. This article examined factors associated with treatment completion among jail inmates with TB disease after their return to the community. Retrospective analyses were performed to explore the relationships between demographic, behavioral, incarceration factors, and treatment methods with treatment completion. Hispanics (vs. blacks), those who had children, and those incarcerated for simple charges (vs. drug related charges) were less likely to complete treatment. DOT users were more likely to complete treatment then those who used the self administration method. Inmates whose DOT was administered at a field site were more likely to complete treatment than those whose DOT took place at a clinic or mixed clinic and field. Although mixed DOT might be less expensive than field DOT, it represented no significant improvement over clinic DOT. Treatment methods must employ an outreach strategy to meet each patient's need, considering the broader socioeconomic context.
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Affiliation(s)
- Seijeoung Kim
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago, School of Public Health, Chicago, IL 60612, USA.
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Cooper CL, Mills EJ. Therapeutic challenges in hepatitis C-infected injection drug using patients. Harm Reduct J 2006; 3:31. [PMID: 17096852 PMCID: PMC1664558 DOI: 10.1186/1477-7517-3-31] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2006] [Accepted: 11/10/2006] [Indexed: 01/30/2023] Open
Abstract
Hepatitis C Viral (HCV) infection in the injection drug user (IDU) population is a major medical concern. Concurrent substance abuse, co-morbid mental health conditions, poor socioeconomic status and a complex treatment protocol that is often incompatible with the life styles of IDUs combine to account for poor uptake and completion of HCV treatment. This article discusses HCV antiviral treatment issues relevant to IDUs chronically infected with this virus. The effect of non-injected substances of abuse on treatment outcome is considered. Priority issues requiring research are discussed.
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Affiliation(s)
- Curtis L Cooper
- Associate Professor of Medicine-University of Ottawa Hospital, Division of Infectious Diseases-The Ottawa Hospital, Ottawa, Canada
- Centre for International Health and Human Rights Studies, Toronto, Canada
| | - Edward J Mills
- Centre for International Health and Human Rights Studies, Toronto, Canada
- Faculty of Health Sciences, Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
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Edlin BR, Kresina TF, Raymond DB, Carden MR, Gourevitch MN, Rich JD, Cheever LW, Cargill VA. Overcoming barriers to prevention, care, and treatment of hepatitis C in illicit drug users. Clin Infect Dis 2006; 40 Suppl 5:S276-85. [PMID: 15768335 PMCID: PMC1510897 DOI: 10.1086/427441] [Citation(s) in RCA: 168] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Injection drug use accounts for most of the incident infections with hepatitis C virus (HCV) in the United States and other developed countries. HCV infection is a complex and challenging medical condition in injection drug users (IDUs). Elements of care for hepatitis C in illicit drug users include prevention counseling and education; screening for transmission risk behavior; testing for HCV and human immunodeficiency virus infection; vaccination against hepatitis A and B viruses; evaluation for comorbidities; coordination of substance-abuse treatment services, psychiatric care, and social support; evaluation of liver disease; and interferon-based treatment for HCV infection. Caring for patients who use illicit drugs presents challenges to the health-care team that require patience, experience, and an understanding of the dynamics of substance use and addiction. Nonetheless, programs are successfully integrating hepatitis C care for IDUs into health-care settings, including primary care, methadone treatment and other substance-abuse treatment programs, infectious disease clinics, and clinics in correctional facilities.
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Affiliation(s)
- Brian R. Edlin
- Center for the Study of Hepatitis C, Weill Medical College of Cornell University, New York
| | - Thomas F. Kresina
- Center on AIDS and Other Medical Consequences of Drug Abuse, National Institute on Drug Abuse, Bethesda, Maryland
| | | | - Michael R. Carden
- Center for the Study of Hepatitis C, Weill Medical College of Cornell University, New York
| | - Marc N. Gourevitch
- Division of General Internal Medicine, New York University School of Medicine, New York
| | - Josiah D. Rich
- Miriam Hospital, Brown University School of Medicine, Providence, Rhode Island
| | - Laura W. Cheever
- HIV/AIDS Bureau, Health Resources and Services Administration, Department of Health and Human Services, Washington, DC
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Taylor LE. Delivering Care to Injection Drug Users Coinfected with HIV and Hepatitis C Virus. Clin Infect Dis 2005; 40 Suppl 5:S355-61. [PMID: 15768348 DOI: 10.1086/427453] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
Injection drug use has fueled the epidemic of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) coinfection in the United States. Nevertheless, drug dependence is among the main reasons that coinfected persons are not being treated for HCV infection. This report describes the development and progress of an HIV clinic program (funded by the Ryan White Comprehensive AIDS Resources Emergency Act) to deliver care for HCV infection to HIV-seropositive injection drug users. To optimize safety and adherence, pegylated interferon is directly administered to patients in the context of integrated addiction, psychiatric, and HIV and HCV therapy. Ribavirin is packed weekly in pill boxes for patients to take at home. Thus far, adherence to weekly visits for treatment with interferon has been 99%. No one has had to stop treatment for HCV infection because of ongoing drug use, addiction relapse or exacerbation, or psychiatric complications. Presented here is a work in progress, rather than a finished research project or definitive model of care.
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Affiliation(s)
- Lynn E Taylor
- Department of Medicine, Division of Infectious Disease, Brown Medical School, Providence, Rhode Island, USA.
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Hepatitis C prevention and treatment for substance users in the United States: acknowledging the elephant in the living room. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2004. [DOI: 10.1016/j.drugpo.2003.10.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Hovell MF, Sipan CL, Blumberg EJ, Hofstetter CR, Slymen D, Friedman L, Moser K, Kelley NJ, Vera AY. Increasing Latino adolescents' adherence to treatment for latent tuberculosis infection: a controlled trial. Am J Public Health 2003; 93:1871-7. [PMID: 14600055 PMCID: PMC1448065 DOI: 10.2105/ajph.93.11.1871] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2002] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to determine the efficacy of coaching Latino adolescents with latent tuberculosis infection to adhere to isoniazid treatment. METHODS Participants (n = 286) were randomly assigned to adherence coaching, attention control, or usual care groups. Adherence was measured via interviews and validated with urine assays. RESULTS Coaching resulted in significant increases in adherence compared with attention and usual care groups. Bicultural adolescents were more likely to be adherent than those most or least acculturated. Age and risk behavior were negatively related to adherence. CONCLUSIONS Coaching can increase Latino adolescents' adherence to treatment for latent tuberculosis infection and should contribute to tuberculosis control for adolescents at high risk of contracting the disease.
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Affiliation(s)
- Melbourne F Hovell
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, CA 92123, USA
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Perlman DC, Friedmann P, Horn L, Nugent A, Schoeb V, Carey J, Salomon N, Des Jarlais DC. Impact of monetary incentives on adherence to referral for screening chest x-rays after syringe exchange-based tuberculin skin testing. J Urban Health 2003; 80:428-37. [PMID: 12930881 PMCID: PMC3455983 DOI: 10.1093/jurban/jtg044] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Syringe-exchange programs (SEPs) have proven to be valuable sites to conduct tuberculin skin testing among active injection drug users. Chest x-rays (CXRs) are needed to exclude active tuberculosis prior to initiating treatment for latent tuberculosis infection. Adherence of drug users to referral for off-site chest x-rays has been incomplete. Previous cost modeling demonstrated that a monetary incentive to promote adherence could be justified on the cost basis if it had even a modest effect on adherence. METHODS We compared adherence to referral for chest x-rays among injection drug users undergoing syringe exchange-based tuberculosis screening in New York City before and after the implementation of monetary incentives. RESULTS From 1995 to 1998, there were 119 IDUs referred for CXRs based on tuberculin skin testing at the SEP. From 1999 to 2001, there were 58 IDUs referred for CXRs with a $25 incentive based on adherence. Adherence to CXR referral within 7 days was 46/58 (79%) among individuals who received the monetary incentive versus 17/119 (14%) prior to the implementation of the monetary incentive (P<.0001; odds ratio [OR]=23; 95% confidence interval [CI]=9.5-57). The median time to obtaining a CXR was significantly shorter among those given the incentive than among those referred without the incentive (2 vs. 11 days, P<.0001). In multivariate logistic regression analysis, use of the incentive was highly independently associated with increased adherence (OR=22.9; 95% CI=10-52). CONCLUSIONS Monetary incentives are highly effective in increasing adherence to referral for screening CXRs to exclude active tuberculosis after syringe exchange-based tuberculin skin testing. Prior cost modeling demonstrated that monetary incentives could be justified on the cost basis if they had even a modest effect on adherence. The current data demonstrated that monetary incentives are highly effective at increasing adherence in this setting and therefore are justifiable on a cost basis. When health care interventions for drug users require referral off site, monetary incentives may be particularly valuable in promoting adherence.
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Affiliation(s)
- David C Perlman
- Department of Medicine, Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, New York 10003, USA.
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Abstract
Injection drug users constitute the largest group of persons infected with the hepatitis C virus (HCV) in the United States, and most new infections occur in drug users. Controlling hepatitis C in the U.S. population, therefore, will require developing, testing, and implementing effective prevention and treatment strategies for persons who inject drugs. Fortunately, a substantial body of research and clinical experience exists on the prevention and management of chronic viral diseases among injection drug users. The need to implement interventions to stop the spread of HCV among drug users is critical. The capacity of substance-use treatment programs need to be expanded to accommodate all who want and need treatment. Physicians and pharmacists should be educated in how to provide access to sterile syringes and to teach safe injection techniques, both of which are lifesaving interventions. The treatment of hepatitis C in drug users requires an interdisciplinary approach that brings together expertise in treating hepatitis and caring for drug users. Treatment decisions should be made individually by patients with their physicians, based on a balanced assessment of risks and benefits and the patient's personal values. Physicians should carefully assess, monitor, and support adherence and mental health in all patients, regardless of whether drug use is known or suspected. Research is needed to better understand how best to prevent and treat hepatitis C in substance users. In the meantime, substantial progress can be made if existing knowledge and resources are brought to bear.
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Affiliation(s)
- Brian R Edlin
- AIDS Research Institute, University of California, San Francisco, CA 94110, USA.
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Abstract
Injection drug users constitute the largest group of persons infected with the hepatitis C virus (HCV) in the United States, and most new infections occur in drug users. Controlling hepatitis C in the U.S. population, therefore, will require developing, testing, and implementing effective prevention and treatment strategies for persons who inject drugs. Fortunately, a substantial body of research and clinical experience exists on the prevention and management of chronic viral diseases among injection drug users. The need to implement interventions to stop the spread of HCV among drug users is critical. The capacity of substance-use treatment programs need to be expanded to accommodate all who want and need treatment. Physicians and pharmacists should be educated in how to provide access to sterile syringes and to teach safe injection techniques, both of which are lifesaving interventions. The treatment of hepatitis C in drug users requires an interdisciplinary approach that brings together expertise in treating hepatitis and caring for drug users. Treatment decisions should be made individually by patients with their physicians, based on a balanced assessment of risks and benefits and the patient's personal values. Physicians should carefully assess, monitor, and support adherence and mental health in all patients, regardless of whether drug use is known or suspected. Research is needed to better understand how best to prevent and treat hepatitis C in substance users. In the meantime, substantial progress can be made if existing knowledge and resources are brought to bear.
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Affiliation(s)
- Brian R Edlin
- AIDS Research Institute, University of California, San Francisco, CA 94110, USA.
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Edlin BR, Seal KH, Lorvick J, Kral AH, Ciccarone DH, Moore LD, Lo B. Is it justifiable to withhold treatment for hepatitis C from illicit-drug users? N Engl J Med 2001; 345:211-5. [PMID: 11463019 PMCID: PMC1510901 DOI: 10.1056/nejm200107193450311] [Citation(s) in RCA: 168] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- B R Edlin
- Urban Health Study, Institute for Health Policy Studies, University of California, San Francisco 94110, USA.
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Buffington J, Rowel R, Hinman JM, Sharp K, Choi S. Lack of awareness of hepatitis C risk among persons who received blood transfusions before 1990. Am J Public Health 2001; 91:47-8. [PMID: 11189824 PMCID: PMC1446504 DOI: 10.2105/ajph.91.1.47] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- J Buffington
- Hepatitis Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA
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Lorvick J, Kral AH, Seal K, Gee L, Edlin BR. Prevalence and duration of hepatitis C among injection drug users in San Francisco, Calif. Am J Public Health 2001; 91:46-7. [PMID: 11189823 PMCID: PMC1446502 DOI: 10.2105/ajph.91.1.46] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- J Lorvick
- Urban Health Study, University of California, San Francisco, Box 1304, San Francisco, CA 94143-1304, USA.
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