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Tseng AS, Sambai B, Monroe-Wise A, Mbogo LW, Ludwig-Barron NT, Masyuko SJ, Chohan BH, Scott JD, Sinkele W, Herbeck JT, Farquhar C, Guthrie BL. Assisted Partner Services for People Who Inject Drugs: Index Characteristics Associated With Untreated HIV in Partners. J Acquir Immune Defic Syndr 2022; 91:269-275. [PMID: 35969466 PMCID: PMC9588565 DOI: 10.1097/qai.0000000000003062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 06/28/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Assisted partner services (APSs) is a feasible, acceptable, and effective strategy that increases uptake of HIV testing; however, it has not been used widely among people who inject drugs (PWID) in Africa to notify sexual and injecting partners of potential exposures to HIV and provide testing services. SETTING Nairobi, Kilifi, and Mombasa counties in Kenya. METHODS PWID living with HIV (indexes) were enrolled and asked to provide contact information for sexual and injecting partners who were traced and offered HIV testing. APS efficiency was assessed by the number of indexes needed to interview (NNTI) to find 1 additional partner who was unaware of their HIV status or not on antiretroviral therapy (ART). We defined index participant characteristics associated with greater efficiency, defined as lower NNTIs. RESULTS Among 783 indexes, the NNTI to identify one partner unaware of their HIV status was 7.1 and to identify one HIV-positive partner not on ART (regardless of status awareness) was 4.1. APS was provided to 977 partners and was more efficient in identifying partners who were not on ART (n = 201) among indexes who were female (NNTI = 2.9 vs. 5.7, P < 0.001), unaware of their HIV status (NNTI = 2.2 vs. 4.2, P = 0.009), not on ART (NNTI = 2.1 vs. 4.9; P < 0.001), not enrolled in a methadone program (NNTI = 3.3 vs. 10.4, P < 0.001), reported injecting <5 years (NNTI = 3.3 vs. 5.0; P = 0.005), or from Nairobi (NNTI = 3.2 vs. 5.6, P < 0.001). CONCLUSION Scaling up APS among PWID living with HIV with certain characteristics could result in more efficient APS and greater partner engagement in HIV care.
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Affiliation(s)
- Ashley S Tseng
- Departments of Epidemiology, and
- Global Health, University of Washington, Seattle, WA
| | | | | | | | | | - Sarah J Masyuko
- Global Health, University of Washington, Seattle, WA
- National AIDS and STI Control Program, Kenya Ministry of Health, Nairobi, Kenya
| | - Bhavna H Chohan
- Global Health, University of Washington, Seattle, WA
- Center for Virology, Kenya Medical Research Institute, Nairobi, Kenya
| | - John D Scott
- Department of Medicine, University of Washington, Seattle, WA; and
| | - William Sinkele
- Support for Addiction Prevention and Treatment in Africa, Nairobi, Kenya
| | | | - Carey Farquhar
- Departments of Epidemiology, and
- Global Health, University of Washington, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA; and
| | - Brandon L Guthrie
- Departments of Epidemiology, and
- Global Health, University of Washington, Seattle, WA
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Woody GE. Commentary on Farnum et al.: Agonist maintenance in Ukraine-ambivalence, success and moving forward. Addiction 2021; 116:94-95. [PMID: 33001461 DOI: 10.1111/add.15219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/06/2020] [Indexed: 11/30/2022]
Affiliation(s)
- George E Woody
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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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] [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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Dumchev K, Dvoryak S, Chernova O, Morozova O, Altice FL. Retention in medication-assisted treatment programs in Ukraine-Identifying factors contributing to a continuing HIV epidemic. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 48:44-53. [PMID: 28800420 PMCID: PMC5603251 DOI: 10.1016/j.drugpo.2017.05.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 01/31/2017] [Accepted: 05/02/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Opioid agonist treatments (OAT) are widely-used, evidence-based strategies for treating opioid dependence and reducing HIV transmission. The positive benefits of OAT are strongly correlated with time spent in treatment, making retention a key indicator for program quality. This study assessed patient retention and associated factors in Ukraine, where OAT was first introduced in 2004. METHODS Data from clinical records of 2916 patients enrolled in OAT at thirteen sites from 2005 to 2012 were entered into an electronic monitoring system. Survival analysis methods were used to determine the probability of retention and its correlates. RESULTS Twelve-month retention was 65.8%, improving from 27.7% in 2005, to 70.9% in 2011. In multivariable analyses, the correlates of retention were receiving medium and high doses of medication (compared to low doses, dropout aHR=0.57 for both medium and high doses), having not been tested for HIV and tuberculosis (compared to not being tested, dropout aHR=4.44 and 3.34, respectively), and among those who were tested-a negative TB test result (compared to receiving a positive test result, dropout aHR=0.67). CONCLUSION Retention in Ukrainian OAT programs, especially in recent years, is comparable to other countries. The results confirm the importance of adequate OAT dosing (≥60mg of methadone, ≥8mg of buprenorphine). Higher dosing, however, will require interventions that address negative attitudes toward OAT by patients and providers. Interruption of OAT, in the case developing tuberculosis, should incorporate continuity of OAT for TB patients through integrated care delivery systems.
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Affiliation(s)
| | - Sergii Dvoryak
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | - Olena Chernova
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | - Olga Morozova
- Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA
| | - Frederick L Altice
- Yale University School of Medicine and School of Public Health, New Haven, CT, USA
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Dethier D, Rybak N, Hirway P, Bachmaha M, Carroll J, Sorokolit A, Flanigan T, Sluzhynska M. The changing face of women living with HIV in western Ukraine. Int J STD AIDS 2017; 29:318-323. [PMID: 28771077 DOI: 10.1177/0956462417724708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ukraine has the second largest HIV epidemic in Eastern Europe/Central Asia. This study characterizes the demographics of HIV-infected women in the Lviv region of western Ukraine, patterns in their clinical presentation, and factors associated with delays in seeking care. A retrospective chart review was conducted of 622 HIV-infected women who registered for HIV treatment at the Lviv AIDS Center between 2008 and 2013. A total of 81.6% of women were infected through heterosexual transmission and the remaining 18.4% through intravenous drug use. Slightly less than half (45.4%) was between 26 and 35 years old. Slightly more than half (56.7%) listed their residence in a city, 22.6% in villages. One-third (30.0%) of all women presented with AIDS, and 37.7% presented with symptomatic conditions. Women diagnosed with HIV during antenatal care experienced a median delay of 34 days between diagnosis and registration, compared to 87.5 days for nonpregnant women tested in the context of intravenous drug use. Overall, HIV-infected women in western Ukraine experience time delays in care, and often present with advanced HIV disease and secondary complications. Linkage to care in a timely manner is a high priority and substantial challenge for women, particularly for intravenous drug users who may face stigma and other additional barriers.
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Affiliation(s)
- Divya Dethier
- 1 The Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Natasha Rybak
- 1 The Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Priya Hirway
- 1 The Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Mariya Bachmaha
- 2 School of Public Health at Brown University, Providence, RI, USA
| | - Jennifer Carroll
- 1 The Warren Alpert Medical School at Brown University, Providence, RI, USA
| | | | - Timothy Flanigan
- 1 The Warren Alpert Medical School at Brown University, Providence, RI, USA
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Evolution of Monitoring and Evaluation of AIDS Response in Ukraine: Laying the Groundwork for Evidence-Based Health Care. AIDS Behav 2017; 21:72-82. [PMID: 27714524 DOI: 10.1007/s10461-016-1571-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Once facing the most severe HIV epidemic in Eastern Europe, Ukraine has built an elaborate Monitoring and Evaluation (M&E) system to track the response to AIDS. This system was developed using recommendations and input from multiple international expert organizations and donors and, at the current stage, serves as a best practice model in many areas. The present paper aims to provide a comprehensive overview of the evolution of the M&E system in Ukraine since its inception. Notable achievements and challenges are described and illustrated by epidemiological data and the recommendations for future development are discussed. Unique experiences and advances in M&E in Ukraine may be useful to other countries facing similar epidemiological, structural or methodological issues.
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Morozova O, Dvoriak S, Pykalo I, Altice FL. Primary healthcare-based integrated care with opioid agonist treatment: First experience from Ukraine. Drug Alcohol Depend 2017; 173:132-138. [PMID: 28242537 PMCID: PMC5545131 DOI: 10.1016/j.drugalcdep.2016.12.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 12/13/2016] [Accepted: 12/24/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Ukraine's HIV epidemic is concentrated among people who inject drugs (PWID), however, coverage with opioid agonist therapies (OATs) available mostly at specialty addiction clinics is extremely low. OAT integrated into primary healthcare clinics (PHCs) provides an opportunity for integrating comprehensive healthcare services and scaling up OAT. METHODS A pilot study of PHC-based integrated care for drug users conducted in two Ukrainian cities between 2014 and 2016 included three sub-studies: 1) cross-sectional treatment site preference assessment among current OAT patients (N=755); 2) observational cohort of 107 PWID who continued the standard of care versus transition of stabilized and newly enrolled PWID into PHC-based integrated care; and 3) pre/post analysis of attitudes toward PWID and HIV patients by PHC staff (N=26). RESULTS Among 755 OAT patients, 53.5% preferred receiving OAT at PHCs, which was independently correlated with convenience, trust in physician, and treatment with methadone (vs. buprenorphine). In 107 PWID observed over 6 months, retention in treatment was high: 89% in PWID continuing OAT in specialty addiction treatment settings (standard of care) vs 94% in PWID transitioning to PHCs; and 80% among PWID newly initiating OAT in PHCs. Overall, satisfaction with treatment, subjective self-perception of well-being, and trust in physician significantly increased in patients prescribed OAT in PHCs. Among PHC staff, attitudes towards PWID and HIV patients significantly improved over time. CONCLUSIONS OAT can be successfully integrated into primary care in low and middle-income countries and improves outcomes in both patients and clinicians while potentially scaling-up OAT for PWID.
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Affiliation(s)
- Olga Morozova
- Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, USA
| | - Sergey Dvoriak
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine,Academy of Labour, Social Relations and Tourism, Kyiv, Ukraine
| | - Iryna Pykalo
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | - Frederick L. Altice
- Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, USA,Yale University School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, USA,Corresponding author at: 135 College Street, Suite 323, New Haven, CT 06510-2283, USA. (F.L. Altice)
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Ompad DC, Wang J, Dumchev K, Barska J, Samko M, Zeziulin O, Saliuk T, Varetska O, DeHovitz J. Patterns of harm reduction service utilization and HIV incidence among people who inject drugs in Ukraine: A two-part latent profile analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 43:7-15. [PMID: 28160736 DOI: 10.1016/j.drugpo.2016.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 11/11/2016] [Accepted: 12/16/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Program utilization patterns are described within a large network of harm reduction service providers in Ukraine. The relationship between utilization patterns and HIV incidence is determined among people who inject drugs (PWID) controlling for oblast-level HIV incidence and treatment/syringe coverage. METHODS Data were extracted from the network's monitoring and evaluation database (January 2011-September 2014, n=327,758 clients). Latent profile analysis was used to determine harm reduction utilization patterns using the number of HIV tests received annually and the number of condoms, syringes, and services (i.e., information and counseling sessions) received monthly over a year. Cox proportional hazards regression determined the relations between HIV seroconversion and utilization class membership. RESULTS In the final 4-class model, class 1 (34.0% of clients) received 0.1 HIV tests, 1.3 syringes, 0.6 condom and minimal counseling and information sessions per month; class 2 (33.6%) received 8.6 syringes, 3.2 condoms, and 0.5 HIV tests and counseling and information sessions; class 3 (19.1%) received 1 HIV test, 11.9 syringes, 4.3 condoms, and 0.7 information and counseling sessions; class 4 (13.3%) received 1 HIV test, 26.1 syringes, 10.3 condoms, and 1.8 information and 1.9 counseling sessions. Class 4 clients had significantly decreased risk for HIV seroconversion as compared to those in class 1 after controlling for oblast-level characteristics. CONCLUSION Injection drug use continues to be a major mode of HIV transmission in Ukraine, making evaluation of harm reduction efforts in reducing HIV incidence among PWID critical. These analyses suggest that receiving more syringes and condoms decreased risk of HIV. Scaling up HIV testing and harm reduction services is warranted.
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Affiliation(s)
- Danielle C Ompad
- New York University College of Global Public Health, New York, NY, USA; Center for Drug Use and HIV Research, New York University, New York, NY, USA; Center for Health, Identity, Behavior, and Prevention Studies, New York University, New York, NY, USA.
| | - Jiayu Wang
- Center for Health, Identity, Behavior, and Prevention Studies, New York University, New York, NY, USA
| | | | - Julia Barska
- National University of Kyiv-Mohyla Academy, Kiev, Ukraine
| | - Maria Samko
- Alliance for Public Health (Formerly ICF International HIV/AIDS Alliance in Ukraine), Kiev, Ukraine
| | | | - Tetiana Saliuk
- Alliance for Public Health (Formerly ICF International HIV/AIDS Alliance in Ukraine), Kiev, Ukraine
| | - Olga Varetska
- Alliance for Public Health (Formerly ICF International HIV/AIDS Alliance in Ukraine), Kiev, Ukraine
| | - Jack DeHovitz
- SUNY Downstate Medical Center, Department of Medicine, Brooklyn, NY, USA
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Factors associated with physical and sexual violence by police among people who inject drugs in Ukraine: implications for retention on opioid agonist therapy. J Int AIDS Soc 2016; 19:20897. [PMID: 27435717 PMCID: PMC4951533 DOI: 10.7448/ias.19.4.20897] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 04/11/2016] [Accepted: 04/24/2016] [Indexed: 12/20/2022] Open
Abstract
Introduction Ukraine's volatile HIV epidemic, one of the largest in Eastern Europe and Central Asia, remains concentrated in people who inject drugs (PWID). HIV prevalence is high (21.3% to 41.8%) among the estimated 310,000 PWID. Opioid agonist therapy (OAT) is the most cost-effective HIV prevention strategy there, yet OAT services are hampered by negative attitudes and frequent harassment of OAT clients and site personnel by law enforcement. This paper examines the various types of police violence that Ukrainian PWID experience and factors associated with the different types of violence, as well as the possible implications of police harassment on OAT retention. Methods In 2014 to 2015, we conducted a cross-sectional survey in five Ukrainian cities with 1613 PWID currently, previously and never on OAT, using a combination of respondent-driven sampling, as well as random sampling. We analysed correlates of police violence by multiple factors, including by gender, and their effects on duration of OAT retention. Self-reported physical and sexual violence by police were the two primary outcomes, while retention on OAT was used as a secondary outcome. Results Overall, 1033 (64.0%) PWID reported being physically assaulted by police, which was positively correlated with currently or previously being on OAT (69.1% vs. 60.2%; p<0.01). HIV prevalence rates were higher in those receiving OAT than those not on OAT (47.6% vs. 36.1%; p<0.01). Police violence experiences differed by sex, with men experiencing significantly more physical violence, while women experienced more sexual violence (65.9% vs. 42.6%; p<0.01). For PWID who had successfully accessed OAT, longer OAT retention was significantly correlated both with sexual assault by police and fewer non-fatal overdoses. Conclusions Police violence is a frequent experience among PWID in Ukraine, particularly for those accessing OAT, an evidence-based primary and secondary HIV prevention strategy. Police violence experiences, however, were different for men and women, and interventions with police that address these sexual differences and focus on non-violent interactions with PWID to improve access and retention on OAT are crucial for improving HIV prevention and treatment goals for Ukraine.
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Police, Law Enforcement and HIV. J Int AIDS Soc 2016. [DOI: 10.7448/ias.19.4.21260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Moore CB, Ciaraldi E. Quality of Care and Service Expansion for HIV Care and Treatment. Curr HIV/AIDS Rep 2016; 12:223-30. [PMID: 25855339 DOI: 10.1007/s11904-015-0263-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The last two decades have seen exceptional development of antiretroviral treatment programs throughout the world. Over 14 million persons are accessing antiretroviral treatment (ART) treatment as of early 2015, and life expectancy has risen markedly in the most-affected populations. However, large patient numbers threaten to overwhelm already over-burdened health care systems and retention in care remains suboptimal. Developing innovative strategies to alleviate these burdens and retain patients in care remains a challenge. Furthermore, despite this expansion, large populations of HIV-infected persons remain undiagnosed and are unwilling or unable to access care and treatment programs. Marginalized and high-risk populations are particularly in danger of remaining outside of care and are also disproportionately affected by HIV. To reverse the trend and "fast track" our way out of the epidemic, ambitious treatment targets are required, and a concerted effort has to be made to engage these populations into care, initiate ART, and attain viral suppression.
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Abstract
Persons who inject drugs (PWID) are at high risk for infection with and poor outcomes from HIV and hepatitis C virus (HCV). Well-established interventions for HIV/HCV prevention among PWID include syringe access, opioid agonist maintenance treatment, and supervised injection facilities, yet these interventions remain unavailable or inadequately resourced in much of the world. We review recent literature on biomedical and behavioral interventions to reduce the burden of HIV/HCV among PWID, with an emphasis on randomized controlled trials and quasi-experimental studies. Since 2013, there have been significant advancements in utilizing antiviral therapy and behavioral interventions for prevention among PWID, including approaches that address the unique needs of couples and sex workers. In addition, there have been significant developments in pharmacotherapies for substance use and the implementation of naloxone for opioid overdose prevention. Notwithstanding multiple ongoing structural challenges in delivering HIV/HCV prevention interventions to PWID, these emerging and rigorously evaluated interventions expand possibilities for prevention among PWID.
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Ahn JV, Bailey H, Malyuta R, Volokha A, Thorne C. Factors Associated with Non-disclosure of HIV Status in a Cohort of Childbearing HIV-Positive Women in Ukraine. AIDS Behav 2016; 20:174-83. [PMID: 26054389 DOI: 10.1007/s10461-015-1089-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Ukraine has one of the largest populations of persons living with HIV in Europe. Data on 2019 HIV-positive married or cohabiting women enrolled in a postnatal cohort from 2007 to 2012 were analysed to investigate prevalence and factors associated with self-reported non-disclosure of HIV status. Median age at enrolment was 27.5 years, with two-thirds diagnosed during their most recent pregnancy. Almost all had received antenatal antiretroviral therapy and 24 % were taking it currently. One-tenth (n = 198) had not disclosed their HIV status to their partner and 1 in 20 (n = 93) had disclosed to no-one. Factors associated with non-disclosure were: unmarried status (AOR 2.99 (95 % CI 1.51-5.92), younger age at leaving full-time education (AOR 0.41 (95 % CI 0.19-0.88) for ≥19 years vs ≤16 years) and lack of knowledge of partner's HIV status (AOR 2.01 (95 % CI 1.09-3.66). Further work is needed to support disclosure in some groups and to explore relationships between disclosure and psychological factors in this setting, including depression, lack of support and perception of stigma.
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Affiliation(s)
- Jane V Ahn
- Population Policy and Practice Programme, UCL Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Heather Bailey
- Population Policy and Practice Programme, UCL Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Ruslan Malyuta
- Perinatal Prevention of AIDS Initiative, Odessa, Ukraine
| | - Alla Volokha
- Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | - Claire Thorne
- Population Policy and Practice Programme, UCL Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.
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Rawson RA, Woody G, Kresina TF, Gust S. The globalization of addiction research: capacity-building mechanisms and selected examples. Harv Rev Psychiatry 2015; 23:147-56. [PMID: 25747927 PMCID: PMC4356020 DOI: 10.1097/hrp.0000000000000067] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Over the past decade, the amount and variety of addiction research around the world has increased substantially. Researchers in Australia, Canada, United Kingdom, United States, and western Europe have significantly contributed to knowledge about addiction and its treatment. However, the nature and context of substance use disorders and the populations using drugs are far more diverse than is reflected in studies done in Western cultures. To stimulate new research from a diverse set of cultural perspectives, the National Institute on Drug Abuse (NIDA) has promoted the development of addiction research capacity and skills around the world for over 25 years. This review will describe the programs NIDA has developed to sponsor international research and research fellows and will provide some examples of the work NIDA has supported. NIDA fellowships have allowed 496 individuals from 96 countries to be trained in addiction research. The United Arab Emirates and Saudi Arabia have recently developed funding to support addiction research to study, with advice from NIDA, the substance use disorder problems that affect their societies. Examples from Malaysia, Tanzania, Brazil, Russian Federation, Ukraine, Republic of Georgia, Iceland, China, and Vietnam are used to illustrate research being conducted with NIDA support. Health services research, collaboratively funded by the U.S. National Institutes of Health and Department of State, addresses a range of addiction service development questions in low- and middle-income countries. Findings have expanded the understanding of addiction and its treatment, and are enhancing the ability of practitioners and policy makers to address substance use disorders.
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Affiliation(s)
- Richard A. Rawson
- Professor and Co-Director, UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California at Los Angeles
| | - George Woody
- Professor, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania Principal Investigator, Delaware Valley Node of Clinical Trials Network, Treatment Research Institute
| | - Thomas F. Kresina
- Division of Pharmacologic Therapies, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, Maryland
| | - Steve Gust
- Director, International Program, National Institute on Drug Abuse, United States National Institutes of Health
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