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Sokale I, Wilkerson J, Wermuth P, Atem F, Burnett J, Wejnert C, Khuwaja S, Troisi C. Past-Year HIV Testing, Current Antiretroviral Therapy Use, and Participation in Services for People Who Inject Drugs. AIDS Behav 2024:10.1007/s10461-024-04369-0. [PMID: 38822083 DOI: 10.1007/s10461-024-04369-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2024] [Indexed: 06/02/2024]
Abstract
Evaluating routine HIV testing and treatment and use of services for people who inject drugs (PWID) is critical to curb the ongoing HIV epidemic. We analyzed data from the 2018 National HIV Behavioral Surveillance of PWID aged 18 years or older, recruited using respondent-driven sampling and offered anonymous HIV testing after survey. We performed bivariate and multivariable analyses with log-linked Poisson regression of the generalized linear models to examine the associations between demographics and PWID service use, past-year HIV testing, and current antiretroviral therapy (ART) use. Among 10,311 HIV-negative PWID, 56% reported past-year HIV testing, and of the 553 HIV-positive PWID, 69% reported current ART use. Of the HIV-negative PWID, 64% (2874/4482) in drug treatment and 62% (3386/5440) who used syringe service programs (SSPs) reported past-year HIV testing. Among HIV-positive PWID, 75% (187/248) in drug treatment and 67% (200/298) SSP participants were on ART. In the adjusted multivariable model, past-year HIV testing was associated with drug use treatment (aPR 1.26, 95% CI 1.23-1.31) and SSP participation (aPR 1.19, 95% CI 1.13-1.26) among HIV-negative PWID. Current ART use was associated with drug use treatment (aPR 1.13, 95% CI 1.00-1.28) but the link was not significant probably due to small sample size. Findings support the expansion and improvement of PWID-targeted services, into comprehensive programs, including drug use treatment, SSP, and HIV testing and treatment.
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Affiliation(s)
- Itunu Sokale
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Room RAS E927, Houston, TX, 77030, USA
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Johnny Wilkerson
- Department of Health Promotion & Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Paige Wermuth
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Room RAS E927, Houston, TX, 77030, USA
| | - Folefac Atem
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Janet Burnett
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cyprian Wejnert
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Salma Khuwaja
- Disease Prevention and Control Division, Houston Health Department, Houston, TX, USA
| | - Catherine Troisi
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Room RAS E927, Houston, TX, 77030, USA.
- Department of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA.
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Lee YG, Zhakupova G, Vinogradov V, Paine EA, Laughney CI, Reeder K, Davis A, Hunt T, Mergenova G, Primbetova S, Terlikbayeva A, Wu E. Polydrug Use, Sexual Risk, and HIV Testing Among Cisgender Gay, Bisexual, and Other Men and Transgender and Nonbinary Individuals Who Have Sex With Men in Kazakhstan. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2022; 34:413-426. [PMID: 36181500 PMCID: PMC10662254 DOI: 10.1521/aeap.2022.34.5.413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
This study examined substance use and sexual risk correlates of HIV testing among cisgender gay, bisexual, and other men (MSM) and transgender and nonbinary individuals (TSM) who have sex with men in Kazakhstan. We analyzed baseline data from an HIV prevention trial collected prior to intervention deployment (N = 304). Multivariable logistic regression analyses revealed that lifetime HIV testing was positively associated with poly-drug use (AOR = 4.4, 95% CI [2.0, 9.9]) and negatively with sexual risk (AOR = 0.4, 95% CI [0.2, 1.0]). Similarly, recent HIV testing was positively associated with polydrug use (AOR = 2.7, 95% CI [1.4, 5.2]) and negatively with sexual risk (AOR = 0.5, 95% CI [0.3, 0.9]). Current HIV testing was negatively associated with sexual risk (AOR = 0.6, 95% CI [0.3. 0.9]). Findings support the value of integrating drug treatment with HIV testing among MSM and TSM in Kazakhstan.
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Affiliation(s)
- Yong Gun Lee
- Social Intervention Group, Columbia University School of Social Work, New York, New York, USA
| | - Gulnara Zhakupova
- Columbia University Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Vitaliy Vinogradov
- Columbia University Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Emily Allen Paine
- HIV Center for Clinical and Behavioral Studies, Columbia University and the New York Psychiatric Institute, New York, New York, USA
| | | | - Kelsey Reeder
- Columbia University School of Social Work, New York, New York, USA
| | - Alissa Davis
- Social Intervention Group, Columbia University School of Social Work, New York, New York, USA
| | - Timothy Hunt
- Social Intervention Group, Columbia University School of Social Work, New York, New York, USA
| | - Gaukhar Mergenova
- Columbia University Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Sholpan Primbetova
- Columbia University Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Assel Terlikbayeva
- Columbia University Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Elwin Wu
- Social Intervention Group, Columbia University School of Social Work, New York, New York, USA
- Columbia University Global Health Research Center of Central Asia, Almaty, Kazakhstan
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Twelve-month Treatment Retention and Associated Factors: A Comparison of 2 Medically Assisted Therapy Clinics in Dar es Salaam, Tanzania. J Addict Med 2022; 16:e382-e389. [PMID: 35678425 DOI: 10.1097/adm.0000000000000995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Retention in methadone maintenance treatment is instrumental in achieving better treatment outcomes. In this study, we compared 2 medication-assisted treatment (MAT) clinics in Dar es Salaam, Tanzania with respect to patient characteristics, outcomes, and factors that predict 12-month treatment retention. METHODS This retrospective registry-based cohort study utilized data collected for routine clinical and program monitoring at 2 sites, Mwananyamala and Muhimbili MAT clinics. Cumulative retention in treatment was calculated using life tables. The analysis of treatment retention predictor variables used both Kaplan-Meier and Cox proportional hazard analyses. RESULTS We examined the socio-demographic and program-related characteristics of 362 (181 from each clinic) patients. Twelve-month treatment retention was higher at Mwananyamala (73%) than Muhimbili (64%) MAT clinic, but the difference was not significant. In both clinics, a higher methadone dose (>60 mg) significantly predicted treatment retention (P < 0.05). Being employed and traveling an average short distance (<5 km) from home to clinic significantly increased the likelihood of remaining in treatment in Muhimbili MAT clinic (P < 0.05) only. CONCLUSIONS A methadone dose of 60 mg and above was associated with longer retention in treatment. At 1 clinic in a denser and more central location, employment and a short travel distance from home to clinic were associated with longer tenure in treatment. These findings have potential implications for clinical practice, research, and scaling up MAT services in Tanzania.
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Linton SL, Jarlais DCD, Ornstein JT, Kasman M, Hammond R, Kianian B, Smith JC, Wolfe ME, Ross Z, German D, Flynn C, Raymond HF, Klevens RM, Spencer E, Schacht JM, Finlayson T, Paz-Bailey G, Wejnert C, Cooper HLF. An application of agent-based modeling to explore the impact of decreasing incarceration rates and increasing drug treatment access on sero-discordant partnerships among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 94:103194. [PMID: 33812133 PMCID: PMC8608566 DOI: 10.1016/j.drugpo.2021.103194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 02/19/2021] [Accepted: 02/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND People who inject drugs (PWID) lag behind other key populations in HIV care continuum outcomes. The impacts of criminal justice reform and increasing drug treatment access on HIV have been underexplored. METHODS We developed agent-based models (ABM) of sexual partnerships among PWID and non-PWID, and injection equipment-sharing partnerships among PWID in five US cities (Baltimore, Boston, Miami, New York City, San Francisco) over 3 years. The first set of ABM projected changes in partnership discordance among PWID as a function of decreasing ZIP code-level incarceration rates. The second set projected discordance as a function of increasing ZIP code-level drug treatment access. ABM were parameterized and validated overall, and by city and PWID race/ethnicity (Black, Latino, White) using National HIV Behavioral Surveillance data, administrative ZIP code-level data, surveillance reports and prior literature. Informed by research on prisoner release and community-level HIV prevalence, reductions in incarceration rates were fixed at 5% and 30% and respectively projected to increase ZIP code-level HIV prevalence by 2% and 12%. Increases in drug treatment access were fixed at 30% and 58%. RESULTS In each city, a 30% reduction in ZIP code-level incarceration rates and 12% increase in ZIP code-level HIV prevalence significantly increased sero-discordance among at least one racial/ethnic group of PWID by 1-3 percentage points. A 5% reduction in incarceration rates, and 30% and 58% increases in drug treatment access, led to isolated significant changes in sero-discordance among Black and White PWID that were less than 1 percentage point. CONCLUSION Reductions in incarceration rates may lead to short-term increases in sero-discordant partnerships among some PWID by increasing community-level HIV prevalence. Efforts to increase HIV testing, engagement in care and community reintegration post release, should be strengthened in the wake of incarceration reform. Additional research should confirm these findings and explore the lack of widespread impacts of drug treatment in this study.
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Affiliation(s)
- Sabriya L Linton
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Don C Des Jarlais
- College of Global Public Health, New York University, New York City, NY, USA
| | - Joseph T Ornstein
- School of Public and International Affairs, The University of Georgia, Athens, GA, USA
| | - Matt Kasman
- Brookings Institution, District of Columbia, USA
| | - Ross Hammond
- Brookings Institution, District of Columbia, USA
| | - Behzad Kianian
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Justin C Smith
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Mary E Wolfe
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Zev Ross
- ZevRoss Spatial Analysis, Ithaca, NY, USA
| | - Danielle German
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Colin Flynn
- Maryland Department of Health and Mental Hygiene, Baltimore, MD, USA
| | | | | | - Emma Spencer
- Florida Department of Health, Tallahassee, FL, USA
| | | | | | | | - Cyprian Wejnert
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Peavy KM, Darnton J, Grekin P, Russo M, Green CJB, Merrill JO, Fotinos C, Woolworth S, Soth S, Tsui JI. Rapid Implementation of Service Delivery Changes to Mitigate COVID-19 and Maintain Access to Methadone Among Persons with and at High-Risk for HIV in an Opioid Treatment Program. AIDS Behav 2020; 24:2469-2472. [PMID: 32347404 PMCID: PMC7186943 DOI: 10.1007/s10461-020-02887-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Fortier E, Sylvestre MP, Artenie AA, Minoyan N, Jutras-Aswad D, Roy É, Grebely J, Bruneau J. Associations between housing stability and injecting frequency fluctuations: findings from a cohort of people who inject drugs in Montréal, Canada. Drug Alcohol Depend 2020; 206:107744. [PMID: 31785537 DOI: 10.1016/j.drugalcdep.2019.107744] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 11/09/2019] [Accepted: 11/14/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The relationship between housing stability and drug injecting is complex, as both outcomes fluctuate over time. The objectives were to identify short-term trajectories of housing stability and injecting frequency among people who inject drugs (PWID) and examine how patterns of injecting frequency relate to those of housing stability. METHODS At three-month intervals, PWID enrolled between 2011 and 2016 in the Hepatitis Cohort completed an interviewer-administered questionnaire and were tested for hepatitis C and HIV infections. At each visit, participants reported, for each of the past three months, the accommodation they lived in the longest (stable/unstable) and the number of injecting days (0-30). Group-based dual trajectory modeling was conducted to identify housing stability and injecting frequency trajectories evolving concomitantly over 12 months and estimate the probabilities of following injecting trajectories conditional upon housing trajectories. RESULTS 386 participants were included (mean age 40.0, 82 % male). Three housing stability trajectories were identified: sustained (53 %), declining (20 %), and improving (27 %). Five injecting frequency trajectories were identified: sporadic (26 %), infrequent (34 %), increasing (15 %), decreasing (11 %), and frequent (13 %). PWID with improving housing were less likely to increase injecting (8 %) compared to those with sustained (17 %) or declining housing (17 %). CONCLUSIONS Improving housing was associated with a lower probability of increasing injecting compared to declining housing, while sustained housing stability was associated with a higher probability of increasing injecting compared to improving housing. Therefore, policies to improve PWID's access to stable housing are warranted and may reduce, to some extent, drug injecting and related harms.
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Affiliation(s)
- Emmanuel Fortier
- CHUM Research Centre, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Marie-Pierre Sylvestre
- CHUM Research Centre, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, QC, Canada
| | - Andreea Adelina Artenie
- CHUM Research Centre, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, QC, Canada
| | - Nanor Minoyan
- CHUM Research Centre, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, QC, Canada
| | - Didier Jutras-Aswad
- CHUM Research Centre, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Élise Roy
- Addiction Research and Study Program, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada; Institut national de santé publique du Québec, Montréal, QC, Canada
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Julie Bruneau
- CHUM Research Centre, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.
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Employment Cessation, Long Term Labour Market Engagement and HIV Infection Risk Among People Who Inject Drugs in an Urban Canadian Setting. AIDS Behav 2019; 23:3267-3276. [PMID: 30924066 DOI: 10.1007/s10461-019-02472-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The potential for changes in socio-economic status, such as employment exits, to increase HIV infection risk are not well examined among people who inject illicit drugs (PWID). We used longstanding cohort data from Vancouver, Canada, to longitudinally assess associations between employment cessation and outcomes with documented linkages to HIV infection risk among PWID. From 2005 to 2015, 1222 participants reported 1154 employment exits. Employment exits were significantly associated with transitions into unstable housing; moving to the inner-city; initiating informal, prohibited or illegal income generation; high risk drug use practices; and exiting methadone maintenance therapy. HIV infection rates were higher among participants with lower long-term labour market engagement. These findings suggest that employment cessation coincides with initiating exposure to aspects of socioeconomic marginalization and drug use associated with HIV infection risk. Support for employment retention that prevents poverty entrenchment and harmful drug use could contribute to HIV prevention measures for PWID.
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Ramsey S, Ames E, Uber J, Habib S, Clark S. A Mobile Health App to Improve HIV Medication Adherence: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e15356. [PMID: 31719030 PMCID: PMC6881780 DOI: 10.2196/15356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 08/31/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Adherence to antiretroviral therapy (ART) is essential for allowing persons living with HIV to live longer, healthier lives. However, a large portion of this population has suboptimal adherence and are not virally suppressed. Conventional interventions aimed at improving ART adherence lack portability and scalability, and improvements in adherence are not often sustained. Mobile health (mHealth) ART interventions offer a low-cost and accessible method of improving adherence, but many have limited functionality and do not offer comprehensive support. The combination of an mHealth intervention with a face-to-face adherence intervention and interactive health coaching feature may offer sufficient support in a manner that is sensitive to resource limitations that are often found in HIV treatment settings. This paper details the protocol of a study designed to evaluate the potential of an enhanced mHealth intervention for improving ART adherence. OBJECTIVE The primary objective of this study is to assess the feasibility and acceptability of the Fitbit Plus app enhanced with a face-to-face LifeSteps session (Fitbit Plus condition) for improving ART adherence. In addition, we will determine the preliminary efficacy of the intervention by calculating treatment effect sizes. METHODS This study will be conducted in 2 phases. The intervention will be developed and piloted with a small group of participants during phase 1. Pilot participants will provide feedback that will be used to refine the intervention for phase 2. In phase 2, a preliminary randomized controlled trial (RCT) comparing Fitbit Plus with a condition that approximates the standard of care (SOC) will be conducted with 60 persons living with HIV. Interviews will be conducted with RCT participants at baseline, and follow-up interviews will be conducted at 1, 3, 6, and 12 months. ART adherence is the primary outcome and will be monitored throughout the study via electronic pill boxes. Effect sizes will be generated using a fractional logit model estimated by generalized estimating equations. RESULTS Phase 1 of this trial is complete; data collection for phase 2 is ongoing. Follow-ups with enrolled participants will conclude in January 2020. CONCLUSIONS This study will contribute to the literature on ART adherence and may produce an efficacious intervention. Owing to a small sample size, there may be insufficient power to detect statistically significant differences between Fitbit Plus and SOC. However, if Fitbit Plus is found to be acceptable and feasible and yields promising effect size estimates, this pilot study could serve as the foundation for a larger, fully powered trial of Fitbit Plus. TRIAL REGISTRATION ClinicalTrials.gov NCT02676128; https://clinicaltrials.gov/ct2/show/NCT02676128. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/15356.
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Affiliation(s)
- Susan Ramsey
- The Warren Alpert Medical School of Brown University, Providence, RI, United States.,Rhode Island Hospital, Providence, RI, United States
| | - Evan Ames
- Rhode Island Hospital, Providence, RI, United States
| | - Julia Uber
- Rhode Island Hospital, Providence, RI, United States
| | - Samia Habib
- Rhode Island Hospital, Providence, RI, United States
| | - Seth Clark
- The Warren Alpert Medical School of Brown University, Providence, RI, United States.,Rhode Island Hospital, Providence, RI, United States
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Impact of Behavioral Drug Abuse Treatment on Sexual Risk Behaviors: An Integrative Data Analysis of Eight Trials Conducted Within the National Drug Abuse Treatment Clinical Trials Network. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2019; 19:761-771. [PMID: 29868998 DOI: 10.1007/s11121-018-0913-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The extent to which behavioral drug abuse treatments affect sexual risk behaviors is largely unknown. This study examined the impact of behavioral drug abuse treatments on sexual risk behaviors using an integrative data analysis approach across eight trials conducted within the National Drug Abuse Treatment Clinical Trials Network (CTN). Participants (N = 1305) from eight randomized controlled trials who were sexually active at baseline were included in the pooled dataset; 48.7% were female, 64.1% self-identified as a racial/ethnic minority, with M (SD) age of 34.9 (9.6). Longitudinal logistic regression estimated the probability of risky sexual behavior (i.e., inconsistent condom use and/or > 1 sexual partner in past 30 days) post-intervention with an indicator variable (1 for post-intervention), study condition (control, intervention), and their interaction as predictors; the analysis employed random effects for each trial and included relevant control variables. Time-varying differences in effects based on weeks post-intervention were incorporated using interacted linear and quadratic terms with condition status. Approximately 84.2% reported risky sexual behaviors at baseline. The control and intervention conditions were 18.5 and 17.3 percentage points less likely to report risky sexual behavior post-intervention, respectively. Results suggest decreasing rates of risky sex engagement until 8 weeks (control) or 9 weeks (intervention) post-intervention; risky sexual behavior subsequently increased. Behavioral CTN trial participation was associated with decreased sexual risk behaviors in both the intervention and control trial conditions. Participation in behavioral substance use treatment may result in secondary benefits of sexual risk behavior reductions.
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Newville H, Sorensen JL, Hatch-Maillette M, Calsyn DA. Temporal Relationship of Sex Risk Behaviors and Substance Use Severity Among Men in Substance Use Treatment. JOURNAL OF SEX RESEARCH 2018; 55:1056-1064. [PMID: 28513227 PMCID: PMC5916504 DOI: 10.1080/00224499.2017.1321101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Sex risk behaviors and substance use are intertwined. Many men continue to engage in high-risk sexual behaviors even when enrolled in substance use disorder (SUD) treatment. We hypothesized that changes in sex risk behaviors would coincide with changes in drug/alcohol use severity among men in SUD treatment. During an HIV risk-reduction trial, men in methadone maintenance and outpatient drug-free treatment (N = 359) completed assessments at baseline and six months after. We assessed changes in sex risk and substance use severity, using the Addiction Severity Index-Lite (ASI-Lite), controlling for treatment condition. In multinomial logistic regressions, decreased alcohol severity was significantly associated with decreases in reported sex partners, and increased alcohol severity was significantly associated with increases in reported sex partners. Increasing drug use severity was significantly associated with maintaining and initiating sex with a high-risk partner, while decreasing alcohol use severity was significantly associated with discontinuing sex under the influence. However, changes in drug/alcohol use severity were not associated with changes in unprotected sex. Substance use reductions may decrease HIV risk behaviors among male substance users. Our findings highlight the importance of integrating interventions in SUD treatment settings that address the intersection of sex risk behaviors and substance use.
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Affiliation(s)
- Howard Newville
- Alcohol & Drug Abuse Institute, University of Washington, Seattle WA
| | - James L. Sorensen
- Department of Psychiatry, University of California, San Francisco, San Francisco CA
| | - Mary Hatch-Maillette
- Alcohol & Drug Abuse Institute, University of Washington, Seattle WA
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle WA
| | - Donald A. Calsyn
- Alcohol & Drug Abuse Institute, University of Washington, Seattle WA
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle WA
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Medication Treatment With Methadone or Buprenorphine: Differential Reasons for Premature Discharge. J Addict Med 2018; 13:113-118. [PMID: 30199427 DOI: 10.1097/adm.0000000000000456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Medication treatment with methadone or buprenorphine has shown demonstrated effectiveness for opioid dependence; while premature discharge is associated with adverse outcomes. Specific reasons for premature discharge generally fall into 2 broad categories (ie, patient- and program-initiated). Previous studies have typically failed to distinguish between different types of discharge reasons among patients who leave treatment early. This study sought to determine whether type of medication was associated with differential discharge reasons among medication treatment patients who were prematurely discharged. METHODS Data were derived from electronic health records for 5486 patients prematurely discharged from 41 for-profit licensed opioid treatment programs in the United States from 2012 to 2013. All patients were treated with methadone or buprenorphine. Patients were studied through retrospective chart review until premature discharge. RESULTS Buprenorphine patients who left treatment prematurely were 2.18 times (95% confidence interval [CI] 1.89-2.53) more likely to be discharged against medical advice relative to methadone patients after controlling for intake differences. Methadone patients were 1.76 times (95% CI 1.47-2.10) more likely to be administratively discharged after adjustment for covariates. CONCLUSIONS Further research is warranted to determine whether individually-tailored strategies may improve retention for certain patients based on medication. Ongoing review of program rules and policies may benefit methadone patients, who are nearly twice as likely to be discharged for an administrative, program-initiated reason. Strategies including contingency management, motivational incentives, and psychoeducation regarding the advantages of retention may benefit buprenorphine patients who are over 2 times more likely to leave treatment early due to a patient-initiated reason.
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12
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Pilot Studies Examining Feasibility of Substance Use Disorder Screening and Treatment Linkage at Urban Sexually Transmitted Disease Clinics. J Addict Med 2018; 11:350-356. [PMID: 28590392 DOI: 10.1097/adm.0000000000000327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Sexually transmitted disease (STD) clinics provide critical public health services for screening and treatment of sexually transmitted infections throughout the United States. These settings serve high-risk populations, often on a walk-in basis, and may be promising venues for integrating substance use disorder (SUD) services. METHODS We report findings from 2 pilot studies conducted at Baltimore City Health Department's STD clinics. The screening study characterized rates of SUDs among STD clinic patients. Patients waiting for services completed a diagnostic interview mapping to Diagnostic and Statistical Manual of Mental Disorders, 5th Edition SUD criteria (n = 100). The Treatment Linkage Feasibility study examined the feasibility of linking STD clinic patients with opioid and/or cocaine use disorders to SUD treatment in the community (n = 21), using SUD-focused Patient Navigation services for 1 month after the STD clinic visit. Assessments were conducted at baseline and 1-month follow-up. RESULTS In the screening study, the majority of STD clinic patients met diagnostic criteria for alcohol and/or drug SUD (57%). Substance-specific SUD rates among patients were 35% for alcohol, 31% for cannabis, 11% for opioids, and 8% for stimulants (cocaine/amphetamines). In the Treatment Linkage Feasibility study, 57% (12/21) of participants attended at least 1 SUD service, and 38% (8/21) were actively enrolled in SUD treatment by 1-month follow-up. The sample reported significant reductions in past 30-day cocaine use from baseline to follow-up (P = 0.01). CONCLUSIONS SUD rates are high among STD clinic patients. STD clinics are viable settings for initiating SUD treatment linkage services. Larger-scale research on integrating SUD services in these settings is needed.
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Organ and tissue donation from poisoned patients in the emergency department: A Canadian emergency physician survey. CAN J EMERG MED 2018; 21:47-54. [PMID: 29631642 DOI: 10.1017/cem.2018.43] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Screening for organ and tissue donation is an essential skill for emergency physicians. In 2015, 4,631 Canadians were on a waiting list for a transplant, and 262 died while waiting. Canada’s donation rates are less than half of comparable countries, so it is essential to explore strategies to improve the referral of donors. Poisoned patients may be one such underutilized source for donation. This study explores physician practices and perceptions regarding the referral of poisoned patients as donors. METHODS In this cross-sectional unidirectional survey, 1,471 physician members of the Canadian Association of Emergency Physicians were invited to participate. Physicians were presented with 20 scenarios and asked whether they would refer the patient as a potential organ or tissue donor. Results were reported descriptively, and associations between demographics and referral patterns were assessed. RESULTS Physicians totalling 208 participated in the organ or tissue donation scenarios (14.1%); 75% of scenarios involving poisoning were referred for organ or tissue donation, compared with 92% in a non-poisoning scenario. Poisons associated with lower referrals included sedatives, acetaminophen, chemical exposure, and organophosphates. A total of 175 physicians completed the demographic survey (11.9%). Characteristics associated with increased referrals included previous referral experience, donation training, donation support, >10 years of service, urban practice, emergency medicine certification, and male gender. CONCLUSIONS Scenarios involving poisoning were referred less often when compared with an ideal scenario. Because poisoning is not a contraindication for referral, this represents a potential source of donors. Targeted training and referral support may help improve donation rates in this demographic.
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Des Jarlais DC, Cooper HLF, Arasteh K, Feelemyer J, McKnight C, Ross Z. Potential geographic "hotspots" for drug-injection related transmission of HIV and HCV and for initiation into injecting drug use in New York City, 2011-2015, with implications for the current opioid epidemic in the US. PLoS One 2018; 13:e0194799. [PMID: 29596464 PMCID: PMC5875800 DOI: 10.1371/journal.pone.0194799] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 03/10/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE We identified potential geographic "hotspots" for drug-injecting transmission of HIV and hepatitis C virus (HCV) among persons who inject drugs (PWID) in New York City. The HIV epidemic among PWID is currently in an "end of the epidemic" stage, while HCV is in a continuing, high prevalence (> 50%) stage. METHODS We recruited 910 PWID entering Mount Sinai Beth Israel substance use treatment programs from 2011-2015. Structured interviews and HIV/ HCV testing were conducted. Residential ZIP codes were used as geographic units of analysis. Potential "hotspots" for HIV and HCV transmission were defined as 1) having relatively large numbers of PWID 2) having 2 or more HIV (or HCV) seropositive PWID reporting transmission risk-passing on used syringes to others, and 3) having 2 or more HIV (or HCV) seronegative PWID reporting acquisition risk-injecting with previously used needles/syringes. Hotspots for injecting drug use initiation were defined as ZIP codes with 5 or more persons who began injecting within the previous 6 years. RESULTS Among PWID, 96% injected heroin, 81% male, 34% White, 15% African-American, 47% Latinx, mean age 40 (SD = 10), 7% HIV seropositive, 62% HCV seropositive. Participants resided in 234 ZIP codes. No ZIP codes were identified as potential hotspots due to small numbers of HIV seropositive PWID reporting transmission risk. Four ZIP codes were identified as potential hotspots for HCV transmission. 12 ZIP codes identified as hotspots for injecting drug use initiation. DISCUSSION For HIV, the lack of potential hotspots is further validation of widespread effectiveness of efforts to reduce injecting-related HIV transmission. Injecting-related HIV transmission is likely to be a rare, random event. HCV prevention efforts should include focus on potential hotspots for transmission and on hotspots for initiation into injecting drug use. We consider application of methods for the current opioid epidemic in the US.
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Affiliation(s)
- D. C. Des Jarlais
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - H. L. F. Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - K. Arasteh
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - J. Feelemyer
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - C. McKnight
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Z. Ross
- ZevRoss Spatial Analysis, Ithaca, New York, United States of America
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Appel PW, Warren BE, Yu J, Rogers M, Harris B, Highsmith S, Davis C. Implementing Substance Abuse Intervention Services in New York City Sexually Transmitted Disease Clinics: Factors Promoting Interagency Collaboration. J Behav Health Serv Res 2018; 44:168-176. [PMID: 26276420 DOI: 10.1007/s11414-015-9473-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This report presents results of Project LINK, a Substance Abuse and Mental Health Services Administration (SAMHSA)-funded, 5-year collaboration (2007-2012) between New York City (NYC) health and NY State substance abuse disorder (SUD) agencies, an LGBT organization contractor, and multiple SUD, social service, and mental health referral agencies. LINK allowed the first ever SUD screening, brief intervention, and referrals to treatment (SBIRT) intervention services onsite in NYC Bureau of Sexually Transmitted Disease Control (BSTDC) clinics. Factors favoring collaboration were (a) joint recognition of substance abuse as an STD risk factor; (b) prior collaborations; (c) agreement on priority of BSTDC's mission and policies; (d) extensive SBIRT training, cross training on STDs; (e) a memorandum of agreement; and (f) mutual transparency of collaborative efforts, among others. LINK screened over 151,000 STD clinic patients and delivered brief interventions to 60% of positively screened patients and met a mandated follow-up target. Factors found to facilitate collaboration here may help screen prospective new health collaborations.
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Affiliation(s)
- Philip W Appel
- NYS Office of Alcoholism and Substance Abuse Services, 501 7th Avenue, New York, NY, 10018, USA.
| | - Barbara E Warren
- Office of Diversity and Inclusion, Mount Sinai Health System, New York, NY, USA
| | - Jiang Yu
- NYS Office of Alcoholism and Substance Abuse Services, 1450 Western Avenue, Albany, NY, 12203, USA
- Center for Addictions Research, School of Social Welfare, University at Albany, Albany, NY, USA
| | - Meighan Rogers
- Bureau of STD Control and Prevention, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Brett Harris
- Research Foundation for Mental Hygiene, 1450 Western Avenue, Albany, NY, 12203, USA
| | | | - Carrie Davis
- LGBT Center, 208 West 13th Street, New York, NY, 10011, USA
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Meredith SE, Rash CJ, Petry NM. Alcohol use disorders are associated with increased HIV risk behaviors in cocaine-dependent methadone patients. J Subst Abuse Treat 2017; 83:10-14. [PMID: 29129191 PMCID: PMC5726558 DOI: 10.1016/j.jsat.2017.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 09/03/2017] [Accepted: 09/29/2017] [Indexed: 11/29/2022]
Abstract
People who inject drugs (PWID) are at increased risk of HIV infection. Although methadone maintenance therapy can help lower this risk, many methadone patients continue to engage in HIV risk behaviors, especially patients who use cocaine and alcohol. The purpose of the current study was to investigate relations between alcohol use disorders and HIV risk behavior in 239 cocaine-dependent methadone patients participating in a randomized controlled trial of a behavioral intervention to promote cocaine abstinence. Past 3-month HIV Risk-taking Behavior Scale (HRBS) scores were compared between cocaine-dependent methadone patients who met DSM-IV-TR diagnostic criteria for alcohol abuse or dependence and those who did not meet these criteria. No significant differences in HRBS drug subscale scores were observed between participants with and without alcohol use disorders, indicating risky drug use was similar between groups. However, alcohol use disorder was significantly associated with HRBS sex subscale scores (t=2.59, p=0.01), indicating participants with alcohol use disorders were more likely to engage in risky sexual behavior. Item-level analyses of the sex-related HRBS questions showed participants with alcohol use disorders were significantly more likely than participants without alcohol use disorders to have unprotected sex, engage in transactional (paid) sex, and have anal sex. Interventions are needed to reduce risky sexual behavior and attenuate the spread of HIV in this high-risk population.
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Affiliation(s)
- Steven E Meredith
- University of Connecticut School of Medicine, Calhoun Cardiology Center, 263 Farmington Avenue, Farmington, CT 06030, United States
| | - Carla J Rash
- University of Connecticut School of Medicine, Calhoun Cardiology Center, 263 Farmington Avenue, Farmington, CT 06030, United States
| | - Nancy M Petry
- University of Connecticut School of Medicine, Calhoun Cardiology Center, 263 Farmington Avenue, Farmington, CT 06030, United States.
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Boggiano VL, Nguyen HLT, Nguyen LH, Tran TD, Van Nguyen H, Le HT, Le HQ, Hoang CD, Nguyen CT, Tran BX, Latkin CA, Zary N, Vu TMT. Sexual behaviors among methadone maintenance patients in a mountainous area in northern Vietnam. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2017; 12:39. [PMID: 28841918 PMCID: PMC5574107 DOI: 10.1186/s13011-017-0123-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 08/21/2017] [Indexed: 11/10/2022]
Abstract
Background Methadone maintenance treatment (MMT) improves patients’ ability to access HIV-related services and reduces needle sharing and other risky HIV-related behaviors. However, patients may continue to engage in risky sexual practices. In this study, we evaluate sexual behaviors of MMT patients in a mountainous province in Northern Vietnam. Methods We explored the health status, MMT and substance use history, and sexual practices of 241 male MMT patients in Tuyen Quang province. Health status was investigated using the EuroQOL-5 Dimensions-5 Levels (EQ-5D-5 L). Multivariate logistic regression was employed to assess associated factors. Results Most patients (66.4%) reported having at least one sexual partner within the previous twelve months. Most of these partners were spouses or primary partners (72.6%). About 8.3% of patients had casual partners, and 5.8% had visited sex workers; of those who engaged in casual sexual relationships, 90.9% reported using condoms. Current drug use and living in a remote area were associated with an increased odd of having two or more sexual partners, while anxiety or depression was associated with lower odds. Conclusion This study highlights a low proportion of having sexual risk behaviors among MMT patients in Vietnamese mountainous settings. Integrating education about safe sexual practices into MMT services, along with providing medical care and ensuring methadone treatment adherence, is an important component in HIV risk reduction for these patients who were at risk of unsafe sexual practices.
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Affiliation(s)
- Victoria L Boggiano
- Berkeley School of Public Health, University of California, Berkeley, California, USA
| | - Huong Lan Thi Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, 550000, Vietnam.
| | - Long Hoang Nguyen
- School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Tho Dinh Tran
- Department of Hepatobiliary Surgery, Vietnam-Germany Hospital, Hanoi, Vietnam
| | - Hung Van Nguyen
- Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam
| | - Huong Thi Le
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Hai Quan Le
- Tuyen Quang Provincial AIDS Center, Tuyen Quang, Vietnam
| | - Canh Dinh Hoang
- Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, 550000, Vietnam
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carl A Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nabil Zary
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Thuc Minh Thi Vu
- Department of Immunology and Allergy, National Otolaryngology Hospital, Hanoi, Vietnam
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Lion RR, Watt MH, Wechsberg WM, Meade CS. Gender and Sex Trading Among Active Methamphetamine Users in Cape Town, South Africa. Subst Use Misuse 2017; 52:773-784. [PMID: 28379107 PMCID: PMC5600888 DOI: 10.1080/10826084.2016.1264964] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND South Africa has experienced a tremendous rise in methamphetamine use since the year 2000. Sex trading is a global phenomenon that has been observed in active drug users and has been associated with risks for HIV infection and violence. OBJECTIVES This paper describes and examines the correlates of sex trading among active methamphetamine users in Cape Town, South Africa. METHODS Through peer referral, 360 (201 male; 159 female) active methamphetamine users were recruited in a peri-urban township. Demographics, sex trading, drug use, trauma, and mental health were assessed by a structured clinical interview and computer survey. Logistic regression models were used to examine predictors of sex trading for men and women. RESULTS In the past 3 months, 40% of men and 33% of women endorsed trading sex for methamphetamine or money. Among these, they reported trading with same sex partners (33%), high rates of inconsistent condom use (73%), and incidences of physical (23%) and sexual (27%) assault when sex trading. Increased drug use severity was correlated with sex trading. Women with experiences of violence and trauma were also more likely to trade sex. Conclusions/importance: The results stress a need for linkage to drug treatment, as addiction may be fueling sex trading. Targeted interventions geared towards safe sex practices may reduce risky sexual behaviors. Women need interventions that are attuned to their specific vulnerabilities. More research is needed to explore the experiences of men who have sex with men given their particularly high rates of sex trading behavior.
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Affiliation(s)
- Ryan R Lion
- a Duke Global Health Institute, Duke University , Durham , North Carolina , USA
| | - Melissa H Watt
- b Department of Psychiatry & Behavioral Science , Duke University School of Medicine , Durham , North Carolina , USA
| | - Wendee M Wechsberg
- c Substance Abuse Treatment Evaluations and Interventions, RTI International , Research Triangle Park , North Carolina , USA
| | - Christina S Meade
- a Duke Global Health Institute, Duke University , Durham , North Carolina , USA
- b Department of Psychiatry & Behavioral Science , Duke University School of Medicine , Durham , North Carolina , USA
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Pan Y, Metsch LR, Wang W, Wang KS, Duan R, Kyle TL, Gooden LK, Feaster DJ. Gender Differences in HIV Sexual Risk Behaviors Among Clients of Substance Use Disorder Treatment Programs in the U.S. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:1151-1158. [PMID: 26892100 PMCID: PMC6261376 DOI: 10.1007/s10508-015-0686-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 12/15/2015] [Accepted: 12/23/2015] [Indexed: 06/05/2023]
Abstract
This study examined differences in sexual risk behaviors by gender and over time among 1281 patients (777 males and 504 females) from 12 community-based substance use disorder treatment programs throughout the United States participating in CTN-0032, a randomized control trial conducted within the National Drug Abuse Treatment Clinical Trials Network. Zero-inflated negative binomial and negative binomial models were used in the statistical analysis. Results indicated significant reductions in most types of sexual risk behaviors among substance users regardless of the intervention arms. There were also significant gender differences in sexual risk behaviors. Men (compared with women) reported more condomless sex acts with their non-primary partners (IRR = 1.80, 95 % CI 1.21-2.69) and condomless anal sex acts (IRR = 1.74, 95 % CI 1.11-2.72), but fewer condomless sex partners (IRR = 0.87, 95 % CI 0.77-0.99), condomless vaginal sex acts (IRR = 0.83, 95 % CI 0.69-1.00), and condomless sex acts within 2 h of using drugs or alcohol (IRR = 0.70, 95 % CI 0.53-0.90). Gender-specific intervention approaches are called for in substance use disorder treatment.
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Affiliation(s)
- Yue Pan
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, Room 1066, 1120 N.W. 14th St., Miami, FL, 33136, USA.
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Weize Wang
- Department of Biostatistics, Robert Stempel College of Public Health & Social Work at Florida International University, Miami, FL, USA
| | - Ke-Sheng Wang
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Rui Duan
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, Room 1066, 1120 N.W. 14th St., Miami, FL, 33136, USA
| | | | - Lauren K Gooden
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, Room 1066, 1120 N.W. 14th St., Miami, FL, 33136, USA
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Lamei N, Ezoddin M, Abdi K. Air assisted emulsification liquid-liquid microextraction based on deep eutectic solvent for preconcentration of methadone in water and biological samples. Talanta 2017; 165:176-181. [DOI: 10.1016/j.talanta.2016.11.036] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 11/17/2016] [Accepted: 11/17/2016] [Indexed: 11/16/2022]
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Habibi M, Farmanfarmaee S, Darharaj M, Khoshnood K, Matacotta JJ, O’Bryan J. Predictors of HIV Risk Behavior in Iranian Women Who Inject Drugs. JOURNAL OF DRUG ISSUES 2017. [DOI: 10.1177/0022042617693383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aimed to investigate predictors of drug-related HIV risk behaviors among women who inject drugs. A total of 163 women were recruited from harm-reduction-oriented drug-treatment centers in Tehran, Iran. Each completed a set of measures that included the Risk Behavior Assessment, Beck Depression Inventory–Second Edition, Revised Self-Efficacy Scale, and Peer Group Beliefs Regarding HIV-related Risk Behaviors Scale. The results indicated that past attempts to abstain from drugs, using methadone maintenance treatment programs, and acceptance of peers’ risky norms were significant predisposing, enabling, and reinforcing predictors of frequency of injection, respectively. Furthermore, predictors of frequency of sharing injection paraphernalia included purchasing drugs jointly with other drug users and peers’ norms conforming injecting drug use behaviors. Harm reduction services that take into consideration cultural and peer norms, as well as the development and implementation of HIV prevention programs, are likely to reduce drug-related HIV risk behaviors in women who inject drugs.
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Affiliation(s)
| | | | | | - Kaveh Khoshnood
- Center for Interdisciplinary Research on AIDS, New Haven, CT, USA
| | | | - Jane O’Bryan
- Yale School of Public Health, New Haven, CT, USA
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Mohammadiazar S, Hasanli F, Maham M, Payami Samarin S. Solid-phase microextraction of methadone in urine samples by electrochemically co-deposited sol-gel/Cu nanocomposite fiber. Biomed Chromatogr 2017; 31. [PMID: 28035708 DOI: 10.1002/bmc.3926] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 11/11/2016] [Accepted: 12/27/2016] [Indexed: 11/10/2022]
Abstract
Electrochemically co-deposited sol-gel/Cu nanocomposites have been introduced as a novel, simple and single-step technique for preparation of solid-phase microextraction (SPME) coating to extract methadone (MDN) (a synthetic opioid) in urine samples. The porous surface structure of the sol-gel/Cu nanocomposite coating was revealed by scanning electron microscopy. Direct immersion SPME followed by HPLC-UV determination was employed. The factors influencing the SPME procedure, such as the salt content, desorption solvent type, pH and equilibration time, were optimized. The best conditions were obtained with no salt content, acetonitrile as desorption solvent type, pH 9 and 10 min equilibration time. The calibration graphs for urine samples showed good linearity. The detection limit was about 0.2 ng mL-1 . Also, the novel method for preparation of nanocomposite fiber was compared with previously reported techniques for MDN determination. The results show that the novel nanocomposite fiber has relatively high extraction efficiency.
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Affiliation(s)
- Sirwan Mohammadiazar
- Department of Chemistry, Sanandaj Branch, Islamic Azad University, Sanandaj, Iran
| | - Fateme Hasanli
- Department of Chemistry, Islamic Azad University, Tehran North Branch, Tehran, Iran
| | - Mehdi Maham
- Department of Chemistry, Aliabad Katoul Branch, Islamic Azad University, Aliabad Katoul, Iran
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HIV Risk Behavior Among Methamphetamine Users Entering Substance Abuse Treatment in Cape Town, South Africa. AIDS Behav 2016; 20:2387-2397. [PMID: 26873492 DOI: 10.1007/s10461-016-1333-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
South Africa is experiencing a growing methamphetamine problem, and there is concern that methamphetamine use may accelerate HIV transmission. There has been little research on the HIV prevention needs of methamphetamine users receiving substance abuse treatment in South Africa. This study assessed the prevalence and correlates of HIV risk behaviors among 269 methamphetamine users entering substance abuse treatment in two clinics in Cape Town. The prevalence of sexual risk behaviors was high among sexually active participants: 34 % multiple partners, 26 % unprotected intercourse with a casual partner, and 24 % sex trading for money/methamphetamine. The strongest predictor of all sexual risk behaviors was concurrent other drug use. Over half had not been HIV tested in the past year, and 25 % had never been tested, although attitudes toward HIV testing were overwhelmingly positive. This population of primarily heterosexual, non-injecting methamphetamine users is a high-risk group in need of targeted HIV prevention interventions. Substance abuse treatment is an ideal setting in which to reach methamphetamine users for HIV services.
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Substance Use Patterns of HIV-Infected Russian Women with and Without Hepatitis C Virus Co-infection. AIDS Behav 2016; 20:2398-2407. [PMID: 26995679 DOI: 10.1007/s10461-016-1362-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Individuals with HIV and hepatitis C virus (HCV) co-infection may experience substance use related health complications. This study characterized substance use patterns between HIV/HCV co-infected and HIV mono-infected Russian women. HIV-infected women (N = 247; M age = 30.0) in St. Petersburg, Russia, completed a survey assessing substance use, problematic substance use, and the co-occurrence of substance use and sexual behaviors. Covariate adjusted logistic and linear regression analyses indicated that HIV/HCV co-infected participants (57.1 %) reported more lifetime drug use (e.g., heroin: AOR: 13.2, 95 % CI 4.9, 35.3, p < .001), problem drinking (β = 1.2, p = .05), substance use problems (β = 1.3, p = .009), and increased likelihood of past injection drug use (AOR: 26.4, 95 % CI 8.5, 81.9, p < .001) relative to HIV mono-infected individuals. HIV/HCV co-infection was prevalent and associated with increased substance use and problematic drug use. Findings highlight the need for ongoing substance use and HIV/HCV risk behavior assessment and treatment among HIV/HCV co-infected Russian women.
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Wenz B, Nielsen S, Gassowski M, Santos-Hövener C, Cai W, Ross RS, Bock CT, Ratsch BA, Kücherer C, Bannert N, Bremer V, Hamouda O, Marcus U, Zimmermann R. High variability of HIV and HCV seroprevalence and risk behaviours among people who inject drugs: results from a cross-sectional study using respondent-driven sampling in eight German cities (2011-14). BMC Public Health 2016; 16:927. [PMID: 27595567 PMCID: PMC5011883 DOI: 10.1186/s12889-016-3545-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 08/18/2016] [Indexed: 12/15/2022] Open
Abstract
Background People who inject drugs (PWID) are at increased risk of acquiring and transmitting HIV and Hepatitis C (HCV) due to sharing injection paraphernalia and unprotected sex. To generate seroprevalence data on HIV and HCV among PWID and related data on risk behaviour, a multicentre sero- and behavioural survey using respondent driven sampling (RDS) was conducted in eight German cities between 2011 and 2014. We also evaluated the feasibility and effectiveness of RDS for recruiting PWID in the study cities. Methods Eligible for participation were people who had injected drugs within the last 12 months, were 16 years or older, and who consumed in one of the study cities. Participants were recruited, using low-threshold drop-in facilities as study sites. Initial seeds were selected to represent various sub-groups of people who inject drugs (PWID). Participants completed a face-to-face interview with a structured questionnaire about socio-demographics, sexual and injecting risk behaviours, as well as the utilisation of health services. Capillary blood samples were collected as dried blood spots and were anonymously tested for serological and molecular markers of HIV and HCV. The results are shown as range of proportions (min. and max. values (%)) in the respective study cities. For evaluation of the sampling method we applied criteria from the STROBE guidelines. Results Overall, 2,077 PWID were recruited. The range of age medians was 29–41 years, 18.5–35.3 % of participants were female, and 9.2–30.6 % were foreign born. Median time span since first injection were 10–18 years. Injecting during the last 30 days was reported by 76.0–88.4 % of participants. Sharing needle/syringes (last 30 days) ranged between 4.7 and 22.3 %, while sharing unsterile paraphernalia (spoon, filter, water, last 30 days) was reported by 33.0–43.8 %. A majority of participants (72.8–85.8 %) reported incarceration at least once, and 17.8–39.8 % had injected while incarcerated. Between 30.8 and 66.2 % were currently in opioid substitution therapy. Unweighted HIV seroprevalence ranged from 0–9.1 %, HCV from 42.3–75.0 %, and HCV-RNA from 23.1–54.0 %. The implementation of RDS as a recruiting method in cooperation with low-threshold drop in facilities was well accepted by both staff and PWID. We reached our targeted sample size in seven of eight cities. Conclusions In the recruited sample of mostly current injectors with a long duration of injecting drug use, seroprevalence for HIV and HCV varied greatly between the city samples. HCV was endemic among participants in all city samples. Our results demonstrate the necessity of intensified prevention strategies for blood-borne infections among PWID in Germany. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3545-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Benjamin Wenz
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Stine Nielsen
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany.,Charité University Medicine, Berlin, Germany
| | - Martyna Gassowski
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Claudia Santos-Hövener
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Wei Cai
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - R Stefan Ross
- Institute of Virology, National Reference Centre for Hepatitis C, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Claus-Thomas Bock
- Department of Infectious Diseases, Division for Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Robert Koch Institute, Berlin, Germany
| | - Boris-Alexander Ratsch
- Department of Infectious Diseases, Division for Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Robert Koch Institute, Berlin, Germany
| | - Claudia Kücherer
- Department of Infectious Diseases, Division for HIV and other Retroviruses, Robert Koch Institute, Berlin, Germany
| | - Norbert Bannert
- Department of Infectious Diseases, Division for HIV and other Retroviruses, Robert Koch Institute, Berlin, Germany
| | - Viviane Bremer
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Osamah Hamouda
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Ulrich Marcus
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Ruth Zimmermann
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany.
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Furr-Holden DM, Milam AJ, Nesoff ED, Garoon J, Smart MJ, Duncan A, Warren GC. Triangulating Syndemic Services and Drug Treatment Policy: Improving Drug Treatment Portal Locations in Baltimore City. Prog Community Health Partnersh 2016; 10:319-27. [PMID: 27346779 DOI: 10.1353/cpr.2016.0025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
THE PROBLEM The prevalence of injection drug use (IDU) and incidence of human immunodeficiency virus (HIV) remain high in Baltimore, where IDU is a primary HIV risk factor. Substance use disorders and HIV are related syndemically--their causes and consequences interact synergistically. Baltimore is increasingly considering the syndemic relationship of substance use disorders, IDU, and HIV in making decisions about drug treatment funding and location. PURPOSE OF ARTICLE Our goal was to empirically identify the optimal location of new drug treatment programs through the development and application of a novel, practical tool. KEY POINTS Syndemic triangles were constructed to measure and visualize unmet need for drug treatment services. These data were used to determine priority zones for new treatment centers. CONCLUSIONS The application of this tool helped inform strategies for locating drug treatment services in Baltimore, and its successful use suggests its potential value in other metropolitan areas.
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Che Z, Tian Y, Hu Z, Chen Y, Liu S, Chen G. Synthesis and in vitro anti-HIV-1 activity of a series of N-arylsulfonyl-3-propionylindoles. ACTA ACUST UNITED AC 2016; 71:105-9. [PMID: 27124676 DOI: 10.1515/znc-2015-0122] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 03/30/2016] [Indexed: 11/15/2022]
Abstract
Fifteen N-arylsulfonyl-3-propionylindoles (3a-o) were prepared and preliminarily evaluated as in vitro inhibitors of human immunodeficiency virus type-1 (HIV-1). Three compounds 3c, 3g and 3i exhibited potent anti-HIV-1 activity with effective concentration (EC(50)) values of 0.8, 4.0 and 1.2 μg/mL, and therapeutic index (TI) values of 11.7, 16.6 and 84.1, respectively. N-(m-Nitro)phenylsulfonyl-3-propionyl-6-methylindole (3i) exhibited the most promising and best activity against HIV-1 replication. The cytotoxicity of these compounds was assessed as well.
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Corsi KF, Kwiatkowski CF, Booth RE. Long-Term Predictors of HIV Risk Behaviors among IDUs. JOURNAL OF DRUG ISSUES 2016. [DOI: 10.1177/002204260603600307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Drug users are at high risk for disease due to injection and sex behaviors. Longitudinal research with drug users can help researchers understand reasons for continued high-risk behaviors among this vulnerable population. Data are from a follow-up study conducted from 1999 to 2003, which attempted to relocate clients who were initially recruited through street outreach in Denver, Colorado from 1990 to 1995. A total of 773 subjects were located (82% relocation rate), 578 of whom were interviewed at follow-up. Statistical analysis revealed significant improvement in most high-risk injection and sex behaviors. However, over half the sample reported having sex without a condom at follow-up. Further analysis revealed that having sex without a condom at baseline, not having previously participated in drug treatment, being of an ethnicity other than African American, smoking crack, and having sex with a drug injector were all significantly related to having sex without a condom at follow-up. These findings are discussed with regards to developing interventions in order to increase condom use in this high risk population.
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Walter AW, Cheng DM, Lloyd-Travaglini CA, Samet JH, Bernstein J, Saitz R. Are decreases in drug use risk associated with reductions in HIV sex risk behaviors among adults in an urban hospital primary care setting? Prev Med Rep 2016; 4:410-6. [PMID: 27570734 PMCID: PMC4992042 DOI: 10.1016/j.pmedr.2016.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/02/2016] [Indexed: 11/25/2022] Open
Abstract
Drug use is associated with increased sexual risk behaviors. We examined whether decreases in drug use risk are associated with reduction in HIV-related sex risk behaviors among adults. Data was from a cohort of participants (n = 574) identified by drug use screening in a randomized trial of brief intervention for drug use in an urban primary care setting. Inverse probability of treatment weighted (IPTW) logistic regression models were used to examine the relationship between decreases in drug use risk and sex-related HIV risk behavior reduction from study entry to six months. Weights were derived from propensity score modeling of decreases in drug use risk as a function of potential confounders. Thirty seven percent of the study participants (213/574) reported a decrease in drug use risk, and 7% (33/505) reported decreased sex-related HIV risk behavior at the six-month follow-up point. We did not detect a difference in reduction of risky sexual behaviors for those who decreased drug use risk (unadjusted: OR 1.32, 95% CI 0.65–2.70; adjusted OR [AOR] 1.12, 95% CI 0.54–2.36). Adults who screened positive for high drug use risk had greater odds of reducing sex risk behavior in unadjusted analyses OR 3.71, 95% CI 1.81–7.60; but the results were not significant after adjusting for confounding AOR 2.50, 95% CI 0.85–7.30). In this primary care population, reductions in HIV sex risk behaviors have complex etiologies and reductions in drug use risk do not appear to be an independent predictor of them. No detected difference in reduced sex risk behaviors after decreased drug use risk. Adults with drug dependence had greater odds of reducing sex risk behavior. Target behavioral interventions on multiple risks beyond reductions in drug use
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Affiliation(s)
- Angela Wangari Walter
- Department of Public Health, College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, United States
| | - Debbie M Cheng
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA, United States
| | | | - Jeffrey H Samet
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA, United States
| | - Judith Bernstein
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA, United States
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Corsi KF, Kwiatkowski CF, Booth RE. Predictors of Positive Outcomes for Out-of-Treatment Opiate Injectors Recruited into Methadone Maintenance through Street Outreach. JOURNAL OF DRUG ISSUES 2016. [DOI: 10.1177/002204260203200316] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study was conducted to assess behavior change in the areas of drug use, productivity, criminal activity, and HIV risk among street-recruited injection drug users who entered methadone maintenance treatment. In addition, the study examined a number of variables that could account for these changes, including demographics, intervention effects, and treatment-related measures. A total of 168 participants were interviewed at baseline, received outreach interventions, entered methadone maintenance treatment, and were reinterviewed 5–9 months later. Significant (p<.001) improvements were seen in the areas of drug use, productivity, criminality, and HIV risk behaviors. The only variables significantly associated with behavior change were related to drug treatment. In particular, being in treatment at the time of the follow-up assessment had the strongest relationship to positive outcomes, including length of treatment. Having no prior treatment experience was associated with fewer injections at follow-up. These findings emphasize the importance of retaining clients, given the likelihood that positive change is likely to be evidenced while they remain in treatment
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Affiliation(s)
- Karen Fortuin Corsi
- University of Colorado Health Sciences Center, Department of Psychiatry in the Division of Substance Dependence
| | - Carol F. Kwiatkowski
- University of Colorado Health Sciences Center, Department of Psychiatry in the Division of Substance Dependence
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Loewinger G, Sharma B, Karki DK, Khatiwoda P, Kainee S, Poudel KC. Low knowledge and perceived Hepatitis C risk despite high risk behaviour among injection drug users in Kathmandu, Nepal. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 33:75-82. [PMID: 27318773 DOI: 10.1016/j.drugpo.2016.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 04/17/2016] [Accepted: 05/10/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND In Nepal, prevalence of Hepatitis C (HCV) among injecting drug users (IDUs) has been measured at 50% and knowledge of the virus is low. Rehabilitation and harm reduction attendees constitute populations to whom health care providers can deliver services. As such, characterizing their drug use and risk profiles is important for developing targeted service delivery. We measured drug use and risk patterns of IDUs participating in residential rehabilitation as well as those contacted through needle exchanges to identify correlates of drug use frequency, risky injection practices as well as HCV testing, knowledge and perceived risk. METHODS We collected cross-sectional data from one-on-one structured interviews of IDUs contacted through needle-exchange outreach workers (n=202) and those attending rehabilitation centres (behaviour immediately prior to joining rehabilitation) (n=167). RESULTS Roughly half of participants reported injecting at least 30 times in the past 30 days and individuals with previous residential rehabilitation experience reported frequent injection far more than those without it. About one in fourteen respondents reported past week risky injection practices. Participants were over three times as likely to report risky injection if they consumed alcohol daily (17.2%) than if they did not (5.0%) (p=0.002). Those who reported injecting daily reported risky injection practices (11.9%) significantly more than non-daily injectors (1.8%) (p<0.001). Respondents reported high HCV infection rates, low perceived risk, testing history and knowledge. HCV knowledge was not associated with differences in risky injecting. CONCLUSION Treatment centres should highlight the link between heavy drinking, frequent injection and risky injecting practices. The link between rehabilitation attendance and frequent injection may suggest IDUs with more severe use patterns are more likely to attend rehabilitation. Rehabilitation centres and needle exchanges should provide testing and education for HCV. Education alone may not be sufficient to initiate change since knowledge did not predict lower risk.
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Affiliation(s)
| | | | - Deepak Kumar Karki
- Nepal Health Economics Association, Kathmandu, Nepal; Nobel College, Kathmandu, Nepal
| | | | - Sher Kainee
- Rural Environment Development Center (REDC), Dadeldhura, Nepal
| | - Krishna C Poudel
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
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Proctor SL, Copeland AL, Kopak AM, Hoffmann NG, Herschman PL, Polukhina N. Outcome predictors for patients receiving methadone maintenance treatment: findings from a retrospective multi-site study. JOURNAL OF SUBSTANCE USE 2016. [DOI: 10.3109/14659891.2015.1118564] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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A cross-national analysis of the effects of methadone maintenance and needle and syringe program implementation on incidence rates of HIV in Europe from 1995 to 2011. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 32:3-10. [PMID: 27212656 DOI: 10.1016/j.drugpo.2016.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 02/02/2016] [Accepted: 02/06/2016] [Indexed: 11/23/2022]
Abstract
Although many studies have found an association between harm reduction interventions and reductions in incidence rates of Human Immunodeficiency Virus (HIV) infection, scant research explores the effects of harm reduction cross-nationally. This study used a year- and country-level fixed effects model to estimate the potential effects of needle-and-syringe programs (NSPs) and methadone maintenance therapy (MMT) on incidence rates of HIV in the general population and among people who inject drugs (PWID), in a sample of 28 European nations. After adjusting for Gross Domestic Product (GDP) and total expenditures on healthcare, we identified significant associations between years of MMT and NSP implementation and lower incidence rates of HIV among PWID and the general population. In addition to years of implementation of NSP and MMT, the greater proportion of GDP spent on healthcare was associated with a decrease in logged incidence rates of HIV. The findings of this study suggest that MMT and NSP may reduce incidence rates of HIV among PWID cross-nationally. The current study opens a new avenue of exploration, which allows for a focus on countrywide policies and economic drivers of the epidemic. Moreover, it highlights the immense importance of the adoption of harm reduction programs as empirically-based health policy as well as the direct benefits that are accrued from public spending on healthcare on incidence rates of HIV within the general population and among subpopulations of PWID.
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Lee YC, Chao JK, Shi MD, Ma MC, Chao IC. HCV and HIV Infection among Heroin Abusers in a Methadone Maintenance Treatment Program. Health (London) 2016. [DOI: 10.4236/health.2016.812124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lin HC, Wang PW, Yang YH, Tsai JJ, Yen CF. Incarcerated intravenous heroin users: predictors of post-release utilization of methadone maintenance treatment. J Addict Dis 2015; 35:109-18. [PMID: 26670167 DOI: 10.1080/10550887.2015.1122467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Incarcerated intravenous heroin users have more problematic patterns of heroin use, but are less likely to access methadone maintenance treatment by their own initiative than heroin users in the community. The present study examined predictors for receiving methadone maintenance treatment post-release among incarcerated intravenous heroin users within a 24-month period. This cohort study recruited 315 incarcerated intravenous heroin users detained in 4 prisons in southern Taiwan and followed up within the 24-month period post-release. Cox proportional hazards regression analysis was applied to determine the predictive effects of sociodemographic and drug-use characteristics, attitude toward methadone maintenance treatment, human immunodeficiency virus serostatus, perceived family support, and depression for access to methadone maintenance treatment after release. There were 295 (93.7%) incarcerated intravenous heroin users released that entered the follow-up phase of the study. During the 24-month follow-up period, 50.8% of them received methadone maintenance treatment. After controlling for the effects of the detainment period before and after recruitment by Cox proportional hazards regression analysis, incarcerated intravenous heroin users who had positive human immunodeficiency virus serostatus (HR = 2.85, 95% CI = 1.80-4.52, p < .001) and had ever received methadone maintenance treatment before committal (HR = 1.94, 95% CI = 1.23-3.05, p < .01) were more likely to enter methadone maintenance treatment within the 24-month follow-up period. Positive human immunodeficiency virus serostatus with fully subsidized treatment and previous methadone maintenance treatment experiences predicted access of methadone maintenance treatment post-release. Strategies for getting familiar with methadone maintenance treatment during detainment, including providing methadone maintenance treatment prior to release and lowering the economic burden of receiving treatment, may facilitate entry of methadone maintenance treatment for incarcerated intravenous heroin users.
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Affiliation(s)
- Huang-Chi Lin
- a Department of Psychiatry , Kaohsiung Medical University Hospital , Kaohsiung , Taiwan.,b Department of Psychiatry , Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University , Kaohsiung , Taiwan
| | - Peng-Wei Wang
- a Department of Psychiatry , Kaohsiung Medical University Hospital , Kaohsiung , Taiwan.,b Department of Psychiatry , Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University , Kaohsiung , Taiwan
| | - Yi-Hsin Yang
- c School of Pharmacy, Kaohsiung Medical University , Kaohsiung , Taiwan.,d Division of Medical Statistics and Bioinformatics , Department of Medical Research, Kaohsiung Medical University Hospital , Kaohsiung , Taiwan
| | - Jih-Jin Tsai
- e Department of Infectious Diseases , Kaohsiung Medical University Hospital , Kaohsiung , Taiwan.,f Tropical Medicine Center, Kaohsiung Medical University Hospital , Kaohsiung , Taiwan.,g Department of Internal Medicine , Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University , Kaohsiung , Taiwan
| | - Cheng-Fang Yen
- a Department of Psychiatry , Kaohsiung Medical University Hospital , Kaohsiung , Taiwan.,b Department of Psychiatry , Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University , Kaohsiung , Taiwan
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Yu J, Appel P, Rogers M, Blank S, Davis C, Warren B, Freeman A, Harris B, Hussain S. Integrating intervention for substance use disorder in a healthcare setting: practice and outcomes in New York City STD clinics. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2015; 42:32-8. [PMID: 26555138 DOI: 10.3109/00952990.2015.1094478] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This article reports the integration and outcomes of implementing intervention services for substance use disorder (SUD) in three New York City public sexually transmitted disease (STD) clinics. METHODS The screening, brief intervention, and referral to treatment (SBIRT) service model was implemented in the STD clinics in 2008. A relational database was developed, which included screening results, service dispositions, face-to-face interviews with 6-month follow-ups, and treatment information. RESULTS From February 2008 to the end of September 2012, 146,657 STD clinic patients 18 years or older were screened for current or past substance use disorders; 15,687 received a brief intervention; 954 received referrals to formal substance abuse treatment; 2082 were referred to substance abuse support services such as Alcoholics Anonymous (AA), and 690 were referred to mental health, social or HIV awareness services. Intervention services delivered through SBIRT resulted in improvements in multiple outcomes at 6 month follow-up. Patients who received interventions had reduced SUD risks, fewer mental health problems, and fewer unprotected sexual contacts. CONCLUSION Delivery of SUD services in a public health setting represents a significant policy and practice change and benefits many individuals whose SUDs might otherwise be overlooked. Intervention services for substance use disorder were integrated and highly utilized in the STD setting. Further research needs to focus on the long-term impact of SUD interventions in the STD setting, their cost effectiveness, and the extent they are financially sustainable under the new healthcare law.
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Affiliation(s)
- Jiang Yu
- a School of Social Welfare, University at Albany, State University of New York, Albany , New York , NY , USA
| | - Phil Appel
- b New York State Office of Alcoholism and Substance Abuse Services, Albany , New York , NY , USA
| | - Meighan Rogers
- c New York City Department of Health and Mental Hygiene , Bureau of STD Control, Long Island City , New York , NY , USA
| | - Susan Blank
- c New York City Department of Health and Mental Hygiene , Bureau of STD Control, Long Island City , New York , NY , USA
| | - Carrie Davis
- d The Lesbian, Gay, Bisexual & Transgender Community Center , New York , NY , USA
| | - Barbara Warren
- e Mount Sinai Health System , Office of Diversity and Inclusion , New York , NY , USA
| | - Anthony Freeman
- d The Lesbian, Gay, Bisexual & Transgender Community Center , New York , NY , USA
| | - Brett Harris
- b New York State Office of Alcoholism and Substance Abuse Services, Albany , New York , NY , USA
| | - Shazia Hussain
- b New York State Office of Alcoholism and Substance Abuse Services, Albany , New York , NY , USA
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Emergence of methadone as a street drug in St. Petersburg, Russia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 27:97-104. [PMID: 26573380 DOI: 10.1016/j.drugpo.2015.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 10/02/2015] [Accepted: 10/12/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND The syndemic of opioid addiction, HIV, hepatitis, tuberculosis, imprisonment, and overdose in Russia has been worsened by the illegality of opioid substitution therapy. As part of on-going serial studies, we sought to explore the influence of opioid availability on aspects of the syndemic as it has affected the city of St. Petersburg. METHODS We employed a sequential approach in which quantitative data collection and statistical analysis were followed by a qualitative phase. Quantitative data were obtained in 2013-2014 from a respondent-driven sample (RDS) of people who inject drugs (PWID). Individuals recruited by RDS were tested for antibodies to HIV and interviewed about drug use and injection practices, sociodemographics, health status, and access to medical care. Subsequently, we collected in-depth qualitative data on methadone use, knowledge, and market availability from PWID recruited at nine different locations within St. Petersburg. RESULTS Analysis of interview data from the sample revealed the percentage of PWID injecting methadone in the 30 days prior to interview increased from 3.6% in 2010 to 53.3% in 2012-2013. Injection of only methadone, as compared to injecting only heroin or both drugs, was associated with less frequent injection and reduced HIV-related injected risk, especially a lower rate of injecting with a previously used syringe. In-depth questioning of methadone injectors corroborated the finding from serial quantitative surveys of PWID that methadone's black market availability is a recent phenomenon. Spatial analysis revealed widespread methadone availability but no concentration in any specific districts of the city. CONCLUSION Despite the prohibition of substitution therapy and demonization of methadone, the drug has emerged to rival heroin as the most commonly available opioid in St. Petersburg. Ironically, its use is associated with reduced injection-related HIV risk even when its use is illegal.
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Bernard JP, Khiabani HZ, Hilberg T, Karinen R, Slørdal L, Waal H, Mørland J. Characteristics of methadone-related fatalities in Norway. J Forensic Leg Med 2015; 36:114-20. [PMID: 26439870 DOI: 10.1016/j.jflm.2015.09.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 05/15/2015] [Accepted: 09/14/2015] [Indexed: 10/23/2022]
Abstract
There are currently over 7000 patients enrolled in opioid maintenance treatment (OMT) programs in Norway. A rise in methadone-related deaths proportional to increasing methadone sales over the period 2000-2006 has been observed, but the causative factors for these fatalities have been elusive. In the present study, individual characteristics, methadone concentrations and additional toxicological findings were analyzed. Methadone intoxication deaths (n = 264) were divided into 3 groups according to toxicological findings in whole blood: group 1 - methadone detected alone, or together with one additional drug at low or therapeutic levels, or a low concentration of ethanol (<1 g/L) (n = 21); group 2 - multiple additional drugs/substances detected below lethal levels (n = 175); group 3 - one or more additional drugs/substances detected at lethal levels, or ethanol >3 g/L (n = 55). Methadone blood concentrations in decedents who had been enrolled in OMT were higher than for decedents not in treatment, in all groups. Blood methadone concentrations around 1 mg/L were present in fatal multi-drug intoxications in OMT patients. Results suggest that some patients may be at risk of dying when combining therapeutic concentrations of methadone with other psychoactive substances. Somatic disease was a common finding among deceased OMT patients. Concentrations in methadone users not enrolled in OMT were predominantly between 0.3 and 0.4 mg/L and were not related to the presence of other drugs. However, methadone concentrations below 0.1 mg/L may be associated with intoxication following methadone use, both alone and in combination with other drugs. Younger male users (mean age 34 years) seemed to have a higher susceptibility to methadone intoxication.
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Affiliation(s)
- Jean-Paul Bernard
- Norwegian Institute of Public Health, Division of Forensic Sciences, Oslo, Norway; Centre for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway.
| | - Hassan Z Khiabani
- Norwegian Institute of Public Health, Division of Forensic Sciences, Oslo, Norway; Oslo University Hospital, Rikshospitalet, Department of Pharmacology, Oslo, Norway
| | - Thor Hilberg
- Norwegian Institute of Public Health, Division of Forensic Sciences, Oslo, Norway; Fürst Medical Laboratory, Oslo, Norway
| | - Ritva Karinen
- Norwegian Institute of Public Health, Division of Forensic Sciences, Oslo, Norway
| | - Lars Slørdal
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Clinical Pharmacology, St. Olav's Hospital, Trondheim, Norway
| | - Helge Waal
- SERAF-Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway; Oslo University Hospital, Division of Mental Health and Addiction, Oslo, Norway
| | - Jørg Mørland
- Norwegian Institute of Public Health, Division of Forensic Sciences, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Norway
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Expanding substance use treatment options for HIV prevention with buprenorphine-naloxone: HIV Prevention Trials Network 058. J Acquir Immune Defic Syndr 2015; 68:554-61. [PMID: 25564105 DOI: 10.1097/qai.0000000000000510] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Injection opioid use plays a significant role in the transmission of HIV infection in many communities and several regions of the world. Access to evidence-based treatments for opioid use disorders is extremely limited. METHODS HIV Prevention Trials Network 058 (HPTN 058) was a randomized controlled trial designed to compare the impact of 2 medication-assisted treatment (MAT) strategies on HIV incidence or death among opioid-dependent people who inject drugs (PWID). HIV-negative opioid-dependent PWID were recruited from 4 communities in Thailand and China with historically high prevalence of HIV among PWID. A total of 1251 participants were randomly assigned to either (1) a 1-year intervention consisting of 2 opportunities for a 15-day detoxification with buprenorphine/naloxone (BUP/NX) combined with up to 21 sessions of behavioral drug and risk counseling [short-term medication-assisted treatment (ST-MAT)] or (2) thrice-weekly dosing for 48 weeks with BUP/NX and up to 21 counseling sessions [long-term medication-assisted treatment (LT-MAT)] followed by dose tapering. All participants were followed for 52 weeks after treatment completion to assess durability of impact. RESULTS Although the study was stopped early due to lower than expected occurrence of the primary end points, sufficient data were available to assess the impact of the interventions on drug use and injection-related risk behavior. At week 26, 22% of ST-MAT participants had negative urinalyses for opioids compared with 57% in the LT-MAT (P < 0.001). Differences disappeared in the year after treatment: at week 78, 35% in ST-MAT and 32% in the LT-MAT had negative urinalyses. Injection-related risk behaviors were significantly reduced in both groups after randomization. CONCLUSIONS Participants receiving BUP/NX 3 times weekly were more likely to reduce opioid injection while on active treatment. Both treatment strategies were considered safe and associated with reductions in injection-related risk behavior. These data support the use of thrice-weekly BUP/NX as a way to reduce exposure to HIV risk. Continued access to BUP/NX may be required to sustain reductions in opioid use.
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Provision of onsite HIV Services in Substance Use Disorder Treatment Programs: A Longitudinal Analysis. J Subst Abuse Treat 2015; 57:1-8. [PMID: 25934459 DOI: 10.1016/j.jsat.2015.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 03/20/2015] [Accepted: 04/08/2015] [Indexed: 11/23/2022]
Abstract
The provision of HIV education and testing in substance use disorder (SUD) treatment programs is an important public health strategy for reducing HIV incidence. For many at-risk individuals, SUD treatment represents the primary point of access for testing and receiving HIV-related services. This study uses two waves of nationally representative data of 265 privately-funded SUD treatment programs in the U.S. to examine organizational and patient characteristics associated with offering a dedicated HIV/AIDS treatment track, onsite HIV/AIDS support groups, and onsite HIV testing. Our longitudinal analysis indicated that the majority of treatment programs reported providing education and prevention services, but there was a small, yet significant, decline in the number of programs providing these services. Programs placed more of an emphasis on providing information on the transmission of HIV rather than on acquiring risk-reduction skills. There was a notable and significant increase (from 26.0% to 31.7%) in programs that offered onsite HIV testing, including rapid HIV testing, and an increase in the percentage of patients who received testing in the programs. Larger programs were more likely to offer a dedicated HIV/AIDS treatment track and to offer onsite HIV/AIDS support groups, while accredited programs and programs with a medical infrastructure were more likely to provide HIV testing. The percentage of injection drug users was positively linked to the availability of specialized HIV/AIDS tracks and HIV/AIDS support groups, and the percentage of female clients was associated with the availability of onsite support groups. The odds of offering HIV/AIDS support groups were also greater in programs that had a dedicated LGBT track. The findings suggest that access to hospitals and medical care services is an effective way to facilitate adoption of HIV services and that programs are providing a needed service among a group of patients who have a heightened risk of HIV transmission. Nonetheless, the fact that fewer than one third of programs offered onsite testing, and, of the ones that did, fewer than one third of their patients received testing, raises concern in light of federal guidelines.
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Ward CL, Mertens JR, Bresick GF, Little F, Weisner CM. Screening and brief intervention for substance misuse: Does it reduce aggression and HIV-related risk behaviours? Alcohol Alcohol 2015; 50:302-9. [PMID: 25731180 DOI: 10.1093/alcalc/agv007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 01/27/2015] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To explore whether reducing substance misuse through a brief motivational intervention also reduces aggression and HIV risk behaviours. METHODS Participants were enrolled in a randomized controlled trial in primary care if they screened positive for substance misuse. Substance misuse was assessed using the Alcohol, Smoking and Substance Involvement Screening Test; aggression, using a modified version of the Explicit Aggression Scale; and HIV risk, through a count of common risk behaviours. The intervention was received on the day of the baseline interview, with a 3-month follow-up. RESULTS Participants who received the intervention were significantly more likely to reduce their alcohol use than those who did not; no effect was identified for other substances. In addition, participants who reduced substance misuse (whether as an effect of the intervention or not) also reduced aggression but not HIV risk behaviours. CONCLUSIONS Reducing substance misuse through any means reduces aggression; other interventions are needed for HIV risk reduction.
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Affiliation(s)
- Catherine L Ward
- Department of Psychology and Safety and Violence Initiative, University of Cape Town, Rondebosch, South Africa
| | | | - Graham F Bresick
- School of Public Health and Family Medicine, University of Cape Town, Rondebosch, South Africa
| | - Francesca Little
- Department of Statistical Sciences, University of Cape Town, Rondebosch, South Africa
| | - Constance M Weisner
- Langley Porter Psychiatric Institute, University of California, San Francisco, CA, USA Division of Research, Kaiser Permanente, Oakland, CA, USA
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Nutt DJ. Considerations on the role of buprenorphine in recovery from heroin addiction from a UK perspective. J Psychopharmacol 2015; 29:43-9. [PMID: 25389219 DOI: 10.1177/0269881114555248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The United Kingdom Drug Strategy emphasises recovery as a key focus in the treatment of drug dependence. A framework for recovery is defined in the Recovery-Orientated Drug Treatment report, written by an expert working group, and comprises four key phases: engagement and stabilisation, including the establishment of treatment goals; preparation for change, involving engagement in psychosocial and pharmacological interventions; active change, including detoxification and medical withdrawal; and completion, including interventions that strengthen community integration. A body of evidence supports the benefits of buprenorphine, a partial agonist at mu opioid receptors, in supporting individualised recovery based on this framework, specifically in relation to the potential for rapid stabilisation, flexibility to transition to other treatment options or achieve abstinence, effective blocking of on-top use of illicit drugs, the treatment of comorbidities through the minimisation of drug-drug interactions, and a good safety profile. In addition, the newer abuse-deterrent formulation of buprenorphine combined with the opioid antagonist naloxone is likely to strengthen recovery-orientated systems of care due to its potential to reduce misuse and diversion. Progress through the recovery journey and the ability to sustain recovery will depend on individual needs and goals and on the amount of recovery capital that individuals have developed.
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HIV risk reduction with buprenorphine-naloxone or methadone: findings from a randomized trial. J Acquir Immune Defic Syndr 2014; 66:288-93. [PMID: 24751432 DOI: 10.1097/qai.0000000000000165] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Compare HIV injecting and sex risk in patients being treated with methadone (MET) or buprenorphine-naloxone (BUP). METHODS Secondary analysis from a study of liver enzyme changes in patients randomized to MET or BUP who completed 24 weeks of treatment and had 4 or more blood draws. The initial 1:1 randomization was changed to 2:1 (BUP:MET) after 18 months due to higher dropout in BUP. The Risk Behavior Survey measured HIV risk before 30 days at baseline and weeks 12 and 24. RESULTS Among 529 patients randomized to MET, 391 (74%) were completers; among 740 randomized to BUP, 340 (46%) were completers; 700 completed the Risk Behavior Survey. There were significant reductions in injecting risk (P < 0.0008) with no differences between groups in mean number of times reported injecting heroin, speedball, other opiates, and number of injections; or percent who shared needles; did not clean shared needles with bleach; shared cookers; or engaged in front/back loading of syringes. The percent having multiple sex partners decreased equally in both groups (P < 0.03). For males on BUP, the sex risk composite increased; for males on MET, the sex risk decreased resulting in significant group differences over time (P < 0.03). For females, there was a significant reduction in sex risk (P < 0.02) with no group differences. CONCLUSIONS Among MET and BUP patients who remained in treatment, HIV injecting risk was equally and markedly reduced; however, MET retained more patients. Sex risk was equally and significantly reduced among females in both treatment conditions, but it increased for males on BUP and decreased for males on MET.
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Clark CB, Hendricks PS, Lane PS, Trent L, Cropsey KL. Methadone maintenance treatment may improve completion rates and delay opioid relapse for opioid dependent individuals under community corrections supervision. Addict Behav 2014; 39:1736-40. [PMID: 25117851 DOI: 10.1016/j.addbeh.2014.07.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 06/06/2014] [Accepted: 07/02/2014] [Indexed: 10/25/2022]
Abstract
AIMS Several studies have demonstrated the importance of agonist therapies such as methadone and buprenorphine for preventing relapse for individuals being released from jail or prison to the community. No studies have examined the impact of methadone for increasing the completion of community supervision requirements and preventing opioid relapse for individuals under community corrections supervision. This observational study compared the community corrections completion rate and opioid relapse rate of individuals receiving methadone maintenance therapy (MMT) to individuals who did not. METHODS Of the 2931 individuals enrolled under criminal justice supervision in the community, Treatment Accountability for Safer Communities (TASC), and who met criteria for opioid dependence, 329 (11%) individuals reported receiving MMT in the community. RESULTS The majority of participants were White (79.8%) and male (63.5%), with a mean age of 31.33years (SD=9.18), and were under supervision for 10.4months (SD=9.1). MMT participants were less likely to fail out of supervision compared to individuals not in MMT (39.0% vs. 52.9%, p<0.001), and had a lower rate of relapse (32.9%) and longer time to relapse (average days=89.7, SD=158.9) compared to the relapse rate (55.9%) and time to relapse (average days=60.5, SD=117.9) of those not on MMT. CONCLUSIONS While the observational nature of this study prevents causal inferences, these results suggest that utilization of MMT in community corrections may increase the likelihood of completing supervision requirements and delay time to opioid relapse. Providing agonist therapies to opioid dependent individuals under supervision appears to be a critical strategy in this important population.
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Xiaoli W, Lirong W, Xueliang W, Jinsong L, Hengxin L, Wei J. Risk Factors of Hepatitis C Virus Infection in Drug Users From Eleven Methadone Maintenance Treatment Clinics in Xi'an, China. HEPATITIS MONTHLY 2014; 14:e19601. [PMID: 25598787 PMCID: PMC4286713 DOI: 10.5812/hepatmon.19601] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 09/30/2014] [Accepted: 11/08/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection rates in drug users vary among different regions of China. Drug users who are unaware of their HCV serostatus tend to engage in more risky behaviors. OBJECTIVES This prospective study aimed to assess risk factors of HCV infection in drug users among 11 methadone maintenance treatment (MMT) clinics in Xi'an, China. PATIENTS AND METHODS Baseline characteristics and drug use information of patients were collected upon enrollment in the study and anti-HCV tests were performed within one month after the enrollment. Data on daily medication, monthly random urine morphine test results, illicit drug use and MMT retention time were recorded during a 5-year follow-up. RESULTS Of 10243 patients, 58.0% had positive results for anti-HCV. Injection drug use, longer duration of drug abuse, older age, female gender, unmarried status and unemployment were independent risk factors of HCV infection. Urine test positivity rate was lower (14.8% vs. 16.7%, χ(2) = 100.235, P < 0.05), but MMT retention rate was higher (log-rank χ(2) = 4.397, P < 0.05) in the anti-HCV positive group than anti-HCV negative one. However, multivariate regression revealed no significant association between anti-HCV serostatus and either MMT retention time or illicit drug use. CONCLUSIONS The major risk factor of HCV infection was injection drug use. The patient's awareness of his or her HCV status had a minor effect in reduction of illicit drug use and improvement in MMT retention. Therefore, adequate counseling is necessary for drug users in MMT clinics in Xi'an.
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Affiliation(s)
- Wei Xiaoli
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
- Xi’an Center for Disease Control and Prevention, Xi’an, China
| | - Wang Lirong
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Wang Xueliang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
- Corresponding Author: Wang Xueliang, Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China. Tel: +86-2982655108, Fax: +86-2982655103, E-mail:
| | - Li Jinsong
- Xi’an Center for Disease Control and Prevention, Xi’an, China
| | - Li Hengxin
- Xi’an Center for Disease Control and Prevention, Xi’an, China
| | - Jia Wei
- Methadone Maintenance Therapy Clinic, Xi’an Mental Health Center, Xi’an, China
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Alcohol and sexual risk reduction interventions among people living in Russia: a systematic review and meta-analysis. AIDS Behav 2014; 18:1835-46. [PMID: 24104461 DOI: 10.1007/s10461-013-0615-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Russia has one of the highest rates of alcohol consumption and is experiencing one of the fastest-growing HIV epidemics in the world. Given these co-occurring health problems, we systematically reviewed combined alcohol and sexual risk interventions to reduce HIV among Russians. We completed comprehensive electronic searches to locate studies that (a) sampled people living in Russia, (b) used a behavioral intervention, and (c) assessed both alcohol and sexual risk behavior. These searches yielded 584 studies, of these, two were included. Compared with controls, intervention participants reported increasing their condom use (ds ranged from 0.12 to 0.85). Within-group improvements in sexual behaviors were found for both groups (ds ranged from 0.19 to 1.94); participants reported fewer sexual partners, more condom use, and reduced alcohol or drug use before sex. These findings support the need and potential benefits for alcohol and HIV interventions among Russians, and suggest directions for public policy.
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Deren S, Gelpí-Acosta C, Albizu-García CE, González Á, Des Jarlais DC, Santiago-Negrón S. Addressing the HIV/AIDS epidemic among Puerto Rican people who inject drugs: the need for a multiregion approach. Am J Public Health 2014; 104:2030-6. [PMID: 25211722 DOI: 10.2105/ajph.2014.302114] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
High levels of HIV risk behaviors and prevalence have been reported among Puerto Rican people who inject drugs (PRPWID) since early in the HIV epidemic. Advances in HIV prevention and treatment have reduced HIV among people who inject drugs (PWID) in the United States. We examined HIV-related data for PRPWID in Puerto Rico and the US Northeast to assess whether disparities continue. Injection drug use as a risk for HIV is still overrepresented among Puerto Ricans. Lower availability of syringe exchanges, drug abuse treatment, and antiretroviral treatment for PWID in Puerto Rico contribute to higher HIV risk and incidence. These disparities should be addressed by the development of a federally supported Northeast-Puerto Rico collaboration to facilitate and coordinate efforts throughout both regions.
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Affiliation(s)
- Sherry Deren
- Sherry Deren is with the Center for Drug Use and HIV Research, College of Nursing, New York University, New York, NY. Camila Gelpí-Acosta is a postdoctoral fellow at National Development and Research Institutes (NDRI), New York, NY. Carmen E. Albizu-García is with the Graduate School of Public Health, University of Puerto Rico, San Juan. At the time of writing, Ángel González and Salvador Santiago-Negrón were with the Administración de Servicios de Salud Mental y Contra la Adicción (ASSMCA; Mental Health and Anti-addiction Services Administration), San Juan. Don C. Des Jarlais is with Mount Sinai Beth Israel, New York, NY
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Carmona J, Slesnick N, Guo X, Letcher A. Reducing High Risk Behaviors among Street Living Youth: Outcomes of an Integrated Prevention Intervention. CHILDREN AND YOUTH SERVICES REVIEW 2014; 43:118-123. [PMID: 25104870 PMCID: PMC4120522 DOI: 10.1016/j.childyouth.2014.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Research efforts to reduce Human Immunodeficiency Virus (HIV) risk behavior among street living youth have shown disappointing outcomes, with few studies reporting reduced risk behaviors. The current study tested the impact of an integrated HIV prevention intervention, and predictors of change, for youth (N=270) between the ages of 14 to 20 years receiving substance use treatment through a drop-in center. Condom use, HIV knowledge, number of sexual partners and behaviors associated with an overall HIV risk index were assessed at baseline, 3, 6 and 12 months post-baseline. Findings suggest that HIV prevention integrated with substance use treatment is associated with increased condom use and reduced sex partners. However, the effects on condom use were short lived and dissipated by 12 months post-baseline. Higher treatment attendance and baseline substance use predicted increased condom use. Although no significant change was observed in the overall HIV risk index, increases in depressive symptoms were associated with increases in the index score, as well as more sexual partners. Future research should determine whether successful intervention requires reinforcement of risk reduction behaviors while youth remain homeless.
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Affiliation(s)
- Jasmin Carmona
- Department of Human Sciences, The Ohio State University,135 Campbell Hall, 1787 Neil Avenue, Columbus, OH, 43220, USA
| | - Natasha Slesnick
- Department of Human Sciences, The Ohio State University,135 Campbell Hall, 1787 Neil Avenue, Columbus, OH, 43220, USA
| | - Xiamei Guo
- Department of Human Sciences, The Ohio State University,135 Campbell Hall, 1787 Neil Avenue, Columbus, OH, 43220, USA
| | - Amber Letcher
- Department of Counseling and Human Development, South Dakota State University, Box 2275A Brookings, SD 57007, USA
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Dale-Perera A, Alam F, Barker P. Opioid-dependence treatment in the era of recovery: insights from a UK survey of physicians, patients and out-of-treatment opioid users. JOURNAL OF SUBSTANCE USE 2014. [DOI: 10.3109/14659891.2014.923532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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50
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Carrico AW, Flentje A, Gruber VA, Woods WJ, Discepola MV, Dilworth SE, Neilands TB, Jain J, Siever MD. Community-based harm reduction substance abuse treatment with methamphetamine-using men who have sex with men. J Urban Health 2014; 91:555-67. [PMID: 24744105 PMCID: PMC4074324 DOI: 10.1007/s11524-014-9870-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Harm reduction approaches endeavor to assist individuals with avoiding the most detrimental consequences of risk taking behaviors, but limited research has documented the outcomes of harm reduction substance abuse treatment. In total, 211 methamphetamine-using men who have sex with men (MSM) enrolled in two outcome studies of substance abuse treatment programs that were implementing an evidence-based, cognitive-behavioral intervention (i.e., the Matrix Model) from a harm reduction perspective. Study 1 (N = 123) examined changes in self-reported substance use, Addiction Severity Index (ASI) composite scores, and HIV care indicators over a 12-month follow-up. Study 2 (N = 88) assessed changes in substance use, sexual risk taking, and HIV care indicators over a 6-month follow-up. Participants in study 1 reported reductions in cocaine/crack use as well as decreases in the ASI drug and employment composite scores. Among HIV-positive participants in study 1 (n = 75), 47 % initiated or consistently utilized anti-retroviral therapy and this was paralleled by significant increases in self-reported undetectable HIV viral load. Study 2 participants reported reductions in methamphetamine use, erectile dysfunction medication use in combination with other substances, and sexual risk-taking behavior while using methamphetamine. Participants in both studies reported concurrent increases in marijuana use. Taken together, these studies are among the first to observe that clients may reduce stimulant use and concomitant sexual risk-taking behavior during harm reduction substance abuse treatment. Randomized controlled trials are needed to examine the differential effectiveness of harm reduction and abstinence-based approaches to substance abuse treatment.
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Affiliation(s)
- Adam W Carrico
- University of California, San Francisco School of Nursing, 2 Koret Way, N511M, San Francisco, CA, 94143, USA,
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