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Yeh PT, Yang X, Kennedy CE, Armstrong KA, Fonner VA, Sherryn, O'Reilly KR, Sweat MD. The Impact of Needle and Syringe Exchange Programs on HIV-Related Risk Behaviors in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis Examining Individual- Versus Community-Level Effects. AIDS Behav 2023; 27:3306-3331. [PMID: 37046029 PMCID: PMC10524190 DOI: 10.1007/s10461-023-04051-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 04/14/2023]
Abstract
We conducted a systematic review and meta-analysis of the impact of needle and syringe exchange programs (NSP) on both individual- and community-level needle-sharing behaviors and other HIV-related outcomes in low- and middle-income countries (LMIC). A search of five databases for peer-reviewed trial or quasi-experimental studies reported through July 2021 identified 42 interventions delivered in 35 studies, with a total of 56,751 participants meeting inclusion criteria. Random-effects meta-analysis showed a significant protective association between NSP exposure and needle-sharing behaviors at the individual-level (odds ratio [OR] = 0.25, 95% confidence interval [CI] = 0.16-0.39, 8 trials, n = 3947) and community-level (OR 0.39, CI 0.22-0.69, 12 trials, n = 6850), although with significant heterogeneity. When stratified by needle-sharing directionality, NSP exposure remained associated with reduced receptive sharing, but not distributive sharing. NSP exposure was also associated with reduced HIV incidence and increased HIV testing but there were no consistent associations with prevalence of bloodborne infections. Current evidence suggests positive impacts of NSPs in LMICs.
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Affiliation(s)
- Ping Teresa Yeh
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
| | - Xuhao Yang
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Caitlin E Kennedy
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Kevin A Armstrong
- Division of Global and Community Health, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Virginia A Fonner
- Division of Global and Community Health, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
- FHI 360, Health Services Research Division, Durham, NC, 27701, USA
| | - Sherryn
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Kevin R O'Reilly
- Division of Global and Community Health, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Michael D Sweat
- Division of Global and Community Health, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
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Nassau T, Al-Tayyib A, Robinson WT, Shinefeld J, Brady KA. The Impact of Syringe Services Program Policy on Risk Behaviors Among Persons Who Inject Drugs in 3 US Cities, 2005-2015. Public Health Rep 2020; 135:138S-148S. [PMID: 32735193 PMCID: PMC7407040 DOI: 10.1177/0033354920930137] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The impact of a syringe services program (SSP) policy on risk behaviors and its durability are not as well studied as the impact of the SSPs themselves. We examined whether trends in syringe sharing among persons who inject drugs (PWID) were associated with changes to syringe access policies in 3 US cities: Denver, New Orleans, and Philadelphia. METHODS PWID were surveyed through National HIV Behavioral Surveillance System surveys in each city in 2005, 2009, 2012, and 2015. We assessed changes in syringe sharing from 2005 to 2015 by city. We used multivariable stepwise logistic regression analysis to measure the associations among syringe sharing and injection works sharing, time, and SSP access. RESULTS From 2005 to 2015, syringe sharing decreased significantly from 49.1% to 33.1% in Denver (P < .001), increased significantly from 32.0% to 50.5% in New Orleans (P < .001), and remained unchanged in Philadelphia (30.4% to 31.5%; P = .87). Compared with persons who obtained syringes from any nonsterile source, the adjusted odds of syringe sharing among PWID were significantly lower in each city if syringes were obtained from sterile sources only: Denver adjusted odds ratio (aOR) = 0.23 (95% confidence interval [CI], 0.18-0.30; New Orleans aOR = 0.26 (95% CI, 0.19-0.35), and Philadelphia aOR = 0.43 (95% CI, 0.33-0.57). CONCLUSIONS The lowest proportion of PWID reporting syringe sharing was in Philadelphia, which has a long-standing legal SSP. Implementation of a legal SSP in Denver in 2012 corresponded to a decrease in sharing, whereas the lack of a legal SSP in New Orleans corresponded to an increase in sharing. Universal long-term access to legal SSPs could further the progress made in HIV prevention among PWID.
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Affiliation(s)
- Tanner Nassau
- 6542 AIDS Activities Coordinating Office, Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Alia Al-Tayyib
- 47804 Denver Health and Hospital Authority, Denver Public Health, Denver, CO, USA
| | - William T Robinson
- 51530 School of Public Health, Louisiana State University Health Sciences Center at New Orleans, New Orleans, LA, USA
- STD/HIV Program, Office of Public Health, Louisiana Department of Health, New Orleans, LA, USA
| | - Jennifer Shinefeld
- 6542 AIDS Activities Coordinating Office, Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Kathleen A Brady
- 6542 AIDS Activities Coordinating Office, Philadelphia Department of Public Health, Philadelphia, PA, USA
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Sutter A, Curtis M, Frost T. Public drug use in eight U.S. cities: Health risks and other factors associated with place of drug use. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 64:62-69. [DOI: 10.1016/j.drugpo.2018.11.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/06/2018] [Accepted: 11/19/2018] [Indexed: 10/27/2022]
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Sawangjit R, Khan TM, Chaiyakunapruk N. Effectiveness of pharmacy-based needle/syringe exchange programme for people who inject drugs: a systematic review and meta-analysis. Addiction 2017; 112:236-247. [PMID: 27566970 DOI: 10.1111/add.13593] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 06/26/2016] [Accepted: 08/21/2016] [Indexed: 11/30/2022]
Abstract
AIMS To appraise the evidence critically for effectiveness of pharmacy-based needle/syringe exchange programmes (pharmacy-based NSPs) on risk behaviours (RBs), HIV/HCV prevalence and economic outcomes among people who inject drugs (PWID). DESIGN Systematic review and meta-analysis. SETTING Primary care setting. PARTICIPANTS Of 1568 studies screened, 14 studies with 7035 PWID were included. MEASURES PubMed, Embase, Web of Sciences, CENTRAL and Cochrane review databases were searched without language restriction from their inception to 27 January 2016. All published study designs with control groups that reported the effectiveness of pharmacy-based NSP on outcomes of interest were included. Outcomes of interest are risk behaviour (RB), HIV/hepatitis C virus (HCV) prevalence and economic outcomes. The estimates of pooled effects of these outcomes were calculated as pooled odds ratio (OR) with 95% confidence interval (CI) using a random-effects model. Heterogeneity was assessed by I2 and χ2 tests. FINDINGS Most studies (nine of 14, 64.3%) were rated as having a serious risk of bias, while 28.6 and 7.1% were rated as having a moderate risk and low risk of bias, respectively. For sharing-syringe behaviour, pharmacy-based NSPs were significantly better than no NSPs for both main (OR = 0.50, 95% CI = 0.34-0.73; I2 = 59.6%) and sensitivity analyses, excluding studies with a serious risk of bias (OR = 0.52, 95% CI = 0.32-0.84; I2 = 41.4%). For safe syringe disposal and HIV/HCV prevalence, the evidence for pharmacy-based NSPs compared with other NSP or no NSP was unclear, as few of the studies reported this and most of them had a serious risk of bias. Compared with the total life-time cost of US$55 640 for treating a person with HIV infection, the HIV prevalence among PWID has to be at least 0.8% (for pharmacy-based NSPs) or 2.1% (for other NSPs) to result in cost-savings. CONCLUSIONS Pharmacy-based needle/syringe exchange programmes appear to be effective for reducing risk behaviours among people who inject drugs, although their effect on HIV/HCV prevalence and economic outcomes is unclear.
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Affiliation(s)
- Ratree Sawangjit
- Clinical Pharmacy Research Unit (CPRU), Department of Clinical Pharmacy, Faculty of Pharmacy, Mahasarakham University, Mahasarakham, Thailand.,School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Tahir Mehmood Khan
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia.,Department of Pharmacy, Abasyn University Peshawar, Pakistan
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia.,Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.,School of Population Health, University of Queensland, Brisbane, Australia.,School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
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Lévesque A, Roy É, Jutras-Aswad D, Zang G, Artenie AA, Bruneau J. Examining the link between psychological distress, mental health disorders and sharing behaviors among cocaine users. Addict Behav 2016; 62:54-9. [PMID: 27318949 DOI: 10.1016/j.addbeh.2016.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 05/10/2016] [Accepted: 06/06/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Psychiatric problems and cocaine use are associated with heightened vulnerability for HIV and Hepatitis C infections. Little is known regarding the relationship between psychiatric symptoms, psychiatric diagnoses and injection risk behaviors among cocaine users. We examined the association between psychological distress and injection material sharing among cocaine users, while accounting for comorbid anxious and mood disorders. METHODS Participants included cocaine users who inject drugs recruited in a prospective cohort study in Montreal, Canada. Diagnosis of mood and anxiety disorders in the year preceding baseline were established using the Composite International Diagnostic Interview (CIDI) questionnaire. Psychological distress based on the Kessler scale and injection material sharing in the past 3months were assessed at baseline and at each of the five follow-up visits at 3-month intervals. Statistical analyses were conducted using generalized estimation equation. RESULTS Of the 387 participants (84.5% male; 80.1%, ≥30y.o.), 35% reported severe psychological distress, 43% qualified for an anxiety disorder diagnosis and 29% for a mood disorder diagnosis at baseline. Psychological distress was not associated with any injection risk behavior when adjusting for socio-demographic and psychiatric disorders. Participants with anxiety disorders were more likely to share needle (adjusted odds ratio: 1.89, 95% CI: 1.17-3.03). Sharing of injection material other than needle was not associated with psychiatric disorders or with psychological distress in multivariate analyses. CONCLUSIONS Anxiety disorders are associated with needle sharing among cocaine users. Our results suggest the importance of screening for anxiety disorders as part of preventive interventions to decrease blood-borne viruses' transmission.
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Siddiqui SS, Armenta RF, Evans JL, Yu M, Cuevas-Mota J, Page K, Davidson P, Garfein RS. Effect of legal status of pharmacy syringe sales on syringe purchases by persons who inject drugs in San Francisco and San Diego, CA. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:1150-7. [PMID: 26252980 DOI: 10.1016/j.drugpo.2015.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 06/01/2015] [Accepted: 06/15/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Sharing blood-contaminated syringes is the main risk factor for acquiring and transmitting blood-borne infections among persons who inject drugs (PWID). To reduce this risk, in 2005, California enacted legislation allowing local health jurisdictions to legalize non-prescription syringe sales after approving a disease prevention demonstration project (DPDP). With San Francisco approving a DPDP immediately and San Diego never approving one, we compared PWID across cities for their use of pharmacies PWID to obtain syringes. METHODS PWID age 18-30 years old were recruited into separate studies in San Francisco (n=243) and San Diego (n=338) between 2008 and 2011. We used multivariable logistic regression to compare the proportions of PWID who obtained syringes from pharmacies by city while controlling for sociodemographics, injection practices and other risk behaviors. RESULTS Overall, most PWID were White (71%), male (63%), and between the ages of 18-25 years (55%). Compared to San Francisco, a smaller proportion of PWID in San Diego had bought syringes from pharmacies in the prior three months (16.9% vs. 49.8%; p<0.001), which remained statistically significant after adjusting for sociodemographic and behavioral factors (adjusted odds ratio=4.45, 95% confidence interval: 2.98, 6.65). CONCLUSIONS Use of pharmacies to obtain syringes was greater where it was legal to do so. Public health policy can influence HIV and hepatitis C associated risk among PWID; however, implementation of these policies is crucial for the benefits to be realized.
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Affiliation(s)
- Saira S Siddiqui
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Richard F Armenta
- Division of Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Jennifer L Evans
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Michelle Yu
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Jazmine Cuevas-Mota
- Division of Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Kimberly Page
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Peter Davidson
- Division of Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Richard S Garfein
- Division of Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA.
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Sherman SG, Patel SA, Ramachandran DV, Galai N, Chaulk P, Serio-Chapman C, Gindi RM. Consequences of a restrictive syringe exchange policy on utilisation patterns of a syringe exchange program in Baltimore, Maryland: Implications for HIV risk. Drug Alcohol Rev 2015; 34:637-44. [PMID: 25919590 DOI: 10.1111/dar.12276] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 03/15/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS Syringe distribution policies continue to be debated in many jurisdictions throughout the USA. The Baltimore Needle and Syringe Exchange Program (NSP) operated under a 1-for-1 syringe exchange policy from its inception in 1994 through 1999, when it implemented a restrictive policy (2000-2004) that dictated less than 1-for-1 exchange for non-program syringes. DESIGN AND METHODS Data were derived from the Baltimore NSP, which prospectively collected data on all client visits. We examined the impact of this restrictive policy on program-level output measures (i.e. distributed : returned syringe ratio, client volume) before, during and after the restrictive exchange policy. Through multiple logistic regression, we examined correlates of less than 1-for-1 exchange ratios at the client level before and during the restrictive exchange policy periods. RESULTS During the restrictive policy period, the average annual program-level ratio of total syringes distributed : returned dropped from 0.99 to 0.88, with a low point of 0.85 in 2000. There were substantial decreases in the average number of syringes distributed, syringes returned, the total number of clients and new clients enrolling during the restrictive compared to the preceding period. During the restrictive period, 33 508 more syringes were returned to the needle exchange than were distributed. In the presence of other variables, correlates of less than 1-for-1 exchange ratio were being white, female and less than 30 years old. DISCUSSION AND CONCLUSIONS With fewer clean syringes in circulation, restrictive policies could increase the risk of exposure to HIV among Injection Drug Users (IDUs) and the broader community. The study provides evidence to the potentially harmful effects of such policies.
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Affiliation(s)
- Susan G Sherman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Shivani A Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Daesha V Ramachandran
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,Department of Statistics, University of Haifa, Haifa, Israel
| | | | | | - Renee M Gindi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Tookes HE, Kral AH, Wenger LD, Cardenas GA, Martinez AN, Sherman RL, Pereyra M, Forrest DW, Lalota M, Metsch LR. A comparison of syringe disposal practices among injection drug users in a city with versus a city without needle and syringe programs. Drug Alcohol Depend 2012; 123:255-9. [PMID: 22209091 PMCID: PMC3358593 DOI: 10.1016/j.drugalcdep.2011.12.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 11/28/2011] [Accepted: 12/01/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND The United States (U.S.) approved use of federal funds for needle and syringe programs (NSPs) in December 2009. This study compares syringe disposal practices in a U.S. city with NSPs to a U.S. city without NSPs by examining the prevalence of improperly discarded syringes in public places and the self-reported syringe disposal practices of injection drug users (IDUs) in the two cities. METHODS We conducted visual inspection walkthroughs in a random sample of the top-quartile of drug-affected neighborhoods in San Francisco, California (a city with NSPs) and Miami, Florida (a city without NSPs). We also conducted quantitative interviews with adult IDUs in San Francisco (N=602) and Miami (N=448). RESULTS In the visual inspections, we found 44 syringes/1000 census blocks in San Francisco, and 371 syringes/1000 census blocks in Miami. Survey results showed that in San Francisco 13% of syringes IDUs reported using in the 30 days preceding the study interviews were disposed of improperly versus 95% of syringes by IDUs in Miami. In multivariable logistic regression analysis, IDUs in Miami had over 34 times the adjusted odds of public syringe disposal relative to IDUs in San Francisco (adjusted odds ratio=34.2, 95% CI=21.92, 53.47). CONCLUSIONS We found eight-fold more improperly disposed syringes on walkthroughs in the city without NSPs compared to the city with NSPs, which was corroborated by survey data. NSPs may help IDUs dispose of their syringes safely in cities with large numbers of IDUs.
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Reynolds GL, Fisher DG, Napper LE. Assessment of risky injection practices associated with hepatitis B, hepatitis C, and human immunodeficiency virus and using the blood-borne virus transmission risk assessment questionnaire. J Addict Dis 2012; 31:80-8. [PMID: 22356671 DOI: 10.1080/10550887.2011.642755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Risky injection practices among injection drug users (IDUs) contribute to the spread of blood-borne infections such as human immunodeficiency virus, hepatitis B, and hepatitis C. The Blood-borne Virus Transmission Risk Assessment Questionnaire (BBV-TRAQ). was developed in Australia to determine risk behaviors for specific infections. Blood testing for human immunodeficiency virus, hepatitis B, and hepatitis C was performed on all participants, and data on blood tests were linked to questionnaires. The BBV-TRAQ was administered to 242 current and former injection drug users in Long Beach, California, and the Long Beach data were compared with the original Australian data. In the comparison of the mean scores on the three subscales and total scores on the BBV-TRAQ between the samples, means for all three subscales and the total BBV-TRAQ score were significantly different, with Long Beach scores consistently lower than the Australian sample. The injecting and sexual risk subscales were significantly different across levels of AIDS risk perception for all three types of injectors; however, the other skin penetration practices subscale had no significant association with AIDS risk perception for any of the injection drug user groups. Despite recent efforts to educate injectors about the risks associated with practices captured by the other skin penetration practices subscale, such as tattooing and sharing razors, this subscale does not have an association with AIDS risk perception. injection drug users in Australia may have better access to health care, giving their self-report of infection greater validity than the California sample.
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Affiliation(s)
- Grace L Reynolds
- Center for Behavioral Research and Services, California State University, Long Beach, Long Beach, California 90813, USA.
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Korthuis PT, Feaster DJ, Gomez ZL, Das M, Tross S, Wiest K, Douaihy A, Mandler RN, Sorensen JL, Colfax G, McCarty D, Cohen SE, Penn PE, Lape D, Metsch LR. Injection behaviors among injection drug users in treatment: the role of hepatitis C awareness. Addict Behav 2012; 37:552-5. [PMID: 22209655 DOI: 10.1016/j.addbeh.2011.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 09/16/2011] [Accepted: 12/06/2011] [Indexed: 01/29/2023]
Abstract
BACKGROUND Injection drug use (IDU) is a primary vector for blood-borne infections. Awareness of Hepatitis C virus (HCV) infection status may affect risky injection behaviors. This study determines the prevalence of risky injection practices and examines associations between awareness of positive HCV status and risky injection behaviors. METHODS We surveyed individuals seeking treatment for substance use at 12 community treatment programs as part of a national HIV screening trial conducted within the National Drug Abuse Treatment Clinical Trials Network. Participants reported socio-demographic characteristics, substance use, risk behaviors, and HCV status. We used multivariable logistic regression to test associations between participant characteristics and syringe/needle sharing. RESULTS The 1281 participants included 244 (19.0%) individuals who reported injecting drugs in the past 6 months and 37.7% of IDUs reported being HCV positive. During the six months preceding baseline assessment, the majority of IDUs reported obtaining sterile syringes from pharmacies (51.6%) or syringe exchange programs (25.0%), but fewer than half of IDUs always used a sterile syringe (46.9%). More than one-third (38.5%) shared syringe/needles with another injector in the past 6 months. Awareness of positive HCV vs. negative/unknown status was associated with increased recent syringe/needle sharing (aOR 2.37, 95% CI 1.15, 4.88) in multivariable analysis. CONCLUSIONS Risky injection behaviors remain prevalent and awareness of HCV infection was associated with increased risky injection behaviors. New approaches are needed to broadly implement HCV prevention interventions for IDUs seeking addiction treatment.
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Affiliation(s)
- P Todd Korthuis
- Department of Medicine and Department of Public Health and Preventive Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
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Ropelewski LR, Mancha BE, Hulbert A, Rudolph AE, Martins SS. Correlates of risky injection practices among past-year injection drug users among the US general population. Drug Alcohol Depend 2011; 116:64-71. [PMID: 21227602 PMCID: PMC3090520 DOI: 10.1016/j.drugalcdep.2010.11.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Revised: 11/16/2010] [Accepted: 11/20/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND With an estimated 1 million active injection drug users (IDUs), injection drug use continues to be a public health concern in the United States. Risky injection practices have been associated with the transmission of HIV, Hepatitis B and C, as well as other skin and soft tissue infections. METHODS We used data from 463 respondents, aged 18 and older, who were past-year IDUs in the 2005-2008 National Survey of Drug Use and Health (NSDUH). We investigated correlates of risky injection behavior among these recent IDUs. RESULTS Older age (≥ 35 versus 18-25) was associated with reusing one's own needle at last injection (aOR=1.80 [1.02-3.17], as were past year heroin (aOR=2.59 [1.18-5.66]) and cocaine injection (aOR=2.17 [1.13-4.15]). Past year crack cocaine use was positively associated with not cleaning needles with bleach (aOR=2.18 [1.10-4.33]). Past year cocaine injection was associated with obtaining needles in a risky manner (aOR=2.29 [1.23-4.25]). Methamphetamine injection was associated with obtaining needles in less risky ways (aOR=0.41 [0.20-0.84]). CONCLUSION Our findings indicate that some IDUs are continuing to engage in high risk injection behaviors. The identification of potential at-risk populations of IDUs may have implications for harm reduction interventions and HIV prevention programs.
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Affiliation(s)
- Lauren R Ropelewski
- Johns Hopkins University Bloomberg School of Public Health, Department of Mental Health, Baltimore, MD 21205, USA.
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de Montigny L, Moudon AV, Leigh BC, Kim SY. A spatial analysis of the physical and social environmental correlates of discarded needles. Health Place 2011; 17:757-66. [PMID: 21371930 DOI: 10.1016/j.healthplace.2011.01.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Revised: 01/12/2011] [Accepted: 01/22/2011] [Indexed: 11/30/2022]
Abstract
The role that the urban environment plays in influencing drug users' injection and needle disposal decisions is poorly understood. We identified potential attractors and deterrents of needle discarding, and then used a geographic information system (GIS) to quantify these factors for a neighborhood in Montréal, Canada. In multivariate logistic regression, discarded needles were found to have more associations with physical factors than with social factors. Visual exposure and proximity to a single-room occupancy hotel, a pay phone, an adult service or a pawnshop were important physical environmental predictors. These findings are discussed in relation to developing public health and urban design-based harm reduction approaches to needle discarding in public space.
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Affiliation(s)
- Luc de Montigny
- The Surveillance Lab, McGill University, Montréal, Québec, Canada
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Wenger LD, Martinez AN, Carpenter L, Geckeler D, Colfax G, Kral AH. Syringe disposal among injection drug users in San Francisco. Am J Public Health 2010; 101:484-6. [PMID: 20466956 DOI: 10.2105/ajph.2009.179531] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
To assess the prevalence of improperly discarded syringes and to examine syringe disposal practices of injection drug users (IDUs) in San Francisco, we visually inspected 1000 random city blocks and conducted a survey of 602 IDUs. We found 20 syringes on the streets we inspected. IDUs reported disposing of 13% of syringes improperly. In multivariate analysis, obtaining syringes from syringe exchange programs was found to be protective against improper disposal, and injecting in public places was predictive of improper disposal. Few syringes posed a public health threat.
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de Montigny L, Vernez Moudon A, Leigh B, Kim SY, Young K. Assessing a drop box programme: a spatial analysis of discarded needles. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2009; 21:208-14. [PMID: 19729291 DOI: 10.1016/j.drugpo.2009.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Revised: 07/22/2009] [Accepted: 07/29/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Distributing sterile injection equipment to injection drug users is one of few proven ways of lowering the transmission rate of blood borne viruses. Distribution of equipment has also been linked to increased needle discarding, which is a public health risk for both injectors and their host communities. Drop boxes (anonymous and public-access sharps containers) are a promising and increasingly popular means of reducing unsafe disposal, yet there is little empirical research to support or guide their implementation. METHODS Using a dataset containing the locations of 7274 discarded needles and syringes collected monthly in the non-park open spaces of a 2.5km(2) neighbourhood of Montréal, Canada for a period of five years, we compared levels of discards before and after the installation of 12 drop boxes. We used quasi-Poisson regression to test the effects of drop boxes on monthly counts of collected discards for areas within a walking distance of 25, 50, 100 and 200m of a drop box. We adjusted for known time-dependent covariates linearly and unknown time-dependent covariates using a smoothing function. RESULTS We found strong evidence of reduced discarding following the installation of drop boxes; drop boxes were associated with reductions of up to 98% (95% CI: 72-100%) and significant reductions for areas up to 200m from a drop box. Reductions were inversely proportional to walking distance from drop boxes. No measure of weather or use of needle exchange programmes (NEPs) had a consistent relationship with discard counts. CONCLUSION Our research suggests that IDUs changed their needle-disposal behaviour in response to increased safe disposal options. In addition to being relatively low-threshold, economical and rapid, drop boxes appear to be a highly effective intervention to reduce discarded needles.
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Affiliation(s)
- Luc de Montigny
- McGill University, The Surveillance Lab, McGill Clinical and Health Informatics, Montreal, QC, Canada H3A 1A3.
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Molecular and Contextual Markers of Hepatitis C Virus and Drug Abuse. Mol Diagn Ther 2009. [DOI: 10.1007/bf03256323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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16
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Shapshak P, Somboonwit C, Drumright LN, Frost SDW, Commins D, Tellinghuisen TL, Scott WK, Duncan R, McCoy C, Page JB, Giunta B, Fernandez F, Singer E, Levine A, Minagar A, Oluwadara O, Kotila T, Chiappelli F, Sinnott JT. Molecular and contextual markers of hepatitis C virus and drug abuse. Mol Diagn Ther 2009; 13:153-79. [PMID: 19650670 PMCID: PMC4447498 DOI: 10.2165/01250444-200913030-00002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The spread of hepatitis C virus (HCV) infection involves a complex interplay of social risks, and molecular factors of both virus and host. Injection drug abuse is the most powerful risk factor for HCV infection, followed by sexual transmission and additional non-injection drug abuse factors such as co-infection with other viruses and barriers to treatment. It is clearly important to understand the wider context in which the factors related to HCV infection occur. This understanding is required for a comprehensive approach leading to the successful prevention, diagnosis, and treatment of HCV. An additional consideration is that current treatments and advanced molecular methods are generally unavailable to socially disadvantaged patients. Thus, the recognition of behavioral/social, viral, and host factors as components of an integrated approach to HCV is important to help this vulnerable group. Equally important, this approach is key to the development of personalized patient treatment - a significant goal in global healthcare. In this review, we discuss recent findings concerning the impact of drug abuse, epidemiology, social behavior, virology, immunopathology, and genetics on HCV infection and the course of disease.
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Affiliation(s)
- Paul Shapshak
- Division of Infectious Disease and International Medicine, Department of Internal Medicine, Tampa General Hospital, University of South Florida, College of Medicine, Tampa, Florida, USA.
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Golub ET, Strathdee SA, Bailey SL, Hagan H, Latka MH, Hudson SM, Garfein RS. Distributive syringe sharing among young adult injection drug users in five U.S. cities. Drug Alcohol Depend 2007; 91 Suppl 1:S30-8. [PMID: 17398039 DOI: 10.1016/j.drugalcdep.2007.02.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Revised: 02/20/2007] [Accepted: 02/20/2007] [Indexed: 11/17/2022]
Abstract
Blood-borne pathogens such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are transmitted most commonly among injection drug users (IDUs) through the sharing of needles and syringes. Distributive syringe sharing (DSS) (i.e., passing on a used needle/syringe to another IDU) poses the potential risk of transmitting HIV and viral hepatitis to others. We studied the prevalence and correlates of DSS among IDUs enrolled in a randomized behavioral intervention trial designed to reduce behaviors associated with HIV and HCV transmission in five U.S. cities. Among 3129 IDUs ages 15-30 years who completed the baseline visit, 1432 (45.8%) engaged in DSS during the 3 months prior to baseline. Significant correlates of DSS were perception that peer norms condone needle sharing, frequent injection, not obtaining most syringes from needle exchange programs or pharmacies, injecting most frequently in shooting galleries and with sex partners, low perceived risk of HIV from sharing syringes, increased anxiety, low self-esteem, and having unprotected sex. Restricting to only those IDUs who reported not injecting with previously used syringes, similar independent correlates of DSS were found. These findings suggest that interventions to reduce ongoing transmission of blood-borne infections should focus on altering peer norms among networks of young IDUs.
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Affiliation(s)
- Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe St., room E-7137, Baltimore, MD 21117, USA.
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Bluthenthal RN, Anderson R, Flynn NM, Kral AH. Higher syringe coverage is associated with lower odds of HIV risk and does not increase unsafe syringe disposal among syringe exchange program clients. Drug Alcohol Depend 2007; 89:214-22. [PMID: 17280802 PMCID: PMC2562866 DOI: 10.1016/j.drugalcdep.2006.12.035] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2006] [Revised: 11/28/2006] [Accepted: 12/21/2006] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine if adequate syringe coverage --"one shot for one syringe"--among syringe exchange program (SEP) clients is associated with injection-related HIV risk behaviors and syringe disposal. DESIGN HIV risk assessments with 1577 injection drug users (IDUs) recruited from 24 SEPs in California between 2001 and 2003. Individual syringe coverage was calculated as a proportion of syringes retained from SEP visits to total number of injections in the last 30 days. RESULTS Participants were divided into four groups based on syringe coverage: <50%, 50-99%, 100-149%, and 150% or more. In multivariate logistic regression, SEP clients with less than 50% syringe coverage had significantly higher odds of reporting receptive syringe sharing in the last 30 days (adjusted odds ratio [AOR]=2.3; 95% confidence interval [CI]=1.4, 3.6) and those with 150% or more coverage had lower odds of reporting receptive syringe sharing (AOR=0.5; 95%CI=0.3, 0.8) as compared to SEP clients with adequate syringe coverage of 100-149%. Similar associations were observed for other main outcomes of distributive syringe sharing and syringe re-use. No differences in safe syringe disposal were observed by syringe coverage. CONCLUSIONS Individual syringe coverage is strongly associated with safer injection behaviors without impacting syringe disposal among SEP clients. Syringe coverage is a useful measure for determining if IDUs are obtaining sufficient syringes to lower HIV risk.
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Affiliation(s)
- Ricky N Bluthenthal
- Health Program and Drug Policy Research Center, RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138, USA.
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