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Lugoboni F, Stella L, Zamboni L, Campagnari S, Fusina F, De Bernardis E. COVID-19 vaccination and drug users: Past, present, and future. J Public Health Res 2022; 11:22799036221105314. [PMID: 35966046 PMCID: PMC9373134 DOI: 10.1177/22799036221105314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 04/19/2022] [Indexed: 11/26/2022] Open
Abstract
Vaccination against COVID-19 is crucial in the attempt of containing the virus' spread, but facing a viral pathogen with such a high prevalence means that vaccination strategies are facing an unprecedented situation. People that use illicit drugs may have elevated risk of adverse outcomes from COVID-19 given their high prevalence of underlying medical conditions, including respiratory and pulmonary disease, chronic liver disease, cardiovascular and cerebrovascular conditions, diabetes, and compromised immune systems. Despite a widespread distribution on the Italian territory, a large presence of health personnel and a long-standing experience in vaccinations, addiction clinics have yet to be involved in the vaccination campaign against COVID-19. The aim of this study was to investigate the beliefs of drug users attending some Italian addiction clinics, in order to envisage any vaccine administration strategies involving the services themselves. A questionnaire used for the Italian general population to investigate the relative importance of some factors in influencing the propensity to vaccinate against COVID-19, was administrated to drug users in a multicenter survey. The majority of respondents expressed general confidence in vaccines and a good willingness to undergo vaccination. Given strong peer networks, high coverage of treatment and harm reduction interventions, Italian public addiction clinics could play a strategic role in administering the vaccine in this hard-to-reach population, usefully aiding the global campaign against the virus.
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Affiliation(s)
- Fabio Lugoboni
- Department of Medicine, Addiction
Medicine Unit, Verona University Hospital, Verona, Italy
| | | | - Lorenzo Zamboni
- Department of Medicine, Addiction
Medicine Unit, Verona University Hospital, Verona, Italy
- Department of Neurosciences,
Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Simone Campagnari
- Department of Medicine, Addiction
Medicine Unit, Verona University Hospital, Verona, Italy
| | - Francesca Fusina
- Department of General Psychology,
University of Padova, Padova, Italy
- Padova Neuroscience Center, University
of Padova, Padova, Italy
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Perlman DC, Jordan AE, McKnight C, Young C, Delucchi KL, Sorensen JL, Des Jarlais DC, Masson CL. Viral hepatitis among drug users in methadone maintenance: associated factors, vaccination outcomes, and interventions. J Addict Dis 2015; 33:322-31. [PMID: 25299236 DOI: 10.1080/10550887.2014.969623] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Drug users are at high risk of viral Hepatitis A, B, and C. The prevalence of Hepatitis A, Hepatitis B, and Hepatitis C, associated factors, and vaccine seroconversion among drug treatment program participants in a randomized controlled trial of hepatitis care coordination were examined. Of 489 participants, 44 and 47% required Hepatitis A/Hepatitis B vaccinations, respectively; 59% were Hepatitis C positive requiring linkage to care. Factors associated with serologic statuses, and vaccine seroconversion are reported; implications for strategies in drug treatment settings are discussed. Results suggest generalizable strategies for drug treatment programs to expand viral hepatitis screening, prevention, vaccination, and linkage to care.
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Affiliation(s)
- David C Perlman
- a Chemical Dependency Institute, Mount Sinai Beth Israel , New York , New York , USA
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Abstract
Chronic disease (care) management (CDM) is a patient-centered model of care that involves longitudinal care delivery; integrated, and coordinated primary medical and specialty care; patient and clinician education; explicit evidence-based care plans; and expert care availability. The model, incorporating mental health and specialty addiction care, holds promise for improving care for patients with substance dependence who often receive no care or fragmented ineffective care. We describe a CDM model for substance dependence and discuss a conceptual framework, the extensive current evidence for component elements, and a promising strategy to reorganize primary and specialty health care to facilitate access for people with substance dependence. The CDM model goes beyond integrated case management by a professional, colocation of services, and integrated medical and addiction care-elements that individually can improve outcomes. Supporting evidence is presented that: 1) substance dependence is a chronic disease requiring longitudinal care, although most patients with addictions receive no treatment (eg, detoxification only) or short-term interventions, and 2) for other chronic diseases requiring longitudinal care (eg, diabetes, congestive heart failure), CDM has been proven effective.
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Masson CL, Delucchi KL, McKnight C, Hettema J, Khalili M, Min A, Jordan AE, Pepper N, Hall J, Hengl NS, Young C, Shopshire MS, Manuel JK, Coffin L, Hammer H, Shapiro B, Seewald RM, Bodenheimer HC, Sorensen JL, Des Jarlais DC, Perlman DC. A randomized trial of a hepatitis care coordination model in methadone maintenance treatment. Am J Public Health 2013; 103:e81-8. [PMID: 23947319 DOI: 10.2105/ajph.2013.301458] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES We evaluated the efficacy of a hepatitis care coordination intervention to improve linkage to hepatitis A virus (HAV) and hepatitis B virus (HBV) vaccination and clinical evaluation of hepatitis C virus (HCV) infection among methadone maintenance patients. METHODS We conducted a randomized controlled trial of 489 participants from methadone maintenance treatment programs in San Francisco, California, and New York City from February 2008 through June 2011. We randomized participants to a control arm (n = 245) and an intervention arm (n = 244), which included on-site screening, motivational-enhanced education and counseling, on-site vaccination, and case management services. RESULTS Compared with the control group, intervention group participants were significantly more likely (odds ratio [OR] = 41.8; 95% confidence interval [CI] = 19.4, 90.0) to receive their first vaccine dose within 30 days and to receive an HCV evaluation within 6 months (OR = 4.10; 95% CI = 2.35, 7.17). A combined intervention adherence outcome that measured adherence to HAV-HBV vaccination, HCV evaluation, or both strongly favored the intervention group (OR = 8.70; 95% CI = 5.56, 13.61). CONCLUSIONS Hepatitis care coordination was efficacious in increasing adherence to HAV-HBV vaccination and HCV clinical evaluation among methadone patients.
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Affiliation(s)
- Carmen L Masson
- Carmen L. Masson, Kevin L. Delucchi, Jennifer Hettema, Nicole Pepper, Jessica Hall, Nicholas S. Hengl, Michael S. Shopshire, Jennifer K. Manuel, Bradley Shapiro, and James L. Sorensen are with the Department of Psychiatry, Mandana Khalili is with the Department of Medicine, and Hali Hammer is with the Department of Family and Community Medicine, University of California, San Francisco. Courtney McKnight, Albert Min, Ashly E. Jordan, Christopher Young, Lara Coffin, Randy M. Seewald, Henry C. Bodenheimer, Jr, Don C. Des Jarlais, and David C. Perlman are with the Beth Israel Medical Center, New York, NY
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Semaan S, Neumann MS, Hutchins K, D'Anna LH, Kamb ML. Brief counseling for reducing sexual risk and bacterial STIs among drug users--results from project RESPECT. Drug Alcohol Depend 2010; 106:7-15. [PMID: 19720471 DOI: 10.1016/j.drugalcdep.2009.07.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Revised: 06/30/2009] [Accepted: 07/16/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Project RESPECT's brief risk reduction counseling (BRRC) reduced sexual risk and bacterial STIs among at-risk heterosexuals and has been packaged for use with this population. We assessed BRRC's efficacy with RESPECT participants who used drugs and examined BRRC's applicability to present-day users of heroin, cocaine, speedball, or crack. METHODS We compared baseline demographic and economic variables, risk behaviors, and prevalence and correlates of bacterial STIs for ever-injectors ([EIs], N=335) and never-injectors ([NIs], N=3963). We assessed changes in risk behaviors and bacterial STIs for EIs and NIs at 12 months. We compared prevalence of HSV-2, hepatitis B core antigen virus (HBV), hepatitis C virus (HCV), and trichomonas among EIs with recently reported rates among drug users. RESULTS At baseline, 19% of EIs and 29% of NIs had bacterial STIs. Both groups had similar baseline STI correlates. At 12 months, 4% of EIs and 7% of NIs had bacterial STIs. Twelve-month cumulative incidence of bacterial STIs in BRRC was 21% lower among EIs and 18% lower among NIs compared to the informational condition. At 12 months, EIs reported fewer sexual risk behaviors than at baseline. Baseline positivity rates of trichomoniasis in EIs (female: 15%) and in male and female EIs of HSV-2 (39%, 68%), HBV (41%, 37%), and HCV (60%, 58%) were similar to rates in present-day drug users. CONCLUSION Efficacy of BRRC in reducing sexual risk and bacterial STIs in EIs, and similar profiles for EIs and present-day drug users suggest evaluating BRRC with present-day drug users.
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Affiliation(s)
- Salaam Semaan
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Office of the Director, 1600 Clifton Rd, NE, E-07, Atlanta, GA 30333, United States.
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TOPP LIBBY, DAY CAROLYN, DORE GREGORYJ, MAHER LISA. Poor criterion validity of self-reported hepatitis B infection and vaccination status among injecting drug users: A review. Drug Alcohol Rev 2009; 28:669-75. [DOI: 10.1111/j.1465-3362.2009.00060.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lugoboni F, Quaglio G, Civitelli P, Mezzelani P. Bloodborne viral hepatitis infections among drug users: the role of vaccination. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2009; 6:400-13. [PMID: 19440291 PMCID: PMC2672321 DOI: 10.3390/ijerph6010400] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/26/2008] [Accepted: 01/20/2009] [Indexed: 12/16/2022]
Abstract
Drug use is a prevalent world-wide phenomenon and hepatitis virus infections are traditionally a major health problem among drug users (DUs). HBV and HCV, and to a lesser extent HAV, are easily transmitted through exposure to infected blood and body fluids. Viral hepatitis is not inevitable for DUs. Licensed vaccines are available for hepatitis A and hepatitis B. The purpose of this overview is to show some epidemiological data about HBV and the other blood-borne viral hepatitis among DUs and to summarize and discuss use of hepatitis vaccinations in this population. Successful vaccination campaigns among DUs are feasible and well described. We try to focus on the most significant results achieved in successful vaccination programs as reported in scientific literature. Vaccination campaigns among DUs represent a highly effective form of health education and they are cost-saving.
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Affiliation(s)
- Fabio Lugoboni
- Medical Unit for Addictive Disorders, Department of Internal Medicine, Policlinico GB Rossi, 37134 Verona, Italy; E-Mails:
;
- * Author to whom correspondence should be addressed; E-Mail:
; Tel +39-045-812-8292; Fax +39-045-812-8290
| | - Gianluca Quaglio
- Medical Unit for Addictive Disorders, Department of Internal Medicine, Policlinico GB Rossi, 37134 Verona, Italy; E-Mails:
;
| | - Paolo Civitelli
- Addiction Treatment Clinic (SerT-Asl 4), Thiene (Vicenza), Italy; E-Mail:
| | - Paolo Mezzelani
- Medical Unit for Addictive Disorders, Department of Internal Medicine, Policlinico GB Rossi, 37134 Verona, Italy; E-Mails:
;
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Sunthornchart S, Linkins RW, Natephisarnwanish V, Levine WC, Maneesinthu K, Lolekha R, Tappero JW, Trirat N, Muktier S, Chancharastong P, Fox K, Donchalermpak S, Vitek C, Supawitkul S. Prevalence of hepatitis B, tetanus, hepatitis A, human immunodeficiency virus and feasibility of vaccine delivery among injecting drug users in Bangkok, Thailand, 2003-2005. Addiction 2008; 103:1687-95. [PMID: 18705685 DOI: 10.1111/j.1360-0443.2008.02303.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To estimate the prevalence of hepatitis B virus (HBV), tetanus, hepatitis A virus (HAV) and human immunodeficiency virus (HIV) in injecting drug users (IDUs), risk factors associated with infection and the feasibility of HBV vaccine delivery in HBV seronegatives. METHODS Cross-sectional seroprevalence survey of 1535 IDUs recruited from 17 Bangkok Metropolitan Administration (BMA) methadone clinics and HBV vaccination of seronegatives. RESULTS Prevalence of antibody to HBV, tetanus, HAV and HIV was 87.8%, 68.1%, 60.2% and 35.9%, respectively. Prevalence of HBV and HAV increased with increasing age; prevalence of tetanus decreased with increasing age. Being HIV seropositive was related inversely to income and being tetanus seronegative. Of the 189 HBV seronegative IDUs, 81.0% completed the vaccine series. IDUs with HIV had a 6.5-fold odds of vaccine non-response. CONCLUSIONS These data underscore the need for, and feasibility of, vaccine delivery in this population and support targeting efforts at high-risk age groups.
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Amesty S, Ompad DC, Galea S, Fuller CM, Wu Y, Koblin B, Vlahov D. Prevalence and Correlates of Previous Hepatitis B Vaccination and Infection Among Young Drug-users In New York City. J Community Health 2008; 33:139-48. [DOI: 10.1007/s10900-007-9082-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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11
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Koblin BA, Xu G, Lucy D, Robertson V, Bonner S, Hoover DR, Fortin P, Latka M. Hepatitis B Infection and Vaccination Among High-Risk Noninjection Drug-Using Women: Baseline Data From the UNITY Study. Sex Transm Dis 2007; 34:917-22. [PMID: 17579337 DOI: 10.1097/olq.0b013e3180ca8f12] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Few studies of hepatitis B virus (HBV) infection and hepatitis B vaccination have focused on women, and specifically, women who are at high risk. This study was designed to assess the extent of HBV infection and vaccination, level of knowledge about hepatitis B, motivators and barriers to accepting vaccination and uptake of hepatitis B vaccine. DESIGN From March 2005 to June 2006, 402 HIV-negative noninjection drug-using women at sexual risk were recruited, interviewed, and tested for markers of HBV infection. RESULTS Based on serologic testing, 16.7% were previously vaccinated against HBV, 31.1% were previously infected and 52.2% were still susceptible to HBV. Knowledge of HBV infection, transmission, and prevention was low with a mean of 6.1 of 12 knowledge items correctly identified as true or false; a substantial percent of women were not sure of the correct answer. Of the women still susceptible, 69.0% started the hepatitis B vaccine series after counseling given through the study. CONCLUSION This study illustrates that there continues to be gaps in current strategies for administering hepatitis B vaccine among female populations at sexual risk. Interventions are needed for this population to increase awareness and knowledge of hepatitis B, its transmission, impact on health and the availability of a safe and effective vaccine, supplemented by community programs for adult vaccination.
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Affiliation(s)
- Beryl A Koblin
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY 10021, USA.
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12
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Cooper CL, Mills EJ. Therapeutic challenges in hepatitis C-infected injection drug using patients. Harm Reduct J 2006; 3:31. [PMID: 17096852 PMCID: PMC1664558 DOI: 10.1186/1477-7517-3-31] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2006] [Accepted: 11/10/2006] [Indexed: 01/30/2023] Open
Abstract
Hepatitis C Viral (HCV) infection in the injection drug user (IDU) population is a major medical concern. Concurrent substance abuse, co-morbid mental health conditions, poor socioeconomic status and a complex treatment protocol that is often incompatible with the life styles of IDUs combine to account for poor uptake and completion of HCV treatment. This article discusses HCV antiviral treatment issues relevant to IDUs chronically infected with this virus. The effect of non-injected substances of abuse on treatment outcome is considered. Priority issues requiring research are discussed.
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Affiliation(s)
- Curtis L Cooper
- Associate Professor of Medicine-University of Ottawa Hospital, Division of Infectious Diseases-The Ottawa Hospital, Ottawa, Canada
- Centre for International Health and Human Rights Studies, Toronto, Canada
| | - Edward J Mills
- Centre for International Health and Human Rights Studies, Toronto, Canada
- Faculty of Health Sciences, Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
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Grogan L, Tiernan M, Geogeghan N, Smyth B, Keenan E. Bloodborne virus infections among drug users in Ireland: a retrospective cross-sectional survey of screening, prevalence, incidence and hepatitis B immunisation uptake. Ir J Med Sci 2005; 174:14-20. [PMID: 16094907 DOI: 10.1007/bf03169123] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Injecting drug users are at high-risk of bloodborne virus infections including hepatitis C (HCV), hepatitis B (HBV) and HIV. AIMS To document screening for and immunisation against bloodborne viruses and to determine the known prevalence and incidence of these infections. METHODS A cross-sectional survey of clients attending 21 specialist addiction treatment clinics in one health board area in greater Dublin. Data collected on demographic characteristics, serology for HCV, HBV and HIV and immunisation against HBV. RESULTS A total of 316 (88%) had been tested for anti-HCV antibody, 244 (68%) had been tested for anti hepatitis B core antibody (anti-HBc), 299 (84%) had been tested for hepatitis B surface antigen (HBsAg) and 307 (86%) had been tested for anti-HIV antibody. The prevalence of anti-HCV, anti-HBc, HBsAg, and anti-HIV were: 66%, 17%, 2% and 11% respectively. The incidence of HCV, HBV and HIV infections were: 24.5, 9.0 and 3.4 per hundred person years respectively. Eighty-one per cent of those in whom it was indicated, had started a targeted HBV immunisation programme in the clinics. CONCLUSION The proportion of clients screened for HCV, HBV and HIV infection has increased since the introduction of a screening protocol in 1998. Targeted vaccination for opiate users against hepatitis B is more successful than previously shown in Ireland. The prevalence and incidence of bloodborne viruses remains high among opiate users attending addiction treatment services, despite an increase in availability of harm reduction interventions.
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Affiliation(s)
- L Grogan
- Addiction Services, Bridge House, Cherry Orchard Hospital, Dublin, Ireland.
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Krahn MD, John-Baptiste A, Yi Q, Doria A, Remis RS, Ritvo P, Friedman S. Potential cost-effectiveness of a preventive hepatitis C vaccine in high risk and average risk populations in Canada. Vaccine 2005; 23:1549-58. [PMID: 15694507 DOI: 10.1016/j.vaccine.2004.09.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2004] [Revised: 09/24/2004] [Accepted: 09/27/2004] [Indexed: 11/19/2022]
Abstract
Hepatitis C virus (HCV) vaccine development remains at an early stage. We explored the economic and health consequences of potential HCV vaccines by comparing universal vaccination with a hepatitis C vaccine to no vaccination in two groups: (1) injecting drug users (IDU); (2) all 12 year olds, using a Markov cohort simulation. Among IDUs, vaccination would avert 248 cases of HCV infection and 89 HCV-related deaths per 1000 individuals, and reduce costs. In average risk cohorts, vaccination did not reduce costs but was reasonably cost effective. These results provide encouragement to vaccine developers that a vaccine that is moderately effective and reasonably priced should not face economic barriers to implementation and will be attractive to third party payers.
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Affiliation(s)
- Murray D Krahn
- Department of Medicine, University Health Network, Department of Health Policy, Management and Evaluation, University of Toronto, 200 Elizabeth Street, Toronto, Ontario, Canada M5G 1C4.
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15
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Taylor LE. Delivering Care to Injection Drug Users Coinfected with HIV and Hepatitis C Virus. Clin Infect Dis 2005; 40 Suppl 5:S355-61. [PMID: 15768348 DOI: 10.1086/427453] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
Injection drug use has fueled the epidemic of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) coinfection in the United States. Nevertheless, drug dependence is among the main reasons that coinfected persons are not being treated for HCV infection. This report describes the development and progress of an HIV clinic program (funded by the Ryan White Comprehensive AIDS Resources Emergency Act) to deliver care for HCV infection to HIV-seropositive injection drug users. To optimize safety and adherence, pegylated interferon is directly administered to patients in the context of integrated addiction, psychiatric, and HIV and HCV therapy. Ribavirin is packed weekly in pill boxes for patients to take at home. Thus far, adherence to weekly visits for treatment with interferon has been 99%. No one has had to stop treatment for HCV infection because of ongoing drug use, addiction relapse or exacerbation, or psychiatric complications. Presented here is a work in progress, rather than a finished research project or definitive model of care.
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Affiliation(s)
- Lynn E Taylor
- Department of Medicine, Division of Infectious Disease, Brown Medical School, Providence, Rhode Island, USA.
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Lugoboni F, Quaglio G, Pajusco B, Civitelli P, Romanò L, Bossi C, Spilimbergo I, Mezzelani P. Immunogenicity, reactogenicity and adherence to a combined hepatitis A and B vaccine in illicit drug users. Addiction 2004; 99:1560-4. [PMID: 15585047 DOI: 10.1111/j.1360-0443.2004.00886.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS The use of illegal drugs is associated with an increase in infective risk for the hepatitis viruses, against which the vaccination of drug users (DUs) is recommended unanimously. The aim of the study was to determine tolerability, adherence and immune response of a combined vaccine providing dual protection against hepatitis A virus (HAV) and hepatitis B virus (HBV). METHODS The vaccine was administered to 38 DU, attending three public health centres for drug users in northern Italy, with a three-dose schedule (at 0, 1 and 6 months). The vaccine was well tolerated: only one adverse reaction (fever) was recorded after the 110 doses administered (0.9%). The vaccine schedule was completed successfully in 35 cases (92.1%). At month 8, in 34 subjects (89.5%) antibody response was evaluated: all showed seroprotection for HAV and in 33 subjects (97.1%) for HBV. CONCLUSIONS The vaccine, studied for the first time in DUs, proved to be safe, well accepted and immunogenic; anti-HAV response was 1272 mIU/ml and 1726 mIU/ml for anti-HBV, titres lower than reported in literature for the general population. This study suggests that DUs who are HAV/HBV-negative could be vaccinated with combined vaccine.
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Affiliation(s)
- Fabio Lugoboni
- Medical Service for Addictive Disorders, Department of Internal Medicine, University of Verona, Italy.
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17
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Quaglio G, Pajusco B, Civitelli P, Migliozzi S, Des Jarlais DC, Romanò L, Lechi A, Mezzelani P, Lugoboni F. Immunogenicity, reactogenicity and adherence with hepatitis A vaccination among drug users. Drug Alcohol Depend 2004; 74:85-8. [PMID: 15072811 DOI: 10.1016/j.drugalcdep.2003.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2003] [Revised: 12/02/2003] [Accepted: 12/05/2003] [Indexed: 11/18/2022]
Abstract
Hepatitis A virus (HAV) vaccination is recommended in drug users (DUs) because this population has a very high prevalence of hepatitis C virus, and additional infection with HAV can lead to increased morbidity and mortality. The efficacy of hepatitis A vaccine (1440 ELISA units), in terms of immunogenicity, reactogenicity and compliance among 44 heroin DUs using a 0-6 month schedule was investigated. Three subjects (6.8%) experienced adverse reactions. After the first dose of hepatitis A vaccine, 37% of subjects seroconverted. Two months after the 6-month booster vaccination, all vaccinated patients became seropositive. The mean serum antibody concentration was 40 mIU/ml after 6 months and 558 mIU/ml after 8 months. Although all DUs proved seropositive after the booster vaccination, the seroconversion rate, at the 2 and 6 months time points was much lower than in healthy subjects. The lower geometric mean titre could affect the kinetics of decrease of antibody titres and the protection conferred by vaccination may be less durable in these patients. These findings indicate that the 0-12 months schedule could be reduced to a shorter 0-6 months schedule in order to shorten the unprotected period. Further studies among drug users are needed to explore the efficacy and immunogenicity of higher doses or alternative schedules of HAV vaccine.
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Affiliation(s)
- Gianluca Quaglio
- Medical Service for Addictive Disorders, Department of Internal Medicine, University of Verona, Verona 37134, Italy
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Lum PJ, Ochoa KC, Hahn JA, Page Shafer K, Evans JL, Moss AR. Hepatitis B virus immunization among young injection drug users in San Francisco, Calif: the UFO Study. Am J Public Health 2003; 93:919-23. [PMID: 12773355 PMCID: PMC1447870 DOI: 10.2105/ajph.93.6.919] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Paula J Lum
- Positive Health Program, Department of Medicine, University of California, San Francisco 94143-0874, USA.
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Hagan H, Thiede H, McGough JP, Alexander ER. Hepatitis B vaccination among research participants, Seattle, Washington. Am J Public Health 2002; 92:1756. [PMID: 12406801 PMCID: PMC1447321 DOI: 10.2105/ajph.92.11.1756] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Holly Hagan
- Public Health-Seattle and King County, Wash 98104, USA.
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Abstract
Injection drug users constitute the largest group of persons infected with the hepatitis C virus (HCV) in the United States, and most new infections occur in drug users. Controlling hepatitis C in the U.S. population, therefore, will require developing, testing, and implementing effective prevention and treatment strategies for persons who inject drugs. Fortunately, a substantial body of research and clinical experience exists on the prevention and management of chronic viral diseases among injection drug users. The need to implement interventions to stop the spread of HCV among drug users is critical. The capacity of substance-use treatment programs need to be expanded to accommodate all who want and need treatment. Physicians and pharmacists should be educated in how to provide access to sterile syringes and to teach safe injection techniques, both of which are lifesaving interventions. The treatment of hepatitis C in drug users requires an interdisciplinary approach that brings together expertise in treating hepatitis and caring for drug users. Treatment decisions should be made individually by patients with their physicians, based on a balanced assessment of risks and benefits and the patient's personal values. Physicians should carefully assess, monitor, and support adherence and mental health in all patients, regardless of whether drug use is known or suspected. Research is needed to better understand how best to prevent and treat hepatitis C in substance users. In the meantime, substantial progress can be made if existing knowledge and resources are brought to bear.
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Affiliation(s)
- Brian R Edlin
- AIDS Research Institute, University of California, San Francisco, CA 94110, USA.
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Abstract
Injection drug users constitute the largest group of persons infected with the hepatitis C virus (HCV) in the United States, and most new infections occur in drug users. Controlling hepatitis C in the U.S. population, therefore, will require developing, testing, and implementing effective prevention and treatment strategies for persons who inject drugs. Fortunately, a substantial body of research and clinical experience exists on the prevention and management of chronic viral diseases among injection drug users. The need to implement interventions to stop the spread of HCV among drug users is critical. The capacity of substance-use treatment programs need to be expanded to accommodate all who want and need treatment. Physicians and pharmacists should be educated in how to provide access to sterile syringes and to teach safe injection techniques, both of which are lifesaving interventions. The treatment of hepatitis C in drug users requires an interdisciplinary approach that brings together expertise in treating hepatitis and caring for drug users. Treatment decisions should be made individually by patients with their physicians, based on a balanced assessment of risks and benefits and the patient's personal values. Physicians should carefully assess, monitor, and support adherence and mental health in all patients, regardless of whether drug use is known or suspected. Research is needed to better understand how best to prevent and treat hepatitis C in substance users. In the meantime, substantial progress can be made if existing knowledge and resources are brought to bear.
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Affiliation(s)
- Brian R Edlin
- AIDS Research Institute, University of California, San Francisco, CA 94110, USA.
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22
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Quaglio G, Talamini G, Lugoboni F, Lechi A, Venturini L, Jarlais DCD, Mezzelani P. Compliance with hepatitis B vaccination in 1175 heroin users and risk factors associated with lack of vaccine response. Addiction 2002; 97:985-92. [PMID: 12144601 DOI: 10.1046/j.1360-0443.2002.00147.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS To investigate the feasibility of hepatitis B vaccination among heroin users, assessing adherence to the vaccination schedules and identifying factors associated with antibody response. DESIGN AND PARTICIPANTS A large cohort study in nine public centres for drug users (PCDUs) in north-eastern Italy, with data collected between January 1989 and December 1998. A total of 1175 heroin users were selected and vaccinated with a recombinant vaccine using two schedules (0-1-6 months and 0-1-2 months). FINDINGS Eighty-eight per cent of patients completed the vaccination series and a protective antibody response occurred in 77% of subjects. Completion of the vaccination series was not related to the length of the vaccination schedule or whether the patient was still in drug abuse treatment at the end of the series, but was related strongly to the number of patients enrolled at each PCDU (Spearman correlation = - 0.93, P < 0.001). Four variables were significantly associated with lack of seroconversion in response to vaccination: older age (AOR = 0.91 per year, 95% CI 0.88-0.94, P < 0.001), 2-month vaccination schedule (AOR = 3.10, 95% CI 2.06-4.68, P < 0.001), HCV seropositivity (AOR = 0.69, 95% CI 0.47-0.99, P = 0.04), HIV seropositivity (AOR = 0.27, 95% CI 0.10-0.77, P = 0.01). CONCLUSIONS A large-scale, multi-site hepatitis B vaccination programme for heroin users proved feasible and effective. The factors associated with a lack of antibody response may be useful in identifying patients who would benefit most from routine post-vaccination testing, with booster doses for non-responders. These results suggest that hepatitis B vaccination for drug users should become a routine public health practice.
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Affiliation(s)
- Gianluca Quaglio
- Medical Service for Addictive Disorders, Department of Internal Medicine, University of Verona, Italy
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23
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Moses S, Mestery K, Kaita KDE, Minuk GY. Viral hepatitis in a Canadian street-involved population. Canadian Journal of Public Health 2002. [PMID: 11963516 DOI: 10.1007/bf03404552] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Data on the prevalence and compliance with management of viral hepatitis in the street-involved population are limited. METHOD Hepatitis A (HAV), B (HBV) and C (HCV) serology and compliance with HBV vaccination were documented in 533 street-involved individuals. RESULTS The mean age of the study population was 25.7 years (range: 11-65) and 53% were female. Serologic evidence of HAV infection was present in 53%; HBV, 12% (3% ongoing infection); and HCV, 17%. HAV infections were associated with Aboriginal/Metis ethnicity and age over 25 years; HBV with injection drug use (IDU); and HCV with IDU, sex trade work and age over 25 years. Compliance with three-step HBV vaccination was 98%, 77% and 63%. CONCLUSIONS HAV, HBV and HCV are common infections in urban street-involved persons. Successful HBV (and presumably HAV) vaccination can be achieved in the majority of this population, but concerns exist regarding compliance with more long-term, parenterally-based antiviral therapies.
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Affiliation(s)
- S Moses
- Public Health Branch, Manitoba Health, Departments of Medical Microbiology, Medicine and Community Health Sciences, University of Manitoba, Winnipeg, MB
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24
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Des Jarlais DC, Fisher DG, Newman JC, Trubatch BN, Yancovitz M, Paone D, Perlman D. Providing hepatitis B vaccination to injection drug users: referral to health clinics vs on-site vaccination at a syringe exchange program. Am J Public Health 2001; 91:1791-2. [PMID: 11684603 PMCID: PMC1446878 DOI: 10.2105/ajph.91.11.1791] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- D C Des Jarlais
- Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, NY 10003, USA.
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25
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Seal KH, Ochoa KC, Hahn JA, Tulsky JP, Edlin BR, Moss AR. Risk of hepatitis B infection among young injection drug users in San Francisco: opportunities for intervention. West J Med 2000; 172:16-20. [PMID: 10695436 PMCID: PMC1070710 DOI: 10.1136/ewjm.172.1.16] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare the demographic characteristics and risk behaviors for hepatitis B infection among injection drug users younger than 30 years with those aged 30 or older and to evaluate participants' knowledge, attitudes, and experiences of infection, screening, and vaccination against hepatitis B virus. DESIGN A systematic sample of injection drug users not currently in a treatment program were recruited and interviewed at needle exchange programs and community sites. PARTICIPANTS 135 injection drug users younger than 30 years and 96 injection drug users aged 30 or older. RESULTS Injection drug users younger than 30 were twice as likely as drug users aged 30 or older to report having shared needles in the past 30 days (36/135 [27%] vs 12/96 [13%]). Injection drug users younger than 30 were also twice as likely to report having had more than two sexual partners in the past 6 months (80/135 [59%] vs 29/96 [30%]). Although 88 of 135 (68%) young injection drug users reported having had contact with medical providers within the past 6 months only 13 of 135 (10%) had completed the hepatitis B vaccine series and only 16 of (13%) perceived themselves as being at high risk of becoming infected with the virus. CONCLUSION Few young injection drug users have been immunized even though they have more frequent contact with medical providers and are at a higher risk for new hepatitis B infection than older drug users. Clinicians caring for young injection drug users and others at high risk of infection should provide education, screening, and vaccination to reduce an important source of hepatitis B infection.
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Affiliation(s)
- K H Seal
- Urban Health Study, UCSF, San Francisco, CA 94110, USA.
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26
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Affiliation(s)
- H Hagan
- Public Health-Seattle and King County, WA 98104, USA.
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27
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Oliveira ML, Bastos FI, Telles PR, Yoshida CF, Schatzmayr HG, Paetzold U, Pauli G, Schreier E. Prevalence and risk factors for HBV, HCV and HDV infections among injecting drug users from Rio de Janeiro, Brazil. Braz J Med Biol Res 1999; 32:1107-14. [PMID: 10464387 DOI: 10.1590/s0100-879x1999000900009] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Viral hepatitis constitutes a major health issue, with high prevalence among injecting drug users (IDUs). The present study assessed the prevalence and risk determinants for hepatitis B, C and D viruses (HBV, HCV and HDV) infections among 102 IDUs from Rio de Janeiro, Brazil. Serological markers and HCV-RNA were detected by enzyme immunoassay and nested PCR, respectively. HCV genotyping was determined by restriction fragment length polymorphism analysis (RFLP). HBsAg, anti-HBc and anti-HBs were found in 7.8, 55.8 and 24. 7% of IDUs, respectively. In the final logistic regression, HBV infection was independently associated with male homosexual intercourse within the last 5 years (odds ratio (OR) 3.1; 95% confidence interval (CI) 1.1-8.8). No subject presented anti-delta (anti-HD). Anti-HCV was detected in 69.6% of subjects, and was found to be independently associated with needle sharing in the last 6 months (OR 3.4; 95% CI 1.3-9.2) and with longer duration of iv drug use (OR 3.1; 95% CI 1.1-8.7). These data demonstrate that this population is at high risk for both HBV and HCV infection. Among IDUs from Rio de Janeiro, unprotected sexual intercourse seems to be more closely associated with HBV infection, whereas HCV is positively correlated with high risk injecting behavior. Comprehensive public health interventions targeting this population and their sexual partners must be encouraged.
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Affiliation(s)
- M L Oliveira
- Laboratório de Hepatites Virais, Departamento de Virologia, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.
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Dal-Ré R, González A, Ramirez V, Ballesteros J, del Romero J, Bru F. Compliance with immunization against hepatitis B. A pragmatic study in sexually transmitted disease clinics. Vaccine 1995; 13:163-7. [PMID: 7625110 DOI: 10.1016/0264-410x(95)93130-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The efficacy of a vaccine is based primarily on the adherence of the subject to the immunization schedule. This paper compares the compliance rates (CR) for the third dose of hepatitis B virus (HBV) vaccine given according to one of two vaccination schedules among subjects attending two sexually transmitted disease (STD) clinics, and the potential influence of place of vaccine administration (STD clinic or at a vaccination centre). Heterosexual, anti-HBc seronegative subjects (n = 331) were randomized to a 0-1-6 month (n = 161) or a 0-1-2-12 month schedule (n = 170) in this prospective, randomized, parallel pragmatic study. Some subjects (n = 50) attended and were vaccinated at one STD clinic (centre A), whereas 281 attended another clinic (centre B) but were referred to a vaccination centre for administration of vaccine. About 31% (103/331) of the subjects received at least three vaccine doses. On assessing the CR at the 3rd dose in all randomized subjects, we observed that administration of the vaccine at the STD clinic attended (A) was associated with a significantly better CR (p < 0.01) than that of the subjects referred to a vaccination centre (B), while the CR is not affected by the schedule. On the other hand, the 0-1-2-12 schedule was associated with a significantly better CR (p = 0.02) at the 3rd dose than the 0-1-6 month schedule among subjects who comply with the first two doses; the actual site of vaccine administration (in situ (A) versus referred (B)) does not affect the CR.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- R Dal-Ré
- Medical Department, SmithKline Beecham SA, Madrid, Spain
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