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Kattari SK, Walls NE, Speer SR. Differences in Experiences of Discrimination in Accessing Social Services Among Transgender/Gender Nonconforming Individuals by (Dis)Ability. ACTA ACUST UNITED AC 2018; 16:116-140. [PMID: 28447917 DOI: 10.1080/1536710x.2017.1299661] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Transgender and gender nonconforming (GNC) individuals frequently experience discrimination and potentially a lack of respect from service providers, suggesting they have decreased access to professionals with cultural competency. Similarly, people with disabilities experience higher levels of discrimination in social services than their nondisabled counterparts. From an intersectional perspective, this study examines rates of discrimination in accessing social services faced by transgender and GNC people, comparing across ability. Data indicate that although transgender and GNC individuals of all abilities experience gender-based discrimination when accessing social services, those with disabilities experience higher levels of antitransgender discrimination in mental health centers, rape crisis centers, and domestic violence shelters.
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Affiliation(s)
- Shanna K Kattari
- a Graduate School of Social Work , University of Denver , Denver , Colorado , USA
| | - N Eugene Walls
- a Graduate School of Social Work , University of Denver , Denver , Colorado , USA
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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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Burt RD, Thiede H. Reduction in Needle Sharing Among Seattle-Area Injection Drug Users Across 4 Surveys, 1994-2013. Am J Public Health 2015; 106:301-7. [PMID: 26691117 DOI: 10.2105/ajph.2015.302959] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated time trends in sharing needles and other injection equipment from 1994 to 2013 among injection drug users in the Seattle, Washington area. METHODS We combined data from 4 sources: the Risk Activity Variables, Epidemiology, and Network (RAVEN) study, recruited from institutional settings; the Kiwi study, recruited from jails; National HIV Behavioral Surveillance system (NHBS) surveys, which used respondent-driven sampling; and surveys at needle-exchange sites. RESULTS Levels of needle sharing were higher in the earlier studies: RAVEN, 1994 to 1997 (43%) and Kiwi, 1998 to 2002 (61%). In the NHBS surveys, the initial level of 44% in 2005 declined to 31% in the period 2009 to 2012. Across needle-exchange surveys (2009-2013) the level was 21%. There was a parallel reduction in sharing other injection equipment. These trends persisted after control for sociodemographic and risk-associated variables. There was a contemporaneous increase in the number of needles distributed by local needle exchanges and a decline in the number of reported HIV cases among injection drug users. CONCLUSIONS The apparent long-term reduction in sharing injection equipment suggests substantial success in public health efforts to reduce the sharing of injection equipment.
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Affiliation(s)
- Richard D Burt
- The authors are with the HIV/STD Program, Public Health-Seattle & King County, Seattle, WA
| | - Hanne Thiede
- The authors are with the HIV/STD Program, Public Health-Seattle & King County, Seattle, WA
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Cipriano LE, Zaric GS, Holodniy M, Bendavid E, Owens DK, Brandeau ML. Cost effectiveness of screening strategies for early identification of HIV and HCV infection in injection drug users. PLoS One 2012; 7:e45176. [PMID: 23028828 PMCID: PMC3445468 DOI: 10.1371/journal.pone.0045176] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 08/17/2012] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To estimate the cost, effectiveness, and cost effectiveness of HIV and HCV screening of injection drug users (IDUs) in opioid replacement therapy (ORT). DESIGN Dynamic compartmental model of HIV and HCV in a population of IDUs and non-IDUs for a representative U.S. urban center with 2.5 million adults (age 15-59). METHODS We considered strategies of screening individuals in ORT for HIV, HCV, or both infections by antibody or antibody and viral RNA testing. We evaluated one-time and repeat screening at intervals from annually to once every 3 months. We calculated the number of HIV and HCV infections, quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs). RESULTS Adding HIV and HCV viral RNA testing to antibody testing averts 14.8-30.3 HIV and 3.7-7.7 HCV infections in a screened population of 26,100 IDUs entering ORT over 20 years, depending on screening frequency. Screening for HIV antibodies every 6 months costs $30,700/QALY gained. Screening for HIV antibodies and viral RNA every 6 months has an ICER of $65,900/QALY gained. Strategies including HCV testing have ICERs exceeding $100,000/QALY gained unless awareness of HCV-infection status results in a substantial reduction in needle-sharing behavior. DISCUSSION Although annual screening for antibodies to HIV and HCV is modestly cost effective compared to no screening, more frequent screening for HIV provides additional benefit at less cost. Screening individuals in ORT every 3-6 months for HIV infection using both antibody and viral RNA technologies and initiating ART for acute HIV infection appears cost effective.
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Affiliation(s)
- Lauren E Cipriano
- Department of Management Science and Engineering, Stanford University, Stanford, California, USA.
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Mitchell MM, Latimer WW. Unprotected casual sex and perceived risk of contracting HIV among drug users in Baltimore, Maryland: evaluating the influence of non-injection versus injection drug user status. AIDS Care 2009; 21:221-30. [PMID: 19229692 DOI: 10.1080/09540120801982897] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The purpose of this study was to assess the relative importance and interactive effects of drug use status (i.e. injection or non-injection drug user) and condom use with casual partners in predicting perceived risk of contracting HIV among drug users in Baltimore, Maryland. Baseline data was used from the longitudinal NEURO-HIV Epidemiological Study. This battery of questionnaires assessed a variety of demographic, drug use and sex risk variables. The current study examined these variables in association with perceived risk of contracting HIV. Significant covariates included having at least some college education (AOR=.42, 95%CI=.20, .89), knowing someone who is HIV-positive (AOR = 1.82, 95%CI = 1.15, 2.89), using drugs twice (AOR = 2.02, 95%CI = 1.02, 3.99) or more (AOR = 2.22, 95%CI = 1.22, 4.04) per day and having unprotected casual sex (AOR = 2.51, 95%CI = 1.42, 4.41). These covariates explained 15% of the variance in perceived HIV risk. A significant interaction between type of drug user and having unprotected casual sex revealed that the greatest likelihood of perceived HIV risk associated with unprotected casual sex occurred among non-injection drug users. The results suggest that non-injection drug users are aware of their risk for contracting HIV if they engage in unprotected casual sex. Future HIV-prevention programs should build on this awareness by targeting this subgroup of drug users for condom-use interventions with casual partners. Additional programs should target injection drug users to increase their perceived risk of contracting HIV through unprotected casual sex.
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Affiliation(s)
- Mary M Mitchell
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
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Burt RD, Thiede H, Barash ET, Sabin K. Recent condom use by arrested injection drug users in King County, Washington, USA. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2006. [DOI: 10.1016/j.drugpo.2006.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Vlahov D, Celentano DD. Access to highly active antiretroviral therapy for injection drug users: adherence, resistance, and death. CAD SAUDE PUBLICA 2006; 22:705-18. [PMID: 16612417 DOI: 10.1590/s0102-311x2006000400002] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Injection drug users (IDUs) continue to comprise a major risk group for HIV infection throughout the world and represent the focal population for HIV epidemics in Asia and Eastern Europe/Russia. HIV prevention programs have ranged from HIV testing and counseling, education, behavioral and network interventions, drug abuse treatment, bleach disinfection of needles, needle exchange and expanded syringe access, as well as reducing transition to injection and primary substance abuse prevention. With the advent of highly active antiretroviral therapy (HAART) in 1996, dramatic clinical improvements have been seen. In addition, the treatment's impact on reducing HIV viral load (and therefore transmission by all routes) provides a stronger rationale for an expansion of the focus on prevention to emphasize early identification and treatment of HIV infected individuals. However, treatment of IDUs has many challenges including adherence, resistance and relapse to high risk behaviors, all of which impact issues of access and ultimately effectiveness of potent antiretroviral treatment. A major current challenge in addressing the HIV epidemic revolves around an appropriate approach to HIV treatment for IDUs.
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Affiliation(s)
- David Vlahov
- Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York 10029, USA.
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McNeely J, Arnsten JH, Gourevitch MN. Sterile syringe access and disposal among injection drug users newly enrolled in methadone maintenance treatment: a cross-sectional survey. Harm Reduct J 2006; 3:8. [PMID: 16503997 PMCID: PMC1402270 DOI: 10.1186/1477-7517-3-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2006] [Accepted: 02/18/2006] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND We sought to assess injection practices, means of acquiring and disposing of syringes, and utilization and knowledge of harm reduction resources among injection drug users (IDUs) entering methadone maintenance treatment (MMT). METHODS Interviews with 100 consecutive patients, including 35 IDUs, entering a MMT program in the Bronx, NY. RESULTS Utilization of unsafe syringe sources was reported by 69% of IDUs in our sample. Most (80%) IDUs reused syringes, and syringe sharing was also common. Fewer than half knew that non-prescription pharmacy purchase of syringes was possible. The most common means of disposing of injecting equipment were the trash (63%) and syringe exchange programs (49%). CONCLUSIONS These findings indicate that drug users entering treatment under-utilize sanctioned venues to obtain sterile syringes or safely dispose of used injection equipment. Programs providing services to drug users should adopt a proactive stance to address the safety and health issues faced by injectors.
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Affiliation(s)
- Jennifer McNeely
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Julia H Arnsten
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Marc N Gourevitch
- Division of General Internal Medicine, Department of Medicine, New York University School of Medicine, New York, NY, USA
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Longshore D, Stein JA, Chin D. Pathways to sexual risk reduction: Gender differences and strategies for intervention. AIDS Behav 2006; 10:93-104. [PMID: 16385391 DOI: 10.1007/s10461-005-9053-7] [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: 10/25/2022]
Abstract
Using the AIDS risk reduction model as our conceptual framework and structural equation modeling as our analytic tool, we tested psychosocial antecedents of sexual risk reduction among heterosexually active men and women who use illegal drugs. With baseline sexual risk behavior controlled, stronger commitment to safer sex predicted less sexual risk behavior for both men and women. For men but not women, greater AIDS knowledge predicted safer sex commitment. For women but not men, higher self-efficacy predicted stronger commitment to safer sex, and peer norms favoring sexual risk reduction predicted higher self-efficacy. Intervention for men should focus on increasing safer sex commitment and AIDS knowledge. Intervention for women should promote safer sex commitment by raising self-efficacy for sexual risk reduction.
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Affiliation(s)
- Douglas Longshore
- Drug Abuse Research Center, University of California, Los Angeles, California, USA.
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Abstract
Injection drug users (IDUs) transmit the human immunodeficiency virus (HIV) via both needle sharing and sex. This analysis explores the effects of population risk behaviors, intervention effectiveness, intervention costs, and budget and capacity constraints when allocating funds between two prevention programs to maximize effectiveness. The two interventions, methadone maintenance and street outreach, address different types of risk behavior. We developed a model of the spread of HIV and divided IDUs into susceptible (uninfected) persons and infective persons and separately portrayed sex and injection risk. We simulated the epidemic in San Francisco, California, and New York City for periods from the mid-1980s to the mid-1990s and incorporated the behavioral effects of the two interventions. We used the simulation to find the allocation of a fixed budget to the two interventions that averted the greatest number of infections in the IDUs and their noninjecting sex partners. We assumed that interventions have increasing marginal costs. In the epidemic scenarios, our analysis found that the best allocation nearly always involves spending as much as possible on street outreach. This result is largely insensitive to variations in epidemic scenario, intervention efficacy, and cost. However, the absolute and relative benefits of the best allocation varied. In mid-1990s San Francisco, maximizing spending on outreach averted 3.5% of total HIV infections expected and 10 times the 0.3% from maximizing spending on treatment. In late 1980s New York City, the difference is five-fold (2.6% vs. 0.44%, respectively). Our analyses suggest that, even though prevention works better in higher risk scenarios, the choice of intervention mix is more important in the lower risk scenarios. Models and analyses such as those presented here may help decision makers adapt individual prevention programs to their own communities and to reallocate resources among programs to reflect the evolution of their own epidemics.
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Affiliation(s)
- Amy R Wilson
- Division of Health Services Research and Policy, School of Public Health, University of Minnesota, Twin Cities, MN, USA.
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Abstract
OBJECTIVES In this article, the authors determine the optimal allocation of HIV prevention funds and investigate the impact of different allocation methods on health outcomes. METHODS The authors present a resource allocation model that can be used to determine the allocation of HIV prevention funds that maximizes quality-adjusted life years (or life years) gained or HIV infections averted in a population over a specified time horizon. They apply the model to determine the allocation of a limited budget among 3 types of HIV prevention programs in a population of injection drug users and nonusers: needle exchange programs, methadone maintenance treatment, and condom availability programs. For each prevention program, the authors estimate a production function that relates the amount invested to the associated change in risky behavior. RESULTS The authors determine the optimal allocation of funds for both objective functions for a high-prevalence population and a low-prevalence population. They also consider the allocation of funds under several common rules of thumb that are used to allocate HIV prevention resources. It is shown that simpler allocation methods (e.g., allocation based on HIV incidence or notions of equity among population groups) may lead to alloctions that do not yield the maximum health benefit. CONCLUSIONS The optimal allocation of HIV prevention funds in a population depends on HIV prevalence and incidence, the objective function, the production functions for the prevention programs, and other factors. Consideration of cost, equity, and social and political norms may be important when allocating HIV prevention funds. The model presented in this article can help decision makers determine the health consequences of different allocations of funds.
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Affiliation(s)
- G S Zaric
- Ivey School of Business, University of Western Ontario, London, Canada
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Thiede H, Romero M, Bordelon K, Hagan H, Murrill CS. Using a jail-based survey to monitor HIV and risk behaviors among Seattle area injection drug users. J Urban Health 2001; 78:264-78. [PMID: 11419580 PMCID: PMC3456353 DOI: 10.1093/jurban/78.2.264] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Routine monitoring of human immunodeficiency virus (HIV) and risk behaviors among injection drug users (IDUs) is difficult outside drug treatment settings. We developed and implemented a survey of recently arrested IDUs to describe the prevalence of HIV, drug use, and sexual behaviors among them. A probability sampling survey was instituted in the King County Correctional Facility in Seattle, Washington, to sample recently arrested IDUs at the time of booking and in the jail health clinic between 1998 and 1999. Following HIV risk assessment and blood draw, additional information on drug use practices was gathered using a standardized questionnaire. Potential participants who were released from jail early could complete the study at a nearby research storefront office. Of the 4,344 persons intercepted at booking, 503 (12%) reported injection drug use, and 201 of the IDUs (40%) participated in the study. An additional 161 IDUs were enrolled in the study from the jail health clinic. Among the 348 unduplicated subjects, HIV prevalence was 2%; in the past 6 months, 69% reported two or more shooting partners, 72% used a cooker after someone else, 60% shared a syringe to divide up drugs, and 62% injected with used needles. Only 37% reported being hepatitis C seropositive, and 8% reported hepatitis B vaccination. It was feasible to conduct a jail-based survey of recently arrested IDUs that yielded useful information. The high prevalence of reported risky drug use practices warrants ongoing monitoring and illustrates the need for improving prevention programs for HIV and hepatitis B and C in this population, including expansion of hepatitis C screening and provision of hepatitis B vaccination at the jail health clinic.
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Affiliation(s)
- H Thiede
- Public Health, Seattle and King County, Washington 98104, USA.
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Thiede H, Hagan H, Murrill CS. Methadone treatment and HIV and hepatitis B and C risk reduction among injectors in the Seattle area. J Urban Health 2000; 77:331-45. [PMID: 10976608 PMCID: PMC3456044 DOI: 10.1007/bf02386744] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Drug treatment has the potential to reduce incidence of blood-borne infections by helping injection drug users (IDUs) achieve abstinence or by decreasing the frequency of injection and sharing practices. We studied the associations between retention in methadone treatment and drug use behaviors and incidence of hepatitis B and C in a cohort of IDUs in the Seattle, Washington, area. Data on IDUs entering methadone treatment at four centers in King County, Washington, were collected through face-to-face interviews using a standardized questionnaire at baseline and 12-month follow-up between October 1994 and January 1998. Blood specimens were obtained and tested for human immunodeficiency virus (HIV) and hepatitis B and C. Drug treatment status at follow-up was analyzed in relation to study enrollment characteristics and potential treatment outcomes, including injection risk behaviors, cessation or reduced frequency of injection, and incidence of hepatitis B and C. Of 716 IDUs, 292 (41%) left treatment, 198 (28%) disrupted (left and returned) treatment, and 226 (32%) continued treatment throughout the 1-year follow-up period. Compared to those who left treatment, subjects who disrupted or continued were less likely to inject at follow-up (odds ratio [OR] = 0.5, 95% CI 0.3-0.7; and OR = 0.1, 95% CI 0.1-0.2, respectively). Among the 468 (65%) subjects who continued injecting, those who continued treatment injected less frequently, were less likely to pool money to buy drugs (OR = 0.5, 95% CI 0.3-0.8) and inject with used needles (OR = 0.5, 95% CI 0.2-0.8) compared to those who left treatment. Cooker or cotton sharing was not associated with retention in treatment, but hepatitis B incidence was lowest among those who continued treatment. The results of this study suggest drug use risk reduction is more likely to be achieved by those who remain in drug treatment and by those who stop injecting, but that those who drop out and return and those who continue to inject while in treatment may also benefit. This supports the role of consistent drug treatment in an overall harm-reduction strategy.
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Affiliation(s)
- H Thiede
- University of Washington, Department of Epidemiology, Public Health--Seattle-King County, 98104, USA.
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Zaric GS, Barnett PG, Brandeau ML. HIV transmission and the cost-effectiveness of methadone maintenance. Am J Public Health 2000; 90:1100-11. [PMID: 10897189 PMCID: PMC1446290 DOI: 10.2105/ajph.90.7.1100] [Citation(s) in RCA: 175] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study determined the cost-effectiveness of expanding methadone maintenance treatment for heroin addiction, particularly its effect on the HIV epidemic. METHODS We developed a dynamic epidemic model to study the effects of increased methadone maintenance capacity on health care costs and survival, measured as quality-adjusted life-years (QALYs). We considered communities with HIV prevalence among injection drug users of 5% and 40%. RESULTS Additional methadone maintenance capacity costs $8200 per QALY gained in the high-prevalence community and $10,900 per QALY gained in the low-prevalence community. More than half of the benefits are gained by individuals who do not inject drugs. Even if the benefits realized by treated and untreated injection drug users are ignored, methadone maintenance expansion costs between $14,100 and $15,200 per QALY gained. Additional capacity remains cost-effective even if it is twice as expensive and half as effective as current methadone maintenance slots. CONCLUSIONS Expansion of methadone maintenance is cost-effective on the basis of commonly accepted criteria for medical interventions. Barriers to methadone maintenance deny injection drug users access to a cost-effective intervention that generates significant health benefits for the general population.
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Affiliation(s)
- G S Zaric
- Cooperative Studies Program, Palo Alto Veterans Affairs Health Care System, Menlo Park, Calif. 94025, USA
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