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King C, Cook R, Giang LM, Bart G, Hoffman K, Waddell EN, Korthuis PT. Incarceration and compulsory rehabilitation impede use of medication for opioid use disorder and HIV care engagement in Vietnam. J Subst Abuse Treat 2022; 134:108451. [PMID: 33962813 PMCID: PMC8558110 DOI: 10.1016/j.jsat.2021.108451] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND Non-prescribed opioid use is illegal in Vietnam. People who are apprehended for use of non-prescribed opioids may be arrested and incarcerated or sent to compulsory rehabilitation centers. For those on medication to treat opioid use disorder (MOUD), incarceration in either setting may disrupt treatment. This study estimates the effects of incarceration and compulsory rehabilitation on MOUD and HIV treatment outcomes in Vietnam. METHODS Data are from a clinical trial testing the effects of MOUD on HIV viral suppression in six Vietnamese HIV clinics. Participants were assessed quarterly for 12 months. We assessed the associations between incarceration or compulsory rehabilitation during months 0-9 and study outcomes of receipt of MOUD, HIV clinic engagement, and antiretroviral therapy prescription during months 9-12, among those who were released by month 9 of the study, using logistic regression and zero-inflated negative binomial models. RESULTS At nine months, 25 of 258 participants (9.7%) were incarcerated or sent to compulsory rehabilitation at least once and completed the month 9 assessment. Of those, 19 (76.0%) did not receive MOUD in months 9 through 12. Both incarceration and compulsory rehabilitation were negatively associated with subsequent receipt of MOUD (aOR = 0.05, 95% CI = (0.01, 0.24); 0.14 (0.04, 0.50), respectively) and HIV clinic engagement (aOR = 0.13, 95% CI = (0.03, 0.71); 0.09 (0.02, 0.39), respectively). In the final three months of the study, participants who were incarcerated had 42.5 fewer days of MOUD (95% CI = 23.1, 61.9), and participants in compulsory rehabilitation had 46.1 fewer days of MOUD (95% CI = 33.8, 58.4) than those not incarcerated or in compulsory rehabilitation. CONCLUSION Our findings suggest that both incarceration and compulsory rehabilitation disrupt MOUD and HIV treatment among people with HIV and Opioid Use Disorder in Vietnam. Prioritization of evidence-based strategies to support engagement in care for people who use drugs could potentially expand HIV and Opioid Use Disorder treatment access and curb substance use more effectively than reliance on incarceration or compulsory rehabilitation.
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Affiliation(s)
- Caroline King
- MD/PhD Program, Oregon Health & Science University, Portland, OR, USA; Dept. of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA.
| | - Ryan Cook
- Addiction Medicine Program, Dept. of Medicine, Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, OR, USA
| | - Le Minh Giang
- Center for Training and Research on Substance Abuse-HIV, Hanoi Medical University, Viet Nam
| | - Gavin Bart
- Hennepin Healthcare, University of Minnesota, Minneapolis, MN, USA
| | - Kim Hoffman
- Addiction Medicine Program, Dept. of Medicine, Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, OR, USA; Oregon Health & Science University-Portland State University School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Elizabeth Needham Waddell
- Addiction Medicine Program, Dept. of Medicine, Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, OR, USA; Oregon Health & Science University-Portland State University School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - P Todd Korthuis
- Addiction Medicine Program, Dept. of Medicine, Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, OR, USA; Oregon Health & Science University-Portland State University School of Public Health, Oregon Health & Science University, Portland, OR, USA
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Gjersing L, Bretteville-Jensen AL. Characteristics and risk of incarceration among "hard-to-reach" people who use drugs: A five-year prospective cohort study combining self-reports and registry data. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 95:103288. [PMID: 34004380 DOI: 10.1016/j.drugpo.2021.103288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 04/12/2021] [Accepted: 04/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Incarcerations are associated with an increased risk of morbidity and mortality among people who use drugs (PWUD). In a sample of 884 PWUD, we examine and estimate the risk of incarcerations (i.e., number, duration, and most serious offense). METHODS In this prospective cohort study, PWUD were recruited from street- and low-threshold services in seven Norwegian cities in 2013 (Sept-Nov), and followed through the Correctional Service Registry until 20.12.2018. The risk of incarceration during follow-up was examined with multivariable logistic (no incarceration vs. at least one) and multinomial regression models ("no incarcerations", vs. "1″, "≥2″), while accounting for gender, age, homelessness/shelter use, opioid substitution treatment, illegal income sources, injecting behaviours, previous incarcerations, and recruitment city. RESULTS During follow-up, there were in total 662 incarceration episodes, and 44.7% of the participants were incarcerated at least once. Overall, 37.5% of those incarcerated had at least one episode due to a drug offense. The average incarceration duration was 65.2 days with 3.5% of the episodes lasting ≥one year. Gender (male), homelessness/shelter use, illegal income sources, injecting stimulants, and previous incarcerations increased the odds of incarceration, while older age decreased the odds. Gender (male), younger age, self-reported theft or theft and dealing, injecting stimulants or heroin and stimulants and previous incarcerations increased the risk of multiple incarcerations. CONCLUSION In a five-year prospective study of PWUD, incarcerations were common, and short-term sentences and recidivism were the norm. This is of concern as incarcerations add to an already elevated morbidity and mortality risk in this population.
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Affiliation(s)
- Linn Gjersing
- Norwegian Institute of Public Health, Department of Alcohol, Tobacco and Drugs, Postboks 222 Skøyen, 0213 Oslo, Norway.
| | - Anne Line Bretteville-Jensen
- Norwegian Institute of Public Health, Department of Alcohol, Tobacco and Drugs, Postboks 222 Skøyen, 0213 Oslo, Norway
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A Zigzag but Upward Way to Develop an HIV-1 Vaccine. Vaccines (Basel) 2020; 8:vaccines8030511. [PMID: 32911701 PMCID: PMC7564621 DOI: 10.3390/vaccines8030511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 01/04/2023] Open
Abstract
After decades of its epidemic, the human immunodeficiency virus type 1 (HIV-1) is still rampant worldwide. An effective vaccine is considered to be the ultimate strategy to control and prevent the spread of HIV-1. To date, hundreds of clinical trials for HIV-1 vaccines have been tested. However, there is no HIV-1 vaccine available yet, mostly because the immune correlates of protection against HIV-1 infection are not fully understood. Currently, a variety of recombinant viruses-vectored HIV-1 vaccine candidates are extensively studied as promising strategies to elicit the appropriate immune response to control HIV-1 infection. In this review, we summarize the current findings on the immunological parameters to predict the protective efficacy of HIV-1 vaccines, and highlight the latest advances on HIV-1 vaccines based on viral vectors.
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Larijani MS, Ramezani A, Sadat SM. Updated Studies on the Development of HIV Therapeutic Vaccine. Curr HIV Res 2020; 17:75-84. [PMID: 31210114 DOI: 10.2174/1570162x17666190618160608] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Among the various types of pharmaceuticals, vaccines have a special place. However, in the case of HIV, nearly after 40 years of its discovery, an effective vaccine still is not available. The reason lies in several facts mainly the variability and smartness of HIV as well as the complexity of the interaction between HIV and immune responses. A robust, effective, and longterm immunity is undoubtedly what a successful preventive vaccine should induce in order to prevent the infection of HIV. Failure of human trials to this end has led to the idea of developing therapeutic vaccines with the purpose of curing already infected patients by boosting their immune responses against the virus. Nevertheless, the exceptional ability of the virus to escape the immune system based on the genetically diverse envelope and variable protein products have made it difficult to achieve an efficient therapeutic vaccine. OBJECTIVE We aimed at studying and comparing different approaches to HIV therapeutic vaccines. METHODS In this review, we summarized the human trials undergoing on HIV therapeutic vaccination which are registered in the U.S. clinical trial database (clinicaltrials.gov). These attempts are divided into different tables, according to the type of formulation and application in order to classify and compare their results. RESULT/CONCLUSION Among several methods applied in studied clinical trials which are mainly divided into DNA, Protein, Peptide, Viral vectors, and Dendritic cell-based vaccines, protein vaccine strategy is based on Tat protein-induced anti-Tat Abs in 79% HIV patients. However, the studies need to be continued to achieve a durable efficient immune response against HIV-1.
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Affiliation(s)
- Mona Sadat Larijani
- Hepatitis, AIDS, and Bloodborne Diseases Department, Pasteur Institute of Iran, Tehran, Iran
| | - Amitis Ramezani
- Hepatitis, AIDS, and Bloodborne Diseases Department, Pasteur Institute of Iran, Tehran, Iran
| | - Seyed Mehdi Sadat
- Hepatitis, AIDS, and Bloodborne Diseases Department, Pasteur Institute of Iran, Tehran, Iran
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Martin M, Vanichseni S, Sangkum U, Mock PA, Leethochawalit M, Chiamwongpaet S, Pitisuttithum P, Kaewkungwal J, van Griensven F, McNicholl JM, Tappero JW, Mastro TD, Kittimunkong S, Choopanya K. HIV Incidence and Risk Behaviours of People Who Inject Drugs in Bangkok, 1995-2012. EClinicalMedicine 2019; 9:44-51. [PMID: 31143881 PMCID: PMC6510716 DOI: 10.1016/j.eclinm.2019.03.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 03/15/2019] [Accepted: 03/19/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Three consecutive prospective studies were conducted among people who inject drugs (PWID) from May 1995 through June 2012 in Bangkok, Thailand. We examined data from these studies to evaluate HIV incidence and explore trends in risk behaviours. METHODS We used data from a 1995-1998 cohort study, a 1999-2004 HIV vaccine trial, and a 2005-2012 HIV pre-exposure prophylaxis (PrEP) study to examine per-quarter trends in HIV incidence, using a restricted cubic spline function for time in a Poisson regression. We also examined temporal trends in HIV-associated risk behaviours. FINDINGS HIV incidence declined from 5.7 per 100 person-years during the cohort study, to 2.7 per 100 person-years in the vaccine trial, to 0.7 per 100 person-years among PrEP study placebo recipients. Incidence peaked at 12.1 per 100 person-years in 1996 and declined to < 1 per 100 person-years during 2005-2012. Reports of injecting drugs and sharing needles also declined from the cohort study to the PrEP study (p < 0.0001). Heroin was the most common drug injected during the cohort study and the vaccine trial, but stimulants (e.g., methamphetamine) and sedatives (e.g., midazolam) were injected more often during the PrEP study. INTERPRETATION HIV incidence among PWID declined during 2005-2012. Several factors likely contributed to the decline, including decreases in the frequency of injecting and sharing, improved access to HIV testing and antiretroviral therapy, and the use of PrEP. Expanding access to effective HIV prevention tools can hasten control of the HIV epidemic among PWID. FUNDING The Bangkok Metropolitan Administration and U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention.
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Affiliation(s)
- Michael Martin
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA
- Thailand MOPH – U.S. CDC Collaboration, Nonthaburi, Thailand
- Corresponding author at: 4 Igor Sikorsky Street, Kyiv 04112, Ukraine.
| | | | | | - Philip A. Mock
- Thailand MOPH – U.S. CDC Collaboration, Nonthaburi, Thailand
| | | | | | | | | | - Frits van Griensven
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA
- Thai Red Cross AIDS Research Center, Bangkok, Thailand
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Janet M. McNicholl
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA
| | - Jordan W. Tappero
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA
- Bill and Melinda Gates Foundation, Seattle, WA, USA
| | - Timothy D. Mastro
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA
- FHI 360, Durham, NC, USA
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Stone J, Fraser H, Lim AG, Walker JG, Ward Z, MacGregor L, Trickey A, Abbott S, Strathdee SA, Abramovitz D, Maher L, Iversen J, Bruneau J, Zang G, Garfein RS, Yen YF, Azim T, Mehta SH, Milloy MJ, Hellard ME, Sacks-Davis R, Dietze PM, Aitken C, Aladashvili M, Tsertsvadze T, Mravčík V, Alary M, Roy E, Smyrnov P, Sazonova Y, Young AM, Havens JR, Hope VD, Desai M, Heinsbroek E, Hutchinson SJ, Palmateer NE, McAuley A, Platt L, Martin NK, Altice FL, Hickman M, Vickerman P. Incarceration history and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2018; 18:1397-1409. [PMID: 30385157 PMCID: PMC6280039 DOI: 10.1016/s1473-3099(18)30469-9] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/30/2018] [Accepted: 07/12/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND People who inject drugs (PWID) experience a high prevalence of incarceration and might be at high risk of HIV and hepatitis C virus (HCV) infection during or after incarceration. We aimed to assess whether incarceration history elevates HIV or HCV acquisition risk among PWID. METHODS In this systematic review and meta-analysis, we searched MEDLINE, Embase, and PsycINFO databases for studies in any language published from Jan 1, 2000 until June 13, 2017 assessing HIV or HCV incidence among PWID. We included studies that measured HIV or HCV incidence among community-recruited PWID. We included only studies reporting original results and excluded studies that evaluated incident infections by self-report. We contacted authors of cohort studies that met the inclusion or exclusion criteria, but that did not report on the outcomes of interest, to request data. We extracted and pooled data from the included studies using random-effects meta-analyses to quantify the associations between recent (past 3, 6, or 12 months or since last follow-up) or past incarceration and HIV or HCV acquisition (primary infection or reinfection) risk among PWID. We assessed the risk of bias of included studies using the Newcastle-Ottawa Scale. Between-study heterogeneity was evaluated using the I2 statistic and the P-value for heterogeneity. FINDINGS We included published results from 20 studies and unpublished results from 21 studies. These studies originated from Australasia, western and eastern Europe, North and Latin America, and east and southeast Asia. Recent incarceration was associated with an 81% (relative risk [RR] 1·81, 95% CI 1·40-2·34) increase in HIV acquisition risk, with moderate heterogeneity between studies (I2=63·5%; p=0·001), and a 62% (RR 1·62, 95% CI 1·28-2·05) increase in HCV acquisition risk, also with moderate heterogeneity between studies (I2=57·3%; p=0·002). Past incarceration was associated with a 25% increase in HIV (RR 1·25, 95% CI 0·94-1·65) and a 21% increase in HCV (1·21, 1·02-1·43) acquisition risk. INTERPRETATION Incarceration is associated with substantial short-term increases in HIV and HCV acquisition risk among PWID and could be a significant driver of HCV and HIV transmission among PWID. These findings support the need for developing novel interventions to minimise the risk of HCV and HIV acquisition, including addressing structural risks associated with drug laws and excessive incarceration of PWID. FUNDING Engineering and Physical Sciences Research Council, National Institute for Health Research, National Institutes of Health.
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Affiliation(s)
- Jack Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Hannah Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Aaron G Lim
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Josephine G Walker
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Zoe Ward
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Louis MacGregor
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Adam Trickey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sam Abbott
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Daniela Abramovitz
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Lisa Maher
- Kirby Institute for Infection and Immunity, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Jenny Iversen
- Kirby Institute for Infection and Immunity, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Julie Bruneau
- Department of Family Medicine, Université de Montréal, Montréal, QC, Canada; Centre hospitalier de l'Université de Montreal, Montréal, QC, Canada
| | - Geng Zang
- Centre hospitalier de l'Université de Montreal, Montréal, QC, Canada
| | - Richard S Garfein
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Yung-Fen Yen
- Section of Infectious Diseases, Taipei City Hospital, Taipei City Government, Taipei, Taiwan
| | - Tasnim Azim
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael-John Milloy
- BC Centre for Excellence in HIV/AIDS and Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Margaret E Hellard
- Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Rachel Sacks-Davis
- Burnet Institute, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | | | | | - Malvina Aladashvili
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Tengiz Tsertsvadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; Faculty of Medicine, Tbilisi State University, Tbilisi, Georgia
| | - Viktor Mravčík
- National Monitoring Centre for Drugs and Addiction, Prague, Czech Republic; Department of Addictology, The First Medical Faculty, Charles University and General University Hospital in Prague, Prague, Czech Republic; National Institute of Mental Health, Klecany, Czech Republic
| | - Michel Alary
- University Hospital Centre of Québec Research Centre-Laval University, QC, Canada; National Institute of Public Health of Québec, QC, Canada
| | - Elise Roy
- National Institute of Public Health of Québec, QC, Canada; Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, QC, Canada
| | - Pavlo Smyrnov
- International Charitable Foundation Alliance for Public Health, Kiev, Ukraine
| | - Yana Sazonova
- International Charitable Foundation Alliance for Public Health, Kiev, Ukraine
| | - April M Young
- Department of Epidemiology, University of Kentucky College of Public Health, KY, USA; Center on Drug and Alcohol Research, University of Kentucky, KY, USA
| | - Jennifer R Havens
- Center on Drug and Alcohol Research, University of Kentucky, KY, USA
| | - Vivian D Hope
- Public Health Institute, Liverpool John Moores University, Liverpool, UK; National Infection Service, Public Health England, London, UK
| | - Monica Desai
- National Infection Service, Public Health England, London, UK
| | | | - Sharon J Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, National Health Service National Services Scotland, Glasgow, UK
| | - Norah E Palmateer
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, National Health Service National Services Scotland, Glasgow, UK
| | - Andrew McAuley
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Natasha K Martin
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Frederick L Altice
- Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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DeBeck K, Cheng T, Montaner JS, Beyrer C, Elliott R, Sherman S, Wood E, Baral S. HIV and the criminalisation of drug use among people who inject drugs: a systematic review. Lancet HIV 2017; 4:e357-e374. [PMID: 28515014 PMCID: PMC6005363 DOI: 10.1016/s2352-3018(17)30073-5] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/22/2017] [Accepted: 03/09/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Mounting evidence suggests that laws and policies prohibiting illegal drug use could have a central role in shaping health outcomes among people who inject drugs (PWID). To date, no systematic review has characterised the influence of laws and legal frameworks prohibiting drug use on HIV prevention and treatment. METHODS Consistent with PRISMA guidelines, we did a systematic review of peer-reviewed scientific evidence describing the association between criminalisation of drug use and HIV prevention and treatment-related outcomes among PWID. We searched MEDLINE, Embase, SCOPUS, PsycINFO, Sociological Abstracts, CINAHL, Web of Science, and other sources. To be included in our review, a study had to meet the following eligibility criteria: be published in a peer-reviewed journal or presented as a peer-reviewed abstract at a scientific conference; examine, through any study design, the association between an a-priori set of indicators related to the criminalisation of drugs and HIV prevention or treatment among PWID; provide sufficient details on the methods followed to allow critical assessment of quality; be published or presented between Jan 1, 2006, and Dec 31, 2014; and be published in the English language. FINDINGS We identified 106 eligible studies comprising 29 longitudinal, 49 cross-sectional, 22 qualitative, two mixed methods, four mathematical modelling studies, and no randomised controlled trials. 120 criminalisation indicators were identified (range 1-3 per study) and 150 HIV indicators were identified (1-5 per study). The most common criminalisation indicators were incarceration (n=38) and street-level policing (n=39), while the most frequent HIV prevention and treatment indicators were syringe sharing (n=35) and prevalence of HIV infection among PWID (n=28). Among the 106 studies included in this review, 85 (80%) suggested that drug criminalisation has a negative effect on HIV prevention and treatment, 10 (9%) suggested no association, five (5%) suggested a beneficial effect, one (1%) suggested both beneficial and negative effects, and five (5%) suggested both null and negative effects. INTERPRETATION These data confirm that criminalisation of drug use has a negative effect on HIV prevention and treatment. Our results provide an objective evidence base to support numerous international policy initiatives to reform legal and policy frameworks criminalising drug use. FUNDING Canadian Institutes of Health Research and US National Institutes of Health.
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Affiliation(s)
- Kora DeBeck
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; School of Public Policy, Simon Fraser University, Vancouver, BC, Canada
| | - Tessa Cheng
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Julio S Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Chris Beyrer
- Centre for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | | | - Susan Sherman
- Centre for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Stefan Baral
- Centre for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD, USA.
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Sawitri AAS, Hartawan AAG, Craine N, Sari AK, Septarini NW, Wirawan DN. Injecting drug use, sexual risk, HIV knowledge and harm reduction uptake in a large prison in Bali, Indonesia. Int J Prison Health 2016; 12:27-38. [PMID: 26933990 DOI: 10.1108/ijph-05-2014-0011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to describe HIV-related risk behavior and knowledge of HIV among inmates of Kerobokan prison Bali, Indonesia. DESIGN/METHODOLOGY/APPROACH A cross-sectional survey of inmates of using a structured questionnaire and sample framework to reflect narcotic use among inmates and the prison gender mix. FINDINGS Among 230 inmates recruited to the study self-reported prevalence of injecting drug use was 7.4 percent (95 percent CI 4.0-10.8 percent). Respondents who participated in a prison based methadone treatment program were all still injecting drugs, these made up 13/17 of the IDU. In total, 47 percent (95 percent CIs 45-55 percent) of respondents who reported injecting also reported sharing needles within the last week. Sexual intercourse while in prison was reported by 3.0 percent (95 percent CI 0.82-5.26 percent) of study respondents. One-third of non-injectors were unaware of the preventative role of condom use. This study suggests that despite harm reduction initiatives within Kerobokan prison HIV risk behavior continues and there is a considerable lack of awareness of the importance of condom use in preventing HIV. RESEARCH LIMITATIONS/IMPLICATIONS The authors relied on self-reported risk behavior that may be subject to reporting bias. The sampling strategy may not reflect the true ratio inmates using or not using narcotics. PRACTICAL IMPLICATIONS The current harm reduction approach, including methadone substitution treatment should be optimized within the Indonesian prison setting. ORIGINALITY/VALUE This is the first study reporting HIV-related risk behavior from an Indonesian prison with an established methadone substitution program.
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Page K, Bacon O. Commitment issues: PrEP adherence in injecting drug users. Lancet HIV 2016; 4:e52-e53. [PMID: 27866872 DOI: 10.1016/s2352-3018(16)30208-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 10/09/2016] [Accepted: 10/10/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Kimberly Page
- Division of Epidemiology, Biostatistics and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
| | - Oliver Bacon
- Division of HIV, Infectious Disease, and Global Health, Department of Medicine, University of California San Francisco, San Francisco, CA, USA; San Francisco Department of Public Health, San Francisco, CA, USA
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Martin M, Vanichseni S, Suntharasamai P, Sangkum U, Mock PA, Chaipung B, Worrajittanon D, Leethochawalit M, Chiamwongpaet S, Kittimunkong S, Gvetadze RJ, McNicholl JM, Paxton LA, Curlin ME, Holtz TH, Samandari T, Choopanya K. Factors associated with the uptake of and adherence to HIV pre-exposure prophylaxis in people who have injected drugs: an observational, open-label extension of the Bangkok Tenofovir Study. Lancet HIV 2016; 4:e59-e66. [PMID: 27866873 DOI: 10.1016/s2352-3018(16)30207-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 09/13/2016] [Accepted: 09/16/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Results of the randomised, double-blind, placebo-controlled Bangkok Tenofovir Study (BTS) showed that taking tenofovir daily as pre-exposure prophylaxis (PrEP) can reduce the risk of HIV infection by 49% in people who inject drugs. In an extension to the trial, participants were offered 1 year of open-label tenofovir. We aimed to examine the demographic characteristics, drug use, and risk behaviours associated with participants' uptake of and adherence to PrEP. METHODS In this observational, open-label extension of the BTS (NCT00119106), non-pregnant, non-breastfeeding, HIV-negative BTS participants, all of whom were current or previous injecting drug users at the time of enrolment in the BTS, were offered daily oral tenofovir (300 mg) for 1 year at 17 Bangkok Metropolitan Administration drug-treatment clinics. Participant demographics, drug use, and risk behaviours were assessed at baseline and every 3 months using an audio computer-assisted self-interview. HIV testing was done monthly and serum creatinine was assessed every 3 months. We used logistic regression to examine factors associated with the decision to take daily tenofovir as PrEP, the decision to return for at least one PrEP follow-up visit, and greater than 90% adherence to PrEP. FINDINGS Between Aug 1, 2013, and Aug 31, 2014, 1348 (58%) of the 2306 surviving BTS participants returned to the clinics, 33 of whom were excluded because they had HIV (n=27) or grade 2-4 creatinine results (n=6). 798 (61%) of the 1315 eligible participants chose to start open-label PrEP and were followed up for a median of 335 days (IQR 0-364). 339 (42%) participants completed 12 months of follow-up; 220 (28%) did not return for any follow-up visits. Participants who were 30 years or older (odds ratio [OR] 1·8, 95% CI 1·4-2·2; p<0·0001), injected heroin (OR 1·5, 1·1-2·1; p=0·007), or had been in prison (OR 1·7, 1·3-2·1; p<0·0001) during the randomised trial were more likely to choose PrEP than were those without these characteristics. Participants who reported injecting heroin or being in prison during the 3 months before open-label enrolment were more likely to return for at least one open-label follow-up visit than those who did not report injecting heroin (OR 3·0, 95 % CI 1·3-7·3; p=0·01) or being in prison (OR 2·3, 1·4-3·7; p=0·0007). Participants who injected midazolam or were in prison during open-label follow-up were more likely to be greater than 90% adherent than were those who did not inject midazolam (OR 2·2, 95% CI 1·2-4·3; p=0·02) or were not in prison (OR 4·7, 3·1-7·2; p<0·0001). One participant tested positive for HIV, yielding an HIV incidence of 2·1 (95% CI 0·05-11·7) per 1000 person-years. No serious adverse events related to tenofovir use were reported. INTERPRETATION More than 60% of returning, eligible BTS participants started PrEP, which indicates that a substantial proportion of PWID who are knowledgeable about PrEP might be interested in taking it. Participants who had injected heroin or been in prison were more likely to choose to take PrEP, suggesting that participants based their decision to take PrEP, at least in part, on their perceived risk of incident HIV infection. FUNDING US Centers for Disease Control and Prevention and the Bangkok Metropolitan Administration.
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Affiliation(s)
- Michael Martin
- Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand; Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | | | | | - Udomsak Sangkum
- Bangkok Tenofovir Study Group, Taksin Hospital, Bangkok, Thailand
| | - Philip A Mock
- Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Benjamaporn Chaipung
- Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Dararat Worrajittanon
- Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | | | | | - Somyot Kittimunkong
- Department of Disease Control, Thailand Ministry of Public Health, Nonthaburi, Thailand
| | | | | | - Lynn A Paxton
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marcel E Curlin
- Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand; Centers for Disease Control and Prevention, Atlanta, GA, USA; Division of Infectious Diseases, Oregon Health and Sciences University, Portland, OR, USA
| | - Timothy H Holtz
- Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand; Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Taraz Samandari
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kachit Choopanya
- Bangkok Tenofovir Study Group, Taksin Hospital, Bangkok, Thailand
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Thomas T, Seay K, Zheng JH, Zhang C, Ochsenbauer C, Kappes JC, Goldstein H. High-Throughput Humanized Mouse Models for Evaluation of HIV-1 Therapeutics and Pathogenesis. Methods Mol Biol 2016; 1354:221-35. [PMID: 26714715 DOI: 10.1007/978-1-4939-3046-3_15] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Mice cannot be used as a model to evaluate HIV-1 therapeutics because they do not become infected by HIV-1 due to structural differences between several human and mouse proteins required for HIV-1 replication. This has limited their use for in vivo assessment of anti-HIV-1 therapeutics and the mechanism by which cofactors, such as illicit drug use accelerate HIV-1 replication and disease course in substance abusers. Here, we describe the development and application of two in vivo humanized mouse models that are highly sensitive and useful models for the in vivo evaluation of candidate anti-HIV therapeutics. The first model, hu-spl-PBMC-NSG mice, uses NOD-SCID IL2rγ(-/-) (NSG) mice intrasplenically injected with human peripheral blood mononuclear cells (PBMC) which develop productive splenic HIV-1 infection after intrasplenic inoculation with a replication-competent HIV-1 expressing Renilla reniformis luciferase (HIV-LucR) and enables investigators to use bioluminescence to visualize and quantitate the temporal effects of therapeutics on HIV-1 infection. The second model, hCD4/R5/cT1 mice, consists of transgenic mice carrying human CD4, CCR5 and cyclin T1 genes, which enables murine CD4-expressing cells to support HIV-1 entry, Tat-mediated LTR transcription and consequently develop productive infection. The hCD4/R5/cT1 mice develop disseminated infection of tissues including the spleen, small intestine, lymph nodes and lungs after intravenous injection with HIV-1-LucR. Because these mice can be infected with HIV-LucR expressing transmitted/founder and clade A/E and C Envs, these mouse models can also be used to evaluate the in vivo efficacy of broadly neutralizing antibodies and antibodies induced by candidate HIV-1 vaccines. Furthermore, because hCD4/R5/cT1 mice can be infected by vaginal inoculation with replication-competent HIV-1 expressing NanoLuc (HIV-nLucR)-, this mouse model can be used to evaluate the mechanisms by which substance abuse and other factors enhance mucosal transmission of HIV-1.
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Affiliation(s)
- Tynisha Thomas
- Departments of Microbiology & Immunology, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Kieran Seay
- Departments of Microbiology & Immunology, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Jian Hua Zheng
- Departments of Microbiology & Immunology, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Cong Zhang
- Departments of Microbiology & Immunology, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Christina Ochsenbauer
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - John C Kappes
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294, USA.,Birmingham Veterans Affairs Medical Center, Research Service, Birmingham, AL, 35294, USA
| | - Harris Goldstein
- Departments of Microbiology & Immunology, Albert Einstein College of Medicine, Bronx, NY, 10461, USA. .,Departments of Pediatrics, Albert Einstein College of Medicine, Forchheimer Building, Room 408, 1300 Morris Park Avenue, Bronx, NY, 10461, USA.
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Piralishvili G, Otiashvili D, Sikharulidze Z, Kamkamidze G, Poole S, Woody GE. Opioid Addicted Buprenorphine Injectors: Drug Use During and After 12-Weeks of Buprenorphine–Naloxone or Methadone in the Republic of Georgia. J Subst Abuse Treat 2015; 50:32-7. [DOI: 10.1016/j.jsat.2014.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Revised: 10/03/2014] [Accepted: 10/06/2014] [Indexed: 12/19/2022]
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Yen YF, Yen MY, Lin T, Li LH, Jiang XR, Chou P, Deng CY. Prevalence and factors associated with HIV infection among injection drug users at methadone clinics in Taipei, Taiwan. BMC Public Health 2014; 14:682. [PMID: 24996558 PMCID: PMC4098925 DOI: 10.1186/1471-2458-14-682] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 06/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Methadone treatment was introduced in Taiwan in 2006 as a harm-reduction program for injection drug users (IDUs), among whom HIV was endemic. We examined the association of HIV serostatus with demographic characteristics, substance use, and sexual behaviors among IDUs at methadone clinics in Taipei, Taiwan. METHODS During 2012-2013, IDUs at methadone clinics in Taipei were recruited to complete a risk assessment interview and undergo serologic testing for HIV infection. Correlates of HIV infection were identified by multivariate logistic regression. RESULTS Of the 827 eligible participants, 85.9% were male, median age was 45 years, and mean years of injecting was 18.0 (range 1-56). The prevalence of HIV infection was 17.7%. In multivariate analysis, HIV infection was significantly associated with age ≤ 45 years (adjusted odds ratio [AOR] = 1.62, 95% confidence interval [CI] 1.01-2.62), being divorced (AOR = 1.67, 95% CI 1.06-2.62), deriving the majority of income during the previous 6 months from temporary jobs or other noncriminal sources (AOR = 1.53, 95% CI 1.02-2.30), unstable housing during the previous 6 months (AOR = 1.47, 95% CI 1.003-2.15), higher number of incarcerations (AOR = 1.14, 95% CI 1.03-1.26), and a history of overdose (AOR = 1.51, 95% CI 1.01-2.28). CONCLUSIONS Taiwanese IDUs at methadone clinics have a relatively high HIV prevalence, which was associated with younger age and history of overdose. It is imperative to educate IDUs' about HIV transmission, particularly for the younger and overdosed IDUs.
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Affiliation(s)
- Yung-Feng Yen
- Section of Infectious Diseases, Taipei City Hospital, Taipei City Government, 145, Zhengzhou Rd., Datong Dist., Taipei 10341, Taiwan
- Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, 155, Section 2, Ni-Long Street, Taipei 11221, Taiwan
| | - Muh-Yong Yen
- Department of Disease Control and Prevention, Taipei City Hospital, Taipei City Government, 145, Zhengzhou Rd., Datong Dist., Taipei 10341, Taiwan
| | - Ting Lin
- Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, 155, Section 2, Ni-Long Street, Taipei 11221, Taiwan
| | - Lan-Huei Li
- Department of Disease Control and Prevention, Taipei City Hospital, Taipei City Government, 145, Zhengzhou Rd., Datong Dist., Taipei 10341, Taiwan
| | - Xiao-Ru Jiang
- Department of Disease Control and Prevention, Taipei City Hospital, Taipei City Government, 145, Zhengzhou Rd., Datong Dist., Taipei 10341, Taiwan
| | - Pesus Chou
- Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, 155, Section 2, Ni-Long Street, Taipei 11221, Taiwan
| | - Chung-Yeh Deng
- Institute of Hospital and Health Care Administration, National Yang-Ming University, 155, Section 2, Ni-Long Street, Taipei 11221, Taiwan
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Martin M, Vanichseni S, Suntharasamai P, Sangkum U, Mock PA, Leethochawalit M, Chiamwongpaet S, Gvetadze RJ, Kittimunkong S, Curlin ME, Worrajittanon D, McNicholl JM, Paxton LA, Choopanya K. Risk behaviors and risk factors for HIV infection among participants in the Bangkok tenofovir study, an HIV pre-exposure prophylaxis trial among people who inject drugs. PLoS One 2014; 9:e92809. [PMID: 24667938 PMCID: PMC3965466 DOI: 10.1371/journal.pone.0092809] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 02/26/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION HIV spread rapidly among people who inject drugs in Bangkok in the late 1980s. In recent years, changes in drug use and HIV-associated risk behaviors have been reported. We examined data from the Bangkok Tenofovir Study, an HIV pre-exposure prophylaxis trial conducted among people who inject drugs, to assess participant risk behavior and drug use, and to identify risk factors for HIV infection. METHODS The Bangkok Tenofovir Study was a randomized, double-blind, placebo-controlled trial. HIV status was assessed monthly and risk behavior every 3 months. We used generalized estimating equations logistic regression to model trends of injecting, needle sharing, drugs injected, incarceration, and sexual activity reported at follow-up visits; and proportional hazards models to evaluate demographic characteristics, sexual activities, incarceration, drug injection practices, and drugs injected during follow-up as predictors of HIV infection. RESULTS The proportion of participants injecting drugs, sharing needles, and reporting sex with more than one partner declined during follow-up (p<0.001). Among participants who reported injecting at enrollment, 801 (53.2%) injected methamphetamine, 559 (37.1%) midazolam, and 527 (35.0%) heroin. In multivariable analysis, young age (i.e., 20-29 years) (p = 0.02), sharing needles (p<0.001), and incarceration in prison (p = 0.002) were associated with incident HIV infection. Participants reporting sex with an opposite sex partner, live-in partner, casual partner, or men reporting sex with male partners were not at a significantly higher risk of HIV infection compared to those who did not report these behaviors. CONCLUSION Reports of HIV-associated risk behavior declined significantly during the trial. Young age, needle sharing, and incarceration were independently associated with HIV infection. Sexual activity was not associated with HIV infection, suggesting that the reduction in HIV incidence among participants taking daily oral tenofovir compared to those taking placebo was due to a decrease in parenteral HIV transmission.
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Affiliation(s)
- Michael Martin
- Thailand MOPH – U.S. CDC Collaboration, Nonthaburi, Thailand
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | | | | | | | - Philip A. Mock
- Thailand MOPH – U.S. CDC Collaboration, Nonthaburi, Thailand
| | | | | | - Roman J. Gvetadze
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Marcel E. Curlin
- Thailand MOPH – U.S. CDC Collaboration, Nonthaburi, Thailand
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Janet M. McNicholl
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Lynn A. Paxton
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Ti L, Hayashi K, Kaplan K, Suwannawong P, Wood E, Montaner J, Kerr T. Willingness to access peer-delivered HIV testing and counseling among people who inject drugs in Bangkok, Thailand. J Community Health 2014; 38:427-33. [PMID: 23149569 PMCID: PMC3639360 DOI: 10.1007/s10900-012-9635-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Peer-based models for human immunodeficiency virus (HIV) testing have been implemented to increase access to testing in various settings. However, little is known about the acceptability of peer-delivered testing and counseling among people who inject drugs (IDU). During July and October 2011, data derived from the Mitsampan Community Research Project were used to construct three multivariate logistic regression models identifying factors associated with willingness to receive peer-delivered pre-test counseling, rapid HIV testing, and post-test counseling. Among a total of 348 IDU, 44, 38, and 36 % were willing to receive peer-delivered pre-test counseling, rapid HIV testing, and post-test counseling, respectively. In multivariate analyses, factors associated with willingness to access peer-delivered pre-test counseling included: male gender (adjusted odds ratio (AOR) = 0.48), higher than secondary education (AOR = 1.91), and binge drug use (AOR = 2.29) (all p < 0.05). Factors associated with willingness to access peer-delivered rapid HIV testing included: higher than secondary education (AOR = 2.06), binge drug use (AOR = 2.23), incarceration (AOR = 2.68), avoiding HIV testing (AOR = 0.24), and having been to the Mitsampan Harm Reduction Center (AOR = 1.63) (all p < 0.05). Lastly, binge drug use (AOR = 2.40), incarceration (AOR = 1.94), and avoiding HIV testing (AOR = 0.23) (all p < 0.05) were significantly associated with willingness to access peer-delivered post-test counseling. We found that a substantial proportion of Thai IDU were willing to receive peer-delivered HIV testing and counseling. These findings highlight the potential of peer-delivered testing to complement existing HIV testing programs that serve IDU.
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Affiliation(s)
- Lianping Ti
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC Canada
| | - Kanna Hayashi
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC Canada
| | - Karyn Kaplan
- Thai AIDS Treatment Action Group, Bangkok, Thailand
| | | | - Evan Wood
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, BC Canada
| | - Julio Montaner
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, BC Canada
| | - Thomas Kerr
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, BC Canada
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The potential uses of preexposure prophylaxis for HIV prevention among people who inject drugs. Curr Opin HIV AIDS 2013; 7:563-8. [PMID: 23076122 DOI: 10.1097/coh.0b013e328358e49e] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE OF REVIEW Oral preexposure prophylaxis (PrEP) has shown HIV preventive efficacy for several key populations at risk for HIV infection including MSM and heterosexual men and women in HIV serodiscordant relationships. An efficacy trial of daily oral tenofovir among people who inject drugs (IDU) is underway in Thailand. RECENT FINDINGS Although efficacy data is pending, there is emerging biological and public health plausibility data suggesting the utility of PrEP as an effective component of combination HIV prevention for IDU. Drawing from studies characterizing adherence to antiretroviral therapy for IDU, there are a range of scientific and operational considerations for the potential use of PrEP for IDU. We review here the available literature on the potential use of PrEP for IDU, barriers to uptake and adherence, and potential implementation science questions, which could address, and potently increase, the effectiveness of this intervention. SUMMARY IDU remain the most underserved population in the HIV response worldwide, and have a marked gap in prevention services, making PrEP a potentially promising addition to the prevention toolkit for people who use drugs and, for those already living with HIV infection, for their spouses and other sexual partners.
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MacArthur GJ, Minozzi S, Martin N, Vickerman P, Deren S, Bruneau J, Degenhardt L, Hickman M. Opiate substitution treatment and HIV transmission in people who inject drugs: systematic review and meta-analysis. BMJ 2012; 345:e5945. [PMID: 23038795 PMCID: PMC3489107 DOI: 10.1136/bmj.e5945] [Citation(s) in RCA: 313] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2012] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To quantify the effect of opiate substitution treatment in relation to HIV transmission among people who inject drugs. DESIGN Systematic review and meta-analysis of prospective published and unpublished observational studies. DATA SOURCES Search of Medline, Embase, PsychINFO, and the Cochrane Library from the earliest year to 2011 without language restriction. REVIEW METHODS We selected studies that directly assessed the impact of opiate substitution treatment in relation to incidence of HIV and studies that assessed incidence of HIV in people who inject drugs and that might have collected data regarding exposure to opiate substitution treatment but not have reported it. Authors of these studies were contacted. Data were extracted by two reviewers and pooled in a meta-analysis with a random effects model. RESULTS Twelve published studies that examined the impact of opiate substitution treatment on HIV transmission met criteria for inclusion, and unpublished data were obtained from three additional studies. All included studies examined methadone maintenance treatment. Data from nine of these studies could be pooled, including 819 incident HIV infections over 23,608 person years of follow-up. Opiate substitution treatment was associated with a 54% reduction in risk of HIV infection among people who inject drugs (rate ratio 0.46, 95% confidence interval 0.32 to 0.67; P<0.001). There was evidence of heterogeneity between studies (I(2)=60%, χ(2)=20.12, P=0.010), which could not be explained by geographical region, site of recruitment, or the provision of incentives. There was weak evidence for greater benefit associated with longer duration of exposure to opiate substitution treatment. CONCLUSION Opiate substitution treatment provided as maintenance therapy is associated with a reduction in the risk of HIV infection among people who inject drugs. These findings, however, could reflect comparatively high levels of motivation to change behaviour and reduce injecting risk behaviour among people who inject drugs who are receiving opiate substitution treatment.
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Affiliation(s)
- Georgie J MacArthur
- School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
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Larney S, Toson B, Burns L, Dolan K. Effect of prison-based opioid substitution treatment and post-release retention in treatment on risk of re-incarceration. Addiction 2012; 107:372-80. [PMID: 21851442 DOI: 10.1111/j.1360-0443.2011.03618.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS People who use heroin are frequently incarcerated multiple times. Reducing re-incarceration of this group is important for reducing both health risks associated with incarceration and the costs of correctional administration. Opioid substitution treatment (OST) in prisons may help to reduce re-incarceration, but research findings on this topic have been mixed. In this study, we examined the effect of OST in prison and after release on re-incarceration. DESIGN Longitudinal cohort study. SETTING, PARTICIPANTS AND MEASUREMENTS: Data on OST and incarceration were linked for a cohort of 375 male heroin users recruited originally in prisons in New South Wales, Australia. Data were linked for the period 1 June 1997-31 December 2006. Re-incarceration was examined using recurrent-event survival analysis models. Model 1 examined the effect of OST status at release from prison (i.e. in treatment versus out of treatment on the day of release) on re-incarceration. Model 2 considered the effect of remaining in OST after release on risk of re-incarceration. FINDINGS Ninety per cent of participants were re-incarcerated following their first observed release. Pre-incarceration cocaine use was associated with a 13% increase in the average risk of re-incarceration. There was no significant association between simply being in OST at the time of release and risk of re-incarceration; however, in the model taking into account post-release retention in treatment, the average risk of re-incarceration was reduced by 20% while participants were in treatment. CONCLUSIONS In New South Wales, Australia, opioid substitution treatment after release from prison has reduced the average risk of re-incarceration by one-fifth.
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Affiliation(s)
- Sarah Larney
- Centre for Health Research in Criminal Justice, Matraville, NSW, Australia.
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Martin M, Vanichseni S, Suntharasamai P, Sangkum U, Chuachoowong R, Mock PA, Leethochawalit M, Chiamwongpaet S, Kittimunkong S, van Griensven F, McNicholl JM, Paxton L, Choopanya K. Enrollment characteristics and risk behaviors of injection drug users participating in the Bangkok Tenofovir Study, Thailand. PLoS One 2011; 6:e25127. [PMID: 21969870 PMCID: PMC3182181 DOI: 10.1371/journal.pone.0025127] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 08/25/2011] [Indexed: 11/30/2022] Open
Abstract
Background The Bangkok Tenofovir Study was launched in 2005 to determine if pre-exposure prophylaxis with tenofovir will reduce the risk of HIV infection among injecting drug users (IDUs). We describe recruitment, screening, enrollment, and baseline characteristics of study participants and contrast risk behavior of Tenofovir Study participants with participants in the 1999–2003 AIDSVAX B/E Vaccine Trial. Methods The Bangkok Tenofovir Study is an ongoing, phase-3, randomized, double-blind, placebo-controlled, HIV pre-exposure prophylaxis trial of daily oral tenofovir. The Tenofovir Study and the Vaccine Trial were conducted among IDUs at 17 drug-treatment clinics in Bangkok. Tenofovir Study sample size was based on HIV incidence in the Vaccine Trial. Standardized questionnaires were used to collect demographic, risk behavior, and incarceration data. The Tenofovir Study is registered with ClinicalTrials.gov, number-NCT00119106. Results From June 2005 through July 2010, 4094 IDUs were screened and 2413 enrolled in the Bangkok Tenofovir Study. The median age of enrolled participants was 31 years (range, 20–59), 80% were male, and 63% reported they injected drugs during the 3 months before enrollment. Among those who injected, 53% injected methamphetamine, 37% midazolam, and 35% heroin. Tenofovir Study participants were less likely to inject drugs, inject daily, or share needles (all, p<0.001) than Vaccine Trial participants. Discussion The Bangkok Tenofovir Study has been successfully launched and is fully enrolled. Study participants are significantly less likely to report injecting drugs and sharing needles than participants in the 1999–2003 AIDSVAX B/E Vaccine Trial suggesting HIV incidence will be lower than expected. In response, the Bangkok Tenofovir Study enrollment was increased from 1600 to 2400 and the study design was changed from a defined 1-year follow-up period to an endpoint-driven design. Trial results demonstrating whether or not daily oral tenofovir reduces the risk of HIV infection among IDUs are expected in 2012.
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Affiliation(s)
- Michael Martin
- Thailand Ministry of Public Health – US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | | | | | | | - Rutt Chuachoowong
- Thailand Ministry of Public Health – US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Philip A. Mock
- Thailand Ministry of Public Health – US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | | | | | | | - Frits van Griensven
- Thailand Ministry of Public Health – US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Janet M. McNicholl
- Thailand Ministry of Public Health – US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Lynn Paxton
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Gowing L, Farrell MF, Bornemann R, Sullivan LE, Ali R. Oral substitution treatment of injecting opioid users for prevention of HIV infection. Cochrane Database Syst Rev 2011:CD004145. [PMID: 21833948 DOI: 10.1002/14651858.cd004145.pub4] [Citation(s) in RCA: 165] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Injecting drug users are vulnerable to infection with Human Immunodeficiency Virus (HIV) and other blood borne viruses as a result of collective use of injecting equipment as well as sexual behaviour OBJECTIVES To assess the effect of oral substitution treatment for opioid dependent injecting drug users on risk behaviours and rates of HIV infections SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and PsycINFO to May 2011. We also searched reference lists of articles, reviews and conference abstracts SELECTION CRITERIA Studies were required to consider the incidence of risk behaviours, or the incidence of HIV infection related to substitution treatment of opioid dependence. All types of original studies were considered. Two authors independently assessed each study for inclusion DATA COLLECTION AND ANALYSIS Two authors independently extracted key information from each of the included studies. Any differences were resolved by discussion or by referral to a third author. MAIN RESULTS Thirty-eight studies, involving some 12,400 participants, were included. The majority were descriptive studies, or randomisation processes did not relate to the data extracted, and most studies were judged to be at high risk of bias. Studies consistently show that oral substitution treatment for opioid-dependent injecting drug users with methadone or buprenorphine is associated with statistically significant reductions in illicit opioid use, injecting use and sharing of injecting equipment. It is also associated with reductions in the proportion of injecting drug users reporting multiple sex partners or exchanges of sex for drugs or money, but has little effect on condom use. It appears that the reductions in risk behaviours related to drug use do translate into reductions in cases of HIV infection. However, because of the high risk of bias and variability in several aspects of the studies, combined totals were not calculated. AUTHORS' CONCLUSIONS Oral substitution treatment for injecting opioid users reduces drug-related behaviours with a high risk of HIV transmission, but has less effect on sex-related risk behaviours. The lack of data from randomised controlled studies limits the strength of the evidence presented in this review.
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Affiliation(s)
- Linda Gowing
- Discipline of Pharmacology, University of Adelaide, Frome Road, Adelaide, South Australia, Australia, 5005
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Leelahavarong P, Teerawattananon Y, Werayingyong P, Akaleephan C, Premsri N, Namwat C, Peerapatanapokin W, Tangcharoensathien V. Is a HIV vaccine a viable option and at what price? An economic evaluation of adding HIV vaccination into existing prevention programs in Thailand. BMC Public Health 2011; 11:534. [PMID: 21729309 PMCID: PMC3224093 DOI: 10.1186/1471-2458-11-534] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 07/05/2011] [Indexed: 11/10/2022] Open
Abstract
Background This study aims to determine the maximum price at which HIV vaccination is cost-effective in the Thai healthcare setting. It also aims to identify the relative importance of vaccine characteristics and risk behavior changes among vaccine recipients to determine how they affect this cost-effectiveness. Methods A semi-Markov model was developed to estimate the costs and health outcomes of HIV prevention programs combined with HIV vaccination in comparison to the existing HIV prevention programs without vaccination. The estimation was based on a lifetime horizon period (99 years) and used the government perspective. The analysis focused on both the general population and specific high-risk population groups. The maximum price of cost-effective vaccination was defined by using threshold analysis; one-way and probabilistic sensitivity analyses were performed. The study employed an expected value of perfect information (EVPI) analysis to determine the relative importance of parameters and to prioritize future studies. Results The most expensive HIV vaccination which is cost-effective when given to the general population was 12,000 Thai baht (US$1 = 34 Thai baht in 2009). This vaccination came with 70% vaccine efficacy and lifetime protection as long as risk behavior was unchanged post-vaccination. The vaccine would be considered cost-ineffective at any price if it demonstrated low efficacy (30%) and if post-vaccination risk behavior increased by 10% or more, especially among the high-risk population groups. The incremental cost-effectiveness ratios were the most sensitive to change in post-vaccination risk behavior, followed by vaccine efficacy and duration of protection. The EVPI indicated the need to quantify vaccine efficacy, changed post-vaccination risk behavior, and the costs of vaccination programs. Conclusions The approach used in this study differentiated it from other economic evaluations and can be applied for the economic evaluation of other health interventions not available in healthcare systems. This study is important not only for researchers conducting future HIV vaccine research but also for policy decision makers who, in the future, will consider vaccine adoption.
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Affiliation(s)
- Pattara Leelahavarong
- Health Intervention and Technology Assessment Program, 6th Floor, 6th Building, Department of Health, Ministry of Public Health, Tiwanon Rd, Amphur Muang, Nonthaburi, Thailand.
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Abstract
This research used open-ended and true-false questions to assess the preparedness of 96 ethnically diverse, economically and socially marginalized adult street drug users to consent to participate in HIV vaccine trials (HVT). Specific areas of consent vulnerability included misconceptions about: (1) the recuperative value and risk of vaccines in general; (2) the presence of the HIV virus within the vaccine and the possibility of contracting or transmitting HIV as a consequence of participation; (3) inclusion criteria and experimental blinds; and (4) distrust in the medical and research establishments. A brief HVT lesson administered to 30 participants was effective in correcting specific HVT knowledge misperceptions and increasing certain, but not all areas of HVT trust. Assessment of post-lesson responses to ethics-relevant questions provides information on respondents' attitudes toward AIDS safe behavior, research risks and benefits, monetary compensation, and willingness to participate. Implications for enhancing informed consent for HVT involving active drug users are discussed.
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Affiliation(s)
- Celia B Fisher
- Center for Ethics Education and Department of Psychology, Fordham University, Dealy Hall, 441 East Fordham Road, Bronx, NY 10458, USA.
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Strathdee SA, Hallett TB, Bobrova N, Rhodes T, Booth R, Abdool R, Hankins CA. HIV and risk environment for injecting drug users: the past, present, and future. Lancet 2010; 376:268-84. [PMID: 20650523 PMCID: PMC6464374 DOI: 10.1016/s0140-6736(10)60743-x] [Citation(s) in RCA: 393] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We systematically reviewed reports about determinants of HIV infection in injecting drug users from 2000 to 2009, classifying findings by type of environmental influence. We then modelled changes in risk environments in regions with severe HIV epidemics associated with injecting drug use. Of 94 studies identified, 25 intentionally examined risk environments. Modelling of HIV epidemics showed substantial heterogeneity in the number of HIV infections that are attributed to injecting drug use and unprotected sex. We estimate that, during 2010-15, HIV prevalence could be reduced by 41% in Odessa (Ukraine), 43% in Karachi (Pakistan), and 30% in Nairobi (Kenya) through a 60% reduction of the unmet need of programmes for opioid substitution, needle exchange, and antiretroviral therapy. Mitigation of patient transition to injecting drugs from non-injecting forms could avert a 98% increase in HIV infections in Karachi; whereas elimination of laws prohibiting opioid substitution with concomitant scale-up could prevent 14% of HIV infections in Nairobi. Optimisation of effectiveness and coverage of interventions is crucial for regions with rapidly growing epidemics. Delineation of environmental risk factors provides a crucial insight into HIV prevention. Evidence-informed, rights-based, combination interventions protecting IDUs' access to HIV prevention and treatment could substantially curtail HIV epidemics.
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Affiliation(s)
- Steffanie A Strathdee
- University of California, San Diego, Division of Global Public Health, Department of Medicine, CA 92093-0507, USA.
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Drug use and the risk of HIV infection amongst injection drug users participating in an HIV vaccine trial in Bangkok, 1999–2003. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2010; 21:296-301. [DOI: 10.1016/j.drugpo.2009.12.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 12/08/2009] [Accepted: 12/15/2009] [Indexed: 11/21/2022]
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Pitisuttithum P, Choopanya K, Rerk-Ngnam S. HIV-vaccine Research and Development in Thailand: Evolution and challenges. Vaccine 2010; 28 Suppl 2:B45-9. [DOI: 10.1016/j.vaccine.2009.08.061] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Revised: 08/19/2009] [Accepted: 08/21/2009] [Indexed: 10/19/2022]
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