1
|
Ribeiro Banze Á, Muleia R, Nuvunga S, Boothe M, Semá Baltazar C. Trends in HIV prevalence and risk factors among men who have sex with men in Mozambique: implications for targeted interventions and public health strategies. BMC Public Health 2024; 24:1185. [PMID: 38678173 PMCID: PMC11055340 DOI: 10.1186/s12889-024-18661-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 04/18/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Men who have sex with Men (MSM) are known to contribute to increased HIV prevalence as an integral part of key populations with high vulnerability to HIV/AIDS due to their sexual behaviours. Mozambique conducted two rounds of bio-behavioral surveys (BBS) in this population with the main objective of estimating HIV prevalence and associated risk behaviors among MSM in Mozambique. The present study aims to estimate the trend of HIV prevalence and determine the correlations of HIV infection among MSM. METHODS A repeated cross-sectional analytical study was conducted from secondary data from the first and second rounds of BBS in Mozambique conducted in 2011 and 2020-2021 respectively. Each round used a similar methodology which allowed for comparison between the two surveys. Chi-square test and logistic regression was used to compare the HIV prevalence between the BBS rounds, identify factors associated with HIV, and assess changes in HIV prevalence across selected risk factors. RESULTS There was a significant increase in HIV prevalence among MSM (7.1-14.9%), living in Maputo (9.3-14.7%), uncircumcised (11.7-25.1%), and those who reported two sexual partners in the last year (5.2-14.4%). In contrast, there was a decrease in prevalence among adult MSM aged between 25 and 29 years (24.7-13.9%), aged 30 years or older (45.7-27.7%), married (29.1-16.8%), with higher education (16.7-5.9%) and moderate perception of HIV risk (10.9-3.4%). Multivariable analysis showed that factors such as age, marital status, religion, sexual identity, circumcision, and the use of lubrication during anal sex are significantly associated with the risk of HIV infection. CONCLUSIONS This study underscores the continuing need for HIV prevention and education efforts. The rise in prevalence among specific population segments and the sustained presence of risk factors emphasize the requirement for holistic strategies tailored to the unique requirements of each subgroup. Understanding trends and risk factors is crucial to guiding public health policies and designing efficacious prevention programs that aim to curtail HIV transmission while enhancing the well-being of those impacted by the condition.
Collapse
Affiliation(s)
- Áuria Ribeiro Banze
- National Institute of Health, EN1, Bairro da Vila- Parcela nº 3943 Marracuene District, Maputo, Maputo Province, Mozambique.
| | - Rachid Muleia
- National Institute of Health, EN1, Bairro da Vila- Parcela nº 3943 Marracuene District, Maputo, Maputo Province, Mozambique
| | - Samuel Nuvunga
- National Institute of Health, EN1, Bairro da Vila- Parcela nº 3943 Marracuene District, Maputo, Maputo Province, Mozambique
| | | | - Cynthia Semá Baltazar
- National Institute of Health, EN1, Bairro da Vila- Parcela nº 3943 Marracuene District, Maputo, Maputo Province, Mozambique
| |
Collapse
|
2
|
Smylie J, Bourgeois C, Snyder M, Maddox R, McConkey S, Rotondi M, Prince C, Dokis B, Hardy M, Joseph S, Kilabuk A, Mattina JA, Cyr M, Blais G. Design and implementation of the Our Health Counts (OHC) methodology for First Nations, Inuit, and Metis (FNIM) health assessment and response in urban and related homelands. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024:10.17269/s41997-024-00867-9. [PMID: 38619750 DOI: 10.17269/s41997-024-00867-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 02/09/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVES Methods for enumeration and population-based health assessment for First Nations, Inuit, and Metis (FNIM) living in Canadian cities are underdeveloped, with resultant gaps in essential demographic, health, and health service access information. Our Health Counts (OHC) was designed to engage FNIM peoples in urban centres in "by community, for community" population health assessment and response. METHODS The OHC methodology was designed to advance Indigenous self-determination and FNIM data sovereignty in urban contexts through deliberate application of Indigenous principles and linked implementation strategies. Three interwoven principles (good relationships are foundational; research as gift exchange; and research as a vehicle for Indigenous community resurgence) provide the framework for linked implementation strategies which include actively building and maintaining relationships; meaningful Indigenous community guidance, leadership, and participation in all aspects of the project; transparent and equitable sharing of project resources and benefits; and technical innovations, including respondent-driven sampling, customized comprehensive health assessment surveys, and linkage to ICES data holdings to generate measures of health service use. RESULTS OHC has succeeded across six urban areas in Ontario to advance Indigenous data sovereignty and health assessment capacity; recruit and engage large population-representative cohorts of FNIM living in urban and related homelands; customize comprehensive health surveys and data linkages; generate previously unavailable population-based FNIM demographic, health, and social information; and translate results into enhanced policy, programming, and practice. CONCLUSION The OHC methodology has been demonstrated as effective, culturally relevant, and scalable across diverse Ontario cities.
Collapse
Affiliation(s)
- Janet Smylie
- Well Living House, Li Ka Shing Research Institute, Unity Health Toronto, Toronto, ON, Canada.
- Dalla Lana School of Public Health and Department of Family & Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | | | - Marcie Snyder
- Well Living House, Li Ka Shing Research Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Raglan Maddox
- Well Living House, Li Ka Shing Research Institute, Unity Health Toronto, Toronto, ON, Canada
- National Centre for Epidemiology and Public Health, College of Health & Medicine, The Australian National University, Canberra, Australia
| | - Stephanie McConkey
- Well Living House, Li Ka Shing Research Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Michael Rotondi
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | | | - Brian Dokis
- Southwest Ontario Aboriginal Health Access Centre, London, ON, Canada
| | - Michael Hardy
- Anishnawbe Mushkiki Aboriginal Health Access Centre, Thunder Bay, ON, Canada
| | - Serena Joseph
- Waasegiizhig Nanaandawe'iyewigamig Aboriginal Health Access Centre, Kenora, ON, Canada
| | | | - Jo-Ann Mattina
- De dwa da dehs nye>s Aboriginal Health Centre, Hamilton, ON, Canada
| | - Monica Cyr
- Aboriginal Health & Wellness Centre, Winnipeg, MB, Canada
| | - Genevieve Blais
- Well Living House, Li Ka Shing Research Institute, Unity Health Toronto, Toronto, ON, Canada
| |
Collapse
|
3
|
Oh KM, Inoue M, Koizumi N, Beran K, Lee JAA. Chronic Health Conditions and Patient Portal Use in Caregivers of People With Alzheimer's Disease and Related Dementias. J Appl Gerontol 2024; 43:363-373. [PMID: 37982671 DOI: 10.1177/07334648231210677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023] Open
Abstract
This study aimed to investigate both chronic health conditions and the utilization of patient portals, focusing particularly on caregivers responsible for individuals with Alzheimer's disease and related dementias (ADRD). Data from the Health Information National Trends Survey 2018-2020 were analyzed, involving a sample of 304 family and unpaid caregivers of individuals with ADRD. Among caregivers of individuals with ADRD, 77.6% had at least one chronic disease. A significant proportion (46.6%) of ADRD caregivers had never accessed their patient portals. The limited utilization of patient portals among caregivers responsible for individuals with ADRD, particularly those with lower education, advanced age, and few chronic conditions, becomes apparent due to challenges associated with digital literacy and discomfort with computers. Recognizing the crucial role caregivers play for individuals with ADRD and their health risks, there's a need for tailored training to enhance their health management skills and caregiving capabilities.
Collapse
Affiliation(s)
| | | | | | | | - Jung-Ah Anna Lee
- Sue & Bill Gross School of Nursing, University of California, Irvine, CA, USA
| |
Collapse
|
4
|
McCartney DJ, Bassichetto KC, Leal AF, Knauth D, Dourado I, Magno L, Carvalho da Silva RJ, Mayaud P, Veras MA. Acceptability and Usability of Self-Sampling for the Detection of Sexually Transmitted Infections Among Transgender Women: The TransOdara Multicentric Study in Brazil. Sex Transm Dis 2024; 51:276-282. [PMID: 38534084 DOI: 10.1097/olq.0000000000001924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND The effective testing of sexually transmitted infections (STIs) requires sampling from potential infection sites. This study aimed to assess the choice, satisfaction, and performance of self-collected samples (SCS) from potential infection sites for STI testing among transgender women in Brazil. METHODS TransOdara was a multicentric, cross-sectional STI prevalence study conducted in 5 Brazilian cities. Using respondent-driven sampling, 1317 transgender women 18 years or older were recruited. Participants completed interviewer-led questionnaires and provided swab samples from multiple sites (anorectal, oropharyngeal, genital) for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and human papillomavirus (HPV) testing. Participants were given a choice of SCS or provider-collected samples (PCS) at each site. RESULTS Most participants selected SCS for anorectal (74.9%; 95% confidence interval [CI], 72.4-77.3) and genital (72.7%; 95% CI, 70.2-75.1) sites, whereas fewer chose for oropharyngeal samples (49.8%; 95% CI, 47.0-52.6). For future testing, most participants expressed a preference for SCS for genital (72.2%; 95% CI, 69.5-74.7) and anorectal (70.2%; 95% CI, 67.6-72.7) sites. There was no significant difference in the positive test results for CT and NG between SCS and PCS at anorectal and oropharyngeal sites, or for HPV at anorectal and genital (penile or neovaginal) sites. CONCLUSIONS This study demonstrated a high level of acceptability and usability of self-sampling for STI testing among transgender women. A preference for SCS was evident at the anorectal and genital sites, and the results of SCS were comparable to those of PCS. The findings suggest that multisite STI testing utilizing self-collection methods as a provided option can be effectively integrated into sexual health services for transgender women.
Collapse
Affiliation(s)
- Daniel Jason McCartney
- From the Department of Clinical Research, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Daniela Knauth
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia
| | - Laio Magno
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador
| | | | - Philippe Mayaud
- From the Department of Clinical Research, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | |
Collapse
|
5
|
Chapin-Bardales J, Asher A, Broz D, Teshale E, Mixson-Hayden T, Poe A, Handanagic S, Blanco C, Wejnert C. Hepatitis C virus infection and co-infection with HIV among persons who inject drugs in 10 U.S. cities-National HIV Behavioral Surveillance, 2018. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024:104387. [PMID: 38531730 DOI: 10.1016/j.drugpo.2024.104387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 02/13/2024] [Accepted: 03/06/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Characterizing acute and chronic hepatitis C virus (HCV) infection and HIV/HCV co-infection among persons who inject drugs (PWID) can inform elimination efforts. METHODS During 2018 National HIV Behavioral Surveillance in 10 U.S. metropolitan statistical areas (MSAs), PWID were recruited using respondent-driven sampling and offered a survey, HIV testing, and HCV antibody and RNA testing. We examined prevalence and associated characteristics of HCV infection and HIV/HCV co-infection. Associations were assessed using log-linked Poisson regression models with robust standard errors accounting for clustering by recruitment chain and adjusting for MSA and network size. RESULTS Overall, 44.2% had current HCV infection (RNA detected), with 3.9% classified as acute infection (HCV antibody non-reactive/RNA detected) and 40.3% as chronic (HCV antibody reactive/RNA detected). Four percent had HIV/HCV co-infection. Current HCV infection was significantly higher among PWID who were male, White, injected >1 time/day, shared syringes in past year, and shared injection equipment in past year. PWID who were transgender, injecting >5 years, and most often injected speedball (heroin and cocaine together) or stimulants alone were more likely to have HIV/HCV co-infection. Among PWID who never previously had HCV infection, 9.9% had acute HCV infection. Among PWID who started injecting ≤5 years ago, 41.5% had already acquired HCV infection. CONCLUSIONS Acute and chronic HCV infections were substantial among a sample of PWID in 10 U.S. MSAs. Accessibility to HCV RNA testing, promoting safer practices, and intervening early with harm reduction programs for recent injection initiates will be critical to disease elimination efforts for PWID.
Collapse
Affiliation(s)
| | - Alice Asher
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dita Broz
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eyasu Teshale
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tonya Mixson-Hayden
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amanda Poe
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Senad Handanagic
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, USA
| | - Cyprian Wejnert
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
6
|
Alvey B, Stone J, Salyuk T, Barzilay EJ, Doan I, Vickerman P, Trickey A. Associations Between Sexual Behavior Stigma and HIV Risk Behaviors, Testing, Treatment, and Infection Among Men Who have Sex with Men in Ukraine. AIDS Behav 2024; 28:786-798. [PMID: 37792231 PMCID: PMC10896872 DOI: 10.1007/s10461-023-04182-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/05/2023]
Abstract
Stigma toward same-sex behaviors may be a structural driver of HIV epidemics among men who have sex with men (MSM) in Eastern Europe and has been linked to adverse HIV-outcomes elsewhere. We explored associations between sexual behavior stigma with HIV risk behaviors, testing, treatment, and infection. From November 2017 to February 2018, MSM across 27 Ukrainian cities were recruited to cross-sectional surveys using respondent driven sampling. Eligible participants were cisgender males aged ≥ 14 years residing in participating cities that reported ≥ 1 sexual contact with another man in the prior 6 months. Participants self-reported experience of stigma (ever) and various HIV-outcomes and were tested for HIV antibodies. Regression models were used to explore associations between three sexual behavior stigma variables with demographic and HIV-related variables. Of 5812 recruited cisgender MSM, 5544 (95.4%) were included. 1663 (30.0%) MSM reported having experienced stigma due to being MSM from family and friends, 698 (12.6%) reported anticipated healthcare stigma, and 1805 (32.6%) reported general public/social stigma due to being MSM (enacted). All forms of stigma were associated with heightened HIV risk behaviors; those experiencing stigma (vs not) had more anal sex partners in the prior month and were less likely to have used condoms during their last anal intercourse. Stigma was not associated with HIV infection, testing, or treatment variables. A sizeable proportion of Ukrainian MSM reported ever experiencing stigma due to being MSM. MSM that had experienced stigma had higher odds of HIV sexual risk behaviors. Further study using longitudinal designs is required to determine causality.
Collapse
Affiliation(s)
- Ben Alvey
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Jack Stone
- Population Health Sciences, University of Bristol, Bristol, UK
- Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, Bristol, UK
| | | | | | - Ivan Doan
- Centers for Disease Control, Kyiv, Ukraine
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
- Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, Bristol, UK
| | - Adam Trickey
- Population Health Sciences, University of Bristol, Bristol, UK.
| |
Collapse
|
7
|
Romo E, Stopka TJ, Jesdale BM, Wang B, Mazor KM, Friedmann PD. Association of spatial proximity to fixed-site syringe services programs with HCV serostatus and injection equipment sharing practices among people who inject drugs in rural New England, United States. Harm Reduct J 2024; 21:23. [PMID: 38282000 PMCID: PMC10822149 DOI: 10.1186/s12954-023-00916-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/10/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) disproportionately affects rural communities, where health services are geographically dispersed. It remains unknown whether proximity to a syringe services program (SSP) is associated with HCV infection among rural people who inject drugs (PWID). METHODS Data are from a cross-sectional sample of adults who reported injecting drugs in the past 30 days recruited from rural counties in New Hampshire, Vermont, and Massachusetts (2018-2019). We calculated the road network distance between each participant's address and the nearest fixed-site SSP, categorized as ≤ 1 mile, 1-3 miles, 3-10 miles, and > 10 miles. Staff performed HCV antibody tests and a survey assessed past 30-day injection equipment sharing practices: borrowing used syringes, borrowing other used injection equipment, and backloading. Mixed effects modified Poisson regression estimated prevalence ratios (aPR) and 95% confidence intervals (95% CI). Analyses were also stratified by means of transportation. RESULTS Among 330 PWID, 25% lived ≤ 1 mile of the nearest SSP, 17% lived 1-3 miles of an SSP, 12% lived 3-10 miles of an SSP, and 46% lived > 10 miles from an SSP. In multivariable models, compared to PWID who lived within 1 mile of an SSP, those who lived 3 to 10 miles away had a higher prevalence of HCV seropositivity (aPR: 1.25, 95% CI 1.06-1.46), borrowing other used injection equipment (aPR: 1.23, 95% CI 1.04-1.46), and backloading (aPR: 1.48, 95% CI 1.17-1.88). Similar results were observed for PWID living > 10 miles from an SSP: aPR [HCV]: 1.19, 95% CI 1.01-1.40; aPR [borrowing other used equipment]:1.45, 95% CI 1.29-1.63; and aPR [backloading]: 1.59, 95% CI 1.13-2.24. Associations between living 1 to 3 miles of an SSP and each outcome did not reach statistical significance. When stratified by means of transportation, associations between distance to SSP and each outcome (except borrowing other used injection equipment) were only observed among PWID who traveled by other means (versus traveled by automobile). CONCLUSIONS Among PWID in rural New England, living farther from a fixed-site SSP was associated with a higher prevalence of HCV seropositivity, borrowing other used injection equipment, and backloading, reinforcing the need to increase SSP accessibility in rural areas. Means of transportation may modify this relationship.
Collapse
Affiliation(s)
- Eric Romo
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | - Thomas J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Bill M Jesdale
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Bo Wang
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Kathleen M Mazor
- Department of Medicine, University of Massachusetts Chan Medical, Worcester, MA, USA
| | - Peter D Friedmann
- Office of Research, University of MA Chan Medical School - Baystate, Springfield, MA, USA
| |
Collapse
|
8
|
McCartney DJ, Luppi CG, Silva RJC, de Araújo S, Bassichetto KC, Mayaud P, Veras MA. Anorectal gonorrhoea and chlamydia among transgender women in Brazil: prevalence and assessment of performance and cost of anorectal infection detection and management approaches. Sex Transm Infect 2024; 100:3-9. [PMID: 38050133 DOI: 10.1136/sextrans-2023-055788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 08/29/2023] [Indexed: 12/06/2023] Open
Abstract
OBJECTIVES We aimed to determine the prevalence of anorectal Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) among transgender women in Brazil, and to assess the performance and costs of various approaches for the diagnosis and management of anorectal NG/CT. METHODS TransOdara was a multicentric, cross-sectional STI prevalence study among 1317 transgender women conducted in five capital cities representing all Brazilian regions. Participants aged >18 years were recruited using respondent-driven sampling (RDS), completed an interviewer-led questionnaire, offered an optional physical examination and given choice between self-collected or provider-collected samples for NG/CT testing. Performance and cost indicators of predetermined management algorithms based on the WHO recommendations for anorectal symptoms were calculated. RESULTS Screening uptake was high (94.3%) and the estimated prevalence of anorectal NG, CT and NG and/or CT was 9.1%, 8.9% and 15.2%, respectively. Most detected anorectal NG/CT infections were asymptomatic (NG: 87.6%, CT: 88.9%), with a limited number of participants reporting any anorectal symptoms (9.1%). Of those who permitted anal examination, few had clinical signs of infection (13.6%). Sensitivity of the tested algorithms ranged from 1.4% to 5.1% (highest for treatment based on the reported anorectal discharge or ulcer and receptive anal intercourse (RAI) in the past 6 months) and specificity from 98.0% to 99.3% (highest for treatment based on the reported anorectal discharge with clinical confirmation or report of RAI). The estimated cost-per-true case of anorectal NG/CT infection treated varied from lowest providing treatment for anorectal discharge syndrome based on the reported RAI ($2.70-4.28), with algorithms including clinical examinations decreasing cost-effectiveness. CONCLUSIONS High prevalence of mostly asymptomatic anorectal NG and CT was observed among Brazilian transgender women. Multi-site NG/CT screening should be offered to transgender women. Where diagnostic testing capacity is limited, syndromic management for those presenting with anorectal symptoms is recommended.
Collapse
Affiliation(s)
- Daniel Jason McCartney
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Carla Gianna Luppi
- Centro de Referência e Treinamento em DST/Aids, Secretaria da Saúde do Estado de São Paulo, Sao Paulo, Brazil
| | - Roberto José Carvalho Silva
- Centro de Referência e Treinamento em DST/Aids, Secretaria da Saúde do Estado de São Paulo, Sao Paulo, Brazil
| | - Sandra de Araújo
- Centro de Referência e Treinamento em DST/Aids, Secretaria da Saúde do Estado de São Paulo, Sao Paulo, Brazil
| | - Katia Cristina Bassichetto
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
- Núcleo de Pesquisa e Direitos Humanos em Saúde da População LGBT+ (NUDHES), São Paulo, Brazil
| | - Philippe Mayaud
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Maria Amélia Veras
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
- Núcleo de Pesquisa e Direitos Humanos em Saúde da População LGBT+ (NUDHES), São Paulo, Brazil
| |
Collapse
|
9
|
Dumchev K, Kovtun O, Salnikov S, Titar I, Saliuk T. Integrated biobehavioral surveillance among people who inject drugs in Ukraine, 2007-2020. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024:104319. [PMID: 38216437 DOI: 10.1016/j.drugpo.2024.104319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 12/16/2023] [Accepted: 01/02/2024] [Indexed: 01/14/2024]
Abstract
BACKGROUND Repeated integrated biobehavioral surveys (IBBS) have been implemented among people who inject drugs (PWID) in Ukraine to monitor the trends in key epidemiologic and programmatic indicators. METHODS The study analyzed seven PWID IBBS rounds from 2007 to 2020 in seven Ukrainian cities. Participants were recruited using respondent-driven sampling, tested for HIV and anti-HCV antibodies, and completed a structured questionnaire. Composite weights (based on individual sampling probability and population size) were applied to generate point estimates and confidence intervals for HIV and HCV prevalence, injection risk behaviors, prevention service coverage, and HIV treatment cascade. Multi-level regression assessed temporal trends in these indicators in 2007-2020. RESULTS The samples consisted of 1587 participants in 2007, 1905 in 2008/9, 3066 in 2011, 2846 in 2013, 2699 in 2015, 2798 in 2017, and 3651 in the 2020 rounds. HIV prevalence decreased from 27% to 19% overall, and among PWID younger than 25 from 10.5% to 5.5%. Anti-HCV prevalence increased from 50% to 73% overall but decreased from 58% to 27% in the younger subgroup. Past-30-days injection risk behaviors consistently decreased, reaching a minimum of 38% for any risk in 2020. HIV treatment cascade indicators and coverage with opioid agonist treatment substantially improved in the last three rounds. Harm reduction services coverage fluctuated, declining from 52% to 33% in the last three rounds. CONCLUSIONS This analysis demonstrates the potential of repeated IBBS for monitoring the HIV epidemic and program coverage. We confirmed a sustained decline in overall HIV and HCV transmission, likely driven by reduced risky injection practices among PWID. The impact of harm reduction services requires further study. HIV status awareness and treatment coverage among PWID markedly increased, reaching the national average, possibly indicating the success of case-finding and linkage-to-care interventions. The upcoming IBBS round in Ukraine will also assess the impact of the war on service provision, risk behavior, and HIV transmission among PWID.
Collapse
Affiliation(s)
| | | | - Serhii Salnikov
- Public Health Center of the Ministry of Health of Ukraine, Kyiv, Ukraine
| | - Ivan Titar
- Public Health Center of the Ministry of Health of Ukraine, Kyiv, Ukraine
| | | |
Collapse
|
10
|
Muir NM, Rotondi M, Brar R, Rotondi NK, Bourgeois C, Dokis B, Hardy M, Maddox R, Smylie J. Our Health Counts: Examining associations between colonialism and ever being incarcerated among First Nations, Inuit, and Métis people in London, Thunder Bay, and Toronto, Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023:10.17269/s41997-023-00838-6. [PMID: 38158518 DOI: 10.17269/s41997-023-00838-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 11/06/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES Indigenous peoples have a disproportionately high prevalence of incarceration in the Canadian justice system. However, there is limited Indigenous-driven research examining colonialism and the justice system, specifically associations between racism, externally imposed family disruptions, and history of ever being incarcerated. Therefore, this study examined the association between the proportion of previous incarceration and family disruption, experiences of racism, and victimization for Indigenous adults in London, Thunder Bay, and Toronto, Ontario, Canada. The three communities expressed that they did not want comparison between the communities; rather, they wanted analysis of their community to understand where more supports were needed. METHODS Indigenous community partners used respondent-driven sampling (RDS) to collect data from First Nations, Inuit, and Métis (FNIM) peoples in London, Thunder Bay, and Toronto. Prevalence estimates, 95% confidence intervals, and relative risk were reported using unweighted Poisson models and RDS-adjusted proportions. RESULTS Proportions of ever being incarcerated ranged from 43.0% in London to 54.0% in Toronto and 72.0% in Thunder Bay. In all three cities, history of child protection involvement and experiencing racism was associated with an approximate 25.0% increase in risk for previous incarceration. In Toronto and London, victimization was associated with increased risk for incarceration. CONCLUSION This research highlights disproportionately high prevalence of ever being incarcerated among FNIM living in three Ontario cities. Experiencing racism, family disruption, and victimization are associated with incarceration. Decreasing the rates of family disruption, experiences of racism, and victimization should inform future policy and services to reduce the disproportionately high prevalence of incarceration for FNIM people living in urban settings.
Collapse
Affiliation(s)
| | | | - Raman Brar
- Well Living House, Li Ka Shing Knowledge Institute, Unity Health Toronto, St. Michael's Hospital, Toronto, ON, Canada
| | | | | | - Brian Dokis
- Southwest Ontario Aboriginal Health Access Centre (SOAHAC), London, ON, Canada
| | | | - Raglan Maddox
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Janet Smylie
- Well Living House, Li Ka Shing Knowledge Institute, Unity Health Toronto, St. Michael's Hospital, Toronto, ON, Canada
| |
Collapse
|
11
|
Lichtwarck HO, Mbotwa CH, Kazaura MR, Moen K, Mmbaga EJ. Early disengagement from HIV pre-exposure prophylaxis services and associated factors among female sex workers in Dar es Salaam, Tanzania: a socioecological approach. BMJ Glob Health 2023; 8:e013662. [PMID: 38154811 PMCID: PMC10759139 DOI: 10.1136/bmjgh-2023-013662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/25/2023] [Indexed: 12/30/2023] Open
Abstract
INTRODUCTION Pre-exposure prophylaxis (PrEP) is an effective HIV prevention tool when taken as prescribed. However, suboptimal use may challenge its real-life impact. To support female sex workers in their efforts to prevent themselves from HIV, it is essential to identify factors that contribute to early disengagement from PrEP care. In this study, we aimed to estimate the risk of early disengagement from PrEP services among female sex workers in Tanzania and associated factors using a socioecological model as a guiding framework. METHODS The study was conducted as part of a pragmatic mHealth trial for PrEP roll-out in Dar es Salaam in 2021. We estimated the risk of early disengagement, defined as not presenting for the first follow-up visit (within 56 days of enrolment), and its associations with individual, social, behavioural and structural factors (age, self-perceived HIV risk, mental distress, harmful alcohol use, condom use, number of sex work clients, female sex worker stigma and mobility) using multivariable logistic regression models, with marginal standardisation to obtain adjusted relative risks (aRR). RESULTS Of the 470 female sex workers enrolled in the study, 340 (74.6%) did not attend the first follow-up visit (disengaged). Mental distress (aRR=1.14; 95% CI 1.01 to 1.27) was associated with increased risk of disengagement. Participants who reported a higher number of clients per month (10-29 partners: aRR=0.87; 95% CI 0.76 to 0.98 and ≥30 partners: aRR=0.80; 95% CI 0.68 to 0.91) and older participants (≥35 years) (RR=0.75; 95% CI 0.56 to 0.95) had a lower risk of disengagement. CONCLUSIONS AND RECOMMENDATIONS Early disengagement with the PrEP programme was high. Mental distress, younger age and having fewer clients were risk factors for disengagement. We argue that PrEP programmes could benefit from including mental health screening and treatment, as well as directing attention to younger sex workers and those reporting fewer clients.
Collapse
Affiliation(s)
- Hanne Ochieng Lichtwarck
- Department of Community Medicine and Global Health, University of Oslo, Faculty of Medicine, Oslo, Norway
| | - Christopher Hariri Mbotwa
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- University of Dar es Salaam, Mbeya College of Health and Allied Sciences, Mbeya, Tanzania
| | | | - Kåre Moen
- Department of Community Medicine and Global Health, University of Oslo, Faculty of Medicine, Oslo, Norway
| | - Elia John Mmbaga
- Department of Community Medicine and Global Health, University of Oslo, Faculty of Medicine, Oslo, Norway
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| |
Collapse
|
12
|
German D, Glick JL, Yenokyan K, Genberg B, Sawyer A, Gribbin M, Flynn C. Injection Behaviors and Use of Syringe Service Programs over Time among People Who Inject Drugs in Baltimore, Maryland. Subst Use Misuse 2023; 59:651-664. [PMID: 38115628 DOI: 10.1080/10826084.2023.2294966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Introduction: People who inject drugs (PWID) are at increased risk for infectious disease transmission, including hepatitis C and HIV. Understanding trends in injection risk behaviors and syringe service program (SSP) use over time can help improve infectious disease prevention and other harm reduction services. Methods: Using National HIV Behavioral Surveillance System data from Baltimore, Maryland, we examined changes in receptive sharing of (1) syringes, (2) injection equipment, (3) syringes to divide drugs; and (4) receipt of syringes from SSPs among PWID from 2009 to 2018 (n = 518 in 2009, n = 638 in 2012, n = 586 in 2015, and n = 575 in 2018) using unadjusted and adjusted logistic models calculated across time for the total sample. Results: The conditional probability of receptive sharing of syringes and receipt of syringes from SSPs remained relatively stable, while receptive sharing of injection equipment and receptive sharing of syringes to divide drugs dropped substantially after 2009. White race and daily injection frequency were positively associated with sharing syringes and injection equipment and negatively associated with SSP use over time. In 2015, there was a notable shift such that women were twice as likely as men to receive syringes from SSPs and less likely than men to report the use of shared syringes or equipment. Conclusion: Findings indicate overall steady or decreasing trends in injection risk and steady trends in SSP usage over time, with some notable improvements among women and indications of shifting drug market patterns. Injection-related risk behaviors remain high among White PWID and may require targeted outreach and interventions.
Collapse
Affiliation(s)
- Danielle German
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer L Glick
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Karine Yenokyan
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Becky Genberg
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Anne Sawyer
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Molly Gribbin
- Maryland Department of Health, Baltimore, Maryland, USA
| | - Colin Flynn
- Maryland Department of Health, Baltimore, Maryland, USA
| |
Collapse
|
13
|
Mehmandoost S, Mirzazadeh A, Karamouzian M, Khezri M, Sharafi H, Shahesmaeili A, Maghsoudi SH, Ghalekhani N, Tavakoli F, Bazrafshani MS, Shokoohi M, Aghaali N, Haghdoost AA, Sharifi H. Injection cessation and relapse to injection and the associated factors among people who inject drugs in Iran: The Rostam study. Subst Abuse Treat Prev Policy 2023; 18:72. [PMID: 38031110 PMCID: PMC10687883 DOI: 10.1186/s13011-023-00583-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 11/22/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Drug injection is a major health-related problem worldwide. Injection cessation and relapse to injection could significantly alter the risk of HIV and hepatitis C virus (HCV) among people who inject drugs (PWID). This study aimed to estimate the rate of injection cessation and relapse to injection among PWID in Iran. METHODS This cohort study was conducted from 2018 to 2021 in the cities of Kerman and Tehran. Using a respondent-driven sampling (RDS) approach, 118 PWID with a history of injection in the last six months and negative HIV and HCV tests were recruited. Follow-up visits occurred every three months over a period of one year. Participants were interviewed and tested for HIV and HCV using rapid tests. Injection cessation was defined as the no injection of any type of drugs in the last three months. Relapse to injection was defined as re-initiating drug injection among those who had ceased injection. Two separate Cox regression models were applied, and an adjusted hazard ratio (aHR) with a 95% confidence interval (CI) were measured to assess the factors associated with each outcome. RESULTS The rate of injection cessation was 26.1 (95% CI: 21.3, 32.0) per 100 person-years, and the rate of relapse to injection was 32.7 (95% CI: 24.7, 43.2) per 100 person-years. At the baseline interview, 39.8% (n = 47) of participants reported injection cessation in the past three months before the interview. In the multivariable Cox regression analysis, the rate of relapse to injection was greater among women (aHR = 1.58; 95% CI: 1.01, 2.52), and those with higher monthly income (aHR = 1.63; 95% CI: 1.03, 2.59). However, there was no significant variable that predicted injection cessation. CONCLUSION Injection cessation was common among PWID in Iran, however, one-third relapsed to injection shortly after cessation. Harm reduction programs should include comprehensive strategies to reduce the probability of relapse among PWID who achieve injection cessation.
Collapse
Affiliation(s)
- Soheil Mehmandoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Mirzazadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Mohammad Karamouzian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mehrdad Khezri
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, USA
| | - Heidar Sharafi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Armita Shahesmaeili
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Saiedeh Haji Maghsoudi
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Nima Ghalekhani
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Tavakoli
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Maliheh Sadat Bazrafshani
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mostafa Shokoohi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Niloufar Aghaali
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Akbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| |
Collapse
|
14
|
Sazonova Y, Kulchynska R, Azarskova M, Liulchuk M, Salyuk T, Doan I, Barzilay E. Population-level prevalence of detectable HIV viremia in people who inject drugs (PWID) in Ukraine: Implications for HIV treatment and case finding interventions. PLoS One 2023; 18:e0290661. [PMID: 37883454 PMCID: PMC10602286 DOI: 10.1371/journal.pone.0290661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/13/2023] [Indexed: 10/28/2023] Open
Abstract
Achievement of viral load suppression among people living with HIV is one of the most important goals for effective HIV epidemic response. In Ukraine, people who inject drugs (PWID) experience the largest HIV burden. At the same time, this group disproportionally missed out in HIV treatment services. We performed a secondary data analysis of the national-wide cross-sectional bio-behavioral surveillance survey among PWID to assess the population-level prevalence of detectable HIV viremia and identify key characteristics that explain the outcome. Overall, 11.4% of PWID or 52.6% of HIV-positive PWID had a viral load level that exceeded the 1,000 copies/mL threshold. In the group of HIV-positive PWID, the detectable viremia was attributed to younger age, monthly income greater than minimum wage, lower education level, and non-usage of antiretroviral therapy (ART) and opioid agonistic therapy. Compared with HIV-negative PWID, the HIV-positive group with detectable viremia was more likely to be female, represented the middle age group (35-49 years old), had low education and monthly income levels, used opioid drugs, practiced risky injection behavior, and had previous incarceration history. Implementing the HIV case identification and ART linkage interventions focused on the most vulnerable PWID sub-groups might help closing the gaps in ART service coverage and increasing the proportion of HIV-positive PWID with viral load suppression.
Collapse
Affiliation(s)
- Yana Sazonova
- PEPFAR Coordination Office in Ukraine, Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Kyiv, Ukraine
| | - Roksolana Kulchynska
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Kyiv, Ukraine
| | - Marianna Azarskova
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Kyiv, Ukraine
| | - Mariia Liulchuk
- State Institution "The L.V. Gromashevskij Institute of Epidemiology and Infectious Diseases of NAMS of Ukraine", Kyiv, Ukraine
| | - Tetiana Salyuk
- Monitoring and Evaluation Unit, ICF "Alliance for Public Health", Kyiv, Ukraine
| | - Ivan Doan
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Kyiv, Ukraine
| | - Ezra Barzilay
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Kyiv, Ukraine
| |
Collapse
|
15
|
Khezri M, Goldmann E, Tavakoli F, Karamouzian M, Shokoohi M, Mehmandoost S, Ghalekhani N, Haghdoost AA, Des Jarlais D, Mirzazadeh A, Sharifi H. Awareness and willingness to use HIV self-testing among people who inject drugs in Iran. Harm Reduct J 2023; 20:145. [PMID: 37805505 PMCID: PMC10560425 DOI: 10.1186/s12954-023-00881-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/03/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Most people who inject drugs (PWID) in Iran have not undergone recent HIV testing. While PWID face barriers when seeking HIV testing at health facilities, HIV self-testing (HIVST) could be a promising approach to improve HIV testing uptake. We examined the awareness and willingness to use HIVST among PWID in Iran. We also identified participants' characteristics associated with a higher willingness to use HIVST. METHODS PWID were recruited in 11 cities using a respondent-driven sampling method. Willingness to use HIVST was defined as a binary variable (very low/low willingness vs. high/very high willingness). We performed multivariable modified Poisson regression to examine associated factors and report adjusted prevalence ratios (aPR) and 95% confidence intervals (CI). RESULTS Of 2,252 PWID, 362 (16.2%; 95% CI 14.7, 17.8) had ever heard of HIVST; however, 1,658 (73.6%; 95% CI 71.7, 75.4) reported high/very high willingness to use HIVST. Willingness to use HIVST was higher among PWID who reported having a high/moderate HIV risk perception (aPR 1.22; 95% CI 1.09, 1.37), ever experiencing homelessness (aPR 1.15; 95% CI 1.03, 1.28), > 10 years of injecting history (aPR 1.16; 95% CI 1.00, 1.34), and high injection frequency in the last three months (aPR 1.18; 95% CI 1.05, 1.32). CONCLUSION Most PWID in Iran, particularly those experiencing homelessness, have a longer injecting history, engage in more frequent injection practices, and possess a heightened perception of HIV risk would be willing to adopt HIVST. Enhancing HIVST awareness through increased access to HIVST and health education programs are needed. Additionally, conducting implementation science studies to effectively design and run HIVST programs in Iran can also increase PWID's access to HIV testing.
Collapse
Affiliation(s)
- Mehrdad Khezri
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, USA
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Emily Goldmann
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, USA
- Center for Drug Use and HIV/HCV Research, New York, NY, USA
| | - Fatemeh Tavakoli
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Karamouzian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mostafa Shokoohi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Health Sciences, Faculty of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
| | - Soheil Mehmandoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Nima Ghalekhani
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Akbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Don Des Jarlais
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, USA
- Center for Drug Use and HIV/HCV Research, New York, NY, USA
| | - Ali Mirzazadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| |
Collapse
|
16
|
Tsui JI, Whitney BM, Korthuis PT, Chan B, Pho MT, Jenkins WD, Young AM, Cooper HLF, Friedmann PD, Stopka TJ, de Gijsel D, Miller WC, Go VF, Westergaard R, Brown R, Seal DW, Zule WA, Feinberg J, Smith GS, Mixson LS, Fredericksen R, Crane HM, Delaney JA. Methamphetamine use and utilization of medications for opioid use disorder among rural people who use drugs. Drug Alcohol Depend 2023; 250:110911. [PMID: 37549545 PMCID: PMC10599300 DOI: 10.1016/j.drugalcdep.2023.110911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Methamphetamine use is common among persons with opioid use disorder. This study evaluated associations between methamphetamine use and treatment with agonist medications for opioid use disorder (MOUD, specifically buprenorphine, and/or methadone) in U.S. rural communities. METHODS The Rural Opioid Initiative (ROI) is a consortium spanning 10 states and 65 rural counties that included persons who reported past 30-day use of opioids and/or injection drug use between 1/2018 and 3/2020. Analyses were restricted to participants who had ever used opioids and had data on past 30-day methamphetamine use. Multivariable models examined the relationship between methamphetamine use and utilization of agonist MOUD. RESULTS Among 2899 participants, 2179 (75.2%) also reported recent methamphetamine use. Persons with methamphetamine use compared to those without were younger, more likely to have injected drugs, be unhoused, criminal justice involved, and less likely to have health insurance. Adjusted for age, sex, race, and study site, recent methamphetamine use was associated with lower relative odds of past 30-day methadone treatment (aOR=0.66; 95% CI: 0.45-0.99) and fewer methadone treatment days (aIRR=0.76; 0.57-0.99), but not past 30-day buprenorphine receipt (aOR=0.90; 0.67-1.20), buprenorphine treatment days in past 6 months: aIRR=0.88; 0.69-1.12) or perceived inability to access buprenorphine (aOR=1.12; 0.87-1.44) or methadone (aOR=1.06; 0.76-1.48). CONCLUSION Methamphetamine use is common among persons who use opioids in rural U.S. areas and negatively associated with current treatment and retention on methadone but not buprenorphine. Future studies should examine reasons for this disparity and reduce barriers to methadone for persons who use opioids and methamphetamine.
Collapse
Affiliation(s)
- Judith I Tsui
- Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195-6420, USA.
| | - Bridget M Whitney
- Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195-6420, USA
| | - P Todd Korthuis
- Department of Medicine, Oregon Health & Science University, 3270 Southwest Pavilion Loop OHSU Physicians Pavilion, Suite 350, Portland, OR 97239, USA
| | - Brian Chan
- Department of Medicine, Oregon Health & Science University, 3270 Southwest Pavilion Loop OHSU Physicians Pavilion, Suite 350, Portland, OR 97239, USA
| | - Mai T Pho
- University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
| | - Wiley D Jenkins
- Southern Illinois University School of Medicine, Springfield, IL 62794, USA
| | - April M Young
- University of Kentucky, 760 Press Avenue Suite 280, Lexington, KY 40536, USA
| | - Hannah L F Cooper
- Rollins School of Public Health, Emory University, Grace Crum Rollins Building 1518 Clifton Road, Atlanta, GA 30322, USA
| | - Peter D Friedmann
- Office of Research, UMass Chan Medical School - Baystate and Baystate Health, 3601 Main Street, 3rd Floor, Springfield, MA 01199, USA
| | - Thomas J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA
| | - David de Gijsel
- Dartmouth-Hitchcock Medical Center, Section of Infectious Disease and International Health, Lebanon, NH, USA
| | - William C Miller
- The Ohio State University, 346 Cunz Hall 1841 Neil Ave, Columbus, OH 43210, USA
| | - Vivian F Go
- University of North Carolina-Chapel Hill, 363 Rosenau Hall CB# 7440, Chapel Hill, NC 27599, USA
| | - Ryan Westergaard
- University of Wisconsin-Madison, 1685 Highland Avenue, 5th Floor, Madison, WI 53705-2281, USA
| | - Randall Brown
- University of Wisconsin-Madison, 1685 Highland Avenue, 5th Floor, Madison, WI 53705-2281, USA
| | - David W Seal
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2210, New Orleans, LA 70112, USA
| | - William A Zule
- RTI International, 3040 E. Cornwallis Road, PO Box 12194, Research Triangle Park, NC 2709-2194, USA
| | - Judith Feinberg
- West Virginia University, 930 Chestnut Ridge Road, PO Box 9156, Morgantown, WV 26505, USA
| | - Gordon S Smith
- West Virginia University, 930 Chestnut Ridge Road, PO Box 9156, Morgantown, WV 26505, USA
| | - L Sarah Mixson
- Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195-6420, USA
| | - Rob Fredericksen
- Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195-6420, USA
| | - Heidi M Crane
- Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195-6420, USA
| | - Joseph A Delaney
- Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195-6420, USA
| |
Collapse
|
17
|
Tavakoli F, Moradi G, Mirzazadeh A, Zarei B, Sharifi H. HIV testing and its associated factors among female sex workers in Iran in 2020: Finding from a respondent-driven sampling survey. PLoS One 2023; 18:e0289307. [PMID: 37527241 PMCID: PMC10393135 DOI: 10.1371/journal.pone.0289307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 07/14/2023] [Indexed: 08/03/2023] Open
Abstract
HIV testing uptake was around 70% among female sex workers (FSWs) in Iran in 2015. Due to the recognized importance of HIV testing in prevention, care, and treatment among FSWs, this study aimed to provide an update and also an improvement as it uses respondent-driven sampling (RDS) for the frequency and the correlates of HIV testing among FSWs in Iran. A total of 1,515 FSWs were recruited from eight cities in Iran between 2019-2020 using RDS. Data were collected using face-to-face interviews. Also, rapid diagnostic tests (RDT) were used to determine HIV and syphilis status as per national guidelines. We used multivariable logistic regression to explore correlates of HIV testing in the last 12 months. Of 1,399 FSWs who had data for HIV testing, 44.7% (95% Confidence Intervals (CI): 40.7; 48.7) reported HIV testing in the last 12 months. The odds of HIV testing in the last 12 months was higher among FSWs who used a condom at last sex with a non-paying partner (Adjusted OR = 1.78; 95% CI: 1.39; 2.27), never used alcohol (Adjusted OR = 1.72; 95% CI: 1.33; 2.23), ever used drug (Adjusted OR = 1.60; 95% CI: 1.22; 2.08). HIV testing among FSWs in Iran is considerably low. It is necessary to know the barriers to HIV testing to improve the cascade of HIV treatment in the country.
Collapse
Affiliation(s)
- Fatemeh Tavakoli
- HIV/STI Surveillance Research Center and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ghobad Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ali Mirzazadeh
- HIV/STI Surveillance Research Center and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, United States of America
| | - Bushra Zarei
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| |
Collapse
|
18
|
Chambers C, Deeks SL, Sutradhar R, Cox J, de Pokomandy A, Grennan T, Hart TA, Lambert G, Moore DM, Grace D, Grewal R, Jollimore J, Lachowsky N, Nisenbaum R, Ogilvie G, Sauvageau C, Tan DHS, Coutlée F, Burchell AN. Vaccine Effectiveness Against 12-Month Incident and Persistent Anal Human Papillomavirus Infection Among Gay, Bisexual, and Other Men Who Have Sex With Men. J Infect Dis 2023; 228:89-100. [PMID: 36655513 PMCID: PMC10304758 DOI: 10.1093/infdis/jiad005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/29/2022] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Real-world evidence of human papillomavirus (HPV) vaccine effectiveness (VE) against longitudinal outcomes is lacking among gay, bisexual, and other men who have sex with men (GBM). We compared 12-month incidence and persistence of anal HPV infection between vaccinated and unvaccinated GBM. METHODS We recruited GBM aged 16-30 years in Montreal, Toronto, and Vancouver, Canada, from 2017 to 2019. Participants were followed over a median of 12 months (interquartile range, 12-13 months). Participants self-reported HPV vaccination and self-collected anal specimens for HPV DNA testing. We calculated prevalence ratios (PR) for 12-month cumulative incidence and persistence with ≥1 quadrivalent vaccine type (HPV 6/11/16/18) between vaccinated (≥1 dose at baseline) and unvaccinated participants using a propensity score-weighted, modified Poisson regression. RESULTS Among 248 participants, 109 (44.0%) were vaccinated at baseline, of whom 62.6% received 3 doses. PRs for HPV 6/11/16/18 were 0.56 (95% confidence interval [CI], .24-1.31) for cumulative incidence and 0.53 (95% CI, .25-1.14) for persistence. PRs were 0.23 (95% CI, .05-1.03) and 0.08 (95% CI, .01-.59) for incidence and persistence, respectively, among participants who received their first dose at age ≤23 years and 0.15 (95% CI, .03-.68) and 0.12 (95% CI, .03-.54) among participants who were sexually active for ≤5 years before vaccination. CONCLUSIONS Findings support national recommendations for HPV vaccination at younger ages or soon after sexual debut.
Collapse
Affiliation(s)
- Catharine Chambers
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
| | - Shelley L Deeks
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Government of Nova Scotia, Halifax, Nova Scotia, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rinku Sutradhar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
| | - Joseph Cox
- McGill University Health Centre - Research Institute, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec, Canada
- Direction Régionale de Santé Publique de Montréal, Montréal, Québec, Canada
| | - Alexandra de Pokomandy
- McGill University Health Centre - Research Institute, Montréal, Québec, Canada
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Troy Grennan
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Trevor A Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Gilles Lambert
- Direction Régionale de Santé Publique de Montréal, Montréal, Québec, Canada
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Jody Jollimore
- Community-Based Research Centre, Vancouver, British Columbia, Canada
| | - Nathan Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - Rosane Nisenbaum
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
| | - Gina Ogilvie
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chantal Sauvageau
- Institut National de Santé Publique du Québec, Québec, Québec, Canada
| | | | - François Coutlée
- Département de microbiologie, infectiologie et immunologie, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Ann N Burchell
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
19
|
Cyplik A, Bocianowski J. A Comparison of Methods to Estimate Additive-by-Additive-by-Additive of QTL×QTL×QTL Interaction Effects by Monte Carlo Simulation Studies. Int J Mol Sci 2023; 24:10043. [PMID: 37373191 DOI: 10.3390/ijms241210043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/05/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023] Open
Abstract
The goal of the breeding process is to obtain new genotypes with traits improved over the parental forms. Parameters related to the additive effect of genes as well as their interactions (such as epistasis of gene-by-gene interaction effect and additive-by-additive-by-additive of gene-by-gene-by-gene interaction effect) can influence decisions on the suitability of breeding material for this purpose. Understanding the genetic architecture of complex traits is a major challenge in the post-genomic era, especially for quantitative trait locus (QTL) effects, QTL-by-QTL interactions and QTL-by-QTL-by-QTL interactions. With regards to the comparing methods for estimating additive-by-additive-by-additive of QTL×QTL×QTL interaction effects by Monte Carlo simulation studies, there are no publications in the open literature. The parameter combinations assumed in the presented simulation studies represented 84 different experimental situations. The use of weighted regression may be the preferred method for estimating additive-by-additive-by-additive of QTL-QTL-QTL triples interaction effects, as it provides results closer to the true values of total additive-by-additive-by-additive interaction effects than using unweighted regression. This is also indicated by the obtained values of the determination coefficients of the proposed models.
Collapse
Affiliation(s)
- Adrian Cyplik
- Department of Mathematical and Statistical Methods, Poznań University of Life Sciences, Wojska Polskiego 28, 60-637 Poznań, Poland
| | - Jan Bocianowski
- Department of Mathematical and Statistical Methods, Poznań University of Life Sciences, Wojska Polskiego 28, 60-637 Poznań, Poland
| |
Collapse
|
20
|
Oh KM, An K, Lee M, Shin C, Steves SL. Colorectal cancer screening disparities in Asian Americans: the influences of patient-provider communication and social media use. Cancer Causes Control 2023:10.1007/s10552-023-01720-z. [PMID: 37266764 PMCID: PMC10237058 DOI: 10.1007/s10552-023-01720-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 05/16/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE We examined the role of patient-provider communication (PPC) during in-person visits and via electronic communication and social media use on colorectal cancer (CRC) screening among Asian Americans (AAs) and Non-Hispanic Whites (NHWs) aged 50 and older. METHODS Health Information National Trends Survey 2017-2020 data were analyzed. RESULTS AAs tended to evaluate the quality of PPC during their in-person visits to a health care provider lower than NHWs. AAs' CRC screening rate was lower than the rate of NHWs (78.8% vs. 84.4%). After adjusting for sociodemographics, healthcare access, and health status, the quality of PPC was the only significant predictor associated with a lower probability of CRC screening among AAs (Adjusted OR 0.74; 95% CI 0.56, 0.96); while the Internet to communicate with a health care provider was the only significant predictor of CRC screening among NHWs (Adjusted OR 1.76; CI 1.11, 2.79). AAs were more likely to use YouTube to watch a health-related video than NHWs (43.5% vs, 24%). However, social media use was not associated with CRC screening in both AAs and NHWs. CONCLUSION Use of electronic communication technology may contribute to improve health information literacy and reduce the disparity. On-line communication may empower the culturally and linguistically diverse AAs by improving their confidence in communication with health care providers. Thus, communication technologies need to be strategically utilized and tailored to better meet the communication needs of racial/ethnic minorities. Online communication technologies may reduce the disparities in PPC related to cancer screening and cancer burden experienced by AAs.
Collapse
Affiliation(s)
- Kyeung Mi Oh
- School of Nursing, George Mason University, Fairfax, VA, USA.
| | - Kyungeh An
- Graduate School of Biomedical Sciences & School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Moonju Lee
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Chanam Shin
- College of Nursing, Texas Woman's University, Denton, TX, USA
| | | |
Collapse
|
21
|
Chambers C, Deeks SL, Sutradhar R, Cox J, de Pokomandy A, Grennan T, Hart TA, Lambert G, Moore DM, Grace D, Grewal R, Jollimore J, Lachowsky NJ, Mah A, Nisenbaum R, Ogilvie G, Sauvageau C, Tan DH, Yeung A, Burchell AN. Self-reported Human Papillomavirus Vaccination and Vaccine Effectiveness Among Men Who Have Sex with Men: A Quantitative Bias Analysis. Epidemiology 2023; 34:225-229. [PMID: 36722804 PMCID: PMC9891269 DOI: 10.1097/ede.0000000000001580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/04/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Self-report of human papillomavirus (HPV) vaccination has ~80-90% sensitivity and ~75-85% specificity. We measured the effect of nondifferential exposure misclassification associated with self-reported vaccination on vaccine effectiveness (VE) estimates. METHODS Between 2017-2019, we recruited sexually active gay, bisexual, and other men who have sex with men aged 16-30 years in Canada. VE was derived as 1-prevalence ratio × 100% for prevalent anal HPV infection comparing vaccinated (≥1 dose) to unvaccinated men using a multivariable modified Poisson regression. We conducted a multidimensional and probabilistic quantitative bias analysis to correct VE estimates. RESULTS Bias-corrected VE estimates were relatively stable across sensitivity values but differed from the uncorrected estimate at lower values of specificity. The median adjusted VE was 27% (2.5-97.5th simulation interval = -5-49%) in the uncorrected analysis, increasing to 39% (2.5-97.5th simulation interval = 2-65%) in the bias-corrected analysis. CONCLUSION A large proportion of participants erroneously reporting HPV vaccination would be required to meaningfully change VE estimates.
Collapse
Affiliation(s)
- Catharine Chambers
- From the University of Toronto, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
| | - Shelley L. Deeks
- Government of Nova Scotia, Halifax, Nova Scotia, Canada
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rinku Sutradhar
- From the University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Joseph Cox
- McGill University, Montréal, Québec, Canada
- Direction régionale de santé publique de Montréal, Montréal, Québec, Canada
| | | | - Troy Grennan
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Trevor A. Hart
- From the University of Toronto, Toronto, Ontario, Canada
- Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Gilles Lambert
- Direction régionale de santé publique de Montréal, Montréal, Québec, Canada
| | - David M. Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver British Columbia, Canada
| | - Daniel Grace
- From the University of Toronto, Toronto, Ontario, Canada
| | | | - Jody Jollimore
- Community-Based Research Centre, Vancouver, British Columbia, Canada
| | | | - Ashley Mah
- Unity Health Toronto, Toronto, Ontario, Canada
| | - Rosane Nisenbaum
- From the University of Toronto, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
| | - Gina Ogilvie
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Chantal Sauvageau
- Institut national de santé publique du Québec, Québec, Québec, Canada
| | | | - Anna Yeung
- Unity Health Toronto, Toronto, Ontario, Canada
| | - Ann N. Burchell
- From the University of Toronto, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
| |
Collapse
|
22
|
Lyons CE, Twahirwa Rwema JO, Makofane K, Diouf D, Mfochive Njindam I, Ba I, Kouame A, Tamoufe U, Cham B, Aliu Djaló M, Obodou EP, Karita E, Simplice A, Nowak RG, Crowell TA, Matse S, Kouanda S, Enama JP, Kavanagh M, Millett GA, Beyrer C, Murray S, Baral S. Associations between punitive policies and legal barriers to consensual same-sex sexual acts and HIV among gay men and other men who have sex with men in sub-Saharan Africa: a multicountry, respondent-driven sampling survey. Lancet HIV 2023; 10:e186-e194. [PMID: 36623537 PMCID: PMC10288909 DOI: 10.1016/s2352-3018(22)00336-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 10/27/2022] [Accepted: 11/08/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Few assessments of associations between structural-level factors and HIV among gay men and other men who have sex with men (MSM) have been conducted, especially in sub-Saharan Africa. Our objective was to examine HIV testing history, HIV status, and stigmas among MSM living in ten countries with heterogeneous legal environments. METHODS This study used pooled data from ten country-specific, cross-sectional studies done in 25 sites in Burkina Faso, Cameroon, Côte d'Ivoire, The Gambia, Guinea-Bissau, Nigeria, Senegal, Eswatini, Rwanda, and Togo. MSM were recruited by respondent-driven sampling and were eligible if they met country-specific requirements for age, area of residence, and self reported being assigned male sex at birth and having anal sex with a man in the past 12 months. Policy related to same-sex sexual behaviour for each country was categorised as not criminalised or criminalised. Countries were also categorised on the basis of recent reports of prosecutions related to same-sex sexual acts. Legal barriers were defined as those that legally prevented registration or operation of sexual orientation related civil society organisations (CSOs). Individual data on HIV testing history, HIV status, and stigma were collected via interviewer-administered sociobehavioural questionnaires and HIV testing. Multilevel logistic regression with random intercepts was used to assess the association between policies, recent prosecutions, legal barriers to CSOs, and HIV-related factors with adjusted odds ratios (aORs) and 95% CIs. FINDINGS Between Aug 3, 2011, and May 27, 2020, we recruited 8047 MSM with a median age of 23 years (IQR 21-27). 4886 (60·7%) lived in countries that criminalise same-sex sexual acts. HIV prevalence among MSM was higher in criminalised settings than non-criminalised settings (aOR 5·15, 95% CI 1·12-23·57); higher in settings with recent prosecutions than in settings without prosecutions (12·06, 7·19-20·25); and higher in settings with barriers to CSOs than without barriers to CSOs (9·83, 2·00-48·30). HIV testing or status awareness was not associated with punitive policies or practices. Stigma was associated with HIV status but did not consistently vary across legal environments. Disparities in HIV prevalence between MSM and other adult men were highest in punitive settings. INTERPRETATION Structural risks including discriminatory country-level policies, prosecutions, and legal barriers might contribute to higher HIV prevalence among MSM. Taken together, these data highlight the importance of decriminalisation and decreasing enforcement, alongside stigma reduction, as central to effective control for HIV. FUNDING National Institutes of Health. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
Collapse
Affiliation(s)
- Carrie E Lyons
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA.
| | | | - Keletso Makofane
- FXB Health and Human Rights, Harvard T H Chan School of Public Health, Boston, MA, USA
| | | | | | | | - Abo Kouame
- Ministère de la Santé et de l'Hygiène Publique, Abidjan, Côte d'Ivoire
| | - Ubald Tamoufe
- Johns Hopkins Cameroon Program/Metabiota, Yaoundé, Cameroon
| | | | | | | | | | | | - Rebecca G Nowak
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Trevor A Crowell
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA; US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Sindy Matse
- Eswatini Ministry of Health, Mbabane, Eswatini
| | - Seni Kouanda
- Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso; Institut Africain de Santé Publique, Ouagadougou, Burkina Faso
| | | | - Matthew Kavanagh
- Department of International Health and Neill Institute for National and Global Health Law, Georgetown University, Washington, DC, USA
| | | | - Chris Beyrer
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA; Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Sarah Murray
- Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| |
Collapse
|
23
|
HIV prevalence and associated risk factors among young tertiary student men who have sex with men (MSM) in Nairobi, Kenya: a respondent-driven sampling survey. AIDS Res Ther 2023; 20:7. [PMID: 36747178 PMCID: PMC9900555 DOI: 10.1186/s12981-023-00502-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 01/24/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Young men who have sex with men (MSM), are a key population at higher risk of HIV infection yet they are underrepresented in research. We conducted a bio-behavioral survey to estimate HIV prevalence and associated risk factors among tertiary student MSM (TSMSM) in Nairobi, Kenya. METHODS Between February and March 2021, 248 TSMSM aged ≥ 18 years who reported sex with another man in the past year participated in a respondent-driven sampling (RDS) based cross-sectional survey. Participants completed an electronically self-administered behavioral survey and provided a blood sample for HIV antibody testing, alongside urine, anorectal and oropharyngeal swabs for pooled testing of sexually transmitted infections using a multiplex nucleic acid amplification test. RDS-Analyst v.0.72 and Stata v.15 software were used for data analysis. Differences in proportions were examined using chi-square (χ2) test, and unweighted multivariate logistic regression was used to assess factors associated with HIV infection. RESULTS HIV prevalence among study participants was 8.3%, whereas the weighted prevalence was 3.6% (95% CI: 1.3-6.0%). Median ages of participants, and at self-reported first anal sex with a man were 21(interquartile range [IQR] 20-22) and 18 (IQR 17-19) years, respectively. A majority (89.3%) of TSMSM owned a smart phone, 46.5% had ever used a geosocial networking app for MSM such as Grindr ® to find a sex partner, and a third (33.6%) met their last sex partner online. Almost three-quarters (71.3%) had > 1 male sex partner in the year before the survey. A third (34.3%) did not use condoms with their last sex partner, 21.2% received money from their last sex partner and 40.9% had taken alcohol/another drug during their last sexual encounter. HIV infection was associated with studying in private institutions (adjusted odds ratio[AOR] = 6.0; 95% confidence intervals [CI] : 1.2-30.0, p = 0.027), preferring a sex partner of any age-younger, same or older (AOR = 5.2; 95 CI: 1.1-25.2, p = 0.041), last sex partner being > 25 years (AOR = 6.4; 95% CI: 1.2-34.6, p = 0.030), meeting the last sex partner online (AOR = 4.2; 95% CI; 1.1-17.0, p = 0.043) and testing positive for Neisseria gonorrhea (AOR = 7.8; 95% CI: 2.0-29.9, p = 0.003). CONCLUSIONS HIV prevalence among TSMSM in Nairobi is alarmingly high, demonstrating a need for tailored prevention and control interventions for this young key population.
Collapse
|
24
|
HIV prevalence and associated factors among female sex workers in Iran: a bio-behavioral survey in 2020. AIDS Behav 2023; 27:909-918. [PMID: 36097087 PMCID: PMC9466307 DOI: 10.1007/s10461-022-03827-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2022] [Indexed: 11/03/2022]
Abstract
Despite the overall decline in human immunodeficiency virus (HIV) prevalence, it remains unacceptably high in key populations. This study aimed to estimate prevalence of HIV infection and high-risk behaviors among female sex workers (FSWs). This study was a cross-sectional survey of FSWs conducted between December 2019 and August 2020 in eight geographically diverse cities in Iran. After providing informed consent, participants completed a bio-behavioral questionnaire and after completion of the interview, rapid diagnostic tests (RDT) and dried blood spots (DBS) were collected to determine HIV and syphilis status as per national guidelines, if the women consented. All analyzes were based on RDS adjustment. Weighting was done according to Giles'SS estimator. Among the 1515 FSWs, the overall prevalence of HIV and syphilis were 1.6% (95% CI: 0.8-2.3) and zero, respectively. The highest HIV prevalence was observed in Shiraz (5.1%) and Khorramabad city (1.6%). In addition, HIV-positive FSWs had a higher mean age at first sexual contact than HIV-negative FSWs (21.4 ± 5.6 vs. 17.2 ± 4.2 years). Injection drug use and a history of arrest or incarceration were associated with an increased odds of HIV infection (OR = 6.25; 95% CI: 1.90-20.55 and OR = 4.57; 95% CI: 1.64-12.72, respectively). Based on the results, strategies to improve early HIV diagnosis, harm reduction, and use of testing and treatment strategies are needed to reduce and control HIV infections.
Collapse
|
25
|
Lichtwarck HO, Kazaura MR, Moen K, Mmbaga EJ. Harmful Alcohol Use and Associated Socio-Structural Factors among Female Sex Workers Initiating HIV Pre-Exposure Prophylaxis in Dar es Salaam, Tanzania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:698. [PMID: 36613018 PMCID: PMC9819768 DOI: 10.3390/ijerph20010698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/21/2022] [Accepted: 12/28/2022] [Indexed: 06/17/2023]
Abstract
Harmful alcohol use is an important risk factor for premature mortality and morbidity and associated with increased HIV risk and lower uptake of and adherence to HIV interventions. This study aimed to assess the extent of harmful alcohol use and associated socio-structural vulnerability factors among female sex workers in Dar es Salaam, Tanzania, a key population in the HIV epidemic. Data from a study of female sex workers initiating pre-exposure prophylaxis (PrEP) recruited through respondent driven sampling were used. We assessed harmful alcohol use with the Alcohol Use Disorders Identification Test (AUDIT) defined as having an AUDIT score ≥ 16. Associations between harmful alcohol use and socio-structural factors were assessed using logistic regression with marginal standardization. Of the 470 women recruited, more than one third (37.3%) had a drinking pattern suggestive of harmful alcohol use. Such use was independently associated with sex work-related mobility (aPR: 1.36, 95% CI: 1.11-1.61), arrest/incarceration (aPR: 1.55, 95% CI: 1.27-1.84) and gender-based violence (aPR: 1.31, 95% CI: 1.06-1.56). The high prevalence of harmful alcohol use and the interconnectedness with socio-structural factors indicate a need for a holistic programmatic approach to health for female sex workers. Programming should not solely direct attention to individual behavior but also include strategies aiming to address socio-structural vulnerabilities.
Collapse
Affiliation(s)
- Hanne Ochieng Lichtwarck
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway
| | - Method Rwelengera Kazaura
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam 11103, Tanzania
| | - Kåre Moen
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway
| | - Elia John Mmbaga
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam 11103, Tanzania
| |
Collapse
|
26
|
Anza-Ramirez C, Lazo M, Zafra-Tanaka JH, Avila-Palencia I, Bilal U, Hernández-Vásquez A, Knoll C, Lopez-Olmedo N, Mazariegos M, Moore K, Rodriguez DA, Sarmiento OL, Stern D, Tumas N, Miranda JJ. The urban built environment and adult BMI, obesity, and diabetes in Latin American cities. Nat Commun 2022; 13:7977. [PMID: 36581636 PMCID: PMC9800402 DOI: 10.1038/s41467-022-35648-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/15/2022] [Indexed: 12/31/2022] Open
Abstract
Latin America is the world's most urbanized region and its heterogeneous urban development may impact chronic diseases. Here, we evaluated the association of built environment characteristics at the sub-city -intersection density, greenness, and population density- and city-level -fragmentation and isolation- with body mass index (BMI), obesity, and type 2 diabetes (T2D). Data from 93,280 (BMI and obesity) and 122,211 individuals (T2D) was analysed across 10 countries. Living in areas with higher intersection density was positively associated with BMI and obesity, whereas living in more fragmented and greener areas were negatively associated. T2D was positively associated with intersection density, but negatively associated with greenness and population density. The rapid urban expansion experienced by Latin America provides unique insights and vastly expand opportunities for population-wide urban interventions aimed at reducing obesity and T2D burden.
Collapse
Affiliation(s)
- Cecilia Anza-Ramirez
- grid.11100.310000 0001 0673 9488CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Mariana Lazo
- grid.166341.70000 0001 2181 3113Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA USA ,grid.166341.70000 0001 2181 3113Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA USA
| | - Jessica Hanae Zafra-Tanaka
- grid.11100.310000 0001 0673 9488CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ione Avila-Palencia
- grid.166341.70000 0001 2181 3113Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA USA ,grid.4777.30000 0004 0374 7521Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, Northern Ireland UK
| | - Usama Bilal
- grid.166341.70000 0001 2181 3113Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA USA ,grid.166341.70000 0001 2181 3113Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA USA
| | - Akram Hernández-Vásquez
- grid.11100.310000 0001 0673 9488CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carolyn Knoll
- grid.166341.70000 0001 2181 3113Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA USA
| | - Nancy Lopez-Olmedo
- grid.415771.10000 0004 1773 4764Center for Population and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Mónica Mazariegos
- grid.418867.40000 0001 2181 0430INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Kari Moore
- grid.166341.70000 0001 2181 3113Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA USA
| | - Daniel A. Rodriguez
- grid.47840.3f0000 0001 2181 7878Department of City and Regional Planning, University of California, Berkeley, CA USA
| | - Olga L. Sarmiento
- grid.7247.60000000419370714School of Medicine, Universidad de los Andes, Bogota, Colombia
| | - Dalia Stern
- grid.415771.10000 0004 1773 4764CONACyT- Center for Population and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Natalia Tumas
- grid.5612.00000 0001 2172 2676Department of Political and Social Sciences, Research Group on Health Inequalities, Environment, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain ,grid.5612.00000 0001 2172 2676Johns Hopkins University - Pompeu Fabra University Public Policy Center (UPF-BSM), Universitat Pompeu Fabra, Barcelona, Spain ,grid.10692.3c0000 0001 0115 2557Centro de Investigaciones y Estudios sobre Cultura y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) y Universidad Nacional de Córdoba, Córdoba, Argentina
| | - J. Jaime Miranda
- grid.11100.310000 0001 0673 9488CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru ,grid.11100.310000 0001 0673 9488School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| |
Collapse
|
27
|
Mehrabi F, Mehmandoost S, Mirzazadeh A, Noroozi A, Tavakoli F, Mirzaei H, Khezri M, Mousavian G, Ghalekhani N, Afsar Kazerooni P, Navaiian F, Farajzadeh Z, Shokoohi M, Sharifi H, Karamouzian M. Characterizing People Who Inject Drugs with no History of Opioid Agonist Therapy Uptake in Iran: Results from a National Bio-behavioural Surveillance Survey in 2020. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00992-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
|
28
|
Vincent W, McFarland W. Missed opportunities for healthcare providers to discuss HIV preexposure prophylaxis with people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 110:103873. [PMID: 36252292 DOI: 10.1016/j.drugpo.2022.103873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 09/19/2022] [Accepted: 09/26/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To identify missed opportunities for healthcare providers to discuss HIV pre-exposure prophylaxis (PrEP) with people who inject drugs (PWID). METHODS Participants were 395 HIV-negative PWID recruited for the 2018 National HIV Behavioral Surveillance survey in San Francisco, California via respondent-driven sampling. Adjusted logistic regression tested whether discussing PrEP with a provider in the last year was associated with sociodemographic characteristics, structural factors, and accessing HIV/STI and substance use treatment services. RESULTS Most PWID (86.3%) reported seeing a healthcare provider, but only 15.0% of these reported discussing PrEP with a healthcare provider. PWID who were sexual minority men had greater odds of having a discussion about PrEP with a healthcare provider than PWID who were heterosexual men (aOR=3.42, 95% CI=1.21-9.73) or heterosexual women (aOR=3.69, 95% CI=1.08-12.62). Additionally, factors associated with discussing PrEP included: being tested for HIV (aOR=4.29, 95% CI=1.21-15.29), having a healthcare provider recommend HIV testing (aOR=2.95, 95% CI=1.23-7.06), and receiving free condoms from a prevention program (aOR=5.45, 95% CI=1.78-16.65). CONCLUSIONS In the face of low PrEP uptake, continuing HIV transmission, and many missed opportunities to discussed PrEP (e.g., PWID who are women, substance use treatment services), these findings from San Francisco indicate that healthcare providers and public health efforts need to systematically offer PrEP to PWID. Additional research may clarify missed opportunities in other locations as well as the impact of COVID-19.
Collapse
Affiliation(s)
- Wilson Vincent
- Department of Epidemiology and Biostatistics, Temple University, Philadelphia, PA, United States of America.
| | - Willi McFarland
- San Francisco Department of Public Health, San Francisco, CA, United States of America; Department of Medicine, University of California, San Francisco, CA, United States of America.
| |
Collapse
|
29
|
Khezri M, Tavakoli F, Karamouzian M, Sharifi H, Ghalehkhani N, Mousavian G, Mehmandoost S, Bazargani M, Hosseinpour AM, Mahboubi M, Baral S, Shokoohi M. Public injecting and its association with mental health and other drug-related outcomes among people who inject drugs in Iran. J Subst Abuse Treat 2022; 143:108868. [PMID: 36137306 DOI: 10.1016/j.jsat.2022.108868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 07/16/2022] [Accepted: 08/17/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Injecting in public places may increase the risk of drug and health-related harms among people who inject drugs (PWID). We examined the prevalence of public injecting and associations with non-fatal overdose, needle/syringe sharing, sexual health, and mental health among PWID in Iran. METHODS Using respondent-driven sampling, we recruited 2684 PWID from 11 major cities between July 2019 and March 2020. We defined public injecting as injecting primarily in public places, such as streets, parks, or abandoned buildings. Multivariable logistic regression models assessed public injecting and its associated factors, as well as the association of public injecting with certain health outcomes. RESULTS Of 2388 respondents, 69.6 % reported public injecting in the previous year. Self-identifying as men (adjusted odds ratio [aOR] = 4.21; 95 % confidence intervals [95 % CI]: 2.31, 7.65), homelessness (aOR = 6.81; 95 % CI: 5.10, 9.10), high injection frequency (aOR = 1.58; 95 % CI: 1.03, 2.44), and free needle/syringe uptake (aOR = 1.47; 95 % CI: 1.04, 2.07) were significantly associated with public injecting. Compared to PWID who primarily inject in non-public places, PWID who mostly used public places had significantly greater odds of reporting non-fatal overdose (aOR = 2.02; 95 % CI: 1.01, 4.02), needle/syringe sharing (aOR = 1.77; 95 % CI: 1.08, 2.90), unsafe sexual practices with casual sexual partners (aOR = 2.16; 95 % CI: 1.03, 4.55), suicidal ideation (aOR = 1.50; 95 % CI: 1.02, 2.21), and self-harm (aOR = 1.78; 95 % CI: 1.24, 2.54) in the last three months. CONCLUSION These results suggest the potential utility of a safer injecting environment to mitigate the multiple harms associated with public injecting in Iran. Optimizing health and well-being of PWID necessitates integrating supervised injection facilities into the current harm reduction programs and services in Iran. Future studies should also consider the experiences of additional mental health harms associated with public injecting when exploring adverse health outcomes among PWID.
Collapse
Affiliation(s)
- Mehrdad Khezri
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Tavakoli
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Karamouzian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; Department of Epidemiology, School of Public Health, Brown University, Providence, RI, United States; Centre on Drug Policy Evaluation, Saint Michael's Hospital, Toronto, ON, Canada
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Nima Ghalehkhani
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ghazal Mousavian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Soheil Mehmandoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Matin Bazargani
- Center for HIV/STI Control and Prevention, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Mohammad Hosseinpour
- Center for HIV/STI Control and Prevention, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Marzieh Mahboubi
- Center for Communicable Disease Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States
| | - Mostafa Shokoohi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| |
Collapse
|
30
|
An K, Zhang L, Qiao R, Li C, Zhong Q, Ma Y, Rao X, Mao T, Liu F, Zhuo Q, She Y, Li S, Su Q. Training needs and curriculum of continuing medical education among general practitioners in Tibet, China: A cross-sectional survey. Front Public Health 2022; 10:914847. [PMID: 36304244 PMCID: PMC9592895 DOI: 10.3389/fpubh.2022.914847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/20/2022] [Indexed: 01/22/2023] Open
Abstract
Background Uneven distribution of health resources is higher in Tibet than in other regions. The development of core professional capability for general practitioners (GPs) is the main goal of continuing medical education (CME) training programs. Aim This study aimed to explore the needs of CME for GPs and provide advice for the development of policy, practice, and CME curriculums. Methods We conducted a cross-sectional online survey among GPs in Tibet Autonomous Region, China. We designed an online questionnaire including the demographic section, training contents, and training formats about CME. Results A total of 108 questionnaires were included in this study. Notably, 79 (73.15%) were women and 56 participants (51.85%) were working in primary care settings. We developed a curriculum priority: first-choice, major alternatives, and secondary considerations. The topics identified as first-choice for CME were related to "cardiovascular disease" (85.19%), "respiratory disease" (81.48%), and "digestive disease" (80.56%). Major alternatives included two essential knowledge and eight clinical skill items. We rated 10 items as secondary considerations. Only 39.81% ranked mental health as an essential priority; bedside teaching (51.85%) was the first choice. Conclusion We presented priority areas identified in this study to focus on CME for GPs in Tibet. The 23 topics may reflect the features of general practice, which increasingly require common disease management skills, while a demand-oriented curriculum and staged training plans should be adopted. CME programs should be adapted dynamically to respond to evolving needs.
Collapse
Affiliation(s)
- Kang An
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Lin Zhang
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Runjuan Qiao
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Caizheng Li
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Qian Zhong
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Yiru Ma
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Rao
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Tingrui Mao
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Feng Liu
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Zhuo
- Department of General Practice, People's Hospital of Lhasa, Lhasa, China
| | - Yi She
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China,Fangcao Community Health Service Center, Chengdu, China
| | - Shuangqing Li
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China,Jincheng Community Health Service Center, Chengdu, China,Shuangqing Li
| | - Qiaoli Su
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Qiaoli Su
| |
Collapse
|
31
|
Abdella S, Demissie M, Worku A, Dheresa M, Berhane Y. HIV prevalence and associated factors among female sex workers in Ethiopia, east Africa: A cross-sectional study using a respondent-driven sampling technique. EClinicalMedicine 2022; 51:101540. [PMID: 35813094 PMCID: PMC9256839 DOI: 10.1016/j.eclinm.2022.101540] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND HIV acquisition among Female Sex Workers (FSWs) is 30 times higher than the acquisition rate among females in the respective general population. A higher HIV burden in FSWs challenges the prevention and control of the virus in other population groups. However, there is inadequate evidence on the burden of HIV among FSWs in Ethiopia. This study was conducted to assess the extent of HIV and associated factors among FSWs in the country. METHODS This was a cross-sectional study that involved a total of 6,085 FSWs. The participants were selected using a respondent-driven sampling technique (RDS). FSWs who lived at the study sites for at least a month before the study time were considered eligible for recruitment. The study was conducted from January 01 to June 30, 2020 in 16 cities across Ethiopia. A mixed-effect logistic regression model was applied to determine factors associated with HIV positivity. FINDINGS The pooled HIV prevalence among FSWs in this study was 18·7% (95% CI: 17·8, 19·7) with considerable variation across cities. The highest HIV prevalence was observed in Bahir Dar city, 28·2% (95% CI: 23·9, 33.0) and the lowest was seen in Shashemene city, 14.0% (95% CI: 10·2, 18·9). The odds of HIV positivity in FSWs was associated with being older than 35 years of age (AOR = 8·1; 95% CI: 6·1, 10·3), reactive for Treponema Pallidum (AOR = 2·6; 95% CI: 1·0, 3·4), being widowed (OR = 2·2; 95% CI: 1·6, 2·9), not able to read and write (OR = 2·0; 95% CI: 1·5, 2·4), incidence of condom breakage (OR = 1·5; 95% CI: 1·2, 1·7) and having a history of STIs (OR = 1·3; 95% CI: 1·1, 1·6). INTERPRETATION One in five FSWs was HIV positive. HIV prevalence was higher in the older age groups and in those who were positive for Treponema Pallidum (Syphilis). The findings indicated the importance of strengthening HIV prevention and control in FSWs to achieve the national goal to eliminate HIV by 2030. FUNDING The study was supported by The Ethiopian Ministry of Health through the Federal HIV/AIDS Prevention and Control Office.
Collapse
Affiliation(s)
- Saro Abdella
- HIV and TB Research directorate, Ethiopian Public Health Institute, Addis Ababa, Swaziland Street, Ethiopia
- School of Nursing and Midwifery, College of Health Sciences, Haramaya University, Harar, Ethiopia
- Corresponding author.
| | - Meaza Demissie
- Department of Global Health and Health Policy, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Sefere Selam Campus, Ethiopia
| | - Merga Dheresa
- School of Nursing and Midwifery, College of Health Sciences, Haramaya University, Harar, Ethiopia
| | - Yemane Berhane
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| |
Collapse
|
32
|
Moradi G, Gouya MM, Ezzati Amini E, Ghorbani SS, Akbarpour S, Zareie B, Izadi N, Kashefi F, Moradi Y. Intentional abortion and its associated factors among female sex workers in Iran: Results from national bio-behavioral surveillance-2020. PLoS One 2022; 17:e0273732. [PMID: 36037196 PMCID: PMC9423624 DOI: 10.1371/journal.pone.0273732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/13/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose
In addition to estimating the prevalence of intentional abortion in Iranian female sex workers (FSWs), this study identified related factors using the data of a national study.
Methods
This cross-sectional study utilizes the third round of integrated bio-behavioral surveillance-III data in Iranian FSWs in December 2019 and August 2020, and 1515 Participants were selected in 8 geographically diverse cities in Iran. Logistic regression was performed using unweighted analysis to identify factors associated with intentional abortion. Stata software (version 14), respondent-driven sampling analyses, and R (version 4.1.2) was used for data analysis.
Results
From 1390 participants with valid responses to the abortion question, 598 (37.3%; 95% CI: 32.43, 42.11%) reported intentional abortion during their life. According to the age groups, the highest prevalence of abortion was in the age group of 31 to 40 years (42.60%). In the multivariate logistic regression model, the marital status (divorced women (AOR = 2.05, 95% CI: 1.29, 3.27), concubines (AOR = 1.78, 95% CI: 1.02, 3.11)), work experience in brothels (AOR = 1.39, 95% CI: 1.04, 1.84), the type of sex (AOR = 2.75, 95% CI: 1.35, 5.58), the history of sexual violence (AOR = 1.54, 95% CI: 1.19, 2.01), and alcohol consumption (AOR = 1.53, 95% CI: 1.18, 2.01) were significantly associated with a history of intentional abortion.
Conclusion
Intentional abortion’s prevalence among Iranian FSWs has been much higher than that of the general female population in Iran, which is an alarming issue in the public health of this group and needs more effective interventions. In addition, alcohol consumption, working in a brothel, and being divorced are essential factors in increasing abortions among sex workers.
Collapse
Affiliation(s)
- Ghobad Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mohammad Mehdi Gouya
- Iranian Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Elnaz Ezzati Amini
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Sahar Sotoodeh Ghorbani
- Department of Epidemiology School of Public health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samaneh Akbarpour
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Bushra Zareie
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Neda Izadi
- Department of Epidemiology School of Public health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzaneh Kashefi
- Reproductive health, Population, Family and School Health Department, Ministry of Health and Medical Education, Tehran, Iran
| | - Yousef Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
- * E-mail:
| |
Collapse
|
33
|
Avery L, Maddox R, Abtan R, Wong O, Rotondi NK, McConkey S, Bourgeois C, McKnight C, Wolfe S, Flicker S, Macpherson A, Smylie J, Rotondi M. Modelling prevalent cardiovascular disease in an urban Indigenous population. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2022:10.17269/s41997-022-00669-x. [PMID: 35945472 DOI: 10.17269/s41997-022-00669-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Studies have highlighted the inequities between the Indigenous and non-Indigenous populations with respect to the burden of cardiovascular disease and prevalence of predisposing risks resulting from historical and ongoing impacts of colonization. The objective of this study was to investigate factors associated with cardiovascular disease (CVD) within and specific to the Indigenous peoples living in Toronto, Ontario, and to evaluate the reliability and validity of the resulting model in a similar population. METHODS The Our Health Counts Toronto study measured the baseline health of Indigenous community members living in Toronto, Canada, using respondent-driven sampling. An iterative approach, valuing information from the literature, clinical insight and Indigenous lived experiences, as well as statistical measures was used to evaluate candidate predictors of CVD (self-reported experience of discrimination, ethnic identity, health conditions, income, education, age, gender and body size) prior to multivariable modelling. The resulting model was then validated using a distinct, geographically similar sample of Indigenous people living in Hamilton, Ontario, Canada. RESULTS The multivariable model of risk factors associated with prevalent CVD included age, diabetes, hypertension, body mass index and exposure to discrimination. The combined presence of diabetes and hypertension was associated with a greater risk of CVD relative to those with either condition and was the strongest predictor of CVD. Those who reported previous experiences of discrimination were also more likely to have CVD. Further study is needed to determine the effect of body size on risk of CVD in the urban Indigenous population. The final model had good discriminative ability and adequate calibration when applied to the Hamilton sample. CONCLUSION Our modelling identified hypertension, diabetes and exposure to discrimination as factors associated with cardiovascular disease. Discrimination is a modifiable exposure that must be addressed to improve cardiovascular health among Indigenous populations.
Collapse
Affiliation(s)
- Lisa Avery
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Raglan Maddox
- Well Living House, Li Ka Shing Knowledge Institute, Unity Health Toronto - St. Michaels Hospital, Toronto, ON, Canada
- Aboriginal and Torres Strait Islander Health Group, National Centre for Epidemiology and Public Health, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Robert Abtan
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Octavia Wong
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Nooshin Khobzi Rotondi
- Well Living House, Li Ka Shing Knowledge Institute, Unity Health Toronto - St. Michaels Hospital, Toronto, ON, Canada
- Ontario Tech University, Oshawa, ON, Canada
| | - Stephanie McConkey
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Well Living House, Li Ka Shing Knowledge Institute, Unity Health Toronto - St. Michaels Hospital, Toronto, ON, Canada
| | - Cheryllee Bourgeois
- Seventh Generation Midwives Toronto, Toronto, ON, Canada
- Metropolitan University, Toronto, ON, Canada
| | | | - Sara Wolfe
- Seventh Generation Midwives Toronto, Toronto, ON, Canada
| | - Sarah Flicker
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Alison Macpherson
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Janet Smylie
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Well Living House, Li Ka Shing Knowledge Institute, Unity Health Toronto - St. Michaels Hospital, Toronto, ON, Canada
| | - Michael Rotondi
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| |
Collapse
|
34
|
Korthuis PT, Cook RR, Foot CA, Leichtling G, Tsui JI, Stopka TJ, Leahy J, Jenkins WD, Baker R, Chan B, Crane HM, Cooper HL, Feinberg J, Zule WA, Go VF, Estadt AT, Nance RM, Smith GS, Westergaard RP, Van Ham B, Brown R, Young AM. Association of Methamphetamine and Opioid Use With Nonfatal Overdose in Rural Communities. JAMA Netw Open 2022; 5:e2226544. [PMID: 35969400 PMCID: PMC9379740 DOI: 10.1001/jamanetworkopen.2022.26544] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/23/2022] [Indexed: 01/29/2023] Open
Abstract
Importance Overdoses continue to increase in the US, but the contribution of methamphetamine use is understudied in rural communities. Objective To estimate the prevalence of methamphetamine use and its correlates among people who use drugs (PWUD) in rural US communities and to determine whether methamphetamine use is associated with increased nonfatal overdoses. Design, Setting, and Participants From January 2018 through March 2020, the National Rural Opioid Initiative conducted cross-sectional surveys of PWUD in rural communities in 10 states (Illinois, Kentucky, New Hampshire, Massachusetts, North Carolina, Ohio, Oregon, Vermont, West Virginia, and Wisconsin). Participants included rural PWUD who reported any past-30-day injection drug use or noninjection opioid use to get high. A modified chain-referral sampling strategy identified seeds who referred others using drugs. Data analysis was performed from May 2021 to January 2022. Exposures Use of methamphetamine alone, opioids alone, or both. Main Outcomes and Measures Unweighted and weighted prevalence of methamphetamine use, any past-180-day nonfatal overdose, and number of lifetime nonfatal overdoses. Results Among the 3048 participants, 1737 (57%) were male, 2576 (85%) were White, and 225 (7.4%) were American Indian; the mean (SD) age was 36 (10) years. Most participants (1878 of 2970 participants with any opioid or methamphetamine use [63%]) reported co-use of methamphetamine and opioids, followed by opioids alone (702 participants [24%]), and methamphetamine alone (390 participants [13%]). The estimated unweighted prevalence of methamphetamine use was 80% (95% CI, 64%-90%), and the estimated weighted prevalence was 79% (95% CI, 57%-91%). Nonfatal overdose was greatest in people using both methamphetamine and opioids (395 of 2854 participants with nonmissing overdose data [22%]) vs opioids alone (99 participants [14%]) or methamphetamine alone (23 participants [6%]). Co-use of methamphetamine and opioids was associated with greater nonfatal overdose compared with opioid use alone (adjusted odds ratio, 1.45; 95% CI, 1.08-1.94; P = .01) and methamphetamine use alone (adjusted odds ratio, 3.26; 95% CI, 2.06-5.14; P < .001). Those with co-use had a mean (SD) of 2.4 (4.2) (median [IQR], 1 [0-3]) lifetime overdoses compared with 1.7 (3.5) (median [IQR], 0 [0-2]) among those using opioids alone (adjusted rate ratio, 1.20; 95% CI, 1.01-1.43; P = .04), and 1.1 (2.9) (median [IQR], 0 [0-1]) among those using methamphetamine alone (adjusted rate ratio, 1.81; 95% CI, 1.45-2.27; P < .001). Participants with co-use most often reported having tried and failed to access substance use treatment: 827 participants (44%) for both, 117 participants (30%) for methamphetamine alone, and 252 participants (36%) for opioids alone (χ22 = 33.8; P < .001). Only 66 participants (17%) using methamphetamine alone had naloxone. Conclusions and Relevance These findings suggest that harm reduction and substance use disorder treatment interventions must address both methamphetamine and opioids to decrease overdose in rural communities.
Collapse
Affiliation(s)
- P. Todd Korthuis
- Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Portland
- Oregon Health & Science University–Portland State University School of Public Health, Portland
| | - Ryan R. Cook
- Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Portland
| | - Canyon A. Foot
- Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Portland
| | | | - Judith I. Tsui
- Section of General Internal Medicine, Department of Medicine, University of Washington, Seattle
| | - Thomas J. Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | | | - Wiley D. Jenkins
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield
| | - Robin Baker
- Oregon Health & Science University–Portland State University School of Public Health, Portland
| | - Brian Chan
- Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Portland
| | - Heidi M. Crane
- Section of General Internal Medicine, Department of Medicine, University of Washington, Seattle
| | - Hannah L. Cooper
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Judith Feinberg
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown
- Department of Medicine, Infectious Diseases, West Virginia University School of Medicine, Morgantown
| | | | - Vivian F. Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina–Chapel Hill, Chapel Hill
| | - Angela T. Estadt
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus
| | - Robin M. Nance
- Section of General Internal Medicine, Department of Medicine, University of Washington, Seattle
| | - Gordon S. Smith
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown
| | - Ryan P. Westergaard
- Division of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
| | - Brent Van Ham
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield
| | - Randall Brown
- Department of Family Medicine & Community Health, University of Wisconsin School of Medicine & Public Health, Madison
| | - April M. Young
- Department of Epidemiology, University of Kentucky, Lexington
- Center on Drug and Alcohol Research, University of Kentucky, Lexington
| |
Collapse
|
35
|
Chiu I, Leathers M, Cano D, Turner CM, Trujillo D, Sicro S, Arayasirikul S, Taylor KD, Wilson EC, McFarland W. HIV prevalence, engagement in care, and risk behavior among trans women, San Francisco: Evidence of recent successes and remaining challenges. Int J STD AIDS 2022; 33:1029-1037. [PMID: 35816424 PMCID: PMC9607899 DOI: 10.1177/09564624221111278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Trans women have high HIV prevalence and lag behind 90–90-90 targets for HIV care. In San Francisco in 2017, 96% of trans women were aware of their status, 75% were on antiretroviral therapy, 88% had viral suppression. Initiatives to address gaps include peer navigators, free gender-affirming surgery, and housing. Our study updates HIV prevalence and engagement in care among trans women. Methods Cross-sectional community-based survey of trans women living in San Francisco sampled by respondent-driven sampling, 7/2019–2/2020 (N = 201). Eligibility was: self-identified trans women or other gender and assigned male at birth; living in San Francisco; English/Spanish-speaking; and 18 years or older. Results HIV prevalence was 42.3% (95%CI 35.4.-49.4) and associated with having a partner who injected drugs (adjusted odds ratio [AOR] 3.30, 95%CI 1.58–6.90), ever injected drugs (AOR 2.28, 95%CI 1.06–4.89), cost not a barrier to healthcare (AOR 2.63, 95%CI 1.02–6.67), emotional support from family (AOR 2.85, 95%CI 1.43–5.65), and Black/African-American (AOR 2.59, 95%CI 1.16–5.79). Of trans women with HIV, 92.9% were previously diagnosed, 89.9% were on ART, 91.5% reported viral suppression. Conclusions Trans women met 90–90–90 targets in 2020, at 93–90–92. Interventions need to reach Black/African-American trans women, trans women who inject drugs, and partners of trans women.
Collapse
Affiliation(s)
- Izzy Chiu
- 1438University of California Berkeley, Berkeley, CA, USA.,Center for Public Health Research, 7152San Francisco Department of Public Health, San Francisco, CA, USA
| | - Matisse Leathers
- 1438University of California Berkeley, Berkeley, CA, USA.,Center for Public Health Research, 7152San Francisco Department of Public Health, San Francisco, CA, USA
| | - Damiana Cano
- 1438University of California Berkeley, Berkeley, CA, USA.,Center for Public Health Research, 7152San Francisco Department of Public Health, San Francisco, CA, USA
| | - Caitlin M Turner
- Center for Public Health Research, 7152San Francisco Department of Public Health, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Dillon Trujillo
- Center for Public Health Research, 7152San Francisco Department of Public Health, San Francisco, CA, USA
| | - Sofia Sicro
- Center for Public Health Research, 7152San Francisco Department of Public Health, San Francisco, CA, USA
| | - Sean Arayasirikul
- Center for Public Health Research, 7152San Francisco Department of Public Health, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Kelly D Taylor
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Erin C Wilson
- Center for Public Health Research, 7152San Francisco Department of Public Health, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Willi McFarland
- Center for Public Health Research, 7152San Francisco Department of Public Health, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| |
Collapse
|
36
|
Scheidell JD, Hoff L, Khan MR, Bennett AS, Elliott L. Parenting and childcare responsibilities, harm reduction service engagement, and opioid overdose among women and men who use illicit opioids in New York City. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 3. [PMID: 35757568 PMCID: PMC9224239 DOI: 10.1016/j.dadr.2022.100054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Little is known regarding relationships among parenting, engagement in harm reduction services, and overdose risk among people who use illicit opioids (PWUIO), and whether associations differ by gender. Methods: Using baseline data from an ongoing study among PWUIO in New York City (n = 575), we measured childcare factors (i.e., residing with children, avoidance of drug treatment for fear of child welfare, difficulty accessing harm reduction due to childcare issues), and harm reduction services and overdose-related outcomes. Among those with children, we estimated prevalence ratios (PR) using modified Poisson regression with a product-interaction term for gender differences. Results: In the total sample (n = 575), approximately 70% reported having children. Compared to men, women were more likely to reside with children (25% vs 36%; p-value = 0.04), avoid treatment for fear of child welfare (16% vs 26%; p-value = 0.04), and less likely to be trained in naloxone administration (68% vs 61%; p-value = 0.09). Among participants with children (n = 403), residing with children was associated with naloxone training among men (aPR 1.28, 95% CI: 1.01, 1.62). Avoiding treatment for fear of child welfare was associated with carrying naloxone overall (aPR 0.68, 95% CI: 0.46, 0.99), with a stronger association among women (aPR 0.48, 95% CI: 0.26, 0.92). Difficulty accessing services due to childcare was associated with lifetime overdose (aPR 1.53, 95% CI: 1.05, 2.23). Conclusion: Childcare responsibilities may be a barrier for accessing substance use services and treatment for men and women. Further qualitative and mixed-methods research is needed to understand how to make treatment and services accessible for parents.
Collapse
Affiliation(s)
- Joy D Scheidell
- Department of Population Health, New York University Grossman School of Medicine, 227 E 30th Street, Sixth Floor, New York, NY 10016, USA
- Corresponding author.
| | - Lee Hoff
- Department of Population Health, New York University Grossman School of Medicine, 227 E 30th Street, Sixth Floor, New York, NY 10016, USA
| | - Maria R Khan
- Department of Population Health, New York University Grossman School of Medicine, 227 E 30th Street, Sixth Floor, New York, NY 10016, USA
| | - Alex S Bennett
- New York University School of Global Public Health, 708 Broadway, New York, NY 10003, USA
| | - Luther Elliott
- New York University School of Global Public Health, 708 Broadway, New York, NY 10003, USA
| |
Collapse
|
37
|
Nyitray AG, Masunaga KIA, Nyoni J, Ross MW. Prevalence of and factors associated with anal high-risk human papillomavirus in urban Tanzanian men who have sex with men, 2011-2012. Int J STD AIDS 2022; 33:672-679. [PMID: 35531601 PMCID: PMC9189599 DOI: 10.1177/09564624221094456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Anal cancer is primarily caused by high-risk human papillomavirus (hrHPV), is associated with HIV infection, and has a very high incidence among men who have sex with men (MSM). We assessed prevalence of hrHPV, and factors associated with hrHPV in anal canal specimens collected in Dar es Salaam, Tanzania from HIV-positive and HIV-negative MSM. Methods: MSM were recruited using respondent-driven sampling in this cross-sectional study. The primary outcome in this ancillary analysis of 116 MSM was prevalence of HPV-16 and other hrHPV types. Prevalence ratios (PR) estimated the association between hrHPV and HIV-negative participants' demographics, sexual behaviour and sexually transmitted infections. Results: Median age was 23 years and 33.6% of participants were HIV-positive. HrHPV and HPV-16 prevalence was 54.3% and 17.2%, respectively, with HPV-16 prevalence highest among HIV-positive MSM identifying as gay (36.1%) and lowest among HIV-negative MSM identifying as bisexual (2.9%). Having two or more receptive anal sex partners in the past month was associated with hrHPV (PR 3.20, 95%CI 1.69-6.07, vs. 0 partners) among HIV-negative MSM.Conclusions: HrHPV prevalence was high among MSM in Dar es Salaam and highest among HIV-positive MSM identifying as gay. These estimates may be used to support HPV vaccination and screening initiatives.
Collapse
Affiliation(s)
- Alan G Nyitray
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioural Medicine, 5506Medical College of Wisconsin, Milwaukee, WI, USA.,Clinical Cancer Center, 5506Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ka Imi Aina Masunaga
- Department of Developmental and Surgical Sciences, 12269University of Minnesota Physicians, Minnesota Children's Hospital, MN, USA
| | - Joyce Nyoni
- Department of Sociology and Anthropology, University of Dar es Salaam, Dar es Salaam, Tanzania
| | - Michael W Ross
- Program in Human Sexuality, Department of Family Medicine, 12269University of Minnesota Medical School, Minneapolis, MN, USA
| |
Collapse
|
38
|
Li E, Tsopra R, Jimenez G, Serafini A, Gusso G, Lingner H, Fernandez MJ, Irving G, Petek D, Hoffman R, Lazic V, Memarian E, Koskela T, Collins C, Espitia SM, Clavería A, Nessler K, O’Neill BG, Hoedebecke K, Ungan M, Laranjo L, Ghafur S, Fontana G, Majeed A, Car J, Darzi A, Neves AL. General practitioners' perceptions of using virtual primary care during the COVID-19 pandemic: An international cross-sectional survey study. PLOS DIGITAL HEALTH 2022; 1:e0000029. [PMID: 36812543 PMCID: PMC9931239 DOI: 10.1371/journal.pdig.0000029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/28/2022] [Indexed: 11/19/2022]
Abstract
With the onset of COVID-19, general practitioners (GPs) and patients worldwide swiftly transitioned from face-to-face to digital remote consultations. There is a need to evaluate how this global shift has impacted patient care, healthcare providers, patient and carer experience, and health systems. We explored GPs' perspectives on the main benefits and challenges of using digital virtual care. GPs across 20 countries completed an online questionnaire between June-September 2020. GPs' perceptions of main barriers and challenges were explored using free-text questions. Thematic analysis was used to analyse the data. A total of 1,605 respondents participated in our survey. The benefits identified included reducing COVID-19 transmission risks, guaranteeing access and continuity of care, improved efficiency, faster access to care, improved convenience and communication with patients, greater work flexibility for providers, and hastening the digital transformation of primary care and accompanying legal frameworks. Main challenges included patients' preference for face-to-face consultations, digital exclusion, lack of physical examinations, clinical uncertainty, delays in diagnosis and treatment, overuse and misuse of digital virtual care, and unsuitability for certain types of consultations. Other challenges include the lack of formal guidance, higher workloads, remuneration issues, organisational culture, technical difficulties, implementation and financial issues, and regulatory weaknesses. At the frontline of care delivery, GPs can provide important insights on what worked well, why, and how during the pandemic. Lessons learned can be used to inform the adoption of improved virtual care solutions and support the long-term development of platforms that are more technologically robust and secure.
Collapse
Affiliation(s)
- Edmond Li
- Institute of Global Health Innovation, Faculty of Medicine, Imperial College London, London, United Kingdom
- * E-mail: (EL); (ALN)
| | - Rosy Tsopra
- INSERM, Université de Paris, Sorbonne Université, Centre de Recherche des Cordeliers, Information Sciences to support Personalized Medicine, F-75006 Paris, France
- Inria Paris, Paris, France
- Department of Medical Informatics, Hôpital Européen Georges-Pompidou, AP-HP, Paris, France
| | - Geronimo Jimenez
- Center for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | | | | | - Heidrun Lingner
- Hannover Medical School, Center for Public, Health and Healthcare, German Center for Lung Research (DZL) / BREATH Hannover, Germany
| | - Maria Jose Fernandez
- Leiro Health Center, Leiro, Spain
- Galicia South Health Research Institute, Vigo, Spain
- Primary Care Prevention and Health Promotion Network (redIAPP), Spain
| | - Greg Irving
- Health Research Institute, Edge Hill University, Ormskirk, United Kingdom
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Robert Hoffman
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Ensieh Memarian
- Department of Clinical Sciences in Malmö, Lund University, Internal Medicine- Epidemiology Research Group, Skane University Hospital, Malmö, Sweden
| | - Tuomas Koskela
- General Practice, Tampere University, Faculty of Medicine and Health Technology and Tampere University Hospital, Finland
| | | | | | - Ana Clavería
- Galicia South Health Research Institute, Vigo, Spain
- Primary Care Prevention and Health Promotion Network (redIAPP), Spain
- Primary Care Research Unit. Vigo Health Area, Vigo, Spain
| | - Katarzyna Nessler
- Department of Family Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Braden Gregory O’Neill
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
| | - Kyle Hoedebecke
- Department of Utilization Management, Oscar Health, Dallas, United States of America
| | - Mehmet Ungan
- Department of Family Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Liliana Laranjo
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Saira Ghafur
- Institute of Global Health Innovation, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Gianluca Fontana
- Institute of Global Health Innovation, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Azeem Majeed
- Department of Primary Care & Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Josip Car
- Center for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
- Leiro Health Center, Leiro, Spain
- Galicia South Health Research Institute, Vigo, Spain
- Primary Care Prevention and Health Promotion Network (redIAPP), Spain
| | - Ara Darzi
- Institute of Global Health Innovation, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Ana Luisa Neves
- Institute of Global Health Innovation, Faculty of Medicine, Imperial College London, London, United Kingdom
- * E-mail: (EL); (ALN)
| |
Collapse
|
39
|
Increases in human papillomavirus vaccine coverage over 12 months among a community-recruited cohort of gay, bisexual, and other men who have sex with men in Canada. Vaccine 2022; 40:3690-3700. [PMID: 35577633 DOI: 10.1016/j.vaccine.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/11/2022] [Accepted: 05/05/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Starting in 2015/16, most Canadian provinces introduced publicly-funded human papillomavirus (HPV) vaccination programs for gay, bisexual, and other men who have sex with men (GBM) aged ≤ 26 years. We estimated 12-month changes in HPV vaccine coverage among community-recruited GBM from 2017 to 2021 and identified baseline factors associated with vaccine initiation (≥1 dose) or series completion (3 doses) among participants who were unvaccinated or partially vaccinated at baseline. METHODS We recruited sexually-active GBM aged ≥ 16 years in Montreal, Toronto, and Vancouver, Canada, from 02/2017 to 08/2019 and followed them over a median of 12 months (interquartile range = 12-13 months). We calculated the proportion who initiated vaccination (≥1 dose) or completed the series (3 doses) by 12-month follow-up. Analyses were stratified by city and age-eligibility for the publicly-funded programs at baseline (≤26 years or > 26 years). We used multivariable logistic regression to identify baseline factors associated with self-reported incident vaccine initiation or series completion. RESULTS Among 165 unvaccinated participants aged ≤ 26 years at baseline, incident vaccine initiation (≥1 dose) during follow-up was 24.1% in Montreal, 33.3% in Toronto, and 38.9% in Vancouver. Among 1,059 unvaccinated participants aged > 26 years, incident vaccine initiation was 3.4%, 8.9%, and 10.9%, respectively. Higher education and trying to access pre-exposure prophylaxis for HIV were associated with incident vaccination among those aged ≤ 26 years, while younger age, residing in Vancouver (vs. Montreal), being diagnosed with anogenital warts, having both government and private extended medical insurance, and being vaccinated against influenza were associated with incident vaccination among those aged > 26 years. CONCLUSIONS We observed substantial gains in HPV vaccine coverage among young GBM within 5 + years of targeted program implementation, but gaps remain, particularly among older men who are ineligible for publicly-funded programs. Findings suggest the need for expanded public funding or insurance coverage for HPV vaccines.
Collapse
|
40
|
Cha S, Adams M, Wejnert C. Intimate partner violence, HIV-risk behaviors, and HIV screening among heterosexually active persons at increased risk for infection. AIDS Care 2022; 35:867-875. [PMID: 35467983 DOI: 10.1080/09540121.2022.2067311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ABSTRACTIntimate partner violence (IPV) can increase a person's risk of HIV and other sexually transmitted infections (STIs), and may affect access to sexual health services. We assessed the prevalence of HIV screening and IPV among heterosexually-active persons using data from the 2016 National HIV Behavioral Surveillance. Participants were eligible if they were 18-60 years old, could complete the interview in English or Spanish, and reported having sex with an opposite sex partner in the previous 12 months. People who reported neither injection drug use within the past 12 months nor prior HIV diagnosis, and persons with valid responses to questions regarding HIV screening and physical/sexual IPV within the past 12 months were included (N = 7,777). Overall, 17% reported IPV in the previous 12 months and 19% had never had HIV screening. Abused persons were more likely to have been screened for HIV and to report high risk behaviors than non-abused persons. There was no difference in the proportion being offered HIV screening by their health care provider in the previous year. Findings suggest an integrated approach to violence prevention and sexual health may help increase awareness about clinical best practices and reduce risk for HIV/STIs among at-risk communities.
Collapse
Affiliation(s)
- Susan Cha
- Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Monica Adams
- Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cyprian Wejnert
- Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | -
- Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
41
|
Pinto AD, Hapsari AP, Ho J, Meaney C, Avery L, Hassen N, Jetha A, Lay AM, Rotondi M, Zuberi D. Precarious work among personal support workers in the Greater Toronto Area: a respondent-driven sampling study. CMAJ Open 2022; 10:E527-E538. [PMID: 35700996 PMCID: PMC9343122 DOI: 10.9778/cmajo.20210338] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has highlighted the role of personal support workers (PSWs) in health care, as well as their work conditions. Our study aimed to understand the characteristics of the PSW workforce, their work conditions and their job security, as well as to explore the health of PSWs and the impact of precarious employment on their health. METHODS Our community-based participatory action research focused on PSWs in the Greater Toronto Area. We administered an online, cross-sectional survey between June and December 2020 using respondent-driven sampling. Data on sociodemographics, employment precarity, worker empowerment and health status were collected. We assessed the association between precarious employment and health using multivariable logistic regression models. RESULTS We contacted 739 PSWs, and 664 consented to participate. Overall, 658 (99.1%) completed at least part of the survey. Using data adjusted for our sampling approach, the participants were predominantly Black (76.5%, 95% confidence interval [CI] 68.2%-84.9%), women (90.1%, 95% CI 85.1%-95.1%) and born outside of Canada (97.4%, 95% CI 94.9%-99.9%). Most worked in home care (43.9%, 95% CI 35.2%-52.5%) or long-term care (34.5%, 95% CI 27.4%-42.0%). Although most participants had at least some postsecondary education (unadjusted proportion = 83.4%, n = 529), more than half were considered low income (55.1%, 95% CI 46.3%-63.9%). Most participants were precariously employed (86.5%, 95% CI 80.7%-92.4%) and lacked paid sick days (89.5%, 95% CI 85.8%-93.3%) or extended health benefits (74.1%, 95% CI 66.8%-81.4%). Nearly half of the participants described their health as less than very good (46.7%, 95% CI 37.9%-55.5%). Employment precarity was significantly associated with higher risk of depression (odds ratio 1.02, 95% CI 1.01-1.03). INTERPRETATION Despite being key members of health care teams, most PSWs were precariously employed with low wages that keep them in poverty; the poor work conditions they faced could be detrimental to their physical and mental health. Equitable strategies are needed to provide decent work conditions for PSWs and to improve their health.
Collapse
Affiliation(s)
- Andrew D Pinto
- Upstream Lab (Pinto, Hapsari, Ho), MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Department of Family and Community Medicine (Pinto), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Meaney), Faculty of Medicine; Dalla Lana School of Public Health (Pinto, Avery, Jetha), University of Toronto; Department of Biostatistics (Avery), Princess Margaret Hospital, University Health Network; Faculty of Environmental and Urban Change (Hassen), York University; Institute for Work and Health (Jetha); Institute of Population and Public Health (Lay), Canadian Institutes for Health Research, Ottawa, Ont.; School of Kinesiology and Health Science (Rotondi), York University; Munk School of Global Affairs & Public Policy (Zuberi); Factor-Inwentash Faculty of Social Work (Zuberi), University of Toronto, Toronto, Ont.
| | - Ayu P Hapsari
- Upstream Lab (Pinto, Hapsari, Ho), MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Department of Family and Community Medicine (Pinto), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Meaney), Faculty of Medicine; Dalla Lana School of Public Health (Pinto, Avery, Jetha), University of Toronto; Department of Biostatistics (Avery), Princess Margaret Hospital, University Health Network; Faculty of Environmental and Urban Change (Hassen), York University; Institute for Work and Health (Jetha); Institute of Population and Public Health (Lay), Canadian Institutes for Health Research, Ottawa, Ont.; School of Kinesiology and Health Science (Rotondi), York University; Munk School of Global Affairs & Public Policy (Zuberi); Factor-Inwentash Faculty of Social Work (Zuberi), University of Toronto, Toronto, Ont
| | - Julia Ho
- Upstream Lab (Pinto, Hapsari, Ho), MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Department of Family and Community Medicine (Pinto), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Meaney), Faculty of Medicine; Dalla Lana School of Public Health (Pinto, Avery, Jetha), University of Toronto; Department of Biostatistics (Avery), Princess Margaret Hospital, University Health Network; Faculty of Environmental and Urban Change (Hassen), York University; Institute for Work and Health (Jetha); Institute of Population and Public Health (Lay), Canadian Institutes for Health Research, Ottawa, Ont.; School of Kinesiology and Health Science (Rotondi), York University; Munk School of Global Affairs & Public Policy (Zuberi); Factor-Inwentash Faculty of Social Work (Zuberi), University of Toronto, Toronto, Ont
| | - Christopher Meaney
- Upstream Lab (Pinto, Hapsari, Ho), MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Department of Family and Community Medicine (Pinto), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Meaney), Faculty of Medicine; Dalla Lana School of Public Health (Pinto, Avery, Jetha), University of Toronto; Department of Biostatistics (Avery), Princess Margaret Hospital, University Health Network; Faculty of Environmental and Urban Change (Hassen), York University; Institute for Work and Health (Jetha); Institute of Population and Public Health (Lay), Canadian Institutes for Health Research, Ottawa, Ont.; School of Kinesiology and Health Science (Rotondi), York University; Munk School of Global Affairs & Public Policy (Zuberi); Factor-Inwentash Faculty of Social Work (Zuberi), University of Toronto, Toronto, Ont
| | - Lisa Avery
- Upstream Lab (Pinto, Hapsari, Ho), MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Department of Family and Community Medicine (Pinto), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Meaney), Faculty of Medicine; Dalla Lana School of Public Health (Pinto, Avery, Jetha), University of Toronto; Department of Biostatistics (Avery), Princess Margaret Hospital, University Health Network; Faculty of Environmental and Urban Change (Hassen), York University; Institute for Work and Health (Jetha); Institute of Population and Public Health (Lay), Canadian Institutes for Health Research, Ottawa, Ont.; School of Kinesiology and Health Science (Rotondi), York University; Munk School of Global Affairs & Public Policy (Zuberi); Factor-Inwentash Faculty of Social Work (Zuberi), University of Toronto, Toronto, Ont
| | - Nadha Hassen
- Upstream Lab (Pinto, Hapsari, Ho), MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Department of Family and Community Medicine (Pinto), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Meaney), Faculty of Medicine; Dalla Lana School of Public Health (Pinto, Avery, Jetha), University of Toronto; Department of Biostatistics (Avery), Princess Margaret Hospital, University Health Network; Faculty of Environmental and Urban Change (Hassen), York University; Institute for Work and Health (Jetha); Institute of Population and Public Health (Lay), Canadian Institutes for Health Research, Ottawa, Ont.; School of Kinesiology and Health Science (Rotondi), York University; Munk School of Global Affairs & Public Policy (Zuberi); Factor-Inwentash Faculty of Social Work (Zuberi), University of Toronto, Toronto, Ont
| | - Arif Jetha
- Upstream Lab (Pinto, Hapsari, Ho), MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Department of Family and Community Medicine (Pinto), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Meaney), Faculty of Medicine; Dalla Lana School of Public Health (Pinto, Avery, Jetha), University of Toronto; Department of Biostatistics (Avery), Princess Margaret Hospital, University Health Network; Faculty of Environmental and Urban Change (Hassen), York University; Institute for Work and Health (Jetha); Institute of Population and Public Health (Lay), Canadian Institutes for Health Research, Ottawa, Ont.; School of Kinesiology and Health Science (Rotondi), York University; Munk School of Global Affairs & Public Policy (Zuberi); Factor-Inwentash Faculty of Social Work (Zuberi), University of Toronto, Toronto, Ont
| | - A Morgan Lay
- Upstream Lab (Pinto, Hapsari, Ho), MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Department of Family and Community Medicine (Pinto), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Meaney), Faculty of Medicine; Dalla Lana School of Public Health (Pinto, Avery, Jetha), University of Toronto; Department of Biostatistics (Avery), Princess Margaret Hospital, University Health Network; Faculty of Environmental and Urban Change (Hassen), York University; Institute for Work and Health (Jetha); Institute of Population and Public Health (Lay), Canadian Institutes for Health Research, Ottawa, Ont.; School of Kinesiology and Health Science (Rotondi), York University; Munk School of Global Affairs & Public Policy (Zuberi); Factor-Inwentash Faculty of Social Work (Zuberi), University of Toronto, Toronto, Ont
| | - Michael Rotondi
- Upstream Lab (Pinto, Hapsari, Ho), MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Department of Family and Community Medicine (Pinto), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Meaney), Faculty of Medicine; Dalla Lana School of Public Health (Pinto, Avery, Jetha), University of Toronto; Department of Biostatistics (Avery), Princess Margaret Hospital, University Health Network; Faculty of Environmental and Urban Change (Hassen), York University; Institute for Work and Health (Jetha); Institute of Population and Public Health (Lay), Canadian Institutes for Health Research, Ottawa, Ont.; School of Kinesiology and Health Science (Rotondi), York University; Munk School of Global Affairs & Public Policy (Zuberi); Factor-Inwentash Faculty of Social Work (Zuberi), University of Toronto, Toronto, Ont
| | - Daniyal Zuberi
- Upstream Lab (Pinto, Hapsari, Ho), MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Department of Family and Community Medicine (Pinto), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Meaney), Faculty of Medicine; Dalla Lana School of Public Health (Pinto, Avery, Jetha), University of Toronto; Department of Biostatistics (Avery), Princess Margaret Hospital, University Health Network; Faculty of Environmental and Urban Change (Hassen), York University; Institute for Work and Health (Jetha); Institute of Population and Public Health (Lay), Canadian Institutes for Health Research, Ottawa, Ont.; School of Kinesiology and Health Science (Rotondi), York University; Munk School of Global Affairs & Public Policy (Zuberi); Factor-Inwentash Faculty of Social Work (Zuberi), University of Toronto, Toronto, Ont
| |
Collapse
|
42
|
Bonett S, Dowshen N, Bauermeister J, Meanley S, Wirtz AL, Celentano DD, Galai N, Arrington-Sanders R. Characterizing the PrEP Continuum for Black and Latinx Sexual and Gender Minority Youth. AIDS Behav 2022; 26:1211-1221. [PMID: 34546472 DOI: 10.1007/s10461-021-03476-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 11/25/2022]
Abstract
Pre-exposure prophylaxis (PrEP) rollout efforts thus far have inadequately reached young people from underrepresented backgrounds. This study explores PrEP engagement among young Black and Latinx men who have sex with men, transgender women, and gender diverse individuals in three U.S. cities using an adapted PrEP continuum measure. We analyze data from the recruitment phase of an ongoing PrEP engagement intervention (n = 319) using partial proportional odds logistic regression. Participants reported high willingness and intention to use PrEP, yet most (82%) were not currently taking PrEP. Being insured (aOR = 2.95, 95%-CI = 1.60-5.49), having one or more PrEP users in one's sexual network (aOR = 4.19, 95%-CI = 2.61-6.79), and higher individual HIV risk scores (aOR = 1.62, 95%-CI = 1.34-1.97) were each associated with being further along the PrEP continuum. Strategies are needed to address barriers to healthcare access and leverage connections within social and sexual networks in order to bolster PrEP engagement among marginalized young people from diverse backgrounds.
Collapse
Affiliation(s)
- Stephen Bonett
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, USA.
| | - Nadia Dowshen
- Craig Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, 3550 Market St, Philadelphia, PA, 19104, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - José Bauermeister
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, USA
| | - Steven Meanley
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, USA
| | - Andrea L Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | - David D Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
- Department of Statistics, University of Haifa, Mt Carmel, Haifa, Israel
| | - Renata Arrington-Sanders
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
- Division of Adolescent and Young Adult Medicine, Johns Hopkins School of Medicine, 200 N. Wolfe Street, Baltimore, MD, 21287, USA
| |
Collapse
|
43
|
Abstract
Abstract
Purpose of Review
We provided an overview of sampling methods for hard-to-reach populations and guidance on implementing one of the most popular approaches: respondent-driven sampling (RDS).
Recent Findings
Limitations related to generating a sampling frame for marginalized populations can make them “hard-to-reach” when conducting population health research. Data analyzed from non-probability-based or convenience samples may produce estimates that are biased or not generalizable to the target population. In RDS and time-location sampling (TLS), factors that influence inclusion can be estimated and accounted for in an effort to generate representative samples. RDS is particularly equipped to reach the most hidden members of hard-to-reach populations.
Summary
TLS, RDS, or a combination can provide a rigorous method to identify and recruit samples from hard-to-reach populations and more generalizable estimates of population characteristics. Researchers interested in sampling hard-to-reach populations should expand their toolkits to include these methods.
Collapse
|
44
|
Ettman CK, Cohen GH, Abdalla SM, Trinquart L, Castrucci BC, Bork RH, Clark MA, Wilson IB, Vivier PM, Galea S. Assets, stressors, and symptoms of persistent depression over the first year of the COVID-19 pandemic. SCIENCE ADVANCES 2022; 8:eabm9737. [PMID: 35235345 PMCID: PMC8890702 DOI: 10.1126/sciadv.abm9737] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/06/2022] [Indexed: 05/05/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has been accompanied by an increase in depression in U.S. adults. Previous literature suggests that having assets may protect against depression. Using a nationally representative longitudinal panel survey of U.S. adults studied in March and April 2020 and in March and April 2021, we found that (i) 20.3% of U.S. adults reported symptoms of persistent depression in Spring 2020 and Spring 2021, (ii) having more assets was associated with lower symptoms of persistent depression, with financial assets-household income and savings-most strongly associated, and (iii) while having assets appeared to protect persons-in particular those without stressors-from symptoms of persistent depression over the COVID-19 pandemic, having assets did not appear to reduce the effects of job loss, financial difficulties, or relationship stress on symptoms of persistent depression. Efforts to reduce population depression should consider the role played by assets in shaping risk of symptoms of persistent depression.
Collapse
Affiliation(s)
- Catherine K. Ettman
- Boston University School of Public Health, Boston, MA, USA
- Brown University School of Public Health, Providence, RI, USA
| | | | | | - Ludovic Trinquart
- Boston University School of Public Health, Boston, MA, USA
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
| | | | | | | | - Ira B. Wilson
- Brown University School of Public Health, Providence, RI, USA
| | - Patrick M. Vivier
- Brown University School of Public Health, Providence, RI, USA
- Hassenfeld Child Health Innovation Institute, Providence, RI, USA
| | - Sandro Galea
- Boston University School of Public Health, Boston, MA, USA
| |
Collapse
|
45
|
Khezri M, Shokoohi M, Mirzazadeh A, Tavakoli F, Ghalekhani N, Mousavian G, Mehmandoost S, Kazerooni PA, Haghdoost AA, Karamouzian M, Sharifi H. HIV Prevalence and Related Behaviors Among People Who Inject Drugs in Iran from 2010 to 2020. AIDS Behav 2022; 26:2831-2843. [PMID: 35195820 DOI: 10.1007/s10461-022-03627-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 11/26/2022]
Abstract
Injection drug use has been the leading route of HIV transmission in Iran. We assessed HIV prevalence, risk behaviors, and uptake of prevention services among people who inject drugs (PWID) in Iran between 2010 and 2020. We also examined the individual and environmental determinants of HIV among PWID. PWID were recruited in major cities across the country in three national bio--behavioral surveillance surveys in 2010, 2014, and 2020. Participants were tested for HIV and interviewed using a behavioral questionnaire. Between 2010 and 2020, the prevalence of HIV (15.1% to 3.5%), receptive needle sharing (25.2% to 3.9%) and unprotected sex (79.4% to 65.2%) decreased. Moreover, uptake of free needle/syringe increased (57.4% to 87.9%), while uptake of free condoms remained relatively stable across the surveys (34.3% to 32.6%). Multivariable analysis for the 2020 survey showed that a history of homelessness, incarceration, and a longer injection career significantly increased the odds of HIV seropositivity. During the past decade, HIV prevalence and drug- and sexual-related risk behaviors decreased among Iranian PWID. However, individual and structural determinants continue to drive HIV among this population. HIV prevention, diagnosis, and treatment among marginalized PWID with a history of homelessness or incarceration and those who inject drugs for a longer period, should be further prioritized in HIV care planning and resource allocation in Iran.
Collapse
Affiliation(s)
- Mehrdad Khezri
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mostafa Shokoohi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ali Mirzazadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Fatemeh Tavakoli
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Nima Ghalekhani
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ghazal Mousavian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Soheil Mehmandoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Ali Akbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Karamouzian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| |
Collapse
|
46
|
Grewal R, Deeks SL, Hart TA, Cox J, De Pokomandy A, Grennan T, Lambert G, Moore D, Coutlée F, Gaspar M, George C, Grace D, Jollimore J, Lachowsky NJ, Nisenbaum R, Ogilvie G, Sauvageau C, Tan DHS, Yeung A, Burchell AN. Human papillomavirus (HPV) vaccination across a cascade of knowledge, willingness, and uptake among gay, bisexual, and other men who have sex with men in Canada's three largest cities. Hum Vaccin Immunother 2021; 17:5413-5425. [PMID: 34856869 DOI: 10.1080/21645515.2021.1979379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Some Canadian jurisdictions offer publicly funded HPV vaccine to gay, bisexual, and other men who have sex with men (GBM) aged ≤26 years. We characterized factors associated with being in different stages of HPV vaccination. METHODS Engage is a sexual health study of GBM in the three largest Canadian cities recruited via respondent driven sampling (RDS). We categorized participants as: (1) unaware of HPV vaccine, (2) undecided/unwilling to get vaccinated, (3) willing to get vaccinated, (4) vaccinated with one or more doses. Our RDS-II weighted analyses used multinomial logistic regression to identify factors associated with being in earlier stages of the cascade compared to Stage 4. RESULTS Across the cities, 26-40%, 7-14%, 33-39%, and 13-28% were in Stages 1 to 4, respectively. Compared to Stage 4, being in earlier stages of the cascade was associated with bisexual-identification (Stage 1: adjusted odds ratio[aOR] = 2.84, 95% confidence interval[CI] = 1.06-7.62; Stage 2: aOR = 3.09, 95%CI = 1.19-8.05), having immigrated to Canada (Stage 1: aOR = 1.79, 95%CI 1.07-2.99), preference to keep same-sex romantic relationships private (Stage 1: aOR = 1.25, 95% CI = 1.05-1.48; Stage 2: aOR = 1.24, 95%CI = 1.05-1.46), not receiving sexual health information (Stage 1: aOR = 0.31, 95% CI = 0.13-0.71; Stage 2: aOR = 0.27, 95%CI = 0.12-0.64), not accessing a health-care provider (Stage 2: aOR = 0.36, 95%CI = 0.15-0.83), and no past hepatitis A/B vaccination (Stage 1: aOR = 0.16, 95% CI = 0.09-0.30; Stage 2: aOR = 0.18, 95%CI = 0.09-0.35; Stage 3: aOR = 0.38, 95%CI = 0.21-0.61). DISCUSSION Interventions are needed to reduce social and financial barriers, increase sexual health knowledge, and improve GBM-competent health-care access to increase vaccine uptake among GBM.
Collapse
Affiliation(s)
- R Grewal
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - S L Deeks
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Nova Scotia Department of Health and Wellness, Halifax, Canada
| | - T A Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of Psychology, Ryerson University, Toronto, Canada
| | - J Cox
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, Montréal, McGill University.,Direction régionale de santé publique, CIUSSS-Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada
| | - A De Pokomandy
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
| | - T Grennan
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - G Lambert
- Direction régionale de santé publique, CIUSSS-Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada
| | - D Moore
- Department of Medicine, University of British Columbia, Vancouver, Canada.,BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - F Coutlée
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, Canada.,Department of Microbiology and Immunology, Université de Montréal, Montréal, Canada
| | - M Gaspar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - C George
- Department of Exercise, Health, and Sport Sciences, University of Maine, Portland, USA
| | - D Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - J Jollimore
- Community-Based Research Centre, Vancouver, Canada
| | - N J Lachowsky
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Community-Based Research Centre, Vancouver, Canada.,School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - R Nisenbaum
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Applied Health Research Centre, Unity Health Toronto, Toronto, Canada
| | - G Ogilvie
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - C Sauvageau
- Faculty of Medicine, Université Laval, Québec City, Canada.,Institut National de santé publique du Québec, Québec, Canada
| | - D H S Tan
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - A Yeung
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - A N Burchell
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| |
Collapse
|
47
|
Smith AD, Fearon E, Kabuti R, Irungu E, Kungu M, Babu H, Nyabuto C, Muthoga P, Weatherburn P, Bourne A, Kimani J. Disparities in HIV/STI burden and care coverage among men and transgender persons who have sex with men in Nairobi, Kenya: a cross-sectional study. BMJ Open 2021. [PMCID: PMC8719220 DOI: 10.1136/bmjopen-2021-055783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
ObjectivesThe study aimed to estimate the prevalence of, and associations, with HIV and metrics of HIV care engagement in a representative population of gay, bisexual and other men who have sex with men (GBMSM) and transgender persons (TP) who have sex with men (GBMSM/TP)SettingUrban districts of Nairobi, Kenya.DesignCross-sectional.Participants608 eligible participants were identified through respondent-driven sampling over 19 waves of recruitment arising from ten seeds between May and December 2017. Inclusion criteria were: age >18 years; Nairobi residence; male sex assignment at birth or current identification as male, and recent consensual sex with male partners. Exclusion criteria were: missing or invalid recruitment coupon; repeat registration; intoxication at study visit.Primary and secondary outcome measuresHIV status measured using Determine Alere HIV 1/2 and First Response HIV 1–2.0 and GeneXpert HIV-1 Qual. Self-reported metrics of HIV status awareness, antiretroviral use and objective quantification of viral suppression using GeneXpert HIV-1 VL.Results26.4% (286/618) were HIV positive of whom 76.6% were status aware, 65.3% were on antiretroviral therapy (ART), and 47.4% were virally suppressed (<50 copies/mL). Participants 18–22 years were less likely to be status aware, be receiving ART or to have achieved viral suppression. Mean log viral load was 3.14 log higher in 18–22 years compared with older participants. Bacterial sexually transmitted infections were common at both urethral and rectal sites and most infections were asymptomatic by self-report (rectal 82.2%, urethral 82.3%).ConclusionsEngagement in the HIV diagnosis and care cascade among GBMSM/TP in Nairobi is markedly better than in most sub-Saharan African countries, yet falls short of achievements for the general population in Kenya and for GBMSM in high income settings. Young GBMSM/TP are least well served by the current configuration of adult key population services, and programmes should identify and address the sexual, social and developmental needs of adolescent and young key populations.
Collapse
Affiliation(s)
- Adrian D Smith
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Elizabeth Fearon
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Rhoda Kabuti
- Partners for Health and Development, Nairobi, Kenya
| | | | - Mary Kungu
- Partners for Health and Development, Nairobi, Kenya
| | - Hellen Babu
- Partners for Health and Development, Nairobi, Kenya
| | | | - Peter Muthoga
- Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Peter Weatherburn
- Sigma Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - Joshua Kimani
- Department of Global Health & Development, Partners for Health and Development, Nairobi, Kenya
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
48
|
Reis A, Sperandei S, de Carvalho PGC, Pinheiro TF, de Moura FD, Gomez JL, Porchat P, Bastos FI, McFarland W, Wilson EC, Veras MA. A cross-sectional study of mental health and suicidality among trans women in São Paulo, Brazil. BMC Psychiatry 2021; 21:557. [PMID: 34758758 PMCID: PMC8579408 DOI: 10.1186/s12888-021-03557-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 10/20/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Trans women have been shown to experience disproportionately poor outcomes in physical and mental health. Although it is common to talk about the violence against trans people, little is still known about mental health outcomes and experiences of suicidality among trans women, particularly in developing countries. This study aims to investigate risk factors and associations with mental health, suicide ideation and suicide attempts among trans women in the largest metropolitan area in Brazil. METHODS Trans women living in São Paulo were recruited between May 2017 and July 2019 using the long-chain peer referral method Respondent-Driven Sampling. Multivariate regression models were used to investigate the associations with K10 score classification (logistic) and suicidal ideation/suicide attempt (ordinal logistic). RESULTS A total of 763 trans women were included in the study. Over one quarter (26.5%) of trans women had been diagnosed with anxiety in the past, and close to one in five (19.1%) trans women had received a diagnosis of depression. More than two in five (41.9%) trans women had moderate to severe psychological distress. More than half of all participating trans women reported having previously either experienced suicidal ideation or attempted to take their own lives (25.0 and 31.2% respectively). In multivariate regression, moderate to severe psychological distress was associated with homelessness, income, current sex work, use of stimulant drugs, history of physical abuse, depression diagnosis and access to mental health treatment. Suicidal ideation and suicide attempts were associated with race/skin color, living arrangements, marital status, current sex work, history of sexual violence, depression and PTSD diagnoses, access to mental health treatment and psychological distress. CONCLUSIONS This study showed that there is a significant association between mental health conditions, lack of treatment for these conditions and suicidality among trans gender women. Findings point to the need for a structural transformation in Brazil that enables a reduction in the social inequality and violence that impact the mental health of trans women. A number of recommendations to achieve this are provided.
Collapse
Affiliation(s)
- Arianne Reis
- grid.1029.a0000 0000 9939 5719School of Health Sciences, Western Sydney University, Penrith, Australia ,grid.1029.a0000 0000 9939 5719Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | - Sandro Sperandei
- grid.1029.a0000 0000 9939 5719Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | | | - Thiago Félix Pinheiro
- grid.419014.90000 0004 0576 9812Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, Brazil
| | - Ferdinando Diniz de Moura
- grid.419014.90000 0004 0576 9812Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, Brazil
| | - José Luis Gomez
- grid.419014.90000 0004 0576 9812Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, Brazil
| | - Patrícia Porchat
- grid.410543.70000 0001 2188 478XSchool of Sciences, São Paulo State University, Bauru, Brazil
| | - Francisco Inácio Bastos
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Willi McFarland
- grid.410359.a0000 0004 0461 9142San Francisco Department of Public Health, Center for Public Health Research, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Department of Epidemiology and Statistics, University of California, San Francisco, CA USA
| | - Erin C. Wilson
- grid.410359.a0000 0004 0461 9142San Francisco Department of Public Health, Trans Research unit for Equity (TRUE), San Francisco, CA USA
| | - Maria Amélia Veras
- Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, Brazil.
| |
Collapse
|
49
|
Ramírez-Ortiz D, Forney DJ, Sheehan DM, Cano MÁ, Romano E, Sánchez M. Pre- and Post-immigration HIV Testing Behaviors among Young Adult Recent Latino Immigrants in Miami-Dade County, Florida. AIDS Behav 2021; 25:2841-2851. [PMID: 33751312 DOI: 10.1007/s10461-021-03233-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2021] [Indexed: 11/28/2022]
Abstract
HIV testing early in the immigration process can facilitate timely linkage to HIV prevention and treatment services for immigrants. This study aims to determine the prevalence of self-report HIV testing pre- and post-immigration and the associations between pre-immigration HIV sexual risk behaviors, access to healthcare post-immigration, and HIV testing post-immigration among young adult recent Latino immigrants. Cross-sectional data from 504 recent Latino immigrants aged 18 to 34 who immigrated to Miami-Dade County, Florida during the 12 months before assessment were analyzed using robust Poisson regression models. We found that 23.8% of participants reported HIV testing post-immigration and 56.7% reported HIV testing pre-immigration. The prevalence ratio for post-immigration HIV testing was higher for participants that had health insurance (adjusted prevalence ratio [aPR]: 1.70, 95% confidence interval [CI]: 1.21-2.38) and a regular doctor or healthcare provider after immigration (aPR: 1.43, 95% CI 1.03-2.00), and post-immigration HIV testing was higher for participants that had ever been tested for HIV before immigration (aPR: 2.41, 95% CI 1.68-3.45). Also, the prevalence ratio was lower for those who engaged in condomless sex in the three months prior to immigration (aPR: 0.65, 95% 0.47-0.90). These findings suggest that addressing barriers to healthcare and prevention services for young adult recent Latino immigrants is needed to scale-up HIV testing in this population early in the immigration process.
Collapse
Affiliation(s)
- Daisy Ramírez-Ortiz
- Department of Epidemiology, Florida International University, Miami, FL, USA
| | - Derrick J Forney
- Department of Health Promotion and Disease Prevention, Florida International University, Miami, FL, USA
| | - Diana M Sheehan
- Department of Epidemiology, Florida International University, Miami, FL, USA
- Center for Research On U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, FL, USA
| | - Miguel Ángel Cano
- Department of Epidemiology, Florida International University, Miami, FL, USA
- Center for Research On U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, FL, USA
| | - Eduardo Romano
- Pacific Institute for Research and Evaluation, Calverton, MD, USA
| | - Mariana Sánchez
- Department of Health Promotion and Disease Prevention, Florida International University, Miami, FL, USA.
- Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, AHC5 411, Miami, FL, 33199, USA.
| |
Collapse
|
50
|
Barbaric J, Bozicevic I, Manathunge A, Gajaweera C, Beneragama S. HIV, syphilis and hepatitis B prevalence, related risk behaviours and correlates of condom use among transgender women in two cities in Sri Lanka: findings from respondent-driven sampling surveys. Sex Health 2021; 18:311-318. [PMID: 34446151 DOI: 10.1071/sh21061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/06/2021] [Indexed: 11/23/2022]
Abstract
Background Biobehavioural data on transgender women (TGW) are limited globally. METHODS We used data collected as part of the 2017-18 National Integrated HIV Biobehavioural Survey, which included 254 TGW in Colombo and 252 in Jaffna, for structured questionnaire interviews and biological testing. We performed multivariable logistic regression analysis to explore factors associated with condom use. RESULTS We found low HIV prevalence in Colombo (0.6%) and no HIV infections in Jaffna. TGW in Colombo had higher positivity on the Treponema pallidum-particle agglutination test (2.5%) compared with TGW in Jaffna (0.4%). We found no hepatitis B infections. In both cities, <25% of TGW have comprehensive knowledge about HIV prevention. In Colombo 54.4%, but only 21.4% of TGW in Jaffna, have ever been tested for HIV. Drug-injecting behaviours are uncommon in both cities (prevalence <1%), whereas 7.4% reported sharing equipment for injecting feminising hormones in Colombo. Greater proportions of TGW in Colombo compared with Jaffna used condom at last sex (82.3% vs 37.7%). Multivariable analysis showed lower odds of condom use at last sex in TGW aged >30 years and those who did not test for HIV in the past 12 months in Colombo, and for TGW with higher income in Jaffna, TGW not visiting outdoor sites to find partners, and TGW who sold sex. CONCLUSIONS Current burden of HIV, syphilis and hepatitis B among TGW in Sri Lanka is low. Although risk behavioural patterns vary between the cities, a substantial sexually transmitted infection vulnerability is a common denominator, calling for strengthening of the capacity to respond to specific TGW needs.
Collapse
Affiliation(s)
- Jelena Barbaric
- World Health Organization Collaborating Centre for HIV Strategic Information, University of Zagreb School of Medicine, Zagreb, Croatia; and Corresponding author.
| | - Ivana Bozicevic
- World Health Organization Collaborating Centre for HIV Strategic Information, University of Zagreb School of Medicine, Zagreb, Croatia
| | | | | | | |
Collapse
|