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Hernández D, Pan Y, Cardenas G, Miranda de León S, Davila-Torres GO, Rodriguez AE, Yanez IG, Maisonet Alejandro M, Calderón Alicea WL, Meléndez-González HJ, Feaster DJ, Metsch LR, Santana-Bagur J. Assessing HIV Care Outcomes Among Persons Who Use Drugs in Puerto Rico Before and After Hurricane Maria. Disaster Med Public Health Prep 2023; 17:e397. [PMID: 37222152 DOI: 10.1017/dmp.2023.21] [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] [Indexed: 05/25/2023]
Abstract
OBJECTIVES To explore the health impacts of Hurricane Maria (HM) on HIV care outcomes among people living with HIV who use drugs. METHODS Using data from an ongoing cohort study in San Juan, Puerto Rico (Proyecto PACTo), we measured differences in HIV care outcomes (viral load, viral suppression, and CD4 counts) before and after HM using assessments conducted at 6-month intervals. Generalized estimating equations were used to assess factors associated with HIV care outcomes. RESULTS All HIV care outcomes showed a deterioration from pre-HM values to post-HM values (mean viral load increased, CD4 counts decreased, and rate of viral suppression decreased) after controlling for pre-HM sociodemographic and health characteristics. In addition to HM, age (aIRR = 1·01), being homeless (aIRR = 0·78) and having health insurance (aIRR = 1·6) were independently associated with viral suppression. PARTICIPANTS 219 participants completed follow-up visits between April 2017 and January 2018, before and after HM. CONCLUSIONS People living with HIV who use drugs in Puerto Rico experienced poorer HIV outcomes following HM. Socio-environmental factors contributing to these outcomes is discussed in the context of disaster response, recovery, and program planning.
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Affiliation(s)
- Diana Hernández
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Yue Pan
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Gabriel Cardenas
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | | | | | - Allan E Rodriguez
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Iveth G Yanez
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Mariela Maisonet Alejandro
- University of Puerto Rico, Oficina para la Protección de Participantes Humanos en Investigación (OPPHI/IRB) Medical Sciences Campus, San Juan, Puerto Rico
| | | | | | - Daniel J Feaster
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
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Cabrera FF, Gamarra ER, Garcia TE, Littlejohn AD, Chinga PA, Pinentel-Morillo LD, Tirado JR, Chung DY, Pande LJ, McCall KL, Nichols SD, Piper BJ. Opioid distribution trends (2006-2017) in the US Territories. PeerJ 2019; 7:e6272. [PMID: 30671308 PMCID: PMC6338096 DOI: 10.7717/peerj.6272] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/10/2018] [Indexed: 12/25/2022] Open
Abstract
Background The US mainland is experiencing an epidemic of opioid overdoses. Unfortunately, the US Territories (Guam, Puerto Rico, and the Virgin Islands) have often been overlooked in opioid pharmacoepidemiology research. This study examined common prescription opioids over the last decade. Methods The United States Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System (ARCOS) was used to report on ten medical opioids: buprenorphine, codeine, fentanyl, hydrocodone, hydromorphone, meperidine, methadone, morphine, oxycodone, and oxymorphone, by weight from 2006 to 2017. Florida and Hawaii were selected as comparison areas. Results Puerto Rico had the greatest Territorial oral morphine mg equivalent (MME) per capita (421.5) which was significantly higher (p < .005) than the Virgin Islands (139.2) and Guam (118.9) but significantly lower than that of Hawaii (794.6) or Florida (1,509.8). Methadone was the largest opioid by MMEs in 2017 in most municipalities, accounting for 41.1% of the total in the Virgin Islands, 37.9% in Florida, 36.6% in Hawaii but 80.8% in Puerto Rico. Puerto Rico and Florida showed pronounced differences in the distribution patterns by pharmacies, hospitals, and narcotic treatment programs for opioids. Conclusions Continued monitoring of the US Territories is needed to provide a balance between appropriate access to these important agents for cancer related and acute pain while also minimizing diversion and avoiding the opioid epidemic which has adversely impacted the US mainland.
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Affiliation(s)
- Fedor F Cabrera
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA, United States of America
| | - Erik R Gamarra
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA, United States of America
| | - Tiffany E Garcia
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA, United States of America
| | - Ashanti D Littlejohn
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA, United States of America
| | - Poul A Chinga
- Department of Biology, University of Scranton, Scranton, PA, United States of America
| | - Luis D Pinentel-Morillo
- Department of Biology, Pennsylvania State University, State College, PA, United States of America
| | - Jorge R Tirado
- Department of Biology, Elizabethtown College, Elizabethtown College, PA, United States of America
| | - Daniel Y Chung
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA, United States of America
| | - Leana J Pande
- Department of Biology, Wilkes University, Wilkes-Barre, PA, United States of America
| | - Kenneth L McCall
- Department of Pharmacy Practice, University of New England, Portland, ME, United States of America
| | - Stephanie D Nichols
- Department of Pharmacy Practice, Husson University School of Pharmacy, Bangor, ME, United States of America
| | - Brian J Piper
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA, United States of America.,Center for Pharmacy Innovation and Outcomes, Geisinger Precision Health Center, Forty Fort, PA, United States of America
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Hernández D, Castellón PC, Fernández Y, Torres-Cardona FA, Parish C, Gorshein D, Vargas Vidot J, Miranda de Leon S, Rodriguez A, Santana Bagur J, Feaster DJ, Schackman BR, Metsch LR. When "the Cure" Is the Risk: Understanding How Substance Use Affects HIV and HCV in a Layered Risk Environment in San Juan, Puerto Rico. HEALTH EDUCATION & BEHAVIOR 2017; 44:748-757. [PMID: 28891344 DOI: 10.1177/1090198117728547] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Substance use, particularly injection drug use, continues to fuel the HIV/HCV (hepatitis C virus) epidemics in San Juan, Puerto Rico (PR). AIM This article examines individual and sociostructural factors that affect HIV/HCV risk among people who use drugs (PWUD) living with or at risk for HIV/HCV in San Juan, PR. Findings were used to inform a community-level intervention to enhance HIV care access and retention for this population. METHOD A rapid ethnographic assessment in collaboration with a community-based organization was conducted. Data collection took place between June and December 2013 and included field observations, 49 unstructured interviews with PWUD, and 19 key informant interviews with community stakeholders. Fieldnotes, photographs, and interview transcripts were analyzed for recurrent themes and to address the intervention-planning needs. Study results are presented as fieldnote excerpts, direct quotes from interviews, and photographs. RESULTS Findings suggest that PWUD in PR face myriad challenges that affect HIV/HCV risk and hinder linkage to and retention in care. Results describe a layered risk environment where PWUD encounter many barriers to prevention, care, and treatment such as transience, social isolation, stigma, limited housing options, and inadequate medical and substance use disorder treatment services. DISCUSSION These observed circumstances provide an empirical basis for the development and evaluation of comprehensive interventions that may serve to reduce barriers to care and link individuals to other supportive services. CONCLUSION New approaches and comprehensive interventions are needed to break the structures that perpetuate risk and lack of engagement and retention in HIV care and substance use disorder treatment in San Juan.
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