Seroprevalence of hepatitis C and factors associated with this in crack users

Housing characteristics of crack cocaine users in Northeast Brazil, 2011-2013

We compared sociodemographic characteristics, substance use patterns, sexual behavior, use of health services, and criminal records of homeless vs. domiciled users. Data are from the Brazilian National Survey on Crack Use. A discriminant model and correspondence analysis cross-compared characteristics of users according to their housing status. The logistic model revealed associations between "living in the streets" and female gender and intermittent work. "Homelessness" was also associated with the use of tobacco and "oxi" in the previous 30 days, reliance on soup kitchens, low access to public mental health services, and arrests in the previous year. Correspondence analysis highlighted the spatial proximity of the variables as follows: "having traded sex for drugs", "informal work", "age 31 years or older", "access to public mental health services", "problems with law enforcement", and female gender with homeless crack users. People who smoke crack cocaine in Northeast Brazil are seldom studied. Their profiles, stratified according to their housing conditions, show subgroups with specific characteristics. While domiciled users have access to specialized clinics, homeless users basically reported access to free food and harm reduction services.

High prevalence of Hepatitis C Virus infection among people who use crack cocaine in an important international drug trafficking route in Central-West Region Brazil

In this study, the prevalence rate, associated risk factors and genetic diversity of hepatitis C virus (HCV) infection were determined among people who use crack from an international drug trafficking route in Central-West, Brazil. Blood samples were collected from 700 users of crack from Campo Grande and two border cities of Mato Grosso do Sul State and tested for HCV infection using serological and molecular testing methodologies. Anti-HCV was detected in 31/700 (4.5%, 95% CI: 2.9-6.0%) and HCV RNA in 26/31 (83.9%) of anti-HCV positive samples. Phylogenetic analysis of three HCV sub-genomic regions (5'UTR, NS5B and HVR-1) revealed the circulation of 1a (73.9%), 1b (8.7%) and 3a (17.4%) genotypes. Next-generation sequencing and phylogenetic analysis of intra-host viral populations of HCV HVR-1 showed a significant variation in intra-host genetic diversity among infected individuals, with 58.8% composed of more than one sub-population. Bayesian analysis estimated that the most recent common HCV ancestor for strains identified here was introduced to this region after 1975 following expansion of intravenous drug use in Brazil. Multivariate analyses showed that only 'ever having injected drugs' was independently associated with HCV infection. These results indicate an increasing spread of multiple HCV strains requiring public health intervention, such as harm reduction, testing services and treatment among crack users in this important border region of Central Brazil.

Molecular and epidemiological aspects of hepatitis C virus infection among crack cocaine users

The aim is to investigate the prevalence, risk factors, and hepatitis C virus (HCV) genotypes/subtypes among crack users in-treatment in Central Brazil. A cross-sectional survey in which 600 in-treatment crack users were interviewed and tested for anti-HCV Ab by enzyme-linked immunosorbent assay was conducted between August 2012 and April 2013. Anti-HCV-positive samples were also submitted for HCV RNA detection by polymerase chain reaction. Positive HCV RNA samples were genotyped by direct sequencing analysis of the NS5B region of the viral genome, followed by phylogenetic analysis. Of the total, 3.7% (95.0% CI, 2.4%-5.6%) were anti-HCV positive. Age over 40 years and history of injecting drugs were risk factors for HCV, while snorting cocaine was a protector variable. HCV RNA was detected in 14 of 22 anti-HCV-positive samples, and the genotypes 1 (n = 10) and 3 (n = 2), subtypes 1a (n = 7), 1b (n = 3), and 3a (n = 2) were identified. The HCV prevalence found among crack users is almost threefold that observed in the general population in Brazil supporting that this population is at higher risk for HCV. The findings of cocaine insufflation as a protective behavior for HCV infection in this population should be explored.

Hepatitis C virus infection status and associated factors among a multi-site sample of people who used illicit drugs in the Amazon region

BACKGROUND

Elevated rates of Hepatitis C Virus (HCV) infection have been reported in epidemiological studies with people who used illicit drugs (PWUIDs) in different Brazilian regions. In Brazil's Amazon region, studies have already identified the common use of illicit drugs among adolescents and the high prevalence of HCV infections among PWUIDs. However, all studies done with PWUIDs were conducted with small samples and within limited geographic coverage. This study determined the prevalence and risk factors for HCV infection in PWUIDs in the Amazon region, northern Brazil, as well as estimating the prevalence and factors associated with the HCV spontaneous clearance (HSC).

METHODS

This cross-sectional study accessed 1666 PWUIDs from multiple municipalities of the Amazon region. Socio-demographic, economic, drug use and health-related information were collected through interviews. Blood samples collected were tested for the presence of anti-HCV antibodies and RNA-HCV. HCV genotypes were identified by real-time polymerase chain reaction (PCR). Logistic regressions were run to identify factors independently associated with HCV infection status and HSC.

RESULTS

In total, 577 (34.6%) featured HCV antibodies, of which 384 (23.1%) had active HCV infection and 193 (11.6%) indicated HSC. Genotypes 1 (80.2%) and 3 (18.8%) were detected. HCV infection status was associated with the length of illicit drug use history, factors related to parenteral and sexual transmission, and factors of socio-economic marginalization leading to potential risk activities for HCV. HSC was associated with the ethnic (including indigenous) background of participants.

CONCLUSIONS

High levels of HCV infection were detected in PWUIDs. Genotype 1 was predominant. Intense use of illicit drugs, unprotected sexual intercourse, high number of sexual partners and social marginalization were associated with all HCV infection. HSC was associated with origin (Amazonian-born) and non-white (e.g., Black or Indigenous) of PWUIDs. These findings emphasize the need for improve HCV prevention and control services and care for PWUIDs in the Brazilian Amazon region.

Hepatitis C: clinical and biological features related to different forms of cocaine use

INTRODUCTION

Hepatitis C virus (HCV) infection is related with several liver diseases such as cirrhosis and hepatocellular carcinomas, leading to more than 0.5 million deaths every year and to a great global burden. It is known that injection drug users show a high prevalence of HCV infection, being considered a risk group for this disease. Cocaine users seem to be in greater risk than other drug users, and several hypotheses for this association are being studied.

AIM

To review data on HCV infection in cocaine users, taking into consideration the relevance of the different routes of drug administration and other risk behaviors.

METHODS

This was a narrative review performed in the main scientific databases.

RESULTS AND CONCLUSION

Data suggest that cocaine use could be associated with HCV infection due to the specificities of cocaine consumption pattern, even in those subjects who do not inject drugs, in addition to other risky behaviors, such as tattooing and unprotected sex. Injectable cocaine users seem to be more susceptible to contamination than users who do not inject drugs. However, evidence is pointing to the possibility of infection by sharing drug paraphernalia other than syringes. Moreover, specific immune system impairments caused by cocaine use are also being linked with HCV infection susceptibility, persistence and increased pathological effects.

Factors associated with HIV prevalence in a prison population

OBJECTIVE

To analyze HIV prevalence and associated factors in inmates in a prison in a state in the Northeast region of Brazil.

METHOD

Epidemiological, cross-sectional study carried out with prisoners. Interviews were conducted using a form and a rapid test for the diagnosis. Bivariate and multivariate hypothesis testing, with a simple logistic ratio (unadjusted odds ratio) and multiple ratio (adjusted odds ratio) were applied. Significance level was set at p≤0.05.

RESULTS

A total of 2,131 inmates participated in the study. The HIV prevalence was 1.0%. Seropositive individuals were mostly Afro-American; their marital status was predominantly single/separated/widower. The mean age was of 31.3 years, and the mean educational level was 6.29 years. There was a link between the HIV virus and the variables: selection of partners based on physical attributes and vaginal sexual intercourse.

CONCLUSION

Tackling the HIV infection represents a major challenge for prison and sanitary authorities, considering that the issues related to the HIV context inside and outside the prison environment are interconnected and, therefore, demands coordinated action.

Health outcomes associated with crack-cocaine use: Systematic review and meta-analyses

BACKGROUND

Crack-cocaine use is prevalent largely in socio-economically marginalized populations in the Americas. Its use has been associated with diverse health outcomes, yet no recent or systematic reviews of these exist.

METHODS

A systematic review of health outcomes associated with crack-cocaine use was performed, using MEDLINE, Scopus, Web of Science, CINAHL, PsycINFO, and LILACS up to October 2016. Search terms included crack-cocaine and health outcome-related keywords, targeting peer-reviewed studies on quantified health outcomes associated with crack-cocaine use. Random effects meta-analyses produced pooled odds ratios. Levels of evidence for major results were assessed using the GRADE approach. A review protocol was registered with PROSPERO (CRD42016035486).

RESULTS

Of 4700 articles returned, 302 met eligibility criteria, reporting on health outcomes for 14 of 22 ICD-10 chapters. Conclusive evidence and meta-analyses showed positive associations between crack-cocaine use and blood/sexually transmitted diseases (HIV and hepatitis C virus, others); moderate evidence and meta-analyses supported associations with neonatal health, and violence. There were mixed associations for mental and other health outcomes, yet insufficient evidence to perform meta-analyses for many categories (e.g., mortality). Most underlying research was of limited or poor quality, with crack-cocaine commonly assessed as a secondary covariate.

CONCLUSIONS

Crack-cocaine use was associated with a range of health outcomes, although it was unclear if there was direct causal impact, interactions between risk factors, or external drivers of both crack-cocaine use and outcomes. Rigorous epidemiological studies are needed to systematically assess health outcomes of crack-cocaine use and underlying pathways, also to inform evidence-based interventions.

The female crack users: Higher rates of social vulnerability in Brazil

Female crack users who sought treatment are a hard to find part of the population. We studied sociodemographic and behavioral characteristics of crack users undergoing treatment in psychosocial care centers for alcohol and other drugs in six Brazilian cities. We carried out a cross-sectional study of 816 crack users and collected data with the Addiction Severity Index. Women were more likely to be in vulnerable situations: had worst levels of education, were not receiving money enough to their basic needs; more likely to be HIV positive (10.1%), to report sexual abuse (34%), and to be separated from their children (20%).

Prevalência de hepatite B e fatores associados em internos de sistema prisional

Resumo Objetivo Estimar a prevalência do marcador HBsAg em internos de sistema prisional brasileiro, correlacionando-a a fatores associados. Métodos Pesquisa epidemiológica, transversal, realizada nas unidades prisionais com regime fechado ou semiaberto (n=12), totalizando 2.131 internos participantes. A coleta de dados ocorreu por meio da realização de entrevista, seguida de testagem rápida para Hepatite B (HBsAg). Foram realizadas análises descritivas simples, bivariadas e multivariadas, utilizando-se a Regressão Logística com o valor de p fixado em 0,05. Resultados A prevalência de HBsAg positivo foi de 0,5%, com associação estatisticamente significativa com as variáveis “não gostar de utilizar preservativo” (ORa=3,63) e “não saber como prevenir infecções sexualmente transmissíveis” (ORa=5,02). Conclusão A prevalência estimada esteve igual ou menor que a encontrada na população geral do país e comprovou-se que existem fatores estatisticamente associados à prevalência de positividade do HBsAg na população estudada.

Transactional Sex among Noninjecting Illicit Drug Users: Implications for HIV Transmission

Noninjecting illicit drug users (NIDUs) present high risk for HIV infection, due especially to transactional sex. This study aimed to estimate the prevalence and risk factors for transactional sex among NIDUs in the Southwest region of Goiás State, Central Brazil. The prevalence of self-reported transactional sex was 22.8%. Prevalence in women and men was 52.7% and 16.8%, respectively, a significant difference (p < 0.001). Crack use and history of sexually transmitted infections (STI) were risk factors for transactional sex in men. Homelessness, crack use, sex under the influence of drugs, and history of sexual violence were risk factors for transactional sex in women. A high prevalence of transactional sex was observed among NIDUs. This risk behavior may contribute to the high rates of HIV among this population and their social networks and in the general population.

Leaving the Hospital Against Medical Advice Among People Who Use Illicit Drugs: A Systematic Review

BACKGROUND

Leaving the hospital against medical advice is an increasing problem in acute care settings and is associated with an array of negative health consequences that may lead to readmission for a worsened health outcome or mortality. Leaving the hospital against medical advice is particularly common among people who use illicit drugs (PWUD) and has been linked to a number of complex issues; however, few studies have focused specifically on this population beyond identifying them as being at an increased risk of leaving the hospital prematurely. Furthermore, programs and interventions for reducing the rate of leaving the hospital against medical advice among PWUD in acute care settings have not been well studied.

OBJECTIVES

We systematically assessed the literature examining hospital discharge against medical advice from acute care among this population and identified potential methods to minimize the occurrence of this phenomenon.

SEARCH METHODS

We searched 5 electronic databases (from database inception to August 2014) and article reference lists for articles investigating hospital discharge from acute care against medical advice among PWUD. Search terms consistent across databases included "patient discharge," "hospital discharge," "against medical advice," "drug user," "substance-related disorders," and "intravenous substance abuse."

SELECTION CRITERIA

Studies were eligible for inclusion if they were published in a peer-reviewed journal as an original research article in English. We excluded gray literature, case reports, case series, reviews, and editorials. We retained original studies that reported illicit drug use as a predictor of leaving the hospital against medical advice and studies of discharge against medical advice that included PWUD as a population of interest, and we assessed significance through appropriate statistical tests. We excluded studies that reported patients leaving the hospital against medical advice from psychiatric hospitals, drug treatment centers and emergency departments, and studies that discussed misuse of alcohol but not illicit drugs.

DATA COLLECTION AND ANALYSIS

We created an electronic database that included study abstracts and relevant information matching the keywords and search criteria. We reviewed potentially eligible articles independently by scanning the titles, abstracts, and full texts of articles after removing duplicates. We identified studies for which eligibility was unclear and decided which studies to include after thoroughly reviewing and discussing them.

RESULTS

Of the 1649 studies that matched the search criteria, 17 met our inclusion criteria. Thirteen studies identified substance misuse as a significant predictor of leaving the hospital against medical advice. Three studies assessed the prevalence and predictors of leaving the hospital against medical advice among people who inject drugs and found that this phenomenon was commonly reported (prevalence range = 25%-30%). Factors positively associated with leaving the hospital against medical advice included recent injection drug use, Aboriginal ancestry, leaving on weekends and welfare check day. In-hospital methadone use, social support, older age, and admission to a community-based model of care were negatively associated with the outcome.

CONCLUSIONS

To better understand risk factors associated with leaving the hospital against medical advice among PWUD, future research should consider the effect of individual, social, and structural characteristics on leaving the hospital against medical advice among PWUD. The development and evaluation of novel methods to address interventions to reduce the rate of leaving the hospital prematurely is necessary.

Factors Associated with Leaving Hospital against Medical Advice among People Who Use Illicit Drugs in Vancouver, Canada

BACKGROUND

Leaving hospital against medical advice (AMA) is common among people who use illicit drugs (PWUD) and is associated with severe health-related harms and costs. However, little is known about the prevalence of and factors associated with leaving AMA among PWUD.

METHODS

Data were collected through two Canadian prospective cohort studies involving PWUD between September 2005 and July 2011 and linked to a hospital admission/discharge database. Bivariable and multivariable generalized estimating equations were used to examine factors associated with leaving hospital AMA among PWUD who were hospitalized.

RESULTS

Among 488 participants who experienced at least one hospitalization, 212 (43.4%) left the hospital AMA at least once during the study period. In multivariable analyses, factors positively and significantly associated with leaving hospital AMA included: unstable employment (AOR = 1.92; 95% confidence interval [CI]: 1.22-3.03); recent incarceration (AOR = 1.63; 95%CI: 1.07-2.49); ≥ daily heroin injection (AOR = 1.49; 95%CI: 1.05-2.11); and younger age per year younger (adjusted odds ratio [AOR] = 1.04; 95%CI: 1.02-1.06).

CONCLUSIONS

We found a substantial proportion of PWUD in this setting left hospital AMA and that various markers of risk and vulnerability were associated with this phenomenon. Our findings highlight the need to address substance abuse issues early following hospital admission. These findings further suggest a need to develop novel interventions to minimize PWUD leaving hospital prematurely.

Risk behaviors for sexually transmitted diseases among crack users

OBJECTIVES

to investigate the prevalence and risk behaviors by means of reporting of sexually transmitted diseases among crack users.

METHOD

cross-sectional study carried out with 588 crack users in a referral care unit for the treatment of chemical dependency. Data were collected by means of face-to-face interview and analyzed using Stata statistical software, version 8.0.

RESULTS

of the total participants, 154 (26.2%; 95% CI: 22.8-29.9) reported antecedents of sexually transmitted diseases. Ages between 25 and 30 years (RP: 2.1; 95% CI: 1.0-4.0) and over 30 years (RP: 3.8; 95% CI: 2.1-6.8), alcohol consumption (RP: 1.9; 95% CI: 1.1-3.3), antecedents of prostitution (RP: 1.9; 95% CI: 1.3-2.9) and sexual intercourse with person living with human immunodeficiency virus/AIDS (RP: 2.7; 95% CI: 1.8-4.2) were independently associated with reporting of sexually transmitted diseases.

CONCLUSION

the results of this study suggest high risk and vulnerability of crack users for sexually transmitted diseases.