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Patel EU, Grieb SM, Winiker AK, Ching J, Schluth CG, Mehta SH, Kirk GD, Genberg BL. Structural and social changes due to the COVID-19 pandemic and their impact on engagement in substance use disorder treatment services: a qualitative study among people with a recent history of injection drug use in Baltimore, Maryland. Harm Reduct J 2024; 21:91. [PMID: 38720307 PMCID: PMC11077846 DOI: 10.1186/s12954-024-01008-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 04/22/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Substance use disorder treatment and recovery support services are critical for achieving and maintaining recovery. There are limited data on how structural and social changes due to the COVID-19 pandemic impacted individual-level experiences with substance use disorder treatment-related services among community-based samples of people who inject drugs. METHODS People with a recent history of injection drug use who were enrolled in the community-based AIDS Linked to the IntraVenous Experience study in Baltimore, Maryland participated in a one-time, semi-structured interview between July 2021 and February 2022 about their experiences living through the COVID-19 pandemic (n = 28). An iterative inductive coding process was used to identify themes describing how structural and social changes due to the COVID-19 pandemic affected participants' experiences with substance use disorder treatment-related services. RESULTS The median age of participants was 54 years (range = 24-73); 10 (36%) participants were female, 16 (57%) were non-Hispanic Black, and 8 (29%) were living with HIV. We identified several structural and social changes due the pandemic that acted as barriers and facilitators to individual-level engagement in treatment with medications for opioid use disorder (MOUD) and recovery support services (e.g., support group meetings). New take-home methadone flexibility policies temporarily facilitated engagement in MOUD treatment, but other pre-existing rigid policies and practices (e.g., zero-tolerance) were counteracting barriers. Changes in the illicit drug market were both a facilitator and barrier to MOUD treatment. Decreased availability and pandemic-related adaptations to in-person services were a barrier to recovery support services. While telehealth expansion facilitated engagement in recovery support group meetings for some participants, other participants faced digital and technological barriers. These changes in service provision also led to diminished perceived quality of both virtual and in-person recovery support group meetings. However, a facilitator of recovery support was increased accessibility of individual service providers (e.g., counselors and Sponsors). CONCLUSIONS Structural and social changes across several socioecological levels created new barriers and facilitators of individual-level engagement in substance use disorder treatment-related services. Multilevel interventions are needed to improve access to and engagement in high-quality substance use disorder treatment and recovery support services among people who inject drugs.
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Affiliation(s)
- Eshan U Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Suzanne M Grieb
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Abigail K Winiker
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer Ching
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Catherine G Schluth
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Gregory D Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Becky L Genberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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Machavariani E, Miceli J, Altice FL, Neblett Fanfair R, Speers S, Nichols L, Jenkins H, Villanueva M. Using Data-To-Care Strategies to Optimize the HIV Care Continuum in Connecticut: Results From a Randomized Controlled Trial. J Acquir Immune Defic Syndr 2024; 96:40-50. [PMID: 38324241 PMCID: PMC11009056 DOI: 10.1097/qai.0000000000003391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/18/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Re-engaging people with HIV who are newly out-of-care remains challenging. Data-to-care (D2C) is a potential strategy to re-engage such individuals. METHODS A prospective randomized controlled trial compared a D2C strategy using a disease intervention specialist (DIS) vs standard of care where 23 HIV clinics in 3 counties in Connecticut could re-engage clients using existing methods. Using a data reconciliation process to confirm being newly out-of-care, 655 participants were randomized to DIS (N = 333) or standard of care (N = 322). HIV care continuum outcomes included re-engagement at 90 days, retention in care, and viral suppression by 12 months. Multivariable regression models were used to assess factors predictive of attaining HIV care continuum outcomes. RESULTS Participants randomized to DIS were more likely to be re-engaged at 90 days (adjusted odds ratios [aOR] = 1.42, P = 0.045). Independent predictors of re-engagement at 90 days were age older than 40 years (aOR = 1.84, P = 0.012) and perinatal HIV risk category (aOR = 3.19, P = 0.030). Predictors of retention at 12 months included re-engagement at 90 days (aOR = 10.31, P < 0.001), drug injection HIV risk category (aOR = 1.83, P = 0.032), detectable HIV-1 RNA before randomization (aOR = 0.40, P = 0.003), and county (Hartford aOR = 1.74, P = 0.049; New Haven aOR = 1.80, P = 0.030). Predictors of viral suppression included re-engagement at 90 days (aOR = 2.85, P < 0.001), retention in HIV care (aOR = 7.07, P < 0.001), and detectable HIV-1 RNA prerandomization (aOR = 0.23, P < 0.001). CONCLUSIONS A D2C strategy significantly improved re-engagement at 90 days. Early re-engagement improved downstream benefits along the HIV care continuum like retention in care and viral suppression at 12 months. Moreover, other factors predictive of care continuum outcomes can be used to improve D2C strategies.
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Affiliation(s)
- Eteri Machavariani
- Department of Internal Medicine, Section of Infectious Disease, HIV/AIDS Program, Yale University School of Medicine, New Haven, CT, USA
| | - Janet Miceli
- Department of Internal Medicine, Section of Infectious Disease, HIV/AIDS Program, Yale University School of Medicine, New Haven, CT, USA
| | - Frederick L. Altice
- Department of Internal Medicine, Section of Infectious Disease, HIV/AIDS Program, Yale University School of Medicine, New Haven, CT, USA
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | | | - Suzanne Speers
- Connecticut Department of Public Health, Hartford, CT, USA
| | - Lisa Nichols
- Department of Internal Medicine, Section of Infectious Disease, HIV/AIDS Program, Yale University School of Medicine, New Haven, CT, USA
| | - Heidi Jenkins
- Connecticut Department of Public Health, Hartford, CT, USA
| | - Merceditas Villanueva
- Department of Internal Medicine, Section of Infectious Disease, HIV/AIDS Program, Yale University School of Medicine, New Haven, CT, USA
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Ahmad A, Bromberg DJ, Shrestha R, Salleh NM, Bazazi AR, Kamarulzaman A, Shenoi S, Altice FL. Higher methadone dose at time of release from prison predicts linkage to maintenance treatment for people with HIV and opioid use disorder transitioning to the community in Malaysia. Int J Drug Policy 2024; 126:104369. [PMID: 38484531 PMCID: PMC11056294 DOI: 10.1016/j.drugpo.2024.104369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 02/14/2024] [Accepted: 02/22/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Incarcerated people with HIV and opioid-dependence often experience poor post-release outcomes in the absence of methadone maintenance treatment (MMT). In a prospective trial, we assessed the impact of methadone dose achieved within prison on linkage to MMT after release. METHODS From 2010 to 2014, men with HIV (N = 212) and opioid dependence before incarceration were enrolled in MMT within 6 months of release from Malaysia's largest prison and followed for 12-months post-release. As a prospective trial, allocation to MMT was at random and later by preference design (predictive nonetheless). MMT dosing was individually targeted to minimally achieve 80 mg/day. Time-to-event analyses were conducted to model linkage to MMT after release. FINDINGS Of the 212 participants allocated to MMT, 98 (46 %) were prescribed higher dosages (≥80 mg/day) before release. Linkage to MMT after release occurred in 77 (36 %) participants and significantly higher for those prescribed higher dosages (46% vs 28 %; p = 0.011). Factors associated with higher MMT dosages were being married, on antiretroviral therapy, longer incarceration periods, having higher levels of depression, and methadone preference compared to randomization. After controlling for other variables, being prescribed higher methadone dosage (aHR: 2.53, 95 %CI: 1.42-4.49) was the only independent predictor of linkage to methadone after release. INTERPRETATION Higher doses of methadone prescribed before release increased the likelihood of linkage to MMT after release. Methadone dosing should be introduced into international guidelines for treatment of opioid use disorder in prisons and further post-release benefits should be explored. FUNDING National Institute of Drug Abuse (NIDA).
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Affiliation(s)
- Ahsan Ahmad
- Yale University School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Daniel J Bromberg
- Yale University School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; Yale University School of Public Health, Department of Social and Behavioral Sciences, New Haven, CT, USA
| | - Roman Shrestha
- University of Connecticut, Department of Allied Health Sciences, Storrs, CT, USA
| | - Na Mohd Salleh
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; University of Malaya, Faculty of Medicine, Department of Social and Preventive Medicine, Kuala Lumpur, Malaysia
| | - Alexander R Bazazi
- Yale University School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | - Adeeba Kamarulzaman
- Yale University School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; University of Malaya, Faculty of Medicine, Department of Social and Preventive Medicine, Kuala Lumpur, Malaysia
| | - Sheela Shenoi
- Yale University School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Frederick L Altice
- Yale University School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Yale University School of Public Health, Department Epidemiology of Microbial Diseases, New Haven, CT, USA.
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Bromberg DJ, Machavariani E, Madden LM, Dumchev K, LaMonaca K, Earnshaw VA, Pykalo I, Filippovych M, Haddad MS, Dvoriak S, Altice FL. Integrating methadone into primary care settings in Ukraine: effects on provider stigma and knowledge. J Int AIDS Soc 2024; 27:e26202. [PMID: 38379179 PMCID: PMC10879646 DOI: 10.1002/jia2.26202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 12/08/2023] [Indexed: 02/22/2024] Open
Abstract
INTRODUCTION Stigma has undermined the scale-up of evidence-based HIV prevention and treatment. Negative beliefs influence clinicians' discriminatory behaviour and ultimately have wide-ranging effects across the HIV prevention and treatment continuum. Stigma among clinicians can be mitigated in several ways, including through interpersonal contact. In this study, we test whether interactions with people who inject drugs (PWID) influence attitudes of both direct and indirect providers of opioid agonist therapies (OATs) within the same primary care clinics (PCCs) where OAT is newly introduced. METHODS In a cluster randomized controlled trial integrating OAT and HIV care into PCCs in Ukraine, clinicians at 24 integrated care sites (two sites in 12 regions) from January 2018 to August 2022 completed a structured survey at baseline, 12 and 24 months. The survey included feeling thermometers and standardized scales related to clinician attitudes towards patients and evidence-based care. Nested linear mixed-effects models were used to examine changes in mean scores over three timepoints for both direct and indirect clinicians. RESULTS There were fewer significant changes in any of the scales for direct providers (n = 87) than for indirect providers (n = 155). Direct providers became less tough-minded about substance use disorders (p = 0.002), had less negative opinions about PWID (p = 0.006) and improved their beliefs regarding OAT maintenance (p<0.001) and medical information (p = 0.004). Indirect providers reported improvements in most stigma constructs, including a significant decrease in prejudice (p<0.001), discrimination (p = 0.001), shame (p = 0.007) and fear (p = 0.001) towards PWID. CONCLUSIONS Integrating OAT services within primary settings was associated with significantly reduced stigma constructs and improved attitudes towards PWID, possibly through increased intergroup contact between PWID and general clinical staff. Unlike most stigma reduction interventions, re-engineering clinical processes so that PWID receive their care in PCCs emerges as a multilevel stigma reduction intervention through the integration of specialized services in PCCs. Integration influences different types of stigma, and has positive effects not only on health outcomes, but also improves clinician attitudes and efficiently reduces clinician stigma.
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Affiliation(s)
- Daniel J. Bromberg
- Yale School of Public Health, Yale UniversityNew HavenConnecticutUSA
- Center for Interdisciplinary Research on AIDS, Yale UniversityNew HavenConnecticutUSA
- Yale School of Medicine, Yale UniversityNew HavenConnecticutUSA
| | | | - Lynn M. Madden
- Yale School of Medicine, Yale UniversityNew HavenConnecticutUSA
- APT FoundationNew HavenConnecticutUSA
| | | | | | | | - Iryna Pykalo
- Ukrainian Institute on Public Health PolicyKyivUkraine
| | | | - Marwan S. Haddad
- Center for Key Populations, Community Health Center, Inc.MiddletownConnecticutUSA
| | | | - Frederick L. Altice
- Yale School of Public Health, Yale UniversityNew HavenConnecticutUSA
- Center for Interdisciplinary Research on AIDS, Yale UniversityNew HavenConnecticutUSA
- Yale School of Medicine, Yale UniversityNew HavenConnecticutUSA
- University of DelawareNewarkDelawareUSA
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Pitpitan EV, Wiginton JM, Bejarano-Romero R, Baker DA. Promoting HIV care continuum outcomes among people who use drugs and alcohol: a systematic review of randomized trials evaluating behavioral HIV care interventions published from 2011 to 2023. BMC Public Health 2023; 23:2182. [PMID: 37936103 PMCID: PMC10629072 DOI: 10.1186/s12889-023-17113-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 10/30/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Substance use remains a robust predictor of HIV infection and a serious impediment to HIV care continuum progression for people living with HIV. The primary research question of this systematic review is focused on understanding the extent to which behavioral HIV care interventions have been efficacious in helping people who live with HIV and who use substances along the HIV care continuum. METHODS Using PubMed and ProQuest databases, we performed a systematic review of randomized trials of behavioral HIV care continuum interventions among people who use substances published from 2011 to August 2023, since the beginning of the treatment-as-prevention era. RESULTS We identified 11 studies (total participants: N = 5635), ten intentionally targeting substance-using populations. Four studies involved samples using ≥ 1 substance (e.g., alcohol, opioids, stimulants, marijuana); four involved injection drug use; one involved methamphetamine use; and one involved alcohol use. One study targeted a population with incidental substance use (i.e., alcohol, injection drug use, non-injection drug use reported in most participants). Each study defined one or more HIV care outcomes of interest. Viral suppression was an outcome targeted in 9/11 studies, followed by uptake of antiretroviral therapy (ART; 7/11), ART adherence (6/11), retention in care (5/11), and linkage to care (3/11). While most (nine) of the studies found significant effects on at least one HIV care outcome, findings were mostly mixed. Mediated (2/11) and moderated (2/11) effects were minimally examined. CONCLUSIONS The results from this systematic review demonstrate mixed findings concerning the efficacy of previous HIV care interventions to improve HIV care continuum outcomes among people who use substances. However, heterogeneity of study components (e.g., diversity of substances used/assessed, self-report vs. objective measures, attrition) prevent broad deductions or conclusions about the amenability of specific substance-using populations to HIV care intervention. More coordinated, comprehensive, and targeted efforts are needed to promote and disentangle intervention effects on HIV care continuum outcomes among substance-using populations.
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Affiliation(s)
- Eileen V Pitpitan
- School of Social Work, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182-4119, USA.
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
| | - John Mark Wiginton
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Raul Bejarano-Romero
- San Diego State University, University of California-San Diego Joint Doctoral Program in Interdisciplinary Research on Substance Use, San Diego, CA, USA
| | - Dania Abu Baker
- San Diego State University, University of California-San Diego Joint Doctoral Program in Interdisciplinary Research on Substance Use, San Diego, CA, USA
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Shukla L, Shivaprakash P, Kumar MS. HIV, hepatitis B & C in people who inject drugs in India: A systematic review of regional heterogeneity & overview of opioid substitution treatment. Indian J Med Res 2023; 158:522-534. [PMID: 38265946 PMCID: PMC10878493 DOI: 10.4103/ijmr.ijmr_1930_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND OBJECTIVES This systematic review evaluates the human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV) burden among people who inject drugs (PWIDs) in India. In addition, we selectively examined research on opioid substitution treatment (OST)-related services due to their role in antiviral treatment uptake and adherence. METHODS Data were sourced from peer-reviewed and government publications between 1991 and September 20, 2023, searched in MEDLINE, Scopus and EBSCOhost. English language studies reporting weighted prevalence or raw numbers and recruitment sites were included for review. Quality was assessed using the Joanna Briggs Institute tool. Data synthesis was done in graphs and tables. RESULTS We included 50 reports, yielding 150 HIV, 68 HCV and 24 HBV prevalence estimates across India, revealing significant regional heterogeneity. Notably, 16 States had a single community-based HIV estimate, and 19 States had limited or no HCV data. The highest HIV and HCV prevalence was in Manipur (74.7% and 97.5%, respectively) in 1996. Recent spikes included 50.2 per cent HIV prevalence in Punjab (2010) and 73 per cent HCV in Uttar Pradesh (2021). Nationally, OST coverage in 2020 was under five per cent, with some northeast, north and central States exceeding this, but most others were falling below two per cent. No studies on the cost-effectiveness of directly observed treatment models for OST were identified. INTERPRETATION CONCLUSIONS There is a lack of sufficiently granular and generalizable estimates for HIV prevalence and any estimates for HCV and HBV among PWIDs in large parts of the country. Community-based representative studies are required to quantify the prevalence and severity of these diseases and allocate resources.
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Affiliation(s)
- Lekhansh Shukla
- Department of Psychiatry, Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Prakrithi Shivaprakash
- Department of Psychiatry, Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - M. Suresh Kumar
- Schizophrenia Research Foundation (SCARF), Chennai, Tamil Nadu, India
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Brizzi M, Green SB. Rationale, evidence, and steps for implementation of medication for opioid use disorder treatment programs in HIV primary care settings. AIDS Care 2023; 35:1760-1767. [PMID: 37039558 DOI: 10.1080/09540121.2023.2185587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/13/2023] [Indexed: 04/12/2023]
Abstract
As the opioid crisis continues to escalate, the management of patients with opioid use disorder has crossed over to the care of patients with chronic infectious diseases, specifically HIV, HBV, and HCV, typically managed in the primary care setting. Consensus guidelines recommend testing for HIV and hepatitis in persons who inject drugs at least annually, but high-risk sexual activity may put other patients at risk as well. Significant barriers to robust care of these patient populations include low rates of HIV and hepatitis testing, limited access to methadone treatment programs, lack of widespread knowledge of how to prescribe office-based opioid treatment, and ongoing stigma surrounding prescribing of HIV treatment and prophylaxis medications. Clinical pharmacists across ambulatory, infectious diseases, and opioid stewardship specialties have the opportunity to play a key role in the implementation and support of harm reduction and medication for opioid use disorder services in the outpatient setting. The goal of this article is to discuss the rationale and evidence for these services and provide a framework for implementation.
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Affiliation(s)
- Marisa Brizzi
- Department of Pharmacy, University of Cincinnati Health, Pharmacy, Cincinnati, OH, USA
| | - Sarah B Green
- Department of Pharmacy, Emory Healthcare, Pharmacy, Atlanta, GA, USA
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Muthulingam D, Hassett TC, Madden LM, Bromberg DJ, Fraenkel L, Altice FL. Preferences in medications for patients seeking treatment for opioid use disorder: A conjoint analysis. J Subst Use Addict Treat 2023; 154:209138. [PMID: 37544510 DOI: 10.1016/j.josat.2023.209138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 07/05/2023] [Accepted: 07/31/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION The opioid epidemic continues to be a public health crisis that has worsened during the COVID-19 pandemic. Medications for opioid use disorder (MOUD) are the most effective way to reduce complications from opioid use disorder (OUD), but uptake is limited by both structural and individual factors. To inform strategies addressing individual factors, we evaluated patients' preferences and trade-offs in treatment decisions using conjoint analysis. METHOD We developed a conjoint analysis survey evaluating patients' preferences for FDA-approved MOUDs. We recruited patients with OUD presenting to initiate treatment. This survey included five attributes: induction, location and route of administration, impact on mortality, side effects, and withdrawal symptoms with cessation. Participants performed 12 choice sets, each with two hypothetical profiles and a "none" option. We used Hierarchical Bayes to identify relative importance of each attribute and part-worth utility scores of levels, which we compared using chi-squared analysis. We used the STROBE checklist to guide our reporting of this cross-sectional observational study. RESULTS Five-hundred and thirty participants completed the study. Location with route of administration was the most important attribute. Symptom relief during induction and withdrawal was a second priority. Mortality followed by side effects had lowest relative importance. Attribute levels with highest part-worth utilities showed patients preferred monthly pick-up from a pharmacy rather than daily supervised dosing; and oral medications more than injection/implants, despite the latter's infrequency. CONCLUSION We measured treatment preferences among patients seeking to initiate OUD treatment to inform strategies to scale MOUD treatment uptake. Patients prioritize the route of administration in treatment preference-less frequent pick up, but also injections and implants were less preferred despite their convenience. Second, patients prioritize symptom relief during the induction and withdrawal procedures of medication. These transition periods influence the sustainability of treatment. Although health professionals prioritize mortality, it did not drive decision-making for patients. To our knowledge, this is the largest study on patients' preferences for MOUD among treatment-seeking people with OUD to date. Future analysis will evaluate patient preference heterogeneity to further target program planning, counseling, and decision aid development.
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Affiliation(s)
- Dharushana Muthulingam
- Washington University School of Medicine, Division of Infectious Disease, 4523 Clayton Ave., CB 8051, St. Louis, MO, 63110, United States of America.
| | - Thomas C Hassett
- Yale School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, United States of America
| | - Lynn M Madden
- Yale School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, United States of America; APT Foundation, New Haven, CT, United States of America
| | - Daniel J Bromberg
- Yale School of Public Health, New Haven, CT, United States of America
| | - Liana Fraenkel
- Yale School of Medicine, Section of Rheumatology, New Haven, CT, United States of America
| | - Frederick L Altice
- Yale School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, United States of America; APT Foundation, New Haven, CT, United States of America; Yale School of Public Health, New Haven, CT, United States of America; University of Malaya, Kuala Lumpur, Malaysia
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Falade-Nwulia O, Agee T, Kelly SM, Park JN, Schwartz S, Hsu J, Schweizer N, Jones J, Keruly J, Shah N, Lesko CR, Lucas GM, Sulkowski M. Implementing a peer-supported, integrated strategy for substance use disorder care in an outpatient infectious disease clinic is associated with improved patient outcomes. Int J Drug Policy 2023; 121:104191. [PMID: 37740989 PMCID: PMC10844957 DOI: 10.1016/j.drugpo.2023.104191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/14/2023] [Accepted: 09/01/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Substance use disorder (SUD) and infectious disease (ID) care integration may lead to improvements in SUD and ID outcomes. We assessed implementation of integrating peer-supported SUD care in an outpatient ID setting. METHODS In this implementation study, we describe REcovery in Specialty care Through medication and OutREach (RESTORE), a low-threshold SUD program implemented in a Baltimore outpatient ID clinic. Key program components were clinician training and support in SUD care, prescription of SUD treatment medications, and peer-based psychosocial support provided by peer recovery specialists. We assessed clinician adoption of RESTORE and compared patient outcomes from baseline to 6 months. RESULTS Between January 2019 and January 2022, the number of ID clinicians (N=61) who prescribed buprenorphine increased eightfold from 3 (5%) to 24 (39%). Of 258 ID patients referred to RESTORE, 182 (71%) engaged, 137 consented to study participation. Mean age in the study sample was 52.1 (SD=10.4), 63% were male, 84% were Black/African-American. Among 127 (93%) who completed 6-month follow-up, fewer participants reported illicit/non-prescribed opioid use in the past 30 days at follow-up (32%) compared to baseline (52%; p<0.001). Similar reductions were noted for cocaine use (47% to 34%; p=0.006), emergency department visits (23% to 9%; p=0.002), and inpatient hospitalizations (15% to 7%; p=0.025). CONCLUSION SUD care integration into an outpatient ID care setting using a peer-supported implementation strategy was adopted by clinicians and improved clinical outcomes for patients. This strategy is a promising approach to treating people with infectious diseases and SUD.
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Affiliation(s)
- Oluwaseun Falade-Nwulia
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Baltimore, MD 21224.
| | - Tracy Agee
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Baltimore, MD 21224
| | - Sharon M Kelly
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Baltimore, MD 21224
| | - Ju Nyeong Park
- Division of General Internal Medicine, Warren Alpert Medical School, Brown University, 1125 N. Main St, Providence, RI 02904
| | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205
| | - Jeffrey Hsu
- Department of Psychiatry, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287
| | - Nicholas Schweizer
- Department of Psychiatry, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287
| | - Joyce Jones
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Baltimore, MD 21224
| | - Jeanne Keruly
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Baltimore, MD 21224
| | - Nishant Shah
- Department of Family and Community Medicine, University of Maryland, 29 South Paca St, Baltimore, MD 21201
| | - Catherine R Lesko
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205
| | - Gregory M Lucas
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Baltimore, MD 21224
| | - Mark Sulkowski
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Baltimore, MD 21224
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Langdon KJ, Hitch AE, Collins AB, Beckwith CG, Becker S, Tashima K, Rich JD. Integrating long-acting injectable treatment to improve medication adherence among persons living with HIV and opioid use disorder: study protocol. Addict Sci Clin Pract 2023; 18:60. [PMID: 37838707 PMCID: PMC10576282 DOI: 10.1186/s13722-023-00418-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/09/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND Oral antiretroviral therapy (ART) has been effective at reducing mortality rates of people with HIV. However, despite its effectiveness, people who use drugs face barriers to maintaining ART adherence. Receipt of opioid agonist treatment, in the context of HIV care, is associated with medication adherence and decreased HIV viral loads. Recent pharmacological advancements have led to the development of novel long-acting, injectable, medications for both HIV (cabotegravir co-administered with rilpivirine) and OUD (extended-release buprenorphine). These therapies have the potential to dramatically improve adherence by eliminating the need for daily pill-taking. Despite the extensive evidence base supporting long-acting injectable medications for both HIV and OUD, and clinical guidelines supporting integrated care provision, currently little is known about how these medications may be optimally delivered to this population. This paper presents the study design for the development of a clinical protocol to guide the delivery of combined treatment for HIV and OUD using long-acting injectable medications. METHODS The study aims are to: (1) develop a clinical protocol to guide the delivery of combined LAI for HIV and OUD by conducting in-depth interviews with prospective patients, clinical content experts, and other key stakeholders; and (2) conduct This single group, open pilot trial protocol to assess feasibility, acceptability, and safety among patients diagnosed with HIV and OUD. Throughout all phases of the study, information on patient-, provider-, and organizational-level variables will be collected to inform future implementation. DISCUSSION Findings from this study will inform the development of a future study to conduct a fully-powered Hybrid Type 1 Effectiveness-Implementation design.
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Affiliation(s)
- Kirsten J Langdon
- Department of Psychiatry, Rhode Island Hospital, 139 Point Street, Providence, RI, 02903, USA.
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, USA.
- Brown-Lifespan Center for Digital Health, Providence, USA.
| | - Anthony E Hitch
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, USA
- Department of Psychology, University of Cincinnati, Cincinnati, USA
| | - Alexandra B Collins
- Department of Epidemiology, Brown University School of Public Health, Providence, USA
| | - Curt G Beckwith
- Department of Medicine, Division of Infectious Diseases, Brown University and The Miriam and Rhode Island Hospitals, Providence, USA
| | - Sara Becker
- Center for Dissemination and Implementation Science, Northwestern University, Evanston, USA
| | - Karen Tashima
- Department of Medicine, Division of Infectious Diseases, Brown University and The Miriam and Rhode Island Hospitals, Providence, USA
| | - Josiah D Rich
- Department of Epidemiology, Brown University School of Public Health, Providence, USA
- Department of Medicine, Division of Infectious Diseases, Brown University and The Miriam and Rhode Island Hospitals, Providence, USA
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Narayan A, Salindri AD, Keshavjee S, Muyoyeta M, Velen K, Rueda ZV, Croda J, Charalambous S, García-Basteiro AL, Shenoi SV, Gonçalves CCM, Ferreira da Silva L, Possuelo LG, Aguirre S, Estigarribia G, Sequera G, Grandjean L, Telisinghe L, Herce ME, Dockhorn F, Altice FL, Andrews JR. Prioritizing persons deprived of liberty in global guidelines for tuberculosis preventive treatment. PLoS Med 2023; 20:e1004288. [PMID: 37788448 PMCID: PMC10547494 DOI: 10.1371/journal.pmed.1004288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
In this Policy Forum piece, Aditya Narayan and colleagues discuss the challenges and opportunities for tuberculosis preventive treatment in carceral settings.
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Affiliation(s)
- Aditya Narayan
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Argita D. Salindri
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Salmaan Keshavjee
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Monde Muyoyeta
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Kavindhran Velen
- Implementation Division, The Aurum Institute, Johannesburg, South Africa
| | - Zulma V. Rueda
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Research Department, School of Medicine, Universidad Pontificia Bolivariana, Medellin, Colombia
| | - Julio Croda
- School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
- Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, United States of America
- Oswaldo Cruz Foundation, Campo Grande, Brazil
| | - Salome Charalambous
- Implementation Division, The Aurum Institute, Johannesburg, South Africa
- Wits School of Public Health, Johannesburg, South Africa
| | - Alberto L. García-Basteiro
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Manhiça Health Research Center, Maputo, Mozambique
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Barcelona, Spain
| | - Sheela V. Shenoi
- Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, United States of America
| | | | | | - Lia G. Possuelo
- Department of Life Sciences, Santa Cruz do Sul University, Santa Cruz do Sul, Brazil
| | - Sarita Aguirre
- National Tuberculosis Control Program, Ministry of Public Health and Social Welfare (MSPyBS), Asunción, Paraguay
| | | | - Guillermo Sequera
- Department of Public Health, Facultad de Ciencias Médicas, Universidad Nacional de Asunción, Asunción, Paraguay
| | - Louis Grandjean
- Department of Infection, Immunity and Inflammation, Institute of Child Health, University College London, London, United Kingdom
| | - Lily Telisinghe
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michael E. Herce
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Fernanda Dockhorn
- Ministry of Health, Health and Environmental Surveillance Secretariat, General Coordination for Tuberculosis, Endemic Mycoses and Non-Tuberculous Mycobacteria Surveillance, Brasília, (DF) Brazil
| | - Frederick L. Altice
- Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Jason R. Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, United States of America
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Wheatley MM, Peterson AD, Wolfson J, Hanft J, Rowles D, Blissett T, Enns EA. Variation in local Ryan White HIV/AIDS program service use and impacts on viral suppression: informing quality improvement efforts. AIDS Care 2023; 35:1526-1533. [PMID: 36161988 DOI: 10.1080/09540121.2022.2126960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/16/2022] [Indexed: 10/14/2022]
Abstract
The U.S. Ryan White HIV/AIDS Program (RWHAP) funds comprehensive services for people living with HIV to support viral suppression (VS). We analyzed five years of RWHAP data from the Minneapolis-St. Paul region to (1) assess variation and (2) evaluate the causal effect of each RWHAP service on sustained VS by race/ethnicity. Sixteen medical and support services were included. Descriptive analyses assessed service use and trends over time. Causal analyses used generalized estimating equations and propensity scores to adjust for the probability of service use. Receipt of AIDS Drug Assistance Program and financial aid consistently showed higher probabilities of sustained VS, while food aid and transportation aid had positive impacts on VS at higher levels of service encounters; however, the impact of services could vary by race/ethnicity. For example, financial aid increased the probability of sustained VS by at least 3 percentage points for white, Hispanic and Black/African American clients, but only 1.6 points for Black/African-born clients. This study found that services addressing socioeconomic needs typically had positive impacts on viral suppression, yet service use and impact of services often varied by race/ethnicity. This highlights a need to ensure these services are designed and delivered in ways that equitably serve all clients.
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Affiliation(s)
- Margo M Wheatley
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | | | - Julian Wolfson
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | | | - Darin Rowles
- Minnesota Department of Human Services, St. Paul, MN, USA
| | | | - Eva A Enns
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
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Samet JH, Blokhina E, Cheng DM, Rosen S, Lioznov D, Lunze K, Truong V, Gnatienko N, Quinn E, Bushara N, Raj A, Krupitsky E. Rapid access to antiretroviral therapy, receipt of naltrexone, and strengths-based case management versus standard of care for HIV viral load suppression in people with HIV who inject drugs in Russia (LINC-II): an open-label, randomised controlled trial. Lancet HIV 2023; 10:e578-e587. [PMID: 37659841 PMCID: PMC10653654 DOI: 10.1016/s2352-3018(23)00143-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Antiretroviral therapy (ART) coverage in Russia is low for people with HIV who inject drugs. HIV and addiction treatment in Russia are not well integrated. We aimed to evaluate an intervention to link people with HIV in addiction treatment to HIV care to achieve HIV viral load suppression. METHODS LINC-II was a two-arm, open-label, randomised controlled trial at the City Addiction Hospital, Saint Petersburg, Russia. Eligible participants were aged 18 years or older, had a positive HIV status, were not currently on ART, were admitted to a narcology hospital, and had a current diagnosis of opioid use disorder. Participants were randomly assigned (1:1) to a multicomponent intervention (ie, rapid access to ART, naltrexone for opioid use disorder, and strengths-based case management) or standard of care. Blocked randomisation was stratified by history of ART use. The primary outcome was undetectable HIV viral load at 12 months, defined as less than 40 copies per mL. The trial was conducted and analysed according to the intention-to-treat principle. This trial is registered with ClinicalTrials.gov, NCT03290391. FINDINGS Between Sept 19, 2018, and Dec 25, 2020, 953 individuals were screened for eligibility, 225 of whom were randomly assigned to the intervention (n=111) or standard of care (n=114). 136 (60%) participants were male and 89 (40%) were female. Participants in the intervention group had higher odds of HIV viral load suppression at 12 months compared with participants in the standard-of-care group (52 [47%] vs 26 [23%]; adjusted odds ratio 3·0 [95% CI 1·4-6·4]; p=0·0039). 21 adverse events (18 in the intervention group and three in the standard-of-care group)and 14 deaths (four in the intervention group and ten in the standard-of-care group) were reported in the study. INTERPRETATION Given the effectiveness of the LINC-II intervention, scaling up this model could be one strategy to advance the UNAIDS goal of ending the HIV epidemic. FUNDING National Institute on Drug Abuse and Providence/Boston Center for AIDS Research.
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Affiliation(s)
- Jeffrey H Samet
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, MA, USA.
| | - Elena Blokhina
- First Pavlov State Medical University of St Petersburg, Saint Petersburg, Russia
| | - Debbie M Cheng
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Sydney Rosen
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Dmitry Lioznov
- First Pavlov State Medical University of St Petersburg, Saint Petersburg, Russia
| | - Karsten Lunze
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Ve Truong
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Natalia Gnatienko
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Emily Quinn
- The Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Natalia Bushara
- First Pavlov State Medical University of St Petersburg, Saint Petersburg, Russia
| | - Anita Raj
- Center on Gender Equity and Health, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Evgeny Krupitsky
- Bekhterev National Medical Research Center for Psychiatry and Neurology, Saint Petersburg, Russia
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Rudolph JE, Cepeda JA, Astemborski J, Kirk GD, Mehta SH, Genberg BL. Trajectories of drug treatment and illicit opioid use in the AIDS Linked to the IntraVenous Experience cohort, 2014-2019. Int J Drug Policy 2023; 118:104120. [PMID: 37429162 PMCID: PMC10528295 DOI: 10.1016/j.drugpo.2023.104120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/29/2023] [Accepted: 07/01/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Medication for opioid use disorder (MOUD) is an effective intervention to combat opioid use disorder and overdose, yet there is limited understanding of engagement in treatment over time in the community, contextualized by ongoing substance use. We aimed to identify concurrent trajectories of methadone prescriptions, buprenorphine prescriptions, and illicit opioid use among older adults with a history of injection drug use. METHODS We used data on 887 participants from the AIDS Linked to the IntraVenous Experience cohort, who were engaged in the study in 2013 and attended ≥1 visit during follow-up (2014-2019). Outcomes were self-reported MOUD prescription and illicit opioid use in the last 6 months. To identify concurrent trajectories in all 3 outcomes, we used group-based multi-trajectory modeling. We examined participant characteristics, including sociodemographics, HIV status, and other substance use, overall and by cluster. RESULTS We identified 4 trajectory clusters: (1) no MOUD and no illicit opioid use (43%); (2) buprenorphine and some illicit opioid use (11%); (3) methadone and no illicit opioid use (28%); and (4) some methadone and illicit opioid use (18%). While prevalence of each outcome was stable across time, transitions on/off treatment or on/off illicit opioid use occurred, with the rate of transition varying by cluster. The rate of transition was highest in Cluster 3 (0.74/person-year) and lowest in Cluster 1 (0.18/person-year). We saw differences in participant characteristics by cluster, including that the buprenorphine cluster had the highest proportion of people with HIV and participants who identified as non-Hispanic Black. CONCLUSIONS Most participants had discontinued illicit opioid use and were also not accessing MOUD. Trajectories defined by engagement with buprenorphine or methadone had distinct sociodemographic and behavioral characteristics, indicating that tailored interventions to expand access to both types of treatment are likely needed to reduce harms associated with untreated opioid use disorder.
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Affiliation(s)
- Jacqueline E Rudolph
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Javier A Cepeda
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jacquie Astemborski
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Gregory D Kirk
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Shruti H Mehta
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Becky L Genberg
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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15
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Ardman E, Brown PC, Thuy DTT, Hang NT, Mai PP, Bart G, Hoffman K, Korthuis PT, Giang LM. Patient-provider relationships: Opioid use disorder and HIV treatment in Vietnam. Drug and Alcohol Dependence Reports 2023; 7:100151. [PMID: 37082138 PMCID: PMC10111938 DOI: 10.1016/j.dadr.2023.100151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 03/08/2023] [Accepted: 03/23/2023] [Indexed: 04/04/2023]
Abstract
Background The provider-patient relationship has been implicated as a positive force in health outcomes. This study examined the provider-patient relationship in the setting of integrated, partially-integrated, and non-integrated opioid use disorder (OUD) and HIV care models in Vietnam. Objective To examine the provider-patient relationship in the setting of integrated, partially integrated, and non-integrated OUD and HIV treatment in North Vietnam. Methods Between 2013 and 2018, we conducted face-to-face qualitative interviews with 44 patients living with HIV and OUD and 43 providers in northern Vietnam. These were analyzed using a semantic, inductive approach to qualitative thematic analysis. Results Several themes were identified. 1) Trust was important to the patient-provider relationship and sensitive to provider attitudes and competence. 2) Patients perceived greater provider competence and understanding of patient health problems in integrated treatment. 3) Patient-provider relationships were initially superficial but deepened over time, facilitated by continuity of care. Conclusions Patient perceptions of competence and respect were important to feeling cared for. Providers felt empathy and competence came with more experience caring for patients with OUD and HIV.
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Affiliation(s)
- Eric Ardman
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
- Corresponding author.
| | - Patrick C.M. Brown
- Oregon Health & Science University School of Medicine, Portland, Oregon, USA
| | - Dinh Thi Thanh Thuy
- Center for Training and Research on Substance Abuse – HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Nguyen Thu Hang
- Center for Training and Research on Substance Abuse – HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Pham Phuong Mai
- Center for Training and Research on Substance Abuse – HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Gavin Bart
- University of Minnesota and Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Kim Hoffman
- Portland State University-Oregon Health & Science University School of Public Health, Portland, Oregon, USA
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - P Todd Korthuis
- Portland State University-Oregon Health & Science University School of Public Health, Portland, Oregon, USA
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Le Minh Giang
- Center for Training and Research on Substance Abuse – HIV, Hanoi Medical University, Hanoi, Vietnam
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Stone J, Trickey A, Walker JG, Bivegete S, Semchuk N, Sazonova Y, Varetska O, Altice FL, Saliuk T, Vickerman P. Modelling the impact and cost-effectiveness of non-governmental organizations on HIV and HCV transmission among people who inject drugs in Ukraine. J Int AIDS Soc 2023; 26:e26073. [PMID: 37012669 PMCID: PMC10070931 DOI: 10.1002/jia2.26073] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 02/23/2023] [Indexed: 04/05/2023] Open
Abstract
INTRODUCTION People who inject drugs (PWID) in Ukraine have high prevalences of HIV and hepatitis C virus (HCV). Non-governmental organizations (NGOs) provide PWID with needles/syringes, condoms, HIV/HCV testing and linkage to opioid agonist treatment (OAT) and antiretroviral therapy (ART). We estimated their impact and cost-effectiveness among PWID. METHODS A dynamic HIV and HCV transmission model among PWID was calibrated using data from four national PWID surveys (2011-2017). The model assumed 37-49% coverage of NGOs among community PWID, with NGO contact reducing injecting risk and increasing condom use and recruitment onto OAT and ART. We estimated the historic (1997-2021) and future (2022-2030, compared to no NGO activities from 2022) impact of NGOs in terms of the proportion of HIV/HCV infections averted and changes in HIV/HCV incidence. We estimated the future impact of scaling-up NGOs to 80% coverage with/without scale-up in OAT (5-20%) and ART (64-81%). We estimated the cost per disability-adjusted life-year (DALY) averted of current NGO provision over 2022-2041 compared to NGO activities stopping over 2022-2026, but restarting after that till 2041. We assumed average unit costs of US$80-90 per person-year of NGO contact for PWID. RESULTS With existing coverage levels of NGOs, the model projects that NGOs have averted 20.0% (95% credibility interval: 13.3-26.1) and 9.6% (5.1-14.1) of new HIV and HCV infections among PWID over 1997-2021, respectively, and will avert 31.8% (19.6-39.9) and 13.7% (7.5-18.1) of HIV and HCV infections over 2022-2030. With NGO scale-up, HIV and HCV incidence will decrease by 54.2% (43.3-63.8) and 30.2% (20.5-36.2) over 2022-2030, or 86.7% (82.9-89.3) and 39.8% (31.4-44.8) if OAT and ART are also scaled-up. Without NGOs, HIV and HCV incidence will increase by 51.6% (23.6-76.3) and 13.4% (4.8-21.9) over 2022-2030. Current NGO provision over 2022-2026 will avert 102,736 (77,611-137,512) DALYs when tracked until 2041 (discounted 3% annually), and cost US$912 (702-1222) per DALY averted; cost-effective at a willingness-to-pay threshold of US$1548/DALY averted (0.5xGDP). CONCLUSIONS NGO activities have a crucial preventative impact among PWID in Ukraine which should be scaled-up to help achieve HIV and HCV elimination. Disruptions could have a substantial detrimental impact.
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Affiliation(s)
- Jack Stone
- Population Health SciencesUniversity of BristolBristolUK
| | - Adam Trickey
- Population Health SciencesUniversity of BristolBristolUK
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Ghalekhani N, Mirzazadeh A, Tavakoli F, Mousavian G, Khezri M, Zamani O, Mehmandoost S, Haghdoost AA, Sharifi H. HIV Continuum of Care Among People Who Inject Drugs in Iran: A Cross-sectional Study. J Assoc Nurses AIDS Care 2023; 34:182-187. [PMID: 36728048 DOI: 10.1097/jnc.0000000000000391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
ABSTRACT People living with HIV who inject drugs may have lower access to treatment services. We aimed to assess the HIV continuum of care among people who inject drugs (PWID) in Iran. Data were collected from 2,663 PWID who were recruited via respondent-driven sampling from 11 cities of Iran between June 2019 and March 2020. Participants who tested positive for HIV infection were asked questions to calculate the status of HIV cascade of care. Of 95 PWID living with HIV, 67% were aware of their HIV status, 57% were linked to care service and initiated ART, 49% retained on ART, and only 15% had viral load less than 1,000 copies/ml. About half of the PWID diagnosed with HIV ever started ART and less than one in six were virally suppressed. Strategies to improve linkage to ART programs and ART retention may improve HIV care outcomes among PWID in Iran.
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Affiliation(s)
- Nima Ghalekhani
- Nima Ghalekhani, PhD, is a Research vice chancellor of 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, PhD, is an Assistant Professor of Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA, and 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, MSc, is a PhD Candidate, who is a Research Assistant at 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 MSc, is a PhD Candidate, who is a Research Assistant at 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. Mehrdad Kherzi, MSc, is a PhD Candidate, who is a Research Assistant at 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. Omid Zamani, MD, MPH, is a Research assistant at 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, MSc, is a PhD Candidate, who is a Research Assistant at 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, PhD, is a Professor of Epidemiology, Head of the Institute for Futures Studies in Health Kerman University of Medical Sciences, HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Kerman, Iran. Hamid Sharifi, PhD, is a Professor of Epidemiology, Head of 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
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Sauceda JA, Lechuga J, Ramos ME, Puentes J, Ludwig-Barron N, Salazar J, Christopoulos KA, Johnson MO, Gomez D, Covarrubias R, Hernandez J, Montelongo D, Ortiz A, Rojas J, Ramos L, Avila I, Gwadz MV, Neilands TB. A factorial experiment grounded in the multiphase optimization strategy to promote viral suppression among people who inject drugs on the Texas-Mexico border: a study protocol. BMC Public Health 2023; 23:307. [PMID: 36765309 PMCID: PMC9921633 DOI: 10.1186/s12889-023-15172-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/31/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND People who inject drugs living with HIV (PWIDLH) suffer the lowest rates of HIV viral suppression due to episodic injection drug use and poor mental health coupled with poor retention in HIV care. Approximately 44% of PWIDLH along the US-Mexico border are retained in care and only 24% are virally suppressed. This underserved region faces a potential explosion of transmission of HIV due to highly prevalent injection drug use. This protocol describes an optimization trial to promote sustained viral suppression among Spanish-speaking Latinx PWIDLH. METHODS The multiphase optimization strategy (MOST) is an engineering-inspired framework for designing and building optimized interventions and guides this intervention. The primary aim is to conduct a 24 factorial experiment in which participants are randomized to one of 16 intervention conditions, with each condition comprising a different combination of four behavioral intervention components. The components are peer support for methadone uptake and persistence; behavioral activation therapy for depression; Life-Steps medication adherence counseling; and patient navigation for HIV care. Participants will complete a baseline survey, undergo intervention, and then return for 3-,6-,9-, and 12-month follow-up assessments. The primary outcome is sustained viral suppression, defined as viral loads of < 40 copies per mL at 6-,9-, and 12-month follow-up assessments. Results will yield effect sizes for each component and each additive and interactive combination of components. The research team and partners will make decisions about what constitutes the optimized multi-component intervention by judging the observed effect sizes, interactions, and statistical significance against real-world implementation constraints. The secondary aims are to test mediators and moderators of the component-to-outcome relationship at the 6-month follow-up assessment. DISCUSSION We are testing well-studied and available intervention components to support PWIDLH to reduce drug use and improve their mental health and engagement in HIV care. The intervention design will allow for a better understanding of how these components work in combination and can be optimized for the setting. TRIAL REGISTRATION This project was registered at clinicaltrials.gov (NCT05377463) on May 17th, 2022.
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Affiliation(s)
- John A Sauceda
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, 550 16th Street, 94158, San Francisco, CA, USA.
| | - Julia Lechuga
- College of Health Sciences, Department of Public Health Sciences, University of Texas at El Paso, 1851 Wiggins Rd., 79968, El Paso, TX, USA
| | - Maria Elena Ramos
- Program Compañeros, Cuidad Juárez, Avenue de la Raza 2661, Silvias, Chihuahua, México
| | - Jorge Puentes
- College of Health Sciences, Department of Public Health Sciences, University of Texas at El Paso, 1851 Wiggins Rd., 79968, El Paso, TX, USA
| | - Natasha Ludwig-Barron
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, 550 16th Street, 94158, San Francisco, CA, USA
| | - Jorge Salazar
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, 996 Potrero Avenue, Building 80, 6th Floor, 94110, San Francisco, CA, USA
| | - Katerina A Christopoulos
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, 996 Potrero Avenue, Building 80, 6th Floor, 94110, San Francisco, CA, USA
| | - Mallory O Johnson
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, 550 16th Street, 94158, San Francisco, CA, USA
| | - David Gomez
- Centro de Integración Juvenil (CIJ), Cuidad Juárez, Blvd Ing Bernardo Norzagaray, 32130, Cazatecas, Chihuahua, México
| | - Rogelio Covarrubias
- Centro Ambulatorio para la prevención y Atención de SIDA y de las Enfermedades de Transmisión Sexual (CAPASITS), Cuidad Juárez, Avenue Paseo Triunfo de la Republica 3530, 32330, Partido Escobedo, Chihuahua, México
| | - Joselyn Hernandez
- Program Compañeros, Cuidad Juárez, Avenue de la Raza 2661, Silvias, Chihuahua, México
| | - David Montelongo
- Program Compañeros, Cuidad Juárez, Avenue de la Raza 2661, Silvias, Chihuahua, México
| | - Alejandro Ortiz
- Program Compañeros, Cuidad Juárez, Avenue de la Raza 2661, Silvias, Chihuahua, México
| | - Julian Rojas
- Program Compañeros, Cuidad Juárez, Avenue de la Raza 2661, Silvias, Chihuahua, México
| | - Luisa Ramos
- Program Compañeros, Cuidad Juárez, Avenue de la Raza 2661, Silvias, Chihuahua, México
| | - Itzia Avila
- Program Compañeros, Cuidad Juárez, Avenue de la Raza 2661, Silvias, Chihuahua, México
| | - Marya V Gwadz
- Silver School of Social Work, New York University, 1 Washington Square N, 10003, New York, NY, USA
| | - Torsten B Neilands
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, 550 16th Street, 94158, San Francisco, CA, USA
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Tookes HE, Oxner A, Serota DP, Alonso E, Metsch LR, Feaster DJ, Ucha J, Suarez E, Forrest DW, McCollister K, Rodriguez A, Kolber MA, Chueng TA, Zayas S, McCoy B, Sutherland K, Archer C, Bartholomew TS. Project T-SHARP: study protocol for a multi-site randomized controlled trial of tele-harm reduction for people with HIV who inject drugs. Trials 2023; 24:96. [PMID: 36750867 PMCID: PMC9904271 DOI: 10.1186/s13063-023-07074-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/05/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND The resurgence of HIV outbreaks and rising prevalence among people who inject drugs (PWID) remain exigent obstacles to Ending the HIV Epidemic in the USA. Adapting a low threshold, comprehensive treatment model for PWID with HIV can leverage syringe services programs (SSPs) to increase availability and accessibility of antiretrovirals (ART), medications for opioid use disorder (MOUD), and hepatitis C cure. We developed Tele-Harm Reduction, a telehealth-enhanced, harm reduction intervention delivered within an SSP venue. METHODS The T-SHARP trial is an open-label, multi-site, randomized controlled superiority trial with two parallel treatment arms. Participants (n=240) recruited from SSPs in Miami, Ft. Lauderdale, and Tampa, Florida, who are PWID with uncontrolled HIV (i.e., HIV RNA>200) will be randomized to Tele-Harm Reduction or off-site linkage to HIV care. The primary objective is to compare the efficacy of Tele-Harm Reduction for initiation of ART at SSPs vs. off-site linkage to an HIV clinic with respect to viral suppression across follow-up (suppression at 3, 6, and 12 months post randomization). Participants with HIV RNA<200 copies/ml will be considered virally suppressed. The primary trial outcome is time-averaged HIV viral suppression (HIV RNA <200 copies/ml) over 3-, 6-, and 12-month follow-up. Secondary outcomes include initiation of MOUD measured by urine drug screen and HCV cure, defined as achieving 12-week sustained virologic response (negative HCV RNA at 12 weeks post treatment completion). A cost-effectiveness analysis will be performed. DISCUSSION The T-SHARP Trial will be the first to our knowledge to test the efficacy of an innovative telehealth intervention with PWID with uncontrolled HIV delivered via an SSP to support HIV viral suppression. Tele-Harm Reduction is further facilitated by a peer to support adherence and bridge the digital divide. This innovative, flipped healthcare model sets aside the traditional healthcare system, reduces multi-level barriers to care, and meets PWID where they are. The T-SHARP trial is a pragmatic clinical trial that seeks to transform the way that PWID access HIV care and improve HIV clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT05208697. Trial registry name: Tele-Harm Reduction. Registration date: January 26, 2022.
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Affiliation(s)
- Hansel E Tookes
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Asa Oxner
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - David P Serota
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Elizabeth Alonso
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Daniel J Feaster
- Biostatistics Division, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jessica Ucha
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Edward Suarez
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - David W Forrest
- Department of Anthropology, University of Miami, Miami, FL, USA
| | - Kathryn McCollister
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Allan Rodriguez
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael A Kolber
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Teresa A Chueng
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Bernice McCoy
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Kyle Sutherland
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Chetwyn Archer
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tyler S Bartholomew
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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20
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Ivasiy R, Galvez de Leon SJ, Meteliuk A, Fomenko T, Pykalo I, Bromberg DJ, Madden LM, Farnum SO, Islam Z, Altice FL. Responding to health policy recommendations on managing opioid use disorder during Russia's invasion of Ukraine: Divergent responses from the frontline to the west. Front Public Health 2023; 10:1044677. [PMID: 36711398 PMCID: PMC9880308 DOI: 10.3389/fpubh.2022.1044677] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/15/2022] [Indexed: 01/15/2023] Open
Abstract
Russia's invasion of Ukraine on February 24, 2022, followed by Ukraine's Martial law, has disrupted the routine delivery of healthcare services, including opioid agonist treatment (OAT) programs. Directors (chief addiction treatment physicians) of these programs in each region had flexibility with implementing a series of adaptations to their practice to respond to war disruptions like mass internal displacement and legislation updates allowing more flexibility with OAT distribution policies and take-home dosing regulations. We conducted 8 in-depth interviews with directors from seven regions of Ukraine to describe their experiences providing OAT during a specific time during the war and the local crisis-response approach under the emergency policy updates. We categorized their experiences according to the level of exposure to conflict in each region and displacement of patients across the country, which may provide future guidance for OAT provision during the conflict.
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Affiliation(s)
- Roman Ivasiy
- Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, United States
| | | | - Anna Meteliuk
- International Charitable Foundation Alliance for Public Health, Kyiv, Ukraine
| | - Tetiana Fomenko
- International Charitable Foundation Alliance for Public Health, Kyiv, Ukraine
| | - Iryna Pykalo
- Ukrainian Institute of Public Health Policy, Kyiv, Ukraine,*Correspondence: Iryna Pykalo ✉
| | - Daniel J. Bromberg
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, United States,Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Lynn M. Madden
- Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, United States,APT Foundation, New Haven, CT, United States
| | | | - Zahedul Islam
- International Charitable Foundation Alliance for Public Health, Kyiv, Ukraine
| | - Frederick L. Altice
- Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, United States,Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, United States,APT Foundation, New Haven, CT, United States,Division of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
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21
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Saleem HT, Knight D, Yang C, Kidorf M, Latkin C, Nkya IH. HIV Stigma, HIV status disclosure, and ART adherence in the context of an integrated opioid use disorder and HIV treatment setting in Dar es Salaam, Tanzania. AIDS Care 2023; 35:91-94. [PMID: 35109727 PMCID: PMC9343474 DOI: 10.1080/09540121.2022.2032575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Little is known about social factors, including stigma, that affect antiretroviral therapy (ART) adherence among people enrolled in opioid use disorder treatment (OUDT) in the context of integrated OUDT and HIV treatment models. We qualitatively examined the relationship between HIV stigma, HIV status disclosure, and ART adherence among clients living with HIV at an OUDT clinic with integrated HIV services in Tanzania. We conducted in-depth interviews with 25 clients receiving HIV care at an OUDT clinic in Dar es Salaam, Tanzania between January and April 2020. HIV stigma, particularly anticipated stigma, and HIV status disclosure were key factors that affected ART adherence. Participants feared non-voluntary HIV status disclosure to and HIV stigma from their peers enrolled in OUDT. Most participants reported concealing their HIV status from peers at the OUDT clinic and not associating with other clients living with HIV at the clinic. Reducing HIV stigma and enhancing clinic structures and procedures to maintain privacy and confidentiality are essential to mitigating the effects of stigma on ART adherence.
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Affiliation(s)
- Haneefa T Saleem
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Deja Knight
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Cui Yang
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Michael Kidorf
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Carl Latkin
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Iddi Haruna Nkya
- Department of Psychiatry and Mental Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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22
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Bart G, Jaber M, Giang LM, Brundage RC, Korthuis PT. Findings from a pilot study of buprenorphine population pharmacokinetics: A potential effect of HIV on buprenorphine bioavailability. Drug Alcohol Depend 2022; 241:109696. [PMID: 36402052 PMCID: PMC9771970 DOI: 10.1016/j.drugalcdep.2022.109696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Buprenorphine is widely used in the treatment of opioid use disorder (OUD). There are few pharmacokinetic models of buprenorphine across diverse populations. Population pharmacokinetics (POPPK) allows for covariates to be included in pharmacokinetic studies, thereby opening the potential to evaluate the effect of comorbidities, medications, and other factors on buprenorphine pharmacokinetics. This pilot study used POPPK to explore buprenorphine pharmacokinetics in patients with and without HIV receiving buprenorphine for OUD. METHODS Plasma buprenorphine levels were measured in 54 patients receiving buprenorphine for OUD just prior to and 2-5 h following regular buprenorphine dosing. A linear one-compartment POPPK model with first-order estimation was used to evaluate buprenorphine clearance (CL/F) and volume of distribution (V/F). Covariates included weight and HIV status. RESULTS All HIV+ patients reported complete past-month adherence to taking antiretroviral therapy that included either efavirenz or nevirapine. Buprenorphine CL/F was 76% higher in HIV+ patients (n = 17) than HIV- patients (n = 37). Buprenorphine V/F was 41% higher in the HIV+ patients. CONCLUSIONS POPPK can be used to model buprenorphine pharmacokinetics in a real-world clinical population. While interactions between ART and buprenorphine alter buprenorphine CL/F, we also found alteration in V/F. Proportionate changes in CL/F and V/F might indicate a primary effect on bioavailability (F) rather than two separate effects. These findings indicate reduced buprenorphine bioavailability in patients with HIV.
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Affiliation(s)
- Gavin Bart
- Department of Medicine, Hennepin Healthcare, 701 Park Avenue, Minneapolis, MN 55415, USA.
| | - Mutaz Jaber
- Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, 417 Delaware Street SE, Minneapolis, MN 55455, USA.
| | - Le Minh Giang
- Center for Training and Research on Substance Abuse and HIV, Hanoi Medical University, 1 Ton That Tung, Hanoi, Viet Nam.
| | - Richard C Brundage
- Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, 417 Delaware Street SE, Minneapolis, MN 55455, USA.
| | - P Todd Korthuis
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University School of Medicine, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA.
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23
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Eller AJ, DiDomizio EE, Madden LM, Oliva JD, Altice FL, Johnson KA. Strengthening systems of care for people with or at risk for HIV, HCV and opioid use disorder: a call for enhanced data collection. Ann Med 2022; 54:1714-1724. [PMID: 35775786 PMCID: PMC9377256 DOI: 10.1080/07853890.2022.2084154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND The syndemic between opioid use disorder (OUD), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) results in excessive burdens on the healthcare system. Integrating these siloed systems of care is critical to address all three conditions adequately. In this implementation project, we assessed the data capacity of the health system to measure a cascade of care (COC) across HIV, HCV and OUD services in five states to help guide public health planning. MATERIALS AND METHODS Data for this study were gathered from publicly available datasets and reports from government (SAMSHA, CMS, HRSA and CDC) sites. We created, where possible, COCs for HIV, HCV, and OUD spanning population estimate, diagnosis, treatment initiation, treatment retention, and patient outcomes for each of five states in the study. RESULTS The process of data collection showed that baseline COCs examining the intersections of OUD, HIV, and HCV cannot be produced and that there are missing data in all states examined. Collection of specific data points is not consistent across all states. States are better at reporting HIV cascades due to federal requirements. Only gross estimates could be made for OUD cascades in all states because data are separated by payer source, leaving no central point of data collection from all sources. Data for HCV were not publicly available. CONCLUSION It is difficult to assess the strategies needed or the progress made towards increasing treatment access and decreasing the burden of disease without the ability to construct an accurate baseline. Using integrated COCs with relevant benchmarks can not only guide public health planning, but also provide meaningful targets for intervention.KEY MESSAGESWhile HIV COCs are available for most states at least annually, they are not disaggregated for populations with co-occurring OUD or HCV.Data to calculate HCV COC are not available and data to calculate OUD COC are partially available, but only for specific payers.States do not have systems in place to measure the scope of the syndemic or to identify targets for quality improvement activities.
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Affiliation(s)
- Anthony J. Eller
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
- CONTACT Anthony J. Eller Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Elizabeth E. DiDomizio
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Lynn M. Madden
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jennifer D. Oliva
- Department of Mental Health Law & Policy, University of South Florida, Tampa, FL, USA
| | - Frederick L. Altice
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Kimberly A. Johnson
- Center for Health & Pharmaceutical Law, Seton Hall University School of Law, Newark, NJ, USA
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24
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Fujita AW, Loughry N, Moore DE, Carter AE, Hussen SA, Cooper H, Colasanti JA, Sheth AN. Prevalence, Distribution, and Characteristics Associated with Possession of Buprenorphine Waivers Among Infectious Diseases Physicians in the United States. Clin Infect Dis 2022; 76:1197-1204. [PMID: 36419250 DOI: 10.1093/cid/ciac909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/10/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Persons with opioid use disorder (OUD) may present with infectious complications from injection drug use, thus ID physicians are uniquely positioned to treat OUD. Buprenorphine is safe and effective for OUD but remains underutilized. The prevalence and geographic distribution of ID physicians who are waivered to prescribe buprenorphine are unknown. METHODS This cross-sectional study merged data from several publicly available datasets from November 1, 2021 to January 15, 2022. Our primary outcome was proportion of ID physicians possessing buprenorphine waivers in the United States. We identified individual and county-level characteristics associated with buprenorphine waiver possession. We then used geospatial analysis to determine geographic distribution of waivered ID physicians. RESULTS We identified 6372 ID physicians in the US, among whom 170 (2.7%) possessed waivers. Most ID physicians (97.3%) practiced in metropolitan counties. In our multivariable analysis, ID physicians had lower odds of having a waiver for every 10-year increase since graduating medical school (OR 0.79, 95% CI 0.68-0.91). ID physicians practicing in counties with higher proportion of uninsured residents had lower odds of having a waiver (OR 0.75, 95% CI 0.62-0.90). Among counties with at least one ID physician (n = 729), only 11.2% had at least one waivered ID physician. CONCLUSIONS We found an extremely low prevalence and skewed geographic distribution of ID physicians with buprenorphine waivers. Our findings suggest an urgent need to increase the workforce of ID physicians waivered to prescribe buprenorphine and a call for increased integration of OUD education into ID training and continuing medical education.
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Affiliation(s)
- Ayako Wendy Fujita
- Division of Infectious Diseases, Emory University Department of Medicine, Atlanta, GA, USA
| | - Nora Loughry
- Division of General Internal Medicine, Emory University Department of Medicine, Atlanta, GA, USA
| | - DeLante E Moore
- Department of Biostatistics, Rollins School of Public Health, Emory University Department of Medicine, Atlanta, GA, USA
| | - Andrea E Carter
- Division of General Internal Medicine, University of Pittsburgh Department of Medicine, Pittsburgh, PA, USA
| | - Sophia A Hussen
- Division of Infectious Diseases, Emory University Department of Medicine, Atlanta, GA, USA.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Hannah Cooper
- Department of Behavioral, Social, and Health Education Services, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jonathan A Colasanti
- Division of Infectious Diseases, Emory University Department of Medicine, Atlanta, GA, USA
| | - Anandi N Sheth
- Division of Infectious Diseases, Emory University Department of Medicine, Atlanta, GA, USA
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25
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Heidari O, Genberg BL, Perrin N, Dangerfield DT, Farley JE, Kirk G, Mehta SH. Multimorbidity classes indicate differential patterns of health care engagement among people who inject drugs. J Subst Abuse Treat 2022; 142:108806. [PMID: 35643587 PMCID: PMC10544774 DOI: 10.1016/j.jsat.2022.108806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/28/2022] [Accepted: 05/09/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Aging people who inject drugs (PWID) have complex health needs. Health care management could be complicated by persistent substance use, multiple health challenges, and inconsistent access to care. However, we know little about the relationship between chronic multimorbidity and health care engagement in this population. The purpose of this study is to characterize patterns and correlates of chronic disease multimorbidity among PWID. METHODS We conducted a latent class analysis (LCA) using data from the AIDS Linked to the IntraVenous Experience (ALIVE) Study, a community-based observational cohort, to determine classes of multimorbid chronic diseases. We then conducted regressions to determine factors associated with class membership and the impact of each multimorbid class on health events and utilization. RESULTS Of 1387 individuals included, the majority were male (67%) and Black (81%), with a mean age of 53 years. We identified four classes of multimorbidity: Low Multimorbidity (54%), and Low Multimorbidity Including Psychiatric Comorbidity (26%), Multimorbidity (12%), and Multimorbidity Including Psychiatric Comorbidity (7%). Female sex, baseline age, and receipt of disability were factors significantly associated with membership in all three classes compared to the Low Multimorbidity class. Additionally, PWID in these three classes were significantly more likely to utilize emergency room and outpatient health care. Membership in both classes with psychiatric comorbidity was associated with significantly higher adjusted odds of receiving medication for opioid use disorder. DISCUSSION Holistic health care systems can best address the needs of aging PWID with integrated care that provides harm reduction, substance use and mental health treatment together, and wrap around services.
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Affiliation(s)
- Omeid Heidari
- Johns Hopkins University, Bloomberg School of Public Health, Department of Mental Health, 615 N. Wolfe St, Baltimore, MD 21205, United States of America; Us Helping Us, People Into Living, Inc., 3636 Georgia Ave NW, Washington, D.C. 20010, United States of America.
| | - Becky L Genberg
- Johns Hopkins University, Bloomberg School of Public Health, Department of Epidemiology, 615 N. Wolfe St, Baltimore, MD 21205, United States of America
| | - Nancy Perrin
- Johns Hopkins University, School of Nursing, 525 N. Wolfe St, Baltimore, MD, 21205, United States of America
| | - Derek T Dangerfield
- Johns Hopkins University, School of Nursing, 525 N. Wolfe St, Baltimore, MD, 21205, United States of America; Us Helping Us, People Into Living, Inc., 3636 Georgia Ave NW, Washington, D.C. 20010, United States of America
| | - Jason E Farley
- The Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, School of Nursing, 525 N. Wolfe St, Baltimore, MD 21205, United States of America; Johns Hopkins University, School of Nursing, 525 N. Wolfe St, Baltimore, MD, 21205, United States of America
| | - Gregory Kirk
- The Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, School of Nursing, 525 N. Wolfe St, Baltimore, MD 21205, United States of America
| | - Shruti H Mehta
- Johns Hopkins University, Bloomberg School of Public Health, Department of Epidemiology, 615 N. Wolfe St, Baltimore, MD 21205, United States of America
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Lier AJ, Seval N, Vander Wyk B, Di Paola A, Springer SA. Maintenance on extended-release naltrexone is associated with reduced injection opioid use among justice-involved persons with opioid use disorder. J Subst Abuse Treat 2022; 142:108852. [PMID: 35988513 PMCID: PMC9509444 DOI: 10.1016/j.jsat.2022.108852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/05/2022] [Accepted: 07/26/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Opioid use disorder (OUD) and injection drug use (IDU) place justice-involved individuals at increased risk for acquiring or transmitting HIV or hepatitis C virus (HCV). Methadone and buprenorphine have been associated with reduced opioid IDU; however, the effect of extended-release naltrexone (XR-NTX) on this behavior is incompletely studied. METHODS This study examined injection opioid use and shared injection equipment behavior from a completed double-blind placebo-controlled trial of XR-NTX among 88 justice-involved participants with HIV and OUD. Changes in participants' self-reported daily injection opioid use and shared injection equipment was evaluated pre-incarceration, during incarceration, and monthly post-release for 6 months. The study also assessed differences in time to first opioid injection post-release. The research team performed intention to treat and "as treated" (high treatment versus low treatment) analyses. RESULTS Fifty-eight of 88 participants (69.5 %) endorsed IDU and 26 (29.5 %) reported sharing injection equipment in the 30 days pre-incarceration; 2 participants (2.2 %) reported IDU during incarceration; 19 (21.6 %) reported IDU one month post-release from prison or jail. Fifty-four (61.4 %) participants had an HIV RNA below 200 copies/mL and 62 (70.5 %) were baseline HCV antibody positive. The 6-month follow-up rate was 49.5 % and 50.5 % for those who received XR-NTX and placebo, respectively, which was not significantly different (p = 0.822). Participants in the XR-NTX and placebo groups had similar low mean opioid injection use post-release and time to first injection opioid use in the Intention-to-treat analysis. In the as-treated analysis, participants in the high treatment group had significantly lower mean proportion of days injecting opioids (13.8 % high treatment versus 22.8 % low treatment, p = 0.02) by month 1, which persisted up to 5 months post-release (0 % high treatment vs 24.3 % low treatment, p < 0.001) and experienced a longer time to first opioid injection post-release (143.8 days high treatment vs 67.4 days low treatment, p < 0.001). CONCLUSIONS Injection opioid use was low during incarceration and remained low post-release in this justice-involved population. Retention on XR-NTX was associated with reduced intravenous opioid use, which has important implications for reducing transmission of HIV and HCV.
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Affiliation(s)
- Audun J Lier
- Department of Internal Medicine, Division of Infectious Diseases, Northport VA Medical Center, Northport, NY, USA
| | - Nikhil Seval
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, New Haven, CT, USA
| | - Brent Vander Wyk
- Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT, USA
| | - Angela Di Paola
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, New Haven, CT, USA
| | - Sandra A Springer
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, New Haven, CT, USA; Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA.
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Khati A, Altice FL, Vlahov D, Eger WH, Lee J, Bohonnon T, Wickersham JA, Maviglia F, Copenhaver N, Shrestha R. Nurse Practitioner-Led Integrated Rapid Access to HIV Prevention for People Who Inject Drugs (iRaPID): Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e42585. [PMID: 36222826 PMCID: PMC9597427 DOI: 10.2196/42585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 09/18/2022] [Accepted: 09/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The ongoing volatile opioid epidemic remains a significant public health concern, alongside continued outbreaks of HIV and hepatitis C virus among people who inject drugs. The limited access to and scale-up of medications for opioid use disorder (MOUD) among people who inject drugs, coupled with multilevel barriers to pre-exposure prophylaxis (PrEP) uptake, makes it imperative to integrate evidence-based risk reduction and HIV prevention strategies in innovative ways. To address this need, we developed an integrated rapid access to HIV prevention program for people who inject drugs (iRaPID) that incorporates same-day PrEP and MOUD for this population. OBJECTIVE The primary objective of this pilot study is to assess the feasibility and acceptability of the program and evaluate its preliminary efficacy on PrEP and MOUD uptake for a future randomized controlled trial (RCT). We also aim to explore information on the implementation of the program in a real-world setting using a type I hybrid implementation trial design. METHODS Using a type I hybrid implementation trial design, we are pilot testing the nurse practitioner-led iRaPID program while exploring information on its implementation in a real-world setting. Specifically, we will assess the feasibility and acceptability of the iRaPID program and evaluate its preliminary efficacy on PrEP and MOUD uptake in a pilot RCT. The enrolled 50 people who inject drugs will be randomized (1:1) to either iRaPID or treatment as usual (TAU). Behavioral assessments will occur at baseline, and at 1, 3, and 6 months. Additionally, we will conduct a process evaluation of the delivery and implementation of the iRaPID program to collect information for future implementation. RESULTS Recruitment began in July 2021 and was completed in August 2022. Data collection is planned through February 2023. The Institutional Review Boards at Yale University and the University of Connecticut approved this study (2000028740). CONCLUSIONS This prospective pilot study will test a nurse practitioner-led, integrated HIV prevention program that incorporates same-day PrEP and MOUD for people who inject drugs. This low-threshold protocol delivers integrated prevention via one-stop shopping under the direction of nurse practitioners. iRaPID seeks to overcome barriers to delayed PrEP and MOUD initiation, which is crucial for people who inject drugs who have had minimal access to evidence-based prevention. TRIAL REGISTRATION ClinicalTrials.gov NCT04531670; https://clinicaltrials.gov/ct2/show/NCT04531670. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/42585.
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Affiliation(s)
- Antoine Khati
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | | | - David Vlahov
- Yale School of Nursing, West Haven, CT, United States
| | - William H Eger
- AIDS Program, Yale School of Medicine, New Haven, CT, United States
| | - Jessica Lee
- AIDS Program, Yale School of Medicine, New Haven, CT, United States
| | - Terry Bohonnon
- AIDS Program, Yale School of Medicine, New Haven, CT, United States
| | | | | | - Nicholas Copenhaver
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Roman Shrestha
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
- AIDS Program, Yale School of Medicine, New Haven, CT, United States
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Valencia J, Troya J, Lazarus JV, Cuevas G, Alvaro-Meca A, Torres-Machado J, Escobar I, Cañamares I, Ryan P. Effectiveness of an HIV care model integrated into addiction care based on medication-assisted treatment for HIV-positive people who use drugs. AIDS Care 2022; 34:1297-1304. [PMID: 34482777 DOI: 10.1080/09540121.2021.1967853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Our objective was to evaluate the effectiveness of initiated or reinitiated antiretroviral therapy (ART) in HIV-positive active drug users receiving integrated HIV and addiction care in a harm reduction setting. We performed a study of HIV-positive persons who use drugs (PWUD) in a harm reduction unit in Madrid, Spain. Participants received HIV care integrated into addiction care and received at least one dose of observed ART based on medication-assisted treatment between January 2013 and December 2019. Individuals newly diagnosed with HIV (n = 13) had a greater median CD4 cell count at baseline were less likely to be late presenters, had a greater CD4 cell count increase, and were less likely to have AIDS in comparison to those who were aware of their HIV status (n = 87) at initiation or reinitiation of ART. The overall VS was 73% in the intention-to-treat (ITT) analysis and 92.4% in the modified intention-to-treat (mITT) analysis. People who were engaged in OST, people with >90% adherence to ART, and older people were positively associated with VS in the multivariate analysis. An HIV care model integrated into a harm reduction facility demonstrated a high uptake of HIV treatment, retention in care, improvement in adherence, and achievement of VS.
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Affiliation(s)
- Jorge Valencia
- Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain.,Harm Reduction Unit "SMASD", Addictions and Mental Health Department, Madrid, Spain
| | - Jesús Troya
- Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Guillermo Cuevas
- Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain
| | - Alejandro Alvaro-Meca
- Unit of Preventive Medicine and Public Health, Rey Juan Carlos University, Madrid, Spain
| | - Juan Torres-Machado
- Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain
| | - Ismael Escobar
- Pharmacy Department, University Hospital Infanta Leonor, Madrid, Spain
| | - Irene Cañamares
- Pharmacy Department, University Hospital Infanta Leonor, Madrid, Spain
| | - Pablo Ryan
- Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain.,School of Medicine, Complutense University of Madrid, Madrid, Spain.,Gregorio Marañón Health Research Institute, Madrid, Spain
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Dumchev K, Kiriazova T, Riabokon S, Shost A, Parrish C, Shapoval A, Germanovych M, Penner J, Beste J, Puttkammer N. Comparative Clinical Outcomes With Scale-up of Dolutegravir as First-Line Antiretroviral Therapy in Ukraine. J Acquir Immune Defic Syndr 2022; 91:197-209. [PMID: 36094487 PMCID: PMC9472572 DOI: 10.1097/qai.0000000000003038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/31/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Achievement of the UNAIDS 95-95-95 targets requires ARV regimens that are easy to use, well-tolerated, and cost-effective. Dolutegravir (DTG)-based regimens are efficacious and less costly than other common first-line regimens. This study assessed real-world effectiveness of DTG regimens in treatment-naive people living with HIV in Ukraine. METHODS We extracted data from the national Medical Information System on all adult patients who initiated antiretroviral therapy (ART) with DTG, lopinavir/ritonavir, or efavirenz (EFV) between October 2017 and June 2018, at 23 large clinics in 12 regions of Ukraine. Viral suppression at 12 ± 3 months and retention at 12 months after treatment initiation were the outcomes of interest. RESULTS Of total 1057 patients, 721 had a viral load test within the window of interest, and 652 (90%) had viral load of ≤ 200 copies/mL. The proportion with suppression was lower in the EFV group [aOR = 0.4 (95% confidence interval: 0.2 to 0.8)] and not different in the LPV group [aOR = 1.6 (0.5 to 4.9)] compared with the DTG group. A 24-month or longer gap between diagnosis and treatment was associated with lower odds of suppression [aOR = 0.4 (0.2 to 0.8)]. Treatment retention was 90% (957/1057), with no significant difference by regimen group. History of injecting drug use was associated with decreased retention [aOR = 0.5 (0.3 to 0.8)]. CONCLUSIONS DTG-based regimens were comparable with LPV and more effective than EFV in achieving viral suppression among ART-naive patients in a multisite cohort in Ukraine. Treatment retention was equally high in all 3 groups. This evidence from Ukraine supports the ART Optimization Initiative as a strategy to improve efficiency of the ART program without negatively affecting patient clinical outcomes.
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Affiliation(s)
| | | | - Serhiy Riabokon
- Public Health Center of the Ministry of Health of Ukraine, Ukraine
| | - Alyona Shost
- International Training & Education Center for Health, Kyiv, Ukraine
| | - Canada Parrish
- Emergency Medicine Department, University of Washington, Seattle, WA
| | - Anna Shapoval
- International Training & Education Center for Health, Kyiv, Ukraine
| | | | - Jeremy Penner
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada; and
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Fujita AW, Wilson JD, Kennedy AJ. A Call to Action: Integration of Buprenorphine Prescribing into the Care of Persons with HIV and Opioid Use Disorder. Open Forum Infect Dis 2022; 9:ofac400. [PMID: 36039099 PMCID: PMC9384664 DOI: 10.1093/ofid/ofac400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/02/2022] [Indexed: 11/12/2022] Open
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, we also experienced a worsening opioid overdose epidemic. Untreated opioid use disorder (OUD) in persons with human immunodeficiency virus (HIV) is associated with worse HIV-related outcomes. Buprenorphine is a safe, evidence-based medication for OUD and is effective in reducing opioid craving and overdose and improving outcomes along the HIV care continuum. Despite the longstanding evidence supporting the benefits of buprenorphine, there remains an implementation gap in the uptake of buprenorphine prescribing in HIV care settings. To improve integration of OUD care and HIV primary care, we recommend (1) all HIV clinicians obtain a buprenorphine waiver, (2) teaching on OUD should be integrated into infectious diseases and HIV continuing medical education, and (3) previously validated models of integrated care should be leveraged to urgently expand access to buprenorphine for persons with HIV and OUD.
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Affiliation(s)
- A Wendy Fujita
- Division of Infectious Diseases, Emory University Department of Medicine , Atlanta, GA , USA
| | - J Deanna Wilson
- Division of General Internal Medicine, University of Pittsburgh School of Medicine , Pittsburgh, PA , USA
| | - Amy J Kennedy
- Division of General Internal Medicine, University of Washington School of Medicine , VA Puget Sound Healthcare System, Seattle, WA , USA
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Juwono S, Milloy MJ, Choi J, Fairbairn N, Nolan S, Socías ME. Opioid agonist treatment improves progression through the HIV cascade of care among people living with HIV who use unregulated opioids. AIDS 2022; 36:1429-1436. [PMID: 35608126 PMCID: PMC9329231 DOI: 10.1097/qad.0000000000003247] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Opioid agonist treatment (OAT) has been shown to improve certain HIV-related treatment measures among people with HIV (PHIV) with opioid use disorder (OUD). However, there is limited data on the impacts of OAT along the whole HIV cascade of care. DESIGN AND METHODS Using data from an ongoing cohort of PHIV who use drugs in Vancouver, Canada, we used cumulative link mixed-effects models to estimate the independent effect of OAT on achieving progressive steps in the HIV cascade among participants using unregulated opioids daily, after adjusting for confounders. RESULTS Between 2005 and 2017, we recruited 639 PHIV regularly using opioids (median age 42 years, 59% male, 56% White), of whom 70% were on OAT at their baseline visit. Engagement in OAT showed a nonsignificant trend with higher linkage to HIV care (adjusted partial proportional odds ratio [APPO] = 1.75, 95% confidence interval [CI]: 0.83-3.69), and significantly higher cumulative odds of successfully achieving subsequent HIV cascade steps: on ART (APPO = 3.85, 95% CI: 2.33-6.37); adherent to ART (APPO = 3.15, 95% CI: 2.15-4.62); and HIV viral suppression (APPO = 2.18, 95% CI: 1.51-3.14). CONCLUSIONS This study found a high level of OAT engagement among PHIV using unregulated opioids and that OAT engagement resulted in significantly increased progression through some of the higher steps of the HIV cascade. While these findings are encouraging, they highlight the need to reach populations off OAT to maximize the clinical and community-level benefits of ART.
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Affiliation(s)
| | - M-J Milloy
- British Columbia Centre on Substance Use
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Nadia Fairbairn
- British Columbia Centre on Substance Use
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Seonaid Nolan
- British Columbia Centre on Substance Use
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - M Eugenia Socías
- British Columbia Centre on Substance Use
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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32
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Garcia CM, Kushel MB. Integrating mental health and substance use treatment with HIV care for people experiencing homelessness. Lancet Psychiatry 2022; 9:606-8. [PMID: 35750061 DOI: 10.1016/S2215-0366(22)00228-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 11/22/2022]
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Korthuis PT, Cook RR, Lum PJ, Waddell EN, Tookes H, Vergara‐Rodriguez P, Kunkel LE, Lucas GM, Rodriguez AE, Bielavitz S, Fanucchi LC, Hoffman KA, Bachrach K, Payne EH, Collins JA, Matthews A, Oden N, Jacobs P, Jelstrom E, Sorensen JL, McCarty D. HIV clinic-based extended-release naltrexone versus treatment as usual for people with HIV and opioid use disorder: a non-blinded, randomized non-inferiority trial. Addiction 2022; 117:1961-1971. [PMID: 35129242 PMCID: PMC9314106 DOI: 10.1111/add.15836] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 01/13/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIM Opioid agonist medications for treatment of opioid use disorder (OUD) can improve human immunodeficiency virus (HIV) outcomes and reduce opioid use. We tested whether outpatient antagonist treatment with naltrexone could achieve similar results. DESIGN Open-label, non-inferiority randomized trial. SETTING Six US HIV primary care clinics. PARTICIPANTS A total of 114 participants with untreated HIV and OUD (62% male; 56% black, 12% Hispanic; positive for fentanyl (62%), other opioids (47%) and cocaine (60%) at baseline). Enrollment halted early due to slow recruitment. INTERVENTION HIV clinic-based extended-release naltrexone (XR-NTX; n = 55) versus treatment as usual (TAU) with buprenorphine or methadone (TAU; n = 59). MEASUREMENTS Treatment group differences were compared for the primary outcome of viral suppression (HIV RNA ≤ 200 copies/ml) at 24 weeks and secondary outcomes included past 30-day use of opioids at 24 weeks. FINDINGS Fewer XR-NTX participants initiated medication compared with TAU participants (47 versus 73%). The primary outcome of viral suppression was comparable for XR-NTX (52.7%) and TAU (49.2%) [risk ratio (RR) = 1.064; 95% confidence interval (CI) = 0.748, 1.514] at 24 weeks. Non-inferiority could not be demonstrated, as the lower confidence limit of the RR did not exceed the pre-specified margin of 0.75 in intention-to-treat (ITT) analysis. The main secondary outcome of past 30-day opioid use was comparable for XR-NTX versus TAU (11.7 versus 14.8 days; mean difference = -3.1; 95% CI = -8.7, 1.1) in ITT analysis. Among those initiating medication, XR-NTX resulted in fewer days of opioid use compared with TAU in the past 30 days (6.0 versus 13.6, mean difference = -7.6; 95% CI = -13.8, -0.2). CONCLUSIONS A randomized controlled trial found supportive, but not conclusive, evidence that human immunodeficiency virus clinic-based extended-release naltrexone is not inferior to treatment as usual for facilitating human immunodeficiency virus viral suppression. Participants who initiated extended-release naltrexone used fewer opioids than those who received treatment as usual.
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Affiliation(s)
- P. Todd Korthuis
- Addiction Medicine ProgramOregon Health and Science UniversityPortlandORUSA
- Oregon Health and Science University‐Portland State University School of Public HealthPortlandORUSA
| | - Ryan R. Cook
- Addiction Medicine ProgramOregon Health and Science UniversityPortlandORUSA
| | - Paula J. Lum
- Division of HIV, ID and Global MedicineUniversity of CaliforniaSan FranciscoCAUSA
| | - Elizabeth Needham Waddell
- Addiction Medicine ProgramOregon Health and Science UniversityPortlandORUSA
- Oregon Health and Science University‐Portland State University School of Public HealthPortlandORUSA
| | - Hansel Tookes
- Division of Infectious DiseasesUniversity of Miami Miller School of MedicineMiamiFLUSA
| | - Pamela Vergara‐Rodriguez
- Ruth M. Rothstein CORE Center, Department of Psychiatry and Department of Internal MedicineCook County HealthChicagoILUSA
| | - Lynn E. Kunkel
- Addiction Medicine ProgramOregon Health and Science UniversityPortlandORUSA
| | | | - Allan E. Rodriguez
- Division of Infectious DiseasesUniversity of Miami Miller School of MedicineMiamiFLUSA
| | - Sarann Bielavitz
- Addiction Medicine ProgramOregon Health and Science UniversityPortlandORUSA
| | - Laura C. Fanucchi
- Division of Infectious Diseases and Center on Drug and Alcohol ResearchUniversity of KentuckyLexingtonKYUSA
| | - Kim A. Hoffman
- Oregon Health and Science University‐Portland State University School of Public HealthPortlandORUSA
| | | | | | | | | | | | - Petra Jacobs
- National Institutes of HealthNational Institute on AgingBethesdaMDUSA
| | | | - James L. Sorensen
- Department of Psychiatry and Behavioral SciencesUniversity of California San FranciscoSan FranciscoCAUSA
| | - Dennis McCarty
- Addiction Medicine ProgramOregon Health and Science UniversityPortlandORUSA
- Oregon Health and Science University‐Portland State University School of Public HealthPortlandORUSA
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Mitra S, Grant C, Nolan S, Mohd Salleh NA, Milloy MJ, Richardson L. Assessing the Temporality Between Transitions onto Opioid Agonist Therapy and Engagement with Antiretroviral Therapy in a Cohort of HIV-Positive People Who Use Opioids Daily. AIDS Behav 2022; 26:1933-1942. [PMID: 34977956 PMCID: PMC9859621 DOI: 10.1007/s10461-021-03543-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 01/25/2023]
Abstract
A robust evidence-base describes the beneficial association between opioid agonist therapy (OAT) and HIV-related outcomes among people living with HIV and opioid use disorder. While some evidence suggests the stabilizing effect of OAT on antiretroviral therapy (ART) treatment engagement, less is understood about the potential for an inverse relationship. We sought to examine the relationship between transitions in ART engagement and transitions onto OAT. We used data from a prospective cohort of people living with HIV who use drugs in Vancouver, Canada-a setting with no-cost access to ART and low or no-cost access to OAT among low-income residents. Restricting the sample to those who reported daily or greater opioid use, we used generalized linear mixed-effects models to estimate the relationships between our primary outcome of transitions onto OAT (methadone or buprenorphine/naloxone) and transitions (1) onto ART and (2) into ART adherence. Subsequent analyses assessed the temporal sequencing of transitions. Between 2005 and 2017, among 433 participants, 48.3% reported transitioning onto OAT at least once. In concurrent analyses, transitions onto ART were positively and significantly associated with transitions onto OAT. Temporal sequencing revealed that transitions into OAT were also positively and significantly associated with subsequent transitions onto ART. OAT's potential to facilitate the uptake of ART points to the continued need to scale-up low-threshold, client-centered substance use services integrated alongside HIV care.
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Affiliation(s)
- Sanjana Mitra
- Interdisciplinary Graduate Studies Program, University of British Columbia, 270-2357 Main Mall, Vancouver, BC V6T 1Z4, Canada,British Columbia Centre on Substance Use, University of British Columbia, 400-1045 Howe, Vancouver, BC V6Z 2A9, Canada
| | - Cameron Grant
- British Columbia Centre on Substance Use, University of British Columbia, 400-1045 Howe, Vancouver, BC V6Z 2A9, Canada
| | - Seonaid Nolan
- British Columbia Centre on Substance Use, University of British Columbia, 400-1045 Howe, Vancouver, BC V6Z 2A9, Canada,Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada
| | - Nur Afiqah Mohd Salleh
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia,Centre of Excellence for Research in AIDS, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - M.-J. Milloy
- British Columbia Centre on Substance Use, University of British Columbia, 400-1045 Howe, Vancouver, BC V6Z 2A9, Canada,Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada
| | - Lindsey Richardson
- British Columbia Centre on Substance Use, University of British Columbia, 400-1045 Howe, Vancouver, BC V6Z 2A9, Canada,Department of Sociology, University of British Columbia, 6303 NW Marine Drive, Vancouver, BC V6T 1Z1, Canada
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Dorgay CE, Bromberg DJ, Doltu S, Litz T, Galvez S, Polonsky M, Dvoryak S, Altice FL. A pilot implementation study to scale-up methadone in incarcerated persons with opioid use disorder and retain them on treatment after release in Moldova. Int J Drug Policy 2022; 104:103683. [PMID: 35417790 PMCID: PMC9827420 DOI: 10.1016/j.drugpo.2022.103683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Eastern Europe and Central Asia have intertwined HIV and incarceration epidemics, concentrated in people who inject drugs. Moldova is one of the few countries in this region that offers methadone within prisons, but uptake and post-release retention remains suboptimal. Screening, brief intervention, and referral to treatment (SBIRT) procedures are a potential implementation strategy to address this problem. METHODS From June 1, 2017 to March 3, 2018, we conducted a 2-stage SBIRT strategy in nine prisons and four pre-trial detention facilities in Moldova among incarcerated persons with opioid use disorder (OUD; N = 121) and within 90 days of release. Survey results were analyzed to evaluate the effect of the SBIRT strategy on the uptake of and post-release retention on methadone maintenance treatment (MMT). RESULTS Among the 121 screened with OUD, 27 were on MMT at baseline within the prison and this number increased to 41 after the two-step SBIRT intervention, reflecting a 51.9% increase over baseline. Eleven (78.6%) of the 14 participants that newly started MMT did so only after completing both SBIRT sessions. The brief intervention did not significantly improve knowledge about methadone but did improve attitudes towards it. Among the 41 participants who received methadone during this trial, 40 (97.6%) were retained 6 months after release; the one participant not retained was on methadone at the time of the intervention and had planned to taper off. CONCLUSION The SBIRT strategy significantly improved participant attitudes, but treatment initiation mostly occurred after completing both sessions, including soon after release, but remained low overall. Work within the Moldovan prison subculture to dispel negative myths and misinformation is needed to further scale-up OAT in Moldova.
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Affiliation(s)
- Coriann E Dorgay
- Yale School of Public Health, Yale University, 60 College Street, New Haven, Connecticut, 06510, United States
| | - Daniel J Bromberg
- Yale School of Public Health, Yale University, 60 College Street, New Haven, Connecticut, 06510, United States; Yale Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, New Haven, Connecticut, 06510, United States
| | - Svetlana Doltu
- Act For Involvement, 7A Varșovia street, Chișinău, 2060, Republic of Moldova
| | - Taylor Litz
- Yale School of Medicine, Yale University, 135 College Street, New Haven, Connecticut, 06510, United States
| | - Samy Galvez
- Yale Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, New Haven, Connecticut, 06510, United States; Yale School of Medicine, Yale University, 135 College Street, New Haven, Connecticut, 06510, United States
| | - Maxim Polonsky
- Yale School of Medicine, Yale University, 135 College Street, New Haven, Connecticut, 06510, United States
| | - Sergey Dvoryak
- Ukrainian Institute on Public Health Policy, 5 Biloruska Str. Office 20, 27, Kyiv, 04050 Ukraine
| | - Frederick L Altice
- Yale School of Public Health, Yale University, 60 College Street, New Haven, Connecticut, 06510, United States; Yale Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, New Haven, Connecticut, 06510, United States; Yale School of Medicine, Yale University, 135 College Street, New Haven, Connecticut, 06510, United States; University of Malaya, 50603 Kuala Lumpur, Malaysia.
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Kremer HJ. Time to initiate randomized controlled clinical trials with methadone in cancer patients. F1000Res 2022; 8:1835. [PMID: 35601274 PMCID: PMC9091806 DOI: 10.12688/f1000research.20454.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 11/20/2022] Open
Abstract
Public media coverage has fueled a demand for methadone as potential cure for cancer itself. Because patients have asked for respective prescriptions, clinical societies issued statements warning against the use of methadone as long as preclinical findings have not been supported by clinical evidence. In fact, not all preclinical data clearly support relevant effects. However, strong epidemiologic data suggest beneficial effects of methadone on cancer. Alternative explanations, namely better safety of methadone or hidden selection bias, seem less likely. This uncertainty can only be resolved by randomized controlled clinical trials. This review discusses all relevant data pertinent to methadone and cancer, uncovers supportive epidemiologic data, and suggests possible study designs.
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Weaver VK, Kennedy MC. Response to “Six Moments of Infection Prevention in Injection Drug Use: An Educational Toolkit for Clinicians” by Harvey et al. Open Forum Infect Dis 2022; 9:ofac145. [PMID: 35663287 PMCID: PMC9154324 DOI: 10.1093/ofid/ofac145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Victoria K Weaver
- British Columbia Centre on Substance Use, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver
| | - Mary Clare Kennedy
- British Columbia Centre on Substance Use, Vancouver, Canada
- School of Social Work, University of British Columbia Okanagan, Canada
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Flountzi E, Lim AG, Vickerman P, Paraskevis D, Psichogiou M, Hatzakis A, Sypsa V. Modeling the impact of interventions during an outbreak of HIV infection among people who inject drugs in 2012-2013 in Athens, Greece. Drug Alcohol Depend 2022; 234:109396. [PMID: 35349919 DOI: 10.1016/j.drugalcdep.2022.109396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/03/2022] [Accepted: 03/03/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND A large HIV outbreak in People Who Inject Drugs (PWID) occurred in Athens, Greece in 2011-2013. In response, opioid substitution treatment (OST) and needle and syringe programs (NSP) were scaled-up and a seek-test-treat program was introduced in mid-2012. We aim to assess the impact of these interventions. METHODS A mathematical model of HIV transmission among PWID was calibrated to data available over time (2009-2013) on HIV prevalence, NSP/antiretroviral treatment (ART) coverage and high-risk injection. A combined interventions scenario, including decrease in high-risk injection through linkage to OST and modification of risk behaviours and access to NSP and ART, was compared to a counterfactual scenario (no improvement at the levels of these interventions), with HIV incidence being the main outcome. RESULTS HIV incidence increased from <0.1 new cases/100 person-years (in 2009) to 11.0 new cases/100 person-years (in 2012). Under both models, a subsequent decline was projected following early 2012, with incidence at the end of 2013 in the combined interventions scenario being lower by 77% compared to the counterfactual. The projected reduction in incidence under the intervention scenario was in agreement with empirical data. HIV prevalence would have escalated to 20.4% (95% CrI: 16.9%, 23.6%) in 2013 under the counterfactual scenario (vs. 16.8% (95% CrI: 11.2%, 23.0%) under the combined interventions scenario). In total, 31.4% of HIV cases (392) were averted over 2012-2013. CONCLUSION These results underline the importance of high-coverage harm reduction programs and of community-based interventions to rapidly reach PWID most in need.
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Affiliation(s)
- Eleni Flountzi
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Aaron G Lim
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Mina Psichogiou
- First Department of Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
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O'Hara GL, Liberman AR, Polonsky M, Azbel L, Marcus R, Doltu S, Cugut S, Altice FL. Multi-level implementation factors that influence scale-up of methadone maintenance treatment in Moldovan prisons: A qualitative study. J Subst Abuse Treat 2022; 136:108660. [PMID: 34801282 PMCID: PMC10879837 DOI: 10.1016/j.jsat.2021.108660] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/22/2021] [Accepted: 11/10/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION People who inject drugs (PWID) are overrepresented in prison populations, especially in the Eastern European and Central Asian region (EECA), where HIV incidence and mortality continue to rise. Modeling data suggest that methadone maintenance treatment (MMT) scale-up in prison with continuation after release could substantially reduce new HIV infections. Moldova, one of four countries in the EECA to have introduced MMT in prisons, has faced challenges with its scale-up. METHOD To improve implementation of MMT in Moldovan prisoners, we analyzed the qualitative interviews of 44 recently released Moldovan prisoners with opioid use disorder who either accepted or rejected MMT while incarcerated; these 44 were among a subset of 56 participants in a quantitative survey who had complete interview data. After translating and back-translating interviews, we used content analysis to identify key barriers and facilitators to MMT uptake. RESULTS Our qualitative analyses revealed that positive attitudes toward methadone facilitated treatment uptake, yet the study identified three thematic barriers as to why PWID do not accept MMT while in prison, including: 1) negative personal attitudes toward MMT; 2) stigmatization of MMT by informal hierarchies within prison; and 3) distrust of the formal prison hierarchy (i.e., administration), which provides MMT. CONCLUSION Overall, the social forces of the two prisoner hierarchies and distrust between them appeared to outweigh the perceived benefits of MMT and impacted MMT uptake. Here we provide strategies to promote MMT more effectively in prison settings.
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Affiliation(s)
- George L O'Hara
- Yale University School of Medicine, Section of Infectious Diseases, 333 Cedar St, New Haven, CT 06510, USA
| | - Amanda R Liberman
- Yale University School of Medicine, Section of Infectious Diseases, 333 Cedar St, New Haven, CT 06510, USA.
| | - Maxim Polonsky
- Yale University School of Medicine, Section of Infectious Diseases, 333 Cedar St, New Haven, CT 06510, USA
| | - Lyuba Azbel
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, UK
| | - Ruthanne Marcus
- Yale University School of Medicine, Section of Infectious Diseases, 333 Cedar St, New Haven, CT 06510, USA.
| | - Svetlana Doltu
- Act for Involvement (AFI) Nongovernmental organization, Varșovia St 2060, Chișinău 2060, Republic of Moldova
| | - Sergiu Cugut
- Act for Involvement (AFI) Nongovernmental organization, Varșovia St 2060, Chișinău 2060, Republic of Moldova.
| | - Frederick L Altice
- Yale University School of Medicine, Section of Infectious Diseases, 333 Cedar St, New Haven, CT 06510, USA; Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, 60 College St, New Haven, CT 06510, USA.
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Peiper NC, Shamblen S, Gilbertson A, Guest G, Kopp M, Guy L, Rose MR. Acceptability of a HIV self-testing program among people who use illicit drugs. International Journal of Drug Policy 2022; 103:103613. [DOI: 10.1016/j.drugpo.2022.103613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 12/19/2022]
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McManus KA, Davy-Mendez T, Killelea A, Schranz AJ. Access to Medications for Opioid Use Disorder for Persons With Human Immunodeficiency Virus in the United States: Gaps in Coverage by State AIDS Drug Assistance Programs. Open Forum Infect Dis 2022; 9:ofac057. [PMID: 35265727 PMCID: PMC8900929 DOI: 10.1093/ofid/ofac057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/27/2022] [Indexed: 11/14/2022] Open
Abstract
Life-saving medications for opioid use disorder are inaccessible for people with human immunodeficiency virus relying on the AIDS Drug Assistance Programs (ADAP) in 40% of jurisdictions. Funding/policies should address this through increasing access through ADAP and the Ryan White HIV/AIDS Program (RWHAP), partnerships between RWHAP and substance use programs, and other state/federal initiatives.
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Affiliation(s)
- Kathleen A McManus
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Thibaut Davy-Mendez
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Asher J Schranz
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
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Vallecillo G, Fonseca F, Marín G, Castillo C, Dinamarca F, Durán X, Torrens M. Reaching the 90–90–90 UNAIDS treatment target for people who inject drugs receiving integrated clinical care at a drug-use outpatient treatment facility. J Public Health (Oxf) 2022; 30:481-486. [DOI: 10.1007/s10389-020-01298-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Rosecrans A, Harris R, Saxton RE, Cotterell M, Zoltick M, Willman C, Blackwell I, Bell J, Hayes D, Weir B, Sherman S, Lucas GM, Greenbaum A, Page KR. Mobile low-threshold buprenorphine integrated with infectious disease services. J Subst Abuse Treat 2022; 133:108553. [PMID: 34238629 PMCID: PMC8702567 DOI: 10.1016/j.jsat.2021.108553] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/24/2021] [Accepted: 06/13/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION In 2018, the Baltimore City Health Department launched a mobile clinic called Healthcare on The Spot, which offers low-threshold buprenorphine services integrated with health care services to meet the needs of people who use drugs. In addition to buprenorphine management, The Spot offers testing and treatment for hepatitis C, sexually transmitted infections, and HIV, as well as pre-exposure prophylaxis for HIV, wound care, vaccinations, naloxone distribution, and case management. METHODS AND MATERIALS This cohort analysis includes clinical service data from the first 15 months of The Spot mobile clinic, from September 4, 2018, to November 23, 2019. The Spot co-located with the Baltimore syringe services program in five locations across the city. Descriptive data are provided for patient demographics and services provided, as well as percent of patients retained in buprenorphine treatment at one and three months. Logistic regression identified factors associated with retention at three months. RESULTS The Spot mobile clinic provided services to 569 individuals from September 4, 2018, to November 23, 2019, including prescribing buprenorphine to 73.8% and testing to more than 70% for at least one infectious disease. Patients receiving a prescription for buprenorphine were more likely to be tested for HIV, hepatitis C, and sexually transmitted infections, as well as receive treatment for hepatitis C and preventive services including vaccination and naloxone distribution. The Spot initiated HIV treatment for four patients and HIV pre-exposure prophylaxis for twelve patients. More than 32% of patients had hepatitis C; nineteen of these patients initiated treatment for hepatitis C with eight having a documented cure. Buprenorphine treatment retention was 56.0% at one month and 26.2% at three months. Patients who were Black or receiving treatment for hepatitis C were more likely to be retained in buprenorphine treatment at three months. CONCLUSIONS Increasing access to integrated medical services and drug treatment through low-threshold, community-based models of care can be an effective tool for addressing the effects of drug use.
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Affiliation(s)
- Amanda Rosecrans
- Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, USA,Baltimore City Health Department, 1200 E. Fayette St., Baltimore, MD, USA
| | - Robert Harris
- Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, USA,Baltimore City Health Department, 1200 E. Fayette St., Baltimore, MD, USA
| | - Ronald E. Saxton
- Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, USA
| | - Margaret Cotterell
- Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, USA,Baltimore City Health Department, 1200 E. Fayette St., Baltimore, MD, USA
| | - Meredith Zoltick
- Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, USA,Baltimore City Health Department, 1200 E. Fayette St., Baltimore, MD, USA
| | - Catherine Willman
- Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, USA,Baltimore City Health Department, 1200 E. Fayette St., Baltimore, MD, USA
| | - Ingrid Blackwell
- Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, USA,Baltimore City Health Department, 1200 E. Fayette St., Baltimore, MD, USA
| | - Joy Bell
- Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, USA,Baltimore City Health Department, 1200 E. Fayette St., Baltimore, MD, USA
| | - Darryl Hayes
- Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, USA,Baltimore City Health Department, 1200 E. Fayette St., Baltimore, MD, USA
| | - Brian Weir
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe, Baltimore, MD USA
| | - Susan Sherman
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe, Baltimore, MD USA
| | - Gregory M. Lucas
- Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, USA
| | - Adena Greenbaum
- Baltimore City Health Department, 1200 E. Fayette St., Baltimore, MD, USA
| | - Kathleen R. Page
- Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, USA
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Lee YK, Gold MS, Fuehrlein BS. Looking beyond the opioid receptor: A desperate need for new treatments for opioid use disorder. J Neurol Sci 2022; 432:120094. [PMID: 34933249 DOI: 10.1016/j.jns.2021.120094] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 10/19/2022]
Abstract
The mainstay of treatment for opioid use disorder (OUD) is opioid agonist therapy (OAT), which modulates opioid receptors to reduce substance craving and use. OAT maintains dependence on opioids but helps reduce overdose and negative sequelae of substance abuse. Despite increasing availability of OAT, its effectiveness is limited by difficulty in initiating and maintaining patients on treatment. With the worsening opioid epidemic in the United States and rising overdose deaths, a more durable and effective treatment for OUD is necessary. This paper reviews novel treatments being investigated for OUD, including neuromodulatory interventions, psychedelic drugs, and other novel approaches. Neuromodulatory interventions can stimulate the addiction neural circuitry involving the dorsolateral prefrontal cortex and deeper mesolimbic structures to curb craving and reduce use, and multiple clinical trials for interventional treatment for OUD are currently conducted. Similarly, psychedelic agents are being investigated for efficacy in OUD specifically. There is a resurgence of interest in psychedelic agents' therapeutic potential, with evidence of improving mood symptoms and decreased substance use even after just one dose. Exact mechanism of their anti-addictive effect is not fully elucidated, but psychedelic agents do not maintain opioid dependence and some may even be helpful in abating symptoms of withdrawal. Other potential approaches for OUD include targeting different parts of the dopamine-dependent addiction pathway, identifying susceptible genes and modulating gene products, as well as utilizing vaccines as immunotherapy to blunt the addictive effects of substances. Much more clinical data are needed to support efficacy and safety of these therapies in OUD, but these proposed novel treatments look beyond the opioid receptor to offer hope for a more durably effective OUD treatment.
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Affiliation(s)
- Yu Kyung Lee
- School of Medicine, Yale University, 333 Cedar St, New Haven, CT 06510, USA.
| | - Mark S Gold
- Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA.
| | - Brian S Fuehrlein
- Department of Psychiatry, Yale University, 300 George Street, New Haven, CT 06511, USA.
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Hassan R, Roland KB, Hernandez B, Goldman L, Evans KN, Gaul Z, Agnew-brune C, Buchacz K, Fukuda HD. A qualitative study of service engagement and unmet needs among unstably housed people who inject drugs in Massachusetts. J Subst Abuse Treat 2022. [DOI: 10.1016/j.jsat.2022.108722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/19/2021] [Accepted: 01/12/2022] [Indexed: 11/22/2022]
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Kennedy AJ, McGinnis KA, Merlin JS, Edelman EJ, Gordon AJ, Korthuis PT, Skanderson M, Williams EC, Wyse J, Oldfield B, Bryant K, Justice A, Fiellin DA, Kraemer KL. Impact of intensity of behavioral treatment, with or without medication treatment, for opioid use disorder on HIV outcomes in persons with HIV. J Subst Abuse Treat 2022; 132:108509. [PMID: 34130128 PMCID: PMC8628025 DOI: 10.1016/j.jsat.2021.108509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Persons with HIV (PWH) and opioid use disorder (OUD) can have poor health outcomes. We assessed whether intensity of behavioral treatment for OUD (BOUD) with and without medication for OUD (MOUD) is associated with improved HIV clinical outcomes. METHODS We used Veterans Aging Cohort Study (VACS) data from 2008 to 2017 to identify PWH and OUD with ≥1 BOUD episode. We assessed BOUD intensity and ≥6 months of MOUD (methadone or buprenorphine) receipt during the 12 months after BOUD initiation. Linear regression models assessed the association of BOUD intensity and MOUD receipt with pre-post changes in log viral load (VL), CD4 cell count, VACS Index 2.0, antiretroviral treatment (ART) initiation, and ART adherence. RESULTS Among 2419 PWH who initiated BOUD, we identified five distinct BOUD intensity trajectories: single visit (39% of sample); low-intensity, not sustained (37%); high-intensity, not sustained (9%); low-intensity, sustained (11%); and high-intensity, sustained (5%). MOUD receipt was low (17%). Among 709 PWH not on ART at the start of BOUD, ART initiation increased with increased BOUD intensity (p < 0.01). Among 1401 PWH on ART at the start of BOUD, ART adherence improved more in higher-intensity BOUD groups (p < 0.01). VL, CD4 count and VACS Index 2.0 did not differ by BOUD or ≥6 months of MOUD treatment. CONCLUSION Among PWH and OUD who initiated BOUD, higher intensity BOUD was associated with improved ART initiation and adherence, but neither BOUD alone nor BOUD plus ≥6 months MOUD was associated with improvements in VL, CD4 count or VACS Index 2.0.
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Affiliation(s)
- Amy J. Kennedy
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Jessica S. Merlin
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - E. Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | - Adam J. Gordon
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy, Division of Epidemiology, Department of Internal Medicine, University of Utah, and Informatics, Decision-Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - P. Todd Korthuis
- Division of General Internal Medicine, Section of Addiction Medicine, Oregon Health and Sciences University, Portland, OR, USA
| | | | - Emily C. Williams
- Department of Health Services, University of Washington, VA Puget Sound Healthcare System, Seattle, WA, USA,Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development VA Puget Sound Healthcare System, Seattle, WA, USA
| | - Jessica Wyse
- VA Portland Healthcare System, Portland, OR, USA,School of Public Health, Oregon Health and Sciences University, Portland, OR, USA
| | - Benjamin Oldfield
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Kendall Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Amy Justice
- VA Connecticut Healthcare System, West Haven, CT, USA,Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - David A. Fiellin
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | - Kevin L. Kraemer
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA,VA Pittsburgh Healthcare System, Pittsburgh, PA, USA,Corresponding author at: Division of General Internal Medicine, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 600, Pittsburgh, PA 15213; Telephone: 412-692-4843, Fax: 412-692-4838,
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Sivakumar A, Madden L, DiDomizio E, Eller A, Villanueva M, Altice FL. Treatment of Hepatitis C virus among people who inject drugs at a syringe service program during the COVID-19 response: The potential role of telehealth, medications for opioid use disorder and minimal demands on patients. Int J Drug Policy 2021; 101:103570. [PMID: 34954493 DOI: 10.1016/j.drugpo.2021.103570] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/19/2021] [Accepted: 12/08/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Healthcare delivery was disrupted during the COVID-19 pandemic, requiring minimized in-person contact between patients and clinicians. During the pandemic, people with opioid use disorder (OUD) were not only at elevated risk for COVID-19, but had markedly reduced access to treatment for OUD, Hepatitis C virus (HCV) and HIV due to recommended decreased in-person visits. METHODS From March 15-June 15, 2020 at the syringe services program (SSP) in New Haven, Connecticut, USA, a differentiated care model evolved with reduced clinical demands on people who inject drugs (PWID) to ensure screening and treatment for HCV, HIV and OUD, with a focus on HCV treatment. This model involved a single, bundled screening, evaluation, testing (SET) and monitoring strategy for all three conditions, minimal in-person visits, followed by tele-health communication between patients, outreach workers and clinicians. In-person visits occurred only during induction onto methadone and phlebotomy at baseline and phlebotomy 12 weeks post-treatment for HCV to measure sustained virological response (SVR). Patients received supportive texts/calls from outreach workers and clinicians. RESULTS Overall, 66 actively injecting PWID, all with OUD, underwent bundled laboratory screening; 35 had chronic HCV infection. Participants were 40 years (mean), mostly white (N = 18) men (N = 28) and 12 were unstably housed. Two were lost to-follow-up and 2 were incarcerated, leaving 31 who started pan-genotypic direct-acting antivirals (DAAs). The mean time from referral to initial phlebotomy and initiation of DAAs was 6.9 and 9.9 days, respectively. Fourteen additional patients were newly started on buprenorphine and 6 started on methadone; three and four, respectively, were on treatment at baseline. Overall, 29 (93.5%) PWID who initiated DAAs achieved SVR; among unstably housed persons the SVR was 83.3%. CONCLUSIONS In response to COVID-19, an innovative differentiated care model for PWID at an SSP evolved that included successful co-treatment for HCV, HIV and OUD using a client-centered approach that reduces treatment demands on patients yet supports ongoing access to evidence-based treatments.
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Simon L, Choudhary A, Ticku S, Barrow J, Tobey M. Dental care utilization in Massachusetts before and after initiation of medication for opioid use disorder: A cross-sectional study of a state all-payer claims database. J Public Health Dent 2021; 82:461-467. [PMID: 34816438 DOI: 10.1111/jphd.12488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 11/02/2021] [Accepted: 11/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Individuals with opioid use disorder (OUD) are at higher risk of poor oral health. Medication for opioid use disorder (MOUD) has been shown to improve outcomes for patients with OUD, but it is unknown how initiation of MOUD affects access to oral health services. METHODS This was a retrospective analysis of all individuals in the Massachusetts All-Payer Claims Database prescribed oral buprenorphine-naloxone or injectable naltrexone from 2013 to 2016. We evaluated dental utilization in the year before and after beginning MOUD. A logistic regression predicting dental utilization was conducted. RESULTS Among the 54,791 individuals, rates of dental utilization were low both before and after MOUD (10.5% and 10% with a dental visit, respectively). Of those who did not have a dental visit in the year before starting MOUD, 95.1% did not have a dental visit in the year after. Rates of various procedure types were comparable before and after MOUD. In a logistic regression, a prior dental visit was associated with 9.82 times the odds (95% CI 9.14-10.55) of having a dental visit after starting MOUD; increasing age, being prescribed naltrexone, having a mood disorder or HIV, year of initiation or being on Medicaid were also associated with having a dental visit. Male patients and those with Medicare or private insurance were less likely to have a dental visit. CONCLUSIONS Initiating MOUD did not substantially result in increased dental access or substantial changes in dental procedures received. Patients receiving treatment for OUD may require additional support to access dental care.
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Affiliation(s)
- Lisa Simon
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Abhishek Choudhary
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Shenam Ticku
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Jane Barrow
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Matthew Tobey
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Kudrina I, Puzhko S, Filion KB, Gore G, Paraskevopoulos E, Windle S, Martel MO, Eisenberg MJ. Effectiveness of interventions for prevention of common infections in people who use opioids: a protocol for a systematic review of systematic reviews. Syst Rev 2021; 10:298. [PMID: 34782008 PMCID: PMC8591821 DOI: 10.1186/s13643-021-01852-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 11/01/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The North American opioid crisis is driven by opioid-related mortality and morbidity, including opioid use-associated infections (OUAIs), resulting in a substantial burden for society. Users of legal and illegal opioids are at an increased risk of OUAIs compared to individuals not using opioids. As reported for hepatitis C virus (HCV), human immunodeficiency virus (HIV), bacterial, fungal, and other infections, OUAIs transmission and acquisition risks may be modifiable. Several systematic reviews (SRs) synthetized data regarding interventions to prevent infections in persons using drugs (e.g., opioid substitution therapy, needle and syringes exchange programs, psycho-social interventions); however, their conclusions varied. Therefore, SR of published SRs is needed to synthesize the highest level of evidence on the scope and effectiveness of interventions to prevent OUAIs in people using opioids legally or illegally. METHODS We will comprehensively search for SRs in the PubMed, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Epistemonikos, and Google Scholar databases from inception to November 2020. Data selection and extraction for each SR will be performed independently by two researchers, with disagreements resolved by consensus. All SRs regarding interventions with evaluated effectiveness to prevent OUAI in legal and/or illegal opioid users will be eligible. Risk of bias assessment will be performed using the AMSTAR2 tool. The results will be qualitatively synthesized, and a typology of interventions' effectiveness with a statement on the strength of evidence for each category will be created. DISCUSSION Our pilot search of PubMed resulted in 379 SRs analyzing the effectiveness of interventions to prevent HCV and HIV in persons who inject different types of drugs, including opioids. Of these 379 SRs, 8 evaluated primary studies where participants used opioids and would therefore be eligible for inclusion. The search results thus justify the application of SR of SRs approach. Comprehensive data on the scope and effectiveness of existing interventions to prevent OUAIs will help policy-makers to plan and implement preventive interventions and will assist clinicians in the guidance for their patients using opioids. SYSTEMATIC REVIEW REGISTRATION Registered in PROSPERO on 30 July 2020 ( #195929 ).
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Affiliation(s)
- Irina Kudrina
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, 5858 Chemin de la Côte-des-Neiges, Suite 300, Montreal, QC H3S 1Z1 Canada
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, 1650 Cedar Ave., Montreal, QC H3G 1A4 Canada
| | - Svetlana Puzhko
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, 5858 Chemin de la Côte-des-Neiges, Suite 300, Montreal, QC H3S 1Z1 Canada
| | - Kristian B. Filion
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Purvis Hall, 1020 Pine Avenue West, Montreal, QC H3A 1A2 Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC H3T 1E2 Canada
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University Health Center, McGill University, 1001 Decarie Boulevard, Suite D05-2212, Montreal, QC H4A3JI Canada
| | - Genevieve Gore
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, 3459 rue McTavish, Montreal, QC H3A OC9 Canada
| | - Elena Paraskevopoulos
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, 5858 Chemin de la Côte-des-Neiges, Suite 300, Montreal, QC H3S 1Z1 Canada
- Queensway Carleton Hospital, 3045 Baseline Rd, Ottawa, ON K2H 8P4 Canada
| | - Sarah Windle
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Purvis Hall, 1020 Pine Avenue West, Montreal, QC H3A 1A2 Canada
| | - Marc O. Martel
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, 1650 Cedar Ave., Montreal, QC H3G 1A4 Canada
- Faculty of Dentistry, McGill University, 2001 Avenue McGill College, Suite 500, Montreal, QC H3A 1G1 Canada
| | - Mark J. Eisenberg
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Purvis Hall, 1020 Pine Avenue West, Montreal, QC H3A 1A2 Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC H3T 1E2 Canada
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, 3605 de la Montagne, Montreal, Qc H3G 2M1 Canada
- Division of Cardiology, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC H3T 1E2 Canada
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50
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Vinh VH, Vallo R, Giang HT, Huong DT, Oanh KTH, Khue PM, Thanh NTT, Quillet C, Rapoud D, Michel L, de Perre PV, Feelemyer J, Moles JP, Cournil A, Jarlais DD, Laureillard D, Nagot N. A cohort study revealed high mortality among people who inject drugs in Hai Phong, Vietnam. J Clin Epidemiol 2021; 139:38-48. [PMID: 34280476 PMCID: PMC10116693 DOI: 10.1016/j.jclinepi.2021.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 06/28/2021] [Accepted: 07/12/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To estimate the residual mortality rate among people who inject drugs (PWID) in a Low-Middle Income Countries context where the HIV epidemic has been controlled and methadone coverage is high. STUDY DESIGN AND SETTING PWID from Haiphong, Vietnam, were recruited through three annual respondent-driven sampling surveys that fueled two cohorts of PWID with HIV (n = 761) and without HIV (n = 897), with bi-annual follow-up. Presumed causes of death were ascertained from medical records and/or interviews of participants family. RESULTS Among the 1658 participants with a median follow-up of 2 years, 67 and 36 died in the HIV-positive and HIV-negative cohort, respectively, yielding crude mortality rates of 4.3 (95% Confidence interval (CI): 3.3-5.4) per 100 person-years of follow-up (PYFU) and 1.9 (CI: 1.4-2.6) per 100 PYFU. In the HIV-positive cohort, in which 81% of participants had undetectable viral load, the two main causes of death were tuberculosis and HIV-related diseases. In the HIV-negative cohort, the two main causes of death were liver-related diseases and overdose. In a time-dependent multivariable model, "unsuppressed viral load" was associated with increased risk of mortality, whereas "being on methadone" or "being employed" was associated with a lower risk. CONCLUSION Despite a very successful HIV and methadone program, the mortality remains high among PWID in Vietnam, largely due to curable infectious diseases such as tuberculosis and viral hepatitis.
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Affiliation(s)
- Vu Hai Vinh
- Department of Infectious and Tropical Diseases, Viet Tiep Hospital, Hai Phong, Vietnam
| | - Roselyne Vallo
- Pathogenesis and control of chronic infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles, Montpellier, France
| | - Hoang Thi Giang
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Duong Thi Huong
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | | | - Pham Minh Khue
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | | | - Catherine Quillet
- Pathogenesis and control of chronic infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles, Montpellier, France
| | - Delphine Rapoud
- Pathogenesis and control of chronic infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles, Montpellier, France
| | - Laurent Michel
- Pierre Nicole Centre, French Red Cross, CESP/Inserm 1018, Paris, France
| | - Philippe Van de Perre
- Pathogenesis and control of chronic infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles, Montpellier, France
| | | | - Jean Pierre Moles
- Pathogenesis and control of chronic infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles, Montpellier, France.
| | - Amandine Cournil
- Pathogenesis and control of chronic infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles, Montpellier, France
| | | | - Didier Laureillard
- Pathogenesis and control of chronic infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles, Montpellier, France; Department of Infectious Diseases, Caremeau University Hospital, Nîmes, France
| | - Nicolas Nagot
- Pathogenesis and control of chronic infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles, Montpellier, France.
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