1
|
Bolinski RS, Walters S, Salisbury-Afshar E, Ouellet LJ, Jenkins WD, Almirol E, Van Ham B, Fletcher S, Johnson C, Schneider JA, Ompad D, Pho MT. The Impact of the COVID-19 Pandemic on Drug Use Behaviors, Fentanyl Exposure, and Harm Reduction Service Support among People Who Use Drugs in Rural Settings. Int J Environ Res Public Health 2022; 19:2230. [PMID: 35206421 PMCID: PMC8872091 DOI: 10.3390/ijerph19042230] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The COVID-19 pandemic has worsened the opioid overdose crisis in the US. Rural communities have been disproportionately affected by opioid use and people who use drugs in these settings may be acutely vulnerable to pandemic-related disruptions due to high rates of poverty, social isolation, and pervasive resource limitations. METHODS We performed a mixed-methods study to assess the impact of the pandemic in a convenience sample of people who use drugs in rural Illinois. We conducted 50 surveys capturing demographics, drug availability, drug use, sharing practices, and mental health symptoms. In total, 19 qualitative interviews were performed to further explore COVID-19 knowledge, impact on personal and community life, drug acquisition and use, overdose, and protective substance use adaptations. RESULTS Drug use increased during the pandemic, including the use of fentanyl products such as gel encapsulated "beans" and "buttons". Disruptions in supply, including the decreased availability of heroin, increased methamphetamine costs and a concomitant rise in local methamphetamine production, and possible fentanyl contamination of methamphetamine was reported. Participants reported increased drug use alone, experience and/or witness of overdose, depression, anxiety, and loneliness. Consistent access to harm reduction services, including naloxone and fentanyl test strips, was highlighted as a source of hope and community resiliency. CONCLUSIONS The COVID-19 pandemic period was characterized by changing drug availability, increased overdose risk, and other drug-related harms faced by people who use drugs in rural areas. Our findings emphasize the importance of ensuring access to harm reduction services, including overdose prevention and drug checking for this vulnerable population.
Collapse
Affiliation(s)
- Rebecca S. Bolinski
- Department of Sociology, Southern Illinois University, 475 Clocktower Drive, Room 323A, Carbondale, IL 62901, USA
| | - Suzan Walters
- Center for Drug Use and HIV|HCV Research, School of Global Public Health, New York University, New York, NY 10003, USA; (S.W.); (D.O.)
| | - Elizabeth Salisbury-Afshar
- Department of Family Medicine and Community Health, Madison School of Medicine and Public Health, University of Wisconsin, Madison, WI 53792, USA;
| | - Lawrence J. Ouellet
- Division of Epidemiology and Biostatistics/COIP (MC 923), School of Public Health, University of Illinois Chicago, 1603 W. Taylor, Chicago, IL 60607, USA;
| | - Wiley D. Jenkins
- Epidemiology and Biostatistics, Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL 62794, USA;
| | - Ellen Almirol
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA;
| | - Brent Van Ham
- Center for Rural Health and Social Service Development, Southern Illinois University School of Medicine, Carbondale, IL 62901, USA;
| | - Scott Fletcher
- The Community Action Place, Inc., 1400 N. Wood Road Suite 7, Murphysboro, IL 62966, USA;
| | - Christian Johnson
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL 60637, USA; (C.J.); (J.A.S.); (M.T.P.)
| | - John A. Schneider
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL 60637, USA; (C.J.); (J.A.S.); (M.T.P.)
| | - Danielle Ompad
- Center for Drug Use and HIV|HCV Research, School of Global Public Health, New York University, New York, NY 10003, USA; (S.W.); (D.O.)
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY 10003, USA
| | - Mai T. Pho
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL 60637, USA; (C.J.); (J.A.S.); (M.T.P.)
| |
Collapse
|
2
|
Liebermann E, Van Devanter N, Frías Gúzman N, Hammer MJ, Ompad D. Dominican Provider Attitudes Towards HPV Testing for Cervical Cancer Screening and, Current Challenges to Cervical Cancer Prevention in the Dominican Republic: a Mixed Methods Study. J Cancer Educ 2021; 36:1170-1185. [PMID: 32307667 PMCID: PMC7572473 DOI: 10.1007/s13187-020-01746-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Indexed: 06/11/2023]
Abstract
Creating effective programs for cervical cancer prevention is essential to avoid premature deaths from cervical cancer. The Dominican Republic has persistently high rates of cervical cancer, despite the availability of Pap smear screening. This study explored Dominican provider attitudes towards human papillomavirus (HPV) testing and current challenges to effective cervical cancer prevention. In this Consolidated Framework for Implementation Research (CFIR)-driven mixed methods study, we conducted in-depth interviews (N = 21) and surveys (N = 202) with Dominican providers in Santo Domingo and Monte Plata provinces regarding their perspectives on barriers to cervical cancer prevention and their knowledge and attitudes towards HPV testing as an alternative to Pap smear. Providers believed the main barrier to cervical cancer prevention was lack of cervical cancer awareness and resulting inadequate population screening coverage. Providers felt that Pap smear was widely available to women in the Dominican Republic and were unsure how a change to HPV testing for screening would address gaps in current cervical cancer screening programs. A subset of providers felt HPV testing offered important advantages for early detection of cervical cancer and were in favor of more widespread use. Cost of the HPV test and target age for screening with HPV testing were the main barriers to acceptability. Providers had limited knowledge of HPV testing as a screening test. The group was divided in terms of the potential impact of a change in screening test in addressing barriers to cervical cancer prevention in the Dominican Republic. Findings may inform interventions to disseminate global evidence-based recommendations for cervical cancer screening.
Collapse
Affiliation(s)
- Erica Liebermann
- New York University Rory Meyers College of Nursing, 433 First Avenue, 6th floor, New York, NY, 10010, USA.
| | - Nancy Van Devanter
- New York University Rory Meyers College of Nursing, 433 First Avenue, 6th floor, New York, NY, 10010, USA
| | - Natalia Frías Gúzman
- Instituto Nacional de Cáncer Rosa Emilia Sánchez Pérez de Tavares (INCART), Avenida Correa y Cidrón, 10103, Santo Domingo, Dominican Republic
| | - Marilyn J Hammer
- Dana-Farber Cancer Institute, 450 Brookline Avenue, LW523, Boston, MA, 02215, USA
| | - Danielle Ompad
- New York University College of Global Public Health, 715 Broadway, Rm 1011, New York, NY, 10003, USA
| |
Collapse
|
3
|
Liebermann E, Hammer MJ, Gúzman NF, Van Devanter N, Ompad D. Dominican Provider Practices for Cervical Cancer Screening in Santo Domingo and Monte Plata Provinces. J Cancer Educ 2021; 36:693-701. [PMID: 31953801 PMCID: PMC9743805 DOI: 10.1007/s13187-020-01690-9] [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] [Indexed: 06/10/2023]
Abstract
Cervical cancer is the second leading cause of cancer death for women in the Dominican Republic. Pap smear screening in the Dominican Republic has not achieved adequate reduction in cervical cancer mortality. The purpose of this study was to examine Dominican provider practices for cervical cancer screening and the use of national or international screening guidelines. We surveyed 101 gynecology specialists, 50 non-specialists, and 51 obstetrics-gynecology residents in the Santo Domingo and Monte Plata provinces of the Dominican Republic regarding their cervical cancer screening practices and use of guidelines. Bivariate (chi-square) analyses were conducted to compare screening practices by demographic and practice characteristics. The majority of providers followed WHO guidelines (62.9%) and/or Dominican national norms (59.4%). The majority (87%) of providers use time since first sexual activity as the basis for screening initiation; 96% advise screening every 6-12 months. The most commonly used screening test is the conventional Pap smear. Colposcopy was recommended most often for all abnormal Pap results. Dominican providers report they follow national and/or international cervical cancer screening guidelines. They do not follow age-based screening guidelines, nor have they adopted an extended interval for screening and continue to recommend screening at least annually. A culture of early and frequent screening has consequences in terms of cost, high demand for follow-up services, and reduced capacity to reach the populations at highest risk. Early screening also may challenge the acceptability of adopting alternative screening technologies such as HPV testing.
Collapse
Affiliation(s)
- Erica Liebermann
- New York University Rory Meyers College of Nursing, 433 First Avenue, 6th floor, New York, NY, 10010, USA.
| | - Marilyn J Hammer
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, 450 Brookline Avenue, LW523, Boston, MA, 02215, USA
| | - Natalia Frías Gúzman
- Instituto Nacional de Cáncer Rosa Emilia Sánchez Pérez de Tavares (INCART), Avenida Correa y Cidrón, 10103, Santo Domingo, Dominican Republic
| | - Nancy Van Devanter
- New York University Rory Meyers College of Nursing, 433 First Avenue, Rm 670, New York, NY, 10010, USA
| | - Danielle Ompad
- New York University College of Global Public Health, 715 Broadway, Rm 1011, New York, NY, 10003, USA
| |
Collapse
|
4
|
Liebermann E, Devanter NV, Frías Gúzman N, Ompad D, Shirazian T, Healton C. Parent-Level Barriers and Facilitators to HPV Vaccine Implementation in Santo Domingo, Dominican Republic. J Community Health 2020; 45:1061-1066. [PMID: 32394119 PMCID: PMC10626339 DOI: 10.1007/s10900-020-00830-y] [Citation(s) in RCA: 2] [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] [Indexed: 10/24/2022]
Abstract
Cervical cancer is the second leading cause of cancer death for women in the Dominican Republic. Vaccination against human papillomavirus (HPV) could reduce mortality from cervical cancer globally by as much as 90%. The purpose of our study was to explore multi-level barriers and facilitators to implementation of a national HPV vaccine program in the Dominican Republic; this article focuses on parent-level barriers and facilitators. In this qualitative study, we conducted six focus groups (N = 64) with parents of school-age children in the Santo Domingo area of the Dominican Republic, representing diverse socioeconomic groups and geographic settings. Thematic content analysis, using inductive and deductive approaches, was done following transcription and translation of audio-recordings from focus group discussions. Among this group of parents in the Santo Domingo area, facilitators to vaccine uptake were favorable attitudes towards vaccines in general and concern about cervical cancer as a health issue. Barriers found were low to moderate knowledge of HPV and cervical cancer, especially in the rural and suburban groups, and cost and lack of public awareness of the vaccine. This study identified key barriers and facilitators to HPV vaccine implementation in the Dominican Republic. Health messaging, incorporating specialist providers as opinion leaders, will need to be tailored to broad audiences with varying levels of information and awareness, anticipating misinformation and concerns, and will need to emphasize HPV vaccine as a method to prevent cancer.
Collapse
Affiliation(s)
- Erica Liebermann
- New York University Rory Meyers College of Nursing, 433 First Avenue, 6th floor, New York, NY, 10010, USA.
| | - Nancy Van Devanter
- New York University Rory Meyers College of Nursing, 433 First Avenue, Rm 670, New York, NY, 10010, USA
| | - Natalia Frías Gúzman
- Instituto Nacional de Cáncer Rosa Emilia Sánchez Pérez de Tavares (INCART), Avenida Correa y Cidrón, Santo Domingo, 10103, Dominican Republic
| | - Danielle Ompad
- New York University College of Global Public Health, 715 Broadway, Rm 1011, New York, NY, 10003, USA
| | - Taraneh Shirazian
- New York University College of Global Public Health, 207 E 84th Street, 206, New York, NY, 10028, USA
| | - Cheryl Healton
- New York University College of Global Public Health, 665 Broadway, New York, NY, 10012, USA
| |
Collapse
|
5
|
Lopez Jr V, Victoria C, Ompad D, Ma R, Weinstein M, Cantu R, Allen A. Are playing differences between men and women risk factors for head, neck & face injuries in U.S. rugby-7s? J Sci Med Sport 2019. [DOI: 10.1016/j.jsams.2019.08.186] [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: 11/30/2022]
|
6
|
Liebermann EJ, VanDevanter N, Shirazian T, Frías Gúzman N, Niles M, Healton C, Ompad D. Barriers to Cervical Cancer Screening and Treatment in the Dominican Republic: Perspectives of Focus Group Participants in the Santo Domingo Area. J Transcult Nurs 2019; 31:121-127. [DOI: 10.1177/1043659619846247] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction: Cervical cancer is the second leading cause of cancer death among women in the Dominican Republic, and high rates persist despite existing Pap smear screening programs. The purpose of this study was to explore Dominican women’s knowledge and attitudes regarding human papillomavirus (HPV) and cervical cancer, cervical cancer screening practices, and perceived barriers and facilitators to early detection of cervical cancer. Method: Six focus groups ( N = 64) were conducted in Spanish in urban, suburban, and rural locations, in private and public school settings, community and workplace settings, in or near Santo Domingo, as part of a larger study on barriers and facilitators to HPV vaccine implementation. Audio recordings were transcribed verbatim and translated from Spanish to English. Qualitative data analysis used inductive and deductive approaches. Results: Knowledge regarding HPV and cervical cancer varied across groups, but all agreed there was significant stigma and fear regarding HPV. Most women reported having Pap screening at least yearly. Follow-up of abnormal Pap testing was less consistent, with cost and uncertainty about provider recommendations identified as barriers. Discussion: Broader examination of provider-level and health system barriers and facilitators to cervical cancer prevention in the Dominican Republic is essential, in order to inform interventions to improve the effectiveness of cervical cancer screening and treatment programs and reduce preventable deaths.
Collapse
Affiliation(s)
| | | | | | - Natalia Frías Gúzman
- Instituto Nacional de Cáncer Rosa Emilia Sánchez Pérez de Tavares, Santo Domingo, Dominican Republic
| | | | | | | |
Collapse
|
7
|
Tieu HV, Nandi V, Hoover DR, Lucy D, Stewart K, Frye V, Cerda M, Ompad D, Latkin C, Koblin BA. Do Sexual Networks of Men Who Have Sex with Men in New York City Differ by Race/Ethnicity? AIDS Patient Care STDS 2016; 30:39-47. [PMID: 26745143 DOI: 10.1089/apc.2015.0237] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
The United States HIV epidemic disproportionately affects Black and Hispanic men who have sex with men (MSM). This disparity might be partially explained by differences in social and sexual network structure and composition. A total of 1267 MSM in New York City completed an ACASI survey and egocentric social and sexual network inventory about their sex partners in the past 3 months, and underwent HIV testing. Social and sexual network structure and composition were compared by race/ethnicity of the egos: black, non-Hispanic (N = 365 egos), white, non-Hispanic (N = 466), and Hispanic (N = 436). 21.1% were HIV-positive by HIV testing; 17.2% reported serodiscordant and serostatus unknown unprotected anal/vaginal intercourse (SDUI) in the last 3 months. Black MSM were more likely than white and Hispanic MSM to report exclusively having partners of same race/ethnicity. Black and Hispanic MSM had more HIV-positive and unknown status partners than white MSM. White men were more likely to report overlap of social and sex partners than black and Hispanic men. No significant differences by race/ethnicity were found for network size, density, having concurrent partners, or having partners with ≥10 years age difference. Specific network composition characteristics may explain racial/ethnic disparities in HIV infection rates among MSM, including HIV status of sex partners in networks and lack of social support within sexual networks. Network structural characteristics such as size and density do not appear to have such an impact. These data add to our understanding of the complexity of social factors affecting black MSM and Hispanic MSM in the U.S.
Collapse
Affiliation(s)
- Hong-Van Tieu
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York City, New York
| | - Vijay Nandi
- Laboratory of Analytical Sciences, New York Blood Center, New York City, New York
| | - Donald R. Hoover
- Department of Biostatistics, Rutgers University, New Brunswick, New Jersey
| | - Debbie Lucy
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York City, New York
| | - Kiwan Stewart
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York City, New York
| | - Victoria Frye
- Laboratory of Behavioral and Social Sciences, New York Blood Center, New York City, New York
| | - Magdalena Cerda
- Department of Emergency Medicine, University of California, Davis, California
| | - Danielle Ompad
- New York University Steinhardt School of Culture, Education, and Human Development, New York City, New York
| | - Carl Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Beryl A. Koblin
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York City, New York
| | | |
Collapse
|
8
|
Joshi S, Mooney SJ, Kennedy GJ, Benjamin EO, Ompad D, Rundle AG, Beard JR, Cerdá M. Beyond METs: types of physical activity and depression among older adults. Age Ageing 2016; 45:103-9. [PMID: 26764399 DOI: 10.1093/ageing/afv164] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [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: 01/30/2023] Open
Abstract
BACKGROUND/OBJECTIVES physical activity may be beneficial in reducing depression incidence among the elderly. A key unanswered question is whether certain types of physical activity are particularly associated with decreased depression incidence. We examined the relationship between quantity and type of physical activity and subsequent depression using longitudinal data from elderly adults in New York City (NYC). METHODS we followed 3,497 adults aged 65-75 living in NYC for three years. Total physical activity was measured using the Physical Activity Scale for the Elderly (PASE) and type of physical activity was measured using a latent class analysis of PASE item responses. We used generalised estimating equations to measure the relationship between quantity and latent class of physical activity at waves 1-2 and depression at waves 2-3, controlling for wave-1 depression. RESULTS individuals in the second highest quartile (50-75%) (odds ratio (OR) = 0.45; 95% confidence interval (CI) = 0.23, 0.88) and highest quartile of activity (OR = 0.31; 95% CI = 0.16, 0.63) had lower odds of depression. Among all subjects, athletic types (OR = 0.25; 95% CI = 0.12, 0.51) and walker types (OR = 0.58; 95% CI = 0.34, 0.99) had lower odds of depression. Among non-disabled participants, walkers (OR = 0.36; 95% CI = 0.18, 0.73), athletic types (OR = 0.14; 95% CI = 0.06, 0.32), domestic/gardening types (OR = 0.29; 95% CI = 0.12, 0.73) and domestic/gardening athletic types (OR = 0.13; 95% CI = 0.02, 0.75) had lower odds of depression. CONCLUSION respondents who practised the highest levels of physical activity and who performed athletic activities were at lower risk for depression. Interventions aimed at promoting athletic physical activity among older adults may generate benefits for mental health.
Collapse
Affiliation(s)
- Spruha Joshi
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Stephen J Mooney
- Department of Epidemiology, Columbia University, New York, NY 10032, USA
| | - Gary J Kennedy
- Geriatric Psychiatry, Montefiore Medical Center, New York, NY, USA Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York, NY, USA
| | - Ebele O Benjamin
- Center for Evaluation and Applied Research, The New York Academy of Medicine, New York, NY, USA
| | | | - Andrew G Rundle
- Department of Epidemiology, Columbia University, New York, NY 10032, USA
| | - John R Beard
- School of Public Health, University of Sydney, Australia
| | - Magdalena Cerdá
- Department of Emergency Medicine, University of California, Davis, Sacramento, CA, USA
| |
Collapse
|
9
|
Frye V, Egan JE, Van Tieu H, Cerdá M, Ompad D, Koblin BA. "I didn't think I could get out of the fucking park." Gay men's retrospective accounts of neighborhood space, emerging sexuality and migrations. Soc Sci Med 2014; 104:6-14. [PMID: 24581056 PMCID: PMC4226215 DOI: 10.1016/j.socscimed.2013.12.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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: 08/22/2012] [Revised: 08/07/2013] [Accepted: 12/05/2013] [Indexed: 11/21/2022]
Abstract
Young, African American and Latino gay, bisexual and other men who have sex with men (MSM) are disproportionately represented among new HIV cases according to the most recent national surveillance statistics. Analysts have noted that these racial/ethnic disparities in HIV among MSM exist within the wider context of sexual, mental and physical health disparities between MSM and heterosexuals. The intercorrelation of these adverse health outcomes among MSM, termed syndemics, has been theorized to be socially produced by a heterosexist social system that marginalizes lesbian, gay, bisexual, MSM and other sexual minorities. African American and Latino MSM experience overlapping systems of oppression that may increase their risk of experiencing syndemic health outcomes. In this paper, using data from twenty in-depth qualitative interviews with MSM living in four New York City (NYC) neighborhoods, we present accounts of neighborhood space, examining how space can both physically constitute and reinforce social systems of stratification and oppression, which in turn produce social disparities in sexual health outcomes. By analyzing accounts of emerging sexuality in neighborhood space, i.e. across time and space, we identify pathways to risk and contribute to our understanding of how neighborhood space is experienced by gay men, adding to our ability to support young men as they emerge in place and to shape the social topography of urban areas.
Collapse
Affiliation(s)
- Victoria Frye
- Lindsley F. Kimball Research Institute, United States; Columbia University, United States.
| | | | - Hong Van Tieu
- Lindsley F. Kimball Research Institute, United States; Columbia University, United States
| | | | | | | |
Collapse
|
10
|
Hofstetter AM, Stockwell MS, Al-Husayni N, Ompad D, Natarajan K, Rosenthal SL, Soren K. HPV vaccination: are we initiating too late? Vaccine 2014; 32:1939-45. [PMID: 24530404 DOI: 10.1016/j.vaccine.2014.01.084] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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: 09/23/2013] [Revised: 01/27/2014] [Accepted: 01/30/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) vaccination is recommended in early adolescence. While limited data suggest that patients frequently delay initiation of the three-dose series, age-based variability in initiation of HPV vaccination and its clinical relevance are not well described. Thus, this study aims to characterize HPV vaccination delay among adolescent and young adult females. METHODS This retrospective cohort study examined age at HPV vaccination initiation and missed opportunities for receipt of the first vaccine dose (HPV1) among 11-26 year-old females (n=22,900) receiving care at 16 urban academically-affiliated ambulatory care clinics between 2007 and 2011. Predictors of timely vaccination and post-licensure trends in age at HPV1 receipt were assessed using multivariable logistic regression and a generalized linear mixed model, respectively. Chlamydia trachomatis and Papanicolaou screening before HPV vaccination initiation, as markers of prior sexual experience and associated morbidity, were examined in a subcohort of subjects (n=15,049). RESULTS The proportion of 11-12 year-olds who initiated HPV vaccination increased over time (44.4% [2007] vs. 74.5% [2011], p<0.01). Initiation rates also improved among 13-26 year-olds. Thus, the mean age at HPV1 receipt remained unchanged between 2007 and 2011 (16.0 ± 2.7 vs. 15.9 ± 4.0 years, p=0.45). Spanish language was a positive predictor (AOR 1.62, 95% CI 1.05-2.48) of HPV vaccination initiation among 11-12 year-olds in 2011. The majority (70.8-76.4%) of unvaccinated subjects experienced missed vaccination opportunities. Of the subcohort, 36.9% underwent Chlamydia screening before HPV1 receipt (19.1% with ≥ 1 positive result). Of those with prior Papanicolaou screening (16.6%), 32.1% had ≥ 1 abnormal result. CONCLUSIONS These low-income, minority females frequently delayed initiation of HPV vaccination. Many had evidence of prior sexual experience and associated morbidity, placing them at risk of HPV-related complications. Promoting timely HPV vaccination and reducing missed vaccination opportunities are crucial.
Collapse
Affiliation(s)
- Annika M Hofstetter
- Department of Pediatrics, Columbia University, New York, NY, USA; NewYork-Presbyterian Hospital, New York, NY, USA.
| | - Melissa S Stockwell
- Department of Pediatrics, Columbia University, New York, NY, USA; NewYork-Presbyterian Hospital, New York, NY, USA; Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Noor Al-Husayni
- Department of Pediatrics, Columbia University, New York, NY, USA.
| | - Danielle Ompad
- Department of Nutrition, Food Studies, and Public Health, Steinhardt School of Culture, Education and Human Development, New York University, New York, NY, USA; Center for Health, Identity, Behavior, and Prevention Studies, Steinhardt School of Culture, Education and Human Development, New York University, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Karthik Natarajan
- NewYork-Presbyterian Hospital, New York, NY, USA; Department of Biomedical Informatics, Columbia University, New York, NY, USA.
| | - Susan L Rosenthal
- Department of Pediatrics, Columbia University, New York, NY, USA; NewYork-Presbyterian Hospital, New York, NY, USA.
| | - Karen Soren
- Department of Pediatrics, Columbia University, New York, NY, USA; NewYork-Presbyterian Hospital, New York, NY, USA; Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA.
| |
Collapse
|
11
|
Panchanadeswaran S, Frye V, Nandi V, Galea S, Vlahov D, Ompad D. Intimate partner violence and consistent condom use among drug-using heterosexual women in New York City. Women Health 2010; 50:107-24. [PMID: 20437300 PMCID: PMC2882151 DOI: 10.1080/03630241003705151] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [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
The present study examined the associations of relationship factors, partner violence, relationship power, and condom-use related factors with condom use with a main male partner among drug-using women. Over two visits, 244 heterosexual drug-using women completed a cross-sectional survey. Multivariate logistic regression models indicated that women who expected positive outcomes and perceived lower condom-use barriers were more likely to report condom use with their intimate partners. The findings suggest that future interventions aiming at reducing HIV risk among drug-using women should focus on women's subjective appraisals of risks based on key relationship factors in addition to the occurrence of partner violence.
Collapse
Affiliation(s)
- Subadra Panchanadeswaran
- Assistant Professor, Adelphi University School of Social Work, 1 South Avenue, Garden City, NY 11530, , Telephone: 516-877-4310, Fax: 516-877-4392
| | - Victoria Frye
- Adjunct Research Investigator, Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY 10019,
| | - Vijay Nandi
- Sr. Research Analyst, Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY 10019, , Telephone: 212-419-3535
| | - Sandro Galea
- Director, Center for Global Health, Professor of Epidemiology, School of Public Health Professor of Emergency Medicine, Medical School Research Professor, Institute for Social Research University of Michigan, Ann Arbor, MI, 48109, , Telephone: 734.647.9741
| | - David Vlahov
- Senior Vice President for Research and Director, Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY 10019, , Telephone: 212-822-7283
| | - Danielle Ompad
- Associate Director Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY 10019, , Telephone: 212-822-7283
| |
Collapse
|
12
|
Beard JR, Blaney S, Cerda M, Frye V, Lovasi GS, Ompad D, Rundle A, Vlahov D. Neighborhood characteristics and disability in older adults. J Gerontol B Psychol Sci Soc Sci 2009; 64:252-7. [PMID: 19181694 DOI: 10.1093/geronb/gbn018] [Citation(s) in RCA: 141] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To characterize the influence of the residential neighborhood of older adults on the prevalence of disability. METHODS We combined Census data on disability in older adults living in New York City with environmental information from a comprehensive geospatial database. We used factor analysis to derive dimensions of compositional and physical neighborhood characteristics and linear regression to model their association with levels of disability. Measures of neighborhood collective efficacy were added to these models to explore the impact of the social environment. RESULTS Low neighborhood socioeconomic status, residential instability, living in areas with low proportions of foreign born and high proportions of Black residents, and negative street characteristics were associated with higher prevalence of both "physical" disability and "going outside the home" disability. High crime levels were additionally associated with physical disability, although this relationship disappeared when misdemeanor arrests were removed from the crime variable. Low levels of collective efficacy were associated with more going-outside-the-home disability, with racial/ethnic composition dropping out of this model to be replaced by an interaction term. CONCLUSION The urban environment may have a substantial impact on whether an older adult with a given level of functional impairment is able to age actively and remain independent.
Collapse
Affiliation(s)
- John R Beard
- Center for Urban Epidemiologic Studies, New York Academy of Medicine, 1216 Fifth Avenue, New York, NY 10029-5202, USA.
| | | | | | | | | | | | | | | |
Collapse
|
13
|
|
14
|
Abstract
AbstractObjectivesTo measure the occurrence and correlates of hunger and to evaluate the association between hunger and three health indicators among undocumented Mexican immigrants.DesignNon-probability cross-sectional sample.SettingNeighbourhoods within New York City.SubjectsFour hundred and thirty-one undocumented Mexican immigrants living in the USA.ResultsHunger was indicated by approximately 28% of respondents. In a multivariate model, working as a day labourer was associated with hunger (odds ratio (OR) 3.33, 95% confidence interval (CI) 1.83–6.06) while receiving public assistance protected against hunger (OR 0.23, 95% CI 0.06–0.88). In multivariate models, respondents who reported experiencing hunger also reported poorer overall health (OR 1.69, 95% CI 0.95–3.02) and more days of poor mental (P= 0.045) and physical health (P< 0.0001). Greater amount of time lived in the USA was also associated with worse overall health (P= 0.054) and more days of poor mental and physical health (P< 0.01).ConclusionsThe present study shows that food insecurity and hunger may be problems among undocumented migrants living in the USA. Uncertain and unpredictable work schedules and limited access to public assistance may contribute to high levels of hunger, which in turn may also negatively affect mental and physical health. Increasing amount of time lived in the USA is also associated with poorer health indicators. Programmes that provide undocumented migrants with emergency access to resources may reduce food insecurity and lead to improved health outcomes among this vulnerable population.
Collapse
Affiliation(s)
- Craig Hadley
- Center for Social Epidemiology and Population Health, University of Michigan, Ann Arbor, MI 48104, USA.
| | | | | | | | | | | | | |
Collapse
|
15
|
Vlahov D, Wang C, Ompad D, Fuller CM, Caceres W, Ouellet L, Kerndt P, Jarlais DCD, Garfein RS. Mortality risk among recent-onset injection drug users in five U.S. cities. Subst Use Misuse 2008; 43:413-28. [PMID: 18365941 DOI: 10.1080/10826080701203013] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
To quantify the risk of death among recent-onset (< 5 years) injection drug users, we enrolled 2089 injection drug users (IDUs) age <or= 35 years (minimum age = 18 years) between 1997 and 1999. Median age was 24 years, 62.4% were male, 54.5% were non-Hispanic White, mean duration of injecting was 3 years, and 45.4% injected daily within the prior 6 months. Using the National Death Index, we identified 68 deaths over a follow-up period through December 2002 with a mortality rate of 7.10/1000 person years. Using age-, sex-, and race-adjusted data to the census and mortality, we calculated standardized mortality ratios (SMRs) over time. The adjusted SMR (with national data as the reference) for IDUs was 3.66 for 1997, which increased to 9.78 by 1998, decreased slightly to 7.08 by 1999, and continuously declined to 2.54 by 2002. These data confirm considerable excess mortality among recent onset injection drug users compared to non-IDU peers in the general population and indicate need for interventions such as increased quality and accessibility to drug abuse** treatment and overdose prevention to prevent premature death among young IDUs.
Collapse
Affiliation(s)
- David Vlahov
- Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, New York 10029, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Leon KA, Hyre AD, Ompad D, Desalvo KB, Muntner P. Perceived stress among a workforce 6 months following hurricane Katrina. Soc Psychiatry Psychiatr Epidemiol 2007; 42:1005-11. [PMID: 17932611 DOI: 10.1007/s00127-007-0260-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2006] [Accepted: 09/06/2007] [Indexed: 11/30/2022]
Abstract
To determine stress levels among a workforce 6 months after hurricane Katrina made landfall, a web-based survey that included the four-item Perceived Stress Scale was administered to employees of the largest employer in New Orleans. An overall Perceived Stress Scale score was obtained by pooling responses for the four items. Among 1,542 adult respondents, 24.1% stated they felt that they were "fairly often" or "very often" unable to control the important things in their life and 21.4% considered that their difficulties were "fairly often" or "very often" piling up so high that they could not overcome them. Also, 6.1% reported that they "almost never" or "never" felt confident about their ability to handle their personal problems and 15.2% indicated that things were "almost never" or "never" going their way. The overall mean Perceived Stress Scale score was 6.3 (standard deviation = 3.1; range = 0-16). Higher stress scale scores, indicating more stress, were present for women, and for participants with lower income, displaced longer than 3 months, who were more afraid of losing their life during hurricane Katrina and its immediate aftermath, and who knew someone that died during the storm. Additionally, participants who were living in a relative of friend's house or in a temporary trailer at the time of the survey had higher stress scores compared to their counterparts who had returned to live in their pre-hurricane residence. There was a direct association between higher stress scores and symptoms of post-traumatic stress disorder. Employers and health care providers should be apprised of the need for monitoring stress and offering counseling opportunities for returning workforces following future large-scale disasters.
Collapse
Affiliation(s)
- Kyla A Leon
- Dept. of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1430 Tulane Avenue, SL-18, New Orleans, LA 70112, USA
| | | | | | | | | |
Collapse
|
17
|
Abstract
OBJECTIVES Drug overdose is the second leading cause of accidental deaths among U.S. adults aged 15-64 years. Emergency physicians have a unique opportunity to provide overdose prevention interventions, because habitual drug users are in frequent need of medical care. The authors evaluated associations between individual-level risk factors and experiencing an overdose in the past six months to determine which characteristics and behaviors may be most predictive of overdose. METHODS The authors used data from a sample of street-recruited habitual drug users who participated in face-to-face interviews about overdose from November 2001 to February 2004. This analysis was restricted to 772 respondents who had been injecting for at least one year and who had injected heroin within the past two months. RESULTS A total of 16.6% of participants had overdosed in the past six months. Characteristics and behaviors that were independently associated with an increased risk of a recent overdose were having had a prior overdose (odds ratio [OR], 28.58; 95% confidence interval [CI] = 14.10 to 57.96), using cocaine/crack in the past six months (OR, 2.07; 95% CI = 1.25 to 3.45), using alcohol in the past six months (OR, 1.90; 95% CI = 1.01 to 3.57), experiencing serious withdrawal symptoms in the past two months (OR, 2.70; 95% CI = 1.58 to 4.61), and younger age. CONCLUSIONS Drug users who have previously experienced a nonfatal overdose are at very high risk of experiencing future overdoses. Further longitudinal studies are needed to identify robust predictors of overdose risk over time in habitual drug users, but these data suggest that drug users who have overdosed warrant aggressive prevention efforts such as agonist maintenance treatment or provision of take-home naloxone.
Collapse
Affiliation(s)
- Phillip O Coffin
- Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY, USA.
| | | | | | | | | | | |
Collapse
|
18
|
Abstract
The body of literature exploring neighborhood effects on health has increased rapidly in recent years, yet a number of methodologic concerns remain, including preferred methods for identification and delineation of study neighborhoods. In research combining census or other publicly available data with surveys of residents and/or street-level observations, questions regarding neighborhood definition take on added significance. Neighborhoods must be identified and delineated in such a way as to optimize quality and availability of data from each of these sources. IMPACT (Inner-City Mental Health Study Predicting HIV/AIDS, Club and Other Drug Transitions), a multilevel study examining associations among features of the urban environment and mental health, drug use, and sexual behavior, utilized a multistep neighborhood definition process including development of census block group maps, review of land use and census tract data, and field visits and observation in each of the targeted communities. Field observations were guided by a preidentified list of environmental features focused on the potential for recruitment (e.g., pedestrian volume), characteristics commonly used to define neighborhood boundaries (e.g., obstructions to pedestrian traffic, changes in land use), and characteristics that have been associated in the literature with health behaviors and health outcomes (such as housing type and maintenance and use of open spaces). This process, implemented in February through July 2005, proved feasible and offered the opportunity to identify neighborhoods appropriate to study objectives and to collect descriptive information that can be used as a context for understanding study results.
Collapse
Affiliation(s)
- Linda Weiss
- Office of Special Populations, New York, New York 10029, USA.
| | | | | | | |
Collapse
|
19
|
Abstract
Cities are the predominant mode of living, and the growth in cities is related to the expansion of areas that have concentrated disadvantage. The foreseeable trend is for rising inequities across a wide range of social and health dimensions. Although qualitatively different, this trend exists in both the developed and developing worlds. Improving the health of people in slums will require new analytic frameworks. The social-determinants approach emphasizes the role of factors that operate at multiple levels, including global, national, municipal, and neighborhood levels, in shaping health. This approach suggests that improving living conditions in such arenas as housing, employment, education, equality, quality of living environment, social support, and health services is central to improving the health of urban populations. While social determinant and multilevel perspectives are not uniquely urban, they are transformed when viewed through the characteristics of cities such as size, density, diversity, and complexity. Ameliorating the immediate living conditions in the cities in which people live offers the greatest promise for reducing morbidity, mortality, and disparities in health and for improving quality of life and well being.
Collapse
Affiliation(s)
- David Vlahov
- Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY, USA.
| | | | | | | | | | | | | |
Collapse
|
20
|
Galea S, Nandi A, Coffin PO, Tracy M, Markham Piper T, Ompad D, Vlahov D. Heroin and cocaine dependence and the risk of accidental non-fatal drug overdose. J Addict Dis 2007; 25:79-87. [PMID: 16956872 DOI: 10.1300/j069v25n03_10] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [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: 11/18/2022]
Abstract
The relation between illicit drug dependence and the likelihood of drug overdose is unclear. We recruited 1,066 habitual drug users for this analysis through street-based outreach in New York City. In this sample, 99.3% of respondents used heroin in the past year and 87.1% of respondents used cocaine; 819 (77.5%) heroin users and 735 (79.2%) cocaine users were severely dependent on either drug respectively. In multivariable models, among heroin users, persons who were severely heroin dependent were less likely (OR = 0.6; 95% CI = 0.4-0.9) to have overdosed on any drug in the past year; among cocaine users, those who were severely cocaine dependent were more likely (OR = 1.6; 95% CI = 1.0-2.6) to have overdosed in the past year. The relation between illicit drug dependence and risk of overdose may vary for different patterns of drug dependence. These observations suggest that overdose prevention interventions, perhaps even those specifically targeting opiate overdose, may be more efficiently directed at individuals exhibiting cocaine dependence.
Collapse
Affiliation(s)
- Sandro Galea
- Department of Epidemiology, University of Michigan School of Public Health, 1214 South University, Ann Arbor, MI 48104, USA.
| | | | | | | | | | | | | |
Collapse
|
21
|
Abstract
OBJECTIVES We examined risk behaviors of female drug users, comparing those who reported recently having had sex with women (recent WSW), those who reported previously having had sex with women (former WSW), and those who reported never having had sex with women (never WSW). METHODS We used data from the Risk Evaluation and Assessment of Community Health III Study. Adjusted odds for predictors of WSW status were determined via multinomial logistic regression analyses. RESULTS Of the participants, 75% were never WSW, 12% were former WSW, and 13% were recent WSW. In comparison with never WSW status, significant predictors of recent WSW status were living away from one's parents as a child (adjusted odds ratio [OR]=3.05; 95% confidence interval [CI]=1.07, 8.67) and recently having been paid for sex by men (adjusted OR=4.02; 95% CI=1.67, 9.68). Also, recently having been paid for sex by men was a significant predictor of former WSW status as opposed to never WSW status (adjusted OR=3.97; 95% CI=1.65, 9.59). CONCLUSIONS The recency with which they had sex with women is one of the facets influencing the risk profile of WSW. The diverse characteristics of the WSW population need to be incorporated into future studies and risk interventions targeting this group.
Collapse
Affiliation(s)
- Ann V Bell
- Infectious Disease Program, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Suite E6543, Baltimore, MD 21215.
| | | | | |
Collapse
|
22
|
Tracy M, Piper TM, Ompad D, Bucciarelli A, Coffin PO, Vlahov D, Galea S. Circumstances of witnessed drug overdose in New York City: implications for intervention. Drug Alcohol Depend 2005; 79:181-90. [PMID: 16002027 DOI: 10.1016/j.drugalcdep.2005.01.010] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [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] [Received: 08/31/2004] [Revised: 01/07/2005] [Accepted: 01/26/2005] [Indexed: 11/27/2022]
Abstract
Drug users frequently witness the nonfatal and fatal drug overdoses of their peers, but often fail to intervene effectively to reduce morbidity and mortality. We assessed the circumstances of witnessed heroin-related overdoses in New York City (NYC) among a predominantly minority population of drug users. Among 1184 heroin, crack, and cocaine users interviewed between November 2001 and February 2004, 672 (56.8%) had witnessed at least one nonfatal or fatal heroin-related overdose. Of those, 444 (67.7%) reported that they or someone else present called for medical help for the overdose victim at the last witnessed overdose. In multivariable models, the respondent never having had an overdose her/himself and the witnessed overdose occurring in a public place were associated with the likelihood of calling for medical help. Fear of police response was the most commonly cited reason for not calling or delaying before calling for help (52.2%). Attempts to revive the overdose victim through physical stimulation (e.g., applying ice, causing pain) were reported by 59.7% of respondents, while first aid measures were attempted in only 11.9% of events. Efforts to equip drug users to manage overdoses effectively, including training in first aid and the provision of naloxone, and the reduction of police involvement at overdose events may have a substantial impact on overdose-related morbidity and mortality.
Collapse
Affiliation(s)
- Melissa Tracy
- Center for Urban Epidemiologic Studies, New York Academy of Medicine, 1216 Fifth Avenue, New York, NY 10029, USA
| | | | | | | | | | | | | |
Collapse
|
23
|
Santibanez SS, Garfein RS, Swartzendruber A, Kerndt PR, Morse E, Ompad D, Strathdee S, Williams IT, Friedman SR, Ouellet LJ. Prevalence and correlates of crack-cocaine injection among young injection drug users in the United States, 1997-1999. Drug Alcohol Depend 2005; 77:227-33. [PMID: 15734222 DOI: 10.1016/j.drugalcdep.2004.08.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2003] [Revised: 08/09/2004] [Accepted: 08/13/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVES We estimated prevalence and identified correlates of crack-cocaine injection among young injection drug users in the United States. METHODS We analyzed data from the second Collaborative Injection Drug Users Study (CIDUS II), a 1997-1999 cohort study of 18-30-year-old, street-recruited injection drug users from six US cities. RESULTS Crack-cocaine injection was reported by 329 (15%) of 2198 participants. Prevalence varied considerably by site (range, 1.5-28.0%). No participants injected only crack-cocaine. At four sites where crack-cocaine injection prevalence was greater than 10%, recent (past 6 months) crack-cocaine injection was correlated with recent daily injection and sharing of syringes, equipment, and drug solution. Lifetime crack-cocaine injection was correlated with using shooting galleries, initiating others into drug injection, and having serologic evidence of hepatitis B virus and hepatitis C virus infection. CONCLUSIONS Crack-cocaine injection may be a marker for high-risk behaviors that can be used to direct efforts to prevent HIV and other blood-borne viral infections.
Collapse
Affiliation(s)
- Scott S Santibanez
- Division of HIV/AIDS, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Cox AL, Netski DM, Mosbruger T, Sherman SG, Strathdee S, Ompad D, Vlahov D, Chien D, Shyamala V, Ray SC, Thomas DL. Prospective evaluation of community-acquired acute-phase hepatitis C virus infection. Clin Infect Dis 2005; 40:951-8. [PMID: 15824985 DOI: 10.1086/428578] [Citation(s) in RCA: 167] [Impact Index Per Article: 8.8] [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: 09/01/2004] [Accepted: 11/16/2004] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND More than two-thirds of hepatitis C virus (HCV) infections in Western countries are caused by injection drug use, but prospective clinical data regarding the most common mode of HCV acquisition are rare, in part because acute-phase HCV infection is usually asymptomatic. METHODS To characterize acute-phase HCV infection, 179 HCV antibody-negative injection drug users were prospectively evaluated; 62 (34%) of these patients had seroconverted. Twenty of the participants who seroconverted had long-term follow-up with consistent monthly sampling before and after seroconversion, allowing detailed study. RESULTS The first indication of HCV infection was the presence of HCV RNA in serum, which preceded elevation of alanine transaminase levels and total bilirubin levels to > or =2 times baseline in 45% and 77% of patients, respectively. No subjects had jaundice. The median time from initial viremia to seroconversion was 36 days (range, 32-46 days). In one instance, viremia was detected 434 days before seroconversion. However, in no other case was HCV RNA detected >63 days before seroconversion. In subjects with viral persistence, a stable level of HCV RNA in the blood was noted in some subjects within 60 days after the initial detection of viremia, but in others, it was not apparent until >1 year later. In subjects with long-term viral clearance, HCV became persistently undetectable as early as 94 and as late as 620 days after initial viremia. CONCLUSIONS These data underscore the importance of nucleic acid screening of blood donations to prevent HCV transmission and of long-term follow-up to ascertain whether there is viral persistence, at least among injection drug users.
Collapse
Affiliation(s)
- Andrea L Cox
- Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|