RESUMO
Persons who inject drugs (PWID) have been experiencing a higher burden of new hepatitis C (HCV) due to the opioid epidemic. The greatest increases in injection have been in rural communities. However, less is known about the prevalence of HCV or its risk factors in rural compared to non-rural communities. This study compared HCV infection history, current infection, and associated behavioural and sociodemographic correlates among PWID recruited from rural and non-rural communities from Upstate New York (NY). This cross-sectional study recruited 309 PWID, using respondent-driven sampling. Blood samples were collected through finger stick for HCV antibody and RNA tests. A survey was also self-administered for HCV infection history, sociodemographics and behavioural correlates to compare by setting rurality. HCV seropositivity was significantly higher among PWID from rural than non-rural communities (71.0% vs. 46.8%), as was current infection (41.4% vs. 25.9%). High levels of past year syringe (44.4%) and equipment (62.2%) sharing were reported. Factors associated with infection history include syringe service program utilization, non-Hispanic white race, sharing needles and methamphetamine injection, which was higher in rural vs. non-rural communities (38.5% vs. 15.5%). HCV burden among PWID appears higher in rural than non-rural communities and may be increasing possibly due to greater levels of methamphetamine injection. On-going systematic surveillance of HCV prevalence and correlates is crucial to respond to the changing opioid epidemic landscape. Additionally, improving access to harm reduction services, especially with special focus on stimulants, may be important to reduce HCV prevalence among PWID in rural settings.
Assuntos
Usuários de Drogas , Infecções por HIV , Hepatite C , Metanfetamina , Abuso de Substâncias por Via Intravenosa , Estudos Transversais , Infecções por HIV/epidemiologia , Hepacivirus , Hepatite C/epidemiologia , Humanos , Prevalência , RNA , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/epidemiologiaRESUMO
Approximately 75% of all hepatitis C virus (HCV) infections in the United States and 73% of HCV-associated mortality occur in persons born during 1945-1965, placing this birth cohort at increased risk for liver cancer and other HCV-related liver disease (1). In the United States, an estimated 2.7 million persons are living with HCV infection, and it is estimated that up to 75% of these persons do not know their status. Since 2012, CDC has recommended that persons born during 1945-1965 receive one-time HCV testing. To increase the number of persons tested for HCV and to ensure timely diagnosis and linkage to care, in 2014, New York enacted a hepatitis C testing law that requires health care providers to offer HCV antibody screening to all persons born during 1945-1965 who are receiving services in primary care settings or as hospital inpatients, and to refer persons with positive HCV antibody tests for follow-up health care, including an HCV diagnostic test (i.e., HCV RNA).* The New York State Department of Health (NYSDOH) used survey data from clinical laboratories and Medicaid claims and encounter data, and state and New York City (NYC) HCV surveillance data to assess the number of persons tested for HCV and number of persons with newly diagnosed HCV infections who were linked to care. During the first year of the HCV law implementation, there was a 51% increase in specimens submitted for HCV testing to surveyed clinical laboratories; testing rates among active Medicaid clients increased 52%, and linkage to care among persons with newly diagnosed HCV infection increased approximately 40% in New York and 11% in NYC. These findings highlight the potential for state laws to promote HCV testing and the utility of HCV surveillance and Medicaid claims data to monitor the quality of HCV testing and linkage to care for HCV-infected persons.
Assuntos
Pessoal de Saúde/legislação & jurisprudência , Hepatite C/diagnóstico , Programas Obrigatórios , Programas de Rastreamento/legislação & jurisprudência , Idoso , Hepatite C/epidemiologia , Humanos , Pessoa de Meia-Idade , New York/epidemiologia , Avaliação de Programas e Projetos de SaúdeRESUMO
OBJECTIVES: We investigated a cluster of new hepatitis C cases in rural New York among a cohort of young people who inject drugs (PWID) and misuse prescription opioid analgesics (POA). METHODS: We recruited a purposive sample of PWID from Cortland County for an in-person survey and HCV rapid antibody test (March-July 2012). We examined sociodemographics, drugs currently injected, and lifetime and recent injection behaviors to ascertain associations with HCV antibody (anti-HCV) positivity. RESULTS: Of 123 PWID, 76 (61.8%) were younger than 30 years, and 100 (81.3%) received HCV rapid testing. Of those tested, 34 (34.0%) were positive. Participants who reported injecting POA in the past 12 months were 5 times more likely to be anti-HCV positive than those who injected drugs other than POA, and participants who reported sharing injection equipment in the past 12 months were roughly 4 times more likely to be anti-HCV positive than those who did not. CONCLUSIONS: Our analysis suggests people injecting POA may be at higher risk for HCV infection than people who inject heroin or other drugs but not POA.
Assuntos
Analgésicos Opioides , Hepatite C/etiologia , Uso Indevido de Medicamentos sob Prescrição/efeitos adversos , Abuso de Substâncias por Via Intravenosa/complicações , Adolescente , Adulto , Fatores Etários , Feminino , Hepatite C/epidemiologia , Humanos , Masculino , New York/epidemiologia , Uso Indevido de Medicamentos sob Prescrição/estatística & dados numéricos , Fatores de Risco , População Rural/estatística & dados numéricos , Adulto JovemRESUMO
The degree to which case surveillance captures persons ever infected with HCV is unknown. We determined the discrepancy between HCV seroprevalence, estimated from national survey data, among adults in New York State in 2008 (n = 286 262, or 1.95%) and the number of infected persons reported to the state's surveillance hepatitis registries (n = 144 015). Findings suggest the need to strengthen the existing surveillance system.
Assuntos
Hepatite C Crônica/epidemiologia , Vigilância da População , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Prevalência , Sistema de Registros , Estados Unidos/epidemiologiaRESUMO
Current carbon capture and utilization (CCU) technologies require high energy input and costly catalysts. Here, an effective pathway is offered that addresses climate action by atmospheric CO2 sequestration. Industrially relevant highly reactive alkali cellulose solutions are used as CO2 absorption media. The latter lead to mineralized cellulose materials (MCM) at a tailorable cellulose-to-mineral ratio, forming organic-inorganic viscous systems (viscosity from 102 to 107 mPa s and storage modulus from 10 to 105 Pa). CO2 absorption and conversion into calcium carbonate and associated minerals translate to maximum absorption of 6.5 gCO2 gcellulose -1 , tracking inversely with cellulose loading. Cellulose lean gels are easily converted into dry powders, shown as a functional component of ceramic glazes and cementitious composites. Meanwhile, cellulose-rich gels are moldable and extrudable, yielding stone-like structures tested as artificial substrates for coral reef restoration. Life Cycle Assessment (LCA) suggests new CCU opportunities for building materials, as demonstrated in underwater deployment for coral reef ecosystem restoration.
RESUMO
Blueberry pruning waste (BPw), sourced as residues from agroforestry operations in Chile, was used to produce added-value products, including platform chemicals and materials. BPw fractionation was implemented using biobased solvents (γ-valerolactone, GVL) and pyrolysis (500 °C), yielding solid fractions that are rich in phenols and antioxidants. The liquid fraction was found to be enriched in sugars, acids, and amides. Alongside, filaments and 3D-printed meshes were produced via wet spinning and Direct-Ink-Writing (DIW), respectively. For the latter purpose, BPw was dissolved in an ionic liquid, 1-ethyl-3-methylimidazolium acetate ([emim][OAc]), and regenerated into lignocellulose filaments with highly aligned nanofibrils (wide-angle X-ray scattering) that simultaneously showed extensibility (wet strain as high as 39%). BPw-derived lignocellulose filaments showed a tenacity (up to 2.3 cN dtex-1) that is comparable to that of rayon fibers and showed low light reflectance (R ES factor <3%). Meanwhile, DIW of the respective gels led to meshes with up to 60% wet stretchability. The LCF and meshes were demonstrated to have reliable performance in marine environments. As a demonstration, we show the prospects of replacing plastic cords and other materials used to restore coral reefs on the coast of Mexico.
Assuntos
Promoção da Saúde/métodos , Hepatite C Crônica/prevenção & controle , Prática de Saúde Pública , Política de Saúde , Promoção da Saúde/economia , Hepacivirus , Hepatite C Crônica/economia , Hepatite C Crônica/epidemiologia , Humanos , Prevenção Primária/métodos , Prática de Saúde Pública/economia , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: New York State is home to an estimated 230,000 individuals chronically infected with hepatitis C virus (HCV) and roughly 171,500 active injection drug users (IDUs). HCV/HIV co-infection is common and models of service delivery that effectively meet IDUs' needs are required. A HCV strategic plan has stressed integration. METHODS: HCV prevention and care are integrated within health and human service settings, including HIV/AIDS organisations and drug treatment programmes. Other measures that support comprehensive HCV services for IDUs include reimbursement, clinical guidelines, training and HCV prevention education. Community and provider collaborations inform programme and policy development. RESULTS: IDUs access 5 million syringes annually through harm reduction/syringe exchange programmes (SEPs) and a statewide syringe access programme. Declines in HCV prevalence amongst IDUs in New York City coincided with improved syringe availability. New models of care successfully link IDUs at SEPs and in drug treatment to health care. Over 7000 Medicaid recipients with HCV/HIV co-infection had health care encounters related to their HCV in a 12-month period and 10,547 claims for HCV-related medications were paid. The success rate of transitional case management referrals to drug treatment is over 90%. Training and clinical guidelines promote provider knowledge about HCV and contribute to quality HCV care for IDUs. Chart reviews of 2570 patients with HIV in 2004 documented HCV status 97.4% of the time, overall, in various settings. New HCV surveillance systems are operational. Despite this progress, significant challenges remain. DISCUSSION: A comprehensive, public health approach, using multiple strategies across systems and mobilizing multiple sectors, can enhance IDUs access to HCV prevention and care. A holisitic approach with integrated services, including for HCV-HIV co-infected IDUs is needed. Leadership, collaboration and resources are essential.