First Report of Gender Based Violence as a Deterrent to Methadone Access Among Females Who Use Heroin in Dar es Salaam, Tanzania.

High prevalence of human immunodeficiency virus (HIV) among females who use drugs in Dar es Salaam, Tanzania, contrasts strikingly with their low enrollment in HIV risk reduction services such as methadone assisted therapy (MAT). We conducted a case-control study to examine factors associated with non-enrollment in MAT, with a focus on gender-based violence. We interviewed 202 female heroin users not enrolled in MAT as cases and 93 females enrolled in MAT. We fitted logistic regression models with MAT enrollment as the outcome of interest. The likelihood of MAT enrollment decreased upon being in a violent relationship [odds ratio (OR) 0.23; 95 % CI 0.11-0.40], with experience of discrimination by a healthcare provider (OR 0.11; 95 % CI 0.04-0.35), and having a partner who also uses drugs (OR 0.05; 95 % CI 0.01-0.26). The results indicate that violence and discrimination are major impediments to MAT enrollment, necessitating implementation of interventions to address them.

Pharmacokinetic interactions between buprenorphine/naloxone and raltegravir in subjects receiving chronic buprenorphine/naloxone treatment.

BACKGROUND: Interactions between human immuno-deficiency virus (HIV) and opioid-dependence therapies can occur. OBJECTIVES: We sought to determine whether such interactions occurred between buprenorphine/naloxone and raltegravir. METHODS: We performed a within-subject open-labeled pharmacokinetic and pharmacodynamic study in 12 HIV-seronegative subjects stabilized on at least 3 weeks of buprenorphine/naloxone therapy. Subjects underwent baseline and steady-state evaluation of the effect of raltegravir 400 mg BID on buprenorphine/naloxone parameters. RESULTS: Compared with baseline values, buprenorphine AUC(0-24 h) (58.2 vs. 56.0 hr*ng/mL) and C(max) (7.37 vs. 6.60 ng/mL) did not differ significantly after achieving steady-state raltegravir. Similar analyses of norbuprenorphine, the primary metabolite of buprenorphine, demonstrated no significant difference after raltegravir administration. Naloxone concentrations were unchanged for AUC(0-24 h) (.595 vs. .581 hr*ng/mL), C(max) (.251 vs. .243 ng/mL) and T(max) (.75 vs.1.08 h). Objective opioid withdrawal was not observed. The AUC(0-12 h) and C(max) of raltegravir did not significantly differ from historical controls (5543 vs. 4428 h*ng/mL and 1070 vs. 1266 ng/mL), respectively. CONCLUSION: The addition of raltegravir to stabilized patients receiving buprenorphine/naloxone does not significantly affect buprenorphine/naloxone or raltegravir pharmacokinetic or pharmacodynamic parameters.

Evaluation of irreversible JPEG compression for a clinical ultrasound practice.

A prior ultrasound study indicated that images with low to moderate levels of JPEG and wavelet compression were acceptable for diagnostic purposes. The purpose of this study is to validate this prior finding using the Joint Photographic Experts Group (JPEG) baseline compression algorithm, at a compression ratio of approximately 10:1, on a sufficiently large number of grayscale and color ultrasound images to attain a statistically significant result. The practical goal of this study is to determine if it is feasible for radiologists to use irreversibly compressed images as an integral part of the day to day ultrasound practice (ie, perform primary diagnosis with, and store irreversibly compressed images in the ultrasound PACS archive). In this study, 5 Radiologists were asked to review 300 grayscale and color static ultrasound images selected from 4 major anatomic groups. Each image was compressed and decompressed using the JPEG baseline compression algorithm at a fixed quality factor resulting in an average compression ratio of approximately 9:1. The images were presented in pairs (original and compressed) in a blinded fashion on a PACS workstation in the ultrasound reading areas, and radiologists were asked to pick which image they preferred in terms of diagnostic utility and their degree of certainty (on a scale from 1 to 4). Of the 1499 total readings, 50.17% (95% confidence intervals at 47.6%, and 52.7%) indicated a preference for the original image in the pair, and 49.83% (95% confidence intervals at 47.3%, and 52.0%) indicated a preference for the compressed image. These findings led the authors to conclude that static color and gray-scale ultrasound images compressed with JPEG at approximately 9:1 are statistically indistinguishable from the originals for primary diagnostic purposes. Based on the authors laboratory experience with compression and the results of this and other prior studies, JPEG compression is now being applied to all ultrasound images in the authors' radiology practice before reading. No image quality-related issues have been encountered after 12 months of operation (approximately 48000 examinations).