Shame and stigma in association with the HCV cascade to cure among people who inject drugs.

BACKGROUND: Psycho-social experiences including shame and experienced and internalized stigma have been associated with substance use, HCV infection, and reluctance to disclose HCV status and pursue treatment. These psycho-social barriers have been examined independently for many chronic diseases, including HCV, but to our knowledge have not been quantitatively explored in a large multi-site US-based sample of people who inject drugs (PWID) in HCV treatment. METHODS: We examine baseline relationships with HCV-stigma and engagement across the HCV treatment cascade as well as baseline and longitudinal relationships between shame and engagement across the HCV treatment cascade including treatment initiation, adherence, completion, and sustained virologic response (SVR) among a multi-site sample of PWID with HCV, where N=755 were randomized to the pragmatic trial comparing HCV treatment outcomes in modified directly observed treatment (mDOT) or patient navigation, and N=623 initiated treatment. RESULTS: While cross-sectional assessments of shame and HCV-stigma were not associated with engagement across the HCV treatment cascade, those whose shame scores decreased compared to those who reported consistently high and increasing levels of shame were significantly more likely to complete HCV treatment (aOR=5.29; 95%CI: 1.56,18.00) and achieve SVR (aOR=6.32; 95%CI: 1.61, 24.87). CONCLUSION: Results underscore the relationships between lower levels of shame and health-related behavior and treatment outcomes among PWID and suggest SVR achievement may contribute to reductions in shame or that reductions in shame may contribute to continued treatment and thus SVR.

HUBBLE SPACE TELESCOPE FAR ULTRAVIOLET SPECTROSCOPY OF THE RECURRENT NOVA T PYXIDIS.

With six recorded nova outbursts, the prototypical recurrent nova T Pyxidis (T Pyx) is the ideal cataclysmic variable system to assess the net change of the white dwarf mass within a nova cycle. Recent estimates of the mass ejected in the 2011 outburst ranged from a few ~10-5M⊙ to 3.3 × 10-4M⊙, and assuming a mass accretion rate of 10-8-10-7M⊙ yr-1 for 44 yr, it has been concluded that the white dwarf in T Pyx is actually losing mass. Using NLTE disk modeling spectra to fit our recently obtained Hubble Space Telescope COS and STIS spectra, we find a mass accretion rate of up to two orders of magnitude larger than previously estimated. Our larger mass accretion rate is due mainly to the newly derived distance of T Pyx (4.8 kpc, larger than the previous 3.5 kpc estimate), our derived reddening of E(B - V) = 0.35 (based on combined IUE and GALEX spectra), and NLTE disk modeling (compared to blackbody and raw flux estimates in earlier works). We find that for most values of the reddening (0.25 ≤ E(B-V) ≤ 0.50) and white dwarf mass (0.70 M⊙ ≤ Mwd ≤ 1.35 M⊙) the accreted mass is larger than the ejected mass. Only for a low reddening (~0.25 and smaller) combined with a large white dwarf mass (0.9 M⊙ and larger) is the ejected mass larger than the accreted one. However, the best results are obtained for a larger value of reddening.