Life-time HIV testing among people who inject drugs in Iran: results from the National Rapid Assessment and Response survey.

Background: HIV testing is recommended for people who inject drugs (PWID). The aim of this study was to determine the prevalence of lifetime HIV testing among PWID and to better understand the predictors for HIV testing in a convenience sample across Iran. Materials and methods: This study is a secondary analysis of Iran's National Rapid Assessment and Response survey conducted between October 2016 and March 2017. Analysis includes the 999 people who reported injecting drugs across the capital cities of 21 provinces. Data were collected by using the venue-based application of the Time Location Sampling (TLS) frame. Chi-square tests were used to examine the difference between HIV testing across different quantitative variables. Logistic regression was used to determine the predictors of life-time HIV testing. Analysis was performed using STATA V.12 software with a significance level of 95%. Results: Most participants were male (n = 902, 93.50%), and over half (n = 555, 59.17%) were older than 35 years old. About one-third, (n = 326, 38%) of people interviewed were single and another one-third (n = 251, 29%) reported being divorced. Over two-thirds of participants (n = 678, 69.78%) in this study reported lifetime HIV testing. The results from a multiple variable logistic regression showed people with a university education were more likely to have been previously tested for HIV than illiterate people (OR = 18.87, 95%CI 2.85-124.6, value of p = 0.002). Those individuals who reported ever receiving methadone treatment were 2.8 times more likely to have been tested for HIV than individuals without methadone treatment experience (OR = 2.89, 95%CI 1.53-5.42, value of p < 0.001). Needle syringe sharing in last month, was negatively associated with life-time HIV testing (OR = 0.29, 95%CI 0.17-0.48, value of p < 0.001). Conclusion: Despite Iran's wide availability and access to counseling services for HIV testing in key populations, the proportion of PWID being tested for HIV could be improved. Developing effective strategies to increase people's understanding and awareness of the importance of and need for HIV prevention and familiarity with HIV testing sites is an essential step in increasing HIV testing for this population. Studies on more recent HIV testing are required to better assess and understand the frequency of HIV testing among PWID in Iran.

Epidemiology and Management of invasive infections among people who Use drugs (EMU): protocol for a prospective, multicentre cohort study.

INTRODUCTION: People who inject drugs (PWID) are at risk of invasive infections such as bloodstream infections, endocarditis, osteomyelitis and septic arthritis. Such infections require prolonged antibiotic therapy, but there is limited evidence about the optimal care model to deliver to this population. The Epidemiology and Management of invasive infections among people who Use drugs (EMU) study aims to (1) describe the current burden, clinical spectrum, management and outcomes of invasive infections in PWID; (2) determine the impact of currently available models of care on completion of planned antimicrobials for PWID admitted to hospital with invasive infections and (3) determine postdischarge outcomes of PWID admitted with invasive infections at 30 and 90 days. METHODS AND ANALYSIS: EMU is a prospective multicentre cohort study of Australian public hospitals who provide care to PWIDs with invasive infections. All patients who have injected drugs in the previous six months and are admitted to a participating site for management of an invasive infection are eligible. EMU has two components: (1) EMU-Audit will collect information from medical records, including demographics, clinical presentation, management and outcomes; (2) EMU-Cohort will augment this with interviews at baseline, 30 and 90 days post-discharge, and data linkage examining readmission rates and mortality. The primary exposure is antimicrobial treatment modality, categorised as inpatient intravenous antimicrobials, outpatient antimicrobial therapy, early oral antibiotics or lipoglycopeptide. The primary outcome is confirmed completion of planned antimicrobials. We aim to recruit 146 participants over a 2-year period. ETHICS AND DISSEMINATION: EMU has been approved by the Alfred Hospital Human Research Ethics Committee (Project number 78815.) EMU-Audit will collect non-identifiable data with a waiver of consent. EMU-Cohort will collect identifiable data with informed consent. Findings will be presented at scientific conferences and disseminated by peer-review publications. TRIAL REGISTRATION NUMBER: ACTRN12622001173785; Pre-results.

Review of management priorities for invasive infections in people who inject drugs: highlighting the need for patient-centred multidisciplinary care.

There has been a global increase in the burden of invasive infections in people who inject drugs (PWID). It is essential that patient-centred multidisciplinary care is provided in the management of these infections to engage PWID in care and deliver evidence-based management and preventive strategies. The multidisciplinary team should include infectious diseases, addictions medicine (inclusive of alcohol and other drug services), surgery, psychiatry, pain specialists, pharmacy, nursing staff, social work and peer support workers (where available) to help address the comorbid conditions that may have contributed to the patient's presentation. PWID have a range of antimicrobial delivery options that can be tailored in a patient-centred manner and thus are not limited to prolonged hospital admissions to receive intravenous antimicrobials for invasive infections. These options include discharge with outpatient parenteral antimicrobial therapy, long-acting lipoglycopeptides (dalbavancin and oritavancin) and early oral antimicrobials. Open and respectful discussion with PWID including around harm reduction strategies may decrease the risk of repeat presentations with injecting-related harms.

Health service utilisation and access for people who inject drugs during COVID-19.

INTRODUCTION: The wide-spread implementation of interventions to limit transmission and public health consequences of COVID-19 in the Australian state of Victoria had flow-on consequences for people who use and inject drugs. Consequences included the interruption of illicit drug supply and drug procurement, and the disruption to the delivery of health services. To inform strategies that can minimise the adverse outcomes of similar future disruptive events, this study explored how COVID-19 restrictions impacted access to harm reduction and drug treatment services for people who inject drugs in Melbourne, Victoria. METHODS: Qualitative semi-structured interviews were conducted via an online calling app, with 11 participants of a broader cohort study (the SuperMIX study) in April 2020. Interviews were focused on participants experiences of accessing and using harm reduction and drug treatment services. Data were thematically analysed using a process of blended coding. RESULTS: Findings revealed how disruptions in the delivery of harm reduction and drug treatment services-in response to COVID-19 restrictions-created barriers accessing sterile injecting equipment, increased risk of arrest by police and exacerbated social isolation. Participants reported difficulties adapting to changes in services access, with some increases in injecting risk behaviours. However, improvements in opioid agonist therapy prescriptions were noted as a beneficial outcome. DISCUSSION: By examining the impacts of COVID-19 and the resultant restrictions on people who inject drugs' access to health services in Melbourne, Victoria, findings provide guidance for future responses to the unanticipated large-scale effects of the COVID-19 pandemic, and similar disruptive events.

The Association of Oral Health Status and socio-economic determinants with Oral Health-Related Quality of Life among the elderly: A systematic review and meta-analysis.

OBJECTIVE: The aim of this study was to determine the relationship between poor Oral Health-Related Quality of Life (OHRQoL) and oral health determinants (eg being 75 years of age or greater, marital status, smoking status, denture wearing, depression, low educational level (≤8th grade), poor general health, caries history, tooth-induced pain, decayed, missing filled teeth (DMFT) scores and periodontal diseases) among the elderly. METHODS: Formal search strategies in PubMed, Scopus, Cochrane and Web of Science were performed to identify studies in English published before 1 December 2019. We assessed the impacts of the oral health determinants including being 75 years of age or greater, marital status, smoking status, denture wearing, depression, low educational level (≤8th grade), poor general health, caries history, tooth-induced pain, DMFT scores and periodontal diseases) on OHRQoL among elderly individuals. The data were analysed using Stata 12.0 software. RESULTS: In total, 19 publications met the inclusion criteria of this meta-analysis. Findings indicate a positive association between low educational level (ie ≤8th grade), marital status, depression, smoking status, denture wearing, poor general health, tooth-induced pain, periodontal diseases and poor OHRQoL among the elderly. We also observed a negative association between DMFT, being older than 75 years of age on poor OHRQoL among the elderly. CONCLUSIONS: This review identified that several oral health determinants were associated with poor OHRQoL. The efficacy of preventive measures and the economic aspects of tooth replacement approaches should be explored in the future. Developing oral healthcare plans and policies with the specific aim of improving OHRQoL among this group is essential.

What is the alcohol, tobacco, and other drug prevalence among culturally and linguistically diverse groups in the Australian population? A national study of prevalence, harms, and attitudes.

In Australia, one in three people are born overseas, and one in five households speak languages other than English. This study explores substance use prevalence, related harms, and attitudes among these large groups in the population. Analysis was conducted using cross-sectional data (N = 22, 696) from the 2013 National Drug Strategy Household Survey. General linear model and binary logistic regression were used to assess substance use and harms, using stabilized inverse propensity score weighting to control for potential confounding variables. Between culturally and linguistically diverse populations and the population born in Australia, United Kingdom, or New Zealand who speak only English at home, there is no statistically significant variation in the likelihood of current smoking; using analgesics, tranquilizers, or sleeping pills; or administering drugs via injection. Culturally diverse populations are less likely to drink alcohol or use cannabis or methamphetamines. No difference between these two major groups in the population is observed in substance-related abuse from strangers; but culturally diverse respondents are less likely to report substance-related abuse from known persons. Lower substance use prevalence is not observed among people from culturally diverse backgrounds who have mental health issues. Australian-, UK-, or New Zealand-born respondents who speak only English at home are more likely to oppose drug and tobacco policies, including a range of harm reduction policies. We discuss the practical and ethical limitations of this major Australian data set for examining the burden of drug-related harms experienced by specific migrant populations. Avenues for potential future research are outlined.

Improving hepatitis C direct-acting antiviral access and uptake: A role for patient-reported outcomes and lived experience.

Hepatitis C virus contributes to substantial and growing mortality and morbidity. Fortunately, the advent of highly effective interferon-free direct-acting antiviral (DAA) medications and new diagnostic tests has the potential to dramatically alter the epidemiologic trajectory of hepatitis C, particularly for "hard-to-reach" populations. Treatment advances and cure will also likely alter the individual experience of living with hepatitis C. However, it is not yet known in what capacity. This paper provides an overview of the population-level impact of DAA treatment, highlighting the need to further our understanding of the impact of treatment on behaviour, health and wellbeing through lived experience and more sensitive patient-reported outcome measures.

"Just not all ice users do that": investigating perceptions and potential harms of Australia's Ice Destroys Lives campaign in two studies.

BACKGROUND: In 2015, the Australian government launched the media campaign Ice Destroys Lives targeting crystal methamphetamine use. Previous research indicates mass media campaigns may have harmful effects for people engaged in drug use. This study investigated perceptions and harms of Ice Destroys Lives among adults with a history of injecting drugs and young people. METHODS: This analysis includes data from two studies: an online questionnaire with young people and in-depth interviews with adults who use crystal methamphetamine. Young people from Victoria, Australia, were recruited through Facebook. We collected data on drug use, campaign recognition and behaviours. Participants who recognised the campaign indicated whether they agreed with five statements related to Ice Destroys Lives. We compared campaign perceptions between young people who reported ever using crystal methamphetamine and those who did not. Adults who use crystal methamphetamine were sampled from the Melbourne injecting drug user cohort study. We asked participants if they recognised the campaign and whether it represented their experiences. RESULTS: One thousand twenty-nine young people completed the questionnaire; 71% were female, 4% had used crystal methamphetamine and 69% recognised Ice Destroys Lives. Three quarters agreed the campaign made them not want to use ice. Ever using crystal methamphetamine was associated with disagreeing with three statements including this campaign makes you not want to use ice (adjusted odds ratio (AOR) = 4.3, confidence interval (CI) = 1.8-10.0), this campaign accurately portrays the risks of ice use (AOR = 3.2, CI = 1.4-7.6) and this campaign makes you think that people who use ice are dangerous (AOR = 6.6, CI = 2.2-19.8). We interviewed 14 people who used crystal methamphetamine; most were male, aged 29-39 years, and most recognised the campaign. Participants believed Ice Destroys Lives misrepresented their experiences and exaggerated "the nasty side" of drug use. Participants felt the campaign exacerbated negative labels and portrayed people who use crystal methamphetamine as "violent" and "crazy". CONCLUSION: In our study, Ice Destroys Lives was widely recognised and delivered a prevention message to young people. However, for people with a history of crystal methamphetamine use, the campaign also reinforced negative stereotypes and did not encourage help seeking. Alternative evidence-based strategies are required to reduce crystal methamphetamine-related harms.

Factors Influencing Access to Sexual Health Care Among Behaviorally Bisexual Men in Vientiane, Laos: A Qualitative Exploration.

In Laos, men who have sex with men (MSM) are disproportionately affected by HIV, and bisexual behavior among men is common. We conducted a qualitative study to explore access and influences on sexual health care seeking among bisexual men in Vientiane. In 2013, behaviorally bisexual men were recruited from bars, clubs and dormitories for 5 focus group discussions and 11 in-depth interviews. Participants (aged 18-35 years) commonly reported high-risk sexual behaviors, yet most had never been tested for HIV, and none reported testing for sexually transmitted infections. Common barriers to testing were low perception of risk, expectation of symptoms, fear of HIV, shyness, perceived stigma, confidentiality concerns, and waiting times. Many men were unaware of available services. Most clinics cannot provide comprehensive HIV and sexually transmitted infection services. Strategies are needed to generate demand for testing, improve the capacity of sexual health care providers, and promote available services among behaviorally bisexual men in Vientiane.