Point-of-care hepatitis C screening with direct access referral to improve linkage to care among halfway house residents: a pilot randomised study

INTRODUCTION@#Linkage to care among individuals with substance misuse remains a barrier to the elimination of the hepatitis C virus (HCV). We aimed to determine whether point-of-care (PoC) education, screening and staging for liver disease with direct access to hospitals would improve linkage to care among this group. @*METHODS@#All participants were offered PoC education and HCV screening. HCV-positive participants were randomised to standard care (controls) or direct access, which provided a direct pathway to hospitals. Linkage to care was determined by reviewing electronic medical records. Linkage of care cascade was defined as attendance at the specialist clinic, confirmation of viraemia by HCV RNA testing, discussion about HCV treatment and initiation of treatment. @*RESULTS@#351 halfway house residents were screened. The overall HCV prevalence was 30.5% (n = 107), with 69 residents in the control group and 38 in the direct access group. The direct access group had a significantly higher percentage of cases linked to specialist review for confirmatory RNA testing (63.2% vs. 40.6%, p = 0.025), HCV treatment discussion (p = 0.009) and treatment initiation (p = 0.01) compared to the controls. Overall, only 12.6% (n = 13) had treatment initiation during follow-up. PoC HCV screening with direct access referral had significantly higher linkage to HCV treatment initiation (adjusted odds ratio 9.13, p = 0.005) in multivariate analysis. @*CONCLUSION@#PoC HCV screening with direct access improves linkage to care and simplifies the HCV care cascade, leading to improved treatment uptake. PoC education, screening, diagnosis and treatment may be an effective strategy to achieving HCV micro-elimination in this population.

Factors associated with smoking and transitioning to nyaope injection amongst women in the City of Tshwane Municipality: A self-report by women

Background: Substance use disorder has emerged as a key health and social challenge in South Africa (SA). It is projected that about 15% of South African youth, especially young women are prone to engage in drug use and the prospects of coming into contact with nyaope, a highly addictive drug, are higher. Nyaope is mainly smoked, but the prevalence of injecting it is increasing in most regions. Aim: This study aimed to explore and describe the perception of women, who use nyaope, about the factors contributing to nyaope smoking and transitioning to injecting nyaope amongst women in the City of Tshwane Municipality (CoT), Gauteng. Setting: The research was conducted within Community Oriented Substance Use Programme sites across the CoT Municipality. Methods: Qualitative research methods were utilised to explore and describe the perceptions of the participants on factors contributing to the use of nyaope amongst women residing in the CoT. Data were collected through face-to-face interviews and thematically analysed. Results: Intimate partner influence (IPI), peer pressure, being misled by friends, weight loss, lack of effective coping mechanisms and counteracting other drugs contributed to women smoking nyaope. Additionally, a need for an intense high, IPI, influence by the social network, curiosity and cost-effectiveness contributed to women transitioning from smoking to injecting nyaope. Conclusion: The study has established factors contributing to smoking and transition to injecting nyaope as viewed by women residing in the CoT.

Prevalence of substance abuse, assessment of socio-economic and demo-graphic determinants of commercial motorcyclists in Katsina State Nigeria

Background: Substance abuse has been reported to have adversely affected socio-economic determinants of states and nations. Substance abuse is the use of tobacco, alcohol, illegal or prescription drugs and other substances in ways contrary to the overall health of the individual. It has been grossly under-reported and undermined in Katsina State, Nigeria. Identification and early intervention of associated risk factors had greater impact than later intervention by changing individual's life pathway from problems and towards positive behaviors. Objectives: To determine the prevalence of substance abuse amongst motorcyclists and associated socio-economic characteristics in Katsina State, Nigeria, a cross sectional study approach was commissioned. Methodology: Convenient sampling using a mobile Open Data collection tool (ODK) application was used to collect and collate field data. Data was analyzed using SPSS®. Strength of significance within categorical variables were reported and accepted at P≤0.05. Results:Kola nut (53%) and Marijuana (1%) were identified to have the highest and lowest prevalence respectively (P>0.05) across Jibia and Katsina Local Government Areas the (2 LGAs) in Nigeria where the study was carried out. Almost all types of psychoactive substances were available in Nigeria due to their spill over into the streets from drug traffickers who use Nigeria as a conduit to transport drugs from South East-Asia (the Golden,South America to Europe and North America [12]. Conclusion: With an overall substance abuse prevalence of 19%, it was concluded that substance abuse was endemic in the state and hence public health education must be used to check this societal ill

Consumo de antimicrobianos seleccionados en el Cardiocentro Pediátrico William Soler durante el periodo 2011-2015 / Consumption of selected antimicrobials at William Soler Pediatric Cardiocenter, 2011-2015

Introducción: El uso irracional de antimicrobianos es un problema de salud. En el Cardiocentro Pediátrico William Soler existe una amplia utilización de ellos, sin embargo, no se conoce el comportamiento del consumo de este grupo farmacológico en la institución. Objetivo: Describir el consumo de antimicrobianos seleccionados en la institución en el periodo 2011-2015. Método: Estudio descriptivo, longitudinal del tipo estudio de utilización de medicamentos de consumo de 11 antimicrobianos, de uso restringido y elevado costo (cefepime, meropenem, levofloxacina oral y parenteral, linezolida, teicoplanina, vancomicina, colistina, aztreonam y amoxicilina/sulbactam oral y parenteral). El consumo en unidades físicas se obtuvo a partir de las tarjetas de estiba del almacén de medicamentos de la farmacia intrahospitalaria. Para el cálculo se utilizó la fórmula establecida por la Organización Mundial de la Salud, expresado en dosis diaria definida/100 camas/día (DDD/100 camas/día). Resultados: Se observó un incremento de 7,28 DDD/100 camas/día, los años 2013 y 2015 se mostraron como los de mayor consumo. Los fármacos más consumidos fueron el meropenem con un incremento de 2,71 DDD/100 camas/día; el cefepime con un incremento de 1,68 DDD/100 camas/día y la linezolida con un aumento de 1,15 DDD/100 camas/día. La terapia 1 y la sala 1A mostraron los mayores valores de consumo. Conclusiones: Los antimicrobianos han reducido de manera importante la amenaza de enfermedades infecciosas y son una herramienta indispensable en el tratamiento de los pacientes en los hospitales. El consumo de antimicrobianos seleccionados en el Cardiocentro Pediátrico William Soler, considerados de alto costo y utilización restringida, evidencia una tendencia al incremento, lo cual muestra la necesidad de desarrollar un programa de optimización de uso de estos medicamentos en la institución(AU)

Introduction: The irrational use of antimicrobials is a health problem. In William Soler Pediatric Cardiocenter there is a wide use of them; however, the behavior of the consumption of this pharmacological group in the institution is not known. Objective: To describe the consumption of selected antimicrobials in the institution in the period 2011-2015. Method: Descriptive, longitudinal study of the use of medicines for the consumption of 11 antimicrobials, of restricted use and high cost (cefepime, meropenem, oral and parenteral levofloxacin, linezolid, teicoplanin, vancomycin, colistin, aztreonam and amoxicillin / oral and parenteral sulbactam). The average consumption in physical units was obtained from the stowage cards of the drug store of the in-hospital pharmacy. For the calculation, the formula established by the World Health Organization was used and this is expressed in a defined daily dose / 100 beds / day (DDD / 100 beds / day). Results: An increase of 7.28 DDD / 100 beds / day was observed; the years 2013 and 2015 were shown as those with the highest consumption. The most consumed drugs were meropenem with an increase of 2.71 DD / 100 beds / day; cefepime with an increase of 1.68 DD / 100 beds / day; and linezolid with an increase of 1.15 DDD / 100 beds / day. Therapy room 1 and room 1A showed the highest consumption values. Conclusions: Antimicrobials have reduced in a crucial way the threat that infectious diseases represent, and they are also an indispensable tool in the treatment of patients in hospitals. The consumption of selected antimicrobials considered of high cost and restricted use in William Soler Pediatric Cardiocenter shows a tendency to increase, which shows the need to develop a program to optimize the use of antimicrobials in the institution(AU)

Prevalence of hepatitis C virus infection and the IL28B genotype polymorphism among blood donors and high-risk populations

INTRODUCTION@#To study the prevalence of hepatitis C virus (HCV) infection in blood donor (BD), haemodialysis (HD) and intravenous drug user (IVDU) populations in Singapore and assess the IL28B polymorphism if HCV positive.@*METHODS@#The BD population were healthy volunteers, the HD population were patients who were on haemodialysis for at least six months of follow-up between January 2009 and December 2014. IVDU population was from inmates at halfway houses who consented.@*RESULTS@#Between 2011 and 2014, of 161,658 individuals who underwent screening prior to blood donation, 95 (0.059%) were positive for HCV. Of the 42 sera available, common genotypes (GTs) were GT-3 (47.6%) and GT-1 (31.0%). Of 1,575 HD patients, 2.2% were anti-HCV positive. The HCV GT distribution was HCV GT-1 (32.4%), HCV GT-3 (20.5%) and GT-6 (8.8%). 83 halfway house inmates were screened. Of the 47 IVDUs, 36.2% were anti-HCV positive with predominant GT-3 (%). IL28B polymorphism was noted to be CC predominantly 85.3%.@*CONCLUSION@#Prevalence of HCV infection has decreased in both the BD and HD populations. However, it remains high in the IVDU population. GT-1 remains the most common in the HD population; however, GT-3 infection is now more common among the BD population in Singapore. IL28B - CC is the predominant variant among the HCV-infected individuals in Singapore.

Adherence to antiretroviral therapy in HIV-positive, male intravenous drug users in Pakistan

Background: Human immunodeficiency virus [HIV] is fifth leading cause of mortality and disability among infectious diseases worldwide. HIV burden is increasing annually and compliance with antiretroviral therapy [ART] is low among intravenous drug users, especially in developing countries.

Aim: To determine the adherence level to ART among HIV-positive intravenous drug users in Karachi Pakistan.

Methods: A cross-sectional study was conducted in 2015. A pretested questionnaire was administered to 375 of 3000 people who inject drugs, registered at the Civil Hospital in Karachi, Pakistan.

Results: The mean age was 30 years, 181 were married, 179 were illiterate and 287 had income < 5000 rupees per month. Only 63 patients were adherent to ART and 343 were alcoholics. Nonadherence was greater in patients who were single and did not have children. The most common reason for missing ART was that they simply forgot to take the tablets.

Conclusion: We conclude that adherence to ART among intravenous drug users was low. Family cohesion and support were essential to maintain adherence to ART

Related factors and interaction on HIV/HCV co-infection of patients access to methadone maintenance treatment / 中华流行病学杂志

Objective: To estimate the prevalence of HIV/HCV co-infection and explore the influence factors and their interaction on HIV/HCV co-infection of patient's access to methadone maintenance treatment (MMT). Methods: A face to face interviews were conducted among 750 patients at two MMT clinics in Guangxi Zhuang Autonomous Region. The questionnaires information included demographic characteristics, HIV and HCV infection status, history of drug abuse, urine test for morphine, high risk sex behaviors, needle sharing, dropped out etc. Methods of χ(2) test one-way, multivariate logistic regression and interactions were used to analyze the related factors of HIV/HCV co-infection. Results: The study subjects included 750 participants, 18.31% (127/691) of patients were co-infected with HIV and HCV. The HIV/HCV co-infection rate in patients who shared needles with others or dropped out of treatment was 35.84% (81/226) and 19.88% (64/322) respectively, which were higher than those who have never shared needles or dropped out (9.89%, 46/465 and 17.07%, 63/369). Logistic regression analysis results showed that after adjusted for confounding factors, patients who shared needles (OR=4.50, 95%CI: 2.72-7.43) and dropped out of treatment (OR=1.71, 95%CI: 1.04-2.80) were more likely to be infected with HIV/HCV. Interaction analysis showed that sharing needles and dropping out of treatment exist additive effect on co-infection of HIV and HCV (RERI=4.21, AP=0.44, SI=1.95). Conclusions: Needle sharing and dropping out of treatment are associated with HIV/HCV co-infection. Health education, psychological counseling and other measures should be taken to reduce needle sharing and dropping out of MMT.

Substance use among adolescents in sub-Saharan Africa: a systematic review and meta-analysis

Background. In sub-Saharan Africa, substance use among adolescents has continued to be a major public health concern, albeit poorly documented across many settings. Objective. To estimate the prevalence of substance use among adolescents in sub-Saharan Africa. Methods. We searched Pubmed, EMBASE, AJOL and Google Scholar for population-based studies on adolescents (age 10 - 19 years) and reporting on the prevalence of substance use across sub-Saharan Africa. Search dates were from January 2000 to December 2016. A random effects meta-analysis was conducted with pooled prevalence rates (and 95% confidence interval (95% CI)) of estimated substance abuse among adolescents in sub-Saharan Africa. Results. Twenty-seven studies across sub-Saharan Africa including 143 201 adolescents (mean age 15.6 years) were selected. The overall prevalence of 'any substance use' in sub-Saharan Africa was 41.6%, with the highest rate in Central Africa at 55.5%. The use of caffeine-containing products (including coffee or kola nut) was most predominant at 41.2% (95% CI 24.3 - 58.1) but limited to West Africa. These were followed by alcohol at 32.8% (95% CI 26.0 - 39.5), tobacco products 23.5% (95% CI 17.7 - 29.3), khat 22.0% (95% CI 12.5 - 31.5) and cannabis 15.9% (95% CI 12.2 - 19.1). Other abused substances included depressants at 11.3% (95% CI 6.5 - 16.1), amphetamines 9.4% (95% CI 6.0 - 12.9), heroin 4.0% (95% CI 3.5 - 4.5) and cocaine 3.9% (95% CI 1.4 - 6.5). Conclusion. Our study reflects a high use of psychoactive substances and drugs among adolescents in sub-Saharan Africa. It is important that interventions and rehabilitation programmes are comprehensive and targeted at adolescents and parents in these settings

Complicaciones del uso de la heroína parenteral: artículo de revisión / Parenteral heroin complications: Article review / Complicações do uso da heroína parenteral: artigo de revisão

Revisión narrativa que buscó recopilar informacion sobre complicaciones del uso de la heroína parenteral. Fueron captados artículos científicos, revisiones y casos clínicos en las bases de datos Scielo, Lilacs, Medline. La heroína es una sustancia psicoactiva y su uso tiene consecuencias adversas para la salud física y mental; las complicaciones físicas más frecuentes son infecciones por virus como el HIV, las hepatitis B y C, infecciones de piel, tuberculosis, embolias pulmonares y enfermedades renales. Otras complicaciones frecuentes son los trastornos mentales como depresión, trastornos de personalidad y el uso concomitante de otras sustancias, como el cannabis y la cocaína. Para el profesional de enfermería es importante conocer las complicaciones del uso de la heroína para planear procesos integrales y elaborar programas de reduccion de riesgos y daños derivados del uso de la sustancia.

This literature review sought to collect information on complications of parenteral use of heroin. Scientific articles, reviews, and case reports were selected from Scielo, Lilacs, and Medline databases. Heroin is a psychoactive substance and its use has mental and physical health consequences; among the most common physical consequences are blood-borne infectious diseases such as HIV, hepatitis B and C, skin infections, tuberculosis, pulmonary embolism, and renal disease. Other frequent complications include mental disorders, such as depression, personality disorders, and the concomitant abuse of other substances, such as cannabis and cocaine. It is important for nurses to be aware of the complications of heroin use in order to plan comprehensive processes and develop nursing programs that reduce the risks and harm resulting from use of the substance.

Revisão narrativa que buscou recopilar informação sobre complicações do uso da heroína parenteral. Foram captados artigos científicos, revisões e casos clínicos nas bases de dados Scielo, Lilacs, Medline. A heroína é uma substância psicoativa e seu uso tem consequências adversas para a saúde física e mental; as complicações físicas mais frequentes são infecções por vírus como o HIV, as hepatite B e C, infecções da pele, tuberculose, embolias pulmonares e doenças renais. Outras complicações frequentes são os transtornos mentais como depressão, transtornos de personalidade e o uso concomitante de outras substâncias, como a maconha e a cocaína. Para o profissional de enfermagem é importante conhecer as complicações do uso da heroína para planejar processos integrais e elaborar programas de redução de riscos e estragos derivados do uso da substância.

Uso de heroína inyectada y el riesgo de hepatitis C en tres ciudades de Colombia / Use of injected heroin and risk of hepatitis C in three cities in Colombia

RESUMEN: Introducción: La hepatitis C es uno de los grandes problemas de salud pública en el mundo, especialmente por su alta transmisibilidad por vía inyectada. Objetivo: Identificar la prevalencia de la infección por VHC, y factores asociados en usuarios de drogas psicoactivas inyectables en tres ciudades (Armenia, Bogotá y Cúcuta) de Colombia. Métodos: Estudio descriptivo transversal en 668 usuarios de drogas inyectables captados a través de muestreo guiado por el respondiente, a quienes se indagó sobre características demográficas y comportamientos de riesgo. Se utilizó la prueba de Anticuerpos, tomado en papel de filtro y se confirmaron los casos de VHC, con pruebas de carga viral de RNA. Se estimó la prevalencia de VHC y los factores asociados con pruebas estadísticas Chi-cuadrado y se calcularon razones de prevalencia crudas y ajustadas con regresión logística usando RDSAT y SPSS. Resultados: La prevalencia de infección por VHC fue del 17,5% y se encontraron como factores que aumentan la prevalencia de hepatitis: tener VIH, inyectarse con otra persona portadora del virus, utilizar dosis de una jeringa que estaba compartiendo, inyectarse con una jeringa casera y consumir marihuana. Como factor que reduce la prevalencia, el adquirir jeringas en droguerías u otras tiendas. Conclusión: Se evidencia un consumo establecido de drogas por vía inyectada, poniendo de relieve la importancia de generar intervenciones para la reducción de daños y la prevención de hepatitis C en estas tres ciudades del país.

ABSTRACT: Introduction: Hepatitis C is one of the most neglected diseases by governments internationally. Objective: Identify the prevalence of hepatitis C and associated injection drug users in three cities of factors Colombia. Methods: Cross-sectional study of 668 injecting drug users recruited through respondent-driven sampling, inquired about demographic characteristics and risk behaviors. Laboratory testing was used on filter paper and cases of hepatitis C viral load tests with RNA were confirmed. Hepatitis C prevalence and associated factors was estimated with Chi-square test statistics and reasons for crude and adjusted prevalence were calculated using logistic regression. Results: The prevalence of hepatitis C was 17.5% and were found as factors that increase the prevalence of hepatitis: having HIV, injecting another person carrying the virus dose used was sharing a syringe, injected with a syringe and consume marijuana. As a factor that reduces the prevalence, purchase syringes in drug stores or other stores. Conclusion: This research evidence established consumption of drugs by injection , and the presence of hepatitis C in social networks of IDUs and highlights the importance of developing interventions for harm reduction and prevention of hepatitis C in this population these three cities.

Prevalence of hepatitis C virus among patients with human immunodeficiency and its association with intra-venous drugs addiction in Jeddah, Saudi Arabia

Background: Despite extensive research on HIV and hepatitis C [HCV], there remains a gap in knowledge on the burden

Objectives: To assess the prevalence of hepatitis C virus [HCV] among positive human immunodeficiency virus patients and to study the relationships between these infections and intravenous drug addiction

Methodology: A cross sectional study has been conducted among total of 325 positive immunodeficiency patients [HIV] diagnosed to have HCV infection in the gastroenterology clinic at King Abdul-Aziz hospital and oncology center in Jeddah, Saudi Arabia between January 2015 and January 2016

Conclusion: The high prevalence of these major virulent infections among drug addiction is a sign of a major public health problem. Other than complicating addiction illnesses of patients, they could play major roles in spreading these infections to other intravenous drug addictors

Prevalence of hepatitis C virus antibody among newly reported HIV infection cases in Henan, 2012-2014 / 中华流行病学杂志

<p><b>OBJECTIVE</b>To study the prevalence of antibody to hepatitis C virus (anti-HCV) among newly reported HIV infection cases in Henan province, 2012-2014.</p><p><b>METHODS</b>HIV-1 BED incidence test and anti-HCV test were conducted in newly diagnosed HIV infection cases in Henan, which were reported through national AIDS information system between 1 July 2012 and 30 June 2014.</p><p><b>RESULTS</b>The data of 4 267 newly reported HIV-1 infection cases were analyzed, the positive rate of anti-HCV was 13.19% (563/4 267). The anti HCV was highest in those infected with HIV through injection drug use (77.27%), the anti-HCV positive rates in those infected with HIV through blood donation/transfusion, heterosexual contact, homosexual contact and mother-to-child transmission were 15.06%, 15.81%, 3.74% and 8.96%, respectively. Kaifeng (32.04%), Nanyang (14.67%), Shangqiu (25.00%), Zhumadian (25.00%) and Zhoukou (18.86%) were the first five prefectures with the high anti-HCV positive rates. The anti-HCV positive rate in BED positive patients (recent HIV-1 infections) was 7.50% (86/1 146). The multivariate logistic regressions analysis revealed that BED negative, aged >40 years, being farmer, HIV infection though injection drug use and living in in Kaifeng, Nanyang, Shangqiu, Zhumadian and Zhoukou were the risk factors for HCV infection.</p><p><b>CONCLUSION</b>The positive rate of anti-HCV declined between 2012-2014 in newly reported HIV infection cases in Henan, but the positive rate of anti-HCV was high in risk population and in some areas.</p>

Study on spousal notification in HIV discordant couples and associated factors in four provinces of China / 中华流行病学杂志

<p><b>OBJECTIVE</b>This study was aimed to investigate the ways of spousal notification and its associated factors among HIV discordant couples.</p><p><b>METHODS</b>A face-to-face questionnaire survey was conducted in Henan, Yunnan, Sichuan provinces and Guangxi Zhuang Autonomous Region in China. Information including democratic characteristics, knowledge and behaviors correlated with HIV infections and ways of HIV infectious status notification was collected. 'Data information system' on AIDS prevention and control was used to collect information on the transmission route.</p><p><b>RESULTS</b>A total of 770 pairs of HIV discordant couples were studied, among which 414 (53.77%) HIV positive respondents reported as self-notification, with another 44.68% were notified by medical staff. Factors associated with ways of notification included gender, nation, transmission route, and education level. HIV positive respondents who were female, under Han nationality, being paid blood donors, having had higher education level, were more likely to inform their HIV negative spouse by themselves.</p><p><b>CONCLUSION</b>Nationality and HIV transmission route of the HIV positive individuals were found as significant factors associated with ways of spousal notification. Therefore, HIV discordant couples notification should be strengthened, especially in the Minority-living areas and areas where HIV transmission was predomint through sexual contact and/or via injected drug use.</p>

Burden of blood transmitted infections in substance users admitted for inpatient treatment in Singapore and the associated factors

<p><b>INTRODUCTION</b>There is paucity of local data on the prevalence of blood transmitted infections (BTIs), such as hepatitis B, hepatitis C and human immunodeficiency virus (HIV) infections, among illicit drug users. This study aimed to examine the prevalence of BTIs among substance dependent inpatients and identify the factors associated with BTIs.</p><p><b>METHODS</b>We conducted a retrospective analysis of clinical notes of 170 inpatients with a diagnosis of substance dependence who were admitted at the National Addictions Management Service, Singapore, between 1 June 2009 and 31 May 2010.</p><p><b>RESULTS</b>Majority of the 170 inpatients were male (88.2%) and Chinese (58.2%). The mean age of the patients was 43.1 years, and the main drug of abuse was opioids (86.5%). BTIs were found in 70 (41.2%) inpatients; the prevalence of hepatitis B, hepatitis C and HIV infections was 3.7%, 39.6% and 0%, respectively. Lifetime intravenous drug use, but not needle-sharing, was more common among inpatients who were positive for BTIs (p < 0.01). Logistic regression analysis showed that lifetime intravenous drug use (OR 4.3, 95% CI 1.7- 10.8, p < 0.01) was the only significant predictor of BTIs.</p><p><b>CONCLUSION</b>A large proportion (41.2%) of the substance users seeking help was positive for at least one BTI. Lifetime intravenous drug users were found to be more than four times more likely to have a BTI. Early detection and prevention is essential to improve prognosis.</p>

Survival time and associated factors of 8 310 AIDS patients initially receiving antiretroviral treatment of Liangshan Yi Autonomous Prefecture, Sichuan province of China / 中华预防医学杂志

<p><b>OBJECTIVE</b>To investigate the survival time and its impact factors among AIDS patients who initially received antiretroviral treatment (ART) of Liangshan Yi Autonomous Prefecture, Sichuan province.</p><p><b>METHODS</b>A retrospective cohort study was conducted to analyze the information of AIDS patients over 18 years old initially received ART in Liangshan Yi Autonomous Prefecture during 2005-2013, which were downloaded from Chinese AIDS Antiretroviral Therapy DATA Fax Information System. Cox proportion hazard regression model was used to identify impact factors related survival time.</p><p><b>RESULTS</b>Among 8 310 ART AIDS patients who initially received ART, their mean age was (34.59 ± 9.10) years old, 65.50% (5 443 cases) were infected with HIV through injecting drug use, the mean time from testing HIV positive to starting ART were (24.68 ± 21.69) months. 436 cases died of AIDS related diseases, 28.67% (125 cases) of them died within the first 6 months of treatment. The cumulative survival rate of receiving ART in 1, 2, 3, 4 5 years were 97.11%, 93.41%, 90.61%, 88.81%, 86.02%, respectively. Multivariate Cox regression analysis showed the male patients receiveing ART were at a higher risk death of AIDS related diseases compared to the females (HR = 1.57, 95% CI: 1.13-2.182), the patients infected with HIV through injecting drug use were at a higher risk deathcompared to the infected through heterosexual transmission (HR = 1.64, 95% CI: 1.20-2.24), before the treatment patients with tuberculosis in recent1 year had higher death hazard as compared to those without tuberculosis (HR = 1.53, 95% CI: 1.05-2.21), in the treatment of the first 3 months of AIDS related diseases or symptoms of AIDS patients had higher death hazard as compared to those not suffer these diseases (HR = 1.80, 95% CI: 1.39-2.34). The patients with baseline CD4 (+) T lymphocytes cell counts < 50/µl (HR = 9.79, 95% CI: 6.03-15.89), 50-199/µl (HR = 3.26, 95% CI: 2.32-4.59), 200-349/µl (HR = 1.69, 95% CI: 1.22-2.34), were at a higher risk death than those with CD4 (+) T lymphocytes cell counts ≥ 350/µl.</p><p><b>CONCLUSION</b>Accumulate survival rate was higher after initial antiretroviral treatment among AIDS patients in Liangshan Yi Autonomous Prefecture, Sichuan province. AIDS patients who are males, have tuberculosis in recent year, infected HIV via route of intravenous drug use, with AIDS-related illness or symptoms in 3 months before ART, lower baseline CD4 (+) T lymphocyte count have higher risk of death.</p>

A study on the risk and its determinants of HIV transmission by syringe sharing among HIV-positive drug users / 中华预防医学杂志

<p><b>OBJECTIVE</b>To understand the risks and associated factors of HIV transmission by sharing syringes among HIV-positive drug users.</p><p><b>METHOD</b>The survey was conducted among HIV-positive injecting drug users (IDUs-HIV+) who received HIV counseling, testing and treatment in Changsha city Infectious Disease Hospital and Hengyang city No.3 People's Hospital from July 2012 to May 2013 to understand their socio-demographic characteristics, HIV prevalence and syringe sharing. A total of 503 IDUs-HIV+ were involved in and provided the contact list of 2 460 drug users who had the syringe sharing experience over one month with IDUs-HIV+. 420 IDUs-HIV+ among 503 were defined as infection sources due to sharing syringe with at least one drug user. Among them, 234 HIV-negative persons were in control group, and 186 HIV-positive were in cased group. A total of 1 220 drug users were followed up among 2 460 and defined as vulnerable population. The HIV transmission rate was calculated based on the HIV prevalence among vulnerable population. Based on the result of HIV transmission to vulnerable population from 420 infection sources, case-control study and the multivariate logistic regression analysis were adopted to explore the associated factors of HIV transmission among IDUs-HIV+.</p><p><b>RESULTS</b>As the sources of HIV transmission, 420 IDUs-HIV+ had an average duration of (4.5 ± 1.2) years for drug use. As a susceptible population, 1 220 drug users sharing syringes with the 420 IDUs-HIV+ had an average duration of (1.1 ± 0.5) years for drug use. There were 238 HIV-positive persons among 1 220 vulnerable drug users, with a transmission rate of 0.57. In the case-control study, the proportion of male subjects was 87.1% (162/186) in the case group, which was higher than that in the control group (77.8%, 182/234). The proportion of subjects who received support after knowing their HIV infection status was 51.1% (95/186) in the case group, which was lower than that in the control group (79.5%, 186/234). The proportion of subjects sharing syringes every time of using drugs was 47.8% (89/186) in the case group, which was higher than that in the control group (36.8%, 86/234). The proportion of subjects having AIDS awareness was 21.0% (39/186) in the case group, which was lower than that in the control group (64.5%, 151/234); the proportion of subjects having close contact with HIV-positive persons for more than 106 days was 60.2% (112/186) in the case group, which was higher than that in the control group (31.6%, 74/234). The proportion of subjects maintaining the original drug use method after being infected with HIV was 50.5% (94/186) in the case group, which was higher than that in the control group (16.7%, 39/234) (all P values < 0.05). The multivariate logistic regression analysis was carried out to analyse high correlate factors of HIV transmission by sources of transmission, and the AIDS awareness, duration of contact between sources of transmission and vulnerable population, access to support following confirmed HIV infection were protective factors, OR (95% CI) values were 0.155 (0.104-0.262), 0.170 (0.106-0.253), and 0.306 (0.189-0.450), respectively; while the frequency of syringe sharing and continuous drug use after being infected with HIV were risk factors, and the OR (95% CI) values were 3.06 (1.77-5.29), and 3.54 (2.16-5.80), respectively.</p><p><b>CONCLUSION</b>HIV transmission by IDUs-HIV+ might be contained by raising AIDS awareness, providing comprehensive psychological support, conducting needle exchange and methadone maintenance treatment and reducing syringe sharing.</p>

A case of peritoneal dialysis-associated peritonitis by Rothia mucilaginosa

Rothia muciliaginosa (R. mucilaginosa) is a facultative, Gram-positive coccus that is considered to be part of the normal flora of the mouth and respiratory tract. There are sporadic reports of the organism causing endocarditis in patients with heart valve abnormalities, as well as meningitis, septicemia, and pneumonia associated with intravenous drug abuse. However, it is an unusual pathogen in cases of peritoneal dialysis (PD)-associated peritonitis. Although R. mucilaginosa is generally susceptible to penicillin, ampicillin, cefotaxime, imipenem, rifampicin, and glycopeptides, there are no guidelines for the treatment of PD-associated peritonitis. Herein, we report a case of PD-associated peritonitis due to R. mucilaginosa that was resolved with intraperitoneal antibiotic treatment.

Correlates of perceived risk of HIV infection among persons who inject drugs in Tijuana, Baja California, Mexico / Correlaciones de percepción de riesgo de infección con VIH entre personas que se inyectan droga en Tijuana, Baja California, México

Objective. We identified correlates of perceived risk of HIV infection among persons who inject drugs (PWID) in Tijuana. Materials and methods. PWID ≥18 years of age who injected drugs in the past month were recruited between 2006-2007 and completed risk assessment interviews and serologic testing for HIV, syphilis, and tuberculosis. Logistic regression was used to determine factors associated with high-perceived risk of HIV infection. Results. Among 974 PWID, HIV prevalence was 4.4%; 45.0% of participants perceived themselves to be more likely to become HIV infected relative to other PWID in Tijuana. Participants who reported high-perceived risk of HIV infection participated in high-risk behaviors such as injecting with used syringes, transactional sex, and were less likely to have had an HIV test. Conclusions. Recognition of HIV infection risk was associated with high risk behaviors and markers of vulnerability. Findings support efforts to encourage HIV testing and access to health care for this vulnerable population.

Objetivo. Identificar factores correlacionados con el riesgo percibido de contraer VIH entre personas que se inyectan drogas (PID) en Tijuana. Material y métodos. Entre 2006-2007 se reclutaron PID ≥18 años de edad que se inyectaron drogas en el último año previo al estudio y completaron entrevistas para evaluación de riesgos y pruebas serológicas para VIH, sífilis y tuberculosis. Se utilizó regresión logística para determinar factores asociados con alto-riesgo percibido para la infección del VIH. Resultados. En los 974 PID la prevalencia de VIH fue 4.4%; 45.0% se consideró con mayor probabilidad de infectarse con VIH en relación con otros PID en Tijuana. Los participantes que reportaron alto riesgo percibido participaron en comportamientos de alto riesgo como inyectarse con jeringas usadas y transacción sexual, y tenían menos probabilidades de haber tenido una prueba de VIH. Conclusiones. Reconocer el riesgo del VIH se asoció con comportamientos de alto riesgo y marcadores de vulnerabilidad. Los resultados apoyan los esfuerzos para fomentar las pruebas para VIH y acceso a servicios de salud para esta población vulnerable.

Geografia, saúde e desenvolvimento urbano no interior paulista na passagem para o século XX: Domingos Jaguaribe e a construção da Estância Climática de Campos do Jordão / Geography, health and urban development in São Paulo state at the turn of the twentieth century: Domingos Jaguaribe and the construction of the Climate Resort of Campos do Jordão

As cidades-estância instituídas no início do século XX são objetos privilegiados para estudar a relação entre as políticas de saúde pública e o desenvolvimento urbano e social. Este artigo analisa, a partir da produção e trajetória do médico, geógrafo e empreendedor Domingos Nogueira Jaguaribe Filho, os vetores social e institucional envolvidos na criação da cidade-estância de Campos do Jordão. Estudos geográficos, conhecimento médico e preceitos de urbanização se aliaram a interesse privados e desenvolvimentistas na construção simbólica e concreta da “Suíça brasileira”.

The resort towns created in the early 1900s are prime objects for studying the relationship between public health policies and urban and social development. This article analyzes the social and institutional vectors involved in the creation of the resort town of Campos do Jordão from the perspective of the career and works of physician, geographer and businessman Domingos Nogueira Jaguaribe Filho. Geographical studies, medical knowledge and the precepts of urbanization combined with private and development interests in the symbolism and concrete manifestation of the “Brazilian Switzerland”.