Exploring the multidisciplinary extent of public health career structures in 12 countries: an exploratory mapping.

Background: While much is known about multidisciplinary public health (MDPH) professional practice in the UK which developed particularly in the 1990s, little is known about it in other settings especially low and middle-income countries (LMICs). This study reports on findings of a mapping review of public health career structures and an examination of how multidisciplinary they are in 12 countries. Methods: A 12-element template was used to collect data from relevant websites and key informants with public health experience in the 12 countries. Results: We found that while countries had similarities such as having MDPH professional organizations, there were differences in terms of public health specialty training programmes and openness of senior public health posts at various administrative levels to non-medical professionals. Conclusion: We conclude that there still gaps in MDPH career structures internationally. While this study provides preliminary knowledge on the subject, we recommend further research to inform debates and policies in MDPH professional practice especially in LMICs.

A systematic review of interventions to increase the uptake of opiate substitution therapy in injecting drug users.

BACKGROUND: Opiate substitution therapy (OST) has multiple benefits and is a key component of overdose and blood-borne virus prevention in injecting drug users (IDUs). Interventions that can increase the uptake of OST and/or re-engage people in treatment could become an important component of harm reduction. A systematic literature review was conducted for studies of interventions designed to increase the uptake of OST. METHODS: Searches were conducted using Medline, Embase, PsycInfo and CINHAL. We concentrated on an adult population in a community setting and English language studies. RESULTS: Eighty nine studies were identified after filtering search results, of which, 14 met the inclusion criteria. Studies were broadly categorized into motivational interventions (MI), case management (CM) or mixed approaches. Meta-analysis was performed on six studies investigating MI and two studies investigating CM interventions. Individuals exposed to MI were 1.46 times more likely to enter treatment at follow-up (95% CI: 1.14-1.86, P = 0.003) and individuals exposed to CM were 2.95 times more likely to be entering treatment at follow-up (95% CI: 2.08-4.17, P < 0.001). CONCLUSIONS: There appears to be a promising effect for the use of both CM and MI approaches to increase the uptake of IDUs into treatment. Further investigation of these interventions is warranted.

Assessing IDU prevalence and health consequences (HCV, overdose and drug-related mortality) in a primary care trust: implications for public health action.

BACKGROUND: We report on an exercise to estimate the prevalence of injecting drug use (IDU) and associated harms in a single primary care trust. METHODS: Covariate capture-recapture methods to estimate (i) IDU prevalence; respondent driven sampling to measure (ii) prevalence of HCV and HIV and record linkage to measure (iii) mortality risk. RESULTS: (i) The overall estimated number of IDU was 5540 (95% confidence interval, CI: 4710-6780) for all cases and 3280 (95% CI: 1940-4610) for cases matched to primary care register, i.e. a prevalence of 2.2 and 1.3% aged 15-54, respectively. (ii) The prevalence of HCV, hepatitis B and HIV was: 53, 32 and 0.7%. Over 70% of IDU in Bristol reported having at least one vaccination for HBV; more than half of those who were HCV positive were undiagnosed. (iii) The all-cause and overdose mortality rates for IDU were 0.75 and 0.4% respectively; and the standardized mortality ratio was 7.8 (95% CI: 5.4-10.8). CONCLUSION: Locally specific and useful intelligence on injecting and its health consequence can be generated to inform local public health action, and may contribute information to validate national prevalence estimates.