Analysis of Patients' Characteristics and Treatment Profile of People Who Use Drugs (PWUDs) with and without a Co-Diagnosis of Viral Hepatitis C: A Real-World Retrospective Italian Analysis.

Purpose: Hepatitis C virus (HCV) spreads from contact with blood of an infected person. HCV infections are common among people who use drugs (PWUDs), when sharing needles, syringes, or other equipment for injected drugs. The advent of pangenotypic direct-antiviral agents (DAA) in 2017 transformed the treatment landscape for HCV, but PWUDs remain a complex and hard-to-treat population with high risk of HCV reinfection. The aim of this real-world analysis was to characterize the demographic and clinical features of PWUDs in Italy, also focusing on comorbidity profile, treatment with DAAs, resource consumptions for the National Health System (NHS). Patients and Methods: During 01/2011-06/2020, administrative databases of Italian healthcare entities, covering 3,900,000 individuals, were browsed to identify PWUDs with or without HCV infection. Among HCV+ patients, a further stratification was made into treated and untreated with DAAs. The date of PWUD or HCV first diagnosis or DAA first prescription was considered as index-date. Patients were then followed-up for one year. Alcohol-dependency was also investigated. Results: Total 3690 PWUDs were included, of whom 1141 (30.9%) PWUD-HCV+ and 2549 (69.1%) PWUD-HCV-. HCV-positive were significantly older (43.6 vs 38.5 years, p < 0.001), had a worse comorbidity profile (Charlson-index: 0.8 vs 0.4, p < 0.001), and high rates of psychiatric, respiratory, dermatological, musculoskeletal diseases and genitourinary (sexually transmitted) infections. Moreover, they received more drug prescriptions (other than DAAs, like anti-acids, antiepileptics, psycholeptics) and had undergone more frequent hospitalization, predominantly for hepatobiliary, respiratory system and mental disorders. DDA-untreated had significantly higher Charlson-index than DAA-treated (0.9 vs 0.6, p = 0.003). Alcoholism was found in 436 (11.8%) cases. Conclusion: This Italian real-world analysis suggests that PWUDs with HCV infection, especially those untreated with DAAs, show an elevated drug consumption due to their complex clinical profile. These findings could help to ameliorate the healthcare interventions on PWUDs with HCV infection.

Meet-Test-Treat for HCV management: patients' and clinicians' preferences in hospital and drug addiction services in Italy.

BACKGROUND: It has been estimated that the incidence of chronic hepatitis C virus (HCV) will not decline over the next 10 years despite the improved efficacy of antiviral therapy because most patients remain undiagnosed and/or untreated. This study aimed to investigate the opinion of relevant target populations on the practicability, effectiveness and best modalities of the test-and-treat approach in the fight against HCV in Italy. METHODS: A survey was delivered to patients with HCV from the general population, patients from drug addiction services, hospital physicians and healthcare providers for drug addiction services. RESULTS: For both hospital clinicians and SerD HCPs, tolerability is shown as the most important feature of a suitable treatment. Time to treatment (the time from first contact to initiation of treatment) is deemed important to the success of the strategy by all actors. While a tolerable treatment was the main characteristic in a preferred care pathway for general patients, subjects from drug addiction services indicated that a complete Meet-Test-Treat pathway is delivered within the habitual care center as a main preference. This is also important for SerD HCPs who are a strong reference for their patients; hospital clinicians were less aware of the importance of the patient-HCP relationship in this process. CONCLUSION: The health system is bound to implement suitable pathways to facilitate HCV eradication. A Meet-Test-Treat program within the drug addiction services may provide good compliance from subjects mainly concerned with virus transmission.

Prisoners' ambivalent sexism and domestic violence: a narrative study.

PURPOSE: Gender inequality and sexism are often at the root of domestic violence against women and children, with both serving to justify male domination. This runs in parallel with mother-blaming bias, which constitutes a pervasive common sense and scientific error derived from the myth of the good and the bad mother, characterising a large part of studies on deviance. The purpose of this paper is to consider the possible role of sexism in prisoners' deviant biographies; for this, the authors considered the role of the mother in the biographies of prisoners, and the results lend support to the idea that mother-blaming is a serious fallacy. Starting from a critical psychology point of view and following the retrospective methodology, the authors interviewed 22 drug-addicted prisoners through Interpretative Phenomenological Analysis (IPA) regarding their biographies and their relationships with parents and partners. DESIGN/METHODOLOGY/APPROACH: In the survey, the authors followed the same intention, and the results lend support to the idea that mother-blaming is a serious fallacy. The authors interviewed 22 drug-addicted prisoners through IPA concerning their biographies and their relationships with parents and partners. FINDINGS: The main result of this qualitative study was the recognition of a fundamental sexism assumed by participants, characterised by a paradox between the representation of the mother and the representation of the ideal woman. Despite the mother being their positive affective referent, and battered by her husband/partner, the same participants had been witnesses of domestic violence, and sometimes victims, they interiorised from their father an ambivalent sexism: benevolent sexism with regard to their mother and exhibited hostile sexism with their partner. On the one hand, it emerged that female empowerment was desirable with respect to the mothers. On the other hand, the ideal woman was exactly as their mother was, that is, being absolutely subordinated to men (a patient, caring, submissive housewife, totally dedicated to her children and her husband). RESEARCH LIMITATIONS/IMPLICATIONS: From a mainstream psychological perspective, the limits of the research are linked to the utilisation of the narrative method. Also, this methodology does not verify any hypotheses, so quotations from the participants are used to illustrate themes, and thus, it is difficult to report the informational complexities arising from the dialogues. However, the literature has emphasised that these limitations do not invalidate qualitative research findings, despite the difficulties in generalising the results of the qualitative studies. Thereafter, the critical analysis moved within the intersection of experience-centred approaches and the culturally oriented treatment of narratives, so that the focus on the stories of the prisoners makes meaning because it applies structure to experience, albeit, with the form and content of the texts. This research did not permit us to measure and evaluate post-hoc any post-traumatic hypotheses, which, in turn, would give room for further research. Another limitation of the research was that the relationship between culture of origin and gender biases, especially with participants from non-European countries, was not analysed. This topic would require an important in-depth study, which encompasses how women are treated in different countries and its effects on social maladjustment for immigrants in Italy. PRACTICAL IMPLICATIONS: The outcome of this study suggests that within similar structures in the Institute of Mitigated Custody, the theme of sexism should be considered in more depth. Since sexism justifies violence against women, and is therefore a factor that can cause recidivism in the antisocial behaviour of prisoners once they have served their sentences. It is important to allow them to analyse the relationship between their sexist attitudes, witnessing violence in childhood and the possibility of changing moral values of reference in favour of equality. This type of psychological intervention must necessarily be based not only on the elaboration of traumas suffered during childhood with an abusive father, but also on issues related to gender equality and the theme of social inclusion. SOCIAL IMPLICATIONS: The study suggests the idea that male sexism can be a factor responsible for suffering and maladjustment for men and that therefore an education that promotes equality of gender differences can also help prevent the social distress associated with drug addiction and deviance. ORIGINALITY/VALUE: The paper considers some cogent issues inherent to ambivalent sexism that pervades prisoners' aspirations for their future.

Craving in Opioid Use Disorder: From Neurobiology to Clinical Practice.

Opioid use disorder (OUD) is a major public health issue that has reached epidemic levels in some parts of the world. It is a chronic and complex neurobiological disease associated with frequent relapse to drug taking. Craving, defined as an overwhelmingly strong desire or need to use a drug, is a central component of OUD and other substance use disorders. In this review, we describe the neurobiological and neuroendocrine pathways that underpin craving in OUD and also focus on the importance of assessing and treating craving in clinical practice. Craving is strongly associated with patients returning to opioid misuse and is therefore an important treatment target to reduce the risk of relapse and improve patients' quality of life. Opioid agonist therapies (OAT), such as buprenorphine and methadone, can significantly reduce craving and relapse risk, and it is essential that patients are treated optimally with these therapies. There is also evidence to support the benefits of non-pharmacological approaches, such as cognitive behavioral therapy and mindfulness-based interventions, as supplementary treatments to opioid agonist therapies. However, despite the positive impact of these treatments on craving, many OUD patients continue to suffer with negative affect and dysphoria. There is a clear need for further studies to progress our understanding of the neurobiological basis of craving and addiction and to identify novel therapeutic strategies as well as to optimize the use of existing treatments to improve outcomes for the growing numbers of patients affected by OUD.

The Efficacy of Dog Assisted Therapy in Detained Drug Users: A Pilot Study in an Italian Attenuated Custody Institute.

Drug addiction is a major care and safety challenge in prison context. Nowadays, rehabilitation and specific therapeutic programs are suggested to improve health and well-being of inmates during their detention time and to reduce substance abuse relapse after release from prison. Among these programs, several studies reported the benefits for inmates coming from animal assisted interventions. In this pilot controlled study, we investigated the efficacy of a dog assisted therapy program addressed to 22 drug addicted male inmates housed in an attenuated custody institute in Italy. The study lasted six months, the treated group (12 inmates) was involved once a week for one hour in 20 dog assisted therapy sessions, whereas the control group (10 inmates) followed the standard rehabilitation program. One week before the beginning and one week after the end of the sessions, all inmates involved were submitted to symptom checklist-90-revised and Kennedy axis V. Inmates involved in the dog assisted therapy sessions significantly improved their social skills, reducing craving, anxiety and depression symptoms compared to the control group. Despite the limitation due to the small number of inmates enrolled and to the absence of follow up, we found these results encouraging to the use of dog assisted therapy as co-therapy in drug addicted inmates rehabilitation programs, and we claim the need of more extensive study on this subject.