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2.
Public Health Rep ; 135(1_suppl): 138S-148S, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735193

RESUMO

OBJECTIVES: The impact of a syringe services program (SSP) policy on risk behaviors and its durability are not as well studied as the impact of the SSPs themselves. We examined whether trends in syringe sharing among persons who inject drugs (PWID) were associated with changes to syringe access policies in 3 US cities: Denver, New Orleans, and Philadelphia. METHODS: PWID were surveyed through National HIV Behavioral Surveillance System surveys in each city in 2005, 2009, 2012, and 2015. We assessed changes in syringe sharing from 2005 to 2015 by city. We used multivariable stepwise logistic regression analysis to measure the associations among syringe sharing and injection works sharing, time, and SSP access. RESULTS: From 2005 to 2015, syringe sharing decreased significantly from 49.1% to 33.1% in Denver (P < .001), increased significantly from 32.0% to 50.5% in New Orleans (P < .001), and remained unchanged in Philadelphia (30.4% to 31.5%; P = .87). Compared with persons who obtained syringes from any nonsterile source, the adjusted odds of syringe sharing among PWID were significantly lower in each city if syringes were obtained from sterile sources only: Denver adjusted odds ratio (aOR) = 0.23 (95% confidence interval [CI], 0.18-0.30; New Orleans aOR = 0.26 (95% CI, 0.19-0.35), and Philadelphia aOR = 0.43 (95% CI, 0.33-0.57). CONCLUSIONS: The lowest proportion of PWID reporting syringe sharing was in Philadelphia, which has a long-standing legal SSP. Implementation of a legal SSP in Denver in 2012 corresponded to a decrease in sharing, whereas the lack of a legal SSP in New Orleans corresponded to an increase in sharing. Universal long-term access to legal SSPs could further the progress made in HIV prevention among PWID.


Assuntos
Uso Comum de Agulhas e Seringas/estatística & dados numéricos , Programas de Troca de Agulhas/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adolescente , Adulto , Alcoolismo/epidemiologia , Cidades/epidemiologia , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Assunção de Riscos , Fatores Socioeconômicos , Abuso de Substâncias por Via Intravenosa/mortalidade , Estados Unidos/epidemiologia , Adulto Jovem
3.
Public Health Rep ; 135(1_suppl): 128S-137S, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735195

RESUMO

OBJECTIVE: Law is an important factor in the diffusion of syringe services programs (SSPs). This study measures the current status of, and 5-year change in, state laws governing SSP operations and possession of syringes by participants. METHODS: Legal researchers developed a cross-sectional data set measuring key features of state laws and regulations governing the possession and distribution of syringes across the 50 US states and the District of Columbia in effect on August 1, 2019. We compared these data with previously collected data on laws as of August 1, 2014. RESULTS: Thirty-nine states (including the District of Columbia) had laws in effect on August 1, 2019, that removed legal impediments to, explicitly authorized, and/or regulated SSPs. Thirty-three states had 1 or more laws consistent with legal possession of syringes by SSP participants under at least some circumstances. Changes from 2014 to 2019 included an increase of 14 states explicitly authorizing SSPs by law and an increase of 12 states with at least 1 provision reducing legal barriers to SSPs. Since 2014, the number of states explicitly authorizing SSPs nearly doubled, and the new states included many rural, southern, or midwestern states that had been identified as having poor access to SSPs, as well as states at high risk for HIV and hepatitis C virus outbreaks. Substantial legal barriers to SSP operation and participant syringe possession remained in >20% of US states. CONCLUSION: Legal barriers to effective operation of SSPs have declined but continue to hinder the prevention and reduction of drug-related harm.


Assuntos
Programas de Troca de Agulhas/legislação & jurisprudência , Governo Estadual , Abuso de Substâncias por Via Intravenosa/epidemiologia , Estudos Transversais , Acesso aos Serviços de Saúde/organização & administração , Hepatite/diagnóstico , Humanos , Programas de Rastreamento/organização & administração , Características de Residência , Doenças Sexualmente Transmissíveis/diagnóstico , Serviço Social/organização & administração , Tuberculose/diagnóstico , Estados Unidos
4.
PLoS One ; 15(8): e0237560, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32857765

RESUMO

Pakistan is considered by the World Health Organization to currently have a "concentrated" HIV-1 epidemic due to a rapid rise in infections among people who inject drugs (PWID). Prevalence among the country's nearly 105,000 PWID is estimated to be 37.8% but has been shown to be higher in several large urban centers. A lack of public health resources, the common use of professional injectors and unsafe injection practices are believed to have fueled the outbreak. Here we evaluate the molecular characteristics of HIV-1 sequences (n = 290) from PWID in several Pakistani cities to examine transmission dynamics and the association between rates of HIV-1 transmission with regards to regional trends in opioid trafficking. Tip-to-tip (patristic) distance based phylogenetic cluster inferences and BEAST2 Bayesian phylodynamic analyses of time-stamped data were performed on HIV-1 pol sequences generated from dried blood spots collected from 1,453 PWID as part of a cross-sectional survey conducted in Pakistan during 2014/2015. Overall, subtype A1 strains were dominant (75.2%) followed by CRF02_AG (14.1%), recombinants/unassigned (7.2%), CRF35_AD (2.1%), G (1.0%) and C (0.3%). Nearly three quarters of the PWID HIV-1 sequences belonged to one of five distinct phylogenetic clusters. Just below half (44.4%) of individuals in the largest cluster (n = 118) did seek help injecting from professional injectors which was previously identified as a strong correlate of HIV-1 infection. Spikes in estimated HIV-1 effective population sizes coincided with increases in opium poppy cultivation in Afghanistan, Pakistan's western neighbor. Structured coalescent analysis was undertaken in order to investigate the spatial relationship of HIV-1 transmission among the various cities under study. In general terms, our analysis placed the city of Larkana at the center of the PWID HIV-1 epidemic in Pakistan which is consistent with previous epidemiological data.


Assuntos
Analgésicos Opioides/administração & dosagem , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , HIV-1/isolamento & purificação , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Filogenia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto , Estudos Transversais , Feminino , Infecções por HIV/virologia , Soropositividade para HIV , Humanos , Masculino , Transtornos Relacionados ao Uso de Opioides/virologia , Paquistão/epidemiologia , Adulto Jovem
5.
Public Health Rep ; 135(4): 461-471, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32633599

RESUMO

OBJECTIVES: Hepatitis C virus (HCV) and HIV transmission in the United States may increase as a result of increasing rates of opioid use disorder (OUD) and associated injection drug use (IDU). Epidemiologic trends among American Indian/Alaska Native (AI/AN) persons are not well known. METHODS: We analyzed 2010-2014 Indian Health Service data on health care encounters to assess regional and temporal trends in IDU indicators among adults aged ≥18 years. IDU indicators included acute or chronic HCV infection (only among adults aged 18-35 years), arm cellulitis and abscess, OUD, and opioid-related overdose. We calculated rates per 10 000 AI/AN adults for each IDU indicator overall and stratified by sex, age group, and region and evaluated rate ratios and trends by using Poisson regression analysis. RESULTS: Rates of HCV infection among adults aged 18-35 increased 9.4% per year, and rates of OUD among all adults increased 13.3% per year from 2010 to 2014. The rate of HCV infection among young women was approximately 1.3 times that among young men. Rates of opioid-related overdose among adults aged <50 years were approximately 1.4 times the rates among adults aged ≥50 years. Among young adults with HCV infection, 25.6% had concurrent OUD. Among all adults with arm cellulitis and abscess, 5.6% had concurrent OUD. CONCLUSIONS: Rates of HCV infection and OUD increased significantly in the AI/AN population. Strengthened public health efforts could ensure that AI/AN communities can address increasing needs for culturally appropriate interventions, including comprehensive syringe services programs, medication-assisted treatment, and opioid-related overdose prevention and can meet the growing need for treatment of HCV infection.


Assuntos
Nativos do Alasca/estatística & dados numéricos , Hepatite C/epidemiologia , Índios Norte-Americanos/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , United States Indian Health Service/estatística & dados numéricos , United States Indian Health Service/tendências , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Previsões , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
6.
Arch Virol ; 165(9): 1947-1958, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32617764

RESUMO

Coinfections of hepatitis C virus (HCV) and/or hepatitis B virus (HBV) with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) are associated with high morbidity and mortality and poor prognosis. The main objective of this study was to evaluate the prevalence of HCV and/or HBV coinfections among people who inject drugs (PWID) and female sex workers (FSWs) who live with HIV/AIDS worldwide. Data sources were searched from January 2008 to October 2018 in different databases, including PubMed, Scopus, Web of Science, Embase, and Ovid. Data were analyzed in Stata 14 software using the Metaprop command. The results showed that the prevalence of HCV among PWID and FSWs with HIV/AIDS was 72% (95% CI: 59%-83%) and 40% (95% CI: 0%-94%), respectively. The prevalence of HBV among PWID and FSWs with HIV/AIDS was 8% (95% CI: 5%-13%) and 2% (95% CI: 0%-7%), respectively, and the prevalence of HCV/HBV in PWID with HIV/AIDS was 11% (95% CI: 7%-15%). The highest prevalence of HCV was observed in PWID in the Eastern Mediterranean and Europe regions, and the lowest was observed in the Africa region. The South-East Asia region had the highest prevalence of HBV among PWID, and the Africa region had the lowest prevalence. The high prevalence of HCV coinfection among PWID and FSWs with HIV/AIDS was an alarming health problem and requires appropriate interventions. Therefore, considering that these populations are key populations for HCV elimination, it is recommended to screen them regularly for HCV. In addition, harm reduction and HBV vaccination should be carefully considered.


Assuntos
Síndrome de Imunodeficiência Adquirida/virologia , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Abuso de Substâncias por Via Intravenosa/virologia , Síndrome de Imunodeficiência Adquirida/epidemiologia , Adulto , Coinfecção/epidemiologia , Coinfecção/virologia , Feminino , HIV/isolamento & purificação , HIV/fisiologia , Hepacivirus/isolamento & purificação , Hepacivirus/fisiologia , Hepatite B/virologia , Vírus da Hepatite B/isolamento & purificação , Vírus da Hepatite B/fisiologia , Hepatite C/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Profissionais do Sexo/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto Jovem
8.
PLoS One ; 15(7): e0235350, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32663203

RESUMO

BACKGROUND: Skin and soft tissue infections (SSTI) are a common but preventable cause of morbidity and mortality among people who inject drugs (PWID). They can be severe, and hospitalisations of PWID with SSTI are rising. The most common SSTI presentations are abscesses and cellulitis. METHODS: We used data from Care & Prevent, a cross-sectional community survey of PWID in London. We reported the lifetime prevalence of SSTI, severity of infections, key risk factors, and associated sequelae. Pictorial questions were used to assess SSTI severity. RESULTS: We recruited 455 PWID. SSTI lifetime prevalence was high: 64% reported an abscess and/or cellulitis. Over one-third (37%) reported a severe infection, 137 (47%) reported hospitalisation. SSTIrisk factors were: aged 35+ years, injecting once or more times a day, subcutaneous or intra-muscular injections, and making four or more attempts to achieve an injection. Those who reported having other health conditions were at higher odds of having an abscess or cellulitis, with risk tending to increase with number of reported conditions. Half (46%) employed self-care for their worst SSTI, and 43% waited for ten or more days before seeking medical care or not seeking medical care at all. CONCLUSIONS: Abscess and cellulitis are very common among PWID in London. We corroborate findings indicating SSTIs are associated with risks, e.g. venous access problems, as well as other co-morbid conditions: septicaemia, endocarditis, DVT, and kidney disease. These co-morbidities may impact SSTIs severity and outcomes. Delayed healthcare seeking potentially exacerbates infection severity, which in turn increases poorer health outcomes and complications.


Assuntos
Abscesso/epidemiologia , Celulite (Flegmão)/epidemiologia , Dermatopatias Infecciosas/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Abscesso/complicações , Abscesso/fisiopatologia , Adulto , Celulite (Flegmão)/complicações , Celulite (Flegmão)/fisiopatologia , Feminino , Humanos , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Prevalência , Fatores de Risco , Sepse/complicações , Sepse/epidemiologia , Sepse/fisiopatologia , Dermatopatias Infecciosas/complicações , Dermatopatias Infecciosas/fisiopatologia , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/fisiopatologia , Reino Unido/epidemiologia
9.
PLoS One ; 15(7): e0235237, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32667919

RESUMO

The epidemic of hepatitis C virus (HCV) infection among HIV-infected men who have sex with men (MSM) is in its second decade, but the routes of transmission remain poorly understood. We hypothesized that by pairing single genome sequencing (SGS), to enumerate infecting HCV genomes (viruses), with detailed sexual and drug histories, we could gain insight into the routes of transmission among MSM. We used SGS to analyze blood specimens from eight HIV-infected MSM who had 10 episodes of acute (seronegative) or early HCV infections. Seven of eight men reported condomless receptive anal intercourse (CRAI), six with rectal exposure to semen, and all eight denied rectal trauma or bleeding. Of the 10 HCV infections, eight resulted from transmission of a single virus; one infection resulted from transmission of either one or a few (three or four) closely-related viruses; and one infection resulted from transmission of >10 distinct viruses. The participant infected by >10 viruses reported sharing injection equipment for methamphetamine during sex. Two other participants also injected methamphetamine during sex but they did not share injection equipment and were infected by a single virus. Conclusions: Most HCV infections of HIV-infected MSM without a history of either rectal trauma or bleeding or shared injection equipment were caused by a single virus. Intra-rectal exposure to semen during CRAI is therefore likely sufficient for HCV transmission among MSM. Conversely, rectal trauma or bleeding or shared injection equipment are not necessary for HCV transmission among MSM. These results help clarify routes of HCV transmission among MSM and can therefore help guide the design of much-needed behavioral and other interventions to prevent HCV transmission among MSM.


Assuntos
Coinfecção/epidemiologia , Infecções por HIV/epidemiologia , Hepacivirus/genética , Hepatite C/transmissão , Adulto , Coinfecção/virologia , Genoma Viral/genética , Infecções por HIV/virologia , Hepacivirus/isolamento & purificação , Hepatite C/epidemiologia , Hepatite C/virologia , Humanos , Masculino , Metanfetamina/administração & dosagem , Pessoa de Meia-Idade , Uso Comum de Agulhas e Seringas/efeitos adversos , Uso Comum de Agulhas e Seringas/estatística & dados numéricos , Cidade de Nova Iorque/epidemiologia , Filogenia , RNA Viral/genética , RNA Viral/isolamento & purificação , Fatores de Risco , Análise de Sequência de RNA , Minorias Sexuais e de Gênero/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Sexo sem Proteção/estatística & dados numéricos
10.
PLoS One ; 15(6): e0233927, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32497108

RESUMO

BACKGROUND: The opioid epidemic has led to an increase in the number of persons who inject drugs, and this population accounts for 12% of new human immunodeficiency virus (HIV) and 60% of new hepatitis C virus (HCV) infections in the United States annually. While persons who inject drugs disproportionately utilize the emergency department (ED), accurate data is lacking on the prevalence and patterns of injection drug use, and prevalence of co-occurring HIV and HCV infections among ED patients. OBJECTIVE: The primary outcome was to assess the prevalence of injection drug use and co-occurring HIV and HCV infection among patients presenting to an urban ED. METHODS: This was a cross sectional study conducted at an urban ED, with an annual census of 65,000 visits. A closed-response questionnaire was developed based on publicly available validated surveys to assess patterns of injection drug use and HIV and HCV infection status, and administered by trained research assistants to all registered adult patients during 4-hour blocks of time. RESULTS: Of the 2,319 eligible patients, 2,200 (94.9%) consented and completed the survey. 241 (11.0%) had ever used injection drugs, 103 (4.7%) currently used injection drugs, and 138 (6.3%) formerly used injection drugs. White patients age 25 to 34 years and white patients age 55 to 64 years had the highest prevalence of current (25.6%) and former (27.1%) injection drug use, respectively. Persons who use injection drugs had a higher prevalence of HCV infection (52.7% vs. 3.4%) and HIV infection (6.2% vs. 1.8%) than the rest of the population. CONCLUSION: A high prevalence of ED patients report injection drug use, and this population self-reports a high prevalence of HIV and HCV infection. Emergency departments are in a unique position to engage with this population with regards to substance use treatment and linkage to care for HIV and HCV infection.


Assuntos
Infecções por HIV/epidemiologia , Hepatite C/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adolescente , Adulto , Idoso , Coinfecção/epidemiologia , Estudos Transversais , Serviço Hospitalar de Emergência , Feminino , Hospitais Urbanos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Saúde da População Urbana , Adulto Jovem
11.
Postgrad Med J ; 96(1137): 417-421, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32527757

RESUMO

All animal life on earth is thought to have a common origin and have common genetic mechanisms. Evolution has enabled differentiation of species. Pathogens likewise have evolved within various species and mostly come to a settled dynamic equilibrium such that co-existence results (pathogens ideally should not kill their hosts). Problems arise when pathogens jump species because the new host had not developed any resistance. These infections from related species are known as zoonoses. COVID-19 is the latest example of a virus entering another species but HIV (and various strains of influenza) were previous examples. HIV entered the human population from monkeys in Africa. These two papers outline the underlying principle of HIV and the differing epidemiologies in Africa, the USA and in Edinburgh. The underlying immunosuppression of HIV in Africa was initially hidden behind common infections and HIV first came to world awareness in focal areas of the USA as a disease seemingly limited to gay males. The epidemic of intravenous drug abuse in Edinburgh was associated with overlapping epidemics of bloodborne viruses like hepatitis B, hepatitis C and HIV.


Assuntos
Coinfecção/virologia , Infecções por HIV/fisiopatologia , Hepatite B/fisiopatologia , Hepatite C/fisiopatologia , Animais , Surtos de Doenças , Infecções por HIV/genética , Infecções por HIV/virologia , HIV-1/genética , HIV-1/patogenicidade , Hepatite B/genética , Hepatite C/genética , Humanos , Uso Comum de Agulhas e Seringas/estatística & dados numéricos , Filogenia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Zoonoses
12.
South Med J ; 113(6): 298-304, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32483640

RESUMO

OBJECTIVES: People living with human immunodeficiency virus (HIV) have an increased risk of other infections, including viral hepatitis, which can complicate the treatment and progression of the disease. We sought to characterize Alabama cases of HIV co-infected with hepatitis C virus or hepatitis B virus. METHODS: Using surveillance data, we defined co-infection as a person identified as having hepatitis C or hepatitis B and HIV during 2007-2016. We compared demographics, outcomes, and risk factors for co-infected versus monoinfected individuals with HIV. We mapped co-infected individuals' distribution. RESULTS: Of 5824 people with HIV, 259 (4.4%) were co-infected with hepatitis C (antibody or RNA positive) and 145 (2.5%) with hepatitis B (surface antigen, e antigen, or DNA positive) during 2007-2016. Individuals with HIV and hepatitis C had a greater odds of injection drug use (adjusted odds ratio 9.7; 95% confidence interval 6.0-15.5). Individuals with HIV and hepatitis B had a greater odds of male-to-male sexual contact (adjusted odds ratio 1.7; 95% confidence interval 1.1-2.6). Co-infection was greater in urban public health districts. CONCLUSIONS: We identified risk behaviors among Alabama populations associated with increased odds for HIV and viral hepatitis co-infection. Outreach, prevention, testing, and treatment resources can be targeted to these populations.


Assuntos
Infecções por HIV/epidemiologia , Hepatite B Crônica/epidemiologia , Hepatite C Crônica/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Alabama/epidemiologia , Coinfecção/epidemiologia , Grupos Étnicos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Infecções por HIV/etnologia , Hepatite B Crônica/etnologia , Hepatite C Crônica/etnologia , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Distribuição por Sexo , Comportamento Sexual/estatística & dados numéricos , Minorias Sexuais e de Gênero/estatística & dados numéricos , Adulto Jovem
13.
Lancet HIV ; 7(6): e434-e442, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32504576

RESUMO

During 2011-16, HIV outbreaks occurred among people who inject drugs (PWID) in Canada (southeastern Saskatchewan), Greece (Athens), Ireland (Dublin), Israel (Tel Aviv), Luxembourg, Romania (Bucharest), Scotland (Glasgow), and USA (Scott County, Indiana). Factors common to many of these outbreaks included community economic problems, homelessness, and changes in drug injection patterns. The outbreaks differed in size (from under 100 to over 1000 newly reported HIV cases among PWID) and in the extent to which combined prevention had been implemented before, during, and after the outbreaks. Countries need to ensure high coverage of HIV prevention services and coverage higher than the current UNAIDS recommendation might be needed in areas in which short acting drugs are injected. In addition, monitoring of PWID with special attention for changing drug use patterns, risk behaviours, and susceptible subgroups (eg, PWID experiencing homelessness) needs to be in place to prevent or rapidly detect and contain new HIV outbreaks.


Assuntos
Surtos de Doenças , Infecções por HIV/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Europa (Continente)/epidemiologia , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Pessoas em Situação de Rua/estatística & dados numéricos , Humanos , Israel/epidemiologia , Masculino , América do Norte/epidemiologia , Fatores Socioeconômicos
14.
PLoS One ; 15(6): e0235124, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32569332

RESUMO

We analyze a network of needle-sharing ties among 117 people who inject drugs (PWID) in rural Puerto Rico, using exponential random graph modeling to examine whether network members engage in partner restriction to lower their risk of contracting HIV or hepatitis C (HCV), or in informed altruism to prevent others from contracting these infections. Although sharing of used syringes is a significant risk factor for transmission of these diseases among PWID, we find limited evidence for partner restriction or informed altruism in the network of reported needle-sharing ties. We find however that sharing of needles is strongly reciprocal, and individuals with higher injection frequency are more likely to have injected with a used needle. Drawing on our ethnographic work, we discuss how the network structures we observe may relate to a decision-making rationale focused on avoiding withdrawal sickness, which leads to risk-taking behaviors in this poor, rural context where economic considerations often lead PWID to cooperate in the acquisition and use of drugs.


Assuntos
Abuso de Substâncias por Via Intravenosa/epidemiologia , Síndrome de Abstinência a Substâncias/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Hepatite C/epidemiologia , Humanos , Masculino , Uso Comum de Agulhas e Seringas , Porto Rico/epidemiologia , Fatores de Risco
15.
Ann Epidemiol ; 45: 12-23, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32439148

RESUMO

PURPOSE: After years of stable or declining HIV prevalence and declining incidence among people who inject drugs (PWID) in the United States, some rapidly emerging outbreaks have recently occurred in new areas (e.g., Scott County, Indiana). However, to our knowledge, trends over time in HIV prevalence among PWID in US metropolitan statistical areas (MSAs) across all major regions of the country have not been systematically estimated beyond 2002, and the extent to which HIV prevalence may be increasing in other areas is largely unknown. This article estimates HIV prevalence among PWID in 89 of the most populated US MSAs, both overall and by geographic region, using more recent surveillance and HIV testing data. METHODS: We computed MSA-specific annual estimates of HIV prevalence (both diagnosed and undiagnosed infections) among PWID for these 89 MSAs, for 1992-2013, using several data series from the Centers for Disease Control and Prevention's (CDC) National HIV Surveillance System and National HIV Prevention Monitoring and Evaluation data; Holmberg's (1997) estimates of 1992 PWID population size and of HIV prevalence and incidence among PWID; and research estimates from published literature using 1992-2013 data. A mixed effects model, with time nested within MSAs, was used to regress the literature review estimates on all of the other data series. Multiple imputation was used to address missing data. Resulting estimates were validated using previous 1992-2002 estimates of HIV prevalence and data on antiretroviral (ARV) prescription volumes and examined for patterns based on geographic region, numbers of people tested for HIV, and baseline HIV prevalence. RESULTS: Mean (across all MSAs) trends over time suggested decreases through 2002 (from approximately 11.4% in 1992 to 9.2% in 2002), followed by a period of stability, and steep increases after 2010 (to 10.6% in 2013). Validation analyses found a moderate positive correlation between our estimates and ARV prescription volumes (r = 0.45), and a very strong positive correlation (r = 0.94) between our estimates and previous estimates by Tempalski et al. (2009) for 1992-2002 (which used different methods). Analysis by region and baseline prevalence suggested that mean increases in later years were largely driven by MSAs in the Western United States and by MSAs in the Midwest that had low baseline prevalence. Our estimates suggest that prevalence decreased across all years in the Eastern United States. These trends were particularly clear when MSAs with very low numbers of people tested for HIV were removed from analyses to reduce unexplained variability in mean trajectories. CONCLUSIONS: Our estimates suggest a fairly large degree of variation in 1992-2013 trajectories of PWID HIV prevalence among 89 US MSAs, particularly by geographic region. They suggest that public health responses in many MSAs (particularly those with larger HIV prevalence among PWID in the early 1990s) were sufficient to decrease or maintain HIV prevalence over time. However, future research should investigate potential factors driving the estimated increase in prevalence after 2002 MSAs in the West and Midwest. These findings have potentially important implications for program and/or policy decisions, but estimates for MSAs with low HIV testing denominators should be interpreted with caution and verified locally before planning action.


Assuntos
Infecções por HIV/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , População Urbana/estatística & dados numéricos , Adulto , Centers for Disease Control and Prevention, U.S. , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Vigilância da População , Prevalência , Estados Unidos/epidemiologia
16.
PLoS One ; 15(4): e0231969, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32320448

RESUMO

BACKGROUND: Countries in Sub-Saharan Africa (SSA) have seen rapid increases in injection drug use since 2008. In Uganda, the Global Sate of Harm report and studies conducted by Makerere University Crane Surveys have estimated HIV prevalence among people who inject drugs (PWID) at approximately 17%. The objective of the research was to document injection and other drug-related risks among people who use drugs in Uganda to develop comprehensive HIV/HCV prevention interventions. METHODS: Between August and September 2018, we conducted qualitative interviews among male and female people who use drugs. Interview topics included the availability and accessibility of clean syringes, injection risks, overdose, sexual-risk behaviors, and the availability and accessibility of harm reduction and drug treatment services. RESULTS: Participants reported several injection-related risks including sharing and reusing syringes, pooling and mixing drugs in the same container, measuring drugs using syringes, getting prefilled injections from dealers, being injected by other people who inject drugs, and using contaminated water or blood to dilute drugs. Participants reported a scarcity of harm reduction services, although a few appear to have participated in the syringe exchange pilot conducted by the Uganda Harm Reduction Network (UHRN). Even fewer reported knowing organizations that helped people who use drugs abstain from or reduce their use. Medication assisted therapy (MAT) and naloxone to reverse overdoses are not currently available. CONCLUSIONS: Comprehensive prevention and treatment services are needed in Uganda and should include expanded syringe exchange programs, social network HIV testing, HCV testing, provision of naloxone and MAT, and linkage to and retention in HIV care.


Assuntos
Assunção de Riscos , Comportamento Sexual/psicologia , Comportamento Sexual/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto , Estudos de Avaliação como Assunto , Feminino , Infecções por HIV/complicações , Redução do Dano , Humanos , Injeções , Entrevistas como Assunto , Masculino , Uso Comum de Agulhas e Seringas/psicologia , Uso Comum de Agulhas e Seringas/estatística & dados numéricos , Uganda/epidemiologia
17.
Public Health Rep ; 135(3): 329-333, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32228123

RESUMO

INTRODUCTION: In April 2017, the Tennessee Department of Health (TDH) was notified of an increase in the number of persons newly diagnosed with HIV in eastern Tennessee in the same month. Two were identified as persons with a history of injection drug use (IDU) and named each other as syringe-sharing partners, prompting an investigation into a possible HIV cluster among persons with a history of IDU. MATERIALS AND METHODS: TDH and public health staff members in eastern Tennessee collaborated to implement procedures outlined in TDH's HIV/hepatitis C virus (HCV) Outbreak Response Plan, including conducting enhanced interviewing and using a preestablished database for data collection and management. To complement contact tracing and enhanced interviewing, TDH partnered with the Centers for Disease Control and Prevention to conduct molecular HIV analyses. RESULTS: By June 27, 2017, the investigation had identified 31 persons newly diagnosed with HIV infection; 8 (26%) self-reported IDU, 4 of whom were also men who have sex with men (MSM). Of the remaining 23 persons newly diagnosed with HIV infection, 10 were MSM who did not report IDU, 9 reported high-risk heterosexual contact, and 4 had other or unknown risk factors. Molecular analysis of the 14 HIV-1 polymerase genes (including 7 of the 8 persons self-reporting IDU) revealed 3 distinct molecular clusters, one of which included 3 persons self-reporting IDU. PRACTICE IMPLICATIONS: This investigation highlights the importance of implementing an established Outbreak Response Plan and using HIV molecular analyses in the event of a transmission cluster or outbreak investigations. Future HIV outbreak surveillance will include using Global Hepatitis Outbreak Surveillance Technology to identify HCV gene sequences as a potential harbinger for HIV transmission networks.


Assuntos
Infecções por HIV/epidemiologia , Vigilância em Saúde Pública/métodos , Comportamento Sexual/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Feminino , Hepatite C/epidemiologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Epidemiologia Molecular , Fatores de Risco , Tennessee/epidemiologia
18.
MMWR Morb Mortal Wkly Rep ; 69(12): 317-323, 2020 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-32214077

RESUMO

Methamphetamine is a highly addictive central nervous system stimulant. Methamphetamine use is associated with a range of health harms, including psychosis and other mental disorders, cardiovascular and renal dysfunction, infectious disease transmission, and overdose (1,2). Although overall population rates of methamphetamine use have remained relatively stable in recent years (3), methamphetamine availability and methamphetamine-related harms (e.g., methamphetamine involvement in overdose deaths and number of treatment admissions) have increased in the United States* (4,5); however, analyses examining methamphetamine use patterns and characteristics associated with its use are limited. This report uses data from the 2015-2018 National Surveys on Drug Use and Health (NSDUHs) to estimate methamphetamine use rates in the United States and to identify characteristics associated with past-year methamphetamine use. Rates (per 1,000 adults aged ≥18 years) for past-year methamphetamine use were estimated overall, by demographic group, and by state. Frequency of past-year use and prevalence of other substance use and mental illness among adults reporting past-year use were assessed. Multivariable logistic regression examined characteristics associated with past-year use. During 2015-2018, the estimated rate of past-year methamphetamine use among adults was 6.6 per 1,000. Among adults reporting past-year methamphetamine use, an estimated 27.3% reported using on ≥200 days, 52.9% had a methamphetamine use disorder, and 22.3% injected methamphetamine. Controlling for other factors, higher adjusted odds ratios for past-year use were found among men; persons aged 26-34, 35-49, and ≥50 years; and those with lower educational attainment, annual household income <$50,000, Medicaid only or no insurance, those living in small metro and nonmetro counties,† and those with co-occurring substance use and co-occurring mental illness. Additional efforts to build state and local prevention and response capacity, expand linkages to care, and enhance public health and public safety collaborations are needed to combat increasing methamphetamine harms.


Assuntos
Transtornos Relacionados ao Uso de Anfetaminas/epidemiologia , Metanfetamina/administração & dosagem , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Metanfetamina/efeitos adversos , Pessoa de Meia-Idade , Fatores de Risco , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Adulto Jovem
19.
PLoS One ; 15(3): e0230127, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32160244

RESUMO

INTRODUCTION: Overdose is a leading cause of death in the United States, especially among people who inject drugs (PWID). Improving naloxone access and carrying among PWID may offset recent increases in overdose mortality associated with the influx of synthetic opioids in the drug market. This study characterized prevalence and correlates of several naloxone outcomes among PWID. METHODS: During 2018, a survey to assess experience with naloxone was administered to 915 participants in the AIDS Linked to the IntraVenous Experience (ALIVE) study, an ongoing community-based observational cohort of people who currently inject or formerly injected drugs in Baltimore, Maryland. We examined the associations of naloxone outcomes (training, supply, use, and regular possession) with socio-demographic, substance use and healthcare utilization factors among PWID in order to characterize gaps in naloxone implementation among this high-risk population. RESULTS: Median age was 56 years, 34% were female, 85% were African American, and 31% recently injected. In the past six months, 46% (n = 421) reported receiving training in overdose prevention, 38% (n = 346) had received a supply of naloxone, 9% (n = 85) had administered naloxone, and 9% (n = 82) reported usually carrying a supply of naloxone. Recent non-fatal overdose was not associated with any naloxone outcomes in adjusted analysis. Active opioid use (aOR = 2.10, 95% CI: 1.03, 4.28) and recent treatment of alcohol or substance use disorder (aOR = 2.01, 95% CI: 1.13, 3.56) were associated with regularly carrying naloxone. CONCLUSION: Further work is needed to encourage PWID to carry and effectively use naloxone to decrease rates of fatal opioid overdose. While accessing treatment for substance use disorder was positively associated with carrying naloxone, EMS response to 911 calls for overdose, the emergency department, and syringe services programs may be settings in which naloxone access and carrying could be encouraged among PWID.


Assuntos
Overdose de Drogas/epidemiologia , Naloxona/efeitos adversos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto , Baltimore/epidemiologia , Estudos de Coortes , Estudos Transversais , Feminino , Redução do Dano , Humanos , Masculino , Maryland/epidemiologia , Pessoa de Meia-Idade , Naloxona/farmacologia , Naloxona/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Prevalência , Fatores de Risco
20.
AIDS Behav ; 24(9): 2720-2731, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32185596

RESUMO

We studied mechanisms driving gender differences in HIV incidence among 651 women and men who inject drugs (PWID) in Tijuana, Mexico, hypothesizing that sex work will mediate the association between female gender and HIV incidence. Of 43 HIV seroconversions occurring between 2011 and 2018, 8.8% were among females and 5.2% among males. HIV incidence density was significantly higher among females versus males (1.75 per 100 person years [PY], 95% CI 1.16-2.66, vs. 0.95 per 100 PY, 95% CI 0.62-1.47). Factors significantly associated with HIV seroconversion were: sex work (adjusted hazard ratio [aHR] = 2.25, 95% CI 1.05-4.80); methamphetamine injection (aHR = 2.30, 95% CI 1.12-4.73); and methamphetamine and heroin co-injection in the past six months (aHR = 2.26, 95% CI 1.23-4.15). In mediation analyses, sex work mediated a substantial proportion (84.3%) of the association between female gender and HIV incidence. Interventions should target female PWID who engage in sex work to reduce gender-related disparities in HIV incidence.


Assuntos
Infecções por HIV/epidemiologia , Heroína/efeitos adversos , Metanfetamina/efeitos adversos , Trabalho Sexual , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto , Feminino , Infecções por HIV/diagnóstico , Humanos , Incidência , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , Inquéritos e Questionários
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