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1.
BMC Infect Dis ; 21(1): 211, 2021 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-33632143

RESUMO

BACKGROUND: Inconsistent hand hygiene puts people who inject drugs (PWID) at high risk of infectious diseases, in particular skin and soft tissue infections. In healthcare settings, handwashing with alcohol-based hand rubs (ABRH) is recommended before aseptic procedures including intravenous injections. We aimed to evaluate the acceptability, safety and preliminary efficacy of an intervention combining ABHR provision and educational training for PWID. METHODS: A mixed-methods design was used including a pre-post quantitative study and a qualitative study. Participants were active PWID recruited in 4 harm reduction programmes of France and followed up for 6 weeks. After baseline assessment, participants received a face-to-face educational intervention. ABHR was then provided throughout the study period. Quantitative data were collected through questionnaires at baseline, and weeks 2 (W2) and 6 (W6) post-intervention. Qualitative data were collected through focus groups with participants who completed the 6-week study. RESULTS: Among the 59 participants included, 48 (81%) and 43 (73%) attended W2 and W6 visits, respectively. ABHR acceptability was high and adoption rates were 50% (W2) and 61% (W6). Only a minority of participants reported adverse skin reactions (ranging from 2 to 6%). Preliminary efficacy of the intervention was shown through increased hand hygiene frequency (multivariable linear mixed model: coef. W2 = 0.58, p = 0.002; coef. W6 = 0.61, p = 0.002) and fewer self-reported injecting-related infections (multivariable logistic mixed model: AOR W6 = 0.23, p = 0.021). Two focus groups were conducted with 10 participants and showed that young PWID and those living in unstable housing benefited most from the intervention. CONCLUSIONS: ABHR for hand hygiene prior to injection are acceptable to and safe for PWID, particularly those living in unstable housing. The intervention's educational component was crucial to ensure adoption of safe practices. We also provide preliminary evidence of the intervention's efficacy through increased hand hygiene frequency and a reduced risk of infection.


Assuntos
Anti-Infecciosos Locais/administração & dosagem , Etanol/administração & dosagem , Higiene das Mãos/métodos , Redução do Dano , Abuso de Substâncias por Via Intravenosa/prevenção & controle , Adulto , Feminino , Grupos Focais , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , Infecções dos Tecidos Moles/etiologia , Infecções dos Tecidos Moles/prevenção & controle , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/epidemiologia , Abuso de Substâncias por Via Intravenosa/psicologia
2.
PLoS One ; 15(5): e0229208, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32438390

RESUMO

The primary objective of this study was to examine the impacts associated with implementation of overdose preventions sites (OPSs) in Victoria, Canada during a declared provincial public health overdose emergency. A rapid case study design was employed with three OPSs constituting the cases. Data were collected through semi-structured interviews with 15 staff, including experiential staff, and 12 service users. Theoretically, we were informed by the Consolidated Framework for Implementation Research. This framework, combined with a case study design, is well suited for generating insight into the impacts of an intervention. Zero deaths were identified as a key impact and indicator of success. The implementation of OPSs increased opportunities for early intervention in the event of an overdose, reducing trauma for staff and service users, and facilitated organizational transitions from provision of safer supplies to safer spaces. Providing a safer space meant drug use no longer needed to be concealed, with the effect of mitigating drug related stigma and facilitating a shift from shame and blame to increasing trust and development of relationships with increased opportunities to provide connections to other services. These impacts were achieved with few new resources highlighting the commitment of agencies and harm reduction workers, particularly those with lived experience, in achieving beneficial impacts. Although mitigating harms of overdose, OPSs do not address the root problem of an unsafe drug supply. OPSs are important life-saving interventions, but more is needed to address the current contamination of the illicit drug supply including provision of a safer supply.


Assuntos
Overdose de Drogas/prevenção & controle , Emergências/epidemiologia , Drogas Ilícitas/envenenamento , Abuso de Substâncias por Via Intravenosa/prevenção & controle , Adulto , Colúmbia Britânica , Feminino , Humanos , Masculino , Programas de Troca de Agulhas/métodos , Estudos de Casos Organizacionais/métodos , Saúde Pública/métodos
3.
Int J Pharm ; 577: 119042, 2020 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-31953084

RESUMO

Prescription opioids have widely been abused as an epidemic. In this research, we developed a drug composition based on the crosslinked carboxymethylcellulose (XCMC) and a drug model that can effectively deter abuse by injection via multiple mechanisms. The anionic nature of the XCMC is responsible for complexing the cationic opioids in aqueous solutions, minimizing the free drug amount accessible for extraction. The crosslinked nature of the polymer is responsible for its swelling and partial containment of the drug solution within the swollen polymer's network, thus minimizing the available volume for subsequent injection. We have shown that XCMC can efficiently interact with cationic drugs in the form of physical blends and chemical complexes in different aqueous solvents, forming abuse-deterrent complexes. The complexation efficiency was affected by the solution pH and ionic strength, as well as the drug to polymer ratio in the formulation. The in vitro dissolution studies were conducted in two stages, the stage I in 0.1 M HCl and the stage II in water and pH 7.5 phosphate buffer. These studies confirmed the proper drug release under the legitimate conditions of use. Therefore, the XCMC polymers have a great potential to be used as deterring agents in developing opioid medications with abuse-deterrent properties.


Assuntos
Formulações de Dissuasão de Abuso/métodos , Analgésicos Opioides/administração & dosagem , Carboximetilcelulose Sódica/química , Analgésicos Opioides/química , Química Farmacêutica , Liberação Controlada de Fármacos , Concentração de Íons de Hidrogênio , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Concentração Osmolar , Solventes/química , Abuso de Substâncias por Via Intravenosa/prevenção & controle
4.
Int J Infect Dis ; 87: 170-176, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31404673

RESUMO

OBJECTIVES: Sex workers (SWs) face an increased burden of sexually transmitted and blood-borne infections, yet little is known regarding hepatitis B virus (HBV) prevention and care. This study was performed to characterize cross-sectional and prospective correlates of HBV vaccination among SWs in Vancouver. METHODS: Questionnaire data were drawn from a community-based cohort of SWs (2010-2017). Multivariable logistic regression was used to examine correlates of lifetime self-reported HBV vaccination. Multivariable generalized estimating equation (GEE) regression was used to assess correlates of recent vaccination. RESULTS: Among 855 participants, 68.3% reported lifetime HBV vaccination. Multivariable logistic regression showed that im/migrants (adjusted odds ratio (AOR) 0.50, 95% confidence interval (CI) 0.32-0.78) had lower odds of vaccination and that those using injection drugs (AOR 1.88, 95% CI 1.27- 2.78) and those who had undergone HIV testing (AOR 1.94, 95% CI 1.14-3.29) had higher odds of vaccination. In the multivariable GEE analysis, HIV seropositivity (AOR 1.93, 95% CI 1.26-2.97) and recent STI testing (AOR 2.95, 95% CI 1.99-4.39) correlated with recent HBV vaccination. CONCLUSIONS: Im/migrant SWs from HBV-endemic settings appear to face gaps in HBV prevention. Evidence-based interventions addressing gaps in voluntary HBV prevention and care are needed, including community-based and culturally safe services. Injection drug use and HIV testing were linked to enhanced vaccination, suggesting that harm reduction and HIV programmes may facilitate linkage to HBV prevention.


Assuntos
Vacinas contra Hepatite B/administração & dosagem , Hepatite B/prevenção & controle , Profissionais do Sexo/estatística & dados numéricos , Adulto , Canadá , Estudos Transversais , Feminino , Infecções por HIV/prevenção & controle , Hepatite B/psicologia , Humanos , Masculino , Estudos Prospectivos , Comportamento Sexual , Doenças Sexualmente Transmissíveis/prevenção & controle , Doenças Sexualmente Transmissíveis/psicologia , Abuso de Substâncias por Via Intravenosa/prevenção & controle , Migrantes/estatística & dados numéricos , Vacinação
5.
Addiction ; 114(12): 2267-2278, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31307116

RESUMO

AIMS: To examine the cost-effectiveness of hepatitis C virus (HCV) treatment of people who inject drugs (PWID), combined with medication-assisted treatment (MAT) and syringe-service programs (SSP), to tackle the increasing HCV epidemic in the United States. DESIGN: HCV transmission and disease progression models with cost-effectiveness analysis using a health-care perspective. SETTING: Rural Perry County, KY (PC) and urban San Francisco, CA (SF), USA. Compared with PC, SF has a greater proportion of PWID with access to MAT or SSP. HCV treatment of PWID is negligible in both settings. PARTICIPANTS: PWID data were collected between 1998 and 2015 from Social Networks Among Appalachian People, U Find Out, Urban Health Study and National HIV Behavioral Surveillance System studies. INTERVENTIONS AND COMPARATOR: Three intervention scenarios modeled: baseline-existing SSP and MAT coverage with HCV screening and treatment with direct-acting antiviral for ex-injectors only as per standard of care; intervention 1-scale-up of SSP and MAT without changes to treatment; and intervention 2-scale-up as intervention 1 combined with HCV screening and treatment for current PWID. MEASUREMENTS: Incremental cost-effectiveness ratios (ICERs) and uncertainty using cost-effectiveness acceptability curves. Benefits were measured in quality-adjusted life-years (QALYs). FINDINGS: For both settings, intervention 2 is preferred to intervention 1 and the appropriate comparator for intervention 2 is the baseline scenario. Relative to baseline, for PC intervention 2 averts 1852 more HCV infections, increases QALYS by 3095, costs $21.6 million more and has an ICER of $6975/QALY. For SF, intervention 2 averts 36 473 more HCV infections, increases QALYs by 7893, costs $872 million more and has an ICER of $11 044/QALY. The cost-effectiveness of intervention 2 was robust to several sensitivity analysis. CONCLUSIONS: Hepatitis C screening and treatment for people who inject drugs, combined with medication-assisted treatment and syringe-service programs, is a cost-effective strategy for reducing hepatitis C burden in the United States.


Assuntos
Análise Custo-Benefício , Hepatite C/economia , Hepatite C/prevenção & controle , Abuso de Substâncias por Via Intravenosa/economia , Abuso de Substâncias por Via Intravenosa/prevenção & controle , Antivirais/economia , Antivirais/uso terapêutico , Programas de Triagem Diagnóstica/economia , Humanos , Kentucky/epidemiologia , Modelos Econômicos , Programas de Troca de Agulhas/economia , Tratamento de Substituição de Opiáceos/economia , População Rural , São Francisco/epidemiologia , População Urbana
6.
Int J Drug Policy ; 69: 60-69, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31196730

RESUMO

BACKGROUND: Among people who inject drugs (PWID) in New York City (NYC), racial minorities are disproportionately infected with HIV and hepatitis C (HCV). Prior research has shown that PWID who started injecting drugs in Puerto Rico (P.R.) tend to maintain the risky injection behaviors learned there. This study identifies the P.R.-native norms supporting the continued injection risk behavior of migrant Puerto Rican PWID in NYC to inform a culturally appropriate risk-reduction intervention. METHODS: 40 migrant Puerto Rican PWID were recruited in NYC for a longitudinal qualitative study. The sample was stratified to include 20 migrants with <3 years in NYC and 20 migrants with >3-6 years in NYC. Time-location sampling was used to curb possible network bias in recruitment. Over 12 months, migrants completed semi-structured interviews at baseline, monthly follow-ups, and study exit. Analyses were guided by grounded theory. RESULTS: Most participants (90%) reported having had chronic HCV, and 22.5% reported being HIV-positive. Syringe- and cooker-/cotton-sharing were widespread in both P.R. and NYC. The ubiquitous practice of cleaning used syringes by "water-rinsing and air-blowing" was guided by a normative belief, learned in P.R., that "water and air kill HIV." Sterile syringe use was not a priority. HCV was not a concern. P.R.-native abstinence-only narratives discouraged opioid agonist treatment (OAT) enrollment among recent migrants (≤3 years). Experiences with drug dealers, prison-power groups, and injection doctors ("Gancheros") in P.R. influenced migrants' injection risk behavior in NYC. Those who were Gancheros in P.R. continued working as Gancheros in NYC. CONCLUSIONS: Injection risks make migrant Puerto Rican PWID in NYC vulnerable to HIV/HCV. Harm reduction programs should pay closer attention to the rationales behind these injection risks. A risk-reduction intervention that incorporates the Ganchero figure may be a credible way to help migrants reduce injection risk and accept OAT and syringe exchange programs (SEP).


Assuntos
Programas de Troca de Agulhas/provisão & distribução , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/epidemiologia , Migrantes/psicologia , Adulto , Usuários de Drogas/psicologia , Feminino , Infecções por HIV/epidemiologia , Redução do Dano , Hepatite C/epidemiologia , Humanos , Injeções , Entrevista Psicológica , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Uso Comum de Agulhas e Seringas , Cidade de Nova Iorque/epidemiologia , Porto Rico/epidemiologia , Assunção de Riscos , Fatores Socioeconômicos , Abuso de Substâncias por Via Intravenosa/prevenção & controle
7.
Int J Health Policy Manag ; 8(5): 261-271, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-31204442

RESUMO

BACKGROUND: The Joint United Nations Programme on HIV/AIDS (UNAIDS) has recently set the ambitious "90-90-90 target" of having 90% of people living with HIV (PLHIV) know their status, receive antiretroviral therapy (ART), and achieve viral suppression by 2020. This ambitious new goal is occurring in a context of global "scale-down" following nearly a decade of heightened investment in HIV prevention and treatment efforts. Arguably international goals spur action, however, setting unrealistic goals that do not take weak health systems and variations in the nature of the epidemic across countries into consideration may set them up for failure in unproductive ways that lead to a decline in confidence in global governance institutions. This study explores how policy actors tasked with implementing HIV programs navigate the competing demands placed upon them by development targets and national politics, particularly in the current context of waning international investments towards HIV. METHODS: To examine these questions, we interviewed 29 key informants comprising health experts in donor organizations and government employees in HIV programs in Pakistan, a country where HIV programs must compete with other issues for attention. Themes were identified inductively through an iterative process and findings were triangulated with various data sources and existing literature. RESULTS: We found both political and governance challenges to achieving the target, particularly in the context of the global HIV scale-down. Political challenges included, low and heterogeneous political commitment for HIV and a conservative legal environment that contributed towards a ban on opiate substitution therapy, creating low treatment coverage. Governance challenges includedstrained state and non-governmental organization (NGO) relations creating a hostile service delivery environment, weak bureaucratic and civil society capacity contributing to poor regulation of the health infrastructure, and resource mismanagement on both the part of the government and NGOs. CONCLUSION: Our findings suggest that in a context of waning international attention to HIV, policy actors on the ground face a number of practical hurdles to achieving the ambitious targets set out by international agencies. Greater attention to the political and governance challenges of implementing HIV programs in low- and middle-income countries (LMICs) could help technical assistance agencies to develop more realistic implementation plans.


Assuntos
Infecções por HIV/prevenção & controle , Política de Saúde , Política , Abuso de Substâncias por Via Intravenosa/prevenção & controle , Pessoal Administrativo , Assistência à Saúde/organização & administração , Órgãos Governamentais , Infecções por HIV/terapia , Humanos , Relações Interinstitucionais , Entrevistas como Assunto , Paquistão/epidemiologia
8.
J Correct Health Care ; 25(2): 105-120, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31084277

RESUMO

Despite the fact that a large portion of the prison population is made up of people who use and inject drugs, harm reduction continues to be extremely limited in prison settings. This article begins with a review of drug-related incarceration, drug use in prisons, and HIV and hepatitis C (HCV) prevalence among prisoners globally. It presents the scientific evidence, alongside legal and economic arguments supporting the provision of harm reduction to people who use drugs, both inside and outside of prisons. The article then provides a global overview of the availability, accessibility, and quality of harm reduction services in prisons-specifically needle and syringe programs; opioid substitution therapy; provision of the opioid agonist naloxone; and diagnosis, treatment, and care for HIV, HCV, and tuberculosis.


Assuntos
Redução do Dano , Prisioneiros , Prisões , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Hepatite C/epidemiologia , Hepatite C/prevenção & controle , Humanos , Tratamento de Substituição de Opiáceos , Prevalência , Abuso de Substâncias por Via Intravenosa/epidemiologia , Abuso de Substâncias por Via Intravenosa/prevenção & controle , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Tuberculose/epidemiologia , Tuberculose/prevenção & controle
9.
Drug Alcohol Depend ; 199: 18-26, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-30981045

RESUMO

BACKGROUND: Current models of HIV prevention intervention dissemination involve packaging interventions developed in one context and training providers to implement that specific intervention with fidelity. Providers rarely implement these programs with fidelity due to perceived incompatibility, resource constraints, and preference for locally-generated solutions. Moreover, such interventions may not reflect local drug markets and drug use practices that contribute to HIV risk. PURPOSE: This paper examines whether provider-developed interventions based on common factors of effective, evidence-based behavioral interventions led to reduction in drug-related HIV risk behaviors at four study sites in Ukraine. METHODS: We trained staff from eight nongovernmental organizations (NGOs) to develop HIV prevention interventions based on a common factors approach. We then selected four NGOs to participate in an outcome evaluation. Each NGO conducted its intervention for at least N = 130 participants, with baseline and 3-month follow-up assessments. RESULTS: At three sites, we observed reductions in the prevalence of both any risk in drug acquisition and any risk in drug injection. At the fourth site, prevalence of any risk in drug injection decreased substantially, but the prevalence of any risk in drug acquisition essentially stayed unchanged. CONCLUSIONS: The common factors approach has some evidence of efficacy in implementation, but further research is needed to assess its effectiveness in reducing HIV risk behaviors and transmission. Behavioral interventions to reduce HIV risk developed using the common factors approach could become an important part of the HIV response in low resource settings where capacity building remains a high priority.


Assuntos
Assistência à Saúde Culturalmente Competente/métodos , Infecções por HIV/etnologia , Infecções por HIV/prevenção & controle , Avaliação de Resultados em Cuidados de Saúde/métodos , Abuso de Substâncias por Via Intravenosa/etnologia , Abuso de Substâncias por Via Intravenosa/prevenção & controle , Adolescente , Adulto , Assistência à Saúde Culturalmente Competente/tendências , Feminino , Seguimentos , Humanos , Masculino , Uso Comum de Agulhas e Seringas/efeitos adversos , Uso Comum de Agulhas e Seringas/tendências , Organizações/tendências , Avaliação de Resultados em Cuidados de Saúde/tendências , Fatores de Risco , Ucrânia/etnologia , Adulto Jovem
10.
Int J Drug Policy ; 69: 24-33, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31029914

RESUMO

Despite the proliferation of fentanyl and fentanyl-adulterated opioids in North America, the impacts of this drug market change on injection initiation processes have not been examined. With the aim of informing structural interventions to address injection initiation and related harms, we explore how people who inject drugs (PWID) in Vancouver, Canada understand and navigate social norms of initiating others into injecting within the context of an overdose crisis. In-depth qualitative interviews were conducted with 19 PWID who reported helping someone inject for the first time. Participants were recruited from two cohort studies of PWID. Participants articulated moral dilemmas about assisting others with injecting. While participants described a 'moral code' prohibiting assisting injection-naïve individuals, this code was not the sole consideration shaping social action around injection initiation. Rather, PWID exercised agency about whether and how to assist novice injectors within the context of constraining and enabling social norms around practicing interpersonal responsibility. Changes to the drug market heightened feelings of moral culpability and criminal liability among PWID who assisted others into injection, given that injecting heightened initiates' risk of overdose. These concerns operated in tension with the aim of protecting novice injectors from harms associated with an increasingly potent and unpredictable drug supply by providing them with injection assistance, education and supervision. Our analysis of how PWID practice interpersonal responsibility helps conceptualise how 'moral codes' prohibiting initiation assistance are managed and negotiated amidst structural vulnerability. Structural interventions reducing the vulnerability of novice injectors should be prioritized, including the implementation of supervised injection sites allowing for assisted injection, Good Samaritan laws, and policy changes conducive to a safer drug supply.


Assuntos
Usuários de Drogas/psicologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Abuso de Substâncias por Via Intravenosa/prevenção & controle , Adulto , Canadá , Estudos de Coortes , Feminino , Fentanila , Humanos , Injeções , Relações Interpessoais , Entrevista Psicológica , Masculino , Pessoa de Meia-Idade , Princípios Morais , Comportamento de Redução do Risco , Normas Sociais , Abuso de Substâncias por Via Intravenosa/psicologia
11.
AIDS Behav ; 23(9): 2304-2314, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30879209

RESUMO

We tested the hypothesis that an updated "Break the Cycle" (BtC) intervention, based in social cognitive theory and motivational interviewing, would reduce the likelihood that current persons who inject drugs (PWID) would assist persons who do not inject drugs (non-PWID) with first injections in Tallinn, Estonia and Staten Island, New York City. 402 PWID were recruited, a baseline interview covering demographics, drug use, and assisting non-PWID with first drug injections was administered, followed by BtC intervention. 296 follow-up interviews were conducted 6 months post-intervention. Percentages assisting with first injections declined from 4.7 to 1.3% (73% reduction) in Tallinn (p < 0.02), and from 15 to 6% (60% reduction) in Staten Island (p < 0.05). Persons assisted with first injections declined from 11 to 3 in Tallinn (p = 0.02) and from 32 to 13 in Staten Island. (p = 0.024). Further implementation research on BtC interventions is urgently needed where injecting drug use is driving HIV/HCV epidemics and areas experiencing opioid epidemics.


Assuntos
Analgésicos Opioides/administração & dosagem , Usuários de Drogas/psicologia , Epidemias , Transtornos Relacionados ao Uso de Opioides/psicologia , Adulto , Analgésicos Opioides/efeitos adversos , Estônia/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Entrevista Motivacional , Cidade de Nova Iorque/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Assunção de Riscos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Abuso de Substâncias por Via Intravenosa/prevenção & controle , Abuso de Substâncias por Via Intravenosa/psicologia
12.
Drug Alcohol Depend ; 197: 354-360, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30922483

RESUMO

BACKGROUND: Opioid agonist treatment (OAT) is an effective biomedical intervention to manage opioid use disorder among persons who inject drugs (PWID). Preliminary evidence suggests that OAT may also disrupt the social communicability of injection drug use (IDU) practices by established PWID. We therefore aim to investigate the association between OAT enrollment and initiating others into IDU among PWID in Vancouver, Canada. METHODS: Preventing Injecting by Modifying Existing Responses (PRIMER; NIDA DP2-DA040256-01) is a prospective multi-cohort study seeking to identify structural interventions that reduce the risk that PWID initiate others into IDU. The present analysis was conducted using data from a participating cohort of PWID in Vancouver, Canada, between December 2014 and May 2017. Multivariable logistic regression models were built to assess the association between reporting active (i.e., within the past six months) OAT enrollment and assisting others in injection initiation. A final model was determined using a manual stepwise approach whereby covariates were excluded if their removal altered the coefficient of interest by <5%. RESULTS: Participants (n = 1740) were predominantly male (62.3%); 35.1% reported daily injecting (n = 611); 860 (49.4%) reported active OAT enrollment, and 80 (4.6%) reported recently providing injection initiation assistance. In a multivariable model, participants who reported active OAT enrollment had significantly lower odds of recently providing injection initiation assistance (Adjusted Odds Ratio = 0.52, 95% Confidence Interval: 0.31-0.87, P = 0.01). CONCLUSION: Results suggest a protective association between OAT and the expansion of IDU practices among vulnerable populations, suggesting its potential use as 'addiction treatment as prevention.'


Assuntos
Analgésicos Opioides/uso terapêutico , Tratamento de Substituição de Opiáceos/psicologia , Tratamento de Substituição de Opiáceos/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/psicologia , Abuso de Substâncias por Via Intravenosa/prevenção & controle , Adulto , Canadá , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Estudos Prospectivos , Abuso de Substâncias por Via Intravenosa/psicologia
16.
PLoS One ; 13(10): e0205466, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30312333

RESUMO

BACKGROUND: The Central Appalachian region of the United States is in the midst of a hepatitis C virus epidemic driven by injection of opioids, particularly heroin, with contaminated syringes. In response to this epidemic, several needle exchange programs (NEP) have opened to provide clean needles and other supplies and services to people who inject drugs (PWID). However, no studies have investigated the barriers and facilitators to implementing, operating, and expanding NEPs in less populous areas of the United States. METHODS: This qualitative case study consisted of interviews with program directors, police chiefs, law enforcement members, and PWID affiliated with two NEPs in the rural state of West Virginia. Interview transcripts were coded inductively and analyzed using qualitative data analysis software. Final common themes related to barriers and facilitators of past program openings, current program operations, and future program plans, were derived through a consensus of two data coders. RESULTS: Both NEPs struggled to find existing model programs, but benefited from broad community support that facilitated implementation. The largest operational barrier was the legal conundrum created by paraphernalia laws that criminalize syringe possession. However, both PWID and law enforcement appreciated the comprehensive services provided by these programs. Program location and transportation difficulties were additional noted barriers. Future program operations are threatened by funding shortages and bans, but necessitated by unexpected program demand. CONCLUSION: Despite broad community support, program operations are threatened by growing participant volumes, funding shortages, and the federal government's prohibition on the use of funds to purchase needles. Paraphernalia laws create a legal conundrum in the form of criminal sanctions for the possession of needles, which may inadvertently promote needle sharing and disease transmission. Future studies should examine additional barriers to using clean needles provided by rural NEPs that may blunt the effectiveness of NEPs in preventing disease transmission.


Assuntos
Epidemias/prevenção & controle , Hepatite C/epidemiologia , Programas de Troca de Agulhas/economia , Programas de Troca de Agulhas/legislação & jurisprudência , Abuso de Substâncias por Via Intravenosa/prevenção & controle , Adulto , Idoso , Região dos Apalaches/epidemiologia , Feminino , Humanos , Entrevistas como Assunto , Aplicação da Lei , Masculino , Pessoa de Meia-Idade , Uso Comum de Agulhas e Seringas , Pesquisa Qualitativa , Fatores de Risco , População Rural , West Virginia/epidemiologia , Adulto Jovem
17.
Drug Alcohol Depend ; 192: 1-7, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-30195241

RESUMO

BACKGROUND: People who inject drugs face several health issues because of unsafe injecting practices. We aimed to evaluate changes in supervised drug-injecting practices following the implementation of a face-to-face educational intervention. METHODS: The national study ANRS-AERLI was conducted in 17 harm reduction (HR) facilities in France between 2011 and 2013. Eight offered the intervention and nine did not. We conducted a pre-post analysis focusing on injecting practices data, collected in the 8 HR facilities providing the intervention. The intervention consisted of providing face-to-face educational sessions including direct observation of injecting practices, counseling about safer injecting, and shared discussion. Injecting practices were collected following a checklist and classified as safe or unsafe. To assess changes in injecting practices, practices were compared before (at baseline) and after at least one educational session. FINDINGS: Mixed logistic models showed that the 78 participants included were more likely to improve in the following drug-use steps: setting up a clean preparation area (Adjusted Odds Ratio (AOR) = 3.4, 95% Confidence Interval (95% CI) = 1.6-7.6), hand washing (AOR = 7.2, 95% CI = 3.1-16.4), skin cleaning (AOR = 5.6, 95% CI = 2.5-12.1), choice of safe injection site (AOR = 6.5, 95% CI = 1.5-28.8) and post-injection bleeding management (AOR = 12.8, 95% CI = 5.5-29.9). Furthermore, participants were less likely to lick their needles before injecting (AOR = 8.1, 95% CI = 1.5-43.4) and to perform booting/flushing (AOR = 2.5, 95% CI = 1.2-5.3). CONCLUSIONS: The AERLI intervention seems to be effective in increasing safe drug-injecting practices.


Assuntos
Educação em Saúde/métodos , Vida Independente/educação , Programas de Troca de Agulhas/métodos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Abuso de Substâncias por Via Intravenosa/prevenção & controle , Adulto , Feminino , França/epidemiologia , Redução do Dano , Educação em Saúde/tendências , Humanos , Vida Independente/tendências , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Programas de Troca de Agulhas/tendências , Adulto Jovem
18.
Harm Reduct J ; 15(1): 46, 2018 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-30200991

RESUMO

BACKGROUND: British Columbia, Canada, is experiencing a public health emergency related to opioid overdoses driven by consumption of street drugs contaminated with illicitly manufactured fentanyl. This cross-sectional study evaluates a drug checking intervention for the clients of a supervised injection facility (SIF) in Vancouver. METHODS: Insite is a facility offering supervised injection services in Vancouver's Downtown East Side, a community with high levels of injection drug use and associated harms, including overdose deaths. During July 7, 2016, to June 21, 2017, Insite clients were offered an opportunity to check their drugs for fentanyl using a test strip designed to test urine for fentanyl. Results of the drug check were recorded along with information including the substance checked, whether the client intended to dispose of the drug or reduce the dose and whether they experienced an overdose. Logistic regression models were constructed to assess the associations between drug checking results and dose reduction or drug disposal. Crude odds ratios (OR) and 95% confidence intervals (CI) were reported. RESULTS: About 1% of the visits to Insite during the study resulted in a drug check. Out of 1411 drug checks conducted by clients, 1121 (79.8%) were positive for fentanyl. Although most tests were conducted post-consumption, following a positive pre-consumption drug check, 36.3% (n = 142) of participants reported planning to reduce their drug dose while only 11.4% (n = 50) planned to dispose of their drug. While the odds of intended dose reduction among those with a positive drug check was significantly higher than those with a negative result (OR = 9.36; 95% CI 4.25-20.65), no association was observed between drug check results and intended drug disposal (OR = 1.60; 95% CI 0.79-3.26). Among all participants, intended dose reduction was associated with significantly lower odds of overdose (OR = 0.41; 95% CI 0.18-0.89). CONCLUSIONS: Although only a small proportion of visits resulted in a drug check, a high proportion (~ 80%) of the drugs checked were contaminated with fentanyl. Drug checking at harm reduction facilities such as SIFs might be a feasible intervention that could contribute to preventing overdoses in the context of the current overdose emergency.


Assuntos
Analgésicos Opioides/envenenamento , Contaminação de Medicamentos/prevenção & controle , Fentanila/envenenamento , Analgésicos Opioides/urina , Colúmbia Britânica , Estudos Transversais , Overdose de Drogas/prevenção & controle , Fentanila/urina , Redução do Dano , Heroína/química , Humanos , Drogas Ilícitas/envenenamento , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Programas de Troca de Agulhas , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/urina , Fitas Reagentes , Abuso de Substâncias por Via Intravenosa/prevenção & controle , Abuso de Substâncias por Via Intravenosa/urina
19.
Addict Behav ; 87: 222-230, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30075405

RESUMO

BACKGROUND/AIMS: In line with Self-determination Theory, individuals who feel they are able to adopt new behaviors autonomously, and who perceive their social environment as supportive of their autonomy and confident in their competencies, are more likely to engage in sustainable behavioral change over time. We aimed to study the impact of an educational intervention, which has already shown its effectiveness in reducing transmission-risk behaviors and injection-related complications among drug users (Roux et al., 2016), on three psychosocial factors (PSF) involved in initiating and maintaining new health behaviors over time, as follows: A) self-regulation of behaviors (autonomous vs. controlled regulation); B) perceived competence in adopting new behaviors (a feeling of being able or unable to adopt new behaviors) and C) perceived autonomy support (social environment perceived by drug users as supportive of autonomy vs. controlling). METHODS: This non-random clustered intervention study was conducted in 9 intervention groups (programs offering the intervention) and 8 control groups (programs not offering it). Each participant was followed up through a phone interview at enrolment, at 6 months and 12 months. Of the 271 participants, 113 received at least one educational session in the first six months. We used the "Health-Care Self-Determination Theory Questionnaire" to assess the impact of this intervention on the development of self-regulation, perceived competence and perceived autonomy support. RESULTS: Participants exposed to the intervention at least once were associated with a higher level of perceived competence and perceived autonomy support at M12. However, the intervention did not impact self-regulation (either autonomous or controlled). In addition, the study revealed that other factors, such as gender, age, drug use patterns and participants' healthcare pathways, also have an impact on these PSF. CONCLUSIONS: This educational intervention significantly increases patients' perceived competence but has no impact on the factors specifically involved in maintaining new behaviors over time. This study also highlights the existence of user profiles whose socio-demographic characteristics, use patterns and care pathways can influence these FPS involved in motivation to change and maintain new health behaviors over time.


Assuntos
Comportamentos Relacionados com a Saúde , Educação em Saúde/métodos , Abuso de Substâncias por Via Intravenosa/prevenção & controle , Adulto , Escolaridade , Feminino , Humanos , Masculino , Cooperação do Paciente , Comportamento de Redução do Risco , Assunção de Riscos , Autoimagem , Autocontrole , Abuso de Substâncias por Via Intravenosa/psicologia , Resultado do Tratamento
20.
BMC Public Health ; 18(1): 829, 2018 07 04.
Artigo em Inglês | MEDLINE | ID: mdl-29973179

RESUMO

BACKGROUND: Public injecting of recreational drugs has been documented in a number of cities worldwide and was a key risk factor in a HIV outbreak in Glasgow, Scotland during 2015. We investigated the characteristics and health needs of people involved in this practice and explored stakeholder attitudes to new harm reduction interventions. METHODS: We used a tripartite health needs assessment framework, comprising epidemiological, comparative, and corporate approaches. We undertook an analysis of local and national secondary data sources on drug use; a series of rapid literature reviews; and an engagement exercise with people currently injecting in public places, people in recovery from injecting drug use, and staff from relevant health and social services. RESULTS: Between 400 and 500 individuals are estimated to regularly inject in public places in Glasgow city centre: most experience a combination of profound social vulnerabilities. Priority health needs comprise addictions care; prevention and treatment of blood-borne viruses; other injecting-related infections and injuries; and overdose and drug-related death. Among people with lived experience and staff from relevant health and social care services, there was widespread - though not unanimous - support for the introduction of safer injecting facilities and heroin-assisted treatment services. CONCLUSIONS: The environment and context in which drug consumption occurs is a key determinant of harm, and is inextricably linked to upstream social factors. Public injecting therefore requires a multifaceted response. Though evidence-based interventions exist, their implementation internationally is variable: understanding the attitudes of key stakeholders provides important insights into local facilitators and barriers. Following this study, Glasgow plans to establish the world's first co-located safer injecting facility and heroin-assisted treatment service.


Assuntos
Redução do Dano , Determinação de Necessidades de Cuidados de Saúde , Logradouros Públicos , Abuso de Substâncias por Via Intravenosa/prevenção & controle , Abuso de Substâncias por Via Intravenosa/psicologia , Adulto , Overdose de Drogas/mortalidade , Overdose de Drogas/prevenção & controle , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Heroína/envenenamento , Humanos , Drogas Ilícitas/envenenamento , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Escócia/epidemiologia , Abuso de Substâncias por Via Intravenosa/complicações , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Adulto Jovem
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