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1.
AMA J Ethics ; 26(7): E562-571, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38958425

RESUMO

Practices and interventions that aim to slow progression or reduce negative consequences of substance use are harm reduction strategies. Often described as a form of tertiary prevention, harm reduction is key to caring well for people who use drugs. Evidence-based harm reduction interventions include naloxone and syringe service programs. Improving equitable outcomes for those with opioid use disorder (OUD) requires access to the continuum of evidence-based OUD care, including harm reduction interventions, as well as dismantling policies that undermine mental health and substance use disorder treatment continuity, housing stability, and education and employment opportunities.


Assuntos
Redução do Dano , Naloxona , Transtornos Relacionados ao Uso de Opioides , Humanos , Transtornos Relacionados ao Uso de Opioides/terapia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Naloxona/uso terapêutico , Naloxona/administração & dosagem , Continuidade da Assistência ao Paciente , Antagonistas de Entorpecentes/uso terapêutico , Antagonistas de Entorpecentes/administração & dosagem , Programas de Troca de Agulhas
2.
J Int AIDS Soc ; 27 Suppl 2: e26269, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38988042

RESUMO

INTRODUCTION: Effective HIV prevention programme coverage is necessary to achieve Nigeria's goal of ending the epidemic by 2030. Recent evidence highlights gaps in service coverage and utilization across the country. The Effective Programme Coverage framework is a Programme Science tool to optimize a programme's population-level impact by examining gaps in programme coverage using data generated through programme-embedded research and learning. We apply the framework using Integrated Biological and Behavioural Surveillance Survey (IBBSS) data from Nigeria to examine coverage of four prevention interventions-condoms, HIV testing, and needle and syringe programmes (NSP)-among four key population groups-female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID) and transgender people. METHODS: Data from Nigeria's 2020 IBBSS, implemented in 12 states, were analysed to examine HIV prevention programme coverage among key populations. For each key population group and prevention intervention of interest, weighted IBBSS data were used to retrospectively generate coverage cascades that identify and quantify coverage gaps. Required coverage targets were informed by targets articulated in Nigeria's National HIV/AIDS Strategic Framework or, in their absence, by guidelines from policy normative bodies. Availability-, outreach- and utilization coverage proxy indicators were defined using variables from IBBSS data collection tools. Sankey diagrams are presented to visualize pathways followed by participants between coverage cascade steps. RESULTS: Required coverage targets were missed for HIV testing and NSP among all key population groups. Condom availability coverage surpassed required coverage targets among FSW and MSM, while utilization coverage only among FSW exceeded the 90% required coverage target. Outreach coverage was low for all key population groups, falling below all required coverage targets. CONCLUSIONS: Our findings identify critical gaps in HIV prevention programme coverage for key populations in Nigeria and demonstrate non-linear movement across coverage cascades, signalling the need for innovative solutions to optimize coverage of prevention services. Programme-embedded research is required to better understand how key population groups in Nigeria access and use different HIV prevention services so that programmes, policies and resource allocation decisions can be optimized to achieve effective programme coverage and population-level impact.


Assuntos
Infecções por HIV , Profissionais do Sexo , Humanos , Nigéria/epidemiologia , Infecções por HIV/prevenção & controle , Infecções por HIV/epidemiologia , Masculino , Feminino , Profissionais do Sexo/estatística & dados numéricos , Adulto , Adulto Jovem , Pessoas Transgênero/estatística & dados numéricos , Adolescente , Teste de HIV/estatística & dados numéricos , Teste de HIV/métodos , Preservativos/estatística & dados numéricos , Pessoa de Meia-Idade , Inquéritos e Questionários , Homossexualidade Masculina/estatística & dados numéricos , Programas de Troca de Agulhas/estatística & dados numéricos
3.
Harm Reduct J ; 21(1): 126, 2024 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-38943164

RESUMO

BACKGROUND: Needle and syringe programs (NSP) are effective harm-reduction strategies against HIV and hepatitis C. Although skin, soft tissue, and vascular infections (SSTVI) are the most common morbidities in people who inject drugs (PWID), the extent to which NSP are clinically and cost-effective in relation to SSTVI in PWID remains unclear. The objective of this study was to model the clinical- and cost-effectiveness of NSP with respect to treatment of SSTVI in PWID. METHODS: We performed a model-based, economic evaluation comparing a scenario with NSP to a scenario without NSP. We developed a microsimulation model to generate two cohorts of 100,000 individuals corresponding to each NSP scenario and estimated quality-adjusted life-years (QALY) and cost (in 2022 Canadian dollars) over a 5-year time horizon (1.5% per annum for costs and outcomes). To assess the clinical effectiveness of NSP, we conducted survival analysis that accounted for the recurrent use of health care services for treating SSTVI and SSTVI mortality in the presence of competing risks. RESULTS: The incremental cost-effectiveness ratio associated with NSP was $70,278 per QALY, with incremental cost and QALY gains corresponding to $1207 and 0.017 QALY, respectively. Under the scenario with NSP, there were 788 fewer SSTVI deaths per 100,000 PWID, corresponding to 24% lower relative hazard of mortality from SSTVI (hazard ratio [HR] = 0.76; 95% confidence interval [CI] = 0.72-0.80). Health service utilization over the 5-year period remained lower under the scenario with NSP (outpatient: 66,511 vs. 86,879; emergency department: 9920 vs. 12,922; inpatient: 4282 vs. 5596). Relatedly, having NSP was associated with a modest reduction in the relative hazard of recurrent outpatient visits (HR = 0.96; 95% CI = 0.95-0.97) for purulent SSTVI as well as outpatient (HR = 0.88; 95% CI = 0.87-0.88) and emergency department visits (HR = 0.98; 95% CI = 0.97-0.99) for non-purulent SSTVI. CONCLUSIONS: Both the individuals and the healthcare system benefit from NSP through lower risk of SSTVI mortality and prevention of recurrent outpatient and emergency department visits to treat SSTVI. The microsimulation framework provides insights into clinical and economic implications of NSP, which can serve as valuable evidence that can aid decision-making in expansion of NSP services.


Assuntos
Análise Custo-Benefício , Programas de Troca de Agulhas , Anos de Vida Ajustados por Qualidade de Vida , Infecções dos Tecidos Moles , Abuso de Substâncias por Via Intravenosa , Humanos , Abuso de Substâncias por Via Intravenosa/complicações , Programas de Troca de Agulhas/economia , Doenças Vasculares/economia , Dermatopatias Infecciosas/prevenção & controle , Canadá/epidemiologia , Simulação por Computador , Redução do Dano , Feminino , Masculino , Adulto , Modelos Econômicos
4.
Harm Reduct J ; 21(1): 123, 2024 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-38926755

RESUMO

BACKGROUND: People who inject drugs (PWID) are at risk of HIV acquisition. The number of PWID in South African cities is increasing, and in spite of an advanced HIV prevention and treatment programme, there are PWID who experience challenges accessing sexual and reproductive health (SRH) and HIV related services. Access to and acceptability of SRH and harm reduction services by PWID needs to be further understood and explored. METHODS: In-depth interviews (IDIs) were conducted with 10 key stakeholders and 11 PWID, in Durban, South Africa. Interviews were transcribed and translated. Data were thematically analysed using Dedoose software. RESULTS: Participants described stigma/discrimination from healthcare workers and other clients accessing services as barriers to accessing healthcare services. They were concerned about long waiting times at healthcare facilities because of possibilities of withdrawal, as well as lost opportunities to "hustle". Targeted, non-discriminatory services, as well as mobile clinics existed in the city. Non-governmental organisations reportedly worked together with the public sector, facilitating access to HIV and TB prevention and treatment services. There were also needle exchange programmes and a harm reduction clinic in the city. However, there was limited access to contraceptive and STI services. Although there was reportedly good access to HIV and TB and harm reduction services in the city of Durban, uptake was low. CONCLUSIONS: The integration of services to enable PWID to access different services under one roof is critical. There is also a need to strengthen linkages between public and private healthcare, and ensure services are provided in a non-discriminatory environment. This will facilitate uptake and access to more comprehensive SRH and harm reduction services for PWID in Durban, South Africa.


Assuntos
Infecções por HIV , Redução do Dano , Acessibilidade aos Serviços de Saúde , Estigma Social , Abuso de Substâncias por Via Intravenosa , Humanos , África do Sul , Feminino , Adulto , Masculino , Infecções por HIV/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Serviços de Saúde Reprodutiva , Pessoa de Meia-Idade , Saúde Sexual , Programas de Troca de Agulhas , Saúde Reprodutiva
5.
Harm Reduct J ; 21(1): 119, 2024 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-38890736

RESUMO

BACKGROUND: The current fourth wave of the United States opioid overdose epidemic is characterized by the co-use of opioids and stimulants, including illicit opioids and methamphetamine. The co-use of these two drugs, known as "goofballing," is associated with higher risk for several adverse outcomes, including more frequent injections, greater health risks, and higher morbidity. Considering these differences, this unique subpopulation of people who inject drugs (PWID) may also have unique unmet needs and harm reduction preferences. METHODS: We collected self-reported data from participants (N = 50) of a syringe services program (SSP), including basic needs and harm reduction preferences. Using bivariate analyses, we examined differences between SSP participants who do and do not co-use illicit opioids and methamphetamine. Co-use was defined as reporting the use of both drugs, which may or may not have been used simultaneously. RESULTS: In the overall sample, the mean level of need was highest for bus passes or other transportation, a person who can help you get the services you need, medication for opioid use disorder, and a job or job training. Additionally, all participants reported being either interested or very interested in fentanyl test strips, safe consumption sites, delivery of syringe service supplies, and delivery of naloxone. Those who endorsed co-use had a greater need for food, healthcare, substance use disorder treatment, a support person to help them access needed services, and bus passes or transportation. CONCLUSIONS: Unmet needs were prevalent, and the desire for more harm reduction services was high among these PWID. Results also suggest people who co-use illicit opioids and methamphetamine may have the greatest unmet needs and desire for additional harm reduction services.


Assuntos
Redução do Dano , Metanfetamina , Programas de Troca de Agulhas , Transtornos Relacionados ao Uso de Opioides , Abuso de Substâncias por Via Intravenosa , Humanos , Programas de Troca de Agulhas/estatística & dados numéricos , Feminino , Masculino , Adulto , Abuso de Substâncias por Via Intravenosa/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Preferência do Paciente , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Anfetaminas/epidemiologia , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Drogas Ilícitas , Analgésicos Opioides/uso terapêutico
6.
Int J Equity Health ; 23(1): 124, 2024 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-38886803

RESUMO

BACKGROUND: Hepatitis C virus (HCV) infection is a significant global health burden, particularly among people who inject drugs. Rapid point-of-care HCV testing has emerged as a promising approach to improve HCV detection and linkage to care in harm reduction organizations such as needle and syringe programs. The objective of this study was to use an intersectionality lens to explore the barriers and enablers to point-of-care HCV testing in a needle and syringe program. METHODS: A qualitative study was conducted using semi-structured interviews with clients (people who inject drugs) and service providers in a large community organization focused on the prevention of sexually transmitted and blood borne infections and harm reduction in Montreal, Canada. An intersectionality lens was used alongside the Theoretical Domains Framework to guide the formulation of research questions as well as data collection, analysis, and interpretation. RESULTS: We interviewed 27 participants (15 clients, 12 providers). For clients, four themes emerged: (1) understanding and perceptions of HCV testing, (2) the role of an accessible and inclusive environment, (3) the interplay of emotions and motivations in decision-making, and (4) the impact of intersectional stigma related to HCV, behaviors, and identities. For providers, five themes emerged: (1) knowledge, skills, and confidence for HCV testing, (2) professional roles and their intersection with identity and lived experience, (3) resources and integration of services, (4) social and emotional factors, and (5) behavioral regulation and incentives for HCV testing. Intersectional stigma amplified access, emotional and informational barriers to HCV care for clients. In contrast, identity and lived experience acted as powerful enablers for providers in the provision of HCV care. CONCLUSION: The application of an intersectionality lens provides a nuanced understanding of multilevel barriers and enablers to point-of-care HCV testing. Findings underscore the need for tailored strategies that address stigma, improve provider roles and communication, and foster an inclusive environment for equitable HCV care. Using an intersectionality lens in implementation research can offer valuable insights, guiding the design of equity-focused implementation strategies.


Assuntos
Hepatite C , Testes Imediatos , Pesquisa Qualitativa , Abuso de Substâncias por Via Intravenosa , Humanos , Hepatite C/psicologia , Feminino , Masculino , Abuso de Substâncias por Via Intravenosa/psicologia , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Pessoa de Meia-Idade , Programas de Troca de Agulhas , Acessibilidade aos Serviços de Saúde , Canadá , Pessoal de Saúde/psicologia , Entrevistas como Assunto , Redução do Dano , Estigma Social
7.
Health Aff (Millwood) ; 43(6): 883-891, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38830163

RESUMO

People who inject drugs face many challenges that contribute to poor health outcomes, including drug overdose, HIV, and hepatitis C infections. These conditions require high-quality prevention and treatment services. Syringe services programs are evidence-based harm reduction programs, and they have established track records with people who inject drugs, earning them deep trust within this population. In Baltimore, Maryland, although many syringe support services were limited during the COVID-19 pandemic, the health department's syringe services programs remained operational, allowing for the continuation of harm reduction services, including naloxone distribution. This evaluation describes a collaborative effort to colocate infectious disease testing and COVID-19 vaccination with a syringe services program. Our evaluation demonstrated that colocation of important services with trusted community partners can facilitate engagement and is essential for service uptake. Maintaining adequate and consistent funding for these services is central to program success. Colocation of other services within syringe services programs, such as medications for opioid use disorder, wound care, and infectious disease treatment, would further expand health care access for people who inject drugs.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Programas de Troca de Agulhas , Abuso de Substâncias por Via Intravenosa , Humanos , Baltimore , COVID-19/prevenção & controle , Vacinas contra COVID-19/provisão & distribuição , Redução do Dano , Acessibilidade aos Serviços de Saúde , Teste para COVID-19 , Infecções por HIV/prevenção & controle
8.
Harm Reduct J ; 21(1): 108, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38824597

RESUMO

BACKGROUND: Syringe services programs (SSPs) are critical healthcare access points for people with opioid use disorder (OUD) who face treatment utilization barriers. Co-locating care for common psychiatric comorbidities, like posttraumatic stress disorder (PTSD), at SSPs may reduce harms and enhance the health of individuals with OUD. To guide the development of onsite psychiatric care at SSPs, we collected quantitative survey data on the prevalence of PTSD, drug use patterns, treatment experiences associated with a probable PTSD diagnosis, and attitudes regarding onsite PTSD care in a convenience sample of registered SSP clients in New York City. METHODS: Study participants were administered the PTSD Checklist for the DSM-5 (PCL-5) and asked about sociodemographic characteristics, current drug use, OUD and PTSD treatment histories, and desire for future SSP services using a structured interview. Probable PTSD diagnosis was defined as a PCL-5 score ≥ 31. RESULTS: Of the 139 participants surveyed, 138 experienced at least one potentially traumatic event and were included in the present analysis. The sample was primarily male (n = 108, 78.3%), of Hispanic or Latinx ethnicity (n = 76, 55.1%), and middle-aged (M = 45.0 years, SD = 10.6). The mean PCL-5 score was 35.2 (SD = 21.0) and 79 participants (57.2%) had a probable PTSD diagnosis. We documented frequent SSP utilization, significant unmet PTSD treatment need, and high interest in onsite PTSD treatment. CONCLUSIONS: Study findings point to the ubiquity of PTSD in people with OUD who visit SSPs, large gaps in PTSD care, and the potential for harm reduction settings like SSPs to reach people underserved by the healthcare system who have co-occurring OUD and PTSD.


Assuntos
Serviços de Saúde Mental , Programas de Troca de Agulhas , Transtornos de Estresse Pós-Traumáticos , Humanos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/terapia , Masculino , Feminino , Adulto , Programas de Troca de Agulhas/estatística & dados numéricos , Cidade de Nova Iorque/epidemiologia , Pessoa de Meia-Idade , Serviços de Saúde Mental/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Preferência do Paciente , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Prevalência , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos
9.
Int J Drug Policy ; 128: 104422, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38703621

RESUMO

BACKGROUND: Personal syringe reuse (i.e., reuse of one's own syringes) can place people who inject drugs at increased risk for infectious disease but has received relatively little attention in published literature. The purpose of this study is to identify factors associated with syringe reuse among people who inject drugs in rural Kentucky. METHODS: Participants (n = 238) completed interviewer-administered questionnaires on syringe reuse and demographic, behavioral, and service access characteristics. Unadjusted negative binomial regression with cluster-robust standard errors was used to model the associations with a logged offset for number of injections in the past 30 days. RESULTS: The average age of the sample was 35 and 59.7 % were male. Most participants (77.7 %) reused syringes at least once in the past 30 days, using each syringe a median of three times. Reuse was higher among those who were older and reported a higher street price for syringes. Syringe reuse was lower among people who were within walking distance to a syringe service program (SSP) and who obtained most of their syringes from SSPs or pharmacies. CONCLUSION: Syringe reuse among people who inject drugs in rural Kentucky is common. However, these data suggest that increased access to syringes from SSPs and pharmacies, as well as policy-level interventions that reduce street syringe price, might reduce syringe reuse and related harms.


Assuntos
Reutilização de Equipamento , Programas de Troca de Agulhas , População Rural , Abuso de Substâncias por Via Intravenosa , Seringas , Humanos , Kentucky , Masculino , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto , Feminino , Seringas/provisão & distribuição , População Rural/estatística & dados numéricos , Reutilização de Equipamento/estatística & dados numéricos , Programas de Troca de Agulhas/estatística & dados numéricos , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem , Região dos Apalaches
10.
Int J Drug Policy ; 128: 104433, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38703622

RESUMO

BACKGROUND: The World Health Organization (WHO) has set a goal to eliminate hepatitis C virus (HCV) infection by 2030, including a 90% reduction of HCV incidence. With the introduction of a needle syringe program (NSP) in Stockholm, Sweden, and unrestricted availability of direct acting antiviral (DAA) treatment, we investigate the change of prevalence and incidence of HCV infection among people who inject drugs (PWID) over time. METHODS: All persons attending the Stockholm NSP 2013-2021 (n=4,138) were included. The prevalence of viremic HCV infection was investigated yearly. For incidence analysis, PWID at risk with at least one follow-up test were included. Participants were divided into naive defined as anti-HCV negative (n=791), and exposed, defined as anti-HCV positive with a negative HCV RNA (n=1,030). Risk factors for HCV infection were analyzed using parametric exponential proportional hazards regression models. RESULTS: The prevalence of viremic HCV infection decreased from 62% to 30% year 2013-2021 while the prevalence of cured after treatment increased from 0 to 22%, corresponding to 42% cured after treatment out of eligible in 2021. The overall incidence rate in naive was 16.9 (95% CI 15.0-19.0) and in exposed 12.8 (95% CI 11.6-14.2) per 100 person years (PY) and was not significantly reduced years 2013-2015 to 2020-2021 in either group. Risk factors for incident HCV infection in multivariable analysis were sharing needles/syringes, younger age, custody/prison past year, and homelessness, whereas opioid agonist treatment was protective. CONCLUSION: The prevalence of HCV was halved in PWID as unrestricted DAA treatment became available and NSP was established in Stockholm. However, overall incidence was not reduced. To meet the WHO incidence goal, targeting PWID with high injection risk behaviors for testing and treatment is essential, along with engagement in harm reduction services.


Assuntos
Antivirais , Hepatite C , Programas de Troca de Agulhas , Abuso de Substâncias por Via Intravenosa , Humanos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Incidência , Masculino , Feminino , Prevalência , Hepatite C/epidemiologia , Adulto , Suécia/epidemiologia , Antivirais/administração & dosagem , Fatores de Risco , Programas de Troca de Agulhas/estatística & dados numéricos , Pessoa de Meia-Idade , Adulto Jovem
11.
Int J Drug Policy ; 128: 104468, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38795465

RESUMO

INTRODUCTION: Stigma has negative consequences for the health of people who inject drugs and people living with hepatitis C virus (HCV). This study evaluated factors associated with stigma related to injecting drug use (IDU) or HCV and those associated with being treated negatively by health workers. METHODS: ETHOS Engage is an observational cohort study of people who inject drugs attending drug treatment clinics and needle and syringe programs in Australia. Participants completed a questionnaire including IDU- and HCV-related stigma, and negative treatment by health workers. Logistic regression was used to identify factors associated with experiencing stigma and negative treatment in a cross-sectional sample. RESULTS: Of 1,211 participants, 31% were women, 64% had injected drugs in the previous month, and 65% had been diagnosed with HCV. IDU-related stigma was reported by 57% of participants and was associated with being a woman, higher than Year 10 education, homelessness, opioid agonist treatment, recent injecting, overdose history, hospitalisation for drug use, and unknown HCV status. HCV-related stigma was reported by 34% of participants diagnosed with HCV and was associated with being a woman, homelessness, receptive needle/syringe sharing, arrest for drug use/possession, and recent HCV testing. Negative treatment from health workers was reported by 45% of participants and was associated with being a woman, receptive needle/syringe sharing, hospitalisation for drug use, and arrest for drug use/possession. DISCUSSION AND CONCLUSIONS: Results highlight important intersections and disparities in stigmatising experiences among people who inject drugs. Considering these intersections can assist health services provide more inclusive care.


Assuntos
Hepatite C , Estigma Social , Abuso de Substâncias por Via Intravenosa , Humanos , Feminino , Masculino , Adulto , Estudos Transversais , Austrália , Pessoa de Meia-Idade , Inquéritos e Questionários , Estudos de Coortes , Adulto Jovem , Programas de Troca de Agulhas , Pessoas Mal Alojadas
12.
Int J Drug Policy ; 127: 104394, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38608357

RESUMO

BACKGROUND: Evaluating gender-specific trends in hepatitis C virus (HCV) treatment uptake among men and women who inject drugs is crucial for ensuring equitable progress towards HCV elimination. This study aimed to quantify differences in testing, treatment, and current HCV infection between men and women who inject drugs. METHOD: ETHOS Engage is an observational cohort study of people who inject drugs attending drug treatment clinics and needle and syringe programs in Australia recruited from May 2018-September 2019 (wave 1) and November 2019-April 2021 (wave 2). Participants completed a questionnaire including self-reported HCV testing and treatment history and underwent point-of-care HCV RNA testing (Xpert® HCV Viral Load Fingerstick). Logistic regression was used to compare the factors associated with self-reported HCV testing and treatment and current HCV infection for men and women who inject drugs. RESULTS: Among 2,395 participants enrolled in ETHOS Engage, 66% (n = 1,591) were men, 33% (n = 786) women, and <1% (n = 18) did not identify as a man or woman. HCV testing history and current infection were similar among men and women. Among men or women ever eligible for HCV treatment (ever chronic HCV) (n = 1,242), women were less likely to report a history of HCV treatment compared to men (227/352, 64% vs. 631/890, 71%; p = 0.03). Among women, those aged <45 were less likely to report HCV testing (aOR: 0.57, 95%CI: 0.36, 0.90), treatment (aOR: 0.47, 95%CI: 0.29, 0.77), and more likely to have HCV infection (aOR: 1.48, 95%CI: 1.00, 2.20) CONCLUSION: Among women, those of childbearing age (<45) were less likely to report testing and treatment and were more likely to have current HCV infection. Women <45 years old should be a priority population for HCV care. Services that interface with these women should be optimised to enhance HCV testing and treatment.


Assuntos
Hepatite C , Abuso de Substâncias por Via Intravenosa , Humanos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Masculino , Feminino , Adulto , Hepatite C/epidemiologia , Hepatite C/tratamento farmacológico , Austrália/epidemiologia , Pessoa de Meia-Idade , Estudos de Coortes , Fatores Sexuais , Adulto Jovem , Programas de Troca de Agulhas
13.
AIDS Educ Prev ; 36(2): 129-140, 2024 04.
Artigo em Inglês | MEDLINE | ID: mdl-38648174

RESUMO

The COVID-19 pandemic strained the U.S. health care system, posing logistical challenges for community-based programs. This study surveyed 11 program directors in sexually transmitted infection (STI) clinics and syringe services programs (SSPs) that served people who use substances and are at risk for HIV in five southeastern U.S. states. Brief survey questions asked about programs' use of in-person and telehealth services. Results indicated widespread reduction of in-person services and concomitant adoption of telehealth services. In STI clinics, telehealth replaced in-person visits for all but urgent treatment of active symptoms. In SSPs, in-person contact continued or increased from pre-pandemic volumes. In both programs, the most salient telehealth use barrier was limited device or internet access and limited technological ease. Services were sustained through innovative adaptations. This snapshot of response to the early COVID-19 lockdown phase offers actionable guidance about service preparedness for future public health catastrophes in community-based programs serving vulnerable populations.


Assuntos
COVID-19 , Programas de Troca de Agulhas , SARS-CoV-2 , Infecções Sexualmente Transmissíveis , Telemedicina , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Infecções Sexualmente Transmissíveis/prevenção & controle , Sudeste dos Estados Unidos , Instituições de Assistência Ambulatorial , Infecções por HIV/prevenção & controle , Infecções por HIV/epidemiologia , Infecções por HIV/terapia , Pandemias , Inquéritos e Questionários , Serviços de Saúde Comunitária/organização & administração
14.
Addiction ; 119(7): 1276-1288, 2024 07.
Artigo em Inglês | MEDLINE | ID: mdl-38561602

RESUMO

BACKGROUND AND AIMS: People who inject drugs (PWID) are at risk for adverse outcomes across multiple dimensions. While evidence-based interventions are available, services are often fragmented and difficult to access. We measured the effectiveness of an integrated care van (ICV) that offered services for PWID. DESIGN, SETTING AND PARTICIPANTS: This was a cluster-randomized trial, which took place in Baltimore, MD, USA. Prior to randomization, we used a research van to recruit PWID cohorts from 12 Baltimore neighborhoods (sites), currently served by the city's mobile needle exchange program. INTERVENTION AND COMPARATOR: We randomized sites to receive weekly visits from the ICV (n = 6) or to usual services (n = 6) for 14 months. The ICV offered case management; buprenorphine/naloxone; screening for HIV, hepatitis C virus and sexually transmitted infections; HIV pre-exposure prophylaxis; and wound care. MEASUREMENTS: The primary outcome was a composite harm mitigation score that captured access to evidence-based services, risk behaviors and adverse health events (range = 0-15, with higher numbers indicating worse status). We evaluated effectiveness by comparing changes in the composite score at 7 months versus baseline in the two study arms. FINDINGS: We enrolled 720 cohort participants across the study sites (60 per site) between June 2018 and August 2019: 38.3% women, 72.6% black and 85.1% urine drug test positive for fentanyl. Over a median of 10.4 months, the ICV provided services to 734 unique clients (who may or may not have been cohort participants) across the six intervention sites, including HIV/hepatitis C virus testing in 577 (78.6%) and buprenorphine/naloxone initiation in 540 (74%). However, only 52 (7.2%) of cohort participants received services on the ICV. The average composite score decreased at 7 months relative to baseline, with no significant difference in the change between ICV and usual services (difference in differences: -0.31; 95% confidence interval: -0.70, 0.08; P = 0.13). CONCLUSIONS: This cluster-randomized trial in Baltimore, MD, USA, found no evidence that weekly neighborhood visits from a mobile health van providing injection-drug-focused services improved access to services and outcomes among people who injected drugs in the neighborhood, relative to usual services. The van successfully served large numbers of clients but unexpectedly low use of the van by cohort participants limited the ability to detect meaningful differences.


Assuntos
Programas de Troca de Agulhas , Abuso de Substâncias por Via Intravenosa , Humanos , Feminino , Masculino , Adulto , Baltimore , Infecções por HIV , Pessoa de Meia-Idade , Prestação Integrada de Cuidados de Saúde , Combinação Buprenorfina e Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Redução do Dano , Unidades Móveis de Saúde , Hepatite C , Prática Clínica Baseada em Evidências
16.
Drug Alcohol Rev ; 43(4): 1019-1028, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38630939

RESUMO

INTRODUCTION: Understanding needle/syringe sharing is crucial for reducing hepatitis C virus (HCV) infection and reinfection. This study aimed to assess the prevalence and factors associated with needle/syringe sharing among people who inject drugs in Australia, including those previously receiving HCV treatment. METHODS: The ETHOS Engage study was an observational cohort study which collected self-reported survey data on demographic and drug use information from people who inject drugs attending drug treatment clinics and needle and syringe programs over two waves between May 2018 and June 2021. Logistic regression was used to identify factors associated with needle/syringe sharing. RESULTS: Overall, 1555/2395 people enrolled in ETHOS Engage (65%) injected drugs in the past month. Among these, 432 (28%) reported needle/syringe sharing in the past month and 276 (18%) reported receptive sharing. Factors associated with receptive sharing included younger age (adjusted odds ratio [aOR] 1.72; 95% confidence interval [CI] 1.28-2.30), recent incarceration (aOR 2.04; 95% CI 1.40-2.94), more frequent injecting (≥daily vs. less than weekly; aOR 2.59; 95% CI 1.75-3.84) and unstable housing (aOR 1.78; 95% CI 1.26-2.52). Among 560 participants with prior HCV treatment, 87 (16%) reported receptive sharing with younger age (aOR 2.42; 95% CI 1.45-4.05) and daily or greater injection frequency (aOR 2.51; 95% CI 1.31-4.83) associated with receptive sharing. DISCUSSION AND CONCLUSIONS: Needle/syringe sharing was common among this population accessing harm reduction services. This study identifies high-risk populations with needle/syringe sharing. Research is needed to optimise HCV treatment to ensure people with ongoing risk behaviours receive adequate harm reduction following treatment to prevent reinfection.


Assuntos
Hepatite C , Uso Comum de Agulhas e Seringas , Abuso de Substâncias por Via Intravenosa , Humanos , Uso Comum de Agulhas e Seringas/estatística & dados numéricos , Masculino , Feminino , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto , Austrália , Pessoa de Meia-Idade , Hepatite C/epidemiologia , Estudos de Coortes , Adulto Jovem , Programas de Troca de Agulhas , Prevalência , Fatores de Risco , Redução do Dano
17.
J Subst Use Addict Treat ; 162: 209376, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38641053

RESUMO

BACKGROUND: Due to the considerably heightened risk of overdose immediately following jail or prison release, expansion of harm reduction interventions for citizens returning to the community after an incarceration episode should be of utmost concern. However, there are no studies examining the adoption and use of harm reduction among this population. This short report examines the use of individual-level harm reduction strategies (HRS) among people who use drugs, comparing those who have lifetime histories of incarceration with those who do not. METHODS: This study included baseline data (N = 274) from a larger clinical trial, which recruited participants at two syringe service programs. Fisher's exact tests examine correlations between HRS and lifetime incarceration. RESULTS: Significant variation in HRS use were observed by demographic characteristics. Those with lifetime incarceration histories were less likely to report ensuring naloxone was available when using, using when others were present, using fentanyl test strips, using a trusted drug supplier, and using some other HRS compared to those without lifetime incarceration histories. Similarly, those with lifetime incarceration histories were also less likely to report using non-prescribed buprenorphine and methadone, which could potentially reduce overdose risk even if not explicitly used as an HRS. CONCLUSION: The results suggest that one of the populations at highest risk of overdose is least likely to use strategies that may reduce overdose risk. Targeted efforts to increase exposure to HRS learning opportunities and access to these resources could help reduce overdose disparities for people returning to the community after incarceration.


Assuntos
Redução do Dano , Prisioneiros , Humanos , Masculino , Feminino , Adulto , Prisioneiros/estatística & dados numéricos , Prisioneiros/psicologia , Overdose de Drogas/epidemiologia , Overdose de Drogas/prevenção & controle , Naloxona/uso terapêutico , Naloxona/administração & dosagem , Metadona/uso terapêutico , Pessoa de Meia-Idade , Antagonistas de Entorpecentes/uso terapêutico , Buprenorfina/uso terapêutico , Programas de Troca de Agulhas , Encarceramento
18.
Can J Public Health ; 115(3): 468-471, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38602661

RESUMO

Canada has been a pioneer in adopting a harm reduction approach to address risks associated with drug use for people who inject drugs. Today, Canada is home to 39 supervised injection sites spread throughout the country. The scientific literature demonstrates, unequivocally, that these sites have numerous health benefits for people who inject drugs, namely by decreasing risks of blood-borne diseases, overdose, and mortality. Yet, a lack of clear guidelines on optimal locations for the implementation of such sites and NIMBYISM ("Not In My Back Yard") have been stumbling blocks for planned and operating sites. Various Canadian governments have introduced their own policies to overcome the lack of national public health guidelines on community planning. Namely, policies aim to limit the exposure to sites and drug use for vulnerable populations, such as children. However, there is a veritable lack of research on the public health impacts of supervised injection sites for local communities, who tend to be disadvantaged. The existing literature fails to address the broader and differential impacts of such sites for local vulnerable and disadvantaged populations, including use of active transportation, psychological distress, perceived safety, and social cohesion. Moreover, existing research, largely focusing on assessing pre-implementation social acceptability and post-implementation impacts on crime, faces important methodological limitations. The following commentary reviews the existing literature and makes recommendations for future public health research on the impacts of supervised injection sites.


RéSUMé: Le Canada a été un pionnier dans l'adoption de l'approche de réduction des méfaits liés à la consommation de drogues pour les personnes utilisatrices de drogues par injection. Aujourd'hui, le Canada compte 39 sites d'injection supervisée répartis sur l'ensemble du territoire. La littérature scientifique démontre sans équivoque que ces sites présentent de nombreux avantages pour la santé des personnes utilisatrices de drogues par injection, notamment en réduisant les risques de maladies transmises par le sang, de surdoses et de décès. Toutefois, l'absence de lignes directrices claires sur les emplacements optimaux pour l'implantation de ces sites et le phénomène du « pas dans ma cour ¼ ("Not In My Back Yard") représentent des défis pour les sites existants et futurs. Plusieurs gouvernements canadiens ont introduit des politiques pour pallier l'absence de lignes directrices nationales en matière de santé publique et de planification communautaire. Ces politiques visent à limiter l'exposition aux sites d'injection supervisée et à la consommation de drogues pour les populations vulnérables, comme les enfants. Cependant, il y a un véritable manque de connaissances quant aux impacts en matière de santé publique des sites d'injection supervisée pour les communautés locales, qui ont tendance à être défavorisées. La littérature existante n'aborde pas les impacts élargis et différentiels de ces sites pour les populations vulnérables et défavorisées résidant à proximité, particulièrement sur l'utilisation des transports actifs, la détresse psychologique, la perception de sécurité et la cohésion sociale. En outre, la recherche existante, qui se concentre principalement sur l'évaluation de l'acceptabilité sociale avant l'implantation des sites et sur les impacts sur la criminalité après l'implantation des sites, se heurte à d'importantes limites méthodologiques. Ce commentaire fait état de la littérature existante et formule des recommandations pour de futures recherches sur les impacts en matière de santé publique des sites d'injection supervisée.


Assuntos
Crime , Redução do Dano , Programas de Troca de Agulhas , Saúde Pública , Abuso de Substâncias por Via Intravenosa , Humanos , Canadá , Populações Vulneráveis
19.
Subst Use Misuse ; 59(8): 1174-1181, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38509704

RESUMO

BACKGROUND: Community concerns surrounding syringe waste are a common barrier to syringe services program (SSP) implementation. In Kanawha County, West Virginia, community opposition to SSPs resulted in the closure of needs-based SSPs prior to and during an HIV outbreak among persons who inject drugs (PWID). This qualitative analysis examines views of PWID and community partners on syringe waste and disposal associated with needs-based SSPs. METHODS: Qualitative interviews with 26 PWID and 45 community partners (medical and social service providers, law enforcement personnel, policymakers, and religious leaders) were conducted. Interviews were recorded, transcribed, and coded. Code summaries described participants' views on syringe waste and disposal and needs-based SSPs. RESULTS: Community partners and PWID who favored needs-based SSPs reported that needs-based SSPs had not affected or reduced syringe waste. Conversely, community partners who favored one-to-one exchange models and/or barcoded syringes described needs-based SSPs increasing syringe waste. Community partners often cited pervasive community beliefs that SSPs increased syringe waste, risk of needlesticks, drug use, and crime. Community partners were unsure how to address syringe waste concerns and emphasized that contradictory views on syringe waste posed barriers to discussing and implementing SSPs. CONCLUSIONS: Participants' views on whether syringe waste was associated with needs-based SSPs often aligned with their support or opposition for needs-based SSPs. These differing views resulted in challenges finding common ground to discuss SSP operations amid an HIV outbreak among PWID. SSPs might consider addressing syringe waste concerns by expanding syringe disposal efforts and implementing community engagement and stigma reduction activities.


Assuntos
Programas de Troca de Agulhas , Abuso de Substâncias por Via Intravenosa , Humanos , Abuso de Substâncias por Via Intravenosa/psicologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Feminino , Masculino , Adulto , Seringas , Infecções por HIV/prevenção & controle , West Virginia/epidemiologia , Pessoa de Meia-Idade , Pesquisa Qualitativa
20.
Artigo em Inglês | MEDLINE | ID: mdl-38541289

RESUMO

Community Pharmacy Needle Exchanges are a harm reduction measure that have been established in a number of countries to provide access to sterile injecting equipment for people who inject drugs (PWID). To ensure that they are meeting needs, it is important to monitor the use of the services. This study aimed to determine patterns of needle distribution and return in community pharmacies in Ireland over time. The number of pharmacies, needle packs, clean needles and returned packs was obtained from the Health Service Executive (HSE) Planning and Business Information Unit (PBI). Yearly totals were calculated to show patterns from 2015 to 2022. There has been an 18% decline in the number of pharmacies providing the service since 2015, with a 19% decline in the number of packs provided and a 21% decline in the number of packs returned. The proportion of packs returned was 23% in 2015 and 18% in 2022. There has been a 16% decline in the number of sterile needles provided and a 6% reduction in the average number of needles per individual since 2017. Declining needle use and low rates of used needle return (against a backdrop of large numbers of PWID that have not significantly reduced over time) suggest that there is a need to investigate if community pharmacies in Ireland have the scope to improve their harm reduction impact. This raises questions in terms of the need to both improve and adapt the service against a backdrop of changing drug markets. Key recommendations include the need to review the harm reduction services employed by participating pharmacies when providing new equipment and organising the return of used equipment.


Assuntos
Infecções por HIV , Farmácias , Abuso de Substâncias por Via Intravenosa , Humanos , Programas de Troca de Agulhas , Irlanda , Seringas , Redução do Dano
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