Injection Drug Users Research Articles

Duration of delayed diagnosis in HIV/AIDS patients in Iran: a CD4 depletion model analysis

Delayed diagnosis of HIV can lead to an inappropriate response to antiretroviral therapy (ART), rapid progression of the disease, and death. It can also carry harmful effects on public health due to the increment of transmission. This study aimed to estimate the duration of delayed diagnosis (DDD) in HIV patients in Iran. This hybrid cross-sectional cohort study was conducted on the national HIV surveillance system database (HSSD). Linear mixed effect models with random intercept, random slope, and both were used to estimate the parameters required for the CD4 depletion model to determine the best-fitted model for DDD, stratified by the route of transmission, gender, and age group. The DDD was estimated in 11,373 patients including 4,762 (41.87%) injection drug users (IDUs), 512 (4.5%) men who had sexual contact with men (MSM), 3,762 (33.08%) patients with heterosexual contacts, and 2,337 (20.55%) patients who were infected through other routes of HIV transmission. The total mean DDD was 8.41 ± 5.97 years. The mean DDD was 7.24 ± 0.08 and 9.43 ± 6.83 years in male and female IDUs, respectively. In the heterosexual contact group, DDD was obtained as 8.60 ± 6.43 years in male patients and 9.49 ± 7.17 years in female patients. It was also estimated as 9.37 ± 7.30 years in the MSM group. Furthermore, patients infected through other transmission routes were found with a DDD of 7.90 ± 6.74 years for male patients and a DDD of 7.87 ± 5.87 years for female patients. A simple CD4 depletion model analysis is represented, which incorporates a pre-estimation step to determine the best-fitted linear mixed model for calculating the parameters required for the CD4 depletion model. Considering such a noticeably high HIV diagnostic delay, especially in older adults, MSM, and heterosexual contact groups, regular periodic screening is required to reduce the DDD.

Investigating rates and risk factors for hepatitis C virus reinfection in people receiving antiviral treatment in England.

England has committed to the World Health Organization target to eliminate hepatitis C virus (HCV) as a public threat by the year 2030. Given successful treatments for HCV in recent years, it is unclear whether HCV reinfection will impact England's ability to achieve HCV elimination. We aimed to estimate the HCV reinfection rate among a cohort of patients receiving antiviral treatment using available surveillance data. Linkage between a treatment dataset from 2015 to 2019 and an HCV RNA testing dataset were used to identify people who experienced reinfection using three criteria. A Cox proportional hazards model was used to determine risk factors associated with HCV reinfection among a cohort who received treatment and had follow-up HCV RNA testing. The reinfection rate among those receiving HCV treatment was 7.91 per 100 person-years (PYs, 95% confidence interval (CI) 7.37-8.49) and highest among current injecting drug users (22.55 per 100 PYs, 95% CI 19.98-25.46) and people who had been in prison (20.42 per 100 PYs, 95% CI 17.21-24.24). In the adjusted model, women had a significantly reduced risk of reinfection. Being of younger age, current injecting drug users, and receipt of first treatment in prison were each significantly associated with increased risk of reinfection. Two-fifths of those with reinfection (43%, n=329/767) were linked to treatment after reinfection, and of those starting treatment, three quarters (75%, n=222/296) achieved a sustained virologic response. Guidance for testing groups at risk of reinfection and harm reduction strategies to minimize transmission should be implemented if England is to achieve HCV elimination targets.

Immune profiling in Puerto Rican injection drug users with and without HIV-1 infection.

Antiretroviral therapy has been effective in suppressing HIV viral load and enabling people living with HIV to experience longer, more conventional lives. However, as people living with HIV are living longer, they are developing aging-related diseases prematurely and are more susceptible to comorbidities that have been linked to chronic inflammation. Coincident with HIV infection and aging, drug abuse has also been independently associated with gut dysbiosis, microbial translocation, and inflammation. Here, we hypothesized that injection drug use would exacerbate HIV-induced immune activation and inflammation, thereby intensifying immune dysfunction. We recruited 50 individuals not using injection drugs (36/50 HIV+) and 47 people who inject drugs (PWID, 12/47 HIV+). All but 3 of the HIV+ subjects were on antiretroviral therapy. Plasma immune profiles were characterized by immunoproteomics, and cellular immunophenotypes were assessed using mass cytometry. The immune profiles of HIV+/PWID-, HIV-/PWID+, and HIV+/PWID+ were each significantly different from controls; however, few differences between these groups were detected, and only 3 inflammatory mediators and 2 immune cell populations demonstrated a combinatorial effect of injection drug use and HIV infection. In conclusion, a comprehensive analysis of inflammatory mediators and cell immunophenotypes revealed remarkably similar patterns of immune dysfunction in HIV-infected individuals and in people who inject drugs with and without HIV-1 infection.

HIV-1 Transmission Cluster in Injection Drug Users in Nairobi City, Kenya.

While there is a striking increase in the prevalence of HIV in injection drug users, information on envelope-gene subtypes and transmission clusters in injection drug users is scarce. In a cross-sectional study, 247 injection drug users were recruited via out-rich method. Deoxyribonucleic acid was extracted from dry blood spot samples, amplified by Polymerase Chain Reaction and sequenced. Subtyping was performed using COntext-based Modeling for Expeditious Typing (COMET) and Recombinant Identification Program (RIP) tools. Phylogenetic diversity and Transmission clusters were identified using MEGA version 6.0 and TreeLink, respectively. Overall, 42 (17.0%) injection drug users were sero-positive for HIV-1. Of the 37 samples successfully sequenced, 29 (78.4%) sequences were identified as A1, 6 (16.2%) as AG while 1 (2.7%) as A1/G/AE and A1/C recombinants. The HIV subtypes formed clusters with little genetic diversity. The high HIV prevalence was associated with transmission clusters and diversity in subtypes indicating ongoing local transmission. Therefore, there is need for comprehensive HIV care tailored to this population.

Occult hepatitis C infection identified in injection drug users with direct antiviral agents therapy and spontaneous resolution of hepatitis C virus infection

BackgroundOccult hepatitis C infection (OCI) is characterized by the detection of hepatitis C virus (HCV) RNA in hepatocytes and in peripheral blood mononuclear cells (PBMCs) without detection in serum. We aimed to evaluate OCI in drug and no drug users who achieved sustained virological response (SVR) after therapy with direct-acting antivirals (DAAs) and with HCV spontaneous resolution. MethodsTwenty-four patients in the AVP group (who achieved a SVR after DAAs therapy), 13 in the NAVP group (with HCV spontaneous resolution) and 7 HCV-RNA positive patients (CPP, control positive group) were included in the study. HCV/OCI-RNA was screened in serum and PBMCs samples of the patients by ddPCR for OCI patients’ identification. Plasma and red blood cells (RBCs) samples of the patients were also evaluated for HCV/OCI-RNA detection by ddPCR. ResultsOCI was presented in injection drug users (IDUs) in the AVP (20.8%) and NAVP (23.1%) groups by ddPCR with a higher statistically significant percentage detected in RBCs samples of the patients in the AVP group comparatively to NAVP (p<0.01) and CPP (p < 0.05) groups. ConclusionOCI was identified in IDUs patients of the AVP and NAVP groups by ddPCR. These results suggest that OCI patients in the AVP group might not be entirely cured, and that OCI patients in the NAVP group were not identified at clinical evaluation time when just serum samples were analysed. A higher percentage of HCV/OCI-RNA was detected in RBCs samples. Overall results recommends that HCV/OCI identification in patients with DAAs therapy and spontaneous resolution of HCV infection should be studied more accurately in future and in larger patient groups if possible. Additionally, suggest also PBMCs and RBCs samples as predictors for HCV/OCI diagnosis and management.

Implementation of Training Protocols Addressing Equitable Care in US Student-Run Clinics

Background: Student-run clinics (SRCs) provide free healthcare to surrounding communities—oftentimes underserved communities. In these clinics, medical students see a wide array of patients under the supervision of physicians. SRCs have helped to fill a gap in primary care and provide an opportunity for students to refine their clinical skills. However, no uniform training program exists across all student-run clinics. This study aims to assess and analyze the quality and characterization of these training programs to inform future trainings and ultimately provide more equitable care to the communities being served by SRCs. Methods: A nine-question survey was sent out by email to 96 clinics across the United States. Upon obtaining data, the study team de-identified the results. Two independent raters coded the survey responses using an inductive approach. Themes were derived from responses and summarized into nominal codes.&#x0D; Results: The populations served by the clinics that responded in decreasing order of magnitude were underinsured/uninsured (83%); immigrant/non-English speaking populations (75%); black, indigenous, and people of color (67%); homeless (67%); low-income (67%); sex workers (17%); youth (8%); and injection drug users (8%). Nine (75%) clinics had some form of training for volunteers and 3 (25%) offered no formal trainings. 75% of all clinics surveyed offered both “cultural competency” and “general introduction to systems training.” The majority of clinics partnered with local hospitals/clinics (50%). Other community partners included mental health and homeless agencies, local pharmacies, and schools. Two (17%) of the clinics surveyed did not have any community partners.&#x0D; Conclusion: SRCs offer a unique solution towards bridging the gap in health inequity in America. The study shows possible gaps in training among schools in the US. Although some schools have adopted formal, standardized training programs, many do not encompass instruction on topics including cultural humility, trauma-informed care, de-escalation, and population-specific care.

Influence of socio-cultural factors on hepatitis B infection in Mombasa County, Kenya

Background: The hepatitis B virus (HBV) is responsible for causing a communicable liver disease that can be prevented through vaccination. Although the HBV vaccine was introduced in Kenya’s expanded immunization program in 2003, the incidence of HBV remains high in the country, especially among IDUs. Objective was to investigate the influence of socio-cultural factors on HBV infection in Mombasa County, Kenya. Methods: The study utilized a cross-sectional analytical design. The study was purposely conducted in Mombasa County because the area is highly prevalent with drug users and people with hepatitis B. There are eight treatment centers in the county, 4 public and 4 privates where stratified random sampling was used. The sample size was proportionately distributed across the selected treatment centers. The study employed a mixed method of data collection, involved; self-administered questionnaire to the IDU’s, key informant interviews and focused group discussion with treatment care managers. Results: The prevalence of hepatitis B was 22%; with male (77.1%) most affected than women (22.9%). Bivariate analysis show that a history of drug abuse was significantly associated with prevalence of hepatitis B (χ2=2.485, df=1, p=0.046). Conclusions: The prevalence of hepatitis B is on the increase among injecting drug users. Having a history of drug abuse was a significant predictor to the prevalence of hepatitis B among injecting drug users in this study. Cultural practices such as piercing and tattooing were observed among study participants were established as a risk factor to hepatitis B infection among injecting drug users.

Sexually transmitted infections among key populations in India: A protocol for systematic review.

Sexually transmitted infections (STIs) are one of the leading causes of health, and economic burdens in the developing world, leading to considerable morbidity, mortality, and stigma. The incidence and prevalence of the four curable STIs viz. syphilis, gonorrhoea, chlamydia, and trichomoniasis vary remarkably across different geographical locations. In India, the prevalence of four curable STI among general populations is in between 0 to 3.9 percent. However, it is assumed that STI prevalence is much higher among subpopulations practicing high-risk behaviour. Like men who have sex with men (MSM), transgender (TG), injecting drug users (IDU), and female sex workers (FSW). In the present circumstances, a systematic review is necessary to integrate the available data from previously published peer-reviewed articles and published reports from several competent authorities to provide the prevalence and geographical distribution of the four curable STIs among the key population of India. All available articles will be retrieved from PubMed, Google Scholar, Cochrane database, Scopus, Science Direct, and the Global Health network using the appropriate search terms. The data will be extracted through data extraction form as per PICOS (population, intervention, comparison, outcome, study design) framework. Risk of bias and quality assessment will be performed according to the situation with the help of available conventional protocol. The future systematic review, generated from the present protocol, may provide evidence of the prevalence and geographical distribution of the four curable STIs among the key population of India. We hope that the findings of the future systematic review will strengthen the existing surveillance system in India, to determine the above-mention STIs prevalence among key populations in India. Protocol registration number: International Prospective Register for Systematic Reviews (PROSPERO) number CRD42022346470.

Rising global incidence of invasive group A streptococcus infection and scarlet fever in the COVID-19 era – our knowledge thus far

Rising global incidence of invasive group A streptococcus infection and scarlet fever in the COVID-19 era – our knowledge thus far

Current scenario of recently rising up cases of invasive group A streptococcal (iGAS) infections in younger children in many European nations: clinical management and prospective counteracting measures – an update

Current scenario of recently rising up cases of invasive group A streptococcal (iGAS) infections in younger children in many European nations: clinical management and prospective counteracting measures – an update

Association of ART non-adherence with self-reported behavior and lifestyle among injecting drug users in the coastal region of Kenya

There is a public health concern with the possible widespread of Antiretroviral Therapy (ART) drug-resistance. The widespread resistance could be due to risky behavior and lifestyle of Injecting Drug Users (IDUs) resulting into non-adherence to ART. However, few studies have investigated association of ART non-adherence with the risky behavior and lifestyle of IDUs. A cross-sectional study design was adopted to investigate ART non-adherence association with the risky behavior and lifestyle among 200 IDUs from Malindi in the coastal region of Kenya. Structured questionnaire was used to collect data while exponential discriminative snowball sampling was used for the recruitment of the study participants. Self-reported non-adherence was defined as taking less than 90% of daily ART doses, variable such as missed or stopped ART was used. Chi-square (χ2) tests were used to establish the relationship between various risk behaviors and ART adherence, while binary logistic regression model was used to test the association between independent variables (risky behavior and lifestyle) and dependent variable (ART non-adherence). A significant number 32% of the study participants reported non-adherence to ART, with 17% practicing risky sexual behaviors, 14% being commercial sex workers (CSW) while 89% had multiple sexual partners. Non-adherence to ART was associated with duration of drug use (OR = 6.73; 95%Cl = 1.93-23.0; P = 0.003), IDU/CSW (OR = 6.04; 95%Cl = 3.65-10.0; P = 0.001), needle sharing (OR = 2.96; 95%Cl = 1.60-5.46; P = 0.001) and commercial sex work (OR = 2.16; 95%Cl = 1.40-4.81; P = 0.001). This study reveals that multiple sex, commercial sex, same gender sex, imprisonment, needle share in prison, being in rehabilitation and duration on ART are associated with ART non-adherence among IDUs. Consequently, health education should focus on behavior and lifestyle change to avert potential widespread drug resistance within and beyond the population of IDUs.

Comprehensive needle and syringe program and opioid agonist therapy reduce HIV and hepatitis c virus acquisition among people who inject drugs in different settings: A pooled analysis of emulated trials.

Although the Netherlands, Canada and Australia were early adopters of harm reduction for people who inject drugs (PWID), their respective HIV and hepatitis C (HCV) epidemics differ. We measured the pooled effect of needle and syringe program (NSP) and opioid agonist therapy (OAT) participation on HIV and HCV incidence in these settings. For each cohort, we emulated the design and statistical analysis of a target trial using observational data. We included PWID at risk of HIV or HCV infection from the Amsterdam Cohort Studies (1985-2013), Vancouver Injection Drug Users Study (1997-2009) and Melbourne Injecting Drug User Cohort Study (SuperMIX) (2010-2021). Separately for each infection and cohort (only HCV in SuperMIX), marginal structural models were used to compare the effect of comprehensive (on OAT and 100% NSP coverage or on OAT only if no recent injection drug use) versus no/partial NSP/OAT (no OAT and/or <100% NSP coverage) participation. Pooled hazard ratios (HR) and 95% CI were calculated using random-effects meta-analysis. We observed 94 HIV seroconversions and 81 HCV seroconversions among 2023 and 430 participants, respectively. Comprehensive NSP/OAT led to a 41% lower risk of HIV acquisition (pooled HR = 0.59, 95% CI = 0.36-0.96) and a 76% lower risk of HCV acquisition (pooled HR = 0.24, 95% CI = 0.11-0.51), compared with no/partial NSP/OAT, with little heterogeneity between studies for both infections (I2 = 0%). In the Netherlands, Canada and Australia, comprehensive needle and syringe program and opioid agonist therapy participation appears to substantially reduce HIV and hepatitis C acquisition compared with no or partial needle and syringe program/opioid agonist therapy participation. These findings from an emulated trial design reinforce the critical role of comprehensive access to harm reduction in optimizing infection prevention for people who inject drugs.

Need for integration of hepatitis C (HCV) services in community-based settings for people who inject drugs: results from a global values and preferences survey

BackgroundTo inform the development of updated World Health Organization (WHO) guidelines on simplified service delivery for HCV infection, a global survey was undertaken among people affected or infected by HCV. The objective of this analysis is to identify specific needs and preferences among people who inject drugs.MethodsA multi-country, anonymous, self-administered online survey conducted in 2021 was developed by Coalition PLUS and the World Hepatitis Alliance in partnership with the WHO. Preferences for test and treat locations and simplifying HCV care were collected among people affected or infected by HCV. Chi-square tests were used to compare respondents who identified with current or former injection drug users through identification with key population to other respondents who did not identify with this key population.ResultsAmong 202 respondents, 62 (30.7%) identified with current/former injection drug users. Compared to other respondents, they were: older [median (IQR): 48 (36–57) vs. 39 (31–51) years, p = 0.003]; more likely to have been tested for HCV (90.2% vs. 64.3%, p = 0.001); more likely to prefer testing in a community-based centre (CBC) (55.4% vs. 33.3%, p = 0.005); or in a support centres for people who use drugs (SCPUD)(50.0% vs. 9.8%, p < 0.001). The most important considerations regarding testing locations among people identified with current/former injection drug users (compared to the other respondents) were: non-judgemental atmosphere (p < 0.001), anonymity (p = 0.018) and community worker (CW) presence (p < 0.001). People identified with current/former injection drug users were more likely to prefer to receive HCV treatment in a CBC (63.0% vs. 44.8%, p = 0.028) or in a SCPUD (46.3% vs. 9.5%, p < 0.001), compared to the other respondents. The most important considerations regarding treatment locations among people identified with current/former injection drug users were the non-stigmatising/non-judgemental approach at the site (p < 0.001) and the presence of community-friendly medical personnel or CW (p = 0.016 and 0.002), compared to the other respondents.ConclusionThe preferences of people identified with current/former injection drug users indicated specific needs concerning HCV services. Integration of HCV services in community-based risk reduction centres may be an important element in the development of adapted services to increase uptake and retention in HCV care among this population.

ADVERSE PHYSICAL EFFECTS OF ANTIRETROVIRAL THERAPY AND METHADONE ON PEOPLE LIVING WITH HIV/AIDS (PLWHA) USING INJECTION DRUGS (IDUS)

Background: People with HIV who use injecting drugs besides taking ARVs also use methadone. With these conditions, of course there will be a risk of causing various side effects. Based on this, researchers are interested in exploring the physical side effects experienced by PLWHA IDUs while using ARV therapy and Methadone. Method: This qualitative research uses a phenomenological study approach. Participants were taken based on criteria referring to the purposive sampling technique (snowball sampling). Participants were PLWHA with a history of injecting drug users (IDU) aged 20 years and over and had undergone ARV therapy and Methadone maintenance therapy for at least 6 months. Researchers conducted semi-structured in-depth interviews and used Colaizzi's data analysis stages. Results: HIV AIDS sufferers who inject drug users experience physical side effects on the digestive system, namely tooth decay, constipation, anorexia. Side effects on the musculoskeletal system include muscle pain and weakness and insomnia. Side effects of the covering system are the appearance of itching and rashes. Side effect on the reproductive system is a decrease in sexual function. Recommendation: The results of this study need to be followed up with studies with a larger number of participants so that they can represent other problems experienced by PLWHA while using ARV therapy and methadone together.

Effect of Injecting Drug User on the Risk of Human Immunodeficiency Virus/ Acquired Immunodeficiency Syndrome: A Meta-Analysis

Background: The problem of narcotics abuse is drug users through injecting needles. Injecting drug users are any person who uses narcotics, psychotropics and addictive substances by injection. In addition, another understanding states that injecting drug users (IDU) or Injection Drug Users (IDUs) are users of narcotics/drugs with injecting media. Injecting drug use (IDU) is one of the main causes of HIV infection due to sharing of contaminated injection equipment.Subjects and Method: The meta-analysis was carried out using the PRISMA flowchart and the PICO model. Population = adolescents and adults. Intervention= IDU/Injection Drug User. Comparison= Not an IDU/Injection Drug User. Outcome= HIV/AIDS events. The articles used in this study were obtained from several databases including PubMed, Google Scholar and Scopus. These articles were collected over 3 months. The keywords to search for articles are as follows “IDU (Injection Drug User)” AND “life style“ ”HIV/ AIDS ”. There were 15 studies, 9 cross-sectional and 6 cohort studies published in 2012-2022 that met the inclusion criteria. Analysis was performed with Revman 5.3.Results: 15 articles with a study design of 9 cross-sectional and 6 cohort studies from Canada, China, Ukraine, Virginia, Nepal, Cambodia, Scotland, Boston and Africa. Studies show that IDUs (Injecting Drug Users) have a 2.17 times risk of developing HIV/AIDS compared to non-IDUs for HIV/AIDS, and these results are statistically significant (aOR= 2.71; 95% CI= 1.22 to 6.02; p= 0.010).Conclusion: IDU (Injection Drug User) increases the incidence of HIV (Human Immunodeficiency Virus) / AIDS (Acquired Immunodeficiency Syndrome). Keywords: IDU, lifestyle, HIV/AIDS, Drugs, Meta-Analysis Correspondence:Lusiana Dewi Saputri. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: dewislusiana16@gmail.com. Mobile: +6282328370049.

Perceived Stigma among Injecting Drug Users: New Evidence from an Observational Study in an Opioid Substitution Therapy Centre of Kolkata, India

Introduction: Injecting Drug Users (IDUs) are one of the highrisk groups for Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS). Opioid Substitution Therapy (OST) is a targeted intervention for IDUs. Substance abuse, coupled with the risk of contracting HIV, makes them feel stigmatised. There can be little doubt that IDUs face discrimination and stigma in various forms, which could be a potential barrier for them to seek professional help. Aim: To estimate the magnitude of stigma perceived by IDUs and to identify the associated factors. Materials and Methods: An observational, cross-sectional study was conducted on IDUs attending the OST centre of Calcutta National Medical College, Kolkata, West Bengal, India from April 2016 to March 2018. A total of 168 IDUs were recruited using the census method. The Perceived Stigma of Substance Abuse Scale (PSAS) was used to determine the perceived stigma faced by the study subjects. Factors such as living arrangements, finances for addiction, level of education, emotional attachment, and religiosity were chosen as the predictor variables. Statistical Package for the Social Sciences (SPSS) version 16.0 was used for data analysis. Descriptive statistics were used to summarise the data. Logistic regression was employed to examine the associated factors with perceived stigma. The Odds Ratio (OR) with a 95% Confidence Interval (CI) was computed, and a p-value &lt;0.05 was considered significant. Results: Out of 168, 107 (64%) IDUs reported perceived stigma above the mean value of PSAS. A significant association between perceived stigma and immoral means of finance for addiction (AOR [CI] 4.056 [1.617-10.174]), presence of emotional attachment with any of the family members (AOR [CI] 5.652 [2.588-11.9]), and lack of religiosity (AOR [CI] 5.685 [2.588-12.489]) was observed. Conclusion: There was an alarmingly high proportion of IDUs with perceived stigma. Immoral means of finance for addiction, lack of religiosity, and emotional attachment to family were associated with higher perceived stigma. Hence, appropriate emphasis should be given to information, education, and communication activities to address perceived stigma among IDUs in order to improve treatment adherence to OST among them. Moreover, there is a need for stigma reduction interventions in the larger community. Further research should explore the dynamics between perceived stigma and other predictor variables.

Opioid Dependence Syndrome and Quality of Life: A Facility-based Exploratory Study among Drug Addicts at a Tertiary Care Hospital of Kolkata, India

Introduction: Opioid dependence syndrome is considered a chronic-relapsing medical illness that can affect the Quality of Life (QoL) of Injecting Drug Users (IDUs). They are at risk of contracting Human Immunodeficiency Virus (HIV) due to unsafe injection practices. Opioid Substitution Therapy (OST) is an effective treatment option for opioid dependence as well as HIV prevention and intervention among IDUs, subsequently improving their QoL. Aim: To identify the opioids injected by addicts and evaluate QoL across different life areas among IDUs attending an OST centre. The authors also aimed to determine the factors affecting QoL regarding relationships with family and friends. Materials and Methods: A facility-based, observational crosssectional study was conducted on 168 IDUs at an OST centre in Calcutta National Medical College from April 2016 to March 2018. A predesigned and pretested structured schedule was used, which included socio-demographic characteristics, pattern of substance abuse, and HIV status. To evaluate QoL, the authors used a Likert scale with five domains specific to chronic diseases. Logistic regression was employed to determine associated factors with two QoL domains regarding relationships with family and friends. The Statistical Package for Social Sciences (SPSS) version 16.0 was used for data analysis. Results: The mean age {Standard Deviation (±SD)} of the study participants was 36.53±9.514 years. The most common opioids injected by IDUs were buprenorphine (89.2%). Although QoL scores varied across different domains, it can be interpreted that the majority of participants had poor QoL. When assessing QoL in terms of relationships with family and friends, there was a significant association between better QoL and financial support {Adjusted Odds Ratios (AOR) Confidence Intervals (CI)} 2.550 (1.431-6.082), favourable living arrangements AOR(CI) 2.450 (1.010-4.443), and absence of seropositivity AOR(CI) 2.462 (1.141-7.476). Conclusion: Buprenorphine was the most common substance of abuse among IDUs. The study revealed a high proportion of IDUs with poor QoL. The findings of the study might be helpful in designing appropriate strategies to improve personal relationships and social situations among IDUs.

Challenges Faced and Coping Strategies Adopted by Injecting Drug Users during COVID-19 Lockdown-A Qualitative Study.

The lockdown due to COVID-19 pandemic has adversely affected the lives of vulnerable population, including the injecting drug users (IDUs). The objective of the study was to document the coping mechanism adopted by IDUs and suggest measures to mitigate the adverse effects, if similar situation were to arise in future. A qualitative study was conducted at the Targeted Intervention Non-Government Organizations catering to IDUs in Delhi and Ghaziabad district of Uttar Pradesh. Four focus group discussions among 41 IDUs and 7 key informant interviews of the NGO staff were conducted in the study. The Hindi recordings were coded and the data analysis was performed manually using grounded theory approach. We found that the lockdown affected the lives of most of the IDUs and they found it difficult to access the harm reduction services. To cope with this, many IDUs started following alternate methods to support the drug habits. There was an increase in reuse of needles and syringes. The lockdown during COVID-19 and the resulting challenges negatively impacted the physical and mental health of the IDUs. We recommend that in any similar future scenario, travel pass may be issued to the IDUs and the TI-NGO personnel.

Assessment of effectiveness of targeted intervention program under national AIDS control program among injecting drug users across India.

High HIV prevalence among injecting drug users (IDUs) remains a cause of concern and are considered key drivers of concentrated epidemic in India. The present paper aims to assess the effectiveness of the targeted intervention (TI) program on the risk behaviors among IDUs across regions of India. This paper used the data from the integrated biological and behavioral surveillance 2014-2015 among the IDUs in India. Descriptive statistics and propensity score matching analysis was carried out to understand the effectiveness of the TI program on the new needle/syringe used and needle/syringe shared in the last injecting episode by accounting for the covariates. The matched samples estimate, i.e., average treatment effect on treated of new needles/syringe used and shared in the last injecting episode by those who received needles/syringes from peer educator or outreach workers (PE/ORWs) and those who did not receive was 2.8% (confidence interval [CI]: 0.05-5.6) increase in the use of new needles/syringes and 6.5% (CI: -9.7--3.3) decrease in the needles/syringes shared in last injecting episode indicating that IDUs who received new needles/syringes from PE/ORWs are more likely to use new needle/syringe and less likely to share needle/syringes to those who did not receive needles/syringes. The results vary across the different regions of India. TI program proves to be an effective initiative in the behavior change among IDUs as substantiated by use of new needles/syringes and decreased sharing of needles/syringes. TI program coverage varies from region to region and may further be expanded to accelerate the program services to prevent HIV/AIDS.

Relapse during opioid use disorder treatment: A pilot study to understand the reasons for opioid use during treatment.

Opioid use is a cause of concern in many parts of the world. About 2.1% Indians use opioids. Opioids are also the most common drugs used by injection drug users in India. Despite various treatment strategies used to manage opioid use disorders (OUDs), relapse is common. A good treatment program would make efforts to address lapses and prevent relapse. Hence, there is a need to understand the factors associated with relapse in OUD. One hundred and twenty patients completed a baseline assessment that included socio-demographic details and the Maudsley Addiction Profile (MAP). They were followed up for three months and assessed using telephonic interview for opioid use. All those who relapsed were assessed using the Reasons for Relapse Questionnaire (RRQ). The patients who relapsed were compared with the patients who were abstinent. Relapse was defined as any use of opioid during follow-up. Forty participants relapsed during the 90 days of the study period. Relapsed patients had a greater number of conflict days with family members, used a higher amount of heroin and cannabis at baseline, were less likely to be discharged on buprenorphine, and were more likely to drop out. Participants cited mood and social reasons more often than cue/craving and unwell domains of RRQ. Baseline treatment and prospective factors are associated with relapse in OUD. Addressing these factors can help in reducing relapse in OUD patients.