Non-injection Drug Research Articles

Hepatitis A Person-to-Person Outbreaks: Epidemiology, Morbidity Burden, and Factors Associated With Hospitalization—Multiple States, 2016–2019

Since 2016, the United States has experienced person-to-person hepatitis A outbreaks unprecedented in the vaccine era. The proportion of cases hospitalized in these outbreaks exceeds historical national surveillance data. We described the epidemiology, characterized the reported increased morbidity, and identified factors associated with hospitalization during the outbreaks by reviewing a 10% random sample of outbreak-associated hepatitis A cases in Kentucky, Michigan, and West Virginia-3 heavily affected states. We calculated descriptive statistics and conducted age-adjusted log-binomial regression analyses to identify factors associated with hospitalization. Participants in the random sample (n = 817) were primarily male (62.5%) with mean age of 39.0 years; 51.8% were hospitalized. Among those with available information, 73.2% reported drug use, 14.0% were experiencing homelessness, 29.7% were currently or recently incarcerated, and 61.6% were epidemiologically linked to a known outbreak-associated case. Residence in Michigan (adjusted risk ratio [aRR] = 1.8), being a man who has sex with men (aRR = 1.5), noninjection drug use (aRR = 1.3), and homelessness (aRR = 1.3) were significantly (P < .05) associated with hepatitis A-related hospitalization. Our findings support current Advisory Committee on Immunization Practices recommendations to vaccinate all persons who use drugs, men who have sex with men, and persons experiencing homelessness against hepatitis A.

Provision of Hepatitis A Vaccine by Paramedics During Noncritical Patient Interactions: Lessons Learned

Background: Hepatitis A cases have been regularly increasing in Florida since 2016, after remaining relatively stable for several years. Between January 1, 2019, and October 19, 2019, 2,847 cases of hepatitis were reported to the Florida Department of Health, including 2,209 hospitalizations and 41 deaths due to infection with hepatitis A1. At least 93% of these cases was acquired within the state of Florida.1 During this outbreak, Pasco County clearly emerged as a focal point for new cases. As of week 42 of 2019, Pasco County was the second-highest county for new cases (n = 484) and the leading county for deaths due to hepatitis A infection (n = 8). Risk factors identified from hepatitis A cases reported between January 1, 2019, and October 19, 2019, included any drug use (57%), injection drug use (37%), noninjection drug use (35%), homelessness (22%), and being a man who had sexual intercourse with other men (MSM, 4%).1 Moreover, 33% of newly reported cases were interviewed and denied risk factors; 1 (20%) had recently been incarcerated or was currently incarcerated.1 Individuals with these risk factors are often individuals who also require emergency medical services (EMS). On August 1, 2019, a public health emergency (PHE) was issued for the entire state of Florida. The existence of a PHE allows for paramedics to administer vaccine (with the approval of the fire rescue medical director). Pasco County Fire Rescue routinely operates 28 advanced life support (ALS) ambulances with either a crew of 2 paramedics or a paramedic/EMT pair. On October 7, 2019, the Pasco County Board of County Commissioners (BCC) approved a Memorandum of Understanding between the Florida Department of Health in Pasco County, the Pasco County Fire Rescue Medical Director, and the BCC for ALS crews to provide hepatitis A vaccination to noncritical (ie, basic life support) patients during routine contact. This effort appears to be the first within the of Florida. Pasco County Fire Rescue (PCFR) began stocking hepatitis A vaccine on January 1, 2020 and ceased participation in the program on March 1, 2020. During the window of participation, PCFR responded to approximately 6,570 calls in which the patient would have been non-critical and eligible for hepatitis A vaccination. Twelve hepatitis A vaccinations (0.18%) were administered. Crews verbalized concerns about adding vaccination to their job description, feelings of being overwhelmed with existing emergency medical services (EMS) responsibilities, apathy regarding the potential benefit of provision of vaccine, and perception that successful participation in a vaccine campaign would lead to additional community paramedicine responsibilities. The vaccine program was terminated early due to the significant demands on EMS as SARS-CoV2 impacted Pasco County. This trial highlights the need for crew investments and buy-in for future partial or full community paramedicine initiatives.1. Florida Department of Health, Hepatitis A Surveillance State Report, Week 42.Funding: NoneDisclosures: None

Increasing HIV prevalence and injection drug use among men who have sex with men in Ho Chi Minh City, Vietnam.

Vietnam has been conducting HIV/sexually transmitted infection (STI) integrated bio-behavioral surveillance surveys on men who have sex with men (MSM) as well as other key populations since 2005. Although HIV prevalence in the Vietnamese general population remains below 1%, it is expected to be much higher among MSM.Data on HIV prevalence and sexual and drug use behaviors were collected from MSM in Ho Chi Minh City (HCMC) in 2006 (n = 397), 2009 (n = 399) and 2013 (n = 350) using respondent-driven sampling. Eligible participants were males, aged ≥15 years who reported having manual, oral, or anal sexual activity with males in the past year and lived, worked or socialized in HCMC.HIV seroprevalence among MSM was 5.8% in 2006, 16.1% in 2009 and 12.1% in 2013 and prevalence of at least one STI (syphilis, gonorrhea and/or chlamydia infection) was 11.4% in 2006 and 15.6% in 2009 (no data for 2013). Significant, but small, increasing trends were found for MSM who reported ever testing and receiving results for HIV and for HIV prevalence. No significant changes for condom use, injecting and non-injecting drug use, or and receipt of free condoms were observed.Although a small percentage of MSM reported injecting drugs, HIV was positively associated with ever injecting drugs. Programs targeting MSM should include screening and treatment for injection drug use to most effectively control the HIV/AIDS epidemic among MSM in HCMC.

Is Patient Navigation Used by People with HIV Who Need It? An Assessment from the Medical Monitoring Project, 2015 - 2017.

We (1) estimated the prevalence of not getting patient navigation despite feeling a need for the service (unmet subjective need) or despite having unsuppressed viral load (unmet objective need) among people with HIV (PWH), (2) determined reasons why PWH did not use the service, and (3) determined factors associated with unmet need for patient navigation. We used combined data from the 2015 to 2017 cycles of the Medical Monitoring Project, an HIV surveillance system designed to produce nationally representative estimates of the characteristics of adults with diagnosed HIV infection in the United States. Six percent reported unmet subjective need and 28% had unmet objective need for patient navigation. When needs were combined, more than a third had unmet need for the service. Among PWH with unmet subjective need for patient navigation, 77% reported lack of knowledge about patient navigation as a reason for nonuse. Younger age, female gender, racial/ethnic minority status, limited health literacy, homelessness, incarceration history, lack of health insurance/coverage, noninjection drug use, depression, and recent HIV diagnosis were associated with unmet subjective or objective need for patient navigation. One in three PWH did not use patient navigation despite needing the service. Lack of knowledge about patient navigation was a barrier to use, calling for increased availability, and promotion of such services. PWH with social and economic vulnerabilities were less likely to get patient navigation when needed. It is important to address the question of how to make this service available to everyone who needs it.

Binge Drinking, Non-injection Drug Use, and Sexual Risk Behaviors among Adolescent Sexual Minority Males, 3 US Cities, 2015.

In 2016, more than 90% of HIV diagnoses among young men aged 13-19years were attributed to male-male sexual contact. Little is known about how binge drinking and non-injection drug use may be associated with risky sexual behavior among adolescent sexual minority males (ASMM). Using data from the National HIV Behavioral Surveillance, we examined how binge drinking and non-injection drug use may be associated with sexual risk among ASMM. ASMM were recruited for interviews in 3 cities: Chicago, New York City, and Philadelphia. Among 16-18-year-olds (N = 488), we evaluated the association between binge drinking (≥ 5 drinks in one sitting in the past 30days), non-injection drug use (past 12-month use of methamphetamines, powder cocaine, downers, painkillers, ecstasy, poppers, and "other"), and two past 12-month sexual risk outcomes: condomless anal intercourse with a casual partner and having multiple sex partners. We used log-linked Poisson regression models with robust standard errors to estimate prevalence ratios (PR) and 95% confidence intervals (CI). Overall, 26% of 16-18-year-old ASMM binge drank, and 21% reported non-injection drug use. Among ASMM who binge drank, 34% reported condomless anal intercourse with a casual partner compared with 22% of those who did not (PR: 1.53, 95% CI: 1.04-2.26). Similarly, 84% of ASMM who binge drank reported having multiple partners compared with 61% of those who did not (PR: 1.38, 95% CI: 1.09-1.76). Among ASMM who used non-injection drugs, 37% reported condomless anal intercourse compared with 22% of those who did not (PR: 1.70, 95% CI 1.09-2.50), while 86% of those who used non-injection drugs had multiple partners compared with 62% of those who did not (PR: 1.40, 95% CI: 1.06-1.80). Our findings suggest that the prevalence of substance misuse is high among sexual minority youth and is associated with sexual risk in this population. Our findings highlight the need for high-quality HIV prevention programs for ASMM especially as HIV prevention programs for this population are scarce.

Transitions: Novel Study Methods to Understand Early HIV Risk Among Adolescent Girls and Young Women in Mombasa, Kenya, and Dnipro, Ukraine.

Transitions aims to understand the human immunodeficiency virus (HIV) risk at critical transition points in the sexual life course of adolescent girls and young women (AGYW) who engage in casual sex, transactional sex, and sex work. In this article, we present the Transitions study methods. The Transitions study has the following objectives: (1) to describe how the characteristics and length of the transition period and access gap vary across two epidemiological contexts (Mombasa, Kenya, and Dnipro, Ukraine); (2) to understand how the risk of HIV varies by length and characteristics of the transition period and access gap across epidemiologic contexts; and (3) to assess the extent to which HIV infections acquired during the transition period and access gap could mitigate the population-level impact of focused interventions for female sex workers and explore the potential marginal benefit of expanding programs to reach AGYW during the transition period and access gap. Cross-sectional biobehavioral data were collected from young women aged 14 to 24 years who were recruited from locations in Mombasa County, Kenya, and Dnipro, Ukraine, where sex work took place. Data are available for 1,299 Kenyan and 1,818 Ukrainian participants. The survey addressed the following areas: timing of transition events (first sex, first exchange of sex for money or other resources, self-identification as sex workers, entry into formal sex work, access to prevention program services); sexual behaviors (condom use, anal sex, sex under the influence of drugs or alcohol); partnerships (regular and first-time clients, regular and first-time transactional sex partners, and husbands and boyfriends); alcohol use; injection and non-injection illicit drug use; experience of violence; access to HIV prevention and treatment program; testing for sexually transmitted and blood-borne infections and HIV; and reproductive health (pregnancies, abortions, contraceptives). HIV and hepatitis C virus prevalence data were based on rapid test results. Mathematical modeling will be used to generate projections of onward HIV transmission at specific transition points in the sexual life course of AGYW. Taken together, these data form a novel data resource providing comprehensive behavioral, structural, and biological data on a high-risk group of AGYW in two distinct sociocultural and epidemiologic contexts.

Against Medical Advice Discharges in Injection and Non-injection Drug Use-associated Infective Endocarditis: A Nationwide Cohort Study.

Among those with injection drug use-associated infective endocarditis (IDU-IE), against medical advice (AMA) discharge is common and linked to adverse outcomes. Understanding trends, risk factors, and timing is needed to reduce IDU-IE AMA discharges. We identified individuals ages 18-64 with International Classification of Diseases, 9thRevision, diagnosis codes for infective endocarditis (IE) in the National Inpatient Sample, a representative sample of United States hospitalizations from January 2010 to September 2015. We plotted unadjusted quarter-year trends for AMA discharges and used multivariable logistic regression to identify factors associated with AMA discharge among IE hospitalizations, comparing IDU-IE with non-IDU-IE. We identified 7259 IDU-IE and 23 633 non-IDU-IE hospitalizations. Of these hospitalizations, 14.2% of IDU-IE and 1.9% of non-IDU-IE resulted in AMA discharges. More than 30% of AMA discharges for both groups occurred before hospital day 3. In adjusted models, IDU status (adjusted odds ratio [AOR], 3.92; 95% confidence interval [CI], 3.43-4.48)] was associated with increased odds of AMA discharge. Among IDU-IE, women (AOR, 1.21; 95% CI, 1.04-1.41) and Hispanics (AOR, 1.32; 95% CI, 1.03-1.69) had increased odds of AMA discharge, which differed from non-IDU-IE. Over nearly 6 years, odds of AMA discharge increased 12% per year for IDU-IE (AOR, 1.12; 95% CI, 1.07-1.18) and 6% per year for non-IDU-IE (AOR, 1.06; 95% CI. 1.00-1.13). AMA discharges have risen among individuals with IDU-IE and non-IDE-IE. Among those who inject drugs, AMA discharges were more common and increases sharper. Efforts that address the rising fraction, disparities, and timing of IDU-IE AMA discharges are needed.

Substance use, self-rated health and HIV status in Brazil

ABSTRACT We compared the prevalence of of non-injecting drug use (NIDU) and Self-Rated Health (SRH) among individuals self-reporting as HIV-positive (PLWHA), HIV-negative and unknown at the III Brazilian Household Survey on Substance Use. Overall, 16,273 individuals, 12–65 years old, were interviewed in 2015. Prevalence and Standard Error (SE) were estimated considering the complex sample design and weight calibration. Chi-square tests with Rao-Scott adjustment were used to test independence between NIDU, SRH and HIV status. PLWHA presented higher frequencies of 12-month use for most substances than those reporting to be HIV-negative: alcohol use prevalence was 49.5% (SE 12.8) vs. 43.1% (SE 0.7), p = 0.34; tobacco 45.3% (SE 12.7) vs. 15.3% (SE 0.4), p < 0.01; amphetamines 1.7% (SE 1.7) vs. 0.3% (SE 0.1), p = 0.51; cannabis 10.5%(SE 6.7) vs. 2.5%(0.2), p = 0.06; powder cocaine 3.6% (SE 3.0) vs. 0.9% (SE 0.1), p = 0.45; crack-cocaine 5.3% (SE 3.2) vs. 0.3% (SE 0.1), p < 0.01; inhalants 3.6% (SE 3.0) vs. 0.2% (SE 0), p = 0.03; ketamine 1.7%(SE 1.7) vs. 0.1% (SE 0), p = 0.23; and opioids 1.7% (SE 1.7) vs. 1.4% (SE 0.2), p = 0.93. PLWHA also reported worse SRH. Our results and the scarcity of integrated substance use and HIV treatments call for innovative, cost-effective approaches to tackle these public health challenges.

Validation and psychometric properties of the drug users\u2019 quality of life scale in Iranian population

IntroductionDrug dependence and the resultant problems notably decrease the quality of life (QOL). Measuring the QOL in persons who use drugs (PWUDs) and planning to improve it can be helpful for rehabilitation programs. Given the absence of a standard tool to measure the quality of life of PWUD, the present study is an attempt to validate psychometric and cultural characteristics of non-injection drug users’ QOL scale.MethodThe study was carried out as a validation and methodological work. The study population consisted of 273 PWUDs in Kermanshah-based drug clinics including outgoing and hospitalized patients. The participants were selected through convenient-quota sampling. After securing the required permission from the copyright owner of the tool, it was forward/backward translated. Face validity and content validity were determined quantitatively and qualitatively. To examine construct validity of the tool, explorative factor analysis and confirmatory factor analysis were used. Internal consistency was measured using Cronbach’s alpha and statistical analyses were performed using SPSS (v.25) and LISREL (v.8).ResultsExplorative factor analysis (EFA) and confirmatory factor analysis (CFA) results supported the tool with one factor and 22 items. The R2 index in the model was equal to 0.99, which means that 99% of the variation of dependent variable (total score of QOL) is attributed to independent variable (22 statements). In other words, 99% of the variation of dependent variable is due to the independent variables in the model. The main indices of the model based on CFA all were higher than 0.9, which indicates goodness of fit of the model (χ2/DF = 2.18, CFI, NFI, TLI = 0.93 GF = 0.84, REMSEA = 0.066, R2 = 0.99). The correlative coefficient was significant (p < 0.05). The reliability of the tool based on internal consistency (Cronbach’s alpha) for the subscales ranged from 0.84 to 0.85 and equal to 0.84 for the whole tool.ConclusionThe Farsi version of non-injection drug users’ QOL scale had acceptable indices and it was applicable to assess QOL in the target population. The tool can be used in different fields of drug addiction.

Access to and use of health and social services among people who inject drugs in two urban areas of Mozambique, 2014: qualitative results from a formative assessment

BackgroundPrior to 2014, data about health seeking behaviors or service uptake for People who inject drugs (PWID) in Mozambique did not exist. We present the results from the formative assessment component of the Biological and Behavioral Survey (BBS).MethodsStandardized interview guides were used during key informant interviews (KII) and focus group discussions (FGD) in Maputo and Nampula/Nacala to discuss issues related to risk behaviors and access to and utilization of health and social services by PWID. The target sample size was not defined a priori, but instead KII and FGD were conducted until responses reached saturation. Data analysis was based on the principles of grounded theory related to qualitative research.ResultsEighty-eight respondents, ages 15 to 60, participated in KIIs and FGDs. Participants were majority male from diverse income and education levels and included current and former PWID, non-injection drug users, health and social service providers, peer educators, and community health workers. Respondents reported that PWID engage in high-risk behaviors such as needle and syringe sharing, exchange of sex for drugs or money, and low condom use. According to participants, PWID would rather rent, share or borrow injection equipment at shooting galleries than purchase them due to stigma, fear of criminalization, transportation and purchase costs, restricted pharmacy hours, personal preference for needle sharing, and immediacy of drug need. Barriers to access and utilization of health and social services include distance, the limited availability of programs for PWID, lack of knowledge of the few programs that exist, concerns about the quality of care provided by health providers, lack of readiness as a result of addiction and perceived stigma related to the use of mental health services offering treatment to PWID.ConclusionsMozambique urgently needs to establish specialized harm reduction programs for PWID and improve awareness of available resources. Services should be located in hot spot areas to address issues related to distance, transportation and the planning required for safe injection. Specific attention should go to the creation of PWID-focused health and social services outside of state-sponsored psychiatric treatment centers.

The relationship between individual characteristics and HIV-related stigma in adults living with HIV: medical monitoring project, Florida, 2015\u20132016

BackgroundHuman Immunodeficiency Virus (HIV) disproportionately affects the Southern United States, accounting for approximately 46% of people living with HIV. HIV-related stigma is recognized as a barrier to testing, treatment, and prevention efforts. However, little is known about HIV-related stigma experiences in Florida. Using data collected from the Florida Medical Monitoring Project, we sought to examine individual characteristics associated with HIV-related stigma.MethodsWe analyzed secondary data from the 2015–2016 Medical Monitoring Project in Florida (n = 603). Stigma was measured using the 10-item HIV Stigma Scale. Exploratory factor analysis of the HIV Stigma Scale revealed three subscales: negative self-image, anticipated, and personalized stigma. Bivariate and multivariate regression models were used to determine the individual characteristics associated with the HIV Stigma Scale.ResultsMultivariate analysis indicated that people with severe depression scores (OR: 3.13; CI: 1.38–7.13) and persons with disability (OR: 1.64; CI: 1.03–2.61) had significantly increased odds of higher overall stigma. In the subscale analyses, negative self-image was significantly associated with alcohol misuse (OR: 2.02; CI: 1.15–3.56) depression (OR: 2.81; CI: 1.38–5.72) and/or those who identify as homosexual (OR: 0.54; CI: 0.31–0.93). Anticipated stigma was significantly associated with people who had mild-moderate depression (OR: 3.03; CI: 1.20–7.65), severe depression (OR: 2.87; CI: 1.38–5.98), identified as Black (OR: 0.60; CI: 0.37–0.98), non-injection drug use (OR: 0.55; CI: 0.33–0.91), and/or people aged 50 years and older (OR: 0.28; CI: 0.09–0.82). Personalized stigma was not associated with any of the variables examined.ConclusionsThe implications of these findings reveal that certain individuals are more vulnerable to stigma. Researchers could consider distinct stigma interventions strategies based on the characteristics of specific individuals (i.e., targeting depression, disability, sexual orientation, avoidant coping, racial/ethnic groups, and youth) in Florida.

Number of People who Inject Drugs in Son La, Vietnam: Population Size Estimation Based on Official Records

AimsEstimated population sizes of key populations are critical for resource allocation as well as for monitoring program performance to prevent HIV infection. In 2018, using official records we recruited and conducted a brief survey among People Who Use Drugs (PWUD) to estimate the population size of People Who Inject Drugs (PWID) in Son La Province, Vietnam.MethodsIn Son La, the authorities develop and maintain a master list of individuals who are suspected of using drugs. The list is updated quarterly and is used to monitor the drug use situation in the province. The list, however, does not distinguish injecting from non-injecting drug users. Individual lists from six districts, 24 communes, and 96 hamlets were selected from among those from 12 districts, 204 communes, and 3335 hamlets in the whole province. After reviewing the lists with the hamlet health workers, based on the length of the lists, a minimum of 20% of the total or five drug users in any hamlet with fewer than 25 PWUD were randomly selected for a brief assessment. In addition to basic demographics, the assessment included any drug use in the last 3 months, injection drug use in the last 3 months, and the last time injected.ResultsA total of 250 PWUD were interviewed by hamlet health workers. The total number of PWID across all 12 districts in Son La was estimated at 4475 [95% Confidence Interval (CI): 3379–5570] and the corresponding proportion of PWID among PWUD was 48.4% (95% CI: 36.6–60.4).ConclusionThe exercise provided an estimated number of PWID in Son La. For planning HIV prevention and care service needs among PWID, additional studies using different methods are needed to validate and improve the population size of PWID in the province of Son La.

Home-Based Outpatient Parenteral Antibiotic Therapy at an Urban Safety Net Hospital: Comparing Outcomes in Persons With and Without Noninjection Drug Use.

As stimulant use and infections among persons using drugs rise nationally, evidence remains limited on how best to deliver outpatient parenteral antimicrobial therapy (OPAT) to persons using noninjection drugs. In an urban safety net population including persons using noninjection drugs, home-based OPAT completion rates were similarly high as those of non-drug-using individuals.

Risk of hepatitis C virus infection in injecting and noninjecting drug users receiving opioid substitution therapy.

Hepatitis C virus (HCV) is the most common viral infection among illicit drug users in the world. Although intervention of needle and syringe program and opioid substitution therapy had engaged to prevent HCV infection, the prevalence of HCV infection does not seem to decline. The aim of this study was to estimate the risk of HCV infection in injecting drug users (IDUs) and noninjecting drug users (NIDUs) receiving opioid substitution therapy. We recruited 1179 heroin-dependent patients (age: 20-66 years) under opioid substitution therapy from 2012 to 2015 in a Psychiatric Center, Southern Taiwan. The data of HCV, hepatitis B virus and HIV infection and liver biochemical examination were obtained. We used multivariate logistic regression analysis to predict the risk of HCV infection. There were 93.1% of IDUs and 68.1% of NIDUs positive for HCV infection. In IDUs, HIV infection, age of heroin initiation, duration and dose of heroin use, frequency of detoxification, and number of criminal conviction were significantly associated with HCV infection. In NIDUs, snort/sniff heroin exhibited a significantly increased risk of HCV infection. Intravenous injecting (odds ratio [OR] = 23.10, 95% CI = 8.04-66.40, p < 0.001), intravenous injecting combined snort/sniff (OR = 12.95, 95% CI = 3.90-42.97, p < 0.001), and snort/sniff (OR = 4.14, 95% CI = 1.30-13.18, p = 0.016) were significantly associated with increased risk of HCV infection compared with smoking. The trend was significant (p for trend <0.001). In Taiwan, IDUs had harmful characteristics compared with NIDUs and both had extremely high prevalence of HCV infection. We provided evidence that snort/sniff is a possible way of leak in HCV infection despite needle-syringes supplement program been provided. Opioid substitution therapy program should include HCV assessment and treatment in the new direct-acting antiviral therapy era.

Longitudinal patterns of illicit drug use, antiretroviral therapy exposure and plasma HIV-1 RNA viral load among HIV-positive people who use illicit drugs.

HIV-positive people who use illicit drugs (PWUD) experience elevated rates of HIV-associated morbidity and mortality compared with members of other key affected populations. Although suboptimal levels of access and adherence to antiretroviral therapy (ART) are common among HIV-positive PWUD, there is a need for studies investigating the possible biological impacts of noninjection illicit drug use among people living with HIV in real-world settings. We accessed data from the ACCESS study, an ongoing prospective cohort of illicit drug users with systematic HIV viral load monitoring in a setting with universal care and ART dispensation records. We used multivariable generalized linear mixed models to estimate the longitudinal associations between noninjection use of crack cocaine, powder cocaine, opioids, methamphetamine, cannabis and alcohol on plasma HIV-1 RNA viral load, adjusted for ART exposure and relevant confounders. Between 2005 and 2018, 843 individuals from the ACCESS cohort were included and contributed to 8698 interviews. At baseline, the mean age was 43 years, 566 (67%) reported male sex and 659 (78%) used crack cocaine in the previous 6 months. In multivariable models adjusted for ART exposure, only crack cocaine use in the last 6 months was found to be significantly associated with higher HIV viral load. We observed significantly higher HIV viral load during periods of crack cocaine use independent of ART exposure. Our findings support further research to investigate the possible biological mechanisms of this effect.

Transmission of hepatitis C virus in HIV-positive and PrEP-using MSM in England.

We sought to characterize risk factors and patterns of HCV transmission amongst men who have sex with men (MSM). MSM with recently acquired HCV (AHCV) were prospectively recruited ('clinic cohort') between January and September 2017. Clinical data and risk behaviours were identified and blood obtained for HCV whole genome sequencing. Phylogenetic analyses were performed, using sequences from this cohort and two other AHCV cohorts, to identify transmission clusters. Sixteen (40.0%) men in the clinic cohort were HIV-negative MSM. HIV-negative MSM were younger than HIV-positive MSM; most (81.3%) had taken HIV PrEP in the preceding year. Eighteen men (45.0%) reported injection drug use; most (34, 85.0%) reported noninjection drug use in the last year. Most in both groups reported condomless anal sex, fisting and sex in a group environment. Few (7, 17.5%) men thought partners may have had HCV. There were 52 sequences in the HCV genotype 1a phylogeny, 18 from the clinic cohort and 34 from other AHCV cohorts; 47 (90.4%) clustered with ≥1 other sequence. There were 7 clusters of 2-27 sequences; 6 clusters contained HIV-negative and HIV-positive MSM and 1 cluster only HIV-positive MSM. Four of these clusters were part of larger clusters first described in 2007. PrEP-using MSM are at risk of HCV, sharing similar risk factors to HIV-positive MSM. Phylogenetics highlights that PrEP-using and HIV-positive MSM are involved in the same HCV transmission networks. Few men demonstrated HCV awareness and risk reduction strategies should be expanded.

Antiretroviral prescription, retention in care and viral suppression by place of birth among adults with diagnosed HIV in the United States—2015–2017, medical monitoring project

ABSTRACT HIV clinical outcomes have not been fully assessed by place of birth at the national level. We analyzed the Medical Monitoring Project data, an annual cross-sectional survey designed to produce nationally representative estimates on adults with diagnosed HIV in the United States, collected during 2015–2017 (n = 7617). We compared sociodemographic, behavioral, and clinical outcomes by place of birth using Rao-Scott chi-square tests (P < .05). Overall, 13.6% of adults with diagnosed HIV were non-US-born. During the past 12 months, a higher percentage of non-US-born than US-born adults, respectively, were prescribed ART (89.4% vs. 84.1%), retained in care (87.1% vs. 80.0%), virally suppressed at the last test (77.2% vs. 70.9%), and had sustained viral suppression (70.9% vs. 63.3%). A lower percentage of non-US-born adults reported binge drinking (13.0% vs. 16.1%), using non-injection drugs (15.3% vs. 31.7%), and suffering from depression (15.9% vs. 23.3%) or anxiety (10.0% vs. 20.2%). A significantly higher percentage of non-US-born adults had Ryan White HIV/AIDS Program (RWHAP) coverage (54.4% vs. 43.1%) and attended a RWHAP-funded health care facility (73.9% vs. 66.6%). Factors contributing to better HIV clinical outcomes among non-US-born persons may include access to RWHAP coverage, lower levels of substance use, and better mental health.

Alcohol and drug intake pattern among truckers of Haryana, India

Background: Use of psychoactive substances by truckers is a common occurrence globally. Truckers have been the objects of a great deal of attention for their high-risk behaviour. Intake of drugs and alcohol by truckers is closely interlinked with high risk sex behaviour. Thus, the present study was pursued to know drug and alcohol consumption pattern.Methods: Cross-sectional study among truckers for more than a year in occupation, aged 18 years and above having residence/operating base in Haryana. Sample of 4000 truckers, 1000 from each from four administrative divisions of Haryana, was taken.Results: About three fourth truckers (77%) were less than 40 years. More than half of truckers (53.2%) consumed alcohol. Only 0.4% truckers confessed of using injectable drugs during last 12 months. 14.9% of truckers confessed of using non-injectable drugs. Ganja, Bhurki and Affim were some of the commonly consumed drugs.Conclusions: Majority truckers (53.2%) consumed alcohol. Drug intake was comparatively less common (14.9%). Injectables were used the least. Directly proportional association of alcohol and drug intake with age, duration of job, non-veg diet among truckers primarily indicated as consequences of long, lonely and harsh occupational conditions. Hence, comprehensive interventions including, improvement in road conditions, entertainment and health facility at halt places, stringent driving license terms and conditions to ensure professional competency and better wages to make truckers life worth living. This will also make them amenable to health education promoting healthy and risk-free behavior among them.

European Databases on Stability and Compatibility of Injectable Medicinal Products in Europe

AbstractIn hospitals, the majority of medication therapy is administered intravenously. Especially, in intensive care units, simultaneous of various injectable drugs is a common practice Drug incompatibilities have been reported to be associated with up to 60 % of all serious and life-threatening adverse drug events. Several databases are used by hospital pharmacists to answer the questions of (in)compatibility of co-administered injectable drugs. The objective of this article is to present the European databases on compatibility and stability of injectable drugs. According to a questionnaire which was sent to the National Hospital Pharmacy Associations of the 28 countries of European Community there are three national databases available in EU countries which are in alphabetical order, Belgium, France and Germany. The Belgian database is dedicated to injectable medications, is updated and distributed annually in French language on a USB key. STABILIS® is an international database giving information with pictograms translated into 29 languages. This database contains also monographs of non-injectable drugs. The internet-based ADKA STABIL-Datenbank is focused on anticancer drug therapy, listing detailed datasets in German language on stability and compatibility including the references.

Polysubstance use in rural West Virginia: Associations between latent classes of drug use, overdose, and take-home naloxone

BackgroundRural communities in the United States have been disproportionately affected by the opioid crisis. Little research has explored the relationship between polysubstance use and overdose experiences among people who inject drugs (PWID) in rural communities. We sought to identify classes of polysubstance drug use among rural PWID and evaluate the associations between polysubstance drug use classes, recent overdose experiences, and receipt of take-home naloxone (THN). MethodsWe surveyed 420 PWID (June-July 2018) who had injected drugs in the previous 6 months in Cabell County, West Virginia. Participants were recruited from the local syringe services program and through street-based recruitment. We conducted a latent class analysis using 9 measures of injection and non-injection drug use and tested for associations with having experienced an overdose in the past 6 months and having received THN in the past 6 months. ResultsWe identified four substance use classes in our sample: polydrug/polyroute use (35.0% of the sample), polyroute stimulant/injection opioid use (33.3%), polyroute stimulant use (20.3%), and injection opioid use (11.3%). Overall, 42.6% of the sample had experienced an overdose in the past 6 months. The classes differed in terms of overdose (χ=91.53, p<0.001), with the polydrug/polyroute use class having the highest probability of overdose and the polyroute stimulants class having the lowest. Only 46.5% of participants had received THN, and probabilities differed between classes (χ=21.93, p<0.001). The polyroute stimulants/injection opioid use and polydrug/polyroute use classes had the highest levels of THN receipt while the polyroute stimulants use class had the least. ConclusionAmong rural PWID in West Virginia, polysubstance use was prevalent and associated with overdose and THN acquisition. These analyses demonstrate the importance of scaling up naloxone distribution in rural settings. Overdose prevention initiatives are reaching persons at high risk of overdose, but expansion of services is needed.