Non-injection Users Research Articles

HIV vaccine trial willingness among injection and non-injection drug users in two urban centres, Barcelona and San Francisco

Being able to recruit high-risk volunteers who are also willing to consider future participation in vaccine trials are critical features of vaccine preparedness studies. We described data from two cohorts of injection- and non-injection drug users in Barcelona, Spain [Red Cross centre] and in San Francisco, USA, [UFO-VAX study] at high risk of HIV/HCV infection to assess behaviour risk exposure and willingness to participate in future preventive HIV vaccine trials. We successfully identified drug-using populations that would be eligible for future HIV vaccine efficacy trials, based on reported levels of risk during screening and high levels of willingness to participate. In both groups, Red Cross and UFO-VAX respectively, HCV infection was highly prevalent at baseline (41% and 34%), HIV baseline seroprevalence was 4.2% and 1.5%, and high levels of willingness were seen (83% and 78%).

Sexual Risk and HIV Infection Among Drug Users in New York City: A Pilot Study

Measures of sexual health were assessed during 2008–2009 in a New York City sample of 102 injection and noninjection users of heroin, cocaine, or crack. There was considerable overlap and transitioning between crack smoking and injecting. Crack users were also significantly more likely to be gay, lesbian, or bisexual than other drug users. In multivariate analysis, HIV infection was independently associated with crack use and with being gay or bisexual. In New York City, HIV prevention for drug users has focused on syringe access, safe injection, and drug user treatment, but further progress in HIV control will require strategies to address sexual health among people who use drugs. The study's limitations are noted.

Patient perspectives on once-weekly medications for diabetes

to examine patient beliefs, preferences and concerns regarding a once-weekly (QW) glucose-lowering medication option. a total of 1516 adults with type 2 diabetes drawn from a national Chronic Illness Panel completed an anonymous online survey that assessed perceived attributes of QW therapy, willingness to take an injectable QW medication and patient characteristics that might influence their willingness, such as current perceived glycaemic control and diabetes quality of life (DQOL). positive attitudes regarding QW medication were common, with current injection users significantly more likely than non-injection users to view beneficial aspects: greater convenience, better medication adherence, improved quality of life (QOL) and a less overwhelming sense of treatment (in all cases, p < 0.001). In all, 46.8% reported that they would likely take an injectable QW medication if recommended by their physician, with current injection users more than twice as likely as non-injection users (73.1 vs. 31.5%; p < 0.001). Greater willingness to take QW medications was associated with poorer DQOL [injection users only; odds ratio (OR) = 1.37, p < 0.01] and poorer perceived glycaemic control (non-injection users only; OR = 1.24, p < 0.05). Concerns arose about consistency of dosage over time, potential forgetfulness and cost. QW glucose-lowering medications are viewed positively by patients with type 2 diabetes, especially if they are current injection users or are dissatisfied with their current treatments or outcomes. Greater convenience, better medication adherence and improved QOL are commonly endorsed attributes. Clinicians may need to review both the positive attributes of QW medications as well as common patient concerns, when considering this option.

Progress in HIV Reduction and Prevention Among Injection and Noninjection Drug Users

Substantial progress has been made in reducing HIV among injection drug users (IDUs) in the United States, despite political and social resistance that reduced resources and restricted access to services. The record for HIV prevention among noninjecting drug users is less developed, although they are more numerous than IDUs. Newer treatments for opiate and alcohol abuse can now be integrated into primary HIV care; treatment for stimulant abuse is less developed. All drug users present challenges for newer HIV prevention strategies (eg, "test and treat," nonoccupational postexposure prophylaxis and preexposure prophylaxis, contingency management, and conditional cash transfer). A comprehensive HIV prevention program that includes multicomponent multilevel approaches (ie, individual, network, structural) has been effective in HIV prevention among IDUs. Expanding these approaches to noninjecting drug users, especially those at highest risk (eg, minority men who have sex with men) and incorporating these newer approaches is a public health priority.

Commentary on Caiaffa et al. (2011): The renewed challenge of hepatitis C virus epidemiology among non-injecting drug users

Commentary on Caiaffa et al. (2011): The renewed challenge of hepatitis C virus epidemiology among non-injecting drug users

Drug Treatment as HIV Prevention: A Research Update

Drug use continues to be a major factor fueling the global epidemic of HIV infection. This article reviews the current literature on the ability of drug treatment programs to reduce HIV transmission among injection and noninjection drug users. Most data come from research on the treatment of opiate dependence and provide strong evidence on the effectiveness of medication-assisted treatment for reducing the frequency of drug use, risk behaviors, and HIV infections. This has been a consistent finding since the epidemic began among diverse populations and cultural settings. Use of medications other than methadone (such as buprenorphine/naloxone and naltrexone) has increased in recent years with promising data on their effectiveness as HIV prevention and as new treatment options for communities heavily affected by opiate use and HIV infection. However, few treatment interventions for stimulant abuse and dependence have shown efficacy in reducing HIV risk. The cumulative literature provides strong support of drug treatment programs for improving access and adherence to antiretroviral treatment. Drug users in substance abuse treatment are significantly more likely to achieve sustained viral suppression, making viral transmission less likely. Although there are challenges to implementing drug treatment programs for maximum impact, the scientific literature leaves no doubt about the effectiveness of drug treatment as an HIV prevention strategy.

Can antiviral therapy for hepatitis C reduce the prevalence of HCV among injecting drug user populations? A modeling analysis of its prevention utility

Hepatitis C virus antiviral treatment is effective for individual patients but few active injecting drug users are treated. We considered the utility of antiviral treatment for primary prevention of hepatitis C. A hepatitis C transmission model among injecting drug users was developed, incorporating treatment (62.5% average sustained viral response) with no retreatment after initial treatment failure, potential re-infection for those cured, equal genotype setting (genotype 1:genotype 2/3), and no immunity. In addition, we examined scenarios with varied treatment response rates, immunity, or retreatment of treatment failures. In the baseline scenario, annually treating 10 infections per 1000 injecting drug users results in a relative decrease in hepatitis C prevalence over 10 years of 31%, 13%, or 7% for baseline (untreated endemic chronic infection) prevalences of 20%, 40%, or 60%, respectively. Sensitivity analyses show that including the potential for immunity has minimal effect on the predictions; prevalence reductions remain even if SVR is assumed to be 25% lower among active IDU than current evidence suggests; retreatment of treatment failures does not alter the short-term (<5 years) projections, but does increase treatment gains within 20 years; hepatitis C free life years gained from treating active injecting drug users are projected to be higher than from treating non-injecting drug users for prevalences below 60%. Despite the possibility of re-infection, modest rates of hepatitis C treatment among active injecting drug users could effectively reduce transmission. Evaluating and extending strategies to treat hepatitis C among active injectors are warranted.

Gender and Age Patterns in HSV-2 and HIV Infection Among Non-Injecting Drug Users in New York City

To examine prevalence of and associations between herpes simplex virus type 2 (HSV-2) infection and HIV infection among never-injecting heroin and cocaine drug users (NIDUs) in New York City. Subjects were recruited from patients entering the Beth Israel drug detoxification program. Informed consent was obtained, a structured questionnaire including demographics, drug use history, and sexual risk behavior was administered, and a blood sample was collected for HIV and HSV-2 antibody testing. A total of 1418 subjects who had never (lifetime) injected drugs (NIDUs) were recruited between July 2005 through June 2009. Subjects were primarily male (76%), and black (67%) or Hispanic (25%), reported recent crack cocaine use (74%), and had a mean age of 42 years. Eleven percent of males reported male-with-male sexual (MSM) behavior. The prevalence of both viruses was high: for HSV-2, 61% among the total sample, 50% among non-MSM males, 85% among females, and 72% among MSM; for HIV, 16% among the total sample, 12% among non-MSM males, 20% among females, and 46% among MSM. HSV-2 was associated with HIV (OR = 3.2, 95% CI: 2.3-4.5; PR = 2.7, 95% CI: 2.0-3.7). Analyses by gender and age groups indicated different patterns in mono- and coinfection for the 2 viruses. HSV-2 and HIV rates among these NIDUs are comparable with rates in sub-Saharan Africa. Additional prevention programs, tailored to gender and age groups, are urgently needed. New platforms for providing services to NIDUs are also needed.

Rare Case of Dysphagia

Wound botulism is exceedingly rare and occurs almost exclusively among injection drug users. In 2008 there was a case of wound botulism in a noninjecting drug user reported to the Centers for Disease Control and Prevention (CDC). We report a case of a Caucasian male developing dysphagia due to wound botulism after having a motorcycle accident that left him with open fractures. The CDC was contacted and the patient was transferred to medical intensive care unit to be emergently started on hepatavalent Clostridium botulinum antitoxin. Early suspicion of wound botulism is essential for effective therapy with antitoxin in this life-threatening disease. If not suspected, this patient would likely have died. Nevertheless, the delay in diagnosis and treatment resulted in the patient's suffering dysphagia and neurological deficits. The patient required a percutaneous endoscopic gastrostomy tube and months of dysphagia therapy, supportive care, and rehabilitation. Our aim is to increase the awareness for wound botulism when a patient presents with dysphagia and diplopia after suffering open wounds. If suspected early, the morbidity and mortality from this disease can be prevented.

Who Chooses a Rapid Test for HIV in Los Angeles County, California?

The purpose of this study was to determine who chooses a rapid test for HIV when given a choice in a community-based or mobile van setting in Long Beach, California. Individuals were given a choice of either rapid or standard HIV testing either alone or in conjunction with testing for sexually transmitted diseases (STD). Of the 2,752 HIV tests performed between March 2005 and March 2009, 917 (33%) were rapid tests. Preference for rapid HIV testing was among men who have sex with men (MSM), who reported using alcohol in the last 48 hr but who did not endorse the use of illicit drugs; individuals reporting sex trading were also more likely to choose the rapid HIV test. African Americans, regardless of sexual identification, were significantly less likely to choose an HIV rapid test. Strategies are needed to encourage HIV rapid testing among both noninjection and injection drug users, and other at-risk groups.

Latent Tuberculosis among Persons at Risk for Infection with HIV, Tijuana, Mexico

Because there is little routine tuberculosis (TB) screening in Mexico, the prevalence of latent TB infection (LTBI) is unknown. In the context of an increasing HIV epidemic in Tijuana, Mexico, understanding prevalence of LTBI to anticipate emergence of increased LTBI reactivation is critical. Therefore, we recruited injection drug users, noninjection drug users, female sex workers, and homeless persons for a study involving risk assessment, rapid HIV testing, and TB screening. Of 503 participants, the overall prevalences of TB infection, HIV infection, and TB/HIV co-infection were 57%, 4.2%, and 2.2%, respectively; no significant differences by risk group (p>0.05) were observed. Two participants had TB (prevalence 398/100,000). Incarceration in Mexico (odds ratio [OR] 2.28), age (OR 1.03 per year), and years lived in Tijuana (OR 1.02 per year) were independently associated with TB infection (p<0.05). Frequent LTBI in marginalized persons may lead to increases in TB as HIV spreads.

Non-injected illicit drugs and alcohol and HIV-related high-risk sexual behaviors in a street-recruited sample of non-injecting drug users in New York City

Methods Among the Non-Injecting Drug Users (NIDUs) in the South Bronx and Harlem, New York City questionnaires were administered about the past use and within last three months use of crack cocaine and powder cocaine, alcohol, marijuana/hashish, and heroin and HIV-related sexual behaviors. Sexual behavior was summarized as a single variable, the Vaginal Equivalent Episode (VEE) score; VEE scores above and below the median were categorized as high and low sexual risk respectively.

Epidemiology of HIV Among Injecting and Non-injecting Drug Users: Current Trends and Implications for Interventions

Injecting drug use is a major driver of HIV infections in Eastern Europe, the Commonwealth of Independent States, North Africa, the Middle East, and many parts of Asia and North America. We provide a global overview of the epidemiology of HIV infection among drug users and present current drug use trends that may constitute important epidemic drivers. We describe trends in ethnic disparities among injecting drug using (IDU) populations in the United States, and comment upon how these trends may now be changing. We present examples where HIV infection among non-IDUs who use cocaine, crack, and methamphetamine by other routes of administration is similar to that among IDUs, and discuss potential mechanisms of HIV spread in this overlooked population. Finally, we comment upon the potential implications of these observations for HIV interventions among IDU and non-IDU populations, taking into account different strategies that are needed in settings where HIV and/or injecting drug use has been established, or threatens to emerge.

Continued high prevalence of HIV, HBV and HCV among injecting and noninjecting drug users in Italy.

We estimated the prevalence of HIV, HBV and HCV infections among injecting and noninjecting drug users treated within public drug-treatment centres in Italy to determine the correlates of infection. In the sample of 1330 drug users, the prevalence of HIV was 14.4% among drug injectors and 1.6% among non-injectors; the prevalence of HBV was 70.4% among injecting drug users and 22.8% among non-injectors and of HCV was 83.2% among injecting drug users and 22.0% among non-injectors. Old age, unemployment, and intravenous drug use were significantly correlated with each of the infections, as well as a longer history of injecting drug use. The results indicate that these infections continue to circulate among drug users, highlighting the need for monitoring of this group in Italy.

Heterosexual HIV and Sexual Partnerships Between Injection Drug Users and Noninjection Drug Users

Sex partnerships with injection drug users (IDU) are an understudied network-level risk factor for heterosexual HIV infection. Heterosexuals with no history of injection were recruited from high-risk areas in New York City through respondent-driven sampling. We examined the prevalence of IDU sex partnerships among these non-IDU, the factors associated with having a past year IDU partner, and the independent association of HIV infection and IDU sex partnerships in multiple logistic regression. Of the 601 non-IDU in this analysis, 13.8% had a sex partner in the past year with a history of injection. IDU partnerships were significantly more common among women and those with higher levels of unprotected sex and drug and alcohol use. Overall, 7.0% tested positive for HIV. HIV prevalence was higher (p = 0.07) for participants with IDU partners (9.6%) compared to those with no IDU partners (4.6%). In multiple logistic regression, participants with IDU partners were over twice as likely to be HIV-infected (p = 0.08). Sex partnerships with IDU were common and may play an important role in heterosexual HIV transmission in areas with large IDU populations. Prevention interventions to encourage the disclosure of injection history and risk reduction specifically for those with IDU partners are indicated.

Continued high prevalence of HIV, HBV and HCV among injecting and noninjecting drug users in Italy

Continued high prevalence of HIV, HBV and HCV among injecting and noninjecting drug users in Italy

Ethnographic Strategies in the Tracking and Retention of Street-Recruited Community-Based Samples of Substance Using Hidden Populations in Longitudinal Studies

The article presents practical and methodological strategies in the tracking and retention of a longitudinal community-based sample of 300 Mexican American noninjecting users of heroin. Presented are the ethnographic strategies the research team utilized to maintain high retention rates among this highly marginalized and hidden population. Findings indicate that these ethnographic strategies are the basis for a reliable method for subject retention among drug-using populations. Further, the strategies illustrate how qualitative methods can complement the collection of quantitative data. Discussed is how these strategies can be used to identify and engage similar populations in research studies.

Sexual risk reduction among non-injection drug users: report of a randomized controlled trial

We conducted a randomized controlled trial of a sexual risk-reduction intervention targeting non-injection drug users (NIDUs) and members of their drug-use/sexual networks (N=270). The intervention was based primarily on the social-influencing approach, and was delivered in four sessions. Sexual risk behaviors were examined at baseline, and 3, 6, 9, and 12 months after the completion of the intervention using the vaginal equivalent episodes (VEE), a weighted sexual risk behavior index. VEE scores decreased in both the active and control conditions in the first six months post-intervention and continued to decline in the control group. However, in the active condition, VEE scores increased after the nine-month assessment and approached baseline levels by the 12-month assessment. There was no evidence of significant differences in high-risk sexual behaviors between the intervention and control conditions. Future studies are needed to improve behavioral interventions in this population.

A follow-up study of drug users in Southern Iran

Iran has the highest rate of opium addiction per capita in the world. The aim of this study was to examine the outcome of substance use among a cohort of drug users living in a rural area in Southern Iran. A semi-structured interview was conducted at baseline and at each follow-up visit on 211 substance users. Of the total of 211 drug users, 145 were non-injection drug users (non-IDUs) and 66 were injection drug users (IDUs). The most common method of drug use among all participants was revealed to be opium smoking. Other methods of choice were injection drug use (IDUs) and opium ingestion among 31% and 20% of participants, respectively. From the total of 211 participants in this cohort, on average (SD), each drug user gave up drugs 3.2 (2.7) times over the study period. Among those who were non-IDUs at the base line visit (145), 17 (12%) were abstinent for more than 6 months compared to 9 of 66 non-IDUs (14%) at the end of the study. By the end of the study period, 9 of 145 non-IDUs switched to non-IDUs while 11 of 66 IDUs (17%) switched to non-IDUs (chi-square = 5.78; p = 0.016). One main reason for a higher rate of transition among IDUs was mentioned by them as observing the deaths of several IDUs in their community that were a result of overdose.

Research on co-infections of HIV and human herpesvirus-8 among the Uygur high-risk groups in a city, Xinjiang

To research the co-infections of HIV and human herpesvirus 8 (HHV8) in Uygur high-risk groups of HIV infection in a city Xinjiang. All 468 Uygurs at high HIV risk registered in the sentinel monitoring system in 2006 were enrolled in this study. The antibodies to HHV8 latency-associated nuclear antigens 1 (LANA1), lytic antigens open reading frame 65 (ORF65) and K8.1 were measured by enzyme linked immunosorbent assay (ELISA). Chi-square test and non-condition Logistic regression model were used for data analysis. Of 468 sera samples, 67 (14.3%) were HIV and HHV8 co-infection positive.Male's HIV and HHV8 co-infection rate (22.6%, 54/239) was higher than the female's (5.7%, 13/229) (chi(2) = 27.285, P < 0.001). For those above 24 year old, HIV and HHV8 co-infection rate (15.8%, 65/412) was higher than the < 24 year old group's (3.6%, 2/56) (chi(2) = 5.987, P = 0.014). The group of Elementary school and illiterate people's HIV and HHV8 co-infection rate (20.7%, 40/193) was higher than the junior middle school and the above culture (9.8%, 27/275) (chi(2) = 10.999, P = 0.001). For the unmarried people, the co-infecting rate of HIV and HHV8 for the married, the cohabitants, the divorced or the widowers were 16.9% (14/83), 12.2% (42/345), 27.5% (11/40) respectively. There was significantly statistical difference among three marital status (chi(2) = 7.399, P = 0.025). Injecting drug users' HIV and HHV8 co-infection rate (26.5%, 50/189) was higher than non-injecting drug users' (6.1%, 17/279) (chi(2) = 38.083, P < 0.001), and stratified by gender, OR(M-H) was 4.207 (95%CI: 1.529 - 11.578). Via non-condition logistic stepwise regression analysis, only injecting drug use entered model, compared with non-injecting drug users, injecting drug users were more dangerous for HIV and HHV8 co-infecting (OR = 5.544; 95%CI: 3.081 - 9.975). The HIV and HHV8 co-infection rate was higher in the Uygurs at high HIV risk in Xinjiang. Injecting drug use is a risk factor of the HIV and HHV8 co-infection, which might be one of routes of HIV and HHV8 co-infection among this group.