People Who Inject Drugs Research Articles

Medications for opioid use disorder associated with reduced readmissions for patients with severe injection-related infections: A matched cohort study

IntroductionHospitalizations due to severe injection-related infections (SIRIs) and patient-directed discharge (PDD) in people who inject drugs (PWID) are increasing, but research on readmission outcomes at PDD is limited. In this retrospective, matched cohort study we evaluated predictors of 30-day readmission by discharge status among PWID. MethodsAmong patients diagnosed with SIRIs at a tertiary hospital, Fisher's exact tests assessed differences in readmission rates by discharge status. Medications for opioid use disorder (MOUD) at discharge was defined as either having a buprenorphine dose dispensed within 24 h of discharge and buprenorphine being included in the discharge summary as a prescription, or a methadone dose dispensed inpatient within 24 h of discharge. Logistic regression analyses evaluated predictors of readmission outcomes. ResultsAmong 148 PWID with SIRI diagnosis, 30-day readmission rate following PDD was higher than standard discharge (25.7 % vs. 9.5 %, p = 0.016) and MOUD decreased odds of 30-day readmission (OR = 0.32, 95 % CI: 0.12,0.83, p = 0.012). >7 missed days of antibiotic treatment increased odds of 30-day readmission (OR 4.65, 95 % CI: 1.14, 31.72, p = 0.030) within PDD patients. ConclusionsPDD carries higher 30-day readmission rate compared to standard discharge. Strategies to reduce PDD rates and increase MOUD initiation may improve readmission outcomes.

Inadequate needle and syringe coverage among people who inject psychoactive drugs across England and Wales

Aim Needle and syringe (NS) provision is a proven intervention for reducing harms associated with injecting drug use, such as infections, but impact is coverage-dependent. We characterised people who injected drugs (PWID) in England and Wales who had insufficient NS in the past month to meet their injecting requirements. Methods This study utilised 2017–2019 data from the annual Unlinked Anonymous Monitoring (UAM) Survey of PWID recruited through specialist services. Logistic regression was used to identify factors associated with inadequate NS coverage. Findings Of 2,442 PWID surveyed who had injected in the past month, 34% reported inadequate NS coverage (or as high as 51% if including unsuccessful injections). Younger PWID (adjusted odds ratio: 2.18, 95% confidence interval: 1.35–3.52), those who began injecting in the past three years (1.46, 1.09–2.00), and those who reported sharing injecting equipment (1.46, 1.22–1.75) had greater odds of having inadequate NS coverage. PWID currently prescribed Opioid Substitution Treatment (OST) had lower odds of inadequate NS coverage (0.60, 0.49–0.73). Conclusion Given the poor reported coverage of NS provision in England and Wales, there is urgent need to address inequity in accessing sufficient NS and increase coverage among this vulnerable group to reduce injecting-related harms.

Does a simplified algorithm and integrated HCV care model improve linkage to care, retention, and cure among people who inject drugs? A pragmatic quality improvement randomized controlled trial protocol

BackgroundAs many as 2.4 million Americans are affected by chronic Hepatitis C Virus (HCV) in the United States.In 2018, the estimated number of adults with a history of HCV infection in San Diego County was 55,354 (95% CI: 25,411–93,329). This corresponded to a seroprevalence of 2.1% (95% CI: 2.1–3.4%). One-third of infections were among PWID. Published research has demonstrated that direct-acting antivirals (DAAs) have high efficacy and can now be used by primary care providers to treat HCV. In addition, limited evidence exists to support the effectiveness of simplified algorithms in clinical trial and real-world settings. Even with expanded access to HCV treatment in primary care settings, there are still groups, especially people who inject drugs (PWID) and people experiencing homelessness, who experience treatment disparities due to access and treatment barriers. The current study extends the simplified algorithm with a streetside ‘one-stop-shop’ approach with integrated care (including the offer of buprenorphine prescriptions and abscess care) using a mobile clinic situated adjacent to a syringe service program serving many homeless populations. Rates of HCV treatment initiation and retention will be compared between patients offered HCV care in a mobile clinic adjacent to a syringe services program (SSP) and homeless encampment versus those who are linked to a community clinic’s current practice of usual care, which includes comprehensive patient navigation.MethodsA quasi-experimental, prospective, interventional, comparative effectiveness trial with allocation of approximately 200 patients who inject drugs and have chronic HCV to the "simplified care" pathway (intervention group) or the "usual care" pathway (control group). Block randomization will be performed with a 1:1 randomization.DiscussionPrevious research has demonstrated acceptable outcomes for patients treated using simplified algorithms for DAAs and point-of-care testing in mobile medical clinics; however, there are opportunities to explore how these new, innovative systems of care impact treatment initiation rates or other HCV care cascade outcomes among PWID.Trial registrationWe have registered our study with ClinicalTrials.gov, a resource of the United States National Library of Medicine. This database contains research studies from United States and other countries around the world. Our study has not been previously published. The ClinicalTrials.gov registration identifier is NCT04741750.

Prevention of Viral Hepatitis and HIV Infection among People Who Inject Drugs: A Systematic Review and Meta-Analysis.

This study aimed to explore the current evidence on preventing blood-borne virus infections among people who inject drugs (PWID). We conducted a comprehensive search across three databases (PubMed, Embase, Cochrane Library) for relevant articles published in English between 2014 and 2023. We followed the Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA) guidelines, assessed the quality of the paper using the revised Cochrane Risk of Bias Tool (ROB 2), and conducted a meta-analysis using RevMan 5.3. Completing the harm reduction program (HRP) participation and receiving all three vaccine doses resulted in a 28% reduction in the risk of HBV infection (OR: 0.72, 95% CI: 0.37-1.42). Various interventions increased the willingness of PWIDs to undergo HCV treatment (OR: 5.91, 95% CI: 2.46-14.24) and promoted treatment adherence (OR: 15.04, 95% CI: 2.80-80.61). Taking PrEP, participating in HRP, and modifying risky behaviors were associated with a 33% reduction in the risk of HIV infection (OR: 0.67, 95% CI: 0.61-0.74). Conducting referrals, providing counseling, and implementing antiretroviral therapy resulted in a 44% reduction in the risk of viral transmission (OR: 0.56, 95% CI: 0.47-0.66). Co-infection may potentially compromise effectiveness, so it is important to consider drug resistance.

Impact of Potential Case Misclassification by Administrative Diagnostic Codes on Outcome Assessment of Observational Study for People Who Inject Drugs.

Initiation of medications for opioid use disorder (MOUD) within the hospital setting may improve outcomes for people who inject drugs (PWID) hospitalized because of an infection. Many studies used International Classification of Diseases (ICD) codes to identify PWID, although these may be misclassified and thus, inaccurate. We hypothesized that bias from misclassification of PWID using ICD codes may impact analyses of MOUD outcomes. We analyzed a cohort of 36 868 cases of patients diagnosed with Staphylococcus aureus bacteremia at 124 US Veterans Health Administration hospitals between 2003 and 2014. To identify PWID, we implemented an ICD code-based algorithm and a natural language processing (NLP) algorithm for classification of admission notes. We analyzed outcomes of prescribing MOUD as an inpatient using both approaches. Our primary outcome was 365-day all-cause mortality. We fit mixed-effects Cox regression models with receipt or not of MOUD during the index hospitalization as the primary predictor and 365-day mortality as the outcome. NLP identified 2389 cases as PWID, whereas ICD codes identified 6804 cases as PWID. In the cohort identified by NLP, receipt of inpatient MOUD was associated with a protective effect on 365-day survival (adjusted hazard ratio, 0.48; 95% confidence interval, .29-.81; P < .01) compared with those not receiving MOUD. There was no significant effect of MOUD receipt in the cohort identified by ICD codes (adjusted hazard ratio, 1.00; 95% confidence interval, .77-1.30; P = .99). MOUD was protective of all-cause mortality when NLP was used to identify PWID, but not significant when ICD codes were used to identify the analytic subjects.

All-cause mortality before and after DAA availability among people living with HIV and HCV: An international comparison between 2010 and 2019

BackgroundAmong people living with HIV and hepatitis C virus (HCV), people who inject drugs (PWID) have historically experienced higher mortality rates. Direct-acting antivirals (DAA), which have led to a 90 % HCV cure rate independently of HIV co-infection, have improved mortality rates. However, DAA era mortality trends among PWID with HIV/HCV remain unknown. Using data from the International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC), we compared pre/post-DAA availability mortality changes in three groups: PWID, men who have sex with men (MSM), and all other participants. MethodsWe included InCHEHC participants with HIV/HCV followed between 2010 and 2019 in Canada, France, the Netherlands, Spain, and Switzerland. All-cause mortality hazard was compared in the three groups, using Cox proportional hazards regression models adjusted for sex, age, advanced fibrosis/cirrhosis, and pre/post DAA availability. ResultsOf the 11,029 participants, 76 % were men, 46 % were PWID, baseline median age was 46 years (interquartile range [IQR] = 40;51), and median CD4 T-cell count was 490 cells/mm3 (IQR = 327;689). Over the study period (median follow-up = 7.2 years (IQR = 3.7;10.0)), 6143 (56 %) participants received HCV treatment, 4880 (44 %) were cured, and 1322 participants died (mortality rate = 1.81/100 person-years (PY) [95 % confidence interval (CI)=1.72–1.91]).Overall, PWID had higher mortality rates than MSM (2.5/100 PY [95 % CI = 2.3–2.6] vs. 0.8/100 PY [95 % CI = 0.7–0.9], respectively). Unlike women with other transmission modes, those who injected drugs had a higher mortality hazard than men who did not inject drugs and men who were not MSM (adjusted Hazard-Ratio (aHR) [95 % CI] = 1.3[1.0–1.6]). Post-DAA availability, mortality decreased among MSM in the Netherlands, Spain, and Switzerland and increased among PWID in Canada (aHR [95 % CI] = 1.73 [1.15–2.61]). ConclusionPost-DAA availability, all-cause mortality did not decrease in PWID. Determinants of cause-specific deaths (drug-related, HIV-related, or HCV-related) need to be identified to explain persistently high mortality among PWID in the DAA era.

The Cost of Safe Injection: Insights on Nonprescription Syringe Price Variability From Systematic Secret Shopping.

Although the sale of nonprescription syringes in pharmacies is legal in most states, people who inject drugs (PWID) continue to face obstacles to syringe purchase like stigma, prohibitive costs, restrictive policies, and stocking issues. We examined the consistency of syringe pricing as another possible barrier. We analyzed data on syringe prices and other relevant variables from 153 unique secret shopper visits to 2 retail chain pharmacies in Massachusetts (MA), New Hampshire (NH), Oregon (OR), and Washington (WA) as part of the fidelity component of a large pharmacy-focused intervention study. Pretax prices from purchases made between August 2019 and May 2021 were adjusted for inflation to 2022 dollars, and a linear regression of the price of a 10-pack of syringes was constructed to examine the determinants of syringe pricing. The average real price of a 10-pack of syringes across all states was $4.53 (SD = 0.99), with wide variability between pharmacies (max = $11.44, min = $1.70) and between states (mean OR = $5.76, WA = $4.74, MA = $4.33, NH = $4.30). Forty-seven percent (n = 72) of the purchases were taxed despite syringes being tax exempt in MA and WA, and not having a sales tax in NH or OR. The results of the regression suggest that certain needle gauges were associated with lower overall prices, while 1 pharmacy chain and 2 syringe brands were associated with higher overall prices. The high variability in syringe pricing presents another barrier to pharmacy-based syringe access since high prices may leave PWID no choice but to reuse or share needles, especially in areas with limited alternatives or without a syringe service program. Leadership from healthcare systems, pharmacy chains, and state and local policymakers is essential to reduce stigma and to implement policies that streamline syringe purchases, eliminate the taxation of exempt syringes in accordance with state laws, and reduce the variation in syringe prices.

Willingness to use and distribute HIV self-testing kits among people who inject drugs in the San Diego–Tijuana border region

BackgroundHIV self-testing (HIVST) could increase HIV testing access among people who inject drugs (PWID), and secondary distribution (i.e., peer-delivery) of HIVST kits in PWID social networks could further expand coverage. We assessed willingness to use and distribute HIVST kits among PWID in the San Diego–Tijuana border region.MethodsFrom 2020 to 2021, HIV-negative PWID in San Diego, USA, and Tijuana, Mexico, completed surveys and provided data on individual (N = 539) and social network (N = 366) characteristics. We used modified Poisson regression to examine the effects of individual and social network characteristics on willingness to use and distribute HIVST kits.ResultsMost participants were willing to use (81%) and distribute (81%) HIVST kits. At the individual level, prior HIV testing was positively associated with willingness to use (adjusted prevalence ratio [aPR] = 1.24, 95% confidence interval [CI] 1.10–1.40) and distribute (aPR = 1.27, 95% CI 1.12–1.43) HIVST kits, while perceiving oneself to be at higher HIV risk than others was negatively associated with willingness to use HIVST kits (aPR = 0.83, 95% CI 0.74–0.93). At the network level, willingness to distribute HIVST kits was positively associated with network size (aPR = 1.04 per member, 95% CI 1.01–1.08) and greater proportions of one’s network encouraging them to use drugs (aPR = 1.29, 95% CI 1.16–1.44) and having a history of homelessness (aPR = 1.51, 95% CI 1.31–1.74) or detention/arrest (aPR = 1.57, 95% CI 1.36–1.82), and negatively associated with a greater proportion of one’s network including “very close” persons (aPR = 0.80, 95% CI 0.69–0.94).ConclusionsWe found high potential for HIVST kits and their secondary distribution to increase HIV testing among PWID who face the greatest barriers to facility-based testing.

WaSH insecurity and anxiety among people who inject drugs in the Tijuana-San Diego border region

BackgroundWater, sanitation, and hygiene (WaSH) insecurity increases the risk of water-related diseases. However, limited research has been conducted on psychosocial distress as it relates to WaSH insecurity, especially among people who inject drugs (PWID). We examined the relationship between WaSH insecurity and related anxiety among PWID living in different housing conditions along the US-Mexico border region.MethodsFrom 2020–2021, a cross-sectional study was conducted among 585 people who injected drugs within the last month in Tijuana (N = 202), San Diego (N = 182), and in both Tijuana and San Diego (N = 201). Participants underwent interviewer-administered surveys related to WaSH access, substance use, and generalized anxiety disorder (GAD-7). Quasi-Poisson regressions were used to assess associations between WaSH insecurity and anxiety in the prior 6-months.ResultsParticipants were 75% male, 42% were unhoused and 91% experienced WaSH insecurity in the prior 6-months. After adjusting for housing status, gender, and age, lack of access to basic drinking water (Adj RR: 1.28; 95% CI: 1.02–1.58), sanitation (Adj RR:1.28; 95% CI: 1.07–1.55), and a daily bath/shower (Adj RR: 1.38; 95% CI: 1.15–1.66) were associated with mild-severe anxiety. The number of WaSH insecurities was independently associated with a 20% increased risk of experiencing anxiety per every additional insecurity experienced (Adj RR: 1.20; CI: 1.12–1.27). We also found a significant interaction between gender and housing status (p = 0.003), indicating that among people experiencing sheltered/unsheltered homelessness, women had a higher risk of mild-severe anxiety compared to men (Adj RR: 1.55; 95% CI: 1.27–1.89). At the same time, among women, those who are unhoused have 37% increased risk of anxiety than those who live in stable housing conditions (Adj RR: 1.37; 95% CI: 1.01–1.89).ConclusionThe lack of specific WaSH services, particularly lack of drinking water, toilets, and daily showers were associated with higher levels of anxiety among PWID in the Tijuana-San Diego border region. Women experiencing homelessness were especially vulnerable. WaSH interventions that provide safe, 24-h access may help to reduce anxiety and health risks associated with WaSH insecurity.

Health and Social Service Needs of People who Inject Drugs Living in Rural Settings in the United States: A Qualitative Study

Objective: Rural communities continue to be among the most severely affected by the opioid epidemic, showing some of the highest rates of overdose deaths and increasing rates of injection drug use. Lack of resources among other barriers contribute to the needs of this population going unmet. We assessed service needs among people who inject drugs (PWID) in rural regions, barriers to the implementation of these services, and optimal strategies to intervene with people who inject drugs, as well as to better link them to needed programs and services. Methods: We carried out thematic content analysis of 46 in-depth interviews with key respondents who worked with or had knowledge of the needs of PWID. Results: Respondents saw a need for increased access to services (eg, healthcare, harm reduction, addiction treatment), different treatment options, and education related to substance use as the most needed services among this population. Conclusions: Opioid use disorder interventions and initiatives must address these core service and education needs to best serve PWID. Increasing access to services in rural communities must be a priority for policymakers, local respondents, and healthcare providers.

A service provider’s experience providing telehealth services during the COVID-19 pandemic in a community-based opioid substitution clinic in Bangladesh

Abstract Introduction The COVID-19 pandemic incurred numerous impediments on day-to-day emergency medical services including Opioid Substitution Therapy (OST) for People Who Inject Drugs (PWID). To prevent treatment cessation and lost to follow-up, we tried to implement an alternate mitigating intervention like telehealth. Methodology This research was conducted on a cohort of OST clients during the COVID-19 pandemic ( from 1st April 2020 to 31st March 2021) in Narayanganj, a port city adjacent to the capital Dhaka and one of the most COVID-affected districts, with a high PWID and HIV burden. The participants were male, female and transgender women who were all ex-PWID and were under OST services. A telehealth intervention model was designed and implemented in the OST clinic at Narayangonj. Quantitative data were collected during pre and post-intervention of telehealth services. Results A total of 297 OST clients of Narayangonj were provided with telehealth services from April 2020 to March 2021. The participants were predominantly male (98.7%), 37.7% were between 30–39 years of age. 39.4% of the telephone calls were related to COVID-19-related symptoms followed by 21.7% for opioid withdrawal, 12.5% for COVID-19 &amp; vaccine-related information, 11.3% for chronic diseases like diabetes, hypertension and asthma, 9.3% for Skin and Soft Tissue Infection (SSTI), and 5.8% for methadone-related effects. There was an improvement in treatment retention (14.4% to 87%), loss to follow-up (20% to 8%), and overdose-related death (1.3% to 0%) from pre to post intervention of telehealth services. Conclusion From our experience, we found that the telehealth intervention is beneficial for the OST clients and thus ensures treatment continuity and retention, both of which serve as crucial success indicators of the OST programme. Using simply the mobile phone, this intervention can reduce structural and logistical needs like clinic spaces and fewer human resources, ensuring cost-effectiveness and value for money.

Integrated biobehavioral surveillance among people who inject drugs in Ukraine, 2007-2020

BackgroundRepeated integrated biobehavioral surveys (IBBS) have been implemented among people who inject drugs (PWID) in Ukraine to monitor the trends in key epidemiologic and programmatic indicators. MethodsThe study analyzed seven PWID IBBS rounds from 2007 to 2020 in seven Ukrainian cities. Participants were recruited using respondent-driven sampling, tested for HIV and anti-HCV antibodies, and completed a structured questionnaire. Composite weights (based on individual sampling probability and population size) were applied to generate point estimates and confidence intervals for HIV and HCV prevalence, injection risk behaviors, prevention service coverage, and HIV treatment cascade. Multi-level regression assessed temporal trends in these indicators in 2007-2020. ResultsThe samples consisted of 1587 participants in 2007, 1905 in 2008/9, 3066 in 2011, 2846 in 2013, 2699 in 2015, 2798 in 2017, and 3651 in the 2020 rounds. HIV prevalence decreased from 27% to 19% overall, and among PWID younger than 25 from 10.5% to 5.5%. Anti-HCV prevalence increased from 50% to 73% overall but decreased from 58% to 27% in the younger subgroup. Past-30-days injection risk behaviors consistently decreased, reaching a minimum of 38% for any risk in 2020. HIV treatment cascade indicators and coverage with opioid agonist treatment substantially improved in the last three rounds. Harm reduction services coverage fluctuated, declining from 52% to 33% in the last three rounds. ConclusionsThis analysis demonstrates the potential of repeated IBBS for monitoring the HIV epidemic and program coverage. We confirmed a sustained decline in overall HIV and HCV transmission, likely driven by reduced risky injection practices among PWID. The impact of harm reduction services requires further study. HIV status awareness and treatment coverage among PWID markedly increased, reaching the national average, possibly indicating the success of case-finding and linkage-to-care interventions. The upcoming IBBS round in Ukraine will also assess the impact of the war on service provision, risk behavior, and HIV transmission among PWID.

Social networks, secondary syringe exchange, and opioid agonist therapy retention among people who inject drugs in Hartford, CT

BackgroundOpioid agonist therapies (OAT) and harm reduction such as syringe service programs (SSP) have been shown to be effective in preventing adverse outcomes such as overdose deaths, HIV and Hepatitis C infections among people who inject drugs (PWID). The importance of social network influence on disease transmission is well established, yet the interplay between harm reduction and network structures is, generally, not well understood. This study aims to analyze how social networks can mediate the harm reduction effects associated with secondary exchange through syringe service programs (SSP) and opioid agonist therapies (OAT) among injection network members. MethodsSociometric data on networks on people who inject drugs from Hartford, CT, which were collected in 2012–2013, provided assessment of risk behaviors among 1574 injection network members, including participation in OAT and SSP. Subject's network characteristics were examined in relation to retention in OAT, as well as secondary syringe exchange using exponential random graph model (ERGM) and regression. ResultsBased on the analysis, we found that probability of individuals being retained in OAT was positively associated with the OAT retention status of their peers within the network. Using simulations, we found that higher levels of positive correlation of OAT retention among network members can result in reduced risk of transmission of HIV to network partners on OAT. In addition, we found that secondary syringe exchange engagement was associated with higher probability of sharing of paraphernalia and unsterile needles at the network level. ConclusionsUnderstanding how networks mediate risk behaviors is crucial for making progress toward ending the HIV epidemic.

Piloting a simplified bio-behavioural survey methodology, the BBS-Lite, among people who inject drugs in Georgia

BackgroundDuring 2021 and 2023 two simplified Biological and Behavioural Study (BBS-Lite) surveys, and in 2022 one Standard Integrated Biological and Behavioural Study (IBBS), were conducted among people who inject drugs in seven cities in Georgia. From these, an opportunity to compare the implementation of these survey methods and results was able to be gained. MethodsThe two survey types were compared to find points of similarity and difference in their methodologies. The methodologies of the IBBS and BBS-Lite studies shared many characteristics, including the cities where they were implemented, recruitment criteria, sample sizes, and common questionnaire items. All studies were multi-centre cross-sectional involving administration of a face-to-face behavioural questionnaire and collection of biological specimens for testing of HIV, syphilis, hepatitis B virus (HBV), and hepatitis C virus (HCV). The main differences were in the sampling methods. The IBBS utilised respondent-driven sampling (RDS) while participants of the BBS-Lite studies were enrolled through consecutive recruitment at the harm reduction (HR) programme sites and on outreach and through snowball sampling. We compared the results from each study as well as the implementation modalities modalities such as time taken and budgetary requirements, and the complexity of implementation. ResultsConsiderably less time was required for recruitment, as well as for interviewing, data entry (4 times less) and the analysis for the BSS-Lite studies compared to the IBBS. The BSS-Lite study budgets were at least 2.5 times less than of the IBBS study.The recruited samples were comparable for age distribution, median age at first injection, the last drug injected, sharing of drug injecting equipment or receiving opioid agonist maintenance treatment (OAMT) during the last 12 months. HIV and HCV prevalence were similar including for stratifications by age, client status and city of recruitment. ConclusionOur findings have demonstrated that if implemented on a regular basis, the BBS-Lite can be a complementary solution for systematic data collection, filling surveillance gaps and addressing the challenges that persist in obtaining important data on people who inject drugs (PWID) between IBBS rounds in the country. The methodology is recommended for testing in other settings and in other key populations. In addition, the data collected on a routine base can help the harm reduction (HR) program to better understand the changes in the drug scene and observe new trends in HIV risks and drug injecting behaviours, possible barriers for access to harm reduction, drug treatment, and HIV and/or viral hepatitis testing and treatment services.

Pre-Exposure Prophylaxis and HIV Prevention Among Key Populations in Nigeria.

The discovery of innovative pharmacological preventative measures in Human Immunodeficiency Virus transmission has boosted optimism in the successful control of HIV/AIDS with the objective of eradication and the end of the epidemic. Hence, assessing the effect of pre-exposure prophylaxis (PrEP) on HIV prevention among key populations (KPs) is imperative in advancing the conversation on ending HIV/AIDs. This was a cross-sectional study using data from KPs (female sex workers (FSWs), men who have sex with men (MSM), and people who inject drugs (PWIDs) enrolled in Heartland Alliance Ltd/GTE One Stop Shops (OSS) between May 2019 and April 2023 in the six selected Nigerian states (Lagos, Bayelsa, Cross River, Akwa Ibom, Jigawa, and Niger). Data were cleaned in a spreadsheet and analyzed using IBM-SPSS version 28.0. Descriptive statistics, including frequency and percentage calculations, were conducted to analyze the dataset. Additionally, cross-tabulation analysis was performed, with a significance level set at 0.05, to explore relationships between variables. The study population comprised 13,580 participants, with 56.1% female. In all, 43.9% were aged 18-35 and 97.3% were single. Among the three KPs examined, FSW was the largest subgroup (50.8%), followed by MSM (28.1%) and PWID (21.1%). Most participants had been on PrEP for 0-3 months (87.8%), and PrEP was initiated for 81.6% due to high-risk sexual behaviors and 9.9% for serodiscordant relationship reasons. Most of them were enrolled in community healthcare settings (97.0%). The results showed that 99.9% remained HIV negative, while only two (0.01%) were seroconverted while on PrEP. The HIV-positive cases did not complete one-month PreP treatment, comprising an FSW and a PWID. Recent HIV contact or poor compliance with PrEP medication are two possible causes of seroconversion. The findings underscore the significance of integrating PrEP into a comprehensive HIV prevention approach, including newer molecules that will improve adherence and the necessity of ongoing monitoring and support for PrEP users. With these insights, there can be an advocacy for promoting PrEP among the KPs as a vital component of Nigeria's HIV prevention strategy.

Adherence to antiretroviral therapy among people living with HIV attending medication-assisted treatment clinics in Dar es Salaam, Tanzania: a cross-sectional study.

the prevalence of human immunodeficiency virus (HIV) among people who inject drugs (PWIDs) in Tanzania is estimated at 35%, significantly surpassing the 4.6% HIV prevalence of the general population. People who inject drugs living with HIV have been reported to exhibit lower adherence to antiretroviral therapy (ART), leading to increased rates of mortality, morbidity, and HIV transmission. This study assessed adherence to ART and associated factors among PWIDs in Dar es Salaam. this cross-sectional study involved 277 PWIDs living with HIV who attended MAT clinics in Dar es Salaam from May to July 2022. Antiretroviral therapy adherence was assessed using a validated one-month self-recall medication adherence scale, and associated factors were obtained through a structured questionnaire. Statistical analyses included chi-square tests, Fisher exact tests, and log-binomial regression. Data were analyzed using STATA version 15, with a p-value of <0.05 considered statistically significant. this study found that 83% of the study participants had a high level of adherence to ART. Additionally, the results revealed that PWIDS who consume alcohol were less likely to have high adherence to ART (aPR 0.820). On the other hand, higher odds of ART adherence were observed among participants who had family support (aPR 1.028) and those who had adequate knowledge of ART benefits (aPR 1.285). the government and development partners should implement novel interventions such as alcohol reduction programs, ART education, and expanded HIV community outreach services. These interventions have the potential to improve ART adherence and reduce HIV transmission among PWIDs.

Has the HCV cascade of care changed among people who inject drugs in England since the introduction of direct-acting antivirals?

BackgroundIn England, over 80 % of those with hepatitis C virus (HCV) infection have injected drugs. We quantified the HCV cascade of care (CoC) among people who inject drugs (PWID) in England and determined whether this improved after direct-acting antivirals (DAAs) were introduced. MethodsWe analysed data from nine rounds of national annual cross-sectional surveys of PWID recruited from drug services (2011–2019; N = 12,320). Study rounds were grouped as: 'Pre-DAAs’ (2011–2014), ‘Prioritised DAAs’ (2015–2016) and 'Unrestricted DAAs’ (2017–2019). Participants were anonymously tested for HCV antibodies and RNA and completed a short survey. We assessed the proportion of PWID recently (current/previous year) tested for HCV. For participants ever HCV treatment eligible (past chronic infection with history of treatment or current chronic infection), we assessed the CoC as: HCV testing (ever), received a positive test result, seen a specialist nurse/doctor, and ever treated. We used logistic regression to determine if individuals progressed through the CoC differently depending on time-period, whether time-period was associated with recent testing (all participants) and lifetime HCV treatment (ever eligible participants), and predictors of HCV testing and treatment in the Unrestricted DAAs period. ResultsThe proportion of ever HCV treatment eligible PWID reporting lifetime HCV treatment increased from 12.5 % in the Pre-DAAs period to 25.6 % in the Unrestricted DAAs period (aOR:2.40, 95 %CI:1.95–2.96). There were also increases in seeing a specialist nurse/doctor. The largest loss in the CoC was at treatment for all time periods. During the Unrestricted DAAs period, recent (past year) homelessness (vs never, aOR:0.66, 95 %CI:0.45–0.97), duration of injecting (≤3 years vs >3 years; aOR:0.26, 95 %CI:0.12–0.60), never (vs current, aOR:0.31, 95 %CI:0.13–0.75) or previously being prescribed OAT (vs current, aOR:0.67, 95 %CI:0.47-0.95), and never using a NSP (vs past year, aOR:0.27, 95 %CI:0.08–0.89) were negatively associated with lifetime HCV treatment. The proportion of PWID reporting recent HCV testing was higher during Unrestricted DAAs (56 %) compared to Pre-DAAs (48 %; aOR:1.28, 95 %CI:1.06–1.54). ConclusionCOC stages from seeing a specialist onwards improved after DAAs became widely available. Further improvements in HCV testing are needed to eliminate HCV in England.

Measuring HIV Acquisitions Among Partners of Key Populations: Estimates From HIV Transmission Dynamic Models.

Key populations (KPs), including female sex workers (FSWs), gay men and other men who have sex with men (MSM), people who inject drugs (PWID), and transgender women (TGW) experience disproportionate risks of HIV acquisition. The UNAIDS Global AIDS 2022 Update reported that one-quarter of all new HIV infections occurred among their non-KP sexual partners. However, this fraction relied on heuristics regarding the ratio of new infections that KPs transmitted to their non-KP partners to the new infections acquired among KPs (herein referred to as "infection ratios"). We recalculated these ratios using dynamic transmission models. One hundred seventy-eight settings (106 countries). Infection ratios for FSW, MSM, PWID, TGW, and clients of FSW were estimated from 12 models for 2020. Median model estimates of infection ratios were 0.7 (interquartile range: 0.5-1.0; n = 172 estimates) and 1.2 (0.8-1.8; n = 127) for acquisitions from FSW clients and transmissions from FSW to all their non-KP partners, respectively, which were comparable with the previous UNAIDS assumptions (0.2-1.5 across regions). Model estimates for female partners of MSM were 0.5 (0.2-0.8; n = 20) and 0.3 (0.2-0.4; n = 10) for partners of PWID across settings in Eastern and Southern Africa, lower than the corresponding UNAIDS assumptions (0.9 and 0.8, respectively). The few available model estimates for TGW were higher [5.1 (1.2-7.0; n = 8)] than the UNAIDS assumptions (0.1-0.3). Model estimates for non-FSW partners of FSW clients in Western and Central Africa were high (1.7; 1.0-2.3; n = 29). Ratios of new infections among non-KP partners relative to KP were high, confirming the importance of better addressing prevention and treatment needs among KP as central to reducing overall HIV incidence.

Comparison of Empirically Derived and Model-Based Estimates of Key Population HIV Incidence and the Distribution of New Infections by Population Group in Sub-Saharan Africa.

The distribution of new HIV infections among key populations, including female sex workers (FSWs), gay men and other men who have sex with men (MSM), and people who inject drugs (PWID) are essential information to guide an HIV response, but data are limited in sub-Saharan Africa (SSA). We analyzed empirically derived and mathematical model-based estimates of HIV incidence among key populations and compared with the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates. We estimated HIV incidence among FSW and MSM in SSA by combining meta-analyses of empirical key population HIV incidence relative to the total population incidence with key population size estimates (KPSE) and HIV prevalence. Dynamic HIV transmission model estimates of HIV incidence and percentage of new infections among key populations were extracted from 94 country applications of 9 mathematical models. We compared these with UNAIDS-reported distribution of new infections, implied key population HIV incidence and incidence-to-prevalence ratios. Across SSA, empirical FSW HIV incidence was 8.6-fold (95% confidence interval: 5.7 to 12.9) higher than total population female 15-39 year incidence, and MSM HIV incidence was 41.8-fold (95% confidence interval: 21.9 to 79.6) male 15-29 year incidence. Combined with KPSE, these implied 12% of new HIV infections in 2021 were among FSW and MSM (5% and 7% respectively). In sensitivity analysis varying KPSE proportions within 95% uncertainty range, the proportion of new infections among FSW and MSM was between 9% and 19%. Insufficient data were available to estimate PWID incidence rate ratios. Across 94 models, median proportion of new infections among FSW, MSM, and PWID was 6.4% (interquartile range 3.2%-11.7%), both much lower than the 25% reported by UNAIDS. Empirically derived and model-based estimates of HIV incidence confirm dramatically higher HIV risk among key populations in SSA. Estimated proportions of new infections among key populations in 2021 were sensitive to population size assumptions and were substantially lower than estimates reported by UNAIDS.

Policies for Expanding Hepatitis C Testing and Treatment in United States Prisons and Jails

Hepatitis C virus (HCV) is highly prevalent in United States prisons and jails. In prisons and jails, rates of infection are ten to twenty times greater than national levels. And, more than thirty percent of all people living with HCV in the United States will spend time in prisons and jails in any given year. Rates are especially high among people who inject drugs (PWID), a population whose members are also likely to move between carceral settings and the community. Thus, addressing HCV among incarcerated populations would have a significant effect on the virus’s transmission both in and out of confinement and is a crucial part of any HCV elimination strategy. Safe and effective HCV treatment is available. Direct-acting antivirals (DAAs) offered in an eight to twelve week course of oral treatment cure HCV in more than ninety percent of cases. Widespread testing and treatment in prisons and widespread testing and treatment or linkage to community care in jails are essential public health approaches. But testing and treatment in confinement lags behind medical guidance and public health recommendations. People incarcerated in prisons and detained in jails are entitled to adequate health care, and the U.S. Constitution prohibits deliberate indifference to their serious medical needs. In recent years, lawsuits filed by people with HCV in carceral facilities across the country have alleged violations of federal law for failure to provide DAA treatment. Although litigation results have been mixed, settlement agreements in states across the country have expanded HCV testing and broadened access to DAA treatment. These settlement agreements reflect a growing understanding that widespread testing and treatment is cost-effective, avoid the harmful health consequences of disease progression, and meaningfully reduce community transmission. This paper recommends model policies for prisons and jails to expand HCV testing and DAA treatment. The policy recommendations draw from relevant settlement agreements and current medical guidelines, supplemented by input from public health experts, medical professionals, and advocates. The paper proceeds as follows: • Part I describes the HCV epidemic in United States prisons and jails, the recent sea change in treatment protocols, and relevant clinical guidance and public health recommendations. • Part II sets out the legal landscape, including governing federal law and judicial decisions interpreting that law in this context, and describes settlement agreements in class action lawsuits addressing DAA access. • Finally, Part III offers model policies for prisons and jails to expand testing and treatment and to support successful outcomes for people with HCV in their custody.