Spread Of Blood-borne Viruses Research Articles

A scoping review of home-produced heroin and amphetamine-type stimulant substitutes: implications for prevention, treatment, and policy

Several home-produced substances such as krokodil and boltushka are prevalent in many Eastern European countries. Anecdotal reports of its use have been circulating in Germany and Norway; however, this has not been confirmed. Its use has also been reported by the media in the USA, although only one confirmed report of its use exists. Home-produced drugs are associated with high levels of morbidity and a number of complex health issues such as the spread of blood borne viruses, gangrene, and internal organ damage. The high incidence of HIV rates amongst people who inject home-produced substances is a public health concern. The resulting physical health consequences of injecting these crude substances are very severe in comparison to heroin or amphetamine acquired in black markets. Due to this fact and the increased mortality associated with these substances, professionals in the area of prevention, treatment, and policy development need to be cognisant of the presentation, harms, and the dangers associated with home-produced substances globally. This scoping review aimed to examine existing literature on the subject of home-produced heroin and amphetamine-type stimulant substitutes. The review discussed the many implications such research may have in the areas of policy and practice. Data were gathered through the use of qualitative secondary resources such as journal articles, reports, reviews, case studies, and media reports. The home production of these substances relies on the utilisation of precursor drugs such as less potent stimulants, tranquillizers, analgesics, and sedatives or natural plant ingredients. The Internet underpins the facilitation of this practice as recipes, and diverted pharmaceutical sales are available widely online, and currently, ease of access to the Internet is evident worldwide. This review highlights the necessity of prevention, education, and also harm reduction related to home-produced drugs and also recommends consistent monitoring of online drug fora, online drug marketplaces, and unregulated pharmacies.

Addressing misuse and diversion of opioid substitution medication: guidance based on systematic evidence review and real-world experience.

Opioid dependence treatment, comprising opioid substitution treatment (OST) and psychosocial intervention, is accepted to improve outcomes in opioid addiction for both the individual and public health. OST medication such as methadone or buprenorphine may be misused or diverted. This results in failure to recover from addiction, increased crime and the spread of blood-borne viruses. Worldwide, attempts to address misuse and diversion have been proposed and implemented with varying impact. A structured, expert-led process recommended the most impact. As an initial step, a broad range of strategies were defined, and a systematic review of published literature identified 37 highly relevant sources of evidence. Experts reviewed this evidence and ranked the list of strategies for effectiveness and ease of implementation, based on their clinical experience. Three groups of strategies to address misuse or diversion are defined, depending on impact (effectiveness and ease of implementation). Preferred strategies include the promotion of access to treatment and the use of product formulations less likely to be misused. However, additional data and innovative approaches to address this complex problem are needed.

Comparison of Daily Reports and Retrospective Recall for Eliciting Drug Injection Partners

To understand the spread of bloodborne viruses in injection drug users (IDUs), it is important to ascertain networks of injection contact. However, in retrospective interviews, IDUs often forget many injection partners. We compared retrospective recall with daily reporting.We gave mobile phones to 14 IDUs who had participated in the first daily reporting study of the project. For four weeks, participants reported their injection partners in automated daily telephone interviews. Then, in a retrospective interview, they recalled their partners from the four-week period and received location and network cues to enhance recall. The 11 participants who reported partners in the daily interviews missed 3.4 (out of 28) such interviews on average. In the daily reports, they listed a mean of 6.4 unique partners. In the retrospective interview, they recalled a mean of 5.1 partners, including a mean of 0.8 in response to the recall cues (a 17% increase on average). One-third of cue-elicited partners were mentioned in the daily reports. In the retrospective interview, participants forgot 2.7 partners on average, and listed a mean of 1.5 partners not in the daily reports (perhaps partners on days with missing daily reports). The total number of partners reported at follow-up was moderately positively correlated with the total number of unique partners reported during the daily interviews (r = 0.66, intraclass correlation = 0.64). There was some under- and over-reporting of partnership risk at follow-up, relative to risk reported in the daily interviews, which could be due to missing daily reports and misreporting at follow-up, respectively. Other results mirrored prior research on correlates of forgetting. First, the number of partners freely recalled at follow-up correlated moderately positively with the number of partners elicited by the recall cues (r = 0.52). Second, forgotten partnerships involved, on average, slightly less risk and slightly greater injection frequency. Forgotten partnerships were moderately less recent, though still within the 28-day study period, and one-third of forgotten partnerships occurred within 14 days of the follow-up interview. In conclusion, daily reporting of injection partners is feasible and may be a useful adjunct to retrospective recall in some situations. The replication of the recall cues' effectiveness suggests that such techniques should be used as standard practice in injection network elicitation.

Comparison of daily reports and retrospective recall for eliciting drug injection partners

To understand the spread of bloodborne viruses in injection drug users (IDUs), it is important to ascertain networks of injection contact. However, in retrospective interviews, IDUs often forget many injection partners. We compared retrospective recall with daily reporting.We gave mobile phones to 14 IDUs who had participated in the first daily reporting study of the project. For four weeks, participants reported their injection partners in automated daily telephone interviews. Then, in a retrospective interview, they recalled their partners from the four-week period and received location and network cues to enhance recall. The 11 participants who reported partners in the daily interviews missed 3.4 (out of 28) such interviews on average. In the daily reports, they listed a mean of 6.4 unique partners. In the retrospective interview, they recalled a mean of 5.1 partners, including a mean of 0.8 in response to the recall cues (a 17% increase on average). One-third of cue-elicited partners were mentioned in the daily reports. In the retrospective interview, participants forgot 2.7 partners on average, and listed a mean of 1.5 partners not in the daily reports (perhaps partners on days with missing daily reports). The total number of partners reported at follow-up was moderately positively correlated with the total number of unique partners reported during the daily interviews (r = 0.66, intraclass correlation = 0.64). There was some under- and over-reporting of partnership risk at follow-up, relative to risk reported in the daily interviews, which could be due to missing daily reports and misreporting at follow-up, respectively. Other results mirrored prior research on correlates of forgetting. First, the number of partners freely recalled at follow-up correlated moderately positively with the number of partners elicited by the recall cues (r = 0.52). Second, forgotten partnerships involved, on average, slightly less risk and slightly greater injection frequency. Forgotten partnerships were moderately less recent, though still within the 28-day study period, and one-third of forgotten partnerships occurred within 14 days of the follow-up interview. In conclusion, daily reporting of injection partners is feasible and may be a useful adjunct to retrospective recall in some situations. The replication of the recall cues' effectiveness suggests that such techniques should be used as standard practice in injection network elicitation.

The Jailbreak Health Project – incorporating a unique radio programme for prisoners

Several studies in NSW have identified prisoners to be at high risk for blood borne viruses. The prevalence of hepatitis C among men in NSW correctional centres is 40% and over 60% among women. It is even higher among those with histories of injecting drug use. As part of the state's strategy to minimise the spread of blood borne viruses and promote healthy lifestyles among prisoners, the Community Restorative Centre broadcasts a weekly half hour radio programme to prisoners and the community. The project is funded through the NSW Health Department and aims to provide support to prisoners, ex-prisoners and their families. Jailbreak's success hinges on the participation of the very people [prisoners] the show wishes to target. The radio show is aimed specifically at broadcasting health promotion and harm-minimisation messages to prisoners and their supporters although this is not obvious. When you tune in to Jailbreak you will hear a diverse range of opinion, music and poetry from people caught up in the criminal justice system. Nevertheless at the heart of this exciting and challenging project is the delivery of engaging, relevant and clear health messages to prison inmates, ex-inmates and families in relation to HIV, hepatitis and sexual health. Since 2002, valuable health information, often in the form of personal stories, vignettes and quiz questions, can be heard in and around Sydney on 2SER 107.3 FM or online at http://www.2ser.com. Jailbreak has not been without controversy and has to balance the security focus of correctional authorities and the illegality of substance use in correctional centres with the need to convey messages to prisoners in relation to harm-minimisation.

Alcohol supply, demand, and harm reduction: What is the strongest cocktail?

The concept of harm reduction emerged from the drug field in the 1980s in response to the urgent need to reduce the risk and spread of blood-borne viruses in people who continued to inject illicit drugs. The concept has since become increasingly influential in the alcohol and even tobacco fields. While there are many different applications of the term today, the distinction used by the International Harm Reduction Association (IHRA) between strategies relying on ‘use reduction’ and those that primarily strive for harm reduction without necessarily requiring reduction in consumption is used here. The evidence base for the effectiveness of harm reduction strategies on the one hand, and efforts that require a degree of use reduction via demand or supply reduction on the other hand, is summarised based on a comprehensive review funded by the Australian government. In the alcohol field, the concept of harm reduction has sometimes been proposed as an alternative to the view that alcohol-related harm will only be reduced via a reduction of the total population consumption of alcohol. This paper will present evidence to suggest that, in order to be most effective, a comprehensive policy to reduce alcohol-related harm needs also to include interventions to reduce the quantity of alcohol consumed per occasion. Furthermore, it is highly unlikely in most modern drinking societies that significant reductions in alcohol-related harm can occur without also a significant drop in total population consumption. Nonetheless, harm reduction is an important and influential principle in alcohol policy that can be incorporated alongside such effective strategies as controls on the physical and economic availability of alcohol and the routine delivery of brief interventions in primary health care settings.

Healthcare Settings as Amplifiers of Infectious Disease1

Global outbreaks of severe acute respiratory distress syndrome (SARS) in 2003 demonstrated the potential of healthcare facilities to serve as amplifiers of a new communicable disease. However, healthcare settings can also be amplifiers of multidrug-resistant bacteria and bloodborne viruses. In the public health and healthcare delivery systems, amplifying forces include weaknesses in communication, coordination, early detection and control of emerging diseases, and oversight of healthcare services. Among healthcare personnel, weaknesses include gaps in infection control knowledge and practice. SARS was spread globally by relatively few people and amplified by super-spreading events that occurred primarily in healthcare settings. Healthcare personnel were disproportionately affected, accounting for up to 57% of cases in some countries. The combination of increasing infectivity in the later stages of SARS, performance of the aerosol-generating procedures (bronchoscopy, intubation), and clustering of SARS patients further enhanced transmission of the SARS-associated coronavirus. Systems for early detection and isolation of persons with suspected SARS and public quarantine effectively reduced transmission. Conversely, absence of control measures at initial points of patient encounter, particularly in hospital emergency departments, rendered hospitals particularly vulnerable to SARS transmission. Unsafe injection and blood donation practices have contributed to the global spread of bloodborne viral diseases. Worldwide, unsafe injections alone are estimated to cause 21,000 cases of hepatitis B, 2,000 cases of hepatitis C, and 260 cases of HIV each year. Countries with limited resources are at a disproportionate risk for adverse injection-related outcomes. While lack of sterile supplies is important, unnecessary injections and poor understanding of infection control principles and practices also contribute to the spread of bloodborne viruses. These last two factors are not unique to the developing world. Four recent outbreaks of hepatitis B and C viruses in patients in ambulatory care facilities in the United States are a reminder that unsafe injections can occur in any healthcare setting. In these outbreaks, a lack of administrative oversight and poor understanding of infection control practices contributed to the contamination of multidose vials or the reuse of injection equipment and transmission of hepatitis B or hepatitis C virus to numerous patients. In contrast to SARS and bloodborne viruses, the rise and amplification of multidrug-resistant organisms in healthcare settings have been gradual and subtle. These organisms limit treatment options, increase transmission risks for vulnerable patient populations, increase illness and death, prolong the hospital stay, and add to healthcare costs. The rise of these organisms has been most dramatic in U.S. intensive care units, where >50% of Staphylococcus aureus isolates are resistant to methicillin (MRSA) and >25% of enterococcal isolates are resistant to vancomycin. Cases of vancomycin-intermediate S. aureus and three recent cases of vancomycin-resistant S. aureus, both in outpatient settings, attest to the potential for amplification of these organisms in healthcare settings. Gram-negative organisms resistant to extended-spectrum β-lactamases present similar concerns and have been associated with numerous outbreaks in healthcare facilities. The problem of multidrug-resistant organisms is multifaceted. While colonized and infected patients constitute the major reservoir for dissemination of these organisms, inappropriate use or overuse of antimicrobial agents contributes to acquiring and expressing resistance genes. Healthcare settings become breeding grounds of additional resistance and distribution centers for amplification of multidrug-resistant organisms to other healthcare settings and the community. The notion that our healthcare settings contribute to the amplification of infectious disease contradicts our expectations. Usually, healthcare systems work well, and quality healthcare is delivered safely and efficiently. Nonetheless, there are gaps in infrastructure, knowledge, and practice that can open the door to disease outbreaks.

A simulation model of the spread of Hepatitis C within a closed cohort

Many of the epidemics that have been given much publicity in recent years such as AIDS and hepatitis C, are caused by blood borne viruses. Most of these diseases cause long term illnesses and can often be fatal. Apart from the loss of life, the disease phase also makes considerable demands on the health system. As these viruses are spread through direct contact between individuals, changing the factors that contribute to their transmission may be useful in controlling the epidemics. This paper presents a simulation model of the spread of blood borne viruses that can be used to evaluate the effects of such influences. The model is applied to the spread of the hepatitis C virus and is validated using published results from a cohort study of injecting drug users.