HCV dispersal patterns among intravenous drug users (IDUs) in Athens metropolitan area

BackgroundMost of the HCV transmission the recent years in Greece was among IDUs. Our aim was to estimate the prevalence of HCV genotypes and to investigate the patterns of HCV dispersal among IDUs in Athens using current state of the art molecular epidemiology methods.MethodsHCV sequences were determined from 238 HIV-negative IDUs collected on the basis of the “ARISTOTLE” prevention program carried out in Athens between 2012 and 2013. Phylogenetic trees were inferred on HCV sequences isolated from IDUs in Athens for the most prevalent HCV clades (subtypes 1a and 3a). Phylogenetic analysis was performed by Neighbor-Joining and Bayesian methods using GTR + G as nucleotide substitution model. HCV dispersal patterns were estimated using as references, all globally available HCV sequences for subtypes 1a and 3a.ResultsThe prevalence of HCV subtypes was: 3a (59.2%), 1a (21.9%), 4 (13.0%), 1b (5.4%) and 2 (0.5%). Phylogenetic analyses revealed that most sequences (63.5%) οf subtypes 1a and 3a fell within IDU-specific monophyletic groups. The proportion of sequences in monophyletic clades was similar for subtype 3a (62.9%) and 1a (65.3%). For the latter group, monophyletic clades were smaller in size. Multivariable logistic regression analyses showed that monophyletic clustering was marginally associated recent onset of injecting ([AOR] = 1.44; 95% CI (0.97–2.13), p = 0.068).ConclusionsThe high proportions of HCV sequences within IDU-specific monophyletic clusters suggest that transmissions occurred locally among IDUs in Greece. The numerous clusters for both 1a and 3a provide evidence that both sub-epidemics were the result of multiple introductions among the IDUs. Higher regional clustering was probably associated with a more recent onset of drug use.     

Reconstructing the AIDS epidemic among injection drug users in Brazil

The HIV/AIDS epidemic among injection drug users (IDUs) in Brazil has been unique in terms of temporal and geographical contrasts. This analysis explores these contrasts through the use of multilevel modeling. Standardized AIDS incidence rates among IDUs for Brazilian municipalities (1986-2000) were used as the dependent variable, with a set of social indicators as independent variables (covariates). In some States of the North/Northeast, the epidemic among IDUs has been incipient. The S?o Paulo epidemic extended to reach a network of municipalities, most of which located far from the capital. More recently, on a smaller scale, a similar extension has been observed in the southernmost States of the country. Both "number of physicians per inhabitant" and "standard distance to the State capital" were found to be associated with AIDS incidence. AIDS cases among IDUs appeared to cluster in wealthier, more developed municipalities. The relative weight of such extensive dissemination in key, heavily populated States prevails in the Brazilian IDU epidemic, defining a central-western-southeastern strip of wealthier middle-sized municipalities and more recently a southern strip of municipalities deeply affected by the epidemic in this population.     

Human immunodeficiency virus (HIV) and Hepatitis C virus (HCV) testing among injecting drug users

In Hungary, there is a need for widely accessible HIV and HCV testing and counseling for injecting drug users. Theoretically, free and confidential rapid HIV and HCV testing would be the most suitable for this purpose. Low threshold agencies, such as needle and syringe programs, would provide ideal premises for such a testing system, Here, participants would be able to undergo regular testing every six months. Making rapid testing widely available raises the following three main issues: 1. validity of the testing results (or: the verification of positive rapid test results), 2. circumstances of taking blood (or: legislation regarding drawing blood), and 3. cost effectiveness (or: how important is it to prevent an HIV epidemic). The authors propose the establishment of a system that offers screening using rapid tests and which would be an expansion of a currently existing system of HIV and HCV testing based on finger prick blood. The current system would thus serve as a means to verify the results of the rapid tests. At the same time, there is a need to obtain permission from a public health body to enable in needle and syringe programs the provision of rapid testing and testing of blood using finger pricks. In many countries, test results are given to injecting drug users not by doctors but by trained social workers - such a system could also be established in Hungary. If preventing an HIV epidemic in Hungary is a priority, then wide access to rapid HIV testing is justified. Widely accessible free and confidential rapid HIV and HCV testing and counseling - combined with screening and verification using finger prick blood - may function not only as a testing and counseling service but also as a good quality public health monitoring system. Such a system, however, requires regular financial support from the government.     

Satisfaction with access to health care among injection drug users,other drug users,and nonusers

This article examines the satisfaction of users of cocaine and/or opiates and non-drug users with access to the health care system. Data were obtained from a sample of 1,477 injection drug users, non-injection drug users, and non-drug users recruited from neighborhoods with high drug use. Multiple regression examined the relationship between satisfaction with access to health care and demographic, health status and health care utilization, ability to pay, and alcohol and drug use variables. Age, ethnicity, health status, having received health care in the last 12 months, not having received health care when needed, having received preventive health care, health insurance, and drug use were independently associated with satisfaction. Injection drug users and non-injection drug users were less satisfied with access to health care. The article discusses strategies to improve health care delivery to drug users.     

社区美沙酮维持治疗门诊中HCV感染者接受抗病毒治疗现状及影响因素

抗病毒治疗是降低吸毒人群丙型肝炎病毒（Hepatitis C virus,HCV）感染及肝硬化发生的成本效益最优的措施,参加社区美沙酮维持治疗（Methadone maintenance treatment,MMT）人群HCV感染率高达60.1%,但接受抗病毒治疗率及影响因素目前尚不清楚。本文结合国外社区MMT运行模式及丙肝抗病毒治疗方案的应用,系统综述我国社区MMT人群HCV感染者接受抗病毒治疗现状,并从卫生服务提供方角度阐述其影响因素,为社区MMT更好地防控吸毒人群HCV感染提供理论依据。     

南京地区强制戒毒人群HCV感染的流行病学调查

目的：了解南京地区吸毒人群中丙型肝炎病毒（HCV）感染现状,分析吸毒方式、社会特征、性行为特征等和HCV感染的关系,为制定干预措施提供科学依据。方法：以南京市强制戒毒所587名戒毒人员作为调查对象,制定统一的调查问卷进行调查,并采集静脉血检测HCV抗体。结果：587名吸毒者HCV抗体总阳性率为61．7％。毒品滥用的种类、方式、滥用时间长短是HCV感染率高低的重要影响因素。静脉注射毒品组显著高于其他方式组（X^2=138．97,P=0．000）;吸食海洛因者显著高于吸食其他毒品者（X^2=76．82,P=0．000）;吸毒时间长短与HCV感染率呈趋势性相关（X^2=104．37,P=0．000）;而是否共用注射器及共用频率与HCV感染率未见显著性差异（X^2=0．00,P=0．958;X^2=0．41,P=0．524）。该人群不同性别、民族和职业间HCV感染率无显著性差异,而不同年龄和文化程度之间有显著性差异（X^2=6．44,P=0．011;X^2=8．41,P=0．004）。安全套的使用在遏制吸毒人群HCV感染方面具有着重要的作用。结论：南京地区吸毒人群的HCV感染率总体较高,多个性伴侣,安全套使用率低,以及静脉注射吸毒等高危行为普遍存在,应采取综合干预措施,控制HCV的传播,降低感染率。     

Hepatitis C infection,related services,and barriers to HCV treatment among drug users in methadone maintenance treatment (MMT) clinics in Shanghai,China

Background

The purpose of this study was to document the prevalence of hepatitis C among MMT patients, hepatitis C virus (HCV) knowledge of patients and MMT staff members, and the barriers preventing them from receiving or delivering HCV-related services in MMT clinics of China.

Methods

Data were collected from 240 MMT patients and 58 staff members in Shanghai MMT clinics. Structured questionnaires (HCV Knowledge Scale and Alcohol Use Disorders Identification Test) and several self-developed questionnaires were used to assess (1) patient and staff HCV knowledge, (2) attitudes toward HCV-related services in MMT clinics, and (3) what type of HCV-related services the staff members have provided in their routine work. The HCV test results were based on the patients’ medical records.

Results

The HCV seropositive rate was high (70%), and both patients and staff had limited HCV knowledge. The mean score of patient HCV knowledge was 6.8 out of 20 (SD = 3.7), whereas the mean score of staff HCV knowledge was 10.9 out of 20 (SD = 3.1). For HCV-positive patients, only 13.7% had accessed HCV medical treatment. Barriers included the cost of medical treatment, lack of HCV knowledge, lack of professional training for patients to receive HCV-related services from individuals or MMT clinics, and lack of an adequate policy-making system.

Conclusions

HCV infection remains an important problem among MMT patients in China. Barriers to HCV-related services are attributable to individual, clinical, and policy-related factors. This study may provide evidence-based information for future work to optimize the resources of MMT clinics.

Trial registration

ClinicalTrials.gov NCT01647191. Registered 17 April 2012.

     

Estimating the size of the HIV epidemic among injecting drug users in Amsterdam

Aim of this study was to assess the cumulative incidence of HIV-infection, AIDS and pre-AIDS death in the population of injecting drug users (IDU) in Amsterdam. By assuming equivalence, between a cohort of IDU and the IDU population, of the ratios of incidences of AIDS and pre-AIDS death to the number of HIV positive persons giving rise to these incidences, the numbers of HIV positive persons and pre-AIDS deaths in the population could be calculated, given that other parameters were known. Cohort study data on HIV prevalence and incidences of HIV infection, AIDS, and pre-AIDS death, were combined with national AIDS surveillance data. As of 1 October 1994, the estimated cumulative number of HIV positive IDU in Amsterdam was approximately 1280, far higher than a recent back-calculation estimate. Of the 1280, 204 HIV positive IDU had been diagnosed with AIDS, while about 270 had died pre- AIDS. The HIV prevalence of IDU residing in Amsterdam that were still alive and free of AIDS was hence estimated at around 800. Since the incidence of pre-AIDS death and AIDS exceeded the number of seroconversions during the past four years, the HIV epidemic among IDU in Amsterdam appears to be dwindling. A lower bound of the number of HIV positive IDU being alive, AIDS-free and living elsewhere in the Netherlands was roughly estimated at 600. Because of untimely deaths, only a limited number of HIV positive IDU can be expected to be diagnosed with AIDS in the future. Since these estimates are based upon some rather bold assumptions, they should be interpreted with caution and require further validation by independent sources.     

云南省两地抗病毒治疗门诊注射吸毒HIV感染者入组美沙酮维持治疗的影响因素分析

目的 了解云南省两地抗病毒治疗(ART)门诊注射吸毒HIV感染者的基本特征并分析其入组美沙酮维持治疗(MMT)的影响因素。方法 将云南省两地艾滋病疫情数据库进行关联,在ART门诊筛选出由注射吸毒感染HIV的人群作为研究对象,分成两组,一组是正在参加MMT,另一组是从未入组MMT。提取这些研究对象的一般人口学特征、相关疾病史、高危行为等信息。对研究对象的基本信息进行描述,运用单因素和多因素非条件logistic回归模型分析其影响因素。 结果 635例研究对象中,247例(38.9%)正在参加MMT,388例(61.1%)从未入组MMT;男性536例(84.4%),女性99例(15.6%);年龄M=40.33岁;确证感染HIV时间的M=6.08年。多因素分析结果显示,女性(OR=2.40,95%CI:1.00～5.74)、初中文化程度(OR=3.28,95%CI:1.75～6.14)和高中及以上文化程度(OR=7.10,95%CI:1.90～26.62)、确证感染时间≥6年(OR=3.84,95%CI:2.11～6.98)、患有丙型肝炎(OR=6.21,95%CI:3.06～12.58)是入组MMT的促进因素;已婚(OR=0.38,95%CI:0.20～0.72)、有职业(OR=0.01,95%CI:0.00～0.02)是入组MMT的限制因素。结论 两地ART门诊的注射吸毒人群入组MMT的比例不高,为加强这类人群转介入组MMT,需要对具有不同特征的患者采取有针对性干预措施。     

Syringe access for the prevention of blood borne infections among injection drug users

Background  

Approximately one-third of acquired immunodeficiency syndrome cases in the United States are associated with the practice of sharing of injection equipment and are preventable through the once-only use of syringes, needles and other injection equipment.     

Low perceived benefits and self-efficacy are associated with hepatitis C virus (HCV) infection-related risk among injection drug users

Hepatitis C prevention counselling and education are intended to increase knowledge of disease, clarify perceptions about vulnerability to infection, and increase personal capacity for undertaking safer behaviours. This study examined the association of drug equipment sharing with psychosocial constructs of the AIDS Risk Reduction Model, specifically, knowledge and perceptions related to hepatitis C virus (HCV) among injection drug users (IDUs). Active IDUs were recruited between April 2004 and January 2005 from syringe exchange and methadone maintenance treatment programs in Montreal, Canada. A structured, interviewer-administered questionnaire elicited information on drug preparation and injection practices, self-reported hepatitis C testing and infection status, and AIDS Risk Reduction Model constructs. Separate logistic regression models were developed to examine variables in relation to: (1) the sharing of syringes, and (2) the sharing of drug preparation equipment (drug containers, filters, and water). Among the 321 participants, the mean age was 33 years, 70% were male, 80% were single, and 91% self-identified as Caucasian. In the multivariable analyses, psychosocial factors linked to syringe sharing were lower perceived benefits of safer injecting and greater difficulty to inject safely. As with syringe sharing, the sharing of drug preparation equipment was associated with lower perceived benefits of safer injecting but also with low self-efficacy to convince others to inject more safely. Interventions should aim to heighten awareness of the benefits of risk reduction and provide IDUs with the skills necessary to negotiate safer injecting with their peers.     

社区美沙酮维持治疗者满意度及影响因素

目的 了解广东省15家社区美沙酮维持治疗门诊的辅助服务提供情况及受治者满意度影响因素。方法 对广东省15家社区美沙酮维持治疗门诊的747例受治者进行横断面调查,了解其一般人口学特征、实际接受到的门诊服务情况、期望得到的门诊服务,以及对门诊的满意度。结果 747例受治者中,男性671例,女性76例,平均年龄为（38.34±5.84）岁;大部分受治者接受过门诊提供的入组时美沙酮知识讲解（95.72%）、剂量调整（96.12%）、健康教育（89.02%）及定期讨论病情（85.27%）等服务,曾接受过门诊医生为其制定治疗计划（57.16%）、提供艾滋病治疗服务（52.21%）、丙肝转诊服务（61.85%）及丙肝药物治疗服务（50.47%）的比例则较低;半数以上受治者期望门诊像医院一样有夜间门诊（54.22%）,仅少部分受治者期望门诊维持现状（25.03%）、提供疾病治疗或转介服务（18.21%）及期望治疗收费调整（16.20%）;所有受治者对门诊满意度的平均得分为（69.74±12.08）分。多重线性回归结果显示,剂量调整（β'=0.11）、制定治疗计划（β'=0.08）、定期讨论病情（β'=0.09）、入组时美沙酮知识讲解（β'=0.08）、健康教育（β'=0.09）、丙肝药物治疗（β'=0.17）、艾滋病药物治疗（β'=-0.15）、期望门诊维持现状（β'=0.09）、治疗收费的调整（β'=-0.13）、提供疾病治疗或转介服务（β'=-0.11）10个因素影响受治者对门诊辅助服务的满意度。结论 目前 MMT 门诊提供的辅助服务尚未能满足受治者需求,门诊服务质量仍有待进一步提高,以提高受治者的满意度。     

Methadone treatment and risk of HIV infection in drug users without legal access to clean injection equipment

Summary The particular situation of the Swiss canton of Vaud (population 550 000) provides favourable observational conditions to assess the efficacy of a methadone treatment scheme in reducing the risk of human immunodeficiency virus (HIV) infection among drug users. On the one hand, the canton has a long tradition of methadone treatment dispensed by medical practitioners. On the other hand, no legal access to clean injection equipment was provided up to 1989. For the 754 drug addicts having entered at least one course of treatment at the end of 1988, HIV status was assessed through two surveys conducted at mid-1986 and at end 1988 among the private practitioners and in the screening centers, hospitals, medico-social institutions and prisons. The overall annual HIV seroconversion rate shifted only slightly from 13% in the first study period (1984 to mid-1986) to 11% in the second period (mid-1986 to end 1988). In both periods, patients no longer on treatment, mostly stable abstainers, were the less exposed to HIV infection with a relative risk of 0.65 (p<0.05). For those still on treatment, the risk of infection was associated directly (p<0.001) with the frequency of courses and inversely (p<0.001) with the duration. Between patients with more than 18 months spent on treatment and those with less than 6 months, the relative risk gradient was 0.8 and 1.4 before mid-1986 and widened out to 0.3 and 2.1 later on. This is mainly due to an increasing HIV incidence among newcomers into treatment. In condusion, methadone treatment has contributed to a significant risk reduction both through successful detoxication processes and in long-term maintenance, but facilitated access to sterile injection equipment is needed urgently for patients with poor attendance or new to treatment.

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Methadonbehandlung und HIV-Infektionsrisiko bei Drogenabhängigen ohne Zugang zu sterilem Injektionsmaterial

Zusammenfassung Die Wirksamkeit der Methadonbehandlung der Drogenabhängigen in Bezug auf die Pravention der Infektion mit HIV muss gezielt evaluiert werden Der Schweizer Kanton Waadt (550000 Einwohner) erlaubte vor 1989 keinen erleichterten Zugang zu sterilem Injektionsmaterial, hingegen waren seit 1976 von den Hausärzten verordnete Methadonkuren zulässig. Von 754 Drogenabhängigen, die vor 1989 mindestens eine Methadonkur absolviert hatten wurde in zwei Erhebungen (Mitte 1986 und Ende 1988) bei Arzten, Spitalern, sozialmedizinischen Elnrichtungen und Strafanstalten der HIV-Status erhoben. In den beiden Beobachtungsperioden (Anfang 1984 bis Mitte 1986, Mitte 1986 bis Ende 1988) betrugen die Serokonversionsraten 13%, bzw. 11% pro Jahr Diejenjgen, die nicht mehr in einer Methadonbehandlung waren, es handelte sich meist um Langzeitabstinente, hatten in beiden Perioden ein relatives Infektionsrisiko von 0,65 (p<0,05). Für die behandelten Patienten nahm das Infektionsrisiko mit der Anzahl Kuren zu (p<0,001) und es war mit der gesamten Dauer der Behandlung negativ assozilert (p<0,001). In der ersten Periode war das relative Infektionstisiko 0,8 für jene, die mindestens 18 Monate in Kurwaren und 1,4 für Patienten, die weniger als 6 Monate behandelt wurden. In der zweiten Periode waren die entsprechenden Risiken 0,3 und 2,1. Die zunehmende Diskrepanz ist durch eine hohe Serokonversionsrate der Patienten bedingt, die in der zweiten Periode erstmals zur Behandlung kamen. Aus den Studienresultaten darf man darauf schliessen dass die Methadonbehandlung durch den definition des HIV-Infektionsrisikos beigetragen hat. Hingegen ist der erleichterte Zugang zu sterilen Spritzen für Drogenabhängige, die erst am Anfang threr Behandlung stehen, eine notwendige Begleitmassnanme.

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Traitement à la méthadone et risque d'infection VIH dans une population de toxicomanes sans accès légal à du matériel d'injection stérile

Résumé L'efficacité du traitement à la méthadone comme mesure de prévention de l'infection VIH parmi les toxicomanes doit faire l'objet d'évaluations spécifiques. En Suisse, le canton de Vaud (550000 habitants) constitue une région d'étude intéressante par le fait qu'aucune facilité d'accès à du matériel d'injection stérile n'existait avant 1989, mais que les cures de méthadone auprès d'un médecin praticien sont autorisées depuis 1976. Pour les 754 toxicomanes ayant suivi au moins une cure avant 1989, le statut sérologique VIH a été recherché par le biais de deux enquêtes (mi-1986 et fin 1988) auprès des médecins, hôpitaux, institutions médico-sociales et prisons. Le taux annuel de séroconversion a passé de 13% entre début 1984 et mi-1986 à 11% entre mi-1986 et fin 1988. Dans chacune de ces périodes, les personnes qui ne sont plus en traitement, essentiellement des abstinents stables, sont les moins exposées à l'infection VIH, avec un risque relatif de 0.65 (p<0.05). Pour les patients traités, le risque d'infection VIH est associé directement avec la fréquence des cures (p<0.001) et inversément avec la durée passée sous méthadone (p<0.001) dans chaque période. Cependant, le gradient de risque s'est accru d'une période à l'autre entre les patients qui ont passé respectivement plus de 18 mois et moins de 6 mois en cure, avec des risques relatifs de 0,8 et 1,4 avant mi-1986, de 0,3 et 2,1 après mi-1986. Ce phénomène s'explique par une forte hausse du taux de séroconversion chez les nouveaux patients. Ces résultats soutiennent l'hypothèse que le traitement à la méthadone permet de réduire le risque d'infection VIH à la fois par des processus de sevrage réussis et par des maintenances à long terme. Cependant, la mise à disposition de seringues stériles s'impose comme une mesure complémentaire urgente auprès des toxicomanes qui commencent les cures de méthadone ou les suivent de manière intermittente.

     

2017—2019年贵阳市吸毒人群HCV感染相关因素及HIV、梅毒感染状况

目的 分析贵阳市哨点吸毒人群丙型肝炎病毒(HCV)、人类免疫缺陷病毒(HIV)与梅毒感染状况,并分析HCV感染相关影响因素,为针对性地预防控制吸毒人群感染HCV提供依据.方法 采用重复横断面调查方法调查贵阳市2017—2019年吸毒哨点监测的吸毒人群,每年前往不同的戒毒场所,以4—7月为监测期,同时采集静脉血进行HIV...     

Unofficial policy: access to housing, housing information and social services among homeless drug users in Hartford, Connecticut

Background  

Much research has shown that the homeless have higher rates of substance abuse problems than housed populations and that substance abuse increases individuals' vulnerability to homelessness. However, the effects of housing policies on drug users' access to housing have been understudied to date. This paper will look at the "unofficial" housing policies that affect drug users' access to housing.     

Trends in the AIDS epidemic among New York City’s injection drug users: Localized or citywide?

The New York City injection drug user acquired immunodeficiency syndrome (IDU AIDS)epidemic accounts for almost one quarter of AIDS cases in IDUs in the United States. Recent studies have reported declines in seroprevalence and risk behaviors among IDUs in New York City during the 1990s. These trends, however, are based on studies primarily conducted in the city’s central borough of Manhattan. This article analyzes data from all five boroughs of New York City to examine trends over phases of the epidemic and to determine the level of prevention services available; an exploratory qualitative study was also conducted to assess access to prevention services and injection practices in areas in the “outer boroughs”. Findings indicated that (1)borough differences in services and behaviors existed from early in the epidemic; (2)services have been concentrated in Manhattan; and (3)declines in seroprevalence were greatest among Manhattan-recruited IDUs. Enhancing access to services for IDUs in the boroughs outside Manhattan may be needed to continue the positive trends in all areas of New York City.     

Needle sharing behaviour among injection drug users (IDUs) in treatment in Montreal and Toronto, 1988-1989.

Injection drug users (IDUs) entering treatment programs in Montreal and Toronto were recruited for a study of drug using behaviour and risk of HIV infection. Only those who had injected within 6 months of entering their treatment program were eligible for participation. 183 subjects were recruited in Montreal and 167 in Toronto between November, 1988 and October, 1989. Each participant completed a standardized interviewer-administered questionnaire which focussed on, among other things, drug history and needle sharing behaviour. Approximately three-quarters of respondents in both cities reported sharing needles and syringes within the 6-month period prior to their entry into treatment. Our analysis, which focussed on variables associated with needle sharing revealed that having a sexual partner who injected, trouble obtaining sterile needles and syringes and cocaine injection were significantly and independently associated with needle sharing in a logistic regression model which also controlled for city of recruitment.