Combined prevention for persons who inject drugs in the HIV epidemic in a transitional country: the case of Tallinn,Estonia

The study was undertaken to assess the potential effectiveness of combined HIV prevention on the very high seroprevalence epidemic among persons who inject drugs (PWID) in Tallinn, Estonia, a transitional country. Data from community-based cross-sectional (respondent-driven sampling) surveys of PWID in 2005, 2007, 2009, and 2011 were used together with mathematical modeling of injection-associated HIV acquisition to estimate changes in injection-related HIV incidence during these periods. Utilization of one, two, or three of the interventions available in the community (needle and syringes exchange program, antiretroviral treatment [ART], HIV testing, opioid substitution treatment) was reported by 42.5%, 30.5%, and 11.5% of HIV+ and 34.7%, 36.4%, and 5.7% of HIV– PWIDs, respectively, in 2011. The modeling results suggest that the combination of needle/syringe programs and provision of ART to PWID in Tallinn substantially reduced the incidence of HIV infection in this population, from an estimated 20.7/100 person-years in 2005 to 7.5/100 person-years in 2011. In conclusion, combined prevention targeting HIV acquisition and transmission-related risks among PWID in Tallinn has paralleled the downturn of the HIV epidemic in this population.     

Perceived discrimination among racial and ethnic minority drug users and the association with health care utilization

ABSTRACT

People who use drugs (PWUDs) are at increased risk for several medical conditions, yet they delay seeking medical care and utilize emergency departments (EDs) as their primary source of care. Limited research regarding perceived discrimination and PWUDs’ use of health care services exists. This study explores the association between interpersonal and institutional racial/ethnic and drug use discrimination in health care settings and health care utilization among respondents (N?=?192) recruited from methadone maintenance treatment programs (36%), HIV primary care clinics (35%), and syringe exchange programs (29%) in New York City (n?=?88) and San Francisco (n?=?104). The Kaiser Family Foundation Survey of Race, Ethnicity, and Medical Care questionnaire was utilized to assess perceived institutional racial/ethnic and drug use discrimination. Perceived institutional discrimination was examined across race/ethnicity and by regular use of ERs, having a regular doctor, and consistent health insurance. Perceived interpersonal discrimination was examined by race/ethnicity. Perceived interpersonal drug use discrimination was the most common type of discrimination experienced in health care settings. Perceptions of institutional discrimination related to race/ethnicity and drug use among non-Hispanic Whites did not significantly differ from those among non-Hispanic Blacks or Hispanics. A perception of less frequent institutional racial/ethnic and drug use discrimination in health care settings was associated with increased odds of having a regular doctor. Awareness of perceived interpersonal and institutional discrimination in certain populations and the effect on health care service utilization should inform future intervention development to help reduce discrimination and improve health care utilization among PWUDs.     

氯丙嗪穴位注射治疗顽固性呃逆39例

顽固性呃逆是指膈肌不自主的,持续间歇性痉挛,并且常规止呃药物及针灸不能缓解者,常见于脑血管并发症,胃肠功能紊乱。笔者近7a来采用氯丙嗪穴位注射治疗本病39例,疗效满意。现报告如下。1临床资料39例中男性23例,女性16例,年龄26岁～84岁,平均年龄57.18岁;脑栓塞21例,脑出血8例,胃肠功能紊乱6例,蛛网膜下腔出血4例。本组脑血管疾病均经CT检查确诊,在原发病救治中出现呃逆症状;胃肠功能紊乱者系排除胃肠器质性疾病后引起的呃逆。二者皆经常规止呃治疗无效,确诊为顽固性呃逆。2治疗方法取穴:内关、中脘、足三里、合谷。药物:氯丙嗪注射液。操…     

控制性超促排卵治疗周期HCG注射时间的选择

对我中心1999年7月至2000年5月施行的182个体外受精－胚胎移植（IVF－ET）捉排卵周期,阴道超声监测卵泡发育以及血和尿LH峰的监测情况进行回顾性分析,发现注射HCG日妊娠组和非妊娠组间2个最大卵泡的平均直径及优质胚胎率有显著性意义（P＜0．05）,认为适时注射HCG是很重要的。     

Eligibility of persons who inject drugs for treatment of hepatitis C virus infection

In this decade, an increase is expected in end-stage liver disease and hepatocellular carcinoma, most com-monly caused by hepatitis C virus(HCV) infection. Although people who inject drugs(PWID) are the ma-jor source for HCV infection, they were excluded from antiviral treatments until recently. Nowadays there is incontrovertible evidence in favor of treating these pa-tients, and substitution therapy and active substance use are no longer contraindications for antiviral treat-ment. The viral clearance in PWID after HCV antiviral treatment with interferon or pegylated interferon com-bined with ribavirin is comparable to the viral clearance in non-substance users. Furthermore, multidisciplinary approaches to delivering treatment to PWID are ad-vised, and their treatment should be considered on an individualized basis. To prevent the spread of HCV in the PWID community, recent active PWID are eligible for treatment in combination with needle exchangeprograms and substitution therapy. As the rate of HCV reinfection is low after HCV antiviral treatment, there is no need to withhold HCV treatment due to concerns about reinfection alone. Despite the advances in treat-ment efficacies and data supporting their success, HCV assessment of PWID and initiation of antiviral treatment remains low. However, the proportion of PWID as-sessed and treated for HCV is increasing, which can be further enhanced by understanding the barriers to and facilitators of HCV care. Removing stigmatization and implementing peer support and group treatment strate-gies, in conjunction with greater involvement by nurse educators/practitioners, will promote greater treatment seeking and adherence by PWID. Moreover, screening can be facilitated by noninvasive methods for detect-ing HCV antibodies and assessing liver fibrosis stages. Recently, HCV clearance has become a major endpoint in the war against drugs for the Global Commission on Drug Policy. This review highlights the most recent evi-dence concerning HCV infection and treatment strate-gies in PWID.