Mortality Among Injecting Drugs Users - A Follow-up Study Of Injecting Drug User Cohorts.
Funder
National Health and Medical Research Council
Funding Amount
$47,500.00
Summary
This study will follow-up injecting drug users that participated in research in the 1990s and 2000s to examine mortality rates in these groups over time. Identifying information from these studies will be cross-referenced with National Death Index data to determine participants that died and the dates of their death. This study will be the first in Australia to determine mortality rates over time in a defined cohort of injecting drug users outside drug treatment settings. Studying a defined grou ....This study will follow-up injecting drug users that participated in research in the 1990s and 2000s to examine mortality rates in these groups over time. Identifying information from these studies will be cross-referenced with National Death Index data to determine participants that died and the dates of their death. This study will be the first in Australia to determine mortality rates over time in a defined cohort of injecting drug users outside drug treatment settings. Studying a defined group overcomes some of the problems associated with mortality rate estimates based simply on the number of injecting drug-related deaths. Although the number of deaths can be found, the number of people at risk of injecting drug-related death is unclear because of the hidden nature of drug use and the dynamic characteristics of drug use and drug markets. The examination of mortality trends among injecting drug users over time can provide insights regarding changes in drug use patterns and markets. For example, this study will examine changes in injecting drug use mortality across periods of high heroin availability in the late '90s and periods of interrupted heroin supply - the heroin 'drought' - from 2000 onwards. In addition, factors related to injecting drug-related mortality can be explored by comparing the characteristics of injecting drug users that died and those that survived, such as drug use and drug treatment histories, co-morbidities such as mental illness and socio-demographic backgrounds. This information can inform overdose prevention and harm reduction strategies by identifying individuals most at risk of injecting drug-related mortality. This study will also draw attention to the significant public health burden of injecting drug use. In addition, by comparing the results from this study with other similar studies from overseas, we can more reliably compare mortality among groups of Australian injecting drug users with their peers in other countries.Read moreRead less
Comparing The Role Of Takeaways In Methadone Maintenance Treatment In NSW And Victoria
Funder
National Health and Medical Research Council
Funding Amount
$291,000.00
Summary
This project will make a direct and major contribution to improving methadone maintenance treatment (MMT) provision in Australia. The recent announcement of the continuation of funding for the Federal Government's Illicit Drug Diversion Initiative demonstrates an ongoing commitment to make drug treatment programs more accessible. MMT is currently the primary treatment for opioid addiction in Australia. However, concerns about the potential negative effects of aspects of the programs, in particul ....This project will make a direct and major contribution to improving methadone maintenance treatment (MMT) provision in Australia. The recent announcement of the continuation of funding for the Federal Government's Illicit Drug Diversion Initiative demonstrates an ongoing commitment to make drug treatment programs more accessible. MMT is currently the primary treatment for opioid addiction in Australia. However, concerns about the potential negative effects of aspects of the programs, in particular, takeaway dosing and diversion of methadone to street sale (which has been linked to accidental fatal overdose (Lintzeris, et al., 1999)), remain unresolved. This study will map clients', healthcare workers' and policy makers' attitudes towards takeaways in NSW and Victoria, and investigate the dynamics of methadone diversion in relation to the different takeaway policies in the two states. In doing so, the project will consider how the two different state policies on takeaways stack up. It will contribute essential and detailed data on takeaways and diversion, from which effective, safe and socially responsible methadone maintenance treatment policy can be developed.Read moreRead less
Randomised Controlled Trial Of Hepatitis B Vaccine Completion In Injecting Drug Users
Funder
National Health and Medical Research Council
Funding Amount
$463,355.00
Summary
This randomised trial will examine strategies to increase hepatitis B vaccination in drug users by comparing 1) usual clinical care; 2) enhanced outreach; and 3) financial incentive payments and assessing the proportion in each group who a) complete all 3 doses and b) develop immunity. Results will provide policy-makers and clinicians with important data on effectiveness, including cost effectiveness, and will help scientists and affected communities prepare for clinical trials of new vaccines.
The Natural History Of Injecting Drug Use Among IDU In Melbourne: A Prospective Cohort Study
Funder
National Health and Medical Research Council
Funding Amount
$760,869.00
Summary
Our response to the emergent epidemic of methamphetamine injection is hampered by our lack of understanding of injecting drug use (IDU) natural history that place users at risk of harm and the effectiveness of interventions. This study will examine typical trajectories of IDU and provide a framework for service evaluation. The study will focus on untreated methamphetamine and heroin users, providing the first clear indication of the comparative harms associated with these different types of IDU.
The HITS Study: Modes Of Transmission, Natural History And Determinants Of Outcome From Primary Hepatitis C Infection
Funder
National Health and Medical Research Council
Funding Amount
$948,250.00
Summary
Hepatitis C (HCV) affects approximately 200,000 Australians, of whom a significant minority develop long term complications, including cirrhosis, liver failure and liver cancer. The dominant mode of transmission of this virus is via blood-to-blood contact, particularly via injecting drug use. Prisons appear to be a key focus of transmission of hepatitis C in the community as the majority of inmates are incarcerated for drug-related crimes, and injecting drug use remains prevalent whilst in priso ....Hepatitis C (HCV) affects approximately 200,000 Australians, of whom a significant minority develop long term complications, including cirrhosis, liver failure and liver cancer. The dominant mode of transmission of this virus is via blood-to-blood contact, particularly via injecting drug use. Prisons appear to be a key focus of transmission of hepatitis C in the community as the majority of inmates are incarcerated for drug-related crimes, and injecting drug use remains prevalent whilst in prison. In addition, as almost one in two inmates are already infected at the time of incarceration, those who are uninfected appear to be at significant risk of becoming infected through other (non-injecting) routes such as tattooing, fights and other coincidental blood exposures. This application seeks support for the HITS study (Hepatitis C Incidence and Transmission in Prisons study) - a prospective cohort study of inmates of NSW prisons. Following a successful pilot in which the substantial bureaucratic and logistical hurdles were resolved, the main cohort has been enroling since late 2000. The initial data have confirmed a high rate of at risk behaviour amongst inmates and three primary HCV infections acquired in prison have been documented featuring an unusual antibody negative pattern which would typically pass undetected in screening assays for HCV infection. After exposure to HCV and the development of primary infection, approximately one in five individuals successfully resolves the infection and clears the virus, presumably via an efficient immune response or a non-virulent virus, or a combination of these factors. Therefore, in addition to the public health aspects of the HITS study, the research also aims to define the immunological and virological factors which allow clearance of HCV. These studies will provide key information to guide treatment and immunisation strategies against hepatitis C.Read moreRead less
Improving Understanding Of Psychostimulant-related Harms In Australia: An Integrated Ethno-epidemiological Approach
Funder
National Health and Medical Research Council
Funding Amount
$612,430.00
Summary
National drug surveys and surveillance systems have detected sharp increases in the use of 'psychostimulant' drugs such as the amphetamines, ecstasy and cocaine. The level of harms associated with excessive use of these drugs, such as mental health problems and drug dependence, has also increased, as has the use of these drugs via injection. These increases in the prevalence of use and related harms have also been detected internationally. Previous research on psychostimulant drugs, in Australia ....National drug surveys and surveillance systems have detected sharp increases in the use of 'psychostimulant' drugs such as the amphetamines, ecstasy and cocaine. The level of harms associated with excessive use of these drugs, such as mental health problems and drug dependence, has also increased, as has the use of these drugs via injection. These increases in the prevalence of use and related harms have also been detected internationally. Previous research on psychostimulant drugs, in Australia and overseas, has suggested that using these drugs in particular ways might be associated with a greater chance of contracting HIV and other blood-borne viruses such as hepatitis C (eg through sharing needles and syringes or other equipment associated with injecting drugs); sexually transmitted infections and other sexual health problems (eg through engaging in unsafe sex); and of being involved in violent incidents. Despite this previous research, however, little is known about the specific social and cultural contexts associated with psychostimulant-related harms, and this has stymied the development of appropriate responses to prevent such harms occurring. This research project will provide a greater understanding of the individual, social and cultural factors associated with pychostimulant-related harm through an innovative combination and integration of anthropological and epidemiological research methods known as 'ethno-epidemiology'. In order to access a range of psychostimulant-using contexts, research will focus on three sites: street-based drug users in Sydney, club drug users in Melbourne, and home-based recreational drug users in Perth. These groups have been chosen because they have high prevalences of psychostimulant use. The research project will provide important data that will inform future interventions, improve multidisciplinary models for drug research, and build Australia's capacity to conduct cutting-edge public health research.Read moreRead less
Understanding The Barriers To Improved Access, Engagement And Retention Of Methamphetamine Users In Health Services
Funder
National Health and Medical Research Council
Funding Amount
$788,291.00
Summary
Drug surveys show widespread use of methamphetamine. Its regular use, particularly via injection, is associated with a range of serious harms, including drug dependence, psychosis, viral infection and violence. In order to improve access, engagement and retention of methamphetamine injectors in drug treatment and other health services, and thereby reduce these harms, further research is urgently needed to better understand their healthcare needs and the existing barriers to service utilisation.
An Analysis Of Blood Awareness For The Purposes Of Hepatitis C Prevention Education And Health Promotion.
Funder
National Health and Medical Research Council
Funding Amount
$196,113.00
Summary
This project will make a direct and major contribution to Hepatitis C prevention by addressing the need for blood awareness in prevention education. The need for measures to prevent the spread of HCV is based on the clinical implications of infection combined with its current prevalence and predicted spread within Australia. More than 200,000 Australians are estimated to be living with hepatitis C infection. Around 11,000 new HCV infections per year are estimated to occur across the Australia. H ....This project will make a direct and major contribution to Hepatitis C prevention by addressing the need for blood awareness in prevention education. The need for measures to prevent the spread of HCV is based on the clinical implications of infection combined with its current prevalence and predicted spread within Australia. More than 200,000 Australians are estimated to be living with hepatitis C infection. Around 11,000 new HCV infections per year are estimated to occur across the Australia. HCV is spread through blood to blood exposure. In the absence of effective medical treatment for Hepatitis C virus (HCV) education about modes of transmission presents as the most viable means of containing the spread of the virus. The promotion of blood awareness has been identified as a key strategy for such education as it may ensure greater care on the part of the general community in the prevention of blood exposures. However, the development of a heightened awareness of blood as a source of infection is fraught with social and health implications. A crucial concern for those directly involved in promoting blood awareness is the need to ensure that such a strategy does not contribute to the already existing stigmatisation of those living with HCV or, more generally, promote irrational phobias about blood. Findings of the research will assist in the development of public health education campaigns to prevent the spread of HCV. It will also contribute to education prevention for other blood borne communicable diseases including HIV and other viral hepatitides. Further, it will provide a model of inquiry for developing health promotion programs seeking blood, semen, organ and tissue donation.Read moreRead less