ORCID Profile
0000-0001-6020-6519
Current Organisations
National Health and Medical Research Council
,
Burnet Institute
,
UNSW Sydney
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Infectious Diseases | Clinical Sciences | Public Health and Health Services not elsewhere classified | Epidemiology | Public Health and Health Services | Respiratory Diseases | Criminology not elsewhere classified
Public Health (excl. Specific Population Health) not elsewhere classified | Infectious diseases | Preventive medicine | Justice and the Law not elsewhere classified |
Publisher: Springer Science and Business Media LLC
Date: 05-09-2017
DOI: 10.1186/S13722-017-0085-X
Abstract: HIV prevalence remains high in Cambodia among female entertainment and sex workers (FESW), and hetamine-type stimulant (ATS) use significantly increases risk of infection. A successful continuum of care (CoC) is key to effective clinical care and prevention. This study aimed to describe the HIV CoC in HIV-positive FESW. We examined CoC outcomes among HIV-positive FESW participating in the Cambodia Integrated HIV and Drug Prevention Implementation (CIPI) study, being implemented in ten provinces. CIPI is a trial aimed at reducing ATS use concomitant with the SMARTgirl HIV prevention program. From 2013 to 2016, 1198 FESW ≥ 18 years old who reported multiple sex partners and/or transactional sex were recruited. We identified 88 HIV-positive women at baseline. We described linkage to care as 12-month retention and viral suppression ( copies/mL). Logistic regression analyses were conducted to examine correlates of retention in care at 12 months, and viral suppression. Median age of the 88 HIV-positive women was 32 years [interquartile range (IQR) 28, 35] 50% were working in entertainment venues and 50% as freelance sex workers 70% reported SMARTgirl membership. In the past 3 months, women reported a median of 15 sex partners, 38% reported unprotected sex, and 55% reported using ATS. Overall, 88% were receiving HIV care, 83% were on antiretroviral therapy, 39% were retained in care at 12 months, and 23% were virally suppressed. SMARTgirl membership was independently associated with fourfold greater odds of 12-month retention in care (AOR = 4.16, 95% CI 1.38, 12.56). Those at high risk for an ATS use disorder had 91% lower odds of 12-month retention in care (AOR = 0.09, 95% CI 0.01, 0.72). Viral suppression was independently associated with SMARTgirl membership, older age, reporting of STI symptoms, worse symptoms of psychological distress, and greater numbers of sex partners. This is the first study to characterize the HIV CoC in Cambodian FESW. While most women were successfully linked to HIV care, retention and viral suppression were low. Tailored programs like SMARTgirl, targeting the broader population of HIV-positive FESW as well as interventions to reduce ATS use could optimize the clinical and population health benefits of HIV treatment. Trial registration This work reports data collected as part of a trial: NCT01835574. This work does not present trial results
Publisher: Wiley
Date: 15-06-2016
DOI: 10.1111/HIS.12992
Abstract: BRAF or NRAS mutations occur in approximately 60% of cutaneous melanomas, and the identification of such mutations underpins the appropriate selection of patients who may benefit from BRAF and MEK inhibitor targeted therapies. The utility of immunohistochemistry (IHC) to detect NRAS(Q61L) mutations is currently unknown. This study sought to assess the sensitivity and specificity of anti-BRAF(V600E) (VE1), anti-NRAS(Q61R) (SP174) and anti-NRAS(Q61L) (26193) antibodies for mutation detection in a large series of cases. Mutation status was determined using the OncoCarta assay in 754 cutaneous melanomas. IHC with the anti-BRAF(V600E) antibody was performed in all cases, and the anti-NRAS(Q61R) and anti-NRAS(Q61L) antibodies were assessed in a subset of 302 s les utilizing tissue microarrays. The staining with the anti-BRAF(V600E) and anti-NRAS(Q61R) antibodies was diffuse, homogeneous and cytoplasmic. The anti-NRAS(Q61L) antibody displayed variable intensity staining, ranging from weak to strong in NRAS(Q61L) mutant tumours. The sensitivity and specificity for anti-BRAF(V600E) was 100 and 99.3%, anti-NRAS(Q61R) was 100 and 100% and anti-NRAS(Q61L) was 82.6 and 96.2%, respectively. The use of IHC is a fast, efficient and cost-effective method to identify single specific mutations in melanoma patients. BRAF(V600E) and NRAS(Q61R) antibodies have high sensitivity and specificity however, the NRAS(Q61L) antibody appears less sensitive. IHC can help to facilitate the timely, appropriate selection and treatment of metastatic melanoma patients with targeted therapies. Detection of melanoma-associated mutations by IHC may also provide evidence for a diagnosis of melanoma in metastatic undifferentiated neoplasms lacking expression of melanoma antigens.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2011
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 13-11-2012
Publisher: Springer Science and Business Media LLC
Date: 04-11-2013
Publisher: Elsevier BV
Date: 02-2008
DOI: 10.1016/J.DRUGALCDEP.2008.08.016
Abstract: The prevalences and correlates of non-viral injecting-related injuries and diseases (IRIDs) in Australian injecting drug users (IDUs) remain unknown. A cross-sectional survey of IDUs was conducted in six sites across Australia's eastern states to investigate IRID experience among Australian IDU. Correlates of IRIDs were explored using logistic and negative binomial regression analyses. 393 IDUs were recruited. Lifetime experience of non-serious IRIDs was common (e.g., 'dirty hit' 68%) potentially serious and serious IRIDs were less commonly experienced (e.g., abscess 16% gangrene <1%). Factors independently associated with potentially serious or serious IRIDs in the previous 12 months were: injecting in sites other than arms (Adjusted Odds Ratio 3.0, 95% confidence interval 1.7-5.4), injecting non-powder drug forms (5.0, 2.2-11.2), unstable accommodation (2.0, 1.1-3.5), being aged 25 years or older (4.3, 1.7-10.6) and not always washing hands before injection (9.3, 2.1-41.8). Factors independently associated with multiple IRIDs in the preceding 12 months were using three or more injecting sites (Adjusted Incidence Rate Ratio 1.5, 95% CI 1.1-2.0), injecting in sites other than arms (1.7, 1.3-2.2), using non-powder drug forms (1.9, 1.4-2.5), injecting daily or more often (1.7, 1.3-2.2), current pharmacotherapy experience (1.5, 1.1-1.9), and not always washing hands before injecting (1.9, 1.2-2.9). Some IRIDs are widespread among Australian IDUs. Observed associations, particularly the protective effect of handwashing, have useful public health implications.
Publisher: Springer Science and Business Media LLC
Date: 25-07-2016
Publisher: Mary Ann Liebert Inc
Date: 06-2015
Abstract: Women who inject drugs (WWID) are vulnerable to a range of harms, including exposure to sexually transmitted and blood-borne infections, abusive relationships, physical and sexual violence and mental health issues. Lesbians and bisexual women are at greater risk than heterosexual women for substance use disorders. This study aimed to compare a large s le of heterosexual, bisexual, and lesbian WWID and to identify correlates of sexual orientation. The Australian Needle and Syringe Program (NSP) Survey is an annual cross-sectional survey. People who inject drugs (PWID) who attend NSP services are invited to complete a brief self-administered questionnaire and provide a capillary dried blood spot. Of 22,791 survey respondents between 2004-2013, one third were women (n=7,604). Analyses were restricted to the first participation record for each respondent. Of the 5,378 in idual women, 4,073 (76%) identified as heterosexual, 1,007 (19%) identified as bisexual, and 298 (6%) identified as lesbian. HIV prevalence was low (<1.0%). More than half (56%) had been exposed to hepatitis C virus (HCV), with prevalence highest among bisexual women (59%). In adjusted analysis, bisexual women had significantly greater odds of initiating injection at a younger age (AOR 1.44, 95% CI 1.19-1.73), and reporting public injection (AOR 1.44, 95% CI 1.21-1.73) and receptive sharing of drug preparation equipment (AOR 1.20, 95% CI 1.00-1.44). Bisexual women (AOR 1.42, 95% CI 1.07-1.88) and lesbians (AOR 1.63, 95% CI 1.10-2.44) had significantly greater odds of reporting sex work than their heterosexual counterparts. Results contribute to the literature on HIV and HCV transmission risk among WWID. Analysis of the relationship between sexual orientation and risk behavior identified bisexual orientation as independently associated with increased risk. Services that target PWID need to recognise and address a broad range of sexual identities and behaviors. Future research should explore reasons for increased risk in sexual minority women.
Publisher: Wiley
Date: 24-11-2006
Publisher: Wiley
Date: 28-03-2013
DOI: 10.1111/ADD.12151
Publisher: Wiley
Date: 1999
DOI: 10.1046/J.1360-0443.1999.941714.X
Abstract: To examine patterns and correlates of routes of heroin use among Caucasian and Indochinese heroin users. A cross-sectional survey. Two hundred heroin users resident in South West Sydney. The s le was ided between Caucasian and Indochinese users (each n = 100), with half of each group on methadone maintenance. A semi-structured interview was administered, based on previous studies of transitions between routes of administration. Measures included patterns of drug use, transitions, social, health and legal issues and cultural correlates of use. Almost two-thirds (61%) had smoked heroin. Smoking was more common among the Indochinese (40% were predominantly or exclusively smokers), although injecting was the dominant route for both groups. More than one-quarter (29%) had made a transition from smoking to injecting, primarily due to drug effect and perceived cost-effectiveness. Reverse transitions were rare. Smoking appeared to be more culturally acceptable than injecting among Indochinese users. Among both groups, there was a small but significant risk for the transmission of HIV and other blood-borne viruses. Polydrug use and age were positively associated with having experienced a non-fatal overdose. This research documents the existence of smoking as a popular route of administration among both Indochinese and Caucasian heroin users in the study s le. There is an urgent need to provide smokers and injectors with information explaining the potential risks and ways to minimize harms associated with both routes of use.
Publisher: BMJ
Date: 04-11-2015
DOI: 10.1136/SEXTRANS-2014-051617
Abstract: To undertake the first comprehensive analysis of the incidence of three curable sexually transmissible infections (STIs) within remote Australian Aboriginal populations and provide a basis for developing new control initiatives. We obtained all results for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) testing conducted during 2009-2011 in in iduals aged ≥16 years attending 65 primary health services across central and northern Australia. Baseline prevalence and incidence of all three infections was calculated by sex and age group. A total of 17 849 in iduals were tested over 35 months. Baseline prevalence was 11.1%, 9.5% and 17.6% for CT, NG and TV, respectively. During the study period, 7171, 7439 and 4946 initially negative in iduals had a repeat test for CT, NG and TV, respectively these were followed for 6852, 6981 and 6621 person-years and 651 CT, 609 NG and 486 TV incident cases were detected. Incidence of all three STIs was highest in 16-year-olds to 19-year-olds compared with 35+ year olds (incident rate ratio: CT 10.9 NG 11.9 TV 2.5). In the youngest age group there were 23.4 new CT infections per 100 person-years for men and 29.2 for women and 26.1 and 23.4 new NG infections per 100 person-years in men and women, respectively. TV incidence in this age group for women was also high, at 19.8 per 100 person-years but was much lower in men at 3.6 per 100 person-years. This study, the largest ever reported on the age and sex specific incidence of any one of these three curable infections, has identified extremely high rates of new infection in young people. Sexual health is a priority for remote communities, but will clearly need new approaches, at least intensification of existing approaches, if a reduction in rates is to be achieved.
Publisher: CSIRO Publishing
Date: 2015
DOI: 10.1071/SH14080
Abstract: Background Remote Australian Aboriginal communities experience high rates of bacterial sexually transmissible infections (STI). A key strategy to reduce STIs is to increase testing in primary health care centres. The current study aimed to explore barriers to offering and conducting STI testing in this setting. Methods: A qualitative study was undertaken as part of the STI in Remote communities, Improved and Enhanced Primary Health Care (STRIVE) project a large cluster randomised controlled trial of a sexual health quality improvement program. We conducted 36 in-depth interviews in 22 participating health centres across four regions in northern and central Australia. Results: Participants identified barriers including Aboriginal cultural norms that require the separation of genders and traditional kinship systems that prevent some staff and patients from interacting, both of which were exacerbated by a lack of male staff. Other common barriers were concerns about client confidentiality (lack of private consulting space and living in small communities), staff capacity to offer testing impacted by the competing demands for staff time, and high staff turnover resulting in poor understanding of clinic systems. Many participants also expressed concerns about managing positive test results. To address some of these barriers, participants revealed informal strategies, such as team work, testing outside the clinic and using adult health checks. Conclusions: Results identify cultural, structural and health system issues as barriers to offering STI testing in remote communities, some of which were overcome through the creativity and enthusiasm of in iduals rather than formal systems. Many of these barriers can be readily addressed through strengthening existing systems of cultural and clinical orientation and educating staff to view STI in a population health framework. However others, particularly issues in relation to culture, kinship ties and living in small communities, may require testing modalities that do not rely on direct contact with health staff or the clinic environment.
Publisher: Elsevier BV
Date: 06-2009
DOI: 10.1111/J.1753-6405.2009.00389.X
Abstract: Measure the self-reported prevalence of HIV, history of HIV testing and associated risk factors among injecting drug users (IDUs) attending the Sydney Medically Supervised Injecting Centre (MSIC). Cross-sectional survey of IDUs attending the Sydney MSIC (n=9,778). The majority of IDUs had been tested for HIV (94%), most within the preceding 12 months. Self-reported prevalence of HIV was only 2% (n=162) and homosexuality (AOR 20.68), bisexuality (AOR 5.30), male gender (AOR 3.33), mainly injecting psychostimulants (AOR 2.02), use of local health service (AOR 1.56) and increasing age (AOR 1.62) were independently associated. Among the 195 homosexual male s le 23% were self-reported being HIV positive. HIV positive homosexual males were more likely to report mainly psychostimulant injecting than other drugs, a finding not replicated among the heterosexual males. The associations in this s le are consistent with other data indicating Australia has successfully averted an epidemic of HIV among heterosexual IDUs. The absence of any significant associations between HIV positive sero-status and the injecting-related behaviours that increase vulnerability to BBV transmission suggests that HIV infection in this group may be related to sexual behaviours. In particular, the strong associations between homosexual males and psychostimulant injectors with HIV positive sero-status suggests that patterns of infection within this group reflect the epidemiology of HIV in Australia more generally, where men who have sex with men remain most vulnerable to infection.
Publisher: Elsevier BV
Date: 07-2012
DOI: 10.1016/J.DRUGPO.2012.01.003
Abstract: It is assumed that people who inject drugs (PWID) care little about their health. This emerges from social and moral perceptions of PWID and is framed by research that focuses on their morbidity and mortality. Drawing on the narratives of Australian women who inject drugs, we examined the salience of health for our participants and the contexts that structure their descriptions of health and wellbeing. We conducted qualitative interviews with 83 women who inject drugs and live with hepatitis C virus (HCV) to explore their experiences of health and health care seeking. Although the interviews focused on HCV, women discussed their health within broader contexts of drug dependence, unstable housing, unemployment, financial strain, other health issues and relationships. Concern about HCV was less pronounced than concerns about other health problems and socio-economic circumstances. Broadening the focus of health beyond drug use alone, women's narratives strongly suggest that PWID can and do care about their health. Whilst research and policy often focus on health problems and barriers to health amongst PWID, the women in our s le maintained positive health beliefs and behaviours. Much like other members of society, their health priorities are contextualised by cultural, economic and political factors. This suggests that health interventions aimed at women who inject drugs could build upon the salience of a range of health priorities as well as integrating these with structural interventions designed to improve housing and economic status.
Publisher: Elsevier BV
Date: 06-2020
Publisher: Informa UK Limited
Date: 18-04-2017
Publisher: Springer Science and Business Media LLC
Date: 28-06-2012
Abstract: To assess concordance between self-reported hetamine-type stimulant (ATS) use and toxicology results among young female sex workers (FSW) in Phnom Penh, Cambodia. Cross-sectional data from the Young Women’s Health Study-2 (YWHS-2), a prospective study of HIV and ATS use among young (15 to 29 years) FSW in Phnom Penh, Cambodia, was analyzed. The YWHS-2 assessed sociodemographic characteristics, HIV serology, HIV risk, and ATS use by self-report and urine toxicology testing at each quarterly visit, the second of which provided data for this assessment. Outcomes include sensitivity, specificity, positive- and negative predictive values (overall and stratified by age), sex-work setting, and HIV status. Among 200 women, prevalence of positive toxicology screening for ATS use was 14% (95% confidence interval [CI], 9.2, 18.9%) and concurrent prevalence of self-reported ATS was 15.5% (95% CI, 10.4, 20.6%). The sensitivity and specificity of self-reported ATS use compared to positive toxicology test results was 89.3% (25/28), and 96.5% (166/172), respectively. The positive predictive value of self-reported ATS use was 80.6% (25/31) the negative predictive value was 98.2% (166/169). Some differences in concordance between self-report and urine toxicology results were noted in analyses stratified by age group and sex-work setting but not by HIV status. Results indicate a high prevalence of ATS use among FSW in Phnom Penh, Cambodia, and high concordance between self-reported and toxicology-test confirmed ATS use.
Publisher: Wiley
Date: 14-11-2019
DOI: 10.1111/JVH.13013
Abstract: Subsidized direct-acting antiviral (DAA) treatment recently became available to all adults living with chronic hepatitis C virus (HCV) in Australia. Based on rapid uptake (32 600 people initiated DAA in 2016), we estimated the impact on HCV epidemiology and mortality in Australia and determined if Australia can meet the WHO HCV elimination targets by 2030. Using a mathematical model, we simulated pessimistic, intermediate and optimistic DAA treatment scenarios in Australia over 2016-2030. We assumed treatment and testing rates were initially higher for advanced fibrosis and the same across HCV transmission risk level sub-populations. We also assumed constant testing rates after 2016. We compared the results to the 2015 level and a counterfactual (IFN-based) scenario. During 2016-2030, we estimated an intermediate DAA treatment scenario (2016, 32 600 treated 2017, 21 370 treated 2018 17 100 treated 2019 and beyond, 13 680 treated each year) would avert 40 420 new HCV infections, 13 260 liver-related deaths (15 320 in viraemic -2060 in cured) and 10 730 HCC cases, equating to a 53%, 63% and 75% reduction, respectively, compared to the IFN-based scenario. The model also estimated that Australia will meet the WHO targets of incidence and treatment by 2028. Time to a 65% reduction in liver-related mortality varied considerably between HCV viraemic only cases (2026) and all cases (2047). Based on a feasible DAA treatment scenario incorporating declining uptake, Australia should meet key WHO HCV elimination targets in 10 to15 years. The pre-DAA escalation in those with advanced liver disease makes the achievement of the liver-related mortality target difficult.
Publisher: Wiley
Date: 02-04-2023
DOI: 10.1111/ADD.16189
Abstract: Few studies of the impacts of the coronavirus disease 2019 (COVID‐19) public health measures on drug markets and drug use patterns have used longitudinal data. We aimed to examine whether COVID‐19 measures were associated with increases in meth hetamine price, decreases in meth hetamine use frequency and subsequent changes in secondary outcomes of other drug use frequency in metropolitan Melbourne and regional Victoria. Longitudinal analysis framework was used from a longitudinal cohort of people who use meth hetamine. Victoria state, Australia. One hundred eighty‐five VMAX study participants who reported a meth hetamine purchase after the onset of the pandemic were used for the price paid analysis. Meth hetamine or other drug use frequency analysis was performed using 277 participants who used meth hetamine during the pandemic or in the year before the pandemic. Price paid per gram of meth hetamine derived from the most recent purchase price and most recent purchase quantity. Frequency of meth hetamine and other drug use measured as the average number of days per week used in the last month. Compared with pre‐COVID‐19 period, meth hetamine prices increased by AUD351.63 ( P value .001) and by AUD456.51 ( P value .001) in Melbourne and regional Victoria, respectively, during the period in which the most intense public health measures were implemented in Victoria. Although prices decreased after harder restrictions were lifted (by AUD232.84, P value .001 and AUD263.68, P value .001, in Melbourne and regional Victoria, respectively), they remained higher than pre‐COVID‐19 levels. A complementary 76% decrease was observed in relation to meth hetamine use frequency in regional Victoria ( P value = 0.006) that was not offset by any changes in the frequency of use of other drugs such as alcohol, tobacco or other illicit drugs. COVID‐19 public health measures in Victoria state, Australia, appear to have been associated with major price changes in the meth hetamine market and decreased frequency of use of the drug.
Publisher: Springer Science and Business Media LLC
Date: 18-01-2016
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/SH16025
Abstract: Background Extremely high rates of diagnosis of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) have been recorded in remote communities across northern and central Australia. Re-testing at 3 months, after treatment administered, of CT or NG is recommended to detect repeat infections and prevent morbidity and ongoing transmission. Methods: Baseline CT and NG laboratory data (2009–2010) from 65 remote health services participating in a cluster randomised trial was used to calculate the proportion of in iduals re-tested after an initial CT or NG diagnosis at months (not recommended), 2–4 months (recommended) and 5–12 months and the proportion with repeat positivity on re-test. To assess if there were difference in re-testing and repeat positivity by age group and sex, t-tests were used. Results: There was a total of 2054 people diagnosed with CT and/or NG in the study period 14.9% were re-tested at 2–4 months, 26.9% at 5–12 months, a total of 41.8% overall. Re-testing was higher in females than in males in both the 2–4-month (16.9% v. 11.5%, P 0.01) and 5–12-month (28.9% v. 23.5%, P = 0.01) periods. Women aged 25–29 years had a significantly higher level of re-testing 5–12 months post-diagnosis than females aged 16–19 years (39.8% v. 25.4%, P 0.01). There was a total of 858 people re-tested at 2–12 months and repeat positivity was 26.7%. There was higher repeat NG positivity than repeat CT positivity (28.8% v. 18.1%, P 0.01). Conclusions: Just under half the in iduals diagnosed with CT or NG were re-tested at 2–12 months post-diagnosis however, only 15% were re-tested in the recommended time period of 2–4 months. The higher NG repeat positivity compared with CT is important, as repeat NG infections have been associated with higher risk of pelvic inflammatory disease-related hospitalisation. Findings have implications for clinical practice in remote community settings and will inform ongoing sexual health quality improvement programs in remote community clinics.
Publisher: Elsevier BV
Date: 09-2016
Publisher: Elsevier BV
Date: 04-2009
DOI: 10.1016/J.DRUGALCDEP.2008.12.002
Abstract: The process of drug injection may give rise to vascular and soft tissue injuries and infections. The social and physical environments in which drugs are injected play a significant role in these and other morbidities. Supervised injecting facilities (SIFs) seek to address such issues associated with public injecting drug use. Estimate lifetime prevalence of injecting-related problems, injury and disease and explore the socio-demographic and behavioral characteristics associated with the more serious complications. Self-report data from 9552 injecting drug users (IDUs) registering to use the Sydney Medically Supervised Injecting Centre (MSIC). Lifetime history of either injecting-related problems (IRP) or injecting-related injury and disease (IRID) was reported by 29% of the 9552 IDUs 26% (n=2469) reported ever experiencing IRP and 10% (n=972) reported IRID. Prevalence of IRP included difficulties finding a vein (18%), prominent scarring or bruising (14%) and swelling of hands or feet (7%). Prevalence of IRID included abscesses or skin infection (6%), thrombosis (4%), septicaemia (2%) and endocarditis (1%). Females, those who mainly injected drugs other than heroin, and those who reported a history of drug treatment, drug overdose, and/or sex work, were more likely to report lifetime IRID. Frequency and duration of injecting, recent public injecting, and sharing of needles and/or syringes were also independently associated with IRID. IRPs and IRIDs were common. Findings support the imperative for education and prevention activities to reduce the severity and burden of these preventable injecting outcomes. Through provision of hygienic environments and advice on venous access, safer injecting techniques and wound care, SIFs have the potential to address a number of risk factors for IRID.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 22-11-2014
DOI: 10.1002/HEP.26639
Publisher: Wiley
Date: 11-2013
DOI: 10.1111/DAR.12000
Publisher: Elsevier BV
Date: 2015
Publisher: Elsevier BV
Date: 11-2017
DOI: 10.1016/J.DRUGPO.2017.07.027
Abstract: Gay and bisexual men (GBM) use illicit drugs at higher rates than most other population groups and their use has been associated with sexual risk behavior. The measure of sexual sensation-seeking has been a useful tool for understanding sexual risk behavior in this population, but there is no equivalent measure for sensation-seeking in relation to drug-using behaviors. This paper explores baseline associations with illicit drug use in an online prospective observational study of licit and illicit drug use among GBM. We describe the development of a measure of drug-use sensation-seeking, and its association with illicit drug use. Australian GBM were invited to enroll online through social networking and gay community sites. Between September 2014 and July 2015, a total of 2251 GBM completed the questionnaire and 1900 men provided useable baseline data on items designed to measure drug use sensation-seeking. Mean age was 32.8 years (SD 12.7). Half (50.7%) had used illicit drugs within the previous six months. Among these 963 recent users, 27.3% had used illicit drugs weekly or more often. Responses to items to measure drug use sensation-seeking formed a reliable scale (α=0.944). Within the total s le, any illicit drug use within the previous six months was associated with a higher score on the measure of drug use sensation-seeking (aOR=1.18 95%CI=1.16-1.20). When we restricted our analyses to men who reported recent illicit drug use, it was also associated with using those drugs at least weekly in the previous six months (aOR=1.09 95%CI=1.07-1.11). We developed a reliable measure of drug use sensation-seeking for this s le of GBM. Our measure predicted any use of illicit drugs within the total s le, and when restricted to men who reported illicit drug use, it also predicted more frequent use of those drugs.
Publisher: CSIRO Publishing
Date: 2015
DOI: 10.1071/SH14092
Abstract: Background Compared with non-Indigenous Australians, Aboriginal and Torres Strait Islander people have higher rates of sexually transmissible infections (STI). The identification of the sexual risk and healthcare seeking behaviours of young Aboriginal and Torres Strait Islander people in a regional Australian setting was sought. Methods: A cross-sectional survey of 155 young Aboriginal and Torres Strait Islander people (16–24 years) in Townsville was conducted. Results: Most participants (83%) reported ever having had sex, with a median age of 15 years at first sex and a range from 9 to 22 years. While young men reported more sexual partners in the last 12 months than young women, they were also more likely to report condom use at the last casual sex encounter (92% vs 68%, P = 0.006). Young women were significantly more likely than young men to report never carrying condoms (35% vs 16%) however, they were more likely to have had STI testing (53% vs 28%, P = 0.004). Of those reporting previous STI testing, 29% reported ever being diagnosed with an STI. Conclusions: The s le of young Aboriginal and Torres Strait Islander people reported an early age at first sex, variable condom use and low uptake of STI testing. The high prevalence of self-reported STI diagnoses indicate a need for opportunistic sexual health education and efforts designed to promote the uptake of STI screening in this group.
Publisher: Elsevier BV
Date: 09-2013
Publisher: Wiley
Date: 03-08-2009
Publisher: Elsevier BV
Date: 09-2020
Publisher: Elsevier BV
Date: 12-2016
Publisher: CSIRO Publishing
Date: 2008
DOI: 10.1071/SH07093
Abstract: Background: Vaginal microbicides are in development to provide new options for the prevention of sexually transmissible infections. Although promoted as a female-initiated product, men may influence the decision to use a microbicide and the way that it is used, so it is important to explore their views. Methods: Men (n = 36) enrolled in a 7-day, phase 1 clinical safety trial of SPL7013 Gel were interviewed pre- and post-use of the gel. The trial did not include use of the gel during sex. Interviews were digitally-recorded and transcribed verbatim, and analysed using a framework approach. Results: The men (mean age 37 years) were interested in the idea of vaginal microbicides, had little knowledge about them, and varied beliefs about how they work. They tended to assess microbicide use in relation to condoms and lubricants. Many would want a microbicide to be as effective as condoms. Participants did not anticipate difficulties discussing use with their partners. Many thought that a microbicide would be less intrusive than condoms some anticipated that the lubricating properties might enhance sexual pleasure. Some anticipated using a microbicide with a condom or with a lubricant, and a few raised questions about the timing of use and use during different types of sexual activity. Conclusions: No major barriers to microbicide use were found in this s le of Australian men, who anticipated being willing to use them if they are shown to be safe and effective. Our findings should help to inform the design of further studies as well as future information materials and anticipatory guidance.
Publisher: Springer Science and Business Media LLC
Date: 22-06-2019
Publisher: Springer Science and Business Media LLC
Date: 2011
Publisher: Wiley
Date: 20-03-2017
DOI: 10.1111/DAR.12474
Abstract: Indicators suggest an escalation in opioid use globally, with recent HIV outbreaks linked to non-medical pharmaceutical opioid (NMPO) use. Little is known about how young Australians engage in NMPO use. During 2015, we conducted qualitative interviews with young people (16-29 years) who reported oral NMPO use at least twice in the past 90 days. The study included a s le of injecting (n = 14) and oral (n = 22) users. This paper focuses on the oral user group. Most participants grew up in affluent areas of Sydney, reported few health problems, rarely accessed health or welfare services and had limited contact with police. NMPO use was part of a repertoire of drug use involving: (i) use to come down from stimulants (ii) use in conjunction with cannabis and alcohol and (iii) use by itself. Participants reported limiting their use in order to avoid stigma and dependence. Results suggest culture of self-limiting NMPO use characterised by stable housing, disposable income and intimate friendship networks. Despite the adverse health outcomes observed in other settings, our data suggest that the patterns and meanings of NMPO use observed in this small s le may help explain the limited nature of problematic use among young Australians to date. Findings indicate a need for epidemiological data, including longitudinal data, to assess possible demographic shifts in NMPO use in Australia, and to address risk factors for dependence and transitions to injecting and heroin use in this population. [Dertadian GC, Dixon TC, Iversen J, Maher L. Self-limiting non-medical pharmaceutical opioid use among young people in Sydney, Australia: An exploratory study. Drug Alcohol Rev 2017 :000-000].
Publisher: Wiley
Date: 07-2010
DOI: 10.1111/J.1465-3362.2009.00154.X
Abstract: The comprehensive needle and syringe distribution system in New South Wales is partly based on the premise that different points of access to injecting equipment may attract different groups of injecting drug users. This paper examines patterns of equipment acquisition and risk for blood-borne virus transmission among injecting drug users who use pharmacies and needle and syringe programs (NSP) in south-east Sydney. Clients obtaining injecting equipment from four NSP (n = 147) and eight pharmacies (n = 227) in 2006 voluntarily completed a self-administered questionnaire. Respondents were grouped into three categories based on their needle and syringe acquisition patterns: exclusive use of NSP, exclusive use of pharmacies and use of both. Although it was common for respondents to report using both pharmacies and NSP to obtain needles and syringes (57%), a proportion reported exclusive use of pharmacies (17%) and NSP (14%). Exclusive pharmacy users were more likely to have never received treatment for their drug use and the least likely to have had a recent test for hepatitis C. Compared with respondents who exclusively used NSP, respondents who exclusively used pharmacies were more likely to report receptive sharing of injecting equipment (adjusted odds ratio 5.9, 95% confidence interval 2.02-17.14), as were respondents who reported using both sources (adjusted odds ratio 5.8, 95% confidence interval 2.35-14.40). The high prevalence of receptive equipment sharing among pharmacy clients indicates a need to improve access to needles and syringes and ancillary equipment, possibly by including ancillary equipment at no cost in existing pre-packaged pharmacy products.
Publisher: Elsevier BV
Date: 02-2007
DOI: 10.1111/J.1753-6405.2007.00007.X
Abstract: Evidence of ongoing hepatitis C (HCV) transmission among injecting drug users (IDUs) suggests a need for a better understanding of seroconversion characteristics among new IDUs and other vulnerable subgroups. This study aimed to determine incidence of HCV and associated risk factors among new IDUs in Sydney. IDUs who had injected drugs in the past six months and who were unaware of their antibody HCV status or knew their serostatus to be negative were recruited through street-based outreach, methadone clinics and needle and syringe programs in south-western Sydney. Anti-HCV negative IDUs (n = 215) were enrolled and followed-up at 3-6 monthly intervals. New IDUs (n = 204) were defined as aged below 30 years or injecting for < or = 6 years at baseline. A total of 61 seroconversions were observed and incidence was 45.8 per 100 person years. Independent predictors of seroconversion were duration of injecting < 1 year (IRR = 3.10 95% CI 1.47-6.54), female gender (IRR = 2.0 95% CI 1.16-3.45), culturally and linguistically erse background (CALDB) (IRR = 2.03 95% CI 1.06-3.89) and intravenous cocaine use (IRR = 2.37 95% CI 1.26-4.44). While new IDUs shared common risk factors, strong associations were observed between HCV seroconversion and sharing syringes, sharing other injecting equipment and backloading in CALDB new IDUs. Incidence of HCV infection among new IDUs in Sydney is unacceptably high. Extremely high rates of incident infection among newly initiated CALDB IDUs indicate an urgent need for enhanced policy and resource commitments to reduce the vulnerability of this group to HCV and other blood-borne infections.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2020
Publisher: Elsevier BV
Date: 07-2019
Publisher: Wiley
Date: 03-11-2017
DOI: 10.1111/JVH.12616
Publisher: BMJ
Date: 28-04-2015
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.JCV.2015.11.031
Abstract: People who inject drugs (PWID) are at risk of hepatitis B virus (HBV) but have low rates of vaccination completion. The provision of modest financial incentives increases vaccination schedule completion, but their association with serological protection has yet to be determined. To investigate factors associated with vaccine-induced immunity among a s le of PWID randomly allocated to receive AUD$30 cash following receipt of doses two and three ('incentive condition') or standard care ('control condition') using an accelerated 3-dose (0,7,21 days) HBV vaccination schedule. A randomised controlled trial among PWID attending two inner-city health services and a field site in Sydney, Australia, assessing vaccine-induced immunity measured by hepatitis B surface antibodies (HBsAb ≥ 10 mIU/ml) at 12 weeks. The cost of the financial incentives and the provision of the vaccine program are also reported. Just over three-quarters of participants - 107/139 (77%)--completed the vaccination schedule and 79/139 (57%) were HBsAb ≥ 10 mIU/ml at 12 weeks. Vaccine series completion was the only variable significantly associated with vaccine-induced immunity in univariate analysis (62% vs 41%, p<0.035) but was not significant in multivariate analysis. There was no statistically discernible association between group allocation and series completion (62% vs 53%). The mean costs were AUD$150.5, (95% confidence interval [CI]: 142.7-158.3) and AUD$76.9 (95% CI: 72.6-81.3) for the intervention and control groups respectively. Despite increasing HBV vaccination completion, provision of financial incentives was not associated with enhanced serological protection. Further research into factors which affect response rates and the optimal vaccination regimen and incentive schemes for this population are needed.
Publisher: Elsevier BV
Date: 02-2019
DOI: 10.1016/J.DRUGPO.2018.12.002
Abstract: In Cambodia, HIV infection remains high among female entertainment and sex workers (FESW) and the use of hetamine-type stimulants (ATS) is an independent risk factor for unprotected sex and sexually transmitted infections among this group. For decades public health approaches to HIV prevention in low and middle income countries (LMIC) have attempted to target the macro-power relations that shape risk behaviour with structural interventions. Recent research has highlighted that interventions that combine ATS risk reduction, in the form of financial incentives for abstinence, with existing HIV prevention programmes, may also play an important role. However, whether this approach goes far enough as a response to structural drivers of risk requires further examination. Semi-structured in-depth interviews were conducted with 30 FESW (mean age 25 years) from five provinces in Cambodia, as part of formative research for the implementation of the Cambodia Integrated HIV and Drug Prevention (CIPI) trial. The aim was to explore the contexts and drivers of ATS use. Data were analysed using grounded theory. In addition to increasing occupational functionality, ATS were used to control pervasive feelings of 'sadness' in relation to the lived experience of poverty, family and relationship problems. Feeling sad could be viewed as an expression of social suffering, in response to competing priorities and seemingly inescapable constraints imposed by a lack of options for income generation, gender inequalities and stigma. Participants expressed interest in microenterprise (ME) opportunities, particularly vocational training, that could create new work opportunities beyond sex work and ATS use. In addition to reducing ATS use, HIV prevention interventions need to target sources of sadness and social suffering as drivers of risk among FESW in this context. The inclusion of ME opportunities in HIV prevention, to alleviate social suffering, warrants further investigation through qualitative and ethnographic research.
Publisher: Wiley
Date: 25-09-2017
DOI: 10.1111/JVH.12615
Publisher: The Sax Institute
Date: 2009
DOI: 10.1071/NB09007
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 27-03-2011
Publisher: Oxford University Press (OUP)
Date: 2016
DOI: 10.1093/OFID/OFW024
Abstract: Symptomatic acute HCV infection and interferon lambda 4 (IFNL4) genotypes are important predictors of spontaneous viral clearance. Using data from a multicohort database (Injecting Cohorts [InC3] Collaborative), we establish an independent association between host IFNL4 genotype and symptoms of acute hepatitis C virus infection. This association potentially explains the higher spontaneous clearance observed in some patients with symptomatic disease.
Publisher: Elsevier BV
Date: 2012
Publisher: Elsevier BV
Date: 09-2009
DOI: 10.1016/J.CCT.2009.04.002
Abstract: This pilot study examined knowledge, understanding and perceived acceptability of key methodological concepts in clinical trials among injecting drug users (IDUs) in Sydney, Australia. Participants were clinical trial-experienced (n = 17) and trial-naïve (n = 99) IDUs recruited from community needle and syringe programs, and through institutions involved in clinical trials with IDU participants. Cross-sectional data were collected via a study-specific interviewer-administered survey. Following detailed verbal explanations, higher proportions of trial-experienced than trial-naïve participants demonstrated an understanding of all clinical trial concepts assessed, including single blinding (94% versus 60%) placebo (94% versus 49%) equipoise (71% versus 60%) comparison (59% versus 46%) randomisation (59% versus 21%) and double blinding (47% versus 3%). Multivariate analyses indicated a better understanding among trial-experienced participants. Participants who demonstrated an understanding of 'placebo' and 'double blinding' were significantly more likely to perceive these concepts to be acceptable than those who did not. Results indicate the need for targeted education programs that adequately inform IDUs about clinical trial concepts prior to recruitment to a clinical trial, and support adaptations of informed consent procedures to ensure trial participants' comprehensive understanding of methodologies and their implications.
Publisher: Elsevier BV
Date: 02-2018
Abstract: To examine factors associated with hepatitis C virus (HCV) infection among a national s le of Indigenous and non-Indigenous people who inject drugs (PWID) in Australia. Respondents were recruited from Australia's Needle Syringe Program Survey an annual bio-behavioural surveillance project that monitors HCV antibody prevalence among PWID. Data from 2006-2015 were de-duplicated to retain only one record where in iduals participated in >1 survey round. Univariate and multivariable logistic regression examined demographic characteristics and injection-related behaviours associated with exposure to HCV. Among 17,413 respondents, 2,215 (13%) were Indigenous Australians. Compared to their non-Indigenous counterparts, Indigenous respondents were significantly more likely to be exposed to HCV infection (53% vs. 60% respectively, p<0.001). Among Indigenous respondents, HCV antibody positivity was independently associated with a history of imprisonment (Adjusted Odd Ratio [AOR] 2.13, 95%CI 1.73-2.64), opioid injection (AOR 1.53, 95%CI 11.43-2.16), recruitment in a metropolitan location (AOR 1.27, 95%CI 1.02-1.59), engagement in opioid substitution therapy (AOR 2.83, 95%CI 2.23-3.59) and length of time since first injection (p<0.001). Indigenous PWID are more likely to be exposed to HCV infection than their non-Indigenous counterparts. Implications for public health: Increased access to culturally sensitive harm reduction programs is required to prevent primary HCV infection and reinfection among Indigenous PWID. Given recent advances in HCV treatment, promotion of treatment uptake among Indigenous PWID may reduce future HCV-related morbidity and mortality.
Publisher: CSIRO Publishing
Date: 2009
DOI: 10.1071/HE09195
Abstract: Health services are fundamental to reducing the burden of blood-borne and sexually transmitted infections (BBV/STI) in Indigenous communities. However, we know very little about young Indigenous people's use of mainstream and community-controlled health services for the prevention and treatment of these infections, or how health services can best support young people's efforts to prevent infection. University-researchers, a site co-ordinator and peer researchers developed a project and conducted interviews with 45 Aboriginal and Torres Strait Islander people aged between 17 and 26 years. Thematic analysis of interview notes identified key themes around health service use and experiences of Aboriginal Community-Controlled Health Services (ACCHS). Most participants had accessed health services for the prevention or treatment of BBV/STI, with positive experiences characterised by the provision of information and feeling cared for. Participants described the comfort and understanding they experienced at ACCHS personal relationships and having an Indigenous care provider present were important factors in the overwhelmingly positive accounts. Young people reported strategies for overcoming challenges to prevention and accessing treatment services, including being proactive by carrying condoms and persisting with behavioural intentions despite feeling shame. Our findings reinforce the important role both mainstream and community-controlled health services have in the prevention and treatment of blood-borne and sexually transmitted infections in young Indigenous people. We highlight opportunities to build on young people's strengths, such as their valuing of their health, their persistence, and their offers to support peers, to better prevent transmission of infections and enhance access to treatment.
Publisher: SAGE Publications
Date: 25-08-2012
Abstract: Hepatitis C virus (HCV) infection is a significant global public health problem. In developed countries, 90% of new infections occur among people who inject drugs (PWID), with seroprevalence increasing rapidly among new injectors. Staying Safe is an international, qualitative, social research project, the aim of which is to draw on the experiences of long-term PWID to inform a new generation of HCV prevention strategies. The Sydney project team employed life history interviews and computer-generated timelines to elicit detailed data about unexposed participants’ ( n =13) injecting practices, circumstances, and social networks over time. The motivations and strategies that enabled participants to avoid risk situations, and which might have helped them to “stay safe,” appeared not to be directly related to harm-reduction messages or HCV avoidance. These included the ability and inclination to maintain social and structural resources, to mainly inject alone, to manage withdrawal, and to avoid injecting-related scars. These findings point to the multiple priorities that facilitate viral avoidance among PWID and the potential efficacy of nonspecific HCV harm-reduction interventions for HCV prevention.
Publisher: SAGE Publications
Date: 03-10-2020
Abstract: In a context of ongoing colonization and dispossession in Australia, many Aboriginal people live with experiences of health research that is done “on” rather than “with” or “by” them. Recognizing the agency of young people and contributing to Aboriginal self-determination and community control of research, we used a peer research methodology involving Aboriginal young people as researchers, advisors, and participants in a qualitative sexual health study in one remote setting in the Northern Territory, Australia. We document the methodology, while critically reflecting on its benefits and limitations as a decolonizing method. Findings confirm the importance of enabling Aboriginal young people to play a central role in research with other young people about their own sexual health. Future priorities include developing more enduring forms of coinvestigation with Aboriginal young people beyond data collection during single studies, and support for young researchers to gain formal qualifications to enhance future employability.
Publisher: Wiley
Date: 07-08-2018
DOI: 10.1111/ADD.13931
Abstract: This narrative review aims to highlight key insights from qualitative research on drug use and drug users by profiling a selection of classic works. Consensus methods were used to identify and select four papers published in 1938, 1969, 1973 and 1984 considered to be classics. These landmark qualitative studies included the first account of addiction as a social process, demonstrating that people have meaningful responses to drug use that cannot be reduced to their pharmacological effects the portrayal of inner-city heroin users as exacting, energetic and engaged social agents identification of the interactive social learning processes involved in becoming a drug user the application of the 'career' concept to understanding transitions and trajectories of drug use over time and the articulation of a framework for understanding drug use that incorporates the interaction between pharmacology, psychology and social environments. These classic sociological and anthropological studies deployed qualitative research methods to show how drug use is shaped by complex sets of factors situated within social contexts, viewing drug users as agents engaged actively in social processes and worlds. Their findings have been used to challenge stereotypes about drug use and drug users, develop a deeper understanding of drug use among hidden, hard-to-research and under-studied populations, and provide the foundations for significant developments in scientific knowledge about the nature of drug use. They continue to retain their relevance, providing important correctives to biomedical and behaviourist paradigms, reminding us that drug use is a social process, and demonstrating how the inductive approach of qualitative research can strengthen the way we understand and respond to drug use and related harms.
Publisher: SAGE Publications
Date: 30-11-2009
Abstract: Successful HIV prevention programs—such as sterile needle and syringe programs—have ensured that incidence and prevalence of HIV among people who inject drugs remains low in Australia. However, between 1999 and 2006, 20 of the 46 injecting-related HIV notifications in Melbourne (Australia’s second-largest city) were ethnic Vietnamese heroin users. Through in-depth interviews we explored and documented the coping tactics and strategies of 9 ethnic Vietnamese heroin injectors. We explored their experiences of living with HIV, and in this article identify factors that appear to have contributed to limiting the spread of HIV beyond this cluster of people. The data reveal factors associated with this self-limiting outbreak, including consciously avoiding opioid withdrawal and having closed injecting networks. Early and effective engagement with participants by health care workers also appears to have played an important role in containing the transmission of HIV within this group of ethnic Vietnamese heroin injectors.
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.DRUGPO.2018.02.021
Abstract: Gay and bisexual men (GBM) often use illicit drugs to enhance sexual pleasure, commonly referred to as 'chemsex' or 'party n play'. In particular, the use of meth hetamine and Viagra™, and other erectile dysfunction medications, both together and separately are strongly predictive of subsequent HIV infection. Truvada™, as pre-exposure prophylaxis (PrEP), virtually eliminates HIV transmission during condomless anal intercourse (CLAI). HIV-negative GBM in intensive sex partying networks may be adding PrEP to their drug regimen to actively reduce the possibility of HIV transmission during chemsex. We describe the prevalence and context of concurrent use of meth hetamine, Truvada™ (or its generic formulations), and Viagra™ or other erectile dysfunction medication (collectively, MTV). The Following Lives Undergoing Change study is an online prospective observational study of licit and illicit drug use among Australian GBM. Between January and July 2017, 1831 GBM provided details about their use of MTV. Binary logistic multiple regression analysis were used to estimate adjusted odds ratios (aOR) and associated 95% confidence intervals (95%CI). Concurrent MTV use was reported by 6.0% of participants 3.1% used meth hetamine and Viagra™ or other erectile dysfunction medication ('MV only') and 11.2% used Truvada™ as PrEP ('T only'). In multivariate analysis, compared to use of 'MV only', MTV was independently associated with CLAI with casual partners (aOR = 6.78 %CI = 1.42-32.34) and 'fuckbuddies' (aOR = 3.47 %CI = 1.41-8.56) in the previous six months. Compared to use of 'T only', MTV was independently associated with being older (aOR = 3.95 %CI = 1.55-10.03) and engaging in group sex (aOR = 3.31 %CI = 1.82-6.00). Greater social engagement with other gay men (aOR = 1.44 %CI = 1.18-1.76) and having more sexual partners (aOR = 2.30 %CI = 1.10-4.82) were independently associated with use of MTV compared to use of 'MV only' or 'T only'. GBM in intensive sex partying networks are increasingly adding PrEP alongside other drugs they use to enhance sexual experiences. Interventions that promote the use of PrEP during chemsex could mitigate HIV risk.
Publisher: Elsevier BV
Date: 09-2017
DOI: 10.1016/J.DRUGPO.2017.07.002
Abstract: The burden of hepatitis C virus (HCV) infection is escalating among people who inject drugs (PWID), yet testing and treatment remains suboptimal. The aim of this systematic review was to evaluate the effectiveness of interventions to enhance HCV testing, linkage to care, and treatment uptake among PWID. A systematic literature search of Medline (Ovid 1946 - present), Embase, Global Health, Cochrane Central Register of Controlled Trials, PsycINFO, Clinical Trials Registry, and Web of Science was conducted covering interventional studies published before 20 July 2016. Studies evaluating interventions to enhance HCV testing, linkage to care or treatment among PWID were included. Data from included studies was extracted by one reviewer and checked by a second reviewer with disagreements discussed until consensus was reached. Relative risk ratios and corresponding confidence intervals were generated for studies included in analysis. After adjusting for duplicates, 10,116 records were identified. A total of 14 studies were included for analysis, of which 57% were randomised controlled trials. Interventions to enhance HCV testing included on-site testing with pre-test counselling and education and dried blood spot testing. Interventions to enhance linkage to care included facilitated referral for HCV assessment and scheduling of specialist appointments for clients. Interventions to enhance HCV treatment uptake included integrated HCV care, drug use and psychiatric services delivered by a multidisciplinary team with case management services, with or without non-invasive liver disease assessment. All studies were conducted in the interferon treatment era and there were no studies conducted in low- and middle-income countries. In the direct acting antiviral treatment era, well-designed studies evaluating interventions to enhance a simplified care cascade are crucial in facilitating treatment scale-up.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2020
Publisher: Oxford University Press (OUP)
Date: 28-08-2016
Publisher: Springer Science and Business Media LLC
Date: 24-03-2020
Publisher: Wiley
Date: 14-07-2015
DOI: 10.1111/ADD.13003
Publisher: Oxford University Press (OUP)
Date: 15-08-2013
DOI: 10.1093/CID/CIT300
Publisher: Wiley
Date: 07-2008
DOI: 10.1080/09595230801914743
Abstract: Ethnic and cultural differences in vulnerability to drug-related harms have received little attention in Australia. The current study aimed to explore the influence of cultural beliefs and practices on vulnerability to blood-borne viral infections (BBVIs) among ethnic Vietnamese IDUs and to identify barriers to this group accessing health and preventive programmes. Observational fieldwork and in-depth interviews (n = 58) were conducted in South Western Sydney. Participants were recruited using a mix of snowball and theoretical s ling strategies. Open coding was used to inductively classify data into themes and data examined for regularities and variations in relationships between and within themes. Participants embraced pluralistic approaches to prevention, diagnosis and treatment, relying on co-existing layers of beliefs and utilising both traditional and western remedies. Four main cultural characteristics influenced vulnerability to BBVIs: trust and obligation, stoicism, the importance of 'face' and beliefs in fate. Other factors influencing injecting risk included low levels of knowledge, being in a state of withdrawal, availability of sterile injecting equipment and environmental constraints. Barriers to accessing services included stigma and discrimination, concerns in relation to confidentiality, long waiting times, resistance to pharmacotherapy treatment and language and financial barriers. Results indicate a need for interventions based on culturally specific meanings and contexts of health, illness and risk. By understanding how culture impacts risk and protective behaviours among ethnic Vietnamese IDUs, clinicians and other service providers will be better equipped to meet the needs of this vulnerable group.
Publisher: Public Library of Science (PLoS)
Date: 02-04-2015
Publisher: Wiley
Date: 11-11-2020
DOI: 10.1111/ADD.15301
Publisher: Wiley
Date: 21-12-2012
DOI: 10.1002/CASP.1134
Publisher: Wiley
Date: 11-2009
DOI: 10.1111/J.1465-3362.2009.00060.X
Abstract: Limited resources may dictate the use of self-reported hepatitis B virus (HBV) status to determine the need for testing and/or vaccination in resource-poor settings, as well as in research and surveillance. A synthesis of the literature on the criterion validity of self-reported HBV infection and vaccination history among injecting drug users (IDU) in order to determine the utility or otherwise of self-reports in this area. The degree of agreement between self-reported and serological HBV status is consistently poor among IDU. In previous research, 46-95% of IDU with serological evidence of exposure to HBV did not report a history of infection, and serological evidence of vaccine-conferred immunity was not detected among 50-73% of IDU who reported being vaccinated. A lack of awareness or misapprehension about their HBV status may lead some IDU to inadvertently engage in behaviours which place their injecting and sexual partners at risk, contributing to the continued potential for high incidence of HBV infection among this population. Self-reported histories should not be used in lieu of serological testing when assessing infection history or immunisation status. Poor criterion validity also indicates that self-reports of HBV infection status should not be used to estimate the prevalence and incidence of this infection. Due to their low sensitivity, self-reports of HBV infection should at best be considered only as a lower bound prevalence estimate.
Publisher: CSIRO Publishing
Date: 2018
DOI: 10.1071/SH17146
Abstract: Background Gamma-hydroxybutyrate (GHB) use among gay and bisexual men (GBM) has increased in recent years. It is commonly cited as a sexual-enhancement drug. There is, however, little evidence for factors associated with GHB use or the consequences of its use among GBM. Aim: Factors associated with GHB use, its relationship to sexual risk behaviour, and the contexts, consequences, and motivations for its use were examined. Methods: The Following Lives Undergoing Change (Flux) Study is an online prospective observational study of Australian GBM. At baseline, a total of 3190 GBM provided details about their use of GHB. Data on frequency, methods, pleasures and consequences of their drug use, alongside key demographic variables were collected. Results: Mean age was 35.0 years. One in five men (19.5%) had a history of GHB use and 5.4% reported use within the past 6 months, with 2.7% having used it monthly or more frequently. Overdose had been experienced by 14.7%, this was more common among men who used GHB at least monthly. Being HIV-positive, having more gay friends, greater social engagement with gay men who use drugs, a greater number of sexual partners, group sex, and condomless anal intercourse with casual partners were independently associated with GHB use in the past 6 months. Greater social engagement with gay men who use drugs and group sex were independently associated with at least monthly use. More frequent GHB use was independently associated with experiencing overdose among GHB users. Conclusion: Most men used GHB infrequently and it was often used explicitly to enhance sexual experiences, often in the context of intensive sex partying. Men who used GHB frequently, were at greater risk of overdose and other negative health outcomes. GHB use should be considered alongside other drugs that have been implicated in sexual risk behaviour and HIV transmission. Harm-reduction interventions need to consider the particular impact of frequent GHB use.
Publisher: Informa UK Limited
Date: 28-03-2012
DOI: 10.1080/09540121.2012.663886
Abstract: Research with injecting drug users (IDUs) suggests greater willingness to report sensitive and stigmatised behaviour via audio computer-assisted self-interviewing (ACASI) methods than during face-to-face interviews (FFIs) however, previous studies were limited in verifying this within the same in iduals at the same time point. This study examines the relative willingness of IDUs to report sensitive information via ACASI and during a face-to-face clinical assessment administered in health services for IDUs. During recruitment for a randomised controlled trial undertaken at two IDU-targeted health services, assessments were undertaken as per clinical protocols, followed by referral of eligible clients to the trial, in which baseline self-report data were collected via ACASI. Five questions about sensitive injecting and sexual risk behaviours were administered to participants during both clinical interviews and baseline research data collection. "Percentage agreement" determined the magnitude of concordance/discordance in responses across interview methods, while tests appropriate to data format assessed the statistical significance of this variation. Results for all five variables suggest that, relative to ACASI, FFI elicited responses that may be perceived as more socially desirable. Discordance was statistically significant for four of the five variables examined. Participants who reported a history of sex work were more likely to provide discordant responses to at least one socially sensitive item. In health services for IDUs, information collection via ACASI may elicit more reliable and valid responses than FFI. Adoption of a universal precautionary approach to complement in idually tailored assessment of and advice regarding health risk behaviours for IDUs may address this issue.
Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/SH19204
Abstract: Background Surveillance data indicate that Aboriginal and Torres Strait Islander young people are more likely than their non-Indigenous counterparts to experience sexually transmissible infections (STIs) and teenage pregnancy. Despite increasing emphasis on the need for strengths-based approaches to Aboriginal sexual health, limited published data document how young Aboriginal people reduce sexual health risks encountered in their everyday lives. Methods: In-depth interviews with 35 young Aboriginal women and men aged 16–21 years in two remote Australian settings were conducted inductive thematic analysis examining sexual health risk reduction practices was also conducted. Results: Participants reported in idual and collective STI and pregnancy risk reduction strategies. In idual practices included accessing and carrying condoms having a regular casual sexual partner being in a long-term trusting relationship using long-acting reversible contraception having fewer sexual partners abstaining from sex accessing STI testing. More collective strategies included: refusing sex without a condom accompanied health clinic visits with a trusted in idual encouraging friends to use condoms and go for STI testing providing friends with condoms. Conclusion: Findings broaden understanding of young Aboriginal people’s sexual health risk reduction strategies in remote Aboriginal communities. Findings signal the need for multisectoral STI prevention and sexual health programs driven by young people’s existing harm minimisation strategies and cultural models of collective support. Specific strategies to enhance young people’s sexual health include: peer condom distribution accompanied health service visits peer-led health promotion continued community-based condom distribution enhanced access to a fuller range of available contraception in primary care settings engaging health service-experienced young people as ‘youth health workers’.
Publisher: Informa UK Limited
Date: 02-2011
DOI: 10.1080/13691058.2010.520742
Abstract: The Indigenous Resilience Project is an Australian community-based participatory research project using qualitative methods to explore young Aboriginal and Torres Strait Islander people's views of blood-borne viral and sexually transmitted infections (BBV/STI) affecting their communities. In this paper we present an analysis of narratives from young people who had a previous BBV/STI diagnosis to explore how they actively negotiate the experience of BBV/STI infection to construct a classic resilience narrative. We examine two overarching themes: first, the context of infection and diagnosis, including ignorance of STI/BBV prior to infection/diagnosis and, second, turning points and transformations in the form of insights, behaviours, roles and agency. Responding to critical writing on resilience theory, we argue that providing situated accounts of adversity from the perspectives of young Indigenous people prioritises their subjective understandings and challenges normative definitions of resilience.
Publisher: Elsevier BV
Date: 11-2010
DOI: 10.1016/J.DRUGPO.2010.04.004
Abstract: Global prevalence of hepatitis C virus (HCV) is estimated to be around 3% with approximately 170 million people affected. In Australia, and in many other resource rich countries, injecting drug use is the single most important risk factor for acquiring HCV, with around a third of diagnoses occurring in women. This study aims to assess gender differences in hepatitis C antibody prevalence and associated risk behaviours amongst a large s le of PWID in Australia. During a one to two week period in October, PWID attending selected NSP sites are invited to participate in the Australian NSP Survey. Between 1998 and 2008, approximately 16,000 in iduals completed a self-administered questionnaire and provided a capillary blood s le for HIV and HCV antibody testing. We stratified our s le by time since onset of injecting and analysed the demographic characteristics, injecting behaviours and antibody test results to determine gender differences. Women were found to be at increased risk of exposure to hepatitis C in all duration of injection categories except those injecting for 17 or more years. In the early years of injecting, women also reported higher rates of receptive sharing of needles and syringe and ancillary equipment when compared to men. Last injecting heroin, methadone or buprenorphine was significantly associated with HCV antibody prevalence amongst both males and females injecting for less than 5 years. Findings indicate that women are at greater risk than men of HCV infection during the early years of injection through higher rates of receptive sharing of needles and syringes and/or ancillary equipment. Our results suggest that women who are new to injecting, and Indigenous women in particular, should be identified as priority populations when developing and implementing harm reduction strategies that target people who inject illicit drugs.
Publisher: Wiley
Date: 17-05-2018
DOI: 10.1111/ADD.14217
Publisher: SAGE Publications
Date: 09-02-2019
Abstract: In the 30 years since its introduction, meta-ethnography has become a critical tool for synthesizing qualitative health research and providing a holistic understanding of complex health and social phenomena. Meta-ethnography has also been adapted to integrate a wider range of research methodologies, expanded to include a detailed taxonomy of research methods, and has led to the development of multiple other methods of synthesis. In this article, we describe the development of meta-ethnography, its unique research approaches, the innovations that have occurred since its inception, and potential future directions for the method. These include the need for consensus around the role of systematic database searches and critical appraisal, and a clearer path to action for clinicians interpreting qualitative research. Understanding and updating methods such as meta-ethnography will ensure that the exponentially developing field of qualitative research continues to have a meaningful and cumulative impact on complex issues of health and well-being.
Publisher: Elsevier BV
Date: 11-2019
Publisher: Elsevier BV
Date: 11-2015
Publisher: Informa UK Limited
Date: 22-02-2013
Publisher: Springer Science and Business Media LLC
Date: 28-06-2017
Publisher: Informa UK Limited
Date: 19-01-2017
DOI: 10.1080/13691058.2016.1269203
Abstract: Little is known about the experiences of Vietnamese men who have sex with men in accessing HIV testing and treatment. We aimed to explore barriers to access and uptake of antiretroviral therapy (ART) among HIV-positive men who have sex with men in Hanoi. During 2015, we conducted qualitative interviews with 35 participants recruited using snowball s ling based on previous research and social networks. Key in idual impediments to ART uptake included inadequate preparation for a positive diagnosis and the dual stigmatisation of homosexuality and HIV and its consequences, leading to fear of disclosure of HIV status. Health system barriers included lack of clarity and consistency about how to register for and access ART, failure to protect patient confidentiality and a reticence by providers to discuss sexual identity and same-sex issues. Results suggest fundamental problems in the way HIV testing is currently delivered in Hanoi, including a lack of client-centred counselling, peer support and clear referral pathways. Overcoming these barriers will require educating men who have sex with men about the benefits of routine testing, improving access to quality diagnostic services and building a safe, confidential treatment environment for HIV-positive men to access, receive and remain in care.
Publisher: Springer Science and Business Media LLC
Date: 09-06-2012
Publisher: Springer Science and Business Media LLC
Date: 22-01-2020
DOI: 10.1007/S10461-020-02796-3
Abstract: We report on Australian gay and bisexual men's (GBM) perceptions of preexposure prophylaxis (PrEP). Drawing on an online longitudinal cohort study, 1,404 free-text responses from HIV-negative or untested Australian GBM were qualitatively analysed. The chi-square statistic was then used to assess differences regarding PrEP-perceptions by participants' demographic and behavioral characteristics. Positive views of PrEP were twice more common than negative. Those with positive views thought PrEP helped overcome HIV fear and anxiety, enhanced sexual pleasure, and was a 'socially responsible' course of action. Those with negative views believed that people without medical conditions did not need medication and expressed concern that PrEP was replacing condoms, representing 'dangerous' behavior. Descriptive statistics revealed differences in PrEP-perceptions relating to age, recency of HIV testing, and PrEP eligibility. This study is the first to use free-text data to examine the frequency of Australian GBM's PrEP-perceptions, highlighting the potential benefits and challenges to its promotion.
Publisher: SAGE Publications
Date: 24-02-2022
DOI: 10.1177/00220426211073911
Abstract: The trajectories of people attempting to reduce harmful meth hetamine use are frequently understood within a binary framework of transitioning between states of health and disease. This framework can often be reinforced by service interactions informed by these dominant narratives of recovery and addiction. In this paper, we draw on a critical interactionist analysis of ethnographic fieldwork conducted with people who use meth hetamine, to examine how their experiences could undermine this binary, observing the ways participants experienced growth, change, and progress, without necessarily maintaining abstinence. These findings support a more erse understanding of drug use trajectories, and we explore the concept of ‘living with drug use’, similar to how people live with other chronic conditions by finding ‘health in illness’. Participant experiences are also interpreted within the context of counter public health, arguing for the recognition and integration of values and goals which are ergent from the implicit aims of public health practice.
Publisher: Wiley
Date: 24-06-2022
DOI: 10.1111/ADD.15975
Abstract: To measure mortality rates and factors associated with mortality risk among participants in the SuperMIX study, a prospective cohort study of people who inject drugs. A prospective observational study using self‐reported behavioural and linked mortality data. Melbourne, Australia. A total of 1209 people who inject drugs (67% male) followed‐up between 2008 and 2019 for 6913 person‐years (PY). We linked participant identifiers from SuperMIX to the Australian National Death Index and estimated all‐cause and drug‐related mortality rates and standardized mortality ratios (SMRs). We used Cox regression to examine associations between mortality and fixed and time‐varying socio‐demographic, alcohol and other drug use and health service‐related exposures. Between 2008 and 2019 there were 76 deaths in the SuperMIX cohort. Of those with a known cause of death ( n = 68), 35 (51%) were drug‐related, yielding an all‐cause mortality rate of 1.1 per 100 PY [95% confidence interval (CI) = 0.88–1.37] with an estimated SMR of 16.64 (95% CI = 13.29–20.83) and overall accidental drug‐induced mortality rate of 0.5 per 100 PY (95% CI = 0.36–0.71). Reports of recent use of ambulance services [adjusted hazard ratio (aHR) = 3.77, 95% CI =1.78–7.97] and four or more incarcerations (aHR = 2.78, 95% CI = 1.55–4.99) were associated with increased mortality risk. In Melbourne, Australia, mortality among people who inject drugs appears to be positively associated with recent ambulance attendance and experience of incarceration.
Publisher: Springer Science and Business Media LLC
Date: 06-04-2020
DOI: 10.1186/S12889-020-08565-0
Abstract: Australian surveillance data document higher rates of sexually transmissible infections (STIs) among young Aboriginal people (15 – 29 years) in remote settings than non-Aboriginal young people. Epidemiological data indicate a substantial number of young Aboriginal people do not test for STIs. Rigorous qualitative research can enhance understanding of these findings. This paper documents socio-ecological factors influencing young Aboriginal people’s engagement with clinic-based STI testing in two remote settings in the Northern Territory, Australia. In-depth interviews with 35 young Aboriginal men and women aged 16–21 years thematic analysis examining their perceptions and personal experiences of access to clinic-based STI testing. Findings reveal in idual, social and health service level influences on willingness to undertake clinic-based STI testing. In idual level barriers included limited knowledge about asymptomatic STIs, attitudinal barriers against testing for symptomatic STIs, and lack of skills to communicate about STIs with health service staff. Social influences both promoted and inhibited STI testing. In setting 1, local social networks enabled intergenerational learning about sexual health and facilitated accompanied visits to health clinics for young women. In setting 2, however, social connectedness inhibited access to STI testing services. Being seen at clinics was perceived to lead to stigmatisation among peers and fear of reputational damage due to STI-related rumours. Modalities of health service provision both enhanced and inhibited STI testing. In setting 1, outreach strategies by male health workers provided young Aboriginal men with opportunities to learn about sexual health, initiate trusting relationships with clinic staff, and gain access to clinics. In setting 2, barriers were created by the location and visibility of the clinic, appointment procedures, waiting rooms and waiting times. Where inhibitive factors at the in idual, social and health service levels exist, young Aboriginal people reported more limited access to STI testing. This is the first socio-ecological analysis of factors influencing young Aboriginal people’s willingness to undertake testing for STIs within clinics in Australia. Strategies to improve uptake of STI testing must tackle the overlapping social and health service factors that discourage young people from seeking sexual health support. Much can be learned from young people’s lived sexual health experiences and family- and community-based health promotion practices.
Publisher: Wiley
Date: 13-02-2023
DOI: 10.1111/ADD.16147
Abstract: Although the Netherlands, Canada and Australia were early adopters of harm reduction for people who inject drugs (PWID), their respective HIV and hepatitis C (HCV) epidemics differ. We measured the pooled effect of needle and syringe program (NSP) and opioid agonist therapy (OAT) participation on HIV and HCV incidence in these settings. For each cohort, we emulated the design and statistical analysis of a target trial using observational data. We included PWID at risk of HIV or HCV infection from the Amsterdam Cohort Studies (1985–2013), Vancouver Injection Drug Users Study (1997–2009) and Melbourne Injecting Drug User Cohort Study (SuperMIX) (2010–2021). Separately for each infection and cohort (only HCV in SuperMIX), marginal structural models were used to compare the effect of comprehensive (on OAT and 100% NSP coverage or on OAT only if no recent injection drug use) versus no artial NSP/OAT (no OAT and/or % NSP coverage) participation. Pooled hazard ratios (HR) and 95% CI were calculated using random‐effects meta‐analysis. We observed 94 HIV seroconversions and 81 HCV seroconversions among 2023 and 430 participants, respectively. Comprehensive NSP/OAT led to a 41% lower risk of HIV acquisition (pooled HR = 0.59, 95% CI = 0.36–0.96) and a 76% lower risk of HCV acquisition (pooled HR = 0.24, 95% CI = 0.11–0.51), compared with no artial NSP/OAT, with little heterogeneity between studies for both infections ( I 2 = 0%). In the Netherlands, Canada and Australia, comprehensive needle and syringe program and opioid agonist therapy participation appears to substantially reduce HIV and hepatitis C acquisition compared with no or partial needle and syringe program/opioid agonist therapy participation. These findings from an emulated trial design reinforce the critical role of comprehensive access to harm reduction in optimizing infection prevention for people who inject drugs.
Publisher: Informa UK Limited
Date: 2008
DOI: 10.1080/09540120701426524
Abstract: Testing injecting drug users (IDUs) for HIV and hepatitis C virus (HCV) provides a useful opportunity for health promotion, risk-reduction assessment and counselling, and increases opportunities for treatment assessment, yet little is known about IDUs' experience of testing. This study aimed to examine the experiences of testing among IDUs recruited through primary healthcare and drug treatment services. Almost all the 229 participants recruited had been previously tested for HIV (96%) and HCV (97%), a median of five and four times respectively. Reasons for seeking testing were similar for both HIV and HCV, the most common being to protect others (72 and 74%, respectively), blood/needle exposure (66 and 70%, respectively) and to receive early treatment (66%, both). The most common locations for testing were general medical practices (GPs) (53%), specialised clinics (45%) and methadone clinics (43%). Preferred locations were similar for HIV and HCV testing: methadone clinics (47 and 48%, respectively), GPs (42%, both), specialised clinics (32%, both). The most common reasons for delaying testing were being anxious about waiting for results (66%), scared or afraid of finding out results (65%) and having trouble keeping appointments (64%). The majority of participants (HIV 62% HCV 59%) reported that they would prefer pre-test counselling to be delivered in person rather than receiving written information and would prefer test results to be delivered face-to-face (HIV 83% HCV 80%). High prevalence of testing suggests good uptake and high acceptability among this population in Australia. Specialised services for drug users such as methadone clinics and primary healthcare are suitable locations to provide access to testing.
Publisher: Wiley
Date: 09-2006
DOI: 10.1111/J.1360-0443.2006.01543.X
Abstract: To determine the incidence of hepatitis C virus (HCV) infection and identify risk factors for seroconversion. Prospective cohort study. Participants were recruited through direct approaches, street-based outreach, methadone and sexual health clinics and needle and syringe programmes. Urban, regional and rural settings in New South Wales, Australia. Injecting drug users (IDUs) (n = 584) were screened and tested for exposure to HCV. Between 1999 and 2002 antibody HCV negative IDUs (n = 368) were enrolled and followed-up every 3-6 months until seroconversion or study completion. Interviewer-administered baseline and follow-up questionnaires consisted of 131 items and included demographics, drug use and risk behaviour. Approximately 10 cc of whole blood was drawn at each visit. Specimens were stored at -70C and serology performed using one or two third-generation enzyme-linked immunosorbent assays and polymerase chain reaction testing. Sixty-eight seroconversions were observed and incidence was 30.8 per 100 person-years, with incidence in IDUs injecting < 1 year, 133 per 100 person-years. Independent predictors of seroconversion were female gender, duration of injecting, injecting cocaine, shared use of filters and recruitment strategy. Women, new initiates and IDUs recruited via outreach appear to be at increased risk of infection. Results confirm the significance of cocaine injection as a risk factor and provide the first evidence outside North America of the link between shared use of drug preparation equipment and incident HCV infection. Prevention efforts should attempt to raise awareness of the risks associated with drug sharing and, in particular, the role of potentially contaminated syringes in HCV infection.
Publisher: MDPI AG
Date: 04-04-2023
Abstract: Microbeam radiation therapy (MRT) utilizes coplanar synchrotron radiation beamlets and is a proposed treatment approach for several tumor diagnoses that currently have poor clinical treatment outcomes, such as gliosarcomas. Monte Carlo (MC) simulations are one of the most used methods at the Imaging and Medical Beamline, Australian Synchrotron to calculate the dose in MRT preclinical studies. The steep dose gradients associated with the 50μm-wide coplanar beamlets present a significant challenge for precise MC simulation of the dose deposition of an MRT irradiation treatment field in a short time frame. The long computation times inhibit the ability to perform dose optimization in treatment planning or apply online image-adaptive radiotherapy techniques to MRT. Much research has been conducted on fast dose estimation methods for clinically available treatments. However, such methods, including GPU Monte Carlo implementations and machine learning (ML) models, are unavailable for novel and emerging cancer radiotherapy options such as MRT. In this work, the successful application of a fast and accurate ML dose prediction model for a preclinical MRT rodent study is presented for the first time. The ML model predicts the peak doses in the path of the microbeams and the valley doses between them, delivered to the tumor target in rat patients. A CT imaging dataset is used to generate digital phantoms for each patient. Augmented variations of the digital phantoms are used to simulate with Geant4 the energy depositions of an MRT beam inside the phantoms with 15% (high-noise) and 2% (low-noise) statistical uncertainty. The high-noise MC simulation data are used to train the ML model to predict the energy depositions in the digital phantoms. The low-noise MC simulations data are used to test the predictive power of the ML model. The predictions of the ML model show an agreement within 3% with low-noise MC simulations for at least 77.6% of all predicted voxels (at least 95.9% of voxels containing tumor) in the case of the valley dose prediction and for at least 93.9% of all predicted voxels (100.0% of voxels containing tumor) in the case of the peak dose prediction. The successful use of high-noise MC simulations for the training, which are much faster to produce, accelerates the production of the training data of the ML model and encourages transfer of the ML model to different treatment modalities for other future applications in novel radiation cancer therapies.
Publisher: Springer Science and Business Media LLC
Date: 05-01-2013
DOI: 10.1007/S10461-011-0117-6
Abstract: We aimed to estimate temporal trends in the proportion of HIV diagnoses which could be characterized as recent infections in Australia for men who have sex with men (MSM), people who inject drugs (PWID), and heterosexual men and women using modified back-projection methodology based on data sources from HIV/AIDS Surveillance database. The proportion of HIV diagnoses among MSM that can be classified as recent infections increased in MSM, heterosexual men and women consistently. However, after initial increases during 1996-2000, the proportion of overall recent infections estimated among PWID declined by 50% in 2007 compared to 2000 (from 23 to 11%). These data suggest that late HIV diagnoses were more common among PWID compared to other groups. Ongoing prevention efforts need to be coupled with targeted testing and treatment efforts to increase the diagnosis of recent infection in PWID and reduce apparent inequities in access to screening.
Publisher: Hindawi Limited
Date: 07-03-2013
DOI: 10.1111/HSC.12026
Abstract: Although the levels of injecting drug use among lesbian, gay, bisexual and transgender (LGBT) populations are high, we know little about their experiences of injecting drugs or living with hepatitis C virus (HCV) infection. The loss of traditional family and cultural ties means connection to community is important to the well-being of LGBT populations. Although some kinds of drug use are normalised within many LGBT communities, injecting drug use continues to be stigmatised. This exploratory qualitative study of people with newly acquired HCV used semi-structured interviews to explore participants' understandings and awareness of HCV, seroconversion, testing, diagnosis and treatment. We present a secondary thematic analysis of eight LGBT participants of the experience of injecting drugs, living with HCV and having a marginalised sexual or gender identity. Community was central to the participants' accounts. Drug use facilitated connection to a chosen community by suppressing sexual or gender desires allows them to fit in to the mainstream enacting LGBT community norms of behaviour and connection through shared drug use. Participants also described feeling afraid to come out about their drug use to LGBT peers because of the associated stigma of HCV. They described a similar stigma associated with HIV within the people who inject drugs (PWID) community. Thus, the combination of being LGBT/living with HIV (a gay disease) and injecting drugs/living with HCV (a junkie's disease) left them in a kind of no-man's-land. Health professionals working in drug and HCV care services need to develop capacity in providing culturally appropriate health-care for LGBT PWID.
Publisher: Wiley
Date: 07-2010
DOI: 10.1111/J.1465-3362.2009.00165.X
Abstract: Cleaning needles/syringes is an important second-line harm reduction strategy, yet there is limited information on practices employed by people who inject drugs in Australia. This study attempts to identify and assess cleaning practices in terms of the techniques involved and the social contexts in which cleaning takes place. As part of an exploratory qualitative study in south-west Sydney, in-depth interviews and simulated cleaning exercises were conducted with 12 people who inject drugs. Interviews were digitally recorded and transcribed verbatim. Open coding was used to inductively classify data into themes, and data were examined for patterns and variations in the relationships within and between themes. Data indicate that cleaning and reuse of needles/syringes was common in this small s le. The most frequently utilised reagent was cool water. While all participants reported cleaning and reusing only their own equipment, none of the techniques demonstrated would have been sufficient to deactivate human immunodeficiency virus or hepatitis C virus. Results suggest that even where cleaning of needles and syringes is widespread, people who inject drugs may not engage in efficacious cleaning. The combination of the complexity of current cleaning messages and a lack of accurate information about efficacious techniques are likely to contribute to poor cleaning practice. Australia could benefit from the development of a nationally consistent cleaning message however, the evidence would suggest that this would need to be accompanied by strategies designed to simplify and disseminate this information in order to increase the uptake of efficacious cleaning methods by people who inject drugs.
Publisher: Elsevier BV
Date: 03-2019
Publisher: Oxford University Press (OUP)
Date: 30-11-2013
DOI: 10.1093/IJE/DYS167
Publisher: Springer Science and Business Media LLC
Date: 28-07-2012
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2013
Publisher: Informa UK Limited
Date: 10-2008
DOI: 10.1080/13691050802203838
Abstract: Previous quantitative cross sectional studies of ethnic Vietnamese drug users in Melbourne have been overwhelmingly drawn from s les of men. In this qualitative investigation, 24 women aged between 18 and 33 years were interviewed. This exploratory study sought: to identify issues surrounding heroin initiation and drug use career to examine relationships with family and primary sex partners and to reveal participants' attitudes to drug treatment. Data reveal that for the women in this study the initiation and continued use of heroin was heavily influenced by men, especially their primary sex partners. The women interviewed reported strategies to minimise their risk taking including enrolling in pharmacotherapy treatment programmes, but they remained particularly vulnerable - especially to blood borne viruses - through both injecting and sexual risk behaviour. The data suggest that interventions which focus on the gendered nature of injecting practices within personal relationships may go some way to both reducing harm and increasing control for the women involved.
Publisher: Wiley
Date: 07-2014
DOI: 10.1111/JVH.12129
Abstract: The majority of new and existing cases of hepatitis C virus (HCV) infection occur among people who inject drugs (PWID). Despite safe and efficacious HCV antiviral therapy, uptake remains low in this population. This study examined trends in HCV treatment uptake among a large national s le of PWID attending Australian Needle and Syringe Programs between 1999 and 2011. Annual cross-sectional sero-surveys conducted among PWID since 1995 involve completion of a self-administered questionnaire and provision of a dried blood spot for HCV antibody testing. Multivariate logistic regression identified variables independently associated with HCV treatment uptake among 9478 participants with both self-reported and serologically confirmed prior HCV infection. Between 1999 and 2011, the proportion currently receiving treatment increased from 1.1% to 2.1% (P < 0.001), while the proportion having ever received treatment increased from 3.4% to 8.6% (P < 0.001). Men were significantly more likely than women to have undertaken HCV treatment (P = 0.002). Among men, independent predictors of HCV treatment uptake were homosexual identity and older age among women, independent predictors included homosexual identity and an incarceration history. Despite increases in HCV treatment among Australian PWID between 1999 and 2011, uptake remains low. Strategies are required to increase the proportion of PWID assessed and treated for HCV infection to address the increasing burden of disease. Specific approaches that target women may also be warranted. Continued surveillance of HCV treatment uptake among PWID will be important to monitor the roll-out of simple, safe and more effective HCV treatments expected to be available in the future.
Publisher: IOP Publishing
Date: 22-09-2011
Publisher: Wiley
Date: 09-2008
Publisher: Informa UK Limited
Date: 06-2011
DOI: 10.1080/13691058.2011.566942
Abstract: Global expansion of antiretroviral therapy (ART) programmes for people living with HIV is the largest public health undertaking to date. Antiretroviral therapy adherence drives in idual and programme outcomes, yet little is known regarding the determinants of these behaviours. We investigated beliefs and practices associated with ART use in Cambodia. In-depth interviews were conducted during 2005 with 27 people living with HIV who were recruited using a theoretical s ling strategy and analysed in Khmer and English using an inductive approach to code data and identify themes. Limited access to ART generated a sense of ART as rare and precious, with access granted by doctors once patients proved themselves dependable. The social construction of ART use was strict, precise and modern with ritualistic preparation and dosing procedures. Experiences of life-saving efficacy in self and others built a deep sense of trust. For many, ART was simply equated to life. Antiretroviral therapy dosing was prioritized and supported by an ever-present sense of remembering, reminder devices and social networks. Healthcare workers set norms and provided various forms of adherence support. Antiretroviral therapy use in Cambodia is shaped by the relationship between in iduals and social and healthcare networks that set, encourage and enforce precise norms of ART use.
Publisher: Oxford University Press (OUP)
Date: 24-02-2017
DOI: 10.1093/CID/CIW869
Publisher: Elsevier BV
Date: 11-2015
Publisher: Wiley
Date: 14-07-2020
DOI: 10.1111/ADD.15168
Publisher: Public Library of Science (PLoS)
Date: 09-2011
Publisher: Wiley
Date: 23-01-2019
DOI: 10.1111/ADD.14519
Abstract: To evaluate the cost-effectiveness of needle and syringe programmes (NSPs) compared with no NSPs on hepatitis C virus (HCV) transmission in the United Kingdom. Cost-effectiveness analysis from a National Health Service (NHS)/health-provider perspective, utilizing a dynamic transmission model of HCV infection and disease progression, calibrated using city-specific surveillance and survey data, and primary data collection on NSP costs. The effectiveness of NSPs preventing HCV acquisition was based on empirical evidence. UK settings with different chronic HCV prevalence among people who inject drugs (PWID): Dundee (26%), Walsall (18%) and Bristol (45%) INTERVENTIONS: Current NSP provision is compared with a counterfactual scenario where NSPs are removed for 10 years and then returned to existing levels with effects collected for 40 years. HCV infections and cost per quality-adjusted life year (QALY) gained through NSPs over 50 years. Compared with a willingness-to-pay threshold of £20 000 per QALY gained, NSPs were highly cost-effective over a time-horizon of 50 years and decreased the number of HCV incident infections. The mean incremental cost-effectiveness ratio was cost-saving in Dundee and Bristol, and £596 per QALY gained in Walsall, with 78, 46 and 40% of simulations being cost-saving in each city, respectively, with differences driven by coverage of NSP and HCV prevalence (lowest in Walsall). More than 90% of simulations were cost-effective at the willingness-to-pay threshold. Results were robust to sensitivity analyses, including varying the time-horizon, HCV treatment cost and numbers of HCV treatments per year. Needle and syringe programmes are a highly effective low-cost intervention to reduce hepatitis C virus transmission, and in some settings they are cost-saving. Needle and syringe programmes are likely to remain cost-effective irrespective of changes in hepatitis C virus treatment cost and scale-up.
Publisher: Informa UK Limited
Date: 03-2007
DOI: 10.1080/09540120701192837
Abstract: The current study aimed to compare self-reported injecting and sexual risk behaviour among Needle and Syringe Program (NSP) attendees who self-completed a questionnaire to that of those who received assistance in completing the questionnaire. Information on demographic, injecting and sexual risk behaviour was collected via a self-completed questionnaire for an annual cross-sectional survey of injecting drug users (IDUs) recruited from sentinel NSPs around Australia. Assistance was provided when necessary and recorded. Of 2,035 participants, 1,452 (71%) reported completing the questionnaire without assistance. Being male and nominating a language other than English spoken at home was independently associated with receiving assistance with questionnaire completion. Participants who reported heroin as the drug last injected were also more likely to receive assistance. Multivariate analyses revealed those who received assistance with questionnaire completion were less likely to report re-using a syringe after someone else and less likely to report sex work in the past month. The current findings suggest self-completion of risk behaviour questionnaires should be considered as an alternative to interviewer administered questionnaires to maximise accuracy of self-reports.
Publisher: AMPCo
Date: 09-2011
DOI: 10.5694/MJA11.10815
Publisher: Elsevier BV
Date: 08-2017
Publisher: Wiley
Date: 15-10-2012
DOI: 10.1111/JVH.12016
Abstract: Some hepatitis C (HCV)-uninfected, high-risk in iduals have HCV-specific cellular immunity without viraemia or seroconversion. The characteristics of these responses and the risk behavioural associations were studied in 94 subjects in a prospective cohort of recently seronegative prisoners reporting injecting drug use (IDU). Detailed behavioural data were collected. HCV antibody and PCR testing were performed. ELISpot assays for HCV-induced interferon (IFN)-γ and interleukin (IL)-2 production by T lymphocytes, as well as multiplex in vitro cytokine production assays, were performed. Seventy-eight subjects remained antibody and PCR negative and 16 seroconverted. Of the seronegative group, 22 (28%) had IFN-γ ELISpot responses in comparison with 13 of the 16 seroconverters (82%). This seronegative immune status was associated positively with injecting anabolic steroids and negatively with a recent break from IDU. The IFN-γ ELISpot responses involved both CD4 and CD8 T lymphocytes and were comparable in magnitude, but narrower in specificity, in uninfected subjects than in seroconverters. A subset of seronegative subjects had HCV-induced cytokine production patterns comparable with the seroconverters with increased production of IFN-γ, IL-2 and tumour necrosis factor (TNF)-α and reduced IL-10 in response to nonstructural peptides. In conclusion, comparable patterns of HCV-specific cellular immunity are found in recently infected subjects and in a minority of high-risk, uninfected subjects. Further characterization of these responses and their protective efficacy will inform HCV vaccine development.
Publisher: Wiley
Date: 02-07-2018
DOI: 10.1111/DAR.12831
Abstract: People who use performance and image enhancing drugs (PIED) are a growing population in needle syringe programs (NSP) in Australia. Previous international research has identified heterogeneity among the PIED-using population. This study investigated health behaviours among NSP attendees who had recently (last 12 months) injected PIEDs and examined differences among this group according to recent psychoactive drug use. The Australian Needle and Syringe Program Survey is an annually repeated cross-sectional survey conducted at approximately 50 NSPs nationally. In 2015, respondents provided information on their demographic characteristics, health risk and health monitoring behaviours, and provided a capillary dried blood spot for HIV and hepatitis C virus antibody testing. Univariable and multivariable logistic regressions assessed factors associated with recent (last 12 months) use (all routes of administration) of psychoactive drugs. Among recent PIED injectors (n = 156), 59% had recently used psychoactive substances. Those who had recently used psychoactive drugs were significantly younger, less educated and more likely to have experienced redness at an injection site in the previous 12 months but were more likely to report recent HIV/hepatitis C virus testing. This study identified significant differences in demographic characteristics, risk and health seeking behaviour among PIED users who did and did not also use psychoactive substances. There is a need to enhance and tailor harm reduction efforts and to build the capacity of NSP staff to better meet the needs of this erse group.
Publisher: CSIRO Publishing
Date: 2014
DOI: 10.1071/PY12162
Abstract: The Australian National Hepatitis B Strategy 2010–13 outlines five priority areas for developing a comprehensive response to the hepatitis B virus (HBV): building partnerships and strengthening community action preventing HBV transmission optimising diagnosis and screening clinical management of people with chronic hepatitis B (CHB) and developing health maintenance, care and support for people with HBV. A scoping study was used to map the main sources and types of evidence available on the epidemiology and natural history of HBV among Indigenous Australians as well as public health responses published since 2001 (January 2001–May 2013). Gaps in current knowledge were identified. While the literature documents the success of universal infant immunisation and indicates the potential for screening initiatives to identify infected and susceptible in iduals, prevalence of CHB and hepatocellular cancer remain high in Indigenous Australians. Significant gaps in knowledge and practice were identified in relation to each of the five National Hepatitis B Strategy priority action areas. Successful implementation of the strategy in Indigenous communities and reducing the burden of HBV and hepatocellular cancer in Indigenous Australians will require increased investment in research and knowledge transfer across all priority areas.
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.DRUGALCDEP.2018.11.033
Abstract: Effective targeting of harm reduction programs for people who inject drugs (PWID) requires timely and robust estimates of the size of this population. This study estimated the number of people who inject drugs on a regular basis in Australia, calculated syringe coverage per person and the proportion of their injections covered by a sterile needle and syringe. We used trends in indicators of injection drug use to extend the 2005 estimate of the population of people who regularly inject drugs from 2005 to 2016. Included indicators were lifetime/recent injection of illicit drugs, drug-related arrests, drug-related seizures, accidental deaths due to opioids, opioid-related hospital admissions/separations and new diagnoses of hepatitis C virus infection among those aged 15-24 years. Syringe distribution and frequency of injection data were used to assess syringe coverage per PWID and the proportion of their injections covered by a sterile syringe. The estimated number of people who regularly inject drugs in Australia increased by 7%, from 72,000 in 2005 to 77,270 in 2016. The annual number of syringes distributed per person increased 34%, from 470 syringes in 2005 to 640 syringes in 2016. Syringe coverage per injection first exceeded 100% in Australia in 2013. Despite Australia's high syringe coverage by international standards, the number of syringes distributed is likely to be only narrowly meeting demand. It is critical that needle syringe programs be provided with sufficient resources to continue their role as the key intervention required to prevent HIV and HCV transmission among PWID.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2005
Publisher: Wiley
Date: 02-05-2019
DOI: 10.1111/JVH.13112
Abstract: People who are homeless have increased hepatitis C virus (HCV) infection risk, and are less likely to access primary healthcare. We aimed to evaluate HCV RNA prevalence, liver disease burden, linkage to care and treatment uptake and outcomes among people attending a homelessness service in Sydney. Participants were enrolled in an observational cohort study with recruitment at a homelessness service over eight liver health c aign days. Finger-stick whole-blood s les for Xpert® HCV Viral Load and venepuncture blood s les were collected. Participants completed a self-administered survey and received transient elastography and clinical assessment by a general practitioner or nurse. Clinical follow-up was recommended 2-12 weeks after enrolment. For participants initiating direct-acting antiviral (DAA) therapy, medical records were audited retrospectively and treatment outcome data were collected. Among 202 participants (mean age, 48 years), 82% were male (n = 165), 39% (n = 78) reported ever injecting drugs, of whom 63% (n = 49) injected in the previous month. Overall, 23% (n = 47) had detectable HCV RNA and 6% (n=12) had cirrhosis. HCV RNA prevalence among participants with either injecting or incarceration history was 35% (37/105), compared to 4% (3/73) among participants without these risk factors. Among those with detectable HCV RNA, 23 (49%) commenced therapy, of whom 65% (n = 15) achieved sustained virological response, while the remainder had no available treatment outcome. No participant had documented virological failure. HCV DAA treatment uptake among people attending a homelessness service was encouraging, but innovative models of HCV care are required to improve linkage to care and treatment uptake among this highly marginalized population.
Publisher: Wiley
Date: 06-12-2020
DOI: 10.1111/JVH.13233
Abstract: Gaps in hepatitis C virus (HCV) testing, diagnosis, liver disease assessment and treatment uptake among people who inject drugs (PWID) persist. We aimed to describe the cascade of HCV care among PWID in Australia, prior to and following unrestricted access to direct-acting antiviral (DAA) treatment. Participants enrolled in an observational cohort study between 2014 and 2018 provided fingerstick whole-blood s les for dried blood spot, Xpert HCV Viral Load and venepuncture s les. Participants underwent transient elastography and clinical assessment by a nurse or general practitioner. Among 839 participants (mean age 43 years), 66% were male (n = 550), 64% (n = 537) injected drugs in the previous month, and 67% (n = 560) reported currently receiving opioid substitution therapy. Overall, 45% (n = 380) had detectable HCV RNA, of whom 23% (n = 86) received HCV treatment within 12 months of enrolment. HCV treatment uptake increased from 2% in the pre-DAA era to 38% in the DAA era. Significant liver fibrosis (F2-F4) was more common in participants with HCV infection (38%) than those without (19%). Age 50 years or older (aOR, 2.88 95% CI, 1.18-7.04) and attending a clinical follow-up with nurse (aOR, 3.19 95% CI, 1.61-6.32) or physician (aOR, 11.83 95% CI, 4.89-28.59) were associated with HCV treatment uptake. Recent injection drug use and unstable housing were not associated with HCV treatment uptake. HCV treatment uptake among PWID has increased markedly in the DAA era. Evaluation of innovative and simplified models of care is required to further enhance treatment uptake.
Publisher: Elsevier BV
Date: 11-2018
DOI: 10.1016/J.DRUGPO.2018.08.011
Abstract: Uptake of hepatitis C virus (HCV) testing remains inadequate globally. Simplified point-of-care tests should enhance HCV diagnosis and elimination. We aimed to assess the acceptability of finger-stick and venepuncture HCV RNA testing among people who inject drugs (PWID). Participants were enrolled in an observational cohort study with recruitment at 13 sites between June 2016 and February 2018. Capillary whole-blood collected by finger-stick and plasma collected by venepuncture were performed for Xpert Among 565 participants (mean age, 44 years 69% male), 64% reported injecting drugs in the last month, and 63% were receiving opioid substitution treatment. Eighty three percent reported that finger-stick testing was very acceptable. Overall, 65% of participants preferred finger-stick over venepuncture testing, with 61% of these preferring to receive results in 60 min. The most common reason for preferring finger-stick over venepuncture testing was it was quick (62%) followed by venous access difficulties (21%). The main reasons for preferring venepuncture over finger-stick testing were that it was quick (61%) and accurate (29%). Females were more likely to prefer finger-stick testing than males (adjusted OR 1.96 95% CI 1.30, 2.99 p = 0.002). Among people with recent (previous month) injecting drug use, Aboriginal and/or Torres Strait Islander people were less likely than non-Aboriginal people to prefer finger-stick testing (adjusted OR 0.57 95% CI 0.34, 0.9 p = 0.033). Finger-stick whole-blood collection is acceptable to people who inject drugs, with males and Aboriginal and/or Torres Strait Islander people with recent injecting drug use less likely to prefer finger-stick testing. Further research is needed to evaluate interventions integrating simplified point-of-care HCV testing to engage people in care in a single-visit, thereby facilitating HCV treatment scale-up.
Publisher: Wiley
Date: 08-01-2015
DOI: 10.1111/JVH.12384
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/SH16123
Abstract: Background: In high-incidence Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) settings, annual re-testing is an important public health strategy. Using baseline laboratory data (2009–10) from a cluster randomised trial in 67 remote Aboriginal communities, the extent of re-testing was determined, along with the associated patient, staffing and health centre factors. Methods: Annual testing was defined as re-testing in 9–15 months (guideline recommendation) and a broader time period of 5–15 months following an initial negative CT/NG test. Random effects logistic regression was used to determine factors associated with re-testing. Results: Of 10 559 in iduals aged ≥16 years with an initial negative CT/NG test (median age = 25 years), 20.3% had a re-test in 9–15 months (23.6% females vs 15.4% males, P 0.001) and 35.2% in 5–15 months (40.9% females vs 26.5% males, P 0.001). Factors independently associated with re-testing in 9–15 months in both males and females were: younger age (16–19, 20–24 years) and attending a centre that sees predominantly ( %) Aboriginal people. Additional factors independently associated with re-testing for females were: being aged 25–29 years, attending a centre that used electronic medical records, and for males, attending a health centre that employed Aboriginal health workers and more male staff. Conclusions: Approximately 20% of people were re-tested within 9–15 months. Re-testing was more common in younger in iduals. Findings highlight the importance of recall systems, Aboriginal health workers and male staff to facilitate annual re-testing. Further initiatives may be needed to increase re-testing.
Publisher: Elsevier BV
Date: 09-2017
DOI: 10.1016/J.DRUGPO.2017.06.007
Abstract: Research indicates that hepatitis C antibody (anti-HCV) prevalence is higher among Australian Aboriginal and Torres Strait Islander (Aboriginal) than non-Aboriginal people who inject drugs (PWID). We examined trends in demographic and drug use characteristics and anti-HCV prevalence among Australian Needle and Syringe Program Survey (ANSPS) respondents by Aboriginal status from 1996 to 2015. The ANSPS survey involved collecting demographic, behavioural data and a dried blood spot for anti-HCV testing. We used logistic regression to determine demographic and behavioural factors associated with testing anti-HCV positive in the following time-periods (1996-2000, 2001-2005, 2006-2010, 2011-2015) among Aboriginal and non-Aboriginal PWID respondents. Overall, there were 16,948 PWID, with 11% identifying as Aboriginal. The proportion of Aboriginal respondents increased from 7% in 1996-2000 to 16% in 2011-2015. Overall anti-HCV prevalence was significantly higher among Aboriginal (60%) than non-Aboriginal PWID (52%, p<0.01). Receptive syringe sharing (RSS) declined among non-Aboriginal PWID (p<0.001) over time, however among Aboriginal PWID, RSS remained stable (p=0.619). Factors independently associated with testing positive for anti-HCV among Aboriginal PWID in 2011-2015 were 16 or more years since first injection (adjusted odds ratio [AOR] 6.04, p<0.001), history of incarceration (AOR: 1.74, p=0.010) and currently or previously on opioid substitution therapy (AOR: 1.89, p=0.003). Compared to 1996-2000, testing anti-HCV positive was significantly associated with the time-periods: 2001-2005 (unadjusted odds ratio [OR]: 1.39, p<0.001), 2006-2010 (OR: 1.38, p<0.001) and 2011-2015 (OR: 1.25, p<0.001) among non-Aboriginal PWID however this increase did not occur among Aboriginal PWID. The proportion of Aboriginal PWID attending Needle Syringe Programs appears to have increased. Overall, the prevalence of anti-HCV has remained higher among Aboriginal than non-Aboriginal PWID. Coupling increased access to NSPs with new interferon-free HCV treatments and culturally appropriate education and counselling services could influence new HCV infections among Aboriginal PWID.
Publisher: Elsevier BV
Date: 04-2013
Abstract: People who inject drugs (PWID) report limited access to healthcare, and may avoid disclosing drug use. Health service utilisation was examined among participants in the Australian Needle and Syringe Program Survey (ANSPS), an annual cross-sectional sero-survey of needle syringe program (NSP) attendees. An anonymous questionnaire was self-completed by 2,395 NSP clients throughout Australia. Multivariable logistic regressions identified variables independently associated with (i) disclosure of injecting to the most recent healthcare provider and (ii) recent presentation to emergency departments. Seventy-eight percent of participants reported accessing healthcare in the preceding 12 months. Reasons for presentation included general health issues (46%) medication seeking (17%) and both (37%). Participants who recently accessed healthcare or had previously visited their most recent provider were more likely to disclose injecting drug use. Participants presenting to a GP or medical centre were less likely than others to disclose injecting. Those accessing emergency departments were more likely to report recent imprisonment. Despite Australia's universal healthcare system and harm reduction policies, NSP-participants remain reluctant to disclose injecting, potentially hindering appropriate care and highlighting the need for multiple entry points to the healthcare system, including NSPs and opioid substitution therapy clinics.
Publisher: Elsevier BV
Date: 2016
Publisher: Elsevier BV
Date: 08-2007
DOI: 10.1016/J.DRUGPO.2006.12.006
Abstract: People living with HIV/AIDS (PLWHA) in developing countries are rarely consulted about ways to promote their health and well-being. This study sought to identify and understand, from the perspective of PLWHA, challenges and opportunities for improving access to HIV treatment, care and support in Vietnam, a resource-limited setting with an epidemic driven by injecting drug use. PLWHA trained in participatory research methods completed fieldwork and data collection and co-facilitated focus groups with injecting drug users (IDUs) in Ho Chi Minh City. Qualitative data were analysed in Vietnamese and English using an inductive approach to code and compare content and identify key themes. Results suggest considerable barriers to scaling up in this setting. Against a backdrop of punitive government policies, including mandatory detention of IDUs and sex workers, and widespread stigma and discrimination, many PLWHA lived with the fear of discovery and the threat of abandonment. Lack of confidentiality, limited financial resources and restricted access to essential medications provided powerful disincentives to health service utilisation. Opportunities for scaling up lie firstly in expanding access to confidential HIV counselling and testing. However, in the absence of affordable, quality care and access to anti-retroviral therapy, IDUs are unlikely to see testing as worthwhile. Efforts to scale up also need to address structural barriers including stigma and discrimination, poverty and institutional capacity. Finally, PLWHA in Vietnam are a significant but underutilised resource and consideration should be given to overcoming barriers to building confidence and capacity within affected communities.
Publisher: Wiley
Date: 10-04-2017
DOI: 10.1111/JVH.12701
Abstract: Hepatitis C virus (HCV) transmission is high in prisons. This study investigated trends in HCV incidence and associated factors among a cohort of prisoners with a history of injecting drug use in New South Wales, Australia. Data were available from the Hepatitis C Incidence and Transmission Study-prisons (HITS-p) from 2005 to 2014. Temporal trends in HCV incidence were evaluated. Factors associated with time to HCV seroconversion among people with ongoing injecting was assessed using Cox proportional hazards. Among 320 antibody-negative participants with a history of injecting drug use (mean age 26 72% male), 62% (n=197) reported injecting drug use during follow-up. Overall, 93 infections were observed. HCV incidence was 11.4/100 person-years in the overall population and 6.3/100 person-years among the continually imprisoned population. A stable trend in HCV incidence was observed. Among the overall population with ongoing injecting during follow-up, ≥weekly injecting drug use frequency was independently associated with time to HCV seroconversion. Among continuously imprisoned injectors with ongoing injecting during follow-up, needle/syringe sharing was independently associated with time to HCV seroconversion. This study demonstrates that prison is a high-risk environment for acquisition of HCV infection. Needle and syringe sharing was associated with HCV infection among continually imprisoned participants, irrespective of frequency of injecting or the type of drug injected. These findings highlight the need for the evaluation of improved HCV prevention strategies in prison, including needle/syringe programmes and HCV treatment.
Publisher: Informa UK Limited
Date: 10-12-2009
Publisher: Wiley
Date: 09-2019
DOI: 10.1111/ADD.14777
Abstract: Randomized controlled trials (RCTs) are important for evaluating interventions, and qualitative research is increasingly recognized as being crucial to the success of this enterprise. We aimed to describe and demonstrate a temporal parallel purpose framework to help researchers understand how to make optimum use of qualitative research before, during and after RCTs. This framework sets out specific rationales for conducting qualitative research at each stage of a trial, where the rationales presented relate to both the intervention and evaluation methodology. We conducted a scoping review of published qualitative studies undertaken alongside RCTs focusing on illicit drug use. We then used the temporal parallel purpose framework to present key findings to demonstrate how qualitative studies can add value to addiction RCTs by enhancing understanding of the intervention being trialled and/or the RCT itself. In so doing, we highlight the missed opportunities for addiction science when qualitative research is overlooked. We also explain why barriers to combining qualitative research and RCTs are neither inevitable nor insurmountable. The temporal parallel purpose framework provides a tool for assessing when and why to combine qualitative research with addiction treatment and prevention RCTs. Our paper and framework can help researchers formulate key questions that qualitative research can address. This can potentially save resources by reducing the number of poorly designed interventions and trials and prevent morbidity, mortality, and other addiction-related harms by facilitating the identification and implementation of interventions that are most likely to be effective.
Publisher: Wiley
Date: 03-05-2021
DOI: 10.1111/ADD.15503
Abstract: Major declines in HIV and hepatitis C and B virus (HCV/HBV) incidence among people who inject drugs (PWID) have been attributed to early implementation of harm‐reduction programs (HRP) in the Netherlands, but alternative factors such as selective mortality and demographic and drug market shifts over time probably contributed to observed incidence declines. We quantified and tested the effect of HRP participation on risk of these infections among PWID in Amsterdam, the Netherlands. We emulated the design of a hypothetical, ideal randomized trial using observational data from the Amsterdam Cohort Studies (1985–2014). Amsterdam, the Netherlands. We included PWID who ever used opioids, had a recent history of injecting drug use (IDU) and tested negative for HIV, HCV or HBV. Of 983 participants, 640, 137 and 308 were included for the HIV, HCV and HBV analyses and 59, 45 and 49 seroconversions were observed, respectively. Intervention arms were: complete HRP participation [≥ 60 mg/day methadone and 100% needle and syringe program (NSP) coverage, or any methadone dose if no recent injection drug use] versus no HRP and partial HRP participation combined ( 60 methadone mg/day and/or 100% NSP coverage). Complete participation in harm reduction programs appears to have led to substantial decreases in HIV and hepatitis C and B virus acquisition risk among people who inject drugs in the Netherlands. Separately for each infection, we estimated the hazard ratios (HR) comparing HRP arms using marginal structural models. Compared with no artial HRP participation, complete HRP participation led to lower risk of HIV [HR = 0.54, 95% confidence interval (CI) = 0.27–1.08], HCV (HR = 0.16, 95% CI = 0.06–0.40) and HBV (HR = 0.28, 95% CI = 0.13–0.61) acquisition.
Publisher: Elsevier BV
Date: 07-2018
DOI: 10.1016/J.DRUGALCDEP.2018.04.009
Abstract: We report prevalence and incidence of drug use initiation in Australian gay and bisexual men (GBM) participating in an online cohort study. Between September 2014 and June 2015, 1,710 GBM were enrolled in the Following Lives Undergoing Change Study and followed-up six monthly. Participants were asked about measures of lifetime use at baseline and recent use (last six months) at all visits. Drug use initiation was defined as men who reported having never used a specific drug prior to baseline and reported recent use at follow-up. Participants' median age was 31 years (range: 16-81). Prevalence of lifetime use was significantly associated with older age for all in idual drugs (p trend<0.001), and 84.1% reported lifetime use of any drugs. Just above half (51.9%) reported recent use at baseline, with the majority reporting occasional use (once or twice in the previous six-months). Among men who reported no history of drug use at baseline, drug initiation was highest for amyl nitrite, with an incidence of 10.5 per 100 person-years (95% CI 7.9-13.9), followed by cannabis (7.3 per 100 person-years, 95% CI 5.0-10.6) and ecstasy (5.0 per 100 person-years, 95% CI 3.6-7.0). Younger age was significantly associated with higher incidence of initiation of amyl nitrite, ecstasy, cocaine, ketamine, GHB, and LSD (p trend <0.05 for all). Prevalence of lifetime illicit drug use is lower in younger GBM than in their older counterparts. However, incidence of drug use initiation is high among younger men, providing an opportunity for early intervention.
Publisher: Wiley
Date: 05-2010
Publisher: Springer Science and Business Media LLC
Date: 2015
Publisher: SAGE Publications
Date: 04-2024
Abstract: HIV risk remains high among Cambodian female entertainment and sex workers, driven by hetamine-type substance use and sexual risk. Conditional cash transfer is an evidence-based approach to reduce stimulant use and optimize HIV/AIDS prevention, but questions remain regarding implementation in resource-limited settings. We conducted formative qualitative research to enhance acceptability of a conditional cash transfer intervention aimed at reducing hetamine-type substance use and HIV risk among female entertainment/sex workers and inform implementation as part of a large cluster randomized trial. We conducted in-depth interviews with 30 female entertainment/sex workers. Interviews were digitally recorded and conducted and transcribed in Khmer. English transcripts were read for emerging themes and an initial coding scheme was developed. Data were coded using open and axial coding to clarify and consolidate initial themes. While most participants expressed enthusiasm for the intervention, financial and transportation issues emerged as key barriers to participation. The proposed incentive of USD$1 per screen was regarded as unacceptable and participants identified a need for transportation assistance. Participants also expressed concerns about directly observed urine specimen collection. Finally, while most participants found the 4-week aftercare program acceptable, the need for enjoyable as well as educational content was emphasized. Revisions to the protocol taking these data into account were made to optimize the acceptability of the intervention and the implementation of the trial. Findings identified key concerns and preferences that were taken into account in the final trial protocol. In particular, financial and transportation issues were identified as critical barriers to participation, with the potential to impact both intervention uptake and trial feasibility. Results demonstrate the value of formative qualitative research for clinical trial planning and implementation, particularly in settings where little is known about acceptability of interventions or willingness to participate.
Publisher: Elsevier BV
Date: 04-2016
Publisher: Springer Science and Business Media LLC
Date: 09-09-2013
Publisher: AMPCo
Date: 10-2015
DOI: 10.5694/MJA15.00523
Publisher: Wiley
Date: 14-09-2018
DOI: 10.1111/ADD.14417
Publisher: Springer Science and Business Media LLC
Date: 22-04-2016
Publisher: Springer Science and Business Media LLC
Date: 06-05-2020
DOI: 10.1186/S12954-020-00370-7
Abstract: The impact of COVID-19 across health services, including treatment services for people who use drugs, is emerging but likely to have a high impact. Treatment services for people who use drugs provide essential treatment services including opiate agonist treatment and needle syringe programmes alongside other important treatment programmes across all substance types including withdrawal and counselling services. Drug and alcohol hospital consultation-liaison clinicians support emergency departments and other services provided in hospital settings in efficiently managing patients who use drugs and present with other health problems. COVID-19 will impact on staff availability for work due to illness. Patients may require home isolation and quarantine periods. Ensuring ongoing supply of opiate treatment during these periods will require significant changes to how treatment is provided. The use of monthly depot buprenorphine as well as moving from a framework of supervised dosing will be required for patients on sublingual buprenorphine and methadone. Ensuring ready access to take-home naloxone for patients is crucial to reduce overdose risks. Delivery of methadone and buprenorphine to the homes of people with confirmed COVID-19 infections is likely to need to occur to support home isolation. People who use drugs are likely to be more vulnerable during the COVID-19 epidemic, due to poorer health literacy and stigma and discrimination towards this group. People who use drugs may prioritise drug use above other health concerns. Adequate supply of clean injecting equipment is important to prevent outbreaks of blood-borne viruses. Opiate users may misinterpret SARS-CoV2 symptoms as opiate withdrawal and manage this by using opioids. Ensuring people who use drugs have access to drug treatment as well as access to screening and testing for SARS-CoV2 where this is indicated is important.
Publisher: Elsevier BV
Date: 04-2015
Abstract: This study examined the prevalence of injecting-related injuries and diseases (IRIDs) and associated risk factors among people who inject drugs (PWID) attending a primary health care facility in Sydney's Kings Cross. We calculated prevalence of a wide range of IRIDs utilising data reported by 702 PWID who completed a clinician-administered survey at their first visit. Multivariable logistic regressions identified factors independently associated with at least one episode of: i) cutaneous and ii) non-cutaneous IRIDs. Lifetime prevalence of cutaneous IRIDs was 23%. Forty-two per cent of PWID with a history of abscess attended hospital at their most recent episode. Female gender, lifetime receptive syringe sharing (RSS), injecting while in custody, and ever injecting in places other than the arm were independently associated with reporting at least one episode of cutaneous IRIDs. Ever injecting in sites other than the arm, injecting for five or more years and lifetime history of RSS were independently associated with at least one episode of non-cutaneous IRIDs. IRIDs are a substantial health issue for PWID. Their ongoing surveillance is warranted particularly in primary care settings targeting PWID to inform prevention and early management, thus reducing complications that may require hospital admission.
Publisher: Elsevier BV
Date: 07-2008
DOI: 10.1016/J.DRUGPO.2008.05.001
Abstract: Evidence of harms associated with temazepam gel capsule injecting among injecting drug users in Australia led to its withdrawal from manufacture in Australia. Subsequently, diphenhydramine gel capsule injecting was identified among a subset of ethnic Vietnamese injecting drug users. Observational fieldwork around an active street-based illicit drug marketplace together with targeted purposive s ling enabled 66 ethnic Vietnamese injecting drug users to be recruited for in-depth interview. Data revealed that the injection of gel capsules increases exposure to non-viral infections. Analysis of participant interviews show how participants have established their own ways of reducing these harms including thinning the drug solution by jacking regularly during injection. Controversially, femoral vein administration of diphenhydramine-heroin cocktails was also seen as a harm reduction strategy by participants. Health education c aigns to address the potentially negative consequences of gel capsule groin injection will not be successful unless health workers and policy makers work with drug users and incorporate local understandings and meanings of risk in health promotion activities.
Publisher: Wiley
Date: 21-11-2014
DOI: 10.1111/DAR.12093
Abstract: The non-medical use of pharmaceutical opioids is associated with a range of negative health consequences, including the development of dependence, emergency room presentations and overdose deaths. Drawing on life history data from a broader qualitative study of the non-medical use of painkillers, this brief report presents two cases of transitions from recreational or non-medical pharmaceutical opioid use to intravenous heroin use by young adults in Australia. Although our study was not designed to assess whether recreational oxycodone use is causally linked to transitions to intravenous use, polyopioid use places in iduals at high risk for progression to heroin and injecting. Our first case, Jake, used a range of analgesics before he transitioned to intravenous use, and the first drug he injected was methadone. Our second case, Emma, engaged in a broad spectrum of polydrug use, involving a range of opioid preparations, as well as benzodiazepines, cannabis and alcohol. Both cases transitioned from oral to intravenous pharmaceutical opioids use and subsequent intravenous heroin use. These cases represent the first documented reports of transitions from the non-medical or recreational use of oxycodone to intravenous heroin use in Australia. As such, they represent an important starting point for the examination of pharmaceutical opioids as a pathway to injecting drug use among young Australians and highlight the need for further research designed to identify pharmaceutical opioids users at risk of transitions to injecting and to develop interventions designed to prevent or delay these transitions.
Publisher: CSIRO Publishing
Date: 2015
DOI: 10.1071/SH14240
Abstract: Background Remote Aboriginal communities in Australia experience high rates of bacterial sexually transmissible infections (STIs). To control the transmission and decrease the risk of complications, frequent STI testing combined with timely treatment is required, yet significant delays in treatment have been reported. Perceived barriers to timely treatment for asymptomatic patients in remote communities were explored. Methods: A qualitative study was undertaken as part of the STRIVE (STIs in Remote communities, ImproVed and Enhanced primary health care) project a cluster randomised controlled trial of a sexual health quality improvement program. During 2012, we conducted 36 in-depth interviews with staff in 22 clinics in remote Australia. Results: Participants included registered nurses (72%) and Aboriginal health practitioners (28%). A key barrier to timely treatment was infrequent transportation of specimens to laboratories often hundreds of kilometres away from clinics. Within clinics, there were delays checking and actioning test results, and under-utilisation of systems to recall patients. Participants also described difficulties in physically locating patients due to: (i) high mobility between communities and (ii) low levels of community knowledge created by high staff turnover. Participants also suggested strategies to overcome some barriers such as dedicated clinical time to follow-up recalls and taking treatment out to patients. Conclusions: Participants identified barriers to timely STI treatment in remote Aboriginal communities, and systems to address some of the barriers. Innovative strategies such as point-of-care testing or increased support for actioning results, coupled with incentives to in idual patients to attend for results, may also assist in decreasing the time to treatment.
Publisher: Elsevier BV
Date: 09-2017
DOI: 10.1016/J.DRUGPO.2017.05.022
Abstract: Hepatitis C virus (HCV) infection is endemic among people who inject drugs (PWID) globally. Despite high prevalence, treatment uptake is low, with cumulative uptake <10% in most settings. This study aimed to populate the cascade of HCV testing, care and treatment among PWID using data collected in Australia prior to the introduction of broadly accessible interferon-free direct-acting antiviral (DAA) therapies in March 2016. The Australian Needle and Syringe Program Survey is a cross-sectional surveillance system that recruits ∼2300 PWID annually and collects behavioural data and dried blood s les (DBS). HCV antibody and ribonucleic acid (RNA) test results from DBS collected in 2015 were combined with data on HCV diagnostic testing, care and treatment to populate the HCV cascade among Australian PWID. Among an estimated 93,000 PWID in Australia in 2015, the majority (89%) had a lifetime history of HCV antibody testing. More than half (57%) of PWID tested HCV antibody positive and of these, 79% had detectable HCV RNA consistent with active infection. Less than half (46%) of HCV antibody positive PWID had received confirmatory HCV RNA testing. Among the estimated 43,201 PWID with active infection or chronic infection that had been successfully treated, 31% had received specialist HCV assessment, 8% had received antiviral treatment and 3% were cured. This study provides baseline estimates of the cascade of HCV testing, care and treatment among PWID through enhancement of a well-established surveillance mechanism. Characterisation of the HCV cascade among PWID will be crucial to evaluating and monitoring the roll out of direct-acting antiviral therapies in Australia, including assessing potential HCV treatment as prevention benefits.
Publisher: Elsevier BV
Date: 06-2012
DOI: 10.1016/J.DRUGALCDEP.2011.10.009
Abstract: A safe and efficacious vaccine may be the most efficient and cost-effective strategy for controlling the hepatitis C virus (HCV) epidemic among people who inject drugs (PWID) and several candidates are in development. However, little is known about the factors that influence willingness to participate (WTP) in candidate HCV vaccine trials among this group. HCV seronegative PWID recruited between 2008 and 2010 as part of a prospective observational cohort study in Sydney, Australia were asked whether they would be willing to participate in a future candidate hepatitis C vaccine trial and to provide reasons to explain their decision. Of 113 participants, 74% indicated WTP, 15% were unwilling to participate and 11% reported WTP that was contingent on vaccine characteristics and trial design issues. The most commonly reported motivator for hypothetical trial participation was altruism, followed by potential health benefits, financial remuneration, and knowledge gain. Barriers to hypothetical participation included fears about possible harms to health, such as concerns about vaccine safety, side effects, and acquiring HCV from the vaccine other barriers included mistrust of biomedical research and time constraints. These results may be useful in designing strategies to enhance HCV vaccine trial recruitment and retention and have ethical implications for developing informed consent processes and standards of care.
Publisher: Wiley
Date: 16-01-2019
DOI: 10.1111/DAR.12895
Abstract: Increasing treatment uptake among people who inject drugs (PWID) with chronic hepatitis C virus (HCV) infection is integral to eliminating viral hepatitis. This study explored the role of community-based outreach in engaging and retaining Australian PWID in the testing component of the HCV care cascade. Semi-structured interviews were conducted with 28 PWID, including new initiates to injecting and those from culturally and linguistically erse (CALD) backgrounds, who acquired HCV infection while enrolled in a community-based prospective observational study of hepatitis C vaccine preparedness in Sydney. Participants were interviewed at diagnosis and 12 months later. Transcripts were thematically analysed using constant comparative techniques. Community-based outreach was effective in engaging newly infected participants in HCV monitoring and decision-making about seeking interferon-based treatment. Key factors in the acceptability of outreach were privacy and discretion, and opportunities to build trust with non-judgmental staff. Retaining participants in the HCV cascade of care required more than a one-off session of post-test counselling. Ongoing discussions with staff enabled paced and tailored delivery of information about HCV prevention, testing and treatment. Increased understanding of the role of HCV ribonucleic acid viremia in determining the need for treatment, and access to this testing, was pivotal in making HCV monitoring salient for participants. Outreach is an effective strategy for engaging new initiates to injecting and CALD PWID in HCV testing and decision-making about treatment. Findings highlight the need to increase availability and access to HCV ribonucleic acid testing for PWID.
Publisher: Wiley
Date: 29-04-2017
DOI: 10.1111/DAR.12411
Publisher: Elsevier BV
Date: 05-2011
Publisher: Elsevier BV
Date: 10-2010
Publisher: Wiley
Date: 07-2007
Publisher: Elsevier BV
Date: 11-2013
DOI: 10.1016/J.DRUGALCDEP.2013.06.030
Abstract: Over the last decade, Central Asia has become a focal point of HIV and hepatitis C virus (HCV) transmission among people who inject drugs (PWID). PWID account for the majority of HIV infections in most countries in the region, while a large proportion have been exposed to HCV. Shared modes of transmission of these infections point to an increasing burden of HIV/HCV co-infection in this population. HIV/HCV co-infection is more likely to result in progressive liver disease, increased mortality and hepatic complications from antiretroviral therapy (ART). While the HIV treatment response has improved, less than a quarter of people living with HIV (PLHIV) in the region are receiving ART, with treatment uptake among PWID particularly low. HCV treatment is available in some areas, though at a very high cost to patients thereby preventing access to those at most need. Robust surveillance of HIV/HCV infection among PWID is needed to inform a comprehensive response to HIV and HCV prevention and treatment among PWID, including increasing coverage of opioid substitution therapy (OST) and needle and syringe programs (NSPs), improving access and uptake of ART, and lowering costs and other barriers to HCV treatment across the five republics. Optimising uptake of these initiatives by increasing prevention and treatment literacy among PWID and decreasing barriers to screening and testing will also be necessary to mitigate the increasing burden of HIV/HCV co-infection in the region.
Publisher: Springer Science and Business Media LLC
Date: 31-01-2017
DOI: 10.1038/SREP41719
Abstract: Resistance against new hepatitis C virus (HCV) antivirals is an area of increasing interest. Resistance-associated substitutions (RASs) have been identified in treatment-naïve in iduals, but pressures driving treatment-independent RAS emergence are poorly understood. We analysed the longitudinal evolution of RASs in twelve participants with early acute HCV infections. Full-genome deep sequences were analysed for changes in RAS frequency within NS3, NS5A and NS5B-coding regions over the course of the infection. Emergence of RASs relevant only to the polymerase non-nucleoside inhibitors (NNI) was detected, and these lay within CD8+ T-cell epitopes. Conversely, the loss of NNI RASs over time appeared likely to be driven by viral fitness constraints. These results highlight the importance of monitoring CD8+ T cell epitope-associated RASs in populations with dominant HLA types.
Publisher: Elsevier BV
Date: 10-2017
Publisher: Springer Science and Business Media LLC
Date: 26-06-2012
Publisher: MDPI AG
Date: 15-07-2022
DOI: 10.3390/V14071548
Abstract: Background: This review aimed to identify hepatitis C virus (HCV) prevalence estimates among the general population and six key populations (people who inject drugs, men who have sex with men, sex workers, prisoners/detainees, Indigenous people, and migrants) in the World Health Organization Western Pacific Region (WHO WPR). Methods: Original research articles published between 2016 and 2020 were identified from bibliographic databases. Publications were retrieved, replicas removed, and abstracts screened. Retained full texts were assessed and excluded if inclusion criteria were not met. Methodological quality was assessed using the Johanna Briggs Institute critical appraisal checklist for prevalence data. Data on HCV exposure and active infection were extracted and aggregated and forest plots generated for each population by country. Results: There were no HCV prevalence estimates in any population for more than half of WPR countries and territories. Among the 76 estimates, 97% presented prevalence of exposure and 33% prevalence of active infection. General population viraemic prevalence was 1% or less, except in Mongolia. Results confirm the endemic nature of HCV among people who inject drugs, with estimates of exposure ranging from 30% in Cambodia to 76% in Hong Kong. Conclusions: Countries require detailed knowledge of HCV prevalence in erse populations to evaluate the impact of efforts to support WHO HCV elimination goals. Results provide baseline estimates from which to monitor and evaluate progress and by which to benchmark future elimination efforts.
Publisher: BMJ
Date: 05-2016
Publisher: Elsevier BV
Date: 2015
Publisher: Elsevier BV
Date: 02-2008
DOI: 10.1111/J.1753-6405.2008.00163.X
Abstract: To identify lifetime prevalence and predictors of self-reported injecting-related injuries and diseases (IRID) and/or injecting-related problems (IRP) among a national cross-sectional s le of injecting drug users. 1,961 clients of 45 needle and syringe programs (NSPs) who participated in the 2006 Australian NSP Survey self-completed an item regarding lifetime experience of eight separate IRIDs and IRPs. Sixty-nine per cent of participants reported a history of IRID/IRP, with a mean of 1.9 injuries roblems (range 0-8). Lifetime prevalence of specific injuries roblems ranged from problems finding a vein (43%) to endocarditis (4%). Factors independently associated with IRID/IRP included bisexual identity daily or more frequent injecting injection of pharmaceutical preparations female gender longer injecting history and hepatitis C antibody-positive serostatus. Consistent with existing literature, results suggest that vascular injury and localised infections are common among IDUs and that treatment-seeking is often delayed until serious complications arise. Findings support the imperative for co-ordinated and timely treatment and prevention activities to reduce the severity and burden of these prevalent injecting outcomes.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2019
Publisher: Wiley
Date: 21-12-2019
DOI: 10.1111/DAR.12884
Publisher: Elsevier BV
Date: 05-2015
Publisher: Oxford University Press (OUP)
Date: 24-08-2018
DOI: 10.1093/CID/CIX768
Publisher: Elsevier BV
Date: 08-2012
Publisher: Springer Science and Business Media LLC
Date: 03-05-2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2015
Publisher: Oxford University Press (OUP)
Date: 25-04-2012
Publisher: Elsevier BV
Date: 03-2017
DOI: 10.1016/J.DRUGPO.2016.11.012
Abstract: Drug use among gay and bisexual men (GBM) is higher than most populations. The use of crystal meth hetamine, erectile dysfunction medication (EDM), and amyl nitrite have been associated with sexual risk behaviour and HIV infection among gay and bisexual men (GBM). This paper describes an online prospective observational study of licit and illicit drug use among GBM and explores baseline prevalence of drug use in this s le. Capturing these data poses challenges as participants are required to disclose potentially illegal behaviours in a geographically dispersed country. To address this issue, an entirely online and study specific methodology was chosen. Men living in Australia, aged 16.5 years of age or older, who identified as homosexual or bisexual or had sex with at least one man in the preceding 12 months were eligible to enrol. Between September 2014 and July 2015, a total of 2250 participants completed the baseline questionnaire, of whom, 1710 (76.0%) consented to six-monthly follow-up. The majority (65.7%) were recruited through Facebook targeted advertising. At baseline, over half (50.5%) the men reported the use of any illicit drug in the previous six months, and 28.0% had used party drugs. In the six months prior to enrolment, 12.0% had used crystal meth hetamine, 21.8% had used EDM, and 32.1% had used amyl nitrite. Among the 1710 men enrolled into the cohort, 790 men had used none of these drugs. Ease of entry and minimal research burden on participants helped ensure successful recruitment into this online cohort study. Study outcomes will include the initiation and cessation of drug use, associated risk behaviours, and health consequences, over time. Results will provide insights into the role gay community plays in patterns of drug use among GBM.
Publisher: Public Library of Science (PLoS)
Date: 13-01-2014
Publisher: Springer Science and Business Media LLC
Date: 16-10-2015
Publisher: Elsevier BV
Date: 12-2007
DOI: 10.1016/J.DRUGALCDEP.2007.05.026
Abstract: Hepatitis C virus (HCV) infection in Australia is predominantly transmitted through injecting drug use. A reduction in the heroin supply in Australia in late 2000 and early 2001 may have impacted the number of injecting drug users (IDUs) and consequently the number of new hepatitis C infections in Australia. This paper updates estimates of HCV incidence and prevalence between 1960 and 2005. Simple mathematical models were used to estimate HCV incidence among IDUs, migrants to Australia from high HCV-prevalence countries, and other HCV exposure groups. Recent trends in numbers of IDUs were based on indicators of injecting drug use. A natural history of HCV model was applied to estimate the prevalence of HCV in the population. The modelled best estimate of past HCV incidence showed a consistent increasing rate of HCV infections to a peak of 14,000 new seroconversions in 1999, followed by a decline in 2001-2002 coincident with the decline in heroin availability. HCV incidence was estimated to be 9700 (lower and upper limits of 6600 and 13,200) in 2005. Of these, 88.7% were estimated to be through injecting drug use, 7.2% among migrants and 4.1% through other transmission routes. An estimated 264,000 (lower and upper limits of 206,000 and 318,000) people were HCV antibody positive in 2005. Mathematical models suggest that HCV incidence in Australia decreased from a peak of 14,000 new infections in 1999 to 9700 new infections in 2005, largely attributable to a reduction in injecting drug use. The numbers of people living with HCV in Australia is, however, estimated to continue to increase.
Publisher: Wiley
Date: 24-09-2009
DOI: 10.1111/J.1440-1746.2009.05910.X
Abstract: Regular monitoring of hepatitis C (HCV)-related surveillance data is essential to inform and evaluate strategies to reduce the expanding HCV burden. The aim of this study was to examine trends in the epidemiology and treatment of HCV in Australia. We reviewed data about HCV notifications, treatment of HCV infection through the Highly Specialised Drugs (s100) Program, and liver transplants (Australia and New Zealand Liver Transplant Registry) for the period 1997-2006. HCV case notification rates declined by almost 50% between 1999 and 2006, with the greatest reductions between 2001 and 2002 and amongst young adults. For newly acquired HCV cases, 89% were Australian-born and 90% reported injecting drug use as a risk factor for infection. Overall, 30% of liver transplant recipients had HCV-related cirrhosis, but the number and proportion of HCV diagnoses increased between 1997 and 2006. HCV treatment also increased over the review period. However, only 1.4% of the 202,400 people estimated to be living with chronic HCV at the end of 2006 received treatment that year. The decline in HCV notifications is consistent with a decline in HCV incidence in Australia. However, the burden of advanced HCV disease continues to expand. To reduce this burden, treatment uptake needs to increase. Consistent and sensitive surveillance mechanisms are required to detect newly acquired cases together with an expansion of surveillance for chronic HCV infections.
Publisher: Oxford University Press (OUP)
Date: 15-04-2015
Publisher: American Society for Microbiology
Date: 15-11-6349
DOI: 10.1128/JVI.03717-14
Abstract: The interaction between hepatitis C virus (HCV) and cellular immune responses during very early infection is critical for disease outcome. To date, the impact of antigen-specific cellular immune responses on the evolution of the viral population establishing infection and on potential escape has not been studied. Understanding these early host-virus dynamics is important for the development of a preventative vaccine. Three subjects who were followed longitudinally from the detection of viremia preseroconversion until disease outcome were analyzed. The evolution of transmitted/founder (T/F) viruses was undertaken using deep sequencing. CD8 + T cell responses were measured via enzyme-linked immunosorbent spot (ELISpot) assay using HLA class I-restricted T/F epitopes. T/F viruses were rapidly extinguished in all subjects associated with either viral clearance ( n = 1) or replacement with viral variants leading to establishment of chronic infection ( n = 2). CD8 + T cell responses against 11 T/F epitopes were detectable by 33 to 44 days postinfection, and 5 of these epitopes had not previously been reported. These responses declined rapidly in those who became chronically infected and were maintained in the subject who cleared infection. Higher-magnitude CD8 + T cell responses were associated with rapid development of immune escape variants at a rate of up to 0.1 per day. Rapid escape from CD8 + T cell responses has been quantified for the first time in the early phase of primary HCV infection. These rapid escape dynamics were associated with higher-magnitude CD8 + T cell responses. These findings raise questions regarding optimal selection of immunogens for HCV vaccine development and suggest that detailed analysis of in idual epitopes may be required. IMPORTANCE A major limitation in our detailed understanding of the role of immune response in HCV clearance has been the lack of data on very early primary infection when the transmitted viral variants successfully establish the acute infection. This study was made possible through the availability of specimens from a unique cohort of asymptomatic primary infection cases in whom the first available viremic s les were collected approximately 3 weeks postinfection and at regular intervals thereafter. The study included detailed examination of both the evolution of the viral population and the host cellular immune responses against the T/F viruses. The findings here provide the first evidence of host cellular responses targeting T/F variants and imposing a strong selective force toward viral escape. The results of this study provide useful insight on how virus escapes the host response and consequently on future analysis of vaccine-induced immunity.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2021
Publisher: Springer Science and Business Media LLC
Date: 20-05-2012
DOI: 10.1007/S10461-011-9969-Z
Abstract: The objective of the current study is to describe the impact of Combination antiretroviral therapy (cART) on trends in AIDS incidence over time for selected population groups in Australia, specifically, men who have sex with men (MSM) and injecting drug users (IDUs). A modified back-projection modeling technique was used to predict the number of AIDS diagnoses without cART based on Australia's HIV/AIDS surveillance system database. Modelled estimates indicate that since 1996, the effective cART has reduced overall AIDS cases by ~70 and ~10% among MSM and IDUs respectively. The predicted reduction in AIDS cases among IDUs aged less than 40 years was 36% while there was no reduction predicted for those aged 40 years or older. The impact of cART on AIDS diagnoses has been modest among IDUs. Late presentation, poor access to health services and barriers to uptake of cART may account for the ergence between these population groups.
Publisher: Elsevier BV
Date: 08-2017
DOI: 10.1016/J.DRUGPO.2017.05.005
Abstract: While people who inject drugs (PWID) typically use peripheral veins, some inject into their central veins, including the femoral and jugular veins. Injection into the jugular vein can have serious adverse health consequences, including jugular vein thrombosis, deep neck infections, pneumothorax, endocarditis and sepsis. This study examined the prevalence of, and factors associated with, jugular vein injection among a large s le of PWID in the United Kingdom. Unlinked anonymous surveys (2011-14) recruited PWID from agencies providing services to this population. Self-reported demographic and injection-related data were collected from consenting respondents using a brief questionnaire and dried blood spot s les were tested for exposure to HIV, hepatitis C virus (HCV) and hepatitis B virus (HBV). Univariate and multivariable logistic regression were used to examine factors associated with jugular vein injection. Among 5261 PWID, one third had injected into a central vein in the previous 28 days, including 6% (n=339) who had injected into their jugular vein and 1% (n=52) who had used this site exclusively for recent injections. Factors independently associated with recent jugular vein injection in multivariable analysis included female gender, a lifetime history of imprisonment, sharing needles and syringes, poly-drug injection and injection into multiple body sites. Jugular vein injection was also associated with experiencing injection-related injuries, although no associations were identified with respect to exposure to blood borne viral infections. A significant minority of PWID inject into the jugular vein in the United Kingdom. Public health responses should investigate ways to support and promote good injection site management in order to minimise vascular damage and reduce problems with peripheral venous access. Women who inject drugs, PWID with a history of imprisonment and those people who are experiencing early signs of injection-related skin and soft tissue injuries are priority sub-populations for interventions.
Publisher: Willan
Date: 06-12-2012
Publisher: BMJ
Date: 2012
Publisher: Wiley
Date: 11-2008
DOI: 10.1080/09595230801956116
Abstract: The acceptability of testing methods and procedures has implications for uptake of blood-borne virus screening in sentinel s les of injecting drug users (IDUs) likely to participate in surveillance. The aim of the current study was to determine the acceptability of three methods of hepatitis C virus (HCV) testing among injecting drug users (IDUs): oral fluid, capillary blood and venous blood s ling. A cross-sectional survey of IDUs was conducted in inner-city Sydney in 2005 for a laboratory validation study of HCV antibody testing. Participants were tested using the three different specimen collection methods and asked about the acceptability of each method and a particular preference documented. Two-hundred and twenty-nine IDUs participated in the study. Before and after specimen collection, the acceptability of all three collection methods for HCV testing was high (> 85%). Oral fluid remained the preferred method after s le collection, with females (65%) significantly more likely than males (49%) to report a preference (unadjusted odds ratio 2.0 95% confidence interval 1.1-3.5, p = 0.03) for that method. Findings suggest that oral fluid testing is an acceptable and preferred alternative for HCV testing among IDUs. However, concerns reported by participants in the study indicate that information and education regarding the nature and diagnostic value of oral fluid testing is necessary prior to its implementation for surveillance purposes among this population.
Publisher: Oxford University Press (OUP)
Date: 06-2017
DOI: 10.1016/J.JSXM.2017.04.670
Abstract: Gay and bisexual men (GBM) use oral erectile dysfunction medications (EDMs) often with little evidence of medical indication necessitating their use. To investigate the prevalence, contexts, and motivations for oral EDM use and its relation to sexual risk behavior. A total of 2,250 Australian GBM completed an online survey of licit and illicit drug use and their associated behaviors. Multivariate logistic regression analysis identified factors associated with use of EDMs in the previous 6 months and, for those who had used EDMs, factors associated with use on a weekly basis. Any EDM use and at least weekly use in the previous 6 months. The median age of the s le was 33.0 years (range = 16–81). Two thirds (67.7%) reported no lifetime history of EDM use. Approximately 1 in 10 participants (11.1%) had last used an EDM more than 6 months previously. In the previous 6 months, 11.5% reported using EDMs less than monthly, 5.3% reported using EDMs approximately monthly, and 4.5% reported using EDMs at least weekly. Of men who had used EDMs in the previous 6 months, common reasons cited for its use were to maintain an erection for longer (73.3%), to make it easier to “get hard” (67.3%), and difficulty in attaining or maintain an erection (53.5%). Use of EDMs in the previous 6 months was associated with illicit drug use and higher rates of sexual risk behavior. Weekly users were more likely to have severe anxiety than less frequent users. The use of EDMs in the context of intensive sex partying, with the associated potential for increased risk of HIV transmission and illicit drug use, indicates a need to consider the use of EDMs among GBM in HIV prevention and minimizing harm. This large-scale study of drug use among GBMs includes comprehensive detailed data on their history of use and rationales for use. Our online methodology potentially decreases social desirability bias in reporting illegal or stigmatized behaviors. This volunteer online convenience s le might not be representative of all GBMs in Australia. GBMs who used an oral EDM in the previous 6 months often used it for recreational purposes, but many of those who used it on a weekly basis also might have used it for therapeutic reasons. GBMs often use EDMs to enhance their sexual experiences often in the context of intensive sex partying (which can include risky sexual behavior).
Publisher: Wiley
Date: 15-09-2004
Publisher: Public Library of Science (PLoS)
Date: 31-05-2019
Publisher: BMJ
Date: 26-03-2015
Publisher: Wiley
Date: 09-11-2009
DOI: 10.1111/J.1360-0443.2009.02704.X
Abstract: To determine risk factors and estimate their population-level contribution to hepatitis C virus (HCV) burden. Established and potentially modifiable risk factors were estimated using partial population attributable risk (PAR(p)) in a cohort of new injecting drug users (IDUs) in Sydney, Australia. A total of 204 hepatitis C seronegative IDUs were recruited through street-based outreach, methadone clinics and needle and syringe programmes (NSPs) and followed-up at 3-6-monthly intervals. A total of 61 HCV seroconversions were observed during the follow-up [overall incidence rate of 45.8 per 100 person-years (95% confidence interval: 35.6-58.8)]. Overall, five potentially modifiable risk factors (sharing needles/syringes, sharing other injecting equipment, assisted injecting, frequency of injection and not being in drug treatment) accounted for approximately 50% of HCV cases observed. While sharing needles/syringes or other injecting equipment were associated most strongly with increased risk of HCV infection, the PAR(p) associated with these behaviours was relatively modest (12%) because they are relatively low-prevalence behaviours. Our analyses suggest that more HCV infection could be avoided by changing more common, but less strongly associated behaviours such as assisted injecting or daily injecting. Results suggest that to have a very substantial effect on HCV, a range of risk factors need modifying. The most efficient use of scarce resources in reducing HCV infections will require complex balancing between the PAR for a given risk factor(s), the efficacy of interventions to actually modify the risk factor, and the cost of these interventions.
Publisher: CSIRO Publishing
Date: 2009
DOI: 10.1071/HE09234
Abstract: Increasing the uptake of hepatitis C treatment by injecting drug users (IDUs) is a key strategy in addressing the escalating disease burden of chronic hepatitis C virus (HCV) infection in Australia. Little is known about barriers to treatment uptake among culturally erse groups of IDUs. Indo-Chinese IDUs represent a marginalised group with high rates of incident and prevalent HCV infection. An ethnographic study was conducted to explore barriers to HCV treatment uptake experienced by Indo-Chinese IDUs and inform the development of policies and practices that promote access to treatment. Following a baseline interview, participants (n=23) received a brief intervention about HCV treatment and an offer of facilitated referral to a tertiary liver clinic. Follow-up interviews were conducted three and six months post intervention, to explore decision-making about treatment-seeking and experiences accessing the clinic. While 'getting rid of' HCV was regarded as highly desirable, only three participants were assessed for treatment. For most participants, seeking treatment was not seen as feasible given social and structural barriers related to their drug use, lack of resources and support. Institutional barriers included the clinic's administrative procedures, limited flexibility and apparent reluctance to consider current IDUs suitable candidates for treatment. Resources and support, fexible, low threshold approaches to assessment and a willingness to provide treatment to current IDUs, would promote equitable access to treatment among these groups.
Publisher: Wiley
Date: 09-2004
Publisher: Wiley
Date: 14-01-2020
DOI: 10.1111/DAR.13030
Publisher: Wiley
Date: 03-2021
DOI: 10.1111/DAR.13273
Publisher: Informa UK Limited
Date: 05-2010
DOI: 10.3109/10826080903443586
Abstract: Urban frontline services have recorded increases in psychostimulant-related presentations. A convenience s le of 183 street-based psychostimulant injectors recruited in April 2006 was administered the Kessler Psychological Distress Scale (K10) to assess psychological distress. Homelessness, unemployment, and recent public injection, along with gender (female) and financial and relationship problems, best predicted clinically significant K10 scores. Drug use measures were not significantly associated with distress once indicators of social marginalization were included. The risk environment of the street-based drug market accounts for much of the distress experienced in this milieu, highlighting the need for broad structural interventions, together with drug-specific responses.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2009
Publisher: Informa UK Limited
Date: 17-02-2022
Publisher: Elsevier BV
Date: 05-2015
DOI: 10.1016/J.DRUGALCDEP.2015.02.006
Abstract: Women who sell sex and use drugs have dual risks for HIV infection. Despite increasing reports of drug use among female sex workers (FSW) in Vietnam, FSW HIV interventions remain focused mainly on sexual risk reduction. We assessed the impact of drug use and inconsistent condom use on HIV infection among FSW in Vietnam, which few studies have quantified. We surveyed 5298 women aged ≥18 years who had sold sex in the past month from ten geographically dispersed provinces. We performed multivariate logistic regression on data from provinces with high (≥10%) or low (<10%) HIV prevalence among FSW. Compared to FSW who never used illicit drugs, the odds of HIV infection among FSW who had ever injected drugs and those who reported non-injection drug use were 3.44 (CI 2.32-5.09) and 1.76 (CI 1.14-2.71), respectively, in high-prevalence provinces. FSW who always used condoms with clients had lower odds of HIV infection than those who did not (AOR=0.71 CI 0.52-0.98). In low-prevalence provinces lifetime injection drug use (AOR 22.05, CI 12.00-40.49), but not non-injecting drug use or inconsistent condom use, was significantly associated with HIV infection. Because injection drug use and inconsistent condom use were key risk factors for HIV infection in high-prevalence provinces, drug injection risk reduction should be as much a focus of HIV prevention as sexual risk reduction. Where HIV prevalence remains low in FSW, a more general emphasis on harm reduction for all drug users will benefit FSW.
Publisher: Elsevier BV
Date: 10-2013
DOI: 10.1016/J.YPMED.2013.04.013
Abstract: This study aimed to investigate the efficacy of modest financial incentives in increasing completion of an accelerated 3-dose hepatitis B virus (HBV) vaccination schedule (0, 7, 21days) among people who inject drugs (PWID). Randomised controlled trial. Participants were randomly allocated to receive $30 Australian Dollars cash following receipt of vaccine doses two and three ('incentive condition'), or standard care ('control condition'). Serologically confirmed HBV-susceptible PWID. Two inner-city health services and a field study site in Sydney, Australia. The primary outcome was completion of the vaccination series. Additional assessments included self-reported demographic, drug use and treatment, and risk-taking histories. Compared to the control condition, significantly more participants in the incentive condition received all three vaccine doses, under intention-to-treat analyses (n=139 87% versus 66% p=.004) and within the specified window periods under per protocol analyses (n=107 received three vaccine doses 92% versus 67% p=.001). Multivariate analysis indicated that the incentive condition and longer injecting histories significantly increased the likelihood of series completion. Aboriginal/Torres Strait Islanders were significantly less likely to complete the series. Modest financial incentives, per-dose, increased adherence to the accelerated HBV vaccination schedule among PWID. Results have implications for increasing HBV and, potentially, other vaccine-preventable infections, among PWID.
Publisher: CSIRO Publishing
Date: 2015
DOI: 10.1071/SH14038
Abstract: Background This study aimed to describe sexual health behaviour, alcohol and other drug use, and health service use among young Noongar people in the south-west of Western Australia. Method: A cross-sectional survey was undertaken among a s le of 244 Noongar people aged 16−30 years. Results: The s le was more disadvantaged than the wider Noongar population. Sexual activity was initiated at a young age, 18% had two or more casual sex partners in the previous 12 months, with men more likely to have done so than women (23% vs 14%). Condoms were always or often carried by 57% of men and 37% of women, and 36% of men and 23% of women reported condom use at last sex with a casual partner. Lifetime sexually transmissible infection diagnosis was 14%. Forty percent currently smoked tobacco and 25% reported risky alcohol consumption on a weekly and 7% on an almost daily basis. Cannabis was used by 37%, 12% used drugs in addition to cannabis and 11% reported recently injecting drugs. In the previous 12 months, 66% had a health check and 31% were tested for HIV or sexually transmissible infections. Additionally, 25% sought advice or assistance for mental health or alcohol and other drug issues. Discussion: Although some respondents engaged in risky sexual behaviour, alcohol and other drug use or both, most did not. Particularly encouraging was the engagement of respondents with the health care system, especially among those engaging in risky behaviours. The results confound negative stereotypes of Aboriginal people and demonstrate a level of resilience among respondents.
Publisher: Wiley
Date: 29-12-2022
DOI: 10.1111/ADD.16113
Abstract: The 2016 Global Health Sector Strategy (GHSS) on viral hepatitis aims to reduce new hepatitis C virus (HCV) infections by 80% by 2030, including a 30% reduction by 2020. This study aimed to estimate primary HCV incident infection among a national s le of people who inject drugs (PWID) before and after the introduction of unrestricted access to HCV direct‐acting antiviral (DAA) therapy via Australia's Pharmaceutical Benefits Scheme in 2016. A simple deterministic linkage method identified repeat respondents in serial cross‐sectional surveys conducted among PWID. Two separate retrospective cohorts of HCV antibody‐negative respondents were created, corresponding to the pre‐ (2010–15) and post‐ (2016–21) DAA time‐periods. This study took place in Australia. Among 757 PWID retained (376 pre‐DAA, 381 post‐DAA), more than half were male (60%), the majority were heterosexual (80%), the median age was 40 years (interquartile range = 33–46 years) and the predominant drugs last injected were heroin (24%), pharmaceutical opioids (27%) and meth hetamine (41%). The primary outcome was HCV seroconversion, defined as a negative HCV antibody test result followed by a positive HCV antibody result. Time to primary incident HCV infection was estimated using the person‐years (PY) method. A total 97 of 376 (2010–15) and 41 of 381 (2016–21) HCV seroconversions were identified. Primary HCV incidence more than halved, from 13.6 per 100 PY [95% confidence intervals (CI) = 11.2, 16.6] in 2010–15 to 5.4 per 100 PY (95% CI = 3.9, 7.3) in 2016–21. The decline was independent of observed differences in demographic and drug use characteristics over the two time‐periods (adjusted hazard ratio = 0.47, 95% CI = 0.31–0.69, P 0.001). Australia has had a 53% reduction in primary hepatitis C virus (HCV) incidence among people who inject drugs following unrestricted availability of HCV direct acting antiviral therapy in March 2016. Given that PWID are the predominant population at risk of HCV infection in Australia, findings add to the evidence that Australia has probably met its 2020 Global Health Sector Strategy subtarget of a 30% decline in new infections.
Publisher: Public Library of Science (PLoS)
Date: 07-07-2014
Publisher: Elsevier BV
Date: 03-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2012
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2019
Publisher: BMJ
Date: 05-2019
DOI: 10.1136/BMJOPEN-2018-026679
Abstract: To examine barriers and facilitators to sustaining a sexual health continuous quality improvement (CQI) programme in clinics serving remote Aboriginal communities in Australia. Qualitative study. Primary health care services serving remote Aboriginal communities in the Northern Territory, Australia. Seven of the 11 regional sexual health coordinators responsible for supporting the Northern Territory Government Remote Sexual Health Program. Semi-structured in-depth interviews conducted in person or by telephone data were analysed using an inductive and deductive thematic approach. Despite uniform availability of CQI tools and activities, sexual health CQI implementation varied across the Northern Territory. Participant narratives identified five factors enhancing the uptake and sustainability of sexual health CQI. At clinic level, these included adaptation of existing CQI tools for use in specific clinic contexts and risk environments (eg, a syphilis outbreak), local ownership of CQI processes and management support for CQI. At a regional level, factors included the positive framing of CQI as a tool to identify and act on areas for improvement, and regional facilitation of clinic level CQI activities. Three barriers were identified, including the significant workload associated with acute and chronic care in Aboriginal primary care services, high staff turnover and lack of Aboriginal staff. Considerations affecting the future sustainability of sexual health CQI included the need to reduce the burden on clinics from multiple CQI programmes, the contribution of regional sexual health coordinators and support structures, and access to and use of high-quality information systems. This study contributes to the growing evidence on how CQI approaches may improve sexual health in remote Australian Aboriginal communities. Enhancing sustainability of sexual health CQI in this context will require ongoing regional facilitation, efforts to build local ownership of CQI processes and management of competing demands on health service staff.
Publisher: SAGE Publications
Date: 06-07-2018
Abstract: We examined the proportion and correlates of loss to follow-up (LTFU) among female entertainment and sex workers (FESWs) in a longitudinal HIV prevention intervention trial in Cambodia. The Cambodia Integrated HIV and Drug Prevention Intervention trial tested a comprehensive package of interventions aimed at reducing hetamine-type stimulant use and HIV risk among FESWs in ten provinces. The present study estimated the proportion of women LTFU and assessed factors associated with LTFU. Logistic regression analyses were used. Of a total 596 women enrolled, the cumulative proportion of LTFU was 29.5% (n = 176) between zero- and 12-month follow-up. In multivariate analyses, women with no living children (adjusted odds ratio [AOR] 1.6 95% confidence interval [CI]: 1.1, 2.3) and those who experienced recent food insecurity (AOR 1.7 95%CI: 1.1, 2.7) were more likely to be LTFU. Women who were members of the SMARTgirl HIV prevention programme for ≥ 6 months compared to non-members were less likely to be LTFU (AOR 0.3 95%CI: 0.2, 0.6). LTFU was moderately high in this study and similar to other studies, indicating a need for strategies to retain this population in HIV prevention programmes and research. Interventions aimed at stabilizing women’s lives, including reducing food insecurity and creating communities of engagement for FESWs, should be considered.
Publisher: Springer Science and Business Media LLC
Date: 09-07-2020
DOI: 10.1186/S12889-020-09202-6
Abstract: As research on HIV vaccines continues to advance, studies exploring the feasibility of this intervention are necessary to inform uptake and dissemination strategies with key populations, including people who use drugs (PWUD). We conducted 25 in-depth qualitative interviews examining HIV vaccine acceptability among PWUD in Vancouver, Canada. Participants were recruited from an ongoing prospective cohort of HIV-negative PWUD. Data were coded using NVivo, and analyzed thematically. Acceptability was framed by practical considerations such as cost and side effects, and was influenced by broader trust of government bodies and health care professionals. While an HIV vaccine was perceived as an important prevention tool, willingness to be vaccinated was low. Results suggest that future vaccine implementation must consider how to minimize the burden an HIV vaccine may place on PWUD. Centering the role of health care providers in information dissemination and delivery may assist with uptake. Our findings suggest improvements in care and improved patient-provider relationships would increase the acceptability of a potential HIV vaccine among this population.
Publisher: Wiley
Date: 02-2016
DOI: 10.1111/JVH.12511
Abstract: Injecting drug use remains the major risk factor for hepatitis C (HCV) transmission. A minority of long-term injecting drug users remain seronegative and aviraemic, despite prolonged exposure to HCV - termed highly exposed seronegative subjects. Natural killer (NK) cells have been implicated in this apparent protection. A longitudinal nested, three group case-control series of subjects was selected from a prospective cohort of seronegative injecting drug users who became incident cases (n = 11), remained seronegative (n = 11) or reported transient high-risk behaviour and remained uninfected (n = 11). The groups were matched by age, sex and initial risk behaviour characteristics. Stored peripheral blood mononuclear cells were assayed in multicolour flow cytometry to enumerate natural killer cell subpopulations and to assess functional activity using Toll-like receptor ligands before measurement of activation, cytokine production and natural cytotoxicity receptor expression. Principal components were derived to describe the detailed phenotypic characteristics of the major NK subpopulations (based on CD56 and CD16 co-expression), before logistic regression analysis to identify associations with exposed, seronegative in iduals. The CD56(dim) CD16(+) (P = 0.05, OR 6.92) and CD56(dim) CD16(-) (P = 0.05, OR 6.07) principal components differed between exposed, seronegative in iduals and pre-infection s les of the other two groups. These included CD56(dim) CD16(+) and CD56(dim) CD16(-) subsets with CD56(dim) CD16(+) IFN-γ and TNF-α on unstimulated cells, and CD56(dim) CD16(-) CD69(+) , CD107a(+) , IFN-γ and TNF-α following TLR stimulation. The cytotoxic CD56(dim) NK subset thus distinguished highly exposed, seronegative subjects, suggesting NK cytotoxicity may contribute to protection from HCV acquisition. Further investigation of the determinants of this association and prospective assessment of protection against HCV infection are warranted.
Publisher: Wiley
Date: 29-08-2013
Publisher: BMJ
Date: 28-10-2015
DOI: 10.1136/SEXTRANS-2014-051535
Abstract: To determine the co-occurrence and epidemiological relationships of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) in a high-prevalence setting in Australia. In the context of a cluster randomised trial in 68 remote Aboriginal communities, we obtained laboratory reports on simultaneous testing for CT, NG and TV by nucleic acid lification tests in in iduals aged ≥16 years and examined relationships between age and sex and the coinfection positivity. ORs were used to determine which infections were more likely to co-occur by demographic category. Of 13 480 patients (median age: 30 years men: 37%) tested for all three infections during the study period, 33.3% of women and 21.3% of men had at least one of them, highest in patients aged 16-19 years (48.9% in women, 33.4% in men). The most frequent combination was CT/NG (2.0% of women, 4.1% of men), and 1.8% of women and 0.5% of men had all three. In all co-combinations, coinfection positivity was highest in patients aged 16-19 years. CT and NG were highly predictive of each other's presence, and TV was associated with each of the other two infections, but much more so with NG than CT, and its associations were much stronger in women than in men. In this remote high-prevalence area, nearly half the patients aged 16-19 years had one or more sexually transmitted infections. CT and NG were more common dual infections. TV was more strongly associated with NG coinfections than with CT. These findings confirm the need for increased simultaneous screening for CT, NG and TV, and enhanced control strategies. Australian and New Zealand Clinical Trials Registry ACTRN12610000358044.
Publisher: SAGE Publications
Date: 12-12-2015
Abstract: Summary Human papillomavirus is a common sexually transmitted infection and the causative agent for cervical cancer, a frequently occurring malignant disease among women in developing countries. We assessed human papillomavirus awareness prior to the delivery of a brief information and education intervention, and human papillomavirus vaccine provision to female entertainment and sex workers (N = 220). At baseline, only 23.6% of women had heard of human papillomavirus. Following the educational intervention, 90% answered all the human papillomavirus knowledge questions correctly. Of 192 participants attending the first quarterly cohort visit where vaccine was offered, 149 (78%) were eligible for vaccination HIV-positive (n = 32) and pregnant (n = 11) women were excluded. Acceptance of vaccine among eligible women was universal, and 79.2% completed the three-dose vaccination series. Women who reported use of hetamine-type stimulants had significantly and independently lower odds of vaccine completion (adjusted odds ratio [AOR] 0.24 95% confidence interval [CI] 0.08, 0.69). New pregnancies also had an impact on vaccine completion: 5.4% (8/149 5.4%) who started the series had to stop due to new pregnancy. Results demonstrate the effectiveness of a simple education intervention designed to increase human papillomavirus knowledge and the feasibility of successful human papillomavirus vaccine in a population that is often difficult to engage in preventive health care.
Publisher: Elsevier BV
Date: 02-2001
DOI: 10.1111/J.1467-842X.2001.TB00550.X
Abstract: To investigate patterns of drug use and injection-related risk behaviours among young Indo-Chinese injecting drug users (IDUs). Cross-sectional survey. A structured questionnaire was administered to 184 Indo-Chinese IDUs aged 15 to 24 in Sydney and Melbourne. Participants were recruited using snowball s ling techniques measures included patterns of heroin and other drug use, injection-related risk behaviours, perceived susceptibility to HIV and HCV infection and access to services. Despite perceived high availability of sterile injecting equipment, 36% had ever shared a needle and syringe and 22% had done so in the preceding month. Lifetime sharing was significantly associated with duration of injecting, history of incarceration and residence in Sydney. Sharing of injecting paraphernalia other than needles and syringes was also common, with young women and Sydney residents significantly more likely to report sharing equipment in the preceding month. Young Indo-Chinese IDUs are at high risk of infection with hepatitis C and other blood-borne viruses. Results indicate an urgent need for culturally appropriate and sustainable risk reduction programs which specifically target this population. Health services must respond swiftly to implement effective blood-borne virus prevention programs for young Indo-Chinese IDUs. Failure to do so may sustain the current epidemic of hepatitis C among IDUs.
Publisher: Wiley
Date: 27-08-2020
DOI: 10.1111/ADD.15217
Publisher: Elsevier BV
Date: 10-2007
Publisher: Wiley
Date: 22-01-2019
DOI: 10.1111/JVH.13051
Publisher: Elsevier BV
Date: 05-2012
DOI: 10.1016/J.DRUGALCDEP.2011.09.030
Abstract: Harm associated with injecting drug use is a significant public health issue and a major cause of morbidity and mortality, with global estimates of 3 million injectors infected with HIV and 8 million living with chronic hepatitis C virus (HCV) infection. Estimates of program coverage are widely used in the context of HIV prevention and are critical in determining the effectiveness of interventions such as Needle and Syringe Programs (NSPs). Data from a national cross-sectional study of NSP attendees in Australia were used to estimate in idual-level syringe coverage as a proportion of monthly injections covered by a new syringe. Univariate and multivariate logistic regressions modelled associations between demographics, injecting risk, anti-HIV and HCV prevalence and syringe coverage. The median number of syringes retained per NSP attendee per annum was also estimated. Twenty percent of participants had insufficient new syringes for all injections. Syringe reuse (including reuse of one's own syringe) was independently associated with syringe coverage of <100%. Conversely, procurement of syringes from an NSP was independently associated with syringe coverage ≥100%, with a greater protective effect occurring when NSP utilisation was combined with current engagement in opiate substitution therapy. The median number of syringes retained per participant per annum was 720, equivalent to 2 per day. While Australian NSP attendees report high syringe coverage by international standards, prevention efforts could be scaled up. Syringe reuse was associated with syringe coverage of <100%, suggesting the utility of reuse as a proxy for in idual-level syringe coverage.
Publisher: Public Library of Science (PLoS)
Date: 06-2020
Publisher: Springer Science and Business Media LLC
Date: 27-04-2020
Publisher: Elsevier BV
Date: 11-2014
Publisher: Springer Science and Business Media LLC
Date: 11-2008
Publisher: Wiley
Date: 05-2008
Publisher: Informa UK Limited
Date: 1998
DOI: 10.3109/10826089809069811
Abstract: A very sizable proportion of juvenile delinquents and adult criminals come from backgrounds and family kin systems having deviant parents or kin. This paper provides a focus upon the child-rearing practices directly observed by trained ethnographer during a case study of one highly criminal, drug-using household/kin network. The concrete expectations (and actual practices--called conduct norms--with which the household adults respond to (or "nurture") children and juveniles are delineated. While children are taught to "pay attention" to what adults do, adults typically model various deviant activities and rarely engage in conventional behaviors. Drug-using, and especially crack-using, men and women are expected not to raise (or financially support) children born to them other kin expect to raise children of such unions. Children are not expected, nor able, to develop strong affective bonds with any household adults, and receive little or no psychological parenting. Adults do not take strong measures to protect children/juveniles from harm, and often adults are a major source of harm. In many ways the conduct norms in such crack-using households are well designed to "nurture" those persons who will be antisocial as children, delinquents as juveniles, and become criminals, drug misusers, and prostitutes in adulthood--and who have very few chances to become conventional adults.
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.JHEP.2019.11.011
Abstract: Neutralising antibodies (NAbs) play a key role in clearance of HCV. NAbs have been isolated and mapped to several domains on the HCV envelope proteins. However, the immunodominance of these epitopes in HCV infection remains unknown, hindering efforts to elicit optimal epitope-specific responses. Furthermore, it remains unclear which epitope-specific responses are associated with broad NAb (bNAb) activity in primary HCV infection. The aim of this study was to define B cell immunodominance in primary HCV, and its implications on neutralisation breadth and clearance. Using s les from 168 patients with primary HCV infection, the antibody responses targeted 2 immunodominant domains, termed domains B and C. Genotype 1 and 3 infections were associated with responses targeted towards different bNAb domains. No epitopes were uniquely targeted by clearers compared to those who developed chronic infection. S les with bNAb activity were enriched for multi-specific responses directed towards the epitopes antigenic region 3, antigenic region 4, and domain D, and did not target non-neutralising domains. This study outlines for the first time a clear NAb immunodominance profile in primary HCV infection, and indicates that it is influenced by the infecting virus. It also highlights the need for a vaccination strategy to induce multi-specific responses that do not target non-neutralising domains. Neutralising antibodies will likely form a key component of a protective hepatitis C virus vaccine. In this work we characterise the predominant neutralising and non-neutralising antibody (epitope) targets in acute hepatitis C virus infection. We have defined the natural hierarchy of epitope immunodominance, and demonstrated that viral genotype can impact on this hierarchy. Our findings highlight key epitopes that are associated with broadly neutralising antibodies, and the deleterious impact of mounting a response towards some of these domains on neutralising breadth. These findings should guide future efforts to design immunogens aimed at generating neutralising antibodies with a vaccine candidate.
Publisher: Informa UK Limited
Date: 16-01-2019
DOI: 10.1080/10826084.2018.1552302
Abstract: Gay and bisexual men (GBM) report distinctive patterns and contexts of drug use, yet little has been published about their attitudes toward drug use. We developed measures of attitudes and perceived social norms toward drug use, and examined covariates of more accepting attitudes and norms among GBM in Australia. We analyzed baseline data from the Following Lives Undergoing Change (Flux) study. Flux is an online prospective observational study of drug use among Australian GBM. We used principal components factor analysis to generate two attitudinal scales assessing "drug use for social and sexual enhancement" and "perceptions of drug risk." A third perceived social norms scale examined "acceptability of drug use among gay friends." Among 2,112 participants, 61% reported illicit drug use in the preceding six months. Stronger endorsement of drug use for social and sexual engagement and lower perceptions of drug risk were found among men who were more socially engaged with other gay men and reported regular drug use and drug use for sex. In multivariate analyses, all three scales were associated with recent drug use (any use in the previous six months), but only the drug use for social and sexual enhancement scale was associated with regular (at least monthly) use. Drug use and sex are difficult to disentangle for some GBM, and health services and policies could benefit from a better understanding of attitudinal and normative factors associated with drug use in gay social networks, while recognizing the role of pleasure in substance use.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 14-01-2014
Publisher: Wiley
Date: 05-2020
DOI: 10.1111/TRF.15768
Publisher: Springer Science and Business Media LLC
Date: 2009
Publisher: Springer Science and Business Media LLC
Date: 12-2014
Publisher: Wiley
Date: 10-03-2010
DOI: 10.1111/J.1360-0443.2009.02837.X
Abstract: Supervised injecting facilities (SIFs) are effective in reducing the harms associated with injecting drug use among their clientele, but do SIFs ease the burden on ambulance services of attending to overdoses in the community? This study addresses this question, which is yet to be answered, in the growing body of international evidence supporting SIFs efficacy. Ecological study of patterns in ambulance attendances at opioid-related overdoses, before and after the opening of a SIF in Sydney, Australia. A SIF opened as a pilot in Sydney's 'red light' district with the aim of accommodating a high throughput of injecting drug users (IDUs) for supervised injecting episodes, recovery and the management of overdoses. A total of 20,409 ambulance attendances at opioid-related overdoses before and after the opening of the Sydney SIF. Average monthly ambulance attendances at suspected opioid-related overdoses, before (36 months) and after (60 months) the opening of the Sydney Medically Supervised Injecting Centre (MSIC), in the vicinity of the centre and in the rest of New South Wales (NSW). The burden on ambulance services of attending to opioid-related overdoses declined significantly in the vicinity of the Sydney SIF after it opened, compared to the rest of NSW. This effect was greatest during operating hours and in the immediate MSIC area, suggesting that SIFs may be most effective in reducing the impact of opioid-related overdose in their immediate vicinity. By providing environments in which IDUs receive supervised injection and overdose management and education SIF can reduce the demand for ambulance services, thereby freeing them to attend other medical emergencies within the community.
Publisher: MDPI AG
Date: 21-11-2018
DOI: 10.3390/V10110659
Abstract: Despite recent advances in curative therapy, hepatitis C virus (HCV) still remains a global threat. In order to achieve global elimination, a prophylactic vaccine should be considered high priority. Previous immunogens used to induce broad neutralising antibodies (BnAbs) have been met with limited success. To improve immunogen design, factors associated with the early development of BnAbs in natural infection must first be understood. In this study, 43 subjects identified with acute HCV were analysed longitudinally using a panel of heterogeneous HCV pseudoparticles (HCVpp), to understand the emergence of BnAbs. Compared to those infected with a single genotype, early BnAb development was associated with subjects co-infected with at least 2 HCV subtypes during acute infection. In those that were mono-infected, BnAbs were seen to emerge with increasing viral persistence. If subjects acquired a secondary infection, nAb breadth was seen to boost upon viral re-exposure. Importantly, this data highlights the potential for multivalent and prime-boost vaccine strategies to induce BnAbs against HCV in humans. However, the data also indicate that the infecting genotype may influence the development of BnAbs. Therefore, the choice of antigen will need to be carefully considered in future vaccine trials.
Publisher: Elsevier BV
Date: 09-2014
Publisher: Elsevier BV
Date: 04-2017
DOI: 10.1016/J.DRUGPO.2016.12.004
Abstract: Use of opioid analgesic medicines has doubled globally over the past decade, with a concomitant increase in prevalence of injection of pharmaceutical opioids (PO), including in Australia. This study investigates types of PO injected, methods used to prepare PO for injection and correlates of recent (last 6 months) PO injection among a large national s le of people who inject drugs (PWID). The Australian NSP Survey (ANSPS), conducted annually at ∼50 NSP services across Australia, consists of a brief self-administered questionnaire and provision of a capillary dried blood spot for HIV and hepatitis C antibody testing. Data from 2014 were used to conduct univariable and multivariable logistic regression analysis to determine factors independently associated with recent injection of PO. Among 1488 ANSPS respondents who were identified as opioid injectors, 57% (n=848) reported injection of PO in the previous six months. The majority of PO injectors (85%) reported filtering PO prior to injection, although use of efficacious wheel filters was relatively rare (11%). Correlates of POs injection included daily injection (AOR=1.65, 95% CI 1.31-2.08), receptive sharing of syringes (AOR=2.00, 95% CI 1.43-2.78), receptive sharing of drug preparation equipment (AOR=1.55, 95% CI 1.19-2.01), drug overdose in the previous year (AOR=1.81, 95% CI 1.36-2.42) and residence in inner regional (AOR=3.27, 95% CI 2.21-5.23) or outer regional/remote (AOR=5.50, 95% CI 3.42-8.84) areas of Australia. PO injection is geographically widespread among Australian PWID and takes place in the context of poly-drug use. People who inject POs are at high risk of overdose, injection related injury and disease and blood borne viral infections. Harm reduction services that target this group, including in non-urban areas, should deliver health education regarding PO-specific overdose risks, the requirement to adequately filter PO before injection and to ensure that both naloxone and specialist pill filters are readily accessible.
Publisher: CSIRO Publishing
Date: 2015
DOI: 10.1071/SH14213
Abstract: Background Diagnoses of chlamydia and gonorrhoea have increased steadily in Australia over the past decade. Testing and treatment is central to prevention and control but in some settings treatment may be delayed. Testing at the point of care has the potential to reduce these delays. We explored the potential utility of newly available accurate point-of-care tests in various clinical settings in Australia. Methods: In-depth qualitative interviews were conducted with a purposively selected group of 18 key informants with sexual health, primary care, remote Aboriginal health and laboratory expertise. Results: Participants reported that point-of-care testing would have greatest benefit in remote Aboriginal communities where prevalence of sexually transmissible infections is high and treatment delays are common. Some suggested that point-of-care testing could be useful in juvenile justice services where young Aboriginal people are over-represented and detention periods may be brief. Other suggested settings included outreach (where populations may be homeless, mobile or hard to access, such as sex workers in the unregulated sex industry and services that see gay, bisexual and other men who have sex with men). Point-of-care testing could also improve the consumer experience and facilitate increased testing for sexually transmissible infections among people with HIV infection between routine HIV-management visits. Some participants disagreed with the idea of introducing point-of-care testing to urban services with easy access to pathology facilities. Conclusions: Participants felt that point-of-care testing may enhance pathology service delivery in priority populations and in particular service settings. Further research is needed to assess test performance, cost, acceptability and impact.
Publisher: Elsevier BV
Date: 12-2008
Publisher: Elsevier BV
Date: 03-2017
DOI: 10.1016/J.DRUGPO.2016.12.007
Abstract: Between 1992 and 2012 dispensing episodes for pharmaceutical opioids (PO) in Australia increased from 500000 to 7500000. In the US, increases in the prescription of PO have been linked to increases in opioid-related morbidity and mortality and transitions to heroin injection. However, Australian data indicate that morbidity and mortality related to PO are relatively low, particularly when compared to heroin and other drugs. This paper explores the characteristics and patterns of non-medical pharmaceutical opioid (NMPO) use among a s le of young people in Sydney, Australia. During 2015, we conducted in-depth qualitative interviews with 34 young people who use PO non-medically by oral (n=22) and intravenous (n=12) routes of administration. Oral NMPO users were a more affluent group who clustered around the Northern, Inner and Eastern suburbs of Sydney, while the intravenous users came from a range of locations including rural/regional areas of NSW and socioeconomically disadvantaged suburbs of South Western Sydney. Oral users were characterised by intermittent and largely self-limiting NMPO use and reported few health and social consequences. Intravenous users reported heavy and frequent drug, including NMPO, use and a range of adverse health and social consequences including overdose, injecting risk behaviour, hepatitis C virus (HCV) infection and residential instability. Results highlight the significance of social and structural factors in trajectories of opioid use and related harms. Factors such as stable housing and family relationships, disposable income and close social networks observed in young oral NMPO users may help to explain differences in patterns of NMPO use and related outcomes between the two groups.
Publisher: Wiley
Date: 17-04-2013
DOI: 10.1111/JVH.12098
Abstract: Occult hepatitis C virus (HCV) is a phenomenon where serum HCV RNA is not detected by sensitive commercial assays, but viral RNA is detected by ultrasensitive techniques. Occult HCV infection has not previously been studied in highly exposed, but apparently uninfected (EU) in iduals. Two studies examining occult infection in EU subjects were undertaken - an initial two-centre, masked, case-control study based on cross-sectional s les (n = 35 subjects) and a single-centre confirmatory study based on longitudinal s les (n = 32 subjects). Plasma and peripheral blood mononuclear cells were tested for HCV RNA using an ultrasensitive nested polymerase chain reaction assays. Two EU subjects in the first study (10%) and one in the second study (3%) were found to have consistently detectable HCV RNA. Occult HCV infection occurs in high-risk, apparently uninfected subjects.
Publisher: Elsevier BV
Date: 2019
DOI: 10.1016/J.JHEP.2018.09.030
Abstract: The World Health Organization (WHO) established targets to eliminate hepatitis C virus (HCV) infection as a public health threat by 2030. Evidence that HCV treatment can lower viraemic prevalence among people who inject drugs (PWID) is limited. Broad accessibility of direct-acting antiviral (DAA) therapy in Australia, since March 2016, provides an opportunity to assess the efficacy of these treatments at a population level in a real-world setting. Data from Australia's annual bio-behavioural surveillance examined treatment uptake and estimated viraemic prevalence among PWID attending needle syringe programs nationally between 2015 and 2017. Multivariate logistic regression identified variables independently associated with HCV treatment among those considered eligible (anti-HCV positive excluding HCV RNA negative with no self-reported history of HCV treatment) in 2017. Annual s les ranged from 1,995-2,380 PWID. Anti-HCV prevalence declined from 57% (2015) to 49% (2017, χ This study confirms PWID are willing to initiate treatment when HCV DAA therapy is available and provides population-level evidence of a decline in viraemic prevalence among people most at risk of ongoing HCV transmission. Scaled up surveillance and monitoring are required to evaluate progress toward WHO HCV elimination goals. The World Health Organization's goal to reduce hepatitis C virus incidence by 80% will be difficult to achieve without widespread scale up and a corresponding reduction in viraemic prevalence among those most at risk of onward transmission. Our results indicate that a population-level reduction in viraemic prevalence is achievable through high levels of treatment and cure among people who inject drugs.
Publisher: Wiley
Date: 10-2020
DOI: 10.1002/JIA2.25632
Publisher: Elsevier BV
Date: 07-2010
DOI: 10.1016/J.VACCINE.2010.05.064
Abstract: Several candidate vaccines for hepatitis C are currently in preclinical development or the early stages of clinical trials. Implementing trials of these vaccines among people who inject drugs will be challenging. Previous research, particularly willingness to participate studies in relation to HIV vaccines in marginalized groups, has focused on the modifiable characteristics of in idual participants. This qualitative research with people who inject drugs, health staff and clinicians focuses on social, organisational and structural elements of vaccine trial designs which may exclude or reduce the participation of people who inject drugs.
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 05-2015
Publisher: Wiley
Date: 05-02-2020
DOI: 10.1111/VOX.12891
Publisher: BMJ
Date: 09-2013
Publisher: American Public Health Association
Date: 08-2013
Abstract: Objectives. We examined trends in HCV incident infection among injection drug users (IDUs) attending needle and syringe programs (NSPs) in Australia in 1995 to 2010. Methods. We created a passive retrospective cohort of 724 IDUs who tested negative for HCV antibodies by a simple deterministic method linking partial identifiers to find repeat respondents in annual cross-sectional serosurveillance. Results. We identified 180 HCV seroconversions over the study period, for a pooled incidence density of 17.0 per 100 person-years (95% confidence interval [CI] = 14.68, 19.66). Incidence density declined, from a high of 30.8 per 100 person-years (95% CI = 21.3, 44.6) in 2003 to a low of 4.0 (95% CI = 1.3, 12.3) in 2009. Conclusions. A decline in HCV incidence among Australian IDUs attending NSPs coincided with considerable expansion of harm reduction programs and a likely reduction in the number of IDUs, associated with significant changes in drug markets. Our results demonstrate the capacity of repeat cross-sectional serosurveillance to monitor trends in HCV incidence and provide a platform from which to assess the impact of prevention and treatment interventions.
Publisher: Springer Science and Business Media LLC
Date: 17-03-2016
Publisher: Springer Science and Business Media LLC
Date: 31-12-2016
DOI: 10.1038/S41598-019-49454-W
Abstract: Hepatitis C virus (HCV) is one of very few viruses that are either naturally cleared, or alternatively persist to cause chronic disease. Viral ersity and escape, as well as host adaptive immune factors, are believed to control the outcome. To date, there is limited understanding of the critical, early host-pathogen interactions. The asymptomatic nature of early HCV infection generally prevents identification of the transmitted/founder (T/F) virus, and thus the study of host responses directed against the autologous T/F strain. In this study, 14 rare subjects identified from very early in infection (4–45 days) with varied disease outcomes (n = 7 clearers) were examined in regard to the timing, breadth, and magnitude of the neutralizing antibody (nAb) response, as well as evolution of the T/F strain. Clearance was associated with earlier onset and more potent nAb responses appearing at a mean of 71 days post-infection (DPI), but these responses were narrowly directed against the autologous T/F virus or closely related variants. In contrast, a delayed onset of nAbs (mean 425 DPI) was observed in chronic progressors that appear to have targeted longitudinal variants rather than the T/F strain. The nAb responses in the chronic progressors mapped to known CD81 binding epitopes, and were associated with rapid emergence of new viral variants with reduced CD81 binding. We propose that the prolonged period of viremia in the absence of nAbs in these subjects was associated with an increase in viral ersity, affording the virus greater options to escape nAb pressure once it emerged. These findings indicate that timing of the nAb response is essential for clearance. Further investigation of the specificities of the early nAbs and the factors regulating early induction of protective nAbs is needed.
Publisher: Wiley
Date: 09-2014
DOI: 10.5694/MJA13.00153
Abstract: To estimate hepatitis C virus (HCV) incidence and identify associated risk and protective factors among people who inject drugs (PWID) in Sydney, New South Wales. Community-based prospective observational study of serologically confirmed HCV antibody-negative PWID enrolled in six Sydney neighbourhoods located in three distinct regions between 10 November 2008 and 31 October 2011. Serologically confirmed HCV incidence per person-years (py) and self-reported demographic and behavioural risk factors for HCV infection. The overall incidence of HCV infection was 7.9/100 py. Risk factors independently associated with incident HCV infection were younger age (adjusted hazard ratio [AHR] for age < 27 years, 5.66 95% CI, 1.69-18.95 P = 0.005) and daily or more frequent injecting (AHR, 4.06 95% CI, 1.15-14.30 P = 0.03). Opioid substitution therapy (OST) was protective against HCV seroconversion and was associated with a reduced risk of incident infection among those who mainly injected heroin or other opioids (AHR for those not receiving OST while mainly injecting heroin or other opioids, 5.64 95% CI, 1.30-24.42 P = 0.02). The observed HCV incidence was substantially lower than the incidence of 30.8/100 py observed a decade earlier in a similar NSW-based cohort, suggesting a decline in HCV incidence among PWID. This is likely due to increased coverage of OST, combined with a probable decrease in the population of PWID.
Publisher: John Wiley & Sons, Ltd
Date: 12-01-2016
Publisher: Wiley
Date: 24-11-2017
DOI: 10.1111/JVH.12652
Publisher: Wiley
Date: 2015
Publisher: Elsevier BV
Date: 03-2012
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-04-2008
DOI: 10.1097/QAI.0B013E31816A1D68
Abstract: Australia's annual Needle and Syringe Program (NSP) Survey forms the basis of HIV surveillance among injecting drug users (IDUs) by providing serial point prevalence estimates of patterns of infection and risk behaviors. This study examined the representativeness of NSP Survey s les. National cross-sectional survey of 3920 NSP clients. Demographic and drug use characteristics of respondents and nonrespondents to the 2006 Survey were compared. Relative to NSP clients who last injected heroin, meth hetamine injectors were significantly more likely to complete the Survey, as were people who had last injected an opioid maintenance pharmacotherapy or morphine. Other variables independently associated with Survey completion were female gender and being aged >or=35 years. Although the median age of NSP Survey s les has increased by 1 year per annum since 2002, the increase has occurred among both repeat and first-time respondents, allaying concerns that an ageing cohort of NSP clients repeatedly completes the Survey and unduly influences its results. Inferences derived from the Survey results can reasonably be applied to the population of NSP clients, although because older female pharmaceutic injectors may be overrepresented among NSP Survey participants, recruitment strategies to target specific subpopulations (younger male participants) and stratification of main outcomes by age and gender in future analyses may usefully be considered. Although the extent to which Survey results can be generalized to Australia's broader IDU population cannot be ascertained, their consistency with other sources of surveillance data suggests that NSP Survey s les reflect the changing characteristics of Australia's illicit drug markets. Consequently, these are likely to be as representative s les of injectors as it is practical to obtain, and the Australian NSP Survey provides a useful model for blood-borne virus surveillance among IDUs.
Publisher: Elsevier BV
Date: 04-2010
DOI: 10.1016/J.DRUGALCDEP.2009.11.013
Abstract: Despite the availability of an inexpensive and safe vaccine, injecting drug users (IDUs) remain at risk of hepatitis B virus (HBV) infection. This paper aimed to measure HBV prevalence and vaccination coverage and to assess knowledge and concordance of status among IDUs. Participants were recruited through a primary health care and a drug treatment service and via street press in Sydney, Australia. Face-to-face interviews were conducted and serology collected. All received $30 for participation. 229 participants were recruited, serology was available for 209. Almost all those interviewed had been tested for HBV (95%) a median of four (IQR 2-10) times and 61% had been tested in the preceding year. Fifty-four percent had evidence of previous infection (anti-HBc) and 5% were HBsAg positive. Only 27% had serological evidence of vaccination immunity however, 43% of the s le recalled having being told by a health professional that they were vaccinated against HBV. Although only three participants reported they did not understand the results of their last HBV test, confusion was evident based on self-reported status. Levels of understanding and vaccination coverage were low while evidence of prior infection was high among this IDU s le. This is cause for concern given the majority of participants were recruited through primary care and treatment services. Strategies to bolster vaccination among this group will be discussed.
Publisher: Springer Science and Business Media LLC
Date: 22-11-2019
DOI: 10.1007/S10461-019-02739-7
Abstract: Use of crystal meth hetamine (crystal) among gay and bisexual men (GBM) has been associated with condomless anal intercourse with casual partners (CLAIC) and HIV infection. Pre-exposure prophylaxis (PrEP) and undetectable viral load (UVL) are important biomedical HIV prevention strategies. We investigate the relationship between crystal use and HIV sexual risk behaviours in the context of PrEP and UVL. In 2018, 1367 GBM provided details about crystal use and HIV prevention strategies. Binary logistic regression was used to estimate associations between crystal use and behaviour. Recent crystal use was independently associated with greater social engagement with gay men and having more sexual partners. Crystal use was also independently associated with use of PrEP and UVL among GBM who engaged in CLAIC. Although GBM who used crystal were more likely to have engaged in CLAIC, they were also more likely to use biomedical HIV prevention which mitigates against the risks of HIV infection.
Publisher: Wiley
Date: 15-07-2021
DOI: 10.1111/ADD.12643
Abstract: To document the relationships between injecting drug use, imprisonment and hepatitis C virus (HCV) infection. Prospective cohort study. Multiple prisons in New South Wales, Australia. HCV seronegative prisoners with a life-time history of injecting drug use (IDU) were enrolled and followed prospectively (n = 210) by interview and HCV antibody and RNA testing 6-12-monthly for up to 4 years when in prison. HCV incidence was calculated using the person-years method. Cox regression was used to identify predictors of incident infection using time-dependent covariates. Almost half the cohort reported IDU during follow-up (103 subjects 49.1%) and 65 (31%) also reported sharing of the injecting apparatus. There were 38 HCV incident cases in 269.94 person-years (py) of follow-up with an estimated incidence of 14.08 per 100 py [confidence interval (CI) = 9.96-19.32]. Incident infection was associated independently with Indigenous background, injecting daily or more and injecting heroin. Three subjects were RNA-positive and antibody-negative at the incident time-point, indicating early infection, which provided a second incidence estimate of 9.4%. Analysis of continuously incarcerated subjects (n = 114) followed over 126.73 py, identified 13 new HCV infections (10.26 per 100 py, CI = 5.46-17.54), one of which was an early infection case. Bleach-cleansing of injecting equipment and opioid substitution treatment were not associated with a significant reduction in incidence. In New South Wales, Australia, imprisonment is associated with high rates of hepatitis C virus transmission. More effective harm reduction interventions are needed to control HCV in prison settings.
Publisher: The Sax Institute
Date: 2010
DOI: 10.1071/NB10007
Publisher: Wiley
Date: 11-2018
DOI: 10.1111/DAR.12307
Publisher: Informa UK Limited
Date: 17-02-2015
Publisher: Elsevier BV
Date: 10-2011
DOI: 10.1111/J.1753-6405.2011.00743.X
Abstract: To compare prevalence of hepatitis C virus (HCV) antibody and associated risk behaviours among Indigenous and non-Indigenous participants in the Australian Needle and Syringe Program Survey. During 1 or 2 weeks each October from 1998 to 2008, clients of participating needle and syringe programs (NSPs) completed a self-administered questionnaire on demographics and risk behaviour and provided a capillary blood s le for HIV and HCV antibody testing. After de-duplication, 16,132 in iduals participated during the 11 years, of whom 1,380 (8.6%) identified as Indigenous. Higher proportions of Indigenous than non-Indigenous participants were HCV antibody positive (57% versus 51%, p<0.001). In an overall multivariable analysis, Indigenous status (OR 1.17 CI 1.03-1.32) and female gender (OR 1.25 CI 1.16-1.35) were independently associated with HCV antibody seropositivity. Indigenous participants also reported higher rates of risk behaviour, including receptive sharing of needle syringes (21% vs 16% p<0.001), receptive sharing of ancillary injecting equipment (38% vs 33% p<0.001), having been injected by others (18% vs 13% p<0.001), and injecting in public (54% vs 49% p<0.001). These results highlight the need for targeted, culturally appropriate programs to minimise risks for bloodborne viral transmission among Indigenous people who inject drugs.
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.DRUGPO.2019.02.002
Abstract: Despite the increasing prevalence and distinct nature of meth hetamine-related harms, treatment models are limited, and relapse is common. Meta-ethnography has been increasingly used to synthesise qualitative health research and develop new concepts or theories. This meta-ethnography aimed to explore meth hetamine users' experiences of cessation, recovery, and relapse, to better understand how to tailor support for this population. A systematic review was conducted of six electronic databases, supported by hand searches of leading journals and reviews of reference lists. Reports were included that used naturalistic participant observation to examine meth hetamine cessation, recovery, and relapse with at least 50% of their s le. The life course approach to drug use was used to inform the process of data analysis and interpretation. The final s le was synthesised using Reciprocal Translation supported by open and axial coding. Nineteen sources were selected, thirteen of which were conducted in the United States. Two themes were identified: meth hetamine users are exposed to a range of relapse triggers, but also triggers for recovery, and their susceptibility to these triggers is largely determined by their social environment and the process of recovery requires changes in personal and social identity which can be a barrier to recovery for some users. These findings present the concept of recovery triggers and highlight the role of wider risk environments in determining meth hetamine recovery, and the negative potential of social capital. These themes also address the ongoing debate regarding the agency of drug users, and the impact of this debate on drug user's experiences of recovery.
Publisher: Oxford University Press (OUP)
Date: 28-02-2019
DOI: 10.1093/CID/CIZ162
Abstract: While opioid agonist therapy (OAT) reduces the risk of hepatitis C virus (HCV) acquisition among people who inject drugs (PWID), protective effects may be attenuated in females. We used pooled data from an international collaboration of prospective cohorts to assess sex disparities in HCV incidence among PWID exposed to OAT. Independent predictors of HCV infection were identified using Cox regression models with random effects after accounting for the clustering effect of study sites. Unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) are presented in sex‐specific analyses. Among 701 participants exposed to OAT, HCV incidence was 16.5/100 person-years of observation (PYO) (95% CI, 13.1–20.7) in females and 7.6/100 PYO (95% CI, 6.0–9.5) in males (female:male adjusted HR [aHR], 1.80 [95% CI, 1.37–2.22] P & .001). Factors associated with HCV acquisition among females exposed to OAT included nonwhite race (aHR, 1.79 [95% CI, 1.25–2.56] P = .001), unstable housing (aHR, 4.00 [95% CI, 3.62–4.41] P & .001), daily or more frequent injection (aHR, 1.45 [95% CI, 1.01–2.08] P = .042), and receptive syringe sharing (aHR, 1.43 [95% CI, 1.33–1.53] P & .001). Female PWID exposed to OAT are twice as likely as their male counterparts to acquire HCV. While there is a need for better understanding of sex differences in immune function and opioid pharmacokinetic and pharmacodynamic parameters, structural and behavioral interventions that target women are required to bolster the efficacy of OAT in preventing HCV transmission.
Publisher: Informa UK Limited
Date: 2009
Publisher: Wiley
Date: 06-02-2018
DOI: 10.1111/DAR.12668
Abstract: There is a current epidemic of pharmaceutical opioid (PO) misuse, particularly fentanyl and fentanyl analogues, globally. Fentanyl is a highly potent synthetic opioid with rapid onset and significantly higher risk of overdose compared with other opioids. Contexts and correlates of fentanyl use among people who inject drugs (PWID) in Australia are under-researched. The Australian Needle Syringe Program Survey is conducted annually. Consenting PWID complete a self-administered questionnaire and provide a capillary dried blood spot for human immunodeficiency virus and hepatitis C virus antibody testing. Bivariate and multivariate logistic regressions determined correlates of recent (last 6 months) fentanyl injection in 2014. Recent fentanyl injection was reported by 8% (n = 193) of the total s le. Among the 848 PWID who recently injected POs, 23% injected fentanyl. Compared with PO injectors who had not injected fentanyl, those who had injected fentanyl were significantly more likely to identify as Indigenous Australian [adjusted odds ratio (AOR) 1.61 95% confidence interval (CI) 1.04, 2.51 P = 0.034], inject daily or more frequently (AOR 1.92 95% CI 1.30, 2.83 P = 0.005), inject in public (AOR 1.43 95% CI 1.01, 2.02 P = 0.042) and to have overdosed in the past year (AOR 2.16 95% CI 1.48, 3.13 P < 0.001), but were significantly less likely to receptively share syringes (AOR 0.56 95% CI 0.36, 0.87 P = 0.010). Fentanyl injectors in Australia are significantly more likely to identify as Indigenous, report frequent injection, inject in public and experience overdose. Increased access to harm reduction interventions, including naloxone distribution, wheel filters and supervised injection facilities, are likely to benefit this population.
Publisher: Public Library of Science (PLoS)
Date: 18-03-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2019
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.DRUGPO.2018.01.020
Abstract: Compared to the general population, among gay and bisexual men (GBM) prevalence rates of anxiety and depression, and of drug use, are high. This paper explores the relationship between mental health, sexual risk behavior, and drug use among Australian GBM. We identify factors associated with indicators of poor mental health. Between September 2014 and July 2017, 3017 GBM responded to measures of anxiety and depression in an online cohort study of drug use. Mean age was 35.3 years (SD 12.8). 17.9% screened positive for current moderate-severe anxiety and 28.3% for moderate-severe depression. The majority (52.2%) reported use of illicit drugs in the previous six months, including 11.2% who had used meth hetamine. One third had high (20.4%) or severe (10.6%) risk levels of alcohol consumption, and 18.3% who were current daily smokers. Most illicit drug use in general was not associated with either anxiety or depression, but men who used cannabis were more likely to show evidence of depression (p = 0.005). Among recent meth hetamine users, 28.0% were assessed as dependent: dependent users were more likely to show evidence of both depression and anxiety than were non-dependent users. High or severe risk drinking was associated with depression and daily tobacco use was associated with both anxiety and depression. Depression and anxiety was associated with: less personal support, viewing oneself as 'feminine', and being less socially engaged with gay men. Sexual risk behavior was not associated with either depression or anxiety. Prevalence of anxiety and depression was high, as was prevalence of licit and illicit drug use. Substance use was associated with anxiety and depression only when the use was considered problematic or dependent. Social isolation and marginalization are strong drivers of poor mental health, even within this population for whom anxiety and depression are common.
Publisher: Elsevier BV
Date: 10-2017
DOI: 10.1016/J.DRUGPO.2017.05.058
Abstract: Potential Australian blood donors are deferred indefinitely if they report a history of injecting drug use (IDU), or for 12 months if they report having engaged in sexual activity with someone who might have ever injected. Given incremental improvements in blood safety, this study sought to examine whether Australia's IDU-related eligibility criteria reflected current scientific evidence, were consistent with international best practice and, if current IDU-related policies were to be changed, how this should happen. An expert committee was formed to review relevant literature with a focus on issues including: the epidemiology of IDU in Australia and key transfusion-transmissible infections (TTIs) among Australian people who inject drugs (PWID) and, 'non-compliance' among PWID regarding IDU-related blood donation guidelines. International policies relating to blood donation and IDU were also reviewed. Modelling with available data estimated the risk of TTIs remaining undetected if the Blood Service's IDU-related guidelines were changed. Very few (<1%) Australians engage in IDU, and IDU risk practices are reported by only a minority of PWID. However, the prevalence of HCV remains high among PWID, and IDU remains a key transmission route for various TTIs. Insufficient data were available to inform appropriate estimates of cessation and relapse among Australian PWID. Modelling findings indicated that the risk of not detecting HIV becomes greater than the reference group at a threshold of non-admission of being an active PWID of around 1.8% (0.5-5.1%). Excluding Japan, all Organisation for the Economic Co-operation and Development member countries permanently exclude in iduals with a history of IDU from donating. Numerous research gaps meant that the study's expert Review Committee was unable to recommend altering Australia's current IDU-related blood donation guidelines. However, having identified critical knowledge gaps and future areas of research, the review made important steps toward changing the criteria.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2012
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2015
Publisher: Springer Science and Business Media LLC
Date: 02-04-1000
Publisher: Wiley
Date: 10-11-2014
DOI: 10.1111/ADD.12750
Publisher: Elsevier BV
Date: 04-2020
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.DRUGPO.2018.01.018
Abstract: While illicit drug use is prevalent among gay and bisexual men (GBM) in Australia, little is known about the factors associated with injecting drug use among GBM. The Following Lives Undergoing Change (FLUX) study is a national, online prospective observational cohort investigating drug use among Australian GBM. Eligible participants were men living in Australia who were aged 16.5 years or older, identified as gay or bisexual or had sex with at least one man in the last year. We examined baseline data for associations between socio-demographic and behavioural characteristics and recent (last six months) injecting using log-binomial regression. Of 1995 eligible respondents, 206 (10.3%) reported ever injecting drugs and 93 (4.7%) had injected recently, most commonly crystal (91.4%) and speed (9.7%). Among recent injectors, only 16 (17.2%) reported injecting at least weekly eight (8.6%) reported recent receptive syringe sharing. Self-reported HIV and HCV prevalence was higher among recent injectors than among other participants (HIV: 46.2% vs 5.0%, p < .001 HCV: 16.1% vs. 1.2%, p 10 sex partners: APR = 3.21, 95%CI 1.30-7.92), group sex (APR = 1.42, 95%CI 1.05-1.91) and condomless anal intercourse with casual partners (APR = 1.81, 95%CI 1.34-2.43) in the last six months. Observed associations between injecting and sexual risk reflect a strong relationship between these practices among GBM. The intersectionality between injecting drug use and sex partying indicates a need to integrate harm reduction interventions for GBM who inject drugs into sexual health services and targeted sexual health interventions into Needle and Syringe Programs.
Publisher: Elsevier BV
Date: 05-2010
DOI: 10.1016/J.DRUGPO.2009.04.004
Abstract: Feasibility studies are an important component of preparations for field trials of biomedical prevention interventions, including vaccines. We conducted ethnographic fieldwork to assess feasibility, including eligibility and willingness to participate, prior to recruitment of a prospective observational study of hepatitis C negative people who inject drugs (PWID) in Sydney, Australia. Five staff conducted ethnographic fieldwork in 16 locations during 2008. Observations and interactions with PWID were recorded as field notes and data were used iteratively to guide targeting of locations and the follow-up of networks and in iduals. Findings informed the development of the study protocol, resulting in changes in the amount and type of participant reimbursement and the quantity of blood collected at screening, as well as highlighting the need for increased emphasis on communicating eligibility and exclusion criteria and study remuneration procedures. Results illustrate the value of ethnographic research in facilitating consultation and discussion with potential participants in natural settings, identifying motivations and concerns prior to study commencement and providing affected community input into the development of research protocols.
Publisher: Wiley
Date: 23-10-2017
DOI: 10.1111/ADD.14012
Publisher: Elsevier BV
Date: 04-2017
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.DRUGPO.2019.102659
Abstract: Gay, bisexual and other men who have sex with men (GBM) use alkyl nitrites ('poppers') at higher rates than other populations to functionally enhance sexual experiences. Their use has been associated with HIV sexual risk behaviours including receptive anal sex. We investigate the prevalence, frequency, and motivations for poppers use and their relationship with HIV risk. We also discuss the implications of the recent scheduling changes to poppers by the Australian Therapeutic Goods Administration. Data were drawn from the Following Lives Undergoing Change (Flux) study, a prospective observational study of licit and illicit drug use among GBM. Between 2014 and 2018, 3273 GBM enrolled in the study. In 2018, 1745 GBM provided data relating to frequency of and motivations for poppers use and were included in this analysis. Median age was 33 years (IQR 25-46) and 801 GBM (45.9%) had used poppers in the previous six months ('recent use'). Among these men, 195 (24.3%) had used them weekly or more frequently. Most recent users (77.4%) reported using poppers for a 'buzz' during sex or to facilitate receptive anal intercourse (60.8%). The majority (57.7%) of HIV-negative men reporting recent poppers use were concurrently taking HIV pre-exposure prophylaxis. Recent poppers use was independently associated with receptive anal intercourse with casual partners (aOR 1.71 95%CI 1.35-2.16) and chemsex (aOR 4.32 95%CI 3.15-5.94). Poppers use was not associated with anxiety, depression, or drug-related harms. Only 15.4% of current users indicated they would stop using poppers if they were criminalised 65.0% said they would 'find other ways' to obtain them. Poppers are commonly used by Australian GBM to functionally enhance sexual experiences, particularly to facilitate receptive anal intercourse. Few men experienced drug-related harms from poppers use. Regulatory changes must ensure potential harms from popper use are minimised without increasing barriers to access or perpetuating stigma.
Start Date: 07-2009
End Date: 03-2014
Amount: $185,000.00
Funder: Australian Research Council
View Funded ActivityStart Date: 11-2022
End Date: 10-2025
Amount: $505,682.00
Funder: Australian Research Council
View Funded Activity