ORCID Profile
0000-0001-9864-459X
Current Organisation
University of Bristol
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Publisher: Elsevier BV
Date: 03-2020
DOI: 10.1016/J.DRUGPO.2019.102656
Abstract: People who inject drugs (PWID) are at elevated risk of HIV infection. Data on population sizes of PWID living with HIV are needed to inform the implementation of prevention, treatment and care programs. We estimated national population sizes of people who recently (past 12 months) injected drugs living with HIV and evaluated ecological associations with HIV prevalence in PWID. We used national data on the prevalence of injecting drug use and of HIV among PWID, derived from systematic reviews, to estimate national population sizes of PWID living with HIV. Uncertainty was estimated using Monte Carlo simulation with 100,000 draws. We extracted data on s le characteristics from studies of HIV prevalence among PWID, and identified national indicators that have been observed or hypothesised to be associated with HIV prevalence in PWID. We used linear regression to evaluate associations between these variables and HIV prevalence in PWID. Four countries comprised 55% of the estimated global population of PWID living with HIV: Russia (572,500 95% uncertainty interval (UI) 235,500-1,036,500) Brazil (462,000 95% UI 283,500-674,500) China (316,500 95% UI 171,500-493,500), and the United States (195,500 95% UI 80,000-343,000). Greater anti-HCV prevalence and national income inequality were associated with greater HIV prevalence in PWID. The countries with the largest populations of PWID living with HIV will need to dramatically scale up prevention, treatment and care interventions to prevent further increases in population size. The association between anti-HCV prevalence and HIV prevalence among PWID corroborates findings that settings with increasing HCV should implement effective interventions to prevent HIV outbreaks. The association between income inequality and HIV among PWID reinforces the need to implement structural interventions alongside targeted in idual-level strategies.
Publisher: Elsevier BV
Date: 02-2015
Publisher: Wiley
Date: 10-09-2012
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: Elsevier BV
Date: 05-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-05-2017
Publisher: Elsevier BV
Date: 10-2019
Publisher: Elsevier BV
Date: 2023
Publisher: Wiley
Date: 20-01-2015
DOI: 10.1111/ADD.12822
Publisher: Elsevier BV
Date: 12-2020
Publisher: Wiley
Date: 23-09-2020
DOI: 10.1111/DAR.13173
Publisher: Elsevier BV
Date: 06-2019
Publisher: AMPCo
Date: 06-2012
DOI: 10.5694/MJA11.10981
Abstract: To develop a mathematical model to project the potential impact of hepatitis C virus (HCV) treatment on HCV infection prevalence among people who inject drugs (PWID). An existing model of HCV transmission among PWID was parameterised using data from Victoria, Australia, including specific parameter estimates of the number of people who are currently active injecting drug users, average duration of injecting, chronic HCV infection prevalence among PWID, annual mortality, and annual HCV treatment rate. We also explored the impact of prevalence uncertainty, program scale-up, and new treatments. Prevalence of chronic HCV infection among people who are currently active injecting drug users. With annual treatment rates of 13, 17, or 25 per 1000 PWID, the model predicts relative prevalence reductions of 20%, 30%, and 50%, respectively, within 30 years. If new treatments giving higher sustained viral response rates are available in 5 years, estimated impact is increased by 21%–23% at 15 years, and 17%–38% at 30 years, depending on treatment rates. This model suggests that modest rates of current HCV treatment among PWID in Victoria, Australia could halve HCV infection prevalence among PWID in 30 years. This finding suggests that interventions aimed at increasing access to HCV treatment in community clinics will benefit in idual PWID and reduce HCV infection prevalence.
Publisher: Elsevier BV
Date: 04-2020
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.DRUGALCDEP.2015.06.037
Abstract: Injecting drug use is associated with a range of harms, however cessation of injecting is rare. There is a lack of evidence on factors associated with cessation, notably those related to health services other than drug treatment. We examined the incidence and identified longitudinal correlates of first episode of cessation in a cohort of people who inject drugs (PWID). Using discrete-time survival analysis, we examined correlates of the first episode of cessation (no self-reported injecting drug use in the past 12 months), including the use of health services, socio-demographics and drug-related behaviour in a cohort of PWID recruited between 2008 and 2010. The cohort of 467 participants contributed 1527 person-years from recruitment to 2014. Under a fifth (17.8%) of people reported cessation of 12 months or more, yielding a cessation rate of 5.4 events per 100 person-years. Younger age (25-29 compared to 30 and above) (adjusted hazard ratio (AHR) 1.79, 95% confidence interval (CI) 1.07-3.00) and male gender (AHR 1.67, 95% CI 2.01-2.76) were positively associated with cessation, while past year use of benzodiazepines (AHR 0.45, 95% CI 0.28-0.72), arrest in the past year (AHR 0.50, 95% CI 0.30-0.83) and low SF-8 physical dimension score (AHR 0.42, 95% CI 0.20-1.88) were negatively associated with cessation. Outpatient service use had the largest effect on cessation (AHR 2.28, 95% CI 0.94-5.48, p=0.067). Low rates of cessation emphasise the need for sustained and comprehensive harm reduction services. The relationship between outpatient services and cessation suggests that further research into the use in health services among PWID is warranted.
Publisher: Springer Science and Business Media LLC
Date: 06-2003
Publisher: BMJ
Date: 16-07-2012
DOI: 10.1136/EMERMED-2012-201170
Abstract: People who inject drugs (PWID) have worse health than non-injectors and are at heightened risk of incidents that necessitate hospital emergency department (ED) visits. To describe ED visits by PWIDs in Melbourne, Australia, and compare reasons with those given in Vancouver, Canada. In 2008-2010, 688 Melbourne PWIDs were interviewed about their ED visits these data were contrasted with published data about ED visits by PWIDs in Vancouver. Participants reported 132 ED visits in the month preceding interview--27.3% drug-related, 20.5% trauma-related (principally physical assault), 13.6% for psychiatric problems. Melbourne PWIDs are less likely to attend ED for soft-tissue injuries, and more likely to attend after physical assault than PWIDs in Vancouver. PWID in Melbourne and Vancouver attend EDs for different reasons information about PWID visits can help EDs cater for them and provide insights for prevention.
Publisher: Wiley
Date: 05-10-2018
Publisher: MDPI AG
Date: 05-03-2021
Abstract: Ticks rank high among arthropod vectors in terms of numbers of infectious agents that they transmit to humans, including Lyme disease, Rocky Mountain spotted fever, Colorado tick fever, human monocytic ehrlichiosis, tularemia, and human granulocytic anaplasmosis. Increasing temperature is suspected to affect tick biting rates and pathogen developmental rates, thereby potentially increasing risk for disease incidence. Tick distributions respond to climate change, but how their geographic ranges will shift in future decades and how those shifts may translate into changes in disease incidence remain unclear. In this study, we have assembled correlative ecological niche models for eight tick species of medical or veterinary importance in North America (Ixodes scapularis, I. pacificus, I. cookei, Dermacentor variabilis, D. andersoni, Amblyomma americanum, A. maculatum, and Rhipicephalus sanguineus), assessing the distributional potential of each under both present and future climatic conditions. Our goal was to assess whether and how species’ distributions will likely shift in coming decades in response to climate change. We interpret these patterns in terms of likely implications for tick-associated diseases in North America.
Publisher: Wiley
Date: 20-03-2023
DOI: 10.1111/ADD.16178
Abstract: To quantify the association between opioid agonist treatment (OAT) and overdose death by age group test the hypothesis that across different age groups, opioid overdose mortality is lowest during OAT with buprenorphine compared with time out of treatment or OAT with methadone and test associations between OAT and opioid overdose mortality in the presence of chronic circulatory, respiratory, liver and kidney diseases. Retrospective observational cohort study using linked administrative data. New South Wales, Australia. A total of 37 764 people prescribed OAT, 1 August 2002 and 31 December 2017. OAT exposure, opioid overdose mortality and key confounders were measured using linked population data sets on OAT entry and exit, hospitalization, mental health care, incarceration and mortality. ICD‐10 codes were used to define opioid overdose mortality and chronic disease groups of interest. Relative to time out of treatment, time in OAT was associated with a lower risk of opioid overdose death across all age groups and chronic diseases. Among people aged 50 years and older, there was weak evidence that buprenorphine may be associated with greater protection against opioid overdose death than methadone [generalized estimating equation (GEE) adjusted incident rate ratio (aIRR) = 0.47 95% confidence interval (CI) = 0.21, 1.02 marginal structural models (MSM) aIRR = 0.49 95% CI = 0.17, 1.41]. Buprenorphine was associated with greater protection against overdose death than methadone for clients with circulatory (MSM aIRR = 0.27 95% CI = 0.11, 0.67) or respiratory (MSM aIRR = 0.26 95% CI = 0.07, 0.94) diseases, but not liver (MSM aIRR = 0.59 95% CI = 0.14, 2.43) or kidney (MSM aIRR = 1.16 95% CI = 0.31, 4.36) diseases. Opioid agonist treatment (OAT) appears to reduce mortality risk in people with opioid use disorder who are older or who have physical comorbidities. Opioid overdose mortality during OAT with buprenorphine appears to be lower and reduced in clients with circulatory and respiratory diseases compared with OAT with methadone.
Publisher: Elsevier BV
Date: 06-2023
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.DRUGPO.2019.07.030
Abstract: People who inject drugs (PWID) are at an elevated risk of fatal overdose in the first year after experiencing a non-fatal event. Such non-fatal events may also result in overdose-related sequelae, ranging from physical injury to paralysis. Given variation in drug markets and treatment availability across countries and regions, we may see similar variations in non-fatal overdose prevalence. Monitoring non-fatal overdose prevalence among PWID is essential for informing treatment intervention efforts, and thus our review aims to estimate the global, regional, and national prevalence of non-fatal overdose, and determine characteristics associated with experiencing such an event. We conducted a systematic review and meta-analyses to estimate country, regional, and global estimates of recent and lifetime non-fatal overdose prevalence among PWID. Using meta-regression analyses we also determined associations between s le characteristics and non-fatal overdose prevalence. An estimated 3.2 (1.8-5.2) million PWID have experienced at least one overdose in the previous year. Among PWID, 20.5% (15.0-26.1%) and 41.5% (34.6-48.4%) had experienced a non-fatal event in the previous 12 months and lifetime respectively. Frequent injecting was strongly associated with PWID reporting recent and lifetime non-fatal overdose. Estimates of recent non-fatal overdose were particularly high in Asia and North America. Around one in five PWID are at an elevated risk of fatally overdosing every year, however there is substantial geographical variation. In countries with higher rates of non-fatal overdose there is need to introduce or mainstream overdose prevention strategies such as opioid agonist treatment and naloxone administration training programs.
Publisher: Elsevier BV
Date: 07-2019
Publisher: Springer Science and Business Media LLC
Date: 17-08-2021
DOI: 10.1038/S41467-021-25169-3
Abstract: Controlling COVID-19 transmission in universities poses challenges due to the complex social networks and potential for asymptomatic spread. We developed a stochastic transmission model based on realistic mixing patterns and evaluated alternative mitigation strategies. We predict, for plausible model parameters, that if asymptomatic cases are half as infectious as symptomatic cases, then 15% (98% Prediction Interval: 6–35%) of students could be infected during the first term without additional control measures. First year students are the main drivers of transmission with the highest infection rates, largely due to communal residences. In isolation, reducing face-to-face teaching is the most effective intervention considered, however layering multiple interventions could reduce infection rates by 75%. Fortnightly or more frequent mass testing is required to impact transmission and was not the most effective option considered. Our findings suggest that additional outbreak control measures should be considered for university settings.
Publisher: Wiley
Date: 22-09-2018
DOI: 10.1111/LIV.13949
Publisher: BMJ
Date: 13-07-2010
DOI: 10.1136/BMJ.C3439
Publisher: Elsevier BV
Date: 02-2018
Publisher: Public Library of Science (PLoS)
Date: 25-05-2016
Publisher: Springer Science and Business Media LLC
Date: 29-09-2017
Publisher: Wiley
Date: 14-11-2014
Publisher: Wiley
Date: 24-08-2004
DOI: 10.1111/J.1360-0443.2004.00848.X
Abstract: This study sought to estimate the prevalence of injecting drug users (IDU) in Togliatti city and to examine the implications of these estimates for HIV prevalence and harm reduction. Routine data sources of IDUs were identified. Covariate capture-recapture techniques were used on the in iduals identified on the three data sources and used to estimate the number of IDU 'not observed' by the data sources, and thereby estimate the prevalence of IDU. Togliatti City, Samara Oblast, Russian Federation. IDUs recorded on three data sources (narcology records, HIV positive test results and police arrest data) during 2001. Poisson regression models were fitted to the observed data, with interactions between data sources fitted to replicate 'dependencies' between those data sources. To select the best model the goodness of fit was approximated by chi2 distribution and the best-fitting model was selected on the basis of standard information criteria and log likelihood ratio tests. The total estimated population of IDUs is 20 226 [95% confidence interval (CI): 16 971-24 749] giving a population prevalence of 5.4% (95% CI: 4.5-6.6%) of the registered population and 2.7% (95% CI: 2.4-3.5%) of the population (including migrants) aged 15-44 years. For every one IDU in contact with a service there were three out of contact. There is a high prevalence of IDU which, in the context of a fast-emerging IDU-associated HIV epidemic, will have serious public health implications.
Publisher: Oxford University Press (OUP)
Date: 25-06-2016
DOI: 10.1093/CID/CIW416
Publisher: Wiley
Date: 03-02-2021
DOI: 10.1111/ADD.15316
Abstract: Globally, nearly one in five people who inject drugs (PWID) are living with HIV, and the rate of new HIV infections in PWID is increasing in some settings. Early diagnosis is crucial for effective HIV control. We reviewed the evidence on the association between opioid agonist therapy (OAT) and HIV testing uptake among PWID. We conducted a systematic review searching MEDLINE, Scopus, Web of Science, Cochrane Central Register of Controlled Trials and PsycINFO for studies published from January 2000 to March 2019. Reference lists and conference proceedings were hand‐searched. Observational and intervention studies were eligible for inclusion. Risk of bias was assessed using the Risk of Bias in Non‐Randomised Studies of Interventions (ROBINS‐I) tool. Meta‐analyses were conducted using random‐effects models. Of 13 373 records identified, 11 studies from Australia, Europe, Malaysia and the United States were included. All studies had at least a serious risk of bias, largely due to confounding and selection bias, making it difficult to draw causal conclusions from the evidence. Ten studies provided data on the association between current OAT use and recent HIV testing. Six showed a positive association, while four provided little evidence of an association: pooled odds ratio (OR) = 1.71, 95% confidence interval (CI) = 1.28–2.27. Looking at having ever been on OAT and having ever been HIV tested, seven studies showed a positive association and three showed either weak or no evidence of an association: pooled OR = 3.82, 95% CI = 2.96–4.95. Opioid agonist therapy may increase uptake of HIV testing among people who inject drugs, providing further evidence that opioid agonist therapy improves the HIV treatment care cascade.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2006
DOI: 10.1097/01.QAI.0000219788.73539.47
Abstract: Although syringe distribution is effective in preventing HIV transmission among injecting drug users (IDUs), there is little evidence on the required coverage to substantially reduce HIV transmission. A mathematical model is developed to explore the relationship between the endemic HIV prevalence among IDUs and the coverage of syringe distribution. Data from IDU populations in the United Kingdom and Belarus are used to explore the implications of increasing coverage and the effect of changes in other behaviors. Projections suggest that there is a coverage threshold, which, if reached, could lead to substantial decreases in HIV prevalence. The threshold largely depends on the frequency that IDUs inject and (safely) reuse their syringes, and corresponds to less than 4 syringe-sharing events per IDU per month. Other factors, such as the injecting cessation rate and efficacy of syringe cleaning, only have substantial impact near threshold coverage levels. Our results support a policy of increasing the coverage of syringe distribution but highlight the difficulty in producing a universal coverage target. Great public health benefit could be conferred by encouraging the safe reuse of an IDU's own syringes and small stable injecting groups. Policies that discourage this will negate the impact of syringe distribution interventions.
Publisher: Elsevier BV
Date: 08-2021
Publisher: Elsevier BV
Date: 04-2022
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2015
DOI: 10.1161/CIRCGENETICS.115.001225
Abstract: Smoking is an important cardiovascular disease risk factor, but the mechanisms linking smoking to blood pressure are poorly understood. Data on 141 317 participants (62 666 never, 40 669 former, 37 982 current smokers) from 23 population-based studies were included in observational and Mendelian randomization meta-analyses of the associations of smoking status and smoking heaviness with systolic and diastolic blood pressure, hypertension, and resting heart rate. For the Mendelian randomization analyses, a genetic variant rs16969968/rs1051730 was used as a proxy for smoking heaviness in current smokers. In observational analyses, current as compared with never smoking was associated with lower systolic blood pressure and diastolic blood pressure and lower hypertension risk, but with higher resting heart rate. In observational analyses among current smokers, 1 cigarette/day higher level of smoking heaviness was associated with higher (0.21 bpm 95% confidence interval 0.19 0.24) resting heart rate and slightly higher diastolic blood pressure (0.05 mm Hg 95% confidence interval 0.02 0.08) and systolic blood pressure (0.08 mm Hg 95% confidence interval 0.03 0.13). However, in Mendelian randomization analyses among current smokers, although each smoking increasing allele of rs16969968/rs1051730 was associated with higher resting heart rate (0.36 bpm/allele 95% confidence interval 0.18 0.54), there was no strong association with diastolic blood pressure, systolic blood pressure, or hypertension. This would suggest a 7 bpm higher heart rate in those who smoke 20 cigarettes/day. This Mendelian randomization meta-analysis supports a causal association of smoking heaviness with higher level of resting heart rate, but not with blood pressure. These findings suggest that part of the cardiovascular risk of smoking may operate through increasing resting heart rate.
Publisher: Elsevier BV
Date: 12-2012
DOI: 10.1016/J.DRUGALCDEP.2012.05.036
Abstract: A 2006 respondent driven s ling (RDS) survey of injecting drug users (IDUs) in Bristol, UK, estimated 40 per 100 person years HCV incidence but in 2009 another RDS survey estimated only 10 per 100 person years incidence amongst the same population. Estimated increases in intervention exposure do not fully explain the decrease in risk. We investigate whether the underlying contact network structure and differences in the structure of the RDS trees could have contributed to the apparent change in incidence. We analyse the s les for evidence that in iduals recruit participants who are like themselves (assortative recruiting). Using an assortativity measure, we develop a Monte Carlo approach to determine whether the RDS data exhibit significantly more assortativity than is expected for that s le. Motivated by these findings, a network model is used to investigate how much assortativity and the structure of the RDS tree impacts s le estimates of prevalence and incidence. The s les suggest there is some assortativity on injecting habits or markers of injecting risk. The 2009 s le has lower assortativity than 2006. Simulations of RDS confirm that assortativity influences the estimated incidence in a population and the structure of RDS s les can result in bias. Our simulations suggest that RDS incidence estimates have considerable variance, making them difficult to use for monitoring trends. We suggest there was likely to have been a decline in risk between 2006 and 2009 due to increased intervention coverage, but the bias and variance in the estimates prevents accurate estimation of the incidence.
Publisher: Wiley
Date: 03-1970
DOI: 10.1111/ADD.13779
Abstract: People with opioid use disorder (OUD) in prison face an acute risk of death after release. We estimated whether prison-based opioid substitution treatment (OST) reduces this risk. Prospective observational cohort study using prison health care, national community drug misuse treatment and deaths registers. Recruitment at 39 adult prisons in England (32 male seven female) accounting for 95% of OST treatment in England during study planning. Adult prisoners diagnosed with OUD (recruited: September 2010-August 2013 first release: September 2010 last release: October 2014 follow-up to February 2016 n = 15 141 in the risk set). At release, participants were classified as OST exposed (n = 8645) or OST unexposed (n = 6496). The OST unexposed group did not receive OST, or had been withdrawn, or had a low dose. Primary outcome: all-cause mortality (ACM) in the first 4 weeks. drug-related poisoning (DRP) deaths in the first 4 weeks ACM and DRP mortality after 4 weeks to 1 year admission to community drug misuse treatment in the first 4 weeks. Unadjusted and adjusted Cox regression models (covariates: sex, age, drug injecting, problem alcohol use, use of benzodiazepines, cocaine, prison transfer and admission to community treatment), tested difference in mortality rates and community treatment uptake. During the first 4 weeks after prison release there were 24 ACM deaths: six in the OST exposed group and 18 in the OST unexposed group [mortality rate 0.93 per 100 person-years (py) versus 3.67 per 100 py hazard ratio (HR) = 0.25 95% confidence interval (CI) = 0.10-0.64]. There were 18 DRP deaths: OST exposed group mortality rate 0.47 per 100 py versus 3.06 per 100 py in the OST unexposed group (HR = 0.15 95% CI = 0.04-0.53). There was no group difference in mortality risk after the first month. The OST exposed group was more likely to enter drug misuse treatment in the first month post-release (odds ratio 2.47, 95% CI = 2.31-2.65). The OST mortality protective effect on ACM and DRP mortality risk was not attenuated by demographic, overdose risk factors, prison transfer or community treatment (fully adjusted HR = 0.25 95% CI = 0.09-0.64 and HR = 0.15 95% CI = 0.04-0.52, respectively). In an English national study, prison-based opioid substitution therapy was associated with a 75% reduction in all-cause mortality and an 85% reduction in fatal drug-related poisoning in the first month after release.
Publisher: Oxford University Press (OUP)
Date: 05-04-2009
Abstract: The aim of the study was to measure risk of HIV and HCV infection among injecting drug users (IDUs) through force of infection (FOI) models in three cities of the Russian Federation and assess the value of behavioural data and FOI in predicting risk of infection as a method of second-generation surveillance. FOI models were fitted to prevalence data collected through an anonymous, cross-sectional community-recruited survey of IDUs with oral fluid s le collection for antibodies to HIV and HCV. Risk of infection was estimated from FOI estimates obtained by fitting a model to prevalence data by length of injecting career for each city and then overall. Risk behaviours were examined by injecting career length. A total of 1473 IDUs were recruited. Prevalence of HIV was 8.1% (95% CI 6.7-9.6%) and HCV 63.4% (95% CI 60.9-65.9%). A higher FOI in new initiates to injecting (injecting career length <1 year) was found for both HIV and HCV compared with experienced IDUs (injecting career length <5 years). Increased risk of infection was not corroborated by injecting risk behaviours among new initiates into injecting (n = 38). Only 5.7% (n = 2) reported receptive sharing in the last 4 weeks, 57.9% (n = 22) sharing any injecting paraphernalia, 2.6% (n = 1) frontloading and 8.5% (n = 3) ever injecting with used needles/syringes. However, 29% of new initiates reported exchanging sex in the last 4 weeks (29%) compared with 11% long term IDUs. FOI models can play an important role in surveillance of HIV but caution is needed in the interpretation of behavioural data for predicting current or future risk of HIV.
Publisher: Wiley
Date: 08-09-2020
DOI: 10.1111/DAR.13155
Abstract: Children in families where there is substance misuse are at high risk of being removed from their parents' care. This study describes the characteristics of a community s le of parents who primarily smoke meth hetamine and their child or children's residential status. Baseline data from a prospective study of meth hetamine smokers (‘VMAX’). Participants were recruited via convenience, respondent‐driven and snowball s ling. Univariable and multivariable logistic regression analyses were used to estimate associations between parental status fathers' or mothers' socio‐demographic, psychosocial, mental health, alcohol, meth hetamine use dependence, alcohol use and child or children's co‐residential status. Of the 744 participants, 394 (53%) reported being parents 76% (88% of fathers, 57% of mothers) reported no co‐resident children. Compared to parents without co‐resident children, parents with co‐resident children were more likely to have a higher income. Fathers with co‐resident children were more likely to be partnered and not to have experienced violence in the previous 6 months. Mothers with co‐resident children were less likely to have been homeless recently or to have accessed treatment for meth hetamine use. The prevalence of non‐co‐resident children was much higher than previously reported in studies of parents who use meth hetamine irrespective of whether in or out of treatment. There is a need for accessible support and services for parents who use meth hetamine irrespective of their child or children's co‐residency status. Research is needed to determine the longitudinal impact of meth hetamine use on parents' and children's wellbeing and to identify how parents with co‐resident children (particularly mothers) can be supported.
Publisher: Elsevier BV
Date: 09-2017
Publisher: MDPI AG
Date: 12-02-2021
Abstract: It is estimated that over 100 million people worldwide are affected by the substance use of a close relative and often experience related adverse health and social outcomes. There is a growing body of literature evaluating psychosocial interventions intended to reduce these adverse outcomes. We searched the international literature, using rigorous systematic methods to search and review the evidence for effective interventions to improve the wellbeing of family members affected by the substance use of an adult relative. We synthesised the evidence narratively by intervention type, in line with the systematic search and review approach. Sixty-five papers (from 58 unique trials) meeting our inclusion criteria were identified. Behavioural interventions delivered conjointly with the substance user and the affected family members were found to be effective in improving the social wellbeing of family members (reducing intimate partner violence, enhancing relationship satisfaction and stability and family functioning). Affected adult family members may derive psychological benefit from an adjacent in idually focused therapeutic intervention component. No interventions fully addressed the complex multidimensional adversities experienced by many families affected by substance use. Further research is needed to determine the effect of a multi-component psychosocial intervention, which seeks to support both the substance user and the affected family member.
Publisher: Wiley
Date: 27-02-2018
DOI: 10.1111/JVH.12869
Abstract: The United Kingdom has committed to eliminating viral hepatitis as a public health threat. Innovative interventions for marginalized populations are required to realize this goal. In 2016, the HepCATT study team implemented a complex hepatitis C (HCV) intervention in three English drug treatment services, with five controls. We report qualitative study findings from two intervention sites to explore intervention success and transferability potential. The intervention comprised multiple components, including a nurse facilitator, peer support and education initiatives. Qualitative data were generated at baseline (2014) and post-intervention (2016) at two sites through in-depth interviews, focus groups and observations. The 96 participants comprised drug service and intervention providers and clients with an injecting history. Data were triangulated and thematically analysed. Client engagement with a HCV treatment service rose from 16 at baseline to 147 in 2016. There was no comparable increase at the five control sites. Baseline testing and treatment barriers included the following: limited HCV knowledge fear of diagnosis and treatment precarious living circumstances and service-specific obstacles. Treatment engagement was aided by intervention timeliness improved communication structures personalized care streamlined testing and treatment pathways peer support. Multiple interrelated components influenced the increased levels of treatment engagement documented in HepCATT. The nurse facilitator, involved in implementation and innovation, was key to intervention success. Baseline barriers correspond with international literature-indicating transferability potential. Control data indicate that biomedical innovation alone is not sufficient to increase engagement among the most marginalized. Sustainable resourcing of community services is crucial to effect change.
Publisher: American Medical Association (AMA)
Date: 09-2021
DOI: 10.1001/JAMAPSYCHIATRY.2021.0976
Abstract: Mortality among people with opioid dependence is higher than that of the general population. Opioid agonist treatment (OAT) is an effective treatment for opioid dependence however, there has not yet been a systematic review on the relationship between OAT and specific causes of mortality. To estimate the association of time receiving OAT with mortality. The Embase, MEDLINE, and PsycINFO databases were searched through February 18, 2020, including clinical trial registries and previous Cochrane reviews. All observational studies that collected data on all-cause or cause-specific mortality among people with opioid dependence while receiving and not receiving OAT were included. Randomized clinical trials (RCTs) were also included. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Data on study, participant, and treatment characteristics were extracted person-years, all-cause mortality, and cause-specific mortality were calculated. Crude mortality rates and rate ratios (RRs) were pooled using random-effects meta-analyses. Overall all-cause and cause-specific mortality both by setting and by participant characteristics. Methadone and buprenorphine OAT were evaluated specifically. Fifteen RCTs including 3852 participants and 36 primary cohort studies including 749 634 participants were analyzed. Among the cohort studies, the rate of all-cause mortality during OAT was more than half of the rate seen during time out of OAT (RR, 0.47 95% CI, 0.42-0.53). This association was consistent regardless of patient sex, age, geographic location, HIV status, and hepatitis C virus status and whether drugs were taken through injection. Associations were not different for methadone (RR, 0.47 95% CI, 0.41-0.54) vs buprenorphine (RR, 0.34 95% CI, 0.26-0.45). There was lower risk of suicide (RR, 0.48 95% CI, 0.37-0.61), cancer (RR, 0.72 95% CI, 0.54-0.98), drug-related (RR, 0.41 95% CI, 0.33-0.52), alcohol-related (RR, 0.59 95% CI, 0.49-0.72), and cardiovascular-related (RR, 0.69 95% CI, 0.60-0.79) mortality during OAT. In the first 4 weeks of methadone treatment, rates of all-cause mortality and drug-related poisoning were more than double the rates during the remainder of OAT (RR, 2.81 95% CI, 1.55-5.09) but not for buprenorphine (RR, 0.58 95% CI, 0.18-1.85). All-cause mortality was 6 times higher in the 4 weeks after OAT cessation (RR, 6.01 95% CI, 4.32-8.36), remaining double the rate for the remainder of time not receiving OAT (RR, 1.81 95% CI, 1.50-2.18). Opioid agonist treatment was associated with a lower risk of mortality during incarceration (RR, 0.06 95% CI, 0.01-0.46) and after release from incarceration (RR, 0.09 95% CI, 0.02-0.56). This systematic review and meta-analysis found that OAT was associated with lower rates of mortality. However, access to OAT remains limited, and coverage of OAT remains low. Work to improve access globally may have important population-level benefits.
Publisher: Wiley
Date: 09-2005
DOI: 10.1111/J.1365-2893.2005.00643.X
Abstract: Our aim was to compare the prevalence of antibody to hepatitis C virus (anti-HCV) among recently initiated injecting drug users (IDUs) in London and Glasgow, and to identify risk factors which could explain differences in prevalence between the cities. Complementary studies of community recruited IDUs who had initiated injection drug use since 1996 were conducted during 2001-2002. Data on HCV risk behaviours were gathered using structured questionnaires with identical core questions and respondents were asked to provide an oral fluid specimen which was tested anonymously for anti-HCV but was linked to the questionnaire. Sensitivities of the anti-HCV assays for oral fluid were 92-96%. Prevalence of anti-HCV was 35% (122/354) in London and 57% (207/366) in Glasgow (P < 0.001). Multifactorially, factors significantly associated with raised odds of anti-HCV positivity were increasing length of injecting career, daily injection, polydrug use, having had a needlestick injury, and having served a prison sentence. In addition lower odds of anti-HCV positivity were associated with non-injection use of crack cocaine and recruitment from drug agencies. After adjustment for these factors, the increased odds of anti-HCV associated with being a Glasgow IDU were diminished but remained significant. HCV continues to be transmitted among the IDU population of both cities at high rates despite the availability of syringe exchange and methadone maintenance. Effectiveness of harm reduction interventions may be compromised by inadequate coverage and failure to reduce sufficiently the frequency of sharing different types of injecting equipment, as well as the high background prevalence of HCV, and its high infectivity. Comprehensive action is urgently required to reduce the incidence of HCV among injectors.
Publisher: SAGE Publications
Date: 11-2005
DOI: 10.1258/095646205774763180
Abstract: The objective of this study was to estimate the prevalence of hepatitis C virus (HCV) infection and co-infection with HIV among injecting drug users (IDUs) in Togliatti City, Russia. Unlinked anonymous cross-sectional survey of IDUs recruited from community settings, with oral fluid s le collection for HCV and HIV antibody (anti-HCV, anti-HIV) testing, was carried out. The anti-HCV prevalence was 87% (357/411), anti-HIV prevalence 56% (234/418), and 93% (214/230) of HIV-positive IDUs were co-infected with HCV. Only 23% (94/411) of those HCV positive self-reported as such. In an adjusted model, increased odds of HCV positivity were associated with needle and syringe, as well as injecting paraphernalia sharing in the last four weeks. IDUs injecting more than once with the same needle also had raised odds. There were no marked associations between HCV positivity and the duration of injecting or age group. Almost all IDUs were HCV positive, and almost all HIV-positive IDUs were HCV co-infected. There is an urgent need to maximize syringe distribution coverage, develop health promotion targeting HCV prevention for IDUs, and improve access among IDUs to treatments for HIV and HCV infection.
Publisher: Elsevier BV
Date: 12-2016
Publisher: Wiley
Date: 29-11-2019
DOI: 10.1111/ADD.14852
Abstract: To compare long-term trends in wastewater data with other indicators of stimulant use in three locations and to test the reliability of estimates based on 1 week of s ling. Comparison of trends in quantities ('loads') of stimulants or their metabolites in wastewater with trends in other indicators of stimulant use (e.g. treatment, police, population survey data). Populations in Oslo (Norway), South-East Queensland (Australia) and Eindhoven (the Netherlands). Wastewater data were modelled for MDMA (3,4-methylenedioxymeth hetamine), benzoylecgonine (a metabolite of cocaine), hetamine and meth hetamine in Oslo benzoylecgonine in Eindhoven and meth hetamine in South-East Queensland. Choice of stimulants modelled in each region was primarily determined by availability of useable data. In Oslo, wastewater data, driving under the influence of drugs statistics and seizure data all suggested increasing MDMA use between 2009 and 2017. In South-East Queensland, there was an estimated 31.1% [95% confidence interval (CI) = 29.4-32.9%] annual increase in daily loads of meth hetamine in wastewater between 2009 and 2016, compared with a 14.1% (95% CI = 10.9-17.3%) annual increase in seizures. Some of the increase in wastewater can be explained by increased purity. In Eindhoven, there was no evidence of a change in cocaine consumption from wastewater, but a reduction was observed in numbers in treatment for cocaine use from 2012 to 2017. In approximately half the cases examined in Oslo, credible intervals around estimates of annual average loads from a regression model versus estimates based on a single week of s ling did not overlap. Long-term trends in loads of stimulants in wastewater appear to be broadly consistent with trends in other indicators of stimulant use in three locations. Wastewater data should be interpreted alongside epidemiological indicators and purity data. One week of wastewater s ling may not be sufficient for valid inference about drug consumption.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2004
DOI: 10.1097/00002030-200411190-00010
Abstract: To provide global estimates of the prevalence of injecting drug use (IDU) and HIV prevalence among IDU, in particular to provide estimates for developing and transitional countries. Collation and review of existing estimates of IDU prevalence and HIV prevalence from published and unpublished documents for the period 1998-2003. The strength of evidence for the information was assessed based on the source and type of study. Estimates of IDU prevalence were available for 130 countries. The number of IDU worldwide was estimated as approximately 13.2 million. Over ten million (78%) live in developing and transitional countries (Eastern Europe and Central Asia, 3.1 million South and South-east Asia, 3.3 million East-Asia and Pacific, 2.3 million). Estimates of HIV prevalence were available for 78 countries. HIV prevalence among IDU of over 20% was reported for at least one site in 25 countries and territories: Belarus, Estonia, Kazakhstan, Russia, Ukraine, Italy, Netherlands, Portugal, Serbia and Montenegro, Spain, Libya, India, Indonesia, Malaysia, Myanmar, Nepal, Thailand, Viet Nam, China, Argentina, Brazil, Uruguay, Puerto Rico, USA and Canada. These findings update previous assessments of the number of countries with IDU and HIV-infected IDU, and the previous quantitative global estimates of the prevalence of IDU. However, gaps remain in the information and the strength of the evidence often was weak.
Publisher: BMJ
Date: 08-2017
DOI: 10.1136/BMJOPEN-2016-014854
Abstract: Injecting drug use is a persistent behaviour that increases the risk of morbidities and mortality. We assessed the burden of hospital separations among people who inject drugs (PWID), the excess compared to the general population and characteristics of separations associated with frequent use. Prospective cohort study. All public and private hospitals in Victoria. 757 community-based PWID with hospital separations between January 2008 and June 2013 identified through record linkage, who contributed over 3729 person-years. Counts, proportions and rates of hospital separations, descriptive administrative data including all diagnoses, comparison of separation rates to the general population, trend in separations and factors associated with frequent separations. There were 2106 separations in the cohort. The most common principal diagnoses were related to mental and behavioural disorders (31%), but social circumstances influencing health was the most common group of diagnoses (61%) when all contributing diagnoses for each patient were considered. Separation rates were up to three times higher than in the age-matched population, and there was a 12% increase in separations every 6 months. Over a quarter (29%) of the cohort had frequent separations (defined as two or more separations in a calendar year), which were associated with mental health-related diagnoses, being discharged to locations other than a patient’s residence, having a medical as opposed to surgical intervention, seasonal patterns, relationship status and gender. Mental health conditions and other characteristics associated with separations and frequent separations in particular, emphasise the importance of providing referrals to harm reduction, social services and mental health services at discharge in order to reduce excess hospital separations among PWID.
Publisher: American Medical Association (AMA)
Date: 05-2020
Publisher: Elsevier BV
Date: 2020
Publisher: Springer Science and Business Media LLC
Date: 30-04-2016
DOI: 10.1007/S11121-016-0652-5
Abstract: Alcohol consumption during adolescence is widespread, although there is considerable variation in patterns of use. The aim of this study was to identify patterns of coping-motivated alcohol use in a UK birth cohort and examine in idual and family characteristics associated with the resulting drinker profiles. At age 17, participants (n = 3957 56 % female) reported their alcohol and drug use, internalising symptoms and use of alcohol to cope with a range of emotions. Socio-demographic data were collected via maternal report. Latent class analysis identified drinker subtypes based on the coping motives reported. Association between these profiles and socio-demographic characteristics and internalising disorders was examined. The vast majority (92 %) of adolescents reported alcohol consumption in the past year, and 26 % of those drank weekly or more often. Four distinct motive profiles were identified. These profiles were associated with different socio-demographic characteristics: adolescents from higher socio-economic backgrounds drank primarily for increased confidence, whereas adolescents from low socio-economic backgrounds were more likely to drink to cope with low mood. Adolescents with an anxiety or depressive disorder were six times more likely to fall within the high-risk subtype, characterised by a generalised pattern of drinking to cope with emotions across the board. Coping motives for drinking vary with in idual and family factors. Adolescents from low versus high socio-economic backgrounds were characterised by distinct drinking profiles thus, prevention messages may need to be tailored accordingly. Internalising disorders were strongly associated with a high-risk profile of coping-motivated drinking.
Publisher: Elsevier BV
Date: 02-2019
DOI: 10.1016/J.DRUGALCDEP.2019.107793
Abstract: A range of negative experiences and circumstances that are common among people who inject drugs (PWID) are risk factors for developing mental disorders. Despite this, there has been no systematic review of the prevalence of mental health indicators among PWID. Thus, we aimed to estimate the prevalence of depression, post-traumatic stress disorder (PTSD), suicidality and self-harm among PWID. We searched the peer-reviewed and grey literature for data on depression, PTSD, suicidality and non-suicidal self-harm among PWID from sources published from 2008-2018. We pooled estimates of depression and suicidality using random-effects meta-analysis and provided a narrative summary of estimates of PTSD and self-harm. We found 23 studies that reported on these mental health indicators among PWID. The pooled estimate for current severe depressive symptomology was 42.0 % (95 % confidence interval [CI] = 21.3, 62.8 %), and for a depression diagnosis was 28.7 % (95 % CI = 20.8, 36.6 %). With much variation, the pooled lifetime prevalence of a suicide attempt was 22.1 % (95 % CI = 19.3, 24.9 %). There were only two studies each that reported on PTSD and non-suicidal self-harm among PWID. Recent data investigating these mental health indicators among PWID was limited, particularly from low- and middle-income countries. Even so, estimates were high and call for further research into the epidemiology of such mental health disorders and self-harming behaviours, as well as the promotion of integrated mental health and substance dependence treatment. Finally, incorporating suicide prevention strategies into services accessed by PWID must be considered as a harm reduction priority.
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.DRUGPO.2019.102619
Abstract: People who inject drugs (PWID) do so at varying frequencies. More frequent injecting is associated with skin and soft tissue infection, blood borne viruses, and overdose. The aims of this review are to estimate the prevalence of injecting frequency among PWID and compare these estimates to current needle-syringe distribution coverage estimates, and identify socio-demographic and risk characteristics, and harms associated with daily or more injecting. We conducted a systematic review of the peer-reviewed and grey literature from 2008 to 2018 and extracted needle-syringe distribution coverage data from a recent systematic review. We generated country-, region-, and global-level estimates of daily or more injecting. We also ran meta-regression analyses to determine associations between daily or more injecting and socio-demographic characteristics, injecting risk behaviour, non-fatal overdose, injection site skin infection, and blood borne virus prevalence. Our search resulted in 61,077 sources, from which 198 studies were eligible for inclusion in this review. There were 74 countries with estimates for injecting frequency. Globally, we estimated that 68.1% (95%CI 64.5-71.6%) of PWID, equating to approximately 10.5 (95% UI 6.8-15.0) million people, inject daily or more frequently. There was a higher percentage of participants reporting daily or more injecting among s les with shorter injecting careers, more male participants and higher reporting of opioids as their main drug injected. Daily or more injecting was also associated with s les reporting a higher prevalence of HIV and hepatitis C antibody (anti-HCV), non-fatal overdose, and receptive needle sharing in the previous month. WHO recently recommended a needle-syringe distribution target of 300 needles per PWID per year which is unlikely to be sufficient for the majority of PWID injecting daily or more who are out of drug treatment. The Australian National Drug and Alcohol Research Centre, Australian National Health and Medical Research Council, University of New South Wales.
Publisher: Wiley
Date: 17-05-2018
DOI: 10.1111/ADD.14217
Publisher: Elsevier BV
Date: 07-2022
DOI: 10.1016/J.DRUGALCDEP.2022.109464
Abstract: There are critical periods of mortality risk at onset and cessation of opioid agonist treatment. We aim to determine whether non-fatal overdose followed the same pattern as fatal overdose, comparing the first 4 weeks of treatment and treatment cessation and the remainder time off treatment, with the remainder treatment time, to determine intervention markers. Retrospective cohort study of people with a history of opioid agonist treatment using linked New South Wales data. The incidence of non-fatal overdose hospitalization emergency department presentation and fatal overdose from national death records were compared. Rates were calculated using generalized estimating equations adjusting for demographics, year, and recent health and incarceration events. The remainder time in OAT had the lowest incidence of overdose for all outcomes and is the reference level for the adjusted incident rate ratios (aIRR). Fatal overdose was lowest in treatment and highest in the first four weeks out of treatment, aIRR of 12.83 (95% CI 10.0-16.4). Whereas the highest overdose rate for non-fatal opioid overdose was in the first four weeks in treatment, aIRR of 3.11 (95% CI 2.19-4.42). Retention on opioid agonist treatment is protective against drug related overdose. There is elevated risk of non-fatal overdose at treatment initiation that is not evident for fatal overdose, but the first month of treatment cessation is a critical period for both non-fatal and fatal overdose. These findings emphasize the importance of treatment retention and interventions for polysubstance overdose at cessation.
Publisher: Oxford University Press (OUP)
Date: 24-05-2020
DOI: 10.1093/CID/CIAA612
Abstract: People who inject drugs (PWID) experience barriers to accessing testing and treatment for hepatitis C virus (HCV) infection. Opioid agonist therapy (OAT) may provide an opportunity to improve access to HCV care. This systematic review assessed the association of OAT and HCV testing, treatment, and treatment outcomes among PWID. Bibliographic databases and conference presentations were searched for studies that assessed the association between OAT and HCV testing, treatment, and treatment outcomes (direct-acting antiviral [DAA] therapy only) among PWID (in the past year). Meta-analysis was used to pool estimates. Of 9877 articles identified, 22 studies conducted in Australia, Europe, North America, and Thailand were eligible and included. Risk of bias was serious in 21 studies and moderate in 1 study. Current/recent OAT was associated with an increased odds of recent HCV antibody testing (4 studies odds ratio (OR), 1.80 95% confidence interval [CI], 1.36–2.39), HCV RNA testing among those who were HCV antibody–positive (2 studies OR, 1.83 95% CI, 1.27–2.62), and DAA treatment uptake among those who were HCV RNA–positive (7 studies OR, 1.53 95% CI, 1.07–2.20). There was insufficient evidence of an association between OAT and treatment completion (9 studies) or sustained virologic response following DAA therapy (9 studies). OAT can increase linkage to HCV care, including uptake of HCV testing and treatment among PWID. This supports the scale-up of OAT as part of strategies to enhance HCV treatment to further HCV elimination efforts.
Publisher: Springer Science and Business Media LLC
Date: 02-01-2020
DOI: 10.1186/S12963-019-0201-0
Abstract: There are likely to be differences in alcohol consumption levels and patterns across local areas within a country, yet survey data is often collected at the national or sub-national/regional level and is not representative for small geographic areas. This paper presents a method for reweighting national survey data—the Health Survey for England—by combining survey and routine data to produce simulated locally representative survey data and provide statistics of alcohol consumption for each Local Authority in England. We find a 2-fold difference in estimated mean alcohol consumption between the lightest and heaviest drinking Local Authorities, a 4.5-fold difference in abstention rates, and a 3.5-fold difference in harmful drinking. The method compares well to direct estimates from the data at regional level. The results have important policy implications in itself, but the reweighted data can also be used to model local policy effects. This method can also be used for other public health small area estimation where locally representative data are not available.
Publisher: Elsevier BV
Date: 11-2020
Publisher: Wiley
Date: 06-09-2022
DOI: 10.1111/ADD.16033
Publisher: American Medical Association (AMA)
Date: 16-07-2003
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: Informa UK Limited
Date: 05-02-2014
Publisher: Wiley
Date: 19-08-2018
DOI: 10.1111/ADD.14368
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: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.HEALTHPLACE.2016.06.007
Abstract: Cumulative impact policies (CIPs) are widely used in UK local government to help regulate alcohol markets in localities characterised by high density of outlets and high rates of alcohol related harms. CIPs have been advocated as a means of protecting health by controlling or limiting alcohol availability. We use a comparative qualitative case study approach (n=5 English local government authorities, 48 participants) to assess how CIPs vary across different localities, what they are intended to achieve, and the implications for local-level alcohol availability. We found that the case study CIPs varied greatly in terms of aims, health focus and scale of implementation. However, they shared some common functions around influencing the types and managerial practices of alcohol outlets in specific neighbourhoods without reducing outlet density. The assumption that this will lead to alcohol harm-reduction needs to be quantitatively tested.
Publisher: Wiley
Date: 08-06-2023
DOI: 10.1111/ADD.16268
Abstract: To estimate the prevalence of, and number of unobserved people with opioid dependence by sex and age group in New South Wales (NSW), Australia. We applied a Bayesian statistical modelling approach to opioid agonist treatment records linked to adverse event rate data. We estimated prevalence from three types of adverse event separately: opioid mortality, opioid‐poisoning hospitalizations and opioid‐related charges. We extended the model and produced prevalence estimates from a ‘multi‐source’ model based on all three types of adverse event data. This study was conducted in NSW, Australia, 2014–16 using data from the Opioid Agonist Treatment and Safety (OATS) study, which included all people who had received treatment for opioid dependence in NSW. Aggregate data were obtained on numbers of adverse events in NSW. Rates of each adverse event type within the OATS cohort were modelled. Population data were provided by State and Commonwealth agencies. Prevalence of opioid dependence among those aged 15–64 years in 2016 was estimated to be 0.96% (95% credible interval [CrI] = 0.82%, 1.12%) from the mortality model, 0.75% (95% CrI = 0.70%, 0.83%) from hospitalizations, 0.95% (95% CrI = 0.90%, 0.99%) from charges and 0.92% (95% CrI = 0.88%, 0.96%) from the multi‐source model. Of the estimated 46 460 (95% CrI = 44 680, 48 410) people with opioid dependence in 2016 from the multi‐source model, approximately one‐third (16 750, 95% CrI = 14 960, 18 690) had no record of opioid agonist treatment within the last 4 years. From the multi‐source model, prevalence in 2016 was estimated to be 1.24% (95% CrI = 1.18%, 1.31%) in men aged 15–44, 1.22% (95% CrI = 1.14%, 1.31%) in men 45–64, 0.63% (95% CrI = 0.59%, 0.68%) in women aged 15–44 and 0.56% (95% CrI = 0.50%, 0.63%) in women aged 45–64. A Bayesian statistical approach to estimate prevalence from multiple adverse event types simultaneously calculates that the estimated prevalence of opioid dependence in NSW, Australia in 2016 was 0.92%, higher than previous estimates.
Publisher: Wiley
Date: 24-01-2006
DOI: 10.1111/J.1360-0443.2006.01317.X
Abstract: To estimate the prevalence of HIV, hepatitis C virus (HCV) and syphilis in injecting drug users (IDUs) in Russia. Unlinked anonymous cross-sectional survey of 1473 IDUs recruited from non-treatment settings in Moscow, Volgograd and Barnaul (Siberia), with oral fluid s le collection for HIV, HCV antibody (anti-HIV, anti-HCV) and syphilis testing. Prevalence of antibody to HIV was 14% in Moscow, 3% in Volgograd and 9% in Barnaul. HCV prevalence was 67% in Moscow, 70% in Volgograd and 54% in Barnaul. Prevalence of positive syphilis serology was 8% in Moscow, 20% in Volgograd and 6% in Barnaul. Half of those HIV positive and a third of those HCV positive were unaware of their positive status. Common risk factors associated with HIV and HCV infection across the cities included both direct and indirect sharing of injecting equipment and injection of home-produced drugs. Among environmental risk factors, we found increased odds of anti-HIV associated with being in prison in Moscow, and some association between official registration as a drug user and anti-HIV and anti-HCV. No associations were found between sexual risk behaviours and anti-HIV in any city. HIV prevalence among IDUs was markedly higher than city routine surveillance data suggests and at potentially critical levels in terms of HIV prevention in two cities. HCV prevalence was high in all cities. Syphilis prevalence highlights the potential for sexual risk and sexual HIV transmission. Despite large-scale testing programmes, knowledge of positive status was poor. The scaling-up of harm reduction for IDUs in Russia, including sexual risk reduction, is an urgent priority.
Publisher: Elsevier BV
Date: 10-2020
Publisher: Elsevier BV
Date: 2021
Publisher: Springer Science and Business Media LLC
Date: 2013
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2002
DOI: 10.1097/00002030-200209060-00002
Abstract: To establish the prevalence of antibodies to HIV (anti-HIV) and associated risk factors among injecting drug users (IDU) in Togliatti City, Samara Oblast, Russian Federation. An unlinked anonymous cross-sectional community recruited survey with oral fluid s le collection. Between September and October 2001, 426 IDU were recruited by trained fieldworkers. Participants completed an interviewer administered questionnaire, and oral fluid s les were tested for anti-HIV. Univariate and multivariate analyses compared potential risk factors for anti-HIV. Anti-HIV prevalence was 56% (234/418). Three-quarters of anti-HIV-positive IDU (74%) were unaware of their positive status. In an adjusted model, the odds of HIV infection were higher among IDU who had ever injected home-produced drugs, who reported injecting with used needles and syringes in the past 4 weeks, and who were living in one particular district of the city (Komsomolksii). The high prevalence of HIV, and a recent increase in HIV detected through routine screening tests since 2000, suggests that an explosive epidemic has occurred among IDU in Togliatti City. In the face of currently inadequate HIV prevention coverage among IDU, this has urgent implications for maximizing the distribution of sterile injecting equipment as well as for enhancing sexual risk reduction. Recognizing that it is likely that similar explosive epidemics are taking place in other Russian cities, we recommend community-wide HIV prevention coverage supported by city and state policies oriented to harm reduction.
Publisher: Elsevier BV
Date: 04-2020
DOI: 10.1016/J.JHEP.2019.11.012
Abstract: HCV reinfection following successful treatment can compromise treatment outcomes. This systematic review assessed the rate of HCV reinfection following treatment among people with recent drug use and those receiving opioid agonist therapy (OAT). We searched bibliographic databases and conference abstracts for studies assessing post-treatment HCV reinfection rates among people with recent drug use (injecting or non-injecting) or those receiving OAT. Meta-analysis was used to cumulate reinfection rates and meta-regression was used to explore heterogeneity across studies. Thirty-six studies were included (6,311 person-years of follow-up). The overall rate of HCV reinfection was 5.9/100 person-years (95% CI 4.1-8.5) among people with recent drug use (injecting or non-injecting), 6.2/100 person-years (95% CI 4.3-9.0) among people recently injecting drugs, and 3.8/100 person-years (95% CI 2.5-5.8) among those receiving OAT. Reinfection rates were comparable following interferon-based (5.4/100 person-years 95% CI 3.1-9.5) and direct-acting antiviral (3.9/100 person-years 95% CI 2.5-5.9) therapy. In stratified analysis, reinfection rates were 1.4/100 person-years (95% CI 0.8-2.6) among people receiving OAT with no recent drug use, 5.9/100 person-years (95% CI 4.0-8.6) among people receiving OAT with recent drug use, and 6.6/100 person-years (95% CI 3.4-12.7) among people with recent drug use not receiving OAT. In meta-regression analysis, longer follow-up was associated with lower reinfection rate (adjusted rate ratio [aRR] per year increase in mean/median follow-up 0.77 95% CI 0.69-0.86). Compared with people receiving OAT with no recent drug use, those with recent drug use receiving OAT (aRR 3.50 95% CI 1.62-7.53), and those with recent drug use not receiving OAT (aRR 3.96 95% CI 1.82-8.59) had higher reinfection rates. HCV reinfection risk following treatment was higher among people with recent drug use and lower among those receiving OAT. The lower rates of reinfection observed in studies with longer follow-up suggested higher reinfection risk early post-treatment. Our findings demonstrate that although reinfection by hepatitis C virus occurs following successful treatment in people with recent drug use, the rate of hepatitis C reinfection is lower than the rates of primary infection reported in the literature for this population - reinfection should not be used as a reason to withhold therapy from people with ongoing injecting drug use. The rate of hepatitis C reinfection was lowest among people receiving opioid agonist therapy with no recent drug use. These data illustrate that harm reduction services are required to reduce the reinfection risk, while regular post-treatment hepatitis C assessment is required for early detection and retreatment.
Publisher: Wiley
Date: 04-12-2022
DOI: 10.1111/ADD.15736
Abstract: The in idual‐level effectiveness of opioid agonist treatment (OAT) in reducing mortality is well established, but there is less evidence on population‐level benefits. We use modeling informed with linked data from the OAT program in New South Wales (NSW), Australia, to estimate the impact of OAT provision in the community and prisons on mortality and the impact of eliminating excess mortality during OAT initiation/discontinuation. Dynamic modeling. A cohort of 49 359 in iduals who ever received OAT in NSW from 2001 to 2018. Receipt of OAT was represented through five stages: (i) first month on OAT, (ii) short (1–9 months) and (iii) longer (9+ months) duration on OAT, (iv) first month following OAT discontinuation and (v) rest of time following OAT discontinuation. Incarceration was represented as four strata: (i) never or not incarcerated in the past year, (ii) currently incarcerated, (iii) released from prison within the past month and (iv) released from prison 1–12 months ago. The model incorporated elevated mortality post‐release from prison and OAT impact on reducing mortality and incarceration. Among the cohort, mortality was 0.9 per 100 person‐years, OAT coverage and retention remained high ( 50%, 1.74 years/episode). During 2001–20, we estimate that OAT provision reduced overdose and other cause mortality among the cohort by 52.8% [95% credible interval (CrI) = 49.4–56.9%] and 26.6% (95% CrI =22.1–30.5%), respectively. We estimate 1.2 deaths averted and 9.7 life‐years gained per 100 person‐years on OAT. Prison OAT with post‐release OAT‐linkage accounted for 12.4% (95% CrI = 11.5–13.5%) of all deaths averted by the OAT program, primarily through preventing deaths in the first month post‐release. Preventing elevated mortality during OAT initiation and discontinuation could have averted up to 1.4% (95% CrI = 0.8–2.0%) and 3.0% (95% CrI = 2.1–5.3%) of deaths, respectively. The community and prison opioid agonist treatment program in New South Wales, Australia appears to have substantially reduced population‐level overdose and all‐cause mortality in the past 20 years, partially due to high retention.
Publisher: Elsevier BV
Date: 03-2022
Publisher: Elsevier BV
Date: 02-2017
DOI: 10.1016/J.DRUGALCDEP.2016.11.029
Abstract: Non-viral injecting-related injuries and diseases (IRID), such as abscesses and vascular damage, can result in significant morbidity and mortality if untreated. There has been no systematic assessment of the prevalence of non-viral IRID among people who inject drugs this review aimed to address this gap, as well as identify risk factors for experience of specific IRID. We searched MEDLINE, Embase and CINAHL databases to identify studies on the prevalence of, or risk factors for, IRID directly linked to injecting in s les of people who inject illicit drugs. We included 33 studies: 29 reported IRID prevalence in people who inject drugs, and 17 provided data on IRID risk factors. Skin and soft tissue infections at injecting sites were the most commonly reported IRID, with wide variation in lifetime prevalence (6-69%). Female sex, more frequent injecting, and intramuscular and subcutaneous injecting appear to be associated with skin and soft tissue infections at injecting sites. Cleaning injecting sites was protective against skin infections. Other IRID included infective endocarditis (lifetime prevalence ranging from 0.5-12%) sepsis (2-10%) bone and joint infections (0.5-2%) and thrombosis and emboli (3-27%). There were significant gaps in the data, including a dearth of research on prevalence of IRID in low- and middle-income countries, and potential risk and protective factors for IRID. A consistent approach to measurement, including standardised definitions of IRID, is required for future research.
Publisher: Public Library of Science (PLoS)
Date: 19-07-2022
DOI: 10.1371/JOURNAL.PMED.1004049
Abstract: Injecting-related bacterial and fungal infections are associated with significant morbidity and mortality among people who inject drugs (PWID), and they are increasing in incidence. Following hospitalization with an injecting-related infection, use of opioid agonist treatment (OAT methadone or buprenorphine) may be associated with reduced risk of death or rehospitalization with an injecting-related infection. Data came from the Opioid Agonist Treatment Safety (OATS) study, an administrative linkage cohort including all people in New South Wales, Australia, who accessed OAT between July 1, 2001 and June 28, 2018. Included participants survived a hospitalization with injecting-related infections (i.e., skin and soft-tissue infection, sepsis/bacteremia, endocarditis, osteomyelitis, septic arthritis, or epidural/brain abscess). Outcomes were all-cause death and rehospitalization for injecting-related infections. OAT exposure was classified as time varying by days on or off treatment, following hospital discharge. We used separate Cox proportional hazards models to assess associations between each outcome and OAT exposure. The study included 8,943 participants (mean age 39 years, standard deviation [SD] 11 years 34% women). The most common infections during participants’ index hospitalizations were skin and soft tissue (7,021 79%), sepsis/bacteremia (1,207 14%), and endocarditis (431 5%). During median 6.56 years follow-up, 1,481 (17%) participants died use of OAT was associated with lower hazard of death (adjusted hazard ratio [aHR] 0.63, 95% confidence interval [CI] 0.57 to 0.70). During median 3.41 years follow-up, 3,653 (41%) were rehospitalized for injecting-related infections use of OAT was associated with lower hazard of these rehospitalizations (aHR 0.89, 95% CI 0.84 to 0.96). Study limitations include the use of routinely collected administrative data, which lacks information on other risk factors for injecting-related infections including injecting practices, injection stimulant use, housing status, and access to harm reduction services (e.g., needle exchange and supervised injecting sites) we also lacked information on OAT medication dosages. Following hospitalizations with injection drug use–associated bacterial and fungal infections, use of OAT is associated with lower risks of death and recurrent injecting-related infections among people with opioid use disorder.
Publisher: Elsevier BV
Date: 05-2023
Publisher: MDPI AG
Date: 10-04-2014
DOI: 10.3390/GENES5020330
Publisher: Elsevier BV
Date: 12-2017
Publisher: Wiley
Date: 04-08-2007
DOI: 10.1111/J.1360-0443.2007.01930.X
Abstract: To conduct a systematic review of longitudinal studies that examined the association between childhood socio-economic status (SES) and alcohol use in later life. A systematic search to identify all longitudinal population-based studies that examined the association between childhood SES and later alcohol use. Nineteen relevant articles were identified (eight birth cohorts and 11 papers on school-aged cohorts). There was little consistent evidence to support an association between lower childhood SES and later (mis)use of alcohol. Only a minority of studies included assessment of problem alcohol use, and in only one study was the relationship between SES and alcohol use the main research question. We found little robust evidence to support the assumption that childhood disadvantage is associated with later alcohol use/abuse. Given the importance of this issue in terms of policy, the lack of evidence is surprising and emphasizes the need for further research in order to inform future policies and public health messages.
Publisher: Springer Science and Business Media LLC
Date: 12-2015
Publisher: Wiley
Date: 04-06-2018
DOI: 10.1111/ADD.14234
Abstract: This review provides an up-to-date curated source of information on alcohol, tobacco and illicit drug use and their associated mortality and burden of disease. Limitations in the data are also discussed, including how these can be addressed in the future. Online data sources were identified through expert review. Data were obtained mainly from the World Health Organization, United Nations Office on Drugs and Crime and Institute for Health Metrics and Evaluation. In 2015, the estimated prevalence among the adult population was 18.4% for heavy episodic alcohol use (in the past 30 days) 15.2% for daily tobacco smoking and 3.8, 0.77, 0.37 and 0.35% for past-year cannabis, hetamine, opioid and cocaine use, respectively. European regions had the highest prevalence of heavy episodic alcohol use and daily tobacco use. The age-standardized prevalence of alcohol dependence was 843.2 per 100 000 people for cannabis, opioids, hetamines and cocaine dependence it was 259.3, 220.4, 86.0 and 52.5 per 100 000 people, respectively. High-income North America region had among the highest rates of cannabis, opioid and cocaine dependence. Attributable disability-adjusted life-years (DALYs) were highest for tobacco smoking (170.9 million DALYs), followed by alcohol (85.0 million) and illicit drugs (27.8 million). Substance-attributable mortality rates were highest for tobacco smoking (110.7 deaths per 100 000 people), followed by alcohol and illicit drugs (33.0 and 6.9 deaths per 100 000 people, respectively). Attributable age-standardized mortality rates and DALYs for alcohol and illicit drugs were highest in eastern Europe attributable age-standardized tobacco mortality rates and DALYs were highest in Oceania. In 2015 alcohol use and tobacco smoking use between them cost the human population more than a quarter of a billion disability-adjusted life years, with illicit drugs costing further tens of millions. Europeans suffered proportionately more, but in absolute terms the mortality rate was greatest in low- and middle-income countries with large populations and where the quality of data was more limited. Better standardized and rigorous methods for data collection, collation and reporting are needed to assess more accurately the geographical and temporal trends in substance use and its disease burden.
Publisher: Wiley
Date: 30-08-2019
DOI: 10.1111/JVH.13187
Abstract: The World Health Organization (WHO) recently produced guidelines advising a treat-all policy for HCV to encourage widespread treatment scale-up for achieving HCV elimination. We modelled the prevention impact achieved (HCV infections averted [IA]) from initiating this policy compared with treating different subgroups at country, regional and global levels. We assessed what country-level factors affect impact. A dynamic, deterministic HCV transmission model was calibrated to data from global systematic reviews and UN data sets to simulate country-level HCV epidemics with ongoing levels of treatment. For each country, the model projected the prevention impact (in HCV IA per treatment undertaken) of initiating four treatment strategies either selected randomly (treat-all) or targeted among people who inject drugs (PWID), people aged ≥35, or those with cirrhosis. The IA was assessed over 20 years. Linear regression was used to identify associations between IA per treatment and demographic factors. Eighty-eight countries (85% of the global population) were modelled. Globally, the model estimated 0.35 (95% credibility interval [95%CrI]: 0.16-0.61) IA over 20 years for every randomly allocated treatment, 0.30 (95%CrI: 0.12-0.53) from treating those aged ≥35 and 0.28 (95%CrI: 0.12-0.49) for those with cirrhosis. Globally, treating PWID achieved 1.27 (95%CrI: 0.68-2.04) IA per treatment. The IA per randomly allocated treatment was positively associated with a country's population growth rate and negatively associated with higher HCV prevalence among PWID. In conclusion, appreciable prevention benefits could be achieved from WHO's treat-all strategy, although greater benefits per treatment can be achieved through targeting PWID. Higher impact will be achieved in countries with high population growth.
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: Oxford University Press (OUP)
Date: 29-10-2022
Abstract: In 2021, during a drug-related death crisis in the UK, the Government published its ten-year drugs strategy. This article, written in collaboration with the Faculty of Public Health and the Association of Directors of Public Health, assesses whether this Strategy is evidence-based and consistent with international calls to promote public health approaches to drugs, which put ‘people, health and human rights at the centre’. Elements of the Strategy are welcome, including the promise of significant funding for drug treatment services, the effects of which will depend on how it is utilized by services and local commissioners and whether it is sustained. However, unevidenced and harmful measures to deter drug use by means of punishment continue to be promoted, which will have deleterious impacts on people who use drugs. An effective public health approach to drugs should tackle population-level risk factors, which may predispose to harmful patterns of drug use, including adverse childhood experiences and socioeconomic deprivation, and institute evidence-based measures to mitigate drug-related harm. This would likely be more effective, and just, than the continuation of policies rooted in enforcement. A more dramatic re-orientation of UK drug policy than that offered by the Strategy is overdue.
Publisher: BMJ
Date: 08-2018
DOI: 10.1136/BMJOPEN-2018-025204
Abstract: North America is amid an opioid use epidemic. Opioid agonist treatment (OAT) effectively reduces extramedical opioid use and related harms. As with all pharmacological treatments, there are risks associated with OAT, including fatal overdose. There is a need to better understand risk for adverse outcomes during and after OAT, and for innovative approaches to identifying people at greatest risk of adverse outcomes. The Opioid Agonist Treatment and Safety study aims to address these questions so as to inform the expansion of OAT in the USA. This is a retrospective cohort study using linked, routinely collected health data for all people seeking OAT in New South Wales, Australia, between 2001 and 2017. Linked data include hospitalisation, emergency department presentation, mental health diagnoses, incarceration and mortality. We will use standard regression techniques to model the magnitude and risk factors for adverse outcomes (eg, mortality, unplanned hospitalisation and emergency department presentation, and unplanned treatment cessation) during and after OAT, and machine learning approaches to develop a risk-prediction model. This study has been approved by the Population and Health Services Research Ethics Committee (2018HRE0205). Results will be reported in accordance with the REporting of studies Conducted using Observational Routinely-collected health Data statement.
Publisher: Oxford University Press (OUP)
Date: 26-12-2013
DOI: 10.1093/IJE/DYT243
Abstract: Needle and syringe programmes (NSP) aim to reduce the risk of HIV by providing people who inject drugs (PWID) with sterile injecting equipment. A recent review of reviews (ROR) concluded that there was only tentative evidence to support the effectiveness of NSP in reducing HIV. We carried out a systematic review and meta-analysis to assess the association between NSP and HIV transmission. Relevant primary articles presenting data on the risk of HIV transmission associated with NSP were identified in two stages: (i) from reviews identified in two published RORs (covering the period 1980-2008) and (ii) a literature search of CINAHL, Cochrane Library, EMBASE, MEDLINE and PsychINFO for primary articles published since the most recent high quality review (covering the period 2008-12). Study results were synthesized using random-effects meta-analysis. There were 12 studies comprising at least 12 000 person-years of follow-up. Exposure to NSP was associated with a reduction in HIV transmission: pooled effect size 0·66 [95% confidence interval (CI) 0·43, 1·01] across all studies, and 0·42 (95% CI 0·22, 0·81) across six higher quality studies (according to the Newcastle-Ottawa tool). There is evidence to support the effectiveness of NSP in reducing the transmission of HIV among PWID, although it is likely that other harm reduction interventions have also contributed to the observed reduction in HIV risk. NSP should be considered as just one component of a programme of interventions to reduce both injecting risk and other types of HIV risk behaviour.
Publisher: Elsevier BV
Date: 02-2012
DOI: 10.1016/J.DRUGALCDEP.2012.08.013
Abstract: People who inject drugs (PWID) are at risk of a variety of adverse outcomes. Previous research suggests that alcohol, when consumed with opioids, is a risk factor for overdose, but there has been less investigation of the effects of alcohol consumption on other health, criminogenic or life satisfaction outcomes. In this paper we explore the effects of alcohol on outcomes for PWID across a variety of life domains. Baseline data were drawn from the Melbourne Injecting Drug User cohort study, which is a cohort of 688 PWID. Drinking scores were generated from the AUDIT-C (0, 1-7, 8+) and associations between them and health (recent heroin overdose, Emergency Department use), criminogenic (violent and nonviolent crime) and life satisfaction (personal wellbeing) outcomes were examined using logistic and linear regression. While around 36% of the cohort reported past-month abstinence from alcohol, 44% scored between 1 and 7 and 20% above 7 on the AUDIT-C. A score above 7 was associated with perpetration of violent crime and lower personal wellbeing ratings than a score of 0, after adjusting for potential confounders. There was no association between alcohol and other outcomes examined, after adjustment for confounders. Cohort participants who drink heavily were more likely to report engaging in violent crime and poorer life satisfaction. The relationship between alcohol and the offending behaviours of the cohort was consistent with the effects of alcohol on violent offending in the broader community.
Publisher: Elsevier BV
Date: 2021
Publisher: Wiley
Date: 19-05-2020
DOI: 10.1111/ADD.15087
Publisher: John Wiley & Sons, Ltd
Date: 12-01-2016
Publisher: Wiley
Date: 28-08-2018
DOI: 10.1111/ADD.14393
Publisher: Elsevier BV
Date: 12-2017
Publisher: Elsevier BV
Date: 08-2019
Publisher: Elsevier BV
Date: 12-2005
Publisher: Oxford University Press (OUP)
Date: 18-03-2019
Publisher: Wiley
Date: 12-05-2021
DOI: 10.1111/ADD.15514
Abstract: There is limited evidence on the relationship between retention in opioid agonist treatment for opioid dependence and characteristics of treatment prescribers. This study estimated retention in buprenorphine and methadone treatment and its relationship with person, treatment and prescriber characteristics. Retrospective longitudinal study. New South Wales, Australia. People entering the opioid agonist treatment programme for the first time between August 2001 and December 2015. Time in opioid agonist treatment (primary outcome) was modelled using a generalized estimating equation model to estimate associations with person, treatment and prescriber characteristics. The impact of medication type on opioid agonist treatment retention reduced over time the risk of leaving treatment when on buprenorphine compared with methadone was higher among those who entered treatment earlier [e.g. 2001–03: odds ratio (OR) = 1.59, 95% confidence interval (CI) = 1.45–1.75] and lowest among those who entered most recently (2013–15: OR = 1.23, 95% CI = 1.11–1.36). In adjusted analyses, risk of leaving was reduced among people whose prescriber had longer tenure of prescribing (e.g. 3 versus 8 years: OR = 0.94, 95% CI = 0.93–0.95) compared with prescribers with shorter tenure. Aboriginal and Torres Strait Islander people, being of younger age, past‐year psychosis disorder and having been convicted of more criminal charges in the year prior to treatment entry were associated with increased risk of leaving treatment. In New South Wales, Australia, retention in buprenorphine treatment for opioid dependence, compared with methadone, has improved over time since its introduction in 2001. Opioid agonist treatment retention is affected not only by characteristics of the person and his or her treatment, but also of the prescriber, with those of longer prescribing tenure associated with increased retention of people in opioid agonist treatment.
Publisher: Elsevier BV
Date: 08-2021
Publisher: Wiley
Date: 11-1999
DOI: 10.1046/J.1360-0443.1999.941116534.X
Abstract: To provide an evidence base of estimates of the prevalence of problem drug use in inner London. Re-analysis of three capture-recapture studies using subjects aged 15-49 years, that aim to estimate the hidden population from analysing the overlaps between three data sources. Newham (1995) Camden and Islington (C&I) (1993/4) and Lambeth, Southwark and Lewisham (LSL) (1992). Each study collected data from three sources of problem drug users including: the Regional Drug Misuse Database, specialist drug agencies, HIV tests, social services, police arrests and court records. In LSL opiate users were analysed separately. The studies identified 1832 in iduals in LSL, 543 in Newham, and 1321 in C&I. Poisson models were fitted to the data testing different interactions between the data sources representing potential dependencies. The simplest model was selected on the basis of its AIC score and log-likelihood ratio tests. The number of hidden problem drug users were estimated to be 12,500 (95% CI 9600-16,100) in LSL with 4400 (3200-6100) opiate users 7000 (5000-10,000) in C&I and 3800 (2000-7200) in Newham. The prevalence of problem drug use in those aged 15-49 was estimated to be 3.1% (2.5-3.9%) in LSL with 1.3% (1.0-1.6%) opiate users and 3.6% (2.7-4.9%) and 3.3% (1.9-5.7%) in C&I and Newham, respectively. Despite the inherent problems with capture-recapture methods, our three studies establish an evidence base for estimates of problem drug use in London. It is important that a larger study is carried out in London.
Publisher: Wiley
Date: 13-06-2012
Publisher: Wiley
Date: 04-05-2023
DOI: 10.1111/ADD.16200
Abstract: Studies often rely upon self‐report and biological testing methods for measuring illicit drug use, although evidence for their agreement is limited to specific populations and self‐report instruments. We aimed to examine comprehensively the evidence for agreement between self‐reported and biologically measured illicit drug use among all major illicit drug classes, biological indicators, populations and settings. We systematically searched peer‐reviewed databases (Medline, Embase and PsycINFO) and grey literature. Included studies reported 2 × 2 table counts or agreement estimates comparing self‐reported and biologically measured use published up to March 2022. With biological results considered to be the reference standard and use of random‐effect regression models, we evaluated pooled estimates for overall agreement (primary outcome), sensitivity, specificity, false omission rates (proportion reporting no use that test positive) and false discovery rates (proportion reporting use that test negative) by drug class, potential consequences attached to self‐report (i.e. work, legal or treatment impacts) and time‐frame of use. Heterogeneity was assessed by inspecting forest plots. From 7924 studies, we extracted data from 207 eligible studies. Overall agreement ranged from good to excellent ( 0.79). False omission rates were generally low, while false discovery rates varied by setting. Specificity was generally high but sensitivity varied by drug, s le type and setting. Self‐report in clinical trials and situations of no consequences was generally reliable. For urine, recent (i.e. past 1–4 days) self‐report produced lower sensitivity and false discovery rates than past month. Agreement was higher in studies that informed participants biological testing would occur (diagnostic odds ratio = 2.91, 95% confidence interval = 1.25–6.78). The main source of bias was biological assessments (51% studies). While there are limitations associated with self‐report and biological testing to measure illicit drug use, overall agreement between the two methods is high, suggesting both provide good measures of illicit drug use. Recommended methods of biological testing are more likely to provide reliable measures of recent use if there are problems with self‐disclosure.
Publisher: Springer Science and Business Media LLC
Date: 11-2006
Publisher: Elsevier BV
Date: 07-2010
Publisher: Wiley
Date: 04-01-2023
DOI: 10.1111/DAR.13595
Abstract: Globally, hepatitis B virus (HBV) is a leading cause of liver disease. People who inject drugs (PWID) are at greater risk than the general population of contracting HBV. This risk could depend on societal factors in different countries. We investigated the associations between country‐level chronic HBV prevalence in PWID with national indicators of development and prevalence of HIV and hepatitis C virus (HCV). We used global systematic review data on chronic HBV prevalence (hepatitis B surface antigen‐positive) among PWID and country‐level sociodemographic characteristics from online databases. National random‐effects meta‐analysis estimates of HBV prevalence were the outcome in linear regression models testing for associations with country‐level characteristics. The study included 131,710 PWID from 304 estimates in 55 countries: the pooled HBV prevalence among PWID in the countries analysed was 4.5% (95% CI 3.9–5.1), the highest regional pooled prevalence was in East and Southeast Asia (17.6% [13.3–22.3]), and the lowest was in Western Europe (1.7% [1.4–2.1]). In multivariable models, no indicators of development were associated with HBV prevalence, but there was evidence of positive associations between HBV prevalence in the general population and among PWID, and evidence of HIV and HCV prevalence in PWID being associated with HBV prevalence in PWID: multivariable coefficients 0.03 (95% CI 0.01–0.04) p 0.001, and 0.01 (95% CI 0.00–0.03) p = 0.01, respectively. HBV prevalence among PWID was associated with HIV and HCV prevalence among PWID and background HBV prevalence in the general population, highlighting the need for improving harm reduction in PWID and implementation of HBV vaccination, especially where HBV is endemic.
Publisher: Oxford University Press (OUP)
Date: 06-02-2019
Abstract: Women-specific factors exist that increases vulnerability to drug-related harms from injection drug use, including blood-borne viruses (BBVs), but gender-based differences in BBV prevalence have not been systematically examined. We conducted meta-analyses to estimate country, regional, and global prevalence of serologically confirmed human immunodeficiency virus (HIV), hepatitis C virus (HCV based on detection of anti-HCV antibody), and hepatitis B virus (HBV based on detection of HBV surface antigen) in people who inject drugs (PWID), by gender. Gender-based differences in the BBV prevalence (calculated as the risk among women relative to the risk among men) were regressed on country-level prevalence and inequality measures (Gender inequality index, Human development index, Gini coefficient, and high, low or middle income of the country). Gender-based differences varied by countries and regions. HIV prevalence was higher among women than men in sub-Saharan Africa (relative risk [RR], 2.8 95% confidence interval [CI], 1.8–4.4) and South Asia (RR, 1.7 95% CI, 1.1–2.7) anti-HCV was lower among women in the Middle East and North Africa (RR, 0.6 95% CI, .5–.7) and East and Southeast Asia (RR, 0.8 95% CI, .7–.9). Gender-based differences varied with country-levels of the BBV prevalence in the general population, human development, and income distribution. HIV was more prevalent in women who inject drugs as compared to their male counterparts in some countries, but there is variation between and within regions. In countries where women are at higher risks, there is a need to develop gender-sensitive harm-reduction services for the particularly marginalized population of women who inject drugs.
Publisher: Wiley
Date: 11-11-2021
DOI: 10.1111/DAR.13194
Abstract: Limited research has investigated meth hetamine use and related harms in rural and regional Australia. We investigated whether people who used meth hetamine in non‐metropolitan Victoria differed in their sociodemographics and were more likely to be meth hetamine‐dependent than those recruited in Melbourne. We used baseline data from an ongoing prospective cohort study, ‘VMAX’. Participants were recruited from Melbourne and three non‐metropolitan Victorian regions. Sequential multivariable logistic regression of nested models assessed unadjusted and adjusted associations between residential locations and meth hetamine dependence. The s le mostly (77%) comprised people who used meth hetamine via non‐injecting means ( N = 744). Thirty‐nine percent were female. Melbourne‐based participants were less likely than non‐metropolitan participants to identify as Aboriginal and Torres Strait Islander, be heterosexual, have children and be unemployed. More frequent meth hetamine use (adjusted odds ratio 1.22, 95% confidence interval 1.12–1.34) and using crystal meth hetamine versus ‘speed’ powder (adjusted odds ratio 2.38, 95% confidence interval 1.26–3.64) were independently ( P 0.05) associated with being classified as meth hetamine‐dependent. A significantly higher percentage of participants in every non‐metropolitan region were classified as meth hetamine‐dependent vs. those in Melbourne, but this relationship was attenuated when adjusting for meth hetamine use frequency and primary form used. Despite 65% of participants being classified as meth hetamine‐dependent, less than half had recently (past year) accessed any professional support for meth hetamine, with minimal variation by recruitment location. VMAX participants in non‐metropolitan Victoria were more likely to be meth hetamine‐dependent than those living in Melbourne. Unmet need for professional support appears to exist among people using meth hetamine across the state, regardless of geographical location.
Publisher: Wiley
Date: 09-08-2018
DOI: 10.1111/ADD.14383
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: Wiley
Date: 10-11-2014
DOI: 10.1111/ADD.12750
Publisher: Wiley
Date: 03-2009
DOI: 10.1111/J.1465-3362.2008.00042.X
Abstract: To conduct a systematic review of longitudinal studies that examined the association between childhood socioeconomic status (SES) and illegal drug use in later life. Systematic search with an agreed list of search items was used to identify all longitudinal population-based studies that examined the association between childhood SES and later drug use. These included MEDLINE (1966-2005), EMBASE (1990-2005), CINAHL (1982-2005) and PsychInfo (1806-2005), and specialist databases of the Lindesmith Library, Drugscope and Addiction Abstracts. Foreign-language papers were included. Abstracts were screened independently by two reviewers. If there was disagreement to accept or reject the abstract, then a third reviewer acted as arbiter. Data were extracted by one of the authors. Eleven relevant papers were identified (two birth cohorts and nine papers on school-aged cohorts). There was consistent evidence to support an association between lower childhood SES and later drug use, primarily cannabis use. However, few studies examined cannabis dependence, and studies of more problematic forms of drug use gave contradictory results. We found consistent, though weak, evidence to support the assumption that childhood disadvantage is associated with later cannabis use. Further research is needed to clarify this issue and to inform future policies and public health messages.
Publisher: Elsevier BV
Date: 09-2017
Publisher: Wiley
Date: 03-2006
DOI: 10.1080/09595230500537274
Abstract: We consider the question of what method should be recommended to estimate the prevalence of injecting drug use (IDU) and compare multiplier and capture-recapture (CRC) methods of estimating prevalence of injecting drug use (IDU). The prevalence of injecting drug use in four cities (Brighton, Liverpool, London and Togliatti) was estimated using similar methods: covariate capture-recapture (CRC) and multipliers. The multipliers, generated either from a community recruited survey or historical/literature-based, were applied to a range of 'benchmarks': specialist drug treatment, arrests, accident and emergency department (A&E), syringe exchange, HIV tests and opiate overdose deaths. The CRC estimates were assumed to be 'preferred/gold standard' [2,304 (95% confidence interval 1,514 - 3,737) in Brighton, 2,910 (2,546 - 4,977) in Liverpool, 16,782 (13,793 - 21,620) in 12 London boroughs and 15,039 (12,696 - 18,515) male IDU in Togliatti]. The ranges given by the multiplier estimates obtained through the community survey varied from 200 to 770 in Brighton, 530 to 1,300 in Liverpool, 2,900 to 10,600 in London and 12,400 to 91,000 in Togliatti. Several multipliers gave implausible results, lower than the observed data collected for another benchmark, and in the three English cities all these multiplier estimates were below the lower 95% confidence interval of the CRC estimate. In Togliatti, only one multiplier estimate was close to the preferred CRC estimates, with the rest implausibly high. The multiplier estimates based on historical/literature multipliers also ranged widely from 390 to 4,800 for Brighton, from 1,645 to 2,800 in Liverpool, from 4,650 to 12,600 in the 12 London boroughs and 12,800 to 32,000 in Togliatti. In the three UK cities the mortality multiplier estimates were closest to the capture-recapture estimates. The study was a practical demonstration comparing a range of multiplier estimates with a single CRC study. In almost all the in idual comparisons the multiplier estimates performed poorly. CRC methods should be preferred as the means of estimating numbers of drug users with multiplier methods being used with caution and only where CRC is not possible.
Publisher: Elsevier BV
Date: 05-2023
Publisher: Wiley
Date: 23-10-2017
DOI: 10.1111/ADD.14012
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-04-2008
Publisher: Elsevier BV
Date: 06-2021
Publisher: Elsevier BV
Date: 12-2023
Publisher: Elsevier BV
Date: 07-2022
DOI: 10.1016/J.DRUGALCDEP.2022.109494
Abstract: Injecting-related bacterial and fungal infections cause substantial illness and disability among people who use illicit drugs. Opioid agonist treatment (OAT) reduces injecting frequency and the transmission of blood borne viruses. We estimated the impact of OAT on hospitalisations for non-viral infections and examine trends in incidence over time. We conducted a retrospective cohort study using linked administrative data. The cohort included 47 163 in iduals starting OAT between August 2001 and December 2017 in New South Wales, Australia, with 454 951 person-years of follow-up. The primary outcome was hospitalisation for an injecting-related disease. The primary exposure was OAT status (out of OAT, first four weeks of OAT, and OAT retention [i.e., more than four weeks in treatment]). Covariates included demographic characteristics, year of hospitalisation, and recent clinical treatment. 9122 participants (19.3%) had at least one hospitalisation for any injecting-related disease. Compared to time out of treatment, retention on OAT was associated with a reduced rate of injecting-related diseases (adjusted rate ratio[ARR]=0.92 95%CI 0.87-0.97). The first four weeks of treatment was associated with an increased rate (ARR 1.53, 95%CI 1.38-1.70), which we believe is explained by referral pathways between hospital and community OAT services. The age-adjusted incidence rates of hospitalisations for any injecting-related disease increased from 34.8 (95% CI =30.2-40.0) per 1000 person-years in 2001 to 54.9 (95%CI=51.3-58.8) in 2017. Stable OAT is associated with reduced hospitalisations for injecting-related bacterial infections however, OAT appears insufficient to prevent these harms as the rate of these infections is increasing in Australia.
Publisher: Oxford University Press (OUP)
Date: 09-02-2021
Abstract: Evidence highlights the disproportionate impact of measures that have been introduced to reduce the spread of coronavirus on in iduals from Black, Asian and minority ethnic (BAME) communities, and among those on a low income. An understanding of barriers to adherence in these populations is needed. In this qualitative study, we examined the patterns of adherence to mitigation measures and reasons underpinning these behaviors. Semi-structured interviews were conducted with 20 participants from BAME and low-income White backgrounds. The topic guide was designed to explore how in iduals are adhering to social distancing and self-isolation during the pandemic and to explore the reasons underpinning this behavior. We identified three categories of adherence to lockdown measures: (i) caution-motivated super-adherence (ii) risk-adapted partial-adherence and (iii) necessity-driven partial-adherence. Decisions about adherence considered potential for exposure to the virus, ability to reduce risk through use of protective measures and perceived importance of/need for the behavior. This research highlights a need for a more nuanced understanding of adherence to lockdown measures. Provision of practical and financial support could reduce the number of people who have to engage in necessity-driven partial-adherence. More evidence is required on population level risks of people adopting risk-adapted partial-adherence.
Location: United Kingdom of Great Britain and Northern Ireland
Start Date: 11-2022
End Date: 10-2025
Amount: $505,682.00
Funder: Australian Research Council
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