ORCID Profile
0000-0002-5910-853X
Current Organisations
Brown University
,
UNSW Sydney
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: Oxford University Press (OUP)
Date: 11-2021
DOI: 10.1093/OFID/OFAB466.1037
Abstract: The goal of the U.S. “Ending the HIV Epidemic” (EHE) initiative is to reduce new HIV infections by 90% within 10 years by focusing resources on high-risk geographic “hotspots.” (Figure 1). The criminal justice system bears a disproportionate burden of HIV, yet EHE lacks specific mention of correctional settings for intervention. We conducted a survey study of current HIV and HCV care practices in prisons and jails serving EHE hotspots. Figure 1 Priority jurisdictions for the “Ending the HIV Epidemic” Initiative which include counties, rural states, and territories with the highest HIV burden, together accounting for more than 50 percent of new HIV diagnoses in recent years. Source: Division of HIV/AIDS Prevention, Centers for Diseases Control and Prevention, ndhiv/jurisdictions.html An online survey on HIV/HCV testing, prevention, treatment, and surveillance was sent to Medical Directors or designees at 26 state prison systems and 37 county or city jails serving EHE hotspots in Spring 2021. Twenty-five responses were received (10/26 prisons, 15/37 jails) for an overall response rate of 40%. Routine HIV testing, defined as testing offered to all persons without known infection, was conducted in 76% of facilities (9/10 prisons, 10/15 jails), with policies of “opt-out” in 44% (5/10 prisons, 6/15 jails), “opt-in” in 20% (2/10 prisons, 3/15 jails), and “mandatory” in 12% of facilities (2/10 prisons, 1/15 jails). Most facilities (80%) provided HIV testing upon inmate request. For HIV prevention, education programs and/or treatment for opioid-use disorder was available in 76% of facilities, but PrEP and condoms were only available in 24% and 16%, respectively. All facilities reported providing antiretroviral therapy and 88% provided a short (3- to 30-day) supply upon discharge. Routine testing for HCV was conducted in 52% of facilities (7/10 prisons, 6/15 jails), with policies of “opt-out” in 36% (5/10 prisons, 4/15 jails), “opt-in” in 12% (1/10 prisons, 2/15 jails), and “mandatory” in one prison. Most facilities (80%) provided HCV testing upon inmate request. In 8/10 prisons and 6/15 jails, HCV treatment with direct-acting antivirals was continued if initiated prior to incarceration. Treatment for new diagnoses of HCV was less common (16-44%) and depended on expected length of incarceration. In prisons and jails serving HIV “hotspot” regions, critical opportunities for improved HIV and HCV testing, treatment, prevention, and linkage-to-care services remain. Given these findings, we support the broader inclusion of the justice system as an integral component of the EHE initiative. All Authors: No reported disclosures
Publisher: Elsevier BV
Date: 08-2017
Publisher: Elsevier BV
Date: 04-2018
Publisher: Elsevier BV
Date: 06-2023
Publisher: Elsevier BV
Date: 03-2021
Publisher: Research Square Platform LLC
Date: 20-10-2020
DOI: 10.21203/RS.3.RS-45321/V1
Abstract: Background : Opioid overdose deaths involving synthetic opioids, particularly illicitly manufactured fentanyl, remain a substantial public health concern in North America. Responses to overdose events (e.g. administration of naloxone and rescue breathing) are effective at reducing mortality however, more interventions are needed to prevent overdoses involving illicitly manufactured fentanyl. This study protocol aims to evaluate the effectiveness of a behaviour change intervention that incorporates in idual counseling, practical training in fentanyl test strip use, and distribution of fentanyl test strips for take home use among people who use drugs. Methods: Residents of Rhode Island aged 18–65 years who report recent substance use (including prescription pills obtained from the street heroin, powder cocaine, crack cocaine, meth hetamine or any drug by injection) (n=500) will be recruited through advertisements and targeted street-based outreach into a two-arm randomised clinical trial with 12 months of post-randomisation follow-up. Eligible participants will be randomised (1:1) to receive either the RAPIDS intervention (i.e. fentanyl-specific overdose education, behaviour change motivational interviewing (MI) sessions focused on using fentanyl test strips to reduce overdose risk, fentanyl test strip training, and distribution of fentanyl test strips for personal use), or standard overdose education as control. Participants will attend MI booster sessions (intervention) or attention-matched control sessions at 1, 2, and 3 months post-randomisation. All participants will be offered naloxone at enrolment. The primary outcome is a composite measure of self-reported overdose in the previous month at six- and/or 12-month follow-up visit. Secondary outcome measures include administratively linked data regarding fatal (post-mortem investigation) and non-fatal (hospitalisation or emergency medical service utilisation) overdoses. Discussion: If the RAPIDS intervention is found to be effective, its brief MI and fentanyl test strip training components could be easily incorporated into existing community-based overdose prevention programming to help reduce the rates of fentanyl-related opioid overdose. Trial Registration : clinicaltrials.gov: NCT04372238 01 May 2020
Publisher: Springer Science and Business Media LLC
Date: 28-04-2023
Publisher: Elsevier BV
Date: 04-2013
Publisher: Wiley
Date: 24-09-2009
DOI: 10.1111/J.1440-1746.2009.05978.X
Abstract: Needlestick injuries are an occupational hazard for prison officers. This study aimed to assess the presence of hepatitis C virus (HCV) in syringes found in prisons. Sixty-nine syringes found in prisons were tested for HCV RNA using previously published methods. Three syringes tested positive for HCV RNA. Compared to the prevalence of HCV among injecting drug users in prisons, few syringes were found to contain HCV RNA. It is likely that conditions under which syringes are kept in prisons are not favorable for survival of detectable HCV RNA. Further work is needed to establish the risk of HCV transmission posed by needlestick injuries in prison settings.
Publisher: Elsevier BV
Date: 04-2021
Publisher: Wiley
Date: 04-09-2017
DOI: 10.1111/JVH.12758
Publisher: SAGE Publications
Date: 2020
DOI: 10.1080/08897077.2019.1635954
Abstract: Although people who inject performance- and image-enhancing drugs (PIEDs) report fewer unsafe injecting practices, stigma and discrimination may negatively impact their access to help and information. Engagement with health care services, compared with social networks (friends, relatives, and gym associates) and the Internet and media (steroid user forums, information sites, and magazines), may be important for harm minimization. A cross-sectional Internet or in-person survey of men who use PIEDs in Australia in 2014–2015 examined differences in sources for PIEDs, injecting equipment, and anabolic-androgenic steroids (AAS) information and factors associated with having periodical medical checks related to PIEDs issues using multivariate logistic regression. In total, 267 men (mean age: 25 years, SD: 8.7 years 246 of 267 [92%] reported recent AAS injection) were recruited. Most participants sourced injecting equipment from health professionals, PIEDs from their social networks, and AAS information from the Internet and media. Self-reported AAS knowledge was high and frequent. Higher income (adjusted odds ratio [AOR]: 2.04, 95% confidence interval [CI]: 1.03, 4.00), ≥2 different PIEDs used in addition to AAS (AOR: 1.94, 95% CI: 1.08, 3.49), and sourcing AAS information from health care professionals (AOR: 3.14, 95% CI: 1.81, 5.46) were independently associated with periodical medical checks. Participants nominated preference for improved health services through needle-syringe programs, primary care services, and peer educator support groups. Men who use PIEDs in Australia consider themselves well informed but tend to use Internet and media sources, providing potentially misleading or inaccurate information. Increasing trust between men who use PIEDs and health care providers may enable delivery of PIEDs-specific information to those at greatest need.
Publisher: Springer Science and Business Media LLC
Date: 18-10-2022
DOI: 10.1186/S12954-022-00698-2
Abstract: Narrow or non-existent Good Samaritan Law protections and harsh drug selling statutes in the USA have been shown to deter bystanders from seeking medical assistance for overdoses. Additionally, little is known about the actions that police take when responding to overdose events. The objectives of this study were to assess the prevalence and correlates of naloxone administration by police, as well as to examine overdose events where arrests were made and those in which the person who overdosed was described as combative. We analyzed incident reports of police responding to an overdose between September 1, 2019, and August 31, 2020 (i.e., 6 months prior to and during the COVID-19 pandemic), from a city in Rhode Island. We examined characteristics of incidents, as well as in idual characteristics of the person who overdosed. Correlates of police naloxone administration were assessed using Wilcoxon rank sum tests and Fisher’s exact tests, and we examined incidents where arrests occurred and incidents in which the person who overdosed was described as combative descriptively. Among the 211 incidents in which police responded to an overdose during the study period, we found that police administered naloxone in approximately 10% of incidents. In most incidents, police were the last group of first responders to arrive on scene (59%), and most often, naloxone was administered by others (65%). Police were significantly more likely to administer naloxone when they were the first professionals to arrive, when naloxone had not been administered by others, and when the overdose occurred in public or in a vehicle. Arrests at overdose events were rarely reported (1%), and people who overdosed were rarely (1%) documented in incident reports as being ‘combative.’ Considering these findings, ideally, all jurisdictions should have sufficient first responder staffing and resources to ensure a rapid response to overdose events, with police rarely or never dispatched to respond to overdoses. However, until this ideal can be achieved, any available responders should be dispatched concurrently, with police instructed to resume patrol once other professional responders arrive on scene additionally, warrant searches of persons on scene should be prohibited.
Publisher: American Society for Microbiology
Date: 09-2011
DOI: 10.1128/JCM.02447-10
Abstract: The storage of biological s les may affect detection of viral nucleic acid, yet the stability of viral nucleic acid at standard laboratory storage temperatures (−70°C and −20°C) has not been comprehensively assessed. Deterioration of viral RNA and DNA during storage may affect the detection of viruses, thus leading to an increased likelihood of false-negative results on diagnostic testing. The viral loads of 99 hepatitis C virus (HCV), 41 HIV, and 101 hepatitis B virus (HBV) patient s les were measured before and after storage at −20°C and −70°C for up to 9.1 years using Versant branched DNA assays, Cobas Monitor assays, and/or AmpliPrep/AmpliScreen assays. Clinical s les stored at −20°C for up to 1.2 years and at −70°C for up to 9 years showed a statistically significant difference from baseline with respect to HCV RNA titer, although this difference was not greater than 0.5 log 10 unit. The concentration of HIV RNA in clinical s les stored at −20°C for 2.3 years and at −70°C for up to 9.1 years did not differ significantly from the baseline viral load. HBV DNA-positive clinical s les stored at −20°C for up to 5 years and at −70°C for up to 4 years differed significantly in viral load. In all studies, however, the loss of viral load of HCV, HIV, or HBV in clinical s les tested after storage at −20°C and −70°C for up to 9 years ranged from 0.01 to 0.35 log 10 IU/ml and did not exceed 0.5 log 10 , which is the estimated intra-assay variation for molecular tests. Hence, the loss was considered of minimal clinical impact and adequate for the detection of HCV, HIV-1, and HBV nucleic acids using nucleic acid assays for the assessment of the infectious risk of cell, blood, and tissue donors.
Publisher: Springer Science and Business Media LLC
Date: 08-04-2012
DOI: 10.1007/S10561-011-9252-6
Abstract: Serology assays for standard screening are optimised for use with sera collected from living adults and children. Because of potential changes in the vascular compartments after death, methods used for screening sera from cadaveric organ donors need to be validated before testing these specimens. Serum was separated from blood collected from cadaveric donors within 24 h of death and biochemical parameters measured to detect dilution of protein and haemolysis. In order to demonstrate if any inhibitors that might interfere with the assays were present, pre and post-mortem specimens were spiked with aliquots of human immunodeficiency virus (HIV), hepatitis C virus (HCV), hepatitis B virus (HBV), human T-cell Lymphotropic Virus (HTLV) and T. pallidum-positive sera. Comparison of serum from living subjects with serum obtained post-mortem showed that while the concentration of total protein decreased, concentrations of albumin, immunoglobulin G (IgG) and immunoglobulin M (IgM) remained unchanged. The degree of haemolysis, as measured by free haemoglobin, was within the limits accepted for the Architect analyser. Spiking of pre- and post-mortem specimens with aliquots of HIV, HCV, HBV, HTLV and T. pallidum-positive sera showed no statistical difference in the signal between pre-mortem and post-mortem results when tested on the Abbott Architect analyser. Positive results were obtained in each of a further nine subjects who had tested positive for HIV (n=1), HCV (n=8), HBV (n=1) on pre-mortem serological testing. These findings suggest that the sensitivity of the Abbott Architect serological screening tests is not significantly affected in specimens collected within 24 h of the cessation of life.
Publisher: Elsevier BV
Date: 11-2020
Publisher: Wiley
Date: 02-2019
DOI: 10.1002/JIA2.25222
Publisher: Public Library of Science (PLoS)
Date: 27-06-2013
Publisher: CMA Impact Inc.
Date: 28-04-2019
DOI: 10.1503/CMAJ.181506
Publisher: Wiley
Date: 27-02-2018
DOI: 10.1111/DAR.12688
Abstract: Emerging research suggests that the sub-population of anabolic-androgenic steroid (AAS) users who experience physical appearance concerns may suffer greater psychological dysfunction than other sub-populations, including users with athletic or occupational concerns. Thus, among current AAS users, we sought to determine whether, and to what extent, social physique anxiety-an established measure of appearance concern-was associated with psychological dysfunction. Interviews were conducted with a s le of 74 male AAS users living in Australia. Users completed self-report instruments of the severity of AAS dependence, depression, hazardous and risky drinking, use of non-AAS illicit drugs, psychological side-effects due to AAS use and abnormal test results due to AAS use. Multivariate analyses revealed that greater social physique anxiety was uniquely associated with more severe symptoms of both AAS dependence and depression. Moreover, the effect size of these relationships was large. Social physique anxiety was not associated with hazardous or risky drinking, non-AAS illicit drug use, psychological side-effects or abnormal test results. Limitations notwithstanding, the study is consistent with the notion that AAS users who experience appearance concerns are at heightened risk of co-morbid psychological dysfunction. Given trends indicating an increase in the prevalence of AAS use in Australia and elsewhere, the findings suggest that health-care systems may need to consider prioritising the sub-population of AAS users who experience appearance concerns. Further investigation of the clinical syndrome of AAS dependence is required, including its relation to body image and eating disorders.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 22-05-2017
DOI: 10.1002/HEP4.1050
Abstract: The significance of the clinical impact of direct‐acting antiviral (DAA) resistance‐associated substitutions (RASs) in hepatitis C virus (HCV) on treatment failure is unclear. No standardized methods or guidelines for detection of DAA RASs in HCV exist. To facilitate further evaluations of the impact of DAA RASs in HCV, we conducted a systematic review of RAS sequencing protocols, compiled a comprehensive public library of sequencing primers, and provided expert guidance on the most appropriate methods to screen and identify RASs. The development of standardized RAS sequencing protocols is complicated due to a high genetic variability and the need for genotype‐ and subtype‐specific protocols for multiple regions. We have identified several limitations of the available methods and have highlighted areas requiring further research and development. The development, validation, and sharing of standardized methods for all genotypes and subtypes should be a priority. ( Hepatology Communications 2017 :379–390)
Publisher: PubPub
Date: 31-03-2022
Publisher: Springer Science and Business Media LLC
Date: 26-11-2020
DOI: 10.1186/S13063-020-04898-8
Abstract: Opioid overdose deaths involving synthetic opioids, particularly illicitly manufactured fentanyl, remain a substantial public health concern in North America. Responses to overdose events (e.g., administration of naloxone and rescue breathing) are effective at reducing mortality however, more interventions are needed to prevent overdoses involving illicitly manufactured fentanyl. This study protocol aims to evaluate the effectiveness of a behavior change intervention that incorporates in idual counseling, practical training in fentanyl test strip use, and distribution of fentanyl test strips for take-home use among people who use drugs. Residents of Rhode Island aged 18–65 years who report recent substance use (including prescription pills obtained from the street heroin, powder cocaine, crack cocaine, meth hetamine or any drug by injection) ( n = 500) will be recruited through advertisements and targeted street-based outreach into a two-arm randomized clinical trial with 12 months of post-randomization follow-up. Eligible participants will be randomized (1:1) to receive either the RAPIDS intervention (i.e., fentanyl-specific overdose education, behavior change motivational interviewing (MI) sessions focused on using fentanyl test strips to reduce overdose risk, fentanyl test strip training, and distribution of fentanyl test strips for personal use) or standard overdose education as control. Participants will attend MI booster sessions (intervention) or attention-matched control sessions at 1, 2, and 3 months post-randomization. All participants will be offered naloxone at enrolment. The primary outcome is a composite measure of self-reported overdose in the previous month at 6- and/or 12-month follow-up visit. Secondary outcome measures include administratively linked data regarding fatal (post-mortem investigation) and non-fatal (hospitalization or emergency medical service utilization) overdoses. If the RAPIDS intervention is found to be effective, its brief MI and fentanyl test strip training components could be easily incorporated into existing community-based overdose prevention programming to help reduce the rates of fentanyl-related opioid overdose. ClinicalTrials.gov NCT04372238 . Registered on 01 May 2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-08-2020
Publisher: Elsevier BV
Date: 09-2015
Publisher: Elsevier BV
Date: 07-2015
Publisher: Elsevier BV
Date: 07-2015
DOI: 10.1016/J.MEEGID.2015.04.017
Abstract: Improved surveillance methods are needed to better understand the current hepatitis C virus (HCV) disease burden and to monitor the impact of prevention and treatment interventions on HCV transmission dynamics. Sanger sequencing (HCV NS5B, HVR1 and Core-E1-HVR1) and phylogenetics were applied to s les from in iduals diagnosed with HCV in British Columbia, Canada in 2011. This included in iduals with two or three sequential s les collected <1 year apart. Patristic distances between sequential s les were used to set cutoffs to identify recent transmission clusters. Factors associated with transmission clustering were analyzed using logistic regression. From 618 in iduals, 646 sequences were obtained. Depending on the cutoff used, 63 (10%) to 92 (15%) unique in iduals were identified within transmission clusters of predicted recent origin. Clustered in iduals were more likely to be <40 years old (Adjusted Odds Ratio (AOR) 2.12, 95% CI 1.21-3.73), infected with genotype 1a (AOR 6.60, 95% CI 1.98-41.0), and to be seroconverters with estimated infection duration of 1 year (AOR 2.19, 95% CI 1.22-3.97). Systematic application of molecular phylogenetics may be used to enhance traditional surveillance methods through identification of recent transmission clusters.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 14-09-2022
DOI: 10.1097/ADM.0000000000001077
Abstract: Before the coronavirus disease 2019 pandemic, federal law required in-person evaluation before buprenorphine initiation. Regulatory changes during the pandemic allow for buprenorphine initiation by audio-only or audiovisual telehealth. Little is known about treatment engagement after buprenorphine initiation conducted via audio-only telehealth. A retrospective cohort study of 94 in iduals who received initial treatment through an audio-only encounter between April 2020 and February 2021 was performed. Participant demographics, substance use history, withdrawal symptoms, 30-day treatment engagement, and adverse outcomes were determined by an electronic chart and REDcap database review. Subsequent buprenorphine prescriptions filled within 30 days of the initial encounter were tracked through the Rhode Island Prescription Drug Monitoring Program. Buprenorphine was prescribed for 94 in iduals. Most (92 of 94 [97.9%]) filled their prescription within 30 days. Most had previously taken buprenorphine, including prescribed (42 of 92 [45.7%]) and nonprescribed (58 of 92 [63.0%]). Two thirds were in opioid withdrawal at the time of the call (61 of 92 [66.3%]) with a mean Subjective Opioid Withdrawal Scale of 26.8 (range, 4–57). Four in iduals experienced precipitated withdrawal (4 of 94 [4.3%]), and 2 reported persistent withdrawal at their follow-up visit (2 of 94 [2.1%]). More than 70% filled a subsequent prescription for buprenorphine within 30 days of the end of their hotline prescription (65 of 92 [70.7%]), on average of 5.88 days (range, 0–28) after completion of their telehealth prescription. Expanding telehealth-delivered buprenorphine care has the potential to address treatment gaps and facilitate delivery of on-demand services during peak motivation. This evaluation of audio-only buprenorphine initiation found high rates of unobserved buprenorphine initiation and treatment continuation with low rates of complications.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-12-2022
Publisher: Elsevier BV
Date: 10-2019
DOI: 10.1016/J.DRUGPO.2019.04.001
Abstract: As direct-acting antiviral (DAA) therapy costs fall and eligibility criteria are relaxed, people who inject drugs (PWID) will increasingly become eligible for HCV treatment. Yet eligibility does not necessarily equate to access. Amidst efforts to expand treatment uptake in this population, we seek to synthesise and clarify the conceptual underpinnings of access to health care for PWID, with a view to informing research and practice. Integrating dominant frameworks of health service utilisation, care seeking processes, and ecological perspectives on health promotion, we present a comprehensive theoretical framework to understand, investigate and intervene upon barriers and facilitators to HCV care for PWID. Built upon the concept of Candidacy, the framework describes access to care as a continually negotiated product of the alignment between in iduals, health professionals, and health systems. In iduals must identify themselves as candidates for services and then work to stake this claim health professionals serve as gatekeepers, adjudicating asserted candidacies within the context of localised operating conditions and repeated interactions build experiential knowledge and patient-practitioner relationships, influencing identification and assertion of candidacy over time. These processes occur within a complex social ecology of interdependent in idual, service, system, and policy factors, on which other established theories provide guidance. There is a pressing need for a deliberate and nuanced theory of health care access to complement efforts to document the HCV 'cascade of care' among PWID. We offer this framework as an organising device for observational research, intervention, and implementation science to expand access to HCV care in this vulnerable population. Using practical ex les from the HCV literature, we demonstrate its utility for specifying research questions and intervention targets across multiple levels of influence describing and testing plausible effect mechanisms and identifying potential threats to validity or barriers to research translation.
Publisher: Elsevier BV
Date: 10-2019
DOI: 10.1016/J.DRUGPO.2019.04.002
Abstract: Multiple barriers for accessing hepatitis C virus (HCV) treatment were identified during the interferon-based (IFN) treatment era for people who inject drugs (PWID). Whether these barriers persist since the introduction of IFN-free direct-acting antiviral (DAA) agents in Canada remains to be documented. This study examined temporal trends in HCV treatment initiation and associated factors during the transition from INF-based to all-oral DAA regimens. The study population was drawn from a prospective cohort of PWID in Montreal, Canada. At three-month/one-year intervals between 2011 and 2017, participants with chronic HCV infection completed an interviewer-administered questionnaire on socio-demographic characteristics, drug use and health service utilisation, including HCV treatment. Time-updated Cox multivariate regression models, stratified by DAA + INF (2011-2013) and all-oral DAA (2014-2017) availability periods, were conducted to examine associations between time to HCV treatment initiation and associated barriers and facilitators. Of 308 participants (85% male, median age 42 [IQR: 33, 50]), 80 (26%) initiated HCV treatment during 915 person-years (PY). Incidence rates increased from 1.6 /100 PY (95%CI:0.9-2.6) in 2011 to 12.7 (10.6-15.1) in 2017 (p-trend = 0.0012). In multivariate analyses, visiting a primary care physician (2011-2013: aHR = 3.63[1.21-10.9] 2014-2017: 2.52[1.10-5.77]) and frequent injection (0.23[0.05-0.99] and 0.49[0.24-0.99]) were consistently associated with treatment initiation. Participants aged >40 (2.27[1.24-4.13]), receiving opioid agonist therapy (OAT) (2.17[1.19-3.94]), and reporting prior HCV treatment (3.00[1.75-5.15]) were more likely to initiate treatment in the all-oral DAA period. Treatment initiation increased between 2011 and 2017, but still remains low among PWID. Primary care visiting was a key facilitator regardless of the period, while engagement in OAT and health services, indicated by prior HCV treatment, increased the likelihood of treatment initiation in the DAA era. These findings suggest that access to health services is essential but not enough to scale up treatment in this population.
Publisher: Elsevier BV
Date: 10-2021
Publisher: Wiley
Date: 23-11-2021
DOI: 10.1111/ACEM.14409
Abstract: Emergency department (ED)‐based naloxone distribution and peer‐based behavioral counseling have been shown to be feasible, but little is known about utilization maintenance over time and clinician, patient, and visit level factors influencing implementation. We conducted a retrospective cohort study of an ED overdose prevention program providing take‐home naloxone, behavioral counseling, and treatment linkage for patients treated for an opioid overdose at two Rhode Island EDs from 2017 to 2020: one tertiary referral center and a community hospital. Utilizing a Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE‐AIM) framework, we evaluated program reach, adoption, implementation modifiers, and maintenance using logistic and Poisson regression. Seven hundred forty two patients were discharged after an opioid overdose, comprising 966 visits (median: 32 visits per month interquartile range: 29, 41). At least one intervention was provided at most (86%, 826/966) visits. Take‐home naloxone was provided at 69% of visits (637/919). Over half (51%, 495/966) received behavioral counseling and treatment referral (65%, 609/932). Almost all attending physicians provided take‐home naloxone (97%, 105/108), behavioral counseling (95%, 103/108), or treatment referral (95%, 103/108) at least once. Most residents and advanced practice practitioners (APPs) provided take home naloxone (78% residents 72% APPs), behavioral counseling (76% residents 67% APPs), and treatment referral (80% residents 81% APPs) at least once. Most clinicians provided these services for over half of the opioid overdose patients they cared for. Patients were twice as likely to receive behavioral counseling when treated by an attending in combination with a resident and/or APP (adjusted odds ratio: 2.29 95% confidence interval, 1.68, 3.12) compared to an attending alone. There was no depreciation in use over time. ED naloxone distribution, behavioral counseling, and referral to treatment can be successfully integrated into usual emergency care and maintained over time with high reach and adoption. Further work is needed to identify low‐cost implementation strategies to improve services use and dissemination across clinical settings.
Publisher: Elsevier BV
Date: 06-2016
Publisher: Elsevier BV
Date: 08-2017
Publisher: Public Library of Science (PLoS)
Date: 20-07-2015
Publisher: Wiley
Date: 02-2019
DOI: 10.1111/DAR.12908
Publisher: Wiley
Date: 18-09-2019
DOI: 10.1111/JVH.13196
Abstract: The global scale-up of hepatitis C virus (HCV) diagnosis requires simplified and affordable HCV diagnostic pathways. This study evaluated the sensitivity and specificity of the HCV Architect core antigen (HCVcAg) assay for detection of active HCV infection in plasma and capillary whole blood dried blood spots (DBS) compared with HCV RNA testing in plasma (Abbott RealTime HCV Viral Load). S les were collected from participants in an observational cohort enrolled at three sites in Australia (two-drug treatment and alcohol clinics and one homelessness service). Of 205 participants, 200 had results across all s les and assay types and 186 were included in this analysis (14 participants receiving HCV therapy were excluded). HCV RNA was detected in 29% of participants ([95% CI: 22.6-36.1], 54 of 186). The sensitivity of HCVcAg for detection of active HCV infection in plasma was 98.1% (95% CI: 90-100) and 100% (95% CI: 93-100) when compared to HCV RNA thresholds of ≥12 and ≥1000 IU/mL, respectively. The sensitivity of the HCVcAg assay for detection of active HCV infection in DBS was 90.7% (95% CI: 80-97) and 92.5% (95% CI: 82-98) when compared to HCV RNA thresholds of ≥12 and ≥1000 IU/mL, respectively. The specificity of HCV core antigen for detection of active infection was 100% (95% CI: 97-100) for all s les and RNA thresholds. These data indicate that the detection of HCVcAg is a useful tool for determining active HCV infection to facilitate enhanced testing, linkage to care and treatment particularly when testing plasma s les are collected by venepuncture.
Publisher: Springer Science and Business Media LLC
Date: 29-01-2020
DOI: 10.1007/S10461-020-02800-W
Abstract: Recent studies have highlighted the efficacy of and willingness to use pre-exposure prophylaxis (PrEP) to prevent HIV infection among people who inject drugs (PWID), however knowledge of real-world applicability is limited. We aimed to quantify the real-world eligibility for HIV-PrEP among HIV-negative PWID in Montreal, Canada (n = 718). Eligibility was calculated according to US Centers for Disease Control and Prevention (CDC) guidelines and compared to risk of HIV acquisition according to the assessing the risk of contracting HIV (ARCH-IDU) risk screening tool. Over one-third of participants (37%) were eligible for HIV PrEP, with 1/3 of these eligible due to sexual risk alone. Half of participants were considered high risk of HIV acquisition according to ARCH-IDU, but there was poor agreement between the two measures. Although a large proportion of PWID were eligible for HIV-PrEP, better tools that are context- and location-informed are needed to identify PWID at higher risk of HIV acquisition.
Publisher: Wiley
Date: 11-09-2019
DOI: 10.1111/JVH.13194
Abstract: Hepatitis C virus (HCV) acquisition remains high in key risk environments including injection drug use and sex between men. However, few studies examine the independent contribution of sexual behaviour to HCV acquisition among people who inject drugs (PWID). We estimated HCV incidence and examined sexual behaviour as a time-varying predictor of HCV acquisition in a prospective cohort study of PWID in Montreal (2004-2017). Initially, HCV-negative participants completed behavioural questionnaires and HCV antibody testing (6 months until 2011, 3 months thereafter). A time-updating exposure variable (no sex, opposite-sex partner only, ≥1 same-sex partner) was generated for the previous 6/3 months. Time to HCV seroconversion was examined using Cox regression analysis, adjusted for age, unstable housing and incarceration (both past 3 months), and daily, heroin, cocaine and prescription opioid injecting (all past month). Among 440 PWID (baseline: median age 33 years, 18.9% female, 1.4% HIV-positive), 156 participants seroconverted during follow-up (overall incidence rate: 11.9/100 person-years [PY]). Incidence was lowest in the no sex group (8.70 and 2.91 cases/100 PY in males and females, respectively) and highest in the ≥1 same-sex partner group (24.14 and 21.97 cases/100 PY in males and females, respectively). Among males, HCV risk was 47% lower in those reporting no sex compared to ≥1 same-sex partner (adjusted hazard ratio: 0.53, 95% confidence interval: 0.28, 0.99). In this cohort of PWID, reporting recent same-sex partners was associated with greater risk of HCV acquisition among males, necessitating targeted harm reduction strategies that consider the complex interplay of sexual and injecting risk behaviours.
Publisher: Wiley
Date: 06-12-2020
DOI: 10.1111/JVH.13233
Abstract: Gaps in hepatitis C virus (HCV) testing, diagnosis, liver disease assessment and treatment uptake among people who inject drugs (PWID) persist. We aimed to describe the cascade of HCV care among PWID in Australia, prior to and following unrestricted access to direct-acting antiviral (DAA) treatment. Participants enrolled in an observational cohort study between 2014 and 2018 provided fingerstick whole-blood s les for dried blood spot, Xpert HCV Viral Load and venepuncture s les. Participants underwent transient elastography and clinical assessment by a nurse or general practitioner. Among 839 participants (mean age 43 years), 66% were male (n = 550), 64% (n = 537) injected drugs in the previous month, and 67% (n = 560) reported currently receiving opioid substitution therapy. Overall, 45% (n = 380) had detectable HCV RNA, of whom 23% (n = 86) received HCV treatment within 12 months of enrolment. HCV treatment uptake increased from 2% in the pre-DAA era to 38% in the DAA era. Significant liver fibrosis (F2-F4) was more common in participants with HCV infection (38%) than those without (19%). Age 50 years or older (aOR, 2.88 95% CI, 1.18-7.04) and attending a clinical follow-up with nurse (aOR, 3.19 95% CI, 1.61-6.32) or physician (aOR, 11.83 95% CI, 4.89-28.59) were associated with HCV treatment uptake. Recent injection drug use and unstable housing were not associated with HCV treatment uptake. HCV treatment uptake among PWID has increased markedly in the DAA era. Evaluation of innovative and simplified models of care is required to further enhance treatment uptake.
Publisher: Elsevier BV
Date: 12-2021
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.MEEGID.2016.06.015
Abstract: Effective surveillance and treatment strategies are required to control the hepatitis C virus (HCV) epidemic. Phylogenetic analyses are powerful tools for reconstructing the evolutionary history of viral outbreaks and identifying transmission clusters. These studies often rely on Sanger sequencing which typically generates a single consensus sequence for each infected in idual. For rapidly mutating viruses such as HCV, consensus sequencing underestimates the complexity of the viral quasispecies population and could therefore generate different phylogenetic tree topologies. Although deep sequencing provides a more detailed quasispecies characterization, in-depth phylogenetic analyses are challenging due to dataset complexity and computational limitations. Here, we apply deep sequencing to a characterized population to assess its ability to identify phylogenetic clusters compared with consensus Sanger sequencing. For deep sequencing, a s le specific threshold determined by the 50th percentile of the patristic distance distribution for all variants within each in idual was used to identify clusters. Among seven patristic distance thresholds tested for the Sanger sequence phylogeny ranging from 0.005-0.06, a threshold of 0.03 was found to provide the maximum balance between positive agreement (s les in a cluster) and negative agreement (s les not in a cluster) relative to the deep sequencing dataset. From 77 HCV seroconverters, 10 in iduals were identified in phylogenetic clusters using both methods. Deep sequencing analysis identified an additional 4 in iduals and excluded 8 other in iduals relative to Sanger sequencing. The application of this deep sequencing approach could be a more effective tool to understand onward HCV transmission dynamics compared with Sanger sequencing, since the incorporation of minority sequence variants improves the discrimination of phylogenetically linked clusters.
Publisher: American Public Health Association
Date: 2020
Abstract: Objectives. To determine the number of people who inject drugs (PWID) in Canada and the annual coverage of opioid agonist treatment (OAT) and needle-and-syringe provision for PWID. Methods. We estimated the number of PWID in 11 of 13 Canadian provinces and territories in 2011 by using indirect multiplier methods based on provincial and territorial methadone recipient totals and proportion of surveyed PWID receiving methadone. We modeled annual increases for 2011 to 2016 on Quebec and British Columbia longitudinal data. We calculated needle-and-syringe coverage (World Health Organization [WHO] recommendation: ≥ 200 per PWID) and OAT coverage (WHO recommendation: ≥ 40 per 100 PWID) per province and territory annually. Results. An estimated 130 000 in iduals in Canada (0.55%) injected drugs in 2011, increasing to 171 900 in iduals (0.70%) in 2016. Needle-and-syringe coverage increased from 193 to 291 per PWID, and OAT coverage increased from 55 to 66 per 100 PWID over the study period. Conclusions. While the number of PWID increased between 2011 and 2016, OAT coverage remained high, and needle-and-syringe coverage generally improved over time. Public Health Implications. These data will inform public health surveillance, service planning, and resource allocation, and assist monitoring of treatment and harm-reduction coverage outcomes.
Publisher: Wiley
Date: 06-2015
DOI: 10.1111/JVH.76_12425
Publisher: Cold Spring Harbor Laboratory
Date: 28-08-2023
DOI: 10.1101/2023.08.27.23294704
Abstract: This study investigated the humoral and cellular immune responses in in iduals with long COVID (LC) compared to age and gender matched recovered COVID-19 controls (MC) over 24-months. LC participants showed elevated spike and nucleocapsid IgG levels, higher neutralizing capacity, and increased spike- and nucleocapsid-specific CD4+ T cells, PD-1, and TIM-3 expression on CD4+ and CD8+ T cells at 3- and 8-months, but these differences did not persist at 24-months. Some LC participants had detectable IFN-γ and IFN-β, that was attributed to reinfection and antigen re-exposure. Single-cell RNA sequencing at 24-month timepoint revealed similar immune cell proportions and reconstitution of naïve T and B cell subsets in LC. No significant differences in exhaustion scores or antigen-specific T cell clones were observed. These findings suggest resolution of immune activation in LC and return to comparable immune responses between LC and MC over time. Improvement in self-reported health-related quality of life at 24-months was also evident in the majority of LC (62%). PTX3, CRP levels and platelet count were associated with improvements in health-related quality of life.
Publisher: Elsevier BV
Date: 2016
Publisher: American Medical Association (AMA)
Date: 09-08-2022
Publisher: Wiley
Date: 16-08-2020
DOI: 10.1111/ADD.15192
Publisher: Elsevier BV
Date: 09-2020
Publisher: JMIR Publications Inc.
Date: 31-01-2023
DOI: 10.2196/39424
Abstract: Increasing numbers of opioid overdoses have been observed during the COVID-19 pandemic, likely reflecting the pandemic’s multiple effects on this already vulnerable population. People in recovery from opioid use disorder (OUD) have reported disproportionate psychosocial distress and isolation, as well as significant disruptions in access to treatment, including peer support, during the COVID-19 pandemic. Peer support is a key component of many evidence-based OUD recovery programs it improves recovery capital, treatment engagement, and perceived social support and reduces psychosocial distress, particularly when used in conjunction with other evidence-based treatments, such as medication for OUD. This study aims to evaluate a novel mobile peer support app platform among a national s le of in iduals in recovery from OUD as an adjunct to usual care during the COVID-19 pandemic. In iduals residing in the United States who are aged ≥18 years own a smartphone and self-report being in recovery for an OUD, being in treatment for an OUD (ie, in the past 30 days received prescribed methadone, naltrexone, or buprenorphine), or currently receiving some form of assisted recovery support (n=1300) will be recruited through online, targeted social media advertisements. Eligible participants will be randomly assigned (1:1) to a mobile peer recovery support intervention utilizing a novel smartphone-based app or to a control. Participants will complete 1 baseline survey and then a follow-up survey 1, 3, and 6 months after randomization. The primary aim of recovery capital will be determined by the change in recovery capital between study groups over the 6-month study period. We will also examine treatment engagement by using administrative data from a subset of in iduals (n=650) residing in Rhode Island and Indiana. As of June 2022, we enrolled 43 participants. If this mobile app demonstrates efficacy among a large national s le of patients, it has the potential to augment existing treatment programs, improve recovery capital, and reduce the disproportionate impacts of COVID-19 on this vulnerable population. None declared. ClinicalTrials.gov NCT05405712 t2/show/NCT05405712
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 29-09-2014
DOI: 10.1002/HEP.27310
Publisher: Elsevier BV
Date: 12-2021
DOI: 10.1016/J.JSAT.2021.108588
Abstract: Emergency department (ED) visits for opioid-related overdoses continue to rise across the United States, particularly among Black, Latinx, and American Indian/Alaskan Native communities. A minority of people with opioid use disorder (OUD) engages in formal addiction treatment and there are racial disparities in treatment access. ED visits for opioid overdose are crucial opportunities to link in iduals with OUD to harm reduction and treatment services. However, we know little about whether racial inequities exist in ED treatment after opioid overdose. This observational, cross-sectional study examined differences in services provided to overdose patients who were discharged after an ED visit for opioid overdose by patient race-ethnicity. Primary outcomes included provision of take-home naloxone, ED-based behavioral counseling, and linkage to treatment. Race-ethnicity differences in post-overdose ED services were evaluated using chi-square analyses, and multivariable logistic regression analyses were conducted to examine associations of race-ethnicity with receiving post-overdose services, controlling for other institutional-, provider-, and patient-level factors. From September 2017 to February 2020, 734 patients were discharged from the ED for an opioid-related overdose. Most patients were White non-Latinx (70.0%), 8.9% were Black non-Latinx, 3.3% were Other race non-Latinx, and 18.0% were Latinx. Take-home naloxone was the most frequent intervention provided to patients while behavioral counseling was the lowest across all race-ethnicity categories. There were no statistically significant differences in provision of take-home naloxone and treatment referral based on patient race-ethnicity. However, a lower proportion of discharged Black non-Latinx patients received behavioral counseling compared to patients of other race-ethnicities, and the odds of receiving behavioral counseling was significantly higher for White non-Latinx (OR: 1.75 95% CI: 1.00, 3.06) Latinx (OR: 2.06 95% CI: 1.05, 4.06) and Other race non-Latinx (OR: 3.29 95% CI: 1.18, 9.15) patients compared to Black non-Latinx patients. Black non-Latinx patients discharged from the ED for an opioid-related overdose were less likely to receive behavioral counseling compared to non-Black patients. Possible reasons for this decreased provision of behavioral counseling include provider bias, patient mistrust of the medical and behavioral health care systems, and limited provider training in addiction medicine and motivational interviewing. These inequities add to the known racial disparities in ED patient care. Further research should elucidate barriers to behavioral counseling within ED settings and factors contributing to racial inequities in post-overdose emergency care.
Publisher: Elsevier BV
Date: 04-2014
Publisher: Elsevier BV
Date: 2017
Start Date: 2018
End Date: 2019
Funder: Canadian Institutes of Health Research
View Funded ActivityStart Date: 2011
End Date: 2014
Funder: Canadian Institutes of Health Research
View Funded ActivityStart Date: 2017
End Date: 2019
Funder: Fonds de Recherche du Québec - Santé
View Funded Activity