Trends in homelessness and injection practices among young urban and suburban people who inject drugs: 1997-2017

Increasing overdose mortality and new HIV outbreaks in the U.S. highlight the need to identify risk behavior profiles among people who inject drugs (PWID). We characterized latent classes of drug use among a community-based sample of 671 PWID in Baltimore during 2017 and evaluated associations of these classes with sharing syringes, obtaining syringes from pharmacies or syringe services programs (SSPs), and nonfatal overdose in the past 6 months. We identified three classes of current drug use: infrequent use (76% of participants), prescription drug use (12%), and heroin and/or cocaine injection (12%). PWID in the heroin and/or cocaine injection and prescription drug use classes had higher odds of both overdose and sharing syringes (relative to infrequent use). PWID in the prescription drug use class were 64% less likely to obtain syringes through SSPs/pharmacies relative to heroin and/or cocaine injection. Harm reduction programs need to engage people who obtain prescription drugs illicitly.

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Risky injection practices and HCV awareness in Chiang Mai Province, Thailand: a respondent-driven sampling study of people who inject drugs

BMC Public Health ◽

10.1186/s12889-020-09549-w ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Myrtille Prouté ◽

Sophie Le Coeur ◽

Métrey H. Tiv ◽

Timothée Dub ◽

Parinya Jongpaijitsakul ◽

...

Keyword(s):

Harm Reduction ◽

Addiction Treatment ◽

People Who Inject Drugs ◽

Civil Society Organizations ◽

Public Health Approach ◽

Minority Ethnic Group ◽

Respondent Driven Sampling ◽

Chiang Mai ◽

Chiang Mai Province ◽

Injection Practices

Abstract Background People who inject drugs (PWID) are the most exposed to hepatitis C virus (HCV). In Thailand, drug use is highly criminalized, and harm reduction services are scarce. This study estimates risky injection practices and assesses the proportion of HCV awareness and screening in the PWID population in Northern Thailand. Methods We used respondent-driven sampling (RDS) to recruit PWID in Chiang Mai Province. Social and behavioural data were collected through face-to-face interviews at an addiction treatment facility. Weighted population estimates were calculated to limit biases related to the non-random sampling method. Univariate and multivariate analyses were performed to study factors associated with HCV awareness and screening. Results One hundred seventy-one PWID were recruited between April 2016 and January 2017. Median age was 33 (Interquartile range: 26–40) years, 12.2% were women, and 49.4% belonged to a minority ethnic group. Among participants, 76.8% injected heroin, 20.7% methadone, and 20.7% methamphetamine. We estimate that 22.1% [95% CI: 15.7–28.6] of the population had shared needles in the last 6 months and that 32.0% [95% CI: 23.6–40.4] had shared injection material. Only 26.6% [95% CI: 17.6–35.6] had heard of HCV. Factors independently associated with knowledge of HCV included belonging to a harm reduction organization (adjusted odds ratio (aOR) = 5.5 [95% CI: 2.0–15.3]) and voluntary participation in a drug rehabilitation programme (aOR = 4.3 [95% CI: 1.3–13.9]), while Lahu ethnicity was negatively associated (aOR = 0.3 [95% CI: 0.1–0.9]). We estimate that 5% of the PWID population were screened for HCV; the only factor independently associated with being screened was membership of a harm reduction organization (aOR = 5.7 [95% CI: 1.6–19.9]). Conclusion Our study reveals that the PWID population is poorly informed and rarely screened for HCV, despite widespread risky injection practices. A public health approach aimed at reducing the incidence of HCV should target the PWID population and combine harm reduction measures with information and destigmatization campaigns. Civil society organizations working with PWID are a major asset for the success of such an approach, based on their current positive interventions promoting awareness of and screening for HCV.

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Behavioral characteristics and injection practices associated with skin and soft tissue infections among people who inject drugs: A community-based observational study

Substance Abuse ◽

10.1080/08897077.2016.1263592 ◽

2016 ◽

Vol 38 (1) ◽

pp. 105-112 ◽

Cited By ~ 20

Author(s):

Disa Dahlman ◽

Anders Håkansson ◽

Alex H. Kral ◽

Lynn Wenger ◽

Elizabeth L. Ball ◽

...

Keyword(s):

Soft Tissue ◽

Observational Study ◽

People Who Inject Drugs ◽

Behavioral Characteristics ◽

Soft Tissue Infections ◽

Community Based ◽

Injection Practices

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1050. Hepatitis C Infection amongst People who Inject Drugs (PWID): Injection Practices and Risk Factors

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1236 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S554-S555

Author(s):

Nityasri Sankar ◽

Kim Murray ◽

Debra D Burris ◽

Kinna Thakarar

Keyword(s):

Risk Factors ◽

Hepatitis C ◽

People Who Inject Drugs ◽

Computer Assisted ◽

Opioid Epidemic ◽

Hepatitis C Infection ◽

Item Score ◽

Safe Injection ◽

Unsafe Injection ◽

Injection Practices

Abstract Background The rapidly progressing U.S. opioid epidemic has led to an increased prevalence of infections associated with injection drug use (IDU), such as Hepatitis C (HCV). Previous studies have identified a lack of screening, prevention, and treatment of HCV, which has contributed to an increase in HCV-related mortality. Transmission has been linked to unsafe injection practices. Our study aims to characterize risk factors associated with Hepatitis C (HCV) exposure amongst people who inject drugs (PWID) in Maine, a state heavily impacted by the opioid epidemic. Methods Data was obtained from a cross-sectional study of participants hospitalized with an IDU-associated infection at four hospitals in Maine identified as high-risk for HIV/HCV outbreaks. The Audio Computer-Assisted Self-Interview survey and medical record review were used to collect data. The components from the BIRSI 7-item score were used to assess the use of safe injection practices. HCV exposure was defined as HCV antibody positive and/or self-reported exposure. Analysis was performed using descriptive analyses and univariate regression modeling. Results Of the 101 participants enrolled, n=76 (75%) were identified as having exposure to HCV. Out of participants exposed to HCV, 57% reported homelessness (p=< 0.01). Participants exposed to HCV were more likely to have bacteremia during hospitalization (25%, p=.02). All participants unexposed to HCV perceived low likelihood of contracting HCV due to injecting (p=.01). Seventy-one percent of people exposed to HCV reported infrequent use alcohol pads prior to injecting (p=< 0.01) and 67% reported infrequent hand-washing (p=.09). Participants with a higher BIRSI-7 score had higher odds of exposure to HCV (OR=1.48, 95% CI 1.10-2.04). Conclusion The data obtained highlights significant relationships between HCV exposure and certain risk factors. Homelessness was found to be associated with HCV exposure, suggesting an opportunity for more targeted intervention within this subgroup of PWID. Unsafe injection practices as measured by the BIRSI-7 score were related to HCV exposure, indicating educational opportunities about safe injection practices. Overall, targeted harm reduction services could be beneficial in the screening and prevention of HCV exposure amongst PWID. Disclosures All Authors: No reported disclosures

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Trends in homelessness and injection practices among young urban and suburban people who inject drugs: 1997-2017

10.1101/2021.02.26.21252551 ◽

2021 ◽

Author(s):

Anna L. Hotton ◽

Mary Ellen Mackesy-Amiti ◽

Basmattee Boodram

Keyword(s):

Risk Behaviors ◽

Rural Areas ◽

People Who Inject Drugs ◽

Negative Binomial ◽

Mixed Effects ◽

Treatment Access ◽

Youth Homelessness ◽

Injection Risk ◽

Over Time ◽

Injection Practices

AbstractBackgroundAmong young people who inject drugs (PWID) homelessness is associated with numerous adverse psychosocial and health consequences, including risk of relapse and overdose, psychological distress and suicidality, limited treatment access, and injection practices that increase the risk of HIV and hepatitis C (HCV) transmission. Homeless PWID may also be less likely to access sterile syringes through pharmacies or syringe service programs.MethodsThis study applied random-effects meta-regression to examine trends over time in injection risk behaviors and homelessness among young PWID in Chicago and surrounding suburban and rural areas using data from 11 studies collected between 1997 and 2017. In addition, subject-level data were pooled to evaluate the effect of homelessness on risk behaviors across all studies using mixed effects logistic and negative binomial regression with random study effects.ResultsThere was a significant increase in homelessness among young PWID over time, consistent with the general population trend of increasing youth homelessness. In mixed-effects regression, homelessness was associated with injection risk behaviors (receptive syringe sharing, syringe mediated sharing, equipment sharing) and exchange sex, though we detected no overall changes in risk behavior over time.ConclusionsIncreases over time in homelessness among young PWID highlight a need for research to understand factors contributing to youth homelessness to inform HIV/STI, HCV, and overdose prevention and intervention services for this population.

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Promoting Safe Injection Practices, Substance Use Reduction, Hepatitis C Testing, and Overdose Prevention Among Syringe Service Program Clients Using a Computer-Tailored Intervention: Pilot Randomized Controlled Trial (Preprint)

10.2196/preprints.19703 ◽

2020 ◽

Author(s):

Karli R Hochstatter ◽

Shawnika J Hull ◽

Ajay K Sethi ◽

Marguerite E Burns ◽

Marlon P Mundt ◽

...

Keyword(s):

Substance Use ◽

Drug Use ◽

People Who Inject Drugs ◽

Readiness To Change ◽

Baseline Survey ◽

Overdose Prevention ◽

Prevention Services ◽

Safe Injection ◽

Hcv Testing ◽

Injection Practices

BACKGROUND Syringe service programs (SSPs) are safe, highly effective programs for promoting health among people who inject drugs. However, resource limitations prevent the delivery of a full package of prevention services to many clients in need. Computer-tailored interventions may represent a promising approach for providing prevention information to people who inject drugs in resource-constrained settings. OBJECTIVE The aim of this paper is to assess the effect of a computer-tailored behavioral intervention, called Hep-Net, on safe injection practices, substance use reduction, overdose prevention, and hepatitis C virus (HCV) testing among SSP clients. METHODS Using a social network–based recruitment strategy, we recruited clients of an established SSP in Wisconsin and peers from their social networks. Participants completed a computerized baseline survey and were then randomly assigned to receive the Hep-Net intervention. Components of the intervention included an overall risk synthesis, participants’ selection of a behavioral goal, and an individualized risk reduction exercise. Individuals were followed up 3 months later to assess their behavior change. The effect of Hep-Net on receiving an HCV screening test, undergoing Narcan training, reducing the frequency of drug use, and sharing drug equipment was assessed. The individual’s readiness to change each behavior was also examined. RESULTS From 2014 to 2015, a total of 235 people who injected drugs enrolled into the Hep-Net study. Of these, 64.3% (151/235) completed the follow-up survey 3-6 months postenrollment. Compared with the control group, individuals who received the Hep-Net intervention were more likely to undergo HCV testing (odds ratio [OR] 2.23, 95% CI 1.05-4.74; P=.04) and receive Narcan training (OR 2.25, 95% CI 0.83-6.06; P=.11), and they shared drug equipment less frequently (OR 0.06, 95% CI 0.55-0.65; P<.001). Similarly, individuals who received the intervention were more likely to advance in their stage of readiness to change these 3 behaviors. However, intervention participants did not appear to reduce the frequency of drug use or increase their readiness to reduce drug use more than control participants, despite the fact that the majority of the intervention participants selected this as the primary goal to focus on after participation in the baseline survey. CONCLUSIONS Implementing computer-based risk reduction interventions in SSPs may reduce harms associated with the sharing of injection equipment and prevent overdose deaths; however, brief computerized interventions may not be robust enough to overcome the challenges associated with reducing and ceasing drug use when implemented in settings centered on the delivery of prevention services. CLINICALTRIAL ClinicalTrials.gov NCT02474043; https://clinicaltrials.gov/ct2/show/NCT02474043 INTERNATIONAL REGISTERED REPORT RR1-10.2196/resprot.4830

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Promoting Safe Injection Practices, Substance Use Reduction, Hepatitis C Testing, and Overdose Prevention Among Syringe Service Program Clients Using a Computer-Tailored Intervention: Pilot Randomized Controlled Trial

Journal of Medical Internet Research ◽

10.2196/19703 ◽

2020 ◽

Vol 22 (9) ◽

pp. e19703 ◽

Cited By ~ 2

Author(s):

Karli R Hochstatter ◽

Shawnika J Hull ◽

Ajay K Sethi ◽

Marguerite E Burns ◽

Marlon P Mundt ◽

...

Keyword(s):

Substance Use ◽

Drug Use ◽

People Who Inject Drugs ◽

Readiness To Change ◽

Baseline Survey ◽

Overdose Prevention ◽

Prevention Services ◽

Safe Injection ◽

Hcv Testing ◽

Injection Practices

Background Syringe service programs (SSPs) are safe, highly effective programs for promoting health among people who inject drugs. However, resource limitations prevent the delivery of a full package of prevention services to many clients in need. Computer-tailored interventions may represent a promising approach for providing prevention information to people who inject drugs in resource-constrained settings. Objective The aim of this paper is to assess the effect of a computer-tailored behavioral intervention, called Hep-Net, on safe injection practices, substance use reduction, overdose prevention, and hepatitis C virus (HCV) testing among SSP clients. Methods Using a social network–based recruitment strategy, we recruited clients of an established SSP in Wisconsin and peers from their social networks. Participants completed a computerized baseline survey and were then randomly assigned to receive the Hep-Net intervention. Components of the intervention included an overall risk synthesis, participants’ selection of a behavioral goal, and an individualized risk reduction exercise. Individuals were followed up 3 months later to assess their behavior change. The effect of Hep-Net on receiving an HCV screening test, undergoing Narcan training, reducing the frequency of drug use, and sharing drug equipment was assessed. The individual’s readiness to change each behavior was also examined. Results From 2014 to 2015, a total of 235 people who injected drugs enrolled into the Hep-Net study. Of these, 64.3% (151/235) completed the follow-up survey 3-6 months postenrollment. Compared with the control group, individuals who received the Hep-Net intervention were more likely to undergo HCV testing (odds ratio [OR] 2.23, 95% CI 1.05-4.74; P=.04) and receive Narcan training (OR 2.25, 95% CI 0.83-6.06; P=.11), and they shared drug equipment less frequently (OR 0.06, 95% CI 0.55-0.65; P<.001). Similarly, individuals who received the intervention were more likely to advance in their stage of readiness to change these 3 behaviors. However, intervention participants did not appear to reduce the frequency of drug use or increase their readiness to reduce drug use more than control participants, despite the fact that the majority of the intervention participants selected this as the primary goal to focus on after participation in the baseline survey. Conclusions Implementing computer-based risk reduction interventions in SSPs may reduce harms associated with the sharing of injection equipment and prevent overdose deaths; however, brief computerized interventions may not be robust enough to overcome the challenges associated with reducing and ceasing drug use when implemented in settings centered on the delivery of prevention services. Trial Registration ClinicalTrials.gov NCT02474043; https://clinicaltrials.gov/ct2/show/NCT02474043 International Registered Report Identifier (IRRID) RR1-10.2196/resprot.4830

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Opioid substitution treatment as HIV prevention among people who inject drugs: Focus on developing country settings

PsycEXTRA Dataset ◽

10.1037/e628452012-097 ◽

2012 ◽

Author(s):

Atul Ambekar

Keyword(s):

Hiv Prevention ◽

Developing Country ◽

People Who Inject Drugs ◽

Substitution Treatment ◽

Opioid Substitution Treatment ◽

Opioid Substitution

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