scholarly journals 996Factors predicting retention among people accessing outpatient methadone maintenance therapy in Tshwane, South Africa

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Natasha Rachel Gloeck ◽  
Bernice Harris ◽  
Elizabeth Webb ◽  
Andrew Scheibe
Keyword(s):  
South Africa ◽  
Inner City ◽  
Methadone Maintenance ◽  
Secondary Data ◽  
Population Group ◽  
P Value ◽  
Opioid Use ◽  
Opioid Substitution Therapy ◽  
Heroin Users ◽  
Opioid Substitution

Abstract Background In South Africa, increasing illicit opioid use and associated health challenges can be managed with opioid substitution therapy (OST), like methadone, provided it is prescribed at the recommended dose and duration. The Community Oriented Substance Use Programme (COSUP) provides free methadone to patients with Opiod Use Disorder across Tshwane, South Africa on need-based criteria. Methods A retrospective cohort using secondary data of patients treated with methadone at eight COSUP sites. The factors associated with the retention of 575 participants for the period December 2016 to September 2018 were analysed. Results Participants on lower methadone doses had decreased odds of being retained (0 to 20mg: adjusted odds ratio (aOR) 0.25, p-value (p)=0.002, 95% Confidence Interval (CI) 0.10 - 0.61; 20 to 40mg: aOR 0.20, p < 0.001, 95% CI 0.08 - 0.49). Participants receiving free methadone had 3.75 the odds to be retained (p < 0.001, 95% CI 2.47 - 5.70). Inner-city participants had 5.19 the odds to be retained (p < 0.001, 95% CI 2.99 - 9.03). White participants had 3.39 the odds of being retained (p = 0.001, 95% CI 1.64 - 7.00). Injecting heroin users had 0.63 the odds of being retained (p = 0.032; 95% CI 0.41 - 0.96). Conclusions Methadone doses above 50mg, access to free methadone, accessing care within the inner-city and the white population group were positively associated with retention. Injecting drug use was negatively associated. Key messages Provision of free methadone at adequate doses can aid in retaining patients within an outpatient OST programme.

An Analysis of the Link between Water Infrastructure Financing and Water Provision South Africa

2018 ◽  
Vol 10 (3(J)) ◽  
pp. 74-83
Author(s):  
Lerato C. Bapela ◽  
Collins C. Ngwakwe ◽  
Mokoko P. Sebola
Keyword(s):  
South Africa ◽  
Quantitative Research ◽  
Secondary Data ◽  
P Value ◽  
Unique Contribution ◽  
Water Infrastructure ◽  
Control Variables ◽  
Policy Makers ◽  
Infrastructure Finance ◽  
Water Provision

This paper evaluated the relationship between water infrastructure financing and water provision in South Africa. The research followed a quantitative research design; secondary data for water infrastructure financing and water provision in South Africa was obtained from the Trans - Caledon Tunneling Agency (TCTA) and the World Bank for the period 1994 - 2014 . The regression results indicated two separate findings which offers unique contribution to the current literature; results from water asset finance as a single independent variable on water provision showed a significant relationship. However, an addition of two control variables , corruption and violence, neutralised the effectiveness of water asset finance on water provision to the extent that water asset finance became less significant with a P value of 0.05. The paper makes a nuance contribution from the findings, which specifically is that finance alone may not deliver target water provision if corruption and violence is left unbridled. The paper thus recommends the need for public policy makers to control the rate of corruption and violence to enable effective application of water infrastructure finance in water provision. The paper also recommends the need for further research on other government departments to integrate corruption and violence as control variables. 

scholarly journals Colorectal Cancer Incidence and Mortality Trends by Sex and Population Group in South Africa: 2002-2014.

2020 ◽  
Author(s):  
Lactatia Matsie Motsuku ◽  
Wenlong Carl Chen ◽  
Mazvita Molleen Muchengeti ◽  
Tamlyn Mac Quene ◽  
Patricia Kellett ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
South Africa ◽  
Black Males ◽  
Population Group ◽  
Black Population ◽  
Mortality Rates ◽  
P Value ◽  
Mortality Trends ◽  
Population Groups ◽  
Incidence And Mortality

Abstract BackgroundSouth Africa (SA) has experienced a rapid transition in the Human Development Index (HDI) over the past decade, which had an effect on the incidence and mortality rates of colorectal cancer (CRC). This study aims to provide CRC incidence and mortality trends by population group and sex in SA from 2002 to 2014.MethodsIncidence data were extracted from the South African National Cancer Registry and mortality data obtained from Statistics South Africa (STATS SA), for the period 2002 to 2014. Age-standardised incidence rates (ASIR) and age-standardised mortality rates (ASMR) were calculated using the STATS SA mid-year population as the denominator and the Segi world standard population data for standardisation. A Joinpoint regression analysis was computed for the CRC ASIR and ASMR by population group and sex.ResultsA total of 33,232 incident CRC cases and 26,836 CRC deaths were reported during the study period. Of the CRC cases reported, 54% were males and 46% were females, and among deaths reported, 47% were males and 53% were females. Overall, there was a 2.5% annual average percentage change (AAPC) increase in ASIR from 2002 to 2014 (95% CI: 0.6- 4.5, p-value <0.001). For ASMR overall, there was 1.3% increase from 2002 to 2014 (95% CI: 0.1- 2.6, p-value <0.001). The ASIR and ASMR among population groups were stable, with the exception of the Black population group. The ASIR increased consistently at 4.3% for black males (95% CI: 1.9- 6.7, p-value <0.001) and 3.4% for black females (95% CI: 1.5- 5.3, p-value <0.001) from 2002 to 2014, respectively. Similarly, ASMR for black males and females increased by 4.2% (95% CI: 2.0- 6.5, p-value <0.001) and 3.4% (, 95%CI: 2.0- 4.8, p-value <0.01) from 2002 to 2014, respectively.ConclusionsThe disparities in the CRC incidence and mortality trends may reflect socioeconomic inequalities across different population groups in SA. The rapid increase in CRC trends among the Black population group is concerning and requires further investigation and increased efforts for cancer prevention, early screening and diagnosis, as well as better access to cancer treatment.

scholarly journals Psychosis and Comorbid Opioid Use Disorder: Characteristics and Outcomes in Opioid Substitution Therapy

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Rachel Lamont ◽  
Tea Rosic ◽  
Nitika Sanger ◽  
Zainab Samaan
Keyword(s):  
Psychotic Disorder ◽  
Psychotic Disorders ◽  
Methadone Maintenance ◽  
Opioid Use Disorder ◽  
Mood Stabilizers ◽  
Opioid Use ◽  
Opioid Substitution Therapy ◽  
Group Status ◽  
Urine Drug ◽  
Retention In Treatment

Abstract Background and Objectives Substance use disorders are highly prevalent among individuals with psychotic disorders and are associated with negative outcomes. This study aims to explore differences in characteristics and treatment outcomes for individuals with psychotic disorders when compared with individuals with other nonpsychotic psychiatric disorders enrolled in treatment for opioid use disorder (OUD). Methods Data were collected from a prospective cohort study of 415 individuals enrolled in outpatient methadone maintenance treatment (MMT). Psychiatric comorbidity was assessed using the Mini-International Neuropsychiatric Interview. Participants were followed for 12 months. Participant characteristics associated with having a psychotic disorder versus another nonpsychotic psychiatric disorder were explored by logistic regression analysis. Results Altogether, 37 individuals (9%) with a psychotic disorder were identified. Having a psychotic disorder was associated with less opioid-positive urine drug screens (odds ratio [OR] = 0.97, 95% confidence interval [CI] = 0.95, 0.99, P = .046). Twelve-month retention in treatment was not associated with psychotic disorder group status (OR = 0.73, 95% CI = 0.3, 1.77, P = .485). Participants with psychotic disorders were more likely to be prescribed antidepressants (OR = 2.12, 95% CI = 1.06, 4.22, P = .033), antipsychotics (OR = 3.57, 95% CI = 1.74, 7.32, P = .001), mood stabilizers (OR = 6.61, 95% CI = 1.51, 28.97, P = .012), and benzodiazepines (OR = 2.22, 95% CI = 1.11, 4.43, P = .024). Discussion and Conclusions This study contributes to the sparse literature on outcomes of individuals with psychotic disorders and OUD-receiving MMT. Rates of retention in treatment and opioid use are encouraging and contrast to the widely held belief that these individuals do more poorly in treatment. Higher rates of coprescription of sedating and QTc-prolonging medications in this group may pose unique safety concerns.

scholarly journals Optimising opioid substitution therapy in the prison environment

2019 ◽  
Vol 15 (4) ◽  
pp. 293-307
Author(s):  
Farrukh Alam ◽  
Nat Wright ◽  
Paul Roberts ◽  
Sunny Dhadley ◽  
Joanne Townley ◽  
...  
Keyword(s):  
Online Survey ◽  
Care Plan ◽  
Positive Development ◽  
Opioid Use ◽  
Substitution Therapy ◽  
Treatment Needs ◽  
Opioid Substitution Therapy ◽  
Content Type ◽  
Opioid Substitution ◽  
Current Practices

Purpose The purpose of this paper is to examine the current provision of opioid substitution therapy (OST) during and immediately following release from detention in prisons in England and Wales. Design/methodology/approach A group of experts was convened to comment on current practices and to make recommendations for improving OST management in prison. Current practices were previously assessed using an online survey and a focus group with experience of OST in prison (Webster, 2017). Findings Disruption to the management of addiction and reduced treatment choice for OST adversely influences adequate provision of OST in prison. A key concern was the routine diversion of opiate substitutes to other prisoners. The new controlled drug formulations were considered a positive development to ensure streamlined and efficient OST administration. The following patient populations were identified as having concerns beyond their opioid use, and therefore require additional considerations in prison: older people with comorbidities and complex treatment needs; women who have experienced trauma and have childcare issues; and those with existing mental health needs requiring effective understanding and treatment in prison. Originality/value Integration of clinical and psychosocial services would enable a joint care plan to be tailored for each individual with opioid dependence and include options for detoxification or maintenance treatment. This would better enable those struggling with opioid use to make informed choices concerning their care during incarceration and for the period immediately following their release. Improvements in coordination of OST would facilitate inclusion of strategies to further streamline this process for the benefit of prisoners and prison staff.

scholarly journals Opioid substitution therapy for people living in German prisons—inequality compared with civic sector

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Heino Stöver ◽  
Daniela Jamin ◽  
Ingo Ilja Michels ◽  
Bärbel Knorr ◽  
Karlheinz Keppler ◽  
...  
Keyword(s):  
Health Care ◽  
Human Rights ◽  
Drug Use ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Substitution Therapy ◽  
Opioid Substitution Therapy ◽  
International Convention ◽  
Human Rights Standards ◽  
Opioid Substitution

Abstract Background The above-average proportion of people with opioid use disorder living in prisons is a worldwide reality, and the need to treat these people was recognized internationally more than 20 years ago. Studies have shown that substitution therapies are best suited to treat opioid use disorder and reduce the risk of HIV and hepatitis C transmission and overdose. However, huge health inequalities exist in and outside of prison due to the different implementation of opioid substitution therapy (OST). People living in prisons are entitled to the best possible health care. This is established by the Universal Declaration of Human Rights and by the International Convention on Economic, Social and Cultural Rights. Solely the imprisonment, and not the loss of fundamental human rights, constitutes the punishment. Methods A qualitative literature search using PubMed and Google Scholar was performed in order to identify relevant publications. Results This review shows the inequality in availability of opioid substitution therapy for people living in prison compared with people outside of prison in Germany. It also gives possible reasons and evidence for this inequality, showing that continuing or initiating OST in prison is more beneficial for the health of people living in prison than abstinence-oriented treatment only. Conclusion It is important that drug use disorder is treated as a serious illness also in prison. Joint efforts are needed to provide people living in prison with the best possible treatment and to minimize the adverse effects of drug use. Therefore, with laws, policies, and programs that conform to international human rights standards, each state must ensure that people living in prison receive the same health care as people outside of prison.

scholarly journals Pharmacotherapy Profiles in People with Opioid Use Disorders: Considerations for Relevant Drug–Drug Interactions with Antiviral Treatments for Hepatitis C

Pathogens ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 648
Author(s):  
Andreas Hintz ◽  
Tim Umland ◽  
Gero Niess ◽  
Mehtap Guendogdu ◽  
Anika Moerner ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Drug Interactions ◽  
People Who Inject Drugs ◽  
Lipid Lowering ◽  
Potential Ddis ◽  
Opioid Use ◽  
Opioid Substitution Therapy ◽  
Hcv Therapy ◽  
Direct Acting ◽  
Opioid Substitution

People who inject drugs (PWID) are often affected by physical and psychological diseases and prone to co-medication. In Germany, about 50% of PWID are on opioid substitution therapy (OST). Comprehensive data on pharmacotherapy in these patients may help to select antiviral therapy against hepatitis C virus (HCV) infections and avoid drug–drug interactions (DDIs). We compared co-medication profiles based on statutory health insurance prescriptions (IQVIA database) of PWID (n = 16,693), OST (n = 95,023) and treated HCV patients (n = 7886). Potential DDIs with the most widely used HCV direct-acting agents (Sofosbuvir/Velpatasvir, Glecaprevir/Pibrentasvir and Elbasvir/Grazoprevir) were evaluated based on the Liverpool DDI database. Co-medication was present in 57% of PWID, 57% of OST, 44% of patients on HCV therapy and 46% in a subgroup receiving OST+HCV therapy (n = 747 of 1613). For all groups, co-medication belonging to ATC-class N (nervous system) was most commonly prescribed (in 75%, 68%, 41% and 62% of patients, respectively). Contraindications (i.e., DDIs precluding HCV therapy) were infrequent (0.4–2.5% of co-medications); potential DDIs with HCV therapies were shown for 13–19% of co-medications, namely for specific substances including some analgesics, antipsychotics, anticoagulants, lipid lowering drugs and steroids. In conclusion, concomitant pharmacotherapy is common and clinically relevant when treating HCV infection in PWID.

scholarly journals Colorectal cancer incidence and mortality trends by sex and population group in South Africa: 2002–2014

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lactatia Motsuku ◽  
Wenlong Carl Chen ◽  
Mazvita Molleen Muchengeti ◽  
Megan Naidoo ◽  
Tamlyn Mac Quene ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
South Africa ◽  
Black Males ◽  
Population Group ◽  
Black Population ◽  
Mortality Rates ◽  
P Value ◽  
Mortality Trends ◽  
Population Groups ◽  
Incidence And Mortality

Abstract Background South Africa (SA) has experienced a rapid transition in the Human Development Index (HDI) over the past decade, which had an effect on the incidence and mortality rates of colorectal cancer (CRC). This study aims to provide CRC incidence and mortality trends by population group and sex in SA from 2002 to 2014. Methods Incidence data were extracted from the South African National Cancer Registry and mortality data obtained from Statistics South Africa (STATS SA), for the period 2002 to 2014. Age-standardised incidence rates (ASIR) and age-standardised mortality rates (ASMR) were calculated using the STATS SA mid-year population as the denominator and the Segi world standard population data for standardisation. A Joinpoint regression analysis was computed for the CRC ASIR and ASMR by population group and sex. Results A total of 33,232 incident CRC cases and 26,836 CRC deaths were reported during the study period. Of the CRC cases reported, 54% were males and 46% were females, and among deaths reported, 47% were males and 53% were females. Overall, there was a 2.5% annual average percentage change (AAPC) increase in ASIR from 2002 to 2014 (95% CI: 0.6–4.5, p-value < 0.001). For ASMR overall, there was 1.3% increase from 2002 to 2014 (95% CI: 0.1–2.6, p-value < 0.001). The ASIR and ASMR among population groups were stable, with the exception of the Black population group. The ASIR increased consistently at 4.3% for black males (95% CI: 1.9–6.7, p-value < 0.001) and 3.4% for black females (95% CI: 1.5–5.3, p-value < 0.001) from 2002 to 2014, respectively. Similarly, ASMR for black males and females increased by 4.2% (95% CI: 2.0–6.5, p-value < 0.001) and 3.4% (, 95%CI: 2.0–4.8, p-value < 0.01) from 2002 to 2014, respectively. Conclusions The disparities in the CRC incidence and mortality trends may reflect socioeconomic inequalities across different population groups in SA. The rapid increase in CRC trends among the Black population group is concerning and requires further investigation and increased efforts for cancer prevention, early screening and diagnosis, as well as better access to cancer treatment.

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