Human Immunodeficiency Virus Testing Among People Who Inject Drugs in Rural West Virginia

Abstract Background Limited research exists on factors associated with human immunodeficiency virus (HIV) testing among people who inject drugs (PWID) in rural America. The purpose of this research is to identify factors associated with rural PWID in Appalachia having not been tested for HIV in the past year. Methods Cross-sectional data (n = 408) from a 2018 PWID population estimation study in West Virginia were used to examine factors associated with PWID having not been tested for HIV in the past year. Results Most participants identified as male (61%), white, non-Hispanic (84%), and reported having recently injected heroin (81%) and/or crystal methamphetamine (71%). Most (64%) reported having been tested for HIV in the past year, 17% reported having been tested but not in the past year, and 19% reported never having been tested. In multivariable analysis, not having been in a drug treatment program in the past year was associated with PWID not having been tested for HIV in the past year (adjusted prevalence ratio, 1.430; 95% confidence interval, 1.080–1.894). Conclusions Drug treatment programs may be important venues for rural PWID to access HIV testing; however, testing services should be offered at multiple venues as most PWID had not engaged in drug treatment in the past year.

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Factors associated with HIV testing among men who have sex with men in Guatemala City

International Journal of STD & AIDS ◽

10.1177/0956462419826393 ◽

2019 ◽

Vol 30 (6) ◽

pp. 577-585

Author(s):

Sonia Morales-Miranda ◽

Itzel Loya-Montiel ◽

Julie Ritter ◽

Teresita Rocha-Jiménez ◽

Leah Gordon ◽

...

Keyword(s):

Hiv Testing ◽

Male Partner ◽

Guatemala City ◽

Anal Sex ◽

Hiv Knowledge ◽

Hiv Prevention Intervention ◽

Factors Associated ◽

The Past ◽

Immunodeficiency Virus ◽

Sex With Men

Although men who have sex with men (MSM) have the highest human immunodeficiency virus (HIV) prevalence in Guatemala, prevention efforts have been focused on other vulnerable populations. Respondent-driven sampling was used to recruit 444 MSM in Guatemala City to explore factors related to HIV testing among MSM. About 56% of participants reported HIV testing in the past 12 months, which was associated with a public MSM status (adjusted odds ratio (AOR) 2.08; 95% CI 1.02–4.26), participating in peer HIV prevention intervention (AOR 3.71; 95% CI 1.86–7.43), having at least one casual male partner (AOR 2.16; 95% CI 1.11–4.20), and practicing only insertive anal sex (AOR 3.35; 95% CI 1.59–7.09). Men with comprehensive HIV knowledge (AOR 2.63; 95% CI 1.38–5.02) were also more likely to have been tested. Further interventions in Guatemala targeting the most hidden MSM are needed.

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Food access among people who inject drugs in West Virginia

Harm Reduction Journal ◽

10.1186/s12954-021-00536-x ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Saba Rouhani ◽

Sean T. Allen ◽

Sara Whaley ◽

Rebecca Hamilton White ◽

Allison O’Rourke ◽

...

Keyword(s):

Drug Use ◽

West Virginia ◽

Disease Transmission ◽

Food Access ◽

People Who Inject Drugs ◽

The United States ◽

Cross Sectional ◽

Factors Associated ◽

The Past ◽

Adequate Food

Abstract Background The substance use epidemic in the United States continues to drive high levels of morbidity and mortality, particularly among people who inject drugs (PWID). Poor access to food often co-occurs with drug use and contributes to associated sequelae, such as risks for HIV and diabetes. The objective of this study was to examine factors associated with adequate food access among PWID in a rural Appalachian community. Methods Cross-sectional surveys were used to collect data among PWID aged 18 and older in Cabell County, West Virginia. Frequency of hunger and sociodemographic, structural and drug use characteristics were measured. Adequate food access was defined as reporting ‘never’ going to bed hungry at night in the past six months. Pearson’s χ2 and t-tests and multivariable logistic regression were used to identify factors associated with food access. Results Only 71 individuals (17%) reported never going to bed hungry at night in the past six months. Adjusted odds of having adequate food access were higher among PWID who completed high school (aOR 2.94; P = 0.010) and usually used drugs alone (aOR 1.97; P = 0.025), and lower among PWID who were female (aOR 0.51; P = 0.037), experienced homelessness (aOR 0.23, P < 0.001), were recently arrested (aOR 0.50 P = 0.047), and engaged in receptive sharing of injection equipment (aOR 0.52, P = 0.035). Conclusions We found extremely low food access in a population of PWID in Appalachia who are vulnerable to overdose and infectious disease transmission. Integrated interventions promoting food access are needed to improve the public health and wellbeing of people who inject drugs in Appalachia.

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HIV testing and ART initiation in people who inject drugs and are placed on methadone in Kachin State, Myanmar

Public Health Action ◽

10.5588/pha.19.0063 ◽

2020 ◽

Vol 10 (1) ◽

pp. 27-32

Author(s):

N. Lum ◽

K. T. Wai ◽

A. M. C. Thar ◽

K. L. Show ◽

A. D. Harries ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Hiv Testing ◽

People Who Inject Drugs ◽

Methadone Maintenance ◽

Age Distribution ◽

Methadone Maintenance Therapy ◽

Hiv Positive ◽

Art Initiation ◽

Immunodeficiency Virus ◽

Testing Uptake

Setting: People who inject drugs (PWID) enrolled for methadone maintenance therapy (MMT) and never previously tested for human immunodeficiency virus (HIV) in Myitkyina Drug Dependency Treatment Hospital, Myitkyina, Kachin State, Myanmar.Objectives: To compare before (2016) and after (2018) adoption of ‘Test and Treat’ guidelines for antiretroviral therapy (ART): 1) the demographic profile of PWID, 2) HIV testing uptake and ART initiation in those diagnosed HIV-positive, and 3) time taken for events.Design: This was a cohort study using secondary programme data.Results: In 2016 and 2018, there were respectively 141 and 146 PWID: all were male except for one female and age distribution between the 2 years was similar. In 2018, significantly more PWID were HIV-tested than in 2016 (85% vs. 45%; P ≤ 0.001). Among those tested, the proportions who were HIV-positive were similar (37% in 2016 and 38% in 2018). In 2018, significantly fewer HIV-positive PWID were started on ART than in 2016 (19% vs. 48%; P = 0.01). Median times between enrolment on MMT and HIV testing (2 vs. 1 day) and between being diagnosed HIV-positive and started on ART (31 vs. 17 days) for 2016 and 2018 were not significantly different.Conclusion: ART uptake decreased in 2018 compared with 2016, and ways to rectify this are urgently needed.

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Morbidity and Mortality Among Community-Based People Who Inject Drugs With a High Hepatitis C and Human Immunodeficiency Virus Burden in Chennai, India

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw121 ◽

2016 ◽

Vol 3 (3) ◽

Cited By ~ 8

Author(s):

Shruti H. Mehta ◽

Allison M. McFall ◽

Aylur K. Srikrishnan ◽

M. Suresh Kumar ◽

Paneerselvam Nandagopal ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Liver Disease ◽

Hepatitis C ◽

Alcohol Use ◽

Disease Progression ◽

People Who Inject Drugs ◽

Morbidity And Mortality ◽

Factors Associated ◽

Liver Disease Progression ◽

Immunodeficiency Virus

Abstract Background. There are limited data on clinical outcomes of hepatitis C virus (HCV) infection from low- and middle-income countries. We characterize mortality and liver disease progression in a cohort of people who inject drugs (PWID) with high HCV burden. Methods. In a cohort of PWID in Chennai, India, 851 persons were observed semiannually. Information on death was obtained through verbal autopsy and liver disease progression, which was defined as an incident liver stiffness measurement of ≥12.3 kPa if it was <12.3 at baseline. Poisson and Cox regression were used to identify factors associated with mortality and disease progression, respectively. Results. At baseline, 36.9% of cases were infected with HCV, 16.7% were infected with human immunodeficiency virus (HIV), 71.6% had no or mild stiffness, 14.9% had moderate stiffness, and 13.5% had severe stiffness or cirrhosis. Mortality was significantly higher among those with moderate (mortality rate ratio [MRR] = 2.31) and severe stiffness (MRR = 4.86) at baseline, those with ongoing substance use, those who were HIV monoinfected and not on antiretroviral therapy (ART) (MRR = 6.59), and those who were HIV/HCV coinfected regardless of ART status (MRR for no ART = 5.34; MRR for ART = 4.51). Of those with no or mild stiffness, 25.9% and 6.4% had evidence of progression to moderate and severe stiffness or cirrhosis, respectively; 38.3% of those with moderate stiffness had evidence of progression to severe stiffness or cirrhosis. Factors associated with progression included age, alcohol use, body mass index, and chronic HCV infection. Conclusions. We observed significant morbidity and mortality primarily driven by untreated HIV, HIV/HCV coinfection, and alcohol use. Even with improved access to HIV treatment, in the absence of HCV treatment, outcomes are unlikely to improve for HIV/HCV-coinfected persons.

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Food Security among People who Inject Drugs in West Virginia

10.21203/rs.3.rs-151915/v1 ◽

2021 ◽

Author(s):

Saba Rouhani ◽

Sean T Allen ◽

Sarah Whaley ◽

Rebecca H White ◽

Allison O'Rourke ◽

...

Keyword(s):

Food Security ◽

Drug Use ◽

West Virginia ◽

Disease Transmission ◽

People Who Inject Drugs ◽

The United States ◽

Cross Sectional ◽

Factors Associated ◽

The Past ◽

Poor Access

Abstract Background. The substance use epidemic in the United States continues to drive high levels of morbidity and mortality, particularly among people who inject drugs (PWID). Poor access to food co-occurs with illicit drug use and contributes to associated sequelae, such as HIV and diabetes. The objective of this study was to examine factors associated with food security among PWID in a rural Appalachian community. Methods. Cross-sectional surveys were used to collect data in a sample of 420 PWID aged 18 and older Cabell County, West Virginia. Frequency of food access and sociodemographic, structural and drug use characteristics were measured. Food security was defined as reporting ‘never’ going to bed hungry at night in the past six months. Pearson’s χ2 and t-tests were used to identify factors associated with food security. Multivariable logistic regression was employed to estimate adjusted odds of being food secure.Results. Only 71 individuals (17%) reported never going to bed hungry night in the past six months. Adjusted odds of being food secure were higher among PWID who completed high school (aOR 2.94; P=0.010) and usually using drugs alone (aOR 1.97; P=0.025), and lower among PWID who were female (aOR 0.51; P=0.037), experienced homelessness (aOR 0.23, P<0.001), were recently arrested (aOR 0.50 P=0.049), and engaged in receptive sharing of injection equipment (aOR 0.52, P=0.035).Conclusions. We found extremely low levels of food security in a population of PWID in Appalachia who are vulnerable to overdose and infectious disease transmission. Integrated interventions that approach food provision as harm reduction are needed to address the overlapping factors that jeopardize the health and wellbeing of people who inject drugs.

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Suicidality and Treatment Experience Among Young People Who Inject Drugs

10.31234/osf.io/yxwqd ◽

2020 ◽

Author(s):

Mary Ellen Mackesy-Amiti ◽

Lawrence J. Ouellet

Keyword(s):

Mental Health ◽

Substance Use ◽

Young People ◽

Mental Disorders ◽

Mental Health Treatment ◽

People Who Inject Drugs ◽

Multivariable Analysis ◽

Psychiatric Research ◽

Health Treatment ◽

The Past

Background. We examined correlates of past year suicidal thoughts and behavior (STB) and described past year treatment experiences among young people who inject drugs (PWID). Methods. Participants were 570 adults (18-25 years) who injected primarily heroin. Interviews were conducted at field stations operated by Community Outreach Intervention Projects in Chicago, Illinois (USA). Interviewers administered the Psychiatric Research Instrument for Substance and Mental Disorders. Substance use and mental disorders were based on DSM-IV diagnostic criteria. Past year STB was based on multiple questions. Results. Sixteen percent of men and 25% of women reported STB in the past year. In multivariable analysis, STB was associated with non-heterosexual orientation, foster care, and being raised by two parents. Primary major depression, post-traumatic stress disorder, other anxiety disorders, and borderline personality disorder had independent effects on suicidality. Among those reporting past year STB (n=111), 83% ever received mental health treatment, while 44% did so in the past year. While 24% of respondents indicated that at least one treatment matched their needs very well, 30% reported treatment that did not match their needs at all. The most common reason for ending treatment was program completion (about 50%) while getting better was endorsed by about 25%. Nearly half reported ending treatment due to a bad experience, logistical issues, or expense. Conclusions. Young PWID are at high risk for suicidal behavior and their mental health treatment experiences often do not meet their needs. There is a pressing need for more integrated substance use and mental health treatment.

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1061. False Positive Human Immunodeficiency Virus Testing Due to Acute Hepatitis A Infection: A Case Series

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1247 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S559-S559

Author(s):

Maria V Bandres ◽

Daniel Mueller

Keyword(s):

Human Immunodeficiency Virus ◽

Acute Hepatitis ◽

Hiv Testing ◽

False Positive ◽

Hepatitis A ◽

Screening Tests ◽

Hiv Screening ◽

Immunodeficiency Virus ◽

Acute Hepatitis A ◽

Hiv 1

Abstract Background In our urban, underserved patient population, Human Immunodeficiency Virus (HIV) is hyper-endemic, and HIV screening is frequently performed. Although HIV screening tests have high specificity, false positives can occur. Numerous reasons for false positive testing have been cited, including vaccinations, autoimmune diseases, and viral infections. In 2019, Philadelphia experienced a large Hepatitis A outbreak, during which time false positive HIV screening tests were discovered. Our aim was to further describe these patients who had been diagnosed with acute Hepatitis A infection and in whom false positive HIV testing had occurred. Methods We conducted a retrospective chart review of adult patients admitted to our hospital between January 2017 and December 2019 who had a positive Hepatitis A Virus (HAV) IgM. Demographics, HIV tests, viral hepatitis tests, and liver tests were recorded. False positive HIV was defined as a positive HIV screen (p24 antigen and HIV-1 and 2 antibody combo), followed by a negative differentiation assay for HIV-1 and 2 antibodies, combined with a negative HIV PCR. Results A total of 156 unique patients were found to have acute HAV, with 138 cases identified in 2019. Of these, 3 patients had confirmed false positive HIV testing, and 1 patient had suspected false positive HIV testing (HIV-2 differentiation assay indeterminate, with very low local prevalence of HIV-2), for a false positive test rate of 2.6% (4/156). Ages ranged from 36-47 years, 3 were male, and 2 were persons who injected drugs (PWID). Three patients had prior negative HIV testing. Two patients had fevers during admission, but none of the four were febrile at the time of HIV test collection. Three patients had elevated transaminases, and two had abnormal coagulation testing. Coinfection with Hepatitis C was found in three patients. One patient had follow-up HIV testing performed, which was negative. Conclusion To our knowledge, this is the first report of false positive HIV testing related to acute HAV. Prevalence of false positives was low, but awareness can facilitate patient counseling. With low sample size, conclusions cannot be drawn about risk factors related to false positive testing. Disclosures All Authors: No reported disclosures

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Estimates of the Time From Seroconversion to Antiretroviral Therapy Initiation Among People Newly Diagnosed With Human Immunodeficiency Virus From 2006 to 2015, New York City

Clinical Infectious Diseases ◽

10.1093/cid/ciz1178 ◽

2019 ◽

Vol 71 (8) ◽

pp. e308-e315

Author(s):

McKaylee M Robertson ◽

Sarah L Braunstein ◽

Donald R Hoover ◽

Sheng Li ◽

Denis Nash

Keyword(s):

Human Immunodeficiency Virus ◽

Antiretroviral Therapy ◽

Hiv Testing ◽

Mixed Model ◽

Linear Mixed Model ◽

Population Based ◽

Cd4 Count ◽

Hiv Diagnosis ◽

Art Initiation ◽

Immunodeficiency Virus

Abstract Background We estimated the time from human immunodeficiency virus (HIV) seroconversion to antiretroviral therapy (ART) initiation during an era of expanding HIV testing and treatment efforts. Methods Applying CD4 depletion parameters from seroconverter cohort data to our population-based sample, we related the square root of the first pretreatment CD4 count to time of seroconversion through a linear mixed model and estimated the time from seroconversion. Results Among 28 162 people diagnosed with HIV during 2006–2015, 89% initiated ART by June 2017. The median CD4 count at diagnosis increased from 326 (interquartile range [IQR], 132–504) cells/µL to 390 (IQR, 216–571) cells/µL from 2006 to 2015. The median time from estimated seroconversion to ART initiation decreased by 42% from 6.4 (IQR, 3.3–11.4) years in 2006 to 3.7 (IQR, 0.5–8.3) years in 2015. The time from estimated seroconversion to diagnosis decreased by 28%, from a median of 4.6 (IQR, 0.5–10.5) years to 3.3 (IQR, 0–8.1) years from 2006 to 2015, and the time from diagnosis to ART initiation reduced by 60%, from a median of 0.5 (IQR, 0.2–2.1) years to 0.2 (IQR, 0.1–0.3) years from 2006 to 2015. Conclusions The estimated time from seroconversion to ART initiation was reduced in tandem with expanded HIV testing and treatment efforts. While the time from diagnosis to ART initiation decreased to 0.2 years, the time from seroconversion to diagnosis was 3.3 years among people diagnosed in 2015, highlighting the need for more effective strategies for earlier HIV diagnosis.

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