“I want to stop using drugs. What should I do next?”

HIV ◽  
2020 ◽  
pp. 211-218
Author(s):  
Rick Elion
Keyword(s):  
People Who Inject Drugs ◽  
The United States ◽  
Oral Medications ◽  
Psychosocial Skills ◽  
B Virus ◽  
Key Driver ◽  
Opiate Substitution Therapy ◽  
Living With Hiv ◽  
The Impact ◽  
Actual Selection

The care of individuals living with HIV who inject drugs involves a unique subset of patients. People who inject drugs have become a key driver of new cases in the United States as the opiate epidemic has impacted such a large group of the population. The proliferation of oral narcotics prompted increased use of injectable opiates as the sale of oral medications became both more expensive and difficult. This epidemic has been confluent with the development of addiction, which can be very hard to treat, as well as the impact of adherence of active addiction on antiretroviral therapy medications. The challenge to the clinician caring for people who inject drugs is to become fluent in the treatment of HIV, hepatitis C virus, and hepatitis B virus, the psychosocial skills of dealing with addiction, and opiate substitution therapy. The chapter outlines approaches to care for this population that can assist with these clinical challenges as the actual selection of medications will not be unique for this population. Therefore, different approaches are being learned, not different sets of medications (except for opiate substitution treatment).

scholarly journals Frequent Cannabis Use and Cessation of Injection of Opioids, Vancouver, Canada, 2005–2018

2020 ◽  
Vol 110 (10) ◽  
pp. 1553-1560 ◽  
Author(s):  
Hudson Reddon ◽  
Kora DeBeck ◽  
M. Eugenia Socias ◽  
Stephanie Lake ◽  
Huiru Dong ◽  
...  
Keyword(s):  
Hazard Rate ◽  
People Who Inject Drugs ◽  
Cox Regression ◽  
The United States ◽  
Cannabis Use ◽  
Opioid Overdose ◽  
Cox Regression Analysis ◽  
Prospective Cohorts ◽  
Injection Cessation ◽  
The Impact

Objectives. To evaluate the impact of frequent cannabis use on injection cessation and injection relapse among people who inject drugs (PWID). Methods. Three prospective cohorts of PWID from Vancouver, Canada, provided the data for these analyses. We used extended Cox regression analysis with time-updated covariates to analyze the association between cannabis use and injection cessation and injection relapse. Results. Between 2005 and 2018, at-least-daily cannabis use was associated with swifter rates of injection cessation (adjusted hazard ratio [AHR] = 1.16; 95% confidence interval [CI] = 1.03, 1.30). A subanalysis revealed that this association was only significant for opioid injection cessation (AHR = 1.26; 95% CI = 1.12, 1.41). At-least-daily cannabis use was not significantly associated with injection relapse (AHR = 1.08; 95% CI = 0.95, 1.23). Conclusions. We observed that at-least-daily cannabis use was associated with a 16% increase in the hazard rate of injection cessation, and this effect was restricted to the cessation of injection opioids. This finding is encouraging given the uncertainty surrounding the impact of cannabis policies on PWID during the ongoing opioid overdose crisis in many settings in the United States and Canada.

scholarly journals 1316. Gathering Trauma Narratives: A Qualitative Study on the Impact of Traumas on People Living with HIV (PLWH)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S475-S475
Author(s):  
Doris Pierson ◽  
Vaidehi Mujumdar ◽  
Brittany Briceño ◽  
Elaina Cummer ◽  
Kshipra Hemal ◽  
...  
Keyword(s):  
United States ◽  
Reproductive Health ◽  
Viral Suppression ◽  
The United States ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Structured Interviews ◽  
Reproductive Intentions ◽  
Living With Hiv ◽  
The Impact

Abstract Background Trauma—emotional, physical, and psychological—is common and associated with increased risk behaviors, low rates of care engagement and viral suppression, and overall poor health outcomes for people living with HIV (PLWH). In the United States, there are limited data on how trauma affects reproductive health beliefs for PLWH and even less data on HIV providers’ understanding and consideration of these experiences in their approach to patients. Methods Fifteen semi-structured interviews were conducted with PLWH and nine semi-structured interviews were conducted with HIV care and service providers at an academic medical center in the Southeastern United States. Transcripts were analyzed using thematic analysis. Each transcript was coded by two investigators and discussed to ensure consensus. Results Participants’ narratives described diverse traumas, including sexual abuse (n = 6), the loss of a loved one (n = 8), and personal illness (n = 7). Types of trauma shared with providers included physical, sexual, illness, loss, and psychological. For patients, trauma was both a motivation for having children and a reason to stop having children. Providers perceived a variety of effects of trauma on both sexual behaviors and reproductive intentions. Reproductive counseling by HIV care providers (n = 5) focused on maintaining a healthy pregnancy and less on reproductive intentions prior to pregnancy. Reproductive discussions with pregnant female patients typically centered on reducing the risk of transmission in utero (including the importance of medication adherence to maintain viral suppression), what will happen during delivery, and breastfeeding risks. Reproductive discussions with males typically centered on preventing infection or re-infection of the mother. Conclusion PLWH interpret their trauma experiences differently, particularly when considering reproduction. Providers may not incorporate this information in counseling around reproductive health, highlighting the need fora trauma-informed healthcare practice that promotes awareness, education on the effect of past traumas on health, and access to appropriate resources. Disclosures All authors: No reported disclosures.

Hepatitis B virus exposure and vaccination in a cohort of people who inject drugs: What has been the impact of targeted free vaccination?

2013 ◽  
Vol 28 (2) ◽  
pp. 314-322 ◽  
Author(s):  
Rebecca J Winter ◽  
Paul M Dietze ◽  
Maelenn Gouillou ◽  
Margaret E Hellard ◽  
Priscilla Robinson ◽  
...  
Keyword(s):  
Hepatitis B Virus ◽  
Hepatitis B ◽  
People Who Inject Drugs ◽  
B Virus ◽  
Virus Exposure ◽  
The Impact

scholarly journals What is the impact of patient recruitment on offshoring of clinical trials?

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Maryam Kermanimojarad
Keyword(s):  
Clinical Trials ◽  
Human Subjects ◽  
Policy Decision ◽  
The United States ◽  
Decision Makers ◽  
Related Factors ◽  
Main Driver ◽  
Key Driver ◽  
The Impact ◽  
Insight Into

Abstract The issue of globalization of research is receiving considerable attention due to the increasing number of offshored R&D activities from the United States, Europe, and Japan. This paper explores this phenomenon and provides a model to analyze the factors that will likely contribute to a global transformation of clinical trials. By identifying the main characteristics of clinical trials, I aim to clarify the main driver of the relocation process of clinical research. I reviewed the relevant published articles to address the research questions. The results of this study challenge the traditional thinking of cost-related factors as the major reason for offshoring cilinical trials and show the importance of the recruitment of human subjects in trials. Consequently, this paper suggests that “recruitment crisis” in home country as the main contribution and a key driver to offshore R&D activities, has been underestimated by previous studies. In particular, this study provides policy-decision makers with a new insight into the development issue surrounding the pharmaceutical industry.

scholarly journals 27. Hepatitis B Virus Screening and Vaccination in Patients with HIV: A Survey of Physicians’ Current Clinical Practices

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S37-S38
Author(s):  
Elizabeth Hastie ◽  
Darcy Wooten
Keyword(s):  
Hepatitis B Virus ◽  
Hepatitis B ◽  
People Living With Hiv ◽  
Virologic Suppression ◽  
High Morbidity ◽  
Clinical Practices ◽  
Hbv Vaccination ◽  
B Virus ◽  
Living With Hiv ◽  
The Impact

Abstract Background Hepatitis B virus (HBV) and HIV co-infection is associated with high morbidity and mortality, but data and guidelines vary in terms of the best vaccination, re-vaccination, and monitoring practices. The purpose of this study was to evaluate the current HBV monitoring and vaccination practices of physicians who care for patients living with HIV. Methods A Web-based survey was distributed to the University of California San Diego (UCSD) Infectious Diseases division via the UCSD ID listserv, Infectious Disease Society of America (IDSA) members via the IDea Exchange listserv, and to ID and HIV social network members via Twitter and Facebook. The survey consisted of demographic questions followed by two sets of case-based questions. The case questions focused on type, timing, and dosage of HBV vaccination administration among people living with HIV, HBV monitoring post-vaccination, and clinical approach to patients with isolated hepatitis B core antibody. Results A total of 67 clinicians from 24 states completed the survey (Table 1). Most (55%) provide care for more than 20 patients living with HIV per month. The majority of participants (82%) would not defer HBV vaccination until HIV virologic suppression. Almost half of participants (43%) indicated they would use Heplisav-B over older HBV vaccine formulations (Energix-B or Recombivax-HB) for initial vaccination of susceptible patients. The majority (88%) would repeat a vaccination series if the patient does not seroconvert; 23% would repeat with a standard dose series of Energix-B or Recombivax-HB, 24% with a double dose series of Energix-B or Recombivax-HB, and 45% would repeat with Heplisav-B. Approach to management of a patient living with HIV with isolated hepatitis B core antibody was varied. The majority would check a HBV DNA level (42%), while 25% would initiate a vaccination series and 24% would not pursue further intervention (Table 2). Table 1: Clinician Demographics Table 2: HBV Vaccination Practices of Physicians Caring for People Living with HIV Conclusion This study provides insight into current HBV vaccination and monitoring practices of physicians who care for patients with HIV. The results revealed varied practice preferences and opportunities for improvement through standardization. Additional research is needed to elucidate the impact these various practices have on patient outcomes and healthcare expenditure. Disclosures All Authors: No reported disclosures

scholarly journals Empathizing with Black Women’s Experiences at the Intersections of Collective Trauma, Isolation, Anxiety, Depression, and HIV/AIDS amid a Global Pandemic: Narratives of Two Community Based Organization (CBO) Service Providers

2021 ◽  
Vol 5 (SI) ◽  
Author(s):  
Mattyna Stephens ◽  
Gwenetta Curry ◽  
Stacey Stephens
Keyword(s):  
Service Providers ◽  
The United States ◽  
Qualitative Inquiry ◽  
People Living With Hiv ◽  
Collective Trauma ◽  
Care Plans ◽  
Global Pandemic ◽  
Living With Hiv ◽  
The Impact ◽  
Hiv Aids

The novel coronavirus (COVID-19) emerged in the United States toward the close of 2019. CBOs were forced to either change their hours of operation or completely close their doors to avoid further widespread dissemination of the virus. The abrupt changes among CBOs posed some challenges for people living with HIV/AIDS (PLWHA), especially Black women living with HIV/AIDS (BWLHA). For this reason, this study aimed to explore the impact of the global pandemic on BWLHA receiving services from CBO service providers. A qualitative inquiry was used to examine the narratives of two CBOs’ service providers (i.e., Narrators 1 and 2). Hill-Collins's (1990) Black Feminist Theory was utilized to frame the research. Three approaches to narrative analysis also were employed to analyze participants' stories. Such narratives helped to underscore the trauma experienced by BWLHA. The stories also reflected feelings of loneliness, anxiety, and depression among the women. Meditation and advocacy were forms of learning provided for the women. The participation in "sister circles" was recognized as a system of support. Implications for practice suggested that CBOs' service providers develop collective trauma care plans that are comprehensive, specific to client’s needs, and informed by adult learning principles to help BWLHA navigate trauma events. 

scholarly journals Modeling Combination Hepatitis C Virus Treatment and Prevention Strategies in a Network of People Who Inject Drugs in the United States

2020 ◽  
Author(s):  
Alexei Zelenev ◽  
Jianghong Li ◽  
Portia Shea ◽  
Robert Hecht ◽  
Frederick L Altice
Keyword(s):  
United States ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
People Who Inject Drugs ◽  
Scale Up ◽  
The United States ◽  
Hcv Treatment ◽  
Opioid Agonist ◽  
Hcv Prevalence ◽  
The Impact

Abstract Background Hepatitis C virus (HCV) treatment as prevention (TasP) strategies can contribute to HCV microelimination, yet complimentary interventions such as opioid agonist therapies (OAT) with methadone or buprenorphine and syringe services programs (SSPs) may improve the prevention impact. This modeling study estimates the impact of scaling up the combination of OAT and SSPs with HCV TasP in a network of people who inject drugs (PWID) in the United States. Methods Using empirical data from Hartford, Connecticut, we deployed a stochastic block model to simulate an injection network of 1574 PWID. We used a susceptible-infected model for HCV and human immunodeficiency virus to evaluate the effectiveness of several HCV TasP strategies, including in combination with OAT and SSP scale-up, over 20 years. Results At the highest HCV prevalence (75%), when OAT coverage is increased from 10% to 40%, combined with HCV treatment of 10% per year and SSP scale up to 40%, the time to achieve microelimination is reduced from 18.4 to 11.6 years. At the current HCV prevalence (60%), HCV TasP strategies as low as 10% coverage per year may achieve HCV microelimination within 10 years, with minimal impact from additional OAT scale-up. Strategies based on mass initial HCV treatment (50 per 100 PWID the first year followed by 5 per 100 PWID thereafter) were most effective in settings with HCV prevalence of 60% or lower. Conclusions Scale-up of HCV TasP is the most effective strategy for microelimination of HCV. OAT scale-up, however, scale-up may be synergistic toward achieving microelimination goals when HCV prevalence exceeds 60% and when HCV treatment coverage is 10 per 100 PWID per year or lower.

Sign in / Sign up

Export Citation Format

Share Document