Recurring severe injection-related infections in people who inject drugs and the need for safe injection sites in Madrid, Spain

Abstract Background and aims An estimated 58,749 people with opioid use disorder engaged in opioid agonist therapy in 1132 centers in Spain during 2017. We aimed to calculate the incidence of severe injection-related infections in people who inject drugs (PWID) engaged in opioid agonist therapy (OAT) in harm reduction settings without a safe consumption space (SCS). Methods A retrospective cohort study was performed in PWID engaged in (OAT) and in a mobile harm reduction unit to quantify admissions to a referral hospital for any severe injection-related infections between 1 January 2016 and 31 December 2019. A Cox proportional hazard regression analysis was used to assess factors associated with any severe injection-related infection. Results 237 PWID who engaged in OAT were included in the study. After a median follow-up of 5.5 months (IQR 1.3–22.7), a total of 104 episodes of severe injection-related infections occurred among 56 individuals, and admission due to a second event occurred in 35.7% of this same group. The incidence density of any type of severe injection-related infection was 26.8 (20.2–34.8) episodes per 100 person-years, and the incidence density of complicated skin and soft tissue infections that required hospital admission was 20.4 (15.0–27.3) episodes per 100 person-year. Fifty-six (53.8%) of all the episodes were patient-directed discharge, and people who had two or more hospital admissions had a higher PDD frequency. Conclusion Severe injection-related infections remain highly prevalent among PWID cared for in a harm reduction setting without a SCS. Patient-directed discharge was more frequent among higher-risk individuals who presented two or more hospital readmissions.

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Recurring Severe Injection-related Infections in People Who Inject Drugs and the Need for Safe Injection Sites in Spain

10.21203/rs.3.rs-389593/v1 ◽

2021 ◽

Author(s):

Jorge Valencia ◽

Jesús Troya ◽

Jeffrey V Lazarus ◽

Guillermo Cuevas ◽

Alejandro Alvaro-Meca ◽

...

Keyword(s):

Harm Reduction ◽

People Who Inject Drugs ◽

Hospital Admissions ◽

Hospital Readmissions ◽

Opioid Use Disorder ◽

Incidence Density ◽

Opioid Use ◽

Opioid Agonist ◽

Complicated Skin ◽

Safe Injection

Abstract Background and aims: An estimated 68,297 people with opioid use disorder engage in opioid agonist therapy (OAT) in Spain. We aimed to calculate the incidence of severe injection-related infections in people who inject drugs (PWID) engaged in OAT in a harm reduction setting without a safe injection site (SCS).Methods: A retrospective cohort study was performed in PWID engaged in OAT and in a mobile harm reduction unit to identify who was admitted to a referral hospital for any severe injection-related infections between 1 Jan 2016 and 31 Dec 2019. A Cox proportional hazard regression analysis was used to assess factors associated with any severe injection-related infection.Results: 237 PWID engaged in OAT were included. After a median follow-up of 5.5 months (IQR 1.3–22.7), a total of 104 episodes of severe injection-related infections occurred in 56 individuals, and admission for a second event occurred in 35.7% of this same group. The incidence density of any type of severe injection-related infection was 26.8 (20.2–34.8) episodes per 100 PY, and the incidence density of complicated skin and soft tissue infections (SSTIs) that required hospital admission was 20.4 (15.0–27.3) episodes per 100 PY. Fifty-six (53.8%) of all the episodes were patient-directed discharge (PDD), and people who had two or more hospital admissions had a higher PDD frequency.Conclusion: Severe injection-related infections remain highly prevalent among PWID cared for in a harm reduction setting without a SCS. PDD were more frequent in higher-risk individuals who presented two or more hospital readmissions.

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Concurrent Initiation of Hepatitis C and Opioid Use Disorder Treatment in People Who Inject Drugs

Clinical Infectious Diseases ◽

10.1093/cid/ciaa105 ◽

2020 ◽

Vol 71 (7) ◽

pp. 1715-1722 ◽

Cited By ~ 5

Author(s):

Elana S Rosenthal ◽

Rachel Silk ◽

Poonam Mathur ◽

Chloe Gross ◽

Rahwa Eyasu ◽

...

Keyword(s):

Hepatitis C ◽

Drug Use ◽

People Who Inject Drugs ◽

Opioid Use Disorder ◽

Opioid Use ◽

Agonist Therapy ◽

Hcv Treatment ◽

Opioid Agonist ◽

Opioid Agonist Therapy ◽

The Impact

Abstract Background People who inject drugs have a high prevalence of hepatitis C virus (HCV) and significant disease associated with drug use; however, HCV treatment often occurs in absence of interventions to address opioid use disorder and drug use–related harms. The impact of concurrent initiation of opioid agonist therapy (OAT) on HCV treatment and drug use outcomes is unknown. Methods In this prospective, open-label, observational trial at a harm reduction organization’s drop-in center in Washington, DC, 100 patients with chronic HCV infection, opioid use disorder, and ongoing injection drug use were treated with sofosbuvir-velpatasvir for 12-weeks and offered buprenorphine initiation. The primary end point was sustained virologic response (SVR), and secondary end points included uptake of and retention in OAT, change in risk behavior, and determinants of SVR. Results Eighty-two patients (82%) achieved SVR, which was not associated with baseline OAT status (P = .33), on-treatment drug use (P >.99), or imperfect daily adherence (P = .35) but was significantly associated with completing 2 or more 28-pill bottles of sofosbuvir-velpatasvir (P < .001) and receiving OAT at week 24 (P = .01). Of 67 patients not already receiving OAT at baseline, 53 (79%) started OAT. At week 24, 68 (68%) patients were receiving OAT. Receipt of OAT was associated with fewer opiate-positive urine drug screens (P = .003), lower human immunodeficiency virus risk-taking behavior scores (P < .001), and lower rates of opioid overdose (P = .04). Conclusions The Novel Model of Hepatitis C Treatment as an Anchor to Prevent HIV, Initiate Opioid Agonist Therapy, and Reduce Risky Behavior study demonstrates high uptake of buprenorphine collocated with HCV treatment, and it shows that concurrent initiation of OAT with HCV treatment can result in high rates of SVR while reducing risks associated with drug use. Clinical Trials Registration NCT03221309.

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Opioid agonist therapy uptake among people who inject drugs: The findings of two consecutive bio-behavioral surveillance surveys in Iran

10.21203/rs.3.rs-24098/v2 ◽

2020 ◽

Author(s):

Mehran Nakhaeizadeh ◽

Zahra Abdolahiniya ◽

Hamid Sharifi ◽

Ali Mirzazadeh ◽

Mostafa Shokoohi ◽

...

Keyword(s):

Health Outcomes ◽

Harm Reduction ◽

People Who Inject Drugs ◽

World Health ◽

Agonist Therapy ◽

Opioid Agonist ◽

Behavioral Surveillance ◽

Opioid Agonist Therapy ◽

Opioid Drugs ◽

History Of

Abstract Background Opioid agonist therapy (OAT) uptake has been associated with multiple positive health outcomes among people who inject drugs (PWID). This study evaluated the pattern of OAT uptake among PWID in two consecutive national bio-behavioral surveillance surveys (2010 and 2014) in Iran.Methods Data were obtained from two national bio-behavioral surveillance surveys (N2010 = 1,783 and N2014 = 2,166) implemented using convenience sampling at the harm reduction facilities and street venues in 10 geographically diverse urban centers across Iran. Multivariable logistic regression models were built to determine the correlates of OAT uptake for the 2014 survey and adjusted odds ratios (AORs) and 95% confidence intervals (CI) were reported.Results The prevalence of OAT uptake decreased from 49.2% in 2010 to 45.8% in 2014 (P-value = 0.033). OAT uptake varied across the studied cities ranging from 0.0%-69.3% in the 2010 survey and 3.2%-75.5% in the 2014 survey. Ever being married (AOR = 1.40; 95% CI: 1.12, 1.75), having a history of incarceration (AOR = 1.56; 95% CI: 1.16, 2.09), and human immunodeficiency virus (HIV) sero-positivity (AOR = 1.63; 95% CI: 1.08, 2.5) were associated with OAT uptake. Conversely, PWID who reported using only non-opioid drugs (AOR = 0.43; 95% CI: 0.26, 0.71) and those who reported concurrent use of opioid and non-opioid drugs (AOR = 0.66; 95% CI: 0. 0.51, 0.86) were less likely to uptake OAT. Conclusions Although OAT uptake among PWID in Iran is above the 40% threshold defined by the World Health Organization, there remains significant disparities across urban settings in Iran. Importantly, the OAT services appear to be serving high-risk PWID including those living with HIV and those with a history of incarceration. Evaluating service integration including mental health, HIV and hepatitis C virus care, and other harm reduction services may support the optimization of health outcomes of OAT across Iran.

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Factors associated with physical and sexual violence by police among people who inject drugs in Ukraine: implications for retention on opioid agonist therapy

Journal of the International AIDS Society ◽

10.7448/ias.19.4.20897 ◽

2016 ◽

Vol 19 ◽

pp. 20897 ◽

Cited By ~ 17

Author(s):

Oksana Kutsa ◽

Ruthanne Marcus ◽

Martha J Bojko ◽

Alexei Zelenev ◽

Alyona Mazhnaya ◽

...

Keyword(s):

Sexual Violence ◽

People Who Inject Drugs ◽

Agonist Therapy ◽

Opioid Agonist ◽

Factors Associated ◽

Opioid Agonist Therapy

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The duration dilemma in opioid agonist therapy

Journal of Opioid Management ◽

10.5055/jom.2021.0668 ◽

2021 ◽

Vol 17 (4) ◽

pp. 353-358

Author(s):

Anjali Dhanda, MD ◽

Edwin A. Salsitz, MD, DFASAM

Keyword(s):

Maintenance Treatment ◽

A Priori ◽

Opioid Use ◽

Agonist Therapy ◽

Short Term ◽

Opioid Agonist ◽

Adequate Treatment ◽

Opioid Agonist Therapy ◽

Optimal Outcomes

Objective: Studies dating back to 1964 consistently support the effectiveness of methadone as a maintenance treatment for opioid use disorder (OUD), and since 2003, the effectiveness of buprenorphine. Short-term detoxification has not proven to be an effective treatment, as it results in high relapse rates when compared with maintenance treatment with an opioid agonist therapy (OAT). The question about the duration of maintenance treatment for OUD has been debated with recommendations ranging from a minimum of 1 year, 2 years, to indefinitely. Other factors such as misconceptions, regulations, and insurance barriers also have an impact on the duration dilemma of OAT.Design: There were no a priori criteria for article inclusion and this is not a structured literature review. It is a review of articles of convenience from 1964 to 2018.Main outcome measure: This paper aims to address the dilemma of the ideal duration of OAT and to discuss the factors that could affect this decision.Results: Sustained OAT has had significantly better long-term outcomes than short-term detoxification or time limited maintenance. Optimal outcomes are dependent on adequate treatment duration.Conclusions: Addiction is a chronic brain disease and its treatment should be similar to the treatment of other chronic medical and psychiatric diseases. Long-term, sometimes lifetime, continuation of OAT for the treatment of OUD results in optimal outcomes when measuring morbidity and mortality. The accumulated evidence does not support any arbitrary limitation to the duration of OAT.

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Low Hepatitis C Reinfection Following Direct-acting Antiviral Therapy Among People Who Inject Drugs on Opioid Agonist Therapy

Clinical Infectious Diseases ◽

10.1093/cid/ciz693 ◽

2019 ◽

Vol 70 (12) ◽

pp. 2695-2702 ◽

Cited By ~ 14

Author(s):

Matthew J Akiyama ◽

Daniel Lipsey ◽

Moonseong Heo ◽

Linda Agyemang ◽

Brianna L Norton ◽

...

Keyword(s):

Hepatitis C ◽

People Who Inject Drugs ◽

Controlled Trial ◽

Extension Study ◽

Agonist Therapy ◽

Opioid Agonist ◽

Direct Acting Antiviral ◽

Opioid Agonist Therapy ◽

Direct Acting

Abstract Background Direct-acting antiviral (DAA) therapy is highly effective in people who inject drugs (PWID); however, rates, specific injection behaviors, and social determinants associated with hepatitis C virus (HCV) reinfection following DAA therapy among PWID on opioid agonist therapy (OAT) are poorly understood. Methods PREVAIL was a randomized controlled trial that assessed models of HCV care for 150 PWID on OAT. Those who achieved sustained virologic response (SVR) (n = 141; 94%) were eligible for this extension study. Interviews and assessments of recurrent HCV viremia occurred at 6-month intervals for up to 24 months following PREVAIL. We used survival analysis to analyze variables associated with time to reinfection. Results Of 141 who achieved SVR, 114 had a least 1 visit in the extension study (62% male; mean age, 52 years). Injection drug use (IDU) was reported by 19% (n = 22) in the extension study. HCV reinfection was observed in 3 participants. Over 246 person-years of follow-up, the incidence of reinfection was 1.22/100 person-years (95% CI, 0.25–3.57). All reinfections occurred among participants reporting ongoing IDU. The incidence of reinfection in participants reporting ongoing IDU (41 person-years of follow-up) was 7.4/100 person-years (95% CI, 1.5–21.6). Reinfection was associated with reporting ongoing IDU in the follow-up period (P < .001), a lack confidence in the ability to avoid contracting HCV (P < .001), homelessness (P = .002), and living with a PWID (P = .007). Conclusions HCV reinfection was low overall, but more common among people with ongoing IDU following DAA therapy on OAT, as well as those who were not confident in the ability to avoid contracting HCV, homeless, or living with a PWID. Interventions to mediate these risk factors following HCV therapy are warranted.

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Association between opioid agonist therapy and testing, treatment uptake, and treatment outcomes for hepatitis C infection among people who inject drugs: A systematic review and meta-analysis

Clinical Infectious Diseases ◽

10.1093/cid/ciaa612 ◽

2020 ◽

Cited By ~ 1

Author(s):

Jason Grebely ◽

Lucy Tran ◽

Louisa Degenhardt ◽

Alexander Dowell-Day ◽

Thomas Santo ◽

...

Keyword(s):

Treatment Outcomes ◽

People Who Inject Drugs ◽

Meta Analysis ◽

Hcv Rna ◽

Agonist Therapy ◽

Opioid Agonist ◽

Opioid Agonist Therapy ◽

Treatment Uptake ◽

Hcv Antibody ◽

Hcv Testing

Abstract Background People who inject drugs (PWID) experience barriers to accessing testing and treatment for hepatitis C virus (HCV) infection. Opioid agonist therapy (OAT) may provide an opportunity to improve access to HCV care. This systematic review assessed the association of OAT and HCV testing, treatment, and treatment outcomes among PWID. Methods Bibliographic databases and conference presentations were searched for studies assessing the association between OAT and HCV testing, treatment, and treatment outcomes [direct-acting antiviral (DAA) therapy only] among people who inject drugs (in the past year). Meta-analysis was used to pool estimates. Results Among 9,877 articles identified, 22 studies conducted in Australia, Europe, North America, and Thailand were eligible and included. Risk of bias was serious in 21 studies and moderate in one study. Current/recent OAT was associated with an increased odds of recent HCV antibody testing [4 studies; odds ratio (OR), 1.80; 95% CI:1.36, 2.39), HCV RNA testing among those who were HCV antibody positive (2 studies; OR, 1.83; 95% CI:1.27, 2.62), and DAA treatment uptake among those who were HCV RNA positive (7 studies; OR 1.53; 95% CI: 1.07, 2.20). There was insufficient evidence of an association between OAT and treatment completion (9 studies) or sustained virologic response following DAA therapy (9 studies). Conclusions Opioid agonist therapy can increase linkage to HCV care, including uptake of HCV testing and treatment among PWID. This supports the scale-up of OAT as part of strategies to enhance HCV treatment to further HCV elimination efforts.

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Optimizing Hepatitis C Virus (HCV) Treatment in a US Colocated HCV/Opioid Agonist Therapy Program

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa310 ◽

2020 ◽

Vol 7 (10) ◽

Author(s):

Jackie Habchi ◽

Aurielle M Thomas ◽

Sophie Sprecht-Walsh ◽

Elenita Arias ◽

Jeffrey Bratberg ◽

...

Keyword(s):

United States ◽

Hepatitis C Virus ◽

Hepatitis C ◽

Methadone Maintenance ◽

The United States ◽

Opioid Use ◽

Agonist Therapy ◽

Opioid Agonist ◽

Opioid Agonist Therapy

Abstract Background A minority of patients with opioid use disorder are treated for hepatitis C virus infection (HCV). While colocated HCV and opioid agonist therapy (OAT) along with harm reduction can facilitate prevention and cascade to cure, there are few real-world examples of such embedded care models in the United States in the direct-acting antiviral (DAA) era. Methods We conducted a retrospective chart review to determine sustained virologic response (SVR) and reinfection rates during the first 5-year period of DAA availability among individuals tested and treated on-site at Rhode Island’s only nonprofit methadone maintenance program. Results Of 275 who initiated DAAs, the mean age (range) was 43 (22–71) years, 34.5% were female, 57.5% had genotype 1a, 23.3% had cirrhosis, and 92% were Medicaid recipients. SVR was 85.0% (232/273), while modified intent-to-treat SVR was 93.2% (232/249); 17 patients did not achieve SVR, 2 awaited SVR 12 weeks post-end-of-treatment, and 24 were lost to follow-up. Thirty reinfections were identified over 375.5 person-years of follow-up (rate, 7.99/100 person-years). The median time to first reinfection (interquartile range) was 128 (85.25–202.5) days. Before July 1, 2018, 72 patients accessed DAAs over 3.7 years; after Medicaid DAA restrictions were lifted, 109 patients accessed DAAs over 1.3 years. The Prior Authorization (PA) process requires many steps, differing across 11 RI insurers, taking 45–120 minutes per patient. Conclusions DAA treatment was effective among a marginalized population in an urban colocated OAT/HCV program. Removing DAA restrictions facilitates treatment initiation. The PA process remains a modifiable barrier to expanding capacity in the United States.

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