859. Suboptimal Uptake, Retention, and Adherence of Daily Oral PrEP Among People with OUD Receiving HCV Treatment

Abstract Background Daily oral pre-exposure prophylaxis (PrEP) with tenofovir/emtricitabine (TDF/FTC) effectively prevents HIV among people who use drugs (PWUD). Despite rising rates of HIV incidence and injection drug use, PrEP use remains low and limited research exists on PrEP adherence and retention in this population. Methods Based in Washington, DC and Baltimore, the ANCHOR investigation evaluated a community-based model of care collocating hepatitis C (HCV) therapy, medication for opioid use disorder (OUD), and PrEP in people with chronic HCV, OUD, and drug use within 1 year. PrEP counseling was offered from HCV treatment Day 0 until Week 24 and subjects could start any time during this window. PrEP patients were followed for 48 weeks and assessed for adherence by self-report and dried blood spot analysis of TDF. ANCHOR PrEP study enrollment and participant retention along the PrEP continuum. Results 198 participants enrolled in ANCHOR, of whom 185 (93%) were HIV-negative. 29 subjects (16% of HIV-negative group) initiated PrEP. 116 subjects (63%) met 2014 CDC criteria for PrEP initiation due to IDU (82, 44%), sex (9, 5%), or both (25, 14%). Those who initiated were more likely to meet both CDC sexual and IDU risk criteria than those who declined PrEP (P=0.006). Providers recommended PrEP to 94 subjects (51%), which was associated with uptake (P=0.02). While median treatment duration was 104 days (IQR 28, 276), only 8 subjects were retained through Week 48. The most common reason for discontinuation was side effects in 7 subjects or 24% of PrEP subgroup. Treatment interruptions occurred in one-third of the PrEP subgroup. Adherence of 4 to 7 pills per week was variable over time by self-report and declined by TDF analysis. No HIV seroconversions occurred. Demographic and epidemiological background of the ANCHOR study population. Total duration, in days, on PrEP in the ANCHOR study. Discontinued participants are grouped by reason for cessation of therapy. PrEP Adherence Adherence to PrEP by ANCHOR study timepoint, assessed via self-report (above) and dried bloodspot analysis of tenofovir level (below). Conclusion In this cohort of people with OUD and HCV, 16% of subjects started PrEP. While clinical recommendation was associated with uptake, high rates of disruption and discontinuation, compounded by variable pill adherence, made daily oral TDF/FTC a suboptimal preventive strategy in this cohort. Emerging PrEP modalities like long-acting injectables have potential to address these barriers, but PWUD have been excluded from their research and development to date. Additional work to identify vulnerable individuals and to promote use, adherence, and retention will be critical in implementing PrEP more effectively in this key population. Disclosures Sarah Kattakuzhy, MD, Gilead Sciences (Scientific Research Study Investigator, Research Grant or Support) Elana S. Rosenthal, MD, Gilead Sciences (Research Grant or Support)Merck (Research Grant or Support)

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Suboptimal uptake, retention, and adherence of daily oral PrEP among people with OUD receiving HCV treatment

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab658 ◽

2021 ◽

Author(s):

C Brokus ◽

S Kattakuzhy ◽

B Gayle ◽

S Narayanan ◽

A Davis ◽

...

Keyword(s):

Opioid Use Disorder ◽

Self Report ◽

Washington Dc ◽

Opioid Use ◽

Hcv Treatment ◽

Community Based ◽

Treatment Medication ◽

Long Acting ◽

Exposure Prophylaxis ◽

Hiv Negative

Abstract Introduction Daily oral pre-exposure prophylaxis (PrEP) with tenofovir/emtricitabine (TDF/FTC) prevents HIV among people who inject drugs (PWID). Despite rising HIV incidence and injection drug use, PrEP use remains low and there is limited research about uptake, adherence, and retention among PWID. Methods The ANCHOR investigation evaluated a community-based care model collocating hepatitis C (HCV) treatment, medication for opioid use disorder (OUD), and PrEP in individuals in Washington, DC-Baltimore. PrEP counseling was conducted from HCV treatment Day 0 until Week 24. Subjects could start any time during this window, were followed for 48 weeks, and were assessed for adherence by self-report and dried bloodspot TDF analysis. Results 198 participants were enrolled, of whom 185 (93%) were HIV-negative. Twenty-nine individuals (15.7% of HIV-negative cohort) initiated PrEP. 116 participants (62.7%) met 2014 CDC PrEP criteria due to IDU (82, 44.3%), sex (9, 4.9%), or both practices (25, 13.5%). Providers recommended PrEP to 94 individuals (50.8%), and recommendation was associated with PrEP uptake. Median treatment duration was 104 days (IQR 28, 276), with 8 participants retained through Week 48. Adherence was variable over time by self-report and declined by TDF analysis. No HIV seroconversions occurred. Conclusions This cohort of people with HCV and OUD experienced low uptake of PrEP despite the majority meeting CDC criteria. High rates of disruption and discontinuation, compounded by variable adherence, made TDF/FTC a suboptimal prevention strategy. Emerging modalities like long-acting formulations may address these barriers, but PWID have been excluded from their development to date.

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A cross-sectional study of factors associated with unstable housing among marginalized people who use drugs in Ottawa, Canada

PLoS ONE ◽

10.1371/journal.pone.0253923 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0253923

Author(s):

Ellen C. Rowlands Snyder ◽

Lisa M. Boucher ◽

Ahmed M. Bayoumi ◽

Alana Martin ◽

Zack Marshall ◽

...

Keyword(s):

Drug Use ◽

Community Integration ◽

Individual Characteristics ◽

Self Report ◽

People Who Use Drugs ◽

Cross Sectional ◽

Housing Status ◽

Unstable Housing ◽

Factors Associated ◽

Stable Housing

Introduction Housing affects an individual’s physical and mental health, particularly among people who use substances. Understanding the association between individual characteristics and housing status can inform housing policy and help optimize the care of people who use drugs. The objective of this study was to explore the factors associated with unstable housing among people who use drugs in Ottawa. Methods This is a cross-sectional analysis of data from 782 participants in the Participatory Research in Ottawa: Understanding Drugs (PROUD) Study. PROUD is a prospective cohort study of people who use drugs in Ottawa. Between March and December 2013, participants were recruited through peer-based recruitment on the streets and in social services settings and completed a peer-administered questionnaire that explored socio-demographic information, drug use patterns, community integration, experiences with police and incarceration, and access to health care and harm reduction services. Eligibility criteria included age of 16 years or older, self-reported illicit drug use within the past 12 months and having lived in Ottawa for at least 3 months. Housing status was determined by self-report. “Stable housing” was defined as residence in a house or apartment and “unstable housing” was defined as all other residence types. Exploratory multivariable logistic regression analyses of the association between characteristics of people who use drugs and their housing status were conducted. Results Factors that were associated with unstable housing included: recent incarceration; not having a regular doctor; not having received support from a peer worker; low monthly income; income source other than public disability support payments; and younger age. Gender, language, ethnicity, education level, opioid use and injection drug use were not independently associated with housing status. Conclusions People who use drugs face significant barriers to stable housing. These results highlight key areas to address in order to improve housing stability among this community.

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“Running myself ragged”: stressors faced by peer workers in overdose response settings

Harm Reduction Journal ◽

10.1186/s12954-020-00449-1 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Zahra Mamdani ◽

Sophie McKenzie ◽

Bernadette Pauly ◽

Fred Cameron ◽

Jennifer Conway-Brown ◽

...

Keyword(s):

Drug Use ◽

Focus Groups ◽

Mixed Methods Research ◽

Financial Burden ◽

People Who Use Drugs ◽

Frequency Distributions ◽

Sequential Mixed Methods ◽

Health Quality ◽

Mental Health Effects ◽

Perception Of Health

Abstract Background Peer workers or “peers” (workers with past or present drug use experience) are at the forefront of overdose response initiatives, and their role is essential in creating safe spaces for people who use drugs (PWUD). Working in overdose response settings has benefits for peer workers but is also stressful, with lasting emotional and mental health effects. Yet, little is known about the stressors peer workers face and what interventions can be implemented to support them in their roles. Methods This project used a community-based sequential mixed-methods research design. Eight peer researcher-led focus groups (n = 31) were conducted between November 2018 and March 2019 to assess needs of peer workers. The transcripts were thematically coded and analysed using interpretative description. These results informed a survey, which was conducted (n = 50) in September 2019 to acquire quantitative data on peer workers’ perception of health, quality of life, working conditions and stressors. Frequency distributions were used to describe characteristics of participants. X2 distribution values with Yates correction were conducted to check for association between variables. Results Five themes emerged from the focus groups that point to stressors felt by peer workers: (1) financial insecurity; (2) lack of respect and recognition at work; (3) housing challenges; (4) inability to access and/or refer individuals to resources; and (5) constant exposure to death and trauma. Consistent with this, the factors that survey participants picked as one of their “top three stressors” included financial situation, work situation, and housing challenges. Conclusion Peer workers are faced with a diversity of stressors in their lives which often reflect societal stigmatization of drug use. Recognition of these systemic stressors is critical in designing interventions to ease the emotional, physical and financial burden faced by peer workers.

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Adherence to Direct-Acting Antiviral Therapy in People Actively Using Drugs and Alcohol: The INCLUD Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa564 ◽

2020 ◽

Author(s):

Kristina M Brooks ◽

Jose R Castillo-Mancilla ◽

Mary Morrow ◽

Samantha MaWhinney ◽

Sarah E Rowan ◽

...

Keyword(s):

Drug Use ◽

Linear Models ◽

Virologic Response ◽

Directly Observed Therapy ◽

Hcv Treatment ◽

Open Label ◽

Direct Acting Antiviral ◽

Intention To Treat ◽

Adherence Data ◽

Direct Acting

Abstract Background HCV treatment in persons who use drugs (PWUD) is often withheld due to adherence and reinfection concerns. Here, we report treatment outcomes, technology-based adherence data, and adherence predictors in PWUD and/or alcohol. Methods INCLUD was a prospective, open-label study of ledipasvir/sofosbuvir for 12 weeks in PWUD aged 18-70 years. Participants were randomized to wireless (WOT, Wisepill®) or video-based directly observed therapy (vDOT, Emocha®). Drug use was assessed every 2 weeks. Sustained virologic response (SVR) was examined by intention-to-treat and as-treated. Factors associated with missing ≥1 dose(s) between visits were examined using generalized linear models. Results Sixty participants received ≥1 ledipasvir/sofosbuvir dose (47 HIV/HCV, 13 HCV only; 78% male; 22% Black; 25% cirrhotic). Substance use occurred at 94% of person-visits: 60% marijuana, 56% alcohol, 37% methamphetamine, 22% opioids, 17% cocaine, and 20% injection drug use. SVR by intention-to-treat was 86.7% (52/60) and as-treated was 94.5% (52/55). Confirmed failures included 1 relapse, 1 reinfection, and 1 unknown (suspected reinfection). Median (IQR [range]) total adherence was 96% (85-100% [30-101%]) and between-visit adherence was 100% (86-100% [0-107%]). Odds [95% CI] of missing ≥1 dose between visits increased with HIV coinfection (2.94 [1.37, 6.32], p=0.006), Black race (4.09 [1.42, 11.74], p=0.009), methamphetamine use (2.51 [1.44, 4.37], p=0.0.001) and cocaine use (2.12 [1.08, 4.18], p=0.03), and decreased with marijuana use (0.34 [0.17, 0.70], p=0.003) and vDOT (0.43 [0.21, 0.87], p=0.02). Conclusions PWUD achieved high SVR rates with high, but variable, ledipasvir/sofosbuvir adherence using technology-based methods. These findings support efforts to expand HCV treatment in PWUD.

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Food Insecurity Partially Mediates the Association Between Drug Use and Depressive Symptoms among Men who have Sex with Men in Los Angeles, California

Public Health Nutrition ◽

10.1017/s1368980021002494 ◽

2021 ◽

pp. 1-26

Author(s):

David A. Wiss ◽

Marjan Javanbakht ◽

Michael J. Li ◽

Michael Prelip ◽

Robert Bolan ◽

...

Keyword(s):

Food Security ◽

Depressive Symptoms ◽

High Risk ◽

Los Angeles ◽

Drug Use ◽

Food Insecurity ◽

Hiv Positive ◽

Sex With Men ◽

The Relationship ◽

Hiv Negative

Abstract Objective: To understand the relationship between drug use, food insecurity (FI), and mental health among men who have sex with men (MSM). Design: Cohort study (2014-2019) with at least one follow-up. Setting: Visits at 6-month intervals included self-assessment for FI and depressive symptoms. Urine testing results confirmed drug use. Factors associated with FI were assessed using multiple logistic regression with random effects for repeated measures. General structural equation modeling tested whether FI mediates the relationship between drug use and depressive symptoms. Participants: Data were from HIV-positive and high-risk HIV negative MSM in Los Angeles, CA (n=431; 1,192 visits). Results: At baseline, FI was reported by 50.8% of participants, depressive symptoms in 36.7%, and 52.7% of urine screening tests were positive for drugs (i.e., marijuana, opioids, methamphetamine, cocaine, ecstasy). A positive drug test was associated with a 96% increase in the odds of being food insecure (95% CI: 1.26-3.07). Compared to those with high food security, individuals with very low food security have a nearly 7-fold increase in the odds of reporting depressive symptoms (95% CI: 3.71-11.92). Findings showed 14.9% of the association between drug use (exposure) and depressive symptoms (outcome) can be explained by FI (mediator). Conclusion: The prevalence of FI among this cohort of HIV-positive and high-risk HIV-negative MSM was high; the association between drug use and depressive symptoms was partially mediated by FI. Findings suggest that enhancing access to food and nutrition may improve mood in the context of drug use, especially among MSM at risk for HIV-transmission.

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Use of illicit drugs by adolescents and young adults of an urban settlement in Brazil

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.64.02.114 ◽

2018 ◽

Vol 64 (2) ◽

pp. 114-118

Author(s):

Rafael Alves Guimarães ◽

Márcia Maria de Souza ◽

Karlla Antonieta Amorim Caetano ◽

Sheila Araujo Teles ◽

Marcos André de Matos

Keyword(s):

Young Adults ◽

Drug Use ◽

Illicit Drugs ◽

Illicit Drug ◽

Illicit Drug Use ◽

Self Report ◽

Adolescents And Young Adults ◽

Cross Sectional ◽

Urban Settlement ◽

Factors Associated

Summary Objective: To estimate the prevalence and factors associated with illicit drug use by adolescents and young adults of a formal urban settlement. Method: Cross-sectional study including adolescents and young adults 12-24 years of an urban settlement in the Midwest Region of Brazil. Data were collected using a structured questionnaire and analyzed using Stata, version 12.0. We used Poisson regression model to estimate the factors associated with illicit drug use. Results: Of the total participants (n=105), 27.6% (95CI 20.0-36.9%) had used illicit drugs such as marijuana, cocaine, crack, LSD and inhalants. The consumption of these substances was associated with male gender, use of body piercing and/or tattoos, licit drug use and self-report of signs and/or symptoms of sexually transmitted infections. Conclusion: High prevalence of illicit drug use was found in the individuals investigated, ratifying the presence of risk factors to the vulnerability of the settlers to use these substances in the urban settlement population.

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Efficacy and safety of a combined treatment of sodium stibogluconate at 20mg/kg/day with upper maximum daily dose limit of 850mg and Paromomycin 15mg/kg/day in HIV negative visceral leishmaniasis patients. A retrospective study, northwest Ethiopia

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0009713 ◽

2021 ◽

Vol 15 (8) ◽

pp. e0009713

Author(s):

Aschalew Tamiru ◽

Rezika Mohammed ◽

Saba Atnafu ◽

Girmay Medhin ◽

Asrat Hailu

Keyword(s):

Visceral Leishmaniasis ◽

Adverse Events ◽

Combined Treatment ◽

Daily Maximum ◽

Sodium Stibogluconate ◽

Efficacy And Safety ◽

African Countries ◽

Treatment Interruptions ◽

Hiv Negative

Background Visceral leishmaniasis (VL) is one of the most neglected tropical infectious diseases. It is fatal if left untreated. The objective of this study was to assess the efficacy and safety of 17-day injections of combined regimen of sodium stibogluconate and paromomycin (SSG/PM) in HIV-negative VL patients. Methods A retrospective analysis of medical records of VL patients treated in the University of Gondar Hospital during period 2012–2019 was carried out. Results A total of 2836 patients were treated for VL from 2012 to 2019. Of these 1233 were treated with SSG-PM, and 1000 of them were included in the study. Initial cure was achieved in 922 (92.2%) patients. The frequency of treatment failure, treatment interruptions, default and deaths respectively were 30 (3%), 20 (2%), 13 (1.3%) and 15 (1.5%). Among 280 patients who completed 6-month follow up, the final cure was 93.9% (263/280), 4 (1.4%) relapsed and 13 (4.6%) developed post-kala-azar dermal leishmaniasis (PKDL). The most common adverse events (AEs) were raised liver transaminases (35.1%; 351 patients), injection site pain (29.1%, 291 patients) and raised serum alpha-amylase (29.1%, 291 patients). Factors associated with poor treatment outcomes were sepsis, pneumonia, and adverse events. Conclusion A combination of SSG at 20mg/kg with upper daily maximum dose of 850mg and PM was effective for achieving initial cure at end of treatment and safe for treatment of HIV negative VL patients in northwestern Ethiopia. Our data are consistent with previous reports and confirms effectiveness of SSG/PM treatment regimen in the Eastern African countries. Efficacy at 6-months (93.9%) was estimated on data derived from patients who completed follow up and needs to be interrogated by future studies.

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LONG-TERM INCIDENCE OF CERVICAL CANCER IN WOMEN WITH HUMAN IMMUNODEFICIENCY VIRUS

Journal of Drug Delivery and Therapeutics ◽

10.22270/jddt.v8i5-s.1996 ◽

2018 ◽

Vol 8 (5-s) ◽

pp. 394-399

Author(s):

Subhash Kumar Mishra Golden ◽

Nidhi Vishnoi

Keyword(s):

Cervical Cancer ◽

Human Immunodeficiency Virus ◽

Cancer Prevention ◽

Incidence Rate ◽

Invasive Cervical Cancer ◽

Incidence Rates ◽

Self Report ◽

Prevention Measures ◽

Immunodeficiency Virus ◽

Hiv Negative

Background: The objective of this study was to estimate the incidence of invasive cervical cancer (ICC) in women with human immunodeficiency virus (HIV) and compare it with the incidence in HIV-uninfected women. Methods: In a cohort study of HIV-infected and uninfected women who had Papanicolaou tests obtained every 6 months, pathology reports were retrieved for women who had biopsy results or a self report of ICC. Histology was reviewed when reports confirmed ICC. Incidence rates were calculated and compared with those in HIV-negative women. Results: After a median follow-up of 10.3 years, 3 ICCs were confirmed in HIV-seropositive women, and none were confirmed in HIV-seronegative women. The ICC incidence rate was not found to be associated significantly with HIV status (HIV-negative women [0 of 100,000 person-years] vs HIV-positive women [21.4 of 100,000 person-years]; P = .59). A calculated incidence rate ratio standardized to expected results from the Surveillance Epidemiology and End Results database that was restricted to HIV-infected Women’s Interagency HIV Study participants was 1.32 (95% confidence interval, 0.27-3.85; P = 0.80). Conclusions: Among women with HIV in a prospective study that incorporated cervical cancer prevention measures, the incidence of ICC was not significantly higher than that in a comparison group of HIV-negative women. Keywords: Cervical Cancer, Human Immunodeficiency Virus, Women, Cancer Prevention.

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