scholarly journals Trends in homelessness and injection practices among young urban and suburban people who inject drugs: 1997-2017

2021 ◽  
Author(s):  
Anna L. Hotton ◽  
Mary Ellen Mackesy-Amiti ◽  
Basmattee Boodram
Keyword(s):  
Risk Behaviors ◽  
Rural Areas ◽  
People Who Inject Drugs ◽  
Negative Binomial ◽  
Mixed Effects ◽  
Treatment Access ◽  
Youth Homelessness ◽  
Injection Risk ◽  
Over Time ◽  
Injection Practices

AbstractBackgroundAmong young people who inject drugs (PWID) homelessness is associated with numerous adverse psychosocial and health consequences, including risk of relapse and overdose, psychological distress and suicidality, limited treatment access, and injection practices that increase the risk of HIV and hepatitis C (HCV) transmission. Homeless PWID may also be less likely to access sterile syringes through pharmacies or syringe service programs.MethodsThis study applied random-effects meta-regression to examine trends over time in injection risk behaviors and homelessness among young PWID in Chicago and surrounding suburban and rural areas using data from 11 studies collected between 1997 and 2017. In addition, subject-level data were pooled to evaluate the effect of homelessness on risk behaviors across all studies using mixed effects logistic and negative binomial regression with random study effects.ResultsThere was a significant increase in homelessness among young PWID over time, consistent with the general population trend of increasing youth homelessness. In mixed-effects regression, homelessness was associated with injection risk behaviors (receptive syringe sharing, syringe mediated sharing, equipment sharing) and exchange sex, though we detected no overall changes in risk behavior over time.ConclusionsIncreases over time in homelessness among young PWID highlight a need for research to understand factors contributing to youth homelessness to inform HIV/STI, HCV, and overdose prevention and intervention services for this population.

scholarly journals A23 Population level diversification of hepatitis C viral strains over time among people who inject drugs in Baltimore, MD

2019 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
J Hackman ◽  
O Falade-Nwulia ◽  
S Mehta ◽  
Z Downing ◽  
G Kirk ◽  
...  
Keyword(s):  
Hepatitis C ◽  
People Who Inject Drugs ◽  
Population Level ◽  
Temporal Analysis ◽  
Transmission Risk ◽  
Treatment Access ◽  
Genotype 1A ◽  
Cluster Networks ◽  
Large Clusters ◽  
Over Time

Abstract Hepatitis C virus (HCV) infection occurs in 30–90 per cent of people who inject drugs (PWID). Although cure rates can exceed 95 per cent, treatment access is limited and approximately 400,000 people die each year due to complications of chronic infection. A temporal analysis of cluster networks among PWID can be used to inform strategies to interdict transmission. In Baltimore, PWID have been recruited for The AIDS Linked to the IntraVenous Experience (ALIVE) cohort. A demographic questionnaire was administered and recorded for baseline and recent participants. Viral RNA underwent PCR with primers targeting the core and envelope-1 protein (CE1) and sequenced via Sanger sequencing. Sequences with > 400 bp reads and Q-scores >370 were used for downstream analysis resulting in 322 ALIVE baseline participants (1988–9) and 548 recently diagnosed subjects enrolled approximately two decades later (2005–16). Cluster networks were rendered with a threshold of 4 per cent in MicrobeTRACE, and statistical analyses were performed in R Studio. Of the 1988–9 subjects, the majority (259/317, 81.7%) were a part of cluster. There were nine clusters and fifty-eight singletons, with two large clusters containing most sequences of genotype 1a (73.5%). Two decades later, a minority of recently diagnosed individuals (235/512, 44.1%) were part of a cluster. There were seventeen clusters with 286 singletons with two large clusters containing 1a genotype individuals (21.5%). Additional clustering was done by parsing the two datasets by subtype 1a (n = 714) and 1b (n = 151). The genotype 1a network demonstrates a majority, 65.8 per cent, of participants in clusters. Moreover, two large clusters can be observed with baseline participants towards the center and recent participants on the outskirts indicative of high linkage at baseline. The genotype 1b network produced a single large cluster but subclusters were observed. The sequences between the two time points co-mingled but subclusters were also observed. Interestingly, the two large clusters from 1988 to 1989 were still evident in the 2005–16 viral sequences. We observed greater cluster diversity in more recently diagnosed individuals, indicative of a less connected network of individuals sharing transmission risk, though major viral strains did persist over time in this cohort.

scholarly journals Egocentric Network Characteristics of People Who Inject Drugs in the Chicago Metro Area and Associations with Hepatitis C Virus and Injection Risk Behavior

2021 ◽  
Author(s):  
Mary Ellen Mackesy-Amiti ◽  
Joshua Falk ◽  
Carl Latkin ◽  
Maggie Kaufmann ◽  
Leslie Williams ◽  
...  
Keyword(s):  
Social Support ◽  
Hepatitis C ◽  
Harm Reduction ◽  
Risk Behavior ◽  
Risk Behaviors ◽  
People Who Inject Drugs ◽  
Support Networks ◽  
Support Network ◽  
Network Characteristics ◽  
Injection Risk

Abstract Background Hepatitis C (HCV) infection has been rising in the suburban and rural United States, mainly via injection-based transmission. Injection and sexual networks are recognized as an important element in fostering and preventing risky behavior, however the role of social support networks has received somewhat less attention. Methods Using baseline data from an ongoing longitudinal study, we examined the composition and structure of injection drug use (IDU), sex, and social support networks of young people who inject drugs (aged 18-30) and their injection network members. Lasso logistic regression was used to select a subset of network characteristics that were potentially important predictors of injection risk behaviors and HCV exposure. Results Several measures of IDU, sexual and support network structure and composition were found to be associated with HCV exposure, receptive syringe sharing (RSS), and ancillary equipment sharing. Gender and sexual relationships were important factors for all risk behaviors. Support network characteristics were also important, notably including a protective effect of majority Hispanic support networks for RSS and HCV exposure. Both IDU network residence heterogeneity and support network geography were associated with injection equipment sharing. Conclusions The associations of IDU and support network geography with equipment sharing highlight the need to extend harm reduction efforts beyond urban areas. Greater understanding of support network influences on risk behavior may provide important insights to strengthen the benefits of harm reduction. In considering the probability of HCV transmission, it is important to consider setting and network structures that promote propagation of risk.

scholarly journals The impact of COVID-19 on people who inject drugs in New York City: increased risk and decreased access to services

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Yesenia Aponte-Melendez ◽  
Pedro Mateu-Gelabert ◽  
Chunki Fong ◽  
Benjamin Eckhardt ◽  
Shashi Kapadia ◽  
...  
Keyword(s):  
Mental Health ◽  
New York ◽  
New York City ◽  
Substance Use ◽  
Risk Behaviors ◽  
York City ◽  
People Who Inject Drugs ◽  
Study Group ◽  
Injection Risk ◽  
The Impact

Abstract Background While people who inject drugs (PWID) are vulnerable to the adverse outcomes of events like COVID-19, little is known regarding the impact of the current pandemic on PWID. We examine how COVID-19 has affected PWID in New York City across four domains: substance use, risk behaviors, mental health, and service utilization. Methods As part of a randomized trial to improve access to HCV treatment for PWID, we recruited 165 participants. Eligibility criteria included detectable HCV RNA and recent drug injection. The present cross-sectional analysis is based on a subsample of 106 participants. We compared responses between two separate samples: 60 participants interviewed prior to the pandemic (pre-COVID-19 sample) and 46 participants interviewed during the pandemic (COVID-19 sample). We also assessed differences by study group [accessible care (AC) and usual care (UC)]. Results Compared to the pre-COVID-19 sample, those interviewed during COVID-19 reported higher levels of mental health issues, syringe reuse, and alcohol consumption and greater reductions in syringe-service programs and buprenorphine utilization. In the analysis conducted by study group, the UC group reported significantly higher injection risk behaviors and lower access to buprenorphine treatment during COVID-19, while during the same period, the AC group reported lower levels of substance use and injection risk behaviors. Conclusion The current study provides insight on how COVID-19 has negatively affected PWID. Placing dispensing machines of harm-reduction supplies in communities where PWID live and increasing secondary exchange, mobile services, and mail delivery of supplies may help maintain access to lifesaving supplies during big events, such as COVID-19. Trial registration ClinicalTrials.gov NCT03214679. Registered July 11 2017. https://clinicaltrials.gov/ct2/show/NCT03214679.

scholarly journals Trends in Injection Risk Behaviors among People Who Inject Drugs and the Impact of Harm Reduction Programs in Ukraine, 2007–2013

2017 ◽  
Vol 94 (1) ◽  
pp. 104-114 ◽  
Author(s):  
Iuliia Makarenko ◽  
D. C. Ompad ◽  
Y. Sazonova ◽  
T. Saliuk ◽  
J. DeHovitz ◽  
...  
Keyword(s):  
Harm Reduction ◽  
Risk Behaviors ◽  
People Who Inject Drugs ◽  
Injection Risk ◽  
The Impact

scholarly journals Predictors of historical change in drug treatment coverage among people who inject drugs in 90 large metropolitan areas in the USA, 1993–2007

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Barbara Tempalski ◽  
Leslie D. Williams ◽  
Brooke S. West ◽  
Hannah L. F. Cooper ◽  
Stephanie Beane ◽  
...  
Keyword(s):  
Public Health ◽  
Drug Treatment ◽  
Resource Availability ◽  
People Who Inject Drugs ◽  
Census Data ◽  
Poverty Rate ◽  
Community Action ◽  
Historical Change ◽  
Treatment Coverage ◽  
Over Time

Abstract Background Adequate access to effective treatment and medication assisted therapies for opioid dependence has led to improved antiretroviral therapy adherence and decreases in morbidity among people who inject drugs (PWID), and can also address a broad range of social and public health problems. However, even with the success of syringe service programs and opioid substitution programs in European countries (and others) the US remains historically low in terms of coverage and access with regard to these programs. This manuscript investigates predictors of historical change in drug treatment coverage for PWID in 90 US metropolitan statistical areas (MSAs) during 1993–2007, a period in which, overall coverage did not change. Methods Drug treatment coverage was measured as the number of PWID in drug treatment, as calculated by treatment entry and census data, divided by numbers of PWID in each MSA. Variables suggested by the Theory of Community Action (i.e., need, resource availability, institutional opposition, organized support, and service symbiosis) were analyzed using mixed-effects multivariate models within dependent variables lagged in time to study predictors of later change in coverage. Results Mean coverage was low in 1993 (6.7%; SD 3.7), and did not increase by 2007 (6.4%; SD 4.5). Multivariate results indicate that increases in baseline unemployment rate (β = 0.312; pseudo-p < 0.0002) predict significantly higher treatment coverage; baseline poverty rate (β = − 0.486; pseudo-p < 0.0001), and baseline size of public health and social work workforce (β = 0.425; pseudo-p < 0.0001) were predictors of later mean coverage levels, and baseline HIV prevalence among PWID predicted variation in treatment coverage trajectories over time (baseline HIV * Time: β = 0.039; pseudo-p < 0.001). Finally, increases in black/white poverty disparity from baseline predicted significantly higher treatment coverage in MSAs (β = 1.269; pseudo-p < 0.0001). Conclusions While harm reduction programs have historically been contested and difficult to implement in many US communities, and despite efforts to increase treatment coverage for PWID, coverage has not increased. Contrary to our hypothesis, epidemiologic need, seems not to be associated with change in treatment coverage over time. Resource availability and institutional opposition are important predictors of change over time in coverage. These findings suggest that new ways have to be found to increase drug treatment coverage in spite of economic changes and belt-tightening policy changes that will make this difficult.

scholarly journals The power of modelling pulsatile profiles

2021 ◽  
Author(s):  
Michiel J. van Esdonk ◽  
Jasper Stevens
Keyword(s):  
Growth Hormone ◽  
Statistical Power ◽  
Quantitative Description ◽  
Mixed Effects ◽  
Post Dose ◽  
Deconvolution Analysis ◽  
Linear Mixed Effects ◽  
Non Linear ◽  
Over Time ◽  
Modelling Approach

AbstractThe quantitative description of individual observations in non-linear mixed effects models over time is complicated when the studied biomarker has a pulsatile release (e.g. insulin, growth hormone, luteinizing hormone). Unfortunately, standard non-linear mixed effects population pharmacodynamic models such as turnover and precursor response models (with or without a cosinor component) are unable to quantify these complex secretion profiles over time. In this study, the statistical power of standard statistical methodology such as 6 post-dose measurements or the area under the curve from 0 to 12 h post-dose on simulated dense concentration–time profiles of growth hormone was compared to a deconvolution-analysis-informed modelling approach in different simulated scenarios. The statistical power of the deconvolution-analysis-informed approach was determined with a Monte-Carlo Mapped Power analysis. Due to the high level of intra- and inter-individual variability in growth hormone concentrations over time, regardless of the simulated effect size, only the deconvolution-analysis informed approach reached a statistical power of more than 80% with a sample size of less than 200 subjects per cohort. Furthermore, the use of this deconvolution-analysis-informed modelling approach improved the description of the observations on an individual level and enabled the quantification of a drug effect to be used for subsequent clinical trial simulations.

Neighbourhood places, collective efficacy and crime: A longitudinal perspective

Urban Studies ◽  
2021 ◽  
pp. 004209802110088
Author(s):  
Renee Zahnow ◽  
Jonathan Corcoran ◽  
Anthony Kimpton ◽  
Rebecca Wickes
Keyword(s):  
Land Use ◽  
Social Control ◽  
Social Interactions ◽  
Collective Efficacy ◽  
Social Cohesion ◽  
Mixed Effects ◽  
Land Use Classification ◽  
Social Survey ◽  
Panel Models ◽  
Over Time

Neighbourhood places like shops, cafes and parks support a variety of social interactions ranging from the ephemeral to the intimate. Repeated interactions at neighbourhood places over time lay the foundation for the development of social cohesion and collective efficacy. In this study, we examine the proposition that changes in the presence or arrangement of neighbourhood places can destabilise social cohesion and collective efficacy, which has implications for crime. Using spatially integrated crime, social survey and parcel-level land-use classification data, we estimate mixed effects panel models predicting changes in theft and nuisance crimes across 147 Australian neighbourhoods. The findings are consistent with neighbourhood social control and crime opportunity theories. Neighbourhood development – indicated by fewer vacant properties and fewer industrial and agricultural sites – is associated with higher collective efficacy and less crime over time. Conversely, introducing more restaurants, transit stations and cinemas is associated with higher theft and nuisance over time regardless of neighbourhood collective efficacy. We argue that the addition of socially conducive places can leave neighbourhoods vulnerable to crime until new patterns of sociability emerge and collective efficacy develops.

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