scholarly journals Examining common mental health disorders in people living with HIV on methadone maintenance therapy in Hanoi, Vietnam

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Anisa Y. Mughal ◽  
Melissa Ann Stockton ◽  
Quynh Bui ◽  
Vivian Go ◽  
Brian W. Pence ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Drug Use ◽  
Injection Drug Use ◽  
Hiv Transmission ◽  
Methadone Maintenance ◽  
Injection Drug ◽  
People Living With Hiv ◽  
High Prevalence ◽  
Living With Hiv

Abstract Background Injection drug use drives HIV transmission in Southeast Asia, where around a quarter of users are living with HIV. Vietnam developed Methadone Maintenance Therapy (MMT) programs to reduce unsafe drug abuse. Common mental health disorders (CMD), including depression, anxiety and post-traumatic stress disorder (PTSD), can worsen MMT outcomes and are highly prevalent among people living with HIV (PLH). We aimed to characterize HIV and CMD among MMT patients and assess the impact of HIV and CMD on MMT engagement outcomes in Hanoi, Vietnam. Methods This cross-sectional study was conducted at an urban MMT clinic in Hanoi. Participants were screened for CMD with the relevant sections of the Mini International Neuropsychiatric Interview (MINI). Tabular comparisons and regression models were used to understand the association of HIV and CMD with substance use and methadone compliance. Results Of the 400 MMT participants, 22% were living with HIV, 11% a CMD, 27% reported injection drug use, and 27% reported methadone noncompliance. Around 17% of those with HIV also had a CMD. Reporting non injection and injection drug use were each higher among those with CMD regardless of HIV status. In addition, reporting any drug use was much higher among those with both HIV and CMD than among those with neither (73% vs 31%, p value 0.001). While methadone noncompliance was lower among PLH than among those without HIV (16.3% vs 30.1%, p value 0.010), noncompliance was higher among those with CMD than among those without (40.5% vs 25.6%, p value 0.045). Among those without HIV, noncompliance was higher among those with CMD than among those without, but among those with HIV, the opposite relationship was observed. Conclusion There is complex overlap between substance use and methadone noncompliance among MMT patients living with HIV, CMD or both. In this population, we found a high prevalence of CMD and substance use among PLH, and a high prevalence of substance use and methadone noncompliance among those with CMD. Prioritizing provision of mental health care services to MMT patients living with HIV can help improve engagement with substance use disorder treatment and reduce the risk of HIV transmission.

scholarly journals 890. Bridging the Gap to Help Address the Opioid Crisis: A Novel Model of Care to Integrate Substance Use, Mental Health, and Infectious Disease Services

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S22-S22
Author(s):  
Kimberly Corace ◽  
Nicholas Schubert ◽  
Melanie Willows ◽  
Guy Herbert ◽  
Gary Garber
Keyword(s):  
Mental Health ◽  
Infectious Disease ◽  
Substance Use ◽  
Drug Use ◽  
Infectious Diseases ◽  
Injection Drug Use ◽  
Injection Drug ◽  
Opioid Use ◽  
Care Model ◽  
Rapid Access

Abstract Background There is a converging public health crisis as the opioid epidemic and increased injection drug use is driving rates of infectious diseases. Multidisciplinary care, integrating infectious diseases, substance use, and mental health services, is crucial to address this crisis. This study evaluated a novel rapid access care model to improve treatment access for opioid use, mental health, and related infectious diseases. Methods The Rapid Access Addiction Medicine (RAAM) clinic is a multidisciplinary, walk-in care model located in a mental health center in Ottawa, Canada. RAAM provides collaborative, inter-agency care, with rapid access to care facilitated through seamless care pathways (i.e., from the emergency department). RAAM offers substance use and mental health treatment, screening and care for infectious diseases, harm reduction, and connection to community services. RAAM patients (N = 411) presenting between April 2018 and January 2019 completed substance use and mental health measures upon intake and 30-day follow-ups. Clinical information was collected via chart review. Results Of the total sample, 20% (n = 83; 66% men) had problematic opioid use. Most patients reported high opioid dependence severity (97%), injection drug use (67%), and polysubstance use (97%), including cocaine (62%), alcohol (40%), and amphetamines (35%). Most patients reported anxiety (86%) and depression (75%). The number of patients tested for HIV, HCV, HBV, and other STIs was 29%, 27%, 28%, and 24%, respectively. Most patients tested (61%) were young adults (aged 16–29). Of those tested, 15% tested positive for HCV and treatment initiation was facilitated for 66% of patients (33% resolved spontaneously). At 30-day follow-up, patients showed significantly reduced substance use and improved depression and anxiety (Ps < 0.05). Conclusion Patients with problematic opioid use have multiple comorbidities, including undiagnosed infectious diseases; thus, highlighting the need for integrated care models like RAAM. Substance use treatment is an opportune setting to identify and treat infectious diseases in order to improve outcomes and reduce disease transmission. Leadership from infectious disease specialists is key to this successful integration. Disclosures All Authors: No reported Disclosures.

scholarly journals Leaving no one behind? An equity analysis of the HIV care cascade among a cohort of people living with HIV in Manitoba, Canada

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Leigh M. McClarty ◽  
James F. Blanchard ◽  
Marissa L. Becker
Keyword(s):  
Drug Use ◽  
Injection Drug Use ◽  
Injection Drug ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Virologic Suppression ◽  
Hiv Care Cascade ◽  
Care Cascade ◽  
History Of ◽  
Living With Hiv

Abstract Background Manitoba is a central Canadian province with annual rates of new HIV infections consistently higher than the Canadian average. National surveillance statistics and data from the provincial HIV care program suggest that epidemiological heterogeneity exists across Manitoba. New HIV cases are disproportionately reported among females, Indigenous-identifying individuals, and those with a history of injection drug use. Given the heterogeneity in acquisition, it is of interest to understand whether this translates into inequalities in HIV care across Manitoba. Methods A sample of 703 participants from a clinical cohort of people living with HIV in Manitoba, with data current to the end of 2017, was used to conduct cross-sectional, disaggregated analyses of the HIV care cascade to identify heterogeneity in service coverage and clinical outcomes among different groups receiving HIV care in Manitoba. Equiplots are used to identify and visualize inequalities across the cascade. Exploratory multivariable logistic regression models quantify associations between equity variables (age, sex, geography, ethnicity, immigration status, exposure category) and progression along the cascade. Adjusted odds ratios (AOR) and 95% confidence intervals (95%CI) are reported. Results Equity analyses highlight inequalities in engagement in and coverage of HIV-related health services among cohort participants. Equiplots illustrate that the proportion of participants in each cascade step is greater for those who are older, white, non-immigrants, and report no history of injection drug use. Compared to those living in Winnipeg, participants in eastern Manitoba have greater odds of achieving virologic suppression (AOR[95%CI] = 3.8[1.3–11.2]). The odds of Indigenous participants being virologically suppressed is half that of white participants (AOR[95%CI] = 0.5[0.3–0.7]), whereas African/Caribbean/Black participants are significantly less likely than white participants to be in care and retained in care (AOR[95%CI] = 0.3[0.2–0.7] and 0.4[0.2–0.9], respectively). Conclusions Inequalities exist across the cascade for different groups of Manitobans living with HIV; equiplots are an innovative method for visualizing these inequalities. Alongside future research aiming to understand why inequalities exist across the cascade in Manitoba, our equity analyses can generate hypotheses and provide evidence to inform patient-centred care plans that meet the needs of diverse client subgroups and advocate for policy changes that facilitate more equitable HIV care across the province.

Substance use patterns associated with injection drug use initiation in a low-threshold methadone-maintained sample

2013 ◽  
Vol 19 (6) ◽  
pp. 436-439 ◽  
Author(s):  
Miroslava Kolajova ◽  
Heather G. Fulton ◽  
Christine Darredeau ◽  
Sean P. Barrett
Keyword(s):  
Substance Use ◽  
Drug Use ◽  
Injection Drug Use ◽  
Injection Drug ◽  
Use Patterns ◽  
Low Threshold ◽  
Drug Use Initiation

Mental health disorders and substance use among people living with HIV in Nepal: their influence on non-adherence to anti-retroviral therapy

AIDS Care ◽  
2019 ◽  
Vol 31 (8) ◽  
pp. 923-931 ◽  
Author(s):  
Khem Narayan Pokhrel ◽  
Kalpana Gaulee Pokhrel ◽  
Vidya Dev Sharma ◽  
Krishna Chandra Poudel ◽  
Sanjeev Raj Neupane ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Mental Health Disorders ◽  
People Living With Hiv ◽  
Health Disorders ◽  
Living With Hiv

Injection drug use and HIV transmission in Russia

AIDS ◽  
2006 ◽  
Vol 20 (6) ◽  
pp. 935-936 ◽  
Author(s):  
Robert F Luo ◽  
Joseph Cofrancesco
Keyword(s):  
Drug Use ◽  
Injection Drug Use ◽  
Hiv Transmission ◽  
Injection Drug

scholarly journals Why the Treatment of Mental Disorders Is an Important Component of HIV Prevention among People Who Inject Drugs

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Elizabeth Buckingham ◽  
Ezra Schrage ◽  
Francine Cournos
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Drug Use ◽  
Mental Disorders ◽  
Hiv Infection ◽  
Injection Drug Use ◽  
People Who Inject Drugs ◽  
Injection Drug ◽  
Hiv Care ◽  
Hiv Positive

People who inject drugs are more likely to be HIV positive and to have a mental disorder than the general population. We explore how the detection and treatment of mental illness among people who are injecting drugs are essential to primary and secondary prevention of HIV infection in this population. Aside from opioid addiction, few studies have been conducted on the links between mental disorders and injection-drug use. However, independent of the injection-drug use literature, a growing number of studies demonstrate that untreated mental illness, especially depression and alcohol/substance use disorders, is associated with HIV-related risk behaviors, acquiring HIV infection, failure to access HIV care and treatment, failure to adhere to HIV care and treatment, and increased morbidity and mortality from HIV-related diseases and comorbidities. In our review of both the published literature and gray literature we found a dearth of information on models for providing care for both opioid addiction and other mental illnesses regardless of HIV status, particularly in low- and middle-income countries. We therefore make recommendations on how to address the mental health needs of HIV-positive people who inject drugs, which include the provision of opioid substitution therapy and integrated mental health, substance abuse, and HIV services.

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