46 results on '"Sabina Dobrer"'
Search Results
2. Bringing equity into the fold: a review of interventions to improve mental health
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Andrea Simpson, April Furlong, Sabina Dobrer, and Nina Jetha
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lcsh:R5-920 ,lcsh:Medicine (General) ,equity-focused, mental health, quality of evidence, external validity, intervention design, evidence for equity - Abstract
In Canada, it is challenging to find examples of positive population mental health interventions that meet scientific standards of evidence. It is even more difficult to identify effective interventions that address health equity. The discrepancy between standards of evidence in the health sciences, and the evidence that can be gleaned from social experiments, is not new. Efforts to reconcile these differences show a general tendency toward controlled interventions in public health. However, it is possible to extract findings from quasi-experimental interventions that meet scientific standards while also showing promise of positive impacts on mental health equity. This article describes work undertaken in 2015 to begin to address this evidence gap.
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- 2018
3. Hepatitis C Cascade of Care among People who Inject Drugs in Vancouver, Canada
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Thomas Kerr, M.-J. Milloy, Ekaterina Nosova, Kora DeBeck, Kanna Hayashi, Samantha Young, Sabina Dobrer, and Evan Wood
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Canada ,Hepatitis C virus ,Medicine (miscellaneous) ,HIV Infections ,medicine.disease_cause ,Article ,Health Services Accessibility ,Injection drug use ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Prospective Studies ,030212 general & internal medicine ,Substance Abuse, Intravenous ,High rate ,Harm reduction ,business.industry ,virus diseases ,Hepatitis C ,Hepatitis C, Chronic ,Patient Acceptance of Health Care ,medicine.disease ,Virology ,digestive system diseases ,3. Good health ,Psychiatry and Mental health ,030211 gastroenterology & hepatology ,business - Abstract
Background: People who inject drugs (PWID) have high rates of hepatitis C virus (HCV) infection. Little is known about the rates of diagnosis and treatment for HCV among PWID. Therefore, this study aims to characterize the cascade of care in Vancouver, Canada, to improve HCV treatment access and delivery for PWID. Methods: Data were derived from 3 prospective cohort studies of PWID in Vancouver, Canada, between December 2005 and May 2015. The progression of participants was identified through 5 steps in the cascade of care: (1) chronic HCV; (2) linkage to HCV care; (3) liver disease assessment; (4) initiation of treatment; and (5) completion of treatment. Predictors of undergoing liver disease assessment for HCV treatment were identified using a multivariable extended Cox regression model. Results: Among 1571 participants with chronic HCV, 1359 (86.5%) had ever been linked to care, 1257 (80.0%) had undergone liver disease assessment, 163 (10.4%) had ever started HCV treatment, and 71 (4.5%) had ever completed treatment. In multivariable analyses, human immunodeficiency virus (HIV) seropositivity, use of methadone maintenance therapy, and hospitalization in the past 6 months were independently and positively associated with undergoing liver disease assessment (all P
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- 2018
4. Habitudes d'utilisation des soins de santé chez les personnes ayant fait une surdose de drogues illicites : analyse descriptive fondée sur la Cohorte provinciale des victimes de surdoses de la Colombie-Britannique
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Andrew W. Tu, Brooke Kinniburgh, Sabina Dobrer, Christopher Mill, Mina Park, Anthony Leamon, Salman Klar, Michael Otterstatter, Jennifer May-Hadford, Alexis Crabtree, and Lu Zheng
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General Medicine - Abstract
Introduction La Colombie-Britannique (C.-B.) a déclaré un état d'urgence en santé publique en avril 2016 en réaction à une augmentation rapide du nombre de décès par surdose. Une meilleure compréhension de l'utilisation des soins de santé est nécessaire pour guider les stratégies de prévention pour les personnes qui font une surdose de drogues illicites. Méthodologie La cohorte provinciale des victimes de surdoses comprend des données administratives couplées sur l'utilisation des soins de santé par les personnes qui ont été victimes d'une surdose de drogues illicites en Colombie-Britannique entre le 1er janvier 2015 et le 30 novembre 2016. Les cas de surdose ont été relevés à l'aide de données provenant des services ambulanciers, des enquêtes des coroners, des appels aux centres antipoison et des dossiers administratifs des hôpitaux, des services d'urgence et des médecins. Au total, 10 455 cas de surdose ont été recensés et comparés à 52 275 témoins appariés selon l'âge, le sexe et la zone de résidence en vue d'une analyse descriptive de l'utilisation des soins de santé. Résultats Les deux tiers (66 %) des cas de surdose concernaient des hommes, et environ la moitié (49 %) les 20 à 39 ans. Plus de la moitié des cas (54 %) se sont rendus au service d'urgence, et environ le quart (26 %) ont été admis à l'hôpital au cours de l'année précédant la surdose, comparativement à respectivement 17 % et 9 % des témoins. Cependant, près d'un cinquième (19 %) des cas ont été enregistrés comme ayant quitté le service d'urgence sans avoir été vus par le médecin ou contre son avis. Des proportions élevées de cas (75 %) et de témoins (72 %) ont consulté un médecin en milieu communautaire. La consommation de substances et des problèmes en santé mentale ont été les diagnostics les plus courants chez les personnes qui ont fait une surdose. Conclusion Les personnes qui ont fait une surdose ont souvent eu accès au système de soins de santé au cours de l'année précédant la surdose. Compte tenu de ces taux élevés d'utilisation des soins de santé, on pourrait peut-être repérer les personnes à risque avant qu'elles ne fassent de surdose et les aiguiller vers des programmes ciblés et des interventions fondées sur des données probantes. Il est prévu d'utiliser la cohorte provinciale des victimes de surdoses de la Colombie-Britannique pour déterminer les facteurs de risque relatifs aux surdoses et aux décès par surdose.
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- 2018
5. Patterns of health care utilization among people who overdosed from illegal drugs: a descriptive analysis using the BC Provincial Overdose Cohort
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Andrew W. Tu, Anthony Leamon, Alexis Crabtree, Salman Klar, Christopher Mill, Mina Park, Jennifer May-Hadford, Sabina Dobrer, Brooke Kinniburgh, Michael Otterstatter, and Lu Zheng
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medicine.medical_specialty ,Harm reduction ,lcsh:R5-920 ,Epidemiology ,business.industry ,Health Policy ,Public health ,Public Health, Environmental and Occupational Health ,Poison control ,Emergency department ,Drug overdose ,medicine.disease ,Occupational safety and health ,drug overdose, harm reduction, healthcare, opioids, street drugs ,Family medicine ,Health care ,Cohort ,medicine ,business ,lcsh:Medicine (General) - Abstract
Introduction British Columbia (BC) declared a public health emergency in April 2016 in response to a rapid rise in overdose deaths. Further understanding of health care utilization is needed to inform prevention strategies for individuals who overdose from illegal drugs. Methods The Provincial Overdose Cohort includes linked administrative data on health care utilization by individuals who experienced an illegal drug overdose event in BC between 1 January 2015 and 30 November 2016. Overdose cases were identified using data from ambulance services, coroners’ investigations, poison control centre calls and hospital, emergency department and physician administrative records. In total, 10 455 overdose cases were identified and compared with 52 275 controls matched on age, sex and area of residence for a descriptive analysis of health care utilization. Results Two-thirds (66%) of overdose cases were male and about half (49%) were 20–39 years old. Over half of the cases (54%) visited the emergency department and about one-quarter (26%) were admitted to hospital in the year before the overdose event, compared with 17% and 9% of controls, respectively. Nevertheless, nearly onefifth (19%) of cases were recorded leaving the emergency department without being seen or against medical advice. High proportions of both cases (75%) and controls (72%) visited community-based physicians. Substance use and mental health–related concerns were the most common diagnoses among people who went on to overdose. Conclusion People who overdosed frequently accessed the health care system in the year before the overdose event. In light of the high rates of health care use, there may be opportunities to identify at-risk individuals before they overdose and connect them with targeted programs and evidence-based interventions. Further work using the BC Provincial Overdose Cohort will focus on identifying risk factors for overdose events and death by overdose.
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- 2018
6. Aperçu - Hospitalisations et visites à l’urgence en raison d’un empoisonnement aux opioïdes au Canada
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Michael C. Otterstatter, Alexis Crabtree, Sabina Dobrer, Brooke Kinniburgh, Salman Klar, Anthony Leamon, Jennifer May-Hadford, Christopher Mill, Mina Park, Andrew W. Tu, and Lu Zheng
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surdose, réduction des méfaits, soins de santé, opioïdes, drogues illicites ,lcsh:R5-920 ,lcsh:Medicine (General) - Abstract
L’augmentation des méfaits attribuables aux opioïdes constitue un problème de plus en plus préoccupant en santé publique au Canada. Cette analyse a utilisé les données de la Base de données sur la morbidité des hôpitaux et du Système national de rapports sur les soins ambulatoires pour déterminer le nombre d’hospitalisations et de visites aux services d’urgence en raison d’un empoisonnement aux opioïdes au Canada. Le nombre d’hospitalisations pour empoisonnement aux opioïdes a augmenté au cours des 10 dernières années, atteignant 15,6 par tranche de 100 000 habitants en 2016-2017, et celui des visites aux services d’urgence en raison d’un empoisonnement aux opioïdes a également augmenté en Alberta et en Ontario, les deux provinces qui ont recueilli des données des services d’urgence assez détaillées pour être analysées. Ces résultats soulignent l’importance de la surveillance pancanadienne des méfaits attribuables aux opioïdes, ainsi que la nécessité de politiques fondées sur des données probantes pour aider à les réduire.
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- 2018
7. The relationship between hazardous alcohol use and violence among street-involved youth
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Nadia Fairbairn, Sabina Dobrer, Thomas Kerr, Evan Wood, Huiru Dong, and Kora DeBeck
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business.industry ,030508 substance abuse ,Medicine (miscellaneous) ,Alcohol abuse ,Poison control ,16. Peace & justice ,medicine.disease ,Suicide prevention ,Gee ,03 medical and health sciences ,Psychiatry and Mental health ,Clinical Psychology ,0302 clinical medicine ,5. Gender equality ,Environmental health ,Injury prevention ,Cohort ,medicine ,Domestic violence ,030212 general & internal medicine ,0305 other medical science ,business ,Cohort study - Abstract
Background and objectives Alcohol is a major contributor to premature disability and death among youth, often due to physical trauma, violence, and suicide. The purpose of this study was to longitudinally examine the association between hazardous alcohol use and experiences of violence among a cohort of street-involved youth. Methods Data were derived from the At-Risk Youth Study (ARYS), a prospective cohort of street-involved youth who use illicit substances in Vancouver, Canada. The outcome of interest was hazardous alcohol use defined by the US National Institute on Alcohol Abuse and Alcoholism as >14 drinks/week or >5 drinks on one occasion for men, and >7 drinks/week or >4 drinks on one occasion for women. We used Generalized Estimating Equations (GEE) analyses to examine factors independently associated with hazardous alcohol use. Results Between 2005 and 2014, 1,149 drug-using youth were recruited and 423 (36.8%) reported hazardous alcohol use in the previous 6 months at study baseline. In multivariable GEE analyses, intimate partner violence (Adjusted Odds Ratio [AOR] = 1.53, 95% Confidence Interval [95%CI] = 1.12-2.10), and non-partner physical assault (AOR = 1.39, 95%CI = 1.21-1.59) were independently associated with hazardous alcohol use after adjusting for multiple potential confounders. Discussion and conclusions A considerable proportion of youth in this setting reported hazardous alcohol use, which was independently associated with experiencing recent intimate and non-partner violence. Scientific significance Combined interventions for violence and hazardous alcohol use should be integrated into service provision programs for street-involved youth. (Am J Addict 2017;26:852-858).
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- 2017
8. Social and structural factors increase inconsistent condom use by sex workers’ one-time and regular clients in Northern Uganda
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Kate Shannon, Josephine Birungi, Monika Akello, Putu Duff, Godfrey Muzaaya, and Sabina Dobrer
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Adult ,Safe Sex ,Health (social science) ,Adolescent ,Social Psychology ,Substance-Related Disorders ,Sexual Behavior ,Human immunodeficiency virus (HIV) ,Sex workers ,HIV Infections ,Violence ,medicine.disease_cause ,law.invention ,Condoms ,03 medical and health sciences ,0302 clinical medicine ,Empirical research ,Criminalization ,5. Gender equality ,Condom ,law ,parasitic diseases ,mental disorders ,Humans ,Medicine ,Uganda ,030212 general & internal medicine ,Sex work ,Sex Workers ,030505 public health ,business.industry ,musculoskeletal, neural, and ocular physiology ,Public Health, Environmental and Occupational Health ,3. Good health ,Cross-Sectional Studies ,Female ,Inconsistent condom ,0305 other medical science ,business ,human activities ,Social psychology ,psychological phenomena and processes ,Demography - Abstract
While sex workers (SWs) bear the brunt of the epidemic in Uganda, there remains a dearth of empirical research on the structural drivers of HIV prevention among SWs. This study examined the drivers of inconsistent condom use by one-time and regular clients of young women SWs in Gulu, Northern Uganda. Data were drawn from the Gulu Sexual Health Study, a cross-sectional study of young SWs, aged 14 years and older (2011-2012). SWs were recruited using peer/SW-led outreach, in partnership with The AIDS Support Organization and other CBOs. Multivariable logistic regression was used to examine the correlates of inconsistent condom use by one-time and regular clients. In total, 84.5% of the 381 SWs servicing regular clients and 76.8% of the 393 SWs servicing one-time clients reported inconsistent client condom use. In multivariable analysis, physical/sexual violence by clients (AOR = 5.39; 95%CI 3.05-9.49), low sexual control by workers (measured by the validated Pulweritz scale) (AOR = 2.86; 95%CI 1.47-5.58), alcohol/drug use while working (AOR = 1.98; 95%CI 1.17-3.35) and migration to Gulu for sex work (AOR = 1.73; 95%CI 0.95-3.14) were positively correlated with inconsistent condom use by one-time clients. Correlates of inconsistent condom use by regular clients included: low sexual control by workers (AOR = 4.63; 95%CI 2.32-9.23); physical/sexual violence by clients (AOR = 3.48; 95%CI 1.85-6.53); police harassment (AOR = 2.57; 95%CI 1.17-5.65); and being a single mother (AOR = 2.07; 95%CI 1.09-3.93). Structural and interpersonal factors strongly influence inconsistent condom use by clients, with violence by clients and police, low sexual control by workers, migration and single-parenthood all linked to non-condom use. There is a need for peer-led structural interventions that improve access to occupational health and safety standards (e.g., violence prevention and alcohol/drug harm reduction policies/programming). Shifts away from the current punitive approaches towards SWs are integral to the success of such interventions, as they continue to undermine HIV prevention efforts.
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- 2017
9. Awareness, Possession, and Use of Take-Home Naloxone Among Illicit Drug Users, Vancouver, British Columbia, 2014-2015
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M.-J. Milloy, Thomas Kerr, Kanna Hayashi, Evan Wood, Jane A. Buxton, Huiru Dong, Sabina Dobrer, Julio S. G. Montaner, and Seonaid Nolan
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Male ,medicine.medical_specialty ,Narcotic Antagonists ,030508 substance abuse ,Self Administration ,Drug Users ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,Humans ,Medicine ,Illicit drug ,Prospective Studies ,030212 general & internal medicine ,Psychiatry ,British Columbia ,Illicit Drugs ,Naloxone ,business.industry ,Research ,Public Health, Environmental and Occupational Health ,Opioid overdose ,Awareness ,Middle Aged ,Possession (law) ,medicine.disease ,Opioid ,Optometry ,Female ,Drug Overdose ,0305 other medical science ,business ,medicine.drug - Abstract
Objectives:Although take-home naloxone (THN) programs are integral in strategies to prevent overdose deaths among opioid users, the uptake of THN among people who use drugs (PWUD) (including non-opioid users) is unknown. The objectives of this study were to determine awareness, possession, and use of THN among PWUD in Vancouver, Canada, and identify barriers to adopting this strategy.Methods:From December 1, 2014, to May 29, 2015, participants in 2 prospective cohort studies of PWUD in Vancouver completed a standardized questionnaire, which asked about awareness, possession, and use of THN; sociodemographic characteristics; and drug use patterns. We conducted multivariable logistic regression analyses to determine factors independently associated with awareness and possession of THN.Results:Of 1137 PWUD, 727 (64%) reported at least 1 previous overdose ever, and 220 (19%) had witnessed an overdose in the previous 6 months. Although 769 (68%) participants overall reported awareness of THN, only 88 of 392 (22%) opioid users had a THN kit, 18 (20%) of whom had previously administered naloxone. Factors that were positively associated with awareness of THN included witnessing an overdose in the previous 6 months (adjusted odds ratio [aOR] = 2.23; 95% confidence interval [CI], 1.49-3.34; P < .001), possession of THN (aOR = 1.85; 95% CI, 1.11-3.06; P = .02), younger age (aOR = 1.02; 95% CI, 1.01-1.04; P = .003), white race (aOR = 1.67; 95% CI, 1.27-2.19; P < .001), hepatitis C infection (aOR = 1.63; 95% CI, 1.13-2.36; P = .01), residing in Vancouver’s Downtown Eastside neighborhood (aOR = 1.93; 95% CI, 1.47-2.53; P < .001), and at least daily heroin injection (aOR = 1.69; 95% CI, 1.09-2.62; P < .02).Conclusion:Efforts to improve knowledge of and participation in the THN program may contribute to reduced opioid overdose mortality in Vancouver.
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- 2017
10. Food Insecurity Increases HIV Risk Among Young Sex Workers in Metro Vancouver, Canada
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Jessica St. Jean, Chrissy Taylor, Kathleen N. Deering, Sabina Dobrer, Putu Duff, Shira M. Goldenberg, Kate Shannon, and Daniella Barreto
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Adult ,Male ,Risk ,medicine.medical_specialty ,Social Psychology ,Cross-sectional study ,HIV Infections ,Article ,Food Supply ,law.invention ,Condoms ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Unsafe Sex ,Condom ,law ,Environmental health ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Sex work ,Harm reduction ,Sex Workers ,030505 public health ,British Columbia ,business.industry ,Public health ,Public Health, Environmental and Occupational Health ,3. Good health ,Health psychology ,Cross-Sectional Studies ,Infectious Diseases ,Cohort ,Female ,0305 other medical science ,business ,Social psychology - Abstract
This research aimed to determine the effect of food insecurity on sexual HIV risk with clients among youth sex workers (YSWs)
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- 2016
11. Non-medical prescription opioid use predicts injection initiation among street-involved youth
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Evan Wood, Sabina Dobrer, Huiru Dong, Julio S. G. Montaner, Kora DeBeck, Kanna Hayashi, and Thomas Kerr
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Male ,medicine.medical_specialty ,Prescription Drugs ,Adolescent ,Prescription Drug Diversion ,030508 substance abuse ,Medicine (miscellaneous) ,Poison control ,Article ,Cohort Studies ,Homeless Youth ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Injury prevention ,medicine ,Humans ,Longitudinal Studies ,Prospective Studies ,030212 general & internal medicine ,Medical prescription ,Substance Abuse, Intravenous ,Prospective cohort study ,British Columbia ,Proportional hazards model ,business.industry ,Incidence ,Health Policy ,Incidence (epidemiology) ,Confounding ,Opioid-Related Disorders ,medicine.disease ,Analgesics, Opioid ,Female ,Medical emergency ,Opiate ,0305 other medical science ,business - Abstract
Background The impact of prescription opiate (PO) misuse on the incidence of initiation into injection drug use among youth has not been well characterized. This study longitudinally examined non-injection PO misuse and time to injection initiation among street-involved youth. Methods Data were derived from a prospective cohort of street-involved youth from September 2005 to May 2014. An extended Cox model with time-dependent variables was used to examine the relationship between a history of non-injection PO misuse at baseline and time to injection initiation. Results At baseline, among 462 injection naive youth who completed at least one study follow-up to assess for injection initiation, 178 (39%) participants reported having ever misused a PO via non-injection. During study follow-up, 97 (21%) injection initiation events were observed. In multivariable Cox regression analysis, a baseline history of PO misuse was independently associated with time to injection initiation (adjusted relative hazards [ARH] = 1.70, 95% CI: 1.12-2.58) after adjustment for time-updated potential confounders. In sub analysis, dilaudid was the category of PO that was most highly associated with injection initiation (AHR = 1.94, 95% CI: 1.03-3.63). Conclusion Among a sample of high-risk youth, PO misuse independently predicted injection initiation. These findings underscore the urgent need for interventions to prevent and treat PO use among youth, as a means of preventing initiation of injecting. Language: en
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- 2016
12. Factors associated with initiation of antiretroviral therapy among HIV-positive people who use injection drugs in a Canadian setting
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Julio S. G. Montaner, Lindsey Richardson, Brenden Joseph, Evan Wood, Silvia Guillemi, Thomas Kerr, Sabina Dobrer, Rolando Barrios, Kanna Hayashi, M.-J. Milloy, and Surita Parashar
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Adult ,Male ,Canada ,medicine.medical_specialty ,Time Factors ,Immunology ,HIV Infections ,Article ,Drug Users ,03 medical and health sciences ,0302 clinical medicine ,Acquired immunodeficiency syndrome (AIDS) ,medicine ,Humans ,Immunology and Allergy ,Prospective Studies ,030212 general & internal medicine ,Substance Abuse, Intravenous ,Prospective cohort study ,Psychiatry ,030505 public health ,business.industry ,Proportional hazards model ,Hazard ratio ,Middle Aged ,medicine.disease ,Antiretroviral therapy ,Confidence interval ,Infectious Diseases ,HIV-positive people ,Anti-Retroviral Agents ,Female ,0305 other medical science ,business ,Demography ,Methadone ,medicine.drug - Abstract
OBJECTIVE To identify behavioral, social, and structural factors associated with time from HIV seroconversion to antiretroviral therapy (ART) initiation among people who use injection drugs (PWID). DESIGN Two complementary prospective cohorts of PWID linked to comprehensive ART dispensation records in a setting of universal no-cost HIV/AIDS treatment and care. METHODS Multivariable extended Cox models of time to ART initiation among baseline HIV-seronegative PWID who seroconverted after recruitment adjusted with a time-updated measure of clinical eligibility for ART. RESULTS We included 133 individuals of whom 98 (74%) initiated ART during follow-up at a rate of 12.4 per 100 person-years. In a multivariable model adjusted for ART eligibility, methadone maintenance therapy [adjusted hazard ratio (AHR) = 2.37, 95% confidence interval (95% CI): 1.56-3.60] and a more recent calendar year of observation (AHR = 1.06, 95% CI: 1.00-1.12) were associated with more rapid ART initiation, whereas informal income generation (AHR = 0.51, 95% CI: 0.32-0.79) and incarceration (AHR = 0.52, 95% CI: 0.28-0.97) were negatively associated with ART initiation. CONCLUSION In this sample of community-recruited HIV-positive PWID with well defined dates of HIV seroconversion, we found that two measures related to the criminalization of illicit drug use each independently delayed ART initiation regardless of clinical eligibility. Engagement in methadone promoted ART initiation. Programs to scale-up HIV treatment among PWID should consider decreased criminalization of PWID and increased access to opioid substitution therapy to optimize the impact of ART on HIV/AIDS-associated morbidity, mortality, and HIV transmission.
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- 2016
13. Barriers to Cervical Screening Among Sex Workers in Vancouver
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Ofer Amram, Sabina Dobrer, Paul Nguyen, Jill Chettiar, Kate Shannon, Julio S. G. Montaner, Putu Duff, Jean Shoveller, and Gina Ogilvie
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Adult ,Gerontology ,Adolescent ,Uterine Cervical Neoplasms ,AJPH Research ,Logistic regression ,Health Services Accessibility ,Gee ,Uterine Cervical Diseases ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Health care ,Humans ,Medicine ,Prospective Studies ,030212 general & internal medicine ,Prospective cohort study ,Generalized estimating equation ,Early Detection of Cancer ,Spatial Analysis ,Sex Workers ,030505 public health ,Cervical screening ,British Columbia ,business.industry ,Public Health, Environmental and Occupational Health ,Odds ratio ,Confidence interval ,Logistic Models ,Female ,0305 other medical science ,business ,Papanicolaou Test ,Demography - Abstract
Objectives. We longitudinally examined the social, structural, and geographic correlates of cervical screening among sex workers in Metropolitan Vancouver, British Columbia, to determine the roles that physical and social geography play in routine reproductive health care access. Methods. Analysis drew on (2010–2013) data from an open prospective cohort of sex workers (An Evaluation of Sex Workers’ Health Access). We used multivariable logistic regression with generalized estimating equations (GEE) to model correlates of regular cervical screening. Results. At baseline, 236 (38.6%) of 611 sex workers in our sample had received cervical screening, and 63 (10.3%) were HIV-seropositive. In multivariable GEE analysis, HIV-seropositivity (adjusted odds ratio [AOR] = 1.65; 95% confidence interval [CI] = 1.06, 2.58) and accessing outreach services (AOR = 1.35; 95% CI = 1.09, 1.66) were correlated with regular cervical screening. Experiencing barriers to health care access (e.g., poor treatment by health care staff, limited hours of operation, and language barriers) reduced odds of regular Papanicolaou testing (AOR = 0.81; 95% CI = 0.65, 1.00). Conclusions. Sex workers in Metropolitan Vancouver had suboptimal levels of cervical screening. Innovative mobile outreach service delivery models offering cervical screening as one component of sex worker–targeted comprehensive sexual and reproductive health services may hold promise.
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- 2016
14. The role of dyad-level factors in shaping sexual and drug-related HIV/STI risks among sex workers with intimate partners
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Sabina Dobrer, Elena Argento, Jill Chettiar, Kate Shannon, Paul Nguyen, and Kathleen N. Deering
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Adult ,Safe Sex ,Sexual Behavior ,Sexually Transmitted Diseases ,Psychological intervention ,HIV Infections ,Toxicology ,Logistic regression ,Article ,Odds ,law.invention ,Condoms ,Condom ,Risk Factors ,law ,Odds Ratio ,Humans ,Medicine ,Pharmacology (medical) ,Prospective Studies ,Contraception Behavior ,Reproductive health ,Pharmacology ,Sex Workers ,British Columbia ,business.industry ,Odds ratio ,Psychiatry and Mental health ,Logistic Models ,Sexual Partners ,Domestic violence ,Female ,business ,Social psychology ,Demography ,Dyad - Abstract
Despite high HIV burden among sex workers (SWs) globally, and relatively high prevalence of client condom use, research on potential HIV/STI risk pathways of intimate partnerships is limited. This study investigated partner/dyad-level factors associated with inconsistent condom use among SWs with intimate partners in Vancouver, Canada.Baseline data (2010-2013) were drawn from a community-based prospective cohort of women SWs. Multivariable generalized estimating equations logistic regression examined dyad-level factors associated with inconsistent condom use (100% in last six months) with up to three male intimate partners per SW. Adjusted odds ratios and 95% confidence intervals were reported (AOR[95%CI]).Overall, 369 SWs reported having at least one intimate partner, with 70.1% reporting inconsistent condom use. Median length of partnerships was 1.8 years, with longer duration linked to inconsistent condom use. In multivariable analysis, dyad factors significantly associated with increased odds of inconsistent condom use included: having a cohabiting (5.43[2.53-11.66]) or non-cohabiting intimate partner (2.15[1.11-4.19]) (versus casual partner), providing drugs (3.04[1.47-6.30]) or financial support to an intimate partner (2.46[1.05-5.74]), physical intimate partner violence (2.20[1.17-4.12]), and an intimate partner providing physical safety (2.08[1.11-3.91]); non-injection drug use was associated with a 68% reduced odds (0.32[0.17-0.60]).Our study highlights the complex role of dyad-level factors in shaping sexual and drug-related HIV/STI risk pathways for SWs from intimate partners. Couple and gender-focused interventions efforts are needed to reduce HIV/STI risks to SWs through intimate partnerships. This research supports further calls for integrated violence and HIV prevention within broader sexual/reproductive health efforts for SWs.
- Published
- 2015
15. Original quantitative research - Patterns of health care utilization among people who overdosed from illegal drugs: a descriptive analysis using the BC Provincial Overdose Cohort
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Michael C., Otterstatter, Alexis, Crabtree, Sabina, Dobrer, Brooke, Kinniburgh, Salman, Klar, Anthony, Leamon, Jennifer, May-Hadford, Christopher, Mill, Mina, Park, Andrew, W. Tu, and Lu, Zheng
- Subjects
Adult ,Male ,Adolescent ,British Columbia ,Illicit Drugs ,Substance-Related Disorders ,Infant, Newborn ,Infant ,Middle Aged ,Article ,Hospitalization ,Treatment Refusal ,Young Adult ,Case-Control Studies ,Child, Preschool ,Humans ,Female ,Community Health Services ,Drug Overdose ,Child ,Emergency Service, Hospital - Abstract
British Columbia (BC) declared a public health emergency in April 2016 in response to a rapid rise in overdose deaths. Further understanding of health care utilization is needed to inform prevention strategies for individuals who overdose from illegal drugs.The Provincial Overdose Cohort includes linked administrative data on health care utilization by individuals who experienced an illegal drug overdose event in BC between 1 January 2015 and 30 November 2016. Overdose cases were identified using data from ambulance services, coroners' investigations, poison control centre calls and hospital, emergency department and physician administrative records. In total, 10 455 overdose cases were identified and compared with 52 275 controls matched on age, sex and area of residence for a descriptive analysis of health care utilization.Two-thirds (66%) of overdose cases were male and about half (49%) were 20-39 years old. Over half of the cases (54%) visited the emergency department and about one-quarter (26%) were admitted to hospital in the year before the overdose event, compared with 17% and 9% of controls, respectively. Nevertheless, nearly onefifth (19%) of cases were recorded leaving the emergency department without being seen or against medical advice. High proportions of both cases (75%) and controls (72%) visited community-based physicians. Substance use and mental health-related concerns were the most common diagnoses among people who went on to overdose.People who overdosed frequently accessed the health care system in the year before the overdose event. In light of the high rates of health care use, there may be opportunities to identify at-risk individuals before they overdose and connect them with targeted programs and evidence-based interventions. Further work using the BC Provincial Overdose Cohort will focus on identifying risk factors for overdose events and death by overdose.La Colombie-Britannique (C.-B.) a déclaré un état d'urgence en santé publique en avril 2016 en réaction à une augmentation rapide du nombre de décès par surdose. Une meilleure compréhension de l'utilisation des soins de santé est nécessaire pour guider les stratégies de prévention pour les personnes qui font une surdose de drogues illicites.La cohorte provinciale des victimes de surdoses comprend des données administratives couplées sur l'utilisation des soins de santé par les personnes qui ont été victimes d'une surdose de drogues illicites en Colombie-Britannique entre le 1er janvier 2015 et le 30 novembre 2016. Les cas de surdose ont été relevés à l'aide de données provenant des services ambulanciers, des enquêtes des coroners, des appels aux centres antipoison et des dossiers administratifs des hôpitaux, des services d'urgence et des médecins. Au total, 10 455 cas de surdose ont été recensés et comparés à 52 275 témoins appariés selon l'âge, le sexe et la zone de résidence en vue d'une analyse descriptive de l'utilisation des soins de santé.Les deux tiers (66 %) des cas de surdose concernaient des hommes, et environ la moitié (49 %) les 20 à 39 ans. Plus de la moitié des cas (54 %) se sont rendus au service d'urgence, et environ le quart (26 %) ont été admis à l'hôpital au cours de l'année précédant la surdose, comparativement à respectivement 17 % et 9 % des témoins. Cependant, près d'un cinquième (19 %) des cas ont été enregistrés comme ayant quitté le service d'urgence sans avoir été vus par le médecin ou contre son avis. Des proportions élevées de cas (75 %) et de témoins (72 %) ont consulté un médecin en milieu communautaire. La consommation de substances et des problèmes en santé mentale ont été les diagnostics les plus courants chez les personnes qui ont fait une surdose.Les personnes qui ont fait une surdose ont souvent eu accès au système de soins de santé au cours de l'année précédant la surdose. Compte tenu de ces taux élevés d'utilisation des soins de santé, on pourrait peut-être repérer les personnes à risque avant qu'elles ne fassent de surdose et les aiguiller vers des programmes ciblés et des interventions fondées sur des données probantes. Il est prévu d'utiliser la cohorte provinciale des victimes de surdoses de la Colombie-Britannique pour déterminer les facteurs de risque relatifs aux surdoses et aux décès par surdose.
- Published
- 2018
16. Impacts of im/migration experience on work stress among sex workers in Vancouver, Canada
- Author
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Putu Duff, Shira M. Goldenberg, Julie Sou, Melissa Braschel, Jean Shoveller, Sabina Dobrer, and Kate Shannon
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Adult ,medicine.medical_specialty ,Canada ,Time Factors ,Decriminalization ,Occupational safety and health ,03 medical and health sciences ,Occupational Stress ,medicine ,Humans ,Longitudinal Studies ,Duration (project management) ,Generalized estimating equation ,Sex work ,Transients and Migrants ,030505 public health ,Sex Workers ,Public health ,Public Health, Environmental and Occupational Health ,General Medicine ,Emigration and Immigration ,Work (electrical) ,8. Economic growth ,Female ,Occupational stress ,Quantitative Research ,0305 other medical science ,Psychology ,Demography - Abstract
OBJECTIVES: Despite the precarious and unsafe working conditions frequently experienced by sex workers (SWs) and im/migrant workers, there remains a paucity of research on work-related stress and links to duration of im/migration residency among SWs. This study analyzes the relationship between duration of residency and two dimensions of work stress among SWs in Metro Vancouver. METHODS: Data were drawn from a longitudinal cohort of women SWs across Metro Vancouver (2010–2014). Multivariable confounder models with generalized estimating equations were developed to examine the independent effects of duration of residency on decision authority and job demands, after adjusting for confounders. RESULTS: Of 545 SWs, 9.7% were recent im/migrants, 13.9% were long-term im/migrants, and 76.2% were non-migrants. In comparison to non-migrant SWs, recent (β coefficient − 1.02, 95% CI − 1.57 to − 0.47) and long-term im/migrants (β coefficient − 0.87, 95% CI − 1.36 to −0.38) faced decreased work stress related to job demands after adjustment for key confounders. Decision authority did not retain a significant independent association after adjusting for the same factors. CONCLUSION: Job demands varied significantly by duration of residency. This may be explained by changing working conditions and experiences over the course of arrival and settlement among im/migrant SWs, as well as the role of formal work environments in supporting im/migrant SWs’ well-being. Given high rates of work stress related to job demands and low decision authority among all SWs, decriminalization of sex work, improved occupational standards, and culturally sensitive interventions to promote collectivization and improved access to working conditions remain needed.
- Published
- 2018
17. High rates of Unintended Pregnancies among Young Women Sex Workers in Conflict-affected Northern Uganda: The Social Contexts of Brothels/Lodges and Substance Use
- Author
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Kate Shannon, Josephine Birungi, Monika Akello, Sabina Dobrer, Katherine A. Muldoon, Godfrey Muzaaya, and Putu Duff
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Adult ,Substance-Related Disorders ,Sex workers ,HIV Infections ,Logistic regression ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Pregnancy ,Medicine ,Humans ,Uganda ,030212 general & internal medicine ,sex work, reproductive health, HIV, Uganda, post-conflict ,Contraception Behavior ,Sex work ,Reproductive health ,030505 public health ,Sex Workers ,business.industry ,Public Health, Environmental and Occupational Health ,Obstetrics and Gynecology ,Pregnancy, Unplanned ,Odds ratio ,Pregnancy, Unwanted ,Sex Work ,Confidence interval ,Outreach ,Cross-Sectional Studies ,Logistic Models ,Reproductive Health ,Reproductive Medicine ,Female ,0305 other medical science ,business ,Unintended pregnancy ,Demography - Abstract
This study aimed to examine the correlates of unintended pregnancies among young women sex workers in conflict-affected northern Uganda. Data were drawn from the Gulu Sexual Health Study, a cross-sectional study of young women engaged in sex work. Bivariable and multivariable logistic regression was used to examine the correlates of ever having an unintended pregnancy. Among 400 sex workers (median age=20 years; IQR 19-25), 175 (43.8%) reported at least one unintended pregnancy. In multivariable analysis, primarily servicing clients in lodges/brothels [Adjusted Odds Ratio (AOR= 2.24; 95% Confidence Interval: 1.03-4.84)], hormonal contraceptive usage [AOR=1.68; 95%CI 1.11-2.59] and drug/alcohol use while working [AOR= 1.64; 95%CI 1.04-2.60] were positively correlated with previous unintended pregnancy. Given that unintended pregnancy is an indicator of unmet reproductive health need, these findings highlight a need for improved access to integrated reproductive health and HIV services, catered to sex workers‘ needs. Sex work-led strategies (e.g., peer outreach) should be considered, alongside structural strategies and education targeting brothel/lodge owners and managers. Key words: sex work, reproductive health, HIV, Uganda, post-conflict
- Published
- 2018
18. P148 Population analysis of human leukocyte antigen allele and eplet frequencies in kidney patients and donors to assess the feasibility of epitope matching in Canada
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Jenny N. Tran, Karen Sherwood, Franz Fenninger, Oliver P. Günther, Sabina Dobrer, Lenka Allan, Rene J. Duquesnoy, Ruth Sapir-Pichhadze, Frans H. Claas, Genome Canada Transplant Consortium GCTC, and Paul A. Keown
- Subjects
Matching (statistics) ,Kidney ,education.field_of_study ,Immunology ,Human leukocyte antigen allele ,Population ,General Medicine ,Biology ,Epitope ,medicine.anatomical_structure ,medicine ,Immunology and Allergy ,education - Published
- 2019
19. Declining Mortality Rates in HIV-Infected People Who Inject Drugs During a Seek-and-Treat Initiative in Vancouver, Canada, 1996–2014: A Prospective Cohort Study
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Thomas Kerr, Huiru Dong, Kanna Hayashi, Evan Wood, M.-J. Milloy, Silvia Guillemi, Julio S. G. Montaner, Rolando Barrios, and Sabina Dobrer
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Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Canada ,Adolescent ,030231 tropical medicine ,Human immunodeficiency virus (HIV) ,HIV Infections ,medicine.disease_cause ,Injection drug use ,03 medical and health sciences ,Major Articles and Brief Reports ,Young Adult ,0302 clinical medicine ,Hiv infected ,medicine ,Immunology and Allergy ,Humans ,030212 general & internal medicine ,Prospective Studies ,Young adult ,Mortality ,Prospective cohort study ,Substance Abuse, Intravenous ,Aged ,business.industry ,Mortality rate ,Middle Aged ,Antiretroviral therapy ,3. Good health ,Infectious Diseases ,Female ,business - Abstract
We estimated rates and predictors of death among a community-recruited prospective cohort of 961 human immunodeficiency virus (HIV)-infected people who inject drugs in Vancouver, Canada, between 1996 and 2014. The results demonstrated significant declines in age-adjusted all-cause and HIV-related mortality rates since 2010, coincident with the scale-up of a community-wide "seek-and-treat" campaign.
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- 2017
20. Effect of low-threshold methadone maintenance therapy for people who inject drugs on HIV incidence in Vancouver, BC, Canada: an observational cohort study
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Evan Wood, Keith Ahamad, Julio S. G. Montaner, Christian G. Schütz, Paul Nguyen, Thomas Kerr, Sabina Dobrer, and Kanna Hayashi
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Adult ,Male ,Narcotics ,Gerontology ,medicine.medical_specialty ,Epidemiology ,Immunology ,HIV Infections ,Article ,Maintenance Chemotherapy ,Cohort Studies ,Virology ,medicine ,Humans ,Prospective Studies ,Seroconversion ,Substance Abuse, Intravenous ,Prospective cohort study ,British Columbia ,Proportional hazards model ,business.industry ,Incidence ,Public health ,International health ,Middle Aged ,medicine.disease ,Substance abuse ,Infectious Diseases ,Family medicine ,Female ,business ,Methadone ,medicine.drug ,Cohort study - Abstract
Summary Background HIV infection in people who inject drugs (PWID) is an international public health concern. We aimed to assess the effect of methadone maintenance therapy on HIV incidence in PWID in Vancouver, BC, Canada, where methadone is widely available through family physicians' offices and dispensed by community pharmacies. Methods Data were derived from the Vancouver Injection Drug Users Study (VIDUS), a prospective cohort of PWID in Vancouver. Individuals were eligible to enrol in VIDUS if they had injected illicit drugs at least once in the previous month and lived in the Greater Vancouver region. Participants responded to an interviewer-administered questionnaire and provided blood samples at enrolment and follow-up visits every 6 months. We estimated time to HIV seroconversion with Kaplan-Meier methods and used Cox proportional hazards methods to assess associations between methadone use and time to seroconversion. Findings 1639 HIV-negative individuals were recruited between May 1, 1996, and May 31, 2013. Of these individuals, 138 had HIV seroconversion during a median of 75·5 months (IQR 33·4–115·3) of follow-up. In multivariate Cox regression analyses, methadone maintenance therapy remained independently associated with a reduced hazard of HIV infection after adjustment for sociodemographic characteristics and drug use patterns (adjusted relative hazard 0·64, 95% CI 0·41–0·98). Interpretation Methadone maintenance therapy for PWID made available through primary care physicians and community pharmacies can help to achieve public health goals such as reducing the spread of HIV. Funding US National Institutes of Health, Canada Research Chair, Canadian Institutes of Health Research.
- Published
- 2015
21. Dose-response relationship between methadone dose and adherence to antiretroviral therapy among HIV-positive people who use illicit opioids
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Keith Ahamad, Leslie Lappalainen, Evan Wood, Julio S. G. Montaner, Cathy Puscas, Seonaid Nolan, Thomas Kerr, Sabina Dobrer, M.-J. Milloy, and Huiru Dong
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medicine.medical_specialty ,business.industry ,Medicine (miscellaneous) ,Odds ratio ,Gee ,Confidence interval ,Psychiatry and Mental health ,HIV-positive people ,Internal medicine ,mental disorders ,Cohort ,medicine ,Dosing ,business ,Psychiatry ,Generalized estimating equation ,Methadone ,medicine.drug - Abstract
Background and Aims For HIV-positive individuals who use illicit opioids, engagement in methadone maintenance therapy (MMT) can contribute to improved HIV treatment outcomes. However, to our knowledge, the role of methadone dosing in adherence to antiretroviral therapy (ART) has not yet been investigated. We sought to examine the relationship between methadone dose and ART adherence among a cohort of people who use illicit opioids. Design and Setting We used data from the AIDS Care Cohort to Evaluate Access to Survival Services (ACCESS) study, an ongoing prospective observational cohort of HIV-positive people who use illicit drugs in Vancouver, Canada, linked confidentially to comprehensive HIV treatment data in a setting of universal no-cost medical care, including medications. We evaluated the longitudinal relationship between methadone dose and the likelihood of ≥ 95% adherence to ART among ART-exposed participants during periods of engagement in MMT. Participants Two hundred and ninety-seven ART-exposed individuals on MMT were recruited between December 2005 and May 2013 and followed for a median of 42.1 months. Measurements We measured methadone dose at ≥ 100 versus
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- 2015
22. Illicit drug use in acute care settings
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Lianping Ti, Harjot Kaur Grewal, Evan Wood, Kanna Hayashi, Sabina Dobrer, and Thomas Kerr
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Drug ,Harm reduction ,medicine.medical_specialty ,Health (social science) ,business.industry ,media_common.quotation_subject ,Addiction ,Medicine (miscellaneous) ,Abstinence ,Logistic regression ,Harm ,Acute care ,medicine ,Psychiatry ,business ,Prospective cohort study ,media_common - Abstract
Introduction and Aims While persons with addiction are often hospitalised, hospitals typically employ abstinence-based policies specific to illicit drug use. Although illicit drug use is known to occur within hospitals, this problem has not been well characterised. Therefore, we sought to investigate the prevalence of and factors associated with having ever used drugs in hospital among people who use drugs in Vancouver, Canada. Design and Methods Data were derived from prospective cohort studies of people who use drugs between December 2012 and May 2013. Multivariable logistic regression was used to identify demographic and behavioural factors associated with having ever used illicit drugs in hospital. Results Among 1028 participants who had experienced ≥1 hospitalisation, 43.9% reported having ever used drugs while hospitalised. In multivariable analyses, factors positively associated with having ever used drugs in hospital included daily cocaine injection and daily crack non-injection (both P
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- 2015
23. Willingness to access an in-hospital supervised injection facility among hospitalized people who use illicit drugs
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Scott Harrison, Julio S. G. Montaner, Thomas Kerr, Evan Wood, Jane A. Buxton, Sabina Dobrer, and Lianping Ti
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medicine.medical_specialty ,Harm reduction ,Leadership and Management ,business.industry ,Health Policy ,Addiction ,media_common.quotation_subject ,Psychological intervention ,General Medicine ,Odds ratio ,Assessment and Diagnosis ,Abstinence ,Hospital medicine ,Heroin ,Family medicine ,medicine ,Fundamentals and skills ,Psychiatry ,Prospective cohort study ,business ,Care Planning ,media_common ,medicine.drug - Abstract
BACKGROUND Despite the reliance on abstinence-based drug policies within hospital settings, illicit drug use is common among hospitalized patients with severe drug addiction. Hospitalized patients who use illicit drugs (PWUDs) have been known to resort to high-risk behavior to conceal their drug use from healthcare providers. Novel interventions with the potential to reduce high-risk behavior among PWUDs in hospital settings have not been well studied. OBJECTIVE The objective of the study was to examine factors associated with willingness to access an in-hospital supervised injection facility (SIF). DESIGN Data were derived from participants enrolled in 2 Canadian prospective cohort studies involving PWUDs between June 2013 and November 2013. A cross-sectional study surveying various sociodemographic characteristics, drug use patterns, and experiences was conducted. SETTING Vancouver, Canada. MEASUREMENTS Bivariable and multivariable logistic regression analyses were used to explore factors significantly associated with willingness to access an in-hospital SIF. RESULTS Among 732 participants, 499 (68.2%) would be willing to access an in-hospital SIF. In multivariable analyses, factors positively and significantly associated with willingness to access an in-hospital SIF included: daily heroin injection (adjusted odds ratio [AOR] = 1.90; 95% confidence interval [CI]: 1.20-3.11); having used illicit drugs in hospital (AOR = 1.63; 95% CI: 1.18-2.26); and having recently used an SIF (AOR = 1.53; 95% CI: 1.10-2.15). CONCLUSIONS Our findings highlight the potential of in-hospital SIFs to complement existing harm reduction programs that serve PWUD. Moreover, an in-hospital SIF may minimize the harms associated with high-risk illicit drug use in the hospital. Journal of Hospital Medicine 2015;10:301–306. © 2015 Society of Hospital Medicine
- Published
- 2015
24. Denial of pain medication by health care providers predicts in-hospital illicit drug use among individuals who use illicit drugs
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Pauline Voon, Evan Wood, Julio S. G. Montaner, Thomas Kerr, Sabina Dobrer, and Lianping Ti
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Adult ,Male ,medicine.medical_specialty ,Canada ,Substance-Related Disorders ,media_common.quotation_subject ,Health Personnel ,Pain medication ,Addiction ,Pain ,Cohort Studies ,Health services ,Denial ,Health care ,mental disorders ,Medicine ,Illicit drug ,Humans ,Drug use ,Prospective Studies ,Psychiatry ,media_common ,lcsh:R5-920 ,Analgesics ,British Columbia ,business.industry ,Illicit Drugs ,Refusal to Treat ,Pain management ,Middle Aged ,3. Good health ,Hospitalization ,Anesthesiology and Pain Medicine ,Neurology ,Original Article ,Female ,Substance use ,business ,lcsh:Medicine (General) ,Forecasting - Abstract
People who use illicit drugs are at risk for related health complications, and may rely more heavily on emergency departments and acute care centres for their health care needs. Health care workers may be hesitant to prescribe pain medication to these individuals due to fear of addiction and suspicion of drug-seeking behaviour. Accordingly, the aim of this study was to assess the relationship between having ever been denied pain medication and having reported using illicit drugs in a Vancouver (British Columbia) cohort of illicit drug users., BACKGROUND: Undertreated pain is common among people who use illicit drugs (PWUD), and can often reflect the reluctance of health care providers to provide pain medication to individuals with substance use disorders. OBJECTIVE: To investigate the relationship between having ever been denied pain medication by a health care provider and having ever reported using illicit drugs in hospital. METHODS: Data were derived from participants enrolled in two Canadian prospective cohort studies between December 2012 and May 2013. Using bivariable and multivariable logistic regression analyses, the relationship between having ever been denied pain medication by a health care provider and having ever reported using illicit drugs in hospital was examined. RESULTS: Among 1053 PWUD who had experienced ≥1 hospitalization, 452 (44%) reported having ever used illicit drugs while in hospital and 491 (48%) reported having ever been denied pain medication. In a multivariable model adjusted for confounders, having been denied pain medication was positively associated with having used illicit drugs in hospital (adjusted OR 1.46 [95% CI 1.14 to 1.88]). CONCLUSIONS: The results of the present study suggest that the denial of pain medication is associated with the use of illicit drugs while hospitalized. These findings raise questions about how to appropriately manage addiction and pain among PWUD and indicate the potential role that harm reduction programs may play in hospital settings.
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- 2015
25. Gaps in the Hepatitis C Continuum of Care among Sex Workers in Vancouver, British Columbia: Implications for Voluntary Hepatitis C Virus Testing, Treatment and Care
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Silvia Guillemi, Kate Shannon, M. Eugenia Socías, Sabina Dobrer, Shira M. Goldenberg, Paul Nguyen, Julio S. G. Montaner, and Kathleen N. Deering
- Subjects
education.field_of_study ,Hepatology ,business.industry ,Transmission (medicine) ,Hepatitis C virus ,Population ,Gastroenterology ,virus diseases ,General Medicine ,Hepatitis C ,medicine.disease_cause ,medicine.disease ,digestive system diseases ,Substance abuse ,Immunology ,Medicine ,Original Article ,lcsh:Diseases of the digestive system. Gastroenterology ,Disease management (health) ,lcsh:RC799-869 ,business ,education ,Mass screening ,Demography ,Cohort study - Abstract
BACKGROUND: Hepatitis C virus (HCV) eradication leads to reduced morbidity, mortality and transmission. Despite the disproportionate burden of HCV among sex workers, data regarding the HCV care continuum in this population remain negligible.METHODS: Using baseline data from an ongoing cohort of women sex workers in Vancouver (An Evaluation of Sex Workers’ Health Access, January 2010 to August 2013), the authors assessed HCV prevalence and engagement in the HCV care continuum within the past year. Multivariable logistic regression analyses were used to evaluate associations with recent (ie, in the past year) HCV testing.RESULTS: Among 705 sex workers, 302 (42.8%) were HCV seropositive. Of these, 22.5% were previously unaware of their HCV status, 41.7% had accessed HCV-related care, 13.9% were offered treatment and only 1.0% received treatment. Among 552 HCV-seronegative sex workers, only one-half (52.9%) reported a recent HCV test. In multivariable analysis, women who self-identified as a sexual/gender minority (adjusted OR [aOR] 1.89 [95% CI 1.11 to 3.24]), resided in the inner city drug use epicentre (aOR 3.19 [95%CI 1.78 to 5.73]) and used injection (aOR 2.00 [95% CI 1.19 to 3.34]) or noninjection drugs (aOR 1.95 [95% CI 1.00 to 3.78]) had increased odds of undergoing a recent HCV test, while immigrant participants (aOR 0.24 [95% CI 0.12 to 0.48]) had decreased odds.CONCLUSIONS: Despite a high burden of HCV among sex workers, large gaps in the HCV care continuum remain. Particularly concerning are the low access to HCV testing, with one-fifth of women living with HCV being previously unaware of their status, and the exceptionally low prevalence of HCV treatment. There is a critical need for further research to better understand and address barriers to engage in the HCV continuum for sex workers.
- Published
- 2015
26. Poor working conditions and work stress among Canadian sex workers
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Kate Shannon, Melissa Braschel, Sabina Dobrer, J. Sou, Putu Duff, Shira M. Goldenberg, and J. Chapman
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Adult ,medicine.medical_specialty ,Substance-Related Disorders ,HIV Infections ,Violence ,Occupational safety and health ,Cohort Studies ,03 medical and health sciences ,Occupational Stress ,0302 clinical medicine ,Risk Factors ,Epidemiology ,medicine ,Humans ,030212 general & internal medicine ,Longitudinal Studies ,Workplace ,Generalized estimating equation ,Occupational Health ,Sex work ,030505 public health ,Sexual violence ,Sex Workers ,British Columbia ,Public Health, Environmental and Occupational Health ,Original Papers ,Sex Work ,Work (electrical) ,8. Economic growth ,Multivariate Analysis ,Female ,Occupational stress ,0305 other medical science ,Psychology ,Demography ,Cohort study - Abstract
Background While sex work is often considered the world's oldest profession, there remains a dearth of research on work stress among sex workers (SWs) in occupational health epidemiological literature. A better understanding of the drivers of work stress among SWs is needed to inform sex work policy, workplace models and standards. Aims To examine the factors that influence work stress among SWs in Metro Vancouver. Methods Analyses drew from a longitudinal cohort of SWs, known as An Evaluation of Sex Workers' Health Access (AESHA) (2010-14). A modified standardized 'work stress' scale, multivariable linear regression with generalized estimating equations was used to longitudinally examine the factors associated with work stress. Results In multivariable analysis, poor working conditions were associated with increased work stress and included workplace physical/sexual violence (β = 0.18; 95% confidence interval (CI) 0.06, 0.29), displacement due to police (β = 0.26; 95% CI 0.14, 0.38), working in public spaces (β = 0.73; 95% CI 0.61, 0.84). Older (β = -0.02; 95% CI -0.03, -0.01) and Indigenous SWs experienced lower work stress (β = -0.25; 95% CI -0.43, -0.08), whereas non-injection (β = 0.32; 95% CI 0.14, 0.49) and injection drug users (β = 0.17; 95% CI 0.03, 0.31) had higher work stress. Conclusions Vancouver-based SWs' work stress was largely shaped by poor work conditions, such as violence, policing, lack of safe workspaces. There is a need to move away from criminalized approaches which shape unsafe work conditions and increase work stress for SWs. Policies that promote SWs' access to the same occupational health, safety and human rights standards as workers in other labour sectors are also needed.
- Published
- 2017
27. The relationship between hazardous alcohol use and violence among street-involved youth
- Author
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Nadia, Fairbairn, Evan, Wood, Sabina, Dobrer, Huiru, Dong, Thomas, Kerr, and Kora, Debeck
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Adult ,Male ,Adolescent ,British Columbia ,Violence ,Article ,Cohort Studies ,Homeless Youth ,Young Adult ,Risk Factors ,Dangerous Behavior ,Odds Ratio ,Humans ,Female ,Longitudinal Studies ,Prospective Studies ,Alcoholic Intoxication - Abstract
Alcohol is a major contributor to premature disability and death among youth, often due to physical trauma, violence, and suicide. The purpose of this study was to longitudinally examine the association between hazardous alcohol use and experiences of violence among a cohort of street-involved youth.Data were derived from the At-Risk Youth Study (ARYS), a prospective cohort of street-involved youth who use illicit substances in Vancouver, Canada. The outcome of interest was hazardous alcohol use defined by the US National Institute on Alcohol Abuse and Alcoholism as14 drinks/week or5 drinks on one occasion for men, and7 drinks/week or4 drinks on one occasion for women. We used Generalized Estimating Equations (GEE) analyses to examine factors independently associated with hazardous alcohol use.Between 2005 and 2014, 1,149 drug-using youth were recruited and 423 (36.8%) reported hazardous alcohol use in the previous 6 months at study baseline. In multivariable GEE analyses, intimate partner violence (Adjusted Odds Ratio [AOR] = 1.53, 95% Confidence Interval [95%CI] = 1.12-2.10), and non-partner physical assault (AOR = 1.39, 95%CI = 1.21-1.59) were independently associated with hazardous alcohol use after adjusting for multiple potential confounders.A considerable proportion of youth in this setting reported hazardous alcohol use, which was independently associated with experiencing recent intimate and non-partner violence.Combined interventions for violence and hazardous alcohol use should be integrated into service provision programs for street-involved youth. (Am J Addict 2017;26:852-858).
- Published
- 2017
28. Knowledge of Hepatitis C and Treatment Willingness Amongst People Who Inject Drugs in an Era of Direct Acting Antivirals
- Author
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Allison Mah, Evan Wood, Thomas Kerr, Sabina Dobrer, Kora DeBeck, Mark Hull, Kanna Hayashi, Ekaterina Nosova, and M.-J. Milloy
- Subjects
Adult ,Male ,Canada ,Health Knowledge, Attitudes, Practice ,Hepatitis C virus ,030508 substance abuse ,Medicine (miscellaneous) ,medicine.disease_cause ,DIRECT ACTING ANTIVIRALS ,Antiviral Agents ,Article ,Drug Users ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,030212 general & internal medicine ,Prospective Studies ,Prospective cohort study ,Substance Abuse, Intravenous ,Socioeconomic status ,business.industry ,Health Policy ,Hepatitis C ,Middle Aged ,Patient Acceptance of Health Care ,medicine.disease ,Mental health ,Confidence interval ,Residence ,Female ,0305 other medical science ,business ,Social psychology ,Demography - Abstract
Background: Knowledge of hepatitis C virus (HCV) is believed to be important in altering risk behaviour, improving engagement in care, and promoting willingness to initiate HCV treatment. We assessed factors associated with HCV knowledge and treatment willingness amongst people who inject drugs (PWID) in an era of direct acting antivirals. Methods: Data were derived from three prospective cohort studies of PWID in Vancouver, Canada, betweenJune 2014andMay 2015. HCV knowledge and treatment willingness were assessed using a Likert scale. Multivariable linear regression identified factors associated with higher HCV knowledge and treatment willingness. Results: Amongst 630 participants, mean scores for HCV knowledge and treatment willingness were 25.41 (standard deviation [SD]: 2.52) out of 30, and 6.83 (SD: 1.83) out of 10, respectively. In multivariable analyses, Caucasian ancestry (adjusted linear regression model estimate [β] 0.50; 95% confidence interval [CI] 0.17, 0.82), employment (β 0.76; 95% CI: 0.38, 1.13), diagnosed mental health disorder (β 0.44; 95% CI: 0.11, 0.78) and previous HCV treatment (β 0.94; 95% CI: 0.46, 1.43) were independently associated with higher knowledge. Downtown Eastside (DTES) residence (i.e., epicenter of Vancouver’s drug scene) was independently associated with lower knowledge (β -0.48; 95% CI: -0.81, -0.15). Greater HCV knowledge (β 0.12; 95% CI: 0.07, 0.17) was independently associated with higher HCV treatment willingness. DTES residence (β -0.31; 95% CI: -0.56, -0.06) and daily crack cocaine smoking (β -0.52; 95% CI: -0.92, -0.13) were independently associated with lower treatment willingness. Conclusion: Socioeconomic factors, such as neighborhood residence and employment, were associated with HCV knowledge. Higher HCV knowledge was associated with more HCV treatment willingness. Our findings suggest that increasing HCV knowledge amongst PWID may be an integral component of the HCV cascade of care and that efforts might be best targeted to individuals with greater socioeconomic disadvantage.
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- 2017
29. Alcohol Use among Persons on Methadone Treatment
- Author
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Jan Klimas, Huiru Dong, Kanna Hayashi, Evan Wood, Sabina Dobrer, Thomas Kerr, and M.-J. Milloy
- Subjects
Longitudinal study ,medicine.medical_specialty ,media_common.quotation_subject ,030508 substance abuse ,Medicine (miscellaneous) ,Addiction ,Alcohol ,Article ,Heroin ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,mental disorders ,medicine ,030212 general & internal medicine ,Mortality ,Psychiatry ,media_common ,business.industry ,Methadone maintenance treatment ,Psychiatry and Mental health ,chemistry ,0305 other medical science ,business ,Alcohol consumption ,Methadone ,medicine.drug - Abstract
We read with interest Dr Varshney et al.'s article on brief interventions for alcohol use among persons on maintenance treatment published ahead-of-print on August 11, 2015. While alcohol is found in the majority of drug-related deaths that involve illicit drugs, around the globe, maintenance therapy with methadone (MMT), or buprenorphine, reduces morbidity and mortality among people who use opiates. Although one common clinical challenge is comorbid alcohol use and opioid use disorder, with guidelines often recommending withholding methadone in this context given the potential for fatal overdose due to drug interactions, alcohol's impact on the health outcomes of MMT patients has been 'overlooked and underestimated'. Therefore, we examined the impact of heavy alcohol use on mortality among MMT patients. European Commission Irish Research Council National Institutes of Health Canadian Institutes of Health Research Michael Smith Foundation for Health Research NG Biomed
- Published
- 2017
30. Structural barriers to antiretroviral therapy among sex workers living with HIV : Findings of a longitudinal study in Vancouver, Canada
- Author
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Sabina Dobrer, Julio S. G. Montaner, Kate Shannon, Putu Duff, Silvia Guillemi, Shira M. Goldenberg, and Paul Nguyen
- Subjects
Adult ,Male ,Gerontology ,medicine.medical_specialty ,Longitudinal study ,Delayed Diagnosis ,Social Psychology ,Substance-Related Disorders ,HIV Infections ,Logistic regression ,Article ,Health Services Accessibility ,Gee ,Medication Adherence ,03 medical and health sciences ,0302 clinical medicine ,Acquired immunodeficiency syndrome (AIDS) ,medicine ,Humans ,Longitudinal Studies ,Prospective Studies ,030212 general & internal medicine ,Generalized estimating equation ,Sex Workers ,030505 public health ,British Columbia ,business.industry ,Public health ,Public Health, Environmental and Occupational Health ,Social Support ,Middle Aged ,medicine.disease ,Health psychology ,Logistic Models ,Infectious Diseases ,Cohort ,Female ,0305 other medical science ,business - Abstract
In light of limited data on structural determinants of access and retention in antiretroviral therapy (ART) among sex workers, we examined structural correlates of ART use among sex workers living with HIV over time. Longitudinal data were drawn from a cohort of 646 female sex workers in Vancouver, Canada (2010-2012) and linked pharmacy records on ART dispensation. We used logistic regression with generalized estimating equations (GEE) to examine correlates of gaps in ART use (i.e., treatment interruptions or delayed ART initiation), among HIV seropositive participants (n = 74). Over a 2.5-year period, 37.8 % of participants experienced gaps in ART use (i.e., no ART dispensed in a 6-month period). In a multivariable GEE model, younger age, migration/mobility, incarceration, and non-injection drug use independently correlated with gaps in ART use. In spite of successes scaling-up ART in British Columbia, younger, mobile, or incarcerated sex workers face persistent gaps in access and retention irrespective of drug use. Community-based, tailored interventions to scale-up entry and retention in ART for sex workers should be further explored in this setting.
- Published
- 2017
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31. Phylogenetic clustering of hepatitis C virus among people who inject drugs in Vancouver, Canada
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Vincent Montoya, Andrea D. Olmstead, Tanya L. Applegate, Julio S. G. Montaner, Gregory J. Dore, Mel Krajden, P. Richard Harrigan, Sabina Dobrer, Jason Grebely, Brandon D.L. Marshall, Viviane D. Lima, Conan K. Woods, Kora DeBeck, Brendan Jacka, Jeffrey B. Joy, M.-J. Milloy, Art F. Y. Poon, Oliver G. Pybus, F. Lamoury, and Gkikas Magiorkinis
- Subjects
0303 health sciences ,Harm reduction ,medicine.medical_specialty ,Hepatology ,business.industry ,Transmission (medicine) ,Public health ,Incidence (epidemiology) ,virus diseases ,Hepatitis C ,medicine.disease ,Treatment as prevention ,Virology ,digestive system diseases ,3. Good health ,03 medical and health sciences ,0302 clinical medicine ,Environmental health ,Epidemiology ,medicine ,030212 general & internal medicine ,Prospective cohort study ,business ,030304 developmental biology - Abstract
Hepatitis C virus (HCV) transmission continues to occur among people who inject drugs (PWID), with HCV incidence ranging from 10-40 cases per 100 person-years (1-7). Although needle and syringe programs, opioid substitution treatment (OST) and other harm reduction strategies have been successful at reducing HIV incidence in PWID (8), these programs have been less effective for preventing HCV (9-11). However, in the near future, HCV treatment will be highly curative (>90%), simple (once-daily), short duration (8-12 weeks) and well-tolerated: features that hold great promise for the potential effectiveness of HCV “treatment as prevention” among PWID (12, 13). Given the lack of protective immunity following spontaneous and treatment-induced HCV clearance (14), better preventive strategies are necessary to maximize the impact of HCV “treatment as prevention” initiatives. Mathematical modeling studies have suggested that modest increases in HCV treatment uptake could lead to substantial reductions in HCV prevalence (15), particularly if combined with improved coverage of needle and syringe and OST programs (16). Identifying characteristics of people at high risk of HCV transmission may provide important information for the design and implementation of targeted and more effective public health and treatment strategies for the elimination of HCV among PWID. Phylogenetic studies provide an opportunity to model underlying transmission patterns that cannot be determined through epidemiological studies, as demonstrated in HIV (17, 18). Phylogenetic analyses have identified pan-European HCV clustering among PWID infected with HIV (19), and have been used to document HCV networks within and between cities (20, 21). Social networks (22), younger age (23) and acute HCV (24) are associated with phylogenetic clustering. However, phylogenetic studies among PWID with HCV have been limited by small sample sizes, cross-sectional designs, diverse geographic sampling, and insufficient epidemiological data available to link with sequence data. The aim of this study was to investigate phylogenetic clustering of HCV and associated factors among participants enrolled in a longstanding prospective cohort of PWID in Vancouver, Canada.
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- 2014
32. The impact of childhood emotional abuse on violence among people who inject drugs
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Evan Wood, Huiru Dong, Julio S. G. Montaner, Thomas Kerr, Sabina Dobrer, and Stephanie Lake
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Child abuse ,education.field_of_study ,medicine.medical_specialty ,Health (social science) ,Population ,Medicine (miscellaneous) ,Poison control ,Victimisation ,Suicide prevention ,Injury prevention ,medicine ,Domestic violence ,Psychology ,education ,Psychological abuse ,Psychiatry ,Clinical psychology - Abstract
INTRODUCTION AND AIMS: Childhood emotional abuse is a known risk factor for various poor social and health outcomes. While people who inject drugs (IDU) report high levels of violence, in addition to high rates of childhood maltreatment, the relationship between childhood emotional abuse and later life violence within this population has not been examined. DESIGN AND METHODS: Cross-sectional data were derived from an open prospective cohort of IDU in Vancouver, Canada. Childhood emotional abuse was measured using the Childhood Trauma Questionnaire. We used multivariate logistic regression to examine potential associations between childhood emotional abuse and being a recent victim or perpetrator of violence. RESULTS: Between December 2005 and May 2013, 1437 IDU were eligible for inclusion in this analysis, including 465 (32.4%) women. In total, 689 (48.0%) reported moderate to severe history of childhood emotional abuse, whereas 333 (23.2%) reported being a recent victim of violence and 173 (12.0%) reported being a recent perpetrator of violence. In multivariate analysis, being a victim of violence (adjusted odds ratio = 1.49, 95% confidence interval 1.15-1.94) and being a perpetrator of violence (adjusted odds ratio = 1.58, 95% confidence interval 1.12-2.24) remained independently associated with childhood emotional abuse. DISCUSSION AND CONCLUSIONS: We found high rates of childhood emotional abuse and subsequent adult violence among this sample of IDU. Emotional abuse was associated with both victimisation and perpetration of violence. These findings highlight the need for policies and programmes that address both child abuse and historical emotional abuse among adult IDU. Language: en
- Published
- 2014
33. Self-management of pain among people who inject drugs in Vancouver
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Julio S. G. Montaner, Evan Wood, Sabina Dobrer, Paul Nguyen, Thomas Kerr, Pauline Voon, and Cody Callon
- Subjects
Adult ,Male ,Canada ,medicine.medical_specialty ,Cross-sectional study ,Pain ,Logistic regression ,Article ,Heroin ,Interquartile range ,Internal medicine ,mental disorders ,medicine ,Humans ,Pain Management ,Medical prescription ,Substance Abuse, Intravenous ,Prospective cohort study ,Psychiatry ,Self-management ,business.industry ,General Medicine ,Odds ratio ,Middle Aged ,Self Care ,Cross-Sectional Studies ,Female ,business ,medicine.drug - Abstract
SUMMARY Aims: To evaluate factors and methods associated with self-management of pain among people who inject drugs (IDUs) in Vancouver (Canada). Patients & methods: This cross-sectional study used bivariate statistics and multivariate logistic regression to analyze self-reported responses among 483 IDUs reporting moderate-to-extreme pain in two prospective cohort studies from 1 December 2012 to 31 May 2013. Results: Median age was 49.6 years (interquartile range: 43.9–54.6 years), 33.1% of IDUs were female and 97.5% reported self-management of pain. Variables independently and positively associated with self-managed pain included having been refused a prescription for pain medication (adjusted odds ratio: 7.83; 95% CI: 1.64–37.3) and having ever been homeless (adjusted odds ratio: 3.70; 95% CI: 1.00–13.7). Common methods of self-management of pain included injecting heroin (52.7%) and obtaining diverted prescription pain medication from the street (65.0%). Conclusion: Self-management of pain was common among IDUs who reported moderate-to-extreme pain in this setting, particularly among those who had been refused a prescription for pain medication and those who had ever been homeless. These data highlight the challenges of adequate pain management among IDUs.
- Published
- 2014
34. P094 Comparison of hla antibody assignments between two luminex based platforms
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Hyeongcheol Park, Sabina Dobrer, Paul Keown, Lenka Allan, Jason Wong, Franz Fenninger, and Oliver P. Günther
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business.industry ,Immunology ,Immunology and Allergy ,Medicine ,Hla antibodies ,General Medicine ,business - Published
- 2019
35. P141 Comparison of HLA antibody assignment between two luminex platforms in a cohort of thoracic patients
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Sabina Dobrer, Paul Keown, Karen Sherwood, Oliver P. Günther, and Hyeongcheol Park
- Subjects
business.industry ,Immunology ,Cohort ,Immunology and Allergy ,Medicine ,Hla antibodies ,General Medicine ,business - Published
- 2019
36. Barriers to Viral Suppression Among Female Sex Workers: Role of Structural and Intimate Partner Dynamics
- Author
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Kathleen N. Deering, Julio S. G. Montaner, Putu Duff, Shira M. Goldenberg, Kate Shannon, Paul Nguyen, and Sabina Dobrer
- Subjects
Male ,Anti-HIV Agents ,Psychological intervention ,HIV Infections ,Article ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,Viral suppression ,Longitudinal cohort ,030505 public health ,Intimate partner ,British Columbia ,business.industry ,Female sex ,Odds ratio ,Viral Load ,Antiretroviral therapy ,Sex Work ,Confidence interval ,Infectious Diseases ,Sexual Partners ,Female ,0305 other medical science ,business ,Demography - Abstract
OBJECTIVE Despite global evidence that sex workers (SWs) are disproportionately impacted by HIV, data on HIV treatment outcomes among SWs living with HIV remains sparse. This study examined the correlates of undetectable plasma viral load (pVL) among street- and off-street SWs living with HIV and on antiretroviral therapy (ART) in Metro Vancouver, Canada. METHODS Analyses drew on data (2010-2014) from a longitudinal cohort of SWs (An Evaluation of Sex Workers Health Access) and confidential linkages with the Drug Treatment Program (DTP) data on ART dispensation and outcomes. Bivariate and multivariable generalized linear mixed-effects models were used to identify longitudinal correlates of undetectable pVL (
- Published
- 2016
37. Prevalence and predictors of facing a legal obligation to disclose HIV serostatus to sexual partners among people living with HIV who inject drugs in a Canadian setting:a cross-sectional analysis
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Julio S. G. Montaner, Robert S. Hogg, Evan Wood, Sophie Patterson, Paul Nguyen, Thomas Kerr, Angela Kaida, Gina Ogilvie, M.-J. Milloy, and Sabina Dobrer
- Subjects
medicine.medical_specialty ,030505 public health ,business.industry ,Cross-sectional study ,Research ,Human immunodeficiency virus (HIV) ,General Medicine ,medicine.disease_cause ,Supreme court ,03 medical and health sciences ,0302 clinical medicine ,Criminalization ,medicine ,030212 general & internal medicine ,Obligation ,0305 other medical science ,Psychiatry ,business ,Serostatus ,Hiv transmission ,Viral load ,Demography - Abstract
In October 2012, the Canadian Supreme Court ruled that people living with HIV must disclose their HIV status before sex that poses a "realistic possibility" of HIV transmission, clarifying that in circumstances where condom-protected penile-vaginal intercourse occurred with a low viral load (1500 copies/mL), the realistic possibility of transmission would be negated. We estimated the proportion of people living with HIV who use injection drugs who would face a legal obligation to disclose under these circumstances.: We used cross-sectional survey data from a cohort of people living with HIV who inject drugs. Participants interviewed since October 2012 who self-reported recent penile-vaginal intercourse were included. Participants self-reporting 100% condom use with a viral load consistently1500 copies/mL were assumed to have no legal obligation to disclose. Logistic regression identified factors associated with facing a legal obligation to disclose.We included 176 participants, 44% of whom were women: 94% had a low viral load, and 60% self-reported 100% condom use. If condom use and low viral load were required to negate the realistic possibility of transmission, 44% would face a legal obligation to disclose. Factors associated with facing a legal obligation to disclose were female sex (adjusted odds ratio [OR] 2.19, 95% confidence interval [CI] 1.13-4.24), having 1 recent sexual partner (v.1) (adjusted OR 2.68, 95% CI 1.24-5.78) and self-reporting a stable relationship (adjusted OR 2.00, 95% CI 1.03-3.91).Almost half the participants in our analytic sample would face a legal obligation to disclose to sexual partners under these circumstances (with an increased burden among women), adding further risk of criminalization within this marginalized and vulnerable community.
- Published
- 2016
38. Awareness and understanding of HIV non-disclosure case law among people living with HIV who use illicit drugs in a Canadian setting
- Author
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Gina Ogilvie, Julio S. G. Montaner, Robert S. Hogg, Angela Kaida, Valerie Nicholson, Thomas Kerr, M.-J. Milloy, Sabina Dobrer, Sophie Patterson, and Jean Shoveller
- Subjects
Adult ,Male ,medicine.medical_specialty ,Canada ,Cross-sectional study ,Substance-Related Disorders ,media_common.quotation_subject ,Common law ,Sexual Behavior ,Medicine (miscellaneous) ,HIV Infections ,Disclosure ,Article ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Criminalization ,Surveys and Questionnaires ,Medicine ,Humans ,030212 general & internal medicine ,Prospective Studies ,Psychiatry ,Duty ,media_common ,030505 public health ,British Columbia ,business.industry ,Illicit Drugs ,Health Policy ,virus diseases ,Awareness ,Middle Aged ,Supreme court ,Cross-Sectional Studies ,Logistic Models ,Criminal Behavior ,Female ,Self Report ,0305 other medical science ,business ,Serostatus ,Viral load ,Social psychology ,Cohort study - Abstract
In 2012, the Supreme Court of Canada (SCC) ruled that people living with HIV (PLWH) could face criminal charges if they did not disclose their serostatus before sex posing a "realistic possibility" of HIV transmission. Condom-protected vaginal sex with a low (i.e.,1500copies/mL) HIV viral load (VL) incurs no duty to disclose. Awareness and understanding of this ruling remain uncharacterized, particularly among marginalized PLWH.We used data from ACCESS, a community-recruited cohort of PLWH who use illicit drugs in Vancouver. The primary outcome was self-reported awareness of the 2012 SCC ruling, drawn from cross-sectional survey data. Participants aware of the ruling were asked how similar their understanding was to a provided definition. Sources of information from which participants learned about the ruling were determined. Multivariable logistic regression identified factors independently associated with ruling awareness.Among 249 participants (39% female), median age was 50 (IQR: 44-55) and 80% had a suppressed HIV VL (50copies/mL). A minority (112, 45%) of participants reported ruling awareness, and 44 (18%) had a complete understanding of the legal obligation to disclose. Among those aware (n=112), newspapers/media (46%) was the most frequent source from which participants learned about the ruling, with 51% of participants reporting that no healthcare providers had talked to them about the ruling. Ruling awareness was negatively associated with VL suppression (AOR:0.51, 95% CI:0.27,0.97) and positively associated with recent condomless sex vs. no sex (AOR:2.00, 95% CI:1.03,3.92).Most participants were not aware of the 2012 SCC ruling, which may place them at risk of prosecution. Discussions about disclosure and the law were lacking in healthcare settings. Advancing education about HIV disclosure and the law is a key priority. The role of healthcare providers in delivering information and support to PLWH in this legal climate should be further explored.
- Published
- 2016
39. The population impact of eliminating homelessness on HIV viral suppression among people who use drugs
- Author
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Brandon D.L. Marshall, Robert S. Hogg, Beth Elston, Julio S. G. Montaner, M.-J. Milloy, Surita Parashar, Thomas Kerr, Evan Wood, and Sabina Dobrer
- Subjects
Gerontology ,Adult ,Male ,Canada ,Adolescent ,Immunology ,Population ,HIV Infections ,Article ,Drug Users ,03 medical and health sciences ,symbols.namesake ,Young Adult ,0302 clinical medicine ,Acquired immunodeficiency syndrome (AIDS) ,Immunology and Allergy ,Medicine ,Humans ,030212 general & internal medicine ,Poisson regression ,Prospective Studies ,education ,Prospective cohort study ,Substance Abuse, Intravenous ,education.field_of_study ,030505 public health ,Models, Statistical ,business.industry ,Middle Aged ,Viral Load ,medicine.disease ,Confidence interval ,Substance abuse ,Infectious Diseases ,Treatment Outcome ,Anti-Retroviral Agents ,Ill-Housed Persons ,symbols ,Population study ,Female ,0305 other medical science ,business ,Viral load ,Demography - Abstract
OBJECTIVE We sought to estimate the change in viral suppression prevalence if homelessness were eliminated from a population of HIV-infected people who use drugs. DESIGN Community-recruited prospective cohort of HIV-infected people who use drugs in Vancouver, Canada. Behavioural information was collected at baseline and linked to a province-wide HIV/AIDS treatment database. The primary outcome was viral suppression (
- Published
- 2015
40. Socioeconomic marginalization and plasma HIV-1 RNA nondetectability among individuals who use illicit drugs in a Canadian setting
- Author
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Thomas Kerr, Lindsey Richardson, Silvia Guillemi, Sabina Dobrer, Julio S. G. Montaner, Michael-John Milloy, Cathy M. Puskas, and Evan Wood
- Subjects
Adult ,Male ,medicine.medical_specialty ,Mediation (statistics) ,Canada ,Multivariate analysis ,Substance-Related Disorders ,Immunology ,Psychological intervention ,HIV Infections ,Article ,Medication Adherence ,Plasma ,Environmental health ,medicine ,Immunology and Allergy ,Humans ,Longitudinal Studies ,Prospective Studies ,Psychiatry ,Socioeconomic status ,Sex work ,business.industry ,Illicit Drugs ,Odds ratio ,Middle Aged ,Viral Load ,Infectious Diseases ,Anti-Retroviral Agents ,Cohort ,HIV-1 ,Social Marginalization ,RNA, Viral ,Female ,business ,Viral load - Abstract
Objective Given that people who use illicit drugs (PWUD) often engage in prohibited income generation to support their basic needs, we sought to examine the role of these activities in shaping antiretroviral therapy (ART) adherence and plasma HIV RNA-1 viral load suppression among HIV-infected PWUD. Design Longitudinal analyses among HIV-positive, ART-exposed PWUD in the AIDS Care Cohort to evaluate Exposure to Survival Services prospective cohort study (2005-2013). Methods Generalized linear mixed-effects and mediation analyses examined the relationship between prohibited income generation (e.g., sex work, drug dealing, theft, street-based income) and virologic suppression (plasma viral load ≤50 copies/ml plasma) adjusting for adherence and potential confounders. Results Among 687 HIV-infected PWUD, 391 (56.9%) individuals reported prohibited income generation activity during the study period. In multivariate analyses, prohibited income generation remained independently and negatively associated with virologic suppression (adjusted odds ratio: 0.68, 95% confidence interval: 0.52-0.88) following adjustment for hypothesized confounders, including high-intensity drug use, ART adherence and homelessness. Although partially mediated by ART adherence, the relationship between prohibited income generation and virologic suppression was maintained in mediation analyses (Sobel statistic = -1.95, P = 0.05). Conclusion Involvement in prohibited income generation decreases the likelihood of virologic suppression directly and indirectly through its negative association with ART adherence. These findings suggest that linkages between socioeconomic marginalization, the criminalization of illicit drug use, and insufficient employment opportunities may produce barriers to access and retention in care. Programmatic and policy interventions that decrease socioeconomic vulnerability may therefore reduce HIV-related morbidity, mortality, and onward transmission.
- Published
- 2015
41. THE RELATIONSHIP BETWEEN SOCIAL, POLICY AND PHYSICAL VENUE FEATURES AND SOCIAL COHESION ON CONDOM USE FOR PREGNANCY PREVENTION AMONG SEX WORKERS: A SAFER INDOOR WORK ENVIRONMENT SCALE
- Author
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Kate Shannon, Putu Duff, Jean Shoveller, Jill Chettiar, Sabina Dobrer, Gina Ogilvie, and Julio S. G. Montaner
- Subjects
Adult ,Safe Sex ,Epidemiology ,Population ,Public Policy ,Article ,Health Services Accessibility ,law.invention ,Condoms ,Interviews as Topic ,Social support ,Condom ,law ,Pregnancy ,Environmental health ,Medicine ,Humans ,Longitudinal Studies ,Prospective Studies ,education ,Workplace ,Contraception Behavior ,Occupational Health ,Sex work ,Social policy ,Reproductive health ,Harm reduction ,education.field_of_study ,Sex Workers ,British Columbia ,business.industry ,Public Health, Environmental and Occupational Health ,Social Support ,Multivariate Analysis ,Health education ,Female ,Reproductive Health Services ,business - Abstract
Background This study aims to: report on a newly developed ‘Safer Indoor Work Environmental Scale’ that characterizes the social, policy and physical features of indoor venues and social cohesion; and using this scale, longitudinally evaluate the association between these features on sex workers’ (SWs’) condom use for pregnancy prevention. Methods Drawing on a prospective open cohort of female SWs working in indoor venues, a newly-developed ‘Safer Indoor Work Environment Scale’ was used to build six multivariable models with generalized estimating equations (GEE), to determine the independent effects of social, policy and venue-based features and social cohesion on condom use. Results Of 588 indoor SWs, 63.6% used condoms for pregnancy prevention in the last month. In multivariable GEE analysis, the following venue-based features were significantly correlated with barrier contraceptive use for pregnancy prevention: managerial practices and venue safety policies (Adjusted Odds Ratio (AOR)=1.09; 95% Confidence Interval (95%CI) 1.01–1.17) access to sexual and reproductive health services/supplies (AOR=1.10; 95%CI 1.00–1.20) access to drug harm reduction (AOR=1.13; 95%CI 1.01–1.28), and social cohesion among workers (AOR=1.05; 95%CI 1.03–1.07). Access to security features was marginally associated with condom use (AOR=1.13; 95%CI 0.99–1.29). Conclusion The findings of the current study highlight how work environment and social cohesion among SWs are related to improved condom use. Given global calls for the decriminalization of sex work, and potential legislative reforms in Canada, this study points to the critical need for new institutional arrangements (e.g., legal and regulatory frameworks; labour standards) to support safer sex workplaces. Keywords: Sex work, structural intervention, work environment, condom, social cohesion
- Published
- 2015
42. Factors Associated with Leaving Hospital against Medical Advice among People Who Use Illicit Drugs in Vancouver, Canada
- Author
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M.-J. Milloy, Sabina Dobrer, Evan Wood, Lianping Ti, Ryan McNeil, Jane A. Buxton, Thomas Kerr, and Kanna Hayashi
- Subjects
Adult ,Male ,medicine.medical_specialty ,Canada ,Substance-Related Disorders ,Psychological intervention ,lcsh:Medicine ,Comorbidity ,Heroin ,Drug Users ,Medicine ,Humans ,Prospective cohort study ,Psychiatry ,lcsh:Science ,Multidisciplinary ,business.industry ,Illicit Drugs ,lcsh:R ,Health services research ,Odds ratio ,Middle Aged ,medicine.disease ,Recreational drug use ,Patient Discharge ,3. Good health ,Substance abuse ,Family medicine ,Patient Compliance ,Female ,lcsh:Q ,business ,medicine.drug ,Research Article - Abstract
Background Leaving hospital against medical advice (AMA) is common among people who use illicit drugs (PWUD) and is associated with severe health-related harms and costs. However, little is known about the prevalence of and factors associated with leaving AMA among PWUD. Methods Data were collected through two Canadian prospective cohort studies involving PWUD between September 2005 and July 2011 and linked to a hospital admission/discharge database. Bivariable and multivariable generalized estimating equations were used to examine factors associated with leaving hospital AMA among PWUD who were hospitalized. Results Among 488 participants who experienced at least one hospitalization, 212 (43.4%) left the hospital AMA at least once during the study period. In multivariable analyses, factors positively and significantly associated with leaving hospital AMA included: unstable employment (AOR = 1.92; 95% confidence interval [CI]: 1.22–3.03); recent incarceration (AOR = 1.63; 95%CI: 1.07–2.49); ≥ daily heroin injection (AOR = 1.49; 95%CI: 1.05–2.11); and younger age per year younger (adjusted odds ratio [AOR] = 1.04; 95%CI: 1.02–1.06). Conclusions We found a substantial proportion of PWUD in this setting left hospital AMA and that various markers of risk and vulnerability were associated with this phenomenon. Our findings highlight the need to address substance abuse issues early following hospital admission. These findings further suggest a need to develop novel interventions to minimize PWUD leaving hospital prematurely.
- Published
- 2015
43. Denial of prescription analgesia among people who inject drugs in a Canadian setting
- Author
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Pauline, Voon, Cody, Callon, Paul, Nguyen, Sabina, Dobrer, Julio S G, Montaner, Evan, Wood, and Thomas, Kerr
- Subjects
Adult ,Male ,Canada ,Pain ,Middle Aged ,Article ,Analgesics, Opioid ,Cohort Studies ,Humans ,Female ,Prospective Studies ,Self Report ,Substance Abuse, Intravenous ,Prescription Drug Overuse - Abstract
Despite the high prevalence of pain among people who inject drugs (PWIDs), clinicians may be reluctant to prescribe opioid-based analgesia to those with a history of drug use or addiction. We sought to examine the prevalence and correlates of PWIDs reporting being denied of prescription analgesia (PA). We also explored reported reasons for and actions taken after being denied PA.Using data from two prospective cohort studies of PWIDs, multivariate logistic regression was used to identify the prevalence and correlates of reporting being denied PA. Descriptive statistics were used to characterise reasons for denials and subsequent actions.Approximately two-thirds (66.5%) of our sample of 462 active PWIDs reported having ever been denied PA. We found that reporting being denied PA was significantly and positively associated with having ever been enrolled in methadone maintenance treatment (adjusted odds ratio 1.76, 95% confidence interval 1.11-2.80) and daily cocaine injection (adjusted odds ratio 2.38, 95% confidence interval 1.00-5.66). The most commonly reported reason for being denied PA was being accused of drug seeking (44.0%). Commonly reported actions taken after being denied PA included buying the requested medication off the street (40.1%) or obtaining heroin to treat pain (32.9%).These findings highlight the challenges of addressing perceived pain and the need for strategies to prevent high-risk methods of self-managing pain, such as obtaining diverted medications or illicit substances for pain. Such strategies may include integrated pain management guidelines within methadone maintenance treatment and other substance use treatment programs.
- Published
- 2014
44. The impact of childhood emotional abuse on violence among people who inject drugs
- Author
-
Stephanie, Lake, Evan, Wood, Huiru, Dong, Sabina, Dobrer, Julio, Montaner, and Thomas, Kerr
- Subjects
Adult ,Male ,British Columbia ,Middle Aged ,Violence ,Article ,Cohort Studies ,Cross-Sectional Studies ,Logistic Models ,Risk Factors ,Surveys and Questionnaires ,Multivariate Analysis ,Humans ,Female ,Child Abuse ,Prospective Studies ,Child ,Substance Abuse, Intravenous - Abstract
Childhood emotional abuse is a known risk factor for various poor social and health outcomes. While people who inject drugs (IDU) report high levels of violence, in addition to high rates of childhood maltreatment, the relationship between childhood emotional abuse and later life violence within this population has not been examined.Cross-sectional data were derived from an open prospective cohort of IDU in Vancouver, Canada. Childhood emotional abuse was measured using the Childhood Trauma Questionnaire. We used multivariate logistic regression to examine potential associations between childhood emotional abuse and being a recent victim or perpetrator of violence.Between December 2005 and May 2013, 1437 IDU were eligible for inclusion in this analysis, including 465 (32.4%) women. In total, 689 (48.0%) reported moderate to severe history of childhood emotional abuse, whereas 333 (23.2%) reported being a recent victim of violence and 173 (12.0%) reported being a recent perpetrator of violence. In multivariate analysis, being a victim of violence (adjusted odds ratio = 1.49, 95% confidence interval 1.15-1.94) and being a perpetrator of violence (adjusted odds ratio = 1.58, 95% confidence interval 1.12-2.24) remained independently associated with childhood emotional abuse.We found high rates of childhood emotional abuse and subsequent adult violence among this sample of IDU. Emotional abuse was associated with both victimisation and perpetration of violence. These findings highlight the need for policies and programmes that address both child abuse and historical emotional abuse among adult IDU.
- Published
- 2013
45. P762 TEMPORAL CHANGES IN HEPATITIS C VIRUS GENOTYPE 3A DISTRIBUTION AMONG PEOPLE WHO INJECT DRUGS IN VANCOUVER, CANADA
- Author
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Richard Harrigan, G.J. Dore, Zabrina L. Brumme, M. Krajden, Jason Grebely, Art F. Y. Poon, Tanya L. Applegate, V. Dias Lima, Sabina Dobrer, Thomas Kerr, Jeffrey B. Joy, Brendan Jacka, M.-J. Milloy, Andrea D. Olmstead, F. Lamoury, J. S. G. Montaner, Brandon D.L. Marshall, Conan K. Woods, Kora DeBeck, and Evan Wood
- Subjects
Hepatology ,Hepatitis C virus genotype ,Distribution (pharmacology) ,Biology ,Virology - Published
- 2014
46. Use of a Medically Supervised Injection Facility Among Drug-Injecting Street Youth
- Author
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Kora DeBeck, Evan Wood, Sabina Dobrer, Thomas Kerr, Scott E. Hadland, Paul Nguyen, and Julio S. G. Montaner
- Subjects
business.industry ,Public Health, Environmental and Occupational Health ,medicine.disease ,Drug injecting ,03 medical and health sciences ,Psychiatry and Mental health ,0302 clinical medicine ,Pediatrics, Perinatology and Child Health ,medicine ,Pediatrics, Perinatology, and Child Health ,030212 general & internal medicine ,Medical emergency ,business ,030217 neurology & neurosurgery - Published
- 2014
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