290 results on '"Garfein RS"'
Search Results
2. Problematic use of prescription-type opioids prior to heroin use among young heroin injectors
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Pollini RA, Banta-Green CJ, Cuevas-Mota J, Metzner M, Teshale E, and Garfein RS
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Public aspects of medicine ,RA1-1270 - Abstract
Robin A Pollini1, Caleb J Banta-Green2, Jazmine Cuevas-Mota3, Mitcheal Metzner3, Eyasu Teshale4, Richard S Garfein31Pacific Institute for Research and Evaluation, Calverton, MD; 2Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA; 3Department of Medicine, University of California San Diego, La Jolla, CA; 4National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USABackground: Misuse of prescription-type opioids and related adverse health effects are increasing, but little is known about the role of these drugs as a precursor to heroin use. We conducted an exploratory study to determine the proportion of young heroin injectors reporting problematic use of prescription-type opioids prior to using heroin, and to describe the factors associated with prior problematic prescription-type opioid use.Methods: Between March 2009 and June 2010, we recruited injection drug users (IDUs) for a cross-sectional study of hepatitis C virus infection risk. Participants were aged 18–40 years and had injected illicit drugs within the previous six months. A computerized self-administered survey assessed sociodemographics, drug use history, human immunodeficiency virus (HIV)/hepatitis C virus risk behaviors and perceptions, and medical history. We added questions on prescription-type opioid use to the parent study in March 2010; heroin injectors who subsequently enrolled and reported problematic prescription-type opioid use prior to heroin initiation were compared with other heroin IDUs using univariate and multivariate regression methods.Results: Among 123 heroin IDUs, 49 (39.8%) reported problematic prescription-type opioid use prior to heroin initiation (“prescription-type opioid first injection drug users” (PTO-First IDUs)). PTO-First IDUs had higher odds of injecting with friends (adjusted odds ratio [AOR] 6.01; 95% confidence interval [CI] 1.90–19.07), getting new syringes from a spouse/family member/sex partner (AOR 23.0; 95% CI 2.33–226.0), knowing about the local syringe exchange program (AOR 7.28; 95% CI 1.17–45.05), using powder cocaine (AOR 3.75; 95% CI 1.43–9.86), and perceiving themselves as less likely than other IDUs to get HIV (AOR 4.32; 95% CI 1.26–14.77). They had lower odds of ever being tested for HIV (AOR 0.25; 95% CI 0.08–0.80).Conclusion: A high proportion of young heroin IDUs reported problematic prescription-type opioid use prior to initiating heroin use. Our study provides several avenues for future investigation to help further characterize this subset of IDUs and their risks and perceptions related to HIV and other blood-borne pathogens.Keywords: injection drug users, prescription-type opioids
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- 2011
3. Evaluation of recorded video-observed therapy for anti-tuberculosis treatment
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Garfein, RS, Liu, L, Cuevas-Mota, J, Collins, K, Catanzaro, DG, Muñoz, F, Moser, K, Chuck, C, Higashi, J, Bulterys, MA, Raab, F, and Rios, P
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Infectious Diseases ,Tuberculosis ,Clinical Research ,Rare Diseases ,Vaccine Related ,Infection ,Good Health and Well Being ,Adolescent ,Adult ,Aged ,Aged ,80 and over ,Antitubercular Agents ,Directly Observed Therapy ,Female ,Humans ,Male ,Middle Aged ,New York City ,San Francisco ,United States ,Young Adult ,mHealth ,monitoring ,adherence ,Cardiorespiratory Medicine and Haematology ,Microbiology - Abstract
BACKGROUND: Asynchronous video directly observed therapy (VDOT) may reduce tuberculosis (TB) program costs and the burden on patients. We compared VDOT performance across three cities in the United States, each of which have TB incidence rates above the national average.METHODS: Patients aged ≥18 years who are currently receiving directly observed anti-TB treatment were invited to use VDOT for monitoring treatment. Pre- and post-treatment interviews and medical records were used to assess site differences in treatment adherence and patient characteristics and perceptions.RESULTS: Participants were enrolled in New York City, NY (n = 48), San Diego, CA (n = 52) and San Francisco, CA, USA (n = 49). Overall, the mean age was 41 years (range 18-87); 59% were male; most were Asian (45%) or Hispanic/Latino (30%); and 77% were foreign-born. The median fraction of expected doses observed (FEDO) was 88% (IQR 76-96). At follow-up, 97% thought VDOT was "very or somewhat easy to use" and 95% would recommend VDOT to other TB patients. Age, race/ethnicity, annual income, and country of birth differed by city (P < 0.05), but FEDO and VDOT perceptions did not.CONCLUSIONS: TB programs in three large US cities observed a high FEDO using VDOT while minimizing staff time and travel. Similar findings across sites support VDOT adoption by other large, urban TB programs.
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- 2020
4. Prevalence and Correlates of Injecting with Visitors from the United States Among People Who Inject Drugs in Tijuana, Mexico
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Bórquez, A, Garfein, RS, Abramovitz, D, Liu, L, Beletsky, L, Werb, D, Mehta, SR, Rangel, G, Magis-Rodríguez, C, González-Zúñiga, P, and Strathdee, SA
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Epidemiology ,Health Sciences ,Public Health ,Human Society ,Sociology ,Substance Misuse ,Emerging Infectious Diseases ,Drug Abuse (NIDA only) ,Infectious Diseases ,Good Health and Well Being ,Adolescent ,Adult ,Age Factors ,Female ,Humans ,Male ,Mexico ,Middle Aged ,Needle Sharing ,Prevalence ,Risk Factors ,Sex Factors ,Socioeconomic Factors ,Substance Abuse ,Intravenous ,United States ,Young Adult ,HIV ,HCV ,Injection drug use ,Deportation ,Drug tourism ,Public Health and Health Services ,Public health - Abstract
Cross-border infectious disease transmission is a concern related to drug tourism from the U.S. to Mexico. We assessed this risk among people who inject drugs (PWID) in Tijuana, Mexico. We measured the prevalence and identified correlates of injecting with PWID visiting from the U.S. among PWID in Tijuana using univariable and multivariable logistic regression. Of 727 participants, 18.5% injected during the past 6 months in Mexico with U.S. PWID described mostly as friends (63%) or acquaintances (26%). Injecting with U.S. PWID was independently associated with higher education [adjusted odds ratio (aOR) = 1.13/year], deportation from the U.S. (aOR = 1.70), younger age at first injection (aOR = 0.96/year), more lifetime overdoses (aOR = 1.08), and, in the past 6 months, backloading (aOR = 4.00), syringe confiscation by the police (aOR = 3.02) and paying for sex (aOR = 2.98; all p-values
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- 2019
5. Do law enforcement interactions reduce the initiation of injection drug use? An investigation in three North American settings
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Melo, JS, Garfein, RS, Hayashi, K, Milloy, MJ, DeBeck, K, Sun, S, Jain, S, Strathdee, SA, and Werb, D
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Biochemistry and Cell Biology ,Biomedical and Clinical Sciences ,Biological Sciences ,Epidemiology ,Health Sciences ,Pharmacology and Pharmaceutical Sciences ,Drug Abuse (NIDA only) ,Substance Misuse ,Prevention ,Clinical Research ,Behavioral and Social Science ,Infectious Diseases ,6.1 Pharmaceuticals ,Good Health and Well Being ,Adult ,British Columbia ,California ,Cognition ,Cohort Studies ,Cross-Sectional Studies ,Female ,Humans ,Law Enforcement ,Male ,Mexico ,Middle Aged ,North America ,Prospective Studies ,Substance Abuse ,Intravenous ,Injection initiation ,Law enforcement ,People who inject drugs ,Syndemic ,Medical and Health Sciences ,Psychology and Cognitive Sciences ,Substance Abuse ,Biochemistry and cell biology ,Pharmacology and pharmaceutical sciences - Abstract
BackgroundThe prevention of drug injecting is often cited as a justification for the deployment of law enforcement and for the continuation of drug criminalization policies. We sought to characterize the impact of law enforcement interactions on the risk that people who inject drugs (PWID) report assisting others with injection initiation in three North American countries.MethodsCross-sectional data from PWID participating in cohort studies in three cities (San Diego, USA; Tijuana, Mexico; Vancouver, Canada) were pooled (August 2014-December 2016). The dependent variable was defined as recently (i.e., past six months) providing injection initiation assistance; the primary independent variable was the frequency of recent law enforcement interactions, defined categorically (0 vs. 1 vs. 2-5 vs. ≥6). We employed multivariable logistic regression analyses to assess this relationship while controlling for potential confounders.ResultsAmong 2122 participants, 87 (4.1%) reported recently providing injection initiation assistance, and 802 (37.8%) reported recent law enforcement interactions. Reporting either one or more than five recent interactions with law enforcement was not significantly associated with injection initiation assistance. Reporting 2-5 law enforcement interactions was associated with initiation assistance (Adjusted Odds Ratio=1.74, 95% Confidence Interval: 1.01-3.02).ConclusionsReporting interactions with law enforcement was not associated with a reduced likelihood that PWID reported initiating others into injection drug use. Instead, we identified a positive association between reporting law enforcement interactions and injection initiation assistance among PWID in multiple settings. These findings raise concerns regarding the effectiveness of drug law enforcement to deter injection drug use initiation.
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- 2018
6. The impact of digital health technologies on tuberculosis treatment: a systematic review
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Ngwatu, Brian Kermu, Nsengiyumva, Ntwali Placide, Oxlade, Olivia, Mappin-Kasirer, Benjamin, Nguyen, Nhat Linh, Jaramillo, Ernesto, Falzon, Dennis, Schwartzman, Kevin, Abubakar, I, Alipanah, N, Bastos, M, Boccia, D, Chin, D, Cohen, T, Davis, JL, Denkinger, C, Falzon, D, Fielding, K, Fox, G, Free, C, Garfein, RS, Hayward, A, Jaramillo, E, Lester, R, Lewis, J, Mappin-Kasirer, B, Marx, F, Menzies, D, Migliori, GB, Nahid, P, Ngwatu, B, Nsengiyumva, NP, Nguyen, NL, Oxlade, O, Schwartzman, K, Siddiqi, K, Story, A, Thomas, B, Trajman, A, and Yassin, M
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HIV/AIDS ,Rare Diseases ,Tuberculosis ,Clinical Trials and Supportive Activities ,Prevention ,Clinical Research ,Management of diseases and conditions ,7.1 Individual care needs ,Infection ,Good Health and Well Being ,Biomedical Technology ,Cell Phone ,Communication ,Directly Observed Therapy ,Humans ,Medication Adherence ,Observational Studies as Topic ,Predictive Value of Tests ,Pulmonary Medicine ,Randomized Controlled Trials as Topic ,Risk ,Text Messaging ,Treatment Outcome ,Tuberculosis ,Pulmonary ,Collaborative group on the impact of digital technologies on TB ,Medical and Health Sciences ,Respiratory System - Abstract
Digital technologies are increasingly harnessed to support treatment of persons with tuberculosis (TB). Since in-person directly observed treatment (DOT) can be resource intensive and challenging to implement, these technologies may have the potential to improve adherence and clinical outcomes. We reviewed the effect of these technologies on TB treatment adherence and patient outcomes.We searched several bibliographical databases for studies reporting the effect of digital interventions, including short message service (SMS), video-observed therapy (VOT) and medication monitors (MMs), to support treatment for active TB. Only studies with a control group and which reported effect estimates were included.Four trials showed no statistically significant effect on treatment completion when SMS was added to standard care. Two observational studies of VOT reported comparable treatment completion rates when compared with in-person DOT. MMs increased the probability of cure (RR 2.3, 95% CI 1.6-3.4) in one observational study, and one trial reported a statistically significant reduction in missed treatment doses relative to standard care (adjusted means ratio 0.58, 95% CI 0.42-0.79).Evidence of the effect of digital technologies to improve TB care remains limited. More studies of better quality are needed to determine how such technologies can enhance programme performance.
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- 2018
7. Mycobacterium tuberculosis infection among persons who inject drugs in San Diego, California
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Armenta, RF, Collins, KM, Strathdee, SA, Bulterys, MA, Munoz, F, Cuevas-Mota, J, Chiles, P, and Garfein, RS
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Medical Microbiology ,Biomedical and Clinical Sciences ,Clinical Sciences ,Tuberculosis ,HIV/AIDS ,Rare Diseases ,Emerging Infectious Diseases ,Digestive Diseases ,Hepatitis ,Drug Abuse (NIDA only) ,Chronic Liver Disease and Cirrhosis ,Clinical Research ,Substance Misuse ,Liver Disease ,Infectious Diseases ,Hepatitis - C ,2.2 Factors relating to the physical environment ,Aetiology ,Infection ,Good Health and Well Being ,Adolescent ,Adult ,Aged ,Aged ,80 and over ,California ,Coinfection ,Cross-Sectional Studies ,Female ,HIV Infections ,Hepatitis C ,Humans ,Interferon-gamma Release Tests ,Latent Tuberculosis ,Male ,Middle Aged ,Point-of-Care Systems ,Prevalence ,Risk Factors ,Substance Abuse ,Intravenous ,Travel ,Young Adult ,injection drug use ,HIV ,QuantiFERON((R))-TB Gold In-Tube assay ,latent tuberculous infection ,PWID ,Cardiorespiratory Medicine and Haematology ,Microbiology ,Cardiovascular medicine and haematology ,Clinical sciences ,Epidemiology - Abstract
BackgroundPersons who inject drugs (PWID) might be at increased risk for Mycobacterium tuberculosis infection and reactivation of latent tuberculous infection (LTBI) due to their injection drug use.ObjectivesTo determine prevalence and correlates of M. tuberculosis infection among PWID in San Diego, California, USA.MethodsPWID aged 18 years underwent standardized interviews and serologic testing using an interferon-gamma release assay (IGRA) for LTBI and rapid point-of-care assays for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections. Independent correlates of M. tuberculosis infection were identified using multivariable log-binomial regression.ResultsA total of 500 participants met the eligibility criteria. The mean age was 43.2 years (standard deviation 11.6); most subjects were White (52%) or Hispanic (30.8%), and male (75%). Overall, 86.7% reported having ever traveled to Mexico. Prevalence of M. tuberculosis infection was 23.6%; 0.8% were co-infected with HIV and 81.7% were co-infected with HCV. Almost all participants (95%) had been previously tested for M. tuberculosis; 7.6% had been previously told they were infected. M. tuberculosis infection was independently associated with being Hispanic, having longer injection histories, testing HCV-positive, and correctly reporting that people with 'sleeping' TB cannot infect others.ConclusionsStrategies are needed to increase awareness about and treatment for M. tuberculosis infection among PWID in the US/Mexico border region.
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- 2017
8. Mobility patterns of persons at risk for drug-resistant tuberculosis in Mumbai, India
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Conners, E, Garfein, RS, Rodwell, TC, Udwadia, ZF, and Catanzaro, DG
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Medical Microbiology ,Biomedical and Clinical Sciences ,Health Sciences ,Infectious Diseases ,HIV/AIDS ,Clinical Research ,Antimicrobial Resistance ,Tuberculosis ,Rare Diseases ,Infection ,Good Health and Well Being ,Adult ,Antitubercular Agents ,Cohort Studies ,Cross-Sectional Studies ,Female ,Humans ,India ,Logistic Models ,Male ,Middle Aged ,Population Dynamics ,Prevalence ,Risk Factors ,Socioeconomic Factors ,Tuberculosis ,Multidrug-Resistant ,Young Adult ,Cardiorespiratory Medicine and Haematology ,Microbiology ,Cardiovascular medicine and haematology ,Clinical sciences ,Epidemiology - Abstract
SettingTuberculosis (TB) hospital in Mumbai, India.ObjectiveTo describe the mobility patterns of persons with suspected drug-resistant tuberculosis (DR-TB) and to assess whether there were significant differences in demographic or risk characteristics based on mobility.DesignObservational cohort study of TB clinic patients at risk for DR-TB.ResultsAmong 602 participants, 37% had ever moved from their place of birth; 14% were local movers (within state), and 23% were distant movers, between states or countries. Univariate multinomial logistic regression models showed that distant movers were more likely than non-movers to have lower income, less education, a greater number of previous TB episodes, and to have ever smoked. Compared to non-movers, local movers were more likely to have lower income and were more likely to have seen a doctor in the past 2 years. Clinical outcomes, including DR-TB, diabetes, and human immunodeficiency virus (HIV), did not differ between the three mobility groups.ConclusionMobility was common among patients at risk for DR-TB in Mumbai. TB programs should consider the implications of mobility on the protracted treatment for DR-TB in India.
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- 2016
9. Frequency and Distribution of Tuberculosis Resistance-Associated Mutations between Mumbai, Moldova, and Eastern Cape
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Georghiou, SB, Seifert, M, Catanzaro, D, Garfein, RS, Valafar, F, Crudu, V, Rodrigues, C, Victor, TC, Catanzaro, A, and Rodwell, TC
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Biological Sciences ,Biomedical and Clinical Sciences ,Clinical Sciences ,Infectious Diseases ,Genetics ,Tuberculosis ,Rare Diseases ,Antimicrobial Resistance ,Infection ,Good Health and Well Being ,Bacterial Proteins ,Capreomycin ,Drug Resistance ,Multiple ,Bacterial ,Isoniazid ,Kanamycin ,Microbial Sensitivity Tests ,Moldova ,Mutation ,Mycobacterium tuberculosis ,Rifampin ,South Africa ,Tuberculosis ,Multidrug-Resistant ,Microbiology ,Medical Microbiology ,Pharmacology and Pharmaceutical Sciences ,Medical microbiology ,Pharmacology and pharmaceutical sciences - Abstract
Molecular diagnostic assays, with their ability to rapidly detect resistance-associated mutations in bacterial genes, are promising technologies to control the spread of drug-resistant tuberculosis (DR-TB). Sequencing assays provide detailed information for specific gene regions and can help diagnostic assay developers prioritize mutations for inclusion in their assays. We performed pyrosequencing of seven Mycobacterium tuberculosis gene regions (katG, inhA, ahpC, rpoB, gyrA, rrs, and eis) for 1,128 clinical specimens from India, Moldova, and South Africa. We determined the frequencies of each mutation among drug-resistant and -susceptible specimens based on phenotypic drug susceptibility testing results and examined mutation distributions by country. The most common mutation among isoniazid-resistant (INH(r)) specimens was the katG 315ACC mutation (87%). However, in the Eastern Cape, INH(r) specimens had a lower frequency of katG mutations (44%) and higher frequencies of inhA (47%) and ahpC (10%) promoter mutations. The most common mutation among rifampin-resistant (RIF(r)) specimens was the rpoB 531TTG mutation (80%). The mutation was common in RIF(r) specimens in Mumbai (83%) and Moldova (84%) but not the Eastern Cape (17%), where the 516GTC mutation appeared more frequently (57%). The most common mutation among fluoroquinolone-resistant specimens was the gyrA 94GGC mutation (44%). The rrs 1401G mutation was found in 84%, 84%, and 50% of amikacin-resistant, capreomycin-resistant, and kanamycin (KAN)-resistant (KAN(r)) specimens, respectively. The eis promoter mutation -12T was found in 26% of KAN(r) and 4% of KAN-susceptible (KAN(s)) specimens. Inclusion of the ahpC and eis promoter gene regions was critical for optimal test sensitivity for the detection of INH resistance in the Eastern Cape and KAN resistance in Moldova. (This study has been registered at ClinicalTrials.gov under registration number NCT02170441.).
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- 2016
10. A performance evaluation of MTBDRplus version 2 for the diagnosis of multidrug-resistant tuberculosis
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Seifert, M, Ajbani, K, Georghiou, SB, Catanzaro, D, Rodrigues, C, Crudu, V, Victor, TC, Garfein, RS, Catanzaro, A, and Rodwell, TC
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Medical Microbiology ,Biomedical and Clinical Sciences ,Clinical Sciences ,Tuberculosis ,Emerging Infectious Diseases ,Infectious Diseases ,Lung ,Antimicrobial Resistance ,Rare Diseases ,Clinical Research ,Infection ,Good Health and Well Being ,Adult ,Bacterial Load ,Bacteriological Techniques ,Calibration ,DNA ,Bacterial ,Drug Resistance ,Multiple ,Bacterial ,Female ,Humans ,Male ,Middle Aged ,Molecular Diagnostic Techniques ,Mycobacterium tuberculosis ,Predictive Value of Tests ,Prospective Studies ,Reference Standards ,Reproducibility of Results ,Sputum ,Tuberculosis ,Multidrug-Resistant ,Tuberculosis ,Pulmonary ,Young Adult ,diagnostic ,tuberculosis ,multidrug resistance ,Cardiorespiratory Medicine and Haematology ,Microbiology ,Cardiovascular medicine and haematology ,Clinical sciences ,Epidemiology - Abstract
ObjectiveTo evaluate the performance of a recently updated rapid molecular diagnostic test, GenoType® MTBDRplus version 2, designed to detect drug resistance in both acid-fast bacilli (AFB) smear-negative and -positive specimens.DesignSputum samples from 1128 patients at risk for multidrug-resistant tuberculosis (MDR-TB) were tested using MTBDRplus v2 and compared with reference standard MGIT™ 960™ drug susceptibility testing. The relationship of participant human immunodeficiency virus (HIV) status, diabetic status, previous treatment, and smear gradation to the likelihood of obtaining an interpretable result was assessed using logistic regression.ResultsThe sensitivity and specificity of MTBDRplus v2 for detecting MDR-TB, when compared to a reference standard, were respectively 96.0% (95%CI 93.5-97.6) and 99.2% (95%CI 97.0-99.9) in AFB smear-positive specimens and 82.8% (95%CI 63.5-93.5) and 98.3% (95%CI 89.9-99.9) in AFB smear-negative specimens. A dose-response relationship was observed between the proportion of interpretable test results and AFB smear bacterial load after adjusting for age, sex, body mass index, HIV status, previous treatment and diabetic status.ConclusionWhile MTBDRplus v2 performs well among both AFB smear-positive and -negative specimens, smear gradation appears to influence both the probability of obtaining an interpretable result and test sensitivity, indicating a significant association between bacillary load and test performance.
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- 2016
11. Prevalence and Correlates of the Use of Prefilled Syringes Among Persons Who Inject Drugs in San Diego, CA
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Armenta, RF, Roth, AM, Wagner, KD, Strathdee, SA, Brodine, SK, Cuevas-Mota, J, Munoz, FA, and Garfein, RS
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Injection drug use ,HIV ,Hepatitis C ,Prefilled syringes ,Overdose ,Prevention ,Clinical Research ,Substance Abuse ,Digestive Diseases ,Drug Abuse (NIDA Only) ,Public Health ,Human Movement and Sports Sciences ,Public Health and Health Services - Abstract
© 2015 The New York Academy of Medicine Persons who inject drugs (PWID) are at increased risk for blood-borne virus (BBV) infections and overdose resulting from high-risk injecting practices. Studies of prefilled syringe use ([PFSU] using a syringe that already contained drug solution when it was obtained by the user), an injection practice previously described in Eastern Europe, suggest that it increases susceptibility to BBV. However, little is known about this practice in the USA. Data were obtained from an ongoing cohort study of PWID to determine the prevalence and assess correlates of PFSU in San Diego, CA. Baseline interviews assessed socio-demographics and drug use behaviors. Logistic regression was used to identify factors independently associated with ever using a prefilled syringe (yes/no). Participants (n = 574) were predominately males (73.9 %) and white (50.9 %) with a mean age of 43.4 years (range 18–80); 33.3 % reported ever using prefilled syringes, although only 4.9 % reported use in the past 6 months. In multivariable analyses, PFSU was independently associated with ever having a rushed injection due to police presence [adjusted odds ratio (AOR) = 2.51, 95 % CI 1.66, 3.79], ever being in prison (AOR = 1.80, 95 % CI 1.23, 2.63), injecting most often in public versus private places in the past 6 months (AOR = 1.66, 95 % CI 1.11, 2.48), and injecting drugs in Mexico (AOR = 1.70, 95 % CI 1.16, 2.49). Results indicate that a history of PFSU is common and associated with environmental factors that may also increase risk for adverse health outcomes. Studies are needed to better understand PFSU in order to develop interventions to prevent adverse outcomes associated with their use.
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- 2015
12. Feasibility of tuberculosis treatment monitoring by video directly observed therapy: a binational pilot study
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Garfein, RS, Collins, K, Muñoz, F, Moser, K, Cerecer-Callu, P, Raab, F, Rios, P, Flick, A, Zúñiga, ML, Cuevas-Mota, J, Liang, K, Rangel, G, Burgos, JL, Rodwell, TC, and Patrick, K
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Health Services and Systems ,Biomedical and Clinical Sciences ,Health Sciences ,HIV/AIDS ,Rare Diseases ,Infectious Diseases ,Prevention ,Clinical Research ,Clinical Trials and Supportive Activities ,Orphan Drug ,Tuberculosis ,Good Health and Well Being ,Adolescent ,Adult ,Aged ,Aged ,80 and over ,Antitubercular Agents ,California ,Cell Phone ,Cost-Benefit Analysis ,Directly Observed Therapy ,Feasibility Studies ,Female ,Humans ,Male ,Medication Adherence ,Mexico ,Middle Aged ,Pilot Projects ,Telemedicine ,Video Recording ,Young Adult ,US-Mexico border ,drug resistance ,medication adherence ,DOT ,cellular phone ,mHealth ,Cardiorespiratory Medicine and Haematology ,Microbiology ,Cardiovascular medicine and haematology ,Clinical sciences ,Epidemiology - Abstract
BackgroundAlthough directly observed therapy (DOT) is recommended worldwide for monitoring anti-tuberculosis treatment, transportation and personnel requirements limit its use.ObjectiveTo evaluate the feasibility and acceptability of 'video DOT' (VDOT), which allows patients to record and transmit medication ingestion via videos watched remotely by health care providers to document adherence.MethodsWe conducted a single-arm trial among tuberculosis (TB) patients in San Diego, California, USA, (n = 43) and Tijuana, Mexico (n = 9) to represent high- and low-resource settings. Pre-/post-treatment interviews assessed participant characteristics and experiences. Adherence was defined as the proportion of observed doses to expected doses.ResultsThe mean age was 37 years (range 18-86), 50% were male, and 88% were non-Caucasian. The mean duration of VDOT use was 5.5 months (range 1-11). Adherence was similar in San Diego (93%) and Tijuana (96%). Compared to time on in-person DOT, 92% preferred VDOT, 81% thought VDOT was more confidential, 89% never/rarely had problems recording videos, and 100% would recommend VDOT to others. Seven (13%) participants were returned to in-person DOT and six (12%) additional participants had their phones lost, broken or stolen.ConclusionsVDOT was feasible and acceptable, with high adherence in both high- and low-resource settings. Efficacy and cost-effectiveness studies are needed.
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- 2015
13. Phenotypic and genotypic diversity in a multinational sample of drug-resistant Mycobacterium tuberculosis isolates (vol 19, pg 420, 2015)
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Garfein, RS, Catanzaro, DG, Rodwell, TC, Avalos, E, Jackson, RL, Kaping, J, Evasco, H, Rodrigues, C, Crudu, V, Lin, S-Y, Groessl, E, Hillery, N, Trollip, A, Ganiats, T, Victor, TC, Eisenach, K, Valafar, F, Channick, J, Qian, L, and Catanzaro, A
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Microbiology ,Cardiorespiratory Medicine and Haematology - Published
- 2015
14. Use of synthetic drugs among people who inject drugs in San Diego, CA
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Wagner, Karla D, Cuevas-Mota, J, Armenta, RF, Strathdee, Steffanie, and Garfein, RS
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Medical and Health Sciences ,Psychology and Cognitive Sciences ,Substance Abuse - Published
- 2014
15. Second-line drug susceptibility breakpoints for Mycobacterium tuberculosis using the MODS assay
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Trollip, AP, Moore, D, Coronel, J, Caviedes, L, Klages, S, Victor, T, Romancenco, E, Crudu, V, Ajbani, K, Vineet, VP, Rodrigues, C, Jackson, RL, Eisenach, K, Garfein, RS, Rodwell, TC, Desmond, E, Groessl, EJ, Ganiats, TG, and Catanzaro, A
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Biomedical and Clinical Sciences ,Clinical Sciences ,Good Health and Well Being ,Amikacin ,Antitubercular Agents ,Capreomycin ,Drug Resistance ,Multiple ,Bacterial ,Fluoroquinolones ,Humans ,India ,Kanamycin ,Microbial Sensitivity Tests ,Microscopy ,Moldova ,Moxifloxacin ,Mycobacterium tuberculosis ,Ofloxacin ,Peru ,Predictive Value of Tests ,Reproducibility of Results ,South Africa ,Sputum ,Tuberculosis ,Multidrug-Resistant ,Tuberculosis ,Pulmonary ,tuberculosis ,fluoroquinolones ,aminoglycosides ,drug susceptibility testing ,MODS ,Cardiorespiratory Medicine and Haematology ,Microbiology ,Cardiovascular medicine and haematology ,Clinical sciences ,Epidemiology - Abstract
ObjectiveTo establish breakpoint concentrations for the fluoroquinolones (moxifloxacin [MFX] and ofloxacin [OFX]) and injectable second-line drugs (amikacin [AMK], kanamycin [KM] and capreomycin [CPM]) using the microscopic observation drug susceptibility (MODS) assay.SettingA multinational study conducted between February 2011 and August 2012 in Peru, India, Moldova and South Africa.DesignIn the first phase, breakpoints for the fluoroquinolones and injectable second-line drugs (n = 58) were determined. In the second phase, MODS second-line drug susceptibility testing (DST) as an indirect test was compared to MGIT™ DST (n = 89). In the third (n = 30) and fourth (n = 156) phases, we determined the reproducibility and concordance of MODS second-line DST directly from sputum.ResultsBreakpoints for MFX (0.5 μg/ml), OFX (1 μg/ml), AMK (2 μg/ml), KM (5 μg/ml) and CPM (2.5 μg/ml) were determined. In all phases, MODS results were highly concordant with MGIT DST. The few discrepancies suggest that the MODS breakpoint concentrations for some drugs may be too low.ConclusionMODS second-line DST yielded comparable results to MGIT second-line DST, and is thus a promising alternative. Further studies are needed to confirm the accuracy of the drug breakpoints and the reliability of MODS second-line DST as a direct test.
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- 2014
16. Experience with mobile technology among patients with tuberculosis in San Diego, California and Tijuana, Mexico
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Collins, K, Muñoz, F, Moser, K, Cerecer-Callu, P, Raab, F, Flick, A, Rios, P, Zúñiga, ML, Cuevas-Mota, J, Burgos, JL, Rodwell, T, Rangel, MG, Patrick, K, and Garfein, RS
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- 2013
17. Dose-response association between salivary cotinine levels and Mycobacterium tuberculosis infection
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Shin, SS, Laniado-Laborin, R, Moreno, PG, Novotny, TE, Strathdee, SA, and Garfein, RS
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Biomedical and Clinical Sciences ,Clinical Sciences ,Clinical Research ,Rare Diseases ,Prevention ,Tobacco Smoke and Health ,Tuberculosis ,Tobacco ,Infectious Diseases ,Infection ,Respiratory ,Good Health and Well Being ,Adult ,Chi-Square Distribution ,Cotinine ,Cross-Sectional Studies ,Dose-Response Relationship ,Drug ,Drug Users ,Female ,Humans ,Interferon-gamma Release Tests ,Male ,Mexico ,Middle Aged ,Multivariate Analysis ,Mycobacterium tuberculosis ,Predictive Value of Tests ,Prevalence ,Reagent Strips ,Risk Factors ,Saliva ,Smoking ,Substance Abuse ,Intravenous ,tuberculosis ,tobacco ,substance abuse ,mycobacterial infections ,smoking ,interferon-gamma release assay ,Cardiorespiratory Medicine and Haematology ,Microbiology ,Cardiovascular medicine and haematology ,Clinical sciences ,Epidemiology - Abstract
SettingTijuana, Mexico.ObjectiveTo describe the association between salivary cotinine levels and interferon-gamma (IFN-γ) release assay results.DesignWe conducted a cross-sectional study among injection drug users. Salivary cotinine levels were measured using NicAlert, a semi-quantitative dipstick assay. QuantiFERON©-TB Gold In-Tube (QFT-GIT) was used to determine Mycobacterium tuberculosis infection.ResultsAmong 234 participants, the prevalence of QFT-GIT positivity for NicAlert cotinine categories 0 (non-smoking), 1 (second-hand smoke exposure or low-level smoking) and 26 (regular smoking) were respectively 42.1%, 46.4% and 65.2% (Ptrend 0.012). We found increasing trends in QFT-GIT positivity (Ptrend 0.003) and IFN-γ concentrations (Spearman's r 0.200, P 0.002) across cotinine levels 0 to 6. In multivariable log-binomial regression models adjusted for education, cotinine levels were not associated with QFT-GIT positivity when included as smoking categories (1 and 26 vs. 0), but were independently associated with QFT-GIT positivity when included as an ordinal variable (prevalence ratio 1.09 per 1 cotinine level, 95%CI 1.021.16).ConclusionOur findings suggest that a dose-response relationship exists between tobacco smoke exposure and M. tuberculosis infection. Longitudinal studies that use biochemical measures for smoking status are needed to confirm our findings.
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- 2013
18. Longitudinal determinants of consistent condom use by partner type among young injection drug users: the role of personal and partner characteristics.
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Kapadia, F, Latka, MH, Wu, Y, Strathdee, SA, Mackesy-Amiti, ME, Hudson, SM, Thiede, H, and Garfein, RS
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Humans ,Substance Abuse ,Intravenous ,Risk Factors ,Longitudinal Studies ,Condoms ,Health Knowledge ,Attitudes ,Practice ,Risk-Taking ,Safe Sex ,Self Efficacy ,Social Support ,Adult ,Sexual Partners ,United States ,Female ,Male ,Drug Users ,Young Adult ,HIV ,Injection drug use ,Condom use ,Sexual risk behavior ,Prevention ,Behavioral and Social Science ,Infectious Diseases ,Substance Abuse ,Sexually Transmitted Infections ,Drug Abuse (NIDA Only) ,Public Health ,Public Health and Health Services ,Social Work - Abstract
We investigated the longitudinal influence of individual-, relationship- and social-level factors on condom use by partner type among young injections drug users (IDUs) enrolled in the Collaborative Injection Drug Users Study-III/Drug Users Intervention Trial (CIDUS-III/DUIT) from 2002 to 2004. Based on longitudinal analysis using generalized estimating equations (GEE), consistent condom use with main partners was more commonly reported among males and those with greater self-efficacy for condom use; main partner's desire for pregnancy and needle sharing were negatively associated with consistent condom use. Among those with casual partners, having fewer sex partners was associated with consistent condom use. Positive attitudes toward condom use and partner norms supporting condom use were associated with greater consistent condom use with both partner types. These findings suggest that intervention strategies targeting individual- and partner-level factors may provide avenues for intervening upon sexual risks among young IDUs.
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- 2011
19. Experience with mobile technology among patients with tuberculosis in San Diego, California and Tijuana, Mexico
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Collins, K, Collins, K, Muñoz, F, Moser, K, Cerecer-Callu, P, Raab, F, Flick, A, Rios, P, Zúñiga, ML, Cuevas-Mota, J, Burgos, JL, Rodwell, T, Rangel, MG, Patrick, K, Garfein, RS, Collins, K, Collins, K, Muñoz, F, Moser, K, Cerecer-Callu, P, Raab, F, Flick, A, Rios, P, Zúñiga, ML, Cuevas-Mota, J, Burgos, JL, Rodwell, T, Rangel, MG, Patrick, K, and Garfein, RS
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- 2022
20. Rapid increases in HIV rates – Orel Oblast, Russian Federation, 1999-2001
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Molotilov, V, Safronova, R, Gusseynova, N, Laricheva, N, Hader, SL, Garfein, RS, and Paxton, L
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- 2021
21. Incarceration history and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis
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Stone, J, Fraser, H, Lim, AG, Walker, JG, Ward, Z, MacGregor, L, Trickey, A, Abbott, S, Strathdee, SA, Abramovitz, D, Maher, L, Iversen, J, Bruneau, J, Zang, G, Garfein, RS, Yen, YF, Azim, T, Mehta, SH, Milloy, MJ, Hellard, ME, Sacks-Davis, R, Dietze, PM, Aitken, C, Aladashvili, M, Tsertsvadze, T, Mravčík, V, Alary, M, Roy, E, Smyrnov, P, Sazonova, Y, Young, AM, Havens, JR, Hope, VD, Desai, M, Heinsbroek, E, Hutchinson, SJ, Palmateer, NE, McAuley, A, Platt, L, Martin, NK, Altice, FL, Hickman, M, Vickerman, P, Stone, J, Fraser, H, Lim, AG, Walker, JG, Ward, Z, MacGregor, L, Trickey, A, Abbott, S, Strathdee, SA, Abramovitz, D, Maher, L, Iversen, J, Bruneau, J, Zang, G, Garfein, RS, Yen, YF, Azim, T, Mehta, SH, Milloy, MJ, Hellard, ME, Sacks-Davis, R, Dietze, PM, Aitken, C, Aladashvili, M, Tsertsvadze, T, Mravčík, V, Alary, M, Roy, E, Smyrnov, P, Sazonova, Y, Young, AM, Havens, JR, Hope, VD, Desai, M, Heinsbroek, E, Hutchinson, SJ, Palmateer, NE, McAuley, A, Platt, L, Martin, NK, Altice, FL, Hickman, M, and Vickerman, P
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Background: People who inject drugs (PWID) experience a high prevalence of incarceration and might be at high risk of HIV and hepatitis C virus (HCV) infection during or after incarceration. We aimed to assess whether incarceration history elevates HIV or HCV acquisition risk among PWID. Methods: In this systematic review and meta-analysis, we searched MEDLINE, Embase, and PsycINFO databases for studies in any language published from Jan 1, 2000 until June 13, 2017 assessing HIV or HCV incidence among PWID. We included studies that measured HIV or HCV incidence among community-recruited PWID. We included only studies reporting original results and excluded studies that evaluated incident infections by self-report. We contacted authors of cohort studies that met the inclusion or exclusion criteria, but that did not report on the outcomes of interest, to request data. We extracted and pooled data from the included studies using random-effects meta-analyses to quantify the associations between recent (past 3, 6, or 12 months or since last follow-up) or past incarceration and HIV or HCV acquisition (primary infection or reinfection) risk among PWID. We assessed the risk of bias of included studies using the Newcastle-Ottawa Scale. Between-study heterogeneity was evaluated using the I2 statistic and the P-value for heterogeneity. Findings: We included published results from 20 studies and unpublished results from 21 studies. These studies originated from Australasia, western and eastern Europe, North and Latin America, and east and southeast Asia. Recent incarceration was associated with an 81% (relative risk [RR] 1·81, 95% CI 1·40–2·34) increase in HIV acquisition risk, with moderate heterogeneity between studies (I2=63·5%; p=0·001), and a 62% (RR 1·62, 95% CI 1·28–2·05) increase in HCV acquisition risk, also with moderate heterogeneity between studies (I2=57·3%; p=0·002). Past incarceration was associated with a 25% increase in HIV (RR 1·25, 95% CI 0·94–1·65) and a 21%
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- 2018
22. Phenotypic and genotypic diversity in a multinational sample of drug-resistant Mycobacterium tuberculosis isolates.
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Garfein, RS, Garfein, RS, Catanzaro, DG, Rodwell, TC, Avalos, E, Jackson, RL, Kaping, J, Evasco, H, Rodrigues, C, Crudu, V, Lin, S-YG, Groessl, E, Hillery, N, Trollip, A, Ganiats, T, Victor, TC, Eisenach, K, Valafar, F, Channick, J, Qian, L, Catanzaro, A, Garfein, RS, Garfein, RS, Catanzaro, DG, Rodwell, TC, Avalos, E, Jackson, RL, Kaping, J, Evasco, H, Rodrigues, C, Crudu, V, Lin, S-YG, Groessl, E, Hillery, N, Trollip, A, Ganiats, T, Victor, TC, Eisenach, K, Valafar, F, Channick, J, Qian, L, and Catanzaro, A
- Abstract
ObjectiveTo develop and evaluate rapid, molecular-based drug susceptibility testing (DST) for extensively drug-resistant tuberculosis (XDR-TB), we assembled a phenotypically and genotypically diverse collection of Mycobacterium tuberculosis isolates from patients evaluated for drug resistance in four high-burden countries.MethodsM. tuberculosis isolates from India (n = 111), Moldova (n = 90), the Philippines (n = 96), and South Africa (n = 103) were selected from existing regional and national repositories to maximize phenotypic diversity for resistance to isoniazid, rifampin (RMP), moxifloxacin, ofloxacin, amikacin, kanamycin, and capreomycin. MGIT™ 960 was performed on viable isolates in one laboratory using standardized procedures and drug concentrations. Genetic diversity within drug resistance phenotypes was assessed.ResultsNineteen distinct phenotypes were observed among 400 isolates with complete DST results. Diversity was greatest in the Philippines (14 phenotypes), and least in South Africa (9 phenotypes). Nearly all phenotypes included multiple genotypes. All sites provided isolates resistant to injectables but susceptible to fluoroquinolones. Many patients were taking drugs to which their disease was resistant.DiscussionDiverse phenotypes for XDR-TB-defining drugs, including resistance to fluoroquinolones and/or injectable drugs in RMP-susceptible isolates, indicate that RMP susceptibility does not ensure effectiveness of a standard four-drug regimen. Rapid, low-cost DST assays for first- and second-line drugs are thus needed.
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- 2015
23. Formative Assessment of ARM-U: A Modular Intervention for Decreasing Risk Behaviors Among HIV-Positive and HIV-Negative Methamphetamine-Using MSM.
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Garfein, RS, Metzner, M, Cuevas, J, Bousman, CA, Patterson, T, Garfein, RS, Metzner, M, Cuevas, J, Bousman, CA, and Patterson, T
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BACKGROUND: Methamphetamine is a major contributor to HIV transmission among men who have sex with men (MSM). Recent studies show that up to one-third of methamphetamine-using MSM (MUMSM) inject the drug. We developed a behavioral intervention for MUMSM to decrease unprotected anal intercourse and increase awareness of parenteral HIV transmission risk. This 6-session (3 in-person, 3 by telephone) modular intervention was designed to be tailored to participants' HIV (+/-) and injection drug user ([IDU] yes/no) status. We present results of formative research used to evaluate the content and to assess feasibility and acceptability of this individual-level HIV risk-reduction intervention. SETTING: HIV research clinic in a high MSM and methamphetamine prevalence neighborhood. PROJECT: Avoiding Risks from Methamphetamine-Use (ARM-U) is a brief toolbox intervention that allows counselors to select modules that suit a client's individual risk profile and intervention needs employing motivational interviewing and cognitive behavioral theory. We evaluated the format and content of the intervention through focus groups and pre-testing of the entire intervention using volunteers from the target population stratified into four groups (HIV+/IDU, HIV-/IDU, HIV+/non-IDU, HIV-/non-IDU). Four individuals in each stratum were recruited to undergo the intervention and complete a satisfaction survey at the end of each in-person session. RESULTS: In total, 25 MUMSM attended one of five focus groups. Participants thought all proposed intervention topics were important and could aid in reducing sexual risk behaviors among MUMSM. However, the neurocognitive effects of methamphetamine were reported to be a barrier to practicing safer sex, condom use negotiation or HIV status disclosure. Fifteen (94%) of 16 participants completed all 6 sessions and the satisfaction survey. On average, participants felt the intervention was useful for MUMSM, made them contemplate and move toward behavior chan
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- 2010
24. Effect of a cash transfer programme for schooling on prevalence of HIV and herpes simplex type 2 in Malawi: a cluster randomised trial.
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Baird SJ, Garfein RS, McIntosh CT, and Ozler B
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- 2012
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25. Three years after legalization of nonprescription pharmacy syringe sales in California: where are we now?
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Garfein RS, Stopka TJ, Pavlinac PB, Ross A, Haye BK, Riley ED, Bluthenthal RN, Garfein, Richard S, Stopka, Thomas J, Pavlinac, Patricia B, Ross, Alessandra, Haye, B Karen, Riley, Elise D, and Bluthenthal, Ricky N
- Abstract
In January 2005, passage of California Senate Bill 1159 enabled California's county or city governments to establish disease prevention demonstration projects (DPDPs) through which pharmacies could subsequently register to legally sell up to 10 syringes to adults without a prescription. California's 61 local health jurisdictions (LHJs) were surveyed annually in 2005-2007 to monitor the progress of DPDP implementation and assess program coverage, facilitators, and barriers. Completed surveys were returned by mail, fax, e-mail, phone, or internet. We analyzed 2007 survey data to describe current DPDP status; data from all years were analyzed for trends in approval and implementation status. By 2007, 17 (27.9%) LHJs approved DPDPs, of which 14 (82.4%) had registered 532 (17.8%) of the 2,987 pharmacies in these 14 LHJs. Although only three LHJs added DPDPs since 2006, the number of registered pharmacies increased 102% from 263 previously reported. Among the LHJs without approved DPDPs in 2007, one (2.3%) was in the approval process, seven (16.3%) planned to seek approval, and 35 (81.4%) reported no plans to seek approval. Of 35 LHJs not planning to seek approval, the top four reasons were: limited health department time (40%) or interest (34%), pharmacy disinterest (31%), and law enforcement opposition (26%). Among eight LHJs pursuing approval, the main barriers were "time management" (13%), educating stakeholders (13%), and enlisting pharmacy participation (13%). The17 LHJs with DPDP represent 52% of California's residents; they included 62% of persons living with HIV and 59% of IDU-related HIV cases, suggesting that many LHJs with significant numbers of HIV cases have approved DPDPs. Outcome studies are needed to determine whether SB 1159 had the desired impact on increasing syringe access and reducing blood-borne viral infection risk among California IDUs. [ABSTRACT FROM AUTHOR]
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- 2010
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26. Increased drug use and STI risk with injection drug use among HIV-seronegative heterosexual methamphetamine users.
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Cheng WS, Garfein RS, Semple SJ, Strathdee SA, Zians JK, Patterson TL, Cheng, W Susan, Garfein, Richard S, Semple, Shirley J, Strathdee, Steffanie A, Zians, James K, and Patterson, Thomas L
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Methamphetamine (MA) use has been found to be associated with increased risk of HIV and sexually transmitted infections (STI) among men having sex with men, but it is unknown whether those who inject MA are at greater risk for these infections than those who administer MA by other routes. Furthermore, comparable data from heterosexual MA users are lacking. We investigated whether the HIV and STI risks of male and female heterosexual MA users who inject MA differ from those of comparable users who do not inject. Between 2001 and 2005, we interviewed 452 HIV-negative men and women aged 18 and older who had recently used MA and engaged in unprotected sex. Their mean age was 36.6 years; 68% were male; ethnicity was 49.4% Caucasian, 26.8% African-American, and 12.8% Hispanic. Logistic regression identified factors associated with injecting MA. Compared to non-IDU, IDU were more likely to: be Caucasian; be homeless; have used MA for a longer period and used more grams of MA in the last 30 days; have a history of felony conviction; and report a recent STI. HIV and STI prevention interventions should be tailored according to MA users' method of administration. [ABSTRACT FROM AUTHOR]
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- 2010
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27. Housing status and associated differences in HIV risk behaviors among young injection drug users (IDUs)
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Coady MH, Latka MH, Thiede H, Golub ET, Ouellet L, Hudson SM, Kapadia F, and Garfein RS
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- 2007
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28. Developing an HIV Behavioral Surveillance System for injecting drug users: the National HIV Behavioral Surveillance System.
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Lansky A, Abdul-Quader AS, Cribbin M, Hall T, Finlayson TJ, Garfein RS, Lin LS, and Sullivan PS
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While disease surveillance for HIV/AIDS is now widely conducted in the United States, effective HIV prevention programs rely primarily on changing behavior; therefore, behavioral data are needed to inform these programs. To achieve the goal of reducing HIV infections in the U.S., the Centers for Disease Control and Prevention, in cooperation with state and local health departments, implemented the National HIV Behavioral Surveillance System (NHBS) for injecting drug users (IDUs) in 25 selected metropolitan statistical areas (MSAs) throughout the United States in 2005. The surveillance system used respondent-driven sampling (RDS), a modified chain-referral method, to recruit IDUs for a survey measuring HIV-associated drug use and sexual risk behavior. RDS can produce population estimates for specific risk behaviors and demographic characteristics. Formative assessment activities--primarily the collection of qualitative data--provided information to better understand the IDU population and implement the surveillance activities in each city. This is the first behavioral surveillance system of its kind in the U.S. that will provide local and national data on risk for HIV and other blood-borne and sexually transmitted infections among IDUs for monitoring changes in the epidemic and prevention programs. [ABSTRACT FROM AUTHOR]
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- 2007
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29. Prevalence and correlates of crack-cocaine injection among young injection drug users in the United States, 1997-1999.
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Santibanez SS, Garfein RS, Swartzendruber A, Kerndt PR, Morse E, Ompad D, Strathdee S, Williams IT, Friedman SR, and Ouellet LJ
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OBJECTIVES: We estimated prevalence and identified correlates of crack-cocaine injection among young injection drug users in the United States. METHODS: We analyzed data from the second Collaborative Injection Drug Users Study (CIDUS II), a 1997-1999 cohort study of 18-30-year-old, street-recruited injection drug users from six US cities. RESULTS: Crack-cocaine injection was reported by 329 (15%) of 2198 participants. Prevalence varied considerably by site (range, 1.5-28.0%). No participants injected only crack-cocaine. At four sites where crack-cocaine injection prevalence was greater than 10%, recent (past 6 months) crack-cocaine injection was correlated with recent daily injection and sharing of syringes, equipment, and drug solution. Lifetime crack-cocaine injection was correlated with using shooting galleries, initiating others into drug injection, and having serologic evidence of hepatitis B virus and hepatitis C virus infection. CONCLUSIONS: Crack-cocaine injection may be a marker for high-risk behaviors that can be used to direct efforts to prevent HIV and other blood-borne viral infections. [ABSTRACT FROM AUTHOR]
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- 2005
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30. The effect of a needle exchange program on numbers of discarded needles: a 2-year follow-up.
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Doherty MC, Junge B, Rathouz P, Garfein RS, Riley E, and Vlahov D
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OBJECTIVES: This study estimates the quantity and geographic distribution of discarded needles on the streets of Baltimore, Md, during the 2 years after a needle exchange program opened. METHODS: Thirty-two city blocks were randomly sampled. Counts were taken of the number of syringes, drug vials, and bottles before the needle exchange program opened and then at 6 periodic intervals for 2 years after the program opened. Nonparametric and generalized estimating equation models were used to examine change over time. RESULTS: Two years after the needle exchange program opened, there was a significant decline in the overall quantity of discarded needles relative to that of drug vials and bottles (background trash). The block mean of number of needles per 100 trash items was 2.42 before the program opened and 1.30 2 years later (mean within-block change = -0.028, P < .05). There was no difference in the number of discarded needles by distance from the program site. CONCLUSIONS: These data suggest that this needle exchange program did not increase the number of distribution of discarded needles. [ABSTRACT FROM AUTHOR]
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- 2000
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31. HIV-tuberculosis coinfection in southern California: evaluating disparities in disease burden.
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Rodwell TC, Barnes RFW, Moore M, Strathdee SA, Raich A, Moser KS, and Garfein RS
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Objectives. We sought to understand tuberculosis (TB) and HIV coinfection trends in San Diego County, California, and to identify associations between sociodemographic risk factors and TB and HIV coinfection. Methods. We analyzed TB surveillance data from 1993 through 2007. TB cases were grouped by HIV status: positive, negative, or unknown. We used Poisson regression to estimate trends and tested associations between TB and HIV coinfection and sociodemographic risk factors with polychotomous logistic regression. Results. Of 5172 TB cases, 8.8% were also infected with HIV. Incidence of coinfected cases did not change significantly over the period studied, but the proportion of cases among Hispanics increased significantly, whereas cases among non-Hispanic whites and blacks decreased. TB cases with HIV coinfection were significantly more likely to be Hispanic, male, injection drugs users, and aged 30 to 49 years, relative to cases with TB disease only. Conclusions. The burden of TB and HIV in San Diego has shifted to Hispanics in the last decade. To address this health disparity, binational TB and HIV prevention efforts are needed. [ABSTRACT FROM AUTHOR]
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- 2010
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32. Development, description, and acceptability of a small-group, behavioral intervention to prevent HIV and hepatitis C virus infections among young adult injection drug users.
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Purcell DW, Garfein RS, Latka MH, Thiede H, Hudson S, Bonner S, Golub ET, Ouellet LJ, and DUIT Study Team
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Young injection drug users (IDUs) who are not infected with HIV or hepatitis C virus are at great risk of acquiring one or both of these infections through their sexual or injection behaviors. We describe the development of a behavioral intervention designed to decrease sexual and injection risk behaviors among young IDUs. The intervention was developed through a dynamic and iterative process that involved extensive development activities, focus groups with the target population to pilot individual activities and intervention sessions, and later, pilot testing of the entire intervention. The six-session intervention that emerged from the development process relied on both social-cognitive theories and peer influence models. We also designed a control intervention, trained facilitators to deliver the interventions, and conducted quality assurance of intervention delivery. To better understand intervention trial findings, we asked participants about their intervention experiences and examined potential contamination across arms. Both interventions were delivered with high fidelity and participants in both groups reported positive experiences. More perceived impact was reported for injection risk behaviors than for sexual risk behaviors among participants in the intervention arm. Minimal evidence of contamination was found. Lessons learned can help future researchers to develop stronger interventions for this high-need population. [ABSTRACT FROM AUTHOR]
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- 2007
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33. Convenience is the key to hepatitis A and B vaccination uptake among young adult injection drug users.
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Campbell JV, Garfein RS, Thiede H, Hagan H, Ouellet LJ, Golub ET, Hudson SM, Ompad DC, and Weinbaum C
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BACKGROUND: Despite CDC recommendations to vaccinate injection drug users (IDUs) against hepatitis A virus (HAV) and hepatitis B virus (HBV) infections, coverage remains low. Vaccination programs convenient to IDUs have not been widely implemented or evaluated. We assessed whether convenience and monetary incentives influenced uptake of free vaccine by 18-30-year-old IDUs in five U.S. cities. METHODS: IDUs recruited from community settings completed risk behavior self-interviews and testing for antibodies to HAV (anti-HAV) and hepatitis B core antigen (anti-HBc). Vaccine was offered presumptively at pre-test (except in Chicago); on-site availability and incentives for vaccination differed by site, creating a quasi-experimental design. RESULTS: Of 3181 participants, anti-HAV and anti-HBc seroprevalence was 19% and 23%, respectively. Although 83% of participants were willing to be vaccinated, only 36% received > or =1 dose, which varied by site: Baltimore (83%), Seattle (33%), Los Angeles (18%), New York (17%), and Chicago (2%). Participation was highest when vaccine was available immediately on-site and lowest when offered only after receiving results. Monetary incentives may have increased participation when on-site vaccination was not available. CONCLUSION: IDUs were willing to be vaccinated but immediate, on-site availability was critical for uptake. Convenience should be a key consideration in designing strategies to increase vaccine coverage among IDUs. [ABSTRACT FROM AUTHOR]
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- 2007
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34. Methods to recruit and retain a cohort of young-adult injection drug users for the Third Collaborative Injection Drug Users Study/Drug User Interventional Trial (CIDUS III/DUIT)
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Garfein RS, Swartzendruber A, Ouellet LJ, Kapadia F, Hudson SM, Thiede H, Strathdee SA, Williams IT, Bailey SL, Hagan H, Golub ET, Kerndt P, Hanson DL, and Latka MH
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BACKGROUND: New injection drug users (IDUs) are at high risk for blood-borne viral infections. Given U.S. policy to only fund proven-effective HIV prevention interventions, insights into conducting intervention trials among young IDUs are provided here by describing methods and participants' characteristics in the CIDUS III/DUIT study. METHODS: In 2002-2004, 15-30-year-old IDUs in Baltimore, Chicago, Los Angeles, New York, and Seattle were recruited through community outreach, advertising and coupon-based participant referrals. Baseline interviews assessed sociodemographics, injection, and sexual behaviors. Antibody tests for HIV and hepatitis A, B, and C viruses (HAV, HBV, and HCV) were conducted. IDUs who were HIV and HCV antibody negative at baseline were eligible to participate in a randomized controlled HIV/HCV prevention trial. Follow-up assessments were conducted 3 and 6 months post-intervention. Data were analyzed to identify participant differences at baseline by city, trial enrollment, and trial retention. RESULTS: Baseline assessments were completed by 3285 IDUs. Participants were mean age 23.8 years, 69% male, 64% White, 17% Hispanic, and 8% Black. Seroprevalence of HIV, HCV, HBV, and HAV antibodies were 2.9, 34.4, 22.4, and 19.3%, respectively. Of the 2062 (62.7%) baseline participants who were HIV and HCV antibody negative, 859 (41.7%) were randomized. At least one follow-up assessment was completed by 712 (83%) randomized participants. Contextual factors, primarily homelessness, were associated with lower enrollment and retention. CONCLUSIONS: Recruitment and retention of young-adult IDUs for complex intervention trials is complicated, yet feasible. Risk behaviors among participants enrolling in and completing the trial reflected those eligible to enroll. [ABSTRACT FROM AUTHOR]
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- 2007
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35. Cross-border paid plasma donation among injection drug users in two Mexico-U.S. border cities.
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Volkow P, Brouwer KC, Loza O, Ramos R, Lozada R, Garfein RS, Magis-Rodriguez C, Firestone-Cruz M, Strathdee SA, Volkow, Patricia, Brouwer, Kimberly C, Loza, Oralia, Ramos, Rebeca, Lozada, Remedios, Garfein, Richard S, Magis-Rodriguez, Carlos, Firestone-Cruz, Michelle, and Strathdee, Steffanie A
- Abstract
Objective: Paid plasma donation has contributed to HIV epidemics in many countries. Eleven million liters of plasma are fractionated annually in the U.S., mainly from paid donors. Deferral of high-risk donors such as injection drug users (IDUs) is required for paid donations. We studied circumstances surrounding paid plasma donation among IDUs in two Mexico-U.S. border cities.Methods: In 2005, IDUs > or = 18 years old in Tijuana (N=222) and Cd. Juarez (N=206) who injected in the last month were recruited through respondent-driven sampling. Subjects underwent antibody testing for HIV and HCV and an interviewer-administered survey including questions on donating and selling whole blood and plasma.Results: Of 428 IDUs, HIV and HCV prevalence were 3% and 96%, respectively; 75 (17.5%) reported ever having donated/sold their blood or plasma, of whom 28 (37%) had sold their plasma for an average of $16 USD. The majority of IDUs selling plasma were residents of Ciudad Juarez (82%); 93% had sold their plasma only in the U.S. The last time they sold their plasma, 65% of IDUs had been asked if they injected drugs. Although the median time since last selling plasma was 13 years ago, 3 had done so within the prior 2 years, one within the prior 6 months; of these 3 IDUs, 2 were from Cd. Juarez, one from Tijuana; all 3 had only sold their plasma in the U.S.Conclusions: Although selling plasma appears uncommon among IDUs in these two Mexican border cities, the majority sold plasma in the U.S. and only one-third were deferred as high-risk donors. Paying donors for plasma should be a matter of public inquiry to encourage strict compliance with regulations. Plasma clinics should defer donors not only on behavioral risks, but should specifically inspect for injection stigmata. [ABSTRACT FROM AUTHOR]- Published
- 2009
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36. The influence of needle exchange programs on injection risk behaviors and infection with hepatitis C virus among young injection drug users in select cities in the United States, 1994-2004.
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Holtzman D, Barry V, Ouellet LJ, Des Jarlais DC, Vlahov D, Golub ET, Hudson SM, and Garfein RS
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OBJECTIVE: Our purpose was to assess whether participation in needle exchange programs (NEPs) influenced incident hepatitis C virus (HCV) infection through effects on injection risk behaviors among young injection drug users (IDUs) in the United States. METHODS: Data were drawn from three multi-site studies carried out in four major cities that enrolled IDUs over the period 1994-2004. Bivariate and multivariate analyses were conducted to assess relationships among sociodemographic characteristics, NEP use, injection risk behaviors, and prevalent or incident HCV infection. RESULTS: Of the total participants (n=4663), HCV seroprevalence was 37%; among those who initially tested negative and completed follow-up at three, six, or 12 months (n=1288), 12% seroconverted. Nearly half of participants reported NEP (46%) use at baseline. Multivariate results showed no significant relationship between NEP use and HCV seroconversion. Controlling for sociodemographic characteristics, IDUs reporting NEP use were significantly less likely to share needles (aOR=0.77, 95% CI=0.67-0.88). Additionally, controlling for sociodemographic characteristics and program use, sharing needles, sharing other injection paraphernalia, longer injection duration, and injecting daily were all positively related to prevalent infection. CONCLUSIONS: Our results suggest an indirect protective effect of NEP use on HCV infection by reducing risk behavior. Copyright © 2009 by Elsevier Inc. [ABSTRACT FROM AUTHOR]
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- 2009
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37. Distributive syringe sharing among young adult injection drug users in five U.S. cities.
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Golub ET, Strathdee SA, Bailey SL, Hagan H, Latka MH, Hudson SM, and Garfein RS
- Abstract
Blood-borne pathogens such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are transmitted most commonly among injection drug users (IDUs) through the sharing of needles and syringes. Distributive syringe sharing (DSS) (i.e., passing on a used needle/syringe to another IDU) poses the potential risk of transmitting HIV and viral hepatitis to others. We studied the prevalence and correlates of DSS among IDUs enrolled in a randomized behavioral intervention trial designed to reduce behaviors associated with HIV and HCV transmission in five U.S. cities. Among 3129 IDUs ages 15-30 years who completed the baseline visit, 1432 (45.8%) engaged in DSS during the 3 months prior to baseline. Significant correlates of DSS were perception that peer norms condone needle sharing, frequent injection, not obtaining most syringes from needle exchange programs or pharmacies, injecting most frequently in shooting galleries and with sex partners, low perceived risk of HIV from sharing syringes, increased anxiety, low self-esteem, and having unprotected sex. Restricting to only those IDUs who reported not injecting with previously used syringes, similar independent correlates of DSS were found. These findings suggest that interventions to reduce ongoing transmission of blood-borne infections should focus on altering peer norms among networks of young IDUs. [ABSTRACT FROM AUTHOR]
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- 2007
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38. Injecting alone among young adult IDUs in five US cities: evidence of low rates of injection risk behavior.
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Hagan H, Campbell JV, Thiede H, Strathdee SA, Ouellet L, Latka M, Hudson S, Garfein RS, Hagan, Holly, Campbell, Jennifer V, Thiede, Hanne, Strathdee, Steffanie A, Ouellet, Lawrence, Latka, Mary, Hudson, Sharon, Garfein, Richard S, and DUIT Study Team
- Abstract
Illicit drug injection typically occurs in private or semi-public settings where two or more injectors are present. In a large sample of young adult injectors (aged 15-30) in five US cities, we describe those who reported consistently injecting by themselves in a recent period. Among 3199 eligible subjects, 85% were male, median age was 24 years, and median number of years injecting was four. Fifteen percent (n=467) who reported always injecting alone in the previous 3 months were compared to other IDUs to understand the relationship between this practice and injection risk behavior. IDUs who reported injecting alone were substantially less likely to report injection with a syringe (AOR=0.16, 95% CI 0.1-0.2) or other drug preparation equipment (AOR=0.17, 95% CI 0.13-0.2) previously used by another injector. Markedly low rates of injection risk behavior were observed in IDUs who reported injecting alone; this practice may facilitate safe injection by granting the individual greater control over the injection setting. However, risks may include accidental overdose with severe consequences. [ABSTRACT FROM AUTHOR]
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- 2007
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39. Correlates of consistent condom use with the main partners by partnership patterns among young adult male injection drug users from five US cities.
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Kapadia F, Latka MH, Hudson SM, Golub ET, Campbell JV, Bailey S, Frye V, Garfein RS, and DUIT Study Team
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This paper examined correlates of consistent condom use with a main partner among heterosexual male injection drug users (IDUs). Using data from a multi-site sample of young IDUs, we identified 1770 sexually active men of whom 24% (429/1770) reported an exclusive main female sex partner and 49% (862/1770) reported both main and casual female sex partners. Consistent condom use with a main partner was low among men with an exclusive main partner and those with multiple partners (12% and 17%, respectively). In multivariate analysis, consistent condom use with a main partner across partnership patterns was directly associated with anticipating a positive response to requests for condom use and by partner support of condom use; consistent condom use was inversely associated with a main partner's pregnancy desires. Among men with an exclusive main partner, consistent condom use was also inversely associated with needle sharing with a main partner. Among men with multiple partners, consistent condom use with a main partner was inversely associated with injecting with a used needle and intimate partner violence. The low prevalence of consistent condom use with main female partners among heterosexually active male IDUs indicates an increased risk for HIV transmission between men and their primary sex partners. Interventions for heterosexual males that are geared toward increasing condom use in primary relationships are warranted. [ABSTRACT FROM AUTHOR]
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- 2007
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40. Prevalence and correlates of indirect sharing practices among young adult injection drug users in five U.S. cities.
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Thiede H, Hagan H, Campbell JV, Strathdee SA, Bailey SL, Hudson SM, Kapadia F, Garfein RS, and DUIT Study Team
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BACKGROUND: Sharing of drug paraphernalia to prepare, measure and divide drugs for injection remains an important residual risk factor for hepatitis C and other blood-borne infections among injection drug users (IDUs) especially as sharing of syringes for injection decreases. METHODS: We analyzed data from five U.S. cities to determine the prevalence and independent correlates of non-syringe paraphernalia-sharing (NSPS) and syringe-mediated drug-splitting (SMDS) among 15-30-year-old IDUs who reported not injecting with others' used syringes (receptive syringe-sharing, RSS). RESULTS: NSPS was reported by 54% of IDUs who did not practice RSS and was independently associated (p<0.05) with having > or =5 injection partners, injecting with sex partners or regular injection partners, injecting in shooting galleries, peers' sharing behaviors, lower self-efficacy for avoiding NSPS, and less knowledge of HIV and HCV transmission. SMDS was reported by 26% of IDUs who did not practice RSS, and was independently associated with having > or =5 injection partners, injecting in shooting galleries, and inversely associated with unknown HIV status. CONCLUSIONS: NSPS and SMDS were common among young adult IDUs. Increased efforts to prevent these risky practices should address social and environmental contexts of injection and incorporate knowledge and skills building, self-efficacy, and peer norms. [ABSTRACT FROM AUTHOR]
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- 2007
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41. Perceived risk, peer influences, and injection partner type predict receptive syringe sharing among young adult injection drug users in five U.S. cities.
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Bailey SL, Ouellet LJ, Mackesy-Amiti ME, Golub ET, Hagan H, Hudson SM, Latka MH, Gao W, Garfein RS, and DUIT Study Team
- Abstract
OBJECTIVES: This study examined risk factors for receptive syringe sharing (RSS) during illicit drug injection by persons 15-30 years old in five U.S. cities. METHODS: Participants were recruited through street outreach and respondent-driven referrals in Baltimore, Chicago, Los Angeles, New York, and Seattle between May 2002 and January 2004. Surveys of drug use, sexual behaviors, and correlates were administered through audio computer-assisted self-interviews at baseline and, for the subset of participants who enrolled in an HIV/HCV prevention intervention trial, at 3-months and 6-months post-baseline. The proportions of injections involving RSS at baseline and at follow-up were used as outcomes in multivariate models that adjusted for intervention effects. RESULTS: At baseline, 54% of 3128 participants reported RSS in the past 3 months. RSS decreased to 21% at 6-months post-baseline for the combined trial arms. Participants were more likely to report RSS if they perceived that their peers were not against RSS and if they injected with sex partners. Lower levels of perceived risk of infection with HIV (baseline, p<.001) or HCV (follow-up, p<.001) through RSS were also significant predictors of greater RSS. CONCLUSIONS: Perceived risks, peer influences, and type of injection partner were robust predictors of RSS. Perceived risks and peer influences are particularly amenable to intervention efforts that may prevent RSS in this age group. [ABSTRACT FROM AUTHOR]
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- 2007
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42. Modeling the impact of a supervised consumption site on HIV and HCV transmission among people who inject drugs in three counties in California, USA.
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Killion JA, Jegede OS, Werb D, Davidson PJ, Smith LR, Gaines T, Graff Zivin J, Zúñiga ML, Pines HA, Garfein RS, Strathdee SA, Rivera Saldana C, and Martin NK
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- Humans, California epidemiology, Incidence, Harm Reduction, Models, Theoretical, Male, Substance Abuse, Intravenous epidemiology, Hepatitis C epidemiology, Hepatitis C transmission, Hepatitis C prevention & control, HIV Infections epidemiology, HIV Infections transmission, Needle Sharing statistics & numerical data, Needle-Exchange Programs statistics & numerical data
- Abstract
Background: Supervised consumption sites (SCS) have been shown to reduce receptive syringe sharing among people who inject drugs (PWID) in the United States and elsewhere, which can prevent HIV and hepatitis C virus (HCV) transmission. PWID are at risk of disease transmission and may benefit from SCS, however legislation has yet to support their implementation. This study aims to determine the potential impact of SCS implementation on HIV and HCV incidence among PWID in three California counties., Methods: A dynamic HIV and HCV joint transmission model among PWID (sexual and injecting transmission of HIV, injecting transmission of HCV) was calibrated to epidemiological data for three counties: San Francisco, Los Angeles, and San Diego. The model incorporated HIV and HCV disease stages and HIV and HCV treatment. Based on United States data, we assumed access to SCS reduced receptive syringe sharing by a relative risk of 0.17 (95 % CI: 0.04-1.03). This model examined scaling-up SCS coverage from 0 % to 20 % of the PWID population within the respective counties and assessed its impact on HIV and HCV incidence rates after 10 years., Results: By increasing SCS from 0 % to 20 % coverage among PWID, 21.8 % (95 % CI: -1.2-32.9 %) of new HIV infections and 28.3 % (95 % CI: -2.0-34.5 %) of new HCV infections among PWID in San Francisco County, 17.7 % (95 % CI: -1.0-30.8 %) of new HIV infections and 29.8 % (95 % CI: -2.1-36.1 %) of new HCV infections in Los Angeles County, and 32.1 % (95 % CI: -2.8-41.5 %) of new HIV infections and 24.3 % (95 % CI: -1.6-29.0 %) of new HCV infections in San Diego County could be prevented over ten years., Conclusion: Our models suggest that SCS is an important intervention to enable HCV elimination and could help end the HIV epidemic among PWID in California. It could also have additional benefits such facilitating pathways into drug treatment programs and preventing fatal overdose., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: NM has received unrestricted research grants paid to her university from Gilead unrelated to this work. Unrelated to this work, JK was employed as a contractor for the US Department of Defense and by CommonSpirit Health in a lab has several NIH, DOD and Michael J Fox Foundation grants, but she is not funded under these grants and they were unrelated to this work., (Copyright © 2024. Published by Elsevier B.V.)
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- 2024
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43. Safe Injection Self-Efficacy is Associated with HCV and HIV Seropositivity Among People Who Inject Drugs in the San Diego-Tijuana Border Region.
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Bailey K, Abramovitz D, Rangel G, Harvey-Vera A, Vera CF, Patterson TL, Sánchez-Lira JA, Davidson PJ, Garfein RS, Smith LR, Pitpitan EV, Goldenberg SM, and Strathdee SA
- Abstract
Safe injection self-efficacy (SISE) is negatively associated with injection risk behaviors among people who inject drugs (PWID) but has not been examined in differing risk environments. We compared responses to a validated SISE scale between PWID in San Diego, California and Tijuana, Mexico, and examine correlates of SISE among PWID in Tijuana. PWID were recruited via street outreach for a longitudinal cohort study from October 2020-September 2021. We compared SISE scale items by city. Due to low variability in SISE scores among San Diego residents, we restricted analysis of factors associated with SISE to Tijuana residents and identified correlates of SISE score levels (low, medium, high) using ordinal logistic regression. Of 474 participants, most were male (74%), Latinx (78%) and Tijuana residents (73%). Mean age was 44. Mean SISE scores among San Diego residents were high (3.46 of 4 maximum) relative to Tijuana residents (mean: 1.93). Among Tijuana residents, White race and having previously resided in San Diego were associated with higher SISE scores. HCV and HIV seropositivity, homelessness, fentanyl use, polysubstance co-injection, and greater injection frequency were associated with lower SISE scores. We found profound inequalities between Tijuana and San Diego SISE, likely attributable to differential risk environments. Associations with fentanyl and polysubstance co-injection, injection frequency, and both HIV and HCV seropositivity suggest that SISE contribute to blood-borne infection transmission risks in Tijuana. SISE reflects an actionable intervention target to reduce injection risk behaviors, but structural interventions are required to change the risk environment., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2024
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44. Factors Associated With the Discontinuation of Two Short-Course Tuberculosis Preventive Therapies in Programmatic Settings in the United States.
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Asare-Baah M, Salmon-Trejo LAT, Venkatappa T, Garfein RS, Aiona K, Haas M, and Séraphin MN
- Abstract
Background: The objective of this study was to investigate timing and risk factors for discontinuation of short-course tuberculosis preventive therapy (TPT) comparing directly observed 3-month isoniazid/rifapentine (3HP) vs self-administered 4-month rifampin (4R)., Methods: This was a subanalysis of a 6-month health department cohort (2016-2017) of 993 latent tuberculosis infection (LTBI) patients initiating 3HP (20%) or 4R (80%). Time at risk of TPT discontinuation was compared across regimens. Risk factors were assessed using mixed-effects Cox models., Results: Short-course TPT discontinuation was higher with 4R (31% vs 14%; P < .0001), though discontinuation timing was similar. Latino ethnicity (hazard ratio [HR], 1.80; 95% CI, 1.20-2.90) and adverse events (HR, 4.30; 95% CI, 2.60-7.30) increased 3HP discontinuation risk. Social-behavioral factors such as substance misuse (HR, 12.00; 95% CI, 2.20-69.00) and congregate living (HR, 21.00; 95% CI, 1.20-360.00) increased 4R discontinuation risk., Conclusions: TPT discontinuation differed by regimen, with distinct risk factors. Addressing social determinants of health within TPT programs is critical to enhance completion rates and reduce TB disease risk in marginalized populations., Competing Interests: Potential conflicts of interest. The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
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- 2024
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45. Assessing the impact of institutional mistrust on parental endorsement for COVID-19 vaccination among school communities in San Diego County, California.
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Le T, Flores M, Omaleki V, Hassani A, Vo AV, Wijaya FC, Garfein RS, and Fielding-Miller R
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- Humans, Female, Male, California, Child, Adult, Adolescent, Child, Preschool, SARS-CoV-2, Surveys and Questionnaires, Middle Aged, COVID-19 prevention & control, COVID-19 epidemiology, COVID-19 psychology, Parents psychology, COVID-19 Vaccines administration & dosage, Trust, Schools, Vaccination psychology
- Abstract
Background: Institutional mistrust has weakened COVID-19 mitigation efforts. Assessing to what extent institutional mistrust impacts parental decision making is important in formulating structural efforts for improving future pandemic response. We hypothesized that institutional mistrust is associated with lower parental endorsement for COVID-19 vaccination., Methods: We distributed an online survey among parents from schools in areas with high levels of social vulnerability relative to the rest of San Diego County. We defined vaccination endorsement as having a child aged 5 years or older who received at least one COVID-19 vaccine dose or being very likely to vaccinate their child aged 6 months-4 years when eligible. Institutional mistrust reflected the level of confidence in institutions using an aggregate score from 11 to 44. We built a multivariable logistic regression model with potential confounding variables., Findings: Out of 290 parents in our sample, most were female (87.6%), reported their child as Hispanic/Latino (73.4%), and expressed vaccination endorsement (52.1%). For every one-point increase in mistrust score, there was an 8% reduction in the likelihood of participants endorsing vaccination for their child. Other statistically significant correlates that were positively associated with vaccination endorsement included parent vaccination status, child age, parent age, and Hispanic/Latino ethnicity., Conclusion: Our study further demonstrates how institutional mistrust hinders public response during health emergencies. Our findings also highlight the importance of building confidence in institutions and its downstream effects on pandemic preparedness and public health. One way that institutions can improve their relationship with constituents is through building genuine partnerships with trusted community figures., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Le et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2024
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46. Asynchronous Video Directly Observed Therapy to Monitor Short-Course Latent Tuberculosis Infection Treatment: Results of a Randomized Controlled Trial.
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Garfein RS, Liu L, Cepeda J, Graves S, San Miguel S, Antonio A, Cuevas-Mota J, Mercer V, Miller M, Catanzaro DG, Rios P, Raab F, and Benson CA
- Abstract
Background: Observing medication ingestion through self-recorded videos (video directly observed therapy [VDOT]) has been shown to be a cost-effective alternative to in-person directly observed therapy (DOT) for monitoring adherence to treatment for tuberculosis disease. VDOT could be a useful tool to monitor short-course latent tuberculosis infection (LTBI) treatment., Methods: We conducted a prospective randomized controlled trial comparing VDOT (intervention) and clinic-based DOT (control) among patients newly diagnosed with LTBI who agreed to a once-weekly 3-month treatment regimen of isoniazid and rifapentine. Study outcomes were treatment completion and patient satisfaction. We also assessed costs. Pre- and posttreatment interviews were conducted., Results: Between March 2016 and December 2019, 130 participants were assigned to VDOT (n = 68) or DOT (n = 62). Treatment completion (73.5% vs 69.4%, P = .70) and satisfaction with treatment monitoring (92.1% vs 86.7%, P = .39) were slightly higher in the intervention group than the control group, but neither was statistically significant. VDOT cost less per patient (median, $230; range, $182-$393) vs DOT (median, $312; range, $246-$592) if participants used their own smartphone., Conclusions: While both groups reported high treatment satisfaction, VDOT was not associated with higher LTBI treatment completion. However, VDOT cost less than DOT. Volunteer bias might have reduced the observed effect since patients opposed to any treatment monitoring could have opted for alternative unobserved regimens. Given similar outcomes and lower cost, VDOT may be useful for treatment monitoring when in-person observation is prohibited or unavailable (eg, during a respiratory disease outbreak). The trial was registered at the National Institutes of Health (ClinicalTrials.gov NTC02641106)., Clinical Trials Registration: ClinicalTrials.gov NTC02641106; registered 24 October 2016., Competing Interests: Potential conflicts of interest. R. S. G. is a cofounder of SureAdhere Mobile Technology, Inc—a VDOT service provider. This study used a VDOT app programmed and maintained exclusively at the University of California San Diego. No funding, software, or other resources were provided by SureAdhere for the study. To mitigate potential conflicts of interest, interpretation and reporting of the study findings were reviewed and approved by coauthors unaffiliated with SureAdhere. The terms of this arrangement have been reviewed and approved by the University of California San Diego in accordance with its conflict-of-interest policies. All other authors report no potential conflicts., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
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- 2024
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47. Breastfeeding and neurodevelopment in infants with prenatal alcohol exposure.
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Schaffer KE, Chambers CD, Garfein RS, Wertelecki W, and Bandoli G
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- Infant, Child, Humans, Female, Pregnancy, Cohort Studies, Child Development, Linear Models, Breast Feeding, Prenatal Exposure Delayed Effects
- Abstract
Background: Few studies have evaluated the differential benefits of breastfeeding on infant neurodevelopment at varying levels of prenatal alcohol exposure (PAE). This study examined whether the association between breastfeeding and neurodevelopment is modified by prenatal drinking pattern., Methods: The study included 385 infants from Ukraine born to women prospectively enrolled in a cohort study during pregnancy. Neurodevelopment was assessed at six and 12 months using the Bayley Scales of Infant Development II (BSID-II) Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI). Linear regression modeling with interaction terms and stratification by PAE group was used to determine the relationship between breastfeeding, PAE, and neurodevelopment., Results: A significant interaction between PAE and breastfeeding was observed for the MDI and PDI at six and 12 months. Infants with high PAE who were breastfed at least four months had BSID-II scores 14 or more points higher compared to those never breastfed. Counterintuitively, those with moderate PAE had poorer performance on the BSID-II at 12 months when breastfed longer., Conclusion: There was a significant joint effect of PAE and breastfeeding on infant neurodevelopment at six and 12 months. Breastfeeding may provide distinct benefits to infants exposed to high levels of PAE., Impact: We found a positive effect of breastfeeding on infant neurodevelopment among infants with prenatal alcohol exposure (PAE), particularly those exposed to higher levels during gestation. This study is one of the first to evaluate whether breastfeeding mitigates harm caused by PAE. Breastfeeding may provide distinct benefits to infants with higher levels of PAE., (© 2023. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.)
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- 2024
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48. Genomic surveillance reveals dynamic shifts in the connectivity of COVID-19 epidemics.
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Matteson NL, Hassler GW, Kurzban E, Schwab MA, Perkins SA, Gangavarapu K, Levy JI, Parker E, Pride D, Hakim A, De Hoff P, Cheung W, Castro-Martinez A, Rivera A, Veder A, Rivera A, Wauer C, Holmes J, Wilson J, Ngo SN, Plascencia A, Lawrence ES, Smoot EW, Eisner ER, Tsai R, Chacón M, Baer NA, Seaver P, Salido RA, Aigner S, Ngo TT, Barber T, Ostrander T, Fielding-Miller R, Simmons EH, Zazueta OE, Serafin-Higuera I, Sanchez-Alavez M, Moreno-Camacho JL, García-Gil A, Murphy Schafer AR, McDonald E, Corrigan J, Malone JD, Stous S, Shah S, Moshiri N, Weiss A, Anderson C, Aceves CM, Spencer EG, Hufbauer EC, Lee JJ, King AJ, Ramesh KS, Nguyen KN, Saucedo K, Robles-Sikisaka R, Fisch KM, Gonias SL, Birmingham A, McDonald D, Karthikeyan S, Martin NK, Schooley RT, Negrete AJ, Reyna HJ, Chavez JR, Garcia ML, Cornejo-Bravo JM, Becker D, Isaksson M, Washington NL, Lee W, Garfein RS, Luna-Ruiz Esparza MA, Alcántar-Fernández J, Henson B, Jepsen K, Olivares-Flores B, Barrera-Badillo G, Lopez-Martínez I, Ramírez-González JE, Flores-León R, Kingsmore SF, Sanders A, Pradenas A, White B, Matthews G, Hale M, McLawhon RW, Reed SL, Winbush T, McHardy IH, Fielding RA, Nicholson L, Quigley MM, Harding A, Mendoza A, Bakhtar O, Browne SH, Olivas Flores J, Rincon Rodríguez DG, Gonzalez Ibarra M, Robles Ibarra LC, Arellano Vera BJ, Gonzalez Garcia J, Harvey-Vera A, Knight R, Laurent LC, Yeo GW, Wertheim JO, Ji X, Worobey M, Suchard MA, Andersen KG, Campos-Romero A, Wohl S, and Zeller M
- Subjects
- Humans, Genomics, Pandemics prevention & control, Public Health, SARS-CoV-2 genetics, Infection Control, Geography, COVID-19 epidemiology, COVID-19 transmission, COVID-19 virology
- Abstract
The maturation of genomic surveillance in the past decade has enabled tracking of the emergence and spread of epidemics at an unprecedented level. During the COVID-19 pandemic, for example, genomic data revealed that local epidemics varied considerably in the frequency of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) lineage importation and persistence, likely due to a combination of COVID-19 restrictions and changing connectivity. Here, we show that local COVID-19 epidemics are driven by regional transmission, including across international boundaries, but can become increasingly connected to distant locations following the relaxation of public health interventions. By integrating genomic, mobility, and epidemiological data, we find abundant transmission occurring between both adjacent and distant locations, supported by dynamic mobility patterns. We find that changing connectivity significantly influences local COVID-19 incidence. Our findings demonstrate a complex meaning of "local" when investigating connected epidemics and emphasize the importance of collaborative interventions for pandemic prevention and mitigation., Competing Interests: Declaration of interests K.G.A. has received consulting fees on SARS-CoV-2 and the COVID-19 pandemic., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2023
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49. Unit costs of needle and syringe program provision: a global systematic review and cost extrapolation.
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Killion JA, Magana C, Cepeda JA, Vo A, Hernandez M, Cyr CL, Heskett KM, Wilson DP, Graff Zivin J, Zúñiga ML, Pines HA, Garfein RS, Vickerman P, Terris-Prestholt F, Wynn A, and Martin NK
- Subjects
- Humans, Needle-Exchange Programs, Hepacivirus, Substance Abuse, Intravenous epidemiology, HIV Infections prevention & control, HIV Infections epidemiology, Hepatitis C prevention & control, Hepatitis C epidemiology
- Abstract
Background: Needle and syringe programs (NSPs) are effective at preventing HIV and hepatitis C virus (HCV) among people who inject drugs (PWID), yet global coverage is low, partly because governments lack data on the cost and cost-effectiveness of NSP in their countries to plan and fund their responses. We conducted a global systematic review of unit costs of NSP provision to inform estimation of cost drivers and extrapolated costs to other countries., Methods: We conducted a systematic review to extract data on the cost per syringe distributed and its cost drivers. We estimated the impact of country-level and program-level variables on the cost per syringe distributed using linear mixed-effects models. These models were used to predict unit costs of NSP provision, with the best performing model used to extrapolate the cost per syringe distributed for 137 countries. The total cost for a comprehensive NSP (200 syringes per PWID/year) was also estimated for 68 countries with PWID population size estimates., Results: We identified 55 estimates of the unit cost per syringe distributed from 14 countries. Unit costs were extrapolated for 137 countries, ranging from $0.08 to $20.77 (2020 USD) per syringe distributed. The total estimated spend for a high-coverage, comprehensive NSP across 68 countries with PWID size estimates is $5 035 902 000 for 10 887 500 PWID, 2.1-times higher than current spend., Conclusion: Our review identified cost estimates from high-income, upper-middle-income, and lower-middle-income countries. Regression models may be useful for estimating NSP costs in countries without data to inform HIV/HCV prevention programming and policy., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2023
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50. Association between where men who have sex with men (MSM) meet sexual partners and chlamydia/gonorrhoea infection before and during the COVID-19 pandemic in San Diego, California.
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King CMB, Garfein RS, Bazzi AR, Little SJ, and Skaathun B
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- Male, Humans, Adolescent, Adult, Sexual Partners, Homosexuality, Male, Sexual Behavior, Cross-Sectional Studies, Pandemics, Neisseria gonorrhoeae, Chlamydia trachomatis, California epidemiology, Prevalence, Gonorrhea epidemiology, Gonorrhea prevention & control, Sexual and Gender Minorities, COVID-19 epidemiology, Chlamydia Infections epidemiology, Chlamydia Infections prevention & control
- Abstract
Background: Meeting sex partners online is associated with increased risk of acquiring sexually transmitted infections. We examined whether different venues where men who have sex with men (MSM) meet sex partners was associated with prevalent Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infection, and whether prevalence increased during (vs before) the COVID-19 pandemic., Methods: We conducted a cross-sectional analysis of data from San Diego's 'Good To Go' sexual health clinic from two enrolment periods: (1) March-September 2019 (pre-COVID-19) and (2) March-September 2021 (during COVID-19). Participants completed self-administered intake assessments. This analysis included males aged ≥18 years self-reporting sex with males within 3 months before enrolment. Participants were categorised as (1) meeting new sex partners in-person only (eg, bars, clubs), (2) meeting new sex partners online (eg, applications, websites) or (3) having sex only with existing partners. We used multivariable logistic regression, adjusting for year, age, race, ethnicity, number of sex partners, pre-exposure prophylaxis use and drug use to examine whether venue or enrolment period were associated with CT/NG infection (either vs none)., Results: Among 2546 participants, mean age was 35.5 (range: 18-79) years, 27.9% were non-white and 37.0% were Hispanic. Overall, CT/NG prevalence was 14.8% and was higher during COVID-19 vs pre-COVID-19 (17.0% vs 13.3%). Participants met sex partners online (56.9%), in-person (16.9%) or only had existing partners (26.2%) in the past 3 months. Compared with having only existing sex partners, meeting partners online was associated with higher CT/NG prevalence (adjusted OR (aOR) 2.32; 95% CI 1.51 to 3.65), while meeting partners in-person was not associated with CT/NG prevalence (aOR 1.59; 95% CI 0.87 to 2.89). Enrolment during COVID-19 was associated with higher CT/NG prevalence compared with pre-COVID-19 (aOR 1.42; 95% CI 1.13 to 1.79)., Conclusions: CT/NG prevalence appeared to increase among MSM during COVID-19, and meeting sex partners online was associated with higher prevalence., Competing Interests: Competing interests: SJL has received funding from Gilead Sciences paid to her institution and donation of medications from Gilead Sciences., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2023
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