420 research outputs found
Perceptions of extended-release buprenorphine injections for opioid dependence prior to availability in Australia: a cross-sectional survey of people who use opioids regularly
No full textAbstract Paper 119Briony Larance, Louisa Degenhardt, Jason Grebely, Suzanne Nielsen, Raimondo Bruno, Paul M. Dietze, Kari Lancaster, Sarah Larney, Thomas Santo, Jr., Marian Shanahan, Sonja Memedovic, Robert Ali, & Michael Farrel
A summary of the 20th International Symposium on Hepatitis C Virus and Related Viruses
No full textMichael R. Beard, Rose Ffrench, Eric J. Gowans, Karla J. Helbig, Nicholas M. Eyre, Mark M. W. Douglas, Jason Grebely, Golo Ahlenstiel, Stephen Locarnini, Jacob George, Nick A. Shackel, Peter A. White, Alex J. Thompson, and Heidi E. Drumme
Behavioral intervention to reduce opioid overdose among high-risk persons with opioid use disorder: A pilot randomized controlled trial.
No full textThe United States is amidst an opioid epidemic, including synthetic opioids that may result in rapid death, leaving minimal opportunity for bystander rescue. We pilot tested a behavioral intervention to reduce the occurrence of opioid overdose among opioid dependent persons at high-risk for subsequent overdose.We conducted a single-blinded randomized-controlled trial of a repeated dose motivational interviewing intervention (REBOOT) to reduce overdose versus treatment as usual, defined as information and referrals, over 16 months at the San Francisco Department of Public Health from 2014-2016. Participants were 18-65 years of age, had opioid use disorder by Structured Clinical Interview, active opioid use, opioid overdose within 5 years, and prior receipt of naloxone kits. The intervention was administered at months 0, 4, 8, and 12, preceded by the assessment which was also administered at month 16. Dual primary outcomes were any overdose event and number of events, collected by computer-assisted personal interview, as well as any fatal overdose events per vital records.A total of 78 persons were screened and 63 enrolled. Mean age was 43 years, 67% were born male, 65% White, 17% African-American, and 14% Latino. Ninety-two percent of visits and 93% of counseling sessions were completed. At baseline, 33.3% of participants had experienced an overdose in the past four months, with a similar mean number of overdoses in both arms (p = 0.95); 29% overdosed during follow-up. By intention-to-treat, participants assigned to REBOOT were less likely to experience any overdose (incidence rate ratio [IRR] 0.62 [95%CI 0.41-0.92, p = 0.019) and experienced fewer overdose events (IRR 0.46, 95%CI 0.24-0.90, p = 0.023), findings that were robust to sensitivity analyses. There were no differences between arms in days of opioid use, substance use treatment, or naloxone carriage.REBOOT reduced the occurrence of any opioid overdose and the number of overdoses.clinicaltrials.gov NCT02093559
Variations temporelles de l’injection de drogues et association avec le risque d’infection par le virus de l’hépatite C
No full textLa majorité des personnes utilisatrices de drogues par injection (PUDI) contracteront le virus de l’hépatite C (VHC), les mettant à risque accru de complications hépatiques graves et parfois mortelles. Les comportements les plus risqués pour l’acquisition du VHC incluent le partage de matériel d’injection et l’injection à haute fréquence. Un facteur jusqu’ici négligé dans l’évaluation du risque de VHC est l’aspect dynamique de l’injection, c.-à-d. la manière dont elle varie dans le temps, incluant l’effet des périodes sans injection et celui des changements dans la fréquence d’injection. On reconnaît également l’effet délétère que l’instabilité résidentielle peut avoir sur le risque de VHC, bien que les mécanismes sous-jacents soient mal compris.
Cette thèse s’intéresse à l’effet des variations temporelles de l’injection sur le risque de VHC, et à la manière dont la fréquence d’injection évolue en concomitance avec les conditions résidentielles dans le temps, afin d’aider au développement de nouvelles stratégies de prévention du VHC. Les données ont été recueillies entre mars 2011 et juin 2016 dans la Hepatitis Cohort, une cohorte de PUDI suivies trimestriellement à Montréal, au Québec.
Une première analyse a évalué l’effet des périodes sans injection de trois mois ou moins sur le risque de VHC sur 916 personnes-années de suivi, par régression de Cox (N=372). Celle-ci suggère que les PUDI présentant des périodes sans injection courtes (3/3 mois sans injection) et sporadiques (1/3 ou 2/3 mois sans injection) sont respectivement 76% et 44% moins à risque de VHC que celles s’injectant de manière persistante (0/3 mois sans injection).
Une deuxième analyse a utilisé la modélisation de trajectoires fondée sur le groupement pour identifier cinq types distincts de trajectoires de fréquence d’injection suivies sur une année, lesquels ont ensuite été comparés en termes d’incidence du VHC sur des périodes de suivi allant de 71 à 355 personnes-années (N=386). Les résultats suggèrent que les PUDI dont la fréquence reste élevée (injection fréquente) ou change dans le temps (croissante, décroissante) sont à plus haut risque de VHC que celles s’injectant à basse fréquence (sporadique, peu fréquente).
Une dernière analyse a identifié trois types de trajectoires de stabilité résidentielle suivies sur un an (persistance, déclin, amélioration; N=386), lesquels ont été évalués en association avec les trajectoires de fréquence d’injection suivies simultanément. Les résultats suggèrent qu’il existe un lien entre l’amélioration des conditions résidentielles et la diminution de la fréquence d’injection, mais aussi que la probabilité d’injection à fréquence croissante est plus élevée chez les PUDI maintenant des conditions résidentielles stables que celles chez qui elles s’améliorent.
Collectivement, les résultats ont de nombreuses implications en termes de prévention du VHC. Cliniquement, l’instabilité de la fréquence d’injection semble être un facteur de risque à monitorer régulièrement. En termes de santé publique, les interventions favorisant l’engagement dans des périodes sans injection ou le maintien d’une basse fréquence d’injection pourraient être prometteuses. Enfin, les stratégies visant l’amélioration des conditions résidentielles pourraient éventuellement aider les PUDI à réduire leur fréquence d’injection, mais être insuffisantes pour maintenir celle-ci à basse fréquence une fois la stabilité atteinte.The majority of people who inject drugs (PWID) will become infected with hepatitis C virus (HCV), placing them at risk of serious and sometimes fatal liver complications. Injecting behaviours with higher risk of HCV transmission include injecting equipment sharing and high frequency injecting. One factor that has been overlooked when assessing HCV acquisition risk is the dynamic aspect of drug injecting, i.e., how drug injecting varies over time, including the role of injecting cessation episodes and that of changes in injecting frequency. Moreover, there is growing recognition of the deleterious effect unstable housing can have on HCV acquisition risk, although the underlying mechanisms are not yet fully understood.
This thesis examines how temporal variations in drug injecting relate to HCV acquisition risk and further explores how housing conditions and injecting frequency evolve together over time, for the purposes of contributing to the development of novel HCV prevention strategies. Data were collected between March 2011 and June 2016 in the Hepatitis Cohort, a prospective cohort study of PWID interviewed and tested for HCV infection at three-monthly intervals in Montréal, Québec.
A first analysis examined the effect of injecting cessation episodes of three months or less on the risk of contracting HCV during 916 person-years of follow-up, using Cox regression (N=372). Results suggest that PWID with short injecting cessation episodes (3/3 months without injecting) or sporadic injecting cessation episodes (1/3 or 2/3 months without injecting) are 76% and 44% less at risk of contracting HCV than those with persistent injecting (0/3 months without injecting), respectively.
A second analysis used group-based trajectory modeling to identify five distinct types of one-year injecting frequency trajectories and compared these in terms of HCV incidence over follow-up periods ranging from 71 to 355 person-years (N=386). Findings suggest that PWID injecting with consistently high frequencies (frequent) or time-varying frequencies (increasing, decreasing) are at greater HCV acquisition risk compared with those maintaining low injecting frequencies (sporadic, infrequent).
Finally, a third analysis identified three types of one-year housing stability trajectories (sustained, declining, improving) and examined their associations with concomitant injecting frequency trajectories (N=386). Findings suggest an association between improving housing stability and decreasing injecting frequency, but also a higher probability of increasing injecting frequency among PWID who maintain housing stability compared to those that improve it.
Collectively, these findings have numerous implications for HCV prevention. Clinically, instability in injecting frequency appears to be a risk factor that should be monitored regularly. From a public health perspective, interventions that promote engagement in injecting cessation episodes or maintenance of low injecting frequency may be promising. Finally, strategies aimed to improve housing stability may help PWID to decrease their injecting frequency but may not be sufficient to help them maintain low injecting frequencies once housing stability is achieved
Changes in risk behaviours during and following treatment for hepatitis C virus infection among people who inject drugs: The ACTIVATE study
No full textThe ACTIVATE study was supported in part by a research grant from the Investigator Initiated Studies Program of Merck Sharp & Dohme Corp. The Opinions expressed in this paper are those of the authors and do not necessarily represent those of Merck Sharp & Dohme Corp. The Kirby Institute is funded by the Australian Government Department of Health. The views expressed in this publication do not necessarily represent the position of the Australian Government. Håvard Midgard is supported by research funding from the Norwegian ExtraFoundation for Health and Rehabilitation. Jason Grebely is supported by a National Health and Medical Research Council Career Development Fellowship. Gregory J Dore is supported by a National Health and Medical Research Council Practitioner Research Fellowship. Behzad Hajarizadeh is supported by a National Health and Medical Research Council Early Career Fellowship
NDARC webinar series presentation. Hepatitis C elimination among people who inject drugs: some successes, but still a long way to go.
No full textHarm reduction strategies to prevent new infections and reinfections among people who inject drugs: how effective are they?
No full textHepatitis C virus infection in injection drug users
No full textInjection drug users (IDUs) represent the core of the hepatitis C virus (HCV) epidemic, but little
is known about the natural history and treatment of HCV in IDUs. This thesis characterizes
spontaneous clearance of HCV, investigates HCV re-infection following clearance and evaluates
novel models for improving uptake and treatment responses among IDUs.
To better understand characteristics associated with HCV clearance in IDUs, data from a
community-based cohort study were linked with longitudinal laboratory databases to compare
individuals with HCV clearance to those with HCV persistence to evaluate factors associated
with clearance of HCV infection. Aboriginal ethnicity and female gender were associated with
increased rates of HCV clearance, while HIV co-infection and illicit drug use were associated
with increased HCV persistence.
To further investigate the impact of illicit drug use on HCV persistence, we compared the rate of
re-infection in individuals with HCV clearance to the rate of infection observed in previously
uninfected individuals to evaluate whether previous clearance of HCV infection is protective
against re-infection. Those with viral clearance were about 4 times less likely to become re-infected
than those infected for the first time, suggesting that individuals with HCV clearance
have a lower risk of acquiring HCV than individuals who have never been infected, despite
ongoing exposure to HCV.
Lastly, we sought to evaluate novel models for improving uptake of and response rates to the
treatment of HCV among current and former IDUs. First, we demonstrated that within a
prospective, multidisciplinary, directly observed therapy program for the treatment of HCV
infection of IDUs, overall response rates parallel results from large, randomized controlled trials,
despite ongoing illicit drug use during treatment. Second, we demonstrated a high uptake of and
response to therapy among IDUs infected with HCV attending a weekly support group. Taken
together, these data demonstrate that IDUs can be safely and successfully treated for HCV
infection within a multidisciplinary program integrating HCV, addiction and primary care. Given the considerable burden of HCV infection in IDUs, this data contributes significantly to
the field by providing a greater understanding of the natural history and treatment of HCV in this
setting.Medicine, Faculty ofAnesthesiology, Pharmacology and Therapeutics, Department ofGraduat
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