Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-19 (of 19 Records) |
Query Trace: Zibbell J[original query] |
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Cost-effectiveness of scaling up HCV prevention and treatment in the United States for people who inject drugs
Barbosa C , Fraser H , Hoerger TJ , Leib A , Havens JR , Young A , Kral A , Page K , Evans J , Zibbell J , Hariri S , Vellozzi C , Nerlander L , Ward JW , Vickerman P . Addiction 2019 114 (12) 2267-2278 AIMS: To examine the cost-effectiveness of hepatitis C (HCV) treatment of people who inject drugs (PWID), combined with medication-assisted treatment (MAT) and syringe-service programs (SSP), to tackle the increasing HCV epidemic in the United States. DESIGN: HCV-transmission and disease progression models with cost-effectiveness analysis using a health care perspective. SETTING: Rural Perry County, Kentucky (PC), and urban San Francisco, California (SF),USA. Compared with PC, SF has a greater proportion of PWID with access to MAT or SSP. HCV treatment of PWID is negligible in both settings. PARTICIPANTS: PWID, data collected between 1998 and 2015 from Social Networks Among Appalachian People, U Find Out, Urban Health Study, and National HIV Behavioral Surveillance System studies. INTERVENTIONS AND COMPARATOR: Three intervention scenarios modeled: baseline-existing SSP and MAT coverage with HCV screening and treatment with direct-acting antiviral for ex-injectors only as per standard of care; Intervention 1-scale-up of SSP and MAT without changes to treatment; and Intervention 2-scale-up as Intervention 1 combined with HCV screening and treatment for current PWID. MEASUREMENTS: Incremental cost-effectiveness ratios (ICERs) and uncertainty using cost-effectiveness acceptability curves. Benefits were measured in quality-adjusted life-years (QALYs). FINDINGS: For both settings, Intervention 2 is preferred to Intervention 1 and the appropriate comparator for Intervention 2 is the baseline scenario. Relative to baseline, for PC Intervention 2 averts 1,852 more HCV infections, increases QALYS by 3,095, costs $21.6 million more, and has an ICER of $6,975/QALY. For SF, Intervention 2 averts 36,473 more HCV infections, increases QALYs by 78,93, costs $ 872 million more, and has an ICER of $11,044/QALY. The cost-effectiveness of Intervention 2 was robust to several sensitivity analysis. CONCLUSIONS: Hepatitis C screening and treatment for people who inject drugs, combined with medication-assisted treatment and syringe-service programs, is a cost-effective strategy for reducing hepatitis C burden in the United States. |
Heroin and healthcare: patient characteristics and healthcare prior to overdose
Bohm MK , Bridwell L , Zibbell JE , Zhang K . Am J Manag Care 2019 25 (7) 341-347 OBJECTIVES: To estimate heroin overdose trends among insured individuals and characterize patients and healthcare utilization preceding overdose to inform scale-up of effective prevention and treatment. STUDY DESIGN: Retrospective descriptive analysis. METHODS: We analyzed 2010 to 2014 IBM MarketScan Databases and calculated annual heroin overdose rates. For a subset of patients, we describe their comorbidities, where they accessed health services, and select prescription histories prior to their first heroin overdose. RESULTS: Heroin overdose rates were much lower, but increased faster, among the commercially insured compared with Medicaid enrollees from 2010 to 2014 (270.0% vs 94.3%). By 2012, rates among the commercially insured aged 15 to 24 years reached the overall rates in the Medicaid population. All patients had healthcare encounters in the 6 months prior to their first heroin overdose; two-thirds of commercially insured patients had outpatient visits, whereas two-thirds of Medicaid patients had emergency department visits. One month prior to overdose, 24.5% of Medicaid and 8.6% of commercially insured patients had opioid prescriptions. Fewer Medicaid patients had buprenorphine prescriptions (17.8% vs 27.3%) despite similar rates of known substance-related disorders. A higher proportion of Medicaid patients had non-substance-related comorbidities. CONCLUSIONS: Heroin overdose rates were persistently higher among the Medicaid population than the commercially insured, with the exception of those aged 15 to 24 years. Our findings on healthcare utilization, comorbidities, and where individuals access services could inform interventions at the point of care prior to a first heroin overdose. Outpatient settings are of particular importance for the growing cohort of young, commercially insured patients with opioid use disorders. |
Scaling-up hepatitis C prevention and treatment interventions for achieving elimination in the United States - a rural and urban comparison
Fraser H , Vellozzi C , Hoerger TJ , Evans JL , Kral AH , Havens J , Young AM , Stone J , Handanagic S , Hariri S , Barbosa C , Hickman M , Leib A , Martin NK , Nerlander L , Raymond HF , Page K , Zibbell J , Ward JW , Vickerman P . Am J Epidemiol 2019 188 (8) 1539-1551 In the U.S. Hepatitis C virus (HCV) transmission is increasing among people who inject drugs (PWID). Many regions have insufficient prevention intervention coverage. Using modelling, we investigate the impact of scaling-up prevention and treatment interventions on HCV transmission among PWID in Perry County, Kentucky (PC), and San Francisco, California (SF), where HCV sero-prevalence among PWID is >50%. A greater proportion of PWID access medication-assisted treatment (MAT) or syringe service programs (SSP) in urban SF (established community) than rural PC (young, expanding community). We model the proportion of HCV-infected PWID needing HCV-treatment annually to reduce HCV-incidence by 90% by 2030, with and without MAT scale-up (50% coverage, both settings) and SSP scale-up (PC only) from 2017. With current MAT&SSP coverage during 2017-2030, HCV-incidence will increase in PC (21.3 to 22.6 per 100 person-years (/100pyrs)) and decrease in SF (12.9 to 11.9/100pyrs). With concurrent MAT&SSP scale-up, 5%/year of HCV-infected PWID need HCV-treatment in PC to achieve incidence targets; 13%/year without MAT&SSP scale-up. In SF, a similar proportion need HCV-treatment (10%/year) irrespective of MAT scale-up. Reaching the same impact by 2025 requires increases in treatment rates of 45-82%. Achievable provision of HCV-treatment, alongside MAT&SSP scale-up (PC) and MAT scale-up (SF), could reduce HCV-incidence. |
Increases in acute hepatitis C virus infection related to a growing opioid epidemic and associated injection drug use, United States, 2004 to 2014
Zibbell JE , Asher AK , Patel RC , Kupronis B , Iqbal K , Ward JW , Holtzman D . Am J Public Health 2017 108 (2) e1-e7 OBJECTIVES: To compare US trends in rates of injection drug use (IDU), specifically opioid injection, with national trends in the incidence of acute HCV infection to assess whether these events correlated over time. METHODS: We calculated the annual incidence rate and demographic and risk characteristics of reported cases of acute HCV infection using surveillance data from 2004 to 2014 and the annual percentage of admissions to substance use disorder treatment facilities reporting IDU for the same time period by type of drug injected and demographic characteristics. We then tested for trends. RESULTS: The annual incidence rate of acute HCV infection increased more than 2-fold (from 0.3 to 0.7 cases/100 000) from 2004 to 2014, with significant increases among select demographic subgroups. Admissions for substance use disorder attributed to injection of heroin and prescription opioid analgesics increased significantly, with an almost 4-fold increase in prescription opioid analgesic injection. Significant increases in opioid injection mirrored those for reported cases of acute HCV infection among demographic subgroups. CONCLUSIONS: These findings strongly suggest that the national increase in acute HCV infection is related to the country's opioid epidemic and associated increases in IDU. (Am J Public Health. Published online ahead of print December 21, 2017: e1-e7. doi:10.2105/AJPH.2017.304132). |
Multiple injections per injection episode: High-risk injection practice among people who injected pills during the 2015 HIV outbreak in Indiana
Broz D , Zibbell J , Foote C , Roseberry JC , Patel MR , Conrad C , Chapman E , Peters PJ , Needle R , McAlister C , Duwve JM . Int J Drug Policy 2017 52 97-101 BACKGROUND: Misuse of prescription opioid analgesics (POA) has increased dramatically in the US, particularly in non-urban areas. We examined injection practices among persons who inject POA in a rural area that experienced a large HIV outbreak in 2015. METHODS: Between August-September 2015, 25 persons who injected drugs within the past 12 months were recruited in Scott County, Indiana for a qualitative study. Data from in-depth, semi-structured interviews were analyzed. RESULTS: All 25 participants were non-Hispanic white and the median age was 33 years (range: 19-57). All had ever injected extended-release oxymorphone (Opana((R)) ER) and most (n=20) described preparing Opana((R)) ER for multiple injections per injection episode (MIPIE). MIPIE comprised 2-4 injections during an injection episode resulting from needing >1mL water to prepare Opana((R)) ER solution using 1mL syringes and the frequent use of "rinse shots." MIPIE occurred up to 10 times/day (totaling 35 injections/day), often in the context of sharing drug and injection equipment. CONCLUSIONS: We describe a high-risk injection practice that may have contributed to the rapid spread of HIV in this community. Efforts to prevent bloodborne infections among people who inject POA need to assess for MIPIE so that provision of sterile injection equipment and safer injection education addresses the MIPIE risk environment. |
Scaling up HCV prevention and treatment interventions in rural USA - model projections for tackling an increasing epidemic
Fraser H , Zibbell J , Hoerger T , Hariri S , Vellozzi C , Martin NK , Kral AH , Hickman M , Ward JW , Vickerman P . Addiction 2017 113 (1) 173-182 BACKGROUND AND AIMS: Effective strategies are needed to address dramatic increases in hepatitis C virus (HCV) infection among people who inject drugs (PWID) in rural settings of the United States (US). We determined the required scale-up of HCV treatment with or without scale-up of HCV prevention interventions to achieve a 90% reduction in HCV chronic prevalence or incidence by 2025 and 2030 in a rural US setting. DESIGN: An ordinary differential equation model of HCV transmission calibrated to HCV epidemiological data obtained primarily from a HIV-outbreak investigation in Indiana. SETTING: Scott County, Indiana (population 24,181), USA, a rural setting with negligible baseline interventions, increasing HCV epidemic since 2010, and 55.3% chronic HCV prevalence amongst PWID in 2015 PARTICIPANTS: PWID MEASUREMENTS: Required annual HCV treatments per 1000 PWID (and initial annual percentage of infections treated) to achieve a 90% reduction in HCV chronic prevalence or incidence by 2025/30, either with or without scaling-up syringe service programs (SSPs) and medication-assisted treatment (MAT) to 50% coverage. Sensitivity analyses considered whether this impact could be achieved without retreatment of reinfections, and whether greater intervention scale-up was required due to the increasing epidemic in this setting. FINDINGS: To achieve a 90% reduction in incidence and prevalence by 2030, without MAT and SSP scale-up, 159 per 1000 PWID (initially 25% of infected PWID) need to be HCV-treated annually. However, with MAT and SSP scaled-up, treatment rates are halved (89 per 1000 annually or 15%). To reach the same target by 2025 with MAT and SSP scaled-up, 121 per 1000 PWID (20%) need treatment annually. These treatment requirements are 3-fold higher than if the epidemic was stable, and the impact targets are unattainable without retreatment. CONCLUSIONS: Combined scale-up of hepatitis C virus (HCV) treatment and prevention interventions is needed to decrease the increasing burden of HCV incidence and prevalence in rural Indiana, USA, by 90% by 2025/30. |
Characteristics of fentanyl overdose - Massachusetts, 2014-2016
Somerville NJ , O'Donnell J , Gladden RM , Zibbell JE , Green TC , Younkin M , Ruiz S , Babakhanlou-Chase H , Chan M , Callis BP , Kuramoto-Crawford J , Nields HM , Walley AY . MMWR Morb Mortal Wkly Rep 2017 66 (14) 382-386 Opioid overdose deaths in Massachusetts increased 150% from 2012 to 2015 (1). The proportion of opioid overdose deaths in the state involving fentanyl, a synthetic, short-acting opioid with 50-100 times the potency of morphine, increased from 32% during 2013-2014 to 74% in the first half of 2016 (1-3). In April 2015, the Drug Enforcement Agency (DEA) and CDC reported an increase in law enforcement fentanyl seizures in Massachusetts, much of which was believed to be illicitly manufactured fentanyl (IMF) (4). To guide overdose prevention and response activities, in April 2016, the Massachusetts Department of Public Health and the Office of the Chief Medical Examiner collaborated with CDC to investigate the characteristics of fentanyl overdose in three Massachusetts counties with high opioid overdose death rates. In these counties, medical examiner charts of opioid overdose decedents who died during October 1, 2014-March 31, 2015 were reviewed, and during April 2016, interviews were conducted with persons who used illicit opioids and witnessed or experienced an opioid overdose. Approximately two thirds of opioid overdose decedents tested positive for fentanyl on postmortem toxicology. Evidence for rapid progression of fentanyl overdose was common among both fatal and nonfatal overdoses. A majority of interview respondents reported successfully using multiple doses of naloxone, the antidote to opioid overdose, to reverse suspected fentanyl overdoses. Expanding and enhancing existing opioid overdose education and prevention programs to include fentanyl-specific messaging and practices could help public health authorities mitigate adverse effects associated with overdoses, especially in communities affected by IMF. |
County-level vulnerability assessment for rapid dissemination of HIV or HCV infections among persons who inject drugs, United States
Van Handel MM , Rose CE , Hallisey EJ , Kolling JL , Zibbell JE , Lewis B , Bohm MK , Jones CM , Flanagan BE , Siddiqi AE , Iqbal K , Dent AL , Mermin JH , McCray E , Ward JW , Brooks JT . J Acquir Immune Defic Syndr 2016 73 (3) 323-331 OBJECTIVE: A recent HIV outbreak in a rural network of persons who inject drugs (PWID) underscored the intersection of the expanding epidemics of opioid abuse, unsterile injection drug use (IDU), and associated increases in hepatitis C virus (HCV) infections. We sought to identify US communities potentially vulnerable to rapid spread of HIV, if introduced, and new or continuing high rates of HCV infections among PWID. DESIGN: We conducted a multistep analysis to identify indicator variables highly associated with IDU. We then used these indicator values to calculate vulnerability scores for each county to identify which were most vulnerable. METHODS: We used confirmed cases of acute HCV infection reported to the National Notifiable Disease Surveillance System, 2012-2013, as a proxy outcome for IDU, and 15 county-level indicators available nationally in Poisson regression models to identify indicators associated with higher county acute HCV infection rates. Using these indicators, we calculated composite index scores to rank each county's vulnerability. RESULTS: A parsimonious set of 6 indicators were associated with acute HCV infection rates (proxy for IDU): drug-overdose deaths, prescription opioid sales, per capita income, white, non-Hispanic race/ethnicity, unemployment, and buprenorphine prescribing potential by waiver. Based on these indicators, we identified 220 counties in 26 states within the 95th percentile of most vulnerable. CONCLUSIONS: Our analysis highlights US counties potentially vulnerable to HIV and HCV infections among PWID in the context of the national opioid epidemic. State and local health departments will need to further explore vulnerability and target interventions to prevent transmission. |
Increases in fentanyl-related overdose deaths - Florida and Ohio, 2013-2015
Peterson AB , Gladden RM , Delcher C , Spies E , Garcia-Williams A , Wang Y , Halpin J , Zibbell J , McCarty CL , DeFiore-Hyrmer J , DiOrio M , Goldberger BA . MMWR Morb Mortal Wkly Rep 2016 65 (33) 844-849 In March and October 2015, the Drug Enforcement Administration (DEA) and CDC issued nationwide alerts identifying fentanyl, particularly illicitly manufactured fentanyl (IMF), as a threat to public health and safety (1,2). IMF is pharmacologically similar to pharmaceutical fentanyl (PF), but is unlawfully produced in clandestine laboratories, obtained via illicit drug markets, and includes fentanyl analogs. Fentanyl is a synthetic opioid 50-100 times more potent than morphine and approved for the management of surgical/postoperative pain, severe chronic pain, and breakthrough cancer pain.* DEA's National Forensic Laboratory Information System (NFLIS) collects drug identification results from drug cases analyzed by federal, state, and local forensic laboratories throughout the United States.dagger In 2014, 80% of fentanyl submissions (i.e., drug products obtained by law enforcement that tested positive for fentanyl) in NFLIS were identified from 10 states, including Florida and Ohio (2), and seven of these 10 states reported sharp increases in fentanyl-related overdose deaths (fentanyl deaths) (3). This report presents findings of increased fentanyl deaths during 2013-2015 from investigations conducted by the University of Florida and the Ohio Department of Public Health, in collaboration with CDC. Analyses examined the association between trends in fentanyl-related law enforcement submissions and fentanyl deaths and describes groups at risk for fentanyl death using medical examiner and coroner reports. The marked increases in fentanyl death in Florida and Ohio during 2013-2015 were closely associated with parallel increases in fentanyl submissions, with the largest impact on persons who use heroin, consistent with reports that IMF is commonly mixed with or sold as heroin (1,4). In Ohio, circumstances associated with fentanyl deaths included a current diagnosed mental health disorder section sign and recent release from an institution such as a jail, rehabilitation facility, or hospital. |
Improving Screening Methods for Hepatitis C Among People Who Inject Drugs: Findings from the HepTLC Initiative, 2012-2014.
Blackburn NA , Patel RC , Zibbell JE . Public Health Rep 2016 131 91-97 OBJECTIVE: People who inject drugs (PWID) are at increased risk for hepatitis C virus (HCV) infection. We examined HCV testing outcomes among PWID through CDC's Hepatitis Testing and Linkage to Care initiative, which promoted viral hepatitis B and hepatitis C screening, posttest counseling, and linkage to care at 34 U.S. sites during 2012-2014. Ten grantees in nine geographically diverse cities conducted HCV testing among PWID. METHODS: Among those testing positive for HCV antibody (anti-HCV), we calculated the proportion who were offered a confirmatory HCV ribonucleic acid (RNA) test, positively diagnosed, and referred to a specialist for care. We stratified anti-HCV-positive people who completed each step by same-day testing (i.e., an HCV RNA test administered on the same date as an anti-HCV test) vs. person not receiving same-day testing to evaluate whether the need for follow-up testing affected diagnosis of chronic infection and linkage to care. RESULTS: A total of 15,274 people received an anti-HCV test at 84 testing sites targeting PWID. Of those, 11,159 (73%) reported having injected drugs in their lifetime, 7,789 (51%) reported injecting drugs in the past 12 months, and 3,495 (23%) tested anti-HCV positive. A total of 1,630 people received testing for HCV RNA, of whom 1,244 (76%) were HCV RNA positive. When not receiving both tests on the same day, 601 of 2,465 (24%) anti-HCV-positive people received an HCV RNA test. CONCLUSION: Strategies to diagnose PWID for HCV infection are needed to reduce associated morbidity and mortality. Agencies can substantially increase the number of PWID who are diagnosed and informed of their HCV infection by administering both anti-HCV and HCV RNA tests during a single testing event. |
Increases in drug and opioid overdose deaths - United States, 2000-2014
Rudd RA , Aleshire N , Zibbell JE , Gladden RM . MMWR Morb Mortal Wkly Rep 2016 64 1378-82 The United States is experiencing an epidemic of drug overdose (poisoning) deaths. Since 2000, the rate of deaths from drug overdoses has increased 137%, including a 200% increase in the rate of overdose deaths involving opioids (opioid pain relievers and heroin). CDC analyzed recent multiple cause-of-death mortality data to examine current trends and characteristics of drug overdose deaths, including the types of opioids associated with drug overdose deaths. During 2014, a total of 47,055 drug overdose deaths occurred in the United States, representing a 1-year increase of 6.5%, from 13.8 per 100,000 persons in 2013 to 14.7 per 100,000 persons in 2014. The rate of drug overdose deaths increased significantly for both sexes, persons aged 25-44 years and ≥55 years, non-Hispanic whites and non-Hispanic blacks, and in the Northeastern, Midwestern, and Southern regions of the United States. Rates of opioid overdose deaths also increased significantly, from 7.9 per 100,000 in 2013 to 9.0 per 100,000 in 2014, a 14% increase. Historically, CDC has programmatically characterized all opioid pain reliever deaths (natural and semisynthetic opioids, methadone, and other synthetic opioids) as "prescription" opioid overdoses. Between 2013 and 2014, the age-adjusted rate of death involving methadone remained unchanged; however, the age-adjusted rate of death involving natural and semisynthetic opioid pain relievers, heroin, and synthetic opioids, other than methadone (e.g., fentanyl) increased 9%, 26%, and 80%, respectively. The sharp increase in deaths involving synthetic opioids, other than methadone, in 2014 coincided with law enforcement reports of increased availability of illicitly manufactured fentanyl, a synthetic opioid; however, illicitly manufactured fentanyl cannot be distinguished from prescription fentanyl in death certificate data. These findings indicate that the opioid overdose epidemic is worsening. There is a need for continued action to prevent opioid abuse, dependence, and death, improve treatment capacity for opioid use disorders, and reduce the supply of illicit opioids, particularly heroin and illicit fentanyl. |
Identification and linkage to care of HCV-infected persons in five health centers - Philadelphia, Pennsylvania, 2012-2014
Coyle C , Viner K , Hughes E , Kwakwa H , Zibbell JE , Vellozzi C , Holtzman D . MMWR Morb Mortal Wkly Rep 2015 64 (17) 459-63 Approximately three million persons in the United States are infected with hepatitis C virus (HCV), a blood-borne pathogen that is an increasing cause of liver disease and mortality in the United States. Treatments for HCV are curative, of short duration, and have few associated side effects, increasing the importance of identifying HCV-infected persons. Many persons with HCV infection were infected decades ago, before implementation of prevention measures and most are unaware of their infection, regardless of when it occurred. Most newly diagnosed cases are associated with injection drug use. Persons born during 1945-1965 have a fivefold higher risk of HCV infection than other adults and the highest risk for HCV-related morbidity and mortality. CDC recommends testing for this group, for persons who inject drugs, and others at risk for HCV infection. From October 2012 through July 2014, the National Nursing Centers Consortium (NNCC) carried out a project to integrate routine HCV testing and linkage-to-care in five federally qualified health centers in Philadelphia, PA, that primarily serve homeless persons and public housing residents. During the project period, 4,514 patients across the five centers were tested for HCV. Of these, 595 (13.2%) were HCV-antibody positive and 550 (92.4%) had a confirmatory HCV-RNA test performed. Of those who had a confirmatory HCV-RNA test performed, 390 (70.9%) were identified as having current (i.e., chronic) HCV infection (overall prevalence = 8.6%). Of those currently infected with HCV, 90% were informed of their status, 78% were referred to an HCV care specialist, and 62% went to the referred specialist for care. Replicable system modifications that improved HCV testing and care included enhancements to electronic medical records (EMRs), simplification of HCV testing protocols, and addition of a linkage-to-care coordinator. Findings from this project highlight the need for innovative strategies for HCV testing, care, and treatment, as well as the important role of community health centers in expanding access for patient populations disproportionately affected by HCV infection. |
Increases in hepatitis C virus infection related to injection drug use among persons aged ≤30 years - Kentucky, Tennessee, Virginia, and West Virginia, 2006-2012
Zibbell JE , Iqbal K , Patel RC , Suryaprasad A , Sanders KJ , Moore-Moravian L , Serrecchia J , Blankenship S , Ward JW , Holtzman D . MMWR Morb Mortal Wkly Rep 2015 64 (17) 453-8 Hepatitis C virus (HCV) infection is the most common blood-borne infection in the United States, with approximately three million persons living with current infection. Percutaneous exposure to contaminated blood is the most efficient mode of transmission, and in the United States, injection drug use (IDU) is the primary risk factor for infection. State surveillance reports from the period 2006-2012 reveal a nationwide increase in reported cases of acute HCV infection, with the largest increases occurring east of the Mississippi River, particularly among states in central Appalachia. Demographic and behavioral data accompanying these reports show young persons (aged ≤30 years) from nonurban areas contributed to the majority of cases, with about 73% citing IDU as a principal risk factor. To better understand the increase in acute cases of HCV infection and its correlation to IDU, CDC examined surveillance data for acute case reports in conjunction with analyzing drug treatment admissions data from the Treatment Episode Data Set-Admissions (TEDS-A) among persons aged ≤30 years in four states (Kentucky, Tennessee, Virginia, and West Virginia) for the period 2006-2012. During this period, significant increases in cases of acute HCV infection were found among persons in both urban and nonurban areas, with a substantially higher incidence observed each year among persons residing in nonurban areas. During the same period, the proportion of treatment admissions for opioid dependency increased 21.1% in the four states, with a significant increase in the proportion of persons admitted who identified injecting as their main route of drug administration (an increase of 12.6%). Taken together, these increases indicate a geographic intersection among opioid abuse, drug injecting, and HCV infection in central Appalachia and underscore the need for integrated health services in substance abuse treatment settings to prevent HCV infection and ensure that those who are infected receive medical care. |
Risk factors for HCV infection among young adults in rural New York who inject prescription opioid analgesics
Zibbell JE , Hart-Malloy R , Barry J , Fan L , Flanigan C . Am J Public Health 2014 104 (11) e1-e7 OBJECTIVES: We investigated a cluster of new hepatitis C cases in rural New York among a cohort of young people who inject drugs (PWID) and misuse prescription opioid analgesics (POA). METHODS: We recruited a purposive sample of PWID from Cortland County for an in-person survey and HCV rapid antibody test (March-July 2012). We examined sociodemographics, drugs currently injected, and lifetime and recent injection behaviors to ascertain associations with HCV antibody (anti-HCV) positivity. RESULTS: Of 123 PWID, 76 (61.8%) were younger than 30 years, and 100 (81.3%) received HCV rapid testing. Of those tested, 34 (34.0%) were positive. Participants who reported injecting POA in the past 12 months were 5 times more likely to be anti-HCV positive than those who injected drugs other than POA, and participants who reported sharing injection equipment in the past 12 months were roughly 4 times more likely to be anti-HCV positive than those who did not. CONCLUSIONS: Our analysis suggests people injecting POA may be at higher risk for HCV infection than people who inject heroin or other drugs but not POA. |
Hepatitis C virus-related knowledge and willingness to receive treatment among patients on methadone maintenance
Zeremski M , Dimova RB , Zavala R , Kritz S , Lin M , Smith BD , Zibbell JE , Talal AH . J Addict Med 2014 8 (4) 249-57 OBJECTIVES: Although persons who inject drugs have high prevalence of hepatitis C virus (HCV) infection, few receive treatment mostly because of lack of knowledge about the infection and its treatment. We assessed the level of HCV-related knowledge and willingness to participate in HCV treatment among methadone-maintained patients. METHODS: A 30-item survey covering HCV-related knowledge and willingness to engage in HCV-related education and treatment was developed and completed by 320 methadone-maintained patients. RESULTS: Respondents' mean age was 53 +/- 8.7 years, 59.5% were male, 55.1% were African American, and 38.3% were Hispanic. The mean duration of methadone maintenance was 7 +/- 6.7 years. In the preceding 6 months, 6.9% of patients reported injection drug use, whereas 37.3% used noninjection drugs. Hepatitis C virus seropositivity was self-reported by 46.3% of patients. The majority of patients (78%) expressed willingness to participate in HCV-related education and to receive HCV treatment. Most patients (54.7%) correctly answered 5 or more of 7 questions assessing HCV knowledge. Hepatitis C virus-seropositive individuals and prior attendees at HCV-related educational activities demonstrated a higher level of HCV-related knowledge (P < 0.001 and P = 0.002, respectively). Younger patients (P = 0.014), those willing to attend an HCV-related educational activity (P < 0.001), and those with higher-HCV-related knowledge (P = 0.029) were more accepting of HCV treatment. Fear of medication-related side effects was the most common reason for treatment avoidance. CONCLUSIONS: The majority of patients reported willingness to receive HCV-related education and treatment. Treatment willingness was significantly associated with previous attendance at an HCV educational activity and a higher level of HCV-related knowledge. |
Confronting the emerging epidemic of HCV infection among young injection drug users
Valdiserri R , Khalsa J , Dan C , Holmberg S , Zibbell J , Holtzman D , Lubran R , Compton W . Am J Public Health 2014 104 (5) 816-21 Hepatitis C virus infection is a significant public health problem in the United States and an important cause of morbidity and mortality. Recent reports document HCV infection increases among young injection drug users in several US regions, associated with America's prescription opioid abuse epidemic. Incident HCV infection increases among young injectors who have recently transitioned from oral opioid abuse present an important public health challenge requiring a comprehensive, community-based response. We summarize recommendations from a 2013 Office of HIV/AIDS and Infectious Disease Policy convening of experts in epidemiology, behavioral science, drug prevention and treatment, and other research; community service providers; and federal, state, and local government representatives. Their observations highlight gaps in our surveillance, program, and research portfolios and advocate a syndemic approach to this emerging public health problem. |
"To share or not to share?" serosorting by hepatitis C status in the sharing of drug injection equipment among NHBS-IDU2 participants
Smith BD , Jewett A , Burt RD , Zibbell JE , Yartel AK , Dinenno E . J Infect Dis 2013 208 (12) 1934-42 BACKGROUND: Persons who inject drugs (PWID) are at high risk for acquiring hepatitis C virus (HCV) infection. CDC estimates there are 17,000 new infections per year, mainly among PWID. This study examines injection equipment serosorting - considering HCV serostatus when deciding whether and with whom to share injection equipment.OBJECTIVE: To examine whether injection equipment serosorting is occurring among PWID in selected cities. METHODS: Using data from the National HIV Behavioral Surveillance System-Injection Drug Users (NHBS-IDU2, 2009), we developed multivariate logistic regression models to examine the extent to which participants' self-reported HCV status is associated with their injection equipment serosorting behavior and knowledge of last injecting partner's HCV status.RESULTS:. Participants who knew their HCV status were more likely to know the HCV status of their last injecting partner, compared to those who did not know their status (HCV+: aOR 4.1, 95%CI 3.4-4.9; HCV-: aOR 2.5, 95%CI 2.0-3.0). Participants who reported being HCV+, relative to those of unknown HCV status, were five times more likely to share injection equipment with a partner of HCV-positive status (aOR 4.8, 95%CI 3.9-6.0). CONCLUSION: Our analysis suggests PWID are more likely to share injection equipment with persons of concordant HCV status. |
Centers for Disease Control and Prevention initiatives to prevent hepatitis C virus infection: a selective update
Smith BD , Jorgensen C , Zibbell JE , Beckett GA . Clin Infect Dis 2012 55 Suppl 1 S49-53 Hepatitis C virus (HCV) infection is a complex public health problem, characterized by a high prevalence of chronic infection, an increasing burden of HCV-associated disease, low rates of testing and treatment, and the prospect of increasing incidence associated with the epidemic of injection drug use. Three-quarters of chronic HCV infections occur among persons born from 1945 through 1965. Prevention efforts are complicated by limited knowledge among health care professionals, persons at risk and in the public at large. At the Centers for Disease Control and Prevention, efforts to improve primary and secondary prevention effectiveness center on policy development, education and training initiatives, and applied research. This report provides a brief overview of some of these efforts, including the development of testing recommendations for the 1945-1965 birth cohort, research and evaluation studies in settings where persons who inject drugs receive services, and a national viral hepatitis education campaign that targets health care professionals, the public, and persons at risk. |
Caught between the "soft" and "hard" arms of the state: a conceptual apparatus for situating the formative role of drug user organizations in national policy-making and local service delivery--a commentary
Zibbell JE . Subst Use Misuse 2012 47 (5) 558-65 The purpose of this commentary is to develop a conceptual apparatus for understanding the role of drug user organizations in the development and implementation of national harm reduction initiatives by extrapolating some general trends and important lessons derived from the collection of essays found in this special issue. The development of such a framework will include the findings of this research, while also suggesting systemic trends within which the role of drug users as “change agents” can be more generally examined. | As these essays demonstrate, the formative role of drug user organizations in public policy can be evaluated from a number of perspectives. But rather than present a causal reason for why drug users become involved in policy-making and service delivery, I propose a structural framework that links the theme of drug users as “change agents” to the antagonism that exists between the state institutions of public health (PH) and law enforcement (LE) over the most efficient means to reduce injection-related harm. This approach, which is developed to a certain extent by the essays in this volume, will enable us to assess the strategies that characterize “drug user activism” as well as allowing us to examine the sources of power that become available to drug users when they organize their efforts collectively as civil organizations. |
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