Background: Analyses of the individual-, social- and structural-level factors promoting the transmission of HIV and other blood-borne pathogens have consistently identified exposure to correctional environments, especially for individuals who use injection drugs (IDU), as a risk factor for infection. The objectives of this project were: to review the epidemiologic literature on incarceration and HIV infection among IDU, critically examining evidence presented supporting a causal linkage between imprisonment and infection; to investigate incarceration experiences in a cohort of active IDU; and to assess the possible effects of incarceration on the post-release risk environment of active IDU. Methods: Longitudinal datasets for quantitative analyses were derived from the Vancouver Injection Drug User Study (VIDUS) and the Scientific Evaluation of Supervised Injection (SEOSI), both prospective cohorts of IDU in Vancouver’s Downtown Eastside neighbourhood. In the first analysis, the prevalence and correlates of reporting incarceration in the the previous six months were identified in SEOSI using generalized estimating equations (GEE). In the second analysis, the possible effect of imprisonment on the prevalence of risk factors for HIV infection was estimated in VIDUS using linear growth curve analysis. Results: In the first analysis, 902 individuals interviewed at least once between 1 July 2004 and 30 June 2006 were included. Overall, 423 (46.9%) reported an incarceration event at some point during the study period. In a multivariate GEE model, recent incarceration was independently associated with a number of high-risk factors, including syringe sharing. In the second analysis, 1603 individuals were interviewed at least once between 1 May 1996 and 31 December 2005 and in cluded. Of these, 147 (9.2%) matched the study criteria and were included as cases; 742 (46.3%) were included as matched controls. In linear growth curve analyses adjusted for age, gender and ethnicity, syringe sharing was significantly more common in the incarcerated group (p = 0.03) after incarceration than in the control group. Conclusions: Our findings support the existence of a role for incarceration in continued viral transmission. In response, appropriate harm reduction measures should be expanded within correctional environments and social, political and legal reforms enacted to reduce the incidence of imprisonment for individuals who use illicit drugs.

Background: Analyses of the individual-, social- and structural-level factors promoting the transmission of HIV and other blood-borne pathogens have consistently identified exposure to correctional environments, especially for individuals who use injection drugs (IDU), as a risk factor for infection. The objectives of this project were: to review the epidemiologic literature on incarceration and HIV infection among IDU, critically examining evidence presented supporting a causal linkage between imprisonment and infection; to investigate incarceration experiences in a cohort of active IDU; and to assess the possible effects of incarceration on the post-release risk environment of active IDU. Methods: Longitudinal datasets for quantitative analyses were derived from the Vancouver Injection Drug User Study (VIDUS) and the Scientific Evaluation of Supervised Injection (SEOSI), both prospective cohorts of IDU in Vancouver’s Downtown Eastside neighbourhood. In the first analysis, the prevalence and correlates of reporting incarceration in the the previous six months were identified in SEOSI using generalized estimating equations (GEE). In the second analysis, the possible effect of imprisonment on the prevalence of risk factors for HIV infection was estimated in VIDUS using linear growth curve analysis. Results: In the first analysis, 902 individuals interviewed at least once between 1 July 2004 and 30 June 2006 were included. Overall, 423 (46.9%) reported an incarceration event at some point during the study period. In a multivariate GEE model, recent incarceration was independently associated with a number of high-risk factors, including syringe sharing. In the second analysis, 1603 individuals were interviewed at least once between 1 May 1996 and 31 December 2005 and in cluded. Of these, 147 (9.2%) matched the study criteria and were included as cases; 742 (46.3%) were included as matched controls. In linear growth curve analyses adjusted for age, gender and ethnicity, syringe sharing was significantly more common in the incarcerated group (p = 0.03) after incarceration than in the control group. Conclusions: Our findings support the existence of a role for incarceration in continued viral transmission. In response, appropriate harm reduction measures should be expanded within correctional environments and social, political and legal reforms enacted to reduce the incidence of imprisonment for individuals who use illicit drugs.

Background: Analyses of the individual-, social- and structural-level factors promoting the transmission of HIV and other blood-borne pathogens have consistently identified exposure to correctional environments, especially for individuals who use injection drugs (IDU), as a risk factor for infection. The objectives of this project were: to review the epidemiologic literature on incarceration and HIV infection among IDU, critically examining evidence presented supporting a causal linkage between imprisonment and infection; to investigate incarceration experiences in a cohort of active IDU; and to assess the possible effects of incarceration on the post-release risk environment of active IDU. Methods: Longitudinal datasets for quantitative analyses were derived from the Vancouver Injection Drug User Study (VIDUS) and the Scientific Evaluation of Supervised Injection (SEOSI), both prospective cohorts of IDU in Vancouver’s Downtown Eastside neighbourhood. In the first analysis, the prevalence and correlates of reporting incarceration in the the previous six months were identified in SEOSI using generalized estimating equations (GEE). In the second analysis, the possible effect of imprisonment on the prevalence of risk factors for HIV infection was estimated in VIDUS using linear growth curve analysis. Results: In the first analysis, 902 individuals interviewed at least once between 1 July 2004 and 30 June 2006 were included. Overall, 423 (46.9%) reported an incarceration event at some point during the study period. In a multivariate GEE model, recent incarceration was independently associated with a number of high-risk factors, including syringe sharing. In the second analysis, 1603 individuals were interviewed at least once between 1 May 1996 and 31 December 2005 and in cluded. Of these, 147 (9.2%) matched the study criteria and were included as cases; 742 (46.3%) were included as matched controls. In linear growth curve analyses adjusted for age, gender and ethnicity, syringe sharing was significantly more common in the incarcerated group (p = 0.03) after incarceration than in the control group. Conclusions: Our findings support the existence of a role for incarceration in continued viral transmission. In response, appropriate harm reduction measures should be expanded within correctional environments and social, political and legal reforms enacted to reduce the incidence of imprisonment for individuals who use illicit drugs. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Background: Aboriginals are overrepresented in Canada’s HIV epidemic and are more likely to be infected with HIV through injection drug use (IDU) than non-Aboriginals. However, little research has investigated the outcomes of combination antiretroviral therapy (cART) among Aboriginal HIV-patients or compared outcomes between Aboriginal and non-Aboriginal HIV-patients. Objectives: The primary objectives of this research were to 1) compare all-cause and HIV-related mortality rates between Aboriginal and non-Aboriginal HIV-patients after they start cART, 2) determine if Aboriginal patients were less likely to achieve virological suppression and more likely to experience subsequent treatment failure after starting cART; 3) describe and compare the health-related quality of life (HRQL) of Aboriginal and non-Aboriginal HIV-patients; and 4) describe the life stability of Aboriginal and IDU HIV-patients treated with cART and explore associations between life stability, clinical status, and HRQL. Methods: This research was conducted in northern Alberta, Canada using a clinical database, vital statistics data, and data collected through interview and a self-administered HRQL questionnaire. Data analyses included multivariable Cox proportional hazards models and multiple linear and logistic regression models. Results: After starting cART, Aboriginals suffer higher rates of all-cause and HIV-related mortality than non-Aboriginals. Furthermore, Aboriginals are less likely to achieve virological suppression after starting cART and, among those who achieve suppression, Aboriginals experience higher rates of virological failure ≥1 year after suppression. Aboriginal IDUs, Aboriginal non-IDUs, and non-Aboriginal IDUs reported similarly worse physical HRQL compared to non-Aboriginals non-IDUs. Among Aboriginals and IDUs, factors significantly associated with poor clinical status were unemployment, lower income, not completing high school, homelessness, and perceiving that one’s current life was not much better compared to before starting cART. Similarly, factors significantly associated with lower HRQL in this group were unemployment, perceiving that one’s current health or one’s current life was not much better compared to before starting cART, and having a current CD4 cell count ≤350 cells/μL. Conclusions: Overall, after starting cART, Aboriginal HIV-patients suffer worse outcomes than non-Aboriginal HIV-patients. Future research should investigate adherence among Aboriginals and IDUs treated with cART and explore their treatment experiences to develop interventions to improve the prognosis of these vulnerable populations.

Context & Rationale: Individuals with similar CD4 cell counts and RNA levels can vary considerably with regards to clinical progression. This variation is likely the result of a complex interplay between viral, host and environmental factors. This study aimed to characterize and identify predictors associated with disease progression to AIDS or death in Saskatoon, Saskatchewan. Methods: This is a retrospective cohort study of 343 seroprevalent HIV positive patients diagnosed from Jan 2005 to Dec 2010. Of these, 73 had an estimated seroconversion date. Data was extracted from medical charts at two clinics specialized in HIV/AIDS care. Disease progression was measured as time from HIV diagnosis (or seroconversion) to immunological AIDS and death. The Cox hazard model was used. Results: The 3-year and 5-year immunological AIDS free probability was 53% and 33%, respectively. The 3-year and 5-year survival probability was 89% and 77%, respectively. Among the seroconversion cohort, the 3-year immunological AIDS free probability was 76%. Due to multicollinearity, separate models were built for IDU, hepatitis C and ethnicity. A history of IDU (HR, 3.0; 95%CI, 1.2-7.1), hepatitis C coinfection (HR, 2.9; 95%CI, 1.2-6.9), baseline CD4 counts (HR, 0.95; 95%CI, 0.92-0.98, per ever 10 unit increase), ever on ART, and year of diagnosis were significant predictors of progression to immunological AIDS among the seroprevalent cohort. Age at diagnosis, sex and ethnicity were not. For survival, only treatment use was a significant predictor (HR, 0.34; 95%CI, 0.1-0.8). Hepatitis C coinfection was marginally significant (p=0.067), while a history of IDU, ethnicity, gender, age at diagnosis, and year of diagnosis were not. Among the seroconversion cohort, no predictors of progression to immunological AIDS were identified. Ethnicity, hepatitis C coinfection and history of IDU could not be assessed. Conclusion: Our study found that IDU, HCV coinfections, baseline CD4 counts, and ART use were significant predictors of disease progression. This highlights the need for increased testing and early detection and for targeted interventions for these particularly vulnerable populations to slow disease progression.

Context & Rationale: Individuals with similar CD4 cell counts and RNA levels can vary considerably with regards to clinical progression. This variation is likely the result of a complex interplay between viral, host and environmental factors. This study aimed to characterize and identify predictors associated with disease progression to AIDS or death in Saskatoon, Saskatchewan. Methods: This is a retrospective cohort study of 343 seroprevalent HIV positive patients diagnosed from Jan 2005 to Dec 2010. Of these, 73 had an estimated seroconversion date. Data was extracted from medical charts at two clinics specialized in HIV/AIDS care. Disease progression was measured as time from HIV diagnosis (or seroconversion) to immunological AIDS and death. The Cox hazard model was used. Results: The 3-year and 5-year immunological AIDS free probability was 53% and 33%, respectively. The 3-year and 5-year survival probability was 89% and 77%, respectively. Among the seroconversion cohort, the 3-year immunological AIDS free probability was 76%. Due to multicollinearity, separate models were built for IDU, hepatitis C and ethnicity. A history of IDU (HR, 3.0; 95%CI, 1.2-7.1), hepatitis C coinfection (HR, 2.9; 95%CI, 1.2-6.9), baseline CD4 counts (HR, 0.95; 95%CI, 0.92-0.98, per ever 10 unit increase), ever on ART, and year of diagnosis were significant predictors of progression to immunological AIDS among the seroprevalent cohort. Age at diagnosis, sex and ethnicity were not. For survival, only treatment use was a significant predictor (HR, 0.34; 95%CI, 0.1-0.8). Hepatitis C coinfection was marginally significant (p=0.067), while a history of IDU, ethnicity, gender, age at diagnosis, and year of diagnosis were not. Among the seroconversion cohort, no predictors of progression to immunological AIDS were identified. Ethnicity, hepatitis C coinfection and history of IDU could not be assessed. Conclusion: Our study found that IDU, HCV coinfections, baseline CD4 counts, and ART use were significant predictors of disease progression. This highlights the need for increased testing and early detection and for targeted interventions for these particularly vulnerable populations to slow disease progression.

Hepatitis C (HCV) is an infectious disease of the liver which affects more than 250,000 Canadians; the majority of those living with the disease have experience with injection drug use. Treatment for HCV involves a strict protocol, has only a 50% success rate and has harsh side effects. Interest in HCV treatment among people who use drugs is high, but actual uptake of treatment remains low. The objective of this research was to explore the barriers to accessing HCV treatment for individuals who were accessing methadone. A mixed methods approach was used; a cross sectional survey and an in-depth interview were administered to clients of a methadone maintenance program. The two sets of data identified three main barriers to HCV treatment; stigma, the toxicity of treatment, and day-to-day struggles. Future research should be conducted to further explore how stigma guides decisions around HCV treatment, particularly in a methadone treatment setting.

No description available.

Indiana University-Purdue University Indianapolis (IUPUI)

Hepatitis C virus (HCV) is a major public health concern with significant morbidity and mortality. New HCV infection is primarily associated with intravenous drug use. With the ongoing opioid crisis, the incidence of injection drug use and new HCV infection has risen. From 2010 to 2019, the number of estimated infections increased by 387% which is largely attributed to the opioid epidemic and injection drug use (CDC Viral Hepatitis 2019). In 2011 the treatment of HCV was revolutionized with the introduction of direct acting agents which revolutionized the treatment of HCV. Despite guidelines recommending treatment for PWID infected with chronic HCV there are a number of reasons this population is not commonly offered treatment. A growing body of literature has shown that PWID can be successfully treated and attain SVR even in the presence of ongoing drug use. This thesis was prepared by search of pertinent literature to analysis and arguments and evidence for and against the treatment of HCV in those with active injection drug use. / Urban Bioethics