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Fulltext Material security and adherence to antiretroviral therapy among HIV-positive people who use illicit drugs

Mohd Salleh NA, Van Draanen J, Nosova E, Barrios R, Milloy MJ, Richardson L

AIDS, 2020 06 01;34(7):1037-1045.
PMID: 32073444 DOI: 10.1097/QAD.0000000000002501

OBJECTIVE: To examine the relationship between poverty, operationalized using a novel material security measure, and adherence to antiretroviral therapy (ART) among people who use illicit drugs (PWUD) in a context of universal access to HIV care.
DESIGN: We analyzed data from a community-recruited prospective cohort in Vancouver, Canada (n = 623), from 2014 to 2017.
METHODS: We used multivariable generalized mixed-effects analyses to estimate longitudinal factors associated with mean material security score. We then estimated the association between achieving at least 95% adherence to ART and overall mean material score, as well as mean score for three factors derived from a factor analysis. The three-factor structure, employed in the current analyses, were factor 1 (basic needs); factor 2 (housing-related variables) and factor 3 (economic resources).
RESULTS: Recent incarceration [β-coefficient (β) = -0.176, 95% confidence interval (95% CI): -0.288 to -0.063], unmet health needs [β = -0.110, 95% CI: -0.178 to -0.042), unmet social service needs (β = -0.264, 95% CI: -0.336 to -0.193) and having access to social services (β= -0.102, 95% CI: -0.1586 to -0.0465) were among the factors associated with lower material security scores. Contrary to expectations that low levels of material security in this population would lead to poor ART adherence, we did not observe a significant relationship between adherence and overall material security score, or for each factor individually.
CONCLUSION: Our findings highlight the potentially important role of no-cost, universal access to HIV prevention and treatment, in mitigating the impact of socioeconomic disadvantage on ART adherence.

Matched MeSH terms: Drug Users/psychology*
Fulltext Social Network Strategies to Address HIV Prevention and Treatment Continuum of Care Among At-risk and HIV-infected Substance Users: A Systematic Scoping Review

Ghosh D, Krishnan A, Gibson B, Brown SE, Latkin CA, Altice FL

AIDS Behav, 2017 Apr;21(4):1183-1207.
PMID: 27125244 DOI: 10.1007/s10461-016-1413-y

Social network analysis (SNA) and social network-based interventions (SNI) are important analytical tools harnessing peer and family influences critical for HIV prevention and treatment among substance users. While SNA is an effective way to measure social network influences, SNI directly or indirectly involves network members in interventions. Even though these methods have been applied in heterogeneous ways, leading to extensive evidence-based practices, systematic reviews are however, lacking. We searched five bibliographic databases and identified 58 studies involving HIV in substance users that had utilized SNA or SNI as part of their methodology. SNA was used to measure network variables as inputs in statistical/mathematical models in 64 % of studies and only 22 % of studies used SNI. Most studies focused on HIV prevention and few addressed diagnosis (k = 4), care linkage and retention (k = 5), ART adherence (k = 2), and viral suppression (k = 1). This systematic review highlights both the advantages and disadvantages of social network approaches for HIV prevention and treatment and gaps in its use for HIV care continuum.

Matched MeSH terms: Drug Users
Fulltext HIV Testing and awareness of HIV status among people who inject drugs in greater Kuala Lumpur, Malaysia

Bazazi AR, Vijay A, Crawford FW, Heimer R, Kamarulzaman A, Altice FL

AIDS Care, 2018 Jan;30(1):59-64.
PMID: 28803503 DOI: 10.1080/09540121.2017.1363852

HIV testing services are the gateway into HIV treatment and are critical for monitoring the epidemic. HIV testing is recommended at least annually in high-risk populations, including people who inject drugs (PWID). In Malaysia, the HIV epidemic is concentrated among PWID, but their adherence to testing recommendations and the proportion of HIV-positive PWID who are aware of their status remain unknown. We recruited 460 PWID in Greater Kuala Lumpur using respondent-driven sampling and conducted HIV testing. We examined past testing behaviors, estimating testing frequency, correlates of testing in the past 12 months, and the proportion of those living with HIV who were aware of their status. Results showed that most PWID living with HIV (90.4%, 95% CI: 83.6%-95.9%) were aware of their status. Among those never previously diagnosed with HIV, few had accessed HIV testing in the past 12 months (14.3%, 95% CI: 11.1%-18.0%). Prison (57.0%) and compulsory drug detention centers (36.1%) were the primary locations where PWID reported ever being HIV tested, and the main correlate of recent testing in regression was recent criminal justice involvement. Although awareness of HIV status may be high among PWID living with HIV in Kuala Lumpur, testing occurs primarily in prisons and compulsory drug detention centers, where it is involuntary and linkage to care is limited. A shift in HIV testing policy is needed to align health and human rights objectives, replacing mandatory testing with voluntary testing in settings where individuals can be rapidly linked to HIV care.

Matched MeSH terms: Drug Users/psychology*
Opening up the HIV epidemic: a review of HIV seropositive status disclosure among people who inject drugs

Nasarruddin AM, Saifi RA, Othman S, Kamarulzaman A

AIDS Care, 2017 May;29(5):533-540.
PMID: 27530678 DOI: 10.1080/09540121.2016.1220485

HIV status disclosure plays a crucial role in reducing risk behaviors of drug and sexual partners and thereby limiting HIV transmission. As people who inject drugs (PWID) bear a significant HIV burden and disclosure research among PWID is relatively few, we reviewed the literature to highlight what is known about disclosure among HIV-positive PWID. Searches of articles published from 2000 to 2015 yielded 17 studies addressing different aspects of disclosure, and results are presented by major themes. Our results suggest that despite the difficulties, most PWID (64-86%) disclose their HIV-positive status to trusted individuals (family members and intimate sexual partners) and to those who are known to be HIV-positive. Disclosure to non-intimate sexual partners and fellow drug users is relatively lower. Disclosure decision-making is primarily driven by the perceived positive and negative consequences of disclosure. Subsequent risk reduction practices following disclosure are influenced by the feeling of responsibility, as well as partners' willingness to accept risk. Cultural family values, ethnicity, and different localities were several contextual factors that affect patterns of disclosure and risk behaviors of PWID. Areas for future research are recommended.

Matched MeSH terms: Drug Users/psychology*
Fulltext The effectiveness of auricular acupuncture for drug addiction: a review of research evidence from clinical trials

Lua PL, Talib NS

ASEAN Journal of Psychiatry, 2012;13(1):55-68.
MyJurnal

Objectives: This review aims to compile and evaluate all available randomised controlled trials (RCTs) of auricular acupuncture (AA) treatment in drug addiction population with emphasis on the length of treatment course, needle-points, outcome measures, reported side-effects and overall outcomes.
Methods: Science Direct, Medline and EBSCOhost databases were searched. From the year 1990 until 2010, only full-length English articles incorporating RCTs related to AA studies (needle-based only) in drug addiction such as heroin, morphine, methamphetamine and cocaine were included. Studies involving the usage of various methods of electroacupuncture and investigations relating to cigarette-smoking or alcohol addiction were excluded.
Results: Eight RCTs met all inclusion criteria comprising of 1,594 respondents (age = 19 - 46 years; male = 57% - 76%). Most were involved in cocaine addiction. Overall, trials were designed with brief periods of treatment course and utilised three to five standard National Acupuncture Detoxification Association (NADA) points (Sympathetic, Lung, Liver, Kidney and Shen men), but inconsistent sham points. All trials included urine toxicology test as the main outcome measure while data on side-effects incidence was insufficient. Conclusions: Overall, four of the RCTs reported positive outcomes although at this point, AA’s effectiveness and safety could not be substantially confirmed. For the future, high-quality RCTs of AA are urgently required to provide a clearer understanding on the usefulness of this complementary therapy in drug addiction treatment.

Matched MeSH terms: Drug Users
Fulltext Quality of life assessment of opioid substance abusers on methadone maintenance therapy (MMT) in University Malaya Medical Centre

Lim DS, Sambamoorthy VR, Ling DSY, Syed Aznal SS

ASEAN Journal of Psychiatry, 2009;10(1):8-18.
MyJurnal

Objective: In Malaysia, opioid abuse is an acknowledged problem with severe health and economic repercussions. Until recently, drug addicts were mainly criminalised and forcefully rehabilitated in correctional facilities. However, the high relapse rates of this approach, coupled with the high rates of blood borne infections among drug users, led to increasing acceptance of a healthcare-based approach in the rehabilitation of drug addicts. Methadone was among the medications introduced as substitution maintenance therapy in 2005 and Universiti Malaya Medical Centre (UMMC) is a centre for MMT. This study aimed to determine the effects of MMT on quality of life in patients here. Methods: The sample was 46 patients who attended the Psychiatric outpatient clinic in fill in UMMC. The instrument used to assess quality of life was the WHOQOL-BREF. Results: The study design was cross-sectional with retrospective elements. Baseline QOL scores were obtained from case records and follow-up scores from the month of September 2007. Statistically significant improvements in all four domains of WHOQOL-BREF were found. Physical: p

Study site: Psychiatric outpatient clinic, Universiti Malaya Medical Centre (UMMC

Matched MeSH terms: Drug Users
Fulltext Oral Health Profile Of A Group Of Malayasian Drug Addicts

Sujak, S.L., Abdul Kadir, R.

Ann Dent, 1999;6(1):-.
MyJurnal

A study was undertaken to identify the oral health status and treatment needs of 403 drug abusers enrolled in a drug rehabilitation center in Perak, Malaysia. The prevalence of dental caries was 97.0%. Calculus was present in 82.1% of the dentate individuals, but only 14.6% had pockets greater than 3mm. The mean DMFT observed was 11.7, with missing teeth (MT=9.6) constituting the major component. Denture needs were high (67.2%), but only 11.4% of individuals had prostheses.

Matched MeSH terms: Drug Users
Fulltext Consistent condom use and its predictors among female sexual Partners of People who Inject Drugs in Klang Valley, Malaysia

Abdul Manaf R, Dickson N, Lovell S, Ibrahim F

BMC Public Health, 2019 Nov 07;19(1):1473.
PMID: 31699061 DOI: 10.1186/s12889-019-7855-1

BACKGROUND: Men who inject drugs (MWIDs) comprise the highest percentage of diagnosed HIV cases in Malaysia. Their female partners risk being infected through unprotected sexual contact. This paper reports the prevalence of consistent condom use and its predictors among the wives and regular sexual partners of MWIDs in Klang Valley, Malaysia.
METHODS: A cross-sectional study using a self-administered questionnaire was conducted among the wives and regular sexual partners of MWIDs in the study location; 221 women were recruited through respondent-driven sampling. Data were analysed descriptively for the prevalence of consistent condom use, HIV status and HIV risk-related behaviour. Subsequently, simple and multiple logistic regressions were undertaken to identify the predictors of consistent condom use.
RESULTS: The prevalence of consistent condom use among respondents was 19.5%. Slightly more than half (52.5%) of respondents had never used condoms with their partner. Fourteen women (6.3%) reported being HIV positive. While 7.7% had HIV-positive partners, 45.7% were unaware of their partner's HIV status. Consistent condom use was significantly higher among single women (AOR = 4.95; 95% CI: 2.45, 9.99), women who lived in urban areas (AOR = 2.97; 95% CI: 1.30, 6.78), HIV-positive women (AOR = 3.45; 95% CI: 1.13, 10.5) and women involved in sex work (AOR = 3.55, 95% CI: 1.45, 8.67).
CONCLUSIONS: Inconsistent condom use among the majority of female sexual partners of MWIDs underscores the heightened risk faced by these women and calls for alternative prevention methods that women are able to control.

Matched MeSH terms: Drug Users/statistics & numerical data*
Fulltext Following "the Roots" of Kratom (Mitragyna speciosa): The Evolution of an Enhancer from a Traditional Use to Increase Work and Productivity in Southeast Asia to a Recreational Psychoactive Drug in Western Countries

Cinosi E, Martinotti G, Simonato P, Singh D, Demetrovics Z, Roman-Urrestarazu A, et al.

Biomed Res Int, 2015;2015:968786.
PMID: 26640804 DOI: 10.1155/2015/968786

The use of substances to enhance human abilities is a constant and cross-cultural feature in the evolution of humanity. Although much has changed over time, the availability on the Internet, often supported by misleading marketing strategies, has made their use even more likely and risky. This paper will explore the case of Mitragyna speciosa Korth. (kratom), a tropical tree used traditionally to combat fatigue and improve work productivity among farm populations in Southeast Asia, which has recently become popular as novel psychoactive substance in Western countries. Specifically, it (i) reviews the state of the art on kratom pharmacology and identification; (ii) provides a comprehensive overview of kratom use cross-culturally; (iii) explores the subjective experiences of users; (iv) identifies potential risks and side-effects related to its consumption. Finally, it concludes that the use of kratom is not negligible, especially for self-medication, and more clinical, pharmacological, and socioanthropological studies as well as a better international collaboration are needed to tackle this marginally explored phenomenon.

Matched MeSH terms: Drug Users
Fulltext Survey dataset on the prevalence of childhood maltreatment history among drug addicts in Malaysia

Mey LS, Khairudin R, Muda TEAT, Mokhtar DM, Kamaluddin MR

Data Brief, 2020 Aug;31:105864.
PMID: 32613044 DOI: 10.1016/j.dib.2020.105864

Studies have consistently shown that childhood maltreatment is a significant risk factor for the development of drug addiction across human lifespan. Yet, little is known about the prevalence of childhood maltreatment history among drug addicts in Malaysia. The dataset presented in this article provides demographic information on 200 drug addicts recruited from two rehabilitation centres in Malaysia, the prevalence of different types of childhood maltreatment history and the correlation between all types of maltreatments. Analyses of the data can provide insights into the prevalence of maltreatment history and development of drug addiction, therefore indispensable for mental health professionals designing appropriate interventions for the drug addicts. The data can also provide baseline data for comparative studies in terms of childhood maltreatment history and drug addiction across different countries.

Matched MeSH terms: Drug Users
Fulltext Data on self-awareness, self-determination, and self-efficacy of opioid-dependent patients receiving methadone treatment before and after getting individual psycho-educational (i-SEAZ) intervention

Engku Kamarudin EM, Wan Sulaiman WS, Sarnon NH, Amin AS

Data Brief, 2020 Jun;30:105586.
PMID: 32346583 DOI: 10.1016/j.dib.2020.105586

The readiness to change among drug addicts is a key strength for successful treatment. Self-awareness, self-determination, and self-efficacy have been identified as the fundamentals of readiness that should be embraced by drug addicts while in treatment. In this article, the shared data were applied to assess the effect of individual psycho-educational intervention based on integrated self-awareness and self-determination theories (i-SEAZ) on self-efficacy amongst opioid-dependent patients undergoing methadone treatment (MT). The effectiveness of the i-SEAZ module was evaluated in a total of 75 opioid-dependent MT participants from five Methadone Clinics under the Ministry of Health, Malaysia located across Klang Valley. The experimental group consisted of 38 participants who received 10 sessions of individual i-SEAZ alongside MT, whereas 37 participants of the control group only received MT. The shared data were collected through three questionnaires, namely Scale for Self-Consciousness Assessment (SSCA), Treatment Motivation Questionnaire (TMQ), and General Self Efficacy (GSE). Data collection was performed twice; the first instance was two weeks prior to initiation of i-SEAZ (pretest), and the second was two weeks post completion of i-SEAZ (posttest). The extracted data were precisely represented in terms of means and standard deviations (SDs).

Matched MeSH terms: Drug Users
Fulltext Univariable associations between a history of incarceration and HIV and HCV prevalence among people who inject drugs across 17 countries in Europe 2006 to 2020 - is the precautionary principle applicable?

Wiessing L, Kalamara E, Stone J, Altan P, Van Baelen L, Fotiou A, et al.

Euro Surveill, 2021 12;26(49).
PMID: 34886941 DOI: 10.2807/1560-7917.ES.2021.26.49.2002093

BackgroundPeople who inject drugs (PWID) are frequently incarcerated, which is associated with multiple negative health outcomes.AimWe aimed to estimate the associations between a history of incarceration and prevalence of HIV and HCV infection among PWID in Europe.MethodsAggregate data from PWID recruited in drug services (excluding prison services) or elsewhere in the community were reported by 17 of 30 countries (16 per virus) collaborating in a European drug monitoring system (2006-2020; n = 52,368 HIV+/-; n = 47,268 HCV+/-). Country-specific odds ratios (OR) and prevalence ratios (PR) were calculated from country totals of HIV and HCV antibody status and self-reported life-time incarceration history, and pooled using meta-analyses. Country-specific and overall population attributable risk (PAR) were estimated using pooled PR.ResultsUnivariable HIV OR ranged between 0.73 and 6.37 (median: 2.1; pooled OR: 1.92; 95% CI: 1.52-2.42). Pooled PR was 1.66 (95% CI 1.38-1.98), giving a PAR of 25.8% (95% CI 16.7-34.0). Univariable anti-HCV OR ranged between 1.06 and 5.04 (median: 2.70; pooled OR: 2.51; 95% CI: 2.17-2.91). Pooled PR was 1.42 (95% CI: 1.28-1.58) and PAR 16.7% (95% CI: 11.8-21.7). Subgroup analyses showed differences in the OR for HCV by geographical region, with lower estimates in southern Europe.ConclusionIn univariable analysis, a history of incarceration was associated with positive HIV and HCV serostatus among PWID in Europe. Applying the precautionary principle would suggest finding alternatives to incarceration of PWID and strengthening health and social services in prison and after release ('throughcare').

Matched MeSH terms: Drug Users*
Toxoplasma encephalitis in acquired immunodeficiency syndrome: a case report

Yoong KY, Cheong I, Choy KC

Family Physician, 1995;7:24-27.

A 32 year old HIV positive intravenous drug user (IVDU) with a promiscuous lifestyle in the past presented with altered behaviour and was diagnosed to have pulmonary tuberculosis, tuberculous meningitis and tuberculous osteomyelitis. After initial response to anti-tuberculous therapy, his symptoms recurred with the appearance of cerebral mass lesions. A presumptive diagnosis of toxoplasma encephalitis was made based on clinical, serological and radiological evidence. He showed clinical improGement with anti-toxoplasmic therapy.

Matched MeSH terms: Drug Users
Fulltext Genome Sequence of a Complex HIV-1 Unique Recombinant Form Involving CRF01_AE, Subtype B, and Subtype B' Identified in Malaysia

Chow WZ, Nizam S, Ong LY, Ng KT, Chan KG, Takebe Y, et al.

Genome Announc, 2014;2(2).
PMID: 24675847 DOI: 10.1128/genomeA.00139-14

A complex HIV-1 unique recombinant form involving subtypes CRF01_AE, B, and B' was recently identified from an injecting drug user in Malaysia. A total of 13 recombination breakpoints were mapped across the near-full-length genome of isolate 10MYPR226, indicating the increasingly diverse molecular epidemiology and frequent linkage among various high-risk groups.

Matched MeSH terms: Drug Users
Fulltext Dispensation of antiretroviral therapy and methadone maintenance therapy at the same facility in a low-barrier setting linked to optimal adherence to HIV treatment

Mohd Salleh NA, Fairbairn N, Nolan S, Barrios R, Shoveller J, Richardson L, et al.

HIV Med, 2019 10;20(9):606-614.
PMID: 31359615 DOI: 10.1111/hiv.12777

OBJECTIVES: We sought to examine the association between dispensation of methadone maintenance therapy (MMT) and antiretroviral therapy (ART) at the same facility, across multiple low-barrier dispensing outlets, and achieving optimal adherence to ART among people who use illicit drugs (PWUD).
METHODS: We used data from the AIDS Care Cohort to Evaluate Exposure to Survival Services (ACCESS) study, a long-running study of a community-recruited cohort of HIV-positive PWUD, linked to comprehensive HIV clinical records in Vancouver, Canada, a setting of no-cost, universal access to HIV care. The longitudinal relationship between MMT-ART dispensation at the same facility and the odds of ≥ 95% ART adherence was analysed using multivariable generalized linear mixed-effects modelling. We conducted a further analysis using a marginal structural mode with inverse probability of treatment weights as a sensitivity analysis.
RESULTS: This study included data on 1690 interviews of 345 ART- and MMT-exposed participants carried out between June 2012 and December 2017. In the final multivariable model, MMT-ART dispensation, compared with nondispensation at the same facility, was associated with greater odds of achieving ≥ 95% adherence [adjusted odds ratio (AOR) 1.56; 95% confidence interval (CI) 1.26-1.96]. A marginal structural model estimated a 1.48 (95% CI 1.15-1.80) greater odds of ≥ 95% adherence among participants who reported MMT-ART dispensation at the same facility compared with those who did not.
CONCLUSIONS: The odds of achieving optimal adherence to ART were 56% higher during periods in which MMT and ART medications were dispensed at the same facility, in a low-barrier setting. Our findings highlight the need to consider a simpler integrated approach with medication dispensation at the same facility in low-threshold settings.

Matched MeSH terms: Drug Users
Fulltext Better retention of Malaysian opiate dependents treated with high dose methadone in methadone maintenance therapy

Mohamad N, Bakar NH, Musa N, Talib N, Ismail R

Harm Reduct J, 2010;7:30.
PMID: 21167035 DOI: 10.1186/1477-7517-7-30

BACKGROUND: Methadone is a synthetic opiate mu receptor agonist that is widely used to substitute for illicit opiates in the management of opiate dependence. It helps prevent opiate users from injecting and sharing needles which are vehicles for the spread of HIV and other blood borne viruses. This study has the objective of determining the utility of daily methadone dose to predict retention rates and re-injecting behaviour among opiate dependents.
METHODS: Subjects comprised opiate dependent individuals who met study criteria. They took methadone based on the Malaysian guidelines and were monitored according to the study protocols. At six months, data was collected for analyses. The sensitivity and specificity daily methadone doses to predict retention rates and re-injecting behaviour were evaluated.
RESULTS: Sixty-four patients volunteered to participate but only 35 (54.69%) remained active and 29 (45.31%) were inactive at 6 months of treatment. Higher doses were significantly correlated with retention rate (p < 0.0001) and re-injecting behaviour (p < 0.001). Of those retained, 80.0% were on 80 mg or more methadone per day doses with 20.0% on receiving 40 mg -79 mg.
CONCLUSIONS: We concluded that a daily dose of at least 40 mg was required to retain patients in treatment and to prevent re-injecting behaviour. A dose of at least 80 mg per day was associated with best results.

Matched MeSH terms: Drug Users
Fulltext Facilitating a transition from compulsory detention of people who use drugs towards voluntary community-based drug dependence treatment and support services in Asia

Tanguay P, Kamarulzaman A, Aramrattana A, Wodak A, Thomson N, Ali R, et al.

Harm Reduct J, 2015 Oct 16;12:31.
PMID: 26470779 DOI: 10.1186/s12954-015-0071-0

Evidence indicates that detention of people who use drugs in compulsory centers in the name of treatment is common in Cambodia, China, Indonesia, Lao PDR, Malaysia, Myanmar, Philippines, Thailand, and Vietnam. The expansion of such practices has been costly, has not generated positive health outcomes, and has not reduced supply or demand for illicit drugs. United Nations agencies have convened several consultations with government and civil society stakeholders in order to facilitate a transition to voluntary evidence- and community-based drug dependence treatment and support services. In an effort to support such efforts, an informal group of experts proposes a three-step process to initiate and accelerate national-level transitions. Specifically, the working group recommends the establishment of a national multisectoral decision-making committee to oversee the development of national transition plans, drug policy reform to eliminate barriers to community-based drug dependence treatment and support services, and the integration of community-based drug dependence treatment in existing national health and social service systems.In parallel, the working group recommends that national-level transitions should be guided by overarching principles, including ethics, human rights, meaningful involvement of affected communities, and client safety, as well as good governance, transparency, and accountability. The transition also represents an opportunity to review the roles and responsibilities of various agencies across the public health and public security sectors in order to balance the workload and ensure positive results. The need to accelerate national-level transitions to voluntary community-based drug dependence treatment and support services is compelling--on economic, medical, sustainable community development, and ethical grounds--as extensively documented in the literature. In this context, the expert working group fully endorses initiation of a transition towards voluntary evidence- and community-based drug dependence treatment and support services across the region, as well as the steady scale-down of compulsory centers for drug users.Components of voluntary community-based drug dependence treatment and support services are being implemented in Cambodia, China, Indonesia, Malaysia, and Thailand. However, significant technical and financial support will be required to be allocated from national budgets and by international development agencies in order to complete the transition and reduce the reliance on detention of people who use drugs in Asia.

Matched MeSH terms: Drug Users/statistics & numerical data*
Fulltext Assessing feasibility of a modified same-day test-and-treat model for hepatitis C among rural people who inject drugs

Hassan MRA, Chan HK, Nordin M, Yahya R, Sulaiman WRW, Merican SAA, et al.

Harm Reduct J, 2023 Apr 12;20(1):48.
PMID: 37046294 DOI: 10.1186/s12954-023-00780-3

BACKGROUND: Despite advancements in hepatitis C virus (HCV) treatment, low uptake among hard-to-reach populations remains a global issue. The current study aimed to assess the feasibility of a modified same-day test-and-treat model in improving HCV care for people who inject drugs (PWID) living in resource-constrained rural areas.
METHODS: A pilot study was conducted in four primary healthcare (PHC) centers in Malaysia. The model's key features included on-site HCV ribonucleic acid (RNA) testing using a shared GeneXpert® system; noninvasive biomarkers for cirrhosis diagnosis; and extended care to PWID referred from nearby PHC centers and outreach programs. The feasibility assessment focused on three aspects of the model: demand (i.e., uptake of HCV RNA testing and treatment), implementation (i.e., achievement of each step in the HCV care cascade), and practicality (i.e., ability to identify PWID with HCV and expedite treatment initiation despite resource constraints).
RESULTS: A total of 199 anti-HCV-positive PWID were recruited. They demonstrated high demand for HCV care, with a 100% uptake of HCV RNA testing and 97.4% uptake of direct-acting antiviral treatment. The rates of HCV RNA positivity (78.4%) and sustained virologic response (92.2%) were comparable to standard practice, indicating the successful implementation of the model. The model was also practical, as it covered non-opioid-substitution-therapy-receiving individuals and enabled same-day treatment in 71.1% of the participants.
CONCLUSIONS: The modified same-day test-and-treat model is feasible in improving HCV care for rural PWID. The study finding suggests its potential for wider adoption in HCV care for hard-to-reach populations.

Matched MeSH terms: Drug Users*
Fulltext Human herpes virus 8 antibodies in HIV-positive patients in Surabaya, Indonesia

Oktafiani D, Megasari NL, Fitriana E, Nasronudin, Lusida MI, Soetjipto

Infect Dis Rep, 2020 07 07;12(Suppl 1):8746.
PMID: 32874472 DOI: 10.4081/idr.2020.8746

Background: Human herpesvirus 8 (HHV-8) infection is etiologically related to Kaposi's sarcoma. Antibodies directed against HHV-8 can be detected in 80-95% of HIV-seropositive patients with KS. HHV-8 serological tests have been done in several countries in Southeast Asia such as Malaysia, and Thailand however no serological data is available in Indonesia. This study was to examine the presence of HHV- 8 antibodies in HIV-positive patients in Surabaya, Indonesia.
Material and methods: Ninety-one serum samples were collected from HIVpositive patients in Surabaya, Indonesia. Human immunodeficiency virus-positive serum samples were collected from 10 homosexual men, 25 intravenous drug users (IVDUs) and 56 heterosexuals. Serums were then tested for the presence of HHV-8 antibody by using sandwich ELISA (Abbexa Ltd, Cambridge, UK).
Results: The total of 91 HIV-infected were testing with antibodies to HHV-8 using enzyme-linked immunosorbent assay. Antibodies of HHV-8 were detected in 7/91 (7.7%) of the samples. According to a gender, six men (85.7%) and a women (14.3%) were positive of HHV-8 antibodies. No correlation regarding the gender and age from this study. The antibodies of HHV-8 was detected among intravenous drug users (IVDUs) men 5/7 (42.8%) and 2/7 (28.6%) from homosexual and heterosexual, respectively.
Conclusion: This study found the presence of HHV-8 antibodies in 7.7% of patients in Surabaya, Indonesia. This finding was higher more than Southeast Asian countries. The patients with a positive result could suggest measures to prevent HHV-8 infection.

Matched MeSH terms: Drug Users
Fulltext The Health Status of Muslim Women with HIV/AIDS in Arab Countries

Salih, F.A.M., Haque, Q.M.

International Medical Journal Malaysia, 2007;6(2):1-5.
MyJurnal

The number of people worldwide living with human immunodeficiency virus/ acquired immunodeficiency virus (HIV/AIDS) is more than 40 million, among them 17.7 millions are women (UNAIDS/WHO, 2006) The latest report from the Eastern Mediterranean Region shows that at least one million people are infected with HIV; among them 30% are women. The great majority of reported cases in the Region are men. However, the ratio of men to women cases varies in different countries. It ranges between “9:1 (as for example in Egypt), to 2:1” (as in Morocco and some parts of Yemen). Due to religious, social and cultural values regarding female purity, women and girls living with HIV and AIDS are subjected to greater discrimination than men. WHO reports show that a large percentage of the infected women in Arab countries have contacted the infection from their husbands especially migrants and drug abusers. In Arab countries, studies conducted show that 86% of women choose not to disclose their status of infection for the fear of abandonment, rejection, discrimination, violence, upsetting family members, and accusations of infidelity from their partners, families, and communities. As a result, many women only seek help at the last minute when they are already been terminally ill. Violence against women and girls in its different forms increases women's vulnerability to HIV infection and undermines AIDS control efforts. The fear of violence prevents many women from accessing HIV information, from getting testing and seeking treatment. Stigma and discrimination may also prevent them from carrying out their normal life activities. When women are blamed, this can lead to heightened levels of sexual and domestic violence, abandonment by families and communities, forced abortion or sterilization, dismissal from employment and loss of livelihood opportunities. A study of AIDS-related discrimination in Arab region found that over ten percent of women had lost financial support from family members since being diagnosed as HIV positive. There is a great deal of evidence to establish the significant link between gender-based violence and rising rates of HIV infection among women and girls throughout the world. HIV-positive women must be supported to make their own reproductive choices about whether and/or when to have children. Promote male involvement in sexual and reproductive health programmes. Finally the stigma, discrimination and violations must be stopped.

Matched MeSH terms: Drug Users

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