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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*
Fulltext Patterns of polysubstance use among adults in Malaysia-A latent class analysis

Rodzlan Hasani WS, Robert Lourdes TG, Ganapathy SS, Ab Majid NL, Abd Hamid HA, Mohd Yusoff MF

PLoS One, 2023;18(1):e0264593.
PMID: 36649298 DOI: 10.1371/journal.pone.0264593

INTRODUCTION: Polysubstance use is the use of more than one non-prescribed licit or illicit substance at one time. This is a common phenomenon, but little is known about the severity and the various substances used by adults in Malaysia.
OBJECTIVE: To determine the pattern of polysubstance use and its associated factors among general adults in Malaysia.
METHODOLOGY: This was a secondary data analysis from the National Health and Morbidity Survey (NHMS) 2019), a cross-sectional population survey with a two-stage stratified random sampling design. A total of 10,472 Malaysians aged 18 years and above participated in this survey. Polysubstance use was defined as concurrent use of more than one substance, either alcohol, tobacco, or drugs (opioids, marijuana, amphetamine/ methamphetamine or kratom). A latent class analysis (LCA) was used to identify the membership of polysubstance groups. The association of class membership with demographic profiles was examined using Multinomial Logistic Regression analysis.
RESULTS: Fit indices (AIC = 16458.9, BIC = 16443.6) from LCA supported 3 classes solution: Class 1; "moderate-drug" group primarily combination used of tobacco and alcohol (2.4%), Class 2; "high-drug" group using multiple substance including kratom (0.3%) and Class 3; "low-drug" group reporting minimal alcohol and tobacco use or non-user (97.3%). The multinomial model showed young adults (18-40 years) had a higher likelihood of being polysubstance users both for moderate-drug class (OR = 4.1) and high-drug class (OR = 3.9) compared to older age (≥60 years). Chinese (OR = 18.9), Indian (OR = 23.3), Indigenous Sabah & Sarawak (OR = 34.6) and others ethnicity (OR = 8.9) showed higher odds of being moderate-drug users than Malays. The greater odds of moderate-drug use for males (OR = 35.5), working groups (OR = 1.5) and low education level group (OR = 3.2).
CONCLUSION: Our study highlights patterns and demographics related to the use of polysubstances among adults in Malaysia. These results would help formulate specific prevention programmes for these high-risk groups.

Matched MeSH terms: Drug Users*
Social networks, secondary syringe exchange, and opioid agonist therapy retention among people who inject drugs in Hartford, CT

Zelenev A, Michael L, Li J, Altice FL

Int J Drug Policy, 2024 Jan;123:104250.
PMID: 38088004 DOI: 10.1016/j.drugpo.2023.104250

BACKGROUND: Opioid agonist therapies (OAT) and harm reduction such as syringe service programs (SSP) have been shown to be effective in preventing adverse outcomes such as overdose deaths, HIV and Hepatitis C infections among people who inject drugs (PWID). The importance of social network influence on disease transmission is well established, yet the interplay between harm reduction and network structures is, generally, not well understood. This study aims to analyze how social networks can mediate the harm reduction effects associated with secondary exchange through syringe service programs (SSP) and opioid agonist therapies (OAT) among injection network members.
METHODS: Sociometric data on networks on people who inject drugs from Hartford, CT, which were collected in 2012-2013, provided assessment of risk behaviors among 1574 injection network members, including participation in OAT and SSP. Subject's network characteristics were examined in relation to retention in OAT, as well as secondary syringe exchange using exponential random graph model (ERGM) and regression.
RESULTS: Based on the analysis, we found that probability of individuals being retained in OAT was positively associated with the OAT retention status of their peers within the network. Using simulations, we found that higher levels of positive correlation of OAT retention among network members can result in reduced risk of transmission of HIV to network partners on OAT. In addition, we found that secondary syringe exchange engagement was associated with higher probability of sharing of paraphernalia and unsterile needles at the network level.
CONCLUSIONS: Understanding how networks mediate risk behaviors is crucial for making progress toward ending the HIV epidemic.

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 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 External factor of relapse among male drug addicts in Cure and Care Service Centre, Kuala Pilah

Muhd Dhamir Audi Azizul, Azlina Mohd Khir, Wan Munira Wan Jaafar

Malaysian Journal of Social Sciences and Humanities, 2018;3(2):159-168.
MyJurnal

Relapse is a common phenomenon among former addicts who has undergone a preventive and rehabilitation treatment program. Relaps is a condition of using drugs more than one times after stopping them for a certain period of time depending on one's resistance to a drug withdrawal syndrome. There are various factors that affect the former drug addicts became relaps. Hence, the focus of this study is to explain the external factors of relaps among adult male drug addicts in Cure and Care Service Centre, Kuala Pilah, Negeri Sembilan. This study is a qualitative research that has been using a phenomenology approach using face-to-face interviews and further observation among eight drug addicts who are undergoing rehabilitation programs at CCSC Kuala Pilah. Sample selection was done through purposive sampling techniques and data were analyzed using thematic analysis through an inductive approach that focused on coding to obtain some key themes. The result of the study indicates the external factors such as family, peer and environmental factors play a great role in influencing of relapse. In conclusion, these identified factors illustrate the external influences that cause drug addicts to relapse. Therefore, the researcher proposes a post-rehabilitation module or program done by the responsible agencies after the addicts completed the rehabilitation program as guidance for them to the right direction for efficient recovery.

Matched MeSH terms: Drug Users
Fulltext Societal conflict among relapsing male drug addicts in Cure and Care Service Centre, Kuala Pilah, Negeri Sembilan

Muhammad Dhamir Audi Azizul, Wan Munira Wan Jaafar, Azlina Mohd Khir

Malaysian Journal of Social Sciences and Humanities, 2018;3(3):80-91.
MyJurnal

This social psychology study sought to understand how the inability of former drug addicts controlling
interpersonal conflict that occurs in the community resulted in relapse or back to their addiction. A
qualitative phenomenological approach was taken to conduct interviews with former drug addicts that
are participating in a rehab program in Cure and Care Service Centre, Kuala Pilah, Negeri Sembilan,
Malaysia. Eight informants were consented and interviewed. Purposive sampling was used and
responses were analyzed thematically. These themes included the issue of labeling drug addicts as
convicts, isolation from the community and restricted from participating in community-based
programs. Researcher suggests related agencies to work with rehabilitation officers in restructuring the
rehabilitation learning module and improve the interpersonal conflict management module. Therefore,
it is hoped that in the future, former drug addicts would be capable to manage interpersonal conflict
and simultaneously avoid from recidivism in addiction.

Matched MeSH terms: Drug Users
Fulltext Perceptions of Health-Related Community Reentry Challenges among Incarcerated Drug Users in Azerbaijan, Kyrgyzstan, and Ukraine

Rozanova J, Morozova O, Azbel L, Bachireddy C, Izenberg JM, Kiriazova T, et al.

J Urban Health, 2018 Aug;95(4):508-522.
PMID: 29728898 DOI: 10.1007/s11524-018-0256-4

Facing competing demands with limited resources following release from prison, people who inject drugs (PWID) may neglect health needs, with grave implications including relapse, overdose, and non-continuous care. We examined the relative importance of health-related tasks after release compared to tasks of everyday life among a total sample of 577 drug users incarcerated in Ukraine, Azerbaijan, and Kyrgyzstan. A proxy measure of whether participants identified a task as applicable (easy or hard) versus not applicable was used to determine the importance of each task. Correlates of the importance of health-related reentry tasks were analyzed using logistic regression, with a parsimonious model being derived using Bayesian lasso method. Despite all participants having substance use disorders and high prevalence of comorbidities, participants in all three countries prioritized finding a source of income, reconnecting with family, and staying out of prison over receiving treatment for substance use disorders, general health conditions, and initiating methadone treatment. Participants with poorer general health were more likely to prioritize treatment for substance use disorders. While prior drug injection and opioid agonist treatment (OAT) correlated with any interest in methadone in all countries, only in Ukraine did a small number of participants prioritize getting methadone as the most important post-release task. While community-based OAT is available in all three countries and prison-based OAT only in Kyrgyzstan, Kyrgyz prisoners were less likely to choose help staying off drugs and getting methadone. Overall, prisoners consider methadone treatment inapplicable to their pre-release planning. Future studies that involve patient decision-making and scale-up of OAT within prison settings are needed to better improve individual and public health.

Matched MeSH terms: Drug Users/psychology*; Drug Users/statistics & numerical data*
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 A case study of human immunodeficiency virus with positive seroconversion to negative

Paranthaman V, Yip HL, Ker HB

Malays Fam Physician, 2015;10(1):44-6.
PMID: 26425294 MyJurnal

This case study demonstrates a 36-year-old ex-intravenous drug user (IVDU) who had been initially tested positive for human immunodeficiency virus (HIV) twice using Enzyme Immunoassay (EIA) method (Particle agglutination, PA done), but a year later he was tested HIV-negative. The patient was asymptomatic for HIV and T helper cells (CD4) count remained stable throughout this period. In light of this case, there may be a need to retest by molecular methods for high risk category patients who were initially diagnosed HIV-positive, but later showing an unexpected clinical course, such as a rising or stable CD4 titre over the years.

Matched MeSH terms: Drug Users
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 Anxiety Disorders among Incarcerated Drug Users

Gill, J.S., Koh, O.H., Pillai, S.K.

Malaysian Journal of Psychiatry, 2010;19(1):1-7.
MyJurnal

The problem of illicit drug use has been a long standing problem in Malaysia. It is well recognized that drug mis-use is associated with many social, economic and health problems, including mental health problems. Anxiety disorders have consistently been cited as the commonest type of psychiatric disorder in drug users. In Malaysia, many drug users are incarcerated in rehabilitation centres and prison. They form a different type of population as compared to the drug user in the general population, due to the effects of incarceration. With this in mind, a study was carried out in a rehabilitation centre, looking at anxiety disorders. Utilizing the SCID, we found current and lifetime diagnoses for anxiety disorders at 63.4% and 67.6% respectively. Suggestions are made in regards to our findings.

Matched MeSH terms: Drug Users
Fulltext Personality and career preference of drug abusers in Sabah

Julianah Saguni, Puteri Hayati Megat Ahmad, Guan, Teik Ee

Malaysian Journal of Social Sciences and Humanities, 2018;3(3):31-37.
MyJurnal

Unemployment issue is becoming a factor which causes relapses especially among former drug addicts
that has undergone rehabilitation. Therefore, this paperwork seek to unfold and discuss degree of
relationships between introvert and extrovert personality with career interest according to six RIASEC
major field to drug addicts. Research objective are to identify the relationship between introvert and
extrovert personality with career interest among drug addicts in Sabah. Most of the respondent in
treatment center has no knowledge about their own personality in career development especially after
finishing treatment thus causing relapse due to failure of getting the right employment for themselves.
It is considered serious due to economic and life instability are one of the factor which contribute to
relapse among drug addicts. Occupation or career selection are constantly highlighted as one of the
major problem in former drug addict life. This shows that a careful career selection needs to be done. Career process are also continuous process of involvement to help self-development especially in line
of job they do. Therefore, it is hopeful that this research could give valuable impact and use to drug
addicts rehabilitation authority with implementation of career guidance to clients hence assisting them
in making effective career choice in the future.

Matched MeSH terms: Drug Users
Fulltext Family functioning, cognitive distortion and resilience among clients of Cure and Care Rehabilitation Centre (CCRC) and Cure and Care Clinic (C&C). [Kefungsian keluarga, pengherotan kognitif dan resilien dalam kalangan klien Cure and Care Rehabilitation Centre (CCRC) dan Klinik Cure and Care (C&C)]

Zainah AZ, Nasir R, Desa A, Khairudin R, Yusooff F, Mohamed Yusoff SH

Jurnal Psikologi Malaysia, 2013;27:137-49.

The process of drug rehabilitation is an important agenda for the National Anti-Drug Agency (NADA). Various efforts have been taken to aid NADA in treating drug addicts. This study focuses on identifying the mental health status and psychological factors to design appropriate treatment strategies. Therefore, this research aims to determine the level of family functioning, cognitive distortion and resilience among clients of CCRC and C&C. A total of 495 clients from these institutions took part in this study. The instruments used were FACES III to measure family functioning, CDS to measure cognitive distortion and Resilience Scale to measure resilience. Results indicate that clientsâ€™ family functioning is at a moderate level, clientsâ€™ cognitive distortion is at a low level, whilst their resilence is at a high level. This indicates that the rehabilitation programs conducted at the institution had an impact on clientsâ€™ resiliency and cognitive distortion.The implications of the study can be attributed to the counseling intervention at NADA.

Matched MeSH terms: Drug Users
Fulltext Factors contributing towards high-risk situations in drug relapse. [Faktor-faktor penyumbang kecenderungan situasi berisiko tinggi dalam kalangan penagih dadah berulang di Malaysia]

Hadijah B, Wan Shahrazad Wan S, Fauziah I, Norulhuda Sarnon K

Jurnal Psikologi Malaysia, 2018;32(2):26-41.

The scenario of drug addiction is a chain of threats to individual, families and communities. This is shown through the increasing statistics in addiction relapse causing epidemic to communities. The effects of drug relapse affect individual’s health with problems of comorbidity, psychopathology and psychosocial. After 40 years, Malaysia undertook various efforts in treatment and rehabilitation programs, but these efforts do not indicate success. This situation has led to the study of various factors that contribute towards high-risk situations in drug relapse. Hence this study aims to identify intrapersonal factors consisting of motivation to change and coping strategy as mediator of high-risk situations for drug relapse, which include negative emotions, interpersonal conflict and social pressure. This study employed a cross sectional design which utilized questionnaires administered to 600 clients in the Cure & Care Clinic, Malaysia. The questionnaires used were The Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES), Brief COPE and the tendency of high risk situation for drug relapse scale. Data were analyzed using multiple regression analysis and PROCESS for SPSS. Results showed significant influences of intrapersonal factors and coping strategies towards high-risk situations for drug relapse. In addition, coping strategy mediated the relationship between motivation to change and the tendency of high-risk situations for drug relapse. These findings should be taken into account in establishing treatment and rehabilitation programs for drug relapse in Malaysia.
Keywords: motivation to change, coping strategy, addiction relapse, high risk situations, mediator

Matched MeSH terms: Drug Users
Fulltext Tahap keyakinan diri bekas penagih dadah dalam pengawasan di malaysia: ke arah kepulihan menyeluruh (self-esteem among former drug addicts under observation in Malaysia: towards a comprehensive recovery)

Salina N, Fauziah I, Ezarina Z, Mohd Norahim Mohamed S, Nor Jana S

Jurnal Psikologi Malaysia, 2017;31:29-39.

Recovering drug addict is affected by two main factors, namely internal factors (such as resilience and self-confidence) and external (support from families, employers, friends, and community). One of the internal factors that appear to influence the level of recovery of former drug addict is selfconfidence. Therefore this study aims to measure the level of self-confidence among former drug addicts, also known as Orang Kena Pengawasan (OKP) who underwent rehabilitation in 6-11 months and 12-24 months. The study was conducted using cross-sectional surveys. A total of 386 former drug addicts in Peninsular Malaysia were involved in this study with 198 respondents undergoing 6-11 months rehabilitation programme and 197 were respondents who were released within 12-24 months. The data obtained were analyzed using descriptive statistics. This analysis was used to measure the level of self-confidence between respondents who underwent the 6-11 months rehabilitation programme (Group 1) and 12-24 months (Group 2). The study found that the majority of both groups showed no signiticant difference in the level of recovery from the aspect of self-confidence. The study also found the majority of respondents of both groups showed a moderate level of confidence of 58.5 percent. However, Group 1 showed a higher percentage of self-confidence (63.5%) compared to Group 2 of (53.8%). The findings have implications for the development of strategies towards a strong self-confidence among the inmates to reduce recidivism rates in Malaysia.

Matched MeSH terms: Drug Users
Fulltext Prevalence of HIV, Hepatitis B and C Virus Co-infections among Iranian High-Risk Groups: A Systematic Review and Meta-Analysis

Hashiani AA, Sadeghi F, Ayubi E, Rezaeian S, Moradi Y, Mansori K, et al.

Malays J Med Sci, 2019 May;26(3):37-48.
PMID: 31303849 DOI: 10.21315/mjms2019.26.3.3

Co-infection with hepatitis B and C among HIV infected patients are prevalent among high-risk populations. This meta-analysis aimed to estimate the prevalence of HIV, HCV and HBV co-infections among high-risk populations in Iran. We systematically searched the national and international electronic databases until 2016. The primary outcome was the prevalence of HIV, HBV, HCV and HIV co-infections in different high-risk populations in Iran. All English and Persian studies conducted on Iranian high-risk groups were included in the study. The review was reported based on PRISMA guidelines and data were analysed at 95% confidence level using random effect models. Overall, 916 relevant papers were recognised and 14 articles were included in the meta-analysis. The pooled estimates of HBV/HCV, HCV/HIV, HBV/HIV and HBV/HCV/HIV were 1.3% (95%CI: 0.5-2.1), 16.3% (95%CI: 1.1-31.6), 0.5% (95%CI: 0-1.4) and 0.5% (95%CI: 0.2-0.8), respectively. Based on subgroup analysis, there was a higher proportion of all co-infections from the years 2010-2016 as compared to that of the years 2003-2009. Our results highlighted that HCV/HIV co-infection in Iranian high-risk groups including injection drug users (IDUs) and prisoners is common. In addition, the increasing trend of coinfections should be considered alarming for policymakers.

Matched MeSH terms: Drug Users
Fulltext Can primary care clinic run MMT service well?

Norsiah A, Dharmananda S, Mohammad Nazri MD, Marzafuan MM, Lee BWH, Khalijah MY

Malays Fam Physician, 2010;5(1):19-23.
PMID: 25606181 MyJurnal

Methadone Maintenance Therapy (MMT) for opiate dependence was first started in Malaysia in 2005. The service was initially provided by psychiatric clinics in hospitals and primary care clinics. Handling patients with opiate dependency especially in a primary care clinic is very challenging due to various constraints hence the success is doubtful. 143 patients from Tampin Health Clinic were recruited from November 2006 until March 2009. Retention rate in the program was high. Significant improvement was seen in the World Health Organization Quality Of Life score (WHOQOL-BREF) in all 4 domains done at baseline, 1st year and 2nd year in the program. After joining the program, there were no new blood borne virus infection for HIV and Hepatitis B and only 1 had Hepatitis C. Minimal number of patients were involved in new drug related offences while in the MMT program. Existing primary care clinics can be empowered to scale up this service in Malaysia.

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 Co-infections and transmission networks of HCV, HIV-1 and HPgV among people who inject drugs

Ng KT, Takebe Y, Chook JB, Chow WZ, Chan KG, Abed Al-Darraji HA, et al.

Sci Rep, 2015;5:15198.
PMID: 26459957 DOI: 10.1038/srep15198

Co-infections with human immunodeficiency virus type 1 (HIV-1) and human pegivirus (HPgV) are common in hepatitis C virus (HCV)-infected individuals. However, analysis on the evolutionary dynamics and transmission network profiles of these viruses among individuals with multiple infections remains limited. A total of 228 injecting drug users (IDUs), either HCV- and/or HIV-1-infected, were recruited in Kuala Lumpur, Malaysia. HCV, HIV-1 and HPgV genes were sequenced, with epidemic growth rates assessed by the Bayesian coalescent method. Based on the sequence data, mono-, dual- and triple-infection were detected in 38.8%, 40.6% and 20.6% of the subjects, respectively. Fifteen transmission networks involving HCV (subtype 1a, 1b, 3a and 3b), HIV-1 (CRF33_01B) and HPgV (genotype 2) were identified and characterized. Genealogical estimates indicated that the predominant HCV, HIV-1 and HPgV genotypes were introduced into the IDUs population through multiple sub-epidemics that emerged as early as 1950s (HCV), 1980s (HIV-1) and 1990s (HPgV). By determining the difference in divergence times between viral lineages (ΔtMRCA), we also showed that the frequency of viral co-transmission is low among these IDUs. Despite increased access to therapy and other harm reduction interventions, the continuous emergence and coexistence of new transmission networks suggest persistent multiple viral transmissions among IDUs.

Matched MeSH terms: Drug Users*

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