Aims Despite proven benefits of antiretroviral therapy (ART), many HIV-infected injection drug users (IDU) do not access treatment even in settings with free health care. We examined whether methadone maintenance therapy (MMT) increased initiation and adherence to ART among an IDU population with free health care. Design We prospectively examined a cohort of opioid-using antiretroviral-naïve HIV-infected IDU and investigated factors associated with initiation of antiretroviral therapy as well as subsequent adherence. Factors independently associated with time to first initiation of antiretroviral therapy were modelled using Cox proportional hazards regression. Findings Between May 1996 and April 2008, 231 antiretroviral-naïve HIV-infected opioid using IDU were enrolled, among whom 152 (65.8%) initiated ART, for an incidence density of 30.5 (95% confidence interval [CI]: 25.9–35.6) per 100 person-years. After adjustment for time-updated clinical characteristics and other potential confounders, use of MMT was independently associated with more rapid uptake of antiretroviral therapy (relative hazard = 1.62 [95% CI: 1.15–2.28]; p = 0.006). Those prescribed methadone also had higher rates of ART adherence after first antiretroviral initiation (odds ratio = 1.49 [95% CI: 1.07–2.08]; p = 0.019). Conclusion These results demonstrate that MMT contributes to more rapid initiation and subsequent adherence to ART among opioid-using HIV-infected IDU. Addressing international barriers to the use and availability of methadone may dramatically increase uptake of HIV treatment among this population.

We investigated whether risk of sporadic enteric disease differs by drinking water source and type using surveillance data and a geographic information system. We performed a cross-sectional analysis, at the individual level, that compared reported cases of enteric disease with drinking water source (surface or ground water) and type (municipal or private). We mapped 814 cases of campylobacteriosis, cryptosporidiosis, giardiasis, salmonellosis and verotoxigenic Escherichia coli infection, in a region of British Columbia, Canada, from 1996 to 2005, and determined the water source and type for each case's residence. Over the 10-year period, the risk of disease was 5.2 times higher for individuals living on land parcels serviced by private wells and 2.3 times higher for individuals living on land parcels serviced by the municipal surface/ground water mixed system, than the municipal ground water system. Rates of sporadic enteric disease potentially differ by drinking water source and type. Geographic information system technology and surveillance data are accessible to local public health authorities and used together are an efficient and affordable way to assess the role of drinking water in sporadic enteric disease.

Background and objectives Despite recent increases in crystal methamphetamine use among high-risk populations such as street-involved youth, few prospective studies have examined the health and social outcomes associated with active crystal methamphetamine use. Methods We enrolled 1,019 street-involved youth in Vancouver, Canada, in a prospective cohort known as the At-Risk Youth Study (ARYS). Participants were assessed semi-annually and a generalized estimating equation (GEE) logistic regression was used to identify factors independently associated with active crystal methamphetamine use. Results Among 1,019 participants recruited into ARYS between 2005 and 2012 the median follow up duration was 17 months, 320 (31.4%) participants were female and 454 (44.6%) had previously used crystal methamphetamine at baseline. In adjusted GEE analyses, active crystal methamphetamine use was independently associated with Caucasian ethnicity (Adjusted Odds Ratio [AOR] = 1.37; 95% Confidence Interval [CI]: 1.04 – 1.81), homelessness (AOR = 1.34; 95% CI: 1.15 – 1.56), injection drug use (AOR = 3.40; 95% CI: 2.76 – 4.19), non-fatal overdose (AOR = 1.46; 95% CI: 1.07 – 2.00), being a victim of violence (AOR = 1.19; 95% CI: 1.02 – 1.38), involvement in sex work (AOR = 1.39; 95% CI: 1.03 – 1.86) and drug dealing (AOR = 1.60; 95% CI: 1.35 – 1.90). Discussion and conclusions Prevalence of crystal methamphetamine use was high in this setting and active use was independently associated with a range of serious health and social harms. Scientific Significance Evidence-based strategies to prevent and treat crystal methamphetamine use are urgently needed.

BackgroundAlthough opioid-agonist therapy with methadone or buprenorphine/naloxone is currently the mainstay of medical treatment for opioid use disorder, these medications often are not well accepted or tolerated by patients. Recently, extended release naltrexone (XR-NTX), an opioid antagonist, has been advanced as an alternative treatment. The willingness of opioid-addicted patients to take XR-NTX has not been well described.MethodsOpioid-using persons enrolled in a community-recruited cohort in Vancouver, Canada, were asked whether or not they would be willing to take XR-NTX. Logistic regression was used to independently identify factors associated with willingness to take the medication.ResultsAmong the 657 participants surveyed between June 1, 2013, and November 30, 2013, 342 (52.1%) were willing to take XR-NTX. One factor positively associated with willingness was daily heroin injection (adjusted odds ratio [AOR] = 1.53; 95% confidence interval [CI] = 1.02–2.31), whereas Caucasian ethnicity was negatively associated (AOR = 0.59; 95% CI = 0.43–0.82). Satisfaction with agonist therapy (13.4%) and unwillingness to stop opioids being used for pain (26.9%) were the most common reasons for being unwilling to take XR-NTX.ConclusionsA high level of willingness to take XR-NTX was observed in this setting. Interestingly, daily injection heroin use was positively associated with willingness, whereas Caucasian participants were less willing to take XR-NTX. Although explanations for unwillingness were described in this study, further research is needed to investigate real-world acceptability of XR-NTX as an additional option for the treatment of opioid use disorder.