Are non-injecting opioid users at risk of transition to injecting drug use? A multi-site study from India

Ambekar, Atul; Mishra, Ashwani Kumar; Kumar, Rajesh; Kumar, Manish; Rao, Ravindra; Agrawal, Alok

doi:10.1016/j.ajp.2019.03.017

Cited by 21 publications

(29 citation statements)

References 22 publications

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“…Since its inception, many investigators have successfully used this sampling technique to target various hidden populations such as IDUs and sex workers. [ 11 12 ] More recently, this sampling method has been used for targeting IDUs in Punjab, Haryana, and Chandigarh[ 5 ] and opioid-dependent individuals in Punjab. [ 6 ] The study by Ambedkar and Tripathi, 2008,[ 5 ] focused only on injectable drug use, while in the Punjab opioid dependence survey,[ 6 ] this method was used to estimate the prevalence rates of opioid dependence only.…”

Section: Discussionmentioning

confidence: 99%

“…One of these surveys was carried out in Punjab, Haryana, and Chandigarh and focused on injectable drug use. [ 5 ] The more recent one was the Punjab Opioid Dependence Survey which looked at the prevalence of opioid dependence in Punjab. [ 6 ] Given the obvious concerns regarding reports of a rise in opioid and injectable drug use in this geographic area, it is understandable that these have been the focus of recent RAS surveys.…”

Section: Introductionmentioning

confidence: 99%

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Pattern and prevalence of substance use and dependence in the Union Territory of Chandigarh: Results of a rapid assessment survey

Basu

Subodh

Gupta

et al. 2017

Indian J Psychiatry

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Background:Substance misuse is a matter of major public health concern in India. House-to-house survey, though an appealing method to generate population-level estimates, has limitations for estimating prevalence rates of use of illicit and rare substances.Materials and Methods:In this rapid assessment survey (RAS), respondent-driven sampling was used to recruit substance-using individuals from the field. Size of the substance-using population was estimated using the “benchmark-multiplier” method. This figure was then projected to the entire population of the Union Territory (U.T) of Chandigarh. Focused group discussions were used to study the perceptions and views of the substance users regarding various aspects of substance use.Results:Prevalence of any substance dependence in the U.T of Chandigarh was estimated to be 4.65%. Dependence rates on opioids, cannabinoids, and sedative hypnotics were found to be 1.53%, 0.52%, and 0.015%, respectively. Prevalence of injectable opioids was calculated to be 0.91%. Injectable buprenorphine was the most commonly used opioid, followed by bhukhi/doda/opium and heroin. A huge gap was found between the prevalence rates of substance-using population and those seeking treatment.Conclusion:RAS can be a useful method to determine the prevalence of illicit and rare substances. Our survey shows that the use of substance including that of opioids is highly prevalent in the U.T of Chandigarh. The findings of this survey can have implications for policymaking.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pattern and prevalence of substance use and dependence in the Union Territory of Chandigarh: Results of a rapid assessment survey

Basu

Subodh

Gupta

et al. 2017

Indian J Psychiatry

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“…PWID may be under-represented in household surveys because they are more likely to be homeless or imprisoned [13, 21]. Although some evidence suggests opium/bhuki use could be associated with heroin use [19], its use as a marker of IDU needs further study to understand the validity of using such proxies.…”

Section: Discussionmentioning

confidence: 99%

“…Our survey proportion of ever injectors likely represents an underestimate of the actual prevalence. A report from 2008 linked smoking traditional, plant-based drugs to IDU [19]. We examined other drug exposures/behaviours to investigate using them as proxy measures of IDU.…”

Section: Methodsmentioning

confidence: 99%

Clustering of hepatitis C virus antibody positivity within households and communities in Punjab, India

et al. 2019

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To better understand hepatitis C virus (HCV) epidemiology in Punjab state, India, we estimated the distribution of HCV antibody positivity (anti-HCV+) using a 2013–2014 HCV household seroprevalence survey. Household anti-HCV+ clustering was investigated (a) by individual-level multivariable logistic regression, and (b) comparing the observed frequency of households with multiple anti-HCV+ persons against the expected, simulated frequency assuming anti-HCV+ persons are randomly distributed. Village/ward-level clustering was investigated similarly. We estimated household-level associations between exposures and the number of anti-HCV+ members in a household (N = 1593 households) using multivariable ordered logistic regression. Anti-HCV+ prevalence was 3.6% (95% confidence interval 3.0–4.2%). Individual-level regression (N = 5543 participants) found an odds ratio of 3.19 (2.25–4.50) for someone being anti-HCV+ if another household member was anti-HCV+. Thirty households surveyed had ⩾2 anti-HCV+ members, whereas 0/1000 (P < 0.001) simulations had ⩾30 such households. Excess village-level clustering was evident: 10 villages had ⩾6 anti-HCV+ members, occurring in 31/1000 simulations (P = 0.031). The household-level model indicated the number of household members, living in southern Punjab, lower socio-economic score, and a higher proportion having ever used opium/bhuki were associated with a household's number of anti-HCV+ members. Anti-HCV+ clusters within households and villages in Punjab, India. These data should be used to inform screening efforts.

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“…However, recent evidence suggests that injection drug use is increasing in north and central India, primarily due to injection of buprenorphine and pharmaceutical opioids. 12 As such, PWID have been identified as a key population to monitor trends and disease burden and the National AIDS Control Program of India has prioritized HIV prevention strategies in this group. 13 Yet, injection drug network characteristics and their impact on risk behaviors and HIV clinical outcomes remain poorly understood.…”

Section: Introductionmentioning

confidence: 99%

Injection Drug Network Characteristics Are Important Markers of HIV Risk Behavior and Lack of Viral Suppression

Cepeda

Solomon

Srikrishnan

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background People who inject drugs (PWID) who are highly connected within their injection drug networks may be important HIV transmission nodes if they frequently share syringes with other PWID and are not engaged in HIV care. In India, HIV transmission fueled by injection drug use is increasing, however little is known about the associations between injection network size and syringe sharing and viral suppression. Methods We recruited 14,481 PWID between October 2012 – December 2013 by respondent driven sampling across 15 sites in India. Interviewer-administered questionnaires assessed network characteristics, substance use, HIV testing experience, and access to health services. We used multilevel logistic regression modeling to evaluate the relationship between injection drug network size and 1) syringe sharing at last injection and 2) viral suppression among HIV-positive participants (<150 copies/ml). Findings The median injection network size was 3 [IQR: 1–5] and 7% of participants injected with >10 members in the past 30 days. PWID who had >10 members in their network were 1.65 times (95% CI: 1.12 – 2.42, p=0.0111) more likely to have shared a syringe at last injection compared to those in the 0–1 members in their drug networks. Additionally, individuals with the largest injection drug networks were also 31% (95% CI: 0.53 – 0.90, p=0.006) less likely to be virally suppressed compared to individuals in the smallest injection drug networks. Discussion Individuals with larger networks may be important in HIV transmission within injection drug networks since they were the most likely to engage in recent syringe sharing and least likely to be virally suppressed.

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Are non-injecting opioid users at risk of transition to injecting drug use? A multi-site study from India

Cited by 21 publications

References 22 publications

Pattern and prevalence of substance use and dependence in the Union Territory of Chandigarh: Results of a rapid assessment survey

Pattern and prevalence of substance use and dependence in the Union Territory of Chandigarh: Results of a rapid assessment survey

Clustering of hepatitis C virus antibody positivity within households and communities in Punjab, India

Injection Drug Network Characteristics Are Important Markers of HIV Risk Behavior and Lack of Viral Suppression

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