High Prevalence and Incidence of HIV and HCV Among New Injecting Drug Users With a Large Proportion of Migrants—Is Prevention Failing?

Folch, Cinta; Casabona, Jordi; Espelt, Albert; Majó, Xavier; Meroño, Merçè; González, Victoria; Wiessing, Lucas; Colom, Joan; Brugal, M. Teresa

doi:10.3109/10826084.2015.1092991

Cited by 43 publications

(45 citation statements)

References 32 publications

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“…Sociostructural factors such as unemployment, poverty, discrimination, and marginalization are all risk factors for problematic substance use that disproportionately affect international migrant populations (Durrant & Thakker, 2003; Hacker et al, 2011). Studies in North America, Europe, and Australia have observed that migrants who inject drugs have higher rates of undiagnosed blood-borne infections and lower levels of access to healthcare and preventative services compared with other PWID (Brouwer et al, 2009; Folch et al, 2016; Maher et al, 2004; Swift et al, 1997). Therefore, addressing disparities experienced by migrants may be critical in mitigating risk environments for injection initiation and blood-borne disease.…”

Section: Migration Classes and Injection Initiationmentioning

confidence: 99%

“…Migrant populations have also been shown to be at risk of initiating injection drug use (IDU) (Folch et al, 2016; Horyniak, Melo, Farrell, Ojeda,& Strathdee, 2016a; Ojeda et al, 2011), especially those populations whose migration pathways traverse drug trafficking regions (Beyrer et al, 2000; Rachlis et al, 2007). Relatedly, dual epidemics of IDU and blood-borne disease have been observed across international borders and drug trafficking routes globally (Beyrer et al, 2000; Rachlis et al, 2007; Strathdee, Magis-Rodriguez, Mays, Jimenez, & Patterson, 2012).…”

Section: Introductionmentioning

confidence: 99%

“…Among a sample of recently initiated PWID in Spain, a higher proportion of participants were international migrants than locals (Folch et al, 2016). Along the China–Vietnam and the China–Myanmar borders, mobile drug dealers and migrant PWID populations drive the regional HIV epidemics (Hammett et al, 2012; Rachlis et al, 2007; Williams, Liu, & Levy, 2011).…”

Section: Introductionmentioning

confidence: 99%

“…Along the China–Vietnam and the China–Myanmar borders, mobile drug dealers and migrant PWID populations drive the regional HIV epidemics (Hammett et al, 2012; Rachlis et al, 2007; Williams, Liu, & Levy, 2011). So, although epidemics of blood-borne disease have been identified among PWID over the past three decades, mobility is emerging as a driving factor in syndemics of blood-borne disease and IDU (Beyrer et al, 2000; Folch et al, 2016; Rachlis et al, 2007). Notably, the relationship between migration and IDU may be bidirectional, as studies have observed PWID migrating in order to seek addiction treatment, as well as mixing with local PWID populations upon arrival, as has been observed among Puerto Rican migrants in the Northeastern U.S. (Deren et al, 2014; Michalopoulos, Aifah, & El-Bassel, 2016).…”

Section: Introductionmentioning

confidence: 99%

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Injection Drug Use Trajectories among Migrant Populations: A Narrative Review

Melo

Mittal

Horyniak

et al. 2018

Substance Use & Misuse

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Background Dual epidemics of injection drug use and blood-borne disease, characterized as “syndemics,” are present in a range of settings. Behaviors that drive such syndemics are particularly prevalent among mobile drug-using populations, for whom cross-border migration may pose additional risks. Objectives This narrative review aims to characterize the risk factors for injection drug use initiation associated with migration, employing a risk environment framework and focusing on the San Diego–Tijuana border region as the most dynamic example of these phenomena. Methods Based on previous literature, we divide migration streams into three classes: intra-urban, internal, and international. We synthesized existing literature on migration and drug use to characterize how mobility and migration drive the initiation of injection drug use, as well as the transmission of hepatitis and HIV, and to delineate how these might be addressed through public health intervention. Results Population mixing between migrants and receiving communities and the consequent transmission of social norms about injection drug use create risk environments for injection drug use initiation. These risk environments have been characterized as a result of local policy environments, injection drug use norms in receiving communities, migration-related stressors, social dislocation, and infringement on the rights of undocumented migrants. Conclusion Policies that exacerbate risk environments for migrants may inadvertently contribute to the expansion of epidemics of injection-driven blood-borne disease. Successful interventions that address emerging syndemics in border regions may therefore need to be tailored to migrant populations and distinguish between the vulnerabilities experienced by different migration classes and border settings.

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Section: Migration Classes and Injection Initiationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Injection Drug Use Trajectories among Migrant Populations: A Narrative Review

Melo

Mittal

Horyniak

et al. 2018

Substance Use & Misuse

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“…In high income countries, most new HCV infections occur among people who inject drugs (PWID), with an estimated incidence of 2–46 infections per 100 person-years (Backmund, Reimer, Meyer, Gerlach, & Zachoval, 2005; Folch et al, 2016; Grebely & Dore, 2011; Hajarizadeh, Grebely, & Dore, 2013; Maher, Li, Jalaludin, Chant, & Kaldor, 2007; Page, Morris, Hahn, Maher, & Prins, 2013; van den Berg et al, 2007). While PWID are disproportionately burdened by HCV (prevalence ranging from 60% to 80%), almost half are unaware of their status (Nelson et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

Initiating HCV treatment with direct acting agents in opioid agonist treatment: When to start for people co-infected with HIV?

Panagiotoglou

Krebs

Min

et al. 2017

International Journal of Drug Policy

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Background Direct acting antivirals (DAA) raise the possibility of eliminating Hepatitis C virus (HCV) among people who inject drugs (PWID). However, concerns regarding treatment retention and reinfection challenge implementation efforts. Opioid agonist treatment (OAT) provides an opportunity to engage HCV-positive PWID into DAA-based treatment. Our objective was to identify when OAT adherence sufficiently improved to inform DAA initiation in OAT settings, assuming continuous OAT retention for at least twelve weeks is necessary to complete the DAA treatment course. Methods This was a retrospective cohort study of HCV/HIV co-infected PWID from a population-level linked administrative database of people diagnosed and living with HIV in British Columbia, Canada between 01/1996 and 12/2013. We used monthly follow-up data after initial OAT entry and considered the effects of demographics, disease severity, and HIV and OAT treatment characteristics over time on the probability of subsequent OAT retention of ≥12 weeks, and ≥8 weeks for sensitivity analysis. We fit a generalized linear mixed model to the overall study population, and on stratified samples of those continuously engaged on combination antiretroviral therapy (≥95% ART adherence). A set of monthly indicator variables (months 1, …, 7, >7) were included to fulfil the study objective. Results Our study included 1427 HCV/HIV co-infected PWID (39.0% female, 68.8% OAT-naive). The odds of subsequent twelve-week retention in OAT were statistically significantly greater in month 3 versus month 1 (adjusted odds ratio: 1.18; 95% confidence interval: 1.02, 1.37); and the odds of subsequent 8- week retention in OAT were statistically significantly greater in month 2 versus month 1 (1.15, 95% CI: 1.02, 1.31). Among continuously ART-adherent individuals, the odds of subsequent twelve-week retention were not statistically significantly greater than in month 1 (month 2: 1.12 (0.82,1.51); month 3: 1.08 (0.79, 1.47); month 4: 1.24 (0.91, 1.71)). Conclusion We provide evidence that among HCV/HIV co-infected PWID, those retained in OAT for three or more months had higher odds of completing an additional twelve weeks of OAT, compared to no difference in those already receiving ART. These data may have implications for adherence to DAA therapy and further studies are needed to understand the optimal timing of DAA therapy in PWID receiving and not receiving OAT.

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Characterization of Acute HCV Infection and Transmission Networks in People Who Currently Inject Drugs in Catalonia: Usefulness of Dried Blood Spots

et al. 2021

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BaCKgRoUND aND aIMS: Accurate identification of recent HCV infections is critical for tracing the extent and mechanisms of ongoing transmission. We aimed to validate dried blood spot (DBS) samples for the assessment of HCV genetic diversity and to determine epidemiological parameters including incidence, determinants of acute infection, and phylogenetic clustering in people who inject drugs (PWID). appRoaCH aND ReSUltS: HCV nonstructural protein 5B next-generation sequencing was performed from plasma and/or DBS in 220 viremic PWID from the HepCdetect II study. No significant differences were found in consensus sequences or Shannon entropy (SE) intrahost diversity estimate between paired plasma/DBS specimens. SE values were used to identify acute infections with 93.3% sensitivity (95% CI, 0.81-1.06) and 95.0% specificity (95% CI, 0.88-1.02) in a set of well-defined controls. An acute HCV infection (either primary infection or reinfection) was detected in 13.5% of viremic participants and was associated with age ≤30 years (OR, 8.09), injecting less than daily (OR, 4.35), ≤5 years of injected drug use (OR, 3.43), sharing cocaine snorting straws (OR, 2.89), and being unaware of their HCV status (OR, 3.62). Annualized HCV incidence was estimated between 31 and 59/100 person-years. On phylogenetic analysis, 46.8% of viremic cases were part of a transmission pair or cluster; age ≤30 years (OR, 6.16), acute infection (OR, 5.73), and infection with subtype 1a (OR, 4.78) were independently associated with this condition. CoNClUSIoNS:The results obtained from plasma and DBS characterize PWID with acute infection and those involved in ongoing HCV transmission and allow estimating incidence from cross-sectional data. This information is critical for the design and assessment of targeted harm reduction programs and test-and-treat interventions and to facilitate monitoring of HCV elimination in this key population.

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High Prevalence and Incidence of HIV and HCV Among New Injecting Drug Users With a Large Proportion of Migrants—Is Prevention Failing?

Cited by 43 publications

References 32 publications

Injection Drug Use Trajectories among Migrant Populations: A Narrative Review

Injection Drug Use Trajectories among Migrant Populations: A Narrative Review

Initiating HCV treatment with direct acting agents in opioid agonist treatment: When to start for people co-infected with HIV?

Characterization of Acute HCV Infection and Transmission Networks in People Who Currently Inject Drugs in Catalonia: Usefulness of Dried Blood Spots

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