heroin and Communicable-Diseases

Topics: Analgesics, Opioid; Communicable Diseases; Drug Users; Fentanyl; Hepatitis; Heroin; HIV Infections; Humans; Opioid-Related Disorders; Staphylococcal Infections; Staphylococcus aureus; United States

Despite low HIV prevalence in the South Caucasus region, transmission is volatile. Little data are available from this region about addiction and infectious diseases among prisoners who transition back to communities.. A nation-wide randomly sampled biobehavioral health survey was conducted in 13 non-specialty Azerbaijani prisons among soon-to-be-released prisoners. After informed consent, participants underwent standardized health assessment surveys and testing for HIV, hepatitis B and C, and syphilis.. Of the 510 participants (mean age = 38.2 years), 11.4% were female, and 31.9% reported pre-incarceration drug injection, primarily of heroin. Prevalence of HCV (38.2%), HIV (3.7%), syphilis (3.7%), and HBV (2.7%) was high. Among the 19 HIV-infected inmates, 14 (73.7%) were aware of their HIV status, 12 (63.2%) were receiving antiretroviral therapy (ART), and 5 (26.3%) had CD4 < 350 cells/mL (4 of these were on ART). While drug injection was the most significant independent correlate of HCV (AOR = 12.9; p = 0.001) and a significant correlate of HIV (AOR = 8.2; p = 0.001), both unprotected sex (AOR = 3.31; p = 0.049) and working in Russia/Ukraine (AOR = 4.58; p = 0.008) were also correlated with HIV.. HIV and HCV epidemics are concentrated among people who inject drugs (PWIDs) in Azerbaijan, and magnified among prisoners. A transitioning HIV epidemic is emerging from migration from high endemic countries and heterosexual risk. The high diagnostic rate and ART coverage among Azerbaijani prisoners provides new evidence that HIV treatment as prevention in former Soviet Union (FSU) countries is attainable, and provides new insights for HCV diagnosis and treatment as new medications become available. Within prison evidence-based addiction treatments with linkage to community care are urgently needed.

Topics: Adult; Azerbaijan; Communicable Diseases; Female; Health Surveys; Hepatitis B; Heroin; HIV Infections; Humans; Male; Narcotics; Prevalence; Prisoners; Substance-Related Disorders; Syphilis; USSR

Drug injectors are known to have high rates of hospital and emergency room (ER) use. We hypothesized that out-of-treatment injection drug users (IDUs) have higher rates of health service use than methadone-maintained persons, and that heroin injection frequency mediates health service use among drug injectors (IDUs). HIV-negative individuals with a history of drug injection were recruited from a needle exchange program (NEP) and a methadone maintenance treatment program (MMT) in Providence, RI. ER visits, outpatient visits, and hospitalizations in the last 6 months were the dependent variables with number of heroin injections the hypothesized mediator variable. The 472 participants were predominately male (60.6%) and white (82%) with a mean age of 37. NEP clients were more likely than MMT clients to visit an ER (39.2% vs. 29.8%; P=0.03). NEP participants were somewhat more likely to report a hospital admission (16.0% vs. 10.6%; P=0.08). Relative to non-injecting MMT participants, the odds of visiting an ER were 1.80 and 1.67 times higher for subjects recruited through NEP and actively injecting MMT participants, respectively. Additionally, subjects recruited through NEP (OR=2.2) and actively injecting MMT participants (OR=2.3) were over twice as likely to report a hospital admission than non-injecting MMT participants. Each increase of one heroin injection per day increased the expected odds of injection-related infection by a factor of 1.92. NEP clients are more likely to have ER visits and hospitalizations than methadone clients. We describe a pathway by which injection frequency influences health service use.

Topics: Adult; Chi-Square Distribution; Communicable Diseases; Confidence Intervals; Emergency Service, Hospital; Female; Heroin; Humans; Logistic Models; Male; Middle Aged; Needle-Exchange Programs; Odds Ratio; Patient Acceptance of Health Care; Substance Abuse Treatment Centers; Substance Abuse, Intravenous

Topics: Adolescent; Adult; Animals; Communicable Diseases; Demography; Disease Outbreaks; Disease Reservoirs; Disease Vectors; District of Columbia; Epidemiologic Methods; Heroin; Heroin Dependence; Humans; Male; Social Problems; United States

Topics: Communicable Diseases; Epidemiologic Methods; Heroin; Heroin Dependence; Humans; Substance-Related Disorders

Topics: Communicable Diseases; Drug and Narcotic Control; Heroin; Humans; New York City; Substance-Related Disorders