This document discusses the emerging epidemic of hepatitis C virus (HCV) infection among young injection drug users. Rates of HCV have increased significantly in recent years, particularly among young white adults in non-urban areas who misuse prescription opioids and transition to injecting drugs like heroin. The prescription opioid epidemic has contributed to rising HCV cases by fueling non-medical opioid use and a subsequent rise in injection drug use. Effective prevention strategies include expanding access to syringe services programs and reducing the stigma around drug use to engage more young people in harm reduction.
Risk of hiv infection among men aged 50 to 75 years using erectile dysfunctio...Alexander Decker
This study examined the risk of HIV infection among men aged 50 to 75 years who use erectile dysfunction drugs (EDDs) in Kenya. A case-control study was conducted of 137 HIV-positive men (cases) and 137 HIV-negative men (controls). The study found that a higher percentage of cases than controls reported using EDDs. However, after adjusting for other risk factors like having multiple sexual partners or a history of STDs, EDD use was not a significant independent risk factor for HIV infection. Multiple sexual partners, a history of STDs, and alcohol use were identified as independent risk factors for HIV in this population. The study suggests that while EDD use may be associated with HIV risk, other behavioral
The document discusses the epidemiology and complications of illicit opioid use. It summarizes prevalence rates of heroin use in Australia, risk factors for developing problems, and associated medical and psychosocial risks like infections, overdose, mental health issues, and social consequences. Prescription opioid use and responsible prescribing are also briefly mentioned.
SBIRT and SAMHSA's 8 Strategic Initiativessideponytail
Slides from a webinar held by the National SBIRT ATTC. Video is on TheIRETAChannel on Youtube: http://www.youtube.com/watch?v=f6NrKuGlGRs&feature=share&list=PLiML4AFpuB72LBaPShcu2yQv_WpsGY9a9
This document summarizes the position statement of the American College of Preventive Medicine (ACPM) regarding routine HIV screening. The ACPM supports routine HIV screening for all adolescents and adults ages 13-64, as well as pregnant women, based on evidence that risk-based screening is inadequate and leads to low testing rates, lack of HIV status awareness, and late diagnoses. The ACPM endorses opt-out consent procedures, use of rapid HIV tests, streamlined counseling separate from screening, and linking patients to treatment. The organization also recommends annual repeat testing for high-risk groups and repeat testing every 5 years for the general population.
Risk of hiv infection among men aged 50 to 75 years using erectile dysfunctio...Alexander Decker
This study examined the risk of HIV infection among men aged 50 to 75 years who use erectile dysfunction drugs (EDDs) in Kenya. A case-control study was conducted of 137 HIV-positive men (cases) and 137 HIV-negative men (controls). The study found that a higher percentage of cases than controls reported using EDDs. However, after adjusting for other risk factors like having multiple sexual partners or a history of STDs, EDD use was not a significant independent risk factor for HIV infection. Multiple sexual partners, a history of STDs, and alcohol use were identified as independent risk factors for HIV in this population. The study suggests that while EDD use may be associated with HIV risk, other behavioral
The document discusses the epidemiology and complications of illicit opioid use. It summarizes prevalence rates of heroin use in Australia, risk factors for developing problems, and associated medical and psychosocial risks like infections, overdose, mental health issues, and social consequences. Prescription opioid use and responsible prescribing are also briefly mentioned.
SBIRT and SAMHSA's 8 Strategic Initiativessideponytail
Slides from a webinar held by the National SBIRT ATTC. Video is on TheIRETAChannel on Youtube: http://www.youtube.com/watch?v=f6NrKuGlGRs&feature=share&list=PLiML4AFpuB72LBaPShcu2yQv_WpsGY9a9
This document summarizes the position statement of the American College of Preventive Medicine (ACPM) regarding routine HIV screening. The ACPM supports routine HIV screening for all adolescents and adults ages 13-64, as well as pregnant women, based on evidence that risk-based screening is inadequate and leads to low testing rates, lack of HIV status awareness, and late diagnoses. The ACPM endorses opt-out consent procedures, use of rapid HIV tests, streamlined counseling separate from screening, and linking patients to treatment. The organization also recommends annual repeat testing for high-risk groups and repeat testing every 5 years for the general population.
The document discusses drug use patterns in India based on various surveys and studies. It provides data on the prevalence of alcohol, cannabis, and opioid use among males from a 2001 national household survey. Additional information is presented on new treatment seekers, drugs used, and demographic characteristics from the Drug Abuse Monitoring System. Regional data on drug use patterns among people who use drugs but are not in treatment is also presented. The summary highlights key findings on the prevalence of drug use in India and characteristics of drug using populations.
The document summarizes the results of a survey of 1000 residents in Barnet, UK that was conducted to understand residents' perceptions of health and healthcare services. Some key findings from the survey include:
- 35-44 year olds were most likely to rate their health as good, while 18-24 year olds were least likely.
- Respondents of white ethnicity were more likely than non-white respondents to rate their health as good.
- Satisfaction with healthcare services, including GPs, was generally higher among white respondents, older respondents, and those in lower socioeconomic groups, while satisfaction was lower among ethnic minorities, younger people, and those in higher socioeconomic groups.
This presentation summarizes research on the determinants of access to quality health care for children in Georgia. The study used a merged dataset containing information on over 1,300 Georgia children ages 4-17. Access was defined based on utilization of preventive care and quality of received care. Results from descriptive analyses and multivariable logistic regressions found that over 30% of children had access to higher quality care. Factors like having insurance, higher income levels, and being in better health were associated with higher odds of access, while being a racial/ethnic minority was associated with lower odds. The findings can help inform efforts to improve insurance coverage and reduce disparities in access to quality care for children in Georgia.
Geographic Information Systems for Resource AllocationGPHA
The document summarizes how geographic information systems (GIS) can be used to analyze the relationship between cardiovascular disease morbidity and socioeconomic status in Georgia. It finds that areas with lower socioeconomic status, as measured by several indicators, tend to have higher rates of cardiovascular disease hospitalizations after adjusting for age. Using GIS allows targeting prevention programs to areas of highest need by visualizing disease burden and identifying populations at higher risk.
Leandro Mena, MD, MPH
Chair and Professor of Population Health Science
Department of Population Health Science
University of Mississippi Medical Center
This document summarizes research priorities and findings from the National Institute on Drug Abuse (NIDA) regarding the opioid crisis. It outlines NIDA's focus on alternative pain treatments, preventing opioid use disorder and overdoses, improving treatment for opioid use disorder, and implementing evidence-based solutions. Specific areas of research discussed include biomarkers for pain, abuse-deterrent drug formulations, non-medication pain treatments, universal prevention programs for adolescents, easier-to-use naloxone for overdose reversal, new formulations of addiction medications, increasing access to medication-assisted treatment, and using addiction medications earlier to prevent heroin overdoses and improve treatment retention.
Key Facts over HIV by Dr. Milind KulkarniParvez Pathan
World AIDS Day 2014 focused on closing gaps in HIV prevention and treatment. The document discusses how HIV works by targeting the immune system, the stages of infection from acute to AIDS, transmission methods, risk factors, diagnosis, testing and counselling recommendations, prevention methods including condom use and medical male circumcision, antiretroviral treatment for prevention and care, harm reduction, and eliminating mother-to-child transmission. It notes that while access to antiretroviral treatment has increased in low and middle income countries, coverage must still be expanded to reach more children living with HIV.
This document summarizes lessons learned from implementing HIV screening and treatment programs that could be applied to improving chlamydia screening and treatment efforts. Some key points discussed include the need to remove barriers to testing, improve linkage between testing and treatment, address disparities in screening and treatment rates, and work with private healthcare systems by understanding their unique contexts and incentives. Expanding recommendations and performance metrics could help drive improved chlamydia screening and treatment practices.
1. Combination prevention approaches that integrate biomedical, behavioral, and structural interventions may provide the most effective strategy for HIV prevention.
2. While biomedical interventions like PrEP and treatment as prevention have shown promise, their effectiveness relies on optimal adherence which is influenced by behavioral and social factors.
3. Behavioral interventions alone have had questionable effectiveness, so combining them with biomedical approaches could help ensure medication adherence and uptake.
4. Structural interventions are also needed to address social determinants like poverty, discrimination, and gender inequality that fuel the HIV epidemic.
Does family therapy for adolescent behavior problems work in the real worldCenter on Addiction
This document summarizes a study that compared the effectiveness of routine family therapy (RFT) to treatment as usual (TAU) for adolescent behavior problems. 205 adolescents were randomly assigned to RFT or TAU. Both treatments showed improvements in externalizing and internalizing symptoms, delinquency, and substance use, with some outcomes showing greater improvements for RFT. The study provides preliminary evidence that RFT can be effective when delivered with fidelity in usual care settings, though more research is still needed.
Scores screen, gives follow-up tool for any (+) response
-AUDIT, DAST-10 and/or or PHQ-9
Provider: Scores any follow-up tools, provides brief intervention or
referral as needed
-5-10 minutes for BI
-Referral as needed based on severity
determine severity, provides brief
intervention or referral as needed
–5-10 minutes for BI
–Referral as needed based on severity
• Medical records: Documents screen
results and any interventions
Front desk: Gives screen to patient
-Single-item alcohol and drug questions
-PHQ-2 for depression
Medical records: Documents screen results and any interventions
Socio-demographic Characteristics of Clients Visiting Integrated Counseling and Testing Centre (ICTC) at SMS Medical College, Jaipur (Rajasthan) India-Human immunodeficiency virus (HIV) infection is a global pandemic and India counts for 10% of the global HIV burden and 65% of that in the South and South-East Asia. This study of clients of ICTC was carried out to know the association of HIV positivity with socio-demographic variables. Total 2412 clients have visited at ICTC of SMS Medical College, Jaipur, either voluntarily or referred by various department of this institute in ICTC in 1st quarter of 2009. They Overall HIV positivity was found 12.35% with a significant difference in voluntary and referred clients i.e. 83.59% v/s 8.36%. It was also found that HIV positivity is more in reproductive age group than extremes of ages, more in females than males, more in person who were married but presently single because of separation of spouse, divorce form spouse or death of spouse than the unmarried or married living with their spouses.
A bridge too near injecting drug users' sexual behaviourMd. Nakebul Kausar
This document summarizes a study on the personal profiles and health seeking behaviors of injecting drug users (IDUs) in Dhaka, Bangladesh. The study involved interviews with 120 IDUs attending a drug treatment center between March and September 2005. Key findings included: 1) Most respondents (60%) had little knowledge about diseases spread by injecting drugs or needle sharing, with only 17.5% mentioning HIV/AIDS. 2) Regarding protection, 29.2% mentioned not injecting drugs anymore while 34.2% mentioned using sterile needles/syringes. 3) The majority (60%) had never participated in a needle exchange program, with lack of awareness being a key barrier.
Dr. Kathleen Brady of the AIDS Activities Coordinating Office discussed three cycles of the National HIV Behavioral Surveillance in Philadelphia, including cycles with men who have sex with men (MSM), high-risk heterosexuals, and injection drug users. This presentation took place at the Philadelphia EMA HIV Integrated Planning Council meeting on Thursday, January 11, 2018.
The document summarizes adolescent preventive services and visit patterns. It finds that currently recommended clinical preventive services (CPS) for adolescents often lack strong evidence of effectiveness. Delivery rates of CPS are low, even for services with good evidence like cervical cancer screening. Adolescents average 1.9 total medical visits per year but only 9% are for preventive care. Guidelines calling for one annual preventive visit are met less than 2% of the time. More evidence and attention to improving delivery systems are needed to better provide preventive services to adolescents.
Non-communicable diseases like cardiovascular disease, diabetes and cancer account for over half of all deaths in India and pose a major threat to economic growth. Healthcare IT and technology can help address this challenge by improving access to care through telemedicine, improving treatment effectiveness via clinical protocols and integrated health information systems, and improving patient adherence using remote monitoring and disease management programs.
View only rx16 prev tues_1230_1_duwve_2adams_3proescholdbell-sachdevaOPUNITE
This document summarizes a presentation on preventing hepatitis C and HIV outbreaks. It includes learning objectives about informing attendees of risks of infectious disease outbreaks related to injection drug use and describing collaborations between injury and infectious disease programs. The presentation features four speakers from Indiana and North Carolina public health departments and focuses on lessons learned from an HIV outbreak in Indiana linked to injection drug use.
The document discusses drug use patterns in India based on various surveys and studies. It provides data on the prevalence of alcohol, cannabis, and opioid use among males from a 2001 national household survey. Additional information is presented on new treatment seekers, drugs used, and demographic characteristics from the Drug Abuse Monitoring System. Regional data on drug use patterns among people who use drugs but are not in treatment is also presented. The summary highlights key findings on the prevalence of drug use in India and characteristics of drug using populations.
The document summarizes the results of a survey of 1000 residents in Barnet, UK that was conducted to understand residents' perceptions of health and healthcare services. Some key findings from the survey include:
- 35-44 year olds were most likely to rate their health as good, while 18-24 year olds were least likely.
- Respondents of white ethnicity were more likely than non-white respondents to rate their health as good.
- Satisfaction with healthcare services, including GPs, was generally higher among white respondents, older respondents, and those in lower socioeconomic groups, while satisfaction was lower among ethnic minorities, younger people, and those in higher socioeconomic groups.
This presentation summarizes research on the determinants of access to quality health care for children in Georgia. The study used a merged dataset containing information on over 1,300 Georgia children ages 4-17. Access was defined based on utilization of preventive care and quality of received care. Results from descriptive analyses and multivariable logistic regressions found that over 30% of children had access to higher quality care. Factors like having insurance, higher income levels, and being in better health were associated with higher odds of access, while being a racial/ethnic minority was associated with lower odds. The findings can help inform efforts to improve insurance coverage and reduce disparities in access to quality care for children in Georgia.
Geographic Information Systems for Resource AllocationGPHA
The document summarizes how geographic information systems (GIS) can be used to analyze the relationship between cardiovascular disease morbidity and socioeconomic status in Georgia. It finds that areas with lower socioeconomic status, as measured by several indicators, tend to have higher rates of cardiovascular disease hospitalizations after adjusting for age. Using GIS allows targeting prevention programs to areas of highest need by visualizing disease burden and identifying populations at higher risk.
Leandro Mena, MD, MPH
Chair and Professor of Population Health Science
Department of Population Health Science
University of Mississippi Medical Center
This document summarizes research priorities and findings from the National Institute on Drug Abuse (NIDA) regarding the opioid crisis. It outlines NIDA's focus on alternative pain treatments, preventing opioid use disorder and overdoses, improving treatment for opioid use disorder, and implementing evidence-based solutions. Specific areas of research discussed include biomarkers for pain, abuse-deterrent drug formulations, non-medication pain treatments, universal prevention programs for adolescents, easier-to-use naloxone for overdose reversal, new formulations of addiction medications, increasing access to medication-assisted treatment, and using addiction medications earlier to prevent heroin overdoses and improve treatment retention.
Key Facts over HIV by Dr. Milind KulkarniParvez Pathan
World AIDS Day 2014 focused on closing gaps in HIV prevention and treatment. The document discusses how HIV works by targeting the immune system, the stages of infection from acute to AIDS, transmission methods, risk factors, diagnosis, testing and counselling recommendations, prevention methods including condom use and medical male circumcision, antiretroviral treatment for prevention and care, harm reduction, and eliminating mother-to-child transmission. It notes that while access to antiretroviral treatment has increased in low and middle income countries, coverage must still be expanded to reach more children living with HIV.
This document summarizes lessons learned from implementing HIV screening and treatment programs that could be applied to improving chlamydia screening and treatment efforts. Some key points discussed include the need to remove barriers to testing, improve linkage between testing and treatment, address disparities in screening and treatment rates, and work with private healthcare systems by understanding their unique contexts and incentives. Expanding recommendations and performance metrics could help drive improved chlamydia screening and treatment practices.
1. Combination prevention approaches that integrate biomedical, behavioral, and structural interventions may provide the most effective strategy for HIV prevention.
2. While biomedical interventions like PrEP and treatment as prevention have shown promise, their effectiveness relies on optimal adherence which is influenced by behavioral and social factors.
3. Behavioral interventions alone have had questionable effectiveness, so combining them with biomedical approaches could help ensure medication adherence and uptake.
4. Structural interventions are also needed to address social determinants like poverty, discrimination, and gender inequality that fuel the HIV epidemic.
Does family therapy for adolescent behavior problems work in the real worldCenter on Addiction
This document summarizes a study that compared the effectiveness of routine family therapy (RFT) to treatment as usual (TAU) for adolescent behavior problems. 205 adolescents were randomly assigned to RFT or TAU. Both treatments showed improvements in externalizing and internalizing symptoms, delinquency, and substance use, with some outcomes showing greater improvements for RFT. The study provides preliminary evidence that RFT can be effective when delivered with fidelity in usual care settings, though more research is still needed.
Scores screen, gives follow-up tool for any (+) response
-AUDIT, DAST-10 and/or or PHQ-9
Provider: Scores any follow-up tools, provides brief intervention or
referral as needed
-5-10 minutes for BI
-Referral as needed based on severity
determine severity, provides brief
intervention or referral as needed
–5-10 minutes for BI
–Referral as needed based on severity
• Medical records: Documents screen
results and any interventions
Front desk: Gives screen to patient
-Single-item alcohol and drug questions
-PHQ-2 for depression
Medical records: Documents screen results and any interventions
Socio-demographic Characteristics of Clients Visiting Integrated Counseling and Testing Centre (ICTC) at SMS Medical College, Jaipur (Rajasthan) India-Human immunodeficiency virus (HIV) infection is a global pandemic and India counts for 10% of the global HIV burden and 65% of that in the South and South-East Asia. This study of clients of ICTC was carried out to know the association of HIV positivity with socio-demographic variables. Total 2412 clients have visited at ICTC of SMS Medical College, Jaipur, either voluntarily or referred by various department of this institute in ICTC in 1st quarter of 2009. They Overall HIV positivity was found 12.35% with a significant difference in voluntary and referred clients i.e. 83.59% v/s 8.36%. It was also found that HIV positivity is more in reproductive age group than extremes of ages, more in females than males, more in person who were married but presently single because of separation of spouse, divorce form spouse or death of spouse than the unmarried or married living with their spouses.
A bridge too near injecting drug users' sexual behaviourMd. Nakebul Kausar
This document summarizes a study on the personal profiles and health seeking behaviors of injecting drug users (IDUs) in Dhaka, Bangladesh. The study involved interviews with 120 IDUs attending a drug treatment center between March and September 2005. Key findings included: 1) Most respondents (60%) had little knowledge about diseases spread by injecting drugs or needle sharing, with only 17.5% mentioning HIV/AIDS. 2) Regarding protection, 29.2% mentioned not injecting drugs anymore while 34.2% mentioned using sterile needles/syringes. 3) The majority (60%) had never participated in a needle exchange program, with lack of awareness being a key barrier.
Dr. Kathleen Brady of the AIDS Activities Coordinating Office discussed three cycles of the National HIV Behavioral Surveillance in Philadelphia, including cycles with men who have sex with men (MSM), high-risk heterosexuals, and injection drug users. This presentation took place at the Philadelphia EMA HIV Integrated Planning Council meeting on Thursday, January 11, 2018.
The document summarizes adolescent preventive services and visit patterns. It finds that currently recommended clinical preventive services (CPS) for adolescents often lack strong evidence of effectiveness. Delivery rates of CPS are low, even for services with good evidence like cervical cancer screening. Adolescents average 1.9 total medical visits per year but only 9% are for preventive care. Guidelines calling for one annual preventive visit are met less than 2% of the time. More evidence and attention to improving delivery systems are needed to better provide preventive services to adolescents.
Non-communicable diseases like cardiovascular disease, diabetes and cancer account for over half of all deaths in India and pose a major threat to economic growth. Healthcare IT and technology can help address this challenge by improving access to care through telemedicine, improving treatment effectiveness via clinical protocols and integrated health information systems, and improving patient adherence using remote monitoring and disease management programs.
View only rx16 prev tues_1230_1_duwve_2adams_3proescholdbell-sachdevaOPUNITE
This document summarizes a presentation on preventing hepatitis C and HIV outbreaks. It includes learning objectives about informing attendees of risks of infectious disease outbreaks related to injection drug use and describing collaborations between injury and infectious disease programs. The presentation features four speakers from Indiana and North Carolina public health departments and focuses on lessons learned from an HIV outbreak in Indiana linked to injection drug use.
This document summarizes a presentation on closing treatment gaps in the health care and criminal justice systems for opioid use disorders. It introduces the presenters and moderator and provides learning objectives focused on improving identification and treatment of opioid use disorders in health care settings and strategies for improving outcomes for frequently incarcerated individuals. Disclosures are provided for the presenters stating that they have no relevant financial relationships.
Addiction Medicine: Closing the Gap between Science and PracticeCenter on Addiction
These slides accompany CASAColumbia's report, Addiction Medicine: Closing the Gap between Science and Practice, published in June 2012, which found that, despite the prevalence of addiction, the enormity of its consequences, the availability of effective solutions and the evidence that addiction is a disease, both screening and early intervention for risky substance use are rare, and only about 1 in 10 people with addiction involving alcohol or drugs other than nicotine receive any form of treatment.
Theodoros F. Katsivas, M.D., M.A.S., of UC San Diego Owen Clinic, presents "San Diego Primary Care Providers' Attitudes to HIV and HIV Testing" at AIDS Clinical Rounds
Health Promotion and Disease Prevention under the Aquino Health Agenda by Use...HealthJustice Philippines
The document discusses the Philippine health situation and efforts to promote health and prevent diseases under the Aquino Health Agenda. It outlines the current burden of non-communicable diseases in the Philippines, which are among the top causes of mortality. It also discusses the implementation of universal health care in the country to improve health outcomes through expanding access to essential health services. A key part of this is addressing non-communicable diseases by implementing strategies around prevention and control of risk factors like tobacco use, unhealthy diets, and physical inactivity.
This document summarizes a presentation on engaging physicians in prevention efforts to address the opioid epidemic. It was presented by Yngvild Olsen and included the following key points:
1. Multiple policies like PDMPs, medication-assisted treatment, and naloxone access need to work together to reduce opioid misuse and overdoses.
2. Programs that educate physicians about prescription drug abuse and its link to heroin, and engage them in prevention, screening, and treatment can help address the epidemic.
3. Expanding access to evidence-based treatment with medications like buprenorphine and naloxone, combined with behavioral therapies, can help manage opioid addiction as a chronic disease
This document outlines a proposed study to examine the prevalence of substance abuse and addictions in patients living with HIV and how it affects adherence to antiretroviral therapy (ART) regimens. The study will be conducted at an ART center in Mumbai, India over 18 months. It will collect data on immunological, demographic, and clinical information from patient medical records to analyze the effects of addictions on ART adherence and differences in types of addictions between gender. The document provides background on how substance abuse increases HIV disease progression and negatively impacts medication adherence and health. It lists the study objectives, inclusion/exclusion criteria, and references literature supporting the association between substance abuse and non-adherence to ART.
Jill Blumenthal, MD
Assistant Professor of Medicine
Division of Infectious Diseases and Global Public Health
Department of Medicine
University of California, San Diego
This research presentation summarizes a study on the prevalence and associated factors of substance use among HIV patients receiving ART treatment at Asella Hospital in Ethiopia. The study found that 27.5% of patients had a history of substance use, with alcohol being the most common at 13.6%. Being male, having substance-using friends or family were significantly associated with increased substance use. The study concludes substance use is an important issue among HIV patients and recommends increased awareness efforts by health professionals and further research by the university's public health department.
This document discusses harm reduction strategies and syringe exchange programs (SEPs). It provides evidence that SEPs are effective in preventing HIV and hepatitis C by allowing for safe disposal of used needles and connecting injection drug users to medical care. The document reviews how SEPs make communities safer by reducing improperly discarded syringes, protect first responders from needlestick injuries, and do not increase crime rates. SEPs are also cost-effective by saving millions in avoided healthcare costs from prevented infections. The discussion aims to increase support for SEPs by addressing common myths and concerns.
Dr. Tom Frieden, Director of the Centers for Disease Control and Prevention, keynote presentation at the National Rx Drug Abuse & Heroin Summit on March 30, 2016.
Here are the 11 DSM-5 criteria for substance use disorder filled in with the blank (___) replaced with "alcohol":
1. Alcohol is often taken in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
3. A great deal of time is spent in activities necessary to obtain alcohol, or recover from its effects.
4. Craving, or a strong desire or urge to use alcohol
5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused
Antonio Boone of the Office of HIV Planning reviewed major points from the Mayor's Task Force to Combat the Opioid Epidemic in Philadelphia at the June 12, 2017 Positive Committee meeting.
This document summarizes a presentation given by Neil Dugdale of Sobi (Swedish Orphan Biovitrum) at the 2017 Cambridge Rare Disease Network Summit. The presentation discusses Sobi's work in rare diseases, including developing orphan drugs, partnering with patient advocacy groups, and donating factor therapy to expand treatment access for hemophilia in developing countries. Sobi aims to pioneer new approaches to rare disease management through multi-stakeholder engagement and community co-creation.
This study examined prescription opioid use among disabled Medicare beneficiaries under age 65 from 2007 to 2011. The key findings were:
1. The proportion of beneficiaries using opioids chronically increased from 21.4% in 2007 to 23.1% in 2011, although other measures of intensity like daily morphine equivalent dose peaked in 2010 and declined slightly in 2011.
2. There was wide regional variation in opioid use measures across the US, for example the proportion of beneficiaries using opioids chronically ranged from 13.9% to 36.6% across regions in 2011.
3. Among chronic opioid users, the mean number of opioid prescribers per user was between 2.4-3.7 depending on the region,
This study analyzed prescription claims data from 238,402 patients with type 2 diabetes to identify predictors of changes in adherence to oral antidiabetes medications between years. The study found that about one third of patients changed adherence status from one year to the next, with about 22% becoming nonadherent after being adherent previously. For those who became nonadherent, the strongest predictors were the number of 90-day prescriptions filled, diabetes medication burden, longest gap in filling prescriptions, number of antidiabetes drug classes used, and copay for last drug. For those who became adherent after being nonadherent, the top predictors were medication burden, prescription gaps, fluctuating adherence, 90-day prescript
- Pharmacoepidemiology is the study of the use and effects of medications in large populations. It applies epidemiological methods to study drug effects and usage patterns in human populations.
- Several drug safety events throughout history led to the evolution and increased importance of pharmacoepidemiology, including the Elixir Sulfanilamide tragedy in 1937 and the Thalidomide crisis in the 1960s.
- Pharmacoepidemiology utilizes various study designs like case reports, case series, cross-sectional studies, cohort studies, and case-control studies to generate and test hypotheses about medication risks and benefits at a population level.
Similar to Embargo version rx15_tt_wed_300_zibbell (20)
Kana Enomoto, Acting Administrator, Substance Abuse and Mental Health Services Administration, keynote presentation at the National Rx Drug Abuse & Heroin Summit March 29, 2016
This document summarizes a presentation on managing morphine equivalent dose (MED) and identifying high-risk opioid use through "red flagging." It discusses how calculating MED at the point of sale can help identify unsafe dosages and decrease opioid prescriptions. It also evaluates different methods to screen for overdose risk, finding that simple opioid use thresholds to flag patients may not accurately target those most likely to experience preventable overdoses. The presentation aims to explain MED management, describe payer solutions that reduced opioid use, and identify more precise ways to intervene with highest-risk patients.
Web rx16 prev_tues_330_1_lawal_2warren_3huddleston_4pershingOPUNITE
This document discusses the role of health departments in preventing neonatal abstinence syndrome (NAS). It notes that NAS rates have increased significantly in recent years, disproportionately affecting women. Health departments engage in surveillance to monitor NAS trends, partner with other organizations, support treatment and recovery programs, and provide education to prevent NAS, which is entirely preventable. The document outlines specific strategies health departments use across these areas to address the opioid epidemic and protect maternal and infant health.
The document discusses the opioid crisis in the United States, including rising rates of prescription opioid misuse and abuse, as well as heroin use and overdose deaths. It outlines how research can help address this crisis through developing less abusable analgesics, expanding access to treatment medications like naloxone and buprenorphine, and exploring new treatment approaches such as immunotherapies and precision medicine targeting genetic factors. The National Institute on Drug Abuse is supporting these research efforts and working to disseminate findings to improve prevention and intervention programs.
This document summarizes the opioid crisis in the United States from 2000 to 2014. It shows that the number of opioid-related overdose deaths more than tripled during this period, increasing from about 8,000 to over 28,000. Additionally, 7.9 million Americans aged 12 or older met the criteria for an illicit drug use disorder in 2013-2014 but only 20% received treatment. The document outlines actions by the Obama administration to address the crisis and increase funding for treatment. It emphasizes that stories can help reduce stigma and that recovery is possible through working together.
Web rx16 prev_tues_200_1_bretthaude-mueller_2scott_3debenedittis_4cairnes copyOPUNITE
This presentation covered multi-media prevention strategies for issues like prescription drug overdoses. It discussed the CDC's digital Rx drug prevention campaign, best practices for digital messaging, and programs using expectancy challenge theory and media literacy education in schools. Presenters included representatives from the CDC, Media Literacy for Prevention, and the Hanley Center Foundation who discussed their work developing and implementing digital communications and single-session prevention programs.
This document discusses strategies for reducing buprenorphine diversion and pill mills while improving access to treatment. It notes that limiting access to buprenorphine treatment is associated with increased diversion, while expanded access to quality treatment decreases diversion and overdose deaths. The document recommends educating prescribers, using medically-derived prescribing standards, ensuring adequate insurance coverage of safe prescribing practices, and addressing diversion risks for other controlled medications. It argues against onerous new regulations that could limit treatment access. The goal is to identify and support high-quality treatment while prosecuting criminal operations.
This document summarizes a presentation on linking and mapping prescription drug monitoring program (PDMP) data. It discusses the benefits of linking PDMP data to clinical data, including improving patient safety, evaluating prescribing decisions, and assessing the impact of PDMP interventions. It describes challenges with linking data, such as obtaining consent and negotiating data use agreements. It also discusses Washington State's MAPPING OPIOID AND OTHER DRUG ISSUES (MOODI) tool, which integrates PDMP data with other databases to map and target treatment and overdose prevention efforts at the community level.
Rx16 prev wed_330_workplace issues and strategiesOPUNITE
This document discusses workplace issues related to prescription drug abuse and strategies for prevention. It begins with introductions of the presenters and moderators. The learning objectives are then outlined as understanding challenges of prescription drug abuse in the workplace, identifying prevention strategies, and describing programs available through SAMHSA. The document then covers topics such as the scope of prescription drug misuse among workers, risks to the workplace, prevention strategies employers can consider, and available resources from SAMHSA.
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This document discusses a presentation on pharmacy burglary, robbery, and diversion of prescription drugs. The presentation covers trends in prescription drug diversion, particularly those involving robbery and burglary of pharmacies. It identifies preventative measures to enhance pharmacy security and safety. Strategies to reduce pharmacy crimes are outlined. The offender perspective is examined based on interviews with convicted offenders. Routine activities theory is discussed as relating to suitable targets, capable guardians, and motivated offenders. Partnerships between regulatory agencies and law enforcement are emphasized as key to prevention efforts.
Linking and mapping PDMP data can provide several benefits but also faces challenges. Linking PDMP and clinical data allows for evaluating the impact of PDMP interventions on outcomes and prescribing decisions. However, obtaining permissions and data is difficult due to legal and resource barriers. Mapping PDMP data using GIS tools in Washington identified areas for targeting overdose prevention efforts by visualizing patterns in prescribing risks, treatment availability, and overdoses. Stakeholders used these maps to guide education and funding decisions. Sustaining these tools requires ongoing funding and expanding included data sources.
This document discusses drug court models and the role of law enforcement in drug courts. It begins with introductions from presenters and outlines learning objectives about explaining drug court operations and benefits, how law enforcement can utilize drug courts, and identifying best practices. The following sections provide details on drug court models, including how they integrate treatment into the justice system using a non-adversarial approach. Key components of drug courts are outlined, and presenters discuss issues like prescription drug and heroin abuse as well as outcomes from drug courts in reducing recidivism and saving money. Law enforcement can play roles in prevention, addressing domestic violence, and targeting the right populations for drug court involvement through assessment.
This document summarizes presentations from two communities - Huntington, WV and Camden County, NJ - on their responses to heroin crises. It outlines programs implemented in Huntington, including a harm reduction program, centralized information system, and drug court expansion. It also discusses the region's history with prescription drug abuse and rise in heroin and associated issues like hepatitis and neonatal abstinence syndrome. Long-term strategies proposed include expanding treatment services, promoting career opportunities for those in recovery, and preventing relapse through environmental design changes.
This document discusses neonatal abstinence syndrome (NAS) and universal maternal drug testing. It provides background information on NAS including trends showing large increases in incidence and costs associated with NAS. It outlines objectives related to describing NAS trends, identifying legislative activities impacting NAS, describing family planning for women in substance abuse treatment, and explaining a hospital program using universal drug testing. The document then covers topics including NAS symptoms, incidence and geographic trends, costs of NAS, opioid use in women of childbearing age, unintended pregnancy rates, contraceptive use among opioid users, and maternal drug exposure sources.
Web only rx16-adv_tues_330_1_elliott_2brunson_3willis_4deanOPUNITE
This document outlines an advocacy track presentation on activating communities to address prescription drug abuse. It provides biographies of the presenters and moderators and discloses any conflicts of interest. The learning objectives are to identify best practices for implementing CADCA's seven strategies for community change to impact prescription drug issues. It then provides examples of how various coalitions across the country are utilizing each of the seven strategies, such as providing education, enhancing skills, supporting communities, and changing policies.
This document discusses recovery ready ecosystems and recovery community organizations. It introduces presenters from Young People in Recovery and Hope House Treatment Track who will discuss interventions, prevention, and recovery programs. Examples of Young People in Recovery chapters, programs, and services are provided, including employment workshops, education workshops, housing workshops, and recovery support services. The document also discusses recovery community organizations and initiatives in Texas and Georgia, such as the Association of Persons Affected by Addiction in Dallas and the Georgia Council on Substance Abuse.
This document summarizes a presentation on health plan involvement in safe prescribing. It includes:
1) Presentations from medical experts on prescription drug abuse trends from medical examiner data and a tribal health system's safe prescribing program.
2) A discussion of health plan policies to reduce "red flag" medication combinations like opioids plus benzodiazepines through prior authorization, formulary changes, and provider restrictions.
3) Examples of one health plan's implementation of policies like restricting methadone prescriptions to pain specialists and removing carisoprodol from its formulary.
This document summarizes a presentation on youth performance-enhancing drugs and ADHD medication. It discusses trends in misuse of these substances among young people. The presentation is given by representatives from various organizations focused on prevention, health promotion, and substance abuse issues among youth and college students. The presentation covers types of performance-enhancing drugs and their potential side effects. It also discusses trends in attitudes towards these substances and risks of misuse. Strategies are presented for helping adolescents pursue their goals without these drugs. The document concludes by outlining plans for addressing misuse of ADHD medication among college students through education and collaboration between various stakeholder groups.
Health Tech Market Intelligence Prelim Questions -Gokul Rangarajan
The Ultimate Guide to Setting up Market Research in Health Tech part -1
How to effectively start market research in the health tech industry by defining objectives, crafting problem statements, selecting methods, identifying data collection sources, and setting clear timelines. This guide covers all the preliminary steps needed to lay a strong foundation for your research.
This lays foundation of scoping research project what are the
Before embarking on a research project, especially one aimed at scoping and defining parameters like the one described for health tech IT, several crucial considerations should be addressed. Here’s a comprehensive guide covering key aspects to ensure a well-structured and successful research initiative:
1. Define Research Objectives and Scope
Clear Objectives: Define specific goals such as understanding market needs, identifying new opportunities, assessing risks, or refining pricing strategies.
Scope Definition: Clearly outline the boundaries of the research in terms of geographical focus, target demographics (e.g., age, socio-economic status), and industry sectors (e.g., healthcare IT).
3. Review Existing Literature and Resources
Literature Review: Conduct a thorough review of existing research, market reports, and relevant literature to build foundational knowledge.
Gap Analysis: Identify gaps in existing knowledge or areas where further exploration is needed.
4. Select Research Methodology and Tools
Methodological Approach: Choose appropriate research methods such as surveys, interviews, focus groups, or data analytics.
Tools and Resources: Select tools like Google Forms for surveys, analytics platforms (e.g., SimilarWeb, Statista), and expert consultations.
5. Ethical Considerations and Compliance
Ethical Approval: Ensure compliance with ethical guidelines for research involving human subjects.
Data Privacy: Implement measures to protect participant confidentiality and adhere to data protection regulations (e.g., GDPR, HIPAA).
6. Budget and Resource Allocation
Resource Planning: Allocate resources including time, budget, and personnel required for each phase of the research.
Contingency Planning: Anticipate and plan for unforeseen challenges or adjustments to the research plan.
7. Develop Research Instruments
Survey Design: Create well-structured surveys using tools like Google Forms to gather quantitative data.
Interview and Focus Group Guides: Prepare detailed scripts and discussion points for qualitative data collection.
8. Sampling Strategy
Sampling Design: Define the sampling frame, size, and method (e.g., random sampling, stratified sampling) to ensure representation of target demographics.
Participant Recruitment: Plan recruitment strategies to reach and engage the intended participant groups effectively.
9. Data Collection and Analysis Plan
Data Collection: Implement methods for data gathering, ensuring consistency and validity.
Analysis Techniques: Decide on analytical approaches (e.g., statistical
India Medical Devices Market: Size, Share, and In-Depth Competitive Analysis ...Kumar Satyam
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Recent Trends
Strategic Collaborations and Partnerships
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Browse over XX market data Figures and spread through XX Pages and an in-depth TOC on " India Medical Devices Market.” - https://www.techsciresearch.com/report/india-medical-devices-market/8161.html
The Ultimate Guide in Setting Up Market Research System in Health-TechGokul Rangarajan
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"Market Research it too text-booky, I am in the market for a decade, I am living research book" this is what the founder I met on the event claimed, few of my colleagues rolled their eyes. Its true that one cannot over look the real life experience, but one cannot out beat structured gold mine of market research.
Many 0 to 1 startup founders often overlook market research, but this critical step can make or break a venture, especially in health tech.
But Why do they skip it?
Limited resources—time, money, and manpower—are common culprits.
"In fact, a survey by CB Insights found that 42% of startups fail due to no market need, which is like building a spaceship to Mars only to realise you forgot the fuel."
Sudharsan Srinivasan
Operational Partner Pitchworks VC Studio
Overconfidence in their product’s success leads founders to assume it will naturally find its market, especially in health tech where patient needs, entire system issues and regulatory requirements are as complex as trying to perform brain surgery with a butter knife. Additionally, the pressure to launch quickly and the belief in their own intuition further contribute to this oversight. Yet, thorough market research in health tech could be the key to transforming a startup's vision into a life-saving reality, instead of a medical mishap waiting to happen.
Example of Market Research working
Innovaccer, founded by Abhinav Shashank in 2014, focuses on improving healthcare delivery through data-driven insights and interoperability solutions. Before launching their platform, Innovaccer conducted extensive market research to understand the challenges faced by healthcare organizations and the potential for innovation in healthcare IT.
Identifying Pain Points: Innovaccer surveyed healthcare providers to understand their difficulties with data integration, care coordination, and patient engagement. They found widespread frustration with siloed systems and inefficient workflows.
Competitive Analysis: Analyzed competitors offering similar solutions in healthcare analytics and interoperability. Identified gaps in comprehensive data aggregation, real-time analytics, and actionable insights.
Regulatory Compliance: Ensured their platform complied with HIPAA and other healthcare data privacy regulations. This compliance was crucial to gaining trust from healthcare providers wary of data security issues.
Customer Validation: Conducted pilot programs with several healthcare organizations to validate the platform's effectiveness in improving care outcomes and operational efficiency. Gathered feedback to refine features and user interface.
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According to the TechSci Research report titled "India Home Healthcare Market - By Region, Competition, Forecast and Opportunities, 2029," the India home healthcare market is anticipated to grow at an impressive rate during the forecast period. This growth can be attributed to several factors, including the rising demand for managing health issues such as chronic diseases, post-operative care, elderly care, palliative care, and mental health. The growing preference for personalized healthcare among people is also a significant driver. Additionally, rapid advancements in science and technology, increasing healthcare costs, changes in food laws affecting label and product claims, a burgeoning aging population, and a rising interest in attaining wellness through diet are expected to escalate the growth of the India home healthcare market in the coming years.
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Mental Health and well-being Presentation. Exploring innovative approaches and strategies for enhancing mental well-being. Discover cutting-edge research, effective strategies, and practical methods for fostering mental well-being.
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We look into the evolution of health informatics and its applications in the healthcare industry.
HIMMS TIGER resources are available to assist Health Informatics education.
Indian Health universities, IT Education institutions, and the healthcare industry must proactively collaborate to start health informatics courses on a big scale. An advocacy push from various stakeholders is also needed for this goal.
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Research, Monitoring and Evaluation, in Public Healthaghedogodday
This is a presentation on the overview of the role of monitoring and evaluation in public health. It describes the various components and how a robust M&E system can possitively impact the results or effectiveness of a public health intervention.
Research, Monitoring and Evaluation, in Public Health
Embargo version rx15_tt_wed_300_zibbell
1. Trending Topics Track
Emerging Epidemic: Hepatitis C
Infection among Young Persons
Who Inject Drugs
Presenter
Jon E. Zibbell, PhD, Health Scientist, Division of Viral Hepatitis,
Centers for Disease Control and Prevention
Moderator
Jinhee Lee, PharmD, CDR, Senior Public Health Advisor, Division of
Pharmacologic Therapies, Center for Substance Abuse Treatment,
SAMSHA, and Member, Rx Summit National Advisory Board
Contributor
Emily Winkelstein, MSW, Project Director, Collaborative Hepatitis
Outreach and Integrated Care Evaluation Study, National
Development and Research Institutes
2. Disclosures
• Jon E. Zibbell, PhD, and Jinhee Lee, PharmD, CDR,
have disclosed no relevant, real, or apparent
personal or professional financial relationships with
proprietary entities that produce healthcare goods
and services.
• Emily Winkelstein, MSW – Consulting fees: Prochilo
Health Inc.
3. Disclosures
• All planners/managers hereby state that they or their
spouse/life partner do not have any financial
relationships or relationships to products or devices
with any commercial interest related to the content of
this activity of any amount during the past 12 months.
• The following planners/managers have the following to
disclose:
– Kelly Clark – Employment: Publicis Touchpoint Solutions;
Consultant: Grunenthal US
– Robert DuPont – Employment: Bensinger, DuPont &
Associates-Prescription Drug Research Center
– Carla Saunders – Speaker’s bureau: Abbott Nutrition
4. Learning Objectives
1. Describe the emerging epidemic of HCV
infection among young persons.
2. Explain the association between the
emerging epidemic of HCV infections among
young persons and the Rx drug epidemic in
Appalachia.
3. Identify strategies for HCV prevention, care
and treatment for young PWID.
5. Emerging Epidemic: Hepatitis C Infection
among Young Persons Who Inject Drugs
and Misuse Prescription Opioids
Jon E. Zibbell, PhD
Centers for Disease Control and Prevention
Division of Viral Hepatitis
Prevention Research Branch
6. Learning objectives
• Describe the emerging epidemic of HCV infection
among young persons.
• Explain the association between the emerging
epidemic of HCV infections among young persons
and the Rx drug epidemic in Appalachia.
• Identify strategies for HCV prevention, care and
treatment for young PWID.
7. HCV in the United States
• 4.1 million HCVab infected persons, with 75% of these chronic infections
(3.2 million)
• The most common bloodborne infection in the United States
• HCV-related deaths doubled from 1999-2007 to over 16,000/year
• Leading cause of liver transplants and liver cancer [hepatocellular
carcinoma (HCC)]
– HCC fasting rising cause of cancer-related death
• Injection drug use (IDU) is the principle “motor” of incidence
Approximately 2.7 million persons chronically infected [CI: 2.4—2.9]
Estimate excludes institutionalized and homeless persons
The most common bloodborne infection in the United States
HCV-related deaths doubled from 1999-2007 to over 17,000/year
Leading cause of liver transplants and liver cancer [hepatocellular
carcinoma (HCC)]
HCC fasting rising cause of cancer-related death
Injection drug use (IDU) is the principle driver of incidence
Denniston et al. Ann Intern Med, 2014 ; Armstrong et al. Ann Intern Med, 2006
8. Age-Adjusted Rates of Mortality: Hepatitis B,
Hepatitis C, and HIV, United States, 1999–2007*
0
1
2
3
4
5
6
7
1999 2000 2001 2002 2003 2004 2005 2006 2007
Rateper100,000Persons
Year
Hepatitis B
Hepatitis C
HIV
• In 2007, > 70% of registered deaths in HCV-infected were aged
45-64 years old
*Ly et al. The increasing burden of mortality from viral hepatitis in the United States between 1999 and 2007. Ann Intern
Med. 2012, June 5: 156(4):271-8
9. HCV Cases from Injection Drug Use
• IDU most reported risk factor for acute infections
• Anti-HCV prevalence among persons who inject
drugs (PWID) between 30% and 70%
• Anti-HCV prevalence among younger (<30 yrs)
between 10% and 36%
• HCV incidence between 16% and 42% per year
Hagan et al. 2010; Garfein et al. 1998; Armstrong et al. 2006; Amon et al. 2008; Klevens et al. 2013; Daniels et al. 2007
12. Increases in New HCV Infections
50% increase in national reporting
200% increase in 17 states
Recent studies show
~70% report IDU
Ages 18 to 29 years
Predominantly white
Equally female and male
Non-urban and urban
Antecedent prescription opioid
misuse among PWID
Source: CDC/hepatitis.gov; MMWR 2011; MMWR 2014; CDC unpublished data.
2007-2012
13.
14. Injection Behavior and Drugs Used by Persons 18-29
Years of Age with Acute HCV Infection
• 1202 cases of acute HCV investigated
– 52% female
– 85% white
– 77% persons injected drugs
o 57% shared needles/syringes
o 82% shared equipment
• Percent use and mean age of drug use initiation
- Powder cocaine: 71%,: 17.4 yrs.
- Prescription opioids 76% : 17.9 yrs.
- Heroin: 61%: 19.7 yrs.
Suryaprasad et al., CID, 2014
15. Changing Demographics of HCV Incidence
• During 1990s anti-HCV prevalence was higher among men,
Black Americans, urban residents and persons 40-49 years
aged.
• New cases largely involve males and females equally; mostly
white, rural and suburban residents; persons 18-29 years
aged.
• Key difference: prescription opioid misuse
16. Prescription Opioids Distributed*
(kilograms of opioid analgesics prescribed per 10,000 persons)
*Drug Enforcement Agency, 2010, Automation of Reports and Consolidated Orders System (ARCOS)
19. 0
5
10
15
20
25
30
35
40
2006 2007 2008 2009 2010 2011 2012
ProportionofAllAdmissions
Any Opioid
Admissions
Any Opioid
Admissions < 30
Prescription Opioid
Admissions
Prescription Opioid
Admissions < 30
National Drug Treatment Admissions: All ages vs. <30
*SAMHSA, TEDS—A; Preliminary analysis
20. Opioid deaths, sales, and treatment admissions have increased
in lock step
National Vital Statistics System, DEA’s Automation of Reports and Consolidated Orders System, SAMHSA’s TEDS: National Center for Injury Prevention and Control
0
1
2
3
4
5
6
7
8
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Opioid Sales (kg per 10k)
Opioid Deaths (per 100k)
Opioid Treatment Admissions (per 10k)
21. 0
4
8
12
16
20
2006 2007 2008 2009 2010 2011 2012
ProportionofAllAdmissions
Any Opioid Injection
Any Opioid Injection <30
Other Drug Injection
Other Drug Injection <30
National Drug Injection Trends: All ages vs. <30*
*SAMHSA, TEDS—A; Preliminary analysis
23. Multivariate Associations with anti-HCV positivity‡
5.53
3.79
0 2 4 6 8 10 12 14 16
Inject prescription opioid
Share equipment*
† p-value <0.05
1
*Equipment sharing, injecting prescription opiate , fishing for a vein, and using an SEP
are all measured for within the past 12 months. Prescription opiates respondents reported injecting Opana (n=58), Oxycontin
(n=21), Dilaudid (n=7), Roxycontin (n=3), Morphine (n=4); Vicodin (n=1), Percocet (n=1) (categories not mutually exclusive)
‡ Zibbell et al., AJPH, 2014
24. Heroin use and dependence
is also increasing
SAMHSA, NSDUH, 2012, National Center for Injury Prevention and Control
0
500
1,000
1,500
2,000
2,500
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Estimated#ofpersons12yearsandolderreporting
abuse/dependence
(inthousands)
214K
467K
>2 million
Heroin
Opioids
25. Special Thanks:
Departments of Health: KY; TN; VA; WV
Rachel Hart-Malloy, PhD, MPH
Scott Holmberg, MD
Deborah Holtzman, PhD
Kashif Iqbal, MPH
Brian Manns, PHARM-D
Rajiv Patel, MPH
Anil Suryprasad, MD, MPH
Claudia Vellozzi, MD, MPH
John Ward, MD
27. Learning objectives
• Describe the emerging epidemic of HCV
infection among young persons.
• Explain the association between the emerging
epidemic of HCV infections among young
persons and the Rx drug epidemic in
Appalachia.
• Identify strategies for HCV prevention, care
and treatment for young PWID.
28. Overview
• Offer insight from personal practice
experience
• Share feedback given from younger clients
and peers
• Provide context within a harm reduction
framework
• Explore the role of drug-related stigma
29. What is Harm Reduction?
• A philosophy
• A service delivery model
• A proven effective public health strategy that
reduces harm to people who use drugs and
struggle with related issues
– Includes and embraces abstinence, but does not
assume or require cessation of use
• A social justice and human rights movement
Harm Reduction Coalition, harmreduction.org
30. Basic Principles of Harm Reduction
• Sometimes people engage in behaviors that are
harmful to themselves or others.
• People may engage in these behaviors even if
they know they’re harmful, illegal, unhealthy, or
cause harm to others.
• However, people may be willing and able to
make some changes to decrease the risk of harm
to themselves and their community.
• “Any positive change”
31. Harm Reduction
• Harm reduction doesn’t promote, encourage
or require active drug use
• Drug use can be very harmful – and – we have
to be cautious in assuming or defining harm.
• We do not have control over outcomes or
behaviors – but we can influence process and
provide education
• People may still make unhealthy choices
32. The Problem
• Prescription opioid misuse among youth is high
– white, young adults, non-urban
• Non-medical use of prescription opioids increases
likelihood of transition to injection/heroin use
– Sequelae: increased ER visits, dependence, overdose,
infectious disease; endocarditis; abscesses
• Several recent HCV outbreaks reported
– MA, NY, KY, WI, VA, PA, FL and IN (w/HIV)
• Supply-side strategies alone are insufficient
CDC; DHHS; Cicero 2014; Jones 2013; Hagan 2008; Keyes 2014; Page 2013; Peavy 2012; Arman 2008
33. Differences between HIV and HCV
• HCV is currently more prevalent than HIV
– More people test HCV AB positive
– HCV causing more deaths than HIV
• HCV replicates faster and thus more infectious than HIV
– HCV remains viable for long periods of time outside of the
host, increasing number of transmission fomites
– Results in high viral loads (i.e. there is a lot of virus in per
measure of blood)
• HCV is less likely to be sexually transmitted
• SEPs not as effective reducing HCV incidence compared
to HIV
CDC; Ly 2012; Wicker 2008
34. Lessons from HIV
• HIV rates have fallen dramatically
– PWID account for 8% of new HIV infections v. 55%
in 1990
• Syringe access programs were incredibly
valuable in this effort
• Early HIV messages failed to include
information about risk from ancillary injection
equipment
• Education was widespread, specific,
targeted
CDC; Des Jarlais 2005
35. Urban vs. Non-Urban (Rural, Suburban)
• Higher rates of prescription opioid injection
• Transition to injection may happen earlier
• Less access to harm reduction resources
• Less access to primary and specialized medical care
• Less access to drug treatment, including methadone
and buprenorphine
• Confidentiality and disclosure issues (small, insular
communities)
• High poverty/unemployment rates, lower education
• Less research on effective prevention and treatment
strategies in rural areas
Christian et al 2010; Keyes 2014; Havens et al, 2011; Young et al 2012
36. Influences on Injection-related Risk
• Who
– Number of injection partners; Control over injection; Control
over drug preparation; Power dynamics
• What
– Drug of choice; Formulation; Injection equipment
• Where
– Injection spaces; Privacy; Proximity to services/equipment; Vein
health and location
• When
– Adequate time; Frequency of injection
• Why
– Recreation v. dependence; Trauma; Boredom; Fatalistic
Worldview; Lack of hope for future
37. Why Engage Youth?
• Large numbers of youth are using Rx opioids & heroin
– Enforcement and supply-side strategies alone will not work
for everyone
– Harm reduction and engagement are necessary to reduce
negative consequences of the epidemic
• Youth can and will engage in healthier behaviors when
offered information/tools and treated with respect
• There is a finite window of opportunity to prevent HCV
transmission
– 32% PWID become HCV-infected within 1 year of injecting
– 53% become infected within 5 years
– New injectors develop routines/rituals/patterns
Hagan et al. 2008; Paterson 2008; Raymond 2015
38. Youth
• Isolation from services and medical care; fear
and mistrust
• Invincibility; Haven’t “hit bottom”
• Lack of specific education and knowledge
• Lack of historical memory (e.g. AIDS epidemic)
• Social network issues – Injection patterns,
serosorting, partner roles
• Engagement: Living at home vs. street
involved
39. The Players
• Young people (>12 years of age)
• People who use drugs
– Anyone who experiences an accidental, non-fatal drug
overdose
• Family, friends and partners
• Educators
• Pharmacists
• Healthcare providers
• Community-based organizations
• Houses of worship
• Law enforcement
• Drug sellers
40. Strategies for Engaging Youth
• Meet people where they are – literally and
figuratively
• Keep access low-threshold
• Offer things that people need
• Provide information and tools – not directives,
ultimatums, demands
• Recruit ambassadors/peers
• Be consistent
• Be respectful
• Honor autonomy
41. Meeting People Where They Are
• Schools
• Hangouts (bars, parks, local spots, etc.)
• Medical centers (testing sites, free clinics, VA)
• Pharmacies
• Community-based organizations
• Jails and other state institutions
• Drug treatment facilities
• Mental health centers
• Trauma centers
• Social media
42. Engagement
• Every interaction has the potential to build
trust or diminish it
• Every interaction has the potential reinforce
stigma or challenge it
• Every interaction has the potential to increase
dialogue or shut it down
• Every interaction has the potential to increase
health – baby steps are important
43. Role of Stigma in Perpetuating Risk
• Often decreases willingness to access care and
services
• Erodes relationships and trust
• Can increase patient risk and make healthy
choices less likely
– Fear of disclosure, increased isolation
• Can decrease patient sense of self-worth
– Guilt, shame, self-blame, weakness
44. Syringe Access
• Syringe access programs are critical to engagement
of PWID
– Cost effective, link people to treatment and prevention
services, promote public safety, and reduce health
disparities
– Insufficient access, especially in non-urban areas
– Federal ban on funding of syringe access programs
• Secondary and peer distribution
• Over-the-counter pharmacy access
• Physician prescribing (e.g. buprenorphine docs)
amfAR, 2013
45. Drug Treatment
• Abstinence-based and medicated-assisted therapy
• Young people may not know their options
– More options are needed
– Learn what options are available in your area
• Youth-centered drug treatment is important
• Managed or moderated use are important options
– Alternate routes of use; taking breaks; order of use
• Opioid agonist therapy is highly effective, but not
widely available in non-urban areas
– Methadone, buprenorphine (Suboxone®)
• Confidentiality is needed; parental and family
involvement adds complications
Nolan, 2014
46. Linkage to HCV Testing and Care
• Increased testing is needed; reflex testing
– Testing is a link to engagement, education and
behavioral change
• Offer at Community Health Centers, STI clinics,
syringe access programs, methadone clinics,
buprenorphine docs, correctional facilities
• Increase testing in areas where prescription
opioid misuse is endemic
• Offer incentives for testing in resource-deprived
areas
• Co-localize HCV treatment with drug treatment
settings (SAMHSA and DVH)
47. Role of HCV Treatment
• Traditionally, PWID have had limited access to
HCV treatment
• Treatment restrictions/abstinence requirements
for illicit drug use in most states
• Recent advances in HCV antiviral therapy
– Easy to tolerate
– 95-100% effective, simpler monitoring
– Short duration (8-12 weeks)
• Treatment as prevention
– Minimize transmission within networks
• Treatment as an opportunity for engagement
and ongoing prevention education
49. Trending Topics Track
Emerging Epidemic: Hepatitis C
Infection among Young Persons
Who Inject Drugs
Presenter
Jon E. Zibbell, PhD, Health Scientist, Division of Viral Hepatitis,
Centers for Disease Control and Prevention
Moderator
Jinhee Lee, PharmD, CDR, Senior Public Health Advisor, Division of
Pharmacologic Therapies, Center for Substance Abuse Treatment,
SAMSHA, and Member, Rx Summit National Advisory Board
With Appreciation To
Emily Winkelstein, MSW, Project Director, Collaborative Hepatitis
Outreach and Integrated Care Evaluation Study, National
Development and Research Institutes
Editor's Notes
2007 – HIV 13K vs. HCV 15K
In the US, 1.2m HIV and 3.2m HCV
Many States Are Reporting Increases in New HCV Infection- This data from 2007-2012
New HCV infections are mostly PWID and highest risk in those who previously used prescription narcotics. These are young PWID, equally male female and in both urban and non-urban areas.
S
since 2010, as you can see in the figure on the left, there has been a substantial increase in case reports of acute hepatitis C in all age groups. As opposed to previous years, however, the annual incidence in persons aged ≤30 years since 2010 has exceeded the annual incidence in all age groups combined.
Number of persons w/ heroin dependence/abuse more than doubled from 2007 to 2012 (214,000 to 467,000)
Sterile syringes AND injection equipment
Syringe access programs
Pharmacy
Prescription
Sterile injection surface
Hand washing
Finding and rotating veins (vein health)
Maintaining control over injection process
Finding a safe place to inject (physical location)