James M. McMahon

Sharing of Noninjection Drug-Use Implements as a Risk Factor for Hepatitis C

This study examined sharing noninjection drug implements as a risk factor for hepatitis C (HCV) infection among women drug users (n = 123) with no history of drug injection. Participants were street-recruited from East Harlem, New York City, between October 1997 and June 1999. Participants were administered a survey measuring risk factors for HCV. Prevalence of HCV and HIV infections was 19.5% and 14.6%, respectively. Multiple logistic regression determined significant associations between sharing noninjection drug-use implements and HCV infection. “Ever shared both oral and intranasal noninjection drug implements” was independently associated with HCV infection [Odds ratio (OR) 2.83; Confidence interval (CI) 1.04, 7.72; p = 0.04]; “ever shared noninjected heroin implements with an injector” was a trend (OR 3.06; CI. 85, 10.79; p = 0.08). The strongest association between sharing noninjection drug-use implements and HCV infection was found among HIV positive individuals (χ2 = 8.8, 1 d.f., p < 0.01). These findings, if supported by future research, indicate a need to reassess policies regarding HCV infection.

HEPATITIS C AMONG NONINJECTING DRUG USERS: A REPORT

Objectives: This report documents the prevalence of hepatitis C virus (HCV) infection among self-reported noninjecting drug users recruited from two New York City neighborhoods. Methods: Participants were recruited in separate studies from East Harlem and the Lower East Side of Manhattan and were administered structured questionnaires and tested for HCV. Results: HCV prevalence rates among those reporting no history of injecting drugs ranged from 5% to 29%, according to age, gender, and study location. Conclusions: Our results suggest that more research is needed to elucidate potential noninjecting routes of HCV transmission among drug users. Moreover, policies that rely predominantly on injector status as the only drug-related risk factor for HCV screening need to be reassessed in light of these findings.

Receptive syringe sharing among injection drug users in Harlem and the Bronx during the New York State Expanded Syringe Access Demonstration Program.

Background:Effective on January 1, 2001, New York State enacted the Expanded Syringe Access Demonstration Program (ESAP), which allows syringes to be sold in pharmacies without a prescription or dispensed through doctors, hospitals, and clinics to persons 18 years of age or older and permits the possession of those syringes for the purposes of injecting drugs. Objective:To assess changes in receptive syringe sharing since the inception of the ESAP. Methods:Sociodemographic characteristics and syringe use data regarding the last injection episode were combined from 3 projects (n = 1181) recruiting injection drug users in ongoing studies in Harlem and the Bronx in New York City from January 2001 through June 2003. These data were analyzed as serial cross sections by calendar quarter. Results:Receptive sharing decreased significantly over time, from 13.4% in the first quarter to 3.6% in the last quarter. Obtaining the last injection syringe from an ESAP source (mostly pharmacies) increased significantly over time, from 7.5% in the first quarter to 25.0% in the last quarter. In multiple logistic regression analysis, variables that were significantly associated with less receptive sharing were syringe exchange and ESAP syringe source as well as time since ESAP inception. Female gender and white race/ethnicity were significantly associated with greater receptive sharing. Conclusions:The increase in the use of pharmacies and other ESAP syringe sources in this sample has been accompanied by a decline in receptive sharing.

Intranasal Transmission of Hepatitis C Virus: Virological and Clinical Evidence

Intranasal transmission of hepatitis C virus (HCV) via contaminated drug-sniffing implements is a potential but unconfirmed source of viral infection. We demonstrate the virological plausibility of intranasal transmission by confirming that blood and HCV RNA are present in the nasal secretions and drug-sniffing implements of HCV-infected intranasal drug users recruited from a community health clinic in New York City.

A Potential Hidden Source of Hepatitis C Infection Among Noninjecting Drug Users

Abstract Hepatitis C virus (HCV) is a major cause of chronic liver disease in the United States and worldwide. It is primarily transmitted through blood-to-blood contact with an infected individual. HCV is hyperendemic among injection drug users (IDUs), who contract the virus through contaminated syringes and drug preparation equipment shared with other IDUs. The prevalence of HCV is also high, to a lesser degree, among noninjection drug users, many of whom repon no identifiable HCV risk exposures. This anicle reviews the epidemiological and virological evidence bearing on a potential hidden source of HCV infection among noninjection drug users: namely, the oral or intranasal transmission of HCV through the sharing of noninjection drug-use implements such as pipes or straws. While there is some epidemiological evidence supponing both oral and intranasal HCV transmission, most studies are hampered by methodological limitations. Thus, there is a need for prospective studies designed specifically to examine these potential routes of transmission. Current biological evidence does not refute either oral or intranasal transmission as possible sources of HCV infection, although more research is needed in the areas of oronasal HCV pathogenesis and the detection of HCV RNA in the nasal mucosa of intranasal drug users.

Women's drug injection practices in East Harlem: an event analysis in a high-risk community.

This study described the most recent injection events of injection-drug-using women, determined the prevalence of HIV, hepatitis B (HBV), and hepatitis C (HCV), and identified significant predictors of injection-related risk behaviors. After validation of drug use, 185 street-recruited women participated in structured interviews and were offered HIV, HBV, and HCV testing and counseling. Interview topics included (1) demographic characteristics, (2) characteristics of injection partners (IPs), and (3) relevant situation-specific factors. Prevalence was 28% for HIV infection, 80% for HBV, and 70% for HCV. Injection events were either solitary (n = 110) or social (n = 75). Most were safe, and 75% of syringes used were obtained from a syringe exchange. Inferential analyses identified two variables that independently predicted unsafe events: (1) respondent had injected previously with her IP, and (2) her IP was her spouse or primary heterosexual partner. Two trends were identified: Injection events in which women felt “very close” to their IP or reported lack of control over injection practices tended to be unsafe. Although most events were safe, safe practices were not adhered to with spouses or primary partners. Syringe exchanges should be supported and may be an ideal setting for interventions targeted to drug-injecting couples.

The validity, reliability, and utility of the iButton® for measurement of body temperature circadian rhythms in sleep/wake research

OBJECTIVE Changes in core body temperature due to heat transfer through the skin have a major influence on sleep regulation. Traditional measures of skin temperature are often complicated by extensive wiring and are not practical for use in normal living conditions. This review describes studies examining the reliability, validity and utility of the iButton®, a wireless peripheral thermometry device, in sleep/wake research. METHODS A review was conducted of English language literature on the iButton as a measure of circadian body temperature rhythms associated with the sleep/wake cycle. RESULTS Seven studies of the iButtton as a measure of human body temperature were included. The iButton was found to be a reliable and valid measure of body temperature. Its application to human skin was shown to be comfortable and tolerable with no significant adverse reactions. Distal skin temperatures were negatively correlated with sleep/wake activity, and the temperature gradient between the distal and proximal skin (DPG) was identified as an accurate physiological correlate of sleep propensity. Methodological issues included site of data logger placement, temperature masking factors, and temperature data analysis. CONCLUSIONS The iButton is an inexpensive, wireless data logger that can be used to obtain a valid measurement of human skin temperature. It is a practical alternative to traditional measures of circadian rhythms in sleep/wake research. Further research is needed to determine the utility of the iButton in vulnerable populations, including those with neurodegenerative disorders and memory impairment and pediatric populations.

Recruitment of heterosexual couples in public health research: a study protocol

BackgroundPublic health research involving social or kin groups (such as sexual partners or family members), rather than samples of unrelated individuals, has become more widespread in response to social ecological approaches to disease treatment and prevention. This approach requires the development of innovative sampling, recruitment and screening methodologies tailored to the study of related individuals.MethodsIn this paper, we describe a set of sampling, recruitment and screening protocols developed to enlist urban, drug-using, heterosexual couples into a public health research study. This population is especially hard to reach because they are engaged in illegal and/or stigmatized behaviors. The protocols were designed to integrate adaptive sampling, street- and referral-based recruitment, and screening procedures to verify study eligibility and relationship status.DiscussionRecruitment of heterosexual couples through one partner, preferably the female, can be an effective enlistment technique. Verification of relationship status is an important component of dyadic research. Comparison of parallel questionnaires administered to each member of a dyad can aid in the assessment of relationship status. However, multiple independent sources of information should be used to verify relationship status when available. Adaptive sampling techniques were effective in reaching drug-using heterosexual couples in an urban setting, and the application of these methods to other groups of related individuals in clinical and public health research may prove to be useful. However, care must be taken to consider potential sources of sampling bias when interpreting and generalizing study results.

Contextual Determinants of Condom Use Among Female Sex Exchangers in East Harlem, NYC: An Event Analysis

Recent studies have revealed a variety of contexts involving HIV risk behaviors among women who exchange sex for money or drugs. Event analysis was used to identify the individual, relationship, and contextual factors that contribute to these high-risk sex exchange practices. Analyses were conducted on data obtained from 155 drug-using women who reported details of their most recent sex exchange event with male clients. The majority of sex exchange encounters (78%) involved consistent condom use. In multivariable analysis, protective behavior was associated primarily with situational and relationship variables, such as exchange location, substance use, sexual practices, and respondent/client discussion and control. In order to inform HIV prevention programs targeted to women sex exchangers, further research is needed on the contextual determinants of risk, especially with regard to condom-use negotiation and factors involving substance use that adversely affect womens ability to manage protective behavior in the context of sex exchange.

Oral pre-exposure prophylaxis (PrEP) for prevention of HIV in serodiscordant heterosexual couples in the United States: opportunities and challenges.

Oral HIV pre-exposure prophylaxis (PrEP) is a promising new biomedical prevention approach in which HIV-negative individuals are provided with daily oral antiretroviral medication for the primary prevention of HIV-1. Several clinical trials have demonstrated efficacy of oral PrEP for HIV prevention among groups at high risk for HIV, with adherence closely associated with level of risk reduction. In the United States (US), three groups have been prioritized for initial implementation of PrEP-injection drug users, men who have sex with men at substantial risk for HIV, and HIV-negative partners within serodiscordant heterosexual couples. Numerous demonstration projects involving PrEP implementation among MSM are underway, but relatively little research has been devoted to study PrEP implementation in HIV-serodiscordant heterosexual couples in the US. Such couples face a unique set of challenges to PrEP implementation at the individual, couple, and provider level with regard to PrEP uptake and maintenance, adherence, safety and toxicity, clinical monitoring, and sexual risk behavior. Oral PrEP also provides new opportunities for serodiscordant couples and healthcare providers for primary prevention and reproductive health. This article provides a review of the critical issues, challenges, and opportunities involved in the implementation of oral PrEP among HIV-serodiscordant heterosexual couples in the US.