BackgroundAssisted injection is common among people who inject drugs (IDU), and has been associated with elevated risk for HIV infection and overdose. However, this practice has not been explored in the Asian context, including in Thailand, where HIV prevalence among IDU remains high.MethodsUsing multivariate logistic regression, we examined the prevalence and correlates of assisted injecting among IDU participating in the Mitsampan Community Research Project in Bangkok. We also sought to identify reasons for engaging in assisted injecting and those who provide this form of assistance.ResultsIn total, 430 IDU participated in this study, including 376 (87.5%) who reported having ever required assistance injecting, and 81 (18.8%) who reported assisted injecting in the previous six months. In multivariate analyses, assisted injecting in the previous six months was independently and positively associated with being female (adjusted odds ratio [AOR] = 2.42; 95% confidence interval [CI]: 1.40 – 4.18), being a weekly heroin injector (AOR = 1.78; 95% CI: 0.99 – 3.20), syringe sharing (AOR = 2.08; 95% CI: 1.18 – 3.68) and soft-tissue infection (AOR = 3.51; 95% CI: 1.43 – 2.53). Having a longer injecting career (AOR = 0.96; 95% CI: 0.94 – 0.99) was negatively associated with assisted injecting. Primary reasons given for engaging in assisted injecting included being new to injecting and lacking knowledge on how to inject. The most common providers of assistance with injecting were close friends.ConclusionWe found a high prevalence of assisted injecting among IDU in Bangkok, with females, frequent heroin injectors, those with shorter injecting careers being more likely to engage in this practice. Those who require help with the injecting process are more likely to share syringes, and have skin infections. These findings indicate the need for interventions focused on promoting safer and self-administered injections.

Objectives Sub-optimal adherence to antiretroviral therapy (ART) among HIV-infected people who use illicit drugs (PWUD) remains a significant concern, and there is a lack of effective adherence interventions for this population. Therefore, we sought to identify psychosocial determinants of optimal adherence, including adherence self-efficacy and outcome expectancies, with the aim of informing interventions designed to improve adherence among PWUD. Methods From December 2005 to November 2013, data were derived from the AIDS Care Cohort to evaluate Exposure to Survival Services (ACCESS), a prospective cohort of PWUD in Vancouver, Canada. Multivariable generalized estimating equations (GEE) analysis was used to identify longitudinal factors independently associated with ≥95% adherence to ART. Results Among 667 participants, including 220 (33%) women, 391 (59%) had ≥95% ART adherence at baseline. In multivariable GEE analysis, adherence self-efficacy (Adjusted Odds Ratio [AOR] = 1.16, 95% Confidence Interval [CI]: 1.11 - 1.21 per 10-point increase) was independently and positively associated with adherence, while negative outcome expectancy (AOR = 0.95, 95% CI: 0.93 - 0.98) was negatively associated. Conclusions In light of the ongoing challenges associated with ART adherence among HIV-positive PWUD, and our findings of associations between adherence, self-efficacy and outcomes expectancies, tailored intervention strategies based on constructs of social learning theory should be implemented and evaluated in an effort to improve adherence among HIV-infected PWUD.

Objective: North America is in the midst of a growing drug overdose crisis. While prescription opioid misuse and synthetic opioids such as fentanyl have been implicated in the overdose crisis, less attention has been given to the role that posttraumatic stress disorder (PTSD) may play in this crisis. As such, this study sought to examine the relationship between PTSD and risk of nonfatal overdose among people who use drugs (PWUD). Method: Data were derived from three prospective cohorts of PWUD in Vancouver, Canada. For each participant, PTSD was assessed using the PTSD Checklist for the DSM-5. Multivariate logistic regression analysis was used to estimate the relationship between PTSD and nonfatal overdose, adjusting for potential confounders. Results: Between 2016 and 2018 among 1,059 PWUD, including 363 (34%) nonmale participants, 171 (16%) experienced a nonfatal drug overdose in the past 6 months, and 414 (39%) met criteria for a provisional PTSD diagnosis. In multivariate analysis, PTSD (adjusted odds ratio = 1.98, 95% confidence interval [1.4, 2.79]) remained independently associated with nonfatal overdose after adjustment for a range of confounders. Conclusions: Among participants in these community-recruited cohorts of PWUD, having a provisional PTSD diagnosis nearly doubled the risk of nonfatal overdose. The findings from this study support the need to incorporate a trauma-informed approach within the current overdose prevention framework. Education and training relating to trauma and PTSD should be prioritized for health care professionals who work with and treat PWUD.

Background: Sub-optimal adherence to antiretroviral therapy among people living with HIV/AIDS (PLWHA) who use illicit drugs remains an ongoing health concern. Although health outcomes associated with adherence self-efficacy have been well-documented, there is dearth research exploring the predictors of this construct. This study sought to identify possible determinants of adherence self-efficacy among a cohort of PLWHA who use illicit drugs. Methods: From December 2004 to May 2014, we collected data from the AIDS Care Cohort to evaluate Exposure to Survival Services, a prospective cohort of adult PLWHA who use illicit drugs in Vancouver, Canada. We used multivariate generalized estimating equations (GEE) analyses to identify longitudinal factors independently associated with higher adherence self-efficacy. Results: Among 742 participants, 493 (66.4%) identified as male and 406 (54.7%) reported white ancestry. In multivariate GEE analysis, older age at ART initiation (Adjusted Odds Ratio [AOR] = 1.02, 95% confidence interval [CI]: 1.00 – 1.03) and recent year of baseline interview (AOR = 1.08, 95% CI: 1.05 – 1.11) were independently associated with higher adherence self-efficacy, while homelessness (AOR = 0.78, 95% CI: 0.65 – 0.94); ≥ daily crack smoking (AOR = 0.81, 95% CI: 0.68 – 0.96); experienced violence (AOR = 0.82, 95% CI: 0.69 – 0.98), and childhood abuse (AOR = 0.75, 95% CI: 0.60 – 0.92) were negatively associated. Conclusions: These findings highlight the potential role that personal and contextual factors can play in predicting levels of ART adherence self-efficacy. Future research should seek to identify and validate strategies to optimize adherence self-efficacy.