A prospective cohort study of risk behaviours, retention and loss to follow-up over 5 years among women and men in a needle exchange program in Stockholm, Sweden

Karlsson, Niklas; Kåberg, Martin; Berglund, Torsten; Hammarberg, Anders; Widman, Linnea; Ekström, Anna Mia

doi:10.1016/j.drugpo.2020.103059

Cited by 5 publications

(6 citation statements)

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“…A similar reasoning may be applied regarding gender, where female participants reported lower HRQoL compared to males. It has been a consistent finding in research on PWID that women who inject drugs show a more severely impaired somatic, psychiatric, and social situation [ 40 , 41 ], as well as injection-related behaviors [ 42 ]. It is therefore expected, but not previously shown, that women in this population show lower rates of HRQoL.…”

Section: Discussionmentioning

confidence: 88%

Quality-adjusted life years among people who inject drugs in a needle syringe program in Sweden

et al. 2022

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Purpose Needle syringe programs (NSP) significantly reduce risk behavior and HIV and hepatitis transmission in people who inject drugs (PWID). However, PWID are underrepresented in studies on health-related quality of life (HRQoL), representing a barrier to evaluate effects of public health and preventive measures related to injecting drug use. In this study, we investigate how well the two questionnaires EQ-5D-3L and SF-6D measure health in PWID. We also estimate HRQoL in the PWID population. Method Data on demographics, injection drug use, HIV, hepatitis status, and self-reported HRQoL were collected from 550 PWID enrolled in the Stockholm NSP at enrollment and at 6-, 12-, and 24-month follow-up. Self-rated HRQoL was measured as QALY, using EQ-5D-3L and the SF-6D. Item response theory (IRT) was used to evaluate which of the two instruments that measure health most accurately in this population. Regression analysis was used to estimate population-specific QALYs. Results The IRT analysis showed that SF-6D was better suited to measure health in PWID. More specifically, SF-6D to a larger extent discriminated between persons regardless of their health status, while EQ-5D was more suitable to detect persons with poorer health. Self-rated HRQoL showed that average QALY was lower among PWID compared to the general Swedish population. However, a general increase in self-reported health was noted over time among participants. Conclusion This study increase knowledge of what instruments are most suitable to measure health among PWID. This is of great importance when evaluating effects of public health and preventive measures in the PWID population.

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Section: Discussionmentioning

confidence: 88%

Quality-adjusted life years among people who inject drugs in a needle syringe program in Sweden

et al. 2022

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“…Instead, current treatment options for stimulant use are cognitive behavioral therapy, contingency management programs and psychosocial support. Amphetamine is also associated with high injection and sexual risk behaviors, and thus an increased risk for HCV transmission [ 62 , 63 ]. Furthermore, a recent Swedish register study also noted a higher crude risk of liver-related death among HCV-infected amphetamine users compared to opioid users, highlighting the need to prioritize HCV treatment among PWID who use amphetamines [ 64 ].…”

Section: Discussionmentioning

confidence: 99%

“…The Stockholm NSP has previously been described in detail [ 30 , 32 , 33 , 41 ]. Briefly, the Stockholm NSP is a multi-center (two fixed sites and one mobile unit) low-threshold program with a multidisciplinary care approach and staffed by physicians, counselors, midwifes and nurses specialized in infectious diseases and substance use.…”

Section: Methodsmentioning

confidence: 99%

“…Based on our previous research [ 30 , 32 , 33 , 41 , 44 ], nine sociodemographic-, drug- and HCV-related determinants were selected (described in detail in Table 1 ) for analyses. Demographic data are presented as proportions, mean or median levels with ranges and interquartile ranges (IQR).…”

Section: Methodsmentioning

confidence: 99%

“…Among HCV-treated PWID, a somewhat lower noted SVR rates in treatment studies could be explained by PWID being lost to follow-up (LTFU), rather than treatment failure. However, research also shows that LTFU has been associated with recent IDU risk behaviors, suggesting higher risk of HCV reinfection [ 29 , 30 ].…”

Section: Introductionmentioning

confidence: 99%

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Real-world hepatitis C treatment outcomes and reinfections among people who inject drugs at a needle and syringe program in Stockholm, Sweden

Lindqvist,

Thorin,

Kåberg

2023

Harm Reduct J

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Background People who inject drugs (PWID) represent a population with an increased prevalence of hepatitis C (HCV) infections. HCV treatment among PWID is essential to reach the WHO goal of eliminating HCV as a major public health threat by 2030. Despite better understanding of PWID subgroups and changes in risk behaviors over time, more knowledge about HCV treatment outcomes in different HCV prevalence populations and settings is warranted to enhance the continuum of care. Methods All Stockholm Needle and Syringe Program (NSP) participants who initiated HCV treatment between October 2017 and June 2020 were HCV RNA tested at end of treatment and twelve weeks thereafter to confirm cure with a sustained virological response (SVR). All cured participants were prospectively followed from SVR to the last negative HCV RNA test or a subsequent reinfection, until October 31, 2021. Results Overall, 409 NSP participants initiated HCV treatment, 162 at the NSP and 247 in another treatment setting. There were a total of 6.4% treatment dropouts (n = 26), 11.7% among participants treated at the NSP and 2.8% among those treated elsewhere (p < 0.001). Stimulant use (p < 0.05) and not being in an opioid agonist treatment program (p < 0.05) was associated with dropout. More participants treated outside the NSP were lost to follow-up between end of treatment and SVR (p < 0.05). During follow-up post-SVR, 43 reinfections occurred, corresponding to a reinfection rate of 9.3/100 PY (95% CI 7.0, 12.3). Factors associated with reinfection were younger age (p < 0.001), treatment while in prison (p < 0.01) and homelessness (p < 0.05). Discussion In this high HCV prevalence NSP setting, with a majority of stimulant users, treatment success was high and the level of reinfections manageable. To reach HCV elimination, there is a need to target specific PWID subgroups for HCV treatment, in both harm reduction and adjacent healthcare settings frequented by PWID.

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Characteristics of attrition within the SuperMIX cohort of people who inject drugs: a multiple event discrete-time survival analysis

Abdelsalam,

Agius,

Sacks-Davis

et al. 2024

BMC Med Res Methodol

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Background Compared to the general population, people who inject drugs have poor health and wellbeing. Longitudinal studies can provide insight into factors driving these worse health outcomes but are subject to methodological challenges, such as cohort attrition. The aim of this study was to assess and characterise attrition in a prospective cohort of people who inject drugs in Victoria, Australia. Methods Using annually collected self-reported data from The Melbourne Injecting Drug User Cohort Study (SuperMIX) from September 2008 to January 2021, we estimated the incidence of participants being lost-to-follow-up (LTFU), with an episode of being LTFU defined as participants not undertaking a follow-up interview within two years of their last interview. We utilised a multiple event discrete-time survival analysis on participant period-observation data to estimate the associations between key factors and LTFU. Key areas of exposure measurement in analyses were sociodemographic, drug use and mental health. Results A total of n = 1328 SuperMIX participants completed a baseline interview, with n = 489 (36.8%) LTFU, i.e. not completing a follow-up interview in the following two years. Increased attrition was observed among SuperMIX participants who were: born outside Australia, younger than 30 years, reporting having completed fewer years of education, not residing in stable accommodation, not in stable employment and not on opioid agonist therapy (OAT). Conclusions The attrition rate of the SuperMIX cohort has largely been stable throughout the duration of the study. Higher attrition rates among individuals at greater sociodemographic disadvantage and not on OAT suggest that additional efforts are required to retain these participants. Findings also suggest that SuperMIX might not be capturing data on adverse health and wellbeing outcomes among subpopulations at high risk of harm.

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A prospective cohort study of risk behaviours, retention and loss to follow-up over 5 years among women and men in a needle exchange program in Stockholm, Sweden

Cited by 5 publications

References 74 publications

Quality-adjusted life years among people who inject drugs in a needle syringe program in Sweden

Quality-adjusted life years among people who inject drugs in a needle syringe program in Sweden

Real-world hepatitis C treatment outcomes and reinfections among people who inject drugs at a needle and syringe program in Stockholm, Sweden

Characteristics of attrition within the SuperMIX cohort of people who inject drugs: a multiple event discrete-time survival analysis

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