Identifying injection drug use and estimating population size of people who inject drugs using healthcare administrative datasets

Janjua, Naveed Z.; Islam, Nazrul; Kuo, Margot; Yu, Amanda; Wong, Stanley; Butt, Zahid A; Gilbert, Mark; Buxton, Jane A.; Chapinal, N.; Samji, Hasina; Chong, Mei; Alvarez, Maria; Wong, Jason; Tyndall, Mark; Krajden, Mel

doi:10.1016/j.drugpo.2018.02.001

Cited by 83 publications

(90 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The assessment of such risk factors as IDU and problematic alcohol use was based on diagnostic codes in administrative health-services databases. Our definitions were based on validations done previously;45 however, there could be some misclassification and underestimation of effect. Furthermore, some of the interactions could not be evaluated, because of smaller samples, eg, MSM and IDU.…”

Section: Discussionmentioning

confidence: 99%

Effect of opioid-substitution therapy and mental health counseling on HIV risk among hepatitis C-infected individuals

Butt

Shrestha

Gesink

et al. 2018

CLEP

Self Cite

View full text Add to dashboard Cite

BackgroundUnderstanding differences in HIV incidence among people living with hepatitis C virus (HCV) can help inform strategies to prevent HIV infection. We estimated the time to HIV diagnosis among HCV-positive individuals and evaluated factors that could affect HIV-infection risk in this population.Patients and methodsThe British Columbia Hepatitis Testers Cohort includes all BC residents (~1.5 million: about a third of all residents) tested for HCV and HIV from 1990 to 2013 and is linked to administrative health care and mortality data. All HCV-positive and HIV-negative individuals were followed to measure time to HIV acquisition (positive test) and identify factors associated with HIV acquisition. Adjusted HRs (aHRs) were estimated using Cox proportional-hazard regression.ResultsOf 36,077 HCV-positive individuals, 2,169 (6%) acquired HIV over 266,883 years of follow-up (overall incidence of 8.1 per 1,000 person years). Overall median (IQR) time to HIV infection was 3.87 (6.06) years. In Cox regression, injection-drug use (aHR 1.47, 95% CI 1.33–1.63), HBV infection (aHR 1.34, 95% CI 1.16–1.55), and being a man who has sex with men (aHR 2.78, 95% CI 2.14–3.61) were associated with higher risk of HIV infection. Opioid-substitution therapy (OST) (aHR 0.59, 95% CI 0.52–0.67) and mental health counseling (aHR 0.48, 95% CI 0.43–0.53) were associated with lower risk of HIV infection.ConclusionInjection-drug use, HBV coinfection, and being a man who has sex with men were associated with increased HIV risk and engagement in OST and mental health counseling were associated with reduced HIV risk among HCV-positive individuals. Improving access to OST and mental health services could prevent transmission of HIV and other blood-borne infections, especially in settings where access is limited.

show abstract

Section: Discussionmentioning

confidence: 99%

Effect of opioid-substitution therapy and mental health counseling on HIV risk among hepatitis C-infected individuals

Butt

Shrestha

Gesink

et al. 2018

CLEP

Self Cite

View full text Add to dashboard Cite

show abstract

“…We categorized HCV viral load into quartiles based on its distribution in the study population: Q1: <248 237 (IU/mL), Q2: 248 237‐962 052, Q3: 962 052‐2 589 909 and Q4: ≥2 589 909. Concurrent conditions including HIV or HBV co‐infections, diabetes, problematic alcohol use, injection drug use (IDU), major mental illness, cirrhosis, decompensated cirrhosis and the Elixhauser comorbidity index were also assessed . Assessment of these variables was based on algorithms derived from medical visits, hospitalization or prescription dispensation data using fee‐for‐service, procedure and/or diagnostic codes (Table ).…”

Section: Methodsmentioning

confidence: 99%

“…In BC, OST includes methadone and buprenorphine/naloxone and most OST dispensations are directly observed. IDU was defined according to a previously validated algorithm . Individuals with drug‐related diagnoses in the last three years prior to treatment were considered to be recent IDUs, and those with diagnoses more than three years prior were considered to be past IDUs.…”

Section: Methodsmentioning

confidence: 99%

Loss to follow‐up: A significant barrier in the treatment cascade with direct‐acting therapies

Darvishian

Wong

Binka

et al. 2019

Journal of Viral Hepatitis

Self Cite

View full text Add to dashboard Cite

Effectiveness of direct‐acting antiviral (DAA) therapies could be influenced by patient characteristics such as comorbid conditions, which could lead to premature treatment discontinuation and/or irregular medical follow‐ups. Here, we evaluate loss to follow‐up and treatment effectiveness of sofosbuvir/ledipasvir ± ribavirin (SOF/LDV ± RBV), ombitasvir/paritaprevir/ritonavir + dasabuvir ± ribavirin (OBV/PTV/r + DSV ± RBV) for hepatitis C virus (HCV) genotype 1 (GT1) and sofosbuvir + ribavirin (SOF + RBV) for genotype 3 (GT3) in British Columbia Canada: The British Columbia Hepatitis Testers Cohort includes data on individuals tested for HCV since 1992, integrated with medical visit, hospitalization and prescription drug data. HCV‐positive individuals who initiated DAA regimens, irrespective of treatment completion, for GT1 and GT3 until 31 December, 2017 were included. Factors associated with sustained virological response (SVR) and loss to follow‐up were assessed by using multivariable logistic regression models. In total 4477 individuals initiated DAAs. The most common prescribed DAA was SOF/LDV ± RBV with SVR of 95%. The highest SVR of 99.5% was observed among OBV/PTV/r + DSV‐treated patients. Overall, 453 (10.1%) individuals were lost to follow‐up. Higher loss to follow‐up was observed among GT1 patients treated with OBV (17.8%) and GT3 patients (15.7%). The loss to follow‐up rate was significantly higher among individuals aged <60 years, those with a history of injection drug use (IDU), on opioid substitution therapy and with cirrhosis. Our findings indicate that loss to follow‐up exceeds viral failure in HCV DAA therapy and its rate varies significantly by genotype and treatment regimen. Depending on the aetiology of lost to follow‐up, personalized case management for those with medical complications and supporting services among IDU are needed to achieve the full benefits of effective treatments.

show abstract

“…Within on and off OAT groups, we further classified study participants as recent PWID, former PWID, and those not injecting drugs. PWID were identified based on an algorithm using fee‐for‐service, procedure, and/or diagnostic codes for medical visits, hospitalization, or prescription dispensation and validated in the BC‐HTC subset using interview‐based risk factor data . For this analysis, we used the IDU algorithm with optimal sensitivity (78%) and specificity (83%); this required two medical visits and one hospitalization .…”

Section: Participants and Methodsmentioning

confidence: 99%

Effectiveness of Ledipasvir/Sofosbuvir and Sofosbuvir/Velpatasvir in People Who Inject Drugs and/or Those in Opioid Agonist Therapy

et al. 2019

Self Cite

View full text Add to dashboard Cite

We evaluated the effectiveness of ledipasvir/sofosbuvir (LDV/SOF) in treating hepatitis C virus (HCV) genotype 1 and SOF/velpatasvir (SOF/VEL) for all genotypes among people who inject drugs (PWID) and those not injecting drugs and who were on or off opioid agonist therapy (OAT). Study participants comprised a population‐based cohort in British Columbia, Canada. The British Columbia Hepatitis Testers Cohort includes data on individuals tested for HCV from 1990 to 2016 that are integrated with medical visits, hospitalization, and prescription drug data. We classified study participants as off OAT/recent injection drug use (off‐OAT/RIDU), off OAT/past IDU (off‐OAT/PIDU), off OAT/no IDU (off‐OAT/NIDU), on OAT/IDU (on‐OAT/IDU), and on OAT/no IDU (on‐OAT/NIDU). We assessed sustained virologic response (SVR) 10 weeks after HCV treatment among study groups treated with LDV/SOF or SOF/VEL until January 13, 2018. Analysis included 5,283 eligible participants: 390 off‐OAT/RIDU, 598 off‐OAT/PIDU, 3,515 off‐OAT/NIDU, 609 on‐OAT/IDU, and 171 on‐OAT/NIDU. The majority were male patients (64%‐74%) and aged ≥50 years (58%‐85%). The SVRs for off‐OAT/RIDU, off‐OAT/PIDU, off‐OAT/NIDU, on‐OAT/IDU, and on‐OAT/NIDU were 91% (355/390), 95% (570/598), 96% (3,360/3,515), 93% (567/609), and 95% (163/171), respectively. Among those with no SVR, 14 individuals died while on treatment or before SVR assessment, including 4 from illicit drug overdose. In the overall multivariable model, off‐OAT/RIDU, on‐OAT/IDU, male sex, cirrhosis, treatment duration <8 weeks, treatment duration 8 weeks, and treatment with SOF/VEL were associated with not achieving SVR. Conclusion: In this large real‐world cohort, PWID and/or those on OAT achieved high SVRs, although slightly lower than people not injecting drugs. This finding also highlights the need for additional measures to prevent loss to follow‐up and overdose‐related deaths among PWID.

show abstract

Identifying injection drug use and estimating population size of people who inject drugs using healthcare administrative datasets

Cited by 83 publications

References 36 publications

Effect of opioid-substitution therapy and mental health counseling on HIV risk among hepatitis C-infected individuals

Effect of opioid-substitution therapy and mental health counseling on HIV risk among hepatitis C-infected individuals

Loss to follow‐up: A significant barrier in the treatment cascade with direct‐acting therapies

Effectiveness of Ledipasvir/Sofosbuvir and Sofosbuvir/Velpatasvir in People Who Inject Drugs and/or Those in Opioid Agonist Therapy

Contact Info

Product

Resources

About