Margin trading and comovement during crises

We exploit threshold rules governing margin trading eligibility in India to identify a causal link between margin trading and increased comovement during crises. Margin trading explains more than one-quarter of the increase return comovement that we observe during crises. To understand the mechanisms driving this result, we evaluate the relative importance of stock connections through common brokers (who provide margin financing) versus common margin traders. We find that common brokers are most important. Margin-eligible stocks that are more connected through common brokers experience larger crisis-period increases in pairwise return comovement, especially when those brokers’ clients have experienced recent portfolio losses, when their clients have outstanding margin loans in more volatile stocks, and when the brokers are large. These findings are consistent with Brunnermeier and Pedersen (2009), in which initial shocks propagate due to the tightening of margin constraints imposed by financial intermediaries

Trader leverage and liquidity

Does trader leverage drive equity market liquidity? We use the unique features of the margin trading system in India to identify a causal relationship between traders’ ability to borrow and a stock’s market liquidity. To quantify the impact of trader leverage, we employ a regression discontinuity design that exploits threshold rules that determine a stock’s margin trading eligibility. We find that liquidity is higher when stocks become eligible for margin trading and that this liquidity enhancement is driven by margin traders’ contrarian strategies. Consistent with downward liquidity spirals due to deleveraging, we also find that this effect reverses during crises

P1-S1.11 Prevalence of Trichomonas vaginalis, chlamydia and gonorrhoea in women at the Miami-Dade County Health Department STD Clinic

Background Miami, Florida, has the highest rate of HIV diagnoses in the USA (70.3 per 100 000 people), accounting for 1218 of the 41 269 incident HIV cases nationwide (2008). Although Trichomonas vaginalis (TV) infection has been associated with an increased risk of HIV acquisition in women, the prevalence of TV in Miami is unknown due to lack of routine screening and low sensitivity testing methods. The purpose of this study is to establish a prevalence of TV in women seeking services at the Miami-Dade County Health Department Downtown STD Clinic compared to the prevalence of routinely screened STDs, gonorrhoea (GC) and Chlamydia (CT). Methods This study analyses baseline data from the Miami site of Project AWARE which is a multi-centre randomised clinical trial that seeks to test the effectiveness of risk reduction counselling in preventing sexually transmitted infections including HIV among HIV-negative persons. Eligibility criteria for Project Aware included negative or unknown HIV status, age of 18, and ability to provide informed consent. We recruited 251 women aged 18–64 for STD screening. The screen included FDA-approved Aptima GC/CT NAAT (nucleic acid amplification test) and a newly validated Aptima TV NAAT. Specimens were collected by vaginal swab performed either by a clinician or the patient. Additionally, we report the TV diagnoses given the current clinic protocol in which only symptomatic women received a wet mount analysed by light microscopy. We use descriptive statistics to report the prevalence of GC, CT and TV (as diagnosed by NAAT and wet mount) in our clinic. Results Of the 251 women in our study, 163 high-risk populations. Received a wet mount. By wet mount, we found a 9% prevalence of TV in our patients. Comparatively, when all 251 patients were screened using NAAT, the TV prevalence was 20%. The prevalence of CT was 14% and GC was 6%. Conclusions TV is the most prevalent STD in patients in our clinic which draws upon high-risk individuals in urban Miami. TV infections were greater than CT, often believed to be the most prevalent STD in our population. Further, the routine screening using the TV NAAT detected 27 cases of TV that would have been undiagnosed given current clinic protocol. Since Miami, FL has the highest prevalence of HIV in the country and TV infection has been linked to new HIV infection, we believe that routine TV screening by NAAT should be instituted in high-risk populations

Buprenorphine implementation at syringe service programs following waiver of the Ryan Haight Act in the United States

Among people with an opioid use disorder in the United States, only 10% receive buprenorphine treatment. The Ryan Haight Act is a federal law that has regulated buprenorphine delivery, requiring an in-person examination between a patient and provider before initiating treatment. At the beginning of the COVID-19 pandemic, federal agencies waived in-person examination requirements for buprenorphine treatment initiation. We examined whether Ryan Haight Act waiver improved implementation of telehealth buprenorphine within syringe service programs (SSPs) – organizations that serve people with historically low access to treatment. We surveyed all known SSPs operating in the US in 2021 (N = 421) of which 77% responded (n = 325). We calculated the prevalence and accompanying 95% confidence intervals (CI) for implementation of telehealth buprenorphine inductions at SSPs in 2020. Multivariable logistic regression was used to assess differences in implementing telehealth buprenorphine inductions by organizational characteristics. In 2020, the prevalence of implementing buprenorphine inductions via telehealth was 24% (95% CI:19–30%). Non-governmental SSPs had a higher odds of telehealth buprenorphine inductions (adjusted odds ratio (aOR)= 2.92; 95% CI:1.22–7.00; p = 0.016), compared to governmental SSPs. Furthermore, the larger the organization’s annual budget, the higher the odds of telehealth buprenorphine implementation (aOR=2.00 per quartile (95% CI:1.33–2.99; p = 0.001). SSPs located in states with higher opioid overdose mortality rates did not have significantly higher likelihood of telehealth buprenorphine implementation. A substantial number of SSPs implemented telehealth buprenorphine after waiver of the Ryan Haight Act. Permanent adoption of this waiver will be critical and providing financial resources to SSPs is vital to support implementation of new innovations. •After waiver of the Ryan Haight Act, 24% of SSPs began offering telehealth buprenorphine to their participants in 2020.•Non-governmental syringe service programs were more likely to implement telehealth buprenorphine.•Organizations with larger annual budgets were more likely to implement telehealth buprenorphine.•Opioid overdose mortality rates were not related to likelihood of telehealth buprenorphine implementation

Hospital admissions among people who inject opioids following syringe services program implementation.

BACKGROUND: Syringe services programs (SSPs) are an evidence-based harm reduction strategy that reduces dangerous sequelae of injection drug use among people who inject drugs (PWID) such as overdose. SSP services include safer injection education and community-based naloxone distribution programs. This study evaluates differences in overdose-associated hospital admissions following the implementation of the first legal SSP in Florida, based in Miami-Dade County. METHODS: We performed a retrospective analysis of hospitalizations for injection drug-related sequelae at a county hospital before and after the implementation of the SSP. An algorithm utilizing ICD-10 codes for opioid use and sequelae was used to identify people who inject opioids (PWIO). Florida Department of Law Enforcement Medical Examiners Commission Report data was used to analyze concurrent overdose death trends in Florida counties. RESULTS: Over the 25-month study period, 302 PWIO admissions were identified: 146 in the pre-index period vs. 156 in the post-index period. A total of 26 admissions with PWIO overdose were found: 20 pre-index and 6 post-index (p = 0.0034). CONCLUSIONS: Declining overdose-associated admissions among PWIO suggests early impacts following SSP implementation. These results indicate a potential early benefit of SSP that should be further explored for its effects on future hospital admission and mortality

Updates on syringe coverage and service uptake among needle and syringe programs in the United States, 2019-2020

As injection drug use has increased in the US, so too has the prevalence of receptive syringe sharing. Since the 1980s, Needle and Syringe Programs (NSPs) have been an important source of clean injection equipment and disposal of used syringes. This study reports national syringe coverage and examines the impact of program attributes on organizational-level service uptake, defined as number of syringes distributed per participant contact per year. In 2019 and 2020, we administered an annual cross-sectional survey to NSPs operating in the US (n = 260). A national estimate of coverage was calculated by dividing the total number of syringes distributed by the 2019 and 2020 population estimate of people who inject drugs (PWID). Frequency distributions and percentages were calculated for categorical variables (e.g., funding, census region, distribution policy/modality), and median and interquartile ranges (IQR) were calculated for continuous variables (e.g., participant contacts, syringes distributed). Bivariate and multivariable mixed effects logistic regression models were used to estimate the odds ratio associated with organizational characteristics on increasing service uptake at the NSP level. From 2019 to 2020, the total number of participant contacts by NSPs increased from 871,976 to 898,891, and the number of syringes distributed increased from 92,648,529 to 113,071,748. The national coverage estimate increased from 29.5 (95 % CI = 15.0, 58.2) to 35.8 (95 % CI = 18.2, 70.6) syringes per PWID. Fifty-eight percent of NSPs increased service uptake in 2020 as compared to the previous year. NSPs that received government funding and NSPs that changed to a less restrictive syringe distribution policy were more likely to increase service uptake (aOR 1.80, 95 % CI = 1.01, 3.22 and aOR 3.33, 95 % CI = 1.11, 9.94, respectively). Syringe distribution modalities also diversified, with more NSPs reaching participants via backpacking/outreach, fixed site pop-ups, mobile delivery, mail-based delivery, leaving supplies out, and secondary distribution. Both governmental investment in harm reduction programming and needs-based distribution of syringes increased service uptake and thus should be expanded and sustained to reduce harms associated with injection drug use

Funding and Delivery of Syringe Services Programs in the United States, 2022.

Objectives. To describe the current financial health of syringe services programs (SSPs) in the United States and to assess the predictors of SSP budget levels and associations with delivery of public health interventions. Methods. We surveyed all known SSPs operating in the United States from February to June 2022 (n = 456), of which 68% responded (n = 311). We used general estimating equations to assess factors influencing SSP budget size and estimated the effects of budget size on multiple measures of SSP services. Results. The median SSP annual budget was $100 000 (interquartile range =$20 159‒$290 000). SSPs operating in urban counties and counties with higher levels of opioid overdose mortality had significantly higher budget levels, while SSPs located in counties with higher levels of Republican voting in 2020 had significantly lower budget levels. SSP budget levels were significantly and positively associated with syringe and naloxone distribution coverage. Conclusions. Current SSP funding levels do not meet minimum benchmarks. Increased funding would help SSPs meet community health needs. Public Health Implications. Federal, state, and local initiatives should prioritize sustained SSP funding to optimize their potential in addressing multiple public health crises. (Am J Public Health. 2024;114(4):435-443. https://doi.org/10.2105/AJPH.2024.307583)