19 research outputs found
Hepatitis C and HIV incidence and harm reduction program use in a conflict setting: an observational cohort of injecting drug users in Kabul, Afghanistan
BACKGROUND: Armed conflict may increase the risk of HIV and other pathogens among injecting drug users (IDUs); however, there are few prospective studies. This study aimed to measure incidence and potential predictors, including environmental events and needle and syringe distribution and collection program (NSP) use, of hepatitis C virus (HCV) and HIV among IDUs in Kabul, Afghanistan. METHODS: Consenting adult IDUs completed interviews quarterly in year 1 and semi-annually in year 2 and HCV and HIV antibody testing semi-annually through the cohort period (November 2007âDecember 2009). Interviews detailed injecting and sexual risk behaviors, NSP service use, and conflict-associated displacement. Quarters with peak conflict or local displacement were identified based on literature review, and key events, including insurgent attacks and deaths, were reported with simple counts. Incidence and predictors of HCV and HIV were measured with Cox proportional hazards models. RESULTS: Of 483 IDUs enrolled, 385 completed one or more follow-up visits (483.8 person-years (p-y)). All participants were male with a median age of 28Â years and a median duration of injecting of 2Â years. Reported NSP use among the participants ranged from 59.9 to 70.5Â % in the first year and was 48.4 and 55.4Â % at 18 and 24Â months, respectively. There were 41 confirmed deaths, with a crude death rate of 93.4/1000 p-y (95Â % confidence interval (CI) 67.9â125) and overdose as the most common cause. HCV and HIV incidence were 35.6/100 p-y (95Â % CI 28.3â44.6) and 1.5/100 p-y (95Â % CI 0.6â3.3), respectively. Changing from injecting to smoking was protective for HCV acquisition (adjusted hazard ratio (AHR)â=â0.53, 95Â % CI 0.31â0.92), while duration of injecting (AHRâ=â1.09, 95Â % CI 1.01â1.18/year) and sharing syringes (AHRâ=â10.09, 95Â % CI 1.01â100.3) independently predicted HIV infection. CONCLUSION: There is high HCV incidence and high numbers of reported deaths among male Kabul IDUs despite relatively consistent levels of harm reduction program use; peak violence periods did not independently predict HCV and HIV risk. Programming should increase awareness of HCV transmission and overdose risks, prepare clients for harm reduction needs during conflict or other causes of displacement, and continue efforts to engage community and police force support
Decliners of provider-initiated HIV testing and counselling: Characteristics of participants who refused HIV testing in a population survey in Zambia
Knowledge of Human Immunodeficiency Virus Status and Seropositivity After a Recently Negative Test in Malawi
FUNDING HIV-VACCINE RESEARCH IN DEVELOPING COUNTRIES-WHAT IS WRONG WITH IAVI's RECOMMENDATION?
ARVs and cash too: caring and supporting people living with HIV/AIDS with the Malawi Social Cash Transfer
The financing gaps framework: using need, potential spending and expected spending to allocate development assistance for health
Essential elements of a community empowerment approach to HIV prevention among female sex workers engaged in project Shikamana in Iringa, Tanzania
Innovations to make markets more inclusive for the poor
Market failures, government failures and some of the characteristics of both the poor and business actors as well as their environment can act as barriers preventing the poor from participating more actively in markets, both as consumers and as producers. Private actors â including forâprofit and notâforâprofit entities, often in partnership with the public sector â have been able to mitigate some of these constraints through innovations that have helped to make markets more inclusive for the poor, enabling them not just to gain access, but also to participate in ways that enhance their economic empowerment and human development. This article identifies the strategies and innovations used and devises a possible typology for them