Hepatitis C treatment uptake among people who inject drugs in Oslo, Norway: A registry-based study

Background Improving HCV treatment uptake among people who inject drugs (PWID) is crucial to achieving the WHO elimination targets. The aims were to evaluate HCV treatment uptake and HCV RNA prevalence in a large cohort of PWID in Norway. Methods Registry-based observational study where all users of the City of Oslo's low-threshold social and health services for PWID between 2010–2016 ( n = 5330) were linked to HCV notifications (1990–2019) and dispensions of HCV treatment, opioid agonist treatment (OAT) and benzodiazepines (2004–2019). Cases were weighted to account for spontaneous HCV clearance. Treatment rates were calculated using person-time of observation, and factors associated with treatment uptake were analysed using logistic regression. HCV RNA prevalence was estimated among individuals alive by the end of 2019. Results Among 2436 participants with chronic HCV infection (mean age 46.8 years, 30.7% female, 73.3% OAT), 1118 (45.9%) had received HCV treatment between 2010–2019 (88.7% DAA-based). Treatment rates increased from 1.4/100 PY (95% CI 1.1–1.8) in the pre-DAA period (2010–2013) to 3.5/100 PY (95% CI 3.0–4.0) in the early DAA period (2014–2016; fibrosis restrictions) and 18.4/100 PY (95% CI 17.2–19.7) in the late DAA period (2017–2019; no restrictions). Treatment rates for 2018 and 2019 exceeded a previously modelled elimination threshold of 50/1000 PWID. Treatment uptake was less likely among women (aOR 0.74; 95% CI 0.62–0.89) and those aged 40–49 years (aOR 0.74; 95% CI 0.56–0.97), and more likely among participants with current OAT (aOR 1.21; 95% CI 1.01–1.45). The estimated HCV RNA prevalence by the end of 2019 was 23.6% (95% CI 22.3–24.9). Conclusion Although HCV treatment uptake among PWID increased, strategies to improve treatment among women and individuals not engaged in OAT should be addressed.This research received funding from the following sources. KM receives research grants from the South-Eastern Norway Regional Health Authority , grant number: 2020011 . The funding sponsor has not been involved in study design, collection of data, analysis/interpretation of data, in the writing of the article, or in the decision to submit the article for publication.publishedVersio

People who use drugs show no increase in pre-existing T-cell cross-reactivity toward SARS-CoV-2 but develop a normal polyfunctional T-cell response after standard mRNA vaccination

People who use drugs (PWUD) are at a high risk of contracting and developing severe coronavirus disease 2019 (COVID-19) and other infectious diseases due to their lifestyle, comorbidities, and the detrimental effects of opioids on cellular immunity. However, there is limited research on vaccine responses in PWUD, particularly regarding the role that T cells play in the immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Here, we show that before vaccination, PWUD did not exhibit an increased frequency of preexisting cross-reactive T cells to SARS-CoV-2 and that, despite the inhibitory effects that opioids have on T-cell immunity, standard vaccination can elicit robust polyfunctional CD4+ and CD8+ T-cell responses that were similar to those found in controls. Our findings indicate that vaccination stimulates an effective immune response in PWUD and highlight targeted vaccination as an essential public health instrument for the control of COVID-19 and other infectious diseases in this group of high-risk patients

A cross-sectional study of patients with and without substance use disorders in Community Mental Health Centres

<p>Abstract</p> <p>Background</p> <p>Epidemiological studies have consistently established high comorbidity between psychiatric disorders and substance use disorders (SUD). This comorbidity is even more prominent when psychiatric populations are studied. Previous studies have focused on inpatient populations dominated by psychotic disorders, whereas this paper presents findings on patients in Community Mental Health Centres (CMHCs) where affective and anxiety disorders are most prominent. The purpose of this study is to compare patients in CMHCs with and without SUD in regard to differences in socio-demographic characteristics, level of morbidity, prevalence of different diagnostic categories, health services provided and the level of improvement in psychiatric symptoms.</p> <p>Methods</p> <p>As part of the evaluation of the National Plan for Mental Health, all patients seen in eight CMHCs during a 4-week period in 2007 were studied (n = 2154). The CMHCs were located in rural and urban areas of Norway. The patients were diagnosed according to the ICD-10 diagnoses and assessed with the Health of the Nation Outcome Scales, the Alcohol Use Scale and the Drug Use Scale.</p> <p>Results</p> <p>Patients with SUD in CMHCs are more frequently male, single and living alone, have more severe morbidity, less anxiety and mood disorders, less outpatient treatment and less improvement in regard to recovery from psychological symptoms compared to patients with no SUD.</p> <p>Conclusion</p> <p>CMHCs need to implement systematic screening and diagnostic procedures in order to detect the special needs of these patients and improve their treatment.</p

Introduction to Surface Avatar: the First Heterogeneous Robotic Team to be Commanded with Scalable Autonomy from the ISS

Robotics is vital to the continued development toward Lunar and Martian exploration, in-situ resource utilization, and surface infrastructure construction. Large-scale extra-terrestrial missions will require teams of robots with different, complementary capabilities, together with a powerful, intuitive user interface for effective commanding. We introduce Surface Avatar, the newest ISS-to-Earth telerobotic experiment series, to be conducted in 2022-2024. Spearheaded by DLR, together with ESA, Surface Avatar builds on expertise on commanding robots with different levels of autonomy from our past telerobotic experiments: Kontur-2, Haptics, Interact, SUPVIS Justin, and Analog-1. A team of four heterogeneous robots in a multi-site analog environment at DLR are at the command of a crew member on the ISS. The team has a humanoid robot for dexterous object handling, construction and maintenance; a rover for long traverses and sample acquisition; a quadrupedal robot for scouting and exploring difficult terrains; and a lander with robotic arm for component delivery and sample stowage. The crew's command terminal is multimodal, with an intuitive graphical user interface, 3-DOF joystick, and 7-DOF input device with force-feedback. The autonomy of any robot can be scaled up and down depending on the task and the astronaut's preference: acting as an avatar of the crew in haptically-coupled telepresence, or receiving task-level commands like an intelligent co-worker. Through crew performing collaborative tasks in exploration and construction scenarios, we hope to gain insight into how to optimally command robots in a future space mission. This paper presents findings from the first preliminary session in June 2022, and discusses the way forward in the planned experiment sessions

The effectiveness of integrated treatment in patients with substance use disorders co-occurring with anxiety and/or depression - a group randomized trial

BACKGROUND: Integrated Treatment (IT) has proved effective in treating patients with Substance Use Disorders (SUD) co-occurring with severe Mental Disorders (MD), less is known about the effectiveness of IT for patients with SUD co-occurring with less severe MD. The aim of this study was to investigate the effectiveness of IT for patients with SUD co-occurring with anxiety and/or depression on the following parameters: 1. The use of substances, as measured by the Alcohol Use Identification Test (AUDIT), the Drug Use Identification Test (DUDIT), and the Addiction Severity Index (EuropASI). 2. The severity of psychiatric symptoms, as measured by the Symptom Check List 90 r (SCL 90R). 3. The client’s motivation for changing his/her substance use behaviour, as measured by the Substance Abuse Treatment Scale (SATSr). METHODS: This is a group randomized clinical trial comparing the effectiveness of IT to treatment as usual in Community Mental Health Centres (CMHCs). Five CMHCs were drawn to the Intervention Group (IG) and four CMHCs to the Control Group (CG). The allocation to treatment conditions was not blinded. New referrals were screened with the AUDIT and the DUDIT. Those who scored above the cut-off level of these instruments were assessed with the Structured Clinical Interview for DSM-IV 1 and 2. We included patients with anxiety and/or depression together with one or more SUDs. RESULTS: We included 55 patients in the IG and 21 in the CG. A linear multilevel model was used. Both groups reduced their alcohol and substance use during the trial, while there was no change in psychiatric symptoms in either group. However, the IG had a greater increase in motivation for substance use treatment after 12 months than had the CG with an estimate of 1.76, p = 0.043, CI(95%) (0.08; 3.44) (adjusted analyses). There were no adverse events. CONCLUSIONS: Integrated treatment is effective in increasing the motivation for treatment amongst patients with anxiety and/or depression together with SUD in outpatient clinics. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00447733

When Research Meets Reality—Lessons Learned From a Pragmatic Multisite Group-Randomized Clinical Trial on Psychosocial Interventions in the Psychiatric and Addiction Field

Research on treatments for patients with co-occurring psychiatric and substance use disorders is of core importance and at the same time highly challenging as it includes patients that are normally excluded from clinical studies. Such research may require methodological adaptations which in turn create new challenges. However, the challenges that arise in such studies are insufficiently discussed in the literature. The aim of this methodology paper is, firstly, to discuss the methodological adaptations that may be required in such research; secondly, to describe how such adaptations created new challenges in a group-randomized clinical trial on Integrated Treatment amongst patients with co-occurring psychiatric and substance use disorders. We also discuss how these challenges might be understood and highlight lessons for future research in this field. © the author(s), publisher and licensee Libertas Academica Ltd. This is an open access article. Unrestricted non-commercial use is permitted provided the original work is properly cited