Assessing syringe exchange program access among persons who inject drugs (PWID) in the District of Columbia

Prior research has explored spatial access to syringe exchange programs (SEPs) among persons who inject drugs (PWID), but these studies have been based on limited data from short periods of time. No research has explored changes in spatial access to SEPs among PWID longitudinally. The purpose of this research is to examine spatial access to SEPs among PWID who accessed services at a SEP in Washington, District of Columbia (DC), from 1996 to 2010. The geometric point distance estimation technique was used to calculate the mean walking distance PWID traveled from the centroid point of their zip code of home residence to the mobile exchange site where they accessed SEP services. Analysis of variance (ANOVA) was used to examine differences in walking distance measures by year. The results of this research suggest that the distance DC PWID traveled to access SEP services remained relatively constant (approximately 2.75 mi) from 2003 to 2008, but increased to just over 4 mi in 2010. This research provides support for expanding SEP operations such that PWID have increased access to their services. Increasing SEP accessibility may help resolve unmet needs among injectors

How far will they go?: assessing the travel distance of current and former drug users to access harm reduction services

Background Prior research has explored spatial access to syringe exchange programs (SEPs) among people who inject drugs (PWID), but little is known about service utilization by former PWID who continue to access services (e.g., HIV screenings and referrals for social services) at harm reduction providers. The purpose of this research is to examine differences in access to SEPs between current and former PWID seeking services at a mobile SEP in Washington, DC. Findings A geometric point distance estimation technique was applied to data collected as part of a PWID population estimation study that took place in Washington, DC, in March and April 2014. We calculated the walking distance from the centroid point of home residence zip code to the mobile exchange site where PWID presented for services. An independent samples t-test was used to examine differences in walking distance measures between current and former PWID. Differences in mean walking distance were statistically significant with current and former PWID having mean walking distances of 2.75 and 1.80 miles, respectively. Conclusions The results of this study suggest that former PWID who are engaging with SEPs primarily for non-needle exchange services (e.g., medical or social services) may have decreased access to SEPs than their counterparts who are active injectors. This research provides support for expanding SEP operations such that both active and former PWID have increased access to harm reduction providers and associated health and social services. Increasing service accessibility may help resolve unmet needs among current and former PWID

Impact Evaluation of a Policy Intervention for HIV Prevention in Washington, DC

Syringe exchange programs (SEPs) lower HIV risk. From 1998 to 2007, Congress prohibited Washington, DC, from using municipal revenue for SEPs. We examined the impact of policy change on IDU-associated HIV cases. We used surveillance data for new IDU-associated HIV cases between September 1996 and December 2011 to build an ARIMA model and forecasted the expected number of IDU-associated cases in the 24 months following policy change. Interrupted time series analyses (ITSA) were used to assess epidemic impact of policy change. There were 176 IDU-associated HIV cases in the 2 years post-policy change; our model predicted 296 IDU-associated HIV cases had the policy remained in place, yielding a difference of 120 averted HIV cases. ITSA identified significant immediate (B = −6.0355, p = .0005) and slope changes (B = −.1241, p = .0427) attributed to policy change. Policy change is an effective structural intervention for HIV prevention when it facilitates the implementation of services needed by vulnerable populations

Using Capture-Recapture Methods to Estimate the Population of People Who Inject Drugs in Washington, DC

No current estimates exist for the size of the population of people who inject drugs (PWID) in the District of Columbia (DC). The WHO/UNAIDS Guidelines on Estimating the Size of Populations Most at Risk to HIV was used as the methodological framework to estimate the DC PWID population. The capture phase recruited harm reduction agency clients; the recapture phase recruited community-based PWID. The 951 participants were predominantly Black (83.9 %), male (69.8 %), and 40+ years of age (68.2 %). Approximately 50.3 % reported injecting drugs in the past 30 days. We estimate approximately 8829 (95 % CI 4899 and 12,759) PWID in DC. When adjusted for possible missed sub-populations of PWID, the estimate increases to 12,000; thus, the original estimate of approximately 9000 should be viewed in the context of the 95 % confidence interval. These evidence-based estimations should be used to determine program delivery needs and resource allocation for PWID in Washington, DC

Assessing seasonality of travel distance to harm reduction service providers among persons who inject drugs.

BACKGROUND: Prior research has examined access to syringe exchange program (SEP) services among persons who inject drugs (PWID), but no research has been conducted to evaluate variations in SEP access based on season. This is an important gap in the literature given that seasonal weather patterns and inclement weather may affect SEP service utilization. The purpose of this research is to examine differences in access to SEPs by season among PWID in the District of Columbia (DC). FINDINGS: A geometric point distance estimation technique was applied to records from a DC SEP that operated from 1996 to 2011. We calculated the walking distance (via sidewalks) from the centroid point of zip code of home residence to the exchange site where PWID presented for services. Analysis of variance (ANOVA) was used to examine differences in walking distance measures by season. Differences in mean walking distance measures were statistically significant between winter and spring with PWID traveling approximately 2.88 and 2.77 miles, respectively, to access the SEP during these seasons. CONCLUSIONS: The results of this study suggest that seasonal differences in SEP accessibility may exist between winter and spring. PWID may benefit from harm reduction providers adapting their SEP operations to provide a greater diversity of exchange locations during seasons in which inclement weather may negatively influence engagement with SEPs. Increasing the number of exchange locations based on season may help resolve unmet needs among injectors

Legal space for syringe exchange programs in hot spots of injection drug use-related crime.

BACKGROUND: Copious evidence indicates that syringe exchange programs (SEPs) are effective structural interventions for HIV prevention among persons who inject drugs (PWID). The efficacy of SEPs in supporting the public health needs of PWID populations is partially dependent on their accessibility and consistent utilization among injectors. Research has shown that SEP access is an important predictor of PWID retention at SEPs, yet policies exist that may limit the geographic areas where SEP operations may legally occur. Since 2000 in the District of Columbia (DC), SEP operations have been subject to the 1000 Foot Rule (§48-1121), a policy that prohibits the distribution of any needle or syringe for the hypodermic injection of any illegal drug in any area of the District of Columbia which is within 1000 feet of a public or private elementary or secondary school (including a public charter school). The 1000 Foot Rule may impede SEP services in areas that are in urgent need for harm reduction services, such as locations where injections are happening in real time or where drugs are purchased or exchanged. We examined the effects of the 1000 Foot Rule on SEP operational space in injection drug use (IDU)-related crime (i.e., heroin possession or distribution) hot spots from 2000 to 2010. METHODS: Data from the DC Metropolitan Police Department were used to identify IDU-related crime hot spots. School operation data were matched to a dataset that described the approximate physical property boundaries of land parcels. A 1000-ft buffer was applied to all school property boundaries. The overlap between the IDU-related crime hot spots and the school buffer zones was calculated by academic year. RESULTS: When overlaying the land space associated with IDU-related crime hot spots on the maps of school boundaries per the 1000-ft buffer zone stipulation, we found that the majority of land space in these locations was ineligible for legal SEP operations. More specifically, the ineligible space in the identified hot spots in each academic year ranged from 51.93 to 88.29 % of the total hot spot area. CONCLUSIONS: The removal of the 1000 Foot Rule could significantly improve the public health of PWID via increased access to harm reduction services. Buffer zone policies that restrict SEP operational space negatively affect the provision of harm reduction services to PWID

Cross-Sectional Comparison of Behavioral Risk Factors for HIV/HCV in People Who Inject Drugs (PWID) in Egypt

Background Egypt has the greatest HCV prevalence worldwide at 15% and a concentrated HIV epidemic in male people who inject drugs (PWID) at 6.8%, who are at a high risk for HCV infection as well. Injection drug use is criminalized in Egypt, and there is limited availability of harm reduction programs. Drug-use and sexual risk behaviors between PWID and the general population have not been studied there. Methods To address this gap, a cross-sectional HIV/HCV epidemiological study of 632 consenting injection drug users in Cairo and Alexandria was conducted. Bivariate logistic regression analysis was done to evaluate the associations between HIV/HCV and needle sharing or sexual practices using SAS 9.4. Results 10.6% (63/ 604) of the study population tested positive for HIV and 61.5% (384/624) tested positive for HCV. Sharing needles with more than 10 people was associated with HIV and HCV infection (OR=3.65, p-val=0.001; OR=2.05, p-val=0.02, respectably). Age was associated with both HIV and HCV (p-val=0.03 and Conclusions The results indicate that the growing epidemic among PWID in Egypt may place the general population at risk for HIV and HCV primarily through sexual contact. In Russia, repressive policies toward PWID allowed HIV to spread to the general population at the start of the epidemic in 2000. Now, 48% of HIV is heterosexually transmitted in Russia and the country contributes \u3e80% of the HIV cases in Eastern Europe and Central Asia. In response to the epidemic, even more punitive laws and regulations were introduced in Russia, and their HIV prevalence has seen a 49% increase between 2005 and 2015. A similar trajectory can be expected for Egypt if preventative measures are not taken. Common-sense harm reduction programs like clean needle exchanges and decriminalization of injection drug use should be part of a comprehensive plan to control the spread of HIV and HCV in Egypt

Supplementation of vitamin E and C prevent granulomatosis in meagre larvae

Systemic granulomatosis has already been reported in meagre larvae with an adequate feeding protocol and enrichment media preventing its appearance in the first weeks of life. Afterwards, the control of this disease could be prevented through nutritional components of the inert food, being the antioxidants the key to success. For this reason, in the present study, meagre larvae were reared from 30 days post hatching (dph) with five isonitrogenous and isolipidic experimental microdiets with different levels of vitamin E and C: C- (40 mg kg-1 E, 100 mg kg-1 C), C+ (400 mg kg-1 E, 1,000 mg kg-1 C), Krill (400 mg kg-1 E, 1,000 mg kg-1 C and substitution of fish oil by krill oil), EC (200 mg kg-1 E, 500 mg kg-1 C) and EECC (800 mg kg-1 E, 2,000 mg kg-1 C). Prior to this, larvae were co-fed with rotifers and Artemia following a protocol which prevented the appearance of granulomas, as previously demonstrated. The substitution of fish oil by krill oil significantly increased levels of eicosapentaenoic acid (EPA, 16.6 %) and docosahexaenoic acid (DHA, 17.6 %) in meagre, consequently increasing the peroxidation index, which in turn translated into a higher incidence of granulomas. Although even low levels of vitamin E and C (40 mg kg-1 E, 100 mg kg-1 C; C-) allowed the adequate growth of larvae, these levels were not enough to prevent the appearance of granulomas, requiring superior levels of both antioxidant vitamins (800 mg kg-1 E and 2,000 mg kg-1 C) to mitigate systemic granulomatosis. This mitigation was simultaneous with the reduction of thiobarbituric acid reactive substances TBARs content in larvae, which were highly correlated with the appearance of granulomas (R2=0.892, y=0.0446x+0.0756). A strong negative correlation was observed between the dietary levels of vitamin E (y = -0.0098x + 11.174, R2 = 0.8766, p value = 0.019, r = -0.93) and vitamin C (y = -0.0022x + 6.4777, R2 = 0.9278, p value = 0.003, r = -0.96) and the percentage of larvae with granulomas. The results showed that the occurrence of systemic granulomatosis seems to be associated to the larvae peroxidation status, so that high dietary levels of vitamin E and C (800 and 2,000 mg kg-1, respectively; Diet EECC), reduced lipid peroxidation and completely prevented the appearance of granulomas in meagre larvae at 44 dph

HIV-care access among people with incarceration experience in St. Petersburg, Russia

Background: Little is known about the clinical care experiences of HIV-infected persons in St. Petersburg who have experience with incarceration. To address this question, we conducted a capture-recapture study to identify individuals who had been diagnosed with HIV infection while incarcerated and who subsequently presented for medical care in St. Petersburg, Russia following release from prison. Methods: We matched 292 HIV-positive prisoners tested by the prison system in 2010 to the medical records at the St. Petersburg AIDS Center in the following 4 years. Results: The data analysis shows that as many as half of HIV+ prisoners fail to seek treatment in the community upon release. Of those who had sought care post-release, only 36% were receiving HAART. Of the 109 individuals for whom tuberculosis testing was indicated post-release, 36.7% were found to be reactive. Conclusion: Despite the limitations of the data, this study is the first of its kind to review records documenting HIV care among prisoners in Russia post-incarceration. In addition to providing important descriptive information about this marginalized population, the findings from this study highlight areas where HIV control efforts could be improved in order to address the HIV epidemic in the Russian Federation

Color Tuning of Electrochromic TiO₂ Nanofibrous Layers Loaded with Metal and Metal Oxide Nanoparticles for Smart Colored Windows

Co-axial electrospinning was applied for the structuring of non-woven webs of TiO2 nanofibers loaded with Ag, Au, and CuO nanoparticles. The composite layers were tested in an electrochromic half-cell assembly. A clear correlation between the nanoparticle composition and electrochromic effect in the nanofibrous composite is observed: TiO2 loaded with Ag reveals a black-brown color, Au shows a dark-blue color, and CuO shows a dark-green color. For electrochromic applications, the Au/TiO2 layer is the most promising choice, with a color modulation time of 6 s, transmittance modulation of 40%, coloration efficiency of 20 cm2/C, areal capacitance of 300 F/cm2, and cyclic stability of over 1000 cycles in an 18 h period. In this study, an unexplored path for the rational design of TiO2-based electrochromic device is offered with unique color-switching and optical efficiency gained by the fibrous layer. It is also foreseen that co-axial electrospinning can be an alternative nanofabrication technique for smart colored windows. </p