Aims To estimate adherence and response to therapy for chronic hepatitis C virus (HCV) infection among people with a history of injecting drug use. A secondary aim was to identify predictors of HCV treatment response. Design Prospective cohort recruited between 2009 and 2012. Participants were treated with peg-interferon alfa-2a/ribavirin for 24 (genotypes 2/3, G2/3) or 48 weeks (genotype 1, G1).Setting Six opioid substitution treatment (OST) clinics, two community health centres and one Aboriginal community-controlled health organization providing drug treatment services in New South Wales, Australia.
Participants Among 415 people with a history of injecting drug use and chronic HCV assessed by a nurse, 101 were assessed for treatment outcomes (21% female).
Measurements Study outcomes were treatment adherence and sustained virological response (SVR, undetectable HCV RNA >24 weeks post-treatment). Findings Among 101 treated, 37% (n = 37) had recently injected drugs (past 6 months) and 62% (n = 63) were receiving OST. Adherence ≥ 80% was 86% (n = 87). SVR was 74% (75 of 101), with no difference observed by sex (males: 76%, females: 67%, P = 0.662). In adjusted analysis, age < 35 (versus ≥ 45 years) [adjusted odds ratio (aOR) = 5.06, 95% confidence interval (CI) = 1.47, 17.40] and on-treatment adherence ≥ 80% independently predicted SVR (aOR = 19.41, 95% CI = 3.61, 104.26]. Recent injecting drug use at baseline was not associated with SVR. Conclusions People with a history of injecting drug use and chronic hepatitis C virus attending opioid substitution treatment and community health clinics can achieve adherence and responses to interferon-based therapy similar to other populations, despite injecting drugs at baseline. Younger age and adherence are predictive of improved response to hepatitis C virus therapy.
Keywords: Antiviral therapy; hepatitis C virus; injecting drug use; methadone; opioid substitution treatment; people who inject drugs
Julie R. Adams-Guppy & Andrew Guppy Drugs: Education, Prevention and Policy 2016:23(1);15-30 Abstract
Aims To compile and critically analyse published research on interventions with alcohol-abusing homeless adults. Methods A systematic review was conducted of research published utilising the MEDLINE, EMBASE, PsycInfo, CINAHL and SocIndex databases from inception to March 2015. A meta-analysis was performed on studies that met the inclusion criteria, to determine if there were any significant pre- and post-intervention effects on alcohol-use. Results Seventeen studies from three continents were included in this systematic review. A meta-analysis of pre- and post-intervention effects on alcohol use across the 17 studies found highly significant effects (p < 0.001). A smaller subset of studies (n = 10), where the same specific alcohol use outcome measurement was employed across all studies, also showed highly significant pre–post intervention effects (p < 0.001). Results indicate that a range of interventions were effective in reducing alcohol use and abuse within samples of homeless participants, although short-term effects are more apparent than longer term ones. Conclusions There is a relative paucity of research into alcohol abusing homeless adults, which has implications for evidence-based practice. This systematic meta-analytical review demonstrates that a range of alcohol abuse interventions for homeless adults produces improvements in alcohol use (p < 0.001).
35. In their own words: Content analysis of pathways to recovery among individuals with the lived experience of homelessness and alcohol use disorders
Susan E. Collins, Connor B. Jones, Gail Hoffmann, Lonnie A. Nelson, Starlyn M. Hawes, Véronique S. Grazioli, Jessica L. Mackelprang, Jessica Holttum, Greta Kaese, James Lenert, Patrick Herndon, Seema L. Clifasefi
International Journal of Drug Policy 2016:27;89-96
Background Alcohol use disorders (AUDs) are more prevalent among homeless individuals than in the general population, and homeless individuals are disproportionately affected by alcohol-related morbidity and mortality. Unfortunately, abstinence-based approaches are neither desirable to nor highly effective for most members of this population. Recent research has indicated that homeless people aspire to clinically significant recovery goals beyond alcohol abstinence, including alcohol harm reduction and quality-of-life improvement. However, no research has documented this population's preferred pathways toward self-defined recovery. Considering principles of patient-centred care, a richer understanding of this population's desired pathways to recovery may help providers better engage and support them. Methods Participants (N = 50) had lived experience of homelessness and AUDs and participated in semi-structured interviews regarding histories of homelessness, alcohol use, and abstinence-based treatment as well as suggestions for improving alcohol treatment. Conventional content analysis was used to ascertain participants’ perceptions of abstinence-based treatment and mutual-help modalities, while it additionally revealed alternative pathways to recovery. Results Most participants reported involvement in abstinence-based modalities for reasons other than the goal of achieving long-term abstinence from alcohol (e.g., having shelter in winter months, “taking a break” from alcohol use, being among “like-minded people”). In contrast, most participants preferred alternative pathways to recovery, including fulfilling basic needs (e.g., obtaining housing), using harm reduction approaches (e.g., switching from higher to lower alcohol content beverages), engaging in meaningful activities (e.g., art, outings, spiritual/cultural activities), and making positive social connections. Conclusions Most people with the lived experience of homelessness and AUDs we interviewed were uninterested in abstinence-based modalities as a means of attaining long-term alcohol abstinence. These individuals do, however, have creative ideas about alternative pathways to recovery that treatment providers may support to reduce alcohol-related harm and enhance quality of life.