Risk Factors for Loss to Follow-Up among People Who Inject Drugs in a Risk Reduction Program at Karachi, Pakistan

INTRODUCTION:

Retention of male people who inject drugs (PWIDs) is a major challenge for harm reduction programs that include sterile needle/syringe exchange in resource-limited settings like Pakistan. We assessed the risk factors for loss to follow-up among male PWIDs enrolled in a risk reduction program in Karachi, Pakistan.

METHODS:

We conducted a prospective cohort study among 636 HIV-uninfected male PWIDs enrolled during March-June 2009 in a harm reduction program for the estimation of incidence rate. At 24 months post-enrollment, clients who had dropped out of the program were defined as lost to follow-up and included as cases for case-cohort study.

RESULTS:

The median age of the participants was 29 years (interquartile range: 23-36). Active outreach accounted for 76% (483/636) of cohort recruits. Loss to follow-up at 24 months was 25.5% (162/636). In multivariable logistic regression, younger age (AOR: 0.97, 95% CI: 0.92-0.99, p = 0.028), clients from other provinces than Sindh (AOR: 1.49, 95% CI: 1.01-2.22, p = 0.046), having no formal education (AOR: 3.44, 95% CI: 2.35-4.90, p<0.001), a history of incarceration (AOR: 1.68, 95% CI: 1.14-2.46, p<0.008), and being homeless (AOR: 1.47, 95% CI: 1.00-2.19, p<0.049) were associated with loss to follow-up.

CONCLUSIONS:

Our cohort retained 74.5% of male PWIDs in Karachi for 24 months. Its loss to follow up rate suggested substantial ongoing programmatic challenges. Programmatic enhancements are needed for the highest risk male PWIDs, i.e., younger men, men not from Sindh Province, men who are poorly educated, formerly incarcerated, and/or homeless.

Full article at:  http://goo.gl/nhE42m

By:  Samo RN1, Agha A2, Shah SA3, Altaf A3, Memon A4, Blevins M5, Qian HZ6, Vermund SH7.

• 1Polio Eradication Initiative, World Health Organization, Larkana, Pakistan.
• 2Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
• 3Bridge Consultants Foundation, Karachi, Pakistan.
• 4Sindh AIDS Control Program, Karachi, Pakistan.
• 5Vanderbilt Institute for Global Health & Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America.
• 6Vanderbilt Institute for Global Health & Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America.
• 7Vanderbilt Institute for Global Health & Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America. 
• PLoS One. 2016 Feb 3;11(2):e0147912. doi: 10.1371/journal.pone.0147912. eCollection 2016.

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A Group-Based Sexual Risk Reduction Intervention for Men Who Have Sex with Men in Ho Chi Minh City, Vietnam: Feasibility, Acceptability, and Preliminary Efficacy

An emerging HIV epidemic can be seen among men who have sex with men (MSM) in Vietnam. There are currently no evidence-based behavioral sexual risk reduction interventions for MSM in this setting. 

Between October 2012 and June 2013, 100 high-risk MSM from Ho Chi Minh City were enrolled in an open pilot trial to assess feasibility and acceptability of a group-based, manualized sexual risk reduction intervention, and to preliminarily examine changes in primary and secondary outcomes. 

Participants completed a behavioral assessment battery and HIV testing at baseline, 3, and 6 months post-baseline. Over 80.0 % of the sample was <25 years old and 77.0 % identified as Bong kin ("hidden," masculine-appearing). Feasibility and acceptability of the program was evidenced by 87.0 % retention for the intervention sessions, 78.0 % completion of the 6 month assessment, and positive responses on evaluation forms and qualitative exit interviews. 

There was a decline in the number of condomless anal sex acts from baseline (6.32) to 3 month (2.06) and 6 month (2.49) follow-up (p < .0001). These data support the need for further testing of this group-based, behavioral HIV prevention intervention to reduce sexual risk behavior among MSM in Vietnam in a randomized controlled efficacy trial.

Purchase full article at: http://goo.gl/HGGdo9 

By:   Mimiaga MJ^1,2,3,4, Closson EF^5,6, Biello KB^7,8,5, Nguyen H⁹, Nguyen QH^9,10, Oldenburg CE¹¹, Lan HT¹², Safren SA^5,13, Mayer KH^5,14, Colby DJ¹⁰.

¹Department of Epidemiology and Behavioral & Social Health Sciences, Brown University School of Public Health, Providence, RI, USA. matthew_mimiaga@brown.edu.

²Institute for Community Health Promotion, Brown University, Providence, RI, USA. matthew_mimiaga@brown.edu.

³Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. matthew_mimiaga@brown.edu.

⁴The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA. matthew_mimiaga@brown.edu.

⁵The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA.

⁶Department of Social and Environmental Health, The London School of Hygiene and Tropical Medicine, London, UK.

⁷Department of Epidemiology and Behavioral & Social Health Sciences, Brown University School of Public Health, Providence, RI, USA.

⁸Institute for Community Health Promotion, Brown University, Providence, RI, USA.

⁹Harvard AIDS Initiative in Vietnam, Ho Chi Minh City, Vietnam.

¹⁰Center for Applied Research on Men and Health, Ho Chi Minh City, Vietnam.

¹¹Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

¹²The Life Centre, Ho Chi Minh City, Vietnam.

¹³Department of Psychology, The University of Miami, Miami, FL, USA.

¹⁴Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

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Impact of ASUMA Intervention on HIV Risk Behaviors among Puerto Rican Adolescents

The purpose of this manuscript is to assess and compare HIV risk behaviors among early adolescents after a three-year pilot study. 

A total of 135 public and private junior high schools students completed the intervention protocol. A self-administered questionnaire was given at baseline and at the end of the third year (fourth measure). Descriptive and inferential analyses were performed using SPSS 20.0.

About 60% of the students were 14 years old at the fourth measure. The proportion of students that did not report at least one HIV risk behavior at baseline and those that reported any risk behavior at the fourth measure was lower in the intervention group (45.0%) than in the control group (54.5%). The proportion of students that reported at least one HIV risk behavior at baseline and those that did not report any HIV risk behavior at the fourth measure was higher in the intervention group than in the control group (33.3% vs. 8.3%). 

The proportion of students engaging in HIV risk behaviors was higher in the control group than in the intervention group at the fourth measure, suggesting that A Supportive Model for HIV Risk Reduction in Early Adolescence (ASUMA) intervention might be a promising initiative to reduce adolescents' engagement in HIV risk behaviors.

Below:  A Supportive Model for HIV Risk Reduction in Early Adolescence (ASUMA) theoretical framework

Full article at:   http://goo.gl/KbkJP9

By:   Fernandez-Santos DM1, Miranda-Diaz C2, Figueroa-Cosme WI3, Ramon RO4, Mayor AM5, Rios-Olivares E6, Hunter-Mellado RF7.

• 1Internal Medicine Department, Universidad Central del Caribe, School of Medicine, PO BOX 60327, Bayamon 00960-6032, Puerto Rico. diana.fernandez@uccaribe.edu.
• 2Internal Medicine Department, Universidad Central del Caribe, School of Medicine, PO BOX 60327, Bayamon 00960-6032, Puerto Rico. christine.miranda@uccaribe.edu.
• 3Internal Medicine Department, Universidad Central del Caribe, School of Medicine, PO BOX 60327, Bayamon 00960-6032, Puerto Rico. wanda.figueroa@uccaribe.edu.
• 4Internal Medicine Department, Universidad Central del Caribe, School of Medicine, PO BOX 60327, Bayamon 00960-6032, Puerto Rico. raul.ramon@uccaribe.edu.
• 5Internal Medicine Department, Universidad Central del Caribe, School of Medicine, PO BOX 60327, Bayamon 00960-6032, Puerto Rico. amayorb@hotmail.com.
• 6Internal Medicine Department, Universidad Central del Caribe, School of Medicine, PO BOX 60327, Bayamon 00960-6032, Puerto Rico. eddy.rios@uccaribe.edu.
• 7Internal Medicine Department, Universidad Central del Caribe, School of Medicine, PO BOX 60327, Bayamon 00960-6032, Puerto Rico. robert.hunter@uccaribe.edu.
• Int J Environ Res Public Health. 2015 Dec 23;13(1). pii: E60. doi: 10.3390/ijerph13010060.

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The Impact of Gain- and Loss-Framed Messages on Young Adults' Sexual Decision Making

Messages that frame a target behavior in terms of its benefits (gain frame) or costs (loss frame) have been widely and successfully used for health promotion and risk reduction. However, the impact of framed messages on decisions to have sex and sexual risk, as well as moderators of these effects, has remained largely unexplored. 

We used a computerized laboratory task to test the effects of framed messages about condom use on young adults' sexual decision making. Participants (N = 127) listened to both gain- and loss-framed messages and rated their intentions to have sex with partners who posed a high and low risk for sexually transmitted infections (STIs). The effects of message frame, partner risk, participant gender, ability to adopt the messages, and message presentation order on intentions to have sex were examined. 

Intentions to have sex with high-risk partners significantly decreased after the loss-framed message, but not after the gain-framed message, and intentions to have sex increased for participants who received the gain-framed message first. Yet, participants found it easier to adopt the gain-framed message. 

Results suggest that loss-framed messages may be particularly effective in reducing intentions to have sex with partners who might pose a higher risk for STIs, and that message presentation order may alter the relative effectiveness of gain- and loss-framed messages on sexual decision making. 

Future studies should examine the precise conditions under which gain- and loss-framed messages can promote healthy sexual behaviors and reduce sexual risk behaviors.

Purchase full article at:   http://goo.gl/GIxLyf

By:   Macapagal K^1,2, Janssen E^3,4, Matson M⁵, Finn PR⁶, Heiman JR^3,6.

¹Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 North Michigan Avenue, Suite 2700, Chicago, IL, 60611, USA. kathryn.macapagal@northwestern.edu.

²The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, IN, USA. kathryn.macapagal@northwestern.edu.

³The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, IN, USA.

⁴Institute for Family and Sexuality Studies, Department of Neurosciences, University of Leuven, Leuven, Belgium.

⁵Richard M. Fairbanks School of Public Health, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA.

⁶Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA. 

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Meet James and Craig, two brothers who are also former prisoners. James caught HIV in prison. His infection was entirely preventable

Meet James and Craig, two brothers who are also former prisoners. James caught HIV in prison. His infection was entirely preventable.
For more information: http://www.prisonhealthnow.ca

Self-Care & Risk Reduction Habits in Older Injection Drug Users with Chronic Wounds

BACKGROUND:

We surveyed a population of injection drug users (IDUs) frequenting the mobile Baltimore City Needle Exchange Program (BNEP) to investigate self-care factors associated with chronic wounds, a significant cause of morbidity especially among older IDUs.

METHODS:

Participants ≥18 years old completed a survey regarding chronic wounds (duration ≥8 weeks), injection and hygiene practices. Study staff visually verified the presence of wounds. Participants were categorized into four groups by age and wound status. Factors associated with the presence of chronic wounds in participants ≥45 years were analyzed using logistic regression.

RESULTS:

Of the 152 participants, 19.7% had a chronic wound. Of those with chronic wounds, 18 were ≥45 years old (60.0%). Individuals ≥45 years old with chronic wounds were more likely to be enrolled in a drug treatment program and less likely to use cigarette filters when drawing up prepared drug compared to the same age group without chronic wounds. Compared to individuals <45 years old without chronic wounds, individuals ≥45 with a chronic wound were more likely to report cleaning reused needles with bleach and to use the clinic, rather than an emergency room, as a primary source of medical care.

CONCLUSIONS:

Older IDUs with chronic wounds have different, and perhaps less risky, injection and hygiene behaviors than their peers and younger IDUs without wounds in Baltimore City. Because of these differences, older IDUs with wounds may be more receptive to community-based healthcare and substance abuse treatment messages.

Full article at: http://goo.gl/YTVovJ

By:  Smith ME, Robinowitz N, Chaulk P, Johnson KE1.

• 1Division of Infectious Diseases, Department of Medicine, Johns Hopkins Medical Institutions, 5200 Eastern Avenue, MFL Building, Center Tower, 3rd Floor, Baltimore, MD 21224, USA. kej1229@gmail.com. 

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