Risk of hepatitis C virus transmission among people who inject prescription opioids: examining the contribution of patterns and contexts
Notice bibliographique
Résumé
Introduction: In developed countries, Hepatitis C Virus (HCV) is mainly transmitted through illicit drug injection. Within the last decade, a new population of People Who Inject Drugs (PWID), namely Prescription Opioids (PO) injectors, has emerged both in Canada and worldwide. However, this new group of PWID has not been sufficiently studied. Characterizing PO injectors, and defining the association between PO injection and the risk for HCV seroconversion may be useful for developing specific HCV prevention and treatment programmes. Objectives: The study objectives were: 1) to examine sociodemographic characteristics, drug use patterns, injecting behaviors, and living contexts associated with PO injection in a cohort of PWID in Montreal, 2) to compare HCV incidence rates between PO injectors and non-PO injectors, 3) to examine the association between PO injection, with or without co-use of other drugs, and HCV seroincidence.Methods: Data collected from PWID, who participated in a prospective cohort study (HEPCO Cohort of Montreal), were examined. Eligibility criteria were age of 18 years old or over, drug injection in the previous 6 months, and current residence in Montreal. Data were procured in 2004-2013 by means of a validated, interviewer-administered questionnaire and blood testing for HCV and HIV antibody. Baseline data were assessed in a cross-sectional analysis by Chi-square and Student’s t tests. Logistic regression modeling was applied to identify the correlates of PO injection. HCV negative at baseline PWID were included in the longitudinal analysis. Kaplan-Meier survival and time-varying Cox regression analyses were conducted to calculate the relative rates of HCV seroincidence and examine the association between PO injection and time-to-HCV seroconversion. Results: Cross-sectional analysis. Of 1243 PWID who participated between 2004 and 2011 (83.8% males; mean age: 38.2 years), 380 (30.6%) reported PO injection in the past month. In a multivariate regression analysis, characteristics and behaviors independently associated with PO injection were age (adjusted odds ratio (aOR) by 5-year increment: 0.79; 95% confidence interval [95%CI]: 0.7,0.9), co-use of heroin injection (aOR:3.03, [95%CI: 2.2,4.2]) or non-injection amphetamines (aOR: 1.84; [95%CI: 1.2,2.9]) or non-injection tranquilizers (aOR:2.38, [95%CI: 1.8,3.2]), unstable housing conditions (aOR: 1.78, [95% CI: 1.3,2.4]), injecting in a public place (aOR:2.03, [95%CI: 1.5,2.8]), and HCV seropositivity (aOR: 1.56, [95%CI:1.1,2.2]). Longitudinal analysis. Of 356 participants (81.5% males; mean age: 34.7 years) who were HCV-negative at baseline and were followed up between 2004 and 2013, 123 (34.6%) reported PO injection, and 115 (32%) seroconverted to HCV. Co-use dyads associated with HCV were: PO injection with cocaine injection (crude hazard ratio (cHR): 10.86, [95%CI: 5.8,20.3] vs. use of neither drug), PO injection with crack/cocaine smoking (cHR:4.08, [95%CI: 2.5,6.7]), and PO injection with non-injection tranquilizers (cHR: 4.09, [95%CI: 2.5,6.6]). In a multivariate analysis, PO injection was independently associated with HCV infection. PWID who co-used all three drugs with PO injection had the highest risk of HCV acquisition. Interpretation: Comprehensive harm reduction and HCV prevention strategies for PO injectors in Montreal should address young PWID. In addition, addressing co-use of PO injection with cocaine injection, crack/cocaine smoking, or non-injection use of tranquilizers may also be beneficial. PO injectors who co-use all three drugs should be identified as high priority targets for interventions.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».