Fishermen who inject drugs represent an understudied group at high risk for HIV in Malaysia. This study describes fishing, drug use, and attitudes toward medication-assisted treatment (MAT) for ...opioid use disorders. Thirty-four male ethnic Malay fishermen completed semistructured interviews analyzed by content analysis. Analysis revealed four themes surrounding opioids, which they called ubat ("medicine"): (a) the fishing lifestyle facilitating substance use, (b) previous unsuccessful attempts to quit, (c) categorizing substances as haram or halal, and (d) attitudes toward MAT. Fishermen's environment permits substance use, including injecting drugs on boats. Fishermen expressed more positive attitudes toward methadone and negative attitudes toward buprenorphine.
In 1996, active surveillance in 5 Foodborne Diseases Active Surveillance Network (FoodNet) sites revealed up to a 9-fold difference in Escherichia coli O157:H7 (O157) infection incidence between ...sites. A matched case-control study of sporadic O157 cases was conducted in these sites from March 1996 through April 1997. Case subjects were patients with non-outbreak-related diarrheal illness who had O157 isolated from their stool samples. Control subjects were healthy persons matched by age and telephone number exchange. Overall, 196 case patients and 372 controls were enrolled. O157 infections were associated with farm exposure, cattle exposure, eating a pink hamburger (both at home and away from home), eating at a table-service restaurant, using immunosuppressive medication, and obtaining beef through a private slaughter arrangement. Variations in cattle exposures may explain a part of the regional variability of O157 infection incidence. O157 control measures should focus on reducing risks associated with eating undercooked hamburger, dining at table-service restaurants, and farm exposures.
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To determine risk factors for sporadic Salmonella serotype Heidelberg diarrheal disease, we conducted a population-based case-control study in 5 Foodborne Diseases Active Surveillance Network ...(FoodNet) surveillance areas in 1996–1997. Forty-four case patients and 83 control subjects matched by age and telephone exchange were asked about exposures during the 5-day period before onset of illness in the case patient. Risk factors for infection were evaluated using conditional logistic regression analysis. Eating eggs prepared outside the home remained the only significant risk factor for illness (matched odds ratio MOR, 6.0; 95% confidence interval CI, 1.2–29.6). The population-attributable fraction of S. Heidelberg infections associated with eating eggs prepared outside the home was 37%. Eliminating the risk associated with out-of-home egg consumption could substantially reduce the incidence of S. Heidelberg infections. Control measures to prevent S. Heidelberg infection should include advising consumers to avoid eating undercooked eggs and educating food handlers about proper egg handling and cooking.
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Worldwide, foodborne illness is often associated with consumption of meats and poultry products sold at retail markets. A cross-sectional retail food study was conducted in Bangkok, Thailand to ...assess the prevalence of bacterial pathogens on retail food samples. Raw chicken, beef, pork, and chicken eggs were purchased from fresh markets and supermarkets and tested for Salmonella spp., Campylobacter spp., Arcobacter spp., and Enterococcus spp. Suspect bacterial pathogens were isolated by differential culture and Salmonella species were serotyped. A total of 200 samples were collected from 50 markets between May and August 2003. Of the 200 samples tested, 121 (61%) were positive for at least one Salmonella spp. serogroup. A total of 175 Salmonella spp. were isolated. The most common serotype was Salmonella Anatum, followed by S. Corvallis and S. Derby. Campylobacter spp. were found in 31 (15.5%) of 200 samples. C. jejuni was isolated from 15% of fresh market chicken samples and 35% of supermarket chicken samples. Arcobacter spp. were isolated from 42 (21%) samples; fresh market chicken had significantly higher A. butzleri contamination than supermarket chicken. The presence of Enterococcus spp., an indication of fecal contamination, was detected in 188 (94%) samples, including 100% of the beef and pork sources. Few studies have examined retail food contamination in Thailand. In particular, the high prevalence of samples with Arcobacter spp. warrants further study to determine pathogenicity.
To understand physician practices regarding the diagnosis of acute diarrheal diseases, we conducted a survey, in 1996, of 2839 physicians in Connecticut, Georgia, Minnesota, Oregon, and California. ...Bacterial stool culture was requested for samples from the last patient seen for acute diarrhea by 784 (44%; 95% confidence interval, 42%–46%) of 1783 physicians. Physicians were more likely to request a culture for persons with acquired immune deficiency syndrome, bloody stools, travel to a developing country, diarrhea for >3 days, intravenous rehydration, or fever. Substantial geographic and specialty differences in culture-request practices were observed. Twenty-eight percent of physicians did not know whether stool culture included testing for Escherichia coli O157:H7; 40% did not know whether Yersinia or Vibrio species were included. These variabilities suggest a need for clinical diagnostic guidelines for diarrhea. Many physicians could benefit from education to improve their knowledge about tests included in routine stool examinations.
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Transgender women are disproportionately affected by sexual violence and corresponding mental health sequelae; however, many do not access healthcare due to experiences with transphobia. This ...analysis evaluated the association between sexual violence and suicidal ideation and the moderating effect of having a healthcare provider (HCP) with whom transgender women were comfortable discussing gender-related issues (“gender-affirming HCP”). We analyzed cross-sectional data from the Centers for Disease Control and Prevention’s National HIV Behavioral Surveillance among Transgender Women (NHBS-Trans). Transgender women were recruited using respondent-driven sampling from seven urban areas from 2019 to 2020 and participated in an HIV biobehavioral survey. This analysis was restricted to transgender women who visited a HCP in the past 12 months (“healthcare-seeking transgender women” HSTW) ( N = 1,489). Log-linked Poisson regression models provided adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) to estimate the association between sexual violence and suicidal ideation in the past 12 months. The interaction between sexual violence and having a gender-affirming HCP was statistically significant ( p-value = .034). Among 1,489 HSTW, 225 (15.1%) experienced sexual violence and 261 (17.5%) reported suicidal ideation; 1,203 (80.8%) reported having a gender-affirming HCP. Sexual violence was associated with suicidal ideation (aPR = 2.65, 95% CI 2.08, 3.38); the association was notably higher among those who did not have a gender-affirming HCP (aPR = 3.61, 2.17, 6.02) than among those who did (aPR = 1.87, 1.48, 2.37). Eliminating transphobia and promoting trauma- and violence-informed approaches in healthcare are necessary for sexual violence and suicide prevention among HSTW.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK, VSZLJ
To describe the landscape of needs for housing assistance among people with HIV (PWH) and availability of Housing Opportunities for People with AIDS (HOPWA) funding with respect to housing service ...needs, nationally and for 17 US jurisdictions.
The CDC Medical Monitoring Project (MMP) is an annual, cross-sectional survey designed to report nationally and locally representative estimates of characteristics and outcomes among adults with diagnosed HIV in the United States.
We analyzed 2015-2020 data from MMP and 2019 funding data from HOPWA. Weighted percentages and 95% confidence intervals (CIs) for national and jurisdiction-level estimates were reported.
Nationally, 1 in 4 (27.7%) PWH had shelter or housing service needs. Among those who needed housing services, 2 in 5 (40.4%) did not receive them (range: 21.3% in New York to 62.3% in Georgia). Reasons for unmet needs were multifactorial and varied by jurisdiction. Available 2019 HOPWA funding per person in need would cover up to 1.24 months of rent per person nationally (range: 0.53 months in Virginia to 9.54 months in Puerto Rico), and may not have matched housing assistance needs among PWH in certain jurisdictions.
Addressing housing service needs necessitates a multipronged approach at the provider, jurisdiction, and national level. Locally, jurisdictions should work with their partners to understand and address housing service needs among PWH. Nationally, distribution of HOPWA funding for housing services should be aligned according to local needs; the funding formula could be modified to improve access to housing services among PWH.
Background and Aims
Ukraine's HIV epidemic remains concentrated among opioid‐dependent people who inject drugs (PWID) where opioid agonist therapies (OAT) like methadone (MMT) and buprenorphine (BMT) ...maintenance treatments are the most cost‐effective HIV prevention strategies, but remain under‐scaled. This study aimed to measure the association between dose and type of OAT prescribed and treatment retention.
Design
Observational longitudinal cohort study.
Participants and Setting
Patients (n = 15 290) prescribed OAT throughout Ukraine from 2004 through 2016.
Measurements
Data were analyzed using time–event strategies to estimate cumulative treatment retention, defined as time to OAT discontinuation. Cumulative retention proportions at 1, 12 and 36 months were assessed for outcomes. Cox regression with log‐rank likelihood assessed independent predictors of treatment discontinuation.
Findings
The proportion prescribed high (MMT: > 85 mg; BMT: ≥ 16 mg), medium (MMT: > 40–85 mg; BMT: > 6–15 mg) and low (MMT: ≤ 40 mg; BMT: ≤ 6 mg) dosages was 25, 43 and 32%, respectively. Retention was significantly higher for BMT than MMT both at 12 (89 versus 75%) and 36 months (80 versus 56%). Although dosing levels for BMT did not influence retention, increasing dosages for MMT were significantly associated with higher retention rates at 1 (90, 96, 99%), 12 (59, 78, 91%) and 36 (34, 59, 79%) months, respectively. Independent predictors associated with 12‐month OAT discontinuation were medium adjusted hazard ratio (aHR) = 2.23; 95% confidence limit (CL) = 1.95–2.54 and low (aHR = 4.96; 95% CL = 4.37–5.63) OAT dosage relative to high dosage, male sex (aHR = 1.27; 95% CL = 1.14–1.41), MMT relative to BMT prescription (aHR = 1.57; 95% CL = 1.32–1.87) and receiving OAT in general (aHR = 1.22; 95% CL = 1.02–1.46) or tuberculosis (aHR = 1.43; 95% CL = 1.10–1.85) hospitals, relative to specialty addiction treatment and AIDS center settings. Lower dosages contributed more to dropout especially at 1 month (aHR 3.12; 95% CL = 2.21–4.41 and aHR 7.71; 95% CL = 5.51–10.79 for medium and low dosages, respectively). Younger age was significantly associated with OAT discontinuation only at 36 months (aHR = 1.08; 95% CI = 1.02–1.15).
Conclusions
Higher dosages of opioid agonist therapies, especially for methadone maintenance treatment patients, appear to be associated with higher levels of treatment retention in Ukraine.
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BFBNIB, DOBA, FSPLJ, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
We report a case of Escherichia coli O157:H7, which was acquired by eating wild White-Tailed deer (Odocoileus virginianus). DNA fingerprint analysis verified venison as the source of infection. This ...pediatric case emphasizes the need for dissemination of information to hunters regarding the safe handling and processing of venison.
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DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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