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An external evaluation of a peer-run outreach-based syringe exchange in Vancouver, Canada.

https://arctichealth.org/en/permalink/ahliterature144535
Source
Int J Drug Policy. 2010 Sep;21(5):418-21
Publication Type
Article
Date
Sep-2010
Author
Kanna Hayashi
Evan Wood
Lee Wiebe
Jiezhi Qi
Thomas Kerr
Author Affiliation
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada; Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, Canada.
Source
Int J Drug Policy. 2010 Sep;21(5):418-21
Date
Sep-2010
Language
English
Publication Type
Article
Keywords
Adult
British Columbia - epidemiology
Drug users
Epidemics
Female
HIV Infections - prevention & control
Humans
Male
Needle Sharing - adverse effects
Needle-Exchange Programs
Peer Group
Program Evaluation
Risk factors
Risk-Taking
Sexual Partners
Substance Abuse, Intravenous
Abstract
Vancouver, Canada has been the site of an epidemic of human immunodeficiency virus (HIV) amongst injection drug users (IDU). In response, the Vancouver Area Network of Drug Users (VANDU) initiated a peer-run outreach-based syringe exchange programme (SEP) called the Alley Patrol. We conducted an external evaluation of this programme, using data obtained from the Vancouver Injection Drug Users Study (VIDUS).
Using generalised estimating equations (GEE) we examined the prevalence and correlates of use of the SEP amongst VIDUS participants followed from 1 December 2000 to 30 November 2003.
Of 854 IDU, 233 (27.3%) participants reported use of the SEP during the study period. In multivariate GEE analyses, service use was positively associated with living in unstable housing (adjusted odds ratio [AOR]=1.83, 95% confidence interval [CI]: 1.39-2.40), daily heroin injection (AOR=1.31, 95% CI: 1.01-1.70), daily cocaine injection (AOR=1.34, 95% CI: 1.03-1.73), injecting in public (AOR=3.07, 95% CI: 2.32-4.06), and negatively associated with needle reuse (AOR=0.65, 95% CI: 0.46-0.92).
The VANDU Alley Patrol SEP succeeded in reaching a group of IDU at heightened risk for adverse health outcomes. Importantly, access to this service was associated with lower levels of needle reuse. This form of peer-based SEP may extend the reach of HIV prevention programmes by contacting IDU traditionally underserved by conventional syringe exchange programmes.
Notes
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PubMed ID
20359877 View in PubMed
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An external evaluation of a peer-run "unsanctioned" syringe exchange program.

https://arctichealth.org/en/permalink/ahliterature183989
Source
J Urban Health. 2003 Sep;80(3):455-64
Publication Type
Article
Date
Sep-2003
Author
Evan Wood
Thomas Kerr
Patricia M Spittal
William Small
Mark W Tyndall
Michael V O'Shaughnessy
Martin T Schechter
Author Affiliation
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada. BC V6Z 1Y6. ewood@hivnet.ubc.ca
Source
J Urban Health. 2003 Sep;80(3):455-64
Date
Sep-2003
Language
English
Publication Type
Article
Keywords
Adult
British Columbia
Female
HIV Infections - prevention & control - transmission
Humans
Male
Middle Aged
Needle Sharing - adverse effects
Needle-Exchange Programs - organization & administration
Peer Group
Program Evaluation
Prospective Studies
Questionnaires
Risk Reduction Behavior
Risk-Taking
Substance Abuse, Intravenous - virology
Syringes - utilization
Abstract
In Vancouver, British Columbia, Canada, difficulty accessing syringes at night has been shown to be strongly associated with human immunodeficiency virus (HIV) risk behavior among the city's injection drug users (IDUs). On September 1, 2001, the Vancouver Area Network of Drug Users (VANDU) initiated an unsanctioned all-night needle-exchange program on a street corner in the heart of the neighborhood where many of the city's IDUs are concentrated. An external evaluation of the population reached by the VANDU exchange was performed through the Vancouver Injection Drug User's Study, a prospective cohort study of IDUs begun in 1996. Persons accessing syringes through the exchange were compared to those active injectors who acquired their syringes from other sources, including the city's fixed site exchange, which closes at 8:00 PM. Overall, 587 active IDUs were seen during the period September 2001 to June 2002; of these individuals, 165 (28.1%) reported using the VANDU exchange. In multivariate analyses, participants who used the VANDU table were more likely to frequently inject cocaine (adjusted odds ratio [AOR]=1.56; 95% confidence interval [CI]=1.00-2.44), inject in public (AOR=2.71; 95% CI=1.62-4.53), and require help injecting (OR=2.13; 95% CI=1.33-3.42). Interestingly, use of the table was also independently associated with safer syringe disposal (AOR=2.69; 95% CI=1.38-5.21). Results indicate that the unsanctioned exchange appears to have reached those IDUs at highest risk of HIV infection. Although the cross-sectional nature of the study design warrants caution, we also found that use of the nighttime exchange was strongly associated with higher rates of safe syringe disposal. The data suggest that drug user organizations can play a major role in reducing harm among their peers by reaching the highest risk drug users with harm reduction services. The findings also suggest that other forms of syringe-exchange programs should consider the benefits of offering fixed site nighttime service.
Notes
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PubMed ID
12930883 View in PubMed
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Attendance, drug use patterns, and referrals made from North America's first supervised injection facility.

https://arctichealth.org/en/permalink/ahliterature171504
Source
Drug Alcohol Depend. 2006 Jul 27;83(3):193-8
Publication Type
Article
Date
Jul-27-2006
Author
Mark W Tyndall
Thomas Kerr
Ruth Zhang
Evelyn King
Julio G Montaner
Evan Wood
Author Affiliation
Department of Medicine, and BC Centre for Excellence in HIV/AIDS, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, Canada. mtyndall@cfenet.ubc.ca
Source
Drug Alcohol Depend. 2006 Jul 27;83(3):193-8
Date
Jul-27-2006
Language
English
Publication Type
Article
Keywords
Acquired Immunodeficiency Syndrome - epidemiology - ethnology - prevention & control - psychology
Adult
British Columbia
Cocaine-Related Disorders - epidemiology - ethnology - psychology - rehabilitation
Community Mental Health Services - statistics & numerical data
Cross-Sectional Studies
Drug Overdose - epidemiology - ethnology - prevention & control - psychology
Female
HIV Infections - epidemiology - ethnology - psychology
Health Services Needs and Demand - statistics & numerical data
Heroin Dependence - epidemiology - ethnology - psychology - rehabilitation
Humans
Male
Needle Sharing - adverse effects - statistics & numerical data - trends
Patient Acceptance of Health Care - psychology - statistics & numerical data
Population Groups - psychology - statistics & numerical data
Referral and Consultation - statistics & numerical data
Street Drugs - poisoning
Substance Abuse Treatment Centers - organization & administration - utilization
Substance Abuse, Intravenous - epidemiology - ethnology - psychology - rehabilitation
Utilization Review - statistics & numerical data
Abstract
North America's first government sanctioned supervised injection facility (SIF) was opened in Vancouver in response to the serious health and social consequences of injection drug use and the perseverance of committed advocates and drug user groups who demanded change. This analysis was conducted to describe the attendance, demographic characteristics, drug use patterns, and referrals made during the first 18 months of operation.
As part of the evaluation strategy for the SIF, information is collected through a comprehensive on-site database designed to track attendance and the daily activities within the facility. All users of the SIF must sign a waiver form and are then entered into a database using a unique identifier of their choice. This identifier is used at each subsequent visit to provide a prospective record of attendance, drug use, and interventions.
From 10 March 2004 to 30 April 2005 inclusive, there were 4764 unique individuals who registered at the SIF. The facility successfully attracted a range of community injection drug users including women (23%) and members of the Aboriginal community (18%). Although heroin was used in 46% of all injections, cocaine was injected 37% of the time. There were 273 witnessed overdoses with no fatalities. During just 12 months of observation, 2171 individual referrals were made with the majority (37%) being referred for addiction counseling.
Vancouver's SIF has successfully been integrated into the community, has attracted a wide cross section of community injection drug users, has intervened in overdoses, and initiated over 2000 referrals to counseling and other support services. These findings should be useful for other settings considering SIF trials.
PubMed ID
16356659 View in PubMed
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Baseline self-perceived risk of HIV infection independently predicts the rate of HIV seroconversion in a prospective cohort of injection drug users.

https://arctichealth.org/en/permalink/ahliterature177233
Source
Int J Epidemiol. 2005 Feb;34(1):152-8
Publication Type
Article
Date
Feb-2005
Author
Evan Wood
Kathy Li
Cari L Miller
Robert S Hogg
Julio S G Montaner
Martin T Schechter
Thomas Kerr
Author Affiliation
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital Vancouver, 608-1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada. ewood@cfenet.ubc.ca
Source
Int J Epidemiol. 2005 Feb;34(1):152-8
Date
Feb-2005
Language
English
Publication Type
Article
Keywords
Adult
Attitude to Health
British Columbia - epidemiology
Epidemiologic Methods
Female
HIV Infections - prevention & control
HIV Seropositivity - epidemiology - psychology - transmission
Humans
Male
Patient Selection
Risk-Taking
Substance Abuse, Intravenous - complications - psychology
Abstract
The identification of individuals at the highest risk of human immunodeficiency virus (HIV) infection is critical for targeting prevention strategies. We evaluated self-perceived risk of HIV infection and rates of subsequent HIV seroconversion among a prospective cohort study of injection drug users (IDUs).
We performed an analysis of the time to HIV infection among 994 baseline HIV negative IDUs enrolled in the Vancouver injection drug users study (VIDUS). IDUs were stratified based on their baseline self-perceived risk of HIV seroconversion (higher than others vs same or lower). Kaplan-Meier methods were used to estimate cumulative HIV incidence rates and Cox regression was used to determine adjusted relative hazards for HIV seroconversion.
At the end of 24 months after enrolment into the cohort, the cumulative HIV incidence rate was significantly elevated among the 5.9% of the sample who perceived their risk for HIV infection to be higher at baseline (26.6% vs 7.8% log-rank P
Notes
Comment In: Int J Epidemiol. 2005 Feb;34(1):158-915649963
PubMed ID
15561747 View in PubMed
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Canada moving backwards on illegal drugs.

https://arctichealth.org/en/permalink/ahliterature124971
Source
Can J Public Health. 2012 Mar-Apr;103(2):125-7
Publication Type
Article
Author
Elaine Hyshka
Janet Butler-McPhee
Richard Elliott
Evan Wood
Thomas Kerr
Author Affiliation
Addiction and Mental Health Research Lab, School of Public Health, University of Alberta, Edmonton, AB.
Source
Can J Public Health. 2012 Mar-Apr;103(2):125-7
Language
English
Publication Type
Article
Keywords
Canada - epidemiology
Drug and Narcotic Control - legislation & jurisprudence
Harm Reduction
Humans
Substance-Related Disorders - epidemiology - prevention & control
Abstract
Internationally, illegal drug use remains a major public health problem. In response, many countries have begun to shift their illegal drug policies away from enforcement and towards public health objectives. Recently, both the Global Commission on Drug Policy and the Supreme Court of Canada have endorsed this change in direction, supporting empirically sound illegal drug policies that reduce criminalization and stigmatization of drug users and bolster treatment and harm reduction efforts. Until recently, Canada was a participant in this growing movement towards rational drug policy. Unfortunately, in recent years, policy changes have made Canada one of the few remaining advocates of a "war-on-drugs" approach. Indeed, the current government has implemented a number of new illegal drug policies that contradict well-established scientific evidence from public health, criminology and other fields. As such, their approach is expected to do little to reduce the harms associated with substance use in Canada. The authors call on the current government to heed the recommendations of the Global Commission's report and learn from the many countries that are innovating in illegal drug policy by prioritizing evidence, human rights and public health.
PubMed ID
22530535 View in PubMed
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Canada's new federal 'National Anti-Drug Strategy': an informal audit of reported funding allocation.

https://arctichealth.org/en/permalink/ahliterature156564
Source
Int J Drug Policy. 2009 Mar;20(2):188-91
Publication Type
Article
Date
Mar-2009
Author
Kora Debeck
Evan Wood
Julio Montaner
Thomas Kerr
Author Affiliation
British Columbia Centre for Excellence in HIV/AIDS, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z1Y6, Canada.
Source
Int J Drug Policy. 2009 Mar;20(2):188-91
Date
Mar-2009
Language
English
Publication Type
Article
Keywords
Canada
Evidence-Based Medicine - economics
Financial Audit
Harm Reduction
Health Policy - economics
Humans
Legislation, Drug - economics
Substance-Related Disorders - economics - prevention & control
Abstract
While there is mounting international acceptance of harm reduction approaches and growing support for policies that balance enforcement with more health-focused interventions, in many settings these developments are not reflected in policy. In October 2007, the Canadian federal government launched a new $64 million dollar 'National Anti-Drug Strategy' in which two-thirds of the new monies was reportedly directed towards drug prevention and treatment initiatives.
However, contrary to the impression left by a host of federal politicians, including the Prime Minister, that this new strategy was investing significantly in drug prevention and drug treatment, this analysis finds that when base funding is considered additional monies provided through the new federal National Anti-Drug Strategy only marginally shifts the allocation of funds within each category.
Specifically, law enforcement initiatives continue to receive the overwhelming majority of drug strategy funding (70%) while prevention (4%), treatment (17%) and harm reduction (2%) combined continue to receive less than a quarter of the overall funding.
These findings suggest that the Canadian government is failing to invest resources in evidence-based drug policies.
PubMed ID
18571396 View in PubMed
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Changes in injecting practices associated with the use of a medically supervised safer injection facility.

https://arctichealth.org/en/permalink/ahliterature165587
Source
J Public Health (Oxf). 2007 Mar;29(1):35-9
Publication Type
Article
Date
Mar-2007
Author
Jo-Anne Stoltz
Evan Wood
Will Small
Kathy Li
Mark Tyndall
Julio Montaner
Thomas Kerr
Author Affiliation
Clinical Activities, British Columbia Centre of Excellence in HIV/AIDS, University of British Columbia, Vancouver, Canada. jstoltz@cfenet.ubc.ca
Source
J Public Health (Oxf). 2007 Mar;29(1):35-9
Date
Mar-2007
Language
English
Publication Type
Article
Keywords
Adult
Attitude to Health
British Columbia - epidemiology
Disinfection
Equipment Contamination - prevention & control
Female
HIV Infections - prevention & control
Harm Reduction
Health Behavior
Humans
Interviews as Topic
Logistic Models
Male
Needle Sharing - adverse effects - statistics & numerical data
Needle-Exchange Programs - utilization
Program Evaluation
Risk-Taking
Substance Abuse, Intravenous - complications - epidemiology - virology
Syringes - standards - virology
Abstract
Injection drug users (IDUs) are vulnerable to serious health complications resulting from unsafe injection practices. We examined whether the use of a supervised safer injection facility (SIF) promoted change in injecting practices among a representative sample of 760 IDUs who use a SIF in Vancouver, Canada. Consistent SIF use was compared with inconsistent use on a number of self-reported changes in injecting practice variables. More consistent SIF use is associated with positive changes in injecting practices, including less reuse of syringes, use of sterile water, swabbing injection sites, cooking/filtering drugs, less rushed injections, safe syringe disposal and less public injecting.
PubMed ID
17229788 View in PubMed
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Circumstances of first injection among illicit drug users accessing a medically supervised safer injection facility.

https://arctichealth.org/en/permalink/ahliterature163264
Source
Am J Public Health. 2007 Jul;97(7):1228-30
Publication Type
Article
Date
Jul-2007
Author
Thomas Kerr
Mark W Tyndall
Ruth Zhang
Calvin Lai
Julio S G Montaner
Evan Wood
Author Affiliation
British Columbia Centre for Excellence in HIV/AIDS, Vancouver. tkerr@cfenet.ubc.ca
Source
Am J Public Health. 2007 Jul;97(7):1228-30
Date
Jul-2007
Language
English
Publication Type
Article
Keywords
Adult
British Columbia
Female
HIV Infections - prevention & control
Harm Reduction
Humans
Male
Middle Aged
Needle-Exchange Programs - organization & administration
Substance Abuse Treatment Centers - organization & administration
Substance Abuse, Intravenous - prevention & control
Abstract
There have been concerns that safer injecting facilities may promote initiation into injection drug use. We examined length of injecting career and circumstances surrounding initiation into injection drug use among 1065 users of North America's first safer injecting facility and found that the median years of injection drug use were 15.9 years, and that only 1 individual reported performing a first injection at the safer injecting facility. These findings indicate that the safer injecting facility's benefits have not been offset by a rise in initiation into injection drug use.
Notes
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PubMed ID
17538061 View in PubMed
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Cognitive factors and willingness to participate in an HIV vaccine trial among HIV-negative injection drug users.

https://arctichealth.org/en/permalink/ahliterature146340
Source
Vaccine. 2010 Feb 17;28(7):1663-7
Publication Type
Article
Date
Feb-17-2010
Author
Shayesta Dhalla
Gary Poole
Joel Singer
David M Patrick
Evan Wood
Thomas Kerr
Author Affiliation
School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
Source
Vaccine. 2010 Feb 17;28(7):1663-7
Date
Feb-17-2010
Language
English
Publication Type
Article
Keywords
AIDS Vaccines - administration & dosage
Adult
British Columbia
Clinical Trials, Phase III as Topic
Cross-Sectional Studies
Drug Users - psychology
Educational Status
Female
HIV Infections - prevention & control - psychology
Humans
Indians, North American
Logistic Models
Male
Middle Aged
Multivariate Analysis
Patient Participation - psychology
Abstract
This cross-sectional study involving a cohort of injection drug users (IDU) examined the relationship between cognitive factors (HIV treatment optimism, self-efficacy and knowledge of vaccine trial concepts) as well as risk factors for seroconversion, and willingness to participate (WTP) in a preventive phase 3 HIV vaccine trial. Willingness to participate overall was 56%. In a multivariate analysis, for a 20-unit increase in a 100-point composite scale, self-efficacy was positively related to WTP (adjusted odds ratio [AOR]=1.95, 95% CI=1.40-2.70). HIV treatment optimism and knowledge of vaccine trial concepts were unrelated to WTP. Aboriginal ethnicity (AOR=3.47, 95% CI=1.68-7.18) and a higher educational level (>or=high school) (AOR=1.96, 95% CI=1.07-3.59) were positively related to WTP. This study provides information on WTP for an HIV vaccine trial. Limitations and future directions are also discussed.
PubMed ID
20044049 View in PubMed
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Crystal methamphetamine and initiation of injection drug use among street-involved youth in a Canadian setting.

https://arctichealth.org/en/permalink/ahliterature106678
Source
CMAJ. 2013 Dec 10;185(18):1569-75
Publication Type
Article
Date
Dec-10-2013
Author
Dan Werb
Thomas Kerr
Jane Buxton
Jeannie Shoveller
Chris Richardson
Julio Montaner
Evan Wood
Source
CMAJ. 2013 Dec 10;185(18):1569-75
Date
Dec-10-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
British Columbia - epidemiology
Drug Overdose - epidemiology
Female
Follow-Up Studies
Homeless Youth - statistics & numerical data
Humans
Incidence
Law Enforcement
Male
Methamphetamine - administration & dosage - poisoning
Prospective Studies
Street Drugs - poisoning
Substance Abuse, Intravenous - epidemiology - prevention & control
Young Adult
Abstract
Although injection drug use is known to result in a range of health-related harms, including transmission of HIV and fatal overdose, little is known about the possible role of synthetic drugs in injection initiation. We sought to determine the effect of crystal methamphetamine use on risk of injection initiation among street-involved youth in a Canadian setting.
We used Cox regression analyses to identify predictors of injection initiation among injection-naive street-involved youth enrolled in the At-Risk Youth Study, a prospective cohort study of street-involved youth in Vancouver, British Columbia. Data on circumstances of first injection were also obtained.
Between October 2005 and November 2010, a total of 395 drug injection-naive, street-involved youth provided 1434 observations, with 64 (16.2%) participants initiating injection drug use during the follow-up period, for a cumulative incidence of 21.7 (95% confidence interval [CI] 1.7-41.7) per 100 person-years. In multivariable analysis, recent noninjection use of crystal methamphetamine was positively associated with subsequent injection initiation (adjusted hazard ratio 1.93, 95% CI 1.31-2.85). The drug of first injection was most commonly reported as crystal methamphetamine (14/31 [45%]).
Noninjection use of crystal methamphetamine predicted subsequent injection initiation, and crystal methamphetamine was the most commonly used drug at the time of first injection. Evidence-based strategies to prevent transition to injection drug use among crystal methamphetamine users are urgently needed.
Notes
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PubMed ID
24130244 View in PubMed
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42 records – page 1 of 5.