Brief interventions to reduce frequent alcohol use among persons with HIV (PWH) are evidence-based, but resource-constrained settings must contend with competition for health resources. We evaluated the cost-effectiveness of two... more
Brief interventions to reduce frequent alcohol use among persons with HIV (PWH) are evidence-based, but resource-constrained settings must contend with competition for health resources. We evaluated the cost-effectiveness of two intervention arms compared to the standard of care (SOC) in a three-arm randomized control trial targeting frequent alcohol use in PWH through increasing the percent days abstinent from alcohol and viral suppression. We estimated incremental cost per quality-adjusted life year (QALY) gained from a modified societal perspective and a 1-year time horizon using a Markov model of health outcomes. The two-session brief intervention (BI), relative to the six-session combined intervention (CoI), was more effective and less costly; the estimated incremental cost-effectiveness of the BI relative to the SOC, was $525 per QALY gained. The BI may be cost-effective for the HIV treatment setting; the health utility gained from viral suppression requires further exploration.
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Due to their geographical characteristics, the mountainous areas of Vietnam are particularly vulnerable to illicit drug use. Drug users in remote areas are also more likely to engage in risky sexual behaviors. This study aimed to describe... more
Due to their geographical characteristics, the mountainous areas of Vietnam are particularly vulnerable to illicit drug use. Drug users in remote areas are also more likely to engage in risky sexual behaviors. This study aimed to describe the prevalence and characteristics of substance use and sexual behaviors and explored their related factors among newly admitted drug users in three mountainous provinces of Vietnam. A cross-sectional study was conducted on 300 newly-admitted drug users registering for Methadone Maintenance Treatment (MMT) at 6 clinics in three provinces: Dien Bien, Lai Chau and Yen Bai from October 2014 to December 2015. Information about the socio-demographic characteristics, history of substance use, and sexual behaviors were collected. The multivariate logistic regression model was used to identify potential predictors of four outcomes, which included: drug injection, re-use of needles, using condoms during the last time of having sex, and having sexual interco...
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Social network characteristics have an important role in understanding HIV transmission among female sex workers. The purpose of this systematic review was to summarize and critically appraise the existing studies on the social network... more
Social network characteristics have an important role in understanding HIV transmission among female sex workers. The purpose of this systematic review was to summarize and critically appraise the existing studies on the social network characteristics and HIV risk behaviors among female sex workers. A systematic review was performed using predefined eligibility criteria through searching electronic databases. Two independent reviewers assessed the methodological quality of studies. Nineteen papers met the eligible review criteria. The synthesized evidence suggests that characteristics of social networks, especially functional characteristics such as social support and social capital, are important constructs for understanding the HIV risk behaviors. The findings of the present review enhance our understanding of the role of social network characteristics in HIV risk behaviors among female sex workers. However, the findings also highlighted a dearth of knowledge about the association...
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Traditional mental illness concepts remain prevalent in China. Shenjing shuairuo (i.e., neurasthenia), a depressive-like syndrome less favored in Western psychiatric nosology, has a long tradition of acceptance among Chinese lay people.... more
Traditional mental illness concepts remain prevalent in China. Shenjing shuairuo (i.e., neurasthenia), a depressive-like syndrome less favored in Western psychiatric nosology, has a long tradition of acceptance among Chinese lay people. The concept may be more easily accepted in China due to the culturally informed view of the importance of harmony between mind and body and is consistent with Traditional Chinese Medicine. The goals of this study were to estimate the prevalence of shenjing shuairuo, the overlap between shenjing shuairuo and depression, and whether these two disorders share correlates. Data was obtained from 751 Chinese adults using stratified random sampling. Spatial epidemiological methods were utilized with face-to-face interviews conducted in Guangzhou, China. The Patient Health Questionnaire (PHQ-9) and the neurasthenia criteria from ICD-10 measured depression and shenjing shuairuo. The prevalence of depression and shenjing shuairuo were 5.3% and 15.4%, respectiv...
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Sexual contact has been shown to be a major mode of HIV transmission among people who inject drugs (PWID). This study examined gender and racial differences among PWID' sexual risk behaviors from the perspective of sexual scripts. 696... more
Sexual contact has been shown to be a major mode of HIV transmission among people who inject drugs (PWID). This study examined gender and racial differences among PWID' sexual risk behaviors from the perspective of sexual scripts. 696 PWID enrolled from Philadelphia on HPTN 037 were classified as engaging in high-risk sex behaviors if they reported having sex in the past 30 days and condomless sex with a non-primary partner, giving/receiving sex for money, or multiple partners. A multivariable logistic regression model was used to assess associations between demographic factors and high risk sex. Findings of the multivariable regression analysis demonstrated that being White (OR = 0.52, p < 0.001) and male (OR = 0.59, p = 0.002) were protective of high risk sex, while homelessness (OR = 1.7, p = 0.005), and being single (OR = 1.83, p = 0.006) were positively associated with high risk sex. African American (AA) women were 1.7 times more likely to report high-risk sex than AA m...
Research Interests: Demography, Risk Taking, Medicine, Logistic Regression, Multivariate Analysis, and 15 moreHumans, Female, Male, Men who have Sex with Men, African Americans, Philadelphia, Middle Aged, Adult, Sex Factors, European Continental Ancestry Group, Drug Users, Logistic Models, Psychology and Cognitive Sciences, Medical and Health Sciences, and HIV infections
Methadone maintenance treatment (MMT) improves patients' ability to access HIV-related services and reduces needle sharing and other risky HIV-related behaviors. However, patients may continue to engage in risky sexual practices. In... more
Methadone maintenance treatment (MMT) improves patients' ability to access HIV-related services and reduces needle sharing and other risky HIV-related behaviors. However, patients may continue to engage in risky sexual practices. In this study, we evaluate sexual behaviors of MMT patients in a mountainous province in Northern Vietnam. We explored the health status, MMT and substance use history, and sexual practices of 241 male MMT patients in Tuyen Quang province. Health status was investigated using the EuroQOL-5 Dimensions-5 Levels (EQ-5D-5 L). Multivariate logistic regression was employed to assess associated factors. Most patients (66.4%) reported having at least one sexual partner within the previous twelve months. Most of these partners were spouses or primary partners (72.6%). About 8.3% of patients had casual partners, and 5.8% had visited sex workers; of those who engaged in casual sexual relationships, 90.9% reported using condoms. Current drug use and living in a rem...
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Integrating HIV/AIDS and methadone maintenance treatment (MMT) services with existing health care delivery system is critical in sustaining efforts to fight HIV/AIDS in large injection-driven epidemics. However, efficiency of different... more
Integrating HIV/AIDS and methadone maintenance treatment (MMT) services with existing health care delivery system is critical in sustaining efforts to fight HIV/AIDS in large injection-driven epidemics. However, efficiency of different integrative service models is unknown. This study assessed behavioral and health-related quality-of-life (HRQOL) outcomes of MMT in four service delivery models and explored factors associated with these outcomes of interest. A cross-sectional survey was conducted in two HIV epicenters in Vietnam: Hanoi and Nam Dinh Province. All patients in five selected MMT clinics were invited to participate, and 1016 were interviewed (80-90 % response rate). Respondents had a mean age of 35.8, taken MMT for average 16.5 months and 3.3 % on MMT for 36-60 months. The MMT integrated with rural district health center (DHC) has the highest prevalence of concurrent drug use (11.3 %). The percentage of condom use (last sexual intercourse) with primary and casual partners...
Research Interests: Health Psychology, Quality of life, Treatment Outcome, Medicine, Harm Reduction, and 15 moreHumans, Female, Male, Methadone, Adult, Public health systems and services research, Narcotics, Hiv seropositivity, Cross Sectional Studies, Methadone Maintenance, Unsafe Sex, Socioeconomic Factors, Delivery of Health Care, Rural Population, and Opiate substitution treatment
In 2010, the reported overall HIV prevalence in Liangshan China (1.14%) was 19.7 times of the overall estimated prevalence in China (0.058%), and injection drug use contributed to 60.0% of overall HIV infections in Xichang, the Capital... more
In 2010, the reported overall HIV prevalence in Liangshan China (1.14%) was 19.7 times of the overall estimated prevalence in China (0.058%), and injection drug use contributed to 60.0% of overall HIV infections in Xichang, the Capital city of Liangshan. With one national methadone clinic and three outpatient service sites, and three NEP sites, the HIV prevalence among people who inject drugs (PWID) in Xichang was estimated as 18.0% (2.8 times of national HIV prevalence among PWID) in 2012. Face-to-face questionnaire interviews were used in a cross-sectional study to assess experience, attitudes, possibility and acceptability of implementing 8 pharmacy-delivered services among PWID (n=403). The concordance of attitudes, possibility and acceptability between PWID and pharmacy staff (n=50) was examined. Rather than medical facility (23.1%), and NEP (8.9%), pharmacies were the main source of syringes for PWID in the last 12 months (82.1%), PWID (63.5%) reported syringes could be bought...
Research Interests: Pharmacy, Family Medicine, China, Adolescent, Medicine, and 15 moreDrug Policy, Humans, Feasibility Studies, Male, Young Adult, Prevalence, Middle Aged, Methadone, Adult, Cross Sectional Studies, Surveys and Questionnaires, Psychology and Cognitive Sciences, Pharmaceutical Services, Medical and Health Sciences, and HIV infections
STEP into Action assessed the efficacy of a peer-based HIV prevention intervention in reducing HIV risk behaviors among people who inject drugs (PWIDs) in Baltimore. This analysis examined the effect of the intervention on the change in... more
STEP into Action assessed the efficacy of a peer-based HIV prevention intervention in reducing HIV risk behaviors among people who inject drugs (PWIDs) in Baltimore. This analysis examined the effect of the intervention on the change in frequency of conversation about HIV prevention topics over time. 114 participants were randomized into an experimental and 113 into a control group. Data was collected prospectively at 6, 12, and 18 months. The experimental group talked more frequently about HIV prevention topics compared to the control group at 6-month visit. At 18 months relative risk ratios (RRR) remained statistically significant for conversation about the danger of needle sharing (RRR = 3.21) and condom use (RRR = 2.81). The intervention resulted in an increased conversation about HIV prevention among PWIDs, but the sustainability past 6 months remained a challenge; suggesting that interventions should be designed to constantly reinforce communication about HIV prevention among ...
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Guided by a social influence and empowerment framework, peer leaders in the injecting drug user (IDU) community were trained to promote human immunodeficiency virus (HIV) prevention among their contacts within and beyond their sex and... more
Guided by a social influence and empowerment framework, peer leaders in the injecting drug user (IDU) community were trained to promote human immunodeficiency virus (HIV) prevention among their contacts within and beyond their sex and drug networks. From 1994 to 1995 in Baltimore, Maryland, 36 peer leaders who participated in the 10-session training program were administered pretest and posttest surveys. Evaluation included leaders' self-reported HIV-related behaviors and outreach activities. Survey data also were collected from 78 of the leaders' risk network members. Peer leaders reported a significant increase in condom use and in cleaning used needles with bleach. The leaders' risk network members, compared with controls, were significantly more likely to report greater needle hygiene. In an assessment of diffusion of information, the majority of risk network members who were current injectors reported receiving needle-cleaning materials from the leaders, and the maj...
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Research Interests: Psychology, Depression, Social Support, Injury Prevention, Medicine, and 15 moreHumans, Baltimore, Female, Male, Risk factors, Social Adjustment, African Americans, Middle Aged, Questionnaires, Longitudinal Studies, Human Factors and Ergonomics, Suicidal Ideation, Adult, Risk Factors, and Poison Control
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Research Interests: Psychology, Environmental Health, Adolescent, Medicine, Humans, and 15 moreFemale, Male, Psychological Intervention, Prevalence, Middle Aged, Adult, Odds ratio, Age Factors, Hiv seropositivity, Drug Users, Cross Sectional Studies, Enzyme Linked Immunosorbent Assay, Needle Sharing, High risk, and HIV infections
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Research Interests: Psychiatry, Medicine, Logistic Regression, Emotions, Prospective studies, and 15 moreHumans, African American, Baltimore, Female, Male, Injecting Drug Use, Data Collection, Physical Abuse, Middle Aged, Adult, Logistic Regression Model, Cross Sectional Studies, Epidemiologic Studies, Logistic Models, and Drug treatment
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Despitevery similar political, drug policy and HIV prevention backgrounds, HIV and HCV prevalence is considerably different in Hungary (low HIV and moderate HCV prevalence) and Lithuania (high HCV and moderate HIV prevalence). Wecompared... more
Despitevery similar political, drug policy and HIV prevention backgrounds, HIV and HCV prevalence is considerably different in Hungary (low HIV and moderate HCV prevalence) and Lithuania (high HCV and moderate HIV prevalence). Wecompared the drug use profile of Hungarian (n = 215) and Lithuanian (n = 300) injecting drug users (IDUs). Overall, compared with IDUs in Hungary, IDUs in Lithuania often injected opiates purchased in liquid form (‘shirka’), used and shared 2-piece syringes (vs. 1-piece syringes) disproportionately more often, were less likely to acquire their syringes from legal sources and had significantly more experience with injected and less experience with non-injected drugs. It may not be liquid drugs per se that contribute to a higher prevalence of HCV and/or HIV, but it is probably factors associated with the injecting of liquid drugs, such as the wide-spread use and sharing of potentially contaminated 2-piece syringes acquired often from non-legal sources, and syr...
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Research Interests: Psychology, Treatment, Social Support, Medicine, Logistic Regression, and 14 moreDrug, Prospective studies, Humans, Female, Male, Psychological Intervention, Methadone, Adult, Public health systems and services research, Narcotics, Social Network, Opiate, Severity of Illness Index, and HIV infections
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Injection drug use is a significant mode of HIV transmission. Social networks are potential avenues for behavior change among high-risk populations. Increasing knowledge should include a classification or taxonomy system of networks’... more
Injection drug use is a significant mode of HIV transmission. Social networks are potential avenues for behavior change among high-risk populations. Increasing knowledge should include a classification or taxonomy system of networks’ attributes, risks, and needs. The current study employed 232 networks comprising 232 indexes, with 464 network members enrolled in Philadelphia. LCA revealed a three-class solution, Low-Risk, Paraphernalia Risk, and High Sex/Moderate Paraphernalia Risk class, among participants. The analysis found receiving money or drugs for sex and employment status increased the odds of belonging to PR and PSR classes. Homelessness and incarceration increased the odds of belonging to the PR class when compared to the LR class. Our findings suggest that classes of risk among PWID comprise clusters of information concerning their members. These findings add depth to our understanding while extending our knowledge of the contextual environment that nurtures or exacerbat...
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Quality of life (QOL) has been considered as an important outcome indicator in holistic care for HIV-infected people, especially as HIV/AIDS transforms from a fatal illness to a chronic condition. This study aimed to identify trends and... more
Quality of life (QOL) has been considered as an important outcome indicator in holistic care for HIV-infected people, especially as HIV/AIDS transforms from a fatal illness to a chronic condition. This study aimed to identify trends and emerging topics among research concerning the QOL of people living with HIV/AIDS (PLWHA). The analyzed data were English papers published from 1996 to 2017, searched and extracted from the Web of Science Core Collection. Collaborations between countries and the correlation between the keywords were visualized by VOSviewer while the abstracts’ content was analyzed using exploratory factor analysis and Jaccard’s’ similarity index. There has been an increase in both the number of publications and citations. The United Nations of America leads in terms of paper volume. The cross-nation collaborations are mainly regional. Despite a rather comprehensive coverage of topics relating to QOL in PLWHA, there has evidently been a lack of studies focusing on soci...
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People who inject drugs (PWID) have a high incidence of HIV, little access to antiretroviral therapy (ART) and medication-assisted treatment (MAT), and high mortality. We aimed to assess the feasibility of a future controlled trial based... more
People who inject drugs (PWID) have a high incidence of HIV, little access to antiretroviral therapy (ART) and medication-assisted treatment (MAT), and high mortality. We aimed to assess the feasibility of a future controlled trial based on the incidence of HIV, enrolment, retention, and uptake of the intervention, and the efficacy of an integrated and flexible intervention on ART use, viral suppression, and MAT use. This randomised, controlled vanguard study was run in Kyiv, Ukraine (one community site), Thai Nguyen, Vietnam (two district health centre sites), and Jakarta, Indonesia (one hospital site). PWID who were HIV infected (index participants) and non-infected injection partners were recruited as PWID network units and were eligible for screening if they were aged 18-45 years (updated to 18-60 years 8 months into study), and active injection drug users. Further eligibility criteria for index participants included a viral load of 1000 copies per mL or higher, willingness and ...
Research Interests: Indonesia, General Internal Medicine, Medicine, Counseling, Antiretroviral Therapy, and 15 moreHumans, Substance Abuse, Female, Feasibility Studies, Male, Psychosocial, Incidence, Methadone, Adult, Intravenous, Proportional Hazards Models, The Lancet, Opiate substitution treatment, Medical and Health Sciences, and HIV infections
Despite the high HIV incidence and prevalence among black men who have sex with men (BMSM), little research has examined partner characteristics, partner seeking venue, sexual position, substance use, and sexual risk behavior at the sex... more
Despite the high HIV incidence and prevalence among black men who have sex with men (BMSM), little research has examined partner characteristics, partner seeking venue, sexual position, substance use, and sexual risk behavior at the sex event-level among BMSM. Using the baseline data from a multi-site study of 807 BMSM stratified by their HIV status, the goal of this study was to conduct a detailed event-level analysis of 1577 male anal sex events to assess the factors associated with condomless anal intercourse (CLAI) with a HIV-discordant or HIV status-unknown partner. We found CLAI with an HIV-discordant or unknown HIV status partner among HIV-negative BMSM was negatively associated with having sex with a main partner, and was positively associated with taking both receptive and insertive sexual positions during sex. As compared to a sex partner met at bar, night club or dance club, HIV-positive BMSM were less likely to engage in CLAI with HIV-discordant and unknown HIV status pa...
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This paper presents an overview of different kinds of risk and social network methods and the kinds of research questions each can address. It also reviews what network research has discovered about how network characteristics are... more
This paper presents an overview of different kinds of risk and social network methods and the kinds of research questions each can address. It also reviews what network research has discovered about how network characteristics are associated with HIV and other infections, risk behaviors, preventive behaviors, and care, and discusses some ways in which network-based public health interventions have been conducted. Based on this, risk and social network research and interventions seem both feasible and valuable for addressing the many public health and social problems raised by the widespread use of opioids in the US South.
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Research Interests: Psychology, Psychiatry, Mental Health, Philippines, Social Support, and 15 moreChina, Adolescent, Medicine, Immigrants and Emigrants, Anxiety, Humans, Female, Middle Aged, Adult, Occupational Stress, ANXIETY, Psychological Stress, Psychiatric Status Rating Scales, Psychology and Cognitive Sciences, and Medical and Health Sciences
In Vietnam, an estimated 256,000 people are living with HIV, and 58% of HIV-infections reported are among people who inject drugs (PWID). While antiretroviral therapy (ART) is widely available in Vietnam, marginalized hard-to-reach male... more
In Vietnam, an estimated 256,000 people are living with HIV, and 58% of HIV-infections reported are among people who inject drugs (PWID). While antiretroviral therapy (ART) is widely available in Vietnam, marginalized hard-to-reach male PWID, demonstrate significantly reduced and delayed access to ART. We investigated the effect of a randomized four-arm multi-level intervention trial on ART initiation among male PWID. Our analysis was conducted among a subset of trial participants (n = 136), who were newly diagnosed as HIV-infected, treatment naïve, and eligible for ART (baseline late diagnosis). The trial arms included: 1, standard of care (HIV testing and counseling); 2, structural-level intervention (door-to-door communications and community video screenings); 3, individual-level intervention (counseling plus group support); and 4, individual-level plus structural-level intervention. In a time-to-event analysis, we used a non-parametric approach for competing risks to estimate cu...
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Health communication theories indicate that messages depicting efficacy and threat might promote behavior change by enhancing individuals' efficacy beliefs and risk perceptions, but this has received little attention in graphic... more
Health communication theories indicate that messages depicting efficacy and threat might promote behavior change by enhancing individuals' efficacy beliefs and risk perceptions, but this has received little attention in graphic warning label research. We explored low socioeconomic status (SES) smokers' perceptions of theory-based graphic warning labels to inform the development of labels to promote smoking cessation. Twelve graphic warning labels were developed with self-efficacy and response efficacy messages paired with messages portraying high, low, or no threat from smoking. Self-efficacy messages were designed to promote confidence in ability to quit, while response efficacy messages were designed to promote confidence in the ability of the Quitline to aid cessation. From January - February 2014, we conducted in-depth interviews with 25 low SES adult men and women smokers in Baltimore, Maryland, U.S. Participants discussed the labels' role in their self-efficacy bel...
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Studies on associations between body weight status and specific substance use have provided conflicting findings. This paper investigated the association between substance use and body weight status among African American women. We... more
Studies on associations between body weight status and specific substance use have provided conflicting findings. This paper investigated the association between substance use and body weight status among African American women. We analyzed the data from 328 African American women who were enrolled in a HIV prevention intervention in Baltimore, MD, USA, in order to investigate the association between substance use and their body weight status. Participants' anthropometry was measured by trained research staff. Substance use information was collected via self-administered and interviewer-administered questionnaires. About 33.4% were classified as normal/underweight, 24.2% overweight, and 42.4% obese. Compared to overweight (38.5%) and obese (29.2%) participants, the normal/underweight women had significantly higher prevalence of drug use (52.8%) (χ(2)= 14.11, p < 0.05). BMI was significantly negatively associated with current heroin use (t = -2.21, p < 0.05). The risk of be...
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To assess associations between residences location, risky sexual behaviours and sexually transmitted diseases (STDs) among adults living in Guangzhou, China. Data were obtained from 751 Chinese adults aged 18-59 years in Guangzhou, China,... more
To assess associations between residences location, risky sexual behaviours and sexually transmitted diseases (STDs) among adults living in Guangzhou, China. Data were obtained from 751 Chinese adults aged 18-59 years in Guangzhou, China, using stratified random sampling by using spatial epidemiological methods. Face-to-face household interviews were conducted to collect self-report data on risky sexual behaviours and diagnosed STDs. Kulldorff's spatial scan statistic was implemented to identify and detect spatial distribution and clusters of risky sexual behaviours and STDs. The presence and location of statistically significant clusters were mapped in the study areas using ArcGIS software. The prevalence of self-reported risky sexual behaviours was between 5.1% and 50.0%. The self-reported lifetime prevalence of diagnosed STDs was 7.06%. Anal intercourse clustered in an area located along the border within the rural-urban continuum (p=0.001). High rate clusters for alcohol or ...
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The prevalence of depression among drug users is high. It has been recognized that drug use behaviors can be influenced and spread through social networks. We investigated the directional relationship between social network factors and... more
The prevalence of depression among drug users is high. It has been recognized that drug use behaviors can be influenced and spread through social networks. We investigated the directional relationship between social network factors and depressive symptoms among a sample of inner-city residents in Baltimore, MD. We performed a longitudinal study of four-wave data collected from a network-based HIV/STI prevention intervention for women and network members, consisting of both men and women. Our primary outcome and exposure were depression using CESD scale and social network characteristics, respectively. Linear-mixed model with clustering adjustment was used to account for both repeated measurement and network design. Of the 746 participants, those who had high levels of depression tended to be female, less educated, homeless, smokers, and did not have a main partner. In the univariate longitudinal model, larger size of drug network was significantly associated with depression (OR = 1....
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ABSTRACT
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Vietnam bears a high burden of hepatitis C virus (HCV) and HIV infection among persons who inject drugs (PWID). The high prevalence of HCV and HIV occurs in a context of stigma and limited preventive interventions for PWID. This study... more
Vietnam bears a high burden of hepatitis C virus (HCV) and HIV infection among persons who inject drugs (PWID). The high prevalence of HCV and HIV occurs in a context of stigma and limited preventive interventions for PWID. This study aims to estimate the prevalence of HCV, HIV, and HIV/HCV coinfection among PWID and to explore their associations with lifetime injection behaviors. A total of 1434 PWID were recruited from the Thai Nguyen Province of Vietnam between 2005 and 2007. Participants responded to a structured questionnaire and provided blood samples at baseline. A cross-sectional analysis of data collected at baseline was carried out. Factors associated with HCV monoinfection and HIV/HCV coinfection were evaluated by multinomial logistic regression. The prevalences of HIV and HCV were 35.1 and 88.8%, respectively, and the prevalences of HIV/HCV coinfection and HCV monoinfection were 34.8 and 53.9%, respectively. After adjusting for confounders in multivariate analysis, ever ...
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Research Interests: Perception, Health Communication, Poverty, Biostatistics, Qualitative Research, and 15 moreMedicine, Motivation, Product Labeling, Humans, Smoking Cessation, Smoking, Baltimore, Female, Male, Socioeconomic Status, Middle Aged, Public health systems and services research, Cross Sectional Studies, Tobacco Products, and Product Packaging
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Research Interests: Psychiatry, Depression, Principal Component Analysis, Adolescent, Urban Health, and 15 moreMedicine, Drug, Social Stigma, Humans, Baltimore, Female, Young Adult, Middle Aged, Outreach, Adult, Public health systems and services research, Urban Population, Heroin, Cross Sectional Studies, and drug user
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ABSTRACT We examined the effect on depressive symptoms of a peer network-oriented intervention effective in reducing sexual risk behavior and methamphetamine (MA) use. Current Thai MA users aged 18-25 years and their drug and/or sex... more
ABSTRACT We examined the effect on depressive symptoms of a peer network-oriented intervention effective in reducing sexual risk behavior and methamphetamine (MA) use. Current Thai MA users aged 18-25 years and their drug and/or sex network members enrolled in a randomized controlled trial with 4 follow-ups over 12 months. A total of 415 index participants recruited 568 network members. Linear repeated measures models were fit with depressive symptoms (Center for Epidemiologic Studies Depression Scale [CES-D]) as the outcome. Among indexes in the intervention condition, mean CES-D decreased from 20.0 to 15.7 (p &lt; 0.0001) over follow-up. Controlling for covariates and changes in MA and alcohol use, CES-D in this group decreased by 0.35 points per month (95% confidence interval, 0.45, -0.25). All other groups showed minimal changes in CES-D score. The peer-oriented, community-based intervention designed to reduce MA use and sexual risk behavior also resulted in substantial reduction in depressive symptoms, independent of changes in MA use.