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Current HIV/AIDS Reports
Published in: Current HIV/AIDS Reports 3/2018

01-06-2018 | The Global Epidemic (SH Vermund, Section Editor)

Challenges Facing a Rural Opioid Epidemic: Treatment and Prevention of HIV and Hepatitis C

Authors: Asher J. Schranz, Jessica Barrett, Christopher B. Hurt, Carlos Malvestutto, William C. Miller

Published in: Current HIV/AIDS Reports | Issue 3/2018

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Abstract

Purpose of Review

This article reviews recent epidemiologic trends in HIV and hepatitis C virus (HCV) and strategies for treatment and prevention of these infections as they relate to the opioid epidemic.

Recent Findings

Among people who inject drugs (PWID) in the United States (US), HIV diagnoses are decreasing, while HCV is increasing. Care for HIV and HCV relies heavily on specialist infrastructure, which is lacking in rural areas. Antiretrovirals for HIV and direct-acting antivirals for HCV are effective among PWID, yet multiple barriers make it difficult for rural injectors to access these treatments. Similarly, access to syringe service programs, medication-assisted therapy for opioid addiction, and pre-exposure prophylaxis for HIV are all limited in rural areas.

Summary

Previous research on HIV and HCV among PWID has focused on urban or international populations, yet the US opioid epidemic is moving away from metropolitan centers. Increasing rurality of opioid injection brings unique challenges in treatment and prevention. Research into the care of HIV, HCV, and opioid use disorder among rural populations is urgently needed.
Literature
1.
Peters PJ, Pontones P, Hoover KW, Patel MR, Galang RR, Shields J, et al. HIV infection linked to injection use of oxymorphone in Indiana, 2014–2015. N Engl J Med. 2016;375:229–39.CrossRefPubMed
2.
DeBeck K, Wood E, Dong H, Dobrer S, Hayashi K, Montaner J, et al. Non-medical prescription opioid use predicts injection initiation among street-involved youth. Int J Drug Policy. 2016;34:96–100.CrossRefPubMedPubMedCentral
3.
Al-Tayyib AA, Koester S, Riggs P. Prescription opioids prior to injection drug use: comparisons and public health implications. Addict Behav. 2017;65:224–8.CrossRefPubMed
4.
Jones CM, Logan J, Gladden RM, Bohm MK. Vital signs: demographic and substance use trends among heroin users—United States, 2002-2013. MMWR Morb Mortal Wkly Rep. 2015;64:719–25.CrossRefPubMedPubMedCentral
5.
Kolodny A, Courtwright DT, Hwang CS, Kreiner P, Eadie JL, Clark TW, et al. The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Annu Rev Public Health. 2015;36:559–74.CrossRefPubMed
6.
•• Van Handel MM, Rose CE, Hallisey EJ, et al. County-level vulnerability assessment for rapid dissemination of HIV or HCV infections among persons who inject drugs, United States. JAIDS J Acquir Immune Defic Syndr. 2016;73:323–31. CDC predictive model of US counties at high risk for an outbreak of HIV or HCV due to injection drug use (IDU). Article identifies specific counties of concern, which are largely rural and Appalachian. CrossRefPubMed
7.
• Wejnert C. Vital signs: trends in HIV diagnoses, risk behaviors, and prevention among persons who inject drugs—United States. MMWR Morb mortal Wkly Rep. 2016;65:1336–42. Report of trends in IDU-related HIV diagnoses from 2008 to 2014 stratified by race and urban residence. Demonstrates that new diagnoses due to IDU are rapidly dropping in urban, racial/ethnic minorities but leveling off among nonurban, White persons. CrossRefPubMed
8.
Diagnoses of HIV infection in the United States and dependent areas, 2015. HIV surveillance report. 2016.
9.
Des Jarlais DC, Arasteh K, McKnight C, Feelemyer J, Campbell ANC, Tross S, et al. Consistent estimates of very low HIV incidence among people who inject drugs: New York City, 2005–2014. Am J Public Health. 2016;106:503–8.CrossRefPubMedPubMedCentral
10.
HIV Surveillance in Urban and Nonurban Areas n.d.
11.
Burt RD, Tinsley J, Glick SN. A decline in HIV testing among persons who inject drugs in the Seattle area, 2004–2015. JAIDS J Acquir Immune Defic Syndr. 2017;75:S346–51.CrossRefPubMed
12.
Cooley LA, Wejnert C, Spiller MW, Broz D, Paz-Bailey G, NHBS study Group. Low HIV testing among persons who inject drugs—national HIV behavioral surveillance, 20 U.S. cities, 2012. Drug Alcohol Depend. 2016;165:270–4.CrossRefPubMedPubMedCentral
13.
Friedman SR, Mateu-Gelabert P, Ruggles KV, Goodbody E, Syckes C, Jessell L, et al. Sexual risk and transmission behaviors, partnerships and settings among young adult nonmedical opioid users in New York City. AIDS Behav. 2017;21:994–1003.CrossRefPubMedPubMedCentral
14.
Clayton HB, Lowry R, August E, Everett Jones S. Nonmedical use of prescription drugs and sexual risk behaviors. Pediatrics. 2016;137:e20152480.CrossRef
15.
Latkin CA, Knowlton AR, Forman VL, Hoover DR, Schroeder JR, Hachey M, et al. Injection drug users’ disclosure of HIV seropositive status to network members. AIDS Behav. 2001;5:297–305.CrossRef
16.
Latka MH, Mizuno Y, Wu Y, et al. Are feelings of responsibility to limit the sexual transmission of HIV associated with safer sex among HIV-positive injection drug users? J Acquir Immune Defic Syndr. 2007;46:S88–95.CrossRefPubMed
17.
Nasarruddin AM, Saifi RA, Othman S, Kamarulzaman A. Opening up the HIV epidemic: a review of HIV seropositive status disclosure among people who inject drugs. AIDS Care. 2017;29:533–40.CrossRefPubMed
18.
Suryaprasad AG, White JZ, Xu F, et al. Emerging epidemic of hepatitis C virus infections among young nonurban persons who inject drugs in the United States, 2006–2012. Clin Infect Dis. 2014;59:1411–9.CrossRefPubMed
19.
Centers for Disease Control and Prevention. Viral hepatitis surveillance: United States, 2015 n.d.
20.
Busch MP, Shafer KAP. Acute-phase hepatitis C virus infection: implications for research, diagnosis, and treatment. Clin Infect Dis Off Publ Infect Dis Soc Am. 2005;40:959–61.CrossRef
21.
Ray SC, Thomas DL. Hepatitis C. Mand. Douglas Bennetts Princ. Pract. Infect. Dis. Updat. Ed. 8th ed., Philadelphia, PA: Elsevier/Saunders; 2015, p 1904–1927.e11.
22.
Joy JB, McCloskey RM, Nguyen T, et al. The spread of hepatitis C virus genotype 1a in North America: a retrospective phylogenetic study. Lancet Infect Dis. 2016;16:698–702.CrossRefPubMedPubMedCentral
23.
Jordan AE, Perlman DC. The shift in emphasis from risk-based to age-based hepatitis C virus (HCV) testing in the US tends to remove injection drug use from discourse on HCV. Subst Use Misuse. 2017;52:340–50.CrossRefPubMed
24.
Henderson DK. Risk for occupational transmission of human immunodeficiency virus type 1 (HIV-1) associated with clinical exposures: a prospective evaluation. Ann Intern Med. 1990;113:740–6.CrossRefPubMed
25.
MacDonald M, Crofts N, Kaldor J. Transmission of hepatitis C virus: rates, routes, and cofactors. Epidemiol Rev. 1996;18:137–48.CrossRefPubMed
26.
van Bueren J, Simpson RA, Jacobs P, Cookson BD. Survival of human immunodeficiency virus in suspension and dried onto surfaces. J Clin Microbiol. 1994;32:571–4.PubMedPubMedCentral
27.
Abdala N, Stephens PC, Griffith BP, Heimer R. Survival of HIV-1 in syringes. J Acquir Immune Defic Syndr Hum Retrovirology Off Publ Int Retrovirology Assoc. 1999;20:73–80.CrossRef
28.
Paintsil E, Binka M, Patel A, Lindenbach BD, Heimer R. Hepatitis C virus maintains infectivity for weeks after drying on inanimate surfaces at room temperature: implications for risks of transmission. J Infect Dis. 2014;209:1205–11.CrossRefPubMed
29.
Binka M, Paintsil E, Patel A, et al. Survival of hepatitis C virus in syringes is dependent on the design of the syringe-needle and dead space volume. PLoS One. 2015;10
30.
Zule WA. Low dead-space syringes for preventing HIV among people who inject drugs: promise and barriers. Curr Opin HIV AIDS. 2012;7:369–75.CrossRefPubMed
31.
Oramasionwu CU, Bailey SC, Moore HN, Oramasionwu CO, Russell AL, Zule WA. Dead space in over-the-counter syringes: the implications for HIV and HCV transmission. Int J Drug Policy. 2015;26:1282–4.CrossRefPubMed
32.
Sacks-Davis R, Aitken CK, Higgs P, Spelman T, Pedrana AE, Bowden S, et al. High rates of hepatitis C virus reinfection and spontaneous clearance of reinfection in people who inject drugs: a prospective cohort study. PLoS One. 2013;8:e80216.CrossRefPubMedPubMedCentral
33.
Rowe C, Santos G-M, Raymond HF, Coffin PO. Social mixing and correlates of injection frequency among opioid use partnerships. Int J Drug Policy. 2017;41:80–8.CrossRefPubMed
34.
Meit, Michael, Knudson, Alana, Gilbert, Tess, et al. The 2014 update of the rural-urban Chartbook 2014.
35.
Individual data tables: The 2014 Update of the Rural-Urban Chartbook 2014.
36.
Gallant JE, Adimora AA, Carmichael JK, Horberg M, Kitahata M, Quinlivan EB, et al. Essential components of effective HIV care: a policy paper of the HIV medicine Association of the Infectious Diseases Society of America and the Ryan white medical providers coalition. Clin Infect Dis. 2011;53:1043–50.CrossRefPubMedPubMedCentral
37.
• Schafer KR, Albrecht H, Dillingham R, Hogg RS, Jaworsky D, Kasper K, et al. The continuum of HIV care in rural communities in the United States and Canada: what is known and future research directions. J Acquir Immune Defic Syndr. 2017;75:35–44. Comprehensive review of HIV trends in rural North America and challenges in treating and improving outcomes in this population CrossRefPubMedPubMedCentral
38.
Westergaard RP, Stockman LJ, Hyland HA, Guilfoyle SM, Fangman JJ, Vergeront JM. Provider workforce assessment in a rural hepatitis C epidemic: implications for scale-up of antiviral therapy. J Prim Care Community Health. 2015;6:215–7.CrossRefPubMed
39.
40.
Thomson M, Konerman MA, Choxi H, Lok ASF. Primary care physician perspectives on hepatitis C management in the era of direct-acting antiviral therapy. Dig Dis Sci. 2016;61:3460–8.CrossRefPubMedPubMedCentral
41.
Asher AK, Portillo CJ, Cooper BA, Dawson-Rose C, Vlahov D, Page KA. Clinicians’ views of hepatitis C virus treatment candidacy with direct-acting antiviral regimens for people who inject drugs. Subst Use Misuse. 2016;51:1218–23.CrossRefPubMed
42.
Bradley H, Viall AH, Wortley PM, Dempsey A, Hauck H, Skarbinski J. Ryan White HIV/AIDS program assistance and HIV treatment outcomes. Clin Infect Dis Off Publ Infect Dis Soc Am. 2016;62:90–8.CrossRef
43.
Barua S, Greenwald R, Grebely J, Dore GJ, Swan T, Taylor LE. Restrictions for Medicaid reimbursement of Sofosbuvir for the treatment of hepatitis C virus infection in the United States. Ann Intern Med. 2015;163:215–23.CrossRefPubMed
44.
45.
Lo Re III V, Gowda C, Urick PN, et al. Disparities in absolute denial of modern hepatitis C therapy by type of insurance. Clin Gastroenterol Hepatol. 2016;14:1035–43.CrossRefPubMed
46.
Andrews M, HC. Drug’s lower cost paves way for Medicaid, prisons to expand treatment. Kais Health News. 2017;
47.
Stephens DB, Young AM, Havens JR. Healthcare contact and treatment uptake following hepatitis C virus screening and counseling among rural Appalachian people who use drugs. Int J Drug Policy. 2017;47:86–94.CrossRefPubMedPubMedCentral
48.
•• Grebely J, Hajarizadeh B, Dore GJ. Direct-acting antiviral agents for HCV infection affecting people who inject drugs. Nat Rev Gastroenterol Hepatol. 2017. Extensive review of recent studies of direct-acting antivirals (DAAs) for people who inject drugs (PWID). While some providers may have concern about use of DAAs for PWID, emerging prospective and retrospective studies support their effectiveness.
49.
50.
Hall HI, Frazier EL, Rhodes P, Holtgrave DR, Furlow-Parmley C, Tang T, et al. Differences in human immunodeficiency virus care and treatment among subpopulations in the United States. JAMA Intern Med. 2013;173:1337–44.CrossRefPubMed
51.
Rebeiro PF, Abraham AG, Horberg MA, Althoff KN, Yehia BR, Buchacz K, et al. Sex, race, and HIV risk disparities in discontinuity of HIV care after antiretroviral therapy initiation in the United States and Canada. AIDS Patient Care STDs. 2017;31:129–44.CrossRefPubMedPubMedCentral
52.
Hanna DB, Buchacz K, Gebo KA, Hessol NA, Horberg MA, Jacobson LP, et al. Trends and disparities in antiretroviral therapy initiation and virologic suppression among newly treatment-eligible HIV-infected individuals in North America, 2001–2009. Clin Infect Dis. 2013;56:1174–82.CrossRefPubMedPubMedCentral
53.
Lesko CR, Tong W, Moore RD, Lau B. Retention, antiretroviral therapy use and viral suppression by history of injection drug use among HIV-infected patients in an urban HIV clinical cohort. AIDS Behav. 2017;21:1016–24.CrossRefPubMedPubMedCentral
54.
Lopes BLW, Eron J, Mugavero MJ, et al. HIV care initiation delay among rural residents in the southeastern United States, 1996 to 2012. J Acquir Immune Defic Syndr. 2017;76:171–6.CrossRefPubMedPubMedCentral
55.
Ohl M, Tate J, Duggal M, Skanderson M, Scotch M, Kaboli P, et al. Rural residence is associated with delayed care entry and increased mortality among veterans with human immunodeficiency virus infection. Med Care. 2010;48:1064–70.CrossRefPubMedPubMedCentral
56.
Grebely J, Mauss S, Brown A, Bronowicki JP, Puoti M, Wyles D, et al. Efficacy and safety of Ledipasvir/Sofosbuvir with and without ribavirin in patients with chronic HCV genotype 1 infection receiving opioid substitution therapy: analysis of phase 3 ION trials. Clin Infect Dis. 2016;63(11):1405–11.CrossRefPubMed
57.
Grebely J, Dore GJ, Zeuzem S, Aspinall RJ, Fox R, Han L, et al. Efficacy and safety of Sofosbuvir/Velpatasvir in patients with chronic hepatitis C virus infection receiving opioid substitution therapy: analysis of phase 3 ASTRAL trials. Clin Infect Dis. 2016;63:1479–81.CrossRefPubMedPubMedCentral
58.
Dore GJ, Altice F, Litwin AH, Dalgard O, Gane EJ, Shibolet O, et al. Elbasvir-Grazoprevir to treat hepatitis C virus infection in persons receiving opioid agonist therapy: a randomized trial. Ann Intern Med. 2016;165:625–34.CrossRefPubMed
59.
Lalezari J, Sullivan JG, Varunok P, Galen E, Kowdley KV, Rustgi V, et al. Ombitasvir/paritaprevir/r and dasabuvir plus ribavirin in HCV genotype 1-infected patients on methadone or buprenorphine. J Hepatol. 2015;63:364–9.CrossRefPubMed
60.
Boglione L, Mornese Pinna S, De Nicolò A, et al. Treatment with direct-acting antiviral agents of hepatitis C virus infection in injecting drug users: a prospective study. J Viral Hepat. 2017;24:850–7.CrossRefPubMed
61.
Read P, Lothian R, Chronister K, Gilliver R, Kearley J, Dore GJ, et al. Delivering direct acting antiviral therapy for hepatitis C to highly marginalised and current drug injecting populations in a targeted primary health care setting. Int J Drug Policy. 2017;47:209–15.CrossRefPubMed
62.
Norton BL, Fleming J, Bachhuber MA, Steinman M, DeLuca J, Cunningham CO, et al. High HCV cure rates for people who use drugs treated with direct acting antiviral therapy at an urban primary care clinic. Int J Drug Policy. 2017;47:196–201.CrossRefPubMedPubMedCentral
63.
Elsherif O, Bannan C, Keating S, McKiernan S, Bergin C, Norris S. Outcomes from a large 10 year hepatitis C treatment programme in people who inject drugs: no effect of recent or former injecting drug use on treatment adherence or therapeutic response. PLoS One. 2017;12:e0178398.CrossRefPubMedPubMedCentral
64.
Altice FL, Bruce RD, Lucas GM, Lum PJ, Korthuis PT, Flanigan TP, et al. HIV treatment outcomes among HIV-infected, opioid-dependent patients receiving buprenorphine/naloxone treatment within HIV clinical care settings: results from a multisite study. J Acquir Immune Defic Syndr. 2011;56:S22–32.CrossRefPubMedPubMedCentral
65.
Palepu A, Tyndall MW, Joy R, Kerr T, Wood E, Press N, et al. Antiretroviral adherence and HIV treatment outcomes among HIV/HCV co-infected injection drug users: the role of methadone maintenance therapy. Drug Alcohol Depend. 2006;84:188–94.CrossRefPubMed
66.
Brunet L, Napravnik S, Heine AD, Leone PA, Eron JJ. Longitudinal opioid use among HIV-infected patients, 2000 to 2014. J Acquir Immune Defic Syndr. 2017;75:77–80.CrossRefPubMedPubMedCentral
67.
Edelman EJ, Gordon K, Becker WC, Goulet JL, Skanderson M, Gaither JR, et al. Receipt of opioid analgesics by HIV-infected and uninfected patients. J Gen Intern Med. 2013;28:82–90.CrossRefPubMed
68.
Lum PJ, Little S, Botsko M, Hersh D, Thawley RE, Egan JE, et al. Opioid-prescribing practices and provider confidence recognizing opioid analgesic abuse in HIV primary care settings: JAIDS. J Acquir Immune Defic Syndr. 2011;56:S91–7.CrossRefPubMed
69.
Bruce RD, Merlin J, Lum PJ, et al. 2017 HIVMA of IDSA clinical practice guideline for the management of chronic pain in patients living with HIV. Clin Infect Dis. n.d.
70.
Norton BL, Beitin A, Glenn M, DeLuca J, Litwin AH, Cunningham CO. Retention in buprenorphine treatment is associated with improved HCV care outcomes. J Subst Abus Treat. 2017;75:38–42.CrossRef
71.
Bruggmann P, Litwin AH. Models of care for the management of hepatitis C virus among people who inject drugs: one size does not fit all. Clin Infect Dis. 2013;57:S56–61.CrossRefPubMed
72.
Zaller N, Gillani FS, Rich JD. A model of integrated primary care for HIV-positive patients with underlying substance use and mental illness. AIDS Care. 2007;19:1128–33.CrossRefPubMed
73.
Proeschold-Bell RJ, Heine A, Pence BW, McAdam K, Quinlivan EB. A cross-site, comparative effectiveness study of an integrated HIV and substance use treatment program. AIDS Patient Care STDs. 2010;24:651–8.CrossRefPubMed
74.
Lucas GM, Chaudhry A, Hsu J, Woodson T, Lau B, Olsen Y, et al. Clinic-based treatment for opioid-dependent HIV-infected patients versus referral to an opioid treatment program: a randomized controlled trial. Ann Intern Med. 2010;152:704–11.CrossRefPubMedPubMedCentral
75.
Robaeys G, Grebely J, Mauss S, Bruggmann P, Moussalli J, de Gottardi A, et al. Recommendations for the management of hepatitis C virus infection among people who inject drugs. Clin Infect Dis. 2013;57:S129–37.CrossRefPubMed
76.
Ford MM, Johnson N, Desai P, Rude E, Laraque F. From care to cure: demonstrating a model of clinical patient navigation for hepatitis C care and treatment in high-need patients. Clin Infect Dis. 2017;64:685–91.PubMed
77.
Martin NK, Hickman M, Hutchinson SJ, Goldberg DJ, Vickerman P. Combination interventions to prevent HCV transmission among people who inject drugs: modeling the impact of antiviral treatment, needle and syringe programs, and opiate substitution therapy. Clin Infect Dis. 2013;57:S39–45.CrossRefPubMedPubMedCentral
78.
Wodak A, Cooney A. Do needle syringe programs reduce HIV infection among injecting drug users: a comprehensive review of the international evidence. Subst Use Misuse. 2006;41:777–813.CrossRefPubMed
79.
Abdul-Quader AS, Feelemyer J, Modi S, Stein ES, Briceno A, Semaan S, et al. Effectiveness of structural-level needle/syringe programs to reduce HCV and HIV infection among people who inject drugs: a systematic review. AIDS Behav. 2013;17:2878–92.CrossRefPubMed
80.
Hagan H, Pouget ER, Jarlais D, et al. A systematic review and meta-analysis of interventions to prevent hepatitis C virus infection in people who inject drugs. J Infect Dis. 2011;204:74–83.CrossRefPubMedPubMedCentral
81.
Campbell CA. State HCV incidence and policies related to HCV preventive and treatment services for persons who inject drugs—United States, 2015–2016. MMWR Morb Mortal Wkly Rep. 2017;66:465–9.CrossRefPubMedPubMedCentral
82.
Canary L, Hariri S, Campbell C, Young R, Whitcomb J, Kaufman H, et al. Geographic disparities in access to syringe services programs among young persons with hepatitis C virus infection in the United States. Clin Infect Dis. 2017;65:514–7.CrossRefPubMed
83.
MacArthur GJ, Minozzi S, Martin N, et al. Opiate substitution treatment and HIV transmission in people who inject drugs: systematic review and meta-analysis. BMJ. 2012;345
84.
Karki P, Shrestha R, Huedo-Medina TB, et al. The impact of methadone maintenance treatment on HIV risk behaviors among high-risk injection drug users: a systematic review. Evid-Based Med Public Health. 2016;2
85.
Vickerman P, Page K, Maher L, Hickman M. Opiate substitution treatment and HCV prevention: building an evidence base? Addict Abingdon Engl. 2014;109:2060–1.CrossRef
86.
Perlman DC, Jordan AE, Uuskula A, Huong DT, Masson CL, Schackman BR, et al. An international perspective on using opioid substitution treatment to improve hepatitis C prevention and care for people who inject drugs: structural barriers and public health potential. Int J Drug Policy. 2015;26:1056–63.CrossRefPubMedPubMedCentral
87.
Andrilla, CHA, Coulthard, C, Larson, EH. Changes in the supply of physicians with a DEA DATA waiver to prescribe buprenorphine for opioid use disorder. Data Brief #162 2017.
88.
89.
Hutchinson E, Catlin M, Andrilla CHA, Baldwin LM, Rosenblatt RA. Barriers to primary care physicians prescribing buprenorphine. Ann Fam Med. 2014;12:128–33.CrossRefPubMedPubMedCentral
90.
Sigmon SC. Access to treatment for opioid dependence in rural America: challenges and future directions. JAMA Psychiatry. 2014;71:359–60.CrossRefPubMed
91.
Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365:493–505.CrossRefPubMedPubMedCentral
92.
Rodger AJ, Cambiano V, Bruun T, Vernazza P, Collins S, van Lunzen J, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA. 2016;316:171–81.CrossRefPubMed
93.
Hickman M, De Angelis D, Vickerman P, et al. HCV treatment as prevention in people who inject drugs—testing the evidence. Curr Opin Infect Dis. 2015;28:576–82.CrossRefPubMedPubMedCentral
94.
Zelenev A, Li J, Mazhnaya A, Basu S, Altice FL. Hepatitis C virus treatment as prevention in an extended network of people who inject drugs in the USA: a modelling study. Lancet Infect Dis. 2018;18:215–24.CrossRefPubMed
95.
Echevarria D, Gutfraind A, Boodram B, Major M, del Valle S, Cotler SJ, et al. Mathematical modeling of hepatitis C prevalence reduction with antiviral treatment scale-up in persons who inject drugs in metropolitan Chicago. PLoS One. 2015;10:e0135901.CrossRefPubMedPubMedCentral
96.
97.
Choopanya K, Martin M, Suntharasamai P, Sangkum U, Mock PA, Leethochawalit M, et al. Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet. 2013;381:2083–90.CrossRefPubMed
98.
Martin M, Vanichseni S, Suntharasamai P, Sangkum U, Mock PA, Leethochawalit M, et al. The impact of adherence to preexposure prophylaxis on the risk of HIV infection among people who inject drugs. AIDS. 2015;29:819–24.CrossRefPubMed
99.
Miller WC, Hoffman IF, Latkin CA, Strathdee SA, Shoptaw S. HIV antiretroviral prophylaxis for injecting drug users. Lancet. 2013;382:853.CrossRefPubMed
100.
Preexposure prophylaxis for the prevention of HIV infection in the United States—2014: a clinical practice guideline n.d.
101.
102.
Edelman EJ, Moore BA, Calabrese SK, Berkenblit G, Cunningham C, Patel V, et al. Primary care physicians’ willingness to prescribe HIV pre-exposure prophylaxis for people who inject drugs. AIDS Behav. 2017;21:1025–33.CrossRefPubMedPubMedCentral
103.
Surveillance for Viral Hepatitis - United States, 2015 2017.
104.
105.
106.
Seiber EE, Berman ML. Medicaid expansion and ACA repeal: evidence from Ohio. Am J Public Health. 2017;107:889–92.CrossRefPubMed
107.
Health Insurance Coverage of the Total Population. Henry J Kais Fam Found. 2016.
108.
Feder KA, Mojtabai R, Krawczyk N, Young AS, Kealhofer M, Tormohlen KN, et al. Trends in insurance coverage and treatment among persons with opioid use disorders following the Affordable Care Act. Drug Alcohol Depend. 2017;179:271–4.CrossRefPubMedPubMedCentral
109.
Wen H, Hockenberry JM, Borders TF, Druss BG. Impact of Medicaid expansion on Medicaid-covered utilization of buprenorphine for opioid use disorder treatment. Med Care. 2017;55:336–41.CrossRefPubMed
110.
111.
112.
Arora S, Thornton K, Murata G, Deming P, Kalishman S, Dion D, et al. Outcomes of treatment for hepatitis C virus infection by primary care providers. N Engl J Med. 2011;364:2199–207.CrossRefPubMed
113.
Metadata
Title
Challenges Facing a Rural Opioid Epidemic: Treatment and Prevention of HIV and Hepatitis C
Authors
Asher J. Schranz
Jessica Barrett
Christopher B. Hurt
Carlos Malvestutto
William C. Miller
Publication date
01-06-2018
Publisher
Springer US
Published in
Current HIV/AIDS Reports / Issue 3/2018
Print ISSN: 1548-3568
Electronic ISSN: 1548-3576
DOI
https://doi.org/10.1007/s11904-018-0393-0

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Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

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