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Int J Drug Policy. 2017 Jan;39:114-120. doi: 10.1016/j.drugpo.2016.10.022. Epub 2016 Nov 28.

Fatal and non-fatal overdose after narcology hospital discharge among Russians living with HIV/AIDS who inject drugs.

Author information

1
Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit, Boston University School of Medicine & Boston Medical Center, 801 Massachusetts Avenue, Boston, USA. Electronic address: awalley@bu.edu.
2
Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, USA.
3
Data Coordinating Center, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, USA.
4
First Pavlov State Medical University, St. Petersburg, Russian Federation.
5
Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit, Boston University School of Medicine & Boston Medical Center, 801 Massachusetts Avenue, Boston, USA.
6
Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, USA; Data Coordinating Center, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, USA.
7
First Pavlov State Medical University, St. Petersburg, Russian Federation; Bekhterev Research Psychoneurological Institute, St.Petersburg, Russian Federation.
8
San Francisco Department of Public Health, San Francisco, CA 94102, USA; Division of HIV/AIDS, University of California San Francisco, San Francisco CA 94103, USA.
9
Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit, Boston University School of Medicine & Boston Medical Center, 801 Massachusetts Avenue, Boston, USA; Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, USA.

Abstract

OBJECTIVES:

Among Russians living with HIV/AIDS who inject drugs, we examined the incidence of fatal and non-fatal overdoses following discharge from a narcology hospital and the associations with more advanced HIV infection.

DESIGN:

Prospective cohort study of data collected at baseline, 3 and 6 months from HIV-infected patients with a history of injection drug use who were not treated with anti-retroviral therapy. Participants were recruited between 2012-2014 from a narcology (addiction) hospital in St. Petersburg, Russia.

METHODS:

Fatal overdose was determined based on contact reports to study staff in the year after discharge. Non-fatal overdose was self-reported at the 3- and 6-month assessments. The main independent variable for HIV severity was CD4 cell count at the baseline interview (<200cells/mm3≥200cells/mm3). Secondary analyses assessed time since HIV diagnosis and treated with anti-retroviral treatment (ART) prior to enrolment as independent variables. We fit Cox proportional hazards models to assess whether HIV severity is associated with either fatal or non-fatal overdose.

RESULTS:

Among 349 narcology patients, 18 participants died from overdose within one year after discharge (8.7%, 95% CI 3.4-14.2 by Kaplan-Meier); an estimated 51% [95% CI 34-68%] reported at least one non-fatal overdose within 6 months of discharge. HIV severity, time since HIV diagnosis and ever ART were not significantly associated with either fatal or non-fatal overdose events.

CONCLUSION:

Fatal and non-fatal overdose are common among Russians living with HIV/AIDS who inject drugs after narcology hospital discharge. Overdose prevention interventions are urgently warranted among Russian narcology patients with HIV infection.

KEYWORDS:

HIV; Injection drug use; Mortality; Overdose; Russia

PMID:
27907848
PMCID:
PMC5191979
DOI:
10.1016/j.drugpo.2016.10.022
[Indexed for MEDLINE]
Free PMC Article

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