Publications by authors named "F L Altice"

Background: Women involved in the criminal legal system have elevated rates of opioid use disorder, which is treatable, and HIV, which is preventable with pre-exposure prophylaxis (PrEP). There are significant social and structural barriers to integrated delivery of PrEP and medications for opioid use disorder (MOUD), limiting women's ability to access these life-saving interventions. In a two parallel-arm randomized controlled trial, we are assessing an innovative eHealth delivery model that integrates PrEP with MOUD and is tailored to meet the specific needs of women involved in the criminal legal system.

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Introduction: People who inject drugs experience poor health and social outcomes which improve with opioid agonist therapies like methadone, yet provider stigma may influence healthcare utilization. In Ukraine, integrating methadone into primary care centers (PCCs) provides an opportunity to examine provider stigma and its impact on patient outcomes.

Methods: This sub-analysis included patients randomized to receive methadone in PCCs as part of an implementation trial in which the control group received methadone in specialty addiction clinics in Ukraine.

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The 1990 resolution by the UN General Assembly committed member states to provide health-care equity for people in prison, who are included in the global goals to control HIV and eliminate hepatitis C virus (HCV) by 2030. WHO has set ambitious HCV elimination targets by including people who inject drugs (PWID), yet has not prioritised PWID who are incarcerated, a substantial population who have or are at risk for HCV infection. Human rights principles of health-care equity stipulate that "prisoners should enjoy the same standards of health care that are available in the community, without discrimination on the grounds of their legal status".

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Purpose Of Review: This review evaluates recent literature to understand the ways in which war disrupts HIV prevention and creates conditions for HIV outbreaks, with a focus on Ukraine. We also examine potential responses that can be deployed to sustain HIV prevention services amid ongoing conflict.

Recent Findings: Recent studies and frameworks suggest that disruptions caused during war are comparable to other emergencies, like natural disasters.

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Article Synopsis
  • Ukraine experiences a significant HIV epidemic predominantly among people who inject drugs, especially opioids, but has notably increased the use of opioid agonist therapies (OAT) between 2014 and 2021.
  • A biobehavioral survey conducted on opioid-dependent people who inject drugs (PWID) in 2020-2021 revealed improvements in HIV diagnosis, care, and treatment compared to a prior survey from 2014-2015.
  • The study highlights that any interaction with the OAT system—regardless of ongoing treatment—enhances HIV care engagement and treatment outcomes, demonstrating the positive impact of this approach on the overall HIV care cascade.
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