Holly Hagan
Holly Hagan
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Professor Emeritus
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Professional overview
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Dr. Holly Hagan is Professor Emeritus at the School of Global Public Health. Trained as an infectious disease epidemiologist, Dr. Hagan’s work has sought to understand the causes and consequences of substance use disorders. Her research has examined blood-borne and sexually-transmitted infections among people who use drugs. She is an internationally-recognized expert in the etiology, epidemiology, natural history, prevention and treatment of hepatitis C virus infection among PWUD, and in 2014 her work was recognized by the US Department of Health and Human Services with the President’s Award for Leadership in the Control of Viral Hepatitis in the United States. Dr. Hagan served on the Institute of Medicine Committee on the Prevention and Control of Viral Hepatitis in the United States, and she has been an advisor to the US Department of Health and Human Services, the CDC, and the Canadian Institutes of Health on national programs to detect, diagnose and treat HCV infections. She was recently appointed to the National Academy of Medicine Committee on the Examination of the Integration of Opioid and Infectious Disease Prevention Efforts in Select Programs.
Dr. Hagan is the Director of the NIDA P30 Center for Drug Use and HIV|HCV Research at Global Public Health, which provides research support to investigators throughout NYU and in two other NYC institutions. In 2017, she was selected by NIDA to chair the Executive Steering Committee for the Rural Opioid Initiative funded by NIH, CDC, SAMHSA and the Appalachian Regional Commission. Her research has shifted to examining the impact of the opioid crisis more broadly, to include studying the epidemiology of fatal and non-fatal overdose among PWUD. She was chosen by the American Foundation for AIDS Research to be the Principal Investigator for the New York State Opioid Prevention Center pilot study, which will examine the safety and effectiveness of the Supervised Consumption Sites to be implemented in New York City and in upstate NY.
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Education
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PhD Epidemiology, University of Washington, Seattle, WAMPH Epidemiology, University of Massachusetts, Amherst, MABA Russian Studies, Evergreen State College, Olympia, WA
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Publications
Publications
Estimating HIV incidence and the correlates of recent infection in venue-sampled men who have sex with men in New York city
AbstractNeaigus, A., Jenness, S. M., Hagan, H., Murrill, C. S., Torian, L. V., Wendel, T., & Gelpi-Acosta, C. (n.d.).Publication year
2012Journal title
AIDS and BehaviorVolume
16Issue
3Page(s)
516-524AbstractIn a cross-sectional study, MSM aged C18 years were venue-sampled in New York City in 2008, interviewed, and tested for HIV using oral fluids. Participants who reported testing HIV negative at their last test in the previous 24 months were analyzed (n = 287 of 550 sampled). Those testing positive at the interview were defined as recently infected. HIV incidence was estimated using person-time at-risk methods and correlates of recent infection using proportional hazards regression. Thirty-two (11.1%) were recently infected. HIV incidence was 5.67/100 person-years at-risk. Independent correlates included: study recruitment in parks vs. bars, and in other venues vs. bars; black vs. non-black race/ethnicity; and reporting a last sex partner with a positive or unknown vs. negative HIV status. When assay-based methods are not feasible, cross-sectional HIV test results and self-reported HIV testing history and risk factor data can be used to estimate HIV incidence and the correlates of recent infection.Meta-analysis of hepatitis C seroconversion in relation to shared syringes and drug preparation equipment
AbstractPouget, E. R., Hagan, H., & Des Jarlais, D. C. (n.d.).Publication year
2012Journal title
AddictionVolume
107Issue
6Page(s)
1057-1065AbstractAims We conducted a systematic review of studies reporting seroincidence of hepatitis C infection (HCV) in relation to shared syringes and drug preparation equipment among injection drug users (IDUs). We identified published and unpublished studies that met inclusion criteria. Design We estimated the relative contributions of shared syringes and drug preparation equipment to HCV transmission using random-effects meta-analysis, and analyzed potential sources of heterogeneity of effects among studies. Findings Syringe sharing was associated with HCV seroconversion [pooled risk ratio (PRR)=1.94, 95% confidence interval (CI)1.53, 2.46], as was sharing drug preparation containers (PRR=2.42, 95% CI1.89, 3.10), filters (PRR=2.61, 95% CI1.91, 3.56), rinse water (PRR=1.98, 95% CI1.54, 2.56), combinations of this equipment (PRR=2.24, 95% CI1.28, 3.93) and 'backloading', a syringe-mediated form of sharing prepared drugs (PRR=1.86, 95% CI1.41, 2.44). Meta-regression results showed that the association between syringe sharing and seroconversion was modified by HCV seroprevalence in the IDU populations. Conclusions The risk of hepatitis C infection through shared syringes is dependent upon hepatitis C infection seroprevalence in the population. The risk of hepatitis C infection through shared drug preparation equipment is similar to that of shared syringes. Because the infection status of sharing partners is often unknown, it is important for injection drug users to consistently avoid sharing unsterile equipment used to prepare, divide or inject drugs and avoid backloading with an unsterile syringe.Racial and ethnic disparities and implications for the prevention of HIV among persons who inject drugs
AbstractJarlais, D. C., Cooper, H. L., Bramson, H., Deren, S., Hatzakis, A., & Hagan, H. (n.d.).Publication year
2012Journal title
Current Opinion in HIV and AIDSVolume
7Issue
4Page(s)
354-361AbstractPURPOSE OF REVIEW: There are now an estimated 16 million people who inject drugs (PWID) throughout the world, 3 million of whom are estimated to be infected with HIV. In many countries, substantial proportions of PWID belong to racial/ethnic/nationality minority groups, and are at increased likelihood of being infected with HIV. This article reviews current evidence on ethnic disparities in HIV infection among PWID and assesses the issues that would need to be addressed to reduce these disparities. RECENT FINDINGS: An ongoing systematic review of ethnic disparities has found that, in a pooled weighted odds ratio, ethnic minority PWID are twice as likely to be HIV seropositive than ethnic majority, PWID from the same geographic area. If implemented with sufficient quality and coverage, current HIV prevention programs probably have the capability of ending HIV transmission among both ethnic majority and minority PWID. Large-scale, evidence-based prevention programs need to be implemented in the contexts of patterns of injecting drug use that continue to evolve-with injecting practices spreading to new areas, changes in drugs injected, and some transitions from injecting to noninjecting drug use. Lack of financial resources and policies against evidence-based programming are increasingly important problems that are likely to have particularly adverse effects on ethnic minority PWID. SUMMARY: Racial/ethnic/nationality disparities in HIV infection are quite common among PWID. Addressing these disparities will be a fundamental challenge within a human rights approach to public health.Racial/ethnic disparities in HIV infection among people who inject drugs : An international systematic review and meta-analysis
AbstractDes Jarlais, D. C., Bramson, H. A., Wong, C., Gostnell, K., Cepeda, J., Arasteh, K., & Hagan, H. (n.d.).Publication year
2012Journal title
AddictionVolume
107Issue
12Page(s)
2087-2095AbstractAims: The Ethnic Minority Meta-Analysis (EMMA) aims to assess racial/ethnic disparities in HIV infection among people who inject drugs (PWID) across various countries. This is the first report of the data. Methods: Standard systematic review/meta-analysis methods were utilized, including searching for, screening and coding published and unpublished reports and meta-analytical statistics. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines for reporting methods. Disparities were measured with the odds ratio (OR) for HIV prevalence among ethnic minority PWID compared to ethnic majority PWID; an OR >1.0 indicated higher prevalence among ethnic minorities. Results: Racial/ethnic disparities in HIV prevalence among PWID were examined in 131 prevalence reports, with 214 racial/ethnic minority to majority comparisons, comprising 106715 PWID. Overall, the pooled OR indicates an increased likelihood of higher HIV prevalence among racial/ethnic minority compared to racial/ethnic majority PWID [OR=2.09, 95% confidence interval (CI): 1.92-2.28]. Among 214 comparisons, 106 produced a statistically significant higher OR for minorities; in 102 comparisons the OR was not significantly different from 1.0; six comparisons produced a statistically significant higher OR for majority group members. Disparities were particularly large in the United States, pooled OR=2.22 (95% CI: 2.03-2.44). There was substantial variation in ORs-I2=75.3%: interquartile range=1.38-3.56-and an approximate Gaussian distribution of the log ORs. Conclusions: Among people who inject drugs, ethnic minorities are approximately twice as likely to be HIV seropositive than ethnic majorities. The great heterogeneity and Gaussian distribution suggest multiple causal factors and a need to tailor interventions to local conditions.Recommendations for the identification of chronic hepatitis C virus infection among persons born 1945-1965
AbstractHagan, H., & Hagan, H. (n.d.).Publication year
2012Journal title
MMWR Recommendation ReportVolume
61 (RR-4)Page(s)
1-32Abstract~Reply to high-quality meta-analyses are required for development of evidence in medicine
AbstractHagan, H., Des Jarlais, D. C., & Pouget, E. (n.d.).Publication year
2012Journal title
Journal of Infectious DiseasesVolume
205Issue
9Page(s)
1473Abstract~Transitions from injection-drug-use-concentrated to self-sustaining heterosexual HIV epidemics : Patterns in the international data
AbstractDes Jarlais, D. C., Feelemyer, J. P., Modi, S. N., Arasteh, K., Mathers, B. M., Degenhardt, L., & Hagan, H. (n.d.).Publication year
2012Journal title
PloS oneVolume
7Issue
3AbstractBackground: Injecting drug use continues to be a primary driver of HIV epidemics in many parts of the world. Many people who inject drugs (PWID) are sexually active, so it is possible that high-seroprevalence HIV epidemics among PWID may initiate self-sustaining heterosexual transmission epidemics. Methods: Fourteen countries that had experienced high seroprevalence (Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010 : A systematic analysis for the Global Burden of Disease Study 2010
AbstractVos, T., Flaxman, A. D., Naghavi, M., Lozano, R., Michaud, C., Ezzati, M., Shibuya, K., Salomon, J. A., Abdalla, S., Aboyans, V., Abraham, J., Ackerman, I., Aggarwal, R., Ahn, S. Y., Ali, M. K., Almazroa, M. A., Alvarado, M., Anderson, H. R., Anderson, L. M., … Pandian, J. D. (n.d.).Publication year
2012Journal title
The LancetVolume
380Issue
9859Page(s)
2163-2196AbstractBackground: Non-fatal health outcomes from diseases and injuries are a crucial consideration in the promotion and monitoring of individual and population health. The Global Burden of Disease (GBD) studies done in 1990 and 2000 have been the only studies to quantify non-fatal health outcomes across an exhaustive set of disorders at the global and regional level. Neither eff ort quantified uncertainty in prevalence or years lived with disability (YLDs). Methods: Of the 291 diseases and injuries in the GBD cause list, 289 cause disability. For 1160 sequelae of the 289 diseases and injuries, we undertook a systematic analysis of prevalence, incidence, remission, duration, and excess mortality. Sources included published studies, case notification, population-based cancer registries, other disease registries, antenatal clinic serosurveillance, hospital discharge data, ambulatory care data, household surveys, other surveys, and cohort studies. For most sequelae, we used a Bayesian meta-regression method, DisMod-MR, designed to address key limitations in descriptive epidemiological data, including missing data, inconsistency, and large methodological variation between data sources. For some disorders, we used natural history models, geospatial models, back-calculation models (models calculating incidence from population mortality rates and case fatality), or registration completeness models (models adjusting for incomplete registration with health-system access and other covariates). Disability weights for 220 unique health states were used to capture the severity of health loss. YLDs by cause at age, sex, country, and year levels were adjusted for comorbidity with simulation methods. We included uncertainty estimates at all stages of the analysis. Findings: Global prevalence for all ages combined in 2010 across the 1160 sequelae ranged from fewer than one case per 1 million people to 350 000 cases per 1 million people. Prevalence and severity of health loss were weakly correlated (correlation coefficient -0·37). In 2010, there were 777 million YLDs from all causes, up from 583 million in 1990. The main contributors to global YLDs were mental and behavioural disorders, musculoskeletal disorders, and diabetes or endocrine diseases. The leading specific causes of YLDs were much the same in 2010 as they were in 1990: low back pain, major depressive disorder, iron-deficiency anaemia, neck pain, chronic obstructive pulmonary disease, anxiety disorders, migraine, diabetes, and falls. Age-specific prevalence of YLDs increased with age in all regions and has decreased slightly from 1990 to 2010. Regional patterns of the leading causes of YLDs were more similar compared with years of life lost due to premature mortality. Neglected tropical diseases, HIV/AIDS, tuberculosis, malaria, and anaemia were important causes of YLDs in sub-Saharan Africa. Interpretation: Rates of YLDs per 100 000 people have remained largely constant over time but rise steadily with age. Population growth and ageing have increased YLD numbers and crude rates over the past two decades. Prevalences of the most common causes of YLDs, such as mental and behavioural disorders and musculoskeletal disorders, have not decreased. Health systems will need to address the needs of the rising numbers of individuals with a range of disorders that largely cause disability but not mortality. Quantification of the burden of non-fatal health outcomes will be crucial to understand how well health systems are responding to these challenges. Eff ective and aff ordable strategies to deal with this rising burden are an urgent priority for health systems in most parts of the world.A systematic review and meta-analysis of interventions to prevent hepatitis C virus infection in people who inject drugs
AbstractHagan, H., Pouget, E. R., & Des Jarlais, D. C. (n.d.).Publication year
2011Journal title
Journal of Infectious DiseasesVolume
204Issue
1Page(s)
74-83AbstractIntroduction. High rates of hepatitis C virus (HCV) transmission are found in samples of people who inject drugs (PWID) throughout the world. The objective of this paper was to meta-analyze the effects of risk-reduction interventions on HCV seroconversion and identify the most effective intervention types. Methods. We performed a systematic review and meta-analysis of published and unpublished studies. Eligible studies reported on the association between participation in interventions intended to reduce unsafe drug injection and HCV seroconversion in samples of PWID. Results. The meta-analysis included 26 eligible studies of behavioral interventions, substance-use treatment, syringe access, syringe disinfection, and multicomponent interventions. Interventions using multiple combined strategies reduced risk of seroconversion by 75% (pooled relative risk, .25; 95% confidence interval, .07-.83). Effects of single-method interventions ranged from .6 to 1.6. Conclusions. Interventions using strategies that combined substance-use treatment and support for safe injection were most effective at reducing HCV seroconversion. Determining the effective dose and combination of interventions for specific subgroups of PWID is a research priority. However, our meta-analysis shows that HCV infection can be prevented in PWID.Agent, host, and environment : Hepatitis C virus in people who inject drugs
AbstractHagan, H. (n.d.).Publication year
2011Journal title
Journal of Infectious DiseasesVolume
204Issue
12Page(s)
1819-1821Abstract~Associations between herpes simplex virus type 2 and HCV with HIV among injecting drug users in New York City : The current importance of sexual transmission of HIV
AbstractDes Jarlais, D. C., Arasteh, K., McKnight, C. A., Hagan, H., Perlman, D. C., & Semaan, S. (n.d.).Publication year
2011Journal title
American journal of public healthVolume
101Issue
7Page(s)
1277-1283AbstractObjectives: We examined relationships between herpes simplex virus type 2 (HSV-2), a biomarker for sexual risk, and HCV, a biomarker for injecting risk, with HIV among injecting drug users (IDUs) who began injecting after large-scale expansion of syringe exchange programs in New York City. Methods: We recruited 337 heroin and cocaine users who began injecting in 1995 or later from persons entering drug detoxification. We administered a structured interview covering drug use and HIV risk behavior and collected serum samples for HIV, HCV, and HSV-2 testing. Results: HIV prevalence was 8%, HSV-2 39%, and HCV 55%. We found a significant association between HSV-2 and HIV (odds ratio [OR]=7.9; 95% confidence interval [CI]=2.9, 21.4) and no association between HCV and HIV (OR=1.14; 95% CI=0.5, 2.6). Black IDUs had the highest prevalence of HSV-2 (76%) and HIV (24%) but the lowest prevalence of HCV (34%). Conclusions: Most HIV infections among these IDUs occurred through sexual transmission. The relative importance of injecting versus sexual transmission of HIV may be critical for understanding racial/ethnic disparities in HIV infection.Can intranasal drug use reduce HCV infection among injecting drug users?
AbstractDes Jarlais, D. C., Hagan, H., Arasteh, K., McKnight, C. A., Semaan, S., & Perlman, D. C. (n.d.).Publication year
2011Journal title
Drug and alcohol dependenceVolume
119Issue
3Page(s)
201-206AbstractBackground: Preventing HCV infection among people who inject drugs is a difficult public health challenge. We examined the potential role of intranasal drug use in reducing HCV acquisition. Methods: Subjects were recruited from IDUs entering the Beth Israel drug detoxification program from 2005 to 2010. A structured interview was administered and serum samples were collected for HCV testing. Results: 726 active injecting drug users were recruited from 2005 to 2010. HCV prevalence was 71%, 90% reported recent heroin injection and 44% reported recent intranasal heroin use. In a multiple logistic regression analysis, being HCV seropositive was associated with more years injecting, Latino ethnicity, previous testing for HCV, and recent injection of speedball, and negatively associated with recent intranasal use of heroin (AOR = 0.52, 95% CI 0.33-0.82) and intranasal use of speedball (AOR = 0.41, 95% CI 0.31-0.80). The association between intranasal heroin use and lower HCV seroprevalance was observed among both new injectors and persons with long injecting histories (16+ years since first injection). Conclusion: Encouraging intranasal use as an alternative to injection among persons currently injecting drugs may be a viable strategy for reducing HCV transmission.Continuing HIV risk in New York city injection drug users : The association of syringe source and syringe sharing
AbstractJenness, S. M., Hagan, H., Liu, K. L., Wendel, T., & Murrill, C. S. (n.d.).Publication year
2011Journal title
Substance Use and MisuseVolume
46Issue
2-3Page(s)
192-200AbstractSterile syringe access is an important means to reduce HIV risk, but many injection drug users (IDU) who obtain syringes from sterile sources continue to share syringes. We examined the factors associated with continuing syringe sharing in New York City. We recruited 500 active IDU in 2005 through respondent-driven sampling. In multiple logistic regression, not obtaining all syringes in the past year exclusively from sterile sources was associated with increased syringe sharing. Ensuring adequate syringe availability as well as engaging and retaining nonusers and inconsistent users in sterile syringe services may increase sterile syringe access and decrease syringe sharing.Current and emerging research needs in studying the NYC HIV-drug Use epidemic
AbstractDeren, S., Hagan, H., Friedman, S., Des Jarlais, D. C., Perlman, D., Gwadz, M., Cleland, C., Osborne, A., & Lunievicz, J. (n.d.).Publication year
2011Journal title
Substance Use and MisuseVolume
46Issue
2-3Page(s)
316-319AbstractAs we begin the fourth decade of the epidemic, it is clear that, as demonstrated by the articles in this Special Issue, much has been learned about factors contributing to the decline in HIV prevalence among drug users in New York. However, there are a number of outstanding research questions that remain or are emerging. Following is a summary of some of the topics requiring further research. While this summary does not represent a comprehensive list, it is based on many of the questions raised in the articles in this Special Issue and identifies some of the directions to be investigated during the next decade.Estimated HIV incidence among high-risk heterosexuals in New York city, 2007
AbstractJenness, S. M., Neaigus, A., Murrill, C. S., Wendel, T., Forgione, L., & Hagan, H. (n.d.).Publication year
2011Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
56Issue
2Page(s)
193-197AbstractEstimates of HIV incidence rates among high-risk heterosexuals (HRH) in the United States have been limited to heterosexual subgroups like prison inmates and commercial sex workers. In this analysis, we estimate incidence with detuned assay testing among a group of HRH defined through a multidimensional sampling strategy and recruited through respondent-driven sampling. Incidence was 3.31% per year (95% confidence interval = 1.43 to 6.47) overall and 2.59% per year (95% confidence interval = 0.84 to 6.06) among participants with no lifetime history of drug injection or male-to-male sex. This study design is suggested as an efficient method for recruiting HRH for cohort studies and behavioral interventions.Global epidemiology of hepatitis B and hepatitis C in people who inject drugs : Results of systematic reviews
AbstractNelson, P. K., Mathers, B. M., Cowie, B., Hagan, H., Des Jarlais, D., Horyniak, D., & Degenhardt, L. (n.d.).Publication year
2011Journal title
The LancetVolume
378Issue
9791Page(s)
571-583AbstractInjecting drug use is an important risk factor for transmission of viral hepatitis, but detailed, transparent estimates of the scale of the issue do not exist. We estimated national, regional, and global prevalence and population size for hepatitis C virus (HCV) and hepatitis B virus (HBV) in injecting drug users (IDUs). We systematically searched for data for HBV and HCV in IDUs in peer-reviewed databases (Medline, Embase, and PsycINFO), grey literature, conference abstracts, and online resources, and made a widely distributed call for additional data. From 4386 peer-reviewed and 1019 grey literature sources, we reviewed 1125 sources in full. We extracted studies into a customised database and graded them according to their methods. We included serological reports of HCV antibodies (anti-HCV), HBV antibodies (anti-HBc), or HBV surface antigen (HBsAg) in studies of IDUs with more than 40 participants (Introduction : The New York HIV-drug use epidemic: lessons learned and unresolved issues.
AbstractDeren, S., & Hagan, H. (n.d.).Publication year
2011Journal title
Substance use & misuseVolume
46Issue
2-3Page(s)
129-130Abstract~Patterns of exchange sex and HIV infection in high-risk heterosexual men and women
AbstractJenness, S. M., Kobrak, P., Wendel, T., Neaigus, A., Murrill, C. S., & Hagan, H. (n.d.).Publication year
2011Journal title
Journal of Urban HealthVolume
88Issue
2Page(s)
329-341AbstractHeterosexual partnerships involving the trade of money or goods for sex are a well-described HIV risk factor in Africa and Southeast Asia, but less research has been conducted on exchange partnerships and their impact on HIV infection in the United States. In our study, men and women were recruited from high-risk risk neighborhoods in New York City through respondent-driven sampling in 2006-2007. We examined the factors associated with having an exchange partner in the past year, the relationship between exchange partnerships and HIV infection, and the risk characteristics of those with exchange partners by the directionality of payment. Overall, 28% of men and 41% of women had a past-year exchange partner. For men, factors independently associated with exchange partnerships were older age, more total sexual partners, male partners, and frequent non-injection drug use. For women, factors were homelessness, more total sexual partners, more unprotected sex partners, and frequent non-injection drug use. Exchange partnerships were associated with HIV infection for both men and women, although the relationships were substantially confounded by other behavioral risks. Those who both bought and sold sex exhibited the highest levels of risk with their exchange and non-exchange partners. Exchange partnerships may be an HIV risk both directly and indirectly, given the overlap of this phenomenon with other risk factors that occur with both exchange and non-exchange partners.Performance of premarket rapid hepatitis C virus antibody assays in 4 national human immunodeficiency virus behavioral surveillance system sites
AbstractSmith, B. D., Teshale, E., Jewett, A., Weinbaum, C. M., Neaigus, A., Hagan, H., Jenness, S. M., Melville, S. K., Burt, R., Thiede, H., Al-Tayyib, A., Pannala, P. R., Miles, I. W., Oster, A. M., Smith, A., Finlayson, T., Bowles, K. E., & Dinenno, E. A. (n.d.).Publication year
2011Journal title
Clinical Infectious DiseasesVolume
53Issue
8Page(s)
780-786AbstractBackground. The Centers for Disease Control and Prevention (CDC) estimates that 4.1 million Americans have been infected with hepatitis C virus (HCV) and 75%-80% of them are living with chronic HCV infection, many unaware of their infection. Persons who inject drugs (PWID) account for 57.5% of all persons with HCV antibody (anti-HCV) in the United States. Currently no point-of-care tests for HCV infection are approved for use in the United States. Methods. Surveys and testing for human immunodeficiency virus (HIV) and anti-HCV were conducted among persons who reported injection drug use in the past 12 months as part of the National HIV Behavioral Surveillance System in 2009. The sensitivity and specificity of point-of-care tests (finger-stick and 2 oral fluid rapid assays) from 3 manufacturers (Chembio, MedMira, and OraSure) were evaluated in field settings in 4 US cities. Results. Sensitivity (78.9%-97.4%) and specificity (80.0%-100.0%) were variable across assays and sites. The highest assay-specific sensitivities achieved for the Chembio, MedMira, and OraSure tests were 94.0%, 78.9% and 97.4%, respectively; the highest specificities were 97.7%, 83.3%, and 100%, respectively. In multivariate analysis, false-negative anti-HCV results were associated with HIV positivity for the Chembio oral assay (adjusted odds ratio, 8.4-9.1; P , .01) in 1 site (New York City). Conclusions. Sensitive rapid anti-HCV assays are appropriate and feasible for high-prevalence, high-risk populations such as PWID, who can be reached through social service settings such as syringe exchange programs and methadone maintenance treatment programs.Predictors and correlates of reduced frequency or cessation of injection drug use during a randomized HIV prevention intervention trial
AbstractMackesy-Amiti, M. E., Ouellet, L. J., Golub, E. T., Hudson, S., Hagan, H., & Garfein, R. S. (n.d.).Publication year
2011Journal title
AddictionVolume
106Issue
3Page(s)
601-608AbstractAims This study conducted a secondary analysis to examine injection cessation and decreasing frequency of injection during a multi-site randomized controlled HIV prevention intervention trial that sought to reduce sexual and injection risk behavior among young injection drug users. Design and Setting A six-session, cognitive-behavioral skills-building intervention in which participants were taught peer education skills [peer education intervention (PEI)] was compared with a time-equivalent attention control. Follow-up interviews were conducted at 3 and 6 months post-baseline. Participants Trial participants were HIV and hepatitis C virus (HCV) antibody-negative injection drug users aged 15-30 years. Participants who had at least one follow-up interview and reported injecting drugs in the previous 3 months at baseline were eligible for the present analysis (n=690). Measurements At each interview, data were collected on the number of times participants injected drugs over the previous 3 months. Findings Twenty-seven per cent of participants reported at least one 3-month period of injection cessation. In a multivariate, zero-inflated negative binomial regression adjusting for prior injection frequency, time of follow-up and psychosocial variables, PEI trial arm and smaller session size were associated significantly with injection cessation. Trial arm had no effect on the frequency of injection among those who continued to inject. Conclusions HIV prevention interventions that encourage injection drug users to take on the role of peer educator may have the additional benefit of increasing the likelihood of injection cessation. Intervention group size is also an important consideration, with smaller groups having higher rates of cessation.Predictors and effects of alcohol use on liver function among young HCV-infected injection drug users in a behavioral intervention
AbstractDrumright, L. N., Hagan, H., Thomas, D. L., Latka, M. H., Golub, E. T., Garfein, R. S., Clapp, J. D., Campbell, J. V., Bonner, S., Kapadia, F., Thiel, T. K., & Strathdee, S. A. (n.d.).Publication year
2011Journal title
Journal of HepatologyVolume
55Issue
1Page(s)
45-52AbstractBackground & Aims: Hepatitis C virus (HCV) screening can provide opportunities to reduce disease progression through counseling against alcohol use, but empirical data on this issue are sparse. We determined the efficacy of a behavioral intervention in reducing alcohol use among young, HCV-infected injection drug users (IDUs) (n = 355) and assessed whether changes in liver enzymes were associated with changes in alcohol consumption. Methods: Both the intervention and attention-control groups were counseled to avoid alcohol use, but the intervention group received enhanced counseling. Logistic regression, ANOVA, and continuous time Markov models were used to identify factors associated with alcohol use, changes in mean ALT and AST levels, and change in alcohol use post-intervention. Results: Six months post-intervention, alcohol abstinence increased 22.7% in both groups, with no difference by intervention arm. Transition from alcohol use to abstinence was associated with a decrease in liver enzymes, with a marginally greater decrease in the intervention group (p = 0.05 for ALT; p = 0.06 for AST). In multivariate Markov models, those who used marijuana transitioned from alcohol abstinence to consumption more rapidly than non-users (RR = 3.11); those who were homeless transitioned more slowly to alcohol abstinence (RR = 0.47); and those who had ever received a clinical diagnosis of liver disease transitioned more rapidly to abstinence (RR = 1.88). Conclusions: Although, behavioral counseling to reduce alcohol consumption among HCV-infected IDUs had a modest effect, reductions in alcohol consumption were associated with marked improvements in liver function. Interventions to reduce alcohol use among HCV-infected IDUs may benefit from being integrated into clinical care and monitoring of HCV infection.Recruitment-adjusted estimates of HIV prevalence and risk among men who have sex with men : Effects of weighting venue-based sampling data
AbstractJenness, S. M., Neaigus, A., Murrill, C. S., Gelpi-Acosta, C., Wendel, T., & Hagan, H. (n.d.).Publication year
2011Journal title
Public Health ReportsVolume
126Issue
5Page(s)
635-642AbstractObjectives. We investigated the impact of recruitment bias within the venuebased sampling (VBS) method, which is widely used to estimate disease prevalence and risk factors among groups, such as men who have sex with men (MSM), that congregate at social venues. Methods. In a 2008 VBS study of 479 MSM in New York City, we calculated venue-specific approach rates (MSM approached/MSM counted) and response rates (MSM interviewed/MSM approached), and then compared crude estimates of HIV risk factors and seroprevalence with estimates weighted to address the lower selection probabilities of MSM who attend social venues infrequently or were recruited at high-volume venues. Results. Our approach rates were lowest at dance clubs, gay pride events, and public sex strolls, where venue volumes were highest; response rates ranged from 39% at gay pride events to 95% at community-based organizations. Sixty-seven percent of respondents attended MSM-oriented social venues at least weekly, and 21% attended such events once a month or less often in the past year. In estimates adjusted for these variations, the prevalence of several past-year risk factors (e.g., unprotected anal intercourse with casual/exchange partners, $5 total partners, group sex encounters, at least weekly binge drinking, and hard-drug use) was significantly lower compared with crude estimates. Adjusted HIV prevalence was lower than unadjusted prevalence (15% vs. 18%), but not significantly. Conclusions. Not adjusting VBS data for recruitment biases could overestimate HIV risk and prevalence when the selection probability is greater for higher-risk MSM. While further examination of recruitment-adjustment methods for VBS data is needed, presentation of both unadjusted and adjusted estimates is currently indicated.Sexual and injection-related risks in Puerto Rican-born injection drug users living in New York City : A mixed-methods analysis
AbstractGelpí-Acosta, C., Hagan, H., Jenness, S. M., Wendel, T., & Neaigus, A. (n.d.).Publication year
2011Journal title
Harm Reduction JournalVolume
8AbstractBackground: These data were collected as part of the National HIV Behavioral Surveillance (NHBS) study. NHBS is a cross-sectional study to investigate HIV behavioral risks among core risk groups in 21 U.S. cities with the highest HIV/AIDS prevalence. This analysis examines data from the NHBS data collection cycle with IDU conducted in New York City in 2009. We explored how the recency of migration from Puerto Rico (PR) to New York City (NYC) impacts both syringe sharing and unprotected sex among injection drug users (IDU) currently living in NYC.Methods: We used a mixed-methods approach to examine differences in risk between US-born IDU, PR IDU who migrated to NYC more than three years ago (non-recent migrants), and PR IDU who migrated in the last three years (recent migrants). Respondent-driven sampling (RDS) was used to recruit the sample (n = 514). In addition, qualitative individual and group interviews with recent PR migrants (n = 12) and community experts (n = 2) allowed for an in-depth exploration of the IDU migration process and the material and cultural factors behind continued risk behaviors in NYC.Results: In multiple logistic regression controlling for confounding factors, recent migrants were significantly more likely to report unprotected sexual intercourse with casual or exchange partners (adjusted odds ratio [AOR]: 2.81; 95% confidence intervals [CI]: 1.37-5.76) and receptive syringe sharing (AOR = 2.44; 95% CI: 1.20-4.97) in the past year, compared to US-born IDU. HIV and HCV seroprevalence were highest among non-recent migrants. Qualitative results showed that risky injection practices are partly based on cultural norms acquired while injecting drugs in Puerto Rico. These same results also illustrate how homelessness influences risky sexual practices.Conclusions: Poor material conditions (especially homelessness) may be key in triggering risky sexual practices. Cultural norms (ingrained while using drugs in PR) around injection drug use are perpetuated in their new setting following an almost natural flow. These norms may have a particular stronghold over risky drug injection practices. These results indicate that culturally appropriate HIV and HCV prevention and education services are needed. In addition, homelessness should be addressed to reduce risky sexual practices.Sexual risk and HIV infection among drug users in New York city : A pilot study
AbstractHagan, H., Perlman, D. C., & Des Jarlais, D. C. (n.d.).Publication year
2011Journal title
Substance Use and MisuseVolume
46Issue
2-3Page(s)
201-207AbstractMeasures of sexual health were assessed during 2008-2009 in a New York City sample of 102 injection and noninjection users of heroin, cocaine, or crack. There was considerable overlap and transitioning between crack smoking and injecting. Crack users were also significantly more likely to be gay, lesbian, or bisexual than other drug users. In multivariate analysis, HIV infection was independently associated with crack use and with being gay or bisexual. In New York City, HIV prevention for drug users has focused on syringe access, safe injection, and drug user treatment, but further progress in HIV control will require strategies to address sexual health among people who use drugs. The study's limitations are noted.Unprotected anal intercourse and sexually transmitted diseases in high-risk heterosexual women.
AbstractJenness, S. M., Begier, E. M., Neaigus, A., Murrill, C. S., Wendel, T., & Hagan, H. (n.d.).Publication year
2011Journal title
American journal of public healthVolume
101Issue
4Page(s)
745-750AbstractWe examined the association between unprotected anal intercourse and sexually transmitted diseases (STDs) among heterosexual women. In 2006 through 2007, women were recruited from high-risk areas in New York City through respondent-driven sampling as part of the National HIV Behavioral Surveillance study. We used multiple logistic regression to determine the relationship between unprotected anal intercourse and HIV infection and past-year STD diagnosis. Of the 436 women studied, 38% had unprotected anal intercourse in the past year. Unprotected anal intercourse was more likely among those who were aged 30 to 39 years, were homeless, were frequent drug or binge alcohol users, had an incarcerated sexual partner, had sexual partners with whom they exchanged sex for money or drugs, or had more than 5 sexual partners in the past year. In the logistic regression, women who had unprotected anal intercourse were 2.6 times as likely as women who had only unprotected vaginal intercourse and 4.2 times as likely as women who had neither unprotected anal nor unprotected vaginal intercourse to report an STD diagnosis. We found no significant association between unprotected anal intercourse and HIV infection. Increased screening for history of unprotected anal intercourse and, for those who report recent unprotected anal intercourse, counseling and testing for HIV and STDs would likely reduce STD infections.