Holly Hagan
Holly Hagan
Scroll
Professor Emeritus
-
Professional overview
-
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.
-
Education
-
PhD Epidemiology, University of Washington, Seattle, WAMPH Epidemiology, University of Massachusetts, Amherst, MABA Russian Studies, Evergreen State College, Olympia, WA
-
Publications
Publications
Self-reported hepatitis C virus antibody status and risk behavior in young injectors
AbstractHagan, H., Campbell, J., Thiede, H., Strathdee, S., Ouellet, L., Kapadia, F., Hudson, S., & Garfein, R. S. (n.d.).Publication year
2006Journal title
Public Health ReportsVolume
121Issue
6Page(s)
710-719AbstractObjective. This study was conducted to assess the accuracy of self-reported hepatitis C virus (HCV) antibody (anti-HCV) serostatus in injection drug users (IDUs), and examine whether self-reported anti-HCV serostatus was associated with recent injection risk behavior. Methods. In five U.S. cities (Baltimore, Chicago, Los Angeles, New York, and Seattle), 3,004 IDUs from 15 to 30 years old were recruited for a baseline interview to determine eligibility for a randomized controlled trial of a behavioral intervention. HIV and HCV antibody testing were performed, and subject data (e.g., demographics, drug and sexual risk behavior, and history of HIV and HCV testing) were collected via audio computer-administered self-interview. Risk behavior during the previous three months was compared to self-reported anti-HCV serostatus. Results. Anti-HCV prevalence in this sample of young IDUs was 34.1%. Seventy-two percent of anti-HCV-positive and 46% of anti-HCV-negative IDUs in this sample were not aware of their HCV serostatus. Drug treatment or needle exchange use was associated with increased awareness of HCV serostatus. Anti-HCV-negative IDUs who knew their serostatus were less likely than those unaware of their status to inject with a syringe used by another IDU or to share cottons to filter drug solutions. Knowledge of one's positive anti-HCV status was not associated with safer injection practices. Conclusions. Few anti-HCV-positive IDUs in this study were aware of their serostatus. Expanded availability of HCV screening with high quality counseling is clearly needed for this population to promote the health of chronically HCV-infected IDUs and to decrease risk among injectors susceptible to acquiring or transmitting HCV.Social structural and behavioral underpinnings of hyperendemic hepatitis C virus transmission in drug injectors
AbstractBrewer, D. D., Hagan, H., Sullivan, D. G., Muth, S. Q., Hough, E. S., Feuerborn, N. A., & Gretch, D. R. (n.d.).Publication year
2006Journal title
Journal of Infectious DiseasesVolume
194Issue
6Page(s)
764-772AbstractBackground. Hepatitis C virus (HCV) is hyperendemic in drug injectors, yet social structural and behavioral factors underlying transmission are not well established. Methods. We conducted a case-control study of HCV seroconversion in drug injectors, focusing on transmission within networks. Incident case subjects (n = 17) and seronegative control subjects (n = 42) reported injection and sex partners and referred as many as 5 for interviewing and blood testing. We performed nucleotide sequencing of HCV isolates from infected individuals. Results. Seventy-eight percent of recent injection partnerships involved behavior that could transmit HCV. Case subjects and control subjects were similar demographically and behaviorally. Case subjects, however, had more HCV-infected partners and consequently engaged in injection risk behavior with more infected partners. The injection network was mostly connected, dense, and cyclic, but the sexual network was highly fragmented. Although participants generally injected with partners of similar age, most HCV-uninfected participants recently had injected with infected partners. In at least 1 of 4 pairs of genetically linked infections, transmission appeared to be due to sharing of injection equipment other than syringes. Except for transmission pairs, network distance between incident case subjects and genetic distance between their HCV variants were uncorrelated. Conclusions. Without dramatic reductions in injection risk behaviors, shattering of cohesive injection networks, and/or broad coverage of an effective vaccine, HCV will likely remain hyperendemic in drug injectors.Staff perspectives on facilitating the implementation of hepatitis C services at drug treatment programs
AbstractMunoz-Plaza, C. E., Strauss, S. M., Astone-Twerwll, J. M., Des Jarlais, D. C., & Hagan, H. (n.d.).Publication year
2006Journal title
Journal of Psychoactive DrugsVolume
38Issue
3Page(s)
233-241AbstractDrug users are at risk of acquiring the hepatitis C virus (HCV). Although ancillary services available to clients at drug treatment programs are often limited, some of these programs are providing HCV services. Presenting qualitative data, the authors describe the HCV education and/or support services available at four drug treatment programs and examine staff and client perspectives on factors that facilitated the implementation of these services. Major findings include participants' perceptions that their programs had: (1) at least one change agent on staff who promoted the innovation and delivery ofHCV services; (2) at least one administrator or director who encouraged and supported the adoption of these services; and (3) a treatment team that tended to collectively “buy into” and value the HCV service. Ultimately, we found that some drug treatment programs are finding creative and nonresource-intensive ways of delivering HCV services despite the existence of significant barriers. While programs need more funding and resources to overcome these barriers, these findings may prove helpful to other drug treatment programs that would like to offer HCV services to at least some of their clients.Using latent class analysis to identify patterns of hepatitis C service provision in drug-free treatment programs in the U.S.
AbstractStrauss, S. M., Rindskopf, D. M., Astone-Twerell, J. M., Des Jarlais, D. C., & Hagan, H. (n.d.).Publication year
2006Journal title
Drug and alcohol dependenceVolume
83Issue
1Page(s)
15-24AbstractHepatitis C virus (HCV) infection is a global health problem, and in many countries (including the U.S.), illicit drug users constitute the group at greatest risk for contracting and transmitting HCV. Drug treatment programs are therefore unique sites of opportunity for providing medical care and support for many HCV infected individuals. This paper determines subtypes of a large sample of U.S. drug-free treatment programs (N = 333) according to services they provide to patients with HCV infection, and examines the organizational and aggregate patient characteristics of programs in these subtypes. A latent class analysis identified four subtypes of HCV service provision: a "Most Comprehensive Services" class (13% of the sample), a "Comprehensive Off-Site Medical Services" class (54%), a "Medical Monitoring Services" class (8%) and a "Minimal Services" class (25%). "Comprehensive" services class programs were less likely to be outpatient and private for profit than those in the other two classes. It is of concern that so many programs belong to the "Minimal Services" class, especially because some of these programs serve many injection drug users. "Minimal Services" class programs in the U.S. need to innovate services so that their HCV infected patients can get the medical and support care they need. Similar analyses in other countries can inform their policy makers about the capacity of their drug treatment programs to provide support to their HCV infected patients.Drug abuse and the spread of infection : HIV and AIDS as an example
AbstractDes Jarlais, D. C., Hagan, H., & Friedman, S. R. (n.d.).Publication year
2005Page(s)
193-208Abstract~Factors associated with interest in initiating treatment for hepatitis C virus (HCV) infection among young HCV-infected injection drug users
AbstractHagan, H., Strathdee, S. A., Latka, M., Campbell, J., O'Driscoll, P. T., Golub, E. T., Kapadia, F., Pollini, R. A., Garfein, R. S., Thomas, D. L., & Hagan, H. (n.d.).Publication year
2005Journal title
Clinical Infectious DiseasesVolume
40Issue
SUPPL. 5Page(s)
S304-S312AbstractObjective. We sought to identify factors associated with interest in receiving therapy for hepatitis C virus (HCV) infection among HCV-infected injection drug users (IDUs) in 3 United States cities. Methods. IDUs aged 18-35 years who were HCV-infected and seronegative for human immunodeficiency virus underwent surveys on behaviors, experience, and interest in treatment for HCV infection and readiness to quit drug use. Results. Among treatment-naive IDUs (n = 216), 81.5% were interested in treatment for HCV infection, but only 27.3% had seen a health-care provider since receiving a diagnosis of HCV infection. Interest in treatment for HCV infection was greater among IDUs with a high perceived threat of progressive liver disease, those with a usual source of care, those without evidence of alcohol dependence, and those with higher readiness scores for quitting drug use. Interest in treatment for HCV infection was 7-fold higher among IDUs who were told by their health-care provider that they were at risk for cirrhosis or liver cancer. Conclusions. Improving provider-patient communication and integrating treatments for substance abuse and HCV may increase the proportion of IDUs who initiate treatment for HCV infection.Hepatitis C Among Intravenous Drug Users
AbstractHagan, H., Des Jarlais, D. C., & Thiede, H. (n.d.).Publication year
2005Journal title
EpidemiologyVolume
16Issue
3Page(s)
424Abstract~Hepatitis C among intravenous drug users [6] (multiple letters)
AbstractMaher, L., Jalaludin, B., Chant, K., Kaldor, J., Hagan, H., Des Jarlais, D. C., & Thiede, H. (n.d.).Publication year
2005Journal title
EpidemiologyVolume
16Issue
3Page(s)
423-424Abstract~Hepatitis C Service Delivery in Prisons : Peer Education From the “Guys in Blue”
AbstractMunoz-Plaza, C. E., Strauss, S. M., Astone, J. M., Des Jarlais, D. C., & Hagan, H. (n.d.).Publication year
2005Journal title
Journal of Correctional Health CareVolume
11Issue
4Page(s)
347-368AbstractInmates in U.S. correctional facilities are approximately 9 times more likely to have hepatitis C virus (HCV) infection than the nonincarcerated population. Some correctional facilities provide HCV services, yet little is known about inmate and staff satisfaction with them. Using qualitative data collected in a prison-based drug treatment program in California, this paper describes inmate and staff perceptions of the benefits and barriers to delivering HCV services. Participants commented primarily on their peer education program and on perceived budgetary constraints as a barrier to ongoing HCV service delivery. Participants' recommendations for the future included increasing HCV education and staff training, and expanding the peer educators program.HIV/hepatitis C virus co-infection in drug users : Risk behavior and prevention
AbstractHagan, H., Thiede, H., & Des Jarlais, D. C. (n.d.).Publication year
2005Journal title
AIDSVolume
19Issue
SUPPL. 3Page(s)
S199-S207AbstractStudies of HIV-positive patients have consistently shown that drug users, in particular injection drug users (IDU), are far more likely to have hepatitis C virus (HCV) infection than other patient groups. HIV incidence and prevalence in IDU has declined in recent years, but HCV remains endemic in this population. HCV antibody prevalence among non-injection users of drugs such as heroin and cocaine is between 5 and 30%, although there are scant data on specific transmission risk behavior. The control of HIV/HCV co-infection must address HCV prevention. Epidemiological studies have suggested that HCV prevalence in IDU is subject to various influences, some of which may be modifiable by interventions. However, studies have not shown consistent effects of various prevention strategies on HCV transmission, including studies of HCV screening and education, drug treatment or needle exchange. Although some large cross-sectional studies in regions where needle exchange is available to a large number of drug injectors have reported declining HCV prevalence, the scale of services needed is a matter of considerable debate and has not been systematically quantified. Priorities for research related to the prevention of HIV/HCV co-infection should include estimating the effect on disease occurrence of eliminating specific risk factors, and specifying the level of resources needed to alter HCV incidence.Integrating hepatitis C services into existing HIV services : The experiences of a sample of U.S. drug treatment units
AbstractStrauss, S. M., Astone, J. M., Des Jarlais, D. C., & Hagan, H. (n.d.).Publication year
2005Journal title
AIDS patient care and STDsVolume
19Issue
2Page(s)
78-88AbstractHepatitis C virus (HCV) is the most prevalent blood-borne infectious disease in the United States, especially among drug users, and coinfection with HIV is common. Because drug users are often medically underserved, drug treatment units are important sites of opportunity for providing services for these infectious diseases. Given the commonalities in the routes of transmission of HIV and HCV, and the fact that many drug treatment units have established an infrastructure to provide HIV services, some have suggested integrating HCV services into those already established for HIV. Using data collected in a telephone survey with 89 drug treatment units throughout the United States, this paper examines the extent to which drug treatment units have expanded their HIV services to include those for HCV, and the extent to which this expansion was facilitated by having HIV services in place. Overall, a greater proportion of methadone maintenance than drug-free treatment units provided services for HIV and HCV. The majority of units in both modalities that provided HIV- and HCV-related services expanded their HIV service delivery to include similar HCV services, and one third expanded all of their HIV services. A large number of these units, however, indicated that having an HIV service infrastructure did not facilitate this expansion, often because the units wanted to emphasize differences in the two viral infections. Policy makers and individual treatment units need to develop strategies that capitalize on existing infrastructures while maintaining the distinction between HIV and HCV primary and secondary prevention efforts.Medical examinations at entry to treatment for drug abuse as an opportunity to initiate care for hepatitis C virus infection
AbstractHagan, H., Strauss, S. M., Astone, J. M., & Des Jarlais, D. C. (n.d.).Publication year
2005Journal title
Clinical Infectious DiseasesVolume
40Issue
SUPPL. 5Page(s)
S297-S303AbstractOver the course of addiction, a substantial proportion of drug users enter drug abuse treatment programs. Data from a cross-sectional survey of drug abuse treatment programs in the United States were analyzed to describe the scope of the medical examination performed at admission to such programs. All of the methadone programs (n = 95) and 50% of drug-free programs (80 of 161) required a medical examination at entry. Most examinations included screening for signs and symptoms of liver disease and liver function testing. Nearly all methadone programs (97%) provided referral to medical care or support for patients with test results positive for antibody to hepatitis C virus (HCV), compared with 75% of drug-free programs (P < .01). Drug-free programs requiring medical examinations provided education about HCV and testing for HCV to a larger proportion of their patients (P < .05). With high dropout rates in the early stages of treatment for drug addiction, these medical visits may be an important opportunity for further monitoring and care for HCV infection and other conditions.Reductions in hepatitis C virus and HIV infections among injecting drug users in New York City, 1990-2001
AbstractDes Jarlais, D. C., Perlis, T., Arasteh, K., Torian, L. V., Hagan, H., Beatrice, S., Smith, L., Wethers, J., Milliken, J., Mildvan, D., Yancovitz, S., & Friedman, S. R. (n.d.).Publication year
2005Journal title
AIDSVolume
19Issue
SUPPL. 3Page(s)
S20-S25AbstractObjective: To assess trends in HIV, hepatitis C virus (HCV) and HIV/HCV infection among injecting drug users (IDU) from 1990 to 2001 in New York City. The 1990-2001 time period included a very large expansion of syringe exchange in New York City, from 250 000 to 3 000 000 syringes exchanged annually. Methods: Cross-sectional seroprevalence surveys of IDU entering drug abuse treatment in New York City, with sample sizes for HCV of 72 in 1990-1991 and 412 in 2000-2001. A structured risk behavior questionnaire was administered, and HIV and HCV testing were conducted. HCV testing was performed on de-linked stored serum samples. Results: Over the 1990-2001 period, HIV prevalence declined from 54 to 13%. HCV prevalence declined from 80 to 59% among HIV-seronegative individuals, and from 90 to 63% overall. The estimated HCV incidence in 2000-2001 among new injectors was 18 per 100 person-years at risk. Conclusions: The large-scale expansion of syringe exchange was temporally associated with large reductions in both HIV and HCV prevalence. The prevalence and incidence of HCV, however, still remain at high levels among IDU in New York City.Residential substance user treatment programs as venues for HCV pharmacological treatment : Client and staff perspectives
AbstractStrauss, S. M., Astone, J. M., Munoz-Plaza, C., Hagan, H., & Des Jarlais, D. (n.d.).Publication year
2005Journal title
Substance Use and MisuseVolume
40Issue
12Page(s)
1811-1829AbstractHepatitis C virus (HCV) infection is highly prevalent among drug users. While there are antiviral medications available to combat the virus, the medication regimen is quite arduous, presenting special issues for drug users. We examined the challenges and benefits of using residential substance user treatment programs as venues for clients to undergo HCV medication regimens. Analyses of qualitative data collected from clients and staff in 2003 at four residential substance user treatment programs in the U.S. indicate that challenges primarily include issues involving the medications' side effects, and both financial and communication concerns. Benefits especially involve clients' feelings that they are being proactive in addressing health issues in an environment that provides much-needed support. Findings illuminate the complex issues involved for both clients and the programs, and some steps that programs can take to better support HCV-infected clients regarding HCV medication concerns."Informed Altruism" and "Partner Restriction" in the Reduction of HIV Infection in Injecting Drug Users Entering Detoxification Treatment in New York City, 1990-2001
AbstractDes Jarlais, D. C., Perlis, T., Arasteh, K., Hagan, H., Milliken, J., Braine, N., Yancovitz, S., Mildvan, D., Perlman, D. C., Maslow, C., & Friedman, S. R. (n.d.).Publication year
2004Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
35Issue
2Page(s)
158-166AbstractObjective: To assess recent developments in the HIV epidemic in injecting drug users (IDUs) in New York City. With >50,000 cases of AIDS in IDUs, New York has experienced the largest HIV/AIDS epidemic in IDUs of any city in the world. Methods: Serial cross-sectional surveys conducted continuously from 1990 to 2001 of IDUs entering the Beth Israel Medical Center (BIMC) drug detoxification program in New York City. HIV serostatus, use of prevention services, and risk behaviors were measured. Individuals were permitted to participate multiple times in the surveys but not more than once in any year. Results: Two thousand eight hundred eighty-seven individuals contributed 3100 observations from 1990 to 2001. There was a substantial and consistent decline in the prevalence of HIV infection among IDUs entering the BIMC detoxification program, from 54% (165/304) in 1991 to 13% (39/303) in 2001 (P < 0.0001). The decline was highly linear, with r2 = 0.92 and a slope of -3.7% in seroprevalence per year. The decline occurred for both males and females, both short and long-term IDUs, and the three largest racial/ethnic sub-groups (all P < 0.001 by Cochran-Armitage testing). Use of HIV prevention services increased substantially, particularly syringe exchange and voluntary HIV counseling and testing. General reductions in injection risk behaviors occurred, but substantial numbers of IDUs continued to engage in both receptive and distributive syringe sharing. Two conditional types of risk reduction not currently recommended by health authorities were reported: "informed altruism," in which persons who knew that they were HIV seropositive reduced transmission behavior, and "partner restriction," in which persons who shared needles and syringes primarily confined this sharing within small social networks. Conclusions: HIV infection continues to decline in this population of IDUs in New York City, suggesting the possibility of bringing very high prevalence epidemics under control. Risk elimination may not be required; rather, multiple forms of risk reduction may be effective in reducing HIV transmission within a local population of IDUs.A comparison of HCV antibody testing in drug-free and methadone maintenance treatment programs in the United States
AbstractStrauss, S. M., Astone, J. M., Des Jarlais, D., & Hagan, H. (n.d.).Publication year
2004Journal title
Drug and alcohol dependenceVolume
73Issue
3Page(s)
227-236AbstractDrug treatment programs are uniquely situated to screen patients for antibodies for hepatitis C virus (HCV), an infectious disease that has reached epidemic proportions among drug users. This paper compares the accessibility and patients' use of opportunities for HCV antibody testing in a large sample of methadone and drug-free treatment programs (N=256) in the US, and reports programs' recent changes and future plans concerning it. Results indicate that almost all methadone and about two-thirds of drug-free programs in the sample provided HCV antibody screening to at least some patients in 2001. While about two-thirds of the methadone and close to one-third of the drug-free programs offered this service to all patients, these programs report that only about 3/5 of their patients actually provided specimens for testing for HCV antibodies. Some drug treatment programs were planning to increase the availability and accessibility of HCV antibody screening, but others were planning to cut back on these services, primarily due to limited resources. These results can inform policymakers who advocate for increased HCV antibody screening in drug treatment programs about the current level and future plans for implementing these services, illuminating where resources and motivational efforts need to be targeted.Drug treatment programs as sites of opportunity for the delivery of hepatitis C prevention education : Client and staff perspectives
AbstractMunoz-Plaza, C. E., Strauss, S. M., Astone, J. M., Des Jarlais, D. C., & Hagan, H. (n.d.).Publication year
2004Journal title
Journal of Drug IssuesVolume
34Issue
4Page(s)
861-878AbstractThis paper uses qualitative methods to examine both staff and clients' perceptions about the delivery of hepatitis C prevention education services at their respective residential drug treatment programs. Through in-depth discussion with participants, as well as program observation, we elicited clients' and staff attitudes about the role that drug treatment programs can play in providing prevention education services for hepatitis C, their evaluation of existing hepatitis C prevention education services, and recommendations for enhancing future services. Although participants identified limitations to services, most perceive that treatment programs can play an important role in hepatitis C prevention education service delivery. Participants view clients' misconceptions about hepatitis C, increased disease stigma, and diminished service utilization as potential consequences of limited hepatitis C prevention education services. Recommendations for improving services include more detailed and frequent opportunities for hepatitis C education, formalizing services, offering education in multiple formats, and providing additional staff training.Hepatitis C virus infection among injection drug users : Survival analysis of time to seroconversion
AbstractHagan, H., Thiede, H., & Des Jarlais, D. C. (n.d.).Publication year
2004Journal title
EpidemiologyVolume
15Issue
5Page(s)
543-549AbstractBackground: Time to hepatitis C virus (HCV) seroconversion in initially seronegative injection drug users has not been directly measured, and public health planning would benefit from specifying the window of opportunity for prevention of infection, and factors that affect timing of infection. Methods: Four hundred eighty-four HCV antibody-negative injection drug users in Seattle, Washington were followed a median of 2.1 years to observe seroconversion. We examined time to HCV seroconversion in relation to subject characteristics using the Kaplan-Meier method and Cox proportional hazards regression. A weighted-average time to HCV seroconversion was calculated among new injectors (injecting ≤2 years) using seroprevalence and seroincidence data. Results: There were 134 HCV seroconversions (11.6 per 100 person-years at risk; the 25th percentile of time to seroconversion was 26.2 months). Injection with a syringe used by another injector (adjusted hazards ratio = 1.8; 95% confidence interval = 1.3-3.0) and sharing a cooker or cotton (1.8; 1.0-3.1) were associated with time to HCV seroconversion. Using the estimate of the mean time to seroconversion from first injection in new injectors who were HCV antibody-negative at enrollment (5.4 years), and the midpoint between first injection and study enrollment in new injectors who were HCV antibody-positive at enrollment (0.6 years), the weighted-average time to seroconversion after beginning to inject was estimated to be 3.4 years. Conclusion: The period of susceptibility to HCV infection in the majority of drug injectors appears to be long enough to justify the allocation of substantial resources toward interventions to reduce infection-related risk behavior in these individuals.Highly active antiretroviral therapy for injection drug users : Physician-recommended strategies for enhanced adherence
AbstractVossilev, Z. P., & Hagan, H. (n.d.).Publication year
2004Journal title
Antiviral TherapyVolume
9Issue
3Page(s)
461Abstract~Outpatient drug treatment program directors' hepatitis C-related beliefs and their relationship to the provision of HCV services
AbstractAstone, J. M., Strauss, S. M., Hagan, H., & Des Jarlais, D. C. (n.d.).Publication year
2004Journal title
American Journal of Drug and Alcohol AbuseVolume
30Issue
4Page(s)
783-797AbstractThe hepatitis C virus (HCV) continues to penetrate populations within the United States, especially within the drug-abusing population. Therefore, drug users need access to HCV testing and medical care, and drug treatment programs are well situated to provide these services. Because directors of these programs are gatekeepers who can influence decisions about service provision, their beliefs about the value of providing particular services for drug treatment program patients are of considerable importance. Directors of 121 outpatient drug treatment programs throughout the United States responded to an in-depth telephone survey that included questions on their beliefs about providing HCV services in drug treatment programs. We constructed an eight-item scale to examine these beliefs and investigated the relationship between them and the actual HCV services offered. Overall, directors were moderately supportive of the provision of HCV medical services (on-site or through referral) during drug treatment. Our findings indicate that there is a positive significant relationship between director's beliefs and the provision of HCV antibody testing, follow-up testing, and the provision of HCV medication.Screening for depressive symptoms among HCV-infected injection drug users : Examination of the utility of the CES-D and the Beck Depression Inventory
AbstractGolub, E. T., Latka, M., Hagan, H., Havens, J. R., Hudson, S. M., Kapadia, F., Campbell, J. V., Garfein, R. S., Thomas, D. L., & Strathdee, S. A. (n.d.).Publication year
2004Journal title
Journal of Urban HealthVolume
81Issue
2Page(s)
278-290AbstractThe prevalence of depression is high among injection drug users (IDUs) and among those infected with the hepatitis C virus (HCV). Moreover, one of the drugs used in the standard treatment for HCV infection (interferon) has been known to exacerbate underlying psychiatric disorders such as depression and has been associated with the development of major depressive disorder among HCV-infected patients. For these reasons, the most recent National Institutes of Health consensus statement on the management of HCV infection recommends the identification and treatment of depression prior to the start of HCV treatment. This study aimed to examine the extent of current moderate/severe depressive symptoms in a cohort of HCV-infected IDUs as measured by two screening tools, the Center for Epidemiologic Studies Depression Scale (CES-D) and the Beck Depression Inventory (BDI). Subjects were participants in a multisite behavioral intervention trial among HCV-seropositive, human immunodeficiency virus-negative IDUs aged 18-35 years; the trial was designed to prevent secondary transmission of HCV and to enhance uptake of HCV treatment. Baseline data on demographics, risk behaviors, depression, alcohol use, and health care utilization were measured via audio computer-assisted self-interview. A factor analysis was conducted on each scale to examine the clustering of items used in each to measure depressive symptoms. Baseline depressive symptoms, as measured via the CES-D and the BDI, were also compared using Pearson's correlation coefficient. Of 193 HCV-infected individuals enrolled to date, 75.6% were male, and 65.3% were white. Median age was 25.8 years. Factor analyses revealed that these scales measured depression differently; a distinct somatic component was present in the BDI, but not the CES-D. Using cutoff scores of 23 for the CES-D and 19 for the BDI, 44.0% and 41.5% of the participants were identified as having moderate/severe depressive symptoms, respectively. Over half (56.0%) were identified as having depressive symptoms by either scale. However, there was only moderate agreement between the two scales (κ=0.46). Depressive symptoms were highly prevalent in this cohort of HCV-infected IDUs. Results indicated that both scales should be used in tandem to have the most sensitive detection of depressive symptoms, thereby maximizing the potential for HCV treatment success.The Content and Comprehensiveness of Hepatitis C Education in Methadone Maintenance and Drug-Free Treatment Units
AbstractStrauss, S. M., Astone, J. M., Hagan, H., & Des Jarlais, D. C. (n.d.).Publication year
2004Journal title
Journal of Urban HealthVolume
81Issue
1Page(s)
38-47AbstractAlthough drug users are at elevated risk for hepatitis C virus (HCV) infection, many are uniformed or misinformed about the virus. Drug treatment programs are uniquely situated to provide comprehensive risk-modifying educational programs for decreasing HCV transmission, a strategy advocated in the most recent National Institutes of Health Consensus Development Conference Statement on the Management of Hepatitis C. Given the large proportion of patients that inject drugs in methadone maintenance treatment programs and the high prevalence of HCV among drug injectors, we compared a nationwide sample (N=246) of methadone maintenance treatment programs and drug-free programs regarding the content and comprehensiveness of HCV education. All of these programs provide HCV education to at least some of their patients. Results indicated that, compared to drug-free programs, methadone maintenance treatment programs cover a significantly greater number of HCV-related topics, and that a significantly greater proportion of the methadone programs cover specific topics (e.g., bow to avoid transmitting HCV, the importance of testing for HCV, treatment options if HCV positive). Of special concern is that fewer than three quarters of the drug-free programs address what to do if co-infected with human immunodeficiency virus (HIV) and HCV and bow to maintain health if HCV positive, and only about half of the drug-free and methadone maintenance treatment programs educate HCV-positive patients about the importance of obtaining vaccinations for hepatitis A and B. Drug treatment programs need to educate patients about the proactive steps these individuals can take to deal with HCV, provide critically needed HCV services, and encourage patients to make full use of these services.Depression and HIV risk behavior among Seattle-area injection drug users and young men who have sex with men
AbstractPerdue, T., Hagan, H., Thiede, H., & Valleroy, L. (n.d.).Publication year
2003Journal title
AIDS Education and PreventionVolume
15Issue
1Page(s)
81-92AbstractPsychological depression has been identified as a condition that may influence HIV risk behavior among injection drug users (IDUs) and men who have sex with men (MSM). In two Seattle studies, 1,228 IDUs and 429 young MSM completed the Center for Epidemiologic Studies Depression Scale (CES-D); the relationship between depression and injection and sexual risk behavior was assessed using logistic regression analysis. Forty-seven percent of IDUs had CES-D scores ≥23; a high score was significantly related to injection with a syringe used by another IDU (adjusted odds ratio 1.4) but not other injection risk behavior. Among MSM, CES-D scores ≥16 were related to reporting 3 or more sex partners in the last 6 months but not to other sexual risk behavior. This analysis suggests that psychological depression may influence certain HIV risk behavior in young MSM and IDUs, and that interventions addressing depression may be indicated.Does bleach disinfection of syringes help prevent hepatitis C virus transmission? [1] (multiple letters)
AbstractHagan, H., Thiede, H., Kapadia, F., Garfein, R. S., & Vlahov, D. (n.d.).Publication year
2003Journal title
EpidemiologyVolume
14Issue
5Page(s)
628-629Abstract~Gaps in the drug-free and methadone treatment program response to Hepatitis C
AbstractStrauss, S. M., Astone, J., Vassilev, Z. P., Des Jarlais, D. C., & Hagan, H. (n.d.).Publication year
2003Journal title
Journal of Substance Abuse TreatmentVolume
24Issue
4Page(s)
291-297AbstractDrug treatment programs are sites of opportunity for the delivery of hepatitis C (HCV) prevention and care services to drug users. Using data collected from a random nationwide sample (N = 595) of drug treatment programs in the United States, this study compares the provision of HCV services by drug-free and methadone maintenance treatment programs (MMTPs). It then examines and compares perceived inadequacies in this service provision from the perspective of the managers in these two types of programs. Findings indicate that MMTPs are providing more HCV services to their patients, and that a greater proportion of MMTPs are dissatisfied with their current level of HCV service provision. Managers of drug-free programs would like to be offering patients more HCV education, while MMTP managers would like to be providing more HCV testing to their patients, and more support and care for patients who are HCV+.