Courtney A McKnight
Courtney A McKnight
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Clinical Associate Professor of Epidemiology
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Professional overview
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Dr. Courtney McKnight is a Principal Investigator specializing in mixed methods research focused on the epidemiology of drug use, opioid overdose, HIV and HCV infection. Dr. McKnight has over 20 years of experience conducting public health research related to drug use, as well as field experience as a harm reduction service provider.
Prior to joining NYU, Dr. McKnight served as the assistant director of research at the Chemical Dependency Institute at the Icahn School of Medicine at Mount Sinai, where she was an investigator and project director on numerous federally funded research studies, including evaluations of syringe services programs; investigations of the drivers that contribute to disparate rates of HIV and HCV; and interventions to increase access to HIV and HCV testing and care.
Previous to Dr. McKnight’s work in research, she directed a harm reduction program for women who use drugs and volunteered at a syringe services program in New Jersey.
Dr. McKnight received her DrPH from the City University of New York Graduate Center, her Master of Public Health from Hunter College, and her Bachelor of Arts in sociology from Rutgers University. Her dissertation examined the impact of Medicaid coverage of methadone and buprenorphine on treatment access for opioid dependent beneficiaries.
Dr. McKnight’s current research interests include examining the shifting landscape of illicit opioids, including the increasing prevalence of illicitly manufactured fentanyl, and risk environments of people who use drugs.
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Education
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BA, Women's Studies, Rutgers University, New Brunswick, NJMPH, Community Health Education, Hunter College, New York, NYDrPH, The City University of New York, New York, NY
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Areas of research and study
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Behavioral ScienceDrug addictionEpidemiologyHarm reductionHepatitisHIV/AIDSInfectious DiseasesMixed-Methods ResearchOpioidQualitative ResearchSocial epidemiologySubstance Abuse
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Publications
Publications
A perfect storm : Crack cocaine, HSV-2, and HIV among non-injecting drug users in New York City
AbstractDes Jarlais, D. C., McKnight, C. A., Arasteh, K., Feelemyer, J., Perlman, D. C., Hagan, H., Dauria, E. F., & Cooper, H. L. (n.d.).Publication year
2014Journal title
Substance Use and MisuseVolume
49Issue
7Page(s)
783-792AbstractPrevalence of human immunodeficiency virus (HIV) infection has reached 16% among non-injecting drug users (NIDU) in New York City, an unusually high prevalence for a predominantly heterosexual population that does not inject drugs. Using a long-term study (1983-2011, >7,000 subjects) among persons entering the Beth Israel drug-treatment programs in New York City, we identified factors that contributed to this high prevalence: a preexisting HIV epidemic among injectors, a crack cocaine epidemic, mixing between injectors and crack users, policy responses not centered on public health, and herpes-simplex virus 2 facilitating HIV transmission. Implications for avoiding high prevalence among NIDU in other areas are discussed.A randomized trial of a hepatitis care coordination model in methadone maintenance treatment
AbstractMasson, C. L., Delucchi, K. L., McKnight, C. A., Hettema, J., Khalili, M., Min, A., Jordan, A. E., Pepper, N., Hall, J., Hengl, N. S., Young, C., Shopshire, M. S., Manuel, J. K., Coffin, L., Hammer, H., Shapiro, B., Seewald, R. M., Bodenheimer, H. C., Sorensen, J. L., … Perlman, D. C. (n.d.).Publication year
2013Journal title
American journal of public healthVolume
103Issue
10Page(s)
e81-e88AbstractObjectives. We evaluated the efficacy of a hepatitis care coordination intervention to improve linkage to hepatitis A virus (HAV) and hepatitis B virus (HBV) vaccination and clinical evaluation of hepatitis C virus (HCV) infection among methadone maintenance patients. Methods. We conducted a randomized controlled trial of 489 participants from methadone maintenance treatment programs in San Francisco, California, and New York City from February 2008 through June 2011. We randomized participants to a control arm (n = 245) and an intervention arm (n = 244), which included on-site screening, motivational-enhanced education and counseling, on-site vaccination, and case management services. Results. Compared with the control group, intervention group participants were significantly more likely (odds ratio [OR] = 41.8; 95% confidence interval [CI] = 19.4, 90.0) to receive their first vaccine dose within 30 days and to receive an HCV evaluation within 6 months (OR = 4.10; 95% CI = 2.35, 7.17). A combined intervention adherence outcome that measured adherence to HAV-HBV vaccination, HCV evaluation, or both strongly favored the intervention group (OR = 8.70; 95% CI = 5.56, 13.61). Conclusions. Hepatitis care coordination was efficacious in increasing adherence to HAV-HBV vaccination and HCV clinical evaluation among methadone patients.Alternative kinship structures, resilience and social support among immigrant trans Latinas in the USA
AbstractHwahng, S. J., Allen, B., Zadoretzky, C., Barber, H., McKnight, C. A., & Des Jarlais, D. (n.d.).Publication year
2019Journal title
Culture, Health and SexualityVolume
21Issue
1Page(s)
1-15AbstractLatinas comprise the largest racial/ethnic group of trans women (male-to-female transgender people) in New York City, where HIV seroprevalence among trans Latinas has been found to be as high as 49%. Despite this population’s high risk of HIV, little is known about resilience among trans Latinas that may provide protective health factors. Six focus groups and one in-depth interview were conducted with 34 low-income trans/gender-variant people of colour who attended transgender support groups at harm reduction programmes in New York City. This paper reports on data from 13 participants who identified as immigrant trans Latinas. Focus groups were coded and analysed using thematic qualitative methods. The majority of immigrants were undocumented but reported having robust social support. Unique characteristics of immigrant trans Latinas included alternative kinship structures and sources of income. Social creativity was used to develop achievable ways in which to improve their health outcomes. Resilience was evident in informal kinship dynamics, formal support groups, gender-transition, educational access and skills training and substance use reduction. Individual-level resilience increased as a result of strong community-level resilience.Anti-vaccine attitudes and COVID-19 vaccine status at the end of the U.S. public health emergency
AbstractChoi, J., Feelemyer, J., Choe, K., Lynch, K., McKnight, C. A., Yang, L., Jarlais, D. D., & Chang, V. W. (n.d.).Publication year
2025Journal title
VaccineVolume
55AbstractIntroduction: Despite the end of the federal COVID-19 public health emergency in May 2023, COVID-19 prevention remains a priority. This study investigates how public vaccination attitudes and perceived COVID-19 risks relate to vaccination status, aiming to identify factors associated with COVID-19 vaccination post-emergency. Methods: An online survey was conducted from April to May 2023 among a non-representative, nationally-based sample of MTurk workers. The primary outcome was COVID-19 vaccination status. Variables examined included anti-vaccine attitudes, health status, COVID-19 experiences, and sociodemographic factors. We created a composite measure of anti-vaccine attitudes from 15 items with three levels. Bivariate tests of association and multivariable logistic regression were performed. Results: A final sample of 989 adults were included in this analysis. In our multivariable model, individuals with higher anti-vaccine attitudes were less likely to be vaccinated against COVID-19 compared to those with low anti-vaccine attitudes (OR = 0.10, 95 % CI 0.04, 0.25). Those who identified as LGBQ+ (OR = 2.55, 95 % CI 1.32, 4.94), had chronic conditions (OR = 2.94, 95 % CI 1.43, 6.01) and had felt stigmatized from COVID-19 infections (OR = 3.33, 95 % CI 1.47, 7.58) were more likely to be vaccinated, even after adjusting for anti-vaccine attitudes. News source, perceived risk of contagion by contact, and long COVID-related factors were not significantly associated with vaccination status in the multivariable model. Discussion: Our findings highlight the persistent relationship between anti-vaccine attitudes and vaccination status in the “post-pandemic” era. Beyond vaccine attitudes, sexual orientation, chronic conditions, and stigmatization experiences may influence perceived need for protection. Stigma can sometimes reinforce social norms driving vaccination, but this effect is nuanced, particularly with anti-vaccine attitudes. To promote vaccine uptake, interventions should prioritize community support, counter misinformation, and enhance vaccine literacy. Building trust among vulnerable populations is essential, rather than relying on public health messaging that may reinforce social stigma.As Evidence Mounts that ‘War on Drugs’ Has Failed, Harm Reduction Advocates Call for New Policies.
McKnight, C. A. (n.d.).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.Being “hooked up” during a sharp increase in the availability of illicitly manufactured fentanyl : Adaptations of drug using practices among people who use drugs (PWUD) in New York City
AbstractMcKnight, C. A., McKnight, C., & Des Jarlais, D. C. (n.d.).Publication year
2018Journal title
International Journal of Drug PolicyVolume
60Page(s)
82-88AbstractIllicitly manufactured fentanyl (IMF), a category of synthetic opioids 50–100 times more potent than morphine, is increasingly being added to heroin and other drugs in the United States (US). Persons who use drugs (PWUD) are frequently unaware of the presence of fentanyl in drugs. Use of heroin and other drugs containing fentanyl has been linked to sharp increases in opioid mortality. In New York City (NYC), opioid-related mortality increased from 8.2 per 100,000 residents in 2010 to 19.9 per 100,000 residents in 2016; and, in 2016, fentanyl accounted for 44% of NYC overdose deaths. Little is known about how PWUD are adapting to the increase in fentanyl and overdose mortality. This study explores PWUDs’ adaptations to drug using practices due to fentanyl. In-depth qualitative interviews were conducted with 55 PWUD at three NYC syringe services programs (SSP) about perceptions of fentanyl, overdose experiences and adaptations of drug using practices. PWUD utilized test shots, a consistent drug dealer, fentanyl test strips, naloxone, getting high with or near others and reducing drug use to protect from overdose. Consistent application of these methods was often negated by structural level factors such as stigma, poverty and homelessness. To address these, multi-level overdose prevention approaches should be implemented in order to reduce the continuing increase in opioid mortality.Combined HIV prevention, the New York City Condom Distribution Program, and the evolution of safer sex behavior among persons who inject drugs in New York City
AbstractMcKnight, C. A., Des Jarlais, D. C., Arasteh, K., McKnight, C., Feelemyer, J., Hagan, H., Cooper, H. L., & Perlman, D. C. (n.d.).Publication year
2014Journal title
AIDS and BehaviorVolume
18Issue
3Page(s)
443-451AbstractExamine long term sexual risk behaviors among persons who inject drugs (PWID) in New York City following implementation of "combined" prevention programming, including condom social marketing. Quantitative interviews and human immunodeficiency virus (HIV) testing were conducted among PWID entering Beth Israel Medical Center drug treatment programs 1990-2012. Data were analyzed by four time periods corresponding to the cumulative implementation of HIV prevention interventions. 7,132 subjects were recruited from 1990 to 2012; little change in sexual behavior occurred among HIV seronegative subjects, while HIV seropositive subjects reported significant decreases in being sexually active and significant increases in consistent condom use. HIV transmission risk (being HIV positive and engaging in unprotected sex) declined from 14 % in 1990-1995 to 2 % in 2007-2012 for primary sexual partners and from 6 to 1 % for casual partners. Cumulative implementation of combined prevention programming for PWID was associated with substantial decreases in sexual risk behavior among HIV seropositives.Consistent estimates of very low HIV incidence among people who inject drugs : New York City, 2005-2014
AbstractDes Jarlais, D. C., Arasteh, K., McKnight, C. A., Feelemyer, J., Campbell, A. N., Tross, S., Smith, L., Cooper, H. L., Hagan, H., & Perlman, D. (n.d.).Publication year
2016Journal title
American journal of public healthVolume
106Issue
3Page(s)
503-508AbstractObjectives. To compare methods for estimating low HIV incidence among persons who inject drugs. Methods. We examined 4 methods in New York City, 2005 to 2014: (1) HIV seroconversions among repeat participants, (2) increase of HIV prevalence by additional years of injection among new injectors, (3) the New York State and Centers for Disease Control and Prevention stratified extrapolation algorithm, and (4) newly diagnosed HIV cases reported to the New York City Department of Health and Mental Hygiene. Results. The 4 estimates were consistent: (1) repeat participants: 0.37 per 100 person-years (PY; 95% confidence interval [CI] = 0.05/100 PY, 1.33/100 PY); (2) regression of prevalence by years injecting: 0.61 per 100 PY (95% CI = 0.36/100 PY, 0.87/100 PY); (3) stratified extrapolation algorithm: 0.32 per 100 PY (95% CI = 0.18/100 PY, 0.46/100 PY); and (4)newly diagnosed cases of HIV: 0.14 per 100PY (95%CI = 0.11/100 PY, 0.16/100 PY). Conclusions. All methods appear to capture the same phenomenon of very low and decreasing HIV transmission among persons who inject drugs. Public Health Implications. If resources are available, the use ofmultiple methodswould provide better information for public health purposes.Convergence of HIV seroprevalence among injecting and non-injecting drug users in New York City
AbstractDes Jarlais, D. C., Arasteh, K., Perlis, T., Hagan, H., Abdul-Quader, A., Heckathorn, D. D., McKnight, C. A., Bramson, H., Nemeth, C., Torian, L. V., & Friedman, S. R. (n.d.).Publication year
2007Journal title
AIDSVolume
21Issue
2Page(s)
231-235AbstractOBJECTIVE: To compare HIV prevalence among injecting and non-injecting heroin and cocaine users in New York City. As HIV is efficiently transmitted through the sharing of drug-injecting equipment, HIV infection has historically been higher among injecting drug users. DESIGN: Two separate cross-sectional surveys, both with HIV counseling and testing and drug use and HIV risk behavior questionnaires. METHODS: Injecting and non-injecting heroin and cocaine users recruited at detoxification and methadone maintenance treatment from 2001-2004 (n = 2121) and recruited through respondent-driven sampling from a research storefront in 2004 (n = 448). RESULTS: In both studies, HIV prevalence was nearly identical among current injectors (injected in the last 6 months) and heroin and cocaine users who had never injected: 13% [95% confidence interval (CI), 12-15%] among current injectors and 12% (95% CI, 9-16%) among never-injectors in the drug treatment program study, and 15% (95% CI, 11-19%) among current injectors and 17% (95% CI, 12-21%) among never injectors in the respondent driven sampling storefront study. The 95% CIs overlapped in all gender and race/ethnicity subgroup comparisons of HIV prevalence in both studies. CONCLUSIONS: The very large HIV epidemic among drug users in New York City appears to be entering a new phase, in which sexual transmission is of increasing importance. Additional prevention programs are needed to address this transition.Cost-effectiveness of hepatitis C screening and treatment linkage intervention in US methadone maintenance treatment programs
AbstractSchackman, B. R., Gutkind, S., Morgan, J. R., Leff, J. A., Behrends, C. N., Delucchi, K. L., McKnight, C. A., Perlman, D. C., Masson, C. L., & Linas, B. P. (n.d.).Publication year
2018Journal title
Drug and alcohol dependenceVolume
185Page(s)
411-420AbstractBackground: We evaluated the cost-effectiveness of a hepatitis C (HCV) screening and active linkage to care intervention in US methadone maintenance treatment (MMT) patients using data from a randomized trial conducted in New York City and San Francisco. Methods: We used a decision analytic model to compare 1) no intervention; 2) HCV screening and education (control); and 3) HCV screening, education, and care coordination (active linkage intervention). We also explored an alternative strategy wherein HCV/HIV co-infected participants linked elsewhere. Trial data include population characteristics (67% male, mean age 48, 58% HCV infected) and linkage rates. Data from published sources include treatment efficacy and HCV re-infection risk. We projected quality-adjusted life years (QALYs) and lifetime medical costs using an established model of HCV (HEP-CE). Incremental cost-effectiveness ratios (ICERs) are in 2015 US$/QALY discounted 3% annually. Results: The control strategy resulted in a projected 35% linking to care within 6 months and 31% achieving sustained virologic response (SVR). The intervention resulted in 60% linking and 54% achieving SVR with an ICER of $24,600/QALY compared to no intervention from the healthcare sector perspective and was a more efficient use of resources than the control strategy. The intervention had an ICER of $76,500/QALY compared to the alternative strategy. From a societal perspective, the intervention had a net monetary benefit of $511,000–$975,600. Conclusions: HCV care coordination interventions that include screening, education and active linkage to care in MMT settings are likely cost-effective at a conventional $100,000/QALY threshold for both HCV mono-infected and HIV co-infected patients.COVID-19 vaccination and HIV transmission among persons who inject drugs during the first two years of the COVID-19 pandemic in New York City
AbstractDes Jarlais, D. C., Weng, C. A., Feelemyer, J., & McKnight, C. A. (n.d.).Publication year
2023Journal title
Harm Reduction JournalVolume
20Issue
1AbstractBackground: To examine COVID-19 vaccination and HIV transmission among persons who inject drugs (PWID) during the COVID-19 pandemic (2020–2022) in New York City (NYC). Methods: Two hundred and seventy five PWID were recruited from October 2021 to September 2022. A structured questionnaire was used to measure demographics, drug use behaviors, overdose experiences, substance use treatment history, COVID-19 infection, vaccination, and attitudes. Serum samples were collected for HIV, HCV, and SARS-CoV-2 (COVID-19) antibody testing. Results: Participants were: 71% male, the mean age was 49 (SD 11), 81% reported at least one COVID-19 immunization, 76% were fully vaccinated and 64% of the unvaccinated had antibodies for COVID-19. Self-reported injection risk behaviors were very low. HIV seroprevalence was 7%. Eighty-nine percent of the HIV seropositive respondents reported knowing they were HIV seropositive and being on antiretroviral therapy prior to the COVID-19 pandemic. There were two likely seroconversions in 518.83 person-years at risk from the March 2020 start of the pandemic to the times of interviews, for an estimated incidence rate of 0.39/100 person-years, 95% Poisson CI 0.05–1.39/100 person-years. Conclusions: There is concern that the COVID-19 pandemic disruptions to HIV prevention services and the psychological stress of the pandemic may lead to increased risk behavior and increased HIV transmission. These data indicate adaptive/resilient behaviors in both obtaining COVID-19 vaccination and maintaining a low rate of HIV transmission among this sample of PWID during the first two years of the COVID-19 pandemic in NYC.COVID-19 Vaccination and HIV Transmission Among Persons who Inject Drugs During the First Two Years of the COVID-19 Pandemic in New York City.
AbstractDes Jarlais, D., Weng, C. A., Feelemyer, J., & McKnight, C. A. (n.d.).Publication year
2023Abstract~COVID-19 vaccination uptake and determinants of booster vaccination among persons who inject drugs in New York City
AbstractKhezri, M., McKnight, C. A., Weng, C. A., Kimball, S., & Des Jarlais, D. (n.d.).Publication year
2024Journal title
PloS oneVolume
19Issue
5 MayAbstractBackground Persons who inject drugs (PWID) may be unengaged with healthcare services and face an elevated risk of severe morbidity and mortality associated with COVID-19 due to chronic diseases and structural inequities. However, data on COVID-19 vaccine uptake, particularly booster vaccination, among PWID are limited. We examined COVID-19 vaccine uptake and factors associated with booster vaccination among PWID in New York City (NYC). Methods We recruited PWID using respondent-driven sampling from October 2021 to November 2023 in a survey that included HIV and SARS-CoV-2 antibodies testing. The questionnaire included demographics, COVID-19 vaccination and attitudes, and drug use behaviors. Results Of 436 PWID, 80% received at least one COVID-19 vaccine dose. Among individuals who received at least one COVID-19 vaccine dose, 95% were fully vaccinated. After excluding participants recruited before booster authorization for general adults started in NYC, and those who had never received an initial vaccination, 41% reported having received a COVID-19 booster vaccine dose. COVID-19 booster vaccination was significantly associated with having a high school diploma or GED (adjusted odds ratio (aOR) 1.93; 95% confidence interval (CI) 1.09, 3.48), ever received the hepatitis A/B vaccine (aOR 2.23; 95% CI 1.27, 3.96), main drug use other than heroin/speedball, fentanyl and stimulants (aOR 14.4; 95% CI 2.32, 280), number of non-fatal overdoses (aOR 0.35; 95% CI 0.16, 0.70), and mean vaccination attitude score (aOR 0.94; 95% CI 0.89, 0.98). Conclusions We found a suboptimal level of COVID-19 booster vaccination among PWID, which was consistent with the rates observed in the general population in NYC and the U.S. Community-based interventions are needed to improve COVID-19 booster vaccination access and uptake among PWID. Attitudes towards vaccination were significant predictors of both primary and booster vaccination uptake. Outreach efforts focusing on improving attitudes towards vaccination and educational programs are essential for reducing hesitancy and increasing booster vaccination uptake among PWID.Decline in herpes simplex virus type 2 among non-injecting heroin and cocaine users in New York City, 2005 to 2014 : Prospects for avoiding a resurgence of human immunodeficiency virus
AbstractDes Jarlais, D. C., Arasteh, K., Feelemyer, J., McKnight, C. A., Tross, S., Perlman, D. C., Campbell, A. N., Hagan, H., & Cooper, H. L. (n.d.).Publication year
2017Journal title
Sexually Transmitted DiseasesVolume
44Issue
2Page(s)
85-90AbstractBackground: Herpes simplex virus type 2 (HSV-2) infection increases both susceptibility to and transmissibility of human immunodeficiency virus (HIV), and HSV-2 and HIV are often strongly associated in HIV epidemics. We assessed trends in HSV-2 prevalence among non-injecting drug users (NIDUs) when HIV prevalence declined from 16% to 8% among NIDUs in New York City. Methods: Subjects were current non-injecting users of heroin and/or cocaine and who had never injected illicit drugs. Three thousand one hundred fifty-seven NIDU subjects were recruited between 2005 and 2014 among persons entering Mount Sinai Beth Israel substance use treatment programs. Structured interviews, HIV, and HSV-2 testing were administered. Change over time was assessed by comparing 2005 to 2010 with 2011 to 2014 periods. Herpes simplex virus type 2 incidence was estimated among persons who participated in multiple years. Results: Herpes simplex virus type 2 prevalence was strongly associated with HIV prevalence (odds ratio, 3.9; 95% confidence interval, 2.9-5.1) from 2005 to 2014. Herpes simplex virus type 2 prevalence declined from 60% to 56% (P = 0.01). The percentage of NIDUs with neither HSV-2 nor HIVinfection increased from37% to 43%, (P < 0.001); the percentagewith HSV-2/HIV coinfection declined from 13% to 6% (P < 0.001). Estimated HSV-2 incidence was 1 to 2/100 person-years at risk. Conclusions: There were parallel declines in HIV and HSV-2 among NIDUs in New York City from 2005 to 2014. The increase in the percentage of NIDUs with neither HSV-2 nor HIV infection, the decrease in the percentage with HSV-2/HIV coinfection, and the low to moderate HSV-2 incidence suggest some population-level protection against resurgence of HIV. Prevention efforts should be strengthened to end the combined HIV/HSV-2 epidemic among NIDUs in New York City.Decline in HSV-2 among non-injecting Heroin and Cocaine users in New York City, 2005-2014: potential protection against HIV resurgence
AbstractDes Jarlais, D., Arasteh, K., Feelemyer, J., McKnight, C. A., Tross, S., Perlman, D., Campbell, A. N., Hagan, H., & Cooper, H. L. (n.d.).Publication year
2017Journal title
Sexually Transmitted DiseasesPage(s)
85-90Abstract~Diffusion of the D.A.R.E and syringe exchange programs
AbstractDes Jarlais, D. C., Sloboda, Z., Friedman, S. R., Tempalski, B., McKnight, C. A., & Braine, N. (n.d.).Publication year
2006Journal title
American journal of public healthVolume
96Issue
8Page(s)
1354-1358AbstractWe examined the diffusion of the D.A.R.E program to reduce use of illicit drugs among school-aged children and youths and the diffusion of syringe exchange programs to reduce HIV transmission among injection drug users. The D.A.R.E program was diffused widely in the United States despite a lack of evidence for its effectiveness; there has been limited diffusion of syringe exchange in the United States, despite extensive scientific evidence for its effectiveness. Multiple possible associations between diffusion and evidence of effectiveness exist, from widespread diffusion without evidence of effectiveness to limited diffusion with strong evidence of effectiveness. The decision theory concepts of framing and loss aversion may be useful for further research on the diffusion of public health innovations.Doing harm reduction better : Syringe exchange in the United States
AbstractDes Jarlais, D. C., McKnight, C. A., Goldblatt, C., & Purchase, D. (n.d.).Publication year
2009Journal title
AddictionVolume
104Issue
9Page(s)
1441-1446AbstractObjective To trace the growth of syringe exchange programs (SEPs) in the United States since 1994-95 and assess the current state of SEPs. Methods Annual surveys of US SEPs known to North American Syringe Exchange Network (NASEN). Surveys mailed to executive directors with follow-up interviews by telephone and/or e-mail. Response rates have varied between 70% and 88% since surveys were initiated in 1996. Results The numbers of programs known to NASEN have increased from 68 in 1994-95 to 186 in 2007. Among programs participating in the survey, numbers of syringes exchanged have increased from 8.0 million per year to 29.5 million per year, total annual budgets have increased from $6.3 to $19.6 million and public funding (from state and local governments) has increased from $3.9 to $14.4 million. In 2007, 89% of programs permitted secondary exchange and 76% encouraged it. Condoms, referrals to substance abuse treatment, human immunodeficiency virus (HIV), hepatitis C virus (HCV), hepatitis B virus (HBV) counseling and testing and naloxone for overdose were among the most commonly provided services in addition to basic syringe exchange. Each of these services was provided by 40% or more of SEPs in 2007. Conclusions While syringe exchange has remained controversial in the United States, there has been very substantial growth in numbers of programs, syringes exchange and program budgets. Utilizing secondary exchange to reach large numbers of injecting drug users and utilizing SEPs as a new platform for providing health and social services beyond basic syringe exchange have been the two major organizational strategies in the growth of SEPs in the United States.Education and counseling in the methadone treatment setting improves knowledge of viral hepatitis
AbstractLarios, S. E., Masson, C. L., Shopshire, M. S., Hettema, J., Jordan, A. E., McKnight, C. A., Young, C., Khalili, M., Seewald, R. M., Min, A., Hengl, N., Sorensen, J. L., Des Jarlais, D. C., & Perlman, D. C. (n.d.).Publication year
2014Journal title
Journal of Substance Abuse TreatmentVolume
46Issue
4Page(s)
528-531AbstractThe aim of this study was to evaluate the effectiveness of an educational method of providing viral hepatitis education for methadone maintenance patients. Four hundred forty participants were randomly assigned to either a control or a motivationally-enhanced viral hepatitis education and counseling intervention. Viral hepatitis A (HAV), B (HBV), and C (HCV) knowledge tests were administered at baseline, following each of two education sessions (post-education), and at a 3-month follow-up assessment. Results indicated a significant increase in knowledge of HAV, HBV, and HCV over time. No differences were found in knowledge between the intervention groups in knowledge acquisition regarding any of the hepatitis viruses suggesting that a motivational interviewing style may not augment hepatitis knowledge beyond standard counseling. A two-session viral hepatitis education intervention effectively promotes hepatitis knowledge and can be integrated in methadone treatment settings.Effectiveness of respondent-driven sampling for recruiting drug users in New York City : Findings from a pilot study
AbstractAbdul‐Quader, A. S., Heckathorn, D. D., McKnight, C. A., Bramson, H., Nemeth, C., Sabin, K., Gallagher, K., & Des Jarlais, D. C. (n.d.).Publication year
2006Journal title
Journal of Urban HealthVolume
83Issue
3Page(s)
459-476AbstractA number of sampling methods are available to recruit drug users and collect HIV risk behavior data. Respondent-driven sampling (RDS) is a modified form of chain-referral sampling with a mathematical system for weighting the sample to compensate for its not having been drawn randomly. It is predicated on the recognition that peers are better able than outreach workers and researchers to locate and recruit other members of a "hidden" population. RDS provides a means of evaluating the reliability of the data obtained and also allows inferences about the characteristics of the population from which the sample is drawn. In this paper we present findings from a pilot study conducted to assess the effectiveness of RDS to recruit a large and diversified group of drug users in New York City. Beginning with eight seeds (i.e., initial recruits) we recruited 618 drug users (injecting and non-injecting) in 13 weeks. The data document both cross-gender and cross-race and -ethnic recruitment as well as recruitment across drug-use status. Sample characteristics are similar to the characteristics of the drug users recruited in other studies conducted in New York City. The findings indicate that RDS is an effective sampling method for recruiting diversified drug users to participate in HIV-related behavioral surveys.Effectiveness of respondent-driven sampling for recruiting drug users in New York City : Findings from a pilot study (Journal of Urban Health DOI: 10.1007/s11524-006-9052-7)
AbstractAbdul-Quader, A. S., Heckathorn, D. D., McKnight, C. A., Bramson, H., Nemeth, C., Sabin, K., Gallagher, K., & Des Jarlais, D. C. (n.d.).Publication year
2008Journal title
Journal of Urban HealthVolume
85Issue
1Page(s)
148Abstract~Engagement in hepatitis C virus cascade of care and factors associated with testing among people who inject drugs in Iran
AbstractMcKnight, C. A., Khezri, M., Tavakoli, F., Mehmandoost, S., Sharafi, H., Zamani, O., Bazrafshani, M. S. S., Nasiri, N., Mirzaei, H., Moameri, H., Haghdoost, A. A. A., McKnight, C., Des Jarlais, D., Karamouzian, M., & Sharifi, H. (n.d.).Publication year
2025Journal title
Harm reduction journalVolume
22Issue
1Page(s)
49AbstractUnderstanding the hepatitis C virus (HCV) cascade of care (CoC) and factors associated with engagement is crucial for designing interventions for achieving HCV elimination. However, data on engagement in the HCV CoC among people who inject drugs (PWID) in the Middle East and North Africa remains limited. We examined the HCV CoC and factors associated with testing among Iranian PWID.Engagement in hepatitis C virus cascade of care and factors associated with testing among people who inject drugs in Iran
AbstractKhezri, M., Tavakoli, F., Mehmandoost, S., Sharafi, H., Zamani, O., Bazrafshani, M. S., Nasiri, N., Mirzaei, H., Moameri, H., Haghdoost, A. A., McKnight, C. A., Des Jarlais, D., Karamouzian, M., & Sharifi, H. (n.d.).Publication year
2025Journal title
Harm Reduction JournalVolume
22Issue
1AbstractBackground: Understanding the hepatitis C virus (HCV) cascade of care (CoC) and factors associated with engagement is crucial for designing interventions for achieving HCV elimination. However, data on engagement in the HCV CoC among people who inject drugs (PWID) in the Middle East and North Africa remains limited. We examined the HCV CoC and factors associated with testing among Iranian PWID. Methods: We recruited PWID in 14 cities using respondent-driven sampling. PWID completed structured interviews capturing measures on socio-demographics, behaviors, and HCV CoC. We examined the self-reported numbers and proportions of individuals who ever tested for HCV, tested positive for HCV antibody, were diagnosed with HCV, initiated HCV treatment, and achieved sustained virologic response (SVR). Multivariable logistic regression models were built to assess factors associated with HCV antibody testing. Results: Of 2308 PWID, 23.1% had ever received an HCV antibody test, 13.9% received the HCV antibody test in the last year, 3.4% had tested positive for HCV antibodies, and 2.5% had received an HCV diagnosis. Of those diagnosed, 54.4% reported initiating treatment, and 31.6% had achieved SVR. HCV antibody testing was significantly associated with having knowledge about HCV transmission through sharing needle/syringe (adjusted odds ratio [aOR] 8.09; 95% confidence intervals [CI] 5.25, 12.48), living with HIV (aOR 4.15; 1.58, 10.92), no previous history of homelessness (aOR 1.89; 1.31, 2.72), history of arrest/incarceration (aOR 1.83; 1.26, 2.64), history of being diagnosed with any mental health problems (aOR 2.88; 1.79, 4.61), history of non-fatal overdose (aOR 1.51; 1.08, 2.10), receiving needle exchange programs in the last 12 months (aOR 6.20; 3.86, 9.93), opioid agonist treatment in the last six months (aOR 2.10; 1.39, 3.18), and having ever received HBV vaccine (aOR 2.31; 1.59, 3.35). Conclusions: We found a considerably low engagement in HCV CoC among PWID in Iran. Enhancing access to testing services for PWID, especially those with limited awareness of HCV transmission and those encountering structural challenges, is essential as the initial step in the HCV CoC. This improvement is vital for strengthening HCV elimination efforts in Iran.Epidemiology of pain among outpatients in methadone maintenance treatment programs
AbstractDhingra, L., Masson, C., Perlman, D. C., Seewald, R. M., Katz, J., McKnight, C. A., Homel, P., Wald, E., Jordan, A. E., Young, C., & Portenoy, R. K. (n.d.).Publication year
2013Journal title
Drug and alcohol dependenceVolume
128Issue
1-2Page(s)
161-165AbstractBackground: This analysis explored the prevalence and correlates of pain in patients enrolled in methadone maintenance treatment (MMT). Methods: Patients in two MMT programs starting a hepatitis care coordination randomized controlled trial completed the Brief Pain Inventory Short-Form and other questionnaires. Associations between clinically significant pain (average daily pain. ≥. 5 or mean pain interference. ≥. 5 during the past week) and sociodemographic data, medical status, depressive symptoms, and health-related quality of life, and current substance use were evaluated in multivariate analyses. Results: The 489 patients included 31.8% women; 30.3% Hispanics, 29.4% non-Hispanic Blacks, and 36.0% non-Hispanic Whites; 60.1% had hepatitis C, 10.6% had HIV, and 46.8% had moderate or severe depressive symptomatology. Mean methadone dose was 95.7. mg (SD 48.9) and urine drug screening (UDS) was positive for opiates, cocaine, and amphetamines in 32.9%, 40.1%, and 2.9%, respectively. Overall, 237 (48.5%) reported clinically significant pain. Pain treatments included prescribed opioids (38.8%) and non-opioids (48.9%), and self-management approaches (60.8%), including prayer (33.8%), vitamins (29.5%), and distraction (12.7%). Pain was associated with higher methadone dose, more medical comorbidities, prescribed opioid therapy, and more severe depressive symptomatology; it was not associated with UDS or self-reported substance use. Conclusions: Clinically significant pain was reported by almost half of the patients in MMT programs and was associated with medical and psychological comorbidity. Pain was often treated with opioids and was not associated with measures of drug use. Studies are needed to further clarify these associations and determine their importance for pain treatment strategies.Facilitators and barriers to monitoring and evaluation at syringe service programs
AbstractHealy, E., Means, A. R., Knudtson, K., Frank, N., Juarez, A., Prohaska, S., McKnight, C. A., Des Jarlais, D., Asher, A., & Glick, S. N. (n.d.).Publication year
2024Journal title
Harm Reduction JournalVolume
21Issue
1AbstractBackground: Syringe services programs (SSPs) provide harm reduction supplies and services to people who use drugs and are often required by funders or partners to collect data from program participants. SSPs can use these data during monitoring and evaluation (M&E) to inform programmatic decision making, however little is known about facilitators and barriers to collecting and using data at SSPs. Methods: Using the Consolidated Framework for Implementation Research (CFIR), we conducted 12 key informant interviews with SSP staff to describe the overall landscape of data systems at SSPs, understand facilitators and barriers to data collection and use at SSPs, and generate recommendations for best practices for data collection at SSPs. We used 30 CFIR constructs to develop individual interview guides, guide data analysis, and interpret study findings. Results: Four main themes emerged from our analysis: SSP M&E systems are primarily designed to be responsive to perceived SSP client needs and preferences; SSP staffing capacity influences the likelihood of modifying M&E systems; external funding frequently forces changes to M&E systems; and strong M&E systems are often a necessary precursor for accessing funding. Conclusions: Our findings highlight that SSPs are not resistant to data collection and M&E, but face substantial barriers to implementation, including lack of funding and disjointed data reporting requirements. There is a need to expand M&E-focused funding opportunities, harmonize quantitative indicators collected across funders, and minimize data collection to essential data points for SSPs.