Courtney A McKnight

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Clinical Assistant Professor of Epidemiology

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.

Education

BA, Women's Studies, Rutgers University, New Brunswick, NJ

MPH, Community Health Education, Hunter College, New York, NY

DrPH, The City University of New York, New York, NY

Areas of research and study

Behavioral Science

Drug addiction

Epidemiology

Harm reduction

Hepatitis

HIV/AIDS

Infectious Diseases

Mixed-Methods Research

Opioid

Qualitative Research

Social epidemiology

Substance Abuse

Publications

Heterosexual male and female disparities in HIV infection at the end of an epidemic: HIV infection among persons who inject drugs in New York City, 2001–2005 and 2011–2015

Potential geographic "hotspots" for drug-injection related transmission of HIV and HCV and for initiation into injecting drug use in New York city, 2011-2015, with implications for the current opioid epidemic in the US

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

Des Jarlais, D. C., Arasteh, K., Feelemyer, J., McKnight, C., Tross, S., Perlman, D. C., Campbell, A. N., Hagan, H., & Cooper, H. L. (n.d.).

Publication year

2017

Journal title

Sexually Transmitted Diseases

Volume

Issue

Page(s)

85-90

10.1097/OLQ.0000000000000549

Abstract

Abstract

Background: 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

Des Jarlais, D., Arasteh, K., Feelemyer, J., Mcknight, C., Tross, S., Perlman, D., Campbell, A. N. C., Hagan, H., & Cooper, H. L. F. (n.d.).

Publication year

2017

Journal title

Sexually Transmitted Diseases

Page(s)

85-90

Perceived discrimination among racial and ethnic minority drug users and the association with health care utilization

Racial/ethnic disparities at the end of an HIV epidemic: Persons who inject drugs in New York City, 2011-2015

Risk factors for hepatitis C seropositivity among young people who inject drugs in New York City: Implications for prevention

The New York 911 Good Samaritan Law and Opioid Overdose Prevention Among People Who Inject Drugs

What happened to the HIV epidemic among non-injecting drug users in New York City?

Consistent estimates of very low HIV incidence among people who inject drugs: New York City, 2005-2014

Des Jarlais, D. C., Arasteh, K., McKnight, C., Feelemyer, J., Campbell, A. N., Tross, S., Smith, L., Cooper, H. L., Hagan, H., & Perlman, D. (n.d.).

Publication year

2016

Journal title

American journal of public health

Volume

106

Issue

Page(s)

503-508

10.2105/AJPH.2015.303019

Abstract

Abstract

Objectives. 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.

From Long-Term Injecting to Long-Term Non-Injecting Heroin and Cocaine Use: The Persistence of Changed Drug Habits

Providing ART to HIV Seropositive Persons Who Use Drugs: Progress in New York City, Prospects for “Ending the Epidemic”

Incidence and prevalence of hepatitis c virus infection among persons who inject drugs in New York City: 2006-2013

Longitudinal analysis of pain and illicit drug use behaviors in outpatients on methadone maintenance

Will "combined prevention" eliminate racial/ethnic disparities in HIV infection among persons who inject drugs in New York City?

A perfect storm: Crack cocaine, HSV-2, and HIV among non-injecting drug users in New York City

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

Education and counseling in the methadone treatment setting improves knowledge of viral hepatitis

HSV-2 co-infection as a driver of HIV transmission among heterosexual non-injecting drug users in New York City

Transitions from injecting to non-injecting drug use: Potential protection against HCV infection

Viral hepatitis among drug users in methadone maintenance: Associated factors, vaccination outcomes, and interventions

A randomized trial of a hepatitis care coordination model in methadone maintenance treatment

Masson, C. L., Delucchi, K. L., McKnight, C., 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

2013

Journal title

American journal of public health

Volume

103

Issue

Page(s)

e81-e88

10.2105/AJPH.2013.301458

Abstract

Abstract

Objectives. 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.

Epidemiology of pain among outpatients in methadone maintenance treatment programs

Dhingra, L., Masson, C., Perlman, D. C., Seewald, R. M., Katz, J., McKnight, C., Homel, P., Wald, E., Jordan, A. E., Young, C., & Portenoy, R. K. (n.d.).

Publication year

2013

Journal title

Drug and alcohol dependence

Volume

128

Issue

Page(s)

161-165

10.1016/j.drugalcdep.2012.08.003

Abstract

Abstract

Background: 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.

Courtney A McKnight