Courtney A McKnight
Courtney A McKnight
Scroll
Clinical Assistant Professor of Epidemiology
-
Professional overview
-
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, NJMPH, Community Health Education, Hunter College, New York, NYDrPH, The City University of New York, New York, NY
-
Areas of research and study
-
Behavioral ScienceDrug addictionEpidemiologyHarm reductionHepatitisHIV/AIDSInfectious DiseasesMixed-Methods ResearchOpioidQualitative ResearchSocial epidemiologySubstance Abuse
-
Publications
Publications
Persistence and change in disparities in HIV infection among injection drug users in New York City after large-scale syringe exchange programs
AbstractDes Jarlais, D. C., Arasteh, K., Hagan, H., McKnight, C., Perlman, D. C., & Friedman, S. R. (n.d.).Publication year
2009Journal title
American journal of public healthVolume
99Page(s)
S445-S451AbstractObjectives. We examined racial/ethnic disparities in HIV infection among injection drug users (IDUs) before and after implementation of large-scale syringe exchange programs in New York City. Methods. Participants were recruited from IDUs entering the Beth Israel drug detoxification program in New York City. Participants (n=1203) recruited from 1990 through 1994, prior to large-scale syringe exchange programs (pre-exchange), were compared with 1109 participants who began injecting in 1995 or later and were interviewed in 1995 through 2008 (post-exchange). Results. There were large differences in HIV prevalence among pre-exchange vs post-exchange participants (African Americans, 57% vs 15%; Hispanics, 53% vs 5%; Whites, 27% vs 3%). Pre- and post-exchange relative disparities of HIV prevalence were similar for African Americans vs Whites (adjusted odds ratio [AOR]=3.46, 95% confidence interval [CI]=2.41, 4.96 and AOR=4.02, 95% CI=1.67, 9.69, respectively) and Hispanics vs Whites (AOR=1.76, 95% CI=1.49, 2.09 and AOR=1.49, 95% CI=1.02, 2.17). Racial/ethnic group differences in risk behavior did not explain differences in HIV prevalence. Conclusions. New interventions are needed to address continuing disparities in HIV infection among IDUs, but self-reported risk behaviors by themselves may not be adequate outcome measures for evaluating interventions to reduce racial/ethnic disparities in HIV infection.Using hepatitis C virus and herpes simplex virus-2 to track HIV among injecting drug users in New York City
AbstractDes Jarlais, D. C., Arasteh, K., McKnight, C., Hagan, H., Perlman, D., & Friedman, S. R. (n.d.).Publication year
2009Journal title
Drug and alcohol dependenceVolume
101Issue
1Page(s)
88-91AbstractObjective: To explore the potential utility of hepatitis C virus (HCV) seroprevalence as a biomarker for injection risk, and herpes simplex virus-2 (HSV-2) as a biomarker for sexual risk among injecting drug users (IDUs). We examined the relationships between HCV and HIV and between HSV-2 and HIV among injecting drug users in New York City relative to the large-scale implementation of syringe exchange in the mid-1990s. Methods: 397 injecting drug users were recruited from a drug detoxification program in New York from 2005 to 2007. Informed consent was obtained, a questionnaire covering demographics, drug use and HIV risk was administered. Blood samples were tested for antibody to HIV, HCV and HSV-2. Results: Among all subjects, HIV prevalence was 17%, HCV prevalence 72% and HSV-2 prevalence 48%. Among IDUs who began injecting before 1995, HIV was 28%, HCV serostatus was strongly associated with HIV serostatus (AOR = 8.96, 95% CI 1.16-69.04) and HSV-2 serostatus was not associated with HIV serostatus (AOR = 1.31, 95% CI 0.64-2.67). Among subjects who began injecting in 1995 or later, HIV was 6%, HCV was not associated with HIV (AOR = 1.04, 95% CI 0.27-4.08) and HSV-2 serostatus was strongly related to HIV serostatus (AOR = 10.71, 95% CI 1.18-97.57). Conclusions: HCV and HSV-2 HCV and HSV-2 may provide important new tools for monitoring evolving HIV epidemics among IDUs. Reconsideration of the current CDC hierarchical transmission risk classification system may also be warranted.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., 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.Herpes simplex virus-2 and HIV among noninjecting drug users in New York City
AbstractDes Jarlais, D. C., Hagan, H., Arasteh, K., McKnight, C., Perlman, D., & Friedman, S. R. (n.d.).Publication year
2007Journal title
Sexually Transmitted DiseasesVolume
34Issue
11Page(s)
923-927AbstractOBJECTIVE: To examine the relationship between herpes simplex virus 2 (HSV-2) seroprevalence and human immunodeficiency virus (HIV) seroprevalence among noninjecting heroin and cocaine users in New York City. METHODS: Four hundred sixty-two noninjecting cocaine and heroin users were recruited from a drug detoxification program in New York City. Smoking crack cocaine, intranasal use of heroin, and intranasal use of cocaine were the most common types of drug use. A structured interview was administered and a serum sample was collected for HIV and HSV testing. RESULTS: HIV prevalence was 19% (95% CI 15%-22%) and HSV-2 seroprevalence was 60% (95% CI 55%-64%). The adjusted risk ratio for the association between HSV-2 and HIV was 1.9 (95% CI 1.21%-2.98%). The relationship between HSV-2 and HIV was particularly strong among females, among whom 86% were HSV-2 seropositive, 23% were HIV seropositive, and all HIV seropositives were also HSV-2 seropositive. CONCLUSIONS: HSV-2 appears to be an important factor in sexual transmission of HIV among noninjecting cocaine and heroin users in New York City, especially among females. The estimated population attributable risk for HIV infection attributable to HSV-2 infection in this sample was 38%. Programs to manage HSV-2 infection should be developed as part of comprehensive HIV prevention for noninjecting drug users.Social and political factors predicting the presence of syringe exchange programs in 96 us metropolitan areas
AbstractTempalski, B., Flom, P. L., Friedman, S. R., Des Jarlais, D. C., Friedman, J. J., McKnight, C., & Friedman, R. (n.d.).Publication year
2007Journal title
American journal of public healthVolume
97Issue
3Page(s)
437-447AbstractCommunity activism can be important in shaping public health policies. For example, political pressure and direct action from grassroots activists have been central to the formation of syringe exchange programs (SEPs) in the United States. We explored why SEPs are present in some localities but not others, hypothesizing that programs are unevenly distributed across geographic areas as a result of political, socioeconomic, and organizational characteristics of localities, including needs, resources, and local opposition. We examined the effects of these factors on whether SEPs were present in different US metropolitan statistical areas in 2000. Predictors of the presence of an SEP included percentage of the population with a college education, the existence of local AIDS Coalition to Unleash Power (ACT UP) chapters, and the percentage of men who have sex with men in the population. Need was not a predictor.The transition from injection to non-injection drug use: Long-term outcomes among heroin and cocaine users in New York City
AbstractDes Jarlais, D. C., Arasteh, K., Perlis, T., Hagan, H., Heckathorn, D. D., Mcknight, C., Bramson, H., & Friedman, S. R. (n.d.).Publication year
2007Journal title
AddictionVolume
102Issue
5Page(s)
778-785AbstractAims: To characterize heroin and cocaine users in New York City who have changed from injection to non-injection drug administration and to identify factors associated with long-term non-injection use. Design: Two cross-sectional studies of heroin and cocaine users in New York City. Settings and participants: New admissions were recruited at drug abuse treatment programs (2000-04) and respondent-driven sampling was used to recruit drug users from the community (2004). Both injecting and non-injecting drug users participated in each study. 'Former injectors' were defined operationally as people who had used heroin and/or cocaine in the 6 months prior to the interview and who had injected illicit drugs in the past, but whose most recent injection was more than 6 months before the study interview. 'Current' injectors were defined as people who had injected heroin and/or cocaine in the 6 months prior to the interview. Measurements: A structured interview on drug use history was administered, and a serum sample was collected and tested for the human immunodeficiency virus (HIV). Findings: A total of 104 former injectors was recruited for the drug abuse treatment program study, and 229 current injectors were recruited for the community recruitment study; 160 former injectors and 1731 current injectors were recruited from the drug abuse treatment study. Compared with the current injectors, former injectors were older and more likely to be African American. The former injectors reported long intervals since their most recent injection, a mean of 8 years in the drug abuse treatment program study and a mean of 12 years in the community recruitment study. The most common reasons for stopping injection drug use included concerns about health, social stigmatization and self-image, and preference for intranasal use as a route of drug administration. The results were highly consistent across the two studies. Conclusions: The transition from injection to non-injection use appears to be relatively stable behavior change for many former injectors, who report a decade or more without injecting. Developing a greater understanding of the transition from injection to stable non-injection drug use may provide insights into the natural histories of drug use and addiction.Diffusion of the D.A.R.E and syringe exchange programs
AbstractDes Jarlais, D. C., Sloboda, Z., Friedman, S. R., Tempalski, B., McKnight, C., & 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.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., 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.Respondent-driven sampling in a study of drug users in New York City: Notes from the field
AbstractMcKnight, C., Des Jarlais, D., Bramson, H., Tower, L., Abdul-Quader, A. S., Nemeth, C., & Heckathorn, D. (n.d.).Publication year
2006Journal title
Journal of Urban HealthVolume
83Issue
7Page(s)
i54-i59AbstractBeth Israel Medical Center (BIMC), in collaboration with the Centers for Disease Control (CDC) and the New York State Department of Health (NYSDOH), used respondent-driven sampling (RDS) in a study of HIV seroprevalence among drug users in New York City in 2004. We report here on operational issues with RDS including recruitment, coupon distribution, storefront operations, police and community relations, and the overall lessons we learned. Project staff recruited eight seeds from a syringe exchange in Lower Manhattan to serve as the initial study participants. Upon completion of the interview that lasted approximately 1 h and a blood draw, each seed was given three coupons to recruit three drug users into the study. Each of the subsequent eligible participants was also given three coupons to recruit three of their drug-using acquaintances. Eligible participants had to have: injected, smoked or snorted an illicit drug in the last 6 months (other than marijuana), aged 18 or older, adequate English language knowledge to permit informed consent and complete questionnaire. From April to July 2004, 618 drug users were interviewed, including 263 (43%) current injectors, 119 (19%) former injectors, and 236 (38%) never injectors. Four hundred sixty nine (76%) participants were men, 147 (24%) were women, and two (<1%) were transgender. By race/ethnicity, 285 (46%) were black, 218 (35%) Hispanic, 88 (14%) white, 23 (4%) mixed/not specified, and four (<1%) native American. Interviews were initially done on a drop-in basis but this system changed to appointments 1 month into the study due to the large volume of subjects coming in for interviews. Data collection was originally proposed to last for 1 year with a target recruitment of 500 drug users. Utilizing RDS, we were able to recruit and interview 118 more drug users than originally proposed in one quarter of the time. RDS was efficient with respect to time and economics (we did not have to hire an outreach worker) and effective in recruiting a diverse sample of drug users.What's community got to do with it? Implementation models of syringe exchange programs
AbstractDowning, M., Riess, T. H., Vernon, K., Mulia, N., Hollinquest, M., McKnight, C., Des Jarlais, D. C., & Edlin, B. R. (n.d.).Publication year
2005Journal title
AIDS Education and PreventionVolume
17Issue
1Page(s)
68-78AbstractSyringe exchange programs (SEPs) have been shown to be highly effective in reducing HIV transmission among injection drug users (IDUs). Despite this evidence, SEPs have not been implemented in many communities experiencing HIV epidemics among IDUs. We interviewed 17 key informants in nine U.S. cities to identify factors and conditions that facilitated or deterred the adoption of SEPs. Cities were selected to represent diversity in size, geographic location, AIDS incidence rates, and SEP implementation. Key informants included HIV prevention providers, political leaders, community activists, substance use and AIDS researchers, and health department directors. SEPs were established by one or more of three types of implementation models: (a) broad community coalition support, (b) community activist initiative, and (c) top-down decision making by government authorities. In each model, coalition building and community consultation were critical steps for the acceptance and sustainability of SEPs. When others were not prepared to act, community activists spearheaded SEP development, taking risks in the face of opposition, but often lacked the resources to sustain their efforts. Leadership from politicians and public health officials provided needed authority, clout, and access to resources. Researchers and scientific findings lent force and legitimacy to the effort. Rather than adopting adversarial positions, successful SEP implementers worked with or avoided the opposition. Fear of repercussions and lack of leadership were the greatest barriers to implementing SEPs. Communities that successfully implemented SEPs were those with activists willing to push the agenda, public officials willing to exercise leadership, researchers able to present authoritative findings, and proponents who effectively mobilized resources and worked to build community coalitions, using persistent but nonadversarial advocacy.Public Funding of US Syringe Exchange Programs
AbstractDes Jarlais, D. C., McKnight, C., & Milliken, J. (n.d.).Publication year
2004Journal title
Journal of Urban HealthVolume
81Issue
1Page(s)
118-121AbstractAlthough there has been no federal government funding of syringe exchange, there is substantial state and local government funding. We report here on program characteristics associated with receiving state and local government funding. Annual telephone surveys were made of program directors of syringe exchange programs known to the North American Syringe Exchange Network. The number of syringe exchange programs known to this network has increased from 63 in 1994-1995 to 127 in 2000. Approximately 80% of programs participated in each of the surveys. Approximately 50% of programs receive state and local government funding, and this has remained constant from 1994 to 2000. Receiving state and local government funding was associated with larger numbers of syringes exchanged per year and providing more on-site services. Among programs that received state or local government funding, this funding accounted for a mean of 87% of the budget for syringe exchange services. In the absence of federal funding, state and local government support is associated with better syringe exchange performance.What predicts which metropolitan areas in the USA have syringe exchanges?
AbstractTempalski, B., Friedman, S. R., Des Jarlais, D. C., McKnight, C., Keem, M., & Friedman, R. (n.d.).Publication year
2003Journal title
International Journal of Drug PolicyVolume
14Issue
5Page(s)
417-424AbstractHIV epidemics among IDUs vary widely across different cities in the USA [American Journal of Public Health 86 (5) (1996) 642]. Few studies have focused on how localities differ in regard to response to the HIV epidemic. While syringe exchange programmes (SEPs) are a response to HIV among IDUs, they are often unwelcome and difficult to set up even in communities hit hardest by the epidemic. It is important to understand what metropolitan area characteristics are related to when and if an SEP opens in a particular locality. Logistic regression models are used to explore how need, political factors, SEP diffusion from Tacoma (the first SEP), and metropolitan socioeconomic characteristics are related to SEP presence. Results indicate that need is not a significant predictor of having an SEP. Predictors were the percentage of the population who are men who have sex with men (AOR = 6.95; 95% CI = 1.29-37.49), and metropolitan area population (AOR = 1.08 per 100,000; 95% CI = 1.02-1.14). Predictors of having an SEP in a metropolitan area seem to be political factors and metropolitan area population size, not need among IDUs. Gay political influence and/or support may well facilitate SEP formation, and geographic diffusion may influence where SEPs are established.Legal syringe purchases by injection drug users, Brooklyn and Queens, New York City, 2000-2001.
AbstractDes Jarlais, D. C., McKnight, C., & Friedmann, P. (n.d.).Publication year
2002Journal title
Journal of the American Pharmaceutical Association (Washington,D.C. : 1996)Volume
42Issue
6Page(s)
S73-76AbstractOBJECTIVE: To assess preliminary results of the Expanded Syringe Access Demonstration Program (ESAP) in New York City. DESIGN: Temporal trends of pharmacy use among injection drug users (IDUs) in Brooklyn and Queens were analyzed from December 2000 through December 2001. SETTING: Brooklyn and Queens, New York City. PARTIPANTS: IDUs. MAIN OUTCOME MEASURES: Attempts to purchase syringes from pharmacies and success in doing so. RESULTS: Of the 1,072 IDUs interviewed from December 2000 through December 2001, the majority were daily heroin injectors, but there was also substantial speedball and cocaine injection. There was a clear increase over time in both the percentage of subjects who attempted to purchase syringes in pharmacies and in the percentage who successfully purchased syringes. Among IDUs interviewed 4 or more months after ESAP began, large majorities of those who attempted to purchase syringes were successful in doing so. No differences in use of ESAP by IDUs were identified in Brooklyn versus Queens: 27% of IDUs interviewed in Queens reported that they had attempted to purchase syringes in pharmacies versus 28% in Brooklyn. Persons who reported injecting on a daily or more frequent basis were more likely to have attempted pharmacy purchases than persons who reported injecting less frequently, 32% versus 21%. CONCLUSIONS: The ESAP program has led to an increase in the use of pharmacies as sources of sterile injection equipment among IDUs in New York City. The extent to which pharmacies become an important source of sterile injection equipment and the effect of legal pharmacy sales on risk behaviors for human immunodeficiency virus (HIV) infection remain to be determined.