Danielle C Ompad
Associate Dean for Education
Professor of Epidemiology
Dr. Danielle Ompad is an epidemiologist whose work is focused in the areas of urban health, HIV, illicit drug use, and adult access to vaccines. With respect to illicit drug use, her work has spanned the entire natural history of addiction – from initiation to cessation, with particular attention paid to risk for infectious diseases such as HIV, hepatitis B and C, and STIs. She has primarily worked with people who use heroin, crack, cocaine, and/or club drugs.
In New York City, she has been examining heroin cessation among current, former, and relapsed heroin users. Working with Alliance for Public Health and the Ukrainian Institute on Public Health Policy, she analyzes harm reduction service utilization among people who inject drugs, in order to optimize service delivery in Ukraine. Since 2013, she has served as faculty for the Fogarty-funded New York State International Training and Research Program with the goal of building research capacity in Ukraine.
Dr. Ompad’s National Institute of Allergy and Infectious Diseases-funded study aims to determine if herpes simplex 1 and 2 infections explain racial disparities in HIV incidence among a cohort of young gay, bisexual, and other men who have sex with men (YMSM). In addition, Dr. Ompad and colleagues are assessing HPV infection prevalence, persistence, and clearance among this same cohort.
BS, Biology, Bowie State University, Bowie, MDMHS, Epidemiology, Johns Hopkins University, Baltimore, MDPhD, Epidemiology, Johns Hopkins University, Baltimore, MD
Excellence in Public Health Teaching Award, New York University (2014)Excellence in Public Health Teaching Award, New York University (2013)National Hispanic Science Network on Drug Abuse Scientific Development Travel Fellowship (2010)Delta Omega Honorary Society, Alpha Chapter (2002)
EpidemiologyHIV/AIDSInfectious DiseasesSocial Determinants of HealthSTIsSubstance AbuseVaccines
PrEP Care Continuum Engagement Among Persons Who Inject Drugs: Rural and Urban Differences in Stigma and Social InfrastructureWalters, S. M., Frank, D., Van Ham, B., Jaiswal, J., Muncan, B., Earnshaw, V., Schneider, J., Friedman, S. R., & Ompad, D. C.
Journal titleAIDS and Behavior
Page(s)1308-1320AbstractPre-exposure prophylaxis (PrEP) is a medication that prevents HIV acquisition, yet PrEP uptake has been low among people who inject drugs. Stigma has been identified as a fundamental driver of population health and may be a significant barrier to PrEP care engagement among PWID. However, there has been limited research on how stigma operates in rural and urban settings in relation to PrEP. Using in-depth semi-structured qualitative interviews (n = 57) we explore PrEP continuum engagement among people actively injecting drugs in rural and urban settings. Urban participants had more awareness and knowledge. Willingness to use PrEP was similar in both settings. However, no participant was currently using PrEP. Stigmas against drug use, HIV, and sexualities were identified as barriers to PrEP uptake, particularly in the rural setting. Syringe service programs in the urban setting were highlighted as a welcoming space where PWID could socialize and therefore mitigate stigma and foster information sharing.
Principles and Metrics for Evaluating Oregon’s Innovative Drug Decriminalization MeasureNetherland, J., Kral, A. H., Ompad, D. C., Davis, C. S., Bluthenthal, R. N., Dasgupta, N., Gilbert, M., Morgan, R., & Wheelock, H.
Journal titleJournal of Urban Health
The Impact of the COVID-19 Pandemic on Drug Use Behaviors, Fentanyl Exposure, and Harm Reduction Service Support among People Who Use Drugs in Rural SettingsBolinski, R. S., Walters, S., Salisbury-Afshar, E., Ouellet, L. J., Jenkins, W. D., Almirol, E., Van Ham, B., Fletcher, S., Johnson, C., Schneider, J. A., Ompad, D., & Pho, M. T.
Journal titleInternational journal of environmental research and public health
Issue4AbstractBackground: The COVID-19 pandemic has worsened the opioid overdose crisis in the US. Rural communities have been disproportionately affected by opioid use and people who use drugs in these settings may be acutely vulnerable to pandemic-related disruptions due to high rates of poverty, social isolation, and pervasive resource limitations. Methods: We performed a mixed-methods study to assess the impact of the pandemic in a convenience sample of people who use drugs in rural Illinois. We conducted 50 surveys capturing demographics, drug availability, drug use, sharing practices, and mental health symptoms. In total, 19 qualitative interviews were performed to further explore COVID-19 knowledge, impact on personal and community life, drug acquisition and use, overdose, and protective substance use adaptations. Results: Drug use increased during the pandemic, including the use of fentanyl products such as gel encapsulated “beans” and “buttons”. Disruptions in supply, including the decreased availability of heroin, increased methamphetamine costs and a concomitant rise in local methamphetamine production, and possible fentanyl contamination of methamphetamine was reported. Participants reported increased drug use alone, experience and/or witness of overdose, depression, anxiety, and loneliness. Consistent access to harm reduction services, including naloxone and fentanyl test strips, was highlighted as a source of hope and community resiliency. Conclusions: The COVID-19 pandemic period was characterized by changing drug availability, increased overdose risk, and other drug-related harms faced by people who use drugs in rural areas. Our findings emphasize the importance of ensuring access to harm reduction services, including overdose prevention and drug checking for this vulnerable population.
Acceptability and Effectiveness of Hepatitis C Care at Syringe Service Programs for People Who Inject Drugs in New York CityMuncan, B., Jordan, A. E., Perlman, D. C., Frank, D., Ompad, D. C., & Walters, S. M.
Journal titleSubstance Use and Misuse
Page(s)728-737AbstractIntroduction/Objectives: The incidence of hepatitis C (HCV) infection is rising among people who inject drugs (PWID). Even in the context of known HCV prevention and treatment strategies, some PWID remain unengaged in HCV care. This study aimed to identify and characterize experiences and perceptions of PWID regarding the acceptability and effectiveness of HCV testing and treatment at a local syringe service program (SSP). Methods: A total of 36 PWID participated in semi-structured interviews at an SSP in New York City. Interviews were audio-recorded, transcribed, and coded by three coders, following a constructivist grounded theory approach. Relevant themes were identified as they emerged from the data. Results: Interviews with PWID revealed three themes related to the impact of SSPs on HCV care: (1) non-stigmatizing SSP environments, (2) the role of SSPs in improving HCV knowledge, and (3) acceptability of SSPs as sites for HCV care among PWID. Discussion: This paper contributes to the ongoing understanding that SSPs provide a well-accepted source of HCV services for PWID. Participants believed that SSPs are accessible and effective sites for HCV care, and suggested that stigma among PWID continues to affect receipt of HCV care in traditional settings. Conclusions: Understanding attitudes and beliefs of PWID regarding the effectiveness of SSPs as sites for HCV care is crucial for the development of focused strategies to reduce HCV transmission, and to ultimately achieve HCV elimination. Given this, further research is warranted investigating how best to improve HCV care at harm reduction sites such as SSPs.
Dominican Provider Attitudes Towards HPV Testing for Cervical Cancer Screening and, Current Challenges to Cervical Cancer Prevention in the Dominican Republic: a Mixed Methods Study
Dominican Provider Practices for Cervical Cancer Screening in Santo Domingo and Monte Plata Provinces
How urban and rural built environments influence the health attitudes and behaviors of people who use drugs
Racial and ethnic disparities in "stop-and-frisk" experience among young sexual minority men in New York CityKhan, M. R., Kapadia, F., Geller, A., Mazumdar, M., Scheidell, J. D., Krause, K. D., Martino, R. J., Cleland, C. M., Dyer, T. V., Ompad, D. C., & Halkitis, P. N.
Journal titlePloS one
Issue8AbstractAlthough racial/ethnic disparities in police contact are well documented, less is known about other dimensions of inequity in policing. Sexual minority groups may face disproportionate police contact. We used data from the P18 Cohort Study (Version 2), a study conducted to measure determinants of inequity in STI/HIV risk among young sexual minority men (YSMM) in New York City, to measure across-time trends, racial/ethnic disparities, and correlates of self-reported stop-and-frisk experience over the cohort follow-up (2014-2019). Over the study period, 43% reported stop-and-frisk with higher levels reported among Black (47%) and Hispanic/Latinx (45%) than White (38%) participants. Stop-and-frisk levels declined over follow-up for each racial/ethnic group. The per capita rates among P18 participants calculated based on self-reported stop-and-frisk were much higher than rates calculated based on New York City Police Department official counts. We stratified respondents' ZIP codes of residence into tertiles of per capita stop rates and observed pronounced disparities in Black versus White stop-and-frisk rates, particularly in neighborhoods with low or moderate levels of stop-and-frisk activity. YSMM facing the greatest economic vulnerability and mental disorder symptoms were most likely to report stop-and-frisk. Among White respondents levels of past year stop-and-frisk were markedly higher among those who reported past 30 day marijuana use (41%) versus those reporting no use (17%) while among Black and Hispanic/Latinx respondents stop-and-frisk levels were comparable among those reporting marijuana use (38%) versus those reporting no use (31%). These findings suggest inequity in policing is observed not only among racial/ethnic but also sexual minority groups and that racial/ethnic YSMM, who are at the intersection of multiple minority statuses, face disproportionate risk. Because the most socially vulnerable experience disproportionate stop-and-frisk risk, we need to reach YSMM with community resources to promote health and wellbeing as an alternative to targeting this group with stressful and stigmatizing police exposure.
The effectiveness of malaria camps as part of the Durgama Anchalare Malaria Nirakaran (DAMaN) program in Odisha, India: study protocol for a cluster-assigned quasi-experimental studyOmpad, D. C., Kessler, A., Van Eijk, A. M., Padhan, T. K., Haque, M. A., Sullivan, S. A., Tozan, Y., Rocklöv, J., Mohanty, S., Pradhan, M. M., Sahu, P. K., & Carlton, J. M.
Journal titleGlobal Health Action
Issue1AbstractThe Indian state of Odisha has a longstanding battle with forest malaria. Many remote and rural villages have poor access to health care, a problem that is exacerbated during the rainy season when malaria transmission is at its peak. Approximately 62% of the rural population consists of tribal groups who are among the communities most negatively impacted by malaria. To address the persistently high rates of malaria in these remote regions, the Odisha State Malaria Control Program introduced ‘malaria camps’ in 2017 where teams of health workers visit villages to educate the population, enhance vector control methods, and perform village-wide screening and treatment. Malaria rates declined statewide, particularly in forested areas, following the introduction of the malaria camps, but the impact of the intervention is yet to be externally evaluated. This study protocol describes a cluster-assigned quasi-experimental stepped-wedge study with a pretest-posttest control group design that evaluates if malaria camps reduce the prevalence of malaria, compared to control villages which receive the usual malaria control interventions (e.g. IRS, ITNs), as detected by PCR.
"they look at us like junkies": Influences of drug use stigma on the healthcare engagement of people who inject drugs in New York CityMuncan, B., Walters, S. M., Ezell, J., & Ompad, D. C.
Journal titleHarm Reduction Journal
Issue1AbstractBackground: People who inject drugs (PWID) are a medically and socially vulnerable population with a high incidence of overdose, mental illness, and infections like HIV and hepatitis C. Existing literature describes social and economic correlations to increased health risk, including stigma. Injection drug use stigma has been identified as a major contributor to healthcare disparities for PWID. However, data on this topic, particularly in terms of the interface between enacted, anticipated, and internalized stigma, is still limited. To fill this gap, we examined perspectives from PWID whose stigmatizing experiences impacted their views of the healthcare system and syringe service programs (SSPs) and influenced their decisions regarding future medical care. Methods: Semi-structured interviews conducted with 32 self-identified PWID in New York City. Interviews were audio recorded and transcribed. Interview transcripts were coded using a grounded theory approach by three trained coders and key themes were identified as they emerged. Results: A total of 25 participants (78.1%) reported at least one instance of stigma related to healthcare system engagement. Twenty-three participants (71.9%) reported some form of enacted stigma with healthcare, 19 participants (59.4%) described anticipated stigma with healthcare, and 20 participants (62.5%) reported positive experiences at SSPs. Participants attributed healthcare stigma to their drug injection use status and overwhelmingly felt distrustful of, and frustrated with, medical providers and other healthcare staff at hospitals and local clinics. PWID did not report internalized stigma, in part due to the availability of non-stigmatizing medical care at SSPs. Conclusions: Stigmatizing experiences of PWID in formal healthcare settings contributed to negative attitudes toward seeking healthcare in the future. Many participants describe SSPs as accessible sites to receive high-quality medical care, which may curb the manifestation of internalized stigma derived from negative experiences in the broader healthcare system. Our findings align with those reported in the literature and reveal the potentially important role of SSPs. With the goal of limiting stigmatizing interactions and their consequences on PWID health, we recommend that future research include explorations of mechanisms by which PWID make decisions in stigmatizing healthcare settings, as well as improving medical care availability at SSPs.
Barriers to Cervical Cancer Screening and Treatment in the Dominican Republic: Perspectives of Focus Group Participants in the Santo Domingo Area
Pandemic preparedness and hard to reach populationsVlahov, D., Coady, M. H., Galea, S., Ompad, D. C., & Barondess, J. A.
Journal titleAmerican journal of disaster medicine
Parent-Level Barriers and Facilitators to HPV Vaccine Implementation in Santo Domingo, Dominican RepublicLiebermann, E., Devanter, N. V., Frías Gúzman, N., Ompad, D., Shirazian, T., & Healton, C.
Journal titleJournal of Community Health
Page(s)1061-1066AbstractCervical cancer is the second leading cause of cancer death for women in the Dominican Republic. Vaccination against human papillomavirus (HPV) could reduce mortality from cervical cancer globally by as much as 90%. The purpose of our study was to explore multi-level barriers and facilitators to implementation of a national HPV vaccine program in the Dominican Republic; this article focuses on parent-level barriers and facilitators. In this qualitative study, we conducted six focus groups (N = 64) with parents of school-age children in the Santo Domingo area of the Dominican Republic, representing diverse socioeconomic groups and geographic settings. Thematic content analysis, using inductive and deductive approaches, was done following transcription and translation of audio-recordings from focus group discussions. Among this group of parents in the Santo Domingo area, facilitators to vaccine uptake were favorable attitudes towards vaccines in general and concern about cervical cancer as a health issue. Barriers found were low to moderate knowledge of HPV and cervical cancer, especially in the rural and suburban groups, and cost and lack of public awareness of the vaccine. This study identified key barriers and facilitators to HPV vaccine implementation in the Dominican Republic. Health messaging, incorporating specialist providers as opinion leaders, will need to be tailored to broad audiences with varying levels of information and awareness, anticipating misinformation and concerns, and will need to emphasize HPV vaccine as a method to prevent cancer.
The Opioid/Overdose Crisis as a Dialectics of Pain, Despair, and One-Sided StruggleFriedman, S. R., Krawczyk, N., Perlman, D. C., Mateu-Gelabert, P., Ompad, D. C., Hamilton, L., Nikolopoulos, G., Guarino, H., & Cerdá, M.
Journal titleFrontiers in Public Health
Volume8AbstractThe opioid/overdose crisis in the United States and Canada has claimed hundreds of thousands of lives and has become a major field for research and interventions. It has embroiled pharmaceutical companies in lawsuits and possible bankruptcy filings. Effective interventions and policies toward this and future drug-related outbreaks may be improved by understanding the sociostructural roots of this outbreak. Much of the literature on roots of the opioid/overdose outbreak focuses on (1) the actions of pharmaceutical companies in inappropriately promoting the use of prescription opioids; (2) “deaths of despair” based on the deindustrialization of much of rural and urban Canada and the United States, and on the related marginalization and demoralization of those facing lifetimes of joblessness or precarious employment in poorly paid, often dangerous work; and (3) increase in occupationally-induced pain and injuries in the population. All three of these roots of the crisis—pharmaceutical misconduct and unethical marketing practices, despair based on deindustrialization and increased occupational pain—can be traced back, in part, to what has been called the “one-sided class war” that became prominent in the 1970s, became institutionalized as neo-liberalism in and since the 1980s, and may now be beginning to be challenged. We describe this one-sided class war, and how processes it sparked enabled pharmaceutical corporations in their misconduct, nurtured individualistic ideologies that fed into despair and drug use, weakened institutions that created social support in communities, and reduced barriers against injuries and other occupational pain at workplaces by reducing unionization, weakening surviving unions, and weakening the enforcement of rules about workplace safety and health. We then briefly discuss the implications of this analysis for programs and policies to mitigate or reverse the opioid/overdose outbreak.
The role of access to integrated services at opioid agonist treatment sites in reaching 90-90-90 cascade in people who inject drugs in Ukraine: Country-level dataMeteliuk, A., Prokhorova, T., Filippovych, S., Ompad, D. C., & Zaller, N.
Journal titleDrug and alcohol dependence
Volume216AbstractIntroduction: Opioid agonist treatment (OAT) is an effective means to prevent HIV transmission. Ukraine started integrating HIV services into OAT sites to improve people who inject drugs' (PWID) access to treatment. Methods: Data from the national registry of OAT patients (n = 9,983) were analyzed. These data are collected from all 179 OAT sites countrywide. For the cascade, HIV-positive OAT patients (n = 4,084) were stratified into two categories: OAT alone (received OAT at one site and antiretroviral therapy (ART) at different location, n = 1,789) and integrated care (received OAT and ART at one location, n = 2,295) for comparison. Results: Most HIV-positive OAT patients in Ukraine are male (85.6 %) and the mean age is 40.3 years old. The mean length of injecting before OAT is 17.2 years and the mean length on OAT is 4.2 years. All HIV-positive OAT clients are aware of their HIV status. The proportion of HIV-positive clients receiving ART was higher at integrated care sites compared to OAT alone sites (84.2 vs. 73.1 %, p- = 0.012); distribution of viral suppression among those receiving ART across the strata were 79.4 and 59.2 % for 'integrated care sites' vs. 'OAT only sites' respectively (p < 0.001). Conclusions: This analysis clearly demonstrates much better progress towards the 90−90-90 goals among those OAT patients who receive integrated care services (both OAT and ART) at one site at each stage of the HIV care cascade as compared to receiving OAT and ART at different sites. There is an urgent need to further expand the integration of OAT and HIV services in Ukraine.
A New Generation of Drug Users in St. Petersburg, Russia? HIV, HCV, and Overdose Risks in a Mixed-Methods Pilot Study of Young Hard Drug UsersMeylakhs, P., Friedman, S. R., Meylakhs, A., Mateu-Gelabert, P., Ompad, D. C., Alieva, A., & Dmitrieva, A.
Journal titleAIDS and Behavior
Page(s)3350-3365AbstractRussia has a widespread injection drug use epidemic with high prevalence of HIV and HCV among people who inject drugs (PWID). We conducted a mixed methods study of young (age 18–26) hard drug users in St. Petersburg. Thirty-nine structured and 10 semi-structured interviews were conducted. No HIV cases and two HCV cases were detected among the PWID subsample (n = 29). Amphetamine and other stimulants were common (70%), opioid use was rare and episodic. Consistent condom use was 10%. No PWID reported syringe-sharing, 51% reported other drug paraphernalia sharing. Most (89%) never or rarely communicated with older (30 +) opiate users. A new cohort of drug users in St. Petersburg may have emerged, which is much safer in its injection practices compared to previous cohorts. However, risky sexual practices among this new cohort may expose them to the possibility of sexual transmission of HIV and widespread drug paraphernalia sharing to the HCV epidemic.
Construction trade and extraction workers: A population at high risk for drug use in the United States, 2005–2014Ompad, D. C., Gershon, R. R., Sandh, S., Acosta, P., & Palamar, J. J.
Journal titleDrug and alcohol dependence
Volume205AbstractObjective: To estimate prevalence of past-month marijuana, cocaine, and nonmedical prescription opioid (NPO) use and determine employment-related correlates of drug use among construction trade/extraction workers (CTEW). Methods: We analyzed ten years of data (2005–2014) from 293,492 adults (age≥18) in the National Survey on Drug Use and Health, comparing CTEW and non-CTEW. Results: CTEW were 5.6% (n = 16,610) of the sample. Compared to non-CTEW, CTEW were significantly more likely to report past-month marijuana (12.3% vs. 7.5%), cocaine (1.8% vs. 0.8%), and/or NPO use (3.4% vs. 2.0%; Ps<.001). Among CTEW, past-week unemployment and working for >3 employers was associated with increased odds of marijuana and NPO use. Missing 1–2 days in the past month because the participant did not want to go into work was associated with increased odds for use of marijuana, cocaine, and NPO use. Missing 3–5 days of work in the past month because sick or injured was associated with double the odds (aOR = 2.00 [95% CI: 1.33–3.02]) of using NPO. Having written drug policies was associated with reduced odds for cocaine use, and workplace tests for drug use during hiring and random drug testing were also associated with lower odds of marijuana use. Conclusions: CTEW are a high-risk population for drug use. Precarious employment is associated with higher prevalence of drug use while some workplace drug policies were associated with lower prevalence. Coupled with reports of high overdose mortality among CTEW, these findings suggest that prevention and harm reduction programming is needed to prevent drug-related morbidity and mortality among CTEW.
Human Papillomavirus Vaccination and Infection in Young Sexual Minority Men: The P18 Cohort StudyHalkitis, P. N., Valera, P., Loschiavo, C. E., Goldstone, S. E., Kanztanou, M., Maiolatesi, A. J., Ompad, D. C., Greene, R. E., & Kapadia, F.
Journal titleAIDS patient care and STDs
Page(s)149-156AbstractWe examined the prevalence of infection with human papillomavirus (HPV) and HIV in a cohort of young gay, bisexual, and other men who have sex with men [sexual minority men (SMM)]. HPV vaccination uptake was assessed; HIV antibody testing was performed and genetic testing for oral and anal HPV infection was undertaken. We examined both HPV vaccination and infection in relation to key demographic and structural variables. Participants (n = 486) were on average 23 years old; 70% identified as a member of a racial/ethnic minority group, and 7% identified as transgender females. Only 18.1% of the participants indicated having received the full dosage of HPV vaccination and 45.1% were unvaccinated. Slightly over half the participants (58.6%) were infected with HPV, with 58.1% testing positive for anal infection and 8.8% for oral infection. HIV seropositivity was associated with infection to oral HPV [adjusted odds ratio (AOR) = 4.03] and vaccine-preventable HPV, whereas both neighborhood-level poverty (AOR = 1.68) and HIV infection (AOR = 31.13) were associated with anal infection to HPV (AOR = 1.68). Prevalence of HPV infection is high among unvaccinated young SMM, despite the availability and eligibility for vaccination. HPV infection adds further health burden to these populations and is particularly concerning for those who are HIV positive as HIV infection increases the risk of developing HPV-related cancers. These findings underscore a missed prevention opportunity for an at-risk and underserved population and suggest the need for active strategies to increase HPV vaccination uptake in young SMM before the onset of sexual behavior.
Incidence of Guillain-BarréSyndrome (GBS) in Latin America and the Caribbean before and during the 2015-2016 Zika virus epidemic: A systematic review and meta-analysisCapasso, A., Ompad, D. C., Vieira, D. L., Wilder-Smith, A., & Tozan, Y.
Journal titlePLoS neglected tropical diseases
Issue8AbstractBackground A severe neurological disorder, Guillain-Barrésyndrome (GBS) is the leading cause of acute flaccid paralysis. Enhanced surveillance of GBS in Latin America and the Caribbean (LAC) following the 2015-2016 Zika virus (ZIKV) epidemic presents an opportunity to estimate, for the first time, the regional incidence of GBS. Methods and findings For this systematic review and meta-analysis, we searched nine scientific databases and grey literature from January 1, 1980 to October 1, 2018. Sources with primary data on incident GBS cases in LAC within a well-defined population and timeframe, published in English, Spanish, Portuguese, or French, were included. We calculated the annual GBS incidence rates (IRs) and 95% confidence intervals (CIs) for each source based on published data. Following an assessment of heterogeneity, we used random-effects meta-analysis to calculate the pooled annual IR of GBS. The study is registered with PROSPERO, number CRD42018086659. Of the 6568 initial citation hits, 31 were eligible for inclusion. Background annual GBS IRs in Latin America ranged from 0.40 in Brazil to 2.12/100,000 in Chile. The pooled annual IR in the Caribbean was 1.64 (95% CI 1.29-2.12, I2<0.01, p = 0.44). During the ZIKV epidemic, GBS IRs ranged from 0.62 in Mexico to 9.35/100,000 in Martinique. GBS increased 2.6 (95% CI 2.3-2.9) times during ZIKV and 1.9 (95% CI 1.1- 3.4) times during chikungunya outbreaks over background rates. A limitation of this review is that the studies included employed different methodologies to find and ascertain cases of GBS, which could contribute to IR heterogeneity. In addition, it is important to consider that data on GBS are lacking for many countries in the region. Conclusions Background IRs of GBS appear to peak during arboviral disease outbreaks. The current review contributes to an understanding of the epidemiology of GBS in the LAC region, which can inform healthcare system planning and preparedness, particularly during arboviral epidemics.
On the way to Hepatitis C elimination in the Republic of Georgia—Barriers and facilitators for people who inject drugs for engaging in the treatment program: A formative qualitative studyChikovani, I., Ompad, D. C., Uchaneishvili, M., Sulaberidze, L., Sikharulidze, K., Hagan, H., & Van Devanter, N. L.
Journal titlePloS one
Issue4AbstractHepatitis C virus (HCV) infection is a significant public health concern worldwide. Georgia is among the countries with a high burden of HCV infection. People who inject drugs (PWID) have the highest burden of infection in Georgia. In 2015, the Government of Georgia, with partners’ support, initiated one of the world’s first Hepatitis C Elimination Programs. Despite notable progress, challenges to achieving targets persist. This qualitative study is aimed to better understand some of the barriers and facilitators to HCV testing and treatment services for PWID to inform HCV treatment policies and practices. The study instrument examined social, structural, and individual factors influencing HCV testing and treatment practices. We started with key informant interviews to guide the study instrument development and compare the study findings against health care planners’ and health care providers’ views. Forty PWID with various HCV testing and treatment experiences were recruited through the snowball method. The study found that along with structural factors such as political commitment, co-financing of diagnostic and monitoring tests, and friendly clinic environments, knowledge about HCV infection and elimination program benefits, and support from family and peers also play facilitating roles in accessing testing and treatment services. On the other hand, inability to co-pay for diagnostic tests, fear of side effects associated with treatment, poor knowledge about HCV infection, and lack of social support hampered testing and treatment practices among PWID. Findings from this study are important for increasing the effectiveness of this unique program that targets a population at high risk of HCV infection.
Substance use among older people living with HIV: Challenges for health care providersDeren, S., Cortes, T., Dickson, V. V., Guilamo-Ramos, V., Han, B. H., Karpiak, S., Naegle, M., Ompad, D. C., & Wu, B.
Journal titleFrontiers in Public Health
Volume7AbstractOlder people living with HIV (OPLWH) have higher rates of substance use (tobacco, alcohol and other drugs) than their HIV-negative peers. Addressing health care needs of OPLWH who use substances is more challenging than for those who do not: they are highly impacted by comorbid conditions, substance use can interact with other medications (including antiretroviral therapy-ART) and reduce their effectiveness, and substance use has been associated with reduced adherence to ART and increased risky behaviors (including sexual risks). People who use substances also suffer disparities along the HIV continuum of care, resulting in lower viral suppression rates and poorer health outcomes. They are especially impacted by stigma and stress, which have implications for HIV treatment and care. Recommendations for health care providers working with OPLWH who use substances include: 1) the need to screen and refer for multiple associated conditions, and 2) training/continuing education to enhance care management and maximize health outcomes.
A comparison of self-reported sexual effects of alcohol, marijuana, and ecstasy in a sample of young adult nightlife attendees
A Qualitative Investigation Comparing Psychosocial and Physical Sexual Experiences Related to Alcohol and Marijuana Use among AdultsPalamar, J. J., Acosta, P., Ompad, D. C., & Friedman, S. R.
Journal titleArchives of Sexual Behavior
Page(s)757-770AbstractAlcohol and marijuana are two of the most prevalent psychoactive substances and each may result in distinct psychosocial and physical sexual experiences and different sexual risk behaviors. With marijuana becoming more accepted in the US along with more liberal state-level policies, it is important to examine and compare users’ psychosocial and physical sexual experiences and sexual risk behavior associated with these drugs. In this study, we interviewed 24 adults who recently used marijuana before sex. Participants were 50 % female and all self-identified as heterosexual and HIV-negative. Using thematic analysis, we compared self-reported psychosocial and physical sexual experiences of alcohol and marijuana. Participants described differences between drugs with regard to psychosocial (e.g., partner interactions and contexts before sex, partner choice, perceived attractiveness of self and others, disinhibition, and feelings of regret after sex) and physical sexual experiences (e.g., sexual dysfunction, dose effects, sensations of body/sex organs, length and intensity of sex, and orgasm). Alcohol use was commonly associated with social outgoingness and use facilitated connections with potential sexual partners; however, alcohol was more likely than marijuana to lead to atypical partner choice or post-sex regret. Both alcohol and marijuana had a variety of negative sexual effects, and the illegality of marijuana reportedly facilitated intimate encounters. While sexual experiences tended to be similar across males and females, we did find some variation by gender. Results can inform prevention and harm reduction programming that will allow us to design more realistic programs and to craft interventions, which guide potential users to make safer choices.
Reliability and Validity of a Material Resources Scale and Its Association With Depression Among Young Men Who Have Sex With Men: The P18 Cohort StudyOmpad, D. C., Palamar, J. J., Krause, K. D., Kapadia, F., & Halkitis, P. N.
Journal titleAmerican Journal of Men's Health
Page(s)1384-1397AbstractSocioeconomic status (SES) is a fundamental cause of ill health, but an understudied determinant of health for gay, bisexual, and other men who have sex with men (MSM). Surprisingly, few studies have examined the relations between poverty and depression among young MSM. The aims of this study were to determine the reliability and validity of an 18-item Family Resource Scale (FRS) as a measure of SES among YMSM and examine the relations between SES and depression, while taking into account factors associated with resilience or risk for poor mental health. Reliability of the SES scale was determined with Cronbach’s alpha. Validity was assessed with factor analysis and bivariable comparisons with other SES measures. Multiple logistic regression was used to determine the relations between depressive symptomology (via the Beck Depression Inventory–II), SES, and gay-related psychosocial variables. In this racially/ethnically diverse sample (mean age = 21.8 years, 37.3% Hispanic/Latino, 30.5% White, 14.9% Black, and 17.0% other race/ethnicity), 70.8% reported incomes ≤ $10,000 and the mean FRS score was 4.1 (SD = 0.9, range 0-5). The FRS demonstrated reliability (α =.91) and criterion and construct validity. The Beck Depression Inventory–II rated 17.6% with depressive symptomology. Higher FRS scores were associated with a lower odds of depression (adjusted odds ratio = 0.58; 95% confidence interval = 0.46-0.74) in logistic regression models controlling for gay community affinity and internalized homophobia. This diverse sample of YMSM in New York City reported substantial financial hardship and those who were more gay-identified had fewer material resources. Fewer material resources and internalized homophobia were both associated with higher odds of depression.
Young Drug Users: a Vulnerable Population and an Underutilized Resource in HIV/HCV PreventionMateu-Gelabert, P., Guarino, H., Quinn, K., Meylakhs, P., Campos, S., Meylakhs, A., Berbesi, D., Toro-Tobón, D., Goodbody, E., Ompad, D. C., & Friedman, S. R.
Journal titleCurrent HIV/AIDS Reports
Page(s)324-335AbstractPurpose of Review: The social networks of people who inject drugs (PWID) have long been studied to understand disease transmission dynamics and social influences on risky practices. We illustrate how PWID can be active agents promoting HIV, HCV, and overdose prevention. Recent Findings: We assessed drug users’ connections and interactions with others at risk for HIV/HCV in three cities: New York City (NYC), USA (n = 539); Pereira, Colombia (n = 50); and St. Petersburg, Russia (n = 49). In all three cities, the majority of participants’ network members were of a similar age as themselves, yet connections across age groups were also present. In NYC, knowing any opioid user(s) older than 29 was associated with testing HCV-positive. In NYC and St. Petersburg, a large proportion of PWID engaged in intravention activities to support safer injection and overdose prevention; in Pereira, PWID injected, had sex, and interacted with other key groups at risk. Summary: People who use drugs can be active players in HIV/HCV and overdose risk- reduction; their networks provide them with ample opportunities to disseminate harm reduction knowledge, strategies, and norms to others at risk. Local communities could augment prevention programming by empowering drug users to be allies in the fight against HIV and facilitating their pre-existing health-protective actions.