Holly Hagan
Holly Hagan
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Professor Emeritus
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Professional overview
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Dr. Holly Hagan is Professor Emeritus at the School of Global Public Health. Trained as an infectious disease epidemiologist, Dr. Hagan’s work has sought to understand the causes and consequences of substance use disorders. Her research has examined blood-borne and sexually-transmitted infections among people who use drugs. She is an internationally-recognized expert in the etiology, epidemiology, natural history, prevention and treatment of hepatitis C virus infection among PWUD, and in 2014 her work was recognized by the US Department of Health and Human Services with the President’s Award for Leadership in the Control of Viral Hepatitis in the United States. Dr. Hagan served on the Institute of Medicine Committee on the Prevention and Control of Viral Hepatitis in the United States, and she has been an advisor to the US Department of Health and Human Services, the CDC, and the Canadian Institutes of Health on national programs to detect, diagnose and treat HCV infections. She was recently appointed to the National Academy of Medicine Committee on the Examination of the Integration of Opioid and Infectious Disease Prevention Efforts in Select Programs.
Dr. Hagan is the Director of the NIDA P30 Center for Drug Use and HIV|HCV Research at Global Public Health, which provides research support to investigators throughout NYU and in two other NYC institutions. In 2017, she was selected by NIDA to chair the Executive Steering Committee for the Rural Opioid Initiative funded by NIH, CDC, SAMHSA and the Appalachian Regional Commission. Her research has shifted to examining the impact of the opioid crisis more broadly, to include studying the epidemiology of fatal and non-fatal overdose among PWUD. She was chosen by the American Foundation for AIDS Research to be the Principal Investigator for the New York State Opioid Prevention Center pilot study, which will examine the safety and effectiveness of the Supervised Consumption Sites to be implemented in New York City and in upstate NY.
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Education
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PhD Epidemiology, University of Washington, Seattle, WAMPH Epidemiology, University of Massachusetts, Amherst, MABA Russian Studies, Evergreen State College, Olympia, WA
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Publications
Publications
High HIV prevalence among low-income, black women in New York City with self-reported HIV negative and unknown status
AbstractReilly, K. H., Neaigus, A., Jenness, S. M., Hagan, H., Wendel, T., & Gelpí-Acosta, C. (n.d.).Publication year
2013Journal title
Journal of Women's HealthVolume
22Issue
9Page(s)
745-754AbstractBackground: Black women are disproportionally affected by human immunodeficiency virus (HIV). This study investigates factors associated with newly identified HIV infection among previously self-reported HIV negative or unknown status black women living in high risk areas (HRAs) of New York City (NYC). Methods: Heterosexuals residing in or socially connected to NYC HRAs were recruited using respondent driven sampling for participation in the United States Centers for Disease Control-sponsored National HIV Behavioral Surveillance System in 2010. Eligible individuals were interviewed and offered an HIV test. The analysis reported here focused on black women with valid HIV results who did not report being HIV positive, and examined factors related to HIV infection in this group. Results: Of 153 black women who did not report being HIV positive at enrollment, 15 (9.8%) tested HIV positive. Age ≥40 years, ever injected drugs, and in the last 12 months had unprotected vaginal sex, exchange sex, last sex partner used crack, non-injection crack use, and non-injection heroin use were significantly associated with HIV infection (pHigh prevalence of alcohol use among hepatitis C virus antibody positive injection drug users in three US cities
AbstractCampbell, J. V., Hagan, H., Latka, M. H., Garfein, R. S., Golub, E. T., Coady, M. H., Thomas, D. L., & Strathdee, S. A. (n.d.).Publication year
2006Journal title
Drug and alcohol dependenceVolume
81Issue
3Page(s)
259-265AbstractInjection drug users (IDUs) acquire the majority of new hepatitis C virus (HCV) infections and frequently use alcohol. Alcohol abuse accelerates liver disease among HCV-infected persons, can reduce the effectiveness of treatment for HCV infection and may be a contraindication for HCV treatment. HCV seropositive, HIV-negative IDUs aged 18-35 years in Baltimore, New York City and Seattle who were enrolled in a behavioral risk-reduction intervention trial underwent computerized self-interviews to assess baseline alcohol use and dependence and medical history. We measured problem alcohol use using the 10-item Alcohol Use Disorders Identification Test (AUDIT) scale. Of 598 participants, 84% responded "false" to: "it is safe for a person with HCV to drink alcohol". Problem drinking, defined as score ≥8 on AUDIT, was identified in 37%. Correlates of scoring ≥8 on AUDIT included homelessness, male gender, primarily injecting speedballs, having injected with used needles, prior alcohol treatment and depression. Although most HCV seropositive IDUs in our sample appear informed about their increased risk of liver disease from alcohol, two-fifths screened positive for problem alcohol use. These findings underscore the importance of referring HCV-positive persons to effective alcohol treatment programs to reduce future liver damage and improve eligibility for and effectiveness of treatment of HCV.Highly active antiretroviral therapy for injection drug users : Physician-recommended strategies for enhanced adherence
AbstractVossilev, Z. P., & Hagan, H. (n.d.).Publication year
2004Journal title
Antiviral TherapyVolume
9Issue
3Page(s)
461Abstract~HIV among injecting drug users
AbstractHagan, H., Des Jarlais, D. C., Hagan, H., & Friedman, S. (n.d.). (Merigan, Bartlet, & Bolognesi, Eds.; 2nd eds.).Publication year
1998Abstract~HIV among injecting drug users : Epidemiology and emerging public health perspectives
AbstractHagan, H., Des Jarlais, D. C., Hagan, H., & Friedman, S. (n.d.). (J. Lowinson, P. Ruiz, R. Millman, & J. Langrod, Eds.; 3rd eds.).Publication year
1996Abstract~HIV and HCV infection among injecting drug users
AbstractHagan, H., & Des Jarlais, D. C. (n.d.).Publication year
2000Journal title
Mount Sinai Journal of MedicineVolume
67Issue
5-6Page(s)
423-428AbstractBackground: Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are the two blood-borne pathogens most commonly transmitted among injection drug users via multi-person use of syringes and other injection equipment. However, important differences exist in the epidemiology of HIV and HCV within different populations of intravenous drug users. Methods: A literature review was carried out to summarize publications describing the epidemiology and natural history of HIV and HCV in injection drug users. Results: Among injection drug users worldwide, HIV prevalence varies from < 5% to > 80%, with annual HIV incidence between < 1% and 50%. More consistency is shown in HCV prevalence (50-90%) and incidence (10-30% per year). Host, environmental and viral factors that favor rapid spread of HCV among IDUs suggest that HCV infection in a population of injection drug users may become endemic over a relatively short period of time. Lower transmission efficiency for HIV also indicates that its spread among injection drug users may be somewhat slower. Conclusions: Successful efforts to prevent transmission of blood-borne viruses among IDUs typically result in risk reduction; however, no intervention has resulted in elimination of risk behavior. To reduce HIV transmission, risk reduction may be sufficient, whereas control of HCV may necessitate the use of injection practices that guarantee elimination of exposure to equipment contaminated with even small amounts of blood.HIV infection among people who inject drugs in the United States : Geographically explained variance across racial and ethnic groups
AbstractHagan, H. (n.d.).Publication year
2015Journal title
American journal of public healthVolume
105Issue
12Page(s)
2457-2465AbstractObjectives. We explored how variance in HIV infection is distributed across multiple geographical scales among people who inject drugs (PWID) in the United States, overall and within racial/ethnic groups. Methods. People who inject drugs (n = 9077) were recruited via respondent driven sampling from 19 metropolitan statistical areas (MSAs) for the Centers for Disease Control and Prevention's 2009 National HIV Behavioral Surveillance system. We used multilevel modeling to determine the percentage of variance in HIV infection explained by zip codes, counties, and MSAs where PWID lived, overall and for specific racial/ethnic groups. Results. Collectively, zip codes, counties, and MSAs explained 29% of variance in HIV infection.Within specific racial/ethnic groups, all 3 scales explained variance in HIV infection among non-Hispanic/Latino White PWID (4.3%, 0.2%, and 7.5%, respectively), MSAs explained variance among Hispanic/Latino PWID (10.1%), and counties explained variance among non-Hispanic/Latino Black PWID (6.9%). Conclusions. Exposure to potential determinants of HIV infection at zip codes, counties, and MSAs may vary for different racial/ethnic groups of PWID, and may reveal opportunities to identify and ameliorate intraracial inequities in exposure to determinants of HIV infection at these geographical scales.HIV infection and risk, prevention, and testing behaviors among injecting drug users - National HIV behavioral surveillance system, 20 U.S. Cities, 2009
AbstractBroz, D., Wejnert, C., Pham, H. T., DiNenno, E., Heffelfinger, J. D., Cribbin, M., Krishna, N., Teshale, E. H., Paz-Bailey, G., Taussig, J., Johnson, S., Todd, J., Flynn, C., German, D., Isenberg, D., Driscoll, M., Hurwitz, E., Prachand, N., Benbow, N., … Kuo, I. (n.d.).Publication year
2014Journal title
MMWR Surveillance SummariesVolume
63Issue
1Page(s)
1-56AbstractProblem/Condition: At the end of 2009, an estimated 1,148,200 persons aged ≥13 years were living with human immunodeficiency virus (HIV) infection in the United States. Despite the recent decreases in HIV infection attributed to injection drug use, 8% of new HIV infections in 2010 occurred among injecting drug users (IDUs). Reporting Period: June-December 2009. Description of System: The National HIV Behavioral Surveillance System (NHBS) collects HIV prevalence and risk behavior data in selected metropolitan statistical areas (MSAs) from three populations at high risk for HIV infection: men who have sex with men, IDUs, and heterosexual adults at increased risk for HIV infection. Data for NHBS are collected in rotating cycles. For the 2009 NHBS cycle, IDUs were recruited in 20 participating MSAs using respondent-driven sampling, a peer-referral sampling method. Participants were eligible if they were aged ≥18 years, lived in a participating MSA, were able to complete a behavioral survey in English or Spanish, and reported that they had injected drugs during the past 12 months. Consenting participants completed an interviewer-administered (face-to-face), anonymous standardized questionnaire about HIV-associated behaviors, and all participants were offered anonymous HIV testing. Analysis of 2009 NHBS data represents the first large assessment of HIV prevalence among IDUs in the United States in >10 years. Results: This report summarizes two separate analyses using unweighted data from 10,200 eligible IDUs in 20 MSAs from the second collection cycle of NHBS in 2009. Both an HIV infection analysis and a behavioral analysis were conducted. Different denominators were used in each analysis because of the order and type of exclusion criteria applied. For the HIV infection analysis, of the 10,200 eligible participants, 10,090 had a valid HIV test result, of whom 906 (9%) tested positive for HIV (range: 2%-19% by MSA). When 509 participants who reported receiving a previous positive HIV test result were excluded from this analysis, 4% (397 of 9,581 participants) tested HIV-positive. For the behavioral analysis, because knowledge of HIV status might influence risk behaviors, 548 participants who reported a previous HIV-positive test result were excluded from the 10,200 eligible participants. All subsequent analyses were conducted for the remaining 9,652 participants. The most commonly injected drugs during the past 12 months among these participants were heroin (90%), speedball (heroin and cocaine combined) (58%), and cocaine or crack (49%). Large percentages of participants reported receptive sharing of syringes (35%); receptive sharing of other injection equipment, such as cookers, cotton, or water (58%); and receptive sharing of syringes to divide drugs (35%). Many participants reported having unprotected sex with oppositesex partners during the past 12 months: 70% of men and 73% of women had unprotected vaginal sex, and 25% of men and 21% of women had unprotected anal sex. A combination of unsafe injection- and sex-related behaviors during the past 12 months was commonly reported; 41% of participants who reported unprotected vaginal sex with one or more opposite-sex partners, and 53% of participants who reported unprotected anal sex with one or more opposite-sex partners also reported receptive sharing of syringes. More women than men reported having sex in exchange for money or drugs (31% and 18%, respectively). Among men, 10% had oral or anal sex with one or more male partners during the past 12 months. Many participants (74%) reported noninjection drug use during the past 12 months, and 41% reported binge drinking during the past 30 days. A large percentage of participants (74%) had ever been tested for hepatitis C, 41% had received a hepatitis C virus infection diagnosis, and 29% had received a vaccination against hepatitis A virus, hepatitis B virus, or both. Most (88%) had been tested for HIV during their lifetime, and 49% had been tested during the past 12 months. Approximately half of participants receivedfree HIV prevention materials during the past 12 months, including condoms (50%) and sterile syringes (44%) and other injection equipment (41%). One third of participants had been in an alcohol or a drug treatment program, and 21% had participated in an individual- or a group-level HIV behavioral intervention. Interpretation: IDUs in the United States continue to engage in sexual and drug-use behaviors that increase their risk for HIV infection. The large percentage of participants in this study who reported engaging in both unprotected sex and receptive sharing of syringes supports the need for HIV prevention programs to address both injection and sex-related risk behaviors among IDUs. Although most participants had been tested for HIV infection previously, less than half had been tested in the past year as recommended by CDC. In addition, many participants had not been vaccinated against hepatitis A and B as recommended by CDC. Although all participants had injected drugs during the past year, only a small percentage had recently participated in an alcohol or a drug treatment program or in a behavioral intervention, suggesting an unmet need for drug treatment and HIV prevention services. Public Health Action: To reduce the number of HIV infections among IDUs, additional efforts are needed to decrease the number of persons who engage in behaviors that increase their risk for HIV infection and to increase their access to HIV testing, alcohol and drug treatment, and other HIV prevention programs. The National HIV/AIDS Strategy for the United States delineates a coordinated response to reduce HIV incidence and HIV-related health disparities among IDUs and other disproportionately affected groups. CDC's high-impact HIV prevention approach provides an essential step toward achieving these goals by using combinations of scientifically proven, cost-effective, and scalable interventions among populations at greatest risk. NHBS data can be used to monitor progress toward the national strategy goals and to guide national and local planning efforts to maximize the impact of HIV prevention programs.HIV infection during limited versus combined HIV prevention programs for IDUs in New York City : The importance of transmission behaviors
AbstractDes Jarlais, D. C., Arasteh, K., McKnight, C. A., Hagan, H., Perlman, D. C., Torian, L. V., Beatice, S., Semaan, S., & Friedman, S. R. (n.d.).Publication year
2010Journal title
Drug and alcohol dependenceVolume
109Issue
1-3Page(s)
154-160AbstractObjectives: As no single HIV prevention program has eliminated HIV transmission, there is growing interest in the effectiveness of " combined" prevention programming. To compare HIV infection among persons injecting in the initial programs environment (IPE) in New York City (self-initiated risk reduction, methadone, education/outreach, and HIV testing) to HIV infection among persons injecting in a combined programs environment (CPE) (above programs plus large-scale syringe exchange). To identify potential behavioral mechanisms through which combined programs are effective. Methods: Subjects were recruited from the Beth Israel drug detoxification program. A risk behavior questionnaire was administered and HIV testing conducted. Subjects who injected only between 1984 and 1994 (IPE) were compared to subjects who injected only between 1995 and 2008 (CPE). Results: 261 IPE subjects and 1153 CPE subjects were recruited. HIV infection was significantly lower among the CPE subjects compared to IPE subjects: prevalence 6% versus 21%, estimated incidence 0.3/100 person-years versus 4/100 person-years (both pHIV risk, prevention, and testing behaviors among heterosexuals at increased risk for HIV infection - National HIV behavioral surveillance system, 21 U.S. cities, 2010
AbstractSionean, C., Le, B. C., Hageman, K., Oster, A. M., Wejnert, C., Hess, K. L., Paz-Bailey, G., White, J., Salazar, L., Todd, J., Flynn, C., German, D., Driscoll, M., Doherty, R., Wittke, C., Prachand, N., Benbow, N., Melville, S., Sheu, S., … West, T. (n.d.).Publication year
2014Journal title
MMWR Surveillance SummariesVolume
63Issue
1Page(s)
1-39AbstractProblem/Condition: At the end of 2010, an estimated 872,990 persons in the United States were living with a diagnosis of human immunodeficiency virus (HIV) infection. Approximately one in four of the estimated HIV infections diagnosed in 2011 were attributed to heterosexual contact. Heterosexuals with a low socioeconomic status (SES) are disproportionately likely to be infected with HIV. Reporting Period: June-December 2010. Description of System: The National HIV Behavioral Surveillance System (NHBS) collects HIV prevalence and risk behavior data in selected metropolitan statistical areas (MSAs) from three populations at high risk for HIV infection: men who have sex with men, injecting drug users, and heterosexuals at increased risk for HIV infection. Data for NHBS are collected in rotating cycles in these three different populations. For the 2010 NHBS cycle among heterosexuals, men and women were eligible to participate if they were aged 18-60 years, lived in a participating MSA, were able to complete a behavioral survey in English or Spanish, and reported engaging in vaginal or anal sex with one or more opposite-sex partners in the 12 months before the interview. Persons who consented to participate completed an interviewer-administered, standardized questionnaire about HIVassociated behaviors and were offered anonymous HIV testing. Participants were sampled using respondent-driven sampling, a type of chain-referral sampling. Sampling focused on persons of low SES (i.e., income at the poverty level or no more than a high school education) because results of a pilot study indicated that heterosexual adults of low SES were more likely than those of high SES to be infected with HIV. To assess risk and testing experiences among persons at risk for acquiring HIV infection through heterosexual sex, analyses excluded participants who were not low SES, those who reported ever having tested positive for HIV, and those who reported recent (i.e., in the 12 months before the interview) male-male sex or injection drug use. This report summarizes unweighted data regarding HIV-associated risk, prevention, and testing behaviors from 9,278 heterosexual men and women interviewed in 2010 (the second cycle of NHBS data collection among heterosexuals). Results: The median age of participants was 35 years; 47% were men. The majority of participants were black or African American (hereafter referred to as black) (72%) or Hispanic/Latino (21%). Most participants (men: 88%; women: 90%) reported having vaginal sex without a condom with one or more opposite-sex partners in the past 12 months; approximately one third (men: 30%; women: 29%) reported anal sex without a condom with one or more opposite-sex partners. The majority of participants (59%) reported using noninjection drugs in the 12 months before the interview; nearly one in seven (15%) had used crack cocaine. Although most participants (men: 71%; women: 77%) had ever been tested for HIV, this percentage was lower among Hispanic/Latino participants (men: 52%; women: 62%). Approximately one third (34%) of participants reported receiving free condoms in the 12 months before the interview; 11% reported participating in a behavioral HIV prevention program. Interpretation: A substantial proportion of heterosexuals interviewed for the 2010 NHBS heterosexual cycle reported engaging in behaviors that increase the risk for HIV infection. However, HIV testing was suboptimal among the overall sample, including among groups disproportionately affected by HIV infection (i.e., blacks and Hispanics/Latinos). Public Health Action: Increasing coverage of HIV testing and other HIV prevention services among heterosexuals at increased risk is important, especially among groups disproportionately affected by HIV infection, such as blacks and Hispanics/Latinos. The National HIV/AIDS Strategy for the United States delineates a coordinated national response to reduce infections and HIVrelated health disparities among disproportionately affected groups. NHBS data can guide national and local planning efforts maximize the impact of HIV prevention programs.HIV/hepatitis C virus co-infection in drug users : Risk behavior and prevention
AbstractHagan, H., Thiede, H., & Des Jarlais, D. C. (n.d.).Publication year
2005Journal title
AIDSVolume
19Issue
SUPPL. 3Page(s)
S199-S207AbstractStudies of HIV-positive patients have consistently shown that drug users, in particular injection drug users (IDU), are far more likely to have hepatitis C virus (HCV) infection than other patient groups. HIV incidence and prevalence in IDU has declined in recent years, but HCV remains endemic in this population. HCV antibody prevalence among non-injection users of drugs such as heroin and cocaine is between 5 and 30%, although there are scant data on specific transmission risk behavior. The control of HIV/HCV co-infection must address HCV prevention. Epidemiological studies have suggested that HCV prevalence in IDU is subject to various influences, some of which may be modifiable by interventions. However, studies have not shown consistent effects of various prevention strategies on HCV transmission, including studies of HCV screening and education, drug treatment or needle exchange. Although some large cross-sectional studies in regions where needle exchange is available to a large number of drug injectors have reported declining HCV prevalence, the scale of services needed is a matter of considerable debate and has not been systematically quantified. Priorities for research related to the prevention of HIV/HCV co-infection should include estimating the effect on disease occurrence of eliminating specific risk factors, and specifying the level of resources needed to alter HCV incidence.HSV-2 co-infection as a driver of HIV transmission among heterosexual non-injecting drug users in New York City
AbstractDes Jarlais, D. C., Arasteh, K., McKnight, C. A., Perlman, D. C., Feelemyer, J., Hagan, H., & Cooper, H. L. (n.d.).Publication year
2014Journal title
PloS oneVolume
9Issue
1AbstractObjective: To examine herpes simplex virus 2 (HSV-2)/HIV co-infection as a contributing factor in the increase in HIV infection among non-injecting heroin and cocaine users in New York City. Methods: Subjects were recruited from the Beth Israel Medical Center drug detoxification and methadone maintenance programs in New York City in 1995-1999 and 2005-2011. All reported current heroin and/or cocaine use and no injection drug use. A structured questionnaire was administered and serum samples collected for HIV and HSV-2 testing. Population-attributable risk percentages (PAR%s) were estimated for associations between HSV-2 and increased susceptibility to and increased transmissibility of HIV among female NIDUs. Results: 785 subjects were recruited from 1995-1999, and 1764 subjects from 2005-2011. HIV prevalence increased from 7% to 13%, with nearly uniform increases among all demographic subgroups. HSV-2/HIV co-infection was common in both time periods, with an average (over the two time periods) of 80% of HIV negative females infected with HSV-2, an average of 43% of HIV negative males infected with HSV-2; an average of 97% of HIV positive females also infected with HSV-2 and an average of 67% of HIV positive males also infected with HSV-2. The increase in HIV prevalence was predominantly an increase in HSV-2/HIV co-infection, with relatively little HIV mono-infection in either time period. The estimated PAR%s indicate that approximately half of HIV acquisition among females was caused by HSV-2 infection and approximately 60% of HIV transmission from females was due to HSV-2 co-infection. Conclusions: The increase in HIV infection among these non-injecting drug users is better considered as an increase in HSV-2/HIV co-infection rather than simply an increase in HIV prevalence. Additional interventions (such as treatment as prevention and suppressing the effects of HSV-2 on HIV transmission) are needed to reduce further HIV transmission from HSV-2/HIV co-infected non-injecting drug users.HSV-2 Infection as a Cause of Female/Male and Racial/Ethnic Disparities in HIV Infection
AbstractDes Jarlais, D. C., Arasteh, K., McKnight, C. A., Perlman, D. C., Cooper, H. L., & Hagan, H. (n.d.).Publication year
2013Journal title
PloS oneVolume
8Issue
6AbstractObjectives:To examine the potential contribution of herpes simplex virus 2 (HSV-2) infection to female/male and racial/ethnic disparities in HIV among non-injecting heroin and cocaine drug users. HSV-2 infection increases susceptibility to HIV infection by a factor of two to three.Methods:Subjects were recruited from entrants to the Beth Israel drug detoxification program in New York City 2005-11. All subjects reported current use of heroin and/or cocaine and no lifetime injection drug use. A structured questionnaire was administered and serum samples collected for HIV and HSV-2 testing. Population-attributable risk percentages (PAR%s) were calculated for associations between HSV-2 infection and increased susceptibility to HIV.Results:1745 subjects were recruited from 2005-11. Overall HIV prevalence was 14%. Females had higher prevalence than males (22% vs. 12%) (pHTLV-2 infection in injection drug users in King County, Washington
AbstractZunt, J., Tapia, K., Thiede, H., Lee, R., & Hagan, H. (n.d.).Publication year
2006Journal title
Scandinavian Journal of Infectious DiseasesVolume
38Issue
8Page(s)
654-663AbstractHuman T-cell lymphotropic virus type 2 (HTLV-2) is endemic in injection drug users (IDU), and native American populations in the Americas. Transmission is associated with high-risk injection and sexual practices. A cohort of 2561 IDU in King County, Washington completed 2 study visits over 1 y. HTLV-2 infection was detected in 190 (7.4%) of 2561 IDU, and 13 (7.8 cases per 1000 person-y) incident infections occurred during the study. Prevalent infection was associated with female gender, non-white race, longer duration as IDU, having a tattoo, combined injection of heroin and cocaine, and with serologic evidence of hepatitis B and C infection. Seroconversion was more common in women, and was associated with African American race, heterosexual identity and longer duration as IDU. In conclusion, increased risk of HTLV-2 infection was associated with non-white race, and injection drug of choice, suggesting injection networks may play an important role in transmission of HTLV-2. The high correlation of HTLV-2 infection with HCV infection suggests the major route of transmission in IDU is via injection practices. Additional studies are needed to examine the clinical manifestations of HTLV-2 infection, as well as the clinical and virological manifestations of HTLV-2/HCV coinfection.Hybrid STTR intervention for heterosexuals using anonymous HIV testing and confidential linkage to care : A single arm exploratory trial using respondent-driven sampling
AbstractGwadz, M., Cleland, C. M., Leonard, N. R., Kutnick, A., Ritchie, A. S., Banfield, A., Hagan, H., Perlman, D. C., McCright-Gill, T., Sherpa, D., & Martinez, B. Y. (n.d.).Publication year
2015Journal title
BMC public healthVolume
15Issue
1AbstractBackground: An estimated 14 % of the 1.2 million individuals living with HIV in the U.S. are unaware of their status. Yet this modest proportion of individuals with undiagnosed HIV is linked to 44-66 % of all new infections. Thus innovative intervention approaches are needed to seek out and test those with undiagnosed HIV, and link them to HIV treatment with high retention, an approach referred to as "Seek, Test, Treat, and Retain" (STTR). The present protocol describes a creative "hybrid" STTR approach that uses anonymous HIV testing followed by confidential care linkage, focused on heterosexuals at high risk (HHR) for HIV, who do not test as frequently as, and are diagnosed later, than other risk groups. Methods/Design: This is a single-arm exploratory intervention efficacy trial. The study has two phases: one to seek out and test HHR, and another to link those found infected to HIV treatment in a timely fashion, with high retention. We will recruit African American/Black and Latino adult HHR who reside in urban locations with high poverty and HIV prevalence. Participants will be recruited with respondent-driven sampling, a peer recruitment method. The "Seek and Test" phase is comprised of a brief, convenient, single-session, anonymous HIV counseling and testing session. The "Treat and Retain" component will engage those newly diagnosed with HIV into a confidential research phase and use a set of procedures called care navigation to link them to HIV primary care. Participants will be followed for 6 months with objective assessment of outcomes (using medical records and biomarkers). Discussion: Undiagnosed HIV infection is a major public health problem. While anonymous HIV testing is an important part of the HIV testing portfolio, it does not typically include linkage to care. The present study has potential to produce an innovative, brief, cost-effective, and replicable STTR intervention, and thereby reduce racial/ethnic disparities in HIV/AIDS. Trial Registration: ClinicalTrials.gov, NCT02421159, Registered April 15, 2015.Illicit drug use and HIV risk in the Dominican Republic : Tourism areas create drug use opportunities
AbstractGuilamo-Ramos, V., Lee, J. J., Ruiz, Y., Hagan, H., Delva, M., Quiñones, Z., Kamler, A., & Robles, G. (n.d.).Publication year
2015Journal title
Global Public HealthVolume
10Issue
3Page(s)
318-330AbstractWhile the Caribbean has the second highest global human immunodeficiency virus (HIV) prevalence, insufficient attention has been paid to contributing factors of the region's elevated risk. Largely neglected is the potential role of drugs in shaping the Caribbean HIV/acquired immune deficiency syndrome epidemic. Caribbean studies have almost exclusively focused on drug transportation and seldom acknowledged local user economies and drug-related health and social welfare consequences. While tourism is consistently implicated within the Caribbean HIV epidemic, less is known about the intersection of drugs and tourism. Tourism areas represent distinct ecologies of risk often characterised by sex work, alcohol consumption and population mixing between lower and higher risk groups. Limited understanding of availability and usage of drugs in countries such as the Dominican Republic (DR), the Caribbean country with the greatest tourist rates, presents barriers to HIV prevention. This study addresses this gap by conducting in-depth interviews with 30 drug users in Sosúa, a major sex tourism destination of the DR. A two-step qualitative data analysis process was utilised and interview transcripts were systematically coded using a well-defined thematic codebook. Results suggest three themes: (1) local demand shifts drug routes to tourism areas, (2) drugs shape local economies and (3) drug use facilitates HIV risk behaviours in tourism areas.Impact of the September 11th attacks in New York City on drug users : A preliminary assessment
AbstractDeren, S., Shedlin, M., Hamilton, T., & Hagan, H. (n.d.).Publication year
2002Journal title
Journal of Urban HealthVolume
79Issue
3Page(s)
409-412AbstractAn exploratory assessment of the impact of the September 11th attacks in New York City on drug users, including their perceptions of changes in drug use, drug availability, police activities, and access to services, was undertaken. Methods included focus groups with drug users and acquired immunodeficiency syndrome (AIDS) outreach worker supervisors and surveys of service providers. Results indicated that, while there was some immediate concern about the potential impact on drug availability, there was no perceived scarcity, although some drug users did report a decrease in drug purity. Responses included increased use of drugs and increased demand for drug treatment. The wide range of responses indicates that continued monitoring of the impact may be needed to assess long-term effects.Improved injection network ascertainment with supplementary elicitation techniques
AbstractBrewer, D. D., Hagan, H., & Hough, E. S. (n.d.).Publication year
2008Journal title
International Journal of STD and AIDSVolume
19Issue
3Page(s)
188-191AbstractPrior research indicates that injection drug users forget substantial proportions of their injection partners when asked to recall them. Such under-reporting hampers both ascertainment of the injection networks that underlie transmission of blood-borne pathogens and contact-tracing efforts for disease control. We report here an evaluation of supplementary elicitation techniques - a set of prompting strategies and recall cues - employed in a study that involved tracing of injection partners. Sixty-one index drug injectors in Seattle participated in the study. The supplementary partner elicitation techniques enhanced recall of injection partners substantially and identified persons relevant to transmission of blood-borne pathogens. As a set, the supplementary techniques elicited additional partners from 70% of injectors, and the additional partners elicited represent a 75% increase on average. Drug injectors who recalled many partners before administration of the supplementary techniques tended to report more additional partners in response to the supplementary techniques than injectors who freely recalled few partners. In addition, partners elicited by the supplementary techniques were as likely as freely recalled partners to test positive for hepatitis C virus antibody and engage in risk behaviour with indexes. Furthermore, we found that the supplementary techniques boosted connectivity in the observed injection network considerably.Incidence and prevalence of hepatitis C in prisons and other closed settings : Results of a systematic review and meta-analysis
AbstractLarney, S., Kopinski, H., Beckwith, C. G., Zaller, N. D., Jarlais, D. D., Hagan, H., Rich, J. D., van den Bergh, B. J., & Degenhardt, L. (n.d.).Publication year
2013Journal title
HepatologyVolume
58Issue
4Page(s)
1215-1224AbstractPeople detained in prisons and other closed settings are at elevated risk of infection with hepatitis C virus (HCV). We undertook a systematic review and meta-analysis with the aim of determining the rate of incident HCV infection and the prevalence of anti-HCV among detainees in closed settings. We systematically searched databases of peer-reviewed literature and widely distributed a call for unpublished data. We calculated summary estimates of incidence and prevalence among general population detainees and detainees with a history of injection drug use (IDU), and explored heterogeneity through stratification and meta-regression. The summary prevalence estimates were used to estimate the number of anti-HCV positive prisoners globally. HCV incidence among general detainees was 1.4 per 100 person-years (py; 95% confidence interval [CI]: 0.1, 2.7; k=4), and 16.4 per 100 py (95% CI: 0.8, 32.1; k=3) among detainees with a history of IDU. The summary prevalence estimate of anti-HCV in general detainees was 26% (95% CI: 23%, 29%; k=93), and in detainees with a history of IDU, 64% (95% CI: 58%, 70%; k=51). The regions of highest prevalence were Central Asia (38%; 95% CI 32%, 43%; k=1) and Australasia (35%; 95% CI: 28%, 43%; k=9). We estimate that 2.2 million (range: 1.4-2.9 million) detainees globally are anti-HCV positive, with the largest populations in North America (668,500; range: 553,500-784,000) and East and Southeast Asia (638,000; range: 332,000-970,000). Conclusion: HCV is a significant concern in detained populations, with one in four detainees anti-HCV-positive. Epidemiological data on the extent of HCV infection in detained populations is lacking in many countries. Greater attention towards prevention, diagnosis, and treatment of HCV infection among detained populations is urgently required.Incidence of sexually transmitted hepatitis C virus infection in HIV-positive men who have sex with men
AbstractHagan, H., Jordan, A. E., Neurer, J., & Cleland, C. M. (n.d.).Publication year
2015Journal title
AIDSVolume
29Issue
17Page(s)
2335-2345AbstractObjective: The epidemiology of the incidence of sexually transmitted hepatitis C virus (HCV) infection in HIV-positive men who have sex with men (MSM) is only partially understood. In the presence of HIV, HCV infection is more likely to become chronic and liver fibrosis progression is accelerated. Design: A systematic review and meta-analysis was used to synthesize data characterizing sexually transmitted HCV in HIV-positive MSM. Methods: Electronic and other searches of medical literature (including unpublished reports) were conducted. Eligible studies reported on HCV seroconversion or on reinfection postsuccessful HCV treatment in HIV-positive MSM who were not injecting drugs. Pooled incidence rates were calculated using random-effects meta-analysis, and meta-regression was used to assess study-level moderators. Attributable risk measures were calculated from statistically significant associations between exposures and HCV seroconversion. Results: More than 13000 HIV-positive MSM in 17 studies were followed for more than 91000 person-years between 1984 and 2012; the pooled seroconversion rate was 0.53/100 person-years. Calendar time was a significant moderator of HCV seroconversion, increasing from an estimated rate of 0.42/100 person-years in 1991 to 1.09/100 person-years in 2010, and 1.34/100 person-years in 2012. Reinfection postsuccessful HCV treatment (n=2 studies) was 20 times higher than initial seroconversion rates. Among the seroconverters, a large proportion of infections were attributable to high-risk behaviours including mucosally traumatic sex and sex while high on methamphetamine. Conclusion: The high reinfection rates and the attributable risk analysis suggest the existence of a subset of HIV-positive MSM with recurring sexual exposure to HCV. Approaches to HCV control in this population will need to consider the changing epidemiology of HCV infection in MSM.Increased access to unrestricted pharmacy sales of syringes in Seattle-King County, Washington : Structural and individual-level changes, 1996 versus 2003
AbstractDeibert, R. J., Goldbaum, G., Parker, T. R., Hagan, H., Marks, R., Hanrahan, M., & Thiede, H. (n.d.).Publication year
2006Journal title
American journal of public healthVolume
96Issue
8Page(s)
1347-1353AbstractWe examined pharmacists' attitudes and practices related to syringe sales to injection drug users before and after legal reform and local programming to enhance sterile syringe access. We replicated a 1996 study by conducting pharmacist phone surveys and syringe test-buys in randomly selected pharmacies. Test-buy success increased from 48% in 1996 to 65% in 2003 (P=.04). Pharmacists agreeing that syringes should be available to injection drug users through pharmacy purchase increased from 49% to 71% (P"Informed Altruism" and "Partner Restriction" in the Reduction of HIV Infection in Injecting Drug Users Entering Detoxification Treatment in New York City, 1990-2001
AbstractDes Jarlais, D. C., Perlis, T., Arasteh, K., Hagan, H., Milliken, J., Braine, N., Yancovitz, S., Mildvan, D., Perlman, D. C., Maslow, C., & Friedman, S. R. (n.d.).Publication year
2004Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
35Issue
2Page(s)
158-166AbstractObjective: To assess recent developments in the HIV epidemic in injecting drug users (IDUs) in New York City. With >50,000 cases of AIDS in IDUs, New York has experienced the largest HIV/AIDS epidemic in IDUs of any city in the world. Methods: Serial cross-sectional surveys conducted continuously from 1990 to 2001 of IDUs entering the Beth Israel Medical Center (BIMC) drug detoxification program in New York City. HIV serostatus, use of prevention services, and risk behaviors were measured. Individuals were permitted to participate multiple times in the surveys but not more than once in any year. Results: Two thousand eight hundred eighty-seven individuals contributed 3100 observations from 1990 to 2001. There was a substantial and consistent decline in the prevalence of HIV infection among IDUs entering the BIMC detoxification program, from 54% (165/304) in 1991 to 13% (39/303) in 2001 (P < 0.0001). The decline was highly linear, with r2 = 0.92 and a slope of -3.7% in seroprevalence per year. The decline occurred for both males and females, both short and long-term IDUs, and the three largest racial/ethnic sub-groups (all P < 0.001 by Cochran-Armitage testing). Use of HIV prevention services increased substantially, particularly syringe exchange and voluntary HIV counseling and testing. General reductions in injection risk behaviors occurred, but substantial numbers of IDUs continued to engage in both receptive and distributive syringe sharing. Two conditional types of risk reduction not currently recommended by health authorities were reported: "informed altruism," in which persons who knew that they were HIV seropositive reduced transmission behavior, and "partner restriction," in which persons who shared needles and syringes primarily confined this sharing within small social networks. Conclusions: HIV infection continues to decline in this population of IDUs in New York City, suggesting the possibility of bringing very high prevalence epidemics under control. Risk elimination may not be required; rather, multiple forms of risk reduction may be effective in reducing HIV transmission within a local population of IDUs.Injecting alone among young adult IDUs in five US cities : Evidence of low rates of injection risk behavior
AbstractHagan, H., Campbell, J. V., Thiede, H., Strathdee, S. A., Ouellet, L., Latka, M., Hudson, S., & Garfein, R. S. (n.d.).Publication year
2007Journal title
Drug and alcohol dependenceVolume
91Issue
SUPPL. 1Page(s)
S48-S55AbstractIllicit drug injection typically occurs in private or semi-public settings where two or more injectors are present. In a large sample of young adult injectors (aged 15-30) in five US cities, we describe those who reported consistently injecting by themselves in a recent period. Among 3199 eligible subjects, 85% were male, median age was 24 years, and median number of years injecting was four. Fifteen percent (n = 467) who reported always injecting alone in the previous 3 months were compared to other IDUs to understand the relationship between this practice and injection risk behavior. IDUs who reported injecting alone were substantially less likely to report injection with a syringe (AOR = 0.16, 95% CI 0.1-0.2) or other drug preparation equipment (AOR = 0.17, 95% CI 0.13-0.2) previously used by another injector. Markedly low rates of injection risk behavior were observed in IDUs who reported injecting alone; this practice may facilitate safe injection by granting the individual greater control over the injection setting. However, risks may include accidental overdose with severe consequences.Injection drug use and emerging blood-borne diseases [2]
AbstractHagan, H., Des Jarlais, D. C., Stimson, G. V., Hagan, H., & Friedman, S. R. (n.d.).Publication year
1996Journal title
Journal of the American Medical AssociationVolume
276Issue
13Abstract~Integrating Harm Reduction into Medical Care : Lessons from Three Models
AbstractChang, J. E., Lindenfeld, Z., & Hagan, H. (n.d.).Publication year
2023Journal title
Journal of the American Board of Family MedicineVolume
36Issue
3Page(s)
449-461AbstractBackground: Substance use disorders (SUDs) are at a national high, with significant morbidity and mortality. Harm reduction, a public-health strategy aimed at reducing the negative consequences of a risky behavior without necessarily eliminating the behavior, represents a useful approach to engage patients with SUDs in care. The objective of this article is to describe how 3 medical practices operationalized harm reduction as a framework toward patient care and identify the common practices undertaken across these settings to integrate harm reduction and medical care. Methods: We conducted a qualitative study using in-depth, semistructured interviews with 20 staff and providers at 3 integrated harm reduction and medical care sites across New York State from March to June 2021. Interview questions focused on how harm reduction approaches were implemented, how harm reduction philosophies were demonstrated in practice, and barriers to adoption. Results: The interviews resulted in 8 main themes of integrated harm reduction medical care: 1) role of provider as both learner and informer; 2) pragmatic measures of success; 3) collaborative and interdisciplinary care teams; 4) developing a stigma-free culture; 5) creating a comfortable and welcoming physical space; 6) low-threshold care with flexible scheduling; and; 7) reaching beyond the clinic to disseminate harm reduction orientation; and 8) creating robust referral networks to enhance transitions of care. These themes existed at the patient-provider level (#1 to 3), the organizational level (#4 to 6), and the level extending beyond the clinic (#7 to 8). Conclusions: All 3 sites followed 8 common themes in delivering harm reduction–informed care, most of which are consistent with the broader movement toward patient-centered care. These practices demonstrate how medical providers may overcome some of the barriers imposed by the medical model and successfully integrate harm reduction as an orienting framework toward care delivery. (J Am Board Fam Med 2023;36:449–461.)