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
A peer-education intervention to reduce injection risk behaviors for HIV and hepatitis C virus infection in young injection drug users
AbstractGarfein, R. S., Golub, E. T., Greenberg, A. E., Hagan, H., Hanson, D. L., Hudson, S. M., Kapadia, F., Latka, M. H., Ouellet, L. J., Purcell, D. W., Strathdee, S. A., & Thiede, H. (n.d.).Publication year
2007Journal title
AIDSVolume
21Issue
14Page(s)
1923-1932AbstractOBJECTIVES: To evaluate whether a behavioral intervention, which taught peer education skills, could reduce injection and sexual risk behaviors associated with primary HIV and hepatitis C virus infection (HCV) among young injection drug users (IDU). DESIGN: We conducted a randomized controlled trial involving HIV and HCV antibody-negative IDU, aged 15-30 years, recruited in five United States cities. A six-session, small-group, cognitive behavioral, skills-building intervention in which participants were taught peer education skills (n = 431) was compared with a time-equivalent attention control (n = 423). Baseline visits included interviews for sociodemographic, psychosocial, and behavioral factors during the previous 3 months; HIV and HCV antibody testing; and pre/posttest counselling. Procedures were repeated 3 and 6 months postintervention. RESULTS: The intervention produced a 29% greater decline in overall injection risk 6 months postintervention relative to the control [proportional odds ratio 0.71; 95% confidence limit (CL) 0.52, 0.97], and a 76% decrease compared with baseline. Decreases were also observed for sexual risk behaviors, but they did not differ by trial arm. Overall HCV infection incidence (18.4/100 person-years) did not differ significantly across trial arms (relative risk 1.15; 95% CL 0.72, 1.82). No HIV seroconversions were observed. CONCLUSION: Interventions providing information, enhancing risk-reduction skills, and motivating behavior change through peer education training can reduce injection risk behaviors, although risk elimination might be necessary to prevent HCV transmission.Convenience is the key to hepatitis A and B vaccination uptake among young adult injection drug users
AbstractCampbell, J. V., Garfein, R. S., Thiede, H., Hagan, H., Ouellet, L. J., Golub, E. T., Hudson, S. M., Ompad, D. C., & Weinbaum, C. (n.d.).Publication year
2007Journal title
Drug and alcohol dependenceVolume
91Issue
SUPPL. 1Page(s)
S64-S72AbstractBackground: Despite CDC recommendations to vaccinate injection drug users (IDUs) against hepatitis A virus (HAV) and hepatitis B virus (HBV) infections, coverage remains low. Vaccination programs convenient to IDUs have not been widely implemented or evaluated. We assessed whether convenience and monetary incentives influenced uptake of free vaccine by 18-30-year-old IDUs in five U.S. cities. Methods: IDUs recruited from community settings completed risk behavior self-interviews and testing for antibodies to HAV (anti-HAV) and hepatitis B core antigen (anti-HBc). Vaccine was offered presumptively at pre-test (except in Chicago); on-site availability and incentives for vaccination differed by site, creating a quasi-experimental design. Results: Of 3181 participants, anti-HAV and anti-HBc seroprevalence was 19% and 23%, respectively. Although 83% of participants were willing to be vaccinated, only 36% received ≥1 dose, which varied by site: Baltimore (83%), Seattle (33%), Los Angeles (18%), New York (17%), and Chicago (2%). Participation was highest when vaccine was available immediately on-site and lowest when offered only after receiving results. Monetary incentives may have increased participation when on-site vaccination was not available. Conclusion: IDUs were willing to be vaccinated but immediate, on-site availability was critical for uptake. Convenience should be a key consideration in designing strategies to increase vaccine coverage among IDUs.Convergence of HIV seroprevalence among injecting and non-injecting drug users in New York City
AbstractDes Jarlais, D. C., Arasteh, K., Perlis, T., Hagan, H., Abdul-Quader, A., Heckathorn, D. D., McKnight, C. A., Bramson, H., Nemeth, C., Torian, L. V., & Friedman, S. R. (n.d.).Publication year
2007Journal title
AIDSVolume
21Issue
2Page(s)
231-235AbstractOBJECTIVE: To compare HIV prevalence among injecting and non-injecting heroin and cocaine users in New York City. As HIV is efficiently transmitted through the sharing of drug-injecting equipment, HIV infection has historically been higher among injecting drug users. DESIGN: Two separate cross-sectional surveys, both with HIV counseling and testing and drug use and HIV risk behavior questionnaires. METHODS: Injecting and non-injecting heroin and cocaine users recruited at detoxification and methadone maintenance treatment from 2001-2004 (n = 2121) and recruited through respondent-driven sampling from a research storefront in 2004 (n = 448). RESULTS: In both studies, HIV prevalence was nearly identical among current injectors (injected in the last 6 months) and heroin and cocaine users who had never injected: 13% [95% confidence interval (CI), 12-15%] among current injectors and 12% (95% CI, 9-16%) among never-injectors in the drug treatment program study, and 15% (95% CI, 11-19%) among current injectors and 17% (95% CI, 12-21%) among never injectors in the respondent driven sampling storefront study. The 95% CIs overlapped in all gender and race/ethnicity subgroup comparisons of HIV prevalence in both studies. CONCLUSIONS: The very large HIV epidemic among drug users in New York City appears to be entering a new phase, in which sexual transmission is of increasing importance. Additional prevention programs are needed to address this transition.Correlates of drug treatment program staff's self efficacy to support their clients' hepatitis C virus (HCV) related needs
AbstractStrauss, S. M., Astone-Twerell, J. M., Munoz-Plaza, C., Jarlais, D. C., Gwadz, M., Hagan, H., Osborne, A., & Rosenblum, A. (n.d.).Publication year
2007Journal title
American Journal of Drug and Alcohol AbuseVolume
33Issue
2Page(s)
245-251AbstractDrug treatment staff are uniquely situated to support their clients' HCV related needs, and those with greater self efficacy to do so are more likely to provide this support. Using data collected from staff (N = 140) in 6 drug treatment programs in New York City, we determined the correlates of this self efficacy. Results indicate that medically credentialed staff and staff with more hepatitis C knowledge have greater self efficacy to support their clients' HCV related needs. There was no relationship between this self efficacy and the staff member's own HCV infection or that of a close relative. Efforts should focus on increasing staff's HCV knowledge in order to increase their confidence in providing HCV related support to their clients.Design and feasibility of a randomized behavioral intervention to reduce distributive injection risk and improve health-care access among hepatitis C virus positive injection drug users : The Study to Reduce Intravenous Exposures (STRIVE)
AbstractKapadia, F., Latka, M. H., Hagan, H., Golub, E. T., Campbell, J. V., Coady, M. H., Garfein, R. S., Thomas, D. L., Bonner, S., Thiel, T., & Strathdee, S. A. (n.d.).Publication year
2007Journal title
Journal of Urban HealthVolume
84Issue
1Page(s)
99-115AbstractHepatitis C virus (HCV) is hyperendemic among injection drug users (IDUs). However, few scientifically proven interventions to prevent secondary transmission of HCV from infected IDUs to others exist. This report describes the design, feasibility, and baseline characteristics of participants enrolled in the Study to Reduce Intravenous Exposure (STRIVE). STRIVE was a multisite, randomized-control trial to test a behavioral intervention developed to reduce distribution of used injection equipment (needles, cookers, cottons, and rinse water) and increase health-care utilization among antibody HCV (anti-HCV) positive IDUs. STRIVE enrolled anti-HCV positive IDU in Baltimore, New York City, and Seattle; participants completed behavioral assessments and venipuncture for HIV, HCV-RNA, and liver function tests (LFTs) and were randomized to attend either a six-session, small-group, peer-mentoring intervention workshop or a time-matched, attention-control condition. Follow-up visits were conducted at 3 and 6 months. At baseline, of the 630 HCV-positive IDUs enrolled (mean age of 26 years, 60% white, 76% male), 55% reported distributive needle sharing, whereas 74, 69, and 69% reported sharing cookers, cottons, and rinse water, respectively. Health-care access was low, with 41% reporting an emergency room as their main source of medical care. Among those enrolled, 66% (418/630) were randomized: 53% (222/418) and 47% (196/418) to the intervention and control conditions, respectively. Follow-up rates were 70 and 73% for the 3- and 6-month visits, respectively. As distributive sharing of used injection equipment was common while reports of receiving HCV care were low, these findings indicate an urgent need for HCV-related interventions with IDUs and demonstrate the acceptability and feasibility to do so.Distributive syringe sharing among young adult injection drug users in five U.S. cities
AbstractGolub, E. T., Strathdee, S. A., Bailey, S. L., Hagan, H., Latka, M. H., Hudson, S. M., & Garfein, R. S. (n.d.).Publication year
2007Journal title
Drug and alcohol dependenceVolume
91Issue
SUPPL. 1Page(s)
S30-S38AbstractBlood-borne pathogens such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are transmitted most commonly among injection drug users (IDUs) through the sharing of needles and syringes. Distributive syringe sharing (DSS) (i.e., passing on a used needle/syringe to another IDU) poses the potential risk of transmitting HIV and viral hepatitis to others. We studied the prevalence and correlates of DSS among IDUs enrolled in a randomized behavioral intervention trial designed to reduce behaviors associated with HIV and HCV transmission in five U.S. cities. Among 3129 IDUs ages 15-30 years who completed the baseline visit, 1432 (45.8%) engaged in DSS during the 3 months prior to baseline. Significant correlates of DSS were perception that peer norms condone needle sharing, frequent injection, not obtaining most syringes from needle exchange programs or pharmacies, injecting most frequently in shooting galleries and with sex partners, low perceived risk of HIV from sharing syringes, increased anxiety, low self-esteem, and having unprotected sex. Restricting to only those IDUs who reported not injecting with previously used syringes, similar independent correlates of DSS were found. These findings suggest that interventions to reduce ongoing transmission of blood-borne infections should focus on altering peer norms among networks of young IDUs.Drug treatment program patients' hepatitis C virus (HCV) education needs and their use of available HCV education services
AbstractStrauss, S. M., Astone-Twerell, J., Munoz-Plaza, C. E., Des Jarlais, D. C., Gwadz, M., Hagan, H., Osborne, A., & Rosenblum, A. (n.d.).Publication year
2007Journal title
BMC health services researchVolume
7AbstractBackground. In spite of the disproportionate prevalence of hepatitis C virus (HCV) infection among drug users, many remain uninformed or misinformed about the virus. Drug treatment programs are important sites of opportunity for providing HCV education to their patients, and many programs do, in fact, offer this education in a variety of formats. Little is known, however, about the level of HCV knowledge among drug treatment program patients, and the extent to which they utilize their programs' HCV education services. Methods. Using data collected from patients (N = 280) in 14 U.S. drug treatment programs, we compared patients who reported that they never injected drugs (NIDUs) with past or current drug injectors (IDUs) concerning their knowledge about HCV, whether they used HCV education opportunities at their programs, and the facilitators and barriers to doing so. All of the programs were participating in a research project that was developing, implementing, and evaluating a staff training to provide HCV support to patients. Results. Although IDUs scored higher on an HCV knowledge assessment than NIDUs, there were many gaps in HCV knowledge among both groups of patients. To address these knowledge gaps, all of the programs offered at least one form of HCV education: all offered 1:1 sessions with staff, 12 of the programs offered HCV education in a group format, and 11 of the programs offered this education through pamphlets/books. Only 60% of all of the participating patients used any of their programs' HCV education services, but those who did avail themselves of these HCV education opportunities generally assessed them positively. In all, many patients were unaware that HCV education was offered at their programs through individual sessions with staff, group meetings, and books/pamphlets, (42%, 49%, and 46% of the patients, respectively), and 22% were unaware that any HCV education opportunities existed. Conclusion. Efforts especially need to focus on ensuring that all drug treatment program patients are made aware of and encouraged to use HCV education services at their programs.HCV Synthesis Project : Preliminary analyses of HCV prevalence in relation to age and duration of injection
AbstractHagan, H., Des Jarlais, D. C., Stern, R., Lelutiu-Weinberger, C., Scheinmann, R., Strauss, S., & Flom, P. L. (n.d.).Publication year
2007Journal title
International Journal of Drug PolicyVolume
18Issue
5Page(s)
341-351AbstractEarly acquisition of hepatitis C virus (HCV) infection appears to affect a substantial proportion of injection drug users (IDUs)-between 20 percent and 90 percent. Analysing the range of HCV prevalence estimates in new injectors may help identify factors that can be modified to reduce HCV transmission. The HCV Synthesis Project is a meta-analysis of studies of HCV epidemiology and prevention in drug users worldwide. In this preliminary analysis, we examined data from 127 studies of IDUs that reported HCV prevalence in relation to age or year since onset of drug injection, analysing heterogeneity and calculating summary statistics where appropriate. Six studies reported gender-specific HCV prevalence rates among young or new injectors; the group mean prevalence was 47 percent for men and 44 percent for women (NS). Group mean age for HCV-negatives was 24.7 years (range 24-28) and 26.1 years (range 21-31) for HCV-positives (n = 8 studies). Data were examined from 13 studies that compared HCV prevalence among young injectors to older injectors using 5-year age categories; substantial variation was present within these categories such that measures of central tendency were not calculated. Similarly, among studies reporting HCV prevalence among IDUs in relation to 1-year intervals of duration of injection (Herpes simplex virus-2 and HIV among noninjecting drug users in New York City
AbstractDes Jarlais, D. C., Hagan, H., Arasteh, K., McKnight, C. A., 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.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.Methods to recruit and retain a cohort of young-adult injection drug users for the Third Collaborative Injection Drug Users Study/Drug Users Intervention Trial (CIDUS III/DUIT)
AbstractGarfein, R. S., Swartzendruber, A., Ouellet, L. J., Kapadia, F., Hudson, S. M., Thiede, H., Strathdee, S. A., Williams, I. T., Bailey, S. L., Hagan, H., Golub, E. T., Kerndt, P., Hanson, D. L., & Latka, M. H. (n.d.).Publication year
2007Journal title
Drug and alcohol dependenceVolume
91Issue
SUPPL. 1Page(s)
S4-S17AbstractBackground: New injection drug users (IDUs) are at high risk for blood-borne viral infections. Given U.S. policy to only fund proven-effective HIV prevention interventions, insights into conducting intervention trials among young IDUs are provided here by describing methods and participants' characteristics in the CIDUS III/DUIT study. Methods: In 2002-2004, 15-30-year-old IDUs in Baltimore, Chicago, Los Angeles, New York, and Seattle were recruited through community outreach, advertising and coupon-based participant referrals. Baseline interviews assessed sociodemographics, injection, and sexual behaviors. Antibody tests for HIV and hepatitis A, B, and C viruses (HAV, HBV, and HCV) were conducted. IDUs who were HIV and HCV antibody negative at baseline were eligible to participate in a randomized controlled HIV/HCV prevention trial. Follow-up assessments were conducted 3 and 6 months post-intervention. Data were analyzed to identify participant differences at baseline by city, trial enrollment, and trial retention. Results: Baseline assessments were completed by 3285 IDUs. Participants were mean age 23.8 years, 69% male, 64% White, 17% Hispanic, and 8% Black. Seroprevalence of HIV, HCV, HBV, and HAV antibodies were 2.9, 34.4, 22.4, and 19.3%, respectively. Of the 2062 (62.7%) baseline participants who were HIV and HCV antibody negative, 859 (41.7%) were randomized. At least one follow-up assessment was completed by 712 (83%) randomized participants. Contextual factors, primarily homelessness, were associated with lower enrollment and retention. Conclusions: Recruitment and retention of young-adult IDUs for complex intervention trials is complicated, yet feasible. Risk behaviors among participants enrolling in and completing the trial reflected those eligible to enroll.Non-injection drug use and Hepatitis C Virus : A systematic review
AbstractScheinmann, R., Hagan, H., Lelutiu-Weinberger, C., Stern, R., Jarlais, D. C., Flom, P. L., & Strauss, S. (n.d.).Publication year
2007Journal title
Drug and alcohol dependenceVolume
89Issue
1Page(s)
1-12AbstractThis systematic review examined the evidence on the prevalence of the Hepatitis C Virus (HCV) in non-injecting drug users (NIDUs) who sniff, smoke or snort drugs such as heroin, cocaine, crack or methamphetamine. The search included studies published from January 1989 to January 2006. Twenty-eight eligible studies were identified and the prevalence of HCV in these NIDU populations ranged from 2.3 to 35.3%. There was substantial variation in study focus and in the quality of the NIDU data presented in the studies. The results of our systematic review suggested that there are important gaps in the research of HCV in NIDUs. We identified a problem of study focus; much of the research did not aim to study HCV in users of non-injection drugs. Instead, NIDUs were typically included as a secondary research concern, with a principal focus on the problem of transmission of HCV in IDU populations. Despite methodological issues, HCV prevalence in this population is much higher than in a non-drug using population, even though some IDUs might have inadvertently been included in the NIDU samples. These studies point to a real problem of HCV in NIDU populations, but the causal pathway to infection remains unclear.Perceived risk, peer influences, and injection partner type predict receptive syringe sharing among young adult injection drug users in five U.S. cities
AbstractBailey, S. L., Ouellet, L. J., Mackesy-Amiti, M. E., Golub, E. T., Hagan, H., Hudson, S. M., Latka, M. H., Gao, W., & Garfein, R. S. (n.d.).Publication year
2007Journal title
Drug and alcohol dependenceVolume
91Issue
SUPPL. 1Page(s)
S18-S29AbstractObjectives: This study examined risk factors for receptive syringe sharing (RSS) during illicit drug injection by persons 15-30 years old in five U.S. cities. Methods: Participants were recruited through street outreach and respondent-driven referrals in Baltimore, Chicago, Los Angeles, New York, and Seattle between May 2002 and January 2004. Surveys of drug use, sexual behaviors, and correlates were administered through audio computer-assisted self-interviews at baseline and, for the subset of participants who enrolled in an HIV/HCV prevention intervention trial, at 3-months and 6-months post-baseline. The proportions of injections involving RSS at baseline and at follow-up were used as outcomes in multivariate models that adjusted for intervention effects. Results: At baseline, 54% of 3128 participants reported RSS in the past 3 months. RSS decreased to 21% at 6-months post-baseline for the combined trial arms. Participants were more likely to report RSS if they perceived that their peers were not against RSS and if they injected with sex partners. Lower levels of perceived risk of infection with HIV (baseline, p < .001) or HCV (follow-up, p < .001) through RSS were also significant predictors of greater RSS. Conclusions: Perceived risks, peer influences, and type of injection partner were robust predictors of RSS. Perceived risks and peer influences are particularly amenable to intervention efforts that may prevent RSS in this age group.Prevalence and correlates of indirect sharing practices among young adult injection drug users in five U.S. cities
AbstractThiede, H., Hagan, H., Campbell, J. V., Strathdee, S. A., Bailey, S. L., Hudson, S. M., Kapadia, F., & Garfein, R. S. (n.d.).Publication year
2007Journal title
Drug and alcohol dependenceVolume
91Issue
SUPPL. 1Page(s)
S39-S47AbstractBackground: Sharing of drug paraphernalia to prepare, measure and divide drugs for injection remains an important residual risk factor for hepatitis C and other blood-borne infections among injection drug users (IDUs) especially as sharing of syringes for injection decreases. Methods: We analyzed data from five U.S. cities to determine the prevalence and independent correlates of non-syringe paraphernalia-sharing (NSPS) and syringe-mediated drug-splitting (SMDS) among 15-30-year-old IDUs who reported not injecting with others' used syringes (receptive syringe-sharing, RSS). Results: NSPS was reported by 54% of IDUs who did not practice RSS and was independently associated (p < 0.05) with having ≥5 injection partners, injecting with sex partners or regular injection partners, injecting in shooting galleries, peers' sharing behaviors, lower self-efficacy for avoiding NSPS, and less knowledge of HIV and HCV transmission. SMDS was reported by 26% of IDUs who did not practice RSS, and was independently associated with having ≥5 injection partners, injecting in shooting galleries, and inversely associated with unknown HIV status. Conclusions: NSPS and SMDS were common among young adult IDUs. Increased efforts to prevent these risky practices should address social and environmental contexts of injection and incorporate knowledge and skills building, self-efficacy, and peer norms.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. A., 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.Trends in hepatitis B virus, hepatitis C virus, and human immunodeficiency virus prevalence, risk behaviors, and preventive measures among seattle injection drug users aged 18-30 years, 1994-2004
AbstractBurt, R. D., Hagan, H., Garfein, R. S., Sabin, K., Weinbaum, C., & Thiede, H. (n.d.).Publication year
2007Journal title
Journal of Urban HealthVolume
84Issue
3Page(s)
436-454AbstractInjection drug users (IDUs) are at risk for infection with hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Information on time trends in prevalence of these viruses among IDUs and in behaviors influencing their transmission can help define the status of these epidemics and of public health efforts to control them. We conducted a secondary data analysis combining cross-sectional data from IDUs aged 18-30 years enrolled in four Seattle-area studies from 1994 to 2004. Participants in all four studies were tested for antibody to HIV (anti-HIV), hepatitis B core antigen (anti-HBc), and HCV (anti-HCV), and completed behavioral risk assessments. Logistic regression was used to investigate trends in prevalence over time after controlling for sociodemographic, drug use, and sexual behavior variables. Between 1994 and 2004, anti-HBc prevalence declined from 43 to 15% (pDrug treatment programs' HCV service delivery to their HCV positive clients
AbstractAstone-Twerell, J. M., Strauss, S. M., Hagan, H., & Des Jarlais, D. C. (n.d.).Publication year
2006Journal title
Addiction Research and TheoryVolume
14Issue
3Page(s)
289-302AbstractHepatitis C virus (HCV) infection is the most common blood-borne infectious disease among drug users in the US. Drug treatment programs are ideally situated to assist their clients to obtain HCV medical and support services. Using data collected from 233 drug free and methadone maintenance treatment programs (MMTPs) throughout the US, this article examines the range of HCV services that treatment programs provide to their HCV positive clients. Findings indicate that MMTPs offer more comprehensive HCV services to more of their HCV positive clients than drug free programs, although drug free programs provide more individualized services. While 84% of the programs provided some HCV services, there are still serious gaps in the provision of these services (e.g., dealing with medical providers to obtain HCV medication and facilitating access to liver transplant lists). Drug treatment programs need increased funding and staff training to be able to provide comprehensive HCV services to their HCV positive clients.Eligibility for treatment of hepatitis C virus infection among young injection drug users in 3 US cities
AbstractHagan, H., Latka, M. H., Campbell, J. V., Golub, E. T., Garfein, R. S., Thomas, D. A., Kapadia, F., & Strathdee, S. A. (n.d.).Publication year
2006Journal title
Clinical Infectious DiseasesVolume
42Issue
5Page(s)
669-672AbstractAmong 404 injection drug users aged 18-35 who tested positive for hepatitis C virus (HCV) RNA, 96% had conditions that are potentially unwarranted contraindications for HCV treatment (e.g., problem drinking, moderate-to-severe depression, and recent drug injection). Restrictive eligibility criteria may deny treatment to a large proportion of patients who could benefit from it.Erratum : Eligibility for treatment of hepatitis C virus infection among young injection drug users in 3 US cities (Clinical Infectious Diseases (March 1, 2006) 42 (1118-1126))
AbstractHagan, H., Hagan, H., Latka, M. H., Campbell, J. V., Golub, E. T., Garfein, R. S., Thomas, D. A., Kapadia, F., & Strathdee, S. A. (n.d.).Publication year
2006Journal title
Clinical Infectious DiseasesVolume
42Issue
12Abstract~Hepatitis C knowledge among staff in U.S. drug treatment programs
AbstractStrauss, S. M., Astone-Twerell, J. M., Munoz-Plaza, C., Des Jarlais, D. C., Gwadz, M., Hagan, H., Osborne, A., & Rosenblum, A. (n.d.).Publication year
2006Journal title
Journal of drug educationVolume
36Issue
2Page(s)
141-158AbstractStaff in drug treatment programs are in an optimal position to support the hepatitis C related needs of their patients. To do so effectively, however, staff need to have accurate information about the hepatitis C virus (HCV). This article examines the HCV knowledge of staff (N = 104) in two drug-free and two methadone maintenance treatment programs (MMTPs) in the New York metropolitan area. Five of 20 items on an HCV Knowledge Assessment were not answered correctly by the majority of the participating staff, and total scores on the Assessment averaged 70%, 71%, and 45% among the medically credentialed staff, non-medically credentialed staff in the MMTPs, and non-medically credentialed staff in the drug-free programs, respectively. The majority of those in the latter group had never participated in a training specifically devoted to HCV. Results suggest the need for effective HCV-related training for all staff in drug treatment programs.High 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.HTLV-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.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% (PNeedle exchange use, sexual risk behaviour, and the prevalence of HIV, hepatitis B virus, and hepatitis C virus infections among Bulgarian injection drug users
AbstractHagan, H., Vassilev, Z. P., Hagan, H., Lyubenova, A., Tomov, N., Vasilev, G., Krasteva, D., & Des Jarlais, D. C. (n.d.).Publication year
2006Journal title
International Journal of STD and AIDSVolume
17Issue
9Page(s)
621-626AbstractAt a time when the rates of HIV, hepatitis C virus (HCV), and hepatitis B virus (HBV) infections have risen among injection drug users (IDUs) in other countries in the region, little is known about the prevalence of these infections among Bulgarian injectors and about their sexual risk behaviours. IDUs (n = 773) in a community-based needle exchange programme (NEP) and two major drug treatment facilities in Sofia completed a structured interview and were tested for HIV, HBV, and HCV antibodies. While HCV prevalence in the sample was 73.9%, HBV and HIV prevalence was low -6% and 0.5%, respectively. Having more than 10 sexual partners, having sex with someone with hepatitis C or another IDU, and never using a condom with another IDU were common among those who were recruited through NEP. As 40% of the IDUs reported using NEP, it appears that needle exchange provides an opportunity to reach high-risk populations and prevent sexual transmission of blood-borne pathogens.Providing support to drug users infected with hepatitis C : The role of methadone maintenance treatment staff
AbstractAstone, J. M., Strauss, S. M., Munoz-Plaza, C., Hagan, H., & Des Jarlais, D. C. (n.d.).Publication year
2006Journal title
Journal of Maintenance in the AddictionsVolume
3Issue
1Page(s)
33-46AbstractInjection drug users (IDUs) have the highest rate of HCV infection. Although IDUs need support to access and use HCV services, they often lack this support. Many IDUs, however, have contact with a methadone maintenance treatment program (MMTP) where they can gain access to HCV services and obtain support in using them. Unfortunately, however, IDUs often underutilize theMMTPservices that are available to them. Using qualitative data collected in 4 MMTPs, we identify some reasons for clients' lack of HCV service utilization and staff strategies that influence clients' perceptions of support in using these services.