Holly Hagan

Professor Emeritus

Professional overview

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. 

Education

PhD Epidemiology, University of Washington, Seattle, WA

MPH Epidemiology, University of Massachusetts, Amherst, MA

BA Russian Studies, Evergreen State College, Olympia, WA

Publications

Publications

Preventing Epidemics of HIV-1 among Injecting Drug Users

Des Jarlais, D. C., Hagan, H., Friedman, S. R., Friedmann, P., Goldberg, D., Frischer, M., Green, S., Tunving, K., Ljungberg, B., Wodak, A., Ross, M., Purchase, D., Millson, P., & Myers, T. (n.d.).

Publication year

2003

Page(s)

183-200

10.4324/9780203214015-18

Abstract

Abstract

In many areas, the spread of HIV-1 among injecting drug users (IDUs) due to the multi-person use of drug injection equipment has occurred with extreme rapidity. In New York City, for example, HIV-1 seroprevalence among IDUs increased from under 10 per cent to over 50 per cent in a period of five years (Des Jarlais et al., 1989); in Edinburgh, HIV-1 seroprevalence among IDUs increased from zero to over 40 per cent in one year (Robertson et al., 1986); in Bangkok, HIV-1 seroprevalence increased from 2 per cent to over 40 per cent in two years (Vanichseni and Sakuntanaga, 1990); and in the state of Manipur, India, levels increased from zero to approximately 50 per cent in one year (Naik et al., 1991). HIV-1 has spread rapidly among populations where there has been a lack of awareness of AIDS as a local threat and mechanisms such as ‘shooting galleries’, ‘dealer’s works’ and professional injectors that provide rapid and efficient mixing among large numbers of IDUs (Friedman and Des Jarlais, 1991).

Regional Patterns and Correlates of Substance Use among Young Men Who Have Sex with Men in 7 US Urban Areas

Thiede, H., Valleroy, L. A., MacKellar, D. A., Celentano, D. D., Ford, W. L., Hagan, H., Koblin, B. A., LaLota, M., McFarland, W., Shehan, D. A., & Torian, L. V. (n.d.).

Publication year

2003

Journal title

American journal of public health

Volume

93

Issue

11

Page(s)

1915-1921

10.2105/AJPH.93.11.1915

Abstract

Abstract

Objectives. We sought to characterize substance use patterns in young men who have sex with men (MSM) in 7 US urban areas and sociodemographic characteristics and history associated with such use. Methods. We examined data collected from 1994 through 1998 in a venue-based, cross-sectional survey. Results. Among the 3492 participants, 66% reported use of illicit drugs; 28%, use of 3 or more drugs; 29%, frequent drug use (once a week or more); and 4%, injection drug use. These practices were more common among participants who were White, self-identified as bisexual or heterosexual, had run away, or had experienced forced sex. Conclusions. Effective drug prevention and treatment programs addressing local drug-use patterns and associated factors are urgently needed for young MSM, a population with a high rate of illicit drug use.

The relevance of attributable risk measures to HIV prevention planning

Hagan, H. (n.d.).

Publication year

2003

Journal title

AIDS

Volume

17

Issue

6

Page(s)

911-913

10.1097/00002030-200304110-00017

Abstract

Abstract

~

The Tacoma syringe exchange studies : Public health practice influences research

Hagan, H., Hagan, H., Des Jarlais, D. C., & Purchase, D. (n.d.). (J. Sorensen, R. Rawson, J. Guydish, & J. Zweben, Eds.).

Publication year

2003

Abstract

Abstract

~

Case-reporting of acute hepatitis B and C among injection drug users

Hagan, H., Snyder, N., Hough, E., Yu, T., McKeirnan, S., Boase, J., & Duchin, J. (n.d.).

Publication year

2002

Journal title

Journal of Urban Health

Volume

79

Issue

4

Page(s)

579-585

10.1093/jurban/79.4.579

Abstract

Abstract

Although public health surveillance system data are widely used to describe the epidemiology of communicable disease, occurrence of hepatitis B and C virus (HBV and HCV, respectively) infections may be misrepresented by under-reporting in injection drug users (IDUs). This study was carried out to examine the relationship between HBV and HCV incidence and case-reporting of hepatitis B and C in Seattle IDUs. Names of participants in a Seattle IDU cohort study who acquired HBV or HCV infection over a 12-month follow-up period were compared to a database of persons with acute hepatitis B and C reported to the health department surveillance unit over the same period. Of 2,208 IDUs enrolled in the cohort who completed a follow-up visit, 63/759 acquired HBV infection, 53/317 acquired HCV infection, and 3 subjects acquired both HBV and HCV. Of 113 cohort subjects who acquired HBV or HCV, only 2 (1.5%) cases were reported; both had acute hepatitis B. The upper 95% confidence limit for case-reporting of hepatitis C in the cohort was 5.7%, and for hepatitis B, it was 7.5%. In this study, reporting of acute hepatitis in IDUs was extremely low, raising questions regarding the use of community surveillance data to estimate underlying incidence in that population group.

Hepatitis B vaccination among research participants, Seattle, Washington

Hagan, H., Thiede, H., McGough, J. P., & Alexander, E. R. (n.d.).

Publication year

2002

Journal title

American journal of public health

Volume

92

Issue

11

Page(s)

1756

10.2105/AJPH.92.11.1756

Abstract

Abstract

~

Impact of the September 11th attacks in New York City on drug users : A preliminary assessment

Deren, S., Shedlin, M., Hamilton, T., & Hagan, H. (n.d.).

Publication year

2002

Journal title

Journal of Urban Health

Volume

79

Issue

3

Page(s)

409-412

10.1093/jurban/79.3.409

Abstract

Abstract

An 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.

Supervised injection rooms - Prospects and limitations

Hagan, H. (n.d.).

Publication year

2002

Journal title

International Journal of Drug Policy

Volume

13

Issue

6

Page(s)

449-451

10.1016/S0955-3959(02)00125-1

Abstract

Abstract

~

Syphilis among intravenous drug-using population : Epidemiological situation in St Petersburg, Russia

Hagan, H., Karapetyan, A. F., Sokolovsky, Y. V., Araviyskaya, E. R., Zvartau, E. E., Ostrovsky, D. V., & Hagan, H. (n.d.).

Publication year

2002

Journal title

International Journal of STD and AIDS

Volume

13

Issue

9

Page(s)

618-623

10.1258/09564620260216326

Abstract

Abstract

Introduction. An epidemic of syphilis and other sexually transmitted infections (STI) in the Russian Federation is believed to be related to the rise in injection drug use. A study was carried out in collaboration with a non-governmental organization, Foundation 'Vozvrastcheniye'. Methods: Nine hundred and ten injection drug users participating in the programme were tested for syphilis, HIV, hepatitis C virus (HCV) and hepatitis B virus (HBV); 65 participants who had laboratory markers for syphilis and 45 syphilis-negative serosurvey subjects agreed to participate in a questionnaire study. Results: Syphilis, HIV, HBV and HCV were diagnosed in 12%, 0%, 48% and 79% of drug users, respectively. Prevalence of syphilis seromarkers was nine times higher in females than in males, and strongly associated with sex work. Conclusions: The results of the study indicate that resources to treat and prevent further infections including HIV should be prioritized toward risk reduction in drug injectors and sex workers in St Petersburg.

Hepatitis B virus genotypes and HBsAg subtypes in refugees and injection drug users in the United States determined by LiPA and monoclonal EIA

Hagan, H., Swenson, P. D., Van Geyt, C., Russell Alexander, E., Hagan, H., Freitag-Koontz, J. M., Wilson, S., Norder, H., Magnius, L. O., & Stuyver, L. (n.d.).

Publication year

2001

Journal title

Journal of Medical Virology

Volume

64

Issue

3

Page(s)

305-311

10.1002/jmv.1051

Abstract

Abstract

Hepatitis B virus (HBV) genotyping and hepatitis B surface antigen (HBsAg) subtyping were carried out on sera from 196 HBsAg-positive patients, including 151 refugees entering the United States and 45 injection drug users in Seattle. HBsAg subtyping was performed by enzyme immunoassay (EIA) using a panel of monoclonal antibodies and the HBV genotype was determined by polymerase chain reaction (PCR) followed by detection of amplified HBV DNA by a reverse-phase hybridization line probe assay (LiPA) using genotype-specific probes. HBV DNA was detected by PCR in 155 (79%) of the 196 sera and all 155 were genotyped by LiPA. Samples from Southeast Asia were predominantly genotype B/subtype ayw1 and genotype C/adr; samples from the former Soviet Union and eastern Europe were mostly genotype D/ayw2 and genotype D/ayw3; samples from east Africa were mainly genotype A/adw2 and genotype D/ayw2; and samples from injection drug users were mostly genotype D/ayw3 and genotype A/adw2. Some strains of ayw3 gave atypical monoclonal antibody reactivity patterns in the subtyping assay due to a Val/Ala instead of a Thr at amino acid residue 118 and a Thr instead of a Met at residue 125. A strain of ayw2 also gave an atypical monoclonal antibody reactivity pattern due to an Ala instead of a Thr at amino acid residue 123. LiPA genotyping and monoclonal EIA subtyping can provide useful information for epidemiological studies.

Predictors of accidental fatal drug overdose among a cohort of injection drug users

Hagan, H., O'Driscoll, P. T., McGough, J., Hagan, H., Thiede, H., Critchlow, C., & Alexander, E. R. (n.d.).

Publication year

2001

Journal title

American journal of public health

Volume

91

Issue

6

Page(s)

984-987

10.2105/AJPH.91.6.984

Abstract

Abstract

Objectives. This study evaluated factors associated with accidental fatal drug overdose among a cohort of injection drug users (IDUs). Methods. In a prospective cohort study of 2849 IDUs in King County, Washington, deaths were identified by electronically merging subject identifiers with death certificate records. Univariate and multivariate Cox regression analyses were performed to identify predictors of overdose mortality. Results. Thirty-two overdoses were observed. Independent predictors of overdose mortality were bisexual sexual orientation (relative risk [RR]=4,86; 95% confidence interval [CI]=2.30, 13.2), homelessness (RR=2.30; 95% CI=1.06, 5.01), infrequent injection of speedballs (RR=5.36; 95% CI=1.58, 18.1), daily use of powdered cocaine (RR=4.84; 95% CI=1.13, 20.8), and daily use of poppers (RR=22.0; 95% CI=1.74, 278). Conclusions. Sexual orientation, homelessness, and drug use identify IDUs who may benefit from targeted interventions.

Public health and changes in illicit drug prices

Hagan, H., & Hagan, H. (n.d.).

Publication year

2001

Journal title

American journal of public health

Volume

91

Issue

9

Page(s)

1350

10.2105/AJPH.91.9.1350

Abstract

Abstract

~

Sharing of drug preparation equipment as a risk factor for hepatitis C

Hagan, H., Hagan, H., Thiede, H., Weiss, N. S., Hopkins, S. G., Duchin, J. S., & Alexander, E. R. (n.d.).

Publication year

2001

Journal title

American journal of public health

Volume

91

Issue

1

Page(s)

42-46

10.2105/AJPH.91.1.42

Abstract

Abstract

Objectives. This study investigated the sharing of drug preparation equipment as a possible route of hepatitis C virus (HCV) transmission. Methods. HCV seroconversion was measured in a cohort of 317 injection drug users who tested negative for HCV antibody at recruitment. Results. Cumulative HCV incidence was 16.7% per year. Among those who did not share syringes, HCV seroconversion was associated with sharing drug cookers and filtration cotton (adjusted risk ratio=5.9; 95% confidence interval=1.1, 31.7);54% of HCV infections in injection drug users who did not share syringes were attributable to cooker/cotton sharing. Conclusions. Among injection drug users who do not share syringes, an important proportion of HCV infections may be attributed to cooker/cotton sharing.

Using a jail-based survey to monitor HIV and risk behaviors among Seattle area injection drug users

Hagan, H., Thiede, H., Romero, M., Bordelon, K., Hagan, H., & Murrill, C. (n.d.).

Publication year

2001

Journal title

Journal of Urban Health

Volume

78

Issue

2

Page(s)

264-278

10.1093/jurban/78.2.264

Abstract

Abstract

Routine monitoring of human immunodeficiency virus (HIV) and risk behaviors among injection drug users (IDUs) is difficult outside drug treatment settings. We developed and implemented a survey of recently arrested IDUs to describe the prevalence of HIV, drug use, and sexual behaviors among them. A probability sampling survey was instituted in the King County Correctional Facility in Seattle, Washington; to sample recently arrested IDUs at the time of booking and in the jail health clinic between 1998 and 1999. Following HIV risk assessment and blood draw, additional information on drug use practices was gathered using a standardized questionnaire. Potential participants who were released from jail early could complete the study at a nearby research storefront office. Of the 4,344 persons intercepted at booking, 503 (12%) reported injection drug use, and 201 of the IDUs (40%) participated in the study. An additional 161 IDUs were enrolled in the study from the jail health clinic. Among the 348 unduplicated subjects, HIV prevalence was 2%; in the past 6 months, 69% reported two or more shooting partners, 72% used a cooker after someone else, 60% shared a syringe to divide up drugs, and 62% injected with used needles. Only 37% reported being hepatitis C seropositive, and 8% reported hepatitis B vaccination. It was feasible to conduct a jail-based survey of recently arrested IDUs that yielded useful information. The high prevalence of reported risky drug use practices warrants ongoing monitoring and illustrates the need for improving prevention programs for HIV and hepatitis B and C in this population, including expansion of hepatitis C screening and provision of hepatitis B vaccination at the jail health clinic.

Changes in injection risk behavior associated with participation in the Seattle needle-exchange program

Hagan, H., & Thiede, H. (n.d.).

Publication year

2000

Journal title

Journal of Urban Health

Volume

77

Issue

3

Page(s)

369-382

10.1007/BF02386747

Abstract

Abstract

We studied the influence of the Seattle, Washington, needle-exchange program on sharing of drug injection equipment (syringes, drug cookers, filtration cotton) to identify potential gaps in risk reduction and to understand in greater detail the lack of an association between exchange use and risk of hepatitis B or C virus transmission. In a cohort of 2,208 injection drug users who completed a 1-year follow-up visit, we measured the association between needle-exchange use at study enrollment (ever vs. never) and injection risk behavior at the follow-up. Control for confounding was carried out using both logistic regression and propensity score analytic methods to estimate the adjusted odds ratio (AOR). In both univariate and multivariate analyses, needle-exchange use was associated with a lower likelihood of injection with a used syringe (AOR = 0.7, 95% confidence limit 0.5, 0.9). There was no association between exchange use and cooker or cotton sharing (AOR = 0.8, 95% confidence limit 0.6, 1.1) or between exchange use and use of a common syringe to divide drugs (AOR = 0.9). This analysis suggests that risk reduction measures adopted by users of the Seattle exchange may not be sufficient to prevent transmission of all blood-borne viruses, including hepatitis C virus. Greater awareness of the infection risk associated with these practices may help curb this type of equipment sharing and ultimately prevent disease transmission.

HIV and HCV infection among injecting drug users

Hagan, H., & Des Jarlais, D. C. (n.d.).

Publication year

2000

Journal title

Mount Sinai Journal of Medicine

Volume

67

Issue

5-6

Page(s)

423-428

Abstract

Abstract

Background: 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.

Methadone treatment and HIV and hepatitis B and C risk reduction among injectors in the Seattle area

Thiede, H., Hagan, H., & Murrill, C. S. (n.d.).

Publication year

2000

Journal title

Journal of Urban Health

Volume

77

Issue

3

Page(s)

331-345

10.1007/BF02386744

Abstract

Abstract

Drug treatment has the potential to reduce incidence of blood-borne infections by helping injection drug users (IDUs) achieve abstinence or by decreasing the frequency of injection and sharing practices. We studied the associations between retention in methadone treatment and drug use behaviors and incidence of hepatitis B and C in a cohort of IDUs in the Seattle, Washington, area. Data on IDUs entering methadone treatment at four centers in King County, Washington, were collected through face-to-face interviews using a standardized questionnaire at baseline and 12-month follow-up between October 1994 and January 1998. Blood specimens were obtained and tested for human immunodeficiency virus (HIV) and hepatitis B and C. Drug treatment status at follow-up was analyzed in relation to study enrollment characteristics and potential treatment outcomes, including injection risk behaviors, cessation or reduced frequency of injection, and incidence of hepatitis B and C. Of 716 IDUs, 292 (41%) left treatment, 198 (28%) disrupted (left and returned) treatment, and 226 (32%) continued treatment throughout the 1-year follow-up period. Compared to those who left treatment, subjects who disrupted or continued were less likely to inject at follow-up (odds ratio [OR] = 0.5, 95% CI 0.3-0.7; and OR = 0.1, 95% CI 0.1-0.2, respectively). Among the 468 (65%) subjects who continued injecting, those who continued treatment injected less frequently, were less likely to pool money to buy drugs (OR = 0.5, 95% CI 0.3-0.8) and inject with used needles (OR = 0.5, 95% CI 0.2-0.8) compared to those who left treatment. Cooker or cotton sharing was not associated with retention in treatment, but hepatitis B incidence was lowest among those who continued treatment. The results of this study suggest drug use risk reduction is more likely to be achieved by those who remain in drug treatment and by those who stop injecting, but that those who drop out and return and those who continue to inject while in treatment may also benefit. This supports the role of consistent drug treatment in an overall harm-reduction strategy.

Re : 'Syringe exchange and risk of infection with hepatitis B and C viruses' [2] (multiple letters)

Hagan, H., Voth, E. A., Hagan, H., McGough, J. P., Thiede, H., Hopkins, S. G., & Alexander, E. R. (n.d.).

Publication year

2000

Journal title

American Journal of Epidemiology

Volume

151

Issue

2

Page(s)

207-208

10.1093/oxfordjournals.aje.a010190

Abstract

Abstract

~

Reduced injection frequency and increased entry and retention in drug treatment associated with needle-exchange participation in Seattle drug injectors

Hagan, H., McGough, J. P., Thiede, H., Hopkins, S., Duchin, J., & Alexander, E. R. (n.d.).

Publication year

2000

Journal title

Journal of Substance Abuse Treatment

Volume

19

Issue

3

Page(s)

247-252

10.1016/S0740-5472(00)00104-5

Abstract

Abstract

The association between needle exchange, change in drug use frequency and enrollment and retention in methadone drug treatment was studied in a cohort of Seattle injection drug users (IDUs). Participants included IDUs classified according to whether they had used a needle exchange by study enrollment and during the 12-month follow-up period. The relative risk (RR) and the adjusted RR (ARR) were estimated as measures of the association. It was found that IDUs who had formerly been exchange users were more likely than never-exchangers to report a substantial (≥75%) reduction in injection (ARR = 2.85, 95% confidence limit [CL] 1.47-5.51), to stop injecting altogether (ARR = 3.5, 95% CL 2.1-5.9), and to remain in drug treatment. New users of the exchange were five times more likely to enter drug treatment than never-exchangers. We conclude that reduced drug use and increased drug treatment enrollment associated with needle exchange participation may have many public health benefits, including prevention of blood-borne viral transmission. (C) 2000 Elsevier Science Inc.

Vaccination could improve overall health in a high risk population.

Hagan, H., & Hagan, H. (n.d.).

Publication year

2000

Journal title

The Western journal of medicine

Volume

172

Issue

1

Page(s)

21

10.1136/ewjm.172.1.21

Abstract

Abstract

~

Volunteer bias in nonrandomized evaluations of the efficacy of needle- exchange programs

Hagan, H., McGough, J. P., Thiede, H., Hopkins, S. G., Weiss, N. S., & Alexander, E. R. (n.d.).

Publication year

2000

Journal title

Journal of Urban Health

Volume

77

Issue

1

Page(s)

103-112

10.1007/BF02350966

Abstract

Abstract

Objective. Nonrandomized comparisons of the incidence of HIV and hepatitis B and C between injection drug users (IDUs) who do and do not attend voluntary needle-exchange programs may be subject to bias. To explore possible sources of bias, we examined characteristics associated with voluntarily beginning or ceasing to participate in the Seattle needle exchange. Methods. In a cohort of 2,879 IDUs, a standardized questionnaire measured characteristics present at enrollment. We examined the relation of these characteristics to the proportion of IDUs who began to use the program during the ensuing 12-month follow-up period and to the proportion of current exchangers who dropped out during that period of time. Results. Of the 494 never-exchangers at baseline, 32% attended the exchange program during follow-up; those who reported sharing syringes or who were homeless at enrollment were more likely to become new exchange users (adjusted risk ratio [ARR] for becoming an exchange user = 1.8 for those who shared syringes, and ARR = 2.2 for those who were homeless). Of 1,274 current exchangers, 16% stopped using the exchange during follow-up, with daily injectors (ARR = 0.6) and those who reported backloading (APR = 0.6) being relatively less likely to drop out of the exchange. Conclusions. The analysis suggests that IDUs participating in needle-exchange programs at a given point in time may include a particularly high proportion of those injectors whose pattern of drug use puts them at elevated risk of blood-borne vital infections.

Audio-computer interviewing to measure risk behaviour for HIV among injecting drug users : A quasi-randomised trial

Des Jarlais, D. C., Paone, D., Milliken, J., Turner, C. F., Miller, H., Gribble, J., Shi, Q., Hagan, H., & Friedman, S. R. (n.d.).

Publication year

1999

Journal title

Lancet

Volume

353

Issue

9165

Page(s)

1657-1661

10.1016/S0140-6736(98)07026-3

Abstract

Abstract

Background. We aimed to assess audio-computer-assisted self-interviewing (audio-CASI) as a method of reducing under-reporting of HIV risk behaviour among injecting drug users. Methods. Injecting drug users were interviewed at syringe-exchange programmes in four US cities. Potential respondents were randomly selected from participants in the syringe exchanges, with weekly alternate assignment to either traditional face-to-face interviews or audio-CASI. The questionnaire included items on sociodemographic characteristics, drug use, and HIV risk behaviours for 30 days preceding the interview. We calculated odds ratios for the difference in reporting of HIV risk behaviours between interview methods. Findings. 757 respondents were interviewed face-to-face, and 724 were interviewed by audio-CASI. More respondents reported HIV risk behaviours and other sensitive behaviours in audio-CASI than in face-to-face interviews (odds ratios for reporting of rented or bought used injection equipment in audio-CASI vs face-to-face interview 2.1 [95% CI 1.4-3.3] p = 0.001; for injection with borrowed used injection equipment 1.5 [1.1-2.2] p = 0.02; for renting or selling used equipment 2.3 [1.3-4.0] p = 0.003). Interpretation. Although validation of these self-reported behaviours was not possible, we propose that audio-CASI enables substantially more complete reporting of HIV risk behaviour. More complete reporting might increase understanding of the dynamics of HIV transmission and make the assessment of HIV-prevention efforts easier.

Invited commentary : Needle exchange - No help for hepatitis?

Hagan, H., Moss, A. R., Hahn, J. A., Hagan, H., Weiss, N. S., Thiede, H., Hopkins, S., McGough, J. P., & Alexander, E. R. (n.d.).

Publication year

1999

Journal title

American Journal of Epidemiology

Volume

149

Issue

3

Page(s)

214-218

10.1093/oxfordjournals.aje.a009793

Abstract

Abstract

~

Syringe exchange and risk of infection with hepatitis B and C viruses

Hagan, H., McGough, J. P., Thiede, H., Weiss, N. S., Hopkins, S., & Alexander, E. R. (n.d.).

Publication year

1999

Journal title

American Journal of Epidemiology

Volume

149

Issue

3

Page(s)

203-213

10.1093/oxfordjournals.aje.a009792

Abstract

Abstract

The authors utilized a cohort study among Seattle injection drug users (IDUs) to assess whether participation in a syringe exchange program was associated with incidence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. Susceptible IDU subjects (187 seronegative for antibody to HCV, and 460 seronegative for core antibody to HBV) were identified in drug treatment, corrections, and social service agencies from June 1994 to January 1996, and followed for seroconversion one year later. The subjects included in the analysis were Seattle-King County (Washington State) area IDUs enrolled in a larger multipurpose cohort study, the Risk Activity Variables, Epidemiology, and Network Study (RAVEN Study). There were 39 HCV infections (20.9/100/year) and 46 HBV infections (10.0/100/year). There was no apparent protective effect of syringe exchange against HBV (former exchange users, relative risk (RR) = 0.68, 95% confidence interval (CI) 0.2-2.5; sporadic exchange users, RR = 2.4, 95% CI 0.9-6.5; regular users, RR - 1.81, 95% CI 0.7-4.8; vs. RR = 1.0 for nonusers of the exchange; adjusted for daily drug injection). Neither did the exchange protect against HCV infection (sporadic users, RR = 2.6, 95% CI 0.8-8.5; regular users, RR = 1.3, 95% CI 0.8-2.2; vs. RR = 1.0 for nonusers; adjusted for recent onset of injection and syringe sharing prior to enrollment). While it is possible that uncontrolled confounding or other bias obscured a true beneficial impact of exchange use, these data suggest that no such benefit occurred during the period of the study.

Hepatitis C virus transmission dynamics in injection drug users

Hagan, H. (n.d.).

Publication year

1998

Journal title

Substance Use and Misuse

Volume

33

Issue

5

Page(s)

1197-1212

10.3109/10826089809062214

Abstract

Abstract

Hepatitis C virus (HCV) presents several challenges to the development of prevention programs. HCV infection is persistent in up to 80% of cases, and viremic individuals may transmit infection to others. With 65-90% of injection drug users anti-HCV positive, a large reservoir of infection exists in most drug-injector populations. Studying the genetic variability of HCV infections could permit researchers to reconstruct chains of viral transmission in IDUs. However, the relationship of HCV to HIV epidemiology remains unclear and may depend on whether the proportions of infectious persons in the population are similar for both viruses.