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Inadequate response to injecting drug use ( IDU) is a significant problem the world over. Low levels of funding, political inaction, poor levels of health service coverage, high prevalence and incidence of IDU-related blood-borne viruses ( BBVs) and ongoing stigmatization/marginalization affect people who inject drugs ( PWID) regardless of the income status of the country they reside in. These barriers and system failings are, however, exacerbated in low and middle-income countries ( LMICs), meaning that the potential consequences of inaction are more pressing. In this narrative review, we describe the levels of IDU and IDU-specific BBV prevalence in LMICs; levels of harm reduction implementation; the consequences of late or insufficient response, the shortcomings of data collection and dissemination; and the barriers to effective LMIC harm reduction implementation. We also exemplify cases where IDU-related harms and BBV epidemics have been successfully curtailed in LMICs, showing that effective response, despite the barriers, is possible. In conclusion, we suggest four key priorities on the basis of the review: confirming the presence or absence of IDU in LMICs, improving the collection and dissemination of national IDU-specific data, increasing the level of harm reduction programme implementation in LMICs, and increasing both national and international advocacy for PWID and attendant public health interventions. [ABSTRACT FROM AUTHOR]

Vesicular-arbuscular (VA) mycorrhizal and non-mycorrhizal sweet potato plants [Ipomoea batatas (L.S) Lam. cv. White Star] were grown in a glasshouse in a phosphorus (P)-fixing soil in order to (i) establish the chronology of mycorrhiza-mediated P uptake, (ii) document the distribution of total and metabolically active external hyphae in relation to roots, root hairs and P-depletion zones at the time when the P-uptake response first becomes apparent, (iii) evaluate the pore-size distribution of the soil relative to the radii of roots, root hairs and hyphae of mycorrhizal fungi, and (iv) determine if sweet potato mycorrhiza alter the organic acid composition of the rhizosphere. Phosphorus inflow, VA mycorrhizal root colonization, and active hyphae increased during the first half of an 8 wk experiment. During the latter half of the experiment, however, colonization and active hyphae increased while P inflow decreased. Roots colonized by mvcorrhizal fungi supported a higher proportion of active hyphae in the soil than non-colonized roots. In a second experiment, hyphal distribution around individual roots colonized by mycorrhizal fungi was not consistently different from hyphal distribution around non-colonized roots. Hyphae of mycorrhizal fungi were of a diameter that would allow them to penetrate pores that hold water at water contents less than field capacity while roots, and to a large extent root hairs, would be excluded from these pores. We found no evidence that sweet potato roots, whether or not they were colonized by mycorrhizal fungi, altered the organic acid composition of the rhizosphere. We conclude that mycorrhiza mediated P uptake commenced with the onset of colonization by the fungi and was due to a change in the ability of the root to come into contact with the soil solution. [ABSTRACT FROM AUTHOR]

Many species within the order Actinomycetales contain one or more soluble cytochrome P450 monooxygenases, often substrate-inducible and responsible for a variety of xenobiotic transformations. The individual cytochromes exhibit a relatively broad substrate specificity, and some strains have the capacity to synthesize large amounts of the protein(s) to compensate for low catalytic turnover with some substrates. All three of the Streptomyces cytochromes sequenced to date are exclusive members of one P450 family, CYP105. In several instances, monooxygenase activity arises from induction of a P450 and associated ferredoxin, or of a P450 only, suggesting that some essential electron donor proteins (reductase and ferredoxin) are not co-ordinately regulated with the cytochrome. The overall properties of these systems suggest an adaptive strategy whose twofold purpose is to maintain a competitive advantage via the production of secondary metabolites, and, whenever possible, to utilize unusual growth substrates by introducing metabolites from these reactions into the more substrate-specific primary metabolic pathways. [ABSTRACT FROM AUTHOR]

Issues: People who inject drugs are at risk of acute infections, such as skin and soft tissue infections, infective endocarditis, bone and joint infections and bloodstream infections. There has been an increase in these infections in people who inject drugs internationally over the past 10 years. However, the local data regarding acute infections in Australia has not been well described., Approach: We review the epidemiology of acute infections and associated morbidity and mortality amongst people who inject drugs in Australia. We summarise risk factors for these infections, including the concurrent social and psychological determinants of health., Key Findings: The proportion of people who report having injected drugs in the prior 12 months in Australia has decreased over the past 18 years. However, there has been an increase in the burden of acute infections in this population. This increase is driven largely by skin and soft tissue infections. People who inject drugs often have multiple conflicting priorities that can delay engagement in care., Implications: Acute infections in people who inject drugs are associated with significant morbidity and mortality. Acute infections contribute to significant bed days, surgical requirements and health-care costs in Australia. The increase in these infections is likely due to a complex interplay of microbiological, individual, social and environmental factors., Conclusion: Acute infections in people who inject drugs in Australia represent a significant burden to both patients and health-care systems. Flexible health-care models, such as low-threshold wound clinics, would help directly target, and address early interventions, for these infections., (© 2023 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Introduction: The wide-spread implementation of interventions to limit transmission and public health consequences of COVID-19 in the Australian state of Victoria had flow-on consequences for people who use and inject drugs. Consequences included the interruption of illicit drug supply and drug procurement, and the disruption to the delivery of health services. To inform strategies that can minimise the adverse outcomes of similar future disruptive events, this study explored how COVID-19 restrictions impacted access to harm reduction and drug treatment services for people who inject drugs in Melbourne, Victoria., Methods: Qualitative semi-structured interviews were conducted via an online calling app, with 11 participants of a broader cohort study (the SuperMIX study) in April 2020. Interviews were focused on participants experiences of accessing and using harm reduction and drug treatment services. Data were thematically analysed using a process of blended coding., Results: Findings revealed how disruptions in the delivery of harm reduction and drug treatment services-in response to COVID-19 restrictions-created barriers accessing sterile injecting equipment, increased risk of arrest by police and exacerbated social isolation. Participants reported difficulties adapting to changes in services access, with some increases in injecting risk behaviours. However, improvements in opioid agonist therapy prescriptions were noted as a beneficial outcome., Discussion: By examining the impacts of COVID-19 and the resultant restrictions on people who inject drugs' access to health services in Melbourne, Victoria, findings provide guidance for future responses to the unanticipated large-scale effects of the COVID-19 pandemic, and similar disruptive events., (© 2022 Australasian Professional Society on Alcohol and other Drugs.)

Introduction and Aims: Cleaning drug injection sites with alcohol swabs prior to injecting reduces risk of abscesses and other skin and soft tissue infections (SSTI). Better understanding of swabbing behaviours can inform interventions to improve injecting hygiene. We aimed to determine the socio-demographic, drug use and injecting risk exposure correlates of swabbing prior to injecting and reasons for not swabbing., Design and Methods: The Illicit Drug Reporting System recruited participants who had injected drugs at least monthly in the past six months in June-July 2017 from all Australian capital cities via needle and syringe programs and word-of-mouth. A structured interview was used to collect information on drug use and related behaviour, as well as swabbing practices. Logistic regression was used to identify factors associated with not swabbing at last injection., Results: Of 853 respondents, one-quarter (26%) reported that they did not swab prior to their last injection. In adjusted analyses, crystal methamphetamine as the last drug injected, past month receptive or distributive syringe sharing, and past month re-use of one's own needle were significantly associated with not swabbing at last injection. Among participants who did not swab at last injection, swabbing was frequently considered unnecessary and a small number disliked using alcohol swabs., Discussion and Conclusions: Efforts are needed to increase awareness of the importance of injecting hygiene in preventing SSTI. Interventions to increase swabbing should be included as part of a wider package of injecting hygiene education, particularly in light of associations with receptive and/or distributive syringe sharing., (© 2019 Australasian Professional Society on Alcohol and other Drugs.)

Introduction and Aims: Services provided by needle and syringe programs (NSP) within Australia are easily accessible by international standards. However, important variation in NSP policy remains across Australian jurisdictions. The potential impacts of these variations on program operation for clients have not been systematically analysed in Australia. In this paper we conduct a preliminary examination to compare individual-level syringe coverage between and within Australian capital cities., Design and Methods: Participants were 2498 people who inject drugs (PWID) recruited from all Australian capital cities as part of the annual Illicit Drug Reporting System PWID survey over the period 2014-2016. Insufficient coverage was defined when <100% of a participant's injecting episodes were 'covered' by sterile needles and syringes. We report the percentage of insufficient coverage for each capital city for each year, and present descriptive statistics for coverage parameters, and an alternative measure for insufficient coverage, as Supporting Information., Results: Differences in behaviours that have the potential to impact syringe coverage were highly variable over time and place leading to variations in levels of insufficient coverage between and within all cities. Overall, insufficient coverage was most evident in larger cities where insufficient coverage varied between 19% and 23% (Sydney) over time, compared to smaller cities with variation from 9% to 12% (Adelaide)., Discussion and Conclusions: We found no consistent pattern of differences in individual-level needle and syringe coverage between and within Australian capital cities. Further work is needed to fully evaluate whether policy variation between Australian jurisdictions impacts on NSP coverage., (© 2018 Australasian Professional Society on Alcohol and other Drugs.)

Introduction and Aims: Accurate knowledge of individual hepatitis C virus (HCV) status is an important component of comprehensive health services for people who inject drugs (PWID). In this paper we compare the perceived HCV status of PWID in a longitudinal cohort study with their actual status, as verified by HCV-RNA testing., Methods: Participants who consented to blood testing at first follow up (352/688) were included. Self-reported HCV status (positive/negative/don't know), was compared with serology test results for participants., Results: In comparing self-report with HCV-RNA results, 274 of 352 participants had valid serology and self-report results; of these, 220 (80%) accurately reported their HCV status., Discussion and Conclusions: The findings of this study suggest that large proportions of PWID know their true HCV infection status, but the discordant participants represent potential HCV infection risks. Despite the majority of participants displaying concordance, this study reinforces the need for regular blood testing and the giving of accurate, practical and comprehensive HCV result information., (© 2012 Australasian Professional Society on Alcohol and other Drugs.)