Search

BackgroundPeople who inject drugs (PWID) experience a high prevalence of incarceration and might be at high risk of HIV and hepatitis C virus (HCV) infection during or after incarceration. We aimed to assess whether incarceration history elevates HIV or HCV acquisition risk among PWID.MethodsIn this systematic review and meta-analysis, we searched MEDLINE, Embase, and PsycINFO databases for studies in any language published from Jan 1, 2000 until June 13, 2017 assessing HIV or HCV incidence among PWID. We included studies that measured HIV or HCV incidence among community-recruited PWID. We included only studies reporting original results and excluded studies that evaluated incident infections by self-report. We contacted authors of cohort studies that met the inclusion or exclusion criteria, but that did not report on the outcomes of interest, to request data. We extracted and pooled data from the included studies using random-effects meta-analyses to quantify the associations between recent (past 3, 6, or 12 months or since last follow-up) or past incarceration and HIV or HCV acquisition (primary infection or reinfection) risk among PWID. We assessed the risk of bias of included studies using the Newcastle-Ottawa Scale. Between-study heterogeneity was evaluated using the I2 statistic and the P-value for heterogeneity.FindingsWe included published results from 20 studies and unpublished results from 21 studies. These studies originated from Australasia, western and eastern Europe, North and Latin America, and east and southeast Asia. Recent incarceration was associated with an 81% (relative risk [RR] 1·81, 95% CI 1·40-2·34) increase in HIV acquisition risk, with moderate heterogeneity between studies (I2=63·5%; p=0·001), and a 62% (RR 1·62, 95% CI 1·28-2·05) increase in HCV acquisition risk, also with moderate heterogeneity between studies (I2=57·3%; p=0·002). Past incarceration was associated with a 25% increase in HIV (RR 1·25, 95% CI 0·94-1·65) and a 21% increase in HCV (1·21, 1·02-1·43) acquisition risk.InterpretationIncarceration is associated with substantial short-term increases in HIV and HCV acquisition risk among PWID and could be a significant driver of HCV and HIV transmission among PWID. These findings support the need for developing novel interventions to minimise the risk of HCV and HIV acquisition, including addressing structural risks associated with drug laws and excessive incarceration of PWID.FundingEngineering and Physical Sciences Research Council, National Institute for Health Research, National Institutes of Health.

Introduction: We assessed the prevalence of prescribing of certain medications for alcohol dependence and the extent of any inequalities in receiving prescriptions for individuals with such a diagnosis. Further, we compared the effectiveness of two of the most prescribed medications (acamprosate and disulfiram) for alcohol dependence and assessed whether there is inequality in prescribing either of them. Methods: We used a nationwide dataset on prescriptions and hospitalisations in Scotland, UK (N = 19,748). We calculated the percentage of patients receiving alcohol dependence prescriptions after discharge, both overall and by socio‐economic groups. Binary logistic regressions were used to assess the odds of receiving any alcohol‐dependence prescription and the comparative odds of receiving acamprosate or disulfiram. Comparative effectiveness in avoiding future alcohol‐related hospitalisations (N = 11,239) was assessed using Cox modelling with statistical adjustment for potential confounding. Results: Upto 7% of hospitalised individuals for alcohol use disorder received prescriptions for alcohol dependence after being discharged. Least deprived socio‐economic groups had relatively more individuals receiving prescriptions. Inequalities in prescribing for alcohol dependence existed, especially across sex and comorbidities: males had 12% (odds ratio [OR] 0.88, 95% confidence interval [CI] 0.81–0.96) and those with a history of mental health hospitalisations had 10% (OR 0.90, 95% CI 0.82–0.98) lower odds of receiving prescriptions after an alcohol‐related hospitalisation. Prescribing disulfiram was superior to prescribing acamprosate in preventing alcohol‐related hospitalisations (hazard ratio ranged between 0.60 and 0.81 across analyses). Disulfiram was relatively less likely prescribed to those from more deprived areas. Discussion and Conclusions: Inequalities in prescribing for alcohol dependence exists in Scotland with lower prescribing to men and disulfiram prescribed more to those from least deprived areas. [ABSTRACT FROM AUTHOR]

This article discusses the experiences and challenges of introducing a third-party learning support provider into the teaching and learning culture at Southern Cross University (SCU), a regional university with campus locations in New South Wales and Queensland. The provider was engaged to extend online study support after-hours to first year students to complement the on-campus and online academic skills consultations available during business hours. The case study covers a 2015 pilot, a wider roll-out in 2016, and finally, a 2017 university-wide access via the intranet as well as through nominated units. The project team collaborated, planned, and prepared for adding third-party student support with specific strategies used to implement institutional cultural change. The case study offers implications for practice and policy across the higher education sector through the lessons learned, including the need for a complementarity of services approach with existing student services, a team-based strategic approach with a provider representative, and the benefits from open and positive communication. The partnership between SCU and the third-party provider evolved to the mutual benefit of both organisations. Students received support and feedback when they needed it most, academic staff revitalised coursework, and the third-party provider fine-tuned a targeted service for the institution.

Background and aims: Direct‐acting antiviral (DAA) treatment has an established positive effect on liver outcomes in people with hepatitis C infection; however, there is insufficient evidence regarding its effects on the 'extra‐hepatic' outcomes of drug‐related hospitalization and mortality (DRM) among people who inject drugs (PWID). We investigated associations between these outcomes and DAA treatment by comparing post‐treatment to baseline periods using a within‐subjects design to minimize selection bias concerns with cohort or case–control designs. Design: This was a self‐controlled case‐series study. Setting Scotland, 1 January 2015–30 November 2020. Participants: The study population of non‐cirrhotic, DAA‐treated PWID was identified using a data set linking Scotland's hepatitis C diagnosis, HCV clinical databases, national inpatient/day‐case hospital records and the national deaths register. Three principal outcomes (drug overdose admission, non‐viral injecting related admission and drug‐related mortality) were defined using ICD codes. Measurements Self‐controlled case‐series methodology was used to estimate the relative incidence (RI) of each outcome associated with time on treatment and up to six 90‐day exposure risk periods thereafter. Findings A total of 6050 PWID were treated with DAAs in the sampling time‐frame. Compared with the baseline period, there was a significantly lowered risk of a drug overdose hospital admission in the second to fifth exposure risk periods only [relative incidence (RI) = 0.86, 95% confidence interval (CI) = 0.80–0.99; 0.89, 95% CI = 0.80–0.99; 0.86, 95% CI = 0.77–0.96; 0.88, 95% CI = 0.78–0.99, respectively]. For non‐viral injecting‐related admission, there was a reduced risk in the first, third and fourth exposure risk periods (RI = 0.76, 95% CI = 0.64–0.90; 0.75, 95% CI = 0.62–0.90; 0.79, 95% CI = 0.66–0.96, respectively). There was no evidence for reduced DRM risk in any period following treatment end. Conclusions: Among people who inject drugs in Scotland, direct‐acting antiviral treatment appears to be associated with a small, non‐durable reduction in the risk of drug‐related hospital admission, but not drug‐related mortality. Direct‐acting antiviral therapy, despite high effectiveness against liver disease, does not appear to offer a panacea for reducing other drug‐related health harms. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to explore how universities attempt to balance meeting their traditional mission of education, research and community engagement while remaining economically sustainable. Design/Methodology/Approach: A survey was conducted in 2014 of university executives and found that universities in Australia are rapidly transitioning from public supported institutions to an organizational form much more like social enterprise, with all of the organizational, marketing and ethical ramifications. Findings: Australian universities were found to be focused on maintaining financial viability and that the most significant source of future revenue for Australian universities is perceived to be from international students. Originality/Value: The findings have tremendous public policy and ethical implications--suggesting a shift in the classification of university education from what was generally considered a public good to what is increasingly perceived as a private good in the contemporary market place, with the increasing importance of international students.