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Josiah D Rich

Publications and source records attributed to Josiah D Rich.

14 recordsLinked to original sources
PubMed2003

Drug use patterns over time among HIV-seropositive and HIV-seronegative women: the HER study experience.

BACKGROUND: Drug use, particularly among women, is a public health issue given its health effects and its impact on HIV transmission. Becoming HIV seropositive could lead to differing patterns of drug use over time. HIV infection may decrease drug use due to an increased access to health services. Alternatively, increased drug use may occur due to depression associated with being HIV infected, leading to despair, hopelessness, and a lack of motivation to become drug free. METHODS: We evaluated the potential association between HIV serostatus and drug use among a cohort of 1310 women who were part of a multicenter collaborative study on the natural history of HIV infection. Eight hundred seventy-one HIV-seropositive women and 439 HIV-seronegative women were enrolled at four sites (New York, Providence, Baltimore, and Detroit). We defined drug use as any heroin or cocaine use reported at the baseline visit (enrollment). RESULTS: Drug use was found to decrease during earlier visits (months 1-24) and remained stable at 20% thereafter (months 30-84). No significant differences in change of drug use were noted by HIV serostatus, using generalized estimating equation-based logistic regression analyses. CONCLUSIONS: HIV-seropositive status did not affect drug use patterns over time within our population of high-risk women.

Adult↗
PubMed2003

Treatment of chronic hepatitis C in a state correctional facility.

BACKGROUND: Approximately 1 in 4 of the nearly 2 million individuals in state and federal correctional facilities are infected with hepatitis C virus (HCV). Currently, there are few reports of treatment outcomes of this common infection in this setting. OBJECTIVE: To describe HCV therapy in the incarcerated setting. DESIGN: Retrospective, descriptive observational study. SETTING: Rhode Island Department of Corrections, Cranston, Rhode Island. PATIENTS: 93 inmates with chronic HCV infection. INTERVENTION: Interferon-alpha with ribavirin. MEASUREMENTS: HCV RNA levels 6 months after treatment. RESULTS: Response rates are similar to previously published rates achieved in the community; 63% (50 of 79) of patients achieved viral clearance after 6 months of therapy, and 46% (26 of 57) achieved sustained response 6 months after treatment. CONCLUSION: The incarcerated population (which is disproportionately affected by addiction and psychiatric illness) can be effectively treated for HCV infection with interferon and ribavirin. The correctional setting may provide an opportunity to safely treat patients with these two challenging comorbid conditions.

Adult↗
PubMed2003

A review of the case for hepatitis B vaccination of high-risk adults.

The sequelae of hepatitis B virus infection include fulminant liver failure, chronic liver disease, hepatocellular carcinoma, and death. The hepatitis B vaccine is efficacious, safe, and cost-effective, but has been consistently underutilized in high-risk adults despite long-standing recommendations. Instituting routine hepatitis B vaccination for high-risk adults in settings such as prisons and jails, sexually transmitted disease clinics, drug treatment centers, and needle exchange programs could prevent up to 800 cases of hepatitis, and 10 deaths from hepatitis, per 10,000 vaccinations, with an overall cost savings. Low rates of completion of the three-dose series and lack of funding for adult immunizations have always been challenges to offering hepatitis B vaccines to high-risk adults. However, there is benefit to an incomplete vaccination series, and high-risk populations are accessible for follow-up vaccination outside of traditional medical settings. A clear national objective and federal funding for vaccinating high-risk adults are needed.

Adult↗
PubMed2003

Would you consider prescribing syringes to injection drug users? Addiction Medicine Conference Survey.

In order to assess attitudes and practices of physicians regarding prescribing syringes to injection drug users (IDUs) to prevent disease transmission, a survey was conducted at the 2000 ASAM Conference. Of 497 physicians, 104 responded, representing 30 states and 3 countries. Seventy-eight percent provided care for IDUs. Only 2% had prescribed syringes to IDUs for safer injection of illegal drugs. Nineteen percent had prescribed syringes to diabetic patients whom they believed would use the syringes for injecting illegal drugs. Overall, 61% of physicians (74% of internists, 37% of psychiatrists) (p = 0.04) would consider prescribing syringes to IDUs. Prescribing syringes to IDUs can be part of a comprehensive approach to preventing spread of HIV and other infections, decreasing complications of syringe reuse, and bringing IDUs into medical and substance abuse treatment. The majority of physicians surveyed expressed interest in prescribing syringes. Psychiatrists may be less willing to do so.

Adult↗
PubMed2002

A prospective study of adherence and viral load in a large multi-center cohort of HIV-infected women.

OBJECTIVES: To examine the relationship between antiretroviral adherence and viral load, and to determine the predictors of adherence over time in HIV-infected women. DESIGN: Prospective observational study. METHODS: One-hundred sixty-one HIV-infected women who were taking antiretroviral therapy for a median of 3.0 years were recruited from the HIV Epidemiology Research Study, a multicenter cohort study of HIV infection in women. Antiretroviral adherence (percent of doses taken as prescribed) was measured over a 6-month period using MEMS caps. At baseline and follow-up, CD4 lymphocyte count and viral load were measured, and a standardized interview was administered to elicit medication history and drug use behaviors. To examine changes in adherence over time, the mean adherence to all antiretroviral agents was calculated for each monitored month. RESULTS: Adherence varied significantly over time (P < 0.001), ranging from a mean of 64% in month 1 to 45% in month 6. Nearly one-fourth of the participants had a 10% or greater decrease in adherence between consecutive months. Virologic failure occurred in 17% of women with adherence of > or = 88%, 28% of those with 45-87% adherence, 43% of those with 13-44% adherence, and 71% of those with < or = 12% adherence. In multivariate analysis, factors predicting lower adherence included active drug use, alcohol use, more frequent antiretroviral dosing, shorter duration of antiretroviral use, younger age, and lower initial CD4 lymphocyte count. CONCLUSIONS: Antiretroviral adherence is not stable over time. Interventions aimed at monitoring and improving long-term adherence in women are urgently needed.

Adult↗
PubMed2002

The importance of routine HIV testing in the incarcerated population: the Rhode Island experience.

Routine HIV testing in the correctional setting offered to all inmates at entry has played an important role in the diagnosis of HIV in Rhode Island. Diagnosis and treatment of HIV in prisons can further public health goals of HIV control, prevention, and education. Routine HIV testing can be incorporated into primary and secondary prevention programs in correctional facilities. In Rhode Island, where HIV testing is routine at entry into the correctional facility, approximately one third of all persons who test positive are identified in the correctional facility. The proportion of males and females testing positive in the correctional facility versus those testing positive in other facilities has shown a gradual decrease, with positive female HIV tests declining more substantially in recent years. Specific groups, such as males, African Americans, and injection drug users continue to be more likely diagnosed in the state correctional facility than in other testing sites. These differences may reflect barriers to health care access that other community initiatives have failed to address.

AIDS Serodiagnosis↗
PubMed2002

Strategies to improve access to sterile syringes for injection drug users.

The high prevalence of infection with HIV and other blood-borne pathogens in injection drug users (IDUs) is directly related to the lack of syringe access. Needle exchange programs (NEPs), syringe prescription, and syringe deregulation are 3 approaches to increasing access to sterile syringes for IDUs. The benefits of NEPs have been repeatedly demonstrated, but the impact of NEPs has been limited by a lack of federal funding. Syringe prescription for IDUs is a promising new strategy supported by many organizations; legalizing syringe purchase and possession has led to a substantial improvement in syringe access in many states. Because each approach has unique advantages, providing IDUs with a variety of options for syringe access is likely to be most beneficial.

HIV Infections↗
PubMedDate not supplied

Pharmacist support for selling syringes without a prescription to injection drug users in Rhode Island.

OBJECTIVE: To examine pharmacists' attitudes and obstacles to syringe sales to IDUs without prescriptions in Rhode Island, around the time that such sales became legal in the state. DESIGN: Self-administered written survey. SETTING: Rhode Island. PARTICIPANTS: 400 randomly selected pharmacist members of the Rhode Island Pharmacists Association. MAIN OUTCOME MEASURES: Responses to survey items. RESULTS: Of the 400 pharmacists contacted, 131 (33%) completed and returned the survey; of these, 101 (77%) were pharmacists who worked in stores that provided direct nonprescription syringe sales to the public. The majority of these 101 pharmacists were willing to sell syringes to a suspected IDU without a prescription (65%), favored providing free sharps containers for disposal (68%), and supported providing pamphlets on safer injection practices (88%). Willingness to sell syringes to IDUs without a prescription was significantly correlated with various beliefs about possible consequences of sales. CONCLUSION: The high level of support for nonprescription syringe sales to IDUs is promising. The correlation between the willingness to sell syringes to IDUs without a prescription and various beliefs suggests that future educational interventions might encourage pharmacists to sell syringes to this population without a prescription to decrease HIV and hepatitis transmission.

Adult↗