- Browse by Author
Browsing by Author "Chapman, Erika"
Now showing 1 - 4 of 4
Results Per Page
Sort Options
Item HIV Infection Linked to Injection Use of Oxymorphone in Indiana, 2014-2015(New England Journal of Medicine, 2016-07-21) Peters, Philip J.; Pontones, Pamela; Hoover, Karen W.; Patel, Monita R.; Galang, Romeo R.; Shields, Jessica; Blosser, Sara J.; Spiller, Michael W.; Combs, Brittany; Switzer, William M.; Conrad, Caitlin; Gentry, Jessica; Khudyakov, Yury; Waterhouse, Dorothy; Owen, S. Michele; Chapman, Erika; Roseberry, Jeremy C.; McCants, Veronica; Weidle, Paul J.; Broz, Dita; Samandari, Taraz; Mermin, Jonathan; Walthall, Jennifer; Brooks, John T.; Duwve, Joan M.; Indiana HIV Outbreak Investigation Team; Department of Health Policy and Management, Richard M. Fairbanks School of Public HealthBACKGROUND: In January 2015, a total of 11 new diagnoses of human immunodeficiency virus (HIV) infection were reported in a small community in Indiana. We investigated the extent and cause of the outbreak and implemented control measures. METHODS: We identified an outbreak-related case as laboratory-confirmed HIV infection newly diagnosed after October 1, 2014, in a person who either resided in Scott County, Indiana, or was named by another case patient as a syringe-sharing or sexual partner. HIV polymerase (pol) sequences from case patients were phylogenetically analyzed, and potential risk factors associated with HIV infection were ascertained. RESULTS: From November 18, 2014, to November 1, 2015, HIV infection was diagnosed in 181 case patients. Most of these patients (87.8%) reported having injected the extended-release formulation of the prescription opioid oxymorphone, and 92.3% were coinfected with hepatitis C virus. Among 159 case patients who had an HIV type 1 pol gene sequence, 157 (98.7%) had sequences that were highly related, as determined by phylogenetic analyses. Contact tracing investigations led to the identification of 536 persons who were named as contacts of case patients; 468 of these contacts (87.3%) were located, assessed for risk, tested for HIV, and, if infected, linked to care. The number of times a contact was named as a syringe-sharing partner by a case patient was significantly associated with the risk of HIV infection (adjusted risk ratio for each time named, 1.9; P<0.001). In response to this outbreak, a public health emergency was declared on March 26, 2015, and a syringe-service program in Indiana was established for the first time. CONCLUSIONS: Injection-drug use of extended-release oxymorphone within a network of persons who inject drugs in Indiana led to the introduction and rapid transmission of HIV. (Funded by the state government of Indiana and others.).Item Multiple injections per injection episode: High-risk injection practice among people who injected pills during the 2015 HIV outbreak in Indiana(Elsevier, 2018-02) Broz, Dita; Zibbell, Jon; Foote, Carrie; Roseberry, Jeremy C.; Patel, Monita R.; Conrad, Caitlin; Chapman, Erika; Peters, Philip J.; Needle, Richard; McAlister, Cameron; Duwve, Joan M.; Sociology, School of Liberal ArtsBackground Misuse of prescription opioid analgesics (POA) has increased dramatically in the US, particularly in non-urban areas. We examined injection practices among persons who inject POA in a rural area that experienced a large HIV outbreak in 2015. Methods Between August-September 2015, 25 persons who injected drugs within the past 12 months were recruited in Scott County, Indiana for a qualitative study. Data from in-depth, semi-structured interviews were analyzed. Results All 25 participants were non-Hispanic white and the median age was 33 years (range: 19–57). All had ever injected extended-release oxymorphone (Opana® ER) and most (n = 20) described preparing Opana® ER for multiple injections per injection episode (MIPIE). MIPIE comprised 2–4 injections during an injection episode resulting from needing >1 mL water to prepare Opana® ER solution using 1 mL syringes and the frequent use of “rinse shots.” MIPIE occurred up to 10 times/day (totaling 35 injections/day), often in the context of sharing drug and injection equipment. Conclusions We describe a high-risk injection practice that may have contributed to the rapid spread of HIV in this community. Efforts to prevent bloodborne infections among people who inject POA need to assess for MIPIE so that provision of sterile injection equipment and safer injection education addresses the MIPIE risk environment.Item Prison Health is Community Health: The Indiana Peer Education Program(Research Square, 2022-07-06) Janota, Andrea D.; Hibbard, Patrick F.; Meadows, Meghan E.; Cocco, John P.; Carr, Abigail L.; Nichols, Deborah; Chapman, Erika; Maupomé, Gerardo; Duwve, JoanBackground: Concerning health inequities have been found in incarcerated populations, which likely impact broader community health. This paper evaluates the Indiana Peer Education Program (INPEP ECHO), an initiative that aims to improve health knowledge using the Project ECHO (Extension for Community Healthcare Outcomes) model to train people incarcerated in Indiana prisons (USA) as peer health educators inside prisons. Peer educators undergo a 40-hour training and then facilitate 10-hour long health education workshops inside their facilities over several days. Methods: We assessed the changes observed in pre- and post-session survey responses to estimate the impact this program had on peer educators and those they teach via multivariate regression analysis. We also examined peer educator qualitative data for emergent themes and confirmation of survey findings. Results: Findings from the 10-hour workshops showed improved knowledge scores and post-release behavior intentions. Peer educator surveys indicated increases in knowledge, health attitudes, and self-efficacy scores. Qualitative analysis affirms the latter finding and points toward peer educators acquiring expertise in the content they teach and how to teach it and that positive results likely expand beyond participants to others in prison, their families, and the communities to which they return. Further, peer educators shared they felt new purpose and hope tied to their participation in INPEP ECHO. Although these survey results show positive change in the short term, such improvements have been shown in other research to lead to improved middle- and long-term outcomes. Conclusions: Though preliminary, results indicate this type of public health intervention, training incarcerated individuals as peer educators on health topics, appears to increase important health knowledge and behavior intentions, which will likely lead to improvements in personal and public health outcomes. Results also point toward specific improvements associated with peers providing the education, and not external sources. The skills participants attain, as well, seem to increase their sense of purpose and self-efficacy, which have been shown to precede desistance from crime. While more work is necessary, the high costs associated with treating diseases like hepatitis C point toward an urgent need for programs like INPEP.Item Reduction of Injection-Related Risk Behaviors After Emergency Implementation of a Syringe Services Program During an HIV Outbreak(Wolters Kluwer, 2018-04) Patel, Monita R.; Foote, Carrie; Duwve, Joan; Chapman, Erika; Combs, Brittany; Fry, Alexandra; Hall, Patti; Roseberry, Jeremy; Brooks, John T.; Broz, Dita; Sociology, School of Liberal ArtsObjective: To describe injection-related HIV risk behaviors preimplementation and postimplementation of an emergency syringe services program (SSP) in Scott County, Indiana, after an HIV outbreak among persons who inject drugs (PWID). Design: Mixed methods retrospective pre–post intervention analysis. Methods: We analyzed routine SSP program data collected at first and most recent visit among clients with ≥2 visits, ≥7 days apart from April 4 to August 30, 2015, to quantify changes in injection-related risk behaviors. We also analyzed qualitative data collected from 56 PWID recruited in Scott County to understand factors contributing to these behaviors. Results: SSP clients included in our analysis (n = 148, 62% of all SSP clients) reported significant (P < 0.001) reductions over a median 10 weeks (range 1–23) in syringe sharing to inject (18%–2%) and divide drugs (19%–4%), sharing other injection equipment (eg, cookers) (24%–5%), and number of uses of the same syringe [2 (interquartile range: 1–4) to 1 (interquartile range: 1–1)]. Qualitative study participants described access to sterile syringes and safer injection education through the SSP, as explanatory factors for these reductions. Injection frequency findings were mixed, but overall suggested no change. The number of syringes returned by SSP clients increased from 0 at first visit to median 57. All qualitative study participants reported using sharps containers provided by the SSP. Conclusions: Analyses of an SSP program and in-depth qualitative interview data showed rapid reduction of injection-related HIV risk behaviors among PWID post-SSP implementation. Sterile syringe access as part of comprehensive HIV prevention is an important tool to control and prevent HIV outbreaks.