Identifying the Hidden Population: Former Intravenous Drug Users Who Are No Longer in Contact with Services. "Ask a Friend"

Sarah R Donaldson, Andrew Radley, John F Dillon, Sarah R Donaldson, Andrew Radley, John F Dillon

Abstract

People who, after a period of drug use, have changed their lifestyle and left substance use behind them are a hidden population within our communities. Lack of contact with drug services may mean that they are not tested for hepatitis C (HCV) infection through service-led initiatives and, therefore, may be exposed to the chronic morbidity and risk of death inherent with a legacy of HCV infection. This study utilized respondent-driven sampling (RDS) in a novel fashion to find those at historical risk of HCV. The social networks of people with a history of drug use were mapped, and individuals not currently in contact with services were invited to come forward for testing by members of their social network. The study used a reference group to inform study methodology and communication methods to reach out to this hidden population. One hundred and nine individuals received dry blood spot tests for HCV, 17.4% were antibody positive. Fifty one individuals met the inclusion criteria for this study. One hundred and twenty three invite-to-test coupons were issued; however, only one wave of recruitment consisting of one participant resulted from this method. Using RDS in historical social networks was not effective in this study and did not reach this hidden population and increase testing for HCV. This study is registered with clinicaltrials.gov (Ref NCT03697135).

Keywords: PWID; dry blood spot; hepatitis C; models of care; respondent-driven sampling; social networks.

Conflict of interest statement

SRD declare no conflict of interest. AR declares receipt of research grants from Abbvie, BMS, Pfizer and Gilead. Lecture fees and honorariums from Abbvie and Gilead. JFD declares receipt of research grants, lecture fees and honorariums from Abbvie, BMS, Gilead, MSD and Roche. The sponsors had no role in the design, execution, interpretation or writing of the study.

Figures

Figure 1
Figure 1
Social network mapping tool example. The participants name is placed in the centre, the inner circle represents individuals with whom the participant has a close relationship with and/or is in contact with on a regular basis. The outer circle represents individuals the participant regards as being within their social network but that they are in contact less frequently and/or are considered to be acquaintances rather than friends.
Figure 2
Figure 2
Study profile.

References

    1. Sexual Health & BBV Tayside Elimination of Hepatitis C in Tayside. [(accessed on 28 July 2020)];2020 Available online:
    1. News B. NHS Tayside Claims It Has ‘Effectively Eliminated’ Hepatitis C. [(accessed on 14 September 2020)];2020 Available online: .
    1. David Goldberg S.H., Innes H., Dillon J. Scotland’s Hepatitis C Action Plan: Achievements of the First Decade and Proposals for a Scottish Government Strategy (2019) for the Elimination of both Infection and Disease. Health Protection Scotland; Glasgow, UK: 2019. [(accessed on 9 June 2020)]. Available online: .
    1. Schulkind J., Stephens B., Ahmad F., Johnston L., Hutchinson S., Thain D., Ward Z., Vickerman P., Hickman M., Dillon J.F. High response and re-infection rates among people who inject drugs treated for hepatitis C in a community needle and syringe programme. J. Viral Hepat. 2019;26:519–528. doi: 10.1111/jvh.13035.
    1. Radley A., Tait J., Dillon J.F. DOT-C: A cluster randomised feasibility trial evaluating directly observed anti-HCV therapy in a population receiving opioid substitute therapy from community pharmacy. Int. J. Drug Policy. 2017;47:126–136. doi: 10.1016/j.drugpo.2017.05.042.
    1. Radley A., de Bruin M., Inglis S.K., Donnan P.T., Hapca A., Barclay S.T., Fraser A., Dillon J.F. Clinical effectiveness of pharmacist-led versus conventionally delivered antiviral treatment for hepatitis C virus in patients receiving opioid substitution therapy: A pragmatic, cluster-randomised trial. Lancet Gastroenterol. Hepatol. 2020 doi: 10.1016/S2468-1253(20)30120-5.
    1. Inglis S.K., Beer L.J., Byrne C., Malaguti A., Robinson E., Sharkey C., Gillings K., Stephens B., Dillon J.F. Randomised controlled trial conducted in injecting equipment provision sites to compare the effectiveness of different hepatitis C treatment regimens in people who inject drugs: A Direct obserVed therApy versus fortNightly CollEction study for HCV treatment—ADVANCE HCV protocol study. BMJ Open. 2019;9:e029516.
    1. Hickman M., Dillon J.F., Elliott L., De Angelis D., Vickerman P., Foster G., Donnan P., Eriksen A., Flowers P., Goldberg D. Evaluating the population impact of hepatitis C direct acting antiviral treatment as prevention for people who inject drugs (EPIToPe)–a natural experiment (protocol) BMJ Open. 2019;9:e029538. doi: 10.1136/bmjopen-2019-029538.
    1. Mawson E., Best D., Beckwith M., Dingle G.A., Lubman D. Social identity, social networks and recovery capital in emerging adulthood: A pilot study. Subst. Abus. Treat. Prev. Policy. 2015;10:45. doi: 10.1186/s13011-015-0041-2.
    1. Smith K.P., Christakis N.A. Social networks and health. Annu. Rev. Sociol. 2008;34:405–429. doi: 10.1146/annurev.soc.34.040507.134601.
    1. Jetten J., Haslam C., Alexander S.H. The Social Cure: Identity, Health and Well-Being. Psychology Press; Hove, UK: 2012.
    1. West R. Models of Addiction. EMCDDA; Lisbon, Portugal: 2013. European Monitoring Centre of Drugs and Drug Addiction (EMCDDA), Insights.
    1. Giovazolias T., Themeli O. Social learning conceptualization for substance abuse: Implications for therapeutic interventions. Eur. J. Psychother. Couns. 2014;3:69–88. doi: 10.5964/ejcop.v3i1.23.
    1. Best D., Beckwith M., Haslam C., Alexander Haslam S., Jetten J., Mawson E., Lubman D.I. Overcoming alcohol and other drug addiction as a process of social identity transition: The social identity model of recovery (SIMOR) Addict. Res. Theory. 2016;24:111–123. doi: 10.3109/16066359.2015.1075980.
    1. Bathish R., Best D., Savic M., Beckwith M., Mackenzie J., Lubman D.I. “Is it me or should my friends take the credit?” The role of social networks and social identity in recovery from addiction. J. Appl. Soc. Psychol. 2017;47:35–46. doi: 10.1111/jasp.12420.
    1. Tait J., Stephens B.P., McIntyre P.G., Evans M., Dillon J.F. Dry blood spot testing for hepatitis C in people who injected drugs: Reaching the populations other tests cannot reach. Frontline Gastroenterol. 2013;4:255–262. doi: 10.1136/flgastro-2013-100308.
    1. Heckathorn D.D., Broadhead R.S., Anthony D.L., Weakliem D.L. AIDS and social networks: HIV prevention through network mobilization. Sociol. Focus. 1999;32:159–179. doi: 10.1080/00380237.1999.10571133.
    1. Heckathorn D.D., Semaan S., Broadhead R.S., Hughes J.J. Extensions of respondent-driven sampling: A new approach to the study of injection drug users aged 18–25. Aids Behav. 2002;6:55–67. doi: 10.1023/A:1014528612685.
    1. Shaghaghi A., Bhopal R.S., Sheikh A. Approaches to recruiting ‘hard-to-reach’populations into research: A review of the literature. Health Promot. Perspect. 2011;1:86.
    1. Semaan S., Santibanez S., Garfein R.S., Heckathorn D.D., Des Jarlais D.C. Ethical and regulatory considerations in HIV prevention studies employing respondent-driven sampling. Int. J. Drug Policy. 2009;20:14–27. doi: 10.1016/j.drugpo.2007.12.006.
    1. Hope V., Hickman M., Ngui S., Jones S., Telfer M., Bizzarri M., Ncube F., Parry J. Measuring the incidence, prevalence and genetic relatedness of hepatitis C infections among a community recruited sample of injecting drug users, using dried blood spots. J. Viral Hepat. 2011;18:262–270. doi: 10.1111/j.1365-2893.2010.01297.x.
    1. Abdul-Quader A.S., Heckathorn D.D., Sabin K., Saidel T. Implementation and analysis of respondent driven sampling: Lessons learned from the field. J. Urban Health. 2006;83:1–5. doi: 10.1007/s11524-006-9108-8.
    1. Heckathorn D.D. Respondent-driven sampling: A new approach to the study of hidden populations. Soc. Probl. 1997;44:174–199. doi: 10.2307/3096941.
    1. Sexual Health & Blood Borne Virus Managed Care Network . Dry Blood Spot Testing Guidelines for Hepatitis C, Hepatitis B virus and HIV. NHS Tayside; Dundee, UK: 2018. [(accessed on 5 May 2020)]. Available online: .
    1. Judd A., Parry J., Hickman M., McDonald T., Jordan L., Lewis K., Contreras M., Dusheiko G., Foster G., Gill N. Evaluation of a modified commercial assay in detecting antibody to hepatitis C virus in oral fluids and dried blood spots. J. Med. Virol. 2003;71:49–55. doi: 10.1002/jmv.10463.
    1. Information Service Division . Edinburgh, UK: [(accessed on 5 May 2020)]. Prevalence of Problem Drug Use in Scotland 2015/16 Estimates. Available online: .
    1. Jarvis L. Alcohol Consumption in Black and Minority Ethnic Groups and Recent Immigrants in Scotland: Current Situation on Available Information. ISD Scotland, National Services Scotland; Edinburgh, UK: 2009.
    1. Health Protection Scotland GCUatWoSSVC . The Needle Exchange Surveillance Initiative (NESI): Prevalence of Blood-Borne Viruses and Injecting Risk Behaviours among People Who Inject Drugs (PWID) Attending Injecting Equipment Provision (IEP) Services in Scotland, 2008–2009 to 2017–2018. Health Protection Scotland; Glasgow, UK: 2019.
    1. Health Protection Scotland . Surveillance of Hepatitis C Testing, Diagnosis and Treatment in Scotland, 2019 Update. Glasgow, UK: 2019. [(accessed on 5 May 2020)]. Available online: .
    1. Ashford R.D., Brown A., Brown T., Callis J., Cleveland H.H., Eisenhart E., Groover H., Hayes N., Johnston T., Kimball T. Defining and operationalizing the phenomena of recovery: A working definition from the recovery science research collaborative. Addict. Res. Theory. 2019;27:179–188. doi: 10.1080/16066359.2018.1515352.
    1. Harris M. Injecting, infection, illness: Abjection and hepatitis C stigma. Body Soc. 2009;15:33–51. doi: 10.1177/1357034X09347221.
    1. Treloar C., Rance J., Backmund M. Understanding barriers to hepatitis C virus care and stigmatization from a social perspective. Clin. Infect. Dis. 2013;57:S51–S55. doi: 10.1093/cid/cit263.
    1. Dowsett L.E., Coward S., Lorenzetti D.L., MacKean G., Clement F. Living with hepatitis C virus: A systematic review and narrative synthesis of qualitative literature. Can. J. Gastroenterol. Hepatol. 2017:3268650. doi: 10.1155/2017/3268650.
    1. Johnston L.G., Sabin K. Sampling hard-to-reach populations with respondent driven sampling. Methodol. Innov. Online. 2010;5:38–48. doi: 10.4256/mio.2010.0017.
    1. Johnston L.G., Malekinejad M., Kendall C., Iuppa I.M., Rutherford G.W. Implementation challenges to using respondent-driven sampling methodology for HIV biological and behavioral surveillance: Field experiences in international settings. Aids Behav. 2008;12:131–141. doi: 10.1007/s10461-008-9413-1.
    1. DeJong J., Mahfoud Z., Khoury D., Barbir F., Afifi R.A. Ethical considerations in HIV/AIDS biobehavioral surveys that use respondent-driven sampling: Illustrations from Lebanon. Am. J. Public Health. 2009;99:1562–1567. doi: 10.2105/AJPH.2008.144832.
    1. Scott G. “They got their program, and I got mine”: A cautionary tale concerning the ethical implications of using respondent-driven sampling to study injection drug users. Int. J. Drug Policy. 2008;19:42–51. doi: 10.1016/j.drugpo.2007.11.014.
    1. Abdul-Quader A.S., Heckathorn D.D., McKnight C., Bramson H., Nemeth C., Sabin K., Gallagher K., Des Jarlais D.C. Effectiveness of respondent-driven sampling for recruiting drug users in New York City: Findings from a pilot study. J. Urban Health. 2006;83:459–476. doi: 10.1007/s11524-006-9052-7.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren