scholarly journals Accounting for dropout reason in longitudinal studies with nonignorable dropout

2015 ◽  
Vol 26 (4) ◽  
pp. 1854-1866 ◽  
Author(s):  
Camille M Moore ◽  
Samantha MaWhinney ◽  
Jeri E Forster ◽  
Nichole E Carlson ◽  
Amanda Allshouse ◽  
...  
Keyword(s):  
Longitudinal Studies ◽  
Injection Drug Users ◽  
Drug Users ◽  
Acute Infection ◽  
Loss To Follow Up ◽  
Longitudinal Outcome ◽  
Exposure Variable ◽  
Nonignorable Dropout ◽  
Coefficient Method

Dropout is a common problem in longitudinal cohort studies and clinical trials, often raising concerns of nonignorable dropout. Selection, frailty, and mixture models have been proposed to account for potentially nonignorable missingness by relating the longitudinal outcome to time of dropout. In addition, many longitudinal studies encounter multiple types of missing data or reasons for dropout, such as loss to follow-up, disease progression, treatment modifications and death. When clinically distinct dropout reasons are present, it may be preferable to control for both dropout reason and time to gain additional clinical insights. This may be especially interesting when the dropout reason and dropout times differ by the primary exposure variable. We extend a semi-parametric varying-coefficient method for nonignorable dropout to accommodate dropout reason. We apply our method to untreated HIV-infected subjects recruited to the Acute Infection and Early Disease Research Program HIV cohort and compare longitudinal CD4+ T cell count in injection drug users to nonusers with two dropout reasons: anti-retroviral treatment initiation and loss to follow-up.

Predictors of Positive Outcomes for Out-of-Treatment Opiate Injectors Recruited into Methadone Maintenance through Street Outreach

2002 ◽  
Vol 32 (3) ◽  
pp. 999-1016 ◽  
Author(s):  
Karen Fortuin Corsi ◽  
Carol F. Kwiatkowski ◽  
Robert E. Booth
Keyword(s):  
Drug Use ◽  
Behavior Change ◽  
Hiv Risk ◽  
Methadone Maintenance Treatment ◽  
Injection Drug Users ◽  
Drug Users ◽  
Maintenance Treatment ◽  
Methadone Maintenance ◽  
Positive Outcomes

This study was conducted to assess behavior change in the areas of drug use, productivity, criminal activity, and HIV risk among street-recruited injection drug users who entered methadone maintenance treatment. In addition, the study examined a number of variables that could account for these changes, including demographics, intervention effects, and treatment-related measures. A total of 168 participants were interviewed at baseline, received outreach interventions, entered methadone maintenance treatment, and were reinterviewed 5–9 months later. Significant (p<.001) improvements were seen in the areas of drug use, productivity, criminality, and HIV risk behaviors. The only variables significantly associated with behavior change were related to drug treatment. In particular, being in treatment at the time of the follow-up assessment had the strongest relationship to positive outcomes, including length of treatment. Having no prior treatment experience was associated with fewer injections at follow-up. These findings emphasize the importance of retaining clients, given the likelihood that positive change is likely to be evidenced while they remain in treatment

On- and off-label utilization of dalbavancin and oritavancin for Gram-positive infections

2019 ◽  
Vol 74 (8) ◽  
pp. 2405-2416 ◽  
Author(s):  
Taylor Morrisette ◽  
Matthew A Miller ◽  
Brian T Montague ◽  
Gerard R Barber ◽  
R Brett McQueen ◽  
...  
Keyword(s):  
Health System ◽  
Injection Drug Users ◽  
Drug Users ◽  
Cost Savings ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Gram Positive ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Off Label

AbstractBackgroundLong-acting lipoglycopeptides (laLGPs) are FDA approved only for acute bacterial skin and skin structure infections (ABSSSIs). However, these antibiotics show promise for off-label use, reductions in hospital length of stay (LOS) and healthcare cost savings.ObjectivesTo assess the effectiveness, safety, impact on LOS and estimated cost savings from laLGP treatment for Gram-positive infections.MethodsRetrospective cohort of adult patients who received at least one dose of laLGPs at the University of Colorado Health system. Descriptive statistics were utilized for analysis.ResultsOf 59 patients screened, 56 were included: mean age 47 years, 59% male and 30% injection drug users/polysubstance abusers (dalbavancin, 71%; oritavancin, 25%; both, 4%). Most common indications for laLGP: ABSSSIs (36%), osteomyelitis (27%) and endocarditis (9%). Most common isolated pathogens: MSSA and MRSA (25% and 19%, respectively), Enterococcus faecalis (11%) and CoNS (11%). Previous antibiotics were administered for a median of 13 days (IQR = 7.0–24.5 days) and laLGPs for a median of one dose (IQR = 1–2 doses). Ten (18%) patients were lost to follow-up. Clinical failure was found in 7/47 (15%) cases with adequate follow-up. Mild adverse effects occurred in six (11%) patients. Projected reduction in hospital LOS and health-system costs were 514 days (9.18 days/person average) and $963456.72 ($17204.58/person average), respectively.ConclusionsProspective trials are needed to validate the use of these antibiotics for Gram-positive infections in practice, with the hope that they will reduce hospital LOS and the need for daily antibiotic infusions to provide alternative options for patients not qualifying for outpatient parenteral antimicrobial therapy.

scholarly journals The Edinburgh Addiction Cohort: recruitment and follow-up of a primary care based sample of injection drug users and non drug-injecting controls

2010 ◽  
Vol 10 (1) ◽  
Author(s):  
John Macleod ◽  
Lorraine Copeland ◽  
Matthew Hickman ◽  
James McKenzie ◽  
Jo Kimber ◽  
...  
Keyword(s):  
Primary Care ◽  
Injection Drug Users ◽  
Drug Users ◽  
Injection Drug ◽  
Drug Injecting

scholarly journals The Prevalence and Incidence of Sexually Transmitted Infections in a Prospective Cohort of Injection Drug Users in Vancouver, British Columbia

2005 ◽  
Vol 16 (4) ◽  
pp. 225-229 ◽  
Author(s):  
Laura M Kuyper ◽  
Courtney LC Collins ◽  
Thomas Kerr ◽  
Robert S Hogg ◽  
Kathy Li ◽  
...  
Keyword(s):  
Prospective Cohort ◽  
Injection Drug Users ◽  
Drug Users ◽  
Unprotected Sex ◽  
Relative Hazard ◽  
Sex Trade ◽  
Sexually Transmitted ◽  
Cumulative Rate ◽  
History Of

BACKGROUND: While several studies have reported on sexual risk behaviours and the prevalence of sexually transmitted infections (STIs) among injection drug users (IDUs), there are fewer prospective studies that have been able to examine populations of IDUs with no history of STIs. Therefore, the authors examined prevalence, correlates and factors associated with time to first STI infection in a prospective cohort of IDUs in Vancouver, British Columbia.METHODS: The authors examined the prevalence and correlates of STIs among IDUs at the time of recruitment into a prospective cohort study. The authors also evaluated the cumulative rate of time to first STI among IDUs with no history of STIs at baseline using the Kaplan-Meier method, and modelled factors independently associated with first STI using Cox regression.RESULTS: Between May 1996 and November 2003, 1560 individuals were recruited into the cohort; of these individuals, 745 reported a history of STI at baseline. Among the 815 who did not report an STI at baseline, 671 (82%) had at least one follow-up visit and were eligible for the analysis of time to first STI. After 36 months of follow-up, the cumulative rate of first STI was 8.2% for men and 15.9% for women (log-rank P<0.001), whereas the cumulative rate of first STI was 8.0% for IDUs who did not report sex trade involvement versus 19.8% for IDUs who reported sex trade involvement (log-rank P<0.001). In multivariate analyses, the risk of first STI remained independently associated with unprotected sex with regular partners (relative hazard=2.04, 95% CI 1.29 to 3.23; P=0.001) and unprotected sex with sex trade clients (relative hazard=2.36, 95% CI 1.46 to 3.82; P=0.005).CONCLUSIONS: In the present study, the authors found that STIs were associated with both regular sex partnerships and sex trade involvement. These findings are of particular concern because both unprotected sex with regular partners and sex trade involvement is common among IDUs. Interventions to encourage condom use among IDUs, particularly those with regular sex partners and those involved in the sex trade, should be further developed.

scholarly journals 699. A Retrospective Review of the Progression of Cardiac Vegetations with treatment

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S401-S401
Author(s):  
Roomana Khan ◽  
Saleeha Asghar ◽  
Vivek Kak
Keyword(s):  
Successful Treatment ◽  
Retrospective Review ◽  
Injection Drug Users ◽  
Drug Users ◽  
Primary Outcome ◽  
P Value ◽  
Initial Size ◽  
Adequate Treatment ◽  
History Of

Abstract Background The purpose of our study was to assess the natural history of cardiac vegetations in native valves(NVIE) including changes in size and/or resolution with adequate treatment, as well as analyze factors that influence initial size. Methods We did a retrospective review of 102 patients discharged with a diagnosis NVIE at a community hospital. These patients were then screened to see if they received an adequate course of antimicrobial therapy and had follow up echocardiograms. The primary outcome measured was the change in vegetation size. We also assessed secondary measures including pathogen identified, the valve involved, complications, and associated IDU and any co-infections. Results 31 patients fulfilled the study criteria and showed an initial mean vegetation size of 170mm upon initial echocardiography. The follow-up size after antibiotic treatment was 78mm suggesting a statistically significant relationship between antibiotic completion and reduction in vegetation size. (p-value 0.005). T-Test was used for subgroup analysis and showed that the initial size of vegetations was significantly larger in IDUs (311) when compared to non-IDU (92)(p-value= 0.026).Patients who had embolic phenomena had significantly larger initial vegetations than those with no embolic complication. Initial vegetation size was significantly larger for people with embolic complications (308 mm vs 82.65 mm, p-value 0.013).We also found that patients with Staphylococcal endocarditis had larger vegetations than those with non-staphylococcal endocarditis (264 vs 39, p-value 0.001). and treatment led to a larger decrease in vegetation size (152 vs 7, p value 0.007) Conclusion Our small study suggests that successful treatment of NVIE does lead to a decrease in vegetation size though resolution of the vegetation does not occur. We also found that embolic phenomenon tended to occur with larger vegetations with our study suggesting that a vegetation &gt; 3 cm was more likely to embolize. Our study also shows that vegetations in NVIE in injection drug users were larger than those in non-IDU and vegetation size is larger in patients with staphylococcal endocarditis however successful treatment in these patients also leads to a larger decrease in size of these vegetations Disclosures All Authors: No reported disclosures

Laboratory Abnormalities in Former Blood Donors Seropositive for Human T-Lymphotropic Virus Types 1 and 2

2000 ◽  
Vol 124 (4) ◽  
pp. 550-555
Author(s):  
Simone A. Glynn ◽  
Edward L. Murphy ◽  
David J. Wright ◽  
Ronald A. Sacher ◽  
Joy Fridey ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Injection Drug Users ◽  
Drug Users ◽  
Blood Donors ◽  
The United States ◽  
T Lymphotropic Virus ◽  
Cell Counts ◽  
Absolute Lymphocyte Counts ◽  
Laboratory Changes

Abstract Context.—The human T-lymphotropic viruses types 1 and 2 (HTLV-1 and HTLV-2) are highly prevalent among injection drug users in the United States. However, the clinical course of infection has not been well characterized. Objective.—To understand HTLV-1–and HTLV-2–associated laboratory abnormalities, which may provide insights into their underlying pathophysiology. Design.—Cohort study. Setting.—Five US blood centers. Participants.—A total of 133 HTLV-1–and 332 HTLV-2–seropositive former blood donors and 717 HTLV-seronegative donors followed up prospectively since 1991. Main Outcome Measures.—Selected serum chemistry tests and complete blood cell counts were analyzed at enrollment and approximately 2 years later in participants. Repeated-measures analyses were conducted to evaluate the effect of HTLV infection on laboratory measures. Results.—Compared with seronegative subjects, HTLV-1–seropositive subjects had 13% higher creatine kinase (P = .02) and slightly elevated lactate dehydrogenase (P = .03) levels at follow-up. The HTLV-2–seropositive participants had 11% higher absolute lymphocyte counts than seronegative subjects (P = .0001). Infection with HTLV-2 also appeared to be associated with slightly higher hemoglobin levels (P = .03) and hematocrit (P = .03) and with lower albumin levels (P = .01). Conclusions.—These results further our understanding of the biological mechanisms underlying HTLV and suggest that HTLV-associated laboratory changes are unlikely to alter clinical evaluation or counseling of otherwise healthy HTLV-infected subjects.

Research Note: Acceptability and Utility of a Hand-Held Syringe Disposal Device for Active Injection Drug Users

2003 ◽  
Vol 33 (2) ◽  
pp. 519-532
Author(s):  
Grace E. Macalino ◽  
Rachel S. Weston ◽  
Francis A. Wolf ◽  
Stephanie L. Sanford-Colby ◽  
Michelle M. McKenzie ◽  
...  
Keyword(s):  
Injection Drug Users ◽  
Drug Users ◽  
Research Note ◽  
Injection Drug ◽  
Needlestick Injuries ◽  
Syringe Disposal ◽  
Almost All ◽  
Better Than

Efforts to prevent the spread of HIV and hepatitis among injection drug users (IDUs) by improving access to sterile syringes can raise questions about syringe disposal. This study sought to evaluate the acceptability and utility of the Voyager, a newly approved, hand-held syringe disposal device for active injection drug users (IDUs). We offered the Voyager to active IDUs (n = 97), and interviewed them upon receiving the device and one month later. Almost all (90%) accepted the device. At follow-up, 78% had used the Voyager and 44% reported using it all the time; 65% reported they would like to continue using the Voyager and 77% rated the device “somewhat better” or “much better” than other methods of syringe disposal. Many IDUs care about safe syringe disposal and are willing and able to use a convenient disposal device such as the Voyager. Communities concerned about needlestick injuries and re-use of contaminated syringes should explore increasing the availability of such a device for IDUs as part of an overall approach to prevent improperly discarded syringes.

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