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Biomedical subjects

R S Garfein

Publications and source records attributed to R S Garfein.

16 recordsLinked to original sources
PubMed2000

Correlates of HIV infection among young adult short-term injection drug users.

OBJECTIVES: To identify risks associated with HIV infection among young adult short-term injection drug users. METHODS: Current injection drug users, between 18 and 29 years of age, were recruited through street outreach to participate in a cross-sectional survey of HIV prevalence by circumstances of drug injection initiation, HIV-related risk behaviors, and a follow-up to estimate HIV incidence. RESULTS: At enrollment, 33 (14.4%) of 229 participants were HIV-seropositive. Significant bivariate associations with HIV at the time injection drug use was initiated included age less than or equal to 18 years, having receptive anal sex with the person who assisted with initiation, and having two or more 'trainers' before being able to self-inject. Injecting risks positively associated with HIV included cocaine or speedball (heroin and cocaine together) injection versus heroin or amphetamine injection, injecting five or more times per day, daily crack smoking, backloading, sharing needles at peak drug use, and not using a new needle for every injection. Sexual practices associated with HIV included reporting > 100 lifetime sex partners, a history of sexual assault, being gay or bisexual, and trading sex for money or drugs after starting to inject. In a multivariate model, trading anal sex for money or drugs after initiating injection drug use [odds ratio (OR), 14.2; 95% confidence interval (CI) 3.2-62.3], cocaine/speedball injection (OR, 10.3; 95% CI, 2.2-47.9), daily crack smoking (OR, 4.2; 95% CI, 1.7-10.5), and having two or more trainers (OR, 2.6; 95% CI, 1.1 - 5.9) were independently associated with HIV. During 12 months of follow-up, four persons seroconverted for HIV (annual incidence: 2.6%; 95% CI, 1.1 -5.9%) CONCLUSIONS: Among short-term injectors, both sexual and injecting practices were important predictors of HIV infection, indicating that a proportion of HIV infections among young injection drug users can be attributed to sexual transmission. The incidence rate for HIV infection suggests that immediate steps should be taken to prevent new infections among young injection drug users.

Adolescent↗
PubMed2000

Gender differences in the initiation of injection drug use among young adults.

To characterize the circumstances surrounding initiation of injecting drug use, data were collected from 229 young, recently initiated injection drug users enrolled through community-based recruitment in Baltimore, Maryland. Gender differences in the pattern of initiation, the number of persons present at initiation, risky injection, and sexual behaviors at initiation, as well as behaviors after initiation, were examined. Overall, men and women were similar statistically with respect to age at initiation (19.5 years) and risk behaviors at initiation. While men were initiated by men (77%), women were more often initiated by women (65%), most of whom were friends (75%) or relatives (23%). The percentage of women infected with human immunodeficiency virus (HIV) was slightly greater than that of men, 17% versus 11% (P < .2), whether initiated by a man or a woman. Persons who self-initiated had a lower HIV prevalence and fewer HIV-related risk behaviors. Analysis of variance assessed differences in the HIV risk profiles of female and male IDUs who were initiated by someone of the same sex, of the opposite sex, or who self-initiated. These results indicated that (1) young women and men had similar patterns of injection initiation; (2) most women were initiated by female friends, running counter to earlier literature claims that women were initiated to injection drug use by male sex partners; and (3) women initiated by men had a marginally greater mean score on the HIV risk profile.

Adolescent↗
PubMed2000

The effect of a needle exchange program on numbers of discarded needles: a 2-year follow-up.

OBJECTIVES: This study estimates the quantity and geographic distribution of discarded needles on the streets of Baltimore, Md, during the 2 years after a needle exchange program opened. METHODS: Thirty-two city blocks were randomly sampled. Counts were taken of the number of syringes, drug vials, and bottles before the needle exchange program opened and then at 6 periodic intervals for 2 years after the program opened. Nonparametric and generalized estimating equation models were used to examine change over time. RESULTS: Two years after the needle exchange program opened, there was a significant decline in the overall quantity of discarded needles relative to that of drug vials and bottles (background trash). The block mean of number of needles per 100 trash items was 2.42 before the program opened and 1.30 2 years later (mean within-block change = -0.028, P < .05). There was no difference in the number of discarded needles by distance from the program site. CONCLUSIONS: These data suggest that this needle exchange program did not increase the number of distribution of discarded needles.

Baltimore↗
PubMed1998

Prevalence and incidence of hepatitis C virus infection among young adult injection drug users.

Through community-based outreach, young adult injection drug users (IDUs) were enrolled in a prospective study of the prevalence, incidence, and risk factors for hepatitis C virus (HCV) infection. Demographics and information on sexual and injecting practices were collected during semiannual interviews, and HCV infection was evaluated using a second-generation antibody assay. Of the 229 participants, 86 (37.6%) were HCV-seropositive at baseline. After adjusting for injecting frequency and duration by logistic regression, HCV seroprevalence was independently associated with reusing syringes at least once in the past 6 months (odds ratio [OR]=3.81, 95% confidence interval [CI] 1.39-11.00), injecting the first time with someone > or =5 years older (OR=2.99; 95% CI, 1.43-6.23) or alone (OR=4.02; 95% CI, 1.12-14.43) versus with someone <5 years older, and injecting cocaine or speedball exclusively (OR=4.29; 95% CI, 1.53-12.01) or with other drugs (OR=5.27; 95% CI, 2.62-10.64) versus injecting no cocaine in the past 6 months. Of the 105 originally HCV-seronegative participants who returned for follow-up, 13 seroconverted (incidence rate=16.0/100 person-years). On bivariate analysis, HCV seroconversion was significantly associated with injecting for <2 years (relative risk [RR]=7.3; 95% CI, 1.6-32.8) and continuing to inject during follow-up (RR=4.4; 95% CI, 1.0-19.9). Young adult IDUs are at high risk for HCV infection. These data support the need for wider legal access to sterile syringes, as well as expanded community outreach education to this population to prevent transmission of HCV.

Adult↗
PubMed1997

Discarded needles do not increase soon after the opening of a needle exchange program.

This study examines the effect of a Needle Exchange Program (NEP) on the quantity and geographic distribution of discarded needles on the streets of Baltimore, Maryland, and presents methods to survey discarded needles in the community. A random sample of 32 city blocks located within high-drug-use census tracts, stratified by east and west sides of the city and by proximity to the NEP, was selected for survey. Three teams surveyed the number of needles and the number of drug vials and unbroken glass bottles ("trash") to control for practice effects. Surveillance was conducted prior to initiation of the NEP in August 1994 and 1 and 2 months thereafter. Over the three study periods, the absolute count of discarded needles was 106, 130, and 128, respectively; the number of vials and bottles was 3,048, 3,825, and 3,796, respectively. The initial nonstatistically significant increase in needles (mean change = 0.38, 95% confidence interval (CI) -0.18 to 0.93) was offset by accounting for background trash. Regression models fitted with the generalized estimating equation method, which accounted for within-block correlation over time, showed no significant increase in the number of needles after adjustment for trash during the first 2 months of the NEP's operation. These data suggest that the initiation of NEPs does not result in an increase in the number of discarded needles on the street.

Baltimore↗
PubMed1996

Physician satisfaction with human immunodeficiency virus type 1 and hepatitis B virus testing in San Diego County.

Physician satisfaction with the laboratory testing process is one indicator of the physician's perception of the quality of laboratory testing and the effectiveness of the communication of the laboratory results. This study compares the level of satisfaction of physicians reporting their experience with human immunodeficiency virus type 1 (HIV-1) testing with the satisfaction levels of those physicians reporting their experience with hepatitis B virus (HBV) testing. By mail, 6,570 licensed San Diego County physicians were surveyed. Among those who tested for HIV-1 or HBV, their satisfaction with four different HIV-1 or HBV testing parameters was assessed: 1) specimen submission process, 2) test accuracy, 3) clarity of test report, and 4) turnaround time. Overall, physician satisfaction with both HIV-1 and HBV testing was high, particularly for test accuracy (means of 2.79 and 2.84, respectively on a 3-point scale), although slightly lower for turnaround time (means of 2.40 and 2.43, respectively). Mean satisfaction with the specimen submission process and test accuracy were higher for physicians who ordered HBV tests than for those who ordered HIV-1 tests. Satisfaction with the four HIV-1 testing process parameters varied significantly by physician specialty, practice type, and type of laboratory used. For HBV testing, significant differences were observed only for turnaround time. For both HIV-1 and HBV testing, those who received a final interpretation of laboratory results were more satisfied with test report clarity than those who did not. Although physician satisfaction with HIV-1 and HBV testing is high, this study identifies the least satisfied groups and specific areas in the testing process than may need improvement.

AIDS Serodiagnosis↗
PubMed1996

Viral infections in short-term injection drug users: the prevalence of the hepatitis C, hepatitis B, human immunodeficiency, and human T-lymphotropic viruses.

OBJECTIVES: The purpose of this study was to estimate the prevalence and correlates of four blood-borne viral infections among illicit drug injectors with up to 6 years of injecting experience. METHODS: We analyzed data from 716 volunteers recruited in 1988 and 1989. Test results for hepatitis C virus (HCV), hepatitis B virus (HBV), human immunodeficiency virus, type 1 (HIV), and human T-lymphotropic virus types I and II (HTLV) were examined across six sequential cohorts defined by duration of drug injection. RESULTS: Overall, seroprevalence of HCV, HBV, HIV, and HTLV was 76.9%, 65.7%, 20.5% and 1.8%, respectively, and 64.7%, 49.8%, 13.9%, and 0.5%, respectively, among those who had injected for 1 year or less. Among the newest initiates, HCV and HBV were associated with injecting variables, and HIV was associated with sexual variables. CONCLUSIONS: The high rates of HCV, HBV, and HIV infections among short-term injectors emphasizes the need to target both parenteral and sexual risk reduction interventions early. Renewed efforts at primary prevention of substance abuse are indicated.

Adolescent↗
PubMed1993

Variability of reporting and lack of adherence to consensus guidelines in human T-lymphocyte immunophenotyping reports: results of a case series.

Percentages and absolute counts of CD4+ lymphocytes, as determined by T-lymphocyte immunophenotyping (TLI), are prognostic, as well as diagnostic, of the course of human immunodeficiency virus type 1 infections and are important indicators for initiating Pneumocystis carinii pneumonia prophylaxis and antiretroviral therapy. In December 1990, we requested that a nonrandom sample of 17 laboratories provide us with typical reports of their TLI results from an immunodeficient patient and from a patient whose TLI results were within the laboratory's normal reference ranges. We also searched published literature and documents proposed by professional organizations for recommendations regarding T-lymphocyte testing and reporting. This article compares guidelines for reporting TLI results, as proposed by the National Committee for Clinical Laboratory Standards in Document H42-P, with samples of reports obtained in our case series. Most reports follow some, but not all, of the proposed guidelines. A majority of the laboratories provided interpretations of the results in their reports. We found considerable variation in normal reference ranges. We describe this variation in detail for the CD4+ T-lymphocyte counts and CD4+ T-lymphocyte percentages. This article describes some of the TLI result report forms currently being used and identifies important quality issues in this rapidly expanding area of clinical laboratory testing.

Forms and Records Control↗
PubMed1992

Content and design of laboratory report forms for human immunodeficiency virus type 1 antibody testing.

In a pilot study involving proficiency testing for human immunodeficiency virus, markedly diverse and potentially confusing test report forms were encountered among participating laboratories. Therefore, a comprehensive study of human immunodeficiency virus type 1 report forms was conducted from state-licensed testing laboratories in California. Participants analyzed three serum samples of known human immunodeficiency virus type 1 antibody reactivity and reported their results on forms that they would normally submit to clinicians. Report forms from 84 laboratories were evaluated for content, design, and clarity. Differences were found among commercial, hospital, and public health laboratories. The significance of these findings is discussed. This technique also may be applied to evaluate laboratory report form design and content for other diagnostic test results.

AIDS Serodiagnosis↗
PubMedDate not supplied

Methods for a model blind proficiency testing system.

The method developed for establishing a blind proficiency testing (PT) system is presented. The Laboratory Assurance Program of the Graduate School of Public Health at San Diego State University is developing and pilot testing innovative strategies that will evaluate and improve the performance of clinical laboratories. To date, a total of 32 laboratories have been incorporated into this program along with 12 counseling and testing sites. From June 1988 to December 1989, five blind PT surveys for human immunodeficiency virus type 1 antibody testing were conducted, representing 306 proficiency specimens entered into the testing system as simulated patient specimens. Despite the difficulties and expense involved, we found the system to be acceptable and to have certain advantages over conventional methods of external testing.

AIDS Serodiagnosis↗
PubMedDate not supplied

Analytic results of HIV-1 testing using blind proficiency testing.

The use of blind proficiency testing (PT) to examine analytic performance of human immunodeficiency virus type 1 (HIV-1) antibody testing. A total of 32 hospital, blood bank, public health, and commercial laboratories were included in this study. Test sera were introduced as clinical specimens for HIV-1 testing from private practitioners, group practices, clinics, and hospitals in Southern California. A total of 26 laboratories were located throughout California, with six laboratories located in six other states. Results from 306 enzyme immunoassay screening tests and 192 supplemental tests for HIV-1 were reported. Although one positive specimen was reported as indeterminate in almost 30% of results, screening and supplemental testing performances were excellent, with accuracy levels comparable to performance reported on open PT and performance evaluation surveys in the United States. The indeterminate results were attributed to the interpretive criteria used rather than to laboratory errors. Blind PT can be an important tool in improving the quality of total laboratory testing, the usefulness of laboratory results in patient care, and ultimately the health of the public.

AIDS Serodiagnosis↗
PubMedDate not supplied

Identification of nonanalytic issues in HIV-1 antibody testing using blind proficiency testing.

Blind proficiency testing was used to examine nonanalytic performance indicators for human immunodeficiency virus type 1 (HIV-1) antibody testing. Physician offices, clinics, and hospitals located throughout Southern California submitted simulated patient specimens to laboratories as routine test requests. A total of 32 laboratories were involved during five blind proficiency testing surveys. Turnaround time for a reactive specimen ranged from three to 17 days. Laboratory charges for evaluating a reactive specimen varied depending on the volume of testing, prevalence of reactive specimens, and whether screening and confirmatory tests were billed separately or as a package price. Charges for an enzyme immunoassay screening test plus supplemental tests ranged from $11.75 to $114.50, with a median of $31.00 for 24 laboratories that participated in one of the five surveys. Evaluation of laboratory report content revealed that 37% of the 16 screening reports and 71% of the 14 supplemental reports contained information that was unrelated to the patient results. Evaluation of the testing system documents the need to monitor multiple outcomes of the total laboratory testing process, not just the analytic testing phase.

AIDS Serodiagnosis↗
PubMedDate not supplied

Use of a modified nominal group process for improving laboratory performance in human immunodeficiency virus type 1 antibody testing. Reaching consensus on three questions concerning HIV-1 testing.

Using expert panels of medical technologists and public health microbiologists, a modified nominal group process was used to reach a consensus on three questions concerning current human immunodeficiency virus type 1 (HIV-1) testing methods. The questions related to important sources of error, improving the testing process, and improving proficiency testing. The modified nominal group process proved to be effective in developing lists of errors in laboratory testing; it provided a fast, economic means of identifying possible areas for improving laboratory quality assurance and training programs. For the HIV testing model, the focus group panelists indicated laboratory pipetting errors, labeling, and specimen identification as the most important sources of error. To improve the quality of this testing, the panel recommended standardizing test interpretation and restricting testing to laboratories licensed to perform HIV-1 testing. To improve proficiency testing, the use of blind specimens and establishing minimum standards of performance were suggested.

California↗