Research Papers

@article{T2018,
title = {Methadone treatment, severe food insecurity, and HIV-HCV co-infection: A propensity score matching analysis},
author = {McLinden T and Moodie EEM and Hamelin AM and Harper S and Rossi C and Walmsley SL and Rourke SB and Cooper C and Klein MB and Cox J},
url = {https://pubmed.ncbi.nlm.nih.gov/29544189/},
doi = {10.1016/j.drugalcdep.2017.12.031},
year = {2018},
date = {2018-02-20},
journal = {Drug and Alcohol Dependance},
abstract = {Background: Severe food insecurity (FI) is common among individuals living with HIV-hepatitis C virus (HCV) co-infection. We hypothesize that the injection of opioids is partly responsible for the association between injection drug use and severe FI. Therefore, this analysis examines whether methadone maintenance treatment for opioid dependence is associated with a lower risk of severe FI.

Methods: We used biannual data from the Canadian Co-infection Cohort (N = 608, 2012-2015). Methadone treatment (exposure) was self-reported and severe FI (outcome) was measured using the Household Food Security Survey Module. To quantify the association between methadone treatment and severe FI, we estimated an average treatment effect on the treated (marginal risk difference [RD]) using propensity score matching.

Results: Among participants, 25% experienced severe FI in the six months preceding the first time-point in the analytical sample and 5% concurrently reported receiving methadone treatment. Injection of opioids in the six months preceding the treatment and outcome measurements was much higher among those who received methadone treatment (39% vs. 12%). Among the treated participants, 97% had injected opioids in their lifetimes. After propensity score matching, the average risk of experiencing severe FI is 12.3 percentage-points lower among those receiving methadone treatment, compared to those who are not receiving treatment (marginal RD = -0.123, 95% CI = -0.230, -0.015).

Conclusions: After adjustment for socioeconomic, sociodemographic, behavioural, and clinical confounders, methadone treatment is associated with a lower risk of severe FI. This finding suggests that methadone treatment may mitigate severe FI in this vulnerable subset of the HIV-positive population.},
keywords = {Hepatitis C virus, HIV, Methadone treatment, Propensity score matching, Severe food insecurity},
pubstate = {published},
tppubtype = {article}
}

@article{T2017b,
title = {Injection Drug Use, Unemployment, and Severe Food Insecurity Among HIV-HCV Co-Infected Individuals: A Mediation Analysis},
author = {McLinden T and Moodie EEM and Hamelin AM and Harper S and Walmsley SL and Paradis G and Aibibula W and Klein MB and Cox J},
url = {https://pubmed.ncbi.nlm.nih.gov/28726043/},
doi = {10.1007/s10461-017-1850-2},
year = {2017},
date = {2017-12-01},
journal = {AIDS and Behaviour},
abstract = {Severe food insecurity (FI), which indicates reduced food intake, is common among HIV-hepatitis C virus (HCV) co-infected individuals. Given the importance of unemployment as a proximal risk factor for FI, this mediation analysis examines a potential mechanism through which injection drug use (IDU) is associated with severe FI. We used biannual data from the Canadian Co-infection Cohort (N = 429 with 3 study visits, 2012-2015). IDU in the past 6 months (exposure) and current unemployment (mediator) were self-reported. Severe FI in the following 6 months (outcome) was measured using the Household Food Security Survey Module. An overall association and a controlled direct effect were estimated using marginal structural models. Among participants, 32% engaged in IDU, 78% were unemployed, and 29% experienced severe FI. After adjustment for confounding and addressing censoring through weighting, the overall association (through all potential pathways) between IDU and severe FI was: risk ratio (RR) = 1.69 (95% confidence interval [CI] = 1.15-2.48). The controlled direct effect (the association through all potential pathways except that of unemployment) was: RR = 1.65 (95% CI = 1.08-2.53). We found evidence of an overall association between IDU and severe FI and estimated a controlled direct effect that is suggestive of pathways from IDU to severe FI that are not mediated by unemployment. Specifically, an overall association and a controlled direct effect that are similar in magnitude suggests that the potential impact of IDU on unemployment is not the primary mechanism through which IDU is associated with severe FI. Therefore, while further research is required to understand the mechanisms linking IDU and severe FI, the strong overall association suggests that reductions in IDU may mitigate severe FI in this vulnerable subset of the HIV-positive population.},
keywords = {Hepatitis C virus, HIV, Injection drug use, Severe food insecurity, Unemployment},
pubstate = {published},
tppubtype = {article}
}