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SIGNpost 00731

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *

Post00731 IS & HCWM & Supply tools + Abstracts + News 05 February 2014

CONTENTS
0. Moderators Note
1. AIDSTAR-One Project Highlights: Improving Injection Safety & HC Waste
Management
2. The USAID | DELIVER PROJECT has published 2 innovative toolkits to
help strengthen human resources for public health supply chains in
developing countries
3. Abstract: Reducing therapeutic injection overuse through patients-
prescribers interaction group discussions in Kinondoni District, Dar es
Salaam, Tanzania
4. Abstract: Using reusable containers for hospital waste: is there an
infection risk?
5. Abstract: Compliance to Occupational Safety Measures among the
Paramedical Workers in a Tertiary Hospital in Karnataka, South India
7. Abstract: Attributable causes of liver cancer mortality and incidence
in china
8. Abstract: Hepatitis B vaccination for healthcare personnel in American
Samoa: pre-implementation survey for policy decision
9. Abstract: Prevalence of Hepatitis B Vaccination among Health Care
Workers in Nigeria in 2011-12
10. Abstract: Sharps legislation and assessment of needle protection
systems
11. Abstract: FIT4Safety: recommendations in the diabetes care setting
12. Abstract: Psychosocial Factors at Work and Blood-Borne Exposure among
Nurses
13. Abstract: Preferences of patients and health professionals for route
and frequency of administration of biologic agents in the treatment of
rheumatoid arthritis
14. Abstract: What are the patient factors affecting repetitive use of
injectable pain relievers in outpatient care settings?
16. Abstract: Social Network Structure and HIV Infection Among Injecting
Drug Users in Lithuania: Gatekeepers as Bridges of Infection
17. Abstract: HIV Infection, Risk Factors, and Preventive Services
Utilization among Female Sex Workers in the Mekong Delta Region of
Vietnam
18. Abstract: A novel method to identify routes of hepatitis C virus
transmission
19. Abstract: The impact of hepatitis C burden: an evidence-based approach
20. Abstract: Comparison of intramuscular compound betamethasone and oral
diclofenac sodium in the treatment of acute attacks of gout
21. Abstract: Hand hygiene compliance and associated factors among health
care providers in Gondar University Hospital, Gondar, North West
Ethiopia
22. No Abstract: A previously unidentified risk of needlestick injury in
the emergency medical services setting
23. No Abstract: Finding the right safety device
24. No Abstract: Research on hormonal contraception and HIV
25. Procurement & Supply Management Toolbox Update: Top 20 Tools
26. News
– USA: Ohio lawmakers might enable more clean needle exchanges
– USA: In response to hepatitis C outbreak, NH House gives preliminary OK
to technician registry
– Kashmir India: ‘Unsafe injections’ mainly blamed for Hepatitis-C
outbreak Health Dept Survey, SKIMS Study Makes Case For Proper
Sterilization Facilities
– Canada: Cross-Contamination May Have Caused Hep C Outbreak
– Testing HCV positive has a sustained impact on drug injecting behaviour
– Armenia: AIDS Prevention Center rejects news on infection with needle
– 21 Tribal Members Potentially Exposed to Hepatitis B and C and HIV
– Uganda: How a Nurse Injected Baby With HIV Blood

The web edition of SIGNpost is online at:
http://signpostonline.info/archives/1598

More information follows at the end of this SIGNpost!

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__________________________________________________________________
________________________________*_________________________________

0. Moderators Note
__________________________________________________________________
This edition of SIGN post resumes the News section and its survey of
coverage of injection safety and related infection control in the news
media web media.

Some items are edited to fit within the post.

Please check out the unexplicable reuse of needles, vials and pen
injectors in health care settings in India, Canada, and the USA in stories
posted in news.

The top 20 tools for your Procurement & Supply Management Toolbox might
help end stock-outs of injection and related equipment and supplies.
__________________________________________________________________
________________________________*_________________________________

1. AIDSTAR-One Project Highlights: Improving Injection Safety & HC Waste
Management
__________________________________________________________________
John Nicholson
Jan 22

Hi Alian,

The AIDSTAR-One project will be closing out at the end of the month and
have shared some great HCWM and IS resources that may be good for
SIGNPost.

I believe the website will live on beyond the end of the project so these
should remain available for the foreseeable future.

Best,
John
__________________________________________________________________
From: AIDSTAR-One <info[at]aidstar-one.com>

Subject: AIDSTAR-One Project Highlight: Injection Safety

Improving Injection Safety and Healthcare Waste Management

Building on the successes of the USAID Making Medical Injections Safer
(MMIS) project, USAID Missions in Ethiopia, Nigeria, and Uganda provided
field support funding through AIDSTAR-One in the areas of injection
safety, infection prevention and control, and healthcare waste management.

Capacity Building for Health Workers and Waste Handlers

AIDSTAR-One/Nigeria conducted training and led other capacity building
activities for health workers and waste handlers in the context of IPC-
including cascade and training-of-trainer approaches-and conducted an
assessment in 80 public sector health care settings and laboratories.

Reinforcing M&E Components Through Supportive Supervision

To strengthen infection prevention and control (IPC) systems and to ensure
the sustainability of IPC practices at the facility level,
AIDSTAR-One/Ethiopia provided technical support to local IPC committees
through supportive supervision visits to health facilities.

Healthcare Waste Management

AIDSTAR-One/Uganda engaged in a public private partnership (PPP) with the
MOH and a local waste management company to establish a centralized
healthcare waste disposal facility in eastern Uganda and assess the
functionality of the HCWM system from point of generation to final
disposal.

See all AIDSTAR-One injection safety resources.
http://tinyurl.com/nled4yw

www.aidstar-one.com/resources/project_highlights/injection_safety_hcwm

www.AIDSTAR-One.com
__________________________________________________________________
________________________________*_________________________________

2. The USAID | DELIVER PROJECT has published 2 innovative toolkits to
help strengthen human resources for public health supply chains in
developing countries
__________________________________________________________________
From: Anne Marie Hvid anne_marie_hvid[at]jsi.com

The USAID | DELIVER PROJECT has published two innovative toolkits to
help strengthen human resources for public health supply chains in
developing countries.

The Human Resource Capacity Development in Public Health Supply Chain
Management: Assessment Guide and Tool presents a structured,
rating-based methodology designed to provide a rapid, comprehensive
assessment of the capacity of the human resource support system for a
country’s supply chain. Data are gathered from a document review,
focus group discussions, and in-country stakeholder interviews to
identify the strengths, areas for improvement, opportunities, and
challenges for a wide range of human resource inputs and components. The
findings are transformed into specific recommendations and strategies
for action based on an understanding of country priorities and
programming gaps. The toolkit also includes Word templates, a PowerPoint
template, and an Excel-based Diagnostic Dashboard.

Recruiting Supply Chain Professionals: A Ready Reference Guide for
Finding and Selecting High Performers leads users through the steps
required to hire the right supply chain professionals, in the right
quantities, with the right skills, in the right place, at the right
time, and for the right salaries. It also includes templates that will
be helpful at each stage of the process.

To access the toolkits, please visit http://bit.ly/MpEC56
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Reducing therapeutic injection overuse through patients-
prescribers interaction group discussions in Kinondoni District, Dar es
Salaam, Tanzania
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24409650

Tanzan J Health Res. 2011 Jan;13(1):69-73.

Reducing therapeutic injection overuse through patients-prescribers
interaction group discussions in Kinondoni District, Dar es Salaam,
Tanzania.

Massele AY1, Mashalla YJ1, Kayombo EJ2, Mwaiselage JD3, Mwamba NE4, Kaniki
I5.

1School of Medicine, University of Botswana, Gaborone, Botswana.
2lnstitute of Traditional Medicine, Muhimbili University of Health and
Allied Sciences, Dar es Salaam, Tanzania. 3Ocean Road Cancer Institute,
Dar es Salaam, Tanzania. 4University of Dar es Salaam, Dar es Salaam,
Tanzania. 5Kinondoni Municipal Council, Dar es Salaam, Tanzania.

Inappropriately prescription of injections has been reported in developing
and developed countries. Previous studies in Tanzania showed that over 70%
of patients attending out- patient clinics at private dispensaries
received at least one injection per consultation, a value higher than WHO
recommended target of 10%. This is of concern considering the likelihood
of adverse effects of possible use of unsafe syringes to transmit HIV,
hepatitis B and C, poliomyelitis and added economic impact on the patient
and the healthcare system.

This study aimed to investigate the impact of Interaction Group Discussion
on behavioural change on injection prescribing practices in ten selected
public dispensaries in Kinondoni District, Dar es Salaam, Tanzania.

Patient records of injection prescriptions were obtained covering the
period three months prior to the study from 5 randomly selected control
and 5 randomly selected intervention facilities. At each health facility
IGDs were conducted for one month on mothers and prescribers followed by a
survey 3 months after IGD to determine the impact of IGDs. Chi-square
statistical calculations were made to compare data on the percent of
prescriptions with an injection prescribed and in those conforming to
national standard treatment guidelines (STG) between baseline and 3 months
follow up.

Results showed no significant difference between the percentage of
prescriptions with an injection prescribed at baseline and 3 months
follow-up in public dispensaries (P>0.05, X2 test). Prescribed injections
that complied with STG was low at baseline and did not significantly
improve 3 months after (P>0.05, X2 test).

Comprehensive studies and sensitization of compliance to STG by
prescribers are recommended.

Free full text [download or email]
http://www.ajol.info/index.php/thrb/article/view/63093
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Using reusable containers for hospital waste: is there an
infection risk?
__________________________________________________________________
South Afr J Epidemiol Infect Vol 28, No 4 (2013)

Using reusable containers for hospital waste: is there an infection risk?

Terry Richard Grimmond

Reusable waste containers are used to transport healthcare risk waste
(sharps and non-sharps) in many countries, and are becoming increasingly
common in South Africa.

Initially, there may be a perception of risk of pathogen or disease
transmission with their introduction. This paper assessed the
international literature on reusable waste container infection risk and
found there to be negligible to nil risk of pathogen or disease transfer.

The literature confirms that disinfection and microbiological monitoring
and validation of reusable waste containers is not indicated, and that
washing with hot water and detergent, using visual criteria for
cleanliness and due diligence with regard to contractor selection, enable
reusable containers to be safely used.

Full Text: PDF http://www.sajei.co.za/index.php/SAJEI/article/view/553/753
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Compliance to Occupational Safety Measures among the
Paramedical Workers in a Tertiary Hospital in Karnataka, South India
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24463800

Int J Occup Environ Med. 2014 Jan;5(1):40-50.

Compliance to Occupational Safety Measures among the Paramedical Workers
in a Tertiary Hospital in Karnataka, South India.

Phukan P.

BACKGROUND: The guidelines for minimizing occupational health risk from
exposure to highly infectious diseases is already established but little
information exists on the compliance of these measures among paramedical
workers in India.

OBJECTIVE: To study the awareness of occupational safety measures such as
universal precautions, biomedical waste handling, disposal and its
compliance in their daily practice.

METHODS: A hospital-based cross-sectional study was undertaken in a
tertiary private hospital in Karnataka, Bangalore, India. Data was
collected using a pretested and predesigned proforma from 120 respondents:
85 nurses and 35 laboratory technicians.

RESULTS: 27 (32%) nurses and 20 (57%) laboratory technicians could relate
universal precautions to infection prevention. Only 6 (7%) nurses and 2
(6%) technicians had knowledge about proper hospital waste segregation. 45
(52.9%) nurses and 15 (42.8%) technicians had knowledge about post-
exposure prophylaxis. 3 (4%) nurses and 9 (26%) technicians were formally
trained in following universal precautions. Adequate hand washing was
practiced among 17 (20%) nurses and none of the technicians. Faulty
practice such as recapping of needle was prevalent among 57 (67%) nurses
and 29 (83%) technicians. 32 (38%) nurses and 10 (29%) technicians
received hepatitis B vaccine.

CONCLUSION: As knowledge and practice regarding different aspects of
universal precautions was not satisfactory, training was warranted
urgently in the study population. Also, suggestions were made to develop
and implement institutional policies on the universal precautions and
ensuring supply of personal protection equipment.

Free full text
http://www.theijoem.com/ijoem/index.php/ijoem/article/view/339
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Knowledge, attitude and practices on needle-stick and sharps
injuries in tertiary care cardiac hospital: a survey
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23006418

Indian J Med Sci. 2010 Sep;64(9):396-401.

Knowledge, attitude and practices on needle-stick and sharps injuries in
tertiary care cardiac hospital: a survey.

Sharma S, Gupta A, Arora A.

AIMS: One of the potential hazards for health care workers (HCWs) is
needle- stick and sharp injuries (NSSIs). The objective of the study was
to assess the knowledge and attitude of health care workers about the
NSSIs.

SETTINGS AND DESIGN: This was a cross-sectional survey conducted in the
tertiary care cardiac center. The participants were health care workers
including doctors, nurses, technicians, and housekeeping staff from the
different areas of the hospital.

METHODS AND MATERIALS: This cross-sectional survey was conducted in the
institute using a self- administered validated questionnaire. The
participants consisted of a total of 190 HCWs namely doctors, nurses,
technicians, and housekeeping staff.

STATISTICAL ANALYSIS USED: Nil.

RESULTS: Results showed maximum participant were in the age group of 20-30
years. 94.7% were aware about standard precautions. 91.5% knew about the
procedure for reporting of NSSIs. Only 50.2% HCWs gave correct answers
regarding disease transmission through needle stick and sharp injury. The
prevalence of NSSIs was highest among nurses (38.4%), and needle on the
disposable syringe (76.9%) was the most common source of NSSIs.

CONCLUSIONS: The survey revealed few gaps in the knowledge amongst HCWs
about NSSIs like risks associated with needle-stick injuries and use of
preventive measures, disassembling of needles prior to disposal. These
gaps can be addressed by extensive education. As nurses were the most
affected victim for the NSSIs, more emphasis should be given towards them
for reducing the NSSIs.

Free full text http://tinyurl.com/ox573t8
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Attributable causes of liver cancer mortality and incidence
in china
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24460283
http://tinyurl.com/nwaww83

Asian Pac J Cancer Prev. 2013;14(12):7251-6.

Attributable causes of liver cancer mortality and incidence in china.

Fan JH, Wang JB, Jiang Y, Xiang W, Liang H, Wei WQ, Qiao YL, Boffetta P.

Objectives: To estimate the proportion of liver cancer cases and deaths
due to infection with hepatitis B virus (HBV), hepatitis C virus (HCV),
aflatoxin exposure, alcohol drinking and smoking in China in 2005.

Study design: Systemic assessment of the burden of five modifiable risk
factors on the occurrence of liver cancer in China using the population
attributable fraction.

Methods: We estimated the population attributable fraction of liver cancer
caused by five modifiable risk factors using the prevalence data around
1990 and data on relative risks from meta-analyses, and large-scale
observational studies. Liver cancer mortality data were from the 3rd
National Death Causes Survey, and data on liver cancer incidence were
estimated from the mortality data from cancer registries in China and a
mortality/incidence ratio calculated.

Results: We estimated that HBV infection was responsible for 65.9% of
liver cancer deaths in men and 58.4% in women, while HCV was responsible
for 27.3% and 28.6% respectively.

The fraction of liver cancer deaths attributable to aflatoxin was
estimated to be 25.0% for both men and women. Alcohol drinking was
responsible for 23.4% of liver cancer deaths in men and 2.2% in women.
Smoking was responsible for 18.7% and 1.0% . Overall, 86% of liver cancer
mortality and incidence (88% in men and 78% in women) was attributable to
these five modifiable risk factors.

Conclusions: HBV, HCV, aflatoxin, alcohol drinking and tobacco smoking
were responsible for 86% of liver cancer mortality and incidence in China
in 2005. Our findings provide useful data for developing guidelines for
liver cancer prevention and control in China and other developing
countries.

Free full text http://tinyurl.com/qj3gjts
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Hepatitis B vaccination for healthcare personnel in American
Samoa: pre-implementation survey for policy decision
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24476680

Epidemiol Infect. 2014 Jan 24:1-6.

Hepatitis B vaccination for healthcare personnel in American Samoa: pre-
implementation survey for policy decision.

Ly KN1, Roberts H1, Williams RE1, Masunu-Faleafaga Y2, Drobeniuc J1,
Kamili S1, Teshale EH1.

American Samoa does not have a hepatitis B vaccination policy for
healthcare personnel (HCP). Consequently, hepatitis B has remained a
health threat to HCP.

In this study, we performed a cross-sectional study and examined
demographic and risk information and hepatitis B vaccination, testing, and
serostatus in hospital employees in American Samoa.

Of 604 hospital employees, 231 (38·2%) participated, and of these, 158
(68·4%) were HCP. Of HCP participants, 1·9% had chronic hepatitis B
infection, 36·1% were susceptible, and 60·8% were immune. Nearly half of
HCP participants reported history of needlestick injury. Overall,
participants’ knowledge of their hepatitis B infection and vaccination
status was low.

These data support the adoption of a hepatitis B vaccination policy for
HCP by American Samoa, as currently recommended by the World Health
Organization and the US Centers for Disease Control and Prevention.

Adherence to the policy could be monitored as a way to measure protection.
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Prevalence of Hepatitis B Vaccination among Health Care
Workers in Nigeria in 2011-12
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24463801

Int J Occup Environ Med. 2014 Jan;5(1):51-6.

Prevalence of Hepatitis B Vaccination among Health Care Workers in Nigeria
in 2011-12.

Ogoina D, Pondei K, Adetunji B, Chima G, Isichei C, Gidado S.

BACKGROUND: Hepatitis B virus (HBV) infection is an endemic infection in
Nigeria. Health care workers (HCWs) are at risk of occupational exposures
to HBV- infected blood and body fluids.

OBJECTIVE: To determine the prevalence and determinants of HBV vaccine
coverage among HCWs in two teaching hospitals in Nigeria.

METHODS: This cross-sectional study was undertaken in 2011 and 2012 in two
teaching hospitals in Jos, North-Central Nigeria, and Yenagoa, South-South
Nigeria. A self-administered structured questionnaire was administered to
HCWs to obtain socio-demographic data and history of HBV vaccination.

RESULTS: Out of 290 HCWs who participated in the study, 185 (64.5%) had
received at least one dose of HBV vaccine; 105 (36.2%) had full coverage
of three doses. Professional category and previous training in infection
control were independently associated with HBV vaccination. House officers
and laboratory scientists were more likely to be unvaccinated than
resident doctors, consultant doctors and nurses. Full vaccine coverage was
associated with younger age and shorter years of professional experience.

CONCLUSION: We observed a generally low rate of HBV vaccine coverage among
HCWs in Nigeria. Establishment of policies on compulsory HBV vaccination
of all HCWs in Nigeria is recommended.

Free full text
http://www.theijoem.com/ijoem/index.php/ijoem/article/view/362
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Sharps legislation and assessment of needle protection
systems
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24464057

Br J Nurs. 2014 Jan 23;23(2):S4-8.

Sharps legislation and assessment of needle protection systems.

Wright P1, Caughey G2, Antoniou S3.

Needlestick injuries (NSIs) carry the potential for transmission of
serious blood-borne infections and pose a significant risk to patients and
healthcare staff.

These infections come with an estimated cost of £300 million per year in
the UK (Saia et al, 2010).

An EU directive mandated in May of 2013 has sought to minimise the risk of
NSI though the introduction of needle-protection systems.

The authors of this article set out to assess nursing knowledge of this
legislation and ascertain which needle- protection systems for low-
molecular weight heparin/anti Xa (for subcutaneous administration) were
preferred in a large teaching trust.

Approximately half of the nurses questioned had some knowledge of the
legislation and almost all agreed that there is a need for needle
protection systems.

All four devices tested meet requirements for the legislation but the
preferred devices were the needle protection system for enoxaparin and
fondaparinux with a self-sheathing style device after activation.
__________________________________________________________________
________________________________*_________________________________

11. Abstract: FIT4Safety: recommendations in the diabetes care setting
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24067308

Br J Nurs. 2013 Sep 12-25;22(17):997-1000.

FIT4Safety: recommendations in the diabetes care setting.

Adams D, Down S, Hicks D.

Sharps injuries pose a serious threat to health professionals, patients,
and downstream workers.

FIT4Safety is an initiative that seeks to promote safety and best practice
in the diabetes setting.

An Introduction to FIT4Safety and its Recommendations for the Safety of
Sharps in the Diabetes Care Setting explains how and why the FIT4Safety
initiative was formed, what it aims to achieve, and the importance of
ensuring safety in the diabetes care setting.

Outputs from FIT4Safety include Injection Safety in UK and Ireland: Safety
of Sharps in Diabetes Recommendations.

These recommendations were developed to provide a resource for all those
directly involved in, or overseeing, diabetes care.

The main topics and guidance detailed within the recommendations are
discussed, as well as EU Directive 2010/32 on sharps injury prevention and
the UK’s Health and Safety (Sharp Instruments in Healthcare) Regulations
2013.
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Psychosocial Factors at Work and Blood-Borne Exposure among
Nurses
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/24463799

Int J Occup Environ Med. 2014 Jan;5(1):32-9.

Psychosocial Factors at Work and Blood-Borne Exposure among Nurses.

Mehrdad R, Atkins EH, Sharifian SA, Pouryaghoub G.

BACKGROUND: Exposure to human blood and body fluids is a common risk for
nurses. Many factors can affect the prevalence and incidence of this
occupational hazard. Psychosocial factors at work may be a risk factor for
the exposure.

OBJECTIVE: To assess needle stick, sharp injury and mucus exposure to
blood-borne pathogens among nurses in Iran and to determine the
association between these exposures and psychosocial factors at work.

METHODS: A cross-sectional study was conducted on nurses in a public
hospital, Tehran, Iran. 364 nurses received and 339 completed and returned
a self- reported questionnaire containing demographic data, history of
exposure to blood-borne pathogens at work during previous year and the
General Nordic questionnaire for psychological and social factors at work
(QPS Nordic 34+ Questionnaire).

RESULTS: Of 339 participants, 197 (58.1%) reported needle-stick injury,
186 (54.6%) reported another type of sharp injury, and 112 (33%) reported
a mucous membrane exposure during the previous year. More than half of the
participants who had history of exposure, had not reported it. Those with
middle or high level of stress had higher crude and adjusted odds than
those with lower stress for all kinds of exposure. Adjusted odds ratios
for high stress group (ranging from 2.8 to 4.4) were statistically
different from 1.

CONCLUSION: There is a high prevalence of needle-stick and sharp injury
and mucous membrane exposure to patients’ blood or body fluids among
studied nurses. There is a significant association between increasing
psychosocial factors at work and exposure to blood-borne pathogens among
this group of nurses.

Free full text
http://www.theijoem.com/ijoem/index.php/ijoem/article/view/361
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Preferences of patients and health professionals for route
and frequency of administration of biologic agents in the treatment of
rheumatoid arthritis
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24470758

Patient Prefer Adherence. 2014 Jan 20;8:93-9.

Preferences of patients and health professionals for route and frequency
of administration of biologic agents in the treatment of rheumatoid
arthritis.

Huynh TK1, Ostergaard A2, Egsmose C2, Madsen OR2.

OBJECTIVES: To examine the preferences of rheumatoid arthritis (RA)
patients and health professionals (HPs) for the route and frequency of
administration of biologic drugs.

METHODS: One hundred and seven RA patients treated with biological agents
for intravenous or subcutaneous use, 35 biologic-naïve RA patients treated
with a disease-modifying antirheumatic drug and 30 rheumatology HPs
(physicians and nurses) were recruited from two outpatient clinics in
Copenhagen, Denmark. All subjects filled out a questionnaire interrogating
their choice of preferred route and frequency of administration of a
biologic corresponding to current available options, given that effects,
adverse effects, and financial costs were identical for the different
choices. The subjects were also asked to justify their preferences. The
chi-square goodness-of-fit test was used to examine the distributions over
different preferences. Proportions were compared using Fisher’s exact
test.

RESULTS: Forty-one patients were currently treated with subcutaneous self-
injections at home (SCH) and 66 intravenously at the clinic (IVC). IVC was
preferred by 85% of patients currently treated with IVC (P<0.0001). SCH
was preferred by 71% of patients currently treated with SCH (P<0.001), by
77% of the biologic-naïve patients (P<0.01), and by 87% of HPs (P<0.0001).

The proportion of patients favoring SCH was significantly higher for
patients currently receiving SCH and for biologic-naïve RA patients than
for those currently on IVC (P<0.0001). SCH once a month and IVC every 8
weeks were the most appealing treatment frequencies (P<0.01). The most
frequent reason among patients for choosing IVC or SCH was a wish for
safety, and a wish to minimize the time of transportation and treatment,
respectively.

CONCLUSION: The majority of RA patients treated with biologics preferred
their current route of administration. Most patients, those inexperienced
with biologics, and HPs favored SCH. Low treatment frequencies were
generally preferred.

KEYWORDS: biologic treatment, infusion, rheumatology, subcutaneous
injection

Free Article http://tinyurl.com/m7wu7bv
__________________________________________________________________
________________________________*_________________________________

14. Abstract: What are the patient factors affecting repetitive use of
injectable pain relievers in outpatient care settings?
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24472399

Int J Clin Pharmacol Ther. 2014 Jan 29.

What are the patient factors affecting repetitive use of injectable pain
relievers in outpatient care settings?

Lee J, Jang S, Han E, Lee EJ, Choi YJ, Sohn HS.

Targeting repeated injection users with education interventions aimed at
highlighting the extent of their current use and increasing awareness of
the oral preparation options may reduce unnecessary injection use.

The aim of this retrospective observational study was to investigate the
patient factors related to repeated use of injection formulation
analgesics in patients with musculoskeletal disorders who were frequent
users of ambulatory healthcare services.

Population-based national health insurance claims data for the time period
July 2011 – December 2011 were analyzed.

Patients aged 18 – 80 years with a musculoskeletal disorder, attended
ambulatory healthcare settings > 25 times, and were prescribed pain
relievers such as non-steroidal anti-inflammatory drugs and narcotic
analgesics in an oral formulation for = 14 days or in an injection
formulation = 3 times during the study period were included in the study.
There were 742,675 repeated systemic analgesic users, and 64.1% (n =
476,021) of these patients were injection users.

The average use of injections per patient during the 6-month period was
8.3. Tramadol was the most frequently prescribed medication for injection,
followed by diclofenac, piroxicam, and ketorolac.

Statistical analyses showed significant correlations between prevalent
injection formulation use and patient factors such as gender, age, area of
residence, days of healthcare utilization, number of healthcare centers
visited, type of healthcare center visited, total medical expenditure, and
total out-of-pocket expenditure.

These factors could possibly be used to determine the target population
for educational interventions aimed at changing behavior relating to the
preference for injectable formulations.
__________________________________________________________________
________________________________*_________________________________

15. Abstract: Effects of an HIV peer prevention intervention on sexual and
injecting risk behaviors among injecting drug users and their risk
partners in Thai Nguyen, Vietnam: a randomized controlled trial
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24034963

Soc Sci Med. 2013 Nov;96:154-64.

Effects of an HIV peer prevention intervention on sexual and injecting
risk behaviors among injecting drug users and their risk partners in Thai
Nguyen, Vietnam: a randomized controlled trial.

Go VF, Frangakis C, Le Minh N, Latkin CA, Ha TV, Mo TT, Sripaipan T, Davis
W, Zelaya C, Vu PT, Chen Y, Celentano DD, Quan VM.

Globally, 30% of new HIV infections outside sub-Saharan Africa involve
injecting drug users (IDU) and in many countries, including Vietnam, HIV
epidemics are concentrated among IDU.

We conducted a randomized controlled trial in Thai Nguyen, Vietnam, to
evaluate whether a peer oriented behavioral intervention could reduce
injecting and sexual HIV risk behaviors among IDU and their network
members.

419 HIV-negative index IDU aged 18 years or older and 516 injecting and
sexual network members were enrolled. Each index participant was randomly
assigned to receive a series of six small group peer educator-training
sessions and three booster sessions in addition to HIV testing and
counseling (HTC) (intervention; n = 210) or HTC only (control; n = 209).
Follow-up, including HTC, was conducted at 3, 6, 9 and 12 months post-
intervention.

The proportion of unprotected sex dropped significantly from 49% to 27%
(SE (difference) = 3%, p < 0.01) between baseline and the 3-month visit
among all index- network member pairs. However, at 12 months, post-
intervention, intervention participants had a 14% greater decline in
unprotected sex relative to control participants (Wald test = 10.8, df =
4, p = 0.03).

This intervention effect is explained by trial participants assigned to
the control arm who missed at least one standardized HTC session during
follow-up and subsequently reported increased unprotected sex.

** The proportion of observed needle/syringe sharing dropped significantly
between baseline and the 3-month visit (14% vs. 3%, SE (difference) = 2%,
p < 0.01) and persisted until 12 months, but there was no difference
across trial arms (Wald test = 3.74, df = 3, p = 0.44).

Copyright © 2013 Elsevier Ltd. All rights reserved.

KEYWORDS: Evaluation, HIV, Injecting drug use, Intervention, Peer network,
Randomized controlled trial, Vietnam
__________________________________________________________________
________________________________*_________________________________

16. Abstract: Social Network Structure and HIV Infection Among Injecting
Drug Users in Lithuania: Gatekeepers as Bridges of Infection
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24469223

AIDS Behav. 2014 Jan 28.

Social Network Structure and HIV Infection Among Injecting Drug Users in
Lithuania: Gatekeepers as Bridges of Infection.

Gyarmathy VA, Caplinskiene I, Caplinskas S, Latkin CA.

The aim of the study was to assess-while controlling for individual risk
characteristics-how certain social network structural characteristics
(degree, eigenvector, and betweenness centrality) are related to HIV
infections.

Injecting drug users (N = 299) in Vilnius, Lithuania were recruited using
incentivized chain referral sampling for a cross-sectional study.
Sociometric social links were established between participants, and UCINET
was used to calculate network measures.

HIV prevalence was 10 %, and all except two knew they were infected. Of
the five variables that remained significant in the final multivariate
model, one showed temporal cumulative infection risk (more years since
first drug injecting), three reflected informed altruism (always using
condoms, less distributive syringe sharing and having not more than one
sex partner), and one pointed to the importance of social network
structure (betweenness centrality, indicating bridge populations). Loess
regression indicates that betweenness may have the highest impact on HIV
prevalence (about 60 vs. 20 % estimated HIV prevalence for the highest
betweenness centrality values vs. highest age values).

This analysis contributes to existing evidence showing both potential
informed altruism (or maybe social desirability bias) in connection with
HIV infection, and a link between HIV infection risk and the role of
bridges within the social network of injecting drug user populations.

These findings suggest the importance of harm reduction activities,
including confidential testing and counseling, and of social network
interventions.
__________________________________________________________________
________________________________*_________________________________

17. Abstract: HIV Infection, Risk Factors, and Preventive Services
Utilization among Female Sex Workers in the Mekong Delta Region of
Vietnam
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24475096

PLoS One. 2014 Jan 24;9(1):e86267.

HIV Infection, Risk Factors, and Preventive Services Utilization among
Female Sex Workers in the Mekong Delta Region of Vietnam.

Tran BX1, Nguyen TV2, Pham QD2, Nguyen PD2, Khuu NV2, Nguyen NP3, Bui DH4,
Thi Phan HT4, Nguyen LT4.

BACKGROUND: Risk behaviors among female sex workers (FSW) are considerable
drivers of HIV infections in Vietnam, especially transmission between
high-risk and low-risk groups. We assessed HIV prevalence and its
correlates among FSWs, and the use of preventive services among this
community in the Mekong Delta region, southern Vietnam.

METHODS: A cross-sectional survey of 1,999 FSWs was carried out in five
provinces including Ben Tre, Hau Giang, Kien Giang, Tien Giang, and Vinh
Long between June, 2006 and June, 2007. We interviewed participants face-
to- face in order to elicit information about their lives and potential
risk factors, and we tested their sera to determine their HIV status. We
then performed multivariate logistic regression analyses to investigate
factors associated with HIV infection.

RESULTS: Seventeen percent of the participating FSWs were street-based sex
workers (SSWs) and the rest (83%) were entertainment establishment-based
sex workers (ESWs). Unprotected sex with regular and casual clients in the
past month was frequent among study participants (40.5% and 33.5%
respectively). However, few respondents (1.3%) had ever injected drugs.
Only 2.1% (95% confidence interval (CI): 1.6%-2.8%) of FSWs were found to
be infected with HIV. HIV prevalence among SSWs was greater than among
ESWs (3.8% vs. 1.8%, p?=?0.02, respectively). Increased risk for HIV
infection was significantly associated with the number of clients per
month (adjusted odd ratio (aOR)?=?2.65, 95% CI: 1.26-5.59).

CONCLUSIONS: Interventions to reduce unsafe sex and drug injection, and to
increase uptake of HIV testing among FSWs are necessary. Differences in
HIV prevalence and its correlates by type of sex work emphasize the
importance of constrained contexts in shaping risk behaviors among FSWs;
that should be considered in designing HIV prevention programs.

Free Article
www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0086267
__________________________________________________________________
________________________________*_________________________________

18. Abstract: A novel method to identify routes of hepatitis C virus
transmission
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24465895

PLoS One. 2014 Jan 23;9(1):e86098.

A novel method to identify routes of hepatitis C virus transmission.

Féray C1, Bouscaillou J2, Falissard B3, Mohamed MK4, Arafa N4, Bakr I4,
El-Hoseiny M4, Daly ME5, El-Kafrawy S5, Plancoulaine S6, Abdel-Hamid M7,
Thiers V8, Fontanet A9.

BACKGROUND: We propose a new approach based on genetic distances among
viral strains to infer about risk exposures and location of transmission
at population level.

METHODS: We re-analysed 133 viral sequences obtained during a cross-
sectional survey of 4020 subjects living in a hepatitis C virus (HCV)
endemic area in 2002. A permutation test was used to analyze the
correlation between matrices of genetic distances in the NS5b region of
all pairwise combinations of the 133 viral strains and exposure status
(jointly exposed or not) to several potential HCV risk factors.

RESULTS: Compared to subjects who did not share the same characteristics
or iatrogenic exposures, the median Kimura genetic distances of viral
strains were significantly smaller between brothers and sisters (0.031
versus 0.102, P<0.001), mother and child (0.044 versus 0.102, P<0.001),
father and child (0.045 versus 0.102, P<0.001), or subjects exposed to
periodontal treatment (0.084 versus 0.102, P?=?0.02). Conversely, viral
strains were more divergent between subjects exposed to blood transfusions
(0.216 versus 0.102, P=0.04) or tooth filling or extraction (0.108, versus
0.097, P=0.05), suggesting acquisition of the virus outside of the
village.

CONCLUSION: This method provided insights on where infection took place
(household, village) for several socio-demographic characteristics or
iatrogenic procedures, information of great relevance for targeting
prevention interventions. This method may have interesting applications
for virologists and epidemiologists studying transmission networks in
health- care facilities or among intravenous drug users.

Free Article
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0086098
__________________________________________________________________
________________________________*_________________________________

19. Abstract: The impact of hepatitis C burden: an evidence-based approach
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24461160

Aliment Pharmacol Ther. 2014 Jan 26. doi: 10.1111/apt.12625. [Epub ahead
of print]

The impact of hepatitis C burden: an evidence-based approach.

Younossi ZM, Kanwal F, Saab S, Brown KA, El-Serag HB, Kim WR, Ahmed A,
Kugelmas M, Gordon SC.

BACKGROUND: Infection with the hepatitis C virus (HCV) has been considered
a major cause of mortality, morbidity and resource utilisation in the US.
In addition, HCV is the main cause of hepatocellular cancer (HCC) in the
US. Recent developments in the diagnosis and treatment of HCV, including
new recommendations pertaining to screening for HCV by the Centers for
Disease Control and Prevention and newer treatment regimens with high
efficacy, short duration and the potential for interferon-free therapies,
have energised the health care practitioners regarding HCV management.

AIM: To assess the full impact of HCV burden on clinical, economic and
patient- reported outcomes.

METHODS: An expert panel was convened to assess the full impact of HCV
burden on a number of important outcomes using an evidence-based approach
predicated on Grading of Recommendations Assessment, Development and
Evaluation methodology. The literature was summarised, graded using an
evidence-based approach and presented during the workshop. Workshop
presentations were intended to review recent, relevant evidence-based
literature and provide graded summary statements pertaining to HCV burden
on topics including the relationships between HCV and the development of
important outcomes.

RESULTS: The associations of HCV with cirrhosis, HCC, liver-related
mortality, type 2 diabetes mellitus, rheumatological diseases and quality
of life impairments are supported by strong evidence. Also, there is
strong evidence that sustained viral eradication of HCV can improve
important outcomes such as mortality and quality of life.

CONCLUSIONS: The current evidence suggests that HCV has been associated
with tremendous clinical, economic and quality of life burden.

© 2014 John Wiley & Sons Ltd.
__________________________________________________________________
________________________________*_________________________________

20. Abstract: Comparison of intramuscular compound betamethasone and oral
diclofenac sodium in the treatment of acute attacks of gout
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24472084

Int J Clin Pract. 2014 Jan 29.

Comparison of intramuscular compound betamethasone and oral diclofenac
sodium in the treatment of acute attacks of gout.

Zhang YK, Yang H, Zhang JY, Song LJ, Fan YC.

INTRODUCTION: Non-steroidal anti-inflammatory drugs (NSAIDs) are widely
used for the treatment of acute gouty arthritis but have the risk of
gastrointestinal bleeding and cardiovascular toxicity. Glucocorticoid was
as effective as oral NSAIDs in the initial treatment of gout arthritis of
patients intolerant of NSAIDs. However, whether glucocorticoid has the
same or preferable effect as oral NSAIDs on patients with acute gouty
arthritis irrespective of gastrointestinal and cardiovascular risks factor
remains unknown. This study was to compare the efficacy, safety and
tolerance of compound betamethasone (diprospan) 7 mg intramuscular
injection (i.m.) once for all during the study with diclofenac sodium 75
mg twice a day in the treatment of acute gouty arthritis.

METHODS: Sixty patients with acute gouty arthritis were randomised (1 : 1)
to receive compound betamethasone 7 mg i.m. once for all during the study
or diclofenac sodium 75 mg twice a day for 7 days in this open-label
study. Pain intensity, tenderness, swelling and global assessment of
response to therapy were collected as end-points for the treatment.

RESULTS: The mean change in pain intensity from baseline to Day 3 and Day
7 in both treatment groups demonstrated that compound betamethasone had
preferable efficacy over diclofenac sodium on Day 3 and comparable
efficacy on Day 7. The compound betamethasone group had fewer adverse
effects (AEs) than diclofenac sodium group. No statistically significant
differences were observed about serum uric acid levels at different pain
intensity at baseline.

CONCLUSIONS: A single dose of compound betamethasone may be better than
diclofenac sodium for the treatment of acute gouty arthritis.

© 2014 John Wiley & Sons Ltd.
__________________________________________________________________
________________________________*_________________________________

21. Abstract: Hand hygiene compliance and associated factors among health
care providers in Gondar University Hospital, Gondar, North West
Ethiopia
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/24479696

BMC Public Health. 2014 Jan 30;14(1):96.

Hand hygiene compliance and associated factors among health care providers
in Gondar University Hospital, Gondar, North West Ethiopia.

Abdella NM, Tefera MA, Eredie AE, Landers TF, Malefia YD, Alene KA.

BACKGROUND: Health care associated infections are more predominant in
developing countries where Hand hygiene compliance is associated with so
many factors. However, these factors have not been studied so far in the
study area. This study sought to determine Hand hygiene compliance and
associated factors among health care providers.

METHODS: Institution based cross-sectional study was conducted from April
to May, 2013 in Gondar University Hospital. Stratified sampling technique
was used to select 405 health care providers. Standardized questionnaire
and world health organization observational checklist was used to collect
the data. Data was entered and analyzed by using SPSS version 20.
Descriptive statistics and binary logistic regression model was used to
summarize the result.

RESULTS: A total of 405 study participants were interviewed and observed
with a response rate of 96.4%. Good Hand hygiene compliance of healthcare
providers was found to be 16.5%. Having knowledge about hand hygiene
compliance , (AOR = 3.80, 95%CI 1.60, 8.97), getting training (AOR = 2.60,
95%Cl 1.21, 5.62), the presence of individual towel/tissue paper (AOR =
1.91, 95% CI 1.03, 3.56) presence of alcohol based hand rub for Hand
hygiene compliance(AOR = 6.58, 95% CI 2.67, 16.22) and knew the presence
of infection prevention committees (AOR = 2.6, 95% CI 1.23, 5.37) were
significantly associated with hand hygiene compliance .

CONCLUSIONS: Hand hygiene compliance among health care providers in Gondar
University Hospital was found to be low. It is better to give training on
Hand hygiene compliance and provide Alcohol based hand rub and individual
towel or tissue paper for hand hygiene compliance .

Free full text http://www.biomedcentral.com/1471-2458/14/96/abstract
__________________________________________________________________
________________________________*_________________________________

22. No Abstract: A previously unidentified risk of needlestick injury in
the emergency medical services setting
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24462174

Am J Infect Control. 2014 Jan 23. pii: S0196-6553(13)01298-4.

A previously unidentified risk of needlestick injury in the emergency
medical services setting.

McGuire-Wolfe C.

Pasco County Fire Rescue, Tampa, FL. Electronic address:
cwolfe@health.usf.edu.
__________________________________________________________________
________________________________*_________________________________

23. No Abstract: Finding the right safety device
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24205545

MLO Med Lab Obs. 2013 Aug;45(8):46-7.

Finding the right safety device.

McLean M.

Greiner Bio-One North America, Inc.
__________________________________________________________________
________________________________*_________________________________

24. No Abstract: Research on hormonal contraception and HIV
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24461119

Lancet. 2014 Jan 25;383(9914):305-6.

Ralph L1, McCoy S2, Hallett T3, Padian N2.

Research on hormonal contraception and HIV. [Lancet. 2014]
Research on hormonal contraception and HIV. [Lancet. 2014]
Research on hormonal contraception and HIV. [Lancet. 2014]
Next steps for research on hormonal contraception and HIV. [Lancet. 2013]
__________________________________________________________________
________________________________*_________________________________

25. Procurement & Supply Management Toolbox Update: Top 20 Tools

Crossposted from e-drug with thanks

To subscribe or unsubscribe via the World Wide Web, visit
http://list.healthnet.org/mailman/listinfo/e-drug
__________________________________________________________________
E-DRUG: PSM Toolbox Update: Top 20 Tools

Dear all,

Thanks for the support and contributions from all partners and tool
developers, there were a total of 356 tools in the PSM Toolbox by 2013.
The tools cover all PSM areas and have allowed PSM professionals improve
the public health systems in low and middle income countries.

Below is the list of the top 20 most viewed tools in 2013.

1. Specifications and Quantities for Efficient Procurement of Essential
Equipment and Laboratory Commodities for HIV (WHO)

2. List of WHO/UNFPA Pre-qualified male condom manufacturers (WHO)

3. Quantimed (MSH)

4. Logistics Handbook: A Practical Guide for the Supply Chain Management
of Health Commodities (USAID | DELIVER PROJECT)

5. Managing Drug Supply-3: Managing Access to Medicines and Health
Technologies (MSH)

6. CHANNEL (UNFPA)

7. ARV Procurement Forecasting Tool (CHAI)

8. Emerging Trends in Supply Chain Management: Outsourcing Public Health
Logistics in Developing Countries (USAID | DELIVER PROJECT)

9. International Drug Price Indicator Guide (MSH)

10. IDA Price Indicator (IDA Foundation)

11. Specifications and Quantities for Efficient Procurement of Essential
Equipment and Laboratory Commodities for HIV (WHO)

12. Getting Products to People: The JSI Framework for Integrated Supply
Chain Management in Public Health (John Snow, Inc.)

13. Supply Chain Evolution – Introduction to a Framework for Supply Chain
Strengthening of Developing Country Public Health Programs (USAID |
DELIVER PROJECT)

14. Quality Assurance Template (UNDP)

15. Procurement Performance Indicators Guide (USAID | DELIVER PROJECT)

16. WHO/AMDS website (WHO, 89 views)

17. Computerizing Logistics Management Information Systems: A Program
Manager’s Guide (USAID | DELIVER PROJECT)

18. Resources for Managing the HIV & AIDS and Laboratory Supply Chains
(USAID | DELIVER PROJECT)

19. The Global Fund Price & Quality Reporting (PQR) (The Global Fund)

20. Quantification of Health Commodities; A Guide to Forecasting and
Supply Planning for Procurement (USAID | DELIVER PROJECT)

For more information, please go to the PSM Toolbox website at
http://www.psmtoolbox.org/en/news-details.php?id=76.

Kun-Chieh Wu
Training & Consultancy Coordinator
i+solutions
email: kwu@iplussolutions.org
website: www.iplussolutions.org
i+ Solutions -Training <Training@iplussolutions.org>
__________________________________________________________________
________________________________*_________________________________

26. News

– USA: Ohio lawmakers might enable more clean needle exchanges
– USA: In response to hepatitis C outbreak, NH House gives preliminary OK
to technician registry
– Kashmir India: ‘Unsafe injections’ mainly blamed for Hepatitis-C
outbreak Health Dept Survey, SKIMS Study Makes Case For Proper
Sterilization Facilities
– Canada: Cross-Contamination May Have Caused Hep C Outbreak
– Testing HCV positive has a sustained impact on drug injecting behaviour
– Armenia: AIDS Prevention Center rejects news on infection with needle
– 21 Tribal Members Potentially Exposed to Hepatitis B and C and HIV
– Ukraine: Methadone Clinics Help Ukraine Succeed Where Russia Fails on
HIV
– Uganda: How a Nurse Injected Baby With HIV Blood

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
www.dispatch.com/content/stories/local/2014/02/02/clean-needles.html

USA: Ohio lawmakers might enable more clean needle exchanges

By Will Drabold, The Columbus Dispatch, Ohio USA (02.02.14)

PORTSMOUTH, Ohio — Without fear of prosecution, the man brought 10 needles
he had used to pump heroin into his veins downtown for a trade.

“What’s your ZIP code?” asked Randy Schlegel. “45662,” said the man. “And
your drug of choice?” asked Schlegel, a chemical-dependency counselor at
the Portsmouth City Health Department. “Heroin,” answered the man, who
goes by the initials JM.

After a few more questions, he turned over the bloody, dull points to
Schlegel and was out the door with new needles, indicating they would be
used soon. JM, a Portsmouth resident in his 20s, has used heroin for the
past few years and allowed The Dispatch to observe his exchange only on
the condition of anonymity.

The scene illustrates how authorities across Ohio have made the shift from
combating prescription drugs to fighting heroin, said Orman Hall, director
of Gov. John Kasich’s opiate-action team.

And the new drug of choice comes with a new challenge for both users and
health officials: an increased risk of hepatitis C, which can be
contracted by sharing syringes and can survive for days or weeks on the
end of a needle.

The Ohio Department of Health says that “intravenous drug use is the
leading risk factor for hepatitis C infection,” which often leads to liver
cancer or other severe complications.

Up to 4 million people nationwide are suspected of having hepatitis C,
according to the Centers for Disease Control and Prevention, but they are
difficult to identify because the disease often doesn’t show symptoms
until decades after it is contracted.

Before the end of this year, many Ohio legislators hope that syringe
exchanges similar to this one in Portsmouth will appear across the state,
enabled by a bill that would allow heroin users — or anyone who brings in
a used needle — to get a clean one.

The bill, approved with bipartisan support by the Ohio House, is being
considered by the Senate and would allow any local health authority to
establish a syringe-exchange program without declaring a health emergency.
This gives drug users — primarily heroin users — a way to get clean
needles in the hope of stemming the spread of blood-borne diseases such as
hepatitis C, proponents say.

The bill would provide no state funding for exchange programs, and federal
funding currently cannot be used for them. The exchange in Portsmouth is
run with donations of new syringes.

Cleveland is the only other Ohio city to operate a similar exchange, which
started in 1995 to fight rising rates of HIV. The program exchanged
230,781 syringes in 2013.

A similar exchange is expected to open in February in Springdale, just
north of Cincinnati. Thirty-four states currently have similar programs.

The Portsmouth exchange opened in March 2011, not long after health
department employees helped close the county’s “pill-mill” clinics, where
some doctors overprescribed prescription pain pills. The health officials
quickly turned their attention to combating a heroin addiction that
replaced the prescription drugs.

In 2012, eight areas of Ohio were considered heroin hot spots: Cincinnati,
Columbus, Dayton, Youngstown, Cleveland, an area southeast of the I-71
corridor between Columbus and Cincinnati, an area encompassing northern
Athens County, and Portsmouth.

The exchange in Portsmouth has cut countywide hepatitis C rates, reduced
the number of needles found in parks and on sidewalks to nearly none, and
given addicts a legally safe resource for help, Portsmouth officials say.

Federal research has shown increased rates of hepatitis C in some younger
populations, but the problem has not been studied nationally. No
comprehensive Ohio data on that subject exists, state officials said.

Kasich does not expressly support the exchange idea but said that he is
open to solutions that could help fight opiate addiction, especially if
exchanges are linked with efforts to encourage addicts to seek rehab.

In 2011, 65 percent of drug overdoses in Ohio were due to prescription
opiates or heroin, and there was a 440 percent increase in unintentional
drug overdoses overall between 1999 and 2011, according to the Ohio
Department of Health.

Data that support the success of needle exchanges are hard to come by.
Several federal and state public-health agencies said they do not keep
comprehensive data directly linking intravenous drug use and hepatitis C.

Examples from other states and Ohio’s exchanges show a connection between
the availability of clean needles and lower rates of hepatitis C.

“It hits on three great public policies,” said Rep. Barbara Sears, R-
Sylvania, who is sponsoring House Bill 92 with Rep. Nickie Antonio, D-
Lakewood. “Safety for the person, safety for the community, and the
reduction of the side effects.”

Another heroin addict, who also spoke on the condition of anonymity, said
he has friends who fake injuries just to get near a biohazard box at a
hospital. “They’ll dig needles out of there just so they have something to
shoot with,” said ML, a 27-year-old man from Kentucky , who collects scrap
metal to survive and buy more drugs.

Former addict Jason Jordan, who shot up heroin for a decade after becoming
addicted to OxyContin and Vicodin, is eight months’ clean but now positive
for hepatitis C. He contracted the disease by sharing needles with other
addicts. “I was the kind of junkie that, if I didn’t use my own point, I
would use somebody else’s,” said Jordan, 38, a lifelong resident of Scioto
County.

The Portsmouth exchange encourages addicts to get tested for the disease
and provides them with information on how to beat their addiction, said
Lisa Roberts, a nurse at the health department.

“We’re in the real world, where there are people who don’t want drug-
addiction treatment,” Roberts said. “They’re in active IV-drug use, and
you have to manage their health during that time, so … hopefully,
they’ll emerge at the end of their addiction disease-free — hopefully
alive.”

Will Drabold is a fellow in Ohio University’s E.W. Scripps School of
Journalism Statehouse News Bureau.
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/np6byph

USA: In response to hepatitis C outbreak, NH House gives preliminary OK to
technician registry

By Holly Ramer Associated Press, USA (29.01.14)

CONCORD, New Hampshire — Medical technicians like the one who stole drugs
from Exeter Hospital and infected patients with hepatitis C would be
required to register with the state under a bill given preliminary
approval Wednesday by the New Hampshire House.

The bill would create a board to register health care workers who are not
otherwise already licensed or registered and who have access to both drugs
and patients. Hospitals would be required to report disciplinary actions
to the board, which could perform its own investigations of wrongdoing.

The bill, which was sent to the House Ways and Means Committee for further
review, is a response to David Kwiatkowski, a former traveling technician
who was sentenced in December to 39 years in prison. He had worked as a
cardiac technologist in seven states before being hired in New Hampshire
in 2011, despite being fired numerous times over drug allegations.

Medical technicians aren’t as closely regulated as doctors or nurses, and
there is no nationwide database of misconduct or disciplinary actions
against them, as there is for physicians. While some states require
certain technicians to be licensed, four of the states where Kwiatkowski
worked, including New Hampshire, don’t license any of them.

“This is a simple, commonsense registration bill which will allow the
state of New Hampshire to know who the technicians are who are working in
their hospitals,” said state Rep. Lucy Weber, a Walpole Democrat. “It will
further enhance patient safety by requiring hospitals to report incidents
of discipline for these people who are often employed on a transient
basis.”

Rep. Carol McGuire, R-Epsom, spoke in opposition to the bill, saying it
was unnecessary because the House passed a bill last week that would
require health care facilities to develop and implement drug-free
workplace policies and to test employees for drugs if there is a
reasonable suspicion of drug use. She also argued that the fee that
technicians would have to pay, which isn’t specified in the bill, would
deter people from entering the profession.

“Putting in this requirement to go register, pay the fee, the criminal
background check and all that, instead of relying on the supervision of
their employer to make sure they don’t wander through the halls picking up
syringes of painkillers, is going to interfere with the job growth in
these fast-growing professions,” she said. “We should not be putting new
and probably futile barriers to entry in that case. We should insist that
hospitals and other health care facilities do their jobs.”

Kwiatkowski, who admitted stealing painkillers and replacing them with
saline-filled syringes tainted with his blood, pleaded guilty in August to
16 federal drug charges. Since his arrest in July 2012, 46 people in New
Hampshire, Maryland, Kansas and Pennsylvania have been diagnosed with the
same strain of the hepatitis C virus he carries, and authorities say the
disease played a role in one woman’s death. Kwiatkowski also worked in
Michigan, New York, Arizona and Georgia.
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/orezm9q

Kashmir India: ‘Unsafe injections’ mainly blamed for Hepatitis-C outbreak
Health Dept Survey, SKIMS Study Makes Case For Proper Sterilization
Facilities

ISHFAQ NASEEM, GreaterKashmir.com, Kashmir India (28.01.14)

Srinagar, Jan 28: A Government survey has revealed that Hepatitis-C has
spread in Kashmir due to use of infected syringes and lack of
sterilization facilities at dental clinics.

A survey by the Directorate of Health Services Kashmir (DHSK) has revealed
that the disease has spread due to use of “unsafe injections.” The
findings have been corroborated by a study carried out by Sher-i-Kashmir
Institute of Medical Sciences (SKIMS), Soura, which has asked for checking
use of sterilization facilities at dental clinics.

The Health department survey has found that in Takiya Magam village of
Kokernag and its adjoining areas in south Kashmir’s Anantnag (Islamabad)
district, the Hepatitis-C has spread “due to use of unsafe injections.’’
The survey notes that “a trend was observed that there has been use of
large volume of diluents in preparation of injections which are re-used
for large number of patients.”

The residents of Takiya Magam have also been going to “local self-trained
chemist’’ shops for injections and the dental procedures have also been
carried out at chemist shops, the survey notes.

Director SKIMS, Showkat Ahmed Zargar, said the study has particularly
revealed that proper sterilization facilities have been lacking at health
clinics at Takiya Magam and elsewhere in Kashmir. “The Hepatitis-C has
spread in Kashmir due to lack of proper sterilization facilities at dental
clinics. There is a need to ensure that these clinics have adequate number
of autoclave machines to prevent the spread of Hepatitis-C,” he told
Greater Kashmir.

Government officials said they have written to the Drug Controller asking
for curbing the practice of people being given injections at Chemist shops
without sterilizing syringes.

The J&K’s Drug Controller, Satish Gupta, however said they have not come
across cases where dental procedures have been carried out at chemist
shops. “We are properly checking the Chemist shops and have not given
licenses to people who are running the dental facilities there. The dental
procedures are essentially required to be carried out in a proper set-up,”
he said.

However Director Health Services, Kashmir, Dr Saleem-ur-Rehman said
sharing of syringes has been mostly common earlier and has now been
curbed. He admitted sharing of syringes has resulted into the increase in
Hepatitis-C cases in Takiya Magam.

The Health department survey notes that 787 Hepatitis-C positive cases
have been detected in the village which is mostly inhabited by low-paid
labourers and poorly educated ones who mostly live on cultivation of maize
crop. “Because the initial phase of these infections is usually
asymptomatic, the adverse effects of unsafe injections have been under-
appreciated,” notes the survey.
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http://tinyurl.com/nh4lugt

Canada: Cross-Contamination May Have Caused Hep C Outbreak

Michelle Ruby, Brantford Expositor, Ontario Canada (22.01.14)

Two patients at Brantford General Hospital in Ontario, Canada may have
acquired hepatitis C due to cross-contamination of medication supplies
while undergoing endoscopies.

Dr. Tom Szakacs, an infection control specialist at BGH, told the
Brantford Expositor that medications used in sedation during endoscopies
must be carefully documented, including the type of drug and dose. He said
that in some cases “some pieces of information were not there.”

Szakacs says they are investigating whether the needle used to inject
sedative medications on a patient previously infected with hepatitis C was
then used on the next patient causing transmission of the virus.

Alternatively, says Szakacs, “if sterile technique is not followed, it may
cause contamination of a stock medication vial that is then the source of
virus for the next patient.”

At this time, the Brant Community Healthcare System said in a news release
that it has ruled out other potential sources of contamination, such as
scopes or the medications themselves.

“We are confident that our exhaustive investigation has shown where there
could have been a possible breach, and we are putting in place evidence-
based recommendations that will ensure patient safety,” says Szakacs.

“This situation is not unique and has been reported elsewhere. Staff and
physicians at BCHS are dedicated to improving infection control practices
for our patients.”

The hospital is now resuming elective endoscopy procedures at the
hospital.

“The decision to resume endoscopy procedures was made with confidence as
it was found through an internal investigation that equipment used in BGH
endoscopy procedures is fully cleaned and sterilized,” says Szakacs.

He says infection control specialists examined all staff and physician
practices, sterilization techniques and medication administration.

The investigation involved two patients who underwent endoscopies at the
hospital last year on May 29 and Nov. 8. An endoscopy involves examining
the inside of a person’s body using a medical device consisting of a long
thin tube, which has a light and a video camera.

In mid-November, the hospital became aware of a patient who had recently
acquired hepatitis C, who had an endoscopy procedure on May 29. Szakacs
says the hospital began an immediate investigation into whether this was a
possible transmission case.

He says it couldn’t be deemed a “probable” transmission until January when
blood results from the investigation became available. After exposure to
hepatitis C, it can take up to six months for laboratory testing to
confirm infection. Due in part to this lag time, says Szakacs, the first
case related to endoscopy in May wasn’t identified until November.

Other endoscopy patients from May 29 from the same procedure room were
tested for hepatitis C. The patient immediately preceding the affected
patient had hepatitis C prior to the endoscopy. All other patients from
that day in that procedure room were cleared of hepatitis C, as well as
other blood-borne viruses.

In January, the hospital became aware of an additional patient who
recently acquired hepatitis C, who had an endoscopy procedure on Nov. 8.

Similar to the testing from patients with endoscopies in May, the patient
immediately preceding this newly affected patient had hepatitis C, which
is also believed to have been pre-existing. All other patients who had
procedures on that day in the same room tested negative.

Samples of the infected patients from the May 29 and Nov. 8 days have been
forwarded to the National Microbiology Laboratory in Winnipeg. The
genetics of the viruses are being analyzed. The results will be able to
confirm whether the viruses are identical and whether transmission did
occur. It could be a week or more before the results are known.

If a transmission is confirmed by the national laboratory, the Brant
Community Healthcare System will extend testing and examination to
additional endoscopy patients who may have been at risk, says Jim Hornell,
president and CEO of BCHS.

“In addition to our internal investigations we are working collaboratively
with the Brant County Health Unit,” says Hornell.

“Any new information or actions we may take will be communicated to the
communities we serve. We are committed to putting patients first and being
as open and transparent as possible.”

Hornell says the hospital will be implementing recommendations for future
endoscopies, including:

• Implementation of explicit and comprehensive guidelines on the
preparation, labelling, delivery, storage, documentation, and discarding
of all medications used in endoscopy.
• Additional training on sterile techniques for all staff involved in
endoscopies.
• Implementation of additional guidelines in the storage, sterilization
and disinfection of equipment — above and beyond standard practice.
• Additional personal protective equipment training and measures.

Hepatitis C is a viral infection carried in the blood, affecting primarily
the liver. The infection is often asymptomatic, but chronic infection can
lead to scarring of the liver and ultimately to cirrhosis or liver cancer,
which generally takes more than 10 years to develop. About 75% of people
show no signs or symptoms of infection.
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http://tinyurl.com/pt27o7e

Testing HCV positive has a sustained impact on drug injecting behaviour

Michael Carter, namAidsMap, http://www.aidsmap.com/ (17.01.14)

Diagnosis with hepatitis C virus (HCV) is associated with a sustained
reduction in injecting drug use, according to Canadian research published
in the online edition of Clinical Infectious Diseases. Each additional
three months of follow-up was associated with a 10% reduction in the
likelihood of injecting cocaine or heroin. Screening for HCV was also
associated with a reduction in the likelihood of sharing syringes, not
only for people diagnosed with HCV but also for individuals testing HCV
negative.

“The main finding of this study is that notification of HCV test results
and counseling is related to reductions in subsequent drug use behavior
for PWIDs [people who inject drugs] learning that they recently contracted
an HCV infection, but not for those who are uninfected,” comment the
authors. “Reductions in drug use behaviors are likely to reflect a
response to being informed about a recent seroconversion.”

The authors of an editorial that accompanies the study believe the results
highlight “the importance of HCV testing as a catalyst for behavior
change”.

Worldwide, injecting drug use is the main mode of HCV transmission. Canada
is a case in point, where 83% of incident infections involve PWIDs. Harm-
reduction programmes that provide access to clean needles and syringes,
information about safer injecting practices, and screening for HCV and
HIV, are the mainstay of HCV prevention in Canada and some other
countries.

Investigators in Montreal wanted to see if testing for HCV had a sustained
impact on injecting behaviours and alcohol use among PWIDs.

They therefore designed a longitudinal study involving 208 adults who were
active injecting drug users and who were HCV negative at baseline. Every
six months, participants were screened for HCV and answered questions
about their recent injecting behaviours and use of alcohol. Post-test
counselling and appropriate referrals were provided.

The majority of participants were male (83%), and their mean age was 34
years. The mean duration of follow-up was 30 months. During this time,
participants contributed a total of 528 person-years of follow-up. A third
of participants seroconverted for HCV, an incidence rate of 14.4 per 100
person-years. Individuals who seroconverted were significantly more likely
than individuals who remained HCV negative to report injecting opioids (51
vs 22%, p < 0.001), cocaine (87 vs 63%, p = 0.004) and the sharing of
syringes (39 vs 24%, p = 0.021) in the previous six months.

During follow-up, the proportion of participants who reported sharing
syringes fell to very low levels, irrespective of HCV infection status.

Notification of a positive HCV test result was also associated with
significant and sustained falls in the odds of reporting injecting cocaine
or heroin. Each additional three months of follow-up was associated with a
10% reduction in reporting each of these injecting behaviours. However,
injecting of heroin and cocaine remained unchanged among participants who
tested HCV negative.

“Our results suggest that it is mainly the notification of the HCV
positive status that induces the decrease in risk among PWIDs,” write the
investigators. “There is no sustained change in risk among those who
continue to be seronegative.”

Regardless of the result, there was no evidence that HCV screening had an
impact on alcohol use. The authors believe this finding “should raise
concern” as alcohol is associated with accelerated HCV disease
progression.

“The change in injecting behaviors after testing for HCV that was observed
in this study strongly supports the expansion of HCV testing,” write the
authors of the editorial. “Future research is needed to elucidate which
interventions or experiences promote safer or less injection drug use
among persons testing positive for HCV.”

Reference

Bruneau J et al. Sustained drug use changes following hepatitis C
screening and counseling among recently infected persons who inject drugs.
Clin Infect Dis, online edition, 2013.

Beckwith CG et al. HCV testing and drug use in North America; is there
more than meets the eye? Clin Infect Dis, online edition, 2013.

This news story is also available in Russian. http://tinyurl.com/pt27o7e
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http://tinyurl.com/q5equ43

Armenia: AIDS Prevention Center rejects news on infection with needle

Armenpress, Yerevan Armenia (17.01.14)

A person cannot be infected with AIDS with a needle.

The Head of the AIDS Prevention Centre Janetta Petrosyan told Armenpress
about it, touching about the spread news. The youth movement “We” spread a
message, saying that a certain organization penetrated into Armenia, the
members of which pierce people with HIV-infected needles in crowded areas
to initiate the disease.

“It is impossible to infect with a needle, as the virus is unstable in the
external environment and very quickly gets destroyed out of the human
body. The amount of the virus on the needle cannot be enough to infect a
human”, – said the Head of the AIDS Prevention Centre, adding that the
external temperature and humidity contribute to the quick destruction of
the virus out of a living cell.

According to Janetta Petrosyan, no case on getting a needle pierce in the
public places was registered at the AIDS Prevention Centre.

© 2009 ARMENPRESS.am
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http://tinyurl.com/omnw7ze

21 Tribal Members Potentially Exposed to Hepatitis B and C and HIV

ICTMN, indiancountrytodaymedianetwork.com, Nevada Oregon USA (14.01.14)

At least 21 members of the Fort McDermitt Paiute Shoshone Tribe were
potentially exposed to Hepatitis B, Hepatitis C and HIV during a diabetes
screening, the tribe’s Chairman Tildon Smart told KOLOTV.com.

“It’s very scary,” Smart, who participated in the screening, told
MyNews4.com.

“It was lack of training,” Smart told KTVN.com. “The individual that
exposed everybody to it, according to statements made by IHS, was directed
not to administer the tests or anything like that and continued to do so
anyway.”

The Indian Health Service official allegedly reused the same monitoring
pen, which was not properly sterilized, to check members’ blood glucose
levels at the NuNu Diabetes Wellness Clinic through IHS.

Yesterday tribal members were tested for various diseases at Humboldt
General Hospital in Winnemucca. Test results are pending.

But some members feel their trust has been violated. “Some individuals
don’t have a problem with it,” Smart MyNews4.com. “They’re willing to go
there. There’s others that feel that the program had failed them, and they
don’t feel safe going back.”

For more information, contact the Indian Health Service at (775) 532-8522.
__________________________________________________________________
__________________________________________________________________
http://allafrica.com/stories/201401130041.html

Uganda: How a Nurse Injected Baby With HIV Blood

By Edward Ssekika, The Observer, Kampala Uganda (13.01.14)

The hitherto little-known nurse has been in the news for the wrong reasons
since Friday, after she allegedly drew her own HIV-infected blood and
injected it into a two-year-old child, a patient at the clinic.

Now detained at Wandegeya police station, Namubiru’s conduct has raised
eyebrows about safety in Uganda’s health facilities with the grim
realisation now that some are harbingers of death as opposed to life.

“I’m still wondering why she did such a thing,” said the child’s father,
who preferred anonymity to protect the victim. He also wonders whether
Namubiru is on a deliberate mission to infect children with HIV/Aids or
his child was a deliberate target.

The family’s ordeal started on Tuesday morning, January 7, 2014. The child
was showing signs of tonsillitis, an inflammation of the tonsils, which is
commonly caused by a viral or bacterial infection.

The mother decided to take her sick child to Victoria Medical Centre, one
of the health centres on the family’s health insurance scheme.

“We normally go there for medication, and we have a particular doctor who
attends to us,” the father told us.

However, on the fateful day, the doctor in question was not on duty and it
was around lunch time. It appears there were few health workers present;
so, the medical facility assigned Nurse Rose Namubiru to handle the child.
After dropping mother and child at Victoria Medical Centre, the father
proceeded to his workplace.

Deadly injection

Following diagnosis, the nurse was supposed to administer an injection to
the child. She got hold of a syringe, first pierced one of her fingers,
drew out some blood, and then injected the baby. As she was administering
the injection, the mother became suspicious seeing blood oozing from
Namubiru’s finger while she was injecting her child.

The now alarmed mother shouted at the nurse to stop what she was doing to
her child. She quickly reported what had transpired to the head nurse and
another nurse was called in to complete the treatment as a formal
complaint was made to the health centre authorities. The family now
demanded to know Namubiru’s HIV status. The clinic asked her if she knew
her HIV status and she said she didn’t.

“When the hospital took a HIV test on her [Namubiru], they broke the news
that she was HIV-positive,” the child’s parents narrated.

Namubiru claimed she was discovering her status for the very first time.
The child was also tested and found to be negative. The hospital
administration immediately wrote a termination letter, but withheld it,
insisting that they would formally terminate her services after the matter
had been closed. She has worked there for four years, the police said.

As all this was going on, Namubiru was asked why she drew her own blood
and injected it into the child. She replied that she was tired and lost
her head in the process, before asking for forgiveness. One of the doctors
at the clinic advised the parents to put the child on post-exposure
prophylaxis (PEP), an early preventive treatment regime that can stop
infection once taken immediately after exposure to HIV.

The child was subsequently transferred to another facility and put on PEP
treatment for 30 days.

“They told us after 30 days, the child would be subjected to an HIV test.
But that will not be conclusive, we are only waiting for three months when
a conclusive test will be taken and then we shall be able to know whether
our child got infected or not,” the child’s father narrated.

ARVs found

The police were immediately called in and Namubiru was picked up and
detained at Wandegeya police station where the case was recorded. All this
time, Namubiru maintained that she had not known she was HIV-positive.
However, when she was told she would be detained at the station, she asked
to be taken to her home to pick up a drug that she said she takes “at
specific hours”.

When the police took her to her home off Entebbe road and searched it,
they found several tins of anti-retroviral drugs (ARVs). She first denied
that they belonged to her but later confessed that the drugs were hers.
She added that she gets her ARVs from Nsambya hospital.

In her statement at the police station, Namubiru insisted that what had
happened was accidental.

“The baby was crying and fighting, so I got pierced … I lost my head,
I’m sorry, I just lost my head,” she said.

She claims that she didn’t target the child, since she doesn’t know its
parents and was treating it for the first time.

Police secrets

On Friday, January 10, this writer visited Wandegeya police station to
verify the story after a tip-off from a source. Inside the office of the
O/C CIID, but unnoticed as a journalist and indeed uninvited, this writer
sat quietly as the police officer and the child’s parents discussed the
case.

It was now three days after the incident and the O/C CIID, a copy of the
Penal Code Act in hand, confessed that the police were having trouble
finding an appropriate charge for the accused nurse.

“I was looking at attempted murder, but it can’t stand,” she told the
child’s parents.

Then the child’s mother, who said she had consulted a lawyer, proposed
section 171 of the Penal Code Act, which provides for punishment for a
negligent act likely to spread an infection or a disease. According to
this section, any person who unlawfully or negligently commits this
offence is liable to imprisonment for seven years upon conviction. This is
the offence Namubiru is likely to be charged with this week.

During the meeting, it was also revealed that the clinic had been
uncooperative and that the administrator had switched off all the known
phone numbers. After the parents inquired about the nurse’s
qualifications, the O/C CIID said detectives had asked for her practising
certificate but she didn’t produce any. The police then attempted to get
her academic qualifications from the clinic but it was said she didn’t
have a staff file there. Indeed, the administrators said they didn’t know
her qualifications.

The meeting also heard that the clinic was interested in getting the case
resolved quickly before the media could get wind of it. “The health centre
is worried that if the media get to know, they will lose patients,” the
OC/CIID said.

Indeed, it later emerged that the police at Wandegeya had tried to hide
the story from the media until CIID Director Grace Akullo intervened and
ordered that Namubiru be paraded before the media. Akullo said the
director of the clinic had gone into hiding.

HIV bill

As the child’s parents struggle to come to terms with what has happened to
their child, praying that PEP treatment helps to prevent infection, it is
now feared that Namubiru belongs to a racket of health workers that
deliberately infect people with HIV/Aids.

However, as police struggled to find an appropriate charge to punish such
an evil act, it became clearer that our laws are inadequate to cover such
emerging but deadly crimes.

The HIV and Aids Prevention and Control Bill 2008, which seeks among
others to criminalise the deliberate and intentional spread of HIV/Aids,
has been a subject of intense debate over the last couple of years.
Activists believe it violates human rights and might exacerbate rather
than alleviate the HIV problem.
__________________________________________________________________
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