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Papers by Mona Doshani
Harm Reduction Journal
Background Vaccine-hesitant persons who inject drugs are at increased risk for several vaccine-pr... more Background Vaccine-hesitant persons who inject drugs are at increased risk for several vaccine-preventable diseases. However, vaccination rates among this population remain low. While syringe services programs (SSPs) are places where persons who inject drugs feel comfortable accessing services, few offer vaccination services. This study describes facilitators and barriers to vaccination at SSPs. Methods We used convenience sampling to conduct semi-structured, qualitative in-depth interviews with 21 SSPs in the USA from June to August 2021. Interview questions asked SSPs about their perceptions, priorities, barriers, facilitators, and the effects of partnerships and policies on vaccine administration. We used deductive thematic analysis to identify the main themes. Results Eight (n = 8) SSPs offered vaccinations, and thirteen (n = 13) did not offer vaccinations. Most SSPs believed offering vaccination services was important, although addressing SSP participants’ immediate needs often...
Background Persons who inject drugs (PWID) are at increased risk for several vaccine-preventable ... more Background Persons who inject drugs (PWID) are at increased risk for several vaccine-preventable diseases. However, vaccination rates among this population remain low. While syringe services programs (SSPs) are places where PWID feel comfortable accessing services, few offer vaccination services. This study describes facilitators and barriers to vaccination at SSPs.MethodsWe used convenience sampling to conduct in-depth interviews with 21 SSPs in the United States from June-August 2021. Interview questions asked SSPs about their perceptions, priorities, barriers, facilitators, and the effects of partnerships and policies on vaccine administration.ResultsEight (n=8) SSPs offered vaccinations, and thirteen (n=13) did not offer vaccinations. Most SSPs believed offering vaccination services was important, although addressing SSP participants’ immediate needs often took precedence. Staffing, physical space and logistical issues were the most common barriers to vaccine administration repo...
Drug and Alcohol Dependence
MMWR. Morbidity and Mortality Weekly Report
Data are presented for incidence of HIV infection among adults and adolescents aged 13 years and ... more Data are presented for incidence of HIV infection among adults and adolescents aged 13 years and older based on data on diagnoses of HIV infection reported to CDC through June 2011. The HIV Surveillance Supplemental Report is not copyrighted and may be used and reproduced without permission. Citation of the source is, however, appreciated.
American Journal of Preventive Medicine, 2021
Introduction: The COVID-19 pandemic has disrupted healthcare services, reducing opportunities to ... more Introduction: The COVID-19 pandemic has disrupted healthcare services, reducing opportunities to conduct routine hepatitis C virus antibody screening, clinical care, and treatment. Therefore, people living with undiagnosed hepatitis C virus during the pandemic may later become identified at more advanced stages of the disease, leading to higher morbidity and mortality rates. Further, unidentified hepatitis C virus−infected individuals may continue to unknowingly transmit the virus to others. Methods: To assess the impact of the COVID-19 pandemic, data were evaluated from a large national reference clinical laboratory and from national estimates of dispensed prescriptions for hepatitis C virus treatment. Investigators estimated the average number of hepatitis C virus antibody tests, hepatitis C virus antibody−positive test results, and hepatitis C virus RNA−positive test results by month in January−July for 2018 and 2019, compared with the same months in 2020. To assess the impact of hepatitis C virus treatment, dispensed hepatitis C virus direct-acting antiretroviral medications were examined for the same time periods. Statistical analyses of trends were performed using negative binomial models.
Journal of health disparities research and practice, 2014
American Indians/Alaska Natives (AI/AN) diagnosed with HIV infection have poorer survivorship and... more American Indians/Alaska Natives (AI/AN) diagnosed with HIV infection have poorer survivorship and a higher percentage of Stage 3 (AIDS] diagnoses within one year of HIV diagnosis, compared to most race/ethnicity groups. National HIV surveillance data for 20082011 were used to determine diagnosis rates of HIV infection, persons living with HIV, and persons with a late diagnosis (Stage 3 within three months of HIV diagnosis) by selected characteristics for AI/AN and a combined other race/ethnicity group. The highest percentages of 862 AI/AN diagnosed with HIV infection were among males (75.7%), AI/AN aged 25-34 years (32.9%), persons living in large metropolitan areas (53.4%), and those diagnosed in outpatient facilities (39.4%). Among males, the majority of infections were attributed to male-to-male sexual contact (MSM) (71.8%). The percentage of infections attributed to injection drug use (IDU) for AI/AN females (28.5%) was greater than the other race/ethnicity group (15.2%). Probab...
MMWR. Recommendations and Reports, 2020
Hepatitis A is a vaccine-preventable, communicable disease of the liver caused by the hepatitis A... more Hepatitis A is a vaccine-preventable, communicable disease of the liver caused by the hepatitis A virus (HAV). The infection is transmitted via the fecal-oral route, usually from direct person-to-person contact or consumption of contaminated food or water. Hepatitis A is an acute, self-limited disease that does not result in chronic infection. HAV antibodies (immunoglobulin G [IgG] anti-HAV) produced in response to HAV infection persist for life and protect against reinfection; IgG anti-HAV produced after vaccination confer long-term immunity. This report supplants and summarizes previously published recommendations from the Advisory Committee on Immunization Practices (ACIP) regarding the prevention of HAV infection in the United States. ACIP recommends routine vaccination of children aged 12-23 months and catch-up vaccination for children and adolescents aged 2-18 years who have not previously received hepatitis A (HepA) vaccine at any age. ACIP recommends HepA vaccination for adults at risk for HAV infection or severe disease from HAV infection and for adults requesting protection against HAV without acknowledgment of a risk factor. These recommendations also provide guidance for vaccination before travel, for postexposure prophylaxis, in settings providing services to adults, and during outbreaks.
Journal of Community Health, 2018
Epidemics of opioid use and injection drug use (IDU) are associated with an increase in HIV and v... more Epidemics of opioid use and injection drug use (IDU) are associated with an increase in HIV and viral hepatitis infections and overdose deaths in the United States. Persons who inject drugs (PWID) are also at risk for serious infections caused by skin organisms introduced via IDU. We examined National Inpatient Sample hospital discharge data to determine trends in three serious infectious disease-associated conditions that primarily affect PWID in addition to HIV and viral hepatitis: infective endocarditis (IE), central nervous system (CNS) abscesses, and osteomyelitis. We found an increase in the number of primary hospitalization discharge diagnoses for IE among persons aged ≤39 years from 2009 to 2013. Hospitalization rates for these diagnoses also increased over this study period for person with secondary diagnoses of hepatitis B, C, or D viruses and substance-related disorders for IE, CNS abscess and osteomyelitis. Policies that improve access to sterile injection equipment, improve education regarding IDU, and treatment for substance use disorder may help to reduce the impact of serious and often fatal infectious diseases among PWID.
Journal of Community Health, 2018
Hepatitis C virus (HCV) disproportionately affects American Indians/Alaska Natives (AI/AN). The I... more Hepatitis C virus (HCV) disproportionately affects American Indians/Alaska Natives (AI/AN). The Indian Health Service (IHS), via federal and tribal health facilities provides medical services to an estimated 2.2 million AI/AN people in the United States. HCV diagnoses, defined by International Classification of Diseases 9th Revision, Clinical Modification (ICD-9-CM) codes, were analyzed from 2005 to 2015. Results showed 29,803 patients with an HCV diagnosis; 53.4% were among persons born 1945-1965 and overall HCV burden was higher among males than females. These data will help inform local, regional, and national efforts to address, plan for and carry out a national strategy to provide treatment for HCV infected patients and programs to prevent new HCV infections.
Journal of community health, Jan 5, 2014
National rates from human immunodeficiency virus (HIV) and sexually transmitted disease (STD) sur... more National rates from human immunodeficiency virus (HIV) and sexually transmitted disease (STD) surveillance may not effectively convey the impact of HIV and STDs on American Indian/Alaska Native (AI/AN) communities. Instead, we compared average annual diagnosis rates per 100,000 population of HIV, chlamydia (CT), gonorrhea (GC), and primary and secondary (P&S) syphilis, from 2007 to 2010, among AI/AN aged ≥13 years residing in 625 counties in the 12 Indian Health Service Areas, all AI/AN, and all races/ethnicities to address this gap. AI/AN comprised persons reported as AI/AN only, with or without Hispanic ethnicity. Out of 12 IHS Areas, 10 had higher case rates for CT, 3 for GC, and 4 for P&S syphilis compared to rates for all races/ethnicities. Eight Areas had higher HIV diagnosis rates than for all AI/AN, but HIV rates for all IHS Areas were lower than national rates for all races/ethnicities. Two IHS Areas ranking highest in rates of CT and GC and four Areas with highest P&S syph...
JAMA: The Journal of the American Medical Association, 1998
MATERNAL and infant mortality are basic health indicators that reflect a nation's health status. ... more MATERNAL and infant mortality are basic health indicators that reflect a nation's health status. In the United States, infant mortality has declined steadily; however, this is not true for maternal mortality. This report presents data from death certificates compiled by CDC's National Center for Health Statistics, which indicate that in the United States, the annual maternal mortality ratio* remained approximately 7.5 maternal deaths per 100,000 live births during 1982-1996. Annual maternal mortality ratios were calculated using information contained on death certificates filed in state vital statistics offices and compiled by CDC. 1,2 Maternal deaths were defined as those deaths that occurred during a pregnancy or within 42 days of the end of a pregnancy and for which the cause of death was listed as a complication of pregnancy, childbirth, or the puerperium (International Classification of Diseases, Ninth Revision, codes 630-676). Maternal mortality ratios were calculated as the number of maternal deaths per 100,000 live births. 1,2 In 1930, the national maternal mortality ratio was 670 maternal deaths per 100,000 live births. 3 The ratio declined substantially during the 1940s and 1950s, and continued to decline until 1982. During 1982-1996, the annual maternal mortality ratio fluctuated between approximately 7 and 8 maternal deaths per 100,000 live births. During that time, trends by race were similar to the overall ratio, and no reductions were observed for either black or white women. Maternal mortality ratios remained higher for black women than for white women. Ratios for black women generally fluctuated between 18 and 22 per 100,000 births and for white women between 5 and 6 per 100,000 live births.
American Journal of Transplantation
Harm Reduction Journal
Background Vaccine-hesitant persons who inject drugs are at increased risk for several vaccine-pr... more Background Vaccine-hesitant persons who inject drugs are at increased risk for several vaccine-preventable diseases. However, vaccination rates among this population remain low. While syringe services programs (SSPs) are places where persons who inject drugs feel comfortable accessing services, few offer vaccination services. This study describes facilitators and barriers to vaccination at SSPs. Methods We used convenience sampling to conduct semi-structured, qualitative in-depth interviews with 21 SSPs in the USA from June to August 2021. Interview questions asked SSPs about their perceptions, priorities, barriers, facilitators, and the effects of partnerships and policies on vaccine administration. We used deductive thematic analysis to identify the main themes. Results Eight (n = 8) SSPs offered vaccinations, and thirteen (n = 13) did not offer vaccinations. Most SSPs believed offering vaccination services was important, although addressing SSP participants’ immediate needs often...
Background Persons who inject drugs (PWID) are at increased risk for several vaccine-preventable ... more Background Persons who inject drugs (PWID) are at increased risk for several vaccine-preventable diseases. However, vaccination rates among this population remain low. While syringe services programs (SSPs) are places where PWID feel comfortable accessing services, few offer vaccination services. This study describes facilitators and barriers to vaccination at SSPs.MethodsWe used convenience sampling to conduct in-depth interviews with 21 SSPs in the United States from June-August 2021. Interview questions asked SSPs about their perceptions, priorities, barriers, facilitators, and the effects of partnerships and policies on vaccine administration.ResultsEight (n=8) SSPs offered vaccinations, and thirteen (n=13) did not offer vaccinations. Most SSPs believed offering vaccination services was important, although addressing SSP participants’ immediate needs often took precedence. Staffing, physical space and logistical issues were the most common barriers to vaccine administration repo...
Drug and Alcohol Dependence
MMWR. Morbidity and Mortality Weekly Report
Data are presented for incidence of HIV infection among adults and adolescents aged 13 years and ... more Data are presented for incidence of HIV infection among adults and adolescents aged 13 years and older based on data on diagnoses of HIV infection reported to CDC through June 2011. The HIV Surveillance Supplemental Report is not copyrighted and may be used and reproduced without permission. Citation of the source is, however, appreciated.
American Journal of Preventive Medicine, 2021
Introduction: The COVID-19 pandemic has disrupted healthcare services, reducing opportunities to ... more Introduction: The COVID-19 pandemic has disrupted healthcare services, reducing opportunities to conduct routine hepatitis C virus antibody screening, clinical care, and treatment. Therefore, people living with undiagnosed hepatitis C virus during the pandemic may later become identified at more advanced stages of the disease, leading to higher morbidity and mortality rates. Further, unidentified hepatitis C virus−infected individuals may continue to unknowingly transmit the virus to others. Methods: To assess the impact of the COVID-19 pandemic, data were evaluated from a large national reference clinical laboratory and from national estimates of dispensed prescriptions for hepatitis C virus treatment. Investigators estimated the average number of hepatitis C virus antibody tests, hepatitis C virus antibody−positive test results, and hepatitis C virus RNA−positive test results by month in January−July for 2018 and 2019, compared with the same months in 2020. To assess the impact of hepatitis C virus treatment, dispensed hepatitis C virus direct-acting antiretroviral medications were examined for the same time periods. Statistical analyses of trends were performed using negative binomial models.
Journal of health disparities research and practice, 2014
American Indians/Alaska Natives (AI/AN) diagnosed with HIV infection have poorer survivorship and... more American Indians/Alaska Natives (AI/AN) diagnosed with HIV infection have poorer survivorship and a higher percentage of Stage 3 (AIDS] diagnoses within one year of HIV diagnosis, compared to most race/ethnicity groups. National HIV surveillance data for 20082011 were used to determine diagnosis rates of HIV infection, persons living with HIV, and persons with a late diagnosis (Stage 3 within three months of HIV diagnosis) by selected characteristics for AI/AN and a combined other race/ethnicity group. The highest percentages of 862 AI/AN diagnosed with HIV infection were among males (75.7%), AI/AN aged 25-34 years (32.9%), persons living in large metropolitan areas (53.4%), and those diagnosed in outpatient facilities (39.4%). Among males, the majority of infections were attributed to male-to-male sexual contact (MSM) (71.8%). The percentage of infections attributed to injection drug use (IDU) for AI/AN females (28.5%) was greater than the other race/ethnicity group (15.2%). Probab...
MMWR. Recommendations and Reports, 2020
Hepatitis A is a vaccine-preventable, communicable disease of the liver caused by the hepatitis A... more Hepatitis A is a vaccine-preventable, communicable disease of the liver caused by the hepatitis A virus (HAV). The infection is transmitted via the fecal-oral route, usually from direct person-to-person contact or consumption of contaminated food or water. Hepatitis A is an acute, self-limited disease that does not result in chronic infection. HAV antibodies (immunoglobulin G [IgG] anti-HAV) produced in response to HAV infection persist for life and protect against reinfection; IgG anti-HAV produced after vaccination confer long-term immunity. This report supplants and summarizes previously published recommendations from the Advisory Committee on Immunization Practices (ACIP) regarding the prevention of HAV infection in the United States. ACIP recommends routine vaccination of children aged 12-23 months and catch-up vaccination for children and adolescents aged 2-18 years who have not previously received hepatitis A (HepA) vaccine at any age. ACIP recommends HepA vaccination for adults at risk for HAV infection or severe disease from HAV infection and for adults requesting protection against HAV without acknowledgment of a risk factor. These recommendations also provide guidance for vaccination before travel, for postexposure prophylaxis, in settings providing services to adults, and during outbreaks.
Journal of Community Health, 2018
Epidemics of opioid use and injection drug use (IDU) are associated with an increase in HIV and v... more Epidemics of opioid use and injection drug use (IDU) are associated with an increase in HIV and viral hepatitis infections and overdose deaths in the United States. Persons who inject drugs (PWID) are also at risk for serious infections caused by skin organisms introduced via IDU. We examined National Inpatient Sample hospital discharge data to determine trends in three serious infectious disease-associated conditions that primarily affect PWID in addition to HIV and viral hepatitis: infective endocarditis (IE), central nervous system (CNS) abscesses, and osteomyelitis. We found an increase in the number of primary hospitalization discharge diagnoses for IE among persons aged ≤39 years from 2009 to 2013. Hospitalization rates for these diagnoses also increased over this study period for person with secondary diagnoses of hepatitis B, C, or D viruses and substance-related disorders for IE, CNS abscess and osteomyelitis. Policies that improve access to sterile injection equipment, improve education regarding IDU, and treatment for substance use disorder may help to reduce the impact of serious and often fatal infectious diseases among PWID.
Journal of Community Health, 2018
Hepatitis C virus (HCV) disproportionately affects American Indians/Alaska Natives (AI/AN). The I... more Hepatitis C virus (HCV) disproportionately affects American Indians/Alaska Natives (AI/AN). The Indian Health Service (IHS), via federal and tribal health facilities provides medical services to an estimated 2.2 million AI/AN people in the United States. HCV diagnoses, defined by International Classification of Diseases 9th Revision, Clinical Modification (ICD-9-CM) codes, were analyzed from 2005 to 2015. Results showed 29,803 patients with an HCV diagnosis; 53.4% were among persons born 1945-1965 and overall HCV burden was higher among males than females. These data will help inform local, regional, and national efforts to address, plan for and carry out a national strategy to provide treatment for HCV infected patients and programs to prevent new HCV infections.
Journal of community health, Jan 5, 2014
National rates from human immunodeficiency virus (HIV) and sexually transmitted disease (STD) sur... more National rates from human immunodeficiency virus (HIV) and sexually transmitted disease (STD) surveillance may not effectively convey the impact of HIV and STDs on American Indian/Alaska Native (AI/AN) communities. Instead, we compared average annual diagnosis rates per 100,000 population of HIV, chlamydia (CT), gonorrhea (GC), and primary and secondary (P&S) syphilis, from 2007 to 2010, among AI/AN aged ≥13 years residing in 625 counties in the 12 Indian Health Service Areas, all AI/AN, and all races/ethnicities to address this gap. AI/AN comprised persons reported as AI/AN only, with or without Hispanic ethnicity. Out of 12 IHS Areas, 10 had higher case rates for CT, 3 for GC, and 4 for P&S syphilis compared to rates for all races/ethnicities. Eight Areas had higher HIV diagnosis rates than for all AI/AN, but HIV rates for all IHS Areas were lower than national rates for all races/ethnicities. Two IHS Areas ranking highest in rates of CT and GC and four Areas with highest P&S syph...
JAMA: The Journal of the American Medical Association, 1998
MATERNAL and infant mortality are basic health indicators that reflect a nation's health status. ... more MATERNAL and infant mortality are basic health indicators that reflect a nation's health status. In the United States, infant mortality has declined steadily; however, this is not true for maternal mortality. This report presents data from death certificates compiled by CDC's National Center for Health Statistics, which indicate that in the United States, the annual maternal mortality ratio* remained approximately 7.5 maternal deaths per 100,000 live births during 1982-1996. Annual maternal mortality ratios were calculated using information contained on death certificates filed in state vital statistics offices and compiled by CDC. 1,2 Maternal deaths were defined as those deaths that occurred during a pregnancy or within 42 days of the end of a pregnancy and for which the cause of death was listed as a complication of pregnancy, childbirth, or the puerperium (International Classification of Diseases, Ninth Revision, codes 630-676). Maternal mortality ratios were calculated as the number of maternal deaths per 100,000 live births. 1,2 In 1930, the national maternal mortality ratio was 670 maternal deaths per 100,000 live births. 3 The ratio declined substantially during the 1940s and 1950s, and continued to decline until 1982. During 1982-1996, the annual maternal mortality ratio fluctuated between approximately 7 and 8 maternal deaths per 100,000 live births. During that time, trends by race were similar to the overall ratio, and no reductions were observed for either black or white women. Maternal mortality ratios remained higher for black women than for white women. Ratios for black women generally fluctuated between 18 and 22 per 100,000 births and for white women between 5 and 6 per 100,000 live births.
American Journal of Transplantation