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Fuente, Luis de la

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Luis de la

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Fuente

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ISCIII

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ISCIII::Centro Nacional de Epidemiología (CNE)

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Metodología del estudio de cohortes del proyecto itinere sobre consumidores de heroína en tres ciudades españolas y características básicas de los participantes
(Ministerio de Sanidad, Consumo y Bienestar Social (España), 2005) Fuente, Luis de la; Brugal Puig, M Teresa; Ballesta Gómez, Rosario; Bravo, Maria Jose; Barrio, Gregorio; Domingo Salvany, Antonia; Silva do Rosario, Teresa; Ambrós Hortensi, Mireia; Grupo del proyecto ITÍNERE; Fundación para la Investigación y la Prevención del Sida en España; Redes Temáticas de Investigación Cooperativa en Salud (RETICS) (España); Instituto de Salud Carlos III; Plan Nacional de Drogas (España)
[ES] Fundamento: Los estudios de cohortes permiten monitorizar el impacto del uso de drogas sobre la salud, e identificar los factores condicionantes. El objetivo de este trabajo es describir la metodología y las características básicas de una cohorte de consumidores de heroína diseñada con este fin. Métodos: Participaron 991 jóvenes consumidores de heroína, seleccionados en la comunidad en Barcelona, Madrid y Sevilla, principalmente mediante nominación de otros participantes (39,7%) o de consumidores o exconsumidores no participantes (44,7%). Se administró un cuestionario con ordenador y se recogió una muestra de sangre en papel secante. También se registraron sus medidas antropométricas. Se remuneró a participantes y captadores. Se usaron métodos estadísticos uni y bivariados. Resultados: Un 42,4% había cambiado alguna vez de vía principal de administración de heroína, sobre todo hacia la inyección en Barcelona y hacia la vía pulmonar en Sevilla. Un 75,8% (Barcelona), 49,8% (Madrid), y 15,5% (Sevilla) se habían inyectado drogas en los últimos 12 meses. En Madrid y Sevilla un 96%-97% consumían la heroína sólo en forma de base, y en Barcelona predominaba la heroína-clorhidrato. Frecuentemente mezclaban heroína y cocaína en la misma dosis (generalmente cocaína-base en Madrid y Sevilla, y cocaína-clorhidrato en Barcelona). Conclusiones: Persisten importantes diferencias geográficas en la prevalencia de inyección de drogas y en los patrones de consumo de heroína y cocaína, lo que podría explicar la desigual distribución de algunos problemas de salud. Las dificultades para reunir la muestra prevista sugieren un descenso importante de la incidencia de consumo de heroína. [EN] Background: Cohort studies make it possible to monitor the health impact of drug use and to identify related factors. We describe the methodology and baseline characteristics of a cohort of heroin users designed with this objective. Methods: The participants were 991 young, community-recruited heroin users in Barcelona, Madrid and Seville. Most subjects were named by other participants (39.7%) or by non-participating drug users or ex-users (44.7%). A computer-aided questionnaire was administered (self-administered with audio for questions related with sex). A dried-blood spot sample was collected and anthropometric measurements were made. Both participants and recruiters received remuneration. Univariate and bivariate statistical methods were used. Results: Some 42.4% had changed the main route of heroin administration, mainly to injection in Barcelona and to the pulmonary route in Seville. About 75.8% (Barcelona), 49.8% (Madrid), and 15.5% (Seville) had injected drugs in the last 12 months. In Madrid and Seville, 96-97% used heroin in base form, while in Barcelona heroin hydrochloride predominated. Heroin and cocaine were frequently mixed in the same dose (generally base cocaine in Madrid and Seville, and cocaine hydrochloride in Barcelona). Conclusions: Important geographic differences persist in the prevalence of drug injection and in the patterns of heroin and cocaine use, which could explain the unequal distribution of some health problems. The difficulties encountered in recruiting the sample suggest that the incidence of heroin use has declined considerably.
Directly alcohol-attributable mortality by industry and occupation in a Spanish Census cohort of economically active population
(Elsevier, 2017) Pulido, Jose; Vallejo-Ruiz de Leon, Fernando; Alonso-López, Ignacio; Villar Alvarez, Fernando; Fuente, Luis de la; Domingo-Salvany, Antonia; Barrio, Gregorio; Regidor, Enrique; Plan Nacional de Drogas (España); RETICS-Transtornos Adictivos (RTA-ISCIII) (España); Instituto de Salud Carlos III
AIMS: To assess disparities in directly alcohol-attributable (DAA) mortality by industry/occupation in Spain during 2002-2011 and the contribution of different socio-demographic factors, including socioeconomic position, to explain such disparity. METHODS: Nationwide cohort study covering 16 million economically active people living in Spain in 2001. Deaths at age 25-64 were analyzed. Subjects were classified by employment status, industry and occupation at baseline. Poisson regression models were built, calculating rate ratios (RRs) compared to all employees or those in the education sector. RESULTS: DAA mortality was much higher in the unemployed than in employees (Crude RR: 2.4; 95% CI: 2.3-2.6) and varied widely across industries/occupations. Crude RRs>3.0 (p<0.05) compared to teachers were found in employees in extractive industries/fishing, agriculture/livestock, construction, catering/accommodation and protective services. Socio-demographic factors, especially age, gender and educational attainment contributed more to explain risk disparities than other factors or potential selection bias. However, after exhaustive sociodemographic adjustment, including education attainment and material wealth, a RR>1.33 (p<0.05) remained in unemployed, catering/accommodation employees and unskilled construction workers. RRs were significantly larger in women than men (p<0.05) among mineworkers/fishworkers/sailors (RR=8.6 vs. 1.2) and drivers (RR=3.7 vs. 1.0). CONCLUSIONS: The results could be extrapolated to all alcohol-attributable mortality since disparities for other strongly alcohol-related deaths, although smaller, were in the same direction. Given the wide occupational disparities in alcohol-attributable mortality, implementation of special measures to reduce this mortality in the highest risk groups is fully justified. Future research should better characterize the explanatory factors of disparities and their role in the causal chain.
Más de treinta años de drogas ilegales en España: una amarga historia con algunos consejos para el futuro.
(Ministerio de Sanidad y Consumo (España), 2006-09) Fuente, Luis de la; Brugal, M Teresa; Domingo-Salvany, Antonia; Bravo, Maria Jose; Neira-León, Montserrat; Barrio, Gregorio
[ES] Las dramáticas consecuencias del consumo de heroína (principalmente inyectada) han marcado el fenómeno de las drogas ilegales en España en los últimos treinta años. Más de 300.000 personas han sido tratadas por dependencia de heroína, 20.000-25.000 han muerto por «sobredosis», 100.000 han adquirido el VIH mediante inyección de drogas y bastantes más se han infectado con los virus de la hepatitis. Algunas de estas consecuencias pueden atribuirse al retraso en la puesta en marcha de intervenciones efectivas, como los tratamientos de mantenimiento con metadona (TMM). Actualmente han descendido mucho estos problemas por el descenso del número de personas que se inyectan y el efecto de las intervenciones, principalmente los TMM. Sin embargo, la mortalidad por sobredosis sigue siendo muy alta (más de 700 muertes anuales), y entre los consumidores por vía intravenosa persiste una elevada prevalencia de VIH y hepatitis C, y están emergiendo las consecuencias de las hepatopatías crónicas. Paralelamente, ha aumentado espectacularmente el uso de la cocaína y con él los problemas que causa: hay más de 100.000 consumidores semanales, 25.000 personas tratadas anualmente por abuso o dependencia, y un impacto importante sobre los servicios médicos de urgencia. Su efecto sobre la mortalidad es desconocido. Están aumentando también el consumo y los problemas por cannabis (existe medio millón de consumidores diarios). Se propone mantener y reforzar los programas de reducción del daño (TMM, intercambio de jeringas, salas de consumo, vacunación de hepatitis A y B, etc.), desarrollar con urgencia estrategias específicas para reducir las muertes por sobredosis y los problemas por cocaína, y reevaluar la efectividad de las estrategias preventivas y de control de la oferta. [EN] The phenomenon of illicit drug use in Spain during the last thirty years has been marked by the extremely serious consequences of heroin use (mainly injecting). More than 300,000 persons were treated for heroin dependence, 20,000-25,000 died from overdose, 100,000 became infected with HIV through drug injection and quite more with hepatitis virus. Some of these consequences can be attributed to the delay in the implementation of effective interventions, such as methadone maintenance treatment (MMT). Currently, the decreasing number of injectors and the positive effects of interventions, mainly MMT, have led to an important decline of the mentioned health problems. However, overdose mortality remains very high (more than 700 deceased per year), prevalence of both HIV and HCV are still high among injectors, and consequences of chronic liver diseases are emerging. In the last years the use of cocaine and associated problems have increased a lot. Nowadays there are more than 100,000 weekly cocaine users, 25.000 persons are annually treated from cocaine abuse or dependence, and cocaine has an important impact on medical emergency services, while its impact on mortality is unknown. Both cannabis use and related problems are increasing too (there are half a million of daily users). We propose to maintain and to strengthen harm reduction programs (MMT, syringe exchange, save-use and injection rooms, hepatitis A and B vaccination, etc.), to urgently develop specific strategies targeted to reduce overdose mortality and cocaine related problems, and to re-evaluate the effectiveness of preventive and supply control strategies.
Access to sterile syringes among young drug injectors in Madrid and Barcelona and its association with risk behaviour
(Elsevier, 2008-03) Bravo, Maria Jose; Royuela, Luis; Barrio, Gregorio; Brugal, M Teresa; Domingo, Antònia; Fuente, Luis de la; Fundación para la Investigación y la Prevención del Sida en España
[EN] Background and objective: To evaluate access to sterile syringes and its association with injection risk behaviour in Madrid and Barcelona. Materials and methods: Cross-sectional community study by computer-assisted personal interview in 465 young heroin injectors between 2001 and 2003. Results: Some 4.2% had not obtained any free sterile syringes in the previous 12 months. In Madrid 32.1% had obtained all their sterile syringes free of charge (ASSF), versus 44.6% in Barcelona (p<0.01). Not sharing (not using syringes used by someone else and not front/backloading) was associated with obtaining ASSF (OR=1.69) and with sporadic injection (OR=1.83). Not reusing one's own syringes was associated with the same two variables (OR=4.02 and OR=2.50, respectively). Conclusions: Access to sterile syringes is very high in Madrid and Barcelona, although the two cities have different approaches. The acquisition of all syrin es free of charge should be facilitated, especially among frequent injectors. [ES] Objetivo: Evaluar el acceso a jeringas estériles y su asociación con prácticas de inyección de riesgo en Madrid y Barcelona. Material y método: Estudio transversal en la comunidad de 465 jóvenes que se inyectan heroína, realizado entre 2001 y 2003, mediante entrevista asistida por ordenador. Resultados: Un 4,2% no obtuvo jeringas estériles gratuitas en los últimos 12 meses. En Madrid, el 32,1% obtuvo todas las jeringas estériles gratis (TJEG), frente al 44,6% de Bar celona (p < 0,01). No compartir (no utilizar jeringas ajenas usa das o droga diluida en las usadas por otros) se asoció con obtener TJEG (odds ratio [OR] = 1,69) e inyectarse esporá dicamente (OR = 1,83). No reutilizar las jeringas propias se asoció con las mismas variables (OR = 4,02 y OR = 2,50, res pectivamente). Conclusiones: En Madrid y Barcelona el acceso a jeringas estériles es muy elevado, aunque con modelos diferentes. Debe facilitarse la obtención de todas las jeringas estériles gratis, especialmente entre los jóvenes que se inyectan con mayor frecuencia.
The Association of Geographic Coordinates with Mortality in People with Lower and Higher Education and with Mortality Inequalities in Spain
(Public Library of Science (PLOS), 2015-07-24) Regidor, Enrique; Reques, Laura; Giráldez-García, Carolina; Miqueleiz, Estrella; Santos, Juana M; Martínez, David; Fuente, Luis de la; Banco Santander
OBJECTIVE: Geographic patterns in total mortality and in mortality by cause of death are widely known to exist in many countries. However, the geographic pattern of inequalities in mortality within these countries is unknown. This study shows mathematically and graphically the geographic pattern of mortality inequalities by education in Spain. METHODS: Data are from a nation-wide prospective study covering all persons living in Spain's 50 provinces in 2001. Individuals were classified in a cohort of subjects with low education and in another cohort of subjects with high education. Age- and sex-adjusted mortality rate from all causes and from leading causes of death in each cohort and mortality rate ratios in the low versus high education cohort were estimated by geographic coordinates and province. RESULTS: Latitude but not longitude was related to mortality. In subjects with low education, latitude had a U-shaped relation to mortality. In those with high education, mortality from all causes, and from cardiovascular, respiratory and digestive diseases decreased with increasing latitude, whereas cancer mortality increased. The mortality-rate ratio for all-cause death was 1.27 in the southern latitudes, 1.14 in the intermediate latitudes, and 1.20 in the northern latitudes. The mortality rate ratios for the leading causes of death were also higher in the lower and upper latitudes than in the intermediate latitudes. The geographic pattern of the mortality rate ratios is similar to that of the mortality rate in the low-education cohort: the highest magnitude is observed in the southern provinces, intermediate magnitudes in the provinces of the north and those of the Mediterranean east coast, and the lowest magnitude in the central provinces and those in the south of the Western Pyrenees. CONCLUSION: Mortality inequalities by education in Spain are higher in the south and north of the country and lower in the large region making up the central plateau. This geographic pattern is similar to that observed in mortality in the low-education cohort.
Injection of Anabolic Steroids in Men Who Had Sex with Men in Madrid and Barcelona: Prevalence Correlates and Role as a Risk Factor for Transmitted Infections
(Multidisciplinary Digital Publishing Institute (MDPI), 2021-08-05) Guerras Moreira, Juan Miguel; Hoyos, Juan; Fuente, Luis de la; Román, Francisca; Ayerdi, Oskar; García-Pérez, Jorge-Néstor; García de Olalla, Patricia; Belza Egozcue, Maria Jose; Methysos Project Group; Plan Nacional de Drogas (España)
This study describes the prevalence of anabolic-androgenic steroid (AAS) injection, their main correlates, and the prevalence of specific AAS injection risk behaviours among men who have sex with men (MSM), an area insufficiently addressed in scientific research. Participants were HIV-negative MSM attending four HIV/STI diagnosis services: two clinics and two community programmes in Madrid and Barcelona. Participants answered an online self-administered questionnaire. Crude and adjusted lifetime prevalence and prevalence ratios (PRs) were calculated by different factors and using Poisson regression models with robust variance. Of the 3510 participants, 6.1% (95% CI: 5.3-6.9) had injected AAS before and 3.5% (95% CI: 2.9-4.2) had done so in the last 12 months. In the multivariate analysis, AAS injection was independently associated with being over 40 years old (aPR = 3.6; 95% CI: 2.0-6.5) and being born in Latin America (aPR = 2.5; 95% CI:1.9-3.4), and was less strongly associated (aPRs of around two) with having been recruited into STI clinics, having ever been paid for sex before, injected drugs, used drugs for sex, having been diagnosed with an STI before, and having been diagnosed with HIV at the recruitment consultation. Only three participants, 1.4%, of those who had injected AAS before had shared AAS or equipment for preparation or injecting before. Conclusions: In contrast to drugs, AAS injecting behaviours do not play a relevant, direct role in the transmission of blood-borne infections among MSM. However, AAS injectors have a higher prevalence of sexual risk behaviours. These findings should be confirmed using new studies that employ other sampling procedures.
The incorporation of HIV self-testing as an exclusive option among men who have sex with men in Spain: results of an online cross-sectional study.
(BioMed Central (BMC), 2020-12-04) Hoyos, Juan; Guerras Moreira, Juan Miguel; Koutentakis, Konstantinos; Fuente, Luis de la; Pulido, J; Sordo, Luis; Vallejo-Ruiz de Leon, Fernando; Belza Egozcue, Maria Jose; Instituto de Salud Carlos III
We assessed to what extent HIV self-testing would be incorporated by men who have sex with men (MSM) with previous testing history as their exclusive testing option and describe what actions they would take in the case of obtaining a reactive self-test. We conducted an online survey among Spanish resident MSM recruited mainly in gay dating apps and analyze 6171 ever tested individuals. We used Poisson regression to estimate factors associated with the incorporation of self-testing as the exclusive testing option. Among those who would incorporate self-testing as their exclusive option, we described actions taken if obtaining a reactive self-test by number of tests in the past. Nearly half of the participants (48.3%) were > =35 years old, 84.6% were born in Spain, 57.9% had attained a university degree, 55.1% lived in a municipality of ≤500.000 and 86.4% self-identified as homosexual. For 37.2%, self-testing would become their exclusive testing option. The incorporation of self-testing as the exclusive option increased with age 25-34 (PR:1.1, 95%CI:1.0-1.3), 35-44 (PR:1.3, 95%CI:1.2-1.5), 45-49 (PR:1.5, 95%CI:1.3-1.7) and > 50 (PR:1.5, 95%CI:1.3-1.8) and in those who reported unprotected anal intercourse (PR:1.1, 95%CI:1.0-1.2) or having paid for sex (PR:1.2, 95%CI:1.0-1.3) in the last 12 months. It was also associated with having had < 10 HIV test in the past (2-9 tests (PR:1.3, 95%CI:1.1-1.4); 1 test (PR:1.5, 95%CI:1.3-1.7)), and having been tested ≥2 years (PR:1.4, 95%CI:1.3-1.5) or between 1 and 2 years ago (PR:1.1, 95%CI:1.0-1.2). Of participants who would use self-testing exclusively 76.6% would confirm their result in case of obtaining a reactive self-test and only 6.1% wouldn't know how to react. Only one individual expressed that he would do nothing at all. HIV self-testing could become the exclusive testing option for more than a third of our participants. It was chosen as the exclusive option especially by older, at risk and under-tested MSM. Self-testing strategies need to especially consider the linkage to care process. In this sense, only a small fraction would not know how to react and virtually nobody reported taking no action if obtaining a reactive result.
HIV self-testing in Spain: A valuable testing option for men-who-have-sex-with-men who have never tested for HIV
(Public Library of Science (PLOS), 2019-02-13) Koutentakis, Konstantinos; Hoyos, Juan; Rosales-Statkus, Maria-Elena; Guerras Moreira, Juan Miguel; Pulido, Jose; Fuente, Luis de la; Belza Egozcue, Maria Jose; Ministerio de Sanidad, Servicios Sociales e Igualdad (España)
BACKGROUND: We assessed the capacity of HIV self-testing to promote testing among untested men who have sex with men (MSM) and determined the most benefited subpopulations. METHODS: An online questionnaire was disseminated on several gay websites in Spain from September 2012 to April 2013. We used Poisson regression to estimate factors associated with the intention to use self-testing if already available. Among those who reported intention of use, we assessed several aspects related to the testing and linkage to care process by type of barrier reported: low perceived risk (LR), structural barriers (SB) and fear of testing positive (FTP). RESULTS: Of 2589 never-tested MSM, 83% would have used self-testing if already available. Intention of use was associated with age ≥30 (adj.PR, 95%CI: 1.05, 1.01-1.10), having had protected (adj.PR, 95%CI: 1.15, 1.02-1.30) or unprotected (adj.PR, 95%CI: 1.21, 1.07-1.37) anal intercourse and reporting FTP (adj.PR, 95%CI: 1.12, 1.05-1.20) or SB to access HIV testing (adj.PR, 95%CI: 1.23, 1.19-1.28). Among those who reported intention of using a self-testi, 78.3% declared it their preferred option (83.8% in the SB group; p<0.001), and 56.8% would always use this testing option (60.9% among the SB group; p = 0.001). In the case of obtaining a positive self-test, 69.3% would seek confirmatory testing, 15.3% would self-test again before taking any decision and 13.0% reported not being sure of what they would do. CONCLUSION: HIV self-testing in Spain has the potential of becoming a highly used testing methodology for untested MSM and could represent the gateway to testing especially among older, at risk MSM who report SB or FTP as main barriers to testing.
Are participants in a street-based HIV testing program able to perform their own rapid test and interpret the results?
(Public Library of Science (PLOS), 2012-10-08) Fuente, Luis de la; Rosales-Statkus, Maria-Elena; Hoyos, Juan; Pulido, Jose; Santos, Sara; Bravo, Maria Jose; Barrio, Gregorio; Fernandez-Balbuena, Sonia; Belza Egozcue, Maria Jose; Fundación para la Investigación y la Prevención del Sida en España; Instituto de Salud Carlos III
OBJECTIVE: Availability of over-the-counter rapid HIV tests could improve access to testing those reluctant or unable to use current services. We aimed to evaluate the feasibility of HIV self-testing using a finger-stick whole-blood rapid test (Determine™ HIV Combo) to detect both antigen and antibody. METHODS: Before being tested, 313 participants in a street-based testing program were given adapted instructions and a test kit, and performed the self-test without supervision. These participants, together with another 207 who performed supervised self-testing, received additional instructions on how to interpret the test results shown in six colour photos and filled out a questionnaire. Logistic regression and generalized estimating equations (GEE) were used in the statistical analysis. RESULTS: About 8.0% (95%CI:4.8%-11.2%) obtained an invalid self-test. An invalid result was inversely associated with male participants who had sex with men (OR=0.3;95%CI:0.1-1.0). Of the 3111 photos interpreted,4.9% (95%CI:4.1-5.7) were incorrect. Only 1.1% (95%CI:0.3-1.8) of the positive results were interpreted as negative. Age 30 or older (OR=2.1; 95%CI:1.2-3.7), having been born in Latin America (OR=1.6; 95%CI:1.1-2.2),and not having university education (OR=2.1;95%CI:1.2-3.7) were associated with misinterpreting test results in the GEE. Participant's perceptions of both their proficiency when conducting the test and interpretation were related with actual outcomes. Most participants (83.9%) were more motivated than before to use the self-test in the future, and 51.7% would pay >10 Euros for the test if it was sold in pharmacies. CONCLUSIONS: This is the first study showing that blood-based self-testing with current technology is feasible in HIV-negative participants demanding the test and without prior training or supervision. Bearing in mind that it was conducted under difficult weather conditions and using a complex kit, over-the-counter tests could be a feasible option to complement current diagnostic strategies. More studies are needed to accommodate technology, minimise interpretation mistakes and provide on-line support.
Opinions Towards Key Operational Aspects for the Implementation of HIV Self-Testing in Spain: A Comparison between Stakeholders and Potential Users.
(Multidisciplinary Digital Publishing Institute (MDPI), 2021-02-03) Hoyos, Juan; Guerras Moreira, Juan Miguel; Maté, Tomás; Agustí, Cristina; Fernández-López, Laura; Fuente, Luis de la; Belza Egozcue, Maria Jose; Consumers, Health and Food Executive Agency; Instituto de Salud Carlos III
We assessed previous knowledge about the existence of HIV self-testing of stakeholders in Spain, as well as their personal position towards this methodology. We also assessed their views on potential users' (PU) opinions towards several key operational aspects surrounding self-testing, and compared them to those expressed by a sample of PU comprised of men who have sex with men. In 2017, we recruited three types of stakeholders: public health professionals and policy makers (PHPPM) (n = 33), clinical providers (n = 290) and community-based/non-governmental organization (CBO/NGO) workers (n = 55). Data on PU (n = 3537) were collected in 2016. Previous knowledge about the existence of self-testing was higher in stakeholders than in PU, but being in favor was less frequent. PUs' willingness to pay 25-30 euros for a self-test was higher than that which stakeholders considered. According to clinical providers and PHPPM, pharmacies would be PUs' preferred place to obtain a self-test, which was in line with PUs' actual choice. CBO/NGO workers on the other hand thought it would be CBO/NGOs. PHPPM and clinical providers considered primary care as PUs' preferred setting to confirm a reactive self-test and CBO/NGO chose CBO/NGOs, but PUs preferred an HIV/STI testing service or clinic. Stakeholders' opinions significantly differed from those of PUs. This divergence needs to be brought up to stakeholders as it could vary their position towards self-testing as well as the actions taken in the implementation of a testing option with the potential of increasing testing frequency.