Detection of oncogenic fusion genes in cancers, particularly in the diagnosis of uncertain tumors, is crucial for determining effective therapeutic strategies. Although novel fusion genes have been discovered through sequencing, verifying their oncogenic potential remain difficult. Therefore, we evaluated the utility of targeted RNA sequencing in 165 tumor samples by identifying known and unknown fusions. Additionally, by applying additional criteria, we discovered eight novel fusion genes that are expected to process oncogenicity. Among the novel fusion genes, RAF1 fusion genes were detected in two cases. PTPRG-RAF1 fusion led to an increase in cell growth; while dabrafenib, a BRAF inhibitor, reduced the growth of cells expressing RAF1. This study demonstrated the utility of RNA panel sequencing as a theragnostic tool and established criteria for identifying oncogenic fusion genes during post-sequencing analysis.

SETTING: A harm reduction program at a public health unit in Toronto, Ontario, between August 31, 2011 and August 31, 2013. INTERVENTION: We conducted a process evaluation of the first two years of an opioid overdose prevention and response program, Prevent Overdose in Toronto (POINT), including analysis of data from program documentation forms, as well as qualitative interviews with program staff, representatives from partner agencies, and program clients. OUTCOMES: In the first two years of the program, 662 individuals (52.4% male; mean age 38.3 years) were trained in opioid overdose prevention and given a naloxone kit. Among clients currently using opioids, the most frequently reported opioids were oxycodone (40.4%) and heroin (34.4%). Clients reported 98 administrations of naloxone, primarily to friends and acquaintances. Nearly all naloxone recipients reportedly survived; one did not survive, and one had an unknown outcome. Staff and partner agencies feel the program reaches the target population and that POINT training meets clients’ needs. Clients would like to see the training offered more widely. Overall, staff, partner agencies and clients were pleased with the POINT program, and they offered suggestions on program recruitment and delivery. IMPLICATIONS: Individuals at risk of opioid overdose have participated in overdose prevention and response training, and reported using naloxone in overdose events. Results of this initial program evaluation are being used to improve the delivery of the POINT program and can inform broader public health practice in opioid overdose prevention.

BACKGROUND:Internationally, there is a growing recognition that hepatitis C virus (HCV) may be sexually transmitted among HIV-positive men who have sex with men (MSM).OBJECTIVE:To report the first Canadian estimate of HCV seroincidence in 2000 to 2010 and its risk factors among HIV-positive MSM with no known history of injection drug use.METHODS:Data from the Ontario HIV Treatment Network Cohort Study, an ongoing cohort of individuals in HIV care in Ontario, were analyzed. Data were obtained from medical charts, interviews and record linkage with the provincial public health laboratories. The analysis was restricted to 1534 MSM who did not report injection drug use and had undergone ≥2 HCV antibody tests, of which the first was negative (median 6.1 person-years [PY] of follow-up; sum 9987 PY).RESULTS:In 2000 to 2010, 51 HCV seroconversions were observed, an overall incidence of 5.1 per 1000 PY (95% CI 3.9 to 6.7). Annual incidence varied from 1.6 to 8.9 per 1000 PY, with no statistical evidence of a temporal trend. Risk for seroconversion was elevated among men who had ever had syphilis (adjusted HR 2.5 [95% CI 1.1 to 5.5) and men who had acute syphilis infection in the previous 18 months (adjusted HR 2.8 [95% CI 1.0 to 7.9]). Risk was lower for men who had initiated antiretroviral treatment (adjusted HR 0.49 [95% CI 0.25 to 0.95]). There were no statistically significant effects of age, ethnicity, region, CD4 cell count or HIV viral load.CONCLUSIONS:These findings suggest that periodic HCV rescreening may be appropriate in Ontario among HIV-positive MSM. Future research should seek evidence whether syphilis is simply a marker for high-risk sexual behaviour or networks, or whether it potentiates sexual HCV transmission among individuals with HIV.

BackgroundAlthough the majority of new cases of hepatitis C (HCV) occur among people who inject drugs, very few receive treatment. In response, low-barrier, multidisciplinary models of HCV treatment have emerged in recent years to serve illicit drug users and have demonstrated comparable outcomes to the care delivered in tertiary care settings. However, few studies have measured comprehensive outcomes of these models.MethodsThe Toronto Community Hep C Program (TCHCP) is a community-based partnership between three primary health care centres with integrated specialist support. Program clients were interviewed using standardized questionnaires at three time points (baseline, post completion of HCV support group, and one year post group completion). The primary outcome of this study was self-reported overall health. Secondary outcomes included mental health, substance use, housing and income stability, and access to health care.ResultsTCHCP clients reported high rates of poverty, histories of trauma and incarceration. Physical and mental health co-morbidities were also very common; 78% reported having at least one chronic medical problem in addition to HCV and 41% had a lifetime history of hospitalization for mental health reasons. Participation in the program improved access to HCV care. Prior to joining the TCHCP, only 15% had been assessed by a HCV specialist. By the end of the study period this had increased significantly to 54%. Self-reported overall health did not improve during the study period. Housing status and income showed significant improvement. The proportion of participants with stable housing increased from 54% to 76% during the study period (p=0.0017) and the proportion of patients receiving income from provincial disability benefits also increased significantly (55% vs 75%, p=0.0216).ConclusionThis study demonstrated that a multi-disciplinary, community-based model of HCV treatment improves participant's lives in ways that extend beyond hepatitis C.

AIMTo determine the level and changes in public opinion between 2003 and 2009 among adult Canadians about implementation of supervised injection facilities (SIFs) in Canada.DESIGNPopulation-based, telephone survey data collected in 2003 and 2009 were analysed to identify strong, weak, and intermediate support for SIFs.SETTINGOntario, CanadaPARTICIPANTSRepresentative samples of adults aged 18 years and over.MEASUREMENTSAnalyses of the agreement with implementation of SIFs in relation to four individual SIF goals and a composite measure.FINDINGSThe final sample sizes for 2003 and 2009 were 1212 and 968, respectively. Between 2003 and 2009, there were increases in the proportion of participants who strongly agreed with implementing SIFs to: reduce neighbourhood problems (0.309 versus 0.556, respectively); increase contact of people who use drugs with health and social workers (0.257 versus 0.479, respectively); reduce overdose deaths or infectious disease among people who use drugs (0.269 versus 0.482, respectively); and encourage safer drug injection (0.213 versus 0.310, respectively). Analyses using a composite measure of agreement across goals showed that 0.776 of participants had mixed opinions about SIFs in 2003, compared with only 0.616 in 2009. There was little change among those who strongly disagreed with all SIF goals (0.091 versus 0.113 in 2003 and 2009, respectively).CONCLUSIONSSupport for implementation of supervised injection facilities in Ontario, Canada increased between 2003 and 2009, but at both time-points a majority still held mixed opinions.

INTRODUCTION:A severe healthcare worker shortage in sub-Saharan Africa is inhibiting the expansion of HIV treatment. Task shifting, the transfer of antiretroviral therapy (ART) management and initiation from doctors to nurses and other non-physician clinicians, has been proposed to address this problem. However, many health officials remain wary about implementing task shifting policies due to concerns that non-physicians will provide care inferior to physicians. To determine if non-physician-provided HIV care does result in equivalent outcomes to physician-provided care, a meta-analysis was performed. METHODS:Online databases were searched using a predefined strategy. The results for four primary outcomes were combined using a random effects model with sub-groups of non-physician-managed ART and -initiated ART. TB diagnosis rates, adherence, weight gain and patient satisfaction were summarized qualitatively. RESULTS:Mortality (N=59,666) had similar outcomes for non-physicians and physicians, with a hazard ratio of 1.05 (CI: 0.88-1.26). The increase in CD4 levels at one year, as a difference in means of 2.3 (N=17,142, CI: -12.7-17.3), and viral failure at one year, as a risk ratio of 0.89 (N=10,344, CI: 0.65-1.23), were similar for physicians and non-physicians. Interestingly, loss to follow-up (LTFU) (N=53,435) was reduced for non-physicians with a hazard ratio of 0.72 (CI: 0.56-0.94). TB diagnosis rates, adherence and weight gain were similar for non-physicians and physicians. Patient satisfaction appeared higher for non-physicians in qualitative components of studies and was attributed to non-physicians spending more time with patients as well as providing more holistic care. CONCLUSIONS:Non-physician-provided HIV care results in equivalent outcomes to care provided by physicians and may result in decreased LTFU rates.

BackgroundSupervised consumption facilities (SCFs) aim to improve the health and well-being of people who use drugs by offering safer and more hygienic alternatives to the risk environments where people typically use drugs in the community. People who smoke crack cocaine may be willing to use supervised smoking facilities (SSFs), but their facility design preferences and the views of other stakeholders have not been previously investigated in detail.MethodsWe consulted with people who use drugs and other stakeholders including police, fire and ambulance service personnel, other city employees and city officials, healthcare providers, residents, and business owners (N=236) in two Canadian cities without SCFs and asked how facilities ought to be designed. All consultations were audio-recorded and transcribed. Thematic analyses were used to describe the knowledge and opinions of stakeholders.ResultsPeople who use drugs see SSFs as offering public health and safety benefits, while other stakeholders were more sceptical about the need for SSFs. People who use drugs provided insights into how a facility might be designed to accommodate supervised injection and supervised smoking. Their strongest preference would allow both methods of drug use within the same facility with some form of physical separation between the two based on different highs, comfort regarding exposure to different methods of drug administration, and concerns about behaviours often associated with smoking crack cocaine. Other stakeholders raised a number of SSF implementation challenges worthy of consideration.ConclusionDecision-makers in cities considering SCF or SSF implementation should consider the opinions and preferences of potential clients to ensure that facilities will attract, retain, and engage people who use drugs.

Background There is evidence of sexual HCV transmission among HIV-positive MSM from the UK and Europe. We estimated HCV seroincidence and its risk factors in a North American population of HIV-positive MSM with no known history of injection drug use. Methods We analysed data from the OHTN Cohort Study, an ongoing cohort of persons in HIV care in Ontario, Canada. Data were obtained from medical charts, interviews, and record linkage with the provincial public health laboratories. We restricted the analysis to 1,534 MSM who: (1) did not report injection drug use; (2) were under follow-up in 2000–2010; and (3) had 2+ HCV antibody tests, of which the first was negative. Person-time commenced at the later of the HCV-negative result or HIV diagnosis and ended at the first HCV+ or last date of follow-up (median 6.1 person-years (PY) of follow-up; sum 9,987PY). Results We observed 51 HCV seroconversions, for an overall incidence of 0.51 per 100PY (CI: 0.39–0.67). Annual incidence varied from 0.16 to 0.89 per 100 PY, with no statistical evidence of a temporal trend. Seroconversion was statistically-significantly associated with acute syphilis infection in the previous 6 months (adjusted hazard ratio = 4.9, CI 1.2–21) and there was a marginally statistically-significant association for men who had not yet initiated antiretroviral treatment (adjusted hazard ratio = 1.9, CI 0.91–4.0). There were no statistically significant effects of age, ethnicity, region, CD4+ cell count or viral load. Conclusion Sexual behaviour was unmeasured and we cannot exclude the possibility of HCV acquisition via unreported injection drug use. Nevertheless, the strong association with recent syphilis suggests that at least some cases were due to sexual transmission. Future research is needed to establish whether syphilis is a marker for high-risk behaviour or may potentiate sexual HCV transmission among persons with HIV.

Since 2000, reported syphilis cases increased ten-fold in Canada, particularly among men who have sex with men (MSM) co-infected with HIV. We characterized temporal patterns of of syphilis testing in a large cohort of HIV patients in Ontario, Canada.

BACKGROUNDTask shifting, defined for this review as the shifting of ART initiation and management from physicians to nurses, has been proposed as a possible method to increase access to HIV treatment in Sub-Saharan Africa.OBJECTIVETo critically evaluate the literature on task shifting, determining if there is evidence to support this view.METHODSA systematic search of the literature was undertaken, with both peer reviewed publications and conference abstracts presenting original data eligible for inclusion. Studies were evaluated according to methodology and discussion of confounding factors.RESULTSWe identified 25 articles which evaluated the effect of task shifting on access to ART. The evidence was mixed. Although there is a significant body of field reports indicating that task shifting increases access, these studies were of low methodological quality. The only randomized controlled trial included in this review did not find that task shifting increased in access.CONCLUSIONTask shifting appears to be most effective at increasing access when combined with other interventions and financial support. There is a need for more research into the effects of task shifting policies, especially randomized controlled trials and high quality cohort studies.

Division of Plastic Surgery, Department of Surgery, Faculty of Medicine, McMaster University, Hamilton, Ontario Correspondence: Dr Carolyn M Levis, Division of Plastic Surgery, Department of Surgery, St Joseph’s Healthcare, 50 Charlton Avenue East, Room G820, Hamilton, Ontario L8N 4A6. Telephone 905-522-1155 ext 34969, fax 905-525-6424, e-mail levisc@mcmaster.ca The common peroneal nerve (CPN) is the most commonly injured nerve in the lower limb. Injury to the CPN and, more specifically, the deep peroneal nerve (DPN), can lead to permanent weakness or paresis of toe and ankle dorsiflexors. Causes include trauma, dislocation, iatrogenic injury and peripheral nerve lesions (1). Patients experience difficulties with the swing phase of gait. To compensate, patients adopt a high stepping gait to lift the foot higher off the ground. These injuries can be treated nonoperatively using an anklefoot orthotic. It is known that an individual using an ankle-foot orthotic has a significantly lower quality of life in the domains of physical functioning, mental health, vitality, bodily pain and general health perception when compared with a patient without an impairment necessitating the device (2). Current surgical treatments include decompression at the fibular head for compressive palsies (3,4). Injuries that do not show signs of recovery require early nerve grafting to reconstruct the injured nerve segment with or without tendon transfers (5,6). Tendon transfers alone may also be performed depending on the duration of time since injury (7). However, for both of these procedures, functional outcomes are often poor compared with similar reconstructive procedures for other major nerves in the upper extremity. The current literature characterizes nerve transfers using expendable donor nerves in the lower limb as experimental or alternative surgical procedures, rather than as an accepted surgical option. The authors suggest that this may be a preferred treatment plan – over other traditional options – for several reasons. Nerve transfers minimize dissection and potential injury to surrounding tissues. They facilitate faster recovery because they can lead to more rapid reinnervation than nerve grafts due to the fact that the transferred axons are closer to the targeted motor end plates. In addition, nerve transfers avoid the problem of ‘missed zone of injury’ when using nerve grafts. This is of particular concern for the common peroneal nerve, which can suffer significant and widespread stretch in lateral knee injuries. originAl Article

PURPOSE:To evaluate, by gender, the impact of a structured, comprehensive risk reduction intervention with and without boosters on human immunodeficiency virus (HIV) knowledge, attitudes and behaviors in incarcerated youth; and to determine predictors of increasing HIV knowledge and reducing high-risk attitudes and behaviors. METHODS:This randomized controlled trial involved participants completing structured interviews at 1, 3, and 6 months. Repeated measures analysis of variance was used to analyze changes over time. The study was conducted in secure custody facilities and in the community. The study sample comprising 391 incarcerated youth, 102 female and 289 male aged 12-18, formed the voluntary sample. Participants were randomly assigned to one of three conditions: education intervention; education intervention with booster; or no systematic intervention. The outcome and predictor measures included the Rosenberg Self-Esteem Scale, Youth Self Report, Drug Use Inventory, and HIV Knowledge, Attitudes and Behavior Scale. RESULTS:The 6-month retention rate was 59.6%. At 6 months, males in the education and booster groups sustained increases in knowledge scores (p < 0.001). Females in these groups sustained increased condom attitude scores (p = 0.004). Males in the booster group sustained increased prevention attitude scores (p = 0.017). Females in the booster group reported more consistent condom use (odds ratio [OR] = 4.20; 95% confidence interval [CI] = 1.81, 9.77). Age, gender, drug use, and psychological profiles were predictive of outcome. CONCLUSIONS:The intervention and boosters led to gender-specific improvements in knowledge, attitudes, and condom use. Result variations by gender underline the importance of gender issues in prevention interventions. Predictors of success were identified to inform future HIV education interventions.

BACKGROUND:Harm reduction is a health-centred approach that seeks to reduce the health and social harms associated with high-risk behaviors, such as illicit drug use. The objective of this study is to determine the association between the beliefs of a group of adult, male prisoners in Iran about the transmission of HIV and their high-risk practices while in prison.METHODS:A cross-sectional study was conducted in 2004. The study population was a random selection of 100 men incarcerated at Rajaei-Shahr prison. The data were collected through a self-administered questionnaire. Focus group discussions were held at the prison to guide the design of the questionnaire. The relationship between components of the Health Belief Model (HBM) and prisoners' risky HIV-related behaviors was examined.RESULTS:Calculating Pearson's correlation coefficient, a significant, positive association was found between the benefit component of the HBM and prisoners not engaging in HIV high-risk behaviors.CONCLUSION:Educational harm reduction initiatives that promote the effectiveness of strategies designed to reduce the risk of HIV transmission may decrease prisoners' high-risk behaviors. This finding provides initial support for the Iran prison system's current offering of HIV/AIDS harm reduction programming and suggests the need to offer increased education about the effectiveness of HIV prevention practices.

This study assessed injection-related HIV risk behavioral changes among opioid users 6 months after enrollment in low-threshold (harm reduction based) methadone maintenance treatment (MMT) programs within needle exchange services in Kingston and Toronto, Ontario, Canada. Changes were assessed for all participants (whole cohort), participants who continued to use illicit drugs by any route (drug-using subcohort); and those who continued to inject drugs (injecting subcohort). In this prospective observational cohort study, an interviewer-administered questionnaire examining injection-related HIV risk behaviors was administered to 183 study participants at entry to treatment and 6 months later. Changes in risk behaviors were analyzed using conditional logistic regression which took into account the paired nature of the data. We found that the proportion of participants injecting drugs, sharing needles, sharing drug equipment, indirectly sharing and using shooting galleries declined with follow-up for the whole cohort. Within the drug-using subcohort, there was a decrease in the proportion of individuals who injected drugs, while within the injecting subcohort the sharing of injection equipment and the use of shooting galleries declined. Our findings suggest that low-threshold MMT programs can reduce the risk of HIV without the enforcement of abstinence-based policies.

Injection drug use is a prevalent global phenomenon; one not bound by a country's level of development or geographical location. Injection drug users (IDUs) are at high risk for a variety of parenterally acquired and transmitted infections. Licensed vaccines are available for some of these infectious diseases, such as tetanus, influenza, and hepatitis A and B viruses; however, there have been conflicting reports as to their immunogenicity in IDUs. We summarise the lessons learned from studies evaluating the immunogenicity of vaccination strategies in IDUs. A common theme across these diseases is that although there is a tendency towards decreased antibody responses after immunisation, there is no conclusive evidence linking these observations to a decrease in clinical protection from infection. There is a clear need for definitive studies of vaccination strategies in IDUs; however, a synthesis of the available published evidence suggests that immunisation does result in effective clinical protection from disease in this population. The inclusion of IDUs as a high-risk study population in future trials evaluating HIV and hepatitis C virus vaccines will help to assess the immunogenicity of candidate vaccines against parenteral exposure, and also to evaluate the efficacy of candidates as promising antigens become available.

BACKGROUND:Major increases in HIV-1 prevalence in India have been predicted. Incident infections need to be tracked to understand the epidemic's course, especially in some southern states of India where the epidemic is more advanced. To estimate incidence, we investigated the prevalence of HIV-1 in young people attending antenatal and sexually transmitted infection (STI) clinics in India.METHODS:We analysed unlinked, anonymous HIV-1 prevalence data from 294 050 women attending 216 antenatal clinics and 58 790 men attending 132 STI clinics in 2000-04. Southern and northern states were analysed separately.FINDINGS:The age-standardised HIV-1 prevalence in women aged 15-24 years in southern states fell from 1.7% to 1.1% in 2000-04 (relative reduction 35%; p(trend)<0.0001, yearly reduction 11%), but did not fall significantly in women aged 25-34 years. Reductions in women aged 15-24 years were seen in key demographic groups and were similar in sites tested continuously or in all sites. Prevalence in the north was about a fifth of that in the south, with no significant decreases (or increases) in 2000-04. Prevalence fell in men aged 20-29 years attending STI clinics in the south (p(trend)<0.0001), including those with ulcerative STIs (p(trend)=0.0008), but reductions were more modest in their northern counterparts.INTERPRETATION:A reduction of more than a third in HIV-1 prevalence in 2000-04 in young women in south India seems realistic, and is not easily attributable to bias or to mortality. This fall is probably due to rising condom use by men and female sex workers in south India, and thus reduced transmission to wives. Expansion of peer-based condom and education programmes for sex workers remains a top priority to control HIV-1 in India.

Objectives Communities participating in the longitudinal prevention initiative Better Beginnings, Better Futures (funded by the Ontario Ministries of Health, Community and Social Services, and Education) have developed a wide variety of programs designed to foster healthy child development. Our goal was to determine whether increasing the availability of food resources to economically disadvantaged families had an impact on the dietary intake of children. Residents developed food programs to address local needs; these include community markets, daily bread programs, breakfast and snack programs for school-aged children, and emergency meal cupboards. All programs are run by parent volunteers, and programs are available to all residents at no cost. Methods In 1993, prior to program implementation, 24-hour dietary recalls were conducted with 8-year-old children in three Better Beginnings, Better Futures communities (n = 175). At that time, the proportion of children with intakes at or above recommended amounts was 39.9% for zinc, 27.4% for calcium, 39.7% for iron, and 22.0% for folate. In 1998, recalls were completed with another cohort of 8-year-old children (n = 244) in the same communities.

Objectives Although ample research associates drug use and sexual risk-taking of men who have sex with men (MSM), very little research attempts to understand MSM’s subjective meanings and overall intended functions of drug use during sexual behaviors. This qualitative study explored (1) the relationship between substance use and sexual behaviors and (2) the perceived role of drug use in unsafe sexual behaviors among MSM. Method This exploratory study utilized a maximum variation sampling strategy with respect to age, sexual identity, sexual behaviors, occupation, and drug use to recruit a diverse group of MSM. In response to 17 open-ended semistructured interview items, participants described their drug use behaviors, affiliation with drug “scenes,” and drug use during sexual play. Analysis of audiotaped and transcribed interviews of participants’ accounts revealed common themes consistent across the participants’ experiences. Results The research participants consisted of 27 MSM who were sexually active and used recreational substances within the last 3 months of their interview. Regardless of their sexual identity, participants believed in a widely held assumption that drug use is pervasive within the urban gay male community and highly characteristic of most gay men. Such an assumption stressed the intimate connection between drug use and the “gay lifestyle” that not only described, but also prescribed gay male sexual behaviors. Participants used drugs not only to initiate anonymous or casual MSM sexual encounters, but also to incorporate recreational substance use as part of the sexual act as a means to accomplish specific desired effects. Despite the importance of recreational substance use during their MSM sexual behaviors, many participants were skeptical of the persistent expectation that drug use necessarily “causes” unsafe sex. Instead, participants attributed unsafe sexual behaviors to an individual’s personal choice, maturity, or experience with MSM.

Background Illicit narcotic dependence and associated conditions such as human immunodeficiency virus (HIV) and hepatitis C virus infections impose a great burden on the population health of substance abusers and their communities. In Alberta, treatment options for opiate addiction are limited to two main possibilities. A methadone maintenance program is available through Alberta Alcohol and Drug Abuse Commission (AADAC) for addicts who are unable to discontinue drug use. This approach may be inappropriate for highly motivated individuals seeking to quit completely. Abrupt (“cold turkey”) detoxification treatment is also available through Alberta Alcohol and Drug Abuse Commission and other agencies, but produces severe and undesirable physical withdrawal symptoms. It is therefore necessary to explore additional approaches, such as stepdown treatment, that are better suited to the needs and circumstances of opiate addicts. Objective We aimed to describe an effective codeine substitution and stepdown opiate detoxification program. Method Patients commence detoxification if they present with a history of ongoing opiate addiction and can commit to a minimum opiate dose reduction of 20% per month. Such gradual withdrawal dramatically reduces the severity of withdrawal symptoms. Following an initial medical assessment, detoxification is initiated by voluntary discontinuation of illicit opiates and substitution with oral codeine prescribed at the lowest possible dose (up to a daily maximum of 900 mg) required to minimize withdrawal symptoms. Repeated cycles of dosage reduction every 10–14 days are carried out to gradually taper the patient off opiates within 4 months. Periodic assessments every 2–3 weeks monitor detoxification progress, determine the need for supportive medication, reinforce their detoxification commitment, and encourage involvement in addiction recovery programs or counseling. Results Program safety and efficacy are well demonstrated. From program inception in March 1999 through March 2002, there were 274 patients enrolled and no significant medical complications. Over 90% temporarily reduced overall opiate usage by at least 50%. Furthermore, they benefited from psychosocial program supports and a licit supply of opiates, which provided an often-timely respite from their high-risk lifestyle. There were 85 patients (31%) who self-reportedly achieved at least temporary complete detoxification. while 11 were subsequently referred to methadone maintenance due to their inability to sustain withdrawal. These rates compare favorably to those reported from other outpatient detoxification programs. Conclusion It is unfortunate that this rational and effective opiate detoxification method is novel for Alberta and reportedly is unavailable elsewhere in the province. S96 POSTER ABSTRACTS Insights from Current Injection Drug Users About Methadone Treatment Peggy Millson, Walter Cavalieri, Robert Bright, Ted Myers, Liviana Calzavara, and Carol Strike HIV Social, Behavioural, and Epidemiological Studies Unit, University of Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada

Background Major increases in HIV-1 prevalence in India have been predicted. Incident infections need to be tracked to understand the epidemic's course, especially in some southern states of India where the epidemic is more advanced. To estimate incidence, we investigated the prevalence of HIV-1 in young people attending antenatal and sexually transmitted infection (STI) clinics in India. Methods We analysed unlinked, anonymous HIV-1 prevalence data from 294050 women attending 216 antenatal clinics and 58 790 men attending 132 STI clinics in 2000-04. Southern and northern states were analysed separately. Findings The age-standardised HIV-1 prevalence in women aged 15-24 years in southern states fell from 1·7% to 1·1% in 2000-04 (relative reduction 35%; p trend <0.0001, yearly reduction 11%), but did not fall significantly in women aged 25-34 years. Reductions in women aged 15-24 years were seen in key demographic groups and were similar in sites tested continuously or in all sites. Prevalence in the north was about a fifth of that in the south, with no significant decreases (or increases) in 2000-04. Prevalence fell in men aged 20-29 years attending STI clinics in the south (p trend <0·0001), including those with ulcerative STIs (p trend =0·0008), but reductions were more modest in their northern counterparts. interpretation A reduction of more than a third in HIV-1 prevalence in 2000-04 in young women in south India seems realistic, and is not easily attributable to bias or to mortality. This fall is probably due to rising condom use by men and female sex workers in south India, and thus reduced transmission to wives. Expansion of peer-based condom and education programmes for sex workers remains a top priority to control HIV-1 in India.