HIV and risk environment for injecting drug users: the past, present, and future.
HIV and risk environment for injecting drug users: the past, present, and future.
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DOI：
10.1016/s0140-6736(10)60743-x
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发表时间：
2010-07-24
期刊：
影响因子：
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通讯作者：
Hankins CA
中科院分区：
文献类型：
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作者：
Strathdee SA;Hallett TB;Bobrova N;Rhodes T;Booth R;Abdool R;Hankins CA
我们系统地回顾了2000年至2009年注射吸毒者中艾滋病毒感染决定因素的报告，并按环境影响类型对调查结果进行了分类。然后，我们模拟了与注射吸毒有关的艾滋病毒严重流行地区风险环境的变化。在已确定的94项研究中，有25项是有意考察风险环境的。艾滋病毒流行的模型显示，由于注射吸毒和无保护的性行为而感染艾滋病毒的人数存在很大的差异。我们估计，在2010 - 2015年期间，通过将阿片类药物替代、针头交换和抗逆转录病毒治疗方案的未满足需求减少60%，敖德萨（乌克兰）、卡拉奇（巴基斯坦）和内罗毕（肯尼亚）的艾滋病毒患病率可降低41%、43%和30%。减缓患者从非注射形式向注射药物的过渡，可避免卡拉奇艾滋病毒感染增加98%；而取消禁止阿片类药物替代并同时扩大使用的法律，可在内罗毕预防14%的艾滋病毒感染。优化干预措施的效力和覆盖范围对于流行病迅速增长的区域至关重要。环境风险因素的描述为艾滋病毒预防提供了重要的见解。以证据为依据、以权利为基础、保护注射吸毒者获得艾滋病毒预防和治疗的综合干预措施可以大大减少艾滋病毒的流行。
We systematically reviewed reports about determinants of HIV infection in injecting drug users from 2000 to 2009, classifying findings by type of environmental influence. We then modelled changes in risk environments in regions with severe HIV epidemics associated with injecting drug use. Of 94 studies identified, 25 intentionally examined risk environments. Modelling of HIV epidemics showed substantial heterogeneity in the number of HIV infections that are attributed to injecting drug use and unprotected sex. We estimate that, during 2010–15, HIV prevalence could be reduced by 41% in Odessa (Ukraine), 43% in Karachi (Pakistan), and 30% in Nairobi (Kenya) through a 60% reduction of the unmet need of programmes for opioid substitution, needle exchange, and antiretroviral therapy. Mitigation of patient transition to injecting drugs from non-injecting forms could avert a 98% increase in HIV infections in Karachi; whereas elimination of laws prohibiting opioid substitution with concomitant scale-up could prevent 14% of HIV infections in Nairobi. Optimisation of effectiveness and coverage of interventions is crucial for regions with rapidly growing epidemics. Delineation of environmental risk factors provides a crucial insight into HIV prevention. Evidence-informed, rights-based, combination interventions protecting IDUs’ access to HIV prevention and treatment could substantially curtail HIV epidemics.