Needle exchange is not enough: Lessons from the Vancouver injecting drug use study
Needle exchange is not enough: Lessons from the Vancouver injecting drug use study
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DOI：
10.1097/00002030-199708000-00001
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发表时间：
1997-07-01
期刊：
影响因子：
3.8
通讯作者：
OShaughnessy, MV
中科院分区：
文献类型：
--
作者：
Strathdee, SA;Patrick, DM;OShaughnessy, MV
目的：描述HIV-1、丙型肝炎病毒(HSetting：Vancouver)的流行和发病率。温哥华于1988年开始实施针头交换计划，目前每年交换200多万个针头。设计：通过街头宣传招募前一个月注射非法药物的IDU。在基线和每半年，受试者接受HIV-1和丙型肝炎病毒的血清学检查，并完成关于人口统计学、行为和NEP参加情况的问卷调查。结果：在1006名吸毒者中，65%为男性，白人(65%)或原住民(27%)。HIV-1和丙型肝炎病毒感染率分别为23%和88%。大多数人(92%)参加过温哥华的NEP，这是78%的人最重要的注射器来源。已知的HIV阳性和HIV阴性的注射吸毒者报告的出借使用注射器的比例相同(40%)。在HIV阴性的注射吸毒者中，39%的人在过去6个月内借过用过的针头。相对于艾滋病毒阴性的吸毒者，艾滋病毒阳性的吸毒者更有可能经常注射可卡因(72%比62%；P<；0.001)。HIV阳性血清状态的独立预测因素是低教育程度、住房不稳定、商业性行为、借用针头、是既定的注射吸毒者、与其他人一起注射、经常参加NEP。根据257次随访中的24次血清转换，估计HIV发病率为每100人年18.6例(95%可信区间，11.1-26.0)。结论：尽管温哥华的NEP是北美最大的，但该市一直在经历一场持续的HIV流行。虽然无菌注射对于提供无菌注射器至关重要，但它们应被视为包括咨询、支持和教育在内的综合方案的一个组成部分。
Objective: To describe prevalence and incidence of HIV-1, hepatitis C virus (HSetting: Vancouver, which introduced a needle exchange programme (NEP) in 1988, and currently exchanges over 2 million needles per year.Design: IDU who had injected illicit drugs within the previous month were recruited through street outreach. At baseline and semi-annually, subjects underwent serology for HIV-1 and HCV, and questionnaires on demographics, behaviours and NEP attendance were completed. Logistic regression analysis was used to identify determinants of HIV prevalence.Results: Of 1006 IDU, 65% were men, and either white (65%) or Native (27%). Prevalence rates of HIV-1 and HCV were 23 and 88%, respectively. The majority (92%) had attended Vancouver's NEP, which was the most important syringe source for 78%. Identical proportions of known HIV-positive and HIV-negative IDU reported lending used syringes (40%). Of HIV-negative IDU, 39% borrowed used needles within the previous 6 months. Relative to HIV-negative IDU, HIV-positive IDU were more likely to frequently inject cocaine (72 versus 62%; P < 0.001). Independent predictors of HIV-positive serostatus were low education, unstable housing, commercial sex, borrowing needles, being an established IDU, injecting with others, and frequent NEP attendance. Based on 24 seroconversions among 257 follow-up visits, estimated HIV incidence was 18.6 per 100 person-years (95% confidence interval, 11.1-26.0).Conclusions: Despite having the largest NEP in North America, Vancouver has been experiencing an ongoing HIV epidemic. Whereas NEP are crucial for sterile syringe provision, they should be considered one component of a comprehensive programme including counselling, support and education.