HIV infection during limited versus combined HIV prevention programs for IDUs in New York City: The importance of transmission behaviors
HIV infection during limited versus combined HIV prevention programs for IDUs in New York City: The importance of transmission behaviors
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DOI：
10.1016/j.drugalcdep.2009.12.028
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发表时间：
2010-06-01
影响因子：
4.2
通讯作者：
Friedman, Samuel R.
中科院分区：
文献类型：
--
作者：
Des Jarlais, Don C.;Arasteh, Kamyar;Friedman, Samuel R.
目的：由于没有任何单一的艾滋病毒预防方案能够消除艾滋病毒的传播，人们对“综合”预防方案的有效性越来越感兴趣。比较在纽约市初始计划环境（IPE）（自我发起的风险降低、美沙酮、教育/外展和艾滋病毒检测）中注射的人与在联合计划环境（CPE）（上述计划加上大规模注射器交换）中注射的人的艾滋病毒感染。为了确定潜在的行为机制，通过联合programmes.Methods是有效的：对象被招募从贝丝以色列戒毒计划。进行了危险行为问卷调查和艾滋病毒检测。仅在1984年和1994年之间注射的受试者（WE）与仅在1995年和2008年之间注射的受试者（CPE）进行了比较。CPE受试者中的HIV感染显著低于WE受试者：患病率为6%对21%，估计发病率为0.3/100人-年对4/100人-年（均p < 0.001）。CPE和IPE受试者中通过接受性注射器共享而有感染HIV风险的受试者百分比相似（30% vs 33%）。CPE组中有通过注射相关行为传播HIV风险的受试者比例（HIV血清学阳性和报告使用过的针头/注射器）远低于WE组（1%比10%，p < 0.001）。结论：联合预防方案可以大大减少HIV传播。减少艾滋病毒血清反应阳性的注射吸毒者的分配性分享可能是在高血清反应率环境中减少艾滋病毒传播的一个关键组成部分。(C)2010爱思唯尔爱尔兰有限公司版权所有。
Objectives: As no single HIV prevention program has eliminated HIV transmission, there is growing interest in the effectiveness of "combined" prevention programming. To compare HIV infection among persons injecting in the initial programs environment (IPE) in New York City (self-initiated risk reduction, methadone, education/outreach, and HIV testing) to HIV infection among persons injecting in a combined programs environment (CPE) (above programs plus large-scale syringe exchange). To identify potential behavioral mechanisms through which combined programs are effective.Methods: Subjects were recruited from the Beth Israel drug detoxification program. A risk behavior questionnaire was administered and HIV testing conducted. Subjects who injected only between 1984 and 1994 (WE) were compared to subjects who injected only between 1995 and 2008 (CPE).Results: 261 IPE subjects and 1153 CPE subjects were recruited. HIV infection was significantly lower among the CPE subjects compared to WE subjects: prevalence 6% versus 21%, estimated incidence 0.3/100 person-years versus 4/100 person-years (both p < 0.001). The percentage of subjects at risk of acquiring HIV through receptive syringe sharing was similar across CPE and IPE subjects (30% versus 33%). The percentage of subjects at risk of transmitting HIV through injection-related behaviors (who were both HIV seropositive and reported passing on used needles/syringes), was much lower among the CPE subjects than among the WE subjects (1% versus 10%, p < 0.001).Conclusions: Combined prevention programs can greatly reduce HIV transmission. Reducing distributive sharing by HIV seropositive injecting drug users (IDUs) may be a critical component in reducing HIV transmission in high seroprevalence settings. (C) 2010 Elsevier Ireland Ltd. All rights reserved.