The Syndemic of Opioid Misuse, Overdose, HCV, and HIV: Structural-Level Causes and Interventions.
The Syndemic of Opioid Misuse, Overdose, HCV, and HIV: Structural-Level Causes and Interventions.
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DOI：
10.1007/s11904-018-0390-3
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发表时间：
2018-04
影响因子：
4.6
通讯作者：
Jordan AE
中科院分区：
文献类型：
--
作者：
Perlman DC;Jordan AE
本文回顾了认识1）阿片类药物滥用，过量，丙型肝炎病毒和艾滋病毒作为一种综合征的流行病，以及2）检查和解决这种综合征的结构因素的重要性的情况。我们专注于美国目前的流行病，但也考虑其他地方的数据，以突出现有的问题，并在各种情况下出现。多层次理论和统计方法的发展，使合理的生态和多层次的结构因素的影响，对疫情的分析。对阿片类药物滥用、过量、丙型肝炎病毒和艾滋病毒的研究表明，地区一级获得医疗保健、阿片类药物使用障碍的药物辅助治疗、无菌注射设备和纳洛酮过量预防，以及阿片类药物营销、收入不平等、警务活动强度和医疗保健政策等因素，与药物滥用、过量、感染风险和发病率的普遍性有关。结构变量可以预测地区一级对该流行病的脆弱性。实施综合预防和治疗干预措施可以控制和扭转该流行病的组成部分。认识和监测强有力的结构性因素可有助于确定易受该流行病影响的地区。此外，许多结构性因素是可以通过干预和政策来改变的，以减少结构性脆弱性和创造有利于健康的环境。证据支持立即实施更广泛的HCV和HIV检测和物质使用筛查，药物辅助治疗，针头/注射器交换计划，纳洛酮计划，增加HCV治疗的人口水平实施，并进一步关注预测和促成区域层面脆弱性的结构层面因素，如阿片类药物营销，分销和处方的程度。
This article reviews the case for recognizing 1) the epidemics of opioid misuse, overdose, hepatitis C virus, and HIV as a syndemic, and 2) the importance of examining and addressing structural factors in responses to this syndemic. We focus on the current syndemic in the US, but also consider data from other locations to highlight the issues existing and arising in various contexts. Advances in multi-level theory and statistical methods allow sound ecologic and multi-level analyses of the impact of structural factors on the syndemic. Studies of opioid misuse, overdoses, hepatitis C virus and HIV demonstrate that area-level access to healthcare, medication assisted treatment of opioid use disorders, sterile injection equipment, and overdose prevention with naloxone, as well as factors such as opioid marketing, income inequality, intensity of policing activities, and health care policies, are related to the prevalence of substance misuse, overdoses, infection risk and morbidity. Structural variables can predict area-level vulnerability to the syndemic. The implementation of combined prevention and treatment interventions can control and reverse components of the syndemic. Recognizing and monitoring potent structural factors can facilitate the identification of areas at risk of vulnerability to the syndemic. Further, many structural factors are modifiable through intervention and policy to reduce structural vulnerability and create health-enabling environments. Evidence supports the immediate implementation of broader HCV and HIV testing and substance use screening, medication assisted treatment, needle/syringe exchange programs, naloxone programs, increased population-level implementation of HCV treatment, and further attention to structural-level factors predicting, and contributing to, area-level vulnerability, such as degrees of opioid marketing, distribution, and prescribing.
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