Global, regional, and country-level coverage of interventions to prevent and manage HIV and hepatitis C among people who inject drugs: a systematic review.
Global, regional, and country-level coverage of interventions to prevent and manage HIV and hepatitis C among people who inject drugs: a systematic review.
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DOI：
10.1016/s2214-109x(17)30373-x
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发表时间：
2017-12
期刊：
影响因子：
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通讯作者：
Degenhardt L
中科院分区：
文献类型：
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作者：
Larney S;Peacock A;Leung J;Colledge S;Hickman M;Vickerman P;Grebely J;Dumchev KV;Griffiths P;Hines L;Cunningham EB;Mattick RP;Lynskey M;Marsden J;Strang J;Degenhardt L
注射吸毒者（PWID）是受全球艾滋病毒和丙型肝炎病毒（HCV）流行影响的关键人群。艾滋病毒和丙型肝炎病毒预防措施包括针头和注射器规划（NSP）、阿片类药物替代疗法（OST）、艾滋病毒咨询和检测、艾滋病毒抗逆转录病毒治疗（ART）以及避孕套分发规划。我们的目标是在国家、地区和全球范围内对NSP、OST、HIV检测、ART和安全套规划的覆盖率进行估计。我们完成了对同行评议（MEDLINE、Embase和PsycINFO）、互联网和灰色文献数据库的搜索，并通过社交媒体和有针对性的电子邮件向国际专家传播数据请求。收集了每种指定干预措施的规划和调查数据。根据世卫组织、联合国艾滋病规划署和联合国毒品和犯罪问题办公室确定的指标，利用规划数据得出干预措施覆盖范围的国家一级估计。还计算了NSP、OST和HIV检测覆盖率的区域和全球估计值。该协议在PROSPERO上注册，编号为CRD42017056558。2017年，在有证据表明存在注射吸毒现象的179个国家中，有93个国家提供了一定程度的国家安全计划服务，有86个国家有证据表明实施了药物安全措施。57个国家有估计国家安全保障措施覆盖范围的数据，60个国家有估计OST覆盖范围的数据。各国之间的覆盖率差异很大，但根据世卫组织的指标，覆盖率通常较低（每年每个PWID患者分配的针头注射器少于100支；每年每个PWID患者的OST接受者少于20人）。与NSP和OST相比，艾滋病毒检测的数据较少，而且很少有数据可用于估计感染艾滋病毒的PWID患者获得抗逆转录病毒治疗的情况。在全球范围内，我们估计每个PWID每年有33（不确定区间[UI] 21-50）个针头注射器通过NSP分发，每100个PWID有16（10-24）个OST受助者。不到1%的无艾滋病毒感染者生活在国家国家安全措施和口服避孕药覆盖率高的国家（每个无艾滋病毒感染者分发200支针头注射器，每100名无艾滋病毒感染者分发40支口服避孕药接受者）。艾滋病毒和丙型肝炎病毒预防干预措施的覆盖率仍然很低，可能不足以有效预防艾滋病毒和丙型肝炎病毒传播。扩大对PWID的干预措施仍然是遏制艾滋病毒和丙型肝炎流行的关键优先事项。开放社会基金会、全球基金、世卫组织、艾滋病规划署、联合国毒品和犯罪问题办公室、澳大利亚国家毒品和酒精研究中心、悉尼新南威尔士大学。
People who inject drugs (PWID) are a key population affected by the global HIV and hepatitis C virus (HCV) epidemics. HIV and HCV prevention interventions for PWID include needle and syringe programmes (NSP), opioid substitution therapy (OST), HIV counselling and testing, HIV antiretroviral therapy (ART), and condom distribution programmes. We aimed to produce country-level, regional, and global estimates of coverage of NSP, OST, HIV testing, ART, and condom programmes for PWID. We completed searches of peer-reviewed (MEDLINE, Embase, and PsycINFO), internet, and grey literature databases, and disseminated data requests via social media and targeted emails to international experts. Programme and survey data on each of the named interventions were collected. Programme data were used to derive country-level estimates of the coverage of interventions in accordance with indicators defined by WHO, UNAIDS, and the UN Office on Drugs and Crime. Regional and global estimates of NSP, OST, and HIV testing coverage were also calculated. The protocol was registered on PROSPERO, number CRD42017056558. In 2017, of 179 countries with evidence of injecting drug use, some level of NSP services were available in 93 countries, and there were 86 countries with evidence of OST implementation. Data to estimate NSP coverage were available for 57 countries, and for 60 countries to estimate OST coverage. Coverage varied widely between countries, but was most often low according to WHO indicators (<100 needle-syringes distributed per PWID per year; <20 OST recipients per PWID per year). Data on HIV testing were sparser than for NSP and OST, and very few data were available to estimate ART access among PWID living with HIV. Globally, we estimate that there are 33 (uncertainty interval [UI] 21–50) needle-syringes distributed via NSP per PWID annually, and 16 (10–24) OST recipients per 100 PWID. Less than 1% of PWID live in countries with high coverage of both NSP and OST (>200 needle-syringes distributed per PWID and >40 OST recipients per 100 PWID). Coverage of HIV and HCV prevention interventions for PWID remains poor and is likely to be insufficient to effectively prevent HIV and HCV transmission. Scaling up of interventions for PWID remains a crucial priority for halting the HIV and HCV epidemics. Open Society Foundations, The Global Fund, WHO, UNAIDS, United Nations Office on Drugs and Crime, Australian National Drug and Alcohol Research Centre, University of New South Wales Sydney.