Modelling the impact of HIV and HCV prevention and treatment interventions for people who inject drugs in Dar es Salaam, Tanzania.
Modelling the impact of HIV and HCV prevention and treatment interventions for people who inject drugs in Dar es Salaam, Tanzania.
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DOI：
10.1002/jia2.25817
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发表时间：
2021-10
影响因子：
6
通讯作者：
Vickerman P
中科院分区：
文献类型：
--
作者：
Fraser H;Stone J;Wisse E;Sambu V;Mfisi P;Duran IJ;Soriano MA;Walker JG;Makere N;Luhmann N;Kafura W;Nouvellet M;Ragi A;Mundia B;Vickerman P
坦桑尼亚达累斯萨拉姆的注射毒品者（PWID）艾滋病毒和丙型肝炎病毒（HCV）的流行率很高。虽然坦桑尼亚有针头和注射器方案、阿片类激动剂治疗和抗逆转录病毒治疗，但其覆盖面并不理想。我们评估了现有的和扩大的减少伤害（HR）干预措施对达累斯萨拉姆PWID中HIV和HCV传播的影响。根据2006-2018年的艾滋病毒数据，对坦桑尼亚PWID中的艾滋病毒和HCV传播模型进行了校准（2011年男性和女性的感染率分别为30%和67%）和HCV感染率（2017年为16%），人力资源干预数量（2018年有5254人接受OAT，2017年有766-1479人接受NSP）和ART覆盖率（2015年为63.1%）。我们评估了现有干预措施在2019年的影响，以及从2019年起扩大OAT（占PWID的50%），NSP（75%，两者合并称为“完全HR”）和ART（81%，90%病毒抑制）的覆盖范围到2030年的影响，将性传播艾滋病毒减少50%，和/或每年治疗10%感染HCV的PWID。该模型预测2019年HIV和HCV的患病率分别为19.0%（95%可信区间：16.4-21.2%）和41.0%（24.4-49.0%）。就艾滋病毒而言，在男女艾滋病患者中，分别有24.6%（13.6-32.6%）和70.3%（59.3-77.1%）的新发感染是通过性传播的。由于其覆盖率较低（2019年OAT为22.8%，NSP为16.3%），OAT和NSP在2019年避免了20.4%（12.9-24.7%）的HIV感染和21.7%（17.0-25.2%）的HCV感染。现有的抗逆转录病毒疗法（到2019年覆盖率为68.5%）在2019年避免了48.1%（29.7-64.3%）的艾滋病毒感染。扩大到完全HR将使HIV和HCV发病率降低62.6%（52.5-74.0%）和81.4%（56.7-81.4%），分别超过2019-2030年;扩大抗逆转录病毒疗法与全面的人力资源将减少艾滋病毒的发病率66.8%（55.6-77.5%），增加到81.5%（73.7-87.5%）时，性风险也降低。到2030年，HCV治疗和完全HR将使HCV发病率降低92.4%（80.7-95.8%）。在坦桑尼亚，需要采取包括降低性风险和HCV治疗在内的综合干预措施，以消除PWID中的HCV和艾滋病毒。
People who inject drugs (PWID) in Dar es Salaam, Tanzania, have a high prevalence of HIV and hepatitis C virus (HCV). While needle and syringe programmes (NSP), opioid agonist therapy (OAT) and anti‐retroviral therapy (ART) are available in Tanzania, their coverage is sub‐optimal. We assess the impact of existing and scaled up harm reduction (HR) interventions on HIV and HCV transmission among PWID in Dar es Salaam. An HIV and HCV transmission model among PWID in Tanzania was calibrated to data over 2006–2018 on HIV (∼30% and ∼67% prevalence in males and females in 2011) and HCV prevalence (∼16% in 2017), numbers on HR interventions (5254 ever on OAT in 2018, 766–1479 accessing NSP in 2017) and ART coverage (63.1% in 2015). We evaluated the impact of existing interventions in 2019 and impact by 2030 of scaling‐up the coverage of OAT (to 50% of PWID), NSP (75%, both combined termed “full HR”) and ART (81% with 90% virally suppressed) from 2019, reducing sexual HIV transmission by 50%, and/or HCV‐treating 10% of PWID infected with HCV annually. The model projects HIV and HCV prevalence of 19.0% (95% credibility interval: 16.4–21.2%) and 41.0% (24.4–49.0%) in 2019, respectively. For HIV, 24.6% (13.6–32.6%) and 70.3% (59.3–77.1%) of incident infections among male and female PWID are sexually transmitted, respectively. Due to their low coverage (22.8% for OAT, 16.3% for NSP in 2019), OAT and NSP averted 20.4% (12.9–24.7%) of HIV infections and 21.7% (17.0–25.2%) of HCV infections in 2019. Existing ART (68.5% coverage by 2019) averted 48.1% (29.7–64.3%) of HIV infections in 2019. Scaling up to full HR will reduce HIV and HCV incidence by 62.6% (52.5–74.0%) and 81.4% (56.7–81.4%), respectively, over 2019–2030; scaled up ART alongside full HR will decrease HIV incidence by 66.8% (55.6–77.5%), increasing to 81.5% (73.7–87.5%) when sexual risk is also reduced. HCV‐treatment alongside full HR will decrease HCV incidence by 92.4% (80.7–95.8%) by 2030. Combination interventions, including sexual risk reduction and HCV treatment, are needed to eliminate HCV and HIV among PWID in Tanzania.
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影响因子：
7.7
作者：
Fraser, Hannah;Mukandavire, Christinah;Vickerman, Peter
通讯作者：
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影响因子：
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作者：
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通讯作者：
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DOI：
10.1097/qai.0000000000001852
发表时间：
2018-12-15
影响因子：
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作者：
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通讯作者：
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影响因子：
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作者：
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