HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage
HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage
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DOI：
10.1016/s0140-6736(10)60232-2
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发表时间：
2010-03-20
期刊：
影响因子：
168.9
通讯作者：
Strathdee, Steffanie A.
中科院分区：
文献类型：
--
作者：
Mathers, Bradley M.;Degenhardt, Louisa;Strathdee, Steffanie A.
背景以前的审查审查了全球注射毒品使用者（ID Us）的艾滋病毒预防，治疗和护理服务的存在，但他们没有量化覆盖范围。我们进行了系统的审查，以估计国家，区域和全球范围内的HIV服务IDUs.Methods的覆盖率，我们做了同行评议（Medline，BioMed Central），互联网和灰色文献数据库发表的数据在2004年或以后的系统搜索。在联合国机构和国家专家的参与下，开展了多阶段的数据请求和核查进程。获得了关于向注射吸毒者提供以下核心干预措施的程度的国家数据：针头和针筒方案、阿片类药物替代疗法和其他药物治疗、艾滋病毒检测和咨询、抗逆转录病毒疗法和避孕套方案。我们计算了国家，区域和全球覆盖的NSP，OST，和ART的基础上，现有的估计IDU人口sizes.Findings的基础上，到2009年，NSP已在82个国家和OST在70个国家实施;这两种干预措施在66个国家。区域和国家覆盖面差异很大。澳大拉西亚（每年每名注射吸毒者202支针头注射器）的针头注射器分配率最高;拉丁美洲和加勒比（每年每名注射吸毒者0.3支针头注射器）、中东和北非（每年每名注射吸毒者0.5支针头注射器）和撒哈拉以南非洲（每年每名注射吸毒者0.1支针头注射器）的分配率最低。鸦片替代疗法的覆盖率从中亚、拉丁美洲和撒哈拉以南非洲每100名注射吸毒者中不到或等于一名接受者到西欧非常高的水平（每100名注射吸毒者中61名接受者）不等。接受抗逆转录病毒疗法的注射吸毒者人数从每100名艾滋病毒呈阳性的注射吸毒者中不到1人（智利、肯尼亚、巴基斯坦、俄罗斯和乌兹别克斯坦）到6个欧洲国家每100名艾滋病毒呈阳性的注射吸毒者中超过100人不等。在世界范围内，估计每个注射吸毒者每月分发两个针头注射器（范围1-4），每100名注射吸毒者中有8名接受者（6-12）接受OST，每100名HIV阳性的注射吸毒者中有4名接受ART（范围2-18）。迫切需要扩大这些服务在这一高危人群中的覆盖面。
Background Previous reviews have examined the existence of HIV prevention, treatment, and care services for injecting drug users (ID Us) worldwide, but they did not quantify the scale of coverage. We undertook a systematic review to estimate national, regional, and global coverage of HIV services in IDUs.Methods We did a systematic search of peer-reviewed (Medline, BioMed Central), internet, and grey-literature databases for data published in 2004 or later. A multistage process of data requests and verification was undertaken, involving UN agencies and national experts. National data were obtained for the extent of provision of the following core interventions for IDUs: needle and syringe programmes (NSPs), opioid substitution therapy (OST) and other drug treatment, HIV testing and counselling, antiretroviral therapy (ART), and condom programmes. We calculated national, regional, and global coverage of NSPs, OST, and ART on the basis of available estimates of IDU population sizes.Findings By 2009, NSPs had been implemented in 82 countries and OST in 70 countries; both interventions were available in 66 countries. Regional and national coverage varied substantially. Australasia (202 needle syringes per IDU per year) had by far the greatest rate of needle syringe distribution; Latin America and the Caribbean (0.3 needle syringes per IDU per year), Middle East and north Africa (0.5 needle syringes per IDU per year), and sub-Saharan Africa (0.1 needle syringes per IDU per year) had the lowest rates. OST coverage varied from less than or equal to one recipient per 100 IDUs in central Asia, Latin America, and sub-Saharan Africa, to very high levels in western Europe (61 recipients per 100 IDUs). The number of IDUs receiving ART varied from less than one per 100 HIV-positive IDUs (Chile, Kenya, Pakistan, Russia, and Uzbekistan) to more than 100 per 100 HIV-positive IDUs in six European countries. Worldwide, an estimated two needle syringes (range 1-4) were distributed per IDU per month, there were eight recipients (6-12) of OST per 100 IDUs, and four IDUs (range 2-18) received ART per 100 HIV-positive IDUs.Interpretation Worldwide coverage of HIV prevention, treatment, and care services in IDU populations is very low. There is an urgent need to improve coverage of these services in this at-risk population.