Global prevalence of injecting drug use and sociodemographic characteristics and prevalence of HIV, HBV, and HCV in people who inject drugs: a multistage systematic review.
Global prevalence of injecting drug use and sociodemographic characteristics and prevalence of HIV, HBV, and HCV in people who inject drugs: a multistage systematic review.
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DOI：
10.1016/s2214-109x(17)30375-3
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发表时间：
2017-12
期刊：
影响因子：
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通讯作者：
Larney S
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文献类型：
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作者：
Degenhardt L;Peacock A;Colledge S;Leung J;Grebely J;Vickerman P;Stone J;Cunningham EB;Trickey A;Dumchev K;Lynskey M;Griffiths P;Mattick RP;Hickman M;Larney S
共用注射吸毒器具是造成疾病负担的一个重要原因，也是血液传播病毒的一个促成因素。我们进行了一项全球多阶段系统评价，以确定15-64岁人群中IDU的患病率;注射吸毒者（PWID）的社会人口学特征和风险因素;以及PWID中HIV、丙型肝炎病毒（HCV）和B型肝炎病毒（HBV）的患病率。根据GATHER和PRISMA指南，在没有语言限制的情况下，我们系统地检索了同行评议的数据库（MEDLINE、Embase和PsycINFO;自2008年以来发表的文章，最新检索时间为2017年6月），检索灰色文献（网站和数据库，2016年4月至8月期间的搜索），并向国际专家和机构分发数据请求（请求于2016年10月发送）。我们检索了关于静脉吸毒流行率、PWID特征（包括性别、年龄、社会人口学和风险特征）以及PWID中HIV、HCV和HBV流行率的数据。在PWID中选择关于IDU、HIV抗体、HBsAg和HCV抗体流行率的合格数据，并且在多个估计值可用的情况下，通过随机效应荟萃分析汇总每个国家的数据。关于以下人群的符合条件的数据也是如此：女性; 25岁以下;最近无家可归;曾经被捕;曾经被监禁;最近从事性工作，性风险或注射风险;注射的主要药物是阿片类药物或兴奋剂。我们根据以往的全球评估结果，编制了区域和全球估计数。我们审查了55671篇论文和报告，并从1147个合格的记录中提取数据。 在206个国家或地区中，有179个国家或地区记录了注射吸毒证据，覆盖了99%的15-64岁人口，自2008年审查以来增加了31个国家（主要是撒哈拉以南非洲和太平洋岛屿）。在83个国家确定了注射吸毒流行率估计数。我们估计全球有1560万（95%不确定性区间[UI] 10.2 - 23.7百万）15-64岁的PWID，其中320万（1.6 - 5.1百万）女性和1250万（7.5 - 18.4百万）男性。性别构成因地区而异：在北美，女性估计占PWID的30.0%（95% UI 28.5 - 31.5），在澳大拉西亚占33.4%（31.0 - 35.6），而在南亚占3.1%（2.1 - 4.1）。在全球范围内，我们估计17.8%（10.8 - 24.8）的PWID携带HIV，52.3%（42.4 - 62.1）为HCV抗体阳性，9.0%（5.1 - 13.2）为HBV表面抗原阳性;这些水平存在很大的地理差异。在全球范围内，我们估计82.9%（76.6 - 88.9）的PWID主要注射阿片类药物，33.0%（24.3 - 42.0）主要注射兴奋剂。我们估计，全球27.9%（20.9 - 36.8）的PWID年龄小于25岁，21.7%（15.8 - 27.9）最近（在过去一年内）经历过无家可归或不稳定的住房，57.9%（50.5 - 65.2）有监禁史。我们在比2008年更多的国家发现了注射吸毒的证据，新的国家主要包括非洲的低收入和中等收入国家。在所有国家中，相当数量的PWID携带艾滋病毒和丙型肝炎病毒，并暴露于多种不利的风险环境，增加了健康危害。澳大利亚国家药物和酒精研究中心、澳大利亚国家卫生和医学研究理事会、开放社会基金会、世界卫生组织、全球基金和艾滋病规划署。
Sharing of equipment used for injecting drug use (IDU) is a substantial cause of disease burden and a contributor to blood-borne virus transmission. We did a global multistage systematic review to identify the prevalence of IDU among people aged 15–64 years; sociodemographic characteristics of and risk factors for people who inject drugs (PWID); and the prevalence of HIV, hepatitis C virus (HCV), and hepatitis B virus (HBV) among PWID. Consistent with the GATHER and PRISMA guidelines and without language restrictions, we systematically searched peer-reviewed databases (MEDLINE, Embase, and PsycINFO; articles published since 2008, latest searches in June, 2017), searched the grey literature (websites and databases, searches between April and August, 2016), and disseminated data requests to international experts and agencies (requests sent in October, 2016). We searched for data on IDU prevalence, characteristics of PWID, including gender, age, and sociodemographic and risk characteristics, and the prevalence of HIV, HCV, and HBV among PWID. Eligible data on prevalence of IDU, HIV antibody, HBsAg, and HCV antibody among PWID were selected and, where multiple estimates were available, pooled for each country via random effects meta-analysis. So too were eligible data on percentage of PWID who were female; younger than 25 years; recently homeless; ever arrested; ever incarcerated; who had recently engaged in sex work, sexual risk, or injecting risk; and whose main drugs injected were opioids or stimulants. We generated regional and global estimates in line with previous global reviews. We reviewed 55 671 papers and reports, and extracted data from 1147 eligible records. Evidence of IDU was recorded in 179 of 206 countries or territories, which cover 99% of the population aged 15–64 years, an increase of 31 countries (mostly in sub-Saharan Africa and the Pacific Islands) since a review in 2008. IDU prevalence estimates were identified in 83 countries. We estimate that there are 15·6 million (95% uncertainty interval [UI] 10·2–23·7 million) PWID aged 15–64 years globally, with 3·2 million (1·6–5·1 million) women and 12·5 million (7·5–18·4 million) men. Gender composition varied by location: women were estimated to comprise 30·0% (95% UI 28·5–31·5) of PWID in North America and 33·4% (31·0–35·6) in Australasia, compared with 3·1% (2·1–4·1) in south Asia. Globally, we estimate that 17·8% (10·8–24·8) of PWID are living with HIV, 52·3% (42·4–62·1) are HCV-antibody positive, and 9·0% (5·1–13·2) are HBV surface antigen positive; there is substantial geographic variation in these levels. Globally, we estimate 82·9% (76·6–88·9) of PWID mainly inject opioids and 33·0% (24·3–42·0) mainly inject stimulants. We estimate that 27·9% (20·9–36·8) of PWID globally are younger than 25 years, 21·7% (15·8–27·9) had recently (within the past year) experienced homelessness or unstable housing, and 57·9% (50·5–65·2) had a history of incarceration. We identified evidence of IDU in more countries than in 2008, with the new countries largely consisting of low-income and middle-income countries in Africa. Across all countries, a substantial number of PWID are living with HIV and HCV and are exposed to multiple adverse risk environments that increase health harms. Australian National Drug and Alcohol Research Centre, Australian National Health and Medical Research Council, Open Society Foundation, World Health Organization, the Global Fund, and UNAIDS.