Is the promise of methadone Kenya's solution to managing HIV and addiction? A mixed-method mathematical modelling and qualitative study.
Is the promise of methadone Kenya's solution to managing HIV and addiction? A mixed-method mathematical modelling and qualitative study.
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DOI：
10.1136/bmjopen-2014-007198
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发表时间：
2015-03-06
期刊：
影响因子：
2.9
通讯作者：
Vickerman P
中科院分区：
文献类型：
--
作者：
Rhodes T;Guise A;Ndimbii J;Strathdee S;Ngugi E;Platt L;Kurth A;Cleland C;Vickerman P
阿片类药物替代治疗（OST）作为预防艾滋病毒和治疗注射吸毒者（PWID）海洛因成瘾的循证干预措施在全球推广，可帮助控制PWID中新出现的艾滋病毒流行病。肯尼亚于2014年12月开始实施，是第三个采用开放源码软件的撒哈拉以南非洲国家。我们结合联合收割机动态数学建模与定性社会学研究，以研究“承诺美沙酮"肯尼亚。我们在肯尼亚的内罗毕模拟了OST在不同干预覆盖水平下对艾滋病预防的影响。我们利用109个定性访谈PWID的主题分析，43与利益相关者，图表他们的叙述期望美沙酮的承诺。模拟的开放源码软件的影响显示，在计划推出的开放源码软件的覆盖水平（约10%）下，5年内艾滋病毒发病率（5-10%）和流行率（2-4%）相对略有下降。 然而，随着覆盖率的提高，影响更大，40%的覆盖率使艾滋病毒发病率降低20%，即使考虑到相对较高的性传播。定性研究结果强调了一种文化的“定量期望”在获得护理和“贫困的药物治疗机会”。在这种情况下，美沙酮的承诺可能会被叙述为一个符号的治疗-无论是对个人和社区-在成瘾恢复。美沙酮提供了预防艾滋病毒的潜力，但有必要更好地模拟艾滋病毒性传播的影响，在以广泛和集中流行病相结合为特征的环境中，在PWID中介导OST的影响。我们发现，个人和社区的叙述美沙酮作为恢复的希望与政策的叙述定位美沙酮主要与艾滋病毒预防共存。我们的分析显示了混合方法的价值，以调查新引入的干预措施。
Promoted globally as an evidence-based intervention in the prevention of HIV and treatment of heroin addiction among people who inject drugs (PWID), opioid substitution treatment (OST) can help control emerging HIV epidemics among PWID. With implementation in December 2014, Kenya is the third Sub-Saharan African country to have introduced OST. We combine dynamic mathematical modelling with qualitative sociological research to examine the ‘promise of methadone’ to Kenya. We model the HIV prevention impact of OST in Nairobi, Kenya, at different levels of intervention coverage. We draw on thematic analyses of 109 qualitative interviews with PWID, and 43 with stakeholders, to chart their narratives of expectation in relation to the promise of methadone. The modelled impact of OST shows relatively slight reductions in HIV incidence (5–10%) and prevalence (2–4%) over 5 years at coverage levels (around 10%) anticipated in the planned roll-out of OST. However, there is a higher impact with increased coverage, with 40% coverage producing a 20% reduction in HIV incidence, even when accounting for relatively high sexual transmissions. Qualitative findings emphasise a culture of ‘rationed expectation’ in relation to access to care and a ‘poverty of drug treatment opportunity’. In this context, the promise of methadone may be narrated as a symbol of hope—both for individuals and community—in relation to addiction recovery. Methadone offers HIV prevention potential, but there is a need to better model the effects of sexual HIV transmission in mediating the impact of OST among PWID in settings characterised by a combination of generalised and concentrated epidemics. We find that individual and community narratives of methadone as hope for recovery coexist with policy narratives positioning methadone primarily in relation to HIV prevention. Our analyses show the value of mixed methods approaches to investigating newly-introduced interventions.
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