Rapid situational assessment of people who inject drugs (PWID) in Nairobi and coastal regions of Kenya: a respondent driven sampling survey.
Rapid situational assessment of people who inject drugs (PWID) in Nairobi and coastal regions of Kenya: a respondent driven sampling survey.
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DOI：
10.1186/s12889-021-11373-9
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发表时间：
2021-08-14
影响因子：
4.5
通讯作者：
Abdool R
中科院分区：
文献类型：
--
作者：
Oguya FO;Kenya PR;Ongecha F;Mureithi P;Musyoka H;Muraguri N;Mundia B;Angira C;Shose M;Basheeb TA;Mohamed AA;Oyore JP;Ochieng OG;Dida GO;Abdalla S;Abdool R
在一项旨在评估内罗毕和肯尼亚沿海地区注射吸毒者艾滋病毒流行率和危险行为的研究中，采用了应用响应者驱动抽样技术(RDS)的横断面快速情况评估(PWID)来招募受试者/参与者。撒哈拉以南非洲缺乏关于注射吸毒的数据和信息，有充分证据表明存在促进注射吸毒发展和增长的环境。过去在肯尼亚进行的关于艾滋病毒/艾滋病及其与艾滋病毒/艾滋病关系的研究，没有提供足够的信息来支持有效规划和全面应对艾滋病毒/艾滋病疫情。研究采用了横断面研究设计，首先确定了一组被称为“种子”的初始受试者，从这些受试者中获得了一系列扩展的转诊链，每一波中的受试者指的是后续波的受试者。这些种子是从种群中随机抽取的，并进行了采访，以挑选具有最大网络和其他独特特征的种子。最多招募了12个种子。第二阶段包括对这些地点进行评估访问，以确定潜在的合作者，其中包括非政府组织、戒毒治疗中心、保健设施、社区组织等。确定了位于沿海地区的三个非政府组织和内罗毕地区的一个非政府组织，以协助确定毒品注射地点和潜在参与者。还利用访谈指南进行了关键线人访谈(KIIS)和焦点小组讨论(FGD)。2010年1月至3月，共有646人(内罗毕344人，沿海302人)参加了这项研究。其中590人(91%)为男性，56人(9%)为女性。结果显示，大多数戒毒者开始注射吸毒的年龄在20-29 岁之间，最小的开始年龄为11 ，最大的年龄为53 。最常见的注射毒品是海洛因(98%)，少数(2%)注射可卡因。其他非注射方法，如吸烟或将这两种药物与大麻或催眠药等其他药物联合使用也很常见。大多数戒毒者在开始注射吸毒之前使用其他物质(香烟、酒精和大麻)。调整后的全国艾滋病感染率为18.3%(未调整前为19.62%)，其中内罗毕地区为18.33%(未调整前为20.58%)，沿海地区为18.27%(18.59%未调整前)。基于性别的艾滋病毒流行率显示，女性感染艾滋病毒的风险(44.51%-调整后)高于男性(15.97%-调整后)。特定年龄的艾滋病毒感染率显示，在内罗毕，在11-19 岁开始注射的PWID患者(调整后为44.7%)比沿海地区在20-24 岁开始注射的患者(调整后为23.2%)面临的风险最大。虽然这两个地区的所有残疾人继续面临风险，但来自内罗毕西部和肯尼亚的残疾人风险相对较高，因为他们更倾向于共享注射设备和解决方案。与全国艾滋病毒感染率(4.9%)相比，结果表明，在肯尼亚，注射毒品(PWID)的人感染风险特别高，迫切需要干预(KenPHIA，2018)。这项研究还显示，70%的残疾人受过小学教育，从事高风险注射和性行为，包括共用注射器具、无保护措施的异性和同性性行为。鉴于注射吸毒很早就开始了，并在正规学年(20-29 年)之后达到高峰，预防方案应以中小学生、大学生和校外青年为目标。此外，为了保护注射吸毒者免受艾滋病毒感染，该国应该引入免费针头注射器计划(NSP)，提供避孕套和美沙酮辅助治疗(MAT)作为药物使用的替代品。
A Cross-sectional Rapid Situational Assessment of People Who Inject Drug (PWIDs) applying Respondent Driven sampling techniques (RDS) was used to recruit subjects/participants in a study aimed at assessing HIV prevalence and risk behaviors among injecting drug users in Nairobi and Coastal regions of Kenya. There is paucity of data and information on injecting drug use in sub-Saharan Africa and there is sufficient evidence of existence of the environment for development and growth of injecting drug use. Past studies on PWID and its association to HIV and AIDS that have been conducted in Kenya do not provide sufficient information to support effective planning and comprehensive national response to the HIV and AIDS epidemic. A cross-sectional study design was adopted in which a set of initial subjects referred to as ‘seeds’ were first identified from which an expanding chain of referrals were obtained, with subjects from each wave referring subjects of subsequent waves. The seeds were drawn randomly from the population and interviewed to pick the one with the largest network and other unique characteristics. A maximum of twelve seeds were recruited. The second stage involved conducting assessment visits to the sites to identify potential collaborators that included non-governmental organizations (NGOs), drug treatment centres, health facilities, community based organizations (CBO’s) among others. Three NGOs located in the coast region and one in Nairobi region were identified to assist in identifying drug injection locations and potential participants. Key informant interviews (KIIs) and Focus Group Discussions (FGDs) were also conducted using interview guides. A total of 646 individuals (344 in Nairobi and 302 at the coast) were recruited for the study between January and March 2010. Of these 590 (91%) were male and 56 (9%) were female. Findings showed that most PWIDs initiated injecting drug use between the ages of 20–29 years, with the youngest age of initiation being 11 years and oldest age being 53 years. Most commonly injected drug was heroin (98%), with a small (2%) percentage injecting cocaine. Other non-injecting methods such as smoking or combining these two drugs with other drugs such as cannabis or Rohypnol were also common. Most PWIDs used other substances (cigarettes, alcohol, and cannabis) before initiating injecting drug use. The adjusted national HIV prevalence of PWIDs was 18.3% (19.62% unadjusted) with PWIDs in Nairobi region registering 18.33% (20.58% unadjusted) compared PWIDs for Coastal region indicating 18.27% (18.59% - unadjusted). The gender based HIV prevalence showed that women were more at risk of acquiring HIV (44.51%-adjusted) compared to men (15.97%-adjusted). The age specific HIV prevalence showed that PWIDs who initiated injecting at 11–19 years (44.7% adjusted) were most at risk in Nairobi compared to those who initiated injecting at age 20–24 years (23.2% - adjusted) in the coastal region. While all PWIDs continue to be at risk in the two regions, those from the Western parts of Nairobi, Kenya were at a relatively higher risk given their increased propensity for sharing injecting equipment and solutions. Compared to the national HIV prevalence of (4.9%), the results show that People Who Inject Drugs (PWIDs) are at particularly high risk of infection in Kenya and there is urgent need for intervention (KenPHIA, 2018). This study also showed clear evidence that 70% of PWIDs are primary school educated, engage in high risk injecting and sexual behaviors comprising sharing of injecting equipment, unprotected heterosexual and homosexual sex. Given that initiation of injecting drug use begins early and peaks after formal school years (20–29 years), prevention programmes should be targeted at primary and secondary school students, college and out of school youth. Further, to protect People who inject drugs (PWIDs) from HIV infection, the country should introduce free Needle Syringe Programs (NSP) with provision of condoms and Methadone Assisted Therapy (MAT) as a substitute for drug use.
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影响因子：
4.5
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