Costs and impact on HIV transmission of a switch from a criminalisation to a public health approach to injecting drug use in eastern Europe and central Asia: a modelling analysis.
Costs and impact on HIV transmission of a switch from a criminalisation to a public health approach to injecting drug use in eastern Europe and central Asia: a modelling analysis.
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DOI：
10.1016/s2352-3018(21)00274-5
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发表时间：
2022-01
期刊：
影响因子：
--
通讯作者：
Vickerman P
中科院分区：
文献类型：
--
作者：
Ward Z;Stone J;Bishop C;Ivakin V;Eritsyan K;Deryabina A;Low A;Cepeda J;Kelly SL;Heimer R;Cook R;Altice FL;Litz T;Terlikbayeva A;El-Bassel N;Havarkov D;Fisenka A;Boshnakova A;Klepikov A;Saliuk T;Deshko T;Vickerman P
在东欧和中亚(EECA)，艾滋病毒发病率正在增加，主要是由注射吸毒引起的。抗逆转录病毒疗法(ART)和阿片类激动剂疗法(OAT)的覆盖面并不理想，注射毒品(PWID)的人会经历相当大的监禁。我们评估了使用药物使用和/或持有合法化节省的资金来扩大抗逆转录病毒药物和燕麦片是否可以控制EECA中PWID中的艾滋病毒。在白俄罗斯、哈萨克斯坦、吉尔吉斯斯坦和圣彼得堡(俄罗斯)，建立了包括监禁、抗逆转录病毒治疗和燕麦片在内的艾滋病病毒在PWID中的动态传播模型。对审查处、抗逆转录病毒药物治疗和监禁的国别费用进行了核对/估算。与基线相比，该模型前瞻性地预测了2020-2040年在三种情况下获得的寿命年(LYG)、增量成本(2018欧元)和预防感染：(1)非刑事化：消除因吸毒和个人持有毒品而入狱，将PWID的监禁减少25%-46%；(2)公共卫生方法：使用非犯罪化节省的资金扩大ART和OAT；以及(3)全面扩大：方案2加上投资额外资源，将ART和OAT的覆盖率扩大到81%和40%。计算了每一种情景下每一年的增量成本效益比，并将其与具体国家的1×GDP人均支付意愿阈值进行了比较。成本和LYG每年都有3%的折扣。在2020-2040年期间，目前的监禁、OAT和ART费用估计为1.97亿-41.29亿欧元；74.8-95.8%是由于监禁费用。非刑事化带来了成本节约(38-7.73亿欧元)，但LYG规模不大(745-1,694欧元)。公共卫生方法节省了成本，使每个国家的抗逆转录病毒治疗覆盖率达到81%，燕麦片覆盖率达到29.7%-41.8%，从而实现了17768-148,464个LYG和58.9-83.7%的感染预防。在全面放大的情况下，结果也类似。通过将药物使用合法化而节省的成本可以通过增加欧洲经济共同体中残疾人中的燕麦片和抗逆转录病毒疗法的覆盖面来显著减少艾滋病毒的传播。公共卫生联盟、美国国家卫生研究所、经济学人信息部
HIV incidence is increasing in Eastern Europe and Central Asia (EECA), primarily driven by injecting drug use. Coverage of antiretroviral therapy (ART) and opioid agonist therapy (OAT) are sub-optimal, with people who inject drugs (PWID) experiencing considerable incarceration. We evaluated whether using saved monies from decriminalising drug use and/or possession to scale-up ART and OAT could control HIV among PWID in EECA. A dynamic HIV transmission model among PWID incorporating incarceration, ART and OAT was calibrated to Belarus, Kazakhstan, Kyrgyzstan and St. Petersburg (Russia). Country-specific costs for OAT, ART and incarceration were collated/estimated. Compared to baseline, the model prospectively projected the life years gained (LYG), incremental costs (2018 Euros) and infections prevented over 2020-2040 for three scenarios: (1) Decriminalisation: Remove incarceration due to drug use and drug possession for personal use, reducing incarceration among PWID by 25-46%; (2) Public Health Approach: Use savings from decriminalisation to scale-up ART and OAT; and (3) Full Scale-up: scenario 2 plus invest additional resources to scale-up ART to 81% coverage and OAT to 40% coverage. The incremental cost-effectiveness ratio (ICER) per LYG for each scenario were calculated and compared to country-specific 1xGDP per-capita willingness-to-pay thresholds. Costs and LYG were discounted 3% annually. Current levels of incarceration, OAT and ART are estimated to cost €197-4,129 million over 2020-2040 across settings; 74.8-95.8% due to incarceration costs. Decriminalisation results in cost-savings (€38-773 million) but modest LYG (745-1,694). The Public Health Approach was cost-saving, allowing each country to reach 81% ART coverage and 29.7-41.8% OAT coverage, resulting in 17,768-148,464 LYG and 58.9-83.7% of infections prevented. Results were similar for the Full Scale-up scenario. Cost-savings from decriminalising drug use could dramatically reduce HIV transmission through increased OAT and ART coverage among PWID in EECA. Alliance for Public Health, US National Institute of Health, Economist Intelligence Unit
影响因子：
4.2
作者：
Mills HL;White E;Colijn C;Vickerman P;Heimer R
通讯作者：
Heimer R