An opportunity lost: HIV infections associated with lack of a national needle-exchange programme in the USA
An opportunity lost: HIV infections associated with lack of a national needle-exchange programme in the USA
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DOI：
10.1016/s0140-6736(96)05439-6
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发表时间：
1997-03-01
期刊：
影响因子：
168.9
通讯作者：
Drucker, E
中科院分区：
文献类型：
--
作者：
Lurie, P;Drucker, E
我们的目的是估计如果在美国艾滋病流行的早期阶段实施针头交换方案，本可以预防的艾滋病毒感染的数量。我们还估计了美国医疗保健系统治疗这些可预防的艾滋病毒感染的成本。方法采用公式计算每年可预防艾滋病毒感染人数，考虑了针具交换方案的有效性和使用水平，以及向注射吸毒者（IDUs）的性传播和向其性伴侣和儿童的二次传播。该模型的数据来自于同行评议的已发表研究、政府报告和专家咨询中的流行病学和数学研究。我们以澳大利亚的数据为模型，计算了1987年至1995年间美国国家针头交换计划本可以预防的艾滋病毒感染数量。成本计算基于目前美国政府对治疗艾滋病毒感染的贴现终身成本的估计（55,640美元）。保守估计，本可以预防的HIV感染人数从4394例（由于针头更换，发病率降低15%）到9666例（发病率降低33%）不等。美国医疗保健系统用于治疗这些可预防的艾滋病毒感染的费用分别在2.44亿美元至5.38亿美元之间。如果美国不改变目前的政策。我们估计，到2000年，可预防的艾滋病毒感染可能会增加5150- 11329例。尽管有六份政府资助的报告支持针头交换，但美国联邦政府未能实施一项全国性的针头交换计划，这可能导致成千上万的注射吸毒者、他们的性伴侣和他们的孩子感染艾滋病毒。撤销美国政府禁止为针头交换项目提供资金的禁令，并加快此类项目在美国的发展，是公共卫生领域的当务之急。
Background Our aim was to estimate the number of HIV infections that could have been prevented had needle-exchange programmes been implemented during the early stages of the AIDS epidemic in the USA. We also estimated the cost to the US health-care system to treat these preventable HIV infections.Methods The formula we used to calculate the annual number of preventable HIV infections accounted for the effectiveness and level of use of needle-exchange programmes, as well as sexual transmission to injection drug users (IDUs) and secondary transmission to their sexual partners and children. Data for the model were obtained from epidemiological and mathematical studies in peer-reviewed published research, government reports, and consultations with experts. Using data from Australia as a model, we calculated the number of HIV infections that could have been prevented by a national needle-exchange programme in the USA between 1987 and 1995. Cost calculations were based on the current US government estimate of the discounted lifetime cost of treating an HIV infection (US$55 640).Findings Our conservative calculation of the number of HIV infections that could have been prevented ranged from 4394 (15% incidence reduction due to needle exchanges) to 9666 (33% incidence reduction). The cost to the US health-care system of treating these preventable HIV infections is between US$ 244 million and US$ 538 million, respectively. If current US policies are not changed. we estimate that an additional 5150-11 329 preventable HIV infections could occur by the year 2000.Interpretation The failure of the federal government in the USA to implement a national needle-exchange programme, despite six government-funded reports in support of needle exchanges, may have led to HIV infection among thousands of IDUs, their sexual partners, and their children. Revoking the US government ban on funding for needle-exchange programmes and accelerating the growth of such programmes in the USA are urgent public-health priorities.