Effectiveness of needle-exchange programmes for prevention of HIV infection
Effectiveness of needle-exchange programmes for prevention of HIV infection
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DOI：
10.1016/s0140-6736(96)11380-5
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发表时间：
1997-06-21
期刊：
影响因子：
168.9
通讯作者：
Kaldor, JM
中科院分区：
文献类型：
--
作者：
Hurley, SF;Jolley, DJ;Kaldor, JM
背景 针头交换计划（NEP）可能是遏制注射吸毒者中艾滋病毒感染传播的一项关键策略，但其实施因其有效性的不确定性而受到限制。我们采用生态研究设计来比较全球范围内有和没有 NEP 的城市注射吸毒者中 HIV 血清阳性率随时间的变化。方法 确定了已发表的注射吸毒者中 HIV 血清阳性率的报告，并从疾病控制和预防中心获得了 1988 年至 1993 年间美国接受戒毒治疗的注射吸毒者中 HIV 血清阳性率的未发表信息。 NEP 实施的详细信息来自已发表的报告和专家。对于81个城市中每一个拥有1年以上HIV血清阳性率数据和NEP实施细节的城市，通过回归分析估算血清阳性率的变化率。计算了有和没有 NEP 的城市该比率的平均差异。 结果 平均而言，在 52 个没有 NEP 的城市中，血清阳性率每年增加 5.9%，在 29 个有 NEP 的城市中，每年下降 5.8%。在实施 NEP 的城市中，血清流行率的年平均变化降低了 11%（95% CI - 17.6 至 -3.9，p = 0.004）。解释 对于这种差异的一个合理解释是，NEP 导致注射吸毒者中艾滋病毒发病率的降低。尽管可能会产生混淆，但我们的结果以及 NEP 可以降低 HIV 发病率的明确理论机制，有力地支持了 NEP 有效的观点。
Background Needle-exchange programmes (NEPs) are potentially a key strategy for containing the spread of HIV infection among injecting drug users, but their implementation has been limited by uncertainty about their effectiveness. We used an ecological study design to compare changes over time in HIV seroprevalence in injecting drug users worldwide, for cities with and without NEPs.Methods Published reports of HIV seroprevalence in injecting drug users were identified, and unpublished information on HIV seroprevalence for injecting drug users entering drug treatment in the USA between 1988 and 1993 was obtained from the Centers for Disease Control and Prevention. Details of the implementation of NEPs were obtained from published reports and experts. For each of the 81 cities with HIV seroprevalence data from more than 1 year and NEP implementation details, the rate of change of seroprevalence was estimated by regression analysis. The average difference in this rate for cities with and without NEPs was calculated.Findings On average, seroprevalence increased by 5.9% per year in the 52 cities without NEPs, and decreased by 5.8% per year in the 29 cities with NEPs. The average annual change in seroprevalence was 11% lower in cities with NEPs (95% CI - 17.6 to -3.9, p = 0.004).Interpretation A plausible explanation for this difference is that NEPs led to a reduction in HIV incidence among injecting drug users. Despite the possibility of confounding, our results, together with the clear theoretical mechanisms by which NEPs could reduce HIV incidence, strongly support the view that NEPs are effective.