Evaluation of the Control of HIV After a Prison Amnesty in Taiwan

台湾监狱特赦后艾滋病毒控制评估

• 批准号: 7547723
• 负责人: Kenrad E Nelson
• 金额: $ 14.36万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-08-01 至 2010-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7547723
• 关键词: AIDS/HIV problem; Accounting; Address; Age; Area; Asians; Attitude; Behavior; Biological; Blood; Case Study; Centers for Disease Control and Prevention (U.S.); Central Asia; Characteristics; China; Clinic; Cohort Studies; Collaborations; Commit; Communities; Counseling; Country; Coupled; Crime; Criminology; Death Records; Developed Countries; Developing Countries; Development; Drug Addiction; Drug usage; Eastern Europe; Education; Effectiveness; Epidemic; Evaluation; Face; Far East; General Population; Geographic Locations; Government; HIV; HIV Infections; HIV Seropositivity; HIV-1; Harm Reduction; Health; Health Services Accessibility; Health education; Healthcare; Hepatitis; Hepatitis B Virus; Hepatitis C Prevalence; Hepatitis C virus; Heroin; High Prevalence; Human immunodeficiency virus test; Illicit Drugs; Incidence; Income; Individual; Infection; Injecting drug user; Injection of therapeutic agent; Institutes; Institution; Interview; Knowledge; Law Enforcement; Maintenance; Medical; Methadone; Modeling; Needle-Exchange Programs; Needles; Numbers; Patients; Persons; Pharmaceutical Preparations; Population; Prevention; Prevention program; Prisoner; Prisons; Public Health; Public Health Schools; Rate; Recombinants; Recording of previous events; Reporting; Research; Research Project Grants; Risk; Risk Behaviors; Saliva; Sampling; Seroprevalences; Services; Sex Behavior; Site; Societies; Syphilis; Syringes; Taiwan; United Nations; Universities; base; cohort; methadone clinic/center; mortality; prevent; programs; prospective; sex; social; transmission process; treatment program

DESCRIPTION (provided by applicant): The injection of illicit drugs (IDU) is a major risk behavior for the transmission and acquisition of HIV-1 infection. Globally IDUs account for over 10% of persons with HIV/AIDS. However, in some areas in SE Asia and Eastern Europe, especially, injection drug use is the major behavior accounting for a rapidly expanding HIV epidemic. This situation is characteristic of the HIV/AIDS epidemic in Taiwan in the past 3 years. Recently the numbers of reported cases of HIV/AIDS expanded substantially and about 70% of recent cases have been in IDUs. Also, IDUs have been infected with a new recombinant HIV-1 subtype (CRF07_BC), which was imported from mainland China along with significant increased quantities of heroin. It is estimated that there are over 100,000 persons who inject heroin in Taiwan. There are 30,000 HIV/AIDS cases in Taiwan. In an effort to deal with this epidemic, the Taiwan Health Department has instituted a major Harm Reduction Program including 61 methadone maintenance clinics, 1181 needle exchange sites, HIV testing and counseling and other services. In July, 2007 a large prison amnesty was enacted and over 10,000 prisoners were released, including 4,878 with a history of IDU of whom 15% were HIV-positive. In this research project we plan to evaluate the health effects of the prisoner release, its effect on the prisoners and society and the effectiveness of the harm reduction program in dealing with this challenge. Our specific aims are to: 1. Evaluate the overall and cause specific mortality in prisoners with an IDU history after their release in comparison to those in the general population of similar age and sex, 2. Compare the characteristics of prisoners who use with those who do not use harm reduction services after their release 3. Evaluate the knowledge and attitudes about harm reduction services in a sample of 1000-1500 released prisoners, 4. Estimate the high risk drug use and sexual behavior among a cohort of released prisoners by their HIV infection status and their use/non-use of harm reduction services, and 5. Evaluate the incidence of HIV, HCV, HBV and syphilis infections according to their use or non-use of harm reduction services. The results of this research should be very useful to Taiwan and many other countries having significant HIV/AIDS epidemics in IDU populations. Many developing and developed countries have substantial populations of incarcerated prisoners, many of whom are injection drug users. When these populations are released from prison they are at increased risk of mortality and acquisition or transmission of HIV. This study will evaluate the effectiveness of a comprehensive harm reduction program in mitigating these risks. This project will evaluate the effect of a major harm reduction program instituted by the Taiwan Health Department on prisoners who were IDUs released as part of an amnesty program. To deal with the HIV epidemic among IDUs (who have accounted for about 70% of recent cases of HIV), the Taiwan government instituted many harm reduction services, including methadone maintenance clinics, NEPs and HIV testing and counseling. In 2007, a large prison amnesty was enacted, and Taiwan released over 10,000 prisoners, including about 5,000 with a history of IDU of whom 15% were HIV+. The aim of this project is to evaluate the impact of the prevention program by interviewing and obtaining biological samples from 1,000-1,500 randomly selected released prisoners with an IDU history, in order to: (1) evaluate mortality in prisoners after their release; (2) compare characteristics of prisoners who use and do not use harm reduction services; (3) evaluate their knowledge and attitudes about harm reduction; (4) estimate drug and sexual risk behavior by HIV status and harm reduction use; and (5) evaluate the incidence of HIV, HCV, HBV and syphilis in relation to use of harm reduction services. The addresses of the released prisoners are available and the 3 most populous geographic areas (north, south, and on the central west coast) will be selected, targeting approximately 1500 individuals. Subjects will be contacted for an interview regarding risk behaviors, use of harm reduction services, and testing for HIV, HCV, syphilis and HBV. Overall and cause-specific mortality rates will be assessed by searching official death records for the entire cohort of prisoners with a history of illicit drug use, and comparing their rates with that of similar other persons and with other former prisoners without a known drug use history. The collaboration is between the Bloomberg School of Public Health of Johns Hopkins University and the Center for Disease Control in Taiwan.

描述（由申请人提供）：注射非法药物（IDU）是传播和获得HIV-1感染的主要风险行为。在全球范围内，注射吸毒者占艾滋病毒/艾滋病感染者的10%以上。然而，在东南亚和东欧的一些地区，特别是注射吸毒是艾滋病毒流行迅速蔓延的主要行为。这种情况是过去三年台湾艾滋病毒/艾滋病流行的特点。最近，报告的艾滋病毒/艾滋病病例数量大幅度增加，最近的病例中约70%是注射吸毒者。此外，注射吸毒者感染了一种新的重组HIV-1亚型（CRF 07_BC），这种病毒是沿着大量增加的海洛因从中国大陆进口的。据估计，台湾有超过10万人注射海洛因。台湾有3万名艾滋病感染者。为了应对这一流行病，台湾卫生署制定了一项重大的减少伤害计划，包括61个美沙酮维持诊所、1 181个针头交换点、艾滋病毒检测和咨询以及其他服务。2007年7月，颁布了一项大规模监狱大赦令，释放了10，000多名囚犯，其中包括4，878名有注射吸毒史的囚犯，其中15%是艾滋病毒阳性者。在这个研究项目中，我们计划评估释放囚犯对健康的影响，对囚犯和社会的影响，以及减少危害计划在应对这一挑战方面的有效性。我们的具体目标是：1.评价释放后有注射吸毒史的囚犯与年龄和性别相似的一般人群相比的总体死亡率和具体原因死亡率，2.比较囚犯释放后使用与不使用减少伤害服务的特点3.评估1000-1500名刑满释放人员对减害服务的知识和态度。根据一组刑满释放人员的HIV感染状况和他们使用/不使用减少伤害服务的情况，估计他们的高危毒品使用和性行为。根据使用或不使用减少伤害服务，评估艾滋病毒、丙型肝炎病毒、乙型肝炎病毒和梅毒感染的发生率。本研究之结果对台湾及其他注射吸毒者中HIV/AIDS流行率高的国家，应具有相当的参考价值。许多发展中国家和发达国家有大量被监禁的囚犯，其中许多人是注射毒品使用者。当这些人从监狱释放后，他们死亡和感染或传播艾滋病毒的风险增加。本研究将评价综合伤害降低计划在缓解这些风险方面的有效性。 本研究将评估台湾卫生署针对因注射吸毒而被特赦的囚犯所实施的重大减害计划的效果。为了应对注射吸毒者中的艾滋病毒流行（他们占最近艾滋病毒病例的70%左右），台湾政府制定了许多减少伤害的服务，包括美沙酮维持诊所，NEP和艾滋病毒检测和咨询。2007年，台湾颁布了一项大型监狱大赦令，释放了10，000多名囚犯，其中包括约5，000名有注射吸毒史的囚犯，其中15%是艾滋病毒阳性者。该项目的目的是评价预防方案的影响，方法是对1，000 - 1，500名随机挑选的有注射吸毒史的获释囚犯进行访谈并获取生物样本，以便：（1）评价囚犯获释后的死亡率;（2）比较使用和不使用减少伤害服务的囚犯的特点;（3）评估他们对减少伤害的知识和态度;（4）通过HIV状况和减少伤害的使用来估计毒品和性风险行为;（5）评估与使用减少伤害服务有关的HIV、HCV、HBV和梅毒的发病率。已释放囚犯的地址可用，将选择人口最多的3个地理区域（北部、南部和中西部海岸），目标约为1500人。将联系受试者，就风险行为、使用减少伤害服务以及HIV、HCV、梅毒和HBV检测进行访谈。将通过搜索整个有非法药物使用史的囚犯队列的官方死亡记录，并将他们的死亡率与类似的其他人和其他没有已知药物使用史的前囚犯的死亡率进行比较，来评估总体死亡率和特定原因死亡率。 这项合作是由约翰霍普金斯大学彭博公共卫生学院和台湾疾病控制中心合作进行的。