Modeling the impact and cost-effectiveness of opioid agonist treatments to reduce the negative consequences of incarceration on HIV and TB transmission in Eastern Europe and Central Asia

艾滋病毒的发病率和死亡率在全球有所下降，但在东欧和中亚有所上升 (EECA)，在那里艾滋病毒流行主要通过注射吸毒(IDU)助长，主要是阿片类药物。 此外，结核病越来越多地与艾滋病毒感染和注射吸毒者联系在一起，结核病发病率上升，并成为主要 EECA中艾滋病毒感染者(PWH)的死因。欧洲经济和社会理事会对吸毒的严厉刑事定罪导致 注射毒品者(PWID)的监禁率极高，他们的艾滋病毒和结核病通过 艾滋病毒的高危行为和结核病的过度拥挤。我们来自全球荟萃分析的新数据显示 在PWID中，监禁会增加81%的艾滋病毒感染风险，我们在乌克兰的发现表明，28%- 在PWID中55%的新HIV感染可归因于发生在 PWID最近或曾经被监禁。此外，我们最近的统计分析表明，结核病的负担 在乌克兰，与多年监禁密切相关，特别是在感染艾滋病毒的PWID患者中。 应对艾滋病患者中监禁、艾滋病毒和结核病传播综合征的有效策略 EECA应包括使用美沙酮或丁丙诺啡的阿片激动剂治疗(OAT)。这些有效的 治疗减少了注射的频率和感染艾滋病毒的风险。燕麦还可以改善艾滋病毒和结核病 治疗效果和减少犯罪活动，因此还可以减少艾滋病毒和结核病的传播 减少监禁的有害影响，提高燕麦片本身的预防效益。纵向扩展 如果将社区和监狱中的燕麦片与扩大艾滋病毒和结核病治疗联系起来，将特别有效。 该项目的目的是开发和测试新的建模策略，以评估影响和成本- 在我们收集的乌克兰和吉尔吉斯斯坦的刑事司法环境中扩大审查处的效力 相当多的数据。为了充分了解燕麦片在监狱中的好处，我们还将估计以下因素的贡献 在这两个国家中，因艾滋病毒和结核病传播而被监禁的残疾人和普通民众。我们会 基于我们现有的实施科学研究(R01 DA029910，MATLINK战略)的数据，在 我们已经引入(乌克兰)或扩大(吉尔吉斯斯坦)向有OUD的囚犯提供燕麦片，包括 在发布后链接到OAT，以捕捉这一特定的高风险时期。我们将使用以下结果的数据 MATLINK及相关研究和收集的成本数据，以预测扩大规模的影响和成本效益 监狱内的OAT(使用MATLINK)，在获释后与社区OAT建立联系，纳入直接 在PWID和普通人群中预防艾滋病毒传播的好处以及通过以下方式获得的次级好处 改善艾滋病毒和结核病的治疗结果，减少监禁。调查结果可以用来指导政策 在整个EECA和艾滋病毒集中在PWID的其他环境中。

HIV incidence and mortality has decreased globally, but has increased in Eastern Europe and Central Asia (EECA), where the HIV epidemics are fueled primarily by injecting drug use (IDU), mostly of opioids. Furthermore, TB is increasingly linked to HIV infection and IDU, with TB rates increasing and being the main cause of death among people with HIV (PWH) in EECA. Harsh criminalization of drug use in EECA results in extraordinarily high incarceration rates of people who inject drugs (PWID), whose HIV and TB are amplified by high risk behaviors for HIV and overcrowding for TB. Our new data from a global meta-analysis shows that incarceration increases HIV acquisition risk 81% in PWID, and our findings from Ukraine suggest that 28%– 55% of new HIV infections among PWID are attributable to the heightened risk behavior that occurs among PWID recently or ever incarcerated. Furthermore, our recent statistical analyses suggest that the burden of TB in Ukraine is strongly associated with years of incarceration, particularly among PWID with HIV. An effective strategy for tackling the syndemics of incarceration, HIV and TB transmission among PWID in EECA should include opioid agonist treatments (OAT) with methadone or buprenorphine. These effective treatments reduce the frequency of injecting and the risk of HIV acquisition. OAT also improves HIV and TB treatment outcomes and reduces criminal activity, and so could also reduce HIV and TB transmission through reducing the detrimental effect of incarceration and improving the preventative benefits of OAT itself. Scaled up OAT in the community and prison would be especially effective if linked with HIV and TB treatment scale-up. The aim of this project is to develop and testing new modeling strategies to evaluate the impact and cost- effectiveness of scaling-up OAT in criminal justice settings in Ukraine and Kyrgyzstan where we have collected considerable data. To capture the full benefits of OAT in prison, we will also estimate the contribution of incarceration to HIV and TB transmission among PWID and the general population in both countries. We will build on data from our existing implementation science research (R01 DA029910, the MATLINK strategy), in which we have introduced (Ukraine) or expanded (Kyrgyzstan) OAT provision to prisoners with OUD, including linkage to OAT following release to capture this particular high-risk period. We will use data on outcomes from MATLINK and related studies and collected cost data to project the impact and cost-effectiveness of scaling-up prison-based OAT (using MATLINK) with linkage to community OAT after release, incorporating the direct prevention benefits on HIV transmission in PWID and general population and secondary benefits through improving HIV and TB treatment outcomes and reducing incarceration. Findings can be used to guide policies throughout EECA and other settings where HIV is concentrated in PWID.