Hammett Theodore M, Kling Ryan, Johnston Patrick, Liu Wei, Ngu Doan, Friedmann Patricia, Binh Kieu Thanh, Dong Ha Viet, Van Ly Kieu, Donghua Meng, Chen Yi, Jarlais Don C Des
Abt Associates Inc., Cambridge, MA 02138, USA.
AIDS Educ Prev. 2006 Apr;18(2):97-115. doi: 10.1521/aeap.2006.18.2.97.
In 2002, we implemented a 4-year HIV prevention intervention for injection drug users (IDUs) in Lang Son Province, Vietnam, and Ning Ming County, Guangxi Province, China, a cross-border region seriously affected by inter-twined epidemics of heroin injection and HIV infection. The interventions involve peer education on HIV risk reduction and provision of new needles/syringes through direct distribution and pharmacy vouchers. We consider this to be a structural intervention in which risk reduction information and sterile injection equipment are diffused through the IDU populations and not limited to those who actually interact with peer educators. The evaluation of structural interventions poses complex methodological challenges. The evaluation of our interventions relies primarily on cross-sectional surveys (interviews and HIV testing) of samples of IDUs selected using a combination of targeted cluster and snowball methods. We consider this to be an appropriate, albeit imperfect, design given the study context. This paper presents analyses of data from the IDU surveys conducted just prior to implementation of the interventions and 24 months thereafter. The cross-border interventions have reached large proportions of the IDUs in the project sites, drug-related HIV risk behaviors have declined in frequency, and HIV prevalence among IDUs has been stable in China and declined in Vietnam over the 24 months since the interventions were implemented. Attribution of these positive trends to the interventions must be qualified in light of possible sampling biases and the absence of control groups. However, we believe that the structural interventions implemented by the cross-border project have played a role in stabilizing HIV prevalence among IDUs two years after they were initiated. Evidence of further diffusion of the interventions among IDUs and continued stability or decline of HIV prevalence would strengthen this case.
2002年，我们在越南谅山省和中国广西宁明县（一个受海洛因注射和艾滋病毒感染交织流行严重影响的跨境地区）对注射吸毒者实施了一项为期四年的艾滋病毒预防干预措施。这些干预措施包括开展关于降低艾滋病毒风险的同伴教育，以及通过直接分发和药房代金券提供新针头/注射器。我们认为这是一种结构性干预措施，其中降低风险的信息和无菌注射设备在注射吸毒者群体中传播，而不仅限于那些实际与同伴教育者互动的人。对结构性干预措施的评估带来了复杂的方法学挑战。我们对干预措施的评估主要依赖于采用目标集群和滚雪球方法相结合选取的注射吸毒者样本的横断面调查（访谈和艾滋病毒检测）。考虑到研究背景，我们认为这是一个适当的设计，尽管并不完美。本文介绍了在干预措施实施前及实施后24个月对注射吸毒者进行的调查数据的分析情况。跨境干预措施覆盖了项目地点的大部分注射吸毒者，与毒品相关的艾滋病毒风险行为的发生频率有所下降，并且在干预措施实施后的24个月里，中国注射吸毒者中的艾滋病毒感染率保持稳定，越南则有所下降。鉴于可能存在的抽样偏差和缺乏对照组的情况，将这些积极趋势归因于干预措施必须谨慎。然而，我们认为跨境项目实施的结构性干预措施在启动两年后对稳定注射吸毒者中的艾滋病毒感染率起到了作用。干预措施在注射吸毒者中进一步传播的证据以及艾滋病毒感染率持续稳定或下降的情况将进一步支持这一观点。
