National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
Lancet. 2010 Mar 20;375(9719):1014-28. doi: 10.1016/S0140-6736(10)60232-2. Epub 2010 Feb 26.
BACKGROUND: Previous reviews have examined the existence of HIV prevention, treatment, and care services for injecting drug users (IDUs) worldwide, but they did not quantify the scale of coverage. We undertook a systematic review to estimate national, regional, and global coverage of HIV services in IDUs. METHODS: We did a systematic search of peer-reviewed (Medline, BioMed Central), internet, and grey-literature databases for data published in 2004 or later. A multistage process of data requests and verification was undertaken, involving UN agencies and national experts. National data were obtained for the extent of provision of the following core interventions for IDUs: needle and syringe programmes (NSPs), opioid substitution therapy (OST) and other drug treatment, HIV testing and counselling, antiretroviral therapy (ART), and condom programmes. We calculated national, regional, and global coverage of NSPs, OST, and ART on the basis of available estimates of IDU population sizes. FINDINGS: By 2009, NSPs had been implemented in 82 countries and OST in 70 countries; both interventions were available in 66 countries. Regional and national coverage varied substantially. Australasia (202 needle-syringes per IDU per year) had by far the greatest rate of needle-syringe distribution; Latin America and the Caribbean (0.3 needle-syringes per IDU per year), Middle East and north Africa (0.5 needle-syringes per IDU per year), and sub-Saharan Africa (0.1 needle-syringes per IDU per year) had the lowest rates. OST coverage varied from less than or equal to one recipient per 100 IDUs in central Asia, Latin America, and sub-Saharan Africa, to very high levels in western Europe (61 recipients per 100 IDUs). The number of IDUs receiving ART varied from less than one per 100 HIV-positive IDUs (Chile, Kenya, Pakistan, Russia, and Uzbekistan) to more than 100 per 100 HIV-positive IDUs in six European countries. Worldwide, an estimated two needle-syringes (range 1-4) were distributed per IDU per month, there were eight recipients (6-12) of OST per 100 IDUs, and four IDUs (range 2-18) received ART per 100 HIV-positive IDUs. INTERPRETATION: Worldwide coverage of HIV prevention, treatment, and care services in IDU populations is very low. There is an urgent need to improve coverage of these services in this at-risk population. FUNDING: UN Office on Drugs and Crime; Australian National Drug and Alcohol Research Centre, University of New South Wales; and Australian National Health and Medical Research Council.
背景： 先前的综述已经研究了全球范围内针对注射吸毒者（IDU）的艾滋病毒预防、治疗和关怀服务的存在情况，但并未对其覆盖范围进行量化。我们进行了一项系统综述，以估计 IDU 中艾滋病毒服务的国家、区域和全球覆盖范围。
方法： 我们对同行评审（Medline、BioMed Central）、互联网和灰色文献数据库进行了系统搜索，以获取 2004 年或之后发表的数据。我们进行了多阶段的数据请求和验证过程，涉及联合国机构和国家专家。我们获得了各国提供以下核心干预措施的范围的数据：针具交换计划（NSPs）、阿片类药物替代疗法（OST）和其他药物治疗、艾滋病毒检测和咨询、抗逆转录病毒治疗（ART）和 condom 方案。我们根据 IDU 人口规模的现有估计值，计算了 NSPs、OST 和 ART 的国家、区域和全球覆盖范围。
结果： 到 2009 年，已有 82 个国家实施了 NSPs，70 个国家实施了 OST；有 66 个国家同时提供了这两种干预措施。区域和国家的覆盖范围差异很大。澳大拉西亚（每个 IDU 每年 202 个注射器）的注射器分发率迄今为止最高；拉丁美洲和加勒比地区（每年每个 IDU 0.3 个注射器）、中东和北非（每年每个 IDU 0.5 个注射器）和撒哈拉以南非洲（每年每个 IDU 0.1 个注射器）的注射器分发率最低。OST 的覆盖范围从中亚、拉丁美洲和撒哈拉以南非洲每个 IDU 不到一个受援者不等，到西欧每个 IDU 61 个受援者不等。接受 ART 的 IDU 人数从每个感染艾滋病毒的 IDU 不到一个（智利、肯尼亚、巴基斯坦、俄罗斯和乌兹别克斯坦）到六个欧洲国家每个感染艾滋病毒的 IDU 超过 100 个不等。在全球范围内，估计每个 IDU 每月分发 1 到 4 个注射器，每个 IDU 有 8 个接受 OST（6 到 12 个），每个 IDU 有 4 个接受 ART（2 到 18 个）。
解释： 在 IDU 人群中，艾滋病毒预防、治疗和关怀服务的全球覆盖范围非常低。迫切需要提高这一高危人群中这些服务的覆盖面。
资金： 联合国毒品和犯罪问题办公室；澳大利亚国家药物和酒精研究中心，新南威尔士大学；澳大利亚国家卫生和医学研究理事会。
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