Scott Nick, McBryde Emma, Kirwan Amy, Stoové Mark
Centre for Population Health, Burnet Institute, Melbourne, VIC 3004, Australia.
Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC 3008, Australia.
PLoS One. 2015 Dec 14;10(12):e0144869. doi: 10.1371/journal.pone.0144869. eCollection 2015.
To determine the effects of 1) a condom distribution program and 2) a condom distribution program combined with opt-out sexually transmitted infection (STI) screening on the transmission and prevalence of STIs in a prison system.
Using data from an implementation evaluation of a state-wide prison condom program and parameter estimates from available literature, a deterministic model was developed to quantify the incidence and prevalence of sexually transmitted HIV, hepatitis B, chlamydia, syphilis and gonorrhoea across 14 Victorian prisons. The model included individual prison populations (by longer (>2 years) or shorter sentence lengths) and monthly prisoner transfers. For each STI, simulations were compared: without any intervention; with a condom distribution program; and with a combined condom and opt-out STI screening at prison reception intervention program.
Condoms reduced the annual incidence of syphilis by 99% (N = 66 averted cases); gonorrhoea by 98% (N = 113 cases); hepatitis B by 71% (N = 5 cases); chlamydia by 27% (N = 196 cases); and HIV by 50% (N = 2 cases every 10 years). Condom availability changed the in-prison epidemiology of gonorrhoea and syphilis from self-sustaining to levels unlikely to result in infection outbreaks; however, condoms did not reduce chlamydia prevalence below a self-sustaining level due to its high infectiousness, high prevalence and low detection rate. When combined with a screening intervention program, condoms reduced chlamydia prevalence further, but not below a self-sustaining level. The low prevalence of HIV and hepatitis B in Australian prisons meant the effects of condoms were predicted to be small.
Condoms are predicted to effectively reduce the incidence of STIs in prison and are predicted to control syphilis and gonorrhoea transmission, however even combined with a screening on arrival program may be insufficient to reduce chlamydia prevalence below self-sustaining levels. To control chlamydia transmission additional screening of the existing prison population would be required.
确定1）避孕套发放项目，以及2）避孕套发放项目结合主动式性传播感染（STI）筛查对监狱系统中性传播感染的传播及流行情况的影响。
利用一项全州监狱避孕套项目实施评估的数据以及现有文献中的参数估计值，建立了一个确定性模型，以量化维多利亚州14所监狱中性传播的艾滋病毒、乙型肝炎、衣原体、梅毒和淋病的发病率及流行情况。该模型纳入了各个监狱的在押人数（按刑期长短分为超过2年或不足2年）以及每月的囚犯转押情况。针对每种性传播感染，对以下模拟情况进行了比较：无任何干预措施；实施避孕套发放项目；以及在监狱收押时实施避孕套发放结合主动式性传播感染筛查的干预项目。
避孕套使梅毒的年发病率降低了99%（避免了66例病例）；淋病降低了98%（113例病例）；乙型肝炎降低了71%（5例病例）；衣原体降低了27%（196例病例）；艾滋病毒降低了50%（每10年2例病例）。避孕套的提供改变了监狱内淋病和梅毒的流行情况，使其从自我维持状态转变为不太可能导致感染爆发的水平；然而，由于衣原体传染性高、流行率高且检测率低，避孕套并未将衣原体流行率降低至自我维持水平以下。当与筛查干预项目相结合时，避孕套进一步降低了衣原体流行率，但仍未低于自我维持水平。澳大利亚监狱中艾滋病毒和乙型肝炎的低流行率意味着预计避孕套的效果较小。
预计避孕套可有效降低监狱中性传播感染的发病率，并预计可控制性传播感染的传播，然而，即使与入狱时的筛查项目相结合，可能仍不足以将衣原体流行率降低至自我维持水平以下。要控制性传播感染的传播，需要对现有监狱在押人员进行额外筛查。
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