坦桑尼亚达累斯萨拉姆注射吸毒者中高风险行为与传染病筛查之间的不匹配
A Mismatch between High-Risk Behaviors and Screening of Infectious Diseases among People Who Inject Drugs in Dar es Salaam, Tanzania.
作者信息
Mlunde Linda Beatrice, Sunguya Bruno Fokas, Mbwambo Jessie Kazeni, Ubuguyu Omary Said, Shibanuma Akira, Yasuoka Junko, Jimba Masamine
机构信息
Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
Department of Community Health, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar es Salaam, Tanzania.
出版信息
PLoS One. 2016 Feb 5;11(2):e0148598. doi: 10.1371/journal.pone.0148598. eCollection 2016.
BACKGROUND
People who inject drugs are at risk of various infectious diseases. Despite such a risk, evidence is limited which studied the utilization of screening services for common infectious diseases among people who inject drugs in Tanzania. We aimed to examine their high-risk behaviors; utilization of screening services for HIV infection, hepatitis B/C, any other sexually transmitted infection, and tuberculosis; and their associated factors in Dar es Salaam, Tanzania.
METHODS
We conducted a baseline cross-sectional study as part of a prospective cohort study of people who inject drugs. We included 578 participants comprising of new enrollees of the integrated methadone-assisted treatment program and those who were selected from the communities but not enrolled in the program. We interviewed new enrollees preceding their enrollment and receipt of services from the program. We measured participants' high-risk behaviors and their utilization of screening services. We analyzed the data descriptively and used multiple logistic regressions to identify the factors associated with ever being screened for infectious diseases.
RESULTS
Of 578 participants, 14.2% shared injection needles. Of 547 sexually active participants, 37.5% had multiple sexual partners and only 17.4% used a condom. Of all participants, however, only 36.0% had ever been screened for HIV infection, 18.5% for tuberculosis, 11.8% for any other sexually transmitted infection, and 11.6% for hepatitis B/C. They were more likely to have ever been screened for HIV infection if they had education levels above primary education (adjusted odds ratio [AOR]: 2.54, 95% CI: 1.54-4.20), had a history of transactional sex (OR: 2.63, 95% CI: 1.01-6.84), and were new enrollees of the program (AOR: 7.41, 95% CI: 4.41-12.86).
CONCLUSIONS
People who inject drugs practice high-risk behaviors but their utilization of screening services for infectious diseases is poor in Dar es Salaam, Tanzania. It is crucial to increase the coverage of screening services for them and strengthen the counseling of safer sexual practices.
背景
注射毒品者面临多种传染病风险。尽管存在这种风险，但在坦桑尼亚，针对注射毒品者中常见传染病筛查服务利用情况的研究证据有限。我们旨在调查他们的高危行为；艾滋病毒感染、乙型/丙型肝炎、任何其他性传播感染和结核病筛查服务的利用情况；以及在坦桑尼亚达累斯萨拉姆的相关因素。
方法
作为对注射毒品者的前瞻性队列研究的一部分，我们进行了一项基线横断面研究。我们纳入了578名参与者，包括美沙酮综合辅助治疗项目的新入组者以及从社区中挑选出但未纳入该项目的人员。我们在新入组者登记并接受该项目服务之前对他们进行了访谈。我们测量了参与者的高危行为及其对筛查服务的利用情况。我们对数据进行了描述性分析，并使用多元逻辑回归来确定与曾接受传染病筛查相关的因素。
结果
在578名参与者中，14.2%的人共用注射针头。在547名性活跃参与者中，37.5%有多个性伴侣，只有17.4%使用避孕套。然而，在所有参与者中，只有36.0%的人曾接受过艾滋病毒感染筛查，18.5%接受过结核病筛查，11.8%接受过任何其他性传播感染筛查，11.6%接受过乙型/丙型肝炎筛查。如果他们的教育水平高于小学（调整后的优势比[AOR]：2.54，95%置信区间：1.54 - 4.20）、有交易性行为史（优势比：2.63，95%置信区间：1.01 - 6.84）以及是该项目的新入组者（AOR：7.41，95%置信区间：4.41 - 12.86），他们更有可能曾接受过艾滋病毒感染筛查。
结论
在坦桑尼亚达累斯萨拉姆，注射毒品者存在高危行为，但他们对传染病筛查服务的利用率较低。提高对他们的筛查服务覆盖率并加强对更安全性行为的咨询至关重要。
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