Zelenev Alexei, Long Elisa, Bazazi Alexander R, Kamarulzaman Adeeba, Altice Frederick L
Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, 135 College St., Suite 323, New Haven, CT 06510, USA.
UCLA Anderson School of Management, Decisions, Operations & Technology Management Department, Los Angeles, CA, USA.
Int J Drug Policy. 2016 Nov;37:98-106. doi: 10.1016/j.drugpo.2016.08.008. Epub 2016 Sep 15.
HIV is primarily concentrated among people who inject drugs (PWID) in Malaysia, where currently HIV prevention and treatment coverage is inadequate. To improve the targeting of interventions, we examined HIV clustering and the role that social networks and geographical distance play in influencing HIV transmission among PWID.
Data were derived from a respondent-driven survey sample (RDS) collected during 2010 of 460 PWID in greater Kuala Lumpur. Analysis focused on socio-demographic, clinical, behavioural, and network information. Spatial probit models were developed based on a distinction between the influence of peers (individuals nominated through a recruitment network) and neighbours (residing a close distance to the individual). The models were expanded to account for the potential influence of the network formation.
Recruitment patterns of HIV-infected PWID clustered both spatially and across the recruitment networks. In addition, HIV-infected PWID were more likely to have peers and neighbours who inject with clean needles were HIV-infected and lived nearby (<5km), more likely to have been previously incarcerated, less likely to use clean needles (26.8% vs 53.0% of the reported injections, p<0.01), and have fewer recent injection partners (2.4 vs 5.4, p<0.01). The association between the HIV status of peers and neighbours remained significantly correlated even after controlling for unobserved variation related to network formation and sero-sorting.
The relationship between HIV status across networks and space in Kuala Lumpur underscores the importance of these factors for surveillance and prevention strategies, and this needs to be more closely integrated. RDS can be applied to identify injection network structures, and this provides an important mechanism for improving public health surveillance, accessing high-risk populations, and implementing risk-reduction interventions to slow HIV transmission.
在马来西亚，艾滋病毒主要集中在注射毒品者（PWID）中，目前该国的艾滋病毒预防和治疗覆盖率不足。为了改进干预措施的针对性，我们研究了艾滋病毒的聚集情况以及社交网络和地理距离在影响注射毒品者之间艾滋病毒传播中所起的作用。
数据来自2010年在吉隆坡大都市区对460名注射毒品者进行的应答驱动抽样调查（RDS）。分析重点关注社会人口统计学、临床、行为和网络信息。基于同伴（通过招募网络提名的个体）和邻居（居住在个体附近的人）的影响差异，开发了空间概率模型。这些模型经过扩展，以考虑网络形成的潜在影响。
感染艾滋病毒的注射毒品者的招募模式在空间上以及在招募网络中都呈现出聚集现象。此外，感染艾滋病毒的注射毒品者更有可能有注射时使用干净针头的同伴和邻居也感染了艾滋病毒且居住在附近（<5公里），更有可能曾被监禁，使用干净针头的可能性较小（报告的注射中分别为26.8%和53.0%，p<0.01），并且近期的注射伙伴较少（分别为2.4人和5.4人，p<0.01）。即使在控制了与网络形成和血清分类相关的未观察到的变异之后，同伴和邻居的艾滋病毒感染状况之间的关联仍然显著相关。
吉隆坡网络和空间中艾滋病毒感染状况之间的关系强调了这些因素对监测和预防策略的重要性，并且需要更紧密地整合。应答驱动抽样调查可用于识别注射网络结构，这为改善公共卫生监测、接触高危人群以及实施降低风险干预措施以减缓艾滋病毒传播提供了重要机制。
