印度东北部注射毒品女性中艾滋病毒和丙型肝炎感染的流行病学：一项应答者驱动抽样研究。
Epidemiology of HIV and hepatitis C infection among women who inject drugs in Northeast India: a respondent-driven sampling study.
作者信息
McFall Allison M, Solomon Sunil S, Lucas Greg M, Celentano David D, Srikrishnan Aylur K, Kumar Muniratnam S, Mehta Shruti H
机构信息
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Johns Hopkins University School of Medicine, Baltimore, MD, USA.
出版信息
Addiction. 2017 Aug;112(8):1480-1487. doi: 10.1111/add.13821. Epub 2017 Apr 18.
BACKGROUND AND AIMS
Despite extensive research on HIV and hepatitis C (HCV) among people who inject drugs (PWID), there remains a gap in knowledge on the burden among women who inject drugs and their unique contexts and risk factors. This analysis compares HIV and HCV prevalence in female and male PWID and estimates injection and sexual risk correlates of prevalent HIV and HCV infection among women in Northeast India.
DESIGN
Cross-sectional sample accrued using respondent-driven sampling.
SETTING
Seven cities in Northeast India, 2013.
PARTICIPANTS
A total of 6457 adult PWID.
MEASUREMENTS
Participants completed an interviewer-administered survey. HIV infection was diagnosed on-site and HCV antibody testing was performed on stored specimens. HIV and HCV prevalence estimates were stratified by gender. Among women, the association of risk correlates with HIV and HCV were estimated using multi-level logistic regression models.
FINDINGS
A total of 796 (15.9%) of the PWID were women, of whom 52.9% [95% confidence interval (CI) = 49.3-56.5%] were HIV-infected and 22.3% (CI = 19.9-24.7%) were HCV-infected. HIV and HCV prevalence among men was 17.4% (CI = 16.9-24.7%) and 30.4% (CI = 31.2-32.0%), respectively. Among women, correlates of HIV were widowhood [adjusted odds ratio (aOR) versus currently married = 4.03, CI = 2.13-7.60] and a higher number of life-time sexual partners (aOR ≥8 versus none = 3.08, CI = 1.07-8.86). Correlates of HCV were longer injection duration (aOR per 10 years = 1.70, CI = 1.25-2.27), injecting only heroin and a combination of drugs (aOR versus pharmaceuticals only = 5.63, CI = 1.68-18.9 and aOR = 2.58, CI = 1.60-4.16, respectively), sharing needles/syringes (aOR = 2.46, CI = 1.29-4.56) and a larger PWID network (aOR ≥ 51 versus 1-5 = 4.17, CI = 2.43-7.17).
CONCLUSIONS
Women who inject drugs in Northeast India have a high HIV prevalence, which was more than double their hepatitis C (HCV) prevalence, an opposite pattern than is observed typically among male PWID. HIV infection is associated with sexual risk factors while injection-related behaviors appear to drive HCV infection.
背景与目的
尽管针对注射吸毒者（PWID）中的艾滋病毒和丙型肝炎（HCV）进行了广泛研究，但在注射吸毒女性群体中，关于疾病负担及其独特背景和风险因素的认知仍存在差距。本分析比较了男性和女性注射吸毒者中的艾滋病毒和丙肝病毒感染率，并估算了印度东北部女性中现患艾滋病毒和丙肝病毒感染的注射及性传播风险相关因素。
设计
采用应答驱动抽样方法收集横断面样本。
地点
2013年，印度东北部的七个城市。
参与者
共计6457名成年注射吸毒者。
测量指标
参与者完成了一份由访谈员实施的调查。现场诊断艾滋病毒感染情况，并对储存样本进行丙肝抗体检测。按性别对艾滋病毒和丙肝病毒感染率估计值进行分层。在女性中，使用多水平逻辑回归模型估算风险相关因素与艾滋病毒和丙肝病毒感染之间的关联。
研究结果
共有796名（15.9%）注射吸毒者为女性，其中52.9%[95%置信区间（CI）=49.3 - 56.5%]感染艾滋病毒，22.3%（CI = 19.9 - 24.7%）感染丙肝病毒。男性中的艾滋病毒和丙肝病毒感染率分别为17.4%（CI = 16.9 - 24.7%）和30.4%（CI = 31.2 - 32.0%）。在女性中，艾滋病毒感染的相关因素为丧偶[调整优势比（aOR）与目前已婚者相比=4.03，CI = 2.13 - 7.60]以及性伴侣数量较多（aOR≥8个与无相比=3.08，CI = 1.07 - 8.86）。丙肝病毒感染的相关因素为注射持续时间较长（每10年aOR = 1.70，CI = 1.25 - 2.27）、仅注射海洛因及多种药物混合注射（与仅注射药品相比aOR分别为5.63，CI = 1.68 - 18.9和aOR = 2.58，CI = 1.60 - 4.16）、共用针头/注射器（aOR = 2.46，CI = 1.29 - 4.56）以及较大的注射吸毒者社交网络（aOR≥51人相比1 - 5人=4.17，CI = 2.43 - 7.17）。
结论
印度东北部的注射吸毒女性艾滋病毒感染率较高，是其丙型肝炎（HCV）感染率的两倍多，这与男性注射吸毒者中通常观察到的模式相反。艾滋病毒感染与性传播风险因素相关，而与注射相关的行为似乎是丙肝病毒感染的驱动因素。
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