Socías M Eugenia, Wood Evan, McNeil Ryan, Kerr Thomas, Dong Huiru, Shoveller Jean, Montaner Julio, Milloy M-J
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
Int J Drug Policy. 2017 Jul;45:1-8. doi: 10.1016/j.drugpo.2017.03.008. Epub 2017 Apr 25.
In February 2014, several regulatory reforms were introduced to the methadone maintenance treatment (MMT) program in British Columbia, Canada, including a switch to a ten-times more concentrated methadone formulation and restrictions in pharmacy delivery services. We evaluated possible unintended effects of these changes on illicit drug use patterns and HIV treatment outcomes among HIV-positive opioid users.
Data was drawn from ACCESS, a prospective community-recruited cohort of HIV-positive people who use illicit drugs in Vancouver, Canada. Interrupted Time Series Analyses were used to evaluate impacts of the policy change on monthly rates of MMT enrolment, illicit heroin injection, antiretroviral therapy (ART) adherence, and HIV viral suppression among HIV-positive opioid users between November 2012 and May 2015.
A total of 331 HIV-positive opioid users were included. The MMT policy change led to a significant immediate 11.5% increase in heroin injection, and 15.9% drop in optimal ART adherence. A gradual increase in the prevalence of MMT enrolment after the policy change was also documented (0.9% per month). No changes in viral suppression rates were observed.
We observed immediate increases in illicit heroin injection and decreases in ART adherence in the wake of regulatory changes to the local MMT program. These findings underscore the need to consider potential unintended effects of altering health programmes for vulnerable populations, the need to develop appropriate mitigation strategies, as well as to involve all relevant stakeholders in the planning and implementations of new policies.
2014年2月，加拿大不列颠哥伦比亚省对美沙酮维持治疗（MMT）项目进行了多项监管改革，包括改用浓度高十倍的美沙酮制剂以及限制药房配送服务。我们评估了这些变化对艾滋病毒阳性阿片类药物使用者非法药物使用模式和艾滋病毒治疗结果可能产生的意外影响。
数据来自ACCESS，这是一个在加拿大温哥华通过社区招募的前瞻性艾滋病毒阳性非法药物使用者队列。采用中断时间序列分析来评估2012年11月至2015年5月期间政策变化对艾滋病毒阳性阿片类药物使用者的美沙酮维持治疗登记月率、非法海洛因注射、抗逆转录病毒疗法（ART）依从性和艾滋病毒病毒抑制的影响。
共纳入331名艾滋病毒阳性阿片类药物使用者。美沙酮维持治疗政策变化导致海洛因注射立即显著增加11.5%，最佳抗逆转录病毒疗法依从性下降15.9%。政策变化后美沙酮维持治疗登记患病率也有逐渐上升（每月0.9%）。未观察到病毒抑制率的变化。
我们观察到当地美沙酮维持治疗项目监管变化后，非法海洛因注射立即增加，抗逆转录病毒疗法依从性下降。这些发现强调了需要考虑改变针对弱势群体的健康项目可能产生的意外影响，需要制定适当的缓解策略，以及让所有相关利益攸关方参与新政策的规划和实施。
