注射吸毒者中未诊断出的艾滋病毒和丙型肝炎感染：从新证据到更好的实践。
Undiagnosed HIV and Hepatitis C infection in people who inject drugs: From new evidence to better practice.
作者信息
Parés-Badell Oleguer, Espelt Albert, Folch Cinta, Majó Xavier, González Victoria, Casabona Jordi, Brugal M Teresa
机构信息
Public Health Agency of Barcelona, 1 Pl. de Lesseps, Barcelona 08023, Spain; Institute of Biomedical Research Sant Pau, 167 Sant Antoni Maria Claret, Barcelona 08025, Spain.
Public Health Agency of Barcelona, 1 Pl. de Lesseps, Barcelona 08023, Spain; Institute of Biomedical Research Sant Pau, 167 Sant Antoni Maria Claret, Barcelona 08025, Spain; Department of Psychobiology and Methodology of Health Sciences, Autonomous University of Barcelona, Plaça Cívica, Bellaterra 08093, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Biomedical Research Centre Network for Epidemiology and Public Health (Spain), 5 Monforte de Lemos, Madrid 28029, Spain.
出版信息
J Subst Abuse Treat. 2017 Jun;77:13-20. doi: 10.1016/j.jsat.2017.03.003. Epub 2017 Mar 9.
BACKGROUND
The objective of this study was to estimate the proportion of undiagnosed HIV or Hepatitis C virus (HCV) infection and to assess the risk factors associated with an undiagnosed infection.
METHODS
A questionnaire was distributed among people who inject drugs (PWID) in harm reduction centres in Catalonia, Spain 2008-2012 (n=2243). Self-report of HIV and HCV was compared to oral fluid tests to calculate the proportion of undiagnosed infection. Associations of undiagnosed HIV and HCV with age, origin, risk and protective factors of infection and services use were calculated using a Poisson regression model with robust variance.
RESULTS
The sensitivity of HIV self-report was 78.5% (75.2%-81.5%) and of HCV was 81.2% (79.1%-83.2%), being lower in younger and foreign-born PWID. Specificity for HCV was 55.9% (51.6%-60.1%). PWID who engaged in infection risk behaviors had lower risk of being undiagnosed. Being foreign-born and younger increased the risk of undiagnosed infection. PWID who had not accessed medical care in the last 6months had 1.46 (1.10-1.93) times more risk of undiagnosed HIV and 1.37 (1.11-1.70) times more risk of undiagnosed HCV.
CONCLUSION
Outreach programmes are essential to provide PWID, specially foreign-born and younger PIWD, access to HIV and HCV test.
背景
本研究的目的是估计未被诊断出的艾滋病毒或丙型肝炎病毒（HCV）感染比例，并评估与未被诊断出的感染相关的风险因素。
方法
2008年至2012年期间，在西班牙加泰罗尼亚的减少伤害中心向注射吸毒者（PWID）发放了问卷（n = 2243）。将艾滋病毒和丙型肝炎病毒的自我报告与口腔液检测结果进行比较，以计算未被诊断出的感染比例。使用具有稳健方差的泊松回归模型计算未被诊断出的艾滋病毒和丙型肝炎病毒感染与年龄、出身、感染的风险和保护因素以及服务使用情况之间的关联。
结果
艾滋病毒自我报告的敏感性为78.5%（75.2% - 81.5%），丙型肝炎病毒自我报告的敏感性为81.2%（79.1% - 83.2%），在年轻和外国出生的注射吸毒者中较低。丙型肝炎病毒的特异性为55.9%（51.6% - 60.1%）。从事感染风险行为的注射吸毒者未被诊断出感染的风险较低。外国出生和年轻会增加未被诊断出感染的风险。在过去6个月内未接受医疗护理的注射吸毒者未被诊断出感染艾滋病毒的风险高1.46倍（1.10 - 1.93），未被诊断出感染丙型肝炎病毒的风险高1.37倍（1.11 - 1.70）。
结论
外展项目对于为注射吸毒者，特别是外国出生和年轻的注射吸毒者提供艾滋病毒和丙型肝炎病毒检测至关重要。
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