坦桑尼亚达累斯萨拉姆阿片类药物治疗患者队列中丙型肝炎病毒（HCV）的患病率及预测因素
Prevalence and predictors of HCV among a cohort of opioid treatment patients in Dar es Salaam, Tanzania.
作者信息
Lambdin Barrot H, Lorvick Jennifer, Mbwambo Jessie K, Rwegasha John, Hassan Saria, Lum Paula, Kral Alex H
机构信息
RTI-International, San Francisco, CA , United States; University of California San Francisco, San Francisco, CA, United States; University of Washington, Seattle, WA, United States.
RTI-International, San Francisco, CA , United States.
出版信息
Int J Drug Policy. 2017 Jul;45:64-69. doi: 10.1016/j.drugpo.2017.05.043. Epub 2017 Jun 17.
BACKGROUND
The government of Tanzania launched an opioid treatment program (OTP), using methadone, in Dar es Salaam in February of 2011. Hepatitis C virus (HCV) is a leading cause of morbidity and mortality globally, especially among people who inject drugs (PWID). We conducted a cross-sectional study among PWID engaged in OTP in Dar es Salaam to describe the prevalence and predictors of HCV antibody serostatus.
METHODS
Routine programmatic data on patients enrolled in Muhimbili National Hospital's OTP clinic from February 2011 to January 2013 were utilized. Multivariable Poisson regression was used to examine factors associated with HCV antibody serostatus.
RESULTS
A total of 630 PWID enrolled into the OTP clinic during the study period, seven percent of which were women. The overall seroprevalence of HCV antibody was 57% (95% Confidence interval: 53-61%). In adjusted analysis, methadone patients who used heroin for 5-10 years (adjusted prevalence ratio; aPR=1.41; 95% CI: 1.10-1.81) and >10years (aPR=1.48; 95% CI: 1.17-1.88) were more likely to be HCV antibody positive, compared to patients who used heroin for <5years. Patients who reported sharing needles or other equipment at their last injection (aPR=1.20; 95% CI: 1.01-1.41; p=0.022), being arrested (aPR=1.20; 95% CI: 1.04-1.40; p=0.012) and who were HIV-positive (aPR=1.84; 95% CI: 1.56-2.16; p<0.001) were also more likely to be HCV antibody positive than their counterparts.
CONCLUSION
Our observed HCV antibody prevalence among PWID engaged in OTP is higher than previously reported estimates in Dar es Salaam. Predictors of HCV antibody serostatus in this sample were similar to those found among PWID in many other settings. Integrating HCV care and treatment into OTP clinics should be considered, leveraging lessons learned from the integration of HIV services into OTP. Global efforts to develop HCV care and treatment programs in low and middle-income countries are critical, especially among PWID who have a high burden of HCV.
背景
2011年2月，坦桑尼亚政府在达累斯萨拉姆启动了一项使用美沙酮的阿片类药物治疗项目（OTP）。丙型肝炎病毒（HCV）是全球发病和死亡的主要原因，尤其是在注射吸毒者（PWID）中。我们在达累斯萨拉姆参与OTP的PWID中进行了一项横断面研究，以描述HCV抗体血清学状态的患病率和预测因素。
方法
利用2011年2月至2013年1月在穆希姆比利国家医院OTP诊所登记患者的常规项目数据。采用多变量泊松回归分析与HCV抗体血清学状态相关的因素。
结果
在研究期间，共有630名PWID登记进入OTP诊所，其中7%为女性。HCV抗体的总体血清阳性率为57%（95%置信区间：53 - 61%）。在调整分析中，与使用海洛因<5年的患者相比，使用海洛因5 - 10年（调整患病率比；aPR = 1.41；95% CI：1.10 - 1.81）和>10年（aPR = 1.48；95% CI：1.17 - 1.88）的美沙酮患者更有可能HCV抗体呈阳性。报告在最后一次注射时共用针头或其他设备的患者（aPR = 1.20；95% CI：1.01 - 1.41；p = 0.022）、被逮捕的患者（aPR = 1.20；95% CI：1.04 - 1.40；p = 0.012）以及HIV阳性患者（aPR = 1.84；95% CI：1.56 - 2.16；p < 0.001）也比其对应者更有可能HCV抗体呈阳性。
结论
我们观察到参与OTP的PWID中HCV抗体患病率高于达累斯萨拉姆先前报告的估计值。该样本中HCV抗体血清学状态的预测因素与许多其他环境中PWID的预测因素相似。应考虑将HCV护理和治疗纳入OTP诊所，借鉴将HIV服务纳入OTP的经验教训。在低收入和中等收入国家开展HCV护理和治疗项目的全球努力至关重要，尤其是在HCV负担较重的PWID中。
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