Center for HIV Educational Studies & Training, Hunter College of the City University of New York, NY 10018, United States; Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria 3052, Australia.
The Kirby Institute, UNSW Australia, Sydney, New South Wales 2052, Australia.
Int J Drug Policy. 2017 Sep;47:69-76. doi: 10.1016/j.drugpo.2017.06.007. Epub 2017 Jul 20.
Research indicates that hepatitis C antibody (anti-HCV) prevalence is higher among Australian Aboriginal and Torres Strait Islander (Aboriginal) than non-Aboriginal people who inject drugs (PWID). We examined trends in demographic and drug use characteristics and anti-HCV prevalence among Australian Needle and Syringe Program Survey (ANSPS) respondents by Aboriginal status from 1996 to 2015.
The ANSPS survey involved collecting demographic, behavioural data and a dried blood spot for anti-HCV testing. We used logistic regression to determine demographic and behavioural factors associated with testing anti-HCV positive in the following time-periods (1996-2000, 2001-2005, 2006-2010, 2011-2015) among Aboriginal and non-Aboriginal PWID respondents.
Overall, there were 16,948 PWID, with 11% identifying as Aboriginal. The proportion of Aboriginal respondents increased from 7% in 1996-2000 to 16% in 2011-2015. Overall anti-HCV prevalence was significantly higher among Aboriginal (60%) than non-Aboriginal PWID (52%, p<0.01). Receptive syringe sharing (RSS) declined among non-Aboriginal PWID (p<0.001) over time, however among Aboriginal PWID, RSS remained stable (p=0.619). Factors independently associated with testing positive for anti-HCV among Aboriginal PWID in 2011-2015 were 16 or more years since first injection (adjusted odds ratio [AOR] 6.04, p<0.001), history of incarceration (AOR: 1.74, p=0.010) and currently or previously on opioid substitution therapy (AOR: 1.89, p=0.003). Compared to 1996-2000, testing anti-HCV positive was significantly associated with the time-periods: 2001-2005 (unadjusted odds ratio [OR]: 1.39, p<0.001), 2006-2010 (OR: 1.38, p<0.001) and 2011-2015 (OR: 1.25, p<0.001) among non-Aboriginal PWID; however this increase did not occur among Aboriginal PWID.
The proportion of Aboriginal PWID attending Needle Syringe Programs appears to have increased. Overall, the prevalence of anti-HCV has remained higher among Aboriginal than non-Aboriginal PWID. Coupling increased access to NSPs with new interferon-free HCV treatments and culturally appropriate education and counselling services could influence new HCV infections among Aboriginal PWID.
研究表明，与非土著澳大利亚注射吸毒者（PWID）相比，澳大利亚原住民和托雷斯海峡岛民（土著）的丙型肝炎抗体（抗-HCV）流行率更高。我们通过 1996 年至 2015 年的澳大利亚针具和注射器计划调查（ANSPS）受访者的土著身份，检查了人口统计学和吸毒特征以及抗-HCV 流行率的趋势。
ANSPS 调查涉及收集人口统计学、行为数据和用于抗-HCV 检测的干血斑。我们使用逻辑回归来确定在以下时间段内（1996-2000 年、2001-2005 年、2006-2010 年、2011-2015 年），与土著和非土著 PWID 受访者的抗-HCV 检测呈阳性相关的人口统计学和行为因素。
总体而言，共有 16948 名 PWID，其中 11%为土著。土著受访者的比例从 1996-2000 年的 7%增加到 2011-2015 年的 16%。总体而言，土著（60%）的抗-HCV 流行率明显高于非土著 PWID（52%，p<0.01）。非土著 PWID 中接受性注射器共享（RSS）的比例随着时间的推移而下降（p<0.001），但在土著 PWID 中，RSS 保持稳定（p=0.619）。2011-2015 年，与土著 PWID 抗-HCV 检测呈阳性相关的独立因素包括首次注射后 16 年或以上（调整后的优势比[OR] 6.04，p<0.001）、有监禁史（OR：1.74，p=0.010）和目前或以前接受过阿片类药物替代疗法（OR：1.89，p=0.003）。与 1996-2000 年相比，抗-HCV 检测呈阳性与以下时间段显著相关：2001-2005 年（未调整的优势比[OR]：1.39，p<0.001）、2006-2010 年（OR：1.38，p<0.001）和 2011-2015 年（OR：1.25，p<0.001）非土著 PWID；然而，这种增长并没有发生在土著 PWID 中。
参加针具注射器计划的土著 PWID 的比例似乎有所增加。总体而言，土著 PWID 的抗-HCV 流行率仍然高于非土著 PWID。增加 NSP 的获取机会，结合新的无干扰素 HCV 治疗方法以及文化上适当的教育和咨询服务，可以影响土著 PWID 中的新 HCV 感染。
