全美历史最悠久的州级注射器交换项目的服务对象中丙型肝炎病毒（HCV）和人类免疫缺陷病毒（HIV）的感染血清流行率：社区卫生外展预防艾滋病（CHOW）工作的横断面研究。

Seroprevalence of HCV and HIV infection among clients of the nation's longest-standing statewide syringe exchange program: A cross-sectional study of Community Health Outreach Work to Prevent AIDS (CHOW).

机构信息

University of Hawai'i at Mānoa, Office of Public Health Studies, 1960 East-West Road, Biomed. D204, Honolulu, HI 96822, USA.

The Community Health Outreach Work to Prevent AIDS Project (CHOW Project), 677 Ala Moana Blvd., Suite 226, Honolulu, HI 96813, USA.

出版信息

Int J Drug Policy. 2017 Oct;48:34-43. doi: 10.1016/j.drugpo.2017.06.009. Epub 2017 Aug 2.

DOI:10.1016/j.drugpo.2017.06.009

PMID:28779632

Abstract

BACKGROUND

The Community Health Outreach Work to Prevent AIDS (CHOW) Project is the first and longest-standing statewide integrated and funded needle and syringe exchange program (SEP) in the US. Initiated on O'ahu in 1990, CHOW expanded statewide in 1993. The purpose of this study is to estimate the prevalences of hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infection, and to characterize risk behaviors associated with infection among clients of a long-standing SEP through the analysis of the 2012 CHOW evaluation data.

METHODS

A cross-sectional sample of 130 CHOW Project clients was selected from January 1, 2012 through December 31, 2012. Questionnaires captured self-reported exposure information. HIV and HCV antibodies were detected via rapid, point-of-care FDA-approved tests. Log-binomial regressions were used to estimate prevalence proportion ratios (PPRs). A piecewise linear log-binomial regression model containing 1 spline knot was used to fit the age-HCV relationship.

RESULTS

The estimated seroprevalence of HCV was 67.7% (95% confidence interval [CI]=59.5-75.8%). HIV seroprevalence was 2.3% (95% CI=0-4.9%). Anti-HCV prevalence demonstrated age-specific patterns, ranging from 31.6% through 90.9% in people who inject drugs (PWID) <30 to ≥60 years respectively. Age (continuous/year) prior to spline knot at 51.5 years (adjusted PPR [APPR]=1.03; 95% CI=1.02-1.05) and months exchanging syringes (quartiles) (APPR=1.92; 95% CI=1.3-3.29) were independently associated with anti-HCV prevalence.

CONCLUSION

In Hawai'i, HCV prevalence among PWID is hyperendemic demonstrating age- and SEP duration-specific trends. Relatively low HIV prevalence compared with HCV prevalence reflects differences in transmissibility of these 2 blood-borne pathogens and suggests much greater efficacy of SEP for HIV prevention.

摘要

背景

社区艾滋病外展工作（CHOW）项目是美国首个也是持续时间最长的全州范围内综合性和有资金支持的针具交换项目。该项目于 1990 年在瓦胡岛启动，1993 年在全州范围内推广。本研究的目的是通过分析 2012 年 CHOW 评估数据，估计长期针具交换项目（SEP）使用者中丙型肝炎病毒（HCV）和人类免疫缺陷病毒（HIV）感染的流行率，并描述与感染相关的风险行为。

方法

从 2012 年 1 月 1 日至 2012 年 12 月 31 日，从 CHOW 项目中选择了 130 名项目使用者的横断面样本。问卷收集了自我报告的暴露信息。通过快速、即时的、经食品药品监督管理局批准的检测方法检测 HIV 和 HCV 抗体。使用对数二项回归估计流行率比例比（PPR）。使用包含 1 个样条结的分段线性对数二项回归模型拟合年龄-HCV 关系。

结果

HCV 的估计血清流行率为 67.7%（95%置信区间[CI]=59.5-75.8%）。HIV 的血清流行率为 2.3%（95% CI=0-4.9%）。抗-HCV 的流行率呈现出年龄特异性模式，在年龄分别为<30 至≥60 岁的吸毒者（PWID）中，范围从 31.6%到 90.9%不等。51.5 岁时的年龄（连续/年）（调整后的流行率比例比[APPR]=1.03；95%CI=1.02-1.05）和交换注射器的月数（四分位数）（APPR=1.92；95%CI=1.3-3.29）与抗-HCV 的流行率独立相关。