Müller Jana, Schmidt Daniel, Kollan Christian, Lehmann Marc, Bremer Viviane, Zimmermann Ruth
Department of Infectious Disease Epidemiology, HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany.
Charité - Universitätsmedizin Berlin, Berlin, Germany.
BMC Public Health. 2017 Oct 25;17(1):843. doi: 10.1186/s12889-017-4840-4.
In Germany, medical care of prisoners is completely separated from extramural health care. The extent and quality of medical care among prisoners in Germany are therefore largely unknown. We performed a secondary data analysis of pharmacy sales data for tuberculosis (TB), HIV, hepatitis C (HCV) and opioid substitution treatment (OST) delivered to prisons in 11 federal states (FS) in Germany between 01/2012 and 03/2013. The aims of this study were to assess (i) the treatment availability for the selected diseases and OST in German prisons, (ii) the proportion of prisoners treated per FS and overall for TB, HIV, HCV and OST during the study period.
Substances unique to or typically used for the treatment of each disease were defined as marker substances with defined daily doses (DDD). For each marker substance we assessed the cumulative number of DDD, the average daily number of DDD (DDD) and average treatment prevalence per day in percent (adTP). Accordingly, the DDD represents one person treated per day and the adTP means the proportion of prisoners treated per day. We compared the adTP of the diseases with previously measured prevalences.
We obtained data from pharmacies supplying prisons in 11 of 16 German FS. Of the included prisons, 41% were supplied with medicines for TB, 71% for HIV and 58% for HCV and OST. Twice as many delivered marker substances for TB were indicated for the continuation phase and chemoprevention than the intensive phase. The HIV adTP ranged from 0.06% to 0.94%, HCV adTP ranged from 0.03% to 0.59% and OST adTP ranged from 0% to 7.90%. The overall adTP for the respective treatment was 0.39% for HIV, 0.12% for HCV and 2.18% for OST.
According to our findings treatment rates for TB were consistent with the expected TB prevalence, at least in Berlin. HIV treatment seems to be offered to an adequate proportion of estimated infected prisoners. In contrast, the HCV treatment prevalence was low. High variation among FS in provision of all treatments, particularly of OST, point to inconsistent treatment practices, although nationwide extramural treatment guidelines for Germany exist.
在德国，囚犯的医疗保健与校外医疗保健完全分开。因此，德国囚犯医疗保健的范围和质量在很大程度上尚不为人所知。我们对2012年1月至2013年3月期间德国11个联邦州（FS）监狱提供的结核病（TB）、艾滋病毒、丙型肝炎（HCV）和阿片类药物替代治疗（OST）的药房销售数据进行了二次数据分析。本研究的目的是评估（i）德国监狱中选定疾病和OST的治疗可用性，（ii）在研究期间每个联邦州以及总体上接受结核病、艾滋病毒、丙型肝炎和OST治疗的囚犯比例。
将每种疾病特有的或通常用于治疗的物质定义为具有规定日剂量（DDD）的标记物质。对于每种标记物质，我们评估了DDD的累积数量、DDD的平均每日数量（DDD）以及以百分比表示的每日平均治疗患病率（adTP）。因此，DDD代表每天接受治疗的一人，而adTP表示每天接受治疗的囚犯比例。我们将这些疾病的adTP与先前测量的患病率进行了比较。
我们从为德国16个联邦州中的11个州的监狱供应药品的药房获得了数据。在所纳入的监狱中，41%的监狱有治疗结核病的药品供应，71%有治疗艾滋病毒的药品供应，58%有治疗丙型肝炎和OST的药品供应。用于结核病延续期和化学预防的已交付标记物质是强化期的两倍。艾滋病毒的adTP范围为0.06%至0.94%，丙型肝炎的adTP范围为0.03%至0.59%，OST的adTP范围为0%至7.90%。相应治疗的总体adTP，艾滋病毒为0.39%，丙型肝炎为0.12%，OST为2.18%。
根据我们的研究结果，结核病的治疗率与预期的结核病患病率一致，至少在柏林是这样。似乎有足够比例的估计感染囚犯接受了艾滋病毒治疗。相比之下，丙型肝炎的治疗患病率较低。尽管德国有全国性的校外治疗指南，但各联邦州在提供所有治疗，特别是OST方面存在很大差异，这表明治疗做法不一致。
