National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia.
National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia.
Lancet Glob Health. 2017 Dec;5(12):e1192-e1207. doi: 10.1016/S2214-109X(17)30375-3. Epub 2017 Oct 23.
Sharing of equipment used for injecting drug use (IDU) is a substantial cause of disease burden and a contributor to blood-borne virus transmission. We did a global multistage systematic review to identify the prevalence of IDU among people aged 15-64 years; sociodemographic characteristics of and risk factors for people who inject drugs (PWID); and the prevalence of HIV, hepatitis C virus (HCV), and hepatitis B virus (HBV) among PWID.
Consistent with the GATHER and PRISMA guidelines and without language restrictions, we systematically searched peer-reviewed databases (MEDLINE, Embase, and PsycINFO; articles published since 2008, latest searches in June, 2017), searched the grey literature (websites and databases, searches between April and August, 2016), and disseminated data requests to international experts and agencies (requests sent in October, 2016). We searched for data on IDU prevalence, characteristics of PWID, including gender, age, and sociodemographic and risk characteristics, and the prevalence of HIV, HCV, and HBV among PWID. Eligible data on prevalence of IDU, HIV antibody, HBsAg, and HCV antibody among PWID were selected and, where multiple estimates were available, pooled for each country via random effects meta-analysis. So too were eligible data on percentage of PWID who were female; younger than 25 years; recently homeless; ever arrested; ever incarcerated; who had recently engaged in sex work, sexual risk, or injecting risk; and whose main drugs injected were opioids or stimulants. We generated regional and global estimates in line with previous global reviews.
We reviewed 55 671 papers and reports, and extracted data from 1147 eligible records. Evidence of IDU was recorded in 179 of 206 countries or territories, which cover 99% of the population aged 15-64 years, an increase of 31 countries (mostly in sub-Saharan Africa and the Pacific Islands) since a review in 2008. IDU prevalence estimates were identified in 83 countries. We estimate that there are 15·6 million (95% uncertainty interval [UI] 10·2-23·7 million) PWID aged 15-64 years globally, with 3·2 million (1·6-5·1 million) women and 12·5 million (7·5-18·4 million) men. Gender composition varied by location: women were estimated to comprise 30·0% (95% UI 28·5-31·5) of PWID in North America and 33·4% (31·0-35·6) in Australasia, compared with 3·1% (2·1-4·1) in south Asia. Globally, we estimate that 17·8% (10·8-24·8) of PWID are living with HIV, 52·3% (42·4-62·1) are HCV-antibody positive, and 9·0% (5·1-13·2) are HBV surface antigen positive; there is substantial geographic variation in these levels. Globally, we estimate 82·9% (76·6-88·9) of PWID mainly inject opioids and 33·0% (24·3-42·0) mainly inject stimulants. We estimate that 27·9% (20·9-36·8) of PWID globally are younger than 25 years, 21·7% (15·8-27·9) had recently (within the past year) experienced homelessness or unstable housing, and 57·9% (50·5-65·2) had a history of incarceration.
We identified evidence of IDU in more countries than in 2008, with the new countries largely consisting of low-income and middle-income countries in Africa. Across all countries, a substantial number of PWID are living with HIV and HCV and are exposed to multiple adverse risk environments that increase health harms.
Australian National Drug and Alcohol Research Centre, Australian National Health and Medical Research Council, Open Society Foundation, World Health Organization, the Global Fund, and UNAIDS.
共用注射吸毒（IDU）所用设备是导致疾病负担的一个重要原因，也是血源性病毒传播的一个促成因素。我们进行了一项全球性多阶段系统评价，以确定 15-64 岁人群中 IDU 的流行率；注射吸毒者（PWID）的社会人口学特征和风险因素；以及 PWID 中 HIV、丙型肝炎病毒（HCV）和乙型肝炎病毒（HBV）的流行率。
根据 GATHER 和 PRISMA 指南，且不受语言限制，我们系统地检索了同行评议数据库（MEDLINE、Embase 和 PsycINFO；自 2008 年以来发表的文章，最新搜索于 2017 年 6 月进行），搜索了灰色文献（网站和数据库，2016 年 4 月至 8 月进行搜索），并向国际专家和机构发出数据请求（请求于 2016 年 10 月发出）。我们搜索了 IDU 流行率、PWID 的特征（包括性别、年龄和社会人口学及风险特征）以及 PWID 中 HIV、HCV 和 HBV 的流行率等方面的数据。选择了有关 PWID 中 IDU 流行率、HIV 抗体、HBsAg 和 HCV 抗体的合格数据，如果有多个估计值，则通过随机效应荟萃分析为每个国家进行汇总。同样，合格数据还包括女性 PWID 的百分比；年龄小于 25 岁；最近无家可归；曾被逮捕；曾被监禁；最近从事性工作、性风险或注射风险；以及主要注射的药物是阿片类药物或兴奋剂。我们按照之前的全球审查生成了区域和全球估计值。
我们审查了 55671 篇论文和报告，并从 1147 份合格记录中提取了数据。在 206 个国家或地区中有 179 个记录了 IDU 的证据，涵盖了 15-64 岁人群的 99%，比 2008 年的审查增加了 31 个国家（主要在撒哈拉以南非洲和太平洋岛屿）。在 83 个国家确定了 IDU 流行率估计值。我们估计全球有 1560 万（95%置信区间 [UI] 1020-2370 万）15-64 岁的 PWID，其中 320 万（160-510 万）是女性，1250 万（750-1840 万）是男性。位置的性别构成有所不同：在北美，估计有 30.0%（95% UI 28.5-31.5）的 PWID 为女性，在澳大拉西亚为 33.4%（31.0-35.6），而在南亚为 3.1%（2.1-4.1）。全球范围内，估计有 17.8%（10.8-24.8）的 PWID 携带 HIV，52.3%（42.4-62.1）的 HCV 抗体阳性，9.0%（5.1-13.2）的 HBsAg 阳性；这些水平存在很大的地域差异。全球范围内，估计有 82.9%（76.6-88.9）的 PWID 主要注射阿片类药物，33.0%（24.3-42.0）主要注射兴奋剂。我们估计全球有 27.9%（20.9-36.8）的 PWID 年龄小于 25 岁，21.7%（15.8-27.9）最近（过去一年）经历过无家可归或不稳定的住房，57.9%（50.5-65.2）有监禁史。
我们在比 2008 年更多的国家发现了 IDU 的证据，而这些新国家主要是非洲的低收入和中等收入国家。在所有国家中，大量的 PWID 携带 HIV 和 HCV，并且面临多种不利的风险环境，这会增加健康危害。
澳大利亚国家药物和酒精研究中心、澳大利亚国家健康与医学研究理事会、开放社会基金会、世界卫生组织、全球基金和艾滋病规划署。
