College of Global Public Health, New York University, 665 Broadway, 8th Floor, New York, NY, 10003, USA.
ZevRoss Spatial Analysis, Ithaca, NY, 14850, USA.
Harm Reduct J. 2019 Sep 2;16(1):53. doi: 10.1186/s12954-019-0326-2.
To identify geographic "hotspots" for potential transmission of HIV and HCV and for drug overdose among persons who use heroin and cocaine in New York City and to examine historical continuities in problem drug use hotspots in the city.
A total of 2714 study participants were recruited among persons entering Beth Israel substance use treatment programs. A structured questionnaire was administered and blood samples for HIV and HCV testing were collected. Hotspots for potential virus transmission were defined as ZIP codes with 10+ participants, 2+ persons infected with the virus and engaging in transmission behavior, and 2+ persons not infected and engaging in acquisition behavior. ZIP codes with 3+ persons with previous overdoses were considered potential hotspots for future overdoses.
Participants resided in 166/178 (93%) of the ZIP codes in New York City. Injecting drug use was reported in 150/178 (84%) of the ZIP codes. No zip codes were identified for injecting-related HIV transmission, 5 zip codes were identified for sexual HIV transmission, 3 for HCV transmission, and 8 for drug overdose. Many of the ZIP code potential hotspots were in neighborhoods long associated with drug use: Lower Eastside and Harlem in Manhattan, the South Bronx, and Central Brooklyn.
Heroin and cocaine use requiring treatment were reported from almost all ZIP codes in New York City, indicating needs for widely dispersed harm reduction services. Identified hotspots should be targeted for reducing sexual transmission of HIV, transmission of HCV, and drug overdoses. Some of the hotspots have persisted as problem drug use areas for 40 to over 100 years. Monitoring of drug use patterns in historical hotspot neighborhoods may permit early identification of and response to emerging drug use-related health problems. Persistent historical hotspots for problem drug use present a complex problem for implementing harm reduction services that deserve additional research.
确定纽约市使用海洛因和可卡因的人群中 HIV 和 HCV 潜在传播以及药物过量的地理“热点”，并检查该市滥用药物热点的历史连续性。
共在进入 Beth Israel 药物使用治疗计划的人群中招募了 2714 名研究参与者。对他们进行了结构化问卷调查，并采集了用于 HIV 和 HCV 检测的血样。潜在病毒传播热点定义为 10 名以上参与者、2 名以上感染者有传播行为以及 2 名以上未感染者有感染行为的邮政编码。有 3 名以上既往过量用药者的邮政编码被认为是未来发生过量用药的潜在热点。
参与者居住在纽约市 178 个/166 个（93%）邮政编码中。178 个/150 个（84%）邮政编码报告有注射吸毒行为。没有一个邮政编码被确定为与注射相关的 HIV 传播，5 个邮政编码被确定为性传播 HIV，3 个邮政编码被确定为 HCV 传播，8 个邮政编码被确定为药物过量。许多潜在的邮政编码热点都在与毒品使用长期相关的社区：曼哈顿的下东区和哈莱姆区、南布朗克斯区和布鲁克林中心区。
纽约市几乎所有邮政编码都报告了需要治疗的海洛因和可卡因使用，这表明需要广泛分散的减少伤害服务。确定的热点应成为减少 HIV 性传播、HCV 传播和药物过量的目标。一些热点作为滥用药物问题区域已经存在了 40 年甚至 100 多年。对历史热点社区的药物使用模式进行监测，可能有助于及早发现和应对新出现的与药物使用相关的健康问题。持续存在的滥用药物热点问题给实施减少伤害服务带来了复杂的挑战，值得进一步研究。
