Department of Medicine Huddinge, Division of Infection and Dermatology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden.
Infect Dis (Lond). 2020 May;52(5):336-346. doi: 10.1080/23744235.2020.1727002. Epub 2020 Feb 19.
Sharing of unsterile injection equipment contributes to transmission of hepatitis C virus (HCV), HIV and hepatitis B virus (HBV) among people who inject drugs (PWID) but is largely preventable through needle exchange programmes (NEP). Sweden has been one of the last countries in Europe to scale up access to NEP for PWID, who consequently have high prevalence rates of HCV and HIV. The aim of the study was to investigate demographic and drug-related determinants of injection risk behaviours, sharing of needle/syringe and paraphernalia, and patterns of change over time in subgroups of PWID participating in the Stockholm NEP. The Stockholm NEP started in 2013 as the first formal NEP in the region. A total of 2860 PWID were included in this prospective open cohort study. The association between demographic and drug-related determinants and injection risk behaviours were analysed at baseline and followed up at 6, 12, 24, 36 and 48 months post-enrolment. The following factors were associated with high levels of injection risk behaviours at inclusion: female gender, homelessness, low education level, younger age, amphetamine use, not in opioid substitution therapy (OST), being HIV negative and being HCV positive. We found an overall significant decrease in injection risk behaviours over time among participants. Not previously investigated in depth, we found that subgroups of participants varied in degrees of injection risk behaviour reduction over time and that women decreased injection risk behaviours faster than men. Enrolment in OST, HIV positive and age <25 years at inclusion were not associated with a decrease in injection risk behaviours over time. In this prospective cohort study over 4 years, we found that NEP participation was associated with a significant decrease in injection risk behaviours.
未消毒注射设备的共用会导致注射吸毒者（PWID）中丙型肝炎病毒（HCV）、艾滋病毒和乙型肝炎病毒（HBV）的传播，但通过针具交换计划（NEP）可在很大程度上预防这种情况。瑞典是欧洲最后几个扩大 PWID 获得 NEP 机会的国家之一，因此 HCV 和 HIV 的流行率很高。本研究旨在调查参与斯德哥尔摩 NEP 的 PWID 亚组中与人口统计学和药物相关的决定因素，包括注射风险行为、针具/注射器和用具的共用情况，以及随时间的变化模式。斯德哥尔摩 NEP 于 2013 年作为该地区首个正式 NEP 启动。共有 2860 名 PWID 参与了这项前瞻性开放队列研究。在基线时和入组后 6、12、24、36 和 48 个月时，分析了人口统计学和药物相关决定因素与注射风险行为之间的关系。以下因素与入组时高水平的注射风险行为相关：女性、无家可归、教育程度低、年龄较小、使用苯丙胺、未接受阿片类药物替代疗法（OST）、HIV 阴性和 HCV 阳性。我们发现参与者的注射风险行为总体呈随时间显著下降。我们发现，以前没有深入研究过的亚组参与者在随时间减少注射风险行为的程度上存在差异，并且女性比男性更快地减少注射风险行为。入组时接受 OST、HIV 阳性和年龄<25 岁与随时间减少注射风险行为无关。在这项为期 4 年的前瞻性队列研究中，我们发现 NEP 的参与与注射风险行为的显著减少相关。
