坦桑尼亚达累斯萨拉姆注射吸毒人群中 HIV-1 感染的流行情况及相关危险因素：干预成功的迹象？
Prevalence and risk factors associated with HIV-1 infection among people who inject drugs in Dar es Salaam, Tanzania: a sign of successful intervention?
机构信息
Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, 9 United Nations Road, P.O. Box 65001, Dar es Salaam, Tanzania.
Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
出版信息
Harm Reduct J. 2020 Mar 24;17(1):18. doi: 10.1186/s12954-020-00364-5.
BACKGROUND
Prevalence of HIV infection among people who inject drugs (PWID) has been reported to be higher than that of the general population. The present study aimed to estimate the prevalence of HIV infection and associated risk factors among PWID in Dar es Salaam, Tanzania, following the introduction of a comprehensive HIV intervention package (CHIP) for PWID in the country in 2014.
METHODS
We conducted an integrated bio-behavioral survey (IBBS) among PWID using respondent-driven sampling (RDS) in Dar es Salaam, Tanzania, between October and December 2017. Data on socio-demographic characteristics and risky behaviors were collected through face-to-face interviews. Blood samples were collected and tested for HIV infection. We accounted for weighting in the analyses, and logistic regression was performed to assess risk factors for HIV infection.
RESULTS
A total of 611 PWID (94.4% males and 5.6% females) with a median age of 34 years (IQR 29-38) were recruited. The overall prevalence of HIV infection was 8.7% (95% CI 6.5-10.9). The prevalence of HIV infections for males and females were 6.8% (95% CI 4.7-8.9%) and 41.2% (95% CI 23.7-58.6%) respectively. Adjusted weighted logistic regression analysis (WLRA) showed that being a female (aOR 19.1; 95% CI 5.9-61.8), injecting drugs for more than 10 years (aOR = 7.32; 95% CI 2.1-25.5) compared to 1 year or less and being 45 years or older (aOR = 34.22; 95% CI 2.4-489.5) compared to being 25 years or younger were associated with increased odds of HIV infection. Use of a sterile needle at last injection decreased odds of HIV infection (aOR = 0.3; 95% CI 0.1-0.8).
CONCLUSIONS
The present study observed a decline in prevalence of HIV infections among PWID in Dar es Salaam (8.7%) compared to a previous estimate of 15.5% from an IBBS conducted in 2013. Despite the decrease, HIV prevalence remains high among PWID compared to the general population, and women are disproportionally affected. The decline may be possibly attributed to the on-going implementation of CHIP for PWID, highlighting the need for strengthening the existing harm reduction interventions by incorporating access to sterile needle/syringe and addressing the layered risks for women.
背景
据报道，注射毒品者（PWID）中的艾滋病毒感染率高于一般人群。本研究旨在评估 2014 年坦桑尼亚在全国范围内为 PWID 推出综合艾滋病毒干预一揽子计划（CHIP）后，达累斯萨拉姆 PWID 中的艾滋病毒感染率及其相关危险因素。
方法
我们于 2017 年 10 月至 12 月期间在达累斯萨拉姆采用基于回应者驱动抽样（RDS）的综合生物行为调查（IBBS），对 PWID 进行了调查。通过面对面访谈收集社会人口统计学特征和危险行为数据。采集血样并检测艾滋病毒感染情况。我们在分析中考虑了加权，并进行逻辑回归评估艾滋病毒感染的危险因素。
结果
共招募了 611 名 PWID（94.4%为男性，5.6%为女性），中位年龄为 34 岁（IQR 29-38）。总的艾滋病毒感染率为 8.7%（95%CI 6.5-10.9）。男性和女性的 HIV 感染率分别为 6.8%（95%CI 4.7-8.9%）和 41.2%（95%CI 23.7-58.6%）。调整后的加权逻辑回归分析（WLRA）表明，女性（aOR 19.1；95%CI 5.9-61.8）、与注射毒品 1 年或以下相比，注射毒品 10 年以上（aOR = 7.32；95%CI 2.1-25.5）以及年龄在 45 岁或以上（aOR = 34.22；95%CI 2.4-489.5）与 HIV 感染的几率增加相关。与上次注射使用无菌针相比，最后一次注射使用无菌针会降低 HIV 感染的几率（aOR = 0.3；95%CI 0.1-0.8）。
结论
与 2013 年进行的 IBBS 之前估计的 15.5%相比，本研究观察到达累斯萨拉姆 PWID 的 HIV 感染率有所下降（8.7%）。尽管有所下降，但与一般人群相比，PWID 中的 HIV 流行率仍然很高，而且女性受到的影响不成比例。这种下降可能归因于正在为 PWID 实施的 CHIP，这突出表明需要通过提供无菌针/注射器并解决妇女面临的多层次风险来加强现有的减少伤害干预措施。
Zotero 插件