Department of Behavioral Sciences and Social Medicine, Center for Medicine and Public Health, Florida State University College of Medicine, Tallahassee, Florida.
J Public Health Manag Pract. 2020 May/Jun;26(3):222-226. doi: 10.1097/PHH.0000000000001152.
In the midst of the current opioid epidemic, states have selected differing legislative routes implementing pathways to ensure access to clean needles and syringes.
To determine whether states that implemented laws supporting syringe exchange programs (SEPs) had reductions in transmission rates of hepatitis B, hepatitis C, and HIV infection compared with states without such laws.
Utilizing a longitudinal panel design, we determined the legal status of SEPs in each state for years 1983-2016. Disease transmission rates for this period were estimated via a simple Poisson regression, with transmitted cases as the dependent variable, law categories as the predictor variables, and the log of state population as the exposure. The mean number of incident cases per state-year was also calculated.
US states were utilized as the unit of analysis.
Hepatitis B and hepatitis C mean transmission rate per 100 000 population declined in states with local ordinances/decriminalized statutes and legalized SEPs (hepatitis B: 71% and 81%, respectively, differences P < .001; hepatitis C: 8% and 38%, respectively, differences P < .001). Reductions in mean incident cases per state-year mirrored these findings. HIV infection among injection drug users yielded inconsistent results.
Hepatitis B and hepatitis C transmission were reduced at the population level in states with SEP laws in a pattern reflecting the degree of legal intervention. HIV infection, based upon a smaller data set, showed a mixed impact.
The results show promise that SEPs have population-level effects on disease transmission. States lacking SEPs should reconsider current policies.
在当前阿片类药物泛滥的情况下，各州选择了不同的立法途径，以确保获得清洁的针头和注射器。
确定实施支持注射器交换计划（SEP）的法律的州与没有此类法律的州相比，乙型肝炎、丙型肝炎和 HIV 感染的传播率是否有所降低。
利用纵向面板设计，我们确定了 1983 年至 2016 年期间各州 SEP 的法律地位。通过简单的泊松回归估计了在此期间的疾病传播率，将传播病例作为因变量，法律类别作为预测变量，州人口的对数作为暴露。还计算了每个州-年的平均发病数。
以美国各州为分析单位。
乙型肝炎和丙型肝炎每 10 万人的平均传播率在有地方条例/非刑事化法规和合法化 SEP 的州下降（乙型肝炎：分别为 71%和 81%，差异 P<.001；丙型肝炎：分别为 8%和 38%，差异 P<.001）。每个州每年的平均发病数的减少反映了这些发现。注射吸毒者中的 HIV 感染结果不一致。
在实施 SEP 法律的州，乙型肝炎和丙型肝炎的传播在人群水平上有所降低，这反映了法律干预的程度。基于较小的数据集，HIV 感染显示出混合影响。
结果表明 SEP 对疾病传播具有人群水平的影响。缺乏 SEP 的州应重新考虑当前的政策。
