Ukrainian Institute on Public Health Policy, Kyiv, Ukraine.
Alliance for Public Health, Kyiv, Ukraine.
J Int AIDS Soc. 2020 Jun;23 Suppl 3(Suppl 3):e25509. doi: 10.1002/jia2.25509.
People who inject drugs (PWID) remain at high risk of HIV in many countries. The HIV prevention cascades have been proposed to replicate the success of the treatment cascades and reinvigorate the prevention programmes through improved monitoring, planning and delivery. We adapted the cascade framework to the PWID context in Ukraine, assessed gaps and analysed factors associated with achieving "access" and "effective use" outcomes.
Self-reported data on the use of prevention services and risk behaviours from the 2017 integrated bio-behavioural survey among PWID in Ukraine were used to construct cascades for needle/syringe and condom programmes (NSP and CP). Socio-demographic and behavioural variables were evaluated as potential correlates of cascade outcomes.
The NSP cascade analysis included 7815 HIV-negative PWID. Motivation to use clean syringes was not assessed and assumed at 100%. Access to clean syringes through NSP in the past 12 months was reported by 2789 participants (35.7%). Effective use of syringes (no sharing in the past 30 days) was reported by 7405 participants (94.8%). NSP access was higher among women, individuals older than 44, and mixed drug users; while effective use was reported more frequently by men and opioid users, with no difference by age. The CP cascade analysis included 6606 (85%) of the HIV-negative PWID who had sex in the past three months. Of those, 2282 (34.5%) received condoms, and 1708 (25.9%) reported consistent use with all partners in the past three months. Older PWID and mixed-drug users accessed condoms more frequently; whereas younger subgroups and opioid users used them more consistently.
Overall, the cascade framework was useful to describe the status of HIV prevention among PWID in Ukraine and to identify areas for improvement in the programming and evaluation of HIV prevention. Access to needle/syringe and condom programmes was substantially below the recommended levels. Effective use of clean syringes was reported by a vast majority of PWID, although likely affected by self-report bias; whereas consistent condom use was infrequent. Socio-demographic and behavioural variables showed significant associations in NSP and CP cascade analyses, with little consistency between the access and effective use outcomes.
在许多国家，注射吸毒者（PWID）仍然面临着很高的 HIV 感染风险。HIV 预防级联反应旨在通过改进监测、规划和实施，复制治疗级联反应的成功经验，并重新激发预防项目。我们将级联框架应用于乌克兰的 PWID 人群，评估了差距，并分析了与实现“获得”和“有效使用”结果相关的因素。
使用 2017 年乌克兰 PWID 综合生物行为调查中的自我报告数据，构建了针具和 condom 方案（NSP 和 CP）的级联反应。评估了社会人口统计学和行为变量与级联结果的相关性。
NSP 级联分析包括 7815 名 HIV 阴性的 PWID。未评估使用清洁注射器的动机，假设为 100%。过去 12 个月内，有 2789 名参与者（35.7%）通过 NSP 获得了清洁注射器。有 7405 名参与者（94.8%）报告在过去 30 天内没有共用注射器。女性、年龄大于 44 岁和混合药物使用者的 NSP 获得率较高；而男性和阿片类药物使用者更频繁地报告有效使用，年龄没有差异。CP 级联分析包括过去三个月有过性行为的 6606 名（85%）HIV 阴性的 PWID。其中，2282 名（34.5%）接受了 condom，1708 名（25.9%）报告在过去三个月内与所有性伴侣一致使用 condom。年龄较大的 PWID 和混合药物使用者更频繁地获得 condom；而年龄较小的亚组和阿片类药物使用者更频繁地使用 condom，但使用并不一致。
总体而言，级联框架有助于描述乌克兰 PWID 中 HIV 预防的现状，并确定改善 HIV 预防规划和评估的领域。针具和 condom 方案的获得率远低于建议水平。绝大多数 PWID 报告有效使用清洁注射器，尽管可能受到自我报告偏差的影响；而一致使用 condom 的情况并不常见。社会人口统计学和行为变量在 NSP 和 CP 级联分析中显示出显著的相关性，但在获得和有效使用结果之间几乎没有一致性。
