美沙酮使用与注射吸毒者中的 HIV 风险行为：使用粗化精确匹配进行因果推断。
Methamphetamine use and HIV risk behavior among men who inject drugs: causal inference using coarsened exact matching.
机构信息
Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
Department of Public Health, School of Psychology & Public Health, La Trobe University, Bundoora, Victoria, Australia.
出版信息
Harm Reduct J. 2020 Sep 21;17(1):66. doi: 10.1186/s12954-020-00411-1.
BACKGROUND
Understanding the association between methamphetamine (MA) use and HIV risk behavior among people who inject drugs (PWID) will assist policy-makers and program managers to sharpen the focus of HIV prevention interventions. This study examines the relationship between MA use and HIV risk behavior among men who inject drugs (MWID) in Tehran, Iran, using coarsened exact matching (CEM).
METHODS
Data for these analyses were derived from a cross-sectional study conducted between June and July 2016. We assessed three outcomes of interest-all treated as binary variables, including distributive and receptive needle and syringe (NS) sharing and condomless sex during the month before interview. Our primary exposure of interest was whether study participants reported any MA use in the month prior to the interview. Firstly, we report the descriptive statistics for the pooled samples and matched sub-samples using CEM. The pooled and matched estimates of the associations and their 95% CI were estimated using a logistic regression model.
RESULTS
Overall, 500 MWID aged between 18 and 63 years (mean = 28.44, SD = 7.22) were recruited. Imbalances in the measured demographic characteristics and risk behaviors between MA users and non-users were attenuated using matching. In the matched samples, the regression models showed participants who reported MA use were 1.82 times more likely to report condomless sex (OR = 1.82 95% CI 1.51, 4.10; P = 0.031), and 1.35 times more likely to report distributive NS sharing in the past 30 days, as compared to MA non-users (OR = 1.35 95% CI 1.15-1.81). Finally, there was a statistically significant relationship between MA use and receptive NS sharing in the past month. People who use MA in the last month had higher odds of receptive NS sharing when compared to MA non-users (OR = 4.2 95% CI 2.7, 7.5; P = 0.013).
CONCLUSIONS
Our results show a significant relationship between MA use and HIV risk behavior among MWID in Tehran, Iran. MA use was related with increased NS sharing, which is associated with higher risk for HIV exposure and transmission.
背景
了解冰毒（MA）使用与注射吸毒者（PWID）中的 HIV 风险行为之间的关联，将有助于政策制定者和项目管理人员更准确地聚焦 HIV 预防干预措施。本研究使用粗化精确匹配（CEM）方法，研究了伊朗德黑兰男性注射吸毒者（MWID）中 MA 使用与 HIV 风险行为之间的关系。
方法
这些分析的数据来自于 2016 年 6 月至 7 月期间进行的一项横断面研究。我们评估了三个感兴趣的结果——均视为二项变量，包括分配性和接受性针具和注射器（NS）共享以及在访谈前一个月发生的无保护性行为。我们主要关注的暴露因素是研究参与者在访谈前一个月是否报告有 MA 使用。首先，我们使用 CEM 报告汇总样本和匹配子样本的描述性统计数据。使用逻辑回归模型估计了关联的汇总和匹配估计及其 95%CI。
结果
共有 500 名年龄在 18 至 63 岁之间的 MWID（平均=28.44，标准差=7.22）入组。使用匹配法减轻了 MA 使用者和非使用者在测量的人口统计学特征和风险行为方面的不平衡。在匹配样本中，回归模型显示，与 MA 非使用者相比，报告 MA 使用的参与者报告无保护性行为的可能性高出 1.82 倍（OR=1.82，95%CI 1.51，4.10；P=0.031），且在过去 30 天内报告分配性 NS 共享的可能性高出 1.35 倍（OR=1.35，95%CI 1.15-1.81）。最后，MA 使用与过去一个月的接受性 NS 共享之间存在统计学显著关系。与 MA 非使用者相比，在过去一个月中使用 MA 的人接受 NS 共享的可能性更高（OR=4.2，95%CI 2.7，7.5；P=0.013）。
结论
我们的研究结果表明，伊朗德黑兰 MWID 中 MA 使用与 HIV 风险行为之间存在显著关系。MA 使用与 NS 共享增加有关，而 NS 共享与 HIV 暴露和传播的风险增加有关。
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