Lindqvist K, Wallmofeldt C, Holmén E, Hammarberg A, Kåberg M
Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden.
Norra Stockholms Psykiatri (Psychiatry of Northern Stockholm), S:t Görans Hospital, Stockholm, Sweden.
Harm Reduct J. 2021 May 10;18(1):52. doi: 10.1186/s12954-021-00499-z.
People who inject drugs may be particularly vulnerable to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) due to underlying health problems, stigma and social vulnerabilities. Harm reduction services, including needle exchange programs (NEP), have been subjected to varying degrees of disruption in the world, especially in the beginning of the coronavirus disease 2019 (COVID-19) pandemic. Compared to responses in other countries, Sweden's initial strategy toward limiting the spread and impact of COVID-19 was less restrictive to its citizens with no imposed general societal lockdown. In this study, we investigate changes in drug use patterns, utilization of NEP associated health services, COVID-19 health literacy and the prevalence of SARS-CoV-2 antibodies among NEP clients in Stockholm during the COVID-19 pandemic.
NEP visits and services provided (needles/syringes, HIV and hepatitis C tests and treatment, naloxone distributed) and overall mortality among NEP clients between January 1 and October 31, 2020, were used for trend analyses in comparison with corresponding 2019 data. Between July 27 and October 2, 2020, NEP clients (n = 232) responded to a 27 item COVID-19 Health Literacy Questionnaire. SARS CoV-2 IgG antibody tests (n = 779) were performed between June 15 and October 31, 2020.
During the COVID-19 pandemic number of clients, client visits, naloxone distribution and HCV tests remained stable compared to 2019, while distribution of needles/syringes increased (p < 0.0001); number of HIV tests and HCV treatments decreased (p < 0.05); and mortality decreased (< 0.01). Overall, the level of health literacy concerning transmission routes and protective measures was high. SARS-CoV-2 antibody prevalence was 5.4% (95% CI 4.0-7.2).
The Stockholm NEP managed to maintain a high level of clients and services during the pandemic. In general, COVID-19 health literacy was adequate and the overall SARS-CoV-2 antibody prevalence was low compared to the general population, which highlights a need for prioritized and targeted COVID-19 vaccination among PWID.
由于存在潜在健康问题、耻辱感和社会脆弱性，注射吸毒者可能特别容易感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）。包括针头交换项目（NEP）在内的减少伤害服务在全球范围内受到了不同程度的干扰，尤其是在2019冠状病毒病（COVID-19）大流行初期。与其他国家的应对措施相比，瑞典最初限制COVID-19传播和影响的策略对其公民的限制较少，没有实施全面的社会封锁。在本研究中，我们调查了COVID-19大流行期间斯德哥尔摩NEP客户的吸毒模式变化、NEP相关健康服务的利用情况、COVID-19健康素养以及SARS-CoV-2抗体的流行情况。
将2020年1月1日至10月31日期间NEP客户的就诊情况和提供的服务（针头/注射器、艾滋病毒和丙型肝炎检测及治疗、纳洛酮分发）以及总体死亡率与2019年的相应数据进行趋势分析。2020年7月27日至10月2日期间，NEP客户（n = 232）对一份包含27个项目的COVID-19健康素养问卷进行了回答。2020年6月15日至10月31日期间进行了SARS-CoV-2 IgG抗体检测（n = 779）。
与2019年相比，COVID-19大流行期间客户数量、客户就诊次数、纳洛酮分发量和丙型肝炎检测量保持稳定，而针头/注射器的分发量增加（p < 0.0001）；艾滋病毒检测次数和丙型肝炎治疗次数减少（p < 0.05）；死亡率下降（< 0.01）。总体而言，关于传播途径和保护措施的健康素养水平较高。SARS-CoV-2抗体流行率为5.4%（95%CI 4.0 - 7.2）。
斯德哥尔摩的NEP在大流行期间成功维持了较高的客户数量和服务水平。总体而言，COVID-19健康素养充足，与普通人群相比，SARS-CoV-2抗体总体流行率较低，这突出表明有必要对注射吸毒者优先进行有针对性的COVID-19疫苗接种。
