Department of Epidemiology, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street E 7133, Baltimore, MD, 21205, USA.
Health Development Initiative, Kigali, Rwanda.
Harm Reduct J. 2021 Dec 15;18(1):130. doi: 10.1186/s12954-021-00579-0.
BACKGROUND: In Rwanda, epidemiological data characterizing people who inject drugs (PWID) and their burden of HIV are limited. We examined injection drug use (IDU) history and practices, and HIV infection in a sample of PWID in Kigali. METHODS: From October 2019 to February 2020, 307 PWID aged ≥ 18 were enrolled in a cross-sectional study using convenience sampling in Kigali. Participants completed interviewer-administered questionnaires on IDU history and practices and HIV testing. We used Poisson regression with robust variance estimation to assess IDU practices associated with HIV infection and assessed factors associated with needle sharing in the six months preceding the study. RESULTS: The median age was 28 years (IQR 24-31); 81% (251) were males. Female PWID were more likely to report recent IDU initiation, selling sex for drugs, and to have been injected by a sex partner (p < 0.05). In the prior six months, heroin was the primary drug of choice for 99% (303) of participants, with cocaine and methamphetamine also reported by 10% (31/307) and 4% (12/307), respectively. In total, 91% (280/307) of participants reported ever sharing needles in their lifetime and 43% (133) knew someone who died from a drug-related overdose. HIV prevalence was 9.5% (95% CI 8.7-9.3). Sharing needles at least half of the time in the previous six months was positively associated with HIV infection (adjusted prevalence ratio (aPR) 2.67; 95% CI 1.23-5.78). Overall, 31% (94/307) shared needles and 33% (103/307) reused needles in the prior six months. Female PWID were more likely to share needles compared to males (aPR 1.68; 95% CI 1.09-2.59). Additionally, bisexual PWID (aPR 1.68; 95% CI 1.09-2.59), those who shared needles at the first injection (aPR 2.18; 95% CI 1.59-2.99), reused needles recently (aPR 2.27; 95% CI 1.51-3.43) and shared other drug paraphernalia (aPR 3.56; 95% CI 2.19-5.81) were more likely to report recent needle sharing. CONCLUSION: HIV infection was common in this study. The high prevalence of needle reuse and sharing practices highlights significant risks for onward transmission and acquisition of HIV and viral hepatitis. These data highlight the urgent need for PWID-focused harm reduction services in Rwanda, including syringe services programs, safe injection education, naloxone distribution, and substance use disorder treatment programs and optimizing these services to the varied needs of people who use drugs in Rwanda.
背景：在卢旺达，描述吸毒者（PWID）并评估其 HIV 负担的流行病学数据有限。我们调查了基加利的一组吸毒者的注射吸毒史和吸毒行为，以及 HIV 感染情况。
方法：2019 年 10 月至 2020 年 2 月，我们使用便利抽样法，在基加利招募了 307 名年龄≥18 岁的吸毒者进行横断面研究。参与者完成了有关注射吸毒史和吸毒行为以及 HIV 检测的问卷调查。我们使用泊松回归和稳健方差估计来评估与 HIV 感染相关的吸毒行为，并评估了研究前六个月内与共用针头相关的因素。
结果：中位年龄为 28 岁（IQR 24-31）；81%（251 名）为男性。女性吸毒者更有可能报告最近开始注射吸毒、卖淫买毒，以及曾被性伴侣注射过（p<0.05）。在过去的六个月中，99%（303 名）的参与者主要选择使用海洛因，分别有 10%（31 名/307 名）和 4%（12 名/307 名）的参与者报告使用可卡因和冰毒。总共，91%（280 名/307 名）的参与者报告在其一生中曾共用过针头，43%（133 名）的参与者知道有人因与药物相关的过量用药而死亡。HIV 感染率为 9.5%（95%CI 8.7-9.3）。在过去的六个月中，至少有一半时间共用针头与 HIV 感染呈正相关（调整后的患病率比（aPR）2.67；95%CI 1.23-5.78）。总体而言，31%（94 名/307 名）的参与者在过去六个月内共用过针头，33%（103 名/307 名）重复使用过针头。与男性相比，女性吸毒者更有可能共用针头（aPR 1.68；95%CI 1.09-2.59）。此外，双性恋吸毒者（aPR 1.68；95%CI 1.09-2.59）、首次注射时共用针头（aPR 2.18；95%CI 1.59-2.99）、最近重复使用针头（aPR 2.27；95%CI 1.51-3.43）和共用其他吸毒用具（aPR 3.56；95%CI 2.19-5.81）的人更有可能报告最近的针头共用情况。
结论：本研究中 HIV 感染较为常见。高比例的重复使用和共用针头的行为突显了进一步传播和感染 HIV 和病毒性肝炎的重大风险。这些数据突出表明，卢旺达迫切需要针对吸毒者的减少伤害服务，包括注射器服务项目、安全注射教育、纳洛酮分发以及物质使用障碍治疗项目，并优化这些服务以满足卢旺达吸毒者的不同需求。
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