Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Drug Alcohol Depend. 2022 May 1;234:109396. doi: 10.1016/j.drugalcdep.2022.109396. Epub 2022 Mar 5.
A large HIV outbreak in People Who Inject Drugs (PWID) occurred in Athens, Greece in 2011-2013. In response, opioid substitution treatment (OST) and needle and syringe programs (NSP) were scaled-up and a seek-test-treat program was introduced in mid-2012. We aim to assess the impact of these interventions.
A mathematical model of HIV transmission among PWID was calibrated to data available over time (2009-2013) on HIV prevalence, NSP/antiretroviral treatment (ART) coverage and high-risk injection. A combined interventions scenario, including decrease in high-risk injection through linkage to OST and modification of risk behaviours and access to NSP and ART, was compared to a counterfactual scenario (no improvement at the levels of these interventions), with HIV incidence being the main outcome.
HIV incidence increased from <0.1 new cases/100 person-years (in 2009) to 11.0 new cases/100 person-years (in 2012). Under both models, a subsequent decline was projected following early 2012, with incidence at the end of 2013 in the combined interventions scenario being lower by 77% compared to the counterfactual. The projected reduction in incidence under the intervention scenario was in agreement with empirical data. HIV prevalence would have escalated to 20.4% (95% CrI: 16.9%, 23.6%) in 2013 under the counterfactual scenario (vs. 16.8% (95% CrI: 11.2%, 23.0%) under the combined interventions scenario). In total, 31.4% of HIV cases (392) were averted over 2012-2013.
These results underline the importance of high-coverage harm reduction programs and of community-based interventions to rapidly reach PWID most in need.
2011 年至 2013 年期间，希腊雅典发生了大规模的 HIV 疫情，主要发生在注射毒品者（PWID）人群中。作为回应，阿片类药物替代疗法（OST）和针具交换项目（NSP）得到了扩展，并于 2012 年年中推出了寻求检测治疗项目。我们旨在评估这些干预措施的影响。
我们对 HIV 在 PWID 中的传播模型进行了校准，以反映当时（2009 年至 2013 年）可用的 HIV 流行率、NSP/抗逆转录病毒治疗（ART）覆盖率和高危注射数据。将一个联合干预方案（包括通过与 OST 联系减少高危注射以及改变风险行为和获得 NSP 和 ART 的途径）与一个反事实方案（这些干预水平没有改善）进行比较，以 HIV 发病率作为主要结果。
HIV 发病率从 2009 年的<0.1 例/100 人年增加到 2012 年的 11.0 例/100 人年。在这两种模型下，都预计在 2012 年初之后会出现下降，到 2013 年底，联合干预方案下的发病率比反事实方案低 77%。干预方案下预测的发病率下降与经验数据一致。在反事实方案下，2013 年 HIV 流行率将上升到 20.4%（95%CI：16.9%，23.6%）（而在联合干预方案下为 16.8%（95%CI：11.2%，23.0%））。在 2012 年至 2013 年期间，共避免了 31.4%的 HIV 病例（392 例）。
这些结果强调了高覆盖率的减少伤害方案和基于社区的干预措施的重要性，以便迅速接触到最需要的 PWID。
