建模在墨西哥蒂华纳，监禁和以公共卫生为导向的毒品法律改革对注射吸毒者 HCV 传播和消除的贡献。
Modelling the contribution of incarceration and public health oriented drug law reform to HCV transmission and elimination among PWID in Tijuana, Mexico.
机构信息
Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States; School of Public Health, San Diego State University, San Diego, CA, 92182, United States.
Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States; School of Law and Bouve College of Health Sciences, Northeastern University, Boston, MA, 02115, United States.
出版信息
Int J Drug Policy. 2022 Dec;110:103878. doi: 10.1016/j.drugpo.2022.103878. Epub 2022 Oct 12.
BACKGROUND
Incarceration is associated with increased risk of hepatitis C virus (HCV) among people who inject drugs (PWID). Mexico's previous attempt in implementing a public health-oriented drug law reform resulted in minimal impact on incarceration among PWID. However, implementation of reforms alongside Mexico's HCV elimination program has the potential to reshape the HCV epidemic among PWID in the next decade. We use data from a cohort of PWID in Tijuana, Mexico, to inform epidemic modeling to assess the contribution of incarceration and fully implemented drug reform on HCV transmission and elimination among PWID.
METHODS
We developed a dynamic, deterministic model of incarceration, HCV transmission and disease progression among PWID. The model was calibrated to data from Tijuana, Mexico, with 90% HCV seroprevalence among 10,000 PWID. We estimated the 10-year population attributable fraction (PAF) of incarceration to HCV incidence among PWID and simulated, from 2022, the potential impact of the following scenarios: 1) decriminalization (80% reduction in incarceration rates); 2) fully implemented drug law reform (decriminalization and diversion to opiate agonist therapy [OAT]); 3) fully implemented drug law reform with HCV treatment (direct-acting antivirals [DAA]). We also assessed the number DAA needed to reach the 80% incidence reduction target by 2030 under these scenarios.
RESULTS
Projections suggest a PAF of incarceration to HCV incidence of 5.4% (95% uncertainty interval [UI]:0.6-11.9%) among PWID in Tijuana between 2022-2032. Fully implemented drug reforms could reduce HCV incidence rate by 10.6% (95%UI:3.1-19.2%) across 10 years and reduce the number of DAA required to achieve Mexico's HCV incidence reduction goal by 14.3% (95%UI:5.3-17.1%).
CONCLUSIONS
Among PWID in Tijuana, Mexico, incarceration remains an important contributor to HCV transmission. Full implementation of public health-oriented drug law reform could play an important role in reducing HCV incidence and improve the feasibility of reaching the HCV incidence elimination target by 2030.
背景
在注射毒品者（PWID）中，监禁与丙型肝炎病毒（HCV）感染风险增加有关。墨西哥之前尝试实施以公共卫生为导向的毒品法改革，对 PWID 的监禁率几乎没有影响。然而，在实施改革的同时，墨西哥的 HCV 消除计划有可能在未来十年重塑 PWID 中的 HCV 流行。我们使用来自墨西哥提华纳的一组 PWID 队列的数据，为流行病情报模型提供信息，以评估监禁和全面实施毒品改革对 PWID 中 HCV 传播和消除的贡献。
方法
我们开发了一个 PWID 中监禁、HCV 传播和疾病进展的动态确定性模型。该模型使用来自墨西哥提华纳的数据进行了校准，10000 名 PWID 中有 90%的 HCV 血清阳性率。我们估计了 10 年内监禁对 PWID 中 HCV 发病率的人群归因分数（PAF），并从 2022 年开始模拟以下情景的潜在影响：1）非刑罪化（监禁率降低 80%）；2）全面实施毒品法改革（非刑罪化和转为阿片类激动剂治疗[OAT]）；3）全面实施毒品法改革和 HCV 治疗（直接作用抗病毒药物[DAA]）。我们还评估了在这些情景下，到 2030 年达到 80%发病率降低目标所需的 DAA 数量。
结果
预测表明，在 2022-2032 年期间，提华纳的 PWID 中，监禁对 HCV 发病率的 PAF 为 5.4%（95%置信区间[CI]：0.6-11.9%）。全面实施毒品改革可在 10 年内将 HCV 发病率降低 10.6%（95%CI：3.1-19.2%），并减少实现墨西哥 HCV 发病率降低目标所需的 DAA 数量 14.3%（95%CI：5.3-17.1%）。
结论
在墨西哥提华纳的 PWID 中，监禁仍然是 HCV 传播的一个重要因素。全面实施以公共卫生为导向的毒品法改革可以在降低 HCV 发病率和提高到 2030 年达到 HCV 发病率消除目标的可行性方面发挥重要作用。
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