全球范围内预防和管理注射吸毒者药物相关危害的干预措施覆盖情况：系统评价。

Global coverage of interventions to prevent and manage drug-related harms among people who inject drugs: a systematic review.

机构信息

National Drug Research Institute Melbourne, Curtin University, Melbourne, VIC, Australia; National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.

出版信息

Lancet Glob Health. 2023 May;11(5):e673-e683. doi: 10.1016/S2214-109X(23)00058-X. Epub 2023 Mar 27.

DOI:10.1016/S2214-109X(23)00058-X

PMID:36996860

Abstract

BACKGROUND: Harm reduction and treatment programmes are essential for reducing harms for people who inject drugs (PWID). We aimed to update estimates from a 2017 review of global coverage of needle and syringe exchange programmes (NSPs), opioid agonist treatment (OAT), and other harm reduction services that target PWID (eg, take-home naloxone [THN] programmes, supervised consumption facilities, and drug checking services). METHODS: We did a systematic review of available evidence from peer-reviewed and grey literature databases for studies published between Jan 1, 2017, and May 31, 2022. Programmatic data were collected on the availability of services, the number of sites, people accessing services, and equipment distributed in countries where there is evidence of injecting drug use. National estimates of coverage of OAT (ie, number of people accessing OAT per 100 PWID) and NSPs (ie, number of needles and syringes distributed per PWID per year) were generated where available using the most recent data. Regional and global estimates were derived and compared with WHO indicators. The study was registered with PROSPERO (CRD42020173974). FINDINGS: We included 195 studies and found there were 90 countries implementing OAT (75% of the PWID population) and 94 countries implementing NSPs (88% of the global PWID population). Only five countries (2% of the global PWID population) are providing high coverage of both services. Far fewer countries were implementing THN programmes (n=43), supervised consumption facilities (n=17), and drug checking services (n=26), with nine countries implementing all five services. Globally, we estimated there were 18 (95% uncertainty interval [UI] 12-27) people accessing OAT per 100 PWID, and 35 (95% UI 24-52) needles and syringes being distributed per person who injects drugs per year. More countries reported high (OAT 24; NSPs 10), moderate (OAT 8; NSPs 15), and low (OAT 38; NSPs 47) coverage of services compared with the previous review. INTERPRETATION: Global coverage of OAT and NSPs has increased modestly in the past 5 years but remains low for most countries. Programmatic data on other key harm reduction interventions are scarce. FUNDING: Australian National Health and Medical Research Council.

摘要

背景：减少伤害和治疗计划对于减少注射毒品者（PWID）的伤害至关重要。我们旨在更新 2017 年对全球范围内的针具交换计划（NSP）、阿片类药物激动剂治疗（OAT）和针对 PWID 的其他减少伤害服务（例如，纳洛酮带回家计划[THN]、监督消费场所和药物检测服务）覆盖范围的审查的估计数。

方法：我们对 2017 年 1 月 1 日至 2022 年 5 月 31 日发表的同行评议和灰色文献数据库中的现有证据进行了系统回顾。收集了关于服务提供情况、服务地点数量、使用服务的人数以及在有注射吸毒证据的国家分发的设备的项目数据。根据最新数据，在有可用数据的情况下，计算了 OAT（即每 100 名 PWID 中接受 OAT 的人数）和 NSP（即每年每 1 名 PWID 分发的针头和注射器数量）的国家覆盖率估计数。并得出了区域和全球估计数，并与世卫组织指标进行了比较。该研究已在 PROSPERO（CRD42020173974）上注册。

发现：我们纳入了 195 项研究，发现有 90 个国家实施了 OAT（占 PWID 人口的 75%），94 个国家实施了 NSP（占全球 PWID 人口的 88%）。只有 5 个国家（占全球 PWID 人口的 2%）提供了这两种服务的高覆盖率。实施纳洛酮带回家方案（n=43）、监督消费设施（n=17）和药物检测服务（n=26）的国家要少得多，只有 9 个国家同时实施了这 5 种服务。全球范围内，我们估计每 100 名 PWID 中有 18 人（95%置信区间[UI]为 12-27）接受 OAT，每 1 名注射毒品者每年分发 35 个（95%UI 为 24-52）针头和注射器。与上一次审查相比，更多的国家报告了高（OAT 24；NSP 10）、中（OAT 8；NSP 15）和低（OAT 38；NSP 47）的服务覆盖率。

解释：在过去的 5 年中，OAT 和 NSP 的全球覆盖率略有增加，但对大多数国家来说仍然很低。关于其他关键减少伤害干预措施的项目数据很少。

资金来源：澳大利亚国家卫生和医学研究委员会。