注射毒品者丙型肝炎病毒风险、预防及照护流程中的性别差异：系统评价与荟萃分析
Sex and gender differences in hepatitis C virus risk, prevention, and cascade of care in people who inject drugs: systematic review and meta-analysis.
作者信息
Levinsson Anna, Zolopa Camille, Vakili Farzaneh, Udhesister Sasha, Kronfli Nadine, Maheu-Giroux Mathieu, Bruneau Julie, Valerio Heather, Bajis Sahar, Read Phillip, Martró Elisa, Boucher Lisa, Morris Leith, Grebely Jason, Artenie Adelina, Stone Jack, Vickerman Peter, Larney Sarah
机构信息
Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, Québec, Canada.
出版信息
EClinicalMedicine. 2024 Apr 10;72:102596. doi: 10.1016/j.eclinm.2024.102596. eCollection 2024 Jun.
BACKGROUND
People who inject drugs (PWID) are a priority population in HCV elimination programming. Overcoming sex and gender disparities in HCV risk, prevention, and the cascade of care is likely to be important to achieving this goal, but these have not yet been comprehensively reviewed.
METHODS
Systematic review and meta-analysis. We searched Pubmed, EMBASE and the Cochrane Database of Systematic Reviews 1 January 2012-22 January 2024 for studies of any design reporting sex or gender differences among PWID in at least one of: sharing of needles and/or syringes, incarceration history, injection while incarcerated, participation in opioid agonist treatment or needle and syringe programs, HCV testing, spontaneous HCV clearance, direct-acting antiviral (DAA) treatment initiation or completion, and sustained virological response (SVR). Assessment of study quality was based on selected aspects of study design. Additional data were requested from study authors. Data were extracted in duplicate and meta-analysed using random effects models. PROSPERO registration CRD42022342806.
FINDINGS
9533 studies were identified and 92 studies were included. Compared to men, women were at greater risk for receptive needle and syringe sharing (past 6-12 months: risk ratio (RR) 1.12; 95% confidence interval (CI) 1.01-1.23; <6 months: RR 1.38; 95% CI 1.09-1.76), less likely to be incarcerated (lifetime RR 0.64; 95% CI 0.57-0.73) more likely to be tested for HCV infection (lifetime RR 1.07; 95% CI 1.01, 1.14), more likely to spontaneously clear infection (RR1.58; 95% CI 1.40-1.79), less likely to initiate DAA treatment (0.84; 95% CI 0.78-0.90), and more likely to attain SVR after completing DAA treatment (RR 1.02; 95% CI 1.01-1.04).
INTERPRETATION
There are important differences in HCV risk and cascade of care indicators among people who inject drugs that may impact the effectiveness of prevention and treatment programming. Developing and assessing the effectiveness of gender-specific and gender-responsive HCV interventions should be a priority in elimination programming.
FUNDING
Réseau SIDA-MI du Québec.
背景
注射吸毒者是丙型肝炎病毒（HCV）消除计划中的重点人群。克服HCV风险、预防及护理流程中的性别差异，对于实现这一目标可能至关重要，但尚未得到全面审查。
方法
系统评价和荟萃分析。我们检索了2012年1月1日至2024年1月22日期间的PubMed、EMBASE和Cochrane系统评价数据库，以查找任何设计的研究，这些研究报告了注射吸毒者在以下至少一个方面的性别差异：共用针头和/或注射器、监禁史、监禁期间注射、参与阿片类激动剂治疗或针头和注射器计划、HCV检测、HCV自发清除、直接抗病毒药物（DAA）治疗开始或完成以及持续病毒学应答（SVR）。基于研究设计的选定方面对研究质量进行评估。向研究作者索要了额外数据。数据进行了双人提取，并使用随机效应模型进行荟萃分析。PROSPERO注册号：CRD42022342806。
结果
共识别出9533项研究，纳入了92项研究。与男性相比，女性接受性共用针头和注射器的风险更高（过去6 - 12个月：风险比（RR）1.12；95%置信区间（CI）1.01 - 1.23；<6个月：RR 1.38；95% CI 1.09 - 1.76），被监禁的可能性较小（终生RR 0.64；95% CI 0.57 - 0.73），接受HCV感染检测的可能性更大（终生RR 1.07；95% CI 1.01，1.14），自发清除感染的可能性更大（RR1.58；95% CI 1.40 - 1.79），开始DAA治疗的可能性较小（0.84；95% CI 0.78 - 0.90），完成DAA治疗后实现SVR的可能性更大（RR 1.02；95% CI 1.01 - 1.04）。
解读
注射吸毒者在HCV风险和护理流程指标方面存在重要差异，这可能会影响预防和治疗计划的有效性。制定和评估针对性别及对性别有敏感反应的HCV干预措施的有效性，应成为消除计划的优先事项。
资金来源
魁北克艾滋病 - 米网络。
Zotero 插件