Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA.
Kenya Ministry of Health, National AIDS&STI Control Program (NASCOP), 19361 Nairobi, Kenya.
Viruses. 2024 Aug 10;16(8):1277. doi: 10.3390/v16081277.
Polysubstance use (PSU), injection drug use (IDU), and equipment sharing are associated with bloodborne infection (BBI) transmission risk, particularly Hepatitis C Virus (HCV), yet data on PSU in low- and middle-income countries (LMICs) is limited. We report on baseline PSU, medication-assisted treatment (MAT) engagement, and motivation to reduce IDU among 95 people who inject drugs (PWID) who accessed needle and syringe programs (NSP) in Nairobi and Coastal Kenya prior to HCV treatment. Bivariate and multivariate logistic regression were used to examine the associations between PSU and behaviors that confer HCV transmission and acquisition risks. Most participants (70.5%) reported PSU in the last 30 days, and one-third (35.8%) reported PSU exclusive to just heroin and cannabis use. Common combinations were heroin and cannabis (49.3%), and heroin, cannabis, and bugizi (flunitrazepam) (29.9%). Participants at baseline were receiving MAT (69.5%), already stopped or reduced IDU (30.5%), and were HIV-positive (40%). PSU was significantly associated with IDU ( = 0.008) and the number of times ( = 0.016) and days ( = 0.007) injected in the last 30 days. Participants reported high PSU and equipment sharing, despite high MAT engagement. While co-locating BBI treatment within existing harm reduction services is necessary to promote uptake and curb re-infection, tailored services may be needed to address PSU, particularly in LMICs.
多物质使用 (PSU)、注射吸毒 (IDU) 和共用器具与血源性感染 (BBI) 传播风险相关，尤其是丙型肝炎病毒 (HCV)，但关于低收入和中等收入国家 (LMIC) 中 PSU 的数据有限。我们报告了在 HCV 治疗之前，95 名在肯尼亚内罗毕和沿海地区接受针具交换计划 (NSP) 的注射吸毒者 (PWID) 的基线 PSU、药物辅助治疗 (MAT) 参与情况以及减少 IDU 的动机。二变量和多变量逻辑回归用于检查 PSU 与增加 HCV 传播和感染风险的行为之间的关联。大多数参与者（70.5%）报告在过去 30 天内有 PSU，三分之一（35.8%）报告 PSU 仅涉及海洛因和大麻使用。常见的组合是海洛因和大麻（49.3%），以及海洛因、大麻和 bugizi（氟硝西泮）（29.9%）。参与者在基线时正在接受 MAT（69.5%），已经停止或减少 IDU（30.5%），并且 HIV 阳性（40%）。PSU 与 IDU（=0.008）和过去 30 天内注射的次数（=0.016）和天数（=0.007）显著相关。尽管 MAT 参与度很高，但参与者报告 PSU 和设备共享率很高。虽然将 BBI 治疗与现有的减少伤害服务相结合对于促进接受和遏制再次感染是必要的，但可能需要提供针对性的服务来解决 PSU 问题，尤其是在 LMIC 中。
