Li Xujiao, Tan Lanfen, Chen Jian, Zhang Ruchen, Zeng Weide, Liu Chang, Xie Mengyao, Liang Wangjin, Liang Xu, Qi Guangzi
Department of Public Health, Youjiang Medical University for Nationalities, 98 Chengxiang Road, Baise City, Guangxi Province, China.
Baise Center for Disease Prevention and Control, 98 Chengxiang Road, Baise City, Guangxi Province, China.
BMC Public Health. 2025 Mar 8;25(1):928. doi: 10.1186/s12889-025-22088-6.
To investigate the effect of the restricted access to clean needles and syringes on needle and syringe sharing behavior like Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV) amongst the people who inject drugs (PWID) in Baise, Guangxi province of China, and to provide the scientific evidence for formulating public health policies aimed at preventing HIV transmission.
Using the national unified questionnaire and plan, from 2010 to 2019, snowball sampling was conducted among the community drug users under sentinel surveillance in Baise City's county districts every April to June. During face-to-face interviews with each participant, a structured questionnaire was used to collect demographic, behavioral, and venous blood for serological surveillance. All of this information was input into the HIV/AIDS Comprehensive Response Information Management System (CRIMS). Following China's enforcement of the Regulation on Supervision and Administration of Medical Devices(hereinafter referred to as the Regulation) in June 2014, which limited the sale of clean needles and syringes by community pharmacies. Therefore, we divided the period from 2010 to 2019 into from 2010 to 2015 and from 2016 to 2019. Utilizing the trends of HIV/HCV prevalences during these periods and taking them as indicators to measure the occurrence of needle and syringe sharing behavior. Employing the Event Study Method to verify the influence of community accessibility to needles and syringes for individuals of traditional drug users(TDU) on needle and syringe sharing, focusing on cumulative abnormal positive rates as a key metric. TDU came from the National HIV/AIDS CRIMS in 2010-2019 as the object, whose trend changes of annual HIV/HCV prevalences serve as a generation indicator of needle and syringe sharing. We set the period from 2010 to 2015 as the estimation window and from 2016 to 2019 as the event window, using the Chi-square trend tests to examine the changing trends in annual HIV/HCV prevalences. To construct a linear regression model based on the HIV/HCV prevalences from 2010 to 2015, the model was used to predict the expected prevalences from 2016 to 2019, which were compared with the actual prevalences from 2016 to 2019 to calculate the abnormal prevalences and the cumulative abnormal prevalences. Robustness tests were conducted on the cumulative abnormal prevalences to exclude the random changes in prevalences.
In the event window, The actual trend of HIV/HCV prevalences were both statistically significant from 2010 to 2015( = 7.479, P = 0.006 and = 9.717, P < 0.001), but weren't both statistically significant from 2016 to 2019( = 0.604, P = 0.437 and = 0.134, P = 0.715). The Linear regression model indicates the HIV prevalence showed a negative correlation with time(adjusted R = 0.911, P < 0.001), and the HCV prevalence also exhibited a negative correlation with time from 2010 to 2015(adjusted R = 0.869, P < 0.001). During the event window from 2016 to 2019, the expected HIV and HCV prevalences were as follows: for HIV, 8.24%, 5.62%, 3.01%, and 0.39%; for HCV, 34.55%, 30.56%, 26.56%, and 22.57%. The abnormal HIV/HCV prevalences during this period were: for HIV, 3.29%, 6.26%, 9.56%, and 7.88%; for HCV, 4.71%, 10.69%, 15.28%, and 14.35%. The cumulative abnormal HIV/HCV prevalences were 3.29%, 9.55%, 19.11%, 26.99% for HIV, and 4.71%, 15.40%, 30.68%, 45.03% for HCV; the robustness test results indicated that the changes in HIV and HCV prevalences during the event window were not random events(U = 12.371, P < 0.001 for both Cumulative abnormal HIV/HCV prevalence).
When individuals practice injecting drugs, the important factor in needle and syringe sharing among TDU groups is the restricted access to clean needles and syringes from the community. The community commercial channel for needles and syringes should serve as a public health resource, addressing access to clean needles and syringes for individuals and reducing the frequency of needle and syringe sharing among community-active TDU groups. Public health policies aimed at preventing HIV epidemics in TDU populations should fully consider the accessibility of needles and syringes for the TDU groups in the community, thereby enhancing the effectiveness of public health measures.
探讨限制清洁针具和注射器的获取对中国广西百色市注射吸毒人群中诸如人类免疫缺陷病毒（HIV）和丙型肝炎病毒（HCV）等针具共用行为的影响，并为制定预防HIV传播的公共卫生政策提供科学依据。
采用国家统一问卷和方案，2010年至2019年期间，每年4月至6月在百色市县区接受哨点监测的社区吸毒人群中进行滚雪球抽样。在与每位参与者进行面对面访谈时，使用结构化问卷收集人口统计学、行为学信息，并采集静脉血进行血清学监测。所有这些信息都输入到HIV/AIDS综合防治信息管理系统（CRIMS）中。2014年6月中国实施《医疗器械监督管理条例》（以下简称《条例》）后，社区药店限制销售清洁针具和注射器。因此，我们将2010年至2019年分为2010年至2015年和2016年至2019年两个阶段。利用这两个阶段HIV/HCV流行率的趋势，并将其作为指标来衡量针具共用行为的发生情况。采用事件研究法，以传统吸毒者（TDU）群体中社区获取针具和注射器的情况对针具共用的影响为重点，以累积异常阳性率作为关键指标进行验证。以2010 - 2019年国家HIV/AIDS CRIMS中的TDU为对象，其年度HIV/HCV流行率的趋势变化作为针具共用的代用指标。我们将2010年至2015年设定为估计窗口，2016年至2019年设定为事件窗口，采用卡方趋势检验来检验年度HIV/HCV流行率的变化趋势。基于2010年至2015年的HIV/HCV流行率构建线性回归模型，该模型用于预测2016年至2019年的预期流行率，并与2016年至2019年的实际流行率进行比较，以计算异常流行率和累积异常流行率。对累积异常流行率进行稳健性检验，以排除流行率的随机变化。
在事件窗口期间，2010年至2015年HIV/HCV流行率的实际趋势均具有统计学意义（χ² = 7.479，P = 0.006；χ² = 9.717，P < 0.001），但2016年至2019年并非均具有统计学意义（χ² = 0.604，P = 0.437；χ² = 0.134，P = 0.715）。线性回归模型表明，HIV流行率与时间呈负相关（调整后R = 0.911，P < 0.001），2010年至2015年HCV流行率也与时间呈负相关（调整后R = 0.869，P < 0.001）。在2016年至2019年的事件窗口期间，预期的HIV和HCV流行率如下：HIV分别为8.24%、5.62%、3.01%和0.39%；HCV分别为34.55%、30.56%、26.56%和22.57%。此期间异常的HIV/HCV流行率如下：HIV分别为3.29%、6.26%、9.56%和7.88%；HCV分别为4.71%、10.69%、15.28%和14.35%。HIV的累积异常流行率分别为3.29%、9.55%、19.11%、26.99%，HCV的累积异常流行率分别为4.71%、15.40%、30.68%、45.03%；稳健性检验结果表明，事件窗口期间HIV和HCV流行率的变化并非随机事件（累积异常HIV/HCV流行率的U = 12.371，P均 < 0.001）。
在个体进行注射吸毒时，TDU群体中针具共用的重要因素是社区清洁针具和注射器获取受限。社区针具和注射器商业渠道应作为一种公共卫生资源，解决个体获取清洁针具和注射器的问题，并减少社区活跃TDU群体中的针具共用频率。旨在预防TDU人群中HIV流行的公共卫生政策应充分考虑社区中TDU群体获取针具和注射器的便利性，从而提高公共卫生措施的有效性。
