Background

People who inject drugs (PWID) are a key population affected by the global HIV and hepatitis C virus (HCV) epidemics. HIV and HCV prevention interventions for PWID include needle and syringe programmes (NSP), opioid substitution therapy (OST), HIV counselling and testing, HIV antiretroviral therapy (ART), and condom distribution programmes. We aimed to produce country-level, regional, and global estimates of coverage of NSP, OST, HIV testing, ART, and condom programmes for PWID.

Methods

We completed searches of peer-reviewed (MEDLINE, Embase, and PsycINFO), internet, and grey literature databases, and disseminated data requests via social media and targeted emails to international experts. Programme and survey data on each of the named interventions were collected. Programme data were used to derive country-level estimates of the coverage of interventions in accordance with indicators defined by WHO, UNAIDS, and the UN Office on Drugs and Crime. Regional and global estimates of NSP, OST, and HIV testing coverage were also calculated. The protocol was registered on PROSPERO, number CRD42017056558.

Findings

In 2017, of 179 countries with evidence of injecting drug use, some level of NSP services were available in 93 countries, and there were 86 countries with evidence of OST implementation. Data to estimate NSP coverage were available for 57 countries, and for 60 countries to estimate OST coverage. Coverage varied widely between countries, but was most often low according to WHO indicators (<100 needle-syringes distributed per PWID per year; <20 OST recipients per PWID per year). Data on HIV testing were sparser than for NSP and OST, and very few data were available to estimate ART access among PWID living with HIV. Globally, we estimate that there are 33 (uncertainty interval [UI] 21–50) needle-syringes distributed via NSP per PWID annually, and 16 (10–24) OST recipients per 100 PWID. Less than 1% of PWID live in countries with high coverage of both NSP and OST (>200 needle-syringes distributed per PWID and >40 OST recipients per 100 PWID).

Interpretation

Coverage of HIV and HCV prevention interventions for PWID remains poor and is likely to be insufficient to effectively prevent HIV and HCV transmission. Scaling up of interventions for PWID remains a crucial priority for halting the HIV and HCV epidemics.

Funding

Open Society Foundations, The Global Fund, WHO, UNAIDS, United Nations Office on Drugs and Crime, Australian National Drug and Alcohol Research Centre, University of New South Wales Sydney.

中文翻译：

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预防，管理注射毒品者中的艾滋病毒和丙型肝炎的干预措施的全球，区域和国家级覆盖：系统回顾

背景

注射毒品（PWID）的人是受全球HIV和丙型肝炎病毒（HCV）流行影响的关键人群。针对PWID的HIV和HCV预防干预措施包括针头和注射器计划（NSP），阿片类药物替代疗法（OST），HI​​V咨询和测试，HIV抗逆转录病毒疗法（ART）以及避孕套分发计划。我们的目标是针对NW，OST，HIV测试，ART和PWID的避孕套计划，得出国家，地区和全球范围的估计值。

方法

我们完成了同行评审（MEDLINE，Embase和PsycINFO），互联网和灰色文献数据库的搜索，并通过社交媒体和针对性的电子邮件向国际专家分发了数据请求。收集了有关每个指定干预措施的程序和调查数据。根据卫生组织，艾滋病规划署和联合国毒品和犯罪问题办公室确定的指标，使用方案数据得出了干预措施覆盖面的国家级估算。还计算了NSP，OST和HIV检测覆盖率的区域和全球估计。该协议已在PROSPERO上注册，编号为CRD42017056558。

发现

2017年，在1​​79个有注射毒品证据的国家中，有93个国家提供了一定水平的NSP服务，并且有86个国家有OST实施证据。估计有NSP覆盖面的数据有57个国家，有60个国家有OST覆盖面。各国之间的覆盖率差异很大，但根据WHO指标，覆盖率通常较低（每年每个PWID分发的针头注射器少于100个；每个PWID每年的OST接受者少于20个）。与NSP和OST相比，有关HIV检测的数据稀少，并且仅有很少的数据可用来估计感染HIV的PWID中ART的获取情况。在全球范围内，我们估计每个PWID每年有33个（不确定区间[UI] 21–50）通过NSP分配针头注射器，每100个PWID有16（10–24）个OST接收者。

解释

针对PWID的HIV和HCV预防干预措施的覆盖范围仍然很差，可能不足以有效预防HIV和HCV的传播。扩大针对PWID的干预措施仍然是遏制HIV和HCV流行的关键优先事项。

资金

开放社会基金会，全球基金，卫生组织，艾滋病规划署，联合国毒品和犯罪问题办公室，澳大利亚国家毒品和酒精研究中心，新南威尔士大学悉尼分校。