Effect of expanding opioid agonist therapies on the HIV epidemic and mortality in Ukraine: a modelling study.,The Lancet HIV

当前位置： X-MOL 学术 › Lancet HIV › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Effect of expanding opioid agonist therapies on the HIV epidemic and mortality in Ukraine: a modelling study.
The Lancet HIV ( IF 12.8 ) Pub Date : 2019-12-23 , DOI: 10.1016/s2352-3018(19)30373-x
Jiale Tan ₁ , Frederick L Altice ₂ , Lynn M Madden ₃ , Alexei Zelenev ₁

Affiliation

Background

As HIV incidence and mortality continue to increase in eastern Europe and central Asia, particularly among people who inject drugs (PWID), it is crucial to effectively scale-up opioid agonist therapy (OAT), such as methadone or buprenorphine maintenance therapy, to optimise HIV outcomes. With low OAT coverage among PWID, we did an optimisation assessment using current OAT procurement and allocation, then modelled the effect of increased OAT scale-up on HIV incidence and mortality for 23 administrative regions of Ukraine.

Methods

We developed a linear optimisation model to estimate efficiency gains that could be achieved based on current procurement of OAT. We also developed a dynamic, compartmental population model of HIV transmission that included both injection and sexual risk to estimate the effect of OAT scale-up on HIV infections and mortality over a 10-year horizon. The compartmental population model was calibrated to HIV prevalence and incidence among PWID for 23 administrative regions of Ukraine. Sources for regional data included the SyrEx database, the Integrated Biological and Behavioral Survey, the Ukrainian Center for Socially Dangerous Disease Control of the Ministry of Health of Ukraine, the Public Health Center of the Ministry of Health of Ukraine, and the Ukrainian Census.

Findings

Under a status-quo scenario (OAT coverage of 2·7% among PWID), the number of new HIV infections among PWID in Ukraine over the next 10 years was projected to increase to 58 820 (95% CI 47 968–65 535), with striking regional differences. With optimum allocation of OAT without additional increases in procurement, OAT coverage could increase from 2·7% to 3·3% by increasing OAT doses to ensure higher retention levels. OAT scale-up to 10% and 20% over 10 years would, respectively, prevent 4368 (95% CI 3134–5243) and 10 864 (7787–13 038) new HIV infections and reduce deaths by 7096 (95% CI 5078–9160) and 17 863 (12 828–23 062), relative to the status quo. OAT expansion to 20% in five regions of Ukraine with the highest HIV burden would account for 56% of new HIV infections and 49% of deaths prevented over 10 years.

Interpretation

To optimise HIV prevention and treatment goals in Ukraine, OAT must be substantially scaled up in all regions. Increased medication procurement is needed, combined with optimisation of OAT dosing. Restricting OAT scale-up to some regions of Ukraine could benefit many PWID, but the regions most affected are not necessarily those with the highest HIV burden.

Funding

National Institute on Drug Abuse.

中文翻译：

扩大类阿片激动剂疗法对乌克兰HIV流行和死亡率的影响：一项模型研究。

背景

随着东欧和中亚地区HIV感染率和死亡率继续增加，尤其是在注射毒品者（PWID）中，有效地扩大美沙酮或丁丙诺啡维持治疗等阿片类激动剂治疗（OAT）的规模至关重要HIV结果。由于PWID中的OAT覆盖率较低，我们使用当前OAT的采购和分配进行了优化评估，然后对乌克兰23个行政区域中OAT扩大规模对HIV发病率和死亡率的影响进行了建模。

方法

我们开发了一个线性优化模型，以估算基于当前OAT采购可以实现的效率提升。我们还开发了一个动态的，分区域的HIV传播人群模型，其中包括注射和性风险，以评估OAT扩大规模对10年内HIV感染和死亡率的影响。针对乌克兰23个行政区域的PWID中的艾滋病病毒感染率和发病率，对隔离人群模型进行了校准。区域数据来源包括SyrEx数据库，综合生物学和行为调查，乌克兰卫生部乌克兰社会危害性疾病控制中心，乌克兰卫生部公共卫生中心和乌克兰人口普查。

发现

在现状情况下（PWID中OAT覆盖率为2·7％），乌克兰未来10年PWID中新感染HIV的人数预计将增加到58820（95％CI 47968-65535），具有明显的地区差异。在不增加采购量的情况下优化OAT分配的情况下，通过增加OAT剂量以确保更高的保留水平，OAT覆盖率可以从2·7％增加到3·3％。OAT在10年内扩大到10％和20％，将分别预防4368（95％CI 3134–5243）和10864（7787–13 038）新的HIV感染，并减少7096（95％CI 5078–95）的死亡人数9160）和17 863（12 828–23 062），相对于现状。在乌克兰五个艾滋病毒负担最高的地区，OAT扩大到20％，将占10年内新感染艾滋病毒的56％，预防死亡的49％。