静脉吸毒人群前瞻性队列研究2年随访HIV血清抗体保持率分析

目的:了解静脉吸毒人群前瞻性队列研究2年随访的HIV血清抗体阳转率和保持率情况。方法:于2002年11月,在四川省西昌市从社区招募了HIV血清抗体阴性的静脉吸毒人群前瞻性研究队列333人,队列每6个月随访1次和采集血样进行HIV抗体检测,以及分析队列本底的静脉吸毒人群社会人口学和HIV高危行为特征与队列保持率的关系。结果:静脉吸毒人群队列研究2年随访的HIV血清抗体阳转率为2.53/100人年(95%CI,1.10-3.97)和保持率为75.7%(252/333)。在多因素logistic回归模型分析中,与队列保持率的关系有统计学意义的变量为:彝族(OR,0.52;95%CI,0.29-0.91)、6个月回访(OR,4.72;95%CI,2.69-8.28)、和近3个月静脉吸毒频率高(OR,2.06;95%CI,1.12-3.80)。结论:本研究队列静脉吸毒人群HIV血清抗体阳转率较高和彝族静脉吸毒人群队列保持率低。     

前瞻性队列研究吸毒人群HIV预防随访意愿的初步分析

目的:了解静脉吸毒人群继续参加HIV血清抗体阳转队列研究的意愿及影响其继续参加队列随访的原因.方法:2004年5-6月,于四川省凉山彝族自治州静脉吸毒人群队列研究第18个月随访期间,抽取不同时间阶段随访的48名参加者进行继续参加队列随访意愿的个人深入访谈.结果:绝大多数调查对象愿意继续参加队列随访,但认为影响其回门诊点的主要原因是害怕在回访途中被公安部门抓入强制戒毒所和外出打工;而极少数不愿意或不能确定是否继续参加队列随访的主要原因正在戒毒或几次HIV抗体检测阴性后认为不必再继续参加项目以及害怕来门诊途中遇到吸毒伙伴又复吸.大多数愿意继续参加随访的研究对象都希望在下一次随访日期前得到通知,且认为比较合适的通知方式主要是同伴或朋友通知、工作人员直接给自己打电话和家人转告.结论:在四川省凉山彝族自治州地区,大多数吸毒人员愿意参加艾滋病防治队列研究的随访,但需要在随访开始之前由同伴或朋友通知、工作人员电话通知或者家属转告自己随访时间.需进一步加强有效的随访方法以提高留置率.     

静脉吸毒人群前瞻性队列研究1年随访死因分析

目的:了解四川省某地区静脉吸毒人群的死亡情况.方法:于2002年¨月筛选和招募静脉吸毒人群队列376人,队列随访1年.筛选时调查静脉吸毒人群的社会人口学和吸毒行为特征,对死亡人员进行死因分析.结果:队列随访1年中死亡28人,死亡率为77.32/1000人年,标准化死亡比(SMR)为47.46,95%可信区间为[31.52～68.47].死因中因吸毒过量死亡占64.3%(18人),与吸毒有关的意外伤害死亡占14.3%(4人),其他21.4%(6人).队列随访中未见艾滋病病例.结论:需进一步加强吸毒人群的死亡研究,以便开展针对性的干预措施来降低静脉吸毒人群的死亡率.     

西昌市静脉吸毒人群前瞻性队列研究2年随访死亡分析

目的:了解四川省凉山彝族自治州西昌市静脉吸毒人群死亡率及死因。方法:于2002年11月招募静脉吸毒人群前瞻性研究队列376人,调查其社会人口学、吸毒行为和性行为特征。计算静脉吸毒人群随访2年的死亡率和死因构成,对其影响因素采用单因素和多因素Cox回归模型分析。结果:在队列2年随访中,死亡39人,死亡率为55.30/1000人年(95%CI:37.95-72.66),标准化死亡比为34.53(95%CI:21.60-54.54)。吸毒过量占全部死因的66.7%(26/39)。多因素Cox回归模型分析未见与全因死亡关系有统计学意义的变量;但见吸毒年限(≥9年)与吸毒过量死亡有统计学关联(P=0.0347),其危险比是2.31(95%CI:1.06-5.04)。结论:吸毒过量是西昌市静脉吸毒者的主要死因,需进一步探讨吸毒过量死亡的影响因素及其干预对策。     

佛山市顺德区首次美沙酮门诊吸毒人群HIV、HBV、HCV和梅毒感染状况调查

目的:了解佛山市顺德区首次美沙酮门诊吸毒人员HIV、HBV、HCV和梅毒感染状况及其危险因素。方法:对2006年1月-2013年12月893名首次进行美沙酮门诊吸毒人员进行HIV、HCV、梅毒抗体及HBV抗原进行检测,同时进行问卷调查。结果:893名吸毒者中HIV抗体、HCV抗体、梅毒抗体、HBV抗原阳性率分别为2.24%(20/893)、69.54%(621/893)、0.90%(8/893)、20.94%(187/893),男性吸毒者血清HIV、HCV、梅毒和HBV的阳性检出率分别为1.75%、70.05%、0.75%、21.30%,女性吸毒者血清HIV、HCV、梅毒和HBV的阳性检出率分别为6.31%、65.26%、2.11%、17.89%,女性HIV阳性率显著高于男性(P<0.05),男性HCV、HBV及梅毒的感染与女性无统计学差异(P>0.05)。多个性伴侣吸毒人群HIV、HCV阳性率显著高于单个性伴侣人群(P<0.05)。其中静脉吸毒者556例,非静脉吸毒者337例,静脉吸毒HCV感染率83.81%,明显高于非静脉吸毒感染率46.0%(P<0.01)。静脉吸毒HIV抗体、梅毒抗体、HBV抗原阳性率分别为2.34%(13/556)、1.08%(6/556)、19.97%(111/556),非静脉吸毒HIV抗体、梅毒抗体、HBV抗原阳性率分别为2.08%(7/337)、0.59%(2/337)、22.55%(76/337),两组比较差别无统计学意义,P值分别为0.80、0.70和0.36。合并感染HCV、HBV病毒者15.34%(137/893),其中静脉吸毒19.60%(109/556),明显高于非静脉吸毒者8.31%(28/337),P值为0.00。结论:佛山市顺德区女性吸毒人员HIV感染率显著高于男性,静脉吸毒人群HCV感染率明显较非静脉吸毒人群高,静脉吸毒者合并HCV、HBV病毒感染率较高,多个性伴侣吸毒人群HIV、HCV感染率高。应采取综合干预措施控制HIV、HBV、HCV在吸毒人群中蔓延。     

云南省1139例美沙酮门诊受治者6个月HIV新发感染率调查

目的獉獉:了解云南省美沙酮门诊受治者HIV新发感染率及其影响因素。方法獉獉:于2008年10月招募HIV血清抗体阴性的美沙酮门诊受治者1139名进入队列,6个月后随访并进行血清学检测确定HIV新发感染率。将结果进行χ2检验及帕松回归分析。结果獉獉:6个月后随访894名调查对象,观察总人年为505.25人年,HIV阳转12人,HIV新发感染率为2.38/100人年。影响因素有:临沧地区门诊,"输入带有HIV的血液或血液制品会感染HIV"知识点答错,未了解或接受过免费安全套发放服务,了解或接受过机会性感染治疗、抗病毒治疗的调查对象HIV新发感染率较高。结论獉獉:美沙酮门诊受治者HIV新发感染率低于一般静脉吸毒人员。在美沙酮门诊加强艾滋病知识的培训,各种服务获得途径的宣传,以及扩大安全套免费发放的范围和数量,对于降低HIV新发感染率有意义。     

404名静脉吸毒者HIV感染状况及行为调查分析

目的：了解梧州市2008年吸毒人群HIV感染状况以及危险因素行为特征,为预防控制工作提供依据。方法：2008年4-6月对梧州市市辖区社区中的静脉吸毒人员进行行为学调查,并采血样进行HIV、梅毒抗体检测。结果：共调查了404名静脉吸毒者,吸毒以20—39岁男性为主,吸毒方式以静脉注射吸毒为主,占96．53％（390／404）;吸毒人群HIV抗体阳性率为39．11％（158／404）,梅毒抗体阳性率为1．24％（5／404）。结论：梧州市静脉吸毒人群中不仅存在因静脉注射吸毒经血传播HIV的危险,还存在因性接触传播的危险因素。应及时开展宣传教育以及行为干预工作。     

436例吸毒人员HIV、HCV和梅毒检测结果的分析

目的通过对新会区戒毒所吸毒人员HIV、HCV和梅毒的检测,了解吸毒人群经血传播疾病的危险因素,为预防控制艾滋病在吸毒人群的流行提供科学依据。方法对新会区2011年戒毒所的436例吸毒人员进行问卷调查,采取静脉血的方法抽取血样,进行HIV、HCV和梅毒抗体检测,并对结果进行统计和分析。结果 436例吸毒人员HIV感染率为3.4%(15/436),HCV感染率为36.9%(161/436),梅毒感染率为9.4%(41/436)。HIV、HCV的感染途径以共用注射器静脉吸毒为主。结论被调查人群中存在血源性疾病传播和流行的风险,应加强对吸毒人群的监测,同时开展防病知识宣传教育和行为干预,以降低HIV、HCV和梅毒在该人群中的传播和扩散,控制艾滋病等血源性传染病的蔓延和流行。     

梧州市注射吸毒人群HIV/AIDS死亡情况分析

目的:分析梧州市注射吸毒人群中艾滋病病毒(HIV)感染者和艾滋病(AIDS)病人(简称HIV/AIDS)的死亡獉獉情况。方法:从"艾滋病综合防治信息系统"收集截至2017年12月31日现住址为梧州市和传播途径为注射吸毒獉獉人员的HIV/AIDS死亡病例资料进行分析。结果:截至2017年12月31日,梧州市累计报告554例注射吸毒人员獉獉死亡病例,累计病死率为46. 21%(554/1199);死亡前最后一次CD4+T淋巴细胞≤200个/μl占52. 04%(191/367);死亡病例确认阳性后1年内死亡的仅占17. 32%(96/554);存活5年以上的占45. 85%(254/554)。结论:梧獉獉州市注射吸毒人群HIV/AIDS确证阳性后的生存时间中位数及存活5年以上的比例,均高于梧州市其他感染途径的HIV/AIDS,有关注射吸毒人群HIV/AIDS的生存研究值得今后进一步深入探究。     

社区暗娼吸毒情况及其影响因素调查研究

目的:了解四川省凉山彝族自治州某吸毒严重地区暗娼吸毒情况及其影响因素。方法:从社区招募暗娼调查其社会人口学、吸毒、性行为方式和安全套使用情况。结果:提供知情同意和符合纳入标准的343人中,近3个月内暗娼中吸毒的占9.3%(32/343),其中静脉吸毒的占43.8%(14/32)。多因素分析结果显示当地居民(OR值为7.16;95%CI为2.47-20.69)、低档性服务场所(OR值为10.66;95%CI为2.79-40.72)、近6个月内新性伴人数多(OR值为4.12;95%CI为1.22-13.96)和吸烟(OR值为45.36;95%CI为9.61-214.17)与暗娼吸毒有关。结论:暗娼中存在着经吸毒和性传播HIV的高危行为,需针对这一人群采取有效的干预措施。     

Longitudinal predictors of injection cessation and subsequent relapse among a cohort of injection drug users in Baltimore, MD, 1988-2000

OBJECTIVE: To determine predictors of injection drug use cessation and subsequent relapse among a cohort of injection drug users (IDUs). METHODS: IDUs in Baltimore, MD were recruited through community outreach in 1988-1989. Among IDUs with at least three follow-up visits, parametric survival models for time to injection cessation (>or=6 months) and subsequent relapse were constructed. RESULTS: Of 1327 IDUs, 94.8% were African American, 77.2% were male, median age was 34 years, and 37.7% were HIV-infected. Among 936 (70.5%) subjects who ceased injection, median time from baseline to cessation was 4.0 years. Three-quarters subsequently resumed injection drug use, among whom median time to relapse was 1.0 year. Factors independently associated with a shorter time to cessation were: age <30 years, stable housing, HIV seropositivity, methadone maintenance treatment, detoxification, abstinence from cigarettes and alcohol, injecting less than daily, not injecting heroin and cocaine together, and not having an IDU sex partner. Factors independently associated with shorter time to injection relapse were male gender, homelessness, HIV seropositivity, use of alcohol, cigarettes, non-injection cocaine, sexual abstinence and having a longer time to the first cessation. CONCLUSIONS: This study provides strong support for targeting cessation efforts among young IDUs and severely dependent, unstably housed, and HIV-infected individuals.     

The effect of methadone maintenance on positive outcomes for opiate injection drug users

This study examined outcome variables for 160 opiate injection drug users (IDUs) who entered methadone maintenance between baseline and 6-month follow-up. Outcome variables of interest included drug use, productivity, and HIV risk behaviors. Participants were recruited through street outreach in Denver, CO, from 2000 through 2004 using targeted sampling. The sample was primarily men, White (48%), averaged 39 years of age, and had been injecting drugs for an average of nearly 20 years. Significant improvements were found in univariate tests. Logistic regression revealed that spending more time in treatment was a significant predictor of positive outcomes on drug use and HIV risk behaviors. The results underscore the importance of retaining IDUs in methadone maintenance to maximize their treatment success. Results from this study show that time in treatment can affect many aspects of the participant's life in a positive way, including reduction of HIV risk.     

A randomized controlled trial of monetary incentives vs. outreach to enhance adherence to the hepatitis B vaccine series among injection drug users

BACKGROUND: Injection drug users (IDUs) are at high-risk for hepatitis B virus (HBV) and HIV. Due to concerns about non-adherence to multi-dose vaccine regimens however, IDUs are severely under-immunized against HBV and have been excluded from phase III trials of multi-dose candidate HIV vaccines in the United States. METHODS: Through a randomized controlled trial, we compared the effectiveness of monetary incentives versus outreach to improve IDUs' adherence to the 3-dose hepatitis B vaccine. In 1998-1999, HBV-susceptible IDUs were recruited from San Francisco streets. Eligible participants received their first dose of vaccine and were randomized to either receive monthly monetary incentives (n=48) or maintain weekly contact with an outreach worker (n=48) during the 6-month vaccine series. RESULTS: All 3 doses of vaccine were received by 33 (69%) of IDUs in the monetary incentive arm and 11 (23%) in the outreach arm (odds ratio=13.8; 95% confidence interval, 2.9, 128; P<0.0001). In a multivariate model, receiving monetary incentives was independently associated with vaccine completion (AOR=10.3; 95% CI=3.7, 29.0). CONCLUSIONS: Among IDUs, monetary incentives are superior to outreach in achieving adherence to the multi-dose hepatitis B vaccine series. Monetary incentives may be adapted to future multi-dose candidate HIV vaccine trials in IDUs.     

HIV incidence, retention, and changes of high-risk behaviors among rural injection drug users in Guangxi, China.

BACKGROUND: A prospective observational study of HIV seroincidence among high-risk injection drug users (IDU) was carried out in Guangxi, China. The primary objectives of this study were (1) to estimate HIV seroincidence (2) to estimate participant retention rate and (3) to evaluate changes in drug use and sexual behavior over a one year period. METHODS: Five hundred HIV seronegative IDU were enrolled. HIV-1 incidence and retention rates were analyzed as a function of sociodemographic, behavioral, and recruitment variables. Changes in drug use and sexual behavior were analyzed at the baseline, 6-month and 12-month follow- up visits. RESULTS: At 12 months of follow-up, the HIV-1 incidence rate was 3.1 per 100 person years, [95% CI: (1.6%; 5.2%)] and participant retention rate was 87%. Reported changes in high-risk behaviors over 12-months included significant decreases in the frequency of heroin injection, in direct or indirect sharing of injection equipment, and in the number of sexual partners. CONCLUSIONS: HIV incidence is high among IDU in Guangxi, China despite a self-reported decrease in some high risk behaviors over the course of the study.     

Predictors of risky needle use following interventions with injection drug users in Ukraine

This study was designed to assess factors associated with change in needle-related risk behaviors as well as predictors of continued high-risk behavior following intervention efforts among injection drug users (IDUs) in Ukraine. In each of three locations--Kiev, Odessa, and Makeevka/Donesk--100 IDUs were recruited using modified targeted sampling methods. Following a baseline interview, participants were offered free HIV testing and, over the course of the next 5 months, individualized interventions focusing on reducing HIV-related risk behaviors. Former IDUs conducted interventions through street outreach. The intervention model was based on the Indigenous Leader Outreach Model (ILOM) and stressed assessing an individual's unique risks and developing strategies by which to minimize those risks. Follow-up assessments showed significant reductions in every risk behavior measured. Following the intervention, however, approximately one of four participants reported front- or backloading, using drugs obtained from a common container or injecting with a used needle/syringe. Although the sample as a whole averaged only 28 years of age, those who were younger were significantly more likely to engage in each of these behaviors than those who were older. In light of the overall young age of the Ukrainian IDUs observed in this study, the consistent finding that younger IDUs were at highest risk foreshadows a worsening HIV epidemic in Ukraine.     

A brief intervention for hazardous drinkers in a needle exchange program

Active injection drug users (IDUs) who are also hazardous alcohol users are at particularly high risk for HIV transmission due to sharing of injection equipment. We recruited AUDIT-positive injectors from the Providence, RI needle exchange program for a randomized clinical trial testing the effect of a brief motivational intervention (MI) on frequency of injection-related HIV risk behavior (IRRB). HIV drug risk behavior was measured as the number of days on which subjects reported sharing works using the 30-day Timeline Followback Method. Overall, 109 subjects reported a mean reduction of IRRB days of 9.1 days from baseline to 6-month follow-up (p <.001). When compared to controls, there was a trend in reduction of IRRB days to zero at follow-up for MI subject (OR = 2.1; 95% CI = 0.9-4.5), and strongly significant reductions in IRRB days across a range of alternative improvement thresholds. Results from this study demonstrate that MI reduces drug-related HIV risk behaviors among active IDUs. As a brief intervention, MI may be a useful adjunct to existing services intended to reduce harm.     

Peer-driven HIV interventions for drug injectors in Russia: First year impact results of a field experiment

We report impact results on the first operating year of an HIV prevention field experiment for injection drug users (IDUs) in two cities in western Russia, comparing a Standard “peer-driven intervention” (PDI) in Bragino to a Simplified-PDI in Rybinsk. The PDI relies on IDUs to educate one another in the community about HIV prevention, and recruit peers for enhanced prevention services and education. In the Standard-PDI, IDU-recruiters are offered nominal monetary rewards for both recruiting peers and educating them in a body of prevention information. In the Simplified-PDI, IDU-recruiters are similarly asked to educate and recruit their peers, but the reward for recruiting is woven into their education efforts. This modification streamlined the model's operations and made it 50% less expensive to operate in respondent fees. The overarching research question is whether the modification in the PDI's reward structure affects the model's recruitment power and educational effectiveness. First year results indicate that both PDIs achieved high baseline recruitment rates, although the Standard-PDI out-performed the Simplified-PDI by approximately 35% (493 recruits versus 365 recruits, respectively). However, the IDU-recruiters in the Simplified-PDI did a significantly better job educating their recruits at both baseline (an average knowledge test score of 5.19 versus 4.07 on an 8-point scale) and at follow-up 6 months later (an average knowledge test score of 7.21 versus 5.56 on an 8-point scale). Both PDIs demonstrated about equal and significant efficacy in reducing respondents’ injection frequency, the sharing of syringes and other equipment, and rates of unprotected sex. Two additional refinements in the PDI model were also documented: an enhanced follow-up mechanism more than doubled the PDI's retention strength (to approximately 75%), and clear demonstration that IDUs are capable of educating their recruits in two different bodies of prevention information, depending on whether the recruits are new or follow-up participants.     

African-American injection drug users: tensions and barriers in HIV/AIDS prevention.

This exploratory study utilized a focus group methodology to explore tensions and barriers in HIV/AIDS prevention among African-American injection drug users. Participants discussed HIV infection risks, national/community HIV prevention effectiveness, prevention barriers, ideas on barrier removal, and the tensions which exist between users and the larger African-American community. Recognizing the inevitability of continued drug use for many injectors, participants requested basic harm-reduction supplies including condoms, needle exchange programs, additional drug user treatment services, and the use of culturally- and gender-matched peer-led prevention and treatment outreach. Preliminary recommendations are made for consideration in HIV/AIDS prevention among African-American IDUs.