乘数法估计四川乐山市中区吸毒人群基数研究

目的:使用乘数法估计乐山市中区籍现有吸毒人群基数。方法:获得当地强戒所和自愿咨询检测门诊2003年5月31-2004年5月31日收戒或咨询人数r,问卷调查获乘数1/p,N=r/p计算估计数,定性和定量研究结合以解释估计结果。结果:r=507/511人,271份问卷获自称戒毒比例23.99%/4.17、咨询比例32.47%/3.08,估计数2114/1574人。23.99%和核对比例23.25%比较,χ2=0.0952,P=0.7576;一致性检验,k=0.5705,95%可信区间[0.4547,0.6862];灵敏度68.25%和特异度89.42%。与2002年自称戒毒比例(25.54%)比较,χ2=0.1623,P>0.05。公安部门登记、乘数法计算的总吸毒率为0.20%、0.39%和0.29%,三者多重比较,χ2为185.46、320.27、83.85和12.41,均P<0.01。结论:强戒所和VCT门诊为依托机构进行乘数法估计是可行的;自称戒毒比例稳定为24%,VCT比例33%,可满足估计,但需关注戒毒假阴性问题;至2004年7月26日目标人群估计数1574-2114人,是公安部门同期现有吸毒登记数的1.5-2倍。     

捕获再捕获法估计四川乐山市中区吸毒人群基数

目的:使用捕获再捕获法估计乐山市中区现有吸毒人群基数。方法:利用强戒所建所以来资料确定平均捕获期和平均捕获间隔期及两次捕获起始点并收集相应时间段内的收戒人数。利用Lincoln-Petersen模型进行估计,定性和定量研究结合以解释说明估计结果等。结果:平均捕获期3.02月,平均捕获间期12.59月,两次捕获期起止时间点为2002年9月30日-2003年1月31日和2004年1月31日-2004年5月31日,对应收戒人数为234人和251人,重复捕获34人。不分层点估计数1742人,标准误240.45,95%CI1220-2163(人)。分层后合计点估计数为1645人,标准误225.46,95%CI1203-2087(人)。结论:75%位数捕获期和平均捕获间期为4个月和12个月,可满足分析需要。Lincoln-Petersen模型简单,费用低,可操作性强。估计结果存有一定程度的低估,可作为估计底限值。选择适当的捕获再捕获模型可提高估计精度。估计数为公安部门同期提供现有吸毒登记数的1.5倍。     

女性吸毒人群中丙型肝炎病毒感染状况及其影响因素的研究

目的:了解丙型肝炎病毒在女性吸毒人群中的分布状况,并探索影响因素.方法:采用横断面研究对女性吸毒者进行流行病学调查,并用ELISA对女性吸毒者血清进行抗-HCV检测;资料用SPSS10.0、SAS软件进行统计分析.结果:女性吸毒者抗-HCV阳性率为90.9%,单因素分析表明,年龄、吸毒年限、现在吸毒方式、复吸次数是HCV感染的主要危险因素,多因素logistic回归分析表明年龄、现在吸毒方式是HCV感染的独立相关因素.结论:静脉注射吸毒是HCV感染的主要危险因素.在女性吸毒者中存在极高的HCV感染率.     

海洛因依赖人群规模估计方法研究

目的 :验证和筛选符合我国国情并适用于海洛因依赖者群体规模估计的方法。方法 :“Delphi法”和“滚雪球 -乘数法”结果相互验证。结果 :“Delphi法”估计数 :下限是 70 0 0人 ,上限是 15 0 0 0人 ,分别是当地公安机关在册人数的 1 4 1倍和 3 0 1倍 ;“滚雪球 -乘数法”估计数 :10 6 86人 ,是当地公安机关在册人数的 2 15倍。两种方法的估计结果基本一致。结论 :“Delphi法”和“滚雪球 -乘数法”的估计结果一致性较好 ,处于同一范围 (70 0 0 - 15 0 0 0人 ) ,可信度较高。“Delphi法”、“滚雪球—乘数法”和公安机关的在册登记人数均系利用不同资源和从不同侧面反映了当地海洛因依赖者人群规模状况。单一使用某种方法 ,极有可能造成对当地海洛因依赖者人群规模的估计偏差。因此 ,对某地区的海洛因依赖者人群规模实际估计时 ,应结合当地实际 ,多方法联合应用 ,以便相互对照 ,相互验证     

西安市戒毒者吸毒行为和性行为定性研究

目的:了解吸毒者的吸毒行为和性行为方式以及行为意识。方法:2001年10月-2002年6月采用单独个人深入访谈方式对西安市长安区和碑林区戒毒所的46名吸毒者进行调查。结果:73.9%的调查对象采取烫吸、口服或口含方式吸毒;主要原因是认为注射方式吸毒对健康危害比较大,容易感染疾病、害怕过量致死、害怕感染艾滋病。在静脉注射毒品者中,33.3%的人在不方便携带、晚上不方便购买或犯毒瘾时来不及购买注射器的情况下,共用或重复使用注射器。大多数吸毒者已经不是第一次戒毒,复吸的原因主要是不能脱离原来的环境,其次是不能控制心瘾;社会和家人的歧视,生活压力等也是导致高复吸率的常见原因。戒毒人员发生婚前、婚外性行为的比例分别为71.7%(33人)和28.3%(13人);71.7%(33人)的人有2个以上性伙伴,有性行为的戒毒者中,经常使用安全套的比例不到15%。结论:尽管西安市吸毒者主要以烫吸为主要吸毒方式,但仍存在注射毒品高危行为和高危性行为。     

1080例吸毒者HDV及合并HBV感染情况分析

目的:了解吸毒者丁型肝炎病毒及合并乙型肝炎病毒感染情况。方法:对我所2004年9月-2005年1月新收容的1080例吸毒者进行丁型肝炎病毒抗体(HDV-IgG)及HDV-IgG合并乙型肝炎表面抗原(HBsAg)检测,并用自行设计的《吸毒方式调查表》进行问卷调查。结果:在1080例吸毒者中,HDV感染156例,感染率14.4%,其中静脉注射者153例(98.1%);静脉注射组的HDV感染率15.9%(153/960),高于烫吸组(2.5%,3/120),P<0.01;在静脉注射组的HDV感染者中,共用注射器者的比例(21.3%,132/620)高于非共用注射器者(6.9%,21/340),P<0.001;在156例HDV感染者中有145例合并HBV感染,且合并者的肝功异常率高达73.1%(106/145)。结论:吸毒者中HDV感染率较高,且绝大多数合并HBV感染。共用注射器吸毒是导致HDV及HBV感染的主要原因,有关部门应采取有力措施,做好预防工作。     

同伴教育减少艾滋病伤害

自1983年艾滋病病毒首次感染我国公民,截至2004年底,中国内地累计报告HIV感染者106990例,AIDS病例23955例[1].全国累计报告的病例数据显示,静脉注射吸毒人群中共用注射器的比例平均为50%,最高达98%;共用注射器人群HIV感染率很高,一般为30%～60%[2].因此,如何减少静脉注射吸毒者HIV感染率已成为戒毒工作的一个重要组成部分.     

社会心理健康状况与女性吸毒的关系

目的··:研究社会心理因素与女性吸毒的关系。方法·· :成组病例与对照对比研究。结果·· :吸毒组在吸毒前抑郁及焦虑状况明显比对照组严重(P<0.001) ;吸毒组中遭受感情挫折、失恋或离婚的比例明显高于对照组(χ2=170.80及56.88 ,P<0.001) ;吸毒组吸烟、饮酒的比例明显高于对照组(χ2=518.78及97.88,P<0.001) ;吸毒组吸毒前各种违纪违法行为的比例均明显高于正常人群,其中又以离家出走和逃学所占比例较高 ,分别为33.23 %和16.77%。结论··:女性吸毒者吸毒前普遍社会心理健康状况不佳 ,这可能是导致她们吸毒的主观因素。     

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。     

我国部分地区成瘾物质使用的纵向研究第三部分:吸毒人员的人口学特征

目的 :了解我国部分地区吸毒人群的人口学特征、探讨其变化趋势。方法 :采用单因素分析方法 ,对三次不同时间药物流行病学调查的非法成瘾物质滥用者人口学指标进行纵向比较。结果 :三次调查吸毒人群中 ,女性所占比例逐次增加 ,分别为 10 1%、17 1%和 2 2 4 % ;吸毒人员中 ,2 0 - 2 9a和 30 - 39a两年龄组人员最多 ,且年龄呈增加趋势。约 5 0 %吸毒人员未婚 ,离婚比例逐次增加 (3 3%、7 2 %和 17 0 % ) ,分居比率后两次调查 (6 2 %和5 9% )高于首次调查 (2 3% )。 1993年调查小学或以下文化的吸毒人员占 86 4 % ,后两次调查初中文化者分别占6 5 0 %和 6 2 3%。无业、工人或个体户是吸毒人员最常见的职业 ,无业者逐次增加。年收入 10 0 0元以下者和 70 0 0元以上者是吸毒者主体 ,随调查逐次增加 ,吸毒与经济收入呈“U”字关系。结论 :青中年男性、受教育程度较低者、无业或非固定性职业、未婚或非稳定婚姻形式人员是吸毒的高危人群 ;女性使用非法物质者越来越多 ,应加强对她们的关注。吸毒人群年轻化在研究中没有得到证实。     

Heterosexual relationships among heroin users in Italy

This study investigated how many stable partners of drug users (DUs) had a history of drug use or were current DUs. Of 589 DUs interviewed, 41% reported that they had a partner with current or previous experience of drug addiction. A strong gender difference emerged: 77% of female DUs reported a stable relationship with partners with a history of addiction, versus only 30% for male DUs. Partners with a history of drug dependence are more likely to be: male, older, with a lower educational level and a lower rate of stable employment than partners without a history of drug addiction. Logistic regression analysis indicated that the characteristics of heroin users who have current partners with histories of drug use include: female gender, older age, living with a partner, lengthy duration of the relationship and HIV positive status. Fewer subjects are married if the partner has a history of addiction, and there is an association between lengthy drug use and partner without drug addiction history. The high percentage (59%) of subjects who were in stable relationships with partners without histories of heroin addiction and the relatively long duration of these relationships, raises the issue of possible transmission of blood-borne viruses from the DUs to their sexual partners. The study does suggest the need for consideration of sexual partnerships and gender differences in providing drug abuse treatment for heroin users.     

Estimating the Total Mortality Among Problem Drug Users

This paper's objective is to develop a method to estimate the total mortality among problem drug users. The total mortality is given by a base rate of mortality not related to drugs and the deaths that are directly and indirectly related to drugs. A fatal poisoning by drugs (overdose) is directly related to drugs, whereas a casualty due to a drug-related disease or a drug-related accident is indirectly related to drugs. As an example of a method to estimate the total mortality, the results from a cohort study among methadone patients in Amsterdam were projected on the whole population of problem drug users in The Netherlands. Due to differences between the problem drug users in Amsterdam and the rest of the country, adjustments were required. It was found that an initial estimation did not require adjustment for injection behavior and gender but did require adjustment for age and the percentage of HIV infection. In a first unadjusted estimation, the total number of deaths among problem drug users in The Netherlands in 2001 was estimated at 606 deaths. After adjustment for age, the estimated mortality decreased to 573 deaths, and after adjustment for HIV infection, this estimation again decreased to 479 deaths. From the ultimately estimated mortality, 11% was considered to be not related to drugs, 23% was attributed directly to drugs, and 66% was attributed indirectly to drugs. The number of direct deaths, as estimated by this method, falls in the same order of magnitude as the number extracted from the Causes of Death Statistics, when selecting cases according to the Drug-Related Deaths Standard as established by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). Further cross-validation with other measures will be needed to assess the accuracy of the method, the limitations of which are discussed with respect to stipulating directions for future research.     

Estimating the total mortality among problem drug users

This paper's objective is to develop a method to estimate the total mortality among problem drug users. The total mortality is given by a base rate of mortality not related to drugs and the deaths that are directly and indirectly related to drugs. A fatal poisoning by drugs (overdose) is directly related to drugs, whereas a casualty due to a drug-related disease or a drug-related accident is indirectly related to drugs. As an example of a method to estimate the total mortality, the results from a cohort study among methadone patients in Amsterdam were projected on the whole population of problem drug users in The Netherlands. Due to differences between the problem drug users in Amsterdam and the rest of the country, adjustments were required. It was found that an initial estimation did not require adjustment for injection behavior and gender but did require adjustment for age and the percentage of HIV infection. In a first unadjusted estimation, the total number of deaths among problem drug users in The Netherlands in 2001 was estimated at 606 deaths. After adjustment for age, the estimated mortality decreased to 573 deaths, and after adjustment for HIV infection, this estimation again decreased to 479 deaths. From the ultimately estimated mortality, 11% was considered to be not related to drugs, 23% was attributed directly to drugs, and 66% was attributed indirectly to drugs. The number of direct deaths, as estimated by this method, falls in the same order of magnitude as the number extracted from the Causes of Death Statistics, when selecting cases according to the Drug-Related Deaths Standard as established by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). Further cross-validation with other measures will be needed to assess the accuracy of the method, the limitations of which are discussed with respect to stipulating directions for future research.     

Knowledge of tuberculosis among drug users. Relationship to return rates for tuberculosis screening at a syringe exchange

Tuberculosis is an important health issue among drug users. We sought to evaluate active drug users' (DUs) knowledge of tuberculosis (TB) and to assess the relationship between TB knowledge and attitudes and tuberculin skin test (TST) return rates at a syringe exchange program. DUs were recruited at a syringe exchange program in New York City, were interviewed and offered TSTs, and received $15.00 upon returning for TST reading. The questionnaire evaluated knowledge of TB transmission, prevention, and treatment. From March 13, 1995 to January 31, 1996, 610 of 650 (94%) of DUs approached agreed to participate. Of these, 80% had previous TSTs within the past 2 years and 20% were known to be HIV infected. Almost all knew that TB is contagious and more than two thirds knew that TB is treatable and that TB preventive therapy existed. However, fewer than half knew that HIV-related TB could be treated, 30% thought TB could be treated without a medical doctor, and the majority (70%) thought a reactive TST implied infectivity. The rate of return for TST reading was 93%. In multivariate analysis, those who knew that HIV-related TB was curable were more likely to return for TST reading (odds ratio 2.0; 95% confidence interval 1.04 to 3.95; p = .03). The high acceptance and return rates suggest that TB services can be incorporated into syringe exchange programs. However, several important gaps in TB knowledge existed in this population at high risk of TB, which may impact on adherence and which support the need for TB education for drug users.     

广西西部吸毒人员艾滋病病毒感染情况及有关危险因素调查分析

目的:了解桂西吸毒人员艾滋病病毒感染的流行情况及HIV感染有关危险因素。方法:对广西西部地区三县一市的478例吸毒人员进行了调查和血清HIV抗体检测。结果:在478例吸毒人员中共检出HIV感染者250例,HIV感染率为52·30%。与HIV感染有关的危险因素主要是静脉注射吸毒及共用注射器,其中有静脉注射毒品史者的HIV感染率远高于非注射者(67·87%/4·27%,P<0·001),有共用注射器吸毒史者高于无共用者(70·08%/29·92%,P<0·001);有婚前或婚外性行为者HIV感染率高于无婚前或婚外性行为者(66·98%/40·30%),两者比较差异有显著性(P<0·001)。结论:广西百色地区吸毒人群HIV感染率高。静脉注射吸毒是HIV感染的高危因素;也存在性行为传播的危险性。应该采取预防措施,防止艾滋病病毒进一步扩散。     

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.     

HIV Incidence,Retention, and Changes of High-Risk Behaviors Among Rural Injection Drug Users in Guangxi,China

Abstract

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-monfh and 12-monfh 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-monfhs 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.     

Cost-effectiveness of integrating methadone maintenance and antiretroviral treatment for HIV-positive drug users in Vietnam's injection-driven HIV epidemics

Drug use negatively affects adherence to and outcomes of antiretroviral treatment (ART). This study evaluated the cost-effectiveness of integrating methadone maintenance treatment (MMT) with ART for HIV-positive drug users (DUs) in Vietnam. A decision analytical model was developed to compare the costs and consequences of 3 HIV/AIDS treatment strategies for DUs: (1) only ART, (2) providing ART and MMT in separated sites (ART-MMT), and (3) integrating ART and MMT with direct administration (DAART-MMT). The model was parameterized using empirical data of costs and outcomes extracted from the MMT and ART cohort studies in Vietnam, and international published sources. Probabilistic sensitivity analysis was conducted to examine the model's robustness. The base-case analysis showed that the cost-effectiveness ratio of ART, DAART-MMT, and ART-MMT strategies was USD 1358.9, 1118.0 and 1327.1 per 1 Quality-Adjusted Life Year (QALY), equivalent to 1.22, 1.00, and 1.19 times Gross Domestic Product per capita (GDPpc). The incremental cost-effectiveness ratio for DAART-MMT and ART-MMT versus ART strategy was 569.4 and 1227.8, approximately 0.51 and 1.10 times GDPpc/QALY. At the willingness to pay threshold of 3 times GDPpc, the probability of being cost-effective of DAART-MMT versus ART was 86.1%. These findings indicated that providing MMT along with ART for HIV-positive DUs is a cost-effective intervention in Vietnam. Integrating MMT and ART services could facilitate the use of directly observed therapy that supports treatment adherence and brings about clinically important improvements in health outcomes. This approach is also incrementally cost-effective in this large injection-driven HIV epidemic.