WHO协作研究项目_阿片类依赖的替代治疗和_省略_高危行为_健康和社区

[]THEWHOMULTI-SITECOLLABORATIVESTUDYONSUBSTITUTIONTHERAPYOFOPIOIDDEPENDENCEANDHIV/AIDS:REGIONALCOMPARISONSOFFINDINGSRELATEDTOHIVRISKBEHAVIOURS,HEALTH,ANDCOMMUNITYBENEFITSDavidNEWCOMBE,RobertALI(WHOCollaboratingCentreforResearchintheTreatmentofDrugandAlcoholProblems/DisciplineofPharmacology,SchoolofMedicalSciences,UniversityofAdelaide,Adelaide,SouthAustralia,5005)ABSTRACTIntroduction:TheWHOCollaborativeStudyonSubstitutionTherapyofOpioidDependence(WHOCollaborativeStudy)wasdesignedtoevaluatetheeffectivenessofsubstitutiontreatment(ST)foropioiddependenceinrelationtoHIV/AIDStreatmentandpreventioninanumberoflessresourcedcountriesinAsia(China,Indonesia,andThailand)andEasternEurope(Lithuania,Ukraine,Poland)andtheMiddleEast(Iran).Thepurposeofthispaperwastoundertakeregionalcomparisonsofoutcomedataobtainedfromthesecountries.Tofacilitatethisprocess,countriesweregroupedarbitrarilyintotworegionsAsiaandEurope(includingIran).DatawerealsocollectedfromasmallcohortofpatientsenrolledinSTinAdelaide,SouthAustralia,toallowdatafromnationswithlessresourcetobecomparedtothosecollectedfromanestablishedSTprogram.Methods:ThiswasaprospectiveobservationalstudywhereparticipantsnewlyenrolledintoSTwereinterviewedatbaseline,andagainat3and6-monthfollow-ups.Participantswereadministeredabatteryofinstrumentsdesignedtocollectdemographicinformation,anddataonphysicalandpsychologicalhealth,HIVriskbehaviours(injectingandsexualpractices),andinvolvementinemploymentandcriminalactivity.Thetimeframeofquestionswasthemonthpriortoenteringtreatmen,tortheone-monthpriortothe3and6-monthfollow-upinterview.BloodwasalsotestedtodetermineHIVandHepCserostatus.Results:Atotalof730participantswereenrolledintothestudy(Australia=42,Asia=321,Europe=367).RatesofHIVseropositivitywere3%,16%and35%,forAustralia,Europe,andAsia,respectively.Thereweresignificantreductionsinillicitdruguseandriskyinjectingpractices,andsignificantselfreportedimprovementsinphysicalandpsychologicalhealth,inthosepatientsremainingintreatmen.tFurthermore,therewerealsoincreasesinemploymentactivity,andreductionincriminalinvolvemen.tConclusion:TheseoutcomeevaluationdataareconsistentwithfindingsfromdevelopedeconomiesandshowthattheimplementationofSTinlessresourcedeconomiescanbeeffectiveinreducingHIVriskbehaviours,andimprovinghealthwellbeingofthosewhoremainintreatmen.tKEYWORDScollaborativestudy;substitutiontherapy;opioiddependence:HIVriskbehaviour203(ChinJDrugDepend)2007,16(3):203-211WHO-HIV/AIDS:HIVDavidNEWCOMBE,RobertALI(,,,5005)引言:WHO-HIV/AIDSHIV/AIDS()()(),-(),方法:,,36HIV(),HIV(HCV)结果:730(42,321,367())()HIV3%,16%35%,,,,结论:,HIV,;;;HIV1IntroductionOpioidabuseisagrowingproblemworldwide,andinparticularinjectingdruguseamongstuntreatedopioidusersremainsamajormodeofbloodbornevirustransmission[1-2].Furthermore,whilegloballybetween5%and10%ofHIVinfectionsresultfrominjectingdruguse,insomeregionsinAsiaandEurope,over70%ofHIVinfectionsareattributabletoinjectingdruguse[3].Thus,thereisaneedtodeveloparangeofcommunitybasepreventionandtreatmentresponsestoopioiddependence,thatwillhelpreduceHIVtransmissionassociatedwithintravenousopioiduseinlessresourcedcountries.Substitutiontreatment(ST)foropioiddependencehasbeenshowntobeeffectiveindecreasingHIVtransmission.ArecentCochranereviewexaminedtheeffectofSTonHIVriskbehaviours[1].TheauthorsdeterminedthattheprovisionofSTforopioiddependencewaseffectiveinreducingillicitopioiduse,injectinguse,andsharingofinjectingequipmen,tandthatthesereductionsinHIVriskbehavioursdotranslateintoreductionsincasesofHIVinfection[1].Substitutiontreatmen,tandinparticularmethadonemaintenancetreatmen,talsohasdemonstratedefficacyinimprovingthephysicalandpsychologicalhealthofthosereceivingtreatmentforopioiddependence[4-6].Importantly,amajordeterminantofsuccessfuloutcomeinSTisthelengthoftimepatientsremainedintreatmen;tthosewhodropoutoftreatmentaremorelikelytorelapsetointravenousopioiduse[7].Furthermore,methadonedosagesintherange50to100mgarealsorelatedtobetteroutcomethanlowerdosages[7-8].Itisimportanttonotethatmanyofthelaterstudieswereundertakenindevelopednations,andsomanylessresourcednationswishtoseeevidenceoftheefficacyofSTintheirownculturalcontex.tThus,thegeneralamiofthecurrentstudywastoexploretheeffectivenessandfeasibilityofsubstitutiontherapyforopioiddependenceaspartofHIVprevention,treatmentandcareamongopioid-dependentinjectingdrugusersinpredominantlylowandmiddle-incomecountries.Thecountriesparticipatinginthisstudyincluded:China,Indonesia,Iran,Lithuania,Poland,Thailand,andUkraine.Thereaderisdirectedtopaperspresentedinthecurrentissueofthisjournalthatreport204(ChinJDrugDepend)2007,16(3):203-211ondatacollectedaspartofthemiplementationofSTwithineachoftheabovementionedcountries.ForthepurposeofthecurrentpapersitesweregroupedarbitrarilytogetherintotworegionsAsiaandEurope(includingIran).ThiswasundertakentofacilitateregionalcomparisonsinordertoidentifybroadthemeswithregardtotheeffectivenessofSTforopioiddependenceandHIV/AIDSpreventionandtreatmen.tInaddition,outcomedatawerealsocollectedfromasmallcohortofpatientsenrolledinSTinA