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Prevalence of pretreatment drug resistance in persons initiating and reinitiating antiretroviral therapy in Sri Lanka: results from a national representative survey

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JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY 2023年第6期78卷 1476-1479页

作者： Elwitigala, J. Rajapaksa, L. Inzaule, S. C. Ariyaratne, K. A. M. Jayasena, S. Kurle, S. Patil, A. Kale, D. Siriwardna, L. Samaraweera, G. Perera, H. Jayakody, C. Minist Hlth Natl STD AIDS Control Programme Colombo Sri Lanka Univ Amsterdam Amsterdam Inst Global Hlth & Dev Amsterdam Netherlands Univ Amsterdam Dept Global Hlth Amsterdam UMC Amsterdam Netherlands Natl AIDS Res Inst HIV Drug Resistance Lab Pune India

Background We conducted a nationwide cross-sectional study to estimate pretreatment drug resistance (PDR) prevalence in adults initiating ART in Sri Lanka following the WHO's recommendations. Methods HIV drug resistance was determined on dried blood spots (DBSs) using population-based sequencing of the protease and reverse transcriptase genes and interpretation was based on Stanford HIVdb v9.0. Analyses were weighted to adjust for multistage sampling and genotypic failure rate. We used logistic regression to assess differences between groups. Results Overall, in 10% (15 of 150) of patients initiating ART, HIV drug resistance mutations were detected. The prevalence of resistance to NNRTI drugs efavirenz/nevirapine was 8.4% (95% CI 4.6-15.0) but differed among those reporting having prior antiretroviral (ARV) exposure (24.4%, 95% CI 13.8-39.5) compared with 4.6% (95% CI 1.6-12.8) for those reporting as being ARV naive (OR 4.6, 95% CI 1.3-16.6, P = 0.021). PDR to efavirenz/nevirapine was also nearly twice as high among women (14.1%, 95% CI 6.1-29.4) compared with men (7.0%, 95% CI 3.1-14.7) (P = 0.340) and three times high among heterosexuals (10.4%, 95% CI 2.4-35.4) compared with MSM (3.8%, 95% CI 1.1-12.7) (P = 0.028). NRTI PDR prevalence was 3.8% (95% CI 1.1-12.1) and no PI PDR was observed in the study. Conclusions A high prevalence of efavirenz/nevirapine PDR was reported, especially in patients with prior ARV exposure, in women and those reporting being heterosexual. These findings highlight the need to fast-track the transition to the WHO-recommended dolutegravir-based first-line ART.

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New progress in HBV control and the cascade of health care for people living with HBV in China: evidence from the fourth national serological survey, 2020

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LANCET REGIONAL HEALTH-WESTERN PACIFIC 2024年 51卷 101193-101193页

作者： Zheng, Hui Wang, Yu Wang, Fuzhen Shen, Liping Zhang, Guomin Liu, Jianhua Wang, Feng Miao, Ning Li, Jian Ding, Guowei Meng, Tongtong Tang, Lin Zhang, Shuang Li, Mingshuang Li, Yuan Wang, Xiaoqi Liu, Qianqian Zhang, Qian Wu, Dan Yan, Tingting Su, Qiudong Wang, Miao Li, Li Hou, Qian Li, Yixing Liu, Yi Ye, Shaodong An, Zhijie Rodewald, Lance E. Jia, Jidong Wang, Huaqing Yu, Wenzhou Liu, Zhongfu Li, Qun Feng, Zijian Yin, Zundong Chinese Ctr Dis Control & Prevent Natl Key Lab Intelligent Tracking & Forecasting In Beijing 102206 Peoples R China Chinese Ctr Dis Control & Prevent Natl Immunizat Programme Beijing 100050 Peoples R China Capital Med Univ Beijing Friendship Hosp Liver Res Ctr Natl Clin Res Ctr Digest Dis Beijing 100050 Peoples R China Chinese Ctr Dis Control & Prevent Natl Inst Viral Dis Control & Prevent Natl Key Lab Intelligent Tracking & Forecasting In Beijing 102206 Peoples R China Guangzhou Ctr Dis Control & Prevent Guangzhou 510440 Peoples R China Chinese Ctr Dis Control & Prevent Natl Ctr AIDS STD Control & Prevent Natl Key Lab Intelligent Tracking & Forecasting In Beijing 102206 Peoples R China

Background Since 1992, when recombinant hepatitis B vaccine was introduced in China, government health officials fi cials have used nationally representative serological surveys to monitor progress in prevention and control of hepatitis B. In 2020, we conducted the fourth seroepidemiological survey, which for the fi rst time included medical evaluation of the clinical status of HBsAg positive subjects over the age of 15 and their medical management. We report survey results in comparison with the three previous surveys. Methods Consistent with previous national surveys, the 2020 survey used a stratified, fi ed, three-stage cluster random sampling method to select for evaluation 1-69-year-olds in 120 national disease surveillance points. Blood samples were tested for HBsAg, anti-HBV surface antigen (anti-HBs), and anti-HBV core antigen (anti-HBc) in the National Hepatitis Laboratory of the Institute for Viral Disease control and Prevention of China CDC. HBsAg positive subjects aged >= 15-year were evaluated for evidence of liver disease, and through face-to-face questionnaire-based survey, we determined the healthcare management cascade of HBV-infected individuals. Findings HBsAg prevalence in 1-69 - 69-year-olds was 5.86%;in children 1-4 - 4 years of age, seroprevalence was 0.30%;75 million people were living with HBV nationwide. Among HBsAg-positive individuals 15 years and older, expert medical examination found that 78.03% were HBsAg carriers with no evidence of liver damage, 19.63% had chronic HBV with liver enzyme abnormalities, 0.84% had evidence of cirrhosis, and 0.15% had evidence of liver cancer. 59.78% of HBsAg + individuals were aware that they were positive before the survey, 30 million were unaware;38.25% of those who knew they were positive (17 million) had medical indications for antiviral treatment, and 17.33% of these individuals (3 million) were being treated with antivirals. Interpretation The decline in HBsAg prevalence in the general population,

关键词： Hepatitis B National serological survey Disease burden

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Lessons Learned From Global Hepatitis C Elimination Programs

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JOURNAL OF INFECTIOUS DISEASES 2024年第Sup3期229卷 S334-S341页

作者： Handanagic, Senad Shadaker, Shaun Drobeniuc, Jan Tsereteli, Maia Alkhazashvili, Maia Adesigbin, Clement Adamu, Ibrahim Adabe, Ruth Agwuocha, Chukwuemeka Adisa, Olayinka Azania, Amy Boeke, Caroline E. Ngwije, Alida Serumondo, Janvier Armstrong, Paige A. CDCP Div Viral Hepatitis Atlanta GA USA Natl Ctr Dis Control & Publ Hlth Georgia Tbilisi Georgia Fed Minist Hlth Natl AIDS STIs Control Programme Abuja Nigeria Nasarawa State Minist Hlth Lafia Nasarawa Nigeria Clinton Hlth Access Initiat Abuja Nigeria Clinton Hlth Access Initiat Boston MA USA Clinton Hlth Access Initiat Kigali Rwanda Rwanda Biomed Ctr Kigali Rwanda US Ctr Dis Control & Prevent Div Viral Hepatitis Natl Ctr HIV Viral Hepatitis STD & TB Prevent 1600 Clifton Rd Atlanta GA 30333 USA

In 2016, the World Health Organization introduced global targets for the care and management of hepatitis C virus (HCV) infection to eliminate hepatitis C as a public health threat by 2030. Despite significant improvements in testing and treatment, in 2020 only 23% of all persons infected with HCV globally were diagnosed. We explore examples from global hepatitis C programs in Georgia, Rwanda, and Nigeria that have used decentralized and integrated models to increase access to HCV testing. Georgia established the world's first national hepatitis C elimination program in 2015. In 2022, 2.6 million people (80% of the adults) have been screened for antibodies for HCV infection, and 80 000 persons with HCV RNA detected were treated. To achieve these results, Georgia implemented HCV core antigen testing, utilization of point-of-care (POC) HCV RNA testing, and simplification of HCV viremia detection by qualitative HCV RNA testing. Rwanda was the first country in sub-Saharan Africa to commit to HCV elimination in 2018, and as of 2022 it has achieved its screening target of 7 million people and initiated approximately 60 000 patients on hepatitis C treatment by rapid decentralization and integration of HCV services. In Nigeria, the integrated near-POC testing approach in Nasarawa State has been effective in expanding access to HCV viremia testing and enabling the possibility of same-day testing and treatment initiation. Examples of decentralization and integration of HCV testing and linkage to care in Georgia, Rwanda, and Nigeria could help inform effective strategies to reach 2030 hepatitis C elimination goals in other countries.

关键词： Georgia hepatitis C Nigeria Rwanda viral hepatitis elimination

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High level of HIV viral suppression in a cross-sectional study of Ugandan men with urethritis and bacterial STI

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INTERNATIONAL JOURNAL OF std & aids 2023年第14期34卷 998-1003页

作者： Beck, Evan J. Laeyendecker, Oliver Saraf, Sharada Ashokkumar, Swetha Onzia, Annet Melendez, Johan H. Chan, Justin Kyambadde, Peter Gough, Ethan Parkes-Ratanshi, Rosalind Manabe, Yukari C. Hamill, Matthew M. Natl Inst Allergy & Infect Dis Div Intramural Res NIH Bethesda MD USA Johns Hopkins Univ Sch Med Dept Med Baltimore MD USA Makerere Univ Infect Dis Inst Kampala Uganda Minist Hlth Uganda STD & AIDS Control Programme Kampala Uganda Johns Hopkins Bloomberg Sch Publ Hlth Dept Int Hlth Baltimore MD USA Natl Inst Allergy & Infect Dis Natl Inst Hlth North Wolfe St 855Rangos Bldg Room 540 Baltimore MD 21205 USA

Background Urethritis associated with non-viral sexually transmitted infections (STI) increases the risk of HIV acquisition and transmission in those living with HIV (LWH) without viral load suppression (VLS). Compared to women, men typically have lower rates of HIV VLS. We assessed the prevalence of VLS and drug resistance mutations in men LWH and urethral discharge syndrome (UDS) in Kampala, Uganda. Methods Men with UDS were recruited in Kampala October 2019-November 2020. Medical, demographic, and behavioural data were collected with biological samples. All reactive HIV results (rapid, sequential algorithm) underwent confirmatory HIV antibody- and HIV incidence-testing, and viral load (VL) measurement. The pol and gp41 regions were sequenced on samples with VLs >1000 cpm, phylogenetic trees were generated, and resistance mutations were investigated. Results 50 of 250 participants (20%) had reactive HIV rapid tests and 48/50 (96%) were aware of their HIV status and using antiretroviral therapy (ART). The median age was 38 years (IQR 32-45), 27/50 (54%) had engaged in transactional sex, and 30/50 (60%) reported alcohol before sex. VLS was present in 46/50 (92%). There were no major resistance mutations present in any samples analyzed. Conclusions The prevalence of HIV and VLS was greater in these men than in the general Ugandan adult population. Most men LWH were on ART and thus less likely to transmit HIV despite demonstrating sexual behaviours associated with high-risk of STIs. These data emphasize that high levels of ART coverage and VLS are achievable among men with UDS in urban Kampala.

关键词： HIV viral suppression urethral discharge syndrome sexually transmitted infections antiretroviral therapy resistance factors associated with HIV transmission Uganda men risk behaviours

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Genital Immune Cell Activation and Tenofovir Gel Efficacy: A Case-control Study

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CLINICAL INFECTIOUS DISEASES 2022年第6期75卷 1088-1091页

作者： Liebenberg, Lenine J. P. Passmore, Jo-Ann S. Osman, Farzana Jewanraj, Janine Mtshali, Andile Garcia-Lerma, J. Gerardo Heneine, Walid Holder, Angela Archary, Derseree Ngcapu, Sinaye Sivro, Aida Mansoor, Leila E. Karim, Quarraisha Abdool Karim, Salim S. Abdool McKinnon, Lyle R. Ctr AIDS Programme Res South Africa CAPRISA Durban South Africa Univ KwaZulu Natal Sch Lab Med & Med Sci Durban South Africa Univ Cape Town Inst Infect Dis & Mol Med IDM Cape Town South Africa Natl Hlth Lab Serv Cape Town South Africa Ctr Dis Control & Prevent Div HIV AIDS Prevent Natl Ctr HIV AIDS Viral Hepatitis STD & TB Preven Atlanta GA USA Univ Manitoba Dept Med Microbiol & Infect Dis Winnipeg MB Canada Univ KwaZulu Natal Sch Nursing & Publ Hlth Durban South Africa Columbia Univ Dept Epidemiol New York NY USA

Genital inflammation (GI) undermines topical human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) efficacy through unknown mechanisms. Here, associations between activated endocervical CD4 + T-cell numbers and higher deoxyadenosine triphosphate (dATP) concentrations suggest that competition for intracellular metabolites within HIV target cells may reduce the efficacy of antiretroviral-based PrEP in women with GI.

关键词： immune activation genital inflammation HIV tenofovir dATP

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Beach boys in Galle, Sri Lanka: multiple HIV risk behaviours and potential for HIV bridging

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BMC PUBLIC HEALTH 2020年第1期20卷 1604-1604页

作者： Bozicevic, Ivana Manathunge, Ariyaratne Beneragama, Sriyakanthi Gadjaweera, Chathrini Univ Zagreb World Hlth Org Collaborating Ctr HIV Strateg Info Sch Med Zagreb Croatia Minist Hlth Natl STD AIDS Control Programme Colombo Sri Lanka

Background There are limited data globally on HIV in men who engage in casual and transactional sex with female tourists. Methods In 2018 we carried out a respondent-driven sampling (RDS) survey among beach boys in Galle, Sri Lanka, to determine prevalence of HIV and other infections, HIV risk behaviours and utilisation of HIV prevention services. Eligibility criteria included men who cruise in and around beach areas and who had anal and/or vaginal sex with female or male tourists in the 12 months before the survey. Results We recruited 373 beach boys. Approximately 49.6% of the participants were married, while 45.7% were single and 4.7% divorced, separated or widowed. A lower percentage of beach boys reported regular partners in the past 12 months (52.3%) compared to casual partners (95.4%). Condom use at last sex with a casual partner was higher (76.7%) compared to condom use with regular partners (58.3%). Condom use at last sex with a tourist was reported by 75.3%. Ever receiving money, goods or services in exchange for sex was reported by 39.7%. For 85.5% of beach boys who sold sex, the last paying partner was a tourist (85.5%) and a woman (82.0%). In the past 12 months before the survey, 32.3% of beach boys paid money for sex, and 99.5% did so from women. Ever been tested for HIV was reported by 35.3, and 69.1% of those were tested in the 6 months before the survey. In the adjusted multivariate analysis, significant correlates of never testing for HIV were lack of comprehensive knowledge about HIV and unprotected last sexual intercourse with tourists. The prevalent infections were: HIV, 0.3% (95% CI 0.0-0.4%);syphilis, 0.5% (0.0-1.2%);herpes virus type-2, 5.0% (2.5-7.5%). Conclusions There are low level HIV and syphilis prevalence among beach boys in Galle but a high level of sexual risk taking. Beach boys may be acting as a bridge for HIV transmission between higher-risk groups (paying female tourists, men who have sex with men) and lower-risk heterosexual fem

关键词： HIV Transactional sex Tourists Sri Lanka

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Development of a pseudovirus assay and evaluation to screen natural products for inhibition of HIV-1 subtype C reverse transcriptase

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JOURNAL OF ETHNOPHARMACOLOGY 2020年 258卷 112931-112931页

作者： Mavhandu, Lufuno Grace Cheng, Hua Bor, Yeou-Cheng Tebit, Denis Manga Hammarskjold, Marie-Louise Rekosh, David Bessong, Pascal Obong Univ Venda HIV AIDS & Global Hlth Res Programme PMB X5050 ZA-0950 Thohoyandou South Africa Univ Virginia Myles H Thaler Ctr AIDS & Human Retrovirus Res Dept Microbiol Immunol & Canc Biol POB 800734 Charlottesville VA 22908 USA Shanghai Municipal Ctr Dis Control & Prevent Dept HIV STD & Leprosy 1380 Zhongshan Rd Shanghai 200336 Peoples R China Ambassadors Christ 21 Ambassador Dr Paradise PA 17562 USA Global Biomed Sci LLC POB 2368 Forest VA 24551 USA

Ethnopharmacological relevance: Medicinal plants are used in the management of Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome (HIV/aids) in many developing country settings where HIV-1 subtype C drives the epidemic. Efforts to identify plant derived molecules with anti-HIV properties require reproducible assay systems for routine screening of selected plant compounds. Although a number of standardized HIV-1 pseudoviruses have been generated to assess infectivity, replicability or reproducibility, HIV-1 subtype C (HIV-1-C) pseudoviruses have not been comprehensively characterized to identify inhibitory plant substances. Aim of the study: The current study aimed at developing an HIV-1-C pseudovirus assay, and evaluate plant substances targeting reverse transcriptase (RT) activity. Materials and methods: HIV-1 subtype C pseudoviruses containing a luciferase reporter gene were generated by transfection of human 293T cells. HIV-1 subtype B (HIV-1-B) wild type pseudoviruses and mutants resistant to nucleoside and non-nucleoside RT inhibitors were also generated and used as controls. Selected plant substances and the RT inhibitors Zidovudine (AZT) and Nevirapine (NVP), were used to evaluate inhibition. Pseudovirus infectivity was determined by luciferase measurement in CF2/CD4(+)/CCR5 cells, and cytotoxicity was determined using the MTT assay. AZT and NVP inhibited wild type pseudoviruses in a dose dependent manner, with IC50 values in the nanomolar range. Results: Pseudoviruses harbouring RT drug resistance mutations were poorly suppressed by AZT and NVP. Catechin, obtained from Peltophorum africanum inhibited HIV-1-C and HIV-1-B pseudoviruses with selective indices of 6304 mu M (IC50: 0.49 mu M, CC50: 3089 mu M) and 1343 mu M (IC50: 2.3 mu M, CC50: 3089 mu M), respectively;while the methanol root crude extract of Elaeodendron transvaalense gave IC50 values of 11.11 mu g/ml and 16.86 mu g/ml, respectively. Conclusion: The developed HIV-1-C pseudovirus

关键词： HIV-1 subtype C Pseudoviruses inhibition Bioassay development Natural products

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Effects and cost of different strategies to eliminate hepatitis C virus transmission in Pakistan: a modelling analysis

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LANCET GLOBAL HEALTH 2020年第3期8卷 E440-E450页

作者： Lim, Aaron G. Walker, Josephine G. Mafirakureva, Nyashadzaishe Khalid, Gul Ghuttai Qureshi, Huma Mahmood, Hassan Trickey, Adam Fraser, Hannah Aslam, Khawar Falq, Gregoire Fortas, Camille Zahid, Hassaan Naveed, Ammara Auat, Rosa Saeed, Quaid Davies, Charlotte F. Mukandavire, Christinah Glass, Nancy Maman, David Martin, Natasha K. Hickman, Matthew May, Margaret T. Hamid, Saeed Loarec, Anne Averhoff, Francisco Vickerman, Peter Univ Bristol Bristol Med Sch Populat Hlth Sci Bristol BS8 2BN Avon England Med Sans Frontieres Brussels Belgium Doctors Plaza Karachi Pakistan Pakistan Hlth Res Council Islamabad Pakistan WHO Islamabad Pakistan Med Sans Frontieres Epictr Paris France Pasteur Inst Paris France Pakistan Kidney & Liver Inst & Res Ctr Dept Gastroenterol & Hepatol Lahore Pakistan Natl AIDS Control Programme Islamabad Pakistan Imperial Coll London Dept Infect Dis Epidemiol London England Ctr Dis Control & Prevent Div Viral Hepatitis Natl Ctr HIV AIDS Viral Hepatitis STD & TB Preven Atlanta GA USA Univ Calif San Diego Dept Med Div Infect Dis & Global Publ Hlth La Jolla CA 92093 USA Aga Khan Univ Karachi Pakistan

Background The WHO elimination strategy for hepatitis C virus advocates scaling up screening and treatment to reduce global hepatitis C incidence by 80% by 2030, but little is known about how this reduction could be achieved and the costs of doing so. We aimed to evaluate the effects and cost of different strategies to scale up screening and treatment of hepatitis C in Pakistan and determine what is required to meet WHO elimination targets for incidence. Methods We adapted a previous model of hepatitis C virus transmission, treatment, and disease progression for Pakistan, calibrating using available data to incorporate a detailed cascade of care for hepatitis C with cost data on diagnostics and hepatitis C treatment. We modelled the effect on various outcomes and costs of alternative scenarios for scaling up screening and hepatitis C treatment in 2018-30. We calibrated the model to country-level demographic data for 1960-2015 (including population growth) and to hepatitis C seroprevalence data from a national survey in 2007-08, surveys among people who inject drugs (PWID), and hepatitis C seroprevalence trends among blood donors. The cascade of care in our model begins with diagnosis of hepatitis C infection through antibody screening and RNA confirmation. Diagnosed individuals are then referred to care and started on treatment, which can result in a sustained virological response (effective cure). We report the median and 95% uncertainty interval (UI) from 1151 modelled runs. Findings One-time screening of 90% of the 2018 population by 2030, with 80% referral to treatment, was projected to lead to 13.8 million (95% UI 13.4-14.1) individuals being screened and 350 000 (315 000-385 000) treatments started annually, decreasing hepatitis C incidence by 26.5% (22.5-30.7) over 2018-30. Prioritised screening of high prevalence groups (PWID and adults aged >= 30 years) and rescreening (annually for PWID, otherwise every 10 years) are likely to increase the number screened

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Water insecurity and sexual and gender-based violence among refugee youth: qualitative insights from a humanitarian setting in Uganda

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JOURNAL OF WATER SANITATION AND HYGIENE FOR DEVELOPMENT 2022年第12期12卷 883-893页

作者： Logie, Carmen Okumu, Moses Coelho, Madelaine Loutet, Miranda Narasimhan, Manjulaa Lukone, Simon Odong Kisubi, Nelson Musoke, Daniel Kibuuka Kyambadde, Peter Dorea, Caetano Taing, Lina Univ Toronto Factor Inwentash Fac Social Work Toronto ON M5S 1V4 Canada United Nations Univ Inst Water Environm Hlth Hamilton ON L8P 0A1 Canada Ctr Gender & Sexual Hlth Equ Vancouver BC V6Z 2K5 Canada Womens Coll Hosp Womens Coll Res Inst Toronto ON M5G 1N8 Canada Univ Illinois Sch Social Work Urbana IL 61801 USA Uganda Christian Univ Sch Social Sci Mukono Uganda Univ Toronto Dept Sociol Toronto ON M5S 2J4 Canada Univ Toronto Dalla Lana Sch Publ Hlth Toronto ON M5T 3M7 Canada UNDP UNFPA UNICEF WHOWorld Bank Special Programme ResDept Sexual & Geneva Switzerland Uganda Refugee & Disaster Management Council URDMC Yumbe Uganda Int Res Consortium Kampala Uganda Natl STD HIV AIDS Control Program Ugandan Minist Hlth Kampala Uganda Most Risk Populat Initiat MARPI Kampala Uganda Univ Victoria Dept Civil Engn Victoria BC V8W 2Y2 Canada McMaster Univ Sch Geog & Earth Sci Hamilton ON L8S 4K1 Canada

Refugee youth disproportionately experience sexual and gender-based violence (SGBV) and water insecurity, yet their SGBV experiences in the context of water insecurity are understudied. In this qualitative study, we conducted six focus groups (n = 48) and in-depth individual interviews (IDI) (n = 12) with refugee youth aged 16-24, and IDI with refugee elders (n = 8) in Bidi Bidi refugee Settlement, Uganda. We applied thematic analysis informed by a social contextual framework and found that (1) SGBV is gendered, whereby adolescent girls and young women (AGYW) were targets for violence (symbolic context), and is intertwined with gender norms linked to AGYW's water collection roles (relational context);(2) water scarcity and off-site access to water infrastructure, combined with limited lighting, provide insecure environments that exacerbate AGYW's SGBV risks (material context);(3) participant generated solutions to water insecurity-related SGBV included engaging men and communities in dialogue and water collection (relational context), technology (e.g., solar lighting), improved security, and additional water points (material context). Findings signal the need to integrate water and sanitation hygiene development with SGBV prevention and sexual health (e.g., post-rape care) interventions. Refugee youth and communities should be meaningfully engaged in developing contextually relevant, gender transformative services to mitigate SGBV risks and advance health and rights.

关键词： focus group discussions refugees safety self-care sexual and gender-based violence WASH water insecurity youth

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Impact of COVID-19 & Response Measures on HIV-HCV Prevention Services and Social Determinants in People Who Inject Drugs in 13 Sites with Recent HIV Outbreaks in Europe, North America and Israel

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aids AND BEHAVIOR 2023年第4期27卷 1140-1153页

作者： Wiessing, Lucas Sypsa, V Abagiu, A. O. Arble, A. Berndt, N. Bosch, A. Buskin, S. Chemtob, D. Combs, B. Conyngham, C. Feelemyer, J. Fitzgerald, M. Goldberg, D. Hatzakis, A. Patrascu, R. E. Keenan, E. Khan, I Konrad, S. Leahy, J. McAuley, A. Menza, T. Merrick, S. Metcalfe, R. Rademaker, T. Revivo, S. Rosca, P. Seguin-Devaux, C. Skinner, S. Smith, C. Tinsley, J. Wilberg, M. Des Jarlais, D. European Monitoring Ctr Drugs & Drug Addict EMCDD Publ Hlth Unit Praca Europa 1 P-1249289 Lisbon Portugal Natl & Kapodistrian Univ Athens Med Sch Dept Hyg Epidemiol & Med Stat Athens Greece Natl Inst Infect Dis Bucharest Romania Hamilton Cty Publ Hlth Cincinnati OH USA Luxembourg Natl Focal Point European Monitoring C Directorate Hlth Dept Epidemiol & Stat Luxembourg Luxembourg Minnesota Dept Hlth STD HIV & TB Sect Infect Dis Epidemiol Prevent & Control St Paul MN USA Univ Washington Seattle WA 98195 USA Publ Hlth Seattle & King Cty Seattle WA USA Minist Hlth Dept TB & AIDS Jerusalem Israel Hebrew Univ Jerusalem Braun Sch Publ Hlth & Community Med Hadassah Med Sch Jerusalem Israel Scott Cty Hlth Dept Scottsburg IN USA Philadelphia Dept Publ Hlth Philadelphia PA USA NYU Sch Global Publ Hlth New York NY USA Hlth Serv Execut Natl Social Inclus Off Dublin Ireland Publ Hlth Scotland Glasgow Lanark Scotland Indigenous Serv Canada First Nations & Inuit Hlth Branch Regina SK Canada Oregon Hlth Author Portland OR USA Glasgow Caledonian Univ Sch Hlth & Life Sci Glasgow Lanark Scotland Oregon Hlth & Sci Univ Portland OR 97201 USA Sandyford Sexual Hlth Serv Glasgow Lanark Scotland Minist Hlth Dept Treatment Subst Abuse Jerusalem Israel Luxembourg Inst Hlth Dept Infect & Immun Esch Sur Alzette Luxembourg Univ Saskatchewan Saskatoon SK Canada Minnesota Dept Human Serv St Paul MN USA Publ Hlth Assoc Izhar Needle & Syringe Programme Jerusalem Israel

HIV/HCV prevention among people who inject drugs (PWID) is of key public health importance. We aimed to assess the impact of COVID-19 and associated response measures on HIV/HCV prevention services and socio-economic status of PWID in high-HIV-risk sites. Sites with recent (2011-2019) HIV outbreaks among PWID in Europe North America and Israel, that had been previously identified, were contacted early May 2020. Out of 17 sites invited to participate, 13 accepted. Semi-structured qualitative site reports were prepared covering data from March to May 2020, analyzed/coded and confirmed with a structured questionnaire, in which all sites explicitly responded to all 103 issues reported in the qualitative reports. Opioid maintenance treatment, needle/syringe programs and antiretroviral treatment /hepatitis C treatment continued, but with important reductions and operational changes. Increases in overdoses, widespread difficulties with food and hygiene needs, disruptions in drug supply, and increased homelessness were reported. Service programs rapidly reformed long established, and politically entrenched, restrictive service delivery policies. Future epidemic control measures should include mitigation of negative side-effects on service provision and socio-economic determinants in PWID.

关键词： HIV Hepatitis C COVID-19 People who inject drugs (PWID) Treatment Prevention Services Epidemiology Social determinants Outbreaks Homelessness Overdose

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