PDF(Pubmed)
Abstract：
Criminalization of drug use and punitive policing are key structural drivers of hepatitis C virus (HCV) risk among people who inject drugs (PWID). A police education program (Proyecto Escudo) delivering training on occupational safety together with drug law content was implemented between 2015 and 2016 in Tijuana, Mexico, to underpin drug law reform implementation. We used data from a longitudinal cohort of PWID in Tijuana to inform epidemic modeling and assess the long-term impact of Escudo on HCV transmission and burden among PWID in Tijuana.
We developed a dynamic, compartmental model of HCV transmission and incarceration among PWID and tracked liver disease progression among current and former PWID. The model was calibrated to data from Tijuana, Mexico, with 90% HCV seroprevalence. We used segmented regression analysis to estimate impact of Escudo on recent incarceration among an observational cohort of PWID. By simulating the observed incarceration trends, we estimated the potential impact of the implemented (2-year reduction in incarceration) and an extended (10-year reduction in incarceration) police education program over a 50-year follow-up (2016-2066) on HCV outcomes (incidence, cirrhosis, HCV-related deaths and disability adjusted life-years averted) compared with no intervention.
Over the 2-year follow-up, Proyecto Escudo reduced HCV incidence among PWID from 21.5 per 100 person years (/100py) (95% uncertainty interval [UI] = 15.3-29.7/100py) in 2016 to 21.1/100py (UI = 15.0-29.1/100py) in 2018. If continued for 10 years, Escudo could reduce HCV incidence to 20.0/100py (14.0-27.8/100py) by 2026 and avert 186 (32-389) new infections, 76 (UI = 12-160) cases of cirrhosis and 32 (5-73) deaths per 10 000 PWID compared with no intervention over a 50-year time horizon.
In Tijuana, Mexico, implementation of a police education program delivering training on occupational safety and drug law content appears to have reduced hepatitis C virus incidence among people who inject drugs.
We developed a dynamic, compartmental model of HCV transmission and incarceration among PWID and tracked liver disease progression among current and former PWID. The model was calibrated to data from Tijuana, Mexico, with 90% HCV seroprevalence. We used segmented regression analysis to estimate impact of Escudo on recent incarceration among an observational cohort of PWID. By simulating the observed incarceration trends, we estimated the potential impact of the implemented (2-year reduction in incarceration) and an extended (10-year reduction in incarceration) police education program over a 50-year follow-up (2016-2066) on HCV outcomes (incidence, cirrhosis, HCV-related deaths and disability adjusted life-years averted) compared with no intervention.
Over the 2-year follow-up, Proyecto Escudo reduced HCV incidence among PWID from 21.5 per 100 person years (/100py) (95% uncertainty interval [UI] = 15.3-29.7/100py) in 2016 to 21.1/100py (UI = 15.0-29.1/100py) in 2018. If continued for 10 years, Escudo could reduce HCV incidence to 20.0/100py (14.0-27.8/100py) by 2026 and avert 186 (32-389) new infections, 76 (UI = 12-160) cases of cirrhosis and 32 (5-73) deaths per 10 000 PWID compared with no intervention over a 50-year time horizon.
In Tijuana, Mexico, implementation of a police education program delivering training on occupational safety and drug law content appears to have reduced hepatitis C virus incidence among people who inject drugs.
摘要：
目的：毒品使用的刑事定罪和惩罚性治安是注射毒品（PWID）人群中丙型肝炎病毒（HCV）风险的关键结构驱动因素。2015年至2016年期间，在蒂华纳实施了一项警察教育计划（ProyectoEscudo），提供有关职业安全和毒品法内容的培训，墨西哥,支持禁毒法改革的实施。我们使用来自蒂华纳PWID纵向队列的数据来提供流行病建模，并评估Escudo对蒂华纳PWID中HCV传播和负担的长期影响。
方法：我们开发了一种动态的，PWID中HCV传播和监禁的房室模型，并跟踪当前和以前的PWID中的肝病进展。该模型根据蒂华纳的数据进行了校准，墨西哥,90％的HCV血清阳性率。我们使用分段回归分析来评估Escudo对PWID观察队列中近期监禁的影响。通过模拟观察到的监禁趋势，我们估计了实施（减少监禁2年）和延长（减少监禁10年）的警察教育计划在50年随访（2016-2066）对HCV结局（发病率，肝硬化,HCV相关死亡,和残疾调整寿命年[DALYS]避免)与无干预相比。
结果：经过2年的随访，ProyectoEscudo将PWID中的HCV发病率从2016年的每100人年21.5（/100py）（95％不确定性间隔[UI]：15.3-29.7/100py）降低到2018年的21.1/100py（UI：15.0-29.1/100py）。如果持续10年，到2026年，Escudo可以将HCV发病率降低到20.0/100py（14.0-27.8/100py），并避免186（32-389）新感染，76例（UI：12-160）肝硬化，在50年的时间范围内，每10,000PWID中有32（5-73）例死亡，而没有干预。
结论：在蒂华纳，墨西哥,实施一项警察教育计划，提供有关职业安全和毒品法律内容的培训，似乎减少了注射毒品人群中丙型肝炎病毒的发病率。
方法：我们开发了一种动态的，PWID中HCV传播和监禁的房室模型，并跟踪当前和以前的PWID中的肝病进展。该模型根据蒂华纳的数据进行了校准，墨西哥,90％的HCV血清阳性率。我们使用分段回归分析来评估Escudo对PWID观察队列中近期监禁的影响。通过模拟观察到的监禁趋势，我们估计了实施（减少监禁2年）和延长（减少监禁10年）的警察教育计划在50年随访（2016-2066）对HCV结局（发病率，肝硬化,HCV相关死亡,和残疾调整寿命年[DALYS]避免)与无干预相比。
结果：经过2年的随访，ProyectoEscudo将PWID中的HCV发病率从2016年的每100人年21.5（/100py）（95％不确定性间隔[UI]：15.3-29.7/100py）降低到2018年的21.1/100py（UI：15.0-29.1/100py）。如果持续10年，到2026年，Escudo可以将HCV发病率降低到20.0/100py（14.0-27.8/100py），并避免186（32-389）新感染，76例（UI：12-160）肝硬化，在50年的时间范围内，每10,000PWID中有32（5-73）例死亡，而没有干预。
结论：在蒂华纳，墨西哥,实施一项警察教育计划，提供有关职业安全和毒品法律内容的培训，似乎减少了注射毒品人群中丙型肝炎病毒的发病率。
