PDF(Pubmed)
Abstract：
To prevent the transmission of blood-borne infections and reach the elimination of viral hepatitis by 2030, the World Health Organization (WHO) has set the goal to distribute 300 sterile needles and syringes each year per person who injects drugs (PWID). We aimed to assess drug paraphernalia distribution in Germany in 2021, including the WHO indicator, and to analyse changes to the distribution measured in 2018.
We conducted a repeated cross-sectional study of low-threshold drug services in Germany. We assessed type and quantity of distributed drug paraphernalia and the number of supplied PWID in 2021 using an online and paper-based questionnaire. We conducted a descriptive statistical analysis of data from 2021, assessed fulfillment of the WHO indicator and changes in services that participated 2021 and in the previous study 2018.
Five hundred and eighty-nine of 1760 distributed questionnaires were returned in 2021. 204 drug services from 15 out of 16 federal states confirmed drug paraphernalia distribution, covering 20% of Germany\'s rural and 51% of urban counties. 108 services had also participated in 2018. The most frequently distributed paraphernalia for injecting drug use in 2021 were syringes (97% of services), needles (96%) and vitamin C (90%). Pre-cut aluminium foil (79% of services) and pipes (28%) for inhaling, and sniff tubes (43%) for nasal use were distributed less frequently. We found a median reduction in distributed syringes by 18% and by 12% for needles compared to 2018. Of 15 states, two reached the 2030 WHO-target for needles and one for syringes.
The current national estimates and changes from 2018 to 2021 for drug paraphernalia distribution seem far from meeting the WHO target. Reasons could include a change in drug consumption behaviour towards less injecting use and more inhaling, and effects of the COVID-19 pandemic (supply difficulties, social distancing, lockdown, reduced opening hours of services). We observed pronounced regional differences in drug paraphernalia distribution. To close existing gaps, Germany should expand its drug paraphernalia distribution programmes and other harm reduction services, such as drug consumption rooms. Further investigation of determinants for adequate distribution is essential to reduce blood-borne infections in this key population.
We conducted a repeated cross-sectional study of low-threshold drug services in Germany. We assessed type and quantity of distributed drug paraphernalia and the number of supplied PWID in 2021 using an online and paper-based questionnaire. We conducted a descriptive statistical analysis of data from 2021, assessed fulfillment of the WHO indicator and changes in services that participated 2021 and in the previous study 2018.
Five hundred and eighty-nine of 1760 distributed questionnaires were returned in 2021. 204 drug services from 15 out of 16 federal states confirmed drug paraphernalia distribution, covering 20% of Germany\'s rural and 51% of urban counties. 108 services had also participated in 2018. The most frequently distributed paraphernalia for injecting drug use in 2021 were syringes (97% of services), needles (96%) and vitamin C (90%). Pre-cut aluminium foil (79% of services) and pipes (28%) for inhaling, and sniff tubes (43%) for nasal use were distributed less frequently. We found a median reduction in distributed syringes by 18% and by 12% for needles compared to 2018. Of 15 states, two reached the 2030 WHO-target for needles and one for syringes.
The current national estimates and changes from 2018 to 2021 for drug paraphernalia distribution seem far from meeting the WHO target. Reasons could include a change in drug consumption behaviour towards less injecting use and more inhaling, and effects of the COVID-19 pandemic (supply difficulties, social distancing, lockdown, reduced opening hours of services). We observed pronounced regional differences in drug paraphernalia distribution. To close existing gaps, Germany should expand its drug paraphernalia distribution programmes and other harm reduction services, such as drug consumption rooms. Further investigation of determinants for adequate distribution is essential to reduce blood-borne infections in this key population.
摘要：
背景：为了防止血液传播感染的传播并在2030年之前消除病毒性肝炎，世界卫生组织（WHO）设定了目标，即每年每人分配300个无菌针头和注射器谁注射药物（PWID）。我们旨在评估2021年德国的药物用具分布情况，包括世卫组织指标，并分析2018年测量的分布变化。
方法：我们对德国的低阈值药物服务进行了重复的横断面研究。我们使用在线和纸质问卷评估了2021年分发的药物用具的类型和数量以及供应的PWID数量。我们对2021年的数据进行了描述性统计分析，评估了参与2021年和2018年之前研究的世卫组织指标的履行情况以及服务的变化。
结果：2021年，在1760份发放的问卷中，有589份被退回。来自16个联邦州中的15个的204个药物服务机构确认了药物用具的分发，覆盖德国20%的农村和51%的城市县。2018年还参加了108项服务。2021年分布最频繁的注射吸毒用具是注射器（占服务的97％），针（96％）和维生素C（90％）。预切割铝箔（占服务的79％）和用于吸入的管道（28％），鼻用嗅探管(43%)分布频率较低。我们发现，与2018年相比，分布式注射器的中位数减少了18％，针头减少了12％。15个州中,两个达到了世卫组织2030年的针头目标，一个达到了注射器目标。
结论：目前的国家估计和2018年至2021年药物附件分布的变化似乎远未达到世卫组织的目标。原因可能包括药物消费行为向减少注射使用和增加吸入，以及COVID-19大流行的影响(供应困难，社交距离，封锁,服务开放时间减少)。我们观察到药物用具分布的明显区域差异。为了弥补现有的差距，德国应扩大其毒品用具分销方案和其他减少危害服务，如药物消费室。进一步研究适当分布的决定因素对于减少该关键人群的血液传播感染至关重要。
方法：我们对德国的低阈值药物服务进行了重复的横断面研究。我们使用在线和纸质问卷评估了2021年分发的药物用具的类型和数量以及供应的PWID数量。我们对2021年的数据进行了描述性统计分析，评估了参与2021年和2018年之前研究的世卫组织指标的履行情况以及服务的变化。
结果：2021年，在1760份发放的问卷中，有589份被退回。来自16个联邦州中的15个的204个药物服务机构确认了药物用具的分发，覆盖德国20%的农村和51%的城市县。2018年还参加了108项服务。2021年分布最频繁的注射吸毒用具是注射器（占服务的97％），针（96％）和维生素C（90％）。预切割铝箔（占服务的79％）和用于吸入的管道（28％），鼻用嗅探管(43%)分布频率较低。我们发现，与2018年相比，分布式注射器的中位数减少了18％，针头减少了12％。15个州中,两个达到了世卫组织2030年的针头目标，一个达到了注射器目标。
结论：目前的国家估计和2018年至2021年药物附件分布的变化似乎远未达到世卫组织的目标。原因可能包括药物消费行为向减少注射使用和增加吸入，以及COVID-19大流行的影响(供应困难，社交距离，封锁,服务开放时间减少)。我们观察到药物用具分布的明显区域差异。为了弥补现有的差距，德国应扩大其毒品用具分销方案和其他减少危害服务，如药物消费室。进一步研究适当分布的决定因素对于减少该关键人群的血液传播感染至关重要。
