PDF(Pubmed)
Abstract：
BACKGROUND: Persons who inject drugs (PWID) are at increased risk of HIV and hepatitis C virus (HCV) infections and premature mortality due to drug overdose. Medication for opioid use disorder (MOUD), such as methadone or buprenorphine, reduces injecting behaviors, HIV and HCV transmission, and mortality from opioid overdose. Using data from National HIV Behavioral Surveillance, we evaluated the unmet need for MOUD among PWID in 23 U.S. cities.
METHODS: PWID were recruited by respondent-driven sampling, interviewed, and tested for HIV. This analysis includes PWID who were ≥18 years old and reported injecting drugs and opioid use in the past 12 months. We used Poisson regression to examine factors associated with self-reported unmet need for MOUD and reported adjusted prevalence ratios (aPR) with 95% confidence intervals.
RESULTS: Of 10,879 PWID reporting using opioids, 68.8% were male, 48.2% were ≥45 years of age, 38.8% were non-Hispanic White, 49.6% experienced homelessness, and 28.0% reported an unmet need for MOUD in the past 12 months. PWID who were more likely to report unmet need for MOUD experienced homelessness (aPR 1.26; 95% CI: 1.19-1.34), were incarcerated in the past 12 months (aPR 1.15; 95% CI: 1.08-1.23), injected ≥once a day (aPR 1.42; 95% CI: 1.31-1.55), reported overdose (aPR 1.33; 95% CI: 1.24-1.42), and sharing of syringes (aPR 1.14; 95% CI: 1.06-1.23).
CONCLUSIONS: The expansion of MOUD provision for PWID is critical. Integrating syringe service programs and MOUD provision and linking PWID who experience overdose, incarceration or homelessness to treatment with MOUD could improve its utilization among PWID.
METHODS: PWID were recruited by respondent-driven sampling, interviewed, and tested for HIV. This analysis includes PWID who were ≥18 years old and reported injecting drugs and opioid use in the past 12 months. We used Poisson regression to examine factors associated with self-reported unmet need for MOUD and reported adjusted prevalence ratios (aPR) with 95% confidence intervals.
RESULTS: Of 10,879 PWID reporting using opioids, 68.8% were male, 48.2% were ≥45 years of age, 38.8% were non-Hispanic White, 49.6% experienced homelessness, and 28.0% reported an unmet need for MOUD in the past 12 months. PWID who were more likely to report unmet need for MOUD experienced homelessness (aPR 1.26; 95% CI: 1.19-1.34), were incarcerated in the past 12 months (aPR 1.15; 95% CI: 1.08-1.23), injected ≥once a day (aPR 1.42; 95% CI: 1.31-1.55), reported overdose (aPR 1.33; 95% CI: 1.24-1.42), and sharing of syringes (aPR 1.14; 95% CI: 1.06-1.23).
CONCLUSIONS: The expansion of MOUD provision for PWID is critical. Integrating syringe service programs and MOUD provision and linking PWID who experience overdose, incarceration or homelessness to treatment with MOUD could improve its utilization among PWID.
摘要：
背景：注射药物（PWID）的人因药物过量而感染HIV和丙型肝炎病毒（HCV）和过早死亡的风险增加。阿片类药物使用障碍（MOUD），如美沙酮或丁丙诺啡，减少注射行为，HIV和HCV传播，和阿片类药物过量导致的死亡率。使用来自国家艾滋病毒行为监测的数据，我们评估了美国23个城市PWID中未满足的MOUD需求.
方法：通过受访者驱动的抽样招募PWID，采访,并检测艾滋病毒。该分析包括年龄≥18岁并在过去12个月内报告注射药物和阿片类药物使用的PWID。我们使用Poisson回归来检查与自我报告的未满足的MOUD需求相关的因素，并以95％的置信区间报告调整后的患病率比（aPR）。
结果：在使用阿片类药物的10,879份PWID报告中，68.8%为男性，48.2%的患者年龄≥45岁，38.8%是非西班牙裔白人，49.6%经历过无家可归，28.0%的人报告在过去12个月中对MOUD的需求未得到满足。更有可能报告未满足的MOUD需求的PWID经历了无家可归（APR1.26;95％CI：1.19-1.34），在过去的12个月中被监禁（APR1.15；95％CI：1.08-1.23），每天注射≥一次(APR1.42；95%CI：1.31-1.55)，报告过量（APR1.33；95%CI：1.24-1.42），和共用注射器（APR1.14；95%CI：1.06-1.23）。
结论：扩大PWID的MOUD供应至关重要。整合注射器服务程序和MOUD供应，并将经历用药过量的PWID联系起来，对MOUD治疗的监禁或无家可归可以提高其在PWID中的利用率。
方法：通过受访者驱动的抽样招募PWID，采访,并检测艾滋病毒。该分析包括年龄≥18岁并在过去12个月内报告注射药物和阿片类药物使用的PWID。我们使用Poisson回归来检查与自我报告的未满足的MOUD需求相关的因素，并以95％的置信区间报告调整后的患病率比（aPR）。
结果：在使用阿片类药物的10,879份PWID报告中，68.8%为男性，48.2%的患者年龄≥45岁，38.8%是非西班牙裔白人，49.6%经历过无家可归，28.0%的人报告在过去12个月中对MOUD的需求未得到满足。更有可能报告未满足的MOUD需求的PWID经历了无家可归（APR1.26;95％CI：1.19-1.34），在过去的12个月中被监禁（APR1.15；95％CI：1.08-1.23），每天注射≥一次(APR1.42；95%CI：1.31-1.55)，报告过量（APR1.33；95%CI：1.24-1.42），和共用注射器（APR1.14；95%CI：1.06-1.23）。
结论：扩大PWID的MOUD供应至关重要。整合注射器服务程序和MOUD供应，并将经历用药过量的PWID联系起来，对MOUD治疗的监禁或无家可归可以提高其在PWID中的利用率。
