背景:在注射毒品(PWID)的人群中,监禁与丙型肝炎病毒(HCV)的风险增加相关。墨西哥先前尝试实施以公共卫生为导向的毒品法改革,对PWID的监禁影响最小。然而,与墨西哥的HCV消除计划一起实施的改革有可能在未来十年内重塑PWID中的HCV流行。我们使用来自蒂华纳PWID队列的数据,墨西哥,为流行病建模提供信息,以评估监禁和全面实施药物改革对PWID中HCV传播和消除的贡献。
方法:我们开发了一种动态的,监禁的确定性模型,PWID中HCV传播和疾病进展。该模型根据蒂华纳的数据进行了校准,墨西哥,在10,000PWID中,HCV血清阳性率为90%。我们估计了10年的人口归因分数(PAF)的监禁HCV发病率之间的PWID和模拟,从2022年起,以下方案的潜在影响:1)非刑事化(监禁率降低80%);2)全面实施药物法改革(非刑事化和转向阿片激动剂治疗[OAT]);3)全面实施HCV治疗的药物法改革(直接抗病毒药物[DAA]).我们还评估了在这些情况下,到2030年达到80%发病率降低目标所需的DAA数量。
结果:预测显示,2022-2032年间,蒂华纳的PWID中HCV发病率的PAF为5.4%(95%不确定区间[UI]:0.6-11.9%)。全面实施的药物改革可以在10年内将HCV发病率降低10.6%(95%UI:3.1-19.2%),并将实现墨西哥HCV发病率降低目标所需的DAA数量减少14.3%(95%UI:5.3-17.1%)。
结论:在蒂华纳的PWID中,墨西哥,监禁仍然是HCV传播的重要原因。全面实施以公共卫生为导向的药品法改革,可对降低HCV发病率发挥重要作用,提高2030年达到消除HCV发病率目标的可行性。
BACKGROUND: Incarceration is associated with increased risk of hepatitis C virus (HCV) among people who inject drugs (PWID). Mexico\'s previous attempt in implementing a public health-oriented drug law reform resulted in minimal impact on incarceration among PWID. However, implementation of reforms alongside Mexico\'s HCV elimination program has the potential to reshape the HCV epidemic among PWID in the next decade. We use data from a cohort of PWID in Tijuana, Mexico, to inform epidemic modeling to assess the contribution of incarceration and fully implemented drug reform on HCV transmission and elimination among PWID.
METHODS: We developed a dynamic, deterministic model of incarceration, HCV transmission and disease progression among PWID. The model was calibrated to data from Tijuana, Mexico, with 90% HCV seroprevalence among 10,000 PWID. We estimated the 10-year population attributable fraction (PAF) of incarceration to HCV incidence among PWID and simulated, from 2022, the potential impact of the following scenarios: 1) decriminalization (80% reduction in incarceration rates); 2) fully implemented drug law reform (decriminalization and diversion to opiate agonist therapy [OAT]); 3) fully implemented drug law reform with HCV treatment (direct-acting antivirals [DAA]). We also assessed the number DAA needed to reach the 80% incidence reduction target by 2030 under these scenarios.
RESULTS: Projections suggest a PAF of incarceration to HCV incidence of 5.4% (95% uncertainty interval [UI]:0.6-11.9%) among PWID in Tijuana between 2022-2032. Fully implemented drug reforms could reduce HCV incidence rate by 10.6% (95%UI:3.1-19.2%) across 10 years and reduce the number of DAA required to achieve Mexico\'s HCV incidence reduction goal by 14.3% (95%UI:5.3-17.1%).
CONCLUSIONS: Among PWID in Tijuana, Mexico, incarceration remains an important contributor to HCV transmission. Full implementation of public health-oriented drug law reform could play an important role in reducing HCV incidence and improve the feasibility of reaching the HCV incidence elimination target by 2030.