WHO协作研究项目-阿片类依赖的替代治疗和HIV/AIDS:各地区的HIV高危行为、健康和社区获益结果的比较(英文)

THE WHO MULTI-SITE COLLABORATIVE STUDY ON SUBSTITUTION THERAPY OF OPIOID DEPENDENCE AND HIV/AIDS:REGIONAL COMPARISONS OF FINDINGS RELATED TO HIV RISK BEHAVIOURS,HEALTH,AND COMMUNITY BENEFITS

引言:WHO协作研究项目-阿片类依赖的替代治疗和HIV/AIDS旨在评估阿片类依赖的替代治疗与HIV/AIDS的治疗和预防在一些资源欠缺的亚洲(中国、印度尼西亚和泰国)、东欧(立陶宛、乌克兰和波兰)和中东(伊朗)国家的效果。本文旨在对上述国家的研究结果进行区域对比。为便利起见,将上述国家人为地分为两个地区-亚洲和欧洲(包括伊朗)。在澳大利亚的南部阿德来得也收集了一些数据,作为已开展替代治疗的地区予以对照。方法:该研究为前瞻性调查,被试为新接收的替代治疗者,调查在入组时、3个月和6个月时进行。采用一系列问卷收集被试的人口学资料、身心健康状况资料、HIV危险行为(注射、性行为)、就业情况和犯罪活动。问题回答的时间为进入治疗的前一个月,在第三个月和第六个月随访时的前的一个月。同时采血检测HIV和丙型肝炎病毒(HCV)感染情况。结果:共有730人参加了本研究(澳大利亚42人,亚洲321人,欧洲367人(包括伊朗))。澳大利亚、亚洲和欧洲(包括伊朗)的HIV阳性率分别为3%,16%和35%。在继续治疗者中,非法毒品使用、危险注射行为大大减少,自我报告身心健康明显改善。此外,就业活动增加,犯罪行为减少。结论:结果评估数据与经济发达地区的结果一致,在资源欠缺的国家替代治疗在减少维持治疗者的HIV危险行为,改善身体健康方面是有效的。

Introduction：The WHO Collaborative Study on Substitution Therapy of Opioid Dependence （WHO Collaborative Study ） was designed to evaluate the effectiveness of substitution treatment （ST） for opioid dependence in relation to HIV/AIDS treatment and prevention in a number of less resourced countries in Asia （China, Indonesia, and Thailand） and Eastern Europe （Lithuania, Ukraine, Poland） and the Middle East （Iran）. The purpose of this paper was to undertake regional comparisons of outcome data obtained from these countries. To facilitate this process, countries were grouped arbitrarily into two regions Asia and Europe （including Iran）. Data were also collected from a small cohort of patients enrolled in ST in Adelaide, South Australia, to allow data from nations with less resource to be compared to those collected from an established ST program. Methods： This was a prospective observational study where participants newly enrolled into ST were interviewed at baseline, and again at 3 and 6- month follow -ups. Participants were administered a battery of instruments designed to collect demographic information, and data on physical and psychological health, HIV risk behaviours （injecting and sexual practices）, and involvement in employment and criminal activity. The time frame of questions was the month prior to entering treatment, or the one - month prior to the 3 and 6 -month follow -up interview. Blood was also tested to determine HIV and Hep C serostatus. Results ： A total of 730 participants were enrolled into the study （Australia = 42, Asia = 321, Europe = 367）. Rates of HIV seropositivity were 3%, 16% and 35 %, for Australia, Europe, and Asia, respectively. There were significant reductions in illicit drug use and risky injecting practices, and significant self reported improvements in physical and psychological health, in those patients remaining in treatment. Furthermore, there were also increases in employment activity, and reduction in criminal involvement. Conclusion： These outcome evaluation data are consistent with findings from developed economies and show that the implementation of ST in less reseurced economies can be effective in reducing HIV risk behaviours, and improving health well being of those who remain in treatment.