Impact of scaling up harm reduction interventions on injecting risk behaviours, ART outcomes and HIV incidence among people who inject drugs in Kenya

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy Pub Date : 2025-05-05 DOI:10.1016/j.drugpo.2025.104824

Josephine G. Walker , Matthew J. Akiyama , Adelina Artenie , Charles M. Cleland , John A. Lizcano , Helgar Musyoki , Mercy Nyakowa , Peter Cherutich , Ann E. Kurth , Peter Vickerman

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引用次数: 0

Abstract

Introduction

Little data exists on the effectiveness of HIV prevention interventions among people who inject drugs (PWID) in Africa. We used empirical data from Kenya to fill this evidence gap.

Methods

Six rounds of bio-behavioural surveys using respondent-driven-sampling were conducted among PWID in Nairobi and Coastal Kenya over 2012–2015. Dried blood spot samples were tested for HIV and HIV viral load, and HIV incidence was estimated through linking participants between rounds. Regression analyses evaluated whether self-reported usage of opioid agonist therapy (OAT) or needle and syringe programmes (NSP) in last year were associated with reduced injecting risk behaviours, increased ART uptake and viral suppression, and reduced risk of HIV acquisition.

Results

Overall, 4897 PWID participated in the study, with 3903 participating in >1 round. Over the rounds, coverage increased from zero to 80–86 % for NSP and zero to 10–20 % for OAT. The proportion of people living with HIV (PLHIV) that were virally suppressed increased from 7–14 % to 39–55 %. Accessing NSP and OAT was associated with reduced syringe sharing at last injection (NSP adjusted odds ratio (aOR)=0.31; 95 %CI:0.24–0.40; OAT aOR=0.046; 95 %CI:0.034–0.061) and OAT was associated with reduced injecting frequency (adjusted rate ratio=0.21; 95 %CI:0.12–0.36). Using OAT was associated with increased ART coverage (aOR=2.76; 95 %CI:1.50–5.06) and viral suppression (aOR=2.99; 95 %CI:1.78–5.03) among PLHIV, while NSP was not. HIV incidence decreased from 6.10 (95 %CI:3.56–9.77) to 1.49 (95 %CI:0.79–2.54) per 100 person-years between the first and second half of the study. Accessing NSP was associated with lower HIV incidence (adjusted hazard ratio=0.25; 95 %CI:0.087–0.58).

Conclusions

This study provides strong evidence for the benefits of NSP and OAT on varied HIV outcomes among PWID in Africa.

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扩大减少伤害干预措施对肯尼亚注射吸毒者中注射风险行为、抗逆转录病毒治疗结果和艾滋病毒发病率的影响

关于非洲注射吸毒者（PWID）中艾滋病毒预防干预措施有效性的数据很少。我们使用肯尼亚的经验数据来填补这一证据空白。方法2012-2015年，在内罗毕和肯尼亚沿海地区对PWID进行了6轮生物行为调查。对干血斑样本进行HIV和HIV病毒载量检测，并通过在轮次之间联系参与者来估计HIV发病率。回归分析评估了去年自我报告的阿片类激动剂治疗（OAT）或针头和注射器计划（NSP）的使用是否与注射风险行为减少、抗逆转录病毒药物摄入和病毒抑制增加以及艾滋病毒感染风险降低有关。结果共4897例PWID患者参加了研究，其中3903例患者参加了1轮研究。经过几轮，NSP的覆盖率从零增加到80 - 86%，OAT的覆盖率从零增加到10 - 20%。艾滋病毒感染者（PLHIV）病毒被抑制的比例从7 - 14%增加到39 - 55%。获得NSP和OAT与最后一次注射时注射器共用次数减少相关(NSP调整优势比(aOR)=0.31；95%置信区间:0.24—-0.40;OAT aOR = 0.046;95% CI: 0.034-0.061)和OAT与减少注射频率相关(调整比率比=0.21；95%置信区间:0.12—-0.36)。使用OAT与ART覆盖率增加相关(aOR=2.76；95% CI: 1.50-5.06)和病毒抑制(aOR=2.99；95% CI:1.78 ~ 5.03)，而非NSP。在研究的前半期和后半期，HIV感染率从每100人年6.10例（95% CI: 3.56-9.77）下降到1.49例（95% CI: 0.79-2.54）。获得NSP与较低的艾滋病毒发病率相关(调整风险比=0.25；95%置信区间:0.087—-0.58)。结论本研究为NSP和OAT对非洲PWID患者的不同HIV预后的益处提供了强有力的证据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Drug Policy SUBSTANCE ABUSE-

CiteScore

7.80

自引率

11.40%

发文量

307

审稿时长

62 days

期刊介绍： The International Journal of Drug Policy provides a forum for the dissemination of current research, reviews, debate, and critical analysis on drug use and drug policy in a global context. It seeks to publish material on the social, political, legal, and health contexts of psychoactive substance use, both licit and illicit. The journal is particularly concerned to explore the effects of drug policy and practice on drug-using behaviour and its health and social consequences. It is the policy of the journal to represent a wide range of material on drug-related matters from around the world.