模拟变化的毒品市场和结构性决定因素对美国注射吸毒者中HCV和/或HIV传播的影响：农村和城市比较

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy Pub Date : 2025-07-23 DOI:10.1016/j.drugpo.2025.104925

Natasha K. Martin , Daniela Abramovitz , William H. Eger , Joseph R. Friedman , Annick Borquez , Jaskaran S. Cheema , Tara Stamos-Beusig , Jack Stone , Peter Vickerman , Heather Bradley , Ryan P. Westergaard , Steffanie A. Strathdee

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引用次数: 0

摘要

背景：在美国，药物使用模式的改变对注射吸毒者（PWID）中丙型肝炎病毒（HCV）和HIV发病率的影响尚未得到充分研究。方法将HCV和HIV传播模型校准为城市和农村地区数据（加利福尼亚州圣地亚哥和威斯康星州中部/北部）。根据圣地亚哥的数据，PWID中芬太尼的使用被认为会增加死亡率和注射相关的HIV和HCV风险。我们预测了HCV/HIV发病率的近期趋势（芬太尼的使用，从注射药物到吸烟药物的过渡，阿片激动剂治疗（OAT）和监禁），以及自2020年以来没有趋势变化的情况。我们计算了芬太尼对发病率的人口归因比例，并与2015年至2025年无芬太尼的反事实进行了比较。结果在威斯康星州中部/北部（2018年为20%至2021年为45%）和圣地亚哥（2021年为51%至2023年为66%），PWID中自我报告的芬太尼使用量很高且不断增加。2015-2025年间，模型显示芬太尼的使用分别导致了威斯康星州中部/北部和圣地亚哥PWID中新发HCV感染的18% （95% CI 9-25）和34% （95% CI 26-45）。在圣地亚哥，芬太尼导致了10% （95% CI 1-26）的HIV感染；在威斯康星州中部和北部的PWID人群中未发现HIV。芬太尼相关的风险通过增加OAT、减少监禁（威斯康辛州）和从注射药物转向吸烟药物（圣地亚哥）得到缓解。结论芬太尼的使用增加了城市和农村地区的HCV和/或HIV，表明扩大减少危害的可及性，同时迫切需要采取干预措施降低芬太尼使用的PWID患者的血源性病毒传播风险。

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Modeling the impact of changing drug markets and structural determinants on HCV and/or HIV transmission among people who inject drugs in the United States: A rural and urban comparison

Background

The impact of changing drug use patterns on hepatitis C virus (HCV) and HIV incidence among people who inject drugs (PWID) in the US is understudied.

Methods

An HCV and HIV transmission model was calibrated to urban and rural area data (San Diego, CA and Central/Northern Wisconsin). Fentanyl use among PWID was assumed to increase mortality and injecting-related risk of HIV and HCV based on San Diego data. We predicted HCV/HIV incidence with recent trends (in fentanyl use, transition from injecting to smoking drugs, opiate agonist treatment (OAT) and incarceration), and scenarios with no trend changes since 2020. We calculated the population attributable fraction of fentanyl on incidence, comparing to a no fentanyl counterfactual from 2015 to 2025.

Results

High and increasing self-reported fentanyl use among PWID was observed in Central/Northern Wisconsin (20 % in 2018 to 45 % in 2021) and San Diego (51 % in 2021 to 66 % in 2023). Between 2015–2025, modeling suggests fentanyl use contributed to 18 % (95 %CI 9–25) and 34 % (95 %CI 26–45) of new HCV infections among PWID in Central/Northern Wisconsin and San Diego, respectively. Fentanyl contributed to 10 % (95 %CI 1–26) of HIV infections in San Diego; no HIV was observed among Central/Northern Wisconsin PWID. Fentanyl-associated risk was mitigated by increased OAT, reduced incarceration (Wisconsin), and shifts from injecting to smoking drugs (San Diego).

Conclusions

Fentanyl use increased HCV and/or HIV in an urban and rural area, suggesting expanded access to harm reduction, alongside interventions to reduce blood-borne virus transmission risk among PWID who use fentanyl are urgently needed.

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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.