Modeling the impact and cost-effectiveness of opioid agonist treatments to reduce the negative consequences of incarceration on HIV and TB transmission in Eastern Europe and Central Asia

对阿片类激动剂治疗的影响和成本效益进行建模，以减少监禁对东欧和中亚艾滋病毒和结核病传播的负面影响

• 批准号: 10268175
• 负责人: FREDERICK LEWIS ALTICE
• 金额: $ 15.97万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10268175
• 关键词: AIDS prevention; Accounting; Aftercare; Asians; Buprenorphine; Cause of Death; Central Asia; Clinical; Collaborations; Communities; Complex; Continuity of Patient Care; Country; Criminal Justice; Data; Disease; Drug resistance in tuberculosis; Drug usage; Eastern Europe; Economic Models; Environment; Epidemic; European; Evidence based intervention; Evidence based treatment; Frequencies; General Population; Goals; HIV; HIV Infections; HIV/TB; Imprisonment; Incidence; Individual; Indonesia; Injecting drug user; Injections; International; Intervention; Kyrgyzstan; Level of Evidence; Link; Maintenance; Malaysia; Mathematics; Meta-Analysis; Methadone; Modeling; Multi-Drug Resistance; Opioid; Outcome; Pharmaceutical Preparations; Policies; Prevalence; Prevention; Prisoner; Prisons; Research; Risk; Risk Behaviors; Services; Sexual Partners; Statistical Data Interpretation; Testing; Time; Treatment outcome; Ukraine; Universities; Work; base; co-infection; community setting; cost; cost effective; cost effectiveness; effective therapy; experience; high risk; high risk behavior; implementation science; improved; low and middle-income countries; mathematical model; mortality; opioid agonist therapy; opioid injection; opioid use disorder; preventive intervention; scale up; success; systematic review; tool; transmission process; tuberculosis treatment

HIV incidence and mortality has decreased globally, but has increased in Eastern Europe and Central Asia (EECA), where the HIV epidemics are fueled primarily by injecting drug use (IDU), mostly of opioids. Furthermore, TB is increasingly linked to HIV infection and IDU, with TB rates increasing and being the main cause of death among people with HIV (PWH) in EECA. Harsh criminalization of drug use in EECA results in extraordinarily high incarceration rates of people who inject drugs (PWID), whose HIV and TB are amplified by high risk behaviors for HIV and overcrowding for TB. Our new data from a global meta-analysis shows that incarceration increases HIV acquisition risk 81% in PWID, and our findings from Ukraine suggest that 28%– 55% of new HIV infections among PWID are attributable to the heightened risk behavior that occurs among PWID recently or ever incarcerated. Furthermore, our recent statistical analyses suggest that the burden of TB in Ukraine is strongly associated with years of incarceration, particularly among PWID with HIV. An effective strategy for tackling the syndemics of incarceration, HIV and TB transmission among PWID in EECA should include opioid agonist treatments (OAT) with methadone or buprenorphine. These effective treatments reduce the frequency of injecting and the risk of HIV acquisition. OAT also improves HIV and TB treatment outcomes and reduces criminal activity, and so could also reduce HIV and TB transmission through reducing the detrimental effect of incarceration and improving the preventative benefits of OAT itself. Scaled up OAT in the community and prison would be especially effective if linked with HIV and TB treatment scale-up. The aim of this project is to develop and testing new modeling strategies to evaluate the impact and cost- effectiveness of scaling-up OAT in criminal justice settings in Ukraine and Kyrgyzstan where we have collected considerable data. To capture the full benefits of OAT in prison, we will also estimate the contribution of incarceration to HIV and TB transmission among PWID and the general population in both countries. We will build on data from our existing implementation science research (R01 DA029910, the MATLINK strategy), in which we have introduced (Ukraine) or expanded (Kyrgyzstan) OAT provision to prisoners with OUD, including linkage to OAT following release to capture this particular high-risk period. We will use data on outcomes from MATLINK and related studies and collected cost data to project the impact and cost-effectiveness of scaling-up prison-based OAT (using MATLINK) with linkage to community OAT after release, incorporating the direct prevention benefits on HIV transmission in PWID and general population and secondary benefits through improving HIV and TB treatment outcomes and reducing incarceration. Findings can be used to guide policies throughout EECA and other settings where HIV is concentrated in PWID.

艾滋病毒的发病率和死亡率在全球范围内降低，但在东欧和中亚有所增加 （EECA），其中HIV发作主要是通过注射药物使用（IDU）（主要是阿片类药物）来加油的。 此外，结核病越来越多地与艾滋病毒感染和IDU联系在一起，结核病率提高，是主要的 EECA艾滋病毒（PWH）的死亡原因。 EECA中严格将吸毒的定罪导致 注射毒品的人（PWID）的高度监禁率（PWID）被放大 艾滋病毒的高风险行为和结核病的人满为患。我们来自全球荟萃分析的新数据表明 PWID的艾滋病毒收购风险增加了81％，我们来自乌克兰的发现表明28％ - PWID中有55％的新艾滋病毒感染归因于风险行为的增强 最近或曾经被监禁的PWID。此外，我们最近的统计分析表明，结核病的燃烧 在乌克兰，尤其是在艾滋病毒的PWID中，乌克兰与多年的发生密切相关。 解决PWID中进化，艾滋病毒和结核病传播的联合系统的有效策略 EECA应包括阿片类药物治疗方法（OAT）与Meadadone或丁丙诺啡。这些有效 治疗降低了注射频率和艾滋病毒获取风险。燕麦还改善了艾滋病毒和结核病 治疗结果并减少犯罪活动，因此也可以通过 减少受伤的不利影响并改善燕麦本身的预防效益。缩放 如果与艾滋病毒和结核病治疗量表有关，社区和监狱中的燕麦将特别有效。 该项目的目的是制定和测试新的建模策略，以评估影响和成本 - 在我们收集的乌克兰和吉尔吉斯斯坦的刑事司法环境中缩放燕麦的有效性 大量数据。为了捕获燕麦在监狱中的全部好处，我们还将估计 两国的PWID和普通人群中艾滋病毒和结核病传播的监禁。我们将 基于我们现有的实施科学研究（R01 DA029910，MATLINK策略）的数据， 我们已经介绍了（乌克兰）或扩展（吉尔吉斯斯坦）燕麦的燕麦，包括 释放后与燕麦的链接以捕获此特定的高风险时期。我们将使用有关结果的数据 Matlink及相关研究并收集了成本数据，以投影扩展的影响和成本效益 释放后，以监狱为基础的燕麦（使用Matlink）与社区燕麦有联系，并结合了直接 PWID和普通人群中艾滋病毒传播的预防益处，以及通过 改善艾滋病毒和结核病治疗结果并减少监禁。调查结果可用于指导政策 在EECA和其他艾滋病毒集中在PWID中的环境中。