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.

全球艾滋病毒发病率和死亡率有所下降，但东欧和中亚有所上升 （EECA），那里的艾滋病毒流行主要是由注射毒品（IDU）加剧的，其中大部分是阿片类药物。 此外，结核病与艾滋病毒感染和注射吸毒者的联系日益密切，结核病发病率不断上升，成为主要的 EECA 中艾滋病毒感染者 (PWH) 的死亡原因。 注射吸毒者（PWID）的监禁率极高，他们的艾滋病毒和结核病被放大 艾滋病毒的高危行为和结核病的过度拥挤 我们来自全球荟萃分析的新数据表明： 监禁会使吸毒者感染艾滋病毒的风险增加 81%，我们在乌克兰的调查结果表明，28%—— 吸毒者中 55% 的新发艾滋病毒感染可归因于吸毒者中发生的胃肠道危险行为 最近或曾经被监禁的吸毒者 此外，我们最近的统计分析表明结核病的负担。 在乌克兰，这种情况与多年的监禁密切相关，尤其是感染艾滋病毒的吸毒者。 解决吸毒者中监禁、艾滋病毒和结核病传播综合症的有效策略 EECA 应包括使用美沙酮或丁丙诺啡的阿片类激动剂治疗 (OAT)，这些治疗有效。 治疗可减少注射频率和感染艾滋病毒的风险，也可改善艾滋病毒和结核病。 治疗结果并减少犯罪活动，因此还可以通过以下方式减少艾滋病毒和结核病的传播 减少监禁带来的痛苦并提高 OAT 本身的预防效益。 如果与扩大艾滋病毒和结核病治疗联系起来，社区和监狱中的燕麦治疗将特别有效。 该项目的目的是开发和测试新的建模策略，以评估影响和成本 我们收集了乌克兰和吉尔吉斯斯坦刑事司法环境中扩大 OAT 的有效性 为了充分了解 OAT 在监狱中的好处，我们还将估计 OAT 的贡献。 监禁以防止注射吸毒者和两国普通人群中艾滋病毒和结核病的传播。 基于我们现有的实施科学研究（R01 DA029910，MATLINK 策略）的数据， 我们已向持有 OUD 的囚犯推出（乌克兰）或扩大（吉尔吉斯斯坦）OAT 规定，包括 发布后与 OAT 关联以捕捉这一特定的高风险时期，我们将使用有关结果的数据。 MATLINK 和相关研究并收集成本数据来预测扩大规模的影响和成本效益 基于监狱的 OAT（使用 MATLINK），释放后与社区 OAT 连接，纳入直接 对吸毒者和普通人群艾滋病毒传播的预防效益以及通过以下方式获得的次要效益： 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。 在整个东欧中亚地区以及吸毒者中艾滋病毒集中的其他地区。