HIV治療の治療環境は世界的にはまだまだ


 世界的にみるとHIV予防、治療とケアサービスは、注射薬を使用している患者には、とても不十分。リスクのある人々には早急な対策が必要。

HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage

医薬品を注射している患者へのHIVの予防、治療とケアサービス:各国、地域間のシステマティックレビュー

Lancet. 2010 Mar 20;375(9719):1014-28.

気づき)

・予防、治療とケアサービスの程度を、何で評価するか?

-針と注射器の(供給)プログラムneedle and syringe programmes (NSPs)

-オピオイドの補充療法opioid substitution therapy (OST)

-他の治療薬and other drug treatment

-HIVのテストとカウンセリングと抗ウイルス治療HIV testing and counselling, antiretroviral therapy (ART)

-コンドームプログラムcondom programmesで評価。

なるほど。

・とくに注射器と針の供給は、オーストラリアで年間1人あたり202本使用されているのに比較して、サハラ以南のアフリカでは、0.1本と極端に少ない。使い回しだ。

Background Previous reviews have examined the existence of HIV prevention, treatment, and care services for injecting drug users (IDUs) worldwide, but they did not quantify the scale of coverage. We undertook a systematic review to estimate national, regional, and global coverage of HIV services in IDUs.

Methods We did a systematic search of peer-reviewed (Medline, BioMed Central), internet, and grey-literature databases for data published in 2004 or later. A multistage process of data requests and verification was undertaken, involving UN agencies and national experts. National data were obtained for the extent of provision of the following core interventions for IDUs: needle and syringe programmes (NSPs), opioid substitution therapy (OST) and other drug treatment, HIV testing and counselling, antiretroviral therapy (ART), and condom programmes. We calculated national, regional, and global coverage of NSPs, OST, and ART on the basis of available estimates of IDU population sizes.

Findings By 2009, NSPs had been implemented in 82 countries and OST in 70 countries; both interventions were available in 66 countries. Regional and national coverage varied substantially. Australasia (202 needle?syringes per IDU per year) had by far the greatest rate of needle?syringe distribution; Latin America and the Caribbean (0・3 needle?syringes per IDU per year), Middle East and north Africa (0・5 needle?syringes per IDU per year), and sub-Saharan Africa (0・1 needle?syringes per IDU per year) had the lowest rates. OST coverage varied from less than or equal to one recipient per 100 IDUs in central Asia, Latin America, and sub-Saharan Africa, to very high levels in western Europe (61 recipients per 100 IDUs). The number of IDUs receiving ART varied from less than one per 100 HIV-positive IDUs (Chile, Kenya, Pakistan, Russia, and Uzbekistan) to more than 100 per 100 HIV-positive IDUs in six European countries. Worldwide, an estimated two needle?syringes (range 1?4) were distributed per IDU per month, there were eight recipients (6?12) of OST per 100 IDUs, and four IDUs (range 2?18) received ART per 100 HIV-positive IDUs.

Interpretation Worldwide coverage of HIV prevention, treatment, and care services in IDU populations is very low. There is an urgent need to improve coverage of these services in this at-risk population.

Funding UN Office on Drugs and Crime; Australian National Drug and Alcohol Research Centre, University of New South Wales; and Australian National Health and Medical Research Council.

これから)新しい職員のオリエンテーション、医療安全委員会、職責会議、システム委員会、年度末の仕事。ふう。

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