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Coverage of harm reduction services and HIV infection: a multilevel analysis of five Chinese cities

BACKGROUND: Since 2003, a harm reduction program for injecting drug users has been rolled out countrywide in China. It entails services for condom promotion, a needle and syringe program (NSP), and methadone maintenance treatment (MMT). However, it remains unknown if and to what extent the coverage...

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Autores principales: Wu, Qing, Kamphuis, Carlijn, Duo, Lin, Luo, Jiahong, Chen, Ying, Richardus, Jan Hendrik
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5307648/
https://www.ncbi.nlm.nih.gov/pubmed/28193236
http://dx.doi.org/10.1186/s12954-017-0137-2
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author Wu, Qing
Kamphuis, Carlijn
Duo, Lin
Luo, Jiahong
Chen, Ying
Richardus, Jan Hendrik
author_facet Wu, Qing
Kamphuis, Carlijn
Duo, Lin
Luo, Jiahong
Chen, Ying
Richardus, Jan Hendrik
author_sort Wu, Qing
collection PubMed
description BACKGROUND: Since 2003, a harm reduction program for injecting drug users has been rolled out countrywide in China. It entails services for condom promotion, a needle and syringe program (NSP), and methadone maintenance treatment (MMT). However, it remains unknown if and to what extent the coverage of these services at city level is related to a reduced risk of HIV infection among drug users. METHODS: We wished to quantify the extent to which city-level characteristics (such as NSP and MMT service coverage) and individual-level determinants (e.g., self-reported exposure to NSP and MMT services, knowledge, motivation, and skills) were associated with the risk of HIV infection among drug users. In 2006, we conducted an integrated serological and behavioral survey among drug users in five cities of Yunnan Province, China (N = 685), constructing a multilevel logistic regression model with drug users clustered within these cities. RESULTS: Drug users who reported having received NSP or MMT services were about 50% less likely to be infected with HIV than those who reported not having received them (OR 0.45, 95% CI, 0.26–0.83 for NSP and 0.48, 95% CI, 0.31–0.73 for MMT). Despite a between-city variation of HIV infection risk (ICC 0.24, 95% CI 0.08–0.54), none of the city-level factors could explain this difference. Individual-level determinants such as perceived risk of infection and use of condoms were not associated with HIV infection. CONCLUSIONS: Although people who had used NSP or MMT services were less likely to be HIV infected, this study found no relationship between city-level coverage of HIV prevention programs and variations in HIV infection between cities. This may have been due to the low number of cities in the analysis. Future research should include the analysis of data from a larger number of cities, which are collected widely in China through integrated behavioral and serological surveys. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12954-017-0137-2) contains supplementary material, which is available to authorized users.
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spelling pubmed-53076482017-02-22 Coverage of harm reduction services and HIV infection: a multilevel analysis of five Chinese cities Wu, Qing Kamphuis, Carlijn Duo, Lin Luo, Jiahong Chen, Ying Richardus, Jan Hendrik Harm Reduct J Research BACKGROUND: Since 2003, a harm reduction program for injecting drug users has been rolled out countrywide in China. It entails services for condom promotion, a needle and syringe program (NSP), and methadone maintenance treatment (MMT). However, it remains unknown if and to what extent the coverage of these services at city level is related to a reduced risk of HIV infection among drug users. METHODS: We wished to quantify the extent to which city-level characteristics (such as NSP and MMT service coverage) and individual-level determinants (e.g., self-reported exposure to NSP and MMT services, knowledge, motivation, and skills) were associated with the risk of HIV infection among drug users. In 2006, we conducted an integrated serological and behavioral survey among drug users in five cities of Yunnan Province, China (N = 685), constructing a multilevel logistic regression model with drug users clustered within these cities. RESULTS: Drug users who reported having received NSP or MMT services were about 50% less likely to be infected with HIV than those who reported not having received them (OR 0.45, 95% CI, 0.26–0.83 for NSP and 0.48, 95% CI, 0.31–0.73 for MMT). Despite a between-city variation of HIV infection risk (ICC 0.24, 95% CI 0.08–0.54), none of the city-level factors could explain this difference. Individual-level determinants such as perceived risk of infection and use of condoms were not associated with HIV infection. CONCLUSIONS: Although people who had used NSP or MMT services were less likely to be HIV infected, this study found no relationship between city-level coverage of HIV prevention programs and variations in HIV infection between cities. This may have been due to the low number of cities in the analysis. Future research should include the analysis of data from a larger number of cities, which are collected widely in China through integrated behavioral and serological surveys. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12954-017-0137-2) contains supplementary material, which is available to authorized users. BioMed Central 2017-02-14 /pmc/articles/PMC5307648/ /pubmed/28193236 http://dx.doi.org/10.1186/s12954-017-0137-2 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Wu, Qing
Kamphuis, Carlijn
Duo, Lin
Luo, Jiahong
Chen, Ying
Richardus, Jan Hendrik
Coverage of harm reduction services and HIV infection: a multilevel analysis of five Chinese cities
title Coverage of harm reduction services and HIV infection: a multilevel analysis of five Chinese cities
title_full Coverage of harm reduction services and HIV infection: a multilevel analysis of five Chinese cities
title_fullStr Coverage of harm reduction services and HIV infection: a multilevel analysis of five Chinese cities
title_full_unstemmed Coverage of harm reduction services and HIV infection: a multilevel analysis of five Chinese cities
title_short Coverage of harm reduction services and HIV infection: a multilevel analysis of five Chinese cities
title_sort coverage of harm reduction services and hiv infection: a multilevel analysis of five chinese cities
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5307648/
https://www.ncbi.nlm.nih.gov/pubmed/28193236
http://dx.doi.org/10.1186/s12954-017-0137-2
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