扩大单一场所服务以更好地吸引注射吸毒的年轻人:印度的启示

IF 4 2区 社会学 Q1 SUBSTANCE ABUSE Harm Reduction Journal Pub Date : 2024-09-14 DOI:10.1186/s12954-024-01084-w
Lakshmi Ganapathi, Aylur K. Srikrishnan, Allison M. McFall, Mihili P. Gunaratne, Muniratnam Suresh Kumar, Gregory M. Lucas, Shruti H. Mehta, Sunil S. Solomon
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引用次数: 0

摘要

在过去十年中,印度多个城市的阿片类药物注射量出现了惊人的增长。尽管几十年来印度公共部门为注射吸毒者(PWID)提供的服务不断扩大,但由于服务地点分散,服务的可及性受到影响。为了规避这一障碍,并与世界卫生组织为重点人群提供全面护理的指导方针保持一致,印度在 8 个城市建立了综合护理中心 (ICC),作为一种公私合作的服务提供模式,为注射吸毒者提供免费的单一场所服务。综合护理中心非常成功地扩大了服务的可获得性,并普遍为吸毒者提供了便利。然而,很少有中低收入国家(LMIC)的研究对年轻的吸毒者(定义为年龄小于 29 岁者)如何参与综合咨询中心等单一场所服务模式或此类模式中提供的具体服务进行评估。在印度,年轻的感染艾滋病病毒者是一个重要的亚人群,因为与年龄较大的感染艾滋病病毒者相比,他们面临的风险更大,而且有证据表明他们接受艾滋病病毒检测和减低危害服务的比例较低,因此承担着不成比例的新感染艾滋病病毒的负担。在本评论中,我们从多个定量和定性研究中得出了针对年轻艾滋病感染者的见解,这些研究考察了综合社区中心的覆盖范围和有效性,可以为印度乃至全球范围内针对年轻艾滋病感染者的服务局限性提供具有普遍意义的见解。我们的研究表明,虽然综合社区中心扩大了服务范围,尤其是在注射吸毒流行的城市,但仍可优化人口层面的覆盖范围,以促进年轻的吸毒者初步参与。此外,参与 ICC 的年轻吸毒者在接受和保持药物使用治疗方面存在差距,他们在接受 ICC 服务时遇到的障碍与年龄较大的吸毒者不同。值得注意的是,ICC 服务对象中的艾滋病毒感染率主要集中在年轻的吸毒者身上。最后,ICC 并非针对青少年吸毒者,因此需要为这一亚人群提供新的服务。除了在同一地点提供服务外,ICC 等模式的迭代优化还应纳入针对青少年的差异化干预措施,同时进行政策改革,这对于提高印度青少年感染者中减低危害和艾滋病服务的覆盖面和有效性至关重要。
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Expanding single-venue services to better engage young people who inject drugs: insights from India
Over the last decade, India has had an alarming rise in injection of opioids across several cities. Although scale-up of public sector services for people who inject drugs (PWID) in India has occurred over decades, accessibility has been diminished by fragmented services across physical locations. To circumvent this barrier, and in alignment with the World Health Organization’s guidelines to provide comprehensive care to key populations, Integrated Care Centers (ICCs) were established across 8 Indian cities as a public–private service delivery model for providing free single-venue services to PWID. ICCs have been very successful in expanding service availability and convenience for PWID generally. However, few studies from low- and middle-income countries (LMIC) have evaluated how well young PWID (defined as those ≤ 29 years of age) engage with single-venue service models like ICCs or specific services provided in such models. Young PWID are an important subpopulation in India, as they bear a disproportionate burden of new HIV infections because of greater risk and evidence of lower receipt of HIV testing and harm reduction services compared to older PWID. In this comment, we offer insights specific to young PWID drawn from multiple quantitative and qualitative studies examining the reach and effectiveness of ICCs, which may provide generalizable insights into limitations of services for young PWID more broadly in India and globally. Our studies suggest that while ICCs have expanded service availability, particularly in cities with emerging injection drug use epidemics, population-level reach to foster initial engagement among young PWID can be optimized. Additionally, young PWID who do engage with ICCs experience gaps in substance use treatment receipt and retention, and experience barriers to receipt of ICC services that are distinct from those experienced by older PWID. Notably, HIV incidence among ICC clients is concentrated in young PWID. Finally, ICCs were not intended to reach adolescent PWID, and new services are needed for this subpopulation. In addition to co-locating services, iterative optimization of models such as ICCs should incorporate youth-specific differentiated interventions and be accompanied by policy changes that are critical to improving the reach and effectiveness of harm reduction and HIV services among young PWID in India.
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来源期刊
Harm Reduction Journal
Harm Reduction Journal Medicine-Public Health, Environmental and Occupational Health
CiteScore
5.90
自引率
9.10%
发文量
126
审稿时长
26 weeks
期刊介绍: Harm Reduction Journal is an Open Access, peer-reviewed, online journal whose focus is on the prevalent patterns of psychoactive drug use, the public policies meant to control them, and the search for effective methods of reducing the adverse medical, public health, and social consequences associated with both drugs and drug policies. We define "harm reduction" as "policies and programs which aim to reduce the health, social, and economic costs of legal and illegal psychoactive drug use without necessarily reducing drug consumption". We are especially interested in studies of the evolving patterns of drug use around the world, their implications for the spread of HIV/AIDS and other blood-borne pathogens.
期刊最新文献
Reducing the harms of cannabis use in youth post-legalization: insights from Ontario youth, parents, and service providers. Exploring the substitution of cannabis for alcohol and other drugs among a large convenience sample of people who use cannabis. Navigating transitions into, through, and beyond peer worker roles: insider insights from the Supporting Harm Reduction through Peer Support (SHARPS) study. Unpacking the Effects of Decriminalization: Understanding Drug Use Experiences and Risks among Individuals Who Use Drugs in British Columbia. A scoping review on barriers and facilitators to harm reduction care among youth in British Columbia, Canada.
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