PMID: 40057708 https://pubmed.ncbi.nlm.nih.gov/40057708/

Abstract

OBJECTIVE: To investigate the effect of the restricted access to clean needles and syringes on needle and syringe sharing behavior like Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV) amongst the people who inject drugs (PWID) in Baise, Guangxi province of China, and to provide the scientific evidence for formulating public health policies aimed at preventing HIV transmission.

METHOD: Using the national unified questionnaire and plan, from 2010 to 2019, snowball sampling was conducted among the community drug users under sentinel surveillance in Baise City's county districts every April to June. During face-to-face interviews with each participant, a structured questionnaire was used to collect demographic, behavioral, and venous blood for serological surveillance. All of this information was input into the HIV/AIDS Comprehensive Response Information Management System (CRIMS). Following China's enforcement of the Regulation on Supervision and Administration of Medical Devices(hereinafter referred to as the Regulation) in June 2014, which limited the sale of clean needles and syringes by community pharmacies. Therefore, we divided the period from 2010 to 2019 into from 2010 to 2015 and from 2016 to 2019. Utilizing the trends of HIV/HCV prevalences during these periods and taking them as indicators to measure the occurrence of needle and syringe sharing behavior. Employing the Event Study Method to verify the influence of community accessibility to needles and syringes for individuals of traditional drug users(TDU) on needle and syringe sharing, focusing on cumulative abnormal positive rates as a key metric. TDU came from the National HIV/AIDS CRIMS in 2010-2019 as the object, whose trend changes of annual HIV/HCV prevalences serve as a generation indicator of needle and syringe sharing. We set the period from 2010 to 2015 as the estimation window and from 2016 to 2019 as the event window, using the Chi-square trend tests to examine the changing trends in annual HIV/HCV prevalences. To construct a linear regression model based on the HIV/HCV prevalences from 2010 to 2015, the model was used to predict the expected prevalences from 2016 to 2019, which were compared with the actual prevalences from 2016 to 2019 to calculate the abnormal prevalences and the cumulative abnormal prevalences. Robustness tests were conducted on the cumulative abnormal prevalences to exclude the random changes in prevalences.

RESULT: In the event window, The actual trend of HIV/HCV prevalences were both statistically significant from 2010 to 2015( = 7.479, P = 0.006 and  = 9.717, P < 0.001), but weren't both statistically significant from 2016 to 2019( = 0.604, P = 0.437 and  = 0.134, P = 0.715). The Linear regression model indicates the HIV prevalence showed a negative correlation with time(adjusted R = 0.911, P < 0.001), and the HCV prevalence also exhibited a negative correlation with time from 2010 to 2015(adjusted R = 0.869, P < 0.001). During the event window from 2016 to 2019, the expected HIV and HCV prevalences were as follows: for HIV, 8.24%, 5.62%, 3.01%, and 0.39%; for HCV, 34.55%, 30.56%, 26.56%, and 22.57%. The abnormal HIV/HCV prevalences during this period were: for HIV, 3.29%, 6.26%, 9.56%, and 7.88%; for HCV, 4.71%, 10.69%, 15.28%, and 14.35%. The cumulative abnormal HIV/HCV prevalences were 3.29%, 9.55%, 19.11%, 26.99% for HIV, and 4.71%, 15.40%, 30.68%, 45.03% for HCV; the robustness test results indicated that the changes in HIV and HCV prevalences during the event window were not random events(U = 12.371, P < 0.001 for both Cumulative abnormal HIV/HCV prevalence).

CONCLUSION: When individuals practice injecting drugs, the important factor in needle and syringe sharing among TDU groups is the restricted access to clean needles and syringes from the community. The community commercial channel for needles and syringes should serve as a public health resource, addressing access to clean needles and syringes for individuals and reducing the frequency of needle and syringe sharing among community-active TDU groups. Public health policies aimed at preventing HIV epidemics in TDU populations should fully consider the accessibility of needles and syringes for the TDU groups in the community, thereby enhancing the effectiveness of public health measures.