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首页> 外文期刊>Journal of public health management and practice: JPHMP >Needling Policy Makers and Sharpening the Debate: Do Syringe Exchange Programs Improve Health at the Population Level?
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Needling Policy Makers and Sharpening the Debate: Do Syringe Exchange Programs Improve Health at the Population Level?

机译：针刺政策制定者和锐化辩论：注射器交换计划是否在人口水平改善健康？

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Context: In the midst of the current opioid epidemic, states have selected differing legislative routes implementing pathways to ensure access to clean needles and syringes. Objective: To determine whether states that implemented laws supporting syringe exchange programs (SEPs) had reductions in transmission rates of hepatitis B, hepatitis C, and HIV infection compared with states without such laws. Design and Setting: Utilizing a longitudinal panel design, we determined the legal status of SEPs in each state for years 1983-2016. Disease transmission rates for this period were estimated via a simple Poisson regression, with transmitted cases as the dependent variable, law categories as the predictor variables, and the log of state population as the exposure. The mean number of incident cases per state-year was also calculated. Participants: US states were utilized as the unit of analysis. Results: Hepatitis B and hepatitis C mean transmission rate per 100 000 population declined in states with local ordinances/decriminalized statutes and legalized SEPs (hepatitis B: 71% and 81%, respectively, differences P < .001; hepatitis C: 8% and 38%, respectively, differences P < .001). Reductions in mean incident cases per state-year mirrored these findings. HIV infection among injection drug users yielded inconsistent results. Conclusions: Hepatitis B and hepatitis C transmission were reduced at the population level in states with SEP laws in a pattern reflecting the degree of legal intervention. HIV infection, based upon a smaller data set, showed a mixed impact. Policy Implications: The results show promise that SEPs have population-level effects on disease transmission. States lacking SEPs should reconsider current policies.
机译：背景：在目前的阿片类疫情中，各国已经选择了实施途径的不同立法路线，以确保获得清洁针和注射器。目的：判断是否有助于支持注射器交换计划（SEP）的法律的规定，与未经其他法律的国家相比，乙型肝炎，丙型肝炎和艾滋病毒感染的传播速率降低。设计和设置：利用纵向面板设计，我们确定了1983 - 2016年的每个州中SEP的法律状况。通过简单的泊松回归估计这一时期的疾病传输速率，传输的案例作为从属变量，法律类别作为预测变量，以及状态人群的日志作为曝光。还计算了每年的平均事件案例数。参与者：美国各国被用作分析单位。结果：乙型肝炎和丙型肝炎每100 000人口的平均传输率在当地条例/递减法规和合法化的SEPs（乙型肝炎：71％和81％的差异，P <.001;丙型肝炎：8％和8％ 38％，分别差异P <.001）。每个统计调查结果的平均事件案例减少。注射药物中的HIV感染均产生不一致的结果。结论：乙型肝炎和丙型肝炎在众所周期以为反映法律干预程度的模式中的人口水平降低了人口水平。艾滋病毒感染，基于较小的数据集，显示出混合撞击。政策含义：结果表明，SEPs对疾病传播的人口水平影响。缺乏SEPS的国家应重新考虑当前的政策。

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