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Modelling integrated antiretroviral treatment and harm reduction services on HIV and overdose among people who inject drugs in Tijuana, Mexico

dc.creatorCepeda, Javier A.es_ES
dc.creatorBórquez, Annickes_ES
dc.creatorMagana, Cristopheres_ES
dc.creatorVo, Anhes_ES
dc.creatorRafful, Claudiaes_ES
dc.creatorRangel, Gudeliaes_ES
dc.creatorMedina-Mora, María E.es_ES
dc.creatorStrathdee, Steffaniees_ES
dc.creatorMartin, Natasha K.es_ES
dc.date2020
dc.date.accessioned2023-09-06T16:23:23Z
dc.date.available2023-09-06T16:23:23Z
dc.date.issued2020
dc.identifierJC30DIEP20es_ES
dc.identifier.urihttp://repositorio.inprf.gob.mx/handle/123456789/7755
dc.identifier.urihttps://doi.org/10.1002/jia2.25493
dc.identifier.urihttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7305416/
dc.descriptionIntroduction: The HIV epidemic in Tijuana, Mexico is concentrated in key populations, including people who inject drugs (PWID). However, HIV interventions among PWID are minimal, and federal funding was provided for compulsory abstinence programmes associated with HIV and overdose. Alternatively, opioid agonist therapy reduces overdose, reincarceration, HIV, while improving antiretroviral therapy (ART) outcomes. We assessed potential impact and synergies of scaled-up integrated ART and opioid agonist therapy, compared to scale-up of each separately, and potential harms of compulsory abstinence programmes on HIV and fatal overdose among PWID in Tijuana. Methods: We developed a dynamic model of HIV transmission and overdose among PWID in Tijuana. We simulated scale-up of opioid agonist therapy from zero to 40% coverage among PWID. We evaluated synergistic benefits of an integrated harm reduction and ART scale-up strategy (40% opioid agonist therapy coverage and 10-fold ART recruitment), compared to scale-up of each intervention alone or no scale-up of low coverage ART and no harm reduction). We additionally simulated compulsory abstinence programmes (associated with 14% higher risk of receptive syringe sharing and 76% higher odds of overdose) among PWID. Results: Without intervention, HIV incidence among PWID could increase from 0.72 per 100 person-years (PY) in 2020 to 0.92 per 100 PY in 2030. Over ten years, opioid agonist therapy scale-up could avert 31% (95% uncertainty interval (UI): 18%, 46%) and 22% (95% UI: 10%, 28%) new HIV infections and fatal overdoses, respectively, with the majority of HIV impact from the direct effect on HIV transmission due to low ART coverage. Integrating opioid agonist therapy and ART scale-up provided synergistic benefits, with opioid agonist therapy effects on ART recruitment/retention averting 9% more new infections compared to ART scale-up alone. The intervention strategy could avert 48% (95% UI: 26%, 68%) of new HIV infections and one-fifth of fatal overdoses over ten years. Conversely, compulsory abstinence programmes could increase HIV and overdoses. Conclusions: Integrating ART with opioid agonist therapy could provide synergistic benefits and prevent HIV and overdoses among PWID in Tijuana, whereas compulsory abstinence programmes could cause harm. Policymakers should consider the benefits of integrating harm reduction and HIV services for PWID.es_ES
dc.formatPDFes_ES
dc.language.isoenges_ES
dc.publisherJohn Wiley & Sonses_ES
dc.relation23(S1): e25493
dc.rightsAcceso Cerradoes_ES
dc.titleModelling integrated antiretroviral treatment and harm reduction services on HIV and overdose among people who inject drugs in Tijuana, Mexicoes_ES
dc.typeArtículoes_ES
dc.contributor.affiliationDivision of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA.
dc.contributor.emailjacepeda@ucsd.edu (Javier A. Cepeda)
dc.relation.jnabreviadoJ INT AIDS SOC
dc.relation.jnabreviadoJournal of the International AIDS Society
dc.identifier.placeSuiza
dc.date.published2020
dc.identifier.organizacionInstituto Nacional de Psiquiatría Ramón de la Fuente Muñiz
dc.identifier.eissn1758-2652
dc.identifier.doi10.1002/jia2.25493
dc.subject.kwInject drugs
dc.subject.kwOpioid agonist therapy
dc.subject.kwHIV
dc.subject.kwIntegration
dc.subject.kwMexico
dc.subject.kwOverdose
dc.subject.kwDrug treatment


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