The effect of syringe exchange use on high-risk injection drug users: a cohort study

FRANÇAIS :
L'utilisation des programmes d'échange de seringue (PES) permet-elle aux usagers par voie injectable d'arrêter le partage des seringues ? De 1992 à 1996, 1503 UDVIs d'Oakland, recrutés dans la rue ont été interviewés, ont eu un test VIH et ont reçu des conseils 2 fois par an. Pour les 340 d'entre-eux qui ont rapporté une pratique de partage de seringue et qui ont participé à 2 observations des analyses statistiques ont été établies. Lors de l'interview de suivi, 60% (204) ont déclaré un arrêt du partage de seringue. Les UDVIs à haut risque qui commencent à utiliser le programme d'échange de seringue et ceux qui le continuent sont plus susceptibles d'arrêter le partage de seringue que les UDVIs qui n'utilisent pas le programme. Ces résultats confirment la corrélation indépendante entre participation à un PES et l'arrêt du partage de seringue déjà signalée dans d'autres études de cohorte aux Etats-Unis (notamment à San Francisco).
ENGLISH :
Objective: To determine whether syringe exchange program use is associated with cessation of syringe sharing among high-risk injection drug users. Design and methods: Between 1992 and 1996, street-recruited injection drug users were interviewed and received HIV testing and counseling semi-annually, as part of a dynamic cohort study. We examined a cohort of 340 high-risk injection drug users for whom two observations, 6-months apart, were available and who reported syringe sharing at the first interview. Multivariate logistic regression analysis was performed to determine the relationship between syringe exchange program use and cessation of syringe sharing, while controlling for confounding factors. Results: At follow-up interview, 60% (204 of 340) reported quitting syringe sharing. High-risk injection drug users who began using the syringe exchange program were more likely to quit sharing syringes [adjusted odds ratio (AOR), 2.68; 95% confidence interval (CI), 1.35-5.33], as were those who continued using the syringe exchange program (AOR,1.98; 95% CI, 1.05-3.75) in comparison with non-syringe exchange program users, while controlling for confounding factors. Conclusions: The initiation and continuation of syringe exchange program use among high-risk injection drug users is independently associated with cessation of syringe sharing. Syringe exchange program use can be an important component in reducing the spread of blood-borne infectious diseases among high-risk injection drug users. (Author' s abstract)