● 中文摘要：

　　背景: 台灣目前對愛滋病疫情的了解，主要來自於愛滋病毒和愛滋病的通報系統，但這樣的資料多僅於通報個案人數的描述，缺乏對高危險群的愛滋病毒高危險行為狀況、盛行率和發生率的了解，所以對防治政策的擬定助益有限制。而我國愛滋病流行疫情，自民國94年起共用針具注射藥癮者更為台灣愛滋防治的一項新興急迫問題，長期監測其疫情趨勢和相關危險行為更顯需要。所以希望本計畫期以共用針具注射藥癮者為對象，進行該群體的愛滋病毒行為監測、愛滋病發生率和愛滋病毒感染盛行率估計，以作為政策訂定、預防策略的發展和服務提供的參考建議。 研究目的: 1. 建立國內注射毒品群體的估計數和社會網路情形。 2.了解國內北、中、南不同區域注射毒品群體的愛滋病高危險行為、愛滋病毒篩檢行為和接觸相關愛滋預防服務的情形。 3.提升接受調查的注射毒品個案的愛滋病相關認知。 4.注射毒品群體的愛滋病毒感染年發生數和估計發生率、盛行率。 方法: 本研究採用同伴推動抽樣法(respondent-driven sampling, RDS)進行注射毒癮者抽樣，與衛生署立八里療養院中和附設心理衛生中心、台北縣政府衛生局、彰化縣政府衛生局和高雄市政府衛生局合作，找尋第0波種子。種子接受訪談和抽血後，每名個案給與incentives（新台幣300元），同時發給他三張coupon，請他轉發給其他人。每當成功轉介1個人，則給與該名轉介者種子300元incentives。每名新的參與樣本，給與台幣300元incentives，當該種子第一次介紹的3名個案皆出現時，則再發3張給該種子，此形成的網絡關係即為連鎖-轉介(chain-referral)效應。其後使用The Respondent Driven Sampling Analysis Tool (RDSAT)套裝軟體進行分析注射毒品群體的估計數和社會網路。 檢體進行愛滋病毒、B型肝炎抗原和C型肝炎抗體檢驗，同時使用STARHS檢驗方法檢測受測族群中受到HIV-1感染之發生率。並使用OraQuick快速檢驗法於高危險群篩檢之可行性。 結果: 本研究至96年10月底為止，完成629名注射藥癮個案問卷分析及690名血液傳染病檢驗，其中C型肝炎抗體陽性率高達85.65%，B型肝炎陽性率22.61%，愛滋病毒陽性率為21.88%，可見未來肝炎預防和治療將面臨此一重大問題。同時使用該RDSAT分析統計軟體，初步估計該注射藥癮族群的愛滋病毒陽性率為15.3% 。同時注射藥癮人口的估計值約為43000 人。在共同注射藥物部分的危險行為探討部分，共用針具等行為已大幅下降，惟仍有45%的個案共用稀釋液。受訪個案分別各約3成個案曾至清潔針具服務點和美沙冬療法。 根據研究結果在實務部分建議推廣兌換券和抽血營養獎勵機制、應持續加強注射藥癮者避免共用稀釋液的概念、仍要再評估國內快速檢驗工具的大量推廣可行性和強化減害計畫其服務品質引導個案有效戒毒。在研究方面，建議未來進行世代追蹤研究，以近一步對個案本身行為改變歷程和對疾病感染原因更深入了解。

● English Abstract:

     Backgrounds: In Taiwan monitoring the HIV epidemic situation is mainly from the HIV and AIDS reporting system, but the information from that system just only are obtained the information about case number and charaters. It lacks the information of HIV risk behaviors, HIV incidence and HIV prevalence among high risk group such as injecting drug users, men who have sex with men. Besides, injecting drug users have became the major crisis in HIV epidemic since 2005 in Taiwan. The broad aim of this study is to monitor HIV risk behavior and HIV transmission in a high-risk population of active drug injectors for the purpose of guiding local HIV prevention efforts. Study Aims: The broad aim of this study is to monitor HIV risk behavior and HIV transmission in a high-risk population of active drug injectors for the purpose of guiding local HIV prevention efforts. Methods: The survey will use Respondent Driven Sampling to recruit up to 700 IDUs. The researchers will also collect blood samples, which will be tested for HIV,HCV and HBV; for recent infection with HIV using the STARHS test; and will be stored for future testing. Recruitment will take place in storefronts rented from existing HIV prevention and outreach programs in the city. The recruitment would take place in Taipei area, Koushioung area and the middle area of Taiwan. Study participants will be recruited, using Respondent Driven Sampling (RDS- see below), if they meet the criteria for study inclusion: they must have injected drugs in the last six months, be aged 18 or older, willing and able to provide informed consent, and report living or injecting drugs in the geographic unit being sampled. In the RDS protocol, “seeds” are recruited by study staff and asked to refer to the study three other IDUs that they know. Seeds must meet study eligibility criteria. Seeds will be told that they will receive reimbursement only for referring eligible subjects; we will also inform them that the individuals they refer must be able to show track marks or other evidence of recent injection. Referred individuals who are deemed to be eligible will be asked to refer to the study three of their injection associates; this procedure is repeated for 4 to 6 waves. After completing the interview, participants will be asked if they would be willing to help recruit other IDUs to the study for a small incentive ($10 each). Participants will be given three uniquely coded coupons each, and told to give the coupons to any IDUs they know. The unique code is recorded in the record of the enrolled referred subjects, linking the referent to the referee. Results: Up to the end of October at the year of 2007, we’ve completed questionnaire analysis for 629 injection drug dependency cases and 690 blood infectious diseases examines. Out of which, the positive rate for C hepatitis reaches as high as 85.65%, and 22.61% for B hepatitis positive, 21.88% for HIV positive. Therefore, it is clear that hepatitis prevention and the treatment will be one of the major focuses for our future work. In the meantime, we also use the RDSAT statistical software and estimate the HIV the masculine positive rate for the injection drug dependency groupe to be somewere around 15.3%, and the size of the injection drug user population is estimated to be approximately at 43000 people. Data on the injecting drug users together with the risk behavior suggests that although the needle sharing behavior is improved, however, there still is about 45% ratio in the diluent sharing group. Within these interviewed subjects, there are approximately 30% of which have visited our clean needle service site or receive the methadone therapy. It is concluded that in the experiment implemention part, the exchange bill and the nutrition reward mechanism is effective and is highly suggested; Secondly, the concept to avoid diluent sharing among injection drug user, test for the feasibility of mass domestic quick tests, as well as the service quality of the harm reduction, measured in the effective guidance of the rehabilitation, should all be continued and strengthen. From the research point of view, the preliminary results also suggested the future work should include a generation trace study, to futher investigate the relationship between behavioral change and infection causes. 

● 文章連結：https://goo.gl/Dwgktb

● 資料來源：政府研究資訊系統