NIH资助试验：移动医疗车送综合服务上门，注射毒品者全因死亡下降71%
美国国立卫生研究院（NIH）11月4日公布一项由其资助的临床试验结果：在 Houston、Los Angeles、New York City、Philadelphia 与华盛顿五座城市，通过移动医疗车把艾滋病（HIV）预防与物质使用障碍治疗综合服务送到注射毒品者身边，配合朋辈导航，受试者的全因死亡比仅接受朋辈导航转介到社区服务的一组下降 71%。研究同时发现，两组在每日口服暴露前预防（PrEP）与阿片类药物使用障碍药物治疗（MOUD）的使用上没有差异。研究结果发表于《JAMA Psychiatry》。
这项名为 HPTN 094 的试验共招募 409 名未感染 HIV、注射毒品且患有阿片类药物使用障碍、入组时未接受 MOUD 治疗的成年人。一组接受 26 周朋辈导航，并在移动医疗车上获得 PrEP、MOUD 及有限的临床与支持服务；另一组接受 26 周朋辈导航、转介到社区的非移动服务。研究人员指出，尽管两组 MOUD 使用率无差异，但在第 26 周与第 52 周均有 14% 的人使用 MOUD，考虑到入组时无人接受治疗，这一水平具有临床意义。
资助该研究的国家药物滥用研究所（NIDA）所长 Nora D. Volkow 表示：「注射毒品是美国 HIV 传播的一个重要因素，也会增加其他严重传染病的风险。我们对这一人群已有有效的干预手段，但他们在获取和使用上面临很大障碍。尽管如此，这些发现表明，通过移动单元提供低门槛服务可以挽救生命。」
研究共同主席、哥伦比亚大学社会工作学教授 Nabila El-Bassel 表示，注射毒品者常面临服务碎片化、住房不稳定与污名等障碍，研究显示必须继续开发「到人们所在之处提供服务」的模式。研究人员同时指出，即使有结构化的朋辈导航，口服 PrEP 的使用率仍低，提示需要评估长效 PrEP 制剂在这一人群中的应用。NIH 表示，这一死亡下降为次要结局，结论仍需复制验证。
（来源：美国国立卫生研究院）
NIH-Funded Trial: Integrated Services Delivered by Mobile Medical Units Cut Deaths by 71% Among People Who Inject Drugs
Results from a clinical trial funded by the National Institutes of Health (NIH), announced on November 4, show that delivering integrated HIV and substance use disorder (SUD) services using peer navigation in mobile medical units reduced all-cause deaths by 71% compared to participants who received peer navigation to community-based services alone. The trial was conducted in five major U.S. cities: Houston, Los Angeles, New York City, Philadelphia, and Washington, D.C. Scientists found no difference in the use of daily oral preexposure prophylaxis (PrEP) and medication for opioid use disorder (MOUD) between the groups, although the secondary outcome of reduced mortality was significant. The results were published in JAMA Psychiatry.
The trial, known as HIV Prevention Trials Network Study 094 (HPTN 094), enrolled 409 adults without HIV who injected drugs, had opioid use disorder, were not taking MOUD at enrollment, and were willing to consider MOUD. One group received 26 weeks of peer navigation plus integrated PrEP, MOUD, and limited clinical and supportive services delivered on a mobile unit; the other received 26 weeks of peer navigation linking them to non-mobile community services. Although there was no difference in MOUD use between study arms, 14% of people used MOUD at 26 and 52 weeks, a clinically meaningful level considering none were on MOUD at study start.
"Injection drug use is an important contributor to HIV in the U.S. that also increases risk for other serious infectious diseases," said Nora D. Volkow, M.D., director of NIH's National Institute on Drug Abuse (NIDA), which funded the study. "Although we have effective interventions for this population, there are significant barriers to their accessibility and use. Nonetheless, these findings suggest that delivering low threshold services through mobile units could save lives."
"People who inject drugs often face fragmented systems, unstable housing, stigma, and other barriers that make sustained care difficult," said Nabila El-Bassel, Ph.D., of Columbia University, a study co-chair. Researchers noted that the relatively low use of oral PrEP underscores major challenges for PrEP acceptance among people who inject drugs and points to the importance of evaluating long-acting PrEP formulations in this population. NIH noted that replication of the mortality finding is needed.
(Source: National Institutes of Health)
来源：美国国立卫生研究院
发布：GSM·美国（发布链接）
图片来源：图：移动医疗诊所启用（资料图）。Senator Stabenow 摄，CC BY 2.0，经 Wikimedia Commons。 / Photo: Launching a new mobile medical clinic (file photo). Photo by Senator Stabenow, CC BY 2.0, via Wikimedia Commons.
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