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1.
J Subst Abuse Treat ; 61: 26-33, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26470596

RESUMO

BACKGROUND: Available drug treatment modalities may inadequately address social and structural contexts surrounding recovery efforts. METHODS: This mixed methods analysis drew on (1) surveys with female sex workers and their intimate male partners and (2) semi-structured interviews with a subsample of 41 couples (n=82 individuals, 123 total interviews) in Northern Mexico. Descriptive and content analyses examined drug cessation and treatment experiences. RESULTS: Perceived need for drug treatment was high, yet only 35% had ever accessed services. Financial and institutional barriers (childcare needs, sex-segregated facilities) prevented partners from enrolling in residential programs together or simultaneously, leading to self-treatment attempts. Outpatient methadone was experienced more positively, yet financial constraints limited access and treatment duration. Relapse was common, particularly when one partner enrolled alone while the other continued using drugs. CONCLUSIONS: Affordable, accessible, evidence-based drug treatment and recovery services that acknowledge social and structural contexts surrounding recovery are urgently needed for drug-involved couples.


Assuntos
Área Carente de Assistência Médica , Profissionais do Sexo , Parceiros Sexuais/psicologia , Abuso de Substâncias por Via Intravenosa/reabilitação , Adulto , Relações Familiares , Feminino , Humanos , Entrevistas como Assunto , Masculino , México , Aceitação pelo Paciente de Cuidados de Saúde , Assunção de Riscos , Abuso de Substâncias por Via Intravenosa/economia , Inquéritos e Questionários
2.
PLoS Med ; 10(3): e1001401, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23554579

RESUMO

BACKGROUND: Cost-effectiveness studies inform resource allocation, strategy, and policy development. However, due to their complexity, dependence on assumptions made, and inherent uncertainty, synthesising, and generalising the results can be difficult. We assess cost-effectiveness models evaluating expected health gains and costs of HIV pre-exposure prophylaxis (PrEP) interventions. METHODS AND FINDINGS: We conducted a systematic review comparing epidemiological and economic assumptions of cost-effectiveness studies using various modelling approaches. The following databases were searched (until January 2013): PubMed/Medline, ISI Web of Knowledge, Centre for Reviews and Dissemination databases, EconLIT, and region-specific databases. We included modelling studies reporting both cost and expected impact of a PrEP roll-out. We explored five issues: prioritisation strategies, adherence, behaviour change, toxicity, and resistance. Of 961 studies retrieved, 13 were included. Studies modelled populations (heterosexual couples, men who have sex with men, people who inject drugs) in generalised and concentrated epidemics from Southern Africa (including South Africa), Ukraine, USA, and Peru. PrEP was found to have the potential to be a cost-effective addition to HIV prevention programmes in specific settings. The extent of the impact of PrEP depended upon assumptions made concerning cost, epidemic context, programme coverage, prioritisation strategies, and individual-level adherence. Delivery of PrEP to key populations at highest risk of HIV exposure appears the most cost-effective strategy. Limitations of this review include the partial geographical coverage, our inability to perform a meta-analysis, and the paucity of information available exploring trade-offs between early treatment and PrEP. CONCLUSIONS: Our review identifies the main considerations to address in assessing cost-effectiveness analyses of a PrEP intervention--cost, epidemic context, individual adherence level, PrEP programme coverage, and prioritisation strategy. Cost-effectiveness studies indicating where resources can be applied for greatest impact are essential to guide resource allocation decisions; however, the results of such analyses must be considered within the context of the underlying assumptions made. Please see later in the article for the Editors' Summary.


Assuntos
Fármacos Anti-HIV/economia , Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/economia , Infecções por HIV/prevenção & controle , Modelos Econômicos , Análise Custo-Benefício , Epidemias/estatística & dados numéricos , Infecções por HIV/epidemiologia , Heterossexualidade/estatística & dados numéricos , Humanos , Masculino , Peru/epidemiologia , África do Sul/epidemiologia , Abuso de Substâncias por Via Intravenosa/economia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Ucrânia/epidemiologia , Estados Unidos/epidemiologia
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