Estimation of the impact of changing drug-use trend on HIV, hepatitis C and syphilis epidemics among people who use synthetic drug-only, polydrug and heroin-only during 2005–2035 in China: modelling study

Abstract

ObjectiveThe rapid expansion of the recreational drug market becomes a global health concern. It is worrying that the bacterial and viral infection epidemics linking to drug use may worsen accordingly. This study aimed to estimate the impacts of changing trend and behaviours of using heroin only, synthetic drug (SD) only and polydrug (using SD and heroin concurrently) on HIV, hepatitis C virus (HCV) and syphilis epidemics among people who use drugs in China by 2035.MethodsWe constructed a compartmental model to estimate HIV, HCV and syphilis epidemics in the dynamic drug-use trend by three scenarios: SD-only use, heroin-only use and polydrug use based on Monte Carlo simulations. The parameters for the model were collected from a comprehensive literature search.ResultsOur model estimated that polydrug use led to the highest HIV and HCV prevalence among three drug-use patterns. The prevalences were projected to increase from 10.9% (95% CI 10.2% to 11.5%) and 61.7% (95% CI 59.4% to 62.5%) in 2005 to 19.0% (95% CI 17.3% to 20.7%) and 69.1% (95% CI 67.3% to 69.5%), respectively, in 2035 among people using polydrug. Similarly, HIV and HCV prevalence in the SD-only group were projected to increase from 0.4% (95% CI 0.3% to 0.4%) and 19.5% (95% CI 19.4% to 21.7%) to 1.8% (95% CI 1.4 to 2.1%) and 33.7% (95% CI 33.2% to 34.9%) in 2005–2035. Conversely, HIV prevalence in the heroin-only group was projected to decrease from 8.0% (95% CI 7.6% to 8.1%) to 2.2% (95% CI 2.0% to 2.3%) in 2005–2035. Syphilis prevalence was estimated to remain unchanged in all population groups within this time frame. It was projected that the proportion of HIV transmitted by sexual transmission will increase compared with unsafe injection transmission in all people who use drugs from 2005 to 2035.ConclusionOur modelling suggests that polydrug use is projected to lead to the highest HIV and HCV disease burden by 2035, and the proportion of HIV transmitted by sexual transmission will increase. Current HIV intervention among people using heroin seems effective according to our estimation.

Sociodemographic Factors Associated With HIV/HCV High-Risk Behaviors Among People Who Use Drugs on Methadone Maintenance Treatment: A 10-Year Observational Study

“…According to Chinese national sentinel surveillance, the prevalence of HIV among drug users is ranged from 3.0 to 4.5%, and the HCV prevalence rate is 33.4–41.8% during 2010–2015 ( 5 ). A modeling study estimated that HIV and HCV prevalence expected to increase, respectively, from 10.9 and 61.7 to 19.0 and 69.1% among people using polydrugs (using synthetic drugs and heroin concurrently) from 2005 to 2035 ( 6 ).…”

“…A literature review showed that the proportion of drug injection among heroin-only users remained at 82.2% during 2006–2015, while the ratio increased from 58.6 to 65.2% among people using polydrug during 2012–2015. The proportion of syringe sharing in people using polydrug remained stable in a range of 20–30% and decreased from 38.6 to 22.1% during 2005–2015 ( 6 ). The mean number of sexual partners in the heroin-only users and polydrug users was 1.04 and 5.3, respectively ( 6 ), 37% of male injecting drug users reported having MSP ( 10 ), and even 75.21% of methamphetamine users reported having sex with multiple partners after using drugs ( 11 ).…”

“…The proportion of syringe sharing in people using polydrug remained stable in a range of 20–30% and decreased from 38.6 to 22.1% during 2005–2015 ( 6 ). The mean number of sexual partners in the heroin-only users and polydrug users was 1.04 and 5.3, respectively ( 6 ), 37% of male injecting drug users reported having MSP ( 10 ), and even 75.21% of methamphetamine users reported having sex with multiple partners after using drugs ( 11 ). Therefore, the high-risk behaviors of PWUD and the resulting HIV/HCV infection and transmission have become a paramount public health concern in China.…”

Combating illicit fentanyl: Will increased Chinese regulation generate a public health crisis in India?

“…Heroin, MDMA, methamphetamine, and other hard narcotics are commonly cut with fentanyl to increase their potency. Chinese polydrug users who combined heroin and synthetic drugs (SD) (mostly IMF), when compared to either exclusive heroin or SD use, exhibited more frequent drug use, higher drug sharing (among friends and at gatherings), and riskier sexual behavior (76). Chinese PWID who combined heroin and SD were also more likely to have HIV (10.5%) and syphilis (3.6%) compared to single drug users.…”