社区美沙酮维持治疗评估预测模型(EPM-MMT)的构建和应用

项目名称： 社区美沙酮维持治疗评估预测模型(EPM-MMT)的构建和应用

项目编号： No.81473065

项目类型： 面上项目

立项/批准年度： 2015

项目学科： 医药、卫生

项目作者： 凌莉

作者单位： 中山大学

项目金额： 80万元

中文摘要： 社区美沙酮维持治疗（MMT）在世界范围内被用于减少吸毒人群物质滥用、预防血液传播疾病(BBD)的发生发展，项目在我国开展十年来取得了显著效果。项目运行过程中存在的主要问题包括缺乏针对BBD防治效果的评价及工具研发；治疗模式单一，缺乏MMT与其他干预措施整合模式的探索。本研究拟借鉴已有的SIR疾病发展模型，采用系统综述、Meta分析和现场调查，收集是否参加社区MMT两种情况下，吸毒人群HIV、HCV流行病学和高危行为的相关指标，构建基于社区MMT项目的吸毒人群BBD的流行病学评估预测模型，研制评估工具。应用该工具评价我国社区MMT项目运行十年对吸毒人群HIV、HCV疾病发生发展的影响。根据国外MMT模式，提出我国该项目未来的可能运行模式，预测不同模式的效果；结合卫生经济学评价，为我国社区MMT项目未来发展方向提供参考依据。研制的评估工具和方法学可望在吸毒人群的其他干预措施评估中得到推广。

中文关键词： 美沙酮维持治疗；统计模型；效果评价；卫生经济学评价；发展模式

英文摘要： Community-based Methadone Maintenance Treatment (MMT) has been widely used as an effective means for reducing substance abuse, transmission and spread of blood borne viruses among drug users worldwide. MMT has been implemented for more than a decade in China. Despite its significant achievements, development of MMT programmes has encountered a number of barriers including: the absence of a comprehensive evaluation (with appropriate tools) of its population impacts in curbing the spread of blood borne infections, monotonic implementation and administrative model, and lack of integration with other harm reduction and treatment strategies. This study will first collate relevant HIV/HCV epidemiological indicators and risk behavioural indicators in drug users through systematic reviews, meta-analysis and empirical studies in communities with and without MMT. Informed by these indicators and based on the well-known Susceptible-Infected-Recovered (SIR) model for infectious diseases transmission, this study will further develop an Evaluation and Projection Model for Methadone Maintenance Treatment (EPM-MMT) model to investigate the transmission of blood borne viruses among community-based MMT participants in China. The tool will also assess the operation efficiency of the Chinese MMT program and its population impacts on HIV/HCV epidemic in the past decade. Projection of future epidemic trends and cost-effectiveness analysis will also be conducted using this tool to provide key reference evidence for future development of the program and inform relevant health policies. The evaluation framework, tool and methodology will be transferable to other intervention strategies for drug users in both domestic and international settings.

英文关键词： methadone maintenance treatment;mathematical model;effectiveness;economic evaluation;development strategies