The 1990 resolution by the UN General Assembly committed member states to provide health-care equity for people in prison, who are included in the global goals to control HIV and eliminate hepatitis C virus (HCV) by 2030. WHO has set ambitious HCV elimination targets by including people who inject drugs (PWID), yet has not prioritised PWID who are incarcerated, a substantial population who have or are at risk for HCV infection. Human rights principles of health-care equity stipulate that “prisoners should enjoy the same standards of health care that are available in the community, without discrimination on the grounds of their legal status”. Globally, only nine countries provide prison-based needle and syringe programmes (PNSPs), essential evidence-based interventions to holistically reduce the harms from drug use, of which only three countries extend reach to all prisons. Even where available, these services are accessed by few participants. PNSPs are recommended as an essential element of an effective HIV and HCV prevention strategy in prisons, and studies have shown that they are key to achieving HCV elimination in carceral settings. This Viewpoint, based primarily on unpublished data from key country-level stakeholders and expert opinion, highlights our perspective that implementation factors related to PNSP delivery in diverse settings likely contribute to low adoption and use of these services by PWID in prisons compared with in the community. However, successful expansion of these evidence-based interventions will depend on political commitment, national surveillance and monitoring programmes, and state-of-the-art implementation science methods, where inputs from multilevel stakeholders should guide improved implementation. Policy makers are urged to create and support opportunities to scale up PNSPs within countries where they exist and expand them to other countries where they are needed to solidify years of commitment towards the 2030 HCV elimination goals.

中文翻译：

---

改进针头和注射器计划的实施，以扩大、扩大和维持监狱中针对 HIV 和丙型肝炎的循证预防干预措施


联合国大会 1990 年的决议承诺会员国为监狱人员提供医疗保健公平，他们已被纳入到 2030 年控制 HIV 和消除丙型肝炎病毒 （HCV） 的全球目标中。世卫组织制定了雄心勃勃的消除 HCV 目标，将注射吸毒者 （PWID） 纳入其中，但并未优先考虑被监禁的 PWID，即大量患有或有感染 HCV 风险的人群。医疗保健公平的人权原则规定，“囚犯应享有与社区相同的医疗保健标准，不得因其法律地位而受到歧视”。在全球范围内，只有 9 个国家提供以监狱为基础的针头和注射器计划 （PNSP），这是全面减少吸毒危害的基本循证干预措施，其中只有 3 个国家将覆盖范围扩大到所有监狱。即使可用，也只有少数参与者可以访问这些服务。PNSP 被推荐为监狱中有效 HIV 和 HCV 预防策略的基本要素，研究表明，它们是在监狱环境中消除 HCV 的关键。该观点主要基于来自主要国家级利益相关者和专家意见的未公开数据，强调了我们的观点，即与在不同环境中提供 PNSP 相关的实施因素可能导致 PWID 在监狱中对这些服务的采用和使用率低于社区。然而，这些循证干预措施的成功扩展将取决于政治承诺、国家监测和监测计划以及最先进的实施科学方法，其中多级利益相关者的意见应指导改进实施。 敦促政策制定者创造和支持机会，在存在 PNSP 的国家/地区扩大 PNSP，并将其扩展到需要的其他国家，以巩固多年来对 2030 年消除 HCV 目标的承诺。