Titre :
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Ignoring'downstream infection'in the evaluation of harm reduction interventions for injection drug users. (2001)
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Auteurs :
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Harold-A POLLACK
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Type de document :
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Article
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Dans :
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European journal of epidemiology (vol. 17, n° 4, 2001)
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Pagination :
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391-395
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Langues:
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Anglais
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Mots-clés :
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Toxicomanie
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Sida
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Virose
;
Infection
;
Hépatite virale C
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Epidémiologie
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Incidence
;
Facteur risque
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Homme
;
Prévention santé
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Lutte contre toxicomanie
;
Lutte contre sida
;
Programme santé
;
Evaluation
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Immunopathologie
;
Appareil digestif [pathologie]
;
Foie [pathologie]
;
Etats Unis
;
Amérique
;
Amérique du Nord
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Résumé :
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[BDSP. Notice produite par INIST-CNRS rR0xsyhb. Diffusion soumise à autorisation]. Harm reduction interventions to reduce blood-borne disease incidence among injection drug users (IDUs). A common strategy to estimate the long-term impact of such interventions is to examine short-term incidence changes within a specific group of individuals exposed to the intervention. Such evaluations may overstate or understate long-term program effectiveness, depending upon the relationship between short-term and long-term incidence and prevalence. This short paper uses steady-state comparisons and a standard random-mixing model to scrutinize this evaluation approach. It shows that evaluations based upon short-term incidence changes can be significantly biased. The size and direction of the resulting bias depends upon a simple rule. For modest interventions, such analyses yield over-optimistic estimates of program effectiveness when steady-state disease prevalence exceeds 50% absent intervention. When steady-state prevalence is below 50%, such analyses display the opposite bias.
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