WHO/HIV/2012.27
Annex 6. Evidence summaries Question 1: Should rapid HBV vaccination versus a standard HBV vaccination regimen be used with people who inject drugs? Author, year Christensen 2004 Population Findings
IDUs in prison HBV vaccine regimen completion
Denmark and Randomised study (Denmark) Estonia 63% for rapid schedule vs. 20% for standard schedule N=638 Non-‐randomised study (Estonia) 81% for rapid schedule 67% seroprotection at month 7 Brisette 2002 cocaine and heroin users Canada n=908 HBV vaccine regimen completion 73.7% for rapid schedule vs. 46.6% for standard schedule rapid schedule/high dose group developed a comparable response rate to the standard schedule and dose group 82.4% vs. 81.5%
Question 2: Should incentives for HBV vaccination completion versus no incentives be used with people who inject drugs? Author, year Seal 2003 Population IDU USA Findings HBV vaccine regimen completion 69% (incentive arm) vs. 23% (control arm) completed the HBV vaccine regimen
N=96
Stitzer 2010
Cocaine users HBV vaccine regimen completion USA N=26 77% (incentive arm) vs. 46% (control arm) completed the HBV vaccine regimen
Question 3: Should low dead space syringes versus high dead space syringes be provided to people who inject drugs? Author, year Gyarmathy 2010 Population IDU Hungary N=215 Lithuania N=300 Findings 95% of IDU from Hungary vs. 5% of IDU from Lithuania have only used LDSS syringes HCV prevalence 37% (Hungary) vs. 88% (Lithuania) HIV prevalence 0% (Hungary) vs. 10% (Lithuania) IDUs in Lithuania were also more likely to share and use a greater number of drugs than those in Hungary. In Lithuania, injecting liquid opioids was particularly associated with having HCV infection. Zule 2009 IDU USA N=851 HIV prevalence • • • • Shared LDSSs and never used an HDSS vs. never shared syringes and never used HDSSs: adjusted OR 0.89 (95%CI 0.34-‐2.33) Used a HDSS but never shared any type of syringes vs. never shared syringes and never used HDSSs: adjusted OR 1.59 (95% CI: 0.60-‐3.77) Used an HDSS and shared an LDSS HDSS vs. never shared syringes and never used HDSSs: adjusted OR 1.40 (95% CI 0.53-‐3.73) Used and shared HDSS vs. never shared syringes and never used HDSSs: adjusted OR 2.50 (95% CI 1.01-‐6.15)
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HCV prevalence • • Shared LDSSs and never used an HDSS vs. never shared syringes and never used HDSSs: adjusted OR 0.96 (95% CI 0.53-‐1.71) Used a HDSS but never shared any type of syringes HDSS vs. never shared syringes and never used HDSSs: adjusted OR 2.25 (95% CI 1.30-‐ 3.90) Used an HDSS and shared an LDSS HDSS vs. never shared syringes and never used HDSSs: adjusted OR 2.85 (95% CI 1.43-‐5.69) Used and shared HDSS vs. never shared syringes and never used HDSSs: adjusted OR 2.21 (95% CI 1.12-‐4.35)
• •
Question 4: Should psychosocial interventions versus no psychosocial interventions be used in people who inject drugs? Author, year Abou Saleh 2008 Population IDU UK N=95 Findings 82% were followed up at 6 months 65% were followed up at 12 months. Two interventions -‐ Enhanced prevention counselling (EPC) and simple educational counselling (SEC) HCV seroconversion 13% at 12 months -‐ 5% (EPC) and 8% (SEC) HCV incidence rates 9.1 per 100 person years for the EPC group 17.2 per 100 person years for the SEC group 12.9 per 100 person years for the cohort as a whole Gilbert 2010 Couples who Intervention – couple-‐based HIV/STI risk reduction intervention are IDU Increased condom use and decreased unsafe injections at 3 mo. follow-‐up
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Kazakhstan N=80 Stein 2009
among the intervention arm
heroin or A four-‐session motivational intervention did not differ significantly in reduce cocaine users Hepatitis C virus seroconversion among IDUs and non-‐IDUs compared to an assessment only condition, but did decrease injection initiation. USA n-‐277
Tucker 2004
IDU Australia N=145
Both IDUs in the brief-‐behavioural intervention and the standardised educational intervention control group reported significant reductions in risk behaviour, indicating that although intervention methods were not more effective than control.
Wu 2007
IDU China N=823 (T ) N=852 (T ) 1 0
Needle social marketing programme intervention over a 12-‐month period significantly reduced risky drug use behaviours and HIV and HCV incidence among
Zule 2009
IDU USA N=851
The use of new syringe at last injection or condom use at last sexual encounter did not differ between IDUs receiving a 6-‐session motivational intervention compared those receiving an educational intervention, although the percentage of IDUs using new syringes and condoms significantly increased from baseline in both groups.
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Question 5: Should peer education and mentoring versus no peer education and mentoring be used in people who inject drugs? Author, year Garfein 2007 Population IDU USA N= 853 Findings
29% greater decline in overall injection risk among intervention group 6 months post-‐intervention relative to the control [proportional OR 0.71; 95% CI: 0.52, 0.97], and a 76% decrease compared with baseline. Decreases were also observed for sexual risk behaviors, but they did not differ by trial arm. Overall HCV infection incidence (18.4/100 person-‐years) did not differ significantly across trial arms (RR 1.15; 95% CL 0.72, 1.82). No HIV seroconversions were observed.
Latka 2008
IDU USA N=418
Compared with the control group, intervention-‐group participants were less likely to report distributive risk behaviors at 3 months (OR=0.46; 95% CI: 0.27, 0.79) and 6 months (OR=0.51; 95% CI:0.31, 0.83), a 26% relative risk reduction, but were no more likely to cite their HCV-‐positive status as a reason for refraining from syringe lending. Effects were strongest among intervention-‐group participants who had known their HCVpositive status for at least 6 months. Peer mentoring and self-‐efficacy were significantly increased among intervention-‐group participants, and intervention effects were mediated through improved self-‐efficacy.
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