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 Population Findings Christensen
2004
IDUs in prison
Denmark and Estonia N=638
HBV vaccine regimen completion
Randomised study (Denmark)
63% for rapid schedule vs. 20% for standard schedule
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 Population Findings
Seal 2003
IDU USA
HBV vaccine regimen completion
69% (incentive arm) vs. 23% (control arm) completed the HBV vaccine regimen
N=96
Stitzer 2010
Cocaine users
USA N=26
HBV vaccine regimen completion
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 Population Findings Gyarmathy
2010
IDU
Hungary N=215
Lithuania N=300
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)
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 Population Findings Abou Saleh
2008
IDU UK N=95
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 are IDU
Intervention – couple-‐based HIV/STI risk reduction intervention
Increased condom use and decreased unsafe injections at 3 mo. follow-‐up
Kazakhstan
N=80
among the intervention arm
Stein 2009
heroin or cocaine users
USA n-‐277
A four-‐session motivational intervention did not differ significantly in reduce Hepatitis C virus seroconversion among IDUs and non-‐IDUs compared to an assessment only condition, but did decrease injection initiation.
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 (T0) N=852 (T1)
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.
Question 5: Should peer education and mentoring versus no peer education and mentoring be used in people who inject drugs?
Author, year Population Findings
Garfein 2007 IDU USA N= 853
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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