Who hiv 2012.27_eng

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  • 1.   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  
  • 2.   2   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)  
  • 3.   3     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  
  • 4.   4   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  (T 0 )   N=852  (T 1 )   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.          
  • 5.   5   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.        
  • 6.   6   © World Health Organization 2012 All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: bookorders@who.int). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press through the WHO web site (http://www.who.int/about/licensing/copyright_form/en/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.