Who hiv 2012.27_eng


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Who hiv 2012.27_eng

  1. 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.   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.   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.   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.   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.        
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