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![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.](https://image.slidesharecdn.com/whohiv2012-140612104825-phpapp01/85/Who-hiv-2012-27_eng-5-320.jpg)
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Who hiv 2012.27_eng
Rapid HBV vaccination schedules were more effective at completing the vaccination regimen compared to standard schedules in studies of people who inject drugs in prison in Denmark and Estonia. The use of incentives for HBV vaccination also improved completion rates compared to no incentives in US studies. Providing low dead space syringes rather than high dead space syringes was associated with lower rates of HIV and HCV in a Hungarian study, while a US study found increased risks of HIV and HCV with sharing or using high dead space syringes. Psychosocial interventions showed some benefits over no interventions, such as reduced HCV incidence and increased safer behaviors, though one US study found no difference in HCV seroconversion between a motivational intervention and assessment
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Who hiv 2012.27_eng
- 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.