Health programmes and services addressing the prevention and management of infectious diseases in people who inject drugs in Canada: a systematic integrative review

Abstract

ObjectivesPeople who inject drugs (PWID) experience a high burden of injection drug use-related infectious disease and challenges in accessing adequate care. This study sought to identify programmes and services in Canada addressing the prevention and management of infectious disease in PWID.DesignThis study employed a systematic integrative review methodology. Electronic databases (PubMed, CINAHL and Web of Science Core Collection) and relevant websites were searched for literature published between 2008 and 2019 (last search date was 6 June 2019). Eligible articles and documents were required to address injection or intravenous drug use and health programmes or services relating to the prevention or management of infectious diseases in Canada.ResultsThis study identified 1607 unique articles and 97 were included in this study. The health programmes and services identified included testing and management of HIV and hepatitis C virus (n=27), supervised injection facilities (n=19), medication treatment for opioid use disorder (n=12), integrated infectious disease and addiction programmes (n=10), needle exchange programmes (n=9), harm reduction strategies broadly (n=6), mobile care initiatives (n=5), peer-delivered services (n=3), management of IDU-related bacterial infections (n=2) and others (n=4). Key implications for policy, practice and future research were identified based on the results of the included studies, which include addressing individual and systemic factors that impede care, furthering evaluation of programmes and the need to provide comprehensive care to PWID, involving medical care, social support and harm reduction.ConclusionsThese results demonstrate the need for expanded services across a variety of settings and populations. Our study emphasises the importance of addressing social and structural factors that impede infectious disease care for PWID. Further research is needed to improve evaluation of health programmes and services and contextual factors surrounding accessing services or returning to care.PROSPERO registration numberCRD42020142947.

Impact of harm minimization interventions on reducing blood-borne infection transmission and some injecting behaviors among people who inject drugs: an overview and evidence gap mapping

“…The evidence for THN is limited Inconclusive McDonald [ 47 ] SLR 22 observational studies (n = 2912) Any health setting THN • Overdose reversals: 96.3% [95.5–97.1] (n = 2249/2336 THN administrations) • Deaths: 0.9% [0.5–1.2] (n = 24/2336 THN administrations) Low-moderate THN programmes can reduce overdose mortality with a low rate of adverse events. However, there is a large variability in the size and quality studies Inconclusive Other combined interventions and interventions’ comparisons Bouzanis [ 48 ] SLR 97 interventional and observational studies Any health setting in Canada NSEP SCF/SIF OAT PoC Behavioral interventions Evidence indicates advantages of multifaceted care programmes for PWID, which include harm reduction, medical/pharmaceutical treatments, social support and education – The included studies call for exploratory work in facilitators and barriers to treatment and care, more robust study designs, and attention to contextual factors and more complex interventions Inconclusive Cross [ 49 ] SLRMA 18 interventional studies (n = 7926) Any health setting Educational interventions NSEP • Risky behavior, educational studies : WM: 0.749 [0.708–0.790] • Risky behavior, NSEP studies: WM: 0.279 [0.207–0.352] – Both interventions had a positive impact on reducing HIV risk behaviors, however, results are dependent upon research design, outcomes, follow-up Yes Hagan [ 50 ] SLRMA 26 interventional and observational studies Any health setting ...…”

“…This evidence is further limited by the evaluation design and number of successful reversals. Only one systematic review without meta-analysis by Bouzanis et al [ 48 ] (critically low methodological quality) mentioned the use of point-of-care HIV/HCV testing and treatment interventions, such as integrated multidisciplinary HIV and HCV care, supportive housing models, and addiction treatments for this population. Results should be carefully approached given the limitations in primary studies, including lack of randomization, self-reported measurements, and challenges in data generalizability (i.e., experiences often specific to PWID).…”

“…It may be necessary to consider intermediate outcomes (e.g., changes in practices) jointly with epidemiological data when evaluating interventions without a comparator. Other benefits such as number of diagnostics and immunization, referrals to detoxification, and decreased use of medical services, should be explored [ 48 ].…”

Models of good practice to enhance infectious disease care cascades among people who inject drugs: a qualitative study of interventions implemented in European settings

“…The one-stop shop approach, an integrated care model combining multispecialised teams to gather all necessary competences on one site, can reduce the complexity of care pathways [ 22 ]. These interdisciplinary, integrated care structures consistently show positive effects on the health and wellbeing of PWID, including mental health outcomes [ 15 , 23 , 24 ], by reducing the risk of loss to follow-up when patients have to navigate through complicated standard healthcare pathways [ 25 ]. Our analysis shows that integrated approaches that included testing, medical supervision, peer counselling, social support and/or OAT provided on one site were of particular importance for increasing adherence to treatment (4/4 MoGPs) and also for optimising community-based testing (4/6 MoGPs).…”

Occupational roles and risks of community-embedded peer educators providing HIV, hepatitis C and harm reduction services to persons who inject drugs in Nairobi, Kenya

“…Utilization of PEs is however one of many strategies to reach out to PWID. Countries within Africa and globally have successfully applied community-based approaches to provide a variety of health services to PWID including, HIV and viral hepatitis testing, supervised injection facilities, needle exchange programs, and OST [ 40 , 41 ]. However, PE programs hold several advantages over community-based programs, including reduction of stigma and promotion of effective communication.…”