Human Immunodeficiency Virus Prevention for People Who Use Drugs: Overview of Reviews and the ICOS of PICOS

Abstract

Background This article summarizes the results from systematic reviews of human immunodeficiency virus (HIV) prevention interventions for people who use drugs (PWUD). We performed an overview of reviews, meta-analysis, meta-epidemiology, and PROSPERO Registration CRD42017070117. Methods We conducted a comprehensive systematic literature search using the Centers for Disease Control and Prevention HIV/AIDS Prevention Research Synthesis Project database to identify quantitative systematic reviews of HIV public heath interventions with PWUD published during 2002–2017. We recombined results of US studies across reviews to quantify effects on HIV infections, continuum of HIV care, sexual risk, and 5 drug-related outcomes (sharing injection equipment, injection frequency, opioid use, general drug use, and participation in drug treatment). We conducted summary meta-analyses separately for reviews of randomized controlled trials (RCTs) and quasi-experiments. We stratified effects by 5 intervention types: behavioral-psychosocial (BPS), syringe service programs (SSP), opioid agonist therapy (OAT), financial and scheduling incentives (FSI), and case management (CM). Results We identified 16 eligible reviews including >140 US studies with >55 000 participants. Summary effects among US studies were significant and favorable for 4 of 5 outcomes measured under RCT (eg, reduced opioid use; odds ratio [OR] = 0.70, confidence interval [CI] = 0.56–0.89) and all 6 outcomes under quasi-experiments (eg, reduced HIV infection [OR = 0.42, CI = 0.27–0.63]; favorable continuum of HIV care [OR = 0.68, CI = 0.53–0.88]). Each intervention type showed effectiveness on 1–6 outcomes. Heterogeneity was moderate to none for RCT but moderate to high for quasi-experiments. Conclusions Behavioral-psychosocial, SSP, OAT, FSI, and CM interventions are effective in reducing risk of HIV and sequelae of injection and other drug use, and they have a continuing role in addressing the opioid crisis and Ending the HIV Epidemic.

HIV and Substance Use in Latin America: A Scoping Review

“…HIV prevention studies among PWUS outside of LA include behavioral psychosocial interventions to reduce sex and drug risks, social service interventions, opioid antagonist therapy, financial and scheduling incentives, and syringe service programs to improve access to sterile injection equipment [ 175 ]. These interventions have varying degrees of success in reducing risky behaviors and HIV incidence depending on the populations and specific methodology [ 175 ], underlining the importance of researching their effectiveness in the context where they are to be applied.…”

Konsumutensilienvergabe in Deutschland: Ergebnisse einer Befragung von Einrichtungen der Drogenhilfe und Suchttherapie zur Ausgabe von Utensilien zum sicheren Drogenkonsum 2018

“…Die Datenlage ist jedoch teilweise von niedriger Qualität und der Effekt von NSP allein auf die Inzidenz und Prävalenz von Infektionen lässt sich aufgrund der Heterogenität der Settings und der Vielzahl von Störfaktoren (engl. Confounder) schwer messen [15,22,23]. Die Ausgabe von sterilen Spritzen und Nadeln und anderen Konsumutensilien sollte daher immer mit anderen Angeboten kombiniert werden, wie Wissensvermittlung, psychosoziale Interventionen, der Förderung von weniger risikobehafteten Konsumformen wie dem inhalativen Konsum, der entsprechenden Ausgabe solcher Konsumutensilien und insbesondere OST [15,23].…”

“…Confounder) schwer messen [15,22,23]. Die Ausgabe von sterilen Spritzen und Nadeln und anderen Konsumutensilien sollte daher immer mit anderen Angeboten kombiniert werden, wie Wissensvermittlung, psychosoziale Interventionen, der Förderung von weniger risikobehafteten Konsumformen wie dem inhalativen Konsum, der entsprechenden Ausgabe solcher Konsumutensilien und insbesondere OST [15,23]. Derzeit arbeitet die EMCDDA gemeinsam mit dem European Centre for Disease Prevention and Control (ECDC) an einer Aktualisierung der 2011 publizierten Evidenzübersicht für Empfehlungen zur Infektionsvermeidung und Kontrolle beim Drogenkonsum [8,24].…”

Safety and efficacy of stem cell therapy: an overview protocol on published meta-analyses and evidence mapping

“…A systematic review of systematic reviews or MAs (i.e., overview or umbrella review) is similar to systematic review and MA (7,15), and is also a critical evidence synthesis method that can consolidate an evidence base using data from MAs, while focusing on the quality of included MAs in terms of methodological quality (i.e., rigor methodological design and implementation) and reporting quality (i.e., complete and clear reporting on key information) (7). For example, Zhu and colleagues reviewed systematic reviews and MAs concerning the use of total glucosides of paeony in the treatment of rheumatoid arthritis and found that total glucosides of paeony are an effective and safe compound for treating rheumatoid arthritis, but the methodological quality and reporting quality of included MAs were poor (11).…”