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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.
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