Abstract
Background
Hepatitis C virus (HCV) and HIV remain prevalent among people who inject drugs (PWID) and transmission is usually associated with injecting risk behaviour (IRB). We update a 2011 review of reviews (RoR) to assess the latest evidence on the effectiveness of harm reduction interventions – drug treatment (including opioid agonist therapy [OAT]), needle and syringe programmes (NSP) and other interventions – in the prevention of HCV and HIV transmission, and related measures of infection risk (IRB and injecting frequency [IF]), among PWID.
Methods
We undertook an initial search for systematic reviews (i.e. an Overview of Reviews [OoR]) and subsequent systematic searches for primary studies where required. Where there was sufficient evidence based on synthesis of multiple robust studies for an intervention effect in the 2011 RoR, new evidence was not sought. Medline, CINAHL, The Cochrane Library, EMBASE, PsycINFO and Web of Science were searched (2011-2020). Two reviewers screened papers, extracted data, and graded reviews/studies. We classified evidence as ‘sufficient’, ‘tentative’, ‘insufficient’, or ‘no evidence’.
Results
We screened 8513 reviews and 7133 studies, with 27 and 61 identified as relevant, respectively. The level of evidence increased since the 2011 RoR and is now ‘sufficient’ for OAT (regarding all outcomes), NSP (for reducing HIV transmission and IRB), and combination OAT/NSP (for reducing HCV transmission). There is also now sufficient evidence for in-prison OAT, psychosocial interventions, pharmacy-based NSP and provision of sterile drug preparation equipment for reducing IRB.
Conclusion
There is now a strong body of empirical evidence for the effectiveness of OAT and NSP, alone and in combination, in reducing IRB, and HCV and HIV transmission. However, there is still a relative lack of evidence for other interventions, including heroin-assisted treatment, pharmacological treatment for stimulant dependence, contingency management, technology-based interventions, low dead space syringes and drug consumption rooms on HCV or HIV risk.
Hepatitis C virus (HCV) and HIV remain prevalent among people who inject drugs (PWID) and transmission is usually associated with injecting risk behaviour (IRB). We update a 2011 review of reviews (RoR) to assess the latest evidence on the effectiveness of harm reduction interventions – drug treatment (including opioid agonist therapy [OAT]), needle and syringe programmes (NSP) and other interventions – in the prevention of HCV and HIV transmission, and related measures of infection risk (IRB and injecting frequency [IF]), among PWID.
Methods
We undertook an initial search for systematic reviews (i.e. an Overview of Reviews [OoR]) and subsequent systematic searches for primary studies where required. Where there was sufficient evidence based on synthesis of multiple robust studies for an intervention effect in the 2011 RoR, new evidence was not sought. Medline, CINAHL, The Cochrane Library, EMBASE, PsycINFO and Web of Science were searched (2011-2020). Two reviewers screened papers, extracted data, and graded reviews/studies. We classified evidence as ‘sufficient’, ‘tentative’, ‘insufficient’, or ‘no evidence’.
Results
We screened 8513 reviews and 7133 studies, with 27 and 61 identified as relevant, respectively. The level of evidence increased since the 2011 RoR and is now ‘sufficient’ for OAT (regarding all outcomes), NSP (for reducing HIV transmission and IRB), and combination OAT/NSP (for reducing HCV transmission). There is also now sufficient evidence for in-prison OAT, psychosocial interventions, pharmacy-based NSP and provision of sterile drug preparation equipment for reducing IRB.
Conclusion
There is now a strong body of empirical evidence for the effectiveness of OAT and NSP, alone and in combination, in reducing IRB, and HCV and HIV transmission. However, there is still a relative lack of evidence for other interventions, including heroin-assisted treatment, pharmacological treatment for stimulant dependence, contingency management, technology-based interventions, low dead space syringes and drug consumption rooms on HCV or HIV risk.
| Original language | English |
|---|---|
| Article number | 103872 |
| Journal | International Journal of Drug Policy |
| Volume | 109 |
| Early online date | 3 Oct 2022 |
| DOIs | |
| Publication status | E-pub ahead of print - 3 Oct 2022 |
Bibliographical note
Funding Information:This research was commissioned by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) through service contract CT.19.EU4MD.0099.1.0 under EMCDDA's EU4 Monitoring Drugs project, which is funded by the European Union. This research was also supported by Public Health Scotland, and HF, PV and MH acknowledge support from the NIHR Health Protection Research Unit in Behavioural Science and Evaluation. The funders did not influence the design of the study, the collection, analysis or interpretation of data, the writing of the report, or the decision to submit for publication. The views expressed in this publication do not necessarily represent the views of the European Union.
Funding Information:
SH has received honoraria from Gilead, unrelated to the submitted work. PV has received an unrestricted research grant from Gilead, unrelated to the submitted work. All other authors have no conflicts of interest to declare.
Publisher Copyright:
© 2022
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This output contributes to the following UN Sustainable Development Goals (SDGs)
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SDG 3 Good Health and Well-being
Research Groups and Themes
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