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Tonin FS, Alves da Costa F, Fernandez-Llimos F. 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. Addict Sci Clin Pract 2024; 19:9. [PMID: 38310293 PMCID: PMC10838443 DOI: 10.1186/s13722-024-00439-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 01/18/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND This study aimed to synthetize the evidence on the effectiveness of harm minimization interventions on reducing blood-borne infection transmission and injecting behaviors among people who inject drugs (PWID) through a comprehensive overview of systematic reviews and evidence gap mapping. METHODS A systematic review was conducted with searches in PubMed and Scopus to identify systematic reviews assessing the impact of interventions aimed at reducing the harms associated with injectable drug use. The overall characteristics of the studies were extracted and their methodological quality was assessed using AMSTAR-2. An evidence gap map was constructed, highlighting the most frequently reported outcomes by intervention (CRD42023387713). RESULTS Thirty-three systematic reviews were included. Of these, 14 (42.2%) assessed the impact of needle/syringe exchange programs (NSEP) and 11 (33.3%) examined opioid agonist therapy (OAT). These interventions are likely to be associated with reductions of HIV/HCV incidence (10-40% risk reduction for NSEP; 50-60% for OAT) and sharing injecting paraphernalia (50% for NSEP, 25-85% for OAT), particularly when combined (moderate evidence). Behavioral/educational interventions were assessed in 12 reviews (36.4%) with most authors in favor/partially in favor of the use of these approaches (moderate evidence). Take-home naloxone programs and supervised-injection facilities were each assessed in two studies (6.1%), which reported inconclusive results (limited/inconsistent evidence). Most authors reported high levels of heterogeneity and risk of bias. Other interventions and outcomes were inadequately reported. Most systematic reviews presented low or critically low quality. CONCLUSION The evidence is sufficient to support the effectiveness of OAT, NSEP and their combination in reducing blood-borne infection transmission and certain injecting behaviors among PWID. However, evidence of other harm minimizations interventions in different settings and for some outcomes remain insufficient.
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Affiliation(s)
- Fernanda S Tonin
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Filipa Alves da Costa
- Research Institute for Medicines (iMED.ULisboa), Faculty of Pharmacy, University of Lisbon, Av. Prof. Gama Pinto, Lisbon, Portugal.
| | - Fernando Fernandez-Llimos
- Applied Molecular Biosciences Unit, (UCIBIO-i4HB) Laboratory of Pharmacology, Faculty of Pharmacy, University of Porto, Porto, Portugal
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Sigmon SC, Peck KR, Batchelder SR, Badger GJ, Heil SH, Higgins ST. Technology-Assisted Buprenorphine Treatment in Rural and Nonrural Settings: Two Randomized Clinical Trials. JAMA Netw Open 2023; 6:e2331910. [PMID: 37755833 PMCID: PMC10534272 DOI: 10.1001/jamanetworkopen.2023.31910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/27/2023] [Indexed: 09/28/2023] Open
Abstract
Importance Expansion of opioid use disorder treatment is needed, particularly in rural communities. Objective To evaluate technology-assisted buprenorphine (TAB) efficacy (1) over a longer period than previously examined, (2) with the addition of overdose education, and (3) among individuals residing in rural communities. Design, Setting, and Participants Two parallel, 24-week randomized clinical trials were conducted at the University of Vermont between February 1, 2018, and June 30, 2022. Participants were adults with untreated opioid use disorder from nonrural (trial 1) or rural (trial 2) communities. These trials are part of a programmatic effort to develop TAB protocols to improve treatment availability in underserved areas. Interventions Within each trial, 50 participants were randomized to TAB or control conditions. Participants in the TAB group completed bimonthly visits to ingest medication and receive take-home doses via a computerized device. They received nightly calls via an interactive voice response (IVR) system, IVR-generated random call-backs, and iPad-delivered HIV, hepatitis C virus (HCV), and overdose education. Control participants received community resource guides and assistance with contacting resources. All participants received harm reduction supplies and completed monthly assessments. Main Outcomes and Measures The primary outcome was biochemically verified illicit opioid abstinence across monthly assessments. Secondary outcomes included self-reported opioid use in both groups and abstinence at bimonthly and random call-back visits, treatment adherence, satisfaction, and changes in HIV, HCV, and overdose knowledge among TAB participants. Results Fifty individuals (mean [SD] age, 40.6 [13.1] years; 28 [56.0%] male) participated in trial 1, and 50 (mean [SD] age, 40.3 [10.8] years; 30 [60.0%] male) participated in trial 2. Participants in the TAB group achieved significantly greater illicit opioid abstinence vs controls at all time points in both trial 1 (85.3% [128 of 150]; 95% CI, 70.7%-93.3%; vs 24.0% [36 of 150]; 95% CI, 13.6%-38.8%) and trial 2 (88.0% [132 of 150]; 95% CI, 72.1%-95.4%; vs 21.3% [32 of 150]; 95% CI, 11.4%-36.5%). High abstinence rates were also observed at TAB participants' bimonthly dosing visits (83.0% [95% CI, 67.0%-92.0%] for trial 1 and 88.0% [95% CI, 71.0%-95.0%] for trial 2). Treatment adherence was favorable and similar between trials (with rates of approximately 99% for buprenorphine administration, 93% for daily IVR calls, and 92% for random call-backs), and 183 of 187 urine samples (97.9%) tested negative for illicit opioids at random call-backs. iPad-delivered education was associated with significant and sustained increases in HIV, HCV, and overdose knowledge. Conclusions and Relevance In these randomized clinical trials of TAB treatment, demonstration of efficacy was extended to a longer duration than previously examined and to patients residing in rural communities. Trial Registration ClinicalTrials.gov Identifier: NCT03420313.
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Affiliation(s)
- Stacey C. Sigmon
- Vermont Center on Behavior and Health, University of Vermont, Burlington
- Department of Psychiatry, University of Vermont, Burlington
- Department of Psychological Science, University of Vermont, Burlington
| | - Kelly R. Peck
- Vermont Center on Behavior and Health, University of Vermont, Burlington
- Department of Psychiatry, University of Vermont, Burlington
- Department of Psychological Science, University of Vermont, Burlington
| | - Sydney R. Batchelder
- Vermont Center on Behavior and Health, University of Vermont, Burlington
- Department of Psychiatry, University of Vermont, Burlington
| | - Gary J. Badger
- Department of Medical Biostatistics, University of Vermont, Burlington
| | - Sarah H. Heil
- Vermont Center on Behavior and Health, University of Vermont, Burlington
- Department of Psychiatry, University of Vermont, Burlington
- Department of Psychological Science, University of Vermont, Burlington
| | - Stephen T. Higgins
- Vermont Center on Behavior and Health, University of Vermont, Burlington
- Department of Psychiatry, University of Vermont, Burlington
- Department of Psychological Science, University of Vermont, Burlington
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Davoudi M, Heydari A, Manzari ZS. Psychosocial Interventions by Nurses for Patients with HIV/ AIDS: A Systematic Review. J Caring Sci 2023; 12:94-102. [PMID: 37469749 PMCID: PMC10352634 DOI: 10.34172/jcs.2023.30726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/05/2022] [Indexed: 07/21/2023] Open
Abstract
Introduction Providing psychological support is one of the traditional roles of nurses for patients with HIV/AIDS. Searching the literature showed that various psychological interventions have been performed by nurses to support HIV/AIDS patients; however, no summary of these interventions is available. We aimed to systematically review the interventional studies which investigated the effectiveness of psychosocial interventions delivered by nurses to HIV/AIDS patients. Methods This systematic review was performed based on Cochrane's handbook of systematic reviews of interventional studies. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement were used in this study. The databases of PubMed, Web of Science, Cochrane, Scopus and World Health Organization were searched from January 2009 to December 2022. Based on inclusion criteria, nine studies included in this systematic review. Cochrane data extraction form was used for the systematic review and the article's information was summarized using the modified Jadad scale. Results The interventions provided by the nurses included: virtual and face-to-face educational programs, written information resources, palliative care, motivational interview, case management, home visit, and care services, along with face-to-face and telephone follow-up. These interventions have a significant positive effect on the quality of life and management of high-risk behaviors, disease management, symptoms and complications, adherence to treatment, immune function, and mental health in patients with HIV/AIDS. Conclusion The results of the present study show that despite the fact that the interventions have a purely psychological content and can be done with various methods, they are able to have positive consequences in physical, psychological, behavioral, and laboratory health in HIV/AIDS patients.
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Affiliation(s)
- Malihe Davoudi
- Student Research Committee, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Heydari
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Sadat Manzari
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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Kudrina I, Puzhko S, Filion KB, Gore G, Paraskevopoulos E, Windle S, Martel MO, Eisenberg MJ. Effectiveness of interventions for prevention of common infections in people who use opioids: a protocol for a systematic review of systematic reviews. Syst Rev 2021; 10:298. [PMID: 34782008 PMCID: PMC8591821 DOI: 10.1186/s13643-021-01852-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 11/01/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The North American opioid crisis is driven by opioid-related mortality and morbidity, including opioid use-associated infections (OUAIs), resulting in a substantial burden for society. Users of legal and illegal opioids are at an increased risk of OUAIs compared to individuals not using opioids. As reported for hepatitis C virus (HCV), human immunodeficiency virus (HIV), bacterial, fungal, and other infections, OUAIs transmission and acquisition risks may be modifiable. Several systematic reviews (SRs) synthetized data regarding interventions to prevent infections in persons using drugs (e.g., opioid substitution therapy, needle and syringes exchange programs, psycho-social interventions); however, their conclusions varied. Therefore, SR of published SRs is needed to synthesize the highest level of evidence on the scope and effectiveness of interventions to prevent OUAIs in people using opioids legally or illegally. METHODS We will comprehensively search for SRs in the PubMed, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Epistemonikos, and Google Scholar databases from inception to November 2020. Data selection and extraction for each SR will be performed independently by two researchers, with disagreements resolved by consensus. All SRs regarding interventions with evaluated effectiveness to prevent OUAI in legal and/or illegal opioid users will be eligible. Risk of bias assessment will be performed using the AMSTAR2 tool. The results will be qualitatively synthesized, and a typology of interventions' effectiveness with a statement on the strength of evidence for each category will be created. DISCUSSION Our pilot search of PubMed resulted in 379 SRs analyzing the effectiveness of interventions to prevent HCV and HIV in persons who inject different types of drugs, including opioids. Of these 379 SRs, 8 evaluated primary studies where participants used opioids and would therefore be eligible for inclusion. The search results thus justify the application of SR of SRs approach. Comprehensive data on the scope and effectiveness of existing interventions to prevent OUAIs will help policy-makers to plan and implement preventive interventions and will assist clinicians in the guidance for their patients using opioids. SYSTEMATIC REVIEW REGISTRATION Registered in PROSPERO on 30 July 2020 ( #195929 ).
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Affiliation(s)
- Irina Kudrina
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, 5858 Chemin de la Côte-des-Neiges, Suite 300, Montreal, QC H3S 1Z1 Canada
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, 1650 Cedar Ave., Montreal, QC H3G 1A4 Canada
| | - Svetlana Puzhko
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, 5858 Chemin de la Côte-des-Neiges, Suite 300, Montreal, QC H3S 1Z1 Canada
| | - Kristian B. Filion
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Purvis Hall, 1020 Pine Avenue West, Montreal, QC H3A 1A2 Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC H3T 1E2 Canada
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University Health Center, McGill University, 1001 Decarie Boulevard, Suite D05-2212, Montreal, QC H4A3JI Canada
| | - Genevieve Gore
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, 3459 rue McTavish, Montreal, QC H3A OC9 Canada
| | - Elena Paraskevopoulos
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, 5858 Chemin de la Côte-des-Neiges, Suite 300, Montreal, QC H3S 1Z1 Canada
- Queensway Carleton Hospital, 3045 Baseline Rd, Ottawa, ON K2H 8P4 Canada
| | - Sarah Windle
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Purvis Hall, 1020 Pine Avenue West, Montreal, QC H3A 1A2 Canada
| | - Marc O. Martel
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, 1650 Cedar Ave., Montreal, QC H3G 1A4 Canada
- Faculty of Dentistry, McGill University, 2001 Avenue McGill College, Suite 500, Montreal, QC H3A 1G1 Canada
| | - Mark J. Eisenberg
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Purvis Hall, 1020 Pine Avenue West, Montreal, QC H3A 1A2 Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC H3T 1E2 Canada
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, 3605 de la Montagne, Montreal, Qc H3G 2M1 Canada
- Division of Cardiology, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC H3T 1E2 Canada
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Bouzanis K, Joshi S, Lokker C, Pavalagantharajah S, Qiu Y, Sidhu H, Mbuagbaw L, Qutob M, Henedi A, Levine MAH, Lennox R, Tarride JE, Kalina D, Alvarez E. Health programmes and services addressing the prevention and management of infectious diseases in people who inject drugs in Canada: a systematic integrative review. BMJ Open 2021; 11:e047511. [PMID: 34556508 PMCID: PMC8461723 DOI: 10.1136/bmjopen-2020-047511] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES People 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. DESIGN This 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. RESULTS This 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. CONCLUSIONS These 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 NUMBER CRD42020142947.
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Affiliation(s)
- Katrina Bouzanis
- Department of Global Health, McMaster University, Hamilton, Ontario, Canada
| | - Siddharth Joshi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Cynthia Lokker
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | | | - Yun Qiu
- School of Health Sciences, Jiangsu Institute of Commerce, Nanjing, Jiangsu, China
| | - Hargun Sidhu
- Department of Undergraduate Medical Education, McMaster University, Hamilton, Ontario, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Majdi Qutob
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Alia Henedi
- Faculty of Pharmacy, Eastern Mediterranean University, Famagusta, North Cyprus, Cyprus
| | - Mitchell A H Levine
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Robin Lennox
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Center for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
| | - Dale Kalina
- Department of Infectious Diseases, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
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Within-subject evaluation of interim buprenorphine treatment during waitlist delays. Drug Alcohol Depend 2021; 220:108532. [PMID: 33508690 PMCID: PMC8148627 DOI: 10.1016/j.drugalcdep.2021.108532] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND The effectiveness of opioid agonist treatment for opioid use disorder (OUD) is well established, and delays to treatment are still common, particularly in rural geographic areas. In a randomized 12-week pilot study, we demonstrated initial efficacy of a technology-assisted Interim Buprenorphine Treatment (IBT) vs. continued waitlist control (WLC) for reducing illicit opioid use and other risk behaviors during waitlist delays. Upon completion of that parent trial, WLC participants were given the opportunity to receive 12 weeks of IBT, permitting an additional within-subject examination of IBT effects. METHODS Sixteen WLC participants crossed over to receive IBT, involving buprenorphine maintenance with bi-monthly visits, medication administration at home via a computerized device, daily monitoring calls using an Interactive Voice Response (IVR) phone system, and IVR-generated random call-backs. Biochemically-verified illicit opioid abstinence, changes in psychosocial functioning, and HIV + HCV knowledge were examined among participants originally randomized to the WLC phase and who subsequently crossed over to IBT (IBTc). RESULTS Participants submitted a higher percentage of illicit opioid negative specimens at Weeks 4, 8, and 12 during IBT (75 %, 63 %, and 50 %) vs. WLC (0%, 0%, and 0%), respectively (p's<.01). Participants also demonstrated improvements in anxiety, depression, and HIV and HCV knowledge (p's<.01). Medication administration, daily IVR call and random call-back adherence and treatment satisfaction were also favorable. CONCLUSIONS This within-subject evaluation provides additional support for interim buprenorphine's efficacy in reducing illicit opioid use and improving health outcomes during waitlist delays for more comprehensive treatment.
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Tran MTN, Luong QH, Le Minh G, Dunne MP, Baker P. Psychosocial Interventions for Amphetamine Type Stimulant Use Disorder: An Overview of Systematic Reviews. Front Psychiatry 2021; 12:512076. [PMID: 34220557 PMCID: PMC8245759 DOI: 10.3389/fpsyt.2021.512076] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 05/06/2021] [Indexed: 12/28/2022] Open
Abstract
Introduction: Amphetamine-type stimulants (ATS) use is a global concern due to increased usage and the harm to physical, mental, and social well-being. The objective of this overview of systematic reviews is to summarise trial results of psychosocial interventions and describe their efficacy and safety. Methods: We searched seven bibliographic databases to November 2020 for systematic reviews examining ATS misuse treatment by psychosocial interventions. Given the apparent incompleteness of the included reviews, we undertook a supplemental meta-analysis of all eligible primary studies. Results: We included 11 systematic reviews of moderate to high quality and 39 primary studies which assessed the outcomes of psychosocial interventions on people who use ATS. The key findings include: (1) There were conflicting results about the effectiveness of psychosocial interventions among reviews, which may confuse decision-makers in selecting treatment. (2) In the supplemental meta-analysis, relative to usual care (only counselling or self-help materials), membership of a psychological intervention group was associated with an important reduction in drug usage [risk ratio (RR) 0.80, 95% CI: 0.75 to 0.85]. Patients in psychological interventions used injectables substantially less [odds ratio (OR) 0.35, 95% CI: 0.24 to 0.49]. The risk of unsafe sex in the psychosocial intervention group was lower than in the control group (RR 0.49, 95% CI: 0.34 to 0.71). The combination of therapies reduced 1.51 day using drugs in the preceding 30 days (95% CI: -2.36 to -0.67) compared to cognitive behavioural therapy intervention alone. (3) Compared to usual care, cognitive behavioural therapy was less likely to be retained at follow-up (RR 0.89, 95% CI: 0.82 to 0.97; high-quality evidence). However, the additional of contingency management strategy can make an important improvement upon retention (RR 1.42, 95%CI: 1.25 to 1.62). Authors' Conclusions: Integrated models are more effective than a single-treatment strategy. Comprehensive and sustained psychosocial interventions can help to reduce use of ATS and other drugs, risk behaviours and mental disorders, and significantly improve treatment adherence.
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Affiliation(s)
- Mai Thi Ngoc Tran
- Faculty of Health, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, QLD, Australia.,Center for Training and Research on Substance Abuse-HIV, Hanoi Medical University, Hanoi, Vietnam.,Nursing and Midwifery Faculty, Hanoi Medical University, Hanoi, Vietnam
| | - Quang Hung Luong
- Faculty of Health, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Giang Le Minh
- Center for Training and Research on Substance Abuse-HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Michael P Dunne
- Faculty of Health, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, QLD, Australia.,Faculty of Law, Australian Centre of Health Law Research, Queensland University of Technology (QUT), Brisbane, QLD, Australia.,Institute for Community Health Research, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Philip Baker
- Faculty of Health, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, QLD, Australia
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Lang J, Jin L, Yao Y. Comparative efficacy of interventions for reducing injection and sexual risk behaviours to prevent HIV in injection drug users: protocol for Bayesian network meta-analysis. BMJ Open 2019; 9:e022811. [PMID: 30696672 PMCID: PMC6352824 DOI: 10.1136/bmjopen-2018-022811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Drug users are more vulnerable to AIDS than the general population. While several interventions are effective for addressing HIV in injection drug users, no meta-analysis has yet been performed to compare interventions and determine the relative benefits of each. We intend to conduct a Bayesian network meta-analysis to compare all available interventions evaluated by a randomised controlled trial for reducing injection and risky sexual behaviours for the prevention of HIV in injection drug users. METHODS AND ANALYSIS Studies will be retrieved by searching the following databases: MEDLINE, Embase, PsycINFO and Cochrane Central Register of Controlled Trials. The search will be performed between May and July 2018 for the literature published between 1980 and May 2018. Two authors will extract data independently. Primary outcome measures will be injection risk behaviour and HIV risk behaviour. HIV seroconversion, confirmed using an antibody test, will be the secondary outcome. Bayesian network meta-analyses will be conducted using the Markov Chains Monte Carlo method. The Cochrane revised tool, Risk of Bias, will be used to assess the risk of bias. Grading of Recommendations Assessment, Development and Evaluation will be used to assess evidence quality. ETHICS AND DISSEMINATION The results of this study will be disseminated at professional conferences and via publications in peer-reviewed journals. This study will not include any confidential personal data or data on human trials; therefore, ethical approval is not required. PROSPERO REGISTRATION NUMBER CRD42018086999.
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Affiliation(s)
- Junjie Lang
- School of Public Health, Wannan Medical College, Wuhu, China
| | - Lairun Jin
- School of Public Health, Wannan Medical College, Wuhu, China
| | - Yingshui Yao
- School of Public Health, Wannan Medical College, Wuhu, China
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Elkbuli A, Polcz V, Dowd B, McKenney M, Prado G. HIV prevention intervention for substance users: a review of the literature. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2019; 14:1. [PMID: 30606266 PMCID: PMC6318880 DOI: 10.1186/s13011-018-0189-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/18/2018] [Indexed: 11/18/2022]
Abstract
Background Behavioral Interventions are needed to prevent HIV in substance users, which is associated with higher risk for contracting HIV via unprotected sexual intercourse or syringe-based exposure. We reviewed universal HIV prevention interventions targeting intravenous drug users (IDUs) and non-IDUs (NIDUs) to identify which prevention interventions are the most effective at reducing HIV transmission risk among IDU’s and NIDU’s and identify gaps in the literature. Methods A PubMed literature review (1998–2017), limiting studies to universal HIV prevention interventions targeting adult HIV-negative substance users. Interventions were compared across sample sizes, sociodemographic, intervention setting, study design, use of theoretical models, and intervention effects. Results Of 1455 studies identified, 19 targeted IDUs (n = 9) and NIDUs (n = 10). Both IDU and NIDU studies were conducted in substance use treatment centers and included both group (44% vs. 73%) and individual-based (56% vs. 27%) methods; only one NIDU study used a couple-based intervention. All IDU, and 89% of NIDU, studies used explanatory and behavior-change theoretical models to guide selection of intervention mechanisms. Reduction in frequency of risky sexual behaviors were observed in 33% IDU and 64% NIDU studies, where 56% of IDU studies effectively increased drug use-related hygiene and 67% decreased frequency of injections. Eight studies included start-of-study HIV testing and five examined HIV seroconversion. Conclusion The interventions reviewed demonstrate promising results for decreasing risky sexual practices for NIDUs and reducing high-risk drug practices for IDUs, thereby reducing HIV transmission risk. Future studies should include HIV testing and measurement of HIV seroconversion to fully elucidate intervention effects.
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Affiliation(s)
- Adel Elkbuli
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA. .,Department of Surgery, Kendall Regional Medical Center, Miami, Florida, USA.
| | - Valerie Polcz
- Department of Surgery, Kendall Regional Medical Center, Miami, Florida, USA.,Florida International University, Miami, Florida, USA
| | - Brianna Dowd
- Department of Surgery, Kendall Regional Medical Center, Miami, Florida, USA.,Florida International University, Miami, Florida, USA
| | - Mark McKenney
- Department of Surgery, Kendall Regional Medical Center, Miami, Florida, USA.,Department of Surgery, University of South Florida, Tampa, Florida, USA
| | - Guillermo Prado
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
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Klimas J, Fairgrieve C, Tobin H, Field C, O'Gorman CSM, Glynn LG, Keenan E, Saunders J, Bury G, Dunne C, Cullen W. Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users. Cochrane Database Syst Rev 2018; 12:CD009269. [PMID: 30521696 PMCID: PMC6517179 DOI: 10.1002/14651858.cd009269.pub4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Problem alcohol use is common among people who use illicit drugs (PWID) and is associated with adverse health outcomes. It is also an important factor contributing to a poor prognosis among drug users with hepatitis C virus (HCV) as it impacts on progression to hepatic cirrhosis or opioid overdose in PWID. OBJECTIVES To assess the effectiveness of psychosocial interventions to reduce alcohol consumption in PWID (users of opioids and stimulants). SEARCH METHODS We searched the Cochrane Drugs and Alcohol Group trials register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, and PsycINFO, from inception up to August 2017, and the reference lists of eligible articles. We also searched: 1) conference proceedings (online archives only) of the Society for the Study of Addiction, International Harm Reduction Association, International Conference on Alcohol Harm Reduction and American Association for the Treatment of Opioid Dependence; and 2) online registers of clinical trials: Current Controlled Trials, ClinicalTrials.gov, Center Watch and the World Health Organization International Clinical Trials Registry Platform. SELECTION CRITERIA We included randomised controlled trials comparing psychosocial interventions with other psychosocial treatment, or treatment as usual, in adult PWIDs (aged at least 18 years) with concurrent problem alcohol use. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS We included seven trials (825 participants). We judged the majority of the trials to have a high or unclear risk of bias.The psychosocial interventions considered in the studies were: cognitive-behavioural coping skills training (one study), twelve-step programme (one study), brief intervention (three studies), motivational interviewing (two studies), and brief motivational interviewing (one study). Two studies were considered in two comparisons. There were no data for the secondary outcome, alcohol-related harm. The results were as follows.Comparison 1: cognitive-behavioural coping skills training versus twelve-step programme (one study, 41 participants)There was no significant difference between groups for either of the primary outcomes (alcohol abstinence assessed with Substance Abuse Calendar and breathalyser at one year: risk ratio (RR) 2.38 (95% confidence interval [CI] 0.10 to 55.06); and retention in treatment, measured at end of treatment: RR 0.89 (95% CI 0.62 to 1.29), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was very low.Comparison 2: brief intervention versus treatment as usual (three studies, 197 participants)There was no significant difference between groups for either of the primary outcomes (alcohol use, measured as scores on the Alcohol Use Disorders Identification Test (AUDIT) or Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) at three months: standardised mean difference (SMD) 0.07 (95% CI -0.24 to 0.37); and retention in treatment, measured at three months: RR 0.94 (95% CI 0.78 to 1.13), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low.Comparison 3: motivational interviewing versus treatment as usual or educational intervention only (three studies, 462 participants)There was no significant difference between groups for either of the primary outcomes (alcohol use, measured as scores on the AUDIT or ASSIST at three months: SMD 0.04 (95% CI -0.29 to 0.37); and retention in treatment, measured at three months: RR 0.93 (95% CI 0.60 to 1.43), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low.Comparison 4: brief motivational intervention (BMI) versus assessment only (one study, 187 participants)More people reduced alcohol use (by seven or more days in the past month, measured at six months) in the BMI group than in the control group (RR 1.67; 95% CI 1.08 to 2.60). There was no difference between groups for the other primary outcome, retention in treatment, measured at end of treatment: RR 0.98 (95% CI 0.94 to 1.02), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was moderate.Comparison 5: motivational interviewing (intensive) versus motivational interviewing (one study, 163 participants)There was no significant difference between groups for either of the primary outcomes (alcohol use, measured using the Addiction Severity Index-alcohol score (ASI) at two months: MD 0.03 (95% CI 0.02 to 0.08); and retention in treatment, measured at end of treatment: RR 17.63 (95% CI 1.03 to 300.48), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low. AUTHORS' CONCLUSIONS We found low to very low-quality evidence to suggest that there is no difference in effectiveness between different types of psychosocial interventions to reduce alcohol consumption among people who use illicit drugs, and that brief interventions are not superior to assessment-only or to treatment as usual. No firm conclusions can be made because of the paucity of the data and the low quality of the retrieved studies.
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Affiliation(s)
- Jan Klimas
- BC Centre for Excellence in HIV/AIDSBC Centre on Substance Use611 Powell StreetVancouverBCCanadaV6A 1H2
- School of Medicine, University College DublinHealth Science Centre, Belfield, UCDDublinIrelandD4
| | - Christopher Fairgrieve
- BC Centre for Excellence in HIV/AIDSBC Centre on Substance Use611 Powell StreetVancouverBCCanadaV6A 1H2
| | - Helen Tobin
- University College DublinSchool of MedicineDublinIreland
| | - Catherine‐Anne Field
- National University of Ireland GalwayCollege of Medicine, Nursing, & Health Sciences, School of Health SciencesGalwayIreland
| | - Clodagh SM O'Gorman
- Faculty of Education and Health Sciences, University of LimerickGraduate Entry Medical SchoolLimerickIreland
- Graduate Entry Medical School, University of LimerickDepartment of PaediatricsLimerickIreland
| | - Liam G Glynn
- Graduate Entry Medical School, University of LimerickGeneral PracticeLimerickIreland
| | - Eamon Keenan
- Health Service ExecutiveAddiction ServicesBridge House, Cherry Orchard HospitalBallyfermotDublinIreland10
| | - Jean Saunders
- Graduate Entry Medical School, University of LimerickStatistical Consulting Unit/ Applied Biostatistics Consulting Centre /CSTARLimerickIreland
| | - Gerard Bury
- University College DublinSchool of MedicineDublinIreland
| | - Colum Dunne
- Faculty of Education and Health Sciences, University of LimerickGraduate Entry Medical SchoolLimerickIreland
- Faculty of Education and Health Sciences, University of LimerickCentre for Interventions in Infection, Inflammation & Immunity (4i)LimerickIreland
| | - Walter Cullen
- University College DublinSchool of MedicineDublinIreland
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11
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Ochalek TA, Heil SH, Higgins ST, Badger GJ, Sigmon SC. A novel mHealth application for improving HIV and Hepatitis C knowledge in individuals with opioid use disorder: A pilot study. Drug Alcohol Depend 2018; 190:224-228. [PMID: 30056321 PMCID: PMC6446902 DOI: 10.1016/j.drugalcdep.2018.05.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/04/2018] [Accepted: 05/06/2018] [Indexed: 12/11/2022]
Abstract
AIMS There is a critical need to reduce infectious disease transmission among individuals with opioid use disorder (OUD). Here we examine the ability of a novel, automated educational intervention, delivered via iPad in a single visit, to improve human immunodeficiency virus (HIV) and Hepatitis C (HCV) knowledge among adults with OUD. METHODS Participants were 25 adults enrolled in a 12-week trial evaluating the efficacy of an Interim Buprenorphine Treatment for reducing illicit opioid use and other risk behaviors during delays to opioid treatment. Participants completed baseline HIV and HCV knowledge assessments with corrective feedback. They then completed an interactive HIV flipbook and HCV video followed by a second administration of the knowledge assessments. The knowledge assessments were repeated at post-intake Weeks 4 and 12. RESULTS At baseline, participants answered 69% and 65% of items correctly on the HIV and HCV assessments, respectively. The educational intervention was associated with significant increases in knowledge (86% and 86% correct on the HIV and HCV assessments, respectively; p's<.001). These improvements persisted throughout the study, with scores at Week 4 and 12 significantly greater than baseline (p's<.001). CONCLUSION This HIV+Hepatitis Education intervention was associated with significant and sustained improvements in knowledge of HIV + HCV transmission and risk behaviors in this vulnerable group of individuals with OUD. Given the continuing opioid epidemic, efforts are urgently needed to reduce HIV and HCV contraction and transmission among individuals with OUD. Mobile health educational interventions may offer a time- and cost-effective approach for addressing these risks.
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Affiliation(s)
- Taylor A Ochalek
- Vermont Center on Behavior and Health, University of Vermont, Rm 1415 UHC, 1 S. Prospect St., Burlington VT 05401, USA; Department of Psychology, University of Vermont, Rm 1415 UHC, 1 S. Prospect St., Burlington VT 05401, USA.
| | - Sarah H Heil
- Vermont Center on Behavior and Health, University of Vermont, Rm 1415 UHC, 1 S. Prospect St., Burlington VT 05401, USA; Department of Psychology, University of Vermont, Rm 1415 UHC, 1 S. Prospect St., Burlington VT 05401, USA; Department of Psychiatry, University of Vermont, Rm 1415 UHC, 1 S. Prospect St., Burlington VT 05401, USA
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, Rm 1415 UHC, 1 S. Prospect St., Burlington VT 05401, USA; Department of Psychology, University of Vermont, Rm 1415 UHC, 1 S. Prospect St., Burlington VT 05401, USA; Department of Psychiatry, University of Vermont, Rm 1415 UHC, 1 S. Prospect St., Burlington VT 05401, USA
| | - Gary J Badger
- Department of Biostatistics, University of Vermont, Biostatistics Unit, 27 Hills Building, Rm 25D, Burlington, VT 05401, USA
| | - Stacey C Sigmon
- Vermont Center on Behavior and Health, University of Vermont, Rm 1415 UHC, 1 S. Prospect St., Burlington VT 05401, USA; Department of Psychology, University of Vermont, Rm 1415 UHC, 1 S. Prospect St., Burlington VT 05401, USA; Department of Psychiatry, University of Vermont, Rm 1415 UHC, 1 S. Prospect St., Burlington VT 05401, USA
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12
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Wernette GT, Plegue M, Kahler CW, Sen A, Zlotnick C. A Pilot Randomized Controlled Trial of a Computer-Delivered Brief Intervention for Substance Use and Risky Sex During Pregnancy. J Womens Health (Larchmt) 2018; 27:83-92. [PMID: 28981379 PMCID: PMC5771551 DOI: 10.1089/jwh.2017.6408] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Sexually transmitted infections (STIs) are an increasingly critical and costly health problem for American childbearing women. Pregnant women who misuse substances are more likely to engage in risky sexual behavior that leads to STIs. Substance use and risky sex during pregnancy are both associated with numerous negative consequences for the woman and the developing fetus. STUDY DESIGN A two-group, randomized controlled trial. PARTICIPANTS Recruitment of 50 pregnant women (30% Latina; 24.4 years old [SD = 5.31]) with an average of 13 weeks gestation (SD = 4.5 weeks) was conducted at a prenatal clinic in a large inner-city hospital. Recruitment took place between 2015 and 2016, and data analysis took place in 2016. INTERVENTION A computer-delivered, single-session brief motivational intervention plus booster session addressing both substance use and STI risk. OBJECTIVE To assess participants' perceptions of the intervention and to examine the preliminary efficacy in reduction of substance use and risky sex at 4-month follow-up assessment. RESULTS There were consistently very high ratings of acceptability of the intervention, ranging between 6.3 and 6.8 on a 1-7 scale. At the 4-month follow-up, participants in the intervention arm reported a significantly larger reduction (54%) in any marijuana or alcohol use compared with participants in the control group (16%) (p = 0.015) based on two-group clustered logistic regression using a generalized estimating equations approach. There was a higher reduction in condomless vaginal sex at follow-up in the health checkup for expectant moms (HCEM) arm than control (27% vs. 5%), although this was not significant (p = 0.127). CONCLUSIONS The results of this pilot study are encouraging with respect to the acceptability and preliminary efficacy of an intervention in reducing alcohol/marijuana use and condomless sex during pregnancy, supporting the next step of testing the intervention in a larger sample.
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Affiliation(s)
| | - Melissa Plegue
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Christopher W. Kahler
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island
| | - Ananda Sen
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Caron Zlotnick
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island
- Women & Infants Hospital, Providence, Rhode Island
- Department of Psychiatry and Mental Health, University of Cape Town, South Africa
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13
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Gilchrist G, Swan D, Widyaratna K, Marquez-Arrico JE, Hughes E, Mdege ND, Martyn-St James M, Tirado-Munoz J. A Systematic Review and Meta-analysis of Psychosocial Interventions to Reduce Drug and Sexual Blood Borne Virus Risk Behaviours Among People Who Inject Drugs. AIDS Behav 2017; 21:1791-1811. [PMID: 28365913 PMCID: PMC5491643 DOI: 10.1007/s10461-017-1755-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Opiate substitution treatment and needle exchanges have reduced blood borne virus (BBV) transmission among people who inject drugs (PWID). Psychosocial interventions could further prevent BBV. A systematic review and meta-analysis examined whether psychosocial interventions (e.g. CBT, skills training) compared to control interventions reduced BBV risk behaviours among PWID. 32 and 24 randomized control trials (2000-May 2015 in MEDLINE, PsycINFO, CINAHL, Cochrane Collaboration and Clinical trials, with an update in MEDLINE to December 2016) were included in the review and meta-analysis respectively. Psychosocial interventions appear to reduce: sharing of needles/syringes compared to education/information (SMD −0.52; 95% CI −1.02 to −0.03; I2 = 10%; p = 0.04) or HIV testing/counselling (SMD −0.24; 95% CI −0.44 to −0.03; I2 = 0%; p = 0.02); sharing of other injecting paraphernalia (SMD −0.24; 95% CI −0.42 to −0.06; I2 = 0%; p < 0.01) and unprotected sex (SMD −0.44; 95% CI −0.86 to −0.01; I2 = 79%; p = 0.04) compared to interventions of a lesser time/intensity, however, moderate to high heterogeneity was reported. Such interventions could be included with other harm reduction approaches to prevent BBV transmission among PWID.
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Affiliation(s)
- Gail Gilchrist
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, London, SE5 8BB, UK.
- Department of General Practice, University of Melbourne, Parkville, VIC, 3010, Australia.
| | - Davina Swan
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, London, SE5 8BB, UK
| | - Kideshini Widyaratna
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, London, SE5 8BB, UK
| | - Julia Elena Marquez-Arrico
- Department of Psychiatry and Clinical Psychobiology, School of PsychologyUniversity of Barcelona, 08036, Barcelona, Spain
| | | | - Noreen Dadirai Mdege
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, YO24 2YD, UK
| | - Marrissa Martyn-St James
- School for Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Judit Tirado-Munoz
- Addiction Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Institute of Neuropsychiatry and Addictions, Parc de Salut Mar de Barcelona, 08003, Barcelona, Spain
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14
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Bazazi AR, Wickersham JA, Wegman MP, Culbert GJ, Pillai V, Shrestha R, Al-Darraji H, Copenhaver MM, Kamarulzaman A, Altice FL. Design and implementation of a factorial randomized controlled trial of methadone maintenance therapy and an evidence-based behavioral intervention for incarcerated people living with HIV and opioid dependence in Malaysia. Contemp Clin Trials 2017; 59:1-12. [PMID: 28479216 DOI: 10.1016/j.cct.2017.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 04/13/2017] [Accepted: 05/03/2017] [Indexed: 12/13/2022]
Abstract
Incarcerated people living with HIV and opioid dependence face enormous challenges to accessing evidence-based treatment during incarceration and after release into the community, placing them at risk of poor HIV treatment outcomes, relapse to opioid use and accompanying HIV transmission risk behaviors. Here we describe in detail the design and implementation of Project Harapan, a prospective clinical trial conducted among people living with HIV and opioid dependence who transitioned from prison to the community in Malaysia from 2010 to 2014. This trial involved 2 interventions: within-prison initiation of methadone maintenance therapy and an evidence-based behavioral intervention adapted to the Malaysian context (the Holistic Health Recovery Program for Malaysia, HHRP-M). Individuals were recruited and received the interventions while incarcerated and were followed for 12months after release to assess post-release HIV transmission risk behaviors and a range of other health-related outcomes. Project Harapan was designed as a fully randomized 2×2 factorial trial where individuals would be allocated in equal proportions to methadone maintenance therapy and HHRP-M, methadone maintenance therapy alone, HHRP-M alone, or control. Partway through study implementation, allocation to methadone maintenance therapy was changed from randomization to participant choice; randomization to HHRP-M continued throughout. We describe the justification for this study; the development and implementation of these interventions; changes to the protocol; and screening, enrollment, treatment receipt, and retention of study participants. Logistical, ethical, and analytic issues associated with the implementation of this study are discussed.
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Affiliation(s)
- Alexander R Bazazi
- Yale School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, CT, USA; Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA.
| | - Jeffrey A Wickersham
- Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; University Malaya, Centre of Excellence for Research in AIDS (CERiA), Kuala Lumpur, Malaysia
| | - Martin P Wegman
- Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; University of Florida College of Medicine, Department of Health Outcomes and Policy, Gainesville, FL, USA
| | - Gabriel J Culbert
- Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; University of Illinois at Chicago College of Nursing, Department of Health Systems Science, Chicago, IL, USA
| | - Veena Pillai
- Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; University Malaya, Centre of Excellence for Research in AIDS (CERiA), Kuala Lumpur, Malaysia
| | - Roman Shrestha
- University of Connecticut Health Center, Department of Community Medicine & Health Care, Farmington, CT, USA; University of Connecticut, Department of Allied Health Sciences, Storrs, CT, USA
| | - Haider Al-Darraji
- University Malaya, Centre of Excellence for Research in AIDS (CERiA), Kuala Lumpur, Malaysia; Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin 9016, New Zealand
| | - Michael M Copenhaver
- University of Illinois at Chicago College of Nursing, Department of Health Systems Science, Chicago, IL, USA
| | - Adeeba Kamarulzaman
- Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; University Malaya, Centre of Excellence for Research in AIDS (CERiA), Kuala Lumpur, Malaysia
| | - Frederick L Altice
- Yale School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, CT, USA; Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; University Malaya, Centre of Excellence for Research in AIDS (CERiA), Kuala Lumpur, Malaysia
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15
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Pan Y, Metsch LR, Wang W, Wang KS, Duan R, Kyle TL, Gooden LK, Feaster DJ. Gender Differences in HIV Sexual Risk Behaviors Among Clients of Substance Use Disorder Treatment Programs in the U.S. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:1151-1158. [PMID: 26892100 PMCID: PMC6261376 DOI: 10.1007/s10508-015-0686-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 12/15/2015] [Accepted: 12/23/2015] [Indexed: 06/05/2023]
Abstract
This study examined differences in sexual risk behaviors by gender and over time among 1281 patients (777 males and 504 females) from 12 community-based substance use disorder treatment programs throughout the United States participating in CTN-0032, a randomized control trial conducted within the National Drug Abuse Treatment Clinical Trials Network. Zero-inflated negative binomial and negative binomial models were used in the statistical analysis. Results indicated significant reductions in most types of sexual risk behaviors among substance users regardless of the intervention arms. There were also significant gender differences in sexual risk behaviors. Men (compared with women) reported more condomless sex acts with their non-primary partners (IRR = 1.80, 95 % CI 1.21-2.69) and condomless anal sex acts (IRR = 1.74, 95 % CI 1.11-2.72), but fewer condomless sex partners (IRR = 0.87, 95 % CI 0.77-0.99), condomless vaginal sex acts (IRR = 0.83, 95 % CI 0.69-1.00), and condomless sex acts within 2 h of using drugs or alcohol (IRR = 0.70, 95 % CI 0.53-0.90). Gender-specific intervention approaches are called for in substance use disorder treatment.
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Affiliation(s)
- Yue Pan
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, Room 1066, 1120 N.W. 14th St., Miami, FL, 33136, USA.
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Weize Wang
- Department of Biostatistics, Robert Stempel College of Public Health & Social Work at Florida International University, Miami, FL, USA
| | - Ke-Sheng Wang
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Rui Duan
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, Room 1066, 1120 N.W. 14th St., Miami, FL, 33136, USA
| | | | - Lauren K Gooden
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, Room 1066, 1120 N.W. 14th St., Miami, FL, 33136, USA
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16
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Weissman J, Kanamori M, Dévieux JG, Trepka MJ, De La Rosa M. HIV Risk Reduction Interventions Among Substance-Abusing Reproductive-Age Women: A Systematic Review. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2017; 29:121-140. [PMID: 28467160 PMCID: PMC5536169 DOI: 10.1521/aeap.2017.29.2.121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
HIV/AIDS is one of the leading causes of death among reproductive-age women throughout the world, and substance abuse plays a major role in HIV infection. We conducted a systematic review, in accordance with the 2015 Preferred Items for Reporting Systematic Reviews and Meta-analysis tool, to assess HIV risk-reduction intervention studies among reproductive-age women who abuse substances. We initially identified 6,506 articles during our search and, after screening titles and abstracts, examining articles in greater detail, and finally excluding those rated methodologically weak, a total of 10 studies were included in this review. Studies that incorporated behavioral skills training into the intervention and were based on theoretical model(s) were the most effective in general at decreasing sex and drug risk behaviors. Additional HIV risk-reduction intervention research with improved methodological designs is warranted to determine the most efficacious HIV risk-reduction intervention for reproductive-age women who abuse substances.
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Affiliation(s)
- Jessica Weissman
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, Florida
- Robert Stempel College of Public Health & Social Work, Florida International University
| | - Mariano Kanamori
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, Florida
| | - Jessy G Dévieux
- Robert Stempel College of Public Health & Social Work, Florida International University
| | - Mary Jo Trepka
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, Florida
- Robert Stempel College of Public Health & Social Work, Florida International University
| | - Mario De La Rosa
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, Florida
- Robert Stempel College of Public Health & Social Work, Florida International University
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17
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Gilchrist G, Swan D, Shaw A, Keding A, Towers S, Craine N, Munro A, Hughes E, Parrott S, Strang J, Taylor A, Watson J. The acceptability and feasibility of a brief psychosocial intervention to reduce blood-borne virus risk behaviours among people who inject drugs: a randomised control feasibility trial of a psychosocial intervention (the PROTECT study) versus treatment as usual. Harm Reduct J 2017; 14:14. [PMID: 28320406 PMCID: PMC5359828 DOI: 10.1186/s12954-017-0142-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 03/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While opiate substitution therapy and injecting equipment provision (IEP) have reduced blood-borne viruses (BBV) among people who inject drugs (PWID), some PWID continue to share injecting equipment and acquire BBV. Psychosocial interventions that address risk behaviours could reduce BBV transmission among PWID. METHODS A pragmatic, two-armed randomised controlled, open feasibility study of PWID attending drug treatment or IEP in four UK regions. Ninety-nine PWID were randomly allocated to receive a three-session manualised psychosocial group intervention and BBV transmission information booklet plus treatment as usual (TAU) (n = 52) or information booklet plus TAU (n = 47). The intervention was developed from evidence-based literature, qualitative interviews with PWID, key stakeholder consultations, and expert opinion. Recruitment rates, retention in treatment, follow-up completion rates and health economic data completion measured feasibility. RESULTS Fifty-six percent (99/176) of eligible PWID were recruited. More participants attended at least one intervention session in London (10/16; 63%) and North Wales (7/13; 54%) than in Glasgow (3/12; 25%) and York (0/11). Participants who attended no sessions (n = 32) compared to those attending at least one (n = 20) session were more likely to be homeless (56 vs 25%, p = 0.044), injected drugs for a greater number of days (median 25 vs 6.5, p = 0.019) and used a greater number of needles from an IEP in the last month (median 31 vs 20, p = 0.056). No adverse events were reported. 45.5% (45/99) were followed up 1 month post-intervention. Feedback forms confirmed that the intervention was acceptable to both intervention facilitators and participants who attended it. Follow-up attendance was associated with fewer days of injecting in the last month (median 14 vs 27, p = 0.030) and fewer injections of cocaine (13 vs 30%, p = 0.063). Analysis of the questionnaires identified several service use questionnaire categories that could be excluded from the assessment battery in a full-randomised controlled trial. CONCLUSIONS Findings should be interpreted with caution due to small sample sizes. A future definitive RCT of the psychosocial intervention is not feasible. The complex needs of some PWID may have limited their engagement in the intervention. More flexible delivery methods may have greater reach. TRIAL REGISTRATION ISRCTN66453696.
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Affiliation(s)
- Gail Gilchrist
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Addictions Sciences Building, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, England, UK.
| | - Davina Swan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Addictions Sciences Building, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, England, UK
| | - April Shaw
- School of Media, Culture & Society, University of the West of Scotland, Paisley Campus, High Street, Paisley, PA1 2BE, Scotland, UK
| | - Ada Keding
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York, YO10 5DD, England, UK
| | - Sarah Towers
- Betsi Cadwaladr University Hospital Trust, 10 Grove Road, Wrexham, LL11 1DY, Wales, UK
| | - Noel Craine
- Public Health Wales, Microbiology Department, Ysbyty Gwynedd, Bangor, Gwynedd, LL57 2PW, Wales, UK
| | - Alison Munro
- School of Media, Culture & Society, University of the West of Scotland, Paisley Campus, High Street, Paisley, PA1 2BE, Scotland, UK
| | - Elizabeth Hughes
- School of Health and Human Sciences, University of Huddersfield, Queensgate, Huddersfield, West Yorkshire, HD1 3DH, England, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, England, UK
| | - John Strang
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Addictions Sciences Building, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, England, UK
| | - Avril Taylor
- School of Media, Culture & Society, University of the West of Scotland, Paisley Campus, High Street, Paisley, PA1 2BE, Scotland, UK
| | - Judith Watson
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York, YO10 5DD, England, UK
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Jarlais DCD, Arasteh K, McKnight C, Feelemyer J, Campbell ANC, Tross S, Cooper HLF, Hagan H, Perlman DC. What happened to the HIV epidemic among non-injecting drug users in New York City? Addiction 2017; 112:290-298. [PMID: 27613968 PMCID: PMC5233554 DOI: 10.1111/add.13601] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 08/23/2016] [Accepted: 09/08/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS HIV has reached high prevalence in many non-injecting drug user (NIDU) populations. The aims of this study were to (1) examine the trend in HIV prevalence among non-injecting cocaine and heroin NIDUs in New York City, (2) identify factors potentially associated with the trend and (3) estimate HIV incidence among NIDUs. DESIGN Serial-cross sectional surveys of people entering drug treatment programs. People were permitted to participate only once per year, but could participate in multiple years. SETTING Mount Sinai Beth Israel drug treatment programs in New York City, USA. PARTICIPANTS We recruited 3298 non-injecting cocaine and heroin users from 2005 to 2014. Participants were 78.7% male, 6.1% white, 25.7% Hispanic and 65.8% African American. Smoking crack cocaine was the most common non-injecting drug practice. MEASURES Trend tests were used to examine HIV prevalence, demographics, drug use, sexual behavior and use of antiretroviral treatment (ART) by calendar year; χ2 and multivariable logistic regression were used to compare 2005-10 versus 2011-14. FINDINGS HIV prevalence declined approximately 1% per year (P < 0.001), with a decline from 16% in 2005-10 to 8% in 2011-14 (P < 0.001). The percentages of participants smoking crack and having multiple sexual partners declined and the percentage of HIV-positive people on ART increased. HIV incidence among repeat participants was 1.2 per 1000 person-years (95% confidence interval = 0.03/1000-7/1000). CONCLUSIONS HIV prevalence has declined and a high percentage of HIV-positive non-injecting drug users (NIDUs) are receiving antiretroviral treatment, suggesting an end to the HIV epidemic among NIDUs in New York City. These results can be considered a proof of concept that it is possible to control non-injecting drug use related sexual transmission HIV epidemics.
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Affiliation(s)
| | | | | | | | - Aimee N. C. Campbell
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Medical Center, New York, NY
| | - Susan Tross
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Medical Center, New York, NY
| | - Hannah LF Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta Georgia
| | - Holly Hagan
- College of Nursing, New York University, New York NY
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Hajebi A, Naserbakht M, Noroozi A. Adding-On a Brief Skill-Based HIV Prevention Psychoeducation to Needle and Syringe Programs: A Randomized Controlled Trial. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2016. [DOI: 10.17795/ijpbs-7411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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HIV Risk Behavior Among Methamphetamine Users Entering Substance Abuse Treatment in Cape Town, South Africa. AIDS Behav 2016; 20:2387-2397. [PMID: 26873492 DOI: 10.1007/s10461-016-1333-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
South Africa is experiencing a growing methamphetamine problem, and there is concern that methamphetamine use may accelerate HIV transmission. There has been little research on the HIV prevention needs of methamphetamine users receiving substance abuse treatment in South Africa. This study assessed the prevalence and correlates of HIV risk behaviors among 269 methamphetamine users entering substance abuse treatment in two clinics in Cape Town. The prevalence of sexual risk behaviors was high among sexually active participants: 34 % multiple partners, 26 % unprotected intercourse with a casual partner, and 24 % sex trading for money/methamphetamine. The strongest predictor of all sexual risk behaviors was concurrent other drug use. Over half had not been HIV tested in the past year, and 25 % had never been tested, although attitudes toward HIV testing were overwhelmingly positive. This population of primarily heterosexual, non-injecting methamphetamine users is a high-risk group in need of targeted HIV prevention interventions. Substance abuse treatment is an ideal setting in which to reach methamphetamine users for HIV services.
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Hayashi K, Wood E, Kerr T, Dong H, Nguyen P, Puskas CM, Guillemi S, Montaner JSG, Milloy MJ. Factors associated with optimal pharmacy refill adherence for antiretroviral medications and plasma HIV RNA non-detectability among HIV-positive crack cocaine users: a prospective cohort study. BMC Infect Dis 2016; 16:455. [PMID: 27568002 PMCID: PMC5002322 DOI: 10.1186/s12879-016-1749-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 08/03/2016] [Indexed: 01/18/2023] Open
Abstract
Background Crack cocaine use is known to contribute to poor adherence to antiretroviral medications; however, little is known about facilitators of or barriers to effective HIV treatment use among HIV-infected crack cocaine users. We sought to identify correlates of optimal pharmacy refill adherence for antiretroviral medications and plasma HIV RNA viral load (pVL) suppression among this population. Methods Data from a prospective cohort of HIV-positive people who use illicit drugs in Vancouver, Canada, were linked to comprehensive HIV clinical monitoring and pharmacy dispensation records. We used multivariable generalized linear mixed-effects modelling to longitudinally identify factors associated with ≥95 % adherence to pharmacy refills for antiretroviral medications and pVL <50 copies/mL among crack cocaine users exposed to highly-active antiretroviral therapy (HAART). Results Among 438 HAART-exposed crack cocaine users between 2005 and 2013, 240 (54.8 %) had ≥95 % pharmacy refill adherence in the previous 6 months at baseline. In multivariable analyses, homelessness (adjusted odds ratio [AOR]: 0.58), ≥daily crack cocaine smoking (AOR: 0.64), and ≥ daily heroin use (AOR: 0.43) were independently associated with optimal pharmacy refill adherence (all p < 0.05). The results for pVL non-detectability were consistent with those of medication adherence, except that longer history of HAART (AOR: 1.06), receiving a single tablet-per-day regimen (AOR: 3.02) and participation in opioid substitution therapies was independently associated with pVL non-detectability (AOR: 1.55) (all p < 0.05). Conclusions Homelessness, and daily crack cocaine and/or heroin use were independently and negatively associated with optimal HAART-related outcomes. With the exception of opioid substitution therapies, no addiction treatment modalities assessed appeared to facilitate medication adherence or viral suppression. Evidence-based treatment options for crack cocaine use that also confer benefits to HAART need to be developed.
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Affiliation(s)
- Kanna Hayashi
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Division of AIDS, Department of Medicine, University of British Columbia, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Division of AIDS, Department of Medicine, University of British Columbia, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Division of AIDS, Department of Medicine, University of British Columbia, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Huiru Dong
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Paul Nguyen
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Cathy M Puskas
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Silvia Guillemi
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Division of AIDS, Department of Medicine, University of British Columbia, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Michael-John Milloy
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. .,Division of AIDS, Department of Medicine, University of British Columbia, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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Gilchrist G, Tirado-Munoz J, Taylor A, Fischer G, Moskalewicz J, Köchl B, Giammarchi C, Dabrowska K, Shaw A, Munro A, Di Furia L, Torrens M. An uncontrolled, feasibility study of a group intervention to reduce hepatitis C transmission risk behaviours and increase transmission knowledge among women who inject drugs. DRUGS-EDUCATION PREVENTION AND POLICY 2016. [DOI: 10.1080/09687637.2016.1197885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- G. Gilchrist
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK,
| | - J. Tirado-Munoz
- IMIM-Institut Hospital del Mar d'Investigacions Mèdiques and Institute of Neuropsychiatry and Addictions, Barcelona, Barcelona, Spain,
| | - A. Taylor
- School of Media, Culture and Society, University of the West of Scotland, Paisley, UK,
| | - G. Fischer
- Addiction Clinic, Medical University of Vienna, Vienna, Austria,
| | - J. Moskalewicz
- Department of Studies on Alcoholism and Drug Dependence, Institute of Psychiatry and Neurology, Warsaw, Poland,
| | - B. Köchl
- Addiction Clinic, Medical University of Vienna, Vienna, Austria,
| | | | - K. Dabrowska
- Department of Studies on Alcoholism and Drug Dependence, Institute of Psychiatry and Neurology, Warsaw, Poland,
| | - A. Shaw
- School of Media, Culture and Society, University of the West of Scotland, Paisley, UK,
| | - A. Munro
- School of Media, Culture and Society, University of the West of Scotland, Paisley, UK,
| | - L. Di Furia
- Servizio Salute Regione Marche, Ancona, Italy, and
| | - M. Torrens
- IMIM-Institut Hospital del Mar d'Investigacions Mèdiques and Institute of Neuropsychiatry and Addictions, Barcelona, Barcelona, Spain,
- Psychiatry Department, Universitat Autònoma de Barcelona, Barcelona, Spain
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Bertrand K, Roy É, Vaillancourt É, Vandermeerschen J, Berbiche D, Boivin JF. Randomized controlled trial of motivational interviewing for reducing injection risk behaviours among people who inject drugs. Addiction 2015; 110:832-41. [PMID: 25641704 DOI: 10.1111/add.12867] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 07/23/2014] [Accepted: 01/21/2015] [Indexed: 11/29/2022]
Abstract
AIM We tested the efficacy of a brief intervention based on motivational interviewing (MI) to reduce high-risk injection behaviours over a 6-month period among people who inject drugs (PWID). DESIGN A single-site two-group parallel randomized controlled trial comparing MI with a brief educational intervention (EI). SETTING A study office located in downtown Montréal, Canada, close to the community-based harm reduction programmes where PWID were recruited. PARTICIPANTS PWID who had shared drug injection equipment or shared drugs by backloading or frontloading in the month prior to recruitment were randomized to either the MI (112) or EI (109) groups. INTERVENTION The MI aimed to (1) encourage PWID to voice their desires, needs and reasons to change behaviours; (2) boost motivation to change behaviours; and (3) when the person was ready, support the plan he or she chose to reduce injection risk behaviours. The EI consisted of an individual session about safe injection behaviours. MEASUREMENTS The primary outcome was defined as having any of these risk behaviours at 6 months: having shared syringes, containers, filters or water to inject drugs in the previous month and backloading/frontloading; each behaviour was examined separately, as secondary outcomes. FINDINGS The probability of reporting a risk injection behaviour decreased in both the MI and the EI groups. At 6-month follow-up, participants who reported any risk behaviours were 50% [odds ratio (OR) = 0.50; confidence interval (CI) = 0.13-0.87] less likely to be in the MI group than in the EI group as well as those who reported sharing containers (OR = 0.50; CI = 0.09-0.90). PWID who reported sharing equipment excluding syringes were 53% less likely to be in the MI group (OR = 0.47; CI = 0.11-0.84). CONCLUSIONS A brief motivational interviewing intervention was more effective than a brief educational intervention in reducing some high risk injecting behaviours up in the subsequent 6 months.
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Affiliation(s)
- Karine Bertrand
- University of Sherbrooke, Department of Community Health Sciences, Addiction Research Study Program, Longueuil, Québec, Canada; Charles-LeMoyne Hospital Research Centre, Longueuil, Québec, Canada
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24
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Song DL, Altice FL, Copenhaver MM, Long EF. Cost-effectiveness analysis of brief and expanded evidence-based risk reduction interventions for HIV-infected people who inject drugs in the United States. PLoS One 2015; 10:e0116694. [PMID: 25658949 PMCID: PMC4320073 DOI: 10.1371/journal.pone.0116694] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 12/14/2014] [Indexed: 02/05/2023] Open
Abstract
AIMS Two behavioral HIV prevention interventions for people who inject drugs (PWID) infected with HIV include the Holistic Health Recovery Program for HIV+ (HHRP+), a comprehensive evidence-based CDC-supported program, and an abbreviated Holistic Health for HIV (3H+) Program, an adapted HHRP+ version in treatment settings. We compared the projected health benefits and cost-effectiveness of both programs, in addition to opioid substitution therapy (OST), to the status quo in the U.S. METHODS A dynamic HIV transmission model calibrated to epidemic data of current US populations was created. Projected outcomes include future HIV incidence, HIV prevalence, and quality-adjusted life years (QALYs) gained under alternative strategies. Total medical costs were estimated to compare the cost-effectiveness of each strategy. RESULTS Over 10 years, expanding HHRP+ access to 80% of PWID could avert up to 29,000 HIV infections, or 6% of the projected total, at a cost of $7,777/QALY gained. Alternatively, 3H+ could avert 19,000 infections, but is slightly more cost-effective ($7,707/QALY), and remains so under widely varying effectiveness and cost assumptions. Nearly two-thirds of infections averted with either program are among non-PWIDs, due to reduced sexual transmission from PWID to their partners. Expanding these programs with broader OST coverage could avert up to 74,000 HIV infections over 10 years and reduce HIV prevalence from 16.5% to 14.1%, but is substantially more expensive than HHRP+ or 3H+ alone. CONCLUSIONS Both behavioral interventions were effective and cost-effective at reducing HIV incidence among both PWID and the general adult population; however, 3H+, the economical HHRP+ version, was slightly more cost-effective than HHRP+.
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Affiliation(s)
- Dahye L. Song
- PhD Program in Health Policy, Harvard University, Cambridge, Massachusetts, United States of America
| | - Frederick L. Altice
- AIDS Program, Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Michael M. Copenhaver
- Division of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut, United States of America
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, United States of America
| | - Elisa F. Long
- UCLA Anderson School of Management, Los Angeles, California, United States of America
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25
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Azim T, Bontell I, Strathdee SA. Women, drugs and HIV. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26 Suppl 1:S16-21. [PMID: 25277726 PMCID: PMC4498573 DOI: 10.1016/j.drugpo.2014.09.003] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 09/01/2014] [Accepted: 09/05/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Women who use drugs, irrespective of whether these are injected or not, are faced with multiple issues which enhance their vulnerability to HIV. METHODS In this commentary, we explore the HIV risks and vulnerabilities of women who use drugs as well as the interventions that have been shown to reduce their susceptibility to HIV infection. RESULTS Women who inject drugs are among the most vulnerable to HIV through both unsafe injections and unprotected sex. They are also among the most hidden affected populations, as they are more stigmatized than their male counterparts. Many sell sex to finance their own and their partner's drug habit and often their partner exerts a significant amount of control over their sex work, condom use and injection practices. Women who use drugs all over the world face many different barriers to HIV service access including police harassment, judgmental health personnel and a fear of losing their children. CONCLUSION In order to enable these women to access life-saving services including needle-syringe and condom programs, opioid substitution therapy and HIV testing and treatment, it is essential to create a conducive environment and provide tailor-made services that are adapted to their specific needs.
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Affiliation(s)
- Tasnim Azim
- Centre for HIV and AIDS, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh.
| | - Irene Bontell
- Centre for HIV and AIDS, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh; Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, 141 86 Stockholm, Sweden
| | - Steffanie A Strathdee
- Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA 92093, USA
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McMahon JM, Pouget ER, Tortu S, Volpe EM, Torres L, Rodriguez W. Couple-based HIV counseling and testing: a risk reduction intervention for US drug-involved women and their primary male partners. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2015; 16:341-51. [PMID: 25512179 PMCID: PMC4310810 DOI: 10.1007/s11121-014-0540-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To help reduce the elevated risk of acquiring HIV for African-American and Latina women drug users in primary heterosexual relationships, we developed a brief couple-based HIV counseling and testing prevention intervention. The intervention was based on an integrated HIV risk behavior theory that incorporated elements of social exchange theory, the theory of gender and power, the stages-of-change model, and the information-motivation-behavior skills model. In this article, we describe the development, content, and format of the couple-based HIV testing and counseling intervention, and its delivery to 110 couples (220 individuals) in a randomized effectiveness trial, the Harlem River Couples Project, conducted in New York City from 2005 to 2007. Components of the couple-based intervention included a personalized dyadic action plan based on the couple's risk profile and interactive exercises designed to help build interpersonal communication skills, and facilitated discussion of social norms regarding gender roles. The couple-based HIV testing and counseling intervention significantly reduced women's overall HIV risk compared to a standard-of-care individual HIV testing and counseling intervention. Experiences and perceptions of the intervention were positive among both clients and interventionists. The study was the first to demonstrate the effectiveness and feasibility of delivering a brief couple-based HIV counseling and testing intervention to reduce risk among drug-using heterosexual couples in high HIV prevalent urban communities in the USA. The intervention can be expanded to include new HIV prevention strategies, such as pre-exposure prophylaxis. Further research is needed to evaluate cost-effectiveness and implementation of the intervention in clinical settings.
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Affiliation(s)
- James M. McMahon
- University of Rochester Medical Center, School of Nursing, 601 Elmwood Avenue, BOX SON, Rochester, NY 14642; 585-276-3951; FAX: 585-273-1270
| | | | - Stephanie Tortu
- Louisiana State University Health Sciences Center, School of Public Health, New Orleans, LA
| | | | - Leilani Torres
- University of Rochester Medical Center, School of Nursing, Rochester, NY
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Klimas J, Tobin H, Field CA, O'Gorman CSM, Glynn LG, Keenan E, Saunders J, Bury G, Dunne C, Cullen W. Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users. Cochrane Database Syst Rev 2014:CD009269. [PMID: 25470303 DOI: 10.1002/14651858.cd009269.pub3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Problem alcohol use is common among illicit drug users and is associated with adverse health outcomes. It is also an important factor contributing to a poor prognosis among drug users with hepatitis C virus (HCV) as it impacts on progression to hepatic cirrhosis or opiate overdose in opioid users. OBJECTIVES To assess the effects of psychosocial interventions for problem alcohol use in illicit drug users (principally problem drug users of opiates and stimulants). SEARCH METHODS We searched the Cochrane Drugs and Alcohol Group trials register (June 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 11, June 2014), MEDLINE (1966 to June 2014); EMBASE (1974 to June 2014); CINAHL (1982 to June 2014); PsycINFO (1872 to June 2014) and the reference lists of eligible articles. We also searched: 1) conference proceedings (online archives only) of the Society for the Study of Addiction, International Harm Reduction Association, International Conference on Alcohol Harm Reduction and American Association for the Treatment of Opioid Dependence; 2) online registers of clinical trials: Current Controlled Trials, Clinical Trials.org, Center Watch and the World Health Organization International Clinical Trials Registry Platform. SELECTION CRITERIA Randomised controlled trials comparing psychosocial interventions with another therapy (other psychosocial treatment, including non-pharmacological therapies, or placebo) in adult (over the age of 18 years) illicit drug users with concurrent problem alcohol use. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS Four studies, involving 594 participants, were included. Half of the trials were rated as having a high or unclear risk of bias. The studies considered six different psychosocial interventions grouped into four comparisons: (1) cognitive-behavioural coping skills training versus 12-step facilitation (one study; 41 participants), (2) brief intervention versus treatment as usual (one study; 110 participants), (3) group or individual motivational interviewing (MI) versus hepatitis health promotion (one study; 256 participants) and (4) brief motivational intervention (BMI) versus assessment-only (one study; 187 participants). Differences between studies precluded any data pooling. Findings are described for each trial individually.Comparison 1: low-quality evidence; no significant difference for any of the outcomes considered Alcohol abstinence as maximum number of weeks of consecutive alcohol abstinence during treatment: mean difference (MD) 0.40 (95% confidence interval (CI) -1.14 to 1.94); illicit drug abstinence as maximum number of weeks of consecutive abstinence from cocaine during treatment: MD 0.80 (95% CI -0.70 to 2.30); alcohol abstinence as number achieving three or more weeks of consecutive alcohol abstinence during treatment: risk ratio (RR) 1.96 (95% CI 0.43 to 8.94); illicit drug abstinence as number achieving three or more weeks of consecutive abstinence from cocaine during treatment: RR 1.10 (95% CI 0.42 to 2.88); alcohol abstinence during follow-up year: RR 2.38 (95% CI 0.10 to 55.06); illicit drug abstinence as abstinence from cocaine during follow-up year: RR 0.39 (95% CI 0.04 to 3.98), moderate-quality evidence.Comparison 2: low-quality evidence, no significant difference for all the outcomes considered Alcohol use as AUDIT scores at three months: MD 0.80 (95% -1.80 to 3.40); alcohol use as AUDIT scores at nine months: MD 2.30 (95% CI -0.58 to 5.18); alcohol use as number of drinks per week at three months: MD 0.70 (95% CI -3.85 to 5.25); alcohol use as number of drinks per week at nine months: MD -0.30 (95% CI -4.79 to 4.19); alcohol use as decreased alcohol use at three months: RR 1.13 (95% CI 0.67 to 1.93); alcohol use as decreased alcohol use at nine months: RR 1.34 (95% CI 0.69 to 2.58), moderate-quality evidence.Comparison 3 (group and individual MI), low-quality evidence: no significant difference for all outcomes Group MI: number of standard drinks consumed per day over the past month: MD -0.40 (95% CI -2.03 to 1.23); frequency of drug use: MD 0.00 (95% CI -0.03 to 0.03); composite drug score (frequency*severity for all drugs taken): MD 0.00 (95% CI -0.42 to 0.42); greater than 50% reduction in number of standard drinks consumed per day over the last 30 days: RR 1.10 (95% CI 0.82 to 1.48); abstinence from alcohol over the last 30 days: RR 0.88 (95% CI 0.49 to 1.58).Individual MI: number of standard drinks consumed per day over the past month: MD -0.10 (95% CI -1.89 to 1.69); frequency of drug use (as measured using the Addiction Severity Index (ASI drug): MD 0.00 (95% CI -0.03 to 0.03); composite drug score (frequency*severity for all drugs taken): MD -0.10 (95% CI -0.46 to 0.26); greater than 50% reduction in number of standard drinks consumed per day over the last 30 days: RR 0.92 (95% CI 0.68 to 1.26); abstinence from alcohol over the last 30 days: RR 0.97 (95% CI 0.56 to 1.67).Comparison 4: more people reduced alcohol use (by seven or more days in the past month at 6 months) in the BMI group than in the control group (RR 1.67; 95% CI 1.08 to 2.60), moderate-quality evidence. No significant difference was reported for all other outcomes: number of days in the past 30 days with alcohol use at one month: MD -0.30 (95% CI -3.38 to 2.78); number of days in the past month with alcohol use at six months: MD -1.50 (95% CI -4.56 to 1.56); 25% reduction of drinking days in the past month: RR 1.23 (95% CI 0.96 to 1.57); 50% reduction of drinking days in the past month: RR 1.27 (95% CI 0.96 to 1.68); 75% reduction of drinking days in the past month: RR 1.21 (95% CI 0.84 to 1.75); one or more drinking days' reduction in the past month: RR 1.12 (95% CI 0.91 to 1.38). AUTHORS' CONCLUSIONS There is low-quality evidence to suggest that there is no difference in effectiveness between different types of interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users and that brief interventions are not superior to assessment-only or to treatment as usual. No firm conclusions can be made because of the paucity of the data and the low quality of the retrieved studies.
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Affiliation(s)
- Jan Klimas
- Addiction & Urban Health Research Initiative, BC Centre for Excellence in HIV/AIDS, 611 Powell Street, Vancouver, BC, V6A 1H2, Canada.
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Panagioti M, Richardson G, Murray E, Rogers A, Kennedy A, Newman S, Small N, Bower P. Reducing Care Utilisation through Self-management Interventions (RECURSIVE): a systematic review and meta-analysis. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02540] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BackgroundA critical part of future service delivery will involve improving the degree to which people become engaged in ‘self-management’. Providing better support for self-management has the potential to make a significant contribution to NHS efficiency, as well as providing benefits in patient health and quality of care.ObjectiveTo determine which models of self-management support are associated with significant reductions in health services utilisation (including hospital use) without compromising outcomes, among patients with long-term conditions.Data sourcesCochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health, EconLit (the American Economic Association’s electronic bibliography), EMBASE, Health Economics Evaluations Database, MEDLINE (the US National Library of Medicine’s database), MEDLINE In-Process & Other Non-Indexed Citations, NHS Economic Evaluation Database (NHS EED) and PsycINFO (the behavioural science and mental health database), as well as the reference lists of published reviews of self-management support.MethodsWe included patients with long-term conditions in all health-care settings and self-management support interventions with varying levels of additional professional support and input from multidisciplinary teams. Main outcome measures were quantitative measures of service utilisation (including hospital use) and quality of life (QoL). We presented the results for each condition group using a permutation plot, plotting the effect of interventions on utilisation and outcomes simultaneously and placing them in quadrants of the cost-effectiveness plane depending on the pattern of outcomes. We also conducted conventional meta-analyses of outcomes.ResultsWe found 184 studies that met the inclusion criteria and provided data for analysis. The most common categories of long-term conditions included in the studies were cardiovascular (29%), respiratory (24%) and mental health (16%). Of the interventions, 5% were categorised as ‘pure self-management’ (without additional professional support), 20% as ‘supported self-management’ (< 2 hours’ support), 47% as ‘intensive self-management’ (> 2 hours’ support) and 28% as ‘case management’ (> 2 hours’ support including input from a multidisciplinary team). We analysed data across categories of long-term conditions and also analysed comparing self-management support (pure, supported, intense) with case management. Only a minority of self-management support studies reported reductions in health-care utilisation in association with decrements in health. Self-management support was associated with small but significant improvements in QoL. Evidence for significant reductions in utilisation following self-management support interventions were strongest for interventions in respiratory and cardiovascular disorders. Caution should be exercised in the interpretation of the results, as we found evidence that studies at higher risk of bias were more likely to report benefits on some outcomes. Data on hospital use outcomes were also consistent with the possibility of small-study bias.LimitationsSelf-management support is a complex area in which to undertake literature searches. Our analyses were limited by poor reporting of outcomes in the included studies, especially concerning health-care utilisation and costs.ConclusionsVery few self-management support interventions achieve reductions in utilisation while compromising patient outcomes. Evidence for significant reductions in utilisation were strongest for respiratory disorders and cardiac disorders. Research priorities relate to better reporting of the content of self-management support, exploration of the impact of multimorbidity and assessment of factors influencing the wider implementation of self-management support.Study registrationThis study is registered as PROSPERO CRD42012002694.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Maria Panagioti
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | | | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Anne Rogers
- Health Sciences, University of Southampton, Southampton, UK
| | - Anne Kennedy
- Health Sciences, University of Southampton, Southampton, UK
| | - Stanton Newman
- School of Health Sciences, City University London, London, UK
| | - Nicola Small
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Peter Bower
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Herrmann ES, Hand DJ, Johnson MW, Badger GJ, Heil SH. Examining delay discounting of condom-protected sex among opioid-dependent women and non-drug-using control women. Drug Alcohol Depend 2014; 144:53-60. [PMID: 25190049 PMCID: PMC4252483 DOI: 10.1016/j.drugalcdep.2014.07.026] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 07/15/2014] [Accepted: 07/16/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Opioid-dependent (OD) women tend to engage in unprotected sex with high-risk partners, placing themselves at elevated risk for sexually transmitted HIV infection. This behavior generally persists after completion of interventions that increase sexual HIV risk reduction knowledge and skills, suggesting that decision-making biases may influence HIV transmission among OD women. METHODS The primary aim of this report is to examine delay discounting of condom-protected sex among OD women and non-drug-using control women using the novel Sexual Discounting Task (SDT; Johnson and Bruner, 2012). Data were collected from 27 OD women and 33 non-drug-using control women using the SDT, a monetary discounting task, and the Barratt impulsiveness scale (BIS-11). RESULTS OD women discounted the value of delayed condom-protected sex more steeply than controls for hypothetical sexual partners in the two sets of paired partner conditions examined. Overall, women discounted condom protected sex more steeply for partners they perceived as being lowest STI risk vs. those they perceived as being highest risk. Steeper discounting of condom-protected sex was significantly associated with higher scores on the BIS-11, but not with discounting of money. CONCLUSIONS Delay discounting of condom-protected sex differs between OD women and non-drug-using women, is sensitive to perceived partner risk, and is correlated with a self-report measure of impulsivity, the BIS-11. The effect of delay on sexual decision-making is a critical but underappreciated dimension of HIV risk among women, and the SDT appears to be a promising measure of this domain. Further investigation of these relationships is warranted.
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Affiliation(s)
- Evan S Herrmann
- Department of Psychology, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401, United States.
| | - Dennis J Hand
- Department of Psychiatry, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401, United States; Vermont Center on Behavior and Health, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401, United States
| | - Matthew W Johnson
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, United States
| | - Gary J Badger
- Vermont Center on Behavior and Health, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401, United States; Department of Medical Biostatistics, University of Vermont, 27D Hills Building, Burlington, VT 05401, United States
| | - Sarah H Heil
- Department of Psychology, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401, United States; Department of Psychiatry, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401, United States; Vermont Center on Behavior and Health, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401, United States
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Abstract
Introduction Infections can impact the reproductive health of women and hence may influence pregnancy related outcomes for both the mother and the child. These infections range from sexually transmitted infections (STIs) to TORCHS infections to periodontal disease to systemic infections and may be transmitted to the fetus during pregnancy, labor, delivery or breastfeeding. Methods A systematic review and meta-analysis of the evidence was conducted to ascertain the possible impact of preconception care for adolescents, women and couples of reproductive age on MNCH outcomes. A comprehensive strategy was used to search electronic reference libraries, and both observational and clinical controlled trials were included. Cross-referencing and a separate search strategy for each preconception risk and intervention ensured wider study capture. Results Preconception behavioral interventions significantly declines re-infection or new STI rates by 35% (95% CI: 20-47%). Further, condom use has been shown to be the most effective way to prevent HIV infection (85% protection in prospective studies) through sexual intercourse. Intervention trials showed that preconception vaccination against tetanus averted a significant number of neonatal deaths (including those specifically due to tetanus) when compared to placebo in women receiving more than 1 dose of the vaccine (OR 0.28; 95% CI: 0.15-0.52); (OR 0.02; 95% CI: 0.00-0.28) respectively. Conclusion Preconception counseling should be offered to women of reproductive age as soon as they test HIV-positive, and conversely women of reproductive age should be screened with their partners before pregnancy. Risk assessment, screening, and treatment for specific infections should be a component of preconception care because there is convincing evidence that treatment of these infections before pregnancy prevents neonatal infections.
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Abstract
The notion of preconception care aims to target the existing risks before pregnancy, whereby resources may be used to improve reproductive health and optimize knowledge before conceiving. The preconception period provides an opportunity to intervene earlier to optimize the health of potential mothers (and fathers) and to prevent harmful exposures from affecting the developing fetus. These interventions include birth spacing and preventing teenage pregnancy, promotion of contraceptive use, optimization of weight and micronutrient status, prevention and management of infectious diseases, and screening for and managing chronic conditions. Given existing interventions and the need to organize services to optimize delivery of care in a logical and effective manner, interventions are frequently co-packaged or bundled together. This paper highlights packages of preconception interventions that can be combined and co-delivered to women through various delivery channels and provides a logical framework for development of such packages in varying contexts.
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Affiliation(s)
- Zohra S Lassi
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| | - Sohni V Dean
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| | - Dania Mallick
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
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Effects of behavioral intervention content on HIV prevention outcomes: a meta-review of meta-analyses. J Acquir Immune Defic Syndr 2014; 66 Suppl 3:S259-70. [PMID: 25007195 DOI: 10.1097/qai.0000000000000235] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Numerous meta-analyses have examined the success of trials of interventions to reduce the behavioral risk of acquiring or transmitting HIV. Yet, to date, meta-reviews have not systematically examined which type of intervention content is more likely to lead to successful HIV outcomes. The current study addresses this gap. METHODS Published meta-analyses on HIV prevention (k = 56) were retrieved, then coded, and analyzed in terms of the intervention content. RESULTS Past meta-analyses have examined relatively few dimensions of intervention content. Larger meta-analyses were more likely to find that information content dimensions, especially skill provision and motivational enhancement, relate to risk reduction. CONCLUSIONS Fully incorporating behavior change technique (BCT) taxonomies into both intervention research and systematic reviews of this research offers considerable potential. It can improve the precision of conclusions about which specific types of content best promote HIV prevention behaviors and help to lower the cost of interventions. International efforts to improve reporting standards and generate the scholarly expertise necessary to discern BCTs reliably and validly help to address some of the challenges to including BCTs in study reports. Contextualizing research on effective strategies for HIV prevention by reporting and including in analyses community, social, and sample factors is also recommended. Together, such efforts can help refocus the field of HIV prevention on improved research strategies to further improve future interventions by discerning the content design factors related to success for particular populations, rather than merely to assess whether interventions have been successful.
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Mullins MM, DeLuca JB, Crepaz N, Lyles CM. Reporting quality of search methods in systematic reviews of HIV behavioral interventions (2000-2010): are the searches clearly explained, systematic and reproducible? Res Synth Methods 2014; 5:116-30. [PMID: 26052651 PMCID: PMC5861495 DOI: 10.1002/jrsm.1098] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 08/21/2013] [Accepted: 09/01/2013] [Indexed: 01/08/2023]
Abstract
Systematic reviews are an essential tool for researchers, prevention providers and policy makers who want to remain current with the evidence in the field. Systematic review must adhere to strict standards, as the results can provide a more objective appraisal of evidence for making scientific decisions than traditional narrative reviews. An integral component of a systematic review is the development and execution of a comprehensive systematic search to collect available and relevant information. A number of reporting guidelines have been developed to ensure quality publications of systematic reviews. These guidelines provide the essential elements to include in the review process and report in the final publication for complete transparency. We identified the common elements of reporting guidelines and examined the reporting quality of search methods in HIV behavioral intervention literature. Consistent with the findings from previous evaluations of reporting search methods of systematic reviews in other fields, our review shows a lack of full and transparent reporting within systematic reviews even though a plethora of guidelines exist. This review underscores the need for promoting the completeness of and adherence to transparent systematic search reporting within systematic reviews.
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Affiliation(s)
| | | | - Nicole Crepaz
- Division of HIV/AIDS Prevention, CDC, Atlanta, GA, USA
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Negin J, Rozea A, Martiniuk ALC. HIV behavioural interventions targeted towards older adults: a systematic review. BMC Public Health 2014; 14:507. [PMID: 24884947 PMCID: PMC4049807 DOI: 10.1186/1471-2458-14-507] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 05/20/2014] [Indexed: 11/14/2022] Open
Abstract
Background The increasing number of people living with HIV aged 50 years and older has been recognised around the world yet non-pharmacologic HIV behavioural and cognitive interventions specifically targeted to older adults are limited. Evidence is needed to guide the response to this affected group. Methods We conducted a systematic review of the available published literature in MEDLINE, Embase and the Education Resources Information Center. A search strategy was defined with high sensitivity but low specificity to identify behavioural interventions with outcomes in the areas of treatment adherence, HIV testing uptake, increased HIV knowledge and uptake of prevention measures. Data from relevant articles were extracted into excel. Results Twelve articles were identified all of which originated from the Americas. Eight of the interventions were conducted among older adults living with HIV and four for HIV-negative older adults. Five studies included control groups. Of the included studies, four focused on general knowledge of HIV, three emphasised mental health and coping, two focused on reduced sexual risk behaviour, two on physical status and one on referral for care. Only four of the studies were randomised controlled trials and seven – including all of the studies among HIV-negative older adults – did not include controls at all. A few of the studies conducted statistical testing on small samples of 16 or 11 older adults making inference based on the results difficult. The most relevant study demonstrated that using telephone-based interventions can reduce risky sexual behaviour among older adults with control reporting 3.24 times (95% CI 1.79-5.85) as many occasions of unprotected sex at follow-up as participants. Overall however, few of the articles are sufficiently rigorous to suggest broad replication or to be considered representative and applicable in other settings. Conclusions More evidence is needed on what interventions work among older adults to support prevention, adherence and testing. More methodological rigourised needed in the studies targeting older adults. Specifically, including control groups in all studies is needed as well as sufficient sample size to allow for statistical testing. Addition of specific bio-marker or validated behavioural or cognitive outcomes would also strengthen the studies.
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Affiliation(s)
- Joel Negin
- Sydney School of Public Health, University of Sydney, Edward Ford Building (A27), Sydney, NSW, Australia.
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Kouyoumdjian FG, Calzavara LM, Kiefer L, Main C, Bondy SJ. Drug use prior to incarceration and associated socio-behavioural factors among males in a provincial correctional facility in Ontario, Canada. Canadian Journal of Public Health 2014; 105:e198-202. [PMID: 25165839 DOI: 10.17269/cjph.105.4193] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 05/09/2014] [Accepted: 03/14/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe the prevalence of drug use in males in a provincial detention centre during the year before incarceration and to examine the association between socio-demographic and behavioural factors and drug use. METHODS In 2009, 500 adult males completed a survey after admission to a provincial detention centre in Ontario. Past-year prevalence rates were calculated for the use of opioids, cocaine, crack and methamphetamine, and by route of administration. Bivariate logistic regression was used to examine associations between drug use and socio-demographic and behavioural factors. RESULTS More than 56% of participants reported use of opioids, cocaine, crack or methamphetamine in the previous year. Risk factors for blood-borne and sexually transmitted infections were commonly reported for the previous year: 12.2% had injected drugs, 78.0% had had unprotected sex, and 48.0% had had more than one sexual partner. In unadjusted analyses, participants who were older than 24 years were more likely to have used any drugs and to have injected drugs in the previous year. CONCLUSIONS This study provides the first Canadian data in the past decade on drug use by recently incarcerated adults. We found that drug use and behaviours that increase the risk of transmission of sexually transmitted and blood-borne infections remain very common in this population. Incarceration provides an opportunity to provide services and links to programs for people who use drugs, which could decrease drug-related harms to individuals and society.
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Affiliation(s)
- Fiona G Kouyoumdjian
- currently Centre for Research on Inner City Health, St. Michael's Hospital, formerly Dalla Lana School of Public Health, University of Toronto.
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Crits-Christoph P, Gallop R, Sadicario JS, Markell HM, Calsyn DA, Tang W, He H, Tu X, Woody G. Predictors and moderators of outcomes of HIV/STD sex risk reduction interventions in substance abuse treatment programs: a pooled analysis of two randomized controlled trials. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2014; 9:3. [PMID: 24433412 PMCID: PMC3929547 DOI: 10.1186/1747-597x-9-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 01/08/2014] [Indexed: 11/17/2022]
Abstract
Background The objective of the current study was to examine predictors and moderators of response to two HIV sexual risk interventions of different content and duration for individuals in substance abuse treatment programs. Methods Participants were recruited from community drug treatment programs participating in the National Institute on Drug Abuse Clinical Trials Network (CTN). Data were pooled from two parallel randomized controlled CTN studies (one with men and one with women) each examining the impact of a multi-session motivational and skills training program, in comparison to a single-session HIV education intervention, on the degree of reduction in unprotected sex from baseline to 3- and 6- month follow-ups. The findings were analyzed using a zero-inflated negative binomial (ZINB) model. Results Severity of drug use (p < .01), gender (p < .001), and age (p < .001) were significant main effect predictors of number of unprotected sexual occasions (USOs) at follow-up in the non-zero portion of the ZINB model (men, younger participants, and those with greater severity of drug/alcohol abuse have more USOs). Monogamous relationship status (p < .001) and race/ethnicity (p < .001) were significant predictors of having at least one USO vs. none (monogamous individuals and African Americans were more likely to have at least one USO). Significant moderators of intervention effectiveness included recent sex under the influence of drugs/alcohol (p < .01 in non-zero portion of model), duration of abuse of primary drug (p < .05 in non-zero portion of model), and Hispanic ethnicity (p < .01 in the zero portion, p < .05 in the non-zero portion of model). Conclusion These predictor and moderator findings point to ways in which patients may be selected for the different HIV sexual risk reduction interventions and suggest potential avenues for further development of the interventions for increasing their effectiveness within certain subgroups.
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Dunn KE, Saulsgiver KA, Patrick ME, Heil SH, Higgins ST, Sigmon SC. Characterizing and improving HIV and hepatitis knowledge among primary prescription opioid abusers. Drug Alcohol Depend 2013; 133:625-32. [PMID: 24051063 PMCID: PMC3824383 DOI: 10.1016/j.drugalcdep.2013.08.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 08/08/2013] [Accepted: 08/09/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND The high rates of HIV and Hepatitis C (HCV) infection among opioid abusers is a serious public health problem, and efforts to enhance knowledge regarding risks for HIV/hepatitis infection in this population are important. Abuse of prescription opioids (POs), in particular, has increased substantially in the past decade and is associated with increasing rates of injection drug use and HCV infection. METHODS This study describes the effects of a brief HIV/HCV educational intervention delivered in the context of a larger randomized, double-blind clinical trial evaluating the relative efficacy of 1-, 2-, and 4-week outpatient buprenorphine tapers and subsequent oral naltrexone maintenance for treating PO dependence. HIV- and HCV-related knowledge and risk behaviors were characterized pre- and post-intervention in 54 primary PO abusers. RESULTS The educational intervention was associated with significant improvements in HIV (p<.001) and HCV (p<.001) knowledge. Significant improvements (p<.001) were observed on all three domains of the HIV questionnaire (i.e., general knowledge, sexual risk behaviors, drug risk behaviors) and on 21 and 11 individual items on the HIV and HCV questionnaires, respectively. Self-reported likelihood of using a condom also increased significantly (p<.05) from pre- to post-intervention. No additional changes in self-reported risk behaviors were observed. CONCLUSION These results suggest that a brief, easy-to-administer intervention is associated with substantial gains in HIV and HCV knowledge among PO abusers and represents the necessary first step toward the dissemination of a structured prevention HIV and HCV intervention for PO abusers.
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Affiliation(s)
- Kelly E. Dunn
- Johns Hopkins University School of Medicine Department of Psychiatry and Behavioral Sciences
| | | | | | - Sarah H. Heil
- University of Vermont Department of Psychology,University of Vermont Department of Psychiatry
| | - Stephen T. Higgins
- University of Vermont Department of Psychology,University of Vermont Department of Psychiatry
| | - Stacey C. Sigmon
- University of Vermont Department of Psychology,University of Vermont Department of Psychiatry
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An international systematic review and meta-analysis of multisession psychosocial interventions compared with educational or minimal interventions on the HIV sex risk behaviors of people who use drugs. AIDS Behav 2013; 17:1963-78. [PMID: 23386132 DOI: 10.1007/s10461-012-0403-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This systematic review and meta-analysis examines the effectiveness of multisession psychosocial interventions compared with educational interventions and minimal interventions in reducing sexual risk in people who use drugs (51 studies; 19,209 participants). We conducted comprehensive searches (MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials and PsychINFO 1998-2012). Outcomes (unprotected sex, condom use, or a composite outcome) were extracted by two authors and synthesised using meta-analysis. Subgroup analyses and meta-regression were conducted to explore heterogeneity. Multisession psychosocial interventions had modest additional benefits compared to educational interventions (K = 46; OR 0.86; 95% CI 0.77, 0.96), and large positive effects compared to minimal interventions (K = 7; OR 0.60; 95% CI 0.46, 0.78). Comparison with previous meta-analyses suggested limited progress in recent years in developing more effective interventions. Multisession psychosocial and educational interventions provided similar modest sexual risk reduction justifying offering educational interventions in settings with limited exposure to sexual risk reduction interventions, messages, and resources.
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Mackesy-Amiti ME, Finnegan L, Ouellet LJ, Golub ET, Hagan H, Hudson SM, Latka MH, Garfein RS. Peer-education intervention to reduce injection risk behaviors benefits high-risk young injection drug users: a latent transition analysis of the CIDUS 3/DUIT study. AIDS Behav 2013; 17:2075-83. [PMID: 23142857 PMCID: PMC3672505 DOI: 10.1007/s10461-012-0373-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We analyzed data from a large randomized HIV/HCV prevention intervention trial with young injection drug users (IDUs) conducted in five U.S. cities. The trial compared a peer education intervention (PEI) with a time-matched, attention control group. Applying categorical latent variable analysis (mixture modeling) to baseline injection risk behavior data, we identified four distinct classes of injection-related HIV/HCV risk: low risk, non-syringe equipment-sharing, moderate-risk syringe-sharing, and high-risk syringe-sharing. The trial participation rate did not vary across classes. We conducted a latent transition analysis using trial baseline and 6-month follow-up data, to test the effect of the intervention on transitions to the low-risk class at follow-up. Adjusting for gender, age, and race/ethnicity, a significant intervention effect was found only for the high-risk class. Young IDU who exhibited high-risk behavior at baseline were 90 % more likely to be in the low-risk class at follow-up after the PEI intervention, compared to the control group.
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Affiliation(s)
- Mary E Mackesy-Amiti
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA.
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30 Years on Selected Issues in the Prevention of HIV among Persons Who Inject Drugs. Adv Prev Med 2013; 2013:346372. [PMID: 23840957 PMCID: PMC3694369 DOI: 10.1155/2013/346372] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 03/11/2013] [Accepted: 05/18/2013] [Indexed: 11/17/2022] Open
Abstract
After 30 years of extensive research on human immunodeficiency virus (HIV) among persons who inject drugs (PWID), we now have a good understanding of the critical issues involved. Following the discovery of HIV in 1981, epidemics among PWID were noted in many countries, and consensus recommendations for interventions for reducing injection related HIV transmission have been developed. While high-income countries have continued to develop and implement new Harm Reduction programs, most low-/middle-income countries have implemented Harm Reduction at very low levels. Modeling of combined prevention programming including needle exchange (NSP) and antiretroviral therapy (ARV) suggests that NSP be given the highest priority. Future HIV prevention programming should continue to provide Harm Reduction programs for PWID coupled with interventions aimed at reducing sexual transmission. As HIV continues to spread in low- and middle-income countries, it is important to achieve and maintain high coverage of Harm Reduction programs in these locations. As PWID almost always experience multiple health problems, it will be important to address these multiple problems within a comprehensive approach grounded in a human rights perspective.
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Campbell ANC, Tross S, Calsyn DA. Substance use disorders and HIV/AIDS prevention and treatment intervention: research and practice considerations. SOCIAL WORK IN PUBLIC HEALTH 2013; 28:333-48. [PMID: 23731423 PMCID: PMC3694750 DOI: 10.1080/19371918.2013.774665] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Social workers are often on the front lines of the HIV/AIDS epidemic delivering prevention education and interventions, offering or linking individuals to HIV testing, and working to improve treatment access, retention, and adherence, especially among vulnerable populations. Individuals with substance use disorders face additional challenges to reducing sexual and drug risk behaviors, as well as barriers to testing, treatment, and antiretroviral therapy adherence. This article presents current data on HIV transmission and research evidence on prevention and intervention with substance abusers and highlights how individual social workers can take advantage of this knowledge in practice and through adoption and implementation within organizations.
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Affiliation(s)
- Aimee N C Campbell
- Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY 10032, USA.
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Klimas J, Field CA, Cullen W, O'Gorman CSM, Glynn LG, Keenan E, Saunders J, Bury G, Dunne C. Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users. Cochrane Database Syst Rev 2012; 11:CD009269. [PMID: 23152270 DOI: 10.1002/14651858.cd009269.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Problem alcohol use is common among illicit drug users and is associated with adverse health outcomes. It is also an important factor in poor prognosis among drug users with hepatitis C virus (HCV) as it impacts on progression to hepatic cirrhosis or opiate overdose in opioid users. OBJECTIVES To assess the effects of psychosocial interventions for problem alcohol use in illicit drug users (principally problem drug users of opiates and stimulants). SEARCH METHODS We searched the Cochrane Drugs and Alcohol Group trials register (November 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 11, November 2011), PUBMED (1966 to 2011); EMBASE (1974 to 2011); CINAHL (1982 to 2011); PsycINFO (1872 to 2011) and reference list of articles. We also searched: 1) conference proceedings (online archives only) of the Society for the Study of Addiction (SSA), International Harm Reduction Association (IHRA), International Conference on Alcohol Harm Reduction (ICAHR), and American Association for the Treatment of Opioid Dependence (AATOD); 2) online registers of clinical trials, Current Controlled Trials (CCT), Clinical Trials.org, Center Watch and International Clinical Trials Registry Platform (ICTRP). SELECTION CRITERIA Randomised controlled trials comparing psychosocial interventions with another therapy (other psychosocial treatment, including non-pharmacological therapies or placebo) in adult (over the age of 18 years) illicit drug users with concurrent problem alcohol use. DATA COLLECTION AND ANALYSIS Two review authors independently assessed risk of bias and extracted data from included trials. MAIN RESULTS Four studies, 594 participants, were included. Half of the trials were rated as having high or unclear risk of bias. They considered six different psychosocial interventions grouped into four comparisons: (1) cognitive-behavioural coping skills training versus 12-step facilitation (N = 41), (2) brief intervention versus treatment as usual (N = 110), (3) hepatitis health promotion versus motivational interviewing (N = 256), and (4) brief motivational intervention versus assessment-only group (N = 187). Differences between studies precluded any pooling of data. Findings are described for each trial individually:comparison 1: no significant difference; comparison 2: higher rates of decreased alcohol use at three months (risk ratio (RR) 0.32; 95% confidence interval (CI) 0.19 to 0.54) and nine months (RR 0.16; 95% CI 0.08 to 0.33) in the treatment as usual group; comparison 3 (group and individual format): no significant difference; comparison 4: more people reduced alcohol use (by seven or more days in the past 30 days at 6 months) in the brief motivational intervention compared to controls (RR 1.67; 95% CI 1.08 to 2.60). AUTHORS' CONCLUSIONS Very little evidence exists that there is no difference in the effectiveness between different types of interventions and that brief interventions are not superior to assessment only or treatment as usual. No conclusion can be made because of the paucity of the data and the low quality of the retrieved studies.
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Affiliation(s)
- Jan Klimas
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.
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Lorvick J, Bourgois P, Wenger LD, Arreola SG, Lutnick A, Wechsberg WM, Kral AH. Sexual pleasure and sexual risk among women who use methamphetamine: a mixed methods study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2012; 23:385-92. [PMID: 22954501 DOI: 10.1016/j.drugpo.2012.07.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 06/25/2012] [Accepted: 07/13/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND The intersection of drug use, sexual pleasure and sexual risk behaviour is rarely explored when it comes to poor women who use drugs. This paper explores the relationship between sexual behaviour and methamphetamine use in a community-based sample of women, exploring not only risk, but also desire, pleasure and the challenges of overcoming trauma. METHODS Quantitative data were collected using standard epidemiological methods (N=322) for community-based studies. In addition, using purposive sampling, qualitative data were collected among a subset of participants (n=34). Data were integrated for mixed methods analysis. RESULTS While many participants reported sexual risk behaviour (unprotected vaginal or anal intercourse) in the quantitative survey, sexual risk was not the central narrative pertaining to sexual behaviour and methamphetamine use in qualitative findings. Rather, desire, pleasure and disinhibition arose as central themes. Women described feelings of power and agency related to sexual behaviour while high on methamphetamine. Findings were mixed on whether methamphetamine use increased sexual risk behaviour. CONCLUSION The use of mixed methods afforded important insights into the sexual behaviour and priorities of methamphetamine-using women. Efforts to reduce sexual risk should recognize and valorize the positive aspects of methamphetamine use for some women, building on positive feelings of power and agency as an approach to harm minimization.
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Leukefeld C, Havens J, Tindall MS, Oser CB, Mooney J, Hall MT, Knudsen HK. Risky relationships: targeting HIV prevention for women offenders. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2012; 24:339-49. [PMID: 22827903 PMCID: PMC3490206 DOI: 10.1521/aeap.2012.24.4.339] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
HIV is a health issue for women offenders who are at particularly high risk. Women's prisons can be opportune settings for HIV prevention interventions. How women perceive partner relationships could be central to targeting HIV interventions. Consequently, this study examines changes in women offenders' risky relationships. Baseline and follow-up data are presented from 344 women offenders. Intent-to-treat analysis is used as well as analysis of covariance to control for baseline values. Findings indicate that women released to the community from prison who were randomized into the prevention intervention were significantly more likely to report changes in five of seven risky relationship thinking myths. Findings suggest that a relationship theory-based prevention intervention for reducing HIV risk could be promising for women offenders reentering the community after prison. Additional research is suggested.
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Affiliation(s)
- Carl Leukefeld
- Department of Behavioral Science, Medical Behavioral Science Building, University of Kentucky, Lexington, KY 40536-0086, USA.
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Weine S, Bahromov M, Loue S, Owens L. Trauma exposure, PTSD, and HIV sexual risk behaviors among labor migrants from Tajikistan. AIDS Behav 2012; 16:1659-69. [PMID: 22261829 DOI: 10.1007/s10461-011-0122-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Little is known about the role of trauma and PTSD symptoms in the context of migration-associated HIV risk behaviors. A survey of Tajik married male seasonal labor migrants in Moscow was completed by 200 workers from 4 bazaars and 200 workers from 18 construction sites as part of a mixed method (quantitative and qualitative) study. The mean PC-PTSD score was 1.2 with one-quarter of migrants scoring at or above the cutoff of 3 indicating likely PTSD diagnosis. PC-PTSD score was directly correlated with both direct and indirect trauma exposure, but PC-PTSD score did not predict either HIV sexual risk behaviors or HIV protective behaviors. HIV sexual risk behavior was associated with higher indirect trauma exposure. PC-PTSD score was associated with some indicators of increased caution (e.g., more talking with partners about HIV and condoms; more use of condom when drinking). Qualitative findings were used to illustrate the differences between direct and indirect traumas in terms of HIV sexual risk. The study findings call for future efforts to address labor migrant's mental health needs and to integrate trauma dimensions into HIV prevention.
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Affiliation(s)
- Stevan Weine
- Department of Psychiatry, University of Illinois at Chicago, USA.
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The impact of a brief motivational intervention on unprotected sex and sex while high among drug-positive emergency department patients who receive STI/HIV VC/T and drug treatment referral as standard of care. AIDS Behav 2012; 16:1203-16. [PMID: 22261830 DOI: 10.1007/s10461-012-0134-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
This randomized, controlled trial, conducted among out-of-treatment heroin/cocaine users at an emergency department visit, tests the impact on sexual risk of adding brief motivational intervention (B-MI) to point-of-service testing, counseling and drug treatment referral. 1,030 enrollees aged 18-54 received either voluntary counseling/testing (VC/T) with drug treatment referral, or VC/T, referral, and B-MI, delivered by an outreach worker. We measured number and proportion of non-protected sex acts (last 30 days) at 6 and 12 months (n = 802). At baseline, 70% of past-30-days sex acts were non-protected; 35% of sex acts occurred while high; 64% of sexual acts involved main, 24% casual and 12% transactional sex partners; 1.7% tested positive for an STI, and 8.8% for HIV. At six or 12 month follow-up, 20 enrollees tested positive for Chlamydia and/or Gonorrhea, and 6 enrollees HIV sero-converted. Self-reported high-risk behaviors declined in both groups with no significant between-group differences in behaviors or STI/HIV incidence.
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Sacks-Davis R, Horyniak D, Grebely J, Hellard M. Behavioural interventions for preventing hepatitis C infection in people who inject drugs: A global systematic review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2012; 23:176-84. [DOI: 10.1016/j.drugpo.2011.08.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 08/02/2011] [Accepted: 08/16/2011] [Indexed: 02/05/2023]
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Tross S, Campbell ANC, Calsyn DA, Metsch LR, Sorensen JL, Shoptaw S, Haynes L, Woody GE, Malow RM, Brown LS, Feaster DJ, Booth RE, Mandler RN, Masson C, Holmes BW, Colfax G, Brooks AJ, Hien DA, Schackman BR, Korthuis PT, Miele GM. NIDA's Clinical Trials Network: an opportunity for HIV research in community substance abuse treatment programs. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2011; 37:283-93. [PMID: 21854270 DOI: 10.3109/00952990.2011.596977] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND/OBJECTIVES HIV continues to be a significant problem among substance users and their sexual partners in the United States. The National Drug Abuse Treatment Clinical Trials Network (CTN) offers a national platform for effectiveness trials of HIV interventions in community substance abuse treatment programs. This article presents the HIV activities of the CTN during its first 10 years. RESULTS While emphasizing CTN HIV protocols, this article reviews the (1) HIV context for this work; (2) the collaborative process among providers, researchers, and National Institute on Drug Abuse CTN staff, on which CTN HIV work was based; (3) results of CTN HIV protocols and HIV secondary analyses in CTN non-HIV protocols; and (4) implications for future HIV intervention effectiveness research in community substance abuse treatment programs. CONCLUSION/SIGNIFICANCE While the feasibility of engaging frontline providers in this research is highlighted, the limitations of small to medium effect sizes and weak adoption and sustainability in everyday practice are also discussed.
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Affiliation(s)
- Susan Tross
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, NY 10032, USA.
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Abstract
Research conducted during the first 20 years of the AIDS epidemic provided a solid foundation of data supporting methadone treatment as HIV prevention. Drug users in methadone treatment were consistently found to reduce the frequency of drug use, risk behaviors, and infections. These data have been consistent over time and across cultural settings and have been used to promote the expansion of drug treatment as a prevention intervention. More recently, data have emerged suggesting the prevention potential of medication-assisted treatments other than methadone (buprenorphine/naloxone and naltrexone). Still, with a few notable exceptions, global drug treatment coverage for opiate injectors remains remarkably low and only a few treatment interventions for stimulant use have shown efficacy in reducing HIV risk. Importantly, more recent data provide support for the role of drug treatment programs in improving access and adherence to antiretroviral treatment and that injection drug users in substance abuse treatment are more likely to achieve sustained viral suppression. While important challenges remain in maximizing its impact, the scientific literature provides strong evidence of the efficacy of drug treatment as an HIV prevention strategy.
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Affiliation(s)
- David S Metzger
- HIV/AIDS Prevention Research Division, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA.
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Hagan H, Perlman DC, Des Jarlais DC. Sexual risk and HIV infection among drug users in New York City: a pilot study. Subst Use Misuse 2011; 46:201-7. [PMID: 21303240 PMCID: PMC4458329 DOI: 10.3109/10826084.2011.521470] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Measures of sexual health were assessed during 2008-2009 in a New York City sample of 102 injection and noninjection users of heroin, cocaine, or crack. There was considerable overlap and transitioning between crack smoking and injecting. Crack users were also significantly more likely to be gay, lesbian, or bisexual than other drug users. In multivariate analysis, HIV infection was independently associated with crack use and with being gay or bisexual. In New York City, HIV prevention for drug users has focused on syringe access, safe injection, and drug user treatment, but further progress in HIV control will require strategies to address sexual health among people who use drugs. The study's limitations are noted.
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Affiliation(s)
- Holly Hagan
- College of Nursing, New York University, New York, New York 10003, USA.
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