- 作者：Georgina J. MacArthur ; Eva van Velzen ; Norah Palmateer ; Jo Kimber ; Anastasia Pharris ; Vivian Hope ; Avril Taylor ; Kirsty Roy ; Esther Aspinall ; David Goldberg ; Tim Rhodes ; Dagmar Hedrich ; Mika Salminen ; Matthew Hickman ; Sharon J. Hutchinson
- 关键词：Hepatitis C ; HIV ; Harm reduction ; People who inject drugs ; Review
- 刊名：The International Journal of Drug Policy
- 出版年：January, 2014
- 年：2014
- 卷：25
- 期：1
- 页码：34-52
- 全文大小：2137 K
Background
Injecting drug use is a major risk factor for the acquisition and transmission of HIV and Hepatitis C virus (HCV). Prevention of these infections among people who inject drugs (PWID) is critical to reduce ongoing transmission, morbidity and mortality.Methods
A review of reviews was undertaken involving systematic literature searches of Medline, Embase, CINAHL, PsychINFO, IBSS and the Cochrane Library (2000-2011) to identify English language reviews regarding the effectiveness of harm reduction interventions in relation to HIV transmission, HCV transmission and injecting risk behaviour (IRB). Interventions included needle and syringe programmes (NSP); the provision of injection paraphernalia; opiate substitution treatment (OST); information, education and counselling (IEC); and supervised injecting facilities (SIFs). Reviews were classified into 鈥榗ore鈥?or 鈥榮upplementary鈥?using critical appraisal criteria, and the strength of review-level evidence was assessed.
Results
Twelve core and thirteen supplementary reviews were included. From these reviews we identified: (i) for NSP: tentative review-level evidence to support effectiveness in reducing HIV transmission, insufficient review-level evidence relating to HCV transmission, but sufficient review-level evidence in relation to IRB; (ii) for OST: sufficient review-level evidence of effectiveness in relation to HIV transmission and IRB, but tentative review-level evidence in relation to HCV transmission; (iii) for IEC, the provision of injection paraphernalia and SIFs: tentative review-level evidence of effectiveness in reducing IRB; and either insufficient or no review-level evidence for these interventions in relation to HIV or HCV transmission.
Conclusion
Review-level evidence indicates that harm reduction interventions can reduce IRB, with evidence strongest for OST and NSP. However, there is comparatively little review-level evidence regarding the effectiveness of these interventions in preventing HCV transmission among PWID. Further studies are needed to assess the effectiveness and impact of scaling up comprehensive packages of harm reduction interventions to minimise HIV and HCV transmission among PWID.