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

IF 3.7 2区医学 Q1 SUBSTANCE ABUSE

Addiction Science & Clinical Practice Pub Date : 2024-02-04 DOI:10.1186/s13722-024-00439-9

Fernanda S. Tonin, Filipa Alves da Costa, Fernando Fernandez-Llimos

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Abstract

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. 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). 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. 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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伤害最小化干预措施对减少注射吸毒者血液传播感染和某些注射行为的影响：概述和证据差距图谱

本研究旨在通过对系统综述和证据差距图谱的全面概述，综合分析伤害最小化干预措施在减少注射吸毒者（PWID）血液传播感染和注射行为方面的有效性证据。我们在 PubMed 和 Scopus 上进行了系统性综述检索，以确定评估旨在减少注射吸毒相关危害的干预措施影响的系统性综述。我们提取了这些研究的总体特征，并使用 AMSTAR-2 对其方法学质量进行了评估。绘制了证据差距图，突出了干预措施中最常报告的结果（CRD42023387713）。共纳入 33 篇系统综述。其中14篇（42.2%）评估了针头/针筒交换项目（NSEP）的影响，11篇（33.3%）研究了阿片类激动剂疗法（OAT）。这些干预措施可能会降低 HIV/HCV 的发病率（NSEP 可降低 10-40% 的风险；OAT 可降低 50-60% 的风险）和共用注射用具的风险（NSEP 可降低 50%，OAT 可降低 25-85%），尤其是在联合使用的情况下（中等证据）。12篇综述（36.4%）对行为/教育干预措施进行了评估，大多数作者赞成/部分赞成使用这些方法（中等证据）。有两项研究（6.1%）分别评估了带回家的纳洛酮项目和监督注射设施，但报告的结果并不确定（证据有限/不一致）。大多数作者报告了高度的异质性和偏倚风险。其他干预措施和结果的报告不足。大多数系统综述的质量较低或极低。有足够证据支持 OAT、NSEP 及其组合在减少 PWID 血液传播和某些注射行为方面的有效性。然而，在不同环境下和针对某些结果的其他伤害最小化干预措施的证据仍然不足。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Addiction Science & Clinical Practice Psychology-Clinical Psychology

CiteScore

3.90

自引率

10.80%

发文量

审稿时长

28 weeks

期刊介绍： Addiction Science & Clinical Practice provides a forum for clinically relevant research and perspectives that contribute to improving the quality of care for people with unhealthy alcohol, tobacco, or other drug use and addictive behaviours across a spectrum of clinical settings. Addiction Science & Clinical Practice accepts articles of clinical relevance related to the prevention and treatment of unhealthy alcohol, tobacco, and other drug use across the spectrum of clinical settings. Topics of interest address issues related to the following: the spectrum of unhealthy use of alcohol, tobacco, and other drugs among the range of affected persons (e.g., not limited by age, race/ethnicity, gender, or sexual orientation); the array of clinical prevention and treatment practices (from health messages, to identification and early intervention, to more extensive interventions including counseling and pharmacotherapy and other management strategies); and identification and management of medical, psychiatric, social, and other health consequences of substance use. Addiction Science & Clinical Practice is particularly interested in articles that address how to improve the quality of care for people with unhealthy substance use and related conditions as described in the (US) Institute of Medicine report, Improving the Quality of Healthcare for Mental Health and Substance Use Conditions (Washington, DC: National Academies Press, 2006). Such articles address the quality of care and of health services. Although the journal also welcomes submissions that address these conditions in addiction speciality-treatment settings, the journal is particularly interested in including articles that address unhealthy use outside these settings, including experience with novel models of care and outcomes, and outcomes of research-practice collaborations. Although Addiction Science & Clinical Practice is generally not an outlet for basic science research, we will accept basic science research manuscripts that have clearly described potential clinical relevance and are accessible to audiences outside a narrow laboratory research field.