New York University College of Nursing, NY, USA.
J Infect Dis. 2011 Jul 1;204(1):74-83. doi: 10.1093/infdis/jir196.
High rates of hepatitis C virus (HCV) transmission are found in samples of people who inject drugs (PWID) throughout the world. The objective of this paper was to meta-analyze the effects of risk-reduction interventions on HCV seroconversion and identify the most effective intervention types.
We performed a systematic review and meta-analysis of published and unpublished studies. Eligible studies reported on the association between participation in interventions intended to reduce unsafe drug injection and HCV seroconversion in samples of PWID.
The meta-analysis included 26 eligible studies of behavioral interventions, substance-use treatment, syringe access, syringe disinfection, and multicomponent interventions. Interventions using multiple combined strategies reduced risk of seroconversion by 75% (pooled relative risk, .25; 95% confidence interval, .07-.83). Effects of single-method interventions ranged from .6 to 1.6.
Interventions using strategies that combined substance-use treatment and support for safe injection were most effective at reducing HCV seroconversion. Determining the effective dose and combination of interventions for specific subgroups of PWID is a research priority. However, our meta-analysis shows that HCV infection can be prevented in PWID.
在全球范围内，注射毒品人群（PWID）的样本中发现了高比例的丙型肝炎病毒（HCV）传播。本文的目的是对降低风险干预措施对 HCV 血清转换的影响进行荟萃分析，并确定最有效的干预类型。
我们对已发表和未发表的研究进行了系统评价和荟萃分析。合格的研究报告了旨在减少不安全注射药物的干预措施与 PWID 样本中 HCV 血清转换之间的关联。
荟萃分析包括 26 项关于行为干预、药物使用治疗、注射器获取、注射器消毒和多组分干预的合格研究。使用多种联合策略的干预措施将血清转换的风险降低了 75%（合并相对风险，.25；95%置信区间，.07-.83）。单一方法干预的效果范围为.6 至 1.6。
使用将药物使用治疗和安全注射支持相结合的策略的干预措施在降低 HCV 血清转换方面最有效。确定针对特定 PWID 亚组的干预措施的有效剂量和组合是研究的重点。然而，我们的荟萃分析表明，HCV 感染可以在 PWID 中预防。
