Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Emory Rollins School of Public Health, Atlanta, Georgia, USA.
J Infect Dis. 2020 Sep 2;222(Suppl 5):S278-S300. doi: 10.1093/infdis/jiaa008.
This article summarizes the results from systematic reviews of human immunodeficiency virus (HIV) prevention interventions for people who use drugs (PWUD). We performed an overview of reviews, meta-analysis, meta-epidemiology, and PROSPERO Registration CRD42017070117.
We conducted a comprehensive systematic literature search using the Centers for Disease Control and Prevention HIV/AIDS Prevention Research Synthesis Project database to identify quantitative systematic reviews of HIV public heath interventions with PWUD published during 2002-2017. We recombined results of US studies across reviews to quantify effects on HIV infections, continuum of HIV care, sexual risk, and 5 drug-related outcomes (sharing injection equipment, injection frequency, opioid use, general drug use, and participation in drug treatment). We conducted summary meta-analyses separately for reviews of randomized controlled trials (RCTs) and quasi-experiments. We stratified effects by 5 intervention types: behavioral-psychosocial (BPS), syringe service programs (SSP), opioid agonist therapy (OAT), financial and scheduling incentives (FSI), and case management (CM).
We identified 16 eligible reviews including >140 US studies with >55 000 participants. Summary effects among US studies were significant and favorable for 4 of 5 outcomes measured under RCT (eg, reduced opioid use; odds ratio [OR] = 0.70, confidence interval [CI] = 0.56-0.89) and all 6 outcomes under quasi-experiments (eg, reduced HIV infection [OR = 0.42, CI = 0.27-0.63]; favorable continuum of HIV care [OR = 0.68, CI = 0.53-0.88]). Each intervention type showed effectiveness on 1-6 outcomes. Heterogeneity was moderate to none for RCT but moderate to high for quasi-experiments.
Behavioral-psychosocial, SSP, OAT, FSI, and CM interventions are effective in reducing risk of HIV and sequelae of injection and other drug use, and they have a continuing role in addressing the opioid crisis and Ending the HIV Epidemic.
本文总结了针对吸毒者（PWUD）的人类免疫缺陷病毒（HIV）预防干预措施的系统评价结果。我们进行了系统评价概述、荟萃分析、荟萃流行病学和 PROSPERO 注册 CRD42017070117。
我们使用疾病控制与预防中心 HIV/AIDS 预防研究综合项目数据库进行了全面的系统文献检索，以确定 2002-2017 年期间发表的针对 PWUD 的 HIV 公共卫生干预措施的定量系统评价。我们重新组合了各综述中的美国研究结果，以量化对 HIV 感染、HIV 护理连续性、性风险和 5 项药物相关结局（共用注射器具、注射频率、阿片类药物使用、一般药物使用和药物治疗参与）的影响。我们分别对随机对照试验（RCT）和准实验的综述进行了汇总荟萃分析。我们按 5 种干预类型对效果进行分层：行为-心理社会（BPS）、注射器服务计划（SSP）、阿片类药物激动剂治疗（OAT）、财务和调度激励（FSI）和个案管理（CM）。
我们确定了 16 项符合条件的综述，其中包括 140 多项美国研究，涉及超过 55000 名参与者。在美国研究中，4 项 5 项测量结果（减少阿片类药物使用；比值比[OR] = 0.70，置信区间[CI] = 0.56-0.89）和所有 6 项准实验结果（减少 HIV 感染[OR = 0.42，CI = 0.27-0.63]；有利于 HIV 护理连续性[OR = 0.68，CI = 0.53-0.88]）的汇总效果显著且有利。每种干预类型对 1-6 项结果均有效。RCT 的异质性为中度至无，但准实验的异质性为中度至高度。
行为-心理社会、SSP、OAT、FSI 和 CM 干预措施在降低 HIV 风险和注射及其他药物使用的后果方面是有效的，它们在应对阿片类药物危机和终结 HIV 流行方面仍发挥着作用。
