Daphne Cockwell School of Nursing, Faculty of Community Services, Ryerson University, Toronto, ON, Canada.
Human Biology Program, University of Toronto, Toronto, ON, Canada.
JBI Evid Synth. 2021 Aug;19(8):1887-1914. doi: 10.11124/JBIES-20-00223.
The objective of this systematic review is to identify, appraise, and synthesize the best available evidence on the effectiveness of opioid substitution treatment in reducing HIV risk behavior among African, Caribbean, and Black people.
Substance use plays an important role in HIV transmission among Black people by increasing risky sexual behavior and the risk of HIV acquisition. Opioid substitution treatment, such as methadone maintenance treatment and buprenorphine therapy, has been found to be an effective measure to minimize HIV transmission attributable to opioid addiction.
The current review considered studies that included African, Caribbean, and Black adult patients, aged 18 years or over, who have used methadone maintenance treatment or buprenorphine therapies as part of the intervention for opioid use disorders and have been evaluated for sex- and drug-related HIV risk behaviors. This review considered studies that have evaluated the impact of methadone maintenance treatment or buprenorphine therapy on sex- and drug-related HIV risk behaviors.
Multiple databases were searched, including Embase, MEDLINE, PsycINFO, Cochrane Central Register of Controlled Trials, OpenGrey, Grey Matters, New York Academy of Medicine Grey Literature Report, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform. Two reviewers independently assessed all titles and abstracts, and potentially relevant studies were retrieved in full. Papers selected for retrieval were assessed by two independent reviewers for methodological validity. Data were then extracted from papers. Statistical pooling of quantitative data and meta-analysis was not possible due to heterogeneity of data.
Five articles were included in this review: three randomized controlled trials, one cohort study, and one quasi-experimental study. Four studies focused on methadone maintenance treatment and one study discussed the effectiveness of buprenorphine intervention. All studies were from the United States. One study enrolled participants in methadone maintenance treatment for heroin injectors, of which 10% of the sample was HIV positive. These papers included studies that reported a significant reduction in sex-related HIV risk behavior, including having multiple sex partners, frequency of sexual intercourse, condom use, prostitution, and sex trade. Of the five studies, two reported on drug-related HIV risk behaviors, citing a reduction in drug-related HIV risk behaviors. Also, these papers showed unexpected outcomes relating to frequency of sexual intercourse, prostitution, and sex trade. One study reported a significantly higher number of sexual encounters among persons not participating in treatment. One study reported decreasing prostitution and sex trade among individuals receiving methadone maintenance treatment intervention.
Methadone maintenance treatment or buprenorphine therapy can be effective in reducing sex- and drug-related HIV risk behaviors among African, Caribbean, and Black people. However, due to the weaknesses in the body of evidence and the quality of evidence, it is not possible to make strong conclusions about these interventions. Rigorous studies are necessary to generate more findings and reinforce the body of literature.
PROSPERO CRD42019126954.
本系统评价旨在确定、评估和综合现有最佳证据，评估阿非利加、加勒比和黑人群体中，使用类鸦片操守治疗（简称“美沙酮维持治疗”）减少艾滋病毒风险行为的有效性。
物质滥用是导致黑人群体艾滋病毒传播的一个重要因素，它会增加高危性行为和艾滋病毒感染风险。类鸦片操守治疗，如美沙酮维持治疗和丁丙诺啡治疗，已被证实是减少阿片类药物成瘾导致的艾滋病毒传播的有效措施。
本综述考虑了纳入年龄在 18 岁及以上、使用美沙酮维持治疗或丁丙诺啡治疗作为治疗阿片类药物使用障碍的一部分，并评估了与性和药物相关的艾滋病毒风险行为的非洲、加勒比和黑人成年患者的研究。本综述考虑了评估美沙酮维持治疗或丁丙诺啡治疗对与性和药物相关的艾滋病毒风险行为影响的研究。
我们对多个数据库进行了检索，包括 Embase、MEDLINE、PsycINFO、Cochrane 中央对照试验注册库、OpenGrey、Grey Matters、纽约学院灰色文献报告、ClinicalTrials.gov 和世界卫生组织国际临床试验注册平台。两名评审员独立评估所有标题和摘要，并检索了可能相关的研究。选择检索的论文由两名独立评审员进行方法学有效性评估。然后从论文中提取数据。由于数据异质性，无法对定量数据进行统计合并和荟萃分析。
本综述纳入了 5 篇文章：3 项随机对照试验、1 项队列研究和 1 项准实验研究。其中 4 项研究侧重于美沙酮维持治疗，1 项研究讨论了丁丙诺啡干预的效果。所有研究均来自美国。其中一项研究招募了接受美沙酮维持治疗的海洛因注射者，其中 10%的样本艾滋病毒呈阳性。这些论文包括报告性行为相关艾滋病毒风险行为显著减少的研究，包括拥有多个性伴侣、性行为频率、避孕套使用、卖淫和性交易。在这 5 项研究中，有 2 项报告了与药物相关的艾滋病毒风险行为减少。此外，这些论文还显示了与性行为频率、卖淫和性交易相关的意外结果。一项研究报告称，未参加治疗的人群中，性接触次数明显增加。一项研究报告称，接受美沙酮维持治疗干预的个体中，卖淫和性交易有所减少。
美沙酮维持治疗或丁丙诺啡治疗可以有效降低阿非利加、加勒比和黑人中与性和药物相关的艾滋病毒风险行为。然而，由于证据质量和证据数量的局限性，我们无法对这些干预措施做出强有力的结论。需要进行严格的研究，以产生更多的发现并加强文献体系。
PROSPERO CRD42019126954。
