Center for Global Health, Massachusetts General Hospital, Boston, MA, USA; Department of Psychology, University of Maryland, College Park, MD, USA.
Department of Psychology, University of Maryland, College Park, MD, USA.
Int J Drug Policy. 2021 Sep;95:103252. doi: 10.1016/j.drugpo.2021.103252. Epub 2021 Apr 20.
Addressing the burden of disease associated with substance use is a global priority, yet access to treatment is limited, particularly in low- and middle-income countries (LMICs). Peers, individuals with lived experience of substance use, may play an important role in expanding access to treatment, supporting outcomes, and reducing stigma. While peer-delivered services for substance use have been scaling up in high-income countries (HICs), less is known about their application in LMICs. This systematic review synthesizes the evidence of peer-delivered services for substance use in LMICs.
PsycINFO, Embase, Global Health, PubMed, and six region-specific databases were searched, and articles that described peer-delivered services for substance use and related outcomes in LMICs were included. Risk of bias was evaluated using tools appropriate for each study design. To provide a more stringent evaluation of structured interventions, a subset of articles was analyzed using the Cochrane Effective Practice and Organization of Care (EPOC) framework.
The search yielded 6540 articles. These were narrowed down to 34 included articles. Articles spanned four continents, included quantitative and qualitative methodologies, and primarily targeted infectious disease risk behaviors. Ten articles were included in the EPOC sub-analysis. In the context of high risk of bias, some of these articles demonstrated positive impacts of the peer-delivered services, including reductions in risk behaviors and increases in infectious disease knowledge scores, while many others showed no significant difference in outcomes between peer intervention and control groups.
Peer-delivered services may be feasible for addressing substance use and reducing infectious disease risk behaviors in LMICs, where there are severe human resource shortages. Globally, peers' lived experience is valuable for engaging patients in substance use treatment and harm reduction services. Further research is needed to better characterize and quantify outcomes for peer-delivered services for substance use in LMICs.
解决与物质使用相关的疾病负担是全球重点，但治疗的可及性有限，特别是在中低收入国家（LMICs）。同伴，即有物质使用经验的个人，可能在扩大治疗机会、支持治疗结果和减少污名化方面发挥重要作用。虽然同伴提供的物质使用服务在高收入国家（HICs）中已经在扩大规模，但在 LMICs 中，关于其应用的信息却知之甚少。本系统评价综合了 LMICs 中同伴提供的物质使用服务的证据。
检索了 PsycINFO、Embase、全球健康、PubMed 和六个地区特定数据库，并纳入了描述 LMICs 中同伴提供的物质使用服务及其相关结果的文章。使用适合每种研究设计的工具评估偏倚风险。为了更严格地评估结构化干预措施，对一部分文章使用了 Cochrane 有效实践和组织关怀（EPOC）框架进行分析。
搜索共产生了 6540 篇文章。经过筛选，最终纳入了 34 篇文章。这些文章涵盖了四大洲，包括定量和定性方法，主要针对传染病风险行为。其中 10 篇文章被纳入 EPOC 子分析。在高偏倚风险的背景下，其中一些文章显示出同伴提供的服务具有积极影响，包括减少风险行为和提高传染病知识得分，而许多其他文章则显示同伴干预和对照组之间在结果上没有显著差异。
在人力资源严重短缺的 LMICs 中，同伴提供的服务可能是解决物质使用和减少传染病风险行为的可行方法。在全球范围内，同伴的生活经验对于吸引患者参与物质使用治疗和减少伤害服务非常有价值。需要进一步研究以更好地描述和量化 LMICs 中同伴提供的物质使用服务的结果。
