Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BE, United Kingdom; Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, United Kingdom.
Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BE, United Kingdom; Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, United Kingdom.
Int J Drug Policy. 2022 Nov;109:103872. doi: 10.1016/j.drugpo.2022.103872. Epub 2022 Oct 3.
BACKGROUND: Hepatitis C virus (HCV) and HIV remain prevalent among people who inject drugs (PWID) and transmission is usually associated with injecting risk behaviour (IRB). We update a 2011 review of reviews (RoR) to assess the latest evidence on the effectiveness of harm reduction interventions - drug treatment (including opioid agonist therapy [OAT]), needle and syringe programmes (NSP) and other interventions - in the prevention of HCV and HIV transmission, and related measures of infection risk (IRB and injecting frequency [IF]), among PWID. METHODS: We undertook an initial search for systematic reviews (i.e. an Overview of Reviews [OoR]) and subsequent systematic searches for primary studies where required. Where there was sufficient evidence based on synthesis of multiple robust studies for an intervention effect in the 2011 RoR, new evidence was not sought. Medline, CINAHL, The Cochrane Library, EMBASE, PsycINFO and Web of Science were searched (2011-2020). Two reviewers screened papers, extracted data, and graded reviews/studies. We classified evidence as 'sufficient', 'tentative', 'insufficient', or 'no evidence'. RESULTS: We screened 8513 reviews and 7133 studies, with 27 and 61 identified as relevant, respectively. The level of evidence increased since the 2011 RoR and is now 'sufficient' for OAT (regarding all outcomes), NSP (for reducing HIV transmission and IRB), and combination OAT/NSP (for reducing HCV transmission). There is also now sufficient evidence for in-prison OAT, psychosocial interventions, pharmacy-based NSP and provision of sterile drug preparation equipment for reducing IRB. CONCLUSION: There is now a strong body of empirical evidence for the effectiveness of OAT and NSP, alone and in combination, in reducing IRB, and HCV and HIV transmission. However, there is still a relative lack of evidence for other interventions, including heroin-assisted treatment, pharmacological treatment for stimulant dependence, contingency management, technology-based interventions, low dead space syringes and drug consumption rooms on HCV or HIV risk.
背景：丙型肝炎病毒（HCV）和人类免疫缺陷病毒（HIV）在注射吸毒者（PWID）中仍然普遍存在，传播通常与注射风险行为（IRB）有关。我们更新了 2011 年的综述（RoR），以评估最新证据，评估减少伤害干预措施 - 药物治疗（包括阿片类激动剂治疗[OAT]）、针和注射器方案（NSP）和其他干预措施 - 在预防 HCV 和 HIV 传播方面的有效性，以及与感染风险（IRB 和注射频率[IF]）相关的措施，针对 PWID。
方法：我们进行了初步的系统评价（即综述概述[OoR]）搜索，并根据需要进行了后续的系统搜索。对于 2011 年 RoR 中具有干预效果的综合多项稳健研究的充分证据，不再寻求新的证据。检索了 Medline、CINAHL、Cochrane 图书馆、EMBASE、PsycINFO 和 Web of Science（2011-2020 年）。两名审查员筛选论文、提取数据并对综述/研究进行分级。我们将证据分为“充分”、“暂定”、“不足”或“无证据”。
结果：我们筛选了 8513 篇综述和 7133 篇研究，分别有 27 篇和 61 篇被确定为相关。自 2011 年 RoR 以来，证据水平有所提高，目前 OAT（关于所有结果）、NSP（用于减少 HIV 传播和 IRB）和 OAT/NSP 联合治疗（用于减少 HCV 传播）的证据“充分”。现在也有足够的证据表明在监狱中提供 OAT、心理社会干预、药房 NSP 和提供无菌药物准备设备可减少 IRB。
结论：现在有大量的经验证据表明 OAT 和 NSP 单独或联合使用可降低 IRB、HCV 和 HIV 传播的风险。然而，其他干预措施的证据仍然相对较少，包括海洛因辅助治疗、兴奋剂依赖的药物治疗、条件管理、基于技术的干预措施、低死腔注射器和吸毒室对 HCV 或 HIV 风险的影响。
Cochrane Database Syst Rev. 2017-9-18
BMC Public Health. 2017-4-11
Harm Reduct J. 2025-2-20
Microorganisms. 2024-12-11
Zotero 插件