Effectiveness of community-based outreach in preventing HIV/AIDS among injecting drug users
Effectiveness of community-based outreach in preventing HIV/AIDS among injecting drug users
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DOI：
10.1016/j.drugpo.2005.02.009
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发表时间：
2005-12-01
影响因子：
4.4
通讯作者：
Latkin, C
中科院分区：
文献类型：
--
作者：
Needle, RH;Burrows, D;Latkin, C
本文重点研究了社区外展干预作为预防注射吸毒者（IDU）人群中艾滋病毒感染的综合艾滋病毒预防模式的一个组成部分的有效性证据。三个经验性问题指导了对证据的审查。本文主要包括主要来自发展中国家的关于社区外展的已发表文献，但也包括未发表的文献。尽可能纳入多国、多地点研究或荟萃分析研究的证据。40多项已发表的研究表明，通过社区外展服务接触到并向其提供降低风险服务的注射吸毒者报告说，他们的艾滋病毒风险行为有所减少。证据的强度使用希尔标准进行评估，该标准允许对不同设计的多个研究进行审查。使用这些标准，就有可能推断出干预措施有效性证据的因果关系。以社区为基础的外联战略的有效性有充分的证据。尽管对社区外展服务的有效性进行了20年的评价研究，但在大多数国家，希望或能够受益于外展服务的注射吸毒者人数与实际接受服务的注射吸毒者人数之间存在巨大差距。关于社区外展的有效性的评价研究结果必须使人们能够获得、在全球传播并提供给政策和决策者，以说服他们采取行动并执行扩大的预防方案。这需要持续的宣传和不断加强证据基础。需要制定计划，将循证调查结果与技术援助和培训联系起来，以增强区域和国家的能力，将向注射吸毒者推广、扩大和维持艾滋病毒预防外展作为艾滋病毒综合预防战略的一部分。(c) 2005 Elsevier B.V.版权所有
This paper focuses on the evidence for the effectiveness of community-based outreach intervention as one component of a comprehensive HIV prevention model for preventing HIV infection in injecting drug user (IDU) Populations. Three empirical questions guided the review of the evidence. This article includes primarily published literature on community-based outreach derived mostly from developing countries but also unpublished literature. Wherever possible, evidence from multi-country, multi-site studies or meta-analytical studies is included. More than 40 published studies reveal that injecting drug users (IDUs), who are reached by community-based outreach and provided with access to risk reduction services, report reducing HIV risk behaviours. The strength of the evidence was assessed using Hill's criteria, which permit a review of multiple studies with different designs. Using the criteria, it is possible to infer causation about the evidence of effectiveness of the intervention. The evidence for the effectiveness of a community-based outreach strategy is strong. Despite evidence from 20 years of evaluation studies of the effectiveness of community-based outreach, a huge gap exists in most countries between the number of IDUs who want or could benefit from outreach services and the number of IDUs who actually receive them. Findings from evaluation studies on the effectiveness of community-based outreach must be made accessible, disseminated globally and provided to policy- and decision-makers to persuade them to take action and implement scaled-up prevention programmes. This requires ongoing advocacy and constant strengthening of the evidence base. Plans are needed to link evidence-based findings with technical assistance as well as training to enhance the capacity of regions and countries to introduce, scale up and sustain HIV prevention outreach to IDUs as part of a comprehensive HIM prevention strategy. (c) 2005 Elsevier B.V. All rights reserved.