Effectiveness of needle and syringe Programmes in people who inject drugs - An overview of systematic reviews.
Effectiveness of needle and syringe Programmes in people who inject drugs - An overview of systematic reviews.
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DOI：
10.1186/s12889-017-4210-2
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发表时间：
2017-04-11
影响因子：
4.5
通讯作者：
Carneiro AV
中科院分区：
文献类型：
--
作者：
Fernandes RM;Cary M;Duarte G;Jesus G;Alarcão J;Torre C;Costa S;Costa J;Carneiro AV
针头和针筒方案是注射吸毒者减少危害干预措施的一个关键组成部分。我们的主要目的是总结NSP治疗PWID在减少血源性感染传播和注射风险行为（IRB）方面的有效性证据。我们对包括PWID（不包括监狱和消费室）的系统性综述进行了概述，讨论了基于社区的NSP，并提供了对人类免疫缺陷病毒（HIV）、丙型肝炎病毒（HCV）、乙型肝炎B病毒（HBV）和菌血症/脓毒症的发生率/患病率和/或IRB指标的影响估计。对相关数据库进行了系统性文献检索，包括EMBASE、MEDLINE和PsychINFO（截至2015年5月）。对于每一篇综述，我们识别了相关研究，并提取了方法和结果的数据，包括偏倚风险和综述作者评估的证据质量。我们使用ROBIS工具评估了每份系统性综述的偏见风险。我们根据报告的结果和荟萃分析的使用对综述进行了分类;没有进行额外的统计分析。我们纳入了13篇系统性综述，其中包括1989年至2012年间发表的133项相关独特研究。报告的结局与HIV（n = 9）、HCV（n = 8）和IRB（n = 6）相关。在设计和实施的各个层面使用的方法各不相同，有四篇综述进行荟萃分析。使用ROBIS工具，只有两篇综述被认为偏倚风险较低，大多数纳入的研究被综述作者评价为方法学质量较低。我们发现，NSP是有效地减少艾滋病毒的传播和IRB之间PWID，而有关于减少HCV感染的结果喜忧参半。在结构层面和多组成部分方案中提供的全面减少危害干预措施以及高覆盖率更有益。异质性和整体低质量的证据强调了未来社区水平的研究，充分的设计，以支持这些结果的需要。本系统性综述的方案已在系统性综述前瞻性登记系统（PROSPERO 2015：CRD 42015026145）中注册。本文的在线版本（doi：10.1186/s12889-017-4210-2）包含补充材料，可供授权用户使用。
Needle and syringe programmes (NSP) are a critical component of harm reduction interventions among people who inject drugs (PWID). Our primary objective was to summarize the evidence on the effectiveness of NSP for PWID in reducing blood-borne infection transmission and injecting risk behaviours (IRB). We conducted an overview of systematic reviews that included PWID (excluding prisons and consumption rooms), addressed community-based NSP, and provided estimates of the effect regarding incidence/prevalence of Human Immunodeficiency Virus (HIV), Hepatitis C virus (HCV), Hepatitis B virus (HBV) and bacteremia/sepsis, and/or measures of IRB. Systematic literature searches were undertaken on relevant databases, including EMBASE, MEDLINE, and PsychINFO (up to May 2015). For each review we identified relevant studies and extracted data on methods, and findings, including risk of bias and quality of evidence assessed by review authors. We evaluated the risk of bias of each systematic review using the ROBIS tool. We categorized reviews by reported outcomes and use of meta-analysis; no additional statistical analysis was performed. We included thirteen systematic reviews with 133 relevant unique studies published between 1989 and 2012. Reported outcomes related to HIV (n = 9), HCV (n = 8) and IRB (n = 6). Methods used varied at all levels of design and conduct, with four reviews performing meta-analysis. Only two reviews were considered to have low risk of bias using the ROBIS tool, and most included studies were evaluated as having low methodological quality by review authors. We found that NSP was effective in reducing HIV transmission and IRB among PWID, while there were mixed results regarding a reduction of HCV infection. Full harm reduction interventions provided at structural level and in multi-component programmes, as well as high level of coverage, were more beneficial. The heterogeneity and the overall low quality of evidence highlights the need for future community-level studies of adequate design to support these results. The protocol of this systematic review was registered in Prospective Register of Systematic Reviews (PROSPERO 2015:CRD42015026145). The online version of this article (doi:10.1186/s12889-017-4210-2) contains supplementary material, which is available to authorized users.