Are needle and syringe programmes associated with a reduction in HIV transmission among people who inject drugs: a systematic review and meta-analysis
Are needle and syringe programmes associated with a reduction in HIV transmission among people who inject drugs: a systematic review and meta-analysis
复制标题
DOI：
10.1093/ije/dyt243
复制
发表时间：
2014-02-01
影响因子：
7.7
通讯作者：
Hutchinson, Sharon J.
中科院分区：
文献类型：
--
作者：
Aspinall, Esther J.;Nambiar, Dhanya;Hutchinson, Sharon J.
针头和注射器计划（NSP）旨在通过为注射毒品者（PWID）提供无菌注射设备来降低艾滋病毒的风险。最近的一项审查的审查（ROR）的结论是，只有初步证据支持国家战略计划在减少艾滋病毒方面的有效性。我们进行了系统回顾和荟萃分析，以评估NSP和HIV transmission.Methods之间的关联，相关的主要文章介绍了与NSP相关的HIV传播风险的数据，确定了两个阶段：（i）从两个已发表的ROR中确定的评论（涵盖1980-2008年）;和（ii）CINAHL，科克伦图书馆，EMBASE，MEDLINE和PsychINFO收录了自最近一次高质量综述（涵盖2008- 2012年）以来发表的主要文章。研究结果采用随机效应荟萃分析进行综合分析。结果共有12项研究，包括至少12000人年的后续行动。接触NSP与艾滋病毒传播减少有关：所有研究的合并效应量0中心点66 [95%置信区间（CI）0中心点43，1中心点01]，0中心点42（95%CI 0中心点22，0中心点81），6项高质量研究（根据Newcastle-Ottawa工具）。结论有证据支持NSP在减少艾滋病毒在PWID中传播方面的有效性，尽管其他减少危害的干预措施也可能有助于观察到的艾滋病毒风险降低。国家战略计划应被视为减少注射风险和其他类型艾滋病毒风险行为的干预方案的一个组成部分。
Background Needle and syringe programmes (NSP) aim to reduce the risk of HIV by providing people who inject drugs (PWID) with sterile injecting equipment. A recent review of reviews (ROR) concluded that there was only tentative evidence to support the effectiveness of NSP in reducing HIV. We carried out a systematic review and meta-analysis to assess the association between NSP and HIV transmission.Methods Relevant primary articles presenting data on the risk of HIV transmission associated with NSP were identified in two stages: (i) from reviews identified in two published RORs (covering the period 1980-2008); and (ii) a literature search of CINAHL, Cochrane Library, EMBASE, MEDLINE and PsychINFO for primary articles published since the most recent high quality review (covering the period 2008-12). Study results were synthesized using random-effects meta-analysis.Results There were 12 studies comprising at least 12 000 person-years of follow-up. Exposure to NSP was associated with a reduction in HIV transmission: pooled effect size 0 center dot 66 [95% confidence interval (CI) 0 center dot 43, 1 center dot 01] across all studies, and 0 center dot 42 (95% CI 0 center dot 22, 0 center dot 81) across six higher quality studies (according to the Newcastle-Ottawa tool).Conclusions There is evidence to support the effectiveness of NSP in reducing the transmission of HIV among PWID, although it is likely that other harm reduction interventions have also contributed to the observed reduction in HIV risk. NSP should be considered as just one component of a programme of interventions to reduce both injecting risk and other types of HIV risk behaviour.