Drug Abuse and HIV Adherence Treatments: A Multi-Level, Comparative Meta-Analysis

描述（由申请人提供）：这是对PAR-10-021艾滋病科学跟踪研究过渡奖（R 03）的重新提交，标题为“药物滥用和艾滋病毒依从性治疗：多层次比较荟萃分析”。“药物使用和艾滋病毒药物依从性问题通常同时发生，并可能相互影响。虽然有大量的循证对照试验针对HIV阳性物质使用者的物质使用，药物依从性或两者兼而有之，但没有二次分析巩固了这些发现。需要进行研究综合，以指导循证实践，并向决策者通报艾滋病毒阳性药物使用者的最佳治疗战略。本项目的目的是使用系统回顾和荟萃分析方法来量化物质使用、药物依从性和双重重点干预对物质使用和药物依从性结局的影响。我们将进行全面的文献检索，以确定针对HIV阳性物质使用者中物质使用、HIV药物依从性或两者的对照试验。编码工具和综合编码手册将根据先前的工作进行开发或修改，以提取每项研究的关键方法学质量、研究设计、干预和参与者特征。经过培训的编码员将使用编码工具对每项纳入研究进行双倍评分。对于纳入荟萃分析的每项研究，将计算效应量和95%置信区间，以估计HIV/AIDS、物质使用以及双重重点干预对物质使用和药物依从性的影响程度。个别研究可能有助于这些结果的一个或两个措施。此外，将进行几项调节分析，以确定可能影响或缓和干预措施对结局影响的因素或亚组。对良好对照试验的荟萃分析为治疗效果提供了最有力的证据，并且对个人决策者来说更容易获得和消化。拟议的项目旨在通过对艾滋病毒感染药物使用者的治疗进行第一次全面的荟萃分析，改变目前的研究和临床实践。

DESCRIPTION (provided by applicant): This is a resubmission in response to PAR-10-021 AIDS-Science Track Award for Research Transition (R03) titled "Drug Abuse and HIV Adherence Treatments: A Multi-Level, Comparative Meta-Analysis." Substance use and HIV medication adherence problems commonly co-occur and likely mutually impact one another. Though there is a large evidence-based of controlled trials targeting substance use, medication adherence, or both among HIV positive substance users, no secondarily analyses have consolidated the findings. Research synthesis is needed to guide evidence-based practice and inform decision makers on the optimal treatment strategies for HIV positive substance users. The purpose of this project is to use systematic review and meta-analysis methodology to quantify the impact of substance use, medication adherence, and dual focused interventions on both substance use and medication adherence outcomes. We will conduct a comprehensive literature search to identify controlled trials targeting substance use, HIV medication adherence, or both among HIV positive substance users. Coding instruments and a comprehensive coding manual will be developed or modified from previous work to abstract key methodological quality, study design, intervention, and participant characteristics from each study. Trained coders will double rate each included study using the coding instruments. For each study included in the meta-analysis, effect sizes and 95% confidence intervals will be calculated to estimate the magnitude of HIV/AIDS, substance use, and dual focused intervention effect on substance use and medication adherence. Individual studies may contribute one or both of these outcome measures. In addition, several moderator analyses will be conducted to identify factors or subgroups that may impact or moderate the effects of interventions on outcomes. Meta-analysis of well-controlled trials provides the most powerful evidence available for the effects of treatment and is much more accessible and digestible to individual decision makers. The proposed project seeks to shift current research and clinical practice by conducting the first comprehensive meta-analysis on the treatment of HIV infected substance users.