Historique
Article de Périodique
Needle exchange programs for the prevention of hepatitis C virus infection in people who inject drugs: a systematic review with meta-analysis (2017)
Auteur(s) :
DAVIS, S. M. ;
DAILY, S. ;
KRISTJANSSON, A. L. ;
KELLEY, G. A. ;
ZULLIG, K. ;
BAUS, A. ;
DAVIDOV, D. ;
FISHER, M.
Année
2017
Page(s) :
15 p.
Sous-type de document :
Méta-analyse / Meta-analysis ; Revue de la littérature / Literature review
Langue(s) :
Anglais
Refs biblio. :
68
Domaine :
Drogues illicites / Illicit drugs
Thésaurus mots-clés
REDUCTION DES RISQUES ET DES DOMMAGES
;
ECHANGE DE SERINGUES
;
PROGRAMME
;
HEPATITE
;
USAGER
;
INJECTION
;
HEROINE
;
OPIOIDES
;
INTERVENTION
;
PREVENTION
Résumé :
Background: Previous research on the effectiveness of needle exchange programs (NEP) in preventing hepatitis C virus (HCV) in people who inject drugs (PWID) has shown mixed findings. The purpose of this study was to use the meta-analytic approach to examine the association between NEP use and HCV prevention in PWIDs.
Methods: Study inclusion criteria were (1) observational studies, (2) PWIDs, (3) NEP use, (4) HCV status ascertained by serological testing, (5) studies published in any language since January 1, 1989, and (6) data available for measures of association. Studies were located by searching four electronic databases and cross-referencing. Study quality was assessed using the Newcastle Ottawa (NOS) scale. A ratio measure of association was calculated for each result from cohort or case-control studies and pooled using a random effects model. Odds ratio (OR) and hazard ratio (HR) models were analyzed separately. Results were considered statistically significant if the 95% confidence interval (CI) did not cross 1. Heterogeneity was estimated using Q and I² with alpha values for Q <= 0.10 considered statistically significant.
Results: Of the 555 citations reviewed, 6 studies containing 2437 participants were included. Studies had an average NOS score of 7 out of 9 (77.8%) stars. Concerns over participant representativeness, unclear adjustments for confounders, and bias from participant nonresponse and loss to follow-up were noted. Results were mixed with the odds ratio model indicating no consistent association (OR, 0.51, 95% CI, 0.05-5.15), and the hazard ratio model indicating a harmful effect (HR, 2.05, 95% CI, 1.39-3.03). Substantial heterogeneity (p <= 0.10) and moderate to large inconsistency (I² >= 66%) were observed for both models.
Conclusions: The impact of NEPs on HCV prevention in PWIDs remains unclear. There is a need for well-designed research studies employing standardized criteria and measurements to clarify this issue.
Trial registration: PROSPERO CRD42016035315.
Methods: Study inclusion criteria were (1) observational studies, (2) PWIDs, (3) NEP use, (4) HCV status ascertained by serological testing, (5) studies published in any language since January 1, 1989, and (6) data available for measures of association. Studies were located by searching four electronic databases and cross-referencing. Study quality was assessed using the Newcastle Ottawa (NOS) scale. A ratio measure of association was calculated for each result from cohort or case-control studies and pooled using a random effects model. Odds ratio (OR) and hazard ratio (HR) models were analyzed separately. Results were considered statistically significant if the 95% confidence interval (CI) did not cross 1. Heterogeneity was estimated using Q and I² with alpha values for Q <= 0.10 considered statistically significant.
Results: Of the 555 citations reviewed, 6 studies containing 2437 participants were included. Studies had an average NOS score of 7 out of 9 (77.8%) stars. Concerns over participant representativeness, unclear adjustments for confounders, and bias from participant nonresponse and loss to follow-up were noted. Results were mixed with the odds ratio model indicating no consistent association (OR, 0.51, 95% CI, 0.05-5.15), and the hazard ratio model indicating a harmful effect (HR, 2.05, 95% CI, 1.39-3.03). Substantial heterogeneity (p <= 0.10) and moderate to large inconsistency (I² >= 66%) were observed for both models.
Conclusions: The impact of NEPs on HCV prevention in PWIDs remains unclear. There is a need for well-designed research studies employing standardized criteria and measurements to clarify this issue.
Trial registration: PROSPERO CRD42016035315.
Affiliation :
School of Medicine, Department of Emergency Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, USA