1. WHO/HIV/2012.27
Annex
6.
Evidence
summaries
Question
1:
Should
rapid
HBV
vaccination
versus
a
standard
HBV
vaccination
regimen
be
used
with
people
who
inject
drugs?
Author,
year
Population
Findings
Christensen
2004
IDUs
in
prison
Denmark
and
Estonia
N=638
HBV
vaccine
regimen
completion
Randomised
study
(Denmark)
63%
for
rapid
schedule
vs.
20%
for
standard
schedule
Non-­‐randomised
study
(Estonia)
81%
for
rapid
schedule
67%
seroprotection
at
month
7
Brisette
2002
cocaine
and
heroin
users
Canada
n=908
HBV
vaccine
regimen
completion
73.7%
for
rapid
schedule
vs.
46.6%
for
standard
schedule
rapid
schedule/high
dose
group
developed
a
comparable
response
rate
to
the
standard
schedule
and
dose
group
82.4%
vs.
81.5%
Question
2:
Should
incentives
for
HBV
vaccination
completion
versus
no
incentives
be
used
with
people
who
inject
drugs?
Author,
year
Population
Findings
Seal
2003
IDU
USA
HBV
vaccine
regimen
completion
69%
(incentive
arm)
vs.
23%
(control
arm)
completed
the
HBV
vaccine
regimen

2. 2
N=96
Stitzer
2010
Cocaine
users
USA
N=26
HBV
vaccine
regimen
completion
77%
(incentive
arm)
vs.
46%
(control
arm)
completed
the
HBV
vaccine
regimen
Question
3:
Should
low
dead
space
syringes
versus
high
dead
space
syringes
be
provided
to
people
who
inject
drugs?
Author,
year
Population
Findings
Gyarmathy
2010
IDU
Hungary
N=215
Lithuania
N=300
95%
of
IDU
from
Hungary
vs.
5%
of
IDU
from
Lithuania
have
only
used
LDSS
syringes
HCV
prevalence
37%
(Hungary)
vs.
88%
(Lithuania)
HIV
prevalence
0%
(Hungary)
vs.
10%
(Lithuania)
IDUs
in
Lithuania
were
also
more
likely
to
share
and
use
a
greater
number
of
drugs
than
those
in
Hungary.
In
Lithuania,
injecting
liquid
opioids
was
particularly
associated
with
having
HCV
infection.
Zule
2009
IDU
USA
N=851
HIV
prevalence
• Shared
LDSSs
and
never
used
an
HDSS
vs.
never
shared
syringes
and
never
used
HDSSs:
adjusted
OR
0.89
(95%CI
0.34-­‐2.33)
• Used
a
HDSS
but
never
shared
any
type
of
syringes
vs.
never
shared
syringes
and
never
used
HDSSs:
adjusted
OR
1.59
(95%
CI:
0.60-­‐3.77)
• Used
an
HDSS
and
shared
an
LDSS
HDSS
vs.
never
shared
syringes
and
never
used
HDSSs:
adjusted
OR
1.40
(95%
CI
0.53-­‐3.73)
• Used
and
shared
HDSS
vs.
never
shared
syringes
and
never
used
HDSSs:
adjusted
OR
2.50
(95%
CI
1.01-­‐6.15)

3. 3
HCV
prevalence
• Shared
LDSSs
and
never
used
an
HDSS
vs.
never
shared
syringes
and
never
used
HDSSs:
adjusted
OR
0.96
(95%
CI
0.53-­‐1.71)
• Used
a
HDSS
but
never
shared
any
type
of
syringes
HDSS
vs.
never
shared
syringes
and
never
used
HDSSs:
adjusted
OR
2.25
(95%
CI
1.30-­‐
3.90)
• Used
an
HDSS
and
shared
an
LDSS
HDSS
vs.
never
shared
syringes
and
never
used
HDSSs:
adjusted
OR
2.85
(95%
CI
1.43-­‐5.69)
• Used
and
shared
HDSS
vs.
never
shared
syringes
and
never
used
HDSSs:
adjusted
OR
2.21
(95%
CI
1.12-­‐4.35)
Question
4:
Should
psychosocial
interventions
versus
no
psychosocial
interventions
be
used
in
people
who
inject
drugs?
Author,
year
Population
Findings
Abou
Saleh
2008
IDU
UK
N=95
82%
were
followed
up
at
6
months
65%
were
followed
up
at
12
months.
Two
interventions
-­‐
Enhanced
prevention
counselling
(EPC)
and
simple
educational
counselling
(SEC)
HCV
seroconversion
13%
at
12
months
-­‐
5%
(EPC)
and
8%
(SEC)
HCV
incidence
rates
9.1
per
100
person
years
for
the
EPC
group
17.2
per
100
person
years
for
the
SEC
group
12.9
per
100
person
years
for
the
cohort
as
a
whole
Gilbert
2010
Couples
who
are
IDU
Intervention
–
couple-­‐based
HIV/STI
risk
reduction
intervention
Increased
condom
use
and
decreased
unsafe
injections
at
3
mo.
follow-­‐up

4. 4
Kazakhstan
N=80
among
the
intervention
arm
Stein
2009
heroin
or
cocaine
users
USA
n-­‐277
A
four-­‐session
motivational
intervention
did
not
differ
significantly
in
reduce
Hepatitis
C
virus
seroconversion
among
IDUs
and
non-­‐IDUs
compared
to
an
assessment
only
condition,
but
did
decrease
injection
initiation.
Tucker
2004
IDU
Australia
N=145
Both
IDUs
in
the
brief-­‐behavioural
intervention
and
the
standardised
educational
intervention
control
group
reported
significant
reductions
in
risk
behaviour,
indicating
that
although
intervention
methods
were
not
more
effective
than
control.
Wu
2007
IDU
China
N=823
(T
0
)
N=852
(T
1
)
Needle
social
marketing
programme
intervention
over
a
12-­‐month
period
significantly
reduced
risky
drug
use
behaviours
and
HIV
and
HCV
incidence
among
Zule
2009
IDU
USA
N=851
The
use
of
new
syringe
at
last
injection
or
condom
use
at
last
sexual
encounter
did
not
differ
between
IDUs
receiving
a
6-­‐session
motivational
intervention
compared
those
receiving
an
educational
intervention,
although
the
percentage
of
IDUs
using
new
syringes
and
condoms
significantly
increased
from
baseline
in
both
groups.

5. 5
Question
5:
Should
peer
education
and
mentoring
versus
no
peer
education
and
mentoring
be
used
in
people
who
inject
drugs?
Author,
year
Population
Findings
Garfein
2007
IDU
USA
N=
853
29%
greater
decline
in
overall
injection
risk
among
intervention
group
6
months
post-­‐intervention
relative
to
the
control
[proportional
OR
0.71;
95%
CI:
0.52,
0.97],
and
a
76%
decrease
compared
with
baseline.
Decreases
were
also
observed
for
sexual
risk
behaviors,
but
they
did
not
differ
by
trial
arm.
Overall
HCV
infection
incidence
(18.4/100
person-­‐years)
did
not
differ
significantly
across
trial
arms
(RR
1.15;
95%
CL
0.72,
1.82).
No
HIV
seroconversions
were
observed.
Latka
2008
IDU
USA
N=418
Compared
with
the
control
group,
intervention-­‐group
participants
were
less
likely
to
report
distributive
risk
behaviors
at
3
months
(OR=0.46;
95%
CI:
0.27,
0.79)
and
6
months
(OR=0.51;
95%
CI:0.31,
0.83),
a
26%
relative
risk
reduction,
but
were
no
more
likely
to
cite
their
HCV-­‐positive
status
as
a
reason
for
refraining
from
syringe
lending.
Effects
were
strongest
among
intervention-­‐group
participants
who
had
known
their
HCVpositive
status
for
at
least
6
months.
Peer
mentoring
and
self-­‐efficacy
were
significantly
increased
among
intervention-­‐group
participants,
and
intervention
effects
were
mediated
through
improved
self-­‐efficacy.

6. 6
© World Health Organization 2012
All rights reserved. Publications of the World Health Organization are available on the WHO web site
(www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia,
1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail:
bookorders@who.int).
Requests for permission to reproduce or translate WHO publications – whether for sale or for
noncommercial distribution – should be addressed to WHO Press through the WHO web site
(http://www.who.int/about/licensing/copyright_form/en/index.html).
The designations employed and the presentation of the material in this publication do not imply the
expression of any opinion whatsoever on the part of the World Health Organization concerning the legal
status of any country, territory, city or area or of its authorities, or concerning the delimitation of its
frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may
not yet be full agreement.
The mention of specific companies or of certain manufacturers’ products does not imply that they are
endorsed or recommended by the World Health Organization in preference to others of a similar nature
that are not mentioned. Errors and omissions excepted, the names of proprietary products are
distinguished by initial capital letters.
All reasonable precautions have been taken by the World Health Organization to verify the information
contained in this publication. However, the published material is being distributed without warranty of
any kind, either expressed or implied. The responsibility for the interpretation and use of the material
lies with the reader. In no event shall the World Health Organization be liable for damages arising from
its use.