Introduction
Objective
Methods
Search Strategy
Eligibility
Data Extraction
Authors | Participants (% female) | Intervention delivery setting/staff | Intervention group description | Control group description | Length of follow-up | |||
---|---|---|---|---|---|---|---|---|
Intervention group/s | Number of sessions | Intervention function/s | Control intervention | Number of sessions | ||||
Abou-Saleh et al. [31] | 95 HCV-ve PWID (26%) | Outpatient drug treatment/treatment staff | Enhanced prevention counselling (N = 43) | 4 × 40–60 min sessions | Education, enablement | Simple educational counselling (N = 52) | 1 × 10 min session | 6 months post randomisation |
Avants et al. [32] | 220 PWID in methadone maintenance treatment (MMT) (69%) | MMT/clinician | Standard care + harm reduction group (N = 108) | 12 × 90 min weekly group sessions | Education, enablement, training | Standard care + single HIV risk reduction session (N = 112) | 1 × 2 h session | Post intervention |
Bertrand et al. [33] | 219 PWID that shared drugs or injection equipment (18%) | Not specified/researcher | Motivational intervention (MI) (N = 111) | 1 session | Enablement, persuasion | Education Intervention (N = 108) | 1 × 30–45 min | 6 months post randomisation |
Booth et al. [17] | 632 PWID (24%) | Residential detoxification/interventionist | Treatment as usual (TAU) + HIV/HCV counselling and education (C&E) (N = 212) TAU + intervention to facilitate treatment entry (N = 209) | 2 individual sessions individual session | Education, enablement, training | TAU: HIV/HCV risk assessment screening and referral for testing and counselling (N = 211) | HIV/HCV risk assessment screening and referral for testing and counselling | 6 months post randomisation |
Dushay et al. [34] | 669 drug users [64% injecting] (27%) | Not reported | Ethnic cultural enhanced intervention (n = 453) | 5 sessions | Education, enablement, training | AIDS video educational programme (N = 216) | 2 video sessions | 5–10 months post randomisation (20% interviewed 12 months post randomisation) |
El-Bassell et al. [35] | 282 HIV-negative drug-using couples (16% PWID) (50%) | Not reported/trained facilitator | Couple-based risk reduction (n = 190) Individual-based HIV risk reduction delivered to male or female drug using partner (n = 183) | 7 sessions | Enablement, training | Couple-based wellness promotion (n = 190) | 7 sessions | 12 months post randomisation |
Gagnon et al. [37] | 260 PWID (31%) | Needle exchange/computerised intervention | Standard intervention (needle exchanges, psychosocial support and social and health service referrals) + computer-tailored messages (N = 130) | 4 sessions | Education, enablement, modelling, persuasion | standard intervention (N = 130) | 4 weeks | 3 months post intervention |
654 HIV-ve and HCV-ve PWID (34%) | Not reported/trained facilitators | Peer education (N = 431) | 6 sessions | Education, enablement, training | Video discussion (N = 423) | 6 sessions | 6 months post intervention | |
Gilbert et al. [22] | 40 HIV-ve couples who inject drugs (50%) | Needle exchange/facilitators | Couple based HIV risk reduction (20 couples) | 3 single-gender group sessions + couple session | Education, modelling, training | Wellness promotion condition (20 couples) | 4 group sessions | 3 months post intervention |
Go et al. [59] | 419 index HIV-ve PWID (0%) | Not reported | Peer network-oriented (N = 210) | 6 sessions + 3 booster sessions | Education, enablement, training | TAU + HIV pamphlet (N = 209) | n/a | 12 months post intervention |
Go et al. [30] | 455 HIV + ve PWID (0%) | Community intervention education sessions delivered by a trained community mobilizer; Individual HIV knowledge and skill-building group sessions conducted by two facilitators |
Individual level
HIV testing and counselling, plus 2 individual post-test counselling sessions, 2 small group sessions (HIV knowledge and skill-building) + optional dyad session (N = 95)
Community and individual level
Community-wide programme consisting of a 2-part video and a series of 6 HIV education sessions (N = 132) | 4 individual sessions + 2 group sessions + optional dyad session 2-part video and a series of 6 HIV education sessions | Education, enablement, training education |
Individual level
HIV testing and counselling (N = 89)
Community level
Standard messages on HIV through village weekly public loudspeakers and educational pamphlets already being provided by community health stations (N = 139) | 2 sessions | 24 months post randomisation |
Hoffman [23] | 432 PWID (33%) | Research centre/facilitators | Psychological-communicative behavioral training Peer educator (N = 99) Network members (N = 127) | 7 group + 1 individual session + 4 booster meetings | Education, modelling, persuasion, training | Group sessions devoted to areas of interest (N = 92) Network members (N = 114) | 8 sessions | 24 months post randomisation |
418 HCV + ve PWID (24%) | 3 research sites/facilitators | Peer-mentoring behavioural intervention (N = 222) | 6 sessions | Education, training | Video-discussion (N = 196) | 6 sessions | 6 months post intervention | |
Latkin et al. [21] | 250 [47% PWID] (39%) | Clinic/indigenous para-professional facilitators | Small-group which encouraged peer outreach (N = 81) | 10 group sessions | Enablement, education, training | Equal-attention control condition (N = 36) | 10 sessions | 6 months post intervention |
414 networks with 1123 HIV-ve participants [91% PWID (3% in Thailand; 20% in US) | Not reported/facilitator | HIV counselling and testing (C&T) + group peer-education (N = 204 networks) | 2 individual + 6 group + 2 booster sessions | Education, enablement, persuasion, training | HIV C&T (N = 210 networks) | 2 sessions | Up to 30 months (24 in Thailand) post randomisation | |
Margolin et al. [43] | 90 PWID HIV + ve entering MMT (30%) | MMT/counsellor | Enhanced-MMT (E-MMP) (6 months of daily methadone and weekly individual substance abuse counseling and case management) + HIV Harm Reduction Program (N = 45) | 6-sessions | Enablement, persuasion, training | Enhanced-MMT (E-MMP) + active control that included harm reduction components (N = 45) | 6 sessions | 9 months post randomisation |
330 HIV-ve drug users [48% PWID] (100%) and male partners | Field office/interventionist | (1) Couple-Based HIV C&T (N = 110) [43% PWID] (2) Women only relationship-focused HIV C&T (N = 104) [51% PWID] | 2 sessions 2 sessions | Education, enablement | HIV C&T (N = 116) [51% PWID] | 2 sessions | 9 months post intervention | |
Otiashvili et al. [46] | 40 drug users [98% PWID] (0%) and drug-free female partners | Research unit/counsellor | MI for drug user and couple, contingency management + naltrexone (n = 20). Female partners invited to attend couples counselling | 22 sessions | Enablement, incentivisation | Education sessions. Referrals drug treatment (n = 20) | 22 sessions | 6 months post intervention |
966 HIV +ve PWID (36%) | Not reported/peers | Peer mentoring intervention (N = 486) | 10 sessions (7 group; 2 individual; 1 ‘peer activity’) | Education, enablement, training | Video discussion (N = 480) | 8 sessions | 12 months post intervention | |
Robles et al. [48] | 557 PWID (4%) | Assessment facility or drug treatment/nurse | HIV/AIDS risk intervention + counselling + case management (N = 285) | 2 sessions 6 sessions | Education, Enablement, training | HIV/AIDS risk intervention (N = 272) | 2 sessions | 6 months post randomisation |
1116 drug users [65% PWID] (33%) | Field office/counsellors/outreach workers | HIV C&T + HIV prevention programme (group skills focused workshops, individual counselling, outreach/social events) (N = 558; 359 PWID) | 2 HIV C&T sessions + 5 sessions (2 group, 1 individual +≥2 structured outreach) | Enablement, training | HIV C&T (N = 559; 364 PWID) | 2 sessions | 9 months post randomisation | |
Samet et al. [50] | 700 HIV + ve with risky sex and heavy alcohol consumption [60% PWID] (41%) | Hospital setting/peers | Healthy relationships intervention (n = 350; 212 PWID) | 2 individual + 3 small group sessions | Education, enablement, modelling, training | Attention control (n = 350; 211 PWID) | 2 individual + 3 group sessions | 12 months post randomisation |
81 drug users [96% PWID] (52%) | Research clinic/counsellor | MMT + individual counselling followed by 12 weeks of intervention condition, followed by a 12-week standard treatment (1) weekly CBT + contingent vouchers (CM) (N = 16) (2) weekly CBT + noncontingent vouchers (N = 19) (3) CM plus weekly group therapy (N = 22) | 29 weeks (methadone + 5 weekly individual counselling, 12 weeks of intervention, followed by 12 weeks standard treatment | Education, Enablement, Incentivisation Modelling, training | Standard dose of methadone (70–80 mg/day) + + weekly individual counselling (5 weeks) followed by 12 weeks of control condition, followed by a 12-week standard treatment Group therapy + non-contingent vouchers (N = 24) | 29 weeks (methadone + 5 weekly individual counselling, 12 weeks of intervention, followed by 12 weeks standard treatment | Post intervention | |
Stein et al. [51] | 109 PWID who drink hazardously (38%) | Research site/social worker | Referrals for substance use and medical treatment + brief MI (N = 60) | 2 sessions | Enablement | Referrals for substance abuse and medical treatment provided (N = 49) | n/a | 6 months post randomisation |
Stein et al. [52] | 109 PWID (36%) | Outpatient academic research office/Clinical Psychologist | CBT + pharmacotherapy for depression (N = 53) | 8 CBT sessions + 3 pharmacotherapy visits | Education, Enablement, Training | Assessment (N = 56) | Assessment visit | 9 months post randomisation |
Stein et al. [53] | 277 HCV-ve drug users [28% PWID] (37%) | Not stated/interventionist | MI (N = 140) | 4 sessions | Education, enablement, persuasion | Leaflet about local resources (N = 137) | n/a | 24 months post randomisation |
Sterk et al. [29] | 68 HIV-ve PWID (100%) | Health intervention project house/interventionists | Enhanced MI (EMI) (N = 20) Enhanced negotiation intervention (ENI) (N = 21) | 4 sessions 4 sessions | Education, enablement, training | NIDA standard intervention (N = 27) | 2 sessions | 6-months (not clear if post intervention or post randomisation) |
584 Sex workers who inject drugs (100%) | Not reported/counsellors | Interactive injection risk and didactic sexual risk intervention (N = 146) Interactive sexual risk and didactic injection risk intervention (N = 148) Interactive Injection and Sexual Risk Intervention) (N = 146) | 1 session 1 session 1 session | Education, enablement, modelling, persuasion, training | Didactic injection and sexual risk intervention (N = 144) | 1 × 60 min session | 12 months post randomisation | |
Tobin et al. [25] | 227 PWID (45%) | Research clinic/not reported | Peer educator intervention (N = 114) | 7 sessions (5 group + 1 individual + 1 with participant and enrolled Risk Network Members) | Education, enablement, training | Group information (N = 113) | 5 sessions | 18 months post intervention |
Tucker et al. [54] | 145 PWID (26%) | Out-patient clinical and research organization/clinical researcher | Tailored brief behavioural intervention (N = 73) | 1 session | Education, enablement | HCV educational leaflet (N = 72) | n/a | 1 month post randomisation |
Wechsberg et al. [24] | 100 PWID (100%) | Inpatient detoxification/psychologist | Woman-focused Intervention (N = 51) | 2 sessions | Education, enablement, training | Nutrition intervention (N = 49) | 2 sessions | 3 months post randomisation |
Zule et al. [19] | 851 PWID (27%) | Not reported/lay community members | HCV risk reduction MI (n = 423) | 6 sessions | Education, enablement, modelling, persuasion | Video HCV educational intervention (n = 428) | 6 sessions | 12 months post randomisation |
Methodological Quality
Intervention Descriptions
Statistical Analysis
Main and Subgroup Analysis
Outcome | N studies | N participants | Std. mean difference (IV to random to 95 CI) |
p value for effect | I2 (%) |
---|---|---|---|---|---|
Any injecting risk behaviours by control intervention and length of follow-up post-intervention | |||||
Subgroups
| |||||
Usual care (4–6 months) | 3 | 641 | −0.09 (−0.32 to 0.15) | 0.48 | 26% |
Education/information (≤3 months) | 1 | 145 | 0.00 (−0.35 to 0.36) | 0.98 | N/A |
Education/information (6 months) | 2 | 259 | −0.78 (−1.61 to 0.05) | 0.07 | 73% |
Education/information (≥9 months) | 2 | 646 | −0.41 (−0.74 to −0.08) | 0.01 | 0% |
HIV testing and counselling (6 months) | 1 | 557 | −0.47 (−0.94 to −0.00) | 0.05 | N/A |
HIV testing and counselling (≥9 months) | 2 | 588 | −0.18 (−0.40 to 0.04) | 0.11 | 0% |
Intervention lesser frequency or intensity without OST (≥9 months) | 2 | 1389 | 0.00 (−0.24 to 0.25) | 0.98 | 31% |
Intervention lesser frequency or intensity without OST (≤3 months) | 2 | 180 | −0.79 (−1.56 to −0.02) | 0.04 | 83% |
Intervention lesser frequency or intensity without OST (6 months) | 5 | 1532 | −0.32 (−0.55 to −0.10) | 0.004 | 55% |
Intervention lesser frequency or intensity with OST (≤3 months) | 1 | 40 | 0.66 (−0.72 to 2.03) | 0.35 | N/A |
Intervention lesser frequency or intensity with OST (≥9 months) | 1 | 90 | 0.06 (−0.82 to 0.93) | 0.9 | N/A |
Any injecting risk behaviours by control intervention and length of follow-up post-intervention (overall) | 22 | 6067 | −0.29 (−0.42 to −0.15) | <0.0001 | 61% |
Sharing needles/syringes by control intervention and length of follow-up post-intervention | |||||
Subgroups
| |||||
Usual care (4–6 months) | 1 | 109 | −0.53 (−1.12 to 0.07) | 0.08 | N/A |
Education/information (4–6 months) | 2 | 259 | −0.57 (−1.30 to 0.16) | 0.12 | 44% |
Education/information (≥9 months) | 1 | 419 | −0.24 (−1.23 to 0.76) | 0.64 | N/A |
HIV testing and counselling (4–6 months) | 1 | 557 | −0.47 (−0.94 to −0.00) | 0.05 | N/A |
HIV testing and counselling (≥9 months) | 2 | 588 | −0.18 (−0.40 to 0.04) | 0.11 | 0% |
Intervention lesser frequency or intensity without OST (≥9 months) | 1 | 423 | 0.11 (−0.15 to 0.37) | 0.4 | N/A |
Intervention lesser frequency or intensity without OST (≤3 months) | 1 | 80 | −1.19 (−1.67 to −0.72) | <0.00001 | N/A |
Intervention lesser frequency or intensity without OST (4–6 months) | 2 | 165 | −0.65 (−1.12 to −0.17) | 0.01 | 40% |
Intervention lesser frequency or intensity with OST (≤3 months) | 1 | 40 | 0.66 (−0.72 to 2.03) | 0.35 | N/A |
Intervention lesser frequency or intensity with OST (≥9 months) | 1 | 90 | −0.60 (−1.17 to −0.03) | 0.04 | N/A |
Sharing needles/syringes by control intervention and length of follow-up post-intervention (overall) | 13 | 2730 | −0.43 (−0.69 to −0.18) | 0.0003 | 68% |
Sharing other injecting paraphernalia by control intervention and length of follow-up post-intervention | |||||
Subgroups
| |||||
Education/information (4–6 months) | 1 | 219 | −0.42 (−0.98 to 0.14) | 0.15 | N/A |
HIV testing and counselling (4–6 months) | 1 | 557 | −0.11 (−0.43 to 0.21) | 0.51 | N/A |
HIV testing and counselling (≥9 months) | 2 | 588 | −0.20 (−0.40 to 0.01) | 0.06 | 0% |
Intervention lesser frequency or intensity (≤3 months) | 1 | 100 | −0.41 (−0.83 to 0.01) | 0.05 | N/A |
Intervention lesser frequency or intensity (4–6 months) | 2 | 902 | −0.20 (−0.40 to −0.01) | 0.04 | 0% |
Sharing other injecting paraphernalia by control intervention and length of follow-up post-intervention (overall) | 7 | 2366 | −0.21 (−0.34 to −0.09) | 0.0005 | 0% |
Frequency of injecting by control intervention and length of follow-up post-intervention | |||||
Subgroups
| |||||
Usual care (4–6 months) | 1 | 423 | 0.00 (−0.20 to 0.21) | 0.96 | N/A |
Education/information (4–6 months) | 1 | 40 | −1.05 (−2.07 to −0.03) | 0.04 | N/A |
HIV testing and counselling (≤3 months) | 3 | 1694 | −0.16 (−0.40 to 0.08) | 0.2 | 76% |
HIV testing and counselling (4–6 months) | 3 | 1694 | −0.16 (−0.40 to 0.08) | 0.2 | 76% |
HIV testing and counselling (≥9 months) | 3 | 1694 | −0.16 (−0.40 to 0.08) | 0.2 | 76% |
Intervention lesser frequency or intensity without OST (≤3 months) | 1 | 100 | −0.12 (−0.54 to 0.29) | 0.56 | N/A |
Intervention lesser frequency or intensity without OST (4–6 months) | 1 | 48 | −0.75 (−1.35 to −0.16) | 0.01 | N/A |
Intervention lesser frequency or intensity with OST (≤3 months) | 1 | 40 | 0.09 (−0.61 to 0.79) | 0.8 | N/A |
Frequency of injecting by control intervention and length of follow-up post-intervention (overall) | 8 | 5733 | −0.16 (−0.26 to −0.05) | 0 | 63% |
Outcome | N studies | N participants | Std. mean difference (IV to random to 95 CI) | p value for effect | I2 (%) |
---|---|---|---|---|---|
Any sexual risk behaviours by control intervention and length of follow-up post-intervention | |||||
Subgroups
| |||||
Education/information (≤3 months) | 1 | 145 | −0.21 (−0.56 to 0.15) | 0.25 | N/A |
Education/information (≥9 months) | 2 | 1078 | −0.10 (−0.41 to 0.20) | 0.51 | 60% |
HIV testing and counselling (≥9 months) | 1 | 174 | 0.14 (−0.81 to 1.09) | 0.77 | N/A |
Intervention lesser frequency or intensity without OST (≤3 months) | 2 | 180 | −0.65 (−0.96 to −0.34) | <0.0001 | 0% |
Intervention lesser frequency or intensity without OST (4–6 months) | 1 | 95 | 0.19 (−0.26 to 0.64) | 0.41 | N/A |
Intervention lesser frequency or intensity without (OST ≥9 months) | 1 | 966 | 0.01 (−0.24 to 0.25) | 0.96 | N/A |
Intervention lesser frequency or intensity with OST (≤3 months) | 1 | 40 | 0.51 (−0.54 to 1.57) | 0.34 | N/A |
Intervention lesser frequency or intensity with OST (≥9 months) | 1 | 90 | −0.76 (−1.55 to 0.04) | 0.06 | N/A |
Any sexual risk behaviours by control intervention and length of follow-up post-intervention (overall) | 10 | 2768 | −0.19 (−0.39 to 0.01) | 0.07 | 58% |
Unprotected sex by control intervention and length of follow-up post-intervention | |||||
Subgroups
| |||||
Education/information (≥9 months) | 1 | 851 | 0.03 (−0.18 to 0.24) | 0.79 | N/A |
HIV testing and counselling (≥9 months) | 1 | 174 | 0.14 (−0.81 to 1.09) | 0.77 | N/A |
Intervention lesser frequency or intensity without OST (≤3 months) | 180 | −0.65 (−0.96 to −0.34) | <0.0001 | 0% | |
Intervention lesser frequency or intensity without OST (4–6 months) | 1 | 48 | −0.61 (−1.19 to −0.02) | 0.04 | N/A |
Intervention lesser frequency or intensity without OST (≥9 months) | 1 | 423 | 0.01 (−0.19 to 0.21) | 0.94 | N/A |
Intervention lesser frequency or intensity with OST (≤3 months) | 1 | 40 | 0.51 (−0.54 to 1.57) | 0.34 | N/A |
Intervention lesser frequency or intensity with OST (≥9 months) | 1 | 90 | −0.60 (−1.17 to −0.03) | 0.04 | N/A |
Unprotected sex by control intervention and length of follow-up post-intervention (overall) | 8 | 1806 | −0.27 (−0.54 to −0.01) | 0.04 | 68% |
Number of partners by control intervention and length of follow-up post-intervention | |||||
Subgroups
| |||||
Education/information (≥9 months) | 1 | 227 | 0.01 (−0.14 to 0.17) | 0.89 | N/A |
Intervention lesser frequency or intensity without OST (4–6 months) | 1 | 48 | 3.24 (2.36 to 4.12) | <0.00001 | N/A |
Number of Partners by control intervention and length of follow-up post-intervention (overall) | 2 | 275 | 0.11 (−0.05 to 0.26) | 0.17 | 98% |