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Cochrane summary

Preventing HIV risks in drug users

  • Comment

Several methods are intended to reduce risky injection and sexual behaviour in drug users. This Cochrane review compared multi-session psychosocial support with standard interventions

Author

Nerys Brick is senior lecturer in adult nursing, critical care lead for part-time students and pathway lead for acute care, IPL, CPD, Canterbury Christ Church University and a member of the Cochrane Nursing Care Field (CNCF).

Review question

What is the efficacy of multi-session psychosocial interventions compared to standard education and minimal intervention controls for reducing injection and sexual risk behaviour in drug users?

FREE for one week: Identifying and Testing Patients for HIV Infection CPD unit

Nursing implications

It is widely accepted drug users are at a higher risk of contracting Human Immunodeficiency Virus (HIV) than the general population.  Studies have reported that in some cases 24% of drug users have used needles and syringes that have already been used by another.  Research has also shown drug users engage in higher levels of sexual risk behaviour.

It is important to reduce the injection and/or sexual risk behaviours of this group, both to benefit themselves and society.  Programmes have been established concerning needle and syringe exchanges.

This review aimed to determine the efficacy of multi-session psychosocial interventions to see whether this provision is likely to prevent HIV risk behaviours. It also looked at the effects of this on resources in settings such as the needle and syringe exchange programmes.

Study characteristics

The review included 35 randomised and quasi-randomised control trials - a total of 11,867 participants. Participants were people who misused opiates, cocaine or both.  This included those in contact with drug treatment services and those who were not.  There were no age limitations or requirements regarding the length of time of “drug misuse”.

Types of interventions within studies were multi-session psychosocial, designed to reduce injection and/or sexual risk behaviour among people who misused drugs.  These sessions were defined as “a programme for individuals or groups of people who misuse drugs that consist of a minimum of three sessions, combining education about HIV with skills training to improve communication skills, assertiveness, and safe sexual and injection risk behaviour”.

These sessions took place in such settings as methadone maintenance clinics, needle and syringe exchanges, and outreach programmes.  Standard education interventions were designed for individuals or groups who misused drugs and consisted of one to two sessions.  The content was often similar to multi-session interventions including HIV testing, counselling and some skills training.  Minimal intervention was defined as “receiving minimal or no psychosocial intervention” and often involved providing a self-help booklet.

The intervention studies needed to contain at least one outcome measure of: injection risk behaviour, sexual risk behaviour, or HIV seroconversion. 

28 trials contained comparisons of multi-session psychosocial interventions with standard education.  Five compared multi-session psychosocial interventions with the provision of a self-help booklet, and six compared standard education with a self-help booklet.  The total number of comparisons was greater than the total number of trials, as some included more than one treatment or control arm.

Summary of key evidence

In terms of injection risk behaviour, there was no difference as to whether the participants undertake the standard education to those in multi-sessional psychosocial interventions, as the interventions for both were similar. There was a similar result with regards to sexual risk behaviour.

There was no evidence of any difference between standard and minimal interventions for both injection risk behaviour and sexual risk behaviour.

There was no suggestion of any difference between multi-session psychosocial interventions and minimal interventions for injection risk behaviour.  There was some evidence of benefit for multi-session psychosocial interventions for sexual risk behaviour.

Setting seemed to have an impact on how effective the intervention was.  There appeared to be a small benefit for people already engaged in treatment. 

The effects of the provision of HIV testing did not seem to have an impact on results.

Best practice recommendations

Evidence suggests formal multi-session psychosocial interventions are no more effective than briefer standard education in reducing behaviours in drug users. There is insufficient evidence to recommend the widespread use of formal multi-session psychosocial interventions to reduce the injection and sexual risk behaviours of drug users.

The studies do support the continued use of educational interventions, even though there is minimal difference between more intensive multi-session psychosocial and standard educational interventions.

For the full review of the report, including references,click here

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