An International Systematic Review and Meta-analysis of Multisession Psychosocial Interventions Compared with Educationa
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SUBSTANTIVE REVIEW
An International Systematic Review and Meta-analysis of Multisession Psychosocial Interventions Compared with Educational or Minimal Interventions on the HIV Sex Risk Behaviors of People Who Use Drugs Nicholas Meader • Salaam Semaan • Marie Halton • Henna Bhatti • Melissa Chan Alexis Llewellyn • Don C. Des Jarlais
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Published online: 6 February 2013 Ó Springer Science+Business Media New York 2013
Abstract This systematic review and meta-analysis examines the effectiveness of multisession psychosocial interventions compared with educational interventions and minimal interventions in reducing sexual risk in people who use drugs (51 studies; 19,209 participants). We conducted comprehensive searches (MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials and PsychINFO 1998–2012). Outcomes (unprotected sex, condom use, or a composite outcome) were extracted by two authors and synthesised using meta-analysis. Subgroup analyses and meta-regression were conducted to explore heterogeneity. Multisession psychosocial interventions had modest additional benefits compared to educational interventions (K = 46; OR 0.86; 95 % CI 0.77, 0.96), and large positive
effects compared to minimal interventions (K = 7; OR 0.60; 95 % CI 0.46, 0.78). Comparison with previous meta-analyses suggested limited progress in recent years in developing more effective interventions. Multisession psychosocial and educational interventions provided similar modest sexual risk reduction justifying offering educational interventions in settings with limited exposure to sexual risk reduction interventions, messages, and resources. Keywords HIV/AIDS prevention People who use drugs Harm reduction Meta-analysis Sexual risk behavior
Introduction Electronic supplementary material The online version of this article (doi:10.1007/s10461-012-0403-y) contains supplementary material, which is available to authorized users. N. Meader (&) A. Llewellyn Centre for Reviews and Dissemination, University of York, York YO10 5DD, UK e-mail: [email protected] S. Semaan Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA, USA M. Halton H. Bhatti National Collaborating Centre for Mental Health, Royal College of Psychiatrists Research Unit, London, UK M. Chan University of Hong Kong, Pokfulam, Hong Kong D. C. Des Jarlais Beth Israel Medical Center, Baron Edmond de Rothschild Chemical Dependency Institute, New York, NY, USA
Sharing of drug injection equipment is a very efficient method for transmitting HIV. Persons who inject drugs (PWID) are also at risk of acquiring and transmitting HIV through unsafe sexual behavior. Sexual transmission of HIV among PWID is of increasing importance for several reasons including (but not limited to) the following factors: HIV infection among PWID has been reported in more than 120 countries, with a 20–40 % prevalence in at least 4 countries and over 40 % in nine countries [1]. High seroprevalence epidemics among PWI
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