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Suggested Citation:"Appendix B Literature Search Strategies." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Appendix B
Literature Search Strategies

This appendix discusses the Committee’s strategy for collecting evidence on the effectiveness of HIV prevention interventions for injecting drug users. The Committee targeted its search to include studies of the effectiveness of sterile needle and syringe access programs, drug treatment (including pharmacotherapies and psychosocial interventions), and outreach interventions in reducing HIV infection and drug- and sex-related HIV risk behavior. A secondary objective was to identify studies examining the impact of these interventions on treatment-related outcomes and the use of health and social services, and any unintended consequences they might have.

METHODS FOR COLLECTING EVIDENCE

In gathering evidence, the Committee first drew on previous systematic reviews of the literature. These included the 1995 National Research Council/Institute of Medicine report, Preventing HIV Transmission: The Role of Sterile Needles and Bleach; the World Health Organization’s Evidence for Action reports on access to sterile syringes, drug dependence treatment, and outreach; and recent reviews by the Cochrane Drug and Alcohol Review Group. Because the Committee’s charge differed somewhat from the focus of these reviews, the Committee also conducted its own comprehensive search of the English language published (peer-reviewed) and unpublished literature (including conference abstracts and reports) on the effectiveness of HIV prevention interventions for IDUs.

Suggested Citation:"Appendix B Literature Search Strategies." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

To identify literature relating to sterile needle and syringe access programs, psychosocial interventions, and outreach, a research librarian searched the following databases from 1980 to January 2006: PubMed, EMBASE, PsycINFO, Cochrane, Grey Literature Report, Social Science Abstracts, Web of Science, and WorldCat.

In investigating psychosocial treatment, the Committee also considered evidence from two systematic reviews from the Cochrane Collaboration:1

  • Psychosocial Combined with Agonist Maintenance Treatments versus Agonist Maintenance Treatments Alone for Treatment of Opioid Dependence

  • Psychosocial Treatment for Opiate Abuse and Dependence

In evaluating the effectiveness of pharmacotherapies for opioid and stimulant dependence, the Committee relied primarily on evidence in several Cochrane reviews:

  • Substitution Treatment of Injecting Opioid Users for Prevention of HIV Infection

  • Methadone Maintenance Therapy versus No Opioid Replacement Therapy for Opioid Dependence

  • Buprenorphine Maintenance versus Placebo or Methadone Maintenance for Opioid Dependence

  • LAAM Maintenance versus Methadone Maintenance for Heroin Dependence

  • Oral Naltrexone Maintenance Treatment for Opioid Dependence

  • Methadone Maintenance at Different Dosages for Opioid Dependence

  • Antidepressants for Cocaine Dependence

  • Treatment for Amphetamine Dependence and Abuse

  • Carbamazepine for Cocaine Dependence

  • Dopamine Agonists for Cocaine Dependence

1

The Cochrane Drug and Alcohol Review Group (the Review Group) is part of the Cochrane Collaboration, which was developed in the United Kingdom in 1992 with the goal of producing systematic reviews of the effects of various health care interventions that can be used by clinicians to guide their day-to-day practice. The Review Group conducts systematic reviews of primarily randomized clinical trials and controlled clinical trials of prevention, treatment, and rehabilitation interventions targeting drug dependence. To date, the Review Group has published over 30 reviews and 15 protocols. Available at: http://alcalc.oxfordjournals.org/cgi/content/full/36/2/109; http://www.cochrane.org/newslett/DrugsandAlcoholAutumn2005.pdf.

Suggested Citation:"Appendix B Literature Search Strategies." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

The Committee also reran the search strategies used in some of the Cochrane reviews from the publication date through February 2006. The Committee also considered the reference lists of key studies retrieved in the search, and unpublished data such as conference abstracts identified through the databases.

Together the Committee’s searches generated some 10,000 titles. Two Committee members reviewed all these titles and excluded those obviously unrelated to the targeted interventions. Any title selected by one Committee member remained on the list. IOM staff and consultants then reviewed abstracts of these articles to determine whether they were appropriate for further consideration, using criteria developed by the Committee. A third party resolved any discrepancies, in consultation with the two reviewers.

Committee and staff members then extracted key aspects of these articles—including the study design, their outcome measures, and limitations on their results—for further examination by the Committee. The Committee then assessed the strength and quality of the evidence most relevant to the charge, using the framework described in Chapter 2.

SEARCH STRATEGIES

Drug Dependence Treatment

The Committee reran the search strategies from the following Cochrane reviews to identify new references published since the publication date:

  • Buprenorphine Maintenance versus Placebo or Methadone Maintenance for Opioid Dependence

  • Methadone Maintenance Therapy versus No Opioid Replacement Therapy for Opioid Dependence

  • Oral Naltrexone Maintenance Treatment for Opioid Dependence

  • Psychosocial Combined with Agonist Maintenance Treatments versus Agonist Maintenance Treatments Alone for Treatment of Opioid Dependence

  • Psychosocial Treatment for Opiate Abuse and Dependence

Sterile Needle and Syringe Access

For this topic, the Committee modified search strategies appropriately for each database. The search strategy used on the PubMed database for sterile needle and syringe access is included below.

Suggested Citation:"Appendix B Literature Search Strategies." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×
Search #1:

needle*[tiab] OR syringe*[tiab] OR needle exchange OR syringe exchange

AND

decontaminat*[tiab] OR contaminat*[tiab] OR distribut*[tiab] OR dispos*[tiab] OR disinfect*[tiab] OR exchang*[tiab] OR bleach*

AND

Harm reduction[tiab]

AND

hiv infections/pc OR hiv infections/transmission OR acquired immunodeficiency syndrome/pc OR acquired immunodeficiency syndrome/tm OR hiv seropositivity/pc OR hiv seropositivity/tm OR hiv[tiab] OR aids[tiab]

Search #2:

needle exchange OR syringe exchange

AND

hiv infections/pc OR hiv infections/transmission OR acquired immunodeficiency syndrome/pc OR acquired immunodeficiency syndrome/tm OR hiv seropositivity/pc OR hiv seropositivity/tm OR hiv[tiab] OR aids[tiab]

NOT

results of Search #1

Search #3:

[needle*[tiab] OR syringe*[tiab] OR needle exchange OR syringe exchange

AND

decontaminat*[tiab] OR contaminat*[tiab] OR distribut*[tiab] OR dispos*[tiab] OR disinfect*[tiab] OR exchang*[tiab] OR bleach*

AND

hiv infections/pc OR hiv infections/transmission OR acquired immunodeficiency syndrome/pc OR acquired immunodeficiency syndrome/tm OR hiv seropositivity/pc OR hiv seropositivity/tm OR hiv[tiab] OR aids[tiab]]

OR

[needle exchange OR syringe exchange

AND

hiv infections/pc OR hiv infections/transmission OR acquired immunodeficiency syndrome/pc OR acquired immunodeficiency syndrome/tm OR hiv seropositivity/pc OR hiv seropositivity/tm OR hiv[tiab] OR aids[tiab]]

NOT

results of Searches #1 OR #2

Suggested Citation:"Appendix B Literature Search Strategies." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×
Search #4:

needle*[tiab] OR syringe*[tiab] OR needle exchange OR syringe exchange

AND

(risk* AND behav*) OR risk-taking[mh] OR risk factors[mh]

AND

hiv infections/prevention & control OR hiv infections/transmission OR acquired immunodeficiency syndrome/pc OR acquired immunodeficiency syndrome/tm OR hiv seropositivity/pc OR hiv seropositivity/tm OR hiv[tiab] OR aids[tiab]

Outreach and Psychosocial

The Committee used the following search strategy on the databases mentioned above to retrieve additional references related to outreach and psychosocial interventions:

  1. substance-related disorders/ or exp opioid-related disorders/ or substance abuse, intravenous/

  2. intravenous drug user?.mp.

  3. injecting drug user?.mp.

  4. injection drug use$.mp.

  5. inject$ drug use$.mp.

  6. 3 or 4

  7. intravenous drug use$.mp.

  8. 1 or 5 or 7

  9. exp HIV/

  10. exp hiv infections/ or acquired immunodeficiency syndrome/

  11. HIV Seroprevalence/

  12. 9 or 10 or 11

  13. 8 and 12

  14. prevention & control.fs.

  15. pc.fs. or prevention.mp. [mp=title, original title, abstract, name of substance word, subject heading word]

  16. Primary Prevention/

  17. (15 or 16) and 12

  18. 17 and 8

  19. exp psychotherapy/ or exp psychotherapy,brief/ or exp psychotherapy,group/ or exp psychotherapy,multiple/ or psychotherapy.mp. [mp=title, original title, abstract, name of substance word, subject heading word]

Suggested Citation:"Appendix B Literature Search Strategies." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×
  1. exp cognitive therapy/ or exp social adjustment/ or exp socialization/ or exp teaching/ or social skill? training.mp. or adaptation,psychological/ or coping skill?.mp.

  2. exp behavior therapy/ or self-control training.mp. or exp counseling/ or counseling.mp. or exp marital therapy/ or marital therapy.mp. or exp community mental health services/ or exp community networks/ or exp reinforcement,social/ or exp social support/ or community reinforcement.mp. or exp relaxation techniques/ or stress management.mp. or exp therapeutic community/ or therapeutic community.mp.

  3. exp complementary therapies/ or exp “mind-body and relaxation techniques”/ or “biofeedback (psychology)”/

  4. exp health education/ or patient education/

  5. psychosocial intervention?.mp.

  6. 19 or 20 or 21 or 22 or 24

  7. 18 and 25

  8. limit 26 to yr=“1980 - 2006”

  9. 13 and 25

  10. limit 28 to yr=“1980 - 2006”

  11. Community-Institutional Relations/ or outreach.mp.

  12. peer group/

  13. “peer education”.mp.

  14. behavior$ prevention?.mp.

  15. risk reduction behavior/

  16. “risk reduction”.mp.

  17. “harm reduction”.mp.

  18. peer network?.mp.

  19. 23 or 30 or 31 or 32 or 33 or 34 or 35 or 36 or 37

  20. 38 and 18

  21. 27 or 39

  22. 39

  23. limit 41 to yr=“1980 - 2006”

Suggested Citation:"Appendix B Literature Search Strategies." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×
Page 205
Suggested Citation:"Appendix B Literature Search Strategies." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×
Page 206
Suggested Citation:"Appendix B Literature Search Strategies." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×
Page 207
Suggested Citation:"Appendix B Literature Search Strategies." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×
Page 208
Suggested Citation:"Appendix B Literature Search Strategies." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×
Page 209
Suggested Citation:"Appendix B Literature Search Strategies." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×
Page 210
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Drug dependence is a complex, chronic, relapsing condition that is often accompanied by severe health, psychological, economic, legal, and social consequences. Injecting drug users are particularly vulnerable to HIV and other bloodborne infections (such as hepatitis C) as a result of sharing contaminated injecting equipment. All drug-dependent individuals, including injecting drug users (IDUs), may be at increased risk of HIV infection because of high-risk sexual behaviors. There are an estimated 13.2 million injecting drug users (IDUs) world-wide—78 percent of whom live in developing or transitional countries. The sharing of contaminated injecting equipment has become a major driving force of the global AIDS epidemic and is the primary mode of HIV transmission in many countries. In some cases, epidemics initially fueled by the sharing of contaminated injecting equipment are spreading through sexual transmission from IDUs to non-injecting populations, and through perinatal transmission to newborns. Reversing the rise of HIV infections among IDUs has thus become an urgent global public health challenge—one that remains largely unmet.

In response to this challenge, the Institute of Medicine convened a public workshop in Geneva in December 2005 to gather information from experts on IDU-driven HIV epidemics in the most affected regions of the world with an emphasis on countries throughout Eastern Europe, the Commonwealth of Independent States, and significant parts of Asia. Experts from other regions also provided information on their experiences in preventing HIV infection among IDUs. This report provides a summary of the workshop discussions.

Preventing HIV Infection among Injecting Drug Users in High Risk Countries describes the evidence on the intermediate outcomes of drug-related risk and sex-related risk prior to examining the impact on HIV transmission. This report focuses on programs that are designed to prevent the transmission of HIV among injecting drug users. These programs range from efforts to curtail non-medical drug use to those that encourage reduction in high-risk behavior among drug users. Although the report focuses on HIV prevention for IDUs in high-risk countries, the Committee considered evidence from countries around the world. The findings and recommendations of this report are also applicable to countries where injecting drug use is not the primary driver, but in which injection drug use is nevertheless associated with significant HIV transmission.

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