Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries An Assessment of the Evidence (2007) / Chapter Skim
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Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange
Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange
Pages 225-268
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Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange (NSE)
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226 PREVENTING HIV INFECTION AMONG INJECTING DRUG USERS TABLE D-1 Case-Control Studies Study Description Sample Size (n)
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. exchange's role as the primary source of HIV prevention for local IDUs may have contributed to the magnitude of the association between syringe exchange and risk of viral hepatitis.
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228 PREVENTING HIV INFECTION AMONG INJECTING DRUG USERS TABLE D-1 Continued Study Description Sample Size (n) van Ameijden et al., 1992 Assesses risk factors for Cases: 31 IDU HIV seroconversion among seroconverters IDU and investigates if HIV prevention services Controls: 202 seronegative in Amsterdam have a IDUs protective effect on HIV seroconversion.
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APPENDIX D 229 Outcome Measures Results Limitations HIV seroconversion No evidence was found · Self-reported data. that receiving daily · Small statistical power methadone treatments at and the need to methadone posts and dichotomize most obtaining new needles/ variables because of the syringes via the NSE were small number of protective.
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associated with cessation of syringe sharing among high-risk injecting drug users.
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APPENDIX D 231 Outcome Measures Results Limitations Syringe sharing; use of At follow-up interview, · Participants not randomly syringe exchange. 60% reported quitting selected.
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232 PREVENTING HIV INFECTION AMONG INJECTING DRUG USERS TABLE D-2 Continued Study Description Sample Size (n)
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APPENDIX D 233 Outcome Measures Results Limitations Sustained injection 18.5% of IDUs reported · Majority of study cessation. a period of sustained participants were cocaine injection cessation addicts.
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234 PREVENTING HIV INFECTION AMONG INJECTING DRUG USERS TABLE D-2 Continued Study Description Sample Size (n) Des Jarlais et al., 1996 Uses meta-analytic Syringe Exchange Evaluation techniques to combine study, n=280; Vaccine HIV incidence data from Preparedness Initiative three studies: the Syringe cohort, n=133 continuing Exchange Evaluation, the exchangers and n=188 Vaccine Preparedness non-exchangers; and the Initiative, and the National NADR, n=1029.
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APPENDIX D 235 Outcome Measures Results Limitations HIV incidence. HIV incidence among · Important local conditions continuing exchange users that created a strong in the Syringe Exchange contrast in the risk for Evaluation was 1.58 per HIV infection between 100 person-years at risk syringe-exchange (95% CI: 0.544.65)
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clients with that of non-clients in San Jose, California, and determines if NSE use is protective against high-risk injection behavior. Hagan and Thiede, 2000 Studies the influence of the 1,582 IDUs who met Seattle NSE on sharing of eligibility criterion: injecting drug injection equipment, at least once during the to identify potential gaps month prior to follow-up.
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APPENDIX D 237 Outcome Measures Results Limitations Frequency of injection; Both univariate and · Attrition from baseline to borrowed syringe; multivariate analysis of follow-up rendered the borrowed un-sterilized the impact of NSE on sample less syringe; syringe borrowed HIV risk at follow-up representative. only from HIV-negative revealed a more than · Small sample size.
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238 PREVENTING HIV INFECTION AMONG INJECTING DRUG USERS TABLE D-2 Continued Study Description Sample Size (n)
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previous borrowers, long- · Small sample size. term moderate/heavy alcohol users, current cocaine injectors, and drug users without permanent housing.
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240 PREVENTING HIV INFECTION AMONG INJECTING DRUG USERS TABLE D-2 Continued Study Description Sample Size (n)
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APPENDIX D 241 Outcome Measures Results Limitations HIV, HBV, HCV No new HIV infections · Absence of spread of seroconversion. occurred during a median HIV in this program may follow-up of 31 months.
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242 PREVENTING HIV INFECTION AMONG INJECTING DRUG USERS TABLE D-2 Continued Study Description Sample Size (n)
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APPENDIX D 243 Outcome Measures Results Limitations HIV-related risk Not using previously used · Problems recruiting and behaviors. needles was substantially then re-recruiting large protective against HIV numbers of IDUs in seroconversion (RR=0.29; several US cities.
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244 PREVENTING HIV INFECTION AMONG INJECTING DRUG USERS TABLE D-2 Continued Study Description Sample Size (n)
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APPENDIX D 245 Outcome Measures Results Limitations Self-reports of NSE 35% had registered with · Unlikely to have attendance. the Baltimore NSE.
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246 PREVENTING HIV INFECTION AMONG INJECTING DRUG USERS TABLE D-2 Continued Study Description Sample Size (n)
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No increase in the · Participants may not proportion injecting drugs represent general or the frequency of drug population of drug users use. There was a decrease in Amsterdam.
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associated with reduction(s) in high-risk injection practices among HIV seropositive drug users in Baltimore.
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APPENDIX D 249 Outcome Measures Results Limitations Mortality. The study recorded 77 · Misclassification may deaths.
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Wood et al., 2003 Evaluates the risk profile 587 active IDUs. of the population served by the Vancouver Area Network of Drug Users (VANDU)
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APPENDIX D 251 Outcome Measures Results Limitations High-risk needle sharing Logistic regression · Participants not included (defined as borrowing a analysis found that in this study had different used needle from someone difficulty gaining access characteristics than those other than the intimate to clean needles (AOR= who were included (single, sexual partner in the 3.36) , bingeing (AOR= younger, HIV negative)
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252 PREVENTING HIV INFECTION AMONG INJECTING DRUG USERS TABLE D-3 Ecological Studies Study Description Sample Size (n) Amundsen et al., 2003 Discusses the effectiveness HIV prevention programs of legal access to needles for IDUs in Denmark, and syringes versus HIV Norway, and Sweden.
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APPENDIX D 253 Outcome Measures Results Limitations HIV incidence rates over Results suggest that a high · Susceptible populations time (19801996)
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254 PREVENTING HIV INFECTION AMONG INJECTING DRUG USERS TABLE D-3 Continued Study Description Sample Size (n)
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· HIV seroprevalence may have remained low in some of the cities with NSEs, regardless of their introduction. · It was not possible to separate the effects of implementation of NSEs from the other HIV prevention strategies.
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256 PREVENTING HIV INFECTION AMONG INJECTING DRUG USERS TABLE D-3 Continued Study Description Sample Size (n)
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· It was not possible to separate the effects of implementation of NSEs from the other HIV prevention strategies. · HIV seroprevalence may have remained low in some of the cities with NSEs, regardless of their introduction.
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258 PREVENTING HIV INFECTION AMONG INJECTING DRUG USERS TABLE D-4 Selected Serial Cross-Sectional Studies Study Description Sample Size (n) Des Jarlais et al., 2005b Estimates HIV incidence 3,651 IDUs.
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declined from 46% to · Selected only drug users 10%; and reuse of needles who had injected in the and syringes declined from preceding 6 months.
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260 PREVENTING HIV INFECTION AMONG INJECTING DRUG USERS TABLE D-4 Continued Study Description Sample Size (n) Watters et al., 1994 Evaluates an all-volunteer 5,644 IDUs recruited in two syringe exchange program 21-day drug detoxification in San Francisco using clinics and three street 11 semiannual cross- settings.
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APPENDIX D 261 Outcome Measures Results Limitations Use of syringe exchange In 1992, 45% reported · Self-reported data. program; source of usually obtaining injection · Identifies correlates of syringes; frequency of equipment from the syringe sharing syringes, but not injection; initiation into exchange, and 61% causes of reduced sharing.
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262 PREVENTING HIV INFECTION AMONG INJECTING DRUG USERS TABLE D-5 Selected Cross-Sectional Studies Study Description Sample Size (n) Hagan et al., 1993 Reports on the operation 204 syringe exchange users.
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APPENDIX D 263 Outcome Measures Results Limitations Drug use; injection Frequency of injection did · Retrospective sampling. practices; unsafe injections.
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264 PREVENTING HIV INFECTION AMONG INJECTING DRUG USERS TABLE D-5 Continued Study Description Sample Size (n) Longshore et al., 2001 Tests frequency of 248 IDUs.
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APPENDIX D 265 Outcome Measures Results Limitations Sharing of needles, Results showed that IDUs · May have underestimated cookers, and cotton filters; who attended the NSE relevance of NSE cleaning of the skin before less frequently were more attendance for skin injecting; and use of likely to report needle cleaning. bleach as a needle sharing, less likely to report · Self-reported data.
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2000. Syringe exchanges: A public health response to problem drug use.
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Public Health Reports.
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American Journal of Public Health.
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