Format

Send to

Choose Destination
Harm Reduct J. 2017 May 17;14(1):25. doi: 10.1186/s12954-017-0156-z.

Needle exchange programs for the prevention of hepatitis C virus infection in people who inject drugs: a systematic review with meta-analysis.

Author information

1
School of Medicine, Department of Emergency Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, PO Box 9149, Morgantown, WV, 26506-9149, USA. smdavis@hsc.wvu.edu.
2
Department of Social and Behavioral Sciences, West Virginia University, PO Box 9190, Morgantown, WV, 26506, USA.
3
Department of Biostatistics, West Virginia University, PO Box 9190, Morgantown, WV, 26506, USA.
4
School of Medicine, Department of Emergency Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, PO Box 9149, Morgantown, WV, 26506-9149, USA.
5
Department of Medicine, Section of Infectious Diseases, West Virginia University, PO Box 9163, Morgantown, WV, 26506, USA.

Abstract

BACKGROUND:

Previous research on the effectiveness of needle exchange programs (NEP) in preventing hepatitis C virus (HCV) in people who inject drugs (PWID) has shown mixed findings. The purpose of this study was to use the meta-analytic approach to examine the association between NEP use and HCV prevention in PWIDs.

METHODS:

Study inclusion criteria were (1) observational studies, (2) PWIDs, (3) NEP use, (4) HCV status ascertained by serological testing, (5) studies published in any language since January 1, 1989, and (6) data available for measures of association. Studies were located by searching four electronic databases and cross-referencing. Study quality was assessed using the Newcastle Ottawa (NOS) scale. A ratio measure of association was calculated for each result from cohort or case-control studies and pooled using a random effects model. Odds ratio (OR) and hazard ratio (HR) models were analyzed separately. Results were considered statistically significant if the 95% confidence interval (CI) did not cross 1. Heterogeneity was estimated using Q and I 2 with alpha values for Q ≤ 0.10 considered statistically significant.

RESULTS:

Of the 555 citations reviewed, 6 studies containing 2437 participants were included. Studies had an average NOS score of 7 out of 9 (77.8%) stars. Concerns over participant representativeness, unclear adjustments for confounders, and bias from participant nonresponse and loss to follow-up were noted. Results were mixed with the odds ratio model indicating no consistent association (OR, 0.51, 95% CI, 0.05-5.15), and the hazard ratio model indicating a harmful effect (HR, 2.05, 95% CI, 1.39-3.03). Substantial heterogeneity (p ≤ 0.10) and moderate to large inconsistency (I 2  ≥ 66%) were observed for both models.

CONCLUSIONS:

The impact of NEPs on HCV prevention in PWIDs remains unclear. There is a need for well-designed research studies employing standardized criteria and measurements to clarify this issue.

TRIAL REGISTRATION:

PROSPERO CRD42016035315.

KEYWORDS:

Hepatitis C; Heroin; Injection drug use; Meta-analysis; Needle exchange program; Opioids; Pain; Pain killers; Systematic review

PMID:
28514954
PMCID:
PMC5436422
DOI:
10.1186/s12954-017-0156-z
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for BioMed Central Icon for PubMed Central
Loading ...
Support Center