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Meta-Analysis
. 2010 Jan 20;2010(1):CD007192.
doi: 10.1002/14651858.CD007192.pub2.

Psychosocial interventions for reducing injection and sexual risk behaviour for preventing HIV in drug users

Nicholas Meader  1 , Ryan Li, Don C Des Jarlais, Stephen Pilling
Affiliations
Meta-Analysis

Psychosocial interventions for reducing injection and sexual risk behaviour for preventing HIV in drug users

Nicholas Meader et al. Cochrane Database Syst Rev. .

Abstract

Background: Drug users (including both injection drug users and crack cocaine users), are at high levels of risk for contracting HIV. Therefore it is important to reduce the injection and/or sexual risk behaviours of these groups both for the benefit of themselves and for society as a whole.

Objectives: To assess the efficacy of multi-session psychosocial interventions in comparison with standard education and minimal intervention controls for the reduction of injection and sexual risk behaviour.

Search strategy: Electronic searches were conducted of a number of bibliographic databases (including Cochrane Library, CINAHL, MEDLINE, PsycINFO). In addition, other methods of locating papers were employed including contacting various authors working in the field of HIV risk reduction and examining reference lists of applicable papers identified in the electronic search.

Selection criteria: The inclusion criteria consisted of randomised and quazi-randomised trials assessing the efficacy of psychosocial interventions in the reduction of injection and sexual risk behaviour for people who misused opiates, cocaine, or a combination of these drugs.

Data collection and analysis: Two authors independently assessed the eligibility of studies identified by the search strategy, quality assessed these studies and extracted the data. A total of 35 trials met the eligibility criteria of the review providing data on 11,867 participants.

Main results: There were minimal differences identified between multi-session psychosocial interventions and standard educational interventions for both injection and sexual risk behaviour. Although it should be noted there were large pre-post changes for both groups suggesting both were effective in reducing risk behaviours. In addition, there was some evidence of benefit for multi-session psychosocial interventions when compared with minimal controls. Subgroup analyses suggest that people in formal treatment are likely to respond to multi-session psychosocial interventions. It also appears single-gender groups may be associated with greater benefit.

Authors' conclusions: There is limited support for the widespread use of formal multi-session psychosocial interventions for reducing injection and sexual risk behaviour. Brief standard education interventions appear to be a more cost-effective option. Further research is required to assess if there are particular groups of drug users more likely to respond to such interventions.

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Conflict of interest statement

None known

Figures

1.1
1.1. Analysis
Comparison 1 Multi‐session psychosocial interventions versus Standard education, Outcome 1 Injection risk behaviour (3‐6 month follow up)).
1.2
1.2. Analysis
Comparison 1 Multi‐session psychosocial interventions versus Standard education, Outcome 2 Injection risk behaviour (follow up > 6months).
1.3
1.3. Analysis
Comparison 1 Multi‐session psychosocial interventions versus Standard education, Outcome 3 safer injection behaviour (3‐6 month follow up).
1.4
1.4. Analysis
Comparison 1 Multi‐session psychosocial interventions versus Standard education, Outcome 4 Sexual risk behaviour (3‐6 month follow up).
1.5
1.5. Analysis
Comparison 1 Multi‐session psychosocial interventions versus Standard education, Outcome 5 Sexual risk behaviour (> 6 months follow up).
1.6
1.6. Analysis
Comparison 1 Multi‐session psychosocial interventions versus Standard education, Outcome 6 Safer sexual behaviour (3‐6 month follow up).
1.7
1.7. Analysis
Comparison 1 Multi‐session psychosocial interventions versus Standard education, Outcome 7 Safer risk behaviour (> 6 month follow up).
1.8
1.8. Analysis
Comparison 1 Multi‐session psychosocial interventions versus Standard education, Outcome 8 Injection and Sexual risk behaviour (combined).
1.9
1.9. Analysis
Comparison 1 Multi‐session psychosocial interventions versus Standard education, Outcome 9 Injection and sexual risk behaviour (combined).
2.1
2.1. Analysis
Comparison 2 Standard education versus Minimal Control, Outcome 1 Safer injection risk behaviour (3‐6 month follow up).
2.2
2.2. Analysis
Comparison 2 Standard education versus Minimal Control, Outcome 2 Safer sexual risk behaviour (3‐6 months follow up).
2.3
2.3. Analysis
Comparison 2 Standard education versus Minimal Control, Outcome 3 Injection risk behaviour (3‐6 months follow up).
2.4
2.4. Analysis
Comparison 2 Standard education versus Minimal Control, Outcome 4 Sexual risk behaviour (3‐6 months follow up).
3.1
3.1. Analysis
Comparison 3 Multi‐session psychosocial intervention versus Minimal Control, Outcome 1 Sexual risk behaviour.
3.2
3.2. Analysis
Comparison 3 Multi‐session psychosocial intervention versus Minimal Control, Outcome 2 Injection risk behaviour.
3.3
3.3. Analysis
Comparison 3 Multi‐session psychosocial intervention versus Minimal Control, Outcome 3 Safer sexual behaviour.
4.1
4.1. Analysis
Comparison 4 Multi‐session psychosocial intervention vs Standard education (sub‐group analysis by setting), Outcome 1 Injection and Sexual risk behaviour (combined).
4.2
4.2. Analysis
Comparison 4 Multi‐session psychosocial intervention vs Standard education (sub‐group analysis by setting), Outcome 2 Injection and sexual risk behaviour (combined).
5.1
5.1. Analysis
Comparison 5 Multi‐session psychosocial intervention versus Standard education (subgroup analysis by gender), Outcome 1 Injection and Sexual risk behaviour (combined).
5.2
5.2. Analysis
Comparison 5 Multi‐session psychosocial intervention versus Standard education (subgroup analysis by gender), Outcome 2 Injection and sexual risk behaviour (combined).
6.1
6.1. Analysis
Comparison 6 Multi‐session psychosocial intervention vs Standard education (sub‐group analysis on HIV testing), Outcome 1 Injection and Sexual risk behaviour (combined).
6.2
6.2. Analysis
Comparison 6 Multi‐session psychosocial intervention vs Standard education (sub‐group analysis on HIV testing), Outcome 2 Injection and sexual risk behaviour (combined).
7.1
7.1. Analysis
Comparison 7 Multi‐session psychosocial intervention vs Standard education (sensitivity analysis: study quality), Outcome 1 Injection and Sexual risk behaviour (combined).
7.2
7.2. Analysis
Comparison 7 Multi‐session psychosocial intervention vs Standard education (sensitivity analysis: study quality), Outcome 2 Injection and sexual risk behaviour (combined).
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MeSH terms