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Meta-Analysis
. 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

Stephen M Davis  1 , Shay Daily  2 , Alfgeir L Kristjansson  2 , George A Kelley  3 , Keith Zullig  2 , Adam Baus  2 , Danielle Davidov  4   2 , Melanie Fisher  5
Affiliations
Meta-Analysis

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

Stephen M Davis et al. Harm Reduct J. .

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.

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Figures

Fig. 1
Fig. 1
Flow diagram for the selection of studies. *Number of reasons exceeded the number of studies because some studies were excluded for more than one reason
Fig. 2
Fig. 2
a Forest plot for the risk of hepatitis C infection among needle exchange program participants. The black squares represent the risk of hepatitis C infection observed in each study with the 95% confidence intervals represented by the lines on each side of the squares. The diamond represents the pooled risk of hepatitis C infection with the 95% confidence interval indicated by the left and right extremes of the diamond. b Influence analysis for the risk of hepatitis C infection among needle exchange program participants. Influence analysis for point estimate changes in the risk of hepatitis C infection with each individual study deleted from the model once. c Cumulative meta-analysis for the risk of hepatitis C infection among needle exchange program participants. The results of each corresponding study, ordered by year of publication from oldest to newest, are pooled with all studies preceding it
Fig. 3
Fig. 3
Forest plot for the odds of hepatitis C infection among needle exchange program participants. The black squares represent the odds of hepatitis C infection observed in each study with the 95% confidence intervals represented by the lines on each side of the squares. The diamond represents the pooled odds of hepatitis C infection with the 95% confidence interval indicated by the left and right extremes of the diamond
See this image and copyright information in PMC

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