Interventions to prevent HIV and Hepatitis C in people who inject drugs: A review of reviews to assess evidence of effectiveness

International Journal of Drug Policy

Article in Press

Georgina J. MacArthur, Eva van Velzen, Norah Palmateer, Jo Kimber, Anastasia Pharris, Vivian Hope, Avril Taylor, Kirsty Roy, Esther Aspinall,  David Goldberg, Tim Rhodes, Dagmar Hedrich, Mika Salminen, Matthew Hickman, Sharon J. Hutchinson

Received 27 June 2012; received in revised form 25 June 2013; accepted 3 July 2013. published online 23 August 2013.
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Abstract

Background

Injecting drug use is a major risk factor for the acquisition and transmission of HIV and Hepatitis C virus (HCV). Prevention of these infections among people who inject drugs (PWID) is critical to reduce ongoing transmission, morbidity and mortality.

Methods

A review of reviews was undertaken involving systematic literature searches of Medline, Embase, CINAHL, PsychINFO, IBSS and the Cochrane Library (2000–2011) to identify English language reviews regarding the effectiveness of harm reduction interventions in relation to HIV transmission, HCV transmission and injecting risk behaviour (IRB). Interventions included needle and syringe programmes (NSP); the provision of injection paraphernalia; opiate substitution treatment (OST); information, education and counselling (IEC); and supervised injecting facilities (SIFs). Reviews were classified into ‘core’ or ‘supplementary’ using critical appraisal criteria, and the strength of review-level evidence was assessed.

Results

Twelve core and thirteen supplementary reviews were included. From these reviews we identified: (i) for NSP: tentative review-level evidence to support effectiveness in reducing HIV transmission, insufficient review-level evidence relating to HCV transmission, but sufficient review-level evidence in relation to IRB; (ii) for OST: sufficient review-level evidence of effectiveness in relation to HIV transmission and IRB, but tentative review-level evidence in relation to HCV transmission; (iii) for IEC, the provision of injection paraphernalia and SIFs: tentative review-level evidence of effectiveness in reducing IRB; and either insufficient or no review-level evidence for these interventions in relation to HIV or HCV transmission.

Conclusion

Review-level evidence indicates that harm reduction interventions can reduce IRB, with evidence strongest for OST and NSP. However, there is comparatively little review-level evidence regarding the effectiveness of these interventions in preventing HCV transmission among PWID. Further studies are needed to assess the effectiveness and impact of scaling up comprehensive packages of harm reduction interventions to minimise HIV and HCV transmission among PWID.

Keywords: Hepatitis C, HIV, Harm reduction, People who inject drugs, Review

PII: S0955-3959(13)00116-3

doi:10.1016/j.drugpo.2013.07.001

© 2013 Elsevier B.V. All rights reserved.

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Canada : URGENT REQUEST FOR YOUR INPUT into a new HCV drug, SIMEPREVIR

Provided by HepCBC

On August 22nd, 2013 the Canadian Agency for Drugs and Technologies in Health (CADTH) released a call for patient input into Janssen Inc.’s new HCV drug, SIMEPREVIR. In order to prepare our Patient Group submission by the Sept. 13th deadline, HepCBC is ASKING for INPUT from HCV+ people and caregivers from throughout Canada, by Wednesday, Sept. 11th. CLICK HERE to ADD YOUR VOICE in determining whether this new treatment should be available in Canada, by contributing your ideas and experiences to HepCBC’s group submission.

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Notre Dame researchers develop system that uses a big data approach to personalized health care

William G. Gilroy Published: July 25, 2013

University of Notre Dame researchers have developed a computer-aided method that uses electronic medical records to offer the promise of rapid advances toward personalized health care, disease management and wellness.

Notre Dame computer science associate professor Nitesh V. Chawla and his doctoral student, Darcy A. Davis, developed the system called Collaborative Assessment and Recommendation Engine (CARE) for personalized disease risk predictions and well-being.

“The potential for ‘personalizing’ health care from a disease prevention, disease management and therapeutics perspective is increasing,” Chawla said. “Health care informatics and advanced analytics, or data science, may contribute to this shift from population-based evidence for health care decision-making to the fusion of population- and individual-based evidence in health care. The key question is how to leverage health population data to drive patient-centered health care.”

At the heart of CARE is a novel collaborative filtering method that captures patient similarities and produces personalized disease risk profiles for individuals. Using what is known as Big Data science, the system generates predictions focused on other diseases that are based on Big Data from similar patients.

“In its most conservative use, the CARE rankings can provide reminders for conditions that busy doctors may have overlooked,” Chawla said. “Utilized to its full potential, CARE can be used to explore broader disease histories, suggest previously unconsidered concerns and facilitate discussion about early testing and prevention, as well as wellness strategies that may ring a more familiar bell with an individual and are essentially doable.

“We believe that our work can lead to reduced re-admission rates, improved quality of care ratings and can demonstrate meaningful use, impact personal and population health, and push forward the discussion and impact on the patient-centered paradigm.”

Chawla points out that the core premise of CARE is centered on patient empowerment and patient engagement.

“Imagine visiting your physician’s office with a list of concerns and questions,” he said. “What if you could walk out of the office with a personalized assessment of your health, along with a list of personalized and important lifestyle change recommendations based on your predicted health risks? What if your physician was afforded a limitless experience to gauge the impact of your disease toward developing other diseases in the future? What if you could find out that there are other patients similar to you not only with respect to major symptoms, but also with respect to rare issues that have puzzled your doctor? What if you could have the experience of others at your fingertips and fathom the lifestyle changes warranted for mitigating diseases?”

Chawla believes the timing is right for CARE given changes in health care, reimbursement, reform, meaningful use of electronic health care data and a mandate for patient-centered outcomes.

“The industry is seeing a move toward health and well-being and how that can be personalized to an individual,” he said. “There is an increased focus on preventive care, well-being and reducing re-admission rates in the hospital. This system can help bend the cost curve.”

CARE has been awarded a U.S. patent.

A paper by Chawla and Davis describing the CARE system appears in the Journal of General Internal Medicine.

Chawla is the Frank Freimann Collegiate Associate Professor of Computer Science and Engineering and director of the Notre Dame Interdisciplinary Center for Network Science and Applications.

Contact: Nitesh Chawla, 574-631-1090, nchawla@nd.edu

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