PWID – people who inject drugs

Contingency management (CM) interventions for people with HIV and substance use disorder were found in a systematic review with meta-analysis (Ribeiro et al. 2023, five studies) to have a more positive effect when compared to control conditions in:

• adherence to antiretroviral therapy during the intervention period (improved patient adherence by 2.69 (95% confidence interval: [0.08, 0.51]; p = .007)).

Adherence to antiretroviral therapy was measured by counting the increase in CD4 (a type of white blood cell).

Community distribution of naloxone was the focus of a systematic reviews of economic evaluations (Cherrier et al., 2022, 10 studies, one cost-effectiveness analysis, eight cost-utility analyses, and one cost-benefit analysis) and results showed that:

• all studies concluded that community distribution of naloxone was cost effective, with an incremental cost-utility ratio range of $US111-58,738 (year 2020 values) per quality-adjusted life-year gained.

 Education and naloxone distribution was found in an umbrella review of systematic reviews (Razaghizad et al., 2021, 6 SR containing 87 unique studies) effective in:

• producing long-term knowledge improvement regarding opioid overdose,
• improving participants' attitudes toward naloxone
• providing sufficient training for participants to safely manage overdoses.

Interventions aimed at improving engagement of PWID at any (or combination) of the following stages along the chronic HCV care cascade: a) linkage to care, defined as the clinical assessment of HCV infection or liver disease following diagnosis of HCV infection b) adherence to treatment, with regimens combining inter- feron/DAA or solely DAA were evaluated in a systematic review with meta-analysis (Schwarz et al., 2022, 14 studies).

Integrated care structures, where a variety of services are brought together, and nurse case management approaches that facilitate referral for HCV assessment and scheduling of specialist appointments for clients were found to be the most effective in:

• improving engagement throughout the continuum of HCV care among people who inject drugs and people receiving OST

Psychosocial interventions involving information, education, counselling and/or skills training (IECS) were found in a systematic review (Palmateer et al., 2022, 27 systematic review, 61 studies) to have sufficient evidence in:

• the prevention of injecting risk behaviours and injecting frequency among PWID.

Take home naloxone (THN) programs have been rapidly upscaled in response to increasing opioid-related mortality. One often cited concern is that naloxone provision could be associated with increased opioid use, due to the availability of naloxone to reverse opioid overdose.

A narrative systematic review (Tse et al., 2022, studies =7 - two quasi-experimental studies and five cohort studies, N= 2 578) investigated whether THN provision is associated with changes in substance use by participants enrolled in THN programs and found:

• no evidence that THN provision was associated with increased opioid use or overdose. 

Opioid substitution treatment (OST) was found in a narrative systematic review (Magwood et al., 2020) to be effective in:

• reducing mortality, morbidity, and substance use in homeless populations

The same results were confirmed by a narrative systematic review of reviews (Miler et al., 2021).

Drug consumption rooms (or supervised consumption facilities) were found in a narrative systematic review (Magwood et al., 2020) to be effective in:

• reducing lethal overdoses and other high risk behaviours without any significant harm
• improving access to care in homeless populations

Drug consumption rooms were found in a systematic review without meta-analysis (Kennedy et al., 2017, 47 studies) to have a promising but not significant effect in:

• reducing public disorders associated with illicit drug use (people injecting drugs in public, publicly discarded syringes and injection-related litter) (5 studies).

Results of 6 studies also found no change in drug-related offences (drug dealing, thefts or robbery incidents, drug possession) within the area of the DCRs.

Combined OST and high NSP coverage has been found to be effective in a systematic review with meta-analysis (Platt et al., 2017, 28 studies, N= 11 070 PWID) in:

• reducing the risk of HCV acquisition by 74 % (RR 0.26 95% CI 0.07 to 0.89).

Another systematic review (Palmateer et al., 2022, 27 systematic review, 61 studies) confirmed the results and found sufficient evidence to support the combination of OST and NSP in:

• the prevention of HCV transmission among PWID.
• the prevention of injecting risk behaviour among PWID.

While there are still not enough studies to assess the effect on HIV, considering the positive effect on HCV, experts assume the same positive effect on HIV infections.