Behavioural interventions for preventing hepatitis C infection in people who inject drugs: A global systematic review

Sacks-Davis, Rachel; Horyniak, Danielle; Grebely, Jason; Hellard, Margaret

doi:10.1016/j.drugpo.2011.08.002

« Previous Next »International Journal of Drug Policy
Volume 23, Issue 3 , Pages 176-184, May 2012

Behavioural interventions for preventing hepatitis C infection in people who inject drugs: A global systematic review

Rachel Sacks-Davis
- Centre for Population Health, Burnet Institute, 85 Commercial Rd, Melbourne 3004, Australia
- Department of Epidemiology and Preventative Medicine, Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne 3004, Australia
- Centre for Research Excellence into Injecting Drug Use, Burnet Institute, 85 Commercial Rd, Melbourne 3004, Australia
- Corresponding author at: GPO Box 2284, Melbourne 3001, Victoria, Australia. Tel.: +61 3 8506 2356; fax: +61 3 9282 2138.
Danielle Horyniak
- Centre for Population Health, Burnet Institute, 85 Commercial Rd, Melbourne 3004, Australia
- Department of Epidemiology and Preventative Medicine, Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne 3004, Australia
- Centre for Research Excellence into Injecting Drug Use, Burnet Institute, 85 Commercial Rd, Melbourne 3004, Australia
Jason Grebely
- The Kirby Institute for Infection and Immunity in Society, The University of New South Wales, Ground Floor, CFI Building, Corner Boundary & West Streets, Darlinghurst 2010, Sydney, Australia
Margaret Hellard
- Centre for Population Health, Burnet Institute, 85 Commercial Rd, Melbourne 3004, Australia
- Department of Epidemiology and Preventative Medicine, Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne 3004, Australia
- Centre for Research Excellence into Injecting Drug Use, Burnet Institute, 85 Commercial Rd, Melbourne 3004, Australia

Received 18 May 2011; received in revised form 2 August 2011; accepted 16 August 2011. published online 14 October 2011.

Abstract

Background

A systematic review was conducted to determine whether behavioural interventions are effective in preventing transmission of hepatitis C virus (HCV) amongst people who inject drugs.

Methods

Medline, EMBASE, the Cochrane Clinical Trial Database, PSYCHINFO and hand-searching of bibliographies were used to identify controlled trials of behavioural interventions for reducing HCV transmission amongst people who inject drugs. Behavioural interventions were defined as non-pharmacological interventions that aimed to change individual behaviours without explicitly attempting to change population norms.

Results

Six trials evaluating peer-education training and counselling interventions were included in the review. There was considerable variation between trials with respect to intervention duration, control and study population. Trials evaluated the impact of interventions on HCV incidence (three studies, 1041 participants) and frequency of injecting risk behaviours (six studies, 2472 participants). Amongst the three studies which measured the impact of the intervention on HCV incidence, none found a statistically significant difference between intervention and control groups. Measures of frequency of injecting risk behaviours varied greatly and could not be pooled. Only two studies (n=418, 854) showed significantly greater reductions in injecting risk behaviours in the intervention group compared with the control group.

Conclusions

There was considerable variation in study design, outcome measures and magnitude, direction and statistical significance of findings between studies. Nonetheless, it is unlikely that behavioural interventions can have a considerable effect on HCV transmission. It is likely that multi-component interventions are required.

Keywords: People who inject drugs, Injecting drug use, Behavioural interventions, Psychosocial interventions, Hepatitis C, Systematic review