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Racial/ethnic disparities in HIV infection among people who inject drugs: an international systematic review and meta-analysis.

ABSTRACT: The Ethnic Minority Meta-Analysis (EMMA) aims to assess racial/ethnic disparities in HIV infection among people who inject drugs (PWID) across various countries. This is the first report of the data.Standard systematic review/meta-analysis methods were utilized, including searching for, screening and coding published and unpublished reports and meta-analytical statistics. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines for reporting methods. Disparities were measured with the odds ratio (OR) for HIV prevalence among ethnic minority PWID compared to ethnic majority PWID; an OR >1.0 indicated higher prevalence among ethnic minorities.Racial/ethnic disparities in HIV prevalence among PWID were examined in 131 prevalence reports, with 214 racial/ethnic minority to majority comparisons, comprising 106?715 PWID. Overall, the pooled OR indicates an increased likelihood of higher HIV prevalence among racial/ethnic minority compared to racial/ethnic majority PWID [OR?=?2.09, 95% confidence interval (CI): 1.92-2.28]. Among 214 comparisons, 106 produced a statistically significant higher OR for minorities; in 102 comparisons the OR was not significantly different from 1.0; six comparisons produced a statistically significant higher OR for majority group members. Disparities were particularly large in the United States, pooled OR?=?2.22 (95% CI: 2.03-2.44). There was substantial variation in ORs-I(2) ?=?75.3%: interquartile range?=?1.38-3.56-and an approximate Gaussian distribution of the log ORs.Among people who inject drugs, ethnic minorities are approximately twice as likely to be HIV seropositive than ethnic majorities. The great heterogeneity and Gaussian distribution suggest multiple causal factors and a need to tailor interventions to local conditions.

SUBMITTER: Des Jarlais DC

PROVIDER: S-EPMC3504180 | biostudies-literature | 2012 Dec

REPOSITORIES: biostudies-literature

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Racial/ethnic disparities in HIV infection among people who inject drugs: an international systematic review and meta-analysis.

Des Jarlais Don C DC Bramson Heidi A HA Wong Cherise C Gostnell Karla K Cepeda Javier J Arasteh Kamyar K Hagan Holly H

Addiction (Abingdon, England) 20121018 12

<h4>Aims</h4>The Ethnic Minority Meta-Analysis (EMMA) aims to assess racial/ethnic disparities in HIV infection among people who inject drugs (PWID) across various countries. This is the first report of the data.<h4>Methods</h4>Standard systematic review/meta-analysis methods were utilized, including searching for, screening and coding published and unpublished reports and meta-analytical statistics. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) stat ...[more]

PMID: 22823178

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Project description:ObjectiveTo quantify the effect of opiate substitution treatment in relation to HIV transmission among people who inject drugs.DesignSystematic review and meta-analysis of prospective published and unpublished observational studies.Data sourcesSearch of Medline, Embase, PsychINFO, and the Cochrane Library from the earliest year to 2011 without language restriction.Review methodsWe selected studies that directly assessed the impact of opiate substitution treatment in relation to incidence of HIV and studies that assessed incidence of HIV in people who inject drugs and that might have collected data regarding exposure to opiate substitution treatment but not have reported it. Authors of these studies were contacted. Data were extracted by two reviewers and pooled in a meta-analysis with a random effects model.ResultsTwelve published studies that examined the impact of opiate substitution treatment on HIV transmission met criteria for inclusion, and unpublished data were obtained from three additional studies. All included studies examined methadone maintenance treatment. Data from nine of these studies could be pooled, including 819 incident HIV infections over 23,608 person years of follow-up. Opiate substitution treatment was associated with a 54% reduction in risk of HIV infection among people who inject drugs (rate ratio 0.46, 95% confidence interval 0.32 to 0.67; P<0.001). There was evidence of heterogeneity between studies (I(2)=60%, χ(2)=20.12, P=0.010), which could not be explained by geographical region, site of recruitment, or the provision of incentives. There was weak evidence for greater benefit associated with longer duration of exposure to opiate substitution treatment.ConclusionOpiate substitution treatment provided as maintenance therapy is associated with a reduction in the risk of HIV infection among people who inject drugs. These findings, however, could reflect comparatively high levels of motivation to change behaviour and reduce injecting risk behaviour among people who inject drugs who are receiving opiate substitution treatment.

Dataset Information

Racial/ethnic disparities in HIV infection among people who inject drugs: an international systematic review and meta-analysis.

Publications

Racial/ethnic disparities in HIV infection among people who inject drugs: an international systematic review and meta-analysis.

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