Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page R1
PREVENTING HIV INFECTION AMONG INJECTING DRUG USERS IN HIGH-RISK COUNTRIES AN ASSESSMENT OF THE EVIDENCE Committee on the Prevention of HIV Infection Among Injecting Drug Users in High-Risk Countries Board on Global Health INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES THE NATIONAL ACADEMIES PRESS Washington, D.C. www.nap.edu
OCR for page R2
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the Committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by Contract No. 39417 between the National Academy of Sciences and the Bill & Melinda Gates Foundation and by Contract No. HQ-05-413065 between the National Academy of Sciences and the Joint United Nations Programme on HIV/AIDS. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number-10: 0-309-10280-4 (Book) International Standard Book Number-13: 978-0-309-10280-3 (Book) International Standard Book Number-10: 0-309-66343-1 (PDF) International Standard Book Number-13: 978-0-309-66343-4 (PDF) Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2007 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.
OCR for page R3
“Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES Advising the Nation. Improving Health.
OCR for page R4
THE NATIONAL ACADEMIES Advisers to the Nation on Science, Engineering, and Medicine The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council. www.national-academies.org
OCR for page R5
COMMITTEE ON THE PREVENTION OF HIV INFECTION AMONG INJECTING DRUG USERS IN HIGH-RISK COUNTRIES HUGH TILSON (Chair), University of North Carolina School of Public Health, Chapel Hill, NC APINUN ARAMRATTANA, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand SAMUEL A. BOZZETTE, The RAND Corporation, Santa Monica, and the University of California San Diego School of Medicine, La Jolla, CA DAVID D. CELENTANO, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD MATHEA FALCO, Drug Strategies, Washington, DC THEODORE M. HAMMETT, Abt Associates Inc., Cambridge, MA ANDREI P. KOZLOV, Biomedical Center and St. Petersburg University, St. Petersburg, Russia SHENGHAN LAI, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD AJAY MAHAL, Department of Population and International Health, Harvard University School of Public Health, Boston, MA RICHARD S. SCHOTTENFELD, Yale University School of Medicine, New Haven, CT SUNITI SOLOMON, Centre for AIDS Research and Education, Y.R. Gaitonde Medical Educational and Research Foundation, Chennai, India Staff ALICIA R. GABLE, Study Director ALYSON SCHWABER, Senior Program Associate SHEYI LAWOYIN, Senior Program Assistant PATRICK KELLEY, Board Director Consultants SANDRA HACKMAN, Editor LESLIE PRAY, Writer
OCR for page R6
This page intentionally left blank.
OCR for page R7
Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s (NRC’s) Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible, and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Richard Ashcroft, Queen Mary, University of London, Barts and the London Medical and Dental School, Institute of Health Sciences Education, United Kingdom Constance A. Benson, AIDS Clinical Trials Group and Antiviral Research Center, University of California San Diego Chris Beyrer, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD Robert E. Booth, University of Colorado School of Medicine, Denver, CO Lawrence O. Gostin, Georgetown University Law Center, Washington, DC, and Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD Marc N. Gourevitch, New York University School of Medicine
OCR for page R8
Martin Iguchi, RAND Drug Policy Research Center, Santa Monica, California and University of California Los Angeles School of Public Health Adeeba Kamarulzaman, University of Malaya Medical Center, Kuala Lumpur, Malaysia Kenneth Mayer, Brown University Medical School and the Miriam Hospital, Providence, RI A. Thomas McLellan, Treatment Research Institute, Philadelphia, PA Harold Pollack, University of Chicago School of Social Service Administration Vu Minh Quan, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand and Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD David Vlahov, New York Academy of Medicine Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. The review of this report was overseen by Arthur L. Reingold, Professor and Head, Division of Epidemiology, University of California, Berkeley; and Floyd Bloom, Chairman and Professor, Department of Neuropharmacology, The Scripps Research Institute, La Jolla, CA. Appointed by the National Research Council and Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures, and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring Committee and the institution.
OCR for page R9
Acknowledgments The Committee recognizes the tremendous efforts of several individuals whose contributions invigorated discussions at its meetings and enhanced the quality of this report. The Committee extends its most sincere gratitude to all those mentioned below. The Committee thanks the sponsors of this study, Joint United Nations Programme on HIV/AIDS (UNAIDS) and the Bill and Melinda Gates Foundation. Special recognition goes to Anindya Chatterjee, Arminda Dayupay, Marie-Therese Drahamcha, David Haroz, Michael Iskowitz, Mahesh Malingham, Purnima Mane, Peter Piot, and Barbara de Zalduondo, at UNAIDS and David Allen and Todd Summers at the Gates Foundation for their extra effort and repeated attention in providing information and support for the study. The Committee appreciates the testimony of the following individuals at its December 2005 meeting: Andrew Ball, Chris Beyrer, Saulius Caplinskas, Monica Ciupagea, Roel Coutinho, Don Des Jarlais, Ksenia Eroshina, Michael Farrell, Loon Gangte, Peter Ghys, Tomas Hallberg, Catherine Hankins, Lily Hyde, Adeeba Kamarulzaman, Kerstin Kall, Christian Kroll, Alexey Mazus, Samuel Nugraha, Peter Piot, Gerry Stimson, Raminta Stuikyte, Oleg Tchestnov, Inga Upmace, Nikolay Volodin, Alex Wodak, George Zazulin, and Fugie Zhang. The agenda for the information-gathering workshop in which these individuals participated appears in Appendix A. The Committee would also like to express its gratitude to those who shared their extensive knowledge on this topic: Chris Buchner, Don Des
OCR for page R10
Jarlais, Ross Gibson, Herman Joseph, Richard Needle, Pascale LeClerc, Carole Morissette, and Daniel Wolfe. The Committee would be remiss if it did not also acknowledge the hard work and dedication of the study staff from the Board on Global Health. We would like to thank Alicia Gable, study director, for her commitment to ensuring that the report would be of the highest-possible quality. To Alyson Schwaber, senior program associate, the Committee extends its gratitude for her outstanding ability to understand and analyze the research. Sheyi Lawoyin, senior project assistant, did a great job coordinating the logistics of the study. Patrick Kelley, the director of the board, was an extremely valuable resource. In addition, the Committee thanks IOM staff members Matt Solyst and Chelsie Benca for their assistance in preparing the report. Special appreciation goes to writer Leslie Pray and editor Sandra Hackman for their instrumental services. The Committee sincerely thanks research librarians Bill McLeod (IOM) and Roberta Shanman (the RAND Corporation) for assisting the Committee with literature searches. The Committee would also like to thank several consultants who assisted the Committee during the literature review: Sarah Lewis, Katherine McLean, Adriana Van Breda, and Maya Yiadom.
OCR for page R11
Contents Acronyms and Abbreviations xv Summary 1 Introduction 27 1 HIV/AIDS in Injecting Drug Users 33 2 Treatment for Drug Dependence 74 3 Sterile Needle and Syringe Access, and Outreach and Education 137 4 Taking Action 187 Appendixes A Agenda for Information-Gathering Meeting, Geneva, December 2005 199 B Literature Search Strategies 205 C Country Case Studies 211
OCR for page R12
D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange 225 E Additional Thoughts on a Community Randomized Trial of Multi-Component HIV Prevention Programs 269 F Biographies 274
OCR for page R13
TABLES, FIGURES, AND BOXES Tables 1-1 Percent of Injecting Drug Users Covered by HIV Prevention Services in 2003, by Region, 60 3-1 Studies with Drug-Related Risk Outcomes, 143 3-2 Studies with Sex-Related Risk Outcomes, 145 3-3 Studies with HIV Incidence or Prevalence Outcomes, 146 D-1 Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange (NSE) Case-Control Studies, 226 D-2 Multi-Component HIV Prevention Programs That Include NSE Prospective Cohort Studies, 230 D-3 Multi-Component HIV Prevention Programs That Include NSE Ecological Studies, 252 D-4 Multi-Component HIV Prevention Programs That Include NSE Selected Serial Cross-Sectional Studies, 258 D-5 Multi-Component HIV Prevention Programs That Include NSE Selected Cross-Sectional Studies, 262 Figure 1-1 Estimates of IDU Populations by Region, 35 Boxes S-1 Key HIV Prevention Interventions for IDUs, 4 S-2 Recommendations, 18 1-1 Amphetamine-Type Stimulants, 38 1-2 Viral Hepatitis, 40 1-3 Hierarchy of Steps IDUs Can Take to Reduce HIV Risk, 50 2-1 Definitions of Common Research Study Designs, 78 2-2 Psychosocial Interventions for Drug Dependence Treatment, 110 3-1 Potential Outcomes from Needle and Syringe Exchange, 140 3-2 Instructions for Disinfecting Syringes, 164 3-3 An Example of Outreach in India, 170 3-4 Community Randomized Trials, 174
OCR for page R14
This page intentionally left blank.
OCR for page R15
Acronyms and Abbreviations AIDS Acquired Immune Deficiency Syndrome AOR Adjusted Odds Ratio ART Antiretroviral Treatment ASPD Anti-Social Personality Disorder ATS Amphetamine Type Stimulants CBT Cognitive Behavioral Therapy CI Confidence Interval CM Contingency Management CRA Community Reinforcement Approach DAART Directly Administered Antiretroviral Therapy DATOS Drug Abuse Treatment Outcome Studies ESAP Expanded Syringe Access Program HBV Hepatitis B Virus HCV Hepatitis C Virus HIV Human Immunodeficiency Virus IDU(s) Injecting Drug User(s) IOM Institute of Medicine LAAM Levo-Alpha-Acetyl-Methadol
OCR for page R16
MMT Methadone Maintenance Treatment MSIC Medically Supervised Injecting Center NA Narcotics Anonymous NADR National AIDS Demonstration Research Program NIDA National Institute on Drug Abuse (U.S.) NIMH National Institute of Mental Health (U.S.) NSE Needle and Syringe Exchange OR Odds Ratio RCT Randomized Control Trial RR Relative Risk SIF Supervised Injecting Facility STI Sexually Transmitted Infection TC Therapeutic Communities TSF Twelve-Step Facilitation UNAIDS Joint United Nations Programme on HIV/AIDS UNODC United Nations Office on Drugs and Crime VCT Voluntary Counseling and Testing WHO World Health Organization