Appendix B
Literature Search Strategies
This appendix discusses the Committee’s strategy for collecting evidence on the effectiveness of HIV prevention interventions for injecting drug users. The Committee targeted its search to include studies of the effectiveness of sterile needle and syringe access programs, drug treatment (including pharmacotherapies and psychosocial interventions), and outreach interventions in reducing HIV infection and drug- and sex-related HIV risk behavior. A secondary objective was to identify studies examining the impact of these interventions on treatment-related outcomes and the use of health and social services, and any unintended consequences they might have.
METHODS FOR COLLECTING EVIDENCE
In gathering evidence, the Committee first drew on previous systematic reviews of the literature. These included the 1995 National Research Council/Institute of Medicine report, Preventing HIV Transmission: The Role of Sterile Needles and Bleach; the World Health Organization’s Evidence for Action reports on access to sterile syringes, drug dependence treatment, and outreach; and recent reviews by the Cochrane Drug and Alcohol Review Group. Because the Committee’s charge differed somewhat from the focus of these reviews, the Committee also conducted its own comprehensive search of the English language published (peer-reviewed) and unpublished literature (including conference abstracts and reports) on the effectiveness of HIV prevention interventions for IDUs.
To identify literature relating to sterile needle and syringe access programs, psychosocial interventions, and outreach, a research librarian searched the following databases from 1980 to January 2006: PubMed, EMBASE, PsycINFO, Cochrane, Grey Literature Report, Social Science Abstracts, Web of Science, and WorldCat.
In investigating psychosocial treatment, the Committee also considered evidence from two systematic reviews from the Cochrane Collaboration:1
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Psychosocial Combined with Agonist Maintenance Treatments versus Agonist Maintenance Treatments Alone for Treatment of Opioid Dependence
-
Psychosocial Treatment for Opiate Abuse and Dependence
In evaluating the effectiveness of pharmacotherapies for opioid and stimulant dependence, the Committee relied primarily on evidence in several Cochrane reviews:
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Substitution Treatment of Injecting Opioid Users for Prevention of HIV Infection
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Methadone Maintenance Therapy versus No Opioid Replacement Therapy for Opioid Dependence
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Buprenorphine Maintenance versus Placebo or Methadone Maintenance for Opioid Dependence
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LAAM Maintenance versus Methadone Maintenance for Heroin Dependence
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Oral Naltrexone Maintenance Treatment for Opioid Dependence
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Methadone Maintenance at Different Dosages for Opioid Dependence
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Antidepressants for Cocaine Dependence
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Treatment for Amphetamine Dependence and Abuse
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Carbamazepine for Cocaine Dependence
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Dopamine Agonists for Cocaine Dependence
1 |
The Cochrane Drug and Alcohol Review Group (the Review Group) is part of the Cochrane Collaboration, which was developed in the United Kingdom in 1992 with the goal of producing systematic reviews of the effects of various health care interventions that can be used by clinicians to guide their day-to-day practice. The Review Group conducts systematic reviews of primarily randomized clinical trials and controlled clinical trials of prevention, treatment, and rehabilitation interventions targeting drug dependence. To date, the Review Group has published over 30 reviews and 15 protocols. Available at: http://alcalc.oxfordjournals.org/cgi/content/full/36/2/109; http://www.cochrane.org/newslett/DrugsandAlcoholAutumn2005.pdf. |
The Committee also reran the search strategies used in some of the Cochrane reviews from the publication date through February 2006. The Committee also considered the reference lists of key studies retrieved in the search, and unpublished data such as conference abstracts identified through the databases.
Together the Committee’s searches generated some 10,000 titles. Two Committee members reviewed all these titles and excluded those obviously unrelated to the targeted interventions. Any title selected by one Committee member remained on the list. IOM staff and consultants then reviewed abstracts of these articles to determine whether they were appropriate for further consideration, using criteria developed by the Committee. A third party resolved any discrepancies, in consultation with the two reviewers.
Committee and staff members then extracted key aspects of these articles—including the study design, their outcome measures, and limitations on their results—for further examination by the Committee. The Committee then assessed the strength and quality of the evidence most relevant to the charge, using the framework described in Chapter 2.
SEARCH STRATEGIES
Drug Dependence Treatment
The Committee reran the search strategies from the following Cochrane reviews to identify new references published since the publication date:
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Buprenorphine Maintenance versus Placebo or Methadone Maintenance for Opioid Dependence
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Methadone Maintenance Therapy versus No Opioid Replacement Therapy for Opioid Dependence
-
Oral Naltrexone Maintenance Treatment for Opioid Dependence
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Psychosocial Combined with Agonist Maintenance Treatments versus Agonist Maintenance Treatments Alone for Treatment of Opioid Dependence
-
Psychosocial Treatment for Opiate Abuse and Dependence
Sterile Needle and Syringe Access
For this topic, the Committee modified search strategies appropriately for each database. The search strategy used on the PubMed database for sterile needle and syringe access is included below.
Search #1:
needle*[tiab] OR syringe*[tiab] OR needle exchange OR syringe exchange
AND
decontaminat*[tiab] OR contaminat*[tiab] OR distribut*[tiab] OR dispos*[tiab] OR disinfect*[tiab] OR exchang*[tiab] OR bleach*
AND
Harm reduction[tiab]
AND
hiv infections/pc OR hiv infections/transmission OR acquired immunodeficiency syndrome/pc OR acquired immunodeficiency syndrome/tm OR hiv seropositivity/pc OR hiv seropositivity/tm OR hiv[tiab] OR aids[tiab]
Search #2:
needle exchange OR syringe exchange
AND
hiv infections/pc OR hiv infections/transmission OR acquired immunodeficiency syndrome/pc OR acquired immunodeficiency syndrome/tm OR hiv seropositivity/pc OR hiv seropositivity/tm OR hiv[tiab] OR aids[tiab]
NOT
results of Search #1
Search #3:
[needle*[tiab] OR syringe*[tiab] OR needle exchange OR syringe exchange
AND
decontaminat*[tiab] OR contaminat*[tiab] OR distribut*[tiab] OR dispos*[tiab] OR disinfect*[tiab] OR exchang*[tiab] OR bleach*
AND
hiv infections/pc OR hiv infections/transmission OR acquired immunodeficiency syndrome/pc OR acquired immunodeficiency syndrome/tm OR hiv seropositivity/pc OR hiv seropositivity/tm OR hiv[tiab] OR aids[tiab]]
OR
[needle exchange OR syringe exchange
AND
hiv infections/pc OR hiv infections/transmission OR acquired immunodeficiency syndrome/pc OR acquired immunodeficiency syndrome/tm OR hiv seropositivity/pc OR hiv seropositivity/tm OR hiv[tiab] OR aids[tiab]]
NOT
results of Searches #1 OR #2
Search #4:
needle*[tiab] OR syringe*[tiab] OR needle exchange OR syringe exchange
AND
(risk* AND behav*) OR risk-taking[mh] OR risk factors[mh]
AND
hiv infections/prevention & control OR hiv infections/transmission OR acquired immunodeficiency syndrome/pc OR acquired immunodeficiency syndrome/tm OR hiv seropositivity/pc OR hiv seropositivity/tm OR hiv[tiab] OR aids[tiab]
Outreach and Psychosocial
The Committee used the following search strategy on the databases mentioned above to retrieve additional references related to outreach and psychosocial interventions:
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substance-related disorders/ or exp opioid-related disorders/ or substance abuse, intravenous/
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intravenous drug user?.mp.
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injecting drug user?.mp.
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injection drug use$.mp.
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inject$ drug use$.mp.
-
3 or 4
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intravenous drug use$.mp.
-
1 or 5 or 7
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exp HIV/
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exp hiv infections/ or acquired immunodeficiency syndrome/
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HIV Seroprevalence/
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9 or 10 or 11
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8 and 12
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prevention & control.fs.
-
pc.fs. or prevention.mp. [mp=title, original title, abstract, name of substance word, subject heading word]
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Primary Prevention/
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(15 or 16) and 12
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17 and 8
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exp psychotherapy/ or exp psychotherapy,brief/ or exp psychotherapy,group/ or exp psychotherapy,multiple/ or psychotherapy.mp. [mp=title, original title, abstract, name of substance word, subject heading word]
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exp cognitive therapy/ or exp social adjustment/ or exp socialization/ or exp teaching/ or social skill? training.mp. or adaptation,psychological/ or coping skill?.mp.
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exp behavior therapy/ or self-control training.mp. or exp counseling/ or counseling.mp. or exp marital therapy/ or marital therapy.mp. or exp community mental health services/ or exp community networks/ or exp reinforcement,social/ or exp social support/ or community reinforcement.mp. or exp relaxation techniques/ or stress management.mp. or exp therapeutic community/ or therapeutic community.mp.
-
exp complementary therapies/ or exp “mind-body and relaxation techniques”/ or “biofeedback (psychology)”/
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exp health education/ or patient education/
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psychosocial intervention?.mp.
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19 or 20 or 21 or 22 or 24
-
18 and 25
-
limit 26 to yr=“1980 - 2006”
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13 and 25
-
limit 28 to yr=“1980 - 2006”
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Community-Institutional Relations/ or outreach.mp.
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peer group/
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“peer education”.mp.
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behavior$ prevention?.mp.
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risk reduction behavior/
-
“risk reduction”.mp.
-
“harm reduction”.mp.
-
peer network?.mp.
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23 or 30 or 31 or 32 or 33 or 34 or 35 or 36 or 37
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38 and 18
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27 or 39
-
39
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limit 41 to yr=“1980 - 2006”