MetaAnalysis of HIV Risk Reduction Interventions Within Drug Abuse Treatment Programs

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Meta-Analysis of HIV Risk Reduction Interventions
Within Drug Abuse Treatment Programs

• By Dana Trent
• June 2001
• http//gateway1.ovid.com/ovidweb.cgi

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Drug Abuse Treatment Needed For A Host of
Problems

• Unemployment
• Increased mortality
• Family and social problems
• Our Focus HIV Transmission!!!

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Goals of this Meta-Analysis

• Primary Goal
• Are the HIV risk-reduction interventions in drug
  treatment programs effective?
• Secondary Goals
• What will we find if we test hypotheses regarding
  moderators of effect size in past research?
• Are there additional variables impacting program
  effectiveness that could direct future research?

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Study Selection Criteria

• Were intended to reduce HIV risk behavior
• Conducted in the USA or Canada
• Published/Dated between 1985-1998
• Written in English
• Participants primary problem illicit drug
  use/dependence

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Study Selection Criteria Cont

• Study Design
• InterventionComparison Group
• At least one HIV dependent variable
• Effect size calculability
• Random Assignment or
• Pre-intervention differences/similarities stated

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The Source Hunt

• Database from past meta-analysis
• University Library
• Requests to Authors
• Unpublished studies
• Dissertation purchases
• 92 references identified, but

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Methodology

• Only 18 eligible studies coded
• Coded On
• Study content
• Methodology
• Participant and treatment characteristics
• Implementation and integrity
• Dependent variable characteristics
• Effect size calculation

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Data Analysis

• HIV Interventions
• Knowledge, attitudes, beliefs
• Sexual Behavior
• Risk-reduction Skills
• Injection Practices
• Various Moderators
• Intervention intensity, total sample size,
  researcher role, etc
• Exploratory Variables
• Didactic lecture, ethnic group, number of
  techniques used, etc

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Data Analysis

• Effect size
• Every HIV risk dependent variable, moderators,
  and additional variables.
• Corrected and weighted appropriately
• Combined for overall average
• Tested for significance

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Results
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Results

• Effective HIV interventions
• Knowledge, beliefs, and attitudes
• Sexual Behavior
• Risk-reduction skills

• Non-effective HIV interventions
• Injection Practices

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Results

• Moderators of effect size in past research
• plt.05

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Results

• Future Research/ Exploratory Analysis
• plt.05
• plt.01

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Discussion

• HIV interventions DO have a clinically relevant
  impact!
• 2/3rds non-significant individually!
• Insufficient power??
• Publication bias??

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Discussion

• Only one moderator
• Intervention intensity
• Time not as important?

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Discussion

• Ethnic Group Majority
• Greater impact on White participants.
• Minorities enter with lower risk.
• Didactic Lectures
• Intended to teach, particularly in having moral
  instruction as an ulterior motive.
• Non-significant for Knowledge, attitudes, and
  beliefs??

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Discussion

• Separate for gender
• More open discussion
• Self-Control/Coping
• Aimed at changing sexual behavior
• Peer Group Discussion
• Social pressure and support is powerful, but
• Patients were stabilized and receiving counseling
  in variety of other contexts!

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Discussion

• Number of techniques used
• The best had 6 or more
• No relation to hours of contact??
• Stage of Drug Treatment
• What about those outside of treatment system?

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Future Research and Recommendations

• Access outcomes for longer periods of time
• More studies
• Designing new HIV risk-reduction interventions
• Including all that tested significant