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

By: Dana TrentBy: Dana TrentJune 2001June 2001

http://gateway1.ovid.com/ovidweb.cgihttp://gateway1.ovid.com/ovidweb.cgi

Drug Abuse: Treatment Needed Drug Abuse: Treatment Needed For A Host of ProblemsFor A Host of Problems

UnemploymentUnemployment

Increased mortalityIncreased mortality

Family and social Family and social problemsproblems

Our Focus: HIV Our Focus: HIV Transmission!!!Transmission!!!

Goals of this Meta-AnalysisGoals of this Meta-Analysis

Primary Goal:Primary Goal:Are the HIV risk-reduction Are the HIV risk-reduction interventions in drug treatment interventions in drug treatment programs effective?programs effective?

Secondary Goals:Secondary Goals:What will we find if we test What will we find if we test hypotheses regarding moderators hypotheses regarding moderators of effect size in past research?of effect size in past research?

Are there additional variables Are there additional variables impacting program effectiveness impacting program effectiveness that could direct future research?that could direct future research?

Study Selection CriteriaStudy Selection Criteria

Were intended to reduce HIV Were intended to reduce HIV risk behaviorrisk behavior

Conducted in the USA or Conducted in the USA or CanadaCanada

Published/Dated between Published/Dated between 1985-19981985-1998

Written in EnglishWritten in English

Participants’ primary problem: Participants’ primary problem: illicit drug use/dependenceillicit drug use/dependence

Study Selection Criteria Cont…Study Selection Criteria Cont…

Study DesignStudy Design: :

Intervention+Comparison Group Intervention+Comparison Group

At least one HIV dependent variable At least one HIV dependent variable

Effect size calculability Effect size calculability

Random Assignment or:Random Assignment or:

Pre-intervention differences/similarities statedPre-intervention differences/similarities stated

The Source HuntThe Source Hunt

Database from past Database from past meta-analysis meta-analysis

University LibraryUniversity Library

Requests to AuthorsRequests to Authors

Unpublished studiesUnpublished studies

Dissertation Dissertation purchasespurchases

92 references 92 references identified, but…identified, but…

MethodologyMethodology

Only 18Only 18 eligible eligible studies coded studies coded

Coded On:Coded On:Study contentStudy content

MethodologyMethodology

Participant and Participant and treatment characteristicstreatment characteristics

Implementation and Implementation and integrityintegrity

Dependent variable Dependent variable characteristicscharacteristics

Effect size calculation Effect size calculation

Data AnalysisData Analysis

HIV InterventionsHIV InterventionsKnowledge, attitudes, Knowledge, attitudes, beliefsbeliefsSexual BehaviorSexual BehaviorRisk-reduction SkillsRisk-reduction SkillsInjection PracticesInjection Practices

Various ModeratorsVarious ModeratorsIntervention intensity, total Intervention intensity, total sample size, researcher sample size, researcher role, etc…role, etc…

Exploratory VariablesExploratory VariablesDidactic lecture, ethnic Didactic lecture, ethnic group, number of group, number of techniques used, etc…techniques used, etc…

Data AnalysisData AnalysisEffect size Effect size

Every HIV risk dependent variable, moderators, Every HIV risk dependent variable, moderators, and additional variables.and additional variables.

Corrected and weighted appropriatelyCorrected and weighted appropriately

Combined for overall averageCombined for overall average

Tested for significanceTested for significance

VariableVariable

KK

ddunweightedunweighted SDSD MaxMax MinimumMinimum

dd

weightedweighted

95% 95% Confidence Confidence

IntervalIntervalQQ

OverallOverall 1616 .34.34 .16.16 .64.64 .03.03 .31*.31* .20 .20 to .42to .42

8.428.42

Knowledge Knowledge attitudes, attitudes, beliefsbeliefs

1111 .35.35 .17.17 .58.58 .09.09 .31*.31* .18 .18 to .45to .45

7.447.44

Sexual Sexual BehaviorBehavior 1414 .30.30 .20.20 .64.64 -.08-.08 .26*.26* .15 .15

to .38to .388.228.22

Risk-Risk-Reduction Reduction SkillsSkills

66 .63.63 .28.28 .99.99 .32.32 .62*.62* .45 .45 to .79to .79

9.109.10

Injection Injection PracticesPractices 55 .09.09 .14.14 .29.29 -.03-.03 .04.04 -.14 -.14

to .22to .221.241.24

ResultsResults

ResultsResults

Effective HIV Effective HIV interventions :interventions :

Knowledge, beliefs, and Knowledge, beliefs, and attitudesattitudes

Sexual BehaviorSexual Behavior

Risk-reduction skillsRisk-reduction skills

Non-effective HIV Non-effective HIV interventions:interventions:

Injection Practices Injection Practices

ResultsResults

Moderators of effect Moderators of effect size in past research:size in past research:

*p<.05*p<.05

VariableVariable Overall Overall Effect SizeEffect Size

Intensity of Intensity of ContactContact

.57*.57*

ResultsResults

Future Future Research/ Research/ Exploratory Exploratory AnalysisAnalysis

*p<.05*p<.05

**p<.01**p<.01

VariableVariable Overall Overall Effect SizeEffect Size

Sexual Sexual BehaviorBehavior

Ethnic Group MajorityEthnic Group Majority .67*.67* .72*.72*

Didactic LectureDidactic Lecture .75**.75** .59*.59*

Separate Gender SessionsSeparate Gender Sessions .69**.69**

Self-control (coping) skillsSelf-control (coping) skills .59*.59*

Peer Group Peer Group Discussion/CounselingDiscussion/Counseling

.55*.55* .67**.67**

# of technique types used# of technique types used .60*.60* .63*.63*

Stage of drug treatment Stage of drug treatment when intervention was when intervention was delivereddelivered

.68*.68*

DiscussionDiscussion

HIV interventions HIV interventions DODO have a clinically relevant have a clinically relevant impact!impact!

2/3rds non-significant individually!2/3rds non-significant individually!– Insufficient power??Insufficient power??– Publication bias??Publication bias??

DiscussionDiscussion

Only one moderator:Only one moderator:Intervention intensityIntervention intensity

– Time not as Time not as important?important?

DiscussionDiscussion

Ethnic Group MajorityEthnic Group MajorityGreater impact on Greater impact on White participants.White participants.

Minorities enter with Minorities enter with lower risk.lower risk.

Didactic LecturesDidactic LecturesIntended to teach, Intended to teach, particularly in having particularly in having moral instruction as an moral instruction as an ulterior motive.ulterior motive.

Non-significant for Non-significant for Knowledge, attitudes, Knowledge, attitudes, and beliefs??and beliefs??

DiscussionDiscussion

Separate for genderSeparate for genderMore open discussionMore open discussion

Self-Control/CopingSelf-Control/CopingAimed at changing sexual Aimed at changing sexual behaviorbehavior

Peer Group DiscussionPeer Group DiscussionSocial pressure and Social pressure and support is powerful, but…support is powerful, but…Patients were stabilized Patients were stabilized and receiving counseling and receiving counseling in variety of other in variety of other contexts!contexts!

DiscussionDiscussion

Number of techniques Number of techniques usedused

The best had 6 or moreThe best had 6 or more

No relation to hours of No relation to hours of contact??contact??

Stage of Drug Stage of Drug TreatmentTreatment

What about those What about those outside of treatment outside of treatment system?system?

Future Research and Future Research and RecommendationsRecommendations

Access outcomes for Access outcomes for longer periods of timelonger periods of time

More studies More studies

Designing new HIV Designing new HIV risk-reduction risk-reduction interventionsinterventions

Including all that tested Including all that tested significantsignificant