Question

Please read the following two articles (A and B) before answering the questions noted below.

A. Bruneau J, Lamothe F, et al. High rates of HIV infection among IDU participating in needle exchange programs in Montreal: results from a cohort study. American Journal of Epidemiology. 1997;146:994-1002.

B. Lurie P. Invited commentary: le mystere de Montreal. American Journal of Epidemiology. 1997; 146: 1003-1006.

1. This paper provides results from several different study designs. Please briefly describe what these study designs were.

2. Based on your response to question 7, discuss the potential biases that could have impacted the results presented here and what direction they might have biased the risk estimate.

3. What confounders were considered in this study? How did the investigators determine if these confounders were associated with the exposure of interest (NEP use)?

4. What were the overall results of the study? What possible explanations were provided to explain these results?

5. Read Peter Lurie’s accompanying comment on this study. If you were a policymaker, how would the results of this study (in the context of Lurie’s comments) influence your decision about whether toimplement NEP in your community?

Answer 1

1. This paper provides results from several different study designs. Please briefly describe what these study designs were.

Needle exchange programs (NEPs) are designed to prevent human immunodeficiency virus (HIV) transmission among injection drug users.  Albeit most examinations report useful impacts as far as conduct alteration, an immediate evaluation of the viability of NEPs in avoiding HIV disease has been deficient.
An accomplice think about was led to survey the relationship between hazard practices and HIV seroprevalence and seroincidence among infusion medicate clients in Montreal, Canada. The relationship between NEP utilize and HIV contamination was inspected in three hazard evaluation situations utilizing serious covariate alteration for experimental confounders: a cross-sectional examination of NEP use at passage as a determinant of seroprevalence, a companion examination of NEP use at section as an indicator of consequent seroconversion, and a settled case-control investigation of NEP investment amid follow-up as an indicator of seroconversion. From September 1988 to January 1995,1,599 subjects were selected with a pattern seroprevalence of 10.7%.  The mean follow-up period was 21.7 months. The adjusted odds ratio for HIV seroprevalence in injection drug users reporting recent NEP use was 2.2 (95% confidence interval 1.5-3.2). In the cohort study, there were 89 incident cases of HIV infection with a cumulative probability of HIV seroconversion of 33% for NEP users and 13% for nonusers (p < 0.0001). In the nested case-control study, consistent NEP use was associated with HIV seroconversion during follow-up (odds ratio = 10.5, 95% confidence interval 2.7-41.0).  

Hazard rises for HIV disease related with NEP participation were generous and steady in every one of the three hazard evaluation situations in our associate of infusion tranquilize clients, in spite of broad modification for confounders. In synopsis, in Montreal, NEP clients seem to have higher seroconversion rates then NEP nonusers. Am J Epidemiol 1997;146:994-1002.
Infusion tranquilize utilize is currently perceived as one of the significant courses for transmission of HIV contamination. For the recent years, a few techniques have been created to decrease HIV transmission among medication clients, and needle trade programs (NEPs) have established a standout amongst the most supported. These projects go for
expanding openness to sterile needles and syringes also, expelling coursing sullied infusing material. There are numerous challenges and entanglements in attempting to
survey the adequacy of NEPs in diminishing HTV transmission. Openness to the infusing drug client (IDU) populace is troublesome in light of lawful boundaries encompassing medication utilize. Arbitrary task of members to mediations can infrequently be accomplished, presenting potential for choice predisposition in ensuing system assessments.

NEPs are often initiated in the community along with other intervention measures, causing difficulties in the interpretation of the specific effects for each component of the entire intervention program. Such considerations have been recently and extensively reviewed by a panel of experts .

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