best practice

Opioid substitution treatment (OST) was found to be effective in systematic reviews (Mattick et al., 2009; Gowing et al., 2008, WHO, 2009) in:

• reducing the risk of HIV infection by approximately 54 % (RR 0.46, 95 % CI 0.32 to 0.67; 15 studies, N=819 incident HIV cases);
• reducing the frequency of injection, the sharing of injecting equipment and injecting risk behaviour scores:
  • injecting behaviour: prevalence of injecting :
    • one observational study (N=255) (RR 0.87, 95 % CI 0.80 to 0.95);
    • one RCT (N=253) (RR 0.45, 95 % CI 0.35 to 0.59)
  • Injecting behaviour: proportion of patients sharing injecting equipment:
    • three observational studies (N=1321) (RR 0.54, 95 % CI 0.37 to 0.79)
• reducing the risk of unsafe sex:
  • commercial sex:
    • one observational study (follow up to 18 months) (N= 257) (RR 0.62, 95 % CI 0.45 to 0.86);
    • two observational studies (follow up 3-6 months) (N= 867) (RR 0.94, 95 % CI 0.87 to 1.02)

Ecological family-based treatments (including multidimensional family therapy) delivered in community settings were found in a systematic review without meta-analysis (Hogue et al., 2014, 8 RCTs) and a meta-analysis (Hartnett et al., 2016, 14 studies) to have significant effect in:

• reducing adolescent drug use (mainly cannabis and alcohol)
• reducing adolescent disruptive behaviours

High NSP coverage (defined as regular attendance at an NSP or all injections being covered by a new needle/syringe) has been found to be effective in a a systematic review with meta-analysis (Platt et al., 2017, 28 studies, N= 11 070 PWID) in:

• reducing the risk of HCV acquisition by 76 % only in studies in Europe (RR 0.24, 95 % CI 0.09 to 0.62).

Another systematic review (Palmateer et al., 2022, 27 systematic review, 61 studies) confirmed the results and found sufficient evidence to support the effectiveness of OST in:

• the prevention of HCV transmission among PWID.
• the prevention of HIV transmission among PWID.
• reducing self-reported injecting risk behaviour among PWID

According to three narrative reviews (Calafat, 2010; Calafat, Juan and Duch, 2009; Faggiano and Vigna-Taglianti, 2008) and one systematic review (Tay 2005), drink-driving mass media campaigns have proven:

• to reduce alcohol-related crashes in the period during or after the campaign resulting in injury, by a median of 10 % (IQR 6 % to 15 %).

Drink-driving service (free transport home - ‘Tipsy Taxi’ service (operated 24 hours a day, 365 days a year) providing a free ride home for persons too intoxicated to drive. Service offered by bar employee or request made to bar employee by patron. Control areas had no such service.) for intoxicated drinkers was found to be effective in a systematic review (Ker and Chinnock, 2008) in:

• reducing injury in car crashes: 15 % reduction in the experimental area (reported as ‘highly significant’), with no change in the control.
• reducing fatal crashes (ratio reduced from 0.78 to 0.60, P = 0.29 – not statistically significant). 

Standalone mass-media campaigns (not associated with other components such as school-based, community-based or national programmes) were found to be not effective in reducing tobacco consumption in a  review of reviews of mass-media campaigns (Bühler and Kröger, 2006).

Mass media campaigns were found to be effective in a narrative review (Wakefield, 2010, 4 studies):

• to reduce drink driving

Mass-media campaign in combination with school-based, community-based or national programmes were found in a systematic review (Carson et al., 2017, 8 studies, N= 17 385) to be inconclusive regarding:

• reduced smoking behaviour of young people (3 studies (n = 17,385) found some evidence but the remaining 5 studies (n = 72,740) did not detect a significant effect on smoking behaviour)

Multi-component programmes, with both family and schools interventions, for preventing smoking by children and adolescents were found in a systematic review (Thomas et.al., 2015, 27 RCTs), to be more effective than school-only intervention in:

• reducing smokng in adolescents who never smoked at baseline (2 RCTs, N = 2 301)  (RR = 0.85, 95 % CI 0.75–0.96)
• reducing smoking in adolescents who were smokers at baseline (1 RCT, N = 1 096)  (RR = 0.60, 95 % CI 0.38–0.94)

Intensive family-based programmes for preventing smoking by children and adolescents were found in a systematic review (Thomas et.al., 2015, 27 RCTs), to be effective in:

• reducing cigarette use in adolescents (9 studies, N=4 810) (RR = 0.76, 95 % CI 0.68–0.84)