To Access the Effect of Low-Cost Educational Interventions for Reducing the Spread of Hepatitis - Literature review Example

A Systematic Review to Access the Effect of Low Cost Educational Interventions for Reducing the Spread of Hepatitis Background The word ‘hepatitis’ belongs to the ancient Greek word ‘hepar’ which implies liver and the Latin word ‘itis which implies inflammation. Hence, hepatitis refers serious injury to the liver of a person with swelling of the liver cells. Intervention is required in order to minimise the spread of such grave disease. Objectives The objective of the study is to carry out a systematic review of the effectiveness of the low cost educational interventions in order to reduce the spread of hepatitis. Search Methods In order to carry out the review of the articles and to search the appropriate articles related to hepatitis various medical journals are analysed and studied. The study is based upon Cochrane Review structure. The paper has considered the use of the studies published from 2005 until 2008. Selection Criteria Randomised controlled trials, systematic studies and literature reviews that reported both subjectively as well as objectively measured outcomes related to the impacts of low cost educational interventions in order to minimise the spread of hepatitis has been considered. Table of Contents 1 Abstract 2 Background 2 Objectives 2 Search Methods 2 Selection Criteria 2 Background 4 Objectives 6 Selection Criteria 6 Types of Studies 6 Types of Participants 7 Types of Interventions 7 Types of Outcome Measured 7 Search Strategy for Identification of Studies 8 Methods of the Review 9 Description of Studies 11 Methodological Quality of Included Studies 12 Results 13 Discussion 15 Conclusion 15 References 16 Background Hepatitis can be identified as a medical situation which is defined by soreness of the liver and thus featured by the existence of inflammatory cells in the tissue of the organ. Hepatitis might take place with restricted or even no symptoms. However, it often gives rise to jaundice, malaise and anorexia. The disease is said to be acute if it prevails for less than six months and is said to be chronic if it tends to exist for a period for more than a year (Judd & et. al., 2005). There are five different forms of hepatitis that is caused by viruses such as A, B, C, D and E. Acute hepatitis has various reasons such as infectious viral hepatitis, severe bacterial infections, amoebic infections, medicines and toxins. Chronic hepatitis has various sources such as infectious hepatitis, drug reactions, and toxins such as alcohol, autoimmune hepatitis and inborn metabolic disorders. A person is likely to build up hepatitis if the individual comes in contact with any one of the viruses leading to liver inflammation. It may as well take place because of exposure to substances that lead to hepatitis (Smyth & et. al., 2003). Patients with jaundice or any other symptoms of hepatitis or people in high risk groups are at risk of hepatitis. Hepatitis can be prevented by evading contact to the infectious hepatitis viruses (Van Beek & et. al., 1998). Educational interventions are mainly concerned with the communication of information for various reasons such as raising awareness, improvement of knowledge and change in behavior. The educational intervention that aims at alteration of the behaviour is referred as behavioural intervention instead of educational intervention. The chief objective of these types of interventions is to bring about a discontinuation of injecting or to prevent the beginning of injecting in those who have not yet started (Hagan & et. al., 2001). Educational interventions are characterised to be a significant element in ‘harm reduction programmes’ which generally comprise other sorts of interventions such as needle and syringe exchange, opiate substitute prescribing and condom distribution among others. Peer interventions tend to identify the mode by which an educational intervention is delivered. It has been noted that peer intervention is generally based upon the view that the diffusion of viruses such as HIV arises from risk behaviours comprising of close and intimate contact. Hence, attempts in order to stop the spread of HIV need to make use of the benefits provided by social networks into consideration. Minimising the consumption of alcohol among people possessing HCV might slow the disease progression and thus offer significant health benefits. Until and unless an effective HCV treatment is made available, it is significant to have supplementary strategies in order to slow disease progression (WA & et. al., 2009). Objectives The objective of the systematic review was to gauge the effectiveness of low cost educational interventions to minimise the spread of hepatitis. For the purpose of addressing this question, the study shall also address the type of interventions significant for minimising the spread of hepatitis. The study will also gauge the different other methods through which hepatitis can be prevented from spreading. It will also endeavour to identify the evidence for the effectiveness of interventions in order to minimise hepatitis infections and the related morbidity. Infections might take place among the individuals who inject drugs. Hence, the study will also aim at identifying the evidence for the efficiency of the interventions in order to prevent such infections from taking place. Selection Criteria Types of Studies The review took into consideration the following study designs: randomised controlled trials, systematic studies and literature reviews along with clear description of the point of time when the interventions took place. The review also took into consideration the studies published in English language from 2005-2008. Types of Participants Study participants were injection drug users (IDU) who were approached via street outreach and advertising, IDUs belonging to European Union, in a few of the studies participants were categorised into left treatment, disrupted treatment or continued treatment. The review also took into account the participants who were recruited via snowball sampling in those areas with high drug use. These participants were exposed to an intervention aimed at minimising the spread of hepatitis. Types of Interventions The review took into account any type of interventions that have been described in the Cochrane Effective Practice and Organisation of Care Review Group (EPOC) data collection checklist in order to identify the impacts of low cost educational interventions. More precisely, the review made use of behavioural interventions, primary preventive interventions and harm reduction interventions (Thomas & et. al., 1995). Types of Outcome Measured It can be stated that numerous outcome measures had been evaluated in order to identify if the intervention had an impact on minimising various sexual as well as injection risk behaviours. Audio computer assisted self-interview (ACASI) was used as one of the methods to minimise interviewer bias that assisted in improving the validity of participants’ self reported behaviours. Self-reported sexual behaviours and serological testing and self-reported injection behaviours were examined. The other outcome measure that was assessed was the relationship between syringe exchange use/non-use and hepatitis B and C in IDUs. The impact of ‘bleach disinfection’ related to syringes upon ‘anti-HCV seroconversion’ was also assessed in this study. Those studies were reviewed that demonstrated numerous outcomes that may take place with chronic hepatitis C. Those papers were excluded that aimed at identifying the individual outcomes. The review measured the benefits of low cost educational interventions so that hepatitis can be prevented from spreading and thus education related to reduction of harm associated with drug use can be identified. The articles demonstrating the use of needle exchange programmes which is identified to be cost effective had also been considered as a way of educational interventions (Croft & et. al., 1993). Search Strategy for Identification of Studies The review took into account specific strategies in order to search the EPOC register. Additional searches on Cochrane Database of Systematic Reviews, EMBASE, Cumulative Index of Nursing and Allied Health Literature, PsycINFO, abstracts of dissertation, ERIC, Proquest, Ingenta and Biosos Previews were conducted in order to search the data related to low cost educational interventions in minimising the spread of hepatitis. Search strategies were created for electronic database by making use of systematic element of the EPOC search strategy along with educational interventions related terms and other terms related to minimising the spread of hepatitis (Chamot & et. al., 1992). The various terms or keywords that were used in order to arrive at appropriate study materials are injection drug use, HIV infection, costly medical consequences, low cost interventions, educational intervention in hepatitis, and hepatitis prevention interventions for IDUs. The articles possessing only abstract of the entire paper were not taken into consideration and emphasis instead was placed upon making use of the articles that had full review. Along with it, the index pages belonging to last five years publications of selected, high quality academic journals as well as scholarly journals were searched by hand. The reference lists of all the relevant papers were scanned thoroughly. It can be mentioned that it was attempted to minimise the probability of publication bias by communicating with the experts regarding the pertinent ‘unpublished grey literature’ (Broadhead & et. al., 2006). Methods of the Review All the titles and abstracts were screened initially and hence full text copies were taken into account. Each of the five papers that were chosen for the study was independently assessed for the purpose of eligibility. The discrepancies were generally decided by consensus. Independent as well as systematic evaluations of the features of the studies were conducted. The data were extracted by making use of the EPOC Data Collection Checklist. The inconsistencies were resolved in ratings by means of agreement (Craine & et. al., 2006). The methodological quality of the appropriate studies was evaluated by making use of the Cochrane Effective Practice and Organisation of Care Review Group. The quality of data collected has been quite high as they have been extracted from renowned journals in medicine. The criteria that were considered in the reviews are baseline measurements, reliable primary outcome measures as well as shield against any kind of contamination from such disease (Tucker & et. al., 2004). The injection outcomes in the study were generally modelled by making use of cumulative logit models for the purpose of repeated ordinal data with the inclusion of random intercept to justify baseline participant differences. Multivariate models were also considered in the review. Furthermore, drug misuse databases were evaluated by making use of the capture-recapture methods for the purpose of examining the number of injectors. It is worthy of stating that descriptive studies, editorials, opinion pieces and qualitative studies were not taken into account for the review. The quality of the studies was dependent upon the checklist of criteria in order to comprise clear case definition of hepatitis, location, years of recruitment, number of participants, percentage of those identified employed into the study, percentage follow-up of participants. The analyses in most of the studies were conducted in blinded fashion. Statistical analysis took into account both dichotomous as well as continuous process outcome measures. The sample size was conservatively calculated based upon the behaviours that were expected to be least prevalent at baseline from previous studies. Multivariate analysis was also taken into account for a few of the papers. The findings obtained from the study agreed with standard research outcomes that took into account random mixing statistical models by making use of sensitivity analysis to enumerate the cost-effectiveness of the educational intervention in order to minimise the spread of hepatitis (Zule & et. al., 2009). Among the five studies included, one study focused upon peer-education intervention for minimising injection risk behaviours for hepatitis virus infection, one paper focused upon identification of the effectiveness of low cost interventions and a few of the papers have focused upon financial interventions as well. The interventions had proved to be quite effective in minimising the spread of hepatitis. However, the study had also attempted at identifying other alternative interventions through which the risk related to hepatitis can be reduced to a substantial extent. Although needle exchange programmes minimise the incidence of hepatitis, the occurrence still remains high. Therefore, the study attempted at identifying numerous alternative programmes such as opiate maintenance treatment. Certain studies demonstrated that easily accessible education along with counselling regarding the hepatitis and injection drug use can be one of the significant health promotion methods in order to endorse transformation in the behaviours. However, the study also demonstrated the fact that the information needs to be customised according to the needs of the group (Griesbach & Taylor, 2009). Description of Studies The search generated a total of 50 references. From these references, 45 were excluded based upon title alone and abstract. Only 5 studies were selected for detailed evaluation that met the inclusion criteria. The included papers were classified as per the form of intervention. One of the studies was conducted in the United States, one in Australia and a few of the studies were conducted in the countries of European Union. In the first journal titled “A peer-education intervention to reduce injection risk behaviours for HIV and hepatitis C virus infection in young injection drug users”, randomised controlled trials comprising HIV and HCV antibody-negative IDU belonging to the age group 15-30 years who were employed in five United States cities were considered (Garfein & et. al., 2007). In the second journal titled “What is the evidence for the effectiveness of interventions to reduce hepatitis C infection and the associated morbidity?” a systematic review of HCV occurrence for IDUs in the European Union countries were considered. Occurrence ranged from 30% to 95% among the males, 48% to 94% among the females. Furthermore, prevalence ranged from 33% to 98% among those of unspecified gender (Health Evidence Network, 2005). In the third journal titled “Hepatitis C prevention, treatment and care: Guidelines for Australian custodial settings” the methods for the prevention, treatment and care of hepatitis have been based upon custodial settings. Members have been identified from Australian state and territory governments (Australian Government, 2008). In the fourth journal named “A review of the evidence for the effectiveness of primary prevention interventions for Hepatitis C among injecting drug users”, 18 studies were included for the final review out of 1007 abstracts. It demonstrated the fact that needle exchange programmes minimise the occurrence of HCV (Wright & Tompkins, 2006). In the fifth journal titled “Evidence for the effectiveness of interventions to prevent infections among people who inject drugs”, two literature reviews have been conducted. ‘Review of reviews’ method was applied in order to identify the effectiveness of the number of interventions (European Monitoring Center for Drugs and Drug Addiction, 2008). Methodological Quality of Included Studies After reviewing the five journals, it can be identified that the conclusion offered by the authors had been solely based upon the educational interventions. It is significant to focus upon other methods of intervention excluding the low cost educational interventions in order to minimise the spread of hepatitis. More well designed trials are actually required. Results In the first journal, it was found that the intervention was capable of generating a 29% greater decrease in the total injection risk and 76% decline in comparison to the baseline. The six injection outcome variables as well as the compound index measures were found to be declining substantially at follow-up (Garfein & et. al., 2007). From the second journal, it has been apparent that at times it becomes quite difficult to assess the effectiveness of the needle exchange programme in minimising the risk related to blood-borne viruses because of the political as well as ethical considerations (Health Evidence Network, 2005). In the third journal, it has been noted that needle exchange programmes were found to be operating in corrective facilities in most of the countries with favourable results (Australian Government, 2008). In the fourth journal, it has been found that needle exchange programmes tend to minimise the occurrence of HCV however the occurrence remains high. There has been little evidence that assessed the effectiveness related to behavioural interventions or drug consumption rooms (Wright & Tompkins, 2006). The fifth journal depicts that evidence related to the effectiveness of the needle and syringe programme intervention is quite modest however it is improving. There are quite a few journals demonstrating that needle as well as syringe programmes are effective in minimising hepatitis C (European Monitoring Center for Drugs and Drug Addiction, 2008). Discussion Low cost educational interventions have been quite effective at minimising the spread of hepatitis. Simple health education messages aimed at demonstrating the cleaning of the needles after use, tend to have limited effectiveness. Adequate training is required in order to make the individuals aware of the proper use of the needles. Education, information and counselling can alter the behaviour of the individuals suffering from such grave issues by educating them on the risks associated with injecting drugs. Motivational enhancement techniques can be applied as well in such circumstances (Griesbach & Taylor, 2009). Conclusion Education interventions offer a way for minimising the injection risk behaviours among the IDU, essentially those who have been injecting for short time. Training can have a significant impact on the minimisation of the spread of hepatitis. Intensifying the interventions to eliminate instead of minimising the injection risk might be needed to decrease HCV incidence among the IDUs. References Australian Government, 2008. Hepatitis C Prevention, Treatment And Care: Guidelines For Australian Custodial Settings. Introduction. [Online] Available at: http://www.health.gov.au/internet/main/publishing.nsf/content/9F632131D38B580CCA257505007C1A70/$File/prison-guidelines-evidence.pdf [Accessed August 02, 2012]. Broadhead, R. S. & et. al., 2006. “Peer-driven HIV interventions for drug injectors in Russia: First year impact results of a field experiment”, International Journal of Drug Policy. Vol: 17, pp: 379–392. 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Griesbach, D. & Taylor, A., 2009. “Educational Interventions To Prevent Hepatitis C:A Review Of The Literature And Expert Opinion”, NHS Health Scotland. Hunt, N. & et. al., 2002. Break the Cycle: Preventing Initiation Into Injecting. Drugs Education, Prevention and Policy. Vol: 5, Iss: 2, pp: 185-194. Hagan, H. & et. al., 2001. “Sharing Of Drug Preparation Equipment As A Risk Factor For Hepatitis C”, Am J Public Health. Vol: 91, pp:42–46. Health Evidence Network, 2005. “What Is The Evidence For The Effectiveness Of Interventions To Reduce Hepatitis C Infection And The Associated Morbidity?”, WHO Regional Office for Europe’s Health Evidence Network (HEN). Judd, A. & et. al., 2005. “Incidence Of Hepatitis C Virus And HIV Among New injecting Drug Users In London: Prospective Cohort Study”, BMJ. Vol: 330, pp: 24-25. Smyth, B. P. & et. al., 2003. “Retrospective Cohort Study Examining Incidence Of HIV And Hepatitis C Infection Among Injecting Drug Users In Dublin”, Journal Epidemiol Community Health. Vol:57, pp: 310–311. Tucker, T. & et. al., 2004. “Randomized Controlled Trial Of A Brief Behavioural Intervention For Reducing Hepatitis C Virus Risk Practices Among Injecting Drug Users”, Addiction. Vol: 99, Iss: 2, pp: 1157-1166. Thomas, D. L., & et. al., 1995. “Correlates Of Hepatitis C Virus Infection Among Injection Drug User”, Medicine. Vol: 74, pp: 212-220. Van Beek, I. & et. al., 1998. “Infection With HIV And Hepatitis C Virus Among Injecting Drug Users In Aprevention Setting: Retrospective Cohort Study”, BMJ. Vol: 317, pp: 433-437. WA, Z. & et. al., 2009. “Effects of a hepatitis C virus educational intervention or a motivational intervention on alcohol use, injection drug use, and sexual risk behaviors among injection drug users”, American Journal Public Health. Vol: 1, pp: 180-186. Wright, N. MJ. & Tompkins, C. N. E., 2006. “A Review Of The Evidence For The Effectiveness Of Primary Prevention Interventions For Hepatitis C Among Injecting Drug Users”, Harm Reduction Journal. Vol: 3, Iss: 27, pp: 1-9. Zule, W. A. & et. al., 2009. “Effects of a Hepatitis C Virus Educational Intervention or a Motivational Intervention on Alcohol Use, Injection Drug Use, and Sexual Risk Behaviors Among Injection Drug Users”, American Journal Public Health. Vol: 99, Iss: 1, pp: 180-186. Read More