A Systematic Review and Meta-Analysis of Interventions to Prevent Hepatitis C Virus Infection in People Who Inject Drugs
The Journal of Infectious DiseasesPublished 31 May 2011Open access
Holly Hagan, Enrique R. Pouget, Don C. Des Jarlais
Citations317
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TL;DR
The meta-analysis shows that HCV infection can be prevented in PWID, using strategies that combined substance-use treatment and support for safe injection were most effective at reducing HCV seroconversion.
Abstract
Interventions using strategies that combined substance-use treatment and support for safe injection were most effective at reducing HCV seroconversion. Determining the effective dose and combination of interventions for specific subgroups of PWID is a research priority. However, our meta-analysis shows that HCV infection can be prevented in PWID.
Keywords
Medicine
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