1. Meta-Analysis of HIV Risk Reduction Interventions Within Drug Abuse Treatment Programs By: Dana Trent June 2001 http://gateway1.ovid.com/ovidweb.cgi

2. Drug Abuse: Treatment Needed For A Host of Problems Unemployment Increased mortality Family and social problems Our Focus: HIV Transmission!!!

3. Goals of this Meta-Analysis Primary Goal: Are the HIV risk-reduction interventions in drug treatment programs effective? Secondary Goals: What will we find if we test hypotheses regarding moderators of effect size in past research? Are there additional variables impacting program effectiveness that could direct future research?

4. Study Selection Criteria Were intended to reduce HIV risk behavior Conducted in the USA or Canada Published/Dated between 1985-1998 Written in English Participants’ primary problem: illicit drug use/dependence

5. Study Selection Criteria Cont… Study Design : Intervention+Comparison Group Intervention+Comparison Group At least one HIV dependent variable Effect size calculability Random Assignment or: Pre-intervention differences/similarities stated

6. The Source Hunt Database from past meta-analysis University Library Requests to Authors Unpublished studies Dissertation purchases 92 references identified, but…

7. Methodology Only 18 eligible studies coded Coded On: Study content Methodology Participant and treatment characteristics Implementation and integrity Dependent variable characteristics Effect size calculation

8. Data Analysis HIV Interventions Knowledge, attitudes, beliefs Sexual Behavior Risk-reduction Skills Injection Practices Various Moderators Intervention intensity, total sample size, researcher role, etc… Exploratory Variables Didactic lecture, ethnic group, number of techniques used, etc…

9. Data Analysis Effect size Every HIV risk dependent variable, moderators, and additional variables. Corrected and weighted appropriately Combined for overall average Tested for significance

10. VariableKdunweightedSDMaxMinimumdweighted 95% Confidence Interval Q Overall16.34.16.64.03.31*.20 to.42 8.42 Knowledge attitudes, beliefs 11.35.17.58.09.31*.18 to.45 7.44 Sexual Behavior 14.30.20.64-.08.26*.15 to.38 8.22 Risk- Reduction Skills 6.63.28.99.32.62*.45 to.79 9.10 Injection Practices 5.09.14.29-.03.04 -.14 to.22 1.24Results

11. Results Effective HIV interventions : Knowledge, beliefs, and attitudes Sexual Behavior Risk-reduction skills Non-effective HIV interventions: Injection Practices

12. Results Moderators of effect size in past research: *p<.05 Variable Overall Effect Size Intensity of Contact.57*

13. Results Future Research/ Exploratory Analysis *p<.05**p<.01 Variable Overall Effect Size Sexual Behavior Ethnic Group Majority.67*.72* Didactic Lecture.75**.59* Separate Gender Sessions.69** Self-control (coping) skills.59* Peer Group Discussion/Counseling.55*.67** # of technique types used.60*.63* Stage of drug treatment when intervention was delivered.68*

14. Discussion  HIV interventions DO have a clinically relevant impact! 2/3rds non-significant individually! –Insufficient power?? –Publication bias??

15. Discussion Only one moderator: Intervention intensity –Time not as important?

16. Discussion Ethnic Group Majority Greater impact on White participants. Minorities enter with lower risk. Didactic Lectures Intended to teach, particularly in having moral instruction as an ulterior motive. Non-significant for Knowledge, attitudes, and beliefs??

17. Discussion Separate for gender More open discussion Self-Control/Coping Aimed at changing sexual behavior Peer Group Discussion Social pressure and support is powerful, but… Patients were stabilized and receiving counseling in variety of other contexts!

18. Discussion Number of techniques used The best had 6 or more No relation to hours of contact?? Stage of Drug Treatment What about those outside of treatment system?

19. Future Research and Recommendations Access outcomes for longer periods of time More studies Designing new HIV risk-reduction interventions Including all that tested significant