Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a Cochrane Clinical Answer that focuses on the above important clinical question.
Confidence in the evidence is very low or low where GRADE has been performed and the intervention may be more effective/beneficial than the comparison for key outcomes. However, this is uncertain and new evidence could change this in the future.
Population: People who inject drugs (where reported most people injected opiates and/or stimulants)
Intervention: OST and/or NSP
Comparison: No OST or NSP
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
OST versus no OST | ||
Incidence of hepatitis C (mean follow‐up 440.5 person years) | Favors intervention | Low |
High NSP coverage versus no/low NSP coverage ᵃ | ||
Incidence of hepatitis C (mean follow‐up 269 person years) | No statistically significant difference | Very Low |
Low NSP coverage versus no NSP coverage ᵃ | ||
Incidence of hepatitis C (mean follow‐up unclear) | No statistically significant difference | GRADE assessment not performed for this outcome |
Combined OST and high/low NSP versus no OST and low/no NSP | ||
Incidence of hepatitis C (mean follow‐up 356 person years) | Favors intervention | Low |
Note The Cochrane review which this Cochrane Clinical Answer (CCA) is based upon notes that a reduction in the incidence of hepatitis C is associated with OST (50% reduction with OST compared with no OST) and this is strengthened when OST is combined with high/low NSP (55% reduction with OST plus NSP compared with no OST plus low/no NSP). The Cochrane review also states that while many European and International Agencies (e.g., the World Health Organization) recommend OST and NSPs as key interventions for preventing drug‐related harm, including hepatitis C transmission, they are not widely used in many countries, and that restrictions should be removed on the concurrent use of OST and NSP to maximize the reduction in hepatitis C. ᵃ For studies which evaluated NSP alone there was significant heterogeneity with unclear and inconsistent measurement of NSP use across studies.
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- What are the effects of opioid substitution therapy and needle syringe programs for preventing hepatitis C transmission in people who inject drugs?
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