Assessing Harm Reduction Strategies: The Dilemma of Observational Studies

Important note: Information in this article was accurate in 1997. The state of the art may have changed since the publication date.

Assessing Harm Reduction Strategies: The Dilemma of Observational Studies

American Journal of Epidemiology (12/15/97) Vol. 146, No. 12, P. 1007
Bruneau, Julie; Franco, Eduardo; Lamothe, Francois

Abstract: To determine the individual characteristics and behaviors that increase the risk of HIV infection, Julie Bruneau and colleagues from the University of Montreal and elsewhere followed a cohort of subjects attending needle exchange programs (NEPs). Based upon findings as of late 1995, the researchers report in the American Journal of Epidemiology that their study--the Montreal Saint-Luc Cohort Study-- indicates a higher prevalence and incidence rates of HIV infection among NEP participants. In response to a commentary published in the same issue of the Journal, Bruneau et al. acknowledge Peter Lurie's concerns that selection bias may have led to the results observed, but notes that confounding forces from selection bias can never be completely eliminated by covariate adjustment. With regard to Lurie's concept that unmeasured confounders may have led to the observed findings, the researches explain that all regression analyses were conducted using the most informative functional form for each variable. Finally, the authors assert, the data was presented from both cross-sectional and cohort analyses, and--regardless of cohort subgroup and timing of exposure or outcome--the results were consistent with the notion that NEP participation was independently associated with HIV prevalence and incidence rates. Still, Bruneau et al. note that there may be other causal factors other than those related to NEP participation.

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