Supplementary Material for the Article

Supplementary Material for the article

“Risk factors associated with HIV/HCV infection among entrants in methadone

maintenance treatment clinics in China: a systematic review and meta-analysis”

For more information:

Lei Zhang The Kirby Institute CFI Building, Cnr West & Boundary Streets Darlinghurst NSW 2010, Australia Phone: +612 9385 0869 Fax: +61 2 9385 0920 [email protected]

This material supplements but does not replace the peer-reviewed article in Drug and Alcohol Dependence Figure S1: Forest Plot showing the results of meta-analysis of odds ratio for HIV infection among MMT clients stratified by Gender

Study name Study Location Category Statistics for each study Odds ratio and 95% CI Odds Lower Upper Relative ratio limit limit Male Female weight Bai Y,2009 Guangxi HTA 1.367 0.466 4.011 27 / 432 4 / 86 7.33 Dong G,2009 Sichuan HTA 2.871 0.370 22.268 14 / 292 1 / 58 2.02 Fang HR,2008 Xinjiang HTA 1.311 0.794 2.165 194 / 1331 19 / 165 33.75 Han XJ,2010 Guizhou HTA 0.707 0.165 3.025 5 / 210 3 / 90 4.02 Liu JB,2006 Xinjiang HTA 2.571 0.558 11.849 23 / 108 2 / 21 3.64 Wang DY,2009 Sichuan HTA 1.777 1.082 2.921 136 / 529 22 / 135 34.44 Wang J,2010 Guizhou HTA 1.418 0.492 4.086 24 / 112 5 / 31 7.59 Yao W,2008 Sichuan HTA 0.924 0.262 3.265 14 / 620 3 / 123 5.33 Zhou XP,2009 Guangxi HTA 2.861 0.343 23.896 47 / 162 1 / 8 1.89 HTA (I2 = 0, p = 0.893) 1.486 1.111 1.989 Du WJ,2007 Beijing LTA 0.316 0.103 0.973 6 / 201 7 / 79 23.15 Fu FY,2009 Zhejiang LTA 1.181 0.056 24.894 2 / 283 0 / 66 3.14 Hao C,2009 Jiangsu LTA 0.080 0.008 0.776 1 / 526 3 / 129 5.66 Li YF,2009 Guangdong LTA 1.215 0.065 22.819 5 / 181 0 / 19 3.40 Mao NL,2008 Anhui LTA 0.579 0.258 1.302 15 / 267 11 / 118 44.50 Su MF,2010 Zhejiang LTA 0.459 0.018 11.636 1 / 141 0 / 21 2.80 Wang WM,2010 Jiangsu LTA 0.554 0.022 13.883 1 / 182 0 / 33 2.81 Wang YP,2009 Jiangsu LTA 0.807 0.040 16.154 3 / 189 0 / 21 3.25 Wu LH,2007 Fujian LTA 1.074 0.049 23.359 2 / 83 0 / 17 3.08 Xia L,2010 Guangdong LTA 0.112 0.009 1.312 2 / 235 1 / 14 4.81 Zhu XH,2010 Gansu LTA 1.252 0.067 23.491 4 / 539 0 / 74 3.40 LTA (I2 = 0; p = 0.819) 0.458 0.267 0.786 Overall (I2 = 19.715; p = 0.209) 1.140 0.882 1.473 Publication bias (p = 0.119) Fixed-effects model 0.01 0.1 1 10 100 Female Male Figure S2: Forest Plot showing the results of meta-analysis of odds ratio for HCV infection among MMT clients stratified by Gender Study name Study LocationCategory Statistics for each study Odds ratio and 95% CI Odds Lower Upper Relative ratio limit limit Male Female weight Bai Y,2009 Guangxi HTA 0.743 0.365 1.511 367 / 432 76 / 86 10.52 Deng CK,2009 Guizhou HTA 0.907 0.459 1.794 162 / 265 26 / 41 10.94 Fang HR,2008 Xinjiang HTA 1.026 0.725 1.454 919 / 1331 113 / 165 16.73 Han XJ,2010 Guizhou HTA 0.579 0.343 0.977 118 / 210 62 / 90 13.56 Wang DY,2009 Sichuan HTA 0.938 0.554 1.587 476 / 570 108 / 128 13.50 Wang J,2008 Guizhou HTA 1.406 0.724 2.729 55 / 125 19 / 53 11.22 Wang J,2010 Guizhou HTA 1.346 0.444 4.080 98 / 112 26 / 31 6.18 Yao W,2008 Sichuan HTA 0.931 0.552 1.569 513 / 620 103 / 123 13.57 Zhou XP,2009 Guangxi HTA 17.619 3.80581.587 148 / 162 3 / 8 3.77 HTA (I2 = 59.473, p = 0.011) 1.036 0.745 1.440 Du WJ,2007 Beijing LTA 0.383 0.224 0.656 80 / 201 50 / 79 6.37 Fu FY,2009 Zhejiang LTA 0.666 0.388 1.141 109 / 283 32 / 66 6.36 Hao C,2009 Jiangsu LTA 0.882 0.600 1.298 269 / 526 70 / 129 7.68 He XX,2010 Gansu LTA 0.420 0.291 0.605 245 / 1367 51 / 149 7.86 Liu HB,2010 Shanxi LTA 1.804 0.897 3.627 329 / 440 23 / 37 5.12 Li YC,2009 Shanxi LTA 0.978 0.543 1.759 212 / 350 33 / 54 5.96 Li YF,2009 Guangdong LTA 1.220 0.415 3.587 140 / 181 14 / 19 3.07 MengXH,2010 Henan LTA 2.941 0.16452.697 9 / 128 0 / 18 0.59 Song HB,2010 Jiangsu LTA 1.496 0.792 2.827 111 / 162 32 / 54 5.58 Su MF,2010 Zhejiang LTA 0.550 0.218 1.387 47 / 141 10 / 21 3.76 Wang WM,2010Jiangsu LTA 1.319 0.607 2.869 127 / 182 21 / 33 4.60 Wang YP,2009 Jiangsu LTA 0.367 0.104 1.295 130 / 189 18 / 21 2.46 Wu GH,2010 Chongqing LTA 0.819 0.560 1.198 502 / 657 170 / 213 7.74 Wu LH,2007 Fujian LTA 1.431 0.460 4.447 31 / 83 5 / 17 2.87 Xia L,2010 Guangdong LTA 0.644 0.196 2.116 145 / 235 10 / 14 2.68 Xia X,2007 Jiangsu LTA 1.148 0.864 1.526 804 / 1057 238 / 324 8.55 Xu YP,2007 Jiangsu LTA 0.779 0.342 1.775 183 / 223 47 / 55 4.31 Yuan ZX,2010 Jiangsu LTA 1.496 0.813 2.754 101 / 171 27 / 55 5.78 Zhang JF,2010 Shanxi LTA 0.244 0.065 0.911 17 / 48 9 / 13 2.29 Zhu XH,2010 Gansu LTA 0.945 0.555 1.610 154 / 539 22 / 74 6.41 LTA (I2 = 60.833, p < 0.001) 0.849 0.676 1.066 0.905 0.750 1.092 Overall (I2 = 59.781, p < 0.001) Publication bias (p = 0.680) 0.01 0.1 1 10 100 Random-effects model Female Male Figure S3: Forest Plot showing the results of meta-analysis of odds ratio for HIV infection among MMT clients stratified by age groups (a) Study name Study Location Category Statistics for each study Odds ratio and 95% CI Odds Lower Upper Relative ratio limit limit 30-40 >40 weight

BaiY,2009 GuangXi HTA 1.372 0.638 2.950 19 / 272 11 / 212 41.13 HanXJ,2010 GuiZhou HTA 0.404 0.066 2.465 2 / 144 3 / 89 7.36 WangJ,2010 GuiZhou HTA 0.400 0.163 0.984 14 / 84 12 / 36 29.76 YaoW,2008 SiChuan HTA 1.067 0.130 8.733 8 / 338 1 / 45 5.45 ZhouXP,2009 GuangXi HTA 1.929 0.572 6.506 18 / 60 4 / 22 16.29 HTA (I2 = 39.168, p = 0.160) 0.906 0.555 1.480 MaoNL,2008 Anhui LTA 4.474 0.581 34.448 18 / 191 1 / 44 50.82 WangYP,2009 JiangSu LTA 0.871 0.040 18.916 2 / 102 0 / 17 22.34 WuLH,2007 Fujian LTA 1.548 0.093 25.676 1 / 32 1 / 49 26.84 LTA (I2 = 0, p = 0.648) 2.334 0.545 10.003 2 Overall (I =21.362, p = 0.260) 0.998 0.627 1.589 Publication bias (p = 1.000) Fixed-effectsmodel 0.01 0.1 1 10 100

Note:2 studies[81,90] were excludedin this meta-analysis due to null values in both comparing groups. >40 years 30-40 years

Study name Study Location Category Statistics for each study Odds ratio and 95% CI Odds Lower Upper Relative ratio limit limit <30 >40 weight BaiY,2009 GuangXi HTA 0.554 0.069 4.432 1 / 34 11 / 212 11.18 HanXJ,2010 GuiZhou HTA 1.344 0.263 6.877 3 / 67 3 / 89 18.15 WangJ,2010 GuiZhou HTA 0.300 0.074 1.213 3 / 23 12 / 36 24.77 YaoW,2008 SiChuan HTA 1.000 0.122 8.185 8 / 360 1 / 45 10.94 ZhouXP,2009 GuangXi HTA 1.887 0.582 6.118 26 / 88 4 / 22 34.96 HTA (I2 = 7.939, p = 0.361) 0.915 0.457 1.835 HaoXQ,2009 Qinghai Low 6.276 0.332 118.590 4 / 96 0 / 64 20.70 MaoNL,2008 Anhui Low 2.105 0.252 17.586 7 / 150 1 / 44 39.68 SuMF,2010 ZheJiang Low 0.423 0.016 11.071 1 / 75 0 / 10 16.77 WuLH,2007 Fujian Low 0.842 0.051 13.824 1 / 58 1 / 49 22.84 LTA (I2 = 0, p = 0.629) 1.636 0.429 6.229 Overall (I2 = 0, p = 0.575) 1.036 0.559 1.919 Publication bias (p = 0.835) Fixed-effects model 0.01 0.1 1 10 100

>40 years <30 years Note:1 study[90] was excluded in this meta-analysis due to null values in both comparing groups. Figure S4: Forest Plot showing the results of meta-analysis of odds ratio for HCV infection among MMT clients stratified by age groups (a) Study name Study Location Category Statistics for each study Odds ratio and 95% CI Odds Lower Upper Relative ratio limit limit 30-40 >40 weight Bai Y,2009 GuangXi HTA 1.934 1.161 3.221 242 / 272 171 / 212 21.32 Han XJ,2010 GuiZhou HTA 5.613 3.153 9.990 108 / 144 31 / 89 20.33 Wang J,2008 GuiZhou HTA 1.212 0.538 2.733 49 / 113 12 / 31 16.79 Wang J,2010 GuiZhou HTA 5.000 1.656 15.099 78 / 84 26 / 36 12.94 Yao W,2008 SiChuan HTA 1.955 0.949 4.029 285 / 338 33 / 45 18.11 Zhou XP,2009 GuangXi HTA 8.000 2.104 30.415 56 / 60 14 / 22 10.52 HTA (I2 = 68.843, p = 0.007) 2.921 1.664 5.127 Fu FY,2009 ZheJiang LTA 2.011 1.265 3.199 79 / 174 43 / 147 10.41 Hao XQ,2009 QingHai LTA 11.625 5.646 23.934 93 / 117 16 / 64 9.10 He XX,2010 GanSu LTA 0.500 0.358 0.698 149 / 859 68 / 230 10.95 Li YC,2009 ShaanXi LTA 1.885 1.204 2.950 140 / 205 72 / 135 10.48 Su MF,2010 ZheJiang LTA 1.151 0.381 3.476 27 / 74 6 / 17 7.07 Wang YP,2009 JiangSu LTA 2.263 1.032 4.959 84 / 102 33 / 49 8.76 Wu GH,2010 ChongQing LTA 1.287 0.888 1.867 401 / 503 171 / 227 10.80 Wu LH,2007 FuJian LTA 15.000 1.685 133.551 20 / 32 1 / 10 3.31 Xia X,2007 JiangSu LTA 1.702 1.236 2.345 563 / 703 189 / 269 10.99 Xu YP,2007 JiangSu LTA 1.434 0.682 3.014 134 / 161 45 / 58 8.99 Yuan ZX,2010 JiangSu LTA 1.305 0.638 2.670 71 / 118 22 / 41 9.13 LTA (I2 = 87.705, p < 0.001) 1.822 1.138 2.917 Overall (I2 =85.859, p < 0.001) 2.213 1.542 3.175 Publication bias (p = 0.161) 0.01 0.1 1 10 100 Random-effects model >40 years 30-40 years

(b) Study name Study Location Category Statistics for each study Odds ratio and 95% CI Odds Lower Upper Relative ratio limit limit <30 >40 weight Bai Y,2009 GuangXi HTA 1.798 0.600 5.389 30 / 34 171 / 212 13.47 Han XJ,2010 GuiZhou HTA 2.950 1.530 5.691 41 / 67 31 / 89 26.03 Wang J,2008 GuiZhou HTA 0.980 0.360 2.665 13 / 34 12 / 31 15.43 Wang J,2010 GuiZhou HTA 2.564 0.622 10.563 20 / 23 26 / 36 8.98 Yao W,2008 SiChuan HTA 1.748 0.855 3.573 298 / 360 33 / 45 23.75 Zhou XP,2009 GuangXi HTA 6.612 2.068 21.140 81 / 88 14 / 22 12.34 HTA (I2 = 31.329, p = 0.201) 2.243 1.410 3.569 Fu FY,2009 ZheJiang LTA 4.353 1.859 10.194 18 / 28 43 / 147 9.07 Hao XQ,2009 QingHai LTA 29.000 11.916 70.579 87 / 96 16 / 64 8.90 He XX,2010 GanSu LTA 0.541 0.372 0.786 79 / 427 68 / 230 10.86 Li YC,2009 ShaanXi LTA 0.931 0.513 1.690 33 / 64 72 / 135 10.12 Su MF,2010 ZheJiang LTA 0.863 0.285 2.609 24 / 74 6 / 17 7.95 Wang YP,2009 JiangSu LTA 0.537 0.245 1.178 31 / 59 33 / 49 9.35 Wu GH,2010 ChongQing LTA 0.811 0.504 1.304 99 / 139 171 / 227 10.55 Wu LH,2007 FuJian LTA 3.140 0.366 26.897 15 / 58 1 / 10 4.32 Xia X,2007 JiangSu LTA 1.029 0.733 1.445 282 / 398 189 / 269 10.95 Xu YP,2007 JiangSu LTA 1.842 0.700 4.847 51 / 59 45 / 58 8.56 Yuan ZX,2010 JiangSu LTA 0.945 0.434 2.058 35 / 67 22 / 41 9.38 LTA (I2 = 87.924, p < 0.001) 1.443 0.818 2.544 Overall (I2 =84.643, p < 0.001) 1.879 1.312 2.691 Publication bias (p = 0.070) 0.01 0.1 1 10 100 Random-effects model >40 years <30 years Figure S5: Forest Plot showing the results of meta-analysis of odds ratio for HIV infection among MMT clients stratified by injection

Study name Study LocationCategory Statistics for each study Odds ratio and 95% CI Odds Lower Upper Relative ratio limit limit IDU Non-IDU weight BaiY,2009 Guangxi HTA 2.539 0.337 19.134 30 / 479 1 / 39 9.79 DongG,2009 Sichuan HTA 4.979 0.293 84.641 15 / 304 0 / 46 4.98 HanXJ,2010 Guizhou HTA 2.341 0.465 11.795 6 / 170 2 / 130 15.28 WangDY,2009 Sichuan HTA 4.575 1.816 11.520 153 / 648 5 / 79 46.83 WangJ,2010 Guizhou HTA 7.875 1.782 34.798 27 / 99 2 / 44 18.09 YaoW,2008 Sichuan HTA 5.102 0.304 85.567 17 / 651 0 / 92 5.03 HTA (I2 = 0, p = 0.915) 4.343 2.308 8.171 ChenLF,2009 Hunan LTA 49.329 3.014 807.271 42 / 306 0 / 153 5.79 HaoXQ,2009 Qinghai LTA 3.744 0.199 70.350 4 / 197 0 / 80 5.26 MaoNL,2008 Anhui LTA 6.895 1.604 29.641 24 / 252 2 / 133 21.28 SuMF,2010 Zhejiang LTA 0.243 0.010 6.063 0 / 92 1 / 68 4.38 TanXL,2007 Chongqing LTA 2.692 0.354 20.490 28 / 340 1 / 31 10.99 XiaL,2010 Guangdong LTA 1.982 0.101 38.956 3 / 195 0 / 54 5.10 Zhou X,2009 Chongqing LTA 3.423 1.211 9.675 50 / 470 4 / 119 41.92 ZhuXH,2010 Gansu LTA 13.182 0.707 245.930 4 / 251 0 / 362 5.29 2 LTA (I = 8.042, p= 0.368) 4.221 2.154 8.271 2 Overall (I = 0, p = 0.766) 4.285 2.703 6.792 Publication bias (p = 0.412) Fixed-effectsmodel 0.01 0.1 1 10 100

Non-IDU IDU

Figure S6: Forest Plot showing the results of meta-analysis of odds ratio for HIV infection among MMT clients stratified by sharing needles and syringes

Study name Study Location Category Statistics for each study Odds ratio and 95% CI

Odds Lower Upper Relative ratio limit limit Share Non-Share weight

BaiY,2009 Guangxi HTA 2.109 1.010 4.404 18 / 211 13 / 307 37.73 DongG,2009 Sichuan HTA 6.661 0.865 51.310 14 / 241 1 / 109 10.84 WangDY,2009 Sichuan HTA 5.379 3.639 7.951 84 / 212 56 / 515 51.42 HTA (I2 = 60.038, p = 0.082) 3.867 1.840 8.127 TanXL,2007 Chongqing LTA 1.508 0.691 3.287 18 / 196 11 / 175 100.00 LTA (I2 = 0, p = 1.001) 1.508 0.691 3.287

Overall (I2 =73.148, p = 0.011) 2.470 1.443 4.229 Publication bias (p = 0.497) Random-effects model 0.01 0.1 1 10 100 Non-share Share Figure S7: Forest Plot showing the results of meta-analysis of odds ratio for HCV infection among MMT clients stratified by injection

Study name Study LocationCategory Statistics for each study Odds ratio and 95% CI Odds Lower Upper Relative ratio limit limit IDU Non-IDU weight Bai Y,2009 Guangxi HTA 8.115 4.079 16.144 424 / 479 19 / 39 15.39 Dong G,2009 Sichuan HTA 24.462 11.246 53.206 265 / 304 10 / 46 14.82 Han XJ,2010 Guizhou HTA 1.542 0.278 8.552 4 / 170 2 / 130 8.95 Wang DY,2009Sichuan HTA 18.000 10.500 30.856 558 / 620 26 / 78 16.25 Wang J,2010 Guizhou HTA 2.941 1.100 7.862 90 / 99 34 / 44 13.45 Xiang L,2009 Yunnan HTA 13.110 6.415 26.796 203 / 219 30 / 61 15.22 Yao W,2008 Sichuan HTA 50.820 27.950 92.405 599 / 651 17 / 92 15.92 HTA (I2 = 84.330, p < 0.001) 11.785 5.704 24.346 Cai CP,2008 Zhejiang LTA 29.091 5.601 151.091 64 / 75 2 / 12 3.53 Fu FY,2009 Zhejiang LTA 29.867 15.329 58.193 128 / 183 12 / 166 6.92 Hao XQ,2009 Qinghai LTA 23.429 11.783 46.585 164 / 197 14 / 80 6.84 He XX,2010 Gansu LTA 15.426 11.424 20.831 190 / 317 106 / 1199 8.15 Liu HB,2010 Shanxi LTA 3.482 2.198 5.516 297 / 373 55 / 104 7.68 Liu XP,2010 Ningxia LTA 89.600 19.718 407.158 21 / 24 5 / 69 3.89 Li YC,2009 Shanxi LTA 8.095 5.013 13.070 211 / 280 34 / 124 7.62 Song HB,2010 Jiangsu LTA 21.324 7.074 64.281 139 / 183 4 / 31 5.22 Su MF,2010 Zhejiang LTA 4.278 2.029 9.017 44 / 92 12 / 68 6.61 Wu GH,2010 Chongqing LTA 5.381 3.638 7.958 610 / 738 62 / 132 7.90 Xia L,2010 Guangdong LTA 8.450 4.200 17.001 142 / 195 13 / 54 6.80 Xia X,2007 Jiangsu LTA 19.622 14.015 27.473 938 / 1065 67 / 245 8.05 Zhang JF,2010 Shanxi LTA 3.529 1.143 10.901 20 / 37 6 / 24 5.13 Zhou X,2009 Chongqing LTA 10.691 6.786 16.845 399 / 470 41 / 119 7.70 Zhu XH,2010 Gansu LTA 4.026 2.783 5.826 114 / 251 62 / 362 7.96 LTA (I2 = 87.643, p < 0.001) 10.530 7.027 15.778 Overall (I2 = 87.044, p < 0.001) 10.815 7.596 15.397 Publication bias (p = 0.888) 0.01 0.1 1 10 100 Random-effects model Non-IDU IDU

Figure S8: Forest Plot showing the results of meta-analysis of odds ratio for HCV infection among MMT clients stratified by sharing needles and syringes

Study name Study Location Category Statistics for each study Odds ratio and 95% CI

Odds Lower Upper Relative ratio limit limit Share Non-Share weight

BaiY,2009 Guangxi HTA 2.084 1.208 3.595 191 / 211 252 / 307 33.84 DongG,2009 Sichuan HTA 34.129 17.200 67.719 228 / 241 37 / 109 33.13 WangDY,2009 Sichuan HTA 5.670 2.809 11.445 191 / 200 393 / 498 33.03 HTA (I2 = 94.897, p < 0.001) 7.324 1.422 37.727 HeXX,2007 Gansu LTA 4.856 2.486 9.483 15 / 38 175 / 1478 19.01 LiuHB,2010 Shanxi LTA 3.638 2.252 5.879 172 / 198 180 / 279 36.99 LiYC,2009 Shanxi LTA 2.444 0.671 8.903 11 / 14 234 / 390 5.10 Wu GH,2010 Chongqing LTA 2.638 1.652 4.211 173 / 196 499 / 674 38.91 2 LTA (I = 0, p = 0.471) 3.324 2.482 4.450 Overall (I2 =0, p < 0.001) 3.405 2.555 4.539 Publication bias (p = 0.293) Random-effects model 0.01 0.1 1 10 100

Non-share Share Table S1: PRISMA Guideline

Reported Section/topic # Checklist item section # TITLE Title 1 Identify the report as a systematic review, meta- Title analysis, or both. ABSTRACT Structured summary 2 Provide a structured summary including, as Abstract applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number. INTRODUCTION Rationale 3 Describe the rationale for the review in the context of Introduction – 1st what is already known. and 2nd paragraph Objectives 4 Provide an explicit statement of questions being Introduction – 3rd addressed with reference to participants, paragraph interventions, comparisons, outcomes, and study design (PICOS). METHODS Protocol and 5 Indicate if a review protocol exists, if and where it can Methods – section registration be accessed (e.g., Web address), and, if available, 2.1 provide registration information including registration number. Eligibility criteria 6 Specify study characteristics (e.g., PICOS, length of Methods – section follow-up) and report characteristics (e.g., years 2.2 considered, language, publication status) used as criteria for eligibility, giving rationale. Information sources 7 Describe all information sources (e.g., databases Methods – section with dates of coverage, contact with study authors to 2.1 identify additional studies) in the search and date last searched. Search 8 Present full electronic search strategy for at least one Methods – section database, including any limits used, such that it could 2.1 be repeated. Study selection 9 State the process for selecting studies (i.e., Methods – section screening, eligibility, included in systematic review, 2.2 and, if applicable, included in the meta-analysis). Data collection 10 Describe method of data extraction from reports Methods – section process (e.g., piloted forms, independently, in duplicate) and 2.2 any processes for obtaining and confirming data from investigators. Data items 11 List and define all variables for which data were Methods – section sought (e.g., PICOS, funding sources) and any 2.4 assumptions and simplifications made. Risk of bias in 12 Describe methods used for assessing risk of bias of Methods – section individual studies individual studies (including specification of whether 2.3 this was done at the study or outcome level), and how this information is to be used in any data synthesis.

Summary measures 13 State the principal summary measures (e.g., risk Methods – section ratio, difference in means). 2.5 Synthesis of results 14 Describe the methods of handling data and Methods – section combining results of studies, if done, including 2.5 2 measures of consistency (e.g., I ) for each meta- analysis. Risk of bias across 15 Specify any assessment of risk of bias that may Methods – section studies affect the cumulative evidence (e.g., publication bias, 2.5 selective reporting within studies). Additional analyses 16 Describe methods of additional analyses (e.g., Methods – section sensitivity or subgroup analyses, meta-regression), if 2.5 done, indicating which were pre-specified. RESULTS Study selection 17 Give numbers of studies screened, assessed for Results – Section eligibility, and included in the review, with reasons for 3.1 exclusions at each stage, ideally with a flow diagram. Study 18 For each study, present characteristics for which data Results – Section characteristics were extracted (e.g., study size, PICOS, follow-up 3.2; Table 1 and 2 period) and provide the citations. Risk of bias within 19 Present data on risk of bias of each study and, if Table S2 studies available, any outcome level assessment (see item 12). Results of individual 20 For all outcomes considered (benefits or harms), Results – section studies present, for each study: (a) simple summary data for 3.3; Table 3 each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot. Synthesis of results 21 Present results of each meta-analysis done, Figure S1 – S8 including confidence intervals and measures of consistency. Risk of bias across 22 Present results of any assessment of risk of bias Figure S1 – S8 studies across studies (see Item 15). Additional analysis 23 Give results of additional analyses, if done (e.g., Results – section sensitivity or subgroup analyses, meta-regression 3.3; Table 3 [see Item 16]). DISCUSSION Summary of 24 Summarize the main findings including the strength Discussion-1st , evidence of evidence for each main outcome; consider their 2nd relevance to key groups (e.g., healthcare providers, and 3rd paragraph users, and policy makers). Limitations 25 Discuss limitations at study and outcome level (e.g., Discussion-4th risk of bias), and at review-level (e.g., incomplete paragraph retrieval of identified research, reporting bias). Conclusions 26 Provide a general interpretation of the results in the Discussion-5th context of other evidence, and implications for future paragraph research. FUNDING Funding 27 Describe sources of funding for the systematic Funding source review and other support (e.g., supply of data); role of funders for the systematic review. TableS2: Quality assessment score of all studies Q1. Was the Q2. Q3. Did the characteristics Q4. Was the Q5. Were the Q6. Q7. Were measures Q8. Were the QA population Was of respondents match the response rate data collection Were shown to be valid? statistical Score from which the target population? adequate? methods measur methods the sample samp standardised? es appropriate? was drawn ling shown clearly meth to be defined? od reliable repre ? senta tive of the popul ation inten ded to the study ? BaiY,2009(Bai Y, 2009) 1 0 0 1 1 0 0 0 3 CaiCP,2008(Cai CP, 2008) 1 0 0 0 0 1 1 0 3 ChenLF,2009(LF, 2009) 1 0 1 0 0 1 1 0 4 DengCK,2009(Deng CK, 2009) 1 0 1 1 1 0 0 1 5 DongG,2009(Dong G, 2009) 1 0 0 1 1 1 0 0 4 Du WJ,2007(Du et al., 2008) 1 0 0 1 1 1 1 0 5 FangHR,2008(HR et al., 2008) 1 0 0 1 1 0 0 0 3 FuFY,2009(Fu FY, 2009) 1 1 0 1 1 1 0 0 5 HanXJ,2010(Han XJ, 2010) 1 1 0 1 0 0 1 0 4 HaoC,2009(Hao C, 2009) 1 0 1 1 1 0 0 0 4 HaoXQ,2009(XQ, 2009) 1 0 0 1 1 1 0 0 4 HeXX,2010(He XX, 2010) 1 1 0 0 1 0 1 0 4 LiuHB,2010(HB and XL, 2010) 1 0 0 1 1 1 1 0 5 LiuJB,2006(Liu JB, 2006) 1 0 1 1 1 1 0 0 5 LiuXP,2010(XP, 2010) 1 0 0 1 1 1 1 0 5 LiYC,2009(Li YC, 2009) 1 0 1 1 1 1 0 0 5 LiYF,2009(Li YF, 2009) 1 0 1 0 1 1 1 0 5 MaoNL,2008(NL et al., 2010) 1 0 1 0 0 0 1 1 4 MengXH,2010(XH et al., 2010) 0 0 1 1 1 1 0 0 4 SongHB,2010(HB, 2010) 1 0 0 1 1 1 0 0 4 SuMF,2010(MF, 2010) 1 0 0 1 1 1 1 0 5 TanXL,2007(Tan XL, 2007) 1 0 0 1 1 0 0 0 3 WangDY,2009(DY et al., 2009) 1 0 0 1 1 1 0 0 4 WangJ,2008(Wang J, 2010b) 1 0 0 1 0 1 0 1 4 WangJ,2010(Wang J, 2010a) 1 0 0 1 1 0 0 1 4 WangYP,2009(Wang YP, 2009) 1 1 0 0 1 1 0 0 4 WangWM,2010(WM, 2010) 0 1 0 0 0 1 1 0 3 Wu GH,2010(Wu GH, 2010) 1 0 0 1 1 1 1 0 5 WuLH,2007(Wu LH, 2007) 1 1 1 0 1 1 0 1 6 XiaL,2010(Xia L, 2010) 1 1 0 1 0 1 0 1 5 XiaX,2007(Xia X, 2007) 1 0 1 1 1 0 0 0 4 XiangL,2009(L et al., 2009) 0 0 0 1 1 1 1 0 4 XuYP,2007(YP, 2007) 1 1 1 0 0 1 0 1 5 YaoW,2008(Yao W, 2008) 1 0 1 1 0 0 0 0 3 YuanZX,2010(ZX et al., 2010) 1 0 1 1 1 1 1 0 6 ZhangJF,2010(Zhang JF, 2010) 1 0 0 1 1 0 1 1 5 Zhou X,2009(X et al., 2009) 1 0 0 1 1 0 0 0 3 ZhouXP,2009(Zhou XP, 2009) 1 0 0 0 1 1 1 1 5 ZhuXH,2010(Zhu XH, 2010) 1 0 1 1 1 1 1 0 6 References

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