Needle syringe programmes are effective structural interventions

Effectiveness of Structural-Level Needle/Syringe Programs to Reduce HCV and HIV Infection Among People Who Inject Drugs: A Systematic Review.

Abdul-Quader AS, Feelemyer J, Modi S, Stein ES, Briceno A, Semaan S, Horvath T, Kennedy GE, Des Jarlais DC. AIDS Behav. 2013 Aug 22. [Epub ahead of print]

Needle-syringe programs (NSP) have been effective in reducing HIV and hepatitis C (HCV) infection among people who inject drugs (PWID). Achieving sustainable reductions in these blood-borne infections requires addressing structural factors so PWID can legally access NSP services. Systematic literature searches collected information on NSP coverage and changes in HIV or HCV infection prevalence or incidence at the population level. Included studies had to document biomarkers (HIV or HCV) coupled with structural-level NSP, defined by a minimum 50% coverage of PWID and distribution of 10 or more needles/syringe per PWID per year. Fifteen studies reported structural-level NSP and changes in HIV or HCV infection prevalence/incidence. Nine reported decreases in HIV prevalence, six in HCV infection prevalence, and three reported decreases in HIV incidence. The results support NSP as a structural-level intervention to reduce population-level infection and implementation of NSP for prevention and treatment of HIV and HCV infection.

Abstract access [1]

Editor’s notes: Injection drug use is one of the most efficient modes of transmission of human immunodeficiency virus (HIV), hepatitis C (HCV), and other blood-borne diseases. There are an estimated 16 million people who inject drugs (PWID) worldwide, of whom approximately 3 million are estimated to be HIV-positive. Structural interventions focus on contextual or environmental factors that influence risk behaviour, rather than characteristics of individuals who engage in risk behaviours. This paper reviewed evidence from studies that included interventions that evaluated changes in policies, laws and regulations in relation to access and availability of sterile injecting equipment, use of public funds for establishing structural level large-scale syringe access programmes (NSP), and distribution of sterile equipment at the population level. The findings highlight the importance of establishing structural-level large-scale syringe access programmes for HIV prevention, especially early in an epidemic among PWID.  Further, it emphasizes that significant public health benefits can be obtained even when at least 50% of the injecting population in a community receive at least 10 or more sterile syringes per year.

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