Substantive Review

AIDS and Behavior

, Volume 17, Issue 9, pp 2878-2892

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

  • Abu S. Abdul-QuaderAffiliated withCenter for Global Health, Division of Global HIV/AIDS, Epidemiology and Strategic Information Branch, Centers for Disease Control and Prevention Email author 
  • , Jonathan FeelemyerAffiliated withChemical Dependency Institute, Beth Israel Medical Center
  • , Shilpa ModiAffiliated withElliott School of International Affairs, The George Washington University
  • , Ellen S. SteinAffiliated withGlobal Health Sciences, University of California
  • , Alya BricenoAffiliated withGlobal Health Sciences, University of California
  • , Salaam SemaanAffiliated withCenter for Global Health, Division of Global HIV/AIDS, Epidemiology and Strategic Information Branch, Centers for Disease Control and Prevention
  • , Tara HorvathAffiliated withGlobal Health Sciences, University of California
  • , Gail E. KennedyAffiliated withGlobal Health Sciences, University of California
  • , Don C. Des JarlaisAffiliated withChemical Dependency Institute, Beth Israel Medical Center

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Abstract

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.

Keywords

Structural-level interventions Needle-exchange programs HIV Hepatitis C People who inject drugs (PWID)