Effectiveness of Structural-Level Needle/Syringe Programs to Reduce HCV and HIV Infection Among People Who Inject Drugs: A Systematic Review
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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.
KeywordsStructural-level interventions Needle-exchange programs HIV Hepatitis C People who inject drugs (PWID)
The project has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) as part of country activities. Time and effort of Dr. Des Jarlais, Jonathan Feelemyer and Shilpa Modi were supported through US NIH Grant R01 AI 083035.
- 2.Mathers BM, Degenhardt L, Phillips B, Wiessing L, Hickman M, Strathdee SA, Wodak A, Panda S, Tyndall M, Toufik A, Mattick RP, 2007 Reference Group to the UN on HIV and Injecting Drug Use. Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet. 2008;372(9651):1733–45.PubMedCrossRefGoogle Scholar
- 4.Palmateer N, Kimber J, Hickman M, Hutchinson S, Rhodes T, Goldberg D. Evidence for the effectiveness of sterile injecting equipment provision in preventing hepatitis C and human immunodeficiency virus transmission among injecting drug users: a review of reviews. Addiction. 2010;105(5):844–59.PubMedCrossRefGoogle Scholar
- 5.Anderson E, Gans J, Shwayder P, Scofield J, Catizone C. HIV prevention and access to sterile syringes. National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention. Atlanta; 1999.Google Scholar
- 6.Centers for Disease Control. Report on pharmacy sales of sterile syringes. Atlanta; 2005.Google Scholar
- 8.Wright-Deaguero L, Weinstein B, Jones TS, Mills J. Impact of the change in Connecticut syringe prescription laws on pharmacy sales and pharmacy managers’ practices. JAIDS. 1998;18(Supp l):S102–10.Google Scholar
- 17.Wodak A, Cooney A. Effectiveness of sterile needle and syringe programming in reducing HIV/AIDS among injecting drug users. Evidence for Action Technical Papers. Geneva: WHO; 2004.Google Scholar
- 22.AIDS Information and Global Education System. AIDS information and global education system from http://www.aegis.com/ 2011.
- 30.Hammett TM, Kling R, Johnston P, Liu W, Ngu D, Friedmann P, et al. Patterns of HIV prevalence and HIV risk behaviors among injection drug users prior to and 24 months following implementation of cross-border HIV prevention interventions in northern Vietnam and southern China. AIDS Educ Prev. 2006;18(2):97–115.PubMedCrossRefGoogle Scholar
- 40.Personal communication with Kerr on May 21 2010.Google Scholar
- 42.UNAIDS. Practical guidelines for intensifying HIV prevention: towards universal access. Geneva: UNAIDS; 2007.Google Scholar
- 43.GMHC. Syringe exchange programs around the world: the global context. P. Sean Cahill, and Nathan Schaefer, Gay Men’s Health Crisis. http://www.gmhc.org/files/editor/file/gmhc_intl_seps.pdf 2009.