AIDS and Behavior

, Volume 17, Issue 9, pp 2878–2892 | Cite as

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

  • Abu S. Abdul-QuaderEmail author
  • Jonathan Feelemyer
  • Shilpa Modi
  • Ellen S. Stein
  • Alya Briceno
  • Salaam Semaan
  • Tara Horvath
  • Gail E. Kennedy
  • Don C. Des Jarlais
Substantive Review


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.


Structural-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.

Conflict of interest

Dr. Don Des Jarlais was an investigator on six of the included studies Des Jarlais et al. [31, 32, 33, 34, 35, 36]. Dr. Des Jarlais affirms that he has no financial or any other tangible interest in his studies being reviewed.


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Copyright information

© Springer Science+Business Media New York (outside the USA) 2013

Authors and Affiliations

  • Abu S. Abdul-Quader
    • 1
    Email author
  • Jonathan Feelemyer
    • 2
  • Shilpa Modi
    • 3
  • Ellen S. Stein
    • 4
  • Alya Briceno
    • 4
  • Salaam Semaan
    • 1
  • Tara Horvath
    • 4
  • Gail E. Kennedy
    • 4
  • Don C. Des Jarlais
    • 2
  1. 1.Center for Global Health, Division of Global HIV/AIDS, Epidemiology and Strategic Information BranchCenters for Disease Control and PreventionAtlantaUSA
  2. 2.Chemical Dependency InstituteBeth Israel Medical CenterNew YorkUSA
  3. 3.Elliott School of International AffairsThe George Washington UniversityWashingtonUSA
  4. 4.Global Health SciencesUniversity of CaliforniaSan FranciscoUSA

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