Access and coverage of needle and syringe programmes (NSP) in Central and Eastern Europe and Central Asia*

Aceijas, Carmen; Hickman, Matthew; Donoghoe, Martin C.; Burrows, Dave; Stuikyte, Raminta

doi:10.1111/j.1360-0443.2007.01848.x

Cited by 49 publications

(39 citation statements)

References 25 publications

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“…A number of studies conducted in Eastern Europe and other countries have stressed the need for complementary approaches to increase the availability of syringes for IDUs besides the SEPs. [7][8][9][10] A recent Eurasian Harm Reduction Network report also reveals that existing drug policy in Eastern Europe has proved to be inadequate in terms of the increase in problem drug use and resultant epidemics of HIV and hepatitis, suggesting the need for a reformed policy and practical solutions grounded in science and human rights. 11 Involving pharmacies in providing primary prevention services to IDUs is especially important for several reasons.…”

Section: Introductionmentioning

confidence: 99%

Should Pharmacists have a Role in Harm Reduction Services for IDUs? A Qualitative Study in Tallinn, Estonia

et al. 2009

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Despite the high number of injecting drug users (IDUs) in Estonia, little is known about involving pharmacies into human immunodeficiency virus (HIV) prevention activities and potential barriers. Similarly, in other Eastern European countries, there is a need for additional sources for clean syringes besides syringe exchange programmes (SEPs), but data on current practices relating to pharmacists' role in harm reduction strategies is scant. Involving pharmacies is especially important for several reasons: they have extended hours of operation and convenient locations compared to SEPs, may provide access for IDUs who have avoided SEPs, and are a trusted health resource in the community. We conducted a series of focus groups with pharmacists and IDUs in Tallinn, Estonia, to explore their attitudes toward the role of pharmacists in HIV prevention activities for IDUs. Many, but not all, pharmacists reported a readiness to sell syringes to IDUs to help prevent HIV transmission. However, negative attitudes toward IDUs in general and syringe sales to them specifically were identified as important factors restricting such sales. The idea of free distribution of clean syringes or other injecting equipment and disposal of used syringes in pharmacies elicited strong resistance. IDUs stated that pharmacies were convenient for acquiring syringes due to their extended opening hours and local distribution. IDUs were positive toward pharmacies, although they were aware of stigma from pharmacists and other customers. They also emphasized the need for distilled water and other injection paraphernalia. In conclusion, there are no formal or legislative obstacles for providing HIV prevention services for IDUs at pharmacies. Addressing negative attitudes through educational courses and involving pharmacists willing to be public health educators in high drug use areas would improve access for HIV prevention services for IDUs.

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Section: Introductionmentioning

confidence: 99%

Should Pharmacists have a Role in Harm Reduction Services for IDUs? A Qualitative Study in Tallinn, Estonia

et al. 2009

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“…In Bristol and Walsall, size estimation data suggest that the PWID population has decreased by between 10% and 30% between 2009 and 2011. [104][105][106]108 Concurrently, survey data 44,70,73,88,89 suggest that the proportion of PWID injecting for > 10 years has increased, whereas the proportion injecting for between 3 and 10 years has decreased ( Figure 18). There has been little change in the proportion injecting for < 3 years.…”

Section: Model Calibration and Uncertaintymentioning

confidence: 99%

“…An internationally used standardised measure of an individual's NSP coverage was defined as the percentage of injections for which a new needle had been obtained (calculated as the average number of new needles obtained divided by the average number of injections in past four weeks, with the exception of the NESI survey, which measures coverage over 6 months, and the Birmingham study, which uses a 2-week time frame). 5,73,74 The total number of needles or syringes obtained from any source was taken, not limiting data to those needles/syringes obtained from a NSP. We examined the effect of both interventions in two ways.…”

Section: Interventionsmentioning

confidence: 99%

“…The prevalence of HCV infections and the coverage of harm reduction interventions such as NSPs and OST varies across the UK, 16,20,39,44,70,73,[87][88][89][90] and although the coverage of OST has increased in the past 10 years, the level of high-coverage NSPs has remained relatively constant. 70 In this chapter, a HCV infection transmission and progression model, incorporating new evidence on intervention effectiveness, is used to assess the impact of current levels of OST and NSP on HCV infection prevalence, incidence and HCV-related morbidity among current and ex-injecting drug users in three UK settings, and the probable impact of scaling up NSP coverage.…”

Section: Introductionmentioning

confidence: 99%

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Assessing the impact and cost-effectiveness of needle and syringe provision and opioid substitution therapy on hepatitis C transmission among people who inject drugs in the UK: an analysis of pooled data sets and economic modelling

et al. 2017

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Background There is limited evidence of the impact of needle and syringe programmes (NSPs) and opioid substitution therapy (OST) on hepatitis C virus (HCV) incidence among people who inject drugs (PWID), nor have there been any economic evaluations. Objective(s) To measure (1) the impact of NSP and OST, (2) changes in the extent of provision of both interventions, and (3) costs and cost-effectiveness of NSPs on HCV infection transmission. Design We conducted (1) a systematic review; (2) an analysis of existing data sets, including collating costs of NSPs; and (3) a dynamic deterministic model to estimate the impact of differing OST/NSP intervention coverage levels for reducing HCV infection prevalence, incidence and disease burden, and incremental cost-effectiveness ratios to measure the cost-effectiveness of current NSP provision versus no provision. Setting Cost-effectiveness analysis and impact modelling in three UK sites. The pooled analysis drew on data from the UK and Australia. The review was international. Participants PWID. Interventions NSP coverage (proportion of injections covered by clean needles) and OST. Outcome New cases of HCV infection. Results The review suggested that OST reduced the risk of HCV infection acquisition by 50% [rate ratio (RR) 0.50, 95% confidence interval (CI) 0.40 to 0.63]. Weaker evidence was found in areas of high (≥ 100%) NSP coverage (RR 0.77, 95% CI 0.38 to 1.54) internationally. There was moderate evidence for combined high coverage of NSPs and OST (RR 0.29, 95% CI 0.13 to 0.65). The pooled analysis showed that combined high coverage of NSPs and OST reduced the risk of HCV infection acquisition by 29–71% compared with those on minimal harm reduction (no OST, ≤ 100% NSP coverage). NSPs are likely to be cost-effective and are cost-saving in some settings. The impact modelling suggest that removing OST (current coverage 81%) and NSPs (coverage 54%) in one site would increase HCV infection incidence by 329% [95% credible interval (CrI) 110% to 953%] in 2031 and at least double (132% increase; 95% CrI 51% to 306%) the number of new infections over 15 years. Increasing NSP coverage to 80% has the largest impact in the site with the lowest current NSP coverage (35%), resulting in a 27% (95% CrI 7% to 43%) decrease in new infections and 41% (95% CrI 11% to 72%) decrease in incidence by 2031 compared with 2016. Addressing homelessness and reducing the harm associated with the injection of crack cocaine could avert approximately 60% of HCV infections over the next 15 years. Limitations Findings are limited by the misclassification of NSP coverage and the simplified intervention definition that fails to capture the integrated services that address other social and health needs as part of this. Conclusions There is moderate evidence of the effectiveness of OST and NSPs, especially in combination, on HCV infection acquisition risk. Policies to ensure that NSPs can be accessed alongside OST are needed. NSPs are cost-saving in some sites and cost-effective in others. NSPs and OST are likely to prevent considerable rates of HCV infection in the UK. Increasing NSP coverage will have most impact in settings with low coverage. Scaling up other interventions such as HCV infection treatment are needed to decrease epidemics to low levels in higher prevalence settings. Future work To understand the mechanisms through which NSPs and OST achieve their effect and the optimum contexts to support implementation. Funding The National Institute for Health Research Public Health Research programme.

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“…In their paper in this issue of Addiction, Aceijas et al [1] highlight some of the challenges encountered in conceptualizing and evaluating availability and coverage of needle and syringe programmes (NSPs) in 25 countries surveyed in Central and Eastern Europe and Central Asia (CEECA). While they acknowledge the uncertainty of some of the data the authors state that, in general, NSPs had suboptimal levels of implementation, activity and coverage.…”

mentioning

confidence: 99%

The art and the science of scaling‐up needle and syringe programmes

Bedell

2007

Addiction

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Access and coverage of needle and syringe programmes (NSP) in Central and Eastern Europe and Central Asia*

Cited by 49 publications

References 25 publications

Should Pharmacists have a Role in Harm Reduction Services for IDUs? A Qualitative Study in Tallinn, Estonia

Should Pharmacists have a Role in Harm Reduction Services for IDUs? A Qualitative Study in Tallinn, Estonia

Assessing the impact and cost-effectiveness of needle and syringe provision and opioid substitution therapy on hepatitis C transmission among people who inject drugs in the UK: an analysis of pooled data sets and economic modelling

The art and the science of scaling‐up needle and syringe programmes

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