Are needle and syringe programmes associated with a reduction in HIV transmission among people who inject drugs: a systematic review and meta-analysis

Aspinall, Esther; Nambiar, Dhanya; Goldberg, David J.; Hickman, Matthew; Weir, Alan; Velzen, Eva van; Palmateer, Norah; Doyle, Joseph S; Hellard, Margaret; Hutchinson, Sharon J.

doi:10.1093/ije/dyt243

Cited by 315 publications

(233 citation statements)

References 26 publications

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“…3,[12][13][14][15] In 2012 and 2014, two reviews were published that estimated a moderate effect of NSPs on reducing HIV transmission by 48% [95% confidence interval (CI) 3% to 72%] and strong evidence for OST reducing HIV transmission by 54% (95% CI 33% to 68%). 16,17 Similar evidence is lacking for the effect of NSPs or OST on HCV infection. Previous reviews 7,15,18 have synthesised evidence for use of NSPs but have focused primarily on HIV as the main outcome and, as a consequence, have failed to include all the available evidence on HCV infection.…”

Section: Discussionmentioning

confidence: 99%

“…25 There is good evidence that NSPs and OST reduce injecting risk behaviours and increasing evidence to show an impact on HIV incidence. 16,17 However, evidence of their impact on HCV infection incidence among PWID, in combination or alone, is limited. 3,8,[12][13][14][15]20 …”

Section: Research Questionsmentioning

confidence: 99%

“…These previous analyses of 12 observational studies estimated a moderate effect of NSPs on reducing HIV transmission by 48% (95% CI 3% to 72%) and strong evidence for OST reducing HIV transmission by 54% (95% CI 33% to 68%). 16,17 A previous review of reviews from 2010 concluded that there was insufficient evidence to assess the effectiveness of NSPs in reducing HCV infection incidence. This 'meta' review synthesised findings from four primary reviews, three of which focused primarily on HIV as an outcome missing much of the relevant data and the fourth of which predominantly relied on weaker study designs.…”

Section: Agreements and Disagreements With Other Studies Or Reviewsmentioning

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%

See 3 more Smart Citations

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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Section: Discussionmentioning

confidence: 99%

Section: Research Questionsmentioning

confidence: 99%

Section: Agreements and Disagreements With Other Studies Or Reviewsmentioning

confidence: 99%

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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“…Dramatic declines in HIV infections are occurring in other cities with expanded harm reduction programs, including Vancouver with 80% fewer infections in 2014 than 2005 [13]. The science could not be clearer: syringe exchange programs prevent HIV and other viral infections without any risk for proliferation of drug use, increases in criminal activity, or community hazards from discarded syringes/needles [14][15][16]. Nevertheless, unfounded fears, stigmas, prejudices, and ignorance remain the basis for discriminatory practices and policies that account for local surges in injection-related HIV infections.…”

mentioning

confidence: 99%

Pence, Putin, Mbeki and Their HIV/AIDS-Related Crimes Against Humanity: Call for Social Justice and Behavioral Science Advocacy

Kalichman

2017

AIDS Behav

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Effectiveness of needle/syringe programmes and opiate substitution therapy in preventing HCV transmission among people who inject drugs

Platt

Reed

Vickerman

et al. 2016

Cochrane Database of Systematic Reviews

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This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the impact of needle/syringe programmes with and without opiate substitution therapy (OST) on the incidence of HCV infection among people who inject drugs (PWID).To assess the effect of OST alone on the incidence of HCV infection among PWID. Research questions How effective are needle/syringe programmes (NSP) with and without the use of OST for reducing HCV incidence among PWID? How effective is OST alone for reducing HCV incidence among PWID? How does the effect of NSP and OST vary according to duration of treatment (i.e. for NSPs weekly attendance versus monthly)? How does the effect of NSP vary according to the type of service (fixed site versus mobile; high coverage versus low coverage)? How does the effect of OST vary according to the dosage of OST, type of substitution used and adherence to treatment?

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Are needle and syringe programmes associated with a reduction in HIV transmission among people who inject drugs: a systematic review and meta-analysis

Cited by 315 publications

References 26 publications

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

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

Pence, Putin, Mbeki and Their HIV/AIDS-Related Crimes Against Humanity: Call for Social Justice and Behavioral Science Advocacy

Effectiveness of needle/syringe programmes and opiate substitution therapy in preventing HCV transmission among people who inject drugs

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