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

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.

Molecular epidemiology of newly acquired hepatitis C infections in England 2008–2011: Genotype, phylogeny and mutation analysis

“…Available data have shown intervention measures in PWIDs can reduce both prevalence and incidence of HCV infection [2,3,17]. These actions have focussed around injecting drugs as this was, and still remains the dominant route for HCV transmission in England.…”

“…Primary interventions aimed at reducing incident infections by the provision of sterile injecting equipment and reducing injection through opiate substitution therapy have had an impact on the prevalence of HCV in persons who inject drugs (PWIDs) [2,3,17]. In addition, treatment, which leads to viral clearance will clearly impact on both the burden of disease and onward transmission [11].…”

The effect of prevention methods on reducing sexual risk for HIV and their potential impact on a large-scale: a literature review

“…A modeling study about the structural determinants of the HIV epidemic among prostitutes in several countries showed that the decriminalization of sexual work would prevent from 33 to 46% new infections throughout a decade, which is higher to that found for the impact of the amplification of ART 96 . Another systematic review showed that harm reduction programs for drug users carried out in a structural scope (i.e., more access to syringes in drugstores and elimination of prohibitions REV BRAS EPIDEMIOL SEP 2015; 18 SUPPL 1: 43-62 of drug paraphernalia) are able to reduce the incidence of HIV and hepatitis C in the general population 99 . Even though structural interventions approach many actions and mobilize several fields of work, their most important impact comes from complementarity and synergy between the different types of intervention and involved parties, such as combined actions to change the macro and microstructural context, the delivery of services and health products and the mobilization of community 100 .…”

A Decoupled System: Federal Criminal Justice and the Structural Limits of Transformation

“…There are many reasons that criminological research may not translate into public policy interventions (Austin 2003;Schmitt 2013), but even when armed with relevant data, policymakers and legislators do not always make evidence-based choices (Lilienfeld et al 2013 although there is unimpeachable evidence that needle exchange programs are effective in reducing the spread of HIV and AIDS (Abdul-Quader et al 2013), programs of this kind are often opposed on moral and political grounds. Consequently, few such programs have been established in the United States (Lurie and Drucker 1997).…”