The effectiveness of harm reduction in preventing HIV among injecting drug users

Wodak, Alex; Maher, Lisa

doi:10.1071/nb10007

Cited by 41 publications

(32 citation statements)

References 34 publications

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“…The march towards a successful HIV-vaccine has become compellingly close [11]. Both needle exchange and opioid substitution [12,13] programs and improved approaches to blood transfusion [14,15] have been shown to reduce HIV transmission. In 2013, 2.1 million new HIV infections were reported, 38% lower than those reported in 2001.…”

Section: Introductionmentioning

confidence: 99%

Teachers’ Patterns of Implementation of an Evidence-Based Intervention and Their Impact on Student Outcomes: Results from a Nationwide Dissemination over 24-Months Follow-Up

Stanton

2015

AIDS Behav

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More information is needed about factors influencing real-life implementation and program impact of interventions effective in controlled study conditions. Ongoing national implementation of an evidence-based HIV prevention program targeting grade 6 students in The Bahamas offers the opportunity to examine patterns of implementation and relate them to student outcomes. Data were collected from 208 grade 6 teachers, 75 grade 7 teachers and 4,411 grade 6 students followed over two years. Mixed-effects modeling analysis examined the association of teachers’ patterns of implementation with student outcomes. High quality program implementation in grade 6 (high implementation dosage and fidelity) was significantly related to student outcomes six and 18 months post-intervention. Quality of implementation of the booster session in grade 7 was also significantly related to student outcomes in grade 7. Quality of delivery of the brief booster session a year after initial implementation is important in maintaining or resetting the student outcome trajectory.

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Section: Introductionmentioning

confidence: 99%

Teachers’ Patterns of Implementation of an Evidence-Based Intervention and Their Impact on Student Outcomes: Results from a Nationwide Dissemination over 24-Months Follow-Up

Stanton

2015

AIDS Behav

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“…Thus the timely introduction of harm reduction interventions could prevent an explosion in HIV prevalence, as has occurred in other countries (Mathers et al, 2008). Preventing a widespread epidemic among PWID has been accomplished in many locations, including Australia and parts of the United Kingdom, where interventions were implemented before or at an early stage of viral diffusion (Iversen, Wand, Topp, Kaldor, & Maher, 2014; Stimson, 1995, 1996; Wodak & Maher, 2010). These examples illustrate that early prevention can be effective in both keeping HIV prevalence low among PWID and preventing the rapid spread of HIV within injection networks.…”

Section: Discussionmentioning

confidence: 99%

Heroin Use and Injection Risk Behaviors in Colombia: Implications for HIV/AIDS Prevention

Mateu‐Gelabert

Harris

Fernández

et al. 2016

Substance Use & Misuse

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Background Heroin production in Colombia has increased dramatically in recent decades, and some studies point to an increase in local heroin use since the mid-1990s. Despite this rapid increase, little is known about the effects of these activities on heroin injection within Colombia. One of the biggest concerns surrounding heroin injection is the potential spread of HIV through drug user networks. Objectives This article examines injection risk behaviors among heroin injectors in the Colombian cities of Medellín and Pereira to explore the implications for possible increased HIV transmission within this group. Methods A cross-sectional study used respondent-driving sampling to recruit a sample of 540 people who inject drugs (PWID) over 18 years of age (Medellín: n = 242, Pereira: n = 298). Structured interviews with each participant were conducted using the World Health Organization Drug Injection Study Phase II Survey. An HIV test was also administered. Results Information regarding the socio-demographics, injection drug use, HIV risk and transmission behaviors, injection risk management, and HIV knowledge and prevalence of participants are reported. The study identified many young, newly initiated injectors who engage in risky injection practices. The study also found that HIV prevalence is fairly low among participants (2.7%). Conclusions/Importance Findings indicate a potential risk for the spread of HIV among PWID in Colombia given their widespread sharing practices, high rate of new injector initiation, and unsafe syringe cleaning practices. Colombia has a possibly time-limited opportunity to prevent an HIV epidemic by implementing harm reduction interventions among young, newly initiated PWID.

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“…Given their relatively low costs and evidence of effectiveness, NSPs are recognized as one of the most cost-effective public health interventions ever funded (International, 2012). Studies in numerous countries have repeatedly provided compelling evidence that NSPs are cost-effective both from societal and health sector perspectives (Vickerman, Miners, & Williams, 2008;Wodak & Maher, 2010). A systematic review found that all 12 included studies that examined the impact of NSPs on HIV infection found that NSPs were cost-effective according to the studies' defined willingness-to-pay thresholds (Jones, Pickering, Sumnall, McVeigh, & Bellis, 2008).…”

Section: Effectiveness and Cost-effectiveness Of Nspsmentioning

confidence: 96%

The cost-effectiveness of harm reduction

Wilson¹,

Donald²,

Shattock³

et al. 2015

International Journal of Drug Policy

128

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HIV prevalence worldwide among people who inject drugs (PWID) is around 19%. Harm reduction for PWID includes needle-syringe programs (NSPs) and opioid substitution therapy (OST) but often coupled with antiretroviral therapy (ART) for people living with HIV. Numerous studies have examined the effectiveness of each harm reduction strategy. This commentary discusses the evidence of effectiveness of the packages of harm reduction services and their cost-effectiveness with respect to HIV-related outcomes as well as estimate resources required to meet global and regional coverage targets. NSPs have been shown to be safe and very effective in reducing HIV transmission in diverse settings; there are many historical and very recent examples in diverse settings where the absence of, or reduction in, NSPs have resulted in exploding HIV epidemics compared to controlled epidemics with NSP implementation. NSPs are relatively inexpensive to implement and highly cost-effective according to commonly used willingness-to-pay thresholds. There is strong evidence that substitution therapy is effective, reducing the risk of HIV acquisition by 54% on average among PWID. OST is relatively expensive to implement when only HIV outcomes are considered; other societal benefits substantially improve the cost-effectiveness ratios to be highly favourable. Many studies have shown that ART is cost-effective for keeping people alive but there is only weak supportive, but growing evidence, of the additional effectiveness and cost-effectiveness of ART as prevention among PWID. Packages of combined harm reduction approaches are highly likely to be more effective and cost-effective than partial approaches. The coverage of harm reduction programs remains extremely low across the world. The total annual costs of scaling up each of the harm reduction strategies from current coverage levels, by region, to meet WHO guideline coverage targets are high with ART greatest, followed by OST and then NSPs. But scale-up of all three approaches is essential. These interventions can be cost-effective by most thresholds in the short-term and cost-saving in the long-term.

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The effectiveness of harm reduction in preventing HIV among injecting drug users

Abstract: Abstract:There is now compelling evidence that harm reduction approaches to HIV prevention among injecting drug users are effective, safe and cost-effective.

Cited by 41 publications

References 34 publications

Teachers’ Patterns of Implementation of an Evidence-Based Intervention and Their Impact on Student Outcomes: Results from a Nationwide Dissemination over 24-Months Follow-Up

Teachers’ Patterns of Implementation of an Evidence-Based Intervention and Their Impact on Student Outcomes: Results from a Nationwide Dissemination over 24-Months Follow-Up

Heroin Use and Injection Risk Behaviors in Colombia: Implications for HIV/AIDS Prevention

The cost-effectiveness of harm reduction

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