The impact of needle and syringe provision and opiate substitution therapy on the incidence of hepatitis C virus in injecting drug users: pooling of UK evidence

Turner, Katherine Mary Elizabeth; Hutchinson, Sharon; Vickerman, Peter; Hope, Vivian; Craine, Noel; Palmateer, Norah; May, Margaret; Taylor, Avril; Angelis, Daniela De; Cameron, S.; Parry, John; Lyons, Marion; Goldberg, David J.; Allen, Elizabeth; Hickman, Matthew

doi:10.1111/j.1360-0443.2011.03515.x

Cited by 280 publications

(303 citation statements)

References 39 publications

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“…obtaining ≥ 1 sterile syringes per injection) or OST can each reduce HCV infection risk by 50%; and NSPs and OST in combination can reduce HCV infection risk by 80%. 20 However, owing to a small number of incident HCV infection cases (n = 40), the efficacy estimate for 100% coverage of NSPs was weak (95% CI 0.22 to 1.12) and there was insufficient power to evaluate whether or not a dose-response relationship exists. This project will provide a more robust understanding of the likely impact of existing coverage levels of NSPs and changes in the extent of provision.…”

Section: Discussionmentioning

confidence: 99%

“…NIHR Journals Library www.journalslibrary.nihr.ac.uk Needle and syringe programmes versus lower or no needle and syringe programmes coverage A total of 15 studies reported measures of NSP exposure and HCV infection incidence, 14,20,[41][42][43][44]47,48,50,54,58 including five unpublished estimates. [33][34][35]59,60 Only five studies published adjusted estimates, 33,42,44,47,48 restricting the sensitivity analysis that could be conducted.…”

Section: Effectiveness Of Needle/syringe Programmes and Opioid Substimentioning

confidence: 99%

“…[33][34][35][36][37]59,60 Seventeen studies reported the impact of NSPs, 14,20,[41][42][43][44]47,48,50,54,56,58 including five unpublished sources, [33][34][35]59,60 and four reported combined measures of NSPs with OST, 14,33,44,47 including one unpublished data source. 33 One study looked at the impact of distributing injecting paraphernalia (defined as spoons and filters) by itself, with needles/syringes and in combination with OST.…”

Section: Type Of Interventionsmentioning

confidence: 99%

“…Twenty-one of the included studies reported the impact of OST, 14,20,39,40,[45][46][47]49,[51][52][53]55,57,58 including seven unpublished estimates. [33][34][35][36][37]59,60 Seventeen studies reported the impact of NSPs, 14,20,[41][42][43][44]47,48,50,54,56,58 including five unpublished sources, [33][34][35]59,60 and four reported combined measures of NSPs with OST, 14,33,44,47 including one unpublished data source.…”

Section: Type Of Interventionsmentioning

confidence: 99%

“…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%

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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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Section: Discussionmentioning

confidence: 99%

Section: Effectiveness Of Needle/syringe Programmes and Opioid Substimentioning

confidence: 99%

Section: Type Of Interventionsmentioning

confidence: 99%

Section: Type Of Interventionsmentioning

confidence: 99%

“…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%

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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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Association of Opioid Agonist Therapy With Lower Incidence of Hepatitis C Virus Infection in Young Adult Injection Drug Users

et al. 2014

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use is the primary mode of transmission for hepatitis C virus (HCV) infection. Prior studies suggest opioid agonist therapy may reduce the incidence of HCV infection among injection drug users; however, little is known about the effects of this therapy in younger users.OBJECTIVE To evaluate whether opioid agonist therapy was associated with a lower incidence of HCV infection in a cohort of young adult injection drug users.

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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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The impact of needle and syringe provision and opiate substitution therapy on the incidence of hepatitis C virus in injecting drug users: pooling of UK evidence

Cited by 280 publications

References 39 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

Association of Opioid Agonist Therapy With Lower Incidence of Hepatitis C Virus Infection in Young Adult Injection Drug Users

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

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