Cost-effectiveness of syringe exchange programs in Uzbekistan

Between 1999 and 2006, the number of newly diagnosed HIV infections in Uzbekistan rose exponentially from 28 to 2,205, with 80% of new cases attributable to Injecting Drug Use (IDU). The international literature suggests that syringe exchange programs (SEPs) are one of the most effective harm reduction strategies available. In Uzbekistan, governmental SEPs provide mostly an office-based service under which IDU clients come personally to the site. The non-governmental sites (NGOs) employ mostly street outreach workers who go out into the community to recruit IDUs. Our study compared the costs and effectiveness of (1) office-based and (2) street-outreach types of SEPs in Bukhara, the third largest city in Uzbekistan, using 2002 data. The study generated several remarkable findings: In FY 2002 the street outreach SEP (operated by the Bukhara Regional Association of young Medics) cost US $3,670 to serve 110 clients for a year. This street outreach model averted an HIV infection at a cost of only US $1,288, and gained a disability-adjusted life year (DALY) at a cost of only US$50. By comparison, the governmental (operated by the AIDS Center) office-based SEP cost US$14,160 representing US$9,537 per infection averted and $381 per DALY gained. The street based program was 7 times more cost-effective because it employed fewer workers yet was able to provide services to more IDUs. Since these findings suggest that the street outreach SEPs are a highly cost-effective public health intervention, the current system in Uzbekistan, which covers only 1% of injecting drug users, should be expanded.