258210 Structural level interventions to increase needle/syringe access for preventing HIV and hepatitis C among people who inject drugs in low and middle income countries: An international systematic review

Wednesday, October 31, 2012 : 10:30 AM - 10:45 AM

Don Des Jarlais, PhD , The Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, NY
Jonathan Feelemyer, MS , The Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, NY
Shilpa Modi, BA , The Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, NY
Holly Hagan, PhD , College of Nursing, New York University, New York, NY
Background: Persons who inject drugs (PWID) are at elevated risk for HIV and hepatitis C (HCV) infection. In many high-income countries, structural level needle-syringe exchange programs (NSP) have been associated with large reductions in blood-borne infections. However, we do not have a good understanding of NSP effectiveness in low/middle income countries. Methods: Systematic literature searches, following PRISMA guidelines, were utilized to collect primary data on NSP program coverage and changes in HIV and HCV prevalence/incidence among PWID in low/middle income countries. Inclusion criteria were laboratory measures of HIV or HCV over time and structural level NSP, defined as at least 50% coverage of the local injecting population. Results: Data were obtained from: Bangladesh, Brazil, China, Estonia, Iran, Lithuania, Taiwan, Thailand and Vietnam. Decreases in HIV prevalence ranged from 3% to 42% in six studies and increased in two studies by 6% and 15%. Decreases in HCV prevalence ranged from 4.2% to 10% in three studies and HCV incidence remained stable in one study. In four national reports, three showed decreases in newly reported HIV cases among PWID during/after NSP expansion, ranging from 30% to 93%, while one documented a 38% increase. Conclusion: The data generally support the effectiveness of structural NSP in reducing HIV and HCV prevalence/incidence in low/middle income countries. There is, however, great variation in the effectiveness of programs as measured in HIV and HCV data. Future research should utilize an implementation science framework to identify and address factors limiting the effectiveness of NSPs in low/middle income countries.

Learning Areas:
Epidemiology
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Provision of health care to the public
Public health or related public policy
Public health or related research

Learning Objectives:
Describe structural level interventions for people who inject drugs Define what is considered to be structural level of coverage of needle/syringes for people who inject drugs Evaluate the positive and negative outcomes of various needle/syringe exchange programs around the world Identify locations in which structural level needle/syringe exchange programs have been implemented in response to elevated blood borne infection among people who inject drugs

Keywords: Needle Exchange Programs, Injection Drug Users

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I began my research on AIDS in 1982 and was awarded my first NIH grant on AIDS in drug users in 1983 on first submission. Since then, AIDS has been the primary focus of my research. My research has produced articles in journals such as Science, Nature, New England Journal of Medicine and the Journal of the American Medical Association, with over 300 peer-reviewed publications. Currently Director of Research at Beth Israel Medical Center
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.