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AIDS and Behavior
Published in: AIDS and Behavior 9/2013

01-11-2013 | Substantive Review

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

Authors: Abu S. Abdul-Quader, Jonathan Feelemyer, Shilpa Modi, Ellen S. Stein, Alya Briceno, Salaam Semaan, Tara Horvath, Gail E. Kennedy, Don C. Des Jarlais

Published in: AIDS and Behavior | Issue 9/2013

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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.
Footnotes
1
For locations in which study authors specified the number of PWID covered by the exchange, we used that percentage if greater than 50 % as rationale for a structural-level intervention (they also had to provide the number of syringes given). In cases that there was no coverage percentage given, we estimated coverage by taking the number of syringes distributed in the location (estimated or given outright by the author) divided by the number of PWID, and if that result was 10 or more syringes, we considered this to be a structural-level intervention. Finally, in some of the studies, authors not only gave percent coverage, but additionally provided syringe numbers and the number of PWID in the particular location. In these instances, we were able to not only document an estimate number of syringes per PWID, but also give an explicit value for coverage. If we could not establish coverage through the author directly or through supplementary searching, the study was not included in the review as we could not determine the program as structural or not.
 
2
Our coverage criteria were based on Vickerman et al. [21], which indicated threshold coverage of more than 20 % to affect substantial decreases in HIV prevalence.
 
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Metadata
Title
Effectiveness of Structural-Level Needle/Syringe Programs to Reduce HCV and HIV Infection Among People Who Inject Drugs: A Systematic Review
Authors
Abu S. Abdul-Quader
Jonathan Feelemyer
Shilpa Modi
Ellen S. Stein
Alya Briceno
Salaam Semaan
Tara Horvath
Gail E. Kennedy
Don C. Des Jarlais
Publication date
01-11-2013
Publisher
Springer US
Published in
AIDS and Behavior / Issue 9/2013
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI
https://doi.org/10.1007/s10461-013-0593-y

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