High coverage needle/syringe programs for people who inject drugs in low and middle income countries: a systematic review

BMC Public Health

Holly Hagan¹  Abu Abdul-Quader²  Shilpa N Modi³  Jonathan P Feelemyer³  Don C Des Jarlais³ 

[1] College of Nursing, New York University, New York City, USA;Centers for Disease Control and Prevention, Atlanta, USA;The Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York City, USA

关键词: Injecting drug use;    People who inject drugs;    Syringe exchange programs;    Needle and syringe programs;    Hepatitis C;    HIV;   

Others  :  1162626
DOI  :  10.1186/1471-2458-13-53

 received in 2012-04-18, accepted in 2013-01-07,  发布年份 2013

【 摘 要 】

Background

Persons who inject drugs (PWID) are at an elevated risk for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection. In many high-income countries, needle and syringe exchange programs (NSP) have been associated with reductions in blood-borne infections. However, we do not have a good understanding of the effectiveness of NSP in low/middle-income and transitional-economy countries.

Methods

A systematic literature review based on PRISMA guidelines was utilized to collect primary study data on coverage of NSP programs and changes in HIV and HCV infection over time among PWID in low-and middle-income and transitional countries (LMICs). Included studies reported laboratory measures of either HIV or HCV and at least 50% coverage of the local injecting population (through direct use or through secondary exchange). We also included national reports on newly reported HIV cases for countries that had national level data for PWID in conjunction with NSP scale-up and implementation.

Results

Studies of 11 NSPs with high-coverage from Bangladesh, Brazil, China, Estonia, Iran, Lithuania, Taiwan, Thailand and Vietnam were included in the review. In five studies HIV prevalence decreased (range −3% to −15%) and in three studies HCV prevalence decreased (range −4.2% to −10.2%). In two studies HIV prevalence increased (range +5.6% to +14.8%). HCV incidence remained stable in one study. Of the four national reports of newly reported HIV cases, three reported decreases during NSP expansion, ranging from −30% to −93.3%, while one national report documented an increase in cases (+37.6%). Estimated incidence among new injectors decreased in three studies, with reductions ranging from −11/100 person years at risk to −16/100 person years at risk.

Conclusions

While not fully consistent, the data generally support the effectiveness of NSP in reducing HIV and HCV infection in low/middle-income and transitional-economy countries. If high coverage is achieved, NSP appear to be as effective in LMICs as in high-income countries. Additional monitoring and evaluation research is needed for NSPs where reductions in HIV/HCV infection among PWID are not occurring in order to identify and correct contributing problems.

【 授权许可】

   
2013 Des Jarlais et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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