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

Don C. Des Jarlais, Jonathan P. Feelemyer, Shilpa N. Modi, Abu Abdul-Quader, Holly Hagan

Research output: Contribution to journalArticle

Abstract

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. 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. 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. 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.

Original languageEnglish (US)
Pages (from-to)53
Number of pages1
JournalBMC Public Health
Volume13
DOIs
StatePublished - 2013

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Needle-Exchange Programs
Syringes
Needles
Hepacivirus
Pharmaceutical Preparations
HIV
Virus Diseases
Estonia
Lithuania
Bangladesh
Vietnam
Incidence
Thailand

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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High coverage needle/syringe programs for people who inject drugs in low and middle income countries : a systematic review. / Des Jarlais, Don C.; Feelemyer, Jonathan P.; Modi, Shilpa N.; Abdul-Quader, Abu; Hagan, Holly.

In: BMC Public Health, Vol. 13, 2013, p. 53.

Research output: Contribution to journalArticle

Des Jarlais, Don C. ; Feelemyer, Jonathan P. ; Modi, Shilpa N. ; Abdul-Quader, Abu ; Hagan, Holly. / High coverage needle/syringe programs for people who inject drugs in low and middle income countries : a systematic review. In: BMC Public Health. 2013 ; Vol. 13. pp. 53.
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