Abstract
BackgroundNeedle and syringe programmes (NSP) are a critical component of harm reduction interventions among people who inject drugs (PWID). Our primary objective was to summarize the evidence on the effectiveness of NSP for PWID in reducing blood-borne infection transmission and injecting risk behaviours (IRB).MethodsWe conducted an overview of systematic reviews that included PWID (excluding prisons and consumption rooms), addressed community-based NSP, and provided estimates of the effect regarding incidence/prevalence of Human Immunodeficiency Virus (HIV), Hepatitis C virus (HCV), Hepatitis B virus (HBV) and bacteremia/sepsis, and/or measures of IRB. Systematic literature searches were undertaken on relevant databases, including EMBASE, MEDLINE, and PsychINFO (up to May 2015). For each review we identified relevant studies and extracted data on methods, and findings, including risk of bias and quality of evidence assessed by review authors. We evaluated the risk of bias of each systematic review using the ROBIS tool. We categorized reviews by reported outcomes and use of meta-analysis; no additional statistical analysis was performed.ResultsWe included thirteen systematic reviews with 133 relevant unique studies published between 1989 and 2012. Reported outcomes related to HIV (n = 9), HCV (n = 8) and IRB (n = 6). Methods used varied at all levels of design and conduct, with four reviews performing meta-analysis. Only two reviews were considered to have low risk of bias using the ROBIS tool, and most included studies were evaluated as having low methodological quality by review authors. We found that NSP was effective in reducing HIV transmission and IRB among PWID, while there were mixed results regarding a reduction of HCV infection. Full harm reduction interventions provided at structural level and in multi-component programmes, as well as high level of coverage, were more beneficial.ConclusionsThe heterogeneity and the overall low quality of evidence highlights the need for future community-level studies of adequate design to support these results.Trial registrationThe protocol of this systematic review was registered in Prospective Register of Systematic Reviews (PROSPERO 2015:CRD42015026145).
Highlights
Needle and syringe programmes (NSP) are a critical component of harm reduction interventions among people who inject drugs (PWID)
Another study [37] included in this review examined the impact of dispensation policies, and noted a decrease in Human Immunodeficiency Virus (HIV) prevalence between the period of legal pharmacy syringe purchase and when up to five needles could be exchanged at newly established NSP (35% to 22%; p < 0.05)
Summary of main results In this overview of systematic reviews examining the effectiveness of NSP for PWID in reducing blood-borne infection transmission and injecting risk behaviours, we identified 13 systematic reviews contributing with 133 unique studies, which were mostly observational
Summary
Needle and syringe programmes (NSP) are a critical component of harm reduction interventions among people who inject drugs (PWID). Needle and syringe programmes (NSP) are thought to be a critical component of harm reduction interventions among PWID [3, 4]. The first NSP was established in the 1980s [5], in response to the global HIV epidemic, with the goal of providing access and encouraging the use of sterile injection paraphernalia by PWID. A shift in paradigm has favoured NSP as components of harm reduction or harm minimization policies, which focus on reducing all drug-related harms, i.e. preventing HIV, HBV and HCV infection, minimizing needle and syringe sharing and reuse, reducing the volume of discarded needles and syringes in the environment, and facilitating access to sterile paraphernalia. NSP may promote the use of condoms and provide opportunistic relevant health information and services [3]
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