Abstract
BackgroundPersons 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.MethodsA 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.ResultsStudies 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.ConclusionsWhile 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.
Highlights
Persons who inject drugs (PWID) are at an elevated risk for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection
We examine structural level needle and syringe exchange programs (NSP) in different low-and middleincome and transitional countries (LMICs) around the world to determine if implementation and scale up of NSP are associated with longitudinal changes in blood borne infection among PWID populations
Results of the search A total of 11 studies/reports examining nine low/middle-income or transitional-economy countries were eligible for inclusion in this NSP review based on laboratory HIV or HCV results and greater than 50% coverage of the NSP within the respective community
Summary
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. Human immunodeficiency virus (HIV) and hepatitis C (HCV) are relatively efficiently transmitted through the multi-person use (sharing) of needles and syringes used for injecting illicit psychoactive drugs [1,2]. PWID who live in LMIC are generally at very high risk for infection with HIV and HCV. There is general consensus that these programs reduce risk behavior [6] (sharing of needles and syringes) and large-scale implementation of NSP has been associated with reductions in transmission of HIV [7]. In a Palmateer et al review [8], 144 of the 152 included studies were conducted in high-income countries
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