Needle And Syringe Exchange Programs Research Articles

The Impact of Needle and Syringe Exchange Programs on HIV-Related Risk Behaviors in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis Examining Individual- Versus Community-Level Effects.

We conducted a systematic review and meta-analysis of the impact of needle and syringe exchange programs (NSP) on both individual- and community-level needle-sharing behaviors and other HIV-related outcomes in low- and middle-income countries (LMIC). A search of five databases for peer-reviewed trial or quasi-experimental studies reported through July 2021 identified 42 interventions delivered in 35 studies, with a total of 56,751 participants meeting inclusion criteria. Random-effects meta-analysis showed a significant protective association between NSP exposure and needle-sharing behaviors at the individual-level (odds ratio [OR] = 0.25, 95% confidence interval [CI] = 0.16-0.39, 8 trials, n = 3947) and community-level (OR 0.39, CI 0.22-0.69, 12 trials, n = 6850), although with significant heterogeneity. When stratified by needle-sharing directionality, NSP exposure remained associated with reduced receptive sharing, but not distributive sharing. NSP exposure was also associated with reduced HIV incidence and increased HIV testing but there were no consistent associations with prevalence of bloodborne infections. Current evidence suggests positive impacts of NSPs in LMICs.

Substance use and HIV: some considerations in a global context

ABSTRACT This brief report calls attention to the relationship between substance use and HIV from a global perspective. The epidemiology of substance use disorders among persons living with HIV and AIDS (PLWHA) is discussed along with specific caveats in the assessment of these disorders. Important macro-interventions include needle and syringe exchange programs (NSEP) and medication assisted therapy (MAT). Yet, structural interventions such as social welfare, child protection and support services for survivors of violence and abuse are necessary to reduce HIV incidence and enhance engagement in care among those living with HIV. To this extent health systems strengthening is necessary, as is integrating services provided by health and social development departments.

The impact of point-of-care hepatitis C testing in needle and syringe exchange programs on linkage to care and treatment uptake among people who inject drugs: An Australian pilot study.

Point-of-care (POC) diagnostics overcome barriers to conventional hepatitis C (HCV) testing in people who inject drugs. This study assessed impact on hepatitis C treatment uptake of POC HCV testing in needle and syringe exchange programs (NSPs). Rapid EC was a single-arm interventional pilot study of HCV POC testing conducted in three inner-city community clinics with NSPs. Twelve months after the POC testing, a retrospective medical record and Pharmaceutical Benefits Scheme audit was performed to determine the number of HCV RNA-positive participants who were prescribed HCV treatment. 70 HCV RNA-positive Rapid EC study participants were included. 44 (63%) were prescribed DAAs; 26 (59%) completed treatment and 15 (34%) had SVR testing, all of whom were cured. Age≥40years (aOR 3.45, 95% CI 1.10-11.05, p=.03) and secondary school education (aOR 5.8, 95% CI 1.54-21.80, p=.009) had higher likelihood of being prescribed DAAs, whereas homelessness was inversely associated with prescription of DAAs (aOR 0.30, 95% CI 0.09-1.04, p=.057). Median time to receive a DAA script from date of diagnosis was seven days (IQR 0 to 14days), and time to filling the DAA prescription was 2days (IQR 0-12days). In conclusion, provision of POC testing through NSPs was effective for linking new clients to HCV treatment and reduced the time to treatment. Further studies are needed to define the most cost-effective use of POC testing in models of care for people who inject drugs to increase HCV treatment uptake.

Attitudes toward harm reduction among substance use treatment professionals in Philadelphia

ABSTRACT Background Philadelphia has increasingly adopted Harm Reduction (HR) strategies which, despite reducing morbidity and mortality, remain controversial. This study examines attitudes toward HR among substance use treatment professionals. Methods 117 treatment professionals completed an anonymous online survey assessing their attitudes about four specific HR interventions: medication assisted treatment (MAT), naloxone, needle and syringe exchange programs (NSPs), and overdose prevention sites (OPSs). Results Findings indicate that treatment professionals generally had a positive perception of HR interventions as more than 90% agreed that MAT and naloxone should be discussed with clients and more than 80% agreed that NSPs and OPSs should be discussed. However, treatment professionals also endorsed concern about how certain interventions impact communities as only 28–30% indicated being comfortable if an NSP or OPS were to open on their block. Moreover, only 50% of respondents agreed that NSPs help users to seek treatment while 16% believed that OPSs would lead to increased substance use. Conclusions Of note, professionals with more experience and knowledge about HR tended to have more positive attitudes, whereas professionals who supported abstinence and 12-step programs had more negative views of HR. Implications for education to facilitate improved attitudes toward and implementation of HR interventions are discussed.

Point-of-care hepatitis C testing from needle and syringe programs: An Australian feasibility study

BackgroundAchieving hepatitis C elimination requires novel approaches to engage people at highest risk of infection into care pathways. Point-of-care-tests may help to overcome some of the barriers preventing people who inject drugs (PWID) accessing testing and progressing to treatment for hepatitis C virus (HCV). We assessed the feasibility and acceptability of HCV point-of-care testing at needle and syringe exchange programs (NSPs) co-located in three community health clinics in Melbourne, Australia. MethodsNSP clients were offered an oral fluid point-of-care test for HCV antibody by NSP staff. Positive HCV antibody tests were followed by a point-of-care test for HCV RNA alongside standard-of-care laboratory testing for hepatitis C treatment work-up. Participants were offered same-day point-of-care results on site, via phone or text message, or upon return to the service. Participants were scheduled for follow-up review with the study nurse for assessment and linkage to treatment. ResultsA total of 174 participants completed HCV antibody point-of-care test; 150 (86%) had a reactive result. Of these, 140 (93%) underwent a HCV RNA point-of-care test and 76 (54%) tested positive; few participants (5%) waited on site for results delivery, but the majority of RNA positive (63%) attended a follow-up visit for treatment work-up (median time to follow-up visit = 11 days; IQR = 7–20 days). The majority of participants reported a preference for point-of-care tests (66%) and supported NSP staff involvement in testing (90%). ConclusionProvision of HCV point-of-care tests, follow-up and linkage to treatment services through NSPs was feasible and acceptable to PWID. Despite few participants waiting to receive same-day results, there was effective linkage to care, suggesting value in further evaluation of this approach.

Correlates of anti-hepatitis C positivity and use of harm reduction services among people who inject drugs in two cities in Croatia

BackgroundWe assessed correlates of anti-hepatitis C (anti-HCV) positivity and utilization of needle and syringe exchange programs (NSEP) and opioid agonist treatment (OAT) among people who inject drugs (PWID) in two Croatian cities. MethodsWe conducted a cross-sectional study using respondent-driven (RDS) sampling among PWID in Rijeka (N=255) and Split (N=399). We used RDS-weighted population estimates and multivariable logistic regression to explore correlates of anti-HCV positivity and NSEP and OAT utilization. ResultsSeventy-eight percent (78.0%) of PWID in Rijeka and 61.5% in Split had been tested previously for HCV, while 21.5% and 7.0%, respectively, were tested for HCV in the past 12 months. Among PWID who report being infected with HCV, 24.9% in Rijeka and 11.3% in Split received anti-HCV treatment. In Rijeka, PWID who utilized NSEP and, in Split, those who were ever imprisoned, had higher odds of anti-HCV positivity. In Rijeka, PWID on OAT were more likely to use non-sterile injecting equipment and to inject for longer than 10 years. PWID enrolled in NSEP were more likely to inject opioid agonist medication (OAM) and less likely to use non-sterile injecting equipment. More than half of PWID reported misuse of OAM in the past month, while out of PWID enrolled in OAT, 65.4% in Rijeka and 88.7% in Split injected OAM in the month prior to the survey. ConclusionsKey findings of the paper point to the need to scale up HCV testing and treatment, improve access to NSEP and the quality of OAT provisions in order to prevent its misuse among PWID.

Public Health and Drug Policing in Malaysia: Using Empirical Evidence for Advocacy

Introduction: Malaysia adopted harm reduction (HR) as official policy in 2006 and subsequently implemented needle-and-syringe exchange programs (NSEP) and methadone maintenance therapies (MMT). Today these programs continue, somewhat in conflict with criminalisation of drug use (incarceration, corporal punishment, and police surveillance post-release from incarceration). Seven years from date of Malaysia’s HR policy inception, with funding from the Dutch government under the Community Action on Harm Reduction and the European Union funded Asia Action on Harm Reduction (Asia Action) projects, the Malaysian AIDS Council (MAC) and the Centre of Excellence for Research in AIDS (CERiA) carried out qualitative research with police officers and people who use drugs (PWUD) to determine attitudes towards harm reduction and drug use, and to elicit perspectives on better approaches in drug law enforcement.Methodology: We conducted qualitative research with 20 drug user participants and 11 police officers based in police stations in various states in Malaysia (Kuala Lumpur, Pahang, and Kelantan). Based among others at the Malaysian AIDS Council, the lead author has been undertaking evidence-based advocacy and has been maintaining an advocacy log containing key events including meetings with key officials, tweets, emails and text messages that contributed to improving police awareness about harm reduction and drug evidence-based drug policy.Results: In this article we summarize our approach to evidence-informed advocacy work. Our results show that police lack understanding on the efficacy and operation of harm reduction programs. They also expressed incredulity at the possibility of a drug free ASEAN region. Drug user interviews pointed to a host of police practices that constitute barriers to treatment, including abuse, corruptive practices, and failure to inform of rights. These results will also inform subsequent quantitative surveys to generate further evidence on drug law enforcement and public health implications in Malaysia. Discussion: Based on the results of the qualitative research and mileage gained in advocacy, larger scale interventions involving high-level police officials may be necessary to change practices, which oppose public health evidence but are structural or are ingrained in police culture. Negative practices have the potential to seep (and in some cases, are already seeping) into other agencies in drug policy and drug control. A consolidated written drug policy would assist in mitigating these issues.

Psychosocial and psychopathological predictors of HIV-risk injecting behavior among drug users in Portugal

Despite the introduction of needle and syringe exchange programs (NSPs), sharing of syringes and other materials remains common among injection drug users (IDUs) worldwide. For this reason, IDUs are at high-risk of HIV transmission. This paper studies the psychosocial and psychopathological determinants of sharing among IDUs. Understanding the relationship between psychological morbidity, HIV knowledge, HIV risk perception, and sharing behaviors is important to develop campaigns to curb sharing among IDUs. We recruited 120 male (76.7%) and female (23.3%) IDUs at a public outpatient treatment service in northern Portugal whose age average was 34 (sd=7.56). They were characterized for sociodemographic, clinical, and behavioral variables, as well as for knowledge on HIV transmission and prevention, HIV risk perception, and psychopathological symptoms. Almost all patients (95.8%) were tested for HIV and 31.7% were HIV positive. Half of them had a chronic disease (50.8%) and declared to engage in sharing (51.7%). Most had accurate knowledge of HIV transmission and prevention. A great majority deemed HIV risk to be high in their communities (80.8%) but deemed their personal risk to be zero or low (72.5%). Statistical analysis showed that sociodemographic variables (female sex, lower education, living alone) and psychopathological symptoms (obsessioncompulsion and somatization) predict sharing. We conclude that the development and implementation of campaigns to reduce sharing among IDUs should focus more on women, IDUs living alone, as well as early assessment and intervention on psychopathological disorders.

Retractable Syringes in a Swiss Prison Needle and Syringe Exchange Program: Experiences of Drug-using Inmates and Prison Staff Perceptions

Needle and Syringe Exchange Programs (NSP) prevent infectious diseases in community and prisons. Less than 1 % of prisons worldwide have NSP. One barrier is organizational concern for needle stick injuries from used syringes. Given these concerns, we introduced retractable syringes into our prison NSP and evaluated 1) injection drug users’ experiences with retractable syringes and 2) beliefs and knowledge about NSP among prison officers (PO) and healthcare staff (HS). In 2010, we replaced usual syringes with retractable needle devices in the prison of Champ-Dollon, Geneva, Switzerland. We examined demographics, clinical profiles and NSP use among NSP participants, and asked about ease and safety of retractable syringes use in interviews. We distributed questionnaires to PO and HS, to assess knowledge and general opinions on NSP. The majority of participants expressed that retractable syringes were acceptable alternatives, but needed improvements. Of the questionnaires, 90.3 % of PO and 9.6 % of HS were still concerned about misuse of soiled syringes as weapons. Improving the quality and ease of use of use may increase the acceptance of retractable syringes. Continuing to address PO and HS safety concerns is an important step towards more disseminated NSP implementation and useful innovation.

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

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.

Julia Dickson-Gómez on Francisco Bastos’ “Structural Violence in the Context of Drug Policy and Initiatives Aiming to Reduce Drug-Related Harm in Contemporary Brazil: A Review”

Bastos’ article on structural violence and drug policy in contemporary Brazil raises a number of big questions that substance abuse researchers, particularly social scientists and public health researchers, should tackle to a greater extent than they have to date. The first big question raised by Bastos’ article is the extent to which international drug treaties influence, and often hamper, national drug policies that may reduce the harm associated with illicit drug use. As Bastos hints, more powerful countries (often those that have problems with “demand”) have more power to dictate the content of international drug treaties than poorer countries (often those that supply). International conventions have defined particular drugs as “illicit.” These treaties—and the recent history of Brazil’s dictatorship—have made drug reform “timid” at best. While drug reform has occurred, moving national law and policy from extremely punitive criminalization to some more tolerant and flexible approaches, these efforts have been hampered by local police enforcement and ambiguities in the law that allow judges considerable latitude in prosecution. For example, a number of state legislations protect the implementation of needle and syringe exchange programs (NSEP) to reduce druguse-related harms. In spite of this, national law has not protected outreach workers or NSEP, and outreach workers and users of these programs continue to be harassed by local police. Law 11343, passed in 2006, draws a distinction between personal use and trafficking with penal sanctions recommended only for the latter. However, the distinction between the two in terms of the amount or nature of the substance was not clear in this law, and left to an interpretation of “contextual factors” and the “personal characteristics and history of each individual” giving each judge considerable and somewhat arbitrary latitude in deciding who should be prosecuted as a drug trafficker.

Needle Syringe Acquisition and HIV Prevention Among Injecting Drug Users: A Treatise on the “Good” and “Not So Good” Public Health Practices in South Asia

This article describes the prevalence of HIV/AIDS and other bloodborne infections is well established among injection drug user (IDU) populations in South Asia (SA). IDU populations in SA are diverse and display different demographic and socioeconomic profiles. The current provision of sterile injecting equipment as part of public health initiatives is suboptimal. Although some needle and syringe exchange programs (NSEPs) operate in the region, pharmacies and “friends” continue to be a major source of syringe acquisition. It is suggested that the cost of syringes in the region is significantly higher in real terms than in several other countries and negatively impacts on the ability of IDUs to acquire needles and syringes. In addition, existing NSEPs offer poor coverage both at the population and individual level. Their effective functioning is hampered by resource constraints, ambivalent policy positions, little attention to quality, and environmental factors. Secondary syringe exchange is a nascent phenomenon in SA that needs to be adequately documented and evaluated. Urgent attention needs to be given to developing alternative models of needle syringe delivery to scale-up HIV prevention interventions for IDUs. This study was conducted in the first quarter of 2004 and updated in 2006. We used key informants, previously unpublished and published data from research studies, and interventions programs, service statistics, and primary data to inform this study.

Needle and Syringe Exchange in Poland and the Former Soviet Union: A New Approach to Community-Impact Studies

This article describes a new approach to assessing the impact of needle- and syringe-exchange programs (NSEPs), designed for application in Eastern Europe and the former Soviet Union. In these parts of the world, use of a homemade opiate preparation made from poppy plants is common. The advance of AIDS has been associated with increasing use of this drug. However, NSEP might be less effective in that setting than in the West: with a liquid drug, virus transmission may take place through sharing or selling of the drug itself, even when each user has his or her own works and never shares them with others. NSEPs can be difficult to evaluate, however, particularly where users are stigmatized. Here, we propose methods to assess the community impact of NSEPs by evaluating syringes, not users. These methods involve labeling, tracking, and enumeration of syringes as well as testing of syringes for parenterally transmissible virus (e.g., human immunodeficiency virus). They allow for estimation of the total number of syringes in circulation, the average time each syringe spends circulating among users, and the rate of virus exposure among users. Examples are given of the implementation of these methods in Poland, with assessments of the community impact of local NSEPs there.

Establishing safe injecting rooms in Australia: attitudes of injecting drug users

ObjectiveTo investigate the attitudes of injecting drug users (IDUs) towards the establishment of safe injecting rooms (SIRs) in Melbourne, Australia. MethodsMulti-site convenience sampling at Needle and Syringe Exchange Programs (NSEPs) within six Melbourne suburbs. Four hundred current IDUs were recruited directly through NSEP and participant snowballing. Respondents completed either a semi-structured interview, anonymous self-report questionnaire, face-to-face interview or participated in a focus group. Participants were asked to report on their knowledge and attitudes about SIR, their experiences and concerns as participants of street-based illicit drug markets, and their willingness to use SIRs if established. ResultsParticipants (91%) were knowledgeable about the SIR issue and thought such a strategy had potential to address both personal and wider community harms associated with public injecting. Most (77%) indicated they would be willing to use a SIR if established in Melbourne. Gender, lifetime non-fatal overdose episodes and frequency of heroin use were all significantly related to a person's willingness to use SIRs. A significant number also reported a preference for injecting at their own place of residence due to concerns regarding privacy, safety and police presence within street-based market places. ConclusionsThis study has identified a number of important issues relating to the likely demand and uptake of SIRs that should be addressed when considering the feasibility of establishing SIRs within Australia.

1997 Awards for Innovation and Excellence in Primary Health Care - Health Promotion: Syringe Disposal Hotline

Brief Description of the Program: Although needle and syringe exchange programs (NSEP) remain integral to Australia's internationally recognised response to the pandemic, the public have very real concerns about the health risks posed by syringes that are improperly disposed. The Syringe Disposal Hotline provides a seven days per week advice, referral, collection and disposal service for local residents concerned about inappropriately discarded sharps.