Effectiveness of needle and syringe Programmes in people who inject drugs – An overview of systematic reviews

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).Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4210-2) contains supplementary material, which is available to authorized users.

Framing science: How opioid research is presented in online news media

“…The MeSH term "opioid-related disorders" (U.S. National Library of Medicine), includes abuse, addiction, and dependence and any kind of opioid or opiate (e.g., heroin, morphine, codeine), from which we selected the six subtopics that aligned most closely with prevention, harm reduction, and treatment efforts: diagnosis, drug therapy, prevention and control, rehabilitation, therapy, and epidemiology. These subtopics became the basis of our final query, to which we added the MeSH term "needle-exchange programs" (found under the sub-heading "Preventative Health Services" ) due to their importance as a harm reduction strategy that is not covered by any of the other search terms (Fernandes et al, 2017). This search yielded 12,166 relevant research studies.…”

PrEP awareness, eligibility, and interest among people who inject drugs in Baltimore, Maryland

“…In 2015, the Centers for Disease Control and Prevention (CDC) determined that 6% of HIV diagnoses in the U.S. were attributable to injection drug use (IDU) and another 3% to male-to-male sexual contact and IDU(Centers for Disease Control Prevention, 2016). The most successful, evidence-based HIV prevention effort targeting PWID is syringe service programs (SSPs), which have significantly reduced the incidence of HIV and HCV infections among PWID over the past 30 years (Fernandes et al, 2017; Gibson et al, 2001; MacDonald et al, 2003). The ongoing opioid epidemic threatens to reverse the progress that has been made on HIV prevention.…”

Hepatitis C elimination – Macro‐elimination

“…NSP is recommended to reduce the spread of HIV and hepatitis in PWID . Certain reviews have concluded that there is evidence that NSP is reducing injection risk behaviour and transmission of HIV but the data are insufficient to confirm its effectiveness in preventing the transmission of HCV . On the other hand, there are studies showing that NSP prevents HCV transmission, in particular when it is combined with OAT .…”

“…16,[33][34][35] Certain reviews have concluded that there is evidence that NSP is reducing injection risk behaviour and transmission of HIV but the data are insufficient to confirm its effectiveness in preventing the transmission of HCV. [36][37][38] On the other hand, there are studies showing that NSP prevents HCV transmission, in particular when it is combined with OAT. 16,35 In a recent Cochrane report, Platt et al concluded that OAT was associated with a 50% reduction in the HCV transmission rate, while needle exchange programs (NEP) alone was less effective with a reduction of 21%.…”