Examining the potential role of a supervised injection facility in Saskatoon, Saskatchewan, to avert HIV among people who inject drugs

Abstract

Background: Research predicting the public health and fiscal impact of Supervised Injection Facilities (SIFs), across different cities in Canada, has reported positive results on the reduction of HIV cases among People Who Inject Drugs (PWID). Most of the existing studies have focused on the outcomes of Insite, located in the Vancouver Downtown Eastside (DTES). Previous attention has not been afforded to other affected areas of Canada. The current study seeks to address this deficiency by assessing the cost-effectiveness of opening a SIF in Saskatoon, Saskatchewan. Methods: We used two different mathematical models commonly used in the literature, including sensitivity analyses, to estimate the number of HIV infections averted due to the establishment of a SIF in the city of Saskatoon, Saskatchewan. Results: Based on cumulative cost-effectiveness results, SIF establishment is cost-effective. The benefit to cost ratio was conservatively estimated to be 1.35 for the first two potential facilities. The study relied on 34% and 14% needle sharing rates for sensitivity analyses. The result for both sensitivity analyses and the base line estimates indicated positive prospects for the establishment of a SIF in Saskatoon. Conclusion:The opening of a SIF in Saskatoon, Saskatchewan is financially prudent in the reduction of tax payers' expenses and averting HIV infection rates among PWID. Keywords: People Who Inject Drugs (PWID), HIV, Cost-Benefit Analysis, Canada Copyright: © 2015 by Kerman University of Medical Sciences Citation: Jozaghi E, Jackson A. Examining the potential role of a supervised injection facility in Saskatoon, Saskatchewan, to avert HIV among people who inject drugs.

Exploring the role of an unsanctioned, supervised peer driven injection facility in reducing HIV and hepatitis C infections in people that require assistance during injection

“…The model above has been adopted previously by six costing studies [4, 28, 30–33]. To operationalize the model, the data shown in Table 1 needs to be imputed in excel programing and combined with the reduction in the rate of needle sharing rates in order to calculate the rate of blood borne infection reductions.…”

“…For this research, it was necessary to use a model that reflected the effects of using clean injection equipment and safer injecting behaviours in its calculations. Previous SIF cost studies such as those conducted by Bayoumi and Zaric [5], Pinkerton [60], Pinkerton [61], Andresen and Boyd [3], Andresen and Jozaghi [4], Jozaghi and Jackson [30], Jozaghi et al [31]), Jozaghi et al [32]) and Jozaghi et al [33] have concluded that SIFs are able to prevent the risk of new HIV and HCV cases, since there will be a certain number of known non-shared injections as opposed to shared injections outside of the facility.…”

“…The behavioural change is a phenomenon that has been documented in the clientele of SIFs in Canada and Europe, where such PWID are less likely to share their needles once they leave the injection facility (Bravo et al [7, 37, 39]). This rate has been incorporated in Bayoumi and Zaric [5], Bayoumi et al [6], Andresen and Boyd [3], Andresen and Jozaghi [4], Jozaghi [27, 28]), Jozaghi and Jackson [30], Jozaghi et al [31]), Jozaghi et al [32]), and Jozaghi et al [33] because of the empirical evidence shown in Kerr et al [37, 39]) and Bravo et al [7]. Ultimately, similar to Bayoumi and Zaric [5], Bayoumi et al [6], Jozaghi [29], Jozaghi et al [32]) and Jozaghi et al [33], this study considered 50 % of the reported effects of a SIF on needle sharing.…”

“…This study utilized the numerical figure of CAN$210,555 – as reported in Pinkerton [60], Andresen and Jozaghi [4], Jozaghi and Jackson [30], Jozaghi et al [31]), Jozaghi et al [32]) and Jozaghi et al [33] – because this analysis anticipated a lower cost of treatment for HIV infections among PWID. This lower estimate was chosen because PWID may experience certain self-imposed societal barriers, making them less likely to take full advantage of public health care, especially the expensive ART program [17, 54, 75, 77].…”

“…Numerous other research has demonstrated the cost-effectiveness of operating the only sanctioned SIF in North America [3, 5, 10]. Furthermore, the operation and expansion of potential sanctioned SIFs in numerous Canadian jurisdictions, such as Montreal, Ottawa, Saskatoon, Toronto, and Victoria, has been found to be extremely cost-effective [30–33]. However, the concept of an unsanctioned, peer-run SIF is controversial, particularly because the potential cost-effectiveness impacts and benefits of assisted injections are unknown.…”