Global, regional, and country-level coverage of interventions to prevent and manage HIV and hepatitis C among people who inject drugs: a systematic review

Abstract

SummaryBackgroundPeople who inject drugs (PWID) are a key population affected by the global HIV and hepatitis C virus (HCV) epidemics. HIV and HCV prevention interventions for PWID include needle and syringe programmes (NSP), opioid substitution therapy (OST), HIV counselling and testing, HIV antiretroviral therapy (ART), and condom distribution programmes. We aimed to produce country-level, regional, and global estimates of coverage of NSP, OST, HIV testing, ART, and condom programmes for PWID.MethodsWe completed searches of peer-reviewed (MEDLINE, Embase, and PsycINFO), internet, and grey literature databases, and disseminated data requests via social media and targeted emails to international experts. Programme and survey data on each of the named interventions were collected. Programme data were used to derive country-level estimates of the coverage of interventions in accordance with indicators defined by WHO, UNAIDS, and the UN Office on Drugs and Crime. Regional and global estimates of NSP, OST, and HIV testing coverage were also calculated. The protocol was registered on PROSPERO, number CRD42017056558.FindingsIn 2017, of 179 countries with evidence of injecting drug use, some level of NSP services were available in 93 countries, and there were 86 countries with evidence of OST implementation. Data to estimate NSP coverage were available for 57 countries, and for 60 countries to estimate OST coverage. Coverage varied widely between countries, but was most often low according to WHO indicators (<100 needle-syringes distributed per PWID per year; <20 OST recipients per PWID per year). Data on HIV testing were sparser than for NSP and OST, and very few data were available to estimate ART access among PWID living with HIV. Globally, we estimate that there are 33 (uncertainty interval [UI] 21–50) needle-syringes distributed via NSP per PWID annually, and 16 (10–24) OST recipients per 100 PWID. Less than 1% of PWID live in countries with high coverage of both NSP and OST (>200 needle-syringes distributed per PWID and >40 OST recipients per 100 PWID).InterpretationCoverage of HIV and HCV prevention interventions for PWID remains poor and is likely to be insufficient to effectively prevent HIV and HCV transmission. Scaling up of interventions for PWID remains a crucial priority for halting the HIV and HCV epidemics.FundingOpen Society Foundations, The Global Fund, WHO, UNAIDS, United Nations Office on Drugs and Crime, Australian National Drug and Alcohol Research Centre, University of New South Wales Sydney.

Linkage and retention in HCV care for HIV‐infected populations: early data from the DAA era

“…The six countries in which elimination initiatives or studies were identified all have harm reduction programmes for PWID, and protection against discrimination for LGBT populations. . However, the coverage of harm reduction programmes varies substantially between countries.…”

“…According to a recent systematic review, needle and syringe programme coverage was high in Australia and the Netherlands (>200 needles/syringes distributed per PWID per year), moderate in Canada, France and Switzerland (100 to 200 needles/syringes distributed per PWID per year) and low in Georgia (0 to 50 needles/syringes distributed per PWID per year). Opioid substitution therapy coverage was high in Australia, France, the Netherlands and Switzerland (>40 recipients per 100 PWID), moderate in Canada (20 to 40 recipients per 100 PWID), and low in Georgia (0 to 20 recipients per 100 PWID) . HCV elimination strategies operating at the regional or country level were in place in Australia, France, Georgia and the Netherlands (Table ).…”

The becoming‐methadone‐body: on the onto‐politics of health intervention translations

“…Global indicators of coverage map how this intervention travels (Larney et al . ). The translation of methadone treatment might therefore be imagined in evidence‐based intervention approaches as an ‘immutable mobile’ (Latour ); an intervention or technology which adapts through its translation from one network to another but without changing its overall purpose or effect potential.…”

“…), the introduction and scaling‐up of methadone treatment as a technology of HIV prevention is promoted globally, including to lower and middle‐income settings (Larney et al . , World Health Organization, ). The region of Eastern Europe and Central Asia is presented by global health networks as in particular need of methadone treatment as HIV prevention (Mathers et al ., ).…”

Hepatitis C elimination – Macro‐elimination

“…HCV may be transmitted through both sharing of needle/syringes and other drug paraphernalia . 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 .…”