Measuring The Impact Of Needle Exchange Programs Among Injecting Drug Users Through The National Behavioural Surveillance In Bangladesh

Jenkins, Carol; Rahman, Habibur; Saidel, Tobi; Jana, Smarajit; Hussain, A

doi:10.1521/aeap.13.5.452.24141

Cited by 30 publications

(19 citation statements)

References 7 publications

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“…The model predicts that the intervention may have reduced the incidence of HIV among susceptible IDUs by 89.5%, resulting in an HIV prevalence of 10.4% after eight years of intervention activity, instead of 42.0% if the intervention had not occurred. It is known that an effective NSP can reduce HIV transmission among IDUs and safer behaviours have been documented in IDUs who have participated in the Bangladesh NSP (20). …”

Section: The Hiv Epidemic: Present Status and The Futurementioning

confidence: 99%

HIV and AIDS in Bangladesh

Azim

Khan

Haseen

et al. 2009

J Health Popul Nutr

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Bangladesh initiated an early response to the HIV epidemic starting in the mid-1980s. Since then, the response has been enhanced considerably, and many HIV-prevention interventions among the most at-risk populations and the general youth are being undertaken. Alongside prevention activities, gathering of data has been a key activity fostered by both the Government and individual development partners. This paper reviews available sources of data, including routine surveillance (HIV and behavioural among most at-risk populations), general population surveys, and various research studies with the aim to understand the dynamics of the HIV epidemic in Bangladesh. Available data show that the HIV epidemic is still at relatively low levels and is concentrated mainly among injecting drug users (IDUs) in Dhaka city. In addition, when the passively-reported cases were analyzed, another population group that appears to be especially vulnerable is migrant workers who leave their families and travel abroad for work. However, all sources of data confirm that risk behaviours that make individuals vulnerable to HIV are high-this is apparent within most at-risk populations and the general population (adult males and youth males and females). Based on the current activities and the sources of data, modelling exercises of the future of the HIV epidemic in Dhaka suggest that, if interventions are not enhanced further, Bangladesh is likely to start with an IDU-driven epidemic, similar to other neighbouring countries, which will then move to other population groups, including sex workers, males who have sex with males, clients of sex workers, and ultimately their families. This review reiterates the often repeated message that if Bangladesh wants to be an example of how to avert an HIV epidemic, it needs to act now using evidence-based programming.

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Section: The Hiv Epidemic: Present Status and The Futurementioning

confidence: 99%

HIV and AIDS in Bangladesh

Azim

Khan

Haseen

et al. 2009

J Health Popul Nutr

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“…NSPs have been shown to be safe and effective in reducing HIV transmission in diverse settings (Bastos & Strathdee, 2000;Jenkins et al, 2001;Kwon et al, 2009;Vickerman et al, 2006;Wodak, 2006). A recent review of reviews found sufficient evidence of NSPs to reduce self-reported risky injecting behavior and tentative evidence of effectiveness of NSPs to reduce HIV transmission (Palmateer et al, 2010).…”

Section: Effectiveness and Cost-effectiveness Of Nspsmentioning

confidence: 99%

The cost-effectiveness of harm reduction

Wilson¹,

Donald²,

Shattock³

et al. 2015

International Journal of Drug Policy

122

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HIV prevalence worldwide among people who inject drugs (PWID) is around 19%. Harm reduction for PWID includes needle-syringe programs (NSPs) and opioid substitution therapy (OST) but often coupled with antiretroviral therapy (ART) for people living with HIV. Numerous studies have examined the effectiveness of each harm reduction strategy. This commentary discusses the evidence of effectiveness of the packages of harm reduction services and their cost-effectiveness with respect to HIV-related outcomes as well as estimate resources required to meet global and regional coverage targets. NSPs have been shown to be safe and very effective in reducing HIV transmission in diverse settings; there are many historical and very recent examples in diverse settings where the absence of, or reduction in, NSPs have resulted in exploding HIV epidemics compared to controlled epidemics with NSP implementation. NSPs are relatively inexpensive to implement and highly cost-effective according to commonly used willingness-to-pay thresholds. There is strong evidence that substitution therapy is effective, reducing the risk of HIV acquisition by 54% on average among PWID. OST is relatively expensive to implement when only HIV outcomes are considered; other societal benefits substantially improve the cost-effectiveness ratios to be highly favourable. Many studies have shown that ART is cost-effective for keeping people alive but there is only weak supportive, but growing evidence, of the additional effectiveness and cost-effectiveness of ART as prevention among PWID. Packages of combined harm reduction approaches are highly likely to be more effective and cost-effective than partial approaches. The coverage of harm reduction programs remains extremely low across the world. The total annual costs of scaling up each of the harm reduction strategies from current coverage levels, by region, to meet WHO guideline coverage targets are high with ART greatest, followed by OST and then NSPs. But scale-up of all three approaches is essential. These interventions can be cost-effective by most thresholds in the short-term and cost-saving in the long-term.

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“…A few years later, however, HIV prevalence quickly shot up to 40Á50% (Oelrichs et al 2000), a development attributed in part to the failure of the intervention to reach a sufficient share of IDUs (Crofts 2005). In Bangladesh, several studies suggest that needle/syringe programme participants were less likely than non-participants to share injection equipment (Jenkins et al 2001, Monitoring the AIDS Pandemic Network 2004), but secular cross-sectional serosurveys of HIV among IDUs in three cities with needle/syringe programmes produced mixed results: no cases of HIV in two cities but increasing prevalence from 1.4% to 4% in the other city (Azim et al 2004). It may be that the latter city's intervention, like that in Kathmandu, achieved lower coverage of the IDU population.…”

Section: Dearth Of Evidence From the Developing Worldmentioning

confidence: 99%

HIV prevention for injection drug users in China and Vietnam: Policy and research considerations

Hammett

Jarlais

Johnston

et al. 2007

Global Public Health

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A pattern of serious injection drug user (IDU) driven HIV epidemics in Asia, with emerging evidence of generalization through heterosexual transmission, indicates the need for interventions focusing on both drug- and sex-related risk reduction. In a cross-border HIV prevention project for IDUs in northern Vietnam and southern China, peer educators disseminated risk reduction information to IDUs in the community and provided 20,000-25,000 sterile needles/syringes and 4,000-6,000 condoms per month. Since implementation of these interventions, the frequency of both injecting and sexual risk behaviours fell significantly, HIV prevalence among IDUs declined or stabilized, and HIV incidence dropped. There is official support for harm reduction interventions in both countries but this appears precarious in view of persistently powerful political and financial support for a law enforcement approach. Moreover, the simultaneous pursuit of inconsistent policies can have negative effects on the implementation of interventions. A harmonized and consistent policy environment is needed. Most of the evidence for efficacy of community-based HIV prevention comes from the developed world, but well-designed evaluations of such interventions in Asia and elsewhere in the developing world would have a better chance to influence policy decisions there. A synergistic approach to research, policy development, and service delivery is best calculated to achieve positive results in the struggle against HIV/AIDS in developing countries.

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Measuring The Impact Of Needle Exchange Programs Among Injecting Drug Users Through The National Behavioural Surveillance In Bangladesh

Cited by 30 publications

References 7 publications

HIV and AIDS in Bangladesh

HIV and AIDS in Bangladesh

The cost-effectiveness of harm reduction

HIV prevention for injection drug users in China and Vietnam: Policy and research considerations

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