Evidence for the Effectiveness of Sterile Injecting Equipment Provision in Preventing Hepatitis C and Human Immunodeficiency Virus Transmission Among Injecting Drug Users: A Review of Reviews
May 4, 2010
The study authors aimed to review the evidence on the effectiveness of harm reduction interventions involving the provision of sterile injecting equipment to prevent hepatitis C virus (HCV) and HIV among injecting drug users. Among the interventions assessed: needle and syringe programs (NSP), alternative modes of provision (pharmacies, vending machines and outreach), and the provision of injecting equipment other than needles or syringes.
The team identified three core and two supplementary reviews of injecting equipment interventions. According to the study's proposed framework, the investigators found (a) insufficient evidence supporting the conclusion that any of the interventions are effective in preventing HCV infection; (b) tentative evidence to support the effectiveness of NSP in preventing HIV transmission; (c) sufficient evidence to support the effectiveness of NSP (and tentative evidence of an additional impact of pharmacy NSP) in reducing self-reported IRB; and (d) scant to no evidence on vending machines, outreach, or providing other injecting equipment in relation to any of the outcomes.
"The evidence is weaker than given credit for in the literature," the authors concluded. "The lack of evidence for effectiveness of NSP vis-á-vis biological outcomes (HIV and HCV incidence/prevalence) reflects the limitations of studies that have been undertaken to investigate these associations. Particularly for HCV, low levels of IRB may be insufficient to reduce high levels of transmission. New studies are required to identify the intervention coverage necessary to achieve sustained changes in blood-borne virus transmission."
03.01.2010; Vol. 105; No. 5: P. 844-859; Norah Palmateer; Jo Kimber; Matthew Hickman; Sharon Hutchinson; Tim Rhodes; David Goldberg
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This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.