title: Individual-level syringe coverage among Needle and Syringe Program attendees in Australia.
abstract: BACKGROUND
  Harm associated with injecting drug use is a significant public health issue and a major cause of morbidity and mortality, with global estimates of 3 million injectors infected with HIV and 8 million living with chronic hepatitis C virus (HCV) infection. Estimates of program coverage are widely used in the context of HIV prevention and are critical in determining the effectiveness of interventions such as Needle and Syringe Programs (NSPs).
  
  
  METHODS
  Data from a national cross-sectional study of NSP attendees in Australia were used to estimate individual-level syringe coverage as a proportion of monthly injections covered by a new syringe. Univariate and multivariate logistic regressions modelled associations between demographics, injecting risk, anti-HIV and HCV prevalence and syringe coverage. The median number of syringes retained per NSP attendee per annum was also estimated.
  
  
  RESULTS
  Twenty percent of participants had insufficient new syringes for all injections. Syringe reuse (including reuse of one's own syringe) was independently associated with syringe coverage of <100%. Conversely, procurement of syringes from an NSP was independently associated with syringe coverage ≥100%, with a greater protective effect occurring when NSP utilisation was combined with current engagement in opiate substitution therapy. The median number of syringes retained per participant per annum was 720, equivalent to 2 per day.
  
  
  CONCLUSIONS
  While Australian NSP attendees report high syringe coverage by international standards, prevention efforts could be scaled up. Syringe reuse was associated with syringe coverage of <100%, suggesting the utility of reuse as a proxy for individual-level syringe coverage.
authors: Viral Hepatitis Epidemiology and Prevention Program, Kirby Institute, University of NSW, Australia. JIversen@kirby.unsw.edu.au
authors: Jenny
authors: J
authors: Iversen
authors: Libby
authors: L
authors: Topp
authors: Handan
authors: H
authors: Wand
authors: Lisa
authors: L
authors: Maher
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000191:economics* / Q000639:trends; D008297:Male; D016485:Needle Sharing / Q000191:economics* / Q000639:trends; D018671:Needle-Exchange Programs / Q000191:economics* / Q000639:trends; D015819:Substance Abuse, Intravenous / Q000191:economics* / Q000453:epidemiology; D013594:Syringes / Q000191:economics*