title: The efficiency of targeted intervention in limiting the spread of HIV and Hepatitis C Virus among injecting drug users.
abstract: BACKGROUND
  Interventions aimed at minimizing the spread of blood borne infections among Injecting Drug Users (IDU) are impeded by limitations in resources. To enhance their efficiency, it may be beneficial to target specific behavioural subpopulations, distinguished by syringe sharing tendencies.
  
  
  METHODS
  We used mathematical modelling to explore the effects of two types of intervention: removal of individuals from the injecting population and risk decrease at group-level (e.g. distribution of syringes). We computed the direct effects of intervention on the probability of obtaining and spreading infection as a function of baseline risk behaviour. Population level effects of (targeted) intervention were explored using a differential equations model, which incorporated two levels of risk.
  
  
  RESULTS
  Within most scenarios of risk distribution considered, HIV could be substantially reduced or eliminated by targeting high risk IDU only. Conversely, higher incidence reductions for HCV were reached in many scenarios when targeting low risk IDU. The potential for preventing infections by removal of uninfected IDU increases with baseline risk, but so does the probability that an IDU is already infected before being reached by intervention. Decreasing risk is likely to only delay rather than prevent infection for IDU borrowing many syringes, especially for a very infectious disease such as HCV.
  
  
  CONCLUSIONS
  The efficiency of intervention on injecting drug users may be much enhanced by targeting specific risk subgroups. However, the optimal targeting policy depends strongly on the infection under consideration.
authors.affiliation: Julius Center, University Medical Center Utrecht, Stratenum 6.131, Postbus 85500, 3508GA Utrecht, The Netherlands. anneke@blub.net
authors.forename: Anneke S
authors.initials: AS
authors.lastname: De Vos
authors.forename: Mirjam E E
authors.initials: ME
authors.lastname: Kretzschmar
mesh_terms: D017848:Blood-Borne Pathogens; D055030:Drug Users; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission; D016174:Hepacivirus; D006526:Hepatitis C / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D008297:Male; D008954:Models, Biological; D012307:Risk Factors; D019966:Substance-Related Disorders
keywords: Epidemiology; Mathematical modelling; Risk variability