title: Effectiveness of structural-level needle/syringe programs to reduce HCV and HIV infection among people who inject drugs: a systematic review.
abstract: Needle-syringe programs (NSP) have been effective in reducing HIV and hepatitis C (HCV) infection among people who inject drugs (PWID). Achieving sustainable reductions in these blood-borne infections requires addressing structural factors so PWID can legally access NSP services. Systematic literature searches collected information on NSP coverage and changes in HIV or HCV infection prevalence or incidence at the population level. Included studies had to document biomarkers (HIV or HCV) coupled with structural-level NSP, defined by a minimum 50 % coverage of PWID and distribution of 10 or more needles/syringe per PWID per year. Fifteen studies reported structural-level NSP and changes in HIV or HCV infection prevalence/incidence. Nine reported decreases in HIV prevalence, six in HCV infection prevalence, and three reported decreases in HIV incidence. The results support NSP as a structural-level intervention to reduce population-level infection and implementation of NSP for prevention and treatment of HIV and HCV infection.
authors: Center for Global Health, Division of Global HIV/AIDS, Epidemiology and Strategic Information Branch, Centers for Disease Control and Prevention, CORP Bldg 1 Rm 2308.02, MS E30, Atlanta, GA, 30329-1902, USA, afa3@cdc.gov.
authors: Abu S
authors: AS
authors: Abdul-Quader
authors: Jonathan
authors: J
authors: Feelemyer
authors: Shilpa
authors: S
authors: Modi
authors: Ellen S
authors: ES
authors: Stein
authors: Alya
authors: A
authors: Briceno
authors: Salaam
authors: S
authors: Semaan
authors: Tara
authors: T
authors: Horvath
authors: Gail E
authors: GE
authors: Kennedy
authors: Don C
authors: DC
authors: Des Jarlais
mesh_terms: D003140:Communicable Disease Control / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D040261:Harm Reduction; D007722:Health Knowledge, Attitudes, Practice; D006526:Hepatitis C / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D018671:Needle-Exchange Programs / Q000458:organization & administration / Q000706:statistics & numerical data; D015995:Prevalence; D015397:Program Evaluation; D011634:Public Health; D016032:Randomized Controlled Trials as Topic; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*
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