title: Are needle and syringe programmes associated with a reduction in HIV transmission among people who inject drugs: a systematic review and meta-analysis.
abstract: BACKGROUND
  Needle and syringe programmes (NSP) aim to reduce the risk of HIV by providing people who inject drugs (PWID) with sterile injecting equipment. A recent review of reviews (ROR) concluded that there was only tentative evidence to support the effectiveness of NSP in reducing HIV. We carried out a systematic review and meta-analysis to assess the association between NSP and HIV transmission.
  
  
  METHODS
  Relevant primary articles presenting data on the risk of HIV transmission associated with NSP were identified in two stages: (i) from reviews identified in two published RORs (covering the period 1980-2008); and (ii) a literature search of CINAHL, Cochrane Library, EMBASE, MEDLINE and PsychINFO for primary articles published since the most recent high quality review (covering the period 2008-12). Study results were synthesized using random-effects meta-analysis.
  
  
  RESULTS
  There were 12 studies comprising at least 12 000 person-years of follow-up. Exposure to NSP was associated with a reduction in HIV transmission: pooled effect size 0·66 [95% confidence interval (CI) 0·43, 1·01] across all studies, and 0·42 (95% CI 0·22, 0·81) across six higher quality studies (according to the Newcastle-Ottawa tool).
  
  
  CONCLUSIONS
  There is evidence to support the effectiveness of NSP in reducing the transmission of HIV among PWID, although it is likely that other harm reduction interventions have also contributed to the observed reduction in HIV risk. NSP should be considered as just one component of a programme of interventions to reduce both injecting risk and other types of HIV risk behaviour.
authors.affiliation: School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK, Health Protection Scotland, Glasgow, UK, Centre for Population Health, Burnet Institute, Melbourne, Australia, School of Social and Community Medicine, University of Bristol, Bristol, UK, Infectious Diseases Unit, Alfred Hospital, Melbourne, Australia and Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Esther J
authors.initials: EJ
authors.lastname: Aspinall
authors.forename: Dhanya
authors.initials: D
authors.lastname: Nambiar
authors.forename: David J
authors.initials: DJ
authors.lastname: Goldberg
authors.forename: Matthew
authors.initials: M
authors.lastname: Hickman
authors.forename: Amanda
authors.initials: A
authors.lastname: Weir
authors.forename: Eva
authors.initials: E
authors.lastname: Van Velzen
authors.forename: Norah
authors.initials: N
authors.lastname: Palmateer
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Doyle
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Hellard
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Hutchinson
mesh_terms: D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission / Q000821:virology; D040261:Harm Reduction; D006801:Humans; D018671:Needle-Exchange Programs; D009339:Needles / Q000600:supply & distribution*; D015397:Program Evaluation; D015819:Substance Abuse, Intravenous / Q000150:complications*; D013594:Syringes / Q000600:supply & distribution*
keywords: HIV; needle-exchange programmes; people who inject drugs