Optimal provision of needle and syringe programmes for injecting drug users: A systematic review |
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| Authors: | Lisa Jones Lucy Pickering Harry Sumnall James McVeigh Mark A Bellis |
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| Institution: | 1. Centre for Public Health, Research Directorate, Faculty of Health and Applied Social Sciences, Liverpool John Moores University, United Kingdom;2. School of Health and Social Care, Oxford Brookes University, United Kingdom;1. National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia;2. Kirby Institute, UNSW Sydney, Sydney, NSW, Australia;3. School of Public Health, Faculty of Medicine, University of Queensland, Herston, QLD, Australia;4. Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK;5. Ukrainian Institute for Public Health Policy, Kiev, Ukraine;6. European Monitoring Centre on Drugs and Drug Addiction, Lisbon, Portugal;7. National Addiction Centre, King''s College London, London, UK;1. BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6;2. BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, Canada V5Z 4R4;3. School of Population and Public Health, 2206 East Mall, University of British Columbia, Vancouver, BC, Canada V6T 1Z3;4. Clinical Policy Office, Fraser Health Professional Practice and Integration, 400-13450 102nd Avenue, Surrey, BC, Canada V3T 0H1;1. Division of Allergy and Infectious Diseases, University of Washington, SLU Building E, Box 358062, Seattle, WA, 98195, United States;2. HIV/STD Program, Public Health – Seattle and King County, 401 5th Ave, Suite 1250, Seattle, WA, 98104, United States;3. Department of Epidemiology, University of Washington, 1959 NE Pacific Street, Health Sciences Building, F-262, Box 357236, Seattle, WA, 98195, United States;4. Alcohol and Drug Abuse Institute, University of Washington, 1107 NE 45th Street, Suite 120, Box 354805, Seattle, WA, 98105, United States;1. Kirketon Road Centre, South Eastern Sydney Local Health District, PO Box 22, Kings Cross, NSW 1340, Australia;2. School of Public Health and Community Medicine, Faculty of Medicine, UNSW Australia, Sydney, NSW 2052, Australia;3. Viral Hepatitis Epidemiology and Prevention Program, Kirby Institute, Faculty of Medicine, UNSW Australia, Sydney, NSW 2052, Australia;1. ICAP at Columbia University, Mailman School of Public Health, Columbia University, United States;2. ICAP in Central Asia, Kazakhstan;1. British Columbia Centre on Substance Use, Vancouver, BC, Canada;2. Canadian Institutes of Health Research, Canadian HIV Trials Network, Vancouver, BC, Canada;3. Department of Medicine, University of British Columbia, St Paul''s Hospital, Vancouver, BC, Canada;4. Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA |
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| Abstract: | The introduction of needle and syringe programmes (NSPs) during the 1980s is credited with averting an HIV epidemic in the United Kingdom and Australia, but hepatitis C (HCV) incidence continues to rise among injecting drug users (IDUs). NSPs incorporating additional harm reduction strategies have been highlighted as an approach that may impact on HCV incidence. This systematic review sought to determine which approaches to the organisation and delivery of NSPs are effective. Fifteen databases were searched for studies published since 1990. Two reviewers screened all titles and abstracts, and data extraction and quality assessment of individual studies were undertaken independently by one reviewer and checked for accuracy by a second. Sixteen studies met the criteria for inclusion. Based on 11 studies there was no evidence of an impact of different NSP settings or syringe dispensation policies on drug injecting behaviours, but mobile van sites and vending machines appeared to attract younger IDUs and IDUs with higher risk profiles. Two studies of interventions aimed at encouraging IDUs to enter drug treatment reported limited effects, but one study found that the combination of methadone treatment and full participation in NSPs was associated with a lower incidence of HIV and HCV. In addition, one study indicated that hospital-based programmes may improve access to health care services among IDUs. Currently, it is difficult to draw conclusions on ‘what works best’ within the range of harm reduction services available to IDUs. Further studies are required which have a stated aim of evaluating how different approaches to the organisation and delivery NSPs impact on effectiveness. |
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