Evidence for the Effectiveness of Sterile Injecting Equipment Provision in Preventing Hepatitis C and Human Immunodeficiency Virus Transmission Among Injecting Drug Users: a Review of Reviews

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CDC 05-04-10

UNITED KINGDOM: " Evidence for the Effectiveness of Sterile Injecting Equipment

Provision in Preventing Hepatitis C and Human Immunodeficiency Virus

Transmission Among Injecting Drug Users: a Review of Reviews "

Addiction Vol. 105; No. 5: P. 844-859 (03.01.10):: Norah Palmateer; Jo

Kimber; Hickman; Sharon Hutchinson; Tim ; Goldberg

The study authors aimed to review the evidence on the effectiveness of harm

reduction interventions involving the provision of sterile injecting equipment

to prevent hepatitis C virus (HCV) and HIV among injecting drug users. Among the

interventions assessed: needle and syringe programs (NSP), alternative modes of

provision (pharmacies, vending machines and outreach), and the provision of

injecting equipment other than needles or syringes.

This review of reviews used systematic searches of the English language

literature to March 2007 to identify systemic, narrative, or meta-analytical

reviews of the interventions' impact on HCV transmission, HIV transmission or

injecting risk behavior (IRB). " Critical appraisal criteria classified the

reviews as either high quality ('core') or supplementary: a framework based on

the quality of reviews, the reviewers' conclusions, and the designs/findings of

the primary studies was used to derive evidence statements, " the investigators

reported.

The team identified three core and two supplementary reviews of injecting

equipment interventions. According to the study's proposed framework, the

investigators found (a) insufficient evidence supporting the conclusion that any

of the interventions are effective in preventing HCV infection; ( tentative

evidence to support the effectiveness of NSP in preventing HIV transmission; ©

sufficient evidence to support the effectiveness of NSP (and tentative evidence

of an additional impact of pharmacy NSP) in reducing self-reported IRB; and (d)

scant to no evidence on vending machines, outreach, or providing other injecting

equipment in relation to any of the outcomes.

" The evidence is weaker than given credit for in the literature, " the authors

concluded. " The lack of evidence for effectiveness of NSP vis-á-vis biological

outcomes (HIV and HCV incidence/prevalence) reflects the limitations of studies

that have been undertaken to investigate these associations. Particularly for

HCV, low levels of IRB may be insufficient to reduce high levels of

transmission. New studies are required to identify the intervention coverage

necessary to achieve sustained changes in blood-borne virus transmission. "