Are needle and syringe programmes associated with a reduction in HIV transmission among people who inject drugs: a systematic review and meta-analysis

Esther J Aspinall, Dhanya Nambiar, David J Goldberg, Amanda Weir, Eva Van Velzen, Norah Palmateer, Joseph S Doyle, Margaret E Hellard, Sharon J Hutchinson, Matthew Hickman

Research output: Contribution to journalArticle (Academic Journal)peer-review

178 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)235-248
Number of pages14
JournalInternational Journal of Epidemiology
Volume43
Issue number1
Early online date27 Dec 2013
DOIs
Publication statusPublished - Feb 2014

Keywords

  • HIV
  • needle-exchange programmes
  • people who inject drugs

Fingerprint

Dive into the research topics of 'Are needle and syringe programmes associated with a reduction in HIV transmission among people who inject drugs: a systematic review and meta-analysis'. Together they form a unique fingerprint.

Cite this