Design: Costing study and longitudinal cohort study.
Setting: Tijuana, Mexico
Participants: Personnel from a local needle and syringe program (N=6) and people who inject drugs (N=734) participating in a longitudinal study.
Primary outcome measures: Provision of needle and syringe program services and cost (per contact and per syringe distributed, in 2017 $USD) during Global Fund support (2012) and after withdrawal (2015/16). An additional outcome included needle and syringe program utilization from a concurrent cohort of people who inject drugs during and after Global Fund withdrawal.
Results: During the Global Fund period, the needle and syringe program distributed 55,920 syringes to 932 contacts (60 syringes/contact) across 14 geographical locations. After Global Fund withdrew, the needle and syringe program distributed 10,700 syringes to 2,140 contacts (5 syringes/contact) across 3 geographical locations. During the Global Fund period, the cost per harm reduction contact was approximately 10-fold higher compared to after Global Fund ($44.72 vs. $3.81), however the cost per syringe distributed was nearly equal ($0.75 vs. $0.76) due to differences in syringes per contact and reductions in ancillary kit components. The mean log odds of accessing a needle and syringe program in the post- Global Fund period was significantly lower than during the GF period (p=0.02).
Conclusions: Withdrawal of Global Fund support for needle and syringe program provision in Mexico was associated with a substantial drop in provision of sterile syringes, geographical coverage, and recent clean syringe utilization among people who inject drugs. Better planning is required to ensure harm reduction program sustainability is at scale after donor withdrawal.
- needle and syringe program
- Global Fund
- harm reduction
- people who inject drugs