Evaluating the impact of Global Fund withdrawal on needle and syringe provision, cost, and use among people who inject drugs in Tijuana, Mexico a costing analysis

Javier A. Cepeda, Jose Luis Burgos, James G. Kahn, Rosario Padilla, Pedro Emilio Meza Martinez, Luis Alberto Segovia, Tommi Gaines, Daniela Abramovitz, Gudelia Rangel, Carlos Magis-Rodriguez, Peter Vickerman, Steffanie Strathdee, Natasha Martin

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

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Abstract

Objective: From 2011 – 2013, the Global Fund supported needle and syringe programs in Mexico to prevent transmission of HIV among people who inject drugs. It remains unclear how Global Fund withdrawal affected the costs, quality, and coverage of needle and syringe program provision.

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.
Original languageEnglish
Article numbere026298
Number of pages8
JournalBMJ Open
Volume9
Issue number1
DOIs
Publication statusPublished - 29 Jan 2019

Keywords

  • needle and syringe program
  • Mexico
  • Global Fund
  • cost
  • harm reduction
  • people who inject drugs

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