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

doi:10.1136/ bmjopen-2018-026298

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

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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 language	English
Article number	e026298
Number of pages	8
Journal	BMJ Open
Volume	9
Issue number	1
DOIs	https://doi.org/10.1136/ bmjopen-2018-026298
Publication status	Published - 29 Jan 2019

Research Groups and Themes

GEM-B

Keywords

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

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cepeda, J. A., Burgos, J. L., Kahn, J. G., Padilla, R., Martinez, P. E. M., Segovia, L. A., Gaines, T., Abramovitz, D., Rangel, G., Magis-Rodriguez, C., Vickerman, P., Strathdee, S., & Martin, N. (2019). 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. BMJ Open, 9(1), Article e026298. https://doi.org/10.1136/ bmjopen-2018-026298

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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. ",

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

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Cepeda, JA, Burgos, JL, Kahn, JG, Padilla, R, Martinez, PEM, Segovia, LA, Gaines, T, Abramovitz, D, Rangel, G, Magis-Rodriguez, C, Vickerman, P, Strathdee, S & Martin, N 2019, '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', BMJ Open, vol. 9, no. 1, e026298. https://doi.org/10.1136/ bmjopen-2018-026298

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T1 - 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

AU - Cepeda, Javier A.

AU - Burgos, Jose Luis

AU - Kahn, James G.

AU - Padilla, Rosario

AU - Martinez, Pedro Emilio Meza

AU - Segovia, Luis Alberto

AU - Gaines, Tommi

AU - Abramovitz, Daniela

AU - Rangel, Gudelia

AU - Magis-Rodriguez, Carlos

AU - Vickerman, Peter

AU - Strathdee, Steffanie

AU - Martin, Natasha

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Y1 - 2019/1/29

N2 - 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.

AB - 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.

KW - needle and syringe program

KW - Mexico

KW - Global Fund

KW - cost

KW - harm reduction

KW - people who inject drugs

U2 - 10.1136/ bmjopen-2018-026298

DO - 10.1136/ bmjopen-2018-026298

M3 - Article (Academic Journal)

C2 - 30700490

SN - 2044-6055

VL - 9

JO - BMJ Open

JF - BMJ Open

IS - 1

M1 - e026298

ER -

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

Abstract

Research Groups and Themes

Keywords

UN SDGs

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