Abstract
Background: Harm reduction and treatment programs are essential for reducing harms experienced by people who inject drugs (PWID). We aimed to update estimates from a 2017 review of global coverage of needle-syringe exchange programmes (NSPs), opioid agonist treatment (OAT), and other harm reduction services that target PWID (take-home naloxone [THN] programs, supervised consumption facilities, and drug checking services).
Methods: We conducted a systematic review of available evidence from peer-reviewed and grey literature databases. Programmatic data were collected on the availability of services, as well as the number of sites, people accessing services, and equipment distributed in countries where there is evidence of injecting drug use. National estimates of coverage of OAT (i.e., number of people accessing OAT per 100 PWID) and NSP (i.e., number of needle-syringes distributed per PWID per year) were generated where available, using the most recent data. Regional and global estimates were derived and compared to the World Health Organization indicators.
Findings: We included 195 studies and found there were 89 countries implementing OAT (75% of PWID population) and 91 countries implementing NSP (88% of the global PWID population). Only five countries (2% of the global PWID population) are providing high coverage of both services. Far fewer countries were found to be implementing THN programs (n=40), supervised consumption facilities (n=16), and drug checking services (n=23), with nine countries implementing all five services. Globally, we estimated there were 18 (95% uncertainty intervals [UI]=12-27) people accessing OAT per 100 PWID, and 35 (UI=24-52) needle-syringes being distributed per person who injects drugs per year. More countries reported high (OAT 24; NSP 10), moderate (OAT 8; NSP 15), and low (OAT 37; NSP 46) coverage of services compared to the previous review.
Interpretation: Global coverage of OAT and NSP has increased modestly in the past five years but remains low for most countries. Programmatic data on other key harm reduction interventions are scarce.
Methods: We conducted a systematic review of available evidence from peer-reviewed and grey literature databases. Programmatic data were collected on the availability of services, as well as the number of sites, people accessing services, and equipment distributed in countries where there is evidence of injecting drug use. National estimates of coverage of OAT (i.e., number of people accessing OAT per 100 PWID) and NSP (i.e., number of needle-syringes distributed per PWID per year) were generated where available, using the most recent data. Regional and global estimates were derived and compared to the World Health Organization indicators.
Findings: We included 195 studies and found there were 89 countries implementing OAT (75% of PWID population) and 91 countries implementing NSP (88% of the global PWID population). Only five countries (2% of the global PWID population) are providing high coverage of both services. Far fewer countries were found to be implementing THN programs (n=40), supervised consumption facilities (n=16), and drug checking services (n=23), with nine countries implementing all five services. Globally, we estimated there were 18 (95% uncertainty intervals [UI]=12-27) people accessing OAT per 100 PWID, and 35 (UI=24-52) needle-syringes being distributed per person who injects drugs per year. More countries reported high (OAT 24; NSP 10), moderate (OAT 8; NSP 15), and low (OAT 37; NSP 46) coverage of services compared to the previous review.
Interpretation: Global coverage of OAT and NSP has increased modestly in the past five years but remains low for most countries. Programmatic data on other key harm reduction interventions are scarce.
| Original language | English |
|---|---|
| Pages (from-to) | e673-e683 |
| Journal | Lancet Global Health |
| Volume | 11 |
| Issue number | 5 |
| Early online date | 27 Mar 2023 |
| DOIs | |
| Publication status | E-pub ahead of print - 27 Mar 2023 |
Bibliographical note
Funding Information:This review was supported by the Australian National Health and Medical Research Council (NHMRC) ASCEND Program Grant (1150078); a NHMRC Investigator Grant (1176131); the US National Institute of Allergy and Infectious Diseases; the National Drug and Alcohol Research Centre (NDARC), University of New South Wales Sydney (UNSW), Australia; and the US National Institute for Drug Abuse (R01AI147490 RFA-AI-18-026). LD is supported by an NHMRC Senior Principal Research Fellowship (1135991). SC-F acknowledges funding from the UNSW Scientia Scholarship Program, and the National Drug Research Institute Melbourne. AP, GJD, and JG (1176131) are supported by NHMRC Investigator Awards. JL is supported by an NHMRC Emerging Leader Fellowship. MH and PV acknowledge support from the UK National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, and the NIHR Programme Grant EPIToPe. PV acknowledges support from the HPRU in Blood Borne and Sexually Transmitted Infections, and the US National Institute for Drug Abuse (grant number R01 DA037773-01A1). PW acknowledges support from an Australian Government Research Training Program scholarship and an NDARC Higher Degree Research scholarship. NDARC, the Kirby Institute, and the Australian National Centre for Youth Substance Use Research are funded by the Australian Government Department of Health. The views expressed in this publication do not necessarily represent the position of the Australian Government. We thank the people who assisted with searches for and extraction of data from the eligible papers in this review: Aaron Lim, Adam Trickey, Adelina Artenie, Brodie Clark, Clare French, Deborah Down, Hannah Fraser, MJ Stowe, Tesfa Mekonen Yimer, Thomas Davies, Sandra Kreuser, Hannah Fraser, and the review team. We also thank the individuals who provided encouragement and support in various ways throughout the conduct of this review, including circulating requests for data, provision of contacts in countries and assistance with locating data: Andrew Scheibe, Angela Me, Annette Verster, Keith Sabin, Monica Ciupagea, Niklas Luhmann, and Virginia MacDonald. We would like to acknowledge the detailed review and feedback on prevalence estimates of injecting drug use provided by Kamran Niaz (UN Office on Drugs and Crime) in particular. Assistance in sourcing and verifying data was provided by individuals from government, non-government, and research organisations, for which we are thankful. These individuals are listed in the appendix (p 105) .
Funding Information:
This review was supported by the Australian National Health and Medical Research Council (NHMRC) ASCEND Program Grant (1150078); a NHMRC Investigator Grant (1176131); the US National Institute of Allergy and Infectious Diseases; the National Drug and Alcohol Research Centre (NDARC), University of New South Wales Sydney (UNSW), Australia; and the US National Institute for Drug Abuse (R01AI147490 RFA-AI-18-026). LD is supported by an NHMRC Senior Principal Research Fellowship (1135991). SC-F acknowledges funding from the UNSW Scientia Scholarship Program, and the National Drug Research Institute Melbourne. AP, GJD, and JG (1176131) are supported by NHMRC Investigator Awards. JL is supported by an NHMRC Emerging Leader Fellowship. MH and PV acknowledge support from the UK National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, and the NIHR Programme Grant EPIToPe. PV acknowledges support from the HPRU in Blood Borne and Sexually Transmitted Infections, and the US National Institute for Drug Abuse (grant number R01 DA037773-01A1). PW acknowledges support from an Australian Government Research Training Program scholarship and an NDARC Higher Degree Research scholarship. NDARC, the Kirby Institute, and the Australian National Centre for Youth Substance Use Research are funded by the Australian Government Department of Health. The views expressed in this publication do not necessarily represent the position of the Australian Government. We thank the people who assisted with searches for and extraction of data from the eligible papers in this review: Aaron Lim, Adam Trickey, Adelina Artenie, Brodie Clark, Clare French, Deborah Down, Hannah Fraser, MJ Stowe, Tesfa Mekonen Yimer, Thomas Davies, Sandra Kreuser, Hannah Fraser, and the review team. We also thank the individuals who provided encouragement and support in various ways throughout the conduct of this review, including circulating requests for data, provision of contacts in countries and assistance with locating data: Andrew Scheibe, Angela Me, Annette Verster, Keith Sabin, Monica Ciupagea, Niklas Luhmann, and Virginia MacDonald. We would like to acknowledge the detailed review and feedback on prevalence estimates of injecting drug use provided by Kamran Niaz (UN Office on Drugs and Crime) in particular. Assistance in sourcing and verifying data was provided by individuals from government, non-government, and research organisations, for which we are thankful. These individuals are listed in the appendix (p 105). Editorial note: The Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations.
Publisher Copyright:
© 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license