HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage

Bradley M Mathers, Louisa Degenhardt, Hammad Ali, Lucas Wiessing, Richard P Mattick, Bronwyn Myers, Atul Ambekar, Steffanie A Strathdee, 2009 Reference Group to the UN on HIV and Injecting Drug Use, Matthew Hickman

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

520 Citations (Scopus)

Abstract

BACKGROUND: Previous reviews have examined the existence of HIV prevention, treatment, and care services for injecting drug users (IDUs) worldwide, but they did not quantify the scale of coverage. We undertook a systematic review to estimate national, regional, and global coverage of HIV services in IDUs.

METHODS: We did a systematic search of peer-reviewed (Medline, BioMed Central), internet, and grey-literature databases for data published in 2004 or later. A multistage process of data requests and verification was undertaken, involving UN agencies and national experts. National data were obtained for the extent of provision of the following core interventions for IDUs: needle and syringe programmes (NSPs), opioid substitution therapy (OST) and other drug treatment, HIV testing and counselling, antiretroviral therapy (ART), and condom programmes. We calculated national, regional, and global coverage of NSPs, OST, and ART on the basis of available estimates of IDU population sizes.

FINDINGS: By 2009, NSPs had been implemented in 82 countries and OST in 70 countries; both interventions were available in 66 countries. Regional and national coverage varied substantially. Australasia (202 needle-syringes per IDU per year) had by far the greatest rate of needle-syringe distribution; Latin America and the Caribbean (0.3 needle-syringes per IDU per year), Middle East and north Africa (0.5 needle-syringes per IDU per year), and sub-Saharan Africa (0.1 needle-syringes per IDU per year) had the lowest rates. OST coverage varied from less than or equal to one recipient per 100 IDUs in central Asia, Latin America, and sub-Saharan Africa, to very high levels in western Europe (61 recipients per 100 IDUs). The number of IDUs receiving ART varied from less than one per 100 HIV-positive IDUs (Chile, Kenya, Pakistan, Russia, and Uzbekistan) to more than 100 per 100 HIV-positive IDUs in six European countries. Worldwide, an estimated two needle-syringes (range 1-4) were distributed per IDU per month, there were eight recipients (6-12) of OST per 100 IDUs, and four IDUs (range 2-18) received ART per 100 HIV-positive IDUs.

INTERPRETATION: Worldwide coverage of HIV prevention, treatment, and care services in IDU populations is very low. There is an urgent need to improve coverage of these services in this at-risk population.

FUNDING: UN Office on Drugs and Crime; Australian National Drug and Alcohol Research Centre, University of New South Wales; and Australian National Health and Medical Research Council.

Translated title of the contributionHIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage
Original languageEnglish
Pages (from-to)1014 - 1028
Number of pages15
JournalLancet
Volume375
Issue number9719
DOIs
Publication statusPublished - 20 Mar 2010

Bibliographical note

Copyright 2010 Elsevier Ltd. All rights reserved.

Keywords

  • Africa
  • Anti-Retroviral Agents
  • Buprenorphine
  • Europe
  • HIV Infections
  • Humans
  • Methadone
  • Middle East
  • Narcotic Antagonists
  • Needle-Exchange Programs
  • Substance Abuse, Intravenous

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