Abstract
Background and aims
Major declines in HIV and hepatitis C and B virus (HCV/HBV) incidence among people who inject drugs (PWID) have been attributed to early implementation of harm‐reduction programs (HRP) in the Netherlands but alternative factors such as selective mortality and demographic and drug markets shifts over time likely contributed to observed incidence declines. We quantified and tested the effect of HRP participation on risk of these infections among PWID in Amsterdam, the Netherlands.
Design
We emulated the design of a hypothetical, ideal randomized trial using observational data from the Amsterdam Cohort Studies (1985‐2014).
Setting
Amsterdam, the Netherlands
Participants
We included PWID who ever used opioids, had a recent history of injecting drug use (IDU) and tested negative for HIV, HCV, or HBV. Of 983 participants, 640, 137 and 308 were included for the HIV, HCV and HBV analyses and 59, 45 and 49 seroconversions were observed, respectively.
Interventions
Intervention arms were: complete HRP participation (≥60 mg/day methadone and 100% needle and syringe program (NSP) coverage, or any methadone dose if no recent injection drug use) versus no HRP and partial HRP participation combined (<60 methadone mg/day and/or <100% NSP coverage).
Measurements
Separately for each infection, we estimated the hazard ratios (HR) comparing HRP arms using marginal structural models.
Findings
Compared with no/partial HRP participation, complete HRP participation led to lower risk of HIV (HR=0.54, 95%CI:0.27‐1.08), HCV (HR=0.16, 95%CI:0.06‐0.40) and HBV (HR=0.28, 95%CI:0.13‐0.61) acquisition.
Conclusions
Complete participation in harm reduction programs appears to have led to substantial decreases in HIV and hepatitis C and B virus acquisition risk among people who inject drugs in the Netherlands.
Funding
AidsFonds (Project number 29703), National Institute for Public Health and the Environment (the Netherlands), and Boston University/Brown CFAR P30 AI042853 (USA).
| Original language | English |
|---|---|
| Pages (from-to) | 3115-3126 |
| Number of pages | 12 |
| Journal | Addiction |
| Volume | 116 |
| Issue number | 11 |
| Early online date | 31 Mar 2021 |
| DOIs | |
| Publication status | Published - Nov 2021 |
Bibliographical note
Funding Information:The present study was funded by Aidsfonds (project number 29703). The authors wish to thank the participants of the ACS for their contribution, research nurses of the ACS for data collection and cohort management. We also wish to thank Dr Marcel Buster from the Public Health Service of Amsterdam for providing information on the history of the Dutch harm reduction approach. We also acknowledge the technical statistical software support provided by Ronald B. Geskus, Geoffrey Chan and Maria del Mar Quiroga. The Amsterdam Cohort Studies on HIV infection and AIDS, which is a collaboration between the Public Health Service of Amsterdam (Gemeentelijke Gezondheidsdienst Amsterdam; GGD Amsterdam), Department of Infectious Diseases, Research and Prevention, Amsterdam, the Netherlands, Amsterdam University Medical Centers (UMC), University of Amsterdam (Department of Medical Microbiology, Experimental Immunology, Department of Internal Medicine, Division of Infectious Diseases, Emma's Children's Hospital (Emma Kinderziekenhuis), HIV treatment center), Dutch Monitoring Foundation (Stichting HIV Monitoring; SHM), Jan van Goyen Medical Centre, Department of Internal Medicine, HIV Focus Centre (DC Klinieken), and Sanquin Blood Supply Foundation financially supports the maintenance of the biobank. The ACS is financially supported by the Center for Infectious Disease Control of the Netherlands National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
Funding Information:
L.M. is supported by an Australian National Health and Medical Research Council Research Fellowship. All funding sources had no involvement in the study. S.L. was supported by Boston University/Brown CFAR P30 AI042853. The funding parties did not have any role in study design, analyses and interpretation of the data. None of the other authors had any conflicts to declare related to this study.
Funding Information:
The present study was funded by Aidsfonds (project number 29703). The authors wish to thank the participants of the ACS for their contribution, research nurses of the ACS for data collection and cohort management. We also wish to thank Dr Marcel Buster from the Public Health Service of Amsterdam for providing information on the history of the Dutch harm reduction approach. We also acknowledge the technical statistical software support provided by Ronald B. Geskus, Geoffrey Chan and Maria del Mar Quiroga. The Amsterdam Cohort Studies on HIV infection and AIDS, which is a collaboration between the Public Health Service of Amsterdam (Gemeentelijke Gezondheidsdienst Amsterdam; GGD Amsterdam), Department of Infectious Diseases, Research and Prevention, Amsterdam, the Netherlands, Amsterdam University Medical Centers (UMC), University of Amsterdam (Department of Medical Microbiology, Experimental Immunology, Department of Internal Medicine, Division of Infectious Diseases, Emma's Children's Hospital (Emma Kinderziekenhuis), HIV treatment center), Dutch Monitoring Foundation (Stichting HIV Monitoring; SHM), Jan van Goyen Medical Centre, Department of Internal Medicine, HIV Focus Centre (DC Klinieken), and Sanquin Blood Supply Foundation financially supports the maintenance of the biobank. The ACS is financially supported by the Center for Infectious Disease Control of the Netherlands National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
Publisher Copyright:
© 2021 Society for the Study of Addiction.
Keywords
- people who inject drugs
- HIV
- hepatitis C
- hepatitis B
- harm reduction programs
- needle and syringe programs
- opioid agonist therapy
Access to Document
- Full-text PDF (author’s accepted manuscript)
This is the author accepted manuscript (AAM). The final published version (version of record) is available online via Wiley at https://doi.org/10.1111/add.15503 . Please refer to any applicable terms of use of the publisher.