Systematic review research on needle/syringe programs and opiate substitution programs in low- and middle-income countries

摘要

Abstract People who inject drugs (PWID) are at an elevated risk of infection by human immunodeficiency virus (HIV) or hepatitis C virus (HCV). In many high-income countries, needle and syringe exchange programs (NSPs) have been associated with reductions in blood-borne infections. However, there is not a good understanding of the effectiveness of {NSP} in low- and middle-income countries and transitional-economy countries. A systematic literature review, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was utilized to collect primary study data on the coverage of {NSP} programs and the changes in {HIV} and {HCV} infection over time among {PWID} in low- and middle-income and transitional countries (LMICs). We included studies that reported laboratory measures of {HIV} or {HCV} and at least 50% coverage of the local injecting population (either through direct use or through secondary exchange). We also included national reports of newly reported {HIV} cases in countries that had national level data for {PWID} in conjunction with {NSP} scale-up and {NSP} implementation. Included in the review were studies of 11 {NSPs} with high-coverage from Bangladesh, Brazil, China, Estonia, Iran, Lithuania, Taiwan, Thailand, and Vietnam. In five studies, the {HIV} prevalence decreased (ranged from ?3% to ?15%) and in three studies the {HCV} prevalence decreased (ranged from ?4.2% to ?10.2%). In two studies, the {HIV} prevalence increased (ranged from 5.6% to 14.8%). The {HCV} incidence remained stable in one study. Of the four national reports of newly reported {HIV} cases, three studies reported decreases during the expansion of the NSP, and ranged from ?30% to ?93.3%; however, one national report documented an increase in {HIV} cases (37.6%). The estimated incidence among new injectors decreased in three studies with the reductions ranging from ?11/100 person-years at risk to ?16/100 person-years at risk. The data, although not fully consistent, generally support the effectiveness of {NSP} in reducing {HIV} and {HCV} infection in LMICs. If high coverage is achieved, {NSP} appears to be as effective in {LMICs} as in high-income countries. To identify and correct contributing problems, additional monitoring and evaluation research is needed for {NSPs} in which reductions in HIV/HCV infection among {PWID} are not occurring.