HIV prevention for people who inject drugs lacking

January 01, 0001

HIV prevention for people who inject drugs lacking

The researchers from Australia, Portugal, UK, South Africa, India and USA undertook a systematic review to estimate national, regional, and global coverage of HIV services in injection drug users (IDUs). They 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. They calculated national, regional, and global coverage of NSPs, OST, and ART on the basis of available estimates of IDU population sizes.

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), Middle East and north Africa (0.5), and sub-Saharan Africa (0.1) 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.

The researchers concluded: "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."

So much underprevention!

For the full abstract, click here.

The Lancet published online 1 March 2010
© 2010 Elsevier Limited
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 et al for the 2009 Reference Group to the UN on HIV and Injecting Drug Use. Correspondence to::

Category: HSR. Health Services Research Keywords: HIV, prevention, treatment, care, services, inject, drugs, systematic search of databases, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor BLANK 2010

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