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Research Summary

Needle and Syringe Provision and Opioid Agonist Treatment May Reduce the Spread of HCV in People with Injection Drug Use

Injection drug use (IDU) is the primary route of HCV transmission. Interventions that impact injection drug use behaviors, such as needle and syringe provision (NSP) and opioid agonist treatment (OAT), may decrease the spread of HCV. However, there is little direct evidence linking such interventions to reductions in HCV incidence. This meta-analysis pooled data from 6 studies to assess whether NSP* (alone or in combination) and OAT were associated with reduced incidence of HCV. Studies were included if they were published in the UK after 2000, if they contained individual-level data on NSP and/or OAT, and if they measured newly acquired cases HCV infection. Six observational studies were identified: 4 were cross-sectional studies, and 2 were cohort studies.

  • Participants receiving OAT had 59% lower odds of new HCV infection (adjusted odds ratio [AOR], 0.41).
  • Participants engaged in high NSP had 52% lower odds of new HCV infection (AOR, 0.48).
  • The combined effect of the interventions was stronger than each alone (AOR, 0.21).
*Needle and syringe provision (NSP) was defined as "high" or "low" ("high" indicating 1 or more sterile needles were obtained from a provider for each injection reported).

Comments:

This meta-analysis suggests that NSP and OAT may reduce the incidence of HCV. Limitations include the design of the studies (i.e., observational versus randomized controlled trials) and moderate heterogeneity among studies included for OAT. These results support those of a prior meta-analysis (www.bu.edu/aodhealth/issues/issue_sept11/tetrault_hagan.html) that found evidence supporting the effectiveness of needle exchange and OAT as components of interventions to reduce HCV seroconversion in people with IDU. Judith Tsui, MD, MPH

Reference:

Turner KM, Hutchinson S, Vickerman P, et al. The impact of needle and syringe provision and opiate substitution therapy on the incidence of HCV in injecting drug users. Addiction. 2011;106(11):1978-1988.

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