Comprehensive needle and syringe program and opioid agonist therapy reduce HIV and hepatitis c virus acquisition among people who inject drugs in different settings: A pooled analysis of emulated trials

Author:

van Santen Daniela K.123ORCID,Lodi Sara4,Dietze Paul2,van den Boom Wijnand2,Hayashi Kanna56ORCID,Dong Huiru56,Cui Zishan56,Maher Lisa7ORCID,Hickman Matthew8ORCID,Boyd Anders149,Prins Maria141011

Affiliation:

1. Department of Infectious Diseases Research and Prevention, Public Health Service of Amsterdam Amsterdam The Netherlands

2. Department of Disease Elimination Burnet Institute Melbourne Australia

3. School of Public Health and Preventive Medicine Monash University Melbourne Australia

4. Department of Biostatistics Boston University School of Public Health Boston Massachusetts USA

5. British Columbia Centre on Substance Use Vancouver Canada

6. Faculty of Health Sciences Simon Fraser University Burnaby Canada

7. The Kirby Institute for Infection and Immunity, Faculty of Medicine UNSW Sydney Sydney Australia

8. Population Health Sciences, Bristol Medical School University of Bristol Bristol UK

9. Stichting HIV Monitoring Amsterdam The Netherlands

10. Amsterdam Institute for Infection and Immunity (AII) Amsterdam The Netherlands

11. Amsterdam Public Health Research Institute (APH) Amsterdam The Netherlands

Abstract

AbstractBackground and AimsAlthough the Netherlands, Canada and Australia were early adopters of harm reduction for people who inject drugs (PWID), their respective HIV and hepatitis C (HCV) epidemics differ. We measured the pooled effect of needle and syringe program (NSP) and opioid agonist therapy (OAT) participation on HIV and HCV incidence in these settings.DesignFor each cohort, we emulated the design and statistical analysis of a target trial using observational data.Setting and ParticipantsWe included PWID at risk of HIV or HCV infection from the Amsterdam Cohort Studies (1985–2013), Vancouver Injection Drug Users Study (1997–2009) and Melbourne Injecting Drug User Cohort Study (SuperMIX) (2010–2021).MeasurementsSeparately for each infection and cohort (only HCV in SuperMIX), marginal structural models were used to compare the effect of comprehensive (on OAT and 100% NSP coverage or on OAT only if no recent injection drug use) versus no/partial NSP/OAT (no OAT and/or <100% NSP coverage) participation. Pooled hazard ratios (HR) and 95% CI were calculated using random‐effects meta‐analysis.FindingsWe observed 94 HIV seroconversions and 81 HCV seroconversions among 2023 and 430 participants, respectively. Comprehensive NSP/OAT led to a 41% lower risk of HIV acquisition (pooled HR = 0.59, 95% CI = 0.36–0.96) and a 76% lower risk of HCV acquisition (pooled HR = 0.24, 95% CI = 0.11–0.51), compared with no/partial NSP/OAT, with little heterogeneity between studies for both infections (I2 = 0%).ConclusionsIn the Netherlands, Canada and Australia, comprehensive needle and syringe program and opioid agonist therapy participation appears to substantially reduce HIV and hepatitis C acquisition compared with no or partial needle and syringe program/opioid agonist therapy participation. These findings from an emulated trial design reinforce the critical role of comprehensive access to harm reduction in optimizing infection prevention for people who inject drugs.

Publisher

Wiley

Subject

Psychiatry and Mental health,Medicine (miscellaneous)

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