About the Project
The provision of sterile injecting equipment through needle and syringe programs (NSP) to people who inject drugs (PWID), along with opiate substitution treatment (OST), is an important public health intervention for preventing blood borne infections such as HIV and hepatitis C virus (HCV). However,evidence of their impact on HCV infection remains weak. We will ooldata from three routine surveys of PWID from England, Wales, Scotland and Australia (n~15,000) that collect comparable indicators on service use, behaviours and biological markers for HCV. Findings will be compared with international data identified through a systematic review. Cost data will be collected from 3 NSP sites and used with the intervention effect estimates in mathematical models to identify the impact on HCV transmission and cost-effectiveness of existing and expanded NSP provision in England, Scotland and Wales.
While there is good evidence that NSP and OST in combination reduce injecting risk behaviours and prevent HIV infection, there is little evidence of impact on HCV incidence among PWID. No economic evaluations of NSPs undertaken in Western Europe and few have considered the costs saved due to care and treatment averted.
The project aims to answer the following questions:
1) What is the impact of different coverage levels of needle/syringe provision on the incidence of hepatitis C among PWID at the individual level?
2) What are the contribution of other risk factors on HCV incidence and the overall transmission of HCV among PWID?
3) What is the international evidence on the impact of NSPs with and without OST on incidence of hepatitis C among PWID?
4) What are the costs associated with existing NSP provision in three UK settings?
5) What is the impact and cost-effectiveness of existing provision of NSP, compared to no provision, on HCV and HIV transmission and disease burden among PWID in three UK settings? 6) What are the possible strategies for increasing the coverage of NSP provision in three UK settings, and likely impact and cost-effectiveness of these strategies?
Design & Method
Three linked data collection activities and analyses will be undertaken: 1. Analysis of pooled data (Aims 1, 2): Data will be collated from the unlinked anonymous monitoring (UAM) survey of PWID (England, Wales and Northern Ireland), the Australian Needle and Syringe Program Survey (ANSPS), the Needle Exchange Surveillance Initiative (NESI) and studies of community-recruited PWID. We will analyse the pooled data sets using logistic regression to model the odds of recent infection by NSP exposure adjusting for key confounders (injecting duration, gender, crack use and homelessness) and assessing joint effects of NSP and OST. We will explore evidence of a dose-response relationship and linear decrease in the odds of infection with increasing NSP coverage and examine the impact of OST. 2. Systematic Review (Aim 3): We will conduct a systematic review, following Cochrane Guidelines, of published studies and unpublished analyses that report on the effect of NSP exposure and/or OST on HCV incidence. We will conduct a meta-analysis to estimate the unadjusted effects of NSP exposure and/or OST on HCV incidence incorporating the pooled analysis results to determine the generalisability of findings to other settings. 3. Modelling Impact and Economic evaluation (Aims 4-6): An existing dynamic deterministic model of HIV and HCV transmission and OST/NSP intervention coverage among PWID will be adapted. Intervention efficacy estimates will come from the pooled analysis. In addition we will estimate the cost-effectiveness of current NSP provision compared to no provision and the potential cost-effectiveness of increasing NSP coverage in each setting compared to maintaining stable coverage.
This project will fill gaps in the evidence by providing robust estimates of the efficacy of NSP and OST on reducing HCV transmission and estimating the likely impact of existing coverage levels of NSP and changes in the extent of provision. It will also produce the first assessment of the cost-effectiveness of needle and syringe provision in the UK.
Peer-reviewed publications, conference presentations and reports
NHMRC Early Career Fellow
Ph +61 (0)2 9385 0900
Professor and Program Head and NHMRC Senior Research Fellow
Ph +61 (0)2 9385 0936
Lucy Platt, Noel Craine, Matthew Hickman, John Parry, Peter Vickerman, Avril Taylor, Vivian Hope, Fortune Ncube, Sharon Hutchinson, Josie Smith, Lorna Guinness
Project Collaborators: External
London School of Hygiene & Tropical Medicine
Health Protection Agency UK
University of the West of Scotland
Glasgow Caledonian University