Needle and syringe programmes and opioid substitution therapy for preventing HCV transmission among people who inject drugs: findings from a Cochrane Review and meta‐analysis

• Published in: Addiction (Abingdon, England) England), 2018-03, Vol.113 (3), p.545-563
• Main Authors: Platt, Lucy, Minozzi, Silvia, Reed, Jennifer, Vickerman, Peter, Hagan, Holly, French, Clare, Jordan, Ashly, Degenhardt, Louisa, Hope, Vivian, Hutchinson, Sharon, Maher, Lisa, Palmateer, Norah, Taylor, Avril, Bruneau, Julie, Hickman, Matthew
• Format: Article
• Language: English
• Subjects: Acquisition; Australia - epidemiology; Bias; Bibliographic data bases; China - epidemiology; Cochrane; Comorbidity; Databases, Factual; Disease transmission; Drug abuse; Drug addiction; Drug use; Europe - epidemiology; harm reduction; HCV Prevention; Hepatitis; Hepatitis C; Hepatitis C - epidemiology; Hepatitis C - prevention & control; Heterogeneity; Humans; incidence; Internationality; Meta-analysis; Narcotics; needle and syringe programmes; Needle exchange programs; Needle-Exchange Programs - statistics & numerical data; Needles; North America - epidemiology; Opiate Substitution Treatment - statistics & numerical data; opioid substitution therapy; Opioids; Prevention programs; review; Risk assessment; Risk reduction; Substance Abuse, Intravenous - epidemiology; substance use; Syringes; Systematic review; Treatment Outcome; United Kingdom - epidemiology; Viruses
• ISSN: 0965-2140; 1360-0443; 1360-0443
• DOI: 10.1111/add.14012

Aims To estimate the effects of needle and syringe programmes (NSP) and opioid substitution therapy (OST), alone or in combination, for preventing acquisition of hepatitis C virus (HCV) in people who inject drugs (PWID). Methods Systematic review and meta‐analysis. Bibliographic databases were searched for studies measuring concurrent exposure to current OST (within the last 6 months) and/or NSP and HCV incidence among PWID. High NSP coverage was defined as regular NSP attendance or ≥ 100% coverage (receiving sufficient or greater number of needles and syringes per reported injecting frequency). Studies were assessed using the Cochrane risk of bias in non‐randomized studies tool. Random‐effects models were used in meta‐analysis. Results We identified 28 studies (n = 6279) in North America (13), United Kingdom (five), Europe (four), Australia (five) and China (one). Studies were at moderate (two), serious (17) critical (seven) and non‐assessable risk of bias (two). Current OST is associated with 50% [risk ratio (RR) =0.50, 95% confidence interval (CI) = 0.40–0.63] reduction in HCV acquisition risk, consistent across region and with low heterogeneity (I2 = 0, P = 0.889). Weaker evidence was found for high NSP coverage (RR = 0.79, 95% CI = 0.39–1.61) with high heterogeneity (I2 = 77%, P = 0.002). After stratifying by region, high NSP coverage in Europe was associated with a 56% reduction in HCV acquisition risk (RR = 0.44, 95% CI = 0.24–0.80) with low heterogeneity (I2 = 12.3%, P = 0.337), but not in North America (RR = 1.58, I2 = 89.5%, P =