www.hivandhepatitis.com

Needle Exchange May Have Prevented More Than 100 New HIV Infections in D.C.

A federal policy change allowing funding of syringe exchange programs in Washington, DC, averted 120 new HIV infections relative to the number that likely would have occurred had the funding ban remained in place, saving approximately $44 million, according to a mathematical modeling study published in the September 4 edition of AIDS and Behavior. "Our study adds to the evidence that needle exchange programs not only work but are cost-effective investments in the battle against HIV," said lead author Monica Ruiz.

HIV is a blood-borne infection and sharing syringes and other equipment for drug injection is one of the most efficient routes of transmission. A substantial body of epidemiological evidence has shown that needle and syringe exchange or distribution reduces HIV risk for people who inject drugs, but laws banning such programs and restrictions on their funding remain in effect in many jurisdictions worldwide.

Ruiz and colleagues from George Washington University's Milken Institute School of Public Health examined the impact of policy change on injection-related HIV incidence.

Starting in 1998 Congress banned the use of federal funds for needle exchange programs. States were allowed to use local revenue for such programs, but this did not apply to Washington, DC, where the local budget is controlled by Congress. The DC funding ban was lifted in December 2007, and the city's health department promptly started a program that included needle exchange and referrals to HIV testing and addiction treatment, according to a George Washington Universitypress release.

A total of 176 injection-associated HIV cases were reported in the 2 years after the local funding policy change. During this period the average number of new infections attributed to injection drug use fell from 19 per month to about 6 per month. The researchers' model predicted 296 such cases had the policy remained in place, for a difference of 120 averted HIV infections. This represents a 70% decrease in newly diagnosed HIV cases where the reported transmission route was injection drug use.

In their discussion the researchers noted that the predicted decrease in HIV infections is within the range of findings from other studies of the effect of syringe access on blood-borne infections, such as a 70% decrease in HIV infections in New York City and an 80% reduction in hepatitis B and C incidence in Tacoma.

DC awarded approximately $1.3 million to community organizations to operate the citywide syringe exchange in the 2 years after the funding ban was lifted. In FY 2009 the DC needle exchange reported exchanging approximately 314,000 syringes, providing 2279 HIV tests, distributing 378,000 condoms, and linking 321 people to substance use treatment. Averting 120 HIV infections translates to an approximate cost savings of $45.6 million in lifetime HIV-related medical costs, or $44.3 million after subtracting the program costs, they estimated.

"A significant immediate and persistent drop" in the number of monthly cases, as well as a significant decrease in the trend over the 44 months following the policy change, indicates that the lifting the DC funding ban "continues to have a significant impact on the number of [injection drug use]-associated HIV cases that are observed in the city," the study authors wrote.

"The findings of this research demonstrate that policy change can serve as an effective structural intervention for HIV prevention, particularly when changes in policy facilitate the creation or scale up of prevention services most needed by vulnerable and marginalized populations such as people who inject drugs," they concluded. "In showing the epidemic impact of policy change in the DC, our findings support the creation, promotion, and implementation of evidence-based policy for HIV prevention."

9/8/15

Reference

MS Ruiz, A O’Rourke, and ST Allen. Impact Evaluation of a Policy Intervention for HIV Prevention in Washington, DC. AIDS and Behavior. September 4, 2015 (Epub).

Other Source

George Washington UniversityMilken Institute School of Public Health.DC Needle Exchange Program Prevented 120 New Cases of HIV in Two Years. Press release. September 3, 2015.