Prevention of HIV infection for people who inject drugs: why individual, structural, and combination approaches are needed

HIV can spread rapidly between people who inject drugs (through injections and sexual transmission), and potentially the virus can pass to the wider community (by sexual transmission). Here, we summarise evidence on the effectiveness of individual-level approaches to prevention of HIV infection; rev...

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Published in:The Lancet (British edition) Vol. 376; no. 9737; pp. 285 - 301
Main Authors: Degenhardt, Louisa, Mathers, Bradley, Vickerman, Peter, Rhodes, Tim, Latkin, Carl, Hickman, Matt
Format: Journal Article
Language:English
Published: Kidlington Elsevier Ltd 2010
Elsevier
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ISSN:0140-6736, 1474-547X, 1474-547X
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Abstract HIV can spread rapidly between people who inject drugs (through injections and sexual transmission), and potentially the virus can pass to the wider community (by sexual transmission). Here, we summarise evidence on the effectiveness of individual-level approaches to prevention of HIV infection; review global and regional coverage of opioid substitution treatment, needle and syringe programmes, and antiretroviral treatment; model the effect of increased coverage and a combination of these three approaches on HIV transmission and prevalence in injecting drug users; and discuss evidence for structural-level interventions. Each intervention alone will achieve modest reductions in HIV transmission, and prevention of HIV transmission necessitates high-coverage and combined approaches. Social and structural changes are potentially beneficial components in a combined-intervention strategy, especially when scale-up is difficult or reductions in HIV transmission and injection risk are difficult to achieve. Although further evidence is needed on how to optimise combinations of interventions in different settings and epidemics, we know enough now about which actions are effective: the challenge is to deliver these well and to scale.
AbstractList HIV can spread rapidly between people who inject drugs (through injections and sexual transmission), and potentially the virus can pass to the wider community (by sexual transmission). Here, we summarise evidence on the effectiveness of individual-level approaches to prevention of HIV infection; review global and regional coverage of opioid substitution treatment, needle and syringe programmes, and antiretroviral treatment; model the effect of increased coverage and a combination of these three approaches on HIV transmission and prevalence in injecting drug users; and discuss evidence for structural-level interventions. Each intervention alone will achieve modest reductions in HIV transmission, and prevention of HIV transmission necessitates high-coverage and combined approaches. Social and structural changes are potentially beneficial components in a combined-intervention strategy, especially when scale-up is difficult or reductions in HIV transmission and injection risk are difficult to achieve. Although further evidence is needed on how to optimise combinations of interventions in different settings and epidemics, we know enough now about which actions are effective: the challenge is to deliver these well and to scale.
Summary HIV can spread rapidly between people who inject drugs (through injections and sexual transmission), and potentially the virus can pass to the wider community (by sexual transmission). Here, we summarise evidence on the effectiveness of individual-level approaches to prevention of HIV infection; review global and regional coverage of opioid substitution treatment, needle and syringe programmes, and antiretroviral treatment; model the effect of increased coverage and a combination of these three approaches on HIV transmission and prevalence in injecting drug users; and discuss evidence for structural-level interventions. Each intervention alone will achieve modest reductions in HIV transmission, and prevention of HIV transmission necessitates high-coverage and combined approaches. Social and structural changes are potentially beneficial components in a combined-intervention strategy, especially when scale-up is difficult or reductions in HIV transmission and injection risk are difficult to achieve. Although further evidence is needed on how to optimise combinations of interventions in different settings and epidemics, we know enough now about which actions are effective: the challenge is to deliver these well and to scale.
HIV can spread rapidly between people who inject drugs (through injections and sexual transmission), and potentially the virus can pass to the wider community (by sexual transmission). Here, we summarise evidence on the effectiveness of individual-level approaches to prevention of HIV infection; review global and regional coverage of opioid substitution treatment, needle and syringe programmes, and antiretroviral treatment; model the effect of increased coverage and a combination of these three approaches on HIV transmission and prevalence in injecting drug users; and discuss evidence for structural-level interventions. Each intervention alone will achieve modest reductions in HIV transmission, and prevention of HIV transmission necessitates high-coverage and combined approaches. Social and structural changes are potentially beneficial components in a combined-intervention strategy, especially when scale-up is difficult or reductions in HIV transmission and injection risk are difficult to achieve. Although further evidence is needed on how to optimise combinations of interventions in different settings and epidemics, we know enough now about which actions are effective: the challenge is to deliver these well and to scale.HIV can spread rapidly between people who inject drugs (through injections and sexual transmission), and potentially the virus can pass to the wider community (by sexual transmission). Here, we summarise evidence on the effectiveness of individual-level approaches to prevention of HIV infection; review global and regional coverage of opioid substitution treatment, needle and syringe programmes, and antiretroviral treatment; model the effect of increased coverage and a combination of these three approaches on HIV transmission and prevalence in injecting drug users; and discuss evidence for structural-level interventions. Each intervention alone will achieve modest reductions in HIV transmission, and prevention of HIV transmission necessitates high-coverage and combined approaches. Social and structural changes are potentially beneficial components in a combined-intervention strategy, especially when scale-up is difficult or reductions in HIV transmission and injection risk are difficult to achieve. Although further evidence is needed on how to optimise combinations of interventions in different settings and epidemics, we know enough now about which actions are effective: the challenge is to deliver these well and to scale.
Author Mathers, Bradley
Hickman, Matt
Vickerman, Peter
Latkin, Carl
Rhodes, Tim
Degenhardt, Louisa
Author_xml – sequence: 1
  givenname: Louisa
  surname: Degenhardt
  fullname: Degenhardt, Louisa
  email: l.degenhardt@unsw.edu.au
  organization: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
– sequence: 2
  givenname: Bradley
  surname: Mathers
  fullname: Mathers, Bradley
  organization: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
– sequence: 3
  givenname: Peter
  surname: Vickerman
  fullname: Vickerman, Peter
  organization: London School of Hygiene and Tropical Medicine, London, UK
– sequence: 4
  givenname: Tim
  surname: Rhodes
  fullname: Rhodes, Tim
  organization: Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London, UK
– sequence: 5
  givenname: Carl
  surname: Latkin
  fullname: Latkin, Carl
  organization: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
– sequence: 6
  givenname: Matt
  surname: Hickman
  fullname: Hickman, Matt
  organization: Department of Social Medicine, University of Bristol, Bristol, UK
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Keywords Infection
Human
Prevention
Immunopathology
Drug addiction
Intravenous administration
Methodology
Viral disease
AIDS
Immune deficiency
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Snippet HIV can spread rapidly between people who inject drugs (through injections and sexual transmission), and potentially the virus can pass to the wider community...
Summary HIV can spread rapidly between people who inject drugs (through injections and sexual transmission), and potentially the virus can pass to the wider...
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SubjectTerms Antiviral agents
Biological and medical sciences
Harm Reduction
HIV Infections - etiology
HIV Infections - prevention & control
HIV Infections - therapy
Human immunodeficiency virus
Human viral diseases
Humans
Immunodeficiencies
Immunodeficiencies. Immunoglobulinopathies
Immunopathology
Infectious diseases
Internal Medicine
Medical sciences
Prevention and actions
Public health. Hygiene
Public health. Hygiene-occupational medicine
Substance Abuse, Intravenous - complications
Viral diseases
Viral diseases of the lymphoid tissue and the blood. Aids
Title Prevention of HIV infection for people who inject drugs: why individual, structural, and combination approaches are needed
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https://www.ncbi.nlm.nih.gov/pubmed/20650522
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