Background:
Evidence of the effectiveness of needle and syringe programmes (NSP) in reducing HIV-risk in low/middle-income countries is sparse. We assessed the associations between needles/syringes received and incident HIV acquisition status among people who inject drugs (PWID) attending NSP in
Pakistan.
Methods:
Nai Zindagi Trust provides harm-reduction services (NSP and HIV-testing) to PWID across Pakistan. All PWID are tested for HIV at enrolment, with re-testing offered every 3-6 months for HIV-negative PWID. Eligibility for this study included testing HIV-negative at enrolment and having >=1 additional
tests in subsequent years. Self-reported socio-demographic information and risk behaviours were collected at enrolment. The yearly number of needles/syringes received by each participant was recorded. HIV infection status was defined based on each participants’ last test each year and lagged
forward one year relative to the yearly needles/syringes received. As PWID can contribute to multiple years of data, univariable and multivariable associations were estimated between annual number of needles/syringes received and next-year risk of HIV-acquisition using generalized estimation equations for binary outcomes with a logit link. Age, sex, province, recent homelessness, and incarceration were included in the multivariable model.
Results:
Between 2012–2023, 88,427 PWID were enrolled (33.2% HIV-positive at enrolment) with 36,980 (41.8%) eligible for this analysis. We found progressively lower odds of HIV-acquisition with increasing numbers of yearly needles/syringes received, except for the group who received the least needles/syringes (Figure).
For example, HIV-risk was decreased by 39% on average if an individual received 1000+ syringes/year versus 100-199 syringes/year. Additionally, we found that greater needles/syringes were needed for reducing HIV-acquisition risk among PWID with higher frequency of injection (data not shown).
Conclusions:
Evidence suggests that NSP in Pakistan has reduced HIV incidence. Higher levels of needle/syringe coverage (1000+ syringes/year) than recommended by World Health Organization (200-300 syringes/year) are needed to maximize impact. |