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Background:
Harm reduction funding in low- and middle-income countries is in a profound moment of crisis due to the US funding cuts and European government foreign aid reductions. Advocates must become familiar with economic evidence to call for strategic resource allocations by donors and governments. HRI conducted a study to review and compile economic evidence for harm reduction from across the world. Findings were used to equip advocates and policy makers with evidence for harm reduction investments.
Methods:
A scoping review was conducted, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews and modified to accommodate limited literature on harm reduction from low and middle-income countries. The review included peer-reviewed and grey cost-effectiveness literature published since 2005, including cost impact studies and economic modelling. The quality of evidence was graded using Criteria for Health Economic Quality Evaluation (CHEQUE). The review identified 119 articles, including 111 peer-reviewed and 8 grey literature articles from search engines including PubMed, PsychInfo, Web of Science, and Google Scholar.
Results:
The cost-effectiveness of opioid agonist therapies and needle and syringe programmes was demonstrated in diverse settings, while economic evidence for drug consumption rooms, naloxone distribution, harm reduction in primary care and hospital settings as well as opioid safer supply programmes were also identified. In addition, evidence of the cost of inaction and supportive economic evidence for the decriminalisation of drugs was identified.
Conclusion:
Making the investment case is key to influencing government and donor decision-making processes, particularly at this time of funding threats and competing budgetary priorities. This study provides a robust repository of the strongest evidence on the value of investing in the introduction and scale up of harm reduction interventions, including for HCV prevention, in a variety of settings.
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