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Syringe exchange programmes prevented thousands of new HIV cases

Syringe exchange programmes established in Philadelphia and Baltimore prevented a total of 12,483 new cases of HIV over a 10-year period, according to a study published today. The averted HIV infections also saved both cities millions of dollars every year, according to the researchers. "Small investments in syringe exchange programmes yield large savings in treatment costs," said Dr Monica Ruiz, an associate professor in the department of prevention and community health at the George Washington University Milken Institute School of Public Health (Milken Institute SPH) and the principal investigator on the project. "Syringe exchange programmes represent a powerful way to stop the spread of HIV, especially in communities struggling to fight the opioid epidemic.”

The study may help policymakers nationwide understand the benefits of providing funding for syringe exchange programmes. Such programmes distribute sterile injection equipment to injection drug users and thus discourage the practice of sharing needles, which can spread HIV, the virus that causes Aids.

Ruiz and her colleagues looked at how policy changes allowing for implementation of legal syringe exchange programs in Philadelphia and Baltimore affected the number of new HIV cases over a decade. The researchers used a mathematical modelling technique to estimate how many cases of HIV had been averted after the programs had been set up.

The researchers found that policies to allow syringe exchange programmes to operate averted 10,592 new cases of HIV in Philadelphia and 1,891 new cases of HIV in Baltimore over a ten-year period. Syringe exchange programmes help some of the most vulnerable people in urban, suburban and rural communities avoid HIV infection – a risk associated with injection drug use. Both Philadelphia and Baltimore have seen a spike of new HIV cases associated with drugs, including heroin and other opioids.

This study showed that the averted HIV cases also saved each city money because most people who inject drugs are covered by public health insurance. Philadelphia saved an estimated $243m every year due to the drop in new HIV cases – cases averted by syringe exchange. In Baltimore, the savings amounted to $62m annually.

Ruiz and her colleagues also factored in the lifetime cost of treating someone with HIV and the expense associated with setting up a syringe exchange programme. They found that the one-year return on investment was nearly $183m for Philadelphia. For Baltimore, that same return on investment was estimated at about $47m.

Policymakers and public health officials considering a syringe exchange programme to reduce the threat posed by the opioid epidemic and HIV should take a hard look at the scientific results in this study and others. A former study by Ruiz showed a syringe exchange programme in the District of Columbia prevented 120 new cases of HIV and saved DC an estimated $44m in just a two-year period.

"Giving injection drug users access to clean syringes can not only help them avoid HIV but often helps them obtain other health services, including access to drug treatment programmes," Ruiz said. "Such programmes offer communities huge public health and societal benefits, including a reduction in new HIV cases and cost savings to publicly funded HIV care."

Abstract
Background: Syringe exchange programs (SEP) reduce HIV incidence associated with injection drug use (IDU), but legislation often prohibits implementation. We examined the policy change impact allowing for SEP implementation on HIV diagnoses among people who inject drugs in 2 US cities.
Setting: Philadelphia, PA, and Baltimore, MD.

Methods: Using surveillance data from Philadelphia (1984–2015) and Baltimore (1985–2013) for IDU-associated HIV diagnoses, we used autoregressive integrated moving averages modeling to conduct 2 tests to measure policy change impact. We forecast the number of expected HIV diagnoses per city had policy not changed in the 10 years after implementation and compared it with the number of observed diagnoses postpolicy change, obtaining an estimate for averted HIV diagnoses. We then used interrupted time series analysis to assess the immediate step and trajectory impact of policy change implementation on IDU-attributable HIV diagnoses.
Results: The Philadelphia (1993–2002) model predicted 15,248 new IDU-associated HIV diagnoses versus 4656 observed diagnoses, yielding 10,592 averted HIV diagnoses over 10 years. The Baltimore model (1995–2004) predicted 7263 IDU-associated HIV diagnoses versus 5372 observed diagnoses, yielding 1891 averted HIV diagnoses over 10 years. Considering program expenses and conservative estimates of public sector savings, the 1-year return on investment in SEPs remains high: $243.4 M (Philadelphia) and $62.4 M (Baltimore).
Conclusions: Policy change is an effective structural intervention with substantial public health and societal benefits, including reduced HIV diagnoses among people who inject drugs and significant cost savings to publicly funded HIV care.

Abstract
Ruiz, Monica S; O'Rourke, Allison; Allen, Sean T; Holtgrave, David R; Metzger, David; Benitez, Jose; Brady, Kathleen A; Chaulk, C Patrick; Wen, Leana S

[link url="https://www.eurekalert.org/pub_releases/2019-10/gwu-sep102919.php"]George Washington University material[/link]

[link url="https://journals.lww.com/jaids/Fulltext/2019/12012/Using_Interrupted_Time_Series_Analysis_to_Measure.14.aspx"]Journal of Acquiried Immune Deficiency Diseases abstract[/link]

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