Coverage of HIV prevention and care services for IDUs: very low worldwide, more so in developing countries

[Guest guest]

Dear All

Please find the abstract of a global review of coverage of HIV prevention and care services for IDUs. This article has been published in a recent issue of Lancet and shows the grossly inadequate coverage of HIV-related interventions among IDUs, globally, more so in the developing countries, including India.

ABSTRACTHIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage

Dr Bradley M Mathers MBChB  Prof Louisa Degenhardt PhD  Hammad Ali MBBS , Lucas Wiessing MSc, Prof  Hickman FFPHM , Prof  P Mattick PhD , Bronwyn Myers PhD , Atul Ambekar MD, Prof Steffanie A Strathdee PhD, for the 2009 Reference Group to the UN on HIV and Injecting Drug Use

Background

Previous reviews have examined the existence of HIV prevention, treatment, and care services for injecting drug users (IDUs) worldwide, but they did not quantify the scale of coverage. We undertook a systematic review to estimate national, regional, and global coverage of HIV services in IDUs.

Methods

We did a systematic search of peer-reviewed (Medline, BioMed Central), internet, and grey-literature databases for data published in 2004 or later. A multistage process of data requests and verification was undertaken, involving UN agencies and national experts. National data were obtained for the extent of provision of the following core interventions for IDUs: needle and syringe programmes (NSPs), opioid substitution therapy (OST) and other drug treatment, HIV testing and counselling, antiretroviral therapy (ART), and condom programmes. We calculated national, regional, and global coverage of NSPs, OST, and ART on the basis of available estimates of IDU population sizes.

Findings

By 2009, NSPs had been implemented in 82 countries and OST in 70 countries; both interventions were available in 66 countries. Regional and national coverage varied substantially. Australasia (202 needle—syringes per IDU per year) had by far the greatest rate of needle—syringe distribution; Latin America and the Caribbean (0·3 needle—syringes per IDU per year), Middle East and north Africa (0·5 needle—syringes per IDU per year), and sub-Saharan Africa (0·1 needle—syringes per IDU per year) had the lowest rates. OST coverage varied from less than or equal to one recipient per 100 IDUs in central Asia, Latin America, and sub-Saharan Africa, to very high levels in western Europe (61 recipients per 100 IDUs). The number of IDUs receiving ART varied from less than one per 100 HIV-positive IDUs (Chile, Kenya, Pakistan, Russia, and Uzbekistan) to more than 100 per 100 HIV-positive IDUs in six European countries. Worldwide, an estimated two needle—syringes (range 1—4) were distributed per IDU per month, there were eight recipients (6—12) of OST per 100 IDUs, and four IDUs (range 2—18) received ART per 100 HIV-positive IDUs.

Interpretation

Worldwide coverage of HIV prevention, treatment, and care services in IDU populations is very low. There is an urgent need to improve coverage of these services in this at-risk population.

Funding

UN Office on Drugs and Crime; Australian National Drug and Alcohol Research Centre, University of New South Wales; and Australian National Health and Medical Research Council.

 http://www.lancet.com/journals/lancet/article/PIIS0140-6736(10)60232-2/abstract

-- Dr. Atul Ambekar, M.D.Assistant ProfessorNational Drug Dependence Treatment Centre and Department of PsychiatryAll India Institute of Medical Sciences,Ansari Nagar,New DelhiIndia - 110029

Phone (O): 91-11-26593236Phone ®: 91-11-26105757Mobile: (+91) 9811155682Fax: 91-11-26588641, 91-11-26588663Email: atul.ambekar@...Website: http://www.aiims.edu/aiims/departments/spcenter/nddtc/nddc_intro.htm