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. 2023 May;11(5):e673-e683.
doi: 10.1016/S2214-109X(23)00058-X. Epub 2023 Mar 27.

Global coverage of interventions to prevent and manage drug-related harms among people who inject drugs: a systematic review

Samantha Colledge-Frisby  1 , Sophie Ottaviano  2 , Paige Webb  2 , Jason Grebely  3 , Alice Wheeler  3 , Evan B Cunningham  3 , Behzad Hajarizadeh  3 , Janni Leung  4 , Amy Peacock  2 , Peter Vickerman  5 , Michael Farrell  2 , Gregory J Dore  3 , Matthew Hickman  5 , Louisa Degenhardt  2
Affiliations

Global coverage of interventions to prevent and manage drug-related harms among people who inject drugs: a systematic review

Samantha Colledge-Frisby et al. Lancet Glob Health. 2023 May.

Erratum in

Abstract

Background: Harm reduction and treatment programmes are essential for reducing harms for people who inject drugs (PWID). We aimed to update estimates from a 2017 review of global coverage of needle and syringe exchange programmes (NSPs), opioid agonist treatment (OAT), and other harm reduction services that target PWID (eg, take-home naloxone [THN] programmes, supervised consumption facilities, and drug checking services).

Methods: We did a systematic review of available evidence from peer-reviewed and grey literature databases for studies published between Jan 1, 2017, and May 31, 2022. Programmatic data were collected on the availability of services, the number of sites, people accessing services, and equipment distributed in countries where there is evidence of injecting drug use. National estimates of coverage of OAT (ie, number of people accessing OAT per 100 PWID) and NSPs (ie, number of needles and syringes distributed per PWID per year) were generated where available using the most recent data. Regional and global estimates were derived and compared with WHO indicators. The study was registered with PROSPERO (CRD42020173974).

Findings: We included 195 studies and found there were 90 countries implementing OAT (75% of the PWID population) and 94 countries implementing NSPs (88% of the global PWID population). Only five countries (2% of the global PWID population) are providing high coverage of both services. Far fewer countries were implementing THN programmes (n=43), supervised consumption facilities (n=17), and drug checking services (n=26), with nine countries implementing all five services. Globally, we estimated there were 18 (95% uncertainty interval [UI] 12-27) people accessing OAT per 100 PWID, and 35 (95% UI 24-52) needles and syringes being distributed per person who injects drugs per year. More countries reported high (OAT 24; NSPs 10), moderate (OAT 8; NSPs 15), and low (OAT 38; NSPs 47) coverage of services compared with the previous review.

Interpretation: Global coverage of OAT and NSPs has increased modestly in the past 5 years but remains low for most countries. Programmatic data on other key harm reduction interventions are scarce.

Funding: Australian National Health and Medical Research Council.

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Conflict of interest statement

Declaration of interests LD and MF have received investigator-initiated untied educational grants for studies of opioid medications in Australia from Indivior and Seqirus in the past 3 years. AP has received investigator-initiated untied educational grants from Seqirus. JG is a consultant and adviser and has received research grants from AbbVie, Camurus, Cepheid, Gilead Sciences, Hologic, Indivior, and Merck. GJD has received research grants from Abbvie, Gilead Sciences, and Merck. EBC has received funding from the Canadian Network on hepatitis C. These companies or organisations had no knowledge of or role in the design, conduct, interpretation, or publication of these findings. All other authors declare no competing interests.

Figures

Figure 1.
Figure 1.. Global coverage of opioid agonist treatment (OAT) and needle-syringe exchange programmes (NSP) among people who inject drugs (PWID)
Figure 1.
Figure 1.. Global coverage of opioid agonist treatment (OAT) and needle-syringe exchange programmes (NSP) among people who inject drugs (PWID)
Figure 2.
Figure 2.. Combination coverage of needle-syringe exchange programmes (NSPs) and opioid agonist treatment (OAT) for people who inject drugs
Figure note. Only includes countries with a non-zero estimate for both NSP and OAT coverage
Figure 3.
Figure 3.. Proportion of the estimated number of people who inject drugs covered by opioid agonist treatment (OAT) and needle-syringe exchange programs (NSP), by coverage level
Note. This figure does not include San Marino, where availability of OAT and NSPs was unknown.
See this image and copyright information in PMC

Comment in

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