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Meta-Analysis
. 2023 Oct;27(10):3306-3331.
doi: 10.1007/s10461-023-04051-x. Epub 2023 Apr 12.

The Impact of Needle and Syringe Exchange Programs on HIV-Related Risk Behaviors in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis Examining Individual- Versus Community-Level Effects

Ping Teresa Yeh #  1 , Xuhao Yang #  2 , Caitlin E Kennedy  2 , Kevin A Armstrong  3 , Virginia A Fonner  3   4 , Sherryn  2 , Kevin R O'Reilly  3 , Michael D Sweat  3
Affiliations
Meta-Analysis

The Impact of Needle and Syringe Exchange Programs on HIV-Related Risk Behaviors in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis Examining Individual- Versus Community-Level Effects

Ping Teresa Yeh et al. AIDS Behav. 2023 Oct.

Abstract
in English, Spanish

We conducted a systematic review and meta-analysis of the impact of needle and syringe exchange programs (NSP) on both individual- and community-level needle-sharing behaviors and other HIV-related outcomes in low- and middle-income countries (LMIC). A search of five databases for peer-reviewed trial or quasi-experimental studies reported through July 2021 identified 42 interventions delivered in 35 studies, with a total of 56,751 participants meeting inclusion criteria. Random-effects meta-analysis showed a significant protective association between NSP exposure and needle-sharing behaviors at the individual-level (odds ratio [OR] = 0.25, 95% confidence interval [CI] = 0.16-0.39, 8 trials, n = 3947) and community-level (OR 0.39, CI 0.22-0.69, 12 trials, n = 6850), although with significant heterogeneity. When stratified by needle-sharing directionality, NSP exposure remained associated with reduced receptive sharing, but not distributive sharing. NSP exposure was also associated with reduced HIV incidence and increased HIV testing but there were no consistent associations with prevalence of bloodborne infections. Current evidence suggests positive impacts of NSPs in LMICs.

Realizamos una revisión sistemática y un metanálisis del impacto de los programas de intercambio de agujas y jeringas (NSP, por sus siglas en inglés) de los comportamientos de uso compartido de agujas tanto a nivel individual como comunitario y otros resultados relacionados con el VIH en países de ingresos bajos y medianos (LMIC, por sus siglas en inglés). Realizamos búsquedas sistemáticas en cinco bases de datos hasta julio de 2021 en busca de ensayos revisados por pares o estudios cuasiexperimentales. En general, 42 intervenciones informadas en 35 estudios entre 56 751 participantes cumplieron los criterios de inclusión. El metanálisis de efectos aleatorios de ocho estudios a nivel individual y 12 a nivel comunitario con 11 075 participantes en total mostró una asociación protectora significativa entre la exposición a NSP y los comportamientos de compartir agujas (individual: OR 0,25, IC95%: 0,16–0,39; comunidad: OR 0,39, IC95%:0,22–0,69), aunque con una heterogeneidad importante. Cuando se estratificó por la direccionalidad del intercambio de agujas, la exposición a NSP permaneció asociada con un intercambio receptivo reducido, pero no con un intercambio distributivo. La exposición a NSP también se asoció con una incidencia reducida del VIH y un aumento de las pruebas del VIH, pero no hubo asociaciones consistentes para la prevalencia de infecciones transmitidas por la sangre. La evidencia actual sugiere impactos positivos de los NSP en los LMIC.

Keywords: HIV prevention; Meta-analysis; Needle/syringe exchange program (NSP); People who inject drugs (PWID); Systematic review.

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Conflict of interest statement

Conflicts of interest: The authors have no conflicts of interest to declare.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram of the different phases of the systematic review.
Figure 2.
Figure 2.
Meta-analysis of overall needle sharing (receptive, distributive, and non-directional needle sharing combined), exposure to NSP versus control/comparison group.
Figure 3.
Figure 3.
Meta-analysis of receptive needle sharing, exposure to NSP versus control/comparison group.
Figure 4.
Figure 4.
Meta-analysis of distributive needle sharing, exposure to NSP versus control/comparison group.
Figure 5.
Figure 5.
Meta-analysis of non-directional needle sharing, exposure to NSP versus control/comparison group.
Figure 6.
Figure 6.
Funnel plot of standard error by log odds ratio, N=20.
See this image and copyright information in PMC

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