TY - JOUR
T1 - Comprehensive needle and syringe program and opioid agonist therapy reduce HIV and hepatitis c virus acquisition among people who inject drugs in different settings
T2 - A pooled analysis of emulated trials
AU - van Santen, Daniela K.
AU - Lodi, Sara
AU - Dietze, Paul
AU - van den Boom, Wijnand
AU - Hayashi, Kanna
AU - Dong, Huiru
AU - Cui, Zishan
AU - Maher, Lisa
AU - Hickman, Matthew
AU - Boyd, Anders
AU - Prins, Maria
N1 - Funding Information: The present study was funded by Aidsfonds (project number 29703). S.L. was funded by the Providence/Boston Center for AIDS Research (P30AI042853). The funders had no role in the design, analyses and interpretation of the findings. Funding information Funding Information: The authors wish to thank the participants of the ACS for their contribution and research nurses of the ACS for data collection and cohort management. The Amsterdam Cohort Studies on HIV infection and AIDS, which is a collaboration between the Public Health Service of Amsterdam (Gemeentelijke Gezondheidsdienst Amsterdam; GGD Amsterdam), Department of Infectious Diseases, Research and Prevention, Amsterdam, the Netherlands, Amsterdam University Medical Centers (UMC), University of Amsterdam (Department of Medical Microbiology, Experimental Immunology, Department of Internal Medicine, Division of Infectious Diseases, Emma's Children's Hospital [Emma Kinderziekenhuis], HIV treatment center), Dutch Monitoring Foundation (Stichting HIV Monitoring; SHM), Jan van Goyen Medical Centre, Department of Internal Medicine, HIV Focus Centre (DC Klinieken) and Sanquin Blood Supply Foundation, financially supports the maintenance of the biobank. The ACS is financially supported by the Center for Infectious Disease Control of the Netherlands National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands. We also thank Rachel Sacks-Davis, Shady Abdelsalam and Peter Higgs for their input for the analysis of SuperMIX data (Burnet Institute). The authors thank research nurses of the ACS for data collection, data managers for cohort management and Amy Matser for her contributions in ACS analyses (Public Health Service of Amsterdam). The VIDUS study was supported by the US National Institutes of Health (NIH) (U01DA038886). We also thank Drs. Evan Wood and Thomas Kerr who were the former principal investigators of the VIDUS study. KH holds the St. Paul's Hospital Chair in Substance Use Research and is supported in part by the NIH (U01DA038886), a Michael Smith Foundation for Health Research Scholar Award and the St. Paul's Foundation. MH acknowledges funding from NIHR HPRU in Behavioural Science and Evaluation. Funding Information: The authors wish to thank the participants of the ACS for their contribution and research nurses of the ACS for data collection and cohort management. The Amsterdam Cohort Studies on HIV infection and AIDS, which is a collaboration between the Public Health Service of Amsterdam (Gemeentelijke Gezondheidsdienst Amsterdam; GGD Amsterdam), Department of Infectious Diseases, Research and Prevention, Amsterdam, the Netherlands, Amsterdam University Medical Centers (UMC), University of Amsterdam (Department of Medical Microbiology, Experimental Immunology, Department of Internal Medicine, Division of Infectious Diseases, Emma's Children's Hospital [Emma Kinderziekenhuis], HIV treatment center), Dutch Monitoring Foundation (Stichting HIV Monitoring; SHM), Jan van Goyen Medical Centre, Department of Internal Medicine, HIV Focus Centre (DC Klinieken) and Sanquin Blood Supply Foundation, financially supports the maintenance of the biobank. The ACS is financially supported by the Center for Infectious Disease Control of the Netherlands National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands. We also thank Rachel Sacks‐Davis, Shady Abdelsalam and Peter Higgs for their input for the analysis of SuperMIX data (Burnet Institute). The authors thank research nurses of the ACS for data collection, data managers for cohort management and Amy Matser for her contributions in ACS analyses (Public Health Service of Amsterdam). The VIDUS study was supported by the US National Institutes of Health (NIH) (U01DA038886). We also thank Drs. Evan Wood and Thomas Kerr who were the former principal investigators of the VIDUS study. KH holds the St. Paul's Hospital Chair in Substance Use Research and is supported in part by the NIH (U01DA038886), a Michael Smith Foundation for Health Research Scholar Award and the St. Paul's Foundation. MH acknowledges funding from NIHR HPRU in Behavioural Science and Evaluation. Publisher Copyright: © 2023 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.
PY - 2023/6
Y1 - 2023/6
N2 - Background and Aims: Although the Netherlands, Canada and Australia were early adopters of harm reduction for people who inject drugs (PWID), their respective HIV and hepatitis C (HCV) epidemics differ. We measured the pooled effect of needle and syringe program (NSP) and opioid agonist therapy (OAT) participation on HIV and HCV incidence in these settings. Design: For each cohort, we emulated the design and statistical analysis of a target trial using observational data. Setting and Participants: We included PWID at risk of HIV or HCV infection from the Amsterdam Cohort Studies (1985–2013), Vancouver Injection Drug Users Study (1997–2009) and Melbourne Injecting Drug User Cohort Study (SuperMIX) (2010–2021). Measurements: Separately for each infection and cohort (only HCV in SuperMIX), marginal structural models were used to compare the effect of comprehensive (on OAT and 100% NSP coverage or on OAT only if no recent injection drug use) versus no/partial NSP/OAT (no OAT and/or <100% NSP coverage) participation. Pooled hazard ratios (HR) and 95% CI were calculated using random-effects meta-analysis. Findings: We observed 94 HIV seroconversions and 81 HCV seroconversions among 2023 and 430 participants, respectively. Comprehensive NSP/OAT led to a 41% lower risk of HIV acquisition (pooled HR = 0.59, 95% CI = 0.36–0.96) and a 76% lower risk of HCV acquisition (pooled HR = 0.24, 95% CI = 0.11–0.51), compared with no/partial NSP/OAT, with little heterogeneity between studies for both infections (I2 = 0%). Conclusions: In the Netherlands, Canada and Australia, comprehensive needle and syringe program and opioid agonist therapy participation appears to substantially reduce HIV and hepatitis C acquisition compared with no or partial needle and syringe program/opioid agonist therapy participation. These findings from an emulated trial design reinforce the critical role of comprehensive access to harm reduction in optimizing infection prevention for people who inject drugs.
AB - Background and Aims: Although the Netherlands, Canada and Australia were early adopters of harm reduction for people who inject drugs (PWID), their respective HIV and hepatitis C (HCV) epidemics differ. We measured the pooled effect of needle and syringe program (NSP) and opioid agonist therapy (OAT) participation on HIV and HCV incidence in these settings. Design: For each cohort, we emulated the design and statistical analysis of a target trial using observational data. Setting and Participants: We included PWID at risk of HIV or HCV infection from the Amsterdam Cohort Studies (1985–2013), Vancouver Injection Drug Users Study (1997–2009) and Melbourne Injecting Drug User Cohort Study (SuperMIX) (2010–2021). Measurements: Separately for each infection and cohort (only HCV in SuperMIX), marginal structural models were used to compare the effect of comprehensive (on OAT and 100% NSP coverage or on OAT only if no recent injection drug use) versus no/partial NSP/OAT (no OAT and/or <100% NSP coverage) participation. Pooled hazard ratios (HR) and 95% CI were calculated using random-effects meta-analysis. Findings: We observed 94 HIV seroconversions and 81 HCV seroconversions among 2023 and 430 participants, respectively. Comprehensive NSP/OAT led to a 41% lower risk of HIV acquisition (pooled HR = 0.59, 95% CI = 0.36–0.96) and a 76% lower risk of HCV acquisition (pooled HR = 0.24, 95% CI = 0.11–0.51), compared with no/partial NSP/OAT, with little heterogeneity between studies for both infections (I2 = 0%). Conclusions: In the Netherlands, Canada and Australia, comprehensive needle and syringe program and opioid agonist therapy participation appears to substantially reduce HIV and hepatitis C acquisition compared with no or partial needle and syringe program/opioid agonist therapy participation. These findings from an emulated trial design reinforce the critical role of comprehensive access to harm reduction in optimizing infection prevention for people who inject drugs.
KW - Emulated trial
KW - HIV
KW - harm reduction programs
KW - hepatitis C virus
KW - needle and syringe programs
KW - opioid agonist therapy
KW - people who inject drugs
UR - http://www.scopus.com/inward/record.url?scp=85148014902&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/add.16147
DO - https://doi.org/10.1111/add.16147
M3 - Article
C2 - 36710474
SN - 0965-2140
VL - 118
SP - 1116
EP - 1126
JO - Addiction
JF - Addiction
IS - 6
ER -