TY - JOUR
T1 - Lessons learned from the Amsterdam Cohort Studies among people who use drugs: a historical perspective
AU - van Santen, Daniela K.
AU - Coutinho, Roel A.
AU - van den Hoek, Anneke
AU - van Brussel, Giel
AU - Buster, Marcel
AU - Prins, Maria
N1 - Funding Information: The present study was funded by the Public Health Service of Amsterdam and Aidsfonds (Project Number 29703). Funders had not role in design, data collection, analyses and interpretations of the data and writing of the manuscript. Funding Information: The authors wish to thank the participants of the ACS for their contribution, research nurses, doctors and data managers of the ACS for data collection and cohort management. The authors also wish to thank Rachel Sacks-Davis, Brian Kraft and in particular Anders Boyd for their help editing the manuscript. 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 centre), Dutch HIV 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. Funding Information: The authors wish to thank the participants of the ACS for their contribution, research nurses, doctors and data managers of the ACS for data collection and cohort management. The authors also wish to thank Rachel Sacks-Davis, Brian Kraft and in particular Anders Boyd for their help editing the manuscript. 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 centre), Dutch HIV 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. Publisher Copyright: © 2020, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/12/1
Y1 - 2021/12/1
N2 - The Netherlands is well known for its early adoption of harm reduction (HR) programs at the height of its heroin crisis in the 1970s/1980s, including the implementation of the first needle and syringe program worldwide. In this manuscript, we describe how the Amsterdam Cohort Studies (ACS) among people who use drugs (PWUD) was conceived within the context of the Dutch HR approach, including the challenges scientists faced while establishing this cohort.This required striking a balance between public health and individual benefit, solving research dilemmas in the face of uncertainty, developing controversial innovative and cutting-edge interventions, which changed the prevention landscape for PWUD, and using longitudinal cohort data to provide unique insights. Studies from the ACS covering follow-up between 1985 and 2016 revealed that participation in both opioid agonist therapy and needle and syringe programs led to a major decrease in the risk of HIV and hepatitis B and C infection acquisition. ACS data have shown that the observed decrease in incidence also likely included shifts in drug markets and drug culture over time, selective mortality among those with the highest levels of risk behaviour, demographic changes of the PWUD population, and progression of the HIV and HCV epidemics. Moreover, HR programs in the Netherlands provided services beyond care for drug use, such as social support and welfare services, likely contributing to its success in curbing the HIV and viral hepatitis epidemics, increasing access and retention to HIV and HCV care and ultimately decreases in overdose mortality over time. Given the low coverage of HR programs in certain regions, it is unsurprising that continued HIV and HCV outbreaks occur and that transmission is ongoing in many countries worldwide. If we aim to reach the World Health Organization viral hepatitis and HIV elimination targets in 2030, as well as to improve the life of PWUD beyond infection risk, comprehensive HR programs need to be integrated as a part of prevention services, as in the Netherlands. We should use the evidence generated by longstanding cohorts, including the ACS, as a basis for which implementation and improved coverage of integrated HR services can be achieved for PWUD worldwide.
AB - The Netherlands is well known for its early adoption of harm reduction (HR) programs at the height of its heroin crisis in the 1970s/1980s, including the implementation of the first needle and syringe program worldwide. In this manuscript, we describe how the Amsterdam Cohort Studies (ACS) among people who use drugs (PWUD) was conceived within the context of the Dutch HR approach, including the challenges scientists faced while establishing this cohort.This required striking a balance between public health and individual benefit, solving research dilemmas in the face of uncertainty, developing controversial innovative and cutting-edge interventions, which changed the prevention landscape for PWUD, and using longitudinal cohort data to provide unique insights. Studies from the ACS covering follow-up between 1985 and 2016 revealed that participation in both opioid agonist therapy and needle and syringe programs led to a major decrease in the risk of HIV and hepatitis B and C infection acquisition. ACS data have shown that the observed decrease in incidence also likely included shifts in drug markets and drug culture over time, selective mortality among those with the highest levels of risk behaviour, demographic changes of the PWUD population, and progression of the HIV and HCV epidemics. Moreover, HR programs in the Netherlands provided services beyond care for drug use, such as social support and welfare services, likely contributing to its success in curbing the HIV and viral hepatitis epidemics, increasing access and retention to HIV and HCV care and ultimately decreases in overdose mortality over time. Given the low coverage of HR programs in certain regions, it is unsurprising that continued HIV and HCV outbreaks occur and that transmission is ongoing in many countries worldwide. If we aim to reach the World Health Organization viral hepatitis and HIV elimination targets in 2030, as well as to improve the life of PWUD beyond infection risk, comprehensive HR programs need to be integrated as a part of prevention services, as in the Netherlands. We should use the evidence generated by longstanding cohorts, including the ACS, as a basis for which implementation and improved coverage of integrated HR services can be achieved for PWUD worldwide.
KW - HIV
KW - Harm reduction programs
KW - Hepatitis B
KW - Hepatitis C
KW - Infection
KW - Mortality
KW - People who inject drugs
KW - The Netherlands
UR - http://www.scopus.com/inward/record.url?scp=85098758401&partnerID=8YFLogxK
U2 - https://doi.org/10.1186/s12954-020-00444-6
DO - https://doi.org/10.1186/s12954-020-00444-6
M3 - Review article
C2 - 33407562
SN - 1477-7517
VL - 18
JO - Harm Reduction Journal
JF - Harm Reduction Journal
IS - 1
M1 - 2
ER -