Increasing access to sterile needles and syringes and to opioid substitution therapy, as well as to HIV and hepatitis C screening services and effective treatment would lower new infection rates by double digit percentages, save money and lives, and contain the spread of the viruses in Eastern European and Central Asian countries where people who inject drugs currently have limited access to proven interventions, a study reported in the March Open Forum Infectious Diseases says.
Sharing needles used to inject drugs contributed to doubling new cases of HIV during the first decade of this century across countries in Eastern Europe and Central Asia, where 1.1 million people were living with the virus in 2013, with an estimated 110,000 new infections occurred each year, according to the authors. Across the region, the authors add, an estimated 2.3 million people who inject drugs are infected with hepatitis C. Interventions to lower incidence of HIV and hepatitis C among people who inject drugs are critical, the authors note, to controlling the spread of the viruses overall in the region.
The authors, led by Guillaume Mabileau of INSERM used modelling to determine both the public health and economic impacts across five countries in the region — Belarus, Georgia, Kazakhstan, Republic of Moldova, and Tajikistan of increasing access among people who inject drugs to harm reduction and medical services that included opioid substitution therapy, and direct acting antiviral medicines for hepatitis C currently not available at all in some of the countries.
Increasing access to all interventions — harm reduction and medical — would avert the most illnesses, but even then the cost-effectiveness would be compromised at the current high price of the regimen of treatment needed to cure hepatitis. Increasing access to HIV screening and antiretroviral treatment, by contrast would save money over 20 years. The combined strategy, overall however was cost-effective — with costs balanced by benefits — across the countries with a reduced price for hepatitis treatment.