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Abstract
The present study evaluates a combination prevention intervention for crack users
in San Salvador, El Salvador that included social network HIV testing, community events
and small group interventions. We examined the cumulative effects of the social network
HIV testing and small group interventions on rates of HIV testing, beyond the increase
that we saw with the introduction of the social network HIV testing intervention alone.
HIV test data was converted into the number of daily tests and analyzed the immediate
and overtime impact of small group interventions during and in the twelve weeks after
the small group intervention. The addition of the small group interventions to the
baseline of monthly HIV tests resulted in increased rates of testing lasting 7 days
after the small group interventions suggesting a reinforcing effect of small group
interventions on testing rates.
Previous reviews have examined the existence of HIV prevention, treatment, and care services for injecting drug users (IDUs) worldwide, but they did not quantify the scale of coverage. We undertook a systematic review to estimate national, regional, and global coverage of HIV services in IDUs. We did a systematic search of peer-reviewed (Medline, BioMed Central), internet, and grey-literature databases for data published in 2004 or later. A multistage process of data requests and verification was undertaken, involving UN agencies and national experts. National data were obtained for the extent of provision of the following core interventions for IDUs: needle and syringe programmes (NSPs), opioid substitution therapy (OST) and other drug treatment, HIV testing and counselling, antiretroviral therapy (ART), and condom programmes. We calculated national, regional, and global coverage of NSPs, OST, and ART on the basis of available estimates of IDU population sizes. By 2009, NSPs had been implemented in 82 countries and OST in 70 countries; both interventions were available in 66 countries. Regional and national coverage varied substantially. Australasia (202 needle-syringes per IDU per year) had by far the greatest rate of needle-syringe distribution; Latin America and the Caribbean (0.3 needle-syringes per IDU per year), Middle East and north Africa (0.5 needle-syringes per IDU per year), and sub-Saharan Africa (0.1 needle-syringes per IDU per year) had the lowest rates. OST coverage varied from less than or equal to one recipient per 100 IDUs in central Asia, Latin America, and sub-Saharan Africa, to very high levels in western Europe (61 recipients per 100 IDUs). The number of IDUs receiving ART varied from less than one per 100 HIV-positive IDUs (Chile, Kenya, Pakistan, Russia, and Uzbekistan) to more than 100 per 100 HIV-positive IDUs in six European countries. Worldwide, an estimated two needle-syringes (range 1-4) were distributed per IDU per month, there were eight recipients (6-12) of OST per 100 IDUs, and four IDUs (range 2-18) received ART per 100 HIV-positive IDUs. Worldwide coverage of HIV prevention, treatment, and care services in IDU populations is very low. There is an urgent need to improve coverage of these services in this at-risk population. UN Office on Drugs and Crime; Australian National Drug and Alcohol Research Centre, University of New South Wales; and Australian National Health and Medical Research Council. Copyright 2010 Elsevier Ltd. All rights reserved.
[1
]GRID grid.30760.32, ISNI 0000 0001 2111 8460, Department of Epidemiology, , Institute for Health and Equity, Medical College of Wisconsin, ; 8701 Watertown Plank Road, Milwaukee, WI 53226 USA
[2
]GRID grid.30760.32, ISNI 0000 0001 2111 8460, Center for AIDS Intervention Research, , Medical College of Wisconsin, ; Milwaukee, WI USA
[3
]Fundación Antidrogas de El Salvador, San Salvador, El Salvador
[4
]GRID grid.460701.4, ISNI 0000 0001 2184 8981, Universidad Centroamericana José Simeón Cañas, ; San Salvador, El Salvador
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History
Date
accepted
: 12
January
2021
Funding
Funded by: FundRef http://dx.doi.org/10.13039/100000026, National Institute on Drug Abuse;
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