Coverage of HIV and HCV prevention interventions for people who inject drugs Dr Sarah Larney, Senior Research Fellow

Acknowledgements Co-authors: Amy Peacock, Janni Leung, Samantha Colledge, Matthew Hickman, Peter Vickerman, Jason Grebely, Kostyantyn Dumchev, Paul Griffiths, Lindsey Hines, Evan Cunningham, Richard Mattick, Michael Lynskey, John Marsden, John Strang, Louisa Degenhardt Research assistant team Funding: Open Society Foundations, Global Fund, WHO, UNAIDS, UNODC, National Drug and Alcohol Research Centre Many, many, many people who contributed data and advice

WHO/UNAIDS/UNODC comprehensive package includes: There are effective interventions to prevent HIV and HCV among people who inject drugs WHO/UNAIDS/UNODC comprehensive package includes: Needle and syringe programs (NSP) Opioid substitution therapy (OST) HIV counselling and testing HIV antiretroviral therapy Condom distribution programs

WHO/UNAIDS/UNODC comprehensive package includes: There are effective interventions to prevent HIV and HCV among people who inject drugs WHO/UNAIDS/UNODC comprehensive package includes: Needle and syringe programs (NSP) Opioid substitution therapy (OST) HIV counselling and testing HIV antiretroviral therapy Condom distribution programs

2010: Systematic review reports very poor coverage of these interventions globally Mathers et al., Lancet, 2010

2010: Systematic review reports very poor coverage of these interventions globally Mathers et al., Lancet, 2010

Updated estimates of intervention coverage are needed Advocacy Policy development Service delivery Aim: to estimate coverage of HIV/HCV prevention interventions for people who inject drugs

Approach: Systematic review of published and unpublished literature, with expert consultation

Key findings

Coverage of NSP has improved, but remains low in most countries

Regional and global coverage of NSP

Coverage of OST has improved, but remains low in most countries

Regional and global coverage of OST

Combination high coverage NSP and OST is rare

Low coverage of both is most frequent

<1% of PWID live in countries with high coverage of both NSP and OST

5% of PWID live in countries with either moderate or high coverage of NSP and OST

Implications

NSP and OST are increasingly implemented But access to interventions remains poor Coverage insufficient to prevent, halt or reverse HIV and HCV epidemics among people who inject drugs Scale-up of prevention is needed in most countries

Better data on program implementation and population sizes are needed Numerator data not reported in many settings PWID population sizes (denominator) not available in many settings or are very uncertain Other interventions: HCV testing and treatment

Now available (open access): Larney et al. Systematic review of global, regional and country-level coverage of interventions to prevent and manage HIV and hepatitis C among people who inject drugs. Lancet Global Health. s.larney@unsw.edu.au global.reviews@unsw.edu.au