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

2. 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

3. 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

4. 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

5. 2010: Systematic review reports very poor coverage of these interventions globally
Mathers et al., Lancet, 2010

6. 2010: Systematic review reports very poor coverage of these interventions globally
Mathers et al., Lancet, 2010

7. 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

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 Approach: Systematic review of published and unpublished literature, with expert consultation

9. Key findings

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

11. Regional and global coverage of NSP

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

13. Regional and global coverage of OST

14. Combination high coverage NSP and OST is rare

15. Low coverage of both is most frequent

16. <1% of PWID live in countries with high coverage of both NSP and OST

17. 5% of PWID live in countries with either moderate or high coverage of NSP and OST

18. Implications

19. 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

20. 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

21. 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.