XIX International AIDS Conference


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MOAE0204 - Oral Abstract

Increasing investment in syringe exchange is cost-saving HIV prevention: modeling hypothetical syringe coverage levels in the United States

Presented by Trang Q. Nguyen (United States).

T.Q. Nguyen1, B.W. Weir1, S.D. Pinkerton2, D.C. Des Jarlais3, D. Holtgrave1

1Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, United States, 2Medical College of Wisconsin, Department of Psychiatry and Behavioral Medicine, Milwaukee, United States, 3Beth Israel Medical Center and North American Syringe Exchange Network, New York, United States

Background: Syringe exchange for injecting drug users (IDU) is controversial and has limited funding in the US. To inform policy, we examine whether increasing investment in syringe exchange programs (SEPs) would be cost-effective for HIV prevention.
Methods: We model HIV incidence in hypothetical cases with higher SEP syringe coverage (i.e., percent injections with a new syringe from SEP) than current level--base case, and estimate additional funding required, number of injections averted, and HIV treatment costs saved.
The ratio of HIV incidence (hypothetical to base case) is established based on the transmission equation and simplified to the ratio of proportions of HIV-contaminated syringes (hypothetical to base case), which is a function of number of injections with a receptively shared (“borrowed”) syringe and numbers of syringes from SEPs and other sources. A maximal bound for hypothetical case incidence is calculated.
SEP syringe coverage and costs data are from the Beth Israel/NASEN survey. HIV incidence and lifetime treatment costs are from the CDC. We assume 1/2 of IDU-category and 1/4 of MSM/IDU-category infections are due to injection risk.
We conduct sensitivity analyses on “borrowing” probability, number of non-SEP syringes, extent to which SEP syringes replace non-SEP syringes, and proportions of IDU-category and MSM/IDU-category infections that are due to injection risk.

Table 1
[Table 1]

Results: Increasing SEP syringe coverage (now 2.9%) to 5% would avert 169 infections, requiring 19 million USD additional investment but saving 66 million USD in treatment costs. A larger increase to 10% would avert 497 infections, requiring 64 million USD investment but saving 193 million USD in treatment costs. Results should be updated when new data on parameter values become available.

Figure 1
[Figure 1]

Figure 2
[Figure 2]

Conclusions: SEPs are effective and cost-saving, and thus should be priority in the US. The ban on federal funding for SEPs should be lifted, and federal funding allocated to expanding SEPs.

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