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The cost-effectiveness of harm reduction.

David P Wilson1, Braedon Donald1, Andrew J Shattock1

  • 1The Kirby Institute, UNSW Australia, Australia.

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Summary

Comprehensive harm reduction strategies, including needle-syringe programs (NSPs) and opioid substitution therapy (OST), are effective and cost-effective for preventing HIV among people who inject drugs (PWID). Scaling up these essential services is crucial for global health.

Keywords:
Cost-effectivenessHIVHarm reductionPeople who inject drugs

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Area of Science:

  • Public Health
  • Infectious Disease Epidemiology
  • Health Economics

Background:

  • HIV remains a significant global health challenge, with approximately 19% prevalence among people who inject drugs (PWID).
  • Harm reduction strategies, such as needle-syringe programs (NSPs) and opioid substitution therapy (OST), are critical interventions for PWID.
  • Antiretroviral therapy (ART) is also a key component for managing HIV in this population.

Purpose of the Study:

  • To evaluate the effectiveness and cost-effectiveness of combined harm reduction services for PWID.
  • To estimate the resources required to achieve global and regional coverage targets for these interventions.
  • To synthesize evidence on the impact of NSPs, OST, and ART on HIV prevention and outcomes.

Main Methods:

  • Review and commentary on existing scientific literature and studies.
  • Analysis of cost-effectiveness data for individual and combined harm reduction strategies.
  • Estimation of resource needs for scaling up interventions to meet World Health Organization (WHO) coverage targets.

Main Results:

  • Needle-syringe programs (NSPs) are safe, highly effective, and cost-effective in reducing HIV transmission.
  • Opioid substitution therapy (OST) significantly reduces HIV acquisition risk (54% on average) and is highly cost-effective when societal benefits are considered.
  • Antiretroviral therapy (ART) is cost-effective for individual treatment, with growing evidence for its preventive role among PWID.
  • Combined harm reduction packages are likely more effective and cost-effective than isolated approaches.
  • Current global coverage of harm reduction programs is critically low.
  • Scaling up ART, OST, and NSPs to meet WHO targets requires substantial investment, with ART having the highest cost, followed by OST and NSPs.

Conclusions:

  • Integrated harm reduction packages, including NSPs, OST, and ART, are essential and cost-effective strategies for combating HIV among PWID.
  • Despite high scale-up costs, these interventions are cost-effective in the short-term and potentially cost-saving in the long-term.
  • Urgent and significant investment is needed to expand harm reduction services globally to achieve targeted coverage levels and reduce HIV transmission.