Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
Division of Global and Community Health, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA.
AIDS Behav. 2023 Oct;27(10):3306-3331. doi: 10.1007/s10461-023-04051-x. Epub 2023 Apr 12.
We conducted a systematic review and meta-analysis of the impact of needle and syringe exchange programs (NSP) on both individual- and community-level needle-sharing behaviors and other HIV-related outcomes in low- and middle-income countries (LMIC). A search of five databases for peer-reviewed trial or quasi-experimental studies reported through July 2021 identified 42 interventions delivered in 35 studies, with a total of 56,751 participants meeting inclusion criteria. Random-effects meta-analysis showed a significant protective association between NSP exposure and needle-sharing behaviors at the individual-level (odds ratio [OR] = 0.25, 95% confidence interval [CI] = 0.16-0.39, 8 trials, n = 3947) and community-level (OR 0.39, CI 0.22-0.69, 12 trials, n = 6850), although with significant heterogeneity. When stratified by needle-sharing directionality, NSP exposure remained associated with reduced receptive sharing, but not distributive sharing. NSP exposure was also associated with reduced HIV incidence and increased HIV testing but there were no consistent associations with prevalence of bloodborne infections. Current evidence suggests positive impacts of NSPs in LMICs.
我们对低中等收入国家（LMIC）中针具交换项目（NSP）对个体和社区层面的针具共享行为以及其他与 HIV 相关结果的影响进行了系统评价和荟萃分析。对截至 2021 年 7 月发表的同行评议试验或准试验研究的五大数据库进行了检索，共确定了 35 项研究中的 42 项干预措施，共有 56751 名符合纳入标准的参与者。随机效应荟萃分析显示，NSP 暴露与个体层面（比值比 [OR] = 0.25，95%置信区间 [CI] = 0.16-0.39，8 项试验，n = 3947）和社区层面（OR = 0.39，CI = 0.22-0.69，12 项试验，n = 6850）的针具共享行为存在显著的保护关联，但存在显著的异质性。当按针具共享方向分层时，NSP 暴露仍然与减少接受性共享有关，但与分配性共享无关。NSP 暴露还与降低 HIV 发病率和增加 HIV 检测有关，但与血源性感染的流行率没有一致的关联。现有证据表明 NSP 在 LMIC 中具有积极影响。
