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Addiction. 2018 Mar;113(3):545-563. doi: 10.1111/add.14012. Epub 2017 Oct 23.

Needle and syringe programmes and opioid substitution therapy for preventing HCV transmission among people who inject drugs: findings from a Cochrane Review and meta-analysis.

Author information

Centre for Research on Drugs and Health Behaviour, Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK.
Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.
New York University, College of Nursing, New York, NY, USA.
School of Social and Community Medicine, University of Bristol, Bristol, UK.
National Drug and Alcohol Research Centre, University of New South Wales, Randwick, Australia.
Public Health Institute, Liverpool John Moores University, Liverpool, UK.
School of Health and Life Sciences, Glasgow Caledonian University, Glasgow and Health Protection Scotland, Glasgow, UK.
Kirby Institute, University of New South Wales, Sydney, Sydney, Australia.
School of Social Sciences, University of West of Scotland, Paisley, UK.
Department of Family and Emergency Medicine, University of Montreal, Montreal, Canada.



To estimate the effects of needle and syringe programmes (NSP) and opioid substitution therapy (OST), alone or in combination, for preventing acquisition of hepatitis C virus (HCV) in people who inject drugs (PWID).


Systematic review and meta-analysis. Bibliographic databases were searched for studies measuring concurrent exposure to current OST (within the last 6 months) and/or NSP and HCV incidence among PWID. High NSP coverage was defined as regular NSP attendance or ≥ 100% coverage (receiving sufficient or greater number of needles and syringes per reported injecting frequency). Studies were assessed using the Cochrane risk of bias in non-randomized studies tool. Random-effects models were used in meta-analysis.


We identified 28 studies (n = 6279) in North America (13), United Kingdom (five), Europe (four), Australia (five) and China (one). Studies were at moderate (two), serious (17) critical (seven) and non-assessable risk of bias (two). Current OST is associated with 50% [risk ratio (RR) =0.50, 95% confidence interval (CI) = 0.40-0.63] reduction in HCV acquisition risk, consistent across region and with low heterogeneity (I2  = 0, P = 0.889). Weaker evidence was found for high NSP coverage (RR = 0.79, 95% CI = 0.39-1.61) with high heterogeneity (I2  = 77%, P = 0.002). After stratifying by region, high NSP coverage in Europe was associated with a 56% reduction in HCV acquisition risk (RR = 0.44, 95% CI = 0.24-0.80) with low heterogeneity (I2  = 12.3%, P = 0.337), but not in North America (RR = 1.58, I2  = 89.5%, P = < 0.001). Combined OST/NSP is associated with a 74% reduction in HCV acquisition risk (RR = 0.26, 95% CI = 0.07-0.89, I2  = 80% P = 0.007). According to Grades of Recommendation Assessment, Development and Evaluation (GRADE) criteria, the evidence on OST and combined OST/NSP is low quality, while NSP is very low.


Opioid substitution therapy reduces risk of hepatitis C acquisition and is strengthened in combination with needle and syringe programmes (NSP). There is weaker evidence for the impact of needle syringe programmes alone, although stronger evidence that high coverage is associated with reduced risk in Europe.


Cochrane; harm reduction; hepatitis C; incidence; meta-analysis; needle and syringe programmes; opioid substitution therapy; review; substance use

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