Format

Send to

Choose Destination
Clin Infect Dis. 2019 May 30. pii: ciz321. doi: 10.1093/cid/ciz321. [Epub ahead of print]

Implementation of Syringe Services Programs to Prevent Rapid Human Immunodeficiency Virus Transmission in Rural Counties in the United States: A Modeling Study.

Author information

1
Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island.
2
Department of Epidemiology, School of Public Health, Boston University, Massachusetts.
3
Department of Ecology and Evolutionary Biology, Yale University, New Haven, Connecticut.
4
Program in Computational Biology and Bioinformatics, Yale University, New Haven, Connecticut.
5
Department of Biostatistics, School of Public Health, Yale University, New Haven, Connecticut.
6
Center for Infectious Disease Modeling and Analysis, School of Public Health, Yale University, New Haven, Connecticut.
7
National Development and Research Institutes, Inc, New York, New York.

Abstract

BACKGROUND:

Syringe services programs (SSPs) are effective venues for delivering harm-reduction services to people who inject drugs (PWID). However, SSPs often face significant barriers to implementation, particularly in the absence of known human immunodeficiency virus (HIV) outbreaks.

METHODS:

Using an agent-based model, we simulated HIV transmission in Scott County, Indiana, a rural county with a 1.7% prevalence of injection drug use. We compared outcomes arising in the absence of an SSP, in the presence of a pre-existing SSP, and with implementation of an SSP after the detection of an HIV outbreak among PWID over 5 years following the introduction of a single infection into the network.

RESULTS:

In the absence of an SSP, the model predicted an average of 176 infections among PWID over 5 years or an incidence rate of 12.1/100 person-years. Proactive implementation averted 154 infections and decreased incidence by 90.3%. With reactive implementation beginning operations 10 months after the first infection, an SSP would prevent 107 infections and decrease incidence by 60.8%. Reductions in incidence were also observed among people who did not inject drugs.

CONCLUSIONS:

Based on model predictions, proactive implementation of an SSP in Scott County had the potential to avert more HIV infections than reactive implementation after the detection of an outbreak. The predicted impact of reactive SSP implementation was highly dependent on timely implementation after detecting the earliest infections. Consequently, there is a need for expanded proactive SSP implementation in the context of enhanced monitoring of outbreak vulnerability in Scott County and similar rural contexts.

KEYWORDS:

HIV; agent-based modeling; injection drug use; rural health; syringe services

PMID:
31143944
DOI:
10.1093/cid/ciz321

Supplemental Content

Full text links

Icon for Silverchair Information Systems
Loading ...
Support Center