About the project
Hepatitis C (HCV) is a blood-borne virus that, in the UK, is primarily transmitted between people who inject drugs. The main interventions to reduce the transmission of HCV are programmes that:
- give out free needles and syringes (needle and syringe programme or NSP) to reduce the re-use of syringes
- give methadone to reduce the frequency of injecting drug use (opioid substitution therapy or OST).
Although these interventions are widely used in the UK, there is little evidence that they have a benefit or are a worthwhile investment of resources. In this project we analysed existing data and used modelling techniques to evaluate their effectiveness.
To evaluate the effectiveness, impact and cost-effectiveness of needle and syringe programmes for people who inject drugs in the UK.
What we did
- Synthesised data from different studies to get better estimates of the protective effect of NSP and OST.
- Collected data on the cost of NSP in Bristol, Dundee and Walsall.
- Used mathematical modelling to evaluate the impact and cost-effectiveness of existing NSP interventions in these settings.
What we found and why that’s important
Our review suggested that OST or high coverage NSP reduced the risk of acquiring HCV by about 50%. These interventions combined reduced the risk by 70%. A pooled analysis of data from the UK and Australia gave consistent results. The economic modelling suggested that NSPs are likely to be cost-effective and could be cost-saving in some settings. The impact modelling suggested that current coverage levels of OST and NSP are decreasing levels of HCV incidence by up to 75% in the UK. This was the first good evidence for the effectiveness of NSP and OST globally, and the first evidence for the cost-effectiveness of NSP in UK and Western Europe.
The primary research findings are published or in press. We are currently extending the work to consider prison-based prevention interventions, the impact of HCV treatment, and the use of low dead space syringes to improve the impact and cost-effectiveness of needle and syringe programmes.
London School of Hygiene and Tropical Medicine, Public Health England, Addaction
National Institute for Health Research (NIHR), European Union
2012 to 2018
Platt L, Minozzi S, Reed J, Vickerman P, Hagan H., French C, Jordan A, Degenhardt L, Hope V, Hutchinson S, Maher L, Palmateer N, Taylor A, Bruneau J, Hickman M (2017). Needle syringe programmes and opioid substitution therapy for preventing hepatitis C transmission in people who inject drugs. Cochrane Database Systematic Review 9: 1-89
Turner K, Hutchinson S, Vickerman P, Hope V, Craine N, Palmateer N, May M, Taylor A, De Angelis D, Cameron S, Parry J, Lyons M, Goldberg D, Allen E, Hickman M. (2011). The impact of needle and syringe provision and opiate substitution therapy on the incidence of hepatitis C virus in injecting drug users: pooling of UK evidence. Addiction 106: 1978-88
Vickerman P, Martin N, Turner K, Hickman M. (2012). Can needle and syringe programmes and opiate substitution therapy achieve substantial reductions in hepatitis C virus prevalence? Model projections for different epidemic settings. Addiction 107: 1984–1995
Platt, L., S. Minozzi, J. Reed, P. Vickerman, H. Hagan, C. French, A. Jordan, L. Degenhardt, V. Hope, S. Hutchinson, L. Maher, N. Palmateer, A. Taylor, J. Bruneau and M. Hickman (2018). 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. Addiction 113(3): 545-563.
Platt, L., S. Sweeney, Z. Ward, L. Guinness, M. Hickman, V. Hope, S. Hutchinson, L. Maher, J. Iversen, N. Craine, A. Taylor, A. Munro, J. Parry, J. Smith and P. Vickerman (2017). Assessing the impact and cost-effectiveness of needle and syringe provision and opioid substitution therapy on hepatitis C transmission among people who inject drugs in the UK: an analysis of pooled data sets and economic modelling. NIHR Journals Library. Sep 2017.