Brown study shows suspending needle service programs would lead to increased HIV infections

Last month, a study published by university researchers used a simulation model to show that suspending needle service programs would lead to an increase in HIV infections.

According to the CDC’s website, PHCs “provide a range of services, including a link to treatment for substance use disorders; access to and disposal of sterile syringes and injection equipment; and vaccination, screening and link to the care and treatment of infectious diseases.

The researchers chose to model Scott County, Indiana — the center of a 2015 HIV epidemic — after receiving an email from the CDC in May 2020 raising concerns about the possible forced closure of PHCs. In the region. SSPs faced a sunset clause, which means that even though “the effectiveness (of) SSPs has been proven by so many previous studies,” the CDC has to defend its funding every year, said Xiao Zang, partner. postdoctoral research fellow in epidemiology who conducts the analysis of the study.

“We were interested in pursuing this topic because a number of county and local governments in the United States have withdrawn funding from PHC or have sought to shut it down altogether,” wrote Brandon Marshall, associate professor of epidemiology and principal investigator. of the study. email to The Herald. “Harm reduction programs have always faced some political opposition, but it was particularly discouraging to see successful programs in needy communities threatened with closure,” he added.

Although “the gold standard of clinical studies is clinical trials, they are not always feasible, practical or ethical,” Zang said. Instead, the study constructed Agent-Based Network Infectious Transmission Processing, a mathematical model based on historical data of HIV infections to “simulate the spread of HIV in a network of people who s ‘inject drugs,'” Marshall wrote.

TITAN is agent-based, meaning it simulates the actions of multiple individuals to predict the impact of their interactions. This model has been used in a number of other studies to “examine the effectiveness of hypothetical HIV prevention and treatment strategies in the United States,” Marshall added.

The researchers calibrated their simulation model by comparing TITAN’s predicted number of new diagnoses from 2016 to 2019 to real-world data to ensure the credibility, accuracy and reliability of the model, Zang said.

Next, the researchers simulated how the number of HIV cases in Scott County would change from 2020 to 2025 if only one PHC was closed “to see the real impact of closing the PHC,” Zang added.

They found that a temporary and permanent closure of a single PHC “would most likely lead to an upsurge in the HIV epidemic among people who inject drugs,” Marshall wrote. “For example, we found that closing a PHC could lead to an almost 60% increase in new HIV cases among people who inject drugs in a rural setting in the United States.”

The closure of these programs “will have devastating impacts, not only for Scott County, but also…other regions of the United States, especially rural areas where the operation and implementation of PHC is constantly challenged by social and structural barriers,” Zang added.

“This study is consistent with … previous research,” which demonstrates that a “lack of needle-exchange programs is absolutely linked to large (HIV) epidemics,” said Matthew Murphy, assistant professor of medicine and behavioral and social sciences. Murphy, who was not one of the study’s authors, is also an internal medicine physician who studies infectious diseases and HIV prevention among populations who are or have been incarcerated.

This study adds to a “fairly rich database of the effectiveness of needle and syringe programs and their potential impact in reducing HIV transmission,” Murphy said.

The CDC has identified more than 200 counties at high risk for an HIV epidemic. There have also been “a growing number of notable examples of[HIV]epidemics in the United States among people who inject drugs…even in neighboring Massachusetts,” Murphy said.

“We want to advocate for maintaining existing SSP services,” Zang said. “By implementing more (PSC), you are taking proactive steps to prevent these HIV epidemics from happening in the first place.”

“If we reduce or fail to expand needle and syringe programs, it is only a matter of time before we see increasing numbers of HIV epidemics and cases, at the both in Rhode Island and nationally,” Murphy said.

“I hope this research demonstrates that PHC is absolutely essential if we are truly going to end the HIV epidemic in the United States. No matter where they live, people who inject drugs deserve access to PHC and all forms of HIV prevention services, such as pre-exposure prophylaxis or PrEP,” Marshall wrote.

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