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Needle exchange in Washington, D.C., averts 120 new HIV cases in 2 years
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The needle exchange program in Washington, D.C., prevented 120 new cases of HIV infection in the span of 2 years — saving approximately $44 million in health care costs, according to new research published in AIDS and Behavior.
"The evidence is abundant: needle exchanges save lives and they save money," study researcher Monica S. Ruiz, PhD, MPH, assistant research professor in the department of prevention and community health at George Washington University’s Milken Institute School of Public Health, told Infectious Disease News.
The study is one of several suggesting that needle exchange programs (NEPs) are effective at eliminating new HIV infections — both in the United States and globally — rather than leading to increased injection drug use (IDU) and crime.
“We saw a 70% drop in newly diagnosed HIV cases in just 2 years,” Ruiz said in a press release. “At the same time, this program saved the District millions of dollars that would have been spent for treatment had those 120 persons been infected.”
In 1998, Congress banned federal funding of NEPs, but the ban did not affect the use of locally generated revenue to support these efforts. However, Washington, D.C., a city whose municipal budget is overseen by Congress, was still prohibited from operating NEPs. Nearly a decade later, Congress lifted the so-called “DC ban,” and the city allocated $650,000 for the DC Needle Exchange Program, or DC NEX, which included needle exchange, referrals to HIV testing and addiction treatment, among other initiatives.
Ruiz and colleagues used surveillance data to study the impact of the DC NEX program on the HIV epidemic in the city and its potential cost savings.
According to the researchers, there were 176 IDU-associated HIV infections in the 2 years after the policy change. Had the ban remained in place, 296 IDU-related infections would have occurred during the same time period, they said — a difference of 120 new cases.
“Furthermore, the DC needle exchange program continues to reduce the number of new cases of HIV among injection drug users in the city,” Ruiz said in the release.
The researchers noted that similar programs led to a 33% reduction in new HIV infections in New Haven, Connecticut, and a 77% reduction in New York.
In addition to improving public health, the removal of the DC ban significantly reduced health care costs, the researchers said. Based on CDC estimates, in which the average lifetime cost for each case of HIV infection was $380,000 in 2010, Washington, D.C., saved approximately $44.3 million in 2 years, taking into account the operating costs of needle exchange in that city.
According to Ruiz and colleagues, the results may help inform the public debate about the benefits and risks associated with NEPs.
In response to a recent HIV outbreak associated with IV drug use, Indiana Gov. Mike Pence had declared a public health disaster emergency in Scott County in late March, which allowed the temporary provision of NEPs. In a commentary published in the New England Journal of Medicine, health experts advocated the permanent implementation of those programs.
“Legislation allowing Scott County to operate needle-exchange programs is a step in the right direction,” they wrote. “However, the current provision extends for only 1 year, a limit that ignores the reality that three interrelated chronic diseases — addiction, HIV and HCV — will continue to challenge this community and others like it for decades unless a very aggressive, multipronged public health prevention strategy is implemented.”
Such strategies, according to Ruiz and colleagues, “have substantial benefit to individuals who are vulnerable to HIV/AIDS by virtue of the environments in which they live.” – by John Schoen
For more information:
Strathdee SA, et al. N Engl J Med. 2015;doi:10.1056/NEJMp1507252.
Vlahov D, et al. Clin Infect Dis. 2010;doi:10.1086/651482.
Wodak A, et al. Subst Use Misuse. 2006;doi:10.1080/10826080600669579.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Don C. Des Jarlais, PhD
The study by Ruiz and colleagues of the effectiveness of syringe exchange in Washington, D.C., is consistent with a large body of scientific research on syringe exchange programs. The finding of effective syringe exchange in Washington is in stark contrast to the recent outbreak of HIV among persons who inject drugs in Indiana, which occurred in the absence of syringe exchange.
The current dominant research issues for reducing HIV transmission among persons who inject drugs (PWID) is not whether syringe exchange is effective, but how quickly “combined HIV prevention and care” (syringe access programs, medication-assisted treatment for substance use disorders and ART for HIV-seropositive persons) can come very close to eliminating HIV transmission among PWID. Near-zero rates of HIV transmission among PWID have been observed in places such as New York, Amsterdam, Vancouver, Australia, France and Taiwan.
We should hope that combined prevention will be implemented fully and quickly lead to near-zero HIV transmission among PWID in Washington, D.C., Indiana, and everywhere else where injecting drug use exists.
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