|Titre :||Are major reductions in new HIV infections possible with people who inject drugs? The case for low dead-space syringes in highly affected countries [Commentary] (2013)|
|Auteurs :||W. A. ZULE ; H. E. CROSS ; J. STOVER ; C. PRETORIUS|
|Type de document :||Article : Périodique|
|Dans :||International Journal of Drug Policy (Vol.24, n°1, January 2013)|
|Article en page(s) :||1-7|
|Note générale :||
• Saying goodbye to high-dead-space syringes. Ciccarone D., p. 15-16.
• Low Dead-Space Syringes for HIV prevention among people who inject drugs: Interesting, but a much stronger case is required. Ambekar A., Pawar A., p. 16-18.
• How to encourage use of low dead space syringes? The Viet Nam experience. Jacka D., p. 18-19.
• Implementation of low dead-space syringes needs consultation and engagement with drug users. Albers E.R., p. 19-20.
• Dead space: A risk factor we did not see. Preston A., p. 20.
• Low dead space syringes: Authors' response. Zule W.A., Cross H.E., Stover J., Pretorius C., p. 21-22.
|Discipline :||MAL (Maladies infectieuses / Infectious diseases)|
Thésaurus TOXIBASESERINGUE ; REDUCTION DES RISQUES ET DES DOMMAGES ; VIH ; INJECTION ; CONTAMINATION
|Résumé :||Circumstantial evidence from laboratory studies, mathematical models, ecological studies and bio behavioural surveys, suggests that injection-related HIV epidemics may be averted or reversed if people who inject drugs (PWID) switch from using high dead-space to using low dead-space syringes. In laboratory experiments that simulated the injection process and rinsing with water, low dead space syringes retained 1000 times less blood than high dead space syringes. In mathematical models, switching PWID from high dead space to low dead space syringes prevents or reverses injection-related HIV epidemics. No one knows if such an intervention is feasible or what effect it would have on HIV transmission among PWID. Feasibility studies and randomized controlled trials (RCTs) will be needed to answer these questions definitively, but these studies will be very expensive and take years to complete. Rather than waiting for them to be completed, we argue for an approach similar to that used with needle and syringe programs (NSP), which were promoted and implemented before being tested more rigorously. Before implementation, rapid assessments that involve PWID will need to be conducted to ensure buy-in from PWID and other local stakeholders. This commentary summarizes the existing evidence regarding the protective effects of low dead space syringes and estimates potential impacts on HIV transmission; it describes potential barriers to transitioning PWID from high dead space to low dead space needles and syringes; and it presents strategies for overcoming these barriers.|
|Domaine :||Drogues illicites / Illicit drugs|
|Affiliation :||Substance Abuse, Treatment, Evaluations and Interventions Program, RTI International, Research Triangle Park, NC, USA|