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Full participation in harm reduction programmes is associated with decreased risk for human immunodeficiency virus and hepatitis C virus: evidence from the Amsterdam Cohort Studies among drug users

Authors

  • Charlotte Van Den Berg,

    Corresponding author
    1. Department of Human Retrovirology, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, Amsterdam, the Netherlands,
    2. Cluster Infectious Diseases, Department of Research, Amsterdam Health Service, Amsterdam, the Netherlands,
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  • Colette Smit,

    1. Cluster Infectious Diseases, Department of Research, Amsterdam Health Service, Amsterdam, the Netherlands,
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  • Giel Van Brussel,

    1. Cluster Social and Mental Healthcare, Amsterdam Health Service, Amsterdam, the Netherlands,
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  • Roel Coutinho,

    1. National Institute for Public Health and the Environment, Center for Infectious Disease Control, Bilthoven, the Netherlands and
    2. Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, CINIMA, Academic Medical Center, Amsterdam, the Netherlands
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  • Maria Prins

    1. Cluster Infectious Diseases, Department of Research, Amsterdam Health Service, Amsterdam, the Netherlands,
    2. Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, CINIMA, Academic Medical Center, Amsterdam, the Netherlands
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  • Re-use of this article is permitted in accordance with the Creative Commons Deed, Attribution 2.5, which does not permit commercial exploitation.

Charlotte van den Berg, Cluster Infectious Diseases, Department of Research, Amsterdam Health Service, Amsterdam, the Netherlands. E-mail: cvdberg@ggd.amsterdam.nl

ABSTRACT

Objectives  To investigate the impact of harm-reduction programmes on HIV and hepatitis C virus (HCV) incidence among ever-injecting drug users (DU) from the Amsterdam Cohort Studies (ACS).

Methods  The association between use of harm reduction and seroconversion for human immunodeficiency virus (HIV) and/or hepatitis C virus (HCV) was evaluated using Poisson regression. A total of 714 DU were at risk for HIV and/or HCV during follow-up. Harm reduction was measured by combining its two most important components—methadone dose and needle exchange programme (NEP) use—and looking at five categories of participation, ranging from no participation (no methadone in the past 6 months, injecting drug use in the past 6 months and no use of NEP) to full participation (≥ 60 mg methadone/day and no current injecting or ≥ 60 mg methadone/day and current injecting but all needles exchanged).

Results  Methadone dose or NEP use alone were not associated significantly with HIV or HCV seroconversion. However, with combination of these variables and after correction for possibly confounding variables, we found that full participation in a harm reduction programme (HRP) was associated with a lower risk of HIV and HCV infection in ever-injecting drug users (DU), compared to no participation [incidence rate ratio 0.43 (95% CI 0.21–0.87) and 0.36 (95% CI 0.13–1.03), respectively].

Conclusions  In conclusion, we found that full participation in HRP was associated with a lower incidence of HCV and HIV infection in ever-injecting DU, indicating that combined prevention measures—but not the use of NEP or methadone alone—might contribute to the reduction of the spread of these infections.

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