Transcript Cost-Effectiveness of Needle Exchange Program among

Cost-Effectiveness
of Needle Exchange Program
among IDUs in Uzbekistan
Azizbek A. Boltaev
IREX Contemporary Issues Program Fellow
Dynamic Communications: Strategies & Tools Workshop
Hotel Washington
Washington DC, December 16-19, 2003
Research Methodology
Online search in electronic data bases (MEDLINE, EBSCO,
and LEXIS-NEXIS) for articles containing combination of
words “Cost+Effectiveness+Needle+Exchange+HIV”;
Review of reports of 7 Syringe Exchange Projects in
Uzbekistan;
Onsite interviews of coordinators of 2 public funded SEP in
Boston, MA and Cambridge, MA;
Mathematic modeling of the HIV epidemic in Uzbekistan to
estimate the impact of SEPs on infections averted and
disability-adjusted life years (DALY) gained based on program
and survey data;
Sharing syringe or bowl/cooker
With how many others did you share a syringe or bowl?
40%
37%
36%
35%
% of respondents
30%
Syringe Mean = 1.16
Mean = 1.18
Bowl
28%
28%
25%
24%
25%
20%
15%
10%
7%
7%
4%
5%
4%
0%
0
1
2
Number of other users
3
4+
Sharing drug mixture
Do you share your drug mixture with others?
40%
38%
36%
35%
30%
% of respondents
26%
25%
20%
15%
10%
5%
0%
No
Sometimes
Yes
Budgets of Both NEPs
• Office based
BRAYM's NEP
$3,670
• Outreach based
$14,160
AIDS Center's SEP
Number of Clients in both NEPs
Office based (AIDS Center's) SEP
64
110
Outreach based BRAYM's NEP
Cost per Infection Averted
$9,537
$10,000
$9,000
$8,000
$7,000
$6,000
$5,000
$4,000
$1,288
$3,000
$2,000
$1,000
$0
Office based (AIDS Center's) SEP
Outreach based (BRAYM's) NEP
Series 1
Projected Impact of Needle Exchange Program
Conclusions
Syringe Exchange Program Among IDUs Is Effective Intervention
For HIV Prevention
Data from Uzbekistan show that SEPs can be operated very costeffectively (e.g. $1288 per infection averted among SEP clients for a
SEP that includes outreach) from an “institutional” perspective.
SEP with outreach components should be an integral part of all SEP
programs.
Several factors critically influence accessibility and effectiveness of
SEP; these are political will, financial support, misunderstanding of
the goals of SEP, collaboration of SEP with other health care and
social service providers, education and skills of SEP providers
No cost-effectiveness studies of other preventive or curative
interventions have been identified in Uzbekistan
Conclusions contin.
No cost-effectiveness studies of other preventive or curative
interventions have been identified in Uzbekistan
Although data for policy making are limited, this study suggests that
an appropriate combination of local data and information from the
international literature can be utilized in Uzbekistan with adjustment
for epidemiological, economic and cultural differences between and
within countries.
Recommendations
At a minimum, syringe exchange programs in Uzbekistan should be
continued.
Syringe exchange programs should be conceptualized as an
integral part of public health efforts to stem HIV infection among
drug users and should be part of a comprehensive approach to drug
use.
The Uzbek AIDS Center should provide outreach services for
syringe exchange to expand the number of its SEP participants.
Additional cost-effective approaches to ease access to sterile
injecting equipment, such as secondary exchange, free or low-cost
syringes, and access through 24 hour drug stores should be added
to SEPs.
Recommendations
International donors, such as the US Government, which have bans
on the use their funds for syringe exchange services should
reconsider their policy regarding SEP considering the strong
scientific evidence of SEP effectiveness and its absence of side
effects, such as promoting the use of illegal drugs
The Country Coordinating Mechanism, which will coordinate
Uzbekistan’s $25 million grant from Global Fund, should use costeffectiveness analysis as a powerful tool to strengthen Uzbekistan’s
policies in preventing and treating HIV and TB.
Risk formula for HIV infections
averted*
r = 1-(p(1-se(1-uk))e +(1-p))m
r = cumulative annual probability of infection
j = group of IDUs
p = probability of selecting an infected injection partner (a function of
prevalence)*
s = probability that needle is shared; i.e., probability that someone
used the needle immediately prior to this injection
e = efficiency of transmission of HIV by infected needle, per injection
u = probability that bleach is used, at each injection*
k = efficiency of bleach in eliminating HIV virus from a needle and
syringe
m = number of partners per year
i = number of injections per year
c = average contacts per partner, defined as number of injections (i),
divided by number of partners (m)
*These parameters are group-specific in some model versions
*, Joanna E. Siegel, 1990. Modeling the effectiveness of bleach distribution programs for preventing AIDS among
intravenous drug users. ScD dissertation, HSPH.
Uzbekistan: The Facts
Location: Central Asia,
North of Afghanistan
Area: 447,400 sq.km,
slightly larger than California
Capital: Tashkent
Natural Recourses: Natural
Gas, Petroleum, Gold, Coal,
Uranium, Silver, Copper,
Molybdenum
Geography - note: One of the
two only doubly landlocked
countries in the world
GDP: purchasing power parity
total: $65 billion
per capita: $2,500
Population: 25,981,647
Median age: Total: 21.8 yrs
male: 21.2 yrs
female: 22.5 yrs
Birth rate: 26.09 births/1,000 pop
Death rate: 7.97 deaths/1,000 pop
Sex ratio: 0.98 male/female
Infant mortality rate: 71.51/1000
Fertility rate: 3 children born/ wmn
Life expectancy at birth: 64 years
Ethnic groups: Uzbek 80%,
Russian 5.5%, Tajik 5%, Kazakh
3%, Karakalpak 2.5%, Tatar 1.5%,
other 2.5%
Welcome to Bukhara!