Increasing investment in syringe exchange is cost-saving HIV prevention: modeling hypothetical syringe coverage levels in the United States
exchange for injecting drug users (IDU) is controversial and has limited
funding in the US. To inform policy, we examine whether increasing investment
in syringe exchange programs (SEPs) would be cost-effective for HIV prevention.
Methods: We model HIV incidence in hypothetical cases with higher SEP syringe coverage (i.e., percent
injections with a new syringe from SEP) than current level--base case,
and estimate additional funding required,
number of injections averted, and HIV treatment costs saved.
The ratio of HIV incidence (hypothetical to base case) is established
based on the transmission equation and simplified to the ratio of proportions
of HIV-contaminated syringes (hypothetical to base case), which is a function
of number of injections with a receptively shared (“borrowed”) syringe and
numbers of syringes from SEPs and other sources. A maximal bound for
hypothetical case incidence is calculated.
SEP syringe coverage and costs data are from the Beth Israel/NASEN
survey. HIV incidence and lifetime treatment costs are from the CDC. We assume 1/2
of IDU-category and 1/4 of MSM/IDU-category infections are due to injection
We conduct sensitivity analyses on “borrowing” probability, number of non-SEP
syringes, extent to which SEP syringes replace non-SEP syringes, and
proportions of IDU-category and MSM/IDU-category infections that are due to
SEP syringe coverage (now 2.9%) to 5% would avert 169 infections, requiring 19
million USD additional investment but saving 66 million USD in treatment costs.
A larger increase to 10% would avert 497 infections, requiring 64 million USD
investment but saving 193 million USD in treatment costs. Results should be
updated when new data on parameter values become available.
are effective and cost-saving, and thus should be priority in the US. The ban
on federal funding for SEPs should be lifted, and federal funding allocated to
19th International AIDS Conference
"T.Q.Nguyen, et al.
Increasing investment in syringe exchange is cost-saving HIV prevention: modeling hypothetical syringe coverage levels in the United States.
19th International AIDS Conference: