Copyright Notice
This publication is in the public domain and is therefore without copyright. All text from this work may be reprinted freely. Use of these materials should be acknowledged.
Bookshelf ID: NBK598961
NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
Mackey KM, Beech EH, Williams BE, et al. Effectiveness of Syringe Services Programs: A Systematic Review. Washington (DC): Department of Veterans Affairs (US); 2023 Dec.
SEARCH STRATEGIES
| Search Date: 03/01/23 | Search Statement | Results | |
|---|---|---|---|
| Ovid MEDLINE | 1 | Needle-Exchange Programs/ or (((needle* or syringe*) adj2 (exchange* or program* or service*)).ti,ab,kf. | 3566 |
| 2 | limit 1 to English language | 3342 | |
| CINAHL | 1 | (MH “Needle Exchange Programs”) OR TI (((needle* OR syringe*) N2 (exchange* OR program* OR service*))) | 2175 |
| 2 | limit 1 to English language | 2162 | |
| PsycINFO | 1 | Needle Exchange Programs/ or ((needle* or syringe*) adj2 (exchange* or program* or service*)).ti,ab. | 1506 |
| 2 | limit 1 to English language | 1430 | |
| Cochrane Database of Systematic Reviews | 1 | MeSH descriptor: [Needle-Exchange Programs] this term only | 44 |
| 2 | (((needle* or syringe*) NEAR/2 (exchange* or program* or service*)) or (supervis* NEAR/2 injecti* NEAR/2 (center* or centre* or facilit*))):ti,ab,kw | 195 | |
| 3 | limit 3 to reviews | 2 | |
| 4 | limit 4 to english language | 2 | |
| 5 | limit 5 to last 7 years | 2 | |
| Total | 6,936 | ||
| Total after deduplication | 3,743 |
STUDIES EXCLUDED DURING FULL-TEXT SCREENING
| Citation | Exclude Reason |
|---|---|
| Aalto M, Visapaa J-P, Halme JT, Fabritius C, Salaspuro M. Effectiveness of buprenorphine maintenance treatment as compared to a syringe exchange program among buprenorphine misusing opioid-dependent patients. Nordic Journal of Psychiatry. 2011;65(4):238–243. [PubMed: 21047194] | Ineligible outcome |
| Abou-Saleh MT, Foley S. Prevalence and incidence of hepatitis C in drug users: A review. Addictive Disorders & Their Treatment. 2008;7(4):190–198. | Ineligible publication type |
| Adams M, An Q, Broz D, Burnett J, Wejnert C, Paz-Bailey G. Distributive syringe sharing and use of syringe services programs (SSPs) among persons who inject drugs. AIDS and Behavior. 2019;23(12):3306–3314. [PubMed: 31512066] | Ineligible study design |
| Aitken CK, Kerger M, Crofts N. Peer-delivered hepatitis C testing and counselling: A means of improving the health of injecting drug users. Drug and Alcohol Review. 2002;21(1):33–37. [PubMed: 12189002] | Ineligible study design |
| Alanko Blome M, Bjorkman P, Flamholc L, Jacobsson H, Widell A. Vaccination against hepatitis B virus among people who inject drugs - A 20year experience from a Swedish needle exchange program. Vaccine. 2017;35(1):84–90. [PubMed: 27894721] | Ineligible outcome |
| Allen EJ, Palmateer NE, Hutchinson SJ, Cameron S, Goldberg DJ, Taylor A. Association between harm reduction intervention uptake and recent hepatitis C infection among people who inject drugs attending sites that provide sterile injecting equipment in Scotland. International Journal of Drug Policy. 2012;23(5):346–352. [PubMed: 22940142] | Ineligible study design |
| Allen ST, Grieb SM, O’Rourke A, et al Understanding the public health consequences of suspending a rural syringe services program: A qualitative study of the experiences of people who inject drugs. Harm Reduction Journal. 2019;16. [PMC free article: PMC6528286] [PubMed: 31109339] | Ineligible comparator |
| Allen ST, Schneider KE, Mazhnaya A, et al Factors Associated with Likelihood of Initiating Others into Injection Drug Use Among People Who Inject Drugs in West Virginia. AIDS and behavior. 2022;26(1):47–56. [PMC free article: PMC8170059] [PubMed: 34076812] | Ineligible outcome |
| Alpren C, Dawson EL, John B, et al Opioid Use Fueling HIV Transmission in an Urban Setting: An Outbreak of HIV Infection Among People Who Inject Drugs-Massachusetts, 2015–2018. American journal of public health. 2020;110(1):37–44. [PMC free article: PMC6893347] [PubMed: 31725317] | Ineligible study design |
| Amundsen EJ, Eskild A, Stigum H, Smith E, Aalen OO. Legal access to needles and syringes/needle exchange programmes versus HIV counselling and testing to prevent transmission of HIV among intravenous drug users: A comparative study of Denmark, Norway and Sweden. European Journal of Public Health. 2003;13(3):252–258. [PubMed: 14533729] | Ineligible study design |
| Andia JF, Deren S, Robles RR, Kang S-Y, Colon HM. Peer norms and sharing of injection paraphernalia among Puerto Rican injection drug users in New York and Puerto Rico. AIDS Education and Prevention. 2008;20(3):249–257. [PubMed: 18558821] | Ineligible study design |
| Anonymous. Drug abuse. Study says clean drug needles cut HIV infections in half. AIDS policy & law. 1994;9(23):1–7. [PubMed: 12166378] | Unable to locate FT |
| Anonymous. Needle exchange ends HIV transmission in Swiss jail. AIDS policy & law. 1996;11(13):9. [PubMed: 11363673] | Ineligible publication type |
| Anonymous. Update: syringe exchange programs--United States, 1997. MMWR Morbidity and mortality weekly report. 1998;47(31):652–655. [PubMed: 9716397] | Ineligible outcome |
| Anonymous. Update: syringe exchange programs--United States, 2002. MMWR Morbidity and mortality weekly report. 2005;54(27):673–676. [PubMed: 16015218] | Ineligible comparator |
| Azores-Gococo NM, Fridberg DJ. Harm-reduction strategies for injection drug use. Psychiatric Annals. 2017;47(1):45–48. | Ineligible publication type |
| Bartholomew TS, Tookes HE, Serota DP, Behrends CN, Forrest DW, Feaster DJ. Impact of routine opt-out HIV/HCV screening on testing uptake at a syringe services program: An interrupted time series analysis. The International journal on drug policy. 2020;84:102875. [PMC free article: PMC8814936] [PubMed: 32731112] | Ineligible outcome |
| Bayani A, Ghiasvand H, Rezaei O, et al Factors associated with HIV testing among people who inject drugs: a meta-analysis. Journal of addictive diseases. 2020;38(3):361–374. [PubMed: 32552504] | Ineligible outcome |
| Behrends CN. Evaluating the impact of satellite syringe exchange on reducing hiv risk behavior and seroconversion among people who inject drugs. Dissertation Abstracts International: Section B: The Sciences and Engineering. 2016;76(7-B(E)):No-Specified. | Ineligible intervention |
| Behrends CN, Li C-S, Gibson DR. Decreased odds of injection risk behavior associated with direct versus indirect use of syringe exchange: Evidence from two California cities. Substance Use & Misuse. 2017;52(9):1145–1153. [PMC free article: PMC5592728] [PubMed: 28557553] | Ineligible study design |
| Behrends CN, Nugent AV, Des Jarlais DC, Frimpong JA, Perlman DC, Schackman BR. Availability of HIV and HCV On-Site Testing and Treatment at Syringe Service Programs in the United States. Journal of acquired immune deficiency syndromes (1999). 2018;79(2):e76–e78. [PMC free article: PMC6347107] [PubMed: 29985266] | Ineligible outcome |
| Belisle LA, Solano-Patricio ED C. Harm reduction: a public health approach to prison drug use. International journal of prisoner health. 2021;ahead-of-print(ahead-of-print). [PubMed: 34962726] | Ineligible publication type |
| Benninghoff F, Morency P, Geense R, Huissoud T, Dubois-Arber F. Health trends among drug users attending needle exchange programmes in Switzerland (1994–2000). AIDS Care. 2006;18(4):371–375. [PubMed: 16809115] | Ineligible comparator |
| Betteridge G. Germany: study shows effectiveness of prison needle exchange. HIV/AIDS policy & law review. 2006;11(1):33–36. [PubMed: 16808000] | Ineligible publication type |
| Bhattacharya MK, Naik TN, Palit A, Bhattacharya SK. Impact of a harm-reduction programme on soft tissue infections among injecting drug users of Kolkata, India. Journal of health, population, and nutrition. 2006;24(1):121–122. [PubMed: 16796159] | Ineligible outcome |
| Birkhead GS, Klein SJ, Candelas AR, et al Integrating multiple programme and policy approaches to hepatitis C prevention and care for injection drug users: A comprehensive approach. International Journal of Drug Policy. 2007;18(5):417–425. [PubMed: 17854731] | Ineligible publication type |
| Blome MA, Bjorkman P, Flamholc L, Jacobsson H, Molnegren V, Widell A. Minimal transmission of HIV despite persistently high transmission of hepatitis C virus in a Swedish needle exchange program. Journal of viral hepatitis. 2011;18(12):831–839. [PubMed: 21114587] | Ineligible study design |
| Bluthenthal RN, Gogineni A, Longshore D, Stein M. Factors associated with readiness to change drug use among needle-exchange users. Drug and Alcohol Dependence. 2001;62(3):225–230. [PubMed: 11295327] | Ineligible outcome |
| Bluthenthal RN, Kral AH, Erringer EA, Edlin BR. Use of an illegal syringe exchange and injection-related risk behaviors among street-recruited injection drug users in Oakland, California, 1992 to 1995. Journal of acquired immune deficiency syndromes and human retrovirology: official publication of the International Retrovirology Association. 1998;18(5):505–511. [PubMed: 9715848] | Ineligible study design |
| Bluthenthal RN, Kral AH, Gee L, Erringer EA, Edlin BR. The effect of syringe exchange use on high-risk injection drug users: a cohort study. AIDS (London, England). 2000;14(5):605–611. [PubMed: 10780722] | Ineligible study design |
| Borquez A, Abramovitz D, Cepeda J, et al Syringe sharing among people who inject drugs in Tijuana: Before and after the Global Fund. Salud Mental. 2019;42(4):149–156. | Ineligible study design |
| Bråbäck M, Ekström L, Troberg K, et al Malmö Treatment Referral and Intervention Study—High 12-Month Retention Rates in Patients Referred from Syringe Exchange to Methadone or Buprenorphine/Naloxone Treatment. Front Psychiatry. 2017;8:161. [PMC free article: PMC5583161] [PubMed: 28912734] | Ineligible comparator |
| Braine N, Des Jarlais DC, Ahmad S, Purchase D, Turner C. Long-Term Effects of Syringe Exchange on Risk Behavior and HIV Prevention. AIDS Education and Prevention. 2004;16(3):264–275. [PubMed: 15237055] | Ineligible comparator |
| Bravo MJ, Royuela L, Barrio G, Brugal MT, Domingo A, de la Fuente L. Access to sterile syringes among young drug injectors in Madrid and Barcelona and its association with risk behaviour. Gaceta sanitaria. 2008;22(2):128–132. [PubMed: 18420010] | Ineligible study design |
| Bravo MJ, Royuela L, Barrio G, de la Fuente L, Suarez M, Brugal MT. More free syringes, fewer drug injectors in the case of Spain. Social Science & Medicine. 2007;65(8):1773–1778. [PubMed: 17658207] | Ineligible outcome |
| Brennan R, Wells JS G, Van Hout MC. The injecting use of image and performance-enhancing drugs (IPED) in the general population: a systematic review. Health & social care in the community. 2017;25(5):1459–1531. [PubMed: 26806443] | Ineligible outcome |
| Broz D, Carnes N, Chapin-Bardales J, et al Syringe services programs’ role in ending the HIV epidemic in the U.S.: Why we cannot do it without them. American Journal of Preventive Medicine. 2021;61(5, Suppl 1):S118–S129. [PubMed: 34686281] | Ineligible publication type |
| Bruneau J, Brogly SB, Tyndall MW, Lamothe F, Franco EL. Intensity of drug injection as a determinant of sustained injection cessation among chronic drug users: The interface with social factors and service utilization. Addiction. 2004;99(6):727–737. [PubMed: 15139871] | Ineligible outcome |
| Bryant J, Topp L, Hopwood M, Iversen J, Treloar C, Maher L. Is point of access to needles and syringes related to needle sharing? Comparing data collected from pharmacies and needle and syringe programs in South-East Sydney. Drug and Alcohol Review. 2010;29(4):364–370. [PubMed: 20636651] | Ineligible comparator |
| Buning EC. Effects of Amsterdam needle and syringe exchange. The International journal of the addictions. 1991;26(12):1303–1311. [PubMed: 1787023] | Ineligible study design |
| Bushling C, Walton MT, Conner KL, et al Syringe services programs in the Bluegrass: Evidence of population health benefits using Kentucky Medicaid data. The Journal of rural health: official journal of the American Rural Health Association and the National Rural Health Care Association. 2022;38(3):620–629. [PubMed: 34541715] | Ineligible outcome |
| Cardell D. Maintaining the health of sex workers through outreach work. Professional nurse (London, England). 2001;17(1):31. [PubMed: 12030143] | Ineligible outcome |
| Carvell AM, Hart GJ. Help-seeking and referrals in a needle exchange: A comprehensive service to injecting drug users. British Journal of Addiction. 1990;85(2):235–240. [PubMed: 2317589] | Ineligible comparator |
| Castillo T. Spotlight on the Safety Net: Hepatitis C Virus Infection and Syringe Exchange Programs. North Carolina medical journal. 2016;77(3):224–225. [PubMed: 27154896] | Ineligible publication type |
| Clarke K. The case of a needle exchange policy debate in Fresno, California. Critical Social Policy. 2016;36(2):289–306. [PMC free article: PMC5189978] [PubMed: 28035171] | Ineligible study design |
| Clarke K, Harris D, Zweifler JA, Lasher M, Mortimer RB, Hughes S. The Significance of Harm Reduction as a Social and Health Care Intervention for Injecting Drug Users: An Exploratory Study of a Needle Exchange Program in Fresno, California. Social work in public health. 2016;31(5):398–407. [PMC free article: PMC5129746] [PubMed: 27167664] | Ineligible study design |
| Coffin P. Syringe availability as HIV prevention: a review of modalities. Journal of urban health: bulletin of the New York Academy of Medicine. 2000;77(3):306–330. [PMC free article: PMC3456039] [PubMed: 10976607] | Outdated or ineligible SR |
| Cooper H, Des Jarlais D, Ross Z, Tempalski B, Bossak BH, Friedman SR. Spatial access to sterile syringes and the odds of injecting with an unsterile syringe among injectors: a longitudinal multilevel study. Journal of urban health: bulletin of the New York Academy of Medicine. 2012;89(4):678–696. [PMC free article: PMC3535144] [PubMed: 22585448] | Ineligible study design |
| Cooper HL F, Des Jarlais DC, Ross Z, Tempalski B, Bossak B, Friedman SR. Spatial access to syringe exchange programs and pharmacies selling over-the-counter syringes as predictors of drug injectors’ use of sterile syringes. American journal of public health. 2011;101(6):1118–1125. [PMC free article: PMC3093286] [PubMed: 21088267] | Ineligible study design |
| Crawford ND, Myers S, Young H, Klepser D, Tung E. The Role of Pharmacies in the HIV Prevention and Care Continuums: A Systematic Review. AIDS and behavior. 2021;25(6):1819–1828. [PMC free article: PMC8084889] [PubMed: 33386509] | Outdated or ineligible SR |
| Davis SM. Needle exchange programs to prevent Hepatitis C virus infection in people who inject drugs in rural Appalachia. Dissertation Abstracts International: Section B: The Sciences and Engineering. 2018;79(9-B(E)):No-Specified. | Duplicate |
| DeCuir J, Lovasi GS, El-Sayed A, Lewis CF. The association between neighborhood socioeconomic disadvantage and high-risk injection behavior among people who inject drugs. Drug and Alcohol Dependence. 2018;183:184–191. [PMC free article: PMC5927611] [PubMed: 29288913] | Ineligible study design |
| Deren S, Naegle M, Hagan H, Ompad DC. Continuing Links Between Substance Use and HIV Highlight the Importance of Nursing Roles. The Journal of the Association of Nurses in AIDS Care: JANAC. 2017;28(4):622–632. [PMC free article: PMC5485853] [PubMed: 28456473] | Ineligible publication type |
| Deryabina AP. An assessment of needle-syringe program for people who inject drugs in the Kyrgyz Republic. Dissertation Abstracts International: Section B: The Sciences and Engineering. 2017;78(2-B(E)):No-Specified. | Ineligible comparator |
| Des Jarlais DC, Arasteh K, Hagan H, McKnight C, Perlman DC, Friedman SR. Persistence and change in disparities in HIV infection among injection drug users in New York City after large-scale syringe exchange programs. American Journal of Public Health. 2009;99(Suppl 2):S445–S451. [PMC free article: PMC4451117] [PubMed: 19797757] | Ineligible study design |
| Des Jarlais DC, Braine N, Yi H, Turner C. Residual injection risk behavior, HIV infection, and the evaluation of syringe exchange programs. AIDS education and prevention: official publication of the International Society for AIDS Education. 2007;19(2):111–123. [PubMed: 17411414] | Ineligible comparator |
| Des Jarlais DC, Feelemyer JP, Modi SN, Abdul-Quader A, Hagan H. High coverage needle/syringe programs for people who inject drugs in low and middle income countries: a systematic review. BMC public health. 2013;13:53. [PMC free article: PMC3567947] [PubMed: 23332005] | Outdated or ineligible SR |
| Des Jarlais DC, Fisher DG, Newman JC, et al Providing hepatitis B vaccination to injection drug users: referral to health clinics vs on-site vaccination at a syringe exchange program. American journal of public health. 2001;91(11):1791–1792. [PMC free article: PMC1446878] [PubMed: 11684603] | Ineligible intervention |
| Des Jarlais DC, Friedmann P, Grund J-P, et al HIV risk behaviour among participants of syringe exchange programmes in central/eastern Europe and Russia. International Journal of Drug Policy. 2002;13(3):165–170. | Ineligible comparator |
| Des Jarlais DC, Kling R, Hammett TM, et al Reducing HIV infection among new injecting drug users in the China-Vietnam Cross Border Project. AIDS. 2007;21(Suppl8):S109–S114. [PubMed: 18172378] | Ineligible study design |
| Des Jarlais DC, Marmor M, Paone D, et al HIV incidence among injecting drug users in New York City syringe-exchange programmes. Lancet (London, England). 1996;348(9033):987–991. [PubMed: 8855855] | Ineligible study design |
| Des Jarlais DC, Perlis T, Arasteh K, et al Reductions in hepatitis C virus and HIV infections among injecting drug users in New York City, 1990–2001. AIDS (London, England). 2005;19 Suppl 3:S20–25. [PubMed: 16251819] | Ineligible study design |
| Des Jarlais DC, Sloboda Z, Friedman SR, Tempalski B, McKnight C, Braine N. Diffusion of the D.A.R.E and Syringe Exchange Programs. American Journal of Public Health. 2006;96(8):1354–1357. [PMC free article: PMC1522095] [PubMed: 16809601] | Ineligible publication type |
| Dickson NP, Austin FJ, Paul C, Sharples KJ, Skegg DC. HIV surveillance by testing saliva from injecting drug users: a national study in New Zealand. Journal of epidemiology and community health. 1994;48(1):55–57. [PMC free article: PMC1059895] [PubMed: 8138771] | Ineligible comparator |
| Dolan KA, Donoghoe MC, Stimson GV. Reductions in HIV risk behaviour and stable HIV prevalence in syringe-exchange clients and other injectors in England. Drug and alcohol review. 1993;12(2):133–142. [PubMed: 16818322] | Ineligible outcome |
| Dolan K, Rutter S, Wodak AD. Prison-based syringe exchange programmes: A review of international research and development. Addiction. 2003;98(2):153–158. [PubMed: 12534419] | Outdated or ineligible SR |
| Drucker E, Lurie P, Wodak A, Alcabes P. Measuring harm reduction: the effects of needle and syringe exchange programs and methadone maintenance on the ecology of HIV. AIDS (London, England). 1998;12 Suppl A:S217–230. [PubMed: 9633006] | Outdated or ineligible SR |
| Durante AJ, Hart GJ, Brady AR, Madden PB, Noone A. The Health of the Nation target on syringe sharing: A role for routine surveillance in assessing progress and targeting interventions. Addiction. 1995;90(10):1389–1396. [PubMed: 8616467] | Ineligible study design |
| Dutta A, Wirtz AL, Baral S, Beyrer C, Cleghorn FR. Key harm reduction interventions and their impact on the reduction of risky behavior and HIV incidence among people who inject drugs in low-income and middle-income countries. Current opinion in HIV and AIDS. 2012;7(4):362–368. [PubMed: 22647588] | Ineligible study design |
| Fernando D. Syringe and needle exchange to prevent HIV infection. JAMA. 1994;271(23):1825–1827. [PubMed: 8031397] | Ineligible publication type |
| Fisher DG, Fenaughty AM, Cagle HH, Reynolds GL. Injection drug users’ use of pharmacies for purchasing needles in Anchorage, Alaska. Special Issue: Sterile Syringe Access for Injection Drug Users in the 21st Century: Progress and prospects. 2003;14(5–6):381–387. | Ineligible comparator |
| Fisher DG, Harbke CR, Canty JR, Reynolds GL. Needle and syringe cleaning practices among injection drug users. Journal of Drug Education. 2002;32(2):167–178. [PubMed: 12206065] | Ineligible study design |
| Fisher DG, Reynolds GL, Harbke CR. Selection effect of needle exchange in Anchorage, Alaska. Journal of urban health: bulletin of the New York Academy of Medicine. 2002;79(1):128–135. [PMC free article: PMC3456373] [PubMed: 11937621] | Ineligible outcome |
| Frangakis CE, Brookmeyer RS, Varadhan R, Safaeian M, Vlahov D, Strathdee SA. Methodology for Evaluating a Partially Controlled Longitudinal Treatment Using Principal Stratification, With Application to a Needle Exchange Program. Journal of the American Statistical Association. 2004;99(465):239–249. [PMC free article: PMC4332568] [PubMed: 25705065] | Ineligible publication type |
| Franken IH, Kaplan CD. Risk contexts and risk behaviors in the Euregion Maas-Rhein: the Boule de Neige intervention for AIDS prevention among drug users. AIDS education and prevention: official publication of the International Society for AIDS Education. 1997;9(2):161–180. [PubMed: 9167801] | Unable to locate FT |
| Friedman SR, West BS, Tempalski B, et al Do metropolitan HIV epidemic histories and programs for people who inject drugs and men who have sex with men predict AIDS incidence and mortality among heterosexuals? Annals of epidemiology. 2014;24(4):304–311. [PMC free article: PMC3954755] [PubMed: 24529517] | Ineligible study design |
| Frischer M, Elliott L, Taylor A, et al Do needle exchanges help to control the spread of HIV among injecting drug users? AIDS (London, England). 1993;7(12):1677–1678. [PubMed: 8286081] | Ineligible study design |
| Frischer M, Taylor A, Goldberg D, Elliott L. Direct evaluation of needle and syringe exchange programmes. Lancet (London, England). 1996;347(9003):768. [PubMed: 8602033] | Ineligible study design |
| Gagnon H, Godin G, Alary M, Bruneau J, Otis J. A randomized trial to evaluate the efficacy of a computer-tailored intervention to promote safer injection practices among drug users. AIDS & Behavior. 2010;14(3):538–548. [PubMed: 20033276] | Ineligible intervention |
| Gibson DR, Flynn NM, Perales D. Effectiveness of syringe exchange programs in reducing HIV risk behavior and HIV seroconversion among injecting drug users. AIDS (London, England). 2001;15(11):1329–1341. [PubMed: 11504954] | Outdated or ineligible SR |
| Gibson EK, Exner H, Stone R, Lindquist J, Cowen L, Roth EA. A mixed methods approach to delineating and understanding injection practices among clientele of a Victoria, British Columbia needle exchange program. Drug and Alcohol Review. 2011;30(4):360–365. [PubMed: 21355916] | Ineligible study design |
| Gicquelais RE, Genberg BL, Astemborski J, Celentano DD, Kirk GD, Mehta SH. Association of Injection Practices and Overdose With Drug Use Typologies: A Latent Class Analysis Among People Who Inject Drugs in Baltimore, 2017. AIDS Education & Prevention. 2019;31(4):344–362. [PMC free article: PMC6765400] [PubMed: 31361518] | Ineligible outcome |
| Goldberg D, Burns S, Taylor A, Cameron S, Hargreaves D, Hutchinson S. Trends in HCV prevalence among injecting drug users in Glasgow and Edinburgh during the era of needle/syringe exchange. Scandinavian journal of infectious diseases. 2001;33(6):457–461. [PubMed: 11450866] | Ineligible study design |
| Golub ET, Strathdee SA, Bailey SL, et al Distributive syringe sharing among young adult injection drug users in five U.S. Cities. Drug and Alcohol Dependence. 2007;91(Suppl 1):S30–S38. [PubMed: 17398039] | Ineligible study design |
| Gostin LO, Lazzarini Z. Prevention of HIV/AIDS among injection drug users: the theory and science of public health and criminal justice approaches to disease prevention. Emory law journal. 1997;46(2):587–696. [PubMed: 11769762] | Ineligible publication type |
| Gray J. Operating needle exchange programmes in the hills of Thailand. AIDS Care. 1995;7(4):489–499. [PubMed: 8547363] | Ineligible study design |
| Gray J. Harm reduction in the hills of Northern Thailand. Special Issue: Needle exchange policy and practice: International perspective. 1998;33(5):1075–1091. [PubMed: 9596377] | Ineligible study design |
| Gruer L, Cameron J, Elliott L. Building a city wide service for exchanging needles and syringes. BMJ (Clinical research ed). 1993;306(6889):1394–1397. [PMC free article: PMC1677822] [PubMed: 8518609] | Ineligible comparator |
| Guenter CD, Fonseca K, Nielsen DM, Wheeler VJ, Pim CP. HIV prevalence remains low among Calgary’s needle exchange program participants. Canadian journal of public health = Revue canadienne de sante publique. 2000;91(2):129–132. [PMC free article: PMC6979831] [PubMed: 10832179] | Ineligible comparator |
| Guydish J, Bucardo J, Clark G, Bernheim S. Evaluating needle exchange: a description of client characteristics, health status, program utilization, and HIV risk behavior. Substance use & misuse. 1998;33(5):1173–1196. [PubMed: 9596382] | Ineligible study design |
| Guydish J, Bucardo J, Young M, Woods W, Grinstead O, Clark W. Evaluating needle exchange: are there negative effects? AIDS (London, England). 1993;7(6):871–876. [PubMed: 8395856] | Ineligible comparator |
| Hagan H, Des Jarlais DC, Purchase D, Reid T, Friedman SR. The Tacoma Syringe Exchange. Journal of Addictive Diseases. 1991;10(4):81–88. [PubMed: 1777501] | Ineligible publication type |
| Hagan H, Jarlais DC, Friedman SR, Purchase D, Alter MJ. Reduced risk of hepatitis B and hepatitis C among injection drug users in the Tacoma syringe exchange program. American journal of public health. 1995;85(11):1531–1537. [PMC free article: PMC1615682] [PubMed: 7485666] | Ineligible study design |
| Hagan H, McGough JP, Thiede H, Weiss NS, Hopkins S, Alexander ER. Syringe exchange and risk of infection with hepatitis B and C viruses. American journal of epidemiology. 1999;149(3):203–213. [PubMed: 9927214] | Ineligible study design |
| Hagan H, Reid T, Des Jarlais DC, Purchase D, Friedman SR, Bell TA. The incidence of HBV infection and syringe exchange programs. JAMA. 1991;266(12):1646–1647. [PubMed: 1886182] | Ineligible publication type |
| Hagan H, Thiede H. Changes in injection risk behavior associated with participation in the Seattle needle-exchange program. Journal of urban health: bulletin of the New York Academy of Medicine. 2000;77(3):369–382. [PMC free article: PMC3456035] [PubMed: 10976611] | Ineligible study design |
| Hainsworth SW, Dietze PM, Wilson DP, Sutton B, Hellard ME, Scott N. Hepatitis C virus notification rates in Australia are highest in socioeconomically disadvantaged areas. PloS one. 2018;13(6):e0198336. [PMC free article: PMC6005510] [PubMed: 29912897] | Ineligible study design |
| Handanagic S, Sevic S, Barbaric J, et al Correlates of anti-hepatitis C positivity and use of harm reduction services among people who inject drugs in two cities in Croatia. Drug and alcohol dependence. 2017;171:132–139. [PubMed: 28088084] | Ineligible study design |
| Hart GJ, Carvell AL, Woodward N, Johnson AM, Williams P, Parry JV. Evaluation of needle exchange in central London: Behaviour change and anti-HIV status over one year. AIDS. 1989;3(5):261–265. [PubMed: 2504229] | Ineligible study design |
| Heimer R. Can syringe exchange serve as a conduit to substance abuse treatment? Journal of Substance Abuse Treatment. 1998;15(3):183–191. [PubMed: 9633030] | Ineligible comparator |
| Heimer R. Community coverage and HIV prevention: Assessing metrics for estimating HIV incidence through syringe exchange. International Journal of Drug Policy. 2008;19(S). [PMC free article: PMC2367433] [PubMed: 18207726] | Ineligible outcome |
| Heimer R, Kaplan EH, Khoshnood K, Jariwala B, Cadman EC. Needle exchange decreases the prevalence of HIV-1 proviral DNA in returned syringes in New Haven, Connecticut. The American journal of medicine. 1993;95(2):214–220. [PubMed: 8356986] | Ineligible study design |
| Heimer R, Khoshnood K, Bigg D, Guydish J, Junge B. Syringe use and reuse: effects of syringe exchange programs in four cities. Journal of acquired immune deficiency syndromes and human retrovirology: official publication of the International Retrovirology Association. 1998;18 Suppl 1:S37–44. [PubMed: 9663622] | Ineligible comparator |
| Henderson LA, Vlahov D, Celentano DD, Strathdee SA. Readiness for cessation of drug use among recent attenders and nonattenders of a needle exchange program. Journal of acquired immune deficiency syndromes (1999). 2003;32(2):229–237. [PubMed: 12571535] | Ineligible outcome |
| Hope V, Parry JV, Marongui A, Ncube F. Hepatitis C infection among recent initiates to injecting in England 2000–2008: Is a national hepatitis C action plan making a difference? Journal of viral hepatitis. 2012;19(1):55–64. [PubMed: 22187945] | Ineligible study design |
| Hope VD, McVeigh J, Begley E, et al Factors associated with hepatitis C and HIV testing uptake among men who inject image and performance enhancing drugs. Drug and alcohol review. 2021;40(4):586–596. [PubMed: 33164293] | Ineligible intervention |
| Howell J, Traeger MW, Williams B, et al The impact of point-of-care hepatitis C testing in needle and syringe exchange programs on linkage to care and treatment uptake among people who inject drugs: An Australian pilot study. Journal of viral hepatitis. 2022;29(5):375–384. [PubMed: 35274403] | Ineligible comparator |
| Hu Y. Evaluation of hepatitis B vaccination of injection drug users through syringe exchange programs. Dissertation Abstracts International: Section B: The Sciences and Engineering. 2009;70(1-B):238. | Ineligible intervention |
| Huang S-P, Huang S-D. Determination of organochlorine pesticides in water using solvent cooling assisted dynamic hollow-fiber-supported headspace liquid-phase microextraction. Journal of chromatography A. 2007;1176(1–2):19–25. [PubMed: 18001752] | Ineligible study design |
| Hudoba M, Grenyer B, O’Toole M. Development of an enhanced needle and syringe programme: the First Step programme pilot. Drug and alcohol review. 2004;23(3):295–297. [PubMed: 15370009] | Ineligible comparator |
| Huo D, Bailey SL, Garfein RS, Ouellet LJ. Changes in the Sharing of Drug Injection Equipment among Street-Recruited Injection Drug Users in Chicago, Illinois, 1994–1996. Substance Use & Misuse. 2005;40(1):63–76. [PubMed: 15702649] | Ineligible intervention |
| Huo D, Bailey SL, Hershow RC, Ouellet L. Drug Use and HIV Risk Practices of Secondary and Primary Needle Exchange Users. AIDS Education and Prevention. 2005;17(2):170–184. [PubMed: 15899754] | Ineligible study design |
| Huo D, Ouellet LJ. Needle exchange and injection-related risk behaviors in Chicago: A longitudinal study. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2007;45(1):108–114. [PubMed: 17460474] | Ineligible study design |
| Hurley SF, Jolley DJ, Kaldor JM. Effectiveness of needle-exchange programmes for prevention of HIV infection. Lancet (London, England). 1997;349(9068):1797–1800. [PubMed: 9269214] | Outdated or ineligible SR |
| Hutchinson SJ, Taylor A, Goldberg DJ, Gruer L. Factors associated with injecting risk behaviour among serial community-wide samples of injecting drug users in Glasgow 1990–94: Implications for control and prevention of blood-borne viruses. Addiction. 2000;95(6):931–940. [PubMed: 10946441] | Ineligible study design |
| Hyshka E, Strathdee S, Wood E, Kerr T. Needle exchange and the HIV epidemic in Vancouver: Lessons learned from 15 years of research. International Journal of Drug Policy. 2012;23(4):261–270. [PMC free article: PMC3392518] [PubMed: 22579215] | Ineligible publication type |
| Islam MM, Conigrave KM. Assessing the role of syringe dispensing machines and mobile van outlets in reaching hard-to-reach and high-risk groups of injecting drug users (IDUS): A review. Harm Reduction Journal. 2007;4. [PMC free article: PMC2146997] [PubMed: 17958894] | Outdated or ineligible SR |
| Islam MM, Topp L, Conigrave KM, et al Linkage into specialist hepatitis C treatment services of injecting drug users attending a needle syringe program-based primary healthcare centre. Journal of Substance Abuse Treatment. 2012;43(4):440–445. [PubMed: 22938915] | Ineligible intervention |
| Iversen J, Topp L, Wand H, Maher L. Individual-level syringe coverage among Needle and Syringe Program attendees in Australia. Drug and Alcohol Dependence. 2012;122(3):195–200. [PubMed: 22071120] | Ineligible outcome |
| Ivsins A, Chow C, Macdonald S, et al An examination of injection drug use trends in Victoria and Vancouver, BC after the closure of Victoria’s only fixed-site needle and syringe programme. International Journal of Drug Policy. 2012;23(4):338–340. [PubMed: 22280916] | Ineligible study design |
| Jacob Stover. The transfer of harm-reduction strategies into prisons: needle exchange programmes in two German prisons. The International journal on drug policy. 2000;11(5):325–335. [PubMed: 10967515] | Ineligible comparator |
| Janulis P. Pharmacy nonprescription syringe distribution and HIV/AIDS: a review. Journal of the American Pharmacists Association: JAPhA. 2012;52(6):787–797. [PubMed: 23229966] | Outdated or ineligible SR |
| Jarlais DD, Perlis T, Arasteh K, et al HIV incidence among injection drug users in New York City, 1990 to 2002: use of serologic test algorithm to assess expansion of HIV prevention services. Am J Public Health. 2005;95(8):1439–1444. [PMC free article: PMC1449378] [PubMed: 15985649] | Ineligible study design |
| Jarlais DD. Prevention. Needle-exchange programs effective in New York City. AIDS policy & law. 2001;16(16):6. [PubMed: 11548543] | Ineligible study design |
| Jarlais DD. Systematic review research on needle/syringe programs and opiate substitution programs in low- and middle-income countries. Journal of food and drug analysis. 2013;21(4):S59–S61. [PMC free article: PMC4176926] [PubMed: 25267887] | Ineligible study design |
| Jenkins C, Rahman H, Saidel T, Jana S, Hussain AM. Measuring the impact of needle exchange programs among injecting drug users through the National Behavioural Surveillance in Bangladesh. AIDS education and prevention: official publication of the International Society for AIDS Education. 2001;13(5):452–461. [PubMed: 11718444] | Unable to locate FT |
| Jenness SM, Hagan H, Liu K-L, Wendel T, Murrill CS. Continuing HIV risk in New York City injection drug users: The association of syringe source and syringe sharing. Substance Use & Misuse. 2011;46(2–3):192–200. [PMC free article: PMC4797646] [PubMed: 21303239] | Ineligible study design |
| Jones CM. Estimating the magnitude and characteristics of prescription opioid injection misuse and the role of syringe services programs in response to the opioid crisis in the United States. Dissertation Abstracts International: Section B: The Sciences and Engineering. 2019;80(8-B(E)):No-Specified. | Ineligible comparator |
| Kaberg M. Hepatitis C in people who inject drugs in the Stockholm needle exchange program: Incidence, spontaneous clearance and change in risk behaviour. Dissertation Abstracts International: Section B: The Sciences and Engineering. 2022;83(3-B):No-Specified. | Ineligible study design |
| Kaberg M, Karlsson N, Discacciati A, et al Significant decrease in injection risk behaviours among participants in a needle exchange programme. Infectious diseases (London, England). 2020;52(5):336–346. [PubMed: 32072841] | Ineligible study design |
| Kaplan EH. A method for evaluating needle exchange programmes. Statistics in medicine. 1994;13(19–20):2179–2187. [PubMed: 7846418] | Ineligible study design |
| Kaplan EH, Heimer R. HIV incidence among New Haven needle exchange participants: updated estimates from syringe tracking and testing data. Journal of acquired immune deficiency syndromes and human retrovirology: official publication of the International Retrovirology Association. 1995;10(2):175–176. [PubMed: 7552482] | Ineligible study design |
| Keene J, Stimson GV, Jones S, Parry-Langdon N. Evaluation of syringe-exchange for HIV prevention among injecting drug users in rural and urban areas of Wales. Addiction. 1993;88(8):1063–1070. [PubMed: 8401160] | Ineligible study design |
| Kerr T, Small W, Buchner C, et al Syringe sharing and HIV incidence among injection drug users and increased access to sterile syringes. American Journal of Public Health. 2010;100(8):1449–1453. [PMC free article: PMC2901279] [PubMed: 20558797] | Ineligible study design |
| Khan AA, Khan A. Performance and coverage of HIV interventions for injection drug users: Insights from triangulation of programme, field and surveillance data from Pakistan. The International journal on drug policy. 2011;22(3):219–225. [PubMed: 21530216] | Ineligible intervention |
| Kidorf M, Brooner RK, Leoutsakos J-M, Peirce J. Reducing Risky Drug Use Behaviors by Enrolling Syringe Exchange Registrants in Methadone Maintenance. Substance use & misuse. 2021;56(4):546–551. [PubMed: 33616479] | Ineligible intervention |
| Kidorf M, King VL. Expanding the public health benefits of syringe exchange programs. Canadian journal of psychiatry Revue canadienne de psychiatrie. 2008;53(8):487–495. [PubMed: 18801210] | Outdated or ineligible SR |
| Kidorf M, King VL, Peirce J, Kolodner K, Brooner RK. An observation of lower rates of drug use over time in community syringe exchangers. The American Journal on Addictions. 2013;22(3):271–276. [PubMed: 23617871] | Ineligible outcome |
| Klee H, Faugier J, Hayes C, Morris J. The sharing of injecting equipment among drug users attending prescribing clinics and those using needle-exchanges. British Journal of Addiction. 1991;86(2):217–223. [PubMed: 2021704] | Ineligible study design |
| Klee H, Morris J. The role of needle exchanges in modifying sharing behaviour: Cross-study comparisons 1989–1993. Addiction. 1995;90(12):1635–1645. [PubMed: 8555955] | Ineligible study design |
| Ksobiech K. Beyond needle sharing: meta-analyses of social context risk behaviors of injection drug users attending needle exchange programs. Subst Use Misuse. 2006;41(10–12):1379–1394. [PubMed: 17002988] | Outdated or ineligible SR |
| Ksobiech K. A meta-analysis of needle sharing, lending, and borrowing behaviors of needle exchange program attenders. AIDS Education & Prevention. 2003;15(3):257–268. [PubMed: 12866837] | Outdated or ineligible SR |
| Kudrina I, Puzhko S, Filion KB, et al Effectiveness of interventions for prevention of common infections in people who use opioids: a protocol for a systematic review of systematic reviews. Systematic reviews. 2021;10(1):298. [PMC free article: PMC8591821] [PubMed: 34782008] | Ineligible study design |
| Lamden KH, Kennedy N, Beeching NJ, et al Hepatitis B and hepatitis C virus infections: risk factors among drug users in Northwest England. The Journal of infection. 1998;37(3):260–269. [PubMed: 9892530] | Ineligible study design |
| Lee H-Y, Yang Y-H, Yu W-J, et al Essentiality of HIV testing and education for effective HIV control in the national pilot harm reduction program: the Taiwan experience. The Kaohsiung journal of medical sciences. 2012;28(2):79–85. [PubMed: 22313534] | Ineligible study design |
| Leece PN, Hopkins S, Marshall C, Orkin A, Gassanov MA, Shahin RM. Development and implementation of an opioid overdose prevention and response program in Toronto, Ontario. Canadian journal of public health = Revue canadienne de sante publique. 2013;104(3):e200–204. [PMC free article: PMC6973908] [PubMed: 23823882] | Ineligible outcome |
| Lemon TI, Shah R. Needle exchanges: An important yet forgotten outpost in suicide and self-harm prevention. Journal of Psychosomatic Research. 2013;74(6):551–552. | Unable to locate FT |
| Lenton S. Policy from a harm reduction perspective. Current Opinion in Psychiatry. 2003;16(3):271–277. | Ineligible publication type |
| Leonard L, DeRubeis E, Pelude L, Medd E, Birkett N, Seto J. "I inject less as I have easier access to pipes" Injecting, and sharing of crack-smoking materials, decline as safer crack-smoking resources are distributed. International Journal of Drug Policy. 2008;19(3):255–264. [PubMed: 18502378] | Ineligible intervention |
| Lin T, Chen C-H, Chou P. Effects of combination approach on harm reduction programs: The Taiwan experience. Harm Reduction Journal. 2016;13. [PMC free article: PMC4932706] [PubMed: 27377896] | Ineligible study design |
| Lines R, Jurgens R, Betteridge G, Stover H. Taking action to reduce injecting drug-related harms in prisons: The evidence of effectiveness of prison needle exchange in six countries. International Journal of Prisoner Health. 2005;1(1):49–64. | Ineligible publication type |
| Ljungberg B, Christensson B, Tunving K, et al HIV prevention among injecting drug users: three years of experience from a syringe exchange program in Sweden. Journal of acquired immune deficiency syndromes. 1991;4(9):890–895. [PubMed: 1895210] | Ineligible study design |
| Longshore D, Bluthenthal RN, Stein MD. Needle exchange program attendance and injection risk in Providence, Rhode Island. AIDS Education and Prevention. 2001;13(1):78–90. [PubMed: 11252456] | Ineligible study design |
| Lucas P, Easthope G. Effects of needle exchanges in Hobart, Tasmania. Drug and alcohol review. 1996;15(3):307–310. [PubMed: 16203385] | Ineligible study design |
| Luo W, Wu Z, Poundstone K, et al Needle and syringe exchange programmes and prevalence of HIV infection among intravenous drug users in China. Addiction. 2015;110(Suppl 1):61–67. [PubMed: 25533865] | Ineligible study design |
| MacDonald M, Law M, Kaldor J, Hales J, Dore GJ. Effectiveness of needle and syringe programmes for preventing HIV transmission. Special Issue: Sterile Syringe Access for Injection Drug Users in the 21st Century: Progress and prospects. 2003;14(5–6):353–357. | Ineligible study design |
| MacDonald M, Wodak AD, Ali R, et al HIV prevalence and risk behaviour in needle exchange attenders: a national study. The Collaboration of Australian Needle Exchanges. The Medical journal of Australia. 1997;166(5):237–240. [PubMed: 9076266] | Unable to locate FT |
| Mackesy-Amiti ME, Boodram B, Spiller MW, Paz-Bailey G, Prachand N, Broz D. Injection-Related Risk Behavior and Engagement in Outreach, Intervention and Prevention Services Across 20 US Cities. Journal of acquired immune deficiency syndromes (1999). 2017;75 Suppl 3:S316–S324. [PubMed: 28604433] | Ineligible study design |
| Mansson AS, Moestrup T, Nordenfelt E, Widell A. Continued transmission of hepatitis B and C viruses, but no transmission of human immunodeficiency virus among intravenous drug users participating in a syringe/needle exchange program. Scandinavian journal of infectious diseases. 2000;32(3):253–258. [PubMed: 10879594] | Ineligible study design |
| Marfell K, Mitchell-Christie A, Johnson A, Hinds G. Needle exchange and HIV infection. Lancet (London, England). 1987;2(8550):100–101. [PubMed: 2885548] | Ineligible publication type |
| Marotta PL, McCullagh CA. A cross-national analysis of the effects of methadone maintenance and needle and syringe program implementation on incidence rates of HIV in Europe from 1995 to 2011. International Journal of Drug Policy. 2016;32:3–10. [PMC free article: PMC4899251] [PubMed: 27212656] | Ineligible study design |
| Marotta PL, Stringer K, Beletsky L, et al Assessing the relationship between syringe exchange, pharmacy, and street sources of accessing syringes and injection drug use behavior in a pooled nationally representative sample of people who inject drugs in the United States from 2002 to 2019. Harm Reduction Journal. 2021;18. [PMC free article: PMC8600731] [PubMed: 34789270] | Ineligible study design |
| Marzel A, Kusejko K, Weber R, et al The Cumulative Impact of Harm Reduction on the Swiss HIV Epidemic: Cohort Study, Mathematical Model, and Phylogenetic Analysis. Open forum infectious diseases. 2018;5(5):ofy078. [PMC free article: PMC5965087] [PubMed: 29868622] | Ineligible comparator |
| Masson CL, Sorensen JL, Perlman DC, et al Hospital- versus community-based syringe exchange: A randomized controlled trial. AIDS Education and Prevention. 2007;19(2):97–110. [PMC free article: PMC3853200] [PubMed: 17411413] | Ineligible outcome |
| Mathers BM, Degenhardt L, Ali H, et al HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage. Lancet (London, England). 2010;375(9719):1014–1028. [PubMed: 20189638] | Ineligible outcome |
| McNeely J, Arnsten JH, Gourevitch MN. Improving access to sterile syringes and safe syringe disposal for injection drug users in methadone maintenance treatment. Journal of Substance Abuse Treatment. 2006;31(1):51–57. [PubMed: 16814010] | Ineligible intervention |
| McNeil R, Small W. ‘Safer environment interventions’: A qualitative synthesis of the experiences and perceptions of people who inject drugs. Social Science & Medicine. 2014;106:151–158. [PMC free article: PMC4133147] [PubMed: 24561777] | Ineligible outcome |
| McVeigh J, Hearne E, Boardley I, et al Generating evidence on the use of image and performance enhancing drugs in the UK: Results from a scoping review and expert consultation by the Anabolic Steroid UK network. Harm Reduction Journal. 2021;18. [PMC free article: PMC8522223] [PubMed: 34657627] | Ineligible publication type |
| Menoyo C, Zulaica D, Parras F. Needle exchange programs in prisons in Spain. Canadian HIV/AIDS policy & law review. 2000;5(4):20–21. [PubMed: 11833158] | Ineligible outcome |
| Michel L, Carrieri MP, Wodak A. Harm reduction and equity of access to care for French prisoners: a review. Harm reduction journal. 2008;5:17. [PMC free article: PMC2430551] [PubMed: 18495018] | Outdated or ineligible SR |
| Miller K, Sheaves F, Maher L, Page J, Bridges-Webb I, Treloar C. ‘C’ the potential: Needle and syringe programs as hepatitis C treatment sites. Drugs: Education, Prevention & Policy. 2020;27(1):92–94. | Ineligible publication type |
| Miller M, Eskild A, Mella I, Moi H, Magnus P. Gender differences in syringe exchange program use in Oslo, Norway. Addiction. 2001;96(11):1639–1651. [PubMed: 11784460] | Ineligible study design |
| Mital D, Conway S, Trueman J. High Prevalence of Abandoned Needlesticks from Injecting Drug Users in Milton Keynes, UK: Analysing Access to Needle Exchange Centres and Drug Dependency Services. Current drug abuse reviews. 2017;10(1):76–80. [PubMed: 29714154] | Ineligible comparator |
| Montgomery ME, Fatch RS, Evans JL, et al Injecting risk behavior among traveling young injection drug users: travel partner and city characteristics. Journal of urban health: bulletin of the New York Academy of Medicine. 2013;90(3):500–515. [PMC free article: PMC3665972] [PubMed: 22744293] | Ineligible study design |
| Motie I, Carretta HJ, Beitsch LM. Needling Policy Makers and Sharpening the Debate: Do Syringe Exchange Programs Improve Health at the Population Level? Journal of public health management and practice: JPHMP. 2020;26(3):222–226. [PubMed: 32235205] | Ineligible study design |
| Nacopoulos AG, Lewtas AJ, Ousterhout MM. Syringe exchange programs: Impact on injection drug users and the role of the pharmacist from a U.S. perspective. Journal of the American Pharmacists Association: JAPhA. 2010;50(2):148–157. [PubMed: 20199955] | Outdated or ineligible SR |
| Nazari SS H, Noroozi M, Soori H, et al The effect of on-site and outreach-based needle and syringe programs in people who inject drugs in Kermanshah, Iran. International Journal of Drug Policy. 2016;27:127–131. [PubMed: 26764125] | Ineligible study design |
| Ndimbii J, Guise A, Ayon S, Kalama M, McLean S, Rhodes T. Implementing needle and syringe programmes in Kenya: Changes, opportunities and challenges in HIV prevention. African Journal of Drug and Alcohol Studies. 2015;14(2):95–103. | Ineligible study design |
| Neaigus A, Zhao M, Gyarmathy VA, Cisek L, Friedman SR, Baxter RC. Greater drug injecting risk for HIV, HBV, and HCV infection in a city where syringe exchange and pharmacy syringe distribution are illegal. Journal of urban health: bulletin of the New York Academy of Medicine. 2008;85(3):309–322. [PMC free article: PMC2329750] [PubMed: 18340537] | Ineligible study design |
| Neira-Leon M, Barrio G, Bravo MJ, et al Infrequent opioid overdose risk reduction behaviours among young adult heroin users in cities with wide coverage of HIV prevention programmes. International Journal of Drug Policy. 2011;22(1):16–25. [PubMed: 20800462] | Ineligible intervention |
| Noroozi M, Marshall BD L, Noroozi A, et al Do needle and syringe programs reduce risky behaviours among people who inject drugs in Kermanshah City, Iran? A coarsened exact matching approach. Drug and Alcohol Review. 2018;37(Suppl 1):S303–S308. [PubMed: 29271013] | Ineligible study design |
| Noroozi M, Mirzazadeh A, Noroozi A, et al Client-Level Coverage of Needle and Syringe Program and High-Risk Injection Behaviors: A Case Study of People Who Inject Drugs in Kermanshah, Iran. Addiction & health. 2015;7(3–4):164–173. [PMC free article: PMC4741237] [PubMed: 26885353] | Ineligible study design |
| Noroozi M, Mirzazadeh A, Noroozi A, et al Injecting and Sexual Networks and Sociodemographic Factors and Dual HIV Risk among People Who Inject Drugs: A Cross-sectional Study in Kermanshah Province, Iran. Addiction & health. 2016;8(3):186–194. [PMC free article: PMC5422015] [PubMed: 28496957] | Ineligible study design |
| Noroozi M, Noroozi A, Sharifi H, et al Needle and Syringe Programs and HIV-Related Risk Behaviors Among Men Who Inject Drugs: A Multilevel Analysis of Two Cities in Iran. International journal of behavioral medicine. 2019;26(1):50–58. [PubMed: 30460445] | Ineligible study design |
| O’Keefe D, Scott N, Aitken C, Dietze P. Longitudinal analysis of change in individual-level needle and syringe coverage amongst a cohort of people who inject drugs in Melbourne, Australia. Drug and Alcohol Dependence. 2017;176:7–13. [PubMed: 28463684] | Ineligible outcome |
| Otiashvili D, Gambashidze N, Kapanadze E, Lomidze G, Usharidze D. Effectiveness of needle/syringe exchange program in Tbilisi. Georgian Med News. 2006;(140):62–65. [PubMed: 17179591] | Unable to locate FT |
| Owens L, Gilmore K, Terplan M, Prager S, Micks E. Providing reproductive health services for women who inject drugs: a pilot program. Harm reduction journal. 2020;17(1):47. [PMC free article: PMC7362507] [PubMed: 32664931] | Ineligible outcome |
| Ozga JE, Syvertsen JL, Pollini RA. Hepatitis C antibody prevalence, correlates and barriers to care among people who inject drugs in Central California. Journal of viral hepatitis. 2022;29(7):518–528. [PubMed: 35357738] | Ineligible study design |
| Panagiotoglou D, Abrahamowicz M, Buckeridge DL, et al Evaluating Montreal’s harm reduction interventions for people who inject drugs: protocol for observational study and cost-effectiveness analysis. BMJ open. 2021;11(10):e053191. [PMC free article: PMC8549659] [PubMed: 34702731] | Ineligible study design |
| Paone D, Des Jarlais DC, Caloir S, Jose B, Shi Q, Friedman SR. Continued risky injection subsequent to syringe exchange use among injection drug users in New York City. AIDS Education and Prevention. 1997;9(6):505–510. [PubMed: 9451478] | Ineligible study design |
| Paone D, Des Jarlais DC, Shi Q. Syringe exchange use and HIV risk reduction over time. AIDS. 1998;12(1):121–123. [PubMed: 9456269] | Ineligible study design |
| Paquette CE, Pollini RA. Injection drug use, HIV/HCV, and related services in nonurban areas of the United States: A systematic review. Drug Alcohol Depend. 2018;188:239–250. [PMC free article: PMC5999584] [PubMed: 29787966] | Outdated or ineligible SR |
| Park JN, Frankel S, Morris M, et al Evaluation of fentanyl test strip distribution in two Mid-Atlantic syringe services programs. International Journal of Drug Policy. 2021;94:1–4. [PubMed: 33713964] | Ineligible outcome |
| Patrick DM, Tyndall MW, Cornelisse PG, et al Incidence of hepatitis C virus infection among injection drug users during an outbreak of HIV infection. CMAJ: Canadian Medical Association journal = journal de l’Association medicale canadienne. 2001;165(7):889–895. [PMC free article: PMC81496] [PubMed: 11599327] | Ineligible study design |
| Pattanaphesaj J, Teerawattananon Y. Reviewing the evidence on effectiveness and cost-effectiveness of HIV prevention strategies in Thailand. BMC public health. 2010;10:401. [PMC free article: PMC2912810] [PubMed: 20604975] | Outdated or ineligible SR |
| Peak A, Rana S, Maharjan SH, Jolley D, Crofts N. Declining risk for HIV among injecting drug users in Kathmandu, Nepal: the impact of a harm-reduction programme. AIDS (London, England). 1995;9(9):1067–1070. [PubMed: 8527080] | Ineligible comparator |
| Perlman DC, Perkins MP, Solomon N, Kochems L, Des Jarlais DC, Paone D. Tuberculosis screening at a syringe exchange program. American journal of public health. 1997;87(5):862–863. [PubMed: 9184525] | Ineligible publication type |
| Piper TM, Stancliff S, Rudenstine S, et al Evaluation of a naloxone distribution and administration program in New York City. Substance Use & Misuse. 2008;43(7):858–870. [PubMed: 18570021] | Ineligible comparator |
| Platt L, Reed J, Minozzi S, et al Effectiveness of needle/syringe programmes and opiate substitution therapy in preventing HCV transmission among people who inject drugs. The Cochrane database of systematic reviews. 2016;2016(1). [PMC free article: PMC4843520] [PubMed: 27127417] | Ineligible publication type |
| Platt L, Sweeney S, Ward Z, et al Assessing the impact and cost-effectiveness of needle and syringe provision and opioid substitution therapy on hepatitis C transmission among people who inject drugs in the UK: an analysis of pooled data sets and economic modelling. 2017. [PubMed: 28968044] | Ineligible study design |
| Plitt SS, Gratrix J, Hewitt S, et al Seroprevalence and correlates of HIV and HCV among injecting drug users in Edmonton, Alberta. Canadian journal of public health = Revue canadienne de sante publique. 2010;101(1):50–55. [PMC free article: PMC6974101] [PubMed: 20364539] | Ineligible study design |
| Pollack HA. Cost-effectiveness of harm reduction in preventing hepatitis C among injection drug users. Medical decision making: an international journal of the Society for Medical Decision Making. 2001;21(5):357–367. [PubMed: 11575485] | Ineligible study design |
| Porche DJ, Swayzer R, III. HIV prevention: A review of interventions. JANAC: Journal of the Association of Nurses in AIDS Care. 2003;14(1):79–81. [PubMed: 12585225] | Ineligible publication type |
| Pouget ER, Deren S, Fuller CM, et al Receptive Syringe Sharing Among Injection Drug Users in Harlem and the Bronx During the New York State Expanded Syringe Access Demonstration Program. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2005;39(4):471–477. [PubMed: 16010172] | Ineligible study design |
| Reynolds. The impact of limited needle and syringe availability programmes on HIV transmission-a case study in Kathmandu. The International journal on drug policy. 2000;11(6):377–379. [PubMed: 11099917] | Ineligible publication type |
| Reynolds A. The impact of limited needle and syringe availability programmes on HIV transmission--A case study in Kathmandu. International Journal of Drug Policy. 2000;11(6):377–379. [PubMed: 11099917] | Ineligible study design |
| Rhodes T, Judd A, Mikhailova L, et al Injecting equipment sharing among injecting drug users in Togliatti City, Russian Federation: maximizing the protective effects of syringe distribution. Journal of acquired immune deficiency syndromes (1999). 2004;35(3):293–300. [PubMed: 15076245] | Ineligible study design |
| Riley ED, Vlahov D, Huettner S, Beilenson P, Bonds M, Chaisson RE. Characteristics of injection drug users who utilize tuberculosis services at sites of the Baltimore city needle exchange program. Journal of urban health: bulletin of the New York Academy of Medicine. 2002;79(1):113–127. [PMC free article: PMC3456382] [PubMed: 11937620] | Ineligible outcome |
| Ritter A, Cameron J. A review of the efficacy and effectiveness of harm reduction strategies for alcohol, tobacco and illicit drugs. Drug and Alcohol Review. 2006;25(6):611–624. [PubMed: 17132577] | Outdated or ineligible SR |
| Roberts J. Needle exchanges reduce HIV infection in US. BMJ (Clinical research ed). 1995;311(7009):832. [PubMed: 7580486] | Ineligible publication type |
| Rockwell R, Des Jarlais DC, Friedman SR, Perlis TE, Paone D. Geographic proximity, policy and utilization of syringe exchange programmes. AIDS Care. 1999;11(4):437–442. [PubMed: 10533536] | Ineligible study design |
| Rossi RM, Brady MJ, Hall ES, Warshak CR. Effect of Needle Exchange Program on Maternal Hepatitis C Virus Prevalence. American journal of perinatology. 2020;37(9):881–889. [PubMed: 31962347] | Ineligible study design |
| Roth A, Tran N, Piecara B, Welles S, Shinefeld J, Brady K. Factors associated with awareness of pre-exposure prophylaxis for HIV among persons who inject drugs in Philadelphia: National HIV behavioral surveillance, 2015. AIDS and Behavior. 2019;23(7):1833–1840. [PubMed: 30267367] | Ineligible outcome |
| Ruan Y, Liang S, Zhu J, et al Evaluation of harm reduction programs on seroincidence of HIV, hepatitis B and C, and syphilis among intravenous drug users in southwest China. Sexually transmitted diseases. 2013;40(4):323–328. [PubMed: 23486498] | Ineligible intervention |
| Sanchez DP, Tookes H, Pastar I, Lev-Tov H. Wounds and Skin and Soft Tissue Infections in People Who Inject Drugs and the Utility of Syringe Service Programs in Their Management. Advances in wound care. 2021;10(10):571–582. [PMC free article: PMC8312019] [PubMed: 33913781] | Ineligible outcome |
| Sarkar K, Mitra S, Bal B, Chakraborty S, Bhattacharya SK. Rapid spread of hepatitis C and needle exchange programme in Kolkata, India. Lancet (London, England). 2003;361(9365):1301–1302. [PubMed: 12699985] | Ineligible study design |
| Sears C, Guydish JR, Weltzien EK, Lum PJ. Investigation of a secondary syringe exchange program for homeless young adult injection drug users in San Francisco, California, U.S.A. Journal of acquired immune deficiency syndromes (1999). 2001;27(2):193–201. [PubMed: 11404542] | Ineligible intervention |
| Servegev B, Oparina T, Rumyantseva TP, et al HIV prevention in Yaroslavl, Russia: A peer-driven intervention and needle exchange. Journal of Drug Issues. 1999;29(4):777–804. | Ineligible outcome |
| Sharifi H, Mirzazadeh A, Noroozi A, et al Patterns of HIV Risks and Related Factors among People Who Inject Drugs in Kermanshah, Iran: A Latent Class Analysis. Journal of psychoactive drugs. 2017;49(1):69–73. [PMC free article: PMC5586100] [PubMed: 27937534] | Ineligible study design |
| Sharma D, Goel NK, Walia DK, Thakare MM, Gupta V, Mittal S. Prevalence and predictors of self-reported risk behaviors among male injecting drug users. Indian journal of public health. 2019;63(2):114–118. [PubMed: 31219059] | Ineligible study design |
| Singer M, Romero-Daza N, Weeks M, Pelia P. Ethnography and the evaluation of needle exchange in the prevention of HIV transmission. NIDA research monograph. 1995;157:231–257. [PubMed: 8684439] | Ineligible study design |
| Singh M. Harm reduction and street-based program: looking into Nepal. Substance use & misuse. 1998;33(5):1069–1074. [PubMed: 9596376] | Ineligible publication type |
| Smith DM, Werb D, Abramovitz D, et al Predictors of needle exchange program utilization during its implementation and expansion in Tijuana, Mexico. The American Journal on Addictions. 2016;25(2):118–124. [PMC free article: PMC5470727] [PubMed: 26765073] | Ineligible outcome |
| Smyth BP, Keenan E, O’Connor JJ. Evaluation of the impact of Dublin’s expanded harm reduction programme on prevalence of hepatitis C among short-term injecting drug users. Journal of Epidemiology and Community Health. 1999;53(7):434–435. [PMC free article: PMC1756924] [PubMed: 10492738] | Ineligible study design |
| Soares NS A, Fernandes MA, Ribeiro HK P, Rocha DdM, Ribeiro IAP. Harm reduction in primary healthcare: an integrative review of care strategies. Revista da Escola de Enfermagem da U S P. 2020;54:e03591. [PubMed: 32965442] | Outdated or ineligible SR |
| Solomon SS, Lucas GM, Celentano DD, et al Design of the Indian NCA study (Indian national collaboration on AIDS): a cluster randomized trial to evaluate the effectiveness of integrated care centers to improve HIV outcomes among men who have sex with men and persons who inject drugs in India. BMC health services research. 2016;16(1):652. [PMC free article: PMC5109686] [PubMed: 27842543] | Ineligible comparator |
| Speed S. The sharing of injecting paraphernalia among 96 regular attenders at needle-exchange schemes in the North West of England: Implications for local public health policy. International Journal of Drug Policy. 1998;9(5):351–358. | Ineligible comparator |
| Spijkerman IJ, van Ameijden EJ, Mientjes GH, Coutinho RA, van den Hoek A. Human immunodeficiency virus infection and other risk factors for skin abscesses and endocarditis among injection drug users. Journal of clinical epidemiology. 1996;49(10):1149–1154. [PubMed: 8826995] | Ineligible outcome |
| Stancliff S. Syringe access and HIV incidence in the United States. JAMA. 2008;300(20):2370. [PubMed: 19033586] | Ineligible publication type |
| Stark K, Herrmann U, Ehrhardt S, Bienzle U. A syringe exchange programme in prison as prevention strategy against HIV infection and hepatitis B and C in Berlin, Germany. Epidemiology & Infection. 2006;134(4):814–819. [PMC free article: PMC2870452] [PubMed: 16371183] | Ineligible outcome |
| Stein MD, Anderson B. Injection frequency mediates health service use among persons with a history of drug injection. Drug and Alcohol Dependence. 2003;70(2):159–168. [PubMed: 12732409] | Ineligible outcome |
| Stein MD, Charuvastra A, Anderson BJ. Social support and zero sharing risk among hazardously drinking injection drug users. Journal of Substance Abuse Treatment. 2002;23(3):225–230. [PubMed: 12392809] | Ineligible study design |
| Stimson G, Alldritt L, Dolan K, Donoghoe M. Preventing the spread of HIV in injecting drug users--the experience of syringe-exchange schemes in England and Scotland. NIDA research monograph. 1988;90:302–310. [PubMed: 3151932] | Ineligible publication type |
| Stover H. Evaluation of needle exchange pilot projects shows positive results. Canadian HIV-AIDS policy & law newsletter. 2000;5(2–3):60–69. [PubMed: 11833203] | Unable to locate FT |
| Strathdee SA, Lozada R, Martinez G, et al Social and structural factors associated with HIV infection among female sex workers who inject drugs in the Mexico-US border region. PloS one. 2011;6(4):e19048. [PMC free article: PMC3081836] [PubMed: 21541349] | Ineligible study design |
| Strathdee SA, Ricketts EP, Huettner S, et al Facilitating entry into drug treatment among injection drug users referred from a needle exchange program: Results from a community-based behavioral intervention trial. Drug and Alcohol Dependence. 2006;83(3):225–232. [PMC free article: PMC2196224] [PubMed: 16364566] | Ineligible intervention |
| Strenski TA, Marshall PA, Gacki JK, Sanchez CW. The emergent impact of syringe exchange programs on shooting galleries and injection behaviors in three ethnically diverse Chicago neighborhoods. Special Issue: Emergent trends in illicit drug-use behaviors. 2000;18(4):415–438. | Unable to locate FT |
| Strike C, Miskovic M. Scoping out the literature on mobile needle and syringe programs-review of service delivery and client characteristics, operation, utilization, referrals, and impact. Harm reduction journal. 2018;15(1):6. [PMC free article: PMC5806231] [PubMed: 29422042] | Ineligible publication type |
| Strike C, Rudzinski K, Patterson J, Millson M. Frequent food insecurity among injection drug users: correlates and concerns. BMC public health. 2012;12:1058. [PMC free article: PMC3540007] [PubMed: 23216869] | Ineligible intervention |
| Telles PR. Preventing HIV/AIDS and other sexually transmitted diseases among injecting drug users in Rio de Janeiro. International Journal of Drug Policy. 1999;10(5):365–373. | Ineligible outcome |
| Tempalski B, Beane S, Cooper HL F, et al Structural determinants of Black MSM HIV testing coverage (2011–2016). AIDS and Behavior. 2020;24(9):2572–2587. [PMC free article: PMC7444860] [PubMed: 32124108] | Ineligible outcome |
| Todd CS, Nasir A, Stanekzai MR, et al Hepatitis C and HIV incidence and harm reduction program use in a conflict setting: an observational cohort of injecting drug users in Kabul, Afghanistan. Harm reduction journal. 2015;12:22. [PMC free article: PMC4608295] [PubMed: 26472126] | Ineligible study design |
| Todd CS, Stibich MA, Stanekzai MR, et al A qualitative assessment of injection drug use and harm reduction programmes in Kabul, Afghanistan: 2006–2007. International Journal of Drug Policy. 2009;20(2):111–120. [PMC free article: PMC7201369] [PubMed: 18207381] | Ineligible outcome |
| Tomolillo CM, Crothers LJ, Aberson CL. The damage done: A study of injection drug use, injection related abscesses and needle exchange regulation. Substance Use & Misuse. 2007;42(10):1603–1611. [PubMed: 17918030] | Ineligible outcome |
| Tookes H, Bartholomew TS, Geary S, et al Rapid identification and investigation of an HIV risk network among people who inject drugs -Miami, FL, 2018. AIDS and Behavior. 2020;24(1):246–256. [PMC free article: PMC6954140] [PubMed: 31555932] | Ineligible intervention |
| Tookes HE, Oxner A, Serota DP, et al Project T-SHARP: study protocol for a multisite randomized controlled trial of tele-harm reduction for people with HIV who inject drugs. Trials. 2023;24(1):96. [PMC free article: PMC9904271] [PubMed: 36750867] | Ineligible intervention |
| Tortu S, Deren S, Beardsely M, Hamid R. Factors associated with needle exchange use in East Harlem, New York City. Journal of Drug Issues. 1996;26(4):735–749. | Unable to locate FT |
| Tsai R, Goh EH, Webeck P, Mullins J. Prevention of human immunodeficiency virus infection among intravenous drug users in New South Wales, Australia: the needles and syringes distribution programme through retail pharmacies. Asia-Pacific journal of public health. 1988;2(4):245–251. [PubMed: 3179107] | Ineligible outcome |
| Uuskula A, Des Jarlais DC, Raag M, Pinkerton SD, Feelemyer J. Combined prevention for persons who inject drugs in the HIV epidemic in a transitional country: The case of Tallinn, Estonia. AIDS Care. 2015;27(1):105–111. [PMC free article: PMC4221426] [PubMed: 25054646] | Ineligible publication type |
| Uuskula A, McMahon JM, Raag M, et al Emergent properties of HIV risk among injection drug users in Tallinn, Estonia: synthesis of individual and neighbourhood-level factors. Sexually transmitted infections. 2010;86 Suppl 3:iii79–84. [PubMed: 21098060] | Ineligible study design |
| Valenciano M, Emmanuelli J, Lert F. Unsafe injecting practices among attendees of syringe exchange programmes in France. Addiction. 2001;96(4):597–606. [PubMed: 11300963] | Ineligible comparator |
| van Ameijden EJ, van den Hoek AR, Coutinho RA. Injecting risk behavior among drug users in Amsterdam, 1986 to 1992, and its relationship to AIDS prevention programs. American journal of public health. 1994;84(2):275–281. [PMC free article: PMC1614996] [PubMed: 8296953] | Ineligible study design |
| van den Berg C, Smit C, van Brussel G, Coutinho R, Prins M. 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. Addiction. 2007;102(9):1454–1462. [PMC free article: PMC2040242] [PubMed: 17697278] | Ineligible study design |
| van den Hoek JA, van Haastrecht HJ, Coutinho RA. Risk reduction among intravenous drug users in Amsterdam under the influence of AIDS. American journal of public health. 1989;79(1):1355–1357. [PMC free article: PMC1350173] [PubMed: 2782501] | Ineligible intervention |
| van der Meulen E, Watson TM, De Shalit A. Insights on prison needle and syringe programs: Research with former prisoners in Canada. The Prison Journal. 2017;97(5):628–643. | Ineligible comparator |
| van Santen DK, Boyd A, Matser A, et al The effect of needle and syringe program and opioid agonist therapy on the risk of HIV, hepatitis B and C virus infection for people who inject drugs in Amsterdam, the Netherlands: findings from an emulated target trial. Addiction. 2021;116(11):3115–3126. [PubMed: 33788326] | Ineligible study design |
| van Santen DK, Coutinho RA, van den Hoek A, van Brussel G, Buster M, Prins M. Lessons learned from the Amsterdam Cohort Studies among people who use drugs: A historical perspective. Harm Reduction Journal. 2021;18. [PMC free article: PMC7789277] [PubMed: 33407562] | Ineligible study design |
| van Santen DK, Lodi S, Dietze P, et al Comprehensive needle and syringe program and opioid agonist therapy reduce HIV and hepatitis c virus acquisition among people who inject drugs in different settings: A pooled analysis of emulated trials. Addiction (Abingdon, England). 2023. [PMC free article: PMC10175130] [PubMed: 36710474] | Ineligible study design |
| Vlahov D, Brookmeyer RS. The evaluation of needle exchange programs. American journal of public health. 1994;84(12):1889–1891. [PMC free article: PMC1615393] [PubMed: 7998623] | Ineligible publication type |
| Vlahov D, Junge B. The role of needle exchange programs in HIV prevention. Public health reports (Washington, DC: 1974). 1998;113 Suppl 1:75–80. [PMC free article: PMC1307729] [PubMed: 9722812] | Ineligible publication type |
| Vlahov D, Robertson AM, Strathdee SA. Prevention of HIV infection among injection drug users in resource-limited settings. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 2010;50 Suppl 3:S114–121. [PMC free article: PMC3114556] [PubMed: 20397939] | Ineligible publication type |
| Vlahov D, Ryan C, Solomon L, Cohn S, Holt MR, Akhter MN. A pilot syringe exchange program in Washington, DC. American Journal of Public Health. 1994;84(2):303–304. [PMC free article: PMC1614978] [PubMed: 8296961] | Ineligible comparator |
| Watson DP, Swartz JA, Robison-Taylor L, et al Syringe service program-based telemedicine linkage to opioid use disorder treatment: protocol for the STAMINA randomized control trial. BMC public health. 2021;21(1):630. [PMC free article: PMC8010496] [PubMed: 33789642] | Ineligible publication type |
| Werb D, Kerr T, Buxton J, et al Patterns of injection drug use cessation during an expansion of syringe exchange services in a Canadian setting. Drug and alcohol dependence. 2013;132(3):535–540. [PMC free article: PMC3762907] [PubMed: 23642315] | Ineligible outcome |
| White RH, O’Rourke A, Kilkenny ME, et al Prevalence and correlates of receptive syringe-sharing among people who inject drugs in rural Appalachia. Addiction. 2021;116(2):328–336. [PMC free article: PMC7736103] [PubMed: 32533612] | Ineligible study design |
| Whiteman A, Burnett J, Handanagic S, Wejnert C, Broz D. Distance matters: The association of proximity to syringe services programs with sharing of syringes and injecting equipment-17 U.S. cities, 2015. International Journal of Drug Policy. 2020;85. [PubMed: 32920424] | Ineligible study design |
| Wiessing L, Likatavicius G, Klempová D, Hedrich D, Nardone A, Griffiths P. Associations between availability and coverage of HIV-prevention measures and subsequent incidence of diagnosed HIV infection among injection drug users. American Journal of Public Health. 2009;99(6):1049–1052. [PMC free article: PMC2679784] [PubMed: 19372511] | Ineligible study design |
| Wodak A. Lessons From the First International Review of the Evidence for Needle Syringe Programs: The Band Still Plays On. Special Issue: Syringe Access and Secondary Syringe Exchange: International Perspectives and Future Directions. 2006;41(6–7):837–839. [PubMed: 16809173] | Ineligible publication type |
| Wodak A, Cooney A. Do Needle Syringe Programs Reduce HIV Infection Among Injecting Drug Users: A Comprehensive Review of the International Evidence. Special Issue: Syringe Access and Secondary Syringe Exchange: International Perspectives and Future Directions. 2006;41(6–7):777–813. [PubMed: 16809167] | Outdated or ineligible SR |
| Wolk J, Wodak A, Guinan JJ, Macaskill P, Simpson JM. The effect of a needle and syringe exchange on a methadone maintenance unit. British Journal of Addiction. 1990;85(1):1445–1450. [PubMed: 2285840] | Ineligible outcome |
| Wood E, Lloyd-Smith E, Li K, et al Frequent needle exchange use and HIV incidence in Vancouver, Canada. The American journal of medicine. 2007;120(2):172–179. [PubMed: 17275459] | Ineligible study design |
| Wood E, Tyndall MW, Spittal PM, et al Factors associated with persistent high-risk syringe sharing in the presence of an established needle exchange programme. AIDS. 2002;16(6):941–943. [PubMed: 11919503] | Unable to locate FT |
| Wu Q, Kamphuis C, Duo L, Luo J, Chen Y, Richardus JH. Coverage of harm reduction services and HIV infection: A multilevel analysis of five Chinese cities. Harm Reduction Journal. 2017;14. [PMC free article: PMC5307648] [PubMed: 28193236] | Ineligible study design |
| Yang C-H, Yang S-Y, Shen M-H, Kuo H-S. The changing epidemiology of prevalent diagnosed HIV infections in Taiwan, 1984–2005. International Journal of Drug Policy. 2008;19(4):317–323. [PubMed: 18638704] | Ineligible study design |
| Yee WL, Draper B, Myint KT, et al Access to needles and syringes and methadone maintenance therapy among people who inject drugs in Yangon, Myanmar: a qualitative study. Harm reduction journal. 2022;19(1):107. [PMC free article: PMC9520098] [PubMed: 36175872] | Ineligible comparator |
| Yoast R, Williams MA, Deitchman SD, Champion HC. Report of the Council on Scientific Affairs: Methadone maintenance and needle-exchange programs to reduce the medical and public health consequences of drug abuse. Journal of Addictive Diseases. 2001;20(2):15–40. [PubMed: 11318395] | Ineligible publication type |
| Zaw C, Mehra D. The efficacy of syringe services programs in reducing skin and soft tissue infection-associated healthcare costs and multidrug-resistant bacteria. American journal of infection control. 2020;48(4):467–468. [PubMed: 31959540] | Ineligible publication type |
UNDERWAY STUDIES
| Citation |
|---|
|
NCT02654366. Community Supported Risk Reduction for Syringe Exchange Participants. CN-01555077. https: |
|
NCT01557998. Testing and Linkage to Care for Injecting Drug Users in Kenya. CN-01591363. https://www |
CHARACTERISTICS OF INCLUDED PRIMARY STUDIES
| Study | City/State Country |
Sample Size Follow-up | Participant Characteristics | Non-Prescribed Substance(s) Use | Intervention/Exposure and Comparator (if applicable) | Included Outcome(s) |
|---|---|---|---|---|---|---|
| RCTs | ||||||
| Braback 201685 |
Skane Sweden |
N=75 NR |
Mean age: 37 % Male: 73 Race/ethnicity NR | Heroin | SSP clients receiving a strength-based case management intervention to facilitate treatment referral compared to SSP clients receiving referral only | Linkage to treatment/utilization of referred servicesa |
| Fisher 20033 |
Alaska US |
N=600 12 mos |
Mean age: 39 % Male: 76 % AA/Black: 19 % Native American: 20 % Other: 5 % White: 56 | Heroin, cocaine, speedball, other opioids, amphetamines | Randomized to SSP access or training on acquiring needles from pharmacies | Injection frequency |
| Lewis 2015b 29 |
New York, NY US |
N=592 3 mos |
Mean age: 44 % Male: 69 % AA/Black: 29 % Hispanic: 51 % White: 16 | NR | Pharmacies that received harm reduction training and provided additional services compared to pharmacies providing usual care | Unsafe disposal of syringes |
| Cohort Studies | ||||||
| Brooner 199828,87 |
Baltimore, MD US |
N=325 1 yr |
Mean age: 38 % Male: 50 % White: 41 | Heroin, cocaine, sedative, cannabis | Referred to OAT from SSP compared to other referral sources | Linkage to treatment/utilization of referred services |
| Hagan 20004 |
Seattle, WA US |
N=Variable 1 yr |
Age NR % Male: 62 % AA/Black: 20 % Other: 11 % White: 69 | Heroin, speedball, cocaine, amphetamines | Current exchange users, new exchange users, ex-exchangers compared to never exchangers | Injection frequency, linkage to treatment/utilization of referred services |
| Hartgers 19895 | Amsterdam, Netherlands |
N=54 Mean 13.5 mos |
Mean age: 32 % Male: 70 NR | Heroin, cocaine, methadone, hashish, marijuana, tranquillizers, amphetamines | Regular exchangers (used SSP > 90% of the time) compared to irregular exchangers or non-exchangers | Injection frequency, linkage to treatment/utilization of referred services |
| Huo 20069 |
Chicago, IL US |
N=707 3 yrs |
Mean age: 40 % Male: 71 % AA/Black: 44 % Non-AA/Black: 55 | Heroin, speedball, powder/crack cocaine | SSP users (used SSP at least twice ever and enrolled for at least 30 days) compared to non-SSP users | Injection frequency |
| Kuo 200326 |
Baltimore, MD US |
N=163 3 mos |
Mean age: 43 % Male: 68 % AA/Black: 99 | Heroin, cocaine | Duration and frequency of SSP use | Linkage to treatment/utilization of referred services |
| Latkin 200625 |
Baltimore, MD US |
N=440 Average 15 mos |
57% age >39 yrs % Male: 68 % AA/Black: 94 | Heroin, speedball, powder/crack cocaine | Current SSP utilization (past 6 mo) compared to no SSP use | Linkage to treatment/utilization of referred services |
| Marmor 20006 |
New York, NY US |
N=328 Median 29.7 mos |
Mean age: 40 % Male: 78 29% AA/Black: 29 % Asian: <1 % Hispanic: 28 % Native American: <1 % Other: <1 % White: 42 | Heroin, powder/crack cocaine, marijuana | Consistent or sporadic SSP users compared to no SSP use | Injection frequency |
| Monterroso 20007 |
Multiple US |
N=2,306 Mean 7.8 mos |
Mean age: 38 % Male: 63 % AA/Black: 43 % Hispanic: 32 % White: 21 | NR | Ever used an SSP compared to never used an SSP | Injection frequency |
| Schoenbaum 19968 |
New York, NY US |
N=329 5 yrs |
Median age: 30 % Male: 65 % Black: 17 % Hispanic: 67 % White: 16 | Heroin, cocaine, speedball | Ever used an SSP compared to never used an SSP | Injection frequency |
| Strathdee 199927,86 |
Baltimore, MD US |
N=1,483 4.5 yrs |
Median age: 40 % Male: 74 % AA/Black: 95 % Non-AA/Black: 5 | Heroin, cocaine, speedball | SSP attendance compared to no attendance | Linkage to treatment/utilization of referred services |
| Pre-Post Studies | ||||||
| Bartholomew 202110 |
Miami, FL US |
N=115 Variable |
Median age: 38 % Male: 77 % Hispanic: 45 % Non-Hispanic Black: 4 % Non-Hispanic White: 50 | Heroin, powder/crack cocaine, methamphetamine, speedball, fentanyl | SSP clients | Injection frequency |
| Cox 200011 | Ireland |
N=370 3 mos |
Mean age: 23 % Male: 79 Race/ethnicity NR | Heroin | SSP attendance | Injection frequency, linkage to treatment/utilization of referred services |
| Donoghoe 198912 | England and Scotland |
N=142 Variable |
Mean age: 30 % Male: 86 Race/ethnicity: NR | Heroin, methadone, amphetamine, cocaine, barbiturates, tranquillizers, others | Attendance at an SSP at least once during the 1 year period prior to the study | Injection frequency |
| Iversen 201313 |
Multiple Australia |
N=724 Variable |
Mean age: 32 % Male: 65 Race/ethnicity NR | Methamphetamine, heroin, cocaine, methadone or buprenorphine, pharmaceutical opioids, others | SSP users across 3 time periods | Injection frequency |
| Patel 201814 |
Indiana US |
N=148 Median 10 wks |
Median age: 34 % Male: 56 % Non-Hispanic White: 98 % Other: 2 | Opana, heroin, methamphetamines, others | SSP clients at first and most recent visit to the SSP | Injection frequency |
| Schechter 199915 |
Vancouver Canada |
N=694 6 mos |
Median age: 36 % Male: 68 % Aboriginal: 25 % Other: 10 % White: 65 | Heroin, cocaine | Frequent SSP attendance compared to no attendance | Injection frequency |
| Vertefeuille 200016 |
Baltimore, MD US |
N=112 6 mos |
Mean age: 40 % Male: 71 % AA/Black: 89 % Other: 11 | Heroin, cocaine, speedball | SSP enrollees | Injection frequency, linkage to treatment/utilization of referred services, unsafe disposal of syringes |
| Vlahov 199717 |
Baltimore, MD US |
N=422 6 mos |
Mean age: 38 % Male: 67 % AA/Black: 87 | Heroin, speedball, cocaine | SSP enrollees | Injection frequency, linkage to treatment/utilization of referred services, unsafe disposal of syringes |
| Vogt 199818 |
Hawaii US |
N=208 NR | NR | NR | SSP attenders | Injection frequency |
| Allen 202120 |
Cabell County, WV US |
N=420 NA |
Mean age: 36 % Male: 61 % Non-Hispanic White: 84 | Heroin, fentanyl, buprenorphine or Suboxone, prescription opioid, crystal methamphetamine, speedball, cocaine | Acquired sterile syringes from an SSP in the past 6 mos compared to those who did not | Naloxone distribution or use |
| Bluthenthal 200432,107 |
Multiple US |
N=584 NA |
Mean age: 41 % Male: 58 % AA/Black: 41 % Hispanic: 38 % Other: 2 % White: 18 | Heroin, speedball, amphetamine, powder/crack cocaine | Residence in cities with more permissive exchange policies compared to residence in city with less permissive exchange policy | Unsafe disposal of syringes |
| Cleland 200730 |
New York US |
N=1,030 NA |
Mean age: 37 % Male: 72 % AA/Black: 13 % Hispanic: 77 % White: 11 | Heroin, powder/crack cocaine | Obtained syringe used for last injection from SSP or source related to ESAP (ie, pharmacy, hospital, clinic, doctor) compared to other source | Unsafe disposal of syringes |
| Coffin 200733 |
Multiple US |
N=680 NA |
Mean age: 42 % Male: 62 % AA/Black: 59 % Hispanic: 21 % Other: 9 % White: 12 | Heroin, powder/crack cocaine | Ever used an SSP or safe syringe source compared to never used an SSP or unsafe syringe source | Unsafe disposal of syringes |
| Cotton-Oldenburg 200131 |
Minnesota US |
N=570 NA |
Mean age: 37 % Male: 66 % AA/Black: 36 % American Indian: 9 % Asian: 1 % Hispanic: 14 % Other: 3 % White: 37 | Heroin, cocaine, speedball, methamphetamine, others | Time period (9–12 mos) before and after legislation allowing for legal sale of syringes by pharmacies without a prescription | Unsafe disposal of syringes |
| Dasgupta 201934 |
Indiana US |
N=200 NA |
18–25: 13% 25–34: 35% 35–44: 31% >45: 31% % Male: 58 % Hispanic: 2 % Multiracial: 5 % White: 92 | Opana, methamphetamine, heroin, other prescription opioid | Time period before and after start of large-scale public health response to HIV outbreak including establishment of SSP | Unsafe disposal of syringes |
| Jones 202121 |
Baltimore, MD US |
N=263 NA |
18–44: 42% ≥45: 58% % Male: 70 % AA/Black: 61 % White: 39 | Heroin, speedball, marijuana tranquilizer | Registered SSP client compared to non-client peers | Naloxone distribution or use, knowledge of overdose risk |
| Khoshnood 200035 |
New Haven, CT US |
N=373 NA |
Mean age: 40 % Male: 64 % AA/Black: 37 % Hispanic: 16 % White: 44 | Heroin | Usual syringe source SSP, pharmacy, or both during past 6 mos compared to other source | Unsafe disposal of syringes |
| Kim 202124 |
San Francisco, CA US |
N=458 NA |
Mean age: 46 % Male: 68 % AA/Black: 26 % Asian/Pacific Islander: 7 % Hispanic: 15 % Native American/Alaska Native: 16 % White: 67 | Opioid, methamphetamine | Received needles or syringes from an SSP in the past 12 mos compared to not receiving needles or syringes from SSP | Knowledge of overdose risk |
| Quinn 201436 |
Los Angeles, CA US |
N=412 NA |
Median age: 50 % Male: 69 % AA/Black: 30 % Hispanic: 41 % Other: 9 % White: 21 | Heroin, powder/crack cocaine, methamphetamine, tranquilizers, opiates, methadone | Primary source of syringes past 12 mos SSP or pharmacy compared to other source | Unsafe disposal of syringes |
| Reed 201922 |
Philadelphia, PA US |
N=571 NA |
Median age: 35 % Male: 78 % AA/Black: 12 % Hispanic: 21 % Other: 3 % White: 64 | Heroin, speedball, powder/crack cocaine, methamphetamine, opioid analgesics, benzodiazepines | Primary source of syringes past 6 mos SSP compared to pharmacy or other source in the past 12 mos | Naloxone distribution or use |
| Riley 201037 |
San Francisco, CA US |
N=105 NA |
Median age: 42 % Male: 67 % AA/Black: 14 % Hispanic: 12 % Other: 18 % White: 51 | Heroin, methamphetamine/speed | Obtained syringes from an SSP or pharmacy in the past 30 days compared to not obtaining syringes from an SSP or pharmacy in the past 30 days | Unsafe disposal of syringes |
| Sherman 200438 |
Baltimore, MD US |
N=294 NA |
Median age: 25 % Male: 58 % AA/Black: 30 % Other: 3 % White: 67 | Heroin, powder/crack cocaine | Safe acquisition of syringes (primarily obtaining syringes from an SSP or pharmacy) compared with unsafe acquisition of syringes (primarily obtaining syringes from other sources) past 6 mos | Unsafe disposal of syringes |
| Spring 202223 |
Multiple UK |
N=2,139 NA |
Mean age: 40 % Male: 72 Race/ethnicity: NR | Heroin, benzodiazepines, others | Past-year contact with SSP compared to no past-year contact with SSP | Naloxone distribution or use |
| Turner-Bicknell 202119 |
Ohio US |
N=NR NA | NR | NR | Before and after implementation of a needs-based distribution model | Naloxone distribution or use |
| Wood 200339 |
Vancouver Canada |
N=587 NA |
Median age: 39 for SSP users; 40 for non-SSP users % Male: 61 % Aboriginal: 32 % non-Aboriginal: 68 | Heroin, cocaine | Use of all-night SSP in past 6 mos (includes people who used the city’s fixed exchange sites) compared to non-use of SSP | Unsafe disposal of syringes |
| Zlotorzynska 201840 |
Multiple US |
N=6,321 NA |
Mean age: 43 % Male: 72 % non-Hispanic White: 45 % Other: 55 | Heroin, speedball, powder/crack cocaine, methamphetamines, prescription opioids, others | Primary syringe source SSP compared to pharmacy past 12 mos | Unsafe disposal of syringes |
| Ecological Studies | ||||||
| Broadhead 199944 |
Connecticut US |
N=NA NA | NA | NR | Time period during operation of an SSP compared to time period following closure of the SSP | Unsafe disposal of syringes |
| Cooper 201248 |
New York, NY US |
N=42 health districts NA | NA | NR | SSP access (percent of each district’s surface area within 1 mile of an SSP site) or access to pharmacies selling syringes by study year | Neighborhood crime rates |
| Doherty 199745,88 |
Baltimore, MD US |
N=32 city blocks 2 yrs | NA | NR | 1 and 2 mos after SSP initiation compared to time prior to SSP initiation | Unsafe disposal of syringes |
| Fuller 200246 |
New York, NY US |
N=27 blocks and 10 pharmacies NA | NA | NR | Time period before and after enactment of ESAP (legal pharmacy sale of syringes without a prescription) | Unsafe disposal of syringes |
| Marx 200049 |
Baltimore, MD US |
N=NA NA | NA | NR | Program areas (within 0.5-mile radius of SSP site) before and after establishment of SSPs and compared to non-program areas | Neighborhood crime rates |
| Oliver 199247 |
Portland, OR US |
N=NA NA | NA | NR | Immediate vicinity of an SSP before and after establishment | Unsafe disposal of syringes |
| Ecological and Cross-Sectional Studies | ||||||
| Levine 201941 |
Miami, FI US |
N=930 NA |
18–29: 12.7% 30–39: 26.3% 40–49: 27.9% ≥50: 33.3% % Male: 78 % Asian or Pacific Islander: 1 % Hispanic: 40 % Multiple races/Other: 1 % Native American: 2 % non-Hispanic Black: 32 % non-Hispanic White: 26 | NR | City residence pre- and post-implementation of the SSP | Unsafe disposal of syringes |
| Tookes 201242 |
Multiple US |
N=1,050 NA |
San Francisco: 18–29: 6% 30–39: 18% 40–49: 41% ≥50: 35% % Male: 73 % Asian or Pacific Islander: < 1 % Hispanic: 10 % Multiple races/Other: 5 % Native American: 4 % non-Hispanic Black: 37 % non-Hispanic White: 44 Miami: 18–29: 8% 30–39: 20% 40–49: 31% ≥50: 45% % Male: 79 % Asian or Pacific Islander: 1 % Hispanic: 40 % Native American: 1 % non-Hispanic Black: 36 % non-Hispanic White: 23 | NR | City with an SSP and residents of city with an SSP compared to city without an SSP and residents of city without an SSP | Unsafe disposal of syringes |
| Wenger 201143 |
San Francisco, CA US |
N=602 NA | NR | NR | Syringe source SSP or pharmacy prior 6 mos compared to other source | Unsafe disposal of syringes |
Notes.
- a
This study was included for a comparison relevant to KQ1a
- b
Data for the outcome of interest were cross-sectional.
Abbreviations. AA=African-American; AIDS=acquired immunodeficiency syndrome; ESAP=Expanded Syringe Access Demonstration Program; HIV=human immunodeficiency virus; MMT=methadone maintenance treatment; mos=months; NA=not applicable; NR=not reported; OAT=opioid agonist therapy; RCT=randomized controlled trial; SSP=syringe services program; wks=weeks.
RISK OF BIAS ASSESSMENTS
RANDOMIZED CONTROLLED TRIALS (ROB-2)
| Trial Name or Author Year | Bias from randomization process | Bias from deviation from intended interventions (Assignment) | Bias from deviation from intended interventions (Adherence) | Bias from missing outcome data | Bias in measurement of outcome | Bias in selection of reported result | Overall risk of bias (Low, Some concerns, High) |
|---|---|---|---|---|---|---|---|
| Braback 201685 |
Low Computer generated block randomization with allocation concealed |
Some concerns Participants were likely unblinded, unclear if carers were blinded. Unclear if there were deviations in intervention. |
Some concerns Participants were likely unblinded, unclear if carers were blinded. Intervention occurred right after initial assessment, so likely adhered to. |
Low Low number of dropouts and regarded as non-attenders |
Low Outcome measured as showing up for treatment in both groups. |
Low Main outcome reported | Some concerns |
| Fisher 20033 |
Low Concealed randomization by a separate person |
Some concerns Patients and intervention administrators unblinded at time of giving intervention. Unclear if there were deviations in intervention. |
Some concerns Participants were likely unblinded, unclear if carers were blinded. Intervention occurred right after initial assessment, so likely adhered to. |
Some concerns Unclear what the “305 complete observations” in the GLM corresponds to in terms of patients assessed. 81% had at least 1 follow-up. No difference in baseline variables between those who completed at least 1 follow-up and those completely lost to follow-up. |
Some concerns Injection frequency assessed by RBA in interview, potential for recall bias based on intervention. |
Low Main outcome reported | Some concerns |
Abbreviations. GLM=generalized linear model; RBA=Risk Behavior Assessment.
COHORT STUDIES (ROBINS-I)
| Study Name or Author Year | Bias due to confounding | Selection bias | Bias in classification of interventions | Bias due to departures from intended interventions | Bias due to measurement of outcomes | Bias due to missing data | Bias in the selection of reported results | Overall risk of bias (Low, Moderate, Serious, Critical, No Information) |
|---|---|---|---|---|---|---|---|---|
| Brooner 1998;28 Neufeld 200887 |
Unclear Analyses controlled for baseline measures (sociodemographics, drug and psychiatric disorders), but likely some residual confounding based on high # of differences at baseline in measured variables. |
Low Includes all who presented for treatment during timeframe. |
Low Intervention classified as referral source before treatment started. |
Low “Intervention” is referral source, so likely no overlap/departures. |
Low Retention in treatment objective measurement. Drug use confirmed by urinalysis. |
Low Missing data for urinalysis results only. Analyses conducted without missing data and coding all missing as “positive.” |
Low All prespecified results appear to be reported. | Unclear |
| Hagan 20004 |
Unclear Differences between groups in injection characteristics, adjusted for different variables in different analyses. |
Low Includes sample of IDUs from several recruitment points over time. |
Low Classified SSP use over follow-up period into distinct categories based on when SSP use started/stopped. |
Low Classification of SSP use over time captures changes in use over the follow-up period. |
Low Standard questionnaire administered by trained interviewers at all time points. |
Unclear 78% completed follow-up and were included in sample, unclear if any differences between those without follow-up. |
Low All prespecified results appear to be reported. | Unclear |
| Hartgers 19895 |
Unclear Differences between groups at baseline in injecting and treatment variables. Includes a logistic regression controlling for some variables for borrowing outcome at first interview. |
Low Includes SSP attenders and non-attenders from same geographical region during recruitment. |
Low Classified SSP use over follow-up period into distinct categories based on SSP use. |
Low Classification of SSP use over time captures changes in use over the follow-up period. |
Low Standard questionnaire administered by trained interviewers at all time points. |
High 41% completed second interview, others omitted from follow-up analysis. |
Low All prespecified results appear to be reported. | High |
| Huo 20069 |
Unclear Unclear baseline differences between groups, but did adjust for injecting variables, drug treatment, and age. |
Unclear One SSP site had different recruitment start and follow-up duration. Adjusted for follow-up duration in analyses. Non-SSP users recruited by different people than SSP users. |
Low Classified by SSP use, which was based off neighborhood. Excluded small percentage of participants in neighborhood w/o SSP who travelled to SSP. |
Unclear Does not appear to account for starting/stopping SSP use over follow-up period. |
Low Standard questionnaire administered by trained interviewers at all time points. |
Unclear Excluded participants without at least 1 follow-up (17%), but attrition analysis showed no difference between groups in baseline injection frequency. |
Low All prespecified results appear to be reported. | Unclear |
| Kuo 200326 |
Unclear Baseline variables by SSP use not reported but does adjust for some demographics and other variables. |
Low Includes all referred to LAAM program, except for a small proportion who did not have SSP data. |
Unclear All patients were enrolled in SSP but classifies use as number of visits per month. |
Low Accounts for changes in SSP use by using a variable of “# SSP visits per month.” |
Unclear Doesn’t specifically describe how SSP visit data was collected. |
Unclear Describes level and management of missing urinalysis data, but level and handling of missing data for other variables not described. |
Low All prespecified results appear to be reported. | Unclear |
| Latkin 200625 |
Unclear Baseline variables by SSP use not reported but does adjust for demographics and drug use variables. |
High Appears that 30% without follow-up data were excluded from the study, but unclear proportion among IDUs. |
Low Classified as SSP use within the past 6 months in standard survey responses. |
Unclear New use of SSP or stopping SSP use during follow-up does not appear to be evaluated. |
Low Standard questionnaire administered by trained interviewers at all time points. |
Unclear Excluded participants without follow-up, handling of other missing data not described. |
Low All prespecified results appear to be reported. | High |
| Marmor 20006 |
High Unclear differences at baseline between SSP users and non-users and no adjustment for any variables. |
High Excluded 45% of eligible participants without 4 interviews. Did not differ on most variables but did differ in age and use of methadone maintenance and shooting galleries. |
Low Classified SSP users by use over time. |
Low Classification of SSP use over time captures changes in use over the follow-up period. |
Low Interviewer-administered questionnaires at all visits. |
Unclear Excluded participants without 4 follow-up visits, handling of other missing data not described. |
Low All prespecified results appear to be reported. | High |
| Monterroso 20007 |
Unclear Unclear differences at baseline between SSP users and non-users. Unclear if SSP use analysis is adjusted. |
Low Includes sample of IDUs from several recruitment points over time period. |
Unclear Question around SSP use and classification of use not well described. |
Unclear Mentions “consistent users” reported SSP use at 2 visits, but other classification of changes over time not described. |
Low Interviewer-administered questionnaires at all visits. |
High Excluded 39% of participants that did not have follow-up. Similar on most characteristics, but more likely to be homeless. |
Low All prespecified results appear to be reported. | High |
| Schoenbaum 19968 |
High Differences at baseline in drug use treatment, no adjustment for any confounders for outcome analyses. |
Low Includes sample of IDUs recruited over time period. | Unclear Classified as “ever” using SSP or “never” using SSP based on interviews, but intervention changed from illegal SSP to legal SSP over study period. |
Low Classification of SSP use over time captures changes in use over the follow-up period. |
Low Interviewer-administered questionnaires at all visits. |
High For prospective analyses excluded 36% without full follow-up data. |
Low All prespecified results appear to be reported. | High |
| Strathdee 1999;27 Shah 200086 |
Unclear Baseline variables by SSP use not reported but does adjust for demographics and drug use variables. |
High Excluded 50% of original sample who did not inject from enrollment to post-SSP timeframe, but initial inclusion criteria required drug use from 1977. |
Unclear SSP variable not well described, unclear if it is any visit over the timeframe. |
Unclear SSP variable not well described, unclear if it accounts for potential changes in SSP use over time. |
Low Interviewer-administered questionnaires at all visits. |
Unclear Individuals who were lost to follow-up were censored. Unclear how many (says “ie, 10%” but unclear if this is the actual % that were censored). |
Low All prespecified results appear to be reported. | High |
Abbreviations. IDU=injection drug user; LAAM=levomethadyl acetate hydrochloride; SSP=syringe services program.
UNCONTROLLED PRE-POST STUDIES (ROBINS-I)
| Study Name or Author Year | Bias due to confounding | Selection bias | Bias in classification of interventions | Bias due to departures from intended interventions | Bias due to measurement of outcomes | Bias due to missing data | Bias in the selection of reported results | Overall risk of bias (Low, Moderate, Serious, Critical, No Information) |
|---|---|---|---|---|---|---|---|---|
| Bartholomew 202110 |
Unclear Used GEE to account for some potential confounders but did not have multiple pre-intervention measurements. |
High Only included 12% of total cohort with 2 follow-up assessments, differences between baseline and follow-up groups. |
Low Timepoints based on assessments completed at SSP. |
Unclear Time between assessments varied and was based on SSP use. |
Low Methods of data collection similar across timepoints after initial enrollment. |
Unclear Excluded participants without 2 visits, level of other missing data unclear. |
Low All relevant outcomes appear to be reported. | High |
| Cox 200011 |
High Single initial measurement, no adjustment for time trends. |
Unclear Only included 28% of those invited to participate. Unclear how many completed baseline and no follow-up and unclear differences between those included and excluded. |
Low Timepoints based on initial and follow-up visits. |
Unclear Defines follow-up at 3 months, but unclear adherence to this timing for all participants. Unclear frequency of SSP use. |
Low Structured questionnaires by trained interviewers at both timepoints. |
Unclear Missing data appear to be excluded from analyses for individual outcomes. |
Low All relevant outcomes appear to be reported. | High |
| Donoghoe 198912 |
High Single initial measurement, no adjustment for time trends, and comparison group of non-attenders showed differences. |
High Only included 6% of the initial cohort, differences between those who completed 2nd interview and those who did not. |
Low Timepoints based on initial and follow-up visits. |
Unclear Defines follow-up at 2–4 months, but unclear adherence to this timing for all participants. Unclear frequency of SSP use. |
Low Structured questionnaires by staff at both timepoints. |
Unclear Excluded participants without 2 visits, level and handling of other missing data unclear. |
Low All relevant outcomes appear to be reported. | High |
| Iversen 201313 |
Unclear Appears only to have adjustment for HCV incidence outcome. Accounts for time trends by creating separate groups by timeframe. |
High Excluded high proportion of original sample without matching. Included 60% of the matched sample with negative HCV tests. Differences between those included and excluded. |
Low Timepoints based on repeat surveys and had to be within 1-year. |
Unclear Follow-up had to be within 1-year, but unclear how variable time between records was. Unclear frequency of SSP use. |
Low Same survey used at all time points. |
Unclear Out of original sample, excluded 17% without full data. |
Low All relevant outcomes appear to be reported. | High |
| Patel 201814 |
Unclear Single initial measurement, but timeframe within about 1 year. |
Unclear Included 62% of original sample with at least 2 visits. Unclear differences between those included and excluded. |
Low Timepoints based on visits and had to be at least 7 days apart. |
Unclear Follow-up had to be at least 7 days apart, but unclear how variable time between surveys was. Unclear frequency of SSP use. |
Low Structured questionnaires by staff at both timepoints. |
Low Mentions missing data on only 2 participants. |
Low All relevant outcomes appear to be reported. | Unclear |
| Schechter 199915 |
Unclear Single initial measurement, no adjustment for time trends but injection frequency outcome analysis limited to post-need exchange timeframe. |
Unclear Included 80% of original sample with 1 follow-up visit. Unclear differences between those included and excluded. |
Low Timepoints based on initial and follow-up visits. |
Unclear Unclear how timing of follow-up varied across participants. Classified frequent and infrequent SSP users. |
Low Structured questionnaires by staff at both timepoints. |
Unclear Unclear level and handling of missing data. |
Low All relevant outcomes appear to be reported. | Unclear |
| Vertefeuille 200016 |
Unclear Single initial measurement, no adjustment for time trends, but timeframe within 6 months. |
Unclear Every 7th enrollee invited, differences between those enrolled and not enrolled in some demographics and drug use variables. |
Low Timepoints based on initial and follow-up visits. |
Unclear Follow-up at 6 months, but unclear frequency of SSP use. |
Low Structured questionnaires by staff at both timepoints. |
High Only had follow-up data for 52% of enrollees. Drug injection frequency analysis limited to those with follow-up and who were HIV positive at baseline. |
Low All relevant outcomes appear to be reported. | High |
| Vlahov 199717 |
Unclear Single initial measurement, no adjustment for time trends, but timeframe within 2 weeks. |
Unclear Every 7th enrollee invited, differences between those enrolled and not enrolled in gender and some drug use variables. |
Low Timepoints based on initial and follow-up visits. |
Unclear Follow-up at 2 weeks, but unclear frequency of SSP use. |
Low Structured questionnaires by staff at both timepoints. |
Unclear 79% had follow-up data at 2 weeks, but difference in sharing needles between those with and without follow-up. |
Low All relevant outcomes appear to be reported. | Unclear |
| Vogt 199818 |
Unclear Single initial measurement, no adjustment for time trends, unclear follow-up. |
Unclear Random selection of clients, but unclear how clients were randomly selected and if they differed from those not selected. |
Low Timepoints based on initial and follow-up visits. |
Unclear Unclear timing of follow-up visits and unclear frequency of SSP use. |
Unclear Unclear if structured questionnaire used for interviews. |
High Repeat interviews with 51% of participants included for follow-up analysis. Unclear differences between those with and without follow-up. |
Low All relevant outcomes appear to be reported. | High |
Abbreviations. GEE=generalized estimating equations; HCV=hepatitis C virus; HIV=human immunodeficiency virus; IDU=injection drug use; SSP=syringe services program.
SYSTEMATIC REVIEWS (ROBIS)
| Study Name or Author Year | Study Eligibility Criteria | Identification and Selection of Studies | Data Collection and Study Appraisal | Synthesis and Findings | Overall Risk of Bias |
|---|---|---|---|---|---|
| Jones 20102 |
Low Reasonable and mostly clearly defined eligibility criteria. Do not explicitly describe comparator criteria but specify included study designs. |
Low Multiple databases searched. Searches included both key words and controlled vocabulary, but full search syntax is not provided. Date limit of 1990 seems roughly in line with start of research on SSPs, but some studies may have been published prior to this date. Hand-searched reference lists of included studies. No grey literature searching conducted. Dual independent study selection indicated for title/abstract screening but not explicitly stated for full-text review. |
Low A single reviewer abstracted data and assessed study quality, checked by another reviewer. Study quality was assessed using appropriate criteria. |
Unclear Meta-analysis was not conducted due to variability between studies. Narrative synthesis did not address methodological quality; this is addressed in the discussion section, but individual quality assessments are not included. | Low |
| Palmateer 20221 |
Low Reasonable and clearly defined eligibility criteria. Detailed criteria provided in Appendix. |
Low Update to a 2011 review of reviews. Searches included an initial search for systematic review and additional searches for primary studies when indicated. Multiple databases searched. Conducted grey literature searches and hand searched reference lists of included records. Searches included key words and controlled vocabulary terms and full syntax is provided in the Appendix. |
Unclear Dual independent study selection, data abstraction, and risk of bias assessment. Risk of bias of systematic reviews was assessed using appropriate criteria. Risk of bias of primary studies was not assessed; instead, study design was considered an indicator of quality. |
Low Rated the strength of the evidence for each intervention and outcome using a framework that is clearly described in the review. | Low |
Abbreviations. SSP=syringe services program.
STRENGTH OF EVIDENCE ASSESSMENTS FOR KQ1 PRIMARY STUDIES
| Outcome | Studies | Study Limitations | Directness | Consistency | Precision | Rating and Summary of Evidence |
|---|---|---|---|---|---|---|
| Injection frequency | 1 RCT,3 6 cohort,4–9 and 9 pre-post10–18 studies | Unclear to high | Direct | Consistent | Precise |
Low SSP use does not appear to be associated with an increase in injection frequency. |
| Naloxone distribution | 1 serial cross-sectional19 and 4 cross-sectional20–23 studies | High | Indirect | Consistent | Imprecise |
Low SSP use may be associated with higher rates of carrying naloxone. |
| Overdose education | 2 cross-sectional studies21,24 | High | Indirect | Consistent | Imprecise |
Low SSP use may be associated with receipt of overdose education. |
| Linkage to SUD treatment and utilization of treatment services | 6 cohort4,5,25–28 and 3 pre-post11,16,17 studies | Unclear to high | Direct | Consistent | Precise |
Low SSP use may be associated with increased treatment linkage and/or use of treatment services compared to no SSP use (or less use). |
| Syringe disposal | 1 RCT,29 2 pre-post,16,17 11 cross-sectional,30–40 and 7 ecological41–47 studies | Unclear to high | Direct | Consistent | Imprecise |
Low SSP use and/or presence of an SSP does not appear to be associated with an increase unsafe syringe disposal practices. |
| Neighborhood crime rates | 2 ecological studies48,49 | High | Direct | Inconsistent | Imprecise |
Low Presence of an SSP does not appear to be associated with an increase in neighborhood crime rates. |
INCLUDED SYSTEMATIC REVIEWS
| Citation |
|---|
| Abdul-Quader AS, Feelemyer J, Modi S, et al Effectiveness of structural-level needle/syringe programs to reduce HCV and HIV infection among people who inject drugs: A systematic review. AIDS and Behavior. 2013;17(9):2878–2892. [PMC free article: PMC6509353] [PubMed: 23975473] |
| Aspinall EJ, Nambiar D, Goldberg DJ, et al Are needle and syringe programmes associated with a reduction in HIV transmission among people who inject drugs: a systematic review and meta-analysis. International journal of epidemiology. 2014;43(1):235–248. [PubMed: 24374889] |
| Davis SM, Daily S, Kristjansson AL, et al Needle exchange programs for the prevention of hepatitis C virus infection in people who inject drugs: a systematic review with meta-analysis. Harm reduction journal. 2017;14(1):25. [PMC free article: PMC5436422] [PubMed: 28514954] |
| European Centre for Disease Prevention and Control. Systematic Review on the Prevention and Control of Blood-Borne Viruses in Prison Settings.; 2018. |
| Fernandes RM, Cary M, Duarte G, et al Effectiveness of needle and syringe Programmes in people who inject drugs - An overview of systematic reviews. BMC public health. 2017;17(1):309. [PMC free article: PMC5387338] [PubMed: 28399843] |
| Johnson WD, Rivadeneira N, Adegbite AH, et al Human Immunodeficiency Virus Prevention for People Who Use Drugs: Overview of Reviews and the ICOS of PICOS. The Journal of infectious diseases. 2020;222(S). [PubMed: 32877540] |
| Jones L, Pickering L, Sumnall H, McVeigh J, Bellis MA. Optimal provision of needle and syringe programmes for injecting drug users: A systematic review. The International journal on drug policy. 2010;21(5):335–342. [PubMed: 20189375] |
| Lazarus JV, Safreed-Harmon K, Hetherington KL, et al Health Outcomes for Clients of Needle and Syringe Programs in Prisons. Epidemiologic reviews. 2018;40(1):96–104. [PubMed: 29659780] |
| MacArthur GJ, van Velzen E, Palmateer N, et al Interventions to prevent HIV and Hepatitis C in people who inject drugs: A review of reviews to assess evidence of effectiveness. International Journal of Drug Policy. 2014;25(1):34–52. [PubMed: 23973009] |
| Mir MU, Akhtar F, Zhang M, Thomas NJ, Shao H. A Meta-analysis of the Association Between Needle Exchange Programs and HIV Seroconversion Among Injection Drug Users. Cureus. 2018;10(9). [PMC free article: PMC6248663] [PubMed: 30473961] |
| Palmateer N, Hamill V, Bergenstrom A, et al Interventions to prevent HIV and Hepatitis C among people who inject drugs: Latest evidence of effectiveness from a systematic review (2011 to 2020). The International journal on drug policy. 2022;109:103872. [PubMed: 36202039] |
| Palmateer N, Kimber J, Hickman M, Hutchinson S, Rhodes T, Goldberg D. Evidence for the effectiveness of sterile injecting equipment provision in preventing hepatitis C and human immunodeficiency virus transmission among injecting drug users: A review of reviews. Addiction. 2010;105(5):844–859. [PubMed: 20219055] |
| Platt L, Minozzi S, Reed J, et al Needle syringe programmes and opioid substitution therapy for preventing hepatitis C transmission in people who inject drugs. The Cochrane database of systematic reviews. 2017;9. [PMC free article: PMC5621373] [PubMed: 28922449] |
| Puzhko S, Eisenberg MJ, Filion KB, et al Effectiveness of Interventions for Prevention of Common Infections Among Opioid Users: A Systematic Review of Systematic Reviews. Frontiers in public health. 2022;10:749033. [PMC free article: PMC8901608] [PubMed: 35273933] |
| Sawangjit R, Khan TM, Chaiyakunapruk N. Effectiveness of pharmacy-based needle/syringe exchange programme for people who inject drugs: A systematic review and meta-analysis. Addiction. 2017;112(2):236–247. [PubMed: 27566970] |
| Thomson K, Hillier-Brown F, Walton N, Bilaj M, Bambra C, Todd A. The effects of community pharmacy-delivered public health interventions on population health and health inequalities: A review of reviews. Preventive medicine. 2019;124:98–109. [PubMed: 30959070] |
| Wright NM J, Tompkins CN E. A review of the evidence for the effectiveness of primary prevention interventions for hepatitis C among injecting drug users. Harm reduction journal. 2006;3:27. [PMC free article: PMC1569828] [PubMed: 16956393] |
PEER REVIEW COMMENTS AND RESPONSES
| Comment # | Reviewer # | Comment | Author Response |
|---|---|---|---|
| Are the objectives, scope, and methods for this review clearly described? | |||
| 1 | 1 | Yes | None |
| 2 | 2 | Yes | None |
| 3 | 3 | Yes | None |
| 4 | 5 | Yes | None |
| 5 | 6 | Yes | None |
| 6 | 7 | Yes | None |
| 7 | 8 | Yes | None |
| Is there any indication of bias in our synthesis of the evidence? | |||
| 8 | 1 | No | None |
| 9 | 2 | No | None |
| 10 | 3 | No | None |
| 11 | 5 | No | None |
| 12 | 6 | No | None |
| 13 | 7 | No | None |
| 14 | 8 | No | None |
| Are there any published or unpublished studies that we may have overlooked? | |||
| 15 | 1 | No | |
| 16 | 2 | Yes - Analisa Packham, Syringe exchange programs and harm reduction: New evidence in the wake of the opioid epidemic, Journal of Public Economics, Volume 215, 2022, 104733, ISSN 0047-2727 | Thank you for bringing this study to our attention. It does not meet criteria for inclusion because we did not review evidence from primary studies for HIV incidence or prevalence and drug-related mortality was not one of our pre-specified outcomes. However, this study and the response it inspired from other researchers (Lambdin 2023) is relevant to mention in the discussion section of our review as an example of how misinterpreting data can lead to unjustified conclusions regarding SSP use and health outcomes. |
| 17 | 3 | No | None |
| 18 | 5 | Yes - https://doi | Thank you for highlighting these citations. The first study (Strathdee 1999) is included in our review and synthesis. The second study (Surratt 2020) is also included but was not prioritized for synthesis because it is cross-sectional and we focused on longitudinal evidence for the outcome of treatment linkages. |
| 19 | 6 | No | None |
| 20 | 7 | No | None |
| 21 | 8 | Yes - Packham A. Syringe exchange programs and harm reduction: New evidence in the wake of the opioid epidemic. J Public Economics 2022; 215. https://doi | Thank you. Please see our response to comment #16. |
| Additional suggestions or comments can be provided below. | |||
| 22 | 1 | Table 5: It is not correct that LAAM is no longer approved in the U.S. It is still FDA approved. It was taken off the market voluntarily by the manufacturer because of poor sales. It is the case that it is no longer approved in Europe. | Thank you for making note of this error. We have revised the text to state that LAAM is an opioid agonist no longer on the US market. |
| 23 | 1 | Table 5: Text in the Neufeld row seems incomplete. | Thank you for this comment. Brooner 1998 and Neufeld 2008 are 2 publications associated with a single study and the results are described in a single row. We have edited the study column to improve clarity. |
| 24 | 1 | Table 6: Dasgupta row. What is the “public health response?” | Thank you for this comment. We have added a footnote to specify that the public health response included establishment of the state’s first legal SSP. |
| 25 | 1 | Page 25, line 37: Change “along” to “alone.” Table 9, Harm Reduction row: Remove either “detox” or “detoxification.” | Thank you for making note of these errors. We have made the recommended corrections. |
| 26 | 1 | Page 27, line 35: Change “justice” to “legal.” The supposed “justice” system is anything but “just.” | Thank you for this recommendation. We have revised the text to state “legal system.” |
| 27 | 1 | Page 28, lines 56–57: The trend toward non-injecting of fentanyl may have been short lived. Increasingly, fentanyl is showing up in powder form which is likely to be injected. | Thank you for this comment. We removed the specific reference to fentanyl and instead highlight that drug use patterns are constantly evolving, and future research could help identify best practices for SSPs to respond and maintain relevance. |
| 28 | 2 |
Did the ESP review the extant literature for any association between SSP use and substance use? It was included in the SOW we reviewed in late Feb of this year that included the following outcomes: Drug use behaviors (e.g., sharing, borrowing, lending, reuse, or unsafe disposal of syringes; amount, speed, or frequency of use; etc); knowledge of overdose risk; naloxone distribution/use; linkage to treatment for substance use disorder, HIV/HCV, or other medical needs, or to HIV pre-exposure prophylaxis; utilization of referred services. Please note that one recent study (albeit with several methodological flaws) suggests an association between SSP implementation and increases in opioid use: “https://www “I note that my findings imply that SEPs do little to reduce drug overdoses and may even exacerbate opioid abuse and misuse. However, the results do not suggest that SEPs are ineffective at curbing addiction for all clients. Moreover, prescription drugs, such as Buprenorphine that reduce symptoms of opiate addiction and withdrawal, or other opiate antagonists, which work in the brain to prevent opiate effects and decreases the desire to take opiate, could be one way for SEPs to mitigate clients’ opioid dependence in the future.” |
Thank you for your comments. The association between SSPs and substance use was partly addressed through our inclusion of injection frequency, but we did not specifically review evidence on whether use of SSPs is associated with more or less frequent drug use overall. This decision reflects the review’s focus on the role of SSPs in harm reduction. While we reviewed evidence related to naloxone distribution and overdose education, we did not include drug-related mortality as an outcome of interest. Regarding the Packham 2022 study, please see our response to comment #16. |
| 29 | 2 | [In second bullet of Key Findings, add ‘s’ to ‘encourage’ and ‘facilitate.’] | We have left the wording of the key findings as written, since the phrases regarding naloxone, overdose education, and treatment referral follow “may.” |
| 30 | 2 | [Insert citation substantiating first statement of executive summary.] | To be consistent with our usual style, we did not include citations in the executive summary but did include citations related to increased drug use and HIV/HCV in the background section. |
| 31 | 2 | Please define “needs-based” SSP. Are participants required to submit used syringes to get sterile ones? If not, needs-based seems synonymous with the “distribution” model of SSPs. | Thank you for this comment. In the section on SSP models, we have revised the text to use more precise language referring to syringe distribution policies (which may be needs-based or offer a set number of syringes regardless of how many are returned) and exchange policies (which require returning used syringes). |
| 32 | 2 | Are SSPs that use a distribution model (no exchange) considered “more permissive?” | Thank you for this comment. Please see our response to comment #32. We have revised this section to improve clarity regarding the term “permissive.” |
| 33 | 3 | One area that is not discussed but may be equally important is acquired bacterial infections from using clean needles when the skin has not been cleansed using an alcohol wipe or other procedure. Cellulitis is prevalent among PWID and can lead to severe adverse outcomes. This reviewer realizes that this may not be within scope, however, due to the newest issue - fentanyl adulterated with xylazine wound issues is becoming a hot topic area. | Thank you for this comment. We agree that bacterial infections related to injection-drug use are an important outcome, but this outcome was not within the scope of this review. In the Future Research section, we added a reference to the emergence of xylazine and importance of studying best practices for SSPs to provide PWID with information and tools to reduce xylazine-specific harms. |
| 34 | 5 | This was a well thought out review recognizing that the research methodology is mixed. The review was concise and appropriately addressed the limitation as well as areas for future research. If I might suggest also adding improving in HIV/HCV treatment as part of linkage to care. For example, a pilot study done in 2003 points to the idea that “health services based on needle exchange may enhance access to HAART among out-of-treatment HIV-infected IDUs” (https://doi |
Thank you for your comments. We included linkage to HIV treatment as an outcome but did not identify any studies that met criteria for inclusion in our synthesis. We did not include studies evaluating HIV or HCV treatment services co-located with SSPs as stand-alone interventions, which the study by Altice 2003 is an example of. We realize that the body of literature on co-located treatment services is of high interest, but reviewing this evidence would have made the scope of this review unfeasibly large. Thank you for providing the link to the scoping review. We hand-searched this publication for relevant references as part of our search process. |
| 35 | 6 | This is my first review of the “Effectiveness of Syringe Service Programs: A Systematic Review”. Page numbers reference the page in the PDF document. Generally, the title and corollary mentions of SSPs should be referred to as Syringe Services Programs (missing “s” in services throughout the document: cf. https://www |
Thank you for your comments. We have corrected the text to refer to Syringe Services Programs (plural) throughout the document. We did not specifically examine evidence related to drug testing strips. We would have included evidence regarding drug testing strips as a component of harm reduction services provided at SSPs but did not identify such evidence. We specifically highlighted the Office of National Drug Control Policy (ONDCP) because this review was requested in part to inform ONDCP efforts. We added a sentence to the beginning of the Discussion to highlight that harm reduction is a goal of VA Offices of Mental Health and Suicide Prevention, Research and Development, and Specialty Care Services. |
| 36 | 6 | 1. Page 9, line 10—Key Findings—“carriage” is an uncommon word used regarding naloxone—consider changing to “carrying naloxone” (also on page 10, line 32; page 30, line 50; page 31, line 14; page 40, line 14) | Thank you for this suggestion. We have revised the text to state “carrying” or “possession” of naloxone rather than “carriage.” |
| 37 | 6 | 2. Page 10—it may be helpful to clarify the difference between “Linkage to SUD treatment and utilization of treatment services” and “Additional harm reduction and referral services” (the latter seems to combine a number of services—e.g., motivation interviewing, case management, pharmacy-based SSP referral which seem to be different things). In general, these seem like blended concepts. Not sure if it would help to better explain the universe of what is included. | Thank you for this comment. We reorganized the findings in this table to improve clarity and removed the row describing “Additional harm reduction and referral services.” These findings are best described in the results section where additional context is provided. |
| 38 | 6 | 3. Page 15, lines 11–15—suggest using the term “stimulants” to refer to cocaine and psychostimulants (latter is primarily methamphetamine). Even in reference #4, psychostimulants are reported separately from cocaine (see Figure 1, https://www | Thank you for this suggestion. We have revised the text to use the term “stimulants.” |
| 39 | 6 | 4. Page 16, lines 5–9—not sure if you want to use the NASEN reference; https://www | Thank you for this suggestion. We have updated this text to reflect current data from NASEN. |
| 40 | 6 | 5. Page 16, line 16—There is also funding from OMHSP’s SUD program to fund harm reduction coordinators (should check with them about that sentence); also the “(PMOP)” should come after Program | Thank you for this comment. Because this paragraph is specific to SSPs funding, we did not expand on other VHA initiatives to promote harm reduction (of which there are many). We have corrected the placement of the PMOP acronym. |
| 41 | 6 | 6. Page 20, line 44—based on the 95% CI that is non-significant right? Not “bordered on non-significant” but actually not statistically significant since it include 1.0 | Thank you for this comment. We have corrected this statement to say “bordered on significance.” |
| 42 | 6 | 7. Page 22, line 31—superscript after 5 is underlined and doesn’t need to be | Thank you for making note of this error. We have corrected this text. |
| 43 | 6 | 8. Injection Frequency/Table 3—Bartholomew 2021 seems to indicate an increased average # of injections per day. So does Patel 2018. That is 2 of the 16 studies included in this section. Bringing this up in case it needs to be addressed to fend off potential critics. | Thank you for this comment. We added to the section on injection frequency to discuss these 2 studies specifically and provide more context for their findings. |
| 44 | 6 | 9. Page 30, line 14—what is NEP? I don’t see it defined anywhere. | Thank you for this comment. NEP refers to “needle exchange program.” We have changed this reference to “NEP” to “SSP” instead to be consistent with the language of our review. |
| 45 | 6 | 10. Page 32, lines 11–12—The confidence interval includes 1.0, is this not statistically significant? (same as Page 33, line 11) | Thank you for this comment. You are correct that this finding was not statistically significant. We have revised the text to include that point. |
| 46 | 6 | 11. Page 32, line 30—square typo | Thank you for making note of this error. We have corrected this text. |
| 47 | 6 | 12. Page 32, line 49–50—this is not statistically significant right? | Thank you for this comment. You are correct that this finding was not statistically significant. In most cases, we do not comment on statistical significance in the table (regardless of whether a given finding was significant or non-significant) for the sake of brevity. |
| 48 | 6 | 13. Page 32, line 55—this is not statistically significant right? | Please see the response to comment # 47. |
| 49 | 6 | 14. Page 33, line 21—IVDU=Intravenous Drug Use right? | Thank you for making note of this error. We have corrected this text. |
| 50 | 6 | 15. Page 34, line 5—this is not statistically significant right? | Please see the response to comment # 47. |
| 51 | 6 | 16. Page 35, lines 6–7—is there an extra number in the 2nd set of parentheses? | Thank you for this comment. We have added a footnote to specify that counts were made at 2 time points pre-SSP and 3 time points post-SSP. |
| 52 | 6 | 17. Page 36 line 37—think “along” should be “alone”; should probably be a comma after “meta-analysis” as well | Thank you for making note of these errors. We have corrected the text. |
| 53 | 7 |
Comments to the author: This is a timely and important systematic review of the association of syringe service programs and relevant outcomes such as HIV and HCV prevalence and incidence. This report has a potential for high impact by encouraging the implementation of syringe service programs in the VA. There are several strengths to this review which include clear writing, rigorous and thorough methods, use of person-first language, and including a comprehensive group of outcomes. | Thank you for this comment. |
| 54 | 7 |
Minor comments: 1. The statements from public health organization and professional society regarding syringe service programs are greatly appreciated. The authors may also consider adding statements from the American Academy of Addiction Psychiatry (AAAP) and American Society of Addiction Medicine (ASAM). | Thank you for this suggestion. We have added a policy statement from AAAP but could not locate a current statement from ASAM. |
| 55 | 7 | 2. Including a description of the cost-benefits of implementing syringe service programs may strengthen the discussion, given the relatively low cost of syringes. | Thank you for this suggestion. We revised the Discussion text to specifically highlight the CDC’s statements regarding SSPs as “cost-saving.” |
| 56 | 8 |
1. p. 9 (pdf p. 20) – Re: Reference 24 Palmateer et al. Int J Drug Policy. 2022; 109:103872. Regarding conclusion that pooled studies did not show an effect on HCV transmission, please consider commenting on whether:
| Thank you for your comments. We did not directly assess the quality of evidence for this outcome because we relied on the evidence synthesis conducted by the Palmateer et al. review of reviews, which we assessed to have a low overall risk of bias based on the ROBIS tool. The Palmateer et al. review in turn primarily relied on a Cochrane review and meta-analysis (Platt et al.). While we are unable to address your comments in detail, we have no reason to suspect that the conclusions reached by Palmateer et al. and Platt et al. were inappropriate. |
| 57 | 8 |
2. p. 11 (pdf p. 22) – Primary studies Please consider comment on the following:
|
Thank you for your comments. Duration of follow-up for primary studies is reported in Table 2. Statistical methods and potential risk of bias due to confounding were evaluated as part of the quality assessment of primary studies (details are located in the Appendix). HIV/HCV testing rates and overdose hospitalizations and deaths were not within the scope of this review. |
- Appendix - Effectiveness of Syringe Services Programs: A Systematic ReviewAppendix - Effectiveness of Syringe Services Programs: A Systematic Review
- tmtc2b [Onychostoma macrolepis]tmtc2b [Onychostoma macrolepis]Gene ID:131524256Gene
Your browsing activity is empty.
Activity recording is turned off.
See more...