Is it time to pay more for low dead space syringes in Myanmar? I think so.
Jamie
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Abstract: Are major reductions in new HIV infections possible with people who inject drugs? The case for low dead-space syringes in highly affected countries
http://www.ncbi.nlm.nih.gov/pubmed/22884539
Int J Drug Policy. 2013 Jan;24(1):1-7.
Zule WA, Cross HE, Stover J, Pretorius C.
Substance Abuse, Treatment, Evaluations and Interventions Program, RTI
International, 3040 Cornwallis Road, Research Triangle Park, NC
27709-2194, United States. zule@rti.org
Circumstantial evidence from laboratory studies, mathematical models,
ecological studies and bio behavioural surveys, suggests that injection-
related HIV epidemics may be averted or reversed if people who inject
drugs (PWID) switch from using high dead-space to using low dead-space
syringes.
In laboratory experiments that simulated the injection process and rinsing
with water, low dead space syringes retained 1000 times less blood than
high dead space syringes.
In mathematical models, switching PWID from high dead space to low dead
space syringes prevents or reverses injection-related HIV epidemics.
No one knows if such an intervention is feasible or what effect it would
have on HIV transmission among PWID. Feasibility studies and randomized
controlled trials (RCTs) will be needed to answer these questions
definitively, but these studies will be very expensive and take years to
complete.
Rather than waiting for them to be completed, we argue for an approach
similar to that used with needle and syringe programs (NSP), which were
promoted and implemented before being tested more rigorously.
Before implementation, rapid assessments that involve PWID will need to be
conducted to ensure buy-in from PWID and other local stakeholders.
This commentary summarizes the existing evidence regarding the protective
effects of low dead space syringes and estimates potential impacts on HIV
transmission; it describes potential barriers to transitioning PWID from
high dead space to low dead space needles and syringes; and it presents
strategies for overcoming these barriers.
Abstract: Could low dead-space syringes really reduce HIV transmission to low levels?
http://www.ncbi.nlm.nih.gov/pubmed/23206493
Int J Drug Policy. 2013 Jan;24(1):8-14.
Could low dead-space syringes really reduce HIV transmission to low
levels?
Vickerman P, Martin NK, Hickman M.
Social and Mathematical Epidemiology group and Centre for Research on
Drugs and Health Behaviour, London School of Hygiene and Tropical
Medicine, London, UK. Peter.Vickerman@Lshtm.ac.uk
Studies published by Zule and colleagues have suggested that use of low
dead-space syringes (LDSS) instead of high dead-space syringes (HDSS) by
injecting drug users (IDUs) could dramatically reduce HIV transmission.
However, evidence is limited because experiments have considered a small
range of syringe types and have been unable to reliably estimate the
efficacy of using LDSS for reducing HIV transmission.
We critically appraise available evidence to determine whether using LDSS
is likely to dramatically reduce HIV transmission. We systematically
review the literature on the dead-space volume of syringes and estimate
the factor difference in blood volume transferred from sharing LDSS or
HDSS. Existing data on the relationship between host viral load and HIV
transmission risk is used to evaluate the likely efficacy of using LDSS
instead of HDSS. An HIV transmission model is used to make conservative
impact projections for switching to using LDSS, and explore the
implications of heterogeneity in IDU transmission risk and syringe
preferences.
Although highly variable, reviewed studies suggest that HDSS have on
average 10 times the dead-space volume of LDSS and could result in
6/54/489 times more blood being transferred after 0/1/2 water rinses.
Assuming a conservative 2-fold increase in HIV transmission risk per 10-
fold increase in infected blood inoculum, HDSS use could be associated
with a mean 1.7/3.6/6.5-fold increase in transmission risk compared to
LDSS for 0/1/2 rinses.
However, even for a low efficacy estimate, modelling suggests that
partially transferring to LDSS use from using HDSS could dramatically
reduce HIV prevalence (generally >33% if LDSS use is 50%), but impact will
depend on IDU behavioural heterogeneity and syringe preference.
Indirect evidence suggests that encouraging HDSS users to use LDSS could
be a powerful HIV prevention strategy. There is an urgent need to evaluate
the real life effectiveness of this strategy.
