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Needle and syringe programs in Yunnan, China yield health and financial return.

Zhang L, Yap L, Xun Z, Wu Z, Wilson DP - BMC Public Health (2011)

Bottom Line: The total $1.04 million spending on NSPs from 2002 to 2008 has resulted in an estimated cost-saving over this period of $1.38-$1.97 million due to the prevention of HIV and the associated costs of care and management.NSPs are not only cost-effective but cost-saving in Yunnan.Significant scale-up of NSPs interventions across China and removal of the societal and political barriers that compromise the effects of NSPs should be a health priority of the Chinese government.

View Article: PubMed Central - HTML - PubMed

Affiliation: National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney, Australia. lzhang@nchecr.unsw.edu.au

ABSTRACT

Background: As a harm reduction strategy in response to HIV epidemics needle and syringes programs (NSPs) were initiated throughout China in 2002. The effectiveness of NSPs in reducing the spread of infection in such an established epidemic is unknown. In this study we use data from Yunnan province, the province most affected by HIV in China, to (1) estimate the population benefits in terms of infections prevented due to the programs; (2) calculate the cost-effectiveness of NSPs.

Methods: We developed a mathematical transmission model, informed by detailed behavioral and program data, which accurately reflected the unique HIV epidemiology among Yunnan injecting drug users (IDUs) in the presence of NSPs. We then used the model to estimate the likely epidemiological and clinical outcomes without NSPs and conducted a health economics analysis to determine the cost-effectiveness of the program.

Results: It is estimated that NSPs in Yunnan have averted approximately 16-20% (5,200-7,500 infections) of the expected HIV cases since 2002 and led to gains of 1,300-1,900 DALYs. The total $1.04 million spending on NSPs from 2002 to 2008 has resulted in an estimated cost-saving over this period of $1.38-$1.97 million due to the prevention of HIV and the associated costs of care and management.

Conclusion: NSPs are not only cost-effective but cost-saving in Yunnan. Significant scale-up of NSPs interventions across China and removal of the societal and political barriers that compromise the effects of NSPs should be a health priority of the Chinese government.

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Results of epidemiological model with IDU population size scaling factor 2.5 times the registered number of IDUs. (a) Extracted published prevalence data [9] and model-based estimates of HIV prevalence among IDUs in Yunnan with and without NSPs; (b) model-based estimates of HIV incidence among IDUs in Yunnan with and without NSPs; (c) Estimated cumulative number of HIV infections averted due to NSPs; (d) Estimated cumulative number of AIDS deaths, people on ART, and people in treatment-eligible stage averted due to NSPs.
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Figure 2: Results of epidemiological model with IDU population size scaling factor 2.5 times the registered number of IDUs. (a) Extracted published prevalence data [9] and model-based estimates of HIV prevalence among IDUs in Yunnan with and without NSPs; (b) model-based estimates of HIV incidence among IDUs in Yunnan with and without NSPs; (c) Estimated cumulative number of HIV infections averted due to NSPs; (d) Estimated cumulative number of AIDS deaths, people on ART, and people in treatment-eligible stage averted due to NSPs.

Mentions: The epidemiological model accurately resembles the epidemiological trends of HIV prevalence in Yunnan during the past decade (Figure 2, 3). The model estimates that according to scaling factor (SF) assumptions of the total IDU population size being 2.5-times (Figure 2) or 4-times (Figure 3) the number of registered IDUs, approximately 20,712 or 37,970 new HIV infections have occurred among IDUs during the period of NSPs, respectively. The model also estimated that NSPs have averted 5,263 (SF = 2.5; 7,541 for SF = 4) new HIV infections which accounts for 20% (SF = 2.5; 16% for SF = 4) of infections without NSPs and resulted in a gain of 1,384 (SF = 2.5; 1,978 for SF = 4) DALYs, and will gain a further 12,753 (SF = 2.5; 18,272 for SF = 4) DALYs in the patients' lifetimes. In addition, an extra 849 (SF = 2.5; 1,213 for SF = 4) person-years in the AIDS stage have likely been averted by NSPs and a further 15,347 (SF = 2.5; 21,990 for SF = 4) person-years will be saved in the patients' lifetimes due to the lasting effects of the implemented program. NSPs have led to an estimated 41% (SF = 2.5; 32% for SF = 4) decline in annual HIV incidence in 2008.


Needle and syringe programs in Yunnan, China yield health and financial return.

Zhang L, Yap L, Xun Z, Wu Z, Wilson DP - BMC Public Health (2011)

Results of epidemiological model with IDU population size scaling factor 2.5 times the registered number of IDUs. (a) Extracted published prevalence data [9] and model-based estimates of HIV prevalence among IDUs in Yunnan with and without NSPs; (b) model-based estimates of HIV incidence among IDUs in Yunnan with and without NSPs; (c) Estimated cumulative number of HIV infections averted due to NSPs; (d) Estimated cumulative number of AIDS deaths, people on ART, and people in treatment-eligible stage averted due to NSPs.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3102626&req=5

Figure 2: Results of epidemiological model with IDU population size scaling factor 2.5 times the registered number of IDUs. (a) Extracted published prevalence data [9] and model-based estimates of HIV prevalence among IDUs in Yunnan with and without NSPs; (b) model-based estimates of HIV incidence among IDUs in Yunnan with and without NSPs; (c) Estimated cumulative number of HIV infections averted due to NSPs; (d) Estimated cumulative number of AIDS deaths, people on ART, and people in treatment-eligible stage averted due to NSPs.
Mentions: The epidemiological model accurately resembles the epidemiological trends of HIV prevalence in Yunnan during the past decade (Figure 2, 3). The model estimates that according to scaling factor (SF) assumptions of the total IDU population size being 2.5-times (Figure 2) or 4-times (Figure 3) the number of registered IDUs, approximately 20,712 or 37,970 new HIV infections have occurred among IDUs during the period of NSPs, respectively. The model also estimated that NSPs have averted 5,263 (SF = 2.5; 7,541 for SF = 4) new HIV infections which accounts for 20% (SF = 2.5; 16% for SF = 4) of infections without NSPs and resulted in a gain of 1,384 (SF = 2.5; 1,978 for SF = 4) DALYs, and will gain a further 12,753 (SF = 2.5; 18,272 for SF = 4) DALYs in the patients' lifetimes. In addition, an extra 849 (SF = 2.5; 1,213 for SF = 4) person-years in the AIDS stage have likely been averted by NSPs and a further 15,347 (SF = 2.5; 21,990 for SF = 4) person-years will be saved in the patients' lifetimes due to the lasting effects of the implemented program. NSPs have led to an estimated 41% (SF = 2.5; 32% for SF = 4) decline in annual HIV incidence in 2008.

Bottom Line: The total $1.04 million spending on NSPs from 2002 to 2008 has resulted in an estimated cost-saving over this period of $1.38-$1.97 million due to the prevention of HIV and the associated costs of care and management.NSPs are not only cost-effective but cost-saving in Yunnan.Significant scale-up of NSPs interventions across China and removal of the societal and political barriers that compromise the effects of NSPs should be a health priority of the Chinese government.

View Article: PubMed Central - HTML - PubMed

Affiliation: National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney, Australia. lzhang@nchecr.unsw.edu.au

ABSTRACT

Background: As a harm reduction strategy in response to HIV epidemics needle and syringes programs (NSPs) were initiated throughout China in 2002. The effectiveness of NSPs in reducing the spread of infection in such an established epidemic is unknown. In this study we use data from Yunnan province, the province most affected by HIV in China, to (1) estimate the population benefits in terms of infections prevented due to the programs; (2) calculate the cost-effectiveness of NSPs.

Methods: We developed a mathematical transmission model, informed by detailed behavioral and program data, which accurately reflected the unique HIV epidemiology among Yunnan injecting drug users (IDUs) in the presence of NSPs. We then used the model to estimate the likely epidemiological and clinical outcomes without NSPs and conducted a health economics analysis to determine the cost-effectiveness of the program.

Results: It is estimated that NSPs in Yunnan have averted approximately 16-20% (5,200-7,500 infections) of the expected HIV cases since 2002 and led to gains of 1,300-1,900 DALYs. The total $1.04 million spending on NSPs from 2002 to 2008 has resulted in an estimated cost-saving over this period of $1.38-$1.97 million due to the prevention of HIV and the associated costs of care and management.

Conclusion: NSPs are not only cost-effective but cost-saving in Yunnan. Significant scale-up of NSPs interventions across China and removal of the societal and political barriers that compromise the effects of NSPs should be a health priority of the Chinese government.

Show MeSH
Related in: MedlinePlus