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

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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. / van Santen, Daniela K.; Boyd, Anders ; Matser, Amy et al.
In: Addiction, Vol. 116, No. 11, 11.2021, p. 3115-3126.

Research output: Contribution to journal › Article › Academic › peer-review

BibTeX

@article{96edb2a539c14daa92e8abe5b016b97c,

title = "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",

abstract = "Background and aims: Major declines in HIV and hepatitis C and B virus (HCV/HBV) incidence among people who inject drugs (PWID) have been attributed to early implementation of harm-reduction programs (HRP) in the Netherlands, but alternative factors such as selective mortality and demographic and drug market shifts over time probably contributed to observed incidence declines. We quantified and tested the effect of HRP participation on risk of these infections among PWID in Amsterdam, the Netherlands. Design: We emulated the design of a hypothetical, ideal randomized trial using observational data from the Amsterdam Cohort Studies (1985–2014). Setting: Amsterdam, the Netherlands. Participants: We included PWID who ever used opioids, had a recent history of injecting drug use (IDU) and tested negative for HIV, HCV or HBV. Of 983 participants, 640, 137 and 308 were included for the HIV, HCV and HBV analyses and 59, 45 and 49 seroconversions were observed, respectively. Interventions: Intervention arms were: complete HRP participation [≥ 60 mg/day methadone and 100% needle and syringe program (NSP) coverage, or any methadone dose if no recent injection drug use] versus no HRP and partial HRP participation combined (< 60 methadone mg/day and/or < 100% NSP coverage). Conclusions: Complete participation in harm reduction programs appears to have led to substantial decreases in HIV and hepatitis C and B virus acquisition risk among people who inject drugs in the Netherlands. Measurements: Separately for each infection, we estimated the hazard ratios (HR) comparing HRP arms using marginal structural models. Findings: Compared with no/partial HRP participation, complete HRP participation led to lower risk of HIV [HR = 0.54, 95% confidence interval (CI) = 0.27–1.08], HCV (HR = 0.16, 95% CI = 0.06–0.40) and HBV (HR = 0.28, 95% CI = 0.13–0.61) acquisition.",

keywords = "HIV, harm reduction programs, hepatitis B, hepatitis C, needle and syringe programs, opioid agonist therapy, people who inject drugs",

author = "{van Santen}, {Daniela K.} and Anders Boyd and Amy Matser and Lisa Maher and Matthew Hickman and Sara Lodi and Maria Prins",

note = "Funding Information: The present study was funded by Aidsfonds (project number 29703). The authors wish to thank the participants of the ACS for their contribution, research nurses of the ACS for data collection and cohort management. We also wish to thank Dr Marcel Buster from the Public Health Service of Amsterdam for providing information on the history of the Dutch harm reduction approach. We also acknowledge the technical statistical software support provided by Ronald B. Geskus, Geoffrey Chan and Maria del Mar Quiroga. The Amsterdam Cohort Studies on HIV infection and AIDS, which is a collaboration between the Public Health Service of Amsterdam (Gemeentelijke Gezondheidsdienst Amsterdam; GGD Amsterdam), Department of Infectious Diseases, Research and Prevention, Amsterdam, the Netherlands, Amsterdam University Medical Centers (UMC), University of Amsterdam (Department of Medical Microbiology, Experimental Immunology, Department of Internal Medicine, Division of Infectious Diseases, Emma's Children's Hospital (Emma Kinderziekenhuis), HIV treatment center), Dutch Monitoring Foundation (Stichting HIV Monitoring; SHM), Jan van Goyen Medical Centre, Department of Internal Medicine, HIV Focus Centre (DC Klinieken), and Sanquin Blood Supply Foundation financially supports the maintenance of the biobank. The ACS is financially supported by the Center for Infectious Disease Control of the Netherlands National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands. Funding Information: L.M. is supported by an Australian National Health and Medical Research Council Research Fellowship. All funding sources had no involvement in the study. S.L. was supported by Boston University/Brown CFAR P30 AI042853. The funding parties did not have any role in study design, analyses and interpretation of the data. None of the other authors had any conflicts to declare related to this study. Funding Information: The present study was funded by Aidsfonds (project number 29703). The authors wish to thank the participants of the ACS for their contribution, research nurses of the ACS for data collection and cohort management. We also wish to thank Dr Marcel Buster from the Public Health Service of Amsterdam for providing information on the history of the Dutch harm reduction approach. We also acknowledge the technical statistical software support provided by Ronald B. Geskus, Geoffrey Chan and Maria del Mar Quiroga. The Amsterdam Cohort Studies on HIV infection and AIDS, which is a collaboration between the Public Health Service of Amsterdam (Gemeentelijke Gezondheidsdienst Amsterdam; GGD Amsterdam), Department of Infectious Diseases, Research and Prevention, Amsterdam, the Netherlands, Amsterdam University Medical Centers (UMC), University of Amsterdam (Department of Medical Microbiology, Experimental Immunology, Department of Internal Medicine, Division of Infectious Diseases, Emma's Children's Hospital (Emma Kinderziekenhuis), HIV treatment center), Dutch Monitoring Foundation (Stichting HIV Monitoring; SHM), Jan van Goyen Medical Centre, Department of Internal Medicine, HIV Focus Centre (DC Klinieken), and Sanquin Blood Supply Foundation financially supports the maintenance of the biobank. The ACS is financially supported by the Center for Infectious Disease Control of the Netherlands National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands. Publisher Copyright: {\textcopyright} 2021 Society for the Study of Addiction Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

year = "2021",

month = nov,

doi = "10.1111/add.15503",

language = "English",

volume = "116",

pages = "3115--3126",

journal = "Addiction (Abingdon, England)",

issn = "0965-2140",

publisher = "Wiley-Blackwell",

number = "11",

}

RIS

TY - JOUR

T1 - 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

AU - van Santen, Daniela K.

AU - Boyd, Anders

AU - Matser, Amy

AU - Maher, Lisa

AU - Hickman, Matthew

AU - Lodi, Sara

AU - Prins, Maria

N1 - Funding Information: The present study was funded by Aidsfonds (project number 29703). The authors wish to thank the participants of the ACS for their contribution, research nurses of the ACS for data collection and cohort management. We also wish to thank Dr Marcel Buster from the Public Health Service of Amsterdam for providing information on the history of the Dutch harm reduction approach. We also acknowledge the technical statistical software support provided by Ronald B. Geskus, Geoffrey Chan and Maria del Mar Quiroga. The Amsterdam Cohort Studies on HIV infection and AIDS, which is a collaboration between the Public Health Service of Amsterdam (Gemeentelijke Gezondheidsdienst Amsterdam; GGD Amsterdam), Department of Infectious Diseases, Research and Prevention, Amsterdam, the Netherlands, Amsterdam University Medical Centers (UMC), University of Amsterdam (Department of Medical Microbiology, Experimental Immunology, Department of Internal Medicine, Division of Infectious Diseases, Emma's Children's Hospital (Emma Kinderziekenhuis), HIV treatment center), Dutch Monitoring Foundation (Stichting HIV Monitoring; SHM), Jan van Goyen Medical Centre, Department of Internal Medicine, HIV Focus Centre (DC Klinieken), and Sanquin Blood Supply Foundation financially supports the maintenance of the biobank. The ACS is financially supported by the Center for Infectious Disease Control of the Netherlands National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands. Funding Information: L.M. is supported by an Australian National Health and Medical Research Council Research Fellowship. All funding sources had no involvement in the study. S.L. was supported by Boston University/Brown CFAR P30 AI042853. The funding parties did not have any role in study design, analyses and interpretation of the data. None of the other authors had any conflicts to declare related to this study. Funding Information: The present study was funded by Aidsfonds (project number 29703). The authors wish to thank the participants of the ACS for their contribution, research nurses of the ACS for data collection and cohort management. We also wish to thank Dr Marcel Buster from the Public Health Service of Amsterdam for providing information on the history of the Dutch harm reduction approach. We also acknowledge the technical statistical software support provided by Ronald B. Geskus, Geoffrey Chan and Maria del Mar Quiroga. The Amsterdam Cohort Studies on HIV infection and AIDS, which is a collaboration between the Public Health Service of Amsterdam (Gemeentelijke Gezondheidsdienst Amsterdam; GGD Amsterdam), Department of Infectious Diseases, Research and Prevention, Amsterdam, the Netherlands, Amsterdam University Medical Centers (UMC), University of Amsterdam (Department of Medical Microbiology, Experimental Immunology, Department of Internal Medicine, Division of Infectious Diseases, Emma's Children's Hospital (Emma Kinderziekenhuis), HIV treatment center), Dutch Monitoring Foundation (Stichting HIV Monitoring; SHM), Jan van Goyen Medical Centre, Department of Internal Medicine, HIV Focus Centre (DC Klinieken), and Sanquin Blood Supply Foundation financially supports the maintenance of the biobank. The ACS is financially supported by the Center for Infectious Disease Control of the Netherlands National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands. Publisher Copyright: © 2021 Society for the Study of Addiction Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/11

Y1 - 2021/11

N2 - Background and aims: Major declines in HIV and hepatitis C and B virus (HCV/HBV) incidence among people who inject drugs (PWID) have been attributed to early implementation of harm-reduction programs (HRP) in the Netherlands, but alternative factors such as selective mortality and demographic and drug market shifts over time probably contributed to observed incidence declines. We quantified and tested the effect of HRP participation on risk of these infections among PWID in Amsterdam, the Netherlands. Design: We emulated the design of a hypothetical, ideal randomized trial using observational data from the Amsterdam Cohort Studies (1985–2014). Setting: Amsterdam, the Netherlands. Participants: We included PWID who ever used opioids, had a recent history of injecting drug use (IDU) and tested negative for HIV, HCV or HBV. Of 983 participants, 640, 137 and 308 were included for the HIV, HCV and HBV analyses and 59, 45 and 49 seroconversions were observed, respectively. Interventions: Intervention arms were: complete HRP participation [≥ 60 mg/day methadone and 100% needle and syringe program (NSP) coverage, or any methadone dose if no recent injection drug use] versus no HRP and partial HRP participation combined (< 60 methadone mg/day and/or < 100% NSP coverage). Conclusions: Complete participation in harm reduction programs appears to have led to substantial decreases in HIV and hepatitis C and B virus acquisition risk among people who inject drugs in the Netherlands. Measurements: Separately for each infection, we estimated the hazard ratios (HR) comparing HRP arms using marginal structural models. Findings: Compared with no/partial HRP participation, complete HRP participation led to lower risk of HIV [HR = 0.54, 95% confidence interval (CI) = 0.27–1.08], HCV (HR = 0.16, 95% CI = 0.06–0.40) and HBV (HR = 0.28, 95% CI = 0.13–0.61) acquisition.

AB - Background and aims: Major declines in HIV and hepatitis C and B virus (HCV/HBV) incidence among people who inject drugs (PWID) have been attributed to early implementation of harm-reduction programs (HRP) in the Netherlands, but alternative factors such as selective mortality and demographic and drug market shifts over time probably contributed to observed incidence declines. We quantified and tested the effect of HRP participation on risk of these infections among PWID in Amsterdam, the Netherlands. Design: We emulated the design of a hypothetical, ideal randomized trial using observational data from the Amsterdam Cohort Studies (1985–2014). Setting: Amsterdam, the Netherlands. Participants: We included PWID who ever used opioids, had a recent history of injecting drug use (IDU) and tested negative for HIV, HCV or HBV. Of 983 participants, 640, 137 and 308 were included for the HIV, HCV and HBV analyses and 59, 45 and 49 seroconversions were observed, respectively. Interventions: Intervention arms were: complete HRP participation [≥ 60 mg/day methadone and 100% needle and syringe program (NSP) coverage, or any methadone dose if no recent injection drug use] versus no HRP and partial HRP participation combined (< 60 methadone mg/day and/or < 100% NSP coverage). Conclusions: Complete participation in harm reduction programs appears to have led to substantial decreases in HIV and hepatitis C and B virus acquisition risk among people who inject drugs in the Netherlands. Measurements: Separately for each infection, we estimated the hazard ratios (HR) comparing HRP arms using marginal structural models. Findings: Compared with no/partial HRP participation, complete HRP participation led to lower risk of HIV [HR = 0.54, 95% confidence interval (CI) = 0.27–1.08], HCV (HR = 0.16, 95% CI = 0.06–0.40) and HBV (HR = 0.28, 95% CI = 0.13–0.61) acquisition.

KW - HIV

KW - harm reduction programs

KW - hepatitis B

KW - hepatitis C

KW - needle and syringe programs

KW - opioid agonist therapy

KW - people who inject drugs

UR - http://www.scopus.com/inward/record.url?scp=85104999705&partnerID=8YFLogxK

U2 - 10.1111/add.15503

DO - 10.1111/add.15503

M3 - Article

C2 - 33788326

VL - 116

SP - 3115

EP - 3126

JO - Addiction (Abingdon, England)

JF - Addiction (Abingdon, England)

SN - 0965-2140

IS - 11

ER -

ID: 18093391

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