CostEffectiveness of Needle Exchange Program among IDUs in Uzbekistan

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Cost-Effectiveness of Needle Exchange Program
among IDUs in Uzbekistan

• Azizbek A. Boltaev
• IREX Contemporary Issues Program Fellow
• Dynamic Communications Strategies Tools
  Workshop
• Hotel Washington
• Washington DC, December 16-19, 2003

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Research Methodology

• Online search in electronic data bases (MEDLINE,
  EBSCO, and LEXIS-NEXIS) for articles containing
  combination of words CostEffectivenessNeedleEx
  changeHIV
• Review of reports of 7 Syringe Exchange Projects
  in Uzbekistan
• Onsite interviews of coordinators of 2 public
  funded SEP in Boston, MA and Cambridge, MA
• Mathematic modeling of the HIV epidemic in
  Uzbekistan to estimate the impact of SEPs on
  infections averted and disability-adjusted life
  years (DALY) gained based on program and survey
  data

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Sharing syringe or bowl/cooker
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Sharing drug mixture
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Number of Clients in both NEPs
Budgets of Both NEPs

• Office based

• Outreach based

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Cost per Infection Averted
9,537
1,288
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Projected Impact of Needle Exchange Program
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Conclusions

• Syringe Exchange Program Among IDUs Is Effective
  Intervention For HIV Prevention
• Data from Uzbekistan show that SEPs can be
  operated very cost-effectively (e.g. 1288 per
  infection averted among SEP clients for a SEP
  that includes outreach) from an institutional
  perspective.
• SEP with outreach components should be an
  integral part of all SEP programs.
• Several factors critically influence
  accessibility and effectiveness of SEP these are
  political will, financial support,
  misunderstanding of the goals of SEP,
  collaboration of SEP with other health care and
  social service providers, education and skills of
  SEP providers
• No cost-effectiveness studies of other preventive
  or curative interventions have been identified in
  Uzbekistan

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Conclusions contin.

• No cost-effectiveness studies of other preventive
  or curative interventions have been identified in
  Uzbekistan
• Although data for policy making are limited, this
  study suggests that an appropriate combination of
  local data and information from the international
  literature can be utilized in Uzbekistan with
  adjustment for epidemiological, economic and
  cultural differences between and within
  countries.

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Recommendations

• At a minimum, syringe exchange programs in
  Uzbekistan should be continued.
• Syringe exchange programs should be
  conceptualized as an integral part of public
  health efforts to stem HIV infection among drug
  users and should be part of a comprehensive
  approach to drug use.
• The Uzbek AIDS Center should provide outreach
  services for syringe exchange to expand the
  number of its SEP participants.
• Additional cost-effective approaches to ease
  access to sterile injecting equipment, such as
  secondary exchange, free or low-cost syringes,
  and access through 24 hour drug stores should be
  added to SEPs.
• Using a network approach to deliver SE service

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Recommendations

• International donors, such as the US Government,
  which have bans on the use their funds for
  syringe exchange services should reconsider their
  policy regarding SEP considering the strong
  scientific evidence of SEP effectiveness and its
  absence of side effects, such as promoting the
  use of illegal drugs
• The Country Coordinating Mechanism, which will
  coordinate Uzbekistans 25 million grant from
  Global Fund, should use cost-effectiveness
  analysis as a powerful tool to strengthen
  Uzbekistans policies in preventing and treating
  HIV and TB.

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Risk formula for HIV infections averted
r 1-(p(1-se(1-uk))e (1-p))m r cumulative
annual probability of infection j group of
IDUs p probability of selecting an infected
injection partner (a function of prevalence) s
probability that needle is shared i.e.,
probability that someone used the needle
immediately prior to this injection e
efficiency of transmission of HIV by infected
needle, per injection u probability that bleach
is used, at each injection k efficiency of
bleach in eliminating HIV virus from a needle and
syringe m number of partners per year i
number of injections per year c average
contacts per partner, defined as number of
injections (i), divided by number of partners
(m) These parameters are group-specific in some
model versions
, Joanna E. Siegel, 1990. Modeling the
effectiveness of bleach distribution programs for
preventing AIDS among intravenous drug users.
ScD dissertation, HSPH.
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Uzbekistan The Facts

• Location Central Asia,
• North of Afghanistan
• Area 447,400 sq.km, slightly larger than
  California
• Capital Tashkent
• Natural Recourses Natural Gas, Petroleum, Gold,
  Coal, Uranium, Silver, Copper, Molybdenum
• Geography - note One of the two only doubly
  landlocked countries in the world
• GDP purchasing power parity
• total 65 billion
• per capita 2,500

• Population 25,981,647
• Median age Total 21.8 yrs
• male 21.2 yrs
• female 22.5 yrs
• Birth rate 26.09 births/1,000 pop
• Death rate 7.97 deaths/1,000 pop
• Sex ratio 0.98 male/female
• Infant mortality rate 71.51/1000
• Fertility rate 3 children born/ wmn
• Life expectancy at birth 64 years
• Ethnic groups Uzbek 80, Russian 5.5, Tajik 5,
  Kazakh 3, Karakalpak 2.5, Tatar 1.5, other
  2.5

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