Modeling the impact of harm reduction for opioid use disorder on infectious disease prevention

Abstract

Abstract There is an increasingly strong evidence base that harm reduction interventions such as opiate agonist therapy (OAT) and needle and syringe programs (NSPs) for opioid use disorder prevent individual acquisition of hepatitis C virus (HCV) and HIV. Modeling has highlighted the substantial impact that scale-up of these interventions can have on infectious disease epidemics (such as HIV and HCV) among people who inject drugs. Modeling has also indicated that scale-up of harm reduction for incarcerated populations while in custody and after release could have a substantial benefit on reducing HIV and HCV transmission both within criminal justice settings and the broader community. Additionally, economic studies have shown that OAT and NSPs are cost-effective and potentially cost-saving in preventing HIV and HCV infections. Evidence for the impact of supervised injection facilities on infectious disease transmission is limited, but these could be important components of the epidemic response and could be highly cost-effective or cost-saving. Scale-up of harm reduction, in addition to HCV and HIV treatment and naloxone, is urgently needed to address the opioid crisis and the related infectious disease epidemics in the United States.