Improving the quality of needle and syringe programmes: an overlooked strategy for preventing hepatitis C among people who inject drugs

Introduction The hepatitis C virus (HCV) is 5 to 20 times more infectious than HIV [1]. Even more alarmingly, HCV has the capacity to survive outside of the human body for weeks. Unfortunately, this makes the reuse of injecting equipment that has been contaminated with HCV a highly effective means of spreading the disease [2]. The prevalence of HCV among people who inject drugs (PWID) is shocking, much higher than HIV prevalence, for example [3,4]. Research suggests that needle and syringe programmes (NSPs) contribute less to the prevention of HCV than the prevention of HIV [5]. Nevertheless, the distribution of needles and syringes has become an accepted worldwide strategy to prevent the spread of not only HIV but also other bloodborne infectious diseases such as HCV among people who inject drugs. NSPs and opioid substitution therapy are key recommended interventions of multilateral organisations such as the World Health Organisation (WHO), the Joint United Nations Programme on HIV/AIDS, the United Nations Office on Drugs and Crime, the European Centre for Disease Prevention and Control, and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) [3,6,7]. Yet NSPs are relegated to the sidelines in most European countries. They are neglected by government officials and funders, and are even often underprioritised by drug treatment organizations. Despite the valuable efforts of EMCDDA, key European stakeholders have shown little interest in formulating uniform data collection procedures, minimum quality standards and best practices relating to disease prevention interventions for drug users. This means that experiences in the field are not sufficiently evaluated, and information is lacking on how to further develop programmes to demonstrate and increase effectiveness. Scotland is one of the few favourable exceptions in Europe [8]. Embarrassingly little information exists about the effectiveness of NSPs – an evidence gap that stands out all the more in comparison to the body of research on medicaltherapeutic interventions for hepatitis C infection. Given the limited interest in NSPs among scientific experts and practitioners working in the field of harm reduction, many outstanding questions and challenges remain in regard to optimal procedures for using NSPs as an HCV prevention tool.