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  • Evaluating the impact of global fund withdrawal on needle and syringe provision, cost and use among people who inject drugs in Tijuana, Mexico: a costing analysis

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Health services research
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Evaluating the impact of global fund withdrawal on needle and syringe provision, cost and use among people who inject drugs in Tijuana, Mexico: a costing analysis
  1. Javier A Cepeda1,
  2. Jose Luis Burgos1,
  3. James G Kahn2,
  4. Rosario Padilla3,
  5. Pedro Emilio Meza Martinez4,
  6. Luis Alberto Segovia5,
  7. Tommi Gaines1,
  8. Daniela Abramovitz1,
  9. Gudelia Rangel6,
  10. Carlos Magis-Rodriguez7,
  11. Peter Vickerman8,
  12. Steffanie A Strathdee1,
  13. Natasha K Martin1,8
  1. 1 Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, USA
  2. 2 Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, California, USA
  3. 3 Centro de Servicios (SER), Tijuana, Mexico
  4. 4 Department of Social and Human Development, State Government of Oaxaca, Oaxaca, Mexico
  5. 5 Prevencasa AC, Tijuana, Mexico
  6. 6 Population Studies, El Colegio de la Frontera Norte, Tijuana, Mexico
  7. 7 National Center for the Prevention and Control of HIV and AIDS, Mexico City, Mexico
  8. 8 School of Social and Community Medicine, University of Bristol, Bristol, UK
  1. Correspondence to Dr Javier A Cepeda; jacepeda{at}ucsd.edu

Abstract

Objective From 2011 to 2013, the Global Fund (GF) supported needle and syringe programmes in Mexico to prevent transmission of HIV among people who inject drugs. It remains unclear how GF withdrawal affected the costs, quality and coverage of needle and syringe programme provision.

Design Costing study and longitudinal cohort study.

Setting Tijuana, Mexico.

Participants Personnel from a local needle and syringe programme (n=6) and people who inject drugs (n=734) participating in a longitudinal study.

Primary outcome measures Provision of needle and syringe programme services and cost (per contact and per syringe distributed, in 2017 $USD) during GF support (2012) and after withdrawal (2015/16). An additional outcome included needle and syringe programme utilisation from a concurrent cohort of people who inject drugs during and after GF withdrawal.

Results During the GF period, the needle and syringe programme distributed 55 920 syringes to 932 contacts (60 syringes/contact) across 14 geographical locations. After GF withdrew, the needle and syringe programme distributed 10 700 syringes to 2140 contacts (five syringes/contact) across three geographical locations. During the GF period, the cost per harm reduction contact was approximately 10-fold higher compared with after GF ($44.72 vs $3.81); however, the cost per syringe distributed was nearly equal ($0.75 vs $0.76) due to differences in syringes per contact and reductions in ancillary kit components. The mean log odds of accessing a needle and syringe programme in the post-GF period was significantly lower than during the GF period (p=0.02).

Conclusions Withdrawal of GF support for needle and syringe programme provision in Mexico was associated with a substantial drop in provision of sterile syringes, geographical coverage and recent clean syringe utilisation among people who inject drugs. Better planning is required to ensure harm reduction programme sustainability is at scale after donor withdrawal.

  • health economics
  • epidemiology

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjopen-2018-026298

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    Footnotes

    • Patient consent for publication Not required.

    • JAC and JLB contributed equally.

    • Contributors JAC, JLB, SAS and NKM conceived and designed the analysis and contributed to the writing of the manuscript. JAC and JLB conducted the analyses with input from JGK, DA, TG and PV. JLB and PEMM collected cost data with assistance from RP, LAS, GR and CM-R. All authors critically reviewed and approved the final version.

    • Funding This study was funded by grants from the National Institute on Drug Abuse (R01DA037773, K01DA043421, T32DA023356, R01DA015612), Fogarty International Center (R25TW009343) and by the University of California, San Diego, Center for AIDS Research (CFAR), an NIH-funded program (P30AI036214), which is supported by the following NIH Institutes and Centers: NIAID, NCI, NIMH, NIDA, NICHD, NHLBI, NIA, NIGMS and NIDDK.

    • Competing interests NKM has received unrestricted research grants from Gilead unrelated to this work and honoraria from Gilead and Merck.

    • Ethics approval Study procedures were approved by the institutional review boards at University of California San Diego Human Research Protections Program and Universidad Autónoma de Baja California and all NSP personnel provided written informed consent. The study protocol for the El Cuete IV was approved by the University of California San Diego Human Research Protections Program and El Colegio de la Frontera Norte (Tijuana).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Costing spreadsheets are available upon reasonable request. El Cuete IV data cannot be shared due to the need to ensure the confidentiality of participants.