A study by the BC Centre for Excellence in HIV/AIDS (BC-CfE), published in the top-ranking medical journal The Lancet HIV, has found harm reduction and access to HIV antiretroviral therapy (ART) averted an estimated 3,204 incident HIV cases in British Columbia between 1996 and 2013. Both evidence-based public health interventions had significant, independent effects on the spread of HIV and the control of the epidemic.
To identify the relative impact of ART and harm reduction, which have both been scaled up in BC since 1996, the authors modeled multiple hypothetical scenarios. Assuming harm reduction services were not scaled up beyond 1996 levels, ART alone is estimated to account for 44% (1,409) of the averted HIV cases across the province. The impact of universal access to ART is likely underestimated, as the study only considered its impact on transmission through needle sharing with its efficacy in reducing HIV transmission set conservatively at 50%.
Assuming ART had no effect at all on HIV transmission through needle sharing, harm reduction services alone—defined in this study as needle distribution and opioid agonist therapy (OAT)—are estimated to account for 77% (2,473) of the averted HIV cases.
“Both harm reduction and access to HIV treatment are keys to curbing the transmission of HIV,” said Dr. Bohdan Nosyk, Research Scientist with the BC-CfE and an author on the paper. “As a treatment for addiction, opioid agonist therapy provides benefits in terms of reduction in disease transmission and improvement in quality of life. Our research has linked the treatment to increases in workplace productivity and decreases in crime costs—making a further economic case for its implementation as part of a harm reduction effort.”
Access to harm reduction and ART also significantly increases an individual’s quality of life years (QALY). OAT, a first-line treatment for opioid addiction that reduces cravings and withdrawal associated with opioid addiction, is linked to substantially greater QALY gains than needle distribution programs.
Over the past 20 years, BC has rapidly expanded access to lifesaving OAT (with methadone or buprenorphine/naloxone) and implemented needle distribution programs. There are over 50 unique service providers of harm reduction services within Vancouver’s downtown core alone, covering a spectrum of services such as psychosocial treatment, housing supports and mental health care.
BC and Vancouver are unique within Canada and compared with many jurisdictions worldwide. A global review of interventions to prevent HIV infections among PWID estimates needle distribution programs covered 5% to 8% of injections, and only around 8% of PWID had access to OAT. Globally only 4% of PWID are estimated to have access to ART.
In BC, since the 2013 implementation of the Treatment as Prevention® (TasP®) strategy supported by the provincial government, access to ART has been universally offered upon diagnosis with HIV. On sustained and consistent treatment, an individual living with HIV achieves an undetectable viral load and the chances of HIV transmission drop to negligible. Previous BC-CfE research, based in Vancouver’s Downtown Eastside, found community viral load was the strongest predictor of HIV transmission among PWID.
“If we are to get to the end of AIDS by 2030, as established in the UNAIDS 90-90-90 Target, we must broadly and universally implement harm reduction hand-in-hand with Treatment as Prevention®,” said Dr. Julio Montaner, Director of the BC-CfE. “We know these interventions are mutually supportive and essential to reaching people who inject drugs.”
What is opioid agonist therapy (OAT)?
OAT has been proven effective for treating addiction to opioid drugs by preventing withdrawal and stabilizing cravings. Through analysis of population-level data for BC from 1996 to 2010, a BC-CfE study among HIV positive people engaged in the treatment found OAT alone reduced all-cause mortality by 66%. Research has shown OAT can result in improved quality of life, and may lead to increases in workplace productivity and savings in public spending. Within Vancouver, BC, a 2017 BC-CfE study found OAT could reduce criminal cost by $3.5 million (2013CAD) per 100 treated individuals annually, based on conservative estimates.
What is Treatment as Prevention® (TasP®)?
TasP®, pioneered by the BC-CfE, consists of widespread, earlier HIV testing and the immediate offer of HIV antiretroviral treatment (ART) to those who test positive. TasP® has been proven to greatly improve a patient’s quality of life, prevent progression to AIDS and extend longevity by decades, while reducing the likelihood of HIV transmission by greater than 95%. Within BC, the implementation of TasP®, with support from the provincial government, has resulted in significant declines in HIV transmission among injection drug users. In addition, TasP® has led to an 88% decline in new AIDS cases and a 65% drop in new HIV cases in BC since 1994. Decline in HIV among PWID has been credited as the main driver of the consistent decline in HIV in BC, the only province to see such a drop. On World AIDS Day 2015 (December 1), the Canadian federal government formally embraced TasP® based on the pioneering work of the BC-CfE.
About the British Columbia Centre for Excellence in HIV/AIDS
The BC Centre for Excellence in HIV/AIDS (BC-CfE—http://cfenet.ubc.ca) is Canada’s largest HIV/AIDS research, treatment and education facility and is internationally recognized as an innovative world leader in combating HIV/AIDS and related diseases. BC-CfE is based at St. Paul’s Hospital, Providence Health Care, a teaching hospital of the University of British Columbia. The BC-CfE works in close collaboration with key provincial stakeholders, including government, health authorities, health care providers, academics from other institutions, and the community to decrease the health burden of HIV and AIDS. By developing, monitoring and disseminating comprehensive research and treatment programs for HIV and related illnesses, the BC-CfE helps improve the health of British Columbians.
For further information: For additional information or to request interviews, please contact: Caroline Dobuzinskis, BC-CfE, Cell: 604-366-6540, Phone: 604-682-2344 ext. 66536, Email: email@example.com