1. Enhancing the Effectiveness of
Needle Exchange Programs
(NEPs)
Jim Hales
2011 National HIV Prevention Conference
Atlanta, August 2011

2. Key Findings
• NEPs are an important element in many HIV prevention
strategies worldwide.
• HIV reduced significantly, but HCV rates still high.
• Reuse of non-sterile needles/syringes the main cause.
• New injection safety technologies present an opportunity
to enhance the effectiveness of NEPs.
• US model demonstrates expansion of NEP capacity using
these safety technologies over 25 years may prevent:
– 247,000 cases of HIV
– 11 million cases of HCV
– Savings in health care costs of $163 billion. 2

3. The Australian Experience
• NEPs established nationally in late 1980s.
• NEPs an essential component of National HIV Strategy:
– HIV prevalence among IDUs in Australia is 1%
– HCV prevalence among IDUs in Australia is over 60%.
• Reported sharing & reuse of injecting equipment by
around 17% of IDUs.
• NEPs demonstrated to be effective and cost-effective.
• 2004 study looked at retractable needles & syringes.
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4. New Injection Safety Technology
• Same steps of one-handed use to standard equipment.
• Passive activation of safety mechanism on full dose
delivery.
• User-controlled speed of needle withdrawal directly from
the body into the barrel.
• Minimal activation force assists vein care.
• Capacity to blood witness to avoid risk of dose loss.
• Automatic locking of needle inside barrel prevents
reuse/sharing & safe, convenient disposal.
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5. Potential Benefits
• Minimise transmission of BBVs from sharing/reuse.
• Enhance effectiveness of NEP programs.
• Avoid future costs of treatment.
• Enhance safe vein care practices.
• Enhance safe disposal, reduced risk of needlestick injury.
• Contribute to community approval of NEPs.
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6. Structure of the Model
• Current profile of injection equipment distribution.
• Costs of adopting safety needles and syringes.
• Number of HIV / HCV cases avoided
• Future treatment costs avoided.
• Financial analysis.
• NPV analysis at 10 and 25 year periods.
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7. Data Requirements and Sources
• Based on most recent available data on:
o Number of IDUs
o Injecting equipment distribution & costs
o Frequency of injecting
o Equipment sharing prevalence & frequency
o HIV & HCV prevalence & transmission rates
o HIV & HCV treatment costs.
• Data sources.
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8. Initial Findings for the USA
14000
12000
10000
8000
6000
4000
2000
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
Additional Cost of Equipment HIV Treatment Costs Avoided
HCV Treatment Costs Avoided 8

9. Summary of Findings
10 Year Period 25 Year Period
Additional Investment $985,779,762 $3,135,134,618
Cases of HIV Avoided 77,744 247,254
Cases of HCV Avoided 3,495,235 11,116,105
Costs Avoided - HIV $1,440,121,723 $32,005,918,518
Costs Avoided - HCV - $130,947,438,301
Total Costs Avoided $1,440,121,723 $162,953,356,819
Net Savings – HIV Alone $454,341,961 $28,870,783,900
Net Savings – HIV + HCV $454,341,961 $159,818,222,201
NPV – HIV Alone $176,539,506 $11,143,574,786
NPV – HIV + HCV $176,539,506 $62,781,786,941
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Break Even Point 10 Years

10. Conclusions
• Continued sharing of injecting equipment affects the
effectiveness of NEPs.
• New safety equipment can reduce injection
equipment reuse and sharing.
• Economic modelling demonstrates cost effectiveness
and positive return on investment.
• Other features of the equipment enhance user
acceptability and safety.
• Improved disposal safety may also encourage
community and political approval/support.
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