Skip to main content

01.12.2017 | Research article | Ausgabe 1/2017 Open Access

BMC Public Health 1/2017

Effectiveness of needle and syringe Programmes in people who inject drugs – An overview of systematic reviews

BMC Public Health > Ausgabe 1/2017
Ricardo M Fernandes, Maria Cary, Gonçalo Duarte, Gonçalo Jesus, Joana Alarcão, Carla Torre, Suzete Costa, João Costa, António Vaz Carneiro
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12889-017-4210-2) contains supplementary material, which is available to authorized users.



Needle and syringe programmes (NSP) are a critical component of harm reduction interventions among people who inject drugs (PWID). Our primary objective was to summarize the evidence on the effectiveness of NSP for PWID in reducing blood-borne infection transmission and injecting risk behaviours (IRB).


We conducted an overview of systematic reviews that included PWID (excluding prisons and consumption rooms), addressed community-based NSP, and provided estimates of the effect regarding incidence/prevalence of Human Immunodeficiency Virus (HIV), Hepatitis C virus (HCV), Hepatitis B virus (HBV) and bacteremia/sepsis, and/or measures of IRB. Systematic literature searches were undertaken on relevant databases, including EMBASE, MEDLINE, and PsychINFO (up to May 2015). For each review we identified relevant studies and extracted data on methods, and findings, including risk of bias and quality of evidence assessed by review authors. We evaluated the risk of bias of each systematic review using the ROBIS tool. We categorized reviews by reported outcomes and use of meta-analysis; no additional statistical analysis was performed.


We included thirteen systematic reviews with 133 relevant unique studies published between 1989 and 2012. Reported outcomes related to HIV (n = 9), HCV (n = 8) and IRB (n = 6). Methods used varied at all levels of design and conduct, with four reviews performing meta-analysis. Only two reviews were considered to have low risk of bias using the ROBIS tool, and most included studies were evaluated as having low methodological quality by review authors. We found that NSP was effective in reducing HIV transmission and IRB among PWID, while there were mixed results regarding a reduction of HCV infection. Full harm reduction interventions provided at structural level and in multi-component programmes, as well as high level of coverage, were more beneficial.


The heterogeneity and the overall low quality of evidence highlights the need for future community-level studies of adequate design to support these results.

Trial registration

The protocol of this systematic review was registered in Prospective Register of Systematic Reviews (PROSPERO 2015:CRD42015026145).
Additional file 1: Search Strategies. (DOCX 19 kb)
Additional file 2: List of primary studies included in each review. (DOCX 26 kb)
Additional file 3: Summary results from ROBIS evaluation performed by two assessors (MC&RF). (DOCX 13 kb)
Additional file 4: Prisma Checklist. (DOCX 14 kb)
Über diesen Artikel

Weitere Artikel der Ausgabe 1/2017

BMC Public Health 1/2017 Zur Ausgabe