Meeting need: calculating and improving coverage
What is coverage? Coverage is a measure of the reach of a healthcare intervention to a population Definitions have included: the range of services on offer to a geographical area % of injectors ever in contact with services % of injectors reached in a specific period number of syringes per injector per year
What is coverage? The coverage definition most appropriate for the UK is: the percentage of injections for which a new sterile syringe has been distributed by services.
why does coverage matter? Coverage matters because: we know that injectors will use a new needle and syringe if they have one evidence from Bristol showed that high coverage was associated with reduced risk of hcv infection it measures the impact of service provision on both those in contact, and those not in contact with services
The coverage calculator… As part of the Harm Reduction Works campaign we began to develop an online calculator to work out coverage. Its in a peer review process, so there will be some changes, mainly to bring it more fully into line with the NICE guidance
1% – 9%: coverage is very low If the figures you put in are right - there is a serious shortage of sterile injecting equipment in your area… In these conditions blood borne viruses can spread rapidly amongst injecting drug users. This coverage may be too low to prevent an HIV outbreak, and will not reduce hepatitis C (HCV) transmission. If it persists, HCV infection will rise above 50% of the injecting population, if it is not there already.
1% – 9%: advice includes ensure everyone in contact with services knows how to clean syringes with bleach so that in situations where they are reusing or sharing equipment, they can reduce the risk.
10% to 19%: coverage is low In low HIV prevalence areas (under 2%) coverage even at this level is probably high enough to prevent a widespread epidemic of HIV (but, localised epidemics are possible, and an epidemic could happen quickly if the number of infected individuals rises). in low hepatitis C prevalence areas - under 25% - coverage at this level, in conjunction with good quality opioid substitution treatment (OST), may appear to have held prevalence at its current level, however the situation could change rapidly…
10% to 19%: urgent action points Urgent action points Conduct an audit of commissioning and Needle and Syringe Programme (NSP) delivery to identify areas of non-compliance with the NICE public health guidance… Talk to injecting drug users and service providers to identify areas of low coverage and/or poor access to services and also access to syringes, sharing, and syringe reuse… Increase the number of opiate injecting drug users who have access to good quality opioid substitute prescribing;
20% – 32%: coverage needs improving If the figures you have put in - particularly the estimate for the number of injecting drug users - are right, coverage will probably prevent an HIV epidemic in low prevalence countries such as the UK. …Although it will reduce the numbers of injecting drug users catching hepatitis C, it is unlikely to make significant inroads into reducing the incidence and prevalence of hepatitis C.
20% – 32% – advice includes access to syringes is unlikely to be even… Those reliant on secondary exchange are likely to be using each syringe far more times than the average, and be more likely to share. Ensure that limits are not being placed on the amount of equipment injecting drug users can take
33% to 69%: coverage should be further improved coverage is likely to prevent an HIV epidemic while prevalence of HIV remains low. …It is also likely that there will be significant reduction in the transmission of hepatitis C. Sharing of syringes is still likely to be occurring, particularly in groups with reduced access to the injecting equipment that is being distributed.
33% to 69%: advice includes Encourage those injecting drug users in contact with services to take all the equipment they need so that they have at least one syringe for every injection, and are able to take additional equipment to distribute to their peers.
70% to 99% coverage to a substantial proportion of injectors is good, but further improvement is needed for service provision to be NICE guidance compliant
70% to 99% – advice includes Check the figures for the number of injecting drug users, the number in treatment, and number of syringes distributed are accurate, and if they are continue to: Identify high risk groups and improve access to services for them; Monitor the number of needles and syringes distributed;
100%+: coverage is excellent It is still important for services to: take steps to enable people to get into opioid substitution therapy so they can reduce or stop their injecting, and reduce the risk of accidental BBV infection and overdose