Injecting is a high-risk method of drug use due to the possibility of transmission of blood-borne diseases, such as HIV and viral hepatitis, when contaminated injecting equipment are used. There are an estimated 14∙8 million people (95% UI 10∙0–21∙7) aged 15–64 years who inject drugs (PWID) globally.1 About 2∙3 million (1∙5–3∙1) PWID live with HIV, while 5∙8 million (4∙6–7∙0) live with hepatitis C (HCV).1 Injecting drug use accounts for an estimated 9% of new HIV infections, and 23% of new HCV infections globally.1 In addition to HIV and HCV transmission, injecting drug use is also associated with the risk of other health harms, including fatal and non-fatal overdose, vein damage, and bacterial infections.
There are a range of evidence-based interventions for reducing harms and preventing disease transmission among PWID, which have been recommended for implementation by WHO in all settings were injecting drug use is known to occur. These include needle and syringe programmes (NSPs), opioid agonist therapy (OAT), and take-home naloxone (THN). Other interventions, such as safe consumption facilities and drug checking services are also known to be effective in reducing health and social harms linked to drug use.3 WHO (along with UNAIDS and UNODC) have set target indicators for coverage of harm reduction services for PWID. Estimating the coverage of services based on these target indicators could inform planning and resource management. However, existing estimates are from a 2017 systematic review.
It is in this context that the significance of ColledgeFrisby and colleagues’5 estimation of the global coverage of harm reduction services for PWID should be viewed. They build on previous works4,6 by providing updated estimates of OAT and NSP coverage at national, regional, and global levels. A further contribution is the inclusion of THN, safe consumption facilities, and drug checking services, which serves as a useful reminder of the importance of improving access to other harm reduction services beside NSPs and OAT. The review found that although there has been some increase in the number of countries implementing harm reduction services and improvement in NSPs and OAT coverage in some countries, coverage of services remains low in most countries and for most PWID.
