Designing an Institute for Health and Technology: The Amsterdam Living Lab

Background: Despite progress made in halting the global HIV epidemic, new infections among injection drug users (IDU) in Eastern Europe and Central Asia are increasing, and accounted for 10% of all new HIV infections globally in 2010. With 1.8 million IDUs, the Russian Federation (RF) alone contributed to 70% of these infections. Despite ample evidence on effectiveness of needle exchange programs (NEP), the RF is not actively promoting their development. Our project aims to assess the potential health and cost benefits of scaling-up of NEPs in the RF using our advanced modeling tool. Structure/Method/Design: Using standard systematic review methods, we searched and screened studies assessing the direct and indirect effect of NEP on HIV-related outcomes globally. We extracted outcome data from eligible studies, transformed them to standard metric of relative risk reduction (RRR), and calculated summary measures using the random-effects meta-regression model. We developed and calibrated a Markovestate mathematical model to capture the dynamics of the HIV epidemic in the RF and transformed it into our user-friendly, interactive, web-based tool entitled “Global Health Decisions Policy Explorer.” Results (Scientific Abstract)/Collaborative Partners (Programmatic Abstract): Our meta-analysis revealed that NEP attendance is associated with a 57% (52% to 62%) reduction in needle sharing in IDUs. Using this and other data in our model, we estimate that increasing the coverage of NEPs from 6% to 10% of IDUs in the RF will prevent 11,830 HIV infections and 3369 AIDS-related deaths over the next 20 years for approximately $39 million. Scale-up of programs to reach 25% or 50% of IDUs would avert 70,000 or 164,000 infections, respectively, and 20,000 and 46,000 deaths when compared with the baseline scenario for the cost of $233 million and $557 million. Summary/Conclusion: Resource allocation and governance needs to rely on sound evidence that is easy to use. Our project suggests that large gains in HIV prevention can be made in the Russian Federation through scale-up of NEPs.