{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T19:37:23Z","timestamp":1791488243919,"version":"4.3.4"},"reference-count":55,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2023,2,13]],"date-time":"2023-02-13T00:00:00Z","timestamp":1676246400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Although the Netherlands, Canada and Australia were early adopters of harm reduction for people who inject drugs (PWID), their respective HIV and hepatitis C (HCV) epidemics differ. We measured the pooled effect of needle and syringe program (NSP) and opioid agonist therapy (OAT) participation on HIV and HCV incidence in these settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>For each cohort, we emulated the design and statistical analysis of a target trial using observational data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting and Participants<\/jats:title>\n                    <jats:p>We included PWID at risk of HIV or HCV infection from the Amsterdam Cohort Studies (1985\u20132013), Vancouver Injection Drug Users Study (1997\u20132009) and Melbourne Injecting Drug User Cohort Study (SuperMIX) (2010\u20132021).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>Separately for each infection and cohort (only HCV in SuperMIX), marginal structural models were used to compare the effect of comprehensive (on OAT and 100% NSP coverage or on OAT only if no recent injection drug use) versus no\/partial NSP\/OAT (no OAT and\/or &lt;100% NSP coverage) participation. Pooled hazard ratios (HR) and 95% CI were calculated using random\u2010effects meta\u2010analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>\n                      We observed 94 HIV seroconversions and 81 HCV seroconversions among 2023 and 430 participants, respectively. Comprehensive NSP\/OAT led to a 41% lower risk of HIV acquisition (pooled HR\u2009=\u20090.59, 95% CI\u2009=\u20090.36\u20130.96) and a 76% lower risk of HCV acquisition (pooled HR\u2009=\u20090.24, 95% CI\u2009=\u20090.11\u20130.51), compared with no\/partial NSP\/OAT, with little heterogeneity between studies for both infections (\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>\n                        <jats:italic>2<\/jats:italic>\n                      <\/jats:sup>\n                      \u00a0=\u20090%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In the Netherlands, Canada and Australia, comprehensive needle and syringe program and opioid agonist therapy participation appears to substantially reduce HIV and hepatitis C acquisition compared with no or partial needle and syringe program\/opioid agonist therapy participation. These findings from an emulated trial design reinforce the critical role of comprehensive access to harm reduction in optimizing infection prevention for people who inject drugs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.16147","type":"journal-article","created":{"date-parts":[[2023,1,30]],"date-time":"2023-01-30T01:11:20Z","timestamp":1675041080000},"page":"1116-1126","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Comprehensive needle and syringe program and opioid agonist therapy reduce HIV and hepatitis c virus acquisition among people who inject drugs in different settings: A pooled analysis of emulated trials"],"prefix":"10.1111","volume":"118","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9890-4694","authenticated-orcid":false,"given":"Daniela K.","family":"van Santen","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases Research and Prevention, Public 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