RTI International to Test Effectiveness of Changing Syringes to Reduce HIV Infection in Tajikistan Needle Exchange Program

RESEARCH TRIANGLE PARK, N.C.— Researchers at RTI International will launch a pilot program to change the types of syringes used in needle exchange programs in Tajikistan to see if doing so will reduce the spread of HIV infection among people who inject drugs.

Findings from a recent mathematical modeling study conducted by RTI suggest that switching the type of syringe used by people who inject drugs from high dead-space to low dead-space syringes could help curb HIV transmission within eight years in countries with injection-driven epidemics.

When a plunger on a syringe is fully depressed, all syringes retain fluid in what has been termed “dead space.” In high dead-space syringes, 1,000 times more blood is retained in the syringe after washing than in low dead-space syringes.

This means that if a person who injects drugs shares a high dead-space syringe with an HIV-positive injecting partner, they are more likely to be exposed to HIV than if he or she shared a low dead-space syringe.

As part of the grant from the National Institute on Drug Abuse, RTI researchers will distribute low dead-space syringes to at-risk populations in Tajikistan areas hardest hit by the HIV epidemic. The grant was awarded for up to three years, worth more than $600,000. The syringes will be donated by Exchange Supplies.

“Nearly half of injection drug users in Tajikistan participate in needle exchange programs,” said William Zule, Dr.P.H., a senior health research analyst at RTI and the study’s principal investigator. “Therefore, interventions that can reduce risk as a component of a needle-exchange program have the potential to dramatically reduce HIV risk and transmission in this area of the world at relatively low cost.”

The pilot test will be conducted at two needle exchange programs located in Kulyob, Tajikistan where HIV prevalence among people who inject drugs is 24 percent and Khorog, Tajikistan where it is 14 percent. These exchange programs currently distribute only high dead-space syringes.

“This pilot test is the first human trial aimed at reducing the number of HIV cases by switching syringes,” Zule said.

Syringe exchanges are one of the U.S. President's Emergency Plan for AIDS Relief’s (PEPFAR) recommended approaches for global HIV Prevention.

“If the mathematical models hold true, we may be able to dramatically decrease new infections among intravenous drug users and slow the spread of HIV to non-drug using populations,” Zule said. “Findings from the study will determine whether it makes sense to design and implement a large multi-site randomized controlled trial with syringe exchange programs to test the success of such an intervention.”

This pilot study is supported by the National Institute On Drug Abuse of the National Institutes of Health under Award Number R34DA035094.