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    • Syringe services programs SSPs as

    2022-04-19

    Syringe services programs (SSPs), as well as expanded HIV and hepatitis C virus (HCV) testing, are key components of harm reduction for PWID and can reduce HIV and hepatitis C virus (HCV) transmissions in this troglitazone [14], [15], [16]. The number of SSPs has increased in recent years in West Virginia [17], with plans and resources allocated toward further expansion. In 2017, West Virginia state agencies received increased funding from multiple federal agencies to expand harm reduction services, improve opioid-related surveillance activities, and conduct research to better understand risk factors for opioid misuse. These agencies include CDC [18], the Substance Abuse and Mental Health Services Administration (SAMHSA) [19], and the National Institute on Drug Abuse (NIDA) [20]. In addition, a state opioid response plan was proposed in early 2018 that outlines a comprehensive approach including interventions for prevention and treatment of opioid misuse and overdose reversal [21]. Some political opposition to harm reduction programs remains, however, as evidenced by the recent suspension of a well-attended SSP in Charleston [22], [23]. Continuation and expansion of HIV and HCV testing as part of harm reduction programs are critical for control of these infectious diseases among PWID. We observed overlap between male-to-male sexual contact and IDU behavior (9% of persons living with HIV in this network investigation reported both male-to-male sex and IDU lifetime risk) and bridging of HIV risk from MSM to PWID. To prevent transmissions between these two groups, prevention programs for MSM in West Virginia remain a priority. In particular, expanded pre exposure prophylaxis (PrEP) services are needed for both MSM and PWID. At the time of this investigation, providers were offering PrEP in four of 15 counties of interest and in seven West Virginia counties overall [9]. Additional PrEP clinics are planned in collaboration with county health departments. Other HIV prevention services requiring continued bolstering include HIV testing, sexually transmitted disease testing and treatment, partner services, and care and treatment services after an HIV diagnosis.
    Conclusions
    Acknowledgment
    Funding: This work was supported by the Centers for Disease Control and Prevention, United States.
    Background The significant investment in the global HIV response has been critical to the progress recorded so far in the fight against HIV. Recent estimates show that about US$ 21.3 billion was available in 2017 for the HIV response in low- and middle-income countries compared with US$ 4.8 billion that was available in 2000. However, meeting the 90-90-90 fast track target to end the HIV epidemic will require further and sustained investment in the response. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates, about US$ 23.9 billion will be needed for HIV response in 2020 in low- and middle-income countries. The sources of HIV expenditure in low- and middle-income countries are broadly classified into domestic and external (or international). Domestic sources are HIV expenditures that emanate from within the country, which could be public (government) or private (philanthropic organizations, individuals, and household). External sources are largely from donor governments, provided through bilateral and multilateral channels. Remarkably, domestic expenditure has overtaken external funding in the total resources for HIV in low- and middle-income countries. This is partially attributable to the growing political commitment and adherence to principle of additionality, where countries have to increase their domestic HIV funding in response to external funding. Economic growth has also been reported to be associated with increasing domestic spending in low- and middle-income countries. Evidence indicates that sub-Saharan Africa (SSA)—which bears the largest burden of HIV—has had the highest growth in domestic expenditure in recent time compared with Latin America, South Asia, and Southeast Asia. However, ureter aggregate increase masks the overreliance on external sources in some of these countries. Although not specific to SSA, an assessment of HIV expenditure in 38 high-burden, low-income, and middle-income countries from 2009 to 2013 reported that external funding was responsible for more than 75% of the HIV expenditure in 19 countries.