Kuala Lumpur---Malaysia is combating an epidemic of HIV infections transmitted through sharing contaminated needles and syringes. In 2006, the government initiated limited programs of "harm reduction" interventions. The program included the Needle and Syringe Program (NSP), a program where people who inject drugs are offered clean needles and syringes, and Methadone Maintenance Therapy (MMT), a program offering heroin addicts enrollment in rehabilitation therapy where heroin is replaced with synthetic methadone. These harm reduction programs have succeeded, and Malaysia has now expanded them nationwide.
These harm reduction interventions also have been shown to be cost-effective, according to new research led by the Centre of Excellence for Research in AIDS (CERiA) at the University of Malaya, in collaboration with the Kirby Institute, University of New South Wales and funded by the World Bank. Such interventions can be expected to avert 23,241 new HIV infections as well as result in savings of RM210 million in direct health care costs – producing a return of RM1.07 for every ringgit spent over the next ten years.
The study estimated that 12,653 HIV infections were successfully averted since 2006 with the implementation of these NSP and MMT harm reduction programmes, targeting people who inject drugs. These averted infections have resulted in savings of RM47.1 million in direct health care costs, which the government would have had to spend on treatment and monitoring, demonstrating that harm reduction programmes in Malaysia are highly cost-effective.
Continuing support for harm reduction would produce even higher returns over the next ten years. The savings in healthcare are expected to increase four-fold which will exceed total investment by RM1.07 for every ringgit spent. It is also expected that harm reduction programmes will continue to be cost-effective and help prevent more than 23,000 new infections.
A long term benefits projection for the period 2006-2050 indicates savings of approximately RM910 million in healthcare costs and an average return of RM1.13 for every ringgit invested in harm reduction programmes. This study provides strong evidence that even with the present programme coverage, harm reduction programmes are cost-effective and are expected to produce net cost-savings to the government in the future. Continued support for these programs will save money and save lives.
The Government of Malaysia has provided a considerable amount of resources and efforts to control HIV transmission among people who inject drugs with the implementation of the MMT and NSP. Funding for harm reduction activities is almost exclusively from the public purse although more recently it has been supplemented by funding from the Global Fund for AIDS, TB and Malaria and the International HIV/AIDS Alliance. A total of 34,244 people have been enrolled into the NSP which is being conducted by local non-governmental organizations and the Ministry of Health. The MMT program is currently being provided through public hospitals and clinics, private practitioners, and Malaysia’s National Anti-Drug Agency (NADA)’s Cure&Care clinics and Cure&Care Service Centers, as well as in prisons.
This study is the first of its kind to review the cost-effectiveness and return on investment of Malaysia’s HIV prevention interventions.
According to Ulrich Zachau, World Bank’s Country Director for Malaysia: “We would like to congratulate the Malaysian Government for taking the lead in implementing these cost-effective and cost-saving harm reduction interventions targeting people who inject drugs. These interventions help protect many vulnerable people in Malaysia from HIV infection and save lives. We hope this study will inspire policymakers in other countries in the Asia-Pacific region that face similar HIV epidemics among people who inject drugs.”
"This is a very important study that validates what we have always known – that harm reduction programs save lives and money”, says Professor Adeeba Kamarulzaman, Director of CERiA and the Dean of the Faculty of Medicine, University of Malaya. “With injecting drug use continuing to be a significant driver of the HIV epidemic here in Malaysia and in many parts of the region, this study affirms that needle syringe and methadone maintenance programs must remain as a cornerstone in our fight against HIV”, she adds. “We would like to thank and congratulate Dato’ Seri Najib Tun Razak, our Prime Minister who in his capacity as the Chair of the Cabinet Committee on Drugs in 2005 took the bold step to give the go ahead for the implementation of these programs against much public opposition.”
The report, titled Cost-Effectiveness and Return on Investment of HIV Harm Reduction Programmes for People Who Inject Drugs in Malaysia, forms part of the World Bank’s technical assistance to Malaysia under Malaysia AIDS Support II project (P133134). The project aims to help Malaysia improve strategic information and generate evidence that will support and strengthen the country’s HIV prevention efforts.
Authors:
- Herlianna Naning, Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia;
- Cliff Kerr, Kirby Institute, University of New South Wales, Sydney, Australia;
- Adeeba Kamarulzaman, Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia;
- Maznah Dahlui, Social and Preventive Medicine Department, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia;
- Ng Chiu Wan, Social and Preventive Medicine Department, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia;
- David Wilson, Kirby Institute, University of New South Wales, Sydney, Australia;
- and Sutayut Osornprasop, World Bank Group
