Theme: Epidemiology & Public Health Research Year: 2022
Background:
Georgia has one of the highest prevalences of injecting drug use in the world, an estimated 2.2% of
18-64 year old people inject drugs. Syringe vending machines (SVM) can improve access to sterile
injecting equipment, but they have not been widely implemented or evaluated.
Methods:
From July 2019-December 2020, 10 SVM were installed at five harm reduction sites in Tbilisi, Georgia
and outcomes evaluated as part of an implementation trial. The SVM were stocked with a variety of
package types, including for opioid users, stimulant users, overdose prevention, male and female
condoms, and pregnancy tests. We gathered financial data from the project to estimate fixed (staff
time, start up costs, equipment, running costs, and consumables) and variable (harm reduction kits)
costs. We calculated the full economic cost of the SVM intervention, cost per user, and cost per kit
distributed, compared to no implementation of SVM, in 2020 Euro values.
Results:
Over the study period, 1,132 users were issued with access cards, and 29,238 kits distributed
through the SVM, at a total cost of €204,358. The largest cost component was taff costs, at 51%,
with consumable costs 28%, equipment 10%, and start up, recurrent costs, and overheads 5% or less
each. Opioid and stimulant kits were the most accessed, at 35% and 32% of total. The cost per user
was €66 per year, and the cost per transaction was €7, of which approximately €5 was fixed costs
and €2 consumables. If the monthly number of transactions increased from the average of 1,622 per
month to the highest monthly usage (4,714), the fixed costs per transaction would decrease to less
than €1.
Conclusion:
These costing results will be important for decision makers considering the relative cost of harm
reduction interventions as national programs take on costs previously funded by Global Fund.
Disclosure of Interest Statement:
JGW and PV declare grant funding from Gilead Sciences unrelated to this work. All other authors
declare no conflicts of interest. This study was funded by the 5% Initiative implemented by Expertise
France and funded by the French Ministry of Europe and Foreign Affairs (Grant No. 17SANIN207).