Availability, Accessibility, and Coverage of Needle and Syringe Programs in Prisons in the European Union: A Multi-Stage Scoping Review.

Needle and syringe programs (NSPs) are among the most effective interventions to control infection transmission among people who inject drugs in prisons. This review aimed to evaluate the availability, accessibility, and coverage of NSP in prisons in the European Union countries. In line with the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" criteria, four databases of peer-reviewed publications (PubMed/Medline, ISI Web of Science, EBSCO, and ScienceDirect), and 53 databases for grey literature were systematically searched to collect data published from January 2008 to August 2018. A total of 23,969 documents (17,297 papers and 6,672 grey documents) were identified, of them 26 were included into the study. In 2018, imprisonment rates in 28 EU countries ranged between 51 per 100,000 in Finland and 235 per 100,000 in Lithuania. Only four countries namely Germany (in one prison), Luxemburg (no coverage data were found), Romania (available in more than 50% of prisons), and Spain (in all prisons) have needle and syringe programs in prisons. Portugal stopped the program after a six-months pilot phase. Despite the protective impact of the prison-based NSP on infection transmission, only four EU countries distribute sterile syringes among people who inject drugs in prisons, and coverage of the program within these countries is very low. Since most prisoners will eventually return to the community, lack of NSP in EU prisons is not only a threat to the health of prisoners but also endangers public health.