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Overall, we found very low-quality evidence that high NSP coverage did not reduce risk of HCV acquisition ( RR , 95% CI to ) with high heterogeneity (I 2 = 77%) based on five studies from North America and Europe involving 3530 participants. After stratification by region, high NSP coverage in Europe was associated with a 76% reduction in HCV acquisition risk ( RR , 95% CI to ) with less heterogeneity (I 2 =0%). We found low-quality evidence of the impact of combined high coverage of NSP and OST, from three studies involving 3241 participants, resulting in a 74% reduction in the risk of HCV acquisition ( RR 95% CI to ).

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