BackgroundGrounded in a community-based participatory research (CBPR) framework, the PROUD (Participatory Research in Ottawa: Understanding Drugs) Study aims to better understand HIV risk and prevalence among people who use drugs in Ottawa, Ontario. The purpose of this paper is to describe the establishment of the PROUD research partnership.MethodsPROUD relies on peers’ expertise stemming from their lived experience with drug use to guide all aspects of this CBPR project. A Community Advisory Committee (CAC), comprised of eight people with lived experience, three allies and three ex-officio members, has been meeting since May 2012 to oversee all aspects of the project. Eleven medical students from the University of Ottawa were recruited to work alongside the committee. Training was provided on CBPR; HIV and harm reduction; and administering HIV point-of-care (POC) tests so that the CAC can play a key role in research design, data collection, analysis, and knowledge translation activities.ResultsFrom March-December 2013, the study enrolled 858 participants who use drugs (defined as anyone who has injected or smoked drugs other than marijuana in the last 12 months) into a prospective cohort study. Participants completed a one-time questionnaire administered by a trained peer or medical student, who then administered an HIV POC test. Recruitment, interviews and testing occurred in both the fixed research site and various community settings across Ottawa. With consent, prospective follow-up will occur through linkages to health care records available through the Institute for Clinical and Evaluation Sciences.ConclusionThe PROUD Study meaningfully engaged the communities of people who use drugs in Ottawa through the formation of the CAC, the training of peers as community-based researchers, and integrated KTE throughout the research project. This project successfully supported skill development across the team and empowered people with drug use experience to take on leadership roles, ensuring that this research process will promote change at the local level. The CBPR methods developed in this study provide important insights for future research projects with people who use drugs in other settings.

BackgroundSupervised injection sites (SISs) have been effective in reducing health risks among people who inject drugs (PWID), including those who face issues of homelessness, mental health illness, interactions with local policing practices, and HIV infection. We investigate the risk behaviours and risk environments currently faced by potential users of an SIS in Ottawa to establish the need for such a service and to contribute to the design of an SIS that can address current health risks and reduce harm.MethodsThe PROUD cohort is a community-based participatory research (CBPR) project that examines the HIV risk environment among people who use drugs in Ottawa. From March to October 2013, 593 people who reported using injection drugs or smoking crack cocaine were enrolled through street-based recruitment in the ByWard Market neighbourhood, an area of the city with a high concentration of public drug use and homelessness. Participants completed a demographic, behavioural, and risk environment questionnaire and were offered HIV point-of-care testing. We undertook descriptive and univariate analyses to estimate potential use of an SIS by PWID in Ottawa and to explore risk behaviours and features of the risk environment faced by potential users of the service.ResultsOf those participants who reported injecting drugs in the previous 12 months (n = 270), 75.2 % (203) reported a willingness to use an SIS in Ottawa. Among potential SIS users, 24.6 % had recently injected with a used needle, 19.0 % had trouble accessing new needles, 60.6 % were unstably housed, 49.8 % had been redzoned by the police, and 12.8 % were HIV positive. Participants willing to use an SIS more frequently injected in public (OR = 1.98, 95 % CI = 1.06–3.70), required assistance to inject (OR = 1.84, 95 % CI = 1.00–3.38), were hepatitis C positive (OR = 2.13, 95 % CI = 1.16–3.91), had overdosed in the previous year (OR = 2.00, 95 % CI = 1.02–3.92), and identified as LGBTQ (OR = 5.61, 95 % CI = 1.30–24.19).ConclusionAn SIS in Ottawa would be well-positioned to reach its target group of highly marginalized PWID and reduce drug-related harms. The application of CBPR methods to a large-scale quantitative survey supported the mobilization of communities of PWID to identify and advocate for their own service needs, creating an enabling environment for harm reduction action.

Objectives: The role of migration among people who use drugs (PWUD) remains a complex topic that is often shaped by risk but also has the potential for protective health outcomes. This study examines migration trends and the effect of migration on the use of social support services for PWUD in Ottawa-Gatineau region. Methods: Respondent-driven sampling was used to recruit participants residing in Ottawa-Gatineau who were ≥18 years and used drugs in the preceding 6 months. Migration was defined as a permanent change in location after ≥3 months. Push factors (reasons for leaving previous residence) and pull factors that brought them to Ottawa were explored. Bivariable and multivariable logistic regressions were conducted using odds ratio (OR), adjusted odds ratio (AOR), and 95% confidence interval (CI), respectively, to investigate the effect of migration on shelter use and accessing harm reduction services. Results: Of 398, 358 (89.95%) migrated in their lifetime and 71 (17.83%) within the last 12 months. Our sample was 79.40% male and 22.86% identified as First Nations, Inuit, or Métis. Migratory push factors included getting away from drugs or harmful friends and pull factors included returning home for family. Recent migrants had higher odds of living in a shelter (AOR: 2.51, 95% CI: 1.37–4.61) and lower odds (AOR: 0.40, 95% CI: 0.19–0.82) of accessing harm reduction services. Conclusion: PWUD are a highly mobile group and despite being motivated to migrate to reconnect with family or social networks, a high prevalence of shelter use and low uptake of harm reduction services exists. Objectifs: Le rôle de la migration chez les personnes qui consomment des drogues (PWUD) demeure un sujet complexe qui est souvent façonné par le risque, mais qui a aussi un potentiel de protection pour la santé. Cette étude examine les tendances migratoires et l’effet de la migration sur l’utilisation des services de soutien social pour les PWUD dans la région d’Ottawa-Gatineau. Méthodes: L’échantillonnage dirigé par les répondants a été utilisé pour recruter des participants résidant à Ottawa-Gatineau âgés de 18 ans ou plus et ayant consommé de la drogue au cours des six mois précédents. La migration a été définie comme un changement permanent d’emplacement après ≥3 mois. Les facteurs d’incitation (raisons de quitter la résidence antérieure) et les facteurs d’attraction qui les ont amenés à Ottawa ont été explorés. Des régressions logistiques bi-variables et multi-variées ont été menées en utilisant les rapports de cotes (odds ratios-OR), les OR ajustés et les intervalles de confiance à 95% (IC) respectivement, pour étudier l’effet de la migration sur l’utilisation des abris et l’accès aux services de réduction des risques. Résultats: Sur 398, 358 (89,95%) ont migré au cours de leur vie et 71 (17,83%) au cours des 12 derniers mois. Notre échantillon comprenait 79,40% d’hommes et 22,86% de membres des Premières Nations, d’Inuits ou de Métis. Les facteurs d’incitation migratoires incluaient s’éloigner des drogues ou des amis nuisibles et des facteurs d’attraction incluaient rentrer à la maison pour la famille. Les migrants récents avaient des chances plus élevées de vivre dans un refuge (AOR: 2,51, IC à 95%: 1,37–4,61) et des probabilités plus faibles (AOR: 0,40, IC à 95%: 0,19–0,82) d’accéder aux services de réduction des risques. Conclusion: Les PWUD constituent un groupe très mobile et, bien qu’ils soient motivés à migrer pour se reconnecter avec les réseaux familiaux ou sociaux, il existe une forte prévalence ou utilisation de refuges et une faible utilisation des services de réduction des risques.