Acceptability of low dead space syringes and implications for their introduction: A qualitative study in the West of England

Abstract

Detachable LDSS are likely to be acceptable and should therefore be offered to those using detachable high dead space syringes and/or fixed 1ml LDSS syringes to inject into deeper femoral veins. An intervention is needed to support their introduction with 'training', 'education', 'persuasion' and eventual 'restriction' components.

Usage of low dead space syringes and association with hepatitis C prevalence amongst people who inject drugs in the UK

“…Groin injecting may be a more robust marker of HDSS usage than using questions on the type of syringe use because the latter was less frequently recorded – 98% of participants that injected in the past month answered the groin injecting question, but only 71% answered both questions used to derive the LDSS variable. Groin injecting, due to the preferred size of the needle for this injection site, was strongly correlated with HDSS use, as also found by other studies(Kesten et al, 2017). However, some research suggests that people who inject into the groin also engage in more risky injection practices that could lead to HCV infection(Rhodes et al, 2006).…”

“…Our study sheds further light on who does and does not use LDSS; LDSS use is inversely associated with injecting behaviours that are considered more chaotic such as crack injecting, polydrug use, and groin injecting(Tweed et al, 2018). The study adds to the evidence that those injecting into deep lying veins, the groin in our study, are a distinct subset of PWID with specific syringe needs to enable injection into such sites(Kesten et al, 2017). As previous studies have reported injecting into the groin is often considered a last resort once the peripheral veins are no longer useable(Hope et al, 2015), resources and information about safer injection practices and maintaining better vein health should be used to reduce the extent of injection into the groin, and other deep and/or central veins.…”

“…Regarding reasons for why LDSS or HDSS are used, a recent qualitative study from Bristol, UK, found an important motivation behind syringe choice was to inject successfully, with changes in syringe use only being considered when problems were encountered(Kesten et al, 2017). We did not have information on why individuals used HDSS or LDSS but were able to examine associations between drug use behaviours and what type of syringe was used.…”

“…As injecting in the groin requires longer needles that are usually HDSS(Kesten et al, 2017), groin injecting and HDSS usage were highly correlated, with both potentially being risk factors for HCV infection as groin injecting is associated with other risky behaviours(Rhodes et al, 2006). We did not include groin injecting as a confounder in the multivariable model because of this collinearity and the possibility that it is on the causal pathway.…”

Options for reducing HIV transmission related to the dead space in needles and syringes

“…After NSP selects LDS needles and syringes, they must identify and implement strategies that assure uptake of the LDS equipment by their clients. A recent qualitative study of NSP clients and staff members in the UK concluded that LDS needles were likely acceptable to clients [ 44 ]. The study recommended offering both types of needles and implementing an intervention to promote use of LDS needles and syringes.…”