Accessibility of Needle and Syringe Programs and Injecting and Sharing Risk Behaviors in High Hepatitis C Virus Prevalence Settings

Naserirad, Mohsen; Beulaygue, Isabelle C.

doi:10.1080/10826084.2019.1710210

Cited by 9 publications

(3 citation statements)

References 55 publications

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“…Needle and syringe program's sustainability is dependent upon both their accessibility and continued utilization among the population base they aim to serve [34]. The World Health Organization [35] recommends NSPs distribute 200+ needles per PWID annually for their sustainable use [35].…”

Section: Implications For Nsp Implementation Sustainability Research and Practicementioning

confidence: 99%

“…However, substantial variability in NSP service provision, utilization, coverage, range, needle and syringe distribution and program reach are obstacles to their sustainable implementation [14]. Moreover, provider, structural, and societal barriers to NSP access for PWID [36], alongside communities lack of knowledge surrounding NSP objectives, policies, laws, regulations, locations and stigma hinder their sustainable implementation [34].…”

Section: Implications For Nsp Implementation Sustainability Research and Practicementioning

confidence: 99%

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Sustainable Harm Reduction Needle and Syringe Programs for People Who Inject Drugs: A Scoping Review of Their Implementation Qualities

2021

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While substance use disorders (SUD) continue to be a global concern, harm reduction approaches can provide sustainable harm minimization to people who inject drugs (PWID) without requiring abstinence. Yet, the evidence for the sustainable implementation of harm reduction approaches is newly emerging. This scoping review sought to map the evidence on implementation qualities of sustainable harm reduction needle and syringe programs (NSPs). We searched the Cochrane Database of Systematic Reviews, PubMed, ProQuest Central, and Directory of Open Access Journals for empirical studies (a) with an explicit focus on harm minimization NSPs, (b) with a clearly identified study population, (c) that described the specific NSP implementation protocol, (d) that provided information on accessibility, affordability, and feasibility, and (e) were published in English between 2000–2020. Following narrative qualitative synthesis, the evidence suggests individual implementer characteristics directly influenced sustainable availability and scope of NSP provision while implementation processes explained the predictability and continuity of service provision across services. External factors including community perceptions of NSPs and policing activity influenced the sustainability of NSP implementation. The emerging evidence suggests that sustainable NSP programs for PWID require provider, consumer, and community engagement, supported by enabling health policies.

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Section: Implications For Nsp Implementation Sustainability Research and Practicementioning

confidence: 99%

Section: Implications For Nsp Implementation Sustainability Research and Practicementioning

confidence: 99%

Sustainable Harm Reduction Needle and Syringe Programs for People Who Inject Drugs: A Scoping Review of Their Implementation Qualities

2021

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“…However, SSPs' uptake and coverage are far from meeting recommended targets and provide consistent services to only a quarter of PWID [12]. Reasons for low uptake include (1) long geographical distance to SSPs [13][14][15], especially in rural areas where opioid use is rising substantially [15]; (2) limited SSP hours of operation [16]; (3) lack of public transportation [17]; (4) the limited power of SSP workforces [18]; and (5) perceived stigma among PWID and fear of arrest and police interference [8,[19][20][21][22]. These reasons may largely be attributed to the operational style of current SSPs, that is, services and supplies are either provided at central SSP locations or delivered through mobile vans at selected sites during scheduled hours [23].…”

Section: Introductionmentioning

confidence: 99%

Acceptability of an mHealth App That Provides Harm Reduction Services Among People Who Inject Drugs: Survey Study

Shelby¹,

Zhou²,

Barber³

et al. 2021

J Med Internet Res

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Background Harm reduction services reduce the negative consequences of drug injection and are often embedded within syringe service programs (SSPs). However, people who inject drugs (PWID) suboptimally engage with such services because of stigma, fear, transportation restrictions, and limited hours of operation. Mobile health (mHealth) apps may provide an opportunity to overcome these barriers and extend the reach of SSPs beyond that of the traditional brick-and-mortar models. Objective This study aims to assess the prevalence of smartphone ownership, the level of comfort in providing the personal information required to use mHealth apps, and interest in using an mHealth app to access harm reduction services among PWID to guide the development of an app. Methods We administered a survey to 115 PWID who were enrolled via respondent-driven sampling from July 2018 to July 2019. We examined the extent to which PWID had access to smartphones; were comfortable in providing personal information such as name, email, and address; and expressed interest in various app-based services. We measured participant characteristics (demographics, health status, and behaviors) and used binary logistic and Poisson regressions to identify independent correlates of mHealth-related variables. The primary regression outcomes included summary scores for access, comfort, and interest. The secondary outcomes included binary survey responses for individual comfort or interest components. Results Most participants were White (74/105, 70.5%), male (78/115, 67.8%), and middle-aged (mean=41.7 years), and 67.9% (74/109) owned a smartphone. Participants reported high levels of comfort in providing personal information to use an mHealth app, including name (96/109, 88.1%), phone number (92/109, 84.4%), email (85/109, 77.9%), physical address (85/109, 77.9%), and linkage to medical records (72/109, 66.1%). Participants also reported strong interest in app-based services, including medication or sterile syringe delivery (100/110, 90.9%), lab or appointment scheduling (90/110, 81.8%), medication reminders (77/110, 70%), educational material (65/110, 59.1%), and group communication forums (64/110, 58.2%). Most participants were comfortable with the idea of home delivery of syringes (93/109, 85.3%). Homeless participants had lower access to smartphones (adjusted odds ratio [AOR] 0.15, 95% CI 0.05-0.46; P=.001), but no other participant characteristics were associated with primary outcomes. Among secondary outcomes, recent SSP use was positively associated with comfort with the home delivery of syringes (AOR 3.29, 95% CI 1.04-10.3 P=.04), and being older than 50 years was associated with an increased interest in educational materials (AOR 4.64, 95% CI 1.31-16.5; P=.02) and group communication forums (AOR 3.69, 95% CI 1.10-12.4; P=.04). Conclusions Our findings suggest that aside from those experiencing homelessness or unstable housing, PWID broadly have access to smartphones, are comfortable with sharing personal information, and express interest in a wide array of services within an app. Given the suboptimal access to and use of SSPs among PWID, an mHealth app has a high potential to address the harm reduction needs of this vulnerable population.

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Hepatitis C Virus Reinfection Among People Who Inject Drugs

Litwin,

Tsui,

Heo

et al. 2024

JAMA Netw Open

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IMPORTANCEHepatitis C virus (HCV) reinfection after curative treatment remains a concern for people who inject drugs.OBJECTIVETo assess the incidence of HCV reinfection and associated risk factors.DESIGN, SETTING, AND PARTICIPANTSThis cohort study is a secondary analysis of a randomized clinical trial that was conducted across opioid treatment programs and community health centers in the US between September 2016 and August 2018. The current analyses were performed in March 2022. People who inject drugs who achieved sustained virologic response (SVR) were followed for up to 42 months.ExposurePatients were randomly assigned to receive modified directly observed therapy or patient navigation.MAIN OUTCOMES AND MEASURESThe primary outcome was rate of HCV reinfection. Change in reinfection rates over time was assessed using a Poisson regression model.RESULTSA total of 415 participants (mean [SD] age, 44.7 [11.5] years; 302 male [72.8%]) achieved a SVR and had 1 or more post-SVR assessments for HCV RNA. Overall, 302 (72.8%) reported recent injection drug use, 192 (46.3%) were living in unstable housing, and 313 (75.4%) had received recent methadone or buprenorphine for opioid use disorder. The overall reinfection rate was 11.4 per 100 person-years at risk (95% CI, 8.7-14.7 per 100 person-years at risk) over 518 person-years of follow-up. Reinfection rates varied significantly across sites, ranging from 2.9 per 100 person-years at risk (95% CI, 0.1-16.3 per 100 person-years) to 25.2 per 100 person-years at risk (95% CI, 15.6-38.5 per 100 person-years at risk) (P = .006). There was a significant decrease in incident reinfection with increasing post-SVR follow-up (weeks 0-24, 15.5 per 100 person-years; 95% CI, 10.3-22.3 per 100 person-years; weeks 73-144, 4.3 per 100 person-years; 95% CI, 0.9-12.5 per 100 person-years; P = .008). Reinfection rates were lower for participants aged 40 years or older than for younger participants (adjusted incidence rate ratio, 0.32; 95% CI, 0.18-0.57) and for participants for whom methamphetamine was not detected in urinary drug screening compared with participants for whom methamphetamine was detected (adjusted incidence rate ratio, 0.41; 95% CI, 0.21-0.82). Participants who reported injection drug use within the preceding 3 months had higher risk of reinfection than those who did not have recent injection drug use (adjusted incidence rate ratio, 3.33; 95% CI, 1.86-5.97).CONCLUSIONS AND RELEVANCEIn this cohort study of people who injected drugs and were treated for HCV infection in community settings, reinfection was high in the period immediately after SVR but decreased significantly over time. These findings highlight the importance of early intervention to prevent reinfection.Trial RegistrationClinicalTrials.gov Identifier: NCT02824640

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Accessibility of Needle and Syringe Programs and Injecting and Sharing Risk Behaviors in High Hepatitis C Virus Prevalence Settings

Cited by 9 publications

References 55 publications

Sustainable Harm Reduction Needle and Syringe Programs for People Who Inject Drugs: A Scoping Review of Their Implementation Qualities

Sustainable Harm Reduction Needle and Syringe Programs for People Who Inject Drugs: A Scoping Review of Their Implementation Qualities

Acceptability of an mHealth App That Provides Harm Reduction Services Among People Who Inject Drugs: Survey Study

Hepatitis C Virus Reinfection Among People Who Inject Drugs

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