‘Care and Prevent’: rationale for investigating skin and soft tissue infections and AA amyloidosis among people who inject drugs in London

Harris, Magdalena; Brathwaite, Rachel; McGowan, Catherine R.; Ciccarone, Daniel; Gilchrist, Gail; McCusker, Marie C; O’Brien, Kylie; Dunn, John; Scott, Jennifer; Hope, Vivian

doi:10.1186/s12954-018-0233-y

Cited by 23 publications

(16 citation statements)

References 47 publications

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“…Study methods have been published in detail [32]. Participants were recruited through word of mouth and recruitment flyers at drug treatment services, homeless hostels and day centres across London.…”

Section: Methodsmentioning

confidence: 99%

Navigating environmental constraints to injection preparation: the use of saliva and other alternatives to sterile water among unstably housed PWID in London

et al. 2020

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Background: The United Kingdom is experiencing an increase in drug-related deaths and serious bacterial infections among its most vulnerable citizens. Cuts to essential services, coupled with a growing homeless population, create a challenging environment to tackle this public health crisis. In this paper, we highlight an underexplored environmental constraint faced by people living and injecting drugs on the streets. Access to water for injection is restricted in the UK, due to legislative and financial barriers. Austerity measures, such as public toilet closures, further restrict the ability of people made homeless to access clean water and protect themselves from health harms. Methods: We generated questionnaire (n = 455) and in-depth qualitative interview (n = 32) data with people who inject drugs in London for the Care and Prevent study. Participants provided detail on their life history; drug use, injecting and living environments; health conditions and care seeking practices. Findings: A high proportion of the survey sample reported lifetime history of street homelessness (78%), bacterial infections (65%) and related hospitalisation (30%). Qualitative accounts highlight unsafe, potentially dangerous, injection practices in semi-public spaces. Multiple constraints to sourcing sterile water for injection preparation were reported. Alternatives to sterile water included puddle water, toilet cistern water, whisky, cola soda and saliva. Participants who injected heroin and crack cocaine together unanimously reported adding water at two stages during injection preparation: first, adding water as a vehicle for heroin (which was then heated); second, adding cold water to the heroin mixture prior to adding the crack cocaine. This new finding of a stage addition of solvent may represent an additional risk of infection.(Continued on next page)

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Section: Methodsmentioning

confidence: 99%

Navigating environmental constraints to injection preparation: the use of saliva and other alternatives to sterile water among unstably housed PWID in London

et al. 2020

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“…Care & Prevent (C&P) is a mixed method project aiming to explore risk factors for, and prevalence of, SSTI and associated sequelae among PWID in London. Study rationale and methods detail have been published [17]. Ethical approvals were obtained from the London Bridge Research Ethics Committee [17/LO/0872] and the LSHTM Observational Research Ethics Committee [12021].…”

Section: Methodsmentioning

confidence: 99%

“…The questionnaire was developed through consultation with a panel of experts and drew on existing surveys such as the Unlinked Anonymous Monitoring (UAM) Survey, a National surveillance study with PWID conducted annually [ 17 ]. Question domains comprised: socio-demographics; drug use history, injection preparation and administration practices (lifetime and previous 12 months); reuse and cleaning of injecting equipment (lifetime); experience of SSTI and other health conditions and care seeking practices (lifetime).…”

Section: Methodsmentioning

confidence: 99%

Prevalence and severity of abscesses and cellulitis, and their associations with other health outcomes, in a community-based study of people who inject drugs in London, UK

et al. 2020

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Background Skin and soft tissue infections (SSTI) are a common but preventable cause of morbidity and mortality among people who inject drugs (PWID). They can be severe, and hospitalisations of PWID with SSTI are rising. The most common SSTI presentations are abscesses and cellulitis. Methods We used data from Care & Prevent, a cross-sectional community survey of PWID in London. We reported the lifetime prevalence of SSTI, severity of infections, key risk factors, and associated sequelae. Pictorial questions were used to assess SSTI severity. Results We recruited 455 PWID. SSTI lifetime prevalence was high: 64% reported an abscess and/ or cellulitis. Over one-third (37%) reported a severe infection, 137 (47%) reported hospitalisation. SSTIrisk factors were: aged 35+ years, injecting once or more times a day, subcutaneous or intra-muscular injections, and making four or more attempts to achieve an injection. Those who reported having other health conditions were at higher odds of having an abscess or cellulitis, with risk tending to increase with number of reported conditions. Half (46%) employed self-care for their worst SSTI, and 43% waited for ten or more days before seeking medical care or not seeking medical care at all.

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“…Up to a third of PWID globally have experienced an abscess within the past month [25]. Through early identification, SSTIs can often times be treated with antibiotics without requiring hospital visits or surgical procedures.…”

Section: Discussionmentioning

confidence: 99%

When is an abscess more than an abscess? Syringe services programs and the harm reduction safety-net: a case report

et al. 2020

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Background: Syringe services programs (SSPs) are able to offer wrap-around services for people who inject drugs (PWID) and improve health outcomes. Case presentation: A 47-year-old man screened positive for a skin and soft tissue infection (SSTI) at an SSP and was referred to a weekly on-site student-run wound care clinic. He was evaluated by first-and third-year medical students, and volunteer attending physicians determined that the infection was too severe to be managed on site. Students escorted the patient to the emergency department, where he was diagnosed with a methicillin-resistant Staphylococcus aureus arm abscess as well as acute HIV infection. Conclusion: Student-run wound care clinics at SSPs, in conjunction with ongoing harm reduction measures, screenings, and treatment services, provide a safety-net of care for PWID and help mitigate the harms of injection drug use.

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‘Care and Prevent’: rationale for investigating skin and soft tissue infections and AA amyloidosis among people who inject drugs in London

Cited by 23 publications

References 47 publications

Navigating environmental constraints to injection preparation: the use of saliva and other alternatives to sterile water among unstably housed PWID in London

Navigating environmental constraints to injection preparation: the use of saliva and other alternatives to sterile water among unstably housed PWID in London

Prevalence and severity of abscesses and cellulitis, and their associations with other health outcomes, in a community-based study of people who inject drugs in London, UK

When is an abscess more than an abscess? Syringe services programs and the harm reduction safety-net: a case report

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