Exploring the role of an unsanctioned, supervised peer driven injection facility in reducing HIV and hepatitis C infections in people that require assistance during injection

Abstract

BackgroundSupervised consumption rooms or supervised injection facilities (SIFs) are venues that have reduced the risk of needle sharing and deaths caused by drug overdose among people who inject drugs (PWID). As a result of such a decline in the mortality rate, numerous studies have been able to illustrate its cost-effectiveness. However, studies have neglected to examine the same phenomena for unsanctioned SIFs that are run by peer drug users and provide assisted injections.MethodsThe current study will determine whether the former unsanctioned SIF, that provided assisted injection and was operated by the grass root organization called Vancouver Area Network of Drug Users (VANDU), cost less than the health care consequences of not having such a program in Vancouver, Canada. By analyzing data gathered in 2013, this paper relies on two mathematical models to estimate the number of new HIV and HCV infections prevented by the former unsanctioned facility in Vancouver’s Downtown Eastside.ResultsA conservative estimate indicates that the SIF location that provided assisted injections has a benefit-cost ratio of 33.1:1 due to its low operational cost. At the baseline sharing rate, the facility, on an average, reduced 81 HCV and 30 HIV cases among PWID each year. Such reductions in blood borne infections among PWID resulted in annual savings worth CAN$4.3 million dollars in health care expenditure. In addition to this, the current paper relies on a sensitivity analysis based on different needle sharing rate scenarios.ConclusionsThe sensitivity analysis and the baseline rates indicate that funding SIF facilities operated by peer drug users that facilitate assisted injection appear to be an efficient and effective use of financial resources in the public health domain since they lead to a significant decline in the rate of mortality within a vulnerable population.

Back to the core: A network approach to bolster harm reduction among persons who inject drugs

“…The DTES, Canada, is home to a host of individuals actively involved in diffusing harm reduction practices. In many ways, it follows a network principle to diffuse the message of safe behaviors to as many PWIDs as possible through InSite (Jozaghi, 2015;McNeil et al, 2014;Small et al, 2012) and VANDU, an informal peer-based network of safe injection practices (Kerr et al, 2006), and several peer engagement programs (Greer et al, 2016). Peer-driven research have been used to effectively recruit difficult to reach populations, expanding the reach of intervention services to those who otherwise would have not been reached (Smyrnov et al, 2012;Valente, 2015) whilst capitalizing on the relationship between former or current users (Heckathorn et al, 2015).…”

“…That is, an average of 722 visits per day across its 13 injection booths (Vancouver Coastal Health, 2017), which is estimated to supply approximately 5% of the daily needs in the area. The need for additional harm reduction services in the DTES is partly supplied by more informal peer-driven program "networks" that exploit the interpersonal relationships of users (Greer et al, 2016;Jozaghi, 2014;Jozaghi, 2015;Kerr et al, 2006;McNeil et al, 2014;McNeil et al, 2015;Small et al, 2012). Researching the social structure of harm reduction is important in understanding the types of users who have direct access to harm reduction mentors or peers, and those users who are relatively isolated from harm reduction services across the informal, network-driven services like the Vancouver Area Network of Drug Users (VANDU), and the more established supervised facilities like InSite.…”

The role of medical students’ training and community placement as a tool to enhance medical education in Canada

“…There is also growing evidence of the effectiveness of peer-based models of public health initiatives (Jozaghi, Greer, Lampkin, & Buxton, 2018). These include the Vancouver Area Network of Drug Users, the Western Aboriginal Harm Reduction Society, the British Columbia Association for People on Methadone, the Eastside Illicit Drinkers Group for Education, the SALOME/NAOMI Association of Patients, community clinics, detox centers, overdose prevention sites, and the highly beneficial outcome of networks and partnerships between public health providers who provide specialized care to patients struggling with poverty, mental health, and addiction (Bouchard et al, 2018;Goodman et al, 2017;Jozaghi, 2015bJozaghi, , 2014.…”

Peer-Assisted Injection as a Harm Reduction Measure in a Supervised Consumption Service: A Qualitative Study of Client Experiences

“…At the time, peer injecting was prohibited on the premises by federal law (3)(4)(5), meaning any clients requiring assistance with injection remained vulnerable to unsafe conditions offsite. In a further effort to mitigate risks such as syringe sharing, blood-borne infection and overdose amongst this cohort (2,6), a Vancouver grassroots organization opened an unsanctioned injection site in the same area, wherein peers oversaw and assisted with injections.…”