Implementation and evaluation of an educational intervention for safer injection in people who inject drugs in Europe: a multi-country mixed-methods study

Roux, Perrine; Donadille, Christian; Magen, Carine; Schatz, Eberhard; Stranz, Richard; Curado, Adriana; Tsiakou, T; Verdes, Ludmila; Aleksova, Aleksandrina; Carrieri, Patrizia; Mezaache, Salim; Ali, Ben Charif

doi:10.1016/j.drugpo.2020.102992

Cited by 15 publications

(10 citation statements)

References 33 publications

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“…We will also include studies of interventions that aim to reduce risk, including educational, behavioural or structural (eg, community mobilisation or policy change) interventions. 26 27 46 Studies that only report on individual-level risk factors (eg, skin-cleaning) will be included in the search, and then classified separately in the data synthesis.…”

Section: Methods and Analysismentioning

confidence: 99%

“…The final search strategy will be developed by our review team in consultation with health information specialist-librarians with systematic review experience. We conducted a pilot search in PubMed and validated by checking for inclusion of key, recent studies known to the authors that assessed either risk factors for severe bacterial or fungal infections among PWID, 68 69 social/structural determinants of bacterial infections among PWID 42 70–73 or complex interventions to reduce risk of bacterial infections among PWID 26 ( online supplemental appendix table 1 ). This validation process led to several iterative changes, including specific search terms related to ‘acidifiers’ and ‘groin injecting’.…”

Section: Methods and Analysismentioning

confidence: 99%

“…To date, prevention efforts for injecting-related bacterial and fungal infections have primarily focused on changing individual-level risk behaviours, 1 22 including hand-washing before drug preparation, 23 skin-cleaning before injecting 24 and avoiding subcutaneous or intramuscular injections. 25 Although individual-level interventions may be effective for people who due to their socioeconomic situation can adopt these practices, 26 27 they have not translated into reductions in the population-level incidence of severe bacterial and fungal infections, which continue to rise.…”

Section: Introductionmentioning

confidence: 99%

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Social and structural determinants of injecting-related bacterial and fungal infections among people who inject drugs: protocol for a mixed studies systematic review

Lewer

Bonn²,

Webster

et al. 2021

BMJ Open

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IntroductionInjecting-related bacterial and fungal infections are a common complication among people who inject drugs (PWID), associated with significant morbidity and mortality. Invasive infections, including infective endocarditis, appear to be increasing in incidence. To date, preventive efforts have focused on modifying individual-level risk behaviours (eg, hand-washing and skin-cleaning) without much success in reducing the population-level impact of these infections. Learning from successes in HIV prevention, there may be great value in looking beyond individual-level risk behaviours to the social determinants of health. Specifically, the risk environment conceptual framework identifies how social, physical, economic and political environmental factors facilitate and constrain individual behaviour, and therefore influence health outcomes. Understanding the social and structural determinants of injecting-related bacterial and fungal infections could help to identify new targets for prevention efforts in the face of increasing incidence of severe disease.Methods and analysisThis is a protocol for a systematic review. We will review studies of PWID and investigate associations between risk factors (both individual-level and social/structural-level) and the incidence of hospitalisation or death due to injecting-related bacterial infections (skin and soft-tissue infections, bacteraemia, infective endocarditis, osteomyelitis, septic arthritis, epidural abscess and others). We will include quantitative, qualitative and mixed methods studies. Using directed content analysis, we will code risk factors for these infection-related outcomes according to their contributions to the risk environment in type (social, physical, economic or political) and level (microenvironmental or macroenvironmental). We will also code and present risk factors at each stage in the process of drug acquisition, preparation, injection, superficial infection care, severe infection care or hospitalisation, and outcomes after infection or hospital discharge.Ethics and disseminationAs an analysis of the published literature, no ethics approval is required. The findings will inform a research agenda to develop and implement social/structural interventions aimed at reducing the burden of disease.PROSPERO registration numberCRD42021231411.

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Section: Methods and Analysismentioning

confidence: 99%

Section: Methods and Analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Social and structural determinants of injecting-related bacterial and fungal infections among people who inject drugs: protocol for a mixed studies systematic review

Lewer

Bonn²,

Webster

et al. 2021

BMJ Open

View full text Add to dashboard Cite

show abstract

“…Prevention efforts to date have focused on individual-level behavior change interventions to promote more sterile drug preparation and safer drug injecting techniques. Unfortunately, these have shown mixed results [ 18 – 20 ] and have had limited impact on a population level [ 1 ]. This may be in part because of social and structural factors (e.g., criminalization, discrimination, lack of access to housing, harm reduction services, and supervised injection sites) that constrain the ability of PWID to inject more safely [ 1 , 21 ] and that push PWID away from healthcare [ 22 ].…”

Section: Introductionmentioning

confidence: 99%

Opioid agonist treatment and risk of death or rehospitalization following injection drug use–associated bacterial and fungal infections: A cohort study in New South Wales, Australia

et al. 2022

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Background Injecting-related bacterial and fungal infections are associated with significant morbidity and mortality among people who inject drugs (PWID), and they are increasing in incidence. Following hospitalization with an injecting-related infection, use of opioid agonist treatment (OAT; methadone or buprenorphine) may be associated with reduced risk of death or rehospitalization with an injecting-related infection. Methods and findings Data came from the Opioid Agonist Treatment Safety (OATS) study, an administrative linkage cohort including all people in New South Wales, Australia, who accessed OAT between July 1, 2001 and June 28, 2018. Included participants survived a hospitalization with injecting-related infections (i.e., skin and soft-tissue infection, sepsis/bacteremia, endocarditis, osteomyelitis, septic arthritis, or epidural/brain abscess). Outcomes were all-cause death and rehospitalization for injecting-related infections. OAT exposure was classified as time varying by days on or off treatment, following hospital discharge. We used separate Cox proportional hazards models to assess associations between each outcome and OAT exposure. The study included 8,943 participants (mean age 39 years, standard deviation [SD] 11 years; 34% women). The most common infections during participants’ index hospitalizations were skin and soft tissue (7,021; 79%), sepsis/bacteremia (1,207; 14%), and endocarditis (431; 5%). During median 6.56 years follow-up, 1,481 (17%) participants died; use of OAT was associated with lower hazard of death (adjusted hazard ratio [aHR] 0.63, 95% confidence interval [CI] 0.57 to 0.70). During median 3.41 years follow-up, 3,653 (41%) were rehospitalized for injecting-related infections; use of OAT was associated with lower hazard of these rehospitalizations (aHR 0.89, 95% CI 0.84 to 0.96). Study limitations include the use of routinely collected administrative data, which lacks information on other risk factors for injecting-related infections including injecting practices, injection stimulant use, housing status, and access to harm reduction services (e.g., needle exchange and supervised injecting sites); we also lacked information on OAT medication dosages. Conclusions Following hospitalizations with injection drug use–associated bacterial and fungal infections, use of OAT is associated with lower risks of death and recurrent injecting-related infections among people with opioid use disorder.

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“…Prevention efforts to date have focused on individual-level behavior change interventions to promote more sterile drug preparation and safer drug injecting techniques. Unfortunately, these have shown mixed results [18][19][20] and have had limited impact on a population level [1]. This may be in part because of social and structural factors (e.g., criminalization, discrimination, lack of access to housing, harm reduction services, and supervised injection sites) that constrain the ability of PWID to inject more safely [1,21] and that push PWID away from healthcare [22].…”

Section: Introductionmentioning

confidence: 99%

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Implementation and evaluation of an educational intervention for safer injection in people who inject drugs in Europe: a multi-country mixed-methods study

Cited by 15 publications

References 33 publications

Social and structural determinants of injecting-related bacterial and fungal infections among people who inject drugs: protocol for a mixed studies systematic review

Social and structural determinants of injecting-related bacterial and fungal infections among people who inject drugs: protocol for a mixed studies systematic review

Opioid agonist treatment and risk of death or rehospitalization following injection drug use–associated bacterial and fungal infections: A cohort study in New South Wales, Australia

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