Influence of Peer-Based Needle Exchange Programs on Mental Health Status in People Who Inject Drugs: A Nationwide New Zealand Study

Hay, Bianca; Henderson, C. R.; Maltby, John; Canales, Juan J.

doi:10.3389/fpsyt.2016.00211

Cited by 17 publications

(13 citation statements)

References 38 publications

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“…The only factor that remained statistically significantly associated with HCV treatment in multivariable analysis was having a friend or family member concerned about an individual’s HCV. This is consistent with previous evidence suggesting that peer support improves health outcomes for PWID (Bassuk, Hanson, Greene, Richard, & Laudet, 2016; Hay, Henderson, Maltby, & Canales, 2016; Reif et al, 2014).…”

Section: Discussionsupporting

confidence: 92%

Barriers and facilitators of hepatitis C treatment uptake among people who inject drugs enrolled in opioid treatment programs in Baltimore

Falade‐Nwulia

Irvin

Merkow

et al. 2019

Journal of Substance Abuse Treatment

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Background: Hepatitis C virus (HCV) infection is a major public health issue among people who inject drugs (PWID) with prevalence of 50–80% in the United States. Effective, simple, oral direct acting agents (DAA) of short duration with minimal side effects have been associated with cure rates > 95%. However, HCV treatment uptake among PWID remains low. We characterized the HCV care continuum, HCV treatment knowledge, as well as barriers and facilitators to HCV treatment uptake among PWID enrolled in two opioid treatment programs (OTPs) in Baltimore, Maryland, USA. Methods: Between July and November 2016, 124 HCV infected PWID were recruited from two opioid treatment programs in Baltimore through convenience sampling. Participants completed a 50-item questionnaire to assess HCV treatment knowledge, attitudes, and practices. Progress through the HCV care continuum was assessed based on a series of questions assessing evaluation for HCV treatment, recommendation for HCV treatment by a provider, and HCV treatment initiation. HCV status was assessed based on participant self-report. Results: The median age was 52 years (IQR 44–58), 56% were male, the majority were African American (69%), and 19% reported HIV coinfection. Participants had been tested for HCV at their primary care provider’s (PCP’s) office (34%), drug treatment center (20%), emergency room (11%), or prison (9%), and most (60%) had been diagnosed with HCV over 5 years prior. The majority reported that HCV was a major health concern for them (91%), were aware there were new treatments for HCV (89%), and that the new treatments cure most people (69%). More than half (60%) had seen a health professional who could treat HCV, 40% had HCV therapy recommended by their HCV specialist, and 20% had started or completed treatment. In univariable analysis, PWID were significantly more likely to have been treated if they were HIV co-infected (OR 3.4 (95% CI 1.3–9.2)) or had a partner or friend concerned about their HCV (OR 3.4 (95% CI 1.2–9.7)), and were significantly less likely to have been treated if they had used any illicit drugs in the preceding 6 months (OR 0.4 (95% CI 0.2–0.99). In multivariable analysis, having a friend or partner concerned about their HCV remained significantly associated with HCV treatment (OR 5.0 (95% CI 1.4–17.7)). When questioned about what would facilitate HCV treatment, the majority (85%) reported that a friend telling them that HCV treatment had helped them and having HCV treatment provided at their opioid treatment program would make them more likely to engage in HCV treatment. Conclusion: Despite a high prevalence of HCV among opioid treatment program patients and the availability of effective treatments, uptake remains low. We identified several key barriers and facilitators that can affect HCV treatment uptake.

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Section: Discussionsupporting

confidence: 92%

Barriers and facilitators of hepatitis C treatment uptake among people who inject drugs enrolled in opioid treatment programs in Baltimore

Falade‐Nwulia

Irvin

Merkow

et al. 2019

Journal of Substance Abuse Treatment

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“…A growing body of evidence indicates that peer worker-led programs are successful in creating “safe spaces” for PWUD [ 12 , 14 , 18 – 21 ] and help to reduce harmful health behaviours such as sharing substance use supplies and unsafe sex practices [ 22 , 23 ]. Peer-led programs also improve program accessibility and acceptability [ 10 ], help in building connections and trust [ 24 ], facilitate environments of comfort and safety for service users [ 12 , 13 ], and are associated with mental health benefits for PWUD [ 25 ]. Accumulating evidence suggests that individuals with lived/living experience of substance use are leading the harm reduction movement in meaningful ways, successfully reducing the harms associated with drug use and structural violence [ 12 , 13 , 20 , 26 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

“Running myself ragged”: stressors faced by peer workers in overdose response settings

et al. 2021

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Background Peer workers or “peers” (workers with past or present drug use experience) are at the forefront of overdose response initiatives, and their role is essential in creating safe spaces for people who use drugs (PWUD). Working in overdose response settings has benefits for peer workers but is also stressful, with lasting emotional and mental health effects. Yet, little is known about the stressors peer workers face and what interventions can be implemented to support them in their roles. Methods This project used a community-based sequential mixed-methods research design. Eight peer researcher-led focus groups (n = 31) were conducted between November 2018 and March 2019 to assess needs of peer workers. The transcripts were thematically coded and analysed using interpretative description. These results informed a survey, which was conducted (n = 50) in September 2019 to acquire quantitative data on peer workers’ perception of health, quality of life, working conditions and stressors. Frequency distributions were used to describe characteristics of participants. X2 distribution values with Yates correction were conducted to check for association between variables. Results Five themes emerged from the focus groups that point to stressors felt by peer workers: (1) financial insecurity; (2) lack of respect and recognition at work; (3) housing challenges; (4) inability to access and/or refer individuals to resources; and (5) constant exposure to death and trauma. Consistent with this, the factors that survey participants picked as one of their “top three stressors” included financial situation, work situation, and housing challenges. Conclusion Peer workers are faced with a diversity of stressors in their lives which often reflect societal stigmatization of drug use. Recognition of these systemic stressors is critical in designing interventions to ease the emotional, physical and financial burden faced by peer workers.

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“…Peer-based responses by PWID have been the subject of research for many years, resulting in a growing evidence base regarding their role in prevention of drug related harm, viral hepatitis, HIV and sexually transmittable infections and other health outcomes (for examples see Hay et al, 2017;Jain et al, 2014;Keats et al, 2015;McNeil et al, 2014;Ti et al, 2015;Treloar et al, 2015), and their role as an integrated component of, or complement to, other health care initiatives (for a recent example see Bajis et al, 2017).…”

Section: Peer-based Drug User Organisationsmentioning

confidence: 99%

Characterising the policy influence of peer-based drug user organisations in the context of hepatitis C elimination

Brown

Perry

Byrne

et al. 2019

International Journal of Drug Policy

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Background: Achieving hepatitis C (HCV) elimination goals will require major policy and health service reorientation to scale up testing and treatment among people who inject drugs (PWID). To achieve this, a close partnership with peer-based drug user organisations is required. However, peer organisations have historical and ongoing difficulties in articulating the validity of their service delivery and policy advice, leading to some policy and health services resisting partnership and advice from peer-based drug user organisations. Methods: To develop a deeper understanding of the role of peer-based drug user organisations in the HCV response, we analysed data from the W3 Project which used systems thinking methods to draw together the insights of over 90 peer staff from 10 Australian community and peer organisations in HCV and HIV. The resulting system maps were analysed to identify system dynamics and functions that need to be fulfilled for peer organisations to be influential within their community and policy system. Results: We identified the interactions at a system level which can enhance or constrain the quality and influence of policy advice from peer-based drug user organisations. We found the strength of Peer-based drug user organisations to support the scale up of HCV testing and treatment was their capacity to mediate between, and navigate within, the complex community and policy/health service systems. While peer-based drug user organisations endeavour to demonstrate their capacity and credibility in terms of engagement, alignment, adaptation and influence, policy and service organisations also need recognise their own system role to value and enable peer-based drug user organisations to achieve their potential. Conclusion: If the HCV prevention and treatment system is to reach PWID living with HCV and achieve HCV elimination goals, then policy and health services need to invest in strengthening peer-based drug user organisations as well as recognise, value and act on quality policy advice from PWID peer leadership.

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Influence of Peer-Based Needle Exchange Programs on Mental Health Status in People Who Inject Drugs: A Nationwide New Zealand Study

Cited by 17 publications

References 38 publications

Barriers and facilitators of hepatitis C treatment uptake among people who inject drugs enrolled in opioid treatment programs in Baltimore

Barriers and facilitators of hepatitis C treatment uptake among people who inject drugs enrolled in opioid treatment programs in Baltimore

“Running myself ragged”: stressors faced by peer workers in overdose response settings

Characterising the policy influence of peer-based drug user organisations in the context of hepatitis C elimination

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