Low dead-space syringes for preventing HIV among people who inject drugs

Abstract

Circumstantial evidence suggests that LDSS may substantially reduce HIV transmission among PWID, who share syringes. Additional research that links LDSS to reductions in HIV incidence is needed. Most currently available LDSS are 1 ml or smaller and have fixed needles. These cannot be used by PWID 'injecting' larger volumes of fluid and they may be rejected by PWID, who prefer syringes with detachable needles. Nonetheless, LDSS represent a potentially promising intervention that deserves serious consideration.

Acceptability of low dead space syringes and implications for their introduction: A qualitative study in the West of England

“…Previous research recommends interventions to promote LDSS: increase availability in specialist and pharmacy NSP (Gray, Nguyen, & Neukom, 2012; Huong et al, 2015; NICE, 2014; Rafful et al, 2015; WHO, 2012a); inform NSP providers about the dead space in syringes (Vickerman, Martin, & Hickman, 2013b), encourage the use of LDSS (Bobashev & Zule, 2010; Paintsil et al, 2010; WHO, 2012b; WHO et al, 2007) and discourage HDSS use (Gaughwin et al, 1991; Grund & Stern, 1991) through education (Rafful et al, 2015; Walsh, Verster, Rodolph, & Akl, 2014), social marketing (Zule, 2012), behaviour change techniques (Gray et al, 2012; Huong et al, 2015) and emphasising the benefits to users (Grund & Stern, 1991) such as the reduced drug waste (Zule et al, 2013). Peer based interventions have been highlighted as critical to the success of such initiatives previously (WHO, 2012a).…”

“…Satisfaction with LDSS has been primarily attributed to the syringe design which wastes less drug (Zule et al, 2002), rather than associated health benefits (Gray et al, 2012). Concerns from PWID are the lack of widely available LDSS with detachable needles and syringe volumes larger than 1ml (Albers, 2013; Ibragimov & Latypov, 2012; Jacka, 2013; WHO, 2012a; Zule, 2012; Zule & Cross, 2012; Zule et al, 2013; Zule et al, 2015).…”

Social marketing of low dead space syringes in Vietnam: findings from a 1-year pilot program in Hanoi, Thai Nguyen, and Ho Chi Minh City

“…A growing body of evidence suggests that low dead space syringes (LDSS) may reduce risk of HIV and hepatitis C virus (HCV) infection associated with sharing syringes among people who inject drugs (PWID) [ 1 – 6 ]. In laboratory experiments that simulated the process of injection and rinsing with water, high dead space (i.e., standard needle and syringe combinations) syringes retained over 1000 times more blood than that retained by low dead space syringes.…”

“…Ecological data collected from needle and syringe programs (NSP) in Europe and Asia suggest that HIV prevalence is relatively low in cities where only low dead space syringes are used, while in contrast, HIV prevalence was varied greatly in cities where substantial proportions of PWID used high dead space syringes [ 6 ]. Simulation models of injection-related HIV epidemics predicted that risk of an epidemic among PWIDs would be curtailed if only LDSS are used.…”

“…There are still many questions remaining about the implementation of such an LDSS program component, such as the uncertainty of PWID’s willingness to switch from high dead space needles and syringes to low dead space needles and syringes—particularly because LDSS are not currently manufactured in all needle and syringe (N/S) product sizes and specifications currently used by PWID. User preferences around barrel size and detachable needles have been identified as powerful factors shaping syringe choice made by PWID [ 6 ]. Drug preparation practices (e.g., removing the needle to draw drug solution out of a spoon or cooker) and practices for dividing liquefied drug solution (e.g., frontloading or backloading) influence preferences for detachable needles.…”