Setting foot in private spaces: extending the hepatitis C cascade of care to automatic needle/syringe dispensing machines, a mixed methods study

Abstract

Background Global commitment to achieving hepatitis C virus (HCV) elimination has enhanced efforts in improving access to direct-acting antiviral (DAA) treatments for people who inject drugs (PWID). Scale-up of efforts to engage hard-to-reach groups of PWID in HCV testing and treatment is crucial to success. Automatic needle/syringe dispensing machines (ADMs) have been used internationally to distribute sterile injecting equipment. ADMs are a unique harm reduction service, affording maximum anonymity to service users. This paper explores the feasibility and acceptability of extending the HCV cascade of care to sites where ADMs are located. Methods The ADM users into Treatment (ADMiT) study was undertaken in a metropolitan region in Sydney, Australia. This mixed methods study involved analysis of closed-circuit television footage, ethnographic methods (fieldwork observation and in-depth interviews) and structured surveys. Researchers and peers conducted fieldwork and data collection over 10 weeks at one ADM site, including offering access to HCV testing and treatment. Results Findings from 10 weeks of fieldwork observations, 70 survey participants and 15 interviews highlighted that there is scope for engaging with this population at the time they use the ADM, and enhanced linkage to HCV testing and treatment may be warranted. Most survey participants reported prior HCV testing, 61% in the last 12 months and 38% had received HCV treatment. However, fieldwork revealed that most people observed using the ADM were not willing to engage with the researchers. Field work data and interviews suggested that extending the HCV cascade of care to ADMs may encroach on what is a private space for many PWID, utilized specifically to avoid engagement. Discussion Enhanced linkage to HCV testing and treatment for people who use ADMs may be warranted. However, data suggested that extending the HCV cascade of care to ADMs may encroach on what is a private space for many PWID, utilized specifically to avoid engagement. The current study raises important public health questions about the need to ensure interventions reflect the needs of affected communities, including their right to remain anonymous.

Time-series analysis of presentations to four syringe dispensing machines and a needle and syringe programme during COVID-19 lockdowns in Melbourne, Australia

“…SDM clients may have sought out alternate sources of needles/syringes that were not the NSP, such as pharmacies or mobile delivery services. Given the documented difficulties in recruiting and surveying representative samples of clients who principally utilise SDMs [ 18 , 19 ], it is uncertain how SDM clients may have responded to SDM access difficulties, or if any increase in injecting risk was experienced.…”

Analysis of four syringe dispensing machine point-of-access data 2017–2020 in Melbourne, Australia: machine utilisation and client demographics

“…In research evaluating the effects of SDMs, different recruitment methods have been employed to recruit individuals who acquire syringes from SDMs, such as having researchers stationed adjacent to SDMs [ 9 , 12 ], paper flyers advertising research located near SDMs [ 11 ] and within distributed SDM packs [ 9 ], internal timestamped counting devices [ 14 ] and viewing of CCTV footage at SDM sites [ 15 ]. All these methods have limitations and biases.…”