A socio-structural approach to preventing injection drug use initiation: rationale for the PRIMER study.

Daniel Werb,Marie Jauffret-Roustide,Peter Davidson,Thomas Kerr,Steffanie A Strathdee,Marc Auriacombe,Will Small,Perrine Roux,Richard Garfein

doi:10.1186/s12954-016-0114-1

Abstract

BackgroundInjection drug use remains a primary driver of HIV and HCV-related harms globally. However, there is a gap in efforts to prevent individuals from transitioning into injecting. People who inject drugs (PWID) play a key role in the transition of others into injecting, and while behavioral interventions have been developed to address this phenomenon, socio-structural approaches remain unexplored. To that end, we hypothesize that certain interventions designed to reduce injecting-related risk behaviors may also reduce the risk that PWID expose and introduce others into injecting. Identifying the preventive potential of existing interventions will inform broader efforts to prevent injecting and related harms.MethodsThe Preventing Injecting by Modifying Existing Responses (PRIMER) study is a multi-country mixed methods study with an aim to investigate whether specific interventions (e.g., opioid substitution therapy, supervised injection facilities, stable housing, incarceration environments) and related factors (e.g., public injecting and gender) influence the likelihood that PWID initiate others into injecting. This study will (1) investigate the PWID participation in injection initiation; (2) identify factors influencing the risk that PWID expose others to or facilitate injection initiation; (3) describe drug scene roles that increase the risk of PWID facilitating injection initiation; and (4) evaluate the impact of structural, social, or biomedical interventions on the risk that PWID facilitate injection initiation. It does so by pooling observational data from cohort studies of PWID in six cities: Vancouver, Canada; San Diego, USA; Tijuana, Mexico; Paris, Marseille, and Bordeaux, France.ResultsTeam members are conducting a prospective, multi-site study of PWID (n = 3050) in North America and France that includes quantitative and qualitative data collection through four separate cohort studies of PWID (San Diego, STAHR II; Tijuana, El Cuete IV; Vancouver, V-DUS; Bordeaux, Marseille, Paris and Strasbourg, COSINUS).ConclusionsPRIMER is the largest study of injection initiation to date and the first to investigate structural approaches to preventing injection drug use initiation. Findings have the potential to inform the development and scale up of new and existing interventions to prevent transitions into injecting.Trial registrationPreventing Injecting by Modifying Existing Responses (PRIMER), NIDA DP2-DA040256-01.

Highlights

Injection drug use remains a primary driver of Human immunodeficiency virus (HIV) and Hepatitis C virus (HCV)-related harms globally
Data suggest that the window of opportunity to prevent blood-borne virus transmission among new injectors is limited, given that the majority of incident HCV and hepatitis B virus cases occur within 1 year of initiation [4], which may be due to elevated incidence of risk behaviors such as syringe sharing among recently initiated injectors [1]
We present data from the VIDUS Study to Assess Hepatitis Risk II (II) cohort, which is being transitioned into the Vancouver Drug Users Study (V-DUS) study in 2016 in order to integrate cohorts of People who inject drugs (PWID) and streetinvolved youth, some of whom are injection-naïve

Summary

Introduction

Injection drug use remains a primary driver of HIV and HCV-related harms globally. Injection drug use remains a primary source of HIV- and hepatitis C (HCV)-related harms [1], with a recent estimate suggesting that 15.9 million people inject drugs globally. Among this population, three million (19 %) are believed to be HIV-positive [1], while ten million people who inject drugs (PWID) are estimated to be HCVpositive [2], with prevalence among PWID populations believed to exceed 60 % in 37 countries [2]. Recent increases in prescription opioid misuse in North America may be contributing to a heightened risk of injection initiation [6], given that the use of prescription opioids such as oxycodone has been shown to be associated with a heightened risk of initiating injecting [7]

Methods

Results

Conclusion