Abstract
Distance to health services is known to be negatively associated with usage and needle and syringe programs (NSPs) for people who inject drugs (PWID) are no different. Australia has a mixture of NSP modalities (primary or secondary fixed-site NSPs), which may present unique barriers to access. In this study, we explore 1) the effect of distance to NSPs on individual-level needle and syringe coverage, and 2) differences in coverage dependent on NSP modality. Using data from 219 PWID in an ongoing cohort study in Melbourne, Australia, we measured the straight-line distance from participants’ residence to their nearest primary or secondary fixed-site NSP. We analysed the relationship between geographical distance and coverage via regression analysis. The median distance to any type of NSP was 1872 metres. Regardless of service type, 52% of participants lived within 2 kms of a fixed-site NSP and 87% lived within 5 kms. We found no association between distance to NSPs and syringe coverage or a significant difference in coverage by nearest service type. Our findings suggest that the number and distribution of NSPs in Melbourne, Australia caters adequately for the population of PWID.
Highlights
Needle and syringe programs (NSPs), which provide sterile needles and syringes to people who inject drugs (PWID), are an effective public health intervention to support the reduction of injecting risk behaviours and blood-borne virus (BBV) transmission, HIV transmission [1,2,3], but geographical areas without NSPs have been shown to have higher rates of syringe sharing and BBV prevalence than areas with NSPs [4, 5]
Australian NSPs have a mix of modalities: primary NSPs (fixed-site, free injecting equipment, and PWID-centred access through trained personnel and adjunct services such as opioid substitution therapy (OST) prescribers onsite) or secondary NSPs
The median distances to a primary fixed-site NSP or a secondary fixed-site NSP, for those living closest to either of these services, were almost identical (1.8 km vs. 1.9 km respectively)
Summary
Australian NSPs have a mix of modalities: primary NSPs (fixed-site, free injecting equipment, and PWID-centred access through trained personnel and adjunct services such as opioid substitution therapy (OST) prescribers onsite) or secondary NSPs (syringe distribution through health services such as hospitals or community health centres). Both primary and secondary NSPs can supplement their fixed-site activities with mobile syringe delivery and syringe vending machines (SVMs) for out-of-hours syringe dispensation.
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