Abstract
BackgroundCoverage is used as one indicator of needle and syringe program (NSP) effectiveness. At the individual level, coverage is typically defined as an estimate of the proportion of a person who injects drugs’ (PWID) injecting episodes that utilise a sterile syringe. In this paper, we explore levels of individual syringe coverage and its changes over time.MethodsData were extracted from 1889 interviews involving 502 participants drawn from the Melbourne drug user cohort study (MIX).We asked questions relating to participants syringe acquisition, distribution and injecting frequency within the two weeks before interview. We created a dichotomous coverage variable that classified participants as sufficiently (≥100 %) covered if all their injecting episodes utilised at least one sterile syringe, and insufficiently (<100 %) covered if not. We categorised participants as “consistently covered” if they were sufficiently covered across interviews; as “consistently uncovered” if they were insufficiently covered across interviews; and “inconsistently covered” if they oscillated between coverage states.Chi-square statistics tested proportions of insufficient coverage across sub-groups using broad demographic, drug use and service utilisation domains. Logistic regression tested predictors of insufficient coverage and inconsistently covered categorisation.ResultsAcross the sample, levels of insufficient coverage were substantial (between 22–36 % at each interview wave). The majority (50 %) were consistently covered across interviews, though many (45 %) were inconsistently covered.We found strong statistical associations between insufficient coverage and current hepatitis C virus (HCV) infection (RNA+). Current prescription of opioid substitution therapy (OST) and using NSPs as the main source of syringe acquisition were protective against insufficient coverage.ConclusionInsufficient coverage across the sample was substantial and mainly driven by those who oscillated between states of coverage, suggesting the presence of temporal factors. We recommend a general expansion of NSP services and OST prescription to encourage increases in syringe coverage.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1668-z) contains supplementary material, which is available to authorized users.
Highlights
Coverage is used as one indicator of needle and syringe program (NSP) effectiveness
Melbourne injecting drug user cohort study Data are drawn from the Melbourne injecting drug user cohort study (MIX), which has been described in detail elsewhere [18]
Participants collected a median of 20 syringes at first and most recent interview (IQRs of 10–70 and 10-100 respectively), and gave away/sold a median of one syringe (IQR: 0–8) at first interview and zero syringes (IQR: 0–10) at most recent interview
Summary
Coverage is typically defined as an estimate of the proportion of a person who injects drugs’ (PWID) injecting episodes that utilise a sterile syringe. The coverage of a public health program can be defined as the extent to which it reaches its intended population [1]. It is an indicator of the effectiveness of public health interventions in reducing public health risks. The coverage achieved by NSPs at the population level refers to the proportion of PWID reached by services. Coverage is typically defined as the proportion of a PWID’s injecting episodes that utilise a sterile syringe [2]. It is estimated that globally, only 1–4 syringes are distributed per PWID per month [5], well below the World Health Organization (WHO) recommended rate of 200 syringes per PWID per year [6]
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