People Who Inject Drugs Population Research Articles

Quality-adjusted life years among people who inject drugs in a needle syringe program in Sweden

PurposeNeedle syringe programs (NSP) significantly reduce risk behavior and HIV and hepatitis transmission in people who inject drugs (PWID). However, PWID are underrepresented in studies on health-related quality of life (HRQoL), representing a barrier to evaluate effects of public health and preventive measures related to injecting drug use. In this study, we investigate how well the two questionnaires EQ-5D-3L and SF-6D measure health in PWID. We also estimate HRQoL in the PWID population.MethodData on demographics, injection drug use, HIV, hepatitis status, and self-reported HRQoL were collected from 550 PWID enrolled in the Stockholm NSP at enrollment and at 6-, 12-, and 24-month follow-up. Self-rated HRQoL was measured as QALY, using EQ-5D-3L and the SF-6D. Item response theory (IRT) was used to evaluate which of the two instruments that measure health most accurately in this population. Regression analysis was used to estimate population-specific QALYs.ResultsThe IRT analysis showed that SF-6D was better suited to measure health in PWID. More specifically, SF-6D to a larger extent discriminated between persons regardless of their health status, while EQ-5D was more suitable to detect persons with poorer health. Self-rated HRQoL showed that average QALY was lower among PWID compared to the general Swedish population. However, a general increase in self-reported health was noted over time among participants.ConclusionThis study increase knowledge of what instruments are most suitable to measure health among PWID. This is of great importance when evaluating effects of public health and preventive measures in the PWID population.

Estimating the number of people who inject drugs using repeated respondent-driven sampling (RDS) in a community-based program: implications for the burden of hepatitis C and HIV infections and harm reduction coverage.

Estimates of the population size of people who inject drugs (PWID) are essential for efficient program planning and for monitoring key targets. Existing estimates in Greece are based on the capture-recapture method applied to drug treatment sources. We aimed to obtain estimates based on data collected from a community-based program addressing PWID in Athens, Greece. The program was implemented in 2012-2013 to increase diagnosis and treatment for HIV among PWID during an HIV outbreak. Five Responden-Driven Sampling (RDS) rounds were used to recruit participants. A unique code was used to identify participants among rounds. Capture-recapture was applied to estimate the population size in 2013 (PWID with injection in the past 12 months; active PWID with injection in the past 30 days). Log-linear models were applied. In 2013, the estimated number of active PWID in Athens was 4,117 [95% confidence interval (CI): 3,728-4,507] (vs. 1,956 [95% CI: 1,525-2,565] the existing population size estimate). Based on this estimate, the coverage of needle and syringe programs in 2013 was 103 syringes/PWID/year (vs. 216 based on the existing estimate). The population prevalence of injecting drug use in Athens (past 12 months) was 0.222% (95% CI: 0.200-0.245). The inclusion of data from community-based programs in the estimation of the PWID population size resulted in 2.1-fold higher estimates, compared to the official estimates obtained from drug treatment data, and indicates the need for re-evaluation of necessary resources for harm reduction and elimination of HIV and hepatitis C in PWID.

Estimated Number of People Who Inject Drugs in the United States.

Public health data signal increases in the number of people who inject drugs (PWID) in the United States during the past decade. An updated PWID population size estimate is critical for informing interventions and policies aiming to reduce injection-associated infections and overdose, as well as to provide a baseline for assessments of pandemic-related changes in injection drug use. We used a modified multiplier approach to estimate the number of adults who injected drugs in the United States in 2018. We deduced the estimated number of nonfatal overdose events among PWID from 2 of our previously published estimates: the number of injection-involved overdose deaths and the meta-analyzed ratio of nonfatal to fatal overdose. The number of nonfatal overdose events was divided by prevalence of nonfatal overdose among current PWID for a population size estimate. There were an estimated 3 694 500 (95% confidence interval [CI], 1 872 700-7 273 300) PWID in the United States in 2018, representing 1.46% (95% CI, .74-2.87) of the adult population. The estimated prevalence of injection drug use was highest among males (2.1%; 95% CI, 1.1-4.2), non-Hispanic Whites (1.8%; 95% CI, .9-3.6), and adults aged 18-39 years (1.8%; 95% CI, .9-3.6). Using transparent, replicable methods and largely publicly available data, we provide the first update to the number of people who inject drugs in the United States in nearly 10 years. Findings suggest the population size of PWID has substantially grown in the past decade and that prevention services for PWID should be proportionally increased.

Impact of COVID-19 lockdown restrictions on hepatitis C testing in Australian primary care services providing care for people who inject drugs.

In 2020, the Australian state of Victoria experienced the longest COVID‐19 lockdowns of any jurisdiction, with two lockdowns starting in March and July, respectively. Lockdowns may impact progress towards eliminating hepatitis C through reductions in hepatitis C testing. To examine the impact of lockdowns on hepatitis C testing in Victoria, de‐identified data were extracted from a network of 11 services that specialize in the care of people who inject drugs (PWID). Interrupted time‐series analyses estimated weekly changes in hepatitis C antibody and RNA testing from 1 January 2019 to 14 May 2021 and described temporal changes in testing associated with lockdowns. Interruptions were defined at the weeks corresponding to the start of the first lockdown (week 14) and the start (week 80) and end (week 95) of the second lockdown. Pre‐COVID, an average of 80.6 antibody and 25.7 RNA tests were performed each week. Following the first lockdown in Victoria, there was an immediate drop of 23.2 antibody tests and 8.6 RNA tests per week (equivalent to a 31% and 46% drop, respectively). Following the second lockdown, there was an immediate drop of 17.2 antibody tests and 4.6 RNA tests per week (equivalent to a 26% and 33% drop, respectively). With testing and case finding identified as a key challenge to Australia achieving hepatitis C elimination targets, the cumulative number of testing opportunities missed during lockdowns may prolong efforts to find, diagnose and engage or reengage in care of the remaining population of PWID living with hepatitis C.

Planning for injecting drug use as a means to prevent risky injection behavior

ABSTRACT Objective People who inject drugs (PWIDs) are at risk of exposure to blood borne pathogens. India has a large PWID population and the highest HIV transmission is among PWIDs. Interventions to prevent risky injection is constantly tested by the scientific community and innovations are required in this area. Methods 3748 male PWIDs were recruited into a longitudinal study. 2509 PWIDs who participated in the end of study survey, also responded to multiple open ended questions asked by the interviewers. The qualitative interviews were analyzed focusing on identifying themes and relationship among themes. Results 35.6% of the cohort had engaged in risky injection at least once. Although the project activities promoted safe injection practices among majority of the study participants; 35% is a substantial population at risk. Gaining knowledge about blood borne pathogen transmission, motivated participants to be careful about not sharing injection or paraphernalia. The belief that friends are safe made many share among themselves. Not prepared when the withdrawal set in was the main reason for sharing injection. Conclusion The project intervention had stimulating effect on the PWIDs and they tried to stop injection and follow safe injection practices. However, a failure at least once is an exposure to blood borne pathogens. Hence teaching PWIDs to plan for their injection practice and keeping materials ready at hand is important.

Operational Model and Treatment Costs of a Student-Run Free Clinic Serving People Who Inject Drugs

Background: The student-run Infectious Disease Elimination Act (IDEA) Clinic serves people who inject drugs (PWID) by providing human immunodeficiency virus testing, hepatitis C virus testing, wound care, cutaneous abscess treatment, safe injection education, and basic health screening services. A primary goal of the IDEA Clinic is to prevent the progression of wounds and infections into more severe and costly illnesses. Here, we present the operational model and treatment costs associated with providing these services at the IDEA clinic.
 Methods: Charts of PWID who received medical care at the IDEA Clinic over a 28-month study period were reviewed and the services provided are reported. Total costs were stratified into the cost of medical equipment, procedures, and medications.
 Results: From October 2017 to January 2020, the total cost of supplies of the IDEA Clinic totaled $3,491.65. Over this study period, there were 291 distinct patient visits, which gives the clinic an average cost of $12.00 per visit.
 Conclusions: The IDEA Clinic requires low per-patient operational costs to provide important medical services to a vulnerable population. The results of this study may be used to support the creation of more student-run clinics in other areas with a large population of PWID.

Mapping and population size estimates of people who inject drugs in Afghanistan in 2019: Synthesis of multiple methods.

IntroductionMapping and population size estimates of people who inject drugs (PWID) provide information needed for monitoring coverage of programs and planning interventions. The objectives of this study were to provide the locations and numbers of PWID in eight cities in Afghanistan and extrapolate estimates for the country as a whole.MethodsMultiple population size estimation methods were used, including key informant interviews for mapping and enumeration with reverse tracking, unique object and service multipliers, capture-recapture, and wisdom of the crowds. The results of the several methods were synthesized using the Anchored Multiplier–a Bayesian approach to produce point estimates and 95% credible intervals (CI). Using the prevalence of PWID in the eight cities and their correlation with proxy indicators, we extrapolated the PWID population size for all of Afghanistan.ResultsKey informants and field mapping identified 374 hotspots across the eight cities from December 29, 2018 to March 20, 2019. Synthesizing results of the multiple methods, the number of male PWID in the eight study cities was estimated to be 11,506 (95% CI 8,449–15,093), corresponding to 0.69% (95% CI 0.50–0.90) of the adult male population age 15–64 years. The total number of women who injected drugs was estimated at 484 (95% CI 356–633), corresponding to 0.03% (95% CI 0.02–0.04) of the adult female population. Extrapolating by proxy indicators, the total number of PWID in Afghanistan was estimated to be 54,782 (95% CI 40,250–71,837), men and 2,457 (95% CI 1,823–3,210) women. The total number of PWID in Afghanistan was estimated to be 57,207 (95% CI 42,049–75,005), which corresponds to 0.37% (95% CI 0.27–0.48) of the adult population age 15 to 64 years.DiscussionThis study provided estimates for the number of PWID in Afghanistan. These estimates can be used for advocating and planning services for this vulnerable at-risk population.

Magnitude of medicolegal issues among people who inject drugs in New Delhi: A cross-sectional study

Besides posing a significant health burden, people who inject drugs (PWID) are also implicated in violence, acquisitive crimes, accidents, and suicides. This cross-sectional, observational study was conducted from November 2016 to March 2018 at a tertiary care centre of New Delhi.The data on medicolegal issues and their characteristics were collected through an interviewer-administered structured questionnaire from PWID receiving opioid substitution therapy (OST), and statistical analysis was performed using descriptive statistics and chi-square test. Out of 100 male PWID, nearly half of PWID (n=48, 48%) were involved in criminal activities. Among the population of PWID with criminal activities, acquisitive crimes were the most common (n=37, 37%) type of crime committed. About 29 (29%) PWID revealed suicidal ideations, 12 (12%) attempted suicides, and about one in five (n=21, 21%) PWID had nonsuicidal self-injuries (NSSI) in the preceding year. A statistically significant association was observed between the history of injecting drug use in the preceding three months with the criminal activities of the user (%2=3.853; p=.050). Acquisitive crimes were significantly associated with homelessness (x2=5.884; p=.015). The evidence from the present study suggests that acquisitive crimes, suicidal ideations, and self-harm are highly prevalent among PWID. Efforts should be focused on strict adherence to OST with effective psychiatric counselling, family therapy, and social assistance programs to mitigate PWID's medicolegal issues at large.

Participants of a mail delivery syringe services program are underserved by other safe sources for sterile injection supplies.

In the United States, accessing sterile injection supplies remains challenging for many people who inject drugs (PWID). Although women are less likely to inject drugs than men, women who do inject are disproportionately affected by IDU-related complications. Needle Exchange Technology (NEXT), the first formal online accessed mail delivery syringe services program (SSP) in the US, may overcome access barriers. We evaluated whether NEXT was reaching women participants and people without access to other safe sources of sterile injection supplies. This cross-sectional study examined NEXT participants who enrolled in the mail-delivery SSP from February 2018 through March 2021. All NEXT participants completed an online questionnaire during enrollment, which included sociodemographic and clinical characteristics and injection-related risk factors (including prior sources of sterile injection supplies). Multivariable logistic regression (MVR) was used to examine associations between gender and prior use of safe sources of injection supplies (i.e., SSPs or pharmacies). 1,032 participants received injection supplies. Median age was 34 and participants were mostly cis-gendered women (55%) and white (93%). 34% reported infection with HCV; women were more likely to report HCV infection than men (38% vs 28%; p<0.01). 68% of participants acquired injection supplies from less safe sources. Few participants exclusively used safe sources for injection supplies (26%). In adjusted MVR analysis, women participants had significantly lower odds than men of having exclusively used safe sources for injection supplies (adjusted OR 0.71, 95% CI 0.52, 0.98). Our findings suggest that NEXT services are utilized by women and people without prior access to sterile injection supplies. Women participants were less likely than men to have exclusively used safe sources for sterile injection supplies. Future research should explore women's preference for mail-delivery over in-person SSPs and determine whether online accessed mail delivery services can reach other underserved populations of PWID.

The Effects of live- in rehabilitation on ARV adherence, abstinence from drugs and lifestyle modification in people who inject drugs (PWID) Living with HIV - A clinic review.

Background & Objective:HIV/AIDS is mostly seen in people who inject recreational drugs (PWID). Adherence has to be optimum for its treatment to be effective. Compliance to HIV medication has been problematic in PWID making HIV control difficult. Many studies in the past have validated educational activities like rehabilitation programs beneficial in maintaining regularity in medication intake. This brought us to the question of looking at such programs and its effects on our population. This study was conducted to assess the impact of other perspectives of abstinence and adherence including family support and employment status on a person’s willingness for treatment continuation and avoidance of drugs.Methods:A retrospective chart review of 241 PWID was conducted to assess adherence to antiretroviral agents (ARVs) and abstinence from recreational drugs post visit to the rehabilitation center. Associations with family support, marital status, employment, income and back to work status were also assessed.Results:Adherence to ARVs had significant statistical association with marital status (p=0.025), starting work again (p=0.001), family support (p=0.009), employment status (p=0.009) and monthly income (p=0.025). While family support (p=0.033), employment status (p<0.0001), Going back to work (p<0.0001), mode of travel to Rehabilitation center (p<0.0001) and monthly income (p=0.004) were associated with abstinence from drugs. Duration of rehabilitation or age had no effect on adherence or abstinence in our patient population of PWID.Conclusion:Family and spousal support and employment promote optimal ARV compliance and should be encouraged when starting ARVs. Enrollment in a long-term complementing educational program would further enhance ARV intake and abstinence.

Assessing Drug Consumption Rooms and Longer Term (5 Year) Impacts on Community and Clients.

BackgroundDrug consumption rooms (DCRs) and supervised injecting facilities (SIFs) provide a safe environment in which people who inject drugs (PWIDs) can inject under hygienic and supervised conditions. Numerous reviews have documented the benefits of these facilities; however, there is a lack of clarity surrounding their long-term effects.PurposeTo conduct, with a systematic approach, a literature review, of published peer-reviewed literature assessing the long-term impacts of DCRs/SIFs.MethodsA systematic search of the PubMed and Embase database was performed using the keywords: (“SUPERVISED” OR “SAFE*”) AND (“CONSUMPTION” OR “INJECT*” OR “SHOOTING”) AND (“FACILITY*” OR “ROOM*” OR “GALLERY*” OR “CENTRE*” OR “CENTER*” OR “SITE*”). Included studies were original articles reporting outcomes for five or more years and addressed at least one of the following client or community outcomes; (i) drug-related harms; (ii) access to substance use treatment and other health services; (iii) impact on local PWID population; (iv) impact on public drug use, drug-related crime and violence; and (v) local community attitudes to DCRs.ResultsFour publications met our inclusion criteria, addressing four of the five outcomes. Long-term data suggested that while the health of PWID naturally declined over time, DCRs/SIFs helped reduce injecting-related harms. The studies showed that DCRs/SIFs facilitate drug treatment, access to health services and cessation of drug injecting. Local residents and business owners reported less public drug use and public syringe disposal following the opening of a DCR/SIF.ConclusionLong-term evidence on DCRs/SIFs is consistent with established short-term research demonstrating the benefits of these facilities. A relative paucity of studies was identified, with most evidence originating from Sydney and Vancouver. The overall body of evidence would be improved by future studies following outcomes over longer periods and being undertaken in a variety of jurisdictions and models of DCRs/SIFs.

Rationalities of Space and Drug-Related Harms: Accounts of People Who Inject Drugs in Nigeria

ABSTRACT Background Studies have examined how people who inject drugs (PWID) navigate public spaces for drug consumption, but little is known about consumption of drugs in private apartments. This study explores social, structural and physical environment factors influencing injecting practices and the rationalities shaping how PWID make decisions about where to consume drugs. Methods The study is based on qualitative data from 41 in-depth interviews conducted with both homeless and housed PWID recruited through snowball sampling in Uyo, Nigeria. Thematic analysis, framed by the theoretical constructs of structural and everyday violence, and situated rationality theories, was undertaken on transcripts. Results Analysis revealed different socio-spatial rationalities underlying decisions about where to use drugs: avoidance of police arrest, convenience and relaxation, avoidance of drug sharing, avoidance of drug-scene violence, and stigma and shame. These factors show the impacts of social, structural and physical environment factors on the lived experiences of PWID. Injecting in private apartments potentially offset the risk of stigma, police arrest and violence linked to public injecting, but increase the risk of overdose and sharing of drugs and needle-syringes based on social relations of trust. Conclusions Findings show that PWID chose between competing risks when deciding on where to inject drugs. Interventions should consider the situated contexts of risk, and adapt harm reduction measures to the risk profile of different populations of PWID.

Physician trainees’ compassion satisfaction, burnout, and self-efficacy when caring for people who inject drugs

Background: Front-line providers working with people who inject drugs (PWID) are at increased risk of experiencing burnout. Few studies have examined protective factors against burnout incurred in the care of PWID, including harm reduction counseling skills. We measured self-efficacy in harm reduction counseling, burnout, and compassion satisfaction among Internal Medicine (IM) trainees caring for PWID. Methods: In this cross-sectional study, we surveyed IM interns and residents. Self-efficacy was assessed by asking trainees about attitudes, comfort, and knowledge in harm reduction counseling on a five-point Likert scale. Burnout and compassion satisfaction were assessed via an adapted 20-question Professional Quality of Life Scale. We compared self-efficacy in harm reduction counseling, compassion satisfaction, and burnout between interns and residents using ANOVA and Mann–Whitney U tests. We used Spearman’s rho correlational analysis to examine the relationship between these three variables. Results: Seventy-nine IM trainees (36 interns, 43 residents) completed the survey for a 52% response rate. Residents reported higher self-efficacy in harm reduction counseling, similar levels of burnout, and higher compassion satisfaction compared to interns. Across training levels, we found a negative correlation between burnout and compassion satisfaction (r = −0.55, p < 0.01) and a positive correlation between compassion satisfaction and comfort counseling PWID on harm reduction (r = 0.30, p < 0.01). Conclusions: Among IM trainees at an urban institution serving a large population of PWID, self-efficacy in harm reduction counseling and compassion satisfaction increase with time in training while burnout remains similar. Strengthening trainees’ capacity to counsel PWID on harm reduction may improve their compassion satisfaction in caring for this population, potentially leading to improved care. This relationship should be explored longitudinally in larger cohorts and through evaluations of harm reduction-focused medical education.

Model of Care for Microelimination of Hepatitis C Virus Infection among People Who Inject Drugs.

Background: People who inject drugs (PWID) are the largest group at risk for HCV infection. Despite the direct acting antivirals (DAA) advancements, HCV elimination has been hindered by real-life difficulties in PWID. Aims: This study aimed to assess the impact of a multidisciplinary intervention strategy where HCV screening, treatment and follow-up were performed at the same location on efficacy and safety of DAA-therapy in real-life PWID population. Methods: All HCV-infected PWID referred to five specialized outpatient centers for drug addicts (SerDs) in Northern Italy were prospectively enrolled from May 2015 to December 2019. Hepatologists and SerDs healthcare workers collaborated together in the management of PWID inside the SerDs. Sustained virologic response (SVR), safety of treatment, proportion of patients lost to follow-up and reinfection rate were evaluated. Results: A total of 358 PWID started antiviral treatment. About 50% of patients had advanced fibrosis/cirrhosis, 69% received opioid substitution treatment, and 20.7% self-reported recent injecting use. SVR was achieved in 338 (94.4%) patients. Two patients died during treatment; one prematurely discontinued, resulting in a non-responder; twelve were lost during treatment/follow-up; and five relapsed. No serious adverse events were reported. SVR was lower in recent PWID than in former ones (89.2% vs. 95.8%; p = 0.028). Seven reinfections were detected, equating to an incidence of 1.25/100 person-years. Reinfection was associated with recent drug use (OR 11.07, 95%CI 2.10–58.38; p = 0.005). Conclusion: Our embedded treatment model could be appropriate to increase the linkage to care of HCV-infected PWID. In this setting, DAA regimens are well tolerated and highly effective, achieving a lower rate of reinfection.

Planning the hepatitis C virus elimination in Cyprus: A modeling study.

BACKGROUNDHepatitis C virus (HCV) infection is a major global public health problem. In the Republic of Cyprus, the estimated prevalence of chronic hepatitis C (CHC) among the general population is 0.6%, while the CHC prevalence among people who inject drugs (PWID) is estimated at 46%. Direct-acting antivirals that can eliminate HCV are not yet widely available in the Republic of Cyprus. However, when direct-acting antivirals become available, a long-term strategic plan to guide elimination efforts will be needed to maximize the effect of treatment.AIMTo determine the programmatic targets to eliminate HCV in the Republic of Cyprus.METHODSA dynamic, stochastic, individual-based model of HCV transmission, disease progression, and cascade of care was calibrated to data from Cyprus. The model stratifies the population into the infected general population and the PWID population. A variety of test, prevention, and treatment strategies concerning the general population, PWID, or both were examined. The time horizon of the analysis was until 2034.RESULTSUnder the status quo scenario, the model predicted that 75 (95% confidence interval (CI): 60, 91) and 575 (95%CI: 535, 615) liver-related deaths and new infections would occur by 2034, respectively. Launching an expanded treatment program, without screening interventions, would cause modest outcomes regarding CHC prevalence (16.6% reduction in 2034 compared to 2020) and liver-related deaths (10 deaths would be prevented compared to the status quo scenario by 2034). Implementing a test and treat strategy among the general population but without any intervention in the PWID population would suffice to meet the mortality target but not the incidence target. To achieve HCV elimination in Cyprus, 3080 (95%CI: 3000, 3200) HCV patients need to be diagnosed and treated by 2034 (2680 from the general population and 400 from PWID), and harm reduction coverage among PWID should be increased by 3% per year (from 25% in 2020 to 67% in 2034).CONCLUSIONElimination of HCV is a demanding public health strategy, which requires significant interventions both among the general population and high-risk groups.

Food access among people who inject drugs in West Virginia

BackgroundThe substance use epidemic in the United States continues to drive high levels of morbidity and mortality, particularly among people who inject drugs (PWID). Poor access to food often co-occurs with drug use and contributes to associated sequelae, such as risks for HIV and diabetes. The objective of this study was to examine factors associated with adequate food access among PWID in a rural Appalachian community.MethodsCross-sectional surveys were used to collect data among PWID aged 18 and older in Cabell County, West Virginia. Frequency of hunger and sociodemographic, structural and drug use characteristics were measured. Adequate food access was defined as reporting ‘never’ going to bed hungry at night in the past six months. Pearson’s χ2 and t-tests and multivariable logistic regression were used to identify factors associated with food access.ResultsOnly 71 individuals (17%) reported never going to bed hungry at night in the past six months. Adjusted odds of having adequate food access were higher among PWID who completed high school (aOR 2.94; P = 0.010) and usually used drugs alone (aOR 1.97; P = 0.025), and lower among PWID who were female (aOR 0.51; P = 0.037), experienced homelessness (aOR 0.23, P < 0.001), were recently arrested (aOR 0.50 P = 0.047), and engaged in receptive sharing of injection equipment (aOR 0.52, P = 0.035).ConclusionsWe found extremely low food access in a population of PWID in Appalachia who are vulnerable to overdose and infectious disease transmission. Integrated interventions promoting food access are needed to improve the public health and wellbeing of people who inject drugs in Appalachia.

Factors Associated with Sterile Syringe Acquisition among People Who Inject Drugs in West Virginia

Background Syringe services programs (SSPs) are evidence-based interventions that provide essential overdose and infectious disease prevention resources to people who inject drugs (PWID). Little research has examined factors associated with sterile syringe acquisition at SSPs among rural PWID populations. Objectives We aim to identify factors associated with PWID in a rural county in West Virginia having recently acquired sterile syringes at an SSP. Methods PWID (n = 420) completed a survey that included measures related to sociodemographics, structural vulnerabilities, and substance use. We used multivariable Poisson regression with robust variance estimation to examine independent associations with sterile syringe acquisition at an SSP. Results Sixty-five percent of our sample reported having recently acquired sterile syringes at an SSP. Factors associated with recent sterile syringes acquisition at an SSP included: being older (aPR [adjusted prevalence ratio]: 1.011, 95% CI: 1.003–1.019), single (aPR: 0.862, 95% CI: 0.755–0.984), experiencing food insecurity (aPR: 1.233, 95% CI: 1.062–1.431), recently injecting fentanyl (aPR: 1.178, 95% CI: 1.010–1.375) and prescription opioid pain relievers (aPR: 0.681, 95% CI: 0.551–0.842), and recent naloxone acquisition (aPR: 1.360; 95% CI: 1.178–1.569). Receptive syringe sharing was inversely associated with acquiring sterile syringes at an SSP (aPR: 0.852; 95% CI: 0.741–0.979). Conclusion PWID accessing sterile syringes at an SSP was associated with several sociodemographic, structural, and substance use factors. Ensuring rural SSP operations are tailored to local PWID population-level needs is paramount to the prevention of infectious disease outbreaks and overdose fatalities.

High levels of used syringe use and unsafe sex among people who inject drugs in Kumasi, Ghana: an urgent call for a comprehensive harm reduction approach

BackgroundDrug use is a growing concern in Ghana. People who inject drugs (PWID) are highly vulnerable to HIV and other infectious diseases. Ghana’s National Strategic Plan for HIV/AIDS 2016–2020 identifies PWID as a key population, but efforts to address the needs of PWID have lagged behind those targeting sex workers and men who have sex with men. Lack of information about PWID is a critical barrier to implementing effective HIV prevention and treatment. We aimed to learn more about the vulnerability of the PWID population in order to inform much-needed harm reduction interventions.MethodsFrom April to July 2018, we conducted a mixed methods study in Kumasi, Ghana, to identify all major drug using locations, count the numbers of PWID to obtain rough population size estimations, and administer anonymous surveys to 221 PWID regarding drug use and sexual behavior. We also tested for HIV, HCV, and HBV from syringes used by survey participants.ResultsKey informants identified five major drug using locations and estimated the total PWID population size to be between 600 and 2000. Enumerators counted between 35 and 61 individuals present at each of the five bases. Sharing syringes and reusing discarded syringes are common practices. Over half of survey participants (59%) reported past-month syringe sharing (34% used a used syringe and 52% gave away a used syringe). Individuals with higher injection frequency (≥ 21 times weekly) and who injected with four or more people had higher odds of syringe sharing. Of the survey participants reporting sex in the last month (23%), most reported having one partner, but only 12% used condoms. Nearly all women (11/13) reported exchanging sex for drugs and 6/13 reported exchanging sex for money in the last six months. Fifteen percent of participants (all men) reported paying for sex using drugs or money. Of the used syringes, prevalence estimates were 3% (HIV), 2% (HCV), and 9% (HBV).ConclusionsOur findings confirm the urgent need to implement harm reduction interventions targeting PWID and to build a strong and enabling legal and policy environment in Ghana to support these efforts.

Utilizing patient perception of group treatment in exploring medication adherence, social support, and quality of life outcomes in people who inject drugs with hepatitis C

People who inject drugs (PWID) have a high prevalence of hepatitis C virus (HCV). Group treatment is a practical option for addressing barriers to treatment in this population. Prior research on group treatment has resulted in mixed conclusions about its effectiveness in addressing barriers to treatment. A patient's perception of the group environment may help to explain this variability. This study sought to explore the association between indicators of group treatment environment and improved outcomes in HCV-infected PWID. This secondary analysis of a randomized controlled trial exploring different models of treatment for HCV in a PWID population consisted of 42 participants randomized to the group treatment branch of the trial. Independent variables consisted of group sessions attended and group climate constructs of engagement, conflict, and avoidance. Dependent variables consisted of medication adherence, social support, and health-related quality of life. The study implemented generalized estimating equations to assess associations with the outcomes at the end of treatment. Factors indicative of group treatment environment were related to medication adherence and other barriers to health for HCV-infected PWID: social support and health-related quality of life. Perceptions of conflict or avoidance were associated with worse outcomes, while increased session attendance was generally associated with better outcomes. The study attests to the importance of examining group environment factors during treatment interventions. Although preliminary, the study provides specific indicators of treatment success for HCV-infected PWID and practical implications to improve patients' health outcomes and better tailor treatment to the patient.

Syringe Coverage Among People Who Inject Drugs in West Virginia, USA.

Ensuring people who inject drugs (PWID) have ≥ 100% sterile syringe coverage (i.e., persons have access to a sterile syringe for all injections) is optimal for HIV prevention. Existing syringe coverage literature is informative, yet little work has examined syringe coverage among PWID in rural communities. Using data from a 2018 PWID population estimation study conducted in a rural county in West Virginia, we used logistic regression to identify correlates of adequate sterile syringe coverage (at least 100%). A minority (37%) of PWID reported having adequate syringe coverage. Factors inversely associated with adequate syringe coverage included having recently (past 6months): engaged in transactional sex work, shared syringes, and injected fentanyl. Having exclusively acquired syringes from a syringe services program was associated with increased odds of adequate syringe coverage. Rural PWID may benefit from tailored interventions designed to increase sterile syringe access.