Syringe Distribution Research Articles

Recovering Infectious HIV from Novel Syringe-Needle Combinations with Low Dead Space Volumes.

This study determines if detachable syringe-needle combinations redesigned to reduce their dead space volume may substantially reduce the burden of exposure to infectious HIV among people who inject drugs. Two novel, low dead space (LDS) syringe-needle designs-one added a piston to the plunger (LDS syringe) and the other added a filler to the needle (LDS needle) to reduce their dead space-were compared to standard detachable needle-syringe combinations and to syringes with fixed needles. LDS and standard syringes attached to LDS and standard needles of 23-, 25-, and 27-gauge size were contaminated with HIV-infected blood in the laboratory. The proportion of syringe-needle combinations containing infectious HIV was analyzed after syringes were (1) stored up to 7 days at 22°C or (2) rinsed with water. Detachable syringes attached to 25-gauge needles yielded comparable proportions of syringes with infectious HIV, whether the needle was standard or LDS. Among needles of greater diameter (23 gauge), LDS needles tended to reduce recoverable HIV to a greater extent than standard needles. Syringes with fixed needles showed superior results to LDS syringes attached to needles of equivalent diameter and were less likely to get clogged by blood. Detachable LDS syringe-needle designs must be recommended with caution since they still pose potential risk for HIV transmission. Distribution of LDS syringes and needles must be accompanied by recommendations and instructions for their proper rinsing and disinfection in order to reduce viral burden and chances of needle clogging.

Policy change towards implementing harm reduction in Sub-Saharan Africa

Opiate use has been documented in 36 countries in Africa, with its prevalence ranging from an estimated 2.3% of the adult population in Seychelles, to 1% in Mauritius, and 0.3% in Kenya (Ministry of Health of Seychelles, 2011; UNODC, 2014). Injecting drug use has been reported in 28 African countries, with increasing evidence of linked HIV epidemics (Bouscalliou, Evanno, Proute, Inwole, & Kanran, 2016; Kurth et al., 2015; Lepretres et al., 2015; Matiko et al., 2014; Nyandindi et al., 2014; Scheibe et al., 2016; Eluwa et al. 2013). Two scenarios characterize the diffusion of HIV among people who inject drugs (PWID) in the Sub-Saharan African region: there are countries, such as Kenya and Tanzania, that have moved from a long-established generalized HIV epidemic to a recent mixed epidemic with high HIV prevalence among key populations, including PWID; and there are concentrated HIV epidemics among PWIDs emerging in low HIV prevalence countries, such as Mauritius, Seychelles and Zanzibar. There is now wide consensus in the region that the adoption of the comprehensive package of nine evidence-informed interventions recommended by United Nations (WHO, UNODC and UNAIDS, 2012), and the United States President’s Emergency Fund for AIDS Relief (PEPFAR) tenth intervention, namely outreach, can help significantly reduce new HIV and hepatitis infections among PWID and their sexual partners. The global evidence in support of combination HIV prevention for PWID is compelling (Degenhardt et al., 2010; MacArthur, Minozzi, & Martin, 2012), and this has framed initiatives supported by PEPFAR in the region since 2010 towards fostering policy change supportive of the development of harm reduction. The combination of interventions promoted includes mutually reinforcing biomedical, behavioural, and structural interventions, which are not only evidenceinformed but rights-based as well as community-owned. Countries have begun to endorse and develop a package of HIV prevention intervention for PWIDs, including to varying extent, medically assisted therapies for treating opiate use and addiction, low threshold access to antiretroviral HIV treatment, needle and syringe distribution and exchange, sexual behaviour change communication, and community outreach. There is also a need for structural interventions to address critical social, legal, political, and environmental enablers of HIV risk. The policy environment for harm reduction has significantly improved in the region over the last five years. This has enabled

Commentary on Mounteney et al. (2016): What drug monitoring systems need in 2015.

Keywords: Epidemiology; Europe; illicit drug monitoring; new psychoactive substances; trends; prevalence; harms

Hepatitis C and HIV incidence and harm reduction program use in a conflict setting: an observational cohort of injecting drug users in Kabul, Afghanistan.

BackgroundArmed conflict may increase the risk of HIV and other pathogens among injecting drug users (IDUs); however, there are few prospective studies. This study aimed to measure incidence and potential predictors, including environmental events and needle and syringe distribution and collection program (NSP) use, of hepatitis C virus (HCV) and HIV among IDUs in Kabul, Afghanistan.MethodsConsenting adult IDUs completed interviews quarterly in year 1 and semi-annually in year 2 and HCV and HIV antibody testing semi-annually through the cohort period (November 2007–December 2009). Interviews detailed injecting and sexual risk behaviors, NSP service use, and conflict-associated displacement. Quarters with peak conflict or local displacement were identified based on literature review, and key events, including insurgent attacks and deaths, were reported with simple counts. Incidence and predictors of HCV and HIV were measured with Cox proportional hazards models.ResultsOf 483 IDUs enrolled, 385 completed one or more follow-up visits (483.8 person-years (p-y)). All participants were male with a median age of 28 years and a median duration of injecting of 2 years. Reported NSP use among the participants ranged from 59.9 to 70.5 % in the first year and was 48.4 and 55.4 % at 18 and 24 months, respectively. There were 41 confirmed deaths, with a crude death rate of 93.4/1000 p-y (95 % confidence interval (CI) 67.9–125) and overdose as the most common cause. HCV and HIV incidence were 35.6/100 p-y (95 % CI 28.3–44.6) and 1.5/100 p-y (95 % CI 0.6–3.3), respectively. Changing from injecting to smoking was protective for HCV acquisition (adjusted hazard ratio (AHR) = 0.53, 95 % CI 0.31–0.92), while duration of injecting (AHR = 1.09, 95 % CI 1.01–1.18/year) and sharing syringes (AHR = 10.09, 95 % CI 1.01–100.3) independently predicted HIV infection.ConclusionThere is high HCV incidence and high numbers of reported deaths among male Kabul IDUs despite relatively consistent levels of harm reduction program use; peak violence periods did not independently predict HCV and HIV risk. Programming should increase awareness of HCV transmission and overdose risks, prepare clients for harm reduction needs during conflict or other causes of displacement, and continue efforts to engage community and police force support.

Ideological Anachronism Involving Needle and Syringe Exchange Programs: Lessons From the Indiana HIV Outbreak.

Ideological Anachronism Involving Needle and Syringe Exchange Programs: Lessons From the Indiana HIV Outbreak.

Laws prohibiting peer distribution of injecting equipment in Australia: A critical analysis of their effects

The law is a key site for the production of meanings around the ‘problem’ of drugs in public discourse. In this article, we critically consider the material-discursive ‘effects’ of laws prohibiting peer distribution of needles and syringes in Australia. Taking the laws and regulations governing possession and distribution of injecting equipment in one jurisdiction (New South Wales, Australia) as a case study, we use Carol Bacchi's poststructuralist approach to policy analysis to critically consider the assumptions and presuppositions underpinning this legislative and regulatory framework, with a particular focus on examining the discursive, subjectification and lived effects of these laws. We argue that legislative prohibitions on the distribution of injecting equipment except by ‘authorised persons’ within ‘approved programs’ constitute people who inject drugs as irresponsible, irrational, and untrustworthy and re-inscribe a familiar stereotype of the drug ‘addict’. These constructions of people who inject drugs fundamentally constrain how the provision of injecting equipment may be thought about in policy and practice. We suggest that prohibitions on the distribution of injecting equipment among peers may also have other, material, effects and may be counterproductive to various public health aims and objectives. However, the actions undertaken by some people who inject drugs to distribute equipment to their peers may disrupt and challenge these constructions, through a counter-discourse in which people who inject drugs are constituted as active agents with a vital role to play in blood-borne virus prevention in the community. Such activity continues to bring with it the risk of criminal prosecution, and so it remains a vexed issue. These insights have implications of relevance beyond Australia, particularly for other countries around the world that prohibit peer distribution, but also for other legislative practices with material-discursive effects in association with injecting drug use.

Community attitudes towards harm reduction services and a newly established needle and syringe automatic dispensing machine in an inner-city area of Sydney, Australia

BackgroundAutomatic dispensing machines (ADMs) are an inexpensive method of increasing needle and syringe distribution to people who inject drugs but widespread implementation has been limited. The operation of ADMs in Australia has been met with apparent community opposition despite national data indicating support for harm reduction. Key community concerns include perceived increases in crime and drug use. This study aimed to examine community-level support for a newly implemented ADM in an inner-city Sydney area known for high levels of drug use. MethodsAttitudes to harm reduction and ADMs were assessed via a brief face-to-face survey of local residents (n=118) and businesses (n=35) located within the vicinity of needle and syringe program (NSP) services including the ADM. Participation was voluntary and no reimbursement was provided. Univariate analysis assessed statistically significant differences between residents’ and businesses’ knowledge of, and support for, a range of harm reduction initiatives, both generally and in the local area. Univariate logistic regression models were used to determine factors associated with indicating support for an ADM locally. ResultsThe response rate was higher among businesses (60%) compared to residents living in street-accessible dwellings (42%). Participants indicated support for fixed-site NSPs in general (83%) and locally (77%). Support for ADMs was slightly lower – 67% indicated support for ADMs generally and 60% locally. Negative opinions regarding ADMs (believing that they encourage drug use, attract drug users to the area and increase drug-related crime) were found to be significantly associated with a lower likelihood of indicating support for ADMs locally. ConclusionDespite media reports suggesting widespread community concern, there was general community support for harm reduction, including ADMs. While it is important that harm reduction services are aware of community concerns and respond appropriately, such responses should be considered and interpreted against a broader backdrop of support.

Consequences of a restrictive syringe exchange policy on utilisation patterns of a syringe exchange program in Baltimore, Maryland: Implications for HIV risk.

Syringe distribution policies continue to be debated in many jurisdictions throughout the USA. The Baltimore Needle and Syringe Exchange Program (NSP) operated under a 1-for-1 syringe exchange policy from its inception in 1994 through 1999, when it implemented a restrictive policy (2000-2004) that dictated less than 1-for-1 exchange for non-program syringes. Data were derived from the Baltimore NSP, which prospectively collected data on all client visits. We examined the impact of this restrictive policy on program-level output measures (i.e. distributed : returned syringe ratio, client volume) before, during and after the restrictive exchange policy. Through multiple logistic regression, we examined correlates of less than 1-for-1 exchange ratios at the client level before and during the restrictive exchange policy periods. During the restrictive policy period, the average annual program-level ratio of total syringes distributed : returned dropped from 0.99 to 0.88, with a low point of 0.85 in 2000. There were substantial decreases in the average number of syringes distributed, syringes returned, the total number of clients and new clients enrolling during the restrictive compared to the preceding period. During the restrictive period, 33 508 more syringes were returned to the needle exchange than were distributed. In the presence of other variables, correlates of less than 1-for-1 exchange ratio were being white, female and less than 30 years old. With fewer clean syringes in circulation, restrictive policies could increase the risk of exposure to HIV among Injection Drug Users (IDUs) and the broader community. The study provides evidence to the potentially harmful effects of such policies.

Data triangulation in the context of opioids monitoring via wastewater analyses

BackgroundThe need to contextualise wastewater-based figures about illicit drug consumption by comparing them with other indicators has been stressed by numerous studies. The objective of the present study was to further investigate the possibility of combining wastewater data to conventional statistics to assess the reliability of the former method and obtain a more balanced picture of illicit drug consumption in the investigated area. MethodsWastewater samples were collected between October 2013 and July 2014 in the metropolitan area of Lausanne (226,000 inhabitants), Switzerland. Methadone, its metabolite 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), the exclusive metabolite of heroin, 6-monoacetylmorphine (6-MAM), and morphine loads were used to estimate the amounts of methadone and heroin consumed. ResultsMethadone consumption estimated from EDDP was in agreement with the expectations. Heroin estimates based on 6-MAM loads were inconsistent. Estimates obtained from morphine loads, combined to prescription/sales data, were in agreement with figures derived from syringe distribution data and general population surveys. ConclusionsThe results obtained for methadone allowed assessing the reliability of the selected sampling strategy, supporting its ability to capture the consumption of a small cohort (i.e., 743 patients). Using morphine as marker, in combination with prescription/sales data, estimates in accordance with other indicators about heroin use were obtained. Combining different sources of data allowed strengthening the results and suggested that the different indicators (i.e., administration route, average dosage and number of consumers) contribute to depict a realistic representation of the phenomenon in the investigated area. Heroin consumption was estimated to approximately 13gday−1 (118gday−1 at street level).

State laws, syringe exchange, and HIV among persons who inject drugs in the United States: History and effectiveness.

In 1981, when acquired immune deficiency syndrome (AIDS) was first observed among persons who inject drugs, almost all US states had laws criminalizing the possession and distribution of needles and syringes for injecting illicit drugs. We reviewed changes to these laws to permit 'syringe exchanges' and the provision of public funding for such programs. Most of the changes in law occurred during the 1990s, 5-10 years later than in many other countries. Public funding of syringe exchanges is associated with lower rates of human immunodeficiency virus (HIV) infection, greater numbers of syringes distributed (a possible causal mechanism), and greater numbers of health and social services provided. Experience in the United states may prove useful in other countries: state, provincial, and local governments may need to move ahead of central governments in addressing HIV infection among persons who inject drugs.

Homelessness and Other Risk Factors for HIV Infection in the Current Outbreak Among Injection Drug Users in Athens, Greece

Objectives. We examined HIV prevalence and risk factors among injection drug users (IDUs) in Athens, Greece, during an HIV outbreak. Methods. We used respondent-driven sampling (RDS) to recruit 1404 IDUs to the Aristotle intervention in August to October 2012. We interviewed participants and tested for HIV. We performed bivariate and multivariate analyses. Results. Estimated HIV prevalence was 19.8% (RDS-weighted prevalence = 14.8%). Odds of infection were 2.3 times as high in homeless as in housed IDUs and 2.1 times as high among IDUs who injected at least once per day as among less frequent injectors (both, P < .001). Six percent of men and 23.5% of women reported transactional sex in the past 12 months, and condom use was low. Intercourse with non-IDUs was common (53.2% of men, 25.6% of women). Among IDUs who had been injecting for 2 years or less the estimated incidence rate was 23.4 new HIV cases per 100 person-years at risk. Conclusions. Efforts to reduce HIV transmission should address homelessness as well as scaling up prevention services, such as needle and syringe distribution and other risk reduction interventions.

Commentary on Nolan et al. (2014): Opiate substitution treatment and hepatitis C virus prevention: building an evidence base?

The beneficial effects of opiate substitution treatment (OST) for people who inject drugs (PWID) encompass multiple domains and outcomes. This includes decreasing HIV acquisition risk by half[1], reducing drug related mortality[2, 3], possibly enhancing adherence to HIV anti-retroviral treatment[4], diminishing crime[5] and the societal costs associated with drug use[6], increasing quality of life[5] and sometimes employment status[7, 8]. However, until recently, the evidence for OST or any harm reduction intervention reducing the risk of hepatitis C virus (HCV) acquisition was classified as insufficient[9, 10]. This situation started to change three years ago when a pooled UK analysis of selected observational studies suggested for the first time that OST could reduce HCV acquisition risk amongst PWID by over 50% and that the combination of OST and high coverage needle and syringe distribution could reduce HCV acquisition risk by up to 80%[11]. In recent months, there has been a further strengthening of the evidence base, with results from the Vancouver Injecting Drug Use Study (VIDUS) published in this issue of Addiction[12] and two other prospective studies of PWID from Australia[13] and San Francisco, in USA,[14] each reporting that OST can reduce the risk of HCV acquisition by 50–80% (Table 1). Despite a similar effect size across all four studies, an important difference between the Australian paper[13], from the HITs-c cohort, and the analyses from Vancouver and San Francisco is that White et al. only included PWID for whom OST was potentially indicated – i.e. those who reported primarily injecting heroin or other opioids[13]. In contrast, both the Vancouver and San Francisco papers were inclusive of all cohort participants, including those for whom OST may not be indicated (such as methamphetamine and cocaine injectors), so the protective effects may be under-estimated. While it is encouraging that the size of the protective effect is consistent across the studies in multiple sites, we recognise that these studies are all observational and at greater risk of selection bias and confounding than randomised controlled trials. For instance, in the Nolan study[12] there was a considerable difference in the HCV prevalence among people receiving and not receiving OST at baseline (24% vs 76%)as well as differences in drug using patterns which may suggest the difference in risk may not be entirely due to the direct effects of OST on injecting behaviours. Importantly, methadone and buprenorphine are essential medicines that cannot be randomised in future studies and so the evidence base will have to be built from non-randomised observational studies such as these. Table 1 Summary of findings from recent studies showing protective effect of OST on HCV acquisition. So what are the implications of these results for designing HCV prevention strategies? Firstly, as highlighted by a recent modelling analysis[15], OST averts infections, with projections from the UK suggesting that current high coverage levels of OST (50% of PWID are currently on OST in the UK) may have contributed to reducing the chronic HCV prevalence from 57% to 40%. OST may also have an accumulating effect – the longer the average duration on OST the greater the impact on reducing HCV risk[12] and drug related mortality[2]. Indeed, because economic analyses suggest that OST could be cost saving when societal benefits are accounted for[6], or at least highly cost-effective if just health benefits are considered[6], then it seems there should be no argument against scaling up OST in all settings. There is a long way to go until we achieve the high levels of OST coverage that currently exist in some settings such as the UK and Australia. Data from the last systematic review of intervention coverage among PWID suggested that the worldwide coverage of OST was at best 8%[16], and although many countries have since initiated OST programmes, recent data continue to show inadequate coverage of OST in most settings[17]. This raises the spectre of the potential enormous size of the global prevention gap. For example, adapted results from our previous modelling analysis[15] suggest scaling up OST worldwide could avert between 1 and 2 million HCV infections over the next 10 years if it was scaled up from less than 10% to 50% coverage (8 million) of all PWID. Although these calculations warrant more detailed modelling to capture the heterogeneities in different epidemics, they nonetheless highlight the substantial potential prevention benefit of scaling up OST. It is important to note, however, that although recent results suggest that OST is an essential component of any future HCV prevention strategy, it is not the only answer to HCV prevention. HCV prevalence remains persistently high in many countries despite high coverage of OST and needle and syringe distribution. It is likely that only by also scaling up antiviral treatment and prophylactic vaccine development for HCV that prevalence can be significantly reduced[18, 19].

Improving the quality of needle and syringe programmes: an overlooked strategy for preventing hepatitis C among people who inject drugs.

The hepatitis C virus (HCV) is 5 to 20 times more infectious than HIV [1]. Even more alarmingly, HCV has the capacity to survive outside of the human body for weeks. Unfortunately, this makes the reuse of injecting equipment that has been contaminated with HCV a highly effective means of spreading the disease [2]. The prevalence of HCV among people who inject drugs (PWID) is shocking, much higher than HIV prevalence, for example [3,4]. Research suggests that needle and syringe programmes (NSPs) contribute less to the prevention of HCV than the prevention of HIV [5]. Nevertheless, the distribution of needles and syringes has become an accepted worldwide strategy to prevent the spread of not only HIV but also other bloodborne infectious diseases such as HCV among people who inject drugs. NSPs and opioid substitution therapy are key recommended interventions of multilateral organisations such as the World Health Organisation (WHO), the Joint United Nations Programme on HIV/AIDS, the United Nations Office on Drugs and Crime, the European Centre for Disease Prevention and Control, and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) [3,6,7]. Yet NSPs are relegated to the sidelines in most European countries. They are neglected by government officials and funders, and are even often underprioritised by drug treatment organizations. Despite the valuable efforts of EMCDDA, key European stakeholders have shown little interest in formulating uniform data collection procedures, minimum quality standards and best practices relating to disease prevention interventions for drug users. This means that experiences in the field are not sufficiently evaluated, and information is lacking on how to further develop programmes to demonstrate and increase effectiveness. Scotland is one of the few favourable exceptions in Europe [8]. Embarrassingly little information exists about the effectiveness of NSPs – an evidence gap that stands out all the more in comparison to the body of research on medical-therapeutic interventions for hepatitis C infection. Given the limited interest in NSPs among scientific experts and practitioners working in the field of harm reduction, many outstanding questions and challenges remain in regard to optimal procedures for using NSPs as an HCV prevention tool.

Attitudes of North Carolina law enforcement officers toward syringe decriminalization

BackgroundNorth Carolina, like much of the U.S. South, is disproportionately affected by HIV and hepatitis. This persistently high disease burden may be driven in part by laws that criminalize the possession and distribution of syringes for illicit drug use. Legal change to decriminalize syringes may reduce infection rates in the state, but is unlikely absent support from law enforcement actors. MethodsWe analyzed the responses of 350 North Carolina law enforcement officers to a confidential, anonymous survey. The survey instrument collected data regarding self-reported needle-stick injury (NSI), blood borne disease risk perception and attitudes toward syringe decriminalization. Results82% of respondents reported that contracting HIV was a “big concern” for them. 3.8% of respondents reported ever receiving a job-related NSI, a rate of 36 NSI per 10,000 officer-years. Majorities of respondents reported positive views regarding syringe decriminalization, with approximately 63% agreeing that it would be “good for the community” and 60% agreeing that it would be “good for law enforcement.” Black and female officers were significantly less likely to agree that on-the-job NSI was a “big concern” and significantly more likely to agree that it would be good for law enforcement. ConclusionsThese findings suggest that many North Carolina LEOs understand the public health benefits of syringe access programs and may be inclined to support syringe decriminalization legislation. Further research is indicated to determine the causes of observed differences in perceptions of bloodborne disease risk and attitudes toward syringe decriminalization by race and sex.

Early initiation of alcohol or marijuana use and nonmedical use of prescription drugs

Early initiation of alcohol or marijuana use and nonmedical use of prescription drugs

HIV pre‐exposure prophylaxis for people who inject drugs: a review of current results and an agenda for future research

IntroductionStudies examining the use of pre-exposure prophylaxis (PrEP) to prevent HIV transmission among people who inject drugs (PWIDs) have not been adequately summarized. Recently, the Bangkok Tenofovir Study has shown that PrEP may be effective at reducing new HIV infections among this high-risk group. This randomized controlled trial was the first study to specifically examine the efficacy of PrEP among PWIDs. In this review, we present the current state of evidence regarding the use of PrEP to prevent HIV infection in PWID populations, and set an agenda for future research to inform the most effective implementation of PrEP in the context of existing evidence-based HIV prevention strategies.DiscussionDespite positive trial results confirming that PrEP may prevent HIV transmission among PWIDs, there remain many questions regarding the interpretation of these results, as well as obstacles to the implementation of PrEP regimens within highly diverse drug-using communities. Aside from the Bangkok Tenofovir Study, we identified only one other published study that has collected empirical data to inform the use of PrEP among PWIDs. The large gap in research regarding the use and implementation of PrEP for PWIDs signals the need for further research and attention.ConclusionsWe recommend that future research efforts focus on elucidating the generalizability of the Bangkok Tenofovir Study results in other injection drug–using populations, examining the willingness of PWIDs to use PrEP in diverse contexts, identifying barriers to adherence to PrEP regimens and determining the most effective ways to implement PrEP programmes within the context of existing evidence-based prevention strategies, including opioid substitution therapy and needle and syringe distribution programmes.

Socially-Integrated Transdisciplinary HIV Prevention

Current ideas about HIV prevention include a mixture of primarily biomedical interventions, socio-mechanical interventions such as sterile syringe and condom distribution, and behavioral interventions. This article presents a framework for socially-integrated transdisciplinary HIV prevention that may improve current prevention efforts. It first describes one socially-integrated transdisciplinary intervention project, the Transmission Reduction Intervention Project. We focus on how social aspects of the intervention integrate its component parts across disciplines and processes at different levels of analysis. We then present socially-integrated perspectives about how to improve combination antiretroviral treatment (cART) processes at the population level in order to solve the problems of the treatment cascade and make "treatment as prevention" more effective. Finally, we discuss some remaining problems and issues in such a social transdisciplinary intervention in the hope that other researchers and public health agents will develop additional socially-integrated interventions for HIV and other diseases.

HIV/AIDS trends in China

HIV/AIDS trends in China

&lt;b&gt;Resíduos gerados por usuários de insulina em domicílio: proposta de protocolo para unidades de saúde&lt;/b&gt; doi: 10.4025/cienccuidsaude.v11i4.21653

This study aimed to propose a protocol to the management of medical waste generated in households of individuals with diabetes mellitus who are insulin users, focusing on biological, chemical and sharp waste. This is a descriptive and exploratory study carried out in a Family Health Center in the city of Ribeirao Preto, State of Sao Paulo, Brazil. The sample was composed of 26 users of insulin. Data were collected through the Information System of Primary Care and interviews with selected participants during the month of July 2010. Data were analyzed using descriptive statistics. Results showed the improper disposal of medical waste generated in households of insulin users. This situation requires the adoption to protocols for the control of distribution and disposal of syringes, which could help to minimize the generation of medical waste in households. The rational use of syringes may avoid the wasting and it is a way to ensure the acquisition of adequate amounts of material by the insulin users. The knowledge generated in this research related to the problem of the management of medical waste generated in households of insulin users may to contribute to the development of actions in health education and protocols in health units.

The efficiency of targeted intervention in limiting the spread of HIV and Hepatitis C Virus among injecting drug users

Background. Interventions aimed at minimizing the spread of blood borne infections among Injecting Drug Users (IDU) are impeded by limitations in resources. To enhance their efficiency, it may be beneficial to target specific behavioural subpopulations, distinguished by syringe sharing tendencies.Methods. We used mathematical modelling to explore the effects of two types of intervention: removal of individuals from the injecting population and risk decrease at group-level (e.g. distribution of syringes). We computed the direct effects of intervention on the probability of obtaining and spreading infection as a function of baseline risk behaviour. Population level effects of (targeted) intervention were explored using a differential equations model, which incorporated two levels of risk.Results. Within most scenarios of risk distribution considered, HIV could be substantially reduced or eliminated by targeting high risk IDU only. Conversely, higher incidence reductions for HCV were reached in many scenarios when targeting low risk IDU. The potential for preventing infections by removal of uninfected IDU increases with baseline risk, but so does the probability that an IDU is already infected before being reached by intervention. Decreasing risk is likely to only delay rather than prevent infection for IDU borrowing many syringes, especially for a very infectious disease such as HCV.Conclusions. The efficiency of intervention on injecting drug users may be much enhanced by targeting specific risk subgroups. However, the optimal targeting policy depends strongly on the infection under consideration.