Public Health Outcomes as a Measure of Efficacy of Syringe Exchange Programs

Introduction. A syringe exchange is a public health intervention that offers nonjudgmental services to intravenous drug users (IVDU), providing clean syringes in exchange for used syringes. While prior studies demonstrated that syringe exchanges can reduce transmission of HIV, hepatitis C, and other blood-borne pathogens, other measures of health improvements have been less studied. Methods. 91 members of Vermont CARES syringe exchange program were surveyed on their healthcare practices. New members were defined asprogram. Results. Long-term members tended to have a primary care provider (PCP). Lack of insurance and fear of judgment were commonly cited reasons for not having a PCP. Long-term members were significantly less likely (p=0.04) to use costly emergency department (ED) services and less likely to reuse their own or another person\u27s needles. Long-term members were more likely to be in addiction treatment and reported a greater desire to abstain from drug use. New members were more likely to obtain hepatitis C and HIV testing in the past year. Discussion. Subjects responded positively to the possibility of accessing PCP services through VT CARES, offering a continuation of the nonjudgmental healthcare environment. Decreased ED visits significantly correlated with longer membership, reflecting the positive impact of the syringe exchange education services on reducing healthcare costs. Decreased testing among long-term members may reflect prior knowledge of their status. Long-term members were less likely to reuse their own needles or ones used by another person, suggesting the distribution of clean syringes encourages safer injection practices.https://scholarworks.uvm.edu/comphp_gallery/1247/thumbnail.jp

Reduction of Injection-Related Risk Behaviors After Emergency Implementation of a Syringe Services Program During an HIV Outbreak

Objective: To describe injection-related HIV risk behaviors preimplementation and postimplementation of an emergency syringe services program (SSP) in Scott County, Indiana, after an HIV outbreak among persons who inject drugs (PWID). Design: Mixed methods retrospective pre–post intervention analysis. Methods: We analyzed routine SSP program data collected at first and most recent visit among clients with ≥2 visits, ≥7 days apart from April 4 to August 30, 2015, to quantify changes in injection-related risk behaviors. We also analyzed qualitative data collected from 56 PWID recruited in Scott County to understand factors contributing to these behaviors. Results: SSP clients included in our analysis (n = 148, 62% of all SSP clients) reported significant (P < 0.001) reductions over a median 10 weeks (range 1–23) in syringe sharing to inject (18%–2%) and divide drugs (19%–4%), sharing other injection equipment (eg, cookers) (24%–5%), and number of uses of the same syringe [2 (interquartile range: 1–4) to 1 (interquartile range: 1–1)]. Qualitative study participants described access to sterile syringes and safer injection education through the SSP, as explanatory factors for these reductions. Injection frequency findings were mixed, but overall suggested no change. The number of syringes returned by SSP clients increased from 0 at first visit to median 57. All qualitative study participants reported using sharps containers provided by the SSP. Conclusions: Analyses of an SSP program and in-depth qualitative interview data showed rapid reduction of injection-related HIV risk behaviors among PWID post-SSP implementation. Sterile syringe access as part of comprehensive HIV prevention is an important tool to control and prevent HIV outbreaks

Barriers Encountered by Syringe Exchange Clients in Vermont

Introduction and Aims. Vermont CARES is a nonprofit HIV prevention and advocacy organization which provides a needle exchange program for intravenous drug users. Services are focused on education, prevention, testing, and harm reduction. The Syringe Support Program (SSP) offers clients clean syringes to reduce intravenous transmission of disease. Although SSP are proven avenues for harm reduction, barriers prevent users from utilizing services. Clients are limited by social, economic, and personal obstacles de- scribed in similar populations across the country. This project seeks to identify the barriers Vermont CARES clients face in accessing the SSP, determine needs, and evaluate interest in additional services. Methods. Our team and Vermont CARES staff held a focus group with St. Johnsbury clients to discuss services and barriers. A 39 question paper survey was distributed to three Vermont CARES sites during October, 2017 by Vermont CARES. Participation was voluntary and uncompensated. Sixty-three clients completed the survey. Results and Discussion. Of the 63 respondents, 61.9% stated that lack of ade- quate income contributed most to their inability to meet basic needs. These same clients faced the most barriers to access with economic hardship precipitated by sub- stance abuse, disability, and family commitments. In assessing additional services, clients sought food pantries, hygiene kits, and dental clinics. 56.4% of respondents would use safe injection facilities if provided. Those without income to meet basic needs expressed most interest in safe injection facilities (p=0.022). With barriers recognized, our future aim is to track efficacy of new services in impacting care and quality of life.https://scholarworks.uvm.edu/comphp_gallery/1268/thumbnail.jp

Injecting equipment schemes for injecting drug users : qualitative evidence review

This review of the qualitative literature about needle and syringe programmes (NSPs) for injecting drug users (IDUs) complements the review of effectiveness and cost-effectiveness. It aims to provide a more situated narrative perspective on the overall guidance questions

The Epidemics of Injecting Drug Use and Blood-Borne Disease: A Public Health Perspective

In this article, the author first examines the mechanism by which blood-borne disease is transmitted through sharing of injection equipment. Thereafter, he presents a public health strategy for reducing multi-person use of contaminated injection equipment. This strategy includes: repealing or modifying current laws and regulations making possession and distribution of sterile injection equipment a criminal offense; implementing syringe exchange programs to expand access to new syringes for users of injection drugs; and counseling, education, and treatment targeted to injecting drug users (IDUs), including those in the prison and health care system. The objective of a public health approach is not to encourage or enable IDUs to obtain and use drugs; public health strategies actively seek to reduce drug use due to its profound adverse effects on physical and mental health. Rather, the public health approach seeks to substantially improve health outcomes for IDUs who cannot or will not stop using drugs

UFO Presents! A viral hepatitis prevention and education program for young adult IDUs

UFO Presents! is a Center for Disease Control and Prevention (CDC)-funded program providing much needed hepatitis education, prevention and care services for youth and young adults with injection risk in San Francisco, CA. We aim to meet the broader needs of youth and young adults through comprehensive health and psychosocial support. We are the most experienced group in San Francisco in providing hepatitis, HIV and STI prevention services tailored to young adult IDU, a group with few other health-related resources or programs tailored directly to them

HIV vulnerability of men and women who inject drugs in Kumasi, Ghana

This study was implemented by Boston University in collaboration with the Kwame Nkrumah University of Science and Technology with support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 2010. The content and views expressed here are the authors’ and do not necessarily reflect the opinion or policy of USAID or the U.S. Government.Reducing vulnerability to HIV infection among key populations in Ghana is a major goal for the National AIDS Control Program (NACP) and the GAC. While a number of studies have explored HIV risk behaviours among several key vulnerable populations in Ghana including female sex workers, men who have sex with men, and prisoners, little is known about the drug use and sexual vulnerability of people who inject drugs (PWID). In addition, no programs have been implemented to reduce the vulnerability among this population. This report provides the findings from a qualitative study that aimed to understand the social, economic and behavioral vulnerability to HIV of PWID in Kumasi and to inform the development and implementation of HIV prevention programs for this population. The research was conducted by a collaborative team comprised of researchers from Boston University’s Center for Global and Health and Development (CGHD) and the Kwame Nkrumah University of Science and Technology (KNUST) School of Medical Sciences. It is one of nine studies under the Operations Research on Key Populations project funded by the United States Agency for International Development (USAID). The study was designed and carried out in collaboration with the Ghana AIDS Commission (GAC).Support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 201

Harm reduction among injecting drug users - evidence of effectiveness

This chapter synthesises and evaluates the available direct evidence relating to the impact of needle and syringe programmes (NSPs), opioid substitution treatment (OST), drug consumption rooms (DCRs), and peer naloxone distribution (PND) on HIV/hepatitis C (HCV) incidence/prevalence, injecting risk behaviour and overdose-related mortality. To achieve this, we conducted a review of reviews; a systematic and explicit method used to identify, select and critically appraise relevant findings from secondary level research (systematic reviews and/or meta-analyses) into an evidence briefing. In the absence of high-quality reviews, appraisal of the evidence was supplemented with a targeted review of the primary literature. We find that there is sufficient review-level evidence that OST reduces HIV transmission, while the evidence in support of NSPs reducing HIV transmission is more tentative, and for DCRs currently insufficient. There is tentative evidence that OST has limited effectiveness in reducing HCV transmission, and insufficient evidence to support or discount NSPs or DCRs' ability to reduce HCV transmission. There is sufficient review-level evidence that NSPs, OST and DCRs reduce self-reported injecting risk behaviour. There is sufficient review evidence that OST reduces risk of overdose mortality, but insufficient evidence to support or discount the effect of DCRs or PND on overdose deaths at the community level. Our review shows evidence in support of a variety of harm reduction interventions but highlights an uneven presence of high-quality review evidence. Future evaluation of harm reduction programmes should prioritise methodologically robust study designs

Reducing Infectious Diseases in the U.S.: Focus on HIV/AIDS and Hepatitis

Offers arguments for the efficacy of needle exchange programs in reducing infections among drug users and against the ban on using federal funds for such programs. Includes case summaries, examples of philanthropic initiatives, and recommendations