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O'Keefe D, Jacka D, Maher L. Changes in needle and syringe presentations point to the successes of Australian harm reduction policy and practice. Aust N Z J Public Health 2023; 47:100016. [PMID: 36638580 DOI: 10.1016/j.anzjph.2022.100016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
| | - David Jacka
- Monash Health, Dandenong, Victoria, Australia
| | - Lisa Maher
- Kirby Institute, University of New South Wales, Kensington, New South Wales, Australia
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2
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Marcellin F, Jaquet A, Lazarus JV, Molina P, Carrieri P. Alcohol Use Disorder and Hepatitis C Prevention and Care in People Who Inject Drugs: The State of Play. Semin Liver Dis 2021; 41:109-116. [PMID: 32851613 DOI: 10.1055/s-0040-1716343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Safe and effective treatment with direct-acting antivirals (DAAs) has ushered in an era in which hepatitis C virus (HCV) elimination, as set out by the World Health Organization, is possible. However, alcohol use disorder (AUD) has the potential to reduce the benefits of prevention interventions and reduce access to and continuity of HCV care in at-risk populations, such as people who inject drugs (PWID). We review the literature on the consequences of AUD on the effectiveness of HCV prevention and the cascade of care in PWID and provide recommendations for future research in the field of alcohol use and HCV.
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Affiliation(s)
- Fabienne Marcellin
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Antoine Jaquet
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France.,Inserm, ISPED, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Patricia Molina
- Department of Physiology and Alcohol and Drug Abuse Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Patrizia Carrieri
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
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3
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Plettinckx E, Crawford FW, Antoine J, Gremeaux L, Van Baelen L. Estimates of people who injected drugs within the last 12 months in Belgium based on a capture-recapture and multiplier method. Drug Alcohol Depend 2021; 219:108436. [PMID: 33310486 PMCID: PMC7856246 DOI: 10.1016/j.drugalcdep.2020.108436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND For Belgium, available estimates of the number of people who inject drugs (PWID) are based on data from more than fifteen years ago and apply only to those who report ever injecting drugs. As a result, no reliable baseline data exist to determine the scale of services for PWID. METHODS We obtained pseudo-anonymized identifier information from treatment and harm reduction service providers and a fieldwork study between February and April 2019 in Brussels. We estimated the number of PWID, defined as people who injected within the last 12 months, in Brussels using capture-recapture (CRC) methodology. To obtain national estimates, we scaled the proportion of PWID in Brussels to the total number of this population in Belgium based on two existing drug treatment registers, which were then multiplied with the result of the CRC. RESULTS The total population of PWID is estimated to be 703 (95 %CI 538-935) for Brussels and between 6620 (95 %CI 4711 - 8576) and 7018 (95 %CI 4794 - 9527) for Belgium. CONCLUSIONS These estimates provide crucial information to ensure that services to PWID are adequately maintained. They clearly indicate the need to maximize efforts to achieve the targets set by WHO for 2030 on the provision of 300 sterile needles and syringes per PWID per year, a 90 % reduction of new HCV infections, and a 65 % reduction of liver-related mortality.
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Affiliation(s)
- Els Plettinckx
- Directorate of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsmanstraat, 14, 1050 Brussels, Belgium.
| | - Forrest W Crawford
- Department of Biostatistics, Yale School of Public Health, 60 College Street, New Haven, CT 06520-0834, United States
| | - Jérôme Antoine
- Directorate of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsmanstraat, 14, 1050 Brussels, Belgium
| | - Lies Gremeaux
- Directorate of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsmanstraat, 14, 1050 Brussels, Belgium
| | - Luk Van Baelen
- Directorate of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsmanstraat, 14, 1050 Brussels, Belgium
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4
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O'Keefe D, Scott N, Aitken C, Dietze P. Assessing individual-level needle and syringe coverage parameters and the measurement of coverage in Melbourne, Australia: methods and impacts. J Public Health (Oxf) 2019; 40:e336-e342. [PMID: 29281039 DOI: 10.1093/pubmed/fdx170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/22/2017] [Indexed: 11/14/2022] Open
Abstract
Background To assess the structure of individual-level needle and syringe coverage measurement formula, and to estimate the impact of coverage-related behaviours/parameters (instances of syringe acquisition, total syringes acquired, peer-to-peer syringe distribution, injecting frequency) on overall coverage. Methods Data are drawn from the Melbourne (Australia) injecting drug user cohort study, 2010-16. Data from 518 participants were analysed. We used correlations to explore the relationships between coverage parameters; pooled multiple-linear regression to estimate the effect of each parameter on coverage over time; and exploratory factor analysis to assess the relevance of each parameter within the coverage formula. Results A 1-unit increase in injecting frequency over time reduced coverage by 10.93 percentage points, almost twice as much as other coverage parameters. Factor analysis results indicated potential improvements to coverage formula structure. Conclusions Our results suggest that reducing injecting frequency amongst people who inject drugs has the largest improvement in coverage levels, indicating harm reduction services should prioritize it. We also demonstrate that coverage measurement has been inconsistent to date. We sought to refine the method to assist in generating comparable research.
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Affiliation(s)
- D O'Keefe
- Behaviours and Health Risks Program, Burnet Institute, 85 Commercial Road, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, Australia
| | - N Scott
- Behaviours and Health Risks Program, Burnet Institute, 85 Commercial Road, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, Australia
| | - C Aitken
- School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, Australia.,Disease Elimination Program, Burnet Institute, 85 Commercial Road, Melbourne, Victoria, Australia
| | - P Dietze
- Behaviours and Health Risks Program, Burnet Institute, 85 Commercial Road, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, Australia
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5
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Farrell M, Martin NK, Stockings E, Bórquez A, Cepeda JA, Degenhardt L, Ali R, Tran LT, Rehm J, Torrens M, Shoptaw S, McKetin R. Responding to global stimulant use: challenges and opportunities. Lancet 2019; 394:1652-1667. [PMID: 31668409 PMCID: PMC6924572 DOI: 10.1016/s0140-6736(19)32230-5] [Citation(s) in RCA: 157] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 07/31/2019] [Accepted: 08/29/2019] [Indexed: 12/20/2022]
Abstract
We did a global review to synthesise data on the prevalence, harms, and interventions for stimulant use, focusing specifically on the use of cocaine and amphetamines. Modelling estimated the effect of cocaine and amphetamine use on mortality, suicidality, and blood borne virus incidence. The estimated global prevalence of cocaine use was 0·4% and amphetamine use was 0·7%, with dependence affecting 16% of people who used cocaine and 11% of those who used amphetamine. Stimulant use was associated with elevated mortality, increased incidence of HIV and hepatitis C infection, poor mental health (suicidality, psychosis, depression, and violence), and increased risk of cardiovascular events. No effective pharmacotherapies are available that reduce stimulant use, and the available psychosocial interventions (except for contingency management) had a weak overall effect. Generic approaches can address mental health and blood borne virus infection risk if better tailored to mitigate the harms associated with stimulant use. Substantial and sustained investment is needed to develop more effective interventions to reduce stimulant use.
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Affiliation(s)
- Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia.
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA; Population Health Sciences, University of Bristol, Bristol, UK
| | - Emily Stockings
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Annick Bórquez
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA; Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Javier A Cepeda
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Robert Ali
- Discipline of Pharmacology, School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Lucy Thi Tran
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Jürgen Rehm
- Institute Mental Health Policy Research & Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Epidemiological Research Unit, Technische Universität Dresden, Klinische Psychologie & Psychotherapie, Dresden, Germany; Department of International Health Projects, Institute for Leadership and Health Management, IM Sechenov First Moscow State Medical University, Moscow, Russia
| | - Marta Torrens
- Addiction Research Group, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Institut de Neuropsiquiatria i Addiccions, Barcelona, Spain
| | - Steve Shoptaw
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Rebecca McKetin
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
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6
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O'Keefe D, Bluthenthal RN, Kral AH, Aitken CK, McCormack A, Dietze PM. Measures of harm reduction service provision for people who inject drugs. Bull World Health Organ 2019; 97:605-611. [PMID: 31474773 PMCID: PMC6705510 DOI: 10.2471/blt.18.224089] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 12/18/2022] Open
Abstract
Coverage is an important dimension in measuring the effectiveness of needle and syringe programmes in providing sterile injecting equipment for people who inject drugs. The World Health Organization (WHO), the United Nations Office on Drugs and Crime (UNODC) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) currently recommend methods for measuring coverage at the population level, that is, across an estimated population of people who inject drugs within a given geographical area. However, population-level measures of coverage rely on highly uncertain population estimates and cannot capture the different levels of syringe acquisition and injecting episodes among individual users. Consequently, such measures only broadly evaluate the extent of programme service delivery, rather than describe how people who inject drugs as individuals and sub-groups interact with needle and syringe programmes. In response to these limitations, several researchers have proposed measuring coverage at the individual level, by the percentage of injecting episodes in relation to the number of sterile needles and syringes acquired. These measures evaluate coverage according to each individual’s needs. Such measures provide enhanced information for planning and monitoring of harm reduction programmes and have now been used in multiple international research studies. We advise that WHO, UNODC and UNAIDS add individual-level coverage measurement methods to their international monitoring guidelines for harm reduction programmes. By doing this, more responsive and effective programmes can be created to better reduce injecting risk behaviours and blood-borne virus transmission among people who inject drugs.
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Affiliation(s)
- Daniel O'Keefe
- Behaviours and Health Risks, Burnet Institute, 85 Commercial Rd, Melbourne, Victoria, 3004, Australia
| | - Ricky N Bluthenthal
- Institute for Health Promotion and Disease Prevention, University of Southern California, Los Angeles, United States of America (USA)
| | - Alex H Kral
- Behavioural Health Research Division, RTI International, San Francisco, USA
| | - Campbell K Aitken
- Behaviours and Health Risks, Burnet Institute, 85 Commercial Rd, Melbourne, Victoria, 3004, Australia
| | - Angus McCormack
- Behaviours and Health Risks, Burnet Institute, 85 Commercial Rd, Melbourne, Victoria, 3004, Australia
| | - Paul M Dietze
- Behaviours and Health Risks, Burnet Institute, 85 Commercial Rd, Melbourne, Victoria, 3004, Australia
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7
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O’Keefe D, Wilkinson A, Aitken C, Dietze P. Geo-spatial analysis of individual-level needle and syringe coverage in Melbourne, Australia. PLoS One 2018; 13:e0209280. [PMID: 30550588 PMCID: PMC6294429 DOI: 10.1371/journal.pone.0209280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 12/03/2018] [Indexed: 12/02/2022] Open
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.
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Affiliation(s)
- Daniel O’Keefe
- Behaviours and Health Risks, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- * E-mail:
| | - Anna Wilkinson
- Behaviours and Health Risks, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Campbell Aitken
- Behaviours and Health Risks, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Paul Dietze
- Behaviours and Health Risks, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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8
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Scott N, Sacks-Davis R, Pedrana A, Doyle J, Thompson A, Hellard M. Eliminating hepatitis C: The importance of frequent testing of people who inject drugs in high-prevalence settings. J Viral Hepat 2018; 25:1472-1480. [PMID: 30047625 DOI: 10.1111/jvh.12975] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 06/27/2018] [Accepted: 06/30/2018] [Indexed: 12/11/2022]
Abstract
Modelling suggests that more frequent screening of people who inject drugs (PWID) and an improved care cascade are required to achieve the WHO hepatitis C virus (HCV) elimination target of an 80% reduction in incidence by 2030. We determined the testing frequencies (2-yearly, annually, 6-monthly and 3-monthly) and retention in care required among PWID to achieve the HCV incidence reduction target through treatment as prevention in low (25%), medium (50%) and high (75%) chronic HCV prevalence settings. Mathematical modelling of HCV transmission among PWID, capturing testing, treatment and other features of the care cascade were employed. In low-prevalence settings, 2-yearly antibody testing of PWID was estimated to reach the elimination target by 2027-2030 depending on retention in care, with annual testing reducing the time by up to 3 years. In medium-prevalence settings, if close to 90% testing coverage were achieved, then annual antibody testing of PWID would be sufficient. If testing coverage were lower (80%), 6-monthly antibody testing with at least 70% retention in care or annual HCV RNA/cAg testing would be required. In high-prevalence settings, even 3-monthly HCV RNA/cAg testing of PWID was unable to achieve the incidence reduction target. Thus, for geographical areas or subpopulations with high prevalence, WHO incidence targets are unlikely to be met without 3-monthly RNA/cAg testing accompanied by other prevention measures. Novel testing strategies, such as rapid point-of-care antibody testing or replacing antibody testing with RNA/cAg tests as a screening tool, can provide additional population-level impacts to compensate for imperfect follow-up or testing coverage.
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Affiliation(s)
- Nick Scott
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Alisa Pedrana
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Joseph Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, Australia
| | - Alexander Thompson
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, Australia
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9
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O'Keefe D, Aitken C, Scott N, Dietze P. Analysis of time of drug use according to needle and syringe program operating hours in Melbourne, Australia: Effects on individual-level needle and syringe coverage. Drug Alcohol Depend 2018; 191:259-265. [PMID: 30153607 DOI: 10.1016/j.drugalcdep.2018.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/12/2018] [Accepted: 07/12/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Restricted needle and syringe program (NSP) operating hours in Australia have been reported as a barrier to access for people who inject drugs (PWID). We explored the prevalence of drug use occurring outside NSP operating hours with a particular focus on its impacts on individual-level needle and syringe coverage. METHODS Using data from 584 participants in a cohort of PWID in Melbourne, Australia, we analyzed time and day of drug use for heroin, methamphetamine and pharmaceutical opioids. We related this drug use to the typical operating times of Melbourne's fixed-site NSPs, categorizing drug use as either "in-hours" or "out-of-hours". We explored associations with out-of-hours drug use using a generalized linear mixed model of pooled longitudinal data. RESULTS 23% of heroin use and 50% of methamphetamine use occurred out-of-hours. In regression analysis, males and those injecting in public locations had significantly reduced odds of out-of-hours drug use. Those currently employed and those using methamphetamine (compared to heroin) had significantly increased odds of out-of-hours drug use. There was no significant association between individual-level needle and syringe coverage and hours of drug use. CONCLUSIONS Deficiencies in individual-level needle and syringe coverage may not be due to restricted NSP operating hours. Instead, insufficient coverage may be the result of other factors in the lives of PWID or other NSP access difficulties. These preliminary results suggest improvements to coverage in Australia may not result from increased hours of NSP operation, but instead via improvements to client targeting.
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Affiliation(s)
- Daniel O'Keefe
- Behaviours and Health Risks, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia; School of Public Health and Preventive Medicine, Monash University, 99 Commercial Rd, Melbourne, VIC, 3004, Australia.
| | - Campbell Aitken
- Behaviours and Health Risks, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia; School of Public Health and Preventive Medicine, Monash University, 99 Commercial Rd, Melbourne, VIC, 3004, Australia.
| | - Nick Scott
- Behaviours and Health Risks, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia; School of Public Health and Preventive Medicine, Monash University, 99 Commercial Rd, Melbourne, VIC, 3004, Australia.
| | - Paul Dietze
- Behaviours and Health Risks, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia; School of Public Health and Preventive Medicine, Monash University, 99 Commercial Rd, Melbourne, VIC, 3004, Australia.
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10
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Daniel O, Campbell A, Paul D. Should sterile needle and syringe wastage be included within individual-level needle and syringe coverage measures? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 60:8-9. [PMID: 30077904 DOI: 10.1016/j.drugpo.2018.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/06/2018] [Accepted: 07/15/2018] [Indexed: 10/28/2022]
Affiliation(s)
- O'Keefe Daniel
- Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia; School of Public Health and Preventive Medicine, Monash University, 99 Commercial Rd, Melbourne, VIC, 3004, Australia.
| | - Aitken Campbell
- Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia; School of Public Health and Preventive Medicine, Monash University, 99 Commercial Rd, Melbourne, VIC, 3004, Australia.
| | - Dietze Paul
- Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia; School of Public Health and Preventive Medicine, Monash University, 99 Commercial Rd, Melbourne, VIC, 3004, Australia.
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11
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O'Keefe D, Aung SM, Pasricha N, Wun T, Linn SK, Lin N, Aitken C, Hughes C, Dietze P. Measuring individual-level needle and syringe coverage among people who inject drugs in Myanmar. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 58:22-30. [PMID: 29754104 DOI: 10.1016/j.drugpo.2018.04.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 03/23/2018] [Accepted: 04/16/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Myanmar has prioritised people who inject drugs (PWID) as a key population for HIV mitigation efforts, with targets for needle and syringe distribution set at a population level. However, individual-level coverage, defined as the percentage of an individual's injecting episodes covered by a sterile syringe, is a more sensitive measure of intervention coverage. We sought to examine individual-level coverage in a sample of PWID in Myanmar. METHODS We recruited 512 PWID through urban drop-in-centres in Yangon, Mandalay and Pyin Oo Lwin. Participants were administered a quantitative questionnaire covering five domains: demographics, drug use, treatment and coverage, and injecting risk behaviour. We calculated past fortnight individual-level syringe coverage, estimating levels of sufficient (≥100% of injecting episodes covered by a sterile syringe) and insufficient (<100%) coverage, and examined associations between key variables and insufficient coverage via logistic regression. RESULTS Our sample was predominately male (97%), employed (76%), and living in stable accommodation (96%), with a median age of 27. All participants reported heroin as the drug most frequently injected, and injected a median of 27 times in the past two weeks. Nineteen per cent of participants had insufficient coverage in the two weeks before interview. Insufficient coverage was positively associated with syringe re-use (AOR: 5.19, 95% CIs: 2.57, 10.48) and acquiring sterile syringes from a location other than a formal drop-in-centre (AOR: 2.04, 95% CIs: 1.08, 3.82). Participants recruited in Mandalay (AOR: 0.30, 95% CIs: 0.11, 0.80) and Pyin Oo Lwin (AOR: 0.39, 95% CIs: 0.18, 0.87) had lower odds of insufficient coverage than those recruited in Yangon. CONCLUSION Our study shows coverage in selected areas of Myanmar was comparable with studies in other countries. Our results inform the delivery of harm reduction services for PWID, specifically by encouraging the use of formal drop-in-centres, over other sources of syringe distribution, such as pharmacies.
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Affiliation(s)
- Daniel O'Keefe
- Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia; School of Public Health and Preventive Medicine, Monash University, 99 Commercial Rd, Melbourne, VIC, 3004, Australia.
| | - Soe Moe Aung
- Burnet Institute Myanmar, Second floor, 226 U Wisara Road, Wizaya Plaza, Bahan Township, Yangon, Myanmar.
| | - Naanki Pasricha
- Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia.
| | - Thu Wun
- Burnet Institute Myanmar, Second floor, 226 U Wisara Road, Wizaya Plaza, Bahan Township, Yangon, Myanmar.
| | - Soe Khaing Linn
- Burnet Institute Myanmar, Second floor, 226 U Wisara Road, Wizaya Plaza, Bahan Township, Yangon, Myanmar.
| | - Nay Lin
- Burnet Institute Myanmar, Second floor, 226 U Wisara Road, Wizaya Plaza, Bahan Township, Yangon, Myanmar.
| | - Campbell Aitken
- Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia; School of Public Health and Preventive Medicine, Monash University, 99 Commercial Rd, Melbourne, VIC, 3004, Australia.
| | - Chad Hughes
- Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia; School of Public Health and Preventive Medicine, Monash University, 99 Commercial Rd, Melbourne, VIC, 3004, Australia.
| | - Paul Dietze
- Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia; School of Public Health and Preventive Medicine, Monash University, 99 Commercial Rd, Melbourne, VIC, 3004, Australia.
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