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Allen ST, White RH, O'Rourke A, Schneider KE, Weir BW, Lucas GM, Kilkenny ME, Sherman SG. Syringe Coverage Among People Who Inject Drugs in West Virginia, USA. AIDS Behav 2021; 25:3377-3385. [PMID: 33886011 DOI: 10.1007/s10461-021-03247-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 01/29/2023]
Abstract
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 6 months): 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.
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Affiliation(s)
- Sean T Allen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA.
| | - Rebecca Hamilton White
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Allison O'Rourke
- Department of Psychological and Brain Sciences, DC Center for AIDS Research, George Washington University, 2125 G St. NW, Washington, DC, 20052, USA
| | - Kristin E Schneider
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Brian W Weir
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Gregory M Lucas
- Department of Medicine, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD, 21205, USA
| | - Michael E Kilkenny
- Cabell-Huntington Health Department, 703 7th Ave., Huntington, WV, 25701, USA
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
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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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Kwon JA, Iversen J, Law M, Dolan K, Wand H, Maher L. Estimating the number of people who inject drugs and syringe coverage in Australia, 2005-2016. Drug Alcohol Depend 2019; 197:108-114. [PMID: 30802734 DOI: 10.1016/j.drugalcdep.2018.11.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Effective targeting of harm reduction programs for people who inject drugs (PWID) requires timely and robust estimates of the size of this population. This study estimated the number of people who inject drugs on a regular basis in Australia, calculated syringe coverage per person and the proportion of their injections covered by a sterile needle and syringe. METHODS We used trends in indicators of injection drug use to extend the 2005 estimate of the population of people who regularly inject drugs from 2005 to 2016. Included indicators were lifetime/recent injection of illicit drugs, drug-related arrests, drug-related seizures, accidental deaths due to opioids, opioid-related hospital admissions/separations and new diagnoses of hepatitis C virus infection among those aged 15-24 years. Syringe distribution and frequency of injection data were used to assess syringe coverage per PWID and the proportion of their injections covered by a sterile syringe. RESULTS The estimated number of people who regularly inject drugs in Australia increased by 7%, from 72,000 in 2005 to 77,270 in 2016. The annual number of syringes distributed per person increased 34%, from 470 syringes in 2005 to 640 syringes in 2016. Syringe coverage per injection first exceeded 100% in Australia in 2013. CONCLUSIONS Despite Australia's high syringe coverage by international standards, the number of syringes distributed is likely to be only narrowly meeting demand. It is critical that needle syringe programs be provided with sufficient resources to continue their role as the key intervention required to prevent HIV and HCV transmission among PWID.
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Affiliation(s)
- Jisoo A Kwon
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, 2052, Australia.
| | - Jenny Iversen
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, 2052, Australia
| | - Matthew Law
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, 2052, Australia
| | - Kate Dolan
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, 2052, Australia
| | - Handan Wand
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, 2052, Australia
| | - Lisa Maher
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, 2052, Australia; Burnet Institute, Melbourne, Victoria, 3004, Australia
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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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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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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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