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Lim J, El-Sheikh M, Buckeridge DL, Panagiotoglou D. Economic evaluation of the effect of needle and syringe programs on skin, soft tissue, and vascular infections in people who inject drugs: a microsimulation modelling approach. Harm Reduct J 2024; 21:126. [PMID: 38943164 PMCID: PMC11212409 DOI: 10.1186/s12954-024-01037-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/14/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND Needle and syringe programs (NSP) are effective harm-reduction strategies against HIV and hepatitis C. Although skin, soft tissue, and vascular infections (SSTVI) are the most common morbidities in people who inject drugs (PWID), the extent to which NSP are clinically and cost-effective in relation to SSTVI in PWID remains unclear. The objective of this study was to model the clinical- and cost-effectiveness of NSP with respect to treatment of SSTVI in PWID. METHODS We performed a model-based, economic evaluation comparing a scenario with NSP to a scenario without NSP. We developed a microsimulation model to generate two cohorts of 100,000 individuals corresponding to each NSP scenario and estimated quality-adjusted life-years (QALY) and cost (in 2022 Canadian dollars) over a 5-year time horizon (1.5% per annum for costs and outcomes). To assess the clinical effectiveness of NSP, we conducted survival analysis that accounted for the recurrent use of health care services for treating SSTVI and SSTVI mortality in the presence of competing risks. RESULTS The incremental cost-effectiveness ratio associated with NSP was $70,278 per QALY, with incremental cost and QALY gains corresponding to $1207 and 0.017 QALY, respectively. Under the scenario with NSP, there were 788 fewer SSTVI deaths per 100,000 PWID, corresponding to 24% lower relative hazard of mortality from SSTVI (hazard ratio [HR] = 0.76; 95% confidence interval [CI] = 0.72-0.80). Health service utilization over the 5-year period remained lower under the scenario with NSP (outpatient: 66,511 vs. 86,879; emergency department: 9920 vs. 12,922; inpatient: 4282 vs. 5596). Relatedly, having NSP was associated with a modest reduction in the relative hazard of recurrent outpatient visits (HR = 0.96; 95% CI = 0.95-0.97) for purulent SSTVI as well as outpatient (HR = 0.88; 95% CI = 0.87-0.88) and emergency department visits (HR = 0.98; 95% CI = 0.97-0.99) for non-purulent SSTVI. CONCLUSIONS Both the individuals and the healthcare system benefit from NSP through lower risk of SSTVI mortality and prevention of recurrent outpatient and emergency department visits to treat SSTVI. The microsimulation framework provides insights into clinical and economic implications of NSP, which can serve as valuable evidence that can aid decision-making in expansion of NSP services.
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Affiliation(s)
- Jihoon Lim
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 2001 McGill College Avenue, Suite 1200, Montreal, QC, H3A 1G1, Canada
| | - Mariam El-Sheikh
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 2001 McGill College Avenue, Suite 1200, Montreal, QC, H3A 1G1, Canada
| | - David L Buckeridge
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 2001 McGill College Avenue, Suite 1200, Montreal, QC, H3A 1G1, Canada
| | - Dimitra Panagiotoglou
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 2001 McGill College Avenue, Suite 1200, Montreal, QC, H3A 1G1, Canada.
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Jahangir T, Fuller GK, Livingston MD, Freeman E, Fanucchi LC, Fallin-Bennett A, Cooper HLF, Young AM. Syringe reuse among people who inject drugs in rural Appalachian Kentucky. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 128:104422. [PMID: 38703621 PMCID: PMC11213664 DOI: 10.1016/j.drugpo.2024.104422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 03/20/2024] [Accepted: 04/04/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Personal syringe reuse (i.e., reuse of one's own syringes) can place people who inject drugs at increased risk for infectious disease but has received relatively little attention in published literature. The purpose of this study is to identify factors associated with syringe reuse among people who inject drugs in rural Kentucky. METHODS Participants (n = 238) completed interviewer-administered questionnaires on syringe reuse and demographic, behavioral, and service access characteristics. Unadjusted negative binomial regression with cluster-robust standard errors was used to model the associations with a logged offset for number of injections in the past 30 days. RESULTS The average age of the sample was 35 and 59.7 % were male. Most participants (77.7 %) reused syringes at least once in the past 30 days, using each syringe a median of three times. Reuse was higher among those who were older and reported a higher street price for syringes. Syringe reuse was lower among people who were within walking distance to a syringe service program (SSP) and who obtained most of their syringes from SSPs or pharmacies. CONCLUSION Syringe reuse among people who inject drugs in rural Kentucky is common. However, these data suggest that increased access to syringes from SSPs and pharmacies, as well as policy-level interventions that reduce street syringe price, might reduce syringe reuse and related harms.
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Affiliation(s)
- Tasfia Jahangir
- Emory University Rollins School of Public Health, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - Grayson K Fuller
- University of Kentucky Center on Drug and Alcohol Research, 845 Angliana Avenue, Lexington KY 40508, United States
| | - Melvin D Livingston
- Emory University Rollins School of Public Health, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - Edward Freeman
- University of Kentucky College of Public Health, 111 Washington Avenue, Lexington, KY 40536, United States
| | - Laura C Fanucchi
- University of Kentucky Center on Drug and Alcohol Research, 845 Angliana Avenue, Lexington KY 40508, United States; Division of Infectious Diseases, University of Kentucky College of Medicine, 845 Angliana Ave. Lexington, KY 40508, United States
| | - Amanda Fallin-Bennett
- Voices of Hope, 450 Old Vine Street, Suite 101, Lexington, KY 40507, United States; University of Kentucky College of Nursing, 2265 Harrodsburg Road, Suite 202, Lexington, KY, United States
| | - Hannah L F Cooper
- Emory University Rollins School of Public Health, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - April M Young
- University of Kentucky Center on Drug and Alcohol Research, 845 Angliana Avenue, Lexington KY 40508, United States; University of Kentucky College of Public Health, 111 Washington Avenue, Lexington, KY 40536, United States.
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Tookes HE, Bartholomew TS, Sugar SES, Plesons MD, Bluthenthal RN, Wenger LD, Patel SV, Kral AH, Lambdin BH. Updates on syringe coverage and service uptake among needle and syringe programs in the United States, 2019-2020. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 123:104289. [PMID: 38071932 PMCID: PMC10878422 DOI: 10.1016/j.drugpo.2023.104289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/01/2023] [Accepted: 12/02/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND As injection drug use has increased in the US, so too has the prevalence of receptive syringe sharing. Since the 1980s, Needle and Syringe Programs (NSPs) have been an important source of clean injection equipment and disposal of used syringes. This study reports national syringe coverage and examines the impact of program attributes on organizational-level service uptake, defined as number of syringes distributed per participant contact per year. METHODS In 2019 and 2020, we administered an annual cross-sectional survey to NSPs operating in the US (n = 260). A national estimate of coverage was calculated by dividing the total number of syringes distributed by the 2019 and 2020 population estimate of people who inject drugs (PWID). Frequency distributions and percentages were calculated for categorical variables (e.g., funding, census region, distribution policy/modality), and median and interquartile ranges (IQR) were calculated for continuous variables (e.g., participant contacts, syringes distributed). Bivariate and multivariable mixed effects logistic regression models were used to estimate the odds ratio associated with organizational characteristics on increasing service uptake at the NSP level. RESULTS From 2019 to 2020, the total number of participant contacts by NSPs increased from 871,976 to 898,891, and the number of syringes distributed increased from 92,648,529 to 113,071,748. The national coverage estimate increased from 29.5 (95 % CI = 15.0, 58.2) to 35.8 (95 % CI = 18.2, 70.6) syringes per PWID. Fifty-eight percent of NSPs increased service uptake in 2020 as compared to the previous year. NSPs that received government funding and NSPs that changed to a less restrictive syringe distribution policy were more likely to increase service uptake (aOR 1.80, 95 % CI = 1.01, 3.22 and aOR 3.33, 95 % CI = 1.11, 9.94, respectively). Syringe distribution modalities also diversified, with more NSPs reaching participants via backpacking/outreach, fixed site pop-ups, mobile delivery, mail-based delivery, leaving supplies out, and secondary distribution. CONCLUSION Both governmental investment in harm reduction programming and needs-based distribution of syringes increased service uptake and thus should be expanded and sustained to reduce harms associated with injection drug use.
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Affiliation(s)
- Hansel E Tookes
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tyler S Bartholomew
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA.
| | - Sabrina E Soto Sugar
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Marina D Plesons
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | | | | | | | - Alex H Kral
- RTI International, Berkeley, CA, United States
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Dang CM, Nelson CM, Feaster DJ, Kizhner A, Forrest DW, Nakamura N, Iyer A, Ghanta PP, Jayaweera DT, Rodriguez AE, Pahwa RN, Tookes HE, Pallikkuth S, Pahwa SG. Opioids exacerbate inflammation in people with well-controlled HIV. Front Immunol 2023; 14:1277491. [PMID: 38022645 PMCID: PMC10646416 DOI: 10.3389/fimmu.2023.1277491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction People with HIV (PWH) are known to have underlying inflammation and immune activation despite virologic control. Substance use including opioid dependence is common in this population and is associated with increased morbidity and reduced lifespan. The primary objective of the present study termed opioid immunity study (OPIS), was to investigate the impact of chronic opioids in PWH. Methods The study recruited people with and without HIV who had opioid use disorder (OUD). Study participants (n=221) were categorized into four groups: HIV+OP+, n=34; HIV-OP+, n=66; HIV+OP-, n=55 and HIV-OP-, n=62 as controls. PWH were virally suppressed on ART and those with OUD were followed in a syringe exchange program with confirmation of OP use by urine drug screening. A composite cytokine score was developed for 20 plasma cytokines that are linked to inflammation. Cellular markers of immune activation (IA), exhaustion, and senescence were determined in CD4 and CD8 T cells. Regression models were constructed to examine the relationships of HIV status and opioid use, controlling for other confounding factors. Results HIV+OP+ participants exhibited highest inflammatory cytokines and cellular IA, followed by HIV-OP+ for inflammation and HIV+OP- for IA. Inflammation was found to be driven more by opioid use than HIV positivity while IA was driven more by HIV than opioid use. In people with OUD, expression of CD38 on CD28-CD57+ senescent-like T cells was elevated and correlated positively with inflammation. Discussion Given the association of inflammation with a multitude of adverse health outcomes, our findings merit further investigations to understand the mechanistic pathways involved.
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Affiliation(s)
- Christine M. Dang
- Department of Microbiology and Immunology, University of Miami, Miller School of Medicine, Miami, FL, United States
| | - C. Mindy Nelson
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL, United States
| | - Daniel J. Feaster
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL, United States
| | - Alexander Kizhner
- Department of Microbiology and Immunology, University of Miami, Miller School of Medicine, Miami, FL, United States
| | - David W. Forrest
- Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL, United States
| | - Nobuyo Nakamura
- Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL, United States
| | - Akshay Iyer
- Department of Microbiology and Immunology, University of Miami, Miller School of Medicine, Miami, FL, United States
| | - Priya P. Ghanta
- Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL, United States
| | - Dushyantha T. Jayaweera
- Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL, United States
| | - Allan E. Rodriguez
- Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL, United States
| | - Rajendra N. Pahwa
- Department of Microbiology and Immunology, University of Miami, Miller School of Medicine, Miami, FL, United States
| | - Hansel E. Tookes
- Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL, United States
| | - Suresh Pallikkuth
- Department of Microbiology and Immunology, University of Miami, Miller School of Medicine, Miami, FL, United States
| | - Savita G. Pahwa
- Department of Microbiology and Immunology, University of Miami, Miller School of Medicine, Miami, FL, United States
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Roberts HH, Stone M, Isac AJ. Syringe Services Programs to Reduce Intravenous Disease Transmission in Substance Use Disorders. Nurs Clin North Am 2023; 58:243-256. [PMID: 37105658 DOI: 10.1016/j.cnur.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Syringe services programs (SSPs) are evidence-based programs. SSPs are integral in preventing bloodborne diseases while increasing access to care and reducing drug overdose deaths. SSPs are often the only source of health care for people who use drugs. Several states in the United States support and offer community-based SPPs; however, US prisons do not offer such programs to those incarcerated. Nurses are bridging the gap in support of SSPs and are being backed by organizations such as the American Nurses Association and the Association of Nurses in AIDS Care.
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Affiliation(s)
| | - Misty Stone
- Faculty, School of Nursing, Fayetteville State University
| | - Amanda J Isac
- Division of Public Health, Injury, and Violence Prevention Branch, North Carolina Department of Health and Human Services
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Jacka BP, Nolen S, Bessey S, Zang X, Goedel WC, Yedinak J, Marshall BDL. Brief Report: Use of Pre-Exposure Prophylaxis to Prevent Rapid HIV Transmission Among People Who Inject Drugs in Rural Counties in the United States: A Modeling Study. J Acquir Immune Defic Syndr 2022; 91:449-452. [PMID: 36150038 PMCID: PMC9649854 DOI: 10.1097/qai.0000000000003093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/28/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Despite recent HIV outbreaks among people who inject drugs (PWID) in nonurban US settings, syringe service programs (SSP) are often inaccessible in these communities. Furthermore, pre-exposure prophylaxis (PrEP) awareness and coverage for PWID is limited. We aimed to model the impact of PrEP on HIV transmission among PWID in a rural setting. SETTING Using a calibrated agent-based model, we simulated HIV transmission in an adult population (n = 14,573 agents) in Scott County, Indiana between 2015 and 2024. METHODS We modeled PrEP eligibility according to CDC guidelines for PWID. PrEP coverage increased by 15% points in the range 10%-70%. Two counterfactual scenarios were modeled: Unrestricted access for PWID and PrEP for SSP attendees . We calculated the number of new HIV infections and number of person-years on PrEP per averted infection. RESULTS In the status quo scenario, 153 (95% Simulation Interval: 85, 259) new HIV infections occurred among PWID over 10 years. Compared with the status quo, 40% PrEP coverage resulted in 25% fewer HIV infections in the Unrestricted access for PWID scenario and 10% fewer HIV infections in the PrEP for SSP attendees scenario. The PYPAI was 21 and 43 in the Unrestricted access for PWID and PrEP for SSP attendees scenarios, respectively. CONCLUSION Our modeling suggests that PrEP provides substantial benefit to PWID in rural US communities, with fewer restrictions on access providing the greatest effect. Control of HIV outbreaks will require expansion of public health interventions that meet the needs of all individuals.
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Affiliation(s)
- Brendan P Jacka
- People, Place, & Health Collective, Department of Epidemiology, Brown University School of Public Health, Providence, USA
| | - Shayla Nolen
- People, Place, & Health Collective, Department of Epidemiology, Brown University School of Public Health, Providence, USA
| | - Sam Bessey
- People, Place, & Health Collective, Department of Epidemiology, Brown University School of Public Health, Providence, USA
| | - Xiao Zang
- People, Place, & Health Collective, Department of Epidemiology, Brown University School of Public Health, Providence, USA
| | - William C Goedel
- People, Place, & Health Collective, Department of Epidemiology, Brown University School of Public Health, Providence, USA
| | - Jesse Yedinak
- People, Place, & Health Collective, Department of Epidemiology, Brown University School of Public Health, Providence, USA
| | - Brandon DL Marshall
- People, Place, & Health Collective, Department of Epidemiology, Brown University School of Public Health, Providence, USA
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The impact of the COVID-19 pandemic on people who inject drugs accessing harm reduction services in an rural American state. Harm Reduct J 2022; 19:80. [PMID: 35869523 PMCID: PMC9305035 DOI: 10.1186/s12954-022-00660-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 07/05/2022] [Indexed: 12/01/2022] Open
Abstract
Background The impact of public health policies during the COVID-19 pandemic on people who inject drugs (PWID) has varied across regions. In other countries, recent research has shown that PWID access to harm reduction services, despite rapid adaptations, has been negatively impacted. Our study describes these impacts in a rural state. Methods We conducted semi-structured interviews with PWID, community partners, and healthcare providers in the rural state of Maine (USA). We explored how changes made during the pandemic impacted access to harm reduction services, including basic services (i.e., shelter), syringe service programs, safe drug supply, low barrier treatment, and peer support. Interviews were analyzed using the framework method to apply Penchansky’s model of access, with Saurman’s modification, which includes six dimensions of access—accessibility, availability, acceptability, affordability, accommodation, awareness. Results We interviewed thirty-six stakeholders (N = 9 community partners, N = 9 healthcare providers, N = 18 PWID). Policies such as mobile outreach expansion, mail delivery of equipment, and relaxed telemedicine regulations facilitated accessibility to syringe service programs and low barrier buprenorphine treatment. Public health policies, such as social distancing and screening policies, reduced contact, which subsequently reduced acceptability and awareness of many services. Elimination of the one-for-one needle exchange in some areas increased, acceptability (i.e., perception of service), and affordability for PWID. However, some areas actually began enforcing a one-for-one needle exchange policy, which reduced affordability, acceptability, and awareness of services. Conclusions Changes resulting from the COVID-19 pandemic have impacted all dimensions of access to harm reduction services among PWID. While some barriers to harm reduction services were unavoidable during the pandemic, we found that specific policy decisions mitigated service barriers, while other policies exacerbated them. Relaxing needle exchange policies were particularly helpful in facilitating access to harm reduction services by giving community organizations flexibility to adapt to the evolving needs of PWID. These results can inform policies and service delivery to optimally mitigate the negative impacts on PWID during, and beyond, the pandemic. Supplementary Information The online version contains supplementary material available at 10.1186/s12954-022-00660-2.
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Park D, Oh S, Cano M, Salas-Wright CP, Vaughn MG. Trends and distinct profiles of persons who inject drugs in the United States, 2015-2019. Prev Med 2022; 164:107289. [PMID: 36209817 DOI: 10.1016/j.ypmed.2022.107289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/27/2022] [Accepted: 10/02/2022] [Indexed: 11/30/2022]
Abstract
Drug injection represents a major health problem in the US, with severe health consequences including the transmission of blood-borne infections. An examination of the most recent trends in drug injection is warranted by the fast-evolving drug epidemic and recent policy changes such as the federal funding ban on needle exchange programs. This research examines current drug injection trends, patterns, and socioeconomic and behavioral profiles of people who inject drugs (PWID). Data were derived from the 2002 to 2019 National Survey on Drug Use and Health (NSDUH). After examining the annual prevalence of drug injection since 2002, a latent class analysis was conducted to identify drug injection and other substance misuse patterns among PWID using the latest (2015-2019) NSDUH datasets. Associations between class membership and behavioral health comorbidities and treatment receipt were also assessed. The drug injection prevalence among US adults aged 18-64 increased from 0.21% in 2002/2004 to 0.36% in 2017/2019. Three distinctive groups were identified: the heroin injection group (45.2%), the methamphetamine injection group (28.0%), and the multi-drug injection group (26.8%). The methamphetamine injection group reported greater risks of experiencing serious psychological distress, suicidality, and limited substance use treatment. Special attention is needed for those who primarily injected methamphetamine. Programs to promote harm reduction and increase access to addiction treatment need to be expanded in at-risk communities while accounting for their distinct socioeconomic and drug use/misuse profiles.
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Affiliation(s)
- Daejun Park
- Department of Social Work, Ohio University, Athens, OH 45701, United States..
| | - Sehun Oh
- College of Social Work, The Ohio State University, Columbus, OH 43210, United States
| | - Manuel Cano
- School of Social Work, Arizona State University, Phoenix, AZ 85004, United States
| | | | - Michael G Vaughn
- School of Social Work, Saint Louis University, St. Louis, MO 63103, United States
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Siddig A, Elhassan M, Ali MM, Farah A, Elkhalifa M, Elawad EH, Hassan I, Haboura O, Digna MF, Mohamedalhadi Alamin Alkhalifamohamed H. Non-prescription pharmacy syringes sales to people who inject drugs (PWID) in Khartoum, Sudan: policy, practice, and perceptions. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2022; 48:328-333. [PMID: 35130448 DOI: 10.1080/00952990.2021.2024559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 12/22/2021] [Accepted: 12/24/2021] [Indexed: 06/14/2023]
Abstract
Background: People who inject drugs (PWID) are at high risk of contracting blood-borne infections. Many developed countries started a needle exchange program to provide PWID with sterile syringes. In Sudan, healthcare professionals are exposed to legal liability if they cooperate with people who use drugs; therefore, the accessibility to sterile syringes without prescription depends heavily on pharmacists' knowledge and attitude toward PWID.Objectives: Assessing policy, practice, and perceptions of pharmacists toward selling sterile syringes to PWID in Khartoum, Sudan.Methods: A self-administered questionnaire was given to 157 pharmacists (57 male, 100 female).Results: Out of 157 participating pharmacists, 86.6% reported selling syringes without a medical prescription, 53.5% inquired about the reason for buying syringes, and 87.9% refused to sell the syringes to a PWID. 43.3% of participating pharmacists were uncertain about the presence of law to regulate selling syringes without prescriptions. Although 47.7% of the participants agreed that selling empty syringes without a medical prescription to PWID will reduce harm, 68.5% will not sell them to PWID without a medical prescription even if it is encouraged by law due to their religious or moral beliefs.Conclusion: Pharmacists are the main providers of clean syringes for PWID in Khartoum, Sudan. With the majority of them reporting refusal to provide syringes to PWID, this may put PWID at higher risk of contracting blood-borne infections due syringe sharing. This is a challenge to overcome in planning for effective harm reduction programs in Khartoum.
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Affiliation(s)
| | - Mohamed Elhassan
- Daoud Research Group, Khartoum, Sudan
- Department of Internal Medicine, University of Khartoum, Khartoum, Sudan
| | - Mazin M Ali
- Intensive Care Unit, Jafar Ibn Auf Specialized Hospital for Children, Khartoum, Sudan
| | - Abduraheem Farah
- Department of Anatomy, St. George's University, Grenada, West Indies
| | - Mohammed Elkhalifa
- Department of Internal Medicine, University of Khartoum, Khartoum, Sudan
| | - Emeirii H Elawad
- Department of Internal Medicine, University of Khartoum, Khartoum, Sudan
| | - Israa Hassan
- Department of Internal Medicine, King Abdulaziz Specialist Hospital, Ta'if, Saudi Arabia
| | - Omnia Haboura
- Department of Obstetrics and Gynecology, Almoa'lem Medical City, Khartoum, Sudan
| | - Mutaz F Digna
- Daoud Research Group, Khartoum, Sudan
- Department of Internal Medicine, University of Khartoum, Khartoum, Sudan
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