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Resiak D, Mpofu E, Rothwell R. Harm Minimisation Drug Policy Implementation Qualities: Their Efficacy with Australian Needle and Syringe Program Providers and People Who Inject Drugs. Healthcare (Basel) 2022; 10:781. [PMID: 35627918 PMCID: PMC9141102 DOI: 10.3390/healthcare10050781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/15/2022] [Accepted: 04/19/2022] [Indexed: 12/02/2022] Open
Abstract
(1) Background: Policies and laws in several jurisdictions across the globe have aimed to promote harm minimisation or reduction, through the implementation of Needle and Syringe Programs (NSP) for people who inject drugs (PWID), for whom abstinence may not be possible or desired. While NSPs hold great promise, their implementation qualities are understudied. (2) Aim: We aimed to examine the implementation quality priorities of NSP providers and PWID consumers in an Australian setting. (3) Method: This study utilised a Quantitative-qualitative (QUAN-qual) mixed methods approach. Survey participants included both PWID (n = 70) and NSP providers (n = 26) in Australia. (4) Results: Results following non-parametric data analysis indicate NSP providers prioritised NSP implementation qualities in the following order: compatibility, observability, relative advantage, resourcing and trialability. Contrary to which, PWID prioritised resourcing, compatibility, relative advantage and trialability, respectively. Findings demonstrate that efficacy of implementation qualities is dependent on the juxtaposition of service provision and utilisation whereby implementation quality priorities are balanced. (5) Conclusions: This research presents novel findings guiding NSP harm reduction programmes for sustainability framed on provider and consumer implementation quality priorities. We envisage future studies on boundary conditions of NSP harm reduction implementation in other jurisdictions.
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Affiliation(s)
- Danielle Resiak
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, NSW 2006, Australia;
| | - Elias Mpofu
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, NSW 2006, Australia;
- Rehabilitation and Health Services, University of North Texas, Denton, TX 76203, USA
- School of Human and Community Development, The University of the Witwatersrand, Johannesburg 2000, South Africa
- Family and Community Medicine, Meharry Medical College, Nashville, TN 37208, USA
| | - Roderick Rothwell
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, NSW 2006, Australia;
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Rezaei O, Ghiasvand H, Higgs P, Noroozi A, Noroozi M, Rezaei F, Armoon B, Bayani A. Factors associated with injecting-related risk behaviors among people who inject drugs: a systematic review and meta-analysis study. J Addict Dis 2020; 38:420-437. [DOI: 10.1080/10550887.2020.1781346] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Omid Rezaei
- Fellowship of Psychosomatic, Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hesam Ghiasvand
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
- Health Economics Group, Medical School, Saint Luke’s Campus, University of Exeter, Exeter, UK
| | - Peter Higgs
- Department of Public Health, La Trobe University, Melbourne, Australia
| | - Alireza Noroozi
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Noroozi
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Fatemeh Rezaei
- Department of Epidemiology and Biostatics, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Azadeh Bayani
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Zlotorzynska M, Weidle PJ, Paz-Bailey G, Broz D. Factors associated with obtaining sterile syringes from pharmacies among persons who inject drugs in 20 US cities. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 62:51-58. [PMID: 30359873 DOI: 10.1016/j.drugpo.2018.08.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 08/21/2018] [Accepted: 08/27/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Increased access to sterile syringes has been shown to reduce HIV risk among people who inject drugs (PWID). Where syringe services programs (SSPs) are limited, pharmacies are an important sterile syringe source. We assessed factors associated with using pharmacies as the primary source of syringes among PWID from 20 US cities. METHODS PWID ages ≥18 years were recruited for the 2015 National HIV Behavioral Surveillance using respondent-driven sampling. Using generalized estimating equation (GEE) models, we assessed demographic characteristics independently associated with participant-reported primary syringe source: pharmacies vs. SSPs. We calculated associations between primary syringe source and various behavioural outcomes, adjusted for participant characteristics. RESULTS PWID who were <30 years old, female, white, and less frequent injectors were more likely have used pharmacies as their primary syringe source. Accessing syringes primarily from pharmacies, as compared to SSPs, was associated with receptive syringe sharing and unsafe syringe disposal; using sterile syringes, recent HIV testing and participation in an HIV behavioural intervention were negatively associated with primary pharmacy use. CONCLUSIONS Pharmacies can play an important role in comprehensive HIV prevention among PWID. Linkage to HIV interventions and syringe disposal services at pharmacies could strengthen prevention efforts for PWID who cannot access or choose not to utilize SSPs.
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Affiliation(s)
- Maria Zlotorzynska
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Paul J Weidle
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Gabriela Paz-Bailey
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Dita Broz
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
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Fraser S, Treloar C, Gendera S, Rance J. 'Affording' new approaches to couples who inject drugs: A novel fitpack design for hepatitis C prevention. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 50:19-35. [PMID: 28982041 DOI: 10.1016/j.drugpo.2017.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/29/2017] [Accepted: 07/10/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND In the West, hepatitis C is predominantly transmitted via the sharing of contaminated drug-injecting equipment. Although the majority of this sharing occurs between sexual partners, the responsibility for avoiding transmission has long been conceived as an individual responsibility, with prevention measures such as the distribution of sterile injecting equipment such as injecting packs ('fitpacks') aimed at individuals without regard for the social contexts of injecting. In this article we draw on the work of Bruno Latour to reconceptualise the fitpack. We argue that the fitpack is not inert or neutral in its meaning or effects, that instead it 'affords' particular meanings and actions, for example, that injecting is an individual practice and safety an individual responsibility. METHOD To challenge these affordances, we developed a new fitpack prototype aimed at couples, along with related health promotion messages. We asked 13 couples who inject drugs to examine and reflect on these new objects and messages. RESULTS Overall, we found a high level of support for the broad idea of couples-oriented materials, as well as for our prototype and associated materials. Participants identified opportunities for improving the materials and commented on implications of the symbols and language used. Together the interviews demonstrated ways in which the new fitpacks and messages could afford couples-oriented safe injecting, and better recognition of relationships that are often dismissed by researchers and health care providers as insincere. CONCLUSIONS These findings demonstrate that first, there is a need and desire for a greater range in harm reduction resources. Second, it is essential to find ways of better acknowledging the validity and value of relationships between people who inject. Third, and more broadly, recognition must be given to the role of technological objects in materialising meanings and, as Latour might put it, 'moralities', and in turn to interrogating these meanings and moralities.
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Affiliation(s)
- Suzanne Fraser
- Social Studies of Addiction Concepts Research Program, National Drug Research Institute, Faculty of Health Sciences, Curtin University, Australia.
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Australia
| | | | - Jake Rance
- Centre for Social Research in Health, UNSW Sydney, Australia
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5
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Rance J, Treloar C, Fraser S, Bryant J, Rhodes T. "Don't think I'm going to leave you over it": Accounts of changing hepatitis C status among couples who inject drugs. Drug Alcohol Depend 2017; 173:78-84. [PMID: 28208098 DOI: 10.1016/j.drugalcdep.2016.12.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 11/29/2016] [Accepted: 12/19/2016] [Indexed: 01/29/2023]
Abstract
BACKGROUND While the health-related benefits of intimate partnership are well documented, little attention has been paid to couples exposed to high levels of social stigma and exclusion. In this project we investigated an important site of stigma for partnerships by collecting accounts of changing hepatitis C (HCV) status ("sero-change") among couples that inject drugs. We explored what these accounts reveal about the meaning of HCV for these couples, and how this understanding contributes to our collective efforts at prevention and care. METHODS Drawing from a large dataset of qualitative interviews with couples, we focussed on those containing reports of sero-change. By adopting a methodology that positioned partnerships rather than individuals as the primary unit of analysis, we addressed the commonplace tendency to either overlook or discount as dysfunctional, the sexual relationships of people who inject drugs. RESULTS While some couples sought greater biomedical understanding as a means of coming to terms with sero-change, others drew on alternative logics or "rationalities" that sat firmly outside conventional biomedical discourse (privileging notions of kinship, for example). Regardless of which explanatory framework they drew on, participants ultimately prioritised the security of their relationship over the dangers of viral infection. CONCLUSIONS Effectively engaging couples in HCV prevention and care requires acknowledging and working with the competing priorities and complex realities of such partnerships beyond simply the identification of viral risk. The "new era" of direct acting antiviral treatments will provide ongoing opportunities to learn to integrate biomedical information within more socially sophisticated, relationally aware approaches.
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Affiliation(s)
- Jake Rance
- Centre for Social Research in Health, UNSW Australia, Sydney NSW 2052 Australia.
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Australia, Sydney NSW 2052 Australia.
| | - Suzanne Fraser
- National Drug Research Institute, 19-35 Gertrude Street, Victoria 3065, Australia.
| | - Joanne Bryant
- Centre for Social Research in Health, UNSW Australia, Sydney NSW 2052 Australia.
| | - Tim Rhodes
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
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Sharifi H, Mirzazadeh A, Noroozi A, Marshall BDL, Farhoudian A, Higgs P, Vameghi M, Mohhamadi Shahboulaghi F, Qorbani M, Massah O, Armoon B, Noroozi M. Patterns of HIV Risks and Related Factors among People Who Inject Drugs in Kermanshah, Iran: A Latent Class Analysis. J Psychoactive Drugs 2016; 49:69-73. [PMID: 27937534 DOI: 10.1080/02791072.2016.1262568] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The objective of this study was to explore patterns of drug use and sexual risk behaviors among people who inject drugs (PWID) in Iran. We surveyed 500 PWID in Kermanshah concerning demographic characteristics, sexual risk behaviors, and drug-related risk behaviors in the month prior to study. We used latent class analysis (LCA) to establish a baseline model of risk profiles and to identify the optimal number of latent classes, and we used ordinal regression to identify factors associated with class membership. Three classes of multiple HIV risk were identified. The probability of membership in the high-risk class was 0.33, compared to 0.26 and 0.40 for the low- and moderate-risk classes, respectively. Compared to members in the lowest-risk class (reference group), the highest-risk class members had higher odds of being homeless (OR = 4.5, CI: 1.44-8.22; p = 0.001) in the past 12 months. Members of the high-risk class had lower odds of regularly visiting a needle and syringe exchange program as compared to the lowest-risk class members (AOR = 0.42, CI: 0.2-0.81; p = 0.01). Findings show the sexual and drug-related HIV risk clusters among PWID in Iran, and emphasize the importance of developing targeted prevention and harm reduction programs for all domains of risk behaviors, both sexual and drug use related.
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Affiliation(s)
- Hamid Sharifi
- a Associate Professor, HIV/STI Surveillance Research Center and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health , Kerman University of Medical Sciences , Kerman , Iran
| | - Ali Mirzazadeh
- a Associate Professor, HIV/STI Surveillance Research Center and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health , Kerman University of Medical Sciences , Kerman , Iran.,b Assistant Professor, Department of Epidemiology and Biostatics , University of California at San Francisco , San Francisco , CA , USA
| | - Alireza Noroozi
- c Assistant Professor, School of Advanced Technologies in Medicine , Tehran University of Medical Sciences , Tehran , Iran.,d Assistant Professor, Substance Abuse Prevention and Treatment Office , Ministry of Health and Medical Education , Tehran , Iran
| | - Brandon D L Marshall
- e Assistant Professor, Department of Epidemiology , Brown University School of Public Health , Providence , RI , USA
| | - Ali Farhoudian
- f Assistant Professor, Substance Abuse and Dependence Research Center , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran
| | - Peter Higgs
- g Senior Lecturer, Department of Public Health , La Trobe University , Melbourne , Australia
| | - Meroe Vameghi
- h Assistant Professor, Social Welfare Management Research Center , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran
| | - Farahnaz Mohhamadi Shahboulaghi
- i Associate Professor, Social Determinants of Health Research Center, Nursing Department , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran
| | - Mostafa Qorbani
- j Assistant Professor, Department of Community Medicine, School of Medicine , Alborz University of Medical Sciences , Karaj , Iran.,k Assistant Professor, Chronic Disease Research Center, Endocrinology and Metabolism Population Sciences Institute , Tehran University of Medical Sciences , Tehran , Iran
| | - Omid Massah
- f Assistant Professor, Substance Abuse and Dependence Research Center , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran
| | - Bahram Armoon
- l Ph.D. Student, Student's Research Committee, School of Health , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Mehdi Noroozi
- f Assistant Professor, Substance Abuse and Dependence Research Center , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran
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Treloar C, Rance J, Bryant J, Fraser S. Harm reduction workers and the challenge of engaging couples who inject drugs in hepatitis C prevention. Drug Alcohol Depend 2016; 168:170-175. [PMID: 27665209 DOI: 10.1016/j.drugalcdep.2016.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 09/08/2016] [Accepted: 09/08/2016] [Indexed: 11/17/2022]
Abstract
AIMS Despite injecting-equipment sharing between sexual partners leaving them at increased risk of hepatitis C (HCV), there is scant literature available to guide harm reduction workers in their encounters with couples who inject drugs. This article explored workers' understandings of such couples and their accounts of working with them in relation to HCV prevention. METHOD Semi-structured interviews were conducted with 22 staff of harm reduction services located in Sydney and Melbourne, Australia. RESULTS Overall, staff represented couples as either absent from the service or as presenting with needs indiscernible from those of individual clients. Responses to questions about HCV and couples were framed primarily in terms of risk. Staff participants questioned 'genuineness' of clients' intimate relationships, instead characterising them as inauthentic and drug-driven. Working with couples was seen to present a number of organisational and clinical challenges. The benefits of recognising and working with such partnerships received scant acknowledgement. Rather, staff tended to perceive couples as being 'impenetrable' to health promotion messaging. DISCUSSION The framing and delivery of harm reduction in Australia remains an individualising enterprise with little capacity to recognise the intimate partnerships, including addressing the HCV risks specific to them. More effective harm reduction strategies may be achieved by transitioning to a practice framework that addresses the social context of injecting, including the experience of couples. This would require direct involvement of couples who inject drugs.
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Affiliation(s)
- Carla Treloar
- Centre for Social Research in Health, UNSW Australia, 2052, Australia.
| | - Jake Rance
- Centre for Social Research in Health, UNSW Australia, 2052, Australia
| | - Joanne Bryant
- Centre for Social Research in Health, UNSW Australia, 2052, Australia
| | - Suzanne Fraser
- National Drug Research Institute, Curtin University, Suite 6, 19-35 Gertrude Street, Fitzroy, VIC 3065, Australia
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Rezaie F, Farhadi MH, Farhoudian A, Najafi M, Bazrafshan A, Higgs P, Mohammadi Shahboulagh F, Ranjbar M, Vameghi M, Abbasi M, Noroozi A, Noroozi M. Access to needle and syringe programs and the relationship to equipment sharing among people who inject drugs in Kermanshah, Iran. JOURNAL OF SUBSTANCE USE 2016. [DOI: 10.1080/14659891.2016.1227384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Fatemeh Rezaie
- Department of Social Medicine, Jahrom University of Medical Science, Jahrom, Iran
| | - Mohammad Hassan Farhadi
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ali Farhoudian
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Najafi
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ali Bazrafshan
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Peter Higgs
- Department of Public Health, La Trobe University, Melbourne, Australia
| | - Farahnaz Mohammadi Shahboulagh
- Social Determinants of Health Research Center, Nursing Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Maryam Ranjbar
- Social Determinants of Health Research Center, Nursing Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Meroe Vameghi
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Abbasi
- Department of Nursing and Midwifery, Qom University of Medical Science, Qom, Iran
| | - Alireza Noroozi
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehdi Noroozi
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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9
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Noroozi A, Mirzazadeh A, Hajebi A, Farhoudian A, Sharifi H, Higgs P, Noroozi M. Comparing profile of people who inject drugs (PWID) accessing different types of needle and syringe programs or secondary distribution in Kermanshah, Iran. JOURNAL OF SUBSTANCE USE 2016. [DOI: 10.1080/14659891.2016.1195894] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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10
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Fraser S, Rance J, Treloar C. Hepatitis C prevention and convenience: why do people who inject drugs in sexual partnerships ‘run out’ of sterile equipment? CRITICAL PUBLIC HEALTH 2015. [DOI: 10.1080/09581596.2015.1036839] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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11
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Degenhardt L, Larance B, Bruno R, Lintzeris N, Ali R, Farrell M. Evaluating the potential impact of a reformulated version of oxycodone upon tampering, non-adherence and diversion of opioids: the National Opioid Medications Abuse Deterrence (NOMAD) study protocol. Addiction 2015; 110:226-37. [PMID: 25358480 DOI: 10.1111/add.12746] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 08/28/2014] [Accepted: 09/16/2014] [Indexed: 11/26/2022]
Abstract
AIMS A new oxycodone formulation (Reformulated OxyContin® was released in Australia, early 2014. It was developed as a tamper-resistant ('abuse-deterrent') formulation of the drug. We summarize methods used in the National Opioid Medication Abuse Deterrence (NOMAD) study, which will examine: (i) whether there is a reduction in extra-medical use (including via tampering) of OxyContin® following the introduction of Reformulated OxyContin®; (ii) potential changes in extra-medical use of non-abuse-deterrent forms of oxycodone, other pharmaceutical opioids and illicit drugs; (iii) whether methods of tampering with Reformulated OxyContin® become widespread over time; (iv) Reformulated OxyContin®'s attractiveness on the illicit market; and (v) sales, prescriptions and harms related to OxyContin® and other drugs. METHODS There are three major components. First, analyses of existing routine data sources such as: pharmaceutical sales; prescribing data; data on drug overdose deaths; and survey data on drug use in the general population and among people who inject drugs; secondly, specific data on OxyContin® collected through the Illicit Drug Reporting System; and thirdly, a prospective cohort of n = 606 people who regularly misuse or tamper with pharmaceutical opioids was formed prior to the introduction of Reformulated OxyContin®, followed-up twice post-release to examine potential changes after Reformulated OxyContin®'s introduction. DISCUSSION The study's strengths lie in varied data collections; interrupted time-series analysis; and prospective cohort. To our knowledge, this is one of the most comprehensive and transparently conducted studies conducted to date of the potential impact of an opioid medication upon use, tampering and diversion. Results have the potential to inform policymakers, clinicians, consumers and researchers alike.
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Affiliation(s)
- Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of NSW, Sydney, Australia; School of Population and Global Health, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA
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12
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Kim SW, Pulkki-Brannstrom AM, Skordis-Worrall J. Comparing the cost effectiveness of harm reduction strategies: a case study of the Ukraine. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2014; 12:25. [PMID: 25873788 PMCID: PMC4396789 DOI: 10.1186/1478-7547-12-25] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 11/17/2014] [Indexed: 11/25/2022] Open
Abstract
Background Harm reduction strategies commonly include needle and syringe programmes (NSP), opioid substitution therapy (OST) and interventions combining these two strategies. Despite the proven effectiveness of harm-reduction strategies in reducing human immunodeficiency virus (HIV) infection among injecting drug users (IDUs), no study has compared the cost-effectiveness of these interventions, nor the incremental cost effectiveness of combined therapy. Using data from the Global Fund, this study compares the cost-effectiveness of harm reduction strategies in Eastern Europe and Central Asia, using the Ukraine as a case study. Methods A Markov Monte Carlo simulation is carried out using parameters from the literature and cost data from the Global Fund. Effectiveness is presented as both QALYs and infections averted. Costs are measured in 2011 US dollars. Results The Markov Monte Carlo simulation estimates the cost-effectiveness ratio per infection averted as $487.4 [95% CI: 488.47-486.35] in NSP and $1145.9 [95% CI: 1143.39-1148.43] in OST. Combined intervention is more costly but more effective than the alternative strategies with a cost effectiveness ratio of $851.6[95% CI: 849.82-853.55]. The ICER of the combined strategy is $1086.9/QALY [95% CI: 1077.76:1096.24] compared with NSP, and $461.0/infection averted [95% CI: 452.98:469.04] compared with OST. These results are consistent with previous studies. Conclusions Despite the inherent limitations of retrospective data, this study provides evidence that harm-reduction interventions are a cost-effective way to reduce HIV prevalence. More research on into cost effectiveness in different settings, and the availability of fiscal space for government uptake of programmes, is required.
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Affiliation(s)
- Sung Wook Kim
- UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH UK
| | - Anni-Maria Pulkki-Brannstrom
- UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH UK ; Epidemiology and Global Health Department, Umeå University, Umea, Sweden
| | - Jolene Skordis-Worrall
- UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH UK ; London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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13
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McGowan C, Harris M, Rhodes T. Hepatitis C avoidance in injection drug users: a typology of possible protective practices. PLoS One 2013; 8:e77038. [PMID: 24194855 PMCID: PMC3806740 DOI: 10.1371/journal.pone.0077038] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 09/06/2013] [Indexed: 12/11/2022] Open
Abstract
Introduction Hepatitis C virus (HCV) represents a serious public health concern. People who inject drugs (PWID) are at particular risk and nearly half (45%) of PWID in England may be infected. HCV prevention interventions have only had moderate impact on the prevalence of HCV in this population. Using qualitative methods, we sought to detail the protective practices potentially linked to HCV avoidance among PWID, and explore the motivations for these. Methods The study used a life history approach allowing participants to detail their lived experience both before and during the course of their injecting careers. Thirty-seven participants were recruited from drug services in London, and from referrals within local injecting networks. A baseline and follow-up in-depth qualitative interview was carried out with each participant, and for half, a third interview was also undertaken. All underwent testing for HCV antibody. Analyses focused on developing a descriptive typology of protective practices potentially linked to HCV avoidance. Results Practices were deemed to be protective against HCV if they could be expected a priori to reduce the number of overall injections and/or the number of injections using shared injecting equipment. Participants reported engaging in various protective practices which fell into three categories identified through thematic analysis: principles about injecting, preparedness, and flexibility. Conclusions All participants engaged in protective practices irrespective of serostatus. It is important to consider the relative importance of different motivations framing protective practices in order to formulate harm reduction interventions which appeal to the situated concerns of PWID, especially given that these protective practices may also help protect against HIV and other blood borne infections.
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Affiliation(s)
- Catherine McGowan
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Magdalena Harris
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Tim Rhodes
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
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14
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Werb D, Kerr T, Buxton J, Shoveller J, Richardson C, Montaner J, Wood E. Patterns of injection drug use cessation during an expansion of syringe exchange services in a Canadian setting. Drug Alcohol Depend 2013; 132:535-40. [PMID: 23642315 PMCID: PMC3762907 DOI: 10.1016/j.drugalcdep.2013.03.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 02/21/2013] [Accepted: 03/30/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Needle and syringe programmes (NSPs) have been shown to reduce HIV risk among people who inject drugs (IDUs). However, concerns remain that NSPs delay injecting cessation. METHODS Individuals reporting injection drug use in the past six months in the greater Vancouver area were enrolled in the Vancouver Injection Drug Users Study (VIDUS). Annual estimates of the proportion of IDU reporting injecting cessation were generated. Generalized estimating equation (GEE) analysis was used to assess factors associated with injecting cessation during a period of NSP expansion. RESULTS Between May 1996 and December 2010, the number of NSP sites in Vancouver increased from 1 to 29 (P<0.001). The estimated proportion of participants (n=2710) reporting cessation increased from 2.4% (95% confidence interval [CI]: 0.0-7.0%) in 1996 to 47.9% (95% CI: 46.8-48.9%) in 2010 (P<0.001). In a multivariate GEE analysis, the authors observed an association between increasing calendar year and increased likelihood of injecting cessation (Adjusted Odds Ratio=1.17, 95% CI: 1.15, 1.19, P<0.001). CONCLUSION The proportion of IDU reporting injecting cessation increased during a period of NSP expansion, implying that increased NSP availability did not delay injection cessation. These results should help inform community decisions on whether to implement NSPs.
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Affiliation(s)
- Dan Werb
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
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Iversen J, Wand H, Topp L, Kaldor J, Maher L. Reduction in HCV incidence among injection drug users attending needle and syringe programs in Australia: a linkage study. Am J Public Health 2013; 103:1436-44. [PMID: 23763399 DOI: 10.2105/ajph.2012.301206] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined trends in HCV incident infection among injection drug users (IDUs) attending needle and syringe programs (NSPs) in Australia in 1995 to 2010. METHODS We created a passive retrospective cohort of 724 IDUs who tested negative for HCV antibodies by a simple deterministic method linking partial identifiers to find repeat respondents in annual cross-sectional serosurveillance. RESULTS We identified 180 HCV seroconversions over the study period, for a pooled incidence density of 17.0 per 100 person-years (95% confidence interval [CI] = 14.68, 19.66). Incidence density declined, from a high of 30.8 per 100 person-years (95% CI = 21.3, 44.6) in 2003 to a low of 4.0 (95% CI = 1.3, 12.3) in 2009. CONCLUSIONS A decline in HCV incidence among Australian IDUs attending NSPs coincided with considerable expansion of harm reduction programs and a likely reduction in the number of IDUs, associated with significant changes in drug markets. Our results demonstrate the capacity of repeat cross-sectional serosurveillance to monitor trends in HCV incidence and provide a platform from which to assess the impact of prevention and treatment interventions.
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Affiliation(s)
- Jenny Iversen
- Kirby Institute, University of New South Wales, Sydney, Australia.
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Fraser S. The missing mass of morality: A new fitpack design for hepatitis C prevention in sexual partnerships. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 24:212-9. [DOI: 10.1016/j.drugpo.2013.03.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 03/04/2013] [Accepted: 03/20/2013] [Indexed: 02/02/2023]
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Fraser S, Treloar C, Bryant J, Rhodes T. Hepatitis C prevention education needs to be grounded in social relationships. DRUGS-EDUCATION PREVENTION AND POLICY 2013. [DOI: 10.3109/09687637.2013.776517] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Fazito E, Cuchi P, Mahy M, Brown T. Analysis of duration of risk behaviour for key populations: a literature review. Sex Transm Infect 2013; 88 Suppl 2:i24-32. [PMID: 23172343 PMCID: PMC3512397 DOI: 10.1136/sextrans-2012-050647] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background The objective of this paper is to review literature in order to calculate regional estimates of the average duration of time individuals maintain a specific high-risk behaviour. Methods The review targeted the key populations of female sex workers (FSW), male clients of female sex workers (MCFSW), people who inject drugs (injecting drug users (IDU)) and high-risk men who have sex with men (MSM). To be included in the review the study had to provide information on (1) the time a person spent at risk until death or cessation of the risk behaviour, (2) the percentage of the sample who initiated the risk behaviour in less than a year or (3) the mean or median duration of the behaviour from a representative sample. Results 49 papers were found for the FSW population describing the period of time FSW stay in sex work to be between 2.9 years (Asia) and 12 years (Latin America). Eight papers were found for MCFSW showing the duration of the risk behaviour in this category varying from 4.6 years in Africa to 32 years in Asia. 86 papers were reviewed for the population of IDU showing that the average time a person injects illegal drugs varies from 5.6 years (Africa) to 21 years (South America). No information was found for duration of high-risk behaviour among MSM; instead, the definitions found in the literature for high- and low-risk behaviour among MSM were described. Conclusions There is high variability of estimates of duration of high-risk behaviours at regional level. More research is needed to inform models and prevention programmes on the average duration of time individuals maintain a specific high-risk behaviour.
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Affiliation(s)
- Erika Fazito
- University of Brasília, 26 Chemin Colladon, 1209 Genève, Suisse, Brasília, Brazil.
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Hampton MD, Chafetz L, Portillo C. Differences in substance-related risk behavior between dual and triple diagnosed severely mentally ill adults. MENTAL HEALTH AND SUBSTANCE USE : DUAL DIAGNOSIS 2012; 5:52-63. [PMID: 22582086 PMCID: PMC3347481 DOI: 10.1080/17523281.2011.608374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES: The purpose of this study was to determine if differences exist between adults with dual and triple diagnoses with regard to substance-related risk behaviors. METHODS: This secondary analysis was a cross-sectional study. There were 252 subjects with dual and triple diagnoses recruited from residential crisis programs in San Francisco. Using descriptive and logistic regression analyses, subjects in the two groups were compared with regard to demographic data, types of substances, and routes of administration used in the previous 30 days to determine risk for exposure and/or transmission of HIV/HCV. RESULTS: When compared to the dual diagnosis group, subjects with triple diagnoses were four times more likely to have engaged in IDU (p=.001) and 2.6 times more likely to use amphetamines (p=.05). They also reported using more types of substances over the lifetime (p<.0001). But with regard to other risk behaviors such as alcohol use to intoxication and cocaine/crack use, there were no significant differences. CONCLUSION: Though many substance-related risk behaviors occurred in both groups, adults with triple diagnoses were more likely to engage in IDU, amphetamine use, and to use more types of substances over the lifetime. This information has the potential to inform interventions that might prevent/reduce substance-related risk in this population.
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Affiliation(s)
| | - Linda Chafetz
- Department of Community Health Systems, 2 Koret Way, #N-511H, University of California, San Francisco, CA, USA
| | - Carmen Portillo
- Department of Community Health Systems, 2 Koret Way, #N-511H, University of California, San Francisco, CA, USA
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Seroprevalence and correlates of HIV and HCV among injecting drug users in Edmonton, Alberta. Canadian Journal of Public Health 2011. [PMID: 20364539 DOI: 10.1007/bf03405562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Injection drug users (IDUs) are at risk for acquiring human immunodefiency virus (HIV) and hepatitis C virus (HCV) via parenteral and sexual transmission. We determined the seroprevalence and correlates of HIV and HCV for IDUs recruited in Edmonton, Alberta. METHODS Edmonton was one site of a multi-site, national survey (I-Track Study). From April to June 2005, IDUs were recruited and administered a questionnaire collecting information on demographics, drug use, sexual behaviours, and HIV/HCV testing behaviours. Finger-prick blood samples were collected for serology testing. Seroprevalence of HIV and HCV was determined and correlates of infection were assessed using logistic regression. RESULTS Of 275 IDUs, 68% were male, the median age was 38 years and 70.6% were Aboriginal. HIV prevalence was 23.9%, HCV prevalence was 66.1% and HIV/HCV co-infection was 22.8%. Cocaine (36.9%) was reported to be the drug injected most often in the previous six months. Correlates for HIV were sex trade (OR 2.9, 95% CI 1.0-8.3) for women, and older age (OR 1.1, 95% CI 1.0-1.2) and needle exchange program (NEP) use (OR 5.7, 95% CI 1.3-23.7) for men. For women, having a casual sex partner was protective for HCV (OR 0.28, 95% CI 0.10-0.78). Independent correlates for HCV among males included age (AOR 1.2, 95% CI 1.1-1.3) and younger age of first injection (AOR 0.92, 95% CI 0.87-0.96). CONCLUSION The high HIV and HCV prevalence found in this study among IDUs in Edmonton highlights the complex needs of the IDU community and the continued need for targeted programming.
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Craine N, Hickman M, Parry JV, Smith J, McDonald T, Lyons M. Characteristics of injecting drug users accessing different types of needle and syringe programme or using secondary distribution. J Public Health (Oxf) 2010; 32:328-35. [DOI: 10.1093/pubmed/fdp131] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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BRYANT JOANNE, TOPP LIBBY, HOPWOOD MAX, IVERSEN JENNY, TRELOAR CARLA, MAHER LISA. Is point of access to needles and syringes related to needle sharing? Comparing data collected from pharmacies and needle and syringe programs in south-east Sydney. Drug Alcohol Rev 2010; 29:364-70. [DOI: 10.1111/j.1465-3362.2009.00154.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Treloar C, Hopwood M, Bryant J. ‘Does anyone know where to get fits from around here?’ Policy implications for the provision of sterile injecting equipment through pharmacies in Sydney, Australia. DRUGS-EDUCATION PREVENTION AND POLICY 2010. [DOI: 10.3109/09687630802067251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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EDITORIAL. Drug Alcohol Rev 2009. [DOI: 10.1080/09595230600919471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Vorobjov S, Uusküla A, Abel-Ollo K, Talu A, Rüütel K, Des Jarlais DC. Comparison of injecting drug users who obtain syringes from pharmacies and syringe exchange programs in Tallinn, Estonia. Harm Reduct J 2009; 6:3. [PMID: 19232088 PMCID: PMC2653475 DOI: 10.1186/1477-7517-6-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Accepted: 02/20/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Both syringe exchange programs (SEPs) and pharmacy sales of syringes are available in Estonia, though the current high incidence and high prevalence of HIV among injection drug users (IDUs) in Tallinn, Estonia requires large-scale implementation of additional harm reduction programs as a matter of great urgency. The aims of this report were to compare risk behavior and HIV infection and to assess the prevention needs among IDUs who primarily use pharmacies as their source of sterile syringes with IDUs who primarily use SEPs in Tallinn. METHODS A cross-sectional study using respondent-driven sampling was used to recruit 350 IDUs for an interviewer-administered survey and HIV testing. IDUs were categorized into two groups based on their self-reported main source for syringes within the last six months. Odds ratios with 95% CI were used to compare characteristics and risk factors between the groups. RESULTS The main sources of sterile needles for injection drug users were SEP/SEP outreach (59%) and pharmacies (41%). There were no differences in age, age at injection drug use initiation, the main drug used or experiencing overdoses. Those IDUs using pharmacies as a main source of sterile needles had lower odds for being infected with either HIV (AOR 0.54 95% CI 0.33-0.87) or HCV (AOR 0.10 95% CI 0.02-0.50), had close to twice the odds of reporting more than one sexual partner within the previous 12 months (AOR 1.88 95% CI 1.17-3.04) and engaging in casual sexual relationships (AOR 2.09 95% CI 1.24-3.53) in the last six months. CONCLUSION The data suggest that the pharmacy users were at a less "advanced" stage of their injection career and had lower HIV prevalence than SEP users. This suggests that pharmacies could be utilized as a site for providing additional HIV prevention messages, services for IDUs and in linking IDUs with existing harm reduction services.
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Affiliation(s)
- Sigrid Vorobjov
- Estonian Drug Monitoring Centre, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia
- Estonian Centre of Excellence in Behavioural and Health Sciences, Tiigi 78, 50410 Tartu, Estonia
| | - Anneli Uusküla
- Estonian Centre of Excellence in Behavioural and Health Sciences, Tiigi 78, 50410 Tartu, Estonia
- Department of Public Health, University of Tartu, Ravila 19, 50411 Tartu, Estonia
| | - Katri Abel-Ollo
- Estonian Drug Monitoring Centre, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia
| | - Ave Talu
- Estonian Drug Monitoring Centre, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia
| | - Kristi Rüütel
- Department of Public Health, University of Tartu, Ravila 19, 50411 Tartu, Estonia
- Department of Infectious Diseases and Drug Prevention, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia
| | - Don C Des Jarlais
- Chemical Dependency Institute, Beth Israel Medical Center, 160 Water St, New York, NY, 10038 USA
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Kidorf M, King VL. Expanding the public health benefits of syringe exchange programs. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2008; 53:487-95. [PMID: 18801210 DOI: 10.1177/070674370805300803] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To provide a brief history of community syringe exchange programs (SEPs), describe the clinical profile of those who attend them, identify factors interfering with the transition of SEP participants to more comprehensive substance abuse treatment services, review studies designed to improve rates of treatment seeking, and offer practical suggestions to facilitate links between SEPs and substance abuse treatment. METHOD Relevant articles were identified using a PubMed literature search of English-language journals from 1997 to 2007. Studies were included that evaluated the effectiveness of SEPs or methods for increasing treatment enrolment in SEP participants or other out-of-treatment intravenous drug users. Relevant articles prior to 1997 were identified using reference lists of identified articles. RESULTS SEPs have little impact on rates of drug use or injections. Substance abuse treatment reduces human immunodeficiency virus transmission through drug use reduction and psychosocial functioning improvement, yet SEP participants only infrequently engage in treatment. Psychological and pharmacological interventions delivered at the SEP setting can improve treatment seeking in SEP participants. Use of SEPs by substance abuse treatment programs can improve harm-reduction efforts at these settings. CONCLUSIONS Efforts to improve the link between SEPs and substance abuse treatment should include interventions to enhance cooperation across programs, motivate treatment enrolment and SEP use, and expand access to treatment. A more fluent and bidirectional continuum of services can enhance the public health benefits of both of these health care delivery settings.
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Affiliation(s)
- Michael Kidorf
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Representativeness of Injecting Drug Users Who Participate in HIV Surveillance. J Acquir Immune Defic Syndr 2008; 47:632-8. [DOI: 10.1097/qai.0b013e31816a1d68] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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