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Bazzi AR, Valasek CJ, Stamos-Buesig T, Eger WH, Harvey-Vera A, Vera CF, Syvertsen JL, Storholm ED, Bartholomew TS, Tookes HE, Strathdee SA, Pines HA. Health, harm reduction, and social service providers' perspectives on the appropriateness and feasibility of peer distribution of HIV self-test kits among people who use drugs. Harm Reduct J 2024; 21:29. [PMID: 38311717 PMCID: PMC10838430 DOI: 10.1186/s12954-024-00950-x] [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: 10/10/2023] [Accepted: 01/26/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND People who use drugs (PWUD) experience elevated HIV risk and numerous barriers to facility-based HIV testing. HIV self-testing (HIVST) could circumvent many of those barriers and is acceptable among PWUD, yet HIVST implementation for PWUD is limited. Service providers' perspectives on specific HIVST delivery strategies could help increase availability for PWUD. METHODS From April-November 2021, we interviewed 16 health, harm reduction, and social service providers working with PWUD in San Diego, CA. Interviews and rapid thematic analysis explored perspectives on HIVST's utility and appropriateness, as well as the feasibility of and anticipated challenges with specific HIVST delivery strategies, including peer or secondary distribution. RESULTS Participants viewed HIV as a significant threat to PWUD health and confirmed the presence of numerous barriers to local facility-based HIV testing. Participants viewed HIVST as a promising and potentially empowering solution. Based on community familiarity with secondary distribution of harm reduction supplies (i.e., naloxone) and information, participants viewed secondary distribution of HIVST kits as an appropriate and feasible strategy for increasing the reach of HIVST, but also described potential barriers (e.g., engaging socially disconnected individuals, ensuring linkages to services following HIVST) and provided suggestions for alternative HIVST kit delivery models (e.g., harm reduction vending machines). CONCLUSIONS Service providers viewed secondary distribution of HIVST kits among PWUD as promising, appropriate, and feasible, yet specialized efforts may be needed to reach the most marginalized individuals and ensure consistent provision of educational information and referral supports that maximize the impact of this approach.
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Affiliation(s)
- Angela R Bazzi
- Herbert Wertheim School of Public Health, University of California, San Diego, 9500 Gilman Drive, MTF 265E (Mail Code 0725), La Jolla, CA, 92161, USA.
- School of Public Health, Boston University, Boston, MA, USA.
| | - Chad J Valasek
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | | | - William H Eger
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
- School of Social Work, San Diego State University, San Diego, CA, USA
| | - Alicia Harvey-Vera
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Carlos F Vera
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Jennifer L Syvertsen
- Department of Anthropology, University of California, Riverside, Riverside, CA, USA
| | - Erik D Storholm
- School of Public Health, San Diego State University, San Diego, USA
| | | | - Hansel E Tookes
- University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Heather A Pines
- Herbert Wertheim School of Public Health, University of California, San Diego, 9500 Gilman Drive, MTF 265E (Mail Code 0725), La Jolla, CA, 92161, USA
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
- School of Public Health, San Diego State University, San Diego, USA
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Pines HA, Eger WH, Skaathun B, Vera CF, Harvey-Vera A, Rangel G, Strathdee SA, Bazzi AR. Willingness to use and distribute HIV self-testing kits among people who inject drugs in the San Diego-Tijuana border region. Harm Reduct J 2024; 21:4. [PMID: 38172795 PMCID: PMC10765917 DOI: 10.1186/s12954-023-00922-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 12/26/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND HIV self-testing (HIVST) could increase HIV testing access among people who inject drugs (PWID), and secondary distribution (i.e., peer-delivery) of HIVST kits in PWID social networks could further expand coverage. We assessed willingness to use and distribute HIVST kits among PWID in the San Diego-Tijuana border region. METHODS From 2020 to 2021, HIV-negative PWID in San Diego, USA, and Tijuana, Mexico, completed surveys and provided data on individual (N = 539) and social network (N = 366) characteristics. We used modified Poisson regression to examine the effects of individual and social network characteristics on willingness to use and distribute HIVST kits. RESULTS Most participants were willing to use (81%) and distribute (81%) HIVST kits. At the individual level, prior HIV testing was positively associated with willingness to use (adjusted prevalence ratio [aPR] = 1.24, 95% confidence interval [CI] 1.10-1.40) and distribute (aPR = 1.27, 95% CI 1.12-1.43) HIVST kits, while perceiving oneself to be at higher HIV risk than others was negatively associated with willingness to use HIVST kits (aPR = 0.83, 95% CI 0.74-0.93). At the network level, willingness to distribute HIVST kits was positively associated with network size (aPR = 1.04 per member, 95% CI 1.01-1.08) and greater proportions of one's network encouraging them to use drugs (aPR = 1.29, 95% CI 1.16-1.44) and having a history of homelessness (aPR = 1.51, 95% CI 1.31-1.74) or detention/arrest (aPR = 1.57, 95% CI 1.36-1.82), and negatively associated with a greater proportion of one's network including "very close" persons (aPR = 0.80, 95% CI 0.69-0.94). CONCLUSIONS We found high potential for HIVST kits and their secondary distribution to increase HIV testing among PWID who face the greatest barriers to facility-based testing.
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Affiliation(s)
- Heather A Pines
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA.
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA.
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA.
| | - William H Eger
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
- School of Social Work, San Diego State University, San Diego, CA, USA
| | - Britt Skaathun
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Carlos F Vera
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Alicia Harvey-Vera
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Gudelia Rangel
- Mexico Section of the US-Mexico Border Health Commission, Tijuana, Baja California, Mexico
- El Colegio de la Frontera Norte, Tijuana, Baja California, Mexico
| | | | - Angela R Bazzi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
- School of Public Health, Boston University, Boston, MA, USA
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