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PubMed2026

"It was good because they have a relationship with us": A qualitative study on low-threshold buprenorphine treatment at syringe services programs.

INTRODUCTION: Syringe service programs (SSPs) reach people who inject drugs with opioid use disorder (OUD) and are novel "low-threshold" venues to initiate buprenorphine treatment. The study investigated patients' experiences with SSP-initiated buprenorphine treatment, which could aid in improving buprenorphine treatment delivery at SSPs. METHODS: The study included 12 participants who completed qualitative exit interviews after a randomized controlled trial of buprenorphine treatment at SSPs. In the parent study, participants received buprenorphine treatment through an onsite model at an SSP or enhanced referral to a community health center based on the randomization sequence. Most participants started taking buprenorphine at home. Exit interviews included participants from both study arms, and the semi-structured interview guide focused on their experiences with clinicians, experiences initiating buprenorphine, prior experiences with OUD treatment, and perceptions about continuing buprenorphine treatment. Four researchers iteratively read, coded, and discussed each transcript, then they derived recurring themes using thematic analysis. RESULTS: Participants were mostly male, middle-aged, and 50% identified as Latino. Four main themes related to buprenorphine treatment initiation: 1) Onsite treatment facilitated buprenorphine prescription, but some participants also expressed a need for additional support; 2) Precipitated withdrawal complicated participants' buprenorphine initiation in both arms; 3) Participants largely experienced the SSPs as affirming and welcoming; and 4) Developing strong relationships with healthcare providers was critical to successful buprenorphine treatment initiation. CONCLUSIONS: The SSP-based model provided rapid access to buprenorphine prescriptions, but precipitated withdrawal was a common complication. Some participants desired additional support and guidance when they started taking buprenorphine at home. The findings point to a "low-threshold, high-touch" approach where participants receive expedited access to buprenorphine providers at SSPs but also additional support throughout the initiation process to avoid and/or manage precipitated withdrawal. Despite some challenges, SSP-based buprenorphine treatment was highly valued by study participants.

Humans↗
PubMedDate not supplied

A method for evaluating needle exchange programmes.

This paper details a statistical method for evaluating needle exchange programmes. The approach relies only on needle exchange operations data and the results of HIV tests conducted on needles. We develop statistical models describing the needle infection process and how needle exchange interrupts this process. The method is illustrated using 20 months of data collected in conjunction with the evaluation of New Haven, Connecticut's needle exchange programme, and the results suggest that needle-borne HIV transmission among participating clients has been reduced by at least 33 per cent.

Connecticut↗
PubMed1995

Methadone treatment and risk of HIV infection in drug users without legal access to clean injection equipment.

The particular situation of the Swiss canton of Vaud (population 550,000) provides favourable observational conditions to assess the efficacy of a methadone treatment scheme in reducing the risk of human immunodeficiency virus (HIV) infection among drug users. On the one hand, the canton has a long tradition of methadone treatment dispensed by medical practitioners. On the other hand, no legal access to clean injection equipment was provided up to 1989. For the 754 drug addicts having entered at least one course of treatment at the end of 1988, HIV status was assessed through two surveys conducted at mid-1986 and at end 1988 among the private practitioners and in the screening centers, hospitals, medico-social institutions and prisons. The overall annual HIV seroconversion rate shifted only slightly from 13% in the first study period (1984 to mid-1986) to 11% in the second period (mid-1986 to end 1988). In both periods, patients no longer on treatment, mostly stable abstainers, were the less exposed to HIV infection with a relative risk of 0.65 (p < 0.05). For those still on treatment, the risk of infection was associated directly (p < 0.001) with the frequency of courses and inversely (p < 0.001) with the duration. Between patients with more than 18 months spent on treatment and those with less than 6 months, the relative risk gradient was 0.8 and 1.4 before mid-1986 and widened out to 0.3 and 2.1 later on. This is mainly due to an increasing HIV incidence among newcomers into treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Knowledge, attitudes and beliefs of European injecting drug users concerning preventive measures for HIV.

Strategies for controlling the HIV epidemic include education and information campaigns for intravenous drug users (IDUs), as for all high-risk groups, and the provision of various public health measures and treatment. These can only be effective if the IDU is aware of them and has a favourable image of them. A study of 2330 IDUs in 12 European countries recorded awareness and opinions of various categories of measures and institutions. Of all measures, those mentioned most often related to availability of new injecting equipment; specifically unrestricted sales in pharmacies and needle exchanges, which were also thought to be more useful than anything else. Prompted awareness of rehabilitative institutions was well over 90% in most countries, but up to a quarter of IDUs did not trust them and up to one fifth did not think that they were useful. There appears to be a general need for more effective communication with IDUs to improve the image of the services available.

Adult↗
PubMed1995

AIDS and injecting drug use in the United Kingdom, 1987-1993: the policy response and the prevention of the epidemic.

This paper assesses policy development, service changes and trends in HIV infection and risk behavior among injecting drug users (IDUs) in the United Kingdom. In 1986, the U.K. was faced with the possible rapid spread of HIV infection among IDUs. The combination of an outbreak of HIV infection with prevalence levels of 50% or more in Edinburgh, the recent diffusion of drug injecting, and high levels of syringe-sharing risk behaviour, suggested that HIV infection might spread rapidly through IDU populations. HIV prevention activities commenced in 1986 and developed in 1987. The first report on AIDS and Drugs Misuse by the Advisory Council on the Misuse of Drugs in 1988 was a major catalyst for change. It supported and legitimized emergent views on new ways of working with drug users. Between 1988 and 1993 innovative public health projects increased the ability to target vulnerable populations through syringe distribution, expansion of methadone treatment and outreach to hard-to-reach populations. There were major changes in service philosophy and practices, as ideas of harm minimization, accessibility, flexibility and multiple and intermediate goals were developed. There is evidence that these public health projects encouraged extensive changes in the health behaviour of IDUs. There have been major reductions in syringe-sharing risk behaviour and sharing syringes is no longer the norm. Evaluation of specific interventions (e.g. syringe-exchange) shows their importance in encouraging reductions in risk behaviour. Levels of HIV infection in IDUs remain low by international standards. Outside of London rates of about 1% have been reported; London has a low and declining prevalence of infection to around 7% in 1993; previous high levels in Edinburgh (55%) have since declined to 20%. Britain has to date avoided the rapid increase in HIV infection among injectors that has occurred in many parts of the world. The same period saw the continuation of high prevalence levels in New York and many European cities, and the explosive spread of HIV in many countries in south-east Asia. This paper acknowledges the difficulties is proving links between social interventions and epidemic prevention. It argues that there is prima facie evidence for the success of public health prevention, that the collection of intervention approaches in the U.K. had a significant impact on IDUs behaviour, and that this has helped prevent an epidemic of HIV infection among IDUs. The U.K. experience adds to the growing evidence of the significance of early interventions in encouraging behaviour change and in limiting the spread of HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Anabolic steroid users identified by needle and syringe exchange contact.

The increasing prevalence in the extent of misuse of anabolic-androgenic steroids has been well recognised in the United States and more recently in Great Britain. The injecting misuse of steroids carries with it considerable risks in relation to liver damage, lipid metabolism disturbance and the potential of HIV and viral hepatitis transmission. This study of 21 steroid users contacted at a needle and syringe exchange showed that 42.8% had abnormal liver function tests and 28.5% had lowered high-density lipoprotein concentrations. None of this group reported engaging in high risk behaviour through sharing injecting equipment. The group did contain a bisexual and a previous injecting amphetamine user. Needle and syringe exchanges offering health examination facilities will provide a valuable role in contacting steroid users who will then be in a position to make informed decisions about their own drug use and the potential harm from steroids.

Adult↗
PubMed1995

A comparison of the determinants of safe injecting and condom use among injecting drug users.

A sample of 582 injecting drug users were interviewed as part of an evaluation of an AIDS prevention programme for drug users. This paper examines the biographic and predispositional determinants of five HIV preventive behaviours--equipment sharing (not receiving and not giving) and and condom use (with regular partners, casual partners and sex clients). A two-stage sequential approach was adopted for a logistic regression analysis. Initially, to model each of the five preventive behaviours, biographical and drug use variables were entered. In a second set of models, behavioural predisposition factors were included. Age, drug use and prison experience correlate with variables in both models, although not consistently in the same direction. While a predisposition to reject sharing correlates with safer rejecting and condom use, the predisposition to safer sex only correlates with condom use. Needle exchange programmes that only target the individual would seem to be inadequate. To enhance targeted interventions changes in public and agency policy that create a social environment conductive to behaviour change are required.

Acquired Immunodeficiency Syndrome↗
PubMed1995

The preparedness to share injecting equipment: an analysis using vignettes.

This paper reports on the use of vignettes to study drug injectors' preparedness to share injecting equipment. Separate vignettes referring to borrowing and passing on injecting equipment have been submitted to 505 injecting drug users in Glasgow. Injectors were asked to identify their own likely response in each of the situations described within the vignettes. It was shown that even among those injectors not reporting any actual sharing in the last 6 months a significant proportion would still be prepared to share injecting equipment within certain situations. The preparedness to share injecting equipment was seen to be influenced by such factors as social distance, sex and length of time injecting. It is suggested that even in situations where drug injectors may have modified their behaviour in the direction of lower levels of reported sharing, a propensity to share may remain. This suggests the continuing need to provide injectors with easy access to sterile injecting equipment; in addition, services working with injecting drug users may need to focus not only upon actual sharing behaviour but also upon what we have described here as the preparedness to share. Indeed, the latter dimension should stand as a warning to services of the potential for sharing injecting equipment to increase in the future.

Acquired Immunodeficiency Syndrome↗