Association of skin infections with sharing of injection drug preparation equipment among people who inject drugs

Jawa, Raagini; Stein, Michael D.; Anderson, Bradley J.; Liebschutz, Jane M.; Stewart, Catherine E.; Phillips, Kristina T.; Barocas, Joshua A.

doi:10.1016/j.drugpo.2021.103198

Cited by 14 publications

(4 citation statements)

References 64 publications

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“…We set this value as the “base” probability of SSTVI if the PWID did not inject in the past month, did not share needles, and did not reuse injection equipment. We then included relative risks of SSTVI occurrence associated with injection risk behaviour (e.g., injection frequency, sharing injection equipment, or reusing needles and syringes) [ 16 , 18 , 19 ] and changes in injection risk behaviour associated with the implementation of NSP [ 34 ]. For PWID with behavioural risk factors, this “base” probability was multiplied by the “risk multiplier” (i.e., risk ratios or odds ratios from the literature; see Supplementary Materials for more detail).…”

Section: Methodsmentioning

confidence: 99%

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

Lim,

El-Sheikh,

Buckeridge

et al. 2024

Harm Reduct J

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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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Section: Methodsmentioning

confidence: 99%

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

Lim,

El-Sheikh,

Buckeridge

et al. 2024

Harm Reduct J

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show abstract

“…Similarly, a female participant spoke about the dangers of using dull syringes as well as reported sharing syringes – a well-documented risk factor for infection ( Jawa et al., 2021 ; Kerr et al., 2010 ; Sanchez et al., 2021 ). She shared: “I use dull syringes sometimes…Where it pokes, and that's dangerous.…”

Section: Resultsmentioning

confidence: 99%

Trends and correlates of abscess history among people who inject drugs in Massachusetts: A mixed methods exploration of experiences amidst a rapidly evolving drug supply

Benrubi,

Silcox,

Hughto

et al. 2023

Drug and Alcohol Dependence Reports

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“…In people who inject drugs, harm-reduction practices (i.e., discussing safe injection techniques, like using sterile needles and water) help to reduce the future risk of infections. Sharing injection equipment and needles, a common practice among people who inject drugs, is associated with a higher incidence rate ratio of skin/ soft-tissue infections at 1 year (3.31; 95% CI, 2.04-5.37, p < 0.001) (15). Cleaning of an injection site with alcohol prior to injecting is a simple and cheap intervention that is associated with a lower risk of abscess formation (16).…”

Section: Sepsis and The Opioid Crisis: Integrating Treatment For Two ...mentioning

confidence: 99%

Sepsis and the Opioid Crisis: Integrating Treatment for Two Public Health Emergencies*

Kimball

Levy

2021

Critical Care Medicine

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Association of skin infections with sharing of injection drug preparation equipment among people who inject drugs

Cited by 14 publications

References 64 publications

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

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

Trends and correlates of abscess history among people who inject drugs in Massachusetts: A mixed methods exploration of experiences amidst a rapidly evolving drug supply

Sepsis and the Opioid Crisis: Integrating Treatment for Two Public Health Emergencies*

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