Factors associated with skin and soft tissue infections among people who inject drugs in the United Kingdom: A comparative examination of data from two surveys

Abstract

Background: People who inject drugs (PWID) are at high risk of injection-related skin and soft tissue infections (SSTI). If not treated promptly, these can lead to serious health complications, which are a considerable healthcare burden. Data from two community surveys, with different approaches, were used to assess SSTI prevalence and associated factors among PWID to inform intervention implementation. Methods: Data were analysed from two surveys, a national surveillance survey (n=2,874; 2017-18) of infections among PWID in the United Kingdom (UK) and an in-depth survey (n=455; 2018-19) of SSTI among PWID based in London, UK. Multivariable logistic regression models were constructed to ascertain the factors associated with self-reported SSTI. Results: High prevalence of SSTI were reported in both samples: 52 % of participants from the national surveillance survey reported having SSTI within the preceding 12 months and 65 % of the London sample reported a lifetime history of SSTI. The factors associated with SSTI in both surveys were similar, including older age; number of years injecting; number of attempts required to inject into the vein; injecting into the hands, feet, groin or neck and re-using or sharing needles/syringes. Conclusions: The number of PWID reporting SSTI in the UK is concerningly high. The two surveys used different recruitment approaches but found similar associations. We provide strong evidence of a relationship between venous access difficulty and SSTI. To stem the increase of SSTI and related complications in the UK, it is crucial that interventions attend to the underlying causes of venous damage among PWID.

Normalised pain and severe health care delay among people who inject drugs in London: Adapting cultural safety principles to promote care

“…The survey sample comprised 455 people with a history of injecting drug use. Demographics align with characteristics of PWID recorded in national surveillance data ( Doran et al, 2020 ); predominately male (75%, n = 341), of White ethnicity (74%, n = 336) and a mean age of 46 years. The primary drug injected was heroin, either alone (44%, n = 199) or in combination with crack cocaine (49%, n = 255).…”

“…This paper draws on mixed method data generated for the Care & Prevent study with 455 PWID, many of whom report rough sleeping and injecting-related hospitalisation, to explore the dynamics of medical care seeking and avoidance among the most marginalised. Sample demographics are comparable to those of PWID represented in UK surveillance data ( Doran et al, 2020 ). Findings presented focus on qualitative accounts, from a subsample of survey participants, to illustrate both the severity of health harms incorporated into daily lives and the structures that inform care delay.…”

Prevalence and severity of abscesses and cellulitis, and their associations with other health outcomes, in a community-based study of people who inject drugs in London, UK

“…Analysis has demonstrated that C&P sample is comparable to those of PWID participating in the larger National UAM surveillance survey [32]. We have some confidence, therefore, that findings reported in this paper are generalisable to the broader population of PWID in the UK [33]…”

The impact of the COVID-19 pandemic on harm reduction services in Spain

“…Early detection of COVID-19 could help mitigate possible complications caused by the virus among PWUD, who may have underlying chronic medical conditions that increase their risk of developing severe COVID-19 illness, such as COPD, asthma, cardiovascular diseases, and viral hepatitis [ 9 ]. PWUD are at risk for sepsis and endocarditis, and commonly have skin and soft tissue infections [ 34 , 35 ] which, when left untreated, can lead to hospitalisation and even amputation, putting them at greater risk if infected with COVID-19.…”