Individual-level needle and syringe coverage in Melbourne, Australia: a longitudinal, descriptive analysis

O’Keefe, Daniel; Scott, Nick; Aitken, Campbell

doi:10.1186/s12913-016-1668-z

Cited by 16 publications

(13 citation statements)

References 32 publications

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“…Even so, barriers to accessing NSPs do exist, as demonstrated within our interview data: regardless of closest service type, 17% of participants reported not using NSPs as their usual source of sterile syringes, reporting alternate syringe sources, such as pharmacies, friends or dealers. Whilst the non-use or inconsistent use of NSPs has previously been associated with insufficient coverage [15, 37], it is true that NSPs are simply not acceptable to all PWID [12, 38].…”

Section: Discussionmentioning

confidence: 99%

Geo-spatial analysis of individual-level needle and syringe coverage in Melbourne, Australia

et al. 2018

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Distance to health services is known to be negatively associated with usage and needle and syringe programs (NSPs) for people who inject drugs (PWID) are no different. Australia has a mixture of NSP modalities (primary or secondary fixed-site NSPs), which may present unique barriers to access. In this study, we explore 1) the effect of distance to NSPs on individual-level needle and syringe coverage, and 2) differences in coverage dependent on NSP modality. Using data from 219 PWID in an ongoing cohort study in Melbourne, Australia, we measured the straight-line distance from participants’ residence to their nearest primary or secondary fixed-site NSP. We analysed the relationship between geographical distance and coverage via regression analysis. The median distance to any type of NSP was 1872 metres. Regardless of service type, 52% of participants lived within 2 kms of a fixed-site NSP and 87% lived within 5 kms. We found no association between distance to NSPs and syringe coverage or a significant difference in coverage by nearest service type. Our findings suggest that the number and distribution of NSPs in Melbourne, Australia caters adequately for the population of PWID.

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Section: Discussionmentioning

confidence: 99%

Geo-spatial analysis of individual-level needle and syringe coverage in Melbourne, Australia

et al. 2018

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“…By recording differential syringe acquisition and injecting frequency, individual-level coverage measurement accounts for the cluster of behaviours associated with, and influencing, syringe acquisition and use. For example, the measure can account for secondary exchange of previously acquired syringes with other people who inject drugs 27 , 28 . Also, because individual-level measures necessitate primary data collection, demographic and behavioural exposure variables can be collected at the same time and can then be tested for associations with coverage outcomes 8 , 29 , 30 …”

Section: Individual-level Coveragementioning

confidence: 99%

“…The original work describing the individual-level coverage measure found an inverse relationship between individual-level syringe coverage and injecting risk: the lower the coverage, the higher the percentage of those displaying injecting risk behaviours 8 . Many research groups have since used the method (or variants of it) in various countries 4 , 8 , 14 , 27 – 34 . The findings demonstrate that even in countries that meet or exceed the WHO’s population-level distribution targets, many people who inject drugs may have insufficient coverage at the individual level 27 , 28 .…”

Section: Research Evidencementioning

confidence: 99%

“…Many research groups have since used the method (or variants of it) in various countries 4 , 8 , 14 , 27 – 34 . The findings demonstrate that even in countries that meet or exceed the WHO’s population-level distribution targets, many people who inject drugs may have insufficient coverage at the individual level 27 , 28 . Australia is often estimated to have one of the highest population-level coverage rates globally, 10 supplying needles and syringes via an unlimited and unrestricted dispensing policy 35 .…”

Section: Research Evidencementioning

confidence: 99%

“…Australia is often estimated to have one of the highest population-level coverage rates globally, 10 supplying needles and syringes via an unlimited and unrestricted dispensing policy 35 . However, at the individual level, estimates of the prevalence of insufficient syringe coverage range from 16% (117 out of 735 respondents) to 37% (133 out of 357 respondents) 27 – 30 . The ability, then, for individuals to achieve sufficient coverage may not be enhanced by increasing population-level syringe distribution alone.…”

Section: Research Evidencementioning

confidence: 99%

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Measures of harm reduction service provision for people who inject drugs

O’Keefe

Bluthenthal

Kral

et al. 2019

Bull. World Health Organ.

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Coverage is an important dimension in measuring the effectiveness of needle and syringe programmes in providing sterile injecting equipment for people who inject drugs. The World Health Organization (WHO), the United Nations Office on Drugs and Crime (UNODC) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) currently recommend methods for measuring coverage at the population level, that is, across an estimated population of people who inject drugs within a given geographical area. However, population-level measures of coverage rely on highly uncertain population estimates and cannot capture the different levels of syringe acquisition and injecting episodes among individual users. Consequently, such measures only broadly evaluate the extent of programme service delivery, rather than describe how people who inject drugs as individuals and sub-groups interact with needle and syringe programmes. In response to these limitations, several researchers have proposed measuring coverage at the individual level, by the percentage of injecting episodes in relation to the number of sterile needles and syringes acquired. These measures evaluate coverage according to each individual’s needs. Such measures provide enhanced information for planning and monitoring of harm reduction programmes and have now been used in multiple international research studies. We advise that WHO, UNODC and UNAIDS add individual-level coverage measurement methods to their international monitoring guidelines for harm reduction programmes. By doing this, more responsive and effective programmes can be created to better reduce injecting risk behaviours and blood-borne virus transmission among people who inject drugs.

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Injection Drug Use Frequency Before and After Take-Home Naloxone Training

et al. 2023

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ImportanceConcerns that take-home naloxone (THN) training may lead to riskier drug use (as a form of overdose risk compensation) remain a substantial barrier to training implementation. However, there was limited good-quality evidence in a systematic review of the association between THN access and subsequent risk compensation behaviors.ObjectiveTo assess whether THN training is associated with changes in overdose risk behaviors, indexed through injecting frequency, in a cohort of people who inject drugs.Design, Setting, and ParticipantsThis cohort study used prospectively collected self-reported behavioral data before and after THN training of participants in The Melbourne Injecting Drug User Cohort Study (SuperMIX). Annual interviews were conducted in and around Melbourne, Victoria, Australia, from 2008 to 2021. SuperMIX participants were adults who regularly injected heroin or methamphetamine in the 6 months preceding their baseline interview. The current study included only people who inject drugs who reported THN training and had participated in at least 1 interview before THN training.ExposureIn 2017, the SuperMIX baseline or follow-up survey began asking participants if and when they had received THN training. The first THN training date that was recorded was included as the exposure variable. Subsequent participant interviews were excluded from analysis.Main Outcomes and MeasuresInjecting frequency was the primary outcome and was used as an indicator of overdose risk. Secondary outcomes were opioid injecting frequency, benzodiazepine use frequency, and the proportion of the time drugs were used alone. Fixed-effects generalized linear (Poisson) multilevel modeling was used to estimate the association between THN training and the primary and secondary outcomes. Time-varying covariates included housing status, income, time in study, recent opioid overdose, recent drug treatment, and needle and syringe coverage. Findings were expressed as incidence rate ratios (IRRs) with 95% CIs.ResultsThere were 1328 participants (mean [SD] age, 32.4 [9.0] years; 893 men [67.2%]) who completed a baseline interview in the SuperMIX cohort, and 965 participants completed either a baseline or follow-up interview in or after 2017. Of these 965 participants, 390 (40.4%) reported THN training. A total of 189 people who inject drugs had pretraining participant interviews with data on injecting frequency and were included in the final analysis (mean [SD] number of interviews over the study period, 6.2 [2.2]). In fixed-effects regression analyses adjusted for covariates, there was no change in the frequency of injecting (IRR, 0.91; 95% CI, 0.69-1.20; P = .51), opioid injecting (IRR, 0.95; 95% CI, 0.74-1.23; P = .71), benzodiazepine use (IRR, 0.96; 95% CI, 0.69-1.33; P = .80), or the proportion of reported time of using drugs alone (IRR, 1.04; 95% CI, 0.86-1.26; P = .67) before and after THN training.Conclusions and RelevanceThis cohort study of people who inject drugs found no evidence of an increase in injecting frequency, along with other markers of overdose risk, after THN training and supply. The findings suggest that THN training should not be withheld because of concerns about risk compensation and that advocacy for availability and uptake of THN is required to address unprecedented opioid-associated mortality.

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Individual-level needle and syringe coverage in Melbourne, Australia: a longitudinal, descriptive analysis

Cited by 16 publications

References 32 publications

Geo-spatial analysis of individual-level needle and syringe coverage in Melbourne, Australia

Geo-spatial analysis of individual-level needle and syringe coverage in Melbourne, Australia

Measures of harm reduction service provision for people who inject drugs

Injection Drug Use Frequency Before and After Take-Home Naloxone Training

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