Supporting syringe services programs in the initiation and scale-up of vaccine administration: findings from in-depth interviews

Abstract

Background Vaccine-hesitant persons who inject drugs are at increased risk for several vaccine-preventable diseases. However, vaccination rates among this population remain low. While syringe services programs (SSPs) are places where persons who inject drugs feel comfortable accessing services, few offer vaccination services. This study describes facilitators and barriers to vaccination at SSPs. Methods We used convenience sampling to conduct semi-structured, qualitative in-depth interviews with 21 SSPs in the USA from June to August 2021. Interview questions asked SSPs about their perceptions, priorities, barriers, facilitators, and the effects of partnerships and policies on vaccine administration. We used deductive thematic analysis to identify the main themes. Results Eight (n = 8) SSPs offered vaccinations, and thirteen (n = 13) did not offer vaccinations. Most SSPs believed offering vaccination services was important, although addressing SSP participants’ immediate needs often took precedence. Staffing, physical space, and logistical issues were the most common barriers to vaccine administration reported by SSPs, followed by SSP participant-related barriers. Facilitators of vaccine administration included access to a tracking system, partnering with agencies or other organizations providing vaccines, and having a licensed vaccination provider on-site. Partnerships provided SSPs opportunities to expand capacity but could also restrict how SSPs operate. Recommended policy changes to facilitate vaccine administration included subsidizing the cost of vaccinations and addressing restrictions around who could administer vaccinations. Conclusions Increasing the availability of vaccination services at SSPs requires addressing the varying capacity needs of SSPs, such as tracking systems, licensed vaccinators, and free or low-cost vaccination supplies. While these needs can be met through partnerships and supportive policies, both must consider and reflect cultural competence around the lived experiences of persons who inject drugs.

COVID-19 vaccine implementation in a syringe services program: Experiences of frontline staff

“…For example, other studies found that distrust in medical staff functioned as a barrier to vaccine uptake (43) and noted that disinformation and exposure to social media had a negative impact on PWID's perceived susceptibility to COVID-19 (44). At the same time, this study also a rms other ndings that SSPs have a relative advantage in increasing vaccine uptake among PWID as compared to other vaccine sources (17,20,30), and that the established trust that SSP staff have with PWID is a primary driver of that relative advantage (45). Our study even highlights how the harm reduction approach that SSP staff utilize regarding injection drug use extends into their approach to the COVID-19 vaccines, and that this could be further extended through participant compensation for vaccine uptake.…”

“…These dynamics are playing out against a backdrop of more than 30 years of implementation of other vaccines, such as those for in uenza and pneumococcus, at SSPs (18)(19)(20). Much of this experience has focused on hepatitis B virus (HBV) vaccinations, with the percentage of SSPs in the United States implementing the HBV vaccine doubling from 16% in 2001 to 30% in 2021 (17,21).…”

A Brief Peer-Led Intervention to Increase COVID-19 Vaccine Uptake Among People Who Inject Drugs in San Diego County: Results From a Pilot Randomized Controlled Trial

“…Recent surveys of SSPs in the United States found that the majority were not providing COVID-19 or other vaccination services on-site [ 37 , 38 ], with major barriers including limited staff capacity (eg, licensed personnel), physical infrastructure (eg, appropriate storage space and equipment), and administrative and data systems needed to track multidose vaccines [ 39 ]. In addition to sustained investments in staff capacity and infrastructure, SSP-based vaccination initiatives benefit from adequate financial, political, and local community support [ 9 , 40 , 41 ]. Capacity-strengthening and quality improvement strategies within SSPs could enhance the delivery of on-site vaccination services [ 42 , 43 ].…”

COVID-19 vaccination uptake and determinants of booster vaccination among persons who inject drugs in New York City

“…This suggests that community-developed messages through outreach efforts are essential to clarify the importance of vaccination, highlighting the significantly higher risks of COVID-19 in contrast to potential unintended side effects. Providing COVID-19 vaccination services, including booster doses through organizations that currently offer services to PWID, such as SSPs, have been suggested to facilitate easy access to vaccines on-site [ 27 , 28 ].…”