Treatment experiences for skin and soft tissue infections among participants of syringe service programs in North Carolina

Abstract

Introduction Bacterial and fungal infections, such as skin and soft tissue infections (SSTIs) and infective endocarditis (IE), are increasing among people who use drugs in the United States. Traditional healthcare settings can be inaccessible and unwelcoming to people who use drugs, leading to delays in getting necessary care. The objective of this study was to examine SSTI treatment experiences among people utilizing services from syringe services programs. This study was initiated by people with lived experience of drug use to improve quality of care. Methods We conducted a cross-sectional survey among participants of five syringe services programs in North Carolina from July through September 2020. Surveys collected information on each participant’s history of SSTIs and IE, drug use and healthcare access characteristics, and SSTI treatment experiences. We examined participant characteristics using counts and percentages. We also examined associations between participant characteristics and SSTI history using binomial linear regression models. Results Overall, 46% of participants reported an SSTI in the previous 12 months and 10% reported having IE in the previous 12 months. Those with a doctor they trusted with drug use-related concerns had 27 fewer (95% confidence interval = − 51.8, − 2.1) SSTIs per every 100 participants compared to those without a trusted doctor. Most participants with a SSTI history reported delaying (98%) or not seeking treatment (72%) for their infections. Concerns surrounding judgment or mistreatment by medical staff and self-treating the infection were common reasons for delaying or not seeking care. 13% of participants used antibiotics obtained from sources other than a medical provider to treat their most recent SSTI. Many participants suggested increased access to free antibiotics and on-site clinical care based at syringe service programs to improve treatment for SSTIs. Conclusions Many participants had delayed or not received care for SSTIs due to poor healthcare experiences. However, having a trusted doctor was associated with fewer people with SSTIs. Improved access to non-judgmental healthcare for people who use drugs with SSTIs is needed. Expansion of syringe services program-based SSTI prevention and treatment programs is likely a necessary approach to improve outcomes among those with SSTI and IE.

Improving equity and access to buprenorphine treatment through telemedicine at syringe services programs

“…Relatedly, this model allows clinicians to serve participants from multiple SSPs on the same day, thereby optimizing use of the limited number of trained providers. In addition, embedding telemedicine-based buprenorphine within SSPs might be a better approach for reaching participants who avoid other health care settings due to experiences of discrimination within them [24]. With ten months of data, a limitation of our study is that we did not have sufficient data or number of participants to assess uptake and retention of participants over time.…”

Community-acquired skin and soft-tissue infections in people who inject drugs

“…IDU is an established risk factor for multiple infectious syndromes such as BSI, chronic viral infections and SSTIs, which are the most common acute infectious complication in PWID [6,7 ▪▪ ]. Most data regarding its incidence originates from cross-sectional studies, wherein rates ranging from 50 to 70% have been reported [4,8,9]. There are little data on the burden of IDU-associated SSTIs.…”

“…Healthcare workers need to pay attention to providing a bias-free environment for PWID and promote a proper physician-patient relationship to increase patients’ compliance with treatment and follow-ups. As a matter of fact, in a cross-sectional study, having a doctor whom patients trusted for IDU-related concerns has been shown to be a protective factor against SSTIs [4]. Notably, physicians should be aware that hospitalizations for injection-related complications may not succeed in encouraging patients to adopt safer injection practices but serve as a starting point for SSTI-reducing interventions [44].…”

“…Although SSTIs in PWID may be clinically similar to SSTIs in other settings, the management of IDU-associated SSTIs might be different owing to the underlying background of substance abuse and the necessity for a holistic approach when treating PWID [3]. In addition, IDU-associated SSTIs are more likely to be recurrent and require many preventive efforts [4]. Hence, it is important for clinicians to be able to identify patients with risk factors for SSTIs and be familiar with the multidisciplinary approach to the management of such patients.…”

History and Future of Harm Reduction in North Carolina: Pragmatism and Innovation

“…Working with these partners in Greensboro, in 2022 UNC launched a groundbreaking program for harm reduction programs and health departments to conduct drug checking by mail during overdose outbreaks [28]. Other academic institutions around the state (notably UNC [29,30], Duke, Research Triangle Institute [31], UNC-Greensboro [32], Elon University [33], and North Carolina State University [34]) have developed robust harm reduction research agendas to buttress advocacy and evaluate interventions.…”