Use of North America's First Medically Supervised Safer Injecting Facility Among HIV-Positive Injection Drug Users

Abstract

The objective of this study was to examine supervised injecting facility (SIF) use among a cohort of 395 HIV-positive injection drug users (IDUs) in Vancouver, Canada. The correlates of SIF use were identified using generalized estimating equation analyses. In multivariate analyses, frequent SIF use was associated with homelessness (adjusted odds ratio [AOR] = 1.90), daily heroin injection (AOR = 1.56), and daily cocaine injection (AOR = 1.59). The reasons given for not using the SIF included a preference for injecting at home and already having a safe place to inject. The SIF services most commonly used were needle exchange and nursing services. The SIF appears to have attracted a high-risk subpopulation of HIV-positive IDUs; this coverage perhaps could be extended with the addition of HIV- specific services such as disease monitoring and the provision of antiretroviral therapy.

Drug consumption rooms: A systematic review of evaluation methodologies

“…Most papers were based on prospective design and included cohort/follow‐up studies ( n = 26/57). These largely comprised analysis of the data collected from the Scientific Evaluation of Supervised Injecting (SEOSI) cohort from the Vancouver SIF (Insite) in Canada ( n = 19) , the Vancouver Injection Drug Users Study ( n = 5) , the AIDS Care Cohort to evaluate Exposure to Survival Services ( n = 1) and the At‐Risk Youth Study Cohort ( n = 1) . The SEOSI cohort was established in 2003 and included approximately 1100 participants randomly recruited from the SIF as well as a representative sample of all SIF clients.…”

“…Of these, two frequency indicators were derived from service records and four were based on self‐report . Fourthly, the self‐reported proportion of individual injections that occur at a DCR/SIF from all injections was used in 10 papers, all from Canada .…”

“…The prospective/follow‐up cohort design was used to assess the DCR/SIF impact across all outcome categories specified in Table except for ‘not increasing crime’ (see Table for details). That is, it was used to assess whether DCRs/SIFs were attracting high‐risk drug users , managing overdose , enhancing safe injecting practice , decreasing public use , increasing uptake into treatment and other healthcare , addressing BBV transmission and yield cost savings and the impact on drug use and related risks .…”

Association between public injecting and drug-related harm among HIV-positive people who use injection drugs in a Canadian setting: A longitudinal analysis

“…Since the early 2000’s, many countries have introduced safe injection facilities (SIF) as a part of larger public health initiatives to reduce the risks associated with public injection and increase contact with medical care and addiction treatment services (Broadhead et al, 2002). In our setting, a small SIF has been in operation since 2003 and has been shown to have successfully attracted individuals who engage in public injection (Reddon et al, 2011). The scientific evaluation of Insite documented HIV prevention benefits, including decreased public injection, decreased syringe sharing, and increased uptake of detoxification and addiction treatment services (Kerr et al, 2006; Kerr et al, 2005; Wood et al, 2004; Wood et al, 2006a; Wood et al, 2006b).…”

Disagreeing on whether we agree

“…As health professionals, we should address important barriers to out-patient buprenorphine prescription through educational initiatives, peer support programs and improved clinical pathways [10], whereas policymakers should address critical regulatory barriers to out-patient OUD treatment. For example, the Mainstreaming Addiction Treatment Act (H.R.…”