Between Emergency Department Visits: The Role of Harm Reduction Programs in Mitigating the Harms Associated With Injection Drug Use

Abstract Background Harm reduction services to people who use drugs (PWUD) in Russia are insufficient in terms of quantity, government endorsement, and accessibility. The situation has recently deteriorated even further because of social distancing measures of the COVID-19 pandemic. Several organizations have started to provide some harm reduction services via online platforms by web outreach. However, little is known on how online outreach services are organized and implemented. Drawing on the example of St. Petersburg-based NGO “Humanitarian Action,” we explored web outreach work in Telegram instant messenger. Methods Our data were comprised of 4 semi-structured interviews with the NGO staff and 301 cases of web outreach work with PWUD. We used thematic analysis to study the process of web outreach, harm reduction service provision, and needs of PWUD. Results Three stages of the process of web outreach work were identified: clients initiating communication, NGO workers addressing clients’ needs, and NGO workers receiving clients’ feedback. Communication proceeded in group chat or direct messages. Challenges in addressing clients’ needs happened when clients turned for help after hours, sent recorded voice messages, sent unclear messages, and/or were unwilling to transition to telephone communication. All web outreach workers reported receiving only positive feedback on their work. The needs of PWUD were categorized into two major themes, depending on whether they can be addressed fully or partially online. In cases of online only provision of services, web outreach workers helped PWUD treat minor injection drug use complications, obtain verified harm reduction information and receive general psychological support. In instances of partial online services provision, PWUD were assisted in getting treatment of severe injection drug use complications, overdoses, and in accessing offline medical, psychological, social, legal and harm reduction services. Conclusions Our research demonstrated that web outreach work is a convenient tool for delivering some harm reduction services to PWUD either partially or completely online and for recruiting new clients (including hard-to-reach PWUD that avoid attending brick-and-mortar facilities). Harm reduction organizations should consider incorporating online harm reduction services into their activities. However, further research is needed to explore relative advantages and disadvantages of online harm reduction services.

Download Full-text

Role of Social Network Dimensions in the Transition to Injection Drug Use: Actions Speak Louder than Words

AIDS and Behavior ◽

10.1007/s10461-011-9930-1 ◽

2011 ◽

Vol 15 (7) ◽

pp. 1579-1588 ◽

Cited By ~ 28

Author(s):

Nana Koram ◽

Hongjie Liu ◽

Jianhua Li ◽

Jian Li ◽

Jian Luo ◽

...

Keyword(s):

Social Network ◽

Drug Use ◽

Injection Drug Use ◽

Injection Drug

Download Full-text

The value of harm reduction for injection drug use: A clinical and public health ethics analysis

Disease-a-Month ◽

10.1016/j.disamonth.2018.12.002 ◽

2019 ◽

Vol 65 (5) ◽

pp. 119-141 ◽

Cited By ~ 4

Author(s):

Laura Vearrier

Keyword(s):

Public Health ◽

Drug Use ◽

Harm Reduction ◽

Injection Drug Use ◽

Public Health Ethics ◽

Injection Drug ◽

Health Ethics

Download Full-text

Missed Opportunities for Human Immunodeficiency Virus (HIV) Testing During Injection Drug Use–Related Healthcare Encounters Among a Cohort of Persons Who Inject Drugs With HIV Diagnosed During an Outbreak—Cincinnati/Northern Kentucky, 2017–2018

Clinical Infectious Diseases ◽

10.1093/cid/ciaa507 ◽

2020 ◽

Author(s):

Nathan W Furukawa ◽

Erin F Blau ◽

Zach Reau ◽

David Carlson ◽

Zachary D Raney ◽

...

Keyword(s):

Emergency Department ◽

Human Immunodeficiency Virus ◽

Drug Use ◽

Hiv Testing ◽

Injection Drug Use ◽

Injection Drug ◽

Hiv Diagnosis ◽

Persons Who Inject Drugs ◽

Missed Opportunities ◽

Immunodeficiency Virus

Abstract Background Persons who inject drugs (PWID) have frequent healthcare encounters related to their injection drug use (IDU) but are often not tested for human immunodeficiency virus (HIV). We sought to quantify missed opportunities for HIV testing during an HIV outbreak among PWID. Methods PWID with HIV diagnosed in 5 Cincinnati/Northern Kentucky counties during January 2017–September 2018 who had ≥1 encounter 12 months prior to HIV diagnosis in 1 of 2 Cincinnati/Northern Kentucky area healthcare systems were included in the analysis. HIV testing and encounter data were abstracted from electronic health records. A missed opportunity for HIV testing was defined as an encounter for an IDU-related condition where an HIV test was not performed and had not been performed in the prior 12 months. Results Among 109 PWID with HIV diagnosed who had ≥1 healthcare encounter, 75 (68.8%) had ≥1 IDU-related encounters in the 12 months before HIV diagnosis. These 75 PWID had 169 IDU-related encounters of which 86 (50.9%) were missed opportunities for HIV testing and occurred among 46 (42.2%) PWID. Most IDU-related encounters occurred in the emergency department (118/169; 69.8%). Using multivariable generalized estimating equations, HIV testing was more likely in inpatient compared with emergency department encounters (adjusted relative risk [RR], 2.72; 95% confidence interval [CI], 1.70–4.33) and at the healthcare system receiving funding for emergency department HIV testing (adjusted RR, 1.76; 95% CI, 1.10–2.82). Conclusions PWID have frequent IDU-related encounters in emergency departments. Enhanced HIV screening of PWID in these settings can facilitate earlier diagnosis and improve outbreak response.

Download Full-text