scholarly journals Young and invisible: a qualitative study of service engagement by people who inject drugs in India

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e047350
Author(s):  
Lakshmi Ganapathi ◽  
Aylur K Srikrishnan ◽  
Clarissa Martinez ◽  
Gregory M Lucas ◽  
Shruti H Mehta ◽  
...  
Keyword(s):  
Harm Reduction ◽  
Opioid Dependence ◽  
People Who Inject Drugs ◽  
Hiv Infections ◽  
Young Female ◽  
Structural Factors ◽  
Semistructured Interview ◽  
Initiation Phase ◽  
Injection Initiation ◽  
Service Engagement

ObjectivesThe HIV epidemic in India is concentrated in key populations such as people who inject drugs (PWID). New HIV infections are high among young PWID (≤30 years of age), who are hard to engage in services. We assessed perspectives of young PWID to guide development of youth-specific services.SettingWe conducted focus group discussions (FGDs) with PWID and staff at venues offering services to PWID in three Indian cities representing historical and emerging drug use epidemics.ParticipantsPWID were eligible to participate if they were between 18 and 35 years, had initiated injection as adolescents or young adults and knew adolescent PWID in their networks. 43 PWID (81% male, 19% female) and 10 staff members participated in FGDs. A semistructured interview guide was used to elicit participants’ narratives on injection initiation experiences, barriers to seeking harm reduction services, service delivery gaps and recommendations to promote engagement. Thematic analysis was used to develop an explanatory model for service engagement in each temporal stage across the injection continuum.ResultsInjection initiation followed non-injection opioid dependence. Lack of services for non-injection opioid dependence was a key gap in the preinjection initiation phase. Lack of knowledge and reliance on informal sources for injecting equipment were key reasons for non-engagement in the peri-injection phase. Additionally, low-risk perception resulted in low motivation to seek services. Psychosocial and structural factors shaped engagement after established injection. Housing and food insecurity, and stigma disproportionately affected female PWID while lack of confidential adolescent friendly services impeded engagement by adolescent PWID.ConclusionsDevelopment of youth-specific services for young PWID in India will need to address unique vulnerabilities and service gaps along each stage of the injection continuum. Scaling-up of tailored services is needed for young female PWID and adolescents, including interventions that prevent injection initiation and provision of confidential harm reduction services.

scholarly journals Young and invisible: an explanatory model for service engagement by people who inject drugs in India

2021 ◽  
Author(s):  
Lakshmi Ganapathi ◽  
Aylur K Srikrishnan ◽  
Clarissa Martinez ◽  
Gregory M Lucas ◽  
Shruti H Mehta ◽  
...  
Keyword(s):  
Drug Use ◽  
Harm Reduction ◽  
Opioid Dependence ◽  
People Who Inject Drugs ◽  
Structured Interview ◽  
Explanatory Model ◽  
List Type ◽  
Structural Factors ◽  
Injection Initiation ◽  
Service Engagement

ABSTRACTIntroductionThe HIV epidemic in India is concentrated in key populations such as people who inject drugs (PWID). New HIV infections are high among young PWID (≤ 30 years of age), who are hard to engage in services. We assessed perspectives of young PWID across three Indian cities representing historic and emerging drug use epidemics to guide development of youth-specific services.MethodsWe conducted focus group discussions (FGDs) with PWID (ages 18-35 years) and staff at venues offering services to PWID in three cities (Aizawl and Imphal, Northeast India and Amritsar, Northwest India). A semi-structured interview guide was used to elicit participants’ narratives on injection initiation experiences, motivating factors and barriers to seeking harm-reduction services, service-delivery gaps, and recommendations to promote engagement.Thematic analysis was used to develop an explanatory model for engagement for each temporal stage across the injection continuum: (a) pre-injection initiation, (b) peri-injection initiation and (c) established injection behavior.Results43 PWID (81% male, 19% female) and 10 staff members participated in FGDs. Injection initiation followed non-injection opioid dependence. Lack of services for non-injection opioid dependence was a key gap in the pre-injection initiation phase. Lack of knowledge and reliance on informal sources for injecting equipment were key reasons for non-engagement in the peri-injection phase. Additionally, low risk perception resulted in low motivation to seek services.Psychosocial and structural factors shaped engagement after established injection. Housing and food insecurity, and stigma disproportionately affected female PWID while lack of confidential adolescent friendly services impeded engagement by adolescent PWID.ConclusionsDevelopment of youth-specific services for young PWID in India will need to address unique vulnerabilities and service gaps along each stage of the injection continuum. Scaling-up of tailored services is needed for young female PWID and adolescents, including interventions that prevent injection initiation and provision of confidential harm-reduction services.STRENGTHS AND LIMITATIONSThe findings in this study represent some of the first qualitative data to explore engagement with services, specifically among young PWID in India.The study was conducted in multiple cities representing older and emerging injection drug use epidemics. The inclusion of multiple cities adds strength to the findings.We did not recruit adolescent PWID due to constraints rendered by laws pertaining to informed consent in India.Although all PWID we recruited had initiated injection in adolescence or young adulthood, the preponderance of older PWID in our study limits the conclusions we can draw about the needs of adolescent PWID.

scholarly journals Bridging Epidemiology and System Dynamics Modeling to Better Understand HCV Risk Among Young People Who Inject Drugs.

2021 ◽  
Author(s):  
Pedro Mateu-Gelabert ◽  
Nasim Sabounchi ◽  
Honoria Guarino ◽  
Courtney Ciervo ◽  
Kellie Joseph ◽  
...  
Keyword(s):  
Risk Factors ◽  
System Dynamics ◽  
Harm Reduction ◽  
People Who Inject Drugs ◽  
Positive Impact ◽  
Self Report ◽  
Structural Factors ◽  
Dynamics Modeling ◽  
Antibody Testing ◽  
Sd Model

Abstract Background Injection drug use is the leading risk factor for hepatitis C virus (HCV) transmission in the US. Despite the knowledge of the risk factors for HCV among people who inject drugs (PWID), there is a need to better understand how these multiple factors interact and impact young PWID.MethodsData originated from a study of 539 New York City (NYC) residents ages 18-29 recruited via Respondent-Driven Sampling, who reported past-month nonmedical use of prescription opioids and/or heroin. Analyses are based on a subsample of 337 (62%) who reported injecting any drug 12 months prior to the interview. All variables were assessed via self-report, except HCV status, which was established via rapid antibody testing. Building on the statistical associations found we developed a qualitative system dynamics (SD) model to integrate into a single framework key risk and preventive factors for HCV.ResultsHCV antibody prevalence is 31% with an overall incidence of 10 per 100 person-years. HCV status was independently correlated with sharing cookers with two or more people (AOR=2.17); injecting drugs 4-6 years (AOR=2.49) and 7 or more (AOR=4.95); lifetime homelessness (AOR=2.52); and being incarcerated two or more times (AOR=1.99). The SD model facilitates identifying non-linearities and feedback loop structures not included in the statistical model and high leverage points such as harm reduction and HCV treatment that could ameliorate the spread of HCV.ConclusionsThe results may indicate an overall positive impact of harm reduction efforts in reducing HCV prevalence among young PWID in NYC while injection risks and structural factors remain areas of key concern. An SD approach contributes to a better understanding of how these risk factors interact and what policies could be effective in reducing HCV infections.

scholarly journals Impact of funding harm reduction programs for people who inject drugs in Mexico

Salud Mental ◽  
2019 ◽  
Vol 42 (4) ◽  
pp. 157-163 ◽  
Author(s):  
Marisol Valenzuela-Lara ◽  
Marisol Ponce-Ramos ◽  
Karen Ruiz-Herrera ◽  
Agustín López-González
Keyword(s):  
Harm Reduction ◽  
People Who Inject Drugs ◽  
Deterministic Model ◽  
Cost Effective ◽  
Hiv Infections ◽  
Limited Data ◽  
Community Based ◽  
Public Health Burden ◽  
Community Based Organizations ◽  
Using Data

Introduction. Despite evidence from harm reduction programs, there are limited data on their impact in Mexico. The Mexican National HIV Program has supported harm reduction programs implemented by community-based organizations both financially and technically. Objective. To obtain an estimate of HIV infections averted from 2015 to 2018. Method. A deterministic model was developed to estimate the number of infections, with harm reduction projects financed by CENSIDA and implemented by Community-Based Organizations, using data reported from the period 2015 to 2018. The benefit was obtained by estimating the costs of providing prevention programs and comparing the latter to the costs of providing care. Results. An analysis of 66,973 people included in harm reduction programs showed that an estimated 869 HIV infections were averted between 2015 and 2018. Potential savings obtained by providing these harm reduction services exceeded over $600,000 Mexican pesos for every infection averted. Discussion and conclusion. Harm reduction services play a key role in reducing the incidence of HIV in Mexico. Ensuring their financing is necessary since, combined with other services, they are a cost-effective tool for reducing the economic and public health burden of HIV/AIDS.

scholarly journals Health programmes and services addressing the prevention and management of infectious diseases in people who inject drugs in Canada: a systematic integrative review

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e047511
Author(s):  
Katrina Bouzanis ◽  
Siddharth Joshi ◽  
Cynthia Lokker ◽  
Sureka Pavalagantharajah ◽  
Yun Qiu ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Drug Use ◽  
Infectious Diseases ◽  
Harm Reduction ◽  
Bacterial Infections ◽  
People Who Inject Drugs ◽  
Integrative Review ◽  
Future Research ◽  
Structural Factors ◽  
Health Programmes

ObjectivesPeople who inject drugs (PWID) experience a high burden of injection drug use-related infectious disease and challenges in accessing adequate care. This study sought to identify programmes and services in Canada addressing the prevention and management of infectious disease in PWID.DesignThis study employed a systematic integrative review methodology. Electronic databases (PubMed, CINAHL and Web of Science Core Collection) and relevant websites were searched for literature published between 2008 and 2019 (last search date was 6 June 2019). Eligible articles and documents were required to address injection or intravenous drug use and health programmes or services relating to the prevention or management of infectious diseases in Canada.ResultsThis study identified 1607 unique articles and 97 were included in this study. The health programmes and services identified included testing and management of HIV and hepatitis C virus (n=27), supervised injection facilities (n=19), medication treatment for opioid use disorder (n=12), integrated infectious disease and addiction programmes (n=10), needle exchange programmes (n=9), harm reduction strategies broadly (n=6), mobile care initiatives (n=5), peer-delivered services (n=3), management of IDU-related bacterial infections (n=2) and others (n=4). Key implications for policy, practice and future research were identified based on the results of the included studies, which include addressing individual and systemic factors that impede care, furthering evaluation of programmes and the need to provide comprehensive care to PWID, involving medical care, social support and harm reduction.ConclusionsThese results demonstrate the need for expanded services across a variety of settings and populations. Our study emphasises the importance of addressing social and structural factors that impede infectious disease care for PWID. Further research is needed to improve evaluation of health programmes and services and contextual factors surrounding accessing services or returning to care.PROSPERO registration numberCRD42020142947.

scholarly journals Bridging Epidemiology and System Dynamics Modeling to Better Understand HCV Risk Among Young People Who Inject Drugs.

2021 ◽  
Author(s):  
Pedro Mateu-Gelabert ◽  
Nasim Sabounchi ◽  
Honoria Guarino ◽  
Courtney Ciervo ◽  
Kellie Joseph ◽  
...  
Keyword(s):  
Risk Factors ◽  
System Dynamics ◽  
Harm Reduction ◽  
People Who Inject Drugs ◽  
Positive Impact ◽  
Self Report ◽  
Structural Factors ◽  
Dynamics Modeling ◽  
Antibody Testing ◽  
Sd Model

Abstract Background Injection drug use is the leading risk factor for hepatitis C virus (HCV) transmission in the US. Despite the knowledge of the risk factors for HCV among people who inject drugs (PWID), there is a need to better understand how these multiple factors interact and impact young PWID.MethodsData originated from a study of 539 New York City (NYC) residents ages 18-29 recruited via Respondent-Driven Sampling, who reported past-month nonmedical use of prescription opioids and/or heroin. Analyses are based on a subsample of 337 (62%) who reported injecting any drug 12 months prior to the interview. All variables were assessed via self-report, except HCV status, which was established via rapid antibody testing. Building on the statistical associations found we developed a qualitative system dynamics (SD) model to integrate into a single framework key risk and preventive factors for HCV.ResultsHCV antibody prevalence is 31% with an overall incidence of 10 per 100 person-years. HCV status was independently correlated with sharing cookers with two or more people (AOR=2.17); injecting drugs 4-6 years (AOR=2.49) and 7 or more (AOR=4.95); lifetime homelessness (AOR=2.52); and being incarcerated two or more times (AOR=1.99). The SD model facilitates identifying non-linearities and feedback loop structures not included in the statistical model and high leverage points such as harm reduction and HCV treatment that could ameliorate the spread of HCV.ConclusionThe results may indicate an overall positive impact of harm reduction efforts in reducing HCV prevalence among young PWID in NYC while injection risks and structural factors remain areas of key concern. An SD approach contributes to a better understanding of how these risk factors interact and what policies could be effective in reducing HCV infections.

scholarly journals High levels of used syringe use and unsafe sex among people who inject drugs in Kumasi, Ghana: an urgent call for a comprehensive harm reduction approach

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Lisa J. Messersmith ◽  
Rose Adjei ◽  
Jennifer Beard ◽  
Angela R. Bazzi ◽  
Joel J. Earlywine ◽  
...  
Keyword(s):  
Drug Use ◽  
Harm Reduction ◽  
Population Size ◽  
Sex Workers ◽  
People Who Inject Drugs ◽  
Syringe Sharing ◽  
Unsafe Sex ◽  
Lack Of Information ◽  
Sex With Men ◽  
Major Drug

Abstract Background Drug use is a growing concern in Ghana. People who inject drugs (PWID) are highly vulnerable to HIV and other infectious diseases. Ghana’s National Strategic Plan for HIV/AIDS 2016–2020 identifies PWID as a key population, but efforts to address the needs of PWID have lagged behind those targeting sex workers and men who have sex with men. Lack of information about PWID is a critical barrier to implementing effective HIV prevention and treatment. We aimed to learn more about the vulnerability of the PWID population in order to inform much-needed harm reduction interventions. Methods From April to July 2018, we conducted a mixed methods study in Kumasi, Ghana, to identify all major drug using locations, count the numbers of PWID to obtain rough population size estimations, and administer anonymous surveys to 221 PWID regarding drug use and sexual behavior. We also tested for HIV, HCV, and HBV from syringes used by survey participants. Results Key informants identified five major drug using locations and estimated the total PWID population size to be between 600 and 2000. Enumerators counted between 35 and 61 individuals present at each of the five bases. Sharing syringes and reusing discarded syringes are common practices. Over half of survey participants (59%) reported past-month syringe sharing (34% used a used syringe and 52% gave away a used syringe). Individuals with higher injection frequency (≥ 21 times weekly) and who injected with four or more people had higher odds of syringe sharing. Of the survey participants reporting sex in the last month (23%), most reported having one partner, but only 12% used condoms. Nearly all women (11/13) reported exchanging sex for drugs and 6/13 reported exchanging sex for money in the last six months. Fifteen percent of participants (all men) reported paying for sex using drugs or money. Of the used syringes, prevalence estimates were 3% (HIV), 2% (HCV), and 9% (HBV). Conclusions Our findings confirm the urgent need to implement harm reduction interventions targeting PWID and to build a strong and enabling legal and policy environment in Ghana to support these efforts.

Extremely low and sustained HIV incidence among people who inject drugs in a setting of harm reduction

AIDS ◽  
2014 ◽  
Vol 28 (2) ◽  
pp. 275-278 ◽  
Author(s):  
Jenny Iversen ◽  
Handan Wand ◽  
Libby Topp ◽  
John Kaldor ◽  
Lisa Maher
Keyword(s):  
Harm Reduction ◽  
People Who Inject Drugs ◽  
Hiv Incidence

Barriers and Facilitators of HIV and Hepatitis C Care Among People Who Inject Drugs in Nairobi, Kenya: A Qualitative Study with Peer Educators

2021 ◽  
Author(s):  
Natasha Ludwig-Barron ◽  
Brandon L Guthrie ◽  
Loice Mbogo ◽  
David Bukusi ◽  
William Sinkele ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Law Enforcement ◽  
Harm Reduction ◽  
People Who Inject Drugs ◽  
Community Level ◽  
Barriers And Facilitators ◽  
Peer Educators ◽  
Prevention Education ◽  
Individual Level ◽  
Policy Level

Abstract Background: In Kenya, people who inject drugs (PWID) are disproportionately affected by HIV and hepatitis C (HCV) epidemics, including HIV-HCV coinfections; however, few have assessed factors affecting their access to and engagement in care through the lens of harm reduction specialists. This qualitative study leverages the personal and professional experiences of peer educators to help identify HIV and HCV barriers and facilitators to care among PWID in Nairobi, including resource recommendations to improve service uptake. Methods: We recruited peer educators from two harm reduction facilities in Nairobi, Kenya, using random and purposive sampling techniques. Semi-structured interviews explored circumstances surrounding HIV and HCV service access, prevention education and resource recommendations. A thematic analysis was conducted using the Modified Social Ecological Model (MSEM) as an underlying framework, with illustrative quotes highlighting emergent themes. Results: Twenty peer educators participated, including six women, with 2 months to 6 years of harm reduction service. Barriers to HIV and HCV care were organized by (a) individual-level themes including competing needs of addiction and misinterpreted symptoms; (b) network-level themes including social isolation and drug pusher interactions; (c) community-level themes including transportation, mental and rural healthcare services, and limited HCV resources; and (d) policy-level themes including nonintegrated services, clinical administration, and law enforcement. Stigma, an overarching barrier, was highlighted throughout the MSEM. Facilitators to HIV and HCV care were comprised of (a) individual-level themes including concurrent care, personal reflections, and religious beliefs; (b) network-level themes including community recommendations, navigation services, family commitment, and employer support; (c) community-level themes including quality services, peer support, and outreach; and (d) policy-level themes including integrated services and medicalized approaches within law enforcement. Participant resource recommendations include (i) additional medical, social and ancillary support services, (ii) national strategies to address stigma and violence and (iii) HCV prevention education. Conclusions : Peer educators provided intimate knowledge of PWID barriers and facilitators to HIV and HCV care that were described at each level of the MSEM, and should be given careful consideration when developing future initiatives. Recommendations emphasized policy and community-level interventions including educational campaigns and program suggestions to supplement existing HIV and HCV services.

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