A qualitative study of facilitators and barriers to participate in a needle exchange program for women who inject drugs

Abstract Background Women who inject drugs (WWID) show higher levels of injecting risk behaviour compared to men, putting them at risk of contracting HIV and hepatitis C (HCV). Compared to men, WWID are also less present in harm reduction programs such as needle exchange programs (NEP). The aim of this study is to investigate reasons for, and barriers to, participation in NEP among WWID in Sweden, and to identify measures that could be taken to strengthen the program and increase participation among WWID. Method In-depth interviews (IDIs) were conducted with 20 WWID who had participated in the Stockholm NEP for at least six months and was over 18 years old. IDIs were audio recorded and transcribed et verbatim. Qualitative content analysis was used to identify themes. Results The need for sterile injection equipment was identified as the main driver to join and remain in the NEP program. Continuous participation in the NEP was further driven by easy access to a multitude of health-related services. The most valued service was the sexual and reproductive health services (SRHR), allowing participants to access contraceptives, cervical cancer screening and sexually transmitted infections testing (STI-testing). NEP staffs’ respectful treatment of participants further contributed to program participation. However, participants also expressed a number of concerns around NEP participation, which created barriers to joining. These included losing custody or visitation rights to children, male partner jealousy and violence, unwillingness to spend time in the waiting area and fear of receiving positive HIV/HCV test results. Practical barriers included limited opening hours and travel distance to the NEP. To strengthen the program, most participants requested additional SRHR services. Most participants also proposed some form of “women only” access to the NEP, to strengthen the feeling of the NEP as a safe space. Conclusion This study identified factors that may increase uptake of NEP among WWID. Additional SRHR services and “women only” access are recommended to be implemented and evaluated as part of NEP. These findings may inform and improve the current scale-up of NEPs in Sweden to ensure equal access to services.

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Costs and consequences of the Portuguese needle-exchange program in community pharmacies

Canadian Pharmacists Journal / Revue des Pharmaciens du Canada ◽

10.1177/1715163520915744 ◽

2020 ◽

Vol 153 (3) ◽

pp. 170-178

Author(s):

Margarida Borges ◽

Miguel Gouveia ◽

Francesca Fiorentino ◽

Gonçalo Jesus ◽

Maria Cary ◽

...

Keyword(s):

Health System ◽

Needle Exchange ◽

Hiv Infections ◽

Needle Exchange Program ◽

Community Pharmacies ◽

Net Benefit ◽

Exchange Programs ◽

Exchange Program ◽

Needle Exchange Programs ◽

The Impact

Background: Needle-exchange programs (NEPs) reduce infections in people who inject drugs. This study assesses the impact community pharmacies have had in the Needle-Exchange Program in Portugal since 2015. Methods: Health gains were measured by the number of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections averted, which were estimated, in each scenario, based on a standard model in the literature, calibrated to national data. The costs per infection were taken from national literature; costs of manufacturing, logistics and incineration of injection materials were also considered. The results were presented as net costs (i.e., incremental costs of the program with community pharmacies less the costs of additional infections avoided). Results: Considering a 5-year horizon, the Needle Exchange Program with community pharmacies would account for a 6.8% ( n = 25) and a 6.5% reduction ( n = 22) of HCV and HIV infections, respectively. The present value of net savings generated by the participation of community pharmacies in the program was estimated at €2,073,347. The average discounted net benefit per syringe exchanged is €3.01, already taking into account a payment to community pharmacies per needle exchanged. Interpretation: We estimate that the participation of community pharmacies in the Needle Exchange Program will lead to a reduction of HIV and HCV infections and will generate over €2 million in savings for the health system. Conclusions: The intervention is estimated to generate better health outcomes at lower costs, contributing to improving the efficiency of the public health system in Portugal.

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A Collaborative Evaluation of a Needle Exchange Program for Youth

Health Education & Behavior ◽

10.1177/109019819902600205 ◽

1999 ◽

Vol 26 (2) ◽

pp. 213-224 ◽

Cited By ~ 16

Author(s):

Rebecca L. Weiker ◽

Renee Edgington ◽

Michele D. Kipke

Keyword(s):

Harm Reduction ◽

Quantitative Methods ◽

Needle Exchange ◽

The United States ◽

Injection Drug ◽

Needle Exchange Program ◽

Multimethod Research ◽

Needle Exchange Programs ◽

Research Activities ◽

Collaborative Evaluation

Limited research has been conducted to examine the effectiveness of existing HIV prevention and harm reduction interventions targeted to injection drug-using youth. Moreover, although there are a growing number of needle exchange programs being developed for youth throughout the United States, the effects of these services have yet to be systematically evaluated. This article describes a collaborative evaluation conducted by the Division of Adolescent Medicine, Childrens Hospital Los Angeles, and Clean Needles Now, a needle exchange serving young injection drug users. The evaluation employed a multimethod research design that included both qualitative and quantitative methods. Findings are presented about how a community-based agency’s service delivery philosophy can affect the design and implementation of an evaluation. Lessons learned from this collaborative evaluation are presented, including the potential benefits of incorporating harm reduction principles into research activities.

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Visualizing the effect of needle exchange program scale-up in the Russian Federation: Findings from our web-based modeling tool

Annals of Global Health ◽

10.1016/j.aogh.2014.08.149 ◽

2014 ◽

Vol 80 (3) ◽

pp. 216

Author(s):

A. Goodell ◽

M. Malekinejad ◽

A. Mirzazadeh ◽

B. Harris ◽

E. Marseille ◽

...

Keyword(s):

Russian Federation ◽

Scale Up ◽

Needle Exchange ◽

Needle Exchange Program ◽

Web Based ◽

Modeling Tool ◽

Exchange Program ◽

The Russian Federation

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Health literacy and changes in pattern of drug use among participants at the Stockholm Needle Exchange Program during the COVID-19 pandemic

Harm Reduction Journal ◽

10.1186/s12954-021-00499-z ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

K. Lindqvist ◽

C. Wallmofeldt ◽

E. Holmén ◽

A. Hammarberg ◽

M. Kåberg

Keyword(s):

Health Literacy ◽

Drug Use ◽

Needle Exchange ◽

Needle Exchange Program ◽

Antibody Prevalence ◽

Igg Antibody ◽

Exchange Programs ◽

Needle Exchange Programs ◽

Social Vulnerabilities ◽

High Level

Abstract Background and aims People who inject drugs may be particularly vulnerable to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) due to underlying health problems, stigma and social vulnerabilities. Harm reduction services, including needle exchange programs (NEP), have been subjected to varying degrees of disruption in the world, especially in the beginning of the coronavirus disease 2019 (COVID-19) pandemic. Compared to responses in other countries, Sweden’s initial strategy toward limiting the spread and impact of COVID-19 was less restrictive to its citizens with no imposed general societal lockdown. In this study, we investigate changes in drug use patterns, utilization of NEP associated health services, COVID-19 health literacy and the prevalence of SARS-CoV-2 antibodies among NEP clients in Stockholm during the COVID-19 pandemic. Methods NEP visits and services provided (needles/syringes, HIV and hepatitis C tests and treatment, naloxone distributed) and overall mortality among NEP clients between January 1 and October 31, 2020, were used for trend analyses in comparison with corresponding 2019 data. Between July 27 and October 2, 2020, NEP clients (n = 232) responded to a 27 item COVID-19 Health Literacy Questionnaire. SARS CoV-2 IgG antibody tests (n = 779) were performed between June 15 and October 31, 2020. Results During the COVID-19 pandemic number of clients, client visits, naloxone distribution and HCV tests remained stable compared to 2019, while distribution of needles/syringes increased (p < 0.0001); number of HIV tests and HCV treatments decreased (p < 0.05); and mortality decreased (< 0.01). Overall, the level of health literacy concerning transmission routes and protective measures was high. SARS-CoV-2 antibody prevalence was 5.4% (95% CI 4.0–7.2). Conclusions The Stockholm NEP managed to maintain a high level of clients and services during the pandemic. In general, COVID-19 health literacy was adequate and the overall SARS-CoV-2 antibody prevalence was low compared to the general population, which highlights a need for prioritized and targeted COVID-19 vaccination among PWID.

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