Assessing the relationship between syringe exchange, pharmacy, and street sources of accessing syringes and injection drug use behavior in a pooled nationally representative sample of people who inject drugs in the United States from 2002 to 2019

Provision of sterile syringes is an evidence-based strategy of reducing syringe sharing and reusing and yet, access to sterile syringes through pharmacies and syringe exchange programs (SEPs) in the United States remains inadequate. This nationally representative study examined associations between obtaining syringes from pharmacies, SEPs, and sterilizing syringes with bleach and risk of syringe borrowing, lending and reusing syringes in a pooled cross-sectional dataset of 1737 PWID from the 2002–2019 National Survey on Drug Use and Health. Logistic regression was used to produce odds ratios (OR) of the odds of injection drug behaviors after adjusting for obtaining syringes from SEPs, pharmacies, the street, and other sources and potential confounders of race, ethnicity, sex, education, and insurance coverage. Obtaining syringes through SEPs was associated with lower odds of borrowing (OR = .4, CI95% = .2, .9, p = .022) and reusing syringes (OR = .3, CI95% = .2, .6, < .001) compared to obtaining syringes on the street. Obtaining syringes from pharmacies was associated with lower odds of borrowing (OR = .5, CI95% = .3, .9, p = .037) and lending (OR = .5 CI95% = .3, .9, p = .020) syringes. Using bleach to clean syringes was associated with increased odds of borrowing (OR = 2.0, CI95% = 1.3, 3.0, p = .002), lending (OR = 2.0, CI95% = 1.3, 3.0, p = .002) and reusing syringes (OR = 2.4, CI95% = 1.6, 3.6, p < .001). Our findings support provision of syringes through pharmacies and SEPs as a gold-standard strategy of reducing sharing and reuse of syringes in the US.

Voluntary Pregnancy Screening at Syringe Exchanges: A Feasibility Study

The purpose of this study was to explore the feasibility of offering voluntary pregnancy screening at syringe exchange programs, using the National Implementation Research Network Hexagon Discussion and Analysis Tool. We conducted a survey among female syringe exchange clients, which assessed perceived needs, values, and behavioral intentions for parenting and entering treatment if they received a positive pregnancy screen, and surveys among staff and core volunteers to assess organizational fit, capacity, and needed supports. Participants and staff reported that pregnancy screening was needed at syringe exchange and that capacity needs to be expanded to provide services. Pregnancy screening at syringe exchanges holds the potential to lead to early detection of pregnancy. Early detection of pregnancy among women who inject drugs may result in improved prenatal care, including substance use treatment and treatment of infectious diseases, for women who would otherwise be unlikely to receive prenatal care.

Health Behaviors Survey among People Who Use Opioids: Protocol for Implementing Technology-Based Rapid Response Research in Community Settings (Preprint)

BACKGROUND In 2018, 2 million Americans met the DSM-5 diagnostic criteria for an opioid use disorder and 9.9 million had misused prescription pain relievers the previous year. Despite a rapid increase in opioid misuse, opioid use disorders, and overdoses, data is limited on the behavioral and contextual risk as well as protective factors fueling the opioid epidemic in some of the hardest hit U.S. cities – Atlanta, Los Angeles, and Las Vegas. Almost 70% of the 67,367 drug overdose deaths in the U.S. in 2018 involved an opioid. That same year, Georgia reported that over 60% of drug overdose deaths involved opioids (866), while California reported that 45% of those deaths involved opioids (> 2,400) and Nevada a total of 372 of those deaths involved an opioid. OBJECTIVE To describe characteristics and health behaviors of people who use opioids to inform public health practice, policy, and future research to mitigate the risks faced by this population experiencing multiple vulnerabilities. METHODS We implemented a community-engaged research strategy that involved development and implementation of a two-stage purposive sampling plan involving selection of partner organizations (syringe exchange programs in urban settings), and recruitment and enrollment of participants ages 18-69 years served by these organizations in Atlanta, Los Angeles, and Las Vegas from 2019-2020. The survey included a variety of measures, including those to assess general health behaviors, drug use and misuse, syringe exchange utilization, sex exchange, histories of interpersonal violence, and vaccine confidence. RESULTS The protocol was successfully implemented despite challenges like real-time technology issues and rapidly finding and surveying a difficult to reach population. We sampled 1,127 unique participants (248 in Atlanta, 465 in Los Angeles, 414 in Las Vegas). CONCLUSIONS The establishment and utilization of strong community partnerships enabled the rapid collection of data from a typically difficult to reach population. Local efforts like these are needed to develop policies and practices that promote harm reduction among people who use opioids.

594. Characteristics of an At-Risk Patient Population Presenting to a Philadelphia Student-Run Free Clinic within 30 Days of Hospital Visit

Background 30-day readmission rates are the parameter that hospitals and insurance companies use to measure clinical quality of care and set reimbursement levels for care (McCormack, et al., 2013). The 2019 readmission rate for United States hospitals was 14.9%; however, reported readmission rates vary in accuracy due to exclusion of at-risk populations or patients who seek care outside the hospital network (America’s Health Rankings, 2020; Gupta, et al., 2018). As coordinators of a student-run urgent care clinic operating within a Philadelphia syringe exchange and harm-reduction social services organization, we serve an at-risk patient population that includes a large portion of individuals who are transiently housed, people who engage in sex work, and people who use drugs (PWUD). We sought to determine our at-risk population’s impact on current readmission rates and the ability of hospitalization to meet their unique medical needs. Methods We conducted a retrospective review of 607 electronic charts for patients who sought care at our student run clinic associated with a syringe exchange in Kensington, Philadelphia from January 2017 to January 2020, and identified patients who visited our clinic within 30 days of self-reported hospitalization. We identified time since hospitalization, purpose for hospitalization, and reason for clinic visit. Results Of 607 visits, 100 (16.5%) self-reported hospitalization within 30 days clinic presentation. Of these 100 clinic visits, 64% presented with the same chief complaint as their reason for hospitalization, and 21% presented with a complication related to their hospital visit. 33% of visits associated with previous hospitalization were from infections associated with IV drug use, including abscess, cellulitis, and osteomyelitis. On average, patients presented 7.5 days following hospital departure. Conclusion We identified a high incidence of clinic visits for medical needs associated with recent hospitalization, particularly injection-related infection, which suggests insufficient hospital care for this at-risk population. The number of readmissions for this population is underestimated due to their ability to seek medical care outside of the hospital network. Disclosures All Authors: No reported disclosures

1543. Risk Reduction service delivery during the COVID Pandemic to a marginalized urban population in Newark, NJ

Background North Jersey Community Research Initiative (NJCRI) is a non- profit organization in Newark, NJ that provides medical care and support services for highly vulnerable and hard to reach patient populations (e.g. homeless, HIV/AIDS, transgender, MSM, injection drug users, sex workers), 83% of whom are people of color. We are in a unique position to identify critical vulnerabilities and continued risk factors in our communities and patients during pandemics especially identifying HIV, HCV and other STIs and providing support services to this population. Methods We assessed the impact of COVID on HIV, HCV, STI Clinical care, testing, prevention, treatment, mental health and substance abuse services and patent retention. We used our EMR data to track patient visits, prevention visits and testing pre and post covid. Post Covid we utilized Telemedicine and mobile units to continue to provide services as well as self collection kits for the patients for testing. We staggered schedules on site in our outdoor triage center for support services like syringe exchange and food pantry and made an outdoor triage center for all services. Our phone system was routed to providers who assessed provided medical care through telemedicine and remote lab orders and Medication orders were sent via EMR to pharmacies who delivered the medications. Results Pre Covid Jan-Feb 2020: 855 clinical visits including testing Behavioral visits 191. Syringe exchange 38,653 needles to 73 clients, Food 189 clients received food. LGBTQ service Clients Reached 779 Post Covid March 2020 333 clinical visits including testing behavioral visits 154 April 2020 360 clinical visits including testing behavioral visits 208 May 2020 447 clinical visits including testing behavioral visits 282 Syringe exchange March- May 27,367 needles to 53 clients Food received March-may 118 clients LGBTQ clients reached 2035 Conclusion Assess and implement best practices post COVID to plan for services in the event that we have another wave of COVID. STI, HIV and HCV services and testing can be successfully delivered remotely and through an outdoor triage facility in an underserved urban setting. Point of Service testing for both home and outdoor settings will be added to treatment paradigms to better serve the needs of the community. Disclosures All Authors: No reported disclosures