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Erly S, Menza TW, Granillo L, Navejas M, Udeagu CCN, Brady KA, Hixson LK, Raj-Sing S, Nassau T, Kaasa C, Buskin S. Impact of COVID-19 on People Living With HIV: Data From Five Medical Monitoring Project Sites, 2020-2022. J Acquir Immune Defic Syndr 2024; 96:106-113. [PMID: 38567932 DOI: 10.1097/qai.0000000000003403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/18/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND The COVID-19 pandemic disrupted global economic and healthcare systems. People living with HIV (PLWH) represent a marginalized and stigmatized population who may have been particularly impacted. The purpose of this analysis was to describe the impact of the COVID-19 pandemic on PLWH in the United States. SETTING United States. METHODS We analyzed surveys of behavioral and clinical characteristics of PLWH residing in 5 states that participated in the Medical Monitoring Project between 2020 and 2022. We described the impact of COVID-19 illness, testing, and diagnoses; receipt of medical care; social service access; employment; and preventive measures by project site and demographic characteristics. RESULTS Unweighted data from 1715 PLWH were analyzed. A high proportion of PLWH had medical care disrupted by the pandemic; 31% of PLWH missed medical appointments, 26% missed routine laboratory test results, and 7% missed antiretroviral therapy doses. In total, 30% of PLWH reported losing wages and 19% reported difficulty in accessing social services. Overall, 88% reported receiving at least 1 dose of COVID-19 vaccine, but vaccine uptake was low among younger, Black, and Hispanic or Latina/o/x PLWH. CONCLUSIONS This descriptive analysis reinforces previous findings that show that COVID-19 negatively impacted PLWH and their ability to obtain medical care. Additional efforts will be critical to ameliorating the longer-term impacts of COVID-19 on the health of PLWH and supporting PLWH through future pandemics and healthcare system disruptions.
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Affiliation(s)
- Steven Erly
- Washington State Department of Health Office of Infectious Disease, Olympia, WA
- University of Washington Department of Epidemiology, Seattle WA
| | - Tim W Menza
- Oregon Health Authority Department of Public Health, Salem, OR
- Oregon Health & Science University Division of General Internal Medicine, Portland, OR
| | - Lauren Granillo
- Office of AIDS, Center for Infectious Diseases, California Department of Public Health. Sacramento, CA
| | - Michael Navejas
- New York City Department of Health and Mental Hygiene, New York City, NY
| | - Chi-Chi N Udeagu
- New York City Department of Health and Mental Hygiene, New York City, NY
| | - Kathleen A Brady
- Philadelphia Department of Public Health Division of HIV Health, Philadelphia, PA; and
| | | | - Shavvy Raj-Sing
- New York City Department of Health and Mental Hygiene, New York City, NY
| | - Tanner Nassau
- Philadelphia Department of Public Health Division of HIV Health, Philadelphia, PA; and
| | - Chelsey Kaasa
- Washington State Department of Health Office of Infectious Disease, Olympia, WA
| | - Susan Buskin
- University of Washington Department of Epidemiology, Seattle WA
- Public Health Seattle & King County HIV/STD Program, Seattle, WA
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Hatch MA, Laschober TC, Ertl MM, Paschen-Wolff MM, Norman G, Wright L, Tross S. Program Director Reports of COVID-19 Lockdown-Driven Service Changes in Community-Based STI Clinics and Syringe Services Programs in the Southeastern U.S. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2024; 36:129-140. [PMID: 38648174 DOI: 10.1521/aeap.2024.36.2.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
The COVID-19 pandemic strained the U.S. health care system, posing logistical challenges for community-based programs. This study surveyed 11 program directors in sexually transmitted infection (STI) clinics and syringe services programs (SSPs) that served people who use substances and are at risk for HIV in five southeastern U.S. states. Brief survey questions asked about programs' use of in-person and telehealth services. Results indicated widespread reduction of in-person services and concomitant adoption of telehealth services. In STI clinics, telehealth replaced in-person visits for all but urgent treatment of active symptoms. In SSPs, in-person contact continued or increased from pre-pandemic volumes. In both programs, the most salient telehealth use barrier was limited device or internet access and limited technological ease. Services were sustained through innovative adaptations. This snapshot of response to the early COVID-19 lockdown phase offers actionable guidance about service preparedness for future public health catastrophes in community-based programs serving vulnerable populations.
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Affiliation(s)
- Mary A Hatch
- Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Tanja C Laschober
- Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Melissa M Ertl
- Department of Psychology, University of Minnesota-Twin Cities, Minneapolis, Minnesota
| | - Margaret M Paschen-Wolff
- Division on Substance Use Disorders, Department of Psychiatry, Columbia University Irving Medical Center at New York State Psychiatric Institute, New York, New York
| | - Gaia Norman
- Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Lynette Wright
- Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Susan Tross
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, New York
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Taha S, King S, Atif S, Bate E. Changes in harm reduction service providers professional quality of life during dual public health emergencies in Canada. Harm Reduct J 2024; 21:48. [PMID: 38388932 PMCID: PMC10882723 DOI: 10.1186/s12954-024-00966-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 02/20/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Harm reduction (HR) is a critical response to the pronounced toxicity deaths being experienced in Canada. HR providers report many benefits of their jobs, but also encounter chronic stress from structural inequities and exposure to trauma and death. This research study sought to quantify the emotional toll the toxicity emergency placed on HR providers (Cycle One; 2019). Study objectives were later expanded to determine the impact of the ongoing toxicity as well as the pandemic's impact on well-being (Cycle Two; 2021). METHODS Standardized measures of job satisfaction, burnout, secondary traumatic stress, and vulnerability to grief were used in an online national survey. Open-ended questions addressed resources and supports. HR partners across Canada validated the findings and contributed to alternative interpretations and implications. RESULTS 651 respondents in Cycle One and 1,360 in Cycle Two reported moderately high levels of job satisfaction; they reported finding great meaning in their work. Yet, mean levels of burnout and secondary traumatic stress were moderate, with the latter significantly increasing in Cycle Two. Reported vulnerability to grief was moderate but increased significantly during COVID. When available, supports lacked the quality necessary to respond to the complexities of HR workers' experiences, or an insufficient number of sessions were covered through benefits. Respondents shared that their professional quality of life was affected more by policy failures and gaps in the healthcare system than it was by the demands of their jobs. CONCLUSION Both the benefits and the strain of providing harm reduction services cannot be underestimated. For HR providers, these impacts are compounded by the drug toxicity emergency, making the service gaps experienced by them all the more critical to address. Implications highlight the need for integration of HR into the healthcare system, sustainable and reliable funding, sufficient counselling supports, and equitable staffing models. Support for this essential workforce is critical to ensuring the well-being of themselves, the individuals they serve, and the health of the broader healthcare system.
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Affiliation(s)
- Sheena Taha
- Canadian Centre on Substance Use and Addiction, 75 Albert St, Ottawa, ON, K1P 5E7, Canada.
| | - Samantha King
- Canadian Centre on Substance Use and Addiction, 75 Albert St, Ottawa, ON, K1P 5E7, Canada
| | - Sara Atif
- Canadian Centre on Substance Use and Addiction, 75 Albert St, Ottawa, ON, K1P 5E7, Canada
| | - Eliza Bate
- Canadian Centre on Substance Use and Addiction, 75 Albert St, Ottawa, ON, K1P 5E7, Canada
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Grin B. Opioid Use Disorder in Missouri: An Evidence-Based, Public Health-Oriented Approach. MISSOURI MEDICINE 2024; 121:81-86. [PMID: 38404434 PMCID: PMC10887455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Opioid use disorder (OUD) represents a growing public health crisis in Missouri and nationwide. Reversing the trend of rising OUD-associated morbidity and mortality will require implementing evidence-based approaches grounded in public health principles. Key evidence-based interventions include medications for opioid use disorder, naloxone distribution, overdose education, and syringe services programs. The increasing presence of fentanyl and xylazine in the drug supply represent new challenges to the OUD crisis in Missouri. Optimal implementation of evidence-based interventions will require action at the individual physician, community, and state policy level.
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Affiliation(s)
- Benjamin Grin
- Assistant Professor of Primary Care, Kansas City University, Kansas City, Missouri
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5
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Footman K, Page P, Boydell V, McLaren M, Mudhune S. Adapting to a global pandemic: a qualitative assessment of programmatic responses to COVID-19 in the multi-country Women's Integrated Sexual Health (WISH) programme. Sex Reprod Health Matters 2023; 31:2260174. [PMID: 37830779 PMCID: PMC10578083 DOI: 10.1080/26410397.2023.2260174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
Abstract
The COVID-19 pandemic caused significant disruption to sexual and reproductive health and rights (SRHR) globally but there is little published evidence on the COVID-19 response of SRHR programmes, or lessons learned through their adaptations. To document the COVID-19 response of a global SRHR programme (the Women's Integrated Sexual Health programme), in-depth interviews were conducted between April and July 2021 with 22 key informants from implementing partners in Sierra Leone, Ethiopia and central or regional offices, the UK Foreign, Commonwealth and Development Office and the third-party monitoring partner. Framework analysis methods were used. Several rapid COVID-19 adaptations were identified: the development of crisis management and communication teams; increased partnership and engagement with government; reduced contact and risk in service delivery; reformulated community mobilisation; flexible performance management and remote methods of quality assurance; and sharing of learnings alongside the development of new guidance and tools. Throughout the pandemic, the programme was able to continue high-quality service delivery, though equity goals proved more difficult to reach. Challenges included the continually changing environment, competing pressures on governments, burdensome reporting, and staff burnout. The pandemic response was facilitated by prior experience of health emergencies, strong government relationships, a supportive workforce and some pre-existing approaches, tools, and systems. This study has identified important lessons that can inform programming in future crises, including the need for immediate recognition of SRHR as essential, sustained support for staff, use of multiple mechanisms to reach marginalised groups, adequate funding for equity goals, and a better balance between the burden of reporting and accountability needs.
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Affiliation(s)
- Katy Footman
- Consultant, Itad, Hove, UK; PhD Student, London School of Economics, London, UK
| | | | - Victoria Boydell
- Consultant, Itad, Hove, UK; Lecturer in Global Public Health, University of Essex, Colchester, UK
| | - Megan McLaren
- Evidence and Impact Advisor, MSI Reproductive Choices, London, UK
| | - Sandra Mudhune
- Deputy Director, Evidence and Learning – WISH2ACTION, International Planned Parenthood Federation, Nairobi, Kenya
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Hill K, Dunham K, Grau LE, Heimer R. "It's starting to weigh on me": Exploring the Experiences and Support Needs of Harm Reduction Staff in Connecticut using the Social-Ecological Model. Harm Reduct J 2023; 20:168. [PMID: 37964261 PMCID: PMC10644636 DOI: 10.1186/s12954-023-00898-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/02/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND The experiences and perceived support needs of harm reduction workers in the USA have been understudied. While previous research has explored staff burnout and role-related stress, there is a research gap around potential supports for staff wellbeing and individual longevity in their roles. This is especially critical given the growing overdose crisis and the need for sustainable harm reduction programming. Thus, we sought to describe the experiences of harm reduction staff and identify the perceived support that could empower harm reduction staff to successfully navigate their roles. METHODS Purposive sampling methods were used to recruit harm reduction staff working in Connecticut. Seventeen semi-structured, one-on-one interviews were conducted between December 2022 and March 2023. Participants were asked about their experiences with role-related stressors and supports. Informed by the Social-Ecological Model, transcripts were coded using both inductive and deductive codes, and themes were developed using thematic analysis approaches. RESULTS Study participants described their experiences working in harm reduction and the numerous ways they already are or could be receiving support in their roles. These experiences were organized into eight themes according to the levels of the Social-Ecological Model. At the individual level, participants explained that support could help them navigate the variability of the physical environment, boundary setting, and self-care. Relationships between clients and co-workers were both identified as means of support at the interpersonal level, helping participants navigate difficult situations and feelings of stress. At the organizational level, study participants explained how they look to their organization to provide sufficient support by way of training, staffing, compensation, and benefits. Additionally, participants stressed the importance of having supervisors who valued their work and provided emotional support. Lastly, at the community level, participants discussed how support was needed to help them navigate complex systems while working with a stigmatized population in an often-stigmatized field. CONCLUSIONS To best support harm reduction staff in their day-to-day roles, our findings underscore the need for support on multiple levels. Future research could explore how the provision of support to harm reduction staff impacts not only staff perceptions of support but also the success of clients accessing harm reduction services.
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Affiliation(s)
- Katherine Hill
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
| | - Katherine Dunham
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Lauretta E Grau
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Robert Heimer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
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Hill K, Thakarar K, Eslinger H, Prosperino L, Sue KL. Improving the Health of People Who Inject Drugs Through COVID-19-Related Policies. Public Health Rep 2023; 138:862-864. [PMID: 37610106 PMCID: PMC10576482 DOI: 10.1177/00333549231192468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Affiliation(s)
- Katherine Hill
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Kinna Thakarar
- Center for Interdisciplinary Population & Health Research/Maine, Portland, ME, USA
- Department of Medicine, Maine Medical Center, Portland, ME, USA
- Tufts University School of Medicine, Boston, MA, USA
- Maine Medical Partners Adult Infectious Diseases, South Portland, ME, USA
| | | | | | - Kimberly L. Sue
- Department of General Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
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Bartholomew TS, Tookes HE, Chueng TA, Bluthenthal RN, Wenger LD, Kral AH, Lambdin BH. Availability of telehealth-based services at syringe services programs under the COVID-19 Public Health Emergency. Harm Reduct J 2023; 20:122. [PMID: 37660029 PMCID: PMC10475193 DOI: 10.1186/s12954-023-00861-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/27/2023] [Indexed: 09/04/2023] Open
Abstract
INTRODUCTION The expanded capacity of syringe services programs (SSPs) in the USA to integrate telehealth services was largely related to flexibility of buprenorphine prescription in response to the COVID-19 pandemic. SSPs demonstrated the potential of using telehealth to reach participants with both medical and non-medical services. The present study examines the implementation of medical and non-medical telehealth-based health services in 2020 at SSPs in the USA and organizational characteristics associated with adopting specific telehealth services. METHODS We administered a cross-sectional survey among all known SSPs operating in the USA as of 2021. The two primary study outcomes were (1) implementation of medical telehealth and (2) implementation of non-medical telehealth in 2020. Medical services included HIV counseling/care, hepatitis C virus (HCV) counseling/care, and buprenorphine. Non-medical services included wellbeing/check-ins, overdose prevention training, health navigation, harm reduction and psychological counseling. Bivariate and multivariable mixed effects logistic regression models were used to directly estimate the odds ratio associated with organizational characteristics on the implementation of telehealth-based health services. RESULTS Thirty percent of programs (n = 290) reported implementing telehealth-based health services. In multivariable logistic regression models, community-based organization SSPs had higher odds of implementing medical (aOR = 4.69, 95% CI [1.96, 11.19]) and non-medical (aOR = 2.18, 95% CI [1.10, 4.31]) health services compared to public health department SSPs. SSPs that received governmental funding had higher odds of implementing medical services via telehealth (aOR = 2.45, 95% CI [1.35, 4.47]) compared to programs without governmental funding. CONCLUSION Community-based organization SSPs and those with government funding had the highest odds of telehealth implementation in response to the COVID-19 Public Health Emergency. Federal, state, and local governments must increase funding for low-barrier venues like SSPs to support telehealth implementation to serve the needs of people who use drugs.
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Affiliation(s)
| | - Hansel E Tookes
- University of Miami, 1120 NW 14th St #860, Miami, FL, 33136, USA.
| | - Teresa A Chueng
- University of Miami, 1120 NW 14th St #860, Miami, FL, 33136, USA
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van Draanen J, Hamilton J, Morgan J, Maxwell S, Taylor T, Richardson L, Nolan S. Supervised smoking facility access, harm reduction practices, and substance use changes during the COVID-19 pandemic: a community-engaged cross-sectional study. Harm Reduct J 2023; 20:101. [PMID: 37525168 PMCID: PMC10388471 DOI: 10.1186/s12954-023-00825-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 07/16/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND The potential public health benefits of supervised smoking facilities (SSFs) are considerable, and yet implementation of SSFs in North America has been slow. We conducted this study to respond to significant knowledge gaps surrounding SSF utilization and to characterize substance use, harm reduction practices, and service utilization following the onset of the COVID-19 pandemic. METHODS A questionnaire was self-administered at a single site by 175 clients using an outdoor SSF in Vancouver, Canada, between October-December 2020. Questionnaire responses were summarized using descriptive statistics. Multinomial logistic regression techniques were used to examine factors associated with increased SSF utilization. RESULTS Almost all respondents reported daily substance use (93% daily use of opioids; 74% stimulants). Most used opioids (85%) and/or methamphetamine (66%) on the day of their visit to the SSF. Respondents reported drug use practice changes at the onset of COVID-19 to reduce harm, including using supervised consumption sites, not sharing equipment, accessing medically prescribed alternatives, cleaning supplies and surfaces, and stocking up on harm reduction supplies. Importantly, 45% of SSF clients reported using the SSF more often since the start of COVID-19 with 65.2% reporting daily use of the site. Increased substance use was associated with increased use of the SSF, after controlling for covariates. CONCLUSIONS Clients of the SSF reported increasing not only their substance use, but also their SSF utilization and harm reduction practices following the onset of COVID-19. Increased scope and scale of SSF services to meet these needs are necessary.
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Affiliation(s)
- Jenna van Draanen
- BC Centre On Substance Use, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
- Child, Family, and Population Health Nursing, Health Sciences Building, University of Washington, Box 357262, Seattle, WA, 98195-0005, USA.
| | - Jonah Hamilton
- BC Centre On Substance Use, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Jeffrey Morgan
- BC Centre On Substance Use, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Scott Maxwell
- Overdose Prevention Participatory Research Assistant Program, Overdose Prevention Society, 58 E Hastings St, Vancouver, BC, V6A 1N1, Canada
| | - Tara Taylor
- Overdose Prevention Participatory Research Assistant Program, Overdose Prevention Society, 58 E Hastings St, Vancouver, BC, V6A 1N1, Canada
- Spencer Creo Foundation, 500-610 Main St, Vancouver, BC, V6A 2V3, Canada
| | - Lindsey Richardson
- BC Centre On Substance Use, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Department of Sociology, Faculty of Arts, University of British Columbia, 6303 NW Marine Drive, Vancouver, BC, V6T 1Z1, Canada
| | - Seonaid Nolan
- BC Centre On Substance Use, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
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Pietrantoni D, Barroca C, Lynch S, Byrne J, Ortner M, Kotwani R, Limbrick K, Kaldas P, Moussa M, Fredrickson T, Schaefer J, Jacobs RJ. A Scoping Review on the Effects of COVID-19 on Syringe Service Programs in the United States. Cureus 2023; 15:e39023. [PMID: 37378253 PMCID: PMC10292154 DOI: 10.7759/cureus.39023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/14/2023] [Indexed: 06/29/2023] Open
Abstract
The COVID-19 pandemic has had worldwide impacts, including disrupting community services. One interrupted service was syringe service programs (SSPs), community-established initiatives that provide sterile supplies and aid in overcoming addiction in drug-using participants. In the United States (U.S.), SSPs have been key in combating the recent opioid use crisis and associated infections such as the human immunodeficiency virus (HIV) and hepatitis C. While some published reports on the pandemic's overall impacts on SSPs exist, certain aspects such as operational changes and repercussions on staff and participants may still be lacking. Information about the impact of interrupted SSP services due to the pandemic may provide insight into how to prepare to mitigate similar outcomes during possible future health outbreaks. The aim of this scoping review was thus to explore the effects of the COVID-19 pandemic on the operations, staff, and participants of SSPs in the U.S. The initial search of the databases PubMed, Embase, and Web of Science with selected keywords yielded 117 articles published in English between January 1, 2020, and August 31, 2022. After screening each article for study eligibility, 11 articles were included in the final review. Of the seven articles exploring SSP operational impacts from the pandemic, five acknowledged that mitigation strategies influenced functions, seven highlighted supply changes, and four emphasized the resulting staffing changes. Four studies inspected the pandemic's impacts on SSP participants, which included two articles highlighting participants' struggles with isolation and loneliness, one referencing the fear of exposure to the SARS-CoV-2 virus, and two examining the overall negative psychological effects experienced during this time. SSPs in various settings and regions across the U.S. experienced changes due to the COVID-19 pandemic. Many of these modifications negatively impacted operations, staffing, and participant relationships. Examining the issues that individual SSPs encountered highlights opportunities for structured solutions for the present and in the case of future infectious disease outbreaks. With the severity of the opioid use crisis in the U.S. and the dependence on SSPs for its mitigation, future work in this space should be prioritized.
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Affiliation(s)
- Dylan Pietrantoni
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Crystal Barroca
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Sarah Lynch
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Jonathan Byrne
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Miranda Ortner
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Roshni Kotwani
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Kolin Limbrick
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Paul Kaldas
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Michael Moussa
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Tatem Fredrickson
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Jeffrey Schaefer
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Robin J Jacobs
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
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Stringfellow EJ, Lim TY, DiGennaro C, Hasgul Z, Jalali MS. Enumerating contributions of fentanyls and other factors to the unprecedented 2020 rise in opioid overdose deaths: model-based analysis. PNAS NEXUS 2023; 2:pgad064. [PMID: 37020497 PMCID: PMC10069612 DOI: 10.1093/pnasnexus/pgad064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/13/2023] [Accepted: 02/21/2023] [Indexed: 03/07/2023]
Abstract
In 2020, the ongoing US opioid overdose crisis collided with the emerging COVID-19 pandemic. Opioid overdose deaths (OODs) rose an unprecedented 38%, due to a combination of COVID-19 disrupting services essential to people who use drugs, continued increases in fentanyls in the illicit drug supply, and other factors. How much did these factors contribute to increased OODs? We used a validated simulation model of the opioid overdose crisis, SOURCE, to estimate excess OODs in 2020 and the distribution of that excess attributable to various factors. Factors affecting OODs that could have been disrupted by COVID-19, and for which data were available, included opioid prescribing, naloxone distribution, and receipt of medications for opioid use disorder. We also accounted for fentanyls' presence in the heroin supply. We estimated a total of 18,276 potential excess OODs, including 1,792 lives saved due to increases in buprenorphine receipt and naloxone distribution and decreases in opioid prescribing. Critically, growth in fentanyls drove 43% (7,879) of the excess OODs. A further 8% is attributable to first-ever declines in methadone maintenance treatment and extended-released injectable naltrexone treatment, most likely due to COVID-19-related disruptions. In all, 49% of potential excess OODs remain unexplained, at least some of which are likely due to additional COVID-19-related disruptions. While the confluence of various COVID-19-related factors could have been responsible for more than half of excess OODs, fentanyls continued to play a singular role in excess OODs, highlighting the urgency of mitigating their effects on overdoses.
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Affiliation(s)
- Erin J Stringfellow
- Massachusetts General Hospital, Harvard Medical School, 101 Merrimac St, Boston, MA 02114, USA
| | - Tse Yang Lim
- Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
- MIT Sloan School of Management, 100 Main St, Cambridge, MA 02142, USA
| | - Catherine DiGennaro
- Massachusetts General Hospital, Harvard Medical School, 101 Merrimac St, Boston, MA 02114, USA
- MIT Sloan School of Management, 100 Main St, Cambridge, MA 02142, USA
| | - Zeynep Hasgul
- Massachusetts General Hospital, Harvard Medical School, 101 Merrimac St, Boston, MA 02114, USA
| | - Mohammad S Jalali
- Massachusetts General Hospital, Harvard Medical School, 101 Merrimac St, Boston, MA 02114, USA
- MIT Sloan School of Management, 100 Main St, Cambridge, MA 02142, USA
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Allen ST, Schneider KE, Morris M, Rouhani S, Harris SJ, Saloner B, Sherman SG. Factors associated with receptive injection equipment sharing among people who inject drugs: findings from a multistate study at the start of the COVID-19 pandemic. Harm Reduct J 2023; 20:18. [PMID: 36793041 PMCID: PMC9930060 DOI: 10.1186/s12954-023-00746-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/02/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Receptive injection equipment sharing (i.e., injecting with syringes, cookers, rinse water previously used by another person) plays a central role in the transmission of infectious diseases (e.g., HIV, viral hepatitis) among people who inject drugs. Better understanding these behaviors in the context of COVID-19 may afford insights about potential intervention opportunities in future health crises. OBJECTIVE This study examines factors associated with receptive injection equipment sharing among people who inject drugs in the context of COVID-19. METHODS From August 2020 to January 2021, people who inject drugs were recruited from 22 substance use disorder treatment programs and harm reduction service providers in nine states and the District of Columbia to complete a survey that ascertained how the COVID-19 pandemic affected substance use behaviors. We used logistic regression to identify factors associated with people who inject drugs having recently engaged in receptive injection equipment sharing. RESULTS One in four people who inject drugs in our sample reported having engaged in receptive injection equipment sharing in the past month. Factors associated with greater odds of receptive injection equipment sharing included: having a high school education or equivalent (adjusted odds ratio [aOR] = 2.14, 95% confidence interval [95% CI] 1.24, 3.69), experiencing hunger at least weekly (aOR = 1.89, 95% CI 1.01, 3.56), and number of drugs injected (aOR = 1.15, 95% CI 1.02, 1.30). Older age (aOR = 0.97, 95% CI 0.94, 1.00) and living in a non-metropolitan area (aOR = 0.43, 95% CI 0.18, 1.02) were marginally associated with decreased odds of receptive injection equipment sharing. CONCLUSIONS Receptive injection equipment sharing was relatively common among our sample during the early months of the COVID-19 pandemic. Our findings contribute to existing literature that examines receptive injection equipment sharing by demonstrating that this behavior was associated with factors identified in similar research that occurred before COVID. Eliminating high-risk injection practices among people who inject drugs requires investments in low-threshold and evidence-based services that ensure persons have access to sterile injection equipment.
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Affiliation(s)
- Sean T. Allen
- grid.21107.350000 0001 2171 9311Department of Health, Behavior, Society; Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 184, Baltimore, MD 21205 USA
| | - Kristin E. Schneider
- grid.21107.350000 0001 2171 9311Department of Health, Behavior, Society; Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 184, Baltimore, MD 21205 USA
| | - Miles Morris
- grid.21107.350000 0001 2171 9311Department of Health, Behavior, Society; Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 184, Baltimore, MD 21205 USA
| | - Saba Rouhani
- grid.21107.350000 0001 2171 9311Department of Health, Behavior, Society; Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 184, Baltimore, MD 21205 USA
| | - Samantha J. Harris
- grid.21107.350000 0001 2171 9311Department of Health Policy and Management; Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Brendan Saloner
- grid.21107.350000 0001 2171 9311Department of Health Policy and Management; Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Susan G. Sherman
- grid.21107.350000 0001 2171 9311Department of Health, Behavior, Society; Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 184, Baltimore, MD 21205 USA
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The effects of COVID-19 on New York State's Drug User Health Hubs and syringe service programs: a qualitative study. Harm Reduct J 2023; 20:12. [PMID: 36732773 PMCID: PMC9893960 DOI: 10.1186/s12954-023-00742-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/19/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Syringe service programs (SSPs) deliver critical harm reduction services to people who inject drugs (PWID). Some SSPs in New York State received enhanced funding to provide additional services to combat opioid overdose fatalities. These SSPs, known as Drug User Health Hubs, provide buprenorphine for the treatment of opioid use disorder and other health-related services in addition to their syringe services. While the COVID-19 pandemic posed widespread challenges to the delivery of health services nationwide, the effect of the pandemic on SSPs uniquely impacts PWID. This study examines the impact of COVID-19 on service delivery of Drug User Health Hubs and stand-alone SSPs in New York State. METHODS Between July 2020 and September 2020, we performed eleven semi-structured virtual interviews with staff from three Health Hub SSPs and three stand-alone SSPs. The interviews explored the effect of the COVID-19 pandemic on SSPs and their clients as well as the changes implemented in response. Interviews were recorded and transcribed. We performed content analysis to identify emerging themes from the data. RESULTS Due to the COVID-19 pandemic, some SSPs temporarily shut down while others limited their hours of operation. SSPs modified their service delivery to maintain syringe services and naloxone distribution over other services such as STI and HCV testing. They virtualized components of their services, including telemedicine for the provision of buprenorphine. While SSPs found virtualization to be important for maintaining their services, it negatively impacted the intimate nature of client interactions. Participants also described the impact of the pandemic on the well-being of PWID, including isolation, worsened mental health challenges, and increased drug overdoses. CONCLUSIONS In response to the COVID-19 pandemic, SSPs demonstrated innovation, adaptability, and togetherness. Despite the challenges posed by the pandemic, SSPs continued to be key players in maintaining access to sterile supplies, buprenorphine, and other services for PWID. In addition to adapting to COVID-19 restrictions, they also responded to the dynamic needs of their clients. Sustainable funding and recognition of the critical role of SSPs in supporting PWID can help to improve outcomes for PWID.
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Shrader CH, Borquez A, Vasylyeva TI, Chaillon A, Artamanova I, Harvey-Vera A, Vera CF, Rangel G, Strathdee SA, Skaathun B. Network-level HIV risk norms are associated with individual-level HIV risk and harm reduction behaviors among people who inject drugs: a latent profile analysis. AIDS Behav 2023; 27:484-495. [PMID: 35939177 PMCID: PMC9358371 DOI: 10.1007/s10461-022-03783-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 11/28/2022]
Abstract
The COVID-19 related U.S.-Mexico border-crossing restrictions disrupted social networks and HIV harm reduction services among people who inject drugs (PWID) in San Diego and Tijuana. We assessed associations of descriptive network norms on PWID's HIV vulnerability during this period. Between 10/2020 and 10/2021, 399 PWID completed a behavioral and egocentric questionnaire. We used Latent Profile Analysis to categorize PWID into network norm risk profiles based on proportions of their network (n = 924 drug use alters) who injected drugs and engaged in cross-border drug use (CBDU), among other vulnerabilities. We used logistic and linear regressions to assess network profile associations with individual-level index of HIV vulnerability and harm reduction behaviors. Fit indices specified a 4-latent profile solution of descriptive network risk norms: lower (n = 178), moderate with (n = 34) and without (n = 94) CBDU and obtainment, and higher (n = 93). Participants in higher risk profiles reported more HIV vulnerability behaviors and fewer harm reduction behaviors. PWID's gradient of HIV risk was associated with network norms, warranting intervention on high-vulnerability networks when services are limited.
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Affiliation(s)
- Cho-Hee Shrader
- ICAP at Columbia University, New York, NY United States of America
| | - Annick Borquez
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA United States of America
| | - Tetyana I. Vasylyeva
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA United States of America
| | - Antoine Chaillon
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA United States of America
| | - Irina Artamanova
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA United States of America
| | - Alicia Harvey-Vera
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA United States of America
- Facultad de Medicina, Universidad Xochicalco Campus Tijuana, Tijuana, Baja California Mexico
- Mexican Section, United States-Mexico Border Health Commission, Tijuana, Baja California Mexico
| | - Carlos F. Vera
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA United States of America
| | - Gudelia Rangel
- Mexican Section, United States-Mexico Border Health Commission, Tijuana, Baja California Mexico
- Departmento de Estudios de Población, El Colegio de la Frontera Norte, Tijuana, Baja California Mexico
| | - Steffanie A. Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA United States of America
| | - Britt Skaathun
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA United States of America
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Torres-Leguizamon M, Favaro J, Coello D, Reynaud EG, Néfau T, Duplessy C. Remote harm reduction services are key solutions to reduce the impact of COVID-19-like crises on people who use drugs: evidence from two independent structures in France and in the USA. Harm Reduct J 2023; 20:1. [PMID: 36611167 PMCID: PMC9823260 DOI: 10.1186/s12954-023-00732-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 01/03/2023] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Harm Reduction (HR) policies for People Who Use Drugs (PWUD) have a significant positive impact on their health. Such approaches limit the spread of infections and reduce opioid overdose mortality. These policies have led to the opening of specialized structures located mainly in big cities and urbanized zones. The COVID-19 pandemic reduced access to HR structures in locations undergoing lockdown. Before the pandemic, HR services in France and in the USA were complemented by the development of remote HR programs: HaRePo (Harm Reduction by Post) for France, implemented in 2011, and NEXT Distro for the USA founded in 2017. These programs are free and specifically designed for people who have difficulties accessing HR tools and counseling in-person. PWUD can access HaRePo program by phone and/or email. NEXT Distro users can access the program through its dedicated website. The aim of the study is to test if and possibly how COVID-19 pandemic and the associated lockdowns have impacted the HR services in both countries. METHODS By using t-test comparing the year 2019 with the year 2020, we analyzed how lockdowns impacted the number of new users entering the programs, as well as the numbers of parcels sent and naloxone distributed, by using records of both structures. RESULTS We showed that the activity of both programs was significantly impacted by the pandemic. Both show an increase in the number of new users joining the programs (+ 77.6% for HaRePo and + 247.7% for NEXT Distro) as well as for the number of parcels sent per month (+ 42.7% for HaRePo and + 211.3% for NEXT Distro). It shows that remote HR was able to partially compensate for the reduced HR activities due to COVID-19. We also observed that the distribution of naloxone per parcel tends to increase for both structures. CONCLUSION With the ability to reach PWUD remotely, HaRePo and NEXT Distro were particularly effective at maintaining service continuity and scaling up services to meet the needs of PWUD during the COVID-19 pandemic. By studying two independent structures in France and in the USA sharing similar objectives (remote HR), we showed that this approach can be a key solution to crises that impact classical HR structures despite various differences in operating procedures between countries.
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Affiliation(s)
| | | | | | - Emmanuel G. Reynaud
- grid.7886.10000 0001 0768 2743School of Biomolecular and Biomedical Science, University College Dublin, Dublin, Ireland
| | - Thomas Néfau
- SAFE, 11 Avenue de la Porte de la Plaine, 75015 Paris, France
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16
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Schneider KE, Allen ST, Rouhani S, Morris M, Haney K, Saloner B, Sherman SG. Increased solitary drug use during COVID-19: An unintended consequence of social distancing. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 111:103923. [PMID: 36521196 PMCID: PMC9678832 DOI: 10.1016/j.drugpo.2022.103923] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/29/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, overdose rates substantially increased in the United States. One possible contributor to this phenomenon may be solitary drug use resulting from social distancing efforts to prevent COVID-19 transmission. METHODS We surveyed 458 people who use drugs (PWUD) who were recruited from harm reduction and drug treatment providers located in nine states and the District of Columbia. We assessed if solitary drug use had increased since the start of COVID-19. Associations between increased solitary drug use and sociodemographic characteristics, drug use characteristics, and COVID-19 prevention behaviors were examined using multiple logistic regression. RESULTS Half the sample identified as men (52.7%), White (49.7%), and single (49.3%). The average age was 43.2 (SD:11.8) years. Two-thirds (66.8%) recently injected drugs. 44% reported increased solitary drug use since COVID-19. Significant correlates of increased solitary drug use included being single (adjusted Odds Ratio [aOR]=1.99, 95% Confidence Interval [CI]: 1.33, 2.98), increasing drug use (aOR=2.74, 95% CI: 1.72, 4.37), using more in private locations (aOR=1.91, 95% CI: 1.34, 2.72), and social distancing behaviors (aOR=1.31, 95% CI: 1.11, 1.54). Experiencing homelessness (aOR=0.45, 95% CI: 0.31, 0.65) and identifying as a sexual minority (aOR=0.53, 95% CI: 0.31, 0.93) were associated with being less likely to increase solitary drug use. CONCLUSIONS Solitary drug use increased during the COVID-19 pandemic. Increases in solitary drug use, in the context of a drug market increasingly permeated by fentanyl, indicates an urgent need for comprehensive harm reduction interventions to reduce overdose mortality.
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Affiliation(s)
- Kristin E. Schneider
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, USA,Corresponding author
| | - Sean T. Allen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, USA
| | - Saba Rouhani
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, USA,School of Global Public Health, New York University, 708 Broadway, New York, NY 10003, USA
| | - Miles Morris
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, USA
| | - Katherine Haney
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, USA
| | - Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, USA
| | - Susan G. Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, USA
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The impact of the COVID-19 pandemic on people who inject drugs accessing harm reduction services in an rural American state. Harm Reduct J 2022; 19:80. [PMID: 35869523 PMCID: PMC9305035 DOI: 10.1186/s12954-022-00660-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 07/05/2022] [Indexed: 12/01/2022] Open
Abstract
Background The impact of public health policies during the COVID-19 pandemic on people who inject drugs (PWID) has varied across regions. In other countries, recent research has shown that PWID access to harm reduction services, despite rapid adaptations, has been negatively impacted. Our study describes these impacts in a rural state. Methods We conducted semi-structured interviews with PWID, community partners, and healthcare providers in the rural state of Maine (USA). We explored how changes made during the pandemic impacted access to harm reduction services, including basic services (i.e., shelter), syringe service programs, safe drug supply, low barrier treatment, and peer support. Interviews were analyzed using the framework method to apply Penchansky’s model of access, with Saurman’s modification, which includes six dimensions of access—accessibility, availability, acceptability, affordability, accommodation, awareness. Results We interviewed thirty-six stakeholders (N = 9 community partners, N = 9 healthcare providers, N = 18 PWID). Policies such as mobile outreach expansion, mail delivery of equipment, and relaxed telemedicine regulations facilitated accessibility to syringe service programs and low barrier buprenorphine treatment. Public health policies, such as social distancing and screening policies, reduced contact, which subsequently reduced acceptability and awareness of many services. Elimination of the one-for-one needle exchange in some areas increased, acceptability (i.e., perception of service), and affordability for PWID. However, some areas actually began enforcing a one-for-one needle exchange policy, which reduced affordability, acceptability, and awareness of services. Conclusions Changes resulting from the COVID-19 pandemic have impacted all dimensions of access to harm reduction services among PWID. While some barriers to harm reduction services were unavoidable during the pandemic, we found that specific policy decisions mitigated service barriers, while other policies exacerbated them. Relaxing needle exchange policies were particularly helpful in facilitating access to harm reduction services by giving community organizations flexibility to adapt to the evolving needs of PWID. These results can inform policies and service delivery to optimally mitigate the negative impacts on PWID during, and beyond, the pandemic. Supplementary Information The online version contains supplementary material available at 10.1186/s12954-022-00660-2.
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18
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Allen ST, Schneider KE, Morris M, Saloner B, Sherman SG. Factors Associated with HIV Testing Among People Who Inject Drugs: Findings from a Multistate Study at the Start of the COVID-19 Pandemic. AIDS Behav 2022; 27:1674-1681. [PMID: 36327014 PMCID: PMC9632597 DOI: 10.1007/s10461-022-03899-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
Few studies have examined HIV testing among people who inject drugs (PWID) during the COVID-19 pandemic. This study examines factors associated with PWID who have been recently (past six months) tested for HIV during the COVID-19 pandemic. PWID were recruited between August 2020 and January 2021 from 22 drug treatment and harm reduction programs in nine states and the District of Columbia. We used logistic regression to identify correlates of recent HIV testing among PWID (n = 289). Most (52.9%) PWID reported having been recently tested for HIV. Factors associated with recent HIV testing included: having attended college [adjusted odds ratio (aOR) 2.32, 95% confidence interval (95% CI) 1.32-4.10], weekly hunger (aOR 2.08, 95% CI 1.20-3.60), crystal methamphetamine injection (aOR 2.04, 95% CI 1.05-3.97), and non-metropolitan residence (aOR 0.33, 95% CI 0.13, 0.88). Findings suggest HIV testing initiatives should be expanded during times of crisis, such as global pandemics.
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Affiliation(s)
- Sean T Allen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 21205, Baltimore, MD, USA.
| | - Kristin E Schneider
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 21205, Baltimore, MD, USA
| | - Miles Morris
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 21205, Baltimore, MD, USA
| | - Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., 21205, Baltimore, MD, USA
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 21205, Baltimore, MD, USA
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Kelly PJA, Pilla J, Otor A, Hoadley A, Bauerle Bass S. "We figured it out as we went along": Staff perspectives of COVID-19 response efforts at a large North American syringe services programme. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4605-e4616. [PMID: 35702040 PMCID: PMC9350032 DOI: 10.1111/hsc.13864] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 05/05/2022] [Accepted: 05/28/2022] [Indexed: 06/15/2023]
Abstract
Syringe services programmes face operational challenges to provide life-sustaining services to people who use substances and those who have substance use disorders. COVID-19 has disrupted operations at these programmes and is a threat to people with substance use disorder because of severe poverty, de-prioritisation of COVID-19 safety and high prevalence of comorbidities. This phenomenological qualitative study describes 16 in-depth interviews with staff of one of the largest syringe services programme in North America-Prevention Point Philadelphia, located in the Kensington neighbourhood of Philadelphia, Pennsylvania. Interviews were conducted from December 2020 to February 2021, audio-recorded, transcribed and coded to develop a thematic framework. Participants were mostly white (71.4%) and female (68.8%) with a median age of 31.5. Three main and four sub-themes related to the impact of COVID-19 on the syringe services programme were identified: (1) COVID-19 altered services provision (sub-theme: select service changes should be retained); (2) unclear or absent COVID-19 response guidance which compromised mitigation (sub-themes: COVID-19 messaging was difficult to translate to practice, learn-as-we-go); and (3) staff and clients experienced elevated mental anguish during the pandemic (sub-theme: already limited resources were further strained). COVID-19 presented complex challenges to an organisation normally strained in pre-pandemic times. A staff culture of resourcefulness and resiliency aided the syringe services programme to balance client needs and staff safety. However, staff experienced a serious psychological impact, largely attributable to being unable to find reprieve from the stressors of COVID-19 and the difficulties associated with navigating and acting-on contradictory public health messaging. Staff also shared a belief that the relaxing of some pre-pandemic barriers allowed staff to link clients more readily with services. Syringe services programmes should embrace the potential for lasting changes to health services delivery brought about by wide-scale changes in service provisions because of COVID-19.
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Affiliation(s)
- Patrick J. A. Kelly
- Risk Communication LaboratoryTemple University College of Public HealthPhiladelphiaPennsylvaniaUSA
| | - Jenine Pilla
- Risk Communication LaboratoryTemple University College of Public HealthPhiladelphiaPennsylvaniaUSA
- Department of Social and Behavioral SciencesTemple University College of Public HealthPhiladelphiaPennsylvaniaUSA
| | - AnnaMarie Otor
- Risk Communication LaboratoryTemple University College of Public HealthPhiladelphiaPennsylvaniaUSA
- Department of Social and Behavioral SciencesTemple University College of Public HealthPhiladelphiaPennsylvaniaUSA
| | - Ariel Hoadley
- Risk Communication LaboratoryTemple University College of Public HealthPhiladelphiaPennsylvaniaUSA
- Department of Social and Behavioral SciencesTemple University College of Public HealthPhiladelphiaPennsylvaniaUSA
| | - Sarah Bauerle Bass
- Risk Communication LaboratoryTemple University College of Public HealthPhiladelphiaPennsylvaniaUSA
- Department of Social and Behavioral SciencesTemple University College of Public HealthPhiladelphiaPennsylvaniaUSA
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20
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Supporting syringe services programs in the initiation and scale-up of vaccine administration: findings from in-depth interviews. Harm Reduct J 2022; 19:100. [PMID: 36050735 PMCID: PMC9435406 DOI: 10.1186/s12954-022-00681-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background Vaccine-hesitant persons who inject drugs are at increased risk for several vaccine-preventable diseases. However, vaccination rates among this population remain low. While syringe services programs (SSPs) are places where persons who inject drugs feel comfortable accessing services, few offer vaccination services. This study describes facilitators and barriers to vaccination at SSPs.
Methods We used convenience sampling to conduct semi-structured, qualitative in-depth interviews with 21 SSPs in the USA from June to August 2021. Interview questions asked SSPs about their perceptions, priorities, barriers, facilitators, and the effects of partnerships and policies on vaccine administration. We used deductive thematic analysis to identify the main themes. Results Eight (n = 8) SSPs offered vaccinations, and thirteen (n = 13) did not offer vaccinations. Most SSPs believed offering vaccination services was important, although addressing SSP participants’ immediate needs often took precedence. Staffing, physical space, and logistical issues were the most common barriers to vaccine administration reported by SSPs, followed by SSP participant-related barriers. Facilitators of vaccine administration included access to a tracking system, partnering with agencies or other organizations providing vaccines, and having a licensed vaccination provider on-site. Partnerships provided SSPs opportunities to expand capacity but could also restrict how SSPs operate. Recommended policy changes to facilitate vaccine administration included subsidizing the cost of vaccinations and addressing restrictions around who could administer vaccinations. Conclusions Increasing the availability of vaccination services at SSPs requires addressing the varying capacity needs of SSPs, such as tracking systems, licensed vaccinators, and free or low-cost vaccination supplies. While these needs can be met through partnerships and supportive policies, both must consider and reflect cultural competence around the lived experiences of persons who inject drugs.
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21
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Frost MC, Austin EJ, Corcorran MA, Briggs ES, Behrends CN, Juarez AM, Frank ND, Healy E, Prohaska SM, LaKosky PA, Kapadia SN, Perlman DC, Schackman BR, Des Jarlais DC, Williams EC, Glick SN. Responding to a surge in overdose deaths: perspectives from US syringe services programs. Harm Reduct J 2022; 19:79. [PMID: 35854351 PMCID: PMC9295104 DOI: 10.1186/s12954-022-00664-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 07/03/2022] [Indexed: 11/21/2022] Open
Abstract
Background US overdose deaths have reached a record high. Syringe services programs (SSPs) play a critical role in addressing this crisis by providing multiple services to people who use drugs (PWUD) that help prevent overdose death. This study examined the perspectives of leadership and staff from a geographically diverse sample of US SSPs on factors contributing to the overdose surge, their organization’s response, and ongoing barriers to preventing overdose death. Methods From 2/11/2021 to 4/23/2021, we conducted semi-structured interviews with leadership and staff from 27 SSPs sampled from the North American Syringe Exchange Network directory. Interviews were transcribed and qualitatively analyzed using a Rapid Assessment Process. Results Respondents reported that increased intentional and unintentional fentanyl use (both alone and combined with other substances) was a major driver of the overdose surge. They also described how the COVID-19 pandemic increased solitary drug use and led to abrupt increases in use due to life disruptions and worsened mental health among PWUD. In response to this surge, SSPs have increased naloxone distribution, including providing more doses per person and expanding distribution to people using non-opioid drugs. They are also adapting overdose prevention education to increase awareness of fentanyl risks, including for people using non-opioid drugs. Some are distributing fentanyl test strips, though a few respondents expressed doubts about strips’ effectiveness in reducing overdose harms. Some SSPs are expanding education and naloxone training/distribution in the broader community, beyond PWUD and their friends/family. Respondents described several ongoing barriers to preventing overdose death, including not reaching certain groups at risk of overdose (PWUD who do not inject, PWUD experiencing homelessness, and PWUD of color), an inconsistent naloxone supply and lack of access to intranasal naloxone in particular, inadequate funding, underestimates of overdoses, legal/policy barriers, and community stigma. Conclusions SSPs remain essential in preventing overdose deaths amid record numbers likely driven by increased fentanyl use and COVID-19-related impacts. These findings can inform efforts to support SSPs in this work. In the face of ongoing barriers, support for SSPs—including increased resources, political support, and community partnership—is urgently needed to address the worsening overdose crisis.
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Affiliation(s)
- Madeline C Frost
- Department of Health Systems and Population Health, School of Public Health, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA. .,Health Services Research and Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, 98108, USA.
| | - Elizabeth J Austin
- Department of Health Systems and Population Health, School of Public Health, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Maria A Corcorran
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Elsa S Briggs
- Department of Health Systems and Population Health, School of Public Health, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Czarina N Behrends
- Department of Population Health Sciences, Weill Cornell Medical College, 418 E 71st St #21, New York, NY, 10021, USA
| | - Alexa M Juarez
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Noah D Frank
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Elise Healy
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Stephanie M Prohaska
- Dave Purchase Project, North American Syringe Exchange Network, 535 Dock Street Suite 113, Tacoma, WA, 98402, USA
| | - Paul A LaKosky
- Dave Purchase Project, North American Syringe Exchange Network, 535 Dock Street Suite 113, Tacoma, WA, 98402, USA
| | - Shashi N Kapadia
- Department of Population Health Sciences, Weill Cornell Medical College, 418 E 71st St #21, New York, NY, 10021, USA.,Division of Infectious Diseases, Weill Cornell Medical College, 418 E 71st St #21, New York, NY, 10021, USA
| | - David C Perlman
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, 10029, USA.,Center for Drug Use and HIV/HCV Research, 708 Broadway, 4th Floor, New York, NY, 10003, USA
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, 418 E 71st St #21, New York, NY, 10021, USA
| | - Don C Des Jarlais
- School of Global Public Health, New York University, 708 Broadway, New York, NY, 10003, USA
| | - Emily C Williams
- Department of Health Systems and Population Health, School of Public Health, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA.,Health Services Research and Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, 98108, USA
| | - Sara N Glick
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
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22
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Wang A, Jawa R, Mackin S, Whynott L, Buchholz C, Childs E, Bazzi AR. "We were building the plane as we were flying it, and we somehow made it to the other end": syringe service program staff experiences and well-being during the COVID-19 pandemic. Harm Reduct J 2022; 19:78. [PMID: 35841101 PMCID: PMC9284956 DOI: 10.1186/s12954-022-00661-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Syringe service programs (SSPs) provide essential harm reduction and prevention services for people who inject drugs in the USA, where SSP coverage is expanding. During the COVID-19 pandemic, US SSPs underwent unprecedented shifts in operational procedures (e.g., closures of physical sites, staff redeployment into pandemic response efforts). Given the critical role of US SSP workers in the pandemic, we sought to explore the occupational experiences and well-being of SSP staff to inform future emergency response efforts. METHODS From July-October 2020, we conducted semi-structured interviews with staff members of four SSPs in diverse regions of Massachusetts. Trained interviewers administered qualitative interviews virtually. Interviews were coded in NVivo v12 and thematic analysis identified common occupational experiences and related impacts on staff well-being in the context of the COVID-19 pandemic. RESULTS Among 18 participants, 12 (67%) had client-facing roles such as harm reduction specialists and six (33%) worked in program management or leadership. We found that staff were frequently anxious about SARS-CoV-2 transmission, which contributed to staff turnover. SSPs rapidly adapted and expanded their services to meet increasing client needs during the pandemic (e.g., food distribution, COVID-19 testing), leading to staff overexertion. Simultaneously, public health measures such as physical distancing led to staff concerns about reduced social connections with clients and coworkers. Through these challenges, SSPs worked to protect staff well-being by implementing flexible and tangible COVID-19-related policies (e.g., paid sick leave), mental health resources, and frequent communication regarding pandemic-related operational changes. CONCLUSION SSPs in the USA adapted to the COVID-19 pandemic out of necessity, resulting in operational changes that threatened staff well-being. Despite the protective factors revealed in some narratives, our findings suggest that during prolonged, complex public health emergencies, SSPs may benefit from enhanced occupational supports to prevent burnout and promote wellness for this essential public health workforce.
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Affiliation(s)
- Andrea Wang
- Boston University School of Medicine, Boston, MA, USA
| | - Raagini Jawa
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, Boston, MA, USA
- Section of Infectious Disease, Boston Medical Center, Boston, MA, USA
| | - Sarah Mackin
- Access, Harm Reduction, Overdose Prevention and Education (AHOPE), Boston, MA, USA
| | | | - Connor Buchholz
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | | | - Angela R Bazzi
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
- Herbert Wertheim School of Public Health, University of California, San Diego, 9500 Gilman Drive, MTF 265E (Mail Code 0725), La Jolla, CA, 92161, USA.
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23
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Conway FN, Samora J, Brinkley K, Jeong H, Clinton N, Claborn KR. Impact of COVID-19 among people who use drugs: A qualitative study with harm reduction workers and people who use drugs. Harm Reduct J 2022; 19:72. [PMID: 35780109 PMCID: PMC9250267 DOI: 10.1186/s12954-022-00653-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 06/14/2022] [Indexed: 11/12/2022] Open
Abstract
Background Fatal drug overdoses in the USA hit historical records during the COVID-19 pandemic. Throughout the pandemic, people who used drugs had greater odds of contracting COVID-19, increased drug use due to COVID-related stress, and heightened levels of anxiety and depression. This qualitative study examined the specific ways the pandemic negatively impacted people who use drugs. Methods Qualitative interviews with 24 people who use drugs and 20 substance use harm reduction workers were conducted. Data from the qualitative interviews were analyzed using applied thematic analysis to identify emergent themes based on the a priori research goals. Results Thematic analysis identified several common experiences during the pandemic among people who use drugs. These included mental distress due to financial strain and social isolation; increased drug use; increased risky drug-seeking and use behaviors due to changes in the drug markets; and reduced access to harm reduction, treatment, and recovery support services. Conclusions Our study highlighted critical systemic failures that contributed to the rise in overdose deaths during the COVID-19 pandemic. Addressing these challenges through policy reform and improved funding models will ensure the sustainability of harm reduction services and increase access to substance use treatment among highly vulnerable people who use drugs.
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Affiliation(s)
- Fiona N Conway
- The University of Texas at Austin Steve Hicks School of Social Work, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA.
| | - Jake Samora
- The University of Texas at Austin Steve Hicks School of Social Work, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA
| | - Katlyn Brinkley
- The University of Texas at Austin Steve Hicks School of Social Work, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA
| | - Haelim Jeong
- School of Social Work, The University of Alabama, 670 Judy Bonner Drive, Tuscaloosa, AL, 35401, USA
| | - Nina Clinton
- Department of Psychological Sciences, Texas Tech University, 2700 18th St, Lubbock, TX, 79410, USA
| | - Kasey R Claborn
- The University of Texas at Austin Steve Hicks School of Social Work, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA.,Department of Psychiatry, The University of Texas at Austin Dell Medical School, 1601 Trinity Street, Bldg B, Austin, TX, 78701, USA.,Addiction Research Institute, The University of Texas at Austin Steve Hicks School of Social Work, 3001 Lake Austin Boulevard, Suite 1.204, Austin, TX, 78703, USA
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24
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Glick JL, Grieb SM, Harris SJ, Weir BW, Smith KC, Puryear T, Hamilton White R, Allen ST. Exploring the impact of the COVID-19 pandemic on syringe services programs in rural Kentucky. Harm Reduct J 2022; 19:47. [PMID: 35590373 PMCID: PMC9117854 DOI: 10.1186/s12954-022-00631-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/08/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The coronavirus pandemic (COVID-19) exacerbated risks for adverse health consequences among people who inject drugs by reducing access to sterile injection equipment, HIV testing, and syringe services programs (SSPs). Several decades of research demonstrate the public health benefits of SSP implementation; however, existing evidence primarily reflects studies conducted in metropolitan areas and before the COVID-19 pandemic. OBJECTIVES We aim to explore how the COVID-19 pandemic affected SSP operations in rural Kentucky counties. METHODS In late 2020, we conducted eighteen in-depth, semi-structured interviews with persons (10 women, 8 men) involved in SSP implementation in rural Kentucky counties. The interview guide broadly explored the barriers and facilitators to SSP implementation in rural communities; participants were also asked to describe how COVID-19 affected SSP operations. RESULTS Participants emphasized the need to continue providing SSP-related services throughout the pandemic. COVID-19 mitigation strategies (e.g., masking, social distancing, pre-packing sterile injection equipment) limited relationship building between staff and clients and, more broadly, the pandemic adversely affected overall program expansion, momentum building, and coalition building. However, participants offered multiple examples of innovative solutions to the myriad of obstacles the pandemic presented. CONCLUSION The COVID-19 pandemic impacted SSP operations throughout rural Kentucky. Despite challenges, participants reported that providing SSP services remained paramount. Diverse adaptative strategies were employed to ensure continuation of essential SSP services, demonstrating the commitment and ingenuity of program staff. Given that SSPs are essential for preventing adverse injection drug use-associated health consequences, further resources should be invested in SSP operations to ensure service delivery is not negatively affected by co-occurring crises.
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Affiliation(s)
- Jennifer L. Glick
- grid.21107.350000 0001 2171 9311Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Suzanne M. Grieb
- grid.21107.350000 0001 2171 9311Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21224 USA
| | - Samantha J. Harris
- grid.21107.350000 0001 2171 9311Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Brian W. Weir
- grid.21107.350000 0001 2171 9311Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Katherine C. Smith
- grid.21107.350000 0001 2171 9311Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Tyler Puryear
- grid.21107.350000 0001 2171 9311Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Rebecca Hamilton White
- grid.21107.350000 0001 2171 9311Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Sean T. Allen
- grid.21107.350000 0001 2171 9311Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
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25
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Acceptability of a HIV self-testing program among people who use illicit drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 103:103613. [DOI: 10.1016/j.drugpo.2022.103613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 12/19/2022]
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26
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Morales-Arráez D, Benítez-Zafra F, Díaz-Flores F, Medina-Alonso MJ, Santiago LG, Pérez-Pérez V, Gutiérrez-Nicolás F, Hernández-Guerra M. Hepatitis C diagnosis slowdown in high-prevalence groups and using decentralised diagnostic strategies during the COVID-19 pandemic. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2022; 115:175-180. [PMID: 35012318 DOI: 10.17235/reed.2022.8412/2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The COVID-19 pandemic has had a major impact on hepatitis C virus (HCV) diagnosis by hindering the path to elimination, although probably in an uneven manner depending on the risk group and diagnostic strategy. METHODS We recorded the requests of antibodies/RNA by venipuncture at the hospital and primary care centres (centralised), as well as the requests via venipuncture or dried blood spot test at prison and drug treatment centres referred for central processing (integrated decentralised), for one year before and after the onset of the COVID-19 health alarm. RESULTS A total of 20,600 tests (51% male, 47.9±15.8 years) were recorded. Among them, 96.5% of the cases came from centralised and 3.5% from decentralised settings, with an active infection rate of 0.2% and 2.3% (p<0.001), respectively. There was a 31.3% decrease in the number of requests during the pandemic compared to the pre-pandemic period, which was more pronounced in decentralised diagnosis than centralised (60 vs. 30%, p<0.001). In addition, there was a 31.5% decline in screening and an 18.2% decrease in the diagnosis of new cases of active infection, showing a statistically significant decrease in decentralised compared to centralised diagnosis. CONCLUSIONS During the COVID-19 pandemic, a decline in HCV diagnostic effort has been observed, especially in decentralised strategies with a higher prevalence of infection. Our results suggest a diagnostic delay that will prevent Spain from reaching the elimination target in 2023, and therefore the reactivation of strategies particularly targeting the priority groups is urgently required.
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