scholarly journals Acceptability of an mHealth App to Provide Harm Reduction Services for People Who Inject Drugs: A Survey Study Focusing on Access to Smartphones, Comfort with Shared Personal Information, and Interest in Comprehensive Services (Preprint)

2020 ◽  
Author(s):  
Tyler Shelby ◽  
Xin Zhou ◽  
Douglas Barber ◽  
Frederick Altice
Keyword(s):  
Harm Reduction ◽  
Medical Records ◽  
People Who Inject Drugs ◽  
Group Communication ◽  
Personal Information ◽  
White Male ◽  
Home Delivery ◽  
Negative Consequences ◽  
Participant Characteristics ◽  
Secondary Outcomes

BACKGROUND Harm reduction services reduce negative consequences associated with drug injection and are often embedded within syringe service programs (SSPs). People who inject drugs (PWID), however, suboptimally engage with such services due to stigma, fear, transportation restrictions, and limited hours of operation. mHealth applications (apps) may provide an opportunity to overcome these barriers, extending the reach of SSPs beyond the traditional brick-and-mortar models. OBJECTIVE We sought to assess the prevalence of smartphone ownership, level of comfort providing personal information required to use mHealth apps, and interest in the use of a mHealth app to access harm reduction services among PWID in order to guide development of an app. METHODS We administered a survey to 115 PWID enrolled via respondent-driven sampling from July 2018 to July 2019. We examined the extent to which PWID had access to smartphones; were comfortable providing personal information such as name, email, and address; and expressed interest in a variety of app-based services. Participant demographics, health status and behaviors were also measured to evaluate correlations between participant characteristics and mHealth-related variables. Binary logistic regression and Poisson regression were used to identify independent correlates of mHealth-related variables. Primary regression outcomes included summary scores for access, comfort, and interest. Secondary outcomes included binary survey responses for individual comfort or interest components. RESULTS The majority of this PWID sample were white, male, and middle-aged; and 67.9% owned a smartphone. Participants reported high comfortability with providing personal information in order to use a mHealth app, including name (88.1%), phone number (84.4%), email (78.0%), physical address (78.0%), and linkage to medical records (66.1%). Participants also reported strong interests in app-based services including medications and/or sterile syringes delivery (90.9%), labs or appointments scheduling (81.8%), medication reminders (70.0%), educational material about safe injection practices (59.1%), and group communication forums (58.2%). Most participants were comfortable with the idea of home delivery of syringes (85.0%). Overall, aside from homeless participants having lower access to smartphones (AOR=0.15; P=.001), none of the participant characteristics were associated with primary outcomes. Among secondary outcomes, recent SSP use was positively associated with comfortability with home delivery of syringes (AOR=3.29, P=0.042), and age >50 years was associated with increased interest in educational materials (AOR=4.64, P=.018) and group communication forums (AOR=3.69, P=.035). CONCLUSIONS Findings here suggest that aside from homelessness, PWID broadly have access to smartphones and they are comfortable sharing a wide array of personal information, including linkage to electronic medical records, and express interest in a wide array of services within an app. Given suboptimal access to and utilization of SSP services among PWID, a mHealth app has high potential to address the harm reduction needs of this vulnerable population.

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

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

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

Harm Reduction Strategies and Drug-Related Negative Consequences in the Dance Music Scene: The Moderating Role of Polysubstance Use

2021 ◽  
Vol 56 (6) ◽  
pp. 777-781
Author(s):  
Belén del Valle Vera ◽  
José Carmona-Marquez ◽  
Claudio Vidal-Giné ◽  
Fermín Fernández-Calderón
Keyword(s):  
Harm Reduction ◽  
Dance Music ◽  
Negative Consequences ◽  
Polysubstance Use ◽  
Music Scene ◽  
Reduction Strategies ◽  
Moderating Role

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

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

Policy translation in global health governance: Localising harm reduction in Tajikistan

2020 ◽  
pp. 146801812096185
Author(s):  
Karolina Kluczewska ◽  
Oleg Korneev
Keyword(s):  
Harm Reduction ◽  
Global Governance ◽  
Injection Drug Users ◽  
Drug Users ◽  
Local Population ◽  
Asian Country ◽  
Injection Drug ◽  
Heroin Addiction ◽  
Negative Consequences ◽  
Opioid Substitution Therapy

This article analyses how global governance frameworks and knowledge claims are translated to fit local contexts. It specifically looks at harm reduction initiatives targeting injection drug users utilising the case of Tajikistan. In the 1990s, this post–Soviet Central Asian country became exposed to an inflow of cheap and easily available heroin from Afghanistan. While Tajikistan mainly became a transit country, some parts of the local population also became addicted. To tackle the negative consequences of heroin addiction, starting from the 1990s international donors proposed the country adopt a range of harm reduction measures, including providing access to opioid substitution therapy and establishing drop-in centres where single-use needles and syringes would be distributed. This article discusses how donor-promoted harm reduction initiatives were localised in Tajikistan, why and with what outcomes. It argues that instead of a full acceptance or rejection of knowledge promoted by international actors, a complex translation process can be observed on the ground. International norms are thus localised by taking into account societal attitudes towards injection drug users, the changing nature of legitimate expertise, evolving national legislation and everyday practices, against the background of other conflicting global governance regimes and local geopolitical priorities.

scholarly journals Early innovations in opioid use disorder treatment and harm reduction during the COVID-19 pandemic: a scoping review

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Noa Krawczyk ◽  
Adetayo Fawole ◽  
Jenny Yang ◽  
Babak Tofighi
Keyword(s):  
Harm Reduction ◽  
Scoping Review ◽  
English Language ◽  
Data Extraction ◽  
Home Delivery ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Policy And Practice ◽  
Patient Centered ◽  
Long Acting

Abstract Background The COVID-19 pandemic has exerted a significant toll on the lives of people who use opioids (PWUOs). At the same time, more flexible regulations around provision of opioid use disorder (OUD) services have led to new opportunities for facilitating access to services for PWUOs. In the current scoping review, we describe new services and service modifications implemented by treatment and harm reduction programs serving PWUO, and discuss implications for policy and practice. Methods Literature searches were conducted within PubMed, LitCovid, Embase, and PsycInfo for English-language studies published in 2020 that describe a particular program, service, or intervention aimed at facilitating access to OUD treatment and/or harm reduction services during the COVID-19 pandemic. Abstracts were independently screened by two reviewers. Relevant studies were reviewed in full and those that met inclusion criteria underwent final data extraction and synthesis (n = 25). We used a narrative synthesis approach to identify major themes around key service modifications and innovations implemented across programs serving PWUO. Results Reviewed OUD treatment and harm reduction services spanned five continents and a range of settings from substance use treatment to street outreach programs. Innovative service modifications to adapt to COVID-19 circumstances primarily involved expanded use of telehealth services (e.g., telemedicine visits for buprenorphine, virtual individual or group therapy sessions, provision of donated or publicly available phones), increased take-home medication allowances for methadone and buprenorphine, expanded uptake of long-acting opioid medications (e.g. extended-release buprenorphine and naltrexone), home delivery of services (e.g. MOUD, naloxone and urine drug screening), outreach and makeshift services for delivering MOUD and naloxone, and provision of a safe supply of opioids. Conclusions The COVID-19 pandemic has posed multiple challenges for PWUOs, while simultaneously accelerating innovations in policies, care models, and technologies to lower thresholds for life-saving treatment and harm reduction services. Such innovations highlight novel patient-centered and feasible approaches to mitigating OUD related harms. Further studies are needed to assess the long-term impact of these approaches and inform policies that improve access to care for PWUOs.

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

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

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

Harm Reduction Policy for the Opioid Epidemic

2019 ◽  
Author(s):  
Yngvild Olsen ◽  
Joshua M. Sharfstein
Keyword(s):  
Social Justice ◽  
Drug Use ◽  
Harm Reduction ◽  
People Who Use Drugs ◽  
Opioid Epidemic ◽  
Negative Consequences

What is harm reduction? Harm reduction is “a set of practical strategies aimed at reducing negative consequences associated with drug use.” It is also “a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.”...

The hepatitis C care cascade among people who inject drugs accessing harm reduction services in Catalonia: Major gaps for migrants

2021 ◽  
Vol 90 ◽  
pp. 103057
Author(s):  
Cinta Folch ◽  
Verónica Saludes ◽  
Juliana Reyes-Ureña ◽  
Adrián Antuori ◽  
Nuria Ibáñez ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Harm Reduction ◽  
People Who Inject Drugs ◽  
Care Cascade
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