The effectiveness and safety of syringe vending machines as a component of needle syringe programmes in community settings

Syringe vending machines (SVMs) have been introduced in Europe and Australasia as part of the effort to increase the availability of sterile needles and syringes to injecting drug users (IDUs). This qualitative review of 14 published and grey literature studies examines whether community-based SVMs as a component of a comprehensive needle syringe programme (NSP) assist to reduce the spread of HIV and other blood-borne viruses amongst IDUs. The available evidence suggests that SVMs increase access to sterile injecting equipment, reduce needle and syringe sharing, and are likely to be cost efficient. SVMs also complement other modes of NSP delivery as they are used by IDUs who are less likely to attend staffed NSPs or pharmacies. If installed and properly maintained in a well-chosen location and with the local community well prepared, SVMs can enhance the temporal and geographical availability of sterile injecting equipment.     

Exploring stakeholder perceptions of acceptability and feasibility of needle exchange programmes, syringe vending machines and safer injection facilities in Tijuana, Mexico

BackgroundInjection drug use is a growing public health crisis along the U.S.–Mexican border and rising rates of blood-borne infections highlight the pressing need for harm reduction interventions. We explored the acceptability and feasibility of such interventions in Tijuana, a city adjacent to San Diego, California.MethodsUsing in-depth qualitative interviews conducted from August 2006–March 2007 with 40 key stakeholders – pharmacists, legal professionals, health officials, religious officials, drug treatment providers, and law enforcement personnel – we explored the acceptability and feasibility of interventions to reduce drug-related harm in Tijuana, Mexico. Interviews were taped with consent, transcribed verbatim, and translated. Content analysis was conducted to identify themes which included barriers, structural limitations, and suggestions for implementation.ResultsTopics included acceptance and feasibility of needle exchange programmes (NEPs), syringe vending machines, and safer injection facilities (SIFs), structural barriers and suggestions for implementation. Of these interventions, NEPs were deemed the most acceptable (75%); however, only half believed these could be feasibly implemented, citing barriers involving religion, police, and lack of political will, public awareness, and funding.ConclusionsIncreasing HIV infection rates among injection drug users in Tijuana have prompted interest in public health responses. Our results may assist policy strategists in implementing social-structural interventions that will help create enabling environments that facilitate the scale-up and implementation of harm reduction in Tijuana.     

An external evaluation of a peer-run outreach-based syringe exchange in Vancouver,Canada

ObjectiveVancouver, Canada has been the site of an epidemic of human immunodeficiency virus (HIV) amongst injection drug users (IDU). In response, the Vancouver Area Network of Drug Users (VANDU) initiated a peer-run outreach-based syringe exchange programme (SEP) called the Alley Patrol. We conducted an external evaluation of this programme, using data obtained from the Vancouver Injection Drug Users Study (VIDUS).MethodsUsing generalised estimating equations (GEE) we examined the prevalence and correlates of use of the SEP amongst VIDUS participants followed from 1 December 2000 to 30 November 2003.ResultsOf 854 IDU, 233 (27.3%) participants reported use of the SEP during the study period. In multivariate GEE analyses, service use was positively associated with living in unstable housing (adjusted odds ratio [AOR] = 1.83, 95% confidence interval [CI]: 1.39–2.40), daily heroin injection (AOR = 1.31, 95% CI: 1.01–1.70), daily cocaine injection (AOR = 1.34, 95% CI: 1.03–1.73), injecting in public (AOR = 3.07, 95% CI: 2.32–4.06), and negatively associated with needle reuse (AOR = 0.65, 95% CI: 0.46–0.92).ConclusionThe VANDU Alley Patrol SEP succeeded in reaching a group of IDU at heightened risk for adverse health outcomes. Importantly, access to this service was associated with lower levels of needle reuse. This form of peer-based SEP may extend the reach of HIV prevention programmes by contacting IDU traditionally underserved by conventional syringe exchange programmes.     

Qualitative evaluation of a peer-based needle syringe programme in Vietnam

BackgroundHarm reduction has been identified as an important HIV prevention strategy for injecting drug users (IDUs) in Vietnam. However, to date only small geographically limited formal needle syringe programmes (NSPs) have been implemented; and little attention has been given to assessing the effectiveness of the piloted models. Using data from a qualitative evaluation of an NSP in northern Vietnam, this paper assesses the effectiveness of the intervention, examines barriers to the NSP, and documents lessons which can be applied to replicate and scale up interventions across Vietnam.MethodsData were gathered using key informant interviews, focus group discussions, in-depth interviews, observation and intercept interviews with IDUs and other project stakeholders. IDUs were introduced to the evaluation by peer educators (PEs).ResultsThe project contributed to a shift toward safe injecting practices and safe disposal of used needles and syringes (N&;S) among IDUs. Collection of used N&;S positively influenced community attitudes toward PEs and IDUs. Reduced community discrimination, achieved as a result of project advocacy activities, encouraged IDU to access free needle syringes and other project services provided by PEs. Resistance from the local government officials and community members was turned into support for the programme through intensive advocacy activities. The project highlighted the importance of involving law enforcement in the programme and promoted a public health approach toward working with IDU. However, periodic police campaigns against drug use continued to be an obstacle to successful programme implementation and demonstrated the need for continued efforts to address the issue.ConclusionProgramme success is dependent upon community support. Resistance to NSPs can be overcome through a programme of intensive advocacy with community stakeholders including; local government, mass organizations, local residents, IDUs and their families. Garnering the support of law enforcement officials requires a sustained effort.     

细胞毒性试验评价一次性使用无菌注射器的生物安全性

目的：通过体外细胞毒性试验评价一次性使用无菌注射器的生物安全性。方法按照GB／T14233．2－2005对2010年国家抽验的8个厂家40批次一次性使用无菌注射器进行了体外细胞毒性试验。结果注射针的细胞毒性均符合要求,部分注射器的细胞毒性较大。结论需要加强对一次性使用无菌注射器的细胞毒性评价。     

Client satisfaction and risk behaviours of the users of syringe dispensing machines: a pilot study

INTRODUCTION AND AIMS: The study examines risk behaviours of the users of syringe dispensing machines (SDMs) and evaluates the usefulness of these machines in providing injecting drug users (IDUs) with sterile injecting equipment. DESIGN AND METHODS: Self-administered questionnaires were used among users of SDMs in an Area Health Service of Sydney. RESULTS: The majority of the 167 participants reported being happy with the quality of the SDM services. Problems identified with machines were that they were often broken or jammed (32.8% respondents), not in the right place (21.9%) or require money (16.7%). Just over half (50.9%) of the IDUs use SDMs only from 5 p.m. to 9 a.m., the time when almost all other outlets for accessing sterile injecting equipment remain closed. Relatively young IDUs (age < or = 30 years) were more likely to prefer SDMs over staffed needle syringe programmes (NSPs) compared with older users (age > 30) and to identify stigma (a desire to hide their identity or not liking the way people treat them at staffed NSPs or chemists) as a main reason for using these machines. Primary users of SDMs do not differ from primary users of NSP/chemists in terms of sharing of needles. Those users who had shared in the last month were nearly four times as likely to have never used condoms in sexual encounters over that period (95% confidence interval: 1.2 - 14.5). DISCUSSION AND CONCLUSION: SDMs appear to complement other outlets of NSPs. Providing free-of-cost equipment from SDMs should be considered carefully, as needing money to buy equipment was a reason given for sharing of needles by 35% of those who shared.     

Individual-level syringe coverage among Needle and Syringe Program attendees in Australia

Background

Harm associated with injecting drug use is a significant public health issue and a major cause of morbidity and mortality, with global estimates of 3 million injectors infected with HIV and 8 million living with chronic hepatitis C virus (HCV) infection. Estimates of program coverage are widely used in the context of HIV prevention and are critical in determining the effectiveness of interventions such as Needle and Syringe Programs (NSPs).

Methods

Data from a national cross-sectional study of NSP attendees in Australia were used to estimate individual-level syringe coverage as a proportion of monthly injections covered by a new syringe. Univariate and multivariate logistic regressions modelled associations between demographics, injecting risk, anti-HIV and HCV prevalence and syringe coverage. The median number of syringes retained per NSP attendee per annum was also estimated.

Results

Twenty percent of participants had insufficient new syringes for all injections. Syringe reuse (including reuse of one's own syringe) was independently associated with syringe coverage of <100%. Conversely, procurement of syringes from an NSP was independently associated with syringe coverage ≥100%, with a greater protective effect occurring when NSP utilisation was combined with current engagement in opiate substitution therapy. The median number of syringes retained per participant per annum was 720, equivalent to 2 per day.

Conclusions

While Australian NSP attendees report high syringe coverage by international standards, prevention efforts could be scaled up. Syringe reuse was associated with syringe coverage of <100%, suggesting the utility of reuse as a proxy for individual-level syringe coverage.     

Qualitative accounts of needle and syringe cleaning techniques among people who inject drugs in Sydney,Australia

Introduction and Aims. Cleaning needles/syringes is an important second‐line harm reduction strategy, yet there is limited information on practices employed by people who inject drugs in Australia. This study attempts to identify and assess cleaning practices in terms of the techniques involved and the social contexts in which cleaning takes place. Design and Methods. As part of an exploratory qualitative study in south‐west Sydney, in‐depth interviews and simulated cleaning exercises were conducted with 12 people who inject drugs. Interviews were digitally recorded and transcribed verbatim. Open coding was used to inductively classify data into themes, and data were examined for patterns and variations in the relationships within and between themes. Results. Data indicate that cleaning and reuse of needles/syringes was common in this small sample. The most frequently utilised reagent was cool water. While all participants reported cleaning and reusing only their own equipment, none of the techniques demonstrated would have been sufficient to deactivate human immunodeficiency virus or hepatitis C virus. Discussion and Conclusions. Results suggest that even where cleaning of needles and syringes is widespread, people who inject drugs may not engage in efficacious cleaning. The combination of the complexity of current cleaning messages and a lack of accurate information about efficacious techniques are likely to contribute to poor cleaning practice. Australia could benefit from the development of a nationally consistent cleaning message; however, the evidence would suggest that this would need to be accompanied by strategies designed to simplify and disseminate this information in order to increase the uptake of efficacious cleaning methods by people who inject drugs [Nathani J, Iversen J, Shying K, Byrne J, Maher L. Qualitative accounts of needle and syringe cleaning techniques among people who inject drugs in Sydney, Australia. Drug Alcohol Rev 2010]     

The association of syringe type and syringe cleaning with HCV infection among IDUs in Budapest,Hungary

We assessed whether syringe type, syringe cleaning and distributive syringe sharing were associated with self-reported and laboratory-confirmed HCV infection among Hungarian IDUs. Injecting drug users (N = 215) were recruited from non-treatment settings in Budapest, Hungary between October 2005 and December 2006. Multivariate logistic regression models identified correlates of self-report of being HCV infected and testing positive for HCV. While 37% tested positive for HCV, 14% of the total (39% of those who tested positive) self-reported being HCV infected. Using any two-piece syringes was significantly associated with self-reported HCV infection, while distributive syringe sharing was not associated with self-report of being HCV infected. Engaging in receptive sharing of only one-piece syringes but always cleaning before reuse was not associated with testing HCV positive, while any receptive sharing of only one-piece syringes and not always cleaning before reuse was significantly associated with testing HCV positive. Sharing cookers and squirting drugs from one syringe into another syringe were not associated with testing HCV positive. The high percent of those HCV infected who did not know they were infected highlights the need to provide better access to confidential testing and counseling services. Counseling should emphasize secondary prevention of HCV among HCV infected IDUs. Our findings also indicate that syringe type and syringe cleaning practices may play a role in HCV transmission. Ethnographic research should identify the reasons why IDUs may use two-piece syringes and suggest means to reduce their use. Thorough cleaning of one-piece syringes when sterile syringes are unavailable may be an efficient way to reduce the risk of HCV infection.     

Injecting behaviour of injecting drug users at needle and syringe programmes and pharmacies in Australia

Objective: To compare demographic and injecting characteristics of clients collecting needle syringes from needle syringe programmes (NSPs) and pharmacies. Methods: Clients obtaining needle syringes from three NSPs and one pharmacy in the same geographic area during one and four weeks, respectively were asked to complete a self-administered questionnaire. Results: Approximately half the 336 NSP (56%) and 63 pharmacy (49%) respondents reported using both NSPs and pharmacies in the past month. NSP and pharmacy respondents were similar on many characteristics: male gender (60 and 62%, respectively); median age (30 years for both groups); median age at first injection (18 years both groups); history of methadone treatment (62 and 53%); and heroin as the last drug injected (60 and 59%). NSP respondents were more likely than pharmacy respondents to report imprisonment in the previous year (20% versus 8%, P=0.05), daily injection (67% versus 56%, P=0.09) and re-use of more than one other person’s needle syringe in the previous month (27% versus 7% of 52 and 15 reporting needle syringe re-use). Pharmacy respondents were more likely than NSP respondents to report amphetamine use (32% versus 10%, P<0.001), shared use of tourniquets (24% versus 12%, P=0.01), spoons (43% versus 32%, P=0.09), filters (22% versus 15%, P=0.1), or drug mix (16% versus 9%, P=0.1), and difficulty finding a vein (73% versus 26%, P<0.001). Conclusion: The risk profile of IDUs (Injecting Drug Users) recruited at various sites provides important information for behavioural surveillance and health promotion efforts. Increased convenience of needle syringe access enhances HIV prevention efforts, however, appropriate education is required for people obtaining needle syringes at pharmacies to reduce sharing of injecting equipment other than needle syringes.     

An evaluation of community methadone services in Victoria, Australia: results of a client survey

One hundred and ninety-five metropolitan clients enrolled in the community-based methadone programme in Victoria, Australia were surveyed in order to evaluate client perspectives of methadone treatment delivered from primary health care settings. Results indicated that the average daily methadone dose was 41 mg, ranging from 7 mg to 140 mg. The majority of clients were satisfied with the programme and the services delivered by dispensing pharmacies and prescribing doctors. Most clients were found to have reduced their heroin use and criminal activity since commencing methadone. A number of concerns about the programme were identified, however, including the high proportion of weekly income spent on methadone-related activities and a high use of tranquillizers by clients on higher methadone doses. In general the community-based methadone programme was found to be an acceptable methadone of service delivery to metropolitan clients in Victoria, Australia.