| Abstract: | Ongoing injection drug use contributes to the HIV and HCV epidemics in people who inject drugs. In many places, pharmacies are the primary source of sterile syringes for people who inject drugs; thus, pharmacies provide a viable public health service that reduces blood-borne disease transmission.Replacing the supply of high dead space syringes with low dead space syringes could have far-reaching benefits that include further prevention of disease transmission in people who inject drugs and reductions in dosing inaccuracies, medication errors, and medication waste in patients who use syringes.We explored using pharmacies in a structural intervention to increase the uptake of low dead space syringes as part of a comprehensive strategy to reverse these epidemics.There are approximately 1.1 million people living with HIV in the United States.1 Over the past decade, the HIV incidence rate among people who inject drugs (PWID) has decreased; however, PWID remain disproportionately affected by HIV. It is estimated that 8% of new HIV cases in 2010 were among PWID.1 Co-occurring is the HCV epidemic; approximately 2.7 million people are chronically infected with HCV.2 Studies estimate that the prevalence of HCV among PWID ranges from 40% to 90%.3,4 Ongoing injection drug use and injection risk behaviors contribute to both epidemics.Although effective therapies exist, ultimately, preventing the transmission of HIV and HCV is essential to ending these epidemics, particularly in high-risk populations. PWID constitute a vulnerable population that faces numerous economic and personal barriers (e.g., comorbidities) that prevent them from receiving appropriate medical care.5,6 Public health resources and interventions that focus on the prevention of HIV and HCV in PWID are needed.Multiperson use of needles and syringes (i.e., direct sharing) and multiperson use of drug preparation materials (i.e., indirect sharing) are important risk factors for infection acquisition and transmission among PWID.7 An estimated 50% to 80% of PWID acquire HCV infection within the first year of injection drug use.8 Recommended interventions to discourage injection drug use include risk-reduction programs and substance abuse treatment.9 However, because of limited awareness of available programs, lack of access to treatment facilities, need for program referral, and cost of treatment, many PWID are unable to stop injecting drugs.7 A well-known public health measure to reduce the spread of infection is to promote the use of sterile syringes.10 We explored using pharmacies in a structural intervention to help prevent the transmission of HIV and HCV through syringes. |
