Syringe services program (SSP) initiation among individuals who inject drugs in Appalachian Kentucky Open Access

Gugerty, Paige (Spring 2022)

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There has been a rapid expansion of SSPs into rural areas due to an uptick in drug-related epidemics, such as overdose, human immunodeficiency virus (HIV), and Hepatitis C virus (HCV).  People who inject drugs (PWID) in rural areas experience similar barriers to SSP uptake as urban counterparts, including stigma, policing, and fear of losing child custody (Ibragimov et al., 2021).  Rapid uptake is key to mitigating drug-related harms, as SSPs often provide services including sterile supplies, viral testing, and linkage to care. The purpose of this study is to identify characteristics of PWID who initiated SSP uptake and to understand correlates to uptake in Appalachian Kentucky.  The sample was created from the Gateway2Health cohort, which is part of the CARE2HOPE study.  To enroll, participants must be at least 18 years old, live in one of five counties most impacted by the opioid epidemic, and have either used an opioid to get high or injected any drug in the past 30 days.  We restricted the sample to PWID who had recently injected drugs to get high, who had never gone to an SSP, and who completed the third survey. Key measures included SSP uptake and gender/sex, as well as covariates related to demographics and injection drug use. Descriptive statistics and bivariate logistic regressions were used to evaluate the associations between SSP uptake and the covariates, adjusting for clustering in response-drive sampling (RDS). We found that 41.4% sample reported initiating SSP uptake in the 6 months preceding Wave 3. Additionally, there was a statistically significant association between SSP uptake and gender/sex, as PWID who identified as male were 2.7 times more likely to report SSP uptake than individuals who identify as female [90% CI: (1.0, 7.1)].  Our findings highlight the need to continue boosting SSP initiation among rural PWID, especially among females. Small sample size was major limitation to this study after restricting to PWID who did not attend SSP at Wave 1, so to continue gaining insight into SSP uptake, we need studies with larger samples of PWID who did not go to SSPs at baseline.         

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